Lindsey Jones TMC Exam A Questions With Correct Answers

A patient receiving mechanical ventilation has received Halcion in the last twenty minutes. The physician orders the institution of spontaeneous breathing trials to commence immediately. Which of the following medications would be most helpful to the patient? A. Valium B. Romazicon (Flumazenil) C. Morphine sulfate D. Meperidine - Answer Answer: B. Romazicon (Flumazenil) In preparation for ventilator weaning the physician requests a VD/VT ratio assessment. Which of the following is needed to determine the deadspace-tidal volume ratio? A. arterial blood gases and capnographic data B. single breath nitrogen elimination and capnographic data C. helium dilution study and single breath nitrogen elimination D. helium dilution study and an arterial blood gas - Answer Answer: A. arterial blood gases and capnographic data A respiratory therapist is determining a VD/VT ratio. Which of the following is needed to complete this analysis? A. VT and VA B. PetCO2 and PaCO2 C. FIO2 and PaO2 D. PECO2 and PaO2 - Answer Answer: B. PetCO2 and PaCO2 Which of the following is LEAST likely to promote the spread of nosocomial infection in a hospital? A. use of unit dose medication B. poor hand washing among staff C. changing small volume nebulizer equipment every 48 hours D. frequent disconnection of a ventilator circuit - Answer Answer: A. use of unit dose medication Which of the following can be used to estimate the level of Hemoglobin? A. PAO2 B. C(a-v)O2 C. RBC D. Theophylline level - Answer Answer: C. RBC Which of the following alarms would be most important for a patient receiving positive pressure ventilation by a pressure-cycled ventilator? A. low FIO2 B. I:E ratio C. high pressure D. low volume - Answer Answer: D. low volume Patients with large necks who experience frequent dislodging of their tracheostomy tubes need (a) A. shorter tracheostomy tube B. nasal intubation C. longer tracheostomy tube D. larger tracheostomy tube - Answer Answer: B. nasal intubation Which of the following would be most effective at resolving a humidity deficit for a patient who is intubated with an 8.0-mm endotracheal tube? A. concha heated humidifier B. HME C. large volume nebulizer D. bubble humidifier - Answer Answer: A. concha heated humidifier A patient with suspected myasthenia gravis in the emergency room should receive which of the following to confirm a diagnosis? A. Neostigmine B. Meperidine (Demerol) C. Edrophonium Bromide D. Norcuron - Answer Answer: C. Edrophonium Bromide Which of the following is an important action when drawing an arterial blood gas sample? A. Compress the site prior to puncture B. Use an 16 gauge needle C. run the sample within 15 minutes D. Choose a radial site with adequate ulnar circulation - Answer Answer: D. Choose a radial site with adequate ulnar circulation Which of the following would be most helpful for a patient with fixed upper airway obstruction? A. beta II agonist medication B. aerosolized epinephrine C. heliox therapy D. corticosteroids - Answer Answer: C. heliox therapy Which of the following oxygen modalities would be appropriate for a 220-lb (100-kg) male with diabetic ketoacidosis who requires 40% supplemental oxygen? A. air-entrainment mask B. simple mask C. nasal cannula D. non-rebreathing mask - Answer Answer: A. air-entrainment mask While administering a treatment with Albuterol to a patient with COPD, the therapist notes a sudden change in the patient's color to marked cyanosis. The patient appears apneic and the heart rate on the pulse oximeter indicates 30/min. The therapist should FIRST A. begin mouth-to-mouth resuscitation B. go get help C. administer oxygen by non-rebreathing mask D. auscultate breath sounds - Answer Answer: A. begin mouth-to-mouth resuscitation A 70-kg (154-lb) female patient is receiving mechanical ventilation on the following settings: Mode assist/control Mandatory rate 14Total rate 14VT 500 mLFIO2 0.55PEEP 12 cmH2O Arterial blood gases reveal pH 7.49 PaCO2 32 mmHgPaO2 109 mmHgHCO3- 24 mEq/LBE 0 mEq/L The respiratory therapist should A. increase mandatory rate B. decrease PEEP C. decrease FIO2 D. decrease mandatory rate - Answer Answer: B. decrease PEEP Prior to the removal of chest tubes, which of the following should be done? A. suction pressure should be increased temporarily B. flush the chest tube with normal saline C. the chest tube should be exposed to normal atmospheric pressure D. clamp the chest tube for 24 hours - Answer Answer: D. clamp the chest tube for 24 hours Which of the following will help a patent to speak while intubated with a tracheostomy tube? A. Passy-Muir valve B. double lumen endotracheal tube C. obturator D. inner cannula - Answer Answer: A. Passy-Muir valve Prior to obtaining an MEP value with a pressure manometer, the respiratory therapist notes the needle is pointing at a positive pressure of -4 cmH2O prior to the maneuver. During the MEP maneuver, the needle reaches 32 cmH2O. The therapist should A. record an MEP of 28 cmH2O B. report the problem to the medical director C. record an MEP of 36 cmH2O D. record and MEP of -28 cmH2O - Answer Answer: C. record an MEP of 36 cmH2O A 70-kg (154-lb) male patient is receiving mechanical ventilation. After increasing PEEP, the following data is available: Arterial blood gases reveal pH 7.32 PaCO2 47 mmHgPaO2 80 mmHgHCO3- 26 mEq/LBE +2 mEq/LC.I. 2.5PAP 14 mmHgCVP 4 mmHgPCWP 8 mmHg The respiratory therapist should do which of the following? A. remove 100 mL of deadspace B. decrease FIO2 C. administer sodium bicarbonate D. decrease mandatory rate - Answer Answer: A. remove 100 mL of deadspace What would occur on a time-cycled ventilator with a fixed rate if the inspiratory flow rate were increased? A. increase in inspiratory time B. decrease in inspiratory time C. decrease in tidal volume D. increase in tidal volume - Answer Answer: D. increase in tidal volume Why should a respiratory therapist FIRST open the airway of a patient who is apneic? A. To facilitate the placement of an oral pharyngeal airway B. The patient may be experiencing upper airway occlusion C. To protect the neck if the patient has experienced physical trauma D. The physical contact may help to trigger a spontaneous breath - Answer Answer: B. The patient may be experiencing upper airway occlusion Which of the following is a strategy that may help reduce or prevent autoPEEP in a patient with ARDS? A. matching PEEP B. sedation of the patient C. increasing minute ventilation D. high flow rates - Answer Answer: D. high flow rates A pediatric patient has a non-productive cough. A chest radiograph reveals a foreign body in the right mainstem bronchi. Which of the following should be used to alleviate the problem? A. bronchoscope B. laryngoscope C. suction catheter D. tonsil suction device - Answer Answer: A. bronchoscope An adult male is being suctioned though an 8.0-mm ET tube with a 12 Fr. suction catheter at a pressure of 90 mmHg. Secretion removal has been ineffective. Which of the following modifications should be recommended? A. increase suction pressure to 110 mmHg B. decrease suction pressure to 80 mmHg C. change to a 10-mm ET tube D. increase suction catheter size to 14 Fr. - Answer Answer: A. increase suction pressure to 110 mmHg Which of the following is the most significant complication of bronchoscopy? A. coughing B. laryngospasms C. hypotension D. vagal nerve stimulation - Answer Answer: B. laryngospasms Which of the following can be instructed to a COPD patient to help reduce FRC? A. pursed-lip breathing B. autogenic drainage C. incentive spirometry D. serial coughing - Answer Answer: A. pursed-lip breathing A Bronchogram would be most helpful in evaluating and diagnosing which of the following? A. bronchiectasis B. ARDS C. mycoplasma pneumonia D. chronic bronchitis - Answer Answer: A. bronchiectasis An infant who is 35 weeks of gestation requires supplemental oxygen at 40%. Which of the following modalities is most appropriate? A. nasal cannula at 2 L/min B. nasal CPAP mask C. oxygen hood with an air/oxygen blender D. croup tent - Answer Answer: C. oxygen hood with an air/oxygen blender What is the respiratory therapist observing if monitoring the total amount of gas exhaled in 60 seconds after excluding dead space? A. alveolar minute ventilation B. dead space ventilation C. minute ventilation D. maximum voluntary ventilation - Answer Answer: A. alveolar minute ventilation Which of the following instructions should be given to a patient in preparation for incentive spirometry with a volume-type device? A. "breathe in to total lung capacity" B. "inhale as deeply as possible" C. "exhale to expiratory reserve volume" D. "breathe in complete inspiratory capacity" - Answer Answer: B. "inhale as deeply as possible" In providing a patient with education and direction for the performance of positive expiratory pressure (PEP) therapy, the respiratory therapist will include which of the following directives? A. exhale forcefully and inhale to normal tidal volume B. inhale to normal tidal volume and exhale actively C. inhale deeply and exhale actively D. inhale quickly and exhale quickly - Answer Answer: C. inhale deeply and exhale actively Which of the following equations would help determine cardiac output? A. ejection fraction B. oxygen consumption C. Fick D. A-aDO2 - Answer Answer: C. Fick A patient in the emergency room expectorates thick, yellow sputum. A CBC shows the following: RBC 6.0 mill/cu mm Hb 17 g/dLHCT 64 %WBC 22,000 cu mm The patient could benefit most from which of the following? A. aerosolized Amphotericin B B. Acetylcysteine C. sputum culture and sensitivity D. aerosolized Nystatin - Answer Answer: C. sputum culture and sensitivity A patient has a sleep study (PSG) which shows an AHI of 50 and an average oxygen desaturation of 10%. Which of the following should the respiratory therapist recommend? A. CPAP/BIPAP nocturnal titration study B. surgical insertion of a tracheostomy C. nocturnal supplemental oxygen D. weight loss - Answer Answer: A. CPAP/BIPAP nocturnal titration study A patient has the following input/output history and other clinical information: Yesterday Today IN 1900 cc 1600 ccOUT 2200 cc 1900 ccC.O. 5.1 L/min 3.8 L/minBP 110/80 mm Hg 110/80 mm HgCVP 5 mm Hg 5 mm Hg These data would result in which of the following? A. increase in PCWP B. increase in PAP C. increase in SVR D. decrease in PVR - Answer Answer: C. increase in SVR Which of the following would result in an increase in pulmonary capillary wedge pressure? A. dehydration B. decrease in pulmonary vascular resistance (PVR) C. mitral valve stenosis D. cor pulmonale - Answer Answer: C. mitral valve stenosis The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has A. a pulmonary embolism B. ARDS C. fluid overload D. pneumonia - Answer Answer: A. a pulmonary embolism During a difficult intubation, the emergency room physician requests an endotracheal tube that is smaller than recommended for the patient's height and ideal body weight. As a result, the respiratory therapist should anticipate A. increased I:E ratio B. increase in PAW C. an increase in RAW D. a decrease in static compliance - Answer Answer: C. an increase in RAW A respiratory therapist is monitoring a patient's maximal inhalation and exhalation repeatedly over a period of 15 seconds. The therapist is attempting to observe which of the following? A. inspiratory capacity B. MVV C. minute ventilation D. alveolar ventilation - Answer Answer: B. MVV A patient is on 70%/30% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? A. 8 L/min B. 5 L/min C. 18 L/min D. 16 L/min - Answer Answer: D. 16 L/min A 7-year old female patient is receiving PEP therapy by mouthpiece. In spite of repeated coaching, the child does not keep the mouthpiece in her mouth. The therapist should respond by doing which of the following? A. help support the patient's lip closure around the mouthpiece B. discontinue therapy C. switch to aerosolized Albuterol D. add a mask to the PEP device - Answer Answer: D. add a mask to the PEP device A respiratory therapist is providing chest physiotherapy and postural drainage on a cystic fibrosis patient with pneumonia in the right lateral segment. The patient was in high fowlers prior to therapy. The patient experiences arrhythmias and dyspnea after 5 minutes of therapy. What should the therapist recommend? A. stop therapy, return to high-fowlers, provide oxygen, call the physician B. stop percussion, provide 100% oxygen C. place bed flat, continue therapy, monitor D. stop therapy, place the patint in semi-fowlers, monitor - Answer Answer: A. stop therapy, return to high-fowlers, provide oxygen, call the physician