Lindsey Jones TMC Practice Exam Questions With Correct Answers

The medication prostacyclin is used for which of the following purposes? A. decrease pulmonary hypertension B. bronchodilate large airways C. decrease systemic vascular resistance (SVR) D. improve cardiac contractility - Answer A. decrease pulmonary hypertension The respiratory therapist obtains the following blood gas data on a patient breathing spontaneously on room air: pH 7.35 PaCO2 45 torr PaO2 50 torr HCO3- 27 mEq/L BE +2 mEq/L The therapist could accurately estimate the patient's SaO2 to be which of the following? A. 75% B. 80% C. 85% D. 90% - Answer B. 80% A PaO2 of 50 mmHg most closely correlates with an oxygen saturation of about 80% on the oxygen dissociation curve. After instructing a patient and demonstrating the proper use of a metered dose inhaler with a valved holding chamber, the patient performs the maneuver by placing the chamber in his mouth, actuating the cannister, and then exhaling prior to performing inhalation. The respiratory therapist should A. document that the education was effective. B. re-instruct the patient to inhale immediately after actuation of the cannister. C. instruct the patient to inhale while depressing the cannister. D. remove the cannister and have the patient reattempt the dose delivery. - Answer B. re-instruct the patient to inhale immediately after actuation of the cannister. If the patient exhales through the chamber immediately after actuating the inhaler, the medication may be ejected through the valve and out of the chamber. This would discard the medication. After depressing the cannister, the first action should be to inhale through the chamber. In response to an Asthma action plan, the patient has attempted to contact their physician after determining peak flow measurement is less than 50% of the patient's usual baseline value. The physician is not responding to the call. According to NAEP guidelines, the patient should NEXT A. take a short-term bronchodilator, check peak flow in 1 hour B. take a corticosteroid inhaler and check again in 20 minutes C. take a short-term bronchodilator and contact a different physician D. report to the hospital or call an ambulance - Answer D. report to the hospital or call an ambulance According the national asthma guidelines, a self monitored peak flow of 50% of baseline is an indication to contact one's physician. However, if one's physician is not available, the patient should report to the hospital or to the emergency room or call an ambulance. A patient is orally intubated with a 7.0-mm ET tube. Immediately following the procedure, the respiratory therapist will FIRST do which of the following to check for proper positioning of the airway? A. observe the color of the CO2 detector B. obtain a chest radiograph C. auscultate breath sounds D. palpate the trachea - Answer A. observe the color of the CO2 detector When asked in a question what to do first in any given situation, the most likely answer is that which is quickest. In this case a patient has just been inutbated and the therapist is asked to determine if the tube is in the proper position. Palpating the trachea will not be helpful but the other three options are all legitimate ways to ensure proper positioning of the ET tube. But, the quickest way is to do something visual. In this case, simply observing the color of the CO2 detector is quickest. The next best option is to auscultate breath sounds. This is also very quick but takes a little longer than a simple visual assessment. Finally, the next best answer is to obtain a chest radiograph. This will provide conclusive evidence, but it is time-consuming and is not the best option when trying to determine the position of the tube quickly. Which of the following indicate a patient is ready to wean from mechanical ventilation? A. A-aDO2 of 380 mmHg B. RSBI 138 C. MIP of -12 cmH2O D. VT of 6 mL/kg - Answer D. VT of 6 mL/kg In order to wean from the ventilator the MIP must be more than -28 cmH2O. Tidal volume must be at least 5 mL per kilogram and RSBI must be less than 106. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case only the tidal volume of 6 mL per kilogram and the RSBI of 90 indicate the patient is ready to wean from mechanical ventilatory support. A patient is receiving ventilatory support with CPAP of 5 cm H2O and PS of 10 cm H2O. The following data is observed: Vt(spont) 180 mL RR 28/min HR 104/min MIP -22 cm H2O SpO2 0.95 What should be recommended for this patient? A. increase CPAP to 7 cm H2O B. obtain ABGs, STAT C. implement invasive ventilation D. increase PS to 15 cm H2O - Answer D. increase PS to 15 cm H2O A 12-year-old male patient easily accomplishes the volume on an incentive spirometer that he was able to reach prior to surgery. The respiratory therapist should A. increase the set volume. B. switch a flow-type spirometer. C. decrease the frequency of therapy. D. evaluate the need for continued therapy. - Answer D. evaluate the need for continued therapy. Of the options given, evaluating the patient for the need to continue the therapy is most appropriate. A respiratory therapist is having difficulty effectively removing secretions through endotracheal suctioning of a 7-year-old child with cystic fibrosis. The ET tube size is 6.0-mm. The suction pressures is set at 75 mmHg and the suction catheter size is an 8 Fr. The therapist should do which of the following to increase the efficacy of suctioning? A. increase suction during per pass B. increase suction pressure to 80 mmHg C. instill 20 cc of normal saline prior to each suction attempt D. increase catheter size to 10 Fr - Answer B. increase suction pressure to 80 mmHg There are three ways to increase suction efficiency. In order: 1) increase suction catheter size 2) increase suction pressure 3) increase suction time. However, prior to any of these three one must first ensure adequate minimal pressure for the patient's age is being used. This is a pediatric patient and suction pressure range should be between 80 and 100 mmHg. However, the suction pressure is only set at 75 mmHg. So, this should be corrected first before considering any other action to improve suction efficiency. The physician has asked the respiratory therapist to help determine oxygen consumption by the tissues. The therapist should suggest evaluation of which of the following? A. CaO2 B. CvO2 C. PaO2 D. C(a-v)O2 - Answer D. C(a-v)O2 Oxygen available at the tissue level is best determined by examining the arterial oxygen content or CaO2. However, to determine how much oxygen the tissue is consuming we must look at both the CaO2 and the CVO2. This allows us to determine how much oxygen existed before the tissues and how much oxygen exists after the tissues. When we subtract one from the other we get the C(a-v)O2. This value is most closely related with oxygen consumption at the tissue level. A 40-year-old female presents in the emergency room after being rescued from a building fire where she was found unconscious. Which of the following assessments would be most helpful in the evaluation of the patient? A. measurement of PaO2 B. hemoximetry C. beside pulmonary function testing D. single-wavelength pulse oximetery - Answer B. hemoximetry The primary concern for a patient who has had significant exposure to smoke is smoke inhalation and carbon monoxide poisoning. Of the options offered, hemoximetry will be most helpful. Pulse oximetry and measurement of PaO2 will only assess oxygenation and pulmonary function testing is not helpful. After placing a patient on helium-oxygen therapy (60%/40%) by nonrebreather mask, the respiratory therapist notices a complete collapse of the attached reservoir with each breath initially. After a few moments, the reservoir bag begins to collapse only partially with each breath. The therapist should conclude A. the presence of CO2 overdose. B. a decrease in minute alveolar ventilation. C. inadequate ventilatory drive. D. a decrease in airway resistance. - Answer D. a decrease in airway resistance. A COPD patient is being assess in the hospital for readiness to be discharged home. The respiratory therapist is in charge of establishing the appropriate oxygen flow rate by nasal cannula to be used at home. The patient maintains an SpO2 of 90% on 2 L/min at rest, and 86% during ambulation. Which of the following recommendation would be most appropriate? A. 2 L/min at rest, 3 L/min during exertion B. 2 L/min at all times C. 1 L/min at rest, 2 L/min during ambulation D. 1 L/min during sleep, 2 L/min all other times - Answer A. 2 L/min at rest, 3 L/min during exertion For COPD patients who need supplemental oxygen, 1-2 L/min or 24-28% is appropriate while at rest. However, if the patient is participating in any kind of exercise or pulmonary rehabilitation program that requires activity, additional flow may be provided during the activity only. Increasing flow does not actually increase the FIO2 for the patient, especially if they are on a nasal cannula. When the patient engages in exertion, they typically increase their tidal volume and inspiratory flow rate. In doing so, they entrain more air through their nose and lower their FIO2. Thus, an increase in flow rate during the exercise helps to minimize air entrainment and changes in oxygen percentage. Another way to approach this is to provide an air entrainment mask that delivers high flow. In that case increasing FIO2 is not necessary. A respiratory therapist is caring for a patient who has a sign posted outside their hospital room door that indicates, "Respiratory Isolation". The therapist should observe all of the following EXCEPT: A. Do not allow visitors to enter the room B. Use N95 respirator C. Universal precautions D. Patient should use a mask when visitors are present - Answer A. Do not allow visitors to enter the room Respiratory isolation requires use of an N95 respirator, and universal precautions. The patient's use of a mask when visitors are present is also required. Disallowing visitors in the room is not required. Which of the following should be monitored for a ventilator-dependent newborn with IRDS? A. gas distribution (SBN2) in the lungs B. fluid input and output C. pH D. urine specific gravity - Answer B. fluid input and output All choices are indicated while monitoring a critically ill neonate receiving mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the artificial airway are also essential. The respiratory therapist is preparing to administer bronchodilation medication by metered dose inhaler (MDI) to a patient with COPD. Prior to administration, the therapist checks the MDI canister to determine if any medication remains. To do this, the therapist should do which of the following? A. Discharge the canister and visually note the output B. Ask the patient how many doses have been taken C. Float the canister in the glass of water D. Tap on the canister, listen for a dull tone - Answer A. Discharge the canister and visually note the output The only suitable method to check a metered dose inhaler for remaining medication is to discharge the canister and visually note the output. Inhaled albuterol has which of the following most common side effects? A. increased mPAP B. nausea C. systemic hypotension D. tremors - Answer D. tremors One of the most common side effects associated with inhaled albuterol is tremors. Which of the following, if present, would suggest ventilatory instability in a patient suspected of opioid overdose? A. MEP of 50 cm H2O B. MIP of - 38 cm H2O C. VT of 3.5 mL/kg D. VC of 12 mL/kg - Answer C. VT of 3.5 mL/kg All of the parameters are associated with a stable ability to ventilate except for the VT. Tidal volume should be at least 5 mL/kg of IBW. A physician asks the respiratory therapist to evaluate the effectiveness of PEP therapy on a patient with cystic fibrosis. The therapist can conclude the therapy is effective if A. the patient develops rhonchi that clears with coughing B. increased oxygen saturation during treatment is noted C. increased inspiratory capacity is observed D. improved arterial blood gas values are observed - Answer A. the patient develops rhonchi that clears with coughing Of the options listed the development of rhonchi, which means secretions in the large upper airways, is the best evidence that secretions are being mobilized by the PEP therapy. The other options offered are either too indirect or are not related.