Lindsey Jones TMC Exam Questions & Answer Solved 100%

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. go get help B. administer oxygen by non-rebreathing mask C. auscultate breath sounds D. begin mouth-to-mouth resuscitation - Answer D. 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 14 Total rate 14 VT 500 mL FIO2 0.55 PEEP 12 cmH2O Arterial blood gases reveal pH 7.49 PaCO2 32 mmHg PaO2 109 mmHg HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should A. increase mandatory rate B. decrease PEEP C. decrease FIO2 D. decrease mandatory rate - Answer B. decrease PEEP Prior to the removal of chest tubes, which of the following should be done? A. the chest tube should be exposed to normal atmospheric pressure B. suction pressure should be increased temporarily C. flush the chest tube with normal saline D. clamp the chest tube for 24 hours - Answer D. clamp the chest tube for 24 hours 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 and MEP of -28 cmH2O B. record an MEP of 36 cmH2O C. record an MEP of 28 cmH2O D. report the problem to the medical director - Answer B. record an MEP of 36 cmH2O Which of the following is a strategy that may help reduce or prevent autoPEEP in a patient with ARDS? A. sedation of the patient B. increasing minute ventilation C. high flow rates D. matching PEEP - Answer C. high flow rates Which of the following is the most significant complication of bronchoscopy? A. coughing B. vagal nerve stimulation C. laryngospasms D. hypotension - Answer C. laryngospasms A Bronchogram would be most helpful in evaluating and diagnosing which of the following? A. chronic bronchitis B. bronchiectasis C. ARDS D. mycoplasma pneumonia - Answer B. bronchiectasis An infant who is 35 weeks of gestation requires supplemental oxygen at 40%. Which of the following modalities is most appropriate? A. nasal CPAP mask B. nasal cannula at 2 L/min C. croup tent D. oxygen hood with an air/oxygen blender - Answer D. oxygen hood with an air/oxygen blender A patient has the following input/output history and other clinical information: Yesterday Today IN 1900 cc 1600 cc OUT 2200 cc 1900 cc C.O. 5.1 L/min 3.8 L/min BP 110/80 mm Hg 110/80 mm Hg CVP 5 mm Hg 5 mm Hg These data would result in which of the following? A. increase in PCWP B. increase in PAP C. decrease in PVR D. increase in SVR - Answer D. increase in SVR This question is tricky. The first observation one must make is that the patient is putting out more fluid than he is taking in. This will result in dehydration and a decrease in all hemodynamic values including cardiac output. If cardiac output is decreased, systemic vascular resistance will increase. One must know the formula for systemic vascular resistance in order to understand this. Systemic vascular resistance is determined by subtracting CVP from MAP and dividing it by cardiac output. If cardiac output is decreased then the final SVR number will increase. Which of the following would result in an increase in pulmonary capillary wedge pressure? A. decrease in pulmonary vascular resistance (PVR) B. mitral valve stenosis C. dehydration D. cor pulmonale - Answer B. mitral valve stenosis 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. a decrease in static compliance B. increase in PAW C. an increase in RAW D. increased I:E ratio - Answer C. an increase in RAW 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. pneumonia D. fluid overload - Answer A. a pulmonary embolism 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. 18 L/min B. 8 L/min C. 16 L/min D. 5 L/min - Answer C. 16 L/min Explanation : When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentage. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 70/30% mixture factor of 1.6 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 16 L/min. A patient is receiving 40% aerosol with the oxygen flow meter running at 8 L/min. What is the total flow of gas to the patient? A. 24 L/min B. 16 L/min C. 32 L/min D. 80 L/min - Answer C. 32 L/min Explanation : To determine the answer to this question, one must have memorized the air-oxygen ratios. For 40%, the ratio is 3:1. This means that the Venturi mechanism will incorporate 3 parts air for every 1 part oxygen. One way to solve this problem is to add the ratio numbers together. (3+1= 4). Then, multiply that total by the indicated flow on the oxygen flow meter. In this case, we multiply 8 L/min by 4. We get a total flow of 32 L/min. A pulse oximeter reading is significantly less than oxygen saturation by blood gas. Which of the following could be the cause? A. increased SVR B. decreased QsQt C. decreased CVP D. marked hypotension - Answer D. marked hypotension An adult post-op patient is unable to get any of the balls to rise on an incentive spirometer, in spite of reports of her best effort. The therapist should A. switch to IPPB by mask B. discontinue therapy and report the problem to the physician C. switch to postural drainage and percussion D. switch to a volume-type incentive spirometer - Answer D. switch to a volume-type incentive spirometer Which of the following would be a sufficient reason to discontinue an SBT (spontaneous breathing trial)? A. respiratory rate increases from 18 to 26 per minute B. blood pressure increases from 110/70 to 132/90 mmHg C. heart rate increases from 80 to 96 bpm D. SPO2 decreases from 98% to 94% - Answer B. blood pressure increases from 110/70 to 132/90 mmHg A patient with decreasing pulmonary compliance is receiving volume-controlled ventilation with an I:E ratio of 1:2. A chest radiograph shows increased atelectasis. Blood gases show signs of refractory hypoxemia. Which of the following is an appropriate change for this patient? A. decrease PEEP B. increase expiratory time C. increase inspiratory pressure limit D. decrease inspiratory flow rate - Answer D. decrease inspiratory flow rate A patient is receiving oxygen by nasal cannula at 4 L/min. After 24 hours of use with a properly functioning bubble humidifier, the patient complains of nosebleeds. The therapist would do which of the following to modify therapy? A. decrease flow to 2 L/min B. switch to an air-entrainment mask at FIO2 35% C. provide a heated bubble humidifier D. switch to a simple mask at 4 L/min - Answer B. switch to an air-entrainment mask at FIO2 35% Which of the following airway clearance therapies should be administered first in the order of therapy? A. postural drainage and percussion B. nasal tracheal suctioning C. aerosolized Acetylcysteine (Mucomyst) D. verbal coaching for coughing - Answer C. aerosolized Acetylcysteine (Mucomyst) Which of the following is most indicative of a pulmonary embolism? A. increased PAP, decreased PCWP B. increased PCWP, decreased cardiac output C. decreased CVP, decreased cardiac output D. increased CVP, decreased PAP - Answer A. increased PAP, decreased PCWP A 74-kg (166-lb) 5-ft 8-in (173-cm) female is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: