Lindsey Jones Test C Questions & Answer Solved 100%

The respiratory therapist should evaluate which of the following to develop a teaching plan for a patient who will be using a small volume nebulizer at home? A. highest grade level achieved in school B. manual dexterity C. spousal support D. english speaking proficiency - Answer Your answer was : B The correct answer is : B Explanation : A patient that is taking nebulizer treatments needs to be able to demonstrate manual dexterity, and the ability to hold and manipulate the nebulizer. During the instruction, appropriate language skills are also important but English proficiency is not required. What is NOT important is the patient's spousal support. This will have no effect on their ability to self administer nebulizer treatments. Which of the following would be most beneficial in resolving microatelectasis? A. Thoracentesis B. Bronchoscopy C. Percutaneous ventilation D. Chest tubes - Answer Your answer was : B The correct answer is : B Explanation : A bronchoscopy would be most beneficial because it can ventilate and recruit alveoli in the lung. The other options will not decrease atelectasis. A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should recommend a(n) A. double-lumen endobronchial tube B. nasopharyngeal airway C. bite block D. oropharyngeal airway - Answer Your answer was : D The correct answer is : D Explanation : An oral pharyngeal airway is the primary mechanism used to prevent the time from falling back and obstructing the airway. Although a double lumen endobronchial tube would also do this, it is far too invasive and not necessary. Quality control material has published values for pH of 7.20, PO2 of 65 mmHg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results are as follows: pH PO2 (mmHg) Run 1 7.19 64Run 2 7.1069Run 3 7.2165 Which quality control run(s) indicate the machine is out of control? A. Run 2 and 3 B. Run 1 and 2 C. Run 2 only D. Run 3 only - Answer Your answer was : C The correct answer is : C Explanation : This question involves doing some math. You must look at each pH and add and subtract 0.5%. You must do the same for the PO2, using 3%. From there you can look at the results and determine which Run is out of control. In this case only Run two is out of control. A respiratory therapist is considering a patient's readiness to wean from mechanical ventilation. To determine the A-aDO2, the therapist will need which of the following? A. CaO2 and PAO2 B. VD/VT and PAO2 C. VD/VT and ABG D. ABG and alveolar oxygen tension - Answer Your answer was : A The correct answer is : D Explanation : This question requires you to remember what is needed to calculate A-a gradient. You only need two things - the alveolar oxygen tension (PAO2), and the arterial oxygen tension, determined from an arterial blood gas. A patient with increased airway resistance from a fixed upper airway obstruction would benefit most from which of the following? A. heliox therapy B. aerosolized atropine C. epinephrine D. bronchodilator therapy - Answer Your answer was : A The correct answer is : A Explanation : A fixed upper airway obstruction means air is having difficulty moving both in and out. It is usually caused by cancer or other non-changeable conditions. In this case the best thing we can do is decrease airway resistance by using helium or Heliox therapy. Evaluating MIP (maximum inspiratory pressure) is most useful in evaluating which of the following? A. presence of a restrictive pulmonary defect B. presence of obstructive pulmonary defect C. inspiratory muscle strength D. effectiveness of cough - Answer Your answer was : C The correct answer is : C Explanation : Maximum inspiratory pressure is most useful in evaluating for inspiratory muscle strength, or the ability to sustain ventilation. To determine if a patient has a restricted pulmonary defect one would need to do a pulmonary function test. The effectiveness of a cough would be assessed through doing a maximum expiratory pressure maneuver, or MEP. An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? A. excess water in the tubing B. poorly calibrated analyzer C. leak in the tubing D. low flow through the jet orifice - Answer Your answer was : A The correct answer is : A Explanation : When administering oxygen by any device that has a venturi mechanism, back pressure on the venturi will slow the speed of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options offered, only excess water in the tubing would cause this type of back pressure. During a preoperational test of the ventilator with a test lung, the respiratory therapist notes a return tidal volume of 600 cc. Ventilator settings are: Mode Assist/control FIO2 0.50Mandatory rate 10VT 750 mL What action should the therapist take? A. Obtain a smaller test lung B. Examine the ventilator circuit for proper connections C. Increase the set tidal volume to 900 mL D. Obtain a larger test lung - Answer Your answer was : B The correct answer is : B Explanation : The purpose of a preoperational test on a ventilator is to ensure proper connections and assembly of those necessary parts. The reduced return tidal volume observed would most logically be caused by a failure to make a good connection between the ventilator circuit in the ventilator. During the preoperational test of the ventilator, the respiratory therapist notices the galvanic analyzer on the ventilator is reading erroneously low. Which of the following can the respiratory therapist do to correct the problem? A. change the fuel cell B. replace the analyzer batteries C. tag the ventilator as non-functional and avoid placing it in service D. replace the electrolyte solution in the analyzer - Answer Your answer was : A The correct answer is : A Explanation : A galvanic oxygen analyzer will read erroneously under two conditions: the probe or the fuel cell is depleted or the analyzer requires calibration. In this case the probe, which provides the energy for the analyzer, is the most likely culprit and should be changed. Which of the following is most likely to increase nosocomial infection in a hospital? A. use of alcohol-based hand cleaners B. poor hand washing among staff C. frequent disconnection in the ventilator circuit D. use of an HME for 48 hours - Answer Your answer was : B The correct answer is : B Explanation : The most common nosocomial infection source is from poor hand washing. Although frequent disconnection of a ventilator circuit will also increase incidence of infection, poor hand washing is by far more common. While monitoring a patient receiving mechanical ventilation, the respiratory therapist notices the low-pressure and low exhaled volume alarms are sounding. Which of the following could be the cause? A. disconnected thermistor line B. herniated endotracheal tube cuff C. kinked endotracheal tube D. excess water in the inspiratory limb of the circuit - Answer Your answer was : A The correct answer is : A Explanation : If you have a low pressure or low exhaled volume ventilator alarm, you must look for the problem that could cause that specific type of alarm. If you look at the answers, a kink in the endotracheal tube would cause a high-pressure alarm so that cannot be the cause. Excess water in the limbs of the circuit would do the same. A high-pressure alarm would also develope if there is a herniated endotracheal tube cuff. This leaves the only possible answer which is a disconnected thermistor line. A patient receiving positive pressure ventilation has a low-pressure alarm sounding. Which of the following could be the cause? A. a fracture in the plastic wye B. kinked ET tube C. excess secretions in the airway D. herniated cuff - Answer Your answer was : A The correct answer is : A Explanation : A low-pressure alarm is caused by a leak or a disconnection or by the patient if he or she is inhaling at a higher inspiratory demand than that being delivered by the ventilator. The solution of this problem is to look each of the answers and determine which one of those things could cause a low-pressure alarm. In this case a crack in the Y plastic piece would cause a leak. A herniated cuff, excess secretions in the airway, and a kinked ET tube would all cause high-pressure alarms. The high pressure alarm is sounding on a patient receiving volume controlled ventilation. The respiratory therapist should FIRST A. suction the patient B. cancel the alarm C. observe the alarm panel to determine source D. provide manual ventilation - Answer Your answer was : D The correct answer is : D Explanation : The NBRC knows that in real life, when you hear a ventilator alarm, you're tempted to cancel the alarm or attempt to immediately solve the problem. However, the correct answer is always to first provide manual ventilation to the patient. This is true of any ventilator alarm. Your first action should be to stabilize the ventilatory status of the patient, and then troubleshoot the problem. Which of the following medications is shown to have sufficient affect when facial muscle twitching is observed? A. Curare (d-turbo curare) B. Romazicon C. Halcion D. Anectine (succinylcholine chloride) - Answer Your answer was : D The correct answer is : D Explanation : Anectine is the medication that manifests muscle twitching about the face and neck when it is working properly. A respiratory therapist is preparing to measure SVC on a patient in the emergency department. Which of the following equipment is required? A. Collins water-seal spirometer B. Wheatstone bridge C. respirometer D. Geissler tube - Answer Your answer was : C The correct answer is : C Explanation : A respirometer is the most important piece of equipment when measuring an SVC. A Collins water spirometer would also accomplish an SVC, but it is large equipment that is not transferable to bed side. A respiratory therapist is asked to determine a patient's inspiratory muscle strength. Which of the following equipment is required for this evaluation? A. pressure manometer B. peak flow meter C. respirometer D. Fleisch pneumotachometer - Answer Your answer was : B The correct answer is : A Explanation : Inspiratory muscle strength is determined by measuring the maximum inspiratory pressure. This is done with a pressure manometer. The other devices measure flow, which is not what we are needing. A respiratory therapist is ordered to do a bedside assessment of the effectiveness of a bronchodilator on a patient with an acute asthmatic episode. Which of the following equipment will be needed to perform this evaluation? A. Collins water-seal spirometer B. peak flow meter C. maximum inspiratory pressure manometer D. respirometer - Answer Your answer was : D The correct answer is : B Explanation : To determine the effectiveness of a bronchodilator one must measure the flow. In this case a peak flow meter would be most appropriate. A respirometer would measure volume which is not what we are looking for in this circumstance. Which of the following pressures is most consistent with a normal pulmonary artery pressure (PAP)? A. 25/8 mmHg B. 25/4 mmHg C. 120/80 mmHg D. 12/8 mmHg - Answer Your answer was : A The correct answer is : A Explanation : To answer this question you must memorize normal mPAP. Normally we look at PAP as a mean value and therefore has a single number. But, it can also be expressed as a systolic over a diastolic number. In this case 25/8 mmHg. A patient receiving heliox therapy at 70%/30% mixture by non-rebreathing mask has the following arterial blood gas results: pH 7.35 PaCO2 45 mmHgPaO2 110 mmHgHCO3- 24 mEq/LBE 0 mEq/L Which of the following actions is appropriate? A. change to a heliox mixture of 60%/40% B. switch to a partial rebreathing mask C. change to an 80%20% heliox mixture D. discontinue heliox therapy - Answer Your answer was : C The correct answer is : C Explanation : This patient is receiving 30% oxygen though a Heliox mixture. One look at the blood gas shows a PaO2 of 110 mmHg. This over oxygenation state indicates a need to lower supplemental oxygen. Changing to an 80-20% Heliox mixture is most appropriate A COPD patient complains of shortness of breath while exercising with a 2 L/min nasal cannula. During exercise, SPO2 is noted to fall to 84%. Which of the following would be most helpful to the patient during exercise? A. avoid exercising B. decrease flow to 1 L/min nasal cannula C. use a non-rebreathing mask D. use an air-entrainment mask set at 28% - Answer Your answer was : B The correct answer is : D Explanation : When a COPD patient exercises the patient accidentally lowers FIO2 because they entrain more room air through their nose when they breathe more deeply. One way to compensate for this is to place them on a Venturi mask at the same approximate FIO2. A Venturi mask set at 28% is equivalent to 2 L/min. nasal cannula. A patient in the emergency room is receiving oxygen by nasal cannula at 3 L/min. Blood gases reveal the following: pH 7.53 PaCO2 30 mmHgPaO2 51 torrHCO3- 23 mEq/LBE -1 mEq/L The respiratory therapist should immediately A. place the patient on a non-rebreathing mask B. place the patient on a Venturi mask at 40% C. decrease flow to 1 L/min D. increase flow to 5 L/min - Answer Your answer was : A The correct answer is : A Explanation : This patient has profound hypoxemia even with supplemental oxygen. It is evident that a small increase in oxygen will not be sufficient. 100% oxygen by a non-rebreather mask is the most appropriate option. An 80-kg (176-lb) female patient is receiving mechanical ventilation on the following settings: Mode assist/control Mandatory rate 14/minTotal rate 14/minVT 550 mLFIO2 0.60PEEP 20 cmH2O ABGs pH 7.38PaCO2 42 mmHgPaO2 62 mmHgHCO3- 26 mEq/LBE +2 mEq/L The respiratory therapist should A. increase FIO2 to 0.7 B. order a chest radiograph C. increase FIO2 to 1.0 D. increase PEEP to 22 cmH2O - Answer Your answer was : D The correct answer is : D Explanation : The arterial blood gas reveals that the patient is under oxygenating. Therefore, a change in either PEEP or FIO2 is appropriate. Normally, FIO2 should be increased up to 60% first before PEEP is adjusted. In this case the FIO2 is already at 60%, so the next logical step is to increase the PEEP. suggest to A. sedate the patient B. decrease FIO2 to 0.50 C. increase flow to 15 L/min D. increase FIO2 to 1.0 and the flow to 15 L/min - Answer Your answer was : D The correct answer is : C Explanation : This question is about recognizing that the patient is not receiving adequate inspiratory flow, or that the inspiratory demanded the patient is not being met. Some simple math will show you that the patient's minute ventilation is higher than the total flow being received from the large volume nebulizer. 800 mL multiplied by 30 times a minute is equal to a minute ventilation of 24 L per minute. The ratio of air to oxygen at 60% is 1:1. 1 +1 = 2. Next, 2 x 10 L/min = total gas flow of 20 L/min., 10 L/min less than the inspiratory demand of the patient. Although the question does not ask this, the remedy for this situation would be to implement a tandem device, or another side-by-side large volume nebulizer. This would double the total gas flow to the patient and exceed the inspiratory demand, which is what we want. The physician orders a change in I:E ratio from 1:2 to 1:4 for a COPD patient receiving volume-cycled mechanical ventilation. Which of the following accommodates the physician's request if the mandatory rate is not changed? A. decrease inspiratory flow rate B. increase inspiratory time C. decrease inspiratory time D. decrease expiratory time - Answer Your answer was : B The correct answer is : C Explanation : To decrease the I:E ratio, expiratory time must be increased by decreasing inspiratory time. This is done by decreasing inspiratory flow rate. For a patient receiving volume-controlled ventilation in the assist/control mode, the starting of the inhalation cycle before the expiratory flow rate returns to zero would result in which of the following? A. atelectasis B. autoPEEP C. alveolar collapse D. decreased FRC - Answer Your answer was : B The correct answer is : B Explanation : When a patient on a ventilator is unable to exhale completely before the inhalation cycle starts, the result will be air-trapping, which will result in autoPEEP. While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? A. cold normal saline B. epinephrine C. Heparin D. Atropine - Answer Your answer was : A The correct answer is : B Explanation : The installation of epinephrine down the bronchoscope to an actively bleeding site will help to immediately stop the bleeding. This should be the first step in treating a bleed in the bronchial tree. The next step should be to compress the site with the bronchoscope followed by the insertion of the Fogarty catheter to tamponade the bleeding site. A respiratory therapist is asked to assist a physician with a bronchoscopy procedure on a patient who is ventilator dependent and requires high levels of PEEP. Which of the following equipment should be used? A. Bodai adapter B. closed in-line suction catheter C. manual PEEP valve D. Magill forceps - Answer Your answer was : C The correct answer is : A Explanation : The device that may be attached to the end of the ET tube that allows PEEP to be maintained during a bronchoscopy is called a Bodai adapter. This adapter attaches to then of the ET tube and has a small port that fits snugly around the broncoscope tube. A patient receiving 0.5 mL Albuterol by small volume nebulizer complains of tingling fingers, nervousness, and heart palpitations. The therapist should A. instruct the patient in performing shallow inspirations B. reduce future treatment dosage to 0.25 mL C. have the patient pause at the top of each breath D. decrease dosage to 0.15 mL - Answer Your answer was : C The correct answer is : B Explanation : When a patient is experiencing an adverse reaction from a breathing treatment or any other procedure, the first action should be to stop therapy. However, this is not offered in this question. The next option would be to modify the therapy to accomplish the same objective. In this case the 0.5 mL of albuterol may be reduced to another acceptable adult dosage, 0.25 mL. Keep in mind that you can reduce a dosage only if the new dosage is still in the acceptable therpeutic range. For instance, if the patient was receiving 0.25 mL of albuterol, it would be unacceptable to cut that dose in half. In this case, it is acceptable because the adult therapeutic range of albuterol is 0.25-0.5 mL. For which of the following is the respiratory therapist observing if obtaining a series of oblique chest radiographs? A. pneumothorax B. pneumonia C. cancerous mass in the lung D. pleural effusion - Answer Your answer was : C The correct answer is : C Explanation : The purpose of a series of chest x-rays taken from different angles is to increase the three dimensionality of that which is seen in the lung. Pneumonia, secretions, a pneumothorax, and pleural effusion do not require a three-dimensional examination. However, a cancerous mass or object inside the lung is three-dimensional in nature. For instance, if you saw a round object from a PA x-ray in the lung, and then you obtained a lateral x-ray and the object was round from that point of view as well, you know the shape of the object is spherical. Spherical objects in the lung are usually associated with cancerous masses. A spiral CT scan would be most helpful in evaluating which of the following? A. pneumonia B. asbestosis C. atelectasis D. mass in the left lobe - Answer Your answer was : D The correct answer is : D Explanation : A spiral CT scan is a way of examining the lungs in a three-dimensional fashion. So, it would be most useful for evaluating a mass in the left lobe. Pneumonia, atelectasis, and asbestos do not have three-dimensional qualities and therefore do not need to be observed through a spiral CT scan. A 65-kg (143-lb) patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode Assist/control Mandatory rate 10/minVT 700 mLFIO2 0.5 pH 7.48PaCO2 33 mmHgPaO2 98 mmHgHCO3- 24 mEq/LBE 0 mEq/L Which of the following actions is most appropriate? A. decrease mandatory rate B. decrease tidal volume C. decrease FIO2 D. increase tidal volume - Answer Your answer was : B The correct answer is : B