Lindsey Jones Exam 1 Questions With Correct Answers

Which of the following alarms would be most important for a patient receiving positive pressure ventilation by a pressure-cycled ventilator? A. low volume B. high pressure C. I:E ratio D. low FIO2 - Answer A. low volume *If the patient is on a pressure cycle ventilator, that means the ventilator is going to deliver a certain pressure regardless of how much volume is achieved. If the ventilator does not care about volume, the practitioner must. Thus, the most important alarm for a pressure-cycled ventilator is low-volume. The opposite is also true. The most important alarm on a volume-cycled ventilator would be the high pressure alarm. 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. large volume nebulizer B. bubble humidifier C. concha heated humidifier D. HME - Answer C. concha heated humidifier *A person who has an endotracheal tube in place has bypassed the natural humidification devices of their own body. Therefore, they need additional humidification to make up the humidity deficit and received nearly 100% relative humidity. Of the devices shownm, only a heated humidifier can make up all of the humidity deficit and a approach 100% relative humidity. The two types of humidifiers that can accomplish this are called Concha and Wick. Some passover humifiers are also able to accomplish this if their surface area is drastically increased by some means and if they are heated. 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. non-rebreathing mask D. nasal cannula - Answer A. air-entrainment mask *An 80-kg male with diabetic ketoacidosis has significant inspiratory demand. Therefore this patient requires a high flow oxygen delivery device. The best high flow device listed is the Venturi mask. 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. decrease FIO2 B. increase mandatory rate C. decrease mandatory rate D. decrease PEEP - Answer D. decrease PEEP *In this question there are two problems. The patient is over oxygenating AND hyperventilating. Over oxygenation should be addressed before hyperventilation. To address over-oxygenation one can either change the PEEP or the FIO2. You will always want to lower the FIO2 below 60% before changing PEEP. In this problem FIO2 is already below 60%. Therefore PEEP can be decreased. This is the best answer. Prior to the removal of chest tubes, which of the following should be done? A. clamp the chest tube for 24 hours B. the chest tube should be exposed to normal atmospheric pressure C. flush the chest tube with normal saline D. suction pressure should be increased temporarily - Answer A. clamp the chest tube for 24 hours *There is a specific procedure that must be followed to discontinue chest tubes. Prior to removing the tubes the first step is to clamp the chest tubes for 24 hours and observe if drainage has adequately ceased. 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. report the problem to the medical director C. record an MEP of 36 cmH2O D. record an MEP of 28 cmH2O - Answer C. record an MEP of 36 cmH2O *Although 32 cmH2O is observed on the pressure manometer the real pressure being produced is 36 cmH2O. This is because the manometer is not properly calibrated to zero. Therefore the adjustment must be accounted for when taking a measurement. You must account for the 4 cm H2O negative baseline defection of the needle and add that to the final observed positive number. In this case you must add the observed 32 to the amount of negative deflection of the needle (4). This means the needle is moved by a total of 36 cmH2O, which is the real, corrected MEP. What would occur on a time-cycled ventilator with a fixed rate if the inspiratory flow rate were increased? A. decrease in inspiratory time B. increase in inspiratory time C. decrease in tidal volume D. increase in tidal volume - Answer D. increase in tidal volume *On a time-cycled ventilator inspiratory time is predetermined. So, if the flow rate is increased while the mandatory rate is unchanged, the result would be an increase in tidal volume. Why should a respiratory therapist FIRST open the airway of a patient who is apneic? A. To protect the neck if the patient has experienced physical trauma B. The patient may be experiencing upper airway occlusion C. The physical contact may help to trigger a spontaneous breath D. To facilitate the placement of an oral pharyngeal airway - Answer B. The patient may be experiencing upper airway occlusion *When a patient is not breathing, there may be many reasons. However, there is no time to consider all of the these possibilities during an emergency. Therefore, it is best to provide ventilatory support. Sometimes absence of breathing results when upper airway obstruction, or occlusion, is present. An infant who is 35 weeks of gestation requires supplemental oxygen at 40%. Which of the following modalities is most appropriate? A. oxygen hood with an air/oxygen blender B. croup tent C. nasal CPAP mask D. nasal cannula at 2 L/min - Answer A. oxygen hood with an air/oxygen blender *The most appropriate oxygen delivery device for an infant is an oxygen hood with an air-oxygen blender. A blender is used to decrease the transmitted sound to the plastic or acrylic oxygen hood. If a large volume nebulizer is used the sound in the hood would be too significant and could cause hearing damage and prevent the infant from resting. Which of the following instructions should be given to a patient in preparation for incentive spirometry with a volume-type device? A. "inhale as deeply as possible" B. "exhale to expiratory reserve volume" C. "breathe in to total lung capacity" D. "breathe in complete inspiratory capacity" - Answer A. "inhale as deeply as possible" *When instructing a patient on a procedure, the respiratory therapist must use non-medical lingo. For instance, the patient is unlikely to understand total lung capacity, or inspiratory capacity, or expiratory reserve volume. Thus, the best instruction is to "inhale as deeply as possible". Which of the following equations would help determine cardiac output? A. ejection fraction B. Fick C. oxygen consumption D. A-aDO2 - Answer B. Fick *There are many ways to determine cardiac output. One way is called the Fick equation. A patient in the emergency room expectorates thick, yellow sputum. A CBC shows the following: RBC 6.0 mill/cu mm Hb 17 g/dL HCT 64 % WBC 22,000 cu mm The patient could benefit most from which of the following? A. aerosolized Amphotericin B B. sputum culture and sensitivity C. aerosolized Nystatin D. Acetylcysteine - Answer B. sputum culture and sensitivity *The presence of thick, yellow sputum, in conjunction with an elevated white blood cell count, prove that the patient has an infection in the pulmonary system. The most appropriate action is to address the infection by determining a culture and sensitivity. This will help identify the bacteria that is present and the antibiotic that is most suitable for killing that particular bacteria. 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 SVR B. decrease in PVR C. increase in PCWP D. increase in PA - Answer A. 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. cor pulmonale D. dehydration - Answer B. mitral valve stenosis *If mitral valve stenosis is present, blood would have difficulty transitioning the left ventricle. This would result in a backup pressure occurring and an elevation of the PCWP. 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. fluid overload C. ARDS D. pneumonia - Answer A. a pulmonary embolism *A VQ scan that shows poor perfusion but adequate ventilation is most closely associated with a pulmonary embolism. Supportive data is found in the radiological report of wedge shaped infiltrates. 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. increase in PAW B. increased I:E ratio C. an increase in RAW D. a decrease in static compliance - Answer C. an increase in RAW *As the diameter of an endotracheal tube is reduced, airway resistance is increased. The cuff will require more air to seal the trachea resulting in higher cuff pressures. Also, suctioning will be more difficult because the suction catheter will need to be smaller, making it less efficient. 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. alveolar ventilation C. minute ventilation D. MVV - Answer D. MVV *Maximum voluntary ventilation (MVV) is determined by having the patient breathe maximally in and out for a period of either 12 seconds or 15 seconds and then multiplying that volume by five or by four respectively. 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. 5 L/min B. 8 L/min C. 16 L/min D. 18 L/min - Answer C. 16 L/min *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 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?