Lindsey Jones Exam 6 Questions With Correct Answers

which of the following should be excluded in an evaluation of a pt's ability to learn self administration medication by MDI a)manual dexterity b)level of dementia c)visual ability d)language skills - Answer c)visual ablilty While performing manual ventilation with a self-inflating resuscitator bag through a properly placed endotracheal tube, a respiratory therapist observes no chest rise. To troubleshoot the problem, the therapist should? A. assure the large bore reservoir tubing is connected. B. adjust the PEEP valve C. increase the flowrate. D. check for proper function of the air inlet valve - Answer D) check for proper function of the air Intel valve. The scenario suggests that the ET tube is properly placed, therefore the problem must be in the resuscitator. When the therapist squeezes the device, the air is not being delivered to the patient, which is why there is no chest rise. Which of the following equipment is required to determine VD/VT ratio on a patient receiving mechanical ventilation? A. capnograph B. pressure differential pneumotachometer C. Fleisch pneumotachometer D. EZ® cap CO2 detector - Answer A) capnography This question is largely about memorization. You must know what it takes to calculate of the VD/VT ratio. Of the equipment listed only a capnograph would be helpful because it relates end tidal CO2. For a patient with severe mitral-valve stenosis, a balloon-tipped flow-directed pulmonary artery catheter would be associated with which of the following clinical data? A. PAP 19 mm Hg and PCWP 7 mmHg B. PAP 25/8 mmHg C. PCWP 14 mm Hg and C.O. 4 L/M D. CVP 9 mm Hg and PAP 9 mmHg - Answer c) PCWP 12 and CO 4 Mitral valve stenosis is a problem resulting from left heart failure. Problems in the left heart are manifested hemodynamically with high pulmonary capillary wedge pressure (PCWP) and low or normal cardiac output. A 38-week gestational age infant is to receive oxygen therapy by a blender set at 100% with a heated large-volume nebulizer. To ensure the delivery of the ordered FIO2, the respiratory therapist should properly set the nebulizer FIO2 to A. 100% B. 21% C. 0% D. 50% - Answer A) 100% When using an air-oxygen blender, oxygen percentage is predetermined prior to entering the large volume nebulizer device. When this happens, the large volume nebulizer should be set at 100% in order to avoid entraining additional room air and lowering FIO2. A respiratory therapist is asked to assist in the development of a teaching plan for a 7-year-old asthmatic patient at home. The plan should avoid instructions regarding A. daily monitoring of peak-expiratory flow rates B. the water-float technique to determine MDI canister content C. improving the patient and family's understanding of infection control D. the proper technique for the use of MDIs - Answer B) the water float tech to determine MDI canister content Proper MDI technique, peak-flow monitoring, and improving the understanding of infection control are all appropriate aspects of a teaching plan for a pediatric patient. Determining MDI canister content by floating the canister in water is never appropriate. The proper way to assess content is by actuating the MDI and observing the output. Which of the following pre/post bronchodilator pulmonary function test results is the most meaningful in suggesting that a bronchodilator is indicated? A. FEF 200-1200 increases by 17% B. FEV1 increases by 150 mL C. FEV1.0/FVC % increases by 10%. D. FVC increases from 2.5 L to 2.6 L - Answer A) FEV1 increases by 150 ml The two primary considerations in pre-and post-bronchodilator studies are (1) whether flows increased by at least 12% or more and (2) whether the FEV1 increases by at least 200 mL. The FEF200-1200, indicating the condition of the large airways, increases by well over 12%, and is therefore the correct choice. The resulting flow-volume loop of a patient with pulmonary obstruction following a bronchodilator shows an inflection point on the positive side of the graph that is 25% taller than the loop seen prior to the bronchodilator trial. This would indicate that A. patient may have taken a bronchodilator prior to the test B. study should be repeated C. patient would benefit from bronchodilators D. vital capacity increased by 25% with a bronchodilator - Answer C) pt would benefit from a bronchodilator An inflection point is a significant change in direction seen in various types of graphic depictions. In this case the inflection point represents the top or "peak" of the flow volume loop. This point is peak flow. An increase in peak flow by 25% is well above the 12% threshold that is considered significant, indicating bronchodilator therapy. Which of the following may occur as a result of stimulation of the vagal reflex during a suction procedure? A. PVCs B. decrease in blood pressure C. first degree heart block D. increase in heart rate - Answer B) decrease in BP Suctioning can cause a decrease in heart rate and a decrease in blood pressure. This natural, physiological response is associated with stimulation of the vagal nerve during suctioning. This is also called the vagal reflex A respiratory supervisor is calculating appropriate staffing levels for a shift. Which of the following should be included in calculation? A. frequency of refused therapy B. patient medical history C. patient areas and locations D. staff member preferences - Answer C) pt areas and locati0ns To plan for patient care, staffing must be appropriate. Conditions that affect the amount of staff needed include location of patients (how far staff must travel to get to patients), frequency of ordered therapy (how frequently staff must visit the patient), and the type of therapy (how long the therapy will take). The patient's medical history will not likely affect staffing. A therapist would expect to see which of the following capnographic data after providing the first few manual ventilations on a patient who has been apneic for 4 minutes? A. unreadable PetCO2 B. high PetCO2 C. low PetCO2 D. low PaCO2 - Answer C) low PetC02 Over the course of three weeks, the respiratory therapist notes a documented change in the color of sputum on a patient receiving mechanical ventilatory support. The sputum has changed from white or clear to light green and now has a sweet odor. The respiratory therapist should recommend which of the following? A. Antibiotic therapy B. antiprotozoan therapy C. wetting agent therapy D. antiviral therapy - Answer A) antibiotic therapy A sweet odor noted in sputum is associated with Pseudomonas, which is a bacterial infection in the lungs. Antibiotic therapy is be most appropriate. One important consideration when drawing an arterial blood sample is A. needle size B. the type of antibiotics currently used by the patient C. heart rate D. the patient's potassium level - Answer A) Needle size There are many important considerations when drawing an arterial blood gas. However, of the options listed in this question, the best answer is needle size. Needle size is something the average respiratory therapist may not routinely consider, however, it is a basic recall matter that one should know. Which of the following clinical signs should result in discontinuation of weaning from mechanical ventilation? A. VT < 6 mL/kg B. Frequent apneic periods of 20 seconds C. Respiratory rate above 25/min D. PaCO2 increases 8 torr above baseline - Answer B) freq apneic periods of 20 secs The 20-second periods of apnea strongly indicate the need to return to mechanical ventilation in this scenario. A respiratory rate above 30 per minute would also indicate the need to return to mechanical ventilation. The PaCO2 must increase by 10 torr or more to define weaning failure. The galvanic-type oxygen analyzer is reading 5% when the respiratory therapist is attempting to calibrate it with 100% oxygen. To remedy the problem, the therapist should do which of the following? A. Change the fuel cell B. Change the electrolyte solution C. Discard the analyzer and get a new one D. Change the batteries - Answer A) change the fuel cell When a galvanic-type oxygen analyzer is reading extremely low or zero, the problem is most likely related to a depleted power source. Because the analyzer does not have batteries but receives power from the probe (the fuel cell), the most appropriate action is to change the fuel cell. If this analyzer, however, is only slightly off the actual FIO2, , it is more likely the analyzer requires a high and low calibration. One indication to change from administering a front door bronchodilator to a back door bronchodilator is A. nausea and anxiousness induced by the front door bronchodilator B. the patient's heart rate does not increase with the front door bronchodilator C. ineffectiveness of a side door bronchodilator D. diminished lung sounds result in wheezing after the front door bronchodilator is administered - Answer A) nausea and anxiousness Nausea, anxiousness, tingling of the digits, & excessive increase in heart rate are all examples of poor tolerance by front door (sympathomimetic) bronchodilators. It is appropriate to try either a side door or back door bronchodilator should poor tolerance occur. If diminished lung sounds result in wheezing after a bronchodilator is administered, it is an indication that increased air movement is occurring and the therapy should continue A therapist is making several changes to the mechanical ventilator on a patient receiving volume-controlled ventilation in the SIMV mode. If the therapist decreases peak inspiratory flow but makes no changes in tidal volume or rate, which of the following could the therapist expect to occur? A. Increased peak inspiratory pressures B. Increased I:E ratio C. Decreased inspiratory time D. Increased expiratory time - Answer B) increased I:E ratio A decrease in inspiratory flow rates low will cause an increase in inspiratory time. This changes the I:E ratio. Auscultation of a child's breath sounds reveals unilateral wheezing in the right side. Which of the following should the respiratory therapist recommend to be most helpful to the patient? A. Atropine B. Albuterol C. Bronchoscopy D. Salmeterol - Answer C) Bronchoscopy Bilateral wheezing is associated with bronchoconstriction. When the bronchials constrict, they are not usually capable of constricting on one side of the lung only. Therefore, unilateral wheezing indicates the problem must be something other than bronchoconstriction and is most likely associated with foreign body aspiration. To remove the object a bronchoscopy is most appropriate. A 32-week gestational age infant is receiving supplemental oxygen by oxyhood with an oxygen blender set at 40% and a heated aerosol. The oxygen analyzer fuel cell is placed near the infant's mouth and FIO2 is determined to be 35%. The physician would like to confirm the patient's oxygenation status. The respiratory therapist should evaluate