Lindsey Jones Exam 5 Questions With Correct Answers

Which of the following conditions would be a contraindication for IPPB? A. untreated pneumothorax B. pulmonary edema C. a patient requiring bronchodilation AND lung expansion D. fractured ribs - Answer The correct answer is : A Explanation : Pneumothorax is a contraindication for IPPB due to positive pressure which will exacerbate barotrauma of the lung. The respiratory therapist has an order to cap a patient with a fenestrated tracheostomy tube in preparation for speech therapy. Prior to applying the cap on the end of the tube, the therapist should also ensure A. the inner cannula is removed and the cuff inflated B. the inner cannula is removed and the cuff deflated C. the inner cannula is in place and the cuff inflated. D. the inner cannula is in place and the cuff deflated - Answer The correct answer is : B Explanation : To configure a fenestrated tracheostomy to for speaking, the button must be removed, the inner cannula must also be removed, and the cuff should be deflated. This allows air to be deviated through a hole in the fenestrated tube and pass the vocal folds, allowing speech. A 75-kg (165-lbs) male is in acute ventilatory failure. In preparation for mechanical ventilatory support, the patient is to be orally intubated. Which of the following artificial airways would be most appropriate for this patient? A. Jackson tracheostomy tube B. Size 7.0 mm ET tube with a large volume, low pressure cuff C. Size 8.0 mm ET tube with a small volume, high pressure cuff D. Size 7.5 mm fenestrated tracheostomy tube - Answer The correct answer is : B Explanation : The best way to determine the appropriate size of an endotracheal tube is to take the first digit of the patient's ideal body weight in kilograms. In this case, the patient weighs 75 kg. An endotracheal tube size of 7 or 7.5 is appropriate. The fenestrated tracheostomy tube is intended for long-term mechanical ventilation and is not appropriate in this case. The preferred ET tube is high-volume and low-pressure. Which of the following devices is needed to determine a patient's airway resistance? A. turbine pneumotachometer B. Geissler tube nitrogen analyzer C. Wheatstone bridge helium analyzer D. Body box - Answer The correct answer is : D Explanation : There is a procedure involving panting where airway resistance can be determined. In order to do that procedure all conditions must be standardized, including temperature, pressure, and even humidity to some degree. Only a body box can provide this controlled environment. A patient is receiving manual ventilatory support with a bag-valve connected to a size 8.0 mm ET tube. While transporting the patient from CT scan back to the intensive care unit, the respiratory therapist notices oxygen saturation has dropped to 88% and that the bag-valve is easier to squeeze than normal. Suspecting mal-positioning of the ET tube, the respiratory therapist should first A. obtain an arterial blood gas B. perform diagnostic chest percussion C. examine chest rise and auscultate breath sounds D. call for a chest radiograph - Answer The correct answer is : C Explanation : There are several options when assessing the proper location of an endotracheal tube. These options range from quick to thorough. The quickest way is to assess the tube location visually. This may be done by observing symmetry of chest rise or marking on the tube relative to the lip line. The next quickest way is to auscultate breath sounds. To CONFIRM location of the endotracheal tube, a chest x-ray is required but is time-consuming and should not be the first action taken to assess the endotracheal tube position. A 48-year-old patient has just been orally intubated prior to being placed on volume-controlled ventilation. The respiratory therapist should do which of the following to best confirm proper placement of the endotracheal tube? A. examine tube markings near the lips B. assess chest rise symmetry C. auscultate breath sounds D. obtain a chest radiograph - Answer The correct answer is : D Explanation : Although there are many ways to determine the location of an endotracheal tube inside the patient's airway, there is only one way to confirm its location - a chest x-ray or radiograph. Other methods include auscultation of breath sounds and observation of chest rise and symmetry. While these methods are quick and helpful they do not provide CONFIRMING evidence of the ET tube's location. After 20 minutes into a spontaneous breathing trial (SBT) a mechanically ventilated female patient becomes anxious. Her baseline heart rate has increased by 20 /min. What should the respiratory therapist do? A. Return to full mechanical ventilation B. Measure MIP C. Calculate the RSBI D. Increase the FIO2 and continue to monitor - Answer The correct answer is : A Explanation : An increasing heart rate by at least 20 bpm defines the failure of a weaning trial. Further calculations or measurements are not appropriate as the patient needs mechanical ventilation prior to further deterioration. What is needed to determine arterial oxygen content? A. P/F ratio B. PvO2 C. Hemoglobin level D. Oxygen index - Answer The correct answer is : C Explanation : You must know what is required to calculate arterial oxygen content. If you look at the formula you'll realize you need to know arterial saturation, hemoglobin level, and PaO2 only. Venous saturation is not relevant, but would be relevant if we were calculating venous oxygen content. A patient presents to the emergency room with fulminating pulmonary edema. Which of the following would be experienced with this emergency? A. hypovolemia B. CVP 10 torr and PAP 10 torr C. elevated left ventricular filling pressure with low QT D. a good response to supplemental O2 - Answer The correct answer is : C Explanation : Fulminating pulmonary edema is a serious condition often resulting from left-sided heart failure. Left ventricular filling pressure, a.k.a. pulmonary capillary wedge pressure (PCWP), would likely be elevated while cardiac output (QT) would drop. The back pressure or congestion would become relieved in the lungs, creating severe pulmonary congestion. Which of the following conditions would benefit most from cardioversion? A. asystole B. ventricular tachycardia with a pulse C. ventricular fibrillation D. frequent PVCs - Answer The correct answer is : B Explanation : Cardioversion is appropriate for patients with ventricular tachycardia who have a pulse. If the patient has no pulse then defibrillation should be used. Cardioversion is with the machine in synchronized mode, or the synchronization is set to Active. Defibrillation is done with the machine's synchronization deactivated. Which of the following is the best indicator of the adequacy of alveolar ventilation? A. color B. tidal volume C. PaCO2 from an arterial blood gas analysis D. respiratory rate - Answer The correct answer is : C Explanation : Adequate alveolar ventilation is best manifest by the exhalation of CO2 observed on an arterial blood gas. Tidal volume, respiratory rate, or color are not good indicators of the adequacy of alveolar ventilation. A 32-gestational week newborn is receiving mechanical ventilation via a 3.0 mm endotracheal tube. Which of the following are associated with ongoing assessment of renal function? A. PCWP B. humidification is maintained at a non-invasive temperature C. mPAP D. diaper weight and blood draw volumes are recorded - Answer The correct answer is : D Explanation : NPO (nothing by mouth) indicates that a newborn is not feeding in the usual manner. Intravenous fluids are vital and must be recorded for an intubated patient. Fluid output is measured by diaper weight and carefully recorded blood draws. Humidification of gas through the endotracheal tube must be maintained at an invasive temperature rather than a noninvasive because the nasal passages are bypassed. A patient with ARDS and asthma could benefit from which of the following medications? A. exogenous surfactant B. Spiriva and decadron C. cromolyn sodium D. Tobramycin and albuterol - Answer The correct answer is : D Explanation : A patient with adult respiratory distress syndrome could benefit from bronchodilators to open up the airway and surfactant therapy to decrease the surface tension of the alveoli. The respiratory therapist should look to which of the following clinical data to determine the effectiveness of incentive spirometry? A. Breath sounds before and after every treatment B. Maximum voluntary ventilation done periodically C. Inspiratory capacity predicted volume D. Arterial blood gas analysis pre and post treatment - Answer The correct answer is : A Explanation : The effectiveness of incentive spirometry can best be determined by auscultating breath sounds before and after the treatment and noting changes in air movement. While achieving inspiratory capacity is the goal, the real goal is to increase lung volume, improve alveolar recruitment, and prevent consolidation of sputum in the lungs. Which of the following cannot be measured or evaluated in a comatose patient? A. symptoms B. pupillary response C. objective information D. tidal volume - Answer The correct answer is : A Explanation : If the patient is comatose, they cannot cooperate with procedures or follow commands. To answer this question one must pick the option that does not require compliance with verbal commands. Symptoms, coming from the root word sympathy, require the patient to tell you something. From the list only a tidal volume can be measured without help from the patient. But, the question is asking which of the following CANNOT be measured in a comatose patient. Therefore symptoms, vital capacity, maximum inspiratory pressure are all appropriate answers. A patient with a tracheostomy is receiving supplemental oxygen via tracheostomy collar connected to a large volume nebulizer set at 40%. The respiratory therapist analyzes the FIO2 at the tracheostomy collar with a galvanic fuel cell analyzer. The analysis shows the FIO2 to be 55%. Which of the following could be the cause of the increase in FIO2? A. too much water in the circuit B. calibration error in the galvanic fuel cell C. clogged jet orifice in the nebulizer D. the aerosol tubing is too short - Answer 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. A patient receiving volume-controlled ventilation in SIMV mode has a total respiratory rate of 26/min and is showing signs of increased labor of breathing. The mandatory rate is 14/min. Which of the following would most likely help the patient? A. Use of pressure support B. Increase the machine flow rate C. Increase PEEP D. Switch to pressure control ventilation - Answer The correct answer is : A Explanation : During ventilator weaning, a patient must maintain a moderately low respiratory rate, an adequate sized tidal volume, and low work of breathing. In this case, the patient is experiencing increased labor of breathing and an increase in respiratory rate. This is likely due to a reduced spontaneous tidal volume. Although this data is not shown, this condition can be assumed. The solution for a low spontaneous tidal volume and increased work of breathing during weaning is to provide pressure support. A patient is experiencing atrial arrhythmias and is complaining of light-headedness and nausea. Which of the following should the respiratory therapist recommend to help remedy the problem? A. administration of Lidocaine B. atropine sulfate C. cardioversion D. unsynchronized defibrillation - Answer The correct answer is : C Explanation : Lightheadedness and nausea are associated with atrial cardiac arrhythmias. These rhythms are usually not deadly but should be addressed as quickly as possible. Cardioversion is a form of defibrillation suitable to treat atrial arrhythmias. Cardioversion is done with at low wattage an the defibrillator set to ACTIVE synchronization. When selecting a suction catheter to be used in an oral endotracheal tube, the respiratory therapist should select a catheter whose diameter should not exceed what fraction of the internal diameter of the endotracheal tube? A. 2/3 B. 3/4 C. 1/2 D. 1/4 - Answer The correct answer is : C Explanation : The outer diameter of a suction catheter should not exceed one half of the inner diameter of an endotracheal tube. Which of the following would be most helpful in diagnosing vocal cord paralysis in an adult? A. Neck radiograph B. Thoracic gas volume measurement C. Flow volume loop D. FVC maneuver - Answer The correct answer is : C Explanation : Vocal cord paralysis will cause both obstruction and restriction as airway resistance is increased in both the inspiratory and expiratory phases of breathing. This can be best observed through a pulmonary function maneuver called the flow volume loop. The loop will appear round in shape. When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem, the therapist should A. change the nebulizer entrainment port to 100% B. obtain a smaller oxyhood C. adjust blender setting to 60% D. increase total flow to the oxyhood - Answer The correct answer is : A Explanation : When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen control on the nebulizer should be set to 100%. This will prevent additional entrainment of room air which will cause a decrease in FIO2. Following the insertion of a tracheostomy tube, the patient is found to have diffuse crackles upon auscultation secondary to subcutaneous emphysema. Which of the following radiographic findings would be expected with this condition? A. Hyperlucency in the soft tissues B. Tracheal shift from midline C. Diffuse pulmonary hyperlucency D. Scattered patchy infiltrates - Answer The correct answer is : A Explanation : Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air located in the soft tissue, as seen with subcutaneous emphysema would result in a hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not shift the trachea from midline. Scattered patchy infiltrates are associated with ARDS, not subcutaneous emphysema. Placement of a pulmonary artery catheter is associated with which of the following most common complications? A. pulmonic valve damage B. hypotension C. internal bleeding D. cardiac arrhythmias - Answer The correct answer is : D Explanation : Several complications may arise from the placement of a pulmonary artery catheter, otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the most common complication of the options offered. Another serious complication is perforation of a vessel or cardiac muscle during the insertion. During the placement of a pulmonary artery catheter, the respiratory therapist observes the waveform on the monitor and notices it is repeatedly rising and falling from 0 mmHg to 25 mmHg, which is an indication that the tip of the catheter is in the right ventricle of the heart. Based on this information, the respiratory therapist will recommend A. inflate the catheter balloon to sail the tip to the proper location B. suture the catheter in place C. rotate the catheter to achieve a dicrotic notch in the waveform D. withdraw the catheter back to the upper vena cava - Answer The correct answer is : A