CRT/RRT Exam Review/ Respiratory Therapy Exam Review 175 Questions and Answers latest update 2023

CRT/RRT Exam Review/ Respiratory Therapy Exam Review 175 Questions and Answers latest update 2023 bleeding time (template) - less than 10 minutes erythrocyte count - 4.2 - 5.9 million/mcl erythrocyte sedimentation rate (Westergren) - Male: 0-15mm/hr Female: 0-20 mm/hr hematocrit, blood - Male: 42-50% Female: 40 - 48% hemoglobin, blood - Male: 13-16 g/dl Female: 12-15 g/dl leukocyte count and differential - leukocyte count: /mcl 50-70% segmented neutrophils 0-5% band forms, 0-3% eosinophils 0-1% basophils, 30-45% lymphocytes 0-6% monocytes mean corpuscular volume - 86-98 fL protrhombin time, plasma - 11-13 seconds partial thromboplastin time (activated) - 30-40 seconds platelet count - 150,000 - 300,000/mcL reticulocyte count - 0.5 - 1.5% of red cells amylase, serum - 25 - 125 U/L arterial studies, blood (Patient breathing room air): PO2 - 75-100 mmHg arterial studies, blood (Patient breathing room air): PCO2 - 38-42mmHg arterial studies, blood (Patient breathing room air): Bicarbonate - 23-26 mEq/L arterial studies, blood (Patient breathing room air): pH - 7.38 - 7.44 arterial studies, blood (Patient breathing room air): Oxygen Saturation - 95% or greater bicarbonate, serum - 23 - 28 mEq/L bilirubin, serum: - Total 0.3 - 1.0 mg/dL Direct 0.1 - 0.3 mg/dL Comprehensive metabolic panel: Bilirubin, serum (total) - 0.3 - 1.0 mg/dL Comprehensive metabolic panel: calcium, serum - Male: 9.0 -10.5mg/dL Female: 8.5 - 10.2mg/dL Comprehensive metabolic panel: cholesterol, serum (total) - Desirable: less than 200md/dL Borderline-high: 200-239mg/dL(may be high in the presence of coronary artery disease or other risk factors) High: greater than 239md/dL Comprehensive metabolic panel: creatinine, serum - 0.7-1.5 mg/dL Glucose, plasma - Normal (fasting); 70 -115 mg/dL Borderline: 115-140 mg/dL Abnormal: greater than 140 mg/dL phosphorus, serum - 3.0 - 4.5 mg/dL Proteins, serum: Pre-Albumin - 0.2 - 0.4 g/dL Proteins, serum: Albumin - 3.5 - 5.5 g/dL Urea nitrogen, blood (BUN) - 8 - 20 mg/dL Uric acid, serum - 3.0 -7.0 mg/dL Cholesterol serum: High density lipoprotein (HDL) - Low: less than 40 mg/dL Cholesterol serum: Low density lipoprotein (LDL) - Optimal: less than 100mg/dL Near optimal: 100 - 129 mg/dL Borderline-high: 130-159 mg/dL (may be high in the presence of coronary artery disease or other risk factors) High: 160 - 189 mg/dL Very high: 190 mg/dL and bove Triglycerides, serum (fasting) - Normal: less than 250mg/dL Borderline: 250 - 500 mg/dL Abnormal: greater than 500 mg/dL Electrolytes, serum: sodium - 136 - 145 mEq/L Electrolytes, serum: potassium - 3.5-5.0 mEq/L Electrolytes, serum: chloride - 98-106 mEq/L Follicle-stimulating hormone, serum: - Adult male: 2 - 18 mLU/mL Female: 5-20 mLU/mL (follicular or luteal) 30 - 50 mLU/mL 9mid-cycle peak) greater than 50 mLU/mL (postmenopausal) Lactate dehydrogenase, serum - 140 - 280 U/L Osmolality, serum - 280 - 300 m0sm/kg H20 Phosphatase (alkaline), serum - 30 - 120 U/L Upon review of the patient record, the respiratory therapist notices that the chart indicates that the patient has a code status of "Do Not Resuscitate." During a routine assessment, the patient becomes apneic. Which of these should the respiratory therapist do? - Report this to the charge nurse as soon as possible. A review of physician orders for a patient admitted to an acute care facility with an exacerbation of chronic obstructive pulmonary disease (COPD) shows that the medications responsibility to perform which of these actions? - Contact the ordering physician to verify orders. Upon having difficulty getting a reading with the finger probe of a pulse oximeter, the respiratory therapist decides to check the patient's peripheral circulation and capillary refill. The nail bed on the right index finger, after a brief compression, becomes pink again after one second. This is an indication of which of the following? - normal peripheral circulation and capillary refill A 20-year old female patient is brought to the emergency department (ED) by paramedics after suffering a brief loss of consciousness after a collision with another player on the basketball court. Upon arrival, the patient's SpO2 is 98% on room air, her respiratory rate is 16, and her heart rate is 95. The venous blood draw shows that hemoglobin is 11.0 and hematocrit is 44. How do you report these findings? - Patient is saturating well on room air and has a normal heart rate and respiratory. Hemoglobin is low at 11.0 , and hematocrit is within normal limits. The first patient we see today for an evaluation is a 45-year old female who started smoking cigarettes at age 15. She reports that she smokes one and half packs a day and that she quit for a year when she was pregnant with each or her two children. Her husband is also a smoker. How do you report this smoking history in the patient chart? - Patient is currently a daily cigarette smoker, 1.5 packs per day, with a 42 pack-year history When introducing herself to a patient for the first time, the respiratory therapist notices that the patient is only able to respond to questions in two-or-three-word phrases, breaking up longer responses to take breaths after every couple of words. What conclusions can the respiratory therapist safely make from this speech pattern? - The patient has a decreased vital capacity, and there could be several different causes for this. Auscultation of breath sounds during an examination of a 20-year-old male reveals high-pitched wheezing throughout the lung field. The patient reports that he is slightly short of breath and that the wheezing, though noticeable, bothers him very little. He notices that it usually happens when he mows the lawn. Which of the following might we recommend to the physician? - The patient's respiratory health is uncertain and would be better understood by performing basic spirometry and a methacholine challenge test. A 50-year old female patient presents with a three month history of cough productive of sputum that is more acute in the morning upon waking. The sputum is moderate in consistency, pale yellow in color, and varies from small to moderate in quantity. There is no fever or recent sick contacts. Auscultation reveals scattered rhonchi bilaterally, mostly in the lower lobes. The patient has no smoking history. What do you recommend? - A more complete history including vocation, exposure to environmental hazards, and family history is required. Also, PFTs are indicated for this patient with a pre- and post-bronchodilator FEV1/FVC. A patient presents to the ED of your hospital with productive cough, fever, and bilateral rhonchi in the lower lobes. The CXR shows possible bilateral infiltrate, according to the radiologist. To confirm a diagnosis of pneumonia, what level of white blood cells (WBCs) would we expect to find per microliter (mcL)? - 12,000 to 14,000 WBCs/mcL While performing routine care on a patient with a tracheostomy, you notice that there are traces of blood apparent on the dressing between the stoma and the flange of the tube. Which of these is the correct course of action? - Clean the area of the stoma with normal saline; do a careful inspection of the condition of the stoma; replace the old dressing with a new, clean dressing; carefully note your observation in the patient chart; and directly notify the unit manager that the stoma needs the attention of the patient's physician or advanced practice registered nurse (APRN) when one of them next does rounds. A patient brought into ED by paramedics from a car accident is unconscious and appears to have possibly suffered a chest wall injury. The physician orders an arterial blood gas (ABG) analysis (on room air). The results come back as follows: pH 7.41 PaCo2 58 mmHg PaO2 84 mmHg HCO3 24 mEq/L - stat CXR and possible noninvasive positive pressure ventilation (NIPPV) A patient in your care has appropriate tidal volumes; clear bilateral breath sounds throughout his lung fields; normal CBC; no signs or symptoms of infection; and although he is on a venturi mask delivering an FiO2 of 0.45, he has an SpO2 of 87%. The patient chart shows a history of a clotting disorder, although he is not currently taking an anticoagulant. The patient's condition is rapidly deteriorating. What test would you recommend be performed next? - ventilation perfusion (V/Q) scan A patient in the telemetry unit sets off an alarm when her SpO2 drops below 90% - all the way to 85%. The patient has a No. 6 Shiley tracheostomy tube in place; she has a disposable inner cannula in place, and the cuff is deflated. Upon entering her room, what is the first thing you must do? - attempt to pass a suction catheter through the tracheostomy tube to remove accumulated secretions and to ensure that the tube is patent. Acute or chronic lung disease is best shown in which of the following arterial blood gas (ABG) results (on 4/L/min 02 via nasal cannula)? - pH 7.36 PO2 86 PCO2 52 HCO3 30 If we need to determine a patient's functional residual capacity (FRC), which of these tests should the physician order? - body plethysmography A patient is sent for pulmonary function testing to confirm or refute a tentative diagnosis of COPD. The test is ordered to be performed pre- and post-bronchodilator. What minimum degree of change in forced vital capacity (FVC) do we need to see in order to conclude that there is a significant difference attributable to the bronchodilator? - 12% When calibrating the spirometer in the pulmonary function laboratory, the respiratory therapist performs three trials with a 3 L syringe. The results are 2.92 L, and 3.09 L. What does the respiratory therapist report about the spirometer as a result of these measurements? - It is in good working order. Mrs. Galvez is a 70 year old Hispanic woman with a 50 pack year smoking history. Her physician has sent her to you with an order for full pulmonary function testing because she presented to him with a persistent, productive cough. Her FVC is within normal range for her height/age/race. Her FEV1/FVC is 0.61, or 61% of normal. What does this number suggest? - Mrs. Galvez has a sign of an obstructive lung disorder, possibly moderate COPD. A patient is brought into the ED by paramedics after one care motor vehicle accident. The patient was the driver. He is a 20 year old male. conscious but lethargic. He is complaining of severe pain in his right leg, neck, and chest. The stat CXR shows tracheal deviation to the right side. What is a possible cause of the X-ray findings? - left-side pneumothorax A 35 year old female patient is brought into the ED by her family. They suspect she may have taken an overdose of heroin. The physician wants to check for possible hypoventilation as a result of a suppressed respiratory drive and orders an ABG. In what order do we perform these steps? - Check for written order, check patient ID, perform Allen's test, wash hands, glove, prepare ABG draw kit, clean site with alcohol swab, draw sample Which of the following conditions in a patient chart might cause you to suspect that the SPO2 reading from a pulse oximeter might not be accurate for a particular patient? - The patient is a smoker who stepped out for a cigarette immediately before the examination. The pulmonologist has ordered bedside spirometry for a patient on his service. The patient is a 29 year old male smoker admitted through the ED after a diagnosis was made of ethanol toxicity. The patient is 183 cm tall, Caucasian, and weighs 105 kg. Three trials yield the following results for FVC and FEV1: 4.70 L/4.00 L - 5.67 L/4.66 L - 4.01 L/3.96 L The Centers for Disease Control and Prevention's Third National Health and Nutrition Examination Survey (NHANES III) predicted value is 5.84 L/4.75 L. What should the respiratory therapist report to the physician? - Inconsistent patient effort precludes useful analysis. Your patient is an 18 year old recent immigrant from the Philippines. Due to findings on the patient's CXR and the symptoms he presented with upon initial examination, the physician has given the patient a tentative diagnosis of tuberculosis and has admitted the patient to the hospital, ordering additional tests and appropriate isolation precautions. Which personal protective equipment (PPE) must we use during contact with this patient? - N95 mask, gown, gloves A 14 year old African American female with a diagnosis of asthma has, with your guidance and assistance, prepared an asthma action plan. Her daily peak flow measurements are recorded each morning. What results would indicate she is in the "yellow zone" and needs to use her inhaler according to the plan? - a peak flow reading 25% lower than her best Pulmonary function testing should be postponed for all of the following patients except: a. 71 year old male, status/post cerebrovascular accident (CVA) one week b. 17 year old female, recent CXR showing right sided pneumothorax c. 33 year old female, two broken ribs from a fall three days ago d. 15 year old male, recent respiratory infection - d During the analysis of the flow volume curve of a patient's pulmonary function testing, we suspect that the patient may have coughed during the first second of exhale during one of the trials. What indicator would we see in the graph to lead to this conclusion? - a jagged interruption or dip in the curve during exhale The physician has asked us to evaluate the respiratory status of a patient with muscular dystrophy. Of all the tests that we may use in this assessment, which one should be performed first? a. maximum inspiratory pressure (MIP) b. maximal voluntary ventilation (MVV) c. arterial blood gas (ABG) d. CXR - a When examining the flow time graph of Mr. LaGuardia's pulmonary function test, we see that the line noticeably declines toward the baseline after reaching a plateau. What does this indicate? - a likely leak in the circuit The physician has asked for assistance in diagnosing a patient with moderate respiratory distress, a productive cough, and a fever. The patient coughs and expectorates sputum, which should always be examined for which characteristics? - culture When ABG results reveal that the patient is alkalotic, although she is apparently breathing normally, a possible cause is - repeated vomiting A patient in the telemetry unit is on continuous monitoring for, among other vital signs, SpO2. The patient has no signs of hypoxemia or respiratory distress but is now setting off an alarm when the SpO2 reading dips to 80% on 28% O2 via nasal cannula. A stat ABG shows a PaO2 of 85 mmHg. What course of action is indicated? - Disregard the pulse oximeter reading and maintain the same FiO2. You want to assess the ventilatory status of a long term mechanical ventilator patient in a skilled nursing facility. An ABG analysis is not available in house and would require the patient be sent to a pulmonary laboratory. The next best choice would be which of these tests? - end-tidal CO2 levels measured with capnography A full polysomnography study in a properly equipped sleep lab will include continuous monitoring and recording of which of these sets of parameters? - heart rate, leg movement, snoring, SpO2, chest expansion The interpretation of the sleep study shows definitive evidence of obstructive sleep apnea. The diagnosis will be made for moderate sleep apnea if the apnea hypopnea index (AHI) is - 15 and 30 The ICU team is considering whether a metabolic study with indirect calorimetry is indicated for Mr. Pulaski. Which of the following is not included in the patient groups for whom this test may be indicated? a. patients at the extremes of weight b. patients with high levels of stress c. patients who are difficult to wean from the ventilator d. patients who are typically physically active - d Which of these vital signs are NOT included in the computation of an Apgar score? a. muscle tone b. reflex irritability c. heart rate d. pupillary reaction - d. pupillary reaction With regard to an assessment of gestational age, the different between a very low infant (VLBW) and an extremely low birth weight infant (ELBW) is - the difference between birthweight 1,500 g and birthweight 1,000 g For Ms. Goldberg, whose blood pressure is low and whose cardiac output is decreased, the therapy that is considered before others is - IV fluid administration Mr. Esposito has a diagnosis of congestive heart failure, and he is currently experiencing an exacerbation of this condition. How is this likely to be manifested in his respiratory status? - He may be difficult to oxygenate due to fluid buildup in his lungs (pulmonary edema) When examining the patient for signs of increased work of breathing (WOB), the respiratory therapist must look for all of the following signs or diagnoses except: a. increased respiratory rate b. accessory muscle use c. diagnosis with idiopathic pulmonary fibrosis (IPF) d. decreased GI function - d. decreased GI function Mrs. Jackson is in the intensive care unit (ICU), and her intracranial pressure (ICP) is being monitored out of concern that it may rise to an unsafe level. Monitoring is accomplished with a miniature pressure transducer inserted in the lateral ventricle. The pressure is dangerously high. We can see her ICP return to a safe baseline level when it decreases from - 20 mmHg to 10 mmHg Monitoring an 80 year old male in the telemetry unit, the respiratory therapist notices on the electrocardiogram (ECG) monitor that the patient's P wave has gone from a normal width of about 0.10 seconds to an unusually long 0.20 seconds. A possible cause for this is - hypertension When monitoring hemodynamic parameters with a pulmonary artery catheter, which of these values would NOT give us cause for alarm? a. mean pulmonary artery pressure of 8 mmHg b. pulmonary capillary wedge pressure of 5 mmHg c. central venous pressure of 18 mmHg d. cardiac output of 2 L/min - b. pulmonary capillary wedge pressure of 5 mmHg When giving a report on the status of a patient in the ED, the respiratory therapist describes the patient as "A & O x3." This means that during assessment the patient is - alert and oriented to time, place, person When asked to describe the pain he is feeling, Mr. Faucher responds, "I have no words to describe what I am feeling." How do we help Mr. Faucher and get a useful assessment of the level of his pain? - Ask the patient to rate his pain on a scale from 1 (very little) to 10 (the worst he's ever had) While we are assessing Mr. Salaam, he tells us he has a cough in the morning, productive of sputum. We ask him what color, and he responds, "I never looked." Why is it important for us to know this to better help our patient? - The color can be a telltale sign of respiratory infection. Mr. Jackson reports an occasional feeling of tightness in his chest that is accompanied by wheezing. He tells us he has never had asthma and that because he is adopted, he doesn't know about a family history of respiratory issues. He has never smoked and lives with a nonsmoking partner. What else must the respiratory therapist ask Mr. Jackson to better help the physician with a diagnosis? - What is your work environment like? Mrs. Hunter tells the respiratory therapist that she spends her day on the sofa watching television. When doing so, she feels no shortness of breath. How do we determine and report her ability to perform activities of daily living (ADLs) with regard to dyspnea? - We ask her questions about toileting, meal preparation, and simple housework. During an evaluation of a 37 year old female patient who presents with a cough of unknown etiology, which family and personal history question is most relevant? a. Do you drink? b. Do you have family history of renal failure. c. Do you live with smokers? d. Do you have any food allergies? - c. Do you live with smokers? Tracheal deviation from midline will occur with which of these pairs of disorders? - pneumothorax and hemothorax Lateral neck radiographs can assist with the diagnosis of which acute condition? a. bronchitis b. respiratory syncytial virus c. croup d. pertussis - c. croup Proper patient positioning in a CXR will yield an image that includes all of the following except: a. lung apices b. costophrenic angles c. hemidiaphragms d. hyoid - d. hyoid The presence of pleural effusions will be seen in the CXR as - a light area at the lung base, at the costophrenic angle The difference between an anterior/posterior (A/P) CXR and a posterior/anterior (P/A) CXR is - In an A/P CXR, the heart appears larger A portable CXR shows an elevated hemidiaphragm on the right side. The most common reason this is seen is - enlarged liver resulting from cirrhosis The 12 lead EKG is widely used because - it is noninvasive and painless. A respiratory therapist can determine minute ventilation by first measuring - tidal volume and respiratory rate A respiratory therapist is assigned to a patient in the ICU who is on continuous mechanical ventilation. Among other parameters charted every two hours is the patient's plateau pressure. Why is this of such great importance for the treatment of this patient? - Limiting the plateau pressure reduces the likelihood of lung injury. The alveolar-arterial oxygen tension difference - (PA-Pa)O2 - is a measure of gas exchange that is a useful indicator in helping to determine our patient's pulmonary status. In order for us to assess this difference, the respiratory therapists needs to know: - PaO2 and FiO2 Mrs. Papadopoulos has been referred to the cardiac rehabilitation program for cardiopulmonary exercise evaluation (CPX). The respiratory therapist at the program must be aware of the relative contraindications of CPX, which include all of the following except: a. angina with exercise b. inability or unwillingness of the patient to participate c. uncontrolled diabetes d. mildly elevated BMI - d. mildly elevated BMI On the order of the intensivist on duty in the ICU, a respiratory therapist draws an ABG sample for analysis to see if our patient's minute ventilation is sufficient for maintaining the appropriate PaCO2. There are numerous errors an inexperienced or poorly trained respiratory therapist might make that would degrade the accuracy or reliability of the analysis; they include which of the following? - waiting more than 20 minutes to analyze the sample During regularly scheduled ventilator checks, the thorough and conscientious respiratory therapist will check the cuff pressure on the endotracheal tube to see that it is neither too high nor too low. The device used to make this measurement is a - manometer Mr. Chao has suspended respiratory infection that is proving very difficult to precisely diagnose. His physician wants to perform a sputum culture, but the amount of sputum Mr. Chao is able to expectorate is scant or none. What can the respiratory therapist suggest as a method to help obtain a suitable sputum sample? - Administer hypertonic saline (3%) to the patient via nebulizer Which one of the following statements is NOT true of patients who are demonstrating auto positive end-expiratory pressure (auto-PEEP) while on mechanical ventilation? - Diuresing the patient will reduce the auto-PEEP According to the American Association for Respiratory Care's clinical practice guidelines, when charting the measurements taken via transcutaneous monitoring of PtcCo2, it is required that the respiratory therapist chart all of the following except: a. a subjective assessment of the clinical appearance of the patient b. the mode of ventilatory support and the settings c. the FiO2 (or O2 flow rate) and the method of oxygen delivery d. Atmospheric conditions outside - d. Atmospheric conditions outside The value of performing an overnight pulse oximetry test is demonstrated by its ability to help us determine - which patients may have sleep-disordered breathing versus simple snoring A patient whose respiratory status we are assessing in the ICU is unconscious and unable to cooperate with our efforts. Nevertheless, we can perform which of the following measurements? - maximum inspiratory pressure Acceptable methods of determining the correct continuous positive airway pressure (CPAP) pressure setting for patients with obstructive sleep apnea include the following: - titration in a sleep lab or titration with an auto-CPAP machine at home A respiratory therapist is evaluating the results of hemoximetry just performed on a patient in the labor and delivery unit. Possible causes of measurement errors that must be considered in the evaluation include all of the following except: a. sickle cell anemia b. dirty cuvette chamber c. high lipid levels from parenteral nutrition d. hypertension - d. hypertension A respiratory therapist has returned to his job at a New England hospital center from a charitable medical mission to Central Africa. A month later, he is experiencing a persistent bad cough with hemoptysis. Which of these tests are likely to be ordered to help diagnose the problem? a. magnetic resonance imaging (MRI) b. methacholine provocation c. purified protein derivative (PPD) test d. polysomnography - c. purified protein derivative (PPD) test A respiratory therapist goes to the supply room to get nasal cannula for a patient in their care. The liter flow ordered by the physician is 2 L/min. The therapist notes that the expiration date on the packaging of the item shows that it expired just within the last month. The proper immediate course of action for the therapist is - Discard the expired nasal cannula, and advise the central supply manager of outdated equipment on the shelves. Then, obtain a nasal cannula that has not reached its stated expiration to supply to this patient. When setting up a CPAP machine for Mrs. Rose, a new admission, the respiratory therapist is required to inspect the machine for safety, good overall condition, and proper operation. The respiratory therapist notices that although everything appears fine, there is no preventive maintenance (PM) sticker on the CPAP machine. This sticker shows that it was inspected and when it next needs inspection and bench testing by the biomedical department. What action is indicated by the lack of this sticker? - Obtain another CPAP machine that has the correct PM sticker, and then see to it that the first one is brought to the attention of the biomedical technicians. Set the machine aside until it can be serviced. When setting up an ICU room for a new mechanical ventilator patient, the presence of which item is required? - bag mask ventilation device A patient on mechanical ventilation in the ICU for the past 24 hours, who is recovering from severe pneumonia, is doing well and her condition seems to be improving each shift. Suddenly and without warning, the high-pressure and low-volume alarms are sounding. One possible cause could be - patient biting on the endotracheal (ET) tube Providing tracheostomy care for Mr. Bollela requires that he be suctioned q2h plus PRN. He currently has a No. 6 Shiley tracheostomy tube, uncuffed, with a disposable inner cannula. The respiratory therapist switches on the suction pump on the nightstand, but the pump seems to be failing to deliver sufficient suction. The therapist occludes the distal end of the tubing before attaching the suction catheter and sees the pressure meter climb to only 10 cm H2O. Which of the following is least likely to be the cause of this problem? a. dried secretions accumulated in tubing b. suction canister lid not properly in place c. clogged in line bacterial filter d. system has been recently sterilized - d. system has been recently sterilized The best way for a respiratory therapist to be sure of the concentration of oxygen coming out of an oxygen concentrator is - attach the output to an oxygen concentration meter When the patient exhales slowly into a brand new, volume oriented incentive spirometer, the indicator does not move at all. What does this demonstrate? - the patient is using it incorrectly A patient with tenacious pulmonary secretions has been examined by his physician, who has ordered vibratory positive expiratory pressure (PEP) therapy with respiratory therapist coaching q2h x 5 days. The patient's effort is good, and expiratory force causes the device to vibrate properly. On day two, the patient exhales forcefully but there is no vibration. What should the respiratory therapist NOT do? - begin chest physical therapy (CPT) The nitric oxide (NO) delivery device is giving a low priority alarm, indicating there is a monitoring failure. Which of the following will help troubleshoot the alarm without disconnecting the patient from the device? - check the patient sample line for possible occlusions A patient had a chest tube inserted in the ED following a motorcycle accident that resulted in four broken ribs and a left side pneumothorax. The Heimlich valve on her chest drainage tube is working properly if - it allows air to flow out but not in The pulmonologist uses a bronchoscope to examine the airways of a patient with suspected early stage lung cancer for which the diagnostic imaging has been inconclusive. After use, the bronchoscope is delivered to supply for cleaning prior to the next use. The proper method for preparing the bronchoscope for the next use is - high level disinfection (HLD) with 0.2% peracetic acid To calibrate an oxygen concentration meter, a respiratory therapist can - turn it on and see if it reads 21% while on room air In order to keep the arterial blood gas analyzer working properly, the respiratory therapist may be required to perform regularly scheduled quality assurance procedures, NOT included in these procedures is - uploading software updates An oropharyngeal airway is used for - nonemergency ventilation The laryngeal mask airway (LMA) is preferred over an endotracheal tube in some circumstances. The reasons do NOT include which one of the following? a. insertion is relatively easy b. placement requires no equipment c. it avoids tracheal and laryngeal trauma d. materials are always hypoallergenic - d. Materials are always hypoallergenic Mr. Shimizu has a tracheostomy tube in place for six weeks now since his surgery for laryngeal cancer. He may begin to use a speaking valve on his tube, which will enable him to do which of the following? - inhale through his tracheostomy tube and exhale through his trachea and oropharynx Prevention of ventilator associated pneumonia (VAP) is achieved by observing certain protocols and procedures. Which of the following will NOT help reduce the risk of VAP? a. incline the head of the bed to 30 to 45 degrees b. provide oral care c. spontaneous breathing test daily d. timely administration of albuterol or DuoNeb - d. timely administration of albuterol or DuoNeb Ms. Kwame has passed her spontaneous breathing trials and is ready for extubation. What are the steps for extubation, and in what order are the steps performed? - Suction, oxygenate, deflate cuff, remove tube, supplemental O2 (if indicated), assess patient The physician who is attending to Mr. Borinkov's respiratory infection wants to evaluate the patient for nasotracheal suctioning to determine if it is indicated and safe. Which of the following is not contraindications for this procedure? a. myocardial infarction b. acute facial or neck injury c. coagulopathy or bleeding disorder d. age over 65 - d. age over 65 One of the possible complications that a respiratory therapist might encounter while performing postural drainage is acute hypotension during the procedure. Which of the following describes the appropriate steps to take? - stop therapy, return patient to the original resting position, and consult the physician High frequency chest wall oscillation (vest therapy) is a fundamental component of secretion clearance for patients with which of the following? - cystic fibrosis Incentive spirometry has been ordered for Miss Fontana to assist with her recovery from abdominal surgery. The goal of this therapy is to help prevent - atelectasis In the ambulance on his way from the scene of a domestic violence incident, a young man is receiving supplemental O2 at a flow rate of 2 L/min via simple mask. His SpO2 on arrival at teh ED is 97%. While the trauma team is evaluating injuries sustained by the patient, the respiratory therapist might best recommend - switching the patient to 2 L/min via nasal cannula One of the patients in the skilled nursing facility where you work has been having trouble becoming accustomed to her newly ordered CPAP machine. The prescribed therapy is 10cm H2O of pressure with humidity. The main complaint, which is becoming an impediment to compliance, is that the full face mask is making the patient feel claustrophobic. What is the best thing a respiratory therapist can do to assist this patient? - offer to supply the patient with a smaller mask such as a nasal mask or nasal pillows Acute respiratory failure requiring mechanical ventilation can be the result of all the following EXCEPT: a. sepsis b. Opiate overdose c. Left sided heart failure d. Pneumonia - c. left sided heart failure Which of the following sets of decisions must be made before, or at the time of, initiating mechanical ventilation? - invasive vs. noninvasive, mode of ventilation, FiO2, rate, PEEP Why is pressure controlled ventilation preferred in some situations? - improved gas distribution allows for lower VT High frequency ventilation is sometimes used on pediatric and neonatal patients. A typical high frequency setting is - 900 breaths per minute We are caring for a critically ill patient who is on mechanical ventilation. The ABG results are as follows: pH 7.36 PaCO2 46 torr PaO2 70 torr HCO3 24 mEq/L BE -1 mEq/L Mode Volume Control rate 14 FiO2 0.35 VT 500 mL PEEP 5 cm H2O If the patient is on volume control ventilation, what setting(s) might we recommend changing and in what direction? - increase VT A man with idiopathic pulmonary fibrosis is proving difficult to ventilate due to low lung compliance. The physician has tried to use volume control ventilation to achieve a specific minute ventilation, but the high pressure alarm of 40 cm H2O is regularly going off. We might offer to discuss the following change: - Switch to pressure control ventilation A patient in the ICU is receiving mechanical ventilation. The patiens's SpO2 declines from 97% to 88% over a period of just 20 minutes. The patient's breath sounds are good on the right, but they greatly diminished on the left. The endotracheal tube is at 28 cm at the lip. A stat CXR is ordered. Which of the following is it most likely to show? - right main stem intubation A 55 year old woman with a 42 pack year smoking history is currently receiving mechanical ventilation for respiratory failure resulting from bibasilar pneumonia. When the patient shows signs of respiratory distress, an ABG is ordered and shows that the PaO2 has declined from 70 to 52 mmHg. The PaCO2 is steady at 42 mmHg. The ventilator is on A/C mode, FiO2 is 0.55, and PEEP is 5 cm H2O. The respiratory therapist is asked for a recommendation to improve the patient's condition. What is the best recommendation in this situation? - increase PEEP to 10 cm H2O Mr. Broadhurst, an 80 year old male, is receiving mechanical ventilation (A/C mode) during his recovery from septic shock. He appears to be making very good progress. His VT is 640 mL, his respiratory rate is 12, FiO2 is 0.40, and PEEP is 5 cm H2O. Mr. Broadhurst's ideal body weight is 80 kg. These settings provide him with ventilation at the rate of - 8 mL/kg ideal body weight (IBW) A patient is being transported from the ED to the diagnostic imaging department for a stat computed tomography (CT) scan. Monitoring shows a precipitous increase in the patient's heart rate from 81 to 125 bpm. There is a drop in the patient's SpO2 from 99% to 85%. The first response from the respiratory therapist should be to - use bag mask ventilation to manually ventilate the patient To increase the ratio of the duration of inspiration to the duration of expiration (I:E ratio) from 1:1.5 to 1:2 for a patient on V/C mechanical ventilation, the respiratory therapist can - increase inspiratory flow Patient ventilator dyssynchrony can result from a number of factors and will increase the work of breathing (WOB) for the patient. If we notice that our patient is demonstrating excessive effort during breaths, and the PAW as a result shows a dip, we might best - increase respiratory flow A diagnosis of pneumothorax is suggested by the respiratory therapist in the ED by results of auscultation, observation of tracheal deviation, and CXR analysis. The physician concurs with this diagnosis and decides to place a catheter into the pleural space. Five liters of air is aspirated with no resistance to further aspiration felt. What next step is indicated? - a placement of a chest tube We believe that our patient on mechanical ventilation is ready for their first spontaneous breathing trial. The patient does not tolerate this trial well, and in 15 minutes we must restore mechanical ventilation. Before we try again, we must - wait at least a few hours, allowing the patient to rest The rapid shallow breathing index (RSBI) of a patient on mechanical ventilation is held by many to be a good predictor of successful weaning. We calculate the index by - dividing the frequency by the tidal volume A patient is recovering from an exacerbation of chronic obstructive pulmonary disease (COPD), chronic bronchitis type, and is having difficulty clearing tenacious secretions. Which of the following therapies will NOT assist the patient? - heat and moisture exchangers (HMEs) Mr. Brownstein is an 84 year old male who has been on mechanical ventilation for three days recovering from bibasilar pneumonia. His comorbidities include early stage dementia and type 2 diabetes. He will have an increased likelihood of successful extubation and continuing recovery if - he is conscious and has a good gag reflex when extubated. A 32 week neonate is being treated for hypoxic respiratory failure. Nitric oxide (NO) is indicated if the patient also shows evidence of - pulmonary hypertension Premature infants are frequently born with apnea of prematurity. Sometimes this is a minor problem and resolves on it own over time. The respiratory therapist must look for the following signs to help determine if immediate treatment may be indicated: - episodes are associated with cyanosis A mild form of tetralogy of Fallot may be evident in an infant who demonstrates - a heart murmur and intermittent severe cyanotic spells We are working in the ICU, and one of the patients we are caring for is a 28 year old woman who was reportedly drinking a quart of vodka per day prior to her hospitalization. She is on mechanical ventilation for the second day and is very agitated and unsuccessfully attempting to self extubate. When we notice this behavior, we immediately consult with the intensivist and ask if he would agree with our recommendation to - increase sedation Endotracheal instillation of which of these preparations is NOT currently included in respiratory therapy practice? - saline prior to suctioning When caring for a patient on mechanical ventilation who has a diagnosis of acute respiratory distress syndrome (ARDS), it is important to be mindful of protecting the lungs from ventilator induced lung injury. Guidelines include all of the following EXCEPT: a. maintaining the plateau pressure 28 cm H2O b. maintaining tidal volumes between 4 and 8 mL/kg IBW c. maintaining end expiratory lung volumes with PEEP d. keeping the patient's head elevated 30 - 45 degrees - a. maintaining the plateau pressure 28 cm H2O Heliox therapy is used primarily in with patients who have which of the following? - obstructed airways The RN in the ICU has asked for the assistance of the respiratory therapist in the assessment of a patient's hemodynamic status. The patient is on pressure support mechanical ventilation. She has a reduced cardiac output and lower blood pressure than earlier in the day. We might suggest that the first therapy to try is - IV administration of fluid Per the physicians order, we are changing the tracheostomy tube for one of our patients. We need to assess the patient, review the chart, and assemble our supplies prior to performing the procedure. Which of these lists include ONLY items always needed for this? - tracheostomy tube tie, drain sponge/dressing, suction catheters, Ambu bag, surgical lubricant In the pediatric intensive care unit (PICU), one of our patients on mechanical ventilation is producing copious secretions. He has a 6.0 mm ET tube, and we have only size 10 French suction catheters on hand. What do we do? - proceed with suctioning We begin to suction the tracheal secretions of our intubated patient, but we must stop immediately if we see the patient demonstrate - bradycardia Mr. Kovacs has been on mechanical ventilation for slightly more than 48 hours and is doing well. He is now afebrile, and his white blood cell count continues for fall. His physician would like the respiratory therapist to administer a long acting bronchodilator. Before his hospitalization, Mr. Kovacs was taking Spiriva every day. Which of the following can now be administered as a long acting bronchodilator? - Spiriva via Respimat Percussion and auscultation indicate that there is consolidation in the right lung of a 27 week gestational age neonate who is receiving mechanical ventilation. In what position do we recommend the patient to be placed? - Left side down A premature neonate is being ventilated with high frequency oscillatory ventilation (HFOV). We should recommend increasing the oscillatory amplitude if the blood gas analysis shows. - PaCO2 of 62 mmHg or greater Mrs. Murphy has asked her physician why he is prescribing an additional metered dose inhaler (MDI) for her. She is an asthmatic patient, and in addition to her albuterol rescue inhaler, he is prescribing an inhaler with budesonide to be used daily. What is the physician likely to tell her? - budesonide is an inhaled corticosteroid (an anti-inflammatory), which may prevent some asthma attacks A patient with late stage COPD has fallen and suffered a broken hip. His physician is reluctant to prescribe certain pain medications such as OxyContin or Percocet without close monitoring mainly because - these are opiods and in many cases will suppress the respiratory drive Annual vaccinations for influenza confer which benefit(s) to those vaccinated? - reduce the likelihood of getting the flu A patient stumbles into the waiting area of your ED complaining of chest pain. Suddenly, and without further warning, the patient collapses to the floor, unresponsive. All other medical personnel are at that moment tending to a motor vehicle accident victim in the trauma bay. The most important thing for you to do immediately upon determining that there is no heartbeat and no spontaneous respiration is - call for help and begin chest compressions Miss Edwards brings her three year old child to the emergency room reporting that the child is experiencing sudden onset wheezing and difficulty breathing. Auscultation reveals that the breath sounds are greatly decreased on the right side. There is no fever or cough. What do we first suspect as the cause? - aspiration of a foreign object The respiratory therapist is assisting the intensivist with the care of a patient who has a rapidly falling cardiac status. The ECG shows supraventricular tachycardia (SVT) and atrial fibrillation while the patient is becoming hypotensive and complaining of chest pain. The physician is likely to ask you to assist with - cardioversion When the ventilator patient's status, despite everyone's best efforts, has reached the state where any further medical care is deemed futile, the respiratory therapist may be asked to - perform terminal extubation When assisting the pulmonologist with a thoracentesis, the respiratory therapist is responsible for which of the following? - assist with the sterile collection of pleural fluid samples Mr. Boris brings his son to the community health clinic for a follow up on his appointment with the physician regarding the child's asthma. The respiratory therapist meets with the father and son in an educational capacity to discuss disease management. There have been no asthma attacks since the last visit. Which of the following would NOT be a component of the family's asthma action plan? - when it is okay depart from the medication regimen We meet with Mrs. Tomashevsky at the physicians request. The purpose of our discussion is to determine if the patient has symptoms that indicate a sleep study would be helpful and to give the physician our recommendations. We will ask our patient about which possible complaints? - excessive daytime sleepiness The physician has met with Mr. Stubs to discuss various issues related to helping him maintain his health and hopefully improve his wellness and quality of life. The physician had asked you to work with Mr. Stubs to assist the patient with smoking cessation. One of the best indicators we can use to immediately determine the strength of the nicotine addiction in Mr. Stubs is to ask him - What is the length of time from waking in the morning to your first cigarette? If we are the respiratory therapist assigned to the hospital's rapid response team for the shift, what responsibility is ours for the entire shift, what responsibility is ours for the entire shift? - Do not leave the premises during lunch break without arranging coverage form another therapist. Generally speaking, when we administer supplemental oxygen to one of our patients via nasal cannula best practices would indicate adding humidity to the O2 if the flow rate is at least - 4 L/min or greater Our patient recovering from an exacerbation of COPD is prescribed 1.25 mg albuterol in 3 ml unit dose via nebulizer q4h around the clock. When we check the medication the pharmacy has provided, the label shows that the unit dose they have sent is 0.625 mg per 3 ml. What should the respiratory therapist do in this situation? - Check the original physician order, and immediately call the pharmacy if there is no discrepancy between the order and the medication provided. When we are assessing a patient for use of accessory muscles of respiration, it is best done by - looking closely for shoulder movement (heaving) and neck muscle movement.