RRT- CLIN SIMS- LINDSEY JONES
PRACTICE EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
General Assessment : Visual Assessment (Stage I) - ANSWER-Any assessment that
you can do quickly by just glancing at the patient, a monitor, or the
patient's record should be done first. Visual assessment items include:
General appearance
Color
Medical history
Heart rate (exception to the rule)
General Assessment : Bedside (Patient contact) assessment (Stage II) - ANSWER-This
includes all things that relate to the respiratory status of the patient and can be
done quickly and usually without cost or too much effort from the patient. Bedside
assessment items include:
Breath sounds
Palpation of the chest or trachea
Examination of the upper airway
Blood pressure
Vital capacity measurement
General Assessment : Laboratory assessments (Stage III) - ANSWER-This involves any
test requiring laboratory analysis and/or interpretation. Or, it may
require special equipment or technicians to perform. Laboratory assessments usually
have a cost associated with them. These assessment items must relate to the
respiratory
status of the patient. Examples of laboratory assessments include:
Arterial blood gas analysis
Chest X-ray
CBC
Urinalysis
Pulmonary function screening (FEV1, pre and post bronchodilator studies)
Serum electrolytes
ECG
Bilirubin level
General Assessment : Special tests and assessments (Stage IV) - ANSWER-Special
tests are done when you suspect specific problems or diseases. They are often costly
and/or require significant time for interpretation. Or, it may be a special test because it
relates only to one thing. Very often, this test is used for diagnosis. Picking incorrect
special assessments will usually result in significant negative points. Special tests and
assessment should only be done if it relates! Examples of special tests and
, assessments include: CAT scan of the head, Complete pulmonary function testing
(DLCO, Nitrogen washout), Tensilon test, Bronchogram, Sweat chloride test, Mantoux
test, Pulmonary angiogram, Lung perfusion scan, Tracheal Palpation
Amniocentesis, Acid-fast sputum stain
Ventilator: Initial Adult Settings :
There are five areas that must be addressed when initially placing a patient on a
ventilator. In
order of importance and priority, they are: - ANSWER-Rate, Tidal Volume, Oxygen,
PEEP, & Mode
Ventilator: Initial Adult Settings : Rate - ANSWER-Always between 8 and 12
Immediately weed out all options that do not have rates between 8 and 12.
Consider a rate of 14 only if nothing else is offered.
Ventilator: Initial Adult Settings : Tidal Volume - ANSWER-8 - 12 mL/kg
Calculate the range of appropriate tidal volume
Immediately discount every option that shows a tidal volume not in that range.
Ventilator: Initial Adult Settings : Oxygen - ANSWER-If it is an emergency, then FIO2 is
1.0
Otherwise, the patient should be put on EXACTLY what they were on previously.
If there is no record of previous FIO2 then use the adult therapeutic range of 40 to
60%. Remember that oxygen is drug. So, if 40% and 55% is offered, then choose the
lower.
Ventilator: Initial Adult Settings : PEEP - ANSWER-Therapeutic PEEP for an adult is 10
cm H20. That means that if PEEP is offered
at 0 to 9 cm H20, then it is OK to pick. Do not worry too much about whether it is
indicated or not. Remember, however, that on initial set up, less PEEP is better than
more. While PEEP of zero is acceptable, some PEEP is preferable.
***ARDS Exception—if asked to put someone with ARDS on a ventilator, since PEEP
therapy is considered a key care strategy, a PEEP of 10 is indicated.
Ventilator: Initial Adult Settings : MODE - ANSWER-Notice that mode is last priority
because ALL MODES ARE GOOD. However, on the
NBRC exam, first choose SIMV if available. Next, choose ASSIST/CONTROL.
Lastly, CONTROL MODE should be used.
***ARDS Exception—if asked to put someone with ARDS on a ventilator, Pressure
Control Mode may selected as an initial setting
Adult Ventilator Weaning :
Acceptable methods are what, and how are they done - ANSWER-Acceptable methods:
~Cold cessation—remove from the ventilator and monitor
PRACTICE EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
General Assessment : Visual Assessment (Stage I) - ANSWER-Any assessment that
you can do quickly by just glancing at the patient, a monitor, or the
patient's record should be done first. Visual assessment items include:
General appearance
Color
Medical history
Heart rate (exception to the rule)
General Assessment : Bedside (Patient contact) assessment (Stage II) - ANSWER-This
includes all things that relate to the respiratory status of the patient and can be
done quickly and usually without cost or too much effort from the patient. Bedside
assessment items include:
Breath sounds
Palpation of the chest or trachea
Examination of the upper airway
Blood pressure
Vital capacity measurement
General Assessment : Laboratory assessments (Stage III) - ANSWER-This involves any
test requiring laboratory analysis and/or interpretation. Or, it may
require special equipment or technicians to perform. Laboratory assessments usually
have a cost associated with them. These assessment items must relate to the
respiratory
status of the patient. Examples of laboratory assessments include:
Arterial blood gas analysis
Chest X-ray
CBC
Urinalysis
Pulmonary function screening (FEV1, pre and post bronchodilator studies)
Serum electrolytes
ECG
Bilirubin level
General Assessment : Special tests and assessments (Stage IV) - ANSWER-Special
tests are done when you suspect specific problems or diseases. They are often costly
and/or require significant time for interpretation. Or, it may be a special test because it
relates only to one thing. Very often, this test is used for diagnosis. Picking incorrect
special assessments will usually result in significant negative points. Special tests and
assessment should only be done if it relates! Examples of special tests and
, assessments include: CAT scan of the head, Complete pulmonary function testing
(DLCO, Nitrogen washout), Tensilon test, Bronchogram, Sweat chloride test, Mantoux
test, Pulmonary angiogram, Lung perfusion scan, Tracheal Palpation
Amniocentesis, Acid-fast sputum stain
Ventilator: Initial Adult Settings :
There are five areas that must be addressed when initially placing a patient on a
ventilator. In
order of importance and priority, they are: - ANSWER-Rate, Tidal Volume, Oxygen,
PEEP, & Mode
Ventilator: Initial Adult Settings : Rate - ANSWER-Always between 8 and 12
Immediately weed out all options that do not have rates between 8 and 12.
Consider a rate of 14 only if nothing else is offered.
Ventilator: Initial Adult Settings : Tidal Volume - ANSWER-8 - 12 mL/kg
Calculate the range of appropriate tidal volume
Immediately discount every option that shows a tidal volume not in that range.
Ventilator: Initial Adult Settings : Oxygen - ANSWER-If it is an emergency, then FIO2 is
1.0
Otherwise, the patient should be put on EXACTLY what they were on previously.
If there is no record of previous FIO2 then use the adult therapeutic range of 40 to
60%. Remember that oxygen is drug. So, if 40% and 55% is offered, then choose the
lower.
Ventilator: Initial Adult Settings : PEEP - ANSWER-Therapeutic PEEP for an adult is 10
cm H20. That means that if PEEP is offered
at 0 to 9 cm H20, then it is OK to pick. Do not worry too much about whether it is
indicated or not. Remember, however, that on initial set up, less PEEP is better than
more. While PEEP of zero is acceptable, some PEEP is preferable.
***ARDS Exception—if asked to put someone with ARDS on a ventilator, since PEEP
therapy is considered a key care strategy, a PEEP of 10 is indicated.
Ventilator: Initial Adult Settings : MODE - ANSWER-Notice that mode is last priority
because ALL MODES ARE GOOD. However, on the
NBRC exam, first choose SIMV if available. Next, choose ASSIST/CONTROL.
Lastly, CONTROL MODE should be used.
***ARDS Exception—if asked to put someone with ARDS on a ventilator, Pressure
Control Mode may selected as an initial setting
Adult Ventilator Weaning :
Acceptable methods are what, and how are they done - ANSWER-Acceptable methods:
~Cold cessation—remove from the ventilator and monitor
