TMC test bank NBRC - 450 Questions
and Answers () (Verified by Expert)
Disadvantages of noninvasive ventilation include which one of the following?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP - Answer--Disadvantages of noninvasive ventilation (NPPV) include the
following: it can only be
used in cooperative patients; it does not provide direct airway access (thus increasing
the risk of secretion retention), and more therapist time is needed during the initial
period of use. On the other hand NPPV may help decrease the incidence of VAP and
typically costs less than invasive ventilation.
The correct answer is: limits direct access to lower airway
On a patient receiving volume control AC ventilation, you observe a flow-volume
with a sawtooth pattern on exhalation. Which of the following actions would you
consider most appropriate?
A. recommend administering a bronchodilator
,B. assess the patient's need for suctioning
C. measure the endotracheal tube cuff pressure
D. switch to pressure control ventilation - Answer--The flow-volume loop reveals irregular sawtooth- like
oscillations, primarily in the
expiratory portion of the loop. This indicates either 1) accumulation of airway
secretions in the trachea/large airways (requiring suctioning), or 2) condensate partially
blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow
sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm
excess secretions as the problem.
The correct answer is: assess the patient's need for suctioning
A 30 year-old male was found supine and unresponsive. In the ER it was
confirmed he had aspirated while on his back. After the patient is transferred to
ICU his physician orders postural drainage and percussion every 4 hours. What is
the best position to place him in to drain the affected area?
A. prone with a pillow under his hips
B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees - Answer--This patient aspirated while lying flat on his back.
Most commonly, this affects the
superior segments of both lower lobes. The position which facilitates drainage from
this lung region is a prone position with a pillow under the patient's hips.
The correct answer is: prone with a pillow under his hips
You need to perform nasotracheal suctioning on a patient with retained
secretions. As compared to suctioning via a tracheal airway, which of the
,following complications are unique to this procedure?
A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP - Answer--Complication/hazards common to both tracheobronchial and nasotracheal
suctioning
include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension,
bronchospasm, atelectasis, increased intracranial pressure and the potential for
contamination/infection. Unique complications of nasotracheal suctioning include
nasal trauma/epistaxis, pharyngeal trauma, gagging (with potential
241
vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is more
common with nasotracheal suctioning.
Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD - Answer--Poor skin turgor
ARDS patient, what should RT use to evaluate oxygen delivery for optimal PEEP
A. ABG
B. mixed venous
C. serum lactate
D. CO - Answer--mixed venous
, RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80 - Answer--45
To help prevent infection after an aerosol drug treatment provided via small
volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it - Answer--To minimize the likelihood of infection
in patients receiving aerosol drug therapy via a
small volume nebulizer (SVN), you should 1) use a different SVN for each patient, 2)
change the SVN and tubing every 24 hours, and 3) perform thorough hand hygiene
prior to each therapy session. It is also recommended that the nebulizer NOT be rinsed
with tap water, but rather rinsed with sterile water and blown dry between uses. If
rinsing with sterile water not feasible, rinse the device with filtered or tap water, then
rinse with isopropyl alcohol and dry.
The correct answer is: rinse the SVN with sterile water then dry and bag it
You are called to the ED to provide a bronchodilator treatment for a patient
having a severe asthma attack. When quickly confirming the written order you
find it contains some prohibited notations and thus could be read as either '.5 U
albuterol by SVN' or 5 c.c albuterol by SVN" The prescribing physician is busy
overseeing a code. You should:
and Answers () (Verified by Expert)
Disadvantages of noninvasive ventilation include which one of the following?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP - Answer--Disadvantages of noninvasive ventilation (NPPV) include the
following: it can only be
used in cooperative patients; it does not provide direct airway access (thus increasing
the risk of secretion retention), and more therapist time is needed during the initial
period of use. On the other hand NPPV may help decrease the incidence of VAP and
typically costs less than invasive ventilation.
The correct answer is: limits direct access to lower airway
On a patient receiving volume control AC ventilation, you observe a flow-volume
with a sawtooth pattern on exhalation. Which of the following actions would you
consider most appropriate?
A. recommend administering a bronchodilator
,B. assess the patient's need for suctioning
C. measure the endotracheal tube cuff pressure
D. switch to pressure control ventilation - Answer--The flow-volume loop reveals irregular sawtooth- like
oscillations, primarily in the
expiratory portion of the loop. This indicates either 1) accumulation of airway
secretions in the trachea/large airways (requiring suctioning), or 2) condensate partially
blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow
sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm
excess secretions as the problem.
The correct answer is: assess the patient's need for suctioning
A 30 year-old male was found supine and unresponsive. In the ER it was
confirmed he had aspirated while on his back. After the patient is transferred to
ICU his physician orders postural drainage and percussion every 4 hours. What is
the best position to place him in to drain the affected area?
A. prone with a pillow under his hips
B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees - Answer--This patient aspirated while lying flat on his back.
Most commonly, this affects the
superior segments of both lower lobes. The position which facilitates drainage from
this lung region is a prone position with a pillow under the patient's hips.
The correct answer is: prone with a pillow under his hips
You need to perform nasotracheal suctioning on a patient with retained
secretions. As compared to suctioning via a tracheal airway, which of the
,following complications are unique to this procedure?
A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP - Answer--Complication/hazards common to both tracheobronchial and nasotracheal
suctioning
include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension,
bronchospasm, atelectasis, increased intracranial pressure and the potential for
contamination/infection. Unique complications of nasotracheal suctioning include
nasal trauma/epistaxis, pharyngeal trauma, gagging (with potential
241
vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is more
common with nasotracheal suctioning.
Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD - Answer--Poor skin turgor
ARDS patient, what should RT use to evaluate oxygen delivery for optimal PEEP
A. ABG
B. mixed venous
C. serum lactate
D. CO - Answer--mixed venous
, RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80 - Answer--45
To help prevent infection after an aerosol drug treatment provided via small
volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it - Answer--To minimize the likelihood of infection
in patients receiving aerosol drug therapy via a
small volume nebulizer (SVN), you should 1) use a different SVN for each patient, 2)
change the SVN and tubing every 24 hours, and 3) perform thorough hand hygiene
prior to each therapy session. It is also recommended that the nebulizer NOT be rinsed
with tap water, but rather rinsed with sterile water and blown dry between uses. If
rinsing with sterile water not feasible, rinse the device with filtered or tap water, then
rinse with isopropyl alcohol and dry.
The correct answer is: rinse the SVN with sterile water then dry and bag it
You are called to the ED to provide a bronchodilator treatment for a patient
having a severe asthma attack. When quickly confirming the written order you
find it contains some prohibited notations and thus could be read as either '.5 U
albuterol by SVN' or 5 c.c albuterol by SVN" The prescribing physician is busy
overseeing a code. You should:
