ACTUAL EXAM 2 LATEST VERSIONS
(VERSION A AND B) COMPLETE 240
QUESTIONS AND CORRECT DETAILED
ANSWERS
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia ...ANSWER...Endotracheal tube positioned in right mainstem bronchus
is a problem but the co2 reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation ...ANSWER...6-8 ml/kg (of
ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle
activity is absent. _______ conditions can be imposed with an inspiratory pause when a
patient is sedated and mechanically ventilated. ...ANSWER...Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions,
when non-intubated patient breathes spontaneously. ...ANSWER...Dynamic
Compliance
A balloon tipped flow directed catheter is positioned in the pulmonary artery with the
balloon deflated. Which of the following pressures will be measured by the proximal
lumen:
a. Cvp
b. Pap
c. Pwp
d. Map ...ANSWER...ANSWER is A. Cvp = deflated/proximal lumen
,Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant ...ANSWER...Gas will pass through and out of a long sampling line
before reaching analyzer so, low sampling flow will not give you enough information for
a good reading, and condensation as a rule is always a problem especially in analyzers.
Dessicant removes moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following
should the respiratory therapist use to monitor the neonates overall cardiopulmonary
status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8 ...ANSWER...Since the baby is stable, go less invasive,
also go continuous monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous
monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis ...ANSWER...You wouldn't have asthma on just one side (unilateral),
atelectasis would cause diminished breath sounds, with epiglottitis you would get
stridor, since you are only hearing wheezing on one side, you are hearing it on the side
where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress ...ANSWER...With pneumothorax you would hear a high pitch
hyperresonnance, breath sounds would be absent, and respiratory distress could be
present. Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
,b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine ...ANSWER...Multiple pvc's coming from multiple
locations (multifocal) is a real problem and you should administer oxygen FIRST, so
ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but
would not be first option, atropine is used for bradycardia and cardiac irregularities but
not pvc's, epinephrine is emergency drug not for pvc's but more for pulseless ventricular
tachycardia or ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg ...ANSWER...Mean pulmonary artery pressure in an adult should be in
the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea.
The patient has marked dyspnea and a history of heart disease. Which of the following
should the respiratory therapist recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide ...ANSWER...This is an emergency, they are having heart
problems, dyspnea, frothy secretions indicating severe pulmonary edema, etc. so 100%
oxygen immediately, having the patient in the Fowlers position (an upright position) will
help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic) which gets
rid of excess fluid. You do NOT suction someone with frothy secretions and heart
problems, this just delays appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following
conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup ...ANSWER...Crackles are associated with fluid so a, b, and c would be good
answers, but "fine crepitant" crackles indicates fluid entering alveoli (pulmonary edema)
which is most often caused by heart failure so the best ANSWER is B. (with croup you
would hear more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally
intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would
the respiratory therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
, c. Initially high, stays high
d. Initially low, stays low ...ANSWER...Full cardiac arrest will cause the CO2 in the lungs
to slowly dissipate out because no blood is flowing, then during CPR when you get
blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure
obtained from a sphygmomanometer (cuff pressure). Based upon this information, the
respiratory therapist should conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles ...ANSWER...Arterial line BP and cuff
pressure should be the same, so there is a problem. Non-compliant tubing is a good
thing because it's a stiff tubing, if transducer is placed too high (above the heart), the
flood will have to go uphill and you will get a lower pressure; transducer dome contained
air bubbles would give you erratic readings but not a higher reading, but if the
transducer is placed too low (below heart), the blood is flowing downhill & will give a
higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was
playing with friends and developed violent coughing and unilateral wheezing. Physical
examination reveals a hyperresonant percussion note on the left and resonant
percussion on the right. Inspiratory and expiratory chest films indicate air trapping with
no foreign bodies "noted." The respiratory therapist should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis ...ANSWER...Unilateral wheezing indicates aspirated object and fact
that the child was playing with friends causes you to believe the child inhaled a small toy
or something, hyperresonant percussion indicates air trapping, so you are thinking
foreign object but x-ray says no foreign bodies "noted." Just because it says "noted"
does not mean something is not there, it just means it could not be seen on the xray,
also if the child had swallowed a small plastic toy, "plastic" does not show up on xrays
(radiolucent). The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels ...ANSWER...Since the patient received Lasix and nasogastric tube,
they are losing fluids, and a side effect of fluid loss is a decrease in electrolytes, so
(VERSION A AND B) COMPLETE 240
QUESTIONS AND CORRECT DETAILED
ANSWERS
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia ...ANSWER...Endotracheal tube positioned in right mainstem bronchus
is a problem but the co2 reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation ...ANSWER...6-8 ml/kg (of
ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle
activity is absent. _______ conditions can be imposed with an inspiratory pause when a
patient is sedated and mechanically ventilated. ...ANSWER...Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions,
when non-intubated patient breathes spontaneously. ...ANSWER...Dynamic
Compliance
A balloon tipped flow directed catheter is positioned in the pulmonary artery with the
balloon deflated. Which of the following pressures will be measured by the proximal
lumen:
a. Cvp
b. Pap
c. Pwp
d. Map ...ANSWER...ANSWER is A. Cvp = deflated/proximal lumen
,Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant ...ANSWER...Gas will pass through and out of a long sampling line
before reaching analyzer so, low sampling flow will not give you enough information for
a good reading, and condensation as a rule is always a problem especially in analyzers.
Dessicant removes moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following
should the respiratory therapist use to monitor the neonates overall cardiopulmonary
status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8 ...ANSWER...Since the baby is stable, go less invasive,
also go continuous monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous
monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis ...ANSWER...You wouldn't have asthma on just one side (unilateral),
atelectasis would cause diminished breath sounds, with epiglottitis you would get
stridor, since you are only hearing wheezing on one side, you are hearing it on the side
where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress ...ANSWER...With pneumothorax you would hear a high pitch
hyperresonnance, breath sounds would be absent, and respiratory distress could be
present. Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
,b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine ...ANSWER...Multiple pvc's coming from multiple
locations (multifocal) is a real problem and you should administer oxygen FIRST, so
ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but
would not be first option, atropine is used for bradycardia and cardiac irregularities but
not pvc's, epinephrine is emergency drug not for pvc's but more for pulseless ventricular
tachycardia or ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg ...ANSWER...Mean pulmonary artery pressure in an adult should be in
the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea.
The patient has marked dyspnea and a history of heart disease. Which of the following
should the respiratory therapist recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide ...ANSWER...This is an emergency, they are having heart
problems, dyspnea, frothy secretions indicating severe pulmonary edema, etc. so 100%
oxygen immediately, having the patient in the Fowlers position (an upright position) will
help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic) which gets
rid of excess fluid. You do NOT suction someone with frothy secretions and heart
problems, this just delays appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following
conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup ...ANSWER...Crackles are associated with fluid so a, b, and c would be good
answers, but "fine crepitant" crackles indicates fluid entering alveoli (pulmonary edema)
which is most often caused by heart failure so the best ANSWER is B. (with croup you
would hear more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally
intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would
the respiratory therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
, c. Initially high, stays high
d. Initially low, stays low ...ANSWER...Full cardiac arrest will cause the CO2 in the lungs
to slowly dissipate out because no blood is flowing, then during CPR when you get
blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure
obtained from a sphygmomanometer (cuff pressure). Based upon this information, the
respiratory therapist should conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles ...ANSWER...Arterial line BP and cuff
pressure should be the same, so there is a problem. Non-compliant tubing is a good
thing because it's a stiff tubing, if transducer is placed too high (above the heart), the
flood will have to go uphill and you will get a lower pressure; transducer dome contained
air bubbles would give you erratic readings but not a higher reading, but if the
transducer is placed too low (below heart), the blood is flowing downhill & will give a
higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was
playing with friends and developed violent coughing and unilateral wheezing. Physical
examination reveals a hyperresonant percussion note on the left and resonant
percussion on the right. Inspiratory and expiratory chest films indicate air trapping with
no foreign bodies "noted." The respiratory therapist should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis ...ANSWER...Unilateral wheezing indicates aspirated object and fact
that the child was playing with friends causes you to believe the child inhaled a small toy
or something, hyperresonant percussion indicates air trapping, so you are thinking
foreign object but x-ray says no foreign bodies "noted." Just because it says "noted"
does not mean something is not there, it just means it could not be seen on the xray,
also if the child had swallowed a small plastic toy, "plastic" does not show up on xrays
(radiolucent). The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels ...ANSWER...Since the patient received Lasix and nasogastric tube,
they are losing fluids, and a side effect of fluid loss is a decrease in electrolytes, so
