A 76-year old male presents to the ED following an unwitnessed fall. A CT scan
reveals a large intracranial hemorrhage with a midline shift. The pt is intubated and
transferred to a neurological ICU. After 2 weeks, the pt continues to be unresponsive.
He is not receiving sedating medications. The pt's family wishes to discontinue
mechanical ventilation. An RT should anticipate which of the following orders?
A. perform percutaneous tracheostomy
B. initiate comfort measures following an extubation
C. conduct an apnea test
D. schedule a cerebral perfusion study
Give this one a try later!
Correct answer:
B. initiate comfort measures following an extubation
Explanation:
A. This would be unethical given the pt's poor neurologic status and family's
wish to remove him from the ventilator
B. Providing sedation and analgesia is standard in any protocol for
discontinuing mechanical ventilation during end-of-life care
, C. an apnea test is unnecessary given the neurologic examination and the
family's wish to withdrawal ventilator support
D. a cerebral perfusion study is unnecessary given the neurologic
examination and the family's wish to withdrawal ventilator support
An adult pt is receiving mechanical ventilation. Which of the following should be
recommended to improve oxygenation and recruit collapsed alveoli?
A. PEEP
B. SIMV mode
C. mechanical dead space
D. in-line suctioning
Give this one a try later!
Correct answer:
A. PEEP
Explanation:
A. application of PEEP minimizes the potential for end-expiratory alveolar
collapse and then maintains the alveoli in an open position because it
exceeds the force of surface tension
B. using SIMV mode alone will not prevent alveoli from collapsing
C. the use of mechanical dead space may impact the pt's pCO2; however it
has no impact on oxygenation and the recruitment of collapsed alveoli
D. an in-line suction system can prevent worsening collapse; however, it's
primary purpose is to remove accumulated secretions
What is the approximate total flow that will be delivered from a 40% air-entrainment
mask receiving 12 L/min of O2?
A. 72 L/min
B. 48 L/min
C. 52 L/min
D. 12 L/min
,Give this one a try later!
Correct answer:
B. 48 L/min
Explanation:
A 40% air-entrainment mask entrains air at a ratio of 3 parts air to 1 part O2.
To determine the total flow provided with a 40% mask and 12 L/min, use the
following formula to solve for x:
3x + x = total flow
Note: x = oxygen flow in L/min and 3x = air entrained
So, 3(12) + 12 = total flow
Thus, total flow = 48
Which of the following values for arterial carbon dioxide tension is consistent with
alveolar hyperventilation?
A. 30 mm Hg
B. 40 mm Hg
C. 50 mm Hg
D. 60 mm Hg
Give this one a try later!
Correct answer:
A. 30 mm Hg
Explanations:
A. an arterial CO2 tension of less than 35 mm Hg reflects alveolar
hyperventilation as it results in a decreased arterial CO2 tension in the
blood. The pt is releasing excess CO2.
B. an arterial CO2 tension between 35-45 mm Hg reflects normal alveolar
ventilation
C. an arterial CO2 tension of 50 mm Hg is elevated from the normal range
, (35-45 mm Hg) and reflects CO2 retention
D. an arterial CO2 tension of 60 mm Hg is elevated from the normal range
(35-45 mm Hg) and reflects CO2 retention
A pt is dx with pneumonia and a moderate pleural effusion. Which of the following
procedures should an RT recommend FIRST?
A. chest tube insertion
B. bronchoscopy
C. airway stent
D. thoracentesis
Give this one a try later!
Correct answer:
D. thoracentesis
Explanation:
A. There is no indication that an indwelling tube is needed
B. Bronchoscopy will not treat the pleural effusion or pneumonia
C. An airway stent will not treat the pleural effusion or pneumonia
D. Needle thoracentesis should be performed first to help dx the cause of
the pleural effusion
A pt who is receiving mechanical ventilation requires an FiO2 of 0.7 and 10 cm H2O of
PEEP to maintain an acceptable PaO2. The pt is restless and has become
disconnected from the ventilator circuit several times, during which she experiences
cardiac rhythm disturbances. An RT should conclude that the pt will benefit from a ___.
A. sedative
B. mucolytic
C. neuromuscular blocker
D. pulmonary vasodilator
reveals a large intracranial hemorrhage with a midline shift. The pt is intubated and
transferred to a neurological ICU. After 2 weeks, the pt continues to be unresponsive.
He is not receiving sedating medications. The pt's family wishes to discontinue
mechanical ventilation. An RT should anticipate which of the following orders?
A. perform percutaneous tracheostomy
B. initiate comfort measures following an extubation
C. conduct an apnea test
D. schedule a cerebral perfusion study
Give this one a try later!
Correct answer:
B. initiate comfort measures following an extubation
Explanation:
A. This would be unethical given the pt's poor neurologic status and family's
wish to remove him from the ventilator
B. Providing sedation and analgesia is standard in any protocol for
discontinuing mechanical ventilation during end-of-life care
, C. an apnea test is unnecessary given the neurologic examination and the
family's wish to withdrawal ventilator support
D. a cerebral perfusion study is unnecessary given the neurologic
examination and the family's wish to withdrawal ventilator support
An adult pt is receiving mechanical ventilation. Which of the following should be
recommended to improve oxygenation and recruit collapsed alveoli?
A. PEEP
B. SIMV mode
C. mechanical dead space
D. in-line suctioning
Give this one a try later!
Correct answer:
A. PEEP
Explanation:
A. application of PEEP minimizes the potential for end-expiratory alveolar
collapse and then maintains the alveoli in an open position because it
exceeds the force of surface tension
B. using SIMV mode alone will not prevent alveoli from collapsing
C. the use of mechanical dead space may impact the pt's pCO2; however it
has no impact on oxygenation and the recruitment of collapsed alveoli
D. an in-line suction system can prevent worsening collapse; however, it's
primary purpose is to remove accumulated secretions
What is the approximate total flow that will be delivered from a 40% air-entrainment
mask receiving 12 L/min of O2?
A. 72 L/min
B. 48 L/min
C. 52 L/min
D. 12 L/min
,Give this one a try later!
Correct answer:
B. 48 L/min
Explanation:
A 40% air-entrainment mask entrains air at a ratio of 3 parts air to 1 part O2.
To determine the total flow provided with a 40% mask and 12 L/min, use the
following formula to solve for x:
3x + x = total flow
Note: x = oxygen flow in L/min and 3x = air entrained
So, 3(12) + 12 = total flow
Thus, total flow = 48
Which of the following values for arterial carbon dioxide tension is consistent with
alveolar hyperventilation?
A. 30 mm Hg
B. 40 mm Hg
C. 50 mm Hg
D. 60 mm Hg
Give this one a try later!
Correct answer:
A. 30 mm Hg
Explanations:
A. an arterial CO2 tension of less than 35 mm Hg reflects alveolar
hyperventilation as it results in a decreased arterial CO2 tension in the
blood. The pt is releasing excess CO2.
B. an arterial CO2 tension between 35-45 mm Hg reflects normal alveolar
ventilation
C. an arterial CO2 tension of 50 mm Hg is elevated from the normal range
, (35-45 mm Hg) and reflects CO2 retention
D. an arterial CO2 tension of 60 mm Hg is elevated from the normal range
(35-45 mm Hg) and reflects CO2 retention
A pt is dx with pneumonia and a moderate pleural effusion. Which of the following
procedures should an RT recommend FIRST?
A. chest tube insertion
B. bronchoscopy
C. airway stent
D. thoracentesis
Give this one a try later!
Correct answer:
D. thoracentesis
Explanation:
A. There is no indication that an indwelling tube is needed
B. Bronchoscopy will not treat the pleural effusion or pneumonia
C. An airway stent will not treat the pleural effusion or pneumonia
D. Needle thoracentesis should be performed first to help dx the cause of
the pleural effusion
A pt who is receiving mechanical ventilation requires an FiO2 of 0.7 and 10 cm H2O of
PEEP to maintain an acceptable PaO2. The pt is restless and has become
disconnected from the ventilator circuit several times, during which she experiences
cardiac rhythm disturbances. An RT should conclude that the pt will benefit from a ___.
A. sedative
B. mucolytic
C. neuromuscular blocker
D. pulmonary vasodilator
