LINDSEY JONES FORM N WITH
COMPLETE SOLUTIONS
A 65-kg (143-lb) patient with cor pulmonale is in the cardiac intensive care unit (CICU)
receiving VC A/C ventilation on the following settings:
FIO2 0.55
Rate 16/min
VT 450 mL
PEEP 8 cm H2O
Flow 42 L/min
ABGs
pH 7.35
PaCO2 46 torr
PaO2 119 torr
HCO3- 24 mEq/L
HR 94/min
SpO2 0.99
The respiratory therapist should recommend
A. decreasing rate to 14/min.
B. decreasing FIO2 to 0.45.
C. increasing VT to 500 mL.
D. decreasing PEEP to 5 cm H2O. - ANSWER-D. decreasing PEEP to 5 cm H2O.
Although CO2 is climbing slightly, pH remains within range. The patient, however, is
over-oxygenating. This should be corrected first. Because current FIO2 is already below
0.60, PEEP should be the target for PaO2 reduction.
While assisting a physician with a bronchoscopy, the respiratory therapist notices the
bronchoscope is not applying suction even though the physician is depressing the
suction button on the bronchoscope. The therapist should
A. increase suction pressure at the wall.
B. flush the suction channel on the bronchoscope.
C. change the suction tubing between the vacuum source and the suction canister.
D. recommend a change to a new bronchoscope. - ANSWER-B. flush the suction
channel on the bronchoscope.
The suction channel on a bronchoscope can easily become clogged. Flushing the
channel would be an appropriate first step in resolving the problem.
,A 55-year-old, 95-kg (209-lb), 178 cm (5 ft 10 in) male is in a current state of ventilatory
failure and requires mechanical ventilatory support. Which of the following settings are
most appropriate?
A. VC, SIMV, mandatory rate 12/min, VT 800 mL, PEEP 5 cm H2O
B. PSV 15 cm H2O, PEEP 5 cm H2O
C. VC, A/C, mandatory rate 18/min, VT 600 mL, PEEP 4 cm H2O
D. PC, SIMV, PIP 45 cm H2O, mandatory rate 16/min, PEEP 6 cm H2O - ANSWER-C.
VC, A/C, mandatory rate 18/min, VT 600 mL, PEEP 4 cm H2O
The patient is obese. Thus, predicted body weight should be determined. Based on
height, PBW is about 73 kg. Tidal volume range at PBW would be 438 - 730 mL. Rate
should be 10 - 20/min and PEEP 4 - 6 cm H2O.
A patient with COPD is receiving ventilatory support by non-invasive ventilation with an
of IPAP of 15 cm H2O and EPAP of 4 cm H2O. The following blood gases are available:
pH 7.21
PaCO2 69 torr
PaO2 51 torr
HCO3- 35 mEq/L
The respiratory therapist should recommend
A. raising both IPAP and EPAP by 5 cm H2O.
B. increasing IPAP to 20 cm H2O.
C. discontinuing PEEP (EPAP of 0 cm H20).
D. invasive ventilation. - ANSWER-D. invasive ventilation.
Even though the patient is COPD and is likely normalized to elevated levels of PaCO2,
the pH clearly indicates ventilatory failure. This suggests that non-invasive ventilation is
inadequate and that full, invasive ventilatory support is needed.
A respiratory therapist is providing education to a patient regarding the use of a metered
dose inhaler prior to discharge from the hospital. After explaining the procedure to the
patient and asking for a return demonstration, the patient does not execute the request
and seems confused. How can the therapist best educate the patient on the use of
MDI?
A. have the patient complete a written comprehension quiz
B. ask the patient if there is a language barrier
C. demonstrate MDI use to the patient
D. provide written instructions - ANSWER-C. demonstrate MDI use to the patient
,The most effective method of instruction regarding the physical performance of a
procedure is for the practitioner to perform the action in front of the patient and then ask
the patient to return the demonstration. This method is also most effective in
overcoming language and other communication barriers.
A COPD patient is participating in a pulmonary rehabilitation program. During a visit to
the clinic, the patient complains of shortness of breath when shaving his own face.
About which of the following should the respiratory therapist instruct the patient that
could help minimize shortness of breath during activity?
A. have a family member perform facial shaving and basic hygiene for the patient
B. avoid all activities that cause shortness of breath
C. pursed-lip breathing
D. quad coughing - ANSWER-C. pursed-lip breathing
Pursed-lip breathing is a primary method of minimizing air-trapping during exhalation.
This can lessen the degree of shortness of breath from physical activity and during
performance of activities of daily living. The patient should not be instructed to omit
normal basic activities of daily living, such as personal hygiene, toileting, cooking, etc.
While a family member could perform the basic requirements for hygiene, this can result
in a decrease in the patient's quality of life. When possible, the patient should be given
methods that allow them to cope with the activity rather than remove it.
A patient is receiving mechanical ventilatory support by VC ventilation in the A/C mode
following a bariatric surgery. Current ventilatory parameters show:
MIP -32 cm H2O
VT(spont) 7 mL/kg
VC 12 mL/kg
RSBI 86
Qs/Qt 10%
A-aDO2 110 mm Hg
ABGs
pH 7.35
PaCO2 44 torr
PaO2 87 torr
The patient follows most commands but has confusion regarding person, time, and
place. The respiratory therapist should
A. extubate the patient.
B. begin ventilator weaning efforts.
C. continue mechanical ventilatory support.
, D. administer naloxone (Narcan). - ANSWER-C. continue mechanical ventilatory
support.
Though all ventilatory parameters are suitable for extubation, the mental disposition of
the patient is an indication to avoid all ventilator liberation efforts until further evaluation
of the patient's mental status can be performed.
The respiratory therapist notices that the blood pressure reading from an indwelling
arterial line differs from that of the cuff and sphygmomanometer. The therapist should
A. document the arterial line blood pressure.
B. replace the transducer on the arterial line.
C. have the patient change arm positions and obtain another reading from the arterial
line.
D. document BP ascertained by the cuff. - ANSWER-D. document BP ascertained by
the cuff.
The cuff pressure should be most trusted. If there is a difference in the two sources, the
arterial line is most likely the problem. This can be solved by 'zeroing' the arterial line.
Replacing the transducer or having the patient arbitrarily change arm position is not
helpful.
A parent of a patient with asthma is following an Asthma action plan for their child. For
more than 24 hours, the patient has taken nebulized Albuterol every 4 hours as
prescribed, requiring several PRN treatments in between normal treatment times. After
a night of bronchodilator treatments taken an average of every 2-3 hours, the parent
should be counseled to
A. contact the child's healthcare provider.
B. report to the emergency room immediately.
C. monitor and treat the patient for 24 more hours.
D. call 911, activate the emergency response system. - ANSWER-A. contact the child's
healthcare provider.
According to asthma action plan guidelines, as set forth by the National Asthma
Education and Prevention Program (NAEPP), this level of distress suggests contacting
the patient's healthcare provider. Calling 911 or reporting to the ER is premature.
After insertion of the chest tube for treatment of a hemothorax, a chest radiograph is
ordered. When observing the radiograph results, the respiratory therapist would expect
to see the tip of the chest tube positioned
A. in the pleural space.
B. in the apical region.
C. over the hilar area.
D. over the lower left lung field. - ANSWER-A. in the pleural space.
COMPLETE SOLUTIONS
A 65-kg (143-lb) patient with cor pulmonale is in the cardiac intensive care unit (CICU)
receiving VC A/C ventilation on the following settings:
FIO2 0.55
Rate 16/min
VT 450 mL
PEEP 8 cm H2O
Flow 42 L/min
ABGs
pH 7.35
PaCO2 46 torr
PaO2 119 torr
HCO3- 24 mEq/L
HR 94/min
SpO2 0.99
The respiratory therapist should recommend
A. decreasing rate to 14/min.
B. decreasing FIO2 to 0.45.
C. increasing VT to 500 mL.
D. decreasing PEEP to 5 cm H2O. - ANSWER-D. decreasing PEEP to 5 cm H2O.
Although CO2 is climbing slightly, pH remains within range. The patient, however, is
over-oxygenating. This should be corrected first. Because current FIO2 is already below
0.60, PEEP should be the target for PaO2 reduction.
While assisting a physician with a bronchoscopy, the respiratory therapist notices the
bronchoscope is not applying suction even though the physician is depressing the
suction button on the bronchoscope. The therapist should
A. increase suction pressure at the wall.
B. flush the suction channel on the bronchoscope.
C. change the suction tubing between the vacuum source and the suction canister.
D. recommend a change to a new bronchoscope. - ANSWER-B. flush the suction
channel on the bronchoscope.
The suction channel on a bronchoscope can easily become clogged. Flushing the
channel would be an appropriate first step in resolving the problem.
,A 55-year-old, 95-kg (209-lb), 178 cm (5 ft 10 in) male is in a current state of ventilatory
failure and requires mechanical ventilatory support. Which of the following settings are
most appropriate?
A. VC, SIMV, mandatory rate 12/min, VT 800 mL, PEEP 5 cm H2O
B. PSV 15 cm H2O, PEEP 5 cm H2O
C. VC, A/C, mandatory rate 18/min, VT 600 mL, PEEP 4 cm H2O
D. PC, SIMV, PIP 45 cm H2O, mandatory rate 16/min, PEEP 6 cm H2O - ANSWER-C.
VC, A/C, mandatory rate 18/min, VT 600 mL, PEEP 4 cm H2O
The patient is obese. Thus, predicted body weight should be determined. Based on
height, PBW is about 73 kg. Tidal volume range at PBW would be 438 - 730 mL. Rate
should be 10 - 20/min and PEEP 4 - 6 cm H2O.
A patient with COPD is receiving ventilatory support by non-invasive ventilation with an
of IPAP of 15 cm H2O and EPAP of 4 cm H2O. The following blood gases are available:
pH 7.21
PaCO2 69 torr
PaO2 51 torr
HCO3- 35 mEq/L
The respiratory therapist should recommend
A. raising both IPAP and EPAP by 5 cm H2O.
B. increasing IPAP to 20 cm H2O.
C. discontinuing PEEP (EPAP of 0 cm H20).
D. invasive ventilation. - ANSWER-D. invasive ventilation.
Even though the patient is COPD and is likely normalized to elevated levels of PaCO2,
the pH clearly indicates ventilatory failure. This suggests that non-invasive ventilation is
inadequate and that full, invasive ventilatory support is needed.
A respiratory therapist is providing education to a patient regarding the use of a metered
dose inhaler prior to discharge from the hospital. After explaining the procedure to the
patient and asking for a return demonstration, the patient does not execute the request
and seems confused. How can the therapist best educate the patient on the use of
MDI?
A. have the patient complete a written comprehension quiz
B. ask the patient if there is a language barrier
C. demonstrate MDI use to the patient
D. provide written instructions - ANSWER-C. demonstrate MDI use to the patient
,The most effective method of instruction regarding the physical performance of a
procedure is for the practitioner to perform the action in front of the patient and then ask
the patient to return the demonstration. This method is also most effective in
overcoming language and other communication barriers.
A COPD patient is participating in a pulmonary rehabilitation program. During a visit to
the clinic, the patient complains of shortness of breath when shaving his own face.
About which of the following should the respiratory therapist instruct the patient that
could help minimize shortness of breath during activity?
A. have a family member perform facial shaving and basic hygiene for the patient
B. avoid all activities that cause shortness of breath
C. pursed-lip breathing
D. quad coughing - ANSWER-C. pursed-lip breathing
Pursed-lip breathing is a primary method of minimizing air-trapping during exhalation.
This can lessen the degree of shortness of breath from physical activity and during
performance of activities of daily living. The patient should not be instructed to omit
normal basic activities of daily living, such as personal hygiene, toileting, cooking, etc.
While a family member could perform the basic requirements for hygiene, this can result
in a decrease in the patient's quality of life. When possible, the patient should be given
methods that allow them to cope with the activity rather than remove it.
A patient is receiving mechanical ventilatory support by VC ventilation in the A/C mode
following a bariatric surgery. Current ventilatory parameters show:
MIP -32 cm H2O
VT(spont) 7 mL/kg
VC 12 mL/kg
RSBI 86
Qs/Qt 10%
A-aDO2 110 mm Hg
ABGs
pH 7.35
PaCO2 44 torr
PaO2 87 torr
The patient follows most commands but has confusion regarding person, time, and
place. The respiratory therapist should
A. extubate the patient.
B. begin ventilator weaning efforts.
C. continue mechanical ventilatory support.
, D. administer naloxone (Narcan). - ANSWER-C. continue mechanical ventilatory
support.
Though all ventilatory parameters are suitable for extubation, the mental disposition of
the patient is an indication to avoid all ventilator liberation efforts until further evaluation
of the patient's mental status can be performed.
The respiratory therapist notices that the blood pressure reading from an indwelling
arterial line differs from that of the cuff and sphygmomanometer. The therapist should
A. document the arterial line blood pressure.
B. replace the transducer on the arterial line.
C. have the patient change arm positions and obtain another reading from the arterial
line.
D. document BP ascertained by the cuff. - ANSWER-D. document BP ascertained by
the cuff.
The cuff pressure should be most trusted. If there is a difference in the two sources, the
arterial line is most likely the problem. This can be solved by 'zeroing' the arterial line.
Replacing the transducer or having the patient arbitrarily change arm position is not
helpful.
A parent of a patient with asthma is following an Asthma action plan for their child. For
more than 24 hours, the patient has taken nebulized Albuterol every 4 hours as
prescribed, requiring several PRN treatments in between normal treatment times. After
a night of bronchodilator treatments taken an average of every 2-3 hours, the parent
should be counseled to
A. contact the child's healthcare provider.
B. report to the emergency room immediately.
C. monitor and treat the patient for 24 more hours.
D. call 911, activate the emergency response system. - ANSWER-A. contact the child's
healthcare provider.
According to asthma action plan guidelines, as set forth by the National Asthma
Education and Prevention Program (NAEPP), this level of distress suggests contacting
the patient's healthcare provider. Calling 911 or reporting to the ER is premature.
After insertion of the chest tube for treatment of a hemothorax, a chest radiograph is
ordered. When observing the radiograph results, the respiratory therapist would expect
to see the tip of the chest tube positioned
A. in the pleural space.
B. in the apical region.
C. over the hilar area.
D. over the lower left lung field. - ANSWER-A. in the pleural space.
