TMC test bank NBRC Exam Questions And Answers
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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
A doctor orders aerosol drug therapy via small volume nebulizer for a patient
receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug
residue from affecting ventilator performance you must make sure that:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
C. a heat and moisture exchanger is in place at the patient connector
,D. a HEPA filter is in place on the expiratory limb of the circuit - ANSWER -
HEPA filters are needed to prevent drug residue from entering the ventilator and
affecting its performance. For dual-limb circuits, be sure that inspiratory and
expiratory
HEPA filters are in place. For single-limb circuits, you normally only need an
inspiratory
HEPA filter; expiratory filtration may be required on patients with disorders
requiring
droplet or respiratory precautions.
The correct ANSWER is: both inspiratory and expiratory HEPA filters are in place
Your patient is receiving aerosolized bronchodilators to treat her asthma. What is
the best way to determine whether this treatment is achieving the desired goal?
A. measure the patient's MIP before-and-after treatment
279
B. measure the patient's inspiratory capacity before-and-after treatment
C. measure the patient's FEV1% before-and-after treatment
D. calculate the patient's alveolar minute volume - ANSWER -The best way to
determine the effectiveness of bronchodilator therapy at the bedside
is to measure the patient's forced expiratory flows before and after treatment.
Either
the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the
FEV1% is a
more reliable and valid measure. In general, an improvement of at least 12-15%
between the pre- and post-test values is needed to indicate reversibility of the
obstruction with the bronchodilator.
The correct ANSWER is: measure the patient's FEV1% before-and-after treatment
A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to
produce an acceptable volume of sputum for laboratory studies. The most
appropriate action would be to
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning - ANSWER -Hypertonic saline solution can
help draw fluid out of the airway mucosa. For this
reason, the aerosolization of hypertonic saline solution can help mobilize
secretions
and can be effective with sputum induction.
The correct ANSWER is: change to hypertonic saline
, A patient with asthma is given an adrenergic bronchodilator agent to combat an
acute airway obstruction. Instead of demonstrating improvement in airflow, the
patient's symptoms worsen (e.g., increased wheezing, etc.). A possible
explanation for this observation is:
A. tachyphylaxis or tolerance to the agent
B. alterations in the V/Q ratio (a beta-2 effect)
C. the additive effect of other drug agents
D. a paradoxical response to the agent - ANSWER -Although rare, some patients
exhibit a paradoxical response to adrenergic
bronchodilators in which the symptoms of acute airway obstruction actually are
made
worse by drug agent. It is believed that this adverse effect is a result of an allergy
to
some of the metabolic products of the adrenergic drugs.
The correct ANSWER is: a paradoxical response to the agent
Which of the following patient instructions for using a dry powder inhaler (DPI) is
correct?
A. hold the device vertically after loading
B. inhale rapidly for 1-2 seconds
C. blow slowly into the device
D. breath normally in/out of the device - ANSWER -The following general
guidelines apply to effective use of a DPI: (1) never use a spacer
or VHC with a DPI; (2) lips must be tightly sealed around the mouthpiece; (3) after
loading, most DPIs must be held horizontally (to avoid loss of drug); (4) patient
should
inhale rapidly (> 60 L/min for 1-2 sec) and deeply; and (5) patient must exhale to
room
(not back into the device).
The correct ANSWER is: inhale rapidly for 1-2 seconds
Which of the following is the preferred delivery method for cromolyn sodium to
young children?
A. MDI with mask
B. small volume nebulizer
C. MDI with holding chamber
D. dry powder inhaler - ANSWER -A small volume nebulizer (SVN) is the method
of choice for administering cromolyn
sodium to young children. You should use a tightly fitting face mask for any child
, unable to a mouthpiece.
The correct ANSWER is: small volume nebulizer
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:
272
A. wait until the physician is done with the code so you can clarify the improper
notation and the correct order
B. administer the treatment using the standard dosage (0.5 mL) and clarify the
order as soon as possible thereafter
C. cross out the prohibited notations, provide the correct abbreviations and
initial and date the changes
D. have the nurse review the order and correct the improper notation - ANSWER -
This order contains at least two improper notations, i.e., c.c. (use mL), and lack of
leading zeros before a decimal point (that may be 'lost' on the order line).
Normally, if
an order contains a prohibited notation, the respiratory therapist must confirm the
intent of the order before proceeding. The exception is when order confirmation
might
delay essential or emergency patient treatment (as here). In these cases, if, in the
judgment of the caregiver the order is clear and complete and the delay to obtain
confirmation from the prescriber would place the patient at greater risk, then the
order
should be carried out and the confirmation obtained as soon as possible thereafter.
The correct ANSWER is: administer the treatment using the standard dosage (0.5
mL)
and clarify the order as soon as possible thereafter
A doctor orders 10 mg of 0.5% albuterol (Proventil) in 50 mL normal saline via
continuous nebulization for a patient with asthma. How many mL of albuterol
would you place in the nebulizer?
A. 0.5
B. 2
C. 5
D. 20 - ANSWER -mL = dosage (mg) ¸ concentration (mg/mL) = 10/5 = 2 mL.
Note that a 0.5% solution has
a concentration of 5 mg/mL.
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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
A doctor orders aerosol drug therapy via small volume nebulizer for a patient
receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug
residue from affecting ventilator performance you must make sure that:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
C. a heat and moisture exchanger is in place at the patient connector
,D. a HEPA filter is in place on the expiratory limb of the circuit - ANSWER -
HEPA filters are needed to prevent drug residue from entering the ventilator and
affecting its performance. For dual-limb circuits, be sure that inspiratory and
expiratory
HEPA filters are in place. For single-limb circuits, you normally only need an
inspiratory
HEPA filter; expiratory filtration may be required on patients with disorders
requiring
droplet or respiratory precautions.
The correct ANSWER is: both inspiratory and expiratory HEPA filters are in place
Your patient is receiving aerosolized bronchodilators to treat her asthma. What is
the best way to determine whether this treatment is achieving the desired goal?
A. measure the patient's MIP before-and-after treatment
279
B. measure the patient's inspiratory capacity before-and-after treatment
C. measure the patient's FEV1% before-and-after treatment
D. calculate the patient's alveolar minute volume - ANSWER -The best way to
determine the effectiveness of bronchodilator therapy at the bedside
is to measure the patient's forced expiratory flows before and after treatment.
Either
the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the
FEV1% is a
more reliable and valid measure. In general, an improvement of at least 12-15%
between the pre- and post-test values is needed to indicate reversibility of the
obstruction with the bronchodilator.
The correct ANSWER is: measure the patient's FEV1% before-and-after treatment
A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to
produce an acceptable volume of sputum for laboratory studies. The most
appropriate action would be to
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning - ANSWER -Hypertonic saline solution can
help draw fluid out of the airway mucosa. For this
reason, the aerosolization of hypertonic saline solution can help mobilize
secretions
and can be effective with sputum induction.
The correct ANSWER is: change to hypertonic saline
, A patient with asthma is given an adrenergic bronchodilator agent to combat an
acute airway obstruction. Instead of demonstrating improvement in airflow, the
patient's symptoms worsen (e.g., increased wheezing, etc.). A possible
explanation for this observation is:
A. tachyphylaxis or tolerance to the agent
B. alterations in the V/Q ratio (a beta-2 effect)
C. the additive effect of other drug agents
D. a paradoxical response to the agent - ANSWER -Although rare, some patients
exhibit a paradoxical response to adrenergic
bronchodilators in which the symptoms of acute airway obstruction actually are
made
worse by drug agent. It is believed that this adverse effect is a result of an allergy
to
some of the metabolic products of the adrenergic drugs.
The correct ANSWER is: a paradoxical response to the agent
Which of the following patient instructions for using a dry powder inhaler (DPI) is
correct?
A. hold the device vertically after loading
B. inhale rapidly for 1-2 seconds
C. blow slowly into the device
D. breath normally in/out of the device - ANSWER -The following general
guidelines apply to effective use of a DPI: (1) never use a spacer
or VHC with a DPI; (2) lips must be tightly sealed around the mouthpiece; (3) after
loading, most DPIs must be held horizontally (to avoid loss of drug); (4) patient
should
inhale rapidly (> 60 L/min for 1-2 sec) and deeply; and (5) patient must exhale to
room
(not back into the device).
The correct ANSWER is: inhale rapidly for 1-2 seconds
Which of the following is the preferred delivery method for cromolyn sodium to
young children?
A. MDI with mask
B. small volume nebulizer
C. MDI with holding chamber
D. dry powder inhaler - ANSWER -A small volume nebulizer (SVN) is the method
of choice for administering cromolyn
sodium to young children. You should use a tightly fitting face mask for any child
, unable to a mouthpiece.
The correct ANSWER is: small volume nebulizer
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:
272
A. wait until the physician is done with the code so you can clarify the improper
notation and the correct order
B. administer the treatment using the standard dosage (0.5 mL) and clarify the
order as soon as possible thereafter
C. cross out the prohibited notations, provide the correct abbreviations and
initial and date the changes
D. have the nurse review the order and correct the improper notation - ANSWER -
This order contains at least two improper notations, i.e., c.c. (use mL), and lack of
leading zeros before a decimal point (that may be 'lost' on the order line).
Normally, if
an order contains a prohibited notation, the respiratory therapist must confirm the
intent of the order before proceeding. The exception is when order confirmation
might
delay essential or emergency patient treatment (as here). In these cases, if, in the
judgment of the caregiver the order is clear and complete and the delay to obtain
confirmation from the prescriber would place the patient at greater risk, then the
order
should be carried out and the confirmation obtained as soon as possible thereafter.
The correct ANSWER is: administer the treatment using the standard dosage (0.5
mL)
and clarify the order as soon as possible thereafter
A doctor orders 10 mg of 0.5% albuterol (Proventil) in 50 mL normal saline via
continuous nebulization for a patient with asthma. How many mL of albuterol
would you place in the nebulizer?
A. 0.5
B. 2
C. 5
D. 20 - ANSWER -mL = dosage (mg) ¸ concentration (mg/mL) = 10/5 = 2 mL.
Note that a 0.5% solution has
a concentration of 5 mg/mL.
