Which of the following positions is most appropriate for a patient being treated for extremely low blood pressure
Trendelenburg
Reverse Trendelenburg & Fowler's position decreases
venous return
A respiratory therapist is assisting with a bronchoscopy for a patient with a right middle lobe consolidation. Which of the following should be routinely monitored during the procedure?1. hemoximetry
2. ECG pattern
3. pulse oximetry
4. capnography
ECG
p. ox
Immediately after initiating volume-controlled ventilation, an inverse I:E ratio is noted. Which of the following does this indicate?
ins flow is low
A 24-year-old female presents with seasonal nasal stuffiness and episodes of daytime dyspnea and cough. Which of the following drug classifications should the respiratory therapist recommend to control the patient's symptoms?
leukotriene inhibitor (singulair) controls mild asthma and allergic rhinitis
IgE immunoglobulin antagonist, such as omalizumab (Xolair), is indicated for
severe allergic asthma
A galvanic analyzer is used to assess
oxygen concentration
A mass spectrometer demonstrates
chem composition of a substance
Following endotracheal intubation, which of the following should a respiratory therapist use to confirm proper tube placement?
colorimeteric capnometer
A CVP catheter that has been advanced too far would be in the
right atrium or possibly in the right ventricle.
When in proper position, the tip of the CVP catheter should be in the
lower portion of the superior vena cava.
If the CVP catheter had perforated the vessel, the tip would be located
outside of the lumen of the vena cava.
Which of the following findings indicate a patient who is weaning from mechanical ventilation has decreased muscle strength?
1. reduced maximum inspiratory pressure (MIP)
2. decreased tidal volume
3. decreased vital capacity
4. decreased PaCO2
1 2 3
A patient is receiving 80%/20% heliox using a standard oxygen flowmeter. Which of the following is the correction factor to determine the accurate flow?
1:8
Which of the following is the best device to administer a controlled oxygen concentration for a patient with a variable respiratory pattern?
air entrainment mask
A respiratory therapist is instructing an outpatient in the care of respiratory equipment. Which of the following steps should be included in the cleaning procedure?
1. Wash thoroughly with 50% bleach.
2. Remove soap by rinsing with water.
3. Soak in a vinegar solution for 20 minutes.
4. Drain dry without wiping.
2 3 4
Bleach should not be used for
home resp equipment
Soap should be rinsed away to prevent irritation to the
mucosa
Vinegar is an effective disinfectant for
common pathogens
A patient with a tracheostomy is receiving heated aerosol therapy. A respiratory therapist finds the FIO2 is 0.60 by oxygen analyzer when the air-entrainment setting is 0.40. Which of the following could cause these findings?
1. The analyzer could be improperly calibrated.
2. The tracheostomy tube could be partially occluded with secretions.
3. The water level in the nebulizer could be too low.
4. Water in the tubing could be reducing the gas flow.
1
4
A patient who is afebrile is receiving volume-controlled ventilation with a heat moisture exchanger for the past 24 hours. There is a progressive increase in peak inspiratory pressure. Auscultation reveals scattered coarse crackles, and thick secretions are obtained during suctioning. Which of the following should a respiratory therapist do?
B.
The best way to check the accuracy of a water-seal spirometer is to use a
3 L syringe
A physiologic goal of CPAP in atelectasis is to increase
frc
A respiratory therapist notes an adverse change in a patient's condition during the administration of routine therapy. Which of the following should the therapist do?
1. Notify the nurse who is responsible for the patient.
2. Ask the patient's nurse to confirm the change in clinical presentation.
3. Record the patient's reactions in the chart.
4. Contact the physician if a change in therapy seems warranted.
1
3
4
t/f
The nurse must be informed about the patient's adverse reaction.
t
A patient with multiple trauma is intubated and receiving mechanical ventilation. The patient is extremely anxious, tachypneic, and complaining of severe pain. Which of the following drugs would decrease the total rate and provide pain control?
morphine sulfate
Neostigmine bromide is used in what type of pts
myasthenia gravis patients.
Which of the following should a respiratory therapist use to collect a sputum specimen for culture and sensitivity from an intubated patient?
lukens
Yankauer tube is only used for
oral secretions
A Pleur-evac is used to evacuate a
pleural effusion
A Carlen's tube is a
double lume endotracheal tube
A patient was awakened by shortness of breath. He has fine inspiratory crackles bilaterally and a history of hypertension. Which of the following should a respiratory therapist recommend?
furosemide (Lasix)
Moderate amounts of thin, white sputum are obtained during the suctioning procedure. Which of the following should the respiratory therapist do with the next suction procedure?
Suction the patient without saline instillation.
A 44-year-old patient presents to the emergency department with diabetic ketoacidosis. Which of the following respiratory patterns is most consistent with this diagnosis?
rapid, deep breathing
( An increase in rate and depth of breathing, called Kussmaul's breathing, is most commonly the result of a diabetic crisis/ketoacidosis.)
the most frequently reported adverse effect associated with the use of NebuPent.
bronchospasms
A patient is receiving 35% oxygen through an air-entrainment mask. With an appropriate flow, the oxygen concentration measured in the mask is 42%. Which of the following should a respiratory therapist do FIRST?
Assess the patency of the air-entrainment port
The determinants of FIO2 in this device are the jet size and the size of the entrainment ports. Any obstruction to the air-entrainment port will
increase the FIO2 by decreasing the volume of air entrained.
A patient is receiving continuous mechanical ventilation. A respiratory therapist determines by auscultation that the patient's endotracheal tube is in the right mainstem bronchus. After withdrawing the tube until breath sounds are equal bilaterally, the therapist should FIRST
record this action in the patient's chart.
The physician needs to be notified; however, the first action is to
record the findings in the chart.
An adult patient in the ICU is receiving beta-blocker medication and requires bronchodilator therapy. Which of the following should a respiratory therapist recommend?
ipratropium bromide (Atrovent)
Intracuff pressures on the tracheal wall in excess of 30 torr will cause obstruction of
1. capillary flow.
2. venous flow.
3. arterial flow.
4. lymphatic flow.
1
2
4
While manually ventilating an intubated patient during transport, a respiratory therapist observes a significant decrease in SpO2. Which of the following should the therapist do FIRST?
C.
A 21-year-old male patient with a diagnosis of status asthmaticus is intubated and has been receiving mechanical ventilation. There is a sudden increase in airway pressures. The patient is hemodynamically stable and breath sounds are clear, but significantly decreased on the right. Which of the following should the respiratory therapist recommend?
C.
A respiratory therapist is preparing to administer pentamidine (NebuPent) to a patient. Which of the following devices should the therapist select for this treatment?
B.
A filtered exhalation nebulizer prevents
environmental contamination.
An adult patient is receiving mechanical ventilation. Which of the following should be recommended to improve oxygenation and recruit collapsed alveoli?
C.
A new blood gas analyzer is calibrated by the manufacturer at sea level. Upon receiving the new analyzer at a higher altitude, a respiratory therapist should
C.
While receiving an FIO2 of 1.0 and a tidal volume of 400 mL during volume-controlled ventilation, a 60-kg (132-lb) patient is having difficulty achieving adequate oxygenation. To improve oxygenation, a respiratory therapist should manipulate ventilator settings to increase which of the following?
C.
Increasing the mean airway pressure improves
distribution of ventilation.
A patient is receiving postural drainage, lung expansion therapy, and directed cough to treat obstructive atelectasis. Which of the following diagnostic procedures should be recommended to evaluate the patient's response to respiratory care?
B.
Which of the following would limit the usefulness of pulse oximetry?
A chest tube has been placed in the right pleural space of a patient receiving volume-controlled ventilation and there is vigorous bubbling in the water seal chamber. The low exhaled volume alarm begins to sound. The exhaled tidal volume is two-thirds of the set tidal volume. Which of the following should the respiratory therapist do?
A.Perform endotracheal suctioning.
B.Decrease the exhaled tidal volume alarm setting.
C.Recommend a chest radiograph.
D.Manually ventilate the patient with 100% O2.
c- A chest radiograph will confirm suspicion of a pneumothorax.
Which of the following should a respiratory therapist select to determine the rapid-shallow breathing index?
a- is portable and accurate for the measurement of minute ventilation in this situation.
To assess the effectiveness of CPR, a respiratory therapist should periodically
A.palpate for tracheal deviation.
B.suction to ensure airway patency.
C.auscultate for bilateral breath sounds.
D.check for carotid pulse.
d- objective of CPR is to establish perfusion and checking the carotid pulse would provide information about the effectiveness of CPR.
What is a major advantage of a heated wick humidifier compared with other types of humidifiers?
A.The wick filters exhaled contaminants.
B.Both molecular and particulate water are delivered.
C.A relative humidity of 100% is easily produced.
D.A baffle is not needed to produce the desired humidity.
c- Due to heating and a large damp surface area, high humidity is produced.
A patient is receiving noninvasive positive pressure ventilation. Pulmonary compliance has decreased over the past 4 hours. To increase the patient's tidal volume, it would be most appropriate to
A.permit patient-triggered breaths.
B.change to CPAP.
C.decrease the inspiratory time.
D.increase the IPAP.
d-Increasing the IPAP increases the pressure gradient, which would increase tidal volume.
Which of the following indicates a physical conditioning program has been effective for a patient with COPD?
A.Resting pulse rate is the same after 1 month.
B.Level-walking distance has increased by 15%.
C.Vital capacity has increased by 5%.
D.Respiratory rate has increased by 2/min.
b- An important part of physical conditioning is an increase in exercise tolerance, easily measured by increased walking distance.
A patient with a 7.0 mm ID endotracheal tube has copious, thin secretions. Two hours later, despite unchanged physical findings, only very small amounts of sputum are aspirated when the patient is suctioned with a 14 Fr catheter and a pressure of -120 mm Hg. Which of the following is the most appropriate action?
A.Increase the suction pressure to -200 mm Hg.
B.Instill 5 mL normal saline.
C.Change to a 16 Fr catheter.
D.Evaluate patency of the suction system.
d-Assuring the patency of the suction system will facilitate mucus removal.
A respiratory therapist is reviewing a chest radiograph and notes the presence of a chest tube. The patient has a hemothorax. Which of the following locations is most appropriate for this chest tube to be placed?
A.second intercostal space in the mid-clavicular line
B.third intercostal space in the mid-clavicular line
C.third intercostal space in mid-axillary line
D.fifth intercostal space in mid-axillary line
d- The fifth intercostal space in the mid-axillary line is appropriate for draining fluid from the chest. A tube placed any higher than the thorax may not adequately drain the fluid.
The second/third intercostal space in the mid-clavicular line is more appropriate for a
pneumothorax
During which of the following should apnea monitoring be used for an infant?
1. night time
2. breast feeding
3. naps
4. bathing
1
3
Which pharmacological agents should the respiratory therapist recommend for a patient with a temperature of 40° C (104° F)?
1. acetaminophen
2. ibuprofen
3. ketorolac (Toradol)
4. celecoxib (Celebrex)
1
2
Acetaminophen reduces elevated
temperatures
Ibuprofen is used to treat
fever
A physician orders an FIO2 of 0.40 for a premature infant in an open bed with a radiant warmer. Which of the following delivery devices should a respiratory therapist select?
A.air-entrainment mask
B.oxygen hood
C.infant nasal cannula
D.simple mask
b- The oxygen hood will deliver a precise FIO2. It will allow maintenance of a neutral thermal environment and allow access for nursing care.
A patient with COPD is receiving mechanical ventilation. The patient continues to wheeze despite treatment with albuterol. Peak airway pressure is increased with no change in plateau pressure. A respiratory therapist should recommend
A.obtaining a chest radiograph.
B.administering furosemide (Lasix).
C.obtaining an arterial blood gas analysis.
D.administering ipratropium bromide (Atrovent).
d- Ipratropium bromide treats bronchoconstriction by a mechanism different from albuterol and should decrease airways resistance.
Prior to immersing equipment in alkaline glutaraldehyde, a respiratory therapist checks the solution with a test strip. The test strip indicates a failure when compared to the color chart on the container. The therapist should
A.add 40 mEq/L of bicarbonate.
B.add 100 mL of sterile water.
C.reactivate the solution.
D.replace the solution.
d- The failure indicates the concentration of glutaraldehyde is below the minimum effective concentration and should be replaced.
Which of the following should be used to determine the return of a postoperative patient's ability to breathe adequately after anesthesia?
A.venous PO2
B.MIP
C.MVV
D.pulse oximetry
b- MIP is a measurement that reflects inspiratory muscle strength.
A respiratory therapist is asked to position a patient for orotracheal intubation. The therapist should place the patient's head
A.in the sniffing position.
B.with the neck hyperextended.
C.tilted forward toward the chest.
D.turned to the right.
a- The sniffing position provides optimal alignment of the upper airway.
A spontaneously breathing adult patient is intubated with a 6.0 mm ID endotracheal tube. Which of the following will decrease the patient's work of breathing imposed by the endotracheal tube?
A.CPAP
B.pressure support
C.flow-by
D.inspiratory pause
b- PSV decreases the work of breathing while boosting spontaneous VT.
Which of the following agents is appropriate to recommend for use in the cleaning of home respiratory care equipment?
c- Vinegar (acetic acid) is effective and commonly recommended for home use.
A patient is orally intubated with a size 7.0 mm ID endotracheal tube. The respiratory therapist uses a size 14 Fr suction catheter to suction the patient's airway. The suction setting is -100 mm Hg. The therapist notices the patient's secretions are thick and tenacious and will not aspirate through the suction catheter. Which of the following should the therapist do FIRST?
A.Use a size 16 Fr catheter.
B.Administer acetylcysteine (Mucomyst).
C.Change the suction setting to -120 mm Hg.
D.Apply continuous suction to the patient's airway.
c- A change in the vacuum pressure may improve aspiration of the secretions through the catheter and should be attempted first.
should be considered after attempts to clear the secretions with an increased vacuum pressure have not been successful.
Acetylcysteine (Mucomyst)
A physician orders an FIO2 of 0.40 for a premature infant in an incubator. Which of the following delivery devices should the respiratory therapist select?
b- The oxygen hood will deliver a precise FIO2. It will allow maintenance of a neutral thermal environment and allow access for nursing care.
A 5-year-old child is receiving mechanical ventilation with the following settings:
FIO2 0.21
Mandatory rate 25
Tidal volume 250 mL
A heat moisture exchanger is attached at the circuit Y and the peak pressure increases while the plateau pressure remains stable. Which of the following should be recommended at this time?
A.Change to a heated humidifier.
B.Initiate chest physiotherapy.
C.Increase the set tidal volume to 300 mL.
D.Increase the FIO2 to 0.35.
a- The heat moisture exchanger has resulted in increased resistance in the breathing circuit. Changing to a heated humidifier will correct the problem. bc of the increase in the peak airway pressure
While assessing a patient who is receiving oxygen at 2 L/min through a transtracheal catheter, the patient complains the supply tubing keeps popping off of the catheter. Which of the following actions should a respiratory therapist take to correct this problem?
A.Decrease the flow of oxygen.
B.Check the catheter for obstruction.
C.Perform endotracheal suctioning.
D.Tape the connection securely.
b- The catheter is obviously obstructed with mucus or kinked, resulting in significant back pressure causing the supply tube to pop off.
Digital clubbing can be most easily assessed by
A.palpating the proximal digital joints
.B.inspecting the angulation of the nail bed.
C.examining the fingers for evidence of hyperflexion.
D.comparing the symmetry fingers on one hand to the opposite hand.
b- In clubbing, the angle between the nail bed and the finger becomes increased in the digits.
Auscultation of the chest over a pneumothorax is most likely to reveal
b- Diminished breath sounds are consistent with decreased alveolar ventilation. Pneumothorax or air in the pleural space reduces sound transmission through the chest wall.
An adult patient is intubated after being pulseless for several minutes. An exhaled CO2 detection device indicates 0.03% CO2 despite confirmation of tracheal placement with bilateral breath sounds and chest rise. Which of the following should a respiratory therapist recommend to rapidly confirm correct endotracheal tube placement?
a- Direct visualization of the larynx with a laryngoscope will confirm the tube has passed through the cords.
Which of the following activities must occur as part of tracheostomy decannulation in a 3-month-old infant?
1. Document airway patency during sleep and activity.
2. Add a Passy-Muir valve.
3. Insert a fenestrated tracheostomy tube.
4. Verify the time of last feeding.
1
4
A respiratory therapist is assisting with an intubation of a morbidly obese patient. Intubation is difficult and the airway is secured only after many attempts. Which of the following medications should be administered?
c- Steroid administration may be used for airway edema after difficult intubation.
Which of the following should a respiratory therapist use to determine a neonate's gestational age?
A.APGAR
B.Glasgow
C.Dubowitz
D.Silverman
c- The Dubowitz score uses physical characteristics to determine gestational age.
score assesses adaptation to extra-uterine life.
apgar
score is a neurological assessment tool.
glasgow
The Silverman scale indicates the level of
resp distress
A 20-year-old patient with an acute asthma exacerbation is receiving 2.5 mg of albuterol by hand-held nebulizer. During the treatment, the patient complains of palpitations and has a heart rate of 140/min. Which of the following should the respiratory therapist recommend for the next treatment?
A.Change to a fluticasone propionate/salmeterol (Advair Diskus).
B.Change to 0.63 mg of levalbuterol (Xopenex).
C.Change to 3 puffs of beclomethasone (Vanceril).
D.Administer the treatment with saline.
b- Changing to levalbuterol should decrease the incidence of tachycardia.
Which of the following is the most common side effect of aerosolized albuterol?
a- As a sympathomimetic agent, albuterol will stimulate not only the bronchial muscle beta2-receptors, but will also stimulate the peripheral neuromuscular receptors resulting in tremor
While interviewing a patient prior to starting therapy, a respiratory therapist notes a patient arouses easily. This will help the therapist determine the patient's
A.emotional state.B.
level of consciousness.
C.ability to protect the airway.
D.orientation to time, place, and person.
b- Arousal reflects a person's consciousness.
A patient with asthma presents in severe respiratory distress. The patient has tachypnea and demonstrates accessory muscle use. Breath sounds reveal bilateral expiratory wheezes and SpO2 is 87%. A respiratory therapist should recommend a bronchodilator by
A.MDI with a spacer.
B.hand held nebulizer powered by oxygen.
C.MDI without a spacer.
D.updraft nebulizer powered by air.
b- The patient is in distress and SpO2 is 87%, and oxygen should be used to power the nebulizer.
Noninvasive positive pressure ventilation is most likely indicated for a patient with respiratory failure from
d- Patients with COPD may respond well to noninvasive positive pressure ventilation by increasing alveolar ventilation.
A respiratory therapist is evaluating a patient receiving pressure-controlled ventilation with a mandatory rate of 18/min. The patient's total respiratory rate is 32/min. Which of the following should slow this patient's breathing frequency?
d- Increasing the inspiratory pressure will increase the tidal volume, which will meet the patient's demand and lead to a decrease in breathing frequency.
A 32-week gestational age newborn presents to the NICU with the following findings:
-Decreased breath sounds on the right side
-Hyperresonance on the right side of the chest
-Mediastinal shift to the left side
-Moderate dyspnea and central cyanosis
Which of the following are appropriate treatments at this time?
1. chest tube placement on the right side
2. chest tube placement on the left side
3. intubation and mechanical ventilation
4. 100% oxygen delivery
1
4
While administering an IPPB treatment at 20 cm H2O to a patient with COPD, a respiratory therapist notes the patient has suddenly become very short of breath and cyanotic. The therapist's most appropriate action is to
D. The treatment should be discontinued because the patient is demonstrating severe respiratory distress of unknown etiology. Determining the cause of the distress is of the utmost importance.
Two hours after extubation, a patient develops inspiratory stridor and respiratory distress. A treatment with aerosolized racemic epinephrine decreases the inspiratory stridor and relieves the patient's distress. The most likely source of the airway problem is
D. Subglottic edema can cause stridor and respiratory distress, which may be relieved by the vasoconstrictor effects of racemic epinephrine.
cause both inspiratory and expiratory wheezing, which are nonresponsive to racemic epinephrine.
Tracheal stenosis
causes wheezing, not stridor.
Bronchospasm
While assisting a physician using a synchronous defibrillator for cardioversion, the unit does not discharge. A respiratory therapist should check the
1. charge level of the defibrillator.
2. presence of a P wave.
3. chest lead connections.
4. contact gel on the paddles.
1
3
4
The defibrillator must identify an ____ wave to synchronize the discharge.
r
A patient who had a stroke missed a bronchodilator treatment because he was in the physical therapy department. To assure that the patient receives future treatments, a respiratory therapist should
A. Coordination of treatment schedules with other healthcare providers ensures compliance with treatment requirements.
A respiratory therapist auscultates a patient's chest and identifies the presence of diffuse expiratory wheezing. This indicates
B. Bronchospasm produces a wheezing sound as a result of gas flow through narrowed airways.
Laryngeal edema will produce
inspiratory stridor
would be noted by the presence of coarse crackles.
secretions
Which of the following devices is required for airborne precautions?
D. An N-95 face mask will provide protection against airborne microorganisms.
During IPPB therapy, a patient complains of dizziness and tingling sensations in her fingers. Which of the following should a respiratory therapist record in the patient's chart?
1. the family's reaction to the patient's complaint
2. the patient's vital signs before and after the treatment
3. the patient's symptoms
4. medication administered during the treatment
2
3
4
Tracheal secretions tend to dry in an intubated patient when inspired air has which of the following characteristics?
1. an absolute humidity of 25 mg/L
2. a water vapor pressure of 47 torr
3. a dew point of 37° C (98.6° F)
4. a relative humidity of 100% at 22° C (71.6° F)
1
4
Tracheal absolute humidity must be
30
Which of the following is the maximum amount of air that can be exhaled from the maximum inspiratory level?
D. Vital capacity is the maximum volume exhaled after a maximum inhalation.
the volume of gas remaining in the lungs and airways at the end of a resting tidal exhalation.
FRC
the maximum volume of air that can be exhaled from the end tidal volume.
Expiratory reserve volume
What maximum inspiratory pressure (MIP) should a patient be able to generate before attempting extubation?
D. A MIP of -20 cm H2O is the suggested minimum value required to sustain spontaneous ventilation following an extubation attempt.
IPPB therapy is initiated for a patient with a fenestrated tracheostomy tube. A respiratory therapist notes the IPPB machine will not cycle into the expiratory phase. Which of the following actions will most effectively correct this problem and achieve therapeutic goals for this patient?
B. The reason the device will not cycle into the expiratory phase is that the fenestration creates a large leak. Inserting the nonfenestrated inner cannula and inflating the cuff will close the sources of leak.
A respiratory therapist observes a patient has no chest excursion during the initial attempt to ventilate a patient while performing CPR. The therapist should FIRST
C. During the initial attempt to ventilate a patient while performing CPR, when observing no chest excursion, the first thing the therapist should do is reposition the head and try to ventilate once again.
While analyzing an arterial blood gas sample from a patient breathing air, the measured PaO2 value is 170 torr. Which of the following should a respiratory therapist do FIRST?
D. The sum of PaCO2 and PaO2 cannot exceed 149 torr while breathing air; therefore, a PaO2 of 170 is not possible.
An increase in which of the following will decrease the work of breathing associated with spontaneous breathing through a ventilator circuit?
C. Increasing the pressure support is useful to overcome the added work of breathing imposed by artificial airways and the ventilator circuit.
Which of the following is consistent with adequate respiratory muscle strength for weaning from ventilatory support?
A. This is a measure of respiratory muscle strength. Any value greater than -20 to -30 cm H2O indicates adequate muscle strength.
An adult patient is receiving volume-controlled ventilation and has a tidal volume of 700 mL. The patient's pH is 7.38. The patient is switched to pressure-controlled ventilation. Exhaled tidal volume is now approximately 850 mL. A respiratory therapist should recommend
A.setting the PEEP at 5 cm H2O.
B.maintaining the current settings
.C.increasing the inspiratory time.
D.decreasing the pressure setting.
D. Since the acid-base status was normal with the tidal volume of 700 mL, a reduction in the pressure limit is indicated to achieve the similar tidal volume.
A patient with a laryngeal tumor is presently receiving 80%/20% helium-oxygen by a nonrebreathing mask at 5 L/min. The patient is alert, but appears agitated. Vital signs indicate a HR of 130/min, RR at 30/min, and a BP of 140/90 mm Hg. Which of the following is the most appropriate action to take?
B. The flow to the mask is insufficient and will result in dilution of both the oxygen and helium concentrations with air. Increasing the flow will ensure the patient receives the desired gas mixture.
When coordinating the sequence of the following therapies in bronchopulmonary clearance, which of the following should a respiratory therapist administer concurrently with high-frequency chest wall oscillation?
B. Bronchodilator therapy is administered concurrently with high frequency chest wall oscillation.
The sum of PaO2 and PaCO2 cannot exceed ____ torr while breathing air.
149
A comatose patient is found in a car with the engine running in an enclosed garage. Upon arrival in the emergency department, the patient has a respiratory rate of 36/min, heart rate of 147/min, and an SpO2 of 100% with oxygen at 15 L/min by nonrebreathing mask. Which of the following should the respiratory therapist recommend?
A respiratory therapist examines a patient and notes coarse crackles. Which of the following does this most likely indicate?
C. Secretions in the airway produce low-pitched, discontinuous lung sounds described as coarse crackles upon auscultation.
is demonstrated by the presence of crepitus during chest wall palpation.
Subcutaneous emphysema
The primary purpose of cleaning and sterilizing nondisposable respiratory care equipment after each use is to
A. Contaminated equipment could cause nosocomial infections.
The repeated administration of beclomethasone (Vanceril) by inhalation is associated with which of the following adverse effects?
B. The opportunistic infection of the mouth with Candida albicans is associated with beclomethasone.
While reviewing a chest radiograph, proper positioning of a flow-directed balloon-tipped catheter to obtain a mixed venous sample is confirmed when the tip is located in the
B. Either in the right or left pulmonary artery is the appropriate position for drawing of a mixed venous sample.
Administration of racemic epinephrine after extubation is used to
A. Racemic epinephrine stimulates the alpha-receptors.
A nurse contacts a respiratory therapist to initiate chest physiotherapy for a newly admitted patient. Which of the following should the therapist do FIRST?
C. The first step in the initiation of therapy is to confirm a written order.
An increase in a patient's heart rate during aerosolized bronchodilator therapy is primarily a result of which of the following drug effects?
A. The beta1 effect of an aerosolized bronchodilator is primarily increased heart rate.
The alpha effects of an aerosolized bronchodilator are primarily on
smooth muscle, not cardiac muscle.
The beta1 effect of an aerosolized bronchodilator is primarily
increased heart rate.
A physician's order for the administration of oxygen to a hospitalized patient should include which of the following specifications?
C. To provide the correct delivery of oxygen for a patient, the physician must state the flow in L/min and/or the percentage of oxygen.
The major component of pulmonary surfactant is
B. Phospholipid is 85% of surfactant.
Protein is ___% of surfactant.
7
Rapid assessment of oxygenation status is best achieved by
D. Pulse oximetry would provide the most rapid assessment of oxygenation status.
Increased transpulmonary pressures (PIP - Plateau pressure) are indicative of
increased airways resistance.
A respiratory therapist is ventilating a patient with a self-inflating bag-valve resuscitation device. Following each compression, the bag refills slowly permitting no more than one breath every 10 seconds. To correct this problem, the therapist should
B. The most likely cause of the slow refilling time is an obstructed intake valve.
A patient with status asthmaticus requires continuous mechanical ventilation. The dynamic compliance value has decreased sharply over a 1-hour period. Which of the following drugs may be expected to elicit the most rapid improvement in dynamic compliance?
C. Albuterol is a rapid-acting bronchodilator and is appropriate for use in this setting.
Which of the following could result in an increase in pulmonary vascular resistance (PVR)?
B. Excessive PEEP can compress the pulmonary vessels, resulting in an increase in PVR.
A patient who is conscious with an intact gag reflex requires an artificial airway to prevent obstruction of the upper airway by the tongue. Which of the following types of airways is most appropriate in this situation?
D. A nasopharyngeal airway may prevent obstruction of the upper airway by the tongue without eliciting a gag reflex.
graphic demonstrates a loss of volume from the circuit and the source of
leak
While a respiratory therapist auscultates a patient's chest, the patient repeats the words, one, two, three. An increase in vocal clarity and intensity is noted in the right lower lobe compared to the other lung fields. Which of the following does this most likely indicate?
C. Consolidation increases density resulting in increased voice sounds.
Which of the following findings is expected in a patient with right heart failure?
1. neck vein distention
2. atrophy of accessory ventilatory muscles
3. peripheral edema
4. blood-tinged sputum
1
3
A patient with severe COPD continues to complain of dyspnea on a home regimen that includes ipratropium bromide (Atrovent) and fluticasone propionate/salmeterol (Advair Diskus). A respiratory therapist should recommend adding
C. The GOLD guidelines recommend the addition of theophylline when a patient with severe COPD is not adequately controlled with the use of beta-agonists, ipratropium, and inhaled corticosteroids.
An 8-year-old child with a history of severe kyphoscoliosis is receiving volume-controlled ventilation in the PACU following an appendectomy. The respiratory therapist notes that the compressible volume is 50% of the set tidal volume on a 22 mm circuit. Which of the following should the therapist do?
D. Changing to a pediatric circuit (15 mm) would decrease the compressible volume loss and improve gas delivery to the patient.
Which of the following drugs is the most appropriate to paralyze a sedated 30-year-old patient with status asthmaticus who is receiving mechanical ventilation?
A. Vecuronium is a muscle paralyzing agent without the danger of producing histamines and hypotension.
A patient is ordered to receive albuterol 5 mg and ipratropium bromide (Atrovent) 0.5 mg every 20 minutes for three treatments. The pharmacy provided two 0.083% albuterol unit dose vials and one ipratropium bromide (Atrovent) unit dose vial for each treatment. After the first 20 minutes, one-half of the volume remains in the nebulizer. Which of the following should the respiratory therapist do before the next treatment?
A. This would allow complete nebulization of the prescribed dose.
While performing internal quality control on a blood gas analyzer for PaCO2, a respiratory therapist notes a consistent trend of data points approaching two standard deviations above the mean. Which of the following actions is most appropriate?
B. Trending of data points outside the statistical limit is a bias or system error. Such errors mean there is something wrong with an analyzer component, which may need repair or replacement.
Which of the following most consistently delivers the highest water vapor content to a patient's airway?
C. The combination of heat and high surface area between the water-saturated wick and the gas produces the most water vapor among these devices.
A patient with COPD is receiving oxygen 2 L/min by nasal cannula at home. The SpO2 is normally between 88-90% on 2 L/min. While evaluating the patient, the respiratory therapist finds the patient to be lethargic. The therapist also observes the concentrator is set at 4 L/min and the SpO2 is 96%. Which of the following should the therapist immediately do?
B. This patient needs an adequate PaO2 but not high enough to blunt the hypoxic drive.
A respiratory therapist is administering 1.25 mg of albuterol by small-volume nebulizer. The patient's heart rate increases from 110/min to 140/min 5 minutes after the treatment is started. Which of the following should the therapist do?
A.Allow the patient to rest briefly and then continue the treatment.
B.Continue the treatment after adding 1 mL of saline to the nebulizer
.C.Recommend administering cromolyn sodium (Intal) for the next treatment.
D.Terminate the treatment and monitor the patient's heart rate.
D. Onset occurs within 5-15 minutes of inhalation and the effect may persist for up to 6 hours.
A patient's v/q scan indicates normal ventilation with absent perfusion in the left lower lobe. These results suggest
C. This is the classic description of a pulmonary embolism where the alveolar unit is normally ventilated, but pulmonary capillary blood flow is impeded by the presence of a clot.
A respiratory therapist notices that a patient using a tracheostomy collar with cool aerosol at 60% oxygen is unable to bring up any secretions. The small amount of secretions the patient coughed up earlier were very thick. After finding nothing else remarkable, the therapist should recommend
D. A heated nebulizer would increase the moisture content of the delivered gas and improve removal of thick secretions.
Which of the following can a respiratory therapist do to increase mean airway pressure?
D. Adding inspiratory plateau would increase mean airway pressure.
A respiratory therapist is called to see a 59-year-old patient who has been in a persistent vegetative state for several months following a stroke. He is diaphoretic and has a pulse of 120/min and an SpO2 of 81% with a 28% tracheostomy collar. The therapist is unable to pass a suction catheter. Which of the following should the therapist immediately do?
B. The patient appears to have an obstructed tracheostomy tube and it must be replaced.
Upon entering a patient's room after lunch was served, a respiratory therapist discovers the patient unresponsive and lying in bed. The decision to perform the obstructed airway routine depends on the
.D.observation of a partially eaten lunch.
A. After determining unresponsiveness and breathlessness, the next procedure is rescue breathing. The chest rising after a rescue breath indicates a patent (not obstructed) airway, and therefore, CPR should be implemented, not the obstructed airway routine.
When evaluating a patient receiving oxygen at an FIO2 of 0.60 from a blender and heated wick humidifier, a respiratory therapist observes an SpO2 of 84%. Breath sounds are clear bilaterally. The therapist notes the absence of alarms when the oxygen high pressure hose is disconnected from the wall outlet. Which of the following should the therapist do?
A.Initiate beta-agonist therapy
.B.Suction the patient.
C.Replace the oxygen blender.
D.Increase the set FIO2 to 0.70.
C. The oxygen delivery system is not functioning properly and needs to have the blender replaced because it is defective.
Which of the following should a respiratory therapist check while preparing for a nasotracheal intubation procedure?
1. integrity of the cuff
2. availability of Magill forceps
3. presence of a stylet in the tube
4. availability of a water-based lubricant
1
2
4
After attaching a cardiac monitor to a patient's chest, a respiratory therapist notes the ECG recording contains artifact. Which of the following could cause artifact in this situation?
1. inadequate electrode contact
2. improper electrode placement
3. the patient scratching the electrodes
4. disconnected leads
1
3
While performing a patient-ventilator check, a respiratory therapist observes very little condensation in the heated wire circuit. The heated wick humidifier contains an appropriate amount of water. The most likely explanation is that the
B. The heated wire circuit is designed to maintain gas temperature to prevent condensation.
During volume-controlled ventilation, the high pressure alarm should be set at least 10 cm H2O above which of the following pressures?
A. Setting the high pressure alarm 10 cm H2O of pressure above peak airway pressure allows minor fluctuations in peak airway pressure without allowing dangerous increases to go unnoticed.
During bronchoscopy with a biopsy, possible complications include
A 43-year-old patient with ARDS is receiving pressure-controlled ventilation. The PEEP level is changed from 12 to 16 cm H2O. Immediately following this change, a respiratory therapist should monitor
D. Vital signs need to be monitored because blood pressure can fall rapidly after increasing PEEP.
A patient receiving mechanical ventilation requires frequent suctioning. He has a history of developing PVCs during suctioning procedures. A respiratory therapist should
1. limit the duration of the suctioning.
2. increase the FIO2 before, during, and after suctioning.
3. observe the patient's ECG monitor while suctioning.
4. request an anti-arrhythmic medication for the patient.
1
2
3
What volume of a 1:200 dilution should a respiratory therapist use to administer 2.5 mg of a medication?
A.0.30 mL
B.0.40 mL
C.0.50 mL
D.0.75 mL
The first step is to convert the drug strength to milligrams in each milliliter (1:200 = 1 g /200 mL * 1000 mg / g = 1000 mg / 200 mL = 5 mg / mL).
The second step is to set up a proportion of the milligrams per milliliter of the stock solution with the quantity for the specified dose unknown (5 mg / 1 mL = 2.5 mg / x mL).
Rearrange by cross multiplying (5 mg * x mL = 2.5 mg * 1 mL).
