Extra CRT

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Extra CRT
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2012-12-01 19:52:27
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  1. When using an IPPB device!
    Pure oxygen is delivered when the air mixed knob is pushed in
  2. An adult patient with bronchitis has received bland aersol therapy. Auscultation revels rhonchi (crackles) in both lung bases. What should be recommended?
    The patient should be encouraged to cough


    Having the patient cough vigorously is the simplest and easiest way to mobilize secretions. If coughing is ineffective, a mucolytic drug or postal drainage therapy may be indicated
  3. Beclomethasone (Vancerial)
    Is an inhaled steriod that is widely used to manage asthma
  4. Flumazenil (Romazicon)
    Is used to reverse the drug effects of benzodiazepine drugs, such as diazepam (valium)
  5. Which of the following techniques measured total lung capacity?


    1. Helium diulution
    2. Body plethysmograph
    3. Single Breath nitrogen elimation
    1 and 2 only
  6. What will give the most accurate measurement of volume and flow?
    Collins water sealed spirometer
  7. Which of the following drugs should the therapist recommend for a patient with a serious gram negative infection?


    A. Tobramycin (Nebcin)
    B. Cefaclor (Ceclor)
    C. Doxapram (Dopram)
    D. Pentamidine (NebuPent)
    Tobramycin (Nebcin)
  8. 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?


























    A. Replace the air-entrainment mask.
    B. Decrease the oxygen flow.
    C. Assess the patency of the air-entrainment port.
    D. Calibrate the oxygen analyzer and remeasure.
    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.






  9. Which of the following should a respiratory therapist select to determine the rapid-shallow breathing index?

































    A. vane respirometer
    B. peak flowmeter
    C. pressure manometer
    D. water-seal spirometer
    • A. Vane respirometry
    • A vane respirometer is portable and accurate for the measurement of minute ventilation in this situation.






  10. 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.






  11. An adult patient is intubated after being pulseless for several minutes. An exhaled CO2 detection device indicates 0.03% CO2despite 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 laryngoscopy
    B. another CO2 detection device
    C. stat chest radiograph
    D. pulse oximetry
    A. Direct visualization of the larynx with a laryngoscope will confirm the tube has passed through the cords.






  12. 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

























    A. suction the patient.
    B. terminate the treatment.
    C. decrease the peak pressure to 10 cm H2O.
    D. stop the treatment for 10 to 20 minutes.
    B. 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.






  13. 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

























    A. increase oxygen flow to the device.
    B. add a PEEP valve to the resuscitation device.
    C. inspect the intake valve for proper function.
    D. remove accumulated secretions from the patient connection.
    C. The most likely cause of the slow refilling time is an obstructed intake valve.






  14. 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?

























    A. pleural effusion
    B. consolidation
    C. pneumothorax
    D. normal finding
     B. Consolidation increases density resulting in increased voice sounds.






  15. 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

























    A. theophylline (Aminophylline).
    B. montelukast (Singulair).
    C. acetylcysteine (Mucomyst).
    D. glyceryl guaiacolate (Guaifenesin).
    • Theophulline 
    • A. 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.






  16. 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. d-tubocurarine
    B. morphine sulfate
    C. vecuronium (Norcuron)
    D. succinylcholine (Anectine)
     C. Vecuronium is a muscle paralyzing agent without the danger of producing histamines and hypotension
  17. A patient with a head injury has increased intracranial swelling. What drugs should the therapist recommend to reduce ICP?

    1. Acetazolamide (Daimox)
    2. Mannitol (Osmitrol)
    3. Succinylcholine
    • Acetazolamide (Daimox)
    • Mannitol (Osmitrol)
  18. A patients developes ascites and shortness of breath. where is tissue edema most likely to show up first?
    Abdomen
  19. A patient's chest X ray reveals increased vascular engorgement emanating from the hilar area in a batwing pattern. What is the most likely cause of this finding?
    Fluid overload
  20. Which of the following can be used to calculate the inspiratory capacity?
    TLC-FRC
  21. When the FiO2 setting on a large volume nebulizer is changed from 40% to 60%, which of the following will occur?
    The density of the aerosol will increase
  22. The therapist receives an order for postural drainage and vibration. With the bed flat, the therapist places the patient in prone position with positions under his hip. Which lung segements are being treated with this position?
    Superior segement of the lower lobes
  23. A therapist is administering one rescuer CPR to an adult victim. Another therapist doing chest compressions should
    Start chest compressions at a rate of 100 compressions per minute
  24. The therapist is to suction a patient who has tested positive for the HIV. WHich of the following is the most appropriate infection control procedure to use for this patient>
    Standard
  25. To ensure that a patient on mechanical vent is receiving the actual volume the physician has ordered, which of the following should the respiratory therapist utilize?

    A. Dosimeter
    B. MEP manometer
    C. Respirometer
    D. Aneroid barometer
    Respirometer
  26. A patient receiving a loop diuretic such as furosemide (Lasix) would most likely need what type of electrode replacement?
    • K+
    • Cl-
  27. A therapist enters a patient's room during oxygen rounds. The patient has end stage emphysema and appears to be sleeping. The patient doesn't respond to questions and his pulse is 20 bpm. The therapist should immediately

    A. Confirm DNR status
    B. Go get help
    C. Begin rescue ventilation
    D. Begin chest compressions
    Confirm DNR status
  28. Which of the following drugs would be indicated for a 10 year old patient with asthma who presents to the emergency room with acute, extrinsically- induced bronshospasma?

    1. Montelukast
    2. Epinephrine
    3. Aminophylline
    4. Cromolyn sodium
    5. Levalbuterol
    • Epinephrine
    • Aminophylline
    • Cromolyn sodium
  29. Non rebreathing mask delivers what percent FiO2?
    0.21 to 100%
  30. Non rebreather Mask
    • Used to deliver 100% O2 in an emergency
    • (Pneumothorax, CO poisoning, CHF, Burns)
    • And for mixed gas therapy
    • Ideally has three one way valves
  31. Troubleshooting the Non rebreather mask!
    If a paitent inhales and bag does not slightly contract
    • Mask is not tight, seal mask
    • Non rebreathing valve is stuck, replace mask
  32. Physiologic Assessment
    Static compliance
    Normal: 60-100 ml/cm H2O

    Unacceptable: less than 25 ml/cm H2O
  33. Intial Settings for Mechanical Ventilation!
    Any Mode is acceptable

    Tidal Volume: 8-12 ml/kg (10 ml/kg)

    Respiratory Rate: 8-12

    FiO2: 40-60 or same as previous settings

    PEEP: 0-10 or same as previous settings
  34. Physiologic Assessment
    A-a DO2 (21% O2)
    Normal: 5-10 mm Hg
  35. Physiologic Assessment
    A-a DO2 (100% O2)
    Normal: 25-65

    Unacceptable: greater than 300
  36. Physiologic Assessment
    Qs/QT (Shunting)
    Normal: 2-5%

    Unacceptable: Greater than 20%
  37. Physiologic Assessment
    VD/VT (DeadSpace)
    Normal: 20-40%

    Unacceptable: greater than 20%
  38. Bedside Pulmonary Function
    Tidal Volume
    Normal: 5-8 ml/kg

    Unacceptable: less than 5 ml/kg
  39. Bedside Pulmonary Function
    Vital Capacity
    Normal: 65-75 ml/kg (10 x VT)

    Unacceptable: less than 10 ml/kg (2 x VT)
  40. Bedside Pulmonary Function
    Minute Ventilation
    Normal: 5-6 L/min

    Unacceptable: greater than 10 L/min 
  41. Bedside Pulmonary Function
    MIP
    Normal: -80

    Unacceptable: less than -20
  42. Bedside Pulmonary Function
    MEP
    Normal: 160

    Unacceptable: less than 40
  43. Cardiac Output
    Normal: 4-8 L/min
  44. Central Venous Pressure
    (CVP)
    • Normal: 2-6
    • Monitor fluids
  45. Central Venous Pressure (CVP) increases with!
    • Right heart failure
    • Cor Pulmonale
    • Tricuspid valve stenosis
    • Hypervolemia
  46. Central Venous Pressure (CVP) decreases with!
    Hypovolemia
  47. Pulmonary Wedge Pressure
    (PWP)
    • Normal: 8-10
    • Left heart=wedge pressure
    • mitral valve
  48. Pulmonary Wedge Pressure (PWP) is increased with!
    • Left heart failure
    • Mitral valve stenosis
    • CHF
    • High PEEP effect
    • Hypervolemia
  49. Pulmonary Wedge Pressure (PWP) is decreased with!
    Hypovelemia
  50. Pulmonary Artery Pressure
    (PAP)
    • Normal: 25/8 ; mean: 14
    • Increased with lung problems
  51. Pulmonary artery pressure (PAP) increases with!
    • Lunf disorders
    • Pulmonary embolism
    • Pulmonary hypertension
    • AIr embolism
    • Hypervolemia
  52. Pulmonary artery pressure (PAP) decreases with!
    Hypovelemia
  53. Red blood cells
    Normal: 4-6 mill/mm

    RBC x 3 = Hg
  54. High RBC (Polucythemia)
    Chronic tissue hypoxemia (COPD)
  55. Low RBC (anemia)
    • Blood loss
    • Hemorrhage
  56. Hemoglobin
    Normal: 12-16

    RBC x 3 = Hg
  57. White blood cells
    Normal: 5,000 to 10,000
  58. Increased WBC (leukocutosis)
    Bacterial infection
  59. Decreased WBC (leukopenia)
    Viral infection
  60. Normal heart rate for infant
    110-160
  61. Normal respiratory rate for Infants
    30-60
  62. Normal blood pressure for infants
    60/40
  63. Normal blood gas for new born
    pH should be greater than 7.30

    PaCO2 should be less than 50

    PaO2 should be greater than 60
  64. The A-a Gradient
    (A-aDO2)
    Normal: 25 - 65 mm Hg on 100%

    V/Q mismatch: 66-300 mm Hg

    Shunting: greater than 300 mm Hg
  65. Normal Arterial Oxygen Content (CaO2)
    Normal: 17-20%
  66. Mixed venous oxygen content (CVO2)
    Bad arteriol

    Normal: 14% (12- 16%)

    Represents the cardiac function

    Draw from pulmonary artery

    CVO2 value will decrease when cardiac output decreases
  67. Arteriol-Venous Oxygen content difference
    C(a-v)O2
    Measures the oxygen consumption of the tissues

    Normal: 4-5%

    Will increase when the CvO2 is decreasing and would indicate a decreasing cardiac output
  68. PaO2/FiO2 ratio
    Used in the determination of ALI or ARDS

    Normal: 380 or greater

    ALI: less than 300

    ARDS: less than 200
  69. Shunt Equation
    (QS/QT)
    The portion of the cardiac output (QS) that is shunted (QT)

    Normal:2-5%
  70. Deadspace to tidal volume Ratio
    (VD/VT)
    Ventilation without perfusion

    Normal: 20 to 40% (Up to 60% in ventilated patients
  71. An increase in the VD/VT ratio indicates:
    A deadspace producing disease (pulmonary Embolus)
  72. Direct meds threw ETT
    NAVEL
    Narcan-----Narcotic overdose

    Atropine------Bradycardia

    Valium/Versed-------Sedative

    Epinephrine-------Asystole

    Lidocaine-------PVC
  73. A previously healthy 30-year-old patient is hospitalized with chills and fever. A chest radiograph is consistent with right upper lobe pneumonia. Which of the following is most likely to aid in the patient's management?

    A. in-exsufflation


    B. coached coughing and deep breathing

    C. bland aerosol therapy

    D. spirometry before and after a bronchodilator
    B. Coached coughing and deep breathing will assist the patient with secretion removal and help open the consolidated area.






  74. During a bedside interview of a patient with COPD, a respiratory therapist asks the patient how he accepts the limitations of his daily activities. Which of the following is the therapist most likely assessing?





























    A. emotional state
    B. exercise tolerance
    C. level of cooperation
    D. work of breathing
    A. The emotional state can be assessed by evaluating the patient's attitudes, thoughts, and motivational characteristics as part of the affective domain.






  75. A 50-year-old patient with a tracheostomy is receiving VC ventilation. The high pressure alarm is sounding intermittently and the exhaled tidal volume is reduced. Which of the following should a respiratory therapist do?

























    A. Change the mode of ventilation.
    B. Increase the high pressure alarm setting.
    C. Suction the tracheostomy tube.
    D. Administer a beta-agonist
    C. Suctioning the patient will allow delivery of the set tidal volume by decreasing airway resistance






  76. A 55-year-old patient has the following examination results:

    -  dullness to percussion
    -  decreased tactile fremitus
    -  dry non-productive cough
    -  diminished breath sounds
    -  dyspnea


    Which of the following could produce these findings?

























    A. pleural effusion
    B. consolidation
    C. pneumothorax
    D. atelectasis
    A. These findings are consistent with a pleural effusion.






  77. A 32-week-gestational age neonate has apneic episodes with bradycardia. A respiratory therapist should recommend

























    A. albuterol.
    B. caffeine citrate.
    C. methylprednisolone sodium succinate (Solu-Medrol).
    D. indomethacin (Indocin).
    B. Caffeine citrate stimulates the immature central nervous system and reduces the frequency of episodes of apnea of prematurity.






  78. Which of the following is the best emergency back-up for a hospital's bulk liquid oxygen system?



























    A. secondary liquid supply
    B. oxygen concentrators
    C. portable E cylinders
    D. portable liquid system
    A. A secondary liquid supply is the best choice for back-up in case of failure of a bulk liquid O2 system.






  79. Which of the following medications administered in the therapeutic range is most likely to interfere with a patient's ability to cooperate?

























    A. cortisone
    B. furosemide (Lasix)
    C. theophylline (Aminophylline)
    D. phenobarbital
    D. Phenobarbital is a long-acting barbiturate of the sedative/hypnotic class and can interfere with a patient's ability to cooperate.






  80. Which of the following is the most effective for destroying all microorganisms?

























    A. acetic acid
    B. pasteurization
    C. autoclave
    D. isopropyl alcohol
    C. Autoclaving uses super-heated steam under pressure and will kill almost all microorganisms.






  81. A 58-year-old male presents to the emergency department with bilateral expiratory wheezes, unresponsive to aerosolized beta-agonists. Which of the following is the most appropriate for acute management of this patient?

























    A. fluticasone/salmeterol (Advair)
    B. subcutaneous epinephrine
    C. 80%/20% heliox
    D. systemic steroids
    D. According to NHLBI Guidelines, systemic steroids are the medication of choice in patients unresponsive to short-acting beta-agonists.






  82. Expiratory grunting in a 32-week gestational age neonate who is in respiratory distress will

























    A. decrease apneic episodes.
    B. decrease atelectasis.
    C. increase the PaCO2.
    D. increase blood flow to the vena cava.
    B. An expiratory grunt occurs when the infant exhales against a partially closed glottis in an attempt to increase functional residual capacity and promote end-expiratory alveolar stability.






  83. Which of the following is the major function of the baffle in a nebulizer?

























    A. entraining water from the capillary tube
    B. providing aerosol particles that are consistently small
    C. mixing aerosol particles with the main gas flow
    D. promoting laminar inspiratory flow
    B. An object that is in the path of the aerosol stream can function as a baffle to cause larger particles to return to the liquid reservoir and only allow small particles to travel on to the patient through the gas stream.

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