good luck.txt

Card Set Information

Author:
madali03
ID:
267953
Filename:
good luck.txt
Updated:
2014-11-04 12:06:34
Tags:
good luck
Folders:

Description:
good luck
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user madali03 on FreezingBlue Flashcards. What would you like to do?


  1. Measurement of which of the following would be most useful in evaluating the effectiveness of fluid replacement therapy in a critically ill patient?

    a. systemic vascular resistance
    b. pulmonary vascular resistance
    c. pulmonary artery pressure
    d. central venous pressure
    • d
    • Because all blood returning to the right heart dumps into the right atrium, the central venous pressure is an accurate reflection of the adequacy of preload (blood volume in the right atrium). Therefore, the measurement of the central venous pressure is the most sensitive indicator regarding the effectiveness of fluid replacement therapy.
  2. Which of the following best explains the closing capacity test?

    a. it indicates the degree of lung expansion the patient is capable of
    b. it reflects the status of the small airways
    c. it provides a measurement of the ventilation to pulmonary perfusion uniformity
    d. it provides a measurement of the patient's ability to deep breathe and cough
    • b
    • The closing capacity represents the volume at which closure of the small airways occurs.
  3. Which of the following would a respiratory therapist evaluate when assessing the Silverman score of a neonate?

    1. xiphoid retractions
    2. ventilatory rate
    3. skin color
    4. nasal flaring
    5. expiratory grunting

    a. 1, 4, and 5 only
    b. 3, 4, and 5 only
    c. 1, 2, and 3 only
    d. 1, 2, 3, 4, and 5
    • a
    • The components of the Silverman scoring system include assessing the 1) upper chest movement, 2) lower chest movement, 3) xiphoid retractions, 4)dilation of the nares (nasal flaring), and 5) expiratory grunting.
  4. Which of the following best describes the diagnostic value of the pre- and post-bronchodilator test?

    a. it provides a measurement of the effectiveness of bronchodilator administration
    b. it provides a measurement of the distribution of ventilation
    c. it provides a measurement of airway reactivity
    d. it provides a measurement of the allergic response to allergens
    • a
    • The purpose of performing a pre- and post-bronchodilator test is to determine the effectiveness of bronchodilator administration.
  5. Which of the following best describes the respiratory response to metabolic alkalemia?

    a. the respiratory response generally takes 2 to 3 days to activate
    b. the respiratory response is to attempt to adjust the pH upwards
    c. metabolic alkalemia excites the respiratory center, causing hyperventilation
    d. metabolic alkalemia depresses the respiratory center, causing hypoventilation
    • d
    • Metabolic alkalemia depresses the respiratory center, and hypoventilation ensues. However, as hypoventilation develops, it is accompanied by hypoxia, which then offsets the degree of respiratory depression. Generally, the PaCO2 does not rise above 60 mmHg in fully compensated metabolic alkalosis.
  6. Following the insertion of a chest tube in a mechanically ventilated adult patient, the ventilator's low exhaled volume alarm sounds repeatedly. The respiratory therapist notes that the exhaled volume is 170 mL less than the preset tidal volume. Which of the following actions would be most appropriate at this time?

    a. measure the volume a the machine outlet
    b. measure the volume loss through the chest tube
    c. increase the preset tidal volume by 170 mL
    d. decrease the low exhaled volume alarm setting by 170 mL
    • b
    • In this situation, the most likely cause of the low exhaled volume is loss of volume through the newly placed chest tube. Measuring the volume lost through the chest tube would confirm this. Increasing the preset tidal volume by 170 mL is inappropriate without first finding the cause of the problem. Decreasing the low exhaled volume alarm setting by 170 mL will prevent the alarm from being activated, but this does not find the cause of the problem. This may also be detrimental to the patient. Measuring the volume at the machine outlet is an unlikely cause for a sudden decrease in exhaled volume.
  7. Which of the following are considered complications of the thoracentesis procedure?

    1. pneumothorax
    2. chest pain
    3. vasovagal syncope
    4. hemothorax

    a. 1, 2, and 3 only
    b. 1, 2, and 4 only
    c. 1 and 4 only
    d. 1, 2, 3, and 4
    • d
    • Complications of thoracentesis includes 1) pneumothorax, 2) cough, 3) chest pain, 4) vasovagal syncope, 5) infection, and 6) hemothorax.
  8. Which of the following should be monitored when suctioning a newborn?

    1. heart rate
    2. color
    3. reflex irritability
    4. ventilatory effort

    a. 1 and 2 only
    b. 1, 2, and 4 only
    c. 1, 2, and 3 only
    d. 1, 2, 3 and 4
    • a
    • Of the items listed, only the heart rate (observe for bradycardia) and color (observe for cyanosis) are essential to monitor during suctioning of a newborn.
  9. Components of neurologic environmental management for an infant include which of the following?

    1. noise reduction
    2. light reduction
    3. minimal physical stimulation
    4. uninterrupted sleep

    a. 1, 2, 3, and 4
    b. 1 and 2 only
    c. 1, 2, and 3 only
    d. 3 and 4 only
    • a
    • The rationale for neurologic environmental management is to prevent sensory overload. Sensory overload of an infant may lead to intraventricular hemorrhage (IVH) or abnormal neurologic development. All of the items listed are components of neurologic environmental management for an infant.
  10. For which of the following reasons is a nebulizer not used when setting up an oxygen hood that is to be used on an infant?

    1. a nebulizer produces excessive noise
    2. a nebulizer has the potential of precipitating bronchospasm
    3. a nebulizer has the potential for causing infection
    4. a nebulizer has the potential to cause fluid overload

    a. 1 and 3 only
    b. 2 and 4 only
    c. 1, 2, and 3 only
    d. 1, 2, 3, and 4
    • d
    • All of the items listed are reasons why a nebulizer is not used when setting up an oxygen hood that is to be used on an infant. A heated humidifier is preferred over a nebulizer.
  11. Which of the following is the most reliable method for verification of endotracheal tube placement following intubation?

    a. chest auscultation
    b. observing the presence of exhaled tidal volumes during bag ventilation
    c. observing chest movement during bag ventilation
    d. end-tidal carbon dioxide detection
    • d
    • All of the methods listed can help verify endotracheal tube placement following intubation, but the most reliable method is with end-tidal carbon dioxide detection.
  12. A respiratory therapist is assisting the physician during bronchoscopy. Toward the end of the procedure, the physician pulls the bronchoscope from the lungs and exclaims that no light is being emitted from the tip of the bronchoscope. The therapist could do which of the following to correct the problem?

    1. ensure that the power cord is plugged into the wall outlet
    2. clean the tip of the bronchoscope with sterile gauze
    3. ensure that the bronchoscope is properly connected to the power source

    a. 1 and 3 only
    b. 1 only
    c. 2 only
    d. 1, 2, and 3
    • d
    • Loss of power, an obstructed bronchoscope tip, and a loosely connected bronchoscope to the power source could all cause failure of light transmission. The therapist should check all of them to find which one is causing the problem.
  13. Translaryngeal intubation is usually the route of choice in which of the following situations?

    1. failure to intubate the trachea
    2. upper airway trauma, laryngeal, and esophageal damage
    3. failure to establish a patent airway

    a. 1, 2, and 3
    b. 2 only
    c. 2 and 3 only
    d. 1 and 2 only
    • a
    • According to the Clinical Practice Guidelines published by the American Association for Respiratory Care, failure to intubate the trachea; upper airway trauma, laryngeal, and esophageal damage; and failure to establish a patent airway are indications for translaryngeal intubation.
  14. While evaluating a home care patient during a monthly visit, the patient tells the respiratory therapist that for the past 2 days his secretions have been thick and yellow and that he has become increasingly short of breath. The therapist would most likely suspect that the patient:

    a. has been using contaminated equipment
    b. has not been complying eighths prescribed therapeutic modalities
    c. has been suing outdated medications
    d. has a pulmonary infection
    • d
    • Shortness of breath with thick and yellow secretions is highly suggestive of pulmonary infection. You would not know if the remaining choices are true or not without questioning the patient for compliance to therapy, inspecting medications for expiration date, and inspecting equipment for cleanliness.
  15. Which of the following would be important in the management of a trauma patient during air-transport?

    1. an adequate oxygen source
    2. administration of IV fluids
    3. availability of emergency medications
    4. arterial blood gas sampling and analysis

    a. 1 and 3 only
    b. 1, 2, and 3 only
    c. 1, 2, 3, and 4
    d. 2 and 4 only
    • b
    • All of the items in the list are essential in stabilizing a trauma patient during air transport except the ability to perform arterial blood gas sampling and analysis. Arterial blood gas sampling and analysis would necessitate the use of a blood gas machine. Because of the maintenance and gas sources required for a blood gas machine, as well as its unwieldy size, it would not be practical to use during air transport.
  16. Which of the following are important factors to consider when selecting a home oxygen delivery system?

    1. the patient's personal preferences
    2. the patient's lifestyle
    3. the patient's oxygen requirements

    a. 2 and 3 only
    b. 1 and 2 only
    c. 1, 2, and 3
    d. 3 only
    • c
    • 1. TRUE - the patient's personal preferences should be considered when selecting a home oxygen delivery system. This could improve compliance to therapy. 2. TRUE - considering the patient's lifestyle, whether he/she is active or sedentary, is an important consideration when selecting a home oxygen delivery system. For example, an active patient would require a portable system such as the liquid oxygen system while the oxygen concentrator would be more appropriate and economical for a sedentary patient. 3. TRUE - the patient's oxygen requirements is a very important consideration when selecting a home oxygen delivery system. For example, if the patient requires high oxygen flows, the liquid oxygen system would be more appropriate than the oxygen concentrator.
  17. Which of the following are important considerations when implementing a graded exercise program for a pulmonary rehabilitation patient?

    1. frequency of exercise
    2. type of exercise
    3. intensity of exercise
    4. duration of each exercise session

    a. 1 and 2 only
    b. 1, 2, and 4 only
    c. 1, 2, 3, and 4
    d. 2 and 3 only
    • c
    • All of the items in the list (frequency, type, intensity, and duration of exercise) are important considerations when implementing a graded exercise program and are determined primarily by the patient's condition and tolerance to exercise.
  18. A physician has requested the assistance of the respiratory therapist in performing a transtracheal aspiration procedure. In preparation for the procedure, the respiratory therapist should thoroughly clean and anesthetize:

    a. the suprasternal notch area
    b. between the first and second tracheal rings
    c. at the level of the cricothyroid membrane
    d. above the first tracheal ring
    • c
    • Since the puncture site for transtracheal aspiration is through the cricothyroid membrane, this area should be thoroughly cleansed and anesthetized prior to the procedure.
  19. Which of the following should be assessed after performing an emergency orotracheal intubation?

    1. level of consciousness
    2. presence and character of breath sounds
    3. ease of ventilation
    4. chest symmetry and amount of chest movement
    5. skin color and character

    a. 2, 3, 4, and 5 only
    b. 1, 3, and 5 only
    c. 2 and 4 only
    d. 1, 2, 3, 4, and 5
    • d
    • According to the Clinical Practice Guidelines published by the American Association for Respiratory Care, assessing the level of consciousness; presence and character of breath sounds; ease of ventilation; chest symmetry and amount of chest movement; and skin color and character are indicated following orotracheal intubation.
  20. Which of the following conditions would require emergency tracheal intubation?

    1. persistent apnea
    2. accidental extubation of the patient unable to maintain adequate spontaneous ventilation
    3. laryngotracheobronchitis
    4. obstructive angioedema
    5. uncontrolled upper airway bleeding

    a. 1, 4, and 5 only
    b. 2, 3, and 4 only
    c. 1, 2, and 5 only
    d. 1, 2, 4, and 5 only
    • d
    • All of the items in the list are situation in which the airway is either unprotected or compromised except laryngotracheobronchitis (croup). With croup, there is subglottic edema which is usually relieved by administering and upper airway vasoconstrictor (such as racemic epinephrine).


  21. A respiratory therapist has just entered the room of a patient being resuscitated. The patient is intubated and being manually ventilated with an FIO2 of 1.0.

    The ECG tracing shown above is displayed on the cardiac monitor.

    At this time, the respiratory therapist should recommend which of the following?

    a. administer IV epinephrine
    b. obtain an arterial blood gas sample
    c. discontinue CPR and administer IV atropine
    d. continue CPR and increase the ventilatory rate
    • c
    • The ECG rhythm is Second-Degree AV Block, Mobitz II. Second-Degree AV Block, Mobitz II is a serious AV block that may progress to complete heart block. The patient must be monitored for trend information. Atropine is indicated to accelerate electrical conduction through the AV node. A temporary or permanent pacemaker may be inserted to assure adequate ventricular response. CPR is not indicated for second degree heart block, only atropine or a pacemaker.
  22. A 30-month-old male who was reportedly electrocuted while playing with an electrical cord has been admitted to the emergency department. He is apneic and is currently being ventilated with a bag-valve-mask device. There are burns (entrance and exit wounds) on each hand. The ECG rhythm displayed on the cardiac monitor show fine ventricular fibrillation. There is good mask seal and the chest is rising adequately with ventilations. Which of the following should be the next step in the treatment of this child?

    a. defibrillation with 2 joules/kg
    b. administer atropine at a dose of 0.02 mg/kg
    c. establish and intravenous line
    d. intubation with a 4.5 mm I.D. endotracheal tube
    • a
    • According to the american Heart Association's guidelines for advanced cardiac life support, a post-electrocuted pediatric patient who has a shockable ECG rhythm (in this case, fine ventricular fibrillation) should be immediately defibrillated with 2 joules/kg. To delay defibrillation in order to intubate or establish an IV line is highly detrimental to the patient. Atropine would be indicated only after the heart rate has been restored, and then only for hypotensive bradycardia.
  23. Initiating and maintaining a respiratory care protocol requires a team effort among:

    1. the medical director of respiratory care
    2. a program leader to oversee planning and keep the protocol on track
    3. interested physicians to plan and utilize the protocol
    4. respiratory therapists who will implement the protocol

    a. 1, 3, and 4 only
    b. 1, 2, 3, and 4
    c. 2 and 4 only
    d. 1, 2, and 3 only
    • b
    • All of the members listed are vital when initiating and maintaining a respiratory care protocol.
  24. Which of the following are appropriate suctioning guidelines for infants?

    1. insert the suction catheter only 1 cm beyond the distal end of the endotracheal tube's tip
    2. limit total suction time to 20 seconds
    3. limit the vacuum level to 50-75 mmHg
    4. do not use saline
    5. do not turn the head to suction

    a. 3 only
    b. 1, 2, 3, 4, and 5 only
    c. 1, 3, 4, and 5 only
    d. 1, 2, and 3 only
    • c
    • Recommended suctioning guidelines for infants include 1) suction only when needed, 2) do not use saline, 3) do not turn the head to suction, 4) do not hyperventilate, 5) insert the catheter tip only 1 cm beyond the ETT tip, 6) limit total suction time to 10 seconds, 7) limit the vacuum level to 50-75 mmHg, and 8) pre-oxygenate 10-15% above the ventilator setting, unless severely hypoxemic, then pre-oxygenate with an FIO2 of 1.0.
  25. A 70-kg adult male patient is nasally intubated with a 7.5 mm endotracheal tube. After performing a minimal leak technique, the respiratory therapist records a cuff pressure of 14 mmHg. While auscultating the trachea, the therapist notes a slight leak of air passing around the cuff at peak airway pressure. Which of the following is the therapist's most appropriate action?

    a. inject air into the cuff until no air passes around the cuff at peak pressure
    b. increase the cuff pressure to 16 mmHg
    c. leave the cuff pressure at 14mmHg
    d. recommend changing the endotracheal tube
    • c
    • With the minimal leak technique, there should be a slight leak at peak pressure. Since the cuff pressure setting maintains this slight leak at peak pressure, it should b left at 14 mmHg.
  26. Twelve hours following admission, a spontaneously breathing, orally intubated patient admitted for narcotic overdose regains consciousness, becomes extremely agitated and needs restraining. At this time, the respiratory therapist should recommend which of the following?

    a. removal of the endotracheal tube
    b. reintubation with a nasotracheal tube
    c. sedation with diazepam (Valium)
    d. administration of naloxone (Narcan)
    • a
    • While in a drug-induced state, a patient is unable to adequately protect his airway, thus the reason for the endotracheal tube. Once the patient regains consciousness, the reason for the endotracheal tube no longer exists. Therefore, the patient should be extubated.
  27. An adult patient is receiving independent lung ventilation. The left lung is receiving conventional mechanical ventilation with PEEP while the right lung is receiving 40% humidified oxygen. The current chest x-ray shows slight resolution of a hemopneumothorax on the left with increasing radio-opacity in the right basal region with elevation of the right hemidiaphragm. Current arterial blood gas results are pH 7.37; PaO2 69 mmHg; PaCO2 41 mmHg; HCO3 23 mEq/L. On the basis of this information, which of the following should the respiratory therapist suggest?

    a. instituting mechanical ventilation to the right lung
    b. weaning the patient from left lung mechanical ventilation
    c. increasing PEEP to the left lung and increasing the FIO2 to the right lung
    d. applying CPAP to the right lung
    • d
    • The arterial blood gas results show a normal acid-base status with mild hypoxemia. The chest x-ray is highly suggestive of right lower lobe atelectasis. Applying CPAP to the right lung is the best treatment to increase the PaO2 and treat the right lower lobe atelectasis. CPAP will increase the functional residual capacity, improve oxygenation, and re-expand collapsed alveoli. The hemopneumothorax would need to be resolved before weaning the patient from left lung mechanical ventilation. Because the patient is adequately ventilating, mechanical ventilation of the right lung is not indicated. Increasing PEEP to the left lung is not justified at this time and increasing the FIO2 to the right lung may help, but it is not the best treatment at this time.
  28. The data below are obtained for a 70 kg (154 lb) male patient with COPD who is being mechanically ventilated.

    Ventilator Settings
    Mode: SIMV
    VT: 600 mL
    Set rate: 10/min
    FIO2: 0.40
    PEEP: 5 cmH2O

    Arterial Blood Gases
    pH: 7.36
    PaCO2: 61 mmHg
    HCO3: 33 mEq/L
    PaO2: 68 mmHg

    The respiratory therapist should recommend:

    a. administering a diuretic
    b. increasing the tidal volume
    c. maintaining current settings
    d. obtaining a repeat arterial blood gas sample
    • c
    • The ventilator settings and resulting arterial blood gas results are within acceptable ranges for an adult patient with COPD. Therefore, maintaining current settings is the most appropriate response.
  29. A patient with severe ARDS with a pulmonary artery catheter in place is receiving mechanical ventilation via volume ventilator. The patient requires an FIO2 of 1.0 and PEEP of 22 cmH2O to maintain an adequate PaO2. On occasion, the patient becomes combative and tries to get out of bed. Each time this occurs, the high pressure limit alarm sounds repeatedly and the SvO2 drops below 50%. The respiratory therapist should recommend:

    a. administering midazolam (Versed)
    b. increasing the PEEP level during combative episodes
    c. administering an inotropic agent to maintain an adequate SvO2
    d. administering pancuronium (Pavulon)
    • a
    • Because the patient's condition becomes extremely unstable during combative episodes leading to ineffective ventilation and oxygenation, the patient should be sedated with Versed. Administering Pavulon, a paralyzing agent, by itself without adequate sedation is inhumane and not justified.
  30. Following an excessive dose of furosemide (Lasix), a patient exhibits metabolic alkalosis. The most appropriate treatment for this patient is:

    a. potassium chloride supplement and fluid replacement therapy
    b. diazepam (Valium) to relieve anxiety
    c. epinephrine for anaphylactic shock
    d. acetazolamide (Diamox) to correct the acid-base disturbance
    • a
    • A side effect of furosemide (Lasix), a diuretic, is loss of potassium through excretion, resulting in hypokalemia. Hypokalemia leads to metabolic alkalosis. An excessive dose of furosemide may lead to severe hypokalemia with dehydration. Therefore, the most appropriate treatment in this situation is to administer potassium chloride supplement with fluid replacement therapy.
  31. A 6-year-old girl is admitted to the emergency department following a house fire. She is currently intubated and breathing spontaneously. Arterial blood gases and a carboxyhemoglobin (COHB) level have been obtained with the following results:

    pH: 7.39
    PaO2: 94 mmHg
    PaCO2: 42 mmHg
    COHB: 14.2%

    Which of the following interventions would be most appropriate at this time?

    a. volume control, tidal volume 250 mL, rate 20/min, FIO2 0.50, PEEP 5 cmH2O
    b. CPAP 5 cmH2O with an FIO2 of 0.60
    c. pressure control, inspratory pressure 15 cmH2O, rate 24/min, FIO2 1.0
    d. T-piece with an FIO2 of 1.0
    • d
    • Since the girl is adequately spontaneously ventilating (PaCO2 of 42 mmHg), mechanical ventilation is not indicated. What is a major concern at this time is the elevated COHB, which mandates an FIO2 of 1.0 until carbon monoxide bound to hemoglobin decreases to a safer level. The most appropriate intervention then is to place the patient on a T-piece with an FIO2 of 1.0.
  32. A physician has asked the respiratory therapist to assist with thoracentesis. During the procedure, the patient becomes agitated and diaphoretic. The heart rate is 126/min and the blood pressure is 80/56 mmHg. Respirations have become shallow and labored. Which of the following should the therapist do or recommend?

    a. reposition the patient while instructing him to relax
    b. administer high FIO2 oxygen and request a stat chest x-ray
    c. begin manual ventilation with an FIO2 of 1.0
    d. continue with the procedure while carefully monitoring the clinical status
    • b
    • The vital signs and clinical status of the patient are highly suggestive of a pneumothorax, which is a possible hazard during thoracentesis. To confirm this suspicion, a chest x-ray should be obtained. While waiting for the results, high FIO2 supplemental oxygen is indicated. Beginning manual ventilation with an FIO2 of 1.0 may help, but it is an incomplete response. The remaining choices are not appropriate or indicated at this time.
  33. A 44-year-old white male is admitted to the emergency department complaining of a feeling of tightness in the center of his chest beginning 2 hours ago. The tightness radiates to his left shoulder and has been constant. There is no other significant history other than smoking a pack of cigarettes per day for the last 15 years. Vital signs are as follows:

    Blood Pressure: 136/94 mmHg
    Pulse: 72 beats/min
    Respiratory Rate: 22 breaths/min
    Temperature: 98.9 degree F (37.2 degree C)

    Which of the following would be appropriate for the care of this patient?

    1. supplemental oxygen
    2. cardiac monitoring
    3. establishment of an intravenous line
    4. insertion of a pulmonary artery catheter

    a. 1, 2, and 3 only
    b. 2 and 4 only
    c. 1, 2, 3, and 4
    d. 1 and 3 only
    • a
    • The patient's clinical condition is highly suggestive of a myocardial infarction. Treatment for myocardial infarction consists of supplemental oxygen, cardiac monitoring, and establishment of an IV line for fluid and drug administration. Because the vial signs are relatively stable, insertion of a pulmonary artery catheter is not justified at this time.
  34. Following a laryngeal node biopsy, the patient complains of shortness of breath and a "tight" throat. Which of the following recommendations would be appropriate?

    a. administer ice chips p.r.n.
    b. racemic epinephrine (Vaponefrin) via small volume nebulizer
    c. cool aerosol via 30% aerosol mask
    d. heliox therapy via nonrebreathing mask
    • d
    • Heliox therapy is indicated for patients with upper airway obstruction due to laryngeal or tracheal tumors to reduce their work of breathing. Helium's value as a therapeutic gas is based solely on its low density. Since flow in the upper airway is turbulent, use of a low density gas in place of air or oxygen lowers the driving pressure needed to move air into and out of this area. With less pressure required to move air, the patient's work of breathing will decrease. Racemic epinephrine is not indicated because there is no data suggesting mucosal edema (as evidenced by the presence of stridor). 30% supplemental oxygen is not indicated because there is no data that indicates the patient is hypoxemic.
  35. A mechanically ventilated adult patient has been switched from pressure support ventilation to CPAP. The following data are measured and recorded.

    9:10 AM
    Heart Rate: 88/min
    Blood Pressure: 124/82 mmHg
    Respiratory Rate: 12/min

    9:30 AM
    Heart Rate: 92/min
    Blood Pressure: 128/82 mmHg
    Respiratory Rate: 14/min

    9:50 AM
    Heart Rate: 96/min
    Blood Pressure: 132/86 mmHg
    Respiratory Rate: 18/min

    On the basis of this information, which of the following should the respiratory therapist recommend?

    a. maintaining present therapy and continuing to monitor
    b. increasing the FIO2 and continuing to monitor
    c. switching to SIMV
    d. reinstituting pressure support ventilation
    • a
    • Because the vital signs from 9:10 AM to 9:30 AM to 9:50 AM remain stable and are within normal limits, the patient is tolerating CPAP quite well. Therefore, it would be most appropriate to recommend maintaining present therapy and continuing to monitor.
  36. Current data for a 79-year-old female patient with severe COPD who is receiving mask BiPAP are as follows:

    Inspiratory positive airway pressure (IPAP): 18 cmH2O
    Expiratory positive airway pressure (EPAP): 5 cmH2O
    FIO2: 0.28
    pH: 7.35
    PaO2: 59 mmHg
    PaCO2: 63 mmHg
    HCO3: 34 mEq/L

    Which of the following should the respiratory therapist recommend?

    a. decrease the EPAP level
    b. increase the IPAP level
    c. maintain current settings
    d. increase the FIO2
    • c
    • The arterial blood gas results show compensated respiratory acidosis with mild to moderate hypoxemia. Since these results are typical of a patient with severe COPD, the current BiPAP settings are appropriately set and should not be adjusted.
  37. A 34-week-old intubated neonate is receiving CPAP at 2 cmH2O with an FIO2 of 0.30. Arterial blood gas values are as follows:

    pH: 7.37
    PaO2: 76 mmHg
    PaCO2: 40 mmHg
    HCO3: 22 mEq/L

    On the basis of this information, which of the following should the respiratory therapist recommend?

    a. increase the CPAP to 4 cmH2O
    b. increase the FIO2 to 0.35
    c. institute mechanical ventilation
    d. extubate and administer 30% oxygen
    • d
    • Because the arterial blood gas results are good with minimal CPAP, it would be most appropriate to extubate the patient and administer an FIO2 of 0.30. Increasing the FIO2, instituting mechanical ventilation, or increasing the CPAP are not indicated based on the arterial blood gas results.
  38. The following data are recorded for an adult patient who is being mechanically ventilated via volume ventilator.

    Ventilator Settings
    Mode: SIMV
    Rate: 4/min
    VT: 850 mL
    FIO2: 0.35
    PEEP: 5 cmH2O

    Spontaneous Parameters
    Rate: 24/min
    VT: 150 mL
    VC: 950 mL

    Arterial Blood Gases
    pH: 7.35
    PaO2: 74 mmHg
    PaCO2: 43 mmHg
    HCO3: 23 mEq/L

    On the basis of this information, which of the following should the respiratory therapist recommend?

    a. increase the mandatory rate to 6/min
    b. initiate pressure support ventilation in conjunction with SIMV
    c. increase the PEEP to 10 cmH2O
    d. switch to assist/control mode of ventilation
    • b
    • Because the patient's spontaneous parameters show an increased work of breathing with ineffective spontaneous ventilation, providing support during spontaneous breathing is most indicated. This should help decrease the work of breathing as well as improve oxygenation. Therefore, the most appropriate recommendation is to initiate pressure support ventilation in conjunction with SIMV. Because the acid-base status is adequate, there is no justification at this time to switch the patient to assist/control or to increase the mandatory rate to 6/min. Although increasing the PEEP to 10 cmH2O should help with oxygenation, it is not the best intervention at this time.


  39. A 3-day-old infant is experiencing respiratory distress with substernal retractions and nasal flaring while receiving 40% oxygen via oxyhood.

    Arterial blood gas results are pH 7.28; PaO2 41 mmHg; PaCO2 42 mmHg; HCO3 19 mEq/L.

    The infant's most recent chest x-ray is shown above.

    Which of the following therapeutic interventions would be most appropriate at this time?

    a. intubate and initiate mechanical ventilation
    b. increase the oxygen to 50% and continue to monitor
    c. apply 5 cmH2O CPAP by nasal prongs with an FIO2 of 0.50
    d. increase the oxygen to 100% and continue to monitor
    • c
    • The arterial blood gas results show metabolic acidosis with hypoxemia. The chest x-ray is consistent with respiratory distress syndrome. On the basis of this information, applying 5 cmH2O nasal CPAP and increasing the FIO2 to 0.50 is the best method to increase the PaO2 in a patient with respiratory distress syndrome who is adequately ventilating (PaCO2 42 mmHg). Because the patient is adequately ventilating, intubation and mechanical ventilation are not warranted. An increase in the FIO2 to 50% or 100% may help, but it is not the best treatment at this time.


  40. The chest x-ray shown above was taken immediately after an oral endotracheal tube was placed.

    Based on this chest x-ray, which of the following should the respiratory care therapist recommend?

    a. reposition the endotracheal tube
    b. reintubate the patient
    c. continue with therapy
    d. obtain a repeat chest x-ray
    • c
    • The chest x-ray shows a properly positioned endotracheal tube below the top of the clavicles and above the carina. Therefore, the practitioner should recommend that therapy be continued.


  41. A 36-weeks gestation neonate is being mechanically ventilated via time-cycled pressure-limited ventilator.

    The ventilator settings are: PIP 28 cmH20; RR 32/min; I-time 0.6 sec.; flow rate 8 L/min; PEEP 6 cmH2O; and FIO2 0.45.

    The neonate's physician is concerned about the volume/pressure loop, which is shown above. The respiratory therapist could suggest which of the following?

    a. increasing the PEEP to 8 cmH2O
    b. decreasing the PIP to 24 cmH2O
    c. decreasing the flow rate to 4 L/min
    d. increasing the I-time to 0.8 sec.
    • b
    • The abnormally shaped volume/pressure loop (with the top of the loop resembling a bird's beak) is consistent with lung over-distention. To correct the over-distention, inflating pressure needs to be reduced. This can be effectively done by decreasing the PIP. Decreasing the flowrate may help correct the over-distention; however, a flow rate setting of 4 L/min is inappropriate. Increasing the PEEP to 8 cmH2O and increasing the I-time to 0.8 sec. would worsen the over-distention by either adding more pressure to the lungs or increasing the duration of time that pressure is held within the lungs.
  42. The respiratory therapist is monitoring a hospitalized patient recently diagnosed with myasthenia gravis. Over the last 24 hours, the patient's vital capacity has decreased from 2.6 liters to 1.4 liters. On the basis of this information, which of the following should the therapist recommend?

    a. increase the frequency of vital capacity monitoring
    b. intubation and mechanical ventilation
    c. continue to monitor the patient as prescribed
    d. intermittent positive pressure breathing treatments
    • a
    • With the vital capacity decreasing over a 24 hour time period, it is clear that the patient's condition is worsening rather than improving. However, with a vital capacity still above 1.0 liter, it is not to the point where intubation and mechanical ventilation are required. Because the vital capacity is at pre-critical level, the most appropriate action is to keep a closer watch on the vital capacity by increasing the frequency of vital capacity monitoring.
  43. The physician has asked the respiratory therapist to perform an optimal PEEP study for a patient who is severely hypoxic. Pertinent data are as follows:

    PEEP 5
    SaO2 78%
    Cardiac Output (LPM) 5.2

    PEEP 10
    SaO2 82%
    Cardiac Output (LPM) 4.9

    PEEP 15
    SaO2 87%
    Cardiac Output (LPM) 4.2

    PEEP 20
    SaO2 89%
    Cardiac Output (LPM) 3.6

    Which of the following is the most appropriate level of PEEP?

    a. 5
    b. 10
    c. 15
    d. 20
    • c
    • A cardiac output in the range of 4 LPM is acceptable, while a cardiac output of less than 4 LPM indicates cardiovascular compromise. Therefore, a PEEP of 15 cmH2O for this situation is the highest acceptable level.
  44. Following the administration of succinylcholine to facilitate intubation, the house resident is unable to orally intubate the patient despite repeated attempts. He requests an antidote to reverse the succinylcholine effects. The respiratory therapist should:

    a. recommend naloxone (Narcan)
    b. resume manual ventilation
    c. recommend nasotracheal intubation
    d. recommend neostigmine methylsulfate
    • b
    • Since there is no antidote for succinylcholine, the therapist should resume manual ventilation until the succinylcholine naturally wears off.
  45. A respiratory therapist has received orders to initiate chest physiotherapy with chest percussion and postural drainage on a patient who underwent surgery 16 hours previously for a head injury accident. On reviewing the patient's most recent chest x-ray, the therapist notes the presence of infiltrates in the left basal lung fields. The most appropriate action at this time would be to:

    a. drain the affected areas with a modified approach
    b. initiate chest percussion only
    c. inform the physician of possible hazards and ask for further orders
    d. refuse to perform chest physiotherapy
    • c
    • Since special precautions must be taken for head injury patients due to blood pressure and intracranial pressure, the most appropriate action would be to inform the physician of possible hazards and ask for further orders.
  46. An adult patient being treated in the emergency room is receiving oxygen by nasal cannula at 5 L/min. Over the last hour, the patient's respirations have become irregular and shallow. Arterial blood gas values are as follows:

    pH: 7.24
    PaO2: 89 mmHg
    PaCO2: 86 mmHg
    HCO3: 36 mmHg

    The most appropriate recommendation is to:

    a. decrease the oxygen liter flow
    b. administer a stat IPPB treatment
    c. begin manual ventilation with an FIO2 of 1.0
    d. switch to a nonrebreathing mask
    • a
    • The arterial blood gas results are typical of a patient with severe COPD. Although a PaO2 of 89 mmHg is a normal value for most people, this patient's PaO2 normally ranges much lower in order to stimulate the hypoxic drive. On the basis of this information, the most likely cause for the patient's irregular and shallow breathing pattern, and ensuing respiratory failure, is loss of hypoxic drive from excessive supplemental oxygen administration. The most appropriate action then is to lower the oxygen liter flow. This would bring back the hypoxic drive to breathe and improve the patient's ventilatory status.
  47. An infant in an oxyhood is receiving 40% oxygen via air-oxygen blender at a flow of 4 L/min. During assessment of the infant, the respiratory therapist notes that the infant is difficult to arouse when previously the infant was alert and responsive to stimuli. The respiratory therapist should:

    a. increase the FIO2 to 0.50
    b. recommend intubation and mechanical ventilation
    c. obtain an arterial blood gas sample
    d. increase the flow to 10 L/min
    • d
    • The most likely cause for the patient's lethargy is CO2 rebreathing caused by an inadequate flow setting. The flow should be increased to at least 10 L/min to flush out exhaled CO2.
  48. While the respiratory therapist is performing chest physiotherapy in the head down position to the lateral segment of the right lower lobe, the patient begins to cough vigorously and becomes short of breath. Which of the following actions would be most appropriate at this time?

    a. administer oxygen and continue the treatment
    b. discontinue the therapy, have the patient sit up, notify the physician
    c. sit the patient up and reassure him that coughing is normal during therapy
    d. continue the therapy, but apply a gentle technique
    • c
    • Because of the nature of the therapy (mobilization of secretions), coughing vigorously is normal. The patient should be allowed to sit up during the coughing episodes with reassurance that coughing is to be expected during this type of therapy.
  49. A respiratory therapist is administering He/O2 therapy via nonrebreathing mask and oxygen flowmeter set at 12 L/min. When the patient takes a deep inspiration, the reservoir bag deflates nearly one-third its fully inflated size. Which of the following actions would be appropriate at this time?

    a. increase the flowmeter setting to flush
    b. maintain present therapy
    c. change the flowmeter to a high-flow flowmeter with a setting of 20 L/min
    d. switch to a He/O2 flowmeter with a setting of 15 L/min
    • b
    • Because the therapy is being administered appropriately without collapse of the nonrebreathing bag on a deep inspiration, the most appropriate action is to maintain present therapy.
  50. While assessing a patient who is receiving oxygen via transtracheal catheter, the patient complains of a persistent, nonproductive cough and tracheal irritation. The appropriate action at this time would be which of the following?

    a. reposition the catheter
    b. instill saline and use the cleaning rod to clean the inner lumen of the catheter
    c. remove the catheter and replace it with a new one
    d. administer aerosolized racemic epinephrine (Vaponefrin)
    • a
    • The most common cause of tracheal irritation in a patient with a transtracheal oxygen catheter is that the catheter is resting on the tracheal wall. The catheter should be repositioned.
  51. An intubated, pharmacologically paralyzed patient is being mechanically ventilated in the assist/control mode. The respiratory therapist notes that the preset rate is 10 and the total rate is 14. The therapist should do which of the following?

    a. switch to SIMV at a rate of 10/min
    b. decrease the sensitivity setting
    c. decrease the inspiratory flow setting
    d. adjust the rate until a total rate of 10/min is delivered
    • b
    • If a patient is pharmacologically paralyzed while in the assist/control mode, the preset rate should equal the total rate because the patient is unable to initiate additional mechanical breaths. In this situation, the total rate is higher than the preset rate. Since the patient is not initiating additional mechanical breaths, the ventilator is auto-cycling. To correct auto-cycling, the sensitivity must be decreased.
  52. Transillumination of the chest is performed on a neonatal patient for which of the following reasons?

    a. when the patient's symptoms suggests a tension pneumothorax
    b. to rule out right-to-left shunting
    c. to assess the accuracy of a transcutaneous oxygen electrode
    d. during bronchoscopy to confirm correct endotracheal tube placement
    • a
    • Transillumination is a quick method of diagnosing a pneumothorax. A positive finding indicates that a pneumothorax is present.
  53. While administering a bronchodilator via small volume nebulizer, the respiratory therapist observes that the patient's breathing has become rapid and shallow. Which of the following instructions should the therapist give to the patient to correct this problem?

    1. "inhale at a slower speed"
    2. "inhale fully"
    3. "try to old your breath for at least 5 to 10 seconds before exhaling"
    4. "exhale fully"

    a. 1 and 2 only
    b. 1, 2, 3, and 4
    c. 1, 2, and 3 only
    d. 2 and 4 only
    • c
    • In response to the patient's rapid and shallow breathing pattern, the respiratory care practitioner should instruct the patient to inhale more slowly, to inhale fully, and initiate a breath hold of at least 5 to 10 seconds. This will enable a more effective breathing patterns as well as a more effective treatment. To exhale fully is not indicated or appropriate during the administration of a small volume nebulizer treatment.
  54. Thirty-six hours after the initiation of mechanical ventilation, a patient's chest x-ray shows dense bilateral infiltrates. The patient has gained 2.5 kg (5.5 lbs) and the urinary output is averaging 28 mL/hr. Chest auscultation reveals fine crackles throughout all lung fields. Which of the following interventions would be appropriate at this time?

    1. administering a diuretic
    2. administering a colloid solution
    3. decreasing the patient's fluid intake

    a. 1 and 2 only
    b. 2 and 3 only
    c. 1 and 3 only
    d. 1, 2, and 3
    • c
    • The patient's current clinical signs and symptoms are highly suggestive of pulmonary edema secondary to fluid overload. 1. TRUE - administering a diuretic will relieve fluid overload through urinary excretion. 2. FALSE - administering a colloid solution would add more volume to the vascular system, which would further worsen the situation. 3. TRUE - decreasing the patient's fluid intake will help reduce fluid overload.
  55. A patient about to undergo bronchoscopy becomes fearful and anxious and indicates she does not want the procedure done. The most appropriate action at this time is to:

    a. continue to observe the patient
    b. reschedule the bronchoscopy for another time
    c. administer a sedative to relieve anxiety
    d. cancel the bronchoscopy
    • c
    • It is expected that a patient would become anxious just prior to an invasive procedure such as bronchoscopy. Therefore, the most appropriate action is to recommend a sedative to calm and relax the patient prior to the procedure.
  56. Hemodynamic monitoring has been initiated for an intubated, mechanically ventilated patient with multi-system organ failure. Following the administration of norepinephrine (Levophed), the SvO2 increases from 56% to 64%. Based on this change, the respiratory therapist should conclude that:

    a. the cardiac output has increased
    b. pulmonary compliance has improved
    c. cardiac decompensation has occurred
    d. the central venous pressure has decreased
    • a
    • An increase in the SvO2 reflects an increase in oxygen supply. This indicates the administration of norepinephrine has been effective in improving myocardial contractility and the cardiac output.


  57. The above ECG tracing was observed on a patient's cardiac monitor. On the basis of this tracing, the respiratory therapist should suspect:

    a. patient movement
    b. electrolyte deficiency
    c. pulmonary hypertension
    d. cardiac decompensation
    • b
    • The ECG tracing shows flattened T waves with prominent U waves. This finding is most commonly associated with hypokalemia, indicating an electrolyte deficiency is present.
  58. An intubated patient is receiving mechanical ventilation via volume ventilator. Following an increase in PEEP from 5 cmH2O to 10 cmH2O, the plateau pressure increases from 34 cmH2O to 43 cmH2O. Based on this change, the respiratory therapist should conclude that:

    a. a PEEP trial is indicated
    b. airway resistance has increased
    c. pulmonary compliance has worsened
    d. intrapulmonary shunt has decreased
    • c
    • By using the equation for pulmonary compliance [VT / (plateau - PEEP)], this situation indicates that pulmonary compliance has worsened. Assuming a tidal volume of 1 liter, the pulmonary compliance when the PEEP was 5 cmH20 is 35 mL/cmH2O (1000 / 34 - 5). Assuming the tidal volume was not changed when the PEEP was increased to 10 cmH2O), the pulmonary compliance has decreased to 30 mL/cmH2O (1000 / 43 - 10). Without knowing the peak pressure, airway resistance cannot be measured. A PEEP trial is not indicated at this time. Because the pulmonary compliance has worsened, the PEEP should be decreased back to 5 cmH2O. Without knowing the PaO2 or the PvO2, the shunt cannot be measured.


  59. The pressure and flow curves shown above were recorded from a patient receiving mechanical ventilation via volume ventilator.

    Using the pressure and flow curves represented in "A" as the reference, which of the following best explains the change in the pressure and flow curves represented in "B"?

    a. the patient has initiated a spontaneous breath
    b. the high pressure limit alarm has activated
    c. the inspiratory flow has been decreased
    d. an inspiratory plateau has been added
    • c
    • The most notable difference between the two sets of pressure and flow curves is that in "B", the flow is approximately less than half that of "A". Because of a reduced flow, the peak pressure would correspondingly decrease and the inspiratory time would lengthen.
  60. Which of the following pulmonary function test results indicate inconsistent patient effort?

    SVC (L) FVC (L)
    a. 4.1 4.0
    b. 3.2 3.6
    c. 4.6 4.2
    d. 3.7 3.3
    • b
    • Because of the difference between performing a slow vital capacity maneuver (allows air to be exhaled at a slower rate) and a forced vital capacity maneuver (less air is exhaled if collapsing of the airways occur), the slow vital capacity should always be at least equal to or larger than the forced vital capacity. If the slow vital capacity is less than the forced vital capacity, the patient did not cooperate fully.
  61. An intubated and mechanically ventilated patient with severe ARDS has been receiving high levels of PEEP and FIO2's in order to maintain and adequate PaO2. The patient's physician has become concerned regarding oxygen toxicity and writes an order to maintain the FIO2 at 0.50 and increase PEEP as required. While increasing the PEEP from 20 cmH2O to 25 cmH2O, the therapist notes a significant drop in cardiac output. Which of the following should the therapist recommend?

    a. override the physicians order and increase the FIO2
    b. set the PEEP back to 20 cmH2O and initiate an inflation hold of 0.5 second
    c. administration of an intravascular volume expander
    d. sedate and paralyze the patient to reduce metabolic demands
    • c
    • To overcome the detrimental cardiovascular effect that the high level of PEEP is causing, the most appropriate action is to administer an intravascular volume expander. This would increase the cardiac output while allowing high levels of PEEP.
  62. A respiratory therapist is managing the ventilator of a newborn patient. Pertinent data are as follows:

    Ventilator Settings
    Mode: SIMV
    Rate: 24/min
    I:E: 1:3
    FIO2: 0.80
    PEEP: 3 cmH2O

    Arterial Blood Gases
    pH: 7.22
    PaCO2: 59 mmHg
    HCO3: 19 mEq/L
    PaO2: 43 mmHg

    On the basis of this information, which of the following should the therapist recommend?

    a. increase the rate and the PEEP
    b. switch to assist/control mode and ventilate at an I:E ratio of 1:4
    c. change the I:E ratio to 1:4 and increase the PEEP
    d. increase the FIO2 and initiate inverse ratio ventilation
    • a
    • The arterial blood gases show respiratory acidosis with hypoxemia. To correct the respiratory acidosis, the alveolar ventilation must be increased. This would be accomplished by increasing the rate. Hypoxemia persists despite a high FIO2 which indicates refractory hypoxemia is present. The therapy of choice for refractory hypoxemia is PEEP; therefore, the PEEP should be increased.
  63. An 80 kg male patient is being mechanically ventilated following cardiac surgery. Current ventilator settings are: SIMV mode, rate 12/min, tidal volume 600 mL, FIO2 0.35, PEEP 5 cmH2O. Arterial blood gases are obtained and the results are: pH 7.28, PaCO2 59 mmHg, HCO3 26 mEq?L, PaO2 78 mmHg. Which of the following should the respiratory therapist INITIALLY recommend?

    a. setting the tidal volume at 700 mL
    b. setting the PEEP at 7.5 cmH2O
    c. switching to the assist/control mode
    d. setting the FIO2 at 0.40
    • a
    • In this situation, the tidal volume is set below the recommended range, which is most likely causing the respiratory acidosis and mild hypoxemia. The first step then is to increase the tidal volume. If this does not correct the respiratory acidosis and mild hypoxemia, then other adjustments can be made.
  64. A patient with adult respiratory distress syndrome is being mechanically ventilated with A/C, rate 18/min, tidal volume 475 mL, FIO2 0.90, and PEEP 17 cmH2O. The patient's pulse oximetry is 90%. Which of the following would you suggest?

    a. perform an optimal PEEP study
    b. maintain current settings
    c. switch to the SIMV mode of ventilation
    d. titrate the FIO2 downward
    • d
    • Because the FIO2 is set at a toxic level and the SaO2 value is adequate, the most appropriate action is to titrate the FIO2 downward to a safer level. The remaining options are either not warranted or do not apply to this patient situation.
  65. A pharmacologically paralyzed 32 kg (70 lb) adolescent patient is being mechanically ventilated via volume ventilator in the assist/control mode. Current arterial blood gas results and related data are as follows:

    FIO2: 0.55
    Rate: 18/min
    VT: 350 mL
    PEEP: 5 cmH2)
    pH: 7.32
    PaO2: 52 mmHg
    PaCO2: 51 mmHg
    HCO3: 25 mEq/L

    All of the following ventilator adjustments would be appropriate to help improve the arterial blood gases EXCEPT:

    a. increasing the ventilator rate to 20
    b. increasing the tidal volume to 400 mL
    c. switching to the SIMV mode of ventilation
    d. increasing the PEEP to 10 cmH2O
    • c
    • The arterial blood gas results show uncompensated respiratory acidosis with moderate hypoxemia. Increasing the ventilator rate to 20 is an appropriate action because it would increase ventilation, thus lowering the PaCO2. Increasing the PEEP to 10 cm H2O is an appropriate action because it would alleviate the hypoxemia, thus improving the PaO2. Increasing the tidal volume to 400 mL is an appropriate action because it would increase ventilation, thus lowering the PaCO2. Switching to the SIMV mode of ventilation will not improve the arterial blood gases because the patient is pharmacologically paralyzed.


  66. As the respiratory therapist suctions an intubated patient, the above ECG tracing is observed on the patient's cardiac monitor. The therapist should:

    a. recommend administering lidocane (Xylcaine)
    b. continue suctioning the patient
    c. administer a precordial thump
    d. stop suctioning and manually ventilate with 100% oxygen
    • b
    • The ECG rhythm shows normal sinus rhythm at a rate of 90/min. Because the ECG rhythm is normal, the therapist should continue suctioning.
  67. A spontaneously breathing patient with a tracheostomy tube in place is receiving cool aerosol with 35% oxygen. The aerosol delivery system is a large reservoir jet nebulizer with the entrainment port set at 35% and the oxygen flowmeter set at 12 L/min. While suctioning the patient the respiratory therapist notes that it is increasingly difficult to aspirate secretions. Which of the following could the therapist do to correct this situation?

    a. use a larger size suction catheter
    b. add a heater to the system
    c. increase the suction pressure
    d. use a high-flow humidification system
    • b
    • Because it is increasingly difficult to aspirate secretions, the practitioner should be highly suspicious of thickened secretions. Adding a heater to the system is the most appropriate option because it can raise the moisture level in the lungs and thin the thickened secretions. Modifying the suctioning procedure by using a larger size suction catheter or increasing the suction pressure is not indicated nor appropriate. Using a high-flow humidification system will not solve the problem.
  68. The respiratory therapist is performing endotracheal suctioning on a 37-week gestation mechanically ventilated infant. During the procedure, the infant's heart rate repeatedly drops below 90 beats/min. The therapist should suspect which of the following?

    a. hypothermia
    b. excessive vacuum pressure
    c. vagal stimulation
    d. hyperoxia
    • c
    • A complication of suctioning is activation of the vagal reflex at the carina by the catheter. Vagal stimulation leads to a decrease in hear rate through its association with the parasympathetic system.
  69. A respiratory therapist has been asked to assess a 20-year-old male motor cross rider who has been admitted to the emergency department for a severe rope injury to the neck. The therapist finds an alert, anxious patient in severe distress with audible, moderate stridor. Breath sounds are bilaterally clear. VItal signs are as follows:

    Blood Pressure: 130/86 mmHg
    Pulse: 100 beats/min
    Respiratory Rate: 26 breaths/min
    Temperature: 101.8 degree F (38.8 degree C)

    Attempts at orotracheal intubation have been unsuccessful. The therapist's next recommendation should be:

    a. bronchoscopy
    b. laryngoscopy
    c. nasotracheal intubation
    d. cricothyroidotomy
    • d
    • Due to the severe rope injury to the neck, the laryngeal area is most likely edematous and swollen to the point of airway occlusion which most likely accounts for the unsuccessful orotracheal intubation attempts. Nasotracheal intubation would also be unsuccessful. Because of this, the emergency airway of choice would be a cricothyroidotomy.
  70. A 28-week-gestation neonate is being manually ventilated following delivery. Chest excursion is poor despite manual ventilation with high peak pressures. Which of the following is the most appropriate action at this time?

    a. reposition the head and reattempt manual ventilation
    b. apply PEEP while manually ventilating
    c. obtain a chest x-ray
    d. intubate the patient
    • d
    • A 28-week-gestation neonate who has poor chest excursion despite aggressive manual ventilation should be intubated. Because of the neonate's gestational age, he is highly prone to respiratory distress syndrome which is most likely the reason for poor chest excursion despite manual ventilation with high peak pressures.
  71. Nasotracheal intubation would be preferred over orotracheal intubation in which of the following situations?

    1. repair of a fractured mandible
    2. fractured middle third of the face
    3. choanal atresia

    a. 1, 2, and 3
    b. 1 only
    c. 2 only
    d. 1 and 3 only
    • b
    • Nasotracheal intubation would be contraindicated in a patient with fractures across the middle third of the face (this area involves the entire nasal region) and choanal atresia (lack of a communicating passageway between the nasal fossae and the pharynx) while a fractured mandible would necessitate a nasal endotracheal tube in order to have access to the jaws and mouth to surgically repair the mandible.
  72. A 14-year-old female admitted to the emergency room for acute exacerbation of asthma is treated with 0.5 mL of albuterol via small volume nebulizer. After the treatment, the respiratory therapist notes a decrease in the respiratory rate, but an increase in the heart rate. On auscultation, breath sounds are markedly diminished throughout all lung fields where previously there had been bilateral inspiratory/expiratory wheezes. Which of the following should the therapist do?

    a. continue present therapy and closely monitor
    b. request a stat chest x-ray
    c. notify the physician that the patient's condition is worsening
    d. request IV administration of isoproterenol
    • c
    • Inspiratory/expiratory wheezes is not always a bad indicator. It shows that at least some air is moving through the bronchial tubes whereas markedly diminished breath sounds indicate that little or no air is moving through the bronchial tubes. Markedly diminished breaths sounds where there previously were inspiratory/expiratory wheezes is an ominous sign. The patient's condition has worsened after the treatment with albuterol, therefore the physician should be immediately notified.
  73. A 70 kg (154 lb) male patient is being mechanically ventilated in the assist/control mode with an FIO2 of 1.0. Following the addition of 5 cmH2O PEEP, the patient's calculated percent shunt decreases from 28% to 21%. Based on this change, the respiratory therapist should conclude that:

    a. arterial blood pressure has improved
    b. pulmonary vascular resistance has decreased
    c. the venous admixture has decreased
    d. the deadspace ventilation has increased
    • c
    • A shunt that has decreased from 28% to 21% indicates that more blood is being oxygenated at the lung level and therefore more arterialized blood is entering the left heart. As can be seen, if there is more arterialized blood, the venous portion has decreased.
  74. A patient has the following arterial blood gas results while breathing room air:

    pH: 7.39
    PaO2: 84 mmHg
    PaCO2: 41 mmHg
    HCO3: 24 mEq/L
    SaO2: 79% (measured)

    Based on these results, which of the following could be correctly concluded?

    a. the patient is hypothermic
    b. the COHb is elevated
    c. the blood gas sample was from a venous site
    d. the blood gas sample was contaminated
    • b
    • The expected SaO2 for a PaO2 of 84 mmHg is greater than 95%. In this situation, the SaO2 is less than expected for the given PaO2. This indicates that the oxyhemoglobin curve has shifted to the left. The most notable cause for shifting the oxyhemoglobin curve to the left is an elevated COHb.
  75. When the ventilator rate of a mechanically ventilated patient is decreased from 8/min to 6/min, the PaCO2 increases form 44 mmHg to 49 mmHg. Based on this change, the respiratory therapist should conclude that:

    a. oxygenation at the tissue level has worsened
    b. alveolar ventilation has decreased
    c. physiologic deadspace has decreased
    d. the percent shunt has increased
    • b
    • Since the PaCO2 is inversely related to alveolar ventilation, any increase in PaCO2 indicates that alveolar ventilation has decreased.


  76. The respiratory therapist is reviewing the control data collected from a blood gas analyzer as shown above. Which of the following may be concluded regarding the data collected from point A to point B?

    a. there is loss of linearity
    b. there is a change in mean
    c. there is a systematic error
    d. there is a random error
    • b
    • The data from point A to point B signifies there is a change in mean. A systematic error is an error that is always in one direction and is predictable, in contrast to random errors that may be either positive or negative and whose direction cannot be predicted. Linearity describes the validity of the reportable range of the instrument, one is checking for the relationship of at least three unknown concentration samples to three known concentration samples.
  77. Results of three spirometer test challenges made from a 3.0 liter automated calibrated syringe are as follows:

    Measurement #1: 3.072 liters
    Measurement #2: 2.924 liters
    Measurement #3: 3.055 liters

    Which of the following is true regarding these results?

    a. the spirometer may have a leak
    b. the spirometer is accurate to within plus or minus 3%
    c. the calibrated syringe is set at the wrong volume
    d. a calibration adjustment is required for the spirometer
    • b
    • According to quality control standards for a spirometer, a spirometer must be accurate to within plus or minus 3% or 50 mL of the actual volume being measured, whichever is greater. In this case, 3% of 3.0 liters is 90 mL. Therefore, the spirometer must be accurate to within plus or minus 90 mL of 3.0 liters. Measurement #1 is 72 mL over the volume being measured. Measurement #2 is 76 mL under the volume being measured. Measurement #3 is 55 mL over the volume being measured. Because all three measurements are within plus or minus 90mL of 3.0 liters,t he spirometer is accurate to within plus or minus 3%.
  78. Which of the following best explains the use of heat an moisture exchangers (except where contraindicated), rather than heated humidifiers, in reducing the incidence of ventilator-associated pneumonia (VAP)?

    a. they generate less condensate
    b. they are better tolerated by mechanically ventilated patients
    c. they are disposable
    d. they are more cost-efficient
    Heated humidifiers can produce large amounts of condensate that increases the potential for contamination whereas heat and moisture exchangers reduce this risk because they produce less condensate.
  79. A respiratory therapist is caring for a 5-year-old girl who has measles. All of the following precautions are true EXCEPT:

    a. non-immune staff are allowed to enter the patient's room only if waring a N95 respirator mask
    b. if transport off the unit is required, the patient must wear a surgical mask
    c. strict handwashing after contact with patient or items contaminated with respiratory secretions is required
    d. the patient's door must remain closed except for entry/exit
    • a
    • All of the options listed are true except non-immune staff are allowed to enter the patient's room only if wearing a N95 respirator mask. With a highly contagious disease such as measles, there are no exceptions to non-immune staff entering this patient's room.
  80. Which of the following body positions is considered the standard position for obtaining pulmonary artery pressure measurements?

    a. prone with the head of the bed flat
    b. semi-fowler
    c. fowler
    d. supine with the head of the bed flat
    • d
    • As long as the patient can tolerate the head of the bed being flat, the supine position is preferred for obtaining hemodynamic measurements.
  81. A respiratory therapist is performing nasotracheal suctioning. During the procedure, the therapist occludes the catheter's thumb port and discovers there is no vacuum. The therapist could do all of the following EXCEPT:

    a. check to ensure that the catheter or the catheter's tip is not occluded
    b. use a longer suction catheter
    c. empty the suction canister if it is full
    d. ensure that all connections are tightly fitted
    • b
    • Loss of vacuum can be caused by a loose connection somewhere in the suction system, from a full suction canister, or from an occluded catheter. Using a longer suction catheter; however, will not restore vacuum.
  82. A patient is receiving continuous ventilatory support with the following settings:

    Mode: Assist/Control
    FIO2: 0.60
    VT: 850 mL
    Rate: 8/min
    PEEP: 18 cmH2O

    Upon entering the patient's room, the respiratory therapist hears the high pressure limit alarm sounding. Which of the following would be the most appropriate action?

    a. ensure that the breathing circuit is not kinked
    b. lower the PEEP level
    c. check the endotracheal tube for proper cuff inflation
    d. reconnect the exhalation line
    • a
    • The activation of the high pressure limit alarm indicates there is an increased resistance to air flow somewhere in the patient-ventilator system. The most likely cause in this situation is a kinked breathing circuit. Air flowing into and through the kink places an increased resistance to air movement which would lead to activation of the high pressure limit alarm. An improperly inflated cuff would lead to a leak situation and activation of the low pressure limit alarm, not the high pressure limit alarm. Lowering the PEEP level is an inappropriate action and not warranted. A disconnected exhalation valve would lead to a leak in the system and cause the low pressure limit alarm to activate, not the high pressure limit alarm.
  83. While checking a volume ventilator that is to be used for a postoperative patient, the respiratory therapist occludes the patient connector and depresses the manual breath control. The therapist observes a quick rise in system pressure with the pressure limit alarm sounding. At this time, it would be most appropriate to do which of the following?

    a. increase the pressure limit setting
    b. make no change, the ventilator is functioning normally
    c. decrease the inspiratory flow setting
    d. straighten the kink in the inspiratory line
    • b
    • When occluding the patient connector and initiating a manual breath, the system pressure should quickly rise and activate the high pressure limit alarm setting. A quick rise in pressure indicates the flow rate setting is adequate and activation of the high pressure limit alarm indicates there are no leaks in the circuit. The most appropriate action, therefore, is to make no change as the ventilator is functioning normally.
  84. All of the following are true concerning He/O2 (heliox) therapy EXCEPT:

    a. it requires the use of a flowmeter designed specifically for helium's density
    b. patients requiring oxygen should receive the 70/30 heliox mixture
    c. it is generally administered by a tight-fitting nonrebreathing mask
    d. all heliox mixtures must have at least 21% oxygen
    • a
    • Although a flowmeter designed for heliox administration would be ideal, it is not required to deliver the gas mixture to the patient. An oxygen flowmeter is acceptable to use.
  85. All of the following are true concerning the use of high-frequency jet ventilation EXCEPT:

    a. it incorporates a low compressible volume circuit
    b. it delivers a high-pressure gas source through a small jet catheter
    c. changes in resistance may result in delivery of inconsistent tidal volumes
    d. cycling rates are generally less than 100 cycles per minute
    • d
    • Cycling rates during high-frequency jet ventilation generally range between 300 and 500 per minute.
  86. In which of the following situations would BiPAP therapy be appropriate?

    1. acute exacerbation of COPD
    2. obstructive sleep apnea
    3. patients requiring minimal support after being weaned from conventional mechanical ventilation
    4. postoperative open heart surgery

    a. 2 and 4 only
    b. 1, 2, 3, and 4
    c. 3 only
    d. 1, 2, and 3 only
    • d
    • 1. TRUE - BiPAP is indicated in patients with acute exacerbation of COPD to support ventilation and rest fatigued respiratory muscles during the acutely ill period. 2. TRUE - BiPAP is indicated inpatients with obstructive sleep apnea to help reduce the occurrence of obstructive episodes. 3. TRUE - BiPAP is indicated in patients requiring minimal support after being weaned from conventional mechanical ventilation to help support spontaneous ventilation until the patient can adequately resume ventilation without support. 4. FALSE - postoperative open heart surgery patients are typically mechanically ventilated for a brief period, then extubated. These patients are not usually extubated until fully alert and able to maintain total spontaneous ventilation.
  87. A 27-year-old male has been admitted to the emergency department after he was found unconscious in the bedroom closet of his home following a house fire. He is currently receiving supplemental oxygen via nonrebreathing mask. An arterial blood gas sample is obtained. The values are as follows:

    pH: 7.22
    PaCO2: 45 mmHg
    HCO3: 18 mEq/L
    PaO2: 345 mmHg
    SaO2: 100%

    Which of the following would be most appropriate at this time?

    a. replace the nonrebreathing mask with a simple oxygen mask
    b. maintain current therapy and continue to monitor the patient
    c. re-analyze the blood sample because an analytical error is present
    d. analyze the blood sample using a co-oximeter
    • d
    • Sinced the patient is a victim of smoke inhalation, the practitioner should be highly suspicious of the reported SaO2. The arterial blood gas sample was analyzed in a blood gas analyzer. With smoke inhalation, the COHb is elevated. A blood gas analyzer is not equipped to report an accurate SaO2 when the blood sample contains a high level of COHb, while a co-oximeter does measure the actual SaO2, giving an accurate result. Therefore, analyzing the blood sample using a co-oximeter in order to obtain an accurate SaO2 is indicated.
  88. A 65-year-old Hispanic female has just been admitted to the ED. Through an interpreter it is learned that the patient is complaining of palpitations and chest discomfort. Which of the following would be indicated?

    a. hemodynamic monitoring
    b. 12-lead ECG
    c. arterial blood gas analysis
    d. pulmonary function studies
    • b
    • In this situation where there is the presence of palpitations and chest discomfort, especially in a 65-year-old patient, a 12-lead ECG is indicated to rule out acute myocardial infarction.
  89. An adult male patient is orally intubated and receiving mechanical ventilation via volume ventilator. To obtain diagnostic insight into the patient's pulmonary condition on a breath-by-breath basis, the respiratory therapist would recommend which of the following?

    a. continuous end-tidal CO2 monitoring
    b. continuous SvO2 monitoring
    c. pulmonary artery pressure monitoring
    d. continuous cardiac monitoring
    • a
    • End-tidal CO2 monitoring via capnography provides a breath-by-breath analysis of the patient's pulmonary condition.
  90. A suspected fungal infection of the pleural space would best be confirmed by which of the following?

    a. diagnostic thoracentesis
    b. diagnostic bronchoscopy
    c. chest CT scan
    d. chest MRI
    • a
    • Diagnostic thoracentesis is the gold standard for pleural fluid analysis.
  91. A patient in the intensive care unit requires aggressive fluid and electrolyte replacement therapy. Implementation of which of the following would be most appropriate to evaluate the effectiveness of this therapy?

    a. Holter monitoring
    b. cardiac output monitoring
    c. ECG monitoring
    d. SvO2 monitoring
    Since the administration of electrolytes may potentially cause a cardiac rhythm disturbance, ECG monitoring would be the most appropriate to evaluate the effectiveness of replacement therapy. SvO2 monitoring would be appropriate to evaluate the effectiveness of supplemental oxygen, CPAP, or PEEP. Holter monitoring is indicated when a 24-hour recording of the ECG is required. Cardiac output monitoring is appropriate during the administration of inotropic drug therapy.
  92. The respiratory therapist is asked to assess a patient who has just been admitted to the respiratory ward. The therapist records the following data:

    Temperature: 102 degree F (38.9 degree C)
    Pulse: 128/min
    Blood Pressure: 132/86 mmHg
    Respirations: 32/min and labored
    Chest auscultation: bilateral coarse crackles, bronchial breath sounds heard over left lateral chest
    Chest percussion: dull percussion note present over left lateral chest

    On the basis of these clinical data, the therapist should recommend:

    1. bronchoscopy
    2. sputum culture and sensitivity
    3. AP chest x-ray
    4. arterial blood gas analysis
    5. CBC

    a. 1, 2, 3, 4, and 5
    b. 1, 2, and 4 only
    c. 2, 3, and 5 only
    d. 2, 3, 4, and 5 only
    • d
    • The clinical data is highly suggestive that the patient has a significant pulmonary infection. 1. FALSE - performing fiberoptic bronchoscopy with bronchoalveolar lavage is extreme and unwarranted at this time. 2. TRUE - sputum culture and sensitivity would help diagnose the causative agent and the antibiotic that could eradicate it. 3. TRUE - an AP chest x-ray cold help with the differential diagnosis as well as determining the extent of lung involvement. 4. TRUE - because the patient is tachypneic with labored respirations and tachycardic, arterial blood gas analysis is indicated to evaluate the ventilation and oxygenation status. 5. TRUE - if the pulmonary infection is bacterial in nature, measuring the white blood cell count via the CBC would help determine the degree of inflammation.
  93. A 36-year-old male who has had asthma for many years is currently using fluticasone 500 mcg and salmeterol 50 mcg twice daily. Despite being adherent to using his medicine, he reports coughing on five or six days in the past week and on four or five nights. His recent FEV1 was 65% of predicted. Which of the following could be concluded from this information?

    a. his asthma is being managed appropriately
    b. his asthma is poorly controlled
    c. further studies need to be performed to classify the severity of his asthma
    d. his asthma is acutely exacerbated and he requires hospitalization
    • b
    • From the information presented, the patient's asthma is poorly controlled. Further information is needed, such as exposure to environmental irritants and living conditions, in order to determine why the patient's asthma is being poorly managed.
  94. Three hours postpartum, arterial blood gases are obtained from a preterm infant. The infant is receiving supplemental oxygen via 30% oxyhood. The results are as follows.

    pH: 7.30
    PaO2: 58 mHg
    PaCO2: 49 mmHg
    HCO3: 23 mEq/L

    Which of the following is the correct interpretation for these results?

    a. normal acid-base status with normalized oxygenation
    b. respiratory acidosis with uncorrected oxygenation
    c. normal acid-base status with uncorrected oxygenation
    d. respiratory acidosis with corrected oxygenation
    • a
    • The blood gas results are within the normal range for a 3-hour-old preterm infant.
  95. Following the initiation of pulmonary artery pressure monitoring for an adult male patient being mechanically ventilated, the following data is recorded:

    PAWP: 24 mmHg
    C(a-v)O2: 2.4 vol%

    These results are most likely associated with which of the following?

    a. left ventricular failure
    b. acute pulmonary embolus
    c. hypervolemia
    d. hypovolemia
    • c
    • The increased PAWP is highly suggestive of hypervolemia or left ventricular failure. The low C(a-v)O2 however rules out left ventricular failure. A C(a-v)O2 of less than approximately 4 vol% s indicative of good cardiovascular reserves.
  96. A 76-year-old male presents to the ED complaining of pleuritic pain and shortness of breath. While assessing the patient, the respiratory therapist notes rapid shallow breathing with asymmetric chest movement. Which of the following should the therapist do next?

    a. perform bedside spirometry
    b. request a ventilation/perfusion (V/Q) scan
    c. request a chest x-ray
    d. obtain a 12-lead ECG
    • c
    • The patient's symptoms are highly indicative of a pneumothorax. A chest x-ray would confirm the diagnosis.
  97. The results of an arterial blood gas analysis obtained from a patient breathing room air are as follows:

    pH: 7.22
    PaO2: 89 mmHg
    PaCO2: 36 mmHg
    HCO3: 14 mEq/L

    Which of the following clinical conditions or situations would NOT be a contributing factor to these results?

    a. renal failure
    b. starvation
    c. hypokalemia
    d. uncontrolled diabetes
    • c
    • The blood gas results are consistent with metabolic acidosis. Of the conditions listed, hypokalemia would not contribute to this type of acid-base disturbance.
  98. Results of a pulmonary function study obtained from a 41-year-old female are as follows:

    Actual Predicted
    TLC 5.13 L 6.21 L
    SVC 3.40 L 4.70 L
    FVC 2.99 L 4.70 L
    RV 0.92 L 1.21 L
    FRC 2.11 L 2.61 L
    FEV1 4.41 L 4.41 L

    Which of the following conditions is compatible with these results?

    a. pulmonary emphysema
    b. sarcoidosis
    c. pulmonary embolism
    d. poliomyelitis
    • b
    • The pulmonary function results show a decreased TLC, SVC, RV, FRC, and FVC with a normal FEV1. These results are consistent with a restrictive process such as sarcoidosis.
  99. During polysomnography, the respiratory therapist observes frequent apneic episodes. During the apneic episodes, the patient exhibits no chest wall or abdominal movements immediately followed by paradoxical chest wall and abdominal movements with moderately severe oxygen desaturation. Which of the following clinical conditions is most likely present?

    a. mixed sleep apnea
    b. results are inconclusive for a diagnosis
    c. obstructive sleep apnea
    d. central sleep apnea
    • a
    • Sleep apnea can be classified as obstructive, central, or mixed, depending on the presence or absence of respiratory muscle effort. With each type of apnea, airflow at the nose or the mouth is absent for at least 10 seconds. In obstructive apnea, ribcage and abdominal movements are still present; in central apnea, both types of movement are absent. In mixed apneas, both central and obstructive patterns occur during the same apneic event. the magnitude of any associated decrease in oxygen saturation depends on the degree and duration of apnea. The results of the sleep study for this patient indicate the patient has a mixed sleep apnea disorder.
  100. During assessment of a trauma patient just admitted to the emergency room, the respiratory therapist observes that the patient's pupils constrict when a light is shined on them. This indicates that:

    a. there is poor cerebral perfusion
    b. the pupils are reacting normally
    c. the brain is probably hypoxic
    d. the patient is most likely hypothermic
    • b
    • Pupils that constrict when a light is shined on them is a normal finding.
  101. The respiratory therapist is monitoring the cardiopulmonary status of a patient who is receiving continuous ventilatory support. Current clinical data are as follows:

    PB: 760 mmHg
    FIO2: 0.40
    PaO2: 88 mmHg
    PaCO2: 40 mmHg

    Based on the above data, which of the following most accurately represents this patient's P(A-a)O2?

    a. 125 mmHg
    b. 147 mmHg
    c. 216 mmHg
    d. 235 mmHg
    • b
    • The equation for calculating the P(A-a)O2 is: [(PB-PH2O) x FIO2 - (PaCO2 x 1.25)] - PaO2 = [(760 - 47) x 0.40 - (40 x 1.25)] - 88 = 147 mmHg.
  102. During mechanical ventilation, the respiratory therapist uses higher tidal volumes to overcome alveolar hypoventilation. This results in a decrease in:

    a. P(A-a)O2
    b. C(a-v)O2
    c. Qs/Qt
    d. VD/VT
    • dq
    • Because the tidal volume is the denominator in the VD/VT ratio, any increase in the tidal volume would result in a lower ratio value. The P(A-a)O2, Qs/Qt, and C(a-v)O2 are oxygenation indicators, not ventilation indicators.
  103. While performing a routine ventilator check, the respiratory therapist observes that there is a decrease in the patient's exhaled tidal volume and an increase in the airway pressure, yet there has been no change in ventilator settings. Which of the following could be causing this situation?

    1. increased airway resistance
    2. malfunction of the ventilator
    3. a leak in the patient breathing circuit
    4. decreased pulmonary compliance
    5. decreased pulmonary elastance

    a. 1 and 4 only
    b. 1, 2, 4, and 5 only
    c. 2, 3, and 4 only
    d. 1, 3, and 5 only
    • a
    • 1. TRUE - increased airway resistance is usually caused by bronchospasm which will cause the peak pressure to rise. 2. FALSE - the ventilator itself will not directly cause an increase in airway pressure or a decrease in exhaled volumes. 3. FALSE - a leak in the system will not cause an increase in airway pressure, it will cause a decrease in airway pressure. 4. TRUE - a decreased pulmonary compliance can lead to increased airway pressure and low exhaled tidal volumes because the lungs become "stiffer" and more difficult to ventilate. 5. FALSE - a decreased pulmonary elastance indicates the lungs are more compliant and easier to ventilate. This will not cause a rise in airway pressure or a decrease in exhaled volumes.
  104. An adult intubated patient is receiving 35% oxygen via T-piece adapter. After adding a 6 inch flex tube between the endotracheal tube and T-piece adapter, the respiratory therapist would expect which of the following to occur?

    a. an increase in the PaO2
    b. a decrease in the C(a-v)O2
    c. an increase in the PaCO2
    d. a decrease in the VD/VT
    • c
    • Adding a 6 inch flex tube between the endotracheal tube and T-piece adapter adds mechanical deadspace to the system. By adding mechanical deadspace, a portion of the exhaled CO2 would collect within the deadspace area, leading to a portion of exhaled CO2 being rebreathed during inspiration. Rebreathing CO2 leads to an increase in the PaCO2.
  105. A 52-year-old male in acute respiratory distress has just been admitted to the emergency room. Physical examination reveals accessory ventilatory muscle use, neck vein distention, and pedal edema. There is markedly diminished breath sounds and expiratory wheezes throughout both lung fields. The patient is expectorating small amounts of tenacious, purulent, and foul-smelling sputum.

    His vital signs are: pulse 132/min; BP 196/112 mmHg; respirations 38/min. Arterial blood gases drawn while the patient was breathing room air are: pH 7.27; PaO2 54 mmHg; PaCO2 62 mmHg; HCO3 27 mEq/L. Which of the following is the most likely diagnosis for this patient?

    a. acute cardiogenic pulmonary edema secondary to cardiogenic shock
    b. bullous emphysema with acute alveolar hyperinflation
    c. chronic bronchitis exacerbated by an acute pulmonary infection
    d. severe bilateral pulmonary effusion
    • c
    • Neck vein distention and pedal edema are characteristically associated with chronic bronchitis. Tenacious, purulent, and foul-smelling sputum are indicative of a pulmonary infection


  106. Which of the following is consistent with the flow-volume curve shown above?

    a. variable extrathoracic obstruction
    b. small airways obstruction
    c. normal expiratory flow pattern
    d. fixed large airway obstruction
    • d
    • The flow-volume curve shows equally reduced inspiratory and expiratory flows which is characteristic of fixed large airway obstruction. With small airways obstruction, the portion of the expiratory curve from the peak flow to residual volume is concave. A normal expiratory flow pattern would show a quick rise to peak flow then a more linear decrease in the expiatory curve form the peak flow to residual volume. A variable extrathoracic obstruction would show reduced inspiratory flows with relatively normal expiratory flows.


  107. The capnogram tracing above was obtained from a mechanically ventilated patient. On the basis of this tracing, the respiratory therapist should suspect which of the following?

    a. the patient is rebreathing carbon dioxide
    b. the patient is hyperventilating
    c. the patient has been disconnected from the ventilator
    d. the patient is hypoventilating
    • b
    • Observation of the shape and magnitude of the PetCO2 can yield information about the clinical condition of the patient. In this situation, the capnogram shows decreasing expiratory CO2 values. This is most likely a result of sudden hyperventilation as less CO2 is exhaled from the lungs. Rebreathing of carbon dioxide would show elevated baseline (inspiratory) values of CO2 which indicates that the patient is rebreathing a portion of the exhaled CO2 during inspiration. With disconnection from the ventilator, there would be an abrupt loss of the capnogram tracing. With sudden hypoventilation, there would be rising expiratory CO2 values displayed on the capnogram.



  108. The respiratory therapist is called to the emergency room to evaluate a 4-year-old girl who presents with a history of dysphagia and drooling.

    As the therapist attempts to examine her, she becomes anxious and fretful and has increasing inspiratory stridor. The admission lateral neck x-ray is shown above. On the basis of the patient's history and x-ray, which of the following is the most likely cause of the patient's distress?

    a. foreign body aspiration
    b. laryngotracheal bronchitis (croup)
    c. esophageal fistula
    d. epiglottitis
    • d
    • The lateral neck x-ray shows supraglottic narrowing. Also, the classic "thumb sign" of an edematous epiglottis is evident. This is most suggestive of epiglottitis.
  109. While reviewing a patient's medical chart, the respiratory therapist notes that over the last 24 hours, the patient's fluid intake totals 1,770 mL while the output total is 800 mL. Which of the following would be appropriate to evaluate at this time?

    a. arterial blood gases
    b. chest x-ray
    c. 12-lead ECG
    d. ventilation/perfusion scan
    • b
    • An output less than half the input is consistent with fluid overload. Fluid overload can lead to the lungs becoming congested with fluid resulting in pulmonary edema. Therefore, the patient should be evaluated for pulmonary edema. This can be done by obtaining and evaluating the chest x-ray. Evaluating the ECG, ventilation/perfusion scan, or arterial blood gases can not help to determine the extent the lungs have become involved with fluid excess.
  110. Measurement of electrolytes may be useful in the assessment of all of the following EXCEPT:

    a. cardiac arrhythmias
    b. severe diarrhea
    c. polycythemia
    d. diuretic therapy
    • c
    • Since polycythemia is simply an excess of red blood cells, an electrolyte abnormality will not cause polycythemia and polycythemia will not cause an electrolyte disturbance. Therefore, measurement of electrolytes would not be indicated in a patient with polycythemia. Electrolyte abnormalites are most notable for causing cardiac arrhythmias. Measurement of the electrolytes could be valuable in identifying the cause of the cardiac arrhythmia. Severe diarrhea and diuretic therapy are most notable for causing the loss of essential electrolytes. Measurement of the electrolytes would be valuable in assisting with electrolyte replacement therapy.
  111. The chest radiograph of a patient with left ventricular failure would most likely reveal which of the following?

    1. perihilar haze
    2. Kerley B lines
    3. pulmonary vascular redistribution

    a. 1, 2, and 3
    b. 2 and 3 only
    c. 1 and 3 only
    d. 1 only
    • a
    • As the left ventricle fails and dilates, signs of pulmonary congestion and interstitial edema (perihilar haze, pulmonary vascular redistribution, and Kerley B lines) appear on the chest radiograph.
  112. A patient's calculated P(A-a)O2 is 579 mmHg. On the basis of this value, which of the following may be present?

    a. severe pulmonary fibrosis
    b. massive atelectasis
    c. sarcoidosis
    d. pulmonary embolism
    • b
    • A P(A-a)O2 of 579 mmHg is most consistent with a large intrapulmonary shunt where there is an increase in the amount of blood by-passing the lungs and entering the left heart unoxygenated. Massive atelectasis is a classic shunt (perfusion without ventilation) type disease in which there is an increase in the amount of non-ventilating alveoli, leading to a greater portion of blood entering the left heart unoxygenated. With pulmonary embolism there is a problem with perfusion (leading to an increase in dead space - defined as ventilation without perfusion), not a shunt problem. Pulmonary fibrosis and sarcoidosis cause a diffusion defect, not a shunt.
  113. Which of the following data are required to obtain a CaO2?

    1. Hb
    2. FIO2
    3. PaO2
    4. PaCO2
    5. SaO2

    a. 1, 4, and 5 only
    b. 3 and 5 only
    c. 1, 2, and 3 only
    d. 1, 3, and 5 only
    • d
    • Correctly answering this question relies on the knowledge of the CaO2 equation: (Hb x 1.34 x SaO2) = (PaO2 x 0.003). As can be seen, the FIO2 and PaCO2 are not a part of the equation, therefore they are not correct choices.
  114. The following pulmonary function results are obtained on an adult male patient.

    Predicted
    FVC (L) 3.10
    FEV1 (L) 2.19
    FEF25-75% (L/sec) 4.20
    FRC (L) 2.50
    TLC (L) 4.80

    Observed
    FVC (L) 1.80
    FEV1 (L) 1.45
    FEF25-75% (L/sec) 3.45
    FRC (L) 1.60
    TLC (L) 2.90

    On the basis of these results, which of the following is the most likely conclusion?

    a. obstructive pattern
    b. mixed obstructive/restrictive pattern
    c. normal findings
    d. restrictive pattern
    • d
    • As can be seen from the observed pulmonary function parameters, all values are decreased, except the FEF25-75% (82% of predicted is normal). With pure obstructive disease, lung volumes and flows are decreased while lung capacities are increased. There is no obstructive process present because the FEF25-75% is normal and the lung capacities (FRC and TLC) are decreased, not increased. With pure restrictive disease, lung volumes and lung capacities are decreased while flows are normal. There is a restrictive process present because the lung capacities (FRC and TLC) are decreased and the FEF 25-75% is normal. Therefore, the correct choice is a restrictive pattern.
  115. While reviewing a patient's chart, the respiratory therapist notes that the patient has a long-standing history of respiratory insufficiency due to neuromuscular blockade. To evaluate the patient's current condition, the therapist should recommend:

    a. arterial blood gas analysis
    b. obtaining a complete set of pulmonary function studies
    c. measuring the spontaneous ventilatory parameters
    d. obtaining a chest x-ray
    • c
    • Respiratory insufficiency in conjunction with neuromuscular blockade is consistent with myasthenia gravis. Because the patient's disease, if it worsens, may lead to weakening or paralysis of the diaphragm, resulting in ventilatory failure - the patient's spontaneous ventilatory parameters (MIF, VC, VE) should be measured on a frequent basis to determine if and when ventilatory support is required. Although through arterial blood gas analysis the adequacy of ventilation (PaCO2) can be determined, it is not indicated for this situation because simpler, noninvasive methods are available. Obtaining a complete set of pulmonary function studies is extreme and not appropriate for this situation. A chest x-ray cannot distinguish if ventilatory failure is impending.

What would you like to do?

Home > Flashcards > Print Preview