-tip should be positioned below the vocal chords and no closer than 2 cm or 1 inch above the carina. -approx same level of the aortic knob/arch -observation and auscultation will quickly determine adequate ventilation before CXR is taken -cuff should not extend over the end of the ET or tracheostomy tube
-pacemaker should be positioned in the right ventricle -PAC should appear in right lower lung field -central venous catheters are placed in the right or left subclavian or jugular vein and should rest in the vena cava or right atrium -chest tubes should be located in the pleural space surrounding the lung -NG tubes should be in stomach 2-5 cm below the diaphragm
Ventilation scan -Radioisotope (xenon) gas is inhaled -and obstruction to airflow will allow little gas to enter
Perfusion scan -albumin, tagged with radioactive iodine is injected into a peripheral vein and lodges in the pulmonary capillaries -scanned over chest and shows distribution and volume of perfusion
Ventilation with no perfusion = PE (deadspace disease)
-for diagnosing of abnormalities in the hypopharynx, esophagus, or stomach -ingested and traced through the hypopharynx and into the esophagus via fluoroscope and xray at the end -suspected esophageal malignancy, dysphagia, congenital defect in hypopharync, esophagus, gastric reflux, esophageal varices.
-noninvasive for monitoring cardiac performance -doppler color flow mapping with 2D and M-Mode achocardiography to assess overall ventricular function including LEFT VENTRICULAR VOLUME and EJECTION FRACTION -Valvular disease or dysfunction -myocardial disease -abnormalities of cardiac blood flow -cardiac anomalies in the infant -abnormal heart sounds
-Ventricular Catheter: inserted through a burr hole (surgical opening into the skull -Subarachnoid bolt: metal screw with sensor chip that is inserted through a hole drilled into the subdural or subarachnoid space -Epidural Sensor: consists of placement of a fiberoptic sensor, radio transmitter, or tiny balloon in the epidural space through a burr hole in the skull
-applying positive pressure using a one-way inspiratory valve and a one-way expiratory resistor -expiratory pressure from 10 – 20 cmH20 at mid-exhalation -used for 15-20 mins 3-4x/day -improve secretion expectoration, reduce RV (decrease hyperinflation) and improve airway maintenance (CF, pneumonia) -discontinue if sinusitis, epistaxis or ear infection occurs -inspire larger than normal VT and exhale actively but NOT forcefully. exhalation 2-3x longer than inspiration
-Combination of high frequency pulse delivery (100-250 cycles/min of a sub-tidal colume and a dense aerosol -percussive effect of gas delivery improves ventilation past obstructions in the airway thereby delivering more aerosol to the distal airways. -Dense aerosol delivery promotes bronchial hygiene, reduces edema, and relieves bronchospasm with the appropriate medications -starting source pressure is 30 psi
-patient with uncomplicated obstructive sleep apnea started @ EPAP of 5-10 cmH2O -patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary -patients with NMD @ 10-15 cmH2O -low level of EPAP (5cmH2O) prevents small airway collapse on exhalation -oxygen must be titrated into the system to achieve desired FiO2 -IPAP always greater than EPAP -I:E of 1:2 preferred
-if bag fills rapidly and collapses easily on minimal pressure, check inlet valve -if bag becomes difficult to compress and patient compliance is normal, patient valve may be stuck open or closed -Excessively high flow may causes valves to jam. Use 15L/min or low range of flush -do not attempt to fix, REPLACE
You are trying to wean an alert intubated patient off full ventilatory support using the CPAP protocol with 40% O2. Early in the initial effort her respiratory rate increases from 24 to 30/min and you start to observe some use of her accessory muscles while breathing. Which of the following would be your first action at this time?
After feeling chest pain and shortness of breath, a 38-year-old female drove herself to the emergency room. After starting oxygen therapy on the patient, the RRT performed a physical exam and noted: a hyperresonant percussion note on the right side and a tracheal shift to the left. What is most likely the cause of these findings?
The physician calls you over to examine the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. Currently the patient has a tidal volume of 400 mL, rate of 10/min, and 35% O2. Her blood gas results are as follows: pH 7.31 PaCO2 49 torr HCO3 24 mEq/L BE -2 mEq/L PaO2 74 torr SaO2 95% Based on these values, which of the following changes is appropriate?
While performing a routine ventilator check on a patient receiving volume controlled ventilation, you note that the peak airway pressure has decreased from a prior value of 52 cm H2O to 32 cm H2O. There have been no changes to the ventilator settings. Which of the following actions would be appropriate at this time?
A patient is stabilized with adequate oxygenation and ventilation on volume control ventilation (VC) with the following settings: rate = 15/min, tidal volume = 550 mL, peak inspiratory pressure (PIP) = 45 cm H2O, plateau pressure = 30 H2O and PEEP = 10 cm H2O. The doctor orders a changeover to pressure control ventilation (PC). Which of the following settings would you initially use to implement PC in this patient?
A male patient with a smaller than normal trach tube is placed on volume control SIMV at a rate of 8/min. Over the last hour, you note the patient increasing use of his accessory muscles during spontaneous breaths, accompanied by some abdominal paradox. Which of the following would be the best way to overcome this problem?
A normal 5-foot 4-inch tall staff member serves as a biologic control for the PFT lab. Her established FVC is 3.81 L with a SD of ±0.13 L. During quality control testing of a spirometer, she produces the following FVC results: FVC #1 = 3.73 L, FVC #2 = 3.88 L, FVC #3 = 3.71 L. You should conclude that the
You are using a portable pressure-cycled ventilator with a heated humidifier and IPPB circuit to temporarily ventilate a post-operative patient who is regaining consciousness in the recovery room. After checking the patient and ventilator, you notice that the inspiratory time is prolonged and the machine does not cycle off without active patient effort. What should you do in order to correct the problem?
A 62-year-old male patient with a history of COPD and CHF have arrived in the ER with a complaint of difficulty breathing. To help with the differential diagnosis, the doctor orders the patient’s blood to be tested for bacteremia, CK-MB, cTnI, cTnT, and BNP. All results are negative. What is the most likely cause of the patient’s dyspnea?
You are monitoring a mechanically ventilated patient 36 hours post-craniotomy who has an ICP of 20 mmHg but is otherwise stable. The latest ABG results are as follows: pH 7.39 PaCO2 43 mm Hg HCO3 24 mEq/L BE 0 PaO2 88 mm Hg SaO2 95% Based on this information, which of the following is the most acceptable action?
A 58-year-old postoperative male who weighs 78 kg (172 lb) is receiving volume control A/C ventilation at a rate of 14/min with a tidal volume of 650 mL and an FIO2 of 0.4. Results of arterial blood gas analysis are as follows: pH 7.51 PaCO2 30 torr HCO3 23 mEq/L BE -1 PaO2 117 torr SaO2 99% Based on this information, you should recommend which of the following?
The Respiratory Therapist is called to evaluate a home patient with a nasal CPAP mask for treatment of obstructive sleep apnea. The patient’s wife states that he has been snoring more loudly lately and having periods of apnea. You confirm this after observing the patient’s sleeping and breathing patterns for 2 hours. What would be your first course of action to try to correct the problem?
A 53-year-old female patient with chronic bronchitis is receiving volume controlled A/C ventilation. Wheezing is heard over all lung fields and rhonchial fremitus is felt over the central airways. Also, her secretions are very thick. The patient’s peak pressure is 45 cm H2O and plateau pressure is 20 cm H2O. Which of the following would be useful to treat the patient’s condition?
In order to initiate weaning, you change the patient from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings?
Gas will pass through and out of a long sampling line before reaching analyzer so, low sampling flow will not give you enough information for a good reading, and condensation as a rule is always a problem especially in analyzers. Dessicant removes moisture from the gas, which is a good thing, so ANSWER is D
Multiple pvc’s coming from multiple locations (multifocal) is a real problem and you should administer oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc’s but would not be first option, atropine is used for bradycardia and cardiac irregularities but not pvc’s, epinephrine is emergency drug not for pvc’s but more for pulseless ventricular tachycardia or ventricular fibrilation where heart is not responding .
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea. The patient has marked dyspnea and a history of heart disease. Which of the following should the respiratory therapist recommend. 1.suction immediately 2.administer 100% oxygen 3.place in Fowlers position 4.administer furosemide
This is an emergency, they are having heart problems, dyspnea, frothy secretions indicating severe pulmonary edema, etc. so 100% oxygen immediately, having the patient in the Fowlers position (an upright position) will help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic) which gets rid of excess fluid. You do NOT suction someone with frothy secretions and heart problems, this just delays appropriate therapy. So ANSWER is 2,3,4
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would the respiratory therapist expect to observe on the monitor? a. Initially high, then falling b. Initially low, then rising c. Initially high, stays high d. Initially low, stays low
If the blood pressure obtained from the arterial line is higher than the blood pressure obtained from a sphygmomanometer (cuff pressure). Based upon this information, the respiratory therapist should conclude that. a. Non-compliant tubing is being used b. Transducer is placed too low c. Patient was lying flat during the measurement of the arterial line pressure d. Transducer dome contained air bubbles
Arterial line BP and cuff pressure should be the same, so there is a problem. Non-compliant tubing is a good thing because it’s a stiff tubing, if transducer is placed too high (above the heart), the flood will have to go uphill and you will get a lower pressure; transducer dome contained air bubbles would give you erratic readings but not a higher reading, but if the transducer is placed too low (below heart), the blood is flowing downhill & will give a higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was playing with friends and developed violent coughing and unilateral wheezing. Physical examination reveals a hyperresonant percussion note on the left and resonant percussion on the right. Inspiratory and expiratory chest films indicate air trapping with no foreign bodies “noted.” The respiratory therapist should suspect the child has. a.pneumothorax b.orthopnea c.aspirated a foreign object d.tachyphylaxis
Unilateral wheezing indicates aspirated object and fact that the child was playing with friends causes you to believe the child inhaled a small toy or something, hyperresonant percussion indicates air trapping, so you are thinking foreign object but x-ray says no foreign bodies “noted.” Just because it says “noted” does not mean something is not there, it just means it could not be seen on the xray, also if the child had swallowed a small plastic toy, “plastic” does not show up on xrays (radiolucent). The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric tube has been inserted to help relieve the nausea. The patient was started on Lasix and nitroglycerin. Which of the following should be monitored to closely identify side effects at this time. a. Cardiac enzymes b. Serum electrolytes c. Arterial blood gases d. Digitalis levels
A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated. This would indicate A. atelectasis. B. bronchopulmonary dysplasia. C. fluid overload. D. resolution of a pneumothorax.
bilateral means both sides, radiolucency refers to dark, midline mediastinum is right where is should be, the right hemidiaphragm slightly elevated is normal; so this actually indicates everything is normal. With atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary dysplasia it would look similar to ARDS, with fluid overload you would see pattern similar to butterfly or batwing similar to pulmonary edema, so the best
While assessing a patient’s breath sounds the respiratory therapist notes that when the patient is instructed to say the letter “E”, it comes through the stethescope sounding like “aaaahhh”. This change in the sound is associated with which of the following conditions? A. Pleuritic inflammation B. Pneumonia C. Bronchospasm D. Epiglotitis
An 1800 g neonate in the NICU is being monitored with a TcPO2 electrode. The TcPO2 electrode is reading 42 torr with the temperature set at 38oC. The PO2 from an umbilical artery sample is 72 torr. Which of the following would best explain the difference in these readings? A. There was an error in the arterial blood gas results. B. The TcPO2 electrode needs to be repositioned. C. The TcPO2 electrode temperature setting is too low. D. The TcPO2 electrode has been dislodged.
A patient with COPD has been admitted for possible pneumonia. The patient is producing moderate amounts of thick yellow sputum and breath sounds are decreased in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of the following therapies should the respiratory therapist recommend? A. chest physical therapy B. antibiotic therapy C. incentive spirometry D. IPPB
A premature baby is receiving an FIO2 of .40 and CPAP at 5 cmH2O. As the respiratory therapist increases the CPAP to 7 cmH2O, the baby’s respiratory rate increases to 58 per minute and the TcPCO2 reading increases with a stable SpO2 monitor reading. The respiratory therapist should recommend which of the following? A. Discontinue the CPAP B. Draw an arterial blood gas sample C. Increase the CPAP to 10 cmH2O D. Place the baby in an oxyhood at an FIO2 0.45
A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 3 mEq/L Na+: 115 mEq/L Cl-: 80 mEq/L HCO3-: 24 mEq/L Urine output: 60 mL/hour BP: 125/95 mm Hg Based upon this information the respiratory therapist would conclude A. the patient is hyperkalemic B. the patient requires decreased fluid intake C. the patient is polycythemic D. the patient has a metabolic alkalosis
A 55-year-old patient is admitted to CCU with chest pain. While assembling an oxygen mask, the respiratory therapist notes the following ECG pattern: Ventricular fibrillation The patient is now unconscious, unresponsive and has no palpable pulse. The therapist’s first response should be to: A. administer oxygen by non-rebreather mask. B. deliver a pre-cordial thump. C. recommend intravenous amiodarone. D. perform synchronized cardioversion.
Dampened wave form is when you aren’t getting a nice sharp reading, you should get a clear systolic and diastolic pattern; the most common cause is a blood clot, flushing the catheter with heparin might push the blood clot into the lung at this point (not a good idea), another common cause of a dampened wave form is air bubbles in the transducer dome, so the ANSWER is B.
The results of a patient’s chest radiograph reveal the presence of a left basilar free fluid accumulation with a meniscus formation. Physical examination of the chest indicates a dull percussion note on the left and trachea shifted to the right. These results are consistent with which of the following conditions? A. Pleural effusion on the left B. Basilar pneumonia of the left lung C. Atelectasis of the left lung D. Pneumothorax in the left lung
The respiratory therapist has been paged to the ICU to assist in the treatment of a 98 kg (215 lb) man. The patient is pale, diaphoretic, and suddenly loses consciousness. No palpable pulse or blood pressure is measured. The ECG monitor displays the following sinus bradycardia with a rate of 45): The respiratory therapist should: A. confirm the ECG in another lead. B. begin chest compressions. C. perform cardioversion. D. perform defibrillation.
A patient who recently underwent a total abdominal hysterectomy is complaining of chills and purulent sputum. Breath sounds reveal coarse rales and rhonchi. The results of the CBC indicate a WBC count of 19,000. The most likely diagnosis is that the patient has developed: A. atelectasis B. pneumonia C. hemothorax D. bacterial infection
After injecting a small amount of air into the balloon of a pulmonary artery catheter, the respiratory therapist sees a small amplitude change with the mean pressure reading 2 points below the PA end-diastolic pressure. Based upon this information, the therapist should conclude that A. there is pressure dampening. B. the transducer is placed too high. C. there is an obstruction in the catheter. D. this is a normal wedge tracing.
A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The respiratory therapist suspects that a pneumothorax has developed and performs transillumination, which reveals a brightly illuminated left thorax. The respiratory therapist’s FIRST action should be to A. insert a chest tube and connect to a pleural suction system. B. perform a fiberoptic bronchoscopy. C. obtain a STAT chest film. D. suction the infant.
Since a pneumothorax was suspected, illumination was done and revealed a “brightly illuminated left thorax” (a halo effect would be normal). A brightly illuminated thorax indicates there is definitely too much air or a pneumothorax in the left lung. Whenever there is a pneumothorax, you don’t need more information, you need to insert a chest tube and connect to a pleural suction system, so the ANSWER is A.
A patient with a history of myasthenia gravis has just been admitted for increased muscle weakness. The respiratory therapist should recommend which of the following diagnostic tests to monitor the patient’s drug therapy? A. polysomnography B. electroencephalography C. tensilon challenge test D. methacholine challenge test
Polysomnography is a sleep study, Electroencephalography is an EEG brain test, Methacholine Challenge Test is a pulmonary function test used to check the reactivity of a patients airways, it will induce bronchospasm; Tensilon Challenge Test is specifically for Myasthenia Gravis, it helps them breath right away but only lasts a few minutes, so the ANSWER is D.
A 64-year-old patient is being resuscitated for full cardiopulmonary arrest. After several unsuccessful attempts, the patient is orally intubated with a size 7.0 mm endotracheal tube. The physician is unable to establish a peripheral or central intravenous line. The ECG monitor now shows the following rhythm (sinus rhythm with regular positive p-wave, bradycardia). The respiratory therapist should recommend administration of: A. lidocaine by small volume nebulizer. B. atropine through the endotracheal tube. C. epinephrine by intra-cardiac injection. D. amiodarone by intraosseous injection.
Graph shows sinus rhythm with regular positive p-wave, bradycardia (slow heart rate, heart beat more than 5 boxes wide is bradycardia; boxes less than 3 wide is tachycardia). Since no IV can be inserted, we will administer drugs through endotracheal tube…. but what drug…lidocaine would be for gag reflex or coughing, epinephrine very powerful used for emergencies, for flat line, amiodarone might be used for ventricular disrythmias, pvc’s; atropine is for Bradycardia so ANSWER is Atropine.
A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. To determine the cause of the problem the respiratory therapist should recommend A. administering 100% oxygen. B. a V/Q scan. C. streptokinase. D. a STAT chest x-ray.
The respiratory therapist is called to the emergency department to evaluate a patient who was brought in via an ambulance due to a motor vehicle accident. The patient is cold and clammy with a blood pressure of 82/46 mm Hg. The ECG monitor shows sinus tachycardia with occasional PVC. Which of the following should the therapist evaluate at this time? A. Serum electrolytes B. Cardiac enzymes C. Hb and Hct levels D. 12 lead ECG
Patient seems to be experiencing shock, serum electrolytes would be a good choice, cardiac enzymes would be good but very expensive, 12 lead ECG is another good test but more appropriate if we were mainly concerned with the heart; Hb and Hct most closely corresponds to shock because you know the patient was in an accident and probably had a lot of blood loss, so ANSWER is C Hb and Hct
The following data has been obtained from a 28-week gestational age infant who was born premature: Color: Cyanotic Chest x-ray: Cardiac enlargement Chest Sounds: Systolic murmur Respiratory rate: 55 Br/min. SpO2: 80% Which of the following diagnostic tests should the respiratory therapist recommend? A. Pre- and post-ductal blood gas studies B. L/S ratio C. New Ballard Score D. Capillary blood gas
Nasopharyngeal airway is not for unconscious or uncooperative patients. Patients conscious and expectorating large amounts of secretions on their own does not indicate need for nasopharyngeal airway. So, ANSWER is B, conscious patient with an ineffective cough is the answer and best use of this airway.
A 43-week gestational age infant has just been delivered and is stained with meconium. The physician has asked that the baby be intubated and suctioned immediately. The respiratory therapist should recommend intubating the baby with which of the following size endotracheal tubes? A. 2.0 mm B. 2.5 mm C. 3.0 mm D. 4.0 mm
A patient being mechanically ventilated requires endotracheal suctioning. The patient is on high levels of PEEP therapy and has periods of hypotension. The respiratory therapist hyperoxygenates the patient before beginning the procedure. As the therapist disconnects the patient from the ventilator circuit, the following pattern is seen on the ECG monitor: Which of the following could be the cause of this patient’s ECG pattern? Bradycardia rythm A. loss of PEEP B. inadequate hyperoxygenation time C. vagus nerve stimulation D. normal response to suctioning
Which of the following describes the proper technique when using a stylet? A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube B. The distal end should be positioned at the level of the beveled end C. The distal end should be proximal to the “Murphy’s Eye” D. The distal end should be positioned proximal to the cuff
A patient is diagnosed with a necrotizing pulmonary fistula in the right lung. The physician has requested that the right lung be ventilated at a pressure 10 cmH2O lower than the left lung. The respiratory therapist should recommend providing this type of ventilation via a: A. Transtracheal catheter device B. Double-lumen endobronchial tube C. Cricothyroidotomy D. 14 gauge endotracheal catheter
A patient has been intubated in order to receive volume control ventilation. To inflate the endotracheal tube cuff, the respiratory therapist should add air to the cuff A. until no leak is heard during inspiration. B. and then remove it until a slight leak is heard at peak inspiration. C. to establish a pressure of 20 mmHg. D. to establish a pressure of 40 cmH2O.
A 16-year-old male patient involved in a motorcycle accident presents to the ER with massive maxillary and nasal trauma. Which of the following devices would be most appropriate for maintaining the patient’s airway? A. nasal endotracheal tube B. fenestrated tracheostomy tube C. oral pharyngeal airway D. oral endotracheal tube
A 57-year-old post-op patient is receiving volume control ventilation. The respiratory therapist is having difficulty removing secretions when suctioning. The patient weighs 85 kg (187 lb), is orally intubated with a size 9.0 mm ID endotracheal tube, the vacuum level is set at 90 mm Hg and the suction catheter being used is a size 14 Fr. The therapist should A. switch to a larger catheter size. B. increase the vacuum level. C. switch to a Coude catheter. D. instill normal saline prior to suctioning.
Difficulty removing secretions when suctioning. The airway is large enough at 9.0 mm. For the catheter size, cut airway size in half and multiply by three, this would be 13.5 and they are using 14, so catheter is good size; normal vacuum level for adult is 100 to 120 mm Hg, so ANSWER is B, increase vacuum level. (Coude catheter curves to the left at the end so if you had a problem with the left lung you could use this)
A respiratory therapist is in the cafeteria when an adult visitor begins to choke. The therapist has administered 7 subdiaphragmatic thrusts without clearing the patient’s airway, although the patient remains conscious. The therapist should A. administer 5 back blows. B. continue subdiaphragmatic thrusts. C. attempt to ventilate. D. check for presence of a pulse.
A patient is receiving continuous mechanical ventilation with 100% oxygen. While suctioning the patient, the respiratory therapist observes the following ECG pattern (Sinus Rhythm w Multi-Focal PVCs) on the monitor . The therapist should: A. decrease the suction time per pass. B. increase the oxygenation time. C. use a smaller suction catheter. D. decrease the suction pressure.
While performing orotracheal intubation for a patient in respiratory arrest, the respiratory therapist notices that the stylet has advanced from its original position. The respiratory therapist should A. continue with the intubation procedure. B. stop the procedure, manually ventilate the patient, and reposition the stylet. C. retract the stylet immediately. D. remove the stylet and continue with the procedure.
Which of the following is the best method to minimize damage to the tracheal wall caused by an endotracheal tube cuff? A. Measuring the volume used to inflate the cuff B. Palpating the inflation of the pilot balloon C. Utilizing a cuff pressure manometer D. Using minimal occluding volume to seal the airway
A chronic hypercapnic patient enters the emergency room complaining of shortness of breath. The patient is coughing up inspissated, pale, yellow secretions. Which of the following would you recommend at this time? A. Sputum culture and sensitivity B. Oxygen at 2 LPM via nasal cannula C. A-P and lateral chest x-ray D. Arterial blood gases
A patient with known reversible airway disease takes two puffs of albuterol from his metered-dose inhaler. The respiratory therapist measures the patient’s peak flow following the administration of the medication and determines that the peak flow has increased only minimally. The therapist should A. add a spacer to the metered-dose inhaler. B. change the medication to levalbuterol C. administer the medication by small volume nebulizer. D. contact the physician concerning the care of this patient.
While receiving postural drainage and percussion to her right lower lobe, a 44-year-old patient suddenly vomits and aspirates. The respiratory therapist should immediately A. place the patient in Fowlers position. B. encourage the patient to take deep breaths. C. suction the patient. D. administer acetylcysteine by SVN.
An air flowmeter and an oxygen flowmeter are being used to deliver 40% oxygen to a patient via a non-rebreathing mask. A total flow of 12 LPM is required to prevent the non-rebreathing bag from deflating. How many liters of air and how many liters of oxygen should the therapist use? A. 2 LPM air, 6 LPM oxygen B. 4 LPM air, 8 LPM oxygen C. 6 LPM air, 6 LPM oxygen D. 9 LPM air, 3 LPM oxygen
A 26-year-old patient with shortness of breath is admitted to the emergency room. The patient states that he was running in Central Park with a friend and could not catch his breath. Bedside assessment reveals the following data: Pulse: 120 Respirations: 25 br/min Color: pale SpO2: 89% on room air Breath sounds: slightly diminished on the right The respiratory therapist should: A. request a STAT chest x-ray. B. administer 100% oxygen. C. insert a large bore needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert a chest tube into the 2nd intercostal space on the right side in the midclavicular line.
IPPB machines are pressure cycled and have to reach a preset pressure to turn off inspiration and go into the expiratory phase. Two reasons a machine would not reach a preset pressure, 1) there is a leak, 2) not enough flow, so ANSWER is A, increase the flow. Decreasing sensitivity only controls the machine turning on; and don’t increase pressure because the machine would have to reach an even higher preset pressure to go into the expiratory phase.
While performing routine ventilator parameter checks on a patient on a microprocessor ventilator with a wick humidification system, the respiratory therapist notices there is very little condensation in the tubing. The most likely explanation is that the A. temperature probe is placed distal to the wye adapter. B. room temperature is lower than normal. C. heating element is not functioning properly. D. water level is just slightly above the refill line.
Question A 34-week gestation age infant has just been delivered. The one and five minute apgar scores are 4 and 6. The physician has written an order for 40% humidified oxygen. Which of the following would be the most appropriate device? A. an incubator set at 40% oxygen B. a radient warmer set at 40% C. a oxygen hood set at 40% D. a high humidity oxygen tent set at 40%
Heated cascade humidifier causes moisture in the tubing, heated wick humidifier also causes moisture in the tubing, ultrasonic nebulizer probably gives you the most moisture in the tubing, so the ANSWER is C, heat moisture exchanger (HME). This device traps moisture from exhaled gas in the device and uses it to humidify the next breath; this is indicated for short term use (transportation, weaning off ventilator) because does not give you 100% moisture.
A 24-year-old post-operative male patient is receiving intermittent positive pressure therapy at 20 cm H2O. The patient complains that the machine is cycling off too soon. The patient’s post-operative spontaneous vital capacity is 3.5 L. Which of the following should the respiratory therapist recommend? A. Increase the pressure to 25 cm H2O B. Discontinue therapy, encourage deep breathing and coughing frequently on his own C. Switch to a volume incentive spirometry device D. Recommend decreasing the flow
The key is that the patient’s post-operative spontaneous vital capacity is 3.5L, which shows he can take a pretty good deep breath on his own, so the simplest, easiest ANSWER is B, discontinue therapy, encourage deep breathing and coughing frequently on his own. If they can do it on their own, that’s the best therapy of all.
The respiratory therapist notices that a mask CPAP system is unable to maintain the desired level of pressure. Which of the following might be causing the level to not be maintained? 1. Sticking valve in the system 2. Loose fitting mask 3. Faulty humidifier connection 4. Leak around the airway cuff
GENERAL PATIENT CARE: Which of the following are true statements concerning an automated medication dispensing system? 1. Maintains accurate information about when medication was dispensed. 2. Allows multiple practitioners to access patient medication. 3. Assists with management of medication inventory. A. 2 only B. 1 and 3 only C. 1 and 2 only D. 1, 2, and 3
The ICU director wishes to implement a protocol to reduce the risk of ventilator-associated pneumonia (VAP) for patients requiring mechanical ventilation. The respiratory therapist should recommend that the protocol include A. placing the patient in the prone position. B. changing the ventilator circuit each day. C. utilizing a closed-suction catheter system. D. intubating the patient with a Carlens tube.
A 75-year-old patient with COPD is receiving oxygen at home by nasal cannula with a bubble humidifier. How should the respiratory therapist instruct the patient to clean his humidifier? A. Place it on the top shelf of the dishwasher. B. Soak it in an acetic acid solution for 20 minutes and rinse with water. C. Rinse it with distilled water and allow to air dry. D. Soak it in an alkaline glutaraldehyde solution for 30 minutes and rinse with water.
A patient complains of shortness of breath while receiving oxygen via transtracheal catheter. Her pulse oximeter reading has decreased from 92% to 85%. The respiratory therapist should first A. increase the flow to the catheter. B. flush the catheter with saline. C. administer metaproterenol via small volume nebulizer. D. replace the transtracheal catheter with a nasal cannula.
A patient is being discharged from the hospital. The physician has ordered portable oxygen therapy at home. The patient has been instructed to use the oxygen at 1-2 L/min during the day and PRN at night. Which of the following should the respiratory therapist recommend? A. E cylinders B. Concentrator C. Liquid system D. Molecular sieve
An oxygen conservation cannula would be most appropriate for which of the following patients? A. A patient with pneumonia requiring low flow oxygen. B. A patient with emphysema who is experiencing increased shortness of breath. C. A patient with a severe exacerbation of asthma. D. A patient with pulmonary fibrosis requiring long term oxygen therapy.
While performing a routine ventilator check on a patient in the ICU, the respiratory therapist notes that the patient’s cardiac monitor shows ventricular tachycardia at a rate of 165. The therapist determines the presence of a carotid pulse, although the patient is hypotensive and unresponsive. Which of the following should the respiratory therapist recommend? A. prepare for defibrillation B. administer a precordial thump C. prepare for synchronized cardioversion D. administer 1mg/kg of lidocaine
A 2 kg (4.4 lb) neonate requires transportation to a tertiary care center for cardiac surgery. The infant has a heart rate of 140 and a BP of 60/30.The neonate is intubated with a size 2.5 mm uncuffed endotracheal tube and ventilation is being assisted manually at a rate of 40/min. Which of the following should the respiratory therapist recommend? A. postpone the transport until the neonate has spontaneous respirations B. prepare for the transport immediately C. delay the transport and stabilize the patient D. wait 24 hours and then reassess the patient
Ergometer measures strength, water seal spirometer measures volume, pneumogram measures respiratory movements, like in a sleep study; turbine pneumotachometer is an air speed meter so it measures flow, so ANSWER is B water seal spirometer. It is not most convenient device but would be most accurate in this case.
A body plethysmograph (body ox) measures missing volumes (FRC, RV,TLC); water seal spirometer is most accurate to test chronic bronchitis; wright respirometer (turbine spirometer) measures air speed and is LEAST accurate, so ANSWER is C, wright respirometer; pressure differential pneumotachometer measures air speed but is electronic and more accurate than the wright respirometer.
A patient complaining of dyspnea has the following arterial blood gas results: pH: 7.36 PaCO2: 56 torr PaO2: 49 torr HCO3-: 34 mEq/L SaO2: 80% FIO2: .21 These results are best described as: A. acute respiratory acidosis B. acute metabolic alkalosis C. chronic respiratory acidosis D. chronic metabolic alkalosis
A patient in the intensive care unit has the following blood gas results: Arterial pH: 7.42 PaCO2: 39 torr PaO2: 90 torr SaO2: 97% HCO3-: 25 mEq/L BE: +1 mEq/L Hb: 14 g/dL Venous pH: 7.39 PvCO2: 46 torr PvO2: 50 torr SvO2: 80 % HCO3-: 25 mEq/L BE: +1 mEq/L What should the respiratory therapist report as the patient’s C(a-v)O2? A. 1.8 vol% B. 3.3 vol% C. 5.2 vol% D. 7.3 vol%
A patient in the intensive care unit has the following data obtained: pH: 7.41 PaCO2: 40 torr PaO2: 235 torr SaO2: 99% HCO3-: 23 mEq/L BE: +1 mEq/L
FIO2: 1.0 VD/VT: 0.35 Hb: 15 g/dL RER: 0.8 PB: 747 What should the respiratory therapist report as the P(A-a)O2? A. 210 torr B. 415 torr C. 535 torr D. 620 torr
A patient is being ventilated with a Servo 300 ventilator in the intensive care unit. The following data is obtained: Mode: SIMV Mandatory rate: 12 b/min Total rate: 12 b/min VE: 8.6 L FIO2: 0.60 PIP: 31 cm H2O PEEP: 10 cm H2O
pH: 7.41 PaCO2: 40 torr PaO2: 95 torr SaO2: 96% HCO3-: 23 mEq/L BE: +1 mEq/L A-aDO2: 300 torr C(a-v)O2: 3.6 vol% What should the therapist report as the QS/QT? A. 15% B. 18% C. 20% D. 25%
The FRC (functional residual capacity) is measured on a patient using the helium dilution technique and the result is 3.0 liters. The same patient is then tested in a body box and the result is 4.5 liters. Which of the following would account for the difference? A. The patient has significant non-ventilated lung volume B. There was a leak during the helium dilution procedure C. The patient did not perform the maneuver properly D. Hysteresis is present
Question is asking why is there a difference in the FRC between helium test and body box test. A body box is more accurate, it measures ALL gases in the chest. Helium will not measure any “trapped” gases. So, the difference must be the trapped gases, so the ANSWER is A, the patient has significant non-ventilated lung volume (which is a fancy name for trapped gases).
Prior to performing spirometry on a pre-op patient, the respiratory therapist calibrates the spirometer using a 3.0 L super syringe. The three volumes achieved are: 2.80 L, 2.80 L, 2.79 L. Based upon the information obtained the therapist should conclude that the 1. spirometer is precise. 2. spirometer is accurate. 3. super syringe was advanced too slowly. 4. spirometer may have a leak. A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 4 only
When you use a 3.0 L syringe it should come out within .1, so 2.80, 2.79 are too low. Spirometer is “precise” means “consistent” it does not mean accurate of perfect. Spriometer is accurate means average (the average of the 3 numbers should come out to 3.0). Spirometer has a leak is why when you blow 3.0 L, you only get volumes of 2.80, 2.80 and 2.79, so ANSWER is B 1 and 4
Best way to continuously monitor minute ventilation. Chest transducers measure effort to breathe; thermistor is a temperature probe that will measure effort; water seal spirometer is very accurate in measuring volumes but it can’t continuously measure minute ventilation because it will run out of room; Pneumotachometer will measure flow passing through it for as long as you want, so ANSWER is D, Pneumotachometer.
A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. After administering 100% oxygen, the therapist should recommend A. a barium swallow. B. a CT of the chest. C. starting heparin therapy. D. starting lasix.
Long bone fractures combined with lying around is a recipe for pulmonary embolism. So now lets confirm this. If a VQ scan was there it would be the best answer after 100% oxygen. Since I don’t see the answers I’m looking for, eliminate what you would NOT do. CT scan will be too focused (need to see profusion, etc.), starting Lasix is a diuretic to get rid of excess fluids, but
ANSWER C, starting heparin therapy would be appropriate to dissolve or break up the suspected embolism.
A 62-year-old female has the following arterial blood gas results on room air: pH: 7.37 PaCO2: 38 torr PaO2: 60 torr The co-oximeter is currently down for repair at this time. The physician has asked you to estimate the SaO2. You would estimate the SaO2 to be which of the following? A. 75% B. 80% C. 85% D. 90%
MECHANICAL VENTILATION: During a routine ventilator parameter check on a patient, you notice the low pressure alarm is being briefly activated prior to each breath. Which of the following is most likely the cause? A. the patient is fighting the ventilator B. the flow rate is set too fast C. the alarm delay is set too short D. the peak pressure limit is set too high
C, the alarm delay is set too short; If patient was fighting ventilator you would get a high pressure alarm not a low pressure alarm; if the flow rate is set too fast you would peak at a higher pressure and get a high pressure alarm; If the peak pressure limit is set too high the patient can build up higher and higher pressures without the alarm going off and that could be dangerous.
A spontaneously breathing 76-year-old patient who weighs 60 kg (132 lb) is on an FIO2 of 0.45 via a trach collar. He has had a change in his tidal volume from 600 mL to 300 mL and his respiratory rate went from 12 /min to 24 /min. Which of the following changed due to the change in the tidal volume and rate? A. Minute ventilation B. Alveolar ventilation C. Anatomical deadspace D. Mechanical deadspace
A 5′ 10″, 80 kg (176 lbs) male patient with multiple trauma from a motorcycle accident has developed ARDS and is being ventilated at the following settings: Mode: VC, SIMV VT: 500 mL Set Rate: 14 br/min. FIO2: 0.60 PEEP: 12 cm H2O Arterial blood gas results reveal: pH: 7.35 PaO2: 72 torr PaCO2: 44 torr SpO2: 93% The patient is conscious and pulling on the IV lines and ventilator tubing. At this time, the respiratory therapist should recommend A. changing to assist/control mode. B. restraining the patient. C. increasing the set rate to 16 br/min. D. sedating the patient.
Question 9 of 15 – A 60-year-old male patient weighs 80 kg (176 lb) and is on a volume-cycled ventilator at a set VT of 800 mL, a peak pressure reading of 65 cm H2O, exhaled VT measured at 760 mL, peak inspiratory flowrate is 60 L/min., a plateau pressure reading of 58 cm H2O and a PEEP of 5 cm H2O. Which of the following is most likely occurring at this time? A. Dynamic compliance is decreasing B. Static compliance is increasing C. Airway resistance is increasing D. Thoracic compliance is increasing
An infant on a high frequency jet ventilator (rate of 150 b/m) has the following arterial blood gases: pH: 7.30 PaO2: 60 torr PaCO2: 50 torr HCO3-: 21 mEq/L Which of the following changes would best help to improve these results? A. Increase the inspiratory time B. Increase the drive pressure C. Increase the frequency to 190 br/min D. Increase the FIO2
Question 12 of 15 – By looking at PaCO2 you can see that the patient is not being properly ventilated (and the PaO2 is a little low due to this also). All are good answers but the “best” is ANSWER B, Increase the drive pressure to deliver more volume and blow off more CO2. Think of this as any other machine (PEEP, etc.) and what would you do if the patient was not being properly ventilated? Forget that this is a baby on a fancy named machine… you would increase the pressure, so increase it here.; Increasing inspiratory time
A premature neonate with respiratory distress syndrome is being mechanically ventilated with a pressure-limited, time-cycled ventilator at the following settings: PIP: 25 cm H2O Rate: 24/min Flow: 7 L/min I time: 0.6 sec. FIO2: 0.45 PEEP: 4 cm H2O Arterial blood gas results from an umbilical artery line are as follows: pH: 7.29 PaCO2: 62 torr PaO2: 68 torr HCO3-: 22 mEq/L The therapist should now recommend: A. Increase PEEP B. Increase the I time C. Increase the rate D. Decrease PIP
Mechanical Ventilation – B The respiratory therapist reviews the ventilator parameter sheet for a patient receiving mechanical ventilation. The peak and plateau pressure readings are as follows: Based upon this information, the therapist should conclude that A. airway resistance is increasing. B. water is building up in the tubing. C. pulmonary compliance is decreasing. D. minute volume is increasing.
Peak pressure = how much pressure it takes to put air into the lungs and how much it takes to push air through the tubing; Plateau pressure = only pressure it takes to put air into the lungs. The difference between these two shows airway resistance. You’ll notice by the difference between the two pressures that airway resistance is pretty much staying the same; If water was building up in tubing the airway resistance would also be increasing. You will notice on the Plateau pressure only, that it is gradually “increasing”… it is taking more pressure just to get air into the lungs, so the lungs are becoming stiffer (compliance is decreasing), so the ANSWER C, Pulmonary compliance is decreasing.
Question 4 of 15 – A 48-year-old patient is receiving mechanical ventilation following a hernia repair. He is 6′ tall and weighs 75 kg (165 lb). Prior to initiating a spontaneous breathing trial, the respiratory therapist notes the following information: FIO2: 0.35 SIMV mandatory rate: 6 /min. Total rate: 14 /min. VT: 600 mL MIP: -26 cm H2O Spont. VT: 400 mL Arterial blood gas results show: pH: 7.39 PaCO2: 42 torr PaO2: 88 torr HCO3-: 23 mEq/L The patient is to be placed on CPAP with an FIO2 of 0.40. Five minutes into the SBT, his respiratory rate increases to 28 /min., heart rate changes from 110 /min. to 135 /min. and blood pressure changes from 112/70 mm Hg to 140/88 mm Hg. At this time, the therapist should A. shorten the SBT by 5 minutes. B. continue the SBT. C. discontinue the SBT. D. increase the FIO2 to 0.45.
A post-operative craniotomy patient was thrashing around while on a volume-cycled microprocessor ventilator. The physician has asked for your recommendation in the management of this patient to prevent him from harming himself and to also stabilize his ICP. Which of the following drugs would you recommend administering at this time? A. Anectine B. Versed C. Valium D. Morphine
Ideal drug would be one that sedates, relieves pain, and depresses ventilator drive. Anectine is a short acting paralyzing drug with no sedative and no pain killers; Versed is an anti-anxiety, it would sedate, but that is all; Valium sedates but does not control ventilation or kill pain. Morphine sedates, depresses ventilatory drive, and is a pain killer, so ANSWER is D, Morphine
A 6′ 2″ tall, 80 kg (176 lb) male patient with alpha 1 protease inhibitor deficiency is being mechanically ventilated at the following settings: Mode: VC, SIMV Set rate: 12 br/min. Total rate: 16 br/min. Tidal volume (set): 650 mL Tidal volume (spontaneous): 320 mL Peak flow: 55 L/min FIO2: 0.30
His vital signs are stable and he is sleeping comfortably. An arterial blood gas has been drawn with the following results:
pH: 7.37 PaCO2: 51 torr PaO2: 68 torr HCO3-: 29 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the set rate B. Decrease the tidal volume C. Increase the FIO2 D. Maintain current settings
A premature neonate with respiratory distress syndrome is being mechanically ventilated with a pressure-limited, time-cycled ventilator at the following settings:
PIP: 25 cm H2O Rate: 28/min Flow: 7 L/min I time: 0.5 sec. FIO2: 0.70 PEEP: 4 cm H2O
Arterial blood gas results from an umbilical artery line are as follows:
A 46-year-old female patient weighing 65 kg (143 lb) is on mechanical ventilation following a motor vehicle accident. Ventilator settings are as follows:
FIO2: 0.40 Mode: VC, SIMV Set rate: 10 br/min. Total rate: 16 br/min. VT: 500 mL Pressure support: 25 cm H2O
Based upon this information, what should the respiratory therapist recommend at this time? A. Decrease pressure support to 20 cm H2O B. Decrease FIO2 to 0.30. C. Place on a T-piece at 50% oxygen. D. Decrease set rate to 8 br/min.
It would be appropriate for the respiratory therapist to A. increase the set rate to 25 /min. B. switch to inverse ratio ventilation. C. increase pressure to 40 cm H2O. D. increase PEEP to 25 cm H2O.
Mechanical Ventilation – C A 65 kg (150 lb) patient requires a minute alveolar ventilation of 10 L/min. Which of the following set of parameters would be most appropriate? A. VT 600 mL, RR 16 /min, VD mech 0 mL B. VT 650 mL, RR 18 /min, VD mech 50 mL C. VT 700 mL, RR 20 /min, VD mech 50 mL D. VT 900 mL, RR 12 /min, VD mech 100 Ml
Following mitral valve replacement surgery, a 29-year-old female patient is combative on a volume-control ventilator in the assist/control mode. The peak pressure alarm is sounding with each breath. The nurse practitioner has a STAT call in to the cardiovascular surgeon. She asks the respiratory therapist for an immediate recommendation. Which of the following should the therapist recommend?
A. increase the peak pressure alarm limit B. Order a STAT chest x-ray C. Change to SIMV mode and evaluate the patient D. Order a STAT arterial blood gas
Combative post-op patient. You need to take some action to support the patient and evaluate further. Order a STAT chest x-ray is not going to help the immediate problem and will actually delay action. Change to SIMV mode and evaluate will help correct peak pressure alarm problem by allowing the patient to breathe spontaneously in between ventilator breaths. SIMV as a rule is more comfortable for most patients,
A patient is receiving mechanical ventilation at the following settings: Mode: SIMV Mandatory rate: 12 Total rate: 12 FIO2: 0.50 VT: 750 ml Peak flow: 50 L/min. PEEP: 5 cmH2O
The following volume-pressure loop is observed.
Which of the following changes should the therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decrease the VT D. Increase the peak flow
A 28-week gestational age infant with severe respiratory distress syndrome is being mechanically ventilated in the PC, SIMV mode at the following settings:
Flow rate: 6 L/min Set rate: 32 br/min. PIP: 28 cmH2O FIO2: 0.70 PEEP: 5 cm H2O I time: 0.8 seconds
Based on the above information, the respiratory therapist should change the A. I time to 1.0 second. B. PEEP to 7 cm H2O. C. FIO2 to 0.75. D. PIP to 30 cm H2O.
Question 13 of 15 – Peak Pressure – Plateau Pressure = Airway Resistance. So, we can see that the airway resistance has been increasing steadily. Most common cause are secretions, or bronchospasm though bronchospasm is not as common. Lung compliance is indicated by the Plateau pressure, which has been maintaining. ANSWER C, the patient needs suctioning.
A 70 kg (154 lb) male patient is being mechanically ventilated following a triple coronary artery bypass graft. The chest radiograph shows bilateral radiolucency. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below:
Mode: SIMV FIO2: 0.40 Mandatory rate: 8 Total rate: 16 VT: 650 mL Spontaneous VT: 175 mL PIP: 29 cm H2O Plateau Pressure: 21 cm H2O PEEP: 5 cm H2O
Which of the following should the therapist recommend? A. Independent lung ventilation B. Pressure control ventilation C. Pressure support ventilation D. Inverse ratio ventilation
Mechanical Ventilation – D: A 58-year-old woman who weighs 65 kg (143 lb) arrives in the surgical ICU following surgical repair of an abdominal aortic neurysm. She has a 60 pack year history of cigarette smoking and is currently smoking 1 pack/day. The physician has written orders to initiate mechanical ventilation. Prior to starting mechanical ventilation for this patient, the respiratory therapist should set all of the following controls EXCEPT
A 32-year-old victim of a motor vehicle accident (weight 80 kg, 176 lb) is on mechanical ventilation at the following settings: Tidal volume 700 mL, SIMV mandatory rate 10/min, and FIO2 0.65. As the PEEP level was increased from 17 cm H2O to 20 cm H2O, the respiratory therapist observed that the heart rate changed from 128/min to 106/min.
At this time, the therapist should recommend
A. inserting a balloon tipped flow directed catheter. B. drawing an arterial blood gas. C. reassessing the patient in 20 minutes. D. decreasing the PEEP.
A 52-year-old, 5′ 9″ tall male patient weighing 85 kg (187 lb) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below:
Mode: VC, A/C FIO2: 0.40 Mandatory rate: 16 /min Total rate: 16 /min VT: 800 mL PEEP: 5 cm H2O
An 1800 g neonate is receiving 30% oxygen via an oxyhood with the following arterial blood gas results obtained: pH: 7.34 PaO2: 46 torr PaCO2: 47 torr HCO3-: 22 mEq/L Based upon this information, the respiratory therapist should recommend which of the following at this time? A. Intubate and initiate mechanical ventilation with an FIO2 0.55 B. Increase the FIO2 to 0.35 C. Administer 5 cm H2O endotracheal tube CPAP with an FIO2 0.60 D. Increase the FIO2 to 0.50
A 3-year-old child with cystic fibrosis is being mechanically ventilated at the following settings: PIP: 34 cm H2O I time: 1.0 second Rate: 22 /min. FIO2: 0.60 PEEP: 6 cm H2O Mode: PC, SIMV Arterial blood gas results show: pH: 7.36 PaCO2: 44 torr PaO2: 49 torr HCO3-: 24 mEq/L The respiratory therapist should adjust the A. PEEP to 8 cm H2O. B. FIO2 to 0.65. C. set rate to 24 /min. D. PIP to 36 cm H2O.
Question 10 of 15 – A patient is receiving mechanical ventilation at the following settings: Mode: VC, SIMV Mandatory rate: 12 /min Total rate: 12 /min FIO2: 0.50 VT: 700 mL Peak flow: 40 L/min. PEEP: 5 cm H2O The following scalar graphic is observed. Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to pressure control mode C. Decrease the VT D. Increase the peak flow
A post-operative thoracotomy patient is receiving mechanical ventilation in the recovery room with a tidal volume of 750 mL, SIMV mandatory rate 8/min, FIO2 of 0.40. Arterial blood gas results show: pH: 7.36 PaO2: 89 torr PaCO2: 45 torr SaO2: 95% The patient is breathing fast and shallow. Based upon this information, the respiratory therapist should recommend A. repeating the arterial blood gas in 30 minutes. B. increase SIMV mandatory rate to 10/min. C. sedating the patient. D. paralyzing the patient with pancuronium bromide (Pavulon).
Any patient on any ventilator you must consider patient response. Blood gases are fine and don’t warrant any changes to ventilator settings. Plus this patient is in the recovery room so we want to get them off the ventilator and wake them up.
So the best ANSWER is A, check arterial blood gas in 30 min. (basically monitor the patient).
A post-operative craniotomy patient is receiving mechanical ventilation and has an increased intracranial pressure reading. The goals of mechanical ventilation for this patient include all of the following EXCEPT A. increased PaCO2. B. keep airway pressure to a minimum. C. hyperoxygenate. D. use minimum PEEP levels.
After the Respiratory Therapist sets up a nonrebreathing mask on a patient at a flow rate of 10 L/min, the reservoir bag collapses before the patient finishes inspiring. The RT should do which of the following?
A. Change to a simple mask at a flow rate of 10 L/min B. Remove the one-way valve from the exhalation port. C. Place the patient on continuous positive airway pressure (CPAP) D. Increase the flow rate to 15 L/min
The respiratory therapist receives an order to set up a moderate level of O2 on a patient who arrives in the ED breathing at a rate of 35 breaths/min. Which of the following O2 delivery devices is most appropriate to use in this situation?
A. Simple O2 mask at 10 L/min B. Nasal cannula at 4 L/min C. NRB Mask at 15 L/min D. Air-entrainment mask at 40% O2
Which of the following is the most appropriate recommendation?
A. Increase the liter flow to 4 L/min B. Maintain the current O2 level C. Institute noninvasive positive pressure ventilation (NPPV) D. Place on a NRB mask at 12 L/min
The physician has ordered O2 to be set up on a patient who has a spontaneous tidal volume of 500 mL and an inspiratory time of 1 second. Which of the following O2 delivery devices will deliver a flow that meets or exceeds this patient’s inspiratory flow?
A. 35% air-entrainment mask at 6 L/min B. 60% aerosol mask at 12 L/min C. NRB mask at 15 L/min D. Simple O2 mask at 10 L/min
After connecting a nasal cannula to the humidifier outlet, you kink the tubing and hear a whistling noise coming from the humidifier. Which of the following most likely has caused this?
A. The humidifier jar is cracked B. The capillary tube in the humidifier is disconnected C. The humidifier has no leaks D. The top of the humidifier is not screwed on tightly
You notice that the patient’s secretions have become thicker and more difficult to suction since the ventilator humidifier was replaced with an HME. The RT should recommend which of the following?
A. Increase inspiratory flow B. Decrease the temperature to the HME C. Replace with a new HME D. Replace the HME with a conventional heated humidifier
To minimize an increased airway resistance produced by high-density aerosol inhalation, the RT should recommend which of the following?
A. Administer a bronchodilator along with the aerosol B. Instruct the patient to breathe through the nose C. Use a heated nebulizer to deliver the aerosol D. Perform chest physiotherapy after the aerosol treatment
A chest x-ray film obtained after intubation shows that the tip of the ET tube is resting at the fourth rib. Which of the following actions should be taken?
A. The tube should be advanced 2 cm B. The tube should be advanced until equal breath sounds are heard C. The tube should remain at this level D. The tube should be withdrawn 3 cm
The RT is assessing a patient with severe emphysema and observes pedal edema and jugular venous distention. The therapist should note in the patient’s chart that these signs are most likely the result of:
A. Systemic hypertension B. Hypercapnia C. Pulmonary infection D. Right ventricular hypertrophy
A patient has just been intubated, and the CO2 detector placed on the proximal end of the ETT reads 1.5%. The RT should suspect which of the following?
A. The tube is in the trachea B. The tube is in the right mainstem bronchus and should be withdrawn 4 cm C. The tube is in the esophagus D. The tube is at the level of the carina and should be withdrawn 2 cm
Which of the following statements is true regarding the King Airway?
A. It is double-lumen tube placed in the esophagus to ventilate difficult-to-intubate patients. B. The airway can be used only on patients at least 5 feet tall C. The airway utilizes one cuff, which is inflated with 45-90 mL of air to block off the oropharynx D. Because of the length of the airway, it is unlikely that the trachea can be intubated inadvertently
You are called to a patient’s room because a ventilator alarm is sounding. You hear an audible leak around the patient’s ET tube during a ventilator breath and notice the exhaled volume reading is 150 mL less than the set Vt. You check the cuff pressure and find that it is 12cm H2O. Which of the following is the appropriate action to take?
A. Maintain the current cuff pressure and increase the patient’s Vt to compensate for the leak. B. Instill enough air to maintain a cuff pressure of 30 mm Hg. C. Instill air into the cuff to a pressure of 20-30 cm H2O. D. Instill enough air until only a slight audible leak is heard.
You want to pass a suction catheter into the patient’s left lung to obtain a sputum specimen. What is the most appropriate method of accomplishing this?
A. Have the patient turn his or her head to the left B. Have the patient turn his or her head to the right C. Use a coude suction catheter D. Use a catheter that is one half the internal diameter of the patient’s airway
The RT is using a 12-French suction catheter to suction a female patient who is intubated with a 7.0-mm ET tube and is having difficulty removing the thick secretions. The suction pressure used is -120 mm Hg. Which of the following should be recommended to correct this problem?
A. Increase the suction pressure to -140 mm Hg B. Instill 5 mL of normal saline down the ET tube C. Change to a 14 French suction catheter D. Change to a coude-tipped suction catheter
The RT is called to pediatric ICU to suction a 6-year-old ventilator patient with pneumonia who is intubated with a 5.0 mm ET tube. Which of the following represents the most appropriate catheter size and suction pressure to use on this patient?
A. 8-Fr catheter, -100mm Hg B. 10-Fr catheter, -60mm Hg C. 8-Fr catheter, -60mm Hg D. 10-Fr catheter, -100mm Hg
Which of the following will increase the possibility of the ET tube cuff causing tracheal mucosa damage?
1. Maintaining intracuff pressure of 38 cm H2O 2. Using minimal leak technique 3. Using a low-volume, high-pressure cuff 4. Using minimal occluding volume technique
A. 1 and 3 only B. 2 and 4 only C. 1, 3 and 4 only D. 2, 3, and 4
An intubated patient begins exhibiting severe respiratory distress, and the RT auscultates no breath sounds and determines that there is no gas flow passing through the end of the ET tube. The high pressure alarm is sounding on the ventilator. Which of the following should the therapist do at this time?
A. Instill 5 mL of saline down the ET tube and suction B. Extubate and manually ventilate the patient C. Obtain an arterial blood gas D. Recommend a stat chest x-ray
After a bronchoscopy, the RT notes that it is taking more ventilator pressure to ventilate the patient’s lungs than before the procedure. This could be caused by which of the following?
The RT notices on a patient’s chest tube drainage system that there is fluctuation of the water level in the water-seal chamber with each patient breath, and that air bubbles are seen only in the suction control chamber, which has a suction pressure of -20 cm H2O. The most appropriate action is which of the following?
A. Clamp the chest tube and check for leaks B. Insert
