TMC Secure Form A

Last updated 4 months ago

140 questions

1

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TMC Secure Form A

Last updated 4 months ago

140 questions

1

1. A 55 y/o patient with dyspnea and a non-productive cough has the following noted examination results over the right lower lung field:
- dullness to percussion
- decreased tactile fremitus
- diminished breath sounds
Which of the following is most likely to produce these findings?

A. pulmonary embolism

B. pneumonia

C. pneumothorax

D. pleural effusion

Which of the following is associated with an optimally exposed chest radiograph?

A. vertebrae and lung markings are clearly visible

B. pleural spaces and heart borders are well defined

C. pulmonary vascular markings are absent

D. air bronchograms are easily identified

The use of respiratory accessory muscles is frequently the result of an increase in:

A. alveolar ventilation

B. lung compliance

C. airways resistance

D. cardiac output

A 30 y/o patient has been receiving mechanical ventilation for 24 hours following admission for a
drug overdose. The patient is alert, oriented, and stable, and has been weaned to PSV of 5 cmH20 and
an Fi02 of 0.40. The following data are collected after 30 minutes:

ph 7.45 Vt: 485 ml
C02: 34 torr MIP: -38 cmH20
Pa02: 125 torr RR: 16
HC03: 23 mEq/L

Which of the following should a RT recommend?

A. extubation

B. full ventilatory support

C. increased PS

D. re-evaluation in 4 hours

A physician orders 1 mg of medication to be administered by aerosol. If the concentration of a stock
solution is 0.04%, how many ml of the solution must be administered?

A. 0.25

B. 0.40

C. 4.00

D. 2.50

6. A pulse oximeter provides an accurate indication of a patient’s oxyhemoglobin saturation in which of the following clinical conditions?

Polycythemia pulmonary HTN CHF CO poisoning

A.     Yes                                  Yes                           Yes               No

B.     Yes                                  Yes                            No               Yes

C.     Yes                                   No                            Yes              Yes             

D.     No                                    Yes                           Yes              Yes

A 70 kg (154lb), (6ft 3in) male postoperative patient is receiving VC, A/C ventilation. Pertinent data are below:

Fi02: 0.30 pH 7.29
Mandatory Rate: 12 PaC02: 51 torr
Total Rate: 14 Pa02: 86 torr
VT: 500 ml Hc03: 24 mEq/L
Inspiratory time: 1.0 sec B.E.: -2 mEq/L
PEEP: 5 cmH20

Which of the following should the RT recommend?

A. PEEP of 10 cmH20

B. Inspiratory time of 1.5 sec

C. Mandatory rate of 14

D. Tidal volume of 600 ml

If a RT chooses to use a portable ventilator to transport a patient within a hospital, the ventilator should have the ability to:

A. monitor pulmonary compliance

B. sound a disconnect alarm

C. switch to CPAP mode

D. provide pressure supported breaths

Auscultation immediately following intubation reveals absent breath sounds on the left. Which of the following is the most likely explanation for this finding?

A. the patient is experiencing diffuse bronchospasm

B. the endotracheal tube is in the right mainstem bronchus

C. a tension pneumothorax has developed on the left

D. a tracheoesophageal fistula has developed

A patient with CHF tells a RT that he feels like he can breathe better when he sleeps sitting in a chair. This is most indicative of:

A. Orthopnea

B. Kussmaul breathing

C. Hyperpnea

D. Cheyne-stokes respiration

Which of the following can a RT use to determine a patient’s RSBI?

A. Vane respirometer

B. Peak flowmeter

C. Pressure manometer

D. Capnometer

A pt. involved in a MVA presents with respiratory distress. A chest radiograph confirms the presence of multiple fractures to five adjacent ribs on the left side. Which of the following physical findings should be expected during assessment of the chest?

A. Trachea deviated to the left

B. See-saw movement of the abdomen and chest

C. Paradoxical motion of the left chest during inspiration

D. Tympany over the right chest

A patient with OSA reports he continues to experience significant daytime sleepiness. He states he uses his nasal CPAP at the prescribed level of 12 cmH20 every night, determined by previous polysomnographic testing. A repeat sleep study indicates multiple periods of absent airflow, without chest or abdominal movement. Which of the following should a RT recommend?

A. Increase CPAP to 15 cmH20

B. Perform an uvulopalatopharyngoplasty

C. Switch to a full-face mask

D. initiate bi-level positive airway pressure

Which of the following masks should be used to deliver a 70/30 heliox mixture most
effectively to a patient?

A. Simple

B. Aerosol

C. Air entrainment

D. Nonrebreathing

Which of the following should a RT use to assess the severity of possible CO poisoning?

A. arterial oxygen tension

B. complete blood count

C. hemoximetry

D. pulse oximetry

When reviewing the chart of a newly admitted patient, a RT finds the pt. has COPD and a 70 pk/yr smoking history. The pt. was admitted for dyspnea. The pt. is somnolent and can protect his airway. Which of the following should the therapist recommend FIRST?

CT scan of the chest

pulmonary function testing

echocardiogram

arterial blood gas

A pt. with a 50 pk/yr history of smoking has a cough and an infiltrate on a CXR that persists despite a 1 month course of antibiotic therapy. Which of the following should a RT recommend?

flexible bronchoscopy

pulmonary function tests

open lung biopsy

thoracentesis

Short acting and long acting bronchodilator aerosols have been ordered at inconsistent frequencies, and occasionally for patients who do not require bronchodilator therapy. To address these concerns, a RT should recommend:

developing a bronchodilator therapy protocol

informing physicians on an individual basis when errors are detected

educating nursing staff on what constitutes acceptable physician orders

administering therapy as determined by individual therapist discretion

Which of the following drugs is a beta 2 agonist?

acetylcysteine

beclomethasone dipropionate (vanceril)

ipratropium bromide (atrovent)

levalbuterol (xopenex)

A RT observes the following data while monitoring mechanical ventilation:
8:00 am 9:00 am 10:00 am
peak pressure (cmH20) 35 40 43
Plateau pressure (cmH20) 30 28 24
Set PEEP was constant. Which of the following is present?

airway resistance is increasing and compliance remains the same

lung compliance is decreasing only

airway resistance is increasing and lung compliance in increasing

lung compliance is increasing only 

A RT is asked to review a newborn's history. The following information is available:
1 minute 5 minutes
color acrocyanosis pink
pulse 70 110
reflex cough cough
tone weak active motion
RR 20 40
Which of the following APGAR scores do you expect to see?

4,  8

5,  8

6,  10

7,  10

The primary purpose of cleaning and sterilizing nondisposable respiratory care equipment after each use is to:

extend the life of the equipment

prevent cross infection and reinfection of patients

prevent contamination of other equipment

protect the personnel who are handling the equipment 

Chest physiotherapy is initiated for a patient who is alert and oriented. As therapy progresses, a RT notices the patient is no longer responsive to verbal stimuli. The therapist checks the patient's pulse and finds that the HR is 30. The patient has a RR of 6. Which of the following should the therapist do NEXT?

obtain an ABG

call the patient's physician

perform nasotracheal suctioning

activate the  medical emergency team

1. A 55 y/o patient with dyspnea and a non-productive cough has the following noted examination results over the right lower lung field:
- dullness to percussion
- decreased tactile fremitus
- diminished breath sounds
Which of the following is most likely to produce these findings?

A. pulmonary embolism

B. pneumonia

C. pneumothorax

D. pleural effusion

Which of the following is associated with an optimally exposed chest radiograph?

A. vertebrae and lung markings are clearly visible

B. pleural spaces and heart borders are well defined

C. pulmonary vascular markings are absent

D. air bronchograms are easily identified

The use of respiratory accessory muscles is frequently the result of an increase in:

A. alveolar ventilation

B. lung compliance

C. airways resistance

D. cardiac output

A 30 y/o patient has been receiving mechanical ventilation for 24 hours following admission for a
drug overdose. The patient is alert, oriented, and stable, and has been weaned to PSV of 5 cmH20 and
an Fi02 of 0.40. The following data are collected after 30 minutes:

ph 7.45 Vt: 485 ml
C02: 34 torr MIP: -38 cmH20
Pa02: 125 torr RR: 16
HC03: 23 mEq/L

Which of the following should a RT recommend?

A. extubation

B. full ventilatory support

C. increased PS

D. re-evaluation in 4 hours

A physician orders 1 mg of medication to be administered by aerosol. If the concentration of a stock
solution is 0.04%, how many ml of the solution must be administered?

A. 0.25

B. 0.40

C. 4.00

D. 2.50

6. A pulse oximeter provides an accurate indication of a patient’s oxyhemoglobin saturation in which of the following clinical conditions?

                 Polycythemia             pulmonary HTN         CHF         CO poisoning

A.     Yes                                  Yes                           Yes               No

B.     Yes                                  Yes                            No               Yes

C.     Yes                                   No                            Yes              Yes             

D.     No                                    Yes                           Yes              Yes

A 70 kg (154lb), (6ft 3in) male postoperative patient is receiving VC, A/C ventilation. Pertinent data are below:

Fi02: 0.30 pH 7.29
Mandatory Rate: 12 PaC02: 51 torr
Total Rate: 14    Pa02: 86 torr
VT: 500 ml  Hc03: 24 mEq/L
Inspiratory time: 1.0 sec B.E.: -2 mEq/L
PEEP: 5 cmH20

Which of the following should the RT recommend?

A. PEEP of 10 cmH20

B. Inspiratory time of 1.5 sec

C. Mandatory rate of 14

D. Tidal volume of 600 ml

If a RT chooses to use a portable ventilator to transport a patient within a hospital, the ventilator should have the ability to:

A. monitor pulmonary compliance

B. sound a disconnect alarm

C. switch to CPAP mode

D. provide pressure supported breaths

Auscultation immediately following intubation reveals absent breath sounds on the left. Which of the following is the most likely explanation for this finding?

A. the patient is experiencing diffuse bronchospasm

B. the endotracheal tube is in the right mainstem bronchus

C. a tension pneumothorax has developed on the left

D. a tracheoesophageal fistula has developed

A patient with CHF tells a RT that he feels like he can breathe better when he sleeps sitting in a chair. This is most indicative of:

A. Orthopnea

B. Kussmaul breathing

C. Hyperpnea

D. Cheyne-stokes respiration

Which of the following can a RT use to determine a patient’s RSBI?

A. Vane respirometer

B. Peak flowmeter

C. Pressure manometer

D. Capnometer

A pt. involved in a MVA presents with respiratory distress. A chest radiograph confirms the presence of multiple fractures to five adjacent ribs on the left side. Which of the following physical findings should be expected during assessment of the chest?

A. Trachea deviated to the left

B. See-saw movement of the abdomen and chest

C. Paradoxical motion of the left chest during inspiration

D. Tympany over the right chest

A patient with OSA reports he continues to experience significant daytime sleepiness. He states he uses his nasal CPAP at the prescribed level of 12 cmH20 every night, determined by previous polysomnographic testing. A repeat sleep study indicates multiple periods of absent airflow, without chest or abdominal movement. Which of the following should a RT recommend?

A. Increase CPAP to 15 cmH20

B. Perform an uvulopalatopharyngoplasty

C. Switch to a full-face mask

D. initiate bi-level positive airway pressure

Which of the following masks should be used to deliver a 70/30 heliox mixture most
effectively to a patient?

A. Simple

B. Aerosol

C. Air entrainment

D. Nonrebreathing

Which of the following should a RT use to assess the severity of possible CO poisoning?

A. arterial oxygen tension

B. complete blood count

C. hemoximetry

D. pulse oximetry

When reviewing the chart of a newly admitted patient, a RT finds the pt. has COPD and a 70 pk/yr smoking history. The pt. was admitted for dyspnea. The pt. is somnolent and can protect his airway. Which of the following should the therapist recommend FIRST?

CT scan of the chest

pulmonary function testing

echocardiogram

arterial blood gas

A pt. with a 50 pk/yr history of smoking has a cough and an infiltrate on a CXR that persists despite a 1 month course of antibiotic therapy. Which of the following should a RT recommend? 

flexible bronchoscopy

pulmonary function tests

open lung biopsy

thoracentesis

Short acting and long acting bronchodilator aerosols have been ordered at inconsistent frequencies, and occasionally for patients who do not require bronchodilator therapy. To address these concerns, a RT should recommend: 

developing a bronchodilator therapy protocol

informing physicians on an individual basis when errors are detected

educating nursing staff on what constitutes acceptable physician orders

administering therapy as determined by individual therapist discretion

Which of the following drugs is a beta 2 agonist?

acetylcysteine

beclomethasone dipropionate (vanceril)

ipratropium bromide (atrovent)

levalbuterol (xopenex)

A RT observes the following data while monitoring mechanical ventilation:
                                                  8:00 am        9:00 am    10:00 am
peak pressure (cmH20)                35             40              43
Plateau pressure (cmH20)           30             28              24
Set PEEP was constant. Which of the following is present?

airway resistance is increasing and compliance remains the same

lung compliance is decreasing only

airway resistance is increasing and lung compliance in increasing

lung compliance is increasing only 

A RT is asked to review a newborn's history. The following information is available:
                           1 minute                             5 minutes
color            acrocyanosis                               pink
pulse                  70                                            110
reflex              cough                                        cough
tone                weak                                      active motion
RR                     20                                               40
Which of the following APGAR scores do you expect to see?

4,  8

5,  8

6,  10

7,  10

The primary purpose of cleaning and sterilizing nondisposable respiratory care equipment after each use is to:

extend the life of the equipment

prevent cross infection and reinfection of patients

prevent contamination of other equipment

protect the personnel who are handling the equipment 

Chest physiotherapy is initiated for a patient who is alert and oriented. As therapy progresses, a RT notices the patient is no longer responsive to verbal stimuli. The therapist checks the patient's pulse and finds that the HR is 30. The patient has a RR of 6. Which of the following should the therapist do NEXT?

obtain an ABG

call the patient's physician

perform nasotracheal suctioning

activate the  medical emergency team

Which of the following information may be obtained from a forced expiratory spirogram?

FVC and FEV1

FRC and FVC

FEV1 and RV

RV and FRC

A 20 y/o female with asthma presents in severe respiratory distress. The patient is tachypneic with accessory muscle use. BS reveal bilateral expiratory wheezes and Sp02 is 87% on air. A RT should recommend initiating:

levalbuterol by metered-dose inihaler

albuterol by continuous nebulization

salmeterol by dry powder inhaler

budesonide by small volume nebulizer

A RT examines a pt and notes coarse crackles over both lung fields. Which of the following does this most likely indicate? 

subcutaneous emphysema

pleurisy

bronchospasm

secretions

A pt. had a tracheostomy for several weeks and was recently weaned form ventilatory support. Which of the following devices will allow decannulaiton of the trachea and maintain the patency of the stoma? 

transtracheal catheter

oropharyngeal airway

tracheostomy button

laryngeal mask airway

A 34 y/o with bronchiectasis pt. with a significant amount of daily secretions wishes to continue an appropriate pulmonary hygiene program while maintaining full-time employment. Which of the following will best assist this patient in attaining this goal? 

manual percussion

IPPB

albuterol MDI

vibratory PEP

A RT notes a patient who is receiving VC, A/C ventilation has thick mucoid secretions. The therapist observes that the servo-controlled humidifier is set at 31 C (88 F). Which of the following should the therapist do?

increase the humidifier termperature setting

increase the ventilator set flow

change to a heat moisture exchanger

drain ventllator circuit condensation

Following insertion of a central venous pressure catheter, a chest radiograph is taken to evaluate the position of the catheter. When viewing the radiograph, a RT notes the tip of the catheter is in the superior vena cava The therapist should conclude the catheter:

has been advanced too far

is in the proper position

has perforated a vessel

should be removed

A 39 y/o who is morbidly obese is admitted to teh ED with fever, productive cough, and SOB. The patient's vital signs are stable and he is awake and alert. After initiation of bronchodilator therapy and antibiotics, serial blood gas results reveal:
              10 am                         11 am
Fi02        0.21                           0.50
pH           7.28                          7.22
PaC02      72                               85
Pa02        45                                56
HC03       34                                35
Sa02        78%                             89%
The patient's clinical condition remains unchanged. Which of the following should a RT do NEXT?

maintain current therapy

initiate non-invasive ventilation

decrease Fi02 to 0.45

administer vibratory PEP

A pt. with a history of chronic bronchitis complains of SOB following thoracic surgery. The pt. is receiving 30% 02 by aerosol mask. Rhonchi in the right lower lobe are heard on auscultation. Which of the following should a RT recommend?

vibratory PEP

postural drainage

dornase alfa therapy

manual percussion

Initiation of an expiratory hold just prior to the next ventilator delivered breath facilitates the measurement of:

PPlat

auto-PEEP

peak airway pressure

set PEEP

A 65 y/o who is post CABG was extubated 4 hours ago and complains of increasing SOB. BS are decreased over the right lung field. The following data are available:
RR       25
HR      105
BP       155/90
Sp02   90% on 4LPM BNC
Which of the following studies should a RT recommend NEXT?

bedside spriometry

chest CT with contrast

ventilation-perfusion scan

chest radiograph

A RT is called to see a 59 y/o patient who has been in a persistent vegetative state for several months following a stroke. He is diaphoretic and has a pulse of 120 and an sp02 of 81% with a 28% tracheostomy collar. The therapist is unable to pass a suction catheter. Which of the following should the therapist do FIRST?

Replace the tracheostomy tube

increase suction pressure by 20%

initiate mechanical ventilation

use a smaller suction catheter

A patient's C(a-v)02 increased from 4.0 to 6.2 vol% after PEEP was increased. Which of the following  best explains these results?

VD/VT decreased

static compliance increased

airways resistance increased

cardiac output decreased

A previously healthy 30 y/o patient is hospitalized with chills and fever. A chest radiograph is consistent with right upper lobe pneumonia. Which of the following is most likely to aid in the patient's management

in-exsullfation

coached coughing and deep breathing

bland aerosol therapy

spirometry before and after a bronchodilator

Which of the following is the most appropriate device to administer a controlled oxygen concentration for a patient with a variable respiratory pattern?

aerosol face tent

low flow nasal cannula

parital rebreathing mask

air-entrainment mask

A 168 cm (5ft 6in) 62 kg (135 lb) patient is receiving PC, A/C ventilation. The following data are available:

Fi02:  0.40                                                       pH:    7.52
Mandatory rate:   15                                     PaC02:   26 torr
Total rate:   15                                                Pa02:   110 torr
PEEP  10 cmH20                                            HC03:  21 mEq/L
Set inspiratory pressure:   20 cmH20
I:E      1:4
Exhaled Vt       700 mL

A RT should recommend decreasing the:

Fi02

set inspiratory pressure

mandatory rate

inspiratory time

Which of the following is the primary benefit of respiratory care protocols?

improved patient outcomes

decreased workload

shorter work hours

increased autonomy

Which of the following is most effective for destroying microorganisms on patient care equipment?

acetic acid

pasteurization

autoclave

isopropyl alcohol

If the reservoir bag of a NRB mask collapses during inspiration, the RT should:

tighten the strap holding the mask to the face

increase the flow of oxygen to the reservoir bag

remove the valve between the mask and the reservoir bag

remove valves on the exhalatin ports of the mask

A pt. presents with a 3 month history of episodic SOB with exercise. A CXR, ECG, and echocardiogram are normal. The following spirometry results are obtained:

              Pre-bronchodilator        Post-bronchodilator
FEV1                    2.9 L                    3.1 L
FVC                      3.2 L                    3.4 L

Which of the following should a RT recommend NEXT?

bronchoprovocation test

overnight pulse oximetry

CT scan of the chest

lung volume measurements

When explaining the purpose of incentive spirometry to a patient after abdominal surgery, a RT should tell the patient the procedure is performed to:

prevent areas of the lung from collapsing

treat pneumonia in addition to antibiotics

reduce the pain associated with breathing

shorten the time for wound healing

The following capnographic tracing is noted for a patient receiving mechanical ventilation:

The RT should:

check the exhalation valve for a malfunction

recommend the SIMV mode of ventilation

evaluate the patient for airways obstruction

calculate the gradient between PaC02 and PetC02

A pt. with asthma is receiving a treatment with 2.5 mg of albuterol. During the treatment, the patient's HR increases from 80 to 138. A RT should recommend:

decreasing the dosage of albuterol

increasing the amount of saline per treatment

changing to ipratropium bromide (atrovent)

adding acetylcysteine to the treatment 

Five minutes after extubating a patient, a RT observes marked stridor, labored breathing, intercostal retractions, and an Sp02 of 85%. Aerosolized racemic epi has been delivered without benefit. Which of the following should the therapist recommend at this time?

treatment with dexamethasone (decadron)

manual ventilation with bag and mask

a cool aerosol treatment

reintubation

A pt has a VT of 450 mL and a RR of 15. What is the minute ventilation (L/min)?

5.75

6.75

7.75

8.25

A pt. who is receiving mechanical ventilation is scheduled for a fiberoptic bronchoscopy. Which of the following is the primary threat to adequate ventilation during the procedure? 

secretion production

elevated airway pressure

loss of consciousness

airway obstruction

While administering a hyperinflation treatment at 20 cmH20 to a patient with CF, a RT notes the patient has suddenly become very short of breath and cyanotic. The RT's most appropriate action is to:

suction the patient

terminate the treatment

decrease the peak pressure to 10 cmH20

stop the treatment for 10 to 20 minutes

A pt. with COPD is receiving oxygen by a nasal cannula at 1 L/min. The target Sp02 is 90%. The following data are obtained: 
pH     7.35                    RR   18
PaC02:   64 torr          HR   100
Pa02:   52 torr            BP    145/90 mmHg
HC03:  34 meq/L        Sp02   85%
Which of the following should the RT recommend FIRST?

Place on a NRB

initiate NIV

change to a SFM

titrate nasal cannula flow

While counseling a pt. during a smoking cessation session, the pt. expresses concern about weight gain. A RT should address the patient's concern by explaining that this is partially the result of: 

decreased metabolism

increased loss of self-control

reliance on nicotine replacment therapy

lack of available aversive conditioning

A patient's chest radiograph shows diffuse alveolar infiltrates. The following data are available:

CVP    12 mmHg
RAP    14 mmHg
Mean PAP    30 mmHg
PCWP:    26 mmHg
C.I.    1.6 L/min/m2

A RT should recommend administering:

albuterol

a fluid bolus

nitric oxide

diuretics

An ABG sample is requested for an adult pt. who is undergoing dialysis. The pt. has a surgical shunt in his left arm. Blood flow through the right ulnar artery is absent. A RT should obtain the sample from which of the following arteries?

right radial

left radial

right brachial

left brachial

A pt. is receiving VC, SIMV with the following settings:

Fi02   0.50
VT    400 mL
Mandatory rate:    12

A RT hears the low volume alarm and observes that the system pressure manometer reaches only 4-5 cmH20 during the inspiratory phase. The RT should:

check exhalation valve function

straighten the inspiratory line kink

empty condensate from the breathing circuit

switch to the A/C mode

Fi02    0.40 an who weighs 65 kg (143 lb) is receiving VC ventilation after abdominal surgery. Vent settings & ABG results are below:

Fi02    0.40                                   pH    7.47
Mandatory rate:    14                 PaC02:   31
Total rate:      14                          Pa02  117 torr
Tidal Volume:   700 mL              HC03:   22 mEq/L

The RT should:

decrease the tidal volume

change to PC ventilation

increase the peak flow setting

administer bicarabonate IV

Which of the following is a side effect of inhaled nitric oxide?

decreased cardiac output

methemoglobinemia

systemic hypotension

increased WBC count

A RT instructs a pt. to take a deep breath and then exhale as quickly as possible. The RT observes a recording of the fastest air movement. Which of the following was measured?

peak flow

vital capacity

FEV 1

FEF 25-75%

A 28 y/o pt. is being evaluated by a RT after a trauma. The pt. is receiving PC ventilation with the following settings:
Fi02:     0.65
Mandatory rate:    14
PEEP:     8 cm H20
Set inspiratory pressure:   36 cmH20
The therapist notes the following pressure-volume tracing: 


The therapist should recommend decreasing the: 

mandatory rate

PEEP

set inspiratory pressure

expiratory time

The best way to check the accuracy of a spirometer is to use a:

3 L syringe

pneumotachometer

vortex sensor

Wright respirometer

A pt. receiving oxygen at 2 L/min through a transtracheal catheter complains that the supply tubing keeps popping off of the catheter. To correct this problem, a RT should: 

decrease the flow of oxygen

check the catheter for obstruction

perform endotracheal suctioning

tape the connection securely

A wait of a few minutes should be expected after application of a transcutaneous electrode before values stabilize. This is associated with: 

electrode calibration

capillary dilatation

barometric pressure equilibration

cerebral blood perfusion

For a pt. receiving noninvasive ventilation through a dual-limb circuit, an increase in which of the following will most likely reduce the respiratory effort associated with spontaneous breathing?

inspiratory time

ramp time

PEEP

pressure support

A RT on a Medical Emergency Team is directed to maximize Fi02 for a pt. who is not intubated. Which of the following should the therapist select? 

CPAP of 10 cmH20, Fi02 of 0.50

NPPV of 15/5 cmH20, Fi02 of 0.50

NRB, flowmeter on flush

simple oxygen mask, flowmeter on 6 L/min

The following data are available for a pt. receiving VC, A/C ventilation:

Fi02:    0.50
VT:   500 mL
PEEP:   10 cmH20

Lab results are as follows: 
Pv02:   30 mmHg  
Pa02:  75 mmHg    
Sp02:   91%

Which of the following should a RT recommend?

increase the VT

decrease the PEEP to 5 cmH20

change the Fi02 to 0.75

measure cardiac output

A RT is reviewing the medical record of an infant to determine whether any respiratory care is indicated in the home. Which of the following suggests the need for home apnea monitoring? 

albuteorl aerosol every 4 hours PRN

caffeine citrate daily

APGAR scores of 3 and 4

oxygen by cannula at 0.25 L/min

Which of the following is the most common side effect of aerosolized albuterol?

tremor

tachypnea

dilated pupils

bradycardia

Which of the following should a RT emphasize as a critical infection control step to a pt. who will administer aerosol therapy at home? 

disinfecting equipment every 96 hours

boiling the nebulizer cup each day

handwashing before and after therapy

soaking nondisposable equipmetn in 50% alcohol

A pt. who is a victim of a residential fire is brought to the ED and is receiving oxygen by nasal cannula at 8 lpm. The Sp02 is 100%. ABG results are as follows:

pH   7.30
PaC02:   30 torr
Pa02:   200 torr
HC03:   14 mEq/L
Sa02:   100%
O2Hb:   78%
C02Hb:  21%
HB 14.5 g/dL

A RT should recommend: 

changing to 0.50 with an air-entrainment mask system

administering an Fi02 of 0.60 with a HHFNC

maintaining current oxygen therapy

switching to a NRB at 15 L/min

The most commonly ised bedside measurement to monitor the progression of ventilatory impairment in a patient with Guillain-Barre syndrome is:

capnometry

ABG

VC

peak flow

A pt. complains of a productive cough that started approximately 4 months ago. The pt. most likely has:

asthma

pneumonia

emphysema

bronchitis

Which of the following should be used to most accurately assess oxygen saturation in a pt. with suspected smoke inhalation?

blood gas analyzer

capnometer

hemoximeter

pulse oximeter

Given a normal pH, a Sp02 of 90% should be associated with a Pa02 of approximately:

48 torr

61 torr

74 torr

87 torr

A RT is unable to pass a 14 Fr. suction catheter through a 7.0 mm ID nasotracheal tube. Repositioning the head of the pt. does not allow passage of the catheter. Which of the following should the RT do? 

instill normal saline into the tube

recommend reintubation orally

suction with a 12 Fr catheter

perform subglottic suction

A pt. is suspected of having an upper airway obstruction. Which of the following tests should a RT recommend to detect this abnormality?

FEF 25-75%

nitrogen washout

RV/TLC

flow-volume loop

A pt. with an IBW of 55 kg is receiving mechanical ventilation. The patient's blood gas results and parameters during VC, A/C ventilation are below:

Fi02:    0.70                            pH:   7.35
Mandatory rate: 14             C02:  35 torr
VT:    500 mL                         Pa02:  40 torr
PEEP:  5 cmH20                    HC03:  19 mEq/L

The RT should recommend:

changing to SIMV mode

increasing to 10 cmH20 PEEP

changing to 5 cmH20 CPAP

increasing the VT to 550 mL

Home overnight oximetry is used to assess the need for:

polysomnography

mechanical ventilation

trans-esophageal echo

CVP monitoring

While testing the proper function of a flow-inflating bag, a RT notes the bag does not fully inflate with occlusion of the patient connector. Which of the following may be the cause of the problem?

malfunctioning inlet valve

excessive oxygen flow

open flow control valve

missing oxygen reservoir

Three liters of air are injected into a spirometer from a certified volume standard syringe. The measured value is 2.6 L. Which of the following should the RT conclude?

the plunger was pushed too slowly

spirometer is raedy for patient testing

the time scale was incorrectly claibrated

calibration is outside the accepted range

A 65 y/o pt. with congestive heart failure is receiving 10 cmH20 CPAP and an Fi02 of 0.60. ABG results are:

pH:   7.41
PaC02:    40 torr
P02:   150 torr
HC03:   25 mEq/L

Which of the following should a RT conclude?

the patient is acidotic

hyperoxemia is present

the patient is tachypneic

hypocapnia is present

A RTcollects the following data on a 58 y/o male who has been receivin VC, A/C ventilation for the past 24 hours following thoracic surgery:
MIP    -32 cmH20
Exhaled VT:   420 mL

The pt. is alert and oriented. He has a Sp02 of 98% while receiving ventilation with the following settings:
Fi02:   0.40
Mandatory rate:  12
VT:   600 mL
The best weaning method for this patient is: 

a spontaneous breathing trial

SIMV mode, mandatory rate 14, and set tidal volume 600 mL

PS ventilation at 20 cmH20

PC ventilation at 25 cmH20, and mandatory rate of 12

A 26 y/o pt. who weighs 80 kg (176 lbs) was injured in a motor vehical crash. The pt. was intubated with a 6.0 mmID ETT by EMS. Upon admission to teh ED, VC, A/C ventilation is started. The pt. has peak airway pressures of 40 cmH20, increased work of breathing, and is dyssynchronous with the vent. A RT should recommend:

increasing the peak inspiratory flow

raising the tidal volume

performing a bronchoscopy

reintubating with a larger endotracheal tube

A 24 y/o female presents with a history of nasal stuffiness, episodes of daytime dyspnea, and a cough that occurs every summer. Which of the following drug classifications should a RT recommend to control the patient's symptoms?

leukotriene inhibitor

IgE immunoglobulin antagonist

beta-adrenergicagonist

anticholinergic

An adult victim of a burn injury is being monitored in the ICU. Pt. data are as follows:
Pv02:   45 torr
PCWP:  4 mmHg
Mean PAP:   11 mmHg
CVP:   4 cmH20
Urine output: 5 ml/hr
A RT should conclude the pt. is:

hypovolemic

fluid overloaded

clinically stable

acidotic

A RT is assisting a physician perform a tracheotomy on a pt. who is receiving PC ventilation. The therapist observes an increased HR, decreased exhaled VT, and distant BS over the right chest. This information is most indicative of a:

circuit leak

right pneumothorax

kink in the vent circuit

right mainstem intubation

A RT is called to deliver a 2nd dose of 5 mg albuterol to a pt. with acute asthma. The pt. had audible wheezing after the first treatment 20 minutes ago. After the 2nd treatment, auscultation reveals markedly diminished BS. Which of the following should a RT recommend? 

begin continuous nebulized bronchodilator therapy at 10 mg every hour

continue to administer 5 mg albuterol every 2 hours

decrease albuterol dose to 2.5 mg every 2 hours

change to iprotropium bromide 0.5 mg every 6 hours

A RT observes the following chest radiograph:


Which of the following are evident:
trach tube    pneumothorax       pleural effusion    chest tube

no, yes, yes, no

yes, no, no, yes

no, yes, no, yes

yes, no, yes, no

The diagram below show the results of FVC maneuvers by a patient before and after an albuterol treatment:

Which of the following should a RT recommend NEXT?

bronchoscopy for airway obstruction

non-invasive positive prssure ventilation

inhaled bronchodilator therapy

supplemental oxygen therapy

A pt. was diagnosed wtih bronchiectasis 3 years ago. The pt. reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows cavitary disease. Which of the following should the RT recommend? 

transtracheal aspiration

airway clearance therapy

bronchodilator therapy

respiratory isolation

At the beginning of exhalation, the sharp rise in exhaled C02 on a capnographic tracing represents:

washout of dead space

tidal volume

ventilation/perfusion mismatch

pulmonary shunting

Which of the following is the most effective aerosolized bronchodilator for a pt. with an acute asthma exacerbation?

albuterol

ipratropium bromide (atrovent)

salmeterol (serevent)

tiotropium (spiriva)

The following pt. data are obtained:
Ca02:   12 vol%
Pv02:  30 torr
Sv02:  60%
Hb:  10 g/dL
The patient's C(a-v)02 is approximately:

1.20 mL/dL

3.87 mL/dL

4.80  mL/dL

8.13 mL/dL

A RT determined a pt. receiving mechanical ventilation developed auto-PEEP due to dynamic airflow obstruction. Which of the following should the therapist do? 

Add an inspiratory plateau

add mechanical dead space

decrease the mandatory rate

decrease the inspiratory flow

A 59 y/o pt. with COPD is seen in the pulmonary clnical for a routine appointment. The results of an ABG drawn while the pt. is breathing room air are below:
pH    7.41
PaCo2:   55 torr
Pa02:   41 torr
HC03:  35 mEq/L
Which of the following is the most appropriate NEXT step?

schedule polysomnography

initiate supplemental oxygen

perform a  6 minute walk test

coach on deep breathing

The following data are collected for a pediatric pt. receiving VC ventilation: 
VT:  200 mL
plateau pressure:  10 cmH20
Peak pressure:   20 cmH20
PEEP:   5 cmH20
What is the static compliance in mL/cmH20?

30

20

50

40

The following pulmonary function results are obtained for a patient:
                   Predicted           Observed              % Predicted 
FVC:                5.90                  3.40                          57.6                        
FEV1:              4.00                  0.50                          12.5
FEV1/FVC:       70                     14                           --------
FEF 25-75%:  4.50                   0.77                         17.0
TLC:                7.30                  8.40                        115.0

A RT should recommend a treatment plan for:

severe obstructive lung disease

severe restrictive lung disease

mild obstructive lung disease

mild restrictive lung disease

While receiving postural drainage in the head-down position, a pt. becomes dyspneic due to severe prolonged coughing. A RT should:

perform percussion

turn the patient

administer oxygen

place the pt. in Flowler's position

A 20 y/o pt. with an acute asthma exacerbation is receiving 2.5 mg of albuterol by hand held nebulizer. During the treatment, the pt. complains of palpitations and has a HR of 140. Which of the following should the RT recommend for the next treatment? 

change to fluticasone/salmeterol (Advair HFA)

change to 0.63 mg of levalbuterol (xopenex)

change to 3 puffs of beclomethasone dipropionate (vanceril)

administer the treatment with saline

Which of the following medications should a RT use to anesthetize a patient's airway prior to a flexible bronchoscopy procedure? 

lidocaine HCL (xylocaine)

midazolam HCL (Versed)

ketamine

vecuronium bromide (Norcuron)

A pt. in the ICU who is receiving VC ventilation has a steady increase in the peak inspiratory pressure over a 12 hour shift. The pt. has developed a fever and purulent pulmonary secretions. Which of the following should a RT recommend FIRST? 

perform HFCWO

Replace the ETT

Initiate bronchodilator therapy

Obtain a sputum Gram stainA 22 y/o 

A 22 y/o pt. with a history of intermittent wheezing has the following pulmonary function test results:
                                             Pre-bronchodilator        Post-bronchodilator
FEV1 (% predicted)                           84                            88
FVC (% predicted)                             85                            86
FEV1/FVC (%)                                     84                            86
Peak flow  (% predicted)                 98                            96

Which of the following should a RT recommend?

lung volume measurements

inhalation challenge

DLCO testing

polysomnography

Spontaneous breathing trials with a T-piece have been initiated for a 50 y/o pt. who has been receiving mechanical ventilation for 4 weeks. With each trial, the pt. becomes agitated, dyspneic, and tachypneic, and must be returned to the ventilator. Which of the following should the RT recommend? 

sedate the patient

terminate weaning trials

extubate the patient

initiate pressure support mode

A premature neonate with respiratory distress syndrome receives the first dose of surfactant replacement therapy. Two hours later, the neonate's Fi02 requirements have increased from 0.35 to 0.70. Which of the following should a RT recommend FIRST? 

chest radiograph

second dose of surfactant

high frequency ventilation

inhaled nitric oxide

Which of the following should be recommended to determine the site of bleeding in a pt. with hemoptysis?

nasotracheal suctioning

bronchoscopy

thoracentesis

V/Q scan

Data belwo were obtained while an adult pt. was receiving VC ventilation with an Fi02 of 0.50:

                                     1300       1315        1330         1345
PEEP:                                5           10             15              20
Sp02:                                75         90             94              95
Staic compliance:           20         40             60              55
BP:                               140/90    130/90    120/80     110/80

Which of the following levels of PEEP should a RT choose?

5 cmH20

10 cmH20

15 cmH20

20 cmH20

Monitoring serum electrolytes is indicated in patients who are receiving:

surfactants

sedatives

analgesics

diuretics

While breathing spontaneously, a 54 kg (120 lb) female has a RR of 30 and a VT of 200 mL. After a sedative was administered, her RR decreased to 10 and her VT increased to 600 mL. Which of the following ventilatory parameters increased?

minute ventilation

alveolar ventilation

mechanical dead space ventilation

anatomic dead space ventilation

For a spontaneously breathing pt. , which of the following will provide an elevated baseline pressure during inspiration and expiration? 

IPPB

PEP

CPAP

IPAP

After obtaining an ABG sample, a RT should handle the sample by:

adding heparin

shaking the sample continuously 

removing all air from the syringe

placing the sample on an ice bath

A 77 y/o male pt. is scheduled to undergo open heart surgery. Preoperative spirometry results show the patient's FEV1 is 80% of predicted and the FEV1/FVC is 83%, indicating: 

high risk for postoperative pulmonary complications

low risk for postoperative pulmonary complications

the pt. has obstructive lung disease

the pt. has restrictive lung disease

A gas is saturated with 100% relative humidity at 32.3 C (90F). As the gas cools to 26.7 C (80F), the relative humidity will:

increase by 10%

remain 100% and excess water will rain out

decrease as a result of cooling of the gas

decrease as water condenses

Following placement of an 8.0 mm ID trach tube, how much air should be placed into the cuff?

a minimum of 8 mL

enough to produce a pressure of 35 cmH20

enough to prevent a leak at peak inspiration

enough to provide tension in the pilot balloon

An adult pt. is receiving mechancial ventilation. Which of the following should be recommended to improve oxygenation and recruit collapsed alveoli?

PEEP

SIMV mode

mechanical dead space

in-line suction system

When administering dornase alfa (Pulmozyme) with a hand-held nebulizer, a RT notes a pt. is developing marked congestion with copious sputum production. The therapist's most appropriate action is to pause the treatment and:  

dilute dornase alfa with saline

allow the pt. to clear secretions

increase the dornase alfa dose

contact the physician

An adult pt. has a pulse of 142, a RR of 24, and a BP of 78/55. When examining the patient's chest, the RT notes an absence of BS in the left chest with a hyperresonant percussion note. Which of the following should the RT recommend FIRST? 

insert a chest tube in the left chest

obtain a chest radiograph

insert a 14 gauge needle in the left chest

obtain arterial blood gas results

After SIMV is initiated, the following pt. data are obtained: 
Fi02:       0.40                                pH:   7.27
Mandatory rate:   8                     PaC02:  55 torr
Total rate:       8                            Pa02:  94 torr
Tidal Volume:   550 mL               HC03:   24 mEq/L
PEEP:    8 cmH20
Which of the following should a RT recommend?

maintain current settings

increase the mandatory rate to 12

decrease the Fi02 to 0.30

decrease the Vt to 400 mL

A pt. is receiving mechanical ventilation with 5 cmH20 PEEP. The PEEP is increased to 15 cmH20. Which of the following indicates an adverse effect of the PEEP change? 

bradycardia

increased peripheral perfusion

increased FRC

hypotension

The following data are obtained for a pt. who is receiving VC ventilation with a VT of 600 mL:

                                                               10 am                              12 pm
Peak airway pressure                        38 cmH20                       45 cmH20
Plateau pressure                                34 cmH20                        34 cmH20

This information indicates:

increased air trapping

increased airways resistance

decreased inspiratory flow

decreased static compliance

During nasotracheal suctioning, a patient exhibits a gag reflex but does not cough. Watery secretions
are aspirated through the catheter. Which of the following should the RT do before repeating the
procedure?

A. insert an oropharyngeal airway

B. place the patient in the sniffing position

C. obtain a larger suction catheter

D. increase the suction pressure

Which of the following should a RT use to determine a neonate’s gestational age?

A. APGAR

B. Glasgow

C. Ballard

D.  Silverman

A pt. receiving mechanical ventilation by a portable ventilator is being transported from the ED to
radiology. Which of the following is required during transport?

A.  bag valve resuscitator

B. point of care blood gas analyzer

C. demand valve respirator

D. crash cart

A RT is calibrating a helium analyzer. What should the analyzer read when calibrated on air?

A. 0%

B. 79%

C. 100%

D. 21%

Which of the following drugs is appropriate for the sedation of a 30 y/o patient with status
asthmaticus and hypotension who is receiving mechanical ventilation?

A. Cisatracurium (nimbex)

B. Lorazepam (Ativan)

C. Vecuronium bromide (norcuron)

D.  Morphine

A physician will be sedating a patient for a procedure and asks a RT to monitor the patient’s
ventilation. The therapist should select a:

A. pulse oximeter

B. colorimetric C02 detection device

C. capnometer

D. transcutaneous oxygen monitor

The standard frequency for dosing of inhaled tiotropium (spiriva) is every:

A. 24 hours

B. 4 hours

C. 12 hours

D. 8 hours

A pt. with severe COPD is receiving PC, A/C ventilation on 0.30. The pt. becomes
tachypneic and is apprehensive, mottled, and hypertensive. Auscultation reveals distant breath sounds
on the right as compared to the left. Tracheal deviation to the left is observed. A RT should
recommend evaluation for a potential:

A. mucous plug

B. myocardial infarction

C. pulmonary embolism

D. pneumothorax

A RT intends to change the I:E during VC ventilation. Flow is constant during inspiration. Which of
the following can be adjusted to accomplish this change?
 
                Volume              RR                sensitivity                 inspiratory flow

A.    Yes                           yes                      yes                                no

B.    Yes                           yes                      no                                 yes

C.    Yes                            no                       yes                                yes

D.    No                           yes                       yes                                yes

When reviewing progress notes for a pt. a RT notes that a provider has recommended changes to the
patient’s treatment plan. Which of the following should the RT do NEXT?

A. initiate the changes immediately

B. confer with the patient’s nurse about when to implement the changes

C. check for new RT orders

D. review the planned changes with the shift supervisor

What is the approximate total flow that will be delivered from a 40% air-entrainment mask receiving
12 L/min of oxygen?

A. 12 L/min

B. 48 L/min

C. 52 L/min

D. 72 L/min

A RT is asked to position a pt. for orotracheal intubation. The RT should place the patient’s head:

A. in the sniffing position

B. with the neck hyperextended

C.  tilted forward toward the chest

D. turned to the right

A pt. has been receiving mechanical ventilation through a tracheostomy tube for 16 days. The
patient begins to thrash about in the bed following withdrawal of a drug-induced coma. The
patient’s tracheostomy tube has become dislodged. Following appropriate sedation, the RT should:

A. obtain an ABG sample

B. perform nasal intubation

C. reinsert the tracheostomy tube

D. initiate oxygen therapy and observe the patient

A pt.’s BP is monitored by an appropriately positioned arterial catheter transducer. The transducer is
mounted on an IV pole that is not attached to the bed. The bed is lowered to permit routine patient
care. How will this affect the measured BP?

A. Systolic Increased            Diastolic increased

B. Systolic Increased            Diastolic decreased

C. Systolic Decreased          Diastolic decreased

A. Systolic Decreased          Diastolic increased

A 21 y/o male patient experiencing a acute asthma exacerbation is intubated and receiving
mechanical ventilation. There is a sudden increase in airway pressures. The pt. is hemodynamically
stable and breath sounds are clear, but significantly decreased on the right. Which of the following
should the RT recommend?

A. turn the pt. onto his left side

B. withdraw the ETT 4 cm

C. order a portable chest radiograph

D. add 5 cmH20 PEEP

Which of the following values for arterial carbon dioxide tension is consistent with alveolar
hyperventilation?

A.  30 torr

B. 40 torr

C. 50 torr

D. 60 torr

Which of the following drugs is most appropriate to paralyze a sedated 30 y/o pt. with status
asthmaticus who is receiving continuous mechanical ventilation?

A. rocuronium bromide (zemuron)

B. morphine sulfate

C. midazolam (versed)

D. succinylcholine chloride (anectine)

A 21 y/o man arrives in the ED after rescue from a house fire. Physical examination reveals burns on
the upper chest and face, and marked edema of the face and oropharynx. Results on an ABG sample
obtained while the pt. was breathing air are as follows:
                                                     Ph 7.55   PaC02 26 torr  Pa02 105 torr  HC03 22 mEq/L
Which of the following should a RT recommend?

A. Intubate the patient

B. Sedate the patient

C. Initiate levalbuterol therapy

D. Administer cool aerosol therapy

Moderate stridor with retraction sis noted immediately after extubation of a pt. A RT should
recommend:

A. cool bland aerosol therapy

B. inhaled steroids

C. nebulize racemic epinephrine

D.  A nasopharyngeal airway

For which of the following are peak expiratory flow measurements indicated?

A. establish readiness for weaning

B. evaluate lung compliance

C. determine ventilatory reserve

D. monitor airways obstruction

A pt.’s V/Q scan indicates an excess of ventilation compared to perfusion in the left lower lobe. These results suggest:

A. right to left shunt

B. pulmonary embolism

C. pneumonia

D. hemothorax

Which of the following is characteristic during VC ventilation?

A. inspiration ends after delivery of a preset volume

B. inspiration ends after the patient exhales a targeted volume

C. pressure is held constant during inspiration until a present volume is delivered

D. pressure is held constant during inspiration until the patient exhales a targeted volume

TMC Secure Form A

TMC Secure Form A

1. A 55 y/o patient with dyspnea and a non-productive cough has the following noted examination results over the right lower lung field:- dullness to percussion- decreased tactile fremitus- diminished breath soundsWhich of the following is most likely to produce these findings?

Which of the following is associated with an optimally exposed chest radiograph?

The use of respiratory accessory muscles is frequently the result of an increase in:

A physician orders 1 mg of medication to be administered by aerosol. If the concentration of a stocksolution is 0.04%, how many ml of the solution must be administered?

6. A pulse oximeter provides an accurate indication of a patient’s oxyhemoglobin saturation in which of the following clinical conditions? Polycythemia pulmonary HTN CHF CO poisoning

If a RT chooses to use a portable ventilator to transport a patient within a hospital, the ventilator should have the ability to:

1. A 55 y/o patient with dyspnea and a non-productive cough has the following noted examination results over the right lower lung field:
- dullness to percussion
- decreased tactile fremitus
- diminished breath sounds
Which of the following is most likely to produce these findings?

A physician orders 1 mg of medication to be administered by aerosol. If the concentration of a stock
solution is 0.04%, how many ml of the solution must be administered?

6. A pulse oximeter provides an accurate indication of a patient’s oxyhemoglobin saturation in which of the following clinical conditions?

Polycythemia pulmonary HTN CHF CO poisoning