RRT Self Test1

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NBRC Written RRT Self-Assessment Examination (Test 3) Student ID 410269144 On 2/3/2007 at 6:00:10 PM 1 During the administration of an IPPB treatment, the respiratory therapist notices the system pressure drops after inspiration is initiated. Which of the following actions will best correct this problem? A. Increase the pressure setting. B. Decrease the pressure setting. C. Increase the flow setting. D. Decrease the flow setting. 2 A 21-year-old man arrives in the emergency department (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 of an arterial blood gas sample obtained while the patient was breathing air are as follows: Which of the following should the respiratory therapist recommend? A. Intubate the patient. B. Sedate the patient. C. Initiate levalbuterol (Xopenex) therapy. D. Administer cool aerosol therapy. 3 A patient in the ICU is receiving noninvasive positive pressure ventilation by mask with the following settings and resultant arterial blood gas values with an FIO2 of 0.28:

Transcript of RRT Self Test1

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NBRC Written RRT Self-Assessment Examination (Test 3)Student ID 410269144On 2/3/2007 at 6:00:10 PM 1 During the administration of an IPPB treatment, the respiratory therapist notices the system pressure drops after inspiration is initiated. Which of the following actions will best correct this problem? A. Increase the pressure setting. B. Decrease the pressure setting. C. Increase the flow setting. D. Decrease the flow setting.

2 A 21-year-old man arrives in the emergency department (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 of an arterial blood gas sample obtained while the patient was breathing air are as follows:

Which of the following should the respiratory therapist recommend? A. Intubate the patient. B. Sedate the patient. C. Initiate levalbuterol (Xopenex) therapy. D. Administer cool aerosol therapy. 3 A patient in the ICU is receiving noninvasive positive pressure ventilation by mask with the following settings and resultant arterial blood gas values with an FIO2 of 0.28:

Which of the following should a respiratory therapist recommend to improve the patient's ventilatory status? A. Increase IPAP to 20 cm H2O.

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B. Increase EPAP to 10 cm H2O. C. Decrease IPAP to 10 cm H2O. D. Decrease EPAP to 2 cm H2O.

4 An erratic pulse is palpated on a patient. Which of the following should the respiratory therapist recommend to further evaluate this clinical presentation? A. ECG B. blood pressure C. cardiac ultrasound D. arterial blood gas analysis

5 A patient presents in the emergency department (ED) following a motor vehicle crash. Physical assessment and chest radiograph indicate significant air and fluid in the pleural space. The FIRST action should be to A. obtain a 12-lead ECG. B. intubate the patient and institute mechanical ventilation. C. insert a chest tube and connect to suction. D. recommend a therapeutic fiberoptic bronchoscopy. 5 EXPLANATIONS: (h) A. Obtaining a 12-lead ECG delays correction of the hemopneumothorax. (h) B. Intubation and mechanical ventilation will not remove air and fluid from the pleural space. Delaying treatment of the air and fluid accumulations in the pleural space, coupled with positive pressure ventilation, may result in a life-threatening tension pneumothorax. (c) C. Proper insertion of a chest tube should remove the air and fluid from the pleural space. (h) D. A bronchoscopy will not remove air and fluid from the pleural space and will delay correction of the hemopneumothorax.

6 The respiratory therapist is working at an outpatient cardiac rehabilitation clinic when a patient collapses on the treadmill and is unresponsive and pulseless. The following rhythm is shown:

Which of the following should the therapist perform first?

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A. cardioversion B. defibrillation C. CPR and bag-valve-mask ventilation D. intubation and epinephrine administration 7 A 60-kg (132-lb) patient is receiving volume-controlled ventilation. The respiratory therapist is asked to increase the tidal volume from 500 to 700 mL. Which of the following ventilator alarm settings should be changed? I. low exhaled tidal volume II. high pressure limit III. high minute volumeIV. low respiratory rate A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

8 A patient with emphysema is receiving mechanical ventilation and has acutely begun wheezing. The patient weighs 75 kg (165 lb), pulse is 95/min, and blood pressure is 110/70 mm Hg. Pertinent data are as follows:

Which of the following should the respiratory therapist recommend? A. Administer aerosolized albuterol. B. Administer nebulized budesonide (Pulmicort). C. Add 5 cm H2O PEEP. D. Add 10 cm H2O pressure support. 9 The respiratory therapist is ventilating a patient with a self-inflating bag-valve resuscitation device. Following each compression, the bag refills slowly permitting no more than one breath every 10 seconds. To correct this problem, the therapist should A. increase oxygen flow to the device. B. slow the compression rate to 6 per minute. C. inspect the intake valve for proper function. D. remove accumulated secretions from the patient connection.

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10 A patient has been in the ICU for 3 weeks receiving aggressive therapy for COPD and right heart failure. The ECG now shows flattened T-waves. To plan for future treatment, the respiratory therapist should recommend A. evaluating serum electrolytes. B. obtaining a hemoglobin and hematocrit count. C. discontinuing theophylline (Aminophylline). D. beginning a lidocaine (Xylocaine) drip.

11 A patient with chronic bronchitis is admitted to the ICU with pneumonia. The patient is producing moderate amounts of thick, yellow sputum and has tachypnea. Antibiotic and bronchial hygiene therapy are initiated. After 3 days, which of the following secretion characteristics would indicate the care is being effective? A. thick and green B. pink and frothy C. minimal and clear D. moderate and yellow 12 A patient requiring continuous oxygen at 3 L/min wants to maintain a very active lifestyle. Which of the following would be the best oxygen delivery system for the respiratory therapist to recommend? A. E cylinders B. M cylinders C. a concentrator D. a liquid system

13 The respiratory therapist determines the tip of an endotracheal tube is in the trachea below the aortic knob but 2 cm above the carina on inspection of an AP chest radiograph. The therapist reports the tube should be A. advanced. B. pulled back. C. left in place. D. replaced.

14 When reviewing therapy for a home care patient who has COPD, the respiratory therapist notices every time the patient performs his daily peak flow measurement, it consistently reads 100 L/min. Which of the following is the most appropriate initial action for the therapist to take? A. Instruct the patient to increase daily exercise. B. Recommend complete pulmonary function studies. C. Recheck the patient's peak flow with a new peak flowmeter. D. Continue to monitor the patient's peak flow for 2 weeks. 15 The information below is obtained for a 70 kg (154 lb) postoperative patient who is receiving mechanical ventilation:

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Which of the following is the most appropriate ventilator change? A. Add 5 cm H2O PEEP. B. Decrease the tidal volume to 500 mL. C. Initiate SIMV mode at 10. D. Increase the mandatory rate to 12. 16 The respiratory therapist is assisting the physician with an endotracheal intubation. The therapist auscultates the chest for proper placement of the artificial airway. The therapist notes breath sounds are markedly decreased on the left side of the chest. Which of the following actions is most appropriate at this time? A. Reposition the endotracheal tube. B. Reintubate the patient. C. Monitor for exhaled CO2. D. Obtain a chest radiograph. 17 A 14 kg (30 lb) child with croup is treated with 0.25 mL of 2.25% racemic epinephrine by aerosol mask. The respiratory therapist notes a decrease in stridor after the treatment. Breath sounds are diminished bilaterally and the SpO2 has decreased from 99% to 95%. Which of the following should the therapist do first? I. Repeat the treatment. II. Notify the physician that the patient's condition is worsening. III. Perform endotracheal intubation.IV. Recommend a tracheotomy. A. I and II only B. I and IV only C. II and III only D. III and IV only

18 When reviewing the chart of a newly admitted patient, the respiratory therapist finds the patient has COPD and a 70-pack-year smoking history. The patient was admitted for

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dyspnea. The patient is unresponsive and has a BP of 180/100 mm Hg and a respiratory rate of 40/min. Which of the following available data should the therapist review next? A. chest radiograph report B. PaCO2 C. serum electrolytes D. ECG 19 Following insertion of a central venous pressure (CVP) catheter, a chest radiograph is taken to evaluate the position of the catheter. While viewing the radiograph, the respiratory therapist notes the tip of the catheter is in the lower portion of the superior vena cava. The therapist should conclude the catheter A. has been advanced too far. B. is in the proper position. C. has perforated a vessel. D. is not advanced far enough. 20 The respiratory therapist reviews the chart of a newborn and notes a 1-minute Apgar of 2 and a 5-minute Apgar of 3. For which of the following is this newborn at increased risk? I. mental impairment II. atelectasis III. bronchiolitisIV. first month mortality A. I and III only B. I and IV only C. II and III only D. II and IV only 21 A 50-year-old patient is performing incentive spirometry following laparoscopic surgery. After 3 minutes, the patient complains of lightheadedness and of tingling in the fingers. The patient's SpO2 increased from 96% to 99%. Which of the following should the respiratory therapist recommend for the patient? A. taking deeper breaths B. inhaling less frequently C. administering analgesia D. discontinuing therapy

22 A patient is receiving 35% oxygen through an air-entrainment mask. Cool mist is being provided at the air-entrainment port. The FIO2 measured at the mask is 42%. Which of the following should the respiratory therapist do? A. Remove the condensation from the aerosol delivery tube. B. Check the oxygen flow to the air-entrainment jet.

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C. Verify the integrity of the air-entrainment port. D. Calibrate the oxygen analyzer and remeasure. 23 A patient is suspected of having an upper airway obstruction. Which of the following tests should the respiratory therapist recommend to best detect this abnormality? A. FEF25-75% B. nitrogen washout C. RV/TLC D. flow-volume loops 24 During an acute asthmatic attack, a patient is receiving a levalbuterol (Xopenex) treatment. The patient's respiratory rate goes from 22/min to 14/min, heart rate from 122/min to 91/min, and wheezing has decreased. Which of the following should the respiratory therapist do? A. Continue the treatment. B. Obtain an arterial blood gas analysis. C. Recommend q2h treatments. D. Add aerosolized ipratropium bromide (Atrovent). 25 Five minutes after extubating a patient, the respiratory therapist observes marked stridor, labored breathing, intercostal retractions, and a decreasing SpO2. Aerosolized racemic epinephrine has been delivered without benefit. Which of the following should the therapist recommend at this time? A. treatment with dexamethasone (Decadron) B. manual ventilation with bag and mask C. a cool aerosol treatment D. reintubation

26 A patient using a transdermal nicotine patch complains of local skin irritation and insomnia. Which of the following should the respiratory therapist first recommend?

A. Discontinue use of the patch. B. Change the site and apply topical steroids to the skin. C. Frequently rotate the site and discontinue at night. D. Use the patch 8 hours daily and drink 2 oz of alcohol at bedtime.

27 When a patient cannot increase minute ventilation, increasing mechanical dead space in the ventilator circuit will cause A. increased PaCO2. B. decreased PaCO2.

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C. increased PaO2. D. decreased PaO2. 28 Which of the following chest radiographs provide the best view of the lung apex, lingula, and right middle lobe? A. lateral B. lordotic C. lateral decubitus D. end-expiratory

29 A 24-year-old patient is receiving chest physiotherapy to all segments of the right lung. The PA chest radiograph shows posterior basal right lower lobe atelectasis. In which of the following positions should the respiratory therapist place the patient for postural drainage? A. on his back with pillows under his knees B. face down with the head of the bed down C. left side down with the bed flat D. left side down with the head of the bed down

30 Data for a patient receiving mechanical ventilation are as follows:

Which of the following should the respiratory therapist recommend FIRST? I. Set 5 cm H2O PEEP. II. Change FIO2 to 0.25. III. Change mode to SIMV.IV. Set mandatory rate to 10.

A. I and II only B. I and III only C. II and IV only D. III and IV only

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31 Pulmonary compliance data were collected for a patient who is receiving mechanical ventilation:

The respiratory therapist enters these data in the electronic chart as follows: "...dynamic compliance 20 mL/cm H2O, static compliance 33 mL/cm H2O..." The therapist rechecks the ventilator settings and notices a PEEP setting of 10 cm H2O. The appropriate action is to A. make a new entry and delete the old entry. B. access the error-correction screen and revise the record. C. leave the record as is. D. inform the nurse PEEP was left off the report. 32 While gathering equipment in the ICU to set up an arterial line ordered STAT, the respiratory therapist notes the noncompliant pressure tubing is in a sterile package, but the corner of the package is open. Which of the following should the therapist do? A. Obtain an unopened, sterile pressure tubing. B. Use the tubing if the expiration date has not yet passed. C. Ask the physician if it is appropriate to use this tubing. D. Ask the supervisor if it is appropriate to use this tubing.

33 A 1000 g neonate who is 6 hours old is receiving time-cycled, pressure-limited ventilation. The neonate shows signs of developing RDS on a chest radiograph and severe hypoxemia is noted with an FIO2 of 0.80. Which of the following should the respiratory therapist recommend be used?

A. extracorporeal membrane oxygenation B. volume-controlled ventilation C. exogenous surfactant D. nitric oxide 34 An adult patient has a diagnosis of asthma and has a chest radiograph showing hyperinflation. The patient is prescribed albuterol MDI 2 puffs and beclomethasone dipropionate (Vanceril) 2 puffs. However, his post-treatment peak flows do not increase significantly. Which of the following should the respiratory therapist recommend first? A. Increase the bronchodilator dosage. B. Evaluate the patient's treatment technique. C. Discontinue the inhaled steroids. D. Change albuterol to ipratropium bromide (Atrovent).

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35 Which of the following would indicate a physical conditioning protocol has been effective for a patient with COPD? A. The resting pulse rate remains the same as 1 month prior. B. The patient has increased his level-walking distance by 15%. C. The patient's vital capacity has increased by 5%. D. There is an increase in the resting respiratory rate by 2 breaths/min. 36 Occlusion of the expiratory circuit just prior to the next ventilator delivered breath facilitates the measurement of A. Pplat. B. auto-PEEP. C. peak airway pressure. D. set PEEP. 37 A patient with chronic hypercapnia is receiving home oxygen therapy by nasal cannula at 2 L/min. The SpO2 is 90%. The patient should be told not to increase the flow because a higher oxygen flow A. may be dangerous. B. will have no benefit. C. will displace nitrogen from the blood. D. may damage the lungs. 38 A patient received a head injury in a motor vehicle crash and is 24 hours post admission. He is receiving artificial mechanical ventilation at a mandatory rate of 16 and a tidal volume is 800 mL. The patient's current arterial blood gas results are as follows:

The most appropriate recommendation for this patient is to A. maintain the present settings. B. decrease the mandatory rate. C. decrease the tidal volume. D. add mechanical dead space.

39 A postoperative patient receiving incentive spirometry becomes acutely short of breath. A chest radiograph shows a peripheral wedge-shaped infiltrate. These findings may be associated with I. purulent secretions.

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II. tachypnea. III. hemoptysis.IV. pleuritic pain.

A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

40 A 26-year-old patient who weighs 80 kg (176 lb) received injuries in a motor vehicle crash. The patient was intubated with a size 6 mm endotracheal tube and is receiving volume-controlled ventilation. Three days later, the patient has clear breath sounds, but is unable to tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H2O pressure support. The respiratory therapist should recommend A. increasing the peak inspiratory flow. B. raising the tidal volume. C. setting the mandatory rate to 10. D. reintubating with a larger endotracheal tube.

41 A respiratory therapist is using a test lung to conduct a pre-operational test of a ventilator at the following settings:

The exhaled tidal volume measurement is 500 mL. Which of the following actions should the therapist take? A. Complete the remaining elements of the pre-operational test. B. Increase the tidal volume setting to 900 mL. C. Assess the ventilator circuit for leaks. D. Set the low tidal volume alarm to 400 mL. 42 A patient with severe COPD is receiving oxygen by nasal cannula at 4 L/min. The patient is lethargic and his respirations are shallow at a rate of 20/min. The pulse oximeter is reading 94%. Which of the following should the respiratory therapist recommend?

A. Maintain current therapy. B. Intubate and mechanically ventilate. C. Increase the oxygen flow to 5 L/min. D. Change to a 28% air-entrainment mask.

43 A 36-year-old female was in a motor vehicle crash and sustained a flail chest injury. She is receiving mechanical ventilation. Auscultation reveals clear, but slightly diminished breath sounds. The patient develops worsening tachycardia and shortness of

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breath. Breath sounds on the right side are now virtually absent. These findings are consistent with A. a pneumothorax. B. mucous plugging. C. pneumopericardium. D. a pulmonary contusion.

44 While reviewing a chest radiograph, proper positioning of a flow-directed balloon-tipped catheter to obtain a mixed venous sample is confirmed when the tip is located in the I. right pulmonary artery.II. left pulmonary artery.III. right ventricle.IV. left ventricle. A. I and II only B. I and IV only C. II and III only D. III and IV only

45 The respiratory therapist notices a patient using a tracheostomy collar with a cool aerosol at 60% oxygen is unable to bring up any secretions. The small amount of secretions the patient coughed up earlier were very thick. The therapist should assess the patient and recommend

A. changing to a cool humidifier. B. decreasing the FIO2 to 0.40. C. changing to a heated nebulizer. D. instilling normal saline and suctioning q4h. 46 The respiratory therapist is called to the emergency department (ED) in a small community hospital. A 4-year-old child is brought to the ED following a near drowning. She is unresponsive and pale with peripheral cyanosis. Vital signs are as follows:

Which of the following should be part of the treatment of this patient? I. heated supplemental O2 II. bag-valve-mask ventilation III. vascular accessIV. chest compressions

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A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

47 An unpackaged HME is found lying on top of a ventilator. No condensate is observed inside the HME. The patient has no other humidification device in place. Which of the following should the respiratory therapist do? A. Visually inspect the HME for mucous obstruction. B. Open a new HME and attach it to the endotracheal tube. C. Discard the HME and monitor airway pressures over time. D. Insert the HME between the patient Y and the endotracheal tube.

48 A 79-year-old patient with COPD shows signs of increasing anxiety and cyanosis while receiving continuous heated aerosol therapy. The patient complains of tightness in his chest. His frequent cough produces a small amount of pink, frothy sputum. The patient most likely has A. pulmonary edema. B. a pneumothorax. C. mucus plugging. D. cor pulmonale.

49 A patient who is a victim of a residential fire is brought to the emergency department (ED) and is receiving oxygen by nasal cannula 8 L/min. The SpO2 is 100%. Arterial blood gas results are as follows:

The respiratory therapist should adjust the FIO2 and change the mode of administration to A. 0.28 with an air-entrainment mask system. B. 0.50 with an air-entrainment mask system. C. a simple O2 mask at 10 L/min. D. a nonrebreathing mask at 15 L/min.

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50 A 50-kg (110-lb) patient is receiving volume-controlled ventilation with the following settings:

A chest radiograph shows diffuse bilateral infiltrates. Which of the following should the respiratory therapist recommend? I. Increase the mandatory rate. II. Change to pressure-controlled ventilation. III. Change to assist/control mode.IV. Increase the PEEP to 15 cm H2O. A. III only B. I and III only C. I and IV only D. II and IV only 51 A patient weighing 70 kg (154 lb) and 173 cm (5 ft 8 in) tall is recently sedated and pharmacologically paralyzed. A chest radiograph shows bilateral basilar atelectasis but is otherwise clear. Ventilator settings are:

Arterial blood gas results are as follows:

Which of the following modifications should the therapist recommend to the physician? Tidal Volume Mandatory Rate Mechanical Dead Space A. 650 mL 12 0 mL

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B. 450 mL 14 50 mL C. 550 mL 8 100 mL D. 700 mL 10 200 mL

52 A shift supervisor wishes to determine the number of patients who are to receive bronchodilator treatments during the next 8 hours. To obtain this information quickly, the supervisor could A. check the medication administration records of all patients. B. ask each respiratory therapist. C. review the assignment list from the last shift. D. examine the assignment list from yesterday.

53 While reviewing a patient's chart, results of a chest radiograph indicate complete opacification of the left chest with a shift of the trachea and mediastinum to the left. These findings are consistent with A. pneumothorax of the right lung. B. atelectasis of the left lung. C. right-sided pleural effusion. D. pulmonary embolus in the left lung.

54 The respiratory therapist has received a report for a patient in the ICU who recently had a myocardial infarction. The patient has a history of COPD and congestive heart failure. Which of the following should the therapist monitor? I. SpO2 II. ECGIII. respiratory quotientIV. intake and output A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only 55 A patient who weighs 60 kg (132 lb) is sedated and receiving volume-controlled ventilation. The following information is available: Which of the following should the respiratory therapist decrease to normalize the patient's arterial blood gases?

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A. tidal volume B. peak flow C. FIO2 D. PEEP

56 When performing quality control on an automated blood gas analyzer, the respiratory therapist notices the pH value is more than 2 standard deviations from the control group mean. The therapist should initially A. check the calibrating gases. B. remeasure the reference sample. C. change the pH membrane. D. replace the pH electrode.

57 A patient receiving mechanical ventilation has a 7 mm ID, standard high-volume, low-pressure cuffed tracheostomy tube. It has become increasingly difficult to avoid a significant cuff leak. Cuff pressure monitoring reveals values in excess of 35 cm H2O. The respiratory therapist should recommend a A. larger tracheostomy tube. B. nasotracheal tube. C. fenestrated tracheostomy tube. D. tracheostomy button.

58 A finding consistent with a non-functioning arterial catheter is A. patient complaint of throbbing. B. an increase in the systolic pressure reading. C. the presence of a hematoma. D. difficulty withdrawing blood. 59 A patient who weighs 82 kg (180 lb) and is 178 cm (5 ft 10 in) tall is admitted to the ICU following evacuation of a subdural hematoma from a closed head trauma. The

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patient is intubated with a size 8.0 mm endotracheal tube and has no documented pulmonary history. Mechanical ventilation was initiated with the following settings:

An arterial blood gas was obtained 30 minutes later and results are as follows:

The physician asks for the respiratory therapist's recommendations about changing ventilator settings. Which of the following is the best recommendation?

A. Maintain current settings. B. Add 5 cm H2O of PEEP. C. Set the mandatory rate to 10. D. Adjust the tidal volume to 900 mL. 60 A patient receiving mechanical ventilation in the SIMV mode has failed numerous T-piece weaning trials. Following the last T-piece trial, the arterial blood gas results with an FIO2 of 0.40 were:

Which of the following should the respiratory therapist recommend?

A. Administer IV diazepam (Valium). B. Administer a bronchodilator. C. Change to the assist/control mode. D. Change to CPAP ventilation.

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61 An adult patient is receiving volume-controlled ventilation. The patient's peak airway pressure is 35 cm H2O and the plateau pressure is 25 cm H2O. The respiratory therapist would recommend the high pressure alarm be set at

A. 25 cm H2O. B. 35 cm H2O. C. 40 cm H2O. D. 45 cm H2O.

62 A patient with a history of COPD is receiving volume-controlled ventilation because of respiratory failure. Current ventilator settings and arterial blood gas results are as follows:

Which of the following should the respiratory therapist recommend? A. Set the tidal volume at 700 mL. B. Set the mandatory rate at 14. C. Initiate PEEP at 10 cm H2O. D. Maintain the present settings.

63 The respiratory therapist is assisting a surgeon performing a tracheotomy on a patient who is receiving pressure-controlled ventilation. The therapist notes increased heart rate, decreased exhaled tidal volume, and distant breath sounds over the right chest. This information is most indicative of a A. circuit leak. B. right pneumothorax. C. mucus plug. D. mainstem intubation. 64 A 70-year-old patient on a medical ward has retained secretions due to an ineffective cough and requires nasotracheal suctioning, for which a prn order is written. The patient is receiving air and has an SpO2 of 94%. Which of the following are required to safely perform this procedure? I. Yankauer suction tip

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II. supplemental oxygen III. ECG monitoringIV. a pulse oximeter A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only 65 The respiratory therapist is treating a patient with pulmonary emphysema. During the course of therapy, the patient becomes very dyspneic. The therapist should instruct the patient to perform

A. apneustic breathing. B. pursed-lip breathing. C. paradoxical breathing. D. forced abdominal breathing.

66 The respiratory therapist is using a spring-loaded PEEP valve and notices the pressure reading on the manometer is 5 cm H2O higher than the set level. Which of the following is the probable cause? A. The flow is too low. B. The water level is too high. C. Secretions are in the valve. D. There is a leak in the circuit. 67 A 54.5-kg (120-lb) female has a respiratory rate of 30/min and a tidal volume of 200 mL. Her respirations dropped to 10/min and her tidal volume increased to 600 mL after a sedative was administered. Which of the following ventilatory parameters increased?

A. minute ventilation B. alveolar ventilation C. mechanical dead space ventilation D. anatomic dead space ventilation

68 Which of the following pharmacologic agents should be recommended for a patient who is intubated, receiving mechanical ventilation, and experiencing severe pain from a flail chest?

A. lorazepam (Ativan) B. morphine sulfate C. oxycodone (Percocet) D. midazolam HCl (Versed)

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69 A patient with pulmonary edema receives furosemide (Lasix), dopamine (Intropin), and oxygen. Flattened T waves and occasional PVCs are observed on the monitor. Which of the following should the respiratory therapist initially recommend to evaluate these changes? I. end-tidal CO2 II. pulse oximetryIII. echocardiogramIV. electrolytes

A. I and II only B. I and III only C. II and IV only D. III and IV only

70 Which of the following concerns are relevant when preparing for helicopter transport of an adult patient? I. administering appropriate sedationII. calculating oxygen cylinder durationIII. selecting lightweight and easily portable ventilatorsIV. appropriate heated humidification A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

71 A patient presents with sudden onset of dyspnea associated with cough, sputum production, and a chest radiograph demonstrating opacification of the right lower lobe. Which of the following is most consistent with these findings?

A. shift of the trachea to the left B. crepitus on the right side C. asymmetrical chest movement D. increased tactile fremitus 72 While participating in a helicopter transport, the respiratory therapist notes that it is increasingly difficult to ventilate the patient with a bag-valve resuscitation device and the SpO2 is dropping. The trachea has shifted left and there is no chest excursion on the right. Which of the following should the therapist do?

A. Attempt to pass a suction catheter. B. Pull the endotracheal tube back 2 cm.

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C. Deflate the cuff and re-inflate it slowly. D. Perform needle decompression.

73 Which of the following is the best site for capnograph sampling during mechanical ventilation while using the SIMV mode?

A. expiratory limb of the circuit B. distal to the heated humidifier C. endotracheal tube connector D. exhalation valve

74 A patient is receiving volume-controlled ventilation with the following settings:

The following pressure-volume loop is available:

Which of the following should the respiratory therapist recommend?

A. Change to pressure-controlled ventilation. B. Change to pressure support ventilation. C. Increase the PEEP. D. Increase the peak inspiratory flow. 75 When explaining the purpose of incentive spirometry to a patient after abdominal surgery, the respiratory therapist should tell the patient the procedure is performed to A. prevent areas of the lung from collapsing. B. treat pneumonia in addition to antibiotics. C. reduce the pain associated with breathing. D. shorten the time for wound healing.

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76 An adult patient has some spontaneous respiratory efforts and is receiving volume-controlled ventilation with an FIO2 of 0.40 using a microprocessor ventilator. The source gases to the ventilator fail. According to the ventilator's capabilities, which of the following would the respiratory therapist expect to occur? I. The high airway pressure alarm will sound. II. The low oxygen alarm will sound. III. The ventilator powers off.IV. The safety valve will open.

A. I and III only B. I and IV only C. II and III only D. II and IV only 77 Which of the following therapeutic gas mixtures should the respiratory therapist select to improve the distribution of ventilation for a patient with high airway resistance? A. helium/oxygen B. nitric oxide/oxygen C. nitrous oxide/oxygen D. carbon dioxide/oxygen

78 A patient involved in a motor vehicle crash presents with respiratory distress. A chest radiograph confirms the presence of multiple adjacent ribs fractured on the left side. Which of the following physical findings would be expected during palpation of the chest?

A. trachea deviated to the left B. paradoxical motion of the abdomen C. paradoxical motion of the left chest D. tympany over the right chest 79 The respiratory therapist is asked to review a newborn's history. The following information is available:

What would the respiratory therapist expect to see for the 1 and 5 minute Apgar scores for this neonate?

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A. 5,9 B. 6,8 C. 6,10 D. 7,10 80 When the respiratory therapist initiates an IPPB treatment, the patient's pulse is 78/min. Five minutes after the therapy is started, the patient's pulse increases to 90/min. The therapist should A. continue the treatment as ordered. B. terminate the treatment and notify the physician. C. increase the inspiratory flow. D. decrease the inspiratory pressure.

81 The respiratory therapist assesses a patient receiving supplemental oxygen by a transtracheal oxygen catheter. The patient is diaphoretic, has a higher than normal respiratory rate, and appears cyanotic. Which of the following is a possible explanation?

A. There is excess humidity in the transtracheal system. B. The flow going to the transtracheal catheter is too high. C. The transtracheal catheter is obstructed by a mucous plug. D. The transtracheal catheter is advanced too far into the airway. 82 A respiratory care protocol indicates a patient who is ventilator-dependent should be weaned when his spontaneous tidal volume exceeds 3 mL/lb ideal body weight. Assessment of spontaneous parameters reveals a of 6 L/min and a respiratory rate of 30. The patient's ideal body weight is 68.2 kg (150 lb). Which of the following should the respiratory therapist do?

A. Initiate weaning per protocol. B. Maintain current therapy. C. Discontinue using the protocol. D. Notify the physician. 83 A patient with a size 8 mm endotracheal tube has been receiving mechanical ventilation for 2 weeks, but weaning efforts have failed. If there is no further improvement in ventilatory status within 48 hours, the patient will be sent to the OR for a tracheotomy procedure. The tracheostomy device will facilitate this patient's care by I. increasing dead space.II. decreasing airways resistance.III. decreasing upper airway trauma.IV. increasing secretion clearance.

A. I and II only B. I and IV only

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C. II and III only D. III and IV only

84 To assess an outcome indicator of the department's bronchodilator QA program, the respiratory therapist should monitor the A. number of bronchodilator procedures ordered. B. number of bronchodilator procedures performed. C. average time it takes to deliver bronchodilator treatments. D. average length-of-stay for patients receiving bronchodilators. 85 A patient's tracheostomy tube is being changed due to a cuff leak. After reconnecting the ventilator to the new tube, the high pressure alarm sounds, the patient's heart rate increases to 135/min, and he is cyanotic. Crepitus and swelling are evident around his neck and upper chest. To correct this situation, the respiratory therapist should

A. increase the cuff pressure until adequate ventilation can be achieved. B. reinsert the tube and attempt to manually ventilate the patient. C. obtain an arterial blood gas sample to assess oxygenation. D. increase the pressure limit on the ventilator and set the FIO2 to 1.0.

86 A 7-day-old neonate of 28-weeks gestational age is having frequent periods of apnea with desaturation. Which of the following should the respiratory therapist recommend?

A. racemic epinephrine (Vaponefrin) B. naloxone (Narcan) C. surfactant (Survanta) D. theophylline (Aminophylline) 87 A patient presents with a history of loud snoring and daytime sleepiness. The patient is obese and has a crowded oropharynx. Which of the following should the respiratory therapist evaluate while this patient is sleeping?

I. nocturnal oxygen saturationII. breathing patternIII. inspiratory stridorIV. presence of wheezing A. I and II only B. I and IV only C. II and III only D. III and IV only

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88 A patient is receiving oxygen at home from a liquid oxygen reservoir at 2 L/min. The patient complains he does not feel gas coming out of the nasal cannula. Which of the following are the most likely reasons for this complaint?

I. The system is delivering a low flow.II. The oxygen tubing is not properly connected.III. The electrical system has failed.IV. There is inadequate humidification. A. I and II only B. I and IV only C. II and III only D. III and IV only

89 Which of the following should be monitored and documented in the medical record after a capillary blood gas sample is obtained? I. presence of air in the sample II. appearance of puncture site III. Allen's test resultsIV. capillary refill time A. I and II only B. I and IV only C. II and III only D. III and IV only

90 While assisting with a therapeutic bronchoscopy for an adult patient, the physician is suddenly unable to view any anatomy because everything went black. Which of the following is a likely cause?

A. A mucous plug is blocking the tip of the scope. B. The lung collapsed distal to the scope. C. The suction line is disconnected. D. The light source is disconnected.

91 A patient who is receiving mechanical ventilation using PEEP is switched to a continuous-flow CPAP system for weaning. On initial evaluation, the manometer shows negative pressure during inspiration and the patient appears agitated and uncomfortable. Which of the following actions is most appropriate?

A. Hyperoxygenate and suction the patient. B. Reinstitute mechanical ventilation. C. Increase CPAP by 2 cm H2O.

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D. Increase system flow. 92 Which of the following key points are relevant to patient education for asthma care? I. Begin educating the patient at the time of discharge.II. Patients and families should be taught self-management concepts by all team members.III. Promote open communication between the patient, family, and healthcare providers to encourage adherence to care.IV. Jointly develop treatment goals.

A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only 93 A patient who is ventilator-dependent has an 8 mm endotracheal tube in place. Using a standard 12 Fr catheter kit, the patient requires prolonged suctioning due to profuse, thick secretions. The respiratory therapist notes the patient develops tachycardia and the oxygen saturation decreases. The therapist should recommend using a

A. 10 mm standard catheter. B. closed-suction system. C. 12 Fr Coud? tip catheter. D. q1h suctioning frequency. 94 The following pulmonary function results are obtained for a patient: Predicted Observed % Predicted

Which of the following is the most likely conclusion? A. severe obstructive pattern B. severe restrictive pattern C. mild obstructive pattern D. mild restrictive pattern 95 An adult patient with ARDS has been receiving mechanical ventilation for 2 weeks and is being considered for weaning. Nitric oxide therapy is in use at a concentration of 10 ppm. The patient's PVR has changed from 190 dynes.s.cm-5 to 150 dynes.s.cm-5 and the PaO2 is 90 torr with an FIO2 of 0.50. The nitric oxide concentration should be changed to A. 0 ppm.

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B. 5 ppm. C. 15 ppm. D. 20 ppm.

96 A patient's blood pressure monitored through an arterial catheter is 126/78 mm Hg. The transducer is mounted on a free-standing IV pole. The bed is lowered to permit routine patient care. How will this affect the measured blood pressure? Systolic Diastolic A. increased increased B. increased decreased C. decreased decreased D. decreased increased

97 During an interview, a patient with COPD who was recently admitted to the hospital tells the respiratory therapist that she does not want any heroic measures performed to lengthen her life. This information would best be documented in the A. last will and testament. B. durable power of attorney. C. respiratory care department records. D. advance directive. 98 The information below was obtained from the pulmonary function report for a40-year-old male who weighs 73 kg (161 lb) and is 177 cm (5 ft 9 in) tall:

There is no significant response to the bronchodilator. These data most strongly suggest A. interstitial fibrosis. B. emphysema. C. chronic bronchitis. D. cystic fibrosis. 99 A patient who is oxygen-dependent travels using oxygen from an E cylinder secured in the back seat. He carries a spare cylinder in the trunk of his car when he plans to be out for longer periods of time. The respiratory therapist should inform the patient he should

A. not transport cylinders in his car. B. open the trunk approximately 1 inch when transporting the spare cylinder. C. secure the spare cylinder in the back seat. D. wrap the spare cylinder in a blanket when transporting it in the trunk.

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100 During nasotracheal suctioning, the patient does not cough, but watery secretions are aspirated through the catheter. Which of the following should the respiratory therapist do next?

A. Insert an oropharyngeal airway and repeat the procedure. B. Hyperextend the patient's neck when passing the catheter. C. Ask the patient to swallow while passing the catheter. D. Increase the suction pressure and repeat the procedure.