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A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with - ??heart failure A patient is admitte... d to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? - ??Needle aspirate the 2nd left intercostal space All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT - ??using a low residual volume, low compliance cuff A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend - ??deep breathing & coughing to clear secretions A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? - ??IPPB A healthy adult female can exhale what portion of her forced vital capacity in the first second? - ??70% A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. respiratory rate 3. inspiratory flow 4. sensitivity - ??1, 2, and 3 only Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? - ??insert a chest tube Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. - ??5.0 vol % A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance? - ??50 mL/cm H2O Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 76%. Which of the following would be most appropriate at this time? - ??Reintubation Which of the following patients would most likely benefit from pressure support ventilation? - ??A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min. A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? - ??obtain a sputum gram stain Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV - ??1 & 2 only The respiratory therapist provides education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will - ??retard bacterial growth A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from - ??pleural effusion Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? - ??12 Fr A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that - ??the endotracheal tube has slipped into the right main stem bronchus. The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to - ??apply pressure to the site A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? - ??elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - ??5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes? - ??air leak around the sensor A patient on the general medical ward receives oxygen via 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? - ??55 L/min Which of the following measurements is most indicative of congestive heart failure? - ??pulmonary capillary wedge pressure of 30 mmHg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for - ??10 seconds or longer A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT - ??hypoxemia What size endotracheal tube would be appropriate for an adult female patient? - ??7.0 to 7.5 mm The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should - ??initiate an expiratory hold just prior to the next ventilator-delivered breath. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PCWP 4 mm Hg PAP (mean) 8 mm Hg CVP 2 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend - ??IV fluid challenge What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? - ??VC provides a constant minute ventilation Bronchial breath sounds heard over the lung periphery indicate - ??lung consolidation During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? - ??Normal lung function A 55 year-old male patient is evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should - ??terminate the procedure immediately At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? - ??6 & 10 The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? - ??0.50 mL After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist documents a need to change the patient's treatment regimen in the Progress Notes. The respiratory therapist should - ??check the medical record for new physician orders A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? - ??change to airway pressure release ventilation In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a - ??3.0 L syringe While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Atelectasis - ??2, 3, and 4 only Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as - ??a persistent bronchopleural fistula A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? - ??obtain an ABG A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from - ??myocardial infarction A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? - ??bronchial provocation Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend - ??antibiotic therapy A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? - ??enough to achieve a pressure of 25-35 cm H2O All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT - ??pulmonary hypertension [Show More]

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