Prior to intubation in an emergency, infection of air into a pilot line fails to inflate the cuff. You should:
A. replace the ET tube
Which of the following alarm conditions indicates a potential system leak when delivering volume oriendted ventilatory support?
A. Low volume + low pressure
While a patient is being ventilated with a bag resuciator the bag fills rapidly and collapses on minimal pressure, although little chest movement by the patient noted. The cause of the problem may be which of the following?
B. Absence of inlet valve
During CPR oxygen reservoir bag of bag vlave manula resuscitator collapses during the refill phase. you can corret this problem by:
D. Increasing O2 flow to the bag
What of the following is the most probable cause of insufficinet mist in a croup tent?
A. clogged capillary tube in nebulizer
You observe the reservoir bag on a patient receivn oxygen at 10 L/min does not display at all when the patient inspires what should you do first?
C. Check the mask for snug fit
To continuously monitor the adequacy of ventiatlion of a patient in the ICU being supported by the mask BiPAP, you would recommend which of the following?
D. Transcutaneous Pco2
Which of the following test of lung mechanics would you recommend to use to test the presence of auto peep on a patient receving then to ventiatory support?
C. Flow volume loop
An AP X-ray of a 3 yr old child ith wheezing and striodr shows an area of prominet subglottic edema, but the lateal neck x-ray appears normal. What is th emost likely problem?
During an interview with your patient you discover that he gest SOB when he lays down so he often sleeps with several pillows to prop his head up. what symptom is present?
Resistance is encountered whiel suctioning through a size 6 mm ID ET tube with 14FR catheter. Which of the following is th emost appropriate action for you to take?
D. use a 10 Fr cathther
While obtaining an arterial sample for analysis using a point of care analyzer, you should do all ofthe following except:
A. place the sample in ice slush
A 2 yr old is admitted to the ED with severe asthmatic symptoms. The attending physican orders a bornchodilator that is availabe in both solution and MDI preprations. Which of the following is the best delievery system for this drug to this patient?
C. MDI with holding chamber and mask
All of the following help minimize the risk of cross contaminiation during suctioning except:
A. instilling 10 mL sterile saline before suctioning attempt
If sterilaztion is not feasible, which of the following are acceptable alternatives for processing a specialzied resuable plastic airway?
I. Exposure to high level chemical disinfectant
II. surface disinfection with 70% ethyl alchol
III. Pasteuriztion at 63 C for 30 min
D. I and III
On checking a ventialtor pts progress notes, you see that hte attending physicans treatment plan includes starting spontaneous breathing trails. Your most appropriate action is to do which of the following?
B. check to verify that valid phyhsicans order is present
after completing a ventialtor check, you note tht you incorrectly computed the pts complaince in prior entry. Which of the following is the msot apporpriate course of action?
D. line out the error, write the word "error" correct and inital it
The best way to routinely communicate a pts clinical status to the appropraite members of the health care team is by reproting information:
B. pts chart
If you are giving routine theapry and note adverse chagne sint he pts condition, you should do which of the followin?
I. Notify the nurse who is responsible for the patient
II. contact the phsyican if a change in thepary seems warranted
III. Record the pts recations in the chart
B. I, II, III
Midway thorugh an aerosol drug treatment via IPPB, a patient complains of dizziness and tingling in her fingers. After stoppoing the therapy and adjusting the equipment to correct the problem and completing the treatment, you should recor which of the follwoing in chart?
I. Medicastion used during the treatment
II. The patients pulse and BP and after the treatment
III. Naure of the probelm and the way in which it was corrected
B. I and III
When a patient refues to take a treatment, yo should do which of the following?
A. notify the nurse in charge and chart pts refusal
A patient suddenly loses consciousness. which of the following is the first procedure you should perform to maintain an open airway in this patient?
B. Appplying the head tilt/chin lift maneuver
A pt is in ICU exhibits signs of acute upper airway obstrcution & concurrently having severe seizuers that make it impossible to open the mouth. In this case, what is the adjucnt airway of choice?
C. Nasopharyngeal airway
Which of the following should be prescribed in order to privde adequate humidification to an intubated pt?
A. Inspried gas with an absolute humidity greater than 30 mg.L
All of the following are needed for an effective cough except :
A. a closed glottis
B. compresison phase
C, explosive exhalation
D. low inspriatory volumes
D. low inspriatory volumes
A morning X-ray confirms bilateral infiltrates in the posterior segments of the upper lobe sof 30 yr old female pt. what postural drainge postion should you use to drain these segments?
A. sitting position leaning forward on a pillow
Which of the following should you do in order to properly perform nasotrachela suctioning on an adult pt?
I. lubricate the cathther
II. apply suction for less than 15 sec
III. preoxygneat and postoxgenate the patient
IV. instruct pt to exhale and hold breathe
D. I, II, III
Adult male requres postural drainage of the posterior basal segments bilaterally. docotrs order is ocmpelte and you have performed all pre treatment assessments and takena ll needed precaustions. to properly position this patient you should:
I. elevate food of bed 30 degrees
II. keep bed flat but put pillow under pts hips
III. have pt lie supine with pillow under hips
IV. have pt lie prone with pillow under hips
C. I and IV
While suctioning a pt receiving ventialtory support, you note the HR increases abrupty form 92 to 145 BPM. which of the following actiosn could help prevent or minimzie this problem?
A. incrase oxgyen concentriaon immeidatley before suctioning
A pt with CHF is coughing up large amounts of pink, fothty sputum. ABG vlaues on simple mask O2 of 7L/min follows:
PaCO2 29 torr
which would you recommend
C. Maks CPAP with 80% O2
During pt-ventiator check in the ICU, you observe the following settings and monitored paramets on 70 kg (154lb) patient receving vent support:
VT 600 ml
Mandatory rate 10
total rate 38
Minute volume 10 L/min
what actions would you recommend?
C. add pressure support
which of the following best describes the way a patient should perfomr IS?
A. pt should hold max insp cpaicyt (IC) breath for at least 5 sec
pt rececivng BiPAP for actue resp failure has PaO2 of 48 torr on 65% O2 with IPAP=20 cm h2O and EPAP=5 cm H2O. To raise pts PaO2 yo should recommend?
B. increasing EPAP to 10
Pt receving mechanical vent has following vent settings and ABG results
MODE SIMV pH 7.26
vT 750 PacO2 56
Set rate 4 HCO3 22
Spont rate 0 PaO2 92
FiO2 0.55 SaO2 96
which to recommend
B. increasing SIMV rate
A new medical resident asks for your help in calculating the static lung complaince for an ICU patient receivng voluem cycled ventilation. the patient has the following settings and monitoring data:
Peak pressure 50
Plateau Pressure 30
Mechanical deadspace 100
What is the pts static lung complaince ?
A patient with a size 8 tracheostomy tube is being suctioned by the nurse. While suctioning the patient you obsrve several PVCs on the pts monitor. You should recommend that the nurse:
C. preoxygenate the patient with 100 O2
You need to provide continuous monitoring of the FIO2 for a ventiatlor that uses a heated humdifer delivery systme. the only analyzer avialbe is a galvanic cell analyzer. Where should you place the analzyers sensor?
C. Proximal to the heated humidifer
proximal is before the humidifer to any humidification device
After perfroming a modified Allens test on the left hand of a patient, you note that his palm and fingers do not beocme pink for more than 15 sec after releasing pressure on the ulanr artery. At this point you should:
C. repeate the tes ton the right hand
While suctioning a pt, you observe an abrupt chagne in the ECG waveform being displayed on the cardiac monitor and drop in Spo2. which of the following actions should be taken?
C. Stop suctioning and immediately administer oxygen
after initationg a bronchodilator aerosol via IPPB to an asthmatic, the pt complains of fatigue and SOB. on inspection of the pt, you note increased use of accessory msucles, an incrase in HR from 90 to 122, and other signs of mild to moderate distress. which of the following is the appropriate action at this time?
A. stop the treatment and stay with the pt until she improves
A pt is receving appropriate oxgyen thearpy via simple mask at 5 L/min but coplains that hte mask is confiving and interferes with eating. Which of the following oxygen delviery devices is a subitalbe alternative?
B. nasal cannula 4-5L
You notice that the air entrainment porst of a ventuire mask are occulbed by a pts bedding. what effect would this have on total flow and FiO2?
D. decrease total output flow and incrase Fio2
To prevent hypoxemia during suctioning an orally intiubated pt, you should do which of the following?
D, maintain set FIO2 and increase PEEP prior to suctioning
A. admisinister 100 oxygen through the ventiltor for 1-2 min before suctioning
Physican prescribes IS for postoperative pt who complains of dizziness when performing five insp maneuvers in a row. what action should be taken?
B. begin CPR on the inftant
College student is brought to the ED following a motor vehicle accident. He is tachypneci and tachycardic. He is receiving oxyen via a nonrebreathing mask at 10 L/min. You observe that the maks bag fully deflates on each inspriation. what action should be taken
B. incrase the flow rate to 12-15
48 yr old is orally intubated, receiving mechanical ventilation with a #7.0 endotracheal tube secured in place. cuff pressure is foudn to be 34 during peak inspriation using ht eminimal occluding volume technique. you should suggest
A. Replacing ET with larger size
Pt recving IPPB thearpy for atelectasisi wtih set pressure 25. druing thearpy the pt pusle becomes thready and the BP dropts form 120/80 to 90/50.
A. D/c the treatment and notifty the physican
Prior to beginning an adrenergic aerosol bronchodilator tx on ana adult pt, you record a resting HR of 132 beats/min. Which of the following is the correct action in this case?
D. postpone tharpy unitl you are able to contact the ordering physican
Following administration of bland aerosol tx, auscultation revels rhonchi throughout middle and upper lung fields:
C. encourage pt to cough
While monitoring a pt during a T-tube weaing trial, you note increased HR from 85 to 110 and RR from 15 to 34 and PVCs increasing to an average of 4 per min.
D. Reconnet pt to the ventialtor with prior settings
Pt with acute bornchities is receving mechanhical vent. Wheezing is heard over all lung fields, & rhonchi are heared over the central airways. Previously suctioned secretiosn ahve been quite thick. Pts peak pressure is 45, and Pplat 20. all of the following would be useful to treat pts condition except:
B. Pancuronium bromide (pavulon)
75 yer old female pt with a factured hip has been bedridden for at least one week. The pt has clear breath sounds, but they are diminished slightly in the bases. The pt has nomrla pulmonary fuction based on bedside spirometyr. which would you recommend?
I. bronchodilator thearpy
II. deep suctioning
III. incentive spirometry treatments
IV. coughing and deep breathing
D. III and IV
An intubated pt in the ICU needs to undergo bedside bronchoscopy and is in need of short term modrate sedation. which of the foloowing agents wouldyou reocmmend for this procedure?
C. propofol (diprivan)
You are assisting a medical resent performing an emergent inutabtion on a somewhat combative pt. The resident wants to breifly paralyze the pt to facilitate this procedure. What would you propose?
C. Succinylocholine (anectine)
Which of the following conditions is an indication for the use of CPAP?
A. pulmoanry edema
you would initiate O2 theapry in all of the following causes except:
C. Treating absorption atelectasis
which of the following would you recommend for a patient that has emphysema iwth chronic PacO2 reteniton who expericnes hypoxemia at rest?
A. low flow oxygen
During a "code blue" or other medical emergency, a physican is having trouble starting an intravenous line. Which of the follow drugs can be placed down an ET during emergeny life support?
B. I, II, III, IV
Which of the following techniques can be used to determine effectiveness of ventialtion?
I. Looking for the rise and fall of the victims chest
II. Feeling for air exchange near the victims mouth and nose
III. Listening for audbile breathing efforst from the victim
B. I, II, III
At the oneset of adult mouth to mouth or mouth to mask ventilation, you should provide:
B. two normal breaths, thne assess the pulse
When transporting criticually ill pts who are receivng supplemental oxgyen in unpressurized aircraft, it is often necessary to make which adjustmen tin FiO2 in order to maintain adequte oxygenation?
D. increased FiO2
The essential goals of pulmonary rehabilitation inculde all of the following except:
D. Reverse lung damage
90 kg male pt with flail chest injury is being mechanically ventialtied the A/C mode with FiO2 of 0.5, set rate of 18, and tidal volume of 600mL. he is involuntary brething above the set rate for total resp rate of 28-30. results of arterial blood gas analysis are:
On the basis of these results, th emost appropriate action is to:
A. Add mechanical deadspace
87 yr old nursing home pt is admitted with PNA. On assessment the pt presents with 103.2 F temp, dry mucous membrances, ruine outptu of 10 mL/hr for the past two hours, mild hypotension, and incrased hematocrit on his CBC. You shoudl recomend the ER physican all of the following except:
B. beginning diuretic thearpy
Which of the following airway routes would you recommend to immediatley ventilate a trauma pt in a neck brace w/ suspcted cervical spine injyr who was admitted to the ED/
I. orotrachela intubation
II. nasotracheal intubation
III. Laryngeal mask airway
C. II or III
COPD pt being mechanically ventilated appears to be developing auto peep. which of the following should you recommend to improve this situation?