A 67 YO patient with a hx of COPD and heart failure has arrived in the Ed with a chief complaint of dyspnea. To help with the differential diagnoses, the physician orders the patient's blood to be testing for CK-MB, CTnI, cTnT and BNP. All results are negative What is the most likely cause of the patient's dyspnea?
A) exaccerbation of COPD
In listening to the patient's lungs, bronchial breath sounds are heard over the RLL area. These would indicate which of the following?
B) consolidation in the RLL
After feeling a sudden chest pain and SOB while lifting weights, a 37 TO man drove himself to the ED. after starting oxygen therapy on the patient, a PE is performed. Pertinent findings include a hyperresonant percussion note on the R side and a tracheal shift to the L. Based on these findings, what is the patient's most likely problem?
D) R sided pneumothorax
The therapist is called to the ED to help care for a patient who was in a car accident and has chest injuries, including two broken ribs. Crepitations are felt while palpating the patient's neck. What is the most likely cause of this?
C) the patient's lung has an air leak
A therapist is called to help in the evaluation of a 55 YO male patient. The following S&S are noted: oral temp 40 degrees C (104.5 degrees F), diaphoresis, RR of 22, use of accessory muscles and palpable rhonchi in the RLL. You would suspect which of the following diagnoses?
D) bacterial pneumonia
Since being told of the dx of CA, a patient has become argumentative about the care received and threatens to hit a nurse and therapist. The patient should be evaluated for:
C) emotional state
To help determine a patient's level of consciousness, which of the following questions should be asked?
B) "Do you know what day this is?" and "Do you know where you are?"
To help determine if a patient has orthopnea, which of the following should be asked?
A) Do you need to use extra pillows when you sleep?
In observing an infant's chest configuration, it is noticed that it is the same size in both the AP and lateral dimensions. This would indicate that the patient has:
C) a normal chest
In examining a patient, it is noted that the patient has greatly diminished breath sounds in the RLL and the trachea has shifted to the R. These signs indicate which condition?
C) R-sided atelectasis
In palpating a patient for symmetrical chest movements, it is noted that the patient's L side does not move as much as the R side. This indicates that the patient has which condition or conditions?
A) L-sided pneumonia and/or L-sided pneumothorax
A therapist is called to the ED to evaluate a pediatric patient. Upon entering the room, a harsh, high-pitched sound is heard on the patient's inspiration. Which of the following is true?
A) sounds are stridorous
A therapist is called to evaluate a patient's breathing pattern. It is noted that the patient's tidal volumes go from small to large to small and then stop for 10 seconds before starting up again. This pattern repeats itself. The patient's breathing pattern would best be called:
B) Cheyne-Stokes Respiration
A tension pneumothorax is identified by which of the following:
D) sudden deterioration of VS, depression of hemidiaphragm on one side and the mediastinum shifts away from the affected side
An adult patient is c/o localized pain over the lower R area of the chest while breathing. When you auscultate the chest, a rasping noise is heard at the point of pain on both inspiration & expiration. This is most likely:
A) pleural friction rub
A 65 YO patient has distended ugular veins even though her head and body are raised 45 degrees above her legs. This would indicate that she:
C) is fluid overloaded
Tactile fremitus would be reduced in all of the following conditions EXCEPT:
C) pulmonary edema
It is most important to ask a patient with a broken ankle from a recent lsip on an icy sidewalk about which of the following:
B) level of pain
All of the following could result in a mediastinal shift on a CXR EXCEPT:
A) bilateral LL pneumonia
A patient who is suffering respiratory distress would exhibit all of the following EXCEPT:
B) Normal RR
A patient with a hx of smoking has shown an increased AP diameter and depressed hemidiaphragms on a PA CXR. It is most likely that this patient has:
After two days of vomiting and diarrhea caused by the flu, a 50 YO patient is admitted. The ECG shows 5 PVC's in 1 minute and flat T waves. What laboratory test do you recommend?
A 48 YO patient with an extensive smoking hc usually coughs about 20 ml of sputum each day. The patient developed a "chest cold" 4 days ago and has noticed increased SOB and thicker secretions. What should be done at this time?
A) get a sputum sample for C&S
A recently home-delivered boy is brought to the ED by the paramedics. The physician asks the therapist to evaluate the newborn's condition. Normal VS for a term newborn include all of the following EXCEPT:
D) RR = 20
The therapist is assigned to assist with the delivery of a high-risk infant. After being evaluated, the infant is given a 5-minute APGAR score of 8. What should be recommended to the assisting nurse and physician?
D) give the infant to the mother for bonding
You are called to Peds to assist in the evaluation and care of a 4 YO girl who has been sick with a bad cold for the last 2 days. In viewing a lateral neck film, you note the following: there is a clear air column through the upper airway and pointed narrowing of the tracheal air column below the larynx. What is the child's most likely condition?
C) laryngotracheobronchitis (croup)
A young adult who had surgery for a deviated septum was accidentally given 2 L of IV fluid in one hour. Which of the following signs would point to the patient being fluid overloaded?
C) tachycardia, peripheral edema & low urine specific gravity
Patients with heart or lung disease commonly have shifting of mediastinal structures. In evaluating patients with CP disease, which of the following could result in a mediastinal shift being seen on a CXR?
A) R-sided pneumothorax & L-sided pneumothorax & LLL atelectasis & fibrosis of the L lung
The radiologist remarks upon reviewing a 65 YO patient's CXR, the patient has an increased cardiothoracic ratio. This means to you that:
B) the patient has an abnormal heart
A patient has ARDS and is significantly hypoexemic. It is likely that the patient will exhibit all the following EXCEPT:
B) normal RR
An adult patient with COPD and LV Failure has been hospitalized. A series of dx procedures is being performed. The preferred radiographic position to minimize distortion of the heart is:
An intubated patient has been moved form the operating room to the ICU. Upon arrival, there is concern that the ETT may have moved.What is the best way to determine its location?
A 65 YO patient with repeated episodes of CHF has a CXR taken. The film shows the left costophrenic angle to be blunted with an air/fluid level with a meniscus in the LLL area. How should this be interpreted?
D) pleural effusion of the LLL
A 3 DO newborn is brought to the ED with the father after theyw ere involved in an MVA. The newborn is showing some signs of respiratory distress with cyanosis and tachycardia. What test would you recommend to determine if the newborn has a pneumothorax?
The therapist is assisting in the delivery of a high-risk infant. At 1 minute after birth, the following are noted: HR = 90, weak cry, arms & legs show some flexion, the baby grimaces when a nasal catheter is inserted into the nostril and extremities are blue with a pink body. What APGAR score should the baby be given?
An elderly patient with CHF has been treated with the diuretic furosemide (lasix). Which electrolyte is the most important to monitor in this situation?
A newborn has been admitted to the NICU. THe physician has determined the newborn to have a Silverman Score of 5. How should this be interpreted?
C) moderate respiratory distress
A hospitalized patient who recovered from a C. botulinum infection received several respiratory care services. How should a nondisposable plastic pulmonary function mouthpiece be sterilized before being used?
C) soak in glutaraldehyde solution for 10 hours
A therapist is working with a homecare patient. How should the patient be instructed to clean her SVN?
D) soak in white vinegar and wash in hot water with detergent
After a mechanical ventilator has been discontinued, what is the best method to sterilize the reusable main-flow bacteria filter?
A batch of RT equipment has gone through gas sterilization with ethylene oxide. Routine surveillance of the equipment shows that the spores of B. subtilis have survived the process. What should be done next?
D) resterilize the equipment and check for destruction of the spores
A retired home care patient living on a fixed income needs to be able to disinfect her equipment. Which of the following would be best for her?
A) acetic acid
What is the most cost effective way for an RT Department to disinfect large amounts of reusable plastic tubing and masks?
A contaminated Bird Mark 7 IPPB unit must be sterilized before use with another patient. What is the best method?
B) ethylene oxide
A 58 YO patient had an exacerbation of his COPD related to spring allergies. As he is being prepared for discharge, what should the therapist recommend?
C) get an influenza vaccination in the fall
A home care company has found that several of its tracheostomy patients have E. coli tracheal infections. What is the most likely cause of the infections?
D) poor hand-washing technique by the visiting therapists
An RT notices that two people in the ED waiting room are coughing regularly. All of the following should be done EXCEPT:
B) have the two coughing people sit near each other
A patient has been confirmed to have SARS. Which of the following should be implemented to prevent the disease from spreading?
A) healthcare workers must wear an N95 mask & airborne precautions & contract precautions are used
A homecare therapist is setting up a continuous home oxygen system for a 54 YO patient with CF. In addition to teaching the patient about her condition and how to use the system, which of the following should the therapist recommend:
B) get the pneumovax vaccine
A 47 YO patient who recently returned home from a business trip to Hong Kong has a high fever and other S&S of pneumonia. SARS CoV is among the conditions being investigated. While the patient is being evaluated, what preventative measures should be taken?
D) standard precautions & droplet precautions
An oxygen blender has just been returned from the NICU. What agent should be used for surface disinfection?
C) 70% ethyl alcohol
An annual influenza vaccination should be given to which of the following groups?
C) healthcare workers, people 50 & older, children & adults with asthma
After assisting with a bronchoscopy to inspect a patient's airways, the RT needs to clean the bronchoscope. How should the unit be disinfected?
B) enzymatic detergent & glutaraldehyde solution
After working with a trauma patient in the ED, an RT sees that there is blood on the patient's pulse oximeter. How should it be processed?
C) wiped down with a bleach solution
Before drawing a blood gas sample from the radial artery, which test should be performed?
D) Modified Allen Test
A patient is brought to the ED after being rescued from a house fire. She is unconscious and has facial burns. The physician believes she is suffering from smoke inhalation. What should be recommended as the best way to evaluate her?
A) ABG analyzed through a CO oximeter
A therapist is ordered to draw a blood sample from the patient's radial artery. Before drawing the sample, a circulation test is performed by having the patient make a fist while pressure is applied over his ulnar and radial arteries. The patient's hand is opened and the pressure is released from the ulnar artery. His hand color returns within 15 seconds. This would indicate that the patient's:
B) ulnar circulation is adequate
A therapist working in the ICU notices that an arterial blood sample has been sitting out for 40 minutes. It was not put in ice water. The blood gas analysis could be affected in which of the following ways:
D) increased PaCO2, decreased PaO2, decreased pH
An arterial puncture to obtain a sample for blood gas analysis should be recommended under which of the following conditions:
C) to measure PaO2 after the inspired FiO2 is changed, suspected CO poisoning, to measure PaCO2 after a change in minute ventilation & after a patient with respiratory distress has been admitted to the ED with a tension pneumothorax
Safety precautions for the protection of the therapist who is drawing an ABG sample include which of the following:
D) put gloves on both hands & wear goggles
A 50 YO patient has a PaO2 of 72 while breathing RA. How should this be interpreted?
D) mild hypoxemia
An acute rise in the PaCO2 from 40 to 50 torr would result in the following change in pH:
C) fall of 0.05
Interpret the following ABG drawn from a patient who is breathing 40% O2:
pH 7.37 pCO2 62 pO2 54 HCO3 38 BE+11 Sat 87%
B) uncorrected hypoxemia & compensated respiratory acidosis
Interpret the follow ABG drawn from a patient who is breathing 35% O2:
pH 7.29 pCO2 37 pO2 86 HCO3 17 BE -8 Sat 90%
Which of the following best indicates that a patient's tissues are adequately oxygenated?
B) Mixed Venous O2Sat 75%
Blood gas analyzer calibration values are considered to be in control if they are within:
A) 2 SD of the norm
A 5o YO patient with emphysema seems to be tiring 30 minutes into a weaning attempt on a Briggs adapter (T-piece). The best way to evaluate the patient's ventilatory status is by:
C) checking the PaCO2
A patient has Guillain-Barre Syndrome and pneumonia. The patient has been placed on 35% O2 by mask. The physician asks for your suggestion on the best way to evaluate the patient's overall ability to breathe. What should be recommended?
C) draw an ABG
A therapist is called to evaluate a patient who is using a pulse oximeter. Upon entering the room, it is noted that the patient is an African-American woman with an oximeter probe on her right earlobe. The monitor shows a weak pulse signal and a fluctuating SpO2 level. Which of the following should be done in a attempt to correct the problem?
A) try monitoring from a fingertip & cover the probe with a opaque wrap
A therapist is working with a postanesthesia patient who is on a PtcCO2 monitor. The correlation factor between the PaCO2 and the PtcCO2 is 1.4. The patient's previous PtcCO2 level was 63 torr. The nurse has called you because it is now 75 torr. The patient's approximate PaCO2 value would be calculated as:
A) 45 torr
A 35 YO patient with pneumonia is receiving MV with PEEP. Calculate and interpret the patient's p(A-a)O2 level.
The following conditions exist: PB=750 torr, normal is 760 torr for sea level; pH2O = 54 torr because the patient temperature is 104 degrees F (40 degrees C), normal is 47 torr for a normal temperature; FiO2 = 0.50; PaCO2 = 36; PaO2 = 60; Respiratory Exchange Ratio = 0.8.
PACO2 = [(PB-PH2O) x FiO2] - (PaCO2/0.8)
Based on the listed conditions, what is the PACO2 value?
C) 303 torr
Based on the listed conditions, what is the patient's P(A-a)O2 value?
D) 243 torr
How should the patient's P(A-a)O2 results be interpreted?
A) larger than normal difference (25 torr)
A 50 YO male patient is being treated for a pulmonary embolism. He is receiving 50% O2 by mask. The results of a P(A-a)O2 study indicate that his A-a difference is 205 torr. What is the interpretation of this study?
B) the A-a difference is increase (15 or less in a normal person)
A premature neonate breathing RA has a PtcCO2 electrode on her R thigh and a PtCO2 electrode placed on her L thigh. Both have been showing stable readings over the past hour. After the patient was moved for nursing care, it was noted that the PtCO2 electrode value had increased. The PtcCO2 electrode value is unchanged. What could explain this?
C) the PtcCO2 electrode has pulled loose from the skin
After a modified Allen Test is performed on a patient's R wrist, it takes 25 seconds for the hand to regain its color. What should be done now?
B) perform a modified Allen Test on the patient's L wrist
A 45 YO patient has been admitted to the ED after having smoke inhalation from a house fire. The patient is wearing a nonrebreather mask set at 10 lpm of O2. The most appropriate way to evaluate the patient's oxygenation status is by:
D) ABG sample run through a CO oximeter
Interpret the following ABG drawn while the patient was breathing 45% O2:
pH 7.38 pCO2 59 pO2 64 HCO3 39 BE -112 Sat 91%
A) uncorrected hypoxemia & compensated respiratory acidosis
Intrepret the following mixed venous gases drawn when the patient was breathing 40% O2:
pH 7.35 MVCO2 46 MVO2 40 MVSat 75%
D) correccted hypoxemia (normal MV O2 = 40) and normal acid-base balance
Interpret the following ABG dtawn while the patient was breathing 30% O2:
pH 7.44 pCO2 25 pO2 65 HCO3 17 BE -7 Sat 91%
Which of the following clinical values indicates that a patient;s tissues are hypoxemic?
A) MV O2 25 (40 is normal)
A spontaneously breathing neonate is in an incubator. The patient is being monitored with a tcCO2 electrode on her upper R chest. An hour ago, the patient's CO2 value was 45 torr and now is 5 torr/ THe nurse tells you that no change has occured in the baby's condition. What is the most likely cause for this difference?
A) air has leaked under the electrode
A 17 YO patient is receiving MV becuase of apnea resulting from a drug overdose. While the patient is breathing 25% O2, the following ABG's were drawn:
pH 7.42 pCO2 41 pO2 155 BE +2 Sat 100%. What action should now be taken?
A) recheck the blood gas analyzer: pO2 too high!
A neonatal patient is receiving 40% O2 in a hood. THe following capillary gases have been received:
pH 7.37 pCO2 45 pO2 60 HCO3 22 BE -2 Sat 91%. Which of these values can be reliably used clinically?
D) pH & pCO2
The result of a set of ABG's and central venous gases have been received from a patient in the ICU. The results show that the PcvCO2 is 58 torr and the PaCO2 is 43 torr. How should these results be interpreted?
C) low cardiac output
An adult patient in Dencer is receiving 50% oxygen through an entrainment mask. The ABG's are pH 7.41 pCO2 38 pO2 85 HCO3 25 BE +1 Sat 96%. The local Pb is 745 torr. The patient's P:F ratio would be calculated as which of the following?
D) 85/50 = 1.7
Because it is not possible to obtain an ABG on a newborn, the physician orders analysis of an arterialized capillary blood gas sample. Which of the following shold be selected as the preferred sampling site?