TMCB

  1. Which of the ff is the definitive method on monitoring the effectiveness of equipment sterilization?
    • C. Biological indicator
    • Indicators that microorganisms have been killed in the package
  2. Which of the following clinical observations is most commonly associated with right heart failure?
    • A. Peripheral edema
    • Right heart failure inhibits venous return and results in edema in the periphery.
  3. A pt who is receiving mech vent requires an FiO2 of .70 and a PEEP of 10 cm H2o to maintain an acceptable PaO2. The pt is restless and has become d/c from the ventilator circuit several times, during which she experiences cardiac rhythm disturbances. A RT should conclude that the pt will benefit from a
    • A. Sedative
    • Sedation is required to eliminate excessive activity so the pts cardiopulmonary status can be properly evaluated and treated.
  4. A male pt who is 180 cm (5ft 11 in) tall and weighs 75 kg (165lbs) is intubated and receiving mech Vent. The Endotracheal tube is secured at the 23-cm mark at this incisor. The cuff pressure is 30 mm Hg. Which of the ff should a respiratory therapist do?
    • Deflate the cuff until a slight leak is heard at peak inspiration.
    • Establish  a MLT will determine the pressure needed to maintain the VT.
  5. Capnogram with an increase and slant in CO2 is characteristic of .......... due to prolonged exp phase.
    Emphysema
  6. In the last 6 months, a pt with bronchiectasis who uses postural drainage at home has had three exacerbations requiring hospitalization. What should the RT rec.'d/
    • HFCWO
    • Provides an effective method to loosen and mobilize airways secretions
  7. A RT is assisting a physician with a tracheostomy for pt who is receiving PC ventilation. Following percutaneous placement of a tracheostomy tube, the therapist observes increasing HR, decreasing Exhaled TV and increasingly distant breath sounds over the right chest. The therapist should anticipate treatment for..
    Pneumotherapy

    Lacerating a blood vessel may result in hemorrhage, however, it should have no immediate effect on the exhaled volume or dim BS.
  8. A pt is receiving cont heated aerosol therapy with air by a T-piece develops sub-Q emphysema around the tracheostomy site, neck and chest. After noting unequal BS, a RT should rec'd obtaining.
    Chest radiograph

    SubQ emphysema may indicate the presence of a PNX. A Chest radiograph is the most approp initial diagnostic test when a PNX is suspected.
  9. A pt with neuromuscular disease has been receiving ventilatory support for 4 months through a tracheostomy. The pt uses a speaking valve during the day but receives VC, A/C ventilation at night. Which of the following should be used.
    Cuffed tracheostomy tube

    When using speaking valve, the cuff can be deflated and then reinflated for Mech Vent.
  10. What is an indication for placement of an oropharyngeal airway? It prevents?
    • Prevention of upper airway obstruction in an unconscious pt.
    • The trachea can easily be sxt without an oropharyngeal airway.
  11. A male pt who is 175 cm ( 5ft 9 in) and weighs 82 kg (180Lb) was receiving VC, A/C ventilation with a tidal volume of 600 mL. The pts PH was normal. The pt was switched to PC, A/C ventilation the same mandatory rate. Exhaled TV is averaging 750ml. A RT should conlude the pt is most at risk for?
    • Alkalosis
    • The increased VT will increase the pts minute ventilation and may decrease the PaCO2. Resp Alk may result
  12. Which of the following may be caused the administration of aerosolized pentamidine isethionate (Nebupent)?
    • Bronchospasm
    • is the most frequently reported adverse effect associated with the use of NebuPent.
  13. A RT is administering 1.25mg of albuterol to a pt by svn. Five mins after the tx is started, the pts HR increases from 110 to 140. Which of the FF should the therapist?
    • Terminate the TX.
    • Increase in HR greater than 20 bpm, signaling a tachycardia reaction to the med.
  14. Morbidly obese pt is receiving aerosol by tracheostomy collar 48hrs post tracheostomy. A RT notices the pt is experiencing ARD after being turned to the R side for a bath. What should the therapist do next?
    Place the pt Supine and reassess tube postion.

    Repositioning may have displaced tracheostomy tube. Place the pt supine will allow better access and ability to evaluate and correct the problem.
  15. A fixed wing med transport with an unpressurized cabin has ascended to 10000 ft while transporting a pt with COPD. The pt is reveiving nasal O2 at 2L/min and becomes agitated and confused. An RT should
    Increase O2 flow.

    The is experiencing hypoxemia assoc with altitude and a lower inspired alveolar PO2. Increasing the O2 flow will increase the inspired FiO2.
  16. Pt found comatose in a car with the engine running in an enclosed garage. On arrival to the emergency department, the pt is receiving O2 at 15L/min by NonRe mask and has the ff vital signs.

    ON EXAM! 
    Hemoximetry and Abg 

    An ABG will indicate the pt.s ventilatory status. Hemoximetry will indicate the pts carboxyhemoglobin level, which is essential in CO poisoning, in addition to true O2 saturation.
  17. A pt with COPD is receiving PC ventilation with flow triggering and has significant air trapping displayed on ventilator graphics. The Pt's spontaneous breathing efforts are not always detected by the ventilator. Which of the ff changed should a RT rec'd to improve patient-ventilator synchrony?
    Increase the the set PEEP.

    Pt with patient vent dyssynchrony associated with AIR TRAPPING will often benefit in the set (extrinsic) PEEP level. The increa in applied PEEP can help reduce the diff between end alveolar pressure and end- inspiratory pressure.
  18. When calibrating a fuel cell oxygen analyzer, the analyzer should be set tojQuery112403096313055332811_1594690207136
    21% while exposed to RA.

    RA is used for low calibration of an O2 analyzer and should be set at 21%
  19. A 4 yr old child is seen by a RT for a F/U asthma evaluation. The child denies any dyspnea. The parents report giving the child albuterol by inhaler twice daily. The therapist should..

    ON The EXAM!
    Explain the purpose of the quick relief medication.

    Albuterol is a quick release med. It should be used as needed, not at a scheduled frequency.
  20. A pt with COPD and pneumonia is receiving VC, SIMV. The following values are observed:

    FIO2 .28 Mand R 8 Total R 16 VT 700 S VT 425 PEEP 4 PS 5


    Vital signs have been stable for 48 hrs and the following blood gas values are available.

    PH 7.33 PACO2 54 PAO2 78 HCO3 28 

    Which of the ff should a RT rec'd...
    Initiate a SBT

    With the information provided, this pt qualifies for SBT
  21. A spontaneously breathing pt receiving an FIO2 of .40 by mask has the ff ABG results:

    PhH 7.46 PCO2 33 PO2 48 HCO3 23

     An RT should first ....
    Increase the FIO2 to 1.0

    Administering FiO2 of 1.0 may improve oxygenation.
  22. Two hrs after placing a 30- week gestational age infant in an oxygen hood with an FIO2 of .28, a RT observes an SpO2 of 98%. Which of the ff should the therapist do?

    ON EXAM
    Wean the FiO2

    The FiO2 should be weaned to keep the SpO2 between 88% and 95% on an infant this premature to help prevent retinopathy or prematurity.
  23. Which of the ff should a RT use to confirm the presence of auto-PEEP during VC ventilation?


    ON EXAM!
    End expiratory hold

    Auto-PEEP is detected at the end of the expiratory phase. Exp hold permits pressure to be equilibrated throughout the vent circuit and the pts airway, allowing estimation of alveolar pressure.
  24. What is the amt of air that can be maximally exhaled from maximum inspiration?

    ON EXAM
    Vital Capacity

    VC is the maximum volume exhaled after a max inhalation.
  25. Which of the ff should be use preoperatively to assess a pts risk for resp complications ff abdominal surgery?

    ON EXAM
    Spirometry

    Spirometry provides detail of a pts lung condition as well as the pts ability to cough.
  26. A pt receiving mech vent had a total fluid intake of 4200mL and a total fluid output of 1200 mL over a 24 hr period. Which of ff might increase in the situation?
    P(A-a)O2

    An excess in interstitial fluid can impair O2 diffusion into the capillaries and increase the P(A-a) O2
  27. A pt lost an unknown quantity of blood as a result of a Motor vehicle crash. To full ass OXYGEN delivery, a RT should rec'd.

    ON EXAM
    Complete blood count

    A complete blood count will provide hemoglobin value that is used to calculate oxygen delivery.

    ON EXAM
  28. A 54 yr old woman who weighs 65 kg (143lb) was involved in a motor vehicle crash 8 days ago. VC, A/C settings are follows:

    FiO2 .40, Mand R 10, VT 500mL, 5 cm H2O.

    ABG analysis reveals the ff:
    Ph 7.38, PCO2, 41, PO2 88, HCO3 24, BE -1 SaO2 95%

    The pt is now awake, alert, and oriented. She is hemodynamically stable and initiating inspiratory efforts. Which off the ff should a RT recommend First?

    ON EXAM
    Initiate Spontaneous Breathing trial

    The blood gases values are acceptable for initiating a SBT
  29. An adult pt in the ICU is receiving a beta-blocker med and requires bronchodilator therapy. Which of the ff should a RT rec'd?
    Ipratroprium bromide (Atrovent)

    is an anticholinergic. Beta blockers do not affect its ability to achieve bronchodilation.
  30. A 36 yrd old female pt who weighs 136 (300lb) and is 159 cm (5ft 2 in) tall has just undergone gastric bypass surgery. She brought to the PACU still intubated. The pt should rec'd which of the ff ventilator settings?
    Tidal Volume  Mandatory Rate
    300mL       8
    400 mL      10
    600mL       10
    400mL

    Using the Predicted IBW formulate for women, the pts IBW is 50 (110lb). Tidal volume is 8mL/kg of IBW which is approp.
  31. The major component of pulm surfactant is ?
    Phospholipid

    is 85% of surfactant
  32. During MV, mean airway pressure will always change with a change in?

    ON EXAM
    Insp time.

    Lengthening the I-time allows the vent to increase the VT and mean airway pressure.
  33. While a therapist auscultates a pts chest, the pt repeats the words, 99. Transmission of vocal sounds in increased in the right lower lobe compared to the other lung fields. What does it most likely indicate.?
    Consolidation

    Vocal fremitus is increased with lung consolidation.
  34. Pt with COPD is receiving Mech Vent. The pt continues to wheeze despite the tx with albuterol. A resp therapist should rec'd.

    ON EXAM
    Adding Ipratroprium bromide (ATROVENT)

    Ipratropium bromide txs bronchoconstriction by a mechanism different from albuterol and should decrease airway resistance or bronchospasm.
  35. What values are needed to determine a patients physiological dead space?
    Arterial PCO2 and Mixed expired PCO2

    • Physio dead space is calculated from the BOHR equation
    • VD/VT= (PaCO2- PeCO2) PaCOs.
    • Thus, it is necessary to know the values for the arterial and mixed expired values carbon dioxide.
  36. The EVT for a pt receiving mechanical vent is 500mL. The plat pressure is 15 cm H2O, the peak pressure is 25 H20, and the PEEP is 5 cm H2O. What is the CStat in mL/cm H20?

    ON EXAM
    500mL Tidal Volume divided by 10 cm (PLAT-PEEP) equals 50mL/cm Static compliance.
  37. A RT assess a pt receiving supp oxygen by transtracheal oxygen catheter. The patient is diaphoretic, has a higher than normal RR, and appears cyanotic. Which of the ff is a possible explanation?

    ON EXAM
    Transtracheal catheter is obstructed with a mucus plug

    Mucus plugging will decrease or top oxygen flow to the pt, resulting in hypoxia and related symptoms and signs.
  38. A 163 (5ft,4in), 70kg (154lb) female pt has been weaned from Mech Vent to a T-piece with an FiO2 of 0.30. The patient is awake and alert. The ff info is available:

    *VT 450, VC 1200mL, MIP -42,/// PH 7.38, PaCO2 43, PaO2 80, HCO3 25, BE 0

    Which of the ff is a RT's most approp recom'd?

    ON EXAM
    Extubate pt

    The vent parameters & the accompanying ABG results indicate the pt is ready for extubation.
  39. A pt with multiple traumatic injuries is receiving VC vent. FF data.
          1000       1200      1400
    PIP   29           33          38
    SpO2  96%     91%       89%
    BP     130/76   124/70 
     116/62

    BS sounds over R thorax are Dimin & the trachea is deviated to the L. A RT should rec'd obtaining a:

    ON EXAM
    Chest Radiograph

    The clinical picture suggests the possibility of a Pneumo. A CXR radiograph is quick test to identify the presence of pneumo.
  40. Which of ff factors will influence the O2 concentration delivered by a self-inflating manual resuscitator?

    ON EXAM
    oxygen flow and reservoir size

    FiO2  is impacted by both the flow into the bag and the presence of a reservoir. With O2 flow set at 15LPM and a reservoir attached, the concentration approaches 100%. When a reservoir is not attached, the concentraion is approp 40% less.
  41. Common complications assoc with arterial punctures include:
    Hematoma formation and spasm of the vessel.

    Hematomas, or large extravascular blood accumulations, will result when post-puncture pressure has not been applied adequately. Vesell spasm is a common compl assoc with needle trauma.
  42. A 56 yr old man requires continuous mech vent ff cardiac arrest. His HR is 110 and BP is 96/50. A Pulm artery cath has been inserted. PT data below:
    BSA    2      QT     3.6
    Mean PAP   30   PCWP  12
    A RT should rec'd administering:
    Inotropic agent

    will control fluid overload and decrease preload. It should be used to increase the contractility of the mycoardium in this pt to increase the BP.
  43. FF intubation of an adult male, a RT notices BS are present in the R lung, but extremely DIM in the L lung. Which of ff is the most approp action at this time?

    ON EXAM
    Withdraw the Endo tube until equal breath sounds are heard.

    Most likely the R mainstem bronchus was intubated; withdraw the Endo tube slowly until bilateral vent is ausculated should resolve the situation.
  44. Which of the ff should a RT rec'd for a pt who is receiving mech vent support and has moderate musculoskeletal pain?
    Fentanyl citrate (Sublimaze)

    analgesic agent that will be helpful to reduce musculoskeletol pain
  45. A 70 yr M, who had smoked for 20yrs but recently quit, complains of SOB with exertion. BS are clear but DIM bilaterally. During the evaluation for entry to a pulmonary rehab program, the ff results are obtained after a 6 min walk test while breathing RA.

    distance walked  140 meters  # of stops 2  Spo2 nadir 85%

         Baseline     End of Test
    HR  98               120
    SpO2   92           85%    A resp therapist rec'd...
    Initiating Oxygen with activity

    PT exhibits oxyhemoglobin desaturation with exercise and should have O2 administered with activity.
  46. What assessments can be made from a PRESSURE-VOLUME loop?
  47. A pt is receiving PC vent and the ff data are noted:
                   12pm           1208pm
    Hr           105               175
    PIP           53                52
    PEEP         10                10
    Ex VT        700              300
    I:E          1.5:1.0           1.5:1.0
    SpO2         96                 79

    The pt has become agitated & tympany is noted on the L. A RT should rec'd:
    Perform needle decompression

    The ONSET of AGITATION, tachycardia, oxygen desaturation, and left chest tympany are suggestive of tension pneumothorax. Needle decomp is rec'd.
  48. A 23 yr, 80kg (176lb) 178cm (5ft 10in) male is admitted to the ICU ff a drug overdose. VC A/C vent is initiated with the ff settings:
    FiO2 0.30, Mand Rate 16, VT 650, Flow 25, Press Lim 45
       The high pressure alarm is sounding freq, and wide fluctuations in pressure are noted. A RT's most approp action to
    Increase the flow

    will more adequately meet the pts inspiratory flow demand.
  49. Which of the ff will most accurately & quickly assess a pt's response to changes in FiO2?

    ON EXAM
    • Pulse ox
    • gives rapid response to changes in oxyhemoglobin saturation and is the most accurate of the options given.
  50. In a pt with postoperative atelectasis, PEP therapy is likely to:
    • Increase FRC
    • Pep therapy acts similar to PEEP/CPAP & increases FRC by exhaling through resistance.
  51. A 188cm (6ft, 2in), 80-kg (176lb) male patient who has undergone a R lower lobectomy is receiving VC, A/C ventilation with following settings:
    FiO2 .50, Man R 12, Total R 14, Vt 400mL

    The following blood gas results are available:
    PH 7.32, PaCo2 48, PaO2 75, HcO3 25
    A RT should rec'd:
    • Maintaining current therapy
    • Although the pt has a mild resp acidosis, the values are acceptable for this pt.
  52. A 24 yr pt with Apnea is receiving PC ventilation. ABG results are as follows:
    Ph 7.20, Pco2 65, Po2 70 HcO2 25
    A RT should rec increasing:
    • set inspiratory pressure
    • In PC ventilation, increasing the Inspir pressure with result in an increased VT and MV, potentially causing a decrease in PCO2.
  53. A pt receiving VC, SIMV has the ff ventilator setttings and blood gas results:
    FiO2 55, Man R 12 Total R 12, VT 750 
    PH 7.56, PacO2 26 PaO2 92 HCO3 22 SaO2
    Which of the ff should a RT rec'd:
    • Decrease the Mandatory rate
    • will decrease the minute volume and reduce the respt alkalosis.
  54. A 24 yr old pt with muscular dystrophy is seen in the emergency dept of ff a 2 day history of increasing SOB. Blood gas results while breathing air are below:
    PH 7.31, PaCo2 65, PaO2 58, HCO3 33
    A RT should rec'd:
    • Initiating non-invasive ventilation
    • Blood gas results indicate a need to provide ventilatory assistance. NPPV will address the ventilation problem.
  55. Which of the ff types of nebulizer can be used to deliver aerosolized meds to a vent circuit w/o altering delivered VT?
    • vibrating mesh
    • nebulizers place only the aersololized meds into the circuit
  56. The ff data are obtained:
    FiO2 1.0 Vd/VT .45, Resp exch rate .8, PB 747
    PH 7.42 PaCo2 38, PaO2 152, HcO3 ?25

    What is the P(A-a)O2?
    • 500 torr
    • PAo2-FiO2 (PB-PH2O) - PaCo2/R
    • PAO2= 1.0 (747-47) - 38/.8

    • PAO2= 700-48
    • PAO2 = 652
    • P(A-a) O2 = 652-152
    • P(A-a) O2= 500
  57. While breathing air, a pt's SpO2 is 90% & Hemoglobin is 15. What is the approp oxygen content?
    18

    • SaO2 = 1.36 X Hgb X(SpO2/100)
    • SaO2= 1.36 x 15 x (90/100)
    • SaO2= 1.36x 15 x 0.9
    • SaO2 = 18.36
  58. The ff infor is obtained from a pt breathing air:
    HR 110, RR 22, BP110/70 SpO2 86%

    A RT should FIRST:
    Exchange the site of the oximeter sensor

    The Sat may not be accurate and should be measured at a different site.
  59. If pt's chest radiograph shows infiltrates in the posteria basal lung segments, postural drainage should be performed in which of the ff positions?
    • pt prone, head down, with a pillow under the abdomen
    •  drains posterior basal
  60. A pt is diagnosed with Pneumonia and a Large Pleural effusion. Which of the ff procedures should a RT rec'd?
    • Thoracentesis
    •    A needle thoracentesis can be used quickly to relieve the increased WOB caused by a pleural effusion and potentially aid in diagnosis.
  61. A pt with a history of hypertension was awakened by cough and SOB. He has a fine inspiratory crackles bilaterally. Which of the ff should a RT recommend?
    • Furosemide (Lasix)
    • Noturnal dyspnea and coarse crackles are indications of CHF. Hypertension an be an etiologic factor for heart failure. Diuretics are useful in controlling water retention that can lead to fluid accumulation and narrowing in airways.
  62. A pt intubated after a MVA. A RT palpates asymmetrical chest movement during inspiration, but not crepitus. BS are Dim on the L. Which of the ff should the therapist do FIRST?
    • Assess the depth of the ETT insertion.
    • Intubation of the R mainstem bronchus most likely explains the asymmetrical chest movement and decreased BS. The best corrective action is to assess the depth of the ETT insertion.
  63. An adult pt is intubated after being pulseless for several mins. An exhaled Co2 detective device fails to change color despite confirmation of tracheal placement by auscultation and chest rise. A RT should recommend?
    • Performing a direct laryngoscopy.
    • Direct visualization of the larynx with a laryngoscope will confirm the tube has passed through the cords.
  64. A new blood gas analyzer is calibrated by the manufacturer at sea level. On receiving the analyzer at a higher altitude, a RT should:
    • recalibrate the blood gas analyzer
    •    Regardless of where they are manufactured, a new blood gas analyzer must be calibrated at the site of use before analyzing blood.
  65. The information below was obtained from a pulmonary function report for a 40 yr old M who weighs 73 kg (161 lb) and is 177 cm (5ft, 9in) tall:
    FEV1  2.16L (53% of predicted)
    FVC   2.50L (55% of predicted)
    FEV1/FVC   90%
    DLco    51% of predicted 
       There is no response to bronchodilator therapy. Which of the ff should a RT recommend NEXT?
    • Obtaining lung volume measurements
    •    The pulmonary function findings provide some evidence of restrictive disease. Lung volume measurements will help confirm.
  66. A 44 yr old pt presents to the ED with diabetic ketoacidosis. Which of the ff Respiratory patterns is most convenient with the diagnosis?
    • Rapid, deep breathing
    •    An increase in rate and depth of breathing, called kussmauls breathing is most commonly the result of a diabetic ketoacidosis.
  67. A 55 yr old M presents with GI bleeding. Arterial blood gas results reveal an arterial oxygen tension of 45 torr. Pulse ox readings are unreliable. The pt is in mild resp distress, but is not cyanotic. To evaluate the pts oxygenation status further, it is most important to review the pt's
    • HB
    • Hemoglobin is needed to determine the oxygen carry capacity.
  68. A 57 yr old male is admitted to the hospital complaining of dyspnea on exertion and a dry , non productive cough. He reports his symptoms have been worsening for the past 2 months. The Pt's respiratory rate is 28 with find inspiratory crackles throughout the lung fields, but most prominent over the lower lung fields. Spirometry shows a restrictive defect. Which of the ff should a RT recommend?
    • CT scan of the chest
    • The pt has S/s of interstitial lung disease. A CT scan of the chest will help determine the severity of the disease.
  69. A COHb of >3% is indicative of?
    Continued smoking or environmental exposure.
  70. A 34 gestational age infant has been stable while receiving mechanical ventilation. Oxygen saturation decreases 85% and does not respond to an increased FiO2. Transillumination of the chest produces a 1-cm halo that extends around the point of contact with the skin. Which of the ff should a RT recom?
    additional diagnostic assessments

       Because transillumination findings are normal and increasing the FiO2 fails to improve oxygenation, it is necessary to evaluate other causes that can be contributing to hypoxia.
  71. Three months after lung transplantation, a pt develops SOB and requires invasive mechanical ventilation. A chest radiograph shows diffuse alveolar infiltrates. Which of the ff diagnostic tests should a RT recommend?
    • Bronchoalveolar lavage
    •    Microbiologic analysis of material obtained during a bronchoalveolar lavage will differentiate between hydrostatic pulmonary edema assoc with fluid overload of left ventricular failure, and non hydrostatic pulmonary edema assoc with ARDS/
  72. What could result in an increase in pulmonary vascular resistance (PVR)?
    • Excessive PEEP
    •    can compress the pulmonary vessels and obstruct blood flow, resulting in an increase in PVR.
  73. A RT is using an oxygen calibrated flowmeter to administer a gas mixture of 70% helium and 30% oxygen. To deliver a flow of 16L/min of the gas mixture to the pt. the therapist should set the oxygen flowmeter to?
    • 10 L/min
    •    The correction factor for a 70%/30% helium/oxygen mixture is the oxygen flow multiplied by 1.6. 10L/min X 1.6 =16L/min
  74. What circumstance will tracheal secretions tend to dry in an intubated pt?
    • A relative humidity of 100% sat 22 degrees Celsius (71.7 F)
    •    The absolute humidity at this temp is inadequate.
  75. The repeated administration of fluticasone propionate (Flovent) by inhalation is associated with which of the ff adverse effects?
    • oral candidiasis
    •    Candida albicans is an opportunistic infection associated with the use of inhaled steroids.
  76. A RT is assisting a Physician with ETT intubation. Which of the ff should use INITIALLY to confirm intubation.
    • Colorimetric Capnography
    •      Assesses the presence of CO2 and provides confirmation of tracheal intubation when CO2 is detected.
  77. NPPV is most likely indicated for a pt with Resp failure from?
    • COPD
    •    NPPV may lead to increased alveolar ventilation in pts with COPD>
Author
Dlukeala
ID
352526
Card Set
TMCB
Description
TMC B
Updated