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Gary persing answer test 1 2022
1. The physician wants to add a medication to a cystic fibrosis patient's aerosol therapy
treatment that will help reduce the viscosity of his pulmonary secretions. Which of the
following would be the most appropriate drug to recommend?
A. Atrovent
B. Serevent
C. Pulmozyme
D. Albuterol
Correct Answer is C
Rationale: Pulmozyme is a mucolytic that thins thick secretions seen with cystic fibrosis
patients.
- The respiratory therapist has completed suctioning a patient's ET tube and the patient continues to cough repeatedly triggering the high pressure alarm on the ventilator. Which of the following should the therapist recommend? A. Increase the oxygen to 100% and repeat suctioning. B. Instill Lidocaine down the ET tube. C. Recommend a neuromuscular blocker. D. Instill Atropine down the ET tube. The Correct Answer is B Rationale: The coughing is the result of irritation to the tracheal mucosa. Lidocaine instilled down the ET tube numbs the airway which causes the coughing to subside.
- A 65-kg (143-lb) patient has a respiratory rate of 18 breaths/min and a VT of 450 mL. The VE is: A. 5.5 L. B. 6.9 L. C. 8.1 L. D. 9.8 L. The Correct Answer is C Rationale: See the equation: VE = VT X RR = 0.45 L x 18 = 8.1 L Remember, do not subtract VD when calculating VE. You do this only when calculating alveolar minute volume.
- The following data are obtained from a 70-kg (154-lb) male patient with pneumonia on volume-controlled ventilation: Mode SIMV Ventilator rate 4 breaths/min Pressure support 10 cm H VT 500 mL FIO2 0.. pEEp 5 cm HO pH 7. PaCO2 51 mm Hg PaO2 70 mm Hg PEEP 5 cm H2O HCO3 25 mEq/L BE +1 mEq/L A. Increase the VT to 600 mL. B. Increase the FIO2 to 0.50. C. Increase the SIMV rate to 8 breaths/min. D. Increase PEEP to 10 cm H2O. Correct Answer is C Rationale: Because the patient's PaCO2 is elevated, minute ventilation (VE) must be increased. This can be accomplished by increasing the VT or the ventilator rate. Because this patient is only on a rate of 4 breaths/min and SIMV, it is obvious that this patient is being weaned but was not able to tolerate this low ventilator rate. Thus, the SIMV rate should be increased, not the VT. Increasing the VT would to 600 mL would exceed 8 mL/kg. Although the PaO2 is slightly low, that is the result of inadequate ventilation. Therefore, increasing the FIO2 or PEEP is not indicated.
- Which of the following do you expect to observe after the initiation of mechanical ventilation? A. Increased PaCO2. B. Increased pH. C. Increased P(A-a)02. D. Decreased CL. Correct Answer is B Rationale: When a patient is placed on mechanical ventilation, minute ventilation should increase as a result of a higher VT delivery. This results in a decrease in the PaCO2, which causes the pH to increase. As the distribution of ventilation improves, arterial PO2 increases, resulting in a decreased A-a gradient. CL will increase as a result of improved ventilation.
B. 45 L/min C. 55 L/min D. 64 L/min Correct Answer is B Rationale: With the tic-tac-toe box or the equation, you should be subtracting 21 from 30 (to get
- and 30 from 100 (to get 70) and dividing 70 by 9. This gives an air-to-O2 ratio of about 8:1. To calculate total flow, add the two ratio parts together (8+ 1 = 9) and multiply by the flow rate ( x 5 = 45 L/min).
- These data pertain to a 60-kg (132-lb) patient on volume-controlled ventilation in the assist- control mode: Mode Assist-control VT 500 mL Rate 10 breaths/min Flow 50 L/min FIO2 0. PEEP 4 cm H2O ABGs pH 7. PaCO2 27 mm Hg PaO2 59 mm Hg HCO3 25 mEq/L BE +1 mEq/L On the basis of this information, the respiratory therapist should recommend which of the following ventilator changes? A. Decrease VT to 450 mL. B. Increase FIO2 to 0.70. C. Add 100 mL of dead space. D. Increase PEEP to 8 cm H2O. Correct Answer is D Rationale: The blood gas results indicate acute respiratory alkalosis (hyperventilation). The hyperventilation, however, is not the result of excessive tidal volume but because the patient is hypoxemic. Reducing the VT or adding dead space increases the PaCO2 but does not correct the patient's hypoxemia and, in fact, worsens it. Because the patient is on an FIO2 of 0.60, the most appropriate choice to reverse the hypoxemia is to increase the PEEP level.
- While manually ventilating an intubated apneic patient with a manual resuscitator, very little resistance is found when the bag is compressed, and the patient's chest rises only minimally. Which of the following may be the cause of this problem? A. Excessive ET tube cuff pressure B. Exhalation valve jammed in the closed position C. Patient's lungs are noncompliant D. Leak through the bag intake valve Correct Answer is D Rationale: Three possible causes are a leak through the exhalation valve, bag intake valve, or around the ET tube or tracheostomy tube cuff.
- The respiratory therapist has completed an IPPB treatment on a patient. The most appropriate charting notation is which of the following? A. IPPB treatment given with 0.5ml of albuterol in 2.5ml of normal saline solution; tolerated well; vital signs stable B. Treatment given as ordered C. IPPB treatment given at 20 cm H2O; pulse stable at 80 beats/min during therapy; blood pressure (BP) stable at 115/75 mm Hg during therapy; patient had strong productive cough with small amount of thin white secretions; tolerated well D. IPPB treatment given at 20 cm H2O without difficulty; small amount of thin white secretions coughed up Correct Answer is C Rationale: This choice gives the most concise and pertinent information when compared with the other choices.
- While assessing a 65-kg (143-lb) postoperative patient for incentive spirometry, the respiratory therapist determines that the patient has a 600-mL VC. The therapist should do which of tfollowing? A. Recommend changing the therapy to IPPB. B. Give the treatment as ordered. C. Recommend obtaining an immediate chest radiograph film. D. Obtain ABG levels before initiating therapy. Correct Answer is A Rationale: For effective incentive spirometry, the patient should have a VC of at least 10 mL/kg of body weight. This patient did not meet this criterion, indicating that he would not be able to take deep enough breaths on his own to be of benefit. Therefore, postoperative atelectasis should be treated with IPPB. While IPPB is not used near as commonly as it was in the past, the exam may have one or two questions related to its use.
- Which of the following are potential side effects of PEEP therapy? Fifth Edition ELSEVIER A. Increased blood pressure B. Decreased cardiac output (QT)
- A patient's PaCO2 decreases from 42 to 31 mm Hg. All the following could have increased except which of the following? A. Physiologic VD B. VT C. Minute ventilation D. Respiratory rate The Correct Answer is A Rationale: Increasing VT, respiratory rate, or minute ventilation results in improved ventilation and therefore, decreasing PaCO2 levels. When physiologic VD increases, PaCO2 increases, indicating that less of the patient's VT is reaching the alveoli and taking part in gas exchange.
- A patient has shortness of breath on a 60% aerosol mask. The following data are obtained: Pulse 112 beats/min Respiratory rate 34 breaths/min ABGs pH 7. PaCO2 53 mm Hg PaOn 68 mm Ha A. Place the patient on CPAP and 60% O2. B. Intubate the patient and institute mechanical ventilation. C. Increase levels to 70% O2. D. Place the patient on a nonrebreathing mask. On the basis of this information, which of the following should be recommended at this time? Correct Answer is B Rationale: These ABG levels reveal acute respiratory acidosis, also referred to as acute ventilatory failure, which is evidenced by the elevated PaCO2 value. It must be treated by increasing alveolar ventilation with mechanical ventilation.
- During O2 rounds, the respiratory therapist notices that the bed sheet is pulled over the entrainment port of a patient's air entrainment mask. Which of the following are true statements regarding this situation? A. The FIO2 will decrease. B. The FIO2 will increase. C. The total flow will increase. D. The FIO2 will remain unchanged. Correct Answer is B Rationale: If the entrainment port is occluded, less room air can be entrained to mix with the O2; therefore, FIO2 increases. Because room air entrainment decreases, the total overall flow also decreases.
- A patient on a ventilator has become agitated and combative, and the high-pressure alarm is sounding with each breath. To paralyze the patient to prevent him from fighting the ventilator, the respiratory therapist should recommend which of the following medications? A. Rocuronium B. Versed C. Succinylcholine D. Ativan Correct Answer is A Rationale: Rocuronium is a long-term muscle relaxant used to manage patients who are not accepting the ventilator. The patient should be sedated before being paralyzed. Other appropriate muscle relaxants are vecuronium and pancuronium.
- A 37-year-old patient receiving volume-controlled ventilation is recovering from gallbladder surgery and is receiving continuous IV infusions. Blood chemistry results reveal decreased BUN and Hb levels. The patient's urine output has remained at 50 mL/h for the past 4 hours. Assessment of this patient most likely reveals which of the following? A. Inspiratory stridor B. Hypotension C. Auscultation of fine crackles D. Increased CL Correct Answer is C Rationale: The decreased Hb level may be the result of overhydration via the continuous IV fluids. Note that the urine output has not increased over the past 4 hours, even with continuous infusion of fluids, and the BUN level has decreased. These findings are consistent with overhydration, which can result in fine crackles being auscultated in the lungs.
- These data pertain to an 80-kg (176-lb) patient on volume-controlled ventilation in the assist- control mode: Mode Assist-control VT 600 mL Rate 12 breaths/min PEEP 5 cm H2O Flow 50 L/min FIO2 0. ABGs pH 7. PaCO2 37 mm Hg PaO2 53 mm Hg HCO3 25 mEq/L BE 0 mEq/L On the basis of this information, the respiratory therapist should recommend which of the following ventilator changes? A. Increase VT to 650 mL. B. Increase FIO2 to 0.70.
Correct Answer is B Rationale: Although the patient's PaO2 is 172 mm Hg, he is still hypoxic, as evidenced by his low O2 saturation level (74%). The patient is hyperventilating in response to the metabolic acidosis resulting from severe hypoxia. When severe hypoxia exists, the body increases its lactate production as anaerobic metabolism takes over trying to get O2 to the oxygen-starved tissues. The increased lactate in the blood results in metabolic acidosis. It is not unusual to observe a PaO2 level this high with CO inhalation, although this is not a normal PaO2 on 100% O2 (which would be 500 to 600 mm Hg). Hb has a greater affinity for CO than O2, so CO occupies the Hb binding sites more readily; therefore, more O, dissolves in the blood, which is what the PaO2 is measuring. The patient should remain on high levels of O2 because the higher the PaO2 achieved, the less affinity Hb has for CO, and therefore more O2 may combine with Hb. A pulse oximeter should never be used on a patient exposed to CO since it won't read accurately. A pulse oximeter cannot determine what substance is being carried by Hb, so it will read what the combined O2 and CO level is, often 100%, when the actual O2 saturation is much lower.
- Which of the following is measured when incentive spirometry is administered properly? A. ERV B. Sustained IC C. Sustained VT D. FVC Correct Answer is B Rationale: The patient should be instructed to take the deepest breath possible from a resting expiratory level. Inspiration should be slow, with a 2- to 3-second breath hold at peak inspiration, followed by a normal exhalation.
- A 4-year-old child with croup and inspiratory stridor is admitted to the pediatric department. The respiratory therapist recommends cool mist to be delivered to the airway to do which of the following? A. Reduce the potential of bronchospasm. B. Aid in the mobilization of thick tenacious secretions. C. Prevent laryngospasm. D. Reduce upper airway swelling. Correct Answer is D Rationale: Inspiratory stridor is caused by swelling of the subglottic area, which is common in croup. Cool mist to the upper airway causes vasoconstriction and results in a decrease in swelling.
- A patient in the ICU is receiving noninvasive positive pressure ventilation. The settings and ABG results are as follows:
IPAP 14 cm H2O EPAP 5 cm H2O Respiratory rate 12 breaths/min ABGs pH 7. PaCO2 56 mm Hg PaO2 71 mm Hg HCO3 25 mEq/L BE - Which of the following changes are appropriate at this time? A. Increase the EPAP to 8 cm H2O. B. Decrease the IPAP to 12 cm H2O. C. Decrease the EPAP to 3 cm H2O. D. Increase the IPAP to 18 cm H2O. Correct Answer is D Rationale: The patient's ABG results indicate inadequate ventilation because the PaCO2 is increased. To improve ventilation with noninvasive positive pressure ventilation (NPPV), also referred to as BiPAP, the IPAP must be increased. This increases VT and reduces the PaCO2. EPAP is basically the same as PEEP. It helps increase FRC by keeping the alveoli open, improving oxygenation. Although the patient is hypoxemic, the hypoxemia is a result of poor ventilation. Once ventilation improves, oxygenation should improve.
- A patient has been diagnosed with a septal defect that results in a left-to-right shunt. A pulmonary artery catheter is inserted. Which of the following values will most likely increase? A. Inferior vena cava oxygen saturation B. Mixed venous oxygen saturation C. Cardiac output D. Arterial to venous oxygen content difference Correct Answer is B Rationale: A left-to-right shunt refers to blood that passes through the lungs to the left side of the heart but instead of passing on out to the body, shunts back over to the right side of the heart and through the pulmonary artery. This results in oxygenated blood being sent back through the pulmonary circulation and causes mixed venous oxygen saturation, as measured from the pulmonary artery, to increase.
- A patient's cardiac monitor indicates occasional PVCs. Which of the following should the respiratory therapist recommend? A. an antiarrhythmic drug B. evaluate the SpO
31.The following data are collected on a 70-kg (154lbs) patient receiving volume controlled ventilation: Mode Assist-control Ventilator rate 12 breaths/min Tidal 500 ML FIO2 1. PEEP 12 cm H2O PIP 56 cm H2O SpO2 82% A chest radiograph indicates diffuse bilateral infiltrates. The PaCO2 is 42 torr and the PaO2 is 52 torr. Which of the following ventilator changes should the respiratory therapist recommend? A. Increase the PEEP to 16 cm H2O. B. Increase the ventilator rate. C. Change to pressure control ventilation. D. Increase the tidal volume to 600 mL.. Rationale: The patient in this question nas developеa ARDS. Because the lungs are noncompliant, higher peak inspiratory pressures are necessary to maintain normal PaCO levels. High peak pressures indicate plateau pressure must be elevated as well which results in the release of inflammatory chemical mediators, causing more lung damage. To prevent further lung tissue damage, peak inspiratory pressure should not exceed 35 to 40 cm H2O, and alveolar pressure (static pressure) should be maintained no higher than 30 cm H2O. Placing the patient on pressure control ventilation allows the therapist to control the PIP level, thereby preventing more alveolar damage caused by high pressures. It is important to note that an increased plateau pressure, which results in increased PIP, indicates decreasing lung compliance. If PIP increases, with no change in plateau pressure, then airway resistance is increasing
- The physician orders 40% O2 for a patient with dyspnea. Which of the following devices delivers this O2 level most consistently? A. Nasal cannula at 5 L/min B. Simple O2 mask at 10 L/min C. Partial rebreathing mask at 12 L/min D. Air entrainment mask Correct Answer is D Rationale: The air entrainment mask is a high-flow device, which delivers a more consistent O percentage than low-flow devices. Normal spontaneous inspiratory flow is 25 to 30 L/min. Because the maximum liter flow available on low-flow devices, such as the cannula and simple and partial rebreathing masks, is 6 to 15 L/min, which is less than the patient's flow demands, any inspiratory flow needs of the patient above this flow range decrease the percentage delivered because the patient is inspiring more room air. The actual percentage of O2 delivered by a low-flow device is never known because it fluctuates with the patient's VT, respiratory rate, and inspiratory time.
- Which of the following medications is not a long-acting beta agonist (LABA)? A. Formoterol (Foradil) B. Arformoterol (Brovana) C. Albuterol D. Salmeterol (Serevent) Correct Answer is C Rationale: The bronchodilating effects of Albuterol last approximately 8 hours, making it a short- acting bronchodilator agent (SABA). The bronchodilating effects of LABAS such as the other three choices, last up to 12 hours.
- The respiratory therapist has been asked to recommend an O2 delivery device that has the capability of delivering 40% O2 at a flow rate high enough to meet the patient's 40-L/min inspiratory flow demand. Which of the following devices would meet this demand? A. Simple oxygen mask B. Air entrainment mask C. Nasal cannula D. Non-rebreathing mask Correct Answer is B Rationale: No low-flow device can deliver 40 L/min of flow, so the choice to meet this high flow rate must be a high-flow device. The air entrainment mask and aerosol mask is considered a high-flow mask.
- The following data are collected on a 75-kg (165-lb) patient receiving volume-controlled ventilation: Mode Assist-control Ventilator rate 15/min Tidal volume 600 mL FIO2 0. PEEP 10 cm H2O ADGS PH 7. PaCO 241 mm Hg PaO2 139 mm Hg HCO3 25 mEq/L BE + Which of the following ventilator changes should the respiratory therapist recommend? A. Decrease the PEEP to 8 cm H2O. B. Decrease the FIO2 to 0.60. C. Increase the rate to 20 breaths/min. D. Decrease the tidal volume to 550 mL. Correct Answer is B Rationale: The patient is hyperoxemic (PaO2- 139 mm Hg) on an FIO2 of 0.70 and a PEEP of 10 cm H2O. To reduce the PaO2, the FIO2 or PEEP should be reduced. Because the FIO2 is
capillary hydrostatic pressure, which causes pulmonary edema. In this case, it is termed cardiogenic pulmonary edema because it resulted from cardiac problems-namely, left heart failure-as evidenced by an increased PCWP.
- A 60 kg (132 lb) patient with a suspected drug overdose is receiving volume-controlled ventilation on the following settings: Rate 15 breaths/min Mode Assist-control Tidal volume 450 mL Inspiratory flow 30 L/min Pressure limit 40 cm H2O The I: E ratio alarm is triggered. Which ventilator adjustment should the respiratory therapist make at this time? A. Increase the pressure limit. B. Increase the tidal volume. C. Increase the inspiratory flow. D. Increase the rate. Correct Answer is C Rationale: When inspiratory time exceeds expiratory time, an inverse I:E exists. Sometimes use of this ratio is indicated, such as with patients with ARDS, when high FIO2 levels and PEEP levels are not correcting hypoxemia. In this question, an alarm is sounding to alert the therapist about a problem with the ventilator settings. Inspiration is longer than expiration. This can be corrected to a 1:2 or 1:3 ratio during volume-controlled ventilation by decreasing the tidal volume or decreasing the respiratory rate. Decreasing the tidal volume decreases the inspiratory time, and decreasing the respiratory rate provides a longer expiratory time. However, both these parameters decrease the minute ventilation, which may result in an increased PaCO2 level. The most appropriate parameter change
- Which set of ABG results indicates a partially compensated respiratory acidosis? A. pH 7.23; PCO2 = 58 mm Hg; PO2 = 67 mm Hg; HCO3 = 24 mEq/L B. pH 7.38; PCO2 = 54 mm Hg; PO2 = 74 mm Hg; HCO3 = 36 mEq/L C. pH 7.31; PCO2 = 53 mm Hg; PO2 = 70 mm Hg; HCO3 = 30 mEq/L D. pH 7.29; PCO2 = 24 mm Hg; PO2 = 72 mm Hg; HCO 14 mFa/l Correct Answer is C Rationale: Initially, the pH decreased as a result of an increased PaCO2. The >HCO3 level is increasing in an effort to return the pH back to normal. Because the pH is increasing, but not yet back to normal, it is considered partially compensated.
- A patient with ARDS is receiving mechanical ventilation with PEEP. The PEEP level is increased from 5 to 10 cm H2O. Which of the following should be monitored by the respiratory therapist to evaluate the patient's response? A. Temperature B. PaCO C. Blood pressure D. PECO Correct Answer is C Rationale: Positive pressure in the airways may result in decreased venous blood return to the heart. This may be evidenced by an increased heart rate and decreased blood pressure, so these values should be evaluated after a PEEP change. Positive pressure may also affect urinary output if perfusion to the kidneys is decreased because of a decrease in blood pressure.
- A chest radiograph shows infiltrates in the posterior basal segment of the patient's right lower lobe. The most appropriate postural drainage position is which of the following? A. Trendelenburg position, with patient lying on her or his right side B. Prone position, with bed in a Trendelenburg position C. Fowler's position D. Trendelenburg position, with patient lying supine Correct Answer is B Rationale: Because the infiltrates are in the back (posterior) segments of the lung, the patient must be placed on the stomach (prone) with the head of the bed down (Trendelenburg) to drain the secretions anteriorly into the larger airways for removal.
- Venous return is least impaired by which of the following modes of ventilation? A. SIMV mode, rate of 12 breaths/min B. Assist-control mode, rate of 12 breaths/min C. Assist-control mode, rate of 10 breaths/min D. SIMV mode, rate of 8 breaths/min Correct Answer is D Rationale: SIMV mode always impairs cardiac output less than an assist-control mode because, in SIMV mode, not every breath is a positive-pressure breath, as is every breath in the other modes mentioned. The more positive-pressure breaths, the more potential for cardiac side effects. The lower the SIMV rate, the fewer cardiac problems.
- A patient receiving volume-controlled ventilation has the following arterial blood gas results: pH 7. PaCO2 26 torr PaO2 81 torr HCO3 28 mEq/L BE +2 mEq/L A. Increase the tidal volume. B. Decrease the ventilator rate. C. Repeat the blood gasses since these results indicate a lab error.
- A patient has just arrived in the emergency department after being pulled from a burning house. Which of the following values best determine this patient's oxygenation status? A. Sao B. PaO C. Hb D. CaO Correct Answer is D Rationale: Arterial O2 content (CaO2) takes into account both O2 dissolved in the plasma and that which is bound to Hb. This value gives us a much better picture of the oxygenation status than observing only one value. Arterial O2 content is the total amount of O2 bound to Hb plus the amount of O2 dissolved in the plasma: O2 bound to Hb = 1.34 x Hb x Sao O2 dissolved in plasma = 0.003 × PaO Note: Use the fractional concentration of the Sao2.
- A 26-year-old patient with pneumonia has a PaO2 of 54 mm Hg and a PaCO2 of 31 mm Hg while on a 50% air entrainment mask. Which statement is false regarding this patient? A. The patient is hypocarbic. B. The patient has a decreased (A-a) gradient. C. The patient is hyperventilating in response to hypoxemia. D. This patient's pH is most likely alkaline. Correct Answer is B Rationale: The normal PaO2 on 50% O2 is approximately 250 mm Hg (calculated by multiplying the O2 percentage by 5). This patient's PaO2 is only 54 mm Hg. To determine the A-a gradient, use this formula: PaO2 = PaO PaO2 = (BP (700 x 0.5) 350 41 309 47 mm Hg) x FIO2 PaCO2+ 10 (assume a Pb of 747) (31 + 10) 309 mm Hg 54 (PaO2) = 255 mm Hg
- During O2 rounds, the respiratory therapist notices a nebulizer delivering very little mist to the patient's aerosol mask. Which of the following could cause this problem? A. Excessive flow rate. B. Overheating of the nebulizer. C. Aerosol tubing is too short. D. A plugged capillary tube. Correct Answer is D Rationale: If the capillary tube is plugged, H2O is prevented from being drawn up the tube for aerosolization to occur, with less resulting mist output.
- A patient receiving positive expiratory pressure (PEP) therapy through a mouthpiece at 10 cm H2O has minimal secretion production. Course crackles are heard during auscultation. The respiratory therapist should recommend which of the following? A. Decrease the PEP to 5 cm H2O. B. Discontinue the treatment and begin percussion and postural drainage. C. Increase the PEP to 15 cm H2O. D. Administer the treatment with a mask instead of the mouthpiece. INCORRECT | The Correct Answer is C Rationale: PEP therapy is indicated for patients with retained secretions. Positive pressure applied during exhalation aids in the mobilization of secretions. Generally, PEP levels of 10 to 20 cm H2O are used. If the PEP used does not result in the mobilization of secretions, the PEP should be increased.
- The following data were obtained from a 75-kg (165-lb) male patient on volume-controlled ventilation: Mode Assist-control Ventilator rate 12 breaths/min VT 550 mL PEEP 10 cm H2O FIO2 0. ABGS pH 7. PaCO2 41 mm Hg PaO2 82 mm Hg HCO3 26 mEq/L BE +1 mEq/L A. Decrease FIO2 to 0.40. B. Decrease VT to 500 mL. C. Decrease PEEP to 5 cm H2O. D. Maintain current settings. Correct Answer is D Rationale: These ABG results indicate normal values. Therefore, no ventilator changes are necessary.
- The physician has ordered a 75-kg (165-lb) male patient with pneumonia to be placed on volume-controlled ventilation. Which of the following VT levels and respiratory rates is most appropriate for the initial ventilator settings? A. VT 600 mL, RR = 15 breaths/min B. VT = 550 mL, RR = 18 breaths/min C. VT 700 mL, RR = 16 breaths/min Correct Answer is A
