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NBRC TMC FINAL EXAM AND STUDY GUIDE|ACTUAL 400+
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FINAL EXAM
A patient with ARDS is receiving mechanical ventilatory support. An end-tidal CO monitor shows a PetCO2 of 59 torr. The therapist should A. increase minute ventilation B. obtain an arterial blood gas C. recalibrate the capnography D. continue current therapy and ventilator settings ANSWER:->>> A Which of following parameters indicate a patient is ready to wean? A. A-aDO2 of 410 mm Hg B. PEEP of 10 cm H2O C. pulmonary shunt of 16% D. MIP of - 18 cm H2O ANSWER:->>> C Which of the following data is needed to calculate minute alveolar ventilation? A. IBW, VD/VT
B. PECO2, VT
C. RR, VT, weight in lbs D. RSBI, VD/VT ANSWER:->>> C A respiratory therapist notes a pressure-volume loop on a patient receiving mechanical ventilation has a pronounced beak. What strategy is useful in this case? A. increasing PEEP B. decreasing tidal volume C. decreasing flow D. increasing flow ANSWER:->>> B The respiratory therapist is making a plan of care for a patient with mycoplasma pneumonia who needs assistance with airway clearance of secretions. In which order should therapy be performed? A. percussion, postural drainage, bronchodilator, coach coughing B. bronchodilator, percussion, postural drainage, coach coughing C. coach coughing, bronchodilator, percussion, postural drainage D. postural drainage, percussion, bronchodilator, coach coughing ANSWER:->>> B
Which of the following is NOT normally part of a smoking cessation program? A. information on the cost of cigarettes and tobacco products B. nicotine replacement therapy C. source of emotional support D. education on the hazards of smoking ANSWER:->>> A A patient is receiving an initial pulmonary rehabilitation visit to the clinic. To orient the patient which of the following should be taught to the patient concerning the goals and benefits of pulmonary rehabilitation? A. increase exercise tolerance and improve performance of ADLs B. achieve normal pulmonary function C. return to normal life D. reduce the need for oxygen ANSWER:->>> A An adult patient with asthma is receiving Xopenex by small volume nebulizer T.I.D. at a dosage of 1.25 mg. The patient complains of dizziness, tingling in his fingers, and anxiety with each treatment. The therapist should A. switch to Pulmicort 0.5 mg B. decrease frequency to BID
C. increase dose to 1.88 mg D. change dose to 0.63 mg ANSWER:->>> D A decreasing A-aDO2 is most closely related to which of the following? A. Increased pulmonary shunting B. increasing venous admixture C. decreasing atelectasis D. refractory hypoxemia ANSWER:->>> C Which of the following would be most helpful in determining if a patient regularly smokes tobacco products? A. COHb B. DLCO C. end-tidal carbon dioxide D. pulse oximetery ANSWER:->>> A A 75-kg (165-lb) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings:
D. Valium ANSWER:->>> B A COPD patient is receiving oxygen at 2 L/min by a pulse-dose oxygen delivery device. The patient complains of shortness of breath and feels she is not getting enough oxygen. The home care respiratory therapist should A. switch to a Venturi mask at 40% B. encourage the patient to relax and call her physician C. increase the flow rate D. switch to a continuous oxygen regulator and normal nasal cannul a ANSWER:->>> D A physician orders a chest radiograph on an ambulatory patient in the emergency department (ED) in response to a suspicion of pneumonia. Which of the following should be ordered? A. PA radiograph B. apical lordotic C. series of oblique-angle radiographs D. AP radiograph ANSWER:->>> A
Which of the following could result from the application of positive end-expiratory pressure? A. reduced cardiac index B. reduced alveolar ventilation C. reduced intra-thoracic pressure D. increased A-aDO ANSWER:->>> A The supply of flu vaccination is limited. The respiratory therapist would suggest prioritizing the administration of the vaccine to which of the following groups of people? A. healthcare workers B. children C. teachers D. hospital administrators ANSWER:->>> A A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive pressure ventilation. The therapist should recommend A. monitoring the patient B. replacing the ET tube C. clamping the pilot tube
A patient with a history of hyper-reactive airway disease is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recommend? A. Spiriva (tiotropium bromide) B. Acetylcysteine (mucomyst) C. Solu-Mederol D. Beclamethasone (Beclovent) ANSWER:->>> B A physician suspects a patient has a cancerous mass in the right lobe as identified by a PA chest radiography. Which of the following should the therapist recommend to examine the nature and size of the mass? A. series of oblique chest radiographs B. A-P chest radiograph C. V/Q scan D. pulmonary angiography ANSWER:->>> A A patient receiving volume-controlled ventilation weighs 75 kg (165 lb) and is 5 ft, 7 in (170 cm) tall and within ideal body weight. The following clinical data is available: Mode SIMV Mandatory rate 12 Total rate 32
FIO2 0.
VT 500 mL Exhaled minute volume 9.6 L pH 7. PaCO2 32 torr PaO2 97 torr HCO3- 22 mEq/L BE +1 mEq/L Which of the following changes should the respiratory therapist recommend? A. Reduce mandatory rate to 6 B. Add inspiratory pause C. Administer sedative medication D. Institute pressure support of 5 cm H2O ANSWER:->>> D A modified Allen's test is performed on the patient's right radial artery before performing an arterial puncture. When the ulnar artery occlusion is released, a pink color returns in 35 seconds. Based on this result, the respiratory therapist should A. perform an Allen's test on the left radial artery B. perform a right brachial artery puncture C. perform a femoral artery puncture D. proceed with the puncture of the right radial artery ANSWER:->>> A
Blood pressure taken by a sphygmomanometer reads 110/78 mmHg. The patient is asymptomatic. The therapist should A. record the arterial line blood pressure B. record the sphygmomanometer blood pressure C. discard the blood pressure cuff D. calibrate the blood pressure cuff ANSWER:->>> B Refractory hypoxemia is associated with which of the following diseases? A. Pleural effusion B. Rocky Mountain Spotted Fever C. ARDS D. Chronic bronchitis ANSWER:->>> C A physician suspects a patient has a restrictive pulmonary defect. Which of the following tests would be most helpful in determining this? A. Fev1. B. Slow vital capacity C. Forced vital capacity D. Fev1.0/FVC% ANSWER:->>> B
A patient with cystic fibrosis complains of shortness of breath during postural drainage and percussion treatment after the head of the bed is down for 10 minutes. A bronchogram has revealed consolidation of secretions in the lateral basal segment of the left lower lobe. Which way should the respiratory therapist modify the therapy? A. Use a pneumatic precursor B. Reduce the time in Trendelenburg position C. Switch to IPPB therapy D. Utilize reverse Trendelenburg position ANSWER:->>> B While administering an aerosolized bronchodilator with IPPB, the therapist notices that the pressure manometer has a significant negative deflection with each breath. The patient appears to be showing signs of fatigue. The respiratory therapist should A. increase sensitivity B. decrease pressure C. increase inspiratory flow rate D. increase pressure ANSWER:->>> A A 62-year-old man admitted to the emergency room with chest pain complains of shortness of breath after a bronchodilator treatment. Further examination reveals
C. continue with bronchodilator therapy D. intubate the patient ANSWER:->>> C The respiratory therapist working in a clinic receives a call from a patient who has asthma and is only able to achieve 60% of their normal baseline peak flow measurement. The therapist should advise the patient to A. check flows again in one hour, call if less than 50%of expected B. take a rescue medication every 15 minutes for 2 hours, recheck flows C. call the doctor immediately D. take a rescue medication, check flows in one hour ANSWER:->>> C A 32-year-old 81-kg (178-lb) adult male is receiving mechanical ventilatory support. Settings are as follows: Mode Assist/control Mandatory rate 10 Total rate 18 Tidal volume 450 mL FIO2 0. PEEP 5 cm H2O The patient is cyanotic and anxious. Which of the following will the respiratory therapist recommend?
A. increase FIO B. decrease mandatory rate C. increase tidal volume D. increase inspiratory flow rate ANSWER:->>> C A patient who is receiving volume-controlled ventilation has the following arterial blood gas and clinical data: Mode Assist/control Rate 14/min FIO2 0.50 (analyzed) VT 500 mL Arterial blood gas analysis was done at standard temperature and pressure (STP). Pressure (H2O) is 47 cm H2O pH 7. PaCO2 41 torr PaO2 358 torr HCO3- 25 mEq/L BE +1 mEq/L Which of the following can the respiratory therapist conclude? A. The PaO2 result is erroroneous B. There is a fault in the Sanz electrode C. There is increased permeability in the alveolar capillary membrane
C. the patient's pulmonary compliance is significantly decreasing D. the patient requires endotracheal suctioning ANSWER:->>> D A patient with cystic fibrosis is receiving routine postural drainage and percussion. Which of the following may be used to determine the effectiveness of therapy? A. Sputum analysis B. Arterial blood gas analysis C. Chest radiograph D. DLCO measurements ANSWER:->>> C A patient is being weaned from mechanical ventilation after being placed on the ventilator 3 days prior due to complications from a pulmonary infection. Which of the following would be most helpful in determining the status of the infection prior to weaning? A. CBC B. evaluate color of sputum C. ABG D. temperature ANSWER:->>> A
A COPD patient is in the emergency room. A quick assessment reveals a respiratory rate of 28, spontaneous tidal volume of 200 mL, use of accessory muscles, and venous distension. The patient is receiving oxygen by nasal cannula at 2 L/min and oxygen saturation by pulse oximetry is 88%. Which of the following would provide most help to the patient at this time? A. flutter valve therapy B. non-rebreathing mask C. NIPPV D. adult mechanical ventilation ANSWER:->>> C A patient receiving mechanical ventilator support is on the following settings and has the following clinical data: Mode SIMV Mandatory rate 14 VT 500 mL FIO2 0. PEEP 20 cm H2O Arterial blood gas results pH 7. PaCO2 43 torr PaO2 68 torr HCO3- 26 mEq/L BE +2 mEq/L
