Upgrade to remove ads
TMC Attempt 5
Terms in this set (56)
starting point for FRC measurement via helium dilution or nitrogen washout is:
end of a Normal resting exhalation
advantage of mainstream capnometry?
fast response time
1) fast response (crisp waveform),
2) short lag time (real-time readings) and
4) no reduction in volume due to flow sampling.
limitation of Overnight Oximetry as a screening tool to diagnose patients with sleep apnea-hypopnoea syndrome (SAHS)?
it CANNOT reveal the cause of desaturation events
Overnight oximetry uses a recording pulse oximeter to document changes in a patient's SpO2 and heart rate during sleep. This test can help identify patients with sleep apnea. As compared to a full lab polysomnography exam, overnight oximetry is simpler (2 channels vs. 10), less expensive, and can readily be performed in the home. In general, 15 or more O2 desaturations (> 3-4%) per hour confirm a diagnosis of SAHS. Overnight oximetry also can be used to determine whether serious desaturation occurs in COPD patients while asleep. However, overnight oximetry cannot reveal the cause of desaturation events. For example, a patient may have > 15 desaturations per hour and thus be diagnosed with SAHS, but these results do not reveal whether the sleep apnea is primarily obstructive or central in origin. For that, a full polysomnography is required.
You have only one mainstream capnometer available in ICU, but the attending doctor has asked that you make end-tidal CO2 (PetCO2) measurements on several different patients before morning rounds. In order to obtain these measurements while minimizing the risk of cross infection to you patients, which of the following actions would be most appropriate?
Provide an individual airway adapter for each patient
A patient with COPD is undergoing an O2 titration with exercise protocol. On 2 L/min nasal O2 and an exercise activity level of 4 on the Borg scale, the patient's SpO2 stays steady at 89% for 3 minutes. You would:
end the test and recommend 2 L/min O2 during exertion
The first step in O2 titration with exercise is to gather relevant patient data, including a baseline SpO2 on either air or the prescribed resting O2 liter flow. For patients with a baseline SpO2 > 85% you then slowly increase their exercise level, typically until they reach a 3 to 4 on the Borg perceived exertion scale. After this level is maintained for at least 3 minutes, you re-measure the saturation. If the SpO2 is ≥ 88%, the patient does not need any additional oxygen and the test can be terminated. If the SpO2 drops by 2% or more or if the SpO2 < 88%, you should increase their O2 flow by 1 L/min (up to 6 L/min). After stabilization on the new O2 flow for 3 minutes, re-assess the SpO2 while the patient continues to exercise. Repeat this procedure until the SpO2 is at least 88% or the PaO2 is above 55 torr.
A patient being tested in the pulmonary laboratory exhibits a repeatable FVC of 3.8 liters, with a FEV3 of 2.5 liters. Which of the following conclusions can you draw regarding this patient?
Rather than looking at the FEVt by itself, one should compare it to the patient's forced vital capacity (FVC). In this case the FEV at 3 seconds as a percent of the FVC (FEV3%) is 2.5/3.8 x 100 = 66%, well below the normal FEV3% of 94-97%. A reduced FEVt% is characteristic of obstructive pulmonary disease.
The correct answer is: the patient probably has an obstructive pulmonary disease
For which of the following situations would you recommend transcutaneous monitoring of PO2 or PCO2?
continuously monitoring for hyperoxia in newborn infants
You would recommend an overnight oximetry evaluation to:
evaluate a sleep apnea patient's response to CPAP
Overnight oximetry can be used to:
(1) help identify patients with sleep apnea-hypopnoea syndrome (SAHS);
(2) help assess SAHS patients' response to therapy, such as CPAP; and
(3) identify whether serious desaturation occurs in COPD patients during sleep.
Because oximetry cannot differentiate obstructive from central sleep apnea, when used to screen for SAHS or assess a patients' response to therapy, it should be combined with measures of airflow and respiratory effort (a Type IV Home Sleep Test). It is also important to remember that oximetry should never be used alone to monitor for life-threatening events like prolonged apnea, since the PCO2 can rise to dangerous levels before a large fall in saturation occurs (especially in patients breathing supplemental O2).
Based on an overnight oximetry test, a patient suspected of having sleep-disordered breathing exhibits an oxygen desaturation index (ODI) of 48/hr. Which of the following would you recommend?
CPAP titration at home or in the sleep lab
Based on published decision algorithms, patients with ODIs > 15/hr should be prescribed CPAP therapy and undergo auto-titration CPAP at home or CPAP-titration in the sleep lab.
The correct answer is: CPAP titration at home or in the sleep lab
Which of the following is a contraindication against performing CT pulmonary angiography (CTPA)?
1) known or suspected allergy to the contrast media and 2) renal insufficiency (where contrast media could further impair renal function).
A doctor wants to assess tissue oxygenation in a critically ill patient, but does not want to insert a pulmonary artery catheter. You would recommend which of the following?
a central venous line
Inspection of a trauma patient's chest wall and thorax reveals no obvious abnormalities. Which of the following should you INITIALLY recommend to determine the extent of the trauma?
You would recommend continuous SpO2 monitoring (versus short-term assessment or spot checks) for which of the following?
patient undergoing lab polysomnography
Which of the following could be done to help assure delivery of 70% O2 via a standard air-entrainment nebulizer to an intubated patient?
bleeding in/titrating extra O2 via a T-adapter
You are planning a neonatal transport that will take about 3 hours. The infant is on a ventilator that uses 12 L/min of oxygen. What is the minimum number of full E cylinders you would take for this trip?
A full 2200 psig E cylinder at a flow of 12 L/min will last: duration (min) = [2200 x 0.28]/12 = 51 minutes. You should take at least 4 cylinders, enough to last 200 minutes or 3 hours and 20 min.
4 full E cylinders
When running an arterial blood gas on a point-of-care analyzer, you receive a calibration error message. You should:
repeat analysis using a fresh sample and NEW cartridge
Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula?
increase in patient tidal volume
With a low-flow device like a nasal cannula, the larger the tidal volume, the higher the inspiratory flow, the less the inspiratory time, or the greater the minute ventilation, the greater will be the amount of air diluting the O2 and the lower the FIO2. Conversely, with all else constant, the greater the input O2 flow during inhalation, the less air dilution occurs, and the higher the FIO2.
When performing a routine ventilator check, you note that the airway temperature indicator reads 26° C. The flowsheet indicates a prior temperature of 35° C. Which of the following best explains this discrepancy?
addition of cool water to humidifier
What size nasopharyngeal airway would you select for an average size adult?
24-28 Fr/6-7 mm
CPAP systems used to treat obstructive sleep apnea in the home generates flow via:
an electrically-powered blower/turbine
When using a resuscitation mask for mouth-to-mask ventilation, which of the following will protect you from exposure to the patient's secretions?
All resuscitation masks incorporate a one-way breathing valve. In addition to separating the inspired (you) and expired gas streams (allowing the patient to exhale without removing the mask), these valves protect you from contacting the patient's secretions or vomitus
The correct answer is: one-way valve
Which of the following can help prevent cross-contamination of a portable electronic spirometer used for measuring forced vital capacity?
use a disposable non-rebreathing valve to separate the device from the patient
Analyzers used for online measurement of exhaled nitric oxide should meet which of the instrument standards?
an accuracy better than 1 ppb and response time < 500 ms
Which of the following can cause a hemoximeter's HbO2 reading to be falsely low?
Causes of falsely low hemoximeter HbO2 readings include incomplete hemolysis, presence of vascular dyes, sickle-cell anemia, and high lipid levels. Elevated bilirubin or fetal Hb levels can cause a false high reading, as can a dirty analysis chamber.
The correct answer is: sickle-cell anemia
Which of the following is an appropriate plan for regular calibration of a portable bedside spirometer?
perform volume calibration daily and flow calibration weekly
When properly positioned and with the cuff inflated, the mask of a laryngeal mask airway (LMA) seals off the:
A laryngeal mask airway (LMA) consists of a tube and mask with an inflatable cuff that is blindly inserted into the pharynx. When properly positioned and with the cuff inflated, the mask seals off the laryngeal inlet. This effectively bypasses the esophagus and provides a direct route for bag-valve ventilation via the standard 15 mm connector.
Reintubation immediately after extubation is most commonly needed due to which of the following conditions?
Immediately after extubation, inflammation at or below the cords (glottis) can cause edema that can obstruct the airway. If severe enough and not responsive to therapy, subglottic edema may require reintubation.
In which of the following situations is a laryngeal mask airway (LMA) may be preferred over tracheal intubation?
when the patient cannot be properly positioned for tracheal intubation
Insertion of an LMA may have advantages over tracheal intubation when
(1) access to the patient is limited,
(2) there is a possibility of unstable neck injury ("c-spine"), or
(3)appropriate positioning of the patient for tracheal intubation is impossible.
The average depth of proper oral endotracheal tube insertion from the teeth of an adult female is:
21 cm from the patient's teeth
When inserting or re-inserting a laryngectomy tube, which of the following measures should be used?
An obturator should be used when re-inserting or inserting a laryngectomy tube to help prevent damage to the inner tracheal wall. It is generally not necessary to preoxygenate or sedate a patient when inserting or re-inserting a laryngectomy tube. Also the neck should be maintained in a neutral position because tilting the head back narrows the stoma.
The correct answer is: an obturator should always be used
You are called to the ICU to check an orally intubated, mechanically ventilated patient who was just shaved and repositioned in bed. The high pressure alarm is sounding on each breath. Breath sounds are absent on the left and the trachea is midline. You should:
withdraw the tube 2-3 cm
In combination with the physical findings, the fact that the patient was just shaved and repositioned in bed suggests that the likely problem is ET tube displacement into the right mainstem bronchus. In this case, you should carefully withdraw the tube 2-3 cm and reassess for restoration of breath sounds to the left.
Pulmonary drainage procedures are most helpful for a patient who:
Ciliary dysfunction will lead to decrease mucus clearance and retained secretions. This patient would benefit the most from pulmonary drainage techniques.
The correct answer is: has a ciliary dysfunction
The primary goal of incentive spirometry is to:
TREAT postoperative atelectasis
When adding mechanical deadspace to a patient's ventilator circuit it is important to consider which of the following?
Key considerations when adding mechanical deadspace to a patient's ventilator circuit are
(1) the mode of ventilation (mechanical deadspace generally is contraindicated in modes that include spontaneous unassisted breathing),
(2) the delivered tidal volume,
(3) the respiratory rate, and
(4) the patient's PaCO2.
The correct answer is: ventilator mode
An ideal adult continuous flow CPAP system should be capable of maintaining a baseline pressure of:
+/- 2 cm H2O
A ventilator's low tidal volume and high pressure alarms are sounding but the patient appears stable and their SpO2 is 98%. Your first action should be to:
pass a suction catheter to determine airway patency
For patient in no immediate distress, you should initially attempt to pass a suction catheter and suction the airway, while assessing other possible causes.
When setting up CPAP for an adult patient, which of the following alarms is the most important to ensure maintenance of therapy?
The greatest concerns with CPAP are apnea and disconnect. Normally, the best way to detect disconnect from a CPAP or PEEP system is with a low CPAP/PEEP alarm.
Which of the following ventilator graphics displays would be the best choice to identify the presence of a circuit leak?
volume vs. time display
Which of the following is the preferred delivery method for cromolyn sodium to young children?
small volume nebulizer
Which of the following agents could be administered to reverse the effects of Pavulon?
A physician orders a spontaneous breathing trial (SBT) for a patient using 5/10 cm H2O CPAP + pressure support. After 45 minutes, her respiratory rate increases to 30/min and you observe some minor accessory muscle use. Which of the following would you recommend to alleviate this problem?
Tachypnea and accessory muscle use during an SBT indicate an increased work of breathing. As long as these changes are minor, you first action should be to increase the pressure support level. This will decrease the patient's spontaneous work of breathing, and help achieve a more efficient breathing pattern (higher tidal volume and lower rate).
The correct answer is: increasing pressure support to 15 cm H2O
To remove accumulations of SUBglottic secretions from above the cuff of intubated patients, you should recommend which of the following?
use of a tracheal tube with a suction port above the cuff
A 58-year-old patient in the open heart unit had cardiopulmonary bypass surgery with significant blood loss. On physical exam the patient presents with tachypnea and tachycardia and the SpO2 is 85% on 4 L/min nasal cannula. You should now recommend:
non-rebreathing mask at 12 L/min
In combination, the tachypnea and tachycardia and the SpO2 all signal significant hypoxemia (an SpO2 of 85% equates to a PaO2 of 50 torr), compounded by diminished O2 carrying capacity due to the blood loss during surgery. To treat this hypoxemia, you should deliver the highest possible FIO2 to this patient. Among the available options, only the non-rebreathing mask is capable of consistently providing oxygen concentrations above 60%.
The primary indication for aerosolized steroids is:
patients with asthma who need long-term steroid therapy
A physician has ordered an aerosol treatment with 4 mL acetylcysteine (Mucomyst), 20% concentration. The patient develops end-expiratory wheezes. You should:
discontinue therapy and notify the physician (Usually The answer)
You are about to start a patient on a new regimen of therapy. The patient is irritable, has difficulty focusing, and exhibits mild trembling of his hands. You should:
postpone therapy until the patient's anxiety is resolved
Which of the methods would you recommend for prophylactic administration of surfactant to a newborn infant?
intubation, surfactant instillation, prompt extubation to nasal CPAP
A patient receiving postural drainage and percussion for excessive secretions exhibits severe wheezing during treatment. Which of the following would you recommend to the ordering physician?
administer a bronchodilator before therapy
The primary mechanism causing wheezing during postural drainage is reversible bronchospasm occurring in patients with hyperreactive airways. Ideally, these patients can be identified in advance by virtue of a positive response to bronchodilator agents. Giving a bronchodilator before therapy may minimize or abolish this adverse response.
the most frequent symptom of pulmonary thromboembolism is:
Sudden dyspnea is the most frequent symptom of pulmonary thromboembolism. On physical examination, the patient may also exhibit exhibits crackles (rales) and wheezing on auscultation, and signs of consolidation or pleural effusion may be present. If present, signs of consolidation are due to atelectasis and infarction, which occurs in only about 10% of the cases. Pleuritic pain occurs mainly in those with severe embolization, with about 30% of these patients exhibiting hemoptysis.
The correct answer is: sudden dyspnea
A 10-year-old female patient with cystic fibrosis is admitted to the hospital. She has very thick yellow-green secretions, coarse rhonchi and wheezing in both lower lobes. The doctor asks you to recommend an aerosolized drug regimen to help with her breathing problems. Which of the following would you recommend?
Albuterol should be administered first to treat probable bronchospasm (as indicated by wheezing) and open the airways for administration of the other drugs. Dornase alpha (Pulmozyme) helps break down DNA-rich secretions (typical of CF) and should be administered after albuterol. Hypertonic saline draws water onto the respiratory tract mucosa and can facilitate coughing and airway clearance (and also used in CF patients who cannot tolerate Pulmozyme). Last, tobramycin (TOBI) should be administered to help combat Pseudomonas infection. Some form of airway clearance therapy may also be needed to help the patient mobilize and remove her secretions.
Inhalation of which of the following biological agents can result in the need for ventilatory support?
hich of the following statement about chest compressions during neonatal resuscitation is correct?
there should be at least 90 compressions per minute
According to the American Heart Association (AHA) guidelines for compression and ventilation of neonates, there should be a
3:1 ratio of compressions to ventilations
with 90 compressions and 30 breaths to achieve approximately 120 events per minute to maximize ventilation at an achievable rate.
Each event is thus allotted about 1⁄2 second (requiring a compression rate > 100/min between breaths), with exhalation occurring during the first compression after each ventilation.
To confirm failure of the brainstem to response to breathing stimulus during an apnea test, your goal is to achieve
a PaCO2 of at least 60 torr
While you are assisting an anesthesiologist with an intubation of a premature infant, he asks for a laryngoscope blade. You would give him a:
For infants, you normally select a Miller (straight) blade. A Miller size "0" is indicated for a premature infant.
The correct answer is: Miller blade number 0
The results of a sleep study on a 55 year old male patient with a BMI of 22 kg/m2 indicate an apnea hypopnea index of 13. After consultation with his doctor, he declines to use CPAP. Which of the following alternatives would best suit this patient?
use of an oral appliance
A physician's order for a neuromuscular patient being discharged to the home care setting specifies 'IPPB q4h while awake.' The patient has no other respiratory care equipment needs. Which of the following devices would you consider most appropriate for this patient?
THIS SET IS OFTEN IN FOLDERS WITH...
TMC Attempt 4
RT Board Review Crap
TMC Practice Set 7
TMC Attempt 3
YOU MIGHT ALSO LIKE...
Certified respiratory therapist exam 3-8
MAINTAIN A PATENT AIRWAY INCLUDING THE CARE OF ART…
OTHER SETS BY THIS CREATOR
TMC practice Attempt 2
Unit 15 NBRC 3G
Unit 14 NBRC 3F