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RT20 Midterm Review (example questions)

Terms in this set (69)

A patient has been found to have a core temperature of 103° F (39.5° C). How should this be interpreted?
Hyperthermia (a fever) is when a patient has an elevated temperature. The patient's temperature of 103° F (39.5° C) is much above the normal temperature of about 98.6° F (37° C). Hyperpyrexia would be a temperature of 105.8° F (41° C).
In which of the following pathologic conditions is transmission of the whispered voice of a patient heard more clearly than usual through a stethoscope?1. Chronic obstructive pulmonary disease (COPD)2. Alveolar consolidation3. Atelectasis4. Pneumothorax
2, 3
Whispered pectoriloquy is a louder and more intelligible vocal sound heard over areas of solid lung tissue. With increased air, as in COPD or pneumothorax, the spoken sounds will be even more diminished than normal.
During the auscultation of a patient's anterior and posterior lung fields, you hear soft, low pitched sounds during inspiration. What kind of breath sound should be charted for the patient?
Vesicular
Vesicular breath sounds are normal soft, low-pitched sounds heard primarily during inspiration. While bronchial and bronchovesicular sounds are normal over the trachea and mainstem bronchi respectively, they are not normal over the lung fields. Crackles indicate excessive fluid in the airways.
During the interview before a physical exam, your 30-year-old patient says that her blood pressure is normal. Which of the following would be within the normal range for her?
115/80 mm Hg
A normal adult blood pressure would be within the range of 110-140 mm Hg systolic and 60-90 mm Hg diastolic. 144/95 mm Hg would be hypertension. 75/60 mm Hg would be hypotension.
During a physical examination of a patient, you notice that his fingertips and toes are blue-gray in color. What can be said of this?1. He has hypoxemia2. He is hypoventilating3. He has cyanosis4. Cardiopulmonary resuscitation should be started
1, 3
A blue-gray or purplish discoloration of the mucous membranes, fingertips, and toes is called cyanosis. It indicates that the patient's oxygen level to the skin is lower than normal. An increased carbon dioxide level confirms hypoventilation, not a low oxygen level. CPR is not yet indicated, although the hypoxemia should be corrected as soon as possible.
Your patient has bronchitis and a productive cough. When placing your hands over his anterior chest, you feel vibrations. This referred to as:
tactile fremitus
Your patient has chronic bronchitis. What type of sputum would be expected?
Thick and tenacious

When a patient has chronic bronchitis, there is an increased production of thick and tenacious secretions that are often infected. Normal mucus is clear or white. Pulmonary edema secretions are frothy and pinkish. Blood-tinged secretions would indicate hemoptysis.
A patient with advanced chronic obstructive pulmonary disease is short of breath. All of the following are accessory muscles of inspiration EXCEPT:
internal oblique
The normal range for respiratory rate in an adult is:
12-20/min
Your patient has a heart rate of 55 bpm. How would this be categorized?
Bradycardia in an adult

A heart rate of 55 bpm is bradycardia in an adult, but not necessarily an emergency situation.
In order for the interview to be successful, the respiratory therapist must:1. show an understanding of the patient's situation2. make the patient feel accepted and comfortable 3. build rapport for the future4. gather complete and accurate data
1, 2, 3, 4
During the interview it is important to evaluate the patient's body language for all of the following EXCEPT:
ethnicity
When a respiratory therapist is using facilitation, what will encourage the patient to continue? 1. leaning forward2. turning away 3. maintaining good eye contact4. saying, "I understand."
1, 3, 4
Which of the following is an example of a communication technique that can restrict a patient's responses?
Saying, "Despite what you think, do what your doctor and I are telling you."
An authoritative statement such as, "Despite what you think, do what your doctor and I are telling you." will promote dependency by the patient. He/she will be less likely to speak openly with the respiratory therapist. The other listed options encourage the patient to be open about his/her situation.
During the initial interview with your patient, Mrs. Donna Barrett, is important to:1. state your purpose2. address her by her last name 3. address her by her first name4. introduce yourself
1, 2, 4
Nonverbal communication techniques that a respiratory therapist should use include:1. maintaining continuous eye contact2. touching the patient's face at the end of the interview 3. being well groomed4. sitting using an open position
3, 4
The patient interview is conducted:
after the patient finishes the written history form
The primary purpose of an open-ended question is to:
let the patient provide an extended narrative
When asked a direct question:
the patient provides a short answer
Empathy could be defined as:
viewing the world from the patient's point of view while remaining separate from it
Your patient has acute ventilatory failure and acidemia. What should be done?
Begin mechanical ventilation
If a patient has chronic ventilatory failure, the pH is corrected toward normal by:
the kidneys retaining bicarbonate (HCO3-)
In order to determine if a patient's acidosis is from a metabolic disorder, the physician decides to measure the anion gap. What is a normal anion gap?
9 to 14 mEq/L
Which of the following would be a normal persons' arterial oxygen pressure (PaO2)?
80-100 mm Hg
The physician is concerned that your patient may be sensitive to uncontrolled oxygen administration because of her long-standing chronic ventilatory failure and hypoxemia. As the respiratory therapist, what should be recommended?
Fixed oxygen % despite her breathing pattern
The normal pH of arterial blood is:
7.35-7.45
Which of the following would be found in a patient with a combined metabolic and respiratory acidosis?
Low bicarbonate level and high carbon dioxide level.
What is the most common cause for a patient to have acute alveolar hyperventilation?
Hypoxemia

Hypoxemia is a very powerful breathing stimulant. It can be caused by many pulmonary, cardiac, and neuromuscular diseases and conditions. Pain or anxiety can cause temporary hyperventilation until the underlying problem is resolved. Croup and singultus (hiccups) do not cause hypoxemia.
During their advanced stages, which of the following are associated with chronic ventilatory failure?1. Asthma2. Bronchiectasis3. Cystic fibrosis4. Emphysema
2, 3, 4

Advanced cases of bronchiectasis, cystic fibrosis, and emphysema can result in chronic ventilatory failure. Asthma is a serious condition but does not commonly result in chronic ventilatory failure.
According to the hyperinflation therapy protocol, what should be done when a patient with atelectasis is unconscious and cannot cooperate?
Give volume targeted IPPB
According to the oxygen therapy protocol, what should be done with the oxygen delivery system when the patient's SaO2 is >90% while breathing room air?
Discontinue the oxygen
According to the aerosolized medication protocol, how can a patient with asthma be objectively assessed for the effectiveness of inhaled bronchodilator medications?
Measure the peak flow
A 15-year-old woman has asthma. She has a productive cough and breath sounds reveal bilateral wheezing and crackles. What therapist-driven protocol(s) should be implemented?1. Oxygen therapy2. Aerosolized medication therapy3. Hyperinflation therapy4. Bronchopulmonary hygiene therapy
2, 4

A patient with asthma and wheezing needs aerosolized bronchodilator therapy. Crackles and a productive cough indicate that she has secretions and would benefit from bronchopulmonary hygiene therapy. The other protocols are not indicated
Essential components of a TDP program include:1. evaluation of the patient's response to care2. bedside patient assessment3. selection of appropriate care4. identification of clinical indicators for care
1, 2, 3, 4
Which of the following pathophysiologic mechanisms are associated with the distal airway and alveolar weakening clinical scenario?1. Air trapping2. Decreased ratio3. Fever 4. Irritant reflex
1, 2, 4
The Respiratory Care Department where you work has recently implemented a therapist-driven protocol (TDP) program. Under the program, all licensed practitioners will be able to do all of the following EXCEPT:
write orders for patient care
Your 10-year-old patient with cystic fibrosis is going to be discharged with a flutter valve to use 4 times a day. She can use a 2 L/min nasal cannula as needed. What therapist-driven protocol(s) should be implemented?1. Bronchopulmonary hygiene therapy2. Hyperinflation therapy3. Oxygen therapy4. Aerosolized medication therapy
1, 3

A flutter valve is used with a cystic fibrosis patient as part of the bronchopulmonary hygiene therapy protocol to help mobilize secretions. The oxygen therapy protocol is needed to help the patient and her family with the home respiratory therapist decide when the nasal cannula should be used. The other protocols are not indicated
Incentive spirometry and IPPB are part of what therapist-driven protocol?
Hyperinflation therapy
Which of the following pathophysiologic mechanisms is/are associated with the atelectasis clinical scenario?1. Air trapping2. Decreased ratio3. Deflation reflex4. Irritant reflex
2, 3, 4

Atelectasis results in decreased ventilation compared to perfusion ratio and low lung compliance stimulates the deflation reflex and irritant reflex to increase the respiratory rate. Air trapping is found in diseases like asthma.
The percussion note heard on a patient with emphysema is:
hyperresonance
A patient with moderate-to-severe emphysema will have which of the following pulmonary function values?
Normal or increased VT

The tidal volume (VT) is the only normal volume or capacity found in a patient with emphysema. This is because the lung damage causes some volumes and capacities to be abnormally increased (barrel chest)
The management of chronic obstructive pulmonary disease (COPD) includes:1. supplemental oxygen2. postural drainage and percussion to drain mucus3. antibiotics to fight any pulmonary infection4. bronchodilator medications
1, 2, 3, 4

Because COPD is a mixture of emphysema and chronic bronchitis, all of the listed options will usually be tried to help the patient
The alpha1antitrypsin phenotype associated with the lowest serum concentration is
ZZ
What are the primary structures affected by chronic bronchitis?
Conducting airways

The conducting airways (bronchi) are primarily affected by chronic bronchitis
Inspection of the fingers of a patient with chronic bronchitis will often reveal:1. cyanosis2. reddish skin3. digital clubbing4. thick finger nails
1, 3
All of the following are anatomic alterations found with emphysema EXCEPT:
excessive mucus production
Auscultation of the chest of a patient with emphysema will reveal:
decreased breath sounds

Because of air trapping in a patient with emphysema, breath sounds will be decreased. Patients with chronic bronchitis tend to have wheezes because of bronchospasm and crackles because of secretions. A normal patient would have vesicular breath sounds.
Chronic obstructive pulmonary disease (COPD) includes which of the following conditions?1. Emphysema2. Cystic fibrosis3. Chronic bronchitis4. Bronchiectasis1, 3
1, 3
Chronic bronchitis is defined as:1. daily productive cough for 1 mon2. daily productive cough for 3 mon3. for 2 yr in a row4. for 3 yr in a row
2, 3

People with chronic bronchitis will have a daily productive cough for at least 3 mon of the year for 2 yr (or more).
All of the following mechanisms are involved in the development of cor pulmonale in patients with chronic pulmonary disease EXCEPT:
mucosal edema
What term is used to describe a person having an abnormally low arterial blood oxygen tension (PaO2)?
Hypoxemia
Oxygen is transported:1. attached to leukocytes.2. bound to hemoglobin (Hb).3. dissolved in blood plasma.4. bound to hematocrit (Hct).
2, 3
The P(A-a)O2 increases in response to all of the following EXCEPT:
left-to-right intracardiac shunt
A condition that will cause circulatory hypoxia is:
decreased cardiac output or heart failure.
The tissues extract and use (oxygen extraction ratio) approximately how much oxygen from the arterial blood?
25%
A condition that will cause histotoxic hypoxia is:
cyanide poisoning
A normal person has a shunt of about:
<10%

A normal person would have a shunt of <10%. Any higher shunt level is abnormal and the higher it is, the more dangerous the situation
The ratio between the volume of oxygen consumed and the volume of carbon dioxide produced is called:
respiratory quotient
The normal person's C(a-v)O2 is about:
5 vol%
The measurement of white blood count (WBC) is used as an indicator of:
infection/inflammation
Fiberoptic bronchoscopy can be used for:1. visual examination of the airways2. therapeutic removal of fluid from the pleural space3. sampling of secretions from within the airways4. lung tissue biopsy
1, 3, 4
Your patient has a long smoking history. Because of a spot found on his chest x-ray, the physician suspects lung cancer. What type of sputum sample should be obtained to look for cancer cells?
Cytology

Cytology involves having the patient cough his/her sputum into a special container with fixative solution. The sputum is then evaluated for cancer cells. Gram stain is used to classify bacteria into gram-negative or gram-positive types. Culture and sensitivity involves growing bacteria to find out what antibiotic(s) will kill them. Acid-fast staining is used to identify tuberculosis organisms.
A patient is at an increased risk for bleeding after surgery if the:
the platelet count is below normal
Your patient has decreased values for red blood cell counts (RBCs), Hb, and Hct. What clinical impact would this have?
The blood has a decreased oxygen carrying capacity
Transudate fluid has been found in the pleural space of a patient's left lung. What could be the cause of it?1. Nephritic syndrome2. Left lower lobe pneumonia3. Heart failure4. Cirrhosis
1, 3, 4
The laboratory value of this electrolyte can be used as an indicator of the patient's body fluid balance:
sodium
A pleurodesis procedure:
prevents the recurrence of a pneumothorax
A computed tomography (CT) scan has identified a mass on the outside wall of a major bronchus. What should be tried first to get a sample of the tumor?
Transbronchial needle biopsy
All of the following are true of monocytes EXCEPT:
fight off viral infections
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