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TMC Like Exam
what was missed on practice test 1
Terms in this set (76)
On reviewing the results of the attending physician's physical examination of a patient's chest, you note 'a dull percussion note and bronchial breath sounds - LLL.' Which of the following is a potential problem?
Which of the following is the most likely cause of an increase in the plateau pressure of a patient who is receiving volume control ventilation?
a decrease in compliance
The Ballard scale is used to assess:
gestational age after birth
Which of the following echocardiogram findings are consistent with a diagnosis of pulmonary arterial hypertension (PAH)?
high velocity tricuspid regurgitation
Procedures that can confirm a diagnosis of Pneumocystis carinii (jiroveci) pneumonia (PCP/PJP) include which of the following?
lung biopsy, bronchoalveolar lavage, chest radiograph, and sputum induction.
A patient coughs productively after receiving airway clearance therapy. You note that the sputum sample is foul smelling and green. You would suspect that the patient has:
You note on inspection of an AP chest radiograph that the right hemidiaphragm is elevated above normal. Which of the following is the most likely cause of this abnormality?
right phrenic nerve paralysis
When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly expands during inspiration. Which of the following are potential causes of this problem?
A patient is cachectic, exhibits generalized edema and dry skin, and appears listless. The most likely problem is:
Vesicular breath sounds indicate which of the following?
The most likely cause of bilateral fluffy infiltrates on a chest x-ray is:
A 25-year-old comatose woman is seen in the emergency room. You observe that her respiratory rate is 24/min and her tidal volume is consistently large. No periods of apnea have been observed. Which of the following breathing patterns would be most consistent with these observations?
Which of the following would tend to cause decreased or diminished breath sounds?
You are evaluating a patient in the recovery room following an exploratory laparotomy. The patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine the patient's level of consciousness, you speak to the patient, who does not respond. Which of the following should you do FIRST?
shake the patient's arm gently
An adult patient is receiving 60% oxygen at 40 L/min via a high flow nasal cannula. Blood gas results are as follows: pH =7.52 PCO2 =33 torr PaO2 =48 torr SaO2 =81% HCO3 =26 mEq/L
What is the patient's P/F ratio?
PaO2/FIO2. 48/0.6= 80
When using a point-of-care blood gas analyzer to measure a patient's blood gas values in the ED, the device flags the results as being not reportable, even after repeating the analysis using a fresh sample and new cartridge. What action should you take at this time?
send sample to the central laboratory for analysis
Which of the following chart information must be checked before performing an artery puncture?
PT, PTT and INR values
Which of the following technologies do most home apnea monitors use to detect respirations?
Ventilatory support may be indicated when the pulmonary R-L shunt fraction (Qs/Qt) rises above what level?
While assisting a physician who is inserting a pulmonary artery catheter, you note a changeover on the monitor from pulsatile pressures of about 25/5 mm Hg to pulsatile pressures of 25/15 mm Hg. Which of the following has occurred?
the catheter has moved from right ventricle to pulmonary artery
A patient with viral pneumonia and bilateral infiltrates on X-ray is intubated and placed on pressure control ventilation with 40% O2 and 10 cm H2O PEEP. After 30 minutes of ventilatory support you obtain the following blood gas:
pH = 7.49 PCO2 = 34 torr PaO2 = 60 torr SaO2 = 91% HCO3 = 25 mEq/L BE = +2 MEq/L
When asked by the patient's doctor, you would describe her condition as being consistent with:
moderate OR sever ARDS
On inspection of an adult patient's 12-lead ECG, you note a regular R-R interval of 0.40 sec, with no other apparent abnormalities. Which of the following is the most likely problem?
You obtain an SpO2 measurement on a patient of 80%. Assuming this is an accurate measure of hemoglobin saturation, what is the patient's approximate PaO2?
Which of the following values best indicates that a patient is experiencing tissue hypoxia?
PvO2 of 25 torr
After performing comprehensive pulmonary function testing (PFTs) on a patient, you note the following results:
Test % Predicted
Which of the following interpretations is most consistent with these findings?
The patient has pulmonary emphysema
During capnography monitoring of a mechanically ventilated patient, you note that the end-tidal PCO2 (PetCO2) has dropped to 0 mm Hg. This finding may indicate:
As compared to predicted normals, a patient has an increased TLC and a decreased FEV1%. Test results are repeatable. Which of the following is the most likely underlying problem?
generalized obstruction with air trapping
Which of the following tests would you recommend to help assess the effectiveness of steroid treatment for a patient with asthma?
Exhaled nitric oxide test (FeNO)
The regional distribution of ventilation is the lung is measured via:
radioactive xenon (133Xe) ventilation scans
CO-oximetry analysis should be performed whenever the following information is needed:
abnormal Hb levels
For persons with no known risk factors for tuberculosis (TB), what diameter induration read 48 hours after skin testing constitutes a positive result?
≥ 15 mm
Capnometry can be use to:
estimate physiologic deadspace, detect esophageal intubation, and assess blood flow during cpr.
In working with an electrically powered apparatus, you notice a slight tingling sensation when the metal parts of the equipment are touched. In this case, you should:
immediately take the piece of equipment out of service
You know that an O2 concentrator is working properly if:
it provides at least 85-90% O2 at maximum flow
When administering in-exsufflation (cough assist) therapy to a patient with a tracheostomy tube, the best way to facilitate secretion removal is to
connect to an inline suction catheter
When turning on an H cylinder valve, gas leaks around the regulator connection to the cylinder. Your most appropriate action to correct the problem would be to:
tighten the cylinder connection
Which of the following analyzers would you select if your objective were to continuously measure changes in the FIO2 in a ventilator circuit with the fastest possible response time?
polarographic (Clark) analyzer
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?
4 full E cylinders
Which of the following are essential components of a continuous flow CPAP system?
oxygen blender, demand valve, and threshold resistor.
Unheated bubble-diffusion humidifiers are capable of supplying approximately what percent body humidity?
To minimize the risk of infection when a large-volume nebulizer is set up for an intubated patient, you should do which of the following?
check to be sure that the device has been sterilized
Which of the following types of equipment processing would you recommend for a reusable device that only contacted a patient's intact skin?
Which of the following devices would you select to calibrate a body plethysmograph's pressure transducer?
U-tube water column
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
To manually test a volume control ventilator's I:E ratio alarm, you would:
adjust the peak flow
Oropharyngeal and nasopharyngeal airways helps restore airway patency by:
separating the tongue from the posterior pharyngeal wall
When using a disposable CO2 indicator to confirm ET tube placement, a false negative (absence of color change even with proper tracheal positioning) can occur
during cardiac arrest
Despite "passing" a spontaneous breathing trial (SBT) and a cuff leak test, an orally intubated patient on a 40% T-tube remains obtunded and exhibits no cough reflex when suctioned for copious tracheobronchial secretions. You should:
advise against extubation and continue to assess for airway protection
Which of the following measures can reduce the incidence of infection associated with large volume heated humidifier systems?
use a closed-feed sterile water reservoir system
Which of the following are TRUE regarding the flow resistor-type inspiratory breathing exerciser?
Exhaled gas flows unimpeded outa one-way valve, Resistance is created by a variable-size orifice, and the imposed load varies with the flow rate
You visit a post-op cardiac patient whose nurse has given him the following instructions for performing incentive spirometry: "breathe deeply; try hard to exhale but hold it in for a while; then exhale normally." What potential problem is likely to result from doing the incentive spirometry in this manner?
compromised cardiac output
During volume control SIMV you adjust the proportion of ventilation assumed by the patient primarily by changing the:
Which of the following is true regarding synchronous intermittent ventilation (SIMV)?
asynchrony is more common with SIMV than with A/C mode
A 100 kg (224 lb) adult male is receiving ventilatory support following a motor vehicle accident. Pertinent data are below.
Mode Vol ctrl A/C
Set Rate 12/min
Actual Rate 30/min
VT 800 mL
Flow 50 L/min
I:E ratio 1:1
To provide a more normal I:E ratio, you should:
increase the inspiratory flow
Continuous positive airway pressure (CPAP) is indicated as a treatment for:
Which of the following is a prerequisite for successful application of noninvasive positive pressure ventilation (NPPV)?
adequate bulbar muscle function
Your patient is receiving aerosolized bronchodilators to treat her asthma. What is the best way to determine whether the medication is having a positive effect?
Measure the patient's FEV1% before-and-after treatment
Which of the following measurements done before and after treatment would best determine the effectiveness of an aerosolized albuterol (Proventil) administered to an asthmatic patient?
forced expiratory volume (FEV)
You are called to the ER to assist in the care of an intubated patient who is having frequent premature ventricular contractions (PVCs). Due to hypotension, the physician cannot start an IV line. What would you recommend?
instill lidocaine into the endotracheal tube
You measure an SpO2 of 82% on a patient receiving oxygen at 3 L/min via nasal cannula. Which of the following actions would be appropriate at this time?
increase the cannula liter flow to 4 L/min
A home care patient with COPD who lives alone produces in excess of 30 mL of sputum daily and is having difficulty clearing his airway. Which of the following therapies would you recommend for this patient?
PEP therapy followed by autogenic drainage PRN
A trauma patient has been receiving volume control SIMV via an oral endotracheal tube for a week. Based on the patient's current condition, there is little likelihood that weaning will be considered for at least another 7-10 days. Which of the following actions would you recommend?
switch from ET intubation to tracheostomy
What treatment would you recommend for a patient who has a 50% spontaneous pneumothorax?
inserting of a chest tube
For which of the following conditions would you recommend that the patient receive supplemental O2 therapy?
smoke inhalation, severe trauma, and cardiogenic shock
You are reviewing a postoperative patient's care plan. The physician has changed the patient's therapy from incentive spirometry to IPPB. The most likely goal for this change is to:
treat progressive respiratory muscle weakness
For which of the following intubated infants receiving mechanical ventilation would you recommend rescue surfactant replacement therapy?
full-term infant with meconium aspiration syndrome requiring 60% O2
A patient has a pulmonary capillary wedge pressure (PCWP) of 20 mm Hg. Which of the following does this measurement likely indicate?
left ventricular failure
A resident in ICU places a pulmonary artery catheter in a mechanically ventilated patient via the subclavian route. 5 minutes later, the attending nurse calls you to the bedside because the ventilator's high pressure alarm is sounding and the patient appears to be rapidly deteriorating. You quickly note decreased breath sounds on the right side and severe hypotension. Which of the following conditions is most consistent with these findings?
Which of the following clinical findings are consistent with core pulmonale?
A physician is having difficulty establishing an intravenous route for drug administration to a 3 year old child during resuscitation. You would recommend:
While trying to ventilate an adult patient in cardiac arrest with a manual resuscitator, you encounter extreme difficulty in maintaining an effective seal with the mask. The most appropriate action at this time would be to:
apply mouth-to-mask ventilation
Minimum monitoring of critically ill patients undergoing transport should include the following:
A doctor asks you to assist her with positioning a cooperative and mobile patient for a thoracentesis. The correct position for this procedure is:
a sitting position (chair or bed), leaning forward with arms supported
You are assisting a physician with intubating an adult patient. Three attempts to pass the tube have been unsuccessful, but you can still ventilate the patient between attempts with a manual resuscitator and mask. Which of the following actions would you recommend at this time?
Place an intubating laryngeal mask airway
An anesthesiologist is planning a rapid sequence induction to intubate an adult patient in the surgical ICU. In preparation for intubation, the patient is being pre-oxygenated via a non-rebreathing mask. The anesthesiologist is concerned about the potential for regurgitation and aspiration before the tube is placed. To help minimize the likelihood of aspiration you would:
apply downward pressure on the cricoid cartilage
Which of the following would you NOT expect to observe after a COPD patient completes a pulmonary rehabilitation program that includes physical reconditioning?
a permanent increase in FEV1 and FEF25-75
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