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Cumulative Review

Terms in this set (100)

Which of the following is an expected role of a respiratory therapist?1. Promoting lung health and wellness2. Providing patient education3. Assessing the patient's cardiopulmonary health status4. Selling oxygen (O2) therapy devices to patients.
1,2,3
Which of the following are predicted to be a growing trend in respiratory care for the future?1. Greater use of respiratory therapy protocols2. Increased need for patient assessment skills3. Increased involvement in smoking cessation programs4. Clinical decisions will increasingly be data-driven.
1,2,3, and 4
How is competency to practice Respiratory Care determined?
Obtaining a passing grade on a credentialing examination administered by the NBRC after graduation from a CoARC approved program.
Approximately what percent of hospitalized patients develop a health care-associated infection? *
4%
How do endotracheal tubes increase the risk of infection?
Providing surfaces for biofilms to develop
If you are caring for a patient who is suspected of having SARS, at what distance from the patient is it recommended to wear an effective filtration mask?
6ft
What is the first step in equipment processing for reuse on another patient?
Cleaning the equipment
What is the purpose of an inspiratory HEPA filter in a ventilator circuit?
When placed between the ventilator and the circuit, it can eliminate bacteria.
Which of the following is the simplest level of infection control based on the recognition that all blood, body fluids, secretions, and excretions may contain transmissible infections agents?
Standard Precautions
Which of the following sanctions can apply when one breaks a law?1. Reparations or fines2. Incarceration3. Licensure suspension4. Professional censure
1, 2, and 3 only
A patient has a recorded body temperature of 106° F. What is this temperature in degrees Celsius?
41° C
A near-drowning patient has a recorded body temperature of 30° C. What is the equivalent temperature in degrees Fahrenheit?
86° F
What is the primary purpose of the respiratory system?
Continuous absorption of oxygen (O2) and excretion of carbon dioxide
What is meant by "internal respiration"?
Exchange of gases between the blood and the tissue
What is the primary function of the lungs?
Gas exchange.
During each cycle of normal resting ventilation, a volume of gas is moved into and out of the respiratory tract. This cyclical volume is called the:
tidal volume (VT).
The presence of surfactant in the alveoli tends to do which of the following?
Decrease surface tension
How is compliance calculated?
Change in volume/change in pressure
Normal lung compliance is approximately which of the following?
0.20 L/cm H2O
The PAO2 depends on which of the following factors?1. Ambient (atmospheric) pressure2. Fractional concentration of inspired O23. Level of VA4. Types of fuels burned (fat, protein, and carbohydrate)
1, 2, 3, and 4
Calculate the approximate PAO2 given the following conditions (assume R = 0.8): FiO2 = .40, PB = 770 mm Hg, PACO2 = 31 mm Hg
250 mm Hg
A healthy person breathing 100% O2 at sea level would have PAO2 of approximately what level?
670 mm Hg
What is the normal range of PAO2 - PaO2 for healthy young adults breathing room air?
5 to 10 mm Hg
Why is it necessary to keep the patient's PaO2 greater than 60 mm Hg?
A level of 60 mm Hg marks the beginning of the steep part of O2Hb dissociation curve.
Hypoxia is best defined as a condition in which what occurs?
Tissue O2 delivery is inadequate to meet cellular needs.
A patient breathing room air at sea level has the following arterial blood gases: PaO2 = 62 mm Hg; PCO2 = 75 mm Hg. When the FIO2 is raised to 0.28, the PaO2 rises to 95 mm Hg. What is the most likely cause of the hypoxemia?
Hypoventilation
What is the most common cause of hypoxemia in patients with lung disease?
mismatch
What does / mismatch have the biggest impact on?
Oxygenation
What is the average urine output in a healthy adult?
1000 to 1200 ml/day
What is a normal range for serum sodium?
136.0 to 145.0 mEq/L
What is a normal range for serum Cl-?
98.0 to 106.0 mEq/L
What is a normal K+ blood level?
3.5 to 5.0 mEq/L
What is the most common cause of hyperkalemia?
renal failure
What is the normal serum calcium concentration?
8.7 to 10.4 mg/dl
The primary goal of acid-base homeostasis is to maintain which of the following?
Normal pH
What is the primary buffer system for fixed acids?
HCO3-
Which of the following organ systems assist in acid excretion? 1. Kidneys 2. Liver 3. Lungs
1 and 3 only
Which organ system actually excretes H+ from the body?
Kidneys
If the blood PCO2 is high, the kidneys will do which of the following?
Excrete more H+ and reabsorb more HCO3-
Which organ system maintains the normal level of HCO3- at 24 mEq/L?
Renal
Which of the following accurately describes compensation for acid-base disorders?
Kidneys take hours to days to compensate for respiratory disorders.
How should O2 therapy be administered to chronically hypercapnic patients?
Give as much O2 as required to maintain adequate oxygenation.
While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?
Cheyne-Stokes breathing
You observe a patient's breathing pattern as very irregular, with periods of breathing interspersed with long periods of apnea. Which of the following terms would you use in charting this observation?
Biot's respiration
Biot's respiration is most frequently observed in patients with which of the following?
Increased intracranial pressure
What is the primary function of the lungs?
gas exchange
How is competency to practice Respiratory Care determined?
Obtaining a passing grade on a credentialing examination administered by the NBRC after graduation from a CoARC approved program
What are the mechanisms of airflow obstruction in COPD? Select all that apply.
inflammation and obstruction of small airways, loss of elasticity, bronchospasm
Which of the following medications is indicated for regular use in patients with stable COPD?
Beta-2 agonists
How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease?
12%
Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)?
Diffuse infiltrates in chest radiograph
Which of the following is the primary system for removing fluid and protein from the lungs?
Lymphatic
Which of the following parameters are important in the management of patients with ARDS? 1. Keep systolic blood pressure below 90 mm Hg. 2. Keep hemoglobin saturation above 90%. 3. Ensure adequate urine output. 4. Keep systolic blood pressure above 90 mm Hg.
2, 3, and 4
Which of the following complications has been associated with the use of PEEP in patients with ARDS?
Reduced cardiac output
PEEP improves oxygenation by:
increasing FRC
After initially applying PEEP to a patient on CMV, which of the following should the RCP monitor for immediate changes?
Blood pressure
A patient admitted to the hospital for pulmonary edema would have what type of breath sounds?
inspiratory crackles
If you are asked to change a patient from AC-VC to AC- PC how would you determine the initial Delta P setting?
set based on the Pplat or Cs
Why is PCV considered a superior mode than VC for the management of ARDS? I. generates higher MAP and lower PIP II. More comfortable mode of ventilation for the patient III. Can obtain similar VT for less pressure IV. IRV is only possible in pressure control
I and III
A plateau pressure greater than 28 cmH2O indicates which of the following?
Alveolar overdistention
Which of the following are common causes of ARDS? I. Severe sepsis II. Blunt forces chest trauma III. Heat and smoke inhalation IV. CHF Exacerbation *
I, II, III
During CPR the PetCO2 should be rising
True
How does the Berlin Criteria define the "mild" category of ARDS?
P/F ratio = 201 to 300
Your instructor advises you that the oxygen therapy you have put your patient on will make the patient's nasal cavity very dry and asks you for the best way to decrease the dryness. Which of the following would you recommend?
Bubble humidifier
What is the most accurate oxygen status?
PaO2
What is the quickest way to check a patients oxygen status?
SpO2
What is the most common cause of pleural effusion in the clinical setting?
CHF
What is a common clinical finding even with small pleural effusions?
Dyspnea
What anatomical position is most likely to show the presence of a small pleural effusion in the upright chest radiograph?
Costophrenic angles
Which of the following findings on a radiologic report would indicate the presence of a tension pneumothorax?
Contralateral mediastinal shift, diaphragmatic depression, and flattening of ribs
A Respiratory Therapist discovers that a patient has dyspnea and diminished breath sounds with hyperresonance noted on the left. The chest radiograph indicates a tracheal shift to the right. Which of the following disease states should the therapist suspect is affecting the patient?
tension pneumothorax
Upon beginning an aerosol nebulized tx, you note no output of aerosol on exhalation. You are currently running the nebulizer on 5L
Increase the flow to 6-8L
You enter the patient's room and check the oxygen saturation (SpO2) with a pulse oximeter. The reading is 90% on 50% FIO2. What is your recommendation?
Increase the FIO2 to 60%
You go to the bedside of a patient in the hospital complaining of SOB. Inspection shows: alert and oriented, morbidly obese, edema, tachypnea, shallow and labored breathing pattern. Palpation shows: HR 115. Diagnostic percussion: resonant. Auscultation: BS diminished bases. What is your recommendation?
O2 at 3L/min nasal cannula
An ILD patients FVC would typically be decreased.
True
What is the primary medication used in treatment of ILDs?
Corticosteroids
A pt with a hx of Sarcoidosis presents to the ER with SOB and the following vital signs are measured: HR 114, RR 32, Temp 99F, BP 138/88, SPO2 82%. The Respiratory Care Practitioner:
administer oxygen via NC 2L/min
Computerized radiographic technique that uses radiographic substances to examine the metabolic activity of various body structures.
PET
Imaging technique using magnetic disturbance of tissue to obtain images.
MRI
Radiographic techniques that produce a film that represents a detailed cross section of tissue structure.
CT
Inadequate delivery of oxygen to the tissues is
hypoxia
Inadequate oxygen in the blood is
hypoxemia
What isolation are TB patients placed in?
Respiratory
What A-a gradient value indicates an oxygenation emergency?
>300 torr
Case Scenario- A pt presents to the ER with SOB, cough, chills, fever, and chest pain. Your assessment reveals HR 125, RR 30, BS RH, Temp 104F. What is his most likely diagnosis?
CAP
When PNA is suspected, and medication is required, you should:
order culture & sensitivity
Why do we, as an RT, care about Hb/Hg and what is the normal Hb/Hg level?
Respiratory role: Hemoglobin carries oxygen, CO2, and is a buffer.
Why is K+ important in patients being weaned from the ventilator
Muscle weakness in patient
A patient presents to the ED with vomiting and diarrhea. Blood gas results reveal metabolic alkalosis. Based on this information, you would also suggest..
an electrolyte analysis
What is the normal sound you would hear when assessing a pt using percussion?
resonance
What specific type of WBC is elevated in bacterial pneumonia? *
lymphocytes
After feeling sudden chest pain and shortness of breath, a man drove himself to the emergency department. After starting oxygen therapy on the patient, the respiratory therapist performed a physical exam. You note hyperresonance percussion on the right side and a tracheal shift to the left. Based on these findings what is the patient's most likely problem?
right sided pneumothorax
A respiratory therapist is called to valuated patient's breathing pattern. It is noticed that the patient title volume goes from small to large to small and then stops for 10 seconds before starting up again. The pattern repeats itself. This patient's breathing pattern would best be called
Cheyne-Stokes respiration
To help determine whether a patient has orthopnea, which of the following should be asked?
Do you need to use extra pillows when you sleep?
The respiratory therapist has been called to the emergency department to help care for a patient who was in a car crash which included chest injuries and broken ribs. Crepitations are felt well palpating the patient's neck. What is the most likely cause of this?
the patient's lung has an air leak
Soft tissue being sucked in around the neck and ribs when a patient is in severe distress
Retractions
Crackles/ rales signify:
secretions/ fluid
What percussion note would you associate with an Atelectasis patient?
Dull/flat
What percussion note would you associate with an Emphyema pt?
Hyperresonant
A bluish discoloration of the skin that is associated with hypoxemia.
Cyanosis
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