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What is the monitoring threshold for Maximum Inspiratory Pressure/ Negative Inspiratory Force (MIP/NIF)?
-20 to -25 cm H2O
What is the monitoring threshold for minute volume (VE)?
5-7 L/min (amount of air exhaled in one minute)
What does it mean if patients are using their accessory muscles to breathe?
An increased work of breathing, loss of normal diaphragm function
What does it it mean if the patient has Abdominal paradox?
Diaphragmatic fatigue, increased work of breathing.
What does it mean if the patient has retractions?
The patient has a reduced lung volume, low lung compliance, increased work of breathing.
If a patient has clubbing in their fingers or toes what could that mean?
Bronchogenic carcinoma, COPD, chronic cardiovascular disease.
What does it likely mean if a patient is breathing rapid and shallow?
A loss of lung volume (atelectasis, pulmonary fibrosis, ARDS or acute pulmonary edema)
What does it mean if a patient is breathing in a Kussmaul breathing pattern(deep and fast)?
What does it mean if a patient is breathing in Biot's breathing pattern (irregular with periods of apnea)?
Increased intracranial pressure
What does it mean if a patient is breathing in a Cheyne Stokes pattern (waxing and waning)?
Central Nervous System (CNS) diseases or severe congestive heart failure (CHF).
What conditions is associated with Clear/White (thick or thin) sputum? (Also known as Mucoid)
What conditions is associated with Clear to yellowish (thick) sputum? (Also known as Mucopurulent)
Chronic Bronchitits, cystic fibrosis, pneumonia (blood streaked)
What conditions is associated with yellow to green, thick sputum? (also known as purulent)
Aspiration pneumonia, bronchiectasis (fetid/foul smelling, may separate into layers if left standing), lung abscess (fetid/foul smelling, may separate into layers if left standing)
What conditions is associated with pink to red/dark red, thin (unless coagulated) sputum? (also known as bloody)
TB (red), lung cancer (red), pulmonary infarction (red), pulmonary edema (pink,watery, frothy)
What conditions does an acute cough (<3 wks) imply?
Postnasal drip, allergies, and infections (especially common cold, bronchitis, laryngitis)
What conditions does a Chronic (>3 wks) or recurrent cough imply?
Postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis, COPD, TB, lung tumor, Angiotensin Converting Enzyme (ACE) inhibitors, left heart failure
What conditions does a barking cough imply?
Epiglottitis, croup, influenza, laryngotracheal bronchitis
What conditions does a brassy or hoarse cough imply?
Laryngitis, laryngeal paralysis, laryngotracheal bronchitis, pressure on laryngeal nerve, mediastinal tumor, aortic aneurysm
What conditions does a dry cough imply?
Viral infections, inhalation of irritant gases, interstitial lung diseases, tumor, pleural effusion, cardiac conditions, nervous habit, radiation or chemotherapy
What conditions does a dry to productive cough imply?
Atypical pneumonias, Legionnaires' disease, pulmonary embolus, pulmonary edema, lung abscess, asthma, silicosis, emphysema (late phase), smoking, AIDS
What conditions does a chronic productive cough imply?
Bronchiectasis, chronic bronchitis, lung abscess, asthma, fungal infections, bacterial pneumonias, TB
What conditions does a Paroxysmal (especially at night) cough imply?
Aspiration, asthma, left heart failure
What conditions does a positional (especially when lying down) cough imply?
Bronchiectasis, left heart failure, chronic postnasal drip or sinusitis, GERD with aspiration
What conditions does cough associated with eating or drinking imply?
Neuromuscular disease of the upper airway, esophageal problems, aspiration
To develop an effective program for teaching a patient to use a small volume nebulizer, a respiratory therapist should evaluate the patient's what?
Language skills, mental status and manual dexterity, not visual acuity
To demonstrate significan postbronchodilator improvement, a patient's FEV1 must increase by a minimum of what percentage?
A patient has the lung volume results below:
VC 3600 mL
FRC 6000 mL
ERV 1000 mL
8600 ml (FRC+VC)-ERV)
Which condition results in an abnormal elevation of the left hemidiaphragm?
left lower lobe atelectasis
While the patient is breathing normally a respiratory therapist measures the volume of 1 exhalation. What is the therapist measuring?
A patient has Guillain-Barre syndrome. Which results of bedside pulmonary function testing most strongly indicates the need for ventilatory assistance?
Vital capacity equal to the tidal volume
With an FiO2 of 0.70, a 27-week gestational age neonate who weighs 950 g has the following umbilical artery blood gas results:
pH - 7.38
PaCO2 - 42
PaO2 - 38
HCO3- 24 mEq/L
BE - -2 mEq/L
A physician has decided to intubate the infant. What should the therapist recommend to continuously monitor the infant's oxygenation?
What is the best index of oxygen transport for a patient who has been resuscitated after carbon monoxide poisoning?
Arterial oxygen content
A RT needs to place a cap on the end of a patient's fenestrated tracheostomy tube so that the patient can breathe through her upper airway and speak. Before applying the cap to the tube what does the RT need to do?
Remove the inner cannula and deflate the cuff
A RT is checking a jet nebulizer with an entrainment setting of 35%. A properly calibrated oxygen analyzer measures the concentration at 45%. What explains this finding?
Water in the tubing
A physician has ordered an FiO2 of 0.40 by oxyhood and blender for an infant. When analyzing the oxygen concentration, a RT notes the FiO2 is 0.30, and the flowmeter is set at 10 L/min. The nebulizer's entrainment port is set at 50% and the blender is set at an FiO2 of 0.40. What does the RT need to do to correct the problem?
Set the nebulizer's entrainment port to 100%
After 30 minutes of oxygen delivery by nasal cannula at 6 L/min, a patient with sever fibrotic lung disease has a PaO2 of 45 torr. What should the RT recommend?
A non-rebreathing mask
A 2-year-old child is receiving oxygen by an aerosol tent. the RT is unable to maintain a consistent FiO2 inside the canopy. What should the therapy do?
increase the oxygen flow
The aerosol from an ultrasonic nebulizer is being produced in short, rapid puffs. What does the RT need to do to correct the problem?
Clear the water from the delivery tube
A pt with severe COPD is receiving O2 by nasal cannula at 4 L/min. The pt is lethargic and his respirations are shallow at a rate of 20/min. The pulse oximeter is reading 94%. What should a RT recommend?
Change to a 28% air-entrainment mask
An infant in a oxyhood is receiving 24% oxygen by a large volume nebulizer at a flow of 10 L/min. The infant is restless. The SpO2 is 97%. To calm the infant what should the RT do?
replace the nebulizer with a blender
A patient with hepatitis coughs into a spirometer. What process should be used to disinfect the non-disposable mouthpiece before it is used again?
Quality control results using a 3.0 L calibration syringe spirometer are as follows:
Volume 1- 2.67 L
Volume 2 - 2.70 L
Volume 3 - 2.68 L
According to ATS Standards, the spirometer is considered what?
A 201-kg (442-lb) pt who underwent a gastric bypass and tracheotomy 2 weeks ago remains in the ICU receiving volume-controlled ventilation. After the patient is rolled to the supine position, the ventilator high-pressure alarm sounds with each breath. The suction catheter can be passed only 10 cm into the tracheostomy tube and no secretions are evident. What should the RT do?
Reposition the tracheostomy tube into the trachea.
Which of the following should be used to provide adequate humidity for a spontaneously breathing patient with a tracheostomy tube?
1 air-entrainment nebulizer
2 spinning disk nebulizer
3 heated wick humidifier
4 heat moisture exchanger
heated wick humidifier
heat moisture exchanger
During a routine ventilator check, a respiratory therapist measures endtracheal tube cuff pressure at 45 mm Hg. Air passes around the cuff at peak airway pressure. What is the therapists most appropriate action?
Recommend changing the endotracheal tube
A patient has been intubated for 4 days. When suctioning, a RT notices that the secretions are becoming tenacious. What is the best solution?
Ensure proximal airway temperature is 35 degrees C
A patient receiving a nebulizer treatment with 3% saline complains of shortness of breath. What should a RT do?
Discontinue therapy and notify the physician
What of the following provides the best clinical evaluation of the effects of incentive spirometry?
A. arterial blood gas analysis after treatment.
B. Peak flow before and after treatment.
C. Auscultation of the chest before and after treatment.
D FEV1 measurement before and after treatment
Auscultation of the chest before and after treatment
A RT decreases the inspiratory flow during volume-controlled ventilation. If the patient's total rate does not change, which of the following will decrease?
A. tidal volume
B. end-expiratory pressure
C. expiratory time
D. mean airway pressure
A 65-year old male with a history of COPD is brought to the emergency department because of respiratory distress. The patient is receiving oxygen by a simple mask at 5 L/min. A respiratory therapist notes the patient has shallow breathing and is difficult to arouse. Which of the following should the RT do?
A. Initiate pulse oximetry
B. Request a chest radiograph
C. Intubate and initiate mechanical ventilation
D. Perform an arterial blood gas analysis
Perform an arterial blood gas analysis
A 26-year-old patient is receiving volume ventilation due to status asthmaticus. Current ventilatory settings yield with an I:E of 1:2 and a PaCO2 of 51 torr. Which of the following should a respiratory therapist decrease?
An adult patient with intermittent needs for bilevel ventilation has a 4.0 mm ID single cannula tracheostomy tube. Which of the following is true?
A. The tracheostomy cuff should be fully inflated to allow speech
B. The tracheostomy cuff should be fully inflated during bilevel ventilation.
C. the inner cannula should be removed during speech.
D. The inner cannula should be inserted for bilevel ventilation.
The tracheostomy cuff should be fully inflated during bilevel ventilation
An attending physician writes an order for the administration of 80%/20% heliox to a patient with airways obstruction. What piece of equipment should a RT use to administer the therapy?
A patient is receiving noninvasive positive pressure ventilation. Pulmonary compliance has increased over the past 4 hours. To maintain the patient's tidal volume, is would be appropriate to do what?
decrease the IPAP
A patient with dyspnea is breathing 60% oxygen through a T-piece and reservoir system. A heated air-entrainment nebulizer is connected to a flowmeter set at 12 L/min. The aerosol mist disappears from the reservoir outlet during each inspiration. What should a RT do?
Add a second nebulizer
An adult patient who is being mechanically ventilated has high airways resistance to inspiratory flow. What could be implemented to improve the distribution of ventilation?
A patient receiving receiving beta-adrenergic aerosol therapy is taking slow, deep breaths with a pause at the end of each inspiration. Five minutes into the treatment, the patient complains of lightheadedness, dizziness, and tingling in the fingers. What should a respiratory therapist do?
Have the patient pause every 1-2 minutes during treatment
A patient with known reversible airway disease administers two puffs from his MDI. After the treatment a RT measures the patient's peak flow and notices that it has only increased marginally from pre-administration. A RT should do what?
Add a spacer to the MDI
What drug could be recommended to reduce systemic arterial blood pressure and reduce ventricular preload?
Sodium nitroprusside (Nipride)
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