TMC EXAM REVIEW - Part 3, Questions with answers. Updated Version.

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TMC EXAM REVIEW - Part 3, Questions with answers. Updated Version. Flow Triggering - ✔✔-What trigger mode should be used to help prevent air-trapping during mechanical ventilation? Phospholi... pid - ✔✔-What is the major component of pulmonary surfactant? Inspiratory Time (Ti or i-Time) - ✔✔-During mechanical ventilation, mean airway pressures will always change with what parameter? Vibrating mesh (Aerogen) - ✔✔-What type of nebulizer can be used to deliver aerosolized medications to a ventilator circuit without altering delivered tidal volume? Functional Residual Capacity (FRC) - ✔✔-In a patient with postoperative atelectasis, PEP therapy is likely to increase ________________. Pulse oximetry - ✔✔-What is the most accurate and quick way to asses a patient's response to changes in FiO2? Oxygen flow, Reservoir size - ✔✔-What two factors influence the oxygen concentration delivered by a self-inflating manual resuscitator? For inhalation dosage: Adults, teens, and children 6 years and older - one ampule or container with 300 mg BID for 28 days. Then, stop using the neb for 28 days and repeat. (The dosages should be spaced at least 6 hours apart.) - ✔✔-Your patient is an adult with a WBC count of 20,000. The doctor wishes to use Tobramycin by nebulizer to treat this infection. What is the dosage and schedule? Egophony - ✔✔-_______________ is the "E" to "A" change which we hear with the stethoscope. The patient says the letter E but it sounds like A because of an underlying pneumonia or consolidation. It means "voice of the goat" because the early physicians who heard this change thought that it sounded like the bleating of a goat. Manometer - ✔✔-What device is utilized to measure MIP or NIF? Pleural effusion - ✔✔-The patient has opacity on CXR and a dull percussion note. What does the patient have? Highest results - ✔✔-Which PFT results do you document, the highest (best) or the average? Terminate suction - ✔✔-While suctioning a patient, his oxygen level drops from 98% to 84%. What is the FIRST thing a therapist should do? No therapy is needed (this patient may be fully compensated or chronic) - ✔✔-You have a blood gas result for a COPD patient that shows an elevated PaCO2 but a normal pH. What should you do? Patient on right side, foot of bed elevated, 1/4 turn to the back - ✔✔-A patient has secretions in the lingula segment. What position should be used for postural drainage? Perform the Apnea Test to determine brain death - ✔✔-An EEG is being performed with no spontaneous breathing activity. What is the RT role? Transillumination (if it lights up, it is a pneumo) - ✔✔-A newborn is brought into the ER after being involved in a MVA with his parents. An assessment shows tachypnea and absent breath sounds on the right side. How will you quickly determine if the infant has a pneumothorax? Inspiratory Reserve Volume (IRV) - ✔✔-What is the volume of air which can be inspired above normal tidal volume? Expiratory Reserve Volume (ERV) - ✔✔-What is the volume of air which can be exhaled below normal tidal volume? Pleural effusion - ✔✔-Noted on CXR, your patient has a "blunted and obliterated" costophrenic angle and a meniscus sign in the right lower chest. What is the likely interpretation here? Patient is still smoking (greater than 8 ppm = smoking within last 24 hours) - ✔✔-As you are taking patient history for a PFT, your patient tells you that he has given up smoking completely. You perform an exhaled CO level as part of your workup and the level is 14 ppm. What does this result tell you? Pulmonary embolism (CT is still best test) - ✔✔-What pathology might we utilize angiography for in pulmonary medicine? Emphysema - ✔✔-Which pulmonary diagnosis is most often associated with polycythemia (elevated RBC)? Fully Compensated Respiratory Acidosis with Hypoxemia (pH 7.37 PaCO2 66 PaO2 55 HCO3 30) - ✔✔- What ABG pattern is most commonly associated with stable, chronic emphysema? Head injury - ✔✔-For which condition would you modify any head down positions used for postural drainage? PEP therapy - ✔✔-Your home care chronic bronchitis patient is having difficulty mobilizing secretions using the normal coughing techniques. What would you recommend adding to their regimen? Intrinsic asthma (nonallergic or atopic asthma, episodes are often caused by exercise, cold air, emotion, or other factors) - ✔✔-Your asthma patient has episodes which are not linked to a specific antigen, are not seasonal, and Immunoglobulin E levels are normal. What type of asthma is this? 1. Haemophilus influenzae 2. Enterobacter 3. Pseudomonas aeruginosa - ✔✔-Name 3 common Respiratory Gram Negative organisms. 1. Streptococcus 2. Staphylococcus - ✔✔-Name 2 Respiratory Gram Positive organisms. 10 - ✔✔-A positive tuberculin skin test or Mantoux test demonstrates a wheal greater than __________mm. Check connections (most false alarms are due to faulty connections or lose electrodes) - ✔✔-The SpO2 alarm on your patient's ICU monitor is sounding continuously. Your initial assessment of the patient is that he is breathing normally. Next, the RT should _____________. 70 - ✔✔-Pulse oximeter readings are considered unreliable at SpO2 saturations below _____%. 70-85% - ✔✔-What percentage of FVC will a patient with normal lung function be able to exhale in the first second of the FVC maneuver (FEV1)? Barcode - ✔✔-Ultrasound can be used to identify a pneumothorax quickly. If the patient has a pneumothorax, ultrasound will reveal as a ________ sign. Hyperventilation (high pH, low PaCO2, normal or slightly lower PaO2) - ✔✔-Patients that are experiencing an asthma attack initially will exhibit ___________. 4-5 L - ✔✔-What is the normal range for Vital Capacity (VC) in a young, healthy adult male? Metabolic Acidosis - ✔✔-Interpret the following ABG: pH 7.20 PaCO2 29 PaO2 98 HCO3 15 Diabetic Ketoacidosis (DKA) - ✔✔-Name a condition which is commonly associated with an ABG analysis of Metabolic Acidosis. Refractory hypoxemia (oxygen alone does not raise the PaO2, PEEP is needed) - ✔✔-A common finding in ARDS regarding the patient's oxygenation is ______________. Notify the attending physician immediately (the ability of the spouse to alter the order will be impacted by their status as healthcare proxy [Durable Power of Attorney for Healthcare]) - ✔✔-Your patient has a DNR order but the patient's spouse expresses to you that she wishes to have that order changed. What should you do? Hypoxemia (the low PaO2 is driving the patient to increase ventilation in an effort to raise PaO2) - ✔✔- What is the most common cause of Respiratory Alkalosis on ABG? Dried-out secretions (seen commonly in dehydrated patients) - ✔✔-What are "inspissated" secretions? Shock (the low BP and poor tissue perfusion makes it impossible almost to obtain a reliable SpO2) - ✔✔- What condition is known to significantly impact the accuracy of pulse oximetry readings? Daily Two Point Calibration (Calibrate to ZERO and High % NO calibration) - ✔✔-What type of calibration is needed for Nitric Oxide analyzers in use on patients? Long-term airway needed (>14 days = trach) - ✔✔-What is the most common indication for tracheostomy? Cromolyn sodium (Intal) - ✔✔-What is a medication which would NOT be considered appropriate treatment for a patient that is experiencing an acute asthma attack? Pneumothorax (#1 complication of catheter insertion) - ✔✔-During insertion of a Swan-Ganz, balloontipped flow directed pulmonary artery catheter the patient suddenly becomes agitated, is fighting the vent, and the high pressure alarm is sounding. What may have happened in this case? Measure from nostril to earlobe - ✔✔-How do you determine the proper size for use of a Nasopharyngeal airway? Maximal Inspiratory Pressure (MIP) - ✔✔-Which bedside test should be used to determine the return of a post-operative patient's ability to breathe adequately after surgery and should be greater than -20 cm H2O? 1. Auscultation of both lungs and stomach 2. Colorimetric CO2 detector 3. Waveform capnography 4. CXR - ✔✔-The physician wants you to determine proper placement of an ET tube. Name 4 different ways this can be accomplished. Haemophilus influenzae type B (HIB vaccine) - ✔✔-Which vaccine is helpful in preventing epiglottitis? Partial Pressure of Carbon Dioxide in the air - ✔✔-What does PICO2 stand for? The normal level for this is 0.3 mm Hg. Transillumination - ✔✔-______________ lights up the infant's chest in pneumothorax because of hyperlucency. Discontinue suction - ✔✔-During suctioning, the patient's HR drops to 40. What is the FIRST thing you should do? Nasal pillows - ✔✔-Your patient has sores on his cheek and on the bridge of his nose that was caused by the CPAP mask. What should the RT consider? Higher elevation (At high altitudes, oxygen molecules are further apart because there is less pressure to "push" them together.) - ✔✔-At __________, the partial pressure of oxygen drops because barometric pressure drops but the FiO2 continues to be 21%. Patient is ready to wean - ✔✔-Your patient is receiving ventilatory support after thoracic surgery. FiO2 is 40%, PEEP 5, and SpO2 95%. What does this indicate? Muscular weakness (Patient should probably be intubated to protect their airway) - ✔✔-Your patient has a Maximal Inspiratory Pressure (MIP) of -15 cm H2O. This measurement indicates _________. ARDS (acute respiratory distress syndrome) - ✔✔-What patient pathology is commonly considered for Inverse Ratio Ventilation (IRV)? Airway Pressure Release Ventilation (APRV) - ✔✔-Your patient's vent is set to apply continuous pressure which releases at set timed intervals. You are using this mode to improve oxygenation while maintaining lower mean airway pressures. This mode is called __________. Pressure Regulated Volume Control (PRVC) - ✔✔-Your patient's ventilator is set in a pressure controlled mode but it adds a target tidal volume, so that inspiratory pressure changes breath-by-breath up to a set point in order to maintain a stable tidal volume. This mode is called [Show More]

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