THERAPIST MULTIPLE CHOICE (TMC) EXAMINATION TEST BANK

Therapist Multiple-Choice (TMC) Examination TEST BANK over (Questions with Answers) 1. An adult male patient is admitted to the emergency department and t he following arterial blood gas (ABG) data are obtained: pH 7.50 ...

Therapist Multiple-Choice (TMC) Examination TEST BANK over (Questions with Answers) 1. An adult male patient is admitted to the emergency department and t he following arterial blood gas (ABG) data are obtained: pH 7.50 PaCO2 25 torr PaO2 58 torr HCO3- 25 mEq/L Which of the following is best supported by the findings? A. The patient is chronically hyperventilating CO2. B. The patient's primary ventilatory stimulus is now hypoxemia. C. The patient is in impending respiratory failure. D. The patient is experiencing tissue hypoxia. A PaO2 below 60 will cause the peripheral chemoreceptors to react and send afferent signals to the respiratory components of the medulla, which in turn causes efferent signals to be transmitted to the inspiratory muscles. This causes ventilation to increase. This increase in ventilation has decreased the PaCO2 and increased the pH, resulting in respiratory alkalosis. The correct answer is: The patient's primary ventilatory stimulus is now hypoxemia. 5 2. What is the best way to avoid arterial blood gas analysis errors associated with blood metabolism? A. analyze the sample immediately B. place the sample in an ice slush C. uncap the syringe to get rid of any air D. use dry (lithium) heparin ABG errors caused by blood metabolism are time and temperature dependent. Ideally, all ABG samples should be analyzed immediately. If analysis cannot be performed within 30 minutes, the sample should be placed in an ice slush until analysis can be performed. The correct answer is: analyze the sample immediately 6 3. Which of the following blood gas sampling errors would most likely result in a falsely high pH? A. use of a glass syringe B. ongoing blood metabolism C. air bubbles in the sample D. severe erythrocytosis Pre-analytic arterial blood gas sampling errors that would tend to result in a falsely high pH include air contamination (due to lowering of the PCO2) and dilution with excess liquid heparin (which is alkaline). Ongoing blood metabolism would lower, not raise the pH. Use of glass syringes and the presence of erythrocytosis should not affect the pH. The correct answer is: air bubbles in the sample 7 4. A patient has been admitted to the emergency department with the following arterial blood gas results: pH 7.50 PaCO2 30 torr PaO2 85 torr HCO3- 24 mEq/L The physician asks the respiratory therapist what the results show. The therapist should interpret the results as? A. metabolic alkalosis. B. respiratory acidosis. C. metabolic acidosis. D. respiratory alkalosis. The pH shows that there is an alkalosis, and the low PaCO2 shows a respiratory alkalosis. The bicarbonate level is normal. The best interpretation is respiratory alkalosis. The correct answer is: respiratory alkalosis. 8 5. The respiratory therapist is reviewing the record of a patient for whom an arterial blood gas test has been ordered. In order to properly prepare for the arterial puncture, which of the following lab values is most critical to review? A. bilirubin B. serum sodium C. prothrombin time D. alkaline phosphatase It is important to review a patient's coagulation status before performing any procedure that may involve bleeding. The two most relevant values in this regard are prothrombin time and platelet count. Extra caution should be utilized if prothrombin time is increased or platelet count is low. The correct answer is: prothrombin time 9 6. An adult male patient's FIO2 has been changed several times. He was first placed on a 40% air entrainment mask, and he is now receiving 90-100% oxygen from a nonrebreather mask. His PaO2 is 55 torr. His chest radiograph now shows extensive bilateral infiltrates. He is intubated and placed on the following settings: Assist control rate of 14 Tidal volume 700 mL FIO2 1.0 PIP 40 cm H2 Plateau pressure 35 cm H2 The patient's arterial blood gas results are: pH 7.40 PaCO2 25 torr PaO2 50 torr SaO2 80% HCO3- 15 mEq/L The most likely cause of hypoxemia is A. a shift of the oxyhemoglobin dissociation curve. B. a significant intrapulmonary shunt. C. interstitial fibrosis. D. hypoventilation from fatigue. When a patient's hypoxemia does not respond to high levels of oxygen, the cause is pathologic intrapulmonary shunting. The correct answer is: a significant intrapulmonary shunt. 10 7. An adult patient has been admitted to the emergency department with the following arterial blood gas results: pH 7.49 PaCO2 40 torr PaO2 99 torr HCO3- 50 mEq/L The physician asks the respiratory therapist what the results show. The therapist should respond that the results are interpreted as: A. respiratory acidosis. B. respiratory alkalosis. C. metabolic alkalosis. D. metabolic acidosis. The pH shows an alkalosis. The PaCO2 is normal. The bicarbonate is elevated, which shows metabolic alkalosis. The best interpretation of these results is metabolic alkalosis. The correct answer is: metabolic alkalosis. 11 8. An elderly patient with a history of very significant emphysema presents to the emergency department (ED) with shortness of breath. The ED physician asks the respiratory therapist which value in the patient's ABG analysis would be most reflective of the severity of the patient's pulmonary disease. The therapist's response should be: A. PaCO2 B. pH C. HCO3- D. PaO2 The arterial bicarbonate level is most reflective of chronic CO2 retention. The other values will be more affected by the patient's acute condition. The correct answer is: HCO3- 12 9. A patient has been admitted to the emergency department with the following arterial blood gas results: pH 7.25 PaCO2 30 torr PaO2 80 torr HCO3- 12 mEq/L The physician asks the respiratory therapist what the results show. The therapist should interpret the results as: A. uncompensated respiratory alkalosis. B. partially compensated metabolic acidosis. C. uncompensated respiratory acidosis. D. partially compensated metabolic alkalosis. The patient's PaCO2 is low, showing respiratory alkalosis. The bicarbonate is critically low, showing metabolic acidosis. The pH is acidic, so metabolic acidosis is the primary disorder. Hyperventilation is a compensatory mechanism in this scenario. Since the pH is not normal, the compensation is not complete. The correct answer is "partially compensated metabolic acidosis." The correct answer is: partially compensated metabolic acidosis. 13 10. The respiratory therapist obtains the following arterial blood gas results on a 50-year-old male patient on room air. pH 7.31 PaCO2 55 torr PaO2 60 torr HCO3- 25 mEq/L Which of the following is most likely based on these findings? A. acute respiratory alkalosis with mild hypoxemia B. normal blood gas with mild hypoxemia C. fully compensated metabolic acidosis with mild hypoxemia D. acute uncompensated respiratory acidosis with mild hypoxemia The pH is acidic and out of normal range because of an increase in PaCO2. The normal HCO3- reveals a lack of compensation, suggesting that this is an acute condition. The correct answer is: acute uncompensated respiratory acidosis with mild hypoxemia 14 11. You would expect a patient with acute respiratory acidosis to have a base excess in the range of: A. + 6 mEq/L B. - 6 mEq/L D. +/- 2 mEq/L E. +/- 8 mEq/L In acute (uncompensated) respiratory acidosis, the base excess should always fall within the normal range. On the other hand, when renal compensation is occurring in response to a chronic respiratory acidosis, the base excess should rise above the normal range (due to the increased levels of HCO3). The correct answer is: +/- 2 mEq/L 15 12. Which of the following ABG results would you most likely see for a patient who is having a mild asthma attack? A. pH = 7.30 PCO2 = 49 torr PO2 = 61 torr B. pH = 7.41 PCO2 = 51 torr PO2 = 51 torr C. pH = 7.46 PCO2 = 31 torr PO2 = 61 torr D. pH = 7.45 PCO2 = 42 torr PO2 = 52 torr A mild asthma attack usually results in a respiratory alkalosis with hypoxemia. Therefore, there is only one answer choice that could be correct. The correct answer is: pH = 7.46 PCO2 = 31 torr PO2 = 61 torr 16 13. Review the results of an arterial blood gas analysis: pH 7.29 PaCO2 23 torr HCO3 11 mEq/L BE -14 PaO2 111 torr This data indicates which of the following? A. primary metabolic acidosis B. primary metabolic alkalosis C. primary respiratory alkalosis D. primary respiratory acidosis The pH is acidotic indicating that the primary problem is causing acidosis. The low bicarbonate & base excess confirm that the acidosis is metabolic in origin. The low PaCO2 indicates that the patient is hyperventilating. In the presence of a primary metabolic acidosis, a low PaCO2 (same direction change as the HCO3), represents a (partial) compensation for the metabolic acidosis. The correct answer is: primary metabolic acidosis 17 14. A patient with a 9-year history of chronic bronchitis and an acute pneumonia exhibits the following ABG results on room air: pH = 7.21 PCO2 = 64 torr HCO3 = 25 mEq/L PO2 = 39 torr P(A-a)O2 = 41 torr Which of the following best describes this patient’s condition? A. acute hypercapnic respiratory failure B. chronic hypercapnic respiratory failure C. acute hypoxemic respiratory failure D. combined hypercapnic/hypoxemic respiratory failure A patient with a high PCO2, low PO2 and elevated P(A-a)O2 is suffering from a combined form of respiratory failure, that is combined hypercapnic and hypoxemic respiratory failure. The correct answer is: combined hypercapnic/hypoxemic respiratory failure 18 15. A patient is receiving VC-SIMV with 35% O2 and has following arterial blood gas results: pH 7.52 PaCO2 28 torr PaO2 83 torr HCO3 23 mEq/L BE -1 The blood gas results indicate: A. acute hypoxemic failure B. respiratory acidosis with hypoxemia C. uncompensated respiratory alkalosis D. hyperchloremic metabolic alkalosis This blood gas indicates an acute or uncompensated respiratory alkalosis as shown by an elevated pH (alkalemia) in the presence of a lower than normal PCO2 (hyperventilation) with a normal HCO3. In addition, oxygenation is normal (hypoxemia is not present). The correct answer is: uncompensated respiratory alkalosis 19 16. A patient’s ABG shows respiratory alkalosis. Which of the following problems is most likely? A. hypoxemia B. hypothermia C. opiate overdose D. CNS depression Causes of respiratory alkalosis in patients with normal lungs include anxiety, fever, stimulant drugs, CNS lesions, pain and sepsis. On the other hand, respiratory alkalosis in those with cardiopulmonary disorders is most likely due to arterial hypoxemia. Respiratory alkalosis also can occur as an iatrogenic complication of mechanical ventilation, i.e., providing a minute ventilation in excess of the patient’s needs. Hypothermia, CNS depression and an overdose of opiates would all tend to depress respiration and result in respiratory acidosis. The correct answer is: hypoxemia 20 17. Based on the following ABG report, what is the most likely acid-base diagnosis? pH = 7.51 pCO2 = 45 torr HCO3 = 35 mEq/L A. acute (uncompensated) metabolic alkalosis B. combined respiratory & metabolic alkalosis C. acute (uncompensated) respiratory alkalosis D. fully compensated respiratory alkalosis The pH is above normal (alkaline). The PCO2 is in the normal range and thus not a factor in the alkalosis. The HCO3 is high, which indicates a primary metabolic alkalosis. Since the PCO2 is normal, no compensation is occurring and the problem is an acute or uncompensated metabolic alkalosis. The correct answer is: acute (uncompensated) metabolic alkalosis 21 18. After reviewing the ABG report on a patient, you note a CO2 of 25 torr, a base excess of –10 mEq/L, and a pH of 7.35. You would characterize this acid-based abnormality as: A. compensated metabolic acidosis B. acute (uncompensated) metabolic acidosis C. compensated respiratory alkalosis D. acute (uncompensated) respiratory alkalosis First, you should recognize that compensation is occurring with this patient because both the PaCO2 and BE are abnormally low. Second, because the pH is less than 7.40, you can conclude that the primary problem is the one causing acidosis, in this case the low BE (–10 mEq/L). Therefore, the low PaCO2 must represent compensation for the low BE. Conclusion: the patient has a compensated metabolic acidosis. The correct answer is: compensated metabolic acidosis 22 19. According to the following ABG report, what is the most likely acid-base diagnosis? pH = 7.42 pCO2 = 20 torr HCO3 = 12.6 mEq/L A. partially compensated respiratory alkalosis B. fully compensated respiratory alkalosis C. combined respiratory & metabolic alkalosis D. acute (uncompensated) respiratory alkalosis The pH is normal, but slightly alkaline. The PCO2 is low, indicating hyperventilation and a possible respiratory alkalosis. The HCO3 is low. With the slightly alkaline pH and low PCO2, the low HCO3 must be compensation for the respiratory alkalosis; Since the pH is in the normal range, the problem is a fully compensated respiratory alkalosis. The correct answer is: fully compensated respiratory alkalosis 23 20. Your patient has a pH of 7.57 and a PaCO2 of 49 torr. Based on this data, what is the primary acid-base disturbance? A. respiratory alkalosis B. metabolic acidosis C. respiratory acidosis D. metabolic alkalosis