TMC EXAM 8, Questions with answers, 100% Accurate. Latest update.

TMC EXAM 8, Questions with answers, 100% Accurate. Latest update. A patient with an ideal body weight of 80-kg (176-lb) is being evaluated for cessation of mechanical ventilation. The following weaning parameters an ...

TMC EXAM 8, Questions with answers, 100% Accurate. Latest update. A patient with an ideal body weight of 80-kg (176-lb) is being evaluated for cessation of mechanical ventilation. The following weaning parameters and clinical data are available: Vital Capacity 1.2 L RSBI 50 Spont VT 400 mL Resp Rate 20/min Which of the parameters is the most reliable indicator that the patient is ready for cold cessation of mechanical ventilation? A. VC B. RSBI C. RR D. Spont VT - ✔✔-The correct answer is : B Explanation : The rapid shallow breathing index is the best indicator that the patient is ready for weaning in this scenario. RSBI = RR/VT. A result less than 106 is acceptable. 50 is well below and suggests the patient should be able to successfully wean off mechanical ventilation. A respiratory therapist is preparing a smoking cessation program to be used in conjunction with pulmonary rehabilitation. The therapist should include which of the following methods of support in the plan? A. Counseling for associated emotional challenges B. Acetylzolamide (Diamox) C. electronic vapor cigarrettes D. Daily telephone reminders not to smoke - ✔✔-The correct answer is : A Explanation : A person trying to stop smoking must conquer both physiological and psychological barriers. Appropriate methods of support include emotional counseling and nicotine replacement therapy. A neonate born 48 hours ago is receiving time-cycled, pressure-limited mechanical ventilation in the NICU. How should the patient's fluid output be measured? A. Press and assess duration for blanched skin to return to normal B. Periodically weigh the neonate C. Weigh the diaper D. Insert a urinary catheter - ✔✔-The correct answer is : C Explanation : Fluid control is vital in managing the care of a neonate. It may not seem very scientific to weigh the diaper, but it is the most reliable and practical of the choices offered. A respiratory therapist is performing endotracheal suctioning of a patient with thick, tenacious secretions. Suctioning has been difficult and somewhat ineffective. Which of the following would be most helpful at increasing the effectiveness of suctioning? A. increasing suction catheter length B. increasing suction catheter size C. increasing suction pressure D. increasing suction duration - ✔✔-The correct answer is : B Explanation : To increase the effectiveness of suctioning, increasing suction catheter size, increasing suction pressure, and increasing duration are three methods that may be used. The most effective method is to increase the suction catheter size. However, caution must be used. The suction catheter size may not exceed half the diameter of the endotracheal tube. If the patient is already using a maximum suction catheter size than an increase in suction pressure is the next choice. A respiratory therapist is called to the nursery to assess a 36-week gestational age neonate delivered five hours prior. Supraclavicular retractions are present. Respiratory rate is 70/min with nasal flaring and grunting. Radiological examination has a honeycomb pattern in the chest. The respiratory therapist should A. intubate and mechanically ventilate B. place the patient on a 40% oxygen hood C. place the patient on a nasal cannula at 2 L/min D. intubate and deliver surfactant - ✔✔-The correct answer is : D Explanation : Radiological descriptions such as "honeycomb" or "ground glass" patterns suggest RDS. These signs along with the respiratory distress of a premature neonate strongly suggest the need for surfactant therapy, which must be delivered through an endotracheal tube. Intubation is necessary for delivering surfactant. A newborn with IRDS is being mechanically ventilated in the time-cycled, pressure-limited SIMV mode. The physician would like to increase minute ventilation. In order to accomplish this request, the respiratory therapist would make what modification? A. Change to a volume-cycled mode B. Decrease flowrate C. Increase tidal volume D. Increase I-time - ✔✔-The correct answer is : D Explanation : Unlike volume ventilation, time-cycled pressure-limited mechanical ventilation will deliver more volume per breath when inspiratory time is increased. Because the breath will be delivered for a longer period of time at a constant flow rate, ventilation will increase. It is not appropriate to change to a volume-cycled mode on a newborn. Tidal volume is not a direct control in this mode and therefore is an incorrect answer. Decreasing the flow rate would result in a reduction in ventilation. The low exhaled volume alarm is sounding on a patient receiving volume controlled ventilation. Which of the following could correct the problem? A. suction the patient B. add air to the ET tube cuff C. check for a pneumothorax D. drain excess water in the ventilator circuit - ✔✔-The correct answer is : B Explanation : The solution to this problem is to pick those things that could cause a low volume alarm to sound. In most cases this would be a leak of some sort. When you examine the answers you do not directly see the causes of the alarms but you see the possible solutions. You must examine each solution and determine if the alarm would be a high pressure or a low-pressure alarm or something else. Suctioning the patient would presumably be because of excess secretions and would result in a highpressure alarm. Adding air to the ET tube cuff, if the cuff was deflated, would result in a low-pressure alarm. So, that option has to be a correct one. Excess water and the ventilator circuit and the possibility of a pneumothorax would both result in a high-pressure alarm, and therefore cannot be the correct answer. Two only is the correct answer. A patient with cystic fibrosis is receiving oxygen via a nasal cannula set at 5 L/min become somewhat unresponsive and confused. SpO2 is 99%. The therapist should recommend which of the following as a first action? A. Lower the oxygen flow rate B. Switch to a non-rebreathing mask C. Increase the oxygen flow D. Begin mechanical ventilation - ✔✔-The correct answer is : A Explanation : Cystic fibrosis is a disease associated with chronic obstruction and is therefore considered to be COPD. Patients with COPD should not receive more than 1-2 liters per minute by nasal cannula or more than 28% oxygen by any device. Excessive oxygen delivery can lead to suppression of the ventilatory drive and result in unresponsiveness and confusion. An oxygen saturation of 94% or less should be maintained. A patient with COPD is found with shallow respirations and is disoriented to time and place. The patient is receiving oxygen by Venturi mask set at 45%. SpO2 is 99%. The therapist should first do which of the following? A. switch to a nonrebreathing mask set at 12 L/min B. institute mechanical ventilation C. decrease FIO2 to 0.28 D. switch to a nasal cannula at 5 L/min - ✔✔-The correct answer is : C Explanation : A patient with COPD should not receive more than 28% oxygen, or more than 1-2 liters per minute by nasal cannula. Excessive oxygen delivery can result in suppression of the ventilatory drive, which can lead to disorientation, hypoventilation, and ventilatory failure. Oxygen saturation should be kept at or below 94%. Which of the following would be the best medication to use with a patient who will require oral intubation in an emergent setting? A. Valium B. Versed C. Flurazepam D. Anectine - ✔✔-The correct answer is : D Explanation : The drugs most commonly used to facilitate intubation are Anectine (succinylcholine), Pavulon (pancuronuim bromide), Curare (d-tubocurarine) and Vecuronium. Valium and Versed are anxiety/pain relievers. Flurazepam is used to treat insomnia. An 8-year-old hypotensive male patient has been brought in by paramedics to the emergency room following a house fire. He was found unconscious in the garage where smoke was prevalent. Which of the following is a definitive measure to assess carbon monoxide poisoning? A. Rapid measurement with a multiple wavelength spectrophotometer B. Methemoglobin level C. Carboxyhemoglobin level D. Arterial blood gas - ✔✔-The correct answer is : C Explanation : The clinical background strongly suggests smoke inhalation, which would result in carbon monoxide poisoning. The most definitive way to assess for this condition is by measuring the carboxyhemoglobin level in the blood. One might be tempted to select rapid measurement with a spectrophotometer, but the keyword "definitive" in the question indicates that a diagnostic procedure should be utilized. A respiratory therapist must gather equipment for an arterial puncture on an adult female patient. The correct needle size is A. 22 gauge B. 12 gauge C. 18 gauge D. 25 gauge - ✔✔-The correct answer is : A Explanation : The respiratory therapist is often most concerned with the procedure involved with arterial puncture, or complicated blood gas analyses. However, it is necessary to know the basic recall facts such as the needle size for an adult which is most commonly a 22 gauge needle. A respiratory therapist is called to the recovery room to find a 16-year-old male patient who was recently extubated experiencing anxiety and difficulty breathing. Breath sounds are clear over the chest, with a high-pitched noise heard over the upper airway. The respiratory therapist should recommend A. aerosolized racemic epinephrine B. Decadron injection C. heated aerosol D. cool mist aerosol - ✔✔-The correct answer is : A Explanation : The high-pitched noise heard over the upper airway is also known as stridor and is best treated by delivering aerosolized racemic epinephrine. Cool mist aerosol is also an option to be considered, however, in this case because the patient is experiencing difficulty breathing and anxiety, a more aggressive therapy should be selected. A respiratory therapist is unable to suction thick secretions from an adult patient who requires frequent NT suctioning through a nasal trumpet. The regulator is set to -120 mm Hg. The catheter is 14-Fr. What should the respiratory therapist recommend? A. Increase the suction pressure B. Increase the suction duration C. Remove the nasal trumpet D. Instill normal saline down the suction catheter prior to applying suction - ✔✔-The correct answer is : B Explanation : In this example the suction pressure cannot be increased because the maximum parameter has already been reached. The catheter size should not be increased because it will then exceed half of the diameter of the nasal trumpet. The only viable option is to suction for a longer period of time. Which of the following statements is correct regarding suctioning of an adult patient with tuberculosis? A. All suctioning should be done as needed only B. Alert patients with spontaneous coughs should not be suctioned C. Insertion of a nasal pharyngeal airway should be facilitated with a petroleum based lubricant D. Suction pressure should not exceed -110 mmHg - ✔✔-The correct answer is : A Explanation : Regardless of the disease, suctioning should be reserved for PRN, or as needed situations. Suction pressure should not exceed -120 mm Hg. A nasopharyngeal airway should not be inserted with lubricants that are petroleum or oil-based. While it may seem unusual to suction alert patients with a spontaneous cough, it is permissible and indicated for a patient with rhonchi. An appropriate way to respond to an asthmatic patient who experiences nausea and tingling in her digits with albuterol therapy is to A. tell the patient not to breathe so deeply during the treatment. B. explain in simple words that these are normal, harmless side effects. C. reduce the dosage of the medication within limits. D. reduce the flowrate to the nebulizer during therapy. - ✔✔-The correct answer is : C Explanation : This is an example of therapy modification. It is important to maintain all therapy within the therapeutic range as modifications are made. For example, if one option suggested that the medication be reduced to a non-therapeutic level, it would be incorrect. In this case we have an option that permits a reduction of the dosage within proper limits, which is the correct choice. An adult female weighing 168 lbs is receiving pressure-cycled noninvasive ventilation with a Bird Mark 7. The machine-delivered pressure breaths are not cycling off as expected. What should the respiratory therapist do? A. Suction the patient B. Reduce inspiratory time C. Observe the pressure/volume curve in the ventilator graphics D. Look for a leak in the circuit - ✔✔-The correct answer is : D Explanation : Pressure-cycled mechanical ventilation cycles into exhalation once the preset pressure is reached. If the breaths will not cycle off, a leak exists. The leak may be coming from the patient's mouth or the circuit itself. Therefore the best answer is to look for a leak in the circuit. A patient receiving mechanical ventilation has the following arterial blood gases: pH 7.29 PaCO2 55 torr PaO2 60 torr HCO3- 26 mEq/L BE 1.2 mEq/L After increasing minute ventilation, what new ABG would most likely be seen? A. ph 7.30, PaCO2: 45 torr, PaO2 60 torr B. pH 7.25, PaCO2: 59 torr, PaO2 65 torr C. pH 7.34, PaCO2: 45 torr, PaO2 60 torr D. pH 7.32, PaCO2: 48 torr, PaO2 68 torr - ✔✔-The correct answer is : D Explanation : Increasing minute ventilation should reduce PaCO2, and increase pH. Because CO2 is an acid, the higher the level of the CO2 in the blood, the lower the pH. You will notice also that the PaO2 has increased. It is important to solve the problem of insufficient ventilation prior to insufficient oxygenation because as ventilation improves, oxygenation should also improve to some degree. A patient has two different views of a chest x-ray in the medical record. One is an anterior/posterior view and the other is a lateral view. Both findings show blunt costophrenic angles. The most likely diagnosis associated with these findings is A. pulmonary edema. B. pleural effusion. C. double pneumothoraces. D. COPD. - ✔✔-The correct answer is : B Explanation : A chest X-ray reveals a pleural effusion if one sees descriptors such as "blunt or obliterated costophrenic angles", or "concave superior interface". Regarding patient safety while performing a heel stick on a newborn, the most important thing to consider is A. warming the heel for one minute prior to puncture. B. location of the puncture. C. level of the capillary tube while filling. D. depth of skin puncture. - ✔✔-The correct answer is : B Explanation : One might be tempted to select the depth of the puncture, but actually more concerning is the location. Heel sticks should not be performed on a neonate in an area of their foot that they will walk on in the future as they grow. Damage to this area of the foot can result in difficulty with future ambulation. Therefore, heel sticks are performed on the lateral area of the heel. During the administration of a breathing treatment with Albuterol, the patient suddenly complains of nausea. Heart rate has risen from 80/min to 102/min. The respiratory therapist should A. Discontinue the therapy B. Instruct the patient to breath slower C. Continue treatment but monitor carefully D. Plan to reduce dosage for future treatments - ✔✔-The correct answer is : A Explanation : Adverse reactions during any therapy should be responded to initially by discontinuing therapy and notifying the physician. Which of the following conditions would be most helped by therapy intended for secretion mobilization? A. pulmonary edema B. bronchiectasis C. hemothorax D. bronchiolitis - ✔✔-The correct answer is : B Explanation : Bronchiectasis is a condition which may exist along with several other disease states. While there are multiple types of bronchiectasis, the common outcome is a considerably high amount of sputum produced by the lung. Secretion mobilization therapies should be selected for a patient with bronchiectasis. A high-frequency chest wall occilation device would be the most appropriate tool for use in which of the following patients? A. adult patient with long-term requirements for home mechanical ventilation B. adult patient with ARDS resulting in decreased lung compliance C. 5-year-old child with cystic fibrosis not cooperating with CPT D. 20-year-old patient with cystic fibrosis tolerating CPT in trendelenburg - ✔✔-The correct answer is : C Explanation : High-frequency chest wall oscillation is an alternative device to help mobilize secretions. It is especially helpful for a patient who cannot tolerate the head-of-bed down position that is associated with normal chest physiotherapy. A pediatric patient with cystic fibrosis is receiving postural drainage and percussion for right lower lobe pneumonia with his head down at 30-degrees, three times a day for 20 minutes. The therapy is very effective, but after 15 minutes, the patient complains of difficulty breathing. What should the respiratory therapist recommend? A. Decrease the degree of trendelenburg. B. Increase the degree of trendelenburg. C. Change to PEP therapy. D. Reduce the duration of the therapy. - ✔✔-The correct answer is : D Explanation : In this case, the best option is to decrease the therapy time. Changing the position of the patient would dysfunctionalize the therapy and is not appropriate. A respiratory therapist would expect what change to occur to the deadspace to tidal volume ratio when a patient is intubated and placed on a mechanical ventilator? A. increase at first, then gradually decrease B. decrease C. no change D. increase - ✔✔-The correct answer is : D Explanation : The initial value would be a low end-tidal CO2, followed by a steady and slow rise. During surgery, a patient is placed on an infrared absorption device. Capnographic waveforms are normal. The difference between measured PaCO2 by arterial blood gas analysis and expired gas measurement by capnography is within expectations. PaCO2 is 40 mm Hg. What is the patient's estimated VD/VT? A. 50% B. 40% C. 60% D. 25% - ✔✔-The correct answer is : D Explanation : VD/VT = (PaCO2 - PetCO2)/PaCO2. End tidal CO2 varies from PaCO2 by about 10 mm Hg. (reading lower) Therefore, (40-30)/40 = 0.25 or 25%. What equipment should a respiratory therapist gather when standing by to assist the physician with a cardioversion? A. bronchoscope B. manual resuscitator C. mechanical ventilator D. IPPB - ✔✔-The correct answer is : B Explanation : Cardioversion should be done with resuscitation equipment available because the sedation may severely compromise a patient's airway, and the procedure itself may cause the patient to slip into more deadly rhythms like pulseless V-tach or V-fib. A bronchoscopy is NOT used to diagnose A. malignant processes. B. atelectasis. C. pathogenic involvement. D. foreign body obstruction. - ✔✔-The correct answer is : B Explanation : Bronchoscopy is used to diagnose foreign body obstructions, active bleeding causes, pathogenic involvement (to identify organisms) and cancerous or malignant processes or areas. It may help decrease atelectasis if immobilized mucous plugs are blocking a portion of the lung from expanding, but it does not serve in the diagnosis of atelectasis. A COPD patient on 5 L/min nasal cannula in the emergency room is complaining of continuing shortness of breath and has the following arterial blood gas results: pH 7.37 PaCO2 48 mm Hg PaO2 39 mm Hg HCO3- 29 mEq/L BE +2 mEq/L What is the appropriate intervention? A. NRB mask B. intubation C. CPAP 5 cmH20 D. 8 L/min nasal cannula - ✔✔-The correct answer is : A Explanation : The patient is experiencing severe hypoxemia to a level that is not consistent with maintaining life function. While we are often uncomfortable increasing oxygen flows to COPD patients, this should not stop us from treating the problem. 8 L /min is not appropriate because it exceeds the limits of a nasal cannula. Following a complete sleep study, it is determined that a 45-year-old male requires bi-level therapy at home, with supplemental nocturnal oxygen. Which of the following is indicated? A. nocturnal oximetry study B. oxygen bleed-in device C. arterial blood gas D. blood pressure monitoring - ✔✔-The correct answer is : B Explanation : The best device for home oxygen therapy is a molecular sieve device, commonly known as an oxygen concentrator. This device is powered with electricity, which makes it appropriate for home use. Which of the following may NOT be used with a face mask? A. Wright's respirometer B. peak flow meter C. NPPV D. CPAP - ✔✔-The correct answer is : B Explanation : A respiratory therapist can achieve the goals of CPAP, NPPV, and even a Wright's respirometer with the use of a facemask. However a peak flow meter must be positioned between the teeth of the patient with the lips sealed, and nose plugged in order to achieve accurate peak-flow measurements. Which of the following are associated with a fenestrated tracheostomy tube? A. silver B. foam cuff C. button D. cap - ✔✔-The correct answer is : D Explanation : A fenestrated tracheostomy tube has an inner cannula with a hole to facilitate talking and weaning. It also has an inner cannula for resuscitation, or mechanical ventilation. The cuff is like that of an endotracheal tube, low-pressure, high-volume. And finally, a cap is used to close the tube for speech therapy. When the cap is used, the inner cannula should be removed and the cuff should be deflated. A capnographic tracing shows tidal waveforms within normal, expected ranges for the first hour of surgery. Suddenly, the waveform becomes flat and the value drops to nearly zero. This would be caused by A. apnea. B. low cardiac output. C. hypovolemia. D. a disconnection of the capnograph probe from the circuit. - ✔✔-The correct answer is : D Explanation : A sudden drop in CO2 would be caused by a mechanical malfunction, or disconnection from the patient. Too often we become focused on monitors and graphics, and lose our focus on the patient and basic equipment connections. An artificial nose is A. helpful for thinning thick secretions. B. ideal for post operative patients with hypothermia. C. ineffective with copious secretions. D. sometimes called a nasal trumpet. - ✔✔-The correct answer is : C Explanation : An artificial nose, also known as a heat moisture exchanger (HME), may easily become clogged with secretions and rapidly loses its effectiveness in the presence of thick, copious sputum. It should be replaced with a conventional heated humidification system when secretions are a problem for the patient. A post-operative female patient with atelectasis is ordered to receive SMI every hour while awake. A respiratory therapist instructs the patient to self-administer a single-patient-use, volume-oriented incentive spirometer with a flow rate sensor. The volume column reaches 1250 mL, 50% of her predicted inspiratory capacity. The flow sensor immediately reaches the top of the column regardless of the patient's varying flowrates. You would A. send the spirometer to central for cleaning. B. continue therapy with the spirometer. C. replace the spirometer. D. coach the patient to observe the volume column only. - ✔✔-The co