TMC EXAM A Questions with answers, 100% Verified. Rated A+

TMC EXAM A Questions with answers, 100% Verified. Rated A+ A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent wi ...

TMC EXAM A Questions with answers, 100% Verified. Rated A+ A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with - ✔✔-heart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? - ✔✔-Needle aspirate the 2nd left intercostal space All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT - ✔✔-using a low residual volume, low compliance cuff A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend - ✔✔- deep breathing & coughing to clear secretions A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? - ✔✔-IPPB A healthy adult female can exhale what portion of her forced vital capacity in the first second? - ✔✔- 70% A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. respiratory rate 3. inspiratory flow 4. sensitivity - ✔✔-1, 2, and 3 only Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? - ✔✔-insert a chest tube Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. - ✔✔-5.0 vol % A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance? - ✔✔-50 mL/cm H2O Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 76%. Which of the following would be most appropriate at this time? - ✔✔-Reintubation Which of the following patients would most likely benefit from pressure support ventilation? - ✔✔-A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min. A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? - ✔✔- obtain a sputum gram stain Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV - ✔✔-1 & 2 only The respiratory therapist provides education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will - ✔✔-retard bacterial growth A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from - ✔✔-pleural effusion Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? - ✔✔-12 Fr A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that - ✔✔-the endotracheal tube has slipped into the right main stem bronchus. The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to - ✔✔-apply pressure to the site A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? - ✔✔- elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - ✔✔-5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes? - ✔✔-air leak around the sensor A patient on the general medical ward receives oxygen via 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? - ✔✔-55 L/min Which of the following measurements is most indicative of congestive heart failure? - ✔✔-pulmonary capillary wedge pressure of 30 mmHg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for - ✔✔-10 seconds or longer A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT - ✔✔-hypoxemia What size endotracheal tube would be appropriate for an adult female patient? - ✔✔-7.0 to 7.5 mm The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should - ✔✔-initiate an expiratory hold just prior to the next ventilator-delivered breath. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PCWP 4 mm Hg PAP (mean) 8 mm Hg CVP 2 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend - ✔✔-IV fluid challenge What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? - ✔✔-VC provides a constant minute ventilation Bronchial breath sounds heard over the lung periphery indicate - ✔✔-lung consolidation During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? - ✔✔-Normal lung function A 55 year-old male patient is evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should - ✔✔-terminate the procedure immediately At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? - ✔✔-6 & 10 The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? - ✔✔-0.50 mL After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist documents a need to change the patient's treatment regimen in the Progress Notes. The respiratory therapist should - ✔✔-check the medical record for new physician orders A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? - ✔✔-change to airway pressure release ventilation In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a - ✔✔-3.0 L syringe While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Atelectasis - ✔✔-2, 3, and 4 only Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as - ✔✔-a persistent bronchopleural fistula A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? - ✔✔-obtain an ABG A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from - ✔✔-myocardial infarction A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? - ✔✔-bronchial provocation Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend - ✔✔-antibiotic therapy A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? - ✔✔-enough to achieve a pressure of 25-35 cm H2O All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT - ✔✔- pulmonary hypertension Which of the following factors are determinants of cardiac output? - ✔✔-stroke volume and heart rate The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 10 mEq/L; SaO2 95%; BE -15 mEq/L. The respiratory therapist should recommend - ✔✔- administering sodium bicarbonate. The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request? - ✔✔-decelerating An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is - ✔✔- ventilation/perfusion mismatch A 16 year-old patient with cystic fibrosis attends high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient? - ✔✔-Vibratory/oscillatory PEP A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as - ✔✔- orthopnea A patient receiving oxygen therapy at home calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to - ✔✔- switch to a nasal cannula A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? - ✔✔-Insert a nasopharyngeal airway after bleeding has been controlled. The most probable cause of air bronchograms and increased density on a chest x-ray is - ✔✔-pneumonia Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 torr and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? - ✔✔-increase the FiO2 The primary source of infection in the health care setting is - ✔✔-poor handwashing techniques of personnel A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? - ✔✔-regular coughing and deep breathing The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is - ✔✔-placing the syringe in an ice bath Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? - ✔✔- increased fremitus A spontaneous breathing trial is initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 40 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient's vital signs remained stable throughout the trial. Which of the following is the most appropriate recommendation? - ✔✔-extubate the patient After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include 1. bronchospasm. 2. pneumothorax. 3. pulmonary hemorrhage. - ✔✔-1, 2 and 3 A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? - ✔✔-Head down, patient prone with a pillow under hips A 72 year-old female post stem cell transplant patient in the ICU complains of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? - ✔✔-moderate heart failure Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? - ✔✔- Endobronchial intubation The respiratory therapist performs the quality control procedures for the blood gas analyzer in the NICU and notices a single data point that is 3 standard deviations from the mean value for the pH electrode. The therapist should - ✔✔-perform another control run A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? 1. Increase the pressure limit 2. Increase the sensitivity 3. Increase the mandatory rate 4. Decrease the inspiratory time - ✔✔-1 and 3 only A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient? - ✔✔-lung expansion therapy A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a minimal occluding volume. This would indicate that the - ✔✔-tube is not of the appropriate size A patient receives oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80 torr, HCO3 38 mEq/L. The most likely explanation for these results is that - ✔✔- the numbers were not reported correctly The respiratory therapist completes oxygen rounds and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? - ✔✔-Ethyl alchoho