Question Answer
What defines a “Low Flow System”? Oxygen administering devices that do not meet ALL of the patient’s inspiratory needs.
What defines a “High Flow System”? Oxygen administering devices that provide for ALL of the patient’s inspiratory needs.
Examples of low flow systems? Nasal catheter, Nasal cannula, Simple oxygen mask, Partial rebreathing mask
Examples of high flow systems? Nonrebreathing mask, Air entrainment mask (Venturi mask), Aerosol mask, Face tent, Tracheostomy collar, T-tube
Increase in either tidal volume or RR does what to the O2% the patient receives from a low flow system? Decreases the O2% due to more 21% room air being inhaled.
Decrease in tidal volume or RR does what to the O2% received from a low flow system? Increases the O2% due to more 100% O2 being inhaled.
What are the factors that effect O2% being delivered by a low flow system Flowmeter setting, Patients breathing pattern (RR, Tv, Inspiratoy flowrate), Anatomical reservoir, Equipment reservoir
Criteria for low flow systems? Tv : 300mL – 700mL, RR : <25 Breaths per min, Breathing pattern is regular and consistent
Venturi mask: INDICATIONS? Pts requiring low concentrations of O2(Chronic CO2 retention, COPD, chronic alveolar hypoventilation), When exact O2 concentrations are needed, Pts with changing breathing patterns
Venturi mask: LIMITATIONS? Pulmonary asperation, Pressure necrosis, must be removed to eat, uncomfortable, must be on tight to ensure O2%, air entrainment must remain in tact.
Ratio for 24%? 1:25
Ratio for 28%? 1:10
Ratio for 31%? 1:7
Ratio for 35%? 1:5
Ratio for 40%? 1:3
Ratio for 60%? 1:1
Ratio for 70%? 1:0.6
Ratio for 100%? 1:0
Formula for total flow? Flowmeter setting X sum of parts in ratio
Peak inspiratory flowrate =? (formula) MV x 3
Minute volume =? (formula) RR x Vt
Factors affecting the O2% delivered from an Air-entrainment mask (Venturi mask) Size of the jet orifice, size of the entrainment port, amount of downstream resistance.
An increase in the size of the jet orifice causes? (VENTURI MASK, LVN) Decreases the amt of room air entrained, increases the amt of 100% O2 in the mask, provides less total flow, causes higher O2 concentrations.
A decrease in the size of the jet orifice causes? (VENTURI MASK, LVN) Increases the amt of RA entrained, decreases the amt of 100% O2 in the mask, provides higher total flow, lower O2 concentration.
Cylinder factor for an E tank? 0.28 L/PSI
Cylinder factor for an H tank? 3.14 L/PSI
Formula to determine cylinder factor? (capacity X 28.3) / presssure in a full cyl
Formula to determine tank duration? (pressure X factor) / flowrate
What are the disadvantages of an uncompensated flowmeter? when exposed to back pressure it indicates the incorrect flowrate delivered to the patient (lower than delivered)
Where is the needle valve located on an uncompensated flowmeter? proximal to the thorpe tube
Goals of oxygen therapy? decrease the work of breathing, decrease the work of the heart, treatment of hypoxemia
What is the difference between Hypoxia and Hypoxemia? Hypoxemia is decreased levels of oxygen in the BLOOD, Hypoxia is decreased levels of oxygen in the TISSUE
Formula to determine Air/O2 dilution ratio? A:100-O2 concentration, B:O2 concentration-21, A/B
Indications for NASAL CANNULA? patients with chronic CO2 retention (COPD), chronic alveolar hypoventilation, need low concentrations of O2, stable respiratory rate and tidal volume
Limitations of NASAL CANNULA? unstable (easily dislodged), not suitable for pts with varying inspiratory needs, inadequate O2 delivery in Mucosal Edema, Deviated septum, excessive mucous drainage, nasal polyps, flowrates above 6lpm do not increase O2%, doesn’t provide exact O2%
Indications for SIMPLE O2 MASK? delivery of medium concentrations of O2, post operative patient, temporary therapy while waiting for definate plans
Limitations for SIMPLE O2 MASK? doesn’t provide exact O2%, pulmonary aspiration, pressure necrosis, uncomfortable, must be removed to eat, not suitable for pts with varying inspiratory needs
Indications for PARTIAL REBREATHING MASK? provide high concentrations of O2, Cardiac conditions (MI, after CPR), Trauma patients
Limitatiions of PARTIAL REBREATHING MASK? doesn’t provide exact O2%, pulmonary aspiration, pressure necrosis, must be removed to eat, uncomfortable, not suitable for pts with varying inspriatory needs
Indications for NONREBREATHING MASK? Deliver high concentrations of O2 (carbon monoxide poisoning, pneumothorax, CHF, burns, trauma, MI, after CPR), deliver O2/He mixtures, deliver O2/CO2 mixtures
Limitations of NONREBREATHING MASK? Must remain tight on pts face to provide O2% necessary, must be removed to eat, pressure necrosis, pulmonary aspiration, uncomfortable
Indications for VENTURI MASK? Pts requiring low concentrations of oxygen (COPD, Chronic alvoelar hypoventilation), when exact O2 concentrations are needed, patients with changing breathing patterns
Limitations of VENTURI MASK? pulmonary aspiration, pressure necrosis, must be removed to eat, uncomfortable, must be on tight to insure O2% delivery, air entrainment ports must remain in tact
Purpose of humidity? supply moisture to inspired gases for comfort and prevention of damage to the tracheal mucosa, supply moisture that will match the moisture of the body at the point at which inspired gas enters the body
What is humidity? Invisble moisture / Molecular water / WATER VAPOR / water in gaseous form
Indications for bubble diffusion humidifiers? Nasal catheter, nasal cannula, simple O2 mask, venturi mask
Types of humidifiers? Pass over, bubble diffusion, heated
Complications associated with improper humidification? Impaired cilia activity, impaired mucous movement, inflammatory changes in the tracheal mucosa, necrosis of the tracheal epithelium, retention of secretions, atelectasis, pneumonia
Purpose of humidifiers? increase AH, increase the capacity the gas has to hold moisture (when heated), increase the RH of the gas, increase the %BH, Minimize HD
Characteristics of PASS OVER humidifier? Used with incubators, deliver %BH = 30%, not very efficient
Characteristics of BUBBLE DIFFUSION humidifiers? Deliver %BH = 40% same as RA / RH = 100% at room temp, effective at 2-6lpm
Factors influencing the efficiency of humidifiers? Time, surface area, temperature, gas flowrate
Types of heated humidifiers? Cascade humidifier, Wick humidifier
Characteristics of CASCADE humidifier? Gas passes beneath the surface of the water and up through a grid, efficient bubble humidifier, allows for heating of the water, used with mechanical ventilators, delivers 100% RH and 100% BH
Characteristics of WICK humidifier? Deliver precise control of temp and humidity, provide no resistance to inspired gas flow, low risk of infection, deliver 100% RH (at body temp) and 100% BH
Wick humidifier features? high temp alarm (40 degrees Celsius), low temp alarm (27 degrees Celsius), temp probe disconnect
Indications for heated humidifiers? T-tube, tracheostomy collar, whenever the upper airway is bypassed
Complications of heated humidifiers? Bacterial contamination, overhydration, underhydration, hyperthermia, tracheal burns
Factors affecting the delivered temp (heated humidifiers)? Length of tubing, heater setting, room temp, flowrate of gas
Characteristics of PASSIVE humidifiers? Rely on the exhange of heat and water vapor from the pts exhaled gasses for adding moisture, AKA – Artificial nose
Indications of PASSIVE humidifiers? Short term use (24-48hrs), addition of moisture in pts with artificial airways, addition of moisture in mechanically ventilated pts, pts free of secretins and good fluid intake
Disadvantages of PASSIVE humidifiers? Increased resistance to breathing, infection, requires pt with normal body temp, pt must be well hydrated and absent of secretions
Hazards of OXYGEN THERAPY? Oxygen induced hypoventilation, Retrolental fibroplasia (retinopathy of prematurity), Absorption atelectasis, Pulmonary oxygen toxicity
Normal PaO2 in a COPD patient? 50 – 60 mmHg
Normal PaO2 in a newborn <28 days old? 40 – 60 mmHg
Normal PaO2 in a normal patient? 80 – 100 mmHg
Formula to calculate the desired FiO2? (desired PaO2 X Actual FiO2) / Actual PaO2
Guidelines for O2 administration? Make use of the lowest possible FiO2, maintain PaO2 in the normal range for the patient, utilize 100% O2 for 24hrs or less, pts with history of lung disease are more likely to develop complications
Indications for O2 administration? Documented hypoxemia, an acute care situation where hypoxemia is suspected, severe trauma, acute MI, short term therapy or surgical intervention
Contraindications for O2 administration? No specific contraindications to oxygen therapy exist when indications are judged to be present.
Bleed in calculation formula? (V1 X C1)+(V2 X C2) = (V3 X C3) WHEN V1 = Volume (flow) of gas from main gas source, C1 = Conc of main source gas, V2 = Volume (flow) of bleed-in gas, C2 = Conc of bleed-in gas, V3 = Total flow delivered to patient, C3 = Final oxygen conc
Five major routes for transmission of pathogens? Contact, Droplet, Airborne, Vehicle, Vectorborne
Nosocomial means? Hospital Aquired
Characteristics of a nosocomial infection? not present or incubating at the time of or 3 days after admission, infections within 30 days of discharge or an invasive surgical procedure.
Disinfection? asepsis of inanimate surfaces
Antisepsis? asepsis of body surfaces
What is the most common route of nosocomial infection? Contact, due to improper handwashing.
Two types of CONTACT? Direct, indirect
Direct contact? direct transfer of pathogenic organism from one person to another, STD’s
Indirect contact? contact between host and contaminated objects: EX – clothing, dressings, contaminated needles, nebulizers, humidifiers, suction cath, PFT equipment
Droplet? pathogen reaches the cucous membranes of a host via an infected person who is coughing / sneezing / talking
How far can “droplets” travel? up to 3 feet
Droplet examples? Hemophilus influenza, neisseria meningitis, streptococcal, influenza, rubella, mumps
Airborne? pathogen is spread via the air
Airborne aerosol examples? Legionnaire’s Disease, RSV
Airborne droplet nuclei? Residues of evaporated water, suspended in air for long periods of time, EX: TB, Varicella, Measles
Airborne dust particles? fungal infections
Vehicle route of transmission? Contaminated water, food, soil, or drugs
Waterborne vehilce examples? Shigellosis, Cholera
Foodborne vehicle examples? Salmonellosis, hepatitis A, E.Coli
Vectorborne? Infectious diseases transmitted by animals / insects
Vectorborne examples? Lyme’s disease, Malaria, West Nile Virus, Bubonic plaque
MRSA? Methicillin Resistant Staphyloccus Aureus, resistant to most antibiotics, treat with Vanconycin
VRE? Vancomycin Resistant Enterococcus, lack antibiotics to treat VRE
Disease that is continually present in a population, but does not affect a great number of people at any one time? Endemic
Disease having an extensive outbreak affecting a large number of people for a short period of time? Epidemic
World wide distribution of a disease affecting large numbers of people? Pandemic
What can you do to reduce the risk of cross contamination? Use disposable equipment, reduce the use of multiple dose vials, never exchange equipment between patients, follow a regular schedule for changing equipment
Change HIGH RISK equipment how often? 24hrs
Change LOW RISK equipment how often? 72hrs
The single most effective thing to do to fight infectious disease? PROPER HANDWASHING
CPR breaths per minute for an adult using a manual recussitator? 10 – 12 or one every 6 to 7.5 seconds
CPR compression rate for adults? 100 per minute
Compression to ventilation ratio (adult)? 30:2
Question Answer
Twenty minutes after initiating a 5 cm H2O CPAP trial with an F102 of 0.50, the data below are obtained for a patient who weighs 65 kg (143 Ib): Respiratory rate 30 bpm Maximum inspiratory pressure (MIP) -20 cmH20 Vital capacity 1.0 L PH Resume mechanical ventilation
A patient complains of right chest pain while receiving mechanical ventilation. On examination, the respiratory therapist notes tracheal deviation to the left, tachypnea, and decreased breath sounds on the right. The therapist should recommend chest tube placement
A physician has ordered an F1O2 of 0.35 to be delivered to a patient who is breathing spontaneously and has a peak inspiratory flow of 40 L/min. Which of the following would best meet this objective? 35% air-entrainment mask at 8 L/min
Upon palpating a patient’s radial artery for 1 minute, the respiratory therapist notes 90 unevenly spaced beats with decreased pulse strength during inspiration. Which of the following describes the patient’s pulse? pulsus paradoxus
If the oxygen flow to a 40% air-entrainment mask is increased from 8 to 12 L/min, what is the oxygen concentration? 40%
A diagnosis of chronic bronchitis is consistent with which of the following? 1. morning cough 2. daily sputum production 3. frothy pink sputum 1 and 2 only
Twenty-four hours after undergoing upper abdominal surgery, a patient who is 178 cm (5 ft 10 in) tall and weighs 70 kg (154 Ib) readily achieves a set goal of 500 mL with an incentive spirometer. The respiratory therapist should recommend which of the fo Increase the goal.
The respiratory therapist notes that a patient’s chest does not rise when a nondisposable, self-inflating manual resuscitator is used. Which of the following should the therapist do to correct the problem? Reseat the inlet valve.
A ventilator with a galvanic cell analyzer is being used. The low F102 alarm is activated. After confirming that the ordered F102 is being delivered, the respiratory therapist should do which of the following? Replace the fuel cell.
During CPR, an arterial blood gas analysis would be performed to assess which of the following? 1. oxygenation 2. acid-base status 3. carbon dioxide levels 1, 2, and 3
A postoperative patient’s endotracheal tube cuff requires 35 cm H2O to eliminate a leak. This pressure reading is consistent with which of the following? The endotracheal tube is too small
Mixed venous blood gas results reveal a PV02 of 28 torr. The previous PV02 measurement was 39 torr. Based on these data, the most likely conclusion is that the patient’s cardiac output has decreased
A physician orders an increase in PEEP from 5 to 10 cm H2O for a patient who is being mechanically ventilated. Immediately after the new PEEP setting is initiated, the patient’s blood pressure drops dramatically, and the heart rate increases by 30/min. Wh Decrease the PEEP.
A sudden drop in the peak pressure during volume-controlled ventilation could be due to which of the following? 1.an increase in the flow 2.a leak in the endotracheal tube cuff 3.malfunctioning exhalation valve 2 and 3 only
Which of the following would be the most effective method to identify noncompliance with a smoking cessation program? Interview the patient
A normal arterial blood gas analysis was obtained for a postoperative patient who required mechanical ventilation due to prolonged effects of muscle relaxants. On admission to the postanesthesia care unit (PACU), the patient was apneic and being ventilate Change to the SIMV mode.
While checking a patient receiving mechanical ventilation, the respiratory therapist notes the following: Exhaled tidal volume 800 mL Peak inspiratory pressure 45 cmH20 High pressure limit 80 cmH20 Low pressure alarm 35 cmH20 Low tidal volume high pressure limit to 55 cm H2O.
A patient with hepatitis coughs into a spirometer. Which of the following should be used to sterilize the nondisposable connector before it is used again? glutaraldehyde
When an IV line cannot be established during CPR for asystole, which of the following medications should be instilled first through the endotracheal tube? epinephrine
The respiratory therapist notices that the manometer on a nasal CPAP set-up for a patient with obstructive sleep apnea falls to zero each time the patient inhales. The therapist’s most appropriate action would be to do which of the following? Increase the inspiratory flow.
During a 5-second pause while performing CPR, the respiratory therapist notes no palpable pulse and yet the ECG monitor shows NSR. The threapist should do which of the following? Continue CPR.
A patient has aspirated gastric contents. Wheezes and rhonchi are heard bilaterally. The patient appears short of breath and has a cough producing copious, watery secretions. The physician asks the respiratory therapist to initiate oxygen therapy. bronchodilator therapy
A patient is being mechanically ventilated. At an F1O2 of 0.60, the following arterial blood gas results are reported: pH 7.40 mmHg PaCO2 41 torr PaO2 49 torr HC03 24 mEq/L BE 0 mEq/L Initiate PEEP
Factors that affect the amount of oxygen received by a patient using a nasal cannula include which of the following? 1. liter flow of oxygen 2. depth of inspiration 3. rate of respiration 1, 2, 3
A patient with a history of sleep apnea has been receiving noninvasive positive pressure therapy with an IPAP setting of 12 cm H2O pressure and an EPAP setting of 4 cm H2O pressure. The patient no longer demonstrates any periods of apnea. However, blood g increase the IPAP setting
A patient with severe COPD and CO2 retention is being instructed about home oxygen therapy through a nasal cannula. The instructions should include information about which of the following? 1. how to adjust the flow if breathing becomes difficult 2. how 2 and 3 only
A 19-year-old patient who has a lung contusion with rib fractures is receiving oxygen by a nonrebreathing mask. The patient’s respiratory rate is 40jmin. The following arterial blood gas results are obtained: pH 7.28 PaC02 52 torr Pa02 48 torr HC0 volume-controlled ventilation in the SIMV and PSV mode
A patient is being mechanically ventilated and the following arterial blood gas results are available: pH 7.52 mmHg PaCO2 28 torr PaO2 85 torr HCO3 22 mEq/L ¬BE 0 mEq/L acute alveolar hyperventilation without hypoxemia
A patient receiving home care for COPD consistently expectorates more than 30 mL of sputum daily and is having difficulty clearing his airway to take a deep breath. Which of the following should the respiratory therapist recommend? institution of bronchopulmonary drainage
The respiratory therapist would expect Sp02 to inaccurately reflect oxygenation in patients with carbon monoxide poisoning.
A 60-year-old male patient with COPD is using oxygen by E cylinder. The cylinder pressure is 1000 psi(g). The flowmeter is to be set at 1 L/min during prescribed walking. Approximately how many hours duration is the cylinder gas flow? 4.5
All of the following indicate that IPPB should be terminated EXCEPT bilateral basilar atelectasis
A patient has cool, damp skin with beads of moisture on her forehead. The respiratory therapist would chart the presence of diaphoresis.
What gas source is required for proper functioning of a pneumatic demand valve resuscitator? 50 psi(g) oxygen source
A patient is receiving volume-controlled ventilation. The patient has a tidal volume of 1.0 L. Based on this information, the low exhaled volume alarm should be set no lower than 800 mL.
The respiratory therapist is asked to evaluate and recommend therapy for an infant with congenital heart disease who has contracted respiratory syncytial virus. Which of the following would represent the most appropriate agent to be aerosolized for the tr ribavirin (Virazole)
The respiratory therapist has been asked to recommend the most appropriate airway for an alert patient with copious secretions who requires frequent suctioning Which of the following is the airway of choice for this patient? nasopharyngeal
Immediately after a tracheotomy is performed, an oxygen set-up for a tracheostomy collar should include a large-volume nebulizer.
A child is receiving volume-controlled ventilation. To minimize compressible volume, the respiratory therapist should select a shorter breathing circuit.
A patient who complains of orthopnea has difficulty breathing in the supine position
A patient with severe air trapping is being mechanically ventilated. Which of the following should be used to improve this situation? Use an I:E ratio of 1:3.
A patient receiving oxygen by a nasal cannula at 6 L/min complains of nasal discomfort. Which of the following is the most likely explanation for the problem? the gas flow
A patient with congestive heart failure is receiving oxygen by nonrebreathing mask and has a respiratory rate of 28/min. The following arterial blood gas results are obtained: pH 7.43 PaCO2 35 torr PaO2 55 torr HCO3 22 mEq/L BE -1 mEq/L Initiate mask CPAP.
While evaluating a patient’s thorax, the respiratory therapist observes paradoxical movement of the left chest. This is most consistent with phrenic nerve dysfunction.
Which of the following would be the most practical device to use to measure proper endotracheal tube cuff inflation pressure? manometer
A 42 year old woman who is obese and has a long history of smoking recently underwent upper abdominal surgery. She was extubated last evening and, several hours later, is observed lying supine with shallow, rapid respirations. There are decreased breath 1, 3, 4 only
An intubated patient is being mechanically ventilated with a volume-cycled ventilator. During rounds, the respiratory therapist finds a leak around the endotracheal tube cuff, which results in a large volume loss. The therapist should do which of the foll Add air to the cuff until minimal occluding volume is obtained.
The respiratory therapist is monitoring a patient who has a tracheostomy. The patient is receiving oxygen at an F,O2 of 0.40 by T-piece at a flow of 8 L/min. No mist is visible during inspiration. Which of the following should the therapist do? Increase the flow to 12 L/min.
The respiratory therapist is asked to assist with positioning a patient for a thoracentesis. The most appropriate position is sitting in bed with arms on overbed table.
Following chest percussion, the respiratory therapist auscultates the patient’s chest and hears coarse, low-pitched, sonorous sounds. These sounds should be recorded in the patient’s medical record as rhonchi
Which of the following statements about performing CPR for an infant are correct? 1. The compression/ventilation ratio should be 15:2. 2. The compression rate should be greater than 100/min. 3. Compression should be applied to the sternum at the ni 2 and 3 only
During suctioning of a patient who is being mechanically ventilated, the patient has a dramatic decrease in heart rate to 30/min. The respiratory therapist could prevent, or minimize, this problem by doing which of the following? Increase the F1O2 immediately prior to suctioning.
The respiratory therapist is reviewing a chest radiograph of a 26-year-old patient. The tip of a properly positioned endotracheal tube will be located 3 cm above the carina
Fluctuation of the fluid level with each breath is seen in which chamber of a pleural drainage system? water seal
An oxygen hood would be an appropriate oxygen delivery system for an infant who requires a precise F102.
A patient who is receiving a bronchodilator by a metered dose inhaler (MDl) q6h complains of wheezing before the next treatment. The respiratory therapist should recommend which of the following? Administer the bronchodilator more frequently. .
The values below were reported for a patient breathing room air: PaCO2 40 torr PaO2 67 torr PETCO2 20 torr These data indicate which of the following? Pulmonary embolism
A 42 year old woman who is obese and has a long history of smoking recently underwent upper abdominal surgery. She was extubated last evening and, several hours later, is observed lying supine with shallow, rapid respirations. There are decreased breath 1, 2
A patient with a history of asthma is admitted to the emergency department. The patient is tachypneic, anxious, and bilateral wheezes are heard on auscultation. Which of the following should the respiratory therapist recommend? 1. aerosolized albutero 1 and 2 only
A patient presents to the emergency department in respiratory distress. The physician orders continuous aerosol by an air entrainment device with an F1O2 of 0.60 at 10 L/min. What is the calculated total flow in L/min 20
During resuscitation of an adult patient who is in ventricular fibrillation, sodium bicarbonate should be considered if hyperkalemia is present.
Following successful re-intubation and examination of a patient, the respiratory therapist should recommend a chest radiograph.
Which of the following agents would most likely be beneficial for a patient with severe bronchospasm? albuterol (Ventolin)
The semi-Fowler’s position would be most appropriate to drain the apical segments, upper lobes of both lungs.
The following data are obtained for a patient who is receiving volume-controlled ventilation: Peak pressure 30 cmH20 Plateau pressure 20 cmH20 PEEP 10 cmH20 Set tidal volume 800 mL Exhaled tidal volume 700 mL What is the static lung comp 70
The respiratory therapist is attempting to ventilate a patient with a mouth-to-valve mask resuscitator. The therapist meets resistance, and the patient’s chest does not rise. Repositioning the patient’s head does not solve the problem. Which of the follow Check the position of the one-way valve.
What is the immersion time required for sterilization of respiratory care equipment when using alkaline glutaraldehyde at room temperature? 10 hours
A 70 kg (154 Ib) adult patient is receiving 15 cm H2O pressure support ventilation (PSV). Tidal volume is 560 mL and the respiratory rate is 10/min. One hour later, the tidal volume is 1000 mL and the respiratory rate is 7/min. Which of the following shou Decrease pressure support to 10 cm H2O.
Which of the following devices best measures the accuracy of an air oxygen blender? polarographic electrode
Which of the following ECG leads should be placed in the left midclavicular line? V4
During chest percussion and postural drainage therapy, the patient’s heart rate remains stable at 100 beats/min and the SpO2 is 96%. However, when the respiratory therapist begins endotracheal suctioning, the patient’s heart rate drops rapidly. The most vagus nerve stimulation
The respiratory therapist is asked to determine a patient’s spontaneous minute ventilation. The therapist should do which of the following? Measure the accumulated VT over 1 minute.
What size suction catheter should be selected for use with. an 8 mm ID endotracheal tube 12 Fr
While administering an IPPB treatment with compressed air, the respiratory therapist notes the patient’s neck veins become distended. The patient is becoming diaphoretic. At this time, the therapist should do which of the following? Terminate the treatment and monitor the patient’s vital signs.
A patient has aspirated gastric contents. Wheezes and rhonchi are heard bilaterally. The patient appears short of breath and has a cough producing copious, watery secretions. The physician asks the respiratory therapist to initiate oxygen therapy. nonrebreathing mask
The patient did a pre and post bronchodilator PFT. The volume time curve identifies an increase in the space between the pre bronchodilatory expiratory volume time curve and the post bronchodilator expiratory volume time curve. reversible airway obstruction.
Which of the following is used to assure volume calibration of a spirometer? super syringe
The respiratory therapist is performing a ventilator check on a patient who is receiving volume-controlled ventilation. All breaths are being delivered without detectable patient effort. Ventilator settings are below: Mode Assist/control Mandatory r Adjust the sensitivity setting.
While changing a tracheostomy tube dressing, the respiratory therapist feels vibrations through the patient’s chest wall on inspiration and expiration. The therapist’s most appropriate action would be to do which of the following Suction the patient.
The radial artery is the site of choice when performing an arterial puncture for which of the following reasons? Collateral blood flow is usually present
When providing volume-controlled ventilation with a Puritan-Bennett 7200 ventilator, the I:E ratio is determined by which of the following? 1. tidal volume 2. ventilatory rate 3. flow 1, 2, and 3
A patient has a high cervical vertebral fracture and accompanying spinal cord damage. The best way for the respiratory therapist to evaluate respiratory muscle weakness would be to serially evaluate forced vital capacity
A 29-week gestational age infant is being mechanically ventilated with an F102 of 0.80. The infant has sternal retractions, nasal flaring, and a respiratory rate of 64/min. Which of the following would be appropriate for this infant? exogenous lung surfactant
A patient is mechanically ventilated after exploratory laparotomy. The patient has a maximum inspiratory pressure (MIP)of -30 cm H2O. Based on this value, the patient has sufficient inspiratory pressure to consider weaning.
Which of the following is the most common complication associated with the use of bag-valve-mask ventilation? gastric insufflation
Only one mainstream capnometer is available for daily PETC02 measurements on several patients in the ICU. To protect patients from nosocomial infections, which of the following would be most appropriate to recommend? Provide an individual airway adapter for each patient.
In a patient who has sustained thoracic trauma, inspection of the thorax reveals no abnormalities. The extent of the trauma would be best determined by which of the following? chest radiograph
A patient using an incentive spirometer after abdominal surgery complains of lightheadedness following use of the device. Which of the following is the probable cause of the lightheadedness? The patient is hyperventilating.
The respiratory therapist plans to teach the therapeutic goals of chest physiotherapy to the family of a child with bronchiectasis. The therapist suspects that the family has a language barrier. The therapist should use diagrams to explain the therapeutic goals.
Which of the following patients will benefit most from deep breathing exercises? a postoperative patient
A patient is being mechanically ventilated with the following ventilator settings: Mode SIMV Tidal Volume 800 ml Mandatory rate 10 Total Rate 30 PEEP 5 cmH20 Minute Volume 11 L Which of the following should the respiratory therapis Add pressure support
A patient with COPD is receiving volume-controlled ventilation. The patient has a respiratory rate of 15/min and an inspiratory time of 2 seconds. The patient is still exhaling when the next ventilator breath begins. Which of the following ventilator chan Increase the inspiratory flow
When discussing a pulmonary rehabilitation program with a COPD patient and her family, the respiratory therapist should explain which of the following? The patient may have reduced symptoms and improved exercise tolerance.
An adult patient is in pulseless ventricular tachycardia. The respiratory therapist initially should assist with cardioversion at 200 joules.
The respiratory therapist runs a control solution through a blood gas analyzer as part of daily maintenance. Two successively measured PO2 values are 0.5 torr outside of the acceptable range. The therapist should perform a two-point calibration and rerun the control.
During MVV testing, the patient should be instructed to do which of the following? Breathe rapidly and deeply for 12 to 15 sec.
While performing equipment rounds, the respiratory therapist observes continuous bubbling in the humidifier of a stand-by oxygen set-up. The therapist finds that the needle valve of the flowmeter is completely closed. Which of the following should be done Replace the flowmeter.
If the flow on a volume-cycled ventilator were to increase, the respiratory therapist might expect the inspiratory time to decrease.
To assess the respiratory muscle strength of a patient currently being mechanically ventilated, the respiratory therapist would use which of the following devices? pressure manometer
The pulmonary function data below were obtained from a 56-year-old man who complains of shortness of breath: Actual Percent Predicted FVC 3.9 l 85% FEV1 2.4 l 68% FEV1/FVC 62% FEF25-75% 1.2 l/sec 35% These data indicate which of the following cl COPD
Which of the following should the respiratory therapist select to treat obstructive sleep apnea? nasal CPAP
Transcutaneous gas monitoring would be most accurate for a patient with which of the following conditions? sleep apnea
Oropharyngeal suctioning is being performed on an adult patient. The vacuum pressure is 60 mm Hg. The secretions aspirate slowly when the respiratory therapist occludes the catheter’s control port. To improve suctioning effectiveness, the therapist should increase the vacuum pressure to 120 mm Hg.
During mouth-to-mask ventilation, which of the following will protect the respiratory therapist from exposure to the patient’s secretions? one-way valve
A patient underwent subclavian venous catheter placement. The respiratory therapist is called to the bedside because the high pressure alarm is sounding. The therapist notes an increase in peak inspiratory pressure and a decrease in the patient’s blood pr pneumothorax
A patient suddenly loses consciousness. Which of the following is the INITIAL technique used to ensure airway patency for this patient? A Use the “head-tilt chin-lift” maneuver.
An intubated patient is being mechanically ventilated. The patient’s condition has not changed, but higher ventilation pressures are now required. Which of the following is the most likely cause of this problem? The endotracheal tube is partially obstructed.
Which of the following is the most effective device to hydrate secretions by increasing absolute humidity? ultrasonic nebulizer
The respiratory therapist is attempting to wean an 86.4 kg (190 Ib) patient from an SIMV rate of 8/min and a tidal volume of 1.0 L. Initially, when the rate is decreased to 6/min, the patient’s heart rate increases from 96/min to 110/min. The therapist sh Continue to monitor the patient.
The outlet of a bubble humidifier is occluded and the pressure relief valve is not whistling. All of the following could be responsible for this EXCEPT the bubble diffuser is disconnected from the capillary tube.
Secondary polycythemia is associated with which of the following clinical findings? cyanosis of the lips and nail beds
An FEV1 of 50% of predicted before bronchodilator and 70% of predicted after bronchodilator indicates which of the following? reversible obstructive disease
A patient who requires supplemental oxygen at 1 L/min uses an oxygen concentrator at home. Which of the following oxygen delivery systems would be most appropriate for patient use during short outings? gas cylinders
A patient is receiving 0.25 mL of 0.5% solution of albuterol (Ventolin) and 2 mL normal saline with a small volume nebulizer. Assessm nt reveals persistent expiratory wheezes. Which of the following medication changes should the respiratory therapist rec Alter the dosage to 0.50 mL of albuterol.
A patient is admitted to the ICU with lobar consolidation. Sputum Gram stain reveals small gram-negative organisms. This infection is most likely caused by Klebsiella pneumoniae
Nebulizers should be changed periodically for which of the following reasons? Bacteria readily contaminates the water in the nebulizer.
Which of the following are considered objective data with SOAP charting Lab result Fluid balance Vital sing Physical appearance
When completing the analysis section of SOAP charting, what do you need to do Copy what the physician recorder Justified your diagnosis Develop action plan
When completing the plan section in SOAP charting, what do you want to achieve Critique patient care for improvement.
The patients capillary refill should be in what time frame < 3 second
Which of the following patients is more short of breath 3 word dyspnea
Which of the following would not cause an increase in fremitus Pneumotorax,
Which of the following would not have a dull percussion note Pneumothorax
Which breath sound is normally found throughout the chest Vesicular
Which of the following is not an accessory muscle for expiration Diaphragm
Purulent secretions mean Pus
Elevated neutrophils could be from Inflamation Bacterial infection
Which of the following are indications for IS Treat atelectasis Improve distribution of ventilation Restrictive lung diseases
Which of the following are hazards associated with IS Hypoxemia Hyperventilation Fatigue, Hypocarbia
During inspiration with IS, what does the patient need to do Inspiratory hold
Which of the following are indications for IPPB Improve cough Treat atelectasis
Which of the following are hazards associated with IPPB Increased ICP Gastric distintion Hypocarbia Hypercarbia
Which of the following are ways to assess outcome with IPPB Breath sounds Cough effectiveness CxR SpO2
During IPPB, the exhaled tidal volume is 7 ml/kg. What do you want to do Increase pressure
During an IPPB treatment, the patient suddenly complains of chest pain and becomes short of breath. Upon assessing the patient, you auscultate decreased breath sounds on the left and the trachea is shifted to the right. These findings are consistent left-sided tension pneumothora
What is a contraindication for IPPB therapy? Untreated pneumothorax
In order to minimize the likelihood of nebulizers serving as a source for transmission of infectious agents, all of the following procedures should be scrupulously followed except when checking, drain tubing condensate back into reservoir
A gag response is produced via which of the following reflexes? pharyngeal
Which of the following humidifiers would be most effective in overcoming a humidity deficit? heated cascade humidifier
Racemic epinephrine has which of the following receptor site activities? 1. alpha sites 2. beta-1 sites 3. beta-2 sites 1, 2, 3
All spirometric values obtained under ambient conditions should be converted to: body temperature, ambient pressure, saturated (BTPS)
Bronchodilation is most commonly achieved via the use of which of the following agents: adrenergic
Which of the following patient categories are at high risk for developing atelectasis? 1. those who are heavily sedated 2. those with abdominal or thoracic pain 3. those with neuromuscular disorders 1, 2 and 3
The physician order 28% oxygen to be administered to a COPD patient. Which device will most accurately achieve this? Venturi mask
Upon palpating a patient’s radial artery for 1 minute, the respiratory therapist notes 90 unevenly spaced beats with decreased pulse strength during inspiration. Which of the following describes the patient’s pulse? pulsus paradoxus


Respiratory Therapy Clinical Practice Midterm Practice Questions:


1. What is a surfactant?: A substance secreted by the macrophages that facilitates oxygen transport across the alveolar membrane.

2. During inspiration, air enters the thoracic cavity because of: a decrease in intrathoracic pressure relative to pressure at the airway

3. The ability of the lungs to adequately oxygenate the arterial blood is determined by examination of the: arterial oxygen tension (PaO2)

4. The most important respiratory defense mechanism distal to the respiratory bronchioles is the: alveolar macrophage

5. A rightward shift of the oxygen-hemoblogin dissociation curve: facilitates release of oxygen at the tissue level

6. Signs and symptoms of inadequate oxygenation include all of the following EXCEPT: increased peripheral perfusion, increased urine output

7. When assessing activity, exercise patterns related to respiratory health, you should inquire about: dyspnea during rest or exercise

8. When percussing the chest, you should compare sounds heard: on the left and right anterior and posterior chest in the same areas

9. The left mainstem bronchus is: more angulated than the right

10. Respiration is most affected by: PaCO2

11. Which of the following shift the oxyhemoglobin dissociation curve to the left?: Decrease in temperature, Increase in pH

12. During normal, quiet, relaxed, breathing, what will the intrapleural pressure be: Equal to atmospheric pressure

13. Adventitious breath sounds include all of the following EXCEPT: bronchovesicular sounds

14. Your patient’s tidal volume is 1000cc’s.  He is breathing 15 times a minute.  Calculate his minute volume: 15,000cc’s

15. Oxygen toxicity can occur when a patient receives O2: at 50% or greater for more than 24 hours

16. What range of O2 concentration does a nasal cannula provide?: Between 24% and 40%

17. Early signs of O2 toxicity include: numbness in the extremities and dry, hacking cough

18. A healthy person’s respiratory drive depends on: PCO2

19. The blood’s O2-carrying capacity can be limited to: anemia

20. Lower than normal O2 saturation in arterial blood is called: hypoxemia

21. Which of the following is a high-flow O2 delivery device: venturi mask

22. Percentage normal for Ambient air?: 21%

23. Your client has had GI surgery with a large abdominal incision. When you assess your client, you note that she has a respiratory rate of 26.  Which breath sounds would lead you to call the physician immediately?: Expiratory wheezes throughout

24. If acidosis results from a slow, shallow respiratory rate, you’d expect the following change in acid/base balance: pH decreased and PaCO2 increased

25. After assisting the client to properly use her incentive spirometer, you note an increase in the percentage of her pulse oximetry.  To what anatomical/physiologic change is this related?: The increased oxygen diffusion from alveoli to capillaries

26. When a patient hyperentilates, you would base your interventions on the knowledge that he is likely to experience: increased pH from CO2 depletion

27. What recommendations would you give a patient to maximize the therapeutic effect of pseudoephedrine, a nasal decongestant?: Drink plenty of fluids

28. You are caring for a 14-year-old patient who came to the clinic with her mother.  Privately, the mother tells you that she is concerned that her child might be smoking because she is constantly asking her to buy Robitussin (dextromethorphan) for a cough.  With your knowledge of this drug, what further information would you need from the mother?: Have you noticed any unusual or agitated behavior?

29. You are the nurse working a telephone hot line to answer questions about health problems.  A patient calls and tells you he has been taking Fexofenadine, an antihistamine, for seasonal allergies.  The drug is effective, but the patient reports having an upset stomach after taking it and wonders if he must stop taking the drug. What advice should you give?: Take the drug with food

30. Pseudoephedrine (Sudafed) works by: Mimicking the action of the sympathetic nervous system
Pseudoephedrine (Sudafed) is indicated for the treatment of which of the following?: Viral upper respiratory infection

31. How does oxymetazoline (afrin) differ from pseudoephedrine (Sudafed)?: Route and decreased incidence of adverse effects

32. Which of the following adverse effects may occur during pseudoephedrine (Sudafed) therapy?: Tachycardia

33. Cromolyn sodium (NasalCrom) works by: Preventing the breakdown of mast cells

34. Which of the following statements concerning drug-drug interactions of Guaifenesin (Robitussin) is accurate?: There are no known drug-drug interactions

35. Which of the following nasal sprays is a steroidal anti-inflammatory drug?: Dexamethasone sodium phosphate (Turbinaire)

36. An expectorant drug, such as Guaifenesin (Robitussin), is used to relieve?: A dry, hacking cough

37. Which of the following statements concerning the adverse effects of Dextromethorphan (Benylin) is correct?: There are few minor adverse affects

38. Antihistamines, such as Fexofenadine (Allegra), are the treatment of choice for?: Allergic rhinitis

39. Dextromethorphan (Benylin) works by: Inhibition of the cough center in the medulla

40. Fexofenadine (Allegra), a second-generation antihistamine, differs from first-generation antihistmaines such as diphenhydramine (Benadryl) by?: Decreased sedation

41. Your 46-year-old patient calls the clinic to speak with the advice nurse.  The patient reports having a cough for the past 4 weeks and says she has been self-treating with Guaifenesin (Robitussin) from the local drug store.  The patient states, “This is barely helping me.  I need something else.”  Which of the following statements is the most appropriate?: “Because your cough has been with you for so long, it’s best if you come to the clinic for a checkup.”

42. Which of the following patients should refrain from pseudoephedrine (Sudafed) therapy?: The patient with severe hypertension

43. Which of the following statements would be appropriate for patient teaching regarding pseudoephedrine (Sudafed) therapy?: In addition to this medication, you should use a humidifier and drink at least 10 glasses of water a day.

44. Patient teaching for the patient receiving dextromethorphan (Benylin) should include: Do not drive until you see how this drug affects you.

45. Patient teaching for the patient taking Fexofenadine (Allegra) should include: Try sugarless gum or candy if your mouth is dry.

46. For the hospitalized patient, a priority nursing diagnosis for the patient receiving hydrocodone bitartrate is: Risk for constipation

47. Patient teaching for the patient receiving pseudoephedrine (Sudafed) should include: Do not take any OTC medications without asking your doctor or pharmacist

48. Your patient has a viral upper respiratory infection, and dextromethorphan (Benylin) is prescribed every 4 hours. You note that the patient is taking fluoxetine, a selective serotonin reuptake inhibitor (SSRI). You would advise this patient to: Call if symptoms such as fever, nausea, or hallucinations occur

49. Your 5-year-old patient has allergic rhinitis.  Which of the following drugs would be best for this?: Cetirizine (Zyrtec)

50. Which of the following patients should refrain from Fexofenadine (Allegra) therapy?: The patient that is breast feeding.

51. A client is being discharged with nasal packing in place. He should be told to implement which of the following activities into his home care?: perform frequent mouth care

52. The nurse is planning to give preoperative instructions to a client who will be undergoing rhinoplasty. Which of the following instructions should be included?: Aspirin-containing medications should not be taken for 2 weeks before surgery

53. The nurse is teaching a client how to manage a nosebleed. Which of the following instructions would be appropriate to give the client?: Sit down, lean forward, and pinch the soft portion of your nose

54. Which of the following assessments would be a priority immediately after nasal surgery?: Assessing respiratory status

55. After nasal surgery, the client expresses concern about how to decrease facial pain and swelling while recovering at home. Which of the following discharge instructions would be most effective for decreasing pain and edema?: Apply cold compresses to the area

56. An elderly client had posterior packing inserted to control a severe nosebleed.  After insertion of the packing, the client should be closely monitored for which of the following complications?: Hypoventilation

57. Which of the following activities should the nurse teach the client to implement after the removal of nasal packing on the second postoperative day?: Apply water-soluble jelly to lubricate the nares.

58. Which of the following statements would indicate to the nurse that a client has understood the discharge instructions provided after her nasal surgery?: I will take stool softeners and modify my diet to prevent constipation

59. A client who has undergone outpatient nasal surgery is ready for discharge and the nasal packing in place.  Which of the following discharge instructions would be apropriate for the client?: Avoid activities that elicit the Valsalva maneuver

60. A 27-year-old woman has had elective nasal surgery for a deviated septum.  Which of the following would be an important initial clue that bleeding was occurring even if the nasal drip pad remained dry and intact?: Repeated swallowing

61. If your client had a pulmonary contusion, for what complication will you watch?: Atelectasis

62. Which complication are fractures of the left lower ribs associated with?: Splenic Injury

63. Which physical assessment finding is most frequently associated with a traumatic diaphragmatic rupture?: Bowel sounds in the chest

64. What action is most appropriate when an object is impaled in a patient’s chest?: Stabilize the wound site

65. Signs of a tension pneumothorax on the right side include a tracheal shift toward which side?: The left with absent breath sounds on the right.

66. The most common chest wall injuries are: Fractures of the 5th through 9th ribs.

67. To prepare for chest tube removal,  you would: disconnect the unit from the suction

68. A small volume of air enters the pleural space from the lung and is absorbed in a few days. Indicate whether the explanation refers to an: closed pneumothorax

69. A semi-Fowler’s position, turning toward the side of the chest tube, coughing, and exhaling help to: promote drainage

70. After chest tube removal, your most important patient assessment is for: any indicators of pneumothorax

71. Bubbling in the water seal when the patient exhales or coughs tells you that: the patient still has air in the pleural space.

72. Fluctuations of 5-10 mm in the water seal of a gravity drainage system occur: normally in the patient whose lung hasn’t yet reexpanded.

73. The definitive indicator of lung reexpansion after pleural drainage is: chest x-ray confirmation

74. A few days after surgery, your patient’s drainage diminishes to little or nothing and the water-seal solution fluctuates with each breath, what does this probably indicate?: lung has probably reexpanded

75. Air from the lungs and a chest wound moves in and out of the pleural space as the patient breathes: open pneumothorax

76. When a flutter valve is used instead of a traditional chest drainage system, it: doesn’t work well with serous drainage

77. Your patient has a gunshot wound and has been treated for an open pneumothorax.  Two hours after placement of her chest tube, you find that she has dislodged it.  What is an appropriate nursing intervention?: cover the wound with an occlusive dressing, leaving one side untaped

78. When an attached suction pump is turned off and gravity drainage is begun,  you should
disconnect the suction pump tubing
Intra pleural pressure collapses the affected lung and pushes mediastinal structures toward the opposite side of the chest: tension pneumothorax.

79. In a one-bottle system that serves as both a water seal and a collection chamber, which additional feature must be present?: an exit vent to the atmosphere.