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THERAPIST MULTIPLE-CHOICE (TMC)
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A nasopharyngeal airway is indicated for which of the following patients? A. unconscious patient with a closed head injury B. conscious patient with an ineffective cough C. alert patient who is expectorating a large amount of secretions D. uncooperative patient - Answer B. conscious patient with an ineffective cough A 43-week gestational age infant has just been delivered and is stained with meconium. The physician has asked that the baby be intubated and suctioned immediately. The respiratory therapist should recommend intubating the baby with which of the following size endotracheal tubes? A. 2.0 mm B. 2.5 mm C. 3.0 mm D. 4.0 mm - Answer C. 3.0 mm An 8-month-old infant admitted to the pediatric unit is playing with marbles. The infant suddenly develops violent coughing and is unable to cry. The respiratory therapist administered series of back blows and chest thrusts, and the infant is now unresponsive. The therapist should A. continue back blow and chest thrusts. B. initiate CPR. C. perform a blind finger sweep.
D. prepare to intubate. - Answer B. initiate CPR Which of the following is the most appropriate technique for insertion of a nasopharyngeal airway? A. insert the airway in the opposite direction of its shape and rotate 180 degrees B. insert the airway in the opposite direction of its shape and rotate 90 degrees C. insert the airway in the same direction of its shape into the airway and do not rotate D. insert the airway in the same direction of its shape and rotate 180 degrees - Answer C. insert the airway in the same direction of its shape and into the airway and do not rotate. Which of the following describes the proper technique when using a stylet? A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube B. The distal end should be positioned at the level of the beveled end C. The distal end should be proximal to the "Murphy's Eye" D. The distal end should be positioned proximal to the cuff - Answer A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube When using a flow-inflating resuscitation bag during manual ventilation of a neonate, the FO2 received by the neonate is determined by A. the FO2 of the gas delivered to the bag. B. the size of the oxygen reservoir. C. the oxygen flow rate.
B. and then remove it until a slight leak is heard at peak inspiration. C. to establish a pressure of 20 mmHg. D. to establish a pressure of 40 cmH20. - Answer C. to establish a pressure of 20 mmHg A 16-year-old male patient involved in a motorcycle accident presents to the ER with massive maxillary and nasal trauma. Which of the following devices would be most appropriate for maintaining the patient's airway? A. nasal endotracheal tube B. fenestrated tracheostomy tube C. oral pharyngeal airway D. oral endotracheal tube - Answer B. fenestrated tracheostomy tube Shortly after extubating a patient, the therapist notes an increase in the patient's work of breathing, intercostal retractions, marked stridor and a decreased Sp02. The therapist should recommend: A. Cool aerosol therapy with 50% oxygen B. Assisted ventilation with resuscitation bag and mask C. CPAP therapy with 40% oxygen D. Reintubate orally - Answer D. Reintubate orally A 48-year-old postoperative patient in the recovery room is still unconscious. Vital signs are all stable and the SpO2 is 95%. Which of the following should the therapist recommend to prevent a soft tissue obstruction from occurring? A. Oropharyngeal airway B. Nasopharyngeal airway
C. Laryngeal mask airway D. Esophageal obturator airway - Answer A. Oropharyngeal airway Which of the following factors would increase the difficulty of performing oral endotracheal intubation?
- Small mouth opening
- Macroglossia
- Atrophy of thyroid
- Mallampati Class II A. 1 and 2 only B. 3 and 4 only C. 1 and 3 only D. 2 and 4 only - Answer A. 1 and 2 only A 57-year-old post-op patient is receiving volume control ventilation. The respiratory therapist is having difficulty removing secretions when suctioning. The patient weighs 85 kg (187 Ib), is orally intubated with a size 9.0 mm ID endotracheal tube, the vacuum level is set at 90 mm Hg and the suction catheter being used is a size 14 Fr. The therapist should A. switch to a larger catheter size. B. increase the vacuum level. C. switch to a Coude catheter. D. instill normal saline prior to suctioning. - Answer B. Increase the vacuum level A 2800 g neonate has just been orally intubated with a size 3.0 mm ID endotracheal tube. The respiratory therapist is preparing to suction the neonate and notices that there are size 6 French suction catheters at the bedside. The therapist should
developed redness and swelling. To prevent further irritation, the respiratory therapist should recommend? A. switching to orotracheal suctioning B. inserting an orotracheal tube C. administering an antibiotic to the site D. inserting a nasopharyngeal airway - Answer D. inserting a nasopharyngeal airway A 14-year-old patient has a size 7 mm endotracheal tube placed orally. While suctioning this patient with size 12 French catheter you meet resistance while attempting to pass the catheter through the tube. The respiratory therapist should A. extubate and reintubate with a size 8 mm endotracheal tube. B. switch to a size 10 French catheter. C. instill mucomyst down the endotracheal tube D. lubricate the catheter with K-Y jelly prior to suctioning. - Answer B. switch to a size 10 French catheter. A respiratory therapist working in the intensive care unit would use a stylet to: A. assist with phonation B. facilitate orotracheal intubation C. maintain a stoma opening D. provide protection to the unaffected lung - Answer B. facilitate orotracheal intubation A 58-year-old female patient who weighs 165 Ib (75 kg) is orally intubated with a size 6.0 mm endotracheal tube and is receiving volume-control
ventilation. The tube is taped at the 23 cm mark at the patient's lips. The tube cuff pressure measures 38 mm Hg. When the respiratory therapist reduces the cuff pressure, the low exhaled volume alarm on the ventilator begins to sound. The therapist should A. replace the endotracheal tube with a larger size. B. maintain the cuff pressure at 38 mm Hg. C. deflate the cuff and advance the tube. D. adjust the low exhaled volume alarm. - Answer A. Replace the endotracheal tube with a larger size. During cardiopulmonary resuscitation of a 78-year-old patient, the respiratory therapist provides ventilation with a manual resuscitation bag attached to the patient's endotracheal tube. While squeezing the bag, the therapist observes inadequate chest movement. Which of the following is the LEAST likely cause? A. Missing inlet valve B. Defective endotracheal tube cuff C. Incorrect tube placement D. Excessive oxygen flow - Answer D. Excessive oxygen flow A patient with a size 8.5 mm oral endotracheal tube is transported from the ED to the ICU. The respiratory therapist suspects that the endotracheal tube has changed position during transport. Which of the following is the quickest way to assess the position of the tube? A. Chest radiograph B. Auscultation of the chest C. Observation of chest movement
A. increase the oxygenation time B. utilize an inline suction catheter C. perform nasotracheal suctioning D. discontinue suctioning the patient - Answer B. utilize an inline suction catheter Which of the following is the best way to determine the patency of a nasopharyngeal airway? A. instill 5mL of normal saline into the airway B. attempt to pass a suction catheter through the airway C. listen for air flow through the airway D. recommend a sinus x-ray - Answer B. attempt to pass a suction catheter through the airway While performing orotracheal intubation for a patient in respiratory arrest, the respiratory therapist notices that the stylet has advanced from its original position. The respiratory therapist should A. continue with the intubation procedure. B. stop the procedure, manually ventilate the patient, and reposition the stylet. C. retract the stylet immediately. D. remove the stylet and continue with the procedure. - Answer B. stop the procedure, manually ventilate the patient, and reposition the stylet. Which of the following is the best method to minimize damage to the tracheal wall caused by an endotracheal tube cuff? A. Measuring the volume used to inflate the cuff
B. Palpating the inflation of the pilot balloon C. Utilizing a cuff pressure manometer D. Using minimal occluding volume to seal the airway - Answer C. Utilizing a cuff pressure manometer Which of the following statements is/are true regarding an Esophageal Tracheal Combitube?
- Used for pre-hospital airway management.
- Placed in the trachea with a laryngoscope.
- It should be replaced with an endotracheal tube as soon as possible. A. 3 only B. 2 and 3 only C. 1 and 3 only D. 1 and 2 only - Answer C. 1 and 3 only All of the following could cause a capnography reading to change from 36 torr to 30 torr EXCEPT A. endotracheal tube positioned in the right mainstem bronchus B. hyperventilation C. pulmonary emboli D. hypovolemia - Answer A. endotracheal tube positioned in the right mainstem bronchus A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the proximal lumen? A. CVP
A 1000 g neonate is stable in the NICU. Which of the following should the respiratory therapist use to monitor the neonate's overall cardiopulmonary status? A. TCPCO2 and TCPO2 monitor B. Arterial blood gas analysis Q4 hours C. SpO2 monitor D. Capillary gas analysis Q8 hours - Answer A. TCPCO2 and TCPO monitor A unilateral wheeze would most likely indicate which of the folowing? A. asthma B. atelectasis C. foreign body aspiration D. epiglotitis - Answer C. foreign body aspiration All of the following would be associated with the presence of a pneumothorax EXCEPT: A. tracheal deviation B. dull percussion C. absent breath sounds D. respiratory distress - Answer B. dull percussion A patient presents to the Emergency Department with fatigue and occasional syncope. The following tracing is noted on the ECG monitor in Lead II: What is the correct interpretation of this ECG tracing?
A. Sinus arrhythmia B. Atrial flutter C. Atrial fibrillation D. Ventricular flutter - Answer B. Atrial flutter While suctioning a patient who is being mechanically ventilated, the respiratory therapist notes the following ECG pattern on the monitor: Which of the following should the respiratory therapist recommend FIIRST? A. Administering lidocaine B. Administering 100% oxygen C. Administering atropine D. Administering epinephrine - Answer B. Administering 100% oxygen A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 2 mEq/L Na+: 135 mEg/L CI-: 100 mEg/L HCO3: 32 mEq/L Urine output: 40 mL/hour Based upon this information, the respiratory therapist would conclude that the patient A. is hyperkalemic. B. requires increased fluid intake. C. is polycythemic. D. has a metabolic alkalosis. - Answer D. has a metabolic alkalosis.
dyspnea, the respiratory therapist notes the presence of considerable cardiomegaly. This finding is most often associated with A. cardiogenic shock B. myocardial infarction C. pericardial effusion. D. pulmonary embolism - Answer C. pericardial effusion. A patient in the intensive care unit has the following hemodynamic measurements: CVP: 4 mm Hg PAP: 48/16 mm Hg PCWP: 8 mm Hg MAP: 92 mm Hg Cardiac Output: 5 L/min. Cardiac Index: 2.5 L/min/m The respiratory therapist should recommend the administration of A. bumex. B. dopamine. C. lidocaine. D. oxygen. - Answer D. oxygen. A patient in the emergency department has frothy secretions, moist crackles, and tachypnea. The patient has marked dyspnea and a history of heart disease. Which of the following should the respiratory therapist recommend?
- Suction immediately
- Administer 100% oxygen
- Place in Fowlers position
- Administer furosemide
A. 1,2 & 3 only B. 1, 3 & 4 only C. 1, 2 & 4 only D. 2, 3, & 4 only - Answer D. 2, 3, & 4 only A patient is on a continuous flow CPAP system. The respiratory therapist notes that the pressure drops to zero during inspiration. The therapist should: A. Initiate mechanical ventilation B. Change to an IPAP/EPAP system C. Increase the flow D. Decrease the threshold resistor - Answer C. Increase the flow A chronic hypercapnic patient enters the emergency room complaining of shortness of breath. The patient is coughing up inspissated, pale, yellow secretions. Which of the following would you recommend at this time? A. Sputum culture and sensitivity B. Oxygen at 2 LPM via nasal cannula C. A-P and lateral chest x-ray D. Arterial blood gases - Answer B. Oxygen at 2 LPM via nasal cannula A patient with known reversible airway disease takes two puffs of albuterol from his metered-dose inhaler. The respiratory therapist measures the patient's peak flow following the administration of the medication and determines that the peak flow has increased only minimally. The therapist should A. add a spacer to the metered-dose inhaler.
D. increase the flow to the neonate. - Answer A. confirm placement of the nasal prongs. A2-month-old infant is receiving 40% oxygen via an oxygen hood. While performing oxygen rounds, the respiratory therapist analyzes the FiO inside the hood and discovers that the FIO2 is registering 0.50. The respiratory therapist calibrated the oxygen analyzer at the beginning of the shift. The respiratory therapist should A. check to see that the hood is sealed tightly around the infant's neck. B. decrease the flow to the hood. C. check to see that the temperature setting on the humidifier is at 34°C. D. recalibrate the oxygen analyzer. - Answer D. recalibrate the oxygen analyzer. While receiving postural drainage and percussion to her right lower lobe, a 44-year-old patient suddenly vomits and aspirates. The respiratory therapist should immediately A. place the patient in Fowlers position. B. encourage the patient to take deep breaths. C. suction the patient. D. administer acetylcysteine by SVN. - Answer C. suction the patient An air flowmeter and an oxygen flowmeter are being used to deliver 40% oxygen to a patient via a non- rebreathing mask. A total flow of 12 LPM is required to prevent the non-rebreathing bag from deflating. How many liters of air and how many liters of oxygen should the therapist use? A. 2 LPM air, 6 LPM oxygen B. 4 LPM air, 8 LPM oxygen
C. 6 LPM air, 6 LPM oxygen D. 9 LPM air, 3 LPM oxygen - Answer D. O 9 LPM air, 3 LPM oxygen A patient has been admitted to the emergency department after being rescued from a house fire. The patient has second-degree bums on his neck and chest. The respiratory therapist should administer the oxygen therapy via A. non-rebreather mask. B. aerosol mask. C. face tent. D. transtracheal oxygen catheter. - Answer A. non-rebreather mask. A patient with CO poisoning is recelving oxygen therapy by a non- rebreather mask at 10 Limin. The respiratory therapist notices that the reservoir bag on the mask is emptying completely on inspiration. The therapist should A Increase the flow. B. switch to a partial rebreather mask. C. initiate mask CPAP therapy. D. switch to a venturi-mask. - Answer A Increase the flow. During an incentive spirometry treatment using a flow-sensing device, the float will not rise during inspiration. This may be due to all of the following EXCEPT A a crack in the casing. B. an obstructed mouthpiece. C. inspiratory effort is too strong.
