Download Ventilation Management in Critical Care and more Exams Nursing in PDF only on Docsity!
Answers 2023-
RRT TMC Exam 160 Questions and
Answers 2023-
The patient's lung has an air leak - You are called to the emergency department to help care for a patient who was in a vehicle accident and has chest injuries including broken ribs. Crepitations are felt while palpitating the patient's neck. What is most likely the cause of this? Reversible airway obstruction - A forced expiratory measurement obtained after the administration of a bronchodilator shows an increase in FEV1 from 60% to 80% of predicted. This indicates a: complete airway obstruction - During capnography monitoring of a mechanically ventilated patient, you note that the end-tidal PCO2 (PetCO2) has dropped to 0 mm Hg. This finding may indicate: inserting an esophageal-tracheal combitube - An unconscious apneic patient with a full stomach cannot be orally intubated in the emergency room. Which of the following would your recommend be? patients size and clinical condition - While establishing initial ventilatory support settings for a new patient, the most important consideration is the: Fever (hyperthermia) - A male patient has a lower than normal mixed venous O2 content. Which of the following is the most likely cause of this condition? apply 5-10 cm H20 pressure support - You are trying to wean an alert intubated patient off full ventilatory support using the CPAP protocol with 40% O2. Early in the initial effort her respiratory rate increases from 24 to 30/min and you start to observe some use of her accessory muscles while breathing. Which of the following would be your first action at this time? 70 minutes - What is the approximate duration of flow of an oxygen E-cylinder at 1000 psi running at 4 L/min? increase the suction pressure to -120 mm Hg - While using a Yankauer device to suction an adult patient, you are unable to remove thick secretions. The regulator attached to the oropharyngeal suctioning device displays a reading of -70 mm Hg. Which of the following actions should you take at this time?
Answers 2023-
a missing lead - While setting up a 12-lead EKG on a patient, you are unable obtain any electrical signal. The batteries are fully charged and the device was able to power-on. The most likely cause of this problem is which of the following? angiography - Which of the following imaging procedures is used to evaluate the arteries for abnormalities such as aneurysm, atherosclerosis, embolism, occlusion, stenosis, thrombosis, trauma, or vasculitis? has smoked within the prior 12-24 hours - You obtain an expired carbon monoxide (CO) reading of 18 ppm on a COPD patient participating in a pulmonary rehabilitation program. Based on this finding, you can conclude that the patient: decrease in O2 saturation from 91% to 82% - While monitoring a patient during a spontaneous breathing trial, which of the following observations would cause you to stop the trial and return the patient to ventilatory support? increased ventilation - Your patient is receiving volume control A/C ventilation. She has become increasingly agitated and the end-tidal CO2 has decreased from 38 to 27 torr over the last 3 hours. Which of the following is most likely the cause? 3500 mL - A normal vital capacity for a female patient who is five feet three inches tall and weighs fifty kilograms would be approximately: the sensitivity - An asthmatic patient is struggling to initiate inspiration on a ventilator operating in the assist-control mode. Which of the following ventilator settings would you first check in order to resolve of this problem? atrial fibrillation - On inspection of a patient's EKG strip, you note that there are no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. What is the most likely problem? Vital Capacity (VC) - Which of the following is the best bedside measurement for assessing the integrated function of the respiratory muscles and mechanical properties of the lungs and thorax? Sinus Tachycardia -
Answers 2023-
flowmeter-humidifier connection for leaks - A bubble humidifier is not bubbling during oxygen therapy, despite the flowmeter set and running at 5 L/min. Which of the following should you check? bronchospasm - Which of the following would cause an increase in a patient's peak airway pressure while receiving volume control ventilation? inspissated secretions - After review a patient's chart, you note that an admission diagnosis of fluid depletion/dehydration. Which of the following findings would be most likely on bedside assessment of this patient? it would underestimate the CVP - You are called to help a nurse in ICU measure a patient's central venous pressure (CVP) with a strain-gauge pressure transducer. The pressure transducer appears to be positioned well above the middle of the patient's lateral chest wall. What effect if any would this have on the measurement? pneumothorax - Which of the following would cause a sudden increase in the peak pressure during volume controlled ventilation? heated wick humidifier - Which of the following humidifier devices would you select in order to condition the inspired gas to 100% body humidity? check the A-line stopcock position - While doing a normal patient assessment, you note that the arterial pressure monitor of a conscious patient in no apparent distress that the pressure waveform is absent and the alarm is sounding. What should your first action be? Control Mode Ventilation (CMV) - Which of the following modes of ventilatory support is indicated when a precise I:E ratio must be maintained? intubate/apply A/C ventilation, VT 400 mL, rate 12/min, FIO2 0.50 - A 43-year-old 52 kg patient is admitted to the emergency room after overdosing on heroin. The patient is unconscious and is making minimal respiratory efforts. ABG results on a nonrebreathing mask @ 12 L/min are as follows: pH 7.28 PCO2 74 torr HCO3 20 mEq/L PaO2 315 torr You should you recommend? the presence of a leak in the patient-ventilator system - While comparing previously recorded values to those currently observed on a patient receiving volume control ventilation, you note a decrease in expired volume and a decreased airway pressure. There has been no change in ventilator settings. Which of the following best explains these findings?
Answers 2023-
the catheter has moved from right ventricle to pulmonary artery - You are called to assist a physician who is inserting a pulmonary artery catheter. During the procedure, you note a changeover on the monitor from pressures of about 25/5 mm Hg to pressures of 25/15 mm Hg. Which of the following most likely has occurred? CPAP titration at home or in the sleep lab - Based on an overnight oximetry test, a patient suspected of having sleep disordered breathing exhibits an oxygen desaturation index (ODI) of 48/hr. Which of the following would you recommend? chest transillumination - You are called to the NICU. A premature neonate receiving positive pressure ventilation exhibits acute respiratory distress, hypotension, and asymmetrical chest motion. Which of the following procedures would you initially recommend? the patient normally contributes to minute ventilation - Which of the following is true regarding synchronous intermittent mandatory ventilation (SIMV)? Squeeze the bag more slowly - While ventilating a child with a manual resuscitator, the pressure relief valve continually activates. Your first action should be which of the following? right-sided pleural effusion - While performing posterior thoracic palpation of an adult, you note minimal right-side diaphragmatic movement as the patient takes a deep breath. His left-sided movement is normal. Which of the following conditions would best explain this finding? right-sided pneumothorax - After feeling chest pain and shortness of breath, a 38-year-old female drove herself to the emergency room. After starting oxygen therapy on the patient, the RRT performed a physical exam and noted: a hyperresonant percussion note on the right side and a tracheal shift to the left. What is most likely the cause of these findings? transcutaneous PCO2 - To continuously monitor the adequacy of ventilation of a patient in ICU being supported by mask BiPAP, you would recommend which of the following? peak flow - For testing purposes, you instruct a patient to take a deep breath and then exhale as quickly as possible. You then observe the recording of the fastest air movement. Which of the following tests is being measured? a mucous plug in the ET tube -
Answers 2023-
While reviewing the flow sheet of a patient receiving artificial ventilatory support, you note a progressive rise in heart rate over the last two hours. Which of the following actions would you recommend to help identify the cause of this problem? use of generic vs. brand name medications - After obtaining a medication history from a patient admitted for asthma, which of the following information would you consider least important? Control valve - Which of the following valves in a typical high frequency oscillation ventilator is used to regulate the mean airway pressure? atelectasis of the left lung - After reviewing the patient's chart, you note that results of a chest x-ray show: "Complete opacification of the left chest with a shift of the trachea and mediastinum to the left." These findings are most likely to indicate which of the following? a hemoglobin deficiency - A patient with a normal cardiac output and PaO2 is exhibiting signs and symptoms of tissue hypoxia. Which of the following is the most likely cause? post-extubationedema - The most likely cause of stridor in an adult patient would be which of the following? high-resolution CT scanning - A patient is admitted with signs and symptoms, as well as a history consistent with bronchiectasis. You should recommend which of the following to confirm or rule out this diagnosis? left sided tension pneumothorax - When reviewing a chest x-ray, you note that the heart is shifted to the patient's right. Which of the following is the most likely cause of this finding? noninvasive pulse oximetry - A physician wants your recommendation on how to monitor the cardiopulmonary status of a patient that is undergoing a bronchoscopy procedure with moderate sedation. You would recommend which of the following: pressure limit/PIP = 25 cm H2O; rate = 15/min; inspiratory time = 1 second - The physician orders A/C pressure control for a 55 kg postoperative male patient. Which of the following settings would you choose for this patient? pass through the suction catheter and then enter the Lukens trap - You are called to perform a sputum induction on a trach patient to gather a sample for microbiological identification. The sample is collected using a Lukens trap. When applying suction after entering the airway, the mucus should: Aspirated Foreign Body -
Answers 2023-
You hear wheezing while auscultating a patient's chest. This may indicate the presence of which of the following? decrease the high pressure limit to 45-50 cm H2O - While performing a routine patient-ventilator check, you note the following settings and parameters: Exhaled tidal volume 650 mL Peak inspiratory pressure 33 cm H2O High pressure limit 60 cm H2O Low pressure alarm 20 cm H2O Low tidal volume alarm 500 mL Which of the following change would you make? heart rate rises from 103 to 118/min - Which of the following are acceptable changes in a patient's status during a spontaneous breathing trial for weaning from mechanical ventilation? Check the electrode connections on the patient - An apnea monitor alarm is sounding continuously but your initial assessment of the patient reveals that they are breathing normally. You next action should be to: cardiac tamponade - If a patient develops a paradoxical pulse following trauma or cardiothoracic surgery, especially in connection with increasing venous pressure and heart rate, it would suggest which of the following? check the patient-ventilator circuit for system leaks - While performing a routine ventilator check on a patient receiving volume controlled ventilation, you note that the peak airway pressure has decreased from a prior value of 52 cm H2O to 32 cm H2O. There have been no changes to the ventilator settings. Which of the following actions would be appropriate at this time? terminate the protocol and contact the doctor - A doctor orders O2 titration with exercise for a patient with a chief complaint of dyspnea on exertion. The patient's baseline SpO2 is 84% on room air. You would: monitor cuff integrity and pressure - What is the purpose of the pilot balloon on an endotracheal or tracheostomy tube? vital capacity (VC) - If you were to instruct a patient to take a maximum deep breath and then exhale completely, which maneuver is being measured? V4 - Which of the following ECG leads should be placed in the 5th intercostal space? vibrating mesh nebulizer - A 16-year-old patient with cystic fibrosis is receiving pressure control SIMV with pressure support due to a severe bilateral pneumonia. The pulmonologist asks you to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which of these devices would you select to administer this therapy?
Answers 2023-
While examining a patient, you notice that the patient has greatly diminished breath sounds in the right lower lobe and the trachea has shifted to the right. These signs indicate which of the following conditions? bronchoalveolar lavage - A patient in intensive care unit is suspected of having developed a bacterial ventilator associated pneumonia. Which of the following procedures would you recommend in order to diagnose the cause of this problem? add or increase pressure support - A male patient with a smaller than normal trach tube is placed on volume control SIMV at a rate of 8/min. Over the last hour, you note the patient increasing use of his accessory muscles during spontaneous breaths, accompanied by some abdominal paradox. Which of the following would be the best way to overcome this problem? replace the endotracheal tube - Before intubation in an emergency situation, injection of air into the pilot line fails to inflate the cuff. Which of the following should you do? refractory hypoxemia - In assessing a patient in the acute phase of ARDS, which of the following would you expect to find? check the connecting tubing for leaks or obstructions - A nurse who recently set up a pleural drainage system on a patient with a pneumothorax complains that she doesn't see any bubbling in the suction control chamber. After checking the suction control regulator to confirm that it is on, which of the following would you recommend that she do next? prevent gas leaks and aspiration - To provide long-term positive pressure ventilation, a cuffed artificial airway is needed in order to: kyphosis - While inspecting an elderly female patient, you note that she has an abnormal anteroposterior (AP) curvature of the spine. This best describes which of the following? disconnect patient and provide manual ventilation with 100% O2 - You are called to check on a patient receiving volume controlled A/C ventilation. You note that both the low tidal volume and high pressure limit alarms are sounding on each inspiration. You first action should be which of the following? lower peak pressure - A 54 year-old patient is on a ventilator in the volume control mode. After you perform endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?
Answers 2023-
pulmonary embolism - Which of the following conditions would a ventilation scan appear normal but a perfusion scan reveal areas of absent blood flow? -20 cm H2O - A patient is considered to have sufficient respiratory muscle strength to maintain adequate ventilation and prevent secretion retention when the maximum inspiratory pressure (MIP; NIF) is more negative than which of the following? dietary habits - Which of the following selections in a patient's medical history would be least important to consider in evaluating their pulmonary condition? the spirometer is performing within acceptable limits - A normal 5-foot 4-inch tall staff member serves as a biologic control for the PFT lab. Her established FVC is 3.81 L with a SD of ±0.13 L. During quality control testing of a spirometer, she produces the following FVC results: FVC #1 = 3.73 L, FVC #2 = 3.88 L, FVC #3 = 3.71 L. You should conclude that the tighten the regulator connection - After opening the valve on an E cylinder which has a regulator attached, you hear a hissing noise. The flowmeter/gauge is turned off. Which of the following corrective actions should you take? SIMV allows graded levels of support - Which of the following is an advantage of SIMV over assist/control ventilation? lower the PEEP back to 10 cm H2O - The physician orders an increase in PEEP from 10 to 14 cm H2O for a patient receiving mechanical ventilation. After you adjust the PEEP setting, you note a rapid drop in the patient's blood pressure and a significant rise in heart rate. Which of the following actions would be appropriate? pulmonary barotrauma - What is the major hazard associated with the use of bag-valve resuscitator? discarded the sample and obtain a new one - While analyzing an ABG sample you obtained from a patient breathing room air, you obtain the following values: pH 7.44 PaCO2 46 torr PaO2 163 torr The patient's blood gas results should be: check/adjust ET tube cuff pressure - You are using a portable pressure-cycled ventilator with a heated humidifier and IPPB circuit to temporarily ventilate a post-operative patient who is regaining consciousness in the recovery room. After checking the patient and ventilator, you notice that the inspiratory time is prolonged and the machine does not cycle off without active patient effort. What should you do in order to correct the problem?
Answers 2023-
You notice over a 2-hour period, the plateau pressure of a patient receiving volume controlled ventilation has remained stable, but her peak pressure has steadily increased. Which of the following is most likely the reason for this observation? decrease the minute ventilation - A 58-year-old postoperative male who weighs 78 kg (172 lb) is receiving volume control A/C ventilation at a rate of 14/min with a tidal volume of 650 mL and an FIO of 0.4. Results of arterial blood gas analysis are as follows: pH 7.51 PaCO2 30 torr HCO3 23 mEq/L BE -1 PaO2 117 torr SaO2 99% Based on this information, you should recommend which of the following? vascular dyes - Which of the following will tend to cause false LOW readings when using a pulse oximeter? metabolic acidosis - In assessing a new admission to the Intensive Care Unit, you note a spontaneous respiratory rate of 37/minute. The most likely cause of this observation is: Sensitivity - If the patient complains of difficulty in starting the IPPB treatment, which control should you adjust? delivered volume will decrease - You have a patient that is receiving pressure controlled A/C ventilation. Which of the following changes would you expect to occur if the patient's lung compliance were to decrease? miller - What type of laryngoscope blade would you select when performing an emergency intubation on an infant? inspiratory flow - The attending physician requests that you increase the expiratory time on a patient receiving volume control ventilation, but not alter the minute ventilation. Which of the following settings would you adjust to fulfill this request? increased pH and decreased SaO2 - Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest? check/confirm proper temperature setting - Your patient who is being mechanically ventilated has thick, mucoid secretions. It is determined that the wick humidifier is producing insufficient humidity. In this case, which of the follow should you do? adjust the nasal mask to ensure a better fit with no pressure loss -
Answers 2023-
The Respiratory Therapist is called to evaluate a home patient with a nasal CPAP mask for treatment of obstructive sleep apnea. The patient's wife states that he has been snoring more loudly lately and having periods of apnea. You confirm this after observing the patient's sleeping and breathing patterns for 2 hours. What would be your first course of action to try to correct the problem? pressure vs. volume display - Which of the following ventilator graphics displays is the best choice to assess the work of breathing associated with patient triggering? hypoxemia - A patient's ABG shows respiratory alkalosis. Which of the following problems is most likely? drain any accumulated water from the delivery tubing - A large volume jet nebulizer is operating on 70% oxygen at 12 L/min. You note that the aerosol being delivered is in short rapid puffs and also observe a gurgling sound in the system. Which of the following actions would be most appropriate? increasing the power/amplitude - You are called and asked to decrease the PaCO2 of a patient receiving high- frequency oscillation ventilation. Which of the following should you consider adjusting? "Do you need to use extra pillows when you sleep?" - Which of the following should be asked in order to help determine if a patient has orthopnea? Consolidation in the patient's left lower lobe - While auscultating a patient's lungs, you hear bronchial breath sounds over the left lower lobe area. This would indicate which of the following? left-sided pneumothorax - After assessing your patient, they are acutely dyspneic and hypotensive, you note the following (all limited to the left hemithorax): reduced chest expansion, hyperresonance to percussion, absent of breath sounds and tactile fremitus, and a tracheal shift to the right. Which of the following would these findings suggest? flattening of the diaphragms - While observing the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema, which of the following finding would you expect to see? levalbuterol (Xopenex) - A 53-year-old female patient with chronic bronchitis is receiving volume controlled A/C ventilation. Wheezing is heard over all lung fields and rhonchial fremitus is felt over the central airways. Also, her secretions are very thick. The patient's peak
Answers 2023-
obtain the patient's current prescription vials from the family - A patient presents to the emergency room with a depressed level of consciousness and is severely agitated. Which of the following approaches can be used to obtain their medication history? use an oxygen-conserving device - An ambulatory home oxygen therapy patient complains that her portable liquid system running at 2 L/min doesn't last long enough for her to visit with her grandchildren. Which of the following would you recommend to overcome this limitation? combined hypercapnic/hypoxemic respiratory failure - A patient with a 9-year history of chronic bronchitis and an acute pneumonia exhibits the following ABG results on room air: pH = 7.21, PCO2 = 64 torr, HCO3 = 25 mEq/L, PO2 = 39 torr, P(A-a)O2 = 41 torr Which of the following best describes this patient's condition? assure a stable/fixed FIO2 - What is the primary reason for selecting a high flow nasal cannula system for a patient? restrictive - A pneumothorax in the clinical setting is classified as which of the following primary disorders? ventilation/perfusion scans - For patients with suspected pulmonary thromboembolism whose ordinary X-rays are negative, which of the following procedures can best help establish the diagnosis? decreased vascular markings - Which of the following would you expect to find on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema? tissue biopsy via fiberoptic bronchoscopy - Based on your patient's smoking history and their physical exam, you immediately suspect them of having bronchogenic carcinoma. You would recommend which of the following tests to confirm or rule-out this diagnosis? increase the high rate alarm to 30-35 - In order to initiate weaning, you change the patient from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings? 20-25% - Ventilatory support may be indicated when the pulmonary R-L shunt fraction (Qs/Qt) rises above what level?
Answers 2023-
decreased end-diastolic volume - A patient in intensive care unit develops a supraventricular tachycardia at a rate of 162/min. Which of the following effects would this have on cardiac function? improvement of the air flow - A patient with asthma is in acute respiratory distress and presents to the emergency room with diminished breath sounds. After bronchodilator therapy, auscultation of the chest reveals rhonchi and wheezing. This change suggests which of the following?
