TMC PRACTICE1 Flashcards
(100 cards)
Current settings
IPAP 20 cm H20
EPAP 10 cm H20
ABG : pH 7.32/ PaC02 47/ Pa02 115 /Sa02 100%
What changes must be done to correct this ABG?
A. Increase IPAP to 22
B. Decrease IPAP to 18
C. Decrease EPAP to 8
D. Increase EPAP to 12
THE CORRECT ANSWER IS C AS YOU LOOK AT THIS BLOOD GAS YOU MAY SAY WOW I NEED TO ADJUST THE IPAP RIGHT AWAY SO PATIENT BLOW OFF THE C02, BUT IF YOU LOOK CLOSELY THIS PATIENT IS OVER OXYGENATING , IN ORDER TO DO SO YOU MUST ADJUST AND LOWER THE EPAP FROM 10 TO 8 , DECREASING THE EPAP YOU WILL LOWER THE Pa02 AND WILL INCREASE THE DISTANCE BETWEEN THE IPAP AND EPAP( DELTA P) PRESSURES AND IN THIS CASE IT WILL CORRECT BOTH OXYGENATION AND UNDER VENTILATION
Arterial Hemoglobin saturation ( % Hb02) should be kept above what level in order to guarantee adequate oxygen delivery to the tissues?
A. 65%
B. 70%
C. 90%
D. 75%
THE CORRECT ANSWER IS C. 90% NORMAL Sa02 SHOULD BE MORE THAN 95% BREATHING IN ROOM AIR, ANY LEVELS BELOW 90% INDICATES NEED FOR OXYGEN.
You observe a sudden drop in the peak inspiratory pressure when monitoring a patient on volume targeted ventilaton, Which of the following may explain this change?
I. A defective exhalation valve
II. A burt endotracheal tube cuff
III. A high VT setting
IV. Patient disconnect
A. II and IV only
B. III only
C. I,II, IV
D. II, III, IV
THE CORRECT ANSWER IS C A DEFECTIVE EXHALATION VALVE, A BURST ETT CUFF AND PATIENT DISCONNECT , A SUDDEN DECREASE FALL IN PIP CAN BE CAUSED BY IMPROVED COMPLIANCE IN THE LUNGS OR RESISTANCE , DECREASE IN VOLUME OR FLOW OR PATIENT VENTILATOR LEAKS.
A patient with a size 6 tracheostomy tube is being suctioned by the RN , while suctioning the patient you observe several PVC’s on the monitor, You should recommend to the RN :
A. Use larger suction catheter
B. Pre OX with 100%
C. Sedate the patient prior to suction
D. Suction less often
THE CORRECT ANSWER IS B, ALWAYS PRE OXYGENATE YOUR PATIENTS PRIOR TO SUCTIONING , SUCTIONING IS AN INVASIVE PROCEDURE ,HYPOXIA AND MECHANICAL STIMULATION OF THE MYOCARDIUM CAN LEAD INTO PVC’S. USING LARGER CATH, SEDATION OR SUCTIONING LESS WILL NOT PREVENT HYPOXIA AND PVC’S CAUSE BY THE HYPOXIA ITSELF.
Which of the following test should you recommend for a patient with suspected jaundice while being mechanically ventilated?
A. PTT
B. PT
C. Hepatic function panel
D. Cardiac Enzymes
THE CORRECT ANSWER IS C. HEPATIC FUNCTION PANEL WILL RULE OUT ANY TYPE OF LIVER DISEASE ( AST/ALT ETC) CARDIAC ENZYMES ARE INDICATED IF PATIENT HAD A SUSPECTED MI AND PTT AND PT ARE INDICATED FOR CLOTTING TIME AND FACTORS.
.When using a pulse oximetry device, the most common source of error and false alarms is:
A. Patient motion artifact
B. Presence of HbCO
C. Presence of vascular dyes
D.Ambient light detection
THE CORRECT ANSWER IS A MOTION ARTIFACT , YOU MUST SECURE THE SENSOR PROPERLY OR RELOCATE THE SENSOR TO AN EARLOBE, TOE OR EXTERNAL NARIS TO HELP MINIMIZE THESE ISSUES.
Patient in ICU intubated, PAC in place displaying the following data:
Vent settings: AC 12 500 + 18 PEEP, 50% Fi02, PIP 41
CVP 8
PAP 18
PCWP: 20
C.I. 2.0
Where or what is the problem here with your patient?
A. Right heart failure
B. Fluid overload
C. Cor Pulmonale
D. Left heart failure
THE CORRECT ANSWER IS D LEFT HEART FAILURE ,WITH AN ELEVATED WEDGE PRESSURE ALWAYS ALWAYS WILL BE LEFT HEART FAILURE , PATIENTS WILL LEFT HEART FAILURE WILL HAVE SEVERAL PATHOLOGIES SUCH AS MITRAL VALVE STENOSIS , PULMONARY EDEMA , CHF OR HIGH PIP OR PEEP LEVELS CAN CAUSE LEFT HEART FAILURE
A resident ask for your help in calculating the static lung compliance for an ICU patient receiving volume cycled ventilation, The patient has the following setting and monitoring data:
VT 700ml Rate: 12 Peak Pressure 50 cm H20 Plateau Pressure 30 cmH20 PEEP 10 cmH20 Mechanical Deadspace 100mL The patient's static lung compliance is? ( ml/cmH20)
A. 18
B. 35
C. 22
D. 26
THE CORRECT ANSWER IS B VT/ PLAT PRESS- PEEP THIS FORMULA IS NORMALLY IN ALL THE NBRC EXAMS,
The pulmonologist ask you to assess airway responsiveness during a PFT, the MD wants to rule out Chronic Bronchitis from Asthma in a patient complaining of nocturnal wheezing , you should consider all the following test except:
A. Histamine challenge test
B. TGV - Thoracic Gas Volume
C. Methacholine Challenge
D. Graded Exercise Test
THE CORRECT ANSWER IS B TGV DOES NOT ASSESS FOR AIRWAY RESPONSIVENESS AND REACTIVITY THE REST OF THE TEST WILL BE RULE THOSE DISEASES AND DISTINGUISH HOW TO TREAT EACH OF THEM. The graded exercise test is also used to rule out exercise induced asthma or asthma upon exertion. We do these test to provoke airway reactivity. If you know what TGV is is basically the body box in the PFT lab which measures airway resistance only and the question is asking EXCEPT
80kg male patient with aspiration pneumonia on SIMV in ICU, current blood gases are:
pH 7.28 PaC02 52 Pa02 62 HC03 25 Sa02 92% Vent settings: SIMV 12 500 50% +5 PEEP
As the RT for this patient what should you do first?
A. Increase Fi02 60%
B. Increase VT
C. Add PS
D. Increase PEEP
THE CORRECT ANSWER IS B : INCREASE THE VT, VENTILATION COMES FIRST AND MUST BE YOUR PRIORITY TO CORRECT FIRST THEN OXYGENATION. THE OTHER ANSWERS WERE DISTRACTORS.
A respiratory therapist is preparing to assist with a bronchoscopic biopsy of a patient with a solitary pulmonary nodule. The therapist should assure that which of the following tests have been performed? A. arterial blood gas B. electrolytes and creatinine C. cardiac enzymes D. PT and PTT
D IS CORRECT! You must know if bleeding may occur at any site during the procedure. In order to check this, PT and PTT tests are required!
A 24-year-old patient is comatose and receiving mechanical ventilation following a heroin overdose. The following arterial blood gas results are obtained: pH: 7.26 PaCO2: 58 PaO2: 75 HCO3: 26 BE: -2 Which of the following should the respiratory therapist do? A. Initiate PEEP. B. Decrease the inspiratory flow. C. Maintain the current therapy. D. Increase the minute ventilation
D IS THE CORRECT ANSWER! In order to balance the pH, the first thing that should come to mind here is to increase the minute ventilation!
Which of the following arterial blood gas results would be most representative of a patient who has advanced COPD?
A. 7.37/41/55/24
B. 7.38/59/56/32
C. 7.41/45/79/25
D. 7.50/56/57/21
B IS CORRECT! I think you all already have a pretty good grasp on your ABG’s, notice how the bicarb counteracts the elevated CO2 in order to balance this patient’s pH
A male patient who is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb) is intubated with an endotracheal tube with the 21-cm mark at his teeth. The cuff pressure is currently 30 mm Hg. Which of the following should a respiratory therapist do?
A. Remove air from the cuff until a slight leak is heard.
B. Reintubate the patient with a larger endotracheal tube.
C. Deflate the cuff until the cuff pressure equals 25 mm Hg.
D. Advance the endotracheal tube to the 25-cm mark.
A IS CORRECT AND A WHOLE LOT OF FIST BUMPS TO BE HAD FOR THE FIRST QUESTION! When intubating a patient, it is crucial that you protect their airway should they be extubated within a short time frame, to do this, using the minimal leak technique ensures the tube is secure and you achieving adequate tidal volume!
About how many hours will and H cylinder of oxygen last if it has 1100psig and is emptying a flow of 8L/min?
A. 0.6 hrs
B. 8.2 hrs
C. 7.2 hrs
D. 0.8 hrs
THE CORRECT ANSWER IS C! 7.2 HRS CALCULATION AND FORMULA: DURATION OF FLOW= ( CYLINDER FACTOR X PSIG) / FLOW THE FACTOR FOR H CYLINDERS IS 3.14 THEN PLUG INTO FORMULA (3.14X1100) / 8= 432 MINS / 60 = 7.2HRS
USING THE NEW STANDARDS OF THE NBRC FOR THE 2015 EXAM
USING THE LOWER VT FORMULA 6-10ml/Kg . Choose the best ventilator setting for this patient.
A 62 year old male 76kg ( 164 lbs), 172 cm with diffuse bilateral infiltrates is receiving 02 via non rebreather post surgery , after you drawn an ABG:
pH 7.27 PaC02 54 Pa02 51 HC03- 22 BE -4 Patient is to receive VC ventilation with an Fi02 of 100% what would you recommend for this patient initial ventilator settings?
A. AC 14 650 PEEP +5
B. SIMV 20 350 PEEP +5
C. AC 8 700 PEEP +10
D. SIMV 24 250 PEEP + 5
THE CORRECT ANSWER IS B ( DONT SCREAM ) READ MY EXPLANATION CAREFULLY AND I HOPE YOU ALL READ THE HEADER OF THIS QUESTION. SO WE NEED TO DETERMINE IF THIS PATIENT IS OBESE OR NOT OBVIOUSLY HES NOT OVER 20 LBS FROM HIS GOAL WEIGHT,SO THEREFORE USING THE 76 KG IS OK FOR NOW TO USE TO CALCULATE THE VT. NOW MUST CALCULATE HIGH AND LOW VT’S FOR THIS PATIENT ALSO THE P/F RATIO DUE TO BILATERAL INFILTRATES WHICH INDICATES THAT THIS PATIENT HAS EITHER ALI OR ARDS - REFER TO YOUR ABG AND FI02 GIVEN OK SO THE PF RATIO IS AROUND 50 THEREFORE THIS PATIENT HAS ARDS YOU WILL NEED TO USE THE 4-6ML/KG ARDS PROTOCOL FOR VENTILATION ALTHOUGH I SAID USING THE NEW 6-10ML/KG THE QUESTION IS ASKING TO VENTILATE AN ARDS PATIENT. LOW VT RANGE 304ML AND HIGH VT 456ML SO A GOOD VT FOR THIS PATIENT IS 304- TO 456. HOPE YOU CAN SEE THIS EVERYONE
An 8-year-old boy with cystic fibrosis has copious, tenacious, purulent secretions. He is receiving 2.5 mg albuterol every 4 hours and dornase alfa (Pulmozyme) once a day. Laboratory results on a sputum sample indicate the patient has a Pseudomonas infection. Which of the following is most appropriate?
A. Increase albuterol to 5 mg every 4 hours.
B. Change dornase alfa (Pulmozyme) to every 4 hours.
C. Administer 3 mL of 10% acetylcysteine every 4 hours.
D. Add 300 mg aerosolized tobramycin (TOBI) twice a day
D IS CORRECT! Tobramycin is indicated for the treatment of pseudomonas in the cystic fibrosis population
What is the normal blood pressure for a 29 week gestation infant?
A. 100/60
B. 50/30
C. 40/20
D. None of the above
THE CORRECT ANSWER IS B, ACCORDING TO NBRC MATRIX ANY PRE TERM INFANT WILL HAVE A BP AROUND 50/30 , THIS WILL VARY FROM PATIENT TO PATIENT , A IS COMPLETELY OUT C CAN BE ALSO CORRECT BUT BY NBRC STANDARDS IS AROUND 50/30 AND FOR TERM IS 60/40.
You can use a fluid column pressure manometer for all the following except:
A. To measure atmospheric pressure
B. To measure static pressure
C. To calibrate other manometers
D. To measure rapid pressure changes
THE CORRECT ANSWER IS D : FLUID COLUMN PRESSURE MANOMETERS ARE USED TO MEASURE ATM PRESSURE STATIC - CVP , BP AND ALSO USED TO CALIBRATE OTHER PRESSURING DEVICES , THEY ARE NOT SUITED FOR MEASURING RAPID CHANGING PRESSURES , THEIR ACCURACY DEPENDS ON POSITION AND THEY CAN BE MESSY AND HAZARDOUS IF MERCURY IS USED.
A patient is producing large amounts of purulent, fetid sputum. When left to rest, the sputum separates into three distinct layers. Which of the following is the most likely diagnosis for this patient? A. asthma attack B. pulmonary edema C. chronic bronchitis D. bronchiectasis
D IS CORRECT! Layering and foul smelling should tip you off immediately to bronchiectasis!
Which of the following values is most helpful in assessing a patient suspected of having a pulmonary embolus? A. shunt ( Qs/Qt) B. dead space (VD/VT) C. static compliance (Cst) D. airways resistance (Raw)
B IS THE CORRECT ANSWER! Here’s why:
dead space is the volume of air which is inhaled that does not take part in the gas exchange, either because it either remains in the conducting airways, or reaches alveoli that are not perfused or poorly perfused
A shunt occurs when ventilation fails to supply the perfused region
A 4-day-old, 35-week gestational age infant with symptoms of respiratory distress syndrome is receiving an FIO2 of 0.28 and nasal CPAP at 8 cm H2O. His vital signs, appearance, and fluid output have been stable for 12 hours. The results of a blood gas analysis obtained from an umbilical artery catheter are below:
pH 7.43 PaCO2 42 PaO2 129 HCO3 27 BE +3
Which of the following should a respiratory therapist recommend?
A. Maintain the present therapy and monitor the infant.
B. Discontinue CPAP and increase the FIO2 to 0.40.
C. Decrease CPAP to 5 cm H2O.
D. Decrease the FIO2 to 0.21.
C IS 100% CORRECT! Due to the hazards of increased CPAP over the hazards of increased FIO2, it should be your first priority to decrease the CPAP first before decreasing the FIO2. The reason why you would want to wean the CPAP first in this situation is due to the stress placed on the heart as well as the fact that 0.28 FIO2 could be a lot easier to wean
A patient is receiving PSV at 5 cm H2O with a PEEP of 5 cm H2O. The patient has shown no signs of distress, and vital signs have been stable for the last hour. Which of the following should the respiratory therapist do?
A. Obtain an arterial blood gas sample.
B. Extubate the patient.
C. Initiate a T-piece trial.
D. Maintain current settings.
THE ANSWER HERE IS B! This patient is ready to be extubated, the fact that their vital signs are stable, they are in no distress and have been on PSV for at least an hour (maybe more). In this case, it is safe to assume that a blood gas will be stable, in this case, extubate your patient.
A patient receiving long term positive pressure ventilation support exhibits a progressive weight gain and a reduction in hematocrit to 20, which of the following is most likely the issue?
A. Leukocytosis
B. Chronic Hypoxemia
C. Water retention
D. Leukocytopenia
THE CORRECT ANSWER IS C! FIRST LEUKOCYTOPENIA AND LEUKOCYTOSIS ARE POLAR OPPOSITES AND ACT AS DISTRACTOR FOR THIS QUESTION. THESE ARE TERMS WHICH YOU CAN IDENTIFY IF PATIENT HAS AN INFECTIOUS PROCESS. HYPOXEMIA INCREASES HCT LEVEL NOT DECREASES SO THE ONLY CHOICE IS WATER RETENTION.
