TMC PRACTICE2 Flashcards
(100 cards)
1
Q
The recommemded dose of this medication is 300 mg IV/IO for recurrent VT/VF
A. Vasopressin
B. Amiodarone
C. Naloxone
D. Metoprolol
A
B!!
2
Q
The initial dose of this medication is 6 mg given rapidly over 1-3 seconds followed by a rapid saline flush
A. Amiodarone
B. Vasopressin
C. Adenosine
D. Metoprolol
A
THE ANSWER is ADENOSINE FIRST DOSE IS 6 MG, SECOND DOSE IS DOUBLED 12MG ALWAYS A RAPID PUSH FOLLOWED BY A RAPID FLUSH! iF ITS GOING TO WORK IT NEEDS TO BE GIVEN FAST
3
Q
Normal L/S ratio
A. 1:3
B. 2:4
C. 3:1
D. 2:1
A
THE CORRECT ANSWER IS D! L/S RATIO NORMAL IS 2:1
Lecithin/sphingomyelin is fetal amniotic fluid that determines lung maturity
4
Q
The usual dose of this medication is 40 units IV/IO. It may be used in the treatment of asystole or PEA
A. Vasopressin
B. Metoprolol
C. Naloxone
D. Amiodarone
A
THE ANSWER IS VASOPRESSIN! VASOPRESSIN CAN ONLY BE GIVEN DURING CERTIN TIMES OF ACLS IN PLACE OF EPI AND ITS DOSES are limited!!
5
Q
While reading a chest xray report , radiologist states patient has a deep sulcus sign.
Therefore you must prepare to
A. Intubate
B. Monitor VC and MIP
C. Chest tube
D. Thoracentesis
A
THE CORRECT ANSWER IS C . ANYTIME YOU SEE THIS WORD RECALL PNEUMOTHORAX AND CHEST TUBE SHOULD BE INSTITUTED STAT, THESE ARE RECALL /EVALUATION TYPE QUESTIONS.
6
Q
During an interview with your patient, you determine that she is disoriented to time, place, and person. What may explain this finding?
A. Respiratory Alkalosis
B. Severe hypoxemia
C. Metabolic acidosis
D. Hyperthermia
A
B IS CORRECT! An abnormal sensorium (e.g., confusion or stupor) is often caused by inadequate cerebral oxygenation. In fact, whenever a critically ill patient exhibits this finding, assume that it is due to hypoxemia until proven otherwise.
7
Q
A patient with a confirmed diagnosis of asthma who is prescribed daily inhaled steroids has an exhaled nitric oxide reading of 72 ppb. This could indicate:
- The presence of a comorbidity with similar symptoms, such as cardiac disease.
- The need to increase the dosage of the inhaled steroid or addd a beta agonist.
- Poor compliance with drug regimen or improper inhaler technique.
A. 1 only
B. 1 and 2
C. 2 and 3
D. 1, 2 and 3
A
C IS CORRECT!! In adults with a diagnosis of asthma who are complying with treatment, high NO values (>35 ppb) indicate the need for higher steroid dosing or the addition of a beta agonist. If compliance cannot be confirmed, the problem is likely related to poor disease management or poor inhaler technique
8
Q
Therapeutic end points for this medication include: >50% widening of the QRS complex, total of 17 mg/kg have been given, hypotension, and suppression of dysrhythmia
A
PROCAINAMIDE is correct!
9
Q
A patients advanced directive :
A. Is usually obtained at the time of admission
B. Can be found in the doctors progress notes
C. Represents a guideline , not legal requirement
D. Cannot be altered after is written and signed
A
THE CORRECT ANSWER IS A , THESE TYPE QUESTIONS WILL BE PRESENTED IN YOUR EXAMS THEY ARE LABELED AS QUALIFERS WHICH REPRESENT A CONDITIONAL OR HEDGE WORD OR PHARSE , THESE TYPE QUESTION MAY APPEAR IN ONE OR TWO OPTIONS. BE ON GUARD.
10
Q
A portable spirometer requires you to enter the patient’s height in centimeters in order to derive normal values. The patient tells you that he is 5 feet and 6 inches tall. What value would you enter into the device?
A. 26 cm
B. 66 cm
C. 168 cm
D. 186 cm
A
THE CORRECT ANSWER IS C 168CM USING THIS SIMPLE FORMULA YOU CAN CONVERT INTO CM. MEASUREMENT ( X UNITS) X CONVERSION FACTOR = MEASUREMENT ( Y UNITS)
11
Q
When using Epinephrine in treatment of asystole/PEA all of the following are true except:
a. May be given every 3-5 minutes
b. Must be given as a slow push over 2 minutes.
c. May be given via ETT
d. It may increase the heart rate and blood pressure
A
The EXECPT IS B. IT MUST BE GIVEN AS A RAPID PUSH FOLLOWED UP WITH A 20 cc Nomal saline flush
12
Q
Cardiac/ECG review: What is the ratio of compressions to ventilations in two-rescuer infant CPR?
a. 30 compressions to 2 ventilations
b. 15 compressions to 2 ventilations
c. 30 compressions to 1 ventilation
d. 15 compressions to 1 ventilation
A
THE ANSWER IS B 15:1
13
Q
A patient’s bedside spirometry results (as compared to normal) are as follows: FVC decreased, FEV1 normal, and FEV1% increased. What is the most likely diagnosis?
A. An obstructive disorder
B. Poor patient effort
C. A restrictive disorder
D. Within normal limits
A
C IS CORRECT! A patient with a decreased FVC, normal FEV1 and increased FEV1% is exhibiting the classic pattern of a restrictive pulmonary disorder-decreased volumes and normal (or increased) flows.
14
Q
What is the initial IV/IOadult dose of epinephrine for a patient in PEA?
a. 1mg/kg of a 1:1000 solution
b. 1mg of a 1:1000 solution
c. 1mg/kg of a 1:10,000 solution
d. 1mg of a 1:10,000 solution
A
THE ANSWER IS D! 1:10,000 remember the IV/IO route is always the same and maybe repeated every 3 - 5 minutes. The α-adrenergic effects of epinephrine can increase coronary perfusion pressures and cerebral perfusion pressure during CPR. However, it may increase myocardial work and reduce subendocardial perfusion and increased myocardial oxygen demand thus exacerbating ischemia.
15
Q
What is the initial IV dose of Vasopressin in asystole?
a. 40mcg/min
b. .04mg/kg/min
c. 4.0mg
d. 40 units
A
REMEMBER THE UNITS FOR VASO IS UNITS THE ANSWER IS D. A vasopressor should be given early in cardiac arrest with the primary goal of increasing myocardial and cerebral blood flow during CPR and achieving ROSC. Epinephrine of 1mg may given or alternatively Vasopressin 40 units may be may replace either the FIRST OR SECOND dose of epinephrine in the treatment of cardiac arrest.
16
Q
You hear bronchial breath sounds over the patient’s right middle lobe. Which condition is probably present?
A. Emphysema
B. Asthma
C. Pneumonia
D. Pleural effusion
A
C IS CORRECT!! Bronchial breath sounds normally are heard only over the trachea. When heard over the lung periphery, consolidation (due to pneumonia) is present. Tissue consolidation enhances transmission of the turbulent flow sounds in the larger airways to the chest surface.
17
Q
What is the best way to determine whether a patient has learned the information needed to understand how her disease affects lung function?
A. Have the patient take a multiple choice quiz
B. Discuss the information with the patient’s family
C. Have the patient “teach” the information back to you
D. Have the patient perform a return demonstration
A
C IS CORRECT! Having the patients teach the information back is the best way to determine whether a patient has learned the information AND RETAINED IT!
18
Q
A patient complains that she has a chronic cough usually accompanied by sputum production. This information indicates that the patient probably has which of the following conditions?
A. Acute asthma
B. Chronic bronchitis
C. Pulmonary emphysema
D. Pulmonary fibrosis
A
B IS CORRECT! 2 symptoms that usually raise red flags of chronic bronchitis.
19
Q
During an interview with your patient, you discover that he gets short of breath at night when he lies down, so he often sleeps with several pillows propping his head up. Which symptom is present?
A. Apnea
B. Orthopnea
C. Platypnea
D. Orthodeoxia
A
Orthopnea IS CORRECT, B!! Orthopnea is present when a patient has difficulty breathing when lying down. Most often this is due to either congestive heart failure or abdominal factors impairing diaphragm movement. Most patients learn that elevating the head with pillows can help alleviate orthopnea.
20
Q
On reviewing the results of the attending physician’s physical examination of a patient’s chest, you note a “dull percussion note and bronchial breath sounds in the LLL.” All of the following are potential problems except:
A. Infiltrates
B. Atelectasis
C. Consolidation
D. Pneumothorax
A
D IS CORRECT!! A patient with a dull percussion note and bronchial breath sounds most likely has pulmonary infiltrates, atelectasis, or consolidation of the affected area. A pneumothorax normally results in a hyper resonant sound.
21
Q
Which of these conditions is associated with jugular venous distention?
A. Cor Pulmonale
B. Pneumonia
C. Pneumothorax
D. Septic Shock
A
A IS CORRECT!! Cor Pulmonale is right heart failure due to lung disease. Right heart failure occurs when chronic hypoxemia causes pulmonary vasoconstriction, which puts a strain on the right ventricle. Right heart failure also causes blood to back up in the venous system, including the neck veins.
22
Q
Patient is admitted to the ED comatose with suspected smoke inhalation.After confirming airway patency which of the following should you do first?
A. Measure Sp02
B. Initiate 100% 02
C. Obtain a STAT ABG
D. Request a STAT CXR
A
THE CORRECT ANSWER IS B. THE FIRST PRIORITY IS TO ENSURE ADEQUATE OXYGENATION , GIVEN THE PATIENT IS SUSPECT OF HAVING SMOKE INHALATION INJURY 100% 02 SHOILD BE ADMINISTERED STAT WITHOUT WAITING FOR ANYMORE INFORMATION.
23
Q
CPFT:
The minimum acceptable % for FEV1/FVC ratio is?
A. 90%
B. 70%
C. 40%
D. 50%
A
THE CORRECT ANSWER IS B!! ANYTHING BELOW 70% IS NOT ACCEPTABLE
24
Q
You just inserted an undewelling arterial catheter in an MICU patient. A good indication that the catheter has been successfully inserted an artery is:
A. Positive allens test
B. A good blood return
C. Abiltiy to flush the line
D. Proper blood pressure and waveform
A
THE CORRECT ANSWER IS D: OUT OF ALL THE ANSWERS PRESENTED FOR THIS QUESTION THE OBVIOUS ONE IS PROPER BLOOD PRESSURE AND WAVEFORM
25
Which of the following would facilitate clearance of pulmonary secretions in a patient with CF?
I. Mucomyst
II Flutter Valve
III Atropine
IV DNase
A.I and II
B. II and IV
C. I,II, and IV
D. II, III, IV
THE CORRECT ANSWER IS C MUCOMYST FLUTTER VALVE AND DNASE WILL HELP FACILITATE PULMONARY SECRETIONS , ATROPINE DOES THE OPPOSITE IT DRIES UP SECRETIONS IN PATIENTS. SO BY PROCESS OF ELIMINATION YOU SHOULD AUTOMATICALLY EXCLUDE ATROPINE
26
Surgeon orders an increase in PEEP from 6 to 10mmHg for a post op patient receiving mechanical ventilation. After you adjust the PEEP setting , you notice a rapid fall in patients BP and becomes tachycardic, which of the following actions would you recommend to the surgeon?
A. Increase Fi02 by 5%
B. Give a vasopressor STAT
C. Return to PEEP of 6
D. Obtain ABG STAT
THE CORRECT ANSWER IS C, ONE OF THE ADVERSE EFFECTS OF PEEP IS DECREASED CARDIAC OUTPUT DUE TO INCREASED PLEURAL PRESSURE AND DECREASED VENOUS RETURN. A RAPID DROP IN PATIENTS BP AND TACHYCARDIA INDICATED A DROP IN CARDIAC OUTPUT. FOR EXAM PURPOSES BE ON GUARD ESP WITH OPTIMAL PEEP STUDY QUESTIONS.
27
An oropharyngeal airway is least appropriate for a patient who :
A. Is having seizures
B. Requires manual ventilation
C. Is conscious and alert
D. Is heavily sedated
THE CORRECT ANSWER IS C : THE CONCIOUS AND ALERT PATIENT ,THESE AIRWAYS CAN PROVOKE A GAG REFLEX AND POSSIBLE EMESIS AND HOSULD BE THEREFORE GENERALLY NOT USED FOR CONCIOUS PATIENTS
28
You inspect a chest radiograph and observe the medial borders of the scapulae in the upper lung fields, the ribs positioned horizontally, and the thoracic spine about 5 cm to the left of the sternum. Which of the following describes this radiograph?
A. Anterior-posterior (AP) view, improperly rotated
B. Anterior-posterior (AP) view, properly aligned
C. Posterior-anterior (PA) view, improperly rotated
D. Posterior-anterior (PA) view, properly aligned
A IS ACTUALLY THE CORRECT ANSWER HERE. In the AP view, the medial borders of the scapula are seen in the upper lung fields, ribs appear more horizontal, and the heart is more magnified. With proper alignment, the thoracic spine lines up with center of the sternum and is positioned equally between the medial ends of each clavicle.
29
A 30kg ( 66lb) child is being mechanically ventilated in the SIMV mode ,
Data
```
Vent settings
Fi02 45%
Mandatory rate 18
Total rate 23
VT 350mL
PEEP 12
```
```
ABG
pH 7.38
PaC02 45
Pa02 110
HC03 23
BE 0
```
Based on this information what must you do?
A. Decrease VT
B. Reduce PEEP
C. Decrease RR
D. Lower the Fi02
THE CORRECT ANSWER IS B! IN THIS SCENARIO THE CHILDS ACID BASE STATUS AND PC02 ARE NORMAL SO NO CHANGE IN VENTILATION IS WARRENTED. THE P02 IS IS SHOWING HYPEROXIA AND CAN BE LOWERED IF THE HEMOGLOBIN IS ACCEPTABLE YOU CAN LOWER THE Fi02 OR THE PEEP.ACTUALLY THERES ONLY ONE CORRECT ANSWER HERE AND IN THIS CASE IS TO LOWER THE Fi02 WHICH PRESENTS NO DANGER TO THE PATIENT BUT A PEEP OF 12 CAN BE HAZARDOUS DECRASE THE PEEP FIRST THE FOLLOW WITH THE Fi02.
30
A physician ask you to assess if a 75kg ( 165lbs) patient with a neuromuscular disease being mechanically ventilated, patient is in the SIMV mode and ready for weaning.
```
Data obtained
Spont VT 250mL
Minute ventilation 10L/min
VC 758mL
MIP -29 cm H20
```
Based on this information what would you recommend?
A. Begin SBT's
B. Postpone weaning and reevaluate
C. Begin weaning using PSV protocol
D. Being weaning by decreasing rate
THE CORRECT ANSWER IS B, MANY OF YOU MAY CHOOSE TO START WEANING VC AND MIP ARE BORDERLINE ADEQUATE AND CONCLUDE THAT THE PATIENT IS READY FOR WEANING. WRONG! IN THIS CASE THE MINUTE VENTILATION AND VT SUGGEST A MAJOR MAJOR ISSUE BUT THIS BECOMES CLEAR ONLY AFTER IDENTIFYING THE MISSING DATA THE SBR EQUALS TO 10L/MIN DIVIDED BY 250ML = 40 BPM, THIS YIELDS TO AN RSBI OF 160 FAR ABOVE THE THRESHOLD VALUE OF 100 THIS WILL LEAD INTO WEANING ISSUES WITH THIS PATIENT LOOK AT THE ENTIRE PICTURE NOT JUST MIP OR VC ,ALWAYS FOLLOW AND CALCULATE MISSING DATA!!!!!! SO THEREFORE POSTPONING SBT IS THE CORRECT ANSWER IN THIS SCENARIO
31
32 year old male ABG for a patient that is breathing 100% O2
```
ABG pH 7.27
PaC02 44
Pa02 597
HC03 24
BE +2
Sa02 100%
```
```
Which of the following is the likely problem?>
A. Respiratory acidosis
B. Large physiologic shunt
C. Metabolic Acidosis
D. Laboratory error
```
THE CORRECT ANSWER IS D! WHENEVER THE OPTION INCLUDES LAB ERROR CHECK YOUR ABG VALUES FIRST , YES THE Pa02 IS 598 ON 100% IS NOT ONLY POSSIBLE BUT NEAR NORMAL BASED ON ALEVOLAR AIR EQUATION, IN CONTRAST THE ACID BASE VALUES ARE NOT CONSISTENT WITH THE UNDERLYING RELATIONSHIP THAT DETERMINES THE pH ( H-H EQUATION) PaC02 and HC03 ARE NORMAL WITH BOTH OF THESE VALUES BEING WITHIN NORMAL RANGE THE pH ALSO WOULD HAVE TO BE CLOSE TO NORMAL.
32
```
A 60 kg ( 132 lbs) COPD patient is on SIMV with a VT 500mL at a rate of 9bpm Fi02 40%
ABG
pH 7.36
PaC02 61
Pa02 64
HC03 36
```
Which of the following changes would you recommend?
A. Increase rate
B. Increase Fi02
C. Maintain settings
D. Increase the VT
THE CORRECT ANSWER IS C!! THIS QUESTION IS GIVING ENOUGH INFO THAT THIS PATIENT LIVES IN THIS TYPE OF ACID BASE STATUS, CHANGING PARAMETERS CAN ONLY HINDER OR KNOCK THIS PATIENTS HYPOXIC DRIVE. THEREFORE MUST MAINTAIN CURRENT SETTINGS.
33
What is the PF ratio of a patient breathing 50% 02 with a Pa02 of 68 torr?
A. 128
B. 170
C. 136
D. 190
THE CORRECT IS C ! EXPECT PF RATIOS OF > 500 FOR PATIENTS WITH NORMAL LUNG FUNCTION; <200 SIGNIFIES ALI
34
Which of the following is considered Gram negative organism?
A. Klebsiella
B.Staph
C. Streptococcus
D.Pneumococcus
THE CORRECCT ANSWER IS A: KLEBSIELLA , ALONG WITH OTHER GRAM NEG INCLUDE PROTEUS, E COLI, SERRTIA SP, ETC
35
Which is of these organisms are considered Gram positive?
A. E.Coli
B. Dipolococcus
C. Serratia Marcesens
D. Proteus
THE CORRECT ANSWER IS B : ANY GRAM POSITIVE ORGANISM WILL END IN COCCUS
36
CVP: 9 torr
PAP 18 torr
PCWP: 14 torr
CO: 8.5 L/M
Where and what is the problem here?
A. Fluid overload
B. Dehydration
C. Left heart
D. Right heart
THE CORRECT ANSWER IS FLUID OVERLOAD A!! CVP IS INCREASED
37
A 32 year old patien 65kg ( 143lb) patient is on mechanical ventilation receiving volume oriented SIMV with a set rate of 14 , total rate of 14bpm , VT 550ml and Fi02 0.45
ABG: 7.53/ PaC02 26/ Pa02 94/ HC03 23
What are the appropriate recommendations for you to make as the RT?
A. Decrease the SIMV rate
B. Add mechanical deadspace
C. Decrease the Fi02
D. Add Pressure Support
THE CORRECT ANSWER IS A: THE BLOOD GAS RESULTS SUGGUEST NORMAL OXYGENATION WITH AN UNCOMPROMISSED RESPIRATORY ALKALOSIS DUE TO HYPERVENTILATION THE FACT THAT THERE IS NO SPONT VENTILATION TOTAL RATE= SET RATE INDICATES SUPPRESSION OF THE RESPIRATORY DRIVE PROB DUE TO HYPOCAPNIA . SO IN ORDER TO STIMULATE THE PT TO BREATHE SPONT YOU NEED TO ELIMINATE THE HYPOCAPNIA, ON THE SIMV MIDE THIS IS DONE BY DECREASING THE SET RR, ON THE VENT.
38
A PET Scan would be most useful in the diagnosis of which of the following conditions?
A. Bronchogenic Carcinoma
B. Chronic Bronchitis
C. Pulmonary Fibrosis
D. Smoke Inhalation
THE CORRECT ANSWER IS A : PET SCAN IS A NUCLEAR IMAGINING TECHNIQUE USED IN THE DIAGNOSIS /STAGING AND MANAGEMENT OF TUMORS AND CANCER.
39
Which of the following physical findings would you expect to see in an alert but anxious asthmatic, who has just being admitted to the ER?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Clubbing
D. Cor pulmonale
THE CORRECT ANSWER IS A; RESPIRATORY ALK ASTHMATICS NORMALLY PRESENT TO THE ER WITH RESP ALK , DYSPNEA AND HYPOXEMIA , TACHYPNEA AND ALK OCCURS ITS VERY IMPORTANT THAT ONCE THE HYPOXEMAI IS RELIEVED BY THE ADM OF SUPPLEMENTAL 02 , PATIENTS PaC02 AND pH WILL NORMALIZE.
40
IPPB treatments are sometimes given to patients with emphysema to
A. Lower the diaphragm
B. Abolish the cough reflex
C. Improve Alveolar ventilation
D. Increase FRC
THE CORRECT ANSWER IS C: TO IMPROVE ALVEOLAR VENTILATION. IPPB IS USED ON PATIENTS WHO CANT OR WILL NOT TAKE A DEEP BREATH ON THEIR OWN DUE TO INCREASED WOB, THE MAIN FUNCTION HERE IS TO INCREASE ALVEOLAR VENTILATION BY TAKING OVER THE WOB THROUGH ASSISTED IPPB
41
Which of the following causing agents can cause MetHgb?
A. Dapsone
B. Levophed
C. Vasopressin
D. Dopamine
THE CORRECT ANSWER IS A : DAPSONE , CAUSE In rare cases, DAPSONE has been associated with serious, and sometimes fatal blood and/or liver problems. Contact your doctor immediately if you experience a sore throat, fever, pale skin, bruising or pinpoint red spots on the skin, or yellowing of the skin or eyes. These may be symptoms of blood or liver problems. This drug is used for dermatitis and other diseases, Nausea, vomiting, hyperexcitability can appear a few minutes up to 24 hours after ingestion of an overdosage. Methemoglobin induced depression, convulsions or severe cyanosis requires prompt treatment. In normal and methemoglobin reductase deficient patients, methylene blue, 1-2 mg/kg of body weight, given slowly intravenously, is the treatment of choice. The effect is complete in 30 minutes, but may have to be repeated if methemoglobin reaccumulates. For non-emergencies, if treatment is needed, methylene blue may be given orally in doses of 3-5 mg/kg every 4-6 hours. Methylene blue reduction depends on G6PD and should not be given to fully expressed G6PD deficient patients.
42
When ventilating a patient with a bag valve mask resuscitator through an LMA, you note significant air leakage, which of the following should be your first approach to eliminating this leakage?
A. Bag slowly to reduce peak pressure
B. lower the cuff pressure
C. Pull the tube out 2-3 cm
D. Add more air to LMA cuff
THE CORRECT ANSWER IS A : TO AVOID LEAKS DURING POSITIVE PRESSURE VENTILATION THROUGH AN LMA YOU SHOULD USE SLOW INFLATION , KEEP PEAK INSPIRATORY PRESSURES LESS THAN 30 AND LIMIT THE DELIVED VT TO NO MORE THAN 8ML/KG. IF A LEAK PERSISTS IN SPITE OF THESE EFFORTS TO LIMIT PRESSURE/VOLUME , YOU SHOULD READJUST THE TUBE POSITION BU PRESSING IT DOWNWARD AD RESECURING IT , DO NOT ADD MORE AIR INTO THE LMA CUFF SINCE THIS CAN WORSEN THE LEAK BY PUSHING THE CUFF AWAY FROM THE LARYNX
43
To wean from APRV you must use the Drop and Stretch Method
TRUE or FALSE
THE ABOVE STATEMENT IS A TRUE STATEMENT, THIS IS THE NBRC WORLD GUYS, FOR EXAM PURPOSES YOU WILL USE THE DROP AND STRETCH METHOD. THE DROP AND STRETCH METHOD IS A DROP IN PRESSURE WHICH IS YOUR P-HIGH. AND DROP IN T-HIGH EVENTUALLY PLACING OR WEANING PT TO CPAP
44
Sputum culture and sensitivity would be indicated in the evaluation of which of the following clinical conditions?
A.. Pulmonary Edema
B. Bacterial Pneumonia
C. Bronchiectasis
D. Empyema
THE CORRECT ANSWER IS B: SPUTUM AND SENSISITIVY ARE USED TO IDENTIFY MICROORGANISMS AND THEIR MOST APPROPIATE DRUG THERAPY.
45
When transporting critically ill patient who are receiving supplemental oxygen in unpressurized aircraft, it is often necessary to make which adjustment in Fi02 in order to maintain adequate oxygenation?
A. Increase the Fi02
B. Decrease the Fi02
C.Increase ventilation
D. No change to ventionation or Fi02
THE CORRECT ANSWER IS A : THIS QUESTION IS BASED ON DALTON'S LAW THE PARTIAL PRESSURE OF OXYGEN AT SEA LEVEL IS 160 TORR, VERSUS ONLY 134 TORR AT INCREASED ALT, AS A RESULT IN ORDER TO MAINTAIN ACCEPTABLE OXYGENATION IT IS OFTEN NECESSARY TO INCREASE THE FI02 DURING TRANSPORT
46
Your patient is on HFOV per the following settings. How many times does and inspiratory/expiratory cycle occur each minute?
Freq 5 hz
Amplitude 90cmH20
MAP 24cmH20
FIO2 90%
A. 300
B. 60
C. 450
D. 120
A IS CORRECT! The number of cycles is Frequency*60 seconds per minute. 5*60=300
47
Which of the following is most likely to be associated with a CNS injury, Severe Shock, Metabolic disorders or Neuromuscular disease?
A. ST elevation on ECG
B. Bradypnea
C. Tachypnea
D. Bibasalar atelectasis
B IS THE CORRECT ANSWER! Bradypnea will most likely result from a CNS injury. Tachypnea is usually associated with respiratory distress and early septic shock. ST elevation is the mark of a Myocardial infarction. Atelectasis may appear in some cases, but is not the best answer for this question
48
You are called to the ICU to assess a patient extubated 2 hours prior. She was originally intubated for CAP (community acquired pneumonia) that was complicated by her immunodeficiency due to a drug treating her rheumatoid arthritis. She is currently on 2L NC, resting comfortably and GCS is 13. Sp02 is 97% and HR is 89. Auscultation reveals diminished basalar segments bilaterally. She is slightly anxious. What do you recommend?
A. Reintubation immediately
B. Increase NC to 4L and reassess in 20 minutes.
C. Review deep breathing exercises with an Incentive Spirometer
D. Administer Lopressor
C IS CORRECT, diminished breath sounds raise the alarm to possible atelectasis. Deep breathing exercises would reduce the risk for atelectasis, and incentive spirometers are just the tool!
49
You need to suction a 7-month old orally intubated patient. For this patient, what are the appropriate pressures and time limits for this procedure?
A. Suction pressure range of -40 to -60 mmHg, limiting the time to 30 seconds
B. Suction pressure of 80 to 100 mmHg, limiting the time to less than 10-15 seconds
C. Suction pressure range of -100 to -120 mmHg and continuing until you observe secretions in the suction catheter
D. Suction pressure range of -60 to -80 mmHg, limiting the time to less than 15 seconds
D IS THE CORRECT ANSWER! For infants, a suction pressure should range only from -60 to -80 mmHg. Always pre oxygenate and total suction time (down the tube, suctioning and withdrawal) should total 15 seconds at the most. Always watch your heart rate and always watch your Sp02!
50
Normal Newborn Pa02
A. 40 torr
B. 50 torr
C. 30 torr
D. 60 torr
THE CORRECT ANSWER IS D!
51
Normal Anion Gap- mEq/L
A. 3-11
B. 0-2
C. 12-15
D. 15-20
THE CORRECT ANSWER IS A: THIS IS USED TO DETERMINE THE CAUSES OF METABOLIC ACIDOSIS.
52
Normal Cv02
A. 12-16%
B. 17-20%
C. 9-10%
D. 1-3%
THE CORRECT ANSWER IS A.
53
Approx normal birthweight of a term infant
A. 2800g
B. 3400g
C.3100g
D, 2500g
THE CORRECT ANSWER IS C. CHOSE THE CLOSEST IF 3000g IS NOT GIVEN
54
Normal Ca02
A. 14-16%
B. 12-16%
C. 17-20%
D. 8-10%
THE CORRECT ANSWER IS C.
55
Normal left atrial pressure - mmHg
A. 7-10
B. 2-6
C. 1-2
D. 0
THE CORRECT ANSWER IS B !!
56
Daily sedation vacations and Readiness To Extubate Assessments is most recommended because:
A. Enables greater reimbursement for the hospital
B. Utilizes resources efficiently to get ICU beds available faster for patients
C. Has been shown to reduce VAP
D. Reduces cost of care to the patient
C IS THE CORRECT ANSWER. Daily sedation vacations and readiness to extubate assessments (called unassisted ventilation trials at my hospital) are part of the VAP bundle and may decrease the risk for ventilator associated pneumonia. Every day spent on a ventilator increases these risks, get those patients extubated as soon as possible!
57
Treatment for an adult with Pulmonary Hypertension would best be:
A. Maintain Sp02> 92%
B. Recommend inhaled prostacyclins
C. Initiate nitric oxide at 8 PPM
D. Initiate Heliox 80/20 via nonrebreather mask
Okay, this question is very tricky. B IS CORRECT AND I'LL EXPLAIN WHY. 8ppm is not your starting dosage for inhaled nitric oxide IN MOST CASES (some hospitals do it different, this is the NBRC way). 20ppm is the RECOMMENDED starting dosage for INO. B is correct because inhaled prostacyclins are a great option because they are a great first line treatment in treating pulmonary hypertension. They are also much less expensive, which will reduce the overall cost to the treatment of the patient.
58
Normal WOB is calculated : delta pressure x delta volume. As you assess your patient in clinic you conclude his WOB is calculated to be 0.9J/L , What does this value indicate?
A. Normal WOB
B. Intermediate WOB
C. Excessive WOB
D. None of the above
THE CORRECT ANSWER IS C: EXCESSIVE WOB, , NORMAL WOB IS 5-7J.L, AS ABOVE THIS PATIENT IS > 7J/L THEREFORE THE CORRECT ANSWER IS EXCESSIVE.
59
A 45 year fireman is admitted to the ER with suspected smoke inhalation, You place him on a NRM , what is most appropriate method of monitoring this patient oxygenation?
A. ABG
B. CO-ox
C. Pulse Ox
D. Calculate of P(A-a)02
THE CORRECT ANSWER IS B CO-OX IN CASE OF SMOKE INHALATION CO BING TO THE HB IN PLAC OF THE O2 , NEITHER ABG'S PULSE OX OR A-a GRADIIENT WILL INDICATE HOW MUCH OXYGEN IS BOUND TO HB, ANY VICTIM OF SUSPECTED SMOKE INHLATION MUST BE MONITOROED BY CO-OX
60
You are being asked to assess whether brain death has occurred in a patient. This is best done by:
A. Placing the ventilator to set a PIP of 25cmH20 and monitoring VT for 1 minute
B. Removing the patient from the ventilator and monitoring for a decrease in Sp02
C. Removing the patient from the ventilator, placing supplemental 02 into ET tube for designated period of time, watching closely for chest movement and analyzing pre and post-ABG results
D. Performing a NIF and FVC on patient
Interesting that so many different answers came out of this one. C IS THE CORRECT ANSWER. While there are variations in apnea tests, the NBRC guidelines say to remove the patient from the ventilator and observe for any chest movement. Pre and post ABG results should produce a sharp rise in Pa02 with a relatively stable Pa02 (through passive diffusion).
61
A P/F ratio of 186 supports the diagnosis of:
A. Unlikely to succeed in extubation
B. Septic Shock
C. Mean Airway Pressure needs to be decreased
D. ARDS
D IS THE CORRECT ANSWER. Carrie here is your explanation. According to the ARDSnet guidelines, ARDS is indicated when the Pa02/FIO2 ratio (just divide your P02 by the FIO2 the patient is on) is less than 200. An acute lung injury is indicated when the P/F ratio is 201-300.
62
While suctioning a patient receiving ventilatory support, you note the heart rate increases abruptly from 92-145 beats per minute. Which of the following actions is appropriate?
A. Recommend an IV dose of atropine before suctioning
B. Instill lidocaine into the trachea before suctioning
C. Increase the oxygen concentration immediately before suctioning
D. Give the patient two MDI puffs of beclomethasone before suctioning
C IS THE CORRECT ANSWER! Most cardiac arrhythmias during suctioning are due to arterial hypoxemia. The most effective way to minimize hypoxemia is to pre-oxygenate before suctioning (NBRC says 1-2 minutes and keep suction time between 10-15 seconds FYI!)
63
An adult patient who was started on cool mist therapy after extubation begins to develop stridor. Which of the following actions should you recommend?
A. Changing from cool mist to heated aerosol
B. Administering a racemic epinephrine treatment
C. Reintubating the patient immediately
D. Drawing and analyzing an ABG
B IS CORRECT! The development of stridor is sometimes the result of post-exubation edema. Swelling can dramatically worsen very quickly. If stridor is present, administer racemic epinephrine and monitor your patient very closely. In children, post exubation edema can be subglottic and can sometimes require reinsertion of an airway. Also! Please make sure you include in your treatment an addition of 2 mL normal saline! If any of you have seen racemic vials they are supplied as doses of only 0.25-0.75 ml of a 2.25% solution!
64
An 87-year-old nursing home patient is admitted with pneumonia. On assessment, the patient presents with a 103.2 degree F temperature, dry mucous membranes, urine output of 10 mL/hr for the past 2 hours, mild hypotension, and increased hematocrit on his CBC. You should recommend to the ER physician all of the following except:
A. Initiating IV fluids immediately
B. Beginning diuretic therapy
C. Minimizing insensible water loss
D. Documenting fluid intake/output every hour
B IS THE CORRECT ANSWER! Diuretics are a contraindication for dehydrated patients, this patient appears to be clinically dehydrated and requires immediate IV fluids along with carefully documented I/O output
65
A patient with neuromuscular disease has been on ventilatory support for 4 months via tracheostomy. At this point, she requires only nocturnal ventilator support. Which of the following artificial airways should you recommend?
A. Tracheostomy button
B. Bivona tracheostomy tube
C. Cuffed, fenestrated tracheostomy tube
D. Uncuffed, standard tracheostomy tube
C IS CORRECT! A cuffed fenestrated tube can be used for positive pressure ventilation, however due to the openings in the posterior curve, the patient is allowed to speak when the cuff is down and a speaking valve is in place!
66
A patient with acute bronchitis is receiving mechanical ventilation. Wheezing is heard over all lung fields, and rhonchi are heard over the central airways. Secretions have been quite thick. The patient's peak pressure is 45 cm H20, and plateau pressure is 20 cm H20. All of the following would be useful to treat the patient's condition except:
A. Albuterol (Proventil)
B. Ipratropium bromide (Atrovent)
C. Acetylcysteine (Mucomyst)
D. Pancuronium bromide (Pavulon)
D IS CORRECT! You all clearly understand pharmacology and know that Pavulon is a non depolarizing neuromuscular blocking agent, this will not help with bronchodilation nor mucus clearance, Albuterol or Atrovent combined with Mucumyst will give you both results in one treatment! (FYI if a patient is vented, always suction after the treatment)
67
An intubated patient in the ICU needs to undergo bedside bronchoscopy and is in need of short-term moderate sedation. Which of the following agents would you recommend for this procedure?
A. Propofol (Diprivan)
B. Haloperidol (Haldol)
C. Lorazepam (Ativan)
D. Cisatracurium (Nimbex)
A PROPOFOL IS CORRECT! Propofol achieves rapid sedation along with a short half-life, allowing the patient to recover quickly from a therapeutic dose
68
You are assisting a medical resident performing an emergency intubation on a somewhat combative patient. The resident wants to briefly paralyze th patient to facilitate this procedure. Which drug would you recommend for this purpose?
A. Pancuronium bromide (Pavulon)
B. Succinylcholine (Anectine)
C. Vecuronium (Norcuron)
D. Cisatracurium (Nimbex)
B IS CORRECT!! Succs is the go paralytic for short term procedures such as intubations. Vecuronium, pancuronium and cisatracurium produce a prolonged paralysis that should only be used in the long-term management of ventilated patients
69
A 75 year old female patient with a fractured hip has been bedridden for at least 1 week. The patient has clear breath sounds, but they are diminished slightly in the bases. The patient has normal PFT's based on bedside spirometry. Which of the following should you recommend?
1. Bronchodilator Therapy
2. Deep suctioning
3. Incentive spirometry treatments
4. Coughing and deep breathing
A. 1 and 3 only
B. 2 and 4 only
C. 3 and 4 only
D. 1, 2, and 4 only
C IS CORRECT! At this point, this patient is at high risk for developing atelectasis. By providing incentive spirometry therapy along with deep breathing and cough, the patient may recruit collapsing airways and aid in secretion clearance
70
You are part of the physician rounds this morning and consulting on a patient who is currently on APRV. They were originally admitted for pneumonia which developed into ARDS with a P/F ratio as low as 110. This patient was transferred to APRV from PC due to an elevated plateau pressure required to maintain VT around 4 cc/kg IBW. The patient is arousable and taking breaths on their own. The physician asks you to recommend what should be done about the patient's current ABG:
7.19/49/88/19
Mode APRV: PHigh: 24cmH20, Plow 0cmH20, Thigh 5.0 sec, Tlow 0.5 sec, PS 26cmH20, FIO2 80%
A. Increase Phigh to 28 cmH20
B. Increase Thigh to 6.0 sec
C. Decrease Phigh to 20cmH20
D. Increase sedation
A IS THE CORRECT ANSWER! The first thing you should notice is the ABG result, it appears to be a mixed acidosis. While we cannot directly affect the bicarbonate here, we can control the delta-P. To do this, raise the Phigh to increase minute ventilation. Decreasing minute ventilation would continue to raise the CO2. We do not need to raise the Thigh either (this would raise the Pa02) as the ABG shows a good Pa02.
71
Patient presents to the ER ,you are ready to intubate , the thyromental distance is considered to be at 5cm , this conclude that you must get ready for a ________________ intubation.
A. Easy
B. Non problematic
C. Difficult
D. Somewhat problematic
THE CORRECT ANSWER IS C: DIFFICULT, A THYROMENTAL DISTANCE
72
Hemodynamics:
```
CVP: 10 torr
PAP: 14 torr
PCWP: 9 torr
Cardiac Index: 2.5
Where or what is the problem here?
```
A. Left heart
B. Right heart
C. Fluid overload
D. Dehydration
THE CORRECT ANSWER IS B: RIGHT HEART! THIS COULD BE DUE TO COR PULMONALE
73
What does BNP stand for?
THE CORRECT ANSWER IS B-TYPE NATRIURETIC PEPTIDE
74
Which of the following test should you recommend for a patient with suspected hepatomegaly, elevated alkaline phosphatase levels?
A. Cardiac enzymes
B. CBC with Differential
C. Hepatic enzymes
D. PTT
THE CORRECT ANSWER IS C, HEPTOMEGALY AND INCREASED ALK PHOS ARE RELATED TO LIVER OR BONE DISEASE THEREFORE LIVER OR HEPATIC LIVER ENZYME MUST BE DRAWN TO RULE OUT HEPATITIS OR CIRRHOHIS OF THE LIVER OR TO DIFF BETWEEN BONE METS OR LIVER METS.
75
A patient breathing 100% at sea level has a Pa02 of 350 torr and a PaC02 of 40 torr.
What I her A-aD02 or P(A-a) 02? torr
A. 663
B . 363
C. 563
D.313
THE CORRECT ANSWER IS D! P( A-a) 02 663-350= 313 torr. Ok sea level Pb is 760. PAO2 =1.0 (760-47)-1.25x40=663 torr. So therefore 663-350= 313 torr. ***i used this formula Fio2(713-47)-co2/1 is this also correct formula
76
What is the correct loading dose for Midazolam( Versed)? mg/kg
A. 0.05
B.0.03
C.1.5
D. 0.1
THE CORRECT ANSWER IS B : THE INFUSION RATE IS ABOUT 1-2MG/HR ONSETACTION OF DRUG IS ABOUT 1-3MIN POST ADMIN AND THE HALF LIFE IS 1 HR
77
A 150lb patient has a VT 600mL and PC02 50 torr
and a mix expired PeC02 35 torr
what is this patients physiologic deadspace? mL
A. 200
B.300
C.180
D. 350
THE CORRECT ANSWER IS C: VD= 600X ( 50-35) / 50= 180ML
78
The primary aim in treating cardiogenic pulmonary edema is to :
A.Increase venous return to the heart
B. Decrease right heart and systemic pressures
C. Decrease left heart and pulmonary vascular pressures
D.Increase pulmonary fluid and blood volume
THE CORRECT ANSWER IS C: THE PRIMARY AIM IN TREATING CARDIOGENIC PULMONARY EDEMA IS TO DECREASE LEFT HEART AND PULM VASCULAR PRESSURES.
79
A patient has a peak expiratory flow rate PEFR of 5.2 L/sec before bronchodilator treatment and 6.3L/sec post treatment What is the percent change in PEFR?
A. 8%
B. 17%
C.21%
D.26%
THE CORRECT ANSWER IS C : 21% CHANGE ( 6.3-5.2) /5.2 X 100= 21%
80
What inspiratory flow is needed for a patient receiving volume limited ventilation at a rate of 20/min , IE ratio of 1:2 and VT 500mL? L/min
A. 60
B. 50
C.40
D.30
THE CORREC ANSWER IS D: 30ML VE= 10 L/MIN % I-TIME =33% VINSP = VE /%I-TIME = 10/.33= 30L/MIN
81
Normal Troponin level is? ug/L
A. > 0.2
B. 1.5
C. <0.2
D. 1.0
THE CORRECT ANSWER IS C THE NORMAL TROPONIN LEVEL SHOULD BE < 0.2 UG/L THIS IS A SPECIFIC CARDIAC MARKER IF ELEVATED CAN INDICATE AN MI USUALLY TROPININ LEVELS BEGIN TO RISE WITHIN 5 HRS AFTER AN MI AND PEAKS WITHIN 24-36 HRS.
82
Data for a patient being mechanically ventilated are as follows:
Vent settings: Volume control A/C, Vt 900 mL, Rate 10/min, Actual rate (patient's rate) 20, FIO2 35%
Blood gases: pH 7.55/PaCO2 20 torr/Pa02 125/HCO3 17/Sa02 99%
Based on this information, you would suggest which of the following?
A. Add 5 cmH20 PEEP
B. Add deadspace to the ventilator breathing circuit
C. Change to volume control SIMV at a rate of 10/min
D. Lower the FIO2 to 0.25
C IS CORRECT! The blood gas indicates a partially compensated respiratory alkalosis, most likely the result of the patient initiating 10 machine breaths above the set rate. By changing to SIMV, the patient's additional spontaneous breaths (above 10/min) will most likely reduce the minute ventilation, raising the PaCO2 and lowering the pH.
83
As measured on the Borg Scale which of the following exertion levels is appropriate for titrating a COPD patients 02 flows to support exercise?
A. Weak/light exertion ( rating of 2)
B. Somewhat strong exertion ( rating of 4)
C. Very strong exertion ( rating of 7)
D. Maximal exertion ( rating of 10)
THE CORRECT ANSWER IS B, FOR PATIENTS CONTINUING ON, YOU HAVE THEM INITITE WALKING AND SLOWLY TO INCREASE THEIR ACTIVITY UNTIL IT REPLICATES THE HIGHEST INTENSITY THEY WILL LIKELY PERFORM IN TEH HOME ENVRIONMENT, USUALLY EQUIVALENT TO A 3 OR 4 ON THE BORG SCALE RATING OF PERCEIVED EXERTION.
84
By placing a patient in the prone position with a pillow under the abdomen and keeping the bed level, you would be targeting what segment in postural drainage?
A. Lateral basal segment of lower lobes
B. Superior segment of lower lobes
C. Apical segment of upper lobes
D. Posterior segments of upper lobes
THE CORRECT ANSWER IS B, THE SUPERIOR SEGMENTS OF THE LOWER LOBES ARE DRAINED IN A FLAT PRONE POSITION WITH A PILLOW UNDER THE ABDOMEN.
85
Which of the following is a possible complication of postural drainage,percussion and vibration?
I.Pulmonary barotrauma
II. Acute hypotension during procedure
III. Dyshrythmias
IV. Fracture ribs
A. I and II only
B.I, II,III
C. I, II,III, IV
D.II,III,and IV
THE CORRECT ANSWER IS D, MAJOR HAZARDS AND COMPLICATIONS OF PD , PERCUSSION AND VIBRATION INCLUDE HYPOXEMIA,ACUTE HYPOTENSION DURING THE PROCEDURE ,PULMONARY HEMORRHAGE , PAIN AND INJURY TO THE MUSCLES , RIBS AND SPINE , VOMITING AND ASPIRATION, BRONCHOSPASM AND DYSRTHYMIAS.
86
An adult patient in respiratory failure has the following ABG results on a simple 02 mask at 8L/min: pH=7.19; PaCO2= 68 torr; HCO3= 28 mEq/L; Pa02= 85 torr. The attending physician orders intubation and mechanical ventilation. Which of the following modes of support are appropriate?
1. Volume control A/C at a rate of 12/min
2. Volume control SIMV at a rate of 12/min
3. CPAP with 10 cmH20 pressure
A. 1 or 2 only
B. 2 or 3 only
C. 1 or 3 only
D. 1, 2, or 3
A IS CORRECT! The mode of ventilation initially chosen depends mainly on the patient's underlying pathophysiological problem. A/C is usually the mode of ventilation chosen to initiate simply because you are guaranteed a rate and tidal volume, as well as SIMV.
87
32 year old who is 3 days post traumatic head injury is on AC VC , Decorticate posturing is noted
Which of the following is most likely associated with these findings?
A. Systemic hypotension
B. Cerebral dehydration
C. Suppresion of adrenal glands
D. Increased intracranial pressure
THE CORRECT ANSWER IS D! DECORTICATE POSTURING ( ABNORMAL FLEXING OF LIMB EXTREMETIES ) IS CAUSED BY BRAIN INJURY AND MOST OFTEN BY INCREASED ICP.
88
```
You are performing an assessment on a patient note that the exhaled tidal volume of a patient receiving NPPV has dropped. The most appropriate action to take is?
A. Increase the IPAP
B. Decrease the EPAP
C. Adjust the interface
D. Change the circuit
E. Obtain an ABG
```
THE ANSWER IS C. WE WANT TO THE FIRST A EASIEST THING FIRST. RULE OUT EQUIPMENT. CHECK THE MASK? IS THERE A LEAK? YES, CHANGE IN VOLUMES COULD INDICATE A COMPLIANCE CHANGE BUT FIRST DO NO HARM. DON'T START THE WINDMILL UP IF THERE IS SOMETHING QUICK AND EASY!
89
Auto PEEP should be suspected if you observe which of the following?
A. there is a prolonged post expiratory phase
B. the patient coughs severely when suctioned
C. expiration is continuous up to the next inspiration
D. The SIMV rate is set at 10
THE ANSWER IS C
90
```
Which of the following patients should be excluded from a trial of NPPV?
A. Amyotrophic lateral sclerosis
B. Cardiogenic pulomanry edema
C. Hemodynamically unstable ARDS
D. Community acquired PNA
```
THE ANSWER IS C. THOSE OF YOU WHO SAID ALS THIS DOESN'T EXCLUDE SOMEONE FROM GETTING A SHOT AT NIPPV. BUT A BIG KEY WORD WOULD BE UNSTABLE
91
What are the proper rate and depth of external chest compressions for an adult?
A. 80-100/min with a depth of 1 inch
B. 70-80/min with a depth of 1-1 1/2 inches
C. At least 100/min with a depth of at least 2 inches
D. 60-80/min with a depth of 1 1/2-2 inches
C IS CORRECT! This again is according to AHA guidelines, follow a 100 beat per minute song if you can't keep rhythm "Staying Alive"
92
You are asked to assess whether a 65-kg (143-lb) patient with a neuromuscular disorder receiving pressure control SIMV is ready for weaning. After obtaining the following data during a bedside spontaneous breathing assessment, what would you recommend next?
Spontaneous Vt 250 mL
Minute ventilation 10 L/min
Vital capacity 650 mL
MIP/NIF -20 cm H20
A. Beginning a spontaneous breathing T-piece trial
B. Postponing weaning and reevaluating the patient
C. Beginning weaning using a pressure support control
D. Beginning weaning by decreasing the SIMV rate
B IS THE CORRECT ANSWER! Although the patient's Vital Capacity and MIP/NIF are borderline adequate, the tidal volume is very low (less than 4 mL/kg). If we calculate the respiratory rate {minute volume (10L)/tidal volume (0.250L) = 40 breaths per minute}, this patient's Rapid Shallow Breathing Index (RR/VT) is 40/0.25=160, which is far above the threshold of 105. This patient will not be able to sustain spontaneous ventilation, so weaning should be postponed.
93
The administration of what aerosolized drug is most appropriate to thin secretions and help in the removal of mucous plugs?
A. Albuterol
B. Ipratropium Bromide
C. Acetylceisteine
D. Racemic Epinephrine
THE CORRECT ANSWER IS C, ACETYLCYSTEINE BREAKS DOWN THE DISULFIDE BONDS IN THE MUCOUS THEREBY THIN AND MOBILIZE SECRETIONS IN PATIENTS WITH MUCOUS PLUGS.
94
```
48 year old patient with history of AIDS presents to the ER with moderate dyspnea and increased work of breathing. Patient is a 2L NC upon arrival.
ER Data: HR 120
RR: 28
WBC 23K
RBC 5K
Platelets : 108K
INR 1.0
MD wants a stat ABG and CXR
ABG : 7.30/ 60PaC02/ 85 Pa02/ 29/-5/98
CXR below shows hazy patch in right lung
```
Resident needs help to interpret this ABG:
A. Partially compensated metabolic acidosis
B. Uncompensated Respiratory Alkalosis
C. Partially compensated Respiratory Acidosis
D. None of the above
THE CORRECT ANSWER IS C : PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS , AS YOU CAN SEE THE pH IS ALMOST COMPENSATING BUT NOT QUITE , THIS TYPE OF ABG WILL BE ON YOUR EXAMS!! BE ON GUARD! **What O2 device would you recommend on this patient? NPPV-bipap or cpap. The problem isn't oxygenation, it's ventilation, they aren't blowing off enough CO2 so I would suggest a non-invasive way to help them ventilate (if they haven't requested otherwise of course) and if they continue to decline and couldn't ventilate, then they would require intubation**
95
A respiratory therapist reviews the ventilator flow sheet for a patient who is receiving VC ventilation. The ventilator settings have not been changed. The plateau and peak pressures are recorded below:
8PM PLAT 30cmH2O, PIP 35cmH2O
11PM PLAT 44cmH2O PIP 50cmH2O
Which of the following is indicated by this information?
A. The patient is ready to be weaned from the ventilator.
B. Water is accumulating in the patient circuit.
C. Airways resistance is increasing.
D. Lung compliance is decreasing.
D IS THE CORRECT ANSWER! Plateau pressure increasing indicate that lung compliance is decreasing and you must adjust the ventilator accordingly! **take a look at the pressure applied to the alveoli, if it is increasing, what is that saying about the lungs overall? In other words, if it is taking more pressure to keep the lungs inflated, what does this indicate? decreased lung compliance
96
What is the ideal ratio of chest compressions to rescue breaths that should be given by a single rescuer during a cardiopulmonary resuscitation (CPR) attempt on an adult?
A. 5:1
B. 15:2
C. 2:15
D. 30:2
D IS CORRECT! This is according to American Heart Association guidelines. 30 compressions for every 2 breaths. Always make sure to reassess after 5 minutes!
97
During an interview with your patient you discover that he gets short of breath at night when he lays down so he often sleeps with several pillows propping his head up, What symptom is present?
A. Apnea
B. Orthopnea
C. Platypnea
D. Orthodeoxia
THE CORRECT ANSWER IS B; IN MOST CAUSE THIS IS CAUSED BY PULMONARY EDEMA FILLING THE LUNGS WHEN PATIENT ASSUMES A HORIZONTAL POSITION , KEEPING THE PATIENTS HEAD UP DURING SLEEP WITH THE USE OF PILLOWS REDUCES THE COLLECTION OF FLUIDS IN THE LUNGS.
98
Which of the following intervals represents the time taken for the depolarization to spread from the SA node to the ventricular muscle?
a. ST segment
b. PR interval
c. QT interval
d. PR segment
B! IS THE ANSWER
99
All of the following monitoring equipment is mandatory when transporting a critically ill patient within or outside of the hospital except:
A. End-tidal CO2 monitor
B. Oxygen source/delivery device
C. Blood pressure monitor/cuff
D. Cardiac monitor/defibrillator
The ETCO2 monitor is not the most critical item. A IS THE CORRECT ANSWER. Trust me, you want to know your patient's blood pressure at all times. Oxygen source (Tank and AMBU bag), Heart monitor and BP cuff are absolute musts. ETCO2 is not required, although some hospital prefer it.
100
60 year old patient in the ER with +3 pitting edema , short of breath and heavy diaphoresis.
ER data:
```
RR:32bpm
HR :128
BP 100/78
BNP: 115pg/ml
BS: moist bilat crackles
```
CXR: Bilat infilatraes.
Which would be most helpful for this patient?
A. Dobutamine
B. CPAP via Full Face Mask
C. Mannitol
D. Volume Control ventilation
THE CORRECT ANSWER B!! ALL EVIDENCE POINTS TO CHF PROVIDING, POSTIVE PRESSURE WILL HELP VENTILATION AND SUPPRESS ANY PULMONARY EDEMA.
