Questions and Answers
What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?
A patient with a history of asthma presents to the ED in severe respiratory distress and increased accessory muscle use. What should the respiratory therapist recommend initiating?
A patient in the ICU is being ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. What should the therapist do if over-distension is noted?
An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a non-rebreathing mask. What is the actual flow being delivered to the mask?
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Which of the following should the respiratory therapist utilize to determine the severity of respiratory distress in a newborn?
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While administering 3.5 mg of albuterol, the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment?
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Which neuromuscular blocker has a fast onset and short duration that the therapist should recommend?
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What should the respiratory therapist do if the capnometer suddenly indicates an abrupt decrease in PETCO2 from 5.3% to 0.0%?
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What is the major cause of hypoxemia in this patient?
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Which bronchial hygiene therapy is most appropriate for a 16-year-old patient with cystic fibrosis?
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How should the respiratory therapist document a patient's difficulty breathing while lying down?
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What should be done if oxygen supply tubing does not stay attached to a transtracheal catheter?
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In a patient with copious secretions requiring nasotracheal suctioning who develops mild epistaxis, what should the therapist recommend?
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What is the most probable cause of air bronchograms and increased density on a chest X-ray?
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What should the respiratory therapist recommend for a post-operative patient with stable vital signs but low PvO2?
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What is the primary source of infection in the healthcare setting?
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What should be recommended for a post-operative patient with pneumonia and crackles in both lungs?
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What is the next step after obtaining a blood gas sample from a patient's radial artery?
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Which finding is LEAST compatible with hyperlucency on a chest X-ray?
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What is the most appropriate recommendation after a spontaneous breathing trial on an intubated patient?
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What is the appropriate postural drainage position for a patient with infiltrates in the lower lobes?
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What is the patient's possible condition with a BNP of 700 pg/mL?
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What do diminished breath sounds in the left lung indicate after blunt chest trauma?
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What should be recommended for a post-operative patient with decreased chest expansion?
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What does a cuff pressure of 42 cm H2O indicate in a patient with a high-residual-volume cuff?
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What is the most likely explanation for a patient receiving oxygen via nasal cannula at 2 L/min and having low PaO2?
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What solution is most appropriate for disinfecting a pulse oximeter between patients?
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What is the most likely etiology for a patient with tachypnea and tracheal deviation?
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What is the most serious complication associated with airway suctioning?
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What is the most appropriate position for a patient who is 5'3", weighs 200 kg, and has difficulty breathing?
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Which arterial carbon dioxide tension value is consistent with significant alveolar hypoventilation?
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Which statement regarding cuff inflation techniques is NOT true?
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What does a sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing indicate?
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What might account for a sudden decrease in end-tidal CO2?
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What is the likely cause of mild stridor immediately after extubation?
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What is the primary reason for the use of respiratory care protocols?
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What is normal urine output in an adult patient?
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What device should be used for a patient with a cuffed tracheostomy tube for decannulation while maintaining stoma patency?
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Which test should be recommended for a patient with chronic bronchitis and persistent infiltrates on chest X-ray?
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What best describes a patient with congestive heart failure receiving NPPV?
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Which physiologic value is consistent with proper fluid balance?
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What should the respiratory therapist anticipate when assisting with a bronchoscopy on a ventilated patient?
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In which patient condition is dynamic hyperinflation a major concern?
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What recommendations should be made for a postoperative patient struggling to cough effectively?
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What should be done for a 65-year-old female with advanced emphysema on a nasal cannula when she becomes drowsy?
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What does a prothrombin time (PT) of 20 seconds indicate for a patient on warfarin (Coumadin)?
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What is the most likely condition for a mechanically ventilated patient with a sudden decrease in tidal volume?
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What is the purpose of incentive spirometry for a postoperative abdominal surgery patient?
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A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with:
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What action should the therapist recommend first for a patient with absent breath sounds in the left chest and trachea shifted to the right?
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All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT:
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After completion of postural drainage, a 52 year-old patient’s breath sounds become more coarse. What should the therapist recommend?
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What would be the most appropriate bronchial hygiene therapy for a 65 kg spinal cord injured patient with an inspiratory capacity of 30% of his predicted value?
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What is the most appropriate therapy for a dyspneic patient with crepitus and absent breath sounds on the right?
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Calculate the patient's C(a-v)O2 given the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2.
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What is the patient's static lung compliance based on the following parameters: A patient on VC, SIMV with a VT of 500 mL, PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O?
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Immediately after extubation, a patient shows increasing respiratory distress with intercostal retractions and marked stridor. What is the most appropriate action at this time?
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Which of the following patients would most likely benefit from pressure support ventilation?
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Which initial recommendation should be made for a patient on mechanical ventilation who developed a fever and increased peak inspiratory pressure?
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Why is it important for a patient on aerosol therapy to follow recommended cleaning procedures using a vinegar/water solution?
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What condition should a respiratory therapist suspect in a patient with a dry, non-productive cough, decreased tactile fremitus, and dullness to percussion over the right lower lobe?
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What size suction catheter is appropriate for a patient with an 8.0 mm ID endotracheal tube?
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What is the most likely explanation for diminished breath sounds and trachea shifted to the left in a patient receiving continuous mechanical ventilation?
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What should be the immediate response to a developing hematoma after arterial blood gas drawing?
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What condition is most likely to cause a respiratory pattern that irregularly increases and decreases with periods of apnea?
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What value for the apnea-hypopnea index (AHI) indicates mild obstructive sleep apnea?
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If PtcO2 increases from 60 to 142 torr and PtcCO2 changes from 37 to 2 torr, what is the most likely explanation for these changes?
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A patient on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient?
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Which measurement is most indicative of pulmonary edema?
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What is sleep apnea defined as?
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Which of the following conditions could potentially cause increased peak inspiratory pressure following a bronchoscopy?
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What size endotracheal tube is appropriate for an adult female patient?
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How should the therapist measure Auto-PEEP on a patient receiving mechanical ventilation?
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What is the primary advantage of volume-controlled ventilation compared to pressure-controlled ventilation?
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What does bronchial breath sounds heard over lung periphery indicate?
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How should the respiratory therapist interpret bedside spirometry results showing FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted, and FEF25-75 81% of predicted?
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What action should the respiratory therapist take for a 55 year-old male during a cardiopulmonary stress procedure who suddenly complains of chest pain and shortness of breath?
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Based on the APGAR scores assigned at 1 minute and 5 minutes post-delivery, what should the scores be?
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How much volume of albuterol should be administered to a patient via small volume nebulizer if 2.5 mg is the required dosage with a 0.5% solution?
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What should the respiratory therapist do after a pulmonologist documents a change in a patient's treatment regimen?
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A 60 kg patient mechanically ventilated has peak airway pressure of 60 cm H2O. What is the most appropriate action to reduce this pressure?
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To verify the accuracy of a lab-based spirometer device, what should the respiratory therapist utilize?
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What should be done FIRST to assess a patient brought to the ED after an overdose with sonorous respiratory efforts?
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A 60 year-old male admitted with chest pain has a troponin level of 0.4 ng/mL. What should the physician report to this patient?
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For a young healthy adult complaining of intermittent wheezing and having a normal bronchodilator spirometry result, what should the respiratory therapist recommend?
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Twenty-four hours after being intubated, a patient develops a fever and infiltrate. What should the respiratory therapist recommend?
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What amount of air should be injected into the cuff of a newly inserted tracheostomy tube?
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Which condition can NOT be treated with hyperbaric oxygen (HBO) therapy?
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What factors determine cardiac output?
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Given the following ABG results for a patient in the ED: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 8 mEq/L; SaO2 95%; BE -15 mEq/L, what should the therapist recommend?
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What inspiratory flow pattern will help deliver the lowest peak inspiratory pressure?
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Study Notes
Heart Failure and Its Indicators
- Key indicators of heart failure include diaphoresis, jugular venous distension, and pitting edema in the ankles.
- Patients with heart failure often present with respiratory distress and fatigue.
Emergency Responses in Trauma Cases
- Absent breath sounds and trachea deviation in trauma patients may indicate tension pneumothorax; immediate needle decompression is crucial.
- Hyperresonant percussion notes coupled with vital sign changes require rapid intervention.
Tracheal Mucosa Protection Strategies
- Maintaining cuff pressures between 20 and 25 mm Hg, using the minimal leak technique, and monitoring pressures are essential.
- Incorrect monitoring of intracuff pressures may lead to mucosal damage.
Management of Post-Operative Complications
- Coarse breath sounds post-cholecystectomy indicate the need for deep breathing exercises to clear secretions.
Bronchial Hygiene Therapy for Atelectasis
- Initial bronchial hygiene for spinal cord injury patients with atelectasis should involve intermittent positive pressure breathing (IPPB) with saline.
Understanding Auto-PEEP and Ventilation Adjustments
- Tidal volume, respiratory rate, and inspiratory flow can be adjusted to increase expiratory time and manage auto-PEEP in ventilated patients.
Chest Tube Insertion Protocols
- Conditions such as absent breath sounds, tracheal deviation, and crepitus necessitate the immediate insertion of a chest tube for stabilization.
Arterial Blood Gas Interpretation
- A calculated C(a-v)O2 of 5.0 vol% may indicate inadequate oxygen delivery despite normal parameters.
Lung Compliance and Ventilation Parameters
- Static lung compliance can be calculated using inspiratory pressures and volumes; normal values are important for assessing respiratory mechanics.
Respiratory Distress Post-Extubation
- Increasing respiratory distress and stridor following extubation indicates the need for reintubation as a priority intervention.
Benefits of Pressure Support Ventilation
- Patients on SIMV with a high total respiratory rate may benefit from pressure support ventilation to ease work of breathing.
Infection Control in Mechanical Ventilation
- Increased inspiratory pressure and fever in ventilated patients may necessitate sputum analysis to identify potential infections.
Pulmonary Function Testing Essentials
- Forced vital capacity (FVC) maneuvers help determine FEV1 and peak expiratory flow rate but do not provide total lung capacity.
Aerosol Therapy Best Practices
- Proper cleaning of nebulizers with a vinegar solution is vital to prevent bacterial growth and ensure patient safety.
Diagnostic Indicators of Pleural Effusion
- Symptoms like diminished breath sounds, dull percussion, and decreased tactile fremitus suggest pleural effusion as a likely diagnosis.
Suction Catheter Sizing
- For an 8.0 mm ID endotracheal tube, a 12 Fr catheter is appropriate for effective suctioning without causing trauma.
Complications in Ventilated Patients
- Diminished breath sounds and dullness may indicate endotracheal tube displacement to a wrong bronchus or possible pneumothorax.
Hematoma Management Post-ABG Collection
- Immediate application of pressure to an arterial puncture site is essential for managing hematomas following blood gas sampling.
ABG Analysis and Metabolic Conditions
- A pH of 7.20 with low HCO3 indicates a metabolic acidosis likely requiring intervention such as sodium bicarbonate administration.
Ventilation Techniques and Patient Synchrony
- Volume-controlled ventilation is favored for maintaining consistent minute ventilation, while decelerating flow patterns benefit peak pressures.
Pediatric APGAR Scoring
- APGAR scores reflect a newborn's initial condition and recovery; scoring at 1 minute and 5 minutes should be charted accurately.
Nebulizer Dosage Calculations
- Correct volume administration for nebulized medications is critical; 2.5 mg of albuterol from a 0.5% solution requires 0.50 mL.
Follow-up on Physician's Orders
- Checking electronic medical records for pending treatment changes is essential in the clinical setting to ensure patient care continuity.
Understanding APGAR and Resuscitation Needs
- Monitoring newborns post-delivery includes assessing heart rate, color, and reflexes to ensure they achieve stable APGAR scores.
Equipment Maintenance in Home Care
- Instructions for patients experiencing equipment malfunction should include switching to reliable alternative delivery methods if issues arise.
Managing Large Secretions and Nasotracheal Suctioning
- Continuous suctioning causing complications such as epistaxis necessitates a reassessment of suction needs and potential airway interventions.### Airway Management
- Insert a nasopharyngeal airway after controlling bleeding.
Diagnosis of Conditions
- Air bronchograms and increased density on a chest X-ray most likely indicate pneumonia.
- A patient exhibiting medium crackles throughout both lungs may require regular coughing and deep breathing for management.
- The least compatible finding with hyperlucency on a chest X-ray is increased fremitus.
Respiratory Therapy Recommendations
- For a post-operative patient on mechanical ventilation with stable vital signs, increase FIO2 if PvO2 is low.
- In the context of an intubated patient undergoing a spontaneous breathing trial, extubation is appropriate when vital signs remain stable after 30 minutes.
- If a patient experiences increased peak inspiratory pressure after bronchoalveolar lavage, possible causes may include bronchospasm, pneumothorax, or pulmonary hemorrhage.
Infection Control in Healthcare
- Poor handwashing techniques by personnel are the primary source of infection in healthcare settings.
Monitoring and Interventions
- A blood gas sample should be placed in an ice bath after collection for proper handling.
- For patients receiving mechanical ventilation, assess changes in lung function and adjust pressures as needed; increase the mandatory rate to address hypoventilation.
Urine Output and Patient Monitoring
- Normal urine output for adults is approximately 40 mL/hr, indicating proper kidney function.
- Monitor for complications related to airway suctioning; hypoxemia is the most serious risk.
Patient Positions and Procedures
- The appropriate postural drainage position for a patient with infiltrates is head down, prone with a pillow under the hips.
- Methodologies like lung expansion therapy should be employed for patients post-surgery with radiographic infiltrates.
Specialty Treatments and Techniques
- To facilitate tracheostomy decannulation while maintaining stoma patency, use a tracheostomy button.
- For significant alveolar hypoventilation, an arterial carbon dioxide tension around 50 torr is indicative.
Emergency Situations
- In cases of suspected left tension pneumothorax, symptoms will include tachypnea and deviated trachea based on physical assessment.
- For sudden decreases in end-tidal CO2 in mechanically ventilated patients, check for ventilator disconnections as a possible cause.
Medication and Treatment Precautions
- Elevate FIO2 or change delivery methods (like switching to a Venti-mask) if a patient with COPD deteriorates on low-flow oxygen.
- When administering albuterol, if tachycardia is noted, reduce the dose for subsequent treatments.
- Rocuronium or succinylcholine are recommended neuromuscular blockers for rapid intubation due to their fast onset.
Patient Education
- Incentive spirometry aims to prevent lung collapse, especially following surgery, and should be explained to patients accordingly.
Technical Considerations
- For bronchoscopy preparations, ensure proper monitoring of tidal volume and awareness of resistance changes.
- Disinfect pulse oximeter surfaces between patients with 70% ethyl alcohol for infection control.
Pediatric Monitoring
- The Silverman score assesses the severity of respiratory distress in newborns, important in pediatric care.
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Explore the critical aspects of carbon monoxide poisoning, its symptoms, and management strategies. This quiz delves into the definitions and clinical features to enhance your understanding of this medical emergency.