TMC Practice Questions A - Kettering Exam

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Questions and Answers

What is the correct concentration and volume combination for option B?

15% and 100 mL

20% and 200 mL

10% and 100 mL

12% and 200 mL (correct)

What should the respiratory therapist recommend for a patient with asthma in severe respiratory distress?

Pulmacort® by small volume nebulizer

Ventolin® by continuous nebulization (correct)

Salmeterol® by DPI

Xopenex® by MDI

What action should the respiratory therapist take for a patient in the ICU with a SpO2 of 92% and over-distension on pressure-volume waveform?

Increase the expiratory time

Decrease the respiratory rate

Decrease the PEEP

Decrease the inspiratory pressure (correct)

What is the actual flow being delivered to the mask for a patient receiving a mixture of 70% helium and 30% oxygen at an oxygen flowmeter set at 10 L/min?

16 L/min Signup and view all the answers

Which of the following bronchial hygiene therapies would be most appropriate for this patient?

Vibratory / oscillatory PEP Signup and view all the answers

The respiratory therapist should record a patient's difficulty breathing while lying in a supine position as what?

Orthopnea Signup and view all the answers

What should the respiratory therapist instruct the patient whose oxygen supply tubing will not stay attached?

Switch to a nasal cannula Signup and view all the answers

What should the respiratory therapist recommend for a patient with copious secretions who has developed mild epistaxis?

Insert a nasopharyngeal airway after bleeding control Signup and view all the answers

The most probable cause of air bronchograms and increased density on a chest X-ray is?

Pneumonia Signup and view all the answers

What should the respiratory therapist recommend for a post-operative patient on mechanical ventilation with stable vital signs?

Continue to monitor closely Signup and view all the answers

What is the primary source of infection in healthcare settings?

Poor handwashing techniques of personnel Signup and view all the answers

What is the recommended management for a patient with suspected pneumonia exhibiting medium crackles?

Regular coughing and deep breathing Signup and view all the answers

What should be done with a blood gas sample after applying pressure to the site for 10 minutes?

Placing the syringe in an ice bath Signup and view all the answers

Which of the following findings is LEAST compatible with hyperlucency on a chest X-ray?

Increased fremitus Signup and view all the answers

What would be the most appropriate recommendation for a spontaneous breathing trial result?

Extubate the patient Signup and view all the answers

After bronchoalveolar lavage and lung biopsy, what could cause increased peak inspiratory pressure?

All of the above Signup and view all the answers

What is the appropriate postural drainage position for a post-operative patient with infiltrates in the lower lobes?

Head down, patient prone with a pillow under hips Signup and view all the answers

What might indicate a patient’s possible condition if BNP test results show 700 pg/mL?

Severe heart failure Signup and view all the answers

What condition is indicated by diminished breath sounds and vital sign abnormalities after chest trauma?

Right tension pneumothorax Signup and view all the answers

What should a therapist recommend when reviewing blood gas lab quality control data?

Recalibrate the pH electrode Signup and view all the answers

How can acute hypoventilation with an ETCO2 of 70 torr be best addressed?

Increase the sensitivity Signup and view all the answers

Which treatment should be recommended for a post-operative patient with platelike infiltrates in a chest X-ray?

Lung expansion therapy Signup and view all the answers

What is the indication that a cuff pressure of 42 cm H2O is necessary for a low-pressure cuff?

The tube is not the appropriate size Signup and view all the answers

What could explain ABG results indicating hypoventilation in a patient on nasal cannula at 2 L/min?

The numbers were not reported correctly Signup and view all the answers

What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients?

70% ethyl alcohol Signup and view all the answers

What is the most likely etiology for tachypnea and tracheal deviation?

Left tension pneumothorax Signup and view all the answers

What is the most serious complication associated with airway suctioning?

Hypoxemia Signup and view all the answers

What is the most appropriate position for a female patient weighing 200 kg and complaining of difficulty breathing?

Fowlers Signup and view all the answers

Which of the following values indicates significant alveolar hypoventilation?

50 torr Signup and view all the answers

What physiological values would indicate proper fluid balance?

CVP between 3 and 6 mm Hg Signup and view all the answers

What is the recommended technique for cuff inflation to prevent airway obstruction?

Minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring Signup and view all the answers

What is indicated by a sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing?

Alveolar gas that has participated in gas exchange Signup and view all the answers

What might cause a sudden decrease in end-tidal CO2 in a mechanically ventilated patient?

The ventilator circuit has become disconnected Signup and view all the answers

What finding is most often associated with mild stridor immediately after extubation?

Upper airway obstruction Signup and view all the answers

What should a therapist recommend for a trauma patient with low SpO2 despite being on nasal cannula?

Non-rebreathing mask at 15 L/min Signup and view all the answers

What is the primary reason for using respiratory care protocols?

Standardize provision of care Signup and view all the answers

What is the normal urine output in an adult patient?

40 mL/hr Signup and view all the answers

What device facilitates the decannulation of a patient with a cuffed tracheostomy tube?

Tracheostomy button Signup and view all the answers

What test should a respiratory therapist recommend for a patient with chronic bronchitis demonstrating infiltrates after antibiotic treatment?

Flexible bronchoscopy Signup and view all the answers

How should a respiratory therapist describe a patient on NPPV with a PaO2 of 145 torr?

Hyperoxygenation Signup and view all the answers

What value indicates proper fluid balance in a patient?

CVP between 3 and 6 mm Hg Signup and view all the answers

Which of the following considerations must be addressed before a bronchoscopy?

The patient's extrinsic PEEP levels will increase Signup and view all the answers

Dynamic hyperinflation is a major concern in volume control ventilation for patients with which condition?

Chronic bronchitis Signup and view all the answers

What technique should be avoided for a post-operative thoracic patient struggling to cough effectively?

Applying pressure to patient's abdomen during exhalation Signup and view all the answers

Which considerations should be taken into account during helicopter transport of a patient on mechanical ventilation?

All of the above Signup and view all the answers

What action should be taken for a 65-year-old female patient with advanced emphysema who's drowsy after 1 hour on a nasal cannula?

Change to a 24% Venti-mask and repeat ABG Signup and view all the answers

What do the lab results of a patient receiving warfarin (Coumadin) with PT of 20 seconds indicate?

High likelihood of excessive bleeding Signup and view all the answers

What condition is indicated by decreased breath sounds and reduced tidal volume in a mechanically ventilated patient?

Partial obstruction of the tracheostomy tube Signup and view all the answers

What is the purpose of performing incentive spirometry in a post-operative patient?

Prevent areas of lung collapse Signup and view all the answers

Under what conditions does a pulse oximeter provide an accurate indication of a patient's oxygenation?

Congestive heart failure Signup and view all the answers

What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?

12% or more increase Signup and view all the answers

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?

Heart failure Signup and view all the answers

What action should the therapist recommend first for a patient with absent breath sounds in the left chest following a motor vehicle accident?

Needle aspirate the 2nd left intercostal space Signup and view all the answers

All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT?

Using a low-residual-volume, low-compliance cuff Signup and view all the answers

What should the respiratory therapist recommend for a post-operative cholecystectomy patient's coarse breath sounds after postural drainage?

Deep breathing and coughing to clear secretions Signup and view all the answers

What bronchial hygiene therapy would be most appropriate for a 65 kg spinal cord injured patient with atelectasis and 30% of predicted inspiratory capacity?

IPPB with normal saline Signup and view all the answers

A healthy adult female can exhale what portion of her forced vital capacity in the first second?

70% Signup and view all the answers

Which controls would, when adjusted independently, increase expiratory time in a patient on VC ventilation demonstrating auto-PEEP?

Tidal volume, Respiratory Rate, Inspiratory flow Signup and view all the answers

What is the most appropriate therapy for a dyspneic patient with crepitus, tracheal deviation, and absent breath sounds on the right?

Insert a chest tube Signup and view all the answers

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%. Venous blood gas: pH 7.39, PvCO2 43 torr, PvO2 37 torr, SvO2 66%.

5.0 vol% Signup and view all the answers

What is the patient's static lung compliance based on the given parameters with a VT of 500 mL, PIP of 25 cm H2O, Pplat of 15 cm H2O, and PEEP of 5 cm H2O?

50 mL/cm H2O Signup and view all the answers

What should be done for a patient in ICU after extubation who has increasing respiratory distress and marked stridor?

Reintubation Signup and view all the answers

Which of the following patients would most likely benefit from pressure support ventilation?

A patient on SIMV with a set rate of 12/min and total rate of 24/min Signup and view all the answers

What initial recommendation should be made for a patient on mechanical ventilation with fever and increased peak inspiratory pressure?

Obtain a sputum gram stain Signup and view all the answers

Which information may be obtained from a FVC maneuver during bedside pulmonary function testing?

FEV1 Signup and view all the answers

What is the most important reason for the patient to follow cleaning procedures using a vinegar/water solution for aerosol therapy equipment?

Retard bacterial growth Signup and view all the answers

What condition might a patient with dyspnea and dry, non-productive cough be suffering from, given diminished breath sounds and dullness to percussion on the right?

Pleural effusion Signup and view all the answers

Which suction catheter size is appropriate for a patient with a size 8.0 mm ID endotracheal tube?

12 Fr Signup and view all the answers

What is the most likely explanation for a patient experiencing diminished breath sounds on the left and dullness to percussion, with a trachea shifted to the left?

The endotracheal tube has slipped into the right main stem bronchus Signup and view all the answers

What is the immediate response for a developing hematoma after an ABG was drawn from the right radial artery?

Apply pressure to the site Signup and view all the answers

A patient's breathing pattern increases and decreases irregularly with periods of apnea lasting up to 1 minute. What condition is likely causing this?

Elevated intracranial pressure Signup and view all the answers

What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?

5 to 15 Signup and view all the answers

What is the most likely explanation for a change in transcutaneous monitor showing PtcO2 rising from 60 to 142 torr and PtcCO2 dropping from 37 to 2 torr?

Air leak around the sensor Signup and view all the answers

What is the total flow delivered to a patient on a 28% air entrainment mask with the flowmeter set at 5 L/min?

55 L/min Signup and view all the answers

Which measurement is most indicative of pulmonary edema?

Pulmonary capillary wedge pressure of 30 mm Hg Signup and view all the answers

How is sleep apnea defined?

10 seconds or longer Signup and view all the answers

After a fiberoptic bronchoscopy procedure in the ICU, what should be suspected if peak inspiratory pressure increases?

Hypoxemia Signup and view all the answers

What size endotracheal tube is appropriate for an adult female patient?

7.0 to 7.5 mm Signup and view all the answers

How should Auto-PEEP be measured on a patient receiving mechanical ventilation?

Initiate an expiratory hold just prior to the next ventilator-delivered breath Signup and view all the answers

For a patient with trauma in an ATV accident, which recommendation should be made based on the provided hemodynamic data?

Positive inotropic agent Signup and view all the answers

What is the primary advantage of volume-controlled ventilation compared to pressure-controlled ventilation?

VC provides a constant minute ventilation Signup and view all the answers

What does bronchial breath sounds over the lung periphery indicate?

Lung consolidation Signup and view all the answers

How should the respiratory therapist interpret bedside spirometry results showing FVC 88% of predicted, FEV1 85% of predicted, and FEV1/FVC 82% of predicted?

Normal lung function Signup and view all the answers

What should the respiratory therapist do if a patient experiences chest pain and shortness of breath during a cardiopulmonary stress procedure?

Terminate the procedure immediately Signup and view all the answers

What APGAR scores should be assigned to a newborn observed at 1 minute and at 5 minutes post-delivery?

6 & 10 Signup and view all the answers

What volume of albuterol should be administered for a 2.5 mg dose from a 0.5% solution?

0.50 mL Signup and view all the answers

After changes are documented in a patient's treatment plan, what should the respiratory therapist do?

Check the electronic medical record for new physician orders Signup and view all the answers

What action should be taken to reduce peak airway pressure for a mechanically ventilated patient with a chest x-ray showing diffuse bilateral infiltrates?

Change to airway pressure release ventilation Signup and view all the answers

To verify the accuracy of a lab-based spirometer, what should the respiratory therapist utilize?

3.0 L syringe Signup and view all the answers

While performing diagnostic chest percussion, decreased resonance could indicate which of the following conditions?

Pneumonia Signup and view all the answers

What does bubbling in the water seal chamber during the inspiratory phase of a chest tube indicate?

A persistent bronchopleural fistula Signup and view all the answers

In the event of an overdose patient, which assessment should be done FIRST?

Determine the Glasgow Coma Score Signup and view all the answers

Which condition is indicated by a male patient admitted with chest pain, normal CBC and electrolytes, and troponin levels at 0.4 ng/mL?

Myocardial infarction Signup and view all the answers

What should the RT recommend for a patient with intermittent wheezing and normal pre/post bronchodilator spirometry results?

Bronchial provocation Signup and view all the answers

What recommendation should be made for a patient who develops a fever after intubation, along with a right lower lobe infiltrate and elevated WBC count?

Antibiotic therapy Signup and view all the answers

How much air should initially be injected into the cuff of a tracheostomy tube for a patient with a C3 fracture?

Enough to achieve a pressure of 25-35 cmH2O Signup and view all the answers

Which conditions can be treated with hyperbaric oxygen (HBO) therapy with one exception?

Pulmonary hypertension Signup and view all the answers

What factors are determinants of cardiac output?

Stroke volume and heart rate Signup and view all the answers

Given the ABG results of a patient in the ED, what should the respiratory therapist recommend?

Administering sodium bicarbonate intravenously Signup and view all the answers

Which inspiratory flow pattern does the physician want to set to deliver the lowest peak inspiratory pressure possible?

Decelerating Signup and view all the answers

What is the major cause of hypoxemia in an intubated patient receiving 30% oxygen with low SpO2 and stable ETCO2?

Ventilation/perfusion mismatch Signup and view all the answers

Study Notes

Emergency Department Assessments

Signs of heart failure include diaphoresis, jugular venous distension, and peripheral edema.
Tension pneumothorax presents with absent breath sounds, hyperresonance, and tracheal deviation.
For confirmed tension pneumothorax, immediate needle decompression in the second left intercostal space is essential.

Respiratory Therapy Interventions

Maintaining cuff pressures between 20-25 mm Hg helps prevent tracheal mucosal damage.
Postural drainage and percussion may not be appropriate if breath sounds worsen; deep breathing and coughing should be encouraged instead.
For a spinal cord-injured patient with atelectasis, IPPB with normal saline is the most suitable bronchial hygiene therapy.

Ventilation and Compliance Metrics

A healthy adult can exhale approximately 70% of forced vital capacity within the first second.
Auto-PEEP indicates inadequate expiratory time, which can be managed by adjusting tidal volume, respiratory rate, and inspiratory flow.
Patients experiencing absent breath sounds and crepitus should receive chest tube placement.

Arterial Blood Gas and Compliance Calculations

C(a-v)O2 calculation can be utilized to assess oxygen extraction efficiency with normal ranges typically around 4.0 vol%.
Static lung compliance is determined by assessing peak inspiratory pressure and plateau pressure; typical values are set around 50 mL/cm H2O.

Post-Extubation Care

Following extubation, if respiratory distress and stridor occur, reintubation is crucial for patient safety.
The ABG results suggest respiratory acidosis; immediate actions depend on the patient’s needs, ranging from ventilation to fluid management.

Conditions and Treatment Protocols

Patients with potential obstructive sleep apnea usually present with an apnea-hypopnea index (AHI) between 5 to 15 for mild cases.
Pulmonary edema manifests with elevated pulmonary capillary wedge pressure, often above 30 mm Hg.
Hyperbaric oxygen therapy is effective for conditions like carbon monoxide poisoning but not for pulmonary hypertension.

Measurement Techniques

To verify spirometer accuracy, use a 3.0 L syringe as a standard measurement tool.
For detecting decreased resonance in percussion, conditions may include pleural effusion, pneumonia, or atelectasis.

Clinical Recommendations

Post-operative patients monitored for potential infections show increased peak inspiratory pressures; initiating sputum culture is essential.
The recommended tracheostomy cuff pressure is ideally set at 25-35 cmH2O for effective ventilation support.

Patient Discharge and Education

Encourage proper cleaning of aerosol equipment to inhibit bacterial growth, emphasizing preventive care.
Education on positional breathing difficulties, termed orthopnea, is crucial for patients reporting discomfort while lying down.

Pediatric and Special Considerations

Assessment of newborns immediately post-delivery involves monitoring heart rate and respiratory patterns to ascertain health; APGAR scores evaluate vital signs and responsiveness.
For cystic fibrosis patients, vibratory oscillatory PEP is a preferred method for airway clearance.

Emergency Situations and Advanced Interventions

In patients with severe respiratory challenges and potential drug overdose, oxygen monitoring and ABG assessments are prioritized to establish treatment urgency.
When patient ventilation settings need adjustments to decrease peak pressures, transitioning to airway pressure release ventilation is advised.

General Insights on Patient Monitoring

Timely adjustment and monitoring of ventilation parameters can significantly impact patient outcomes, particularly in critical care settings.
Continuous assessment of lung mechanics, ABG, and peak inspiratory pressures provides essential information for managing complex respiratory issues.### Mechanical Ventilation and Patient Management
Post-operative patients on mechanical ventilation may require adjustments, such as increasing FIO2 if PvO2 levels are low (e.g., 35 mm Hg) even with stable vital signs.
Infection control in healthcare settings typically benefits from improved hand hygiene practices to reduce transmission.
In cases of suspected pneumonia, encouraging regular coughing and deep breathing aids in respiratory management.

Blood Gas Sampling and Management

Proper handling of arterial blood samples mandates placing the syringe on ice after collection to preserve gas levels.
Hyperlucent findings on chest X-rays are least compatible with increased fremitus, which indicates lung consolidation.

Spontaneous Breathing Trials and Recommendations

For patients undergoing spontaneous breathing trials, stable ABG values are critical indicators for successful extubation.
High peak inspiratory pressures after bronchoscopies in mechanically ventilated patients suggest issues like bronchospasm or pneumothorax.

Postural Drainage and Patient Positioning

Specific postural drainage positions are essential for targeting lung infiltrates; head-down positioning may be indicated for lower lobe involvement.
Patients with pulmonary distress, like those post-stem cell transplant, may exhibit high BNP levels indicating heart failure.

Mechanical Ventilation Complications

Reduced breath sounds and tidal volume could signal obstruction, pneumothorax, or disconnection of ventilator circuits; differential diagnosis is crucial.
Monitoring parameters such as ETCO2 is necessary; significant hypoventilation may require alterations in ventilatory settings.

Cuff Techniques and Airway Management

Airway suctioning carries risks like hypoxemia; proper cuff techniques are vital in preventing mucosal injury and ensuring effective ventilation.
Understanding the different apnea types requires monitoring multiple parameters, including airflow and impedance.

Oxygen Therapy Protocols

The use of non-rebreathing masks facilitates higher FIO2 delivery in respiratory distress situations; this is critical in managing low oxygen saturation levels.
Standardized respiratory care protocols improve both patient outcomes and operational efficiency in healthcare settings.

Fluid Balance and Patient Assessment

Maintaining proper fluid balance is reflected in CVP readings; values should ideally fall between 3 and 6 mm Hg.
Changes in oxygen saturation and ventilatory parameters post-oxygen therapy can indicate the need for protocol adjustments.

Diagnostics and Interventions

In instances of chronic bronchitis or suspected infections, bronchoscopy may be warranted to assess and sample pulmonary conditions.
In severe asthma exacerbations, immediate initiation of bronchodilator treatments, such as Ventolin by nebulization, is crucial for respiratory relief.

Capnography and Ventilation Settings

Understanding capnographic waveforms aids in identifying issues such as alveolar hypoventilation; response interventions must be based on such findings.
Continuous monitoring of mechanical ventilation settings, especially with patients showing signs of distress, ensures patient safety and effective management.

Oxygen Saturation and Monitoring

Pulse oximetry can be challenged by conditions like carbon monoxide poisoning, emphasizing the need for accurate assessments and interventions.
Follow-up assessments, including repeat ABGs or switching oxygen delivery methods, are essential after initial therapy to ensure ongoing patient safety and effectiveness.

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