Questions and Answers
What is the correct concentration and volume combination for option B?
What should the respiratory therapist recommend for a patient with asthma in severe respiratory distress?
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?
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?
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Which of the following bronchial hygiene therapies would be most appropriate for this patient?
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The respiratory therapist should record a patient's difficulty breathing while lying in a supine position as what?
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What should the respiratory therapist instruct the patient whose oxygen supply tubing will not stay attached?
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What should the respiratory therapist recommend for a patient with copious secretions who has developed mild epistaxis?
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The most probable cause of air bronchograms and increased density on a chest X-ray is?
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What should the respiratory therapist recommend for a post-operative patient on mechanical ventilation with stable vital signs?
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What is the primary source of infection in healthcare settings?
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What is the recommended management for a patient with suspected pneumonia exhibiting medium crackles?
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What should be done with a blood gas sample after applying pressure to the site for 10 minutes?
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Which of the following findings is LEAST compatible with hyperlucency on a chest X-ray?
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What would be the most appropriate recommendation for a spontaneous breathing trial result?
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After bronchoalveolar lavage and lung biopsy, what could cause increased peak inspiratory pressure?
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What is the appropriate postural drainage position for a post-operative patient with infiltrates in the lower lobes?
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What might indicate a patient’s possible condition if BNP test results show 700 pg/mL?
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What condition is indicated by diminished breath sounds and vital sign abnormalities after chest trauma?
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What should a therapist recommend when reviewing blood gas lab quality control data?
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How can acute hypoventilation with an ETCO2 of 70 torr be best addressed?
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Which treatment should be recommended for a post-operative patient with platelike infiltrates in a chest X-ray?
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What is the indication that a cuff pressure of 42 cm H2O is necessary for a low-pressure cuff?
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What could explain ABG results indicating hypoventilation in a patient on nasal cannula at 2 L/min?
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What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients?
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What is the most likely etiology for 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 female patient weighing 200 kg and complaining of difficulty breathing?
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Which of the following values indicates significant alveolar hypoventilation?
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What physiological values would indicate proper fluid balance?
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What is the recommended technique for cuff inflation to prevent airway obstruction?
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What is indicated by a sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing?
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What might cause a sudden decrease in end-tidal CO2 in a mechanically ventilated patient?
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What finding is most often associated with mild stridor immediately after extubation?
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What should a therapist recommend for a trauma patient with low SpO2 despite being on nasal cannula?
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What is the primary reason for using respiratory care protocols?
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What is the normal urine output in an adult patient?
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What device facilitates the decannulation of a patient with a cuffed tracheostomy tube?
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What test should a respiratory therapist recommend for a patient with chronic bronchitis demonstrating infiltrates after antibiotic treatment?
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How should a respiratory therapist describe a patient on NPPV with a PaO2 of 145 torr?
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What value indicates proper fluid balance in a patient?
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Which of the following considerations must be addressed before a bronchoscopy?
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Dynamic hyperinflation is a major concern in volume control ventilation for patients with which condition?
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What technique should be avoided for a post-operative thoracic patient struggling to cough effectively?
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Which considerations should be taken into account during helicopter transport of a patient on mechanical ventilation?
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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?
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What do the lab results of a patient receiving warfarin (Coumadin) with PT of 20 seconds indicate?
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What condition is indicated by decreased breath sounds and reduced tidal volume in a mechanically ventilated patient?
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What is the purpose of performing incentive spirometry in a post-operative patient?
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Under what conditions does a pulse oximeter provide an accurate indication of a patient's oxygenation?
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What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?
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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 following a motor vehicle accident?
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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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What should the respiratory therapist recommend for a post-operative cholecystectomy patient's coarse breath sounds after postural drainage?
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What bronchial hygiene therapy would be most appropriate for a 65 kg spinal cord injured patient with atelectasis and 30% of predicted inspiratory capacity?
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A healthy adult female can exhale what portion of her forced vital capacity in the first second?
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Which controls would, when adjusted independently, increase expiratory time in a patient on VC ventilation demonstrating auto-PEEP?
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What is the most appropriate therapy for a dyspneic patient with crepitus, tracheal deviation, 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%. Venous blood gas: pH 7.39, PvCO2 43 torr, PvO2 37 torr, SvO2 66%.
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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?
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What should be done for a patient in ICU after extubation who has increasing respiratory distress and marked stridor?
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Which of the following patients would most likely benefit from pressure support ventilation?
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What initial recommendation should be made for a patient on mechanical ventilation with fever and increased peak inspiratory pressure?
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Which information may be obtained from a FVC maneuver during bedside pulmonary function testing?
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What is the most important reason for the patient to follow cleaning procedures using a vinegar/water solution for aerosol therapy equipment?
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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?
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Which suction catheter size is appropriate for a patient with a size 8.0 mm ID endotracheal tube?
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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?
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What is the immediate response for a developing hematoma after an ABG was drawn from the right radial artery?
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A patient's breathing pattern increases and decreases irregularly with periods of apnea lasting up to 1 minute. What condition is likely causing this?
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What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?
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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?
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What is the total flow delivered to a patient on a 28% air entrainment mask with the flowmeter set at 5 L/min?
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Which measurement is most indicative of pulmonary edema?
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How is sleep apnea defined?
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After a fiberoptic bronchoscopy procedure in the ICU, what should be suspected if peak inspiratory pressure increases?
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What size endotracheal tube is appropriate for an adult female patient?
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How should Auto-PEEP be measured on a patient receiving mechanical ventilation?
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For a patient with trauma in an ATV accident, which recommendation should be made based on the provided hemodynamic data?
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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 over the 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, and FEV1/FVC 82% of predicted?
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What should the respiratory therapist do if a patient experiences chest pain and shortness of breath during a cardiopulmonary stress procedure?
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What APGAR scores should be assigned to a newborn observed at 1 minute and at 5 minutes post-delivery?
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What volume of albuterol should be administered for a 2.5 mg dose from a 0.5% solution?
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After changes are documented in a patient's treatment plan, what should the respiratory therapist do?
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What action should be taken to reduce peak airway pressure for a mechanically ventilated patient with a chest x-ray showing diffuse bilateral infiltrates?
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To verify the accuracy of a lab-based spirometer, what should the respiratory therapist utilize?
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While performing diagnostic chest percussion, decreased resonance could indicate which of the following conditions?
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What does bubbling in the water seal chamber during the inspiratory phase of a chest tube indicate?
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In the event of an overdose patient, which assessment should be done FIRST?
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Which condition is indicated by a male patient admitted with chest pain, normal CBC and electrolytes, and troponin levels at 0.4 ng/mL?
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What should the RT recommend for a patient with intermittent wheezing and normal pre/post bronchodilator spirometry results?
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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?
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How much air should initially be injected into the cuff of a tracheostomy tube for a patient with a C3 fracture?
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Which conditions can be treated with hyperbaric oxygen (HBO) therapy with one exception?
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What factors are determinants of cardiac output?
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Given the ABG results of a patient in the ED, what should the respiratory therapist recommend?
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Which inspiratory flow pattern does the physician want to set to deliver the lowest peak inspiratory pressure possible?
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What is the major cause of hypoxemia in an intubated patient receiving 30% oxygen with low SpO2 and stable ETCO2?
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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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Test your knowledge with these TMC practice questions specifically designed for the Kettering exam. Each card presents a clinical scenario requiring critical thinking and application of medical knowledge. Ideal for students preparing for their exams in respiratory therapy.