Respiratory Therapy Exam Questions PDF

1\) A patient receiving positive expiratory pressure (PEP) therapy through a mouthpiece at 10 cm H2O has minimal secretion production. Course crackles are heard during auscultation. The respiratory therapist should recommend which of the following? A. Decrease the PEP to 5 cm H2O. B. Discontinue t...

1\) A patient receiving positive expiratory pressure (PEP) therapy through a mouthpiece at 10 cm H2O has minimal secretion production. Course crackles are heard during auscultation. The respiratory therapist should recommend which of the following? A. Decrease the PEP to 5 cm H2O. B. Discontinue the treatment and begin percussion and postural drainage. C. Increase the PEP to 15 cm H2O. D. Administer the treatment with a mask instead of the mouthpiece. Correct Answer is C Rationale: PEP therapy is indicated for patients with retained secretions. Positive pressure applied during exhalation aids in the mobilization of secretions. Generally, PEP levels of 10 to 20 cm H2O are used. If the PEP used does not result in the mobilization of secretions, the PEP should be increased. 2\) A heated humidifier is delivering 26 mg of H2O/L of gas to an intubated patient. Which of the following statements concerning this situation are true? Correct Answer is B Rationale: Whenever the amount of H2O being delivered to the patient is less than 44 mg/L, a humidity deficit exists. This decreased H2O delivery can result in thickening of pulmonary secretions, with an increased potential of mucous plugging and atelectasis distal to the plugs. Because cooler air cannot hold as much H2O as warmer air, decreasing the heater temperature increases the humidity deficit. 3\) The respiratory therapist is administering acetylcysteine (Mucomyst) via a handheld nebulizer to a patient who suddenly becomes short of breath. Which of the following is the most appropriate recommendation at this time? A. Have the patient take deeper breaths. B. Add racemic epinephrine to the nebulizer. C. Stop the treatment and administer albuterol. D. Stop the treatment and administer cromolyn sodium. Correct Answer is C Rationale: A common complication of acetylcysteine administration is bronchospasm. When respiratory difficulties occur during a Mucomyst treatment, suspect bronchospasm and administer a bronchodilating agent. 4\) An intubated patient\'s secretions tend to become thicker and harder to mobilize in which of the following conditions? Rationale: For delivery of 100% saturated gas at body temperature (100% body humidity) , the gas must be holding 44 mg of H2O/L of gas to have an H2O vapor pressure of 47 mm Hg. Thus, choices 1 and 3 result in a humidity deficit. Although choice 3 indicates a relative humidity of 100%, it is at only 25° C, not at body temperature (37° C), so inadequate H2O is being delivered and the body has to make up the deficit. This causes the airway to dry out and make secretions thicker. 5\) Which of the following is the most appropriate ventilator VT setting for a female patient who is 5 ft, 5 in tall and weighs 85 kg (187 lb) ? A. 450 mL B. 600 mL C. 800 mL D. 900 mL Correct Answer is A Rationale: The ventilator VT should be set at 8 to 12 mL/kg of ideal body weight. Calculation of ideal body weight is as shown: Male: 106 + (6 × \[ (height in inches - 60\]) Female: 105 + (5 × \[height in inches - 60\]) In this problem, the woman is 65 inches tall. 105 + (5 × \[65 - 60\]) = 105 + 25 = 130 lb In other words, you add 5 lb for every inch over 5 ft to a base of 105 lb to obtain the ideal body weight. To change pounds to kilograms, divide by 2.2: 130/2.2 = 59 kg Using 6 to 8 mL/kg of ideal body weight, the most appropriate volume is 450 mL. 6\) During O2 rounds, the respiratory therapist notices a nebulizer delivering very little mist to the patient\'s aerosol mask. Which of the following could cause this problem? C. 2 and 3 only D. 1, 2, and 3 Correct Answer is D Rationale: Inadequate flow to the nebulizer results in an overall decrease in total flow and less mist output. If the capillary tube is plugged, H2O is prevented from being drawn up the tube for aerosolization to occur, with less resulting mist output. Finally, H2O build-up in the aerosol tubing results in an increased resistance to gas flow; therefore, gas flow decreases, along with total mist output. This usually occurs on heated nebulizers because of the temperature change from the outlet of the nebulizer through the cooler tubing, which results in H2O condensation in the tubing. 7\) Chest film results reveal that a patient has consolidation in the left upper lobe. For selective suctioning of the left mainstem bronchus, the respiratory therapist should recommend which of the following? A. Have the patient turn the head to the right during suctioning. B. Use a Yankauer suction device. C. Use a whistle-tip suction catheter. D. Use a coude-tip suction catheter. Correct Answer is D Rationale: A coude-tip catheter is a catheter in which the tip is angled to the left for selective suctioning of the left mainstem bronchus. 8\) A patient receiving volume-controlled ventilation has a PaO2 of 54 mm Hg on a PEEP of 8 cm H2O and an FIO2 of 0.50. After increasing the PEEP to 12 cm H2O, the cardiac output decreases from 5.2 to 4.0 L/min. The most appropriate action is to do which if the following? A. Discontinue PEEP and increase the FIO2 to 0.70. B. Increase PEEP to 15 cm H2O. C. Decrease PEEP to 8 cm H2O and increase the FIO2 to 0.60. D. Maintain the current settings and measure cardiac output in 1 hour. Correct Answer is C Rationale: Because increasing the PEEP level from 8 to 12 cm H2O resulted in a reduction in cardiac output, the PEEP should be returned to 8 cm H2O and the FIO2 should be increased to 0.60. The general rule of thumb for the examination is to increase the FIO2 to 0.60 before increasing PEEP. 9\) This set of ABG results was obtained on a patient in the ICU on a 2-L/min nasal cannula: Correct Answer is A Rationale: The acid pH is the direct result of the decreased HCO3-level. The patient is hyperventilating to decrease the PaCO2 so that the pH returns to normal levels. Because the pH is still low, it is considered a partially compensated metabolic acidosis. 10\) The following data are collected from a 2-month-old infant with respiratory distress syndrome (RDS) who is on pressure control ventilation: Mode SIMV Ventilator rate 40 breaths/min Inspiratory pressure 24 cm H2O FIO2 0.60 PEEP 4 cm H2O PaCO2 36 mm Hg PaO2 41 mm Hg A. Increase PEEP to 6 cm H2O. Correct Answer is A Rationale: The normal PaO2 for a newborn is 50 to 70 mm Hg; therefore, hypoxemia is present. The same rule applies to newborns as for adults when hypoxemia is present and the patient is on 60% O2 or higher. Do not increase the O2; instead, add or increase PEEP. Reducing the ventilator rate increases the PaCO2 and decreases the PaO2. 11\) Postural drainage and percussion have been ordered for a patient with cystic fibrosis with right lower lobe atelectasis. While in the Trendelenburg position, the patient\'s heart rate increases from 74 to 100 beats/min and the respiratory rate increases from 18 to 28 breaths/min. The patient becomes agitated and states, "I can\'t breathe when my head is down." The respiratory therapist should do which of the following? A. Continue the treatment with the patient sitting up. B. Explain the importance of this position to improve his lung condition and continue the therapy. C. Recommend replacing chest physical therapy with fluttervalve oscillation therapy. D. Recommend replacing chest physical therapy with incentive spirometry. Correct Answer is C Rationale: This form of therapy has been shown to be beneficial in the treatment of cystic fibrosis, especially for those patients who cannot tolerate the postural drainage positions indicated for treatment. 12\) The following electrocardiographic (ECG) rhythm is observed on the patient\'s oscilloscope monitor after endotracheal (ET) suctioning: Which of the following is the most appropriate action to help prevent this from occurring? D. Limit the time that the catheter is in the airway to 15 sec. Correct Answer is B Rationale: This ECG strip indicates sinus bradycardia, a fairly common side effect of tracheal suctioning. The sinus bradycardia is the result of vagal nerve stimulation. Hypoxemia caused by suctioning may lead to other cardiac arrhythmias. Increasing the O2 level before suctioning helps compensate for the hypoxemia so that arrhythmias are less likely to occur. 13\) The following ABG values are collected from a 32-year-old patient receiving 50% O2 via aerosol mask: Correct Answer is C Rationale: The ABG levels reveal mild to moderate hypoxemia. Oxygen percentages over 50% to 60% should be avoided because of increasing the possibility of oxygen toxicity. 14\) These data are collected from a sedated, paralyzed patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control Rate 10 breaths/min VT 600 mL (0.6 L) FIO2 0.40 ABGs pH 7.29 PaCO2 50 mm Hg PaO2 77 mm Hg HCO3-- 27 mEq/L BE +3 mEq/L Which of the following ventilator settings would decrease the patient\'s PaCO 2 to 40 mm Hg? A. VT = 700 mL; rate = 12 breaths/min B. VT = 900 mL; rate = 15 breaths/min C. VT = 800 mL; rate = 8 breaths/min D. VT = 750 mL; rate = 10 breaths/min Correct Answer is D Rationale: Use this equation: Desired VE = \[VE (current) × PaCO2 (current) \]/PaCO2 (desired) = (6 L × 50) /40 = 300/40 = 7.5 L (desired VE) A VT of 750 mL (0.75 L) and a rate of 10 breath/min is a VE of 7.5 L. 15\) An alert, spontaneously breathing patient has a PaCO2 of 33 mm Hg and a PaO2 of 55 mm Hg while receiving 70% oxygen. Which of the following is the most appropriate way to increase the patient\'s PaO2? A. Increase the FIO2 only. B. Intubate the patient and increase the FIO2. C. Apply continuous positive airway pressure (CPAP) at 60% oxygen. D. Apply CPAP at 100% oxygen. Correct Answer is C Rationale: A PaO2 of 55 mm Hg on 70% indicates refractory hypoxemia, which does not improve with higher levels of oxygen. Application of CPAP is necessary to improve oxygenation by alveolar recruitment and by opening the alveoli and increasing the surface area for better gas exchange. Once the alveoli are open, oxygen diffusion into the blood increases, resulting in an increased PaO2, often to the point that the FIO2 can be reduced. A level of 0.70, as in this question, can be damaging to lung tissue, so reducing it to 0.60 while applying CPAP is appropriate. Mechanical ventilation is not indicated at this time because the patient is ventilating adequately. The primary problem is hypoxemia, resulting in hyperventilation. Once the PaO2 is increased, the patient\'s need to hyperventilate will diminish with a rise in the PaCO2. 16\) The physician writes an order for a patient to receive 15 L/min of an 80:20 helium-O2 mixture from a premixed heliox cylinder via a nonrebreathing mask. For the patient to receive this flow through an O2 flow meter, the flow must be set at approximately which of the following? A. 8 L/min B. 12 L/min C. 15 L/min D. 24 L/min Correct Answer is A Rationale: An 80:20 mixture of heliox diffuses through an O2 flow meter 1.8 times faster than 100% O2. To determine the correct flow rate setting, divide the desired flow (15 L/min) by 1.8. 17\) The following data were obtained from a 75-kg (165-lb) male patient on volume-controlled ventilation: Which of the following is the most appropriate action to take at this time? A. Decrease FIO2 to 0.40. B. Increase VT to 700 mL. C. Decrease PEEP to 5 cm H2O. D. Maintain current settings. Correct Answer is D Rationale: These ABG results indicate normal values. Therefore, no ventilator changes are necessary. 18) The following data have been obtained from a 70-kg (154-lb) patient with pneumonia who is receiving volume-controlled ventilation: Correct Answer is B Rationale: The patient\'s ABG levels reveal alveolar hyperventilation, a sign that the ventilator rate or VT is excessively high. The VT fits for the patient\'s weight (6 to 8 mL/kg of body weight) and, because the patient is being weaned (SIMV rate = 8 breaths/min) , the most appropriate choice is to decrease the rate to 4 breaths/min. 19\) A 54-year-old patient enters the emergency department with mild chest pain and shortness of breath. Oxygen is started at 3 L/min per nasal cannula. The ABGs drawn 30 minutes later are as follows: pH 7.36 PaCO2 44 mm Hg PaO2 62 mm Hg HCO3- 24 mEq/L Correct Answer is A Rationale: The patient is still hypoxemic on 3 L/min of O2. Choices b and c are too drastic and not necessary at this point, so an increase in liter flow to 5 L/min is most appropriate. 20\) While monitoring vital signs on a patient on a ventilator, the respiratory therapist observes a blood pressure of 175/100 mm Hg. Which of the following should be recommended at this time? A. Administer nitroprusside. B. Decrease the tidal volume (VT). C. Increase inspiratory flow. D. Administer dopamine. Correct Answer is A Rationale: Nitroprusside sodium (Nipride) is a potent, fast-acting, peripheral vasodilator, which reduces peripheral arterial resistance, thereby decreasing blood pressure. 21\) The physician orders 40% O2 for a patient with dyspnea. Which of the following devices delivers this O2 level most consistently? A. Nasal cannula at 5 L/min B. Simple O2 mask at 10 L/min C. Partial rebreathing mask at 12 L/min D. Air entrainment mask Correct Answer is D Rationale: The air entrainment mask is a high-flow device, which delivers a more consistent O2 percentage than low-flow devices. Normal spontaneous inspiratory flow is 25 to 30 L/min. Because the maximum liter flow available on low-flow devices, such as the cannula and simple and partial rebreathing masks, is 6 to 15 L/min, which is less than the patient\'s flow demands, any inspiratory flow needs of the patient above this flow range decrease the percentage delivered because the patient is inspiring more room air. The actual percentage of O2 delivered by a low-flow device is never known because it fluctuates with the patient\'s VT, respiratory rate, and inspiratory time. 22\) You are suctioning a patient with pink frothy secretions who has a PCWP of 23 mm Hg and a PAP of 20/10 mm Hg. This assessment is consistent with which of the following conditions? D. ARDS Correct Answer is B Rationale: The pink frothy secretions indicate pulmonary edema. The pulmonary wedge pressure (PCWP) is elevated, resulting in a backup of fluid in the lungs. Because the edema is the result of a cardiac abnormality, it is cardiogenic pulmonary edema. 23\) A patient\'s chest radiograph reveals moderate pulmonary congestion. Other data are as follows: On the basis of this information, the patient most likely has which of the following? A. Noncardiogenic pulmonary edema B. Pneumothorax Correct Answer is C Rationale: These data reveal an elevation of both the PAP and PCWP, with a reduction in Qt. The radiograph shows excessive lung fluid (pulmonary edema). If wedge pressure increases (as a result of left heart failure) , this causes a backup of blood into the lungs, leading to increased capillary hydrostatic pressure, which causes pulmonary edema. In this case, it is termed cardiogenic pulmonary edema because it resulted from cardiac problems--- namely, left heart failure--- as evidenced by an increased PCWP. 24\) During manual ventilation, minimal resistance is found during compression of the bag, with little rise in the patient\'s chest. Which of the following should the respiratory therapist do to correct this problem? A. Increase oxygen flow to the bag. B. Inflate the cuff on the patient\'s ET tube. C. Add a reservoir to the bag. D. Allow a longer time between bag compressions. Correct Answer is B Rationale: If the ET tube cuff is not inflated, gas being compressed from the bag will leak around the cuff, most likely from the patient\'s mouth. With a leak that large, the bag will not pressurize when compressed and, because little air is entering the patient\'s lungs, the chest will rise very little. 25\) The physician wants a patient with a tracheostomy to be able to talk and still maintain the airway for suctioning. He wants the respiratory therapist\'s recommendation for the airway that would cause the least amount of airway resistance. Which of the following is the best choice? A. Tracheostomy button B. Uncuffed tracheostomy tube C. Fenestrated tracheostomy tube D. Cuffed tracheostomy tube Correct Answer is A Rationale: A tracheostomy button rests on the anterior wall of the inside of the trachea, not in the lumen of the trachea, for minimal airway resistance. 26\) The respiratory therapist is preparing to transport a patient on a 4-L/min nasal cannula from the oncology ward to the radiology department. The E cylinder used for transport contains 1500 psig. How long will the contents last running the cylinder down to 500 psig? Correct Answer is B Rationale: Use the following equation: (Cylinder pressure × 0.28) /flow rate = minutes remaining in the cylinder The "catch" to this question is that the cylinder is not run to empty, but to 500 psig. You must subtract 500 from the tank pressure before multiplying by the E cylinder factor of 0.28: \[ (1500 -- 500) × 0.28\]/4 L/min = 280/4 = 70 min, or 1 h 10 min Note: Although subtraction of 500 psig from the actual cylinder pressure is suggested for the calculation of the time left in a cylinder, unless the question is stated that way on the examination, do not subtract the 500 psig. 27\) A patient with severe COPD enters the emergency department in moderate respiratory distress on a 4-L/min nasal cannula. His ABG results are as follows: pH 7.23 PaCO2 85 mm Hg PaO2 48 mm Hg HCO3- 35 mEq/L BE +12 mEq/L The most appropriate recommendation is which of the following? A. Decrease flow to 2 L/min. B. Place the patient on mask CPAP at 4 cm H2O and 60% O2. C. Begin noninvasive positive pressure ventilation. D. Place the patient on a nonrebreathing mask. Correct Answer is C Rationale: Patients with severe COPD have hypercapnia (high PaCO2 levels) , even at their best. The therapist must look at the pH to determine whether an acute hypercapnia is superimposed on the chronic hypercapnia. Normally, the patient\'s pH level is between 7.30 and 7.35. If the pH is below 7.30, acute respiratory failure should be suspected. Rather than intubating and beginning mechanical ventilation, try noninvasive ventilation first, if given the choice. This often buys more time to treat the underlying factor that has led to the acute failure. If possible, avoid intubation and ventilation in patients with severe COPD because they can be so difficult to wean. If the choice for noninvasive ventilation was not given, mechanical ventilation must be the next choice. It is not appropriate to decrease the liter flow to 2 L/min because the patient\'s respiratory drive has not been reduced by the current oxygen flow, as evidenced by a PaO2 of 48 mm Hg. If the PaO2 is above 70 mm Hg, reducing the flow is appropriate. 28\) The respiratory therapist is calibrating a transcutaneous PO2 monitor before setup on a neonate. The barometric pressure is 747 mm Hg. At room air, the monitor should read: A. 0. Correct Answer is C Rationale: To calculate the partial pressure of O2 in room air, use the following formula: PO2 = (PB -H2O vapor pressure) × 0.21 (747 mm Hg-47 mm Hg) × 0.21 = 147 mm Hg in which PB is barometric pressure. 29\) The following data have been collected on a ventilator patient in the assist-control mode: Mode Assist-control Vo2 200 mL/min C (a-v) o2 5 vol% Hb 14 g/dL pH 7.43 PaCO2 37 mm Hg PaO2 85 mm Hg VT 650 mL Rate 10 breaths/min FIO2 0.45 PEEP 6 cm H2O This patient's QT is which of the following? Correct Answer is C Rationale: Note this equation: QT = O2 consumption (VO2) /\[ (Cao2- Cvo2) × 10\] = 200/50 = 4 L/min Note that much of the data listed are not necessary to calculate QT. This is common in an examination. 30\) A 24-year-old male patient weighing 65 kg (143 lb) is receiving mechanical ventilation after diagnosis of a drug overdose. His chest radiograph is consistent with pulmonary edema. Pertinent data are as follows: Mode SIMV Rate 15 breaths /min ABGs pH 7.41 PaCO2 38 mm Hg PaO2 49 mm Hg Tidal volume 500 mL FIO2 0.75 HCO3- 26 mEq/L PEEP 8 cm H2O Pressure support 5 cm H2O BE +1 PIP 52 cm H2O Sao2 83% Plateau pressure 41 cm H2O Which of the following changes should the respiratory therapist recommend at this time? Correct Answer is C Rationale: The patient\'s ABG results reveal adequate ventilation with hypoxemia on an FIO2 of 0.60 and a PEEP of 8 cm H2O. The pulmonary edema has reduced lung compliance, as evidenced by the elevated plateau pressure (41 cm H2O). This high pressure is damaging to lung tissue and may result in a pneumothorax. The patient must be placed on pressure control ventilation to control the PIP level at 35 cm H2O. This reduces alveolar ventilation, which increases the PaCO2. To counteract hypercapnia, the respiratory rate should be increased. To increase the PaO2, PEEP should be increased because the FIO2 is already 0.75. If FIO2 levels are 0.60 or higher with hypoxemia, the PEEP must be increased. 31\) The respiratory therapist is called to a patient\'s room to check the oxygen setup. The flow to the patient\'s mask is supplied by an air flow meter running at 15 L/min and an O2 flow meter running at 15 L/min. The delivered oxygen percentage from this device is which of the following? A. 24% B. 35% C. 40% D. 60% Correct Answer is D Rationale: A liter flow of 15 L/min of oxygen and 15 L/min of air represents an air-to-O2 ratio of 1:1, which results in an oxygen percentage of 60%. 32\) A 34-year-old patient with pneumonia who is on a 2-L/min nasal cannula becomes slightly cyanotic when in the Trendelenburg position during chest physical therapy. Which of the following is the most appropriate recommendation in this situation? A. Discontinue the treatment and administer IPPB. B. Continue the treatment as ordered, with no modifications. C. Increase the O2 flow on the patient\'s cannula to 5 L/min during the treatment. D. Place the patient on CPAP for the remainder of the treatment. Correct Answer is C Rationale: It is not unusual for the patient with pulmonary problems to become cyanotic while in a head-down position. To help alleviate the hypoxia, increase the O2 liter flow for the duration of the treatment. The flow should be returned to the original flow after the treatment if the patient is no longer cyanotic or in any respiratory distress. 33\) A chest radiograph film of a spontaneously breathing neonate in a 60% O2 hood reveals right upper and middle lobe atelectasis. Arterial blood gases are as follows: To increase this infant\'s PaO2, the respiratory therapist should recommend a change to which of the following devices? A. O2 tent B. High-frequency oscillation C. Nasal CPAP D. Mechanical ventilator Correct Answer is C Rationale: This neonate is ventilating well (no need for mechanical ventilation or high-frequency oscillation) but is hypoxemic on 60% O2. Never increase the FIO2 over 60% in a case such as this. CPAP is indicated to decrease atelectasis and improve the PaO2. This can be accomplished using nasal CPAP or more commonly, a nasal cannula. 34\) These data were obtained from a 70-kg (154-lb) patient on volume-controlled ventilation in the assist-control mode: A. Decrease FIO2 to 0.60. Correct Answer is A Rationale: The patient\'s PaO2 needs to be reduced; this is best accomplished by decreasing the FIO2 (because it is above 0.60) first. Once the FIO2 is decreased to 0.60, the PEEP level can be reduced, unless the patient has ARDS, then reducing the FIO2 would be more appropriate because maintaining PEEP is advantageous for patients with ARDS. 35\) A 40% aerosol mask being analyzed with a polarographic O2 analyzer reads 75%. Which of the following is the appropriate action? A. Decrease the flow to the nebulizer. B. Replace the O2 flowmeter. C. Add H2O to the nebulizer. D. Drain the H2O out of the aerosol tubing. Correct Answer is D Rationale: When H2O builds up in the aerosol tubing, resistance to gas flow occurs and results in back pressure into the nebulizer reservoir. This higher pressure in the nebulizer causes less room air to be entrained; therefore, the concentration of delivered O2 is higher. 36\) A patient on a 60% aerosol mask has the following ABG values: Correct Answer is B Rationale: With the patient already on 60% O2 and still hypoxemic, the most appropriate choice is to place the patient on CPAP, not increase the O2 to 70%. The patient has refractory hypoxemia and intrapulmonary shunting, whereby the PaO2 will only increase marginally with increases in FIO2. Positive pressure is necessary to increase mean airway pressure to increase the PaO2. An FIO2 of more than 0.50 to 0.60 mL should be avoided because exceeding these levels increases the possibility of oxygen toxicity. 37\) The following ventilatory parameters have been measured on a 65-kg (143-lb) patient who is receiving O2 on a 2-L/min nasal cannula: VT 550 mL Respiratory rate 15 breaths/min This patient\'s alveolar minute volume is which of the following? A. 4.3 L B. 6.1 L C. 7.3 L D. 8.3 L Correct Answer is B Rationale: Alveolar ventilation is calculated as follows: Alveolar ventilation = (VT-VD) × RR In which VD is dead space and RR is respiratory rate. Note: VD = 1 mL/lb of body weight. Change the VT from milliliters to liters by dividing by 1000. (0.550 -0.143) × 15 = 0.407 × 15 = 6.1 L 38\) The respiratory therapist has been asked to recommend an O2 delivery device that has the capability of delivering 40% O2 at a flow rate high enough to meet the patient\'s 40-L/min inspiratory flow demand. Which of the following devices would meet this demand? Correct Answer is B Rationale: No low-flow device can deliver 40 L/min of flow, so the choice to meet this high flow rate must be a high-flow device. The air entrainment mask and aerosol mask are both considered high-flow masks. 39\) During a routine ventilator check, the high-pressure alarm begins to sound. The respiratory therapist should do which of the following to determine why the alarm is sounding? A. Check to see whether the patient has become disconnected from the ventilator. B. Ensure that the expiratory drive line is properly connected. C. Listen to the patient\'s breath sounds to determine whether the patient needs to be suctioned. D. Increase the high-pressure limit. Correct Answer is C Rationale: Secretions in the airway increase airway resistance, resulting in higher peak inspiratory pressures. Increasing the pressure limit does not correct the increased airway resistance. The first two choices would result in the low-pressure and low-volume alarms being triggered. 40\) The respiratory therapist is assessing a ventilator-dependent patient\'s ability to be weaned. The weaning protocol states that the patient can be weaned when the patient\'s spontaneous tidal volume is at least 3 mL/lb of the patient\'s ideal body weight, which is 60 kg (132 lb). The therapist measures the patient\'s spontaneous minute ventilation (VE) to be 8 L/min and the respiratory rate to be 20 breaths/min. What is the most appropriate recommendation? D. Maintain the current ventilator settings. Correct Answer is A Rationale: For weaning to be initiated, the patient\'s VT needs to be at least 3 mL/lb of the ideal body weight. In other words, the VT must be at least three times his weight. The patient weighs 132 lb; therefore, his spontaneous VT must be at least 396 mL for weaning to be appropriate. His measured minute ventilation (VE) is 8 L/min with a respiratory rate of 20 breaths/min. To determine his VT, VE must be divided by rate: 8/20 = 0.4 L (400 mL) This indicates that initiating weaning is appropriate.