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SAE PRACTICE 1
TMC REVIEW
| Question | Answer |
|---|---|
| For a patient who is breathing spontaneously, which of the following will result in an elevated baseline pressure during inspiration and expiration? | CPAP: Continuous positive airway pressure provides constant positive airway pressure during the entire respiratory cycle. |
| After obtaining an arterial blood gas sample, a respiratory therapist should handle the sample by | removing air from the syringe: Air in the syringe will affect the results. |
| Which of the following should be recommended to determine the site of bleeding in a patient with hemoptysis? | bronchoscopy: Hemoptysis is bleeding from an airway source. Bronchoscopy may help localize the site of the bleeding. |
| Home overnight oximetry is used to assess the need for | polysomnography: Overnight oximetry may be considered a screening tool for a more detailed polysomnography study. |
| The amount of air that can be maximally exhaled from maximum inspiration is called the | vital capacity: Vital capacity is the maximum volume exhaled after a maximum inhalation. |
| Which of the following is the definitive method of monitoring the effectiveness of equipment sterilization? | biologic indicator: Biologic indicators, or spore tests, indicate whether a highly resistant microorganism has been killed within the package. This is the most accepted method for monitoring effectiveness of heat/stem sterilization. |
| Which of the following is associated with an optimally exposed chest radiograph? | Vertebrae and lung markings are clearly visible.: In an optimally exposed chest radiograph, vertebrae are visible while maintaining visible lung markings. |
| When extubating an adult patient, which of the following should a respiratory therapist do FIRST? | Position the patient in an upright position.: The patient should first be placed in high Fowler's position. |
| Neck and chest palpation reveals crepitus in a patient receiving positive pressure ventilation. A respiratory therapist should assess the patient for which of the following conditions? | pneumothorax: Crepitus may be associated with a pneumothorax due to the presence of subcutaneous emphysema |
| A 30-year-old patient with terminal cancer is intubated. After 72 hours, the patient and her family request extubation with comfort measures. To relieve symptoms of dyspnea following extubation, a respiratory therapist should recommend | morphine: Morphine will alleviate pain and dyspnea associated with a terminal extubation. |
| A patient is diagnosed with pneumonia and a moderate pleural effusion. Which of the following procedures should a respiratory therapist recommend FIRST? | thoracentesis: A needle thoracentesis should be performed first to help diagnose the cause of the pleural effusion |
| While receiving postural drainage in the head-down position, a patient becomes dyspneic due to severe prolonged coughing. A respiratory therapist should | place the patient in Fowler's position.: Fowler's position elevates the head of the bed to an angle between 45 and 60 degrees. This will relieve the dyspnea and alleviate the patient's distress. |
| Which of the following should be used to most accurately assess oxygen saturation in a patient with suspected smoke inhalation? | hemoximeter (CO-oximeter): directly measure various forms of hemoglobin saturation, including oxyhemoglobin, carboxyhemoglobin, and methemoglobin. In a patient with suspected smoke inhalation, elevation in the carboxyhemoglobin level can be expected. |
| A tracheostomy tube that was placed 24 hours ago is accidentally dislodged from a patient receiving mechanical ventilation. A respiratory therapist should FIRST | occlude the stoma and ventilate with a bag-valve-mask resuscitator.: The correct course of action is to occlude the stoma and ventilate with a bag-valve-mask resuscitator while preparations are made to reintubate by the mouth or nose. |
| A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dyspnea, and a cough that occurs every summer. Which of the following drug classifications should a respiratory therapist recommend to control the patient's symptoms? | leukotriene inhibitor: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene inhibitor, such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis. |
| A respiratory therapist on a medical emergency team is directed to maximize FIO2 for a patient who is not intubated. Which of the following should the therapist select? | nonrebreathing mask, flowmeter on flush: A nonrebreathing mask with high-flow oxygen will ensure that each breath contains an FIO2 approximating 1.00, and is most likely to increase this patient's oxygenation. |
| A respiratory therapist auscultates diminished breath sounds on the right and observes tracheal deviation to the right. These signs indicate | right-sided atelectasis.: Right-sided atelectasis causes diminished breath sounds on the right and the trachea is pulled in the direction of the atelectasis. |
| Which of the following should a respiratory therapist recommend for a patient who is receiving mechanical ventilator support and has moderate musculoskeletal pain? | fentanyl citrate (Sublimaze): Fentanyl citrate (Sublimaze) is an analgesic agent and will be helpful to reduce musculoskeletal pain. |
| A respiratory therapist is asked to troubleshoot an air/oxygen blender. The device is plugged in to the air and oxygen outlets, and a high-pitched whistle is heard. The therapist should conclude that the blender | is sensing a loss of gas pressure.: The high-pitched squeal indicates that the oxygen or air source is disconnected or below a critical point. |
| When measuring vital capacity, a respiratory therapist should instruct a patient to inhale | maximally and exhale maximally.: Vital capacity is performed by having the patient inhale to total lung capacity and maximally exhale to residual volume. |
| A patient receiving oxygen at 2 L/min through a transtracheal catheter complains that the supply tubing keeps popping off of the catheter. To correct this problem, a respiratory therapist should | check the catheter for obstruction.: The description suggests obstruction of the catheter due to kinking or mucous, resulting in significant back pressure causing the supply tube to pop off. |
| A 44-year-old patient presents to the ED with diabetic ketoacidosis. Which of the following respiratory patterns is most consistent with this diagnosis? | rapid, deep breathing: To attempt to compensate by blowing off CO2, there is an increase in rate and depth of breathing. This is called Kussmaul's breathing and is the result of diabetic ketoacidosis. |
| After a transcutaneous electrode is attached to a patient's skin, a respiratory therapist should wait a few minutes for the values to stabilize. This wait is associated with | capillary dilatation.: The site must be heated for 2-5 minutes to facilitate capillary dilatation. Once dilatation occurs, transcutaneous values will stabilize. |
| Apnea monitoring should be used for an infant during | naps and night time.: An apnea monitor is indicated when an infant is asleep or when not being observed; therefore, it should be used during naps and at night. |
| To determine the need for ventilatory support in a patient with Guillain-Barré syndrome, which of the following clinical information should be obtained? | MIP and vital capacity: MIP is an indication of respiratory muscle strength. Vital capacity provides information regarding respiratory reserve. Both provide data about the need for ventilatory support in a patient with neuromuscular disease. |
| While testing the proper function of a flow-inflating bag, a respiratory therapist notes the bag does not fully inflate with occlusion of the patient connector. Which of the following may be the cause of the problem? | open-flow control valve: With the flow control valve open, the gas going into the bag will immediately leave the bag through the open-flow control valve. |
| Which of the following clinical observations is most commonly associated with right heart failure? | peripheral edema: Right heart failure inhibits venous return and results in edema in the periphery. |
| A 77-year-old male patient is scheduled to undergo open heart surgery. Preoperative spirometry results show the patient's FEV1 is 80% of predicted and the FEV1/FVC is 83%, indicating | low risk for postoperative pulmonary complications.: The FEV1 and FEV1/FVC values are within normal ranges. The patient should be able to deep breathe and cough after surgery. |
| A respiratory therapist is preparing a bronchoscope for a scheduled procedure. The bronchoscope is plugged into the light source and powered on. No light appears at the distal end of the bronchoscope. The therapist should FIRST | ensure the light cable is seated correctly in the connection port.: The most common cause of issues with the light source of bronchoscopes is the connection port. |
| What is the approximate total flow that will be delivered from a 40% air-entrainment mask receiving 12 L/min of oxygen? | 48 L/min: 3x = air entrained 3x + x = total flow 3(12) + 12 = total flow = 48 L/min. |
| A respiratory therapist notes a patient's soft palate cannot be viewed. What is the patient's Mallampati score? | IV: Mallampati score IV is characterized by the visualization of only the hard palate. None of the soft palate is visible. |
| Which of the following is suggestive of a malfunctioning arterial catheter? | difficulty aspirating blood: Difficulty withdrawing blood through an arterial catheter is a sign of malfunction. |
| Which of the following indicates auto-PEEP in a patient receiving mechanical ventilation? | Expiratory flow does not return to zero before the next mandatory breath.: Auto-PEEP is caused by gas trapping. Expiratory flow will not return to baseline because expiration has not completed before the next breath is delivered. |
| To minimize airway trauma during nasotracheal suctioning on an adult patient, a respiratory therapist should | lubricate the catheter with water-soluble lubricant prior to insertion.: To reduce complications of trauma, the catheter should be lubricated with a water-soluble lubricant to aid catheter passage through the nostril. |
| Which of the following should a respiratory therapist emphasize as a critical infection control step to a patient who will administer aerosol therapy at home? | handwashing before and after each treatment: Handwashing before and after use prevents contamination of equipment and transmission of microorganisms. |
| A respiratory therapist is evaluating the recent polysomnography report in the medical record of a patient with a BMI of 23 kg/m2. The report notes an AHI of 28. Which of the following should the therapist expect to see in the patient's care plan? | PAP therapy: An AHI of 28 is categorized as moderate to severe sleep apnea. PAP therapy is the treatment of choice. |
| A respiratory therapist is preparing to perform an arterial puncture on a nonresponsive patient whose medical history includes a diagnosis of HIV. For the protection of the patient and therapist, the therapist should | use universal precautions when obtaining the sample.: Universal precautions should be used when obtaining an ABG sample. |
| A patient receiving mechanical ventilation had a total fluid intake of 4100 mL and a total fluid output of 1100 mL over a 24-hour period. Which of the following might increase in this situation? | P(A-a) O2: An excess in interstitial fluid can impair oxygen diffusion into the capillaries and increase the P(A-a)O2. |
| A patient complains of a productive cough that started 4 months ago. Which of the following should a respiratory therapist suspect? | bronchitis: Bronchitis is characterized by chronic cough and sputum production. |
| Monitoring of serum electrolytes is indicated in patients who are receiving. | diuretics.: cause fluid shifts and excretion of certain electrolytes in the urine. Therefore, electrolytes should be monitored to detect electrolyte imbalances (particularly in sodium, potassium, and calcium) as these can be life threatening. |
| When examining the patient's chest, the therapist notes an absence of breath sounds in the left chest with a hyperresonant percussion note. Which of the following should the therapist recommend FIRST? | Insert a 14-gauge needle in the left chest: The patient has a tension pneumothorax. Inserting a needle in the chest is the quickest action based on the vital signs. |
| A respiratory therapist is administering 2.5 mg of albuterol to a patient by small-volume nebulizer. Five minutes after the treatment is started, the patient's heart rate increases from 110 to 140/min. Which of the following should the therapist do? | Terminate the treatment: There has been an increase in the patient's heart rate of greater than 20/min, signaling a tachycardic reaction to the medication. Termination of the treatment is advisable. |
| A 61-year-old male with dyspnea and nonproductive cough has the following examination results noted over the right lower lung field: - dullness to percussion - decreased tactile fremitus - diminished breath sounds | pleural effusion: These findings are consistent with a pleural effusion. |
| A patient receiving continuous heated aerosol therapy with air by a T-piece develops subcutaneous emphysema around the tracheostomy site, neck, and chest. After noting unequal breath sounds, a respiratory therapist should recommend obtaining | a chest radiograph: Subcutaneous emphysema may indicate the presence of a pneumothorax. A chest radiograph is the most appropriate initial diagnostic test when a pneumothorax is suspected. |
| Which of the following values is the best indicator of an individual's response to inhaled bronchodilators? | FEV1: best indicator of reversible airway obstruction in response to inhaled bronchodilators. |
| Which of the following will most accurately and quickly assess a patient's response to changes in FIO2? | pulse oximetry: gives a rapid response to changes in oxyhemoglobin saturation and is the most accurate of the options given |
| An air-entrainment mask will deliver an FIO2 higher than intended when | the air-entrainment ports have been blocked: Blocked air-entrainment ports prevent air from being added to the inspired gas flow and results in a higher FIO2. |
| When calibrating a fuel cell oxygen analyzer, the analyzer should be set to | 21% while exposed to room air: Room air is used for the low calibration of an oxygen analyzer and should be set at 21% |
| In the last 6 months, a patient with bronchiectasis who uses postural drainage at home has had three exacerbations requiring hospitalization. Which of the following should a respiratory therapist recommend? | HFCWO: provides an effective method to loosen and mobilize airways secretions. |
| A respiratory therapist is assessing a ventilator for readiness of use. To evaluate the integrity of the circuit, the therapist should check the | peak pressure change when the circuit is capped: Maintaining peak pressure when the circuit is capped indicates a tight circuit without leaks. |
| Three liters of air are injected into a spirometer from a certified-volume standard syringe. The measured value is 2.6 L. Which of the following should a respiratory therapist conclude? | The calibration is outside the accepted range: A leak is the likely cause for the difference of 400 mL and is one of the reasons for checking spirometers with a calibrated syringe. |
| Moderate stridor with retractions is noted immediately after extubation of a patient. A respiratory therapist should recommend | nebulized racemic epinephrine: Given its strong alpha-adrenergic vasoconstrictive properties, racemic epinephrine is the first choice to help reduce the glottic edema that has occurred in this patient. |
| Which of the following questions should a respiratory therapist ask to determine whether a patient has orthopnea? | "Are you short of breath while lying flat?": Orthopnea is defined as the shortness of breath while lying flat. |
| Furosemide (Lasix) and oxygen therapy are initiated for a patient with pulmonary edema. Which of the following should a respiratory therapist recommend? | pulse oximetry and monitoring of electrolyte levels: essential to track the patient's status. As furosemide will impact fluid levels, monitoring the patient's electrolyte levels is essential to ensuring a correct sodium level. |
| A 58-year-old male presents to the ED with a chief complaint of acute chest pain. Which of the following diagnostic tests should be done FIRST? | electrocardiography: An ECG is required to rule out an acute myocardial infarction or arrhythmia before considering other diagnoses. |
| PT has shortness of breath, pleuritic chest pain, low-grade fever, tachypnea, tachycardia, and a swollen, tender right leg. The patient has a 50 pack-year history of smoking and known coronary artery disease. These findings are MOST consistent with | pulmonary embolism.: The signs and symptoms are consistent with pulmonary embolism |
| Which of the following values for arterial carbon dioxide tension is consistent with alveolar hyperventilation? | 30 mm Hg: An arterial carbon dioxide tension of less than 35 mm Hg reflects alveolar hyperventilation as it results in a decreased arterial carbon dioxide tension in the blood. |
| Which of the following types of nebulizer can be used to deliver aerosolized medications to a ventilator circuit without altering delivered tidal volume? | vibrating mesh: Vibrating mesh nebulizers place only the aerosolized medications into the circuit. |
| Which of the following best reflects the adequacy of ventilation? | PaCO2: The arterial level of CO2 reflects the alveolar CO2 and is the best indication of the adequacy of ventilation. |
| Which of the following is a side effect of inhaled nitric oxide? | methemoglobinemia: As inhaled nitric oxide breaks down, methemoglobin is formed. This may lead to methemoglobinemia. |
| After performing tracheostomy care for a patient with a TBI, a RT observes that the low exhaled tidal volume alarm is sounding on the ventilator and audible noises are heard coming from the patient’s mouth. The therapist should conclude that | air has been lost from the patient's cuff.: A low volume alarm with the audible noise from the mouth indicates a leak. |
| A patient who is conscious with an intact gag reflex requires an artificial airway to prevent obstruction of the upper airway by the tongue. Which of the following types of airways is most appropriate in this situation? | nasopharyngeal: A nasopharyngeal airway is the least invasive device to use to prevent upper airway obstruction in a conscious patient. |
| An adult patient is receiving mechanical ventilation. Which of the following should be recommended to improve oxygenation and recruit collapsed alveoli? | PEEP: Application of PEEP minimizes the potential for end-expiratory alveolar collapse and then maintains the alveoli in an open position because it exceeds the force of surface tension. |
| RT called to the ED for a 1-year-old who is having difficulty breathing. Severe suprasternal, subcostal, and substernal retractions are observed. The child has a harsh, barking cough. Stridor is present. | croup: The patient has some degree of upper airway obstruction cause by some type of viral illness. The barky cough is a classic finding for patients experiencing croup. |
| Which of the following should a respiratory therapist recommend to aid in secretion removal for a patient with COPD who has a strong cough? | vibratory PEP: aids in secretion removal. |
| A respiratory therapist is using an oxygen-calibrated flowmeter to administer 70/30 heliox. To deliver a flow of 16 L/min, the therapist should set the oxygen flowmeter to | 10 L/min: The correction factor for a 70/30 heliox is the oxygen flow multiplied by 1.6 (10 L/min X 1.6 = 16 L/min.) |
| Which of the following is the most significant factor leading to the development of tracheomalacia? | cuff pressure: Excessive cuff pressure will obstruct mucosal blood flow to the tracheal wall. The resulting ischemia weakens the tracheal wall and tracheomalacia develops. |
| A DLCO measuring device requires evaluation after being taken out of service because of erroneous values. Which of the following is critical to evaluate? | linearity of analyzed gas concentrations: The integrity of the gas analysis system and its ability to return expected results are critical elements in DLCO measurement. |
| A respiratory therapist is reviewing the medical record of an infant to determine whether any respiratory care is indicated in the home. Which of the following suggests the need for home apnea monitoring? | caffeine citrate daily: Caffeine citrate is used to treat apneic conditions and indicates the need for home apnea monitoring. |
| For which of the following are PEF measurements indicated? | Monitor airways obstruction: PEF measurements are routinely used to monitor airways obstruction in patients with asthma. |
| A patient with severe COPD continues to complain of dyspnea on a home regimen that includes tiotropium bromide (Spiriva) and albuterol. A respiratory therapist should recommend adding | fluticasone/salmeterol (Advair): Fluticasone/salmeterol (Advair) is a long-acting bronchodilator and inhaled steroid that is the generally accepted care for COPD. |
| While counseling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the patient's concern by explaining that this is partially the result of | decreased metabolism: Metabolism decreases when nicotine is withdrawn. If dietary intake remains unaltered and exercise is not included, there may be a resulting weight gain. |
| placement of a subclavian venous catheter the high pressure alarm patient's ventilator begins sounding After 10 minutes, the patient's peak inspiratory pressure has increased from 40 to 60 cm H2O and mean arterial pressure decreased from 80 to 40 mm Hg | recommend needle decompression: Tension pneumothorax is a possible complication of venous catheter insertion and can result in increased airway pressure. This would sound the high pressure alarm and decrease arterial pressure. |
| Which of the following imaging techniques is preferred when identifying metastatic disease associated with non-small cell lung cancer? | PET scan: The metabolically active tissue of a malignant mass will be shown in a PET scan |
| Which of the following devices must be used to comply with airborne precautions? | N95 face mask: An N95 face mask will provide protection against airborne microorganisms. |
| While performing a patient-ventilator assessment, a respiratory therapist observes very little condensation in the heated wire circuit. The reservoir of the heated wick humidifier is full of water. The most likely explanation is that the | patient circuit is operating normally: The heated wire circuit is designed to maintain gas temperature to prevent condensation |
| According to CLIA standards, quality control must be performed for blood gas analyzers every | 8 hours: Eight hours is the CLIA-approved time frame for quality control of blood gas analyzers. |
| Mechanical ventilation was initiated for a patient, after which the PaCO2 decreased from 53 to 40 mm Hg. A respiratory therapist should expect which of the following will increase? | pH: Carbon dioxide and pH move in opposite directions, so a decrease in carbon dioxide will result in an increase in pH |
| A patient receiving mechanical ventilation by a portable ventilator is being transported from the ED to radiology. Which of the following is required during transport? | bag-valve mask resuscitator: A bag-valve mask resuscitator is required in case of transport ventilator failure. |
| A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin saturation in which of the following clinical conditions? 1. congestive heart failure 2. polycythemia 3. pulmonary hypertension 4. carbon monoxide poisoning | CHF, polycythemia, pulmonary hypertension: Carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish oxyhemoglobin from carboxyhemoglobin, which will lead to a falsely elevated SpO2 reading. |
| Which of the following medications should a respiratory therapist use to anesthetize a patient's airway prior to a flexible bronchoscopy procedure? | lidocaine HCl: Lidocaine HCl is a topical anesthetic and will reduce airway reflexes during the procedure. |
| Prior to suctioning the endotracheal tube of an adult patient who is receiving ventilation with an FIO2 of 0.40, a respiratory therapist should FIRST | hyperoxygenate the patient: The FIO2 should be increased prior to each suctioning attempt to minimize hypoxemia. |
| In which of the following circumstances will tracheal secretions tend to dry in an intubated patient? | a relative humidity of 100% at 22° C (71.6° F): The absolute humidity at this temperature is inadequate. |
| A 24-year-old female is diagnosed with exercise-induced asthma and albuterol prn is ordered. A respiratory therapist should NEXT | instruct the patient to use albuterol 15 minutes before exercising: Patient understanding of their disease process and triggers is important part of patient education, as well as knowing when and which medication should be taken. |
| A respiratory therapist is assisting a physician with endotracheal intubation. Which of the following should be used INITIALLY to confirm tracheal intubation? | colorimetric capnography: Colorimetric capnography assesses the presence of CO2 and provides confirmation of tracheal intubation when CO2 is detected. |
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