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SAE PRACTICE 2
TMC REVIEW
| Question | Answer |
|---|---|
| When instructing a patient on the administration of umeclidinium/vilanterol (Anoro Ellipta), which of the following is most important to emphasize? | Breathe in fast and deep: Breathing in fast and deep is the proper method of administration for umeclidinium/vilanterol (Anoro Ellipta). |
| Following placement of a tracheostomy tube for long-term mechanical ventilation, which of the following patient positions best prevents ventilator-associatedpneumonia? | SEMI-FOWLER Routine use of semi-Fowler positioning with the head of the bed elevated at an angle of 30-45 degrees has been shown to decrease rates of ventilator associated pneumonia. |
| Which of the following is used to monitor the partial pressure of transcutaneous carbon dioxide? | Stow-Severinghaus electrode: A Stow-Severinghaus blood gas electrode is used in transcutaneous monitors. |
| An adult patient requires frequent blood sampling and medication administrations through an IV for 1 month. The preferred vascular access is a | peripherally inserted central catheter: A PICC is the best choice for long-term IV access and allows for blood sampling. |
| Which of the following techniques is preferred for a quadriplegic patient having difficulty expectorating secretions? | abdominal thrust: used to assist patients with decreased respiratory muscle function, such as quadriplegics, to more forcefully cough out secretions |
| A patient with a history of hypertension was awakened by cough and shortness of breath. He has fine inspiratory crackles bilaterally. Which of the following should a respiratory therapists recommend? | furosemide (Lasix): A diuretic, such as furosemide (Lasix), is useful in controlling water retention that can lead to fluid. accumulation and narrowing in airways. |
| The preferred suction device to remove large amounts of secretions from the oral cavity of an adult patient is a | Yankauer device: designed specifically to suction secretions from the mouth in an efficient way |
| A respiratory therapist examines a patient and notes coarse crackles over both lung fields. Which of the following does this most likely indicate? | secretions: Secretions in the airway produce low-pitched, discontinuous lung sounds described as coarse crackles upon auscultation. |
| The patient's chest radiograph and CT scan show an RLL infiltrate with a nonloculated, significant pleural effusion on the right side. Which of the following should the therapist anticipate? | thoracentesis: Thoracentesis is indicated based on the patient's chest radiograph and clinical findings. |
| Which of the following is typically associated with bilateral, fluffy infiltrates on a chest radiograph? | pulmonary edema: . Fluffy-appearing infiltrates in both lungs are consistent with the increased interstitial and alveolar fluid in pulmonary edema. |
| . Which of the following should a respiratory therapist use to confirm the presence of auto-PEEP during VC ventilation? | end-expiratory hold: Auto-PEEP is detected at the end of the expiratory phase. Expiratory hold permits pressure to be equilibrated throughout the ventilator circuit and the patient's airway, allowing estimation of alveolar pressure. |
| Which of the following best maintains airway patency during bag-mask ventilation in an unconscious patient? | oropharyngeal airway: The oropharyngeal airway can help restore airway patency and maintain adequate ventilation by pulling the tongue forward in an unconscious patient, where the tongue would otherwise obstruct the oropharynx. |
| Which of the following can result in an increase in PVR? | excessive PEEP: Excessive PEEP can compress the pulmonary vessels and obstruct blood flow, resulting in an increase in PVR. |
| Which of the following is a characteristic of pulse-dose oxygen-conserving devices? | Most of the oxygen delivery occurs during the first quarter of inhalation |
| Which of the following best describes VC ventilation? | Inspiration ends after delivery of a preset volume: VC ventilation terminates inspiration after delivering a preset volume. |
| A gas is saturated with 100% relative humidity at 32º C (89.6º F). After the gas cools to 27º C (80.6º F), which of the following is the best estimate of the relative humidity? | 100%: Relative humidity increases as a gas cools. When the relative humidity is at 100%, the gas is unable to hold more water vapor and it condenses into liquid. |
| A patient who is receiving mechanical ventilation is scheduled for a fiberoptic bronchoscopy. Which of the following is the primary threat to adequate ventilation during the procedure? | airway obstruction: Placing the scope in the artificial airway may obstruct the tube, especially if the scope is too large for the artificial airway. |
| morbidly obese is receiving aerosol by tracheostomy collar 48- hours post-tracheotomy, notices the patient is experiencing acute respiratory distress after being turned to the right side for a bath. Which of the following should the therapist do NEXT? | Place the patient supine before assessing tube position.: Placing the patient supine will allow better access and ability to evaluate and correct the problem. |
| An adult patient's heart rate drops from 82 to 40/min immediately after a suction catheter is inserted into the trachea and before suction is applied to the airway. Which of the following is the most probable cause? | vagal reflex: Stimulation of vagal receptors in the tracheobronchial tree may cause a rapid slowing of the heart rate |
| The major component of pulmonary surfactant is | phospholipid: 85% of surfactant. |
| A patient's V̇/Q̇ scan indicates an excess of ventilation compared to perfusion in the left lower lobe. These results suggest | pulmonary embolism: This is the classic description of a pulmonary embolism where the alveolar unit is normally ventilated, but pulmonary capillary blood flow is impeded by the presence of a clot. |
| A physician will be sedating a patient for a procedure and asks a respiratory therapist to monitor the patient's ventilation. The therapist should select a | capnometer: Capnometry can be performed noninvasively through a cannula to monitor the patient's ventilatory status. |
| The transducer is mounted on an IV pole that is not attached to the bed. The bed is lowered to permit routine patient care. How will this affect the measured blood pressure? | decreased systolic / decreased diastolic: Lowering the patient relative to the height of the transducer will result in both a lower systolic and diastolic blood pressure reading proportionate to the change in patient position. |
| The primary purpose of cleaning and sterilizing non disposable respiratory care equipment after each use is to | prevent patient infections: Cleaning and sterilization are essential to limiting the transmission of organisms related to reusable respiratory care equipment. |
| Which of the following should a respiratory therapist instruct a patient to use when cleaning the home CPAP mask and connecting tubing? | dishwashing soap: Dish washing soap is recommended for cleaning home CPAP masks and tubing. |
| Which of the following values are needed to determine a patient's physiologic dead space? | arterial PCO2 and expired PCO2: Physiological dead space is calculated from the Bohr equation [(VD/VT = (PaCO2- PeCO2 )/PaCO2 Thus, it is necessary to know the values for the arterial and expired values for carbon dioxide. |
| Given a normal oxyhemoglobin dissociation curve, an SpO2 of 75% should be associated with a PaO2 of | 47 mm Hg: Based on the oxyhemoglobin dissociation curve, an SpO2 of 75% is approximately a PaO2 of 47 mm Hg for a patient with a normal pH. |
| A patient lost an unknown quantity of blood as a result of a motor vehicle crash. To fully assess oxygen delivery, a respiratory therapist should recommend. | a CBC: will provide a hemoglobin value that is used to calculate oxygen delivery. |
| When performing a chest physical examination on a patient receiving mechanicalventilation, a respiratory therapist notes the right side of the patient's chest is not moving and the trachea is deviated to the left. These findings are most consistent. with | right tension pneumothorax: will cause a decrease in movement of the right hemithorax and the increased pressure from the pneumothorax will shift the trachea to the left. |
| When administering dornase alfa (Pulmozyme) with a hand-held nebulizer, a respiratory therapist notes a patient is developing marked congestion with copious sputum production. The therapist's most appropriate action is to pause the treatment and | allow the patient to clear secretions: Secretions have been mobilized and the airway must be cleared before continuing treatment. |
| hx of CHF and generalized weakness 5 min later, he is observed in the supine position and experiencing severe SOB. The medical emergency team is called. A respiratory therapist should place the patient in which of the following positions? | high Fowler: Many patients with known CHF suffer from orthopnea. Sitting them upright high Fowler position is the best initial intervention to decrease pulmonary venous return and improve respiratory mechanics. |
| In addition to chest tightness and nausea, an adult male who is experiencing an acute myocardial infarction will most likely have which of the following clinical findings? | elevated ST interval: An elevated ST interval is a classic sign that a male patient is experiencing an acute myocardial infarction. |
| 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. |
| Common complications associated with arterial punctures include | hematoma formation and spasm of the vessel: Hematomas, or large extravascular blood accumulations, will result when post-puncture pressure has not been applied adequately. Vessel spasm is a common complication associated with needle trauma |
| PEEP is increased from 5 cm H2O to 15 cm H2O for an adult patient receiving VC, A/C ventilation. Which of the following is a potential adverse effect of this change? | hypotension: Hypotension can occur with increasing PEEP as the increase in intrathoracic pressure results in decreased venous return and, in turn, decreased preload. |
| Which of the following indicates a physical conditioning program has been effective for a patient with COPD after 2 months of therapy? | The 6-minute walk distance is increased by 60 meters: An important part of physical conditioning is an increase in exercise tolerance, easily measured by increased walking distance. |
| A premature neonate with RDS receives the first dose of surfactant replacement therapy. Two hours later, the neonate's FIO2 requirement has increased from 0.35 to 0.70. Which of the following should a respiratory therapist recommend FIRST? | chest radiograph: With increasing oxygen requirements and the recent administration of surfactant, a chest radiograph will aid in determining the cause of deterioration. |
| A patient with neuromuscular disease has been receiving ventilatory support for 4 months through a tracheostomy. The patient uses a speaking valve during the day, but receives VC, A/C ventilation at night. Which of the following should be used? | cuffed tracheostomy tube: When using a speaking valve, the cuff can be deflated and then reinflated for mechanical ventilation. |
| An HME is most appropriate for a patient | who is receiving mechanical ventilation in the PACU: . An HME should be considered for short-term mechanical ventilation like that used for a patient in PACU |
| An adult patient who requires mechanical ventilation will be transported to another hospital in a helicopter. Prior to transport, a respiratory therapist should | estimate the duration of the oxygen supply: An adequate oxygen supply is necessary to complete the trip |
| A respiratory therapist is assisting a physician in performing cardioversion on a 61-year-old patient. Which of the following should the therapist have available | bag-valve-mask resuscitator: A bag-valve-mask resuscitator is required for patient safety as the patient will be sedated and may have a post-event that requires resuscitation. |
| In a patient with postoperative atelectasis, PEP therapy is likely to | increase functional residual capacity: PEP therapy acts similar to PEEP/CPAP and increases function residual capacity by exhaling through resistance. |
| A respiratory therapist is calibrating a helium analyzer. What should the analyzer read when calibrated in air? | 0%: Air contains essentially no helium; therefore, it should read zero. |
| Rapid assessment of the oxygenation status of a new patient is best achieved by | pulse oximetry: Pulse oximetry will provide the most rapid assessment of oxygenation status. |
| A patient presents with a history of loud snoring and daytime sleepiness. Which of the following is most important for a respiratory therapist to evaluate while the patient is sleeping? | breathing pattern: A patient with obstructive sleep apnea typically has an irregular breathing pattern. |
| Which of the following is the most effective aerosolized bronchodilator for a patient with an acute asthma exacerbation? | albuterol: Albuterol is a fast-acting beta2-agonist and is the appropriate treatment for acute bronchospasm. |
| A new blood gas analyzer was calibrated by the manufacturer at sea level. On receiving the analyzer at a higher altitude, a respiratory therapist should | recalibrate the blood gas analyzer: Regardless of where they are manufactured, new blood gas analyzers must be calibrated at the site of use before analyzing blood. |
| Which of the following factors will influence the oxygen concentration delivered by a self-inflating manual resuscitator? | oxygen flow and reservoir size: FIO2 is impacted by both the flow into the bag and the presence of a reservoir. |
| A respiratory therapist determined a patient receiving mechanical ventilation developed auto-PEEP due to dynamic airflow obstruction. Which of the following should the therapist do? | Decrease the mandatory rate: Decreasing the mandatory rate will increase expiratory time. Allowing more time to exhale will reduce air trapped in the lungs at the end of exhalation, or the auto-PEEP |
| Which of the following drugs is most appropriate to paralyze a sedated 30-year-old patient in status asthmaticus who is receiving continuous mechanical ventilation | cisatracurium (Nimbex): nondepolarizing skeletal muscle relaxant that may be administered to patients prior to endotracheal intubation or during mechanical ventilation. |
| During an inspection of the patient’s oropharynx, the soft palate and the base of the uvula are seen. A respiratory therapist should assign a Mallampati score of | III: Mallampati score III is characterized by the visualization of the soft palate, including the base of the uvula only. |
| Digital clubbing can be most easily assessed by | inspecting the appearance of the nail bed: Clubbing causes an increased angle between the nail bed and the finger, as well as an increase in the diameter of the terminal portion of the finger. |
| A 62-year-old male with COPD is prescribed compressed oxygen by a pulse flow delivery system. During a follow-up home visit, the patient reports to a respiratory therapist that oxygen is being delivered continuously. The therapist should FIRST | check the regulator setting: The therapist should suspect the regulator setting has been switched to continuous mode rather than pulse dose. |
| The most commonly used bedside measurement to monitor the progression of ventilatory impairment in a patient with Guillain-Barré syndrome is | vital capacity: Guillain-Barré syndrome is a neurological disease that causes weakness of respiratory muscles and ascending paralysis. Serial measurements of vital capacity will reveal progressive neuromuscular ventilatory impairment. |
| A respiratory therapist instructed a patient to take a deep breath and then exhale as quickly as possible. The therapist observed a recording of the fastest air movement. Which of the following was measured? | peak flow: Peak flow is the maximum flow during a forced exhalation. |
| According to AASM guidelines, a normal AHI is defined as less than | 5: AASM guidelines classify obstructive sleep apnea by an AHI of 5 or greater. |
| A patient presents to the ED with a fever and a productive cough. A sputum sample reveals purulent sputum. Which of the following should a respiratory therapist suspect? | bacterial pneumonia: These signs and symptoms are often associated with bacterial pneumonia. |
| A 32-week gestational age neonate is receiving 2-L/min oxygen with an FIO2 of 0.60 by a nasal cannula connected to a blender. Two hours later, a respiratory therapist observes an SpO2 of 98%. Which of the following should the therapist do? | Decrease the FIO2: The FIO2 should be decreased to minimize the risk of retinopathy of prematurity |
| PT who has undergone CABG surgery is receiving VC, A/C ventilation. Radial arterial and pulmonary artery catheters are in place for monitoring. Which of the following should a respiratory therapist use to evaluate tissue oxygenation in this patient? | mixed venous analysis: Analysis of a mixed venous sample from the pulmonary artery catheter is the best method to evaluate tissue oxygenation |
| The use of respiratory accessory muscles is frequently the result of an increase in | airways resistance: Increased airways resistance requires the use of accessory muscles to move air. |
| RT called to the ED to assess an adult male with increased work of breathing. The patient is receiving oxygen by a nonrebreathing mask at 8 L/min. The reservoir bag completely deflates during inspiration. Which of the following should the therapist do? | Increase the oxygen flow to 15 L/min: A flow of 10-15 L/min should be used with a nonrebreathing mask. A flow of less than 10 L/min may cause the reservoir bag to deflate during inspiration |
| A respiratory therapist is reviewing a chest radiograph of a patient with a hemothorax and sees the end of a chest tube. On returning to the patient's bedside, where should the therapist expect to see the tube as it enters the chest wall? | fifth intercostal space at the mid-axillary line: The fifth intercostal space in the mid-axillary line is appropriate for draining fluid from the chest. A tube placed any higher than the thorax may not adequately drain the fluid. |
| A homebound, non ambulatory patient is receiving oxygen at 4 L/min from H cylinders. Which of the following should a respiratory therapist recommend as a more economical system? | oxygen concentrator: An oxygen concentrator is the most cost-effective option as it does not require refills or replacements. |
| A respiratory therapist is preparing to suction the endotracheal tube of a 6-year-old child. When the therapist tests the negative suction pressure, the manometer goes to a maximum of -120 mm Hg. Which of the following is the most appropriate action? | Decrease the negative pressure to -100 mm Hg: The correct negative pressure to use when suctioning the airway of a child is -80 to -100 mm Hg. |
| Which of the following may be caused by the administration of aerosolized pentamidine isethionate (NebuPent)? | bronchospasm: Bronchospasm is the most frequently reported adverse effect associated with the use of aerosolized pentamidine isethionate (NebuPent.) |
| A 3 year old is receiving VC ventilation. A respiratory therapist is preparing to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which of the following devices should the therapist select to administer the therapy? | vibrating mesh nebulizer: A vibrating mesh nebulizer will not alter the configuration of the medication and will not increase volume delivery to patient. |
| A respiratory therapist is administering an 80/20 heliox mixture to an adult female. When using a flowmeter calibrated for oxygen, the actual flow is how many times greater than the indicated flow? | 1.8: The conversion factor for an 80/20 heliox mixture is 1.8. |
| The primary reason to evaluate maximum inspiratory pressure is to determine | muscle strength: Evaluation of MIP is to determine the strength of the muscles used for inspiration. |
| For a patient receiving noninvasive ventilation through a dual-limb circuit, an increase in which of the following will decrease work of breathing associated with spontaneous breathing? | pressure support: Increasing pressure support directly impacts the patient's work of breathing. |
| A patient with COPD is receiving mechanical ventilation. The patient continues to wheeze despite treatment with albuterol. A respiratory therapist should recommend | adding ipratropium (Atrovent): treats bronchoconstriction by a mechanism different from albuterol and should decrease airways resistance or bronchospasm. |
| NPPV is best indicated for which of the following clinical diagnoses? | COPD: NPPV may lead to reduced mortality in patients with COPD. |
| A 4-year-old child is seen by a respiratory therapist for a follow-up asthma evaluation. The child denies any dyspnea. The parents report giving the child albuterol by inhaler twice daily. The therapist should | explain the purpose of the quick-relief medication: Albuterol is a quick-relief medication. It should be used as needed, not at a scheduled frequency |
| A 175-cm (5-ft 9-in), 113-kg (250-lb), 56-year-old male with a 48 pack-year smoking history is being prepared for abdominal surgery. Which of the following should be done preoperatively to assess the patient's risk for respiratory complications | Perform spirometry.: Spirometry provides detail of a patient's lung condition as well as the patient's ability to cough. |
| When following CDC droplet isolation precautions, which of the following must a patient don before being transported within the hospital? | surgical mask: According to CDC droplet isolation precautions, a surgical mask is required if the distance between the patient and others is 3 feet or less |
| The accuracy of a spirometer should be assessed using a | 3-liter syringe: A 3-liter syringe provides accurate volumes for calibration and is the gold standard for assessing the volume accuracy of a spirometer. |
| Three months after lung transplantation, a patient develops SOB and requires invasive mechanical ventilation. A chest radiograph shows diffuse alveolar infiltrates. Which of the following diagnostic tests should a respiratory therapist recommend? | bronchoscopy with BAL |
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