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Persing
NBRC examaple questions
| Question | Answer |
|---|---|
| List the air/02 ratios for 60%, 40%, 35%, 30% and 24% 02 | 60% 1:1 40% 3:1 35% 5:1 30% 8:1 24% 25:1 |
| give four examples of a High Flow device | venturi mask, aerosol mask, T piece(Briggs adapter), face tent, tracheotomy collar |
| what is the primary benefit of using a reservoir cannula | conserves 02 by storing it in the reservior |
| calculate 02 content | 1.34xHbxSa02= .003xPa02= |
| Total flow equation | |
| List the three ventilator criteria that should be met by patients receiving 02 from a low flow device | consistent ventilatory pattern, VT 300-700ml, abd RR<25 |
| An 80:20 mixture of helium/02 running through an 02 flowmeter at 6L/min is delevering how much flow to the pt | 1.8x6=10.8 l/min |
| calculate how long an "E" cylinder with 1900psig will run at 5L/m | 199x.28/5=532/5=106 min or 1 hour and 76 mins |
| give examples of low flow devices | nasal cannula, simple mask, partial non rebreather |
| list five conditions that will affect a pulse ox | poor perfusion, severe anemia, hypotentsion, elevated HBC0 level, direct light, photo therapy, fluorescent light, nail polish, dark skin pigment |
| 5 indications for the use of hyperbaric 02 | C0 poisoning, cyanide poisoning, decompression sickness, gas gangrene, gas embolism |
| How does water in aerosol tubing of a mask affect the delivered FI02 | increase FI02 |
| The pt has just been intubated and the CO2 detector placed on the proximal end of the ET tube reads 1.5% the reapiratory therapist should suspect which of the following | the tube is in the esophagus |
| opening that pts airway using an oropharyngeal airway is most beneficial when which of the following causes the obstruction | tongue |
| McGill forceps are used during which of the following procedures | nasotracheal intubation |
| the physician wants to begin weaning a pt from a tracheostomy tube, How may this best be accomplished | change to a fenestrated tracheostomy tube |
| you are called to a patients room because a ventilator alarm is sounding. you hear an audible leak around the pt ET tube during a ventilator breath and notice the exhaled vaolume reading is 150ml less than the set VT. you check the cuff pressure and find | while listening with a stethoscope at the larynx instill air into the cuff until a slight leak is heard on inspiration |
| you want to pass a suction catheter into the pt left lung to obtain a sputum specimen what is the most appropiate method of accomplishing this | use a codue suction catherter |
| To prevent venous congestion on the trachea wall, the ET tube cuff should be maintained below what level of pressure | 20mmhg |
| Inspiratory stridor is a major clinical sign of what airway condition | glottic edema |
| What is the name of the speaking valve that may be attched to a ventilator pt tracheostomy tube that allows the pt to talk | passy muir speaking valve |
| Describe the purpose of an oropharyngeal airway | the oropharyngeal airway is used to prevent upper airway obstruction, manily from the tongue, in unconscious patients only. It may be used as a bite block for unconscious intubated pt |
| What is the primary purpose of a fenestrated tracheostomy tube | a fensetrated tracheostomy tube used to wean a pt from a convential tracheostomy tube and allow the pt to speak |
| List the problems assiciated with the use of oral ET tubes | poorly tolerated by conscious or semiconscious pt, biting the tube, increased production of oral secrections easier inadvertent extubation harder to communicate, gagging, tube not as stable, difficulty passing suction catheter because of curcature of tube |
| How would you determine that an ET tube is resting in the right mainstem bronchus before a chest x ray film is obtained | diminished breath sounds in the left lung asymmetrical chest movement |
| What is a Yankauer suction device used for | to suction the oropharynx |
| What is the maximum amount of suction pressure that may be used to suction an adult patients airway | -120mmhg |
| When extubating a pt, the ET tube should be withdrawn at what point in the breathing cycle | at peak inspiration |
| List 5 indications for a bronchoscopy | removal of foreign bodies and mucus plugs to treat atelectasis; pulmonary hemorrhage; difficult tracheal intubation; biopsy of airway tumors; sputum collection for sulture and sensitivite |
| List eight complications of bronchoscopy | hypoxemia, laryngospasm, bronchospasm, arrhythmisa, hemorrhage, respiratory depression, hypotension, pneumothorax |
| name one medication that is commonly used to achieve conscoius sedation before bronchoscopy | diazepam(valium), or midazolam (versed) |
| What is the purpose of adminstering atropine before bronschoscopy | to dry out the airway |
| how should the bronchoscope be cleaned after the proscedure | soak in glutaraldehyde(cidex) solution for 3 to 10 hours to disinfect or sterlize |
| What is the purpose of inserting a chest tube | to drain fluid or air from the pleural space so the lung may reexxpand |
| if the water in the water-seal bottle is not fluctating what should be suspected | obstruction of the tube |
| if a chest tube becomes obstructed, what may occur | tension pneumothorax |
| if an air leak from a chest tube is suspected, what should be done first | clamp the tube and identify the source of the leak |
| How much negative pressure is generally required to help evacuate fluid or air from the pleural space | -15cmh20 |
| you enter a patients room to give a treatment and observe the pt is unconscious and not breathing. After calling for help your first sction should be | open the airway |
| List three medications that are commonly instilled directly down the ET tube | atropine, epi, lidocaine |
| What is the major indication for the admistration of dopamine | hypotension |
| list two indication for lidocaine | ventricular fib, vent tachy |
| sodium nitroprusside(nipride) is indicated for the treatment of what condition | hypertension |
| describe the proper airway management of a postterm neonate inwhom meconium aspiration is suspected | intubate and suction the airway |
| When resuscitationg a neonate immediately after delivery. what is the proper ventilation rate and peak inspiratory pressure for manual ventilation | RR:40 PIP:30-40chm20 and subsequent pressure of 15-20cmh20 |
| List four criteria that aid in delivering the highest 02 concentration with a manual resuscitator | add 02 reservoir, use high 02 flow rate (10 to 15 L/min) use slower ventilation rate (10 to 20/min) and avoid excessive volumes if reservoir attachment is not used |
| what is the intitial current delivered during defib of an adult with monophasic defib? With a biphasic defib | monophasic 360J biphasic 200J |
| what is the maximum current used to defibrillate an adult | 360J |
| List two drugs that may be administered to improve the success of defibrillation | lido, epi |
| list five arrhythmias that cardioversion is used to terminate | atrial flutter, atrial fibrillation, vent tachycardia, paroxysmal supraventricular tachycardia, ventricular fib |
| how many joules are delivered to the pt during cardioversion | 25 to 100J |
| List three potential consequences that could affect a pt during an air transport at high altitude | decreased PA02, increased size of pneumothorax, increased ET tube cuff pressure |
| List 5 physiologic effects of IPPB | increased mean airway pressure, increased VT, decreased work of breathing, alteration of I:E times, mechanical bronchodilation, resuced cerebral blood flow |
| list seven indications for IPPB | increased work of breathing, hypoventailation, inadequate cough effort, increased airway resistance, atelectasis, pulmonary edema, weaning from ventilator |
| List 8 hazards of IPPB | hyperventaltion, hyoeroxygenation, decreased cardiac output, increased ICP, pneumothorax, hempptysis, gastric distention, nosocomial infection |
| list two absolute contraindications to IPPB | pulmonary hemorrage, untreated pneumothorax |
| The pulse rate must not exceed how many beats/min before the treatment must be terminated | 20 beats per min |
| What effect does an increased airway resistance have on delivered VT on a pressure limited IPPB machine | decreased VT |
| What effect does an increased lung compliance have on the delivered VT on a pressure limited IPPB machine | increased VT |
| How does a decreased lung compliance affect inspiratory time | decreased inspiratory time |
| List ways to help correct a situation in which the pt has difficulty cycling the IPPB machine into expiratory phase | tighten tubing connection; check for leaks around the mouthpiece, mask, or ET tube, check expiratory valve function |
| List 4 causes of a "damped' arterial pressure waveform | clot in catherer, tip of catheter up against vessel wall, clot in tranducer, air bubbles in the line |
| List 5 conditions that cause an increased CVP | hypervolemia, pulmonary hypertension, right ventircular falilure, pulmonary valve stenosis, tricuspid valve stenosis, pulmonary embolism, arterial vasodilation, left sided heart failure, improper transducer placement, positive pressure ventialtor breath, |
| List four conditaions that cause a decreased CVP | hypovolemia, vasodilation, leaks or sir in line, improper transducer placement |
| What are three drugs used to treat PVC's | lidocaine, propranolol, procainamide |
| What is the treatment for ventricular tachycardia | defibrilation, chest compression, lidocaine |
| List three conditions that cause an increased PAP | pulmonary hypertension, mitral valve stenosis, left ventricular failure |
| List two conditions that cause a decreased PAP | decreased PVR, hypovolemia |
| PAWP is a measurement of what functions | left artial pressure |
| List four conditions that cause an increased PCWP | left ventricular failure, mitral valve stenosis, aortic stenosis, systemic hypertension |
| list two conditions that cause a decreased PCWP | hypovolemia, pulmonary embolus (PAWP could also be normal) |
| List the normal values for CVP, PAP and PCWP | CVP, less than 8 cmH20 or less than 6 mmHg; PAP 23-30mmHg/5-15mmHg |
| In a healthy person, what percentage of the cardiac output makes up the intrapulmonary shunt | 2%-5% |
| List four conditions that increase physiologic shunting | pneumonia, pneumothorax, pulmonary edema, atelectasis |
| List four factors that cuase an increased SVR | vasoconstrictiors (dopamine, epi) hypovolemia, decreased PaC02, septic shock (late stages) |
| list three factors that cause a decreased SVR | vasodilation(nitroprusside sodium, morphine, nitroglycerin) increased PaC02, septic shock (early stages |
| List 5 factors that cause an increased PVR | vasoconstrictors, increased PaC02, hypovolemia, acidemia, pulmonary emoblism, pneumothorac, positive pressure centilation, PEEP, CPAP |
| list 3 factors that cause a decreased PVR | vasodilator,hyperoxemia, decreased PaC02, alkalemia |
| List four factors that cause an increased 02 consumption | hyperthermia, exercise, seizures, shivering |
| List 3 factors that cause a decreased 02 consumption | hypothermia, cyanide poisoning, musculoskeletal relaxation |
| Which ABG value best reflects the pt ability to ventialte | PaC02 |
| List a set of ABG levels that are typical of a pt with diebetic ketoacidosis | pH 7.25 PaC02 23 Pa02 80 HC03 12 |
| Pressure control ventilation is most commonly used for adults with what lung condition | ARDS |
| What effect does decreasing lung compliance have on delivered VT in a neonate receiving pressure-limited ventialtion | decrease VT |
| What level of pressure support should be used for weaning so that airway resistance is overcome while breathing is spontaneous | 5-10 cmH20 |
| as the oxygenation status of a pateint worsens while using an 02 mask at what point should CPAP be employed | if 60% 02 still results in hypoxemia (and PaC02 is normal or low) |
| how is minute ventiation calculated | VT x RR |
| How is alveolar minute ventialtion calulated | (VT-VD)x RR |
| list six indications for the use of PEEP | atelectasis, hypoexemia with the use of 60% 02 or more, decreased FRC, to prevent the use of more than 60% 02 to maintain normal Pa02 level decreased lung compliance, pulmonary edema |
| List four hazards PEEP | barotrauma, decreased venous return, decreased cardiac output, decreased urinary output |
| define optimal PEEP | the level of PEEP that improves lung compliance without decreased cardiac output |
| after the PEEP level is increased, how can it be determined that cardiac output has been adversely affected | decreased PV02 levels and a drop in blood pressure |
| How may the ventialtor low pressure alarm be activated | leaks in the circuit, patient disconnect |
| List ways that the ventilatio high pressure alarm may be activated | decreasing lung compliance, airway secrections, bronchospasm, water in the ventilator tubing, kink in the tubing, coughing |
| How should the high pressure alarm be set | 5 to 15 cmH20 above average peak inspiratory pressure |
| List factors that affect airway resistance (Raw) | bronchospasm, water in the ventilator tubing, mucosal edema, secrections |
| What is normal PETC02 | 35-45 mmHg ir 4.5% to 5.5% |
| List four conditions that result in a decreased PETC02 reading | hyperventilation, apnea, total airway obstruction, hypotension, pulmonary embolism, decreased cardiac output |
| list two conditions that result in an increased PETC02 reading | hypeventialtion, hyperthermia |
| list six criteria that indicate mechanical ventilatory assistance is necessary | VC<15 mL/kg, P(A-a)02 > 450mmHg with the use of 100% 02, VD/VT > 60%, unable to obtain an MIP of at least -20cmH20, PEP < 40cmH20, rr >35/min |
| list 8 complications of mechanical ventialtion | barotrauma, pulmonary infection, atelectasis, tracheal damage, decreased venous return, decreased urinary output, lack of nutrition, pulmonary 02 toxicity |
| list some conditions that results in decreased lung compliance | pneumonia, pulmonary edema, consolidation, atelectasis, air trapping, pleural effusion, pneumothorax, ARDS |
| What is indicated if peak pressures are increasing but the plateau pressure is not increasing | increased RAW |
Created by:
amfc2011
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