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TMC 2019 NBRC Qs

QuestionAnswer
Dullness to percussion, decreased tactile fremitus and diminished breath sounds are associated with Pleural Effusion
What is associated with an optimally exposed chest radiograph? Vertebrae and lung markings are clearly visible.
The use of respiratory accessory muscles is frequently the result of Airway resistance
Drug dosage calculation Change % to decimal. Divide desired dosage by the actual concentration. Ex: desires 1mg / .4mg/ml = 2.5mL
A pulsoximeter cannot provide an accurate indication of the oxyhemoglobin saturation in what clinical condition Carbon monoxide poisoning Explanation: carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish their differences resulting in high SpO2 readings.
Portable ventilators for pt. Transport within the hospital should have the ability to Sound a disconnect alarm
A patient that states they feel they can breathe better when they sleep sitting in a chair is indicative of Orthopnea Likely related to CHF Orthopnea is dyspnea that occurs when a patient supine
This determines a persons rapid-shallow breathing index Vane Respirometer RSB Index is calculated using the formula: RR/(minute volume)(RR) the vane respirometer determines the minute volume
What may be suspected in a trauma patient with multiple fractures to multiple adjacent ribs Flail chest -During Inspiration, muscled move the chest wall out and the decreased intrapleural pressure pulls in the flail segment creating a paradoxical movement.
Absent airflow without chest or abdominal movement indicates what Central sleep apneas. BiPAP is indicated to provide pressure support augmenting ventilation.
Which mask should be used to deliver 70% helium 30% oxygen effectively Non rebreather
What is used to assess the severity of CO poisoning? Hemoximetry
Evaluation of Lung Infiltrates requires further diagnostic studies like Flexible Bronchoscopy
This is a mucolytic that may cause irritation and bronchospasm N - acetylcysteine
This drug is an anticholinergic and provides minimal bronchospasm relief Ipatropium Bromide
This drug is a beta2-agonist and is an appropriate substitute for Albuterol Levalbuterol
A decrease in plateau pressures represents Improvement in lung compliance
An increasing difference between peak and plat pressures indicates An increase in airway resistance.
Pale or blue color, absent HR, no reflex irritability, limp muscle tone and absent respirations indicates what APGAR score? 0 for each section
Baby is pink, HR >100, cry cough sneezing, active, strong cry indicates are related to APGAR scores of 2 for dad he section
Color shows acrocyanosis, HR <100, grimace, some flexion, slow or irregular respirations is APGAR scoring of 1 for each section
FVC and FEV1 May be obtained from a Forced expiratory spirogram
Exacerbation of asthma associated with respiratory distress is best treated with Continuous albuterol nebulizer
Cores crackles over both lung fields indicates Secretions Secretions produce low pitched discontinuous lung sounds
Subcutaneous emphysema is demonstrated by the presence of Crepitus During chest wall palpation
Wheezing sound from narrowed airways Bronchospasm
When in proper position, the tip of the CVP catheter should be in the lower portion of the superior vena cava.
The patient's condition continues to deteriorate, based on increased oxygen requirements and an elevated PaCO2, indicating NIV or need for assisted ventilation
A patient with a history of chronic bronchitis complains of SOB following thoracic surgery. The patient is receiving 30% O2. Rhonchi in the right lower lobe are heard. What therapy is recommended? Vibratory PEP Deep breathing accompanied by PEP therapy will provide optimal bronchial hygiene to clear secretions
Initiation of an expiratory hold just prior to the next ventilator-delivered breath facilitates the measurement of auto-PEEP Auto-PEEP is measured by subtracting set PEEP from the measured pressure during an expiratory hold.
A 65-year-old patient who is post-CABG was extubated 4 hours ago and complains of increasing shortness of breath. Breath sounds are decreased over the right lung field. Wh at should be recommended NEXT? chest radiograph
Patient is diaphoretic and has a pulse of 120 and an SpO2 of 81% with a 28% tracheostomy collar. The therapist is unable to pass a suction catheter. Which of the following should the therapist do FIRST? Replace the tracheostomy tube. Unable to pass catheter is the key phrase here. Obstructed tube.
A decreasing cardiac output will result in increasing oxygen extraction and an increased C(a-v̄)O2.
A previously healthy 30-year-old patient is hospitalized with chills and fever. A chest radiograph is consistent with right upper lobe pneumonia. What is most likely to aid in the patient's management? Coughing and deep breathing
the most appropriate device to administer a controlled oxygen concentration for a patient with a variable respiratory pattern? Venti Mask
Decreasing the peak pressure should result in a decreased tidal volume and minute ventilation
most effective for destroying microorganisms on patient care equipment? Autoclave Autoclaving uses super-heated steam under pressure and will kill almost all microorganisms.
There is no response to bronchodilator therapy. In this instance, in evaluation of a patient who is short of breath, further _____ is required Further Lunch Measurments
the purpose of incentive spirometry after abdominal surgery Prevent lung collapse The goals of incentive spirometry are to prevent and treat postoperative atelectasis
Capnography waveforms resembling shark fins indicates Airway Obstruction The lack of a plateau and upward sloping shape of the curves demonstrate unequal distribution of inspired gas associated with obstruction
A patient with asthma is receiving a treatment with 2.5 mg of albuterol. During the treatment, the patient's heart rate increases from 80 to 138. A respiratory therapist should Decrease dosage of albuterol as HR increase is likely secondarily related
After extubation, marked stridor, labored breathing, intercostal retractions, and an SpO2 of 85% is observed. Aerosolized racemic epinephrine has been delivered without benefit. Which of the following should the therapist recommend reintubation
VT x RR = Minute Ventilation
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 Scope may obstruct the tube
While administering an IPV treatment at 20 cm H2O to a patient with cystic fibrosis, a respiratory therapist notes the patient has suddenly become very short of breath and cyanotic. The therapist's most appropriate action is to Terminate the therapy
There is no indication for NPPV for a patient in a Compensated Respiratory Acidosis
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
An elevated pulmonary capillary wedge pressure is an indicator of Left heart failure caused by edema treat with diuretics
Normal (PCWP) Pulm Cap Wedge Pressure 12 to 16
Where is the radial artery located The Wrist "rad wrist"
Where is the brachial artery located Inside arm "Brach your arm"
The right radial artery should not be punctured when there is insufficient collateral circulation through the ulnar artery
side effect of inhaled nitric oxide methemoglobinemia
the maximum flow during a forced exhalation. Peak Flow
"Bird-beak" patterns are a result of hyperinflation. Decreasing what, will decrease the tidal volume and correct the hyperinflation Inspiratory also known as Peak pressure
The best way to check the accuracy of a spirometer is to use a 3mL syringe
A wait of a few minutes should be expected after application of a transcutaneous electrode before values stabilize. This is associated with capillary dilatation
For a patient receiving noninvasive ventilation through a dual-limb circuit, an increase in what, will most likely reduce the respiratory effort associated with spontaneous breathing? Pressure Support
Pv̄O2 values below this number are too low and related to the need for cardiac output measurement 35
Medication used to treat apneic conditions and indicates the need for home apnea monitoring in infants caffeine citrate daily
most common side effect of aerosolized albuterol Tremor
Critical infection control step in the home setting handwashing
The treatment for carbon monoxide poisoning is high concentration of oxygen (close as possible to 100%) administered with nonrebreather mask
The most commonly used bedside measurement to monitor the progression of ventilatory impairment in a patient with Guillain-Barré syndrome is vital capacity
A patient complains of a productive cough that started approximately four months ago. The patient most likely has bronchitis Bronchitis is characterized by cough and sputum production. While pneumonia is similar it is often not chronic.
able to directly measure various forms of hemoglobin saturation, including oxyhemoglobin, carboxyhemoglobin, and methemoglobin hemoximeter
Based on an oxyhemoglobin disassociation curve, an SpO2 of 90% with a normal pH is approximately a PaO2 of 60
A patient is suspected of having an upper airway obstruction. Which test should a respiratory therapist recommend to detect this abnormality flow volume loop
While testing the proper function of a flow-inflating bag, 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
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? Leak Difference of 400mL in this instance indicating outside acceptable calibration range
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 like montelukast known as Singulair
Low PCWP and CVP coupled with a low urine output is characteristic of Hypovolemia
The patient is exhibiting refractory wheezing., diminished breath sounds after the multiple treatments, indicating worsening obstruction, what should be done increased dosage continuous nebulized bronchodilator therapy
The flow-volume loop obtained after bronchodilator administration demonstrates a significant improvement in expiratory flow. What should be recommended? inhaled bronchodilator therapy
A patient was diagnosed with bronchiectasis 3 years ago. The patient reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows cavitary disease. What is recommended? airway clearance therapy
At the beginning of exhalation, the sharp rise in exhaled CO2 on a capnographic tracing represents washout of dead space
A fast-acting beta2-agonist is the appropriate treatment for acute bronchospasm
Which of the following is the most effective aerosolized bronchodilator for a patient with an acute asthma exacerbation albuterol
mechanically ventilated patient developed auto-PEEP. What ventilator settings change should take place Decrease the rate thereby increasing the expiratory time which in turn decreases air trapping
Static Compliance formula Vt / PEEP (Pplat - PEEP)
severe obstructive lung disease is characterized by an FEV1/FVC less than 70% predicted
severe obstructive lung disease is characterized by an FEV1/FVC less than 70% and an FEV1 of 30 to 50% predicted
If a patient becomes tachycardic during albuterol treatment, what drug should be recommended next treatment? Levalbuterol Xopenex
What medication should be used to anesthetize a patient's airway prior to a flexible bronchoscopy procedure? lidocaine HCl Xylocaine
Ventilated pt. has a steady increase in the peak inspiratory pressure over a 12-hour shift. The patient has developed a fever and purulent pulmonary secretions. Which of the following should a respiratory therapist recommend FIRST? Obtain a sputum Gram stain
SBT with a T-piece have been initiated for 4 weeks. With each trial, the patient becomes agitated, dyspneic, and tachypneic, and must be returned to the ventilator. Which of the following should the respiratory therapist recommend? Pressure Support
A premature neonate with RDS receives the first dose of surfactant replacement therapy. Two hours later, FIO2 requirements have increased from 0.35 to 0.70. Which of the following should a respiratory therapist recommend FIRST? chest radiograph Increase in O2 requirements and the recent administration of surfactant, chest radiograph will help determine the cause of deterioration.
Which of the following should be recommended to determine the site of bleeding in a patient with hemoptysis? bronchoscopy
Monitoring serum electrolytes is indicated in patients who are receiving diuretics
For a spontaneously breathing patient, which of the following will provide an elevated baseline pressure during inspiration and expiration? CPAP
After obtaining an arterial blood gas sample, a respiratory therapist should handle the sample by removing all air from the syringe
A gas is saturated with 100% relative humidity at 32.2º C (90º F). As the gas cools to 26.7º C (80º F), the relative humidity will remain 100% and excess water will rain out
Administering dornase alfa Pulmozyme, a patient is developing marked congestion with copious sputum production. The most appropriate action is to pause the treatment and allow the patient to clear secretions
HR 142, RR 24 and BP 78/55 mm Hg. Examining the patient's chest, a respiratory therapist notes an absence of breath sounds in the left chest with a hyperresonant percussion note. What should be done? Insert a 14-gauge needle in the left chest
Hypotension is an adverse effect of PEEP
An increase in the difference between PIP - plateau pressure is indicative of increased airways resistance
During nasotracheal suctioning, a patient exhibits a gag reflex but does not cough. Watery secretions are aspirated through the catheter. Which of the following should a respiratory therapist do before repeating the procedure? Sniffing position
What score is used to determine a neonate's gestational age? Ballard
A respiratory therapist is calibrating a helium analyzer. What should the analyzer read when calibrated in air? Air contains essentially no helium; therefore, it should read zero
What drug is appropriate for the sedation of a 30-year-old patient with status asthmaticus and hypotension who is receiving mechanical ventilation? lorazepam Ativan
The standard frequency for dosing of inhaled tiotropium (Spiriva) is every 24hrs
A right-sided pneumothorax will result in diminished breath sounds on the right and possibly a tracheal shift to the left
Total flow = air to oxygen entrainment factor X set liter flow to the device
A respiratory therapist is asked to position a patient for orotracheal intubation. The therapist should place the patient's head in the sniffing position
Changes in the level of the bed relative to the transducer will make both systolic and diastolic pressures move same direction
drug is most appropriate to paralyze a sedated patient in status asthmaticus who is receiving mechanical ventilation rocuronium bromide Zemuron
What should be done for patient with facial burns, oropharynx edema indicating upper airway burns and the potential for worsening edema and airway obstruction Intubation
Moderate stridor with retractions is noted immediately after extubation of a patient. A respiratory therapist should recommend nebulized racemic epinephrine
Peak expiratory flow measurements are indicated for the measurement of airways obstruction and asthma
A patient's VQ scan indicates an excess of ventilation compared to perfusion in the left lower lobe. These results suggest pulmonary embolism
What classically presents as alveolar unit is normally ventilated, but pulmonary capillary blood flow is impeded causing poor perfusion pulmonary embolism
characteristic during VC ventilation? Inspiration ends after delivery of a preset volume
Created by: jgrisner