1. Disadvantages of noninvasive ventilation include which one of the follow-
ing?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP: Disadvantages of noninvasive ventilation
(NPPV) include the following: it can only be
used in cooperative patients; it does not provide direct airway access (thus increas-
ing
the risk of secretion retention), and more therapist time is needed during the initial
period of use. On the other hand NPPV may help decrease the incidence of VAP
and
typically costs less than invasive ventilation.
The correct answer is: limits direct access to lower airway
2. On a patient receiving volume control AC ventilation, you observe a
flow-volume
with a sawtooth pattern on exhalation. Which of the following actions would
,you
consider most appropriate?
A. recommend administering a bronchodilator
B. assess the patient's need for suctioning
C. measure the endotracheal tube cuff pressure
D. switch to pressure control ventilation: The flow-volume loop reveals irregular
sawtooth- like oscillations, primarily in the
expiratory portion of the loop. This indicates either 1) accumulation of airway
secretions in the trachea/large airways (requiring suctioning), or 2) condensate
partially
blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow
sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm
excess secretions as the problem.
The correct answer is: assess the patient's need for suctioning
3. A 30 year-old male was found supine and unresponsive. In the ER it was
confirmed he had aspirated while on his back. After the patient is transferred
to
ICU his physician orders postural drainage and percussion every 4 hours.
What is
the best position to place him in to drain the affected area?
A. prone with a pillow under his hips
,B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees: This patient aspirated while lying flat
on his back. Most commonly, this affects the
superior segments of both lower lobes. The position which facilitates drainage from
this lung region is a prone position with a pillow under the patient's hips.
The correct answer is: prone with a pillow under his hips
4. You need to perform nasotracheal suctioning on a patient with retained
secretions. As compared to suctioning via a tracheal airway, which of the
following complications are unique to this procedure?
A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP: Complication/hazards common to both tracheobronchial and
nasotracheal suctioning
include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension,
bronchospasm, atelectasis, increased intracranial pressure and the potential for
contamination/infection. Unique complications of nasotracheal suctioning include
nasal trauma/epistaxis, pharyngeal trauma, gagging (with potential
241
vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is more
common with nasotracheal suctioning.
5. Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
,C. cap refill
D. JVD: Poor skin turgor
6. ARDS patient, what should RT use to evaluate oxygen delivery for optimal
PEEP
A. ABG
B. mixed venous
C. serum lactate
D. CO: mixed venous
7. RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80: 45
,8. To help prevent infection after an aerosol drug treatment provided via
small
volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it: To minimize the
likelihood of infection in patients receiving aerosol drug therapy via a
small volume nebulizer (SVN), you should 1) use a different SVN for each patient,
2)
change the SVN and tubing every 24 hours, and 3) perform thorough hand hygiene
prior to each therapy session. It is also recommended that the nebulizer NOT be
rinsed
with tap water, but rather rinsed with sterile water and blown dry between uses. If
rinsing with sterile water not feasible, rinse the device with filtered or tap water,
then
rinse with isopropyl alcohol and dry.
The correct answer is: rinse the SVN with sterile water then dry and bag it
9. A doctor orders aerosol drug therapy via small volume nebulizer for a
patient
receiving mechanical ventilation via a dual-limb breathing circuit. To prevent
drug
residue from affecting ventilator performance you must make sure that:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
,C. a heat and moisture exchanger is in place at the patient connector
D. a HEPA filter is in place on the expiratory limb of the circuit: HEPA filters
are needed to prevent drug residue from entering the ventilator and
affecting its performance. For dual-limb circuits, be sure that inspiratory and expi-
ratory
HEPA filters are in place. For single-limb circuits, you normally only need an
inspiratory
HEPA filter; expiratory filtration may be required on patients with disorders requiring
droplet or respiratory precautions.
The correct answer is: both inspiratory and expiratory HEPA filters are in place
10. Your patient is receiving aerosolized bronchodilators to treat her asthma.
What is
the best way to determine whether this treatment is achieving the desired
goal?
,A. measure the patient's MIP before-and-after treatment
279
B. measure the patient's inspiratory capacity before-and-after treatment
C. measure the patient's FEV1% before-and-after treatment
D. calculate the patient's alveolar minute volume: The best way to determine
the effectiveness of bronchodilator therapy at the bedside
is to measure the patient's forced expiratory flows before and after treatment. Either
the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the
FEV1% is a
more reliable and valid measure. In general, an improvement of at least 12-15%
between the pre- and post-test values is needed to indicate reversibility of the
obstruction with the bronchodilator.
The correct answer is: measure the patient's FEV1% before-and-after treatment
11. A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable
to
produce an acceptable volume of sputum for laboratory studies. The most
appropriate action would be to
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning: Hypertonic saline solution can help draw
fluid out of the airway mucosa. For this
reason, the aerosolization of hypertonic saline solution can help mobilize secre-
tions
and can be effective with sputum induction.
,The correct answer is: change to hypertonic saline
12. A patient with asthma is given an adrenergic bronchodilator agent to
combat an
acute airway obstruction. Instead of demonstrating improvement in airflow,
the
patient's symptoms worsen (e.g., increased wheezing, etc.). A possible
explanation for this observation is:
A. tachyphylaxis or tolerance to the agent
B. alterations in the V/Q ratio (a beta-2 effect)
C. the additive effect of other drug agents
D. a paradoxical response to the agent: Although rare, some patients exhibit a
paradoxical response to adrenergic
bronchodilators in which the symptoms of acute airway obstruction actually are
made
, worse by drug agent. It is believed that this adverse effect is a result of an allergy
to
some of the metabolic products of the adrenergic drugs.
The correct answer is: a paradoxical response to the agent
13. Which of the following patient instructions for using a dry powder inhaler
(DPI) is
correct?
A. hold the device vertically after loading
B. inhale rapidly for 1-2 seconds
C. blow slowly into the device
D. breath normally in/out of the device: The following general guidelines apply
to effective use of a DPI: (1) never use a spacer
or VHC with a DPI; (2) lips must be tightly sealed around the mouthpiece; (3) after
loading, most DPIs must be held horizontally (to avoid loss of drug); (4) patient
should
inhale rapidly (> 60 L/min for 1-2 sec) and deeply; and (5) patient must exhale to
room
(not back into the device).
The correct answer is: inhale rapidly for 1-2 seconds
14. Which of the following is the preferred delivery method for cromolyn
sodium to
young children?
A. MDI with mask
B. small volume nebulizer
C. MDI with holding chamber
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