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TMC test bank wrong questions 6-10/NBRC
new latest version 2024-2025 best studying
material with verified answers graded A
WITH 150+ QUESTIONS
Which of the following is TRUE regarding humidification during high flow nasal
cannula therapy?
A. an unheated large volume nebulizer with large-bore tubing is required
B. a simple unheated wick humidifier provides adequate humidification
C. both a heated humidifier and heated delivery circuit are required
D. extra humidity is not needed because the upper airway is not bypassed
- ANSWER For O2 delivery, a high flow nasal cannula system typically requires the following
equipment: oxygen blender, high flow flowmeter (up to 40 L/min for adults); heated
humidifier (or wick-like cartridge); and O2 analyzer. To prevent condensation, the
delivery tubing also must be heated, either via wires or coaxial flow of warm water.
The correct answer is: both a heated humidifier and heated delivery circuit are
required
To get a better view of the glottis before inserting an ET tube, you could ask the
attending nurse to:
A. place downward pressure on the cricoid cartilage
B. maximally flex the patient's neck and head
C. insert a second laryngoscope in the mouth
D. pass a suction catheter through the nasopharynx
- ANSWER Applying downward pressure to the cricoid cartilage (similar to the Sellick maneuver
used to prevent aspiration) displaces the larynx posteriorly, which may help align the
,laryngopharynx and trachea and provides better visualization of the glottic opening, at
least in some patients. If cricoid pressure fails to improve or worsens the laryngoscopic
view (which also can occur), it should be terminated.
The correct answer is: place downward pressure on the cricoid cartilage
In a neonate, all of the following are indication of HFV except:
A. cleft palate before surgical correction
B. PPHN
C. RDS unresponsive to conventional ventilation
D. mechanical ventilation patient with unresolved pneumothorax
- ANSWER An oral or nasal ET tube is inserted into a patient's airway before a cleft palate is
surgically repaired; a standard neonatal vent is used if needed. There is no special
reason to use HFV. Patients with all of the other clinical situations have been shown to
benefit from HFV.
The correct answer is: cleft palate before surgical correction
Which of the following patients is a poor candidate for IPPB therapy?
A. a post-op female patient with clinically diagnosed atelectasis
B. a chronically hypercapnic patient with full metabolic compensation
C. a patient being treated for acute cardiogenic pulmonary edema
D. a patient with acute-on-chronic respiratory acidosis
- ANSWER Hypercapnic patients with full metabolic compensation are poor candidates for IPPB
therapy. Rapid reduction of the PaCO2 in such patients may impose an acute
"metabolic" alkalosis on top of their compensated state. The best supported
indications for IPPB are for treating 1) clinically diagnosed atelectasis, 2) impending
hypercapnic respiratory failure (acute-on-chronic respiratory acidosis), and 3)
462
decreased compliance in kyphoscoliosis. Note that in most clinical centers BiPAP has
largely replaced IPPB for all of these indications except the treatment of atelectasis.
,The correct answer is: a chronically hypercapnic patient with full metabolic
compensation
Therapeutic gases being delivered to patients need to be humidified because
they:
A. have low specific gravities
B. become less combustible when humidified
C. are supplied at low critical temperatures
D. are supplied in the anhydrous state
- ANSWER The most common use for humidity therapy is to add water vapor to O2 being
administered to patients with normal upper airways. This is necessary because purity
standards require medical gases to be in the dry or anhydrous state. For this reason,
supplemental humidity may also be provided for anesthetic gases, for gases in the
pulmonary function laboratory, or for therapeutic gas mixtures such as oxygen-carbon
dioxide or helium-oxygen mixtures.
The correct answer is: are supplied in the anhydrous state
Continuous positive airway pressure (CPAP) is indicated as a treatment for:
A. post-operative atelectasis
B. acute exacerbation of COPD
C. hypercapnic respiratory failure
D. acute pulmonary emboli
- ANSWER CPAP is indicated to treat hypoxemia due to shunting in patients with adequate
spontaneous ventilation (e.g., ARDS, IRDS). CPAP is also used to treat patients with
atelectasis (intermittent therapy), CHF/pulmonary edema (short term application) and
sleep apnea (nocturnal application). CPAP is contraindicated if the patient cannot
maintain adequate ventilation on their own, e.g., hypercapnic ventilatory failure, acute
exacerbation of COPD.
The correct answer is: post-operative atelectasis
, A patient with chronic bronchitis is receiving volume controlled A/C ventilation.
Wheezing is heard over all lung fields, rhonchial fremitus is felt over the central
airways, and secretions are thick. The patient's peak pressure is 45 cm H2O and
plateau pressure is 20 cm H2O. Which of the following would be useful to treat
the patient's condition?
A. triamcinolone (Azmacort)
B. cromolyn sodium (Intal)
C. pancuronium bromide (Pavulon)
466
D. levalbuterol (Xopenex)
- ANSWER Based on the patient's diagnosis and clinical presentation, the immediate problem is
bronchospasm (wheezing) and thick secretions (rhonchial fremitus) causing an increase
in airway resistance (increased PIP - plateau). A bronchodilator like levalbuterol AND
possibly a mucolytic like acetylcysteine are indicated. Pancuronium is a neuromuscular
blocking agent, triamcinolone a corticosteroid and cromolyn a mast cell stabilizer, none
of which will aid in bronchodilation or secretion clearance.
The correct answer is: levalbuterol (Xopenex
A doctor requests that you increase the expiratory time on a patient receiving
volume control ventilation, but not alter the minute ventilation. Which of the
following settings would you adjust to fulfill the doctor's request?
A. tidal volume
B. rate of breathing
C. trigger sensitivity
D. inspiratory flow
- ANSWER On most ventilators operating in the volume control mode, expiratory time is a
resultant value, i.e., not set directly but dependent on other settings. Since the
expiratory time is essentially the time left over after inspiration, and since the
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