1. Patient Assessment

2. Terminology Terminolgy Terminology  Definition  Association

3. 4 Life Functions 1. Ventilation 2. Oxygenation 3. Circulation 4. Perfusion

4. You have finished charting on your patient when you notice that an error was made. You should do which of the following? A.Tell the nurse so that she will tell the physician B.Tell the nurse so that she will chart the correct information C.Place a line through the error, initial it, and write in the correct information D.Have your supervisor chart the correct information

5. What maximum inspiratory pressure (MIP) should a patient be able to generate before attempting extubation? A. -5 cm H 2 O B. -10 cm H 2 O C. -15 cm H 2 O D. -20 cm H 2 O

6. All of the following could cause a capnography reading to change from 36 torr to 30 torr, EXCEPT A.endotracheal tube positioned in the right mainstem bronchus B.Hyperventilation C.pulmonary emboli D.hypovolemia

7. A patient is on a ventilator and is in the process of being weaned. What is the best way to continuously monitor the minute ventilation? A.Chest transducers B.Thermistors C.Water seal spirometer D.Pneumotachometer

8. In listening to a patient’s lungs you notice bronchial breath sounds in her right lower lobe. These would indicate which of the following? A.She has normal lungs B.She has a pneumothorax C.She has a consolidation in her right lower lobe D.She has a pleural effusion in her right lower lobe

9. A 77-year-old male patient is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following? A. Pulmonary edema B. Pulmonary interstitial emphysema C. Pneumothorax D. Emphysema

10. Radiology Terminology and Interpretation Terminology DescriptionDiagnosis 1. RadiolucentDark pattern, airNormal for lungs 2. RadiodenseWhite pattern, solid, fluidNormal for bones, organs 3. InfiltrateAny ill-defined radiodensityAtelectasis 4. ConsolidationSolid white areaPneumonia/ Pleural effusion 5.HyperlucencyExtra pulmonary airCOPD, asthma, ptx 6. Vascular markingsLymphatics, vessels, lung tissueIncreased with CHF Absent with pneumothorax 7. DiffuseSpread throughoutAtelectasis/ pneumonia 8. OpaqueFluid, solidConsolidation 9. BilateralOn both sides 10. UnilateralOn one side

11. Diagnostic Descriptions and Interpretations Terminology DescriptionDiagnosis 1. Fluffy infiltratesDiffuse whitenessPulmonary edema 2. Butterfly/ batwing patternInfiltrate shapePulmonary edema 3. Patchy infiltratesScattered densitiesAtelectasis 4. Platelike infiltratesThin-layered densitiesAtelectasis 5. Ground glass appearanceReticulogranularARDS/ IRDS 6. Honeycomb PatternReticulogranularARDS/ IRDS 7. Air bronchogramPneumonia 8. Peripheral wedge-shaped infiltratePulmonary embolus 9. Concave superior interface/ borderPleural effusion 10. Basilar infiltrates with meniscusPleural effusion

12. A pulmonologist determines a patient has dyspnea, diminished breath sounds, with a dull percussion note on the left. The chest radiograph indicates a tracheal shift to the right. Which of the following disease states should the therapist suspect is affecting the patient? A. Tension pneumothorax B. Lung abscess C. Atelectasis D. Pleural effusion

13. Causes of tracheal deviation Pulled toward pathology Pushed away from pathology 1. Atelectasis 2. Pulmonary fibrosis 3. Pneumonectomy 4. Diaphragmatic paralysis 1. Massive pleural effusion 2. Tension pneumothorax 3. Neck or thyroid tumors 4. Large mediastinal mass

14. An adult patient is intubated after being pulseless for several minutes. An exhaled CO 2 detection device indicates 0.03% CO 2 despite confirmation of tracheal placement with bilateral breath sounds and chest rise. Which of the following should the respiratory therapist recommend to rapidly confirm correct endotracheal tube placement? A. direct laryngoscopy B. another CO 2 detection device C. stat chest radiograph D. pulse oximetry

15. Which of the following clinical observations is most commonly associated with right heart failure? A. peripheral edema B. muscle wasting C. tracheal deviation D. skin flushing

16. The respiratory therapist is called to deliver a second dose of 5 mg aerosolized albuterol to a patient with acute asthma. The patient had wheezing audible without a stethoscope after the first treatment 20 minutes ago. Auscultation now demonstrates no wheezing with very decreased breath sounds. The patient is receiving oxygen by nasal cannula at 3 L/min and the SpO 2 is 88%. Which of the following has MOST likely occurred? A. The albuterol reversed the bronchospasm. B. The airways obstruction has worsened. C. The SpO 2 value was inaccurate. D. The first treatment was ineffective.

17. A scan reveals ventilation and perfusion are equally decreased in the right mid-lung field. With which of the following is this finding compatible? I. acute pulmonary embolus II. bronchogenic carcinoma III. pneumonia IV. atelectasis A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

18. Which of the following are characteristic findings in patients with emphysema? I. a decreased FEV 1 II. flattening of the hemidiaphragms III. an increased AP diameter on a chest radiograph IV. ventilatory accessory muscle atrophy A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

19. The respiratory therapist performs an assessment prior to initiating aerosol therapy and chest physiotherapy. The therapist notices the patient has a rapid respiratory rate and is using accessory muscles to breathe. During the interview, the patient states, "I seem to breathe fast and lift my shoulders a lot, but I feel like I am getting enough air." The therapist can conclude that the patient likely has A. dyspnea on exertion. B. orthopnea. C. increased work of breathing. D. hypopnea.

20. A patient receiving CPR was just intubated. There was decreased chest wall movement on the left compared to the right and decreased breath sounds on the left during manual ventilation. Which of the following should the respiratory therapist do? A. Assess endotracheal tube placement. B. Add additional air to the endotracheal tube cuff. C. Continue cardiac compressions and ventilation. D. Place a large-gauge needle in the left anterior chest wall.

21. A male patient who is receiving mechanical ventilation has just been turned in bed. The low tidal volume alarm is activated. The respiratory therapist notes the endotracheal tube is positioned at 18 cm at the incisor. Which of the following should the therapist do to correct the problem? I. Suction the patient's airway. II. Request a chest radiograph. III. Deflate the cuff and advance the ET tube to 21 cm. IV. Decrease the low tidal volume alarm. A. I and II only B. I and IV only C. II and III only D. III and IV only

22. If a patient demonstrates poor cooperation when respiratory care is being administered, he should be evaluated for I. acute hypercapnia. II. impaired hearing. III. language difficulties. IV. hyperoxia. A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

23. Characteristics associated with point-of-care data entry such as hand-held systems include I. standardizing documentation. II. measuring the quality of patient care. III. monitoring charge capture. IV. evaluating clinician productivity. A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

24. Three days postoperatively, a patient is febrile and the white blood cell count is 18,000/cu mm. A chest radiograph shows patchy bilateral infiltrates with air bronchograms. Which of the following is the most probable diagnosis? A. pneumonia B. atelectasis C. pulmonary edema D. pleural effusion

25. The respiratory therapist is assisting a physician during an intubation procedure. After several unsuccessful attempts, interrupted by bag-valve-mask ventilation, blind intubation is performed. The therapist reports a color change of the CO 2 detector after six breaths. The most appropriate action for the therapist to perform NEXT is to A. secure the endotracheal tube. B. auscultate the chest. C. prepare for reintubation. D. obtain an arterial blood gas.

26. While performing a chest physical examination on a patient receiving mechanical ventilation, the respiratory therapist notes the right side of the patient's chest is not moving and the trachea is deviated to the left. These findings would be most consistent with A. left tension pneumothorax. B. left mainstem intubation. C. right-sided atelectasis. D. right tension pneumothorax.

27. The respiratory therapist assigned to a new employee's orientation is describing the clinical applications of pulse oximetry (SpO 2 ). Which of the following should the therapist explain are useful applications of pulse oximetry? I. documenting oxygenation for Medicare reimbursement requirements II. evaluating the severity of carbon monoxide poisoning III. preventing retinopathy of prematurity in neonates IV. monitoring the effectiveness of ventilation A. I and III only B. I and IV only C. II and III only D. II and IV only

28. Which of the following are indications of sudden upper airway obstruction? I. retraction of intercostal spaces II. panic III. marked use of the accessory muscles of ventilation IV. an elevation in body temperature A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

29. A 54-year-old female with asthma is receiving oxygen by nasal cannula at 4 L/min and complains of shortness of breath and appears very anxious. Her temperature is 34.6 ° C (94.3 ° F), heart rate 115/min and regular, respiratory rate 26/min, and blood pressure 75/55 mm Hg. The respiratory therapist notices the patient's hands are cool and clammy. Arterial blood gas results are: pH 7.52, PaO2 92 torr, PaCO2 29 torr, HCO3- 23 mEq/L, BE +1, SaO2 97%, SpO2 89%. Which of the following could cause the difference in oxygen saturation measurements? A. hyperventilation B. hypoperfusion C. tachycardia D. radiated light

30. Activity of respiratory accessory muscles most likely indicates A. normal ventilation. B. increased pulmonary compliance. C. increased airway resistance. D. decreased work of breathing.

31. A 57-year-old male is admitted to the hospital complaining of dyspnea on exertion and a dry, non- productive cough. He states his symptoms have been worsening for the past 2 months. The patient's respiratory rate is 28 with fine inspiratory crackles (rales) throughout his lung fields, but are most noticeable in his lower lobes. Spirometry shows some restrictive component. Which of the following would the respiratory therapist recommend? A. chest radiograph B. ventilation/perfusion studies C. exercise stress testing D. bronchoprovocation studies

32. A patient with COPD is sitting on the edge of his bed, leaning over a bedside table, and using his accessory muscles of ventilation at a regular rate of 32/min. He explains that he cannot breathe comfortably lying down. These findings are most characteristic of A. orthopnea. B. eupnea. C. bradypnea. D. Cheyne-Stokes respiration.

33. An upright PA chest radiograph reveals a left lower chest density with a concave superior interface. A left lateral decubitus radiograph shows a density, with a distinct line from the diaphragm to the apices in the left lung. The most likely diagnosis is A. pulmonary edema. B. emphysema. C. congestive heart failure. D. pleural effusion.

34. Which of the following would provide the most information about a patient's orientation to time and place? I. The patient knows she is in a hospital. II. The patient knows her diagnosis. III. The patient recognizes her physician. IV. The patient correctly states the year. A. I and II only B. I and IV only C. II and III only D. III and IV only

35. While manually ventilating an intubated patient during transport, the respiratory therapist observes a significant decrease in SpO 2. Which of the following should the therapist do first? A. Continue ventilation since desaturation is expected during transport. B. Instill saline down the endotracheal tube to dislodge a mucus plug. C. Verify that the resuscitator bag is connected to oxygen. D. Reposition the oximeter probe.

36. While checking a patient's progress notes, the respiratory therapist reviews a physician's treatment plan that includes changes in respiratory care. The therapist's most appropriate action is to A. initiate the physician's changes immediately. B. confer with the patient's nurse about when to implement the changes. C. check to see whether there are new respiratory care orders. D. review the planned changes with the shift supervisor.

37. During a bedside interview of a patient with COPD, the respiratory therapist asks the patient how he accepts the limitations of his daily activities. Which of the following is the therapist most likely assessing? A. emotional state B. exercise tolerance C. level of cooperation D. work of breathing

38. The respiratory therapist takes over bag-valve ventilation during resuscitation of a 71-year-old patient with COPD. The therapist notes increasing resistance to ventilation, decreased chest excursion, and absence of breath sounds on the right. The therapist should A. insert a nasogastric tube. B. perform a needle thoracostomy. C. increase ventilatory pressures. D. reposition the endotracheal tube.

39. Secondary polycythemia can be associated with an adult patient who has I. long-standing COPD. II. an anoxic episode during anesthesia. III. a congenital right-to-left shunt. IV. Guillain-Barré syndrome. A. I and III only B. I and IV only C. II and III only D. II and IV only

40. Which of the following are clinical signs and symptoms of a pneumothorax when detected on the affected side of the chest? I. diminished breath sounds II. hyperresonance on percussion III. increased chest motion IV. increased vocal fremitus A. I and II only B. I and IV only C. II and III only D. III and IV only

41. A patient with a persistent dry cough suddenly starts producing copious amounts of pus-like, yellow, mucoid sputum. Which of the following actions should the respiratory therapist take? A. Request an order for aerosolized acetylcysteine (Mucomyst). B. Notify the physician a draining lung abscess is suspected. C. Obtain an order for postural drainage and percussion. D. Perform nasotracheal suctioning.

42. A patient has received chest physiotherapy and bronchodilator therapy for 48 hours. Sputum production has decreased, but the patient is now coughing up blood-tinged secretions. Breath sounds are decreased and crackles (rales) are present in the left lower lobe. Which of the following diagnostic studies should the respiratory therapist recommend? A. coagulation studies B. chest radiograph C. arterial blood gas analysis D. ventilation/perfusion scan

43. An AP portable chest radiograph will show a heart shadow larger than a PA film because A. the heart is farther away from the film in the AP position. B. radiation waves pass through the heart at an angle in the PA position. C. the PA position is taken at maximum inspiration. D. a larger film is used for the AP position.

44. A patient was involved in a motor vehicle crash. The patient has been immobilized, is breathing spontaneously, and is receiving oxygen by nonrebreathing mask. The patient is responsive and has the following vital signs: Heart rate 147 Heart rhythm: atrial fibrillation Blood Pressure 110/50 mmHg Respiratory Rate 30 Which of the following should the respiratory therapist recommend? A. Transport immediately to a trauma center. B. Intubate and initiate mechanical ventilation. C. Perform electrical cardioversion. D. Administer lidocaine HCl (Xylocaine).

45. A 21-year-old male patient with a diagnosis of status asthmaticus is intubated and has been receiving mechanical ventilation. There is a sudden increase in airway pressures. The patient is hemodynamically stable and breath sounds are clear, but significantly decreased on the right. Which of the following should the respiratory therapist recommend? A. Turn the patient onto his left side. B. Suction the airway through the endotracheal tube. C. Order a portable chest radiograph. D. Decrease the PEEP setting to zero.

46. During the 24 hours following a kidney transplant, a 54-year-old woman has received 3000 mL of intravenous fluids. Blood chemistry results identified decreases in BUN and hemoglobin values. The urine output has been 30 mL/hr. Which of the following would assessment most likely reveal? A. inspiratory crackles B. chest wall crepitus C. hyperresonance to percussion D. bronchial breath sounds

47. Recommend a nicotine patch if you have a heavy smoker who is very agitated. General malaise = electrolyte imbalance If HR increases from 70 to 95 bpm turing a tx, what do you do?  Stop the tx What is the treatment for a unilateral wheeze?  Bronch

48. What is the treatment for severe stridor  Intubation What are normal heart sounds?  S1 and S 2  Anything else… consider an echo Proper ETT placement?  2 – 2.5 cm OR 1 inch What test quickly evaluates sputum?  Gram stain  Culture and sensitivity takes a long time

49. Normal RBC?  5 mill/cu mm (4-6) Normal Hb  15 gm/dl (12 – 16)  3 x RBC Normal Hct?  45% (40-50%)  3 x Hb

50. Normal PaCo2?  35 – 45 mmHg Normal K+?  Just add a decimal point!  3.5 – 4.5 mEq/L Normal Na+?  Just ad a 1 on front!  135 – 145 mEq/L

51. Normal PaO2?  80-100 mmHg Normal Cl-  80-100 mEq/L

52. THE END

53. A patient's fluid balance is relevant because it provides information about I. renal function. II. congestive heart failure. III. pulmonary hypertension. IV. pulmonary edema. A. I, II, and III only B. I, II, and IV only C. I, III, and IV only D. II, III, and IV only

54. A 34-week gestational age infant is receiving mechanical ventilation and the chest is being transilluminated. The transillumination device produces a small halo appearance at the point of contact with the skin. Which of the following does this indicate? A. pneumothorax B. pneumomediastinum C. pneumopericardium D. normal lung appearance

55. During which of the following should apnea monitoring be implemented for an infant? I. night time II. breast feeding III. naps A. I only B. I and II only C. I and III only D. II and III only

56. An intubated premature newborn is experiencing increased signs of respiratory distress. Which of the following tests/procedures would be helpful in diagnosing a pneumothorax? A. suction B. bronchoscopy C. transillumination D. capillary blood gas

57. The major component of pulmonary surfactant is A. protein. B. glucose. C. phospholipid. D. polysaccharide.