RCP 500
ADVANCED RESPIRATORY THERAPY
TEST 1, UNITS 1-3 = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; NAME____________________________
SEPTEMBER 22, 2008
ANSWER THE FOLLOWING QUESTIONS WITH A CONCISE ANSWER O= N THE ANSWER SHEET PROVIDED. (2 PTS= EACH)
1. = Which of the following airways would be best to ensure ventilation in a patient w= ho is in cardiac arrest?
= A) oropharyngeal
= B) nasopharyngeal
= C) oroendotracheal
= D) nasoendotracheal
2. &n= bsp; Which of the following would increase the oxygen percentage delivered by a self-inflating bag?
= I. = increase oxygen flow rate
= II. = increase the size of the reservoir
= III. = ventilate at a faster rate
= A) I only
= B) II only
= C) I and II
= D) II and III
3. = Which of the following patient populations will most likely be ventilated with a manual ventilation bag which has a pressure pop-off?
= A) neonates
= B) children
= C) adolescents
= D) adults
4. = After intubating an adult patient you obtain a chest x-ray. On chest x-ray the tip of the endotracheal tube should be:
= A) 1-2 cm above the carina
= B) 1-2 cm below the carina
= C) 2-3 cm above the carina
= D) 2-3 cm below the carina
5. &n= bsp; Which of the following laryngoscope blades is the largest straight blade?
= A) 0 Miller
= B) 4 Miller
= C) 0 MacIntosh
= D) 4 MacIntosh
6. &n= bsp; Which of the following items would be used for nasal intubation but not for oral intubation?
= I. = lubricant
= II. = Magill forceps
= III. = Tape
= IV. = Yankauer suction catheter
= A) I and II
= B) II and IV
= C) I, II and III
= D) II, III and IV
7. &n= bsp; When intubating which of the following anatomical structures should be visualize= d?
= I. = tongue
= II. = epiglottis
= III. = glottis
= IV. = vocal cords
= A) I, II and III
= B) I, II and IV
= C) II, III and IV
= D) I, II, III and IV
8. = After extubating a patient you notice significant stridor. The physician asks for your recommendation for a medication to alleviate the stridor. You would recommend:
&nbs= p; &= nbsp;
= A) 2.5 mg of albuterol
= B) 0.63 mg of levalbuterol
= C) 0.5 ml of racemic epinephrine
= D) 1 ml of racemic epinephrine
9. = Which of the following disease processes would more likely cause hypoxemic respiratory failure than hypercapneic respiratory failure?
= I. = ARDS
= II. = Myasthenia gravis
= III. = Kyphoscoliosis
= IV. = Severe pulmonary edema
= A) I and III
= B) I and IV
= C) I, II and III
= D) II, III and IV
10. A pat= ient was on a 40% air entrainment mask and had a pulse oximetry reading of 79%.<= span style=3D'mso-spacerun:yes'> You change the patient to a cool a= erosol mask at 80% and the pulse oximeter increases to 82%. What would you recommend doing nex= t?
= A) increasing oxygen to 90%
= B) change to high flow nasal cannula at 15 lpm
= C) change to nonrebreathing mask at 15 lpm
= D) initiate CPAP by mask
11. A pat= ient with known COPD enters the emergency room.= ABG results on 2 lpm nasal cannula reveal the following:
&nbs= p; &= nbsp; &nbs= p; pH &= nbsp; &nbs= p; 7.35
&nbs= p; &= nbsp; &nbs= p; PaCO2 &= nbsp; &nbs= p; &= nbsp; 64
&nbs= p; &= nbsp; &nbs= p; PaO2 &= nbsp; &nbs= p; 48
&nbs= p; You would recommend?
= A) leave patient on nasal cannula at 2 lpm
= B) increase nasal cannula to 3 lpm
= C) initiate noninvasive ventilation
= D) intubate and mechanically ventilate
12. A pat= ient with known COPD enters the emergency room.= ABG results on 1 lpm nasal cannula reveal the following:
&nbs= p; &= nbsp; &nbs= p; pH &= nbsp; &nbs= p; 7.27
&nbs= p; &= nbsp; &nbs= p; PaCO2 &= nbsp; &nbs= p; &= nbsp; 81
&nbs= p; &= nbsp; &nbs= p; PaO2 &= nbsp; &nbs= p; 57
&nbs= p; You would recommend?
= A) increase nasal cannula to 2 lpm
= B) change patient to 35% air entrainment mask
= C) initiate noninvasive ventilation
= D) intubate and mechanically ventilate
13. &= nbsp; A mechanical ventilator that is et to be a constant flow controller would hav= e a:
= A) square flow curve and a square pressure curve
= B) square flow curve and a nonsquare pressure curve
= C) nonsquare flow curve and a square pressure curve
= D) nonsquare flow curve and a nonsquare pressure curve
14. A ventilator is a time-cycled ventilator.&nb= sp; If the only change you make on the ventilator is to increase set tid= al volume the ventilator will:
&nbs= p;
= A) increase flow
= B) decrease flow
= C) increase inspiratory time
= D) increase expiratory time
15. Which= of the following flow curves will generally deliver a mechanical breath with t= he LEAST amount of peak pressure?
= A) square
= B) sine
= C) decelerating
= D) ascending
16. A ventilator is currently set to be time-cycled and volume-targeted. If the only change you make is to decrease inspiratory time the ventilator will:
= A) increase flow
= B) decrease flow
= C) increase tidal volume
= D) decrease expiratory time
17. &= nbsp; Which of the following ventilator modes is generally used for Inverse Ratio Ventilation?
= A) Assist Control
= B) Pressure Control
= C) Pressure Support
= D) CPAP
18. Which= of the following ventilator modes would often require the patient be paralyzed with a neuromuscular blocking agent?
= A) Assist Control
= B) MMV
= C) APRV
= D) Control
19. &= nbsp; Using BiPAP for noninvasive ventilation is most like which of the following venti= lator modes?
= A) SIMV
= B) Pressure Control
= C) Pressure Support
= D) CPAP
20. &= nbsp; Typically, with a Permissive Hypercapnea ventilator strategy we will use:
= A) high tidal volumes and high rates
= B) high tidal volumes and low rates
= C) low tidal volumes and high rates
= D) low tidal volumes and low rates
21. Which= of the following would be possible contraindications to a Permissive Hypercapn= ea ventilatory strategy?
= I. = closed head injury
= II. = COPD with chronic CO2 retention
= III. = Pulmonary hypertension
= IV. = Refractory hypoxemia
= A) I, II and III
= B) I, II and IV
= C) II, III and IV
= D) I, II, III and IV
22. Which= of the following ABG results would most indicate the need or benefit of Inverse Ratio Ventilation?
= A) pH 7.37, PaCO2 64, PaO2 59 on 30% oxygen
= B) pH 7.21, PaCO2 83, PaO2 66 on 50% oxygen
= C) pH 7.29, PaCO2 55, PaO2 83 on 40% oxygen
= D) pH 7.35, PaCO2 43, PaO2 48 on 90% oxygen
23. &= nbsp; Prone ventilation would most likely be used for a patient with:
= A) status asthmaticus
= B) lobar pneumonia
= C) ALS
= D) ARDS
24. &= nbsp; Which of the following patients would be the best candidate for noninvasive venti= lation?
= A) patient with ARDS
= B) patient with a drug overdose
= C) patient with aspiration pneumonitis who has copious production of secretions
= D) patient with an exacerbation of their COPD
25. Nonin= vasive mechanical ventilation has just been initiated on a patient with respiratory distress. Which of the follow= ing would indicate that the noninvasive ventilation is improving the patient’s condition?
= I. = increased breathing rate
= II. = synchronization with the ventilator
= III. = decreased use of accessory muscles
= IV. = decreased oxygen saturation
= A) I and II
= B) II and III
= C) II, III and IV
= D) I, II, III and IV
ANSWER THE FOLLOWING QUESTIONS WITH A CONCISE ANSWER.<= /p>
26. Discu= ss the advantages of doing a tracheotomy on a patient who has been on a mechanical ventilator for a period of time. (4 pts)
27. &=
nbsp; Which
do you prefer a self-inflating bag or a flow-inflating bag? Give rationale for your answer.
(4 pts)
28. &= nbsp; After intubation of a patient how would you ensure that ventilation of the patien= t is adequate? (4 pts)
29. List = four drugs used in the process of Rapid Sequence Intubation and give a brief description of the purpose of each drug you listed. (4 pts)
30. &= nbsp; Describe the minimal leak technique for maintaining pressure in an endotracheal tube cuff. (4 pts)
31. &= nbsp; List the four standard criteria for initiating mechanical ventilation. (4 pts)
32. Calcu= late the inspiratory time on a volume-cycled ventilator if the tidal volume is 6= 00 ml and the peak inspiratory flow rate is 60 lpm. Assume a square flow curve. (2 pts)
33. Descr= ibe the MMV mode of mechanical ventilation.&nb= sp; Include advantages of this mode and drawbacks of this mode in your description. (6 pts)
34. &= nbsp; What four main parameters are set when using the APRV mode? (4 pts)
35. &= nbsp; Discuss the best way to determine appropriate Pressure Support level for a patient. (4 pts)
36. &= nbsp; Discuss four complications of Noninvasive Positive Pressure Ventilation. (4 pts)
37. For t= he following graphics diagrams, identify the problem shown and list one thing you could = try to correct the problem. (6 pt= s)