RESP 2070 Review Unit II

Chapter 21

100

Which control is used to adjust a patients PaCO2 in NIV? a) EPAP b) CPAP c) Vt d) IPAP

What is d) IPAP

200

Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in the acute care setting? a) paradoxical breathing b) jugular venous distention c) respiratory rate more than 25/min d) use of accessory muscles

What is b) jugular venous distention

300

The respiratory therapist has placed a patient on noninvasive ventilation. After two hours the patient showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. What corrective action should be performed?

What is add heated humidity (humidifier)

400

What is the primary physiological effect of positive end-expiratory pressure (PEEP)? a) increase the functional residual capacity (FRC) b) increase the inspiratory reserve volume (IRV) c) decrease the compliance of the lung (CL) d) increase the length of expiration

 a) increase the functional residual capacity (FRC)

500

Which of the following is likely to occur when decreasing the expiratory positive airway pressure in the patient being ventilated using noninvasive ventilation? a) improved PaO2 b) increased functional residual capacity c) increased tidal volume d) increased positive end expiratory pressure

What is c) increased tidal volume

Chapter 9

100

What is the name of the procedure in which a needle is inserted into the chest to remove fluid from the pleural space.  

Thoracentesis

200

Which of the following are examples of therapeutic bronchoscopy (SELECT ALL THAT APPLY)?

I.    Suspected malignancy

II.    BAL

III.    FBO removal

IV.    Transbronchial biopsy (TBB)

II & III

300

What type of pleural fluid typically has a pH > 7.30 and is clear or light straw colored in appearanace?

Transudative fluid

400

Which type of endotracheal tube has a double-lumen and is inserted to allow one lung to be ventilated while the other one can have a procedure done (e.g., a complete lavage)?

Carlens Tube

500

Which of the following describes an endobronchial ultrasound (EBUS)?

a. A magnetic board is placed beneath the patient's chest which transmits low-frequency electromagnetic waves.

b. A hollow metal tube that can act as an airway is inserted into the airway while the patient is under general anesthesia.

c. An ultrasound probe is attached to the distal end of a bronchoscope which provides real-time guidance.

d. Ultrasound is used on the chest while the physician conducts a bronchoscopy.

c. An ultrasound probe is attached to the distal end of a bronchoscope which provides real-time guidance.

Chapter 21 Part II

100

Which control is used to adjust the patients PaO2 in noninvasive ventilation besides FiO2?

What is EPAP

200

A patient is receiving noninvasive PPV by mask. Current settings and ABG results are as follows: IPAP12 cm H2O EPAP6 cm H2O Respiratory Rate12/min pH7.29 PaCO255 mmHg PaO2 79 mmHg HCO327 mEq/L BE+3 mEq/L Which of the following should the therapist recommend? a)Increase the IPAP to 15 cm H2O b)Increase the IPAP to 20 cm H2O c)Increase the EPAP to 8 cm H2O d)Increase the EPAP to 10 cm H2O

What is a)Increase the IPAP to 15 cm H2O

300

\Which of the following are possible solutions to correct a large air leak during noninvasive ventilation (SELECT ALL THAT APPLY)?
1. Selecting an appropriately sized mask
2. Applying chin straps
3. Using a full-face mask
4. Decreasing the inspiratory time

1, 2, 3

400

All of the following are potential benefits of using noninvasive ventilation (NIV) during weaning except reduced:

a)      length of intensive care unit (ICU) stay

b)      incidence of nosocomial pneumonia

c)      mortality rate

d)      incidence of pulmonary embolism

d)      incidence of pulmonary embolism

500

All of the following are goals of noninvasive ventilation (NIV) in the acute care setting, except:

a)    Avoid intubation.

b)    Decrease incidence of ventilation-associated pneumonia.

c)    Decrease length of stay.

d)    Improve mobility. 

d)    Improve mobility.

Chapter 9 Part II

100

What aerosolized medication is used before a bronchoscopy to help control the gag reflex/cough?

Lidocaine

200

Which of the following are examples of diagnostic bronchoscopy (SELECT ALL THAT APPLY)?

I.    Suspected malignancy

II.    BAL

III.    FBO removal

IV.    Transbronchial biopsy (TBB)

I.    Suspected malignancy

IV.    Transbronchial biopsy (TBB)

300

Which of the following is NOT a contraindication for a bronchoscopy?

a)    Status asthmaticus

b)    Mechanical ventilation

c)    Refractory hypoxemia

d)    Cardiovascular instability

b)    Mechanical ventilation

400

Which bronchoscopy instrument is preferable for extracting foreign objects?

a.    Flexible bronchoscope

b.    Tracheal bronchoscope

c.    Rigid bronchoscope 

d.    Video bronchoscope

c.    Rigid bronchoscope

500

What is not an indication for bronchoscopy?

a.    Presence of lesions of unknown etiology

b.    Suspicious or positive sputum cytology results

c.    Severe refractory hypoxemia

d.    A need to obtain lower respiratory tract secretions

c.    Severe refractory hypoxemia

BiPAP Scenarios

100

A patient is receiving noninvasive PPV by mask.  Current settings and ABG results are as follows:

IPAP    12 cm H2O

EPAP    5 cm H2O

Respiratory Rate    12/min

pH    7.33

PaCO2    53 mmHg

PaO2    80 mmHg

HCO3    27 mEq/L

BE    +3 mEq/L

Which of the following should the therapist recommend?

a)    Increase the IPAP to 15 cm H2O

b)    Increase the IPAP to 20 cm H2O

c)    Increase the EPAP to 8 cm H2O

d)    Increase the EPAP to 10 cm H2O

a)    Increase the IPAP to 15 cm H2O

200

A patient is receiving noninvasive PPV by mask.  Current settings and ABG results are as follows:

IPAP    20 cm H2O

EPAP    10 cm H2O

Respiratory Rate    12/min

pH    7.30

PaCO2    65 mmHg

PaO2    65 mmHg

HCO3    27 mEq/L

BE    +3 mEq/L

Which of the following should the therapist recommend (SELECT ALL THAT APPLY)?

1.    Increase the IPAP to 25 cm H20

2.    Increase the EPAP to 20 cm H2O

3.    Increase the EPAP to 15 cm H2O

4.    Increase the IPAP to 30 cm H2O

3.    Increase the EPAP to 15 cm H2O

4.    Increase the IPAP to 30 cm H2O

300

A patient is receiving noninvasive PPV by mask. Current settings and ABG results are as follows:

IPAP    10 cm H2O

EPAP    5 cm H2O

Respiratory Rate    12/min

pH    7.25

PaCO2    70 mmHg

PaO2    60 mmHg

HCO3    27 mEq/L

BE    +3 mEq/L

Which of the following should the therapist do FIRST?

a)    Increase the IPAP to 20 cm H2O

b)    Increase the IPAP to 25 cm H2O

c)    Increase the EPAP to 8 cm H2O

d)    Increase the EPAP to 10 cm H2O

a)    Increase the IPAP to 20 cm H2O

400

A patient is receiving noninvasive PPV by mask. Current settings and ABG results are as follows:

IPAP    25 cm H2O

EPAP    15 cm H2O

Respiratory Rate    12/min

pH    7.36

PaCO2    42 mmHg

PaO2    68 mmHg

HCO3    27 mEq/L

BE    +3 mEq/L

Which of the following should the therapist recommend (SELECT ALL THAT APPLY)?

1.    Increase the IPAP to 30 cm H2O

2.    Decrease the IPAP to 20 cm H2O

3.    Increase the EPAP to 20 cm H2O

4.    Increase the EPAP to 30 cm H2O

1.    Increase the IPAP to 30 cm H2O

3.    Increase the EPAP to 20 cm H2O

500

A patient is receiving noninvasive PPV by mask.  Current settings and ABG results are as follows:

IPAP    15 cm H2O

EPAP    5 cm H2O

Respiratory Rate    12/min

pH    7.31

PaCO2    63 mmHg

PaO2    83 mmHg

HCO3    27 mEq/L

BE    +3 mEq/L

Which of the following should the therapist recommend (SELECT ALL THAT APPLY)?

1.    Increase the IPAP to 20 cm H20

2.    Increase the EPAP to 10 cm H2O

3.    Decrease the IPAP to 10 cm H2O

4.    Decrease the EPAP to 2 cm H2O

1.    Increase the IPAP to 20 cm H20