Respiratory Therapist Exam Review-chapters 1 & 2

A patient who is suffering from respiratory distress would exhibit nasal flaring, intercostal retractions, and use of accessory muscles of inspiration. However, a normal respiratory rate would not be expected in a patient experiencing respiratory distress.

Given the scenario where the drug dosage is outside the normal department guidelines, it is important to ensure patient safety. Contacting the physician to confirm the order is the appropriate course of action as it allows for clarification and verification of the dosage. This step helps to prevent any potential harm to the patient and ensures that the medication is administered correctly.

Stridor is a harsh, high-pitched sound that is heard on inspiration and indicates a partial obstruction in the upper airway. It is a respiratory emergency because it suggests that the patient's airway is compromised and immediate intervention is required to ensure adequate breathing. Tracheal sounds are normal and are heard over the trachea, while bronchial sounds are abnormal and indicate a problem in the larger airways. Bronchovesicular sounds are normal and are heard over the main bronchi.

In acute respiratory distress syndrome (ARDS), the patient experiences a severe decrease in oxygen levels in the blood. This condition leads to increased work of breathing and respiratory distress. The patient is expected to exhibit symptoms such as nasal flaring, intercostal retractions, and the use of accessory muscles of inspiration. However, a normal respiratory rate is not expected in ARDS. The body compensates for the low oxygen levels by increasing the respiratory rate in an attempt to improve oxygenation. Therefore, a normal respiratory rate would be inconsistent with the clinical presentation of ARDS.

Based on the given information, the patient's most likely problem is a right-sided pneumothorax. The hyperresonant percussion note on the right side suggests the presence of air in the pleural space, which is characteristic of a pneumothorax. The tracheal shift to the left indicates a tension pneumothorax, which is a medical emergency. The other options, such as broken ribs, broken clavicle, or acute myocardial infarction, do not explain the hyperresonant percussion note and tracheal shift.

Infants younger than 6 months of age are exempted from receiving an annual influenza vaccination. This is because the flu vaccine is not approved for use in infants below this age group. Infants have immature immune systems and are more susceptible to complications from the vaccine. Therefore, it is recommended to protect them from the flu by ensuring that their caregivers and close family members are vaccinated to reduce the risk of transmission.

The question is asking about a symptom called orthopnea, which is shortness of breath that occurs when lying flat. The correct answer is "Do you need to use extra pillows behind your head and back to keep from getting short of breath when you sleep?" This question specifically addresses the symptom of orthopnea by asking if the patient needs to elevate their head and back with extra pillows to prevent shortness of breath while sleeping. This can help determine if the patient experiences orthopnea.

To ensure that the proper level of care is delivered, it is important to ask the patient's family members whether any advance directives have been documented. Advance directives are legal documents that outline the patient's preferences for medical treatment in case they become unable to communicate their wishes. Knowing if any advance directives exist will help healthcare providers make informed decisions about the patient's care and ensure that their wishes are respected.

A mediastinal shift on a chest x-ray occurs when there is a displacement of the structures in the mediastinum, which is the central area of the chest. This can be caused by various conditions such as hemothorax, tension pneumothorax, and atelectasis. However, bilateral lower lobe pneumonia typically does not cause a mediastinal shift. Pneumonia is an infection that primarily affects the lung tissue, and it does not usually lead to significant displacement of the mediastinal structures. Therefore, bilateral lower lobe pneumonia is the exception in this case.

When an error is made while charting on a patient, the appropriate action is to place a line through the error, initial it, and then write in the correct information. This ensures that the error is clearly marked and the correct information is recorded. Informing the nurse or supervisor is not necessary in this case as the error can be rectified immediately by the person who made it.

The patient's change in behavior, specifically becoming argumentative and making threats, suggests that there may be underlying emotional issues at play. It is important to consider the patient's emotional state in order to understand and address their behavior. This could be a result of fear, anxiety, or frustration related to the cancer diagnosis. Evaluating the patient's emotional state can help healthcare providers provide appropriate support and interventions to address their emotional needs.

The patient's symptoms of increased shortness of breath and thicker secretions after developing a "chest cold" suggest a possible respiratory infection. Getting a sputum sample for a culture and sensitivity study can help identify the specific pathogen causing the infection and determine the most effective antibiotic treatment. This is important in guiding appropriate therapy and preventing further complications. Increasing the flow on his home oxygen concentrator may not address the underlying infection. Performing a 6-minute walk test or percussion to determine the hemidiaphragm positions are not relevant in this context.

The most likely cause of crepitation in the neck while palpating is an air leak from the lung. This can occur due to a pneumothorax, which is a condition where air accumulates in the pleural space between the lung and the chest wall. The presence of broken ribs in the patient suggests the possibility of a traumatic injury to the chest, which could lead to a pneumothorax. The air leak from the lung can cause subcutaneous emphysema, leading to the crepitation felt in the neck. This is a common finding in patients with chest trauma and can be a potentially serious condition requiring immediate medical attention.

The patient is an adult with a history of smoking, and the PA chest radiograph shows increased anteroposterior diameter and depressed hemidiaphragms. These findings are consistent with emphysema, a condition characterized by the destruction of the alveoli in the lungs, leading to air trapping and hyperinflation. Smoking is a common cause of emphysema, and the radiographic findings align with the disease. Pulmonary fibrosis would typically present with a reticular or nodular pattern on imaging, which is not mentioned in the question. Left ventricular failure would typically manifest with cardiomegaly and signs of fluid congestion, which are not described in the radiograph findings. Therefore, the most likely explanation is that the patient has emphysema.

The patient has demonstrated the proper use of the inhaler and medication, indicating that they are capable of self-administering their treatment. Since the patient is a minor, it is important to involve the parent in the decision-making process. By beginning a patient-driven medication protocol with the parent's permission, the patient can take responsibility for managing their asthma while still receiving guidance and support from their parent. This approach promotes independence and self-care while ensuring that the parent remains involved in the treatment process.

If an infant's chest configuration is the same size in both the AP (anterior-posterior) and lateral dimensions, it indicates a normal chest. This means that there are no abnormalities or deformities present in the chest structure.

After experiencing vomiting and diarrhea for two days, the patient's ECG shows five PVCs in one minute and flat T waves. These findings suggest an electrolyte imbalance, which can occur due to dehydration caused by the flu. Therefore, it would be appropriate to recommend an electrolyte test to assess the levels of various electrolytes such as sodium, potassium, and calcium in the patient's blood. This test will help identify any abnormalities and guide the appropriate treatment for the patient.

Normal vital signs for a term newborn include a heart rate of 130/min, a rectal temperature of 36.5 degrees Celsius, a blood pressure of 64/40 mm Hg. However, a respiratory rate of 20/min is not considered normal for a term newborn. The normal respiratory rate for a term newborn is typically higher, around 30-60 breaths per minute. Therefore, a respiratory rate of 20/min would be considered abnormal and may indicate a potential issue with the baby's respiratory system.

The best way to determine the location of the endotracheal tube in an intubated patient who has been moved to the Intensive Care Unit is to get a chest x-ray. This imaging technique will provide a clear visualization of the tube's position within the patient's chest, ensuring that it is correctly placed in the trachea and not causing any complications. Palpating the larynx, listening to stomach sounds, or percussing the patient's chest may not provide accurate information about the tube's location and can lead to misinterpretation. A chest x-ray is the most reliable method to confirm the correct placement of the endotracheal tube.

The correct answer is to resterilize the equipment and check for destruction of the spores. This is because the presence of surviving spores indicates that the initial sterilization process was not effective in eliminating all potential pathogens. Resterilizing the equipment will ensure that it is safe for use, and checking for destruction of the spores will confirm that the process has been successful. Using the equipment without resterilization or simply wiping off the spores may still pose a risk of contamination.

The patient's breathing pattern, characterized by tidal volumes going from small to large to small and then stopping for 10 seconds before starting up again, is consistent with Cheyne-Stokes respiration. This is a cyclic pattern of breathing commonly seen in patients with heart failure, brain damage, or other conditions affecting the respiratory centers in the brain. It is characterized by periods of gradually increasing and decreasing tidal volumes, followed by a period of apnea.

When a patient has a broken ankle from a recent slip on an icy sidewalk, it is most important to ask about the level of pain they are experiencing. This is crucial because pain can indicate the severity of the injury and help determine the appropriate course of treatment. Additionally, assessing the level of pain can help monitor the effectiveness of any pain management interventions that may be administered.

A tension pneumothorax is identified by the sudden deterioration of the patient's vital signs, the elevation of the hemidiaphragm on the affected side on a chest x-ray film, and the shift of the mediastinum away from the affected lung on a chest x-ray film.

The patient's complaint of localized pain over the lower right area of the chest while breathing, along with the presence of a rasping noise at the point of pain on both inspiration and expiration, suggests a pleural friction rub. A pleural friction rub is a specific type of abnormal breath sound that occurs when the inflamed pleural surfaces rub against each other during respiration. This rubbing sound is typically heard on both inspiration and expiration and is associated with conditions such as pleurisy or pneumonia.

Tachycardia, peripheral edema in the dependent parts of the body, and low urine specific gravity are signs that suggest fluid overload. Tachycardia occurs because the body tries to compensate for the increased fluid volume by increasing the heart rate. Peripheral edema in the dependent parts of the body occurs because the excess fluid accumulates in the lower extremities due to gravity. Low urine specific gravity indicates that the kidneys are not able to effectively concentrate urine, which can be a result of fluid overload.

It would be acceptable to take a mixed-venous blood sample from the catheter if the tip were found in the right pulmonary artery. This is because the right pulmonary artery is the vessel that carries deoxygenated blood from the right ventricle of the heart to the lungs for oxygenation. Therefore, a blood sample taken from this location would accurately reflect the mixed-venous blood, which represents the oxygen content of blood returning to the heart from the body's tissues.

The distended external jugular veins in the patient suggest that she is fluid overloaded. When there is an excess of fluid in the body, it can cause increased pressure in the veins, leading to their distention. This can be observed in the external jugular veins, which are located in the neck. Hypertension, emphysema, and dehydration would not typically cause distended external jugular veins.

In patients with congestive heart failure, the use of diuretics like furosemide can cause excessive loss of potassium through increased urine output. Low potassium levels can lead to cardiac arrhythmias and worsen heart failure symptoms. Therefore, monitoring serum potassium levels is crucial in this situation to prevent potential complications and ensure the patient's safety.

Based on the signs and symptoms observed in the patient, such as high fever, diaphoresis (excessive sweating), increased respiratory rate, use of accessory muscles for breathing, and palpable rhonchi (abnormal sounds) in the right lower lobe, the most likely diagnosis would be bacterial pneumonia. Bacterial pneumonia is an infection of the lungs caused by bacteria, which can lead to symptoms such as high fever, difficulty breathing, and abnormal lung sounds. Heart attack and pneumothorax may present with different symptoms, while viral pneumonia may have similar symptoms but is less likely given the severity of the patient's presentation.

The Apgar score is a quick assessment tool used to evaluate the physical condition of a newborn immediately after birth. It consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each component is scored from 0 to 2, with a maximum total score of 10. A score of 5 indicates that the neonate's condition is moderately depressed. In this case, the heart rate is slightly low, there is a weak cry, some flexion is noted in the arms and legs, and the baby grimaces when stimulated. However, the acrocyanosis (blue extremities) suggests some degree of oxygenation.

Patients with heart or lung disease commonly have shifting of mediastinal structures. A mediastinal shift can be seen on a chest radiograph in several conditions. A right-sided hemothorax can cause a shift of the mediastinal structures towards the unaffected side. A left-sided tension pneumothorax can cause a shift of the mediastinal structures towards the unaffected side as well. Right lower lobe atelectasis can cause a shift of the mediastinal structures towards the affected side. Fibrosis of the left lung can cause a shift of the mediastinal structures towards the affected side. Therefore, options 1, 3, 4, and 5 can all result in a mediastinal shift being seen on a chest radiograph in patients with cardiopulmonary disease.

The most likely cause of the Escherichia coli tracheal infections in the home care company's tracheostomy patients is poor hand-washing technique by visiting respiratory therapists. This is because respiratory therapists are directly involved in the care of tracheostomy patients and if they do not practice proper hand hygiene, they can introduce bacteria, such as Escherichia coli, into the patients' trachea. The other options, such as contaminated tracheostomy tubes or bottles of sterile water from the manufacturer, or poor hand-washing technique by patients' family members, may also contribute to infections but are less likely compared to the respiratory therapists' hand-washing technique.

Based on the information provided, the lateral neck radiograph shows a clear air column through the upper airway but a pointed narrowing of the tracheal air column below the larynx. This is consistent with the characteristic findings of laryngotracheobronchitis, also known as croup. Croup is a viral infection that causes inflammation and narrowing of the upper airway, leading to symptoms such as a barking cough, hoarseness, and difficulty breathing. Therefore, the correct answer is Laryngotracheobronchitis.

The radiologist's remark about an enlarged left side of the heart suggests that the patient has an abnormal heart. This could be indicative of conditions such as cardiomegaly, left ventricular hypertrophy, or other structural abnormalities. It is important to further investigate and evaluate the patient's cardiac health to determine the underlying cause and appropriate treatment.

Transillumination is the recommended test to determine whether the newborn has a pneumothorax. Transillumination involves shining a light through the chest wall to assess for the presence of air or fluid. In the case of a pneumothorax, the light will not pass through the affected area, indicating the presence of air in the pleural space. This test is non-invasive and can provide valuable information to aid in diagnosis and management of the newborn's respiratory distress.

When palpating the patient for symmetrical chest movements, if the left side does not move as much as the right side, it indicates that the patient may have left-sided pneumonia or left-sided pneumothorax. Left-sided pneumonia refers to an infection in the left lung, which can cause decreased movement on that side. Left-sided pneumothorax refers to the presence of air in the left pleural space, which can also cause decreased chest movement on the left side. Therefore, the correct answer is 3, 4.

The preferred radiographic position to minimize distortion of the heart is posteroanterior. This positioning involves taking the X-ray from behind the patient and directing the X-ray beam towards their chest. This position helps to reduce the magnification and distortion of the heart, allowing for a clearer and more accurate image. This is particularly important in a patient with COPD and left ventricular failure, as it helps to visualize the heart and assess its condition more effectively.

The blunting of the left costophrenic angle with an air/fluid level and a meniscus in the left lower lung area on the chest radiograph is indicative of a pleural effusion in the left lung. Pleural effusion refers to the accumulation of fluid in the pleural space, which can occur due to various causes, including congestive heart failure. This finding is consistent with the patient's repeated episodes of congestive heart failure and is suggestive of fluid collecting in the pleural space of the left lung.

Diminished breath sounds and a shift in the trachea to the affected side are indicative of atelectasis, which is the collapse or closure of a lung or part of a lung. In this case, the patient's symptoms suggest right-sided atelectasis, as the breath sounds are diminished in the right lower lobe and the trachea is shifted to the right. Atelectasis can be caused by various factors, such as blockage of the airway, compression of the lung, or surfactant deficiency.

To help determine a patient's level of consciousness, it is important to ask questions that assess their orientation to person, place, and time. Question 2, "Can I see your identification wristband?" helps determine if the patient is aware of their own identity and location. Question 4, "How are you feeling today?" helps assess the patient's awareness of their current state and overall well-being. These questions provide valuable information about the patient's cognitive function and level of consciousness.

Giving the infant to the mother as soon as possible for bonding is the correct answer because a 5-minute Apgar score of 8 indicates that the infant is in good condition and does not require immediate medical intervention. Bonding between the mother and the infant is important for establishing a strong emotional connection and promoting breastfeeding. It is also beneficial for the infant's overall well-being and development.

Steam autoclaving is the best method to sterilize the reusable main-flow bacteria filter. Steam autoclaving uses high pressure and high temperature steam to kill microorganisms, including bacteria, viruses, and spores. This method is highly effective in sterilizing medical equipment and is commonly used in healthcare settings. Wrapping and soaking the filter in acetic acid, pasteurization, and glutaraldehyde soak are not as effective as steam autoclaving for sterilization purposes.

Ethylene oxide is the best method for sterilizing a contaminated Bird Mark 7 IPPB unit before use with another patient. Ethylene oxide is a gas that is commonly used for sterilization because it is highly effective in killing bacteria, viruses, and other microorganisms. It can penetrate through various materials and reach all areas of the equipment, ensuring thorough sterilization. Additionally, ethylene oxide does not require high temperatures or moisture, making it suitable for sensitive equipment like the IPPB unit.

The correct answer is to have the two coughing people sit near each other to minimize their contact with other people in the waiting room. This is because if the two individuals are sitting near each other, they are more likely to spread their respiratory illness to each other and potentially to others in the waiting room. The other options, such as having each person wear a face mask, giving them facial tissues, and having them sit at least 3 feet away from anyone else, are all appropriate measures to prevent the spread of respiratory illnesses.

Bronchial breath sounds are harsh and high-pitched sounds heard over the trachea or bronchi, and they are not normally heard in healthy lung tissue. The presence of bronchial breath sounds in the right lower lobe suggests consolidation, which refers to the filling of the alveoli with fluid or solid material. This can be caused by conditions such as pneumonia or lung abscess. Therefore, the correct answer is consolidation in her right lower lobe.

To prevent the spread of SARS, several measures should be implemented. First, the patient's healthcare workers must wear an N-95 face mask (answer 1) to protect themselves and others from inhaling the virus. Second, Airborne Precautions should be used (answer 3) to minimize the risk of airborne transmission. This includes isolating the patient in a negative pressure room and using appropriate ventilation systems. Finally, Contact Precautions should be used (answer 5) to prevent direct contact transmission. This involves wearing gloves and gowns when interacting with the patient and properly disinfecting surfaces. Therefore, the correct answers are 1, 3, and 5.

Pasteurization is the most cost-effective way for a respiratory care department to disinfect large amounts of reusable plastic tubing and oxygen masks. Pasteurization is a process that uses heat to kill bacteria, viruses, and other microorganisms. It is a widely used method in the food industry to kill pathogens while preserving the quality of the product. In the context of disinfecting medical equipment, pasteurization can effectively eliminate harmful microorganisms without causing damage to the plastic materials. Additionally, pasteurization is a relatively simple and inexpensive process compared to other methods such as steam autoclave or dry heat.

The correct answer is to soak the nondisposable plastic pulmonary function testing mouthpiece in a glutaraldehyde solution for 10 hours. Glutaraldehyde is a high-level disinfectant that is effective against a wide range of microorganisms, including Clostridium botulinum. Soaking the mouthpiece in this solution for 10 hours ensures thorough sterilization before reuse. The other options, such as steam autoclaving, pasteurizing, or soaking in an alcohol solution, may not provide the same level of sterilization as the glutaraldehyde solution.

Acetic acid would be the best option for the retired home care patient living on a fixed income to disinfect her respiratory therapy equipment. Acetic acid is a common household item, also known as vinegar, which is easily accessible and affordable. It has antimicrobial properties and can effectively kill bacteria and viruses. Additionally, it is safe to use and does not leave any harmful residue on the equipment. Therefore, using acetic acid as a disinfectant would be a practical and cost-effective solution for the patient.

Soaking the equipment in white vinegar can help reduce bacterial growth because vinegar has antimicrobial properties. Washing the equipment in hot water with a detergent can also help remove bacteria. Therefore, options 1 and 4 are correct as they both provide methods to reduce bacterial growth in respiratory care equipment.