Respiratory Therapist Competency Exams Prep Test

The patient is experiencing moderate stridor, which is a high-pitched sound caused by narrowing of the airway. The fact that the patient's Spo2 is 95% indicates that they are adequately oxygenated. The heart rate and respiratory rate are within normal range. Racemic epinephrine is a bronchodilator that can help alleviate stridor by reducing airway inflammation and improving airflow. Therefore, the respiratory therapist should recommend racemic epinephrine as the next course of action to address the patient's stridor.

A patient with multiple right-sided rib fractures would present with flail chest. Flail chest refers to a condition where a segment of the chest wall becomes detached from the rest of the chest due to multiple rib fractures. This results in paradoxical chest movement, where the affected segment moves in an opposite direction to the rest of the chest during respiration. It is characterized by inward movement during inspiration and outward movement during expiration. Dull percussion on the right side may be present due to the underlying rib fractures, but it is not specific to flail chest. Symmetrical chest expansion would not be expected in flail chest.

Spiked or peaked T waves on an ECG may be due to hyperkalemia. Hyperkalemia is a condition characterized by high levels of potassium in the blood. This can affect the electrical conduction system of the heart, leading to changes in the T wave on an ECG. The elevated potassium levels can cause delayed repolarization of the ventricles, resulting in tall and peaked T waves. It is important to identify and treat hyperkalemia promptly, as it can lead to serious cardiac complications.

The patient's symptoms, including increased peak inspiratory pressures, coarse rhonchi, and a fever, suggest the presence of a respiratory infection. Therefore, the respiratory therapist should recommend a sputum culture and gram stain to identify the causative organism and guide appropriate antibiotic treatment. This will help in determining the most effective treatment for the patient's condition.

An elevated ST segment is often a sign of myocardial infarction, also known as a heart attack. During a heart attack, the blood supply to a part of the heart is blocked, leading to damage in the affected area. This can cause changes in the electrical activity of the heart, including an elevation of the ST segment on an electrocardiogram (ECG). It is an important diagnostic finding that helps healthcare professionals identify and treat a heart attack promptly.

The presence of distant breath sounds on the left side with a tracheal shift to the right indicates a potential left side pneumothorax. A pneumothorax occurs when air accumulates in the pleural space, causing the lung to collapse. In this case, the shift in the trachea suggests that the lung on the left side is affected, causing it to collapse and shift the trachea towards the unaffected side. This is a serious condition that requires immediate attention and intervention.

Increased airway resistance causes difficulty in moving air in and out of the lungs, leading to increased effort from the accessory muscles to aid in breathing. When the airways become narrowed or obstructed, such as in conditions like asthma or chronic obstructive pulmonary disease (COPD), the body compensates by recruiting additional muscles to assist with breathing. This increased accessory muscle use is a protective mechanism to ensure adequate ventilation and oxygenation of the body.

The distant breath sounds and resonant percussion on the left side suggest that the endotracheal tube has been placed too far into the right mainstem bronchus. This causes ventilation to be directed primarily to the right lung, resulting in decreased airflow and breath sounds on the left side.

When the therapist hears the soft A sound, or "ahhhh," when the patient says the letter "E," it indicates a change in voice sounds. This change is commonly associated with the condition of pneumonia.

Coarse bilateral crackles heard during lung auscultation are most likely due to secretions. Secretions in the airways can cause obstruction and result in abnormal lung sounds. This can occur in conditions such as bronchitis, pneumonia, or respiratory tract infections where there is an excessive production of mucus or phlegm. These secretions can create a gurgling or rattling sound when air passes through them, leading to coarse crackles on auscultation. Pulmonary edema, pulmonary fibrosis, and atelectasis may also cause abnormal lung sounds, but secretions are the most likely cause in this scenario.

The correct answer is Foreign body airway obstruction. Auscultation of unilateral wheezing in a 3-year-old child suggests a partial obstruction in the airway caused by a foreign body. Asthma typically presents with bilateral wheezing, secretions in the airway may cause crackles rather than wheezing, and pneumonia usually presents with bilateral findings such as crackles or decreased breath sounds.

The patient's edema and elevated CVP reading of 12 suggest hypervolemia, which refers to an excess of fluid volume in the body. In hypervolemia, there is an increase in blood volume, leading to fluid accumulation in the tissues and organs. This condition can be caused by various factors such as heart failure, kidney disease, or excessive fluid intake. The presence of a pulmonary artery catheter indicates that the patient is in a critical condition and requires close monitoring of their fluid status.

Pneumonia is an infection in the lungs that causes inflammation and fluid buildup. This can lead to increased tactile fremitus, which is the vibration felt when a patient speaks. The inflammation and fluid in the right lower lobe of the patient's lungs would cause increased transmission of vibrations, resulting in increased tactile fremitus. Pneumothorax, COPD, and pleural effusion are not typically associated with increased tactile fremitus.

A tracheal shift to the right side is most likely caused by right side atelectasis. Atelectasis refers to the collapse or closure of a lung or a part of it, which can result in a shift of the trachea towards the affected side. This occurs because the collapsed lung is unable to maintain its normal position, causing the trachea to deviate towards the unaffected side. In this case, the right side atelectasis is causing the tracheal shift to the right side.

Decreased LOC (Level of Consciousness) is not an immediate potential complication of percutaneous tracheostomy tube insertion. This procedure involves creating a surgical opening in the trachea to assist with breathing, and complications can occur. Bleeding, pneumothorax (collapsed lung), and subcutaneous emphysema (air trapped under the skin) are all possible immediate complications. However, decreased LOC is not directly related to the procedure itself and is more likely to be caused by other factors such as anesthesia or underlying medical conditions.

The correct answer is the Modified jaw thrust maneuver. This technique is used to open the airway of an unconscious patient without moving the neck or spine. It involves placing the fingers behind the angle of the mandible and lifting the jaw forward, which helps to bring the tongue away from the back of the throat and allows for better airflow. This maneuver is considered the safest and most effective way to establish an airway in patients with potential cervical spine injuries.

Given the auscultation and percussion findings of distant breath sounds and hyperresonance, along with the suspicion of a pneumothorax, the next recommended step would be needle decompression. This procedure involves inserting a large-bore needle into the chest to release trapped air and relieve the pressure on the lung. It is an immediate intervention that can be life-saving for a hemodynamically unstable patient with a suspected pneumothorax. Obtaining an ABG or ordering a chest X-ray may provide further information, but needle decompression takes priority in this critical situation. Chest tube insertion may be considered if the pneumothorax is confirmed or if the needle decompression is not effective.

The estimated heart rate of this ECG is 75. This can be determined by counting the number of QRS complexes (the spikes on the ECG) within a specific time frame, usually one minute. In this case, the ECG shows a heart rate of 75 beats per minute.

When the patient's bed in the ICU is raised, it will cause a false low reading of the patient's central venous pressure (CVP). This is because the transducer, which is attached to an IV pole, measures the pressure at the level of the heart. When the bed is raised, the transducer is positioned below the level of the heart, leading to a decrease in hydrostatic pressure and a false low reading of the CVP.

In status asthmaticus, there is severe and prolonged bronchoconstriction, leading to increased resistance in the airways. This results in a significant increase in airway pressure during inspiration, leading to a large difference between PIP (peak inspiratory pressure) and Pplat (plateau pressure). Pulmonary fibrosis and bronchiectasis may cause increased airway resistance, but they do not typically result in the same degree of bronchoconstriction as seen in status asthmaticus. Quadriplegia does not directly affect the airways and would not cause a large difference between PIP and Pplat.