Respiratory Therapy Quiz

1. What is the best way to reduce intrapulmonary shunting in ARDS patients while on a ventilator.

High FiO2

Increase in i Time

Decrease in i Tim

Carefully adjusting the PEEP to help Oxygenation

High Pressures to help Oxygenation

Carefully adjusting the PEEP (positive end-expiratory pressure) can help improve oxygenation in ARDS (acute respiratory distress syndrome) patients on a ventilator. PEEP is used to keep the alveoli open and prevent collapse during expiration, improving gas exchange. By carefully adjusting the PEEP, the clinician can optimize lung recruitment and oxygenation while minimizing the risk of lung injury. This approach is considered the best way to reduce intrapulmonary shunting, which is the mixing of oxygenated and deoxygenated blood in the lungs, in ARDS patients on a ventilator.

Explanation

Carefully adjusting the PEEP (positive end-expiratory pressure) can help improve oxygenation in ARDS (acute respiratory distress syndrome) patients on a ventilator. PEEP is used to keep the alveoli open and prevent collapse during expiration, improving gas exchange. By carefully adjusting the PEEP, the clinician can optimize lung recruitment and oxygenation while minimizing the risk of lung injury. This approach is considered the best way to reduce intrapulmonary shunting, which is the mixing of oxygenated and deoxygenated blood in the lungs, in ARDS patients on a ventilator.

2. What formula correctly calculates the dead space of a patient

(PaCO2 - PetCO2) / PaCO2

(PetCO2 - PaCO2) / PetCO2

(PaCO2 - PetCO2) / PetCO2

(PetCO2 - PaCO2) / PaCO2

The formula (PaCO2 - PetCO2) / PaCO2 correctly calculates the dead space of a patient. Dead space refers to the portion of the respiratory system where no gas exchange occurs, and it is measured by comparing the partial pressure of carbon dioxide (PaCO2) in arterial blood to the partial pressure of end-tidal carbon dioxide (PetCO2), which represents the concentration of carbon dioxide at the end of expiration. Dividing the difference between these two values by the arterial partial pressure of carbon dioxide gives an accurate measurement of dead space.

Explanation

The formula (PaCO2 - PetCO2) / PaCO2 correctly calculates the dead space of a patient. Dead space refers to the portion of the respiratory system where no gas exchange occurs, and it is measured by comparing the partial pressure of carbon dioxide (PaCO2) in arterial blood to the partial pressure of end-tidal carbon dioxide (PetCO2), which represents the concentration of carbon dioxide at the end of expiration. Dividing the difference between these two values by the arterial partial pressure of carbon dioxide gives an accurate measurement of dead space.

3. An adult patient is on a pressure controlled ventilation mode. Suctioning is needed often. The patient is experiencing repeated bouts of severe coughing, tachypnea, wheezing and is not receiving adequate tidal volumes. This can be best corrected by:

Increasing the diameter of the suction catheter.

Changing to a closed system (inline) suction catheter.

Increasing the pressure limit.

Changing to a volume regulated mode.

The patient should be changed from a pressure-cycled to a volume-cycled ventilator to deliver a consistent tidal volume. Changing airway resistance conditions in the patient will result in a pressure-cycled ventilator delivering inconsistent tidal volumes.

Explanation

The patient should be changed from a pressure-cycled to a volume-cycled ventilator to deliver a consistent tidal volume. Changing airway resistance conditions in the patient will result in a pressure-cycled ventilator delivering inconsistent tidal volumes.

4. Patients with variable airway compliance and resistance should be placed on what type of ventilation mode?

CPAP

Pressure Control

Volume Control

Ask a pulmonologist.

Explanation

Ask a pulmonologist.

5. A 20-year-old patient is admitted to the ER while having an asthma attack. She is being treated with 0.63 mg of levalbuterol (Xopenex) by small volume nebulizer. After 45 minutes, the patient's wheezing has decreased in the lower lobes, her respiratory rate has decreased from 32 to 15 per minute, and heart rate has decreased from 120 to 87 beats/min. Based on this information, the physician wants to know what you would recommend.

Switch to 2.5 mg Albuterol

Decrease the levalbuterol dose to 0.31 mg

Continue this dose (0.63) of levalbuterol.

Send the patient home after telling them to always use their inhaler

Based on the given information, the patient's condition has improved after receiving 0.63 mg of levalbuterol. Her wheezing has decreased, respiratory rate has decreased, and heart rate has also decreased. Therefore, it is recommended to continue with the same dose of levalbuterol (0.63 mg) as it has shown effectiveness in managing the asthma attack. Switching to a higher dose or decreasing the dose may not be necessary at this point. Sending the patient home with instructions to always use their inhaler may not be appropriate as they may still require further observation and treatment in the ER.

Explanation

Based on the given information, the patient's condition has improved after receiving 0.63 mg of levalbuterol. Her wheezing has decreased, respiratory rate has decreased, and heart rate has also decreased. Therefore, it is recommended to continue with the same dose of levalbuterol (0.63 mg) as it has shown effectiveness in managing the asthma attack. Switching to a higher dose or decreasing the dose may not be necessary at this point. Sending the patient home with instructions to always use their inhaler may not be appropriate as they may still require further observation and treatment in the ER.

6. Which test best diagnosis upper airway obstructions?

FEV 1

FEV 25%-75%

Helium Washout

Nitrogen Washout

Maximum Expiatory Flow Volume

The Maximum Expiatory Flow Volume test is the best for diagnosing upper airway obstructions. This test measures the maximum flow rate of air that can be forcefully exhaled after a full inhalation. It provides information about the flow of air through the upper airways, which can be helpful in identifying obstructions such as narrowing or blockages. The other options listed, such as FEV 1, FEV 25%-75%, Helium Washout, and Nitrogen Washout, are not specifically designed to diagnose upper airway obstructions.

Explanation

The Maximum Expiatory Flow Volume test is the best for diagnosing upper airway obstructions. This test measures the maximum flow rate of air that can be forcefully exhaled after a full inhalation. It provides information about the flow of air through the upper airways, which can be helpful in identifying obstructions such as narrowing or blockages. The other options listed, such as FEV 1, FEV 25%-75%, Helium Washout, and Nitrogen Washout, are not specifically designed to diagnose upper airway obstructions.

7. The heart is appears larger in AP than a PA chest x-rays because:

The film is closer to the heart

The film is farther from the heart

The AP x-ray is taken closer to the patient

The PA x-ray is taken closer to the patient

In an Anteroposterior (AP) chest X-ray, the X-ray source is positioned in front of the patient, while the X-ray detector (film or digital sensor) is placed behind the patient. This configuration places the heart closer to the X-ray source, resulting in a larger heart silhouette on the X-ray image compared to a Posteroanterior (PA) chest X-ray, where the X-ray source is behind the patient, producing a smaller heart image.

Explanation

In an Anteroposterior (AP) chest X-ray, the X-ray source is positioned in front of the patient, while the X-ray detector (film or digital sensor) is placed behind the patient. This configuration places the heart closer to the X-ray source, resulting in a larger heart silhouette on the X-ray image compared to a Posteroanterior (PA) chest X-ray, where the X-ray source is behind the patient, producing a smaller heart image.

8. To calculate a patients dead space (VD) without body plethysmography a caregiver needs to know:

The change in the amount of Helium.

The change in the amount of Nitrogen.

The PaCO2

The average PetCO2

The average PetO2

Arterial carbon dioxide and average exhaled carbon dioxide are needed to calculate the dead space to tidal volume ratio.

Explanation

Arterial carbon dioxide and average exhaled carbon dioxide are needed to calculate the dead space to tidal volume ratio.

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9. When implementing positive expiratory pressure (PEP) therapy the following are true:

The patient inhale larger then normal tidal volume.

Breath pressures that provide a volume slightly less then their FRC.

Do not use diaphragmatic breathing.

Forcefully use a huffing maneuver to clear their secretions.

Is a worthy alternative to Chest Physio-therapy.

The patient should use controlled diaphragmatic breathing to inspire volumes larger then their tidal volume at pressures of 10-20cmH20 to achieve their FRC.

Airway clearance maneuvers (huffing) should be gently done.

PEP therapy is in many cases an effective replacement to CPT.

Explanation

The patient should use controlled diaphragmatic breathing to inspire volumes larger then their tidal volume at pressures of 10-20cmH20 to achieve their FRC.

Airway clearance maneuvers (huffing) should be gently done.

PEP therapy is in many cases an effective replacement to CPT.

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10. The following are true in regards to APRV

The expiratory time should be between 0.4 and 0.6 seconds

The tidal volume should be between 4ml - 6ml per kg

Should have the high pressure set at the mean airway pressure of the previous mode

Should start at 28 cmH20 or less if first mode on a patient

The low pressure (peep or low CPAP) should be 0 cmH20

APRV stands for Airway Pressure Release Ventilation. In APRV, the expiratory time should be between 0.4 and 0.6 seconds, which allows for adequate time for expiration and prevents air trapping. The tidal volume should be between 4ml - 6ml per kg, ensuring adequate ventilation. The high pressure should be set at the mean airway pressure of the previous mode, maintaining consistent pressure levels. If APRV is the first mode used on a patient, it should start at 28 cmH20 or less to avoid excessive pressure. The low pressure, also known as peep or low CPAP, should be 0 cmH20, providing no additional pressure during expiration.

Explanation

APRV stands for Airway Pressure Release Ventilation. In APRV, the expiratory time should be between 0.4 and 0.6 seconds, which allows for adequate time for expiration and prevents air trapping. The tidal volume should be between 4ml - 6ml per kg, ensuring adequate ventilation. The high pressure should be set at the mean airway pressure of the previous mode, maintaining consistent pressure levels. If APRV is the first mode used on a patient, it should start at 28 cmH20 or less to avoid excessive pressure. The low pressure, also known as peep or low CPAP, should be 0 cmH20, providing no additional pressure during expiration.

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