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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia begins to exhibit hypotension and decreased consciousness. Which of the following actions would you recommend at this time? immediately initiate CPR apply cardioversion administer epinephrine defibrillate the patient. Ans- apply cardioversion *If drug management fails, if the ventricular rate exceeds 150/min, or if the patient becomes hemodynamically unstable, synchronous cardioversion is indicated. A physician orders intubation and volume-controlled A/C ventilation for a 6- foot, 3-inch tall 190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator settings would you aim for to support this patient? rate/min: 10; VT (mL): 800 rate/min: 15; VT (mL): 500 rate/min: 20; VT (mL): 900 rate/min: 8; VT (mL): 1200. Ans- rate/min: 15; VT (mL): 500 Tidal volume 6ml/kg IBW 6ft 3= 85kg IBW Vt= 500 Rate= 10 to 20 A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a targeted tidal volume of 420 mL To maintain adequate ventilation with this tidal volume, the maximum respiratory rate you would allow is: 25/ min 35/mi n 20/mi n 30/min. Ans- 35/min Which of the following PaCO2 levels would be considered a positive result for brain death determination at the end of an apnea test?
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -at least 50 mm Hg
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -at least 45 mm Hg -at least 60 mm Hg -at least 55 mm Hg. Ans- at least 60 mm Hg or 20+ from baseline CO2 A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of 650 mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives would you recommend to help overcome this problem? 1. add an end-inspiratory pause 2. switch to SIMV and decrease the rate 3. increase the inspiratory flow 2 and 3 only 1, 2, and 3 1 and 3 only 1 and 2 only. Ans- 2 and 3 only * Adding an end-inspiratory pause would cause more airtrapping A patient who just underwent major thoracic surgery is placed on pressure-controlled A/C ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water seal chamber of his pleural drainage system. Which of the following is the most likely cause of this observation? -the patient has a pleural effusion -the suction/ vacuum pressure is too low -the drainage system is obstructed -the patient has a bronchopleural fistula. Ans- the patient has a bronchopleural fistula * Constant bubbling indicates a leak; either in the patient or in the tubing/chamber system. To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you would: -measure pressure during an end-expiratory pause -measure expiratory flow before and after bronchodilator -measure pressure at volume increments using a super syringe -measure pressure during an end-inspiratory pause. Ans- measure pressure during an end-expiratory pause Which of the following indicate that a pleural drainage system is working
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED properly? 1. the water seal chamber level rises and falls with breathing
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED 2. there is continuous bubbling in the suction control chamber 3. there is continuous bubbling in the water seal chamber
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED 1, 2, and 3 1 only 1 and 2 3 only. Ans- 1 and 2 * Suction control should bubble continuously and water seal chamber should rise and fall. * Continuous bubbling in the water seal chamber= leak. A physician wants to calculate the static lung compliance for a 110-kg patient receiving volume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900 ml, Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10 cmH2O, Mechanical dead space 100ml. The patient's static lung compliance is: 22 mL/cmH2O 26 mL/cmH2O 18 mL/cmH2O 36 mL/cmH2O. Ans- 36 mL/cmH2O *VT/(Plat-PEEP) A physician has attempted on several occasions to insert a central venous catheter into the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator's high-pressure alarm sounds, the patient's blood pressure drops, and the SPO2 value drips from 96% to 84%. Breath sounds are greatly diminished over the right-lung field. What action should you recommend? -insert a chest tube into the right pleural space -insert a pulmonary artery catheter -pull the ET back 2-3 cm into the trachea -insert a chest tube into the left pleural space. Ans- insert a chest tube into the right pleural space * Pneumothorax is a complication of central venous catheter. A 48-year-old 180-lb male is orally intubated receiving mechanical ventilation with a 6.0 mm endotracheal tube secured in place, which requires a cuff pressure of 38 cm H2O to prevent significant volume loss. Which of the following actions would be appropriate in this case? -accept the large volume loss during inspiration -deflate and reinflate the cuff with 20 ml of air
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -replace the endotracheal tube with a larger size
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -replace the endotracheal tube with a smaller size. Ans- replace the endotracheal tube with a larger size *Most common cause of high ET tube cuff pressure is the tube is too small You are assisting with the oral intubation of an adult patient. After the ET tube has been placed, you note that breath sounds are decreased on the left compared with the right lung. The most likely cause of this observation is: -the tip of the tube is in the right mainstem bronchus -the endotracheal tube has been inserted into the esophagus -the cuff of the endotracheal tube has been overinflated -the tip Of the tube is in the left mainstem bronchus. Ans- the tip of the tube is in the right mainstem bronchus *Confirmed with CXR and corrected by withdrawing tube until it is 4-6cm above carina To minimize the risk of aspiration of glottic secretions or cord damage during removal of an oral endotracheal tube, you should: -have the patient cough while you quickly pull the tube -fully occlude the ET tube while you quickly it out -provide 100% o»gen for 1-2 minute before extubation -keep the tube cuff pressure below 25—30 cm H20. Ans- have the patient cough while you quickly pull the tube * Prevents damage to vocal cords and minimizes aspiration If progressively higher and higher cuff pressures are needed to avoid leakage over time, the most likely problem is: -tracheal dilation/tracheomalacia -tube is too small -tracheal stenosis -right mainstem intubation. Ans- dilation/tracheomalacia * Or cuff/pilot balloon malfunction Immediately after endotracheal tube extubation, an adult patient exhibits a high pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend? -a STAT racemic epinephrine aerosol treatment -careful observation of the patient for 6 hours
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -a STAT heated aerosol treatment with saline
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -immediate reintubation via the nasal route. Ans- a STAT racemic epinephrine aerosol treatment *Stridor indicates severe glottic obstruction, usually caused by edema. Treated with epinephrine/vaponephrine via aersol To lower the PaC02 of a patient receiving high-frequency oscillation ventilation (HFOV) you would: increase mean pressure (Pmean) increase the oscillation frequency increase the % inspiratory time decrease the oscillation frequency. Ans- decrease the oscillation frequency * Or increase amplitude A premature infant receiving positive pressure ventilation exhibits acute respiratory distress, asymmetrical chest motion, and hypotension. Which of the following procedures would you initially recommend? -capillary heal stick -arterial blood gas -A-P chest radiograph -chest transillumination. Ans- chest transillumination * quickly detects a pneumothorax. Affected side lights up. You need to transport several contaminated nondisposable ventilator circuits from a patient unit to an equipment processing area. You would: -transport the circuits in leak- and puncture-resistant biohazard bags -place circuits in biohazard bags, then transport in a closed, rigid container -bag the circuits, then transport on a cleaned and sanitized cart -wash and disinfect the circuits at point of origin before transporting. Ans- place circuits in biohazard bags, then transport in a closed, rigid container You are assisting a nurse in ICU to measure a patient's central venous pressure (CVP) with a strain-gauge pressure transducer. You note that the pressure transducer is positioned well above the middle of the patient's lateral chest wall. What effect if any would this have on the CVP measurement? -it would cause damping of the signal -it would overestimate the CVP
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -it would not affect the measurement
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -it would underestimate the CVP. Ans- it would underestimate the CVP
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED When measuring vascular pressure such as central venous, pulmonary artery, or capillary wedge pressures, it is essential that you ensure that the base of the fluid column or pressure transducer is positioned at a level equal to the point of measurement, i.e., the right atrium (also called the phlebostatic axis). You are monitoring a patient with myasthenia gravis and find that the maximum inspiratory pressure (MIP/NIF) has changed from -35 cmH2O 4 hours ago to -10 cmH2O. Based on this change, you should recommend which of the following? -measuring maximum voluntary ventilation (MVV) -administering oxygen via nasal cannula at 5 L/min -obtaining/analyzing an arterial blood gas sample -administering oxygen via partial rebreathing mask. Ans- Obtaining/analyzing an arterial blood gas sample * A rapid decrease indicates disease has progressed An intubated patient with COPD who is in acute respiratory failure requires a ventilator. To optimize support of this patient you would recommend a ventilator capable of: -airway pressure release ventilation -pressure support with adjustable off-cycling -mandatory minute ventilation -high frequency oscillation ventilation. Ans- pressure support with adjustable off- cycling Which of the following is the most effective diagnostic test to quantify the amount of ventilatory impairment in a patient with Guillain-Barre syndrome? -serial end-expired PCO2 measurements -serial vital capacity measurements -serial P(A-a)O2 measurements -serial total lung capacity measurements. Ans- serial vital capacity measurements Other bedside measures of muscle strength include: -The maximum inspiratory and expiratory pressure (MIP/NIF and MEP) Which of the following patients has the most serious problem with the adequacy of oxygenation? Patient FiO2, PaO2 A. 1.00, 85
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED B. 0.70, 90 C. 0.40, 95 D. 0.28, 65. Ans- A
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED The lower the P/F ratio the greater the impairment.
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED P/F <300 =ALI/Mild ARDS P/F <200= Moderate ARDS P/F <100= Severe ARDS A patient is receiving volume-controlled A/C ventilation. Which of the following changes would occur if the patient's compliance were to decrease? -the flow rate will decrease -the system pressure will increase -the expiratory time will increase -the delivered volume will decrease. Ans- the system pressure will increase Absolute contraindications to turning or rotating critical ill patients include which of the following? 1. unstable cardiac arrhythmias 2. unstable spinal cord injuries 3. ventilatory dependency. Ans- 1 and 2 *Absolute contraindications to turning or rotating critical ill patients include unstable spinal cord injuries, unstable cardiac arrhythmias that may require defibrillation or cardiac compression, and traction of arm abductors A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient's cardiopulmonary status? I. Cardiopulmonary exercise evaluation II. Pulmonary function testing III. Cardiac (left heart) catheterization. Ans- I and II Which of the the following types of breathing circuits would you select when assembling a noninvasive positive pressure/BiPAP ventilator? -single-limb circuit without any valve -single-limb circuit with expiratory balloon valve -dual-limb wye circuit -single-limb circuit with leakage-type exhaust valve. Ans- single-limb circuit with leakage-type exhaust valve Most noninvasive positive pressure (NPPV) ventilators/BiPAP devices use single-limb circuit with a leakage-type exhaust valve. Which one of the following measures could be used to assess changes in exercise tolerance associated with participation in a pulmonary rehabilitation program?
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -frequency and duration of hospitalizations -pre- and post-peak expiratory flow rates -pre- and post- 6-minute walking distance -pre- and post-resting minute ventilation. Ans- pre- and post- 6-minute walking distance A patient has a lower than normal mixed venous O2 content. All of the following could cause this condition EXCEPT: -cardiogenic shock -hyperthermia -cyanide poisoning -hypovolemia. Ans- cyanide poisoning *Cyanide poisoning would cause CVO2 higher than normal [ tissue hypoxia may be present] To help minimize family distress, a doctor wants to avoid gurgling, sonorous breathing, or stridor in a terminally ill patient who is scheduled for withdrawal of ventilatory support. Which of the following procedures would you recommend to help achieve the doctors goal? -exchange the endotracheal tube for an LMA -immediate extubation to nasal cannula -withdrawal to T-tube with humidified 02 -IMV weaning followed by rapid extubation. Ans- withdrawal to T-tube with humidified 02 *Rapid withdrawal of the patient from the ventilator and placement on a T- tube (with ET tube remaining in place) ensures that the airway remains patent and protected through the procedure, avoiding occurrences that may be distressful to the family, such as gurgling or post-extubation stridor Airway management techniques that can help decrease the incidence of ventilator- associated pneumonia (VAP) include all of the following EXCEPT: -maintaining proper endotracheal tube cuff pressures -using only sterile fluids to flush suction catheters -using the nasal route instead of the oral route for intubation -using an ET tube that can aspirate subglottic secretions. Ans- -using the nasal route instead of the oral route for intubation Airway management that decreases the incidence of VAP * Avoiding intubation [use non- invasive] *Intubate orally * Maintain proper ET tube cuff pressures: 20- 30cmH20
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED * aspirating subglottic secretions * Using only sterile water
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED * Vent circuits should only be changed when visibly soiled or malfunctioning To help minimize the risk of ventilator-associated pneumonia in patients receiving invasive ventilatory support you would: -keep the airway temperature above 45 degrees Celsius -use an HME or humidifier with heated wire circuit -change the ventilator circuit every 24-48 hours -drain any circuit condensate back into the humidifier. Ans- -use an HME or humidifier with heated wire circuit A patient is being mechanically ventilated in the SIMV volume control (VC) mode at a rate of 4/min. The spontaneous respiratory rate increases from 12 to 35/min. Which of the following is the most appropriate action? -sedate the patient -initiate pressure control -add 10 cmH2O PEEP -increase the SIMV rate. Ans- increase the SIMV rate *In the SIMV mode, a significant increase in the total respiratory rate indicates increased work of breathing. To maintain a normal patient rate of breathing, you can increase the machine rate and/or add pressure support. A 90-kg male patient with a traumatic chest injury is receiving volume- controlled A/C ventilation with an FiO2 of 0.5, a set rate of 18, and a tidal volume of 600 mL. Due to patient triggering of machine breaths, the total respiratory rate is 28-30 breaths per minute. Results of an arterial blood gas analysis are as follows: pH 7.52, PaCO2 28 torr, HCO3 22 mEq/L, BE-2, PaO2 81 torr, SaO2 96%. On the basis of these results, the most appropriate action is to: increase the tidal volume increase the FiO2 add mechanical deadspace increase the ventilator rate. Ans- add mechanical deadspace *Deadspace will raise PaCO2 and normalize PH *Could also switch to SIMV or sedate patient A postoperative 40-year-old 70-kg (154-1b) patient is breathing spontaneously at a rate of 28/min with a delivered FiO2 of 0.4. The following arterial blood gases are obtained: Blood Gases
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED pH 7.24 PaC02 38 torr
TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED HC03 23 mEq/L BE-1 Pa02 610 torr Sa02 100% Based on the above data, VC, SIMV ventilation is instituted with a tidal volume of 650 mL and an FiO2 of 0.5. The SIMV rate should be set at which of the following? 28/ min 2/ min 6/ min 12/min. Ans- 12/min *Most patients started on mechanical ventilation are initially provided full ventilatory support. The initial rate setting for patients receiving full ventilatory support ranges from 8 to 12 breaths per minute. A 60-kg patient receiving mechanical ventilation has the following ventilator settings and arterial blood gas results: Ventilator settings Mode: Vol ctrl SIMV VT: 500 mL Set rate: 14/min Spon rate: 0 FiO2: 0.55 Blood gases pH 7.56 PaC02 26 torr Pa02 92 torr HC03: 22 mEq/L Sa0296% Which of the following should you recommend? -decrease the FiO2 to 0.50 -increase the inspiratory time -increase the tidal volume to 600 mL -decrease the SIMV rate. Ans- decrease the SIMV rate *To restore the pH back down to normal, you need to increase the PaCO2. To
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED increase the PaCO2 you need to reduce the patient's minute ventilation. In this case the best option would be to decrease the SIMV rate.
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED A 28 year-old 80-kg (175 1b) male trauma victim with a closed-head injury is receiving volume-controlled A/C ventilation and has been paralyzed with a cisatracurium (Nimbex). The ventilator settings and current ABGs are as follows: Ventilator SettingsMode: Vol Ctrl A/C VT: 700 mL12: RateFiO2: 0.30PEEP: 0 cmH2O Blood GasespH: 7.36PaC02: 40 torrHC03: 22 mEqLPa02: 63 torrSa02: 92% -raising the FiO2 to obtain an SaO2 of 100% -raising the PEEP to 10 cm H2O -decreasing the mandatory rate to 8/ min -increasing the tidal volume to 1.0 L. Ans- raising the FiO2 to obtain an SaO2 of 100% *Goals of ventilatory support: 1. Maximize cerebral oxygenation 2. Assure good patient-ventilatory synchrony 3. Avoid settings/techniques that affect ICP A 60-kg (132-lb) COPD patient is receiving: SIMV VT of 500 mL at 9/ min with an FiO2 of 0.35. Blood gases are as follows: pH = 7.36; PC02 = 61 torr; HCO3 = 36 mEq/L; PaO2 = 64 torr. Which of the following changes would you recommend at this time? -increase the FiO2 -maintain settings -increase the VT -increase the IMV rate. Ans- maintain settings -Pa02 of 64 torr (indicating an Hb saturation of at least 90%) is considered acceptable for a COPD patient. You are working with a 49 year-old patient who weighs about 80 kg (175 lbs). The patient is receiving volume-controlled A/C ventilation and has the following settings and blood gases: Ventilator settings VT: 750 mL Rate: 12/min FiO2: 35% PEEP: 5 cmH20
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Blood gases pH: 7.42
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED PaC02: 36 mm Hg Pa02: 58 mmHg
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED HC03: 23 mEq/L What change should you recommend to the physician? -increase the rate to 16/min -increase the FiO2 to 45% -switch from A/C to SIMV -add 150 mL of deadspace. Ans- increase the FiO2 to 45% *With an FiO2 below 50%, the hypoxemia is most likely due to a V/Q imbalance. In this instance, the FiO2 should be increased to 45%. If this does not adequately address the problem, an increase in PEEP may need to be considered. Data for a 78-kg (172-1b) patient receiving ventilatory support are as follows: Ventilator Settings Mode: vol ctrl VT: 750 mL Rate: 8 FiO2: 0.45 PEEP: 15 cm H20 pH: 7.36 PaC02: 40 torr HC03: 22 mEq/L Pa02: 155 torr Sa02: 99% Which of the following changes would you recommend at this time? -increase the rate -decrease the FiO2 -decrease PEEP -lower the VT. Ans- decrease PEEP *When two changes could achieve the same goal, always first choose the one that either will cause the least harm or best reduce potential harm to the patient. In this case, the FiO2 is at a safe level (< 0.60), but the PEEP is potentially harmful. You therefore should first recommend decreasing the PEEP. Data for a 63-kg (140-1b) patient receiving ventilatory support are as follows: Ventilator Settings Mode: SIMV vol ctrl VT: 600 mL
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Rate: 10
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED FiO2: 0.75 PEEP: 10 cm H20
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED pH: 7.44 PaC02: 38 torr HC03: 25 mEq/L Pa02: 180 torr Sa02: 100% Which of the following changes would you recommend at this time? -decrease the FiO2 -increase the rate -lower the VT -decrease PEEP. Ans- decrease the FiO2 *The PEEP level is no a cause for major concern, but the FiO2 is dangerously high. You therefore should first recommend decreasing the FiO2. Which of the following conditions is an indication for the use of PEEP? -pulmonary edema -tension pneumothorax -pulmonary embolism -asthma. Ans- pulmonary edema *In noncardiogenic pulmonary edema (e.g., ARDS), PEEP opens collapsed alveoli and improves the V/Q ratio. A 70-kg patient with a history of COPD is being mechanically ventilated because of respiratory failure. Current ventilator settings and arterial blood gas results are as follows: Ventilator settings Mode: Vol control A/C VT: 600 mL PEEP: 0 cmH20 Blood gases pH: 7.38 PaC02: 50 torr Sa02: 91% You should recommend which of the following? -set the rate at 6/min -add 8 cm H20 PEEP
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -maintain present settings
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -increase tidal volume to 750 mL. Ans- maintain present settings *Because the acidosis is fully compensated, ventilation should remain unchanged. Regarding oxygenation, the target range for Pa02 in COPD patients who are C02 retainers such as this patient, is 50 to 70 torr. Consequently, the settings should NOT be changed at this time. A patient with status asthmaticus is being mechanically ventilated. Which of the following values are consistent with this condition? -peak pressure cm H20: 40; plateau pressure cm H20: 20; tidal volume mL: 600 peak pressure cm H20: 20; plateau pressure cm H20: 15; tidal volume mL: 600 peak pressure cm H20: 25; plateau pressure cm H20: 20; tidal volume mL: 800 peak pressure cm H20: 60; plateau pressure cm H20: 55; tidal volume mL: 800. Ans- peak pressure cm H20: 40; plateau pressure cm H20: 20; tidal volume mL: 600 Increased airway resistance is the hallmark of asthma. On a mechanically ventilated patient this is indicated by an increase between the peak and plateau pressures. You observe the following pressure-volume loop display on a patient receiving volume- controlled ventilation. Which of the following actions would be appropriate? increase the PEEP level increase the inspiratory flow decrease the I:E ratio decrease the delivered volume. Ans- *decrease the delivered volume When you observe this problem, you generally can resolve it by either reducing the volume (in volume ventilation) or the pressure setting. While performing a patient-ventilator check, you note the following settings and parameters: Exhaled tidal volume 650 ml Peak inspiratory pressure 35 cmH2O. High-pressure limit 60 cmH2O Low-pressure alarm 20 cmH2O Low-tidal volume alarm 500 ml. Which of the following change would you make? -increase the set tidal volume to 800 ml -decrease the high-pressure limit to 45-50 cmH2O -decrease the low-pressure alarm to 5 cmH2O -increase the low-tidal volume alarm to 600 ml. Ans- decrease the high-
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED pressure limit to 45-50 cmH2O
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED All alarm/limit settings in this example are acceptable except the high- pressure limit, which should be set 10 to 15 cmH2O above the peak inspiratory pressure, in this case to 45 or 50 cmH2O. A 2-year old asthmatic child is placed on an inline small volume nebulizer while receiving volume-controlled SIMV. Shortly after the treatment has started, an alarm on the servo-controlled humidifier is activated. Which of the following is the most likely cause for this alarm? -empty water reservoir -low gas temperature -decreased humidity output -clogged expiratory filter. Ans- low gas temperature While performing a routine check on an intubated patient receiving pressure control SIMV, you feel course vibrations on his chest wall during both inspiration and expiration. You should do which of the following? -perform endobronchial suctioning -switch to volume-controlled SIMV -recommend a bronchodilator treatment -decrease the ventilator pressure limit. Ans- perform endobronchial suctioning *Course vibrations that you can palpate through the chest wall during breathing are termed rhonchial fremitus. Rhonchial fremitus is most often associated with the presence of excess secretions in the large airways, which should be cleared by suctioning. During a ventilator test, you determine that the delivered volume is substantially less than the set volume. To determine if the ventilator volume setting is out of calibration, you would: -perform a manual circuit leak test using a low volume and inspiratory pause -measure the volume delivered at the patient connector using a calibrated volumeter -measure the volume delivered at the ventilator outlet using a calibrated volumeter -compare a variety of inspiratory time settings against a digital stop watch. Ans- measure the volume delivered at the ventilator outlet using a calibrated volumeter In assessing a patient receiving volume-controlled A/C ventilation, you hear the high- pressure limit alarm sounding and note a decrease in expired volume. No settings have been changed on the ventilator. Which of the following best explains these findings?
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -increased airway resistance or decreased compliance -improperly set trigger sensitivity
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -the presence of a leak in the patient-ventilator system
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -an increase in patient-triggered respiratory frequency. Ans- increased airway resistance or decreased compliance *During volume-controlled ventilation, a decrease in expired volume occurring together with an INCREASED airway pressure (high-pressure limit activated) usually indicates an increase in total impedance, as occurs with either an increase in airway resistance or a decrease in compliance. Tube kinking, obstruction, or patient-ventilator asynchrony would have a similar effect. All of the following would cause a sudden increase in the peak pressure during volume controlled ventilation EXCEPT: pneumothora x decreased flow bronchospas m coughing. Ans- decreased flow *Common causes for sudden increase in PIP - coughing - increased secretions/mucous plugging - kinking of the tubing circuit - occlusion of the tubing circuit with water - kinked ET tube - ET tube into mainstem bronchus - patient ventilator asychrony - bronchospasm - pneumothorax In performing a patient-ventilator check, you note that the expiratory portion of the flow- volume loop does not return to baseline. Which of the following is the most likely problem? air leak overdistensi on auto- PEEP decreased compliance. Ans- auto- PEEP The presence of auto-PEEP can be visualized on a ventilator's graphic display when flow does not return to the baseline before the start of next breath. Either a flow vs. volume loop or a flow vs. time scalar will reveal this pattern.
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED While doing a ventilator check on a patient receiving volume-controlled ventilation you observe a substantial drop in the pressure on the pressure vs. time waveform after triggering of most machine breaths. Which of the following best explains this finding?
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -a leak in the patient-ventilator system
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -inadequate inspiratory flow setting -improper sensitivity setting -presence of auto-PEEP/airtrapping. Ans- inadequate inspiratory flow setting *A drop in pressure (scalloping) after triggering a volume-controlled breath usually indicates inadequate inspiratory flow. Normally, pressure should rise after inspiration begins. To correct this problem increase the inspiratory flow until the "scalloping" of the pressure waveform disappears. A patient receiving pressure support ventilation (PSV) exhibits repeated overshooting of the set pressure early in the airway pressure waveform. Which of the following is the likely cause of this problem? -expiratory trigger set too low -expiratory trigger set too high -rise time set too fast/high -rise time set too slow/low. Ans- rise time set too fast/high During a spontaneous breathing trial on a patient with a tracheostomy, the mist disappears at the T-piece early in inspiration. You should: -add deadspace between the T-piece and patient -increase the flow from the nebulizer -direct the patient to inhale more slowly -decrease the lenth of tubing from the nebulizer. Ans- increase the flow from the nebulizer *This will result in the patient getting less oxygen than that set on the nebulizer. You should either increase the flow from the nebulizer or use two nebulizers connected in parallel (to double the flow). A doctor is considering weaning a patient from invasive mechanical ventilation. Which of the following approaches would you recommend to wean this patient? -decreasing rate SIMV -pressure control with PEEP -pressure support with CPAP -airway pressure release ventilation. Ans- pressure support with CPAP Which of the following is an acceptable change in patient status during a spontaneous breathing trial for weaning from mechanical ventilation? scalene muscle activity increases heart rate rises from 103 to 118/min
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED systolic BP falls from 110 to 75 mm Hg PaCO2 rises 11 torr. Ans- heart rate rises from 103 to 118/min
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED As part of a weaning protocol, you switch a 85-kg (187-lb) patient from SIMV at 4/min to 5 cm H2O CPAP and an FiO2 of 0.45. Twenty minutes after switching to CPAP, you obtain the following data: pH 7.24, Spon resp rate 36/min, PaCO2 53 mmHg, MIP/NlF -23 cmH2O, PaO2, 49 mm Hg, Vital capacity (VC) 1.2 L, HCO3 22 mEq/L. Which of the following should actions would you recommend at this time? administer sodium bicarbonate continue CPAP, but raise the FiO2 to 0.55 put the patient back on SIMV increase the CPAP to 8 cm H20. Ans- put the patient back on SIMV *MIP and VC are adequate, the high PC02, high respiratory rate with low tidal volume (RSBI = 36/0.275 = 131) and dangerously low pH and PaO2 indicate a failed weaning attempt. You should put the patient back on ventilatory support and try again when appropriate. You are trying to wean an alert intubated patient off full ventilatory support using an "on ventilator" CPAP protocol with 40%02. Early in the initial effort the respiratory rate increases from 24 to 30/min and you start to observe some use of the accessory muscles of respiration. Which of the following would be your first action? apply 5—10 cm H20 pressure support restore the patient to full ventilatory support increase the FiO2 to 0.50 extubate the patient and re-evaluate. Ans- apply 5—10 cm H20 pressure support *PSV can augment a patient's spontaneous tidal and thus allow for a more efficient breathing pattern and lower respiratory rate. PSV also can help unload the respiratory muscles from the extra work of breathing imposed by artificial airways and thus further aid in weaning. A patient is receiving volume-controlled A/C ventilation. The patient has become increasingly agitated and the end-tidal CO2 has decreased from 39 to 28 torr over the last 2 hours. Which of the following is the most likely cause? high body temperature increased cardiac output increased ventilation mainstem intubation. Ans- increased ventilation
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *The most likely cause of this patient's low end-tidal CO2 is hyperventilation caused by
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED the patient's agitation.
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Treating the cause of the agitation may restore normal ventilation and thus normalize end-tidal CO2. High body temperature (fever) increases metabolism and would tend to increase, not decrease, expired CO2 levels. Which of the following would indicate that a patient may not be ready to extubate? a negative cuff leak test (no leakage) a positive gag reflex a deep cough on suctioning a successful spontaneous breathing trial. Ans- a negative cuff leak test (no leakage) *If leakage occurs (a "positive" test), then the airway most likely is patent. A 36-year-old woman who has just undergone intestinal bypass surgery is brought to the recovery room intubated. She has normal pulmonary function, weighs 136 kg (300 lbs), and is 159 cm (5 feet, 2 in) tall. In this situation, you should recommend which of the following ventilator settings? rate/ min: 8, VT (mL): 300 rate/min: 10, VT (mL): 400 rate/min: 8, VT (mL): 1000 rate/min: 15, VT (mL): 700. Ans- rate/min: 10, VT (mL): 400 *Use IBW 6- 8ml/kg The recommended initial dose of inhaled nitric oxide (INO)) is: -2 ppm -200 ppm -2000 ppm -20 ppm. Ans- 20 ppm The recommended initial dose of inhaled nitric oxide is 20 parts per million, ppm, but can often be quickly reduced to 5 to 6 ppm. After ordering three albuterol treatments for a status asthmaticus patient, the doctor then orders continuous nebulization of 25 mg of 0.5% albuterol for an asthmatic patient. How many mL of albuterol would you place in the nebulizer chamber? -5.0 mL -2.5 mL -0.5 mL
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -0.25 mL. Ans- 5.0 mL
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED 0.5% = 0.5g/100mL 0.5g/100mL = 0.025g/XmL 0.5X = 2.5 X = 5 mL 25/5 5mg per 1ml Albuterol comes in 2.5mg A patient has a body surface area (BSA) of 2.0 m2 and a cardiac output (CO) of 3.0 L/min. What conclusions can you draw regarding the patient's cardiac index? -there is insufficient data to compute the cardiac index -the patient's cardiac index is above normal -the patient's cardiac index is normal -the patient's cardiac index is below normal. Ans- Cardiac index (CI) = CO/ BSA. In this case CI - 3.0/2.0 = 1.5 L/min/m2. Because a normal range for cardiac index is 2.5—5 L/ min/m2 this patient's cardiac index is below normal. A physician orders 2.5 mL (1.0 mg/mL) dornase alpha (Pulmozyme) via aerosol once per day for a 12-year-old cystic fibrosis patient with purulent secretions. Which of the following methods would you use to deliver this drug? -breath-actuated drug nebulizer with mouthpiece -standard drug nebulizer with aerosol mask -standard drug nebulizer with mouthpiece -breath-actuated drug nebulizer with aerosol mask. Ans- breath-actuated drug nebulizer with mouthpiece *Due to the high cost of dornase alpha and the need to minimize its wastage, masks are not used for delivery of this drug, except to babies. A small child is admitted to the emergency department with fever, diffculty swallowing, drooling, and stridor. An AP x-ray of the nech area is negative, but a lateral neck film indicates supraglottic swelling. Which of the following is the most likely diagnosis? -epiglottitis
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -asthma -foreign body obstruction
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -croup. Ans- epiglottitis
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *thumb sign You are called to the ER to help in the assessment and care of a patient admitted with CHF and severe pulmonary edema. While starting an intravenous line, the physician tells you to give the patient 02. You would start the following: -35% air-entrainment mask -nonrebreathing mask -nasal cannula at 4 L/min -simple face mask at 5 L/min. Ans- nonrebreathing mask *Of the devices listed, only the nonrebreathing mask can deliver high FiO2s. You might also recommend CPAP with 100% 02 for this patient, since the elevated airway pressure can help reduce venous return and alleviate pulmonary congestion. In patients with COPD, pedal edema is a sign of: -hypercapnia (impaired CO2 removal) -systemic hypertension -right ventricular hypertrophy -impaired pulmonary diffusion. Ans- right ventricular hypertrophy *Chronic hypoxemia causes pulmonary vasoconstriction, which forces the right ventricle to work harder than normal. Over time, this increase in workload may result in right ventricular hypertrophy and poor venous blood flow return to the heart. When the venous return to the right side of the heart is reduced, the peripheral blood vessels engorge, resulting in an accumulation of fluid in the tissues of the ankles, referred to as pedal edema. A patient has a history of recurrent asthma symptoms that begin early every spring and persist throughout the summer. Which of the following tests would you recommend to help identify the cause of the patient's symptoms? -exhaled nitric oxide (NO) analysis -pre- and post bronchodilator spirometry -skin testing to a panel of outdoor allergens -sputum Gram stain, culture and sensitivity. Ans- skin testing to a panel of outdoor allergens Which of the following would NOT be appropriate for the initial management of a child during an acute asthmatic attack? cromolyn sodium
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED (Intal) terbutaline (Brethaire)
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED albuterol (Proventil) epinephrine. Ans- cromolyn sodium (Intal)
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *Cromolyn sodium (Intal) is a controller medication used to prevent asthma attacks. It will do nothing for an acute attack. A first-year resident has just inserted an indwelling arterial catheter in an ICU patient. A good indication that the catheter has been successfully inserted in an artery is -proper blood pressure and waveform -a good blood return -a positive Allen test -ability to flush the line. Ans- proper blood pressure and waveform Which of the following factors are associated with difficult airway during manual bag- valve-mask ventilation? -malnutrition -edentulousness -sinusitis -lack of facial hair. Ans- edentulousness *MOANS M- Mask seal O- Obesity/obstruction A- Aged N- No teeth (endentulousness) S- Stiff lungs Immediately after insertion of a #4 laryngeal mask airway (LMA) in a 70-kg adult, you should inflate the cuff to: 30 cm H20 pressure 60 cm H20 pressure 10 mL volume 60 mL volume. Ans- 60 cm H20 pressure While performing nasotracheal suctioning, you note that one of the patient's nostrils is obstructed and the other is becoming traumatized. You should: -discontinue the procedure and tell the patient to cough -recommend inserting an endotracheal tube for suctioning -obtain an order for postural drainage and percussion -recommend inserting a nasopharyngeal airway for suctioning. Ans-
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED recommend inserting a nasopharyngeal airway for suctioning
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED * Helps to minimize nasal trauma
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Which of the following arterial blood gas results would be most representative of a patient who has advanced, but stable, COPD breathing room air? PH -7.37/41/55 -7.38/59/56 -7.41/45/79 -7.50/56/57. Ans- 7.38/59/56 *A stable COPD patient typically exhibits a chronic or compensated respiratory acidosis with hypoxemia In what position should you place an unconscious patient in order to facilitate a thoracentesis procedure? -prone position with foot of bed raised 12-18 inches -slighted rotated from supine with the affected side up near the edge of the bed -slighted rotated from supine with the affected side down on edge Of the bed -sitting at the edge Of the bed leaning forward at a 45-degree angle. Ans- slighted rotated from supine with the affected side down on edge Of the bed *For thoracentesis, immobile or unconscious patients should be placed with the affected side down on the very edge of the bed, slighted rotated from supine Obstructive sleep apnea is defined as: -at least 10 seconds of no airflow without respiratory effort -increasing respiratory effort that leads to an arousal from sleep -at least 10 seconds of no airflow with increasing respiratory effort -a decrease in breathing greater than 50% that causes desaturation. Ans- at least 10 seconds of no airflow with increasing respiratory effort *Central apnea is characterized by a lack of airflow for 10 or more seconds, but occurs without respiratory effort. Which of the following bedside measurements require a conscious and cooperative patient? -spontaneous respiratory rate -maximum expiratory pressure -maximum inspiratory pressure -spontaneous tidal volume. Ans- maximum expiratory pressure *Vital capacity and maximum expiratory pressure measurements require that
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED the patient be conscious and cooperative.
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED Upon palpating a patient's pulse, you note 85 unevenly spaced beats, with a marked decrease in pulse strength during inspiration. Which of the following describes the patient's pulse? -thready pulse -pulsus paradoxus -bounding pulse -pulsus alternans. Ans- pulsus paradoxus *A decrease in pulse strength or blood pressure during inspiration is termed pulsus paradoxus. It is often seen in patients during severe episodes of airway obstruction (e.g., status asthmaticus) and also in patients with constrictive pericarditis or cardiac tamponade. Hypoxia can occur without cyanosis in patients with what disorder? -hyperthermia -polycythemla -anemia -hypothermia. Ans- anemia *Patients with anemia have low Hb levels, and thus can be severely hypoxic before cyanosis ever appears. In which of the following conditions are fine, late inspiratory crackles most likely to be heard on auscultation? -pleural effusion -atelectasis - croup -asthma. Ans- atelectasis *Patients with disorders that reduce lung volume—such as atelectasis, pneumonia, pulmonary edema, and fibrosis—are most likely to have late inspiratory crackles. -Asthma: wheezing -Croup: stridor -Pleural Effusion: diminished Which of the following is being measured if you instruct a patient to take a maximum deep breath and then exhale completely? -inspiratory force -vital capacity (VC)
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -residual volume (RV) -total lung capacity (TLC). Ans- vital capacity (VC)
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *The vital capacity or VC is obtained by measuring the total amount of air that can be exhaled after a maximum inspiration. The VC is the sum of the inspiratory reserve volume, the tidal volume, and the expiratory reserve volume (IRV + ERV). After an intubated patient successfully completes a 90 minute trial of spontaneous breathing on a ventilator (CPAP with pressure support), the attending doctor requests that he be extubated. Which of the following would you want to confirm before agreeing to remove the patient's ET tube? 1. that the likelihood of aspiration is minimal 2. that the risk of upper airway obstruction is low 3. that secretion clearance can be assured: Yes 1 and 3 3 only 2 and 3 1, 2, and 3. Ans- 1, 2, and 3 The results of an arterial blood gas analysis for a patient who is breathing 100% oxygen are below: pH: 7.24 PaCO2: 38 torr HCO3: 23 mEq/L BE: - 1 PaO2: 610 torr SaO2: 100% Which of the following is the likely problem? respiratory acidosis laboratory error large physiologic shunt metabolic acidosis. Ans- laboratory error To periodically confirm the validity of blood gas analyzer or hemoximeter results, you would perform: control media calibration verification regular preventive maintenance instrument performance validation internal statistical quality control. Ans- control media calibration verification
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *Calibration verification requires analysis of at least three materials with known values
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED (controls) spanning the entire range of results expected for clinical samples. As a
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED general recommendation, at least one control should be analyzed every 8- hour shift. A rotation system should assure that all three levels of the control media are analyzed at least once each 24 hours. Based on the following blood-gas report, what is the most likely acid-base diagnosis? pH = 7.51 pCO2 = 44 torr HCO3 = 35.1 mEq/L -fully compensated respiratory alkalosis -combined respiratory and metabolic alkalosis -acute (uncompensated) respiratory alkalosis -acute (uncompensated) metabolic alkalosis. Ans- acute (uncompensated) metabolic alkalosis *The pH is above normal (alkaline). The PC02 is in the normal range and thus not a factor in the alkalosis. The HCO3 is high, which indicates a primary metabolic alkalosis. Since the PC02 is normal, no compensation is occurring and the problem is an acute or uncompensated metabolic alkalosis. The normal range of negative pressure to use when suctioning children is: -80 to -100 mmHg -60 to -80 mmHg -100 to -120 mmHg -150 to -200mmHg. Ans- -80 to -100 mmHg Adults: -100 to -120 Children: -80 to -100 Infants: -60 to -80 While suctioning an adult patient receiving ventilatory support, you note the heart rate decreases abruptly from 92 to 55/min. Which of the following actions could help prevent or minimize this problem? -recommend a bolus of atropine before suctioning -instill lidocaine (Xylocaine) into the trachea before suctioning -increase the FiO2 to 1.0 for at least 30—60 seconds before suctioning -give the patient 2 MDI puffs of beclomethasone before suctioning. Ans- increase the FiO2 to 1.0 for at least 30—60 seconds before suctioning *Most cardiac arrhythmias during suctioning are due to arterial hypoxemia. The best
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED way to prevent or minimize arterial hypoxemia during suctioning is to preoxygenate the patient
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED You should recommend a therapeutic bronchoscopy to: -investigating the source of hemoptysis -evaluating recurrent atelectasis -determine the location and extent of injury from toxic inhalation -facilitate endotracheal tube insertion. Ans- facilitate endotracheal tube insertion *Also recommended for: - Difficult intubations - Aiding intubation of a mainstem bronchus - Locating and removing mucous plugs causing lobar or segmental atelectasis - Removing foreign bodies - Placement and assessment of airway stent function Continuous positive airway pressure (CPAP) is indicated as a treatment for: -acute pulmonary emboli -acute exacerbation of COPD -post-operative atelectasis -hypercapnic respiratory failure. Ans- post-operative atelectasis *CPAP contraindicated if patient cannot maintain adequate ventilation on their own; hypercapnic ventilatory failure/acute exacerbation of COPD A patient breathing 02 has a P(A-a)02 of 400 torr. What is her approximate % shunt? 5% 15% 10% 20%. Ans- 20% *In estimating the percent shunt, with the FiO2 = 1.0 (100% 02), every 100 torr P(A-a)02 equals about a 5% shunt. In this case, you would estimate the %shunt as 400/100 = 4 x 5 = 20%. Six hours after a confused 71-year-old male is admitted to the emergency department with dyspnea, diaphoresis, and hypotension, lab results indicate elevated creatine kinase isoenzyme (CK-MB) and troponin I. These finding are most consistent with:
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -fluid overload
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -neurogenic shock
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -pulmonary edema -myocardial infarction. Ans- myocardial infarction *CK-MB and troponin I are biomarkers whose concentrations rise when there is damage to the myocardium When reviewing the chart of a patient who presents with evidence of acute pulmonary infection, which of the following laboratory studies would provide the most useful information? -blood culture -sputum culture and sensitivity -sputum Gram stain -sputum acid-fast stain. Ans- sputum culture and sensitivity *Confirms the organisms growing in the lung and the drugs most effective in controlling the microbe An echocardiogram on a 64-year-old patient who experiences dyspnea and palpitations on exertion reveals the following left ventricular data: elevated end-diastolic pressure, elevated end-diastolic volume, and an ejection fraction of 38%. There is no evidence of valvular heart disease, intracardiac shunts, cardiac tamponade, or pericardial constriction. Which of the following is the most likely problem? -constrictive cardiomyopathy -pericardial effusion -diastolic heart failure -systolic heart failure. Ans- systolic heart failure *LV ejection fraction is reduced 645% in systolic failure but normal in diastolic failure. On reviewing an ECG printout you note widened QRS complexes. Which of the following is the most likely cause of this problem? -1st-degree heart block -bundle branch block -sinus arrhythmia -atrial fibrillation. Ans- bundle branch block *Hyperkalemia *Ventricular pre-excitation [Wolf-Parkinson White pattern] *Any ventricular rhythm, including those caused by a ventricular pacemaker Which of the following is indicated by a sound of popping and whistling when
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED the water
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED bottle of a humidifer is tested by obstructing the gas outlet with the finger? -broken tubing
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -a worn gasket -no leakage - a cracked bottle. Ans- no leakage When inspecting the X-ray of a patient with a history of congestive heart failure being treated in the emergency department, you note patchy densities in the perihilar areas and in the gravity-dependent lower lung fields, with an increased CT ratio. Which of the following is the most likely problem? -atelectasis -bacterial pneumonia -pleural effusion -pulmonary edema. Ans- pulmonary edema On X-ray, fluffy or patchy densities in the perihilar areas and in the gravity-dependent lower lung fields is most consistent with pulmonary edema. Cardiomegaly and pleural effusions may also be seen, especially in severe left heart failure. When checking for proper adult placement of an endotracheal or tracheostomy tube on chest X-ray, the distal tip of the tube should be positioned where? -4 to 6 cm above the carina -1 to 3 cm above the carina -1 to 3 cm below the larynx -23 cm from the base of the tongue. Ans- 4 to 6 cm above the carina Which of the following chemical disinfectants would you choose if the objective were to kill both the vegetative and spore forms of bacterial pathogens? -iodophor solution -glutaraldehyde solution -quaternary ammonium solution -70% ethyl alcohol solution. Ans- glutaraldehyde solution *Immersion in gluteraldehyde (e.g. cydex) can achieve full sterilization (sporicidal action), but can require up to 10 hours. Shorter periods provide only high-level disinfection. A patient admitted to the emergency room is spontaneously breathing but comatose due to carbon monoxide inhalation. He has a PaO2 of 87 torr and PaCO2 of 36 torr on room air. Which of the following actions would you recommended?
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -administer as high a FiO2 as possible -initiate aerosol therapy with 40% 02
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -administer continuous positive airway pressure -initiate mechanical ventilatory support. Ans- administer as high a FiO2 as possible
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED *Anemia and carbon monoxide inhalation are two conditions in which high PO2s are needed to increase dissolved 02, compensating for the deficient hemoglobin transport. Instruction for incentive spirometry should include all of the following EXCEPT: -stressing the need for frequent use -minimizing recovery time between breaths -setting reasonable volume goals -emphasizing the value of breath holding. Ans- minimizing recovery time between breaths *Instruction for incentive spirometry should establish reasonable goals, emphasize the value of breath holding, stress the need for frequent use (6- 10 times/ hour), and point out how to avoid hyperventilation by allowing sufficient recovery time between breaths. A patient being monitored by capnography exhibits a sudden rise in end- tidal CO2 levels. All of the following are possible causes of this change EXCEPT: -massive pulmonary embolism -sudden release of a tourniquet -sudden increase in cardiac output -injection of sodium bicarbonate. Ans- massive pulmonary embolism * A massive PE= sudden fall in ETCO2 * Causes of sudden rise in ETCO2: 1. Sudden increase in cardiac output 2. Sudden release of a tourniquet 3. Injection of sodium bicarbonate A patient receiving oxygen at 10 L/min via nonrebreathing mask has a Pa02 of 600 mm Hg. You should recommend which of the following? -discontinue oxygen therapy -remove the valve at the reservoir bag -change to a partial rebreathing mask -change to a simple mask at 8 L/min. Ans- discontinue oxygen therapy *A patient with normal oxygenation does not need oxygen therapy. A physician has requested delivery of a stable, moderate 02 concentration (FiO2 = 0.35) to a patient with a tracheostomy. Which of the following
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED systems is the best and simplest way to achieve this goal?
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -air/02 blender system with T- tube -transtracheal oxygen catheter -demand-flow CPAP system -air entrainment nebulizer with T-tube. Ans- air entrainment nebulizer with T- tube * Devices in this category include air entrainment masks (AEMs/venturi masks) and all- purpose nebulizers. AEMs are indicated for alert patients with normal upper airway function. A patient has a peak expiratory flow rate (PEFR) of 5.2 L/sec before bronchodilator treatment and 6.3 L/sec after treatment. What percent change in PEFR occurred? 21% 8% 26% 17%. Ans- 21% % change = [(post — pre) / pre] x 100 % change = [(6.3 - 5.2) / 5.2] x 100 =21% When performing spirometry on an adult patient, which of the following would indicate invalid/unacceptable test results? -forced expiratory time >6.0 sec -back extrapolated volume 300 mL -time to peak flow 100 msec -repeat FVCs match within 150 mL. Ans- back extrapolated volume 300 mL A physician asks you to assess a patient's respiratory muscle strength. Which of the following bedside measures would you consider appropriate in order to obtain this data? 1. maximum voluntary ventilation 2. deadspace to tidal volume ratio 3. forced vital capacity 4. maximum inspiratory pressure 1 and 3 1, 3, and 4 2 and 4 2, 3, and 4. Ans- 1, 3, and 4 For which of the following purposes would you recommend pressure support ventilation (PSV)?
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -to help manage hypoxemic respiratory failure
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -to control a patient's minute ventilation -to increase the functional residual capacity
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -to decrease work of breathing caused by ET tubes. Ans- to decrease work of breathing caused by ET tubes You are working the night shift and receive an order from a new resident to provide an albuterol treatment via SVN to a CHF patient with acute pulmonary edema who is wheezing. What should you do? -recommend ethyl alcohol instead of albuterol -perform the therapy as ordered -recommend diuresis and 02 therapy -perform the therapy with supplemental oxygen. Ans- recommend diuresis and 02 therapy * Wheezing in CHF is usually due to peribronchial edema and not bronchospasm. In general, acute pulmonary edema is best managed with diuresis (e.g., Lasix), digitalis, and oxygen therapy.Noninvasive positive pressure ventilation (e.g., BiPAP) may also be employed to help reduce venous return and pulmonary vascular pressures. The administration of what drug is most appropriate to thin secretions and help in the removal of a mucous plug? -acetylcysteine -albuterol -racemic epinephrine -ipratropium bromide. Ans- acetylcysteine [mucomyst] * Albuterol (adrenergic)= bronchodilation * Racemic Epinephrine (adrenergic) = vasoconstriction * Ipratropium Bromide (anticholinergic) = bronchodilation A doctor wants an outpatient with idiopathic pulmonary hypertension to self- administer an inhaled pulmonary vasodilator. Which of the following drugs would you recommend? -bosentan (Tracleer) -diltiazem (Cardizem) -epoprostenol (Flolan) -iloprost (Ventavis). Ans- iloprost (Ventavis) *Only treprostinil (Tyvaso) and iloprost (Ventavis) are approved for administration via the inhalation route In order for CPAP to be successful in treating hypoxemic respiratory failure, the patient must have: -a secure artificial airway in place
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -an adequate Pa02 on less than 50% 02 -adequate spontaneous ventilation
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED -a cardiac output greater than 5 L/min. Ans- adequate spontaneous ventilation *CPAP alone does not provide ventilation, serving only to maintain the FRC and prevent alveoli from collapsing. Because this mode depends entirely on patient breathing efforts, to succeed the patient must have adequate spontaneous ventilation. Assuming all else being equal, which of the following BiPAP settings would result in the greatest increase in FRC? -EPAP = 15 cm H20; IPAP = 30 cm H20 -EPAP = 5 cm H20; IPAP = 25 cm H20 -EPAP = 10 cm H20; IPAP = 20 cm H20 -EPAP = 5 cm H20; IPAP = 15 cm H20. Ans- EPAP = 15 cm H20 IPAP = 30 cm H20 The resting lung volume or FRC during BiPAP is primarily determined by the EPAP pressure setting. All else being equal, the higher the EPAP pressure, the larger the FRC. Increasing FRC is associated with improved oxygenation due to recruitment of alveoli/increasing alveolar surface area. Thus, EPAP can be utilized in certain situations to improve oxygenation A patient's mixed venous PO2 has decreased from 41 mm Hg to 27 mm Hg over the last hour. What is the most likely explanation for this change? -the blood sample was withdrawn too rapidly -a pulmonary diffusion defect is developing -the patient's cardiac output has decreased -the patient's temperature has decreased. Ans- the patient's cardiac output has decreased *The drop in Pv02 from a normal value of 41 mm Hg to 27 mm Hg (abnormally low) indicates inadequate perfusion relative to tissue needs, as usually caused by a significant decrease in cardiac output A 36-year-old woman who has just undergone intestinal bypass surgery is brought to the recovery room intubated. She has normal pulmonary function, weighs 136 kg (300 lbs), and is 159 cm (5 feet, 2 in) tall. In this situation, you should recommend which of the following ventilator settings? -rate/ min: 8, VT (mL): 300 -rate/min: 10, VT (mL): 400 -rate/min: 8, VT (mL): 1000 -rate/min: 15, VT (mL): 700. Ans- rate/min: 10, VT (mL): 400
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED This patient's actual weight should not be used to establish an initial tidal volume. Rather, her initial tidal volumes should be set using a formula of 6 to 8 mL/kg PREDICTED body weight (PDW), which is probably about 50 kg. It is also recommended that the initial respiratory rate be set between 8— 12/min. While working in the intensive care unit, you notice the following airway pressures on an adult patient receiving volume-controlled ventilation with 5 cmH2O PEEP: Plateau Pressure/ Peak Pressure 9:00am 34 / 44 10:00am 38 / 49 11:00am 44 / 55 Knowing that no ventilator setting changes have been made, what is the most likely cause of these changes? - The patient is developing pneumonia - Endotracheal suctioning is needed - The patients lungs are becoming more compliant - The patient is developing bronchospasm. Ans- the patient is developing pneumonia *Peak pressures are progressively rising, due primarily to the increase in plateau pressures. With the delivered volume constant, this indicates a decrease in either lung or thoracic compliance. Pneumonia causes consolidation, which decreases lung compliance. What conclusions can you draw from the following data, obtained on a 47- year-old 55- kg female patient admitted for pulmonary complications arising from kyphoscoliosis: Actual Predicted %Predicted TLC 3.13 4.10 76% FRC 1.44 1.96 73% RV 0.85 1.09 77% FVC 2.28 2.92 78% FEF200 4.32 4.48 97% - 1200 FEF25- 2.83 2.74 103%
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED 75
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED - Results indicate a restrictive lung disorder - Results indicate poor patient effort during the test
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED - Results indicate generalized airway obstruction - Results indicate normal pulmonary function. Ans- results indicate a restrictive lung disorder *With all lung volume less than predicted (including the FVC), but normal expiratory flows, this patient has a restrictive disorder, consistent with her history of kyphoscoliosis. Which of the following would be the most likely cause of an absent waveform during continuous arterial pressure monitoring via an A-line? - patient movement - clot in catheter - air bubbles in tubing - catheter fling. Ans- clot in catheter [ aspirate the clot with a syringe then flush with heparinized saline] *Other causes: - Equipment set up errors; stopcock off to patient, loose connections, transducer not connected to the monitor, monitor set to zero, etc. A patient with a chronic neuromuscular disorder requires nocturnal positive pressure ventilation over the long term. Which of the following airways would you recommend for this patient? -fenestrated tracheostomy tube -standard tracheostomy tube -laryngeal mask airway - oral endotracheal tube. Ans- fenestrated tracheostomy tube *A fenestrated tracheostomy tube is the best choice to support patients needing intermittent (e.g., nocturnal) ventilatory support. You are assisting a physician in exchanging the ET tube of a patient using a fiberoptic bronchoscope (FOB) as the re-intubation guide. You would remove the old tube: - only after confirming the FOB tip is just above the carina only after the new tube is positioned in the trachea -prior to insertion of the FOB into the pharynx -immediately upon insertion of the FOB into the pharynx. Ans- only after confirming the FOB tip is just above the carina *During fiberoptic-assisted ET tube exchange, a small (pediatric size) bronchoscope is 'preloaded" or ensleeved with a new ET tube. Using the
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED scope for visual guidance, the
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED tip of the new tube is positioned in the laryngopharynx. Then the tip of the scope is passed through the glottis and into trachea alongside the existing tube (requires
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TMC MOCK EXAM 150 QUESTIONS WITH 100% CORRECT ANSWERS 2023-2024 COMPLETE SOLUTION/A+ GRADE GUARANTEED deflation of the old tube cuff). Only after the scope tip is confirmed to be in proper position (just above the carina), should the old tube be removed. Once the old tube is removed, the physician threads the new tube over the bronchoscope into the trachea.
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