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Special Procedures
Special Procedures
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1
If a pt is stable with a pneumo, p. effusion or hemo, immediate action should be taken to insert a large bore needle
True
False
2
Treatment of sleep apnea does not depend it's cause
True
False
3
In order to maintain adequate ventilation and oxygenation for organ donation, what parameters are to be kept?
PaCO2: 35-45, PaO2: >90 torr, SaO2 >90
PaCO: 35-45, PaO2: >100 torr, SaO2: >95 %
4
A procedure that involves administering a low voltage current to the hear in an attempt to convert to a normal rhythm.
Defibrillation
Cardioversion
5
After the AED delivers the shock, you MUST check for a pulse.
True
False
6
When removing AIR from the pleural space, the tube should be placed?
2nd intercostal space in the midaxillary line
5th to 7th intercostal space in the midaxillary line.
7
A patient is 100 miles away and needs to be transported to the hospital, which should be used?
Ambulance
Airplane
Helicopter
Car
8
Side effects of INO includes all of these EXCEPT?
Methemoglobin levels may increase
Oxygen toxicity may be seen
Rebound pulmonary hypertension
Nitrogen dioxide levels may increase.
9
All of the following are treatment options for sleep apnea, EXCEPT?
Weight loss
Surgery
Sleep study
Respiratory Stimulants
10
A condition in which the pt has apnea during sleep for periods of 10 seconds of longer.
Obstructive Sleep Apnea
Mixed Sleep Apnea
Insomnia Sleep Apnea
Central Sleep Apnea
11
In order to measure the Apnea Hypopnea Index you must?
Divide no. of apneas and hypopneas by Minutes of Sleep.
Divide the no. of apnea and hypopnea by Hours of sleep
12
What color would fluid from a CHF patient look like?
Purulent (pus)
Opaque appearance
Transudate (clear)
Bloody
13
Infant apnea monitoring is indicated for an infant who may be at risk for period of significant apnea >30
False
True
14
Identify the sleep apneas from the image below
A: Central B: Obstructive C: Mixed
A: Obstructive B: Central C: Mixed
A: Central B: Mixed C: Obstructive
A Mixed B: Central C: Obstructive
15
TIP: Know the moderate number. Anything below it is mild and any above it is High. Moderate is 16-30
Low cut is okay too!
We are going to pass HIGH CUT!!
16
During withdrawal of life support in terminally ill patients, dyspnea should be treated with
Analgesics
Neuromuscular blocking agents
Benzodiazepines
Methylxanthines
17
When should you discontinue Apnea monitoring?
Infant is 2 months free of events
No alarms of apnea >20 and HR <60
Infant crying efficiently
18
What therapy is used to increase the PaO2 by means of increasing the barometric pressure?
Hyperbaric Oxyen Therapy (HBO)
Helium/Oxygen Therapy (HeO2)
19
A patient is diagnosed with pulmonary artery hypertension and cor pulmonale. Which should the RT recommend to treat?
Nitric oxide therapy
100% oxygen therapy
IV delivery of sodium nitroprusside
Intrapulmonary percussive ventilation
20
A patient with end-stage renal disease wishes to spend her remaining days at home. The RT should refer the pt for?
Extended acute care
Skilled nursing care
Palliative care
Hospice care
21
The standard initial dose of INO is 20 - 40 ppm and should not exceed 80 ppm
True
False
22
Pulmonary hypertension rebound could occur during
Withdrawal of life support
Administration of respiratory stimulants
Early termination of iNO therapy
He/O2 therapy
23
A cardiopulmonary stress testing is indicated when
Determine maximum workload for developing an exercise plan
To deterine ventilatory limitations to work
Determine cardiac llimitations to work
For disabilty purposes
24
All of these are non-life threatening arrhythmias that are indicated for Cardioversion, EXCEPT?
Unstable atrial flutter
Sinus Tachycardia
Unstable atrial fibrillation
Stable ventricular tachycardia (SVT)
25
At what atmospheric pressure is most HBO therapy conducted?
2-3 ATA
4-6 ATA
2-4 ATA
4-8 ATA
26
Transudate fluid is drawn from the patient during a thoracentesis procdedure. This finding assists in the diagnosis of?
Hemothorax
Congestive heart failure
Pulmonary embolism
Pleural effusion
27
In order to minimize major side effects, inhaled nitric oxide therapy dosage should not exceed?
80 ppm
40 ppm
20 ppm
60 ppm
28
What is the amount of fluid needed for diagnostic purposes?
100 - 300 mL
500 mL
1000 mL
200 - 400 mL
29
Using the AHI scale, a pt has 17 as their score, what is your interpretation?
Moderate
High
MIld
30
Which of the following is the appropriate range of pressure for a pt receiving HBO therapy in a monoplace chamber?
6 - 7 ATA
4 - 5 ATA
2 - 3 ATA
8 - 9 ATA
31
A patient is over 150 miles away and needs to be transported to the hospital, which should be used?
Helicopter
Airplane
Car
Ambulance
32
A mini BAL is indicated to obtain proximal lung specimen for diagnosis of VAP
False
True
33
The ratio CO2 production to oxygen consumption can be calculated by
VO2/VCO
VCO/VO2
34
The presence of a pleural effusion can be established by but not limited to?
Lateral decubitus film showing concave upper border
Tracheal shift away from the site
Diminished breath sounds
Examination reveal flat or dull percussion note
35
A pt has an increased WOB due to post extubation stridor, severe asthma, obstructive tumors, which therapy is indicated?
Heliox Therapy
HBO
Reintubation/Intubate
Heated aerosol therapy
36
Formula to calculate patients maximum heart rate
220 - Age in years
220 * Age in years
37
Which therapy is indicated for these issues?
Inhaled Nitric Oxide
Helium/Oxygen therapy
IPPB therapy
Aerosol Therapy
38
A patient with asthma inhales a 70/30 heliox mixture. The RT selects a non-rebreather mask for the therapy.
12 L/min
24 L/min
30 L/min
18 L/min
39
A pt cant tolerate high pressures of CPAP or has continued obstruction after a CPAP pressure of 15, you should initiate?
Non rebreather
NPPV
Mechinical Ventilation
PFT
40
Please answer the question below:
A leak in the collection bottle
Excessive vacuum pressure
Inadequate water in the suction control chamber
A leak in the water seal chamber
41
What are the concentrations used for heliox therapy?
70% He 30% O2
80% He 20% O2
90% He 10% O2
60% He 40% O2
42
What percentage of air within a pneumothorax definitely requires a chest tube?
>30%
>10%
>20%
>50%
43
A 52 year-old female patient undergoes polysomnography. The RT reports her (AHI) to be 10. The value would be?
Normal
Mild
Moderate
Severe
44
For diagnostic lavage what type of bronchoscope is used?
Rigid
Flexible
45
Sudden Infant Syndrome is an indication of infant apnea monitoring
False
True
46
All of the following are indications of an AED, EXCEPT?
No response
No pulse
No breathing
Choking
47
Assessment of RQ may be helpful in critically ill patients to adjust their dietary intake.
True
False
48
Alveolar proteinosis, interstitial pneumonia, cystic fibrosis, pneumocystis pneumonia and alveolar hemorrhage are indica
BAL
Mini-BAL
49
Fluid with an opaque appearance would be considered to be?
Purulent
Exudate
Chyle
Empyema
50
Obstructive Sleep Apnea is due to loss of ventilation effort
True
False
51
Before removing a chest, the therapist must have the patient?
Cough several times then perform the valsalva maneuver
Take a deep breath, exhale and perform valsalva maneuver
52
Control of pain and other symptoms of terminally ill pts and maximizing the psychological social and spiritual being.
Hospice Care
Palliative care
53
Discontinuing INO therapy must be done quickly to prevent a rebound effect
True
False
54
In order to initiate Apnea testing for brain death, the therapist must:
Disconnect the pt from the vent while administering 100% O2
Check for absence of respiratory movement indicating a positive test
Observe pt for chest or abdominal movements
Confirm diagnosis with cerebral perfusion scan
55
Equipment needed for transport includes all of the following EXCEPT?
Intubation equipment
Portable oxygen
Manual resuscitation device and mask
Mechanical Ventilator
56
A gas that acts as a potent pulmonary vasodilator, which improves pulmonary blood flow and PaO2, is called?
Inhaled Nitric Oxide (INO)
Helium/Oxygen Therapy (HeO2)
57
A philosophy of care which helps support the efforts of terminally ill patients by providing clinician coverage at home.
Hospice care
Pallative Care
58
All of the following statement are true concerning Supplemental O2, EXCEPT?
Only indicated for adults
Wait 15 mins before increasing O2
Should be given when the pt has a SpO2 <88% while breathing RA
O2 should be started at 1 L/min
59
A disaster plan should not be practiced at all
False
True
60
Central Sleep Apnea is due to blockage of the upper airway
False
True
61
An initial setting for NPPV should be an IPAP of 8-10 and EPAP of 2-5. 1-2 increments of EPAP And IPAP until relief.
False
True
62
TIP: Go over pages F-12 to F- 13
Cool
Why???
63
Please answer the question below:
Advise the patient to sleep with his head elevated.
Continuous positive airway pressure therapy
Nocturnal oxygen therapy
Nothing, this is not definitive for sleep apnea
64
A chest tube should be clamped for 24 hours before removing the tube.
True
False
65
Water seal level on a water seal bottle should be set at 5 cm
False
True
66
A pt is diagnosed with unstable a fib and the physician is preparing to attempt to restore a normal sinus rhythm.
Cardioversion
Cardiac catherization
IV infusion of procainamide
Defibrillation
67
The actual flow delivered to a pt on HeO2 is calculated by what formula?
Indicated flow * concentration
Indicated flow * Factor
Volume * Factor
Volume * concentration
68
Hyperbaric Oxygen Therapy is indicated for:
Decompression sickness (bends)
Anaerobic infections (gas gangrene)
CO poisoning
Tissue transplants/grafts
69
A patient diagnosed with central sleep apnea will display what type of breathing pattern during an afternoon nap study?
2 and 4 only
2 and 3 only
1 and 3 only
1 and 4 only
70
What is the first line treatment for sleep apnea?
NPPV treatment
Mechnical Ventilation
Sleep study
CPAP
71
The term used to describe fluid containing lymphatic exudative fluid is called Chyle
False
True
72
The most common disorder that requires a thorancentesis is?
Pulmonary Edema
Pulmonary Emboli
Pleural Effusion
Pneumothorax
73
Which of the following is the correct location for needle insertion during a thorancentesis procedure?
5th to 6th intercostal space
3rd to 4th intercostal space
1st to 2nd intercostal space
7th to 8th intercostal space
74
Used when life threatening cardiac dysrththmias are present
Defibrillation
Cardioversion
75
Indications for defibrillation include all, EXCEPT
A flutter
V Fib
Pulseless V tach
76
Hyperbaric oxygen therapy improves the oxygenation status of a patient by?
Having the patient inspire 100% oxygen
Elevating the fractional concentration of oxygen
Increasing the barometric pressure of oxygen
Decreasing the patient pressure of oxygen
77
During intra-hospital of a patient receiving oxygen via nasal cannula at 2 L/min.
Replace the cylinder with a fully pressurized cylinder
Calibrate the regulator and reevaluate the flow reading
Look for an obstruction in the oxygen tubing.
Place the cylinder in an upright position
78
When removing FlUID from the pleural space, the tube should be placed?
2nd intercostal space in the midaxillary line
5th to 7th intercostal space in the midaxillary line.
79
During the procedure of the AED, it is important to clear the victim and press the shock button.
That's true!
Nope, thats not right!
80
Ultrasounds are contraindicated in the process of thoracentesis.
False
True
81
A lateral decubitus chest radiograph shows a concave upper border. This is most indicative of which of the following?
Tension pneumothorax
Fluid in pleural cavity
Subcutaneous emphysema
Extra-pulmonary air
82
Answer the question below:
Prepare to insert a chest in the 2nd anterior ICS.
Pull the endotracheal tube back slightly.
Insert a large bore needle in the 2nd anterior ICS.
Position the patient for thoracentesis
83
What is the role of a RT in a disaster plan?
Keep adequate supply of humidifiers, cannulas, mask and flow meters.
Have established call in list
Keep resuscitation equipment in working order and easily accessible.
Be prepared to assist in treatment areas
84
Presentation of sleep apnea includes all of the following EXCEPT
History of snoring and obesity
Muscle twitching
Complaining of daytime sleepiness and insomnia at night
Increase appetite
85
Please answer the question below:
Loss of volume from the peripheral airways into the chest tube
An obstruction in the water seal chamber
A full collection chamber
Inappropriate water level in the suction control chamber
86
What are the factors for the 80/20 and 70/30 concentrations?
1.8 and 1.6
1.2 and 1
2 and 3
87
A patient is under 80 miles away and needs to be transported to the hospital, which should be used?
Helicopter
Ambulance
Airplane
Car
88
The RT prepares to assist with a bronchoalveolar lavage for a patient being mechanically ventilated in the ICU.
2 and 3 only
2 and 4 only
1 and 3 only
1 and 4 only
