CRTE Nursing Diagnosis Practice Exam With Answers (100 Solved Questions)

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CRTE Nursing Diagnosis Practice Exam With Answers (100 Solved Questions) - Page 1 preview image

CERTIFIED RESPIRATORY THERAPIST EXAM 3-8 100 QUESTIONSAND ANSWERS RATED A+ WITH COMPLETE SOLUTIONSAssessment of a 28-year-old trauma patient reveals diminishedbreath sounds, asymmetrical chest expansion, severe chest pain,and an SpO2 of 90%, despite receiving oxygen via cannula at 5L/min. These findings are most consistent with what diagnosis? - B).PneumothoraxBoth viral pneumonia and pleural effusion can be ruled out ascorrect answers as they are related to trauma. Breath sounds,though diminished, can be heard, and chest expansion, thoughasymmetrical, is present; both of these are not consistent with acomplete airway obstruction. The physical assessment is consistentwith the correct answer, pneumothorax.A 23-year-old firefighter is admitted with suspected smokeinhalation. You place him on a nonrebreathing mask. What is themost appropriate method of monitoring his oxygenation? - B). CO-oximetryIn the case of smoke inhalation, carbon monoxide (CO) binds to thehemoglobin molecule in place of oxygen. Neither ABGs, pulseoximetry, or calculation of A-a gradient will indicate how much

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oxygen is bound to hemoglobin. Any victim of suspected smokeinhalation must be monitored with CO-oximetry.The ratio of lecithin to sphingomyelin, or L/S ratio, is a test todetermine fetal lung maturity. Such a test may be done in the laterstages of pregnancy, and the values will initially be noted in the labresults section of the mother's medical record. Approximately whatratio is associated with the onset of mature surfactant production?- A). 2:1The lecithin to sphingpmyelin ratio, or L/S ratio, is used todetermine fetal lung maturity. Generally, this ratio reaches 2:1(twice as much lecithin as sphingomyelin) near week 35 ofgestation, which corresponds to the onset of mature surfactantproduction. The L/S ratio will generally be noted in the lab resultssection of the mother's medical record.Sputum culture and sensitivity would be indicated in the evaluationof which of the following clinical conditions? - B). BacterialpneumoniaSputum culture and sensitivity are used to identify microorganismsand their most appropriate drug therapy. Bacterial pneumonia is theobvious infectious process in the choice of answers.

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You measure an oxygen concentration of 55% being delivered by anair-entrainment mask set to deliver 31% oxygen. - C). Check theentrainment ports.Because air-entrainment masks mix air and oxygen at a constantratio, an alteration in the delivered oxygen concentration couldresult onlyfrom an alteration in the mixing ratio. Since jet size (for a givenadapter) is fixed, the problem must be with the entrainment ports.Obstruction of the entrainment ports will decrease air entrainmentand raise the delivered oxygen concentration.Which of the following is the approximate total output flow deliveredfrom a 35% air-entrainment mask operating at 8L/min? - B).48L/minTo compute the total output flow delivered by an air-entrainmentdevice, multiply the sum of its ratio parts by the input flow. A 35%air-entrainment mask mixes air and oxygen at a fixed 5:1 ratio; thus(5+1) x 8 = 48 L/minYou observed that the reservoir bag on a patient receiving O2 at 10L/min does not deflate at all when the patient inspires. What to dofirst. - C). Check the mask for a snug fit.If a nonrebreathing mask reservoir bag does not deflate at all whenthe patient inspires, either the flow is higher than needed, there are

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large inspiratory air leaks (around the mask or through theexhalation valves), or the inspiratory valve is jammed. The mostcommon cause is large air leakage, which can easily be corrected bymaking sure that the mask is fit comfortably tight to the patient,sface.Which of the following is the most probable cause of insufficient mistin a croup tent)? - D). A clogged capillary tube in the nebulizer.Since most croup tents use large-volume jet nebulizers to generatemist, insufficient mist indicates malfunction of the nebulizer. Themost common cause of nebulizer malfunction is clogging of thecapillary tube that feeds liquid water to the jet.A physician specifies in her respiratory orders the followingobjective for a patient with an artificial airway: " to overcome thepatient's humidity deficit." Aerosol generator to be used for thispatient. - B). Large -reservoir heated jet nebulizer.The large-reservoir air-entrainment jet nebulizer is the primarygas-powered aerosol generator used to provide humidification tothe respiratory tract.During CPR, the oxygen reservoir bag of a bag-valve manualresuscitator collapses during the refill phase. You can correct thisproblem by: - B). Increasing O2 flow to the bag.

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Think of the reservoir bag of a bag-valve manual resuscitator asequivalent to the bag on a reservoir mask. If the reservoir bagcollapses during the resuscitator's refill phase (equivalent topatient inspiration), the flow is inadequate and should be increaseduntil the bag does not empty.While a patient is being ventilated with a bag-valve resuscitator, thebag fills rapidly and collapses on minimal pressure, although littlechest movement by the patient is noted. The cause may be. - A).Absence of the inlet valve.If a bag-valve resuscitator fills rapidly but collapses on minimalpressure and delivers little volume, the likely problem is a missing,torn or malpositioned inlet valve. In this case, when you squeeze thebag, gas follows the path of least resistance and escapes out theinlet port (instead of going to the patient). Can be avoided byperforming an operational check on the bag before applying it to thepatient.An intubated adult patient with severe expiratory airway obstructionrequires ventilatory support. Which of the following factors is mostimportant in selecting a ventilator for this patient? - B). Variableflow control and adjustable I:E ratios.Of the functions listed, the most important capability when selectinga ventilator for an intubated adult patient with severe expiratoryairway obstruction would be variable flow control and adjustable I:E

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ratios. This will allow clinicians to make sure the expiratory time issufficiently long to prevent air trapping / auto-PEEPWhat type of breathing circuit would you use when assembling ahome-care ventilator. - B). Single-limb circuit with expiratoryballoon valve.Most home-care ventilators use a single-limb circuit with expiratoryballoon valve. Single-limb circuits have a separate pneumatic linerunning from the ventilator to the expiratory valve that pressurizesthe expiratory valve during inspiration in order to block gas outflowduring the application of positive pressure. An expiratory valve canalso be used to control or retard expiratory flow or provideCPAP/PEEP.To provide a low to moderate concentration of oxygen to a patientreceiving nasal BIPAP via a device that uses a turbine or blower togenerate pressure, you should: - C). Bleed supplemental O2 from aflowmeter into the circuit.Most NPPV ventilators and BIPAP devices use a simple air blower togenerate pressure. In order to provide supplemental oxygen withdevices, you place a small-bore tubing adapter at either the patientinterface or machine outlet. After connecting this adapter to aflowmeter via O2 delivery tubing, you bleed O2 into the circuit untilhe desired level is confirmed by O2 analysis. Note that high

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supplemental O2 flows can interfere with the proper triggering orcycling of some NPPV ventilators.What alarm conditions indicates a potential system leak whendelivering volume-oriented ventilatory support? - D). Low volume +low pressure.When delivering volume-oriented ventilatory support, potentialsystem leaks are indicated by a low-volume and low-pressure alarmcondition. Check for and correct any loose circuit connections.A patient with a chronic neuromuscular condition requires nocturnalpositive pressure ventilation over the long term. What airway wouldyou recommend for this patient? - B). Fenestrated tracheostomytube.A fenestrated tracheostomy tube is the best choice to supportpatients needing intermittent (e.g. nocturnal) ventilatory support.For positive pressure ventilation, the inner cannula is inserted toclose the fenestration and the cuff inflated to provide a seal. Whenthe patient is not on the ventilator, the inner cannula is removed (toopen the fenestration), the cuff is deflated, and the tube is plugged.This allows normal use of the upper airway.What would indicate an obstruction in the ET tube of a patient who isbeing mechanically ventilated by a volume-cycled ventilator? - A). I.

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High pressure is required to deliver the volume. & III). A suctioncatheter cannot be passed.An obstruction in the ET tube of a patient who is being mechanicallyventilated increases flow resistance and thus the peak pressureneeded by a volume-cycled ventilator to deliver its preset volume. Inaddition, you could detect the obstruction by trying to pass a suctioncatheter through the ET tube. Failure to pass a suction catheterthrough a tracheal airway indicates tube obstruction.Prior to intubation in an emergency, injection of air into the pilot linefails to inflate the cuff. You should: - C). Replace the endotrachealtube.A cuff that fails when injected with air has a large leak. The faulty ETtube should be replaced and the new tube tested in the samemanner.Resistance is encountered while suctioning through a size 6-mm IDET tube with a 14-Fr catheter. What is the most appropriate action totake? - B). Use a 10-Fr catheter.The catheter is too large for the ET tube. In general, the outsidediameter of a suction catheter should not be more than about 1/2 aslarge as the inside diameter of the airway through which it passes.To quickly estimate the correct catheter size in french units (Fr),simply multiply the internal diameter (ID) of the tracheal tube (in

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mm) by 2 and select the next smallest catheter size.(e.g. 6.0-mmtube, 2 x 6 = 12, next smallest catheter size = 10 Fr. 10Fr is the bestsize to use for this patient.What can cause suctioning stop suddenly during tracheobronchialaspiration. - B). Clearence of secretions.Conditions that could cause suctioning to stop suddenly duringtracheobronchial aspiration include: 1) disconnected tubing (leak:loss of vacuum), 2). a full suction reservoir (ball-valve shutoff), and3) plugging of the catheter (system obstruction).About how many hours will an H-cylinder of oxygen last if it has 1100psig and is emptying at a flow of 8L/min? - C). 7.2 hoursDuration of flow = (cylinder factor x psig)/flow. The factor for an Hcylinder is 3.14 Thus duration of flow = (3.14 x 1100)/ 8 = 432minutes. 432/ 60 = 7.2 hours.After attaching a yoke connector to an E-size cylinder and openingthe cylinder valve, you notice a leak at the gas outlet. What are thepossible causes of the leak? - C). The gas outlet bushing is missing &The yoke hand screw is not tight enough.Yoke connectors for cylinders A-E use a hand screw to hold the tokeon the valve stem. If not tightened properly, a leak could result. Inaddition the small receiving nipple on the yoke is normally sealed to

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the gas outlet with a nylon bushing. A missing or damaged bushingcould also cause a leak.While obtaining an arterial sample for analysis using a point-of-careanalyzer, you should do what? - B). Place the sample in an ice slush.When obtaining an arterial sample for analysis using a point-of-careanalyzer, the equipment performed are essentially the same aswhen preparing the sample for central lab analysis.Exceptions = 1) sample to be analyzed within 3 minutes, & 2) sampleshould not be placed in ice.An alert 55-year-old patient who has two days earlier had abdominalsurgery has moderate basilar crackles on the left side, arespiratory rate of 13 breaths/min, and an SpO2 of 96% on nasalcannula at 2L/min. The surgeon is concerned that the patient maybe developing atelectasis, What approach can manage this patient? -B). Incentive breathing therapy.Incentive spirometry is the first choice for treating suspected orconfirmed atelectasis in an alert patient who does not have evidenceof bronchospasm or secretion clearance problems.To apply vibrations to a patient when using an electrically poweredpercussor during postural drainage, you should use the ______available frequency and apply during _______ only. - A). Highest;exhalation

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To provide vibration with a mechanical percussor, you should usethe higher available frequencies (20-30 Hz) and apply duringexhalation only.After setting up a flow-resistor expiratory airway pressure (PEP)device for a patient with postoperative atelectasis, you note that thesystem does not generate any pressure during active patientexpiration. Your first action in this case should be to: - B). Recheckand tighten all connections.If a PEP device fails to generate pressure during patient expiration,the most likely problem is a leak, either in the device itself or in theconnecting tubing (including any connection to a pressuremanometer,You can use a fluid column pressure manometer for what? - D). Tomeasure rapid pressure changes.Fluid pressure manometers are used to measure 1) atmosphericpressure (barometer); 2) static or slowing changing pressures- e.g.CVP; 3) systolic/diastolic blood pressures (occlusion method); andalso to calibrate other pressure measuring devices. They are notsuited for measuring rapidly changing pressures, thier accuracydepends on position, and they can be messy or hazardous (ifmercury is used).

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You need to measure the forced vital capacity (FVC) of an adultpatient at the bedside. What device should be used to make thismeasurement? - A). A computerized electronic spirometer with flowsensor.If you need to measure a patient's forced vital capacity or relatedmeasures (e.g., peak flow, FEV1, FEV25-75%) at the bedside, youshould choose a portable electronic spirometer that incorporates aflow sensor (pneumotachometer) and computer analysis module.Mechanical turbine-type volumeters like the Wright respirometerare used to measure tidal volume, minute volume, inspiratorycapacity, and slow vital capacity. Because the Wright respirometercan be damaged by flows greater than 60 L/min, it should not beused to measure forced inspiratory or expiratory volumes.Upon inspection of a portable spirometer's FVC curve obtained on anadult outpatient, you determine that the back extrapolated volume isexcessive. Prior to repeating the maneuver, what instruction shouldyou provide to the patient. - A). "Don't hesitate"In adults, a back extrapolated volume greater than 150 ml, indicatespatient hesitation at the beginning of the breath, which will invalidatethe results.After setting up a 12-lead ECG on a patient, you note a noisy andunstable signal. What will help to resolve the problem. - C). Turningoff filtering of extraneous electrical activity.

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