Respiratory Therapist Practice Exam

Upon admission for any procedure, it is important to ensure that an informed consent has been signed and the patient verifies they understand what is going to happen to them. DNR status/Advance Directives are also important to verify as they will determine what actions will be taken if something were to happen to the patient during the procedure.

The CXR will give you important information and should be obtained. However, the CXR takes time to order and to get the results back. When you have a patient arrive in the ER you want to perform initial assessment procedures that take little time and give you valuable data almost immediately. Pulse Oximetry, Breath Sounds and the Cardiac Monitor can give you vital information that gives you a baseline assessment of oxygen status, heart rhythm and breath sounds quickly.

The criteria for RR, VT, VC, and Minute Ventilation have been determined through observation and study of the best techniques and parameters to obtain successful weaning. The Standard Weaning Criteria (SWC) uses the respiratory muscle strength and endurance by using the negative inspiratory force (NIF) and positive expiratory pressure (PEP) to determine how well a patient will do when weaned from the ventilator. The RSBI which is the Respiratory Shallow Breathing Index is used as well. As the patient tires the spontaneous breathing rate becomes rapid and shallow and it is necessary to evaluate muscle fatigue. RSBI =(f/VT) which helps to identify the breathing pattern associated with an unsuccessful weaning. The ratio of success is considered.

Oxygen and Atropine are the initial drugs of choice for the treatment of Sinus Bradycardia. If the Bradycardia persists or devolves to a heart block you may consider placing transthoracic pacing pads along with medication and oxygen.

Capnography gives you the most immediate information. Breath sounds and Bilateral Chest Expansion can be considered subjective. Oximetry is also a device that gives you data, but it is on Oxygen, not End Tidal CO2.

Patient safety always comes first. If the dosage is incorrect, you must call the Provider and ask for clarification of the order. You do not give a medication order that is not correct. You do not give the "correct" dose and then confirm the order afterwards. All orders must be verified before administration. You do not just "skip" a treatment because the order is incorrect. Make sure the order error is corrected and the treatment given to the patient.

Compliance = Change in Volume/Change in Pressure. Remember that the lungs are normally compliant. They adjust to changes in volume and pressure relatively easy. As the lungs become less compliant, less volume can be accommodated, thus increasing the pressure in the lungs as lung volumes are trying to be maintained.

Too high a level of PEEP can cause a decrease in Cardiac Output by decreasing Venous return to the heart and decreases Urine Output due to the decrease in Cardiac Output. Too high a PEEP can decrease lung compliance as the lung cannot properly deflate.

Keep RR high to keep PaCO2 levels between 25 and 30 mmHg and PIP below 30 cmH2O to avoid suctioning and causing coughing which raises ICP.

Acetic Acid soak for 20 minutes. Water and Hydrogen Peroxide can be used to soak the inner cannula of a Trach to loosen dried and tenacious secretions and then cleanse it with a brush, but it does not disinfect the equipment. Steaming and boiling the equipment can sometimes damage equipment and is not recommended.