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Lpn med surg proctored exam

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Total Questions : 61

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Question 1:

ABG: pH 7.50, PaCO2 = 28 mm Hg, HCO = 24 mEq/L
Interpretation?

A. Uncompensated respiratory alkalosis B. Fully compensated respiratory alkalosis C. Metabolic alkalosis D. Partially compensated metabolic alkalosis

Answer and Explanation

Choice A:

The pH is alkalemic (7.50), PaCO₂ is low (28 mm Hg), and HCO₃⁻ is within the normal range (24 mEq/L), indicating primary respiratory alkalosis without renal compensation.

Choice B:

Full compensation would involve reduced HCO₃⁻ with pH closer to normal (≈7.40).

Choice C:

Metabolic alkalosis would show elevated HCO₃⁻ with compensatory hypoventilation, not low PaCO₂.

Choice D:

This would show elevated HCO₃⁻ and pH >7.45, with a secondary respiratory change (elevated PaCO₂).

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Question 2:

A patient presents with asthma not well controlled on a low-dose ICS. Which step-up strategy is preferred for patients over 5 years old?

A. Double the ICS dose immediately B. Switch to an oral corticosteroid daily C. Add a leukotriene receptor antagonist (LTRA) D. Add a long-acting beta-agonist (LABA)

Answer and Explanation

Choice A:

Doubling the ICS dose may help in some cases, but adding a controller medication is generally more effective for persistent symptoms.

Choice B:

Long-term oral corticosteroids are not recommended for asthma control due to severe systemic side effects; they are reserved for acute exacerbations or severe, refractory cases.

Choice C:

LTRAs can be considered as an alternative, but they are less effective than adding a LABA when stepping up therapy.

Choice D:

According to asthma guidelines (e.g., GINA), for patients >5 years whose asthma is not well controlled on a low-dose ICS, the preferred next step is to add a LABA, either in a combination inhaler with ICS or as part of a step-up therapy.

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Question 3:

An adult man on ventilatory support has just been intubated with a 7-mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H2O. What is most likely the problem?

A. The tube is in the right main stem bronchus B. The cuff pilot balloon and line are obstructed C. The tube chosen is too small for the patient D. The cuff has herniated over the tube tip

Answer and Explanation

Choice A:

This would cause unilateral breath sounds but not directly explain high cuff pressure.

Choice B:

This would prevent cuff inflation rather than cause abnormally high pressures.

Choice C:

A 7-mm ETT is relatively small for most adult men. A small tube requires overinflation of the cuff to achieve an adequate seal, resulting in dangerously high cuff pressures (>30 cm H₂O can damage tracheal mucosa).

Choice D:

This would lead to obstruction or difficulty ventilating, not isolated high cuff pressure readings.

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Question 4:

What is the primary role of NIV in the palliative care setting?

A. Reduce cost of care B. Normalize CO2 C. Relief of dyspnea D. Normalize O2

Answer and Explanation

Choice A:

Cost reduction is not the main goal in palliative care. The focus is patient comfort and quality of life.

Choice B:

While NIV can help with CO₂ clearance, the primary goal in palliative care is not to correct labs but to improve comfort.

Choice C:

The main purpose of NIV (non-invasive ventilation) in palliative care is to alleviate breathlessness, enhancing comfort in patients with advanced illness.

Choice D:

Oxygenation may improve, but full normalization is not the goal in a palliative setting; symptom relief is prioritized.

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Question 5:

Which of the following is a major complication that can result from prolonged endotracheal intubation?

A. Increased alveolar oxygenation B. Tracheal widening C. Tracheal stenosis D. Nasal bleeding

Answer and Explanation

Choice A:

Intubation does not cause increased oxygenation as a complication; it is the intended effect of ventilation.

Choice B:

Prolonged intubation typically causes narrowing, not widening, of the trachea.

Choice C:

Prolonged pressure from the endotracheal tube cuff can cause ischemia, scarring, and narrowing of the trachea, leading to tracheal stenosis.

Choice D:

Nasal bleeding may occur with nasotracheal intubation, but it is a minor and immediate complication, not a major long-term one.

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Question 6:

Increased dead space-to-tidal volume ratio (VD/VT) is most commonly seen in which patient population, leading to increased work of breathing?

A. Patients with neuromuscular junction disorders B. Patients with COPD C. Patients with pleural effusion D. Patients with metabolic acidosis

Answer and Explanation

Choice A:

These patients have impaired ventilation due to muscle weakness, but dead space is not typically increased.

Choice B:

Patients with COPD often have areas of the lung that are ventilated but poorly perfused, leading to increased physiologic dead space (VD/VT). This increases the work of breathing and contributes to hypercapnia.

Choice C:

Pleural effusions cause restrictive lung mechanics but do not primarily increase dead space.

Choice D:

Metabolic acidosis stimulates increased respiratory rate (hyperventilation) but does not directly increase dead space.

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Question 7:

You might think being a respiratory therapist is easy, but it's SNOT

A. True B. False

Answer and Explanation

Choice A:

“SNOT” humorously refers to the fact that respiratory therapists often deal with nasal secretions, mucus, and airway management, highlighting that the job involves challenging and sometimes messy patient care.

Choice B:

While the statement is humorous, it reflects the reality that respiratory therapy requires skill, attention, and handling of complex airway issues—not always “easy” work.

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Question 8:

ABG: pH 7.25, PaCO2 = 65 mm Hg, HCO₃⁻ = 29 mEq/L Interpretation?

A. Fully compensated respiratory acidosis B. Partially compensated respiratory acidosis C. Uncompensated respiratory alkalosis D. Metabolic acidosis 1

Answer and Explanation

Choice A:

In full compensation, the pH would be within the normal range (7.35–7.45). Here, pH is still acidotic (7.25).

Choice B:

Elevated PaCO₂ indicates a primary respiratory acidosis. HCO₃⁻ is increased as the kidneys begin to compensate, but pH remains <7.35, so compensation is partial, not complete.

Choice C:

This ABG shows acidosis, not alkalosis, and CO₂ is elevated rather than decreased.

Choice D:

The primary disturbance is respiratory (PaCO₂ ↑), not metabolic (HCO₃⁻ ↓).

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Question 9:

A 65-year-old male with COPD is prescribed Tiotropium. What type of medication is this?

A. Leukotriene receptor antagonist B. Short-acting beta agonist C. Inhaled corticosteroid D. Long-acting muscarinic antagonist (LAMA)

Answer and Explanation

Choice A:

Leukotriene receptor antagonists (e.g., montelukast) are used mainly for asthma and allergic rhinitis, not COPD management.

Choice B:

Short-acting beta agonists (SABAs, e.g., albuterol) provide rapid relief of acute bronchospasm but are not the same as tiotropium.

Choice C:

Inhaled corticosteroids reduce airway inflammation and are often combined with LABAs in COPD, but tiotropium is not a steroid.

Choice D:

Tiotropium is a long-acting muscarinic antagonist (LAMA) that works by blocking M3 receptors in the airway smooth muscle, leading to sustained bronchodilation. It is a cornerstone of maintenance therapy in COPD.

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Question 10:

Your patient is diagnosed with persistent asthma. Which type of drug would you recommend for maintenance bronchodilation and control of bronchospasm?

A. Long-acting adrenergic agent B. Alpha-adrenergic agent C. Mucolytic agent D. Short-acting adrenergic agent

Answer and Explanation

Choice A:

Long-acting beta-agonists (LABAs) are used as maintenance therapy for persistent asthma to provide sustained bronchodilation and control of symptoms, usually in combination with an inhaled corticosteroid.

Choice B:

Alpha-adrenergic agents primarily cause vasoconstriction and are not used for bronchodilation.

Choice C:

Mucolytics help thin mucus but do not control bronchospasm.

Choice D:

Short-acting beta-agonists (SABAs) like albuterol are used for rescue therapy, not maintenance control.

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Total Questions : 61

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Lpn med surg proctored exam

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