RRT RRT Ultimate 4 — Questions and Answers
Question 1: A patient with myasthenia gravis is in respiratory failure. Which measurement BEST indicates the need for intubation?
- PaO2 < 60 mmHg on room air
- Vital capacity < 15 mL/kg (Correct answer)
- RR > 20 breaths/min
- SpO2 < 95% on 2 L/min O2
Correct answer: Vital capacity < 15 mL/kg
The 20-30-40 rule in neuromuscular disease: VC < 20 mL/kg, MIP weaker than -30 cmH2O, or MEP < 40 cmH2O indicate impending failure.
Question 2: Which FEV1/FVC ratio is most consistent with obstructive lung disease?
- 0.85
- 0.78
- 0.65 (Correct answer)
- 0.90
Correct answer: 0.65
An FEV1/FVC ratio below 0.70 (or the LLN) is the diagnostic criterion for airflow obstruction per GOLD guidelines.
Question 3: Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA) used in COPD management?
- Salmeterol
- Tiotropium (Correct answer)
- Formoterol
- Budesonide
Correct answer: Tiotropium
Tiotropium is a once-daily LAMA that blocks M3 muscarinic receptors, reducing bronchoconstriction in COPD.
Question 4: What is the MOST common complication of endotracheal suctioning?
- Pneumothorax
- Hypoxemia (Correct answer)
- Tracheomalacia
- Subcutaneous emphysema
Correct answer: Hypoxemia
Suctioning removes oxygen along with secretions, making hypoxemia the most frequent complication, especially if pre-oxygenation is omitted.
Question 5: A patient receiving heated high-flow nasal cannula (HFNC) at 40 L/min and FiO2 0.60 still has SpO2 of 86%. What is the BEST next step?
- Increase flow to 60 L/min
- Transition to non-invasive positive pressure ventilation (NIV) or intubation (Correct answer)
- Decrease FiO2 to 0.40 and reassess
- Add a simple mask over the HFNC
Correct answer: Transition to non-invasive positive pressure ventilation (NIV) or intubation
Failure to maintain adequate oxygenation on maximal HFNC settings is an indication to escalate to NIV or invasive mechanical ventilation.
Question 6: Which acid-base disorder is associated with prolonged nasogastric suctioning?
- Metabolic acidosis
- Respiratory alkalosis
- Metabolic alkalosis (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic alkalosis
Loss of gastric HCl via NG suction removes acid, leaving a net alkalotic state—metabolic alkalosis.
Question 7: During a helium-oxygen (heliox) therapy session, the therapist notices significant improvement in a patient's stridor. What does this indicate?
- Heliox improved alveolar gas exchange
- The obstruction is in the upper airway (large airway) (Correct answer)
- The patient's asthma is responding to treatment
- Heliox has reduced pulmonary vascular resistance
Correct answer: The obstruction is in the upper airway (large airway)
Heliox reduces turbulent flow in large, obstructed upper airways; its benefit implies the obstruction is in a region where flow is turbulent.
RRT RRT Ultimate 4
A patient with myasthenia gravis is in respiratory failure.
Which measurement BEST indicates the need for intubation?