RRT RRT Ultimate 5 — Questions and Answers
Question 1: Which ventilator waveform finding is most consistent with auto-PEEP (intrinsic PEEP)?
- Inspiratory flow that never returns to zero
- Expiratory flow that does not return to zero before the next breath (Correct answer)
- A spike in airway pressure at end-inspiration
- Decreased tidal volume with constant pressure
Correct answer: Expiratory flow that does not return to zero before the next breath
Auto-PEEP occurs when expiratory flow is still present when the next breath begins, indicating incomplete exhalation.
Question 2: A patient with a tracheostomy tube has a plugged inner cannula causing acute respiratory distress. What is the FIRST action the therapist should take?
- Call the physician
- Remove and replace the inner cannula (Correct answer)
- Apply 100% oxygen via mask
- Deflate the cuff and remove the tracheostomy tube
Correct answer: Remove and replace the inner cannula
Removing and replacing (or cleaning) the inner cannula immediately relieves the obstruction caused by secretion plugging.
Question 3: What is the recommended maximum suction pressure for an adult patient during endotracheal suctioning?
- -60 to -80 mmHg
- -80 to -120 mmHg
- -100 to -150 mmHg (Correct answer)
- -150 to -200 mmHg
Correct answer: -100 to -150 mmHg
AARC guidelines recommend suctioning pressure of -100 to -150 mmHg for adults to effectively clear secretions while minimizing trauma.
Question 4: Which condition is MOST likely to cause a normal chest X-ray in a patient with severe hypoxemia?
- Cardiogenic pulmonary edema
- Pulmonary embolism (Correct answer)
- Lobar pneumonia
- ARDS
Correct answer: Pulmonary embolism
Pulmonary embolism obstructs blood flow without direct parenchymal changes, often leaving the CXR normal or near-normal despite severe hypoxemia.
Question 5: When setting up a 6-minute walk test (6MWT), which criterion would DISQUALIFY a patient from completing the test?
- Resting SpO2 of 92%
- Unstable angina or recent MI within 1 month (Correct answer)
- Mild dyspnea on exertion
- Use of a bronchodilator within 4 hours
Correct answer: Unstable angina or recent MI within 1 month
Unstable angina or an MI within the past month is an absolute contraindication to the 6MWT due to risk of serious cardiac events.
Question 6: A patient is receiving non-invasive positive pressure ventilation (NIPPV) with IPAP 14 cmH2O and EPAP 6 cmH2O. What is the effective pressure support delivered?
- 6 cmH2O
- 8 cmH2O (Correct answer)
- 14 cmH2O
- 20 cmH2O
Correct answer: 8 cmH2O
Effective pressure support on NIPPV = IPAP − EPAP = 14 − 6 = 8 cmH2O.
Question 7: Which finding on a capnography waveform (EtCO2) suggests esophageal intubation?
- EtCO2 of 38 mmHg with stable plateau
- Gradual rise in EtCO2 over several breaths
- Absence of CO2 waveform after intubation (Correct answer)
- EtCO2 of 45 mmHg with a shark-fin waveform
Correct answer: Absence of CO2 waveform after intubation
Absence of a CO2 waveform after intubation confirms esophageal placement, as the esophagus contains no CO2.
RRT RRT Ultimate 5
Which ventilator waveform finding is most consistent with auto-PEEP (intrinsic PEEP)?