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RRT-ACCS

NBRC Registered Respiratory Therapist Adult Critical Care Specialist (RRT-ACCS)

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Question: 489

A patient with community-acquired pneumonia is started on empiric antibiotic therapy. Which of the following antibiotic regimens provides coverage for the most common pathogens causing community-acquired pneumonia?

mpicillin-sulbactam eftriaxone evofloxacin

zithromycin plus ceftriaxone wer: D

anation: Azithromycin plus ceftriaxone provides coverage for the mos mon pathogens causing community-acquired pneumonia. Azithromyci rs atypical pathogens such as Mycoplasma pneumoniae and Legionell mophila, while ceftriaxone covers typical pathogens such as Streptoc moniae.

stion: 490

ch of the following ventilator modes is most appropriate for a patient w re chronic obstructive pulmonary disease (COPD) and respiratory dist

Que

Assist-Control Volume Ventilation (ACVV)
Pressure Support Ventilation (PSV)
Synchronized Intermittent Mandatory Ventilation (SIMV)
Pressure Control Ventilation (PCV) Answer: D

Explanation: Patients with severe COPD and respiratory distress often require a ventilator mode that allows for adequate time for exhalation and minimizes air trapping. Pressure Control Ventilation (PCV) provides control over inspiratory pressure and allows for longer expiratory times, making it suitable for patients with COPD.

Question: 491

-year-old female with a history of chronic heart failure presents to the gency department with acute worsening of dyspnea, orthopnea, and eral lower extremityedema. On physical examination, she has elevated ar venous pressure, crackles on lung auscultation, and hepatomegaly. ch of the following is the most likely diagnosis?

cute exacerbation of chronic obstructive pulmonary disease (COPD) ulmonary embolism

cute respiratory distress syndrome (ARDS) cute decompensated heart failure

anation: The patient's history of chronic heart failure, acute worsening nea, orthopnea, bilateral lower extremity edema, elevated jugular ven ure, crackles on lung auscultation, and hepatomegaly are highly sugg ute decompensated heart failure. Acute decompensated heart failure o there is an acute exacerbation of heart failure symptoms, leading to f

emer bilat jugul Whi

A
P
A
A

accumulation in the lungs (pulmonary edema) and peripheral edema.

Question: 492

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with a high positive end-expiratory pressure (PEEP) strategy. Which of the following is a potential benefit of high PEEP in this

Reduced risk of barotrauma
Improved cardiac output
Decreased pulmonary vascular resistance

anation: One potential benefit of using a high positive end-expiratory ure (PEEP) strategy in a patient with acute respiratory distress syndro DS) is enhanced alveolar recruitment. High PEEP levels help maintai olume during expiration, preventing alveolar collapse and promotin ecruitment. This can improve oxygenation and increase the surface a
able for gas exchange.

stion: 493

When assessing a patient's pulmonary function testing flow-volume curve, ator would suggest that the patient may have coughed during the first nd of exhale during one of the trials?

jagged interruption or dip in the curve during exhale
steep slope of the line during the expiratory phase of the maneuver n unusually high value for FVC1
diminished value for FVC1
Enhanced alveolar recruitment Answer: D

Que

A
A
A
A

Explanation: If a patient coughs during the first second of exhale, it can lead to a jagged interruption or dip in the flow-volume curve during that time period. Coughing can cause a sudden decrease in airflow, resulting in an abnormal pattern in the curve. Therefore, option A is the correct indicator to suggest

coughing during the exhalation phase of the maneuver. Options B, C, and D are not directly related to coughing during the first second of exhale and can be considered incorrect choices in this scenario.

Question: 494

lation. Which of the following ventilator modes is most appropriate f orting respiratory muscle function and reducing the risk of ventilator- ced diaphragmatic dysfunction?

ssist-control ventilation (ACV) ressure support ventilation (PSV)

ynchronized intermittent mandatory ventilation (SIMV) roportional assist ventilation (PAV)

anation: Proportional assist ventilation (PAV) is the most appropriate lator mode for supporting respiratory muscle function and reducing th f ventilator-induced diaphragmatic dysfunction in a patient with omuscular disease. PAV uses sophisticated algorithms to assist the nt's spontaneous breaths in proportion to their effort. It provides onalized support to match the patient's respiratory drive, promoting hragmatic function and improving patient-ventilator synchrony.

A patient with neuromuscular disease requires long-term mechanical

A
P
S
P

risk o neur patie pers diap

Question: 495

Which of the following is an appropriate target range for mean arterial pressure (MAP) in patients with septic shock?

40-50 mmHg
60-70 mmHg
80-90 mmHg
100-110 mmHg

mic vasodilation and hypotension, leading to inadequate tissue perfus ntaining an adequate MAP is essential to ensure organ perfusion and en delivery. A target range of 60-70 mmHg is generally recommende

shock, although individual patient factors and comorbidities may ence the specific target.

stion: 496

-year-old female with a history of asthma presents to the emergency rtment with acute dyspnea and wheezing. She has been using her albu er every 4 hours without significant relief. Her initial peak expiratory PEFR) is 40% of her predicted value. Which of the following is the m opriatenext step in managing this patient?

dminister a short-acting anticholinergic inhaler (e.g., ipratropium bro dminister intravenous magnesium sulfate

itiate continuous nebulized albuterol therapy dminister systemic corticosteroids (e.g., prednisone)

Explanation: A target range of 60-70 mmHg for mean arterial pressure (MAP) is appropriate in patients with septic shock. Septic shock is characterized by syste ion.

Que

A mide)
A
In
A

Explanation: The patient's presentation with acute dyspnea, wheezing, and poor response to short-acting bronchodilators suggests a severe exacerbation of asthma. The most appropriate next step in management is to administer systemic corticosteroids (option D) to reduce airway inflammation and improve

stion: 497

ch of the following is a potential complication of central venous cathet tion?

rterial puncture ypernatremia ypoglycemia

ncreased platelet count wer: A

anation: Arterial puncture is a potential complication of central venou eter insertion. Central venous catheterization involves accessing a larg such as the internal jugular, subclavian, or femoral vein, for various ations, including monitoring central venous pressure, administering

symptoms. Systemic corticosteroids are recommended early in the treatment of severe asthma exacerbations. Administering a short-acting anticholinergic inhaler (option A) such as ipratropium bromide can be considered as an adjunctive therapy to bronchodilators but is not the initial step. Intravenous magnesium sulfate (option B) is also an adjunctive treatment option for severe asthma exacerbations but is not the first-line intervention. Continuous nebulized albuterol therapy (option C) may be used in severe exacerbations that do not respond to intermittent nebulized therapy, but systemic corticosteroids are the prior

Que

A
H
H
I

medications, or obtaining blood samples. However, inadvertent arterial puncture can occur during the procedure, leading to bleeding and hematoma formation. Proper technique, real-time ultrasound guidance, and knowledge of vascular anatomy can help minimize the risk of arterial puncture during central venous catheter insertion.

Question: 498

A 70-year-old male presents with acute-onset confusion, fever, and neck stiffness. On physical examination, he has nuchal rigidity, positive Kernig's sign, and a petechial rash. What is the most likely diagnosis?

Meningitis
Subarachnoid hemorrhage
ocky Mountain spotted fever wer: D
anation: The most likely diagnosis in this patient is Rocky Mountain ed fever (RMSF). RMSF is a tick-borne infectious disease caused by erium Rickettsia rickettsii. It typically presents with acute-onset fever, ache, myalgias, and a characteristic petechial rash. Neurologic festations can occur and may include confusion, neck stiffness, and ngeal signs such as nuchal rigidity and positive Kernig's sign. Mening
resent with fever, confusion, and neck stiffness, but the petechial ras specific to RMSF. Subarachnoid hemorrhage would not typically ca usion or a petechial rash. Migraine headache would not present with f stiffness, or a petechial rash. Therefore, option D, Rocky Mountain
ed fever, is the most likely diagnosis.

stion: 499
Migraine headache
R

Que

A patient with severe respiratory distress is receiving mechanical ventilation. The arterial blood gas (ABG) results show a pH of 7.28, PaCO2 of 58 mmHg, and PaO2 of 70 mmHg. Which of the following ventilator settings should be adjusted to improve oxygenation?

Increase the FiO2
Increase the respiratory rate
Decrease the tidal volume
Decrease the PEEP Answer: A

nt's lungs and subsequently improves the arterial oxygen partial press

stion: 500

tient with acute respiratory distress syndrome (ARDS) is receiving hanical ventilation with a high positive end-expiratory pressure (PEEP

The respiratory therapist is concerned about the risk of ventilator- ciated pneumonia (VAP). Which of the following interventions should pist implement to reduce the risk of VAP?

hange the ventilator circuit every 24 hours.

erform routine oral care with an antiseptic solution. dminister prophylactic antibiotics.

ncrease the fraction of inspired oxygen (FiO2).

Explanation: To improve oxygenation in a patient with severe respiratory distress, increasing the fraction of inspired oxygen (FiO2) is the appropriate intervention. It helps increase the oxygen concentration delivered to the

Que

C
P
A
I

Explanation: To reduce the risk of ventilator-associated pneumonia (VAP) in a patient receiving mechanical ventilation, the respiratory therapist should implement routine oral care with an antiseptic solution. Maintaining good oral hygiene helps reduce the colonization of bacteria in the oropharynx, which can contribute to the development of VAP. Changing the ventilator circuit every 24 hours is a common practice but is not the most effective intervention for preventing VAP. Administering prophylactic antibiotics is not recommended as

a routine measure for VAP prevention. Increasing the fraction of inspired oxygen (FiO2) is not directly related to VAP prevention.

Question: 501

lator-induced lung injury (VILI) in this patient?

ncreasing the respiratory rate

ecreasing the positive end-expiratory pressure (PEEP) imiting the plateau pressure to less than 30 cmH2O dministering inhaled bronchodilators

anation: To minimize ventilator-induced lung injury (VILI) in a patie RDS, it is important to limit the plateau pressure to less than 30 cm plateau pressures can lead to barotrauma and further lung injury, so ing them within a saferange is crucial.

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with a tidal volume of 6 mL/kg of predicted body weight (PBW). Which of the following is an appropriate strategy to minimize venti

I
D
L
A