Egan Fundamentals of Respiratory Care 10th Edition By Kacmarek Stoller Test Bank

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Egan Fundamentals of Respiratory Care 10th Edition By Kacmarek Stoller Test Bank

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WITH ANSWERS
Egans Fundamentals of Respiratory Care 10th Edition By Kacmarek Stoller Test Bank

Chapter 02: Quality and Evidence-Based Respiratory Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Quality in the practice of respiratory care encompasses which of the following?
a. personnel performing care
b. equipment used
c. method or manner in which care is provided
d. level of experience of respiratory care providers
e. all of the above

 

 

ANS:  E

Quality, as applied to the practice of respiratory care, is multidimensional. It encompasses the personnel who perform respiratory care, the equipment used, and the method or manner in which care is provided.

 

DIF:    Recall             REF:   p. 20              OBJ:   1

 

  1. Who is professionally responsible for the clinical function of the respiratory care department?
a. shift supervisor
b. department head
c. medical director
d. clinical supervisor
e. senior pulmonologist

 

 

ANS:  C

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the most essential aspect of providing quality respiratory care?
a. Care being provided is indicated.
b. Care is delivered competently and appropriately.
c. Patient is appropriately evaluated by physician before care is initiated.
d. A and B.
e. A, B, and C.

 

 

ANS:  D

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   2

 

  1. The medical director of respiratory care is responsible for all the following except:
a. supervision of ongoing quality assurance activities
b. supervision of respiratory therapists performing pulmonary function testing
c. participation in the selection and promotion of technical staff
d. medical direction of the in-service and educational programs
e. establishment of safety and equipment effectiveness standards

 

 

ANS:  E

Perhaps the most essential aspect of providing quality respiratory care is to ensure that the care being provided is indicated and that it is delivered competently and appropriately.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the chief reason that respiratory care protocols were developed and are currently being used in hospitals throughout North America?
a. enhance proper allocation of respiratory care services
b. decrease patient care costs to hospitals and insurance companies
c. expand patient care skills among respiratory care providers
d. enhance efficiency of respiratory care personnel in providing patient care
e. justify reasons for increasing patient care costs

 

 

ANS:  A

Misallocation has led to the use of respiratory care protocols that are implemented by respiratory therapists (as described under Methods for Enhancing the Quality of Respiratory Care).

 

DIF:    Application    REF:   p. 21              OBJ:   1

 

  1. Which of the following factors is important in determining the quality of care delivered by a respiratory therapist?
a. education
b. experience
c. training
d. all the above
e. none of the above

 

 

ANS:  D

The quality of respiratory therapists depends primarily on their training, education, experience, and professionalism.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. For the CRT credential, what does the letter T stand for?
a. therapist
b. technician
c. trainee
d. teacher
e. none of the above

 

 

ANS:  A

Currently, there are two levels of general practice credentialing in respiratory care: (1) certified respiratory therapists (CRTs) and (2) registered respiratory therapists (RRTs).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. Respiratory care education programs are reviewed by which committee to ensure quality?
a. Committee for Accreditation of Respiratory Care
b. American Association for Respiratory Care Education
c. Joint Review Committee Respiratory Care Education
d. Respiratory Care Education Committee
e. none of the above

 

 

ANS:  A

Respiratory care education programs are reviewed by the Committee on Accreditation for Respiratory Care (CoARC).

 

DIF:    Recall             REF:   p. 22              OBJ:   1

 

  1. The word credentialing in general refers to what?
a. recognition of an individual in the profession
b. licensure by a state or national organization
c. successful completion of entry-level board examination
d. voluntary certification by state agency
e. not used in the field of respiratory care

 

 

ANS:  A

Credentialing is a general term that refers to the recognition of individuals in particular occupations or professions.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What term is used to describe the process in which a government agency gives an individual permission to practice an occupation?
a. certification
b. licensure
c. registry
d. credentialing
e. none of the above

 

 

ANS:  B

Licensure is the process in which a government agency gives an individual permission to practice an occupation.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What agency is responsible for ensuring quality in respiratory care through voluntary certification and registration?
a. JRCRTE
b. CoARC
c. NBRC
d. AARC
e. CAAHE

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What organization is responsible for credentialing respiratory therapists?
a. AARC
b. ATS
c. NBRC
d. ACCP
e. all the above

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. Which of the following is/are characteristics of a respiratory care professional?
a. participates in continuing education activities
b. obtains professional credentials
c. adheres to a code of ethics
d. completes an accredited education program
e. all of the above

 

 

ANS:  E

A professional is characterized as an individual conforming to the technical and ethical standards of a profession. Respiratory therapists demonstrate their professionalism by maintaining the highest practice standards, by engaging in ongoing learning, by conducting research to advance the quality of respiratory care, and by participating in organized activities through professional societies such as the American Association for Respiratory Care and associated state societies. Box 2-3 lists the professional attributes of a respiratory therapist.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. HIPAA was established in 1996 to set standards related to sharing confidential health history information about patients. What does the letter P stand for?
a. privacy
b. portability
c. patient
d. protection
e. people

 

 

ANS:  B

HIPAA is the Health Insurance Portability and Accountability Act.

 

DIF:    Recall             REF:   p. 26              OBJ:   1

 

  1. Responsibility for the technical direction of a respiratory care department lies with whom?
a. medical director
b. department manager
c. hospital administrator
d. shift supervisor
e. hospital biomedical engineering department

 

 

ANS:  B

Technical direction is often the responsibility of the manager of a respiratory care department, who must make sure the equipment and the associated protocols and procedures have sufficient quality to ensure the safety, health, and welfare of the patient using the equipment.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. The responsibilities of a respiratory care department manager include all of the following except:
a. check that medical devices function at an appropriate and safe level
b. develop respiratory care protocols and procedures
c. regulate medications delivered by respiratory care staff
d. maintain knowledge of changes in medications and delivery devices
e. evaluate new devices and methods for effectiveness commensurate with cost

 

 

ANS:  C

Those responsible for technical direction must be certain that these new devices, methods, and strategies not only are effective but also deliver a benefit commensurate with the cost.

 

DIF:    Recall             REF:   p. 24              OBJ:   2

 

  1. Which of the following is a key element of a respiratory care protocol program?
a. strong and committed medical direction
b. collaborative environment among health care providers
c. responsiveness to address and correct problems
d. capable therapists
e. all of the above

 

 

ANS:  E

The success of a respiratory care protocol program requires several key elements including active and committed medical direction, capable respiratory therapists, collaboration with physicians and nurses, careful monitoring, and a responsive hospital environment. (Box 2-5).

 

DIF:    Recall             REF:   p. 27              OBJ:   2

 

  1. Which of the following is an essential element of a comprehensive protocol program?
a. carefully structured assessment tool and care plan form
b. active quality monitoring
c. comprehensive delineation of boundaries between respiratory care, nursing, and physician personnel
d. both B and C
e. none of the above

 

 

ANS:  A

A carefully structured assessment tool and care plan form (Figures 2-3 and 2-4) are essential elements for a comprehensive protocol program.

 

DIF:    Application    REF:   p. 28              OBJ:   2

 

  1. What voluntary accrediting agency monitors quality in respiratory care departments?
a. JRCRTE
b. AARC
c. FDA
d. The Joint Commission
e. AMA

 

 

ANS:  D

The Joint Commission requires a hospital service to have a quality assurance plan to provide a system for controlling quality.

 

DIF:    Recall             REF:   p. 31              OBJ:   1

 

  1. Current Joint Commission standards for accreditation emphasize which of the following?
a. continual quality improvement
b. therapist-driven protocols
c. license and registration of health care providers
d. health, welfare, and safety of patients using respiratory care equipment
e. development of continuing education programs for health care providers

 

 

ANS:  A

Current Joint Commission standards for accreditation emphasize organization-wide efforts for continuous quality improvement (CQI).

 

DIF:    Application    REF:   p. 31              OBJ:   1

 

  1. To monitor correctness of respiratory care plans, which of the following should be used?
a. nursing care plans
b. physician progress notes
c. care plan auditors and case study exercises
d. daily patient rounds with medical director
e. regular multidisciplinary patient rounds

 

 

ANS:  C

Specific methods to monitor the quality of respiratory care protocol programs include conducting care plan audits in real time and ensuring practitioner training by using case study exercises.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. Respiratory care plans may be monitored by which of the following?
a. experienced care plan auditors
b. computerized case study exercises
c. patient scenarios
d. comparison of therapists patient assessment with the departments gold standard assessment
e. all of the above

 

 

ANS:  E

The assessment sheets and the care plans are then compared with the gold standard, or correct assessments and care plans as determined by the consensus of the education coordinator and the supervisors.

 

DIF:    Recall             REF:   p. 33              OBJ:   3

 

  1. What system has the federal government developed to evaluate the quality of care given to Medicare beneficiaries?
a. hospital restructuring and design
b. patient-focused care
c. peer review organizations (PROs)
d. protocols
e. case study reviews

 

 

ANS:  C

In addition to the voluntary accreditation process that health care organizations use to help ensure that patients are receiving quality care, the federal government has established an elaborate system of PROs to evaluate the quality and appropriateness of care given to Medicare beneficiaries.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. Hospital restructuring and redesign have involved all of the following except:
a. cross-training employees and using unlicensed assistive staff
b. nursing unit having its own admitting and medical laboratory facilities
c. downsizing and decentralizing high-budget, labor-intensive departments
d. deploying respiratory care personnel to individual nursing units
e. training multiskilled assistive personnel to perform basic patient care

 

 

ANS:  B

Approaches for restructuring commonly include cross-training employees, using unlicensed assistive staff, and decentralizing services by bringing them directly to the patient.

 

DIF:    Application    REF:   p. 33              OBJ:   3

 

  1. The effectiveness of the patient-focused care model has been limited by which one of the following?
a. requirement that each nursing unit has its own admitting, x-ray unit, medical laboratory, pharmacy, and physical therapy facilities
b. reduction of the number of health care providers for patients
c. expense of relocating radiology, pharmacy, and laboratory services to nursing units
d. assignment of cross-trained personnel to specific units
e. expense of training multiskilled personnel to perform patient care

 

 

ANS:  C

The obvious challenges of the patient-focused care model (e.g., decentralizing equipment, extensive cross-training, etc.) explain its very limited adoption.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. What is one advantage that has been shown of respiratory care protocols?
a. increase in the number of procedures performed by respiratory care providers
b. decrease in the overordering of respiratory care services
c. decrease in the cost savings to respiratory care departments
d. decrease in the cost of performing each respiratory care procedure
e. decrease in the demand for qualified respiratory care providers

 

 

ANS:  B

Most studies show a significant decrease in overordering respiratory care services.

 

DIF:    Application    REF:   p. 35              OBJ:   2

 

  1. What term is used in current healthcare that refers to an organized strategy of delivering care to a large group of individuals?
a. patient-focused care
b. protocol-based medicine
c. disease management
d. evidence-based medicine

 

 

ANS:  C

Disease management refers to an organized strategy of delivering care to a large group of individuals with chronic disease in order to improve outcomes and reduce cost.

 

DIF:    Recall             REF:   p. 36              OBJ:   4

 

  1. Treatment based on careful review of available literature is known as:
a. evidence-based medicine
b. protocol-based medicine
c. review-based medicine
d. team health care

 

 

ANS:  A

Evidence-based medicine refers to an approach to determining optimal clinical management based on several practices.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What term is used to describe the work done by a researcher who reviews numerous studies on a single topic and gives more weight to the more rigorous ones before making recommendations?
a. state-of-the-art paper
b. meta-analysis
c. alpha review
d. apical review
e. none of the above

 

 

ANS:  B

Meta-analyses assess the quality of available evidence and gives weight to better-designed, more rigorous studies.

 

DIF:    Recall             REF:   p. 38              OBJ:   5

 

  1. How are competencies being used to monitor the quality of respiratory care?
a. They focus on cost saving strategies.
b. They are used to check the skill and knowledge of respiratory through the use of clinical simulations.
c. They are used to educate therapist on new treatments and procedures.
d. They are used to review protocols

 

 

ANS:  B

The purpose of competencies is to check for having suitable and sufficient skills, knowledge and experience for specific tasks.

 

DIF:    Recall             REF:   p. 31              OBJ:   3

 

  1. Which organization is an emerging model of health care providers that work to meet quality and care targets, receive and disburse payments?
a. NBRC
b. CDC
c. ACO
d. The Joint Commission

 

 

ANS:  C

Accountable care organizations (ACOs) is an emerging group of health care providers that work to enhance the quality of care, receive payments, and lessen costs.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. What is/are the essential components comprise disease management programs?
a. an integrated healthcare system that can provide a full range of a patients needs
b. a knowledge regarding prevention, diagnosis, and treatment of diseases
c. a commitment to CQI
d. a sophisticated clinical and administrative information system that helps assess patterns in the clinical practice
e. all of the above

 

 

ANS:  E

All of the above are the essential components for a disease management team to be successful at meeting the clinical needs of the patients and hospital.

 

DIF:    Recall             REF:   p. 33              OBJ:   4

 

  1. What is a cohort study?
a. comparing the clinical outcomes from two different groups
b. single patient study
c. a literature-based review
d. collection of patients with similar clinical situations

 

 

ANS:  A

Cohort studies, which compare the clinical outcomes in two compared groups (or cohorts), generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: observational cohort studies and randomized controlled trials.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What are the key outcomes that are looked at in different types of studies?
a. patient survival
b. discharge from ICU
c. organ system failure
d. all of the above

 

 

ANS:  D

All three are important key out comes that are evaluated and compared when looking at study results.

 

DIF:    Recall             REF:   p. 37              OBJ:   5

 

Chapter 16: Interpreting Clinical Laboratory Data

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following is NOT one of the formed elements in the blood?
a. leukocytes
b. erythrocytes
c. thrombocytes
d. electrolytes

 

 

ANS:  D

The complete blood count (CBC) is routinely performed from a venous blood sample and examines the formed elements in the blood. It provides a detailed description of the number of circulating white blood cells (WBCs), called leukocytes, red blood cells (RBCs), called erythrocytes, and platelets, called thrombocytes.

 

DIF:    Recall             REF:   p. 358            OBJ:   2

 

  1. What term is used to describe a white blood cell (WBC) count that is above normal values?
a. leukocytosis
b. leukopenia
c. neutropenia
d. polycythemia

 

 

ANS:  A

Elevation of the WBC count is known as leukocytosis.

 

DIF:    Recall             REF:   p. 358            OBJ:   2

 

  1. What term is used to describe a white blood cell (WBC) count that is below normal values?
a. anemia
b. thrombocytopenia
c. leukopenia
d. hyponatremia

 

 

ANS:  C

A WBC count that is below normal is known as leucopenia.

 

DIF:    Recall             REF:   p. 358            OBJ:   2

 

  1. Which of the following is NOT a cause of leukopenia?
a. chemotherapy
b. bone marrow disease
c. radiation therapy
d. antibiotics

 

 

ANS:  D

Diseases of the bone marrow (e.g., leukemia, lymphoma) and chemotherapy and radiation therapy for cancer are common causes of leukopenia.

 

DIF:    Recall             REF:   p. 358            OBJ:   2

 

  1. What type of white blood cell increases in response to allergic reactions?
a. neutrophils
b. eosinophils
c. lymphocytes
d. monocytes

 

 

ANS:  B

See Table 16-2 for a list of the normal differential counts in the adult patient and common causes for elevation of each cell type.

 

DIF:    Recall             REF:   p. 359            OBJ:   2

 

  1. What type of white blood cell increases in response to viral infections?
a. neutrophils
b. eosinophils
c. lymphocytes
d. monocytes

 

 

ANS:  C

See Table 16-2 for a list of the normal differential counts in the adult patient and common causes for elevation of each cell type.

 

DIF:    Recall             REF:   p. 359            OBJ:   1

 

  1. What is the name used for immature neutrophils?
a. segs
b. bands
c. polys
d. monos

 

 

ANS:  B

Immature neutrophils are known as bands due to the banded shape of the nucleus.

 

DIF:    Recall             REF:   p. 358            OBJ:   2

 

  1. What term is used to describe a result significantly outside the reference range that may represent a pathophysiologic condition?
a. reference range
b. biological reference intervals
c. expected value
d. critical test value

 

 

ANS:  D

A critical test value is a result significantly outside the reference range, and represents a pathophysiologic condition. A critical value may be potentially life-threatening unless corrective action is taken promptly.

 

DIF:    Recall             REF:   p. 357            OBJ:   1

 

  1. What term is used to describe a red blood cell (RBC) count that is below normal values?
a. leukocytosis
b. leukopenia
c. anemia
d. polycythemia

 

 

ANS:  C

An abnormally low RBC count is referred to as anemia and suggests that either RBC production by the bone marrow is inadequate or excessive loss of blood has occurred.

 

DIF:    Recall             REF:   p. 359            OBJ:   2

 

  1. What term is used to describe a red blood cell (RBC) count that is above normal values?
a. leukocytosis
b. leukopenia
c. anemia
d. polycythemia

 

 

ANS:  D

An abnormally elevated RBC count is known as polycythemia.

 

DIF:    Recall             REF:   p. 359            OBJ:   2

 

  1. What abnormality in the complete blood count is often seen in a patient with significant hypoxemia caused by chronic lung disease?
a. leukocytosis
b. anemia
c. polycythemia
d. leukopenia

 

 

ANS:  C

Polycythemia helps prevent the negative side effects of reduced PO2 in the blood by increasing the oxygen-carrying capacity of the blood.

 

DIF:    Recall             REF:   p. 359            OBJ:   2

 

  1. The mean cell hemoglobin concentration of your patient is reduced. What type of anemia is this?
a. microcytic
b. macrocytic
c. hypochromic
d. hypotrophic

 

 

ANS:  C

Patients with an inadequate hemoglobin concentration will have red blood cells that are smaller than normal (microcytic) and lack normal color (hypochromic).

 

DIF:    Recall             REF:   p. 360            OBJ:   2

 

  1. What test is useful for evaluating the blood-clotting ability of your patient?
a. red blood cell count
b. platelet count
c. neutrophil count
d. hematocrit

 

 

ANS:  B

The complete blood cell count also reports the number of circulating platelets (thrombocytes), which are the smallest formed elements in the blood and are important for coagulation.

 

DIF:    Recall             REF:   p. 366            OBJ:   1

 

  1. What term is used to describe a platelet count below normal?
a. anemia
b. leukopenia
c. thrombocytopenia
d. neutropenia

 

 

ANS:  C

A significant reduction in the platelet count (known as thrombocytopenia) occurs with bone marrow diseases or with disseminated intravascular coagulation.

 

DIF:    Recall             REF:   p. 364            OBJ:   2

 

  1. Which of the following values represents a normal serum potassium level?
a. 137 to 147 mEq/L
b. 98 to 105 mEq/L
c. 7 to 20 mEq/L
d. 3.5 to 4.8 mEq/L

 

 

ANS:  D

The normal values for these electrolytes are listed in Table 16-3.

 

DIF:    Recall             REF:   p. 361            OBJ:   3

 

  1. What term is used to describe a sodium concentration that is below normal in the blood serum?
a. hypokalemia
b. hyponatremia
c. hypocalcemia
d. hypochloremia

 

 

ANS:  B

A low sodium level is referred to as hyponatremia, and it may occur with diuretic therapy, diarrhea, or certain kidney problems.

 

DIF:    Recall             REF:   p. 361            OBJ:   3

 

  1. What term is used to describe a potassium concentration that is below normal in the blood serum?
a. hypokalemia
b. hyponatremia
c. hypocalcemia
d. hypochloremia

 

 

ANS:  A

An abnormally low serum potassium level is known as hypokalemia.

 

DIF:    Recall             REF:   p. 361            OBJ:   3

 

  1. In which of the following clinical settings would hyperkalemia be a significant problem?
a. during weaning from mechanical ventilation
b. in a patient with pleural effusion
c. in a patient with kyphoscoliosis
d. during spirometry testing

 

 

ANS:  A

The potassium level is of particular interest in the patient being weaned from mechanical ventilation, because both hyperkalemia and hypokalemia may render the diaphragm weak and less effective.

 

DIF:    Application    REF:   p. 361            OBJ:   3

 

  1. The total carbon dioxide (CO2) value is linked to what electrolyte in the blood serum?
a. sodium
b. potassium
c. bicarbonate (HCO3)
d. chloride

 

 

ANS:  C

The total CO2 represents the level of HCO3 in venous blood.

 

DIF:    Recall             REF:   p. 360            OBJ:   3

 

  1. The sweat chloride level is used to diagnose which of the following disorders?
a. asthma
b. cystic fibrosis
c. hyperthyroidism
d. hepatitis

 

 

ANS:  B

Patients with cystic fibrosis have increased levels of chloride in their sweat because of their inability to reabsorb it.

 

DIF:    Recall             REF:   p. 364            OBJ:   3

 

  1. What is the normal anion gap?
a. 5 to 10 mEq/L
b. 8 to 16 mEq/L
c. 25 to 32 mEq/L
d. 35 to 45 mEq/L

 

 

ANS:  B

The normal anion gap is 8 to 16 mEq/L.

 

DIF:    Recall             REF:   p. 362            OBJ:   3

 

  1. What is indicated by an elevation of the anion gap?
a. respiratory failure
b. metabolic alkalosis
c. metabolic acidosis
d. renal failure

 

 

ANS:  C

Elevation of the anion gap suggests that a metabolic acidosis is present, and further evaluation of the patients acid-base status is necessary.

 

DIF:    Recall             REF:   p. 362            OBJ:   3

 

  1. Which of the following tests is used to evaluate renal function?
a. creatinine
b. protein level
c. serum enzymes
d. sweat chloride

 

 

ANS:  A

The most common tests performed to evaluate kidney function are blood urea nitrogen and creatinine.

 

DIF:    Recall             REF:   p. 362            OBJ:   3

 

  1. Your patient has an elevated aspartate aminotransferase (AST). What two organs are most likely diseased?
a. heart and brain
b. liver and kidney
c. brain and kidney
d. heart and liver

 

 

ANS:  D

The highest concentrations of AST are found in patients with liver disease, such as hepatitis, and during the second day after a myocardial infarction.

 

DIF:    Recall             REF:   p. 363            OBJ:   4

 

  1. A patient receiving heparin has a prothrombin time (PT) of 19 seconds and an International Standardized Ratio (INR) of approximately 5.0, what does this indicated?
a. high likelihood of excessive bleeding
b. patients results are normal
c. high likelihood of increased clotting
d. possible embolism

 

 

ANS:  A

Prothrombin time (PT) is defined as the time in seconds required by plasma to form a fibrin clot following exposure to tissue factors. Clinically, abnormal increases in PT and PTT are found in patients with Vitamin K deficiencies, and patients on anticoagulation therapy such as warfarin or heparin. PT is accompanied by an additional measurement known as the International Standardized Ratio (INR). The INR expresses PT relative to an established sample value. A normal INR value is 0.9 to 1.3. INR values of approximately 5.0 indicate a high likelihood for bleeding. Values of 0.5 are associated with a tendency towards increased clotting.

 

DIF:    Application    REF:   p. 364            OBJ:   4

 

  1. What is the upper limit of normal for the fasting blood glucose level?
a. 50 mg/dl
b. 85 mg/dl
c. 105 mg/dl
d. 140 mg/dl

 

 

ANS:  D

A blood glucose level above 140 mg/dl on two occasions indicates diabetes is present in most cases.

 

DIF:    Recall             REF:   p. 360            OBJ:   2

 

  1. A patient is brought into the ER with chest pain. The physician is having difficulty confirming the patients diagnosis through an ECG. Blood results show an elevated level of CPK-2. What can the physician suspect after reviewing the blood work?
a. pulmonary embolism
b. gastroesophageal reflux
c. myocardial infarction
d. valvular stenosis

 

 

ANS:  C

The most common CPK enzyme test is CPK-2 (CPK-MB) which is released from the heart following myocardial infarction. Peak levels occur sometime between 12 to 24 hours following injury. Serial CPK-2 measurements are monitored in patients with suspected myocardial infarction, as well as patients with cardiac contusion from chest trauma, open-heart surgery, or myocarditis.

 

DIF:    Analysis         REF:   p. 364            OBJ:   4

 

  1. An 80 year-old patient arrives in the emergency room complaining of difficulty breathing with signs of pulmonary edema. The clinician orders a B-type Natriuretic Peptide (BNP) test to be performed on the patient. The test result shows 800 picograms/mL. What is the patients possible condition?
a. severe heart failure
b. respiratory distress syndrome
c. sever sepsis
d. mild heart failure

 

 

ANS:  A

B-type Natriuretic Peptide (BNP) is a substance secreted by the heart in response to increased stretch in the cardiac muscle. The BNP test is used primarily to evaluate patients for heart failure, particularly those who present to the emergency department with dyspnea and pulmonary edema.4 In general, values greater than 300 picograms/mL are indicative of mild heart failure whereas values in excess of 600 and 900 pg/mL are found in patients with moderate and severe heart failure respectively.

 

DIF:    Application    REF:   p. 364            OBJ:   4

 

  1. Which of the following Gram stain results suggests the most legitimate sputum sample in a patient with pneumonia?
a. many epithelial cells and many pus cells
b. few pus cells and many epithelial cells
c. few pus cells and few epithelial cells
d. few epithelial cells and many pus cells

 

 

ANS:  D

In such cases, the Gram stain will demonstrate few (less than 25 per low-power field) or no pus cells and numerous epithelial cells.

 

DIF:    Recall             REF:   p. 365            OBJ:   6

 

  1. What should be done in response to a sputum sample that has many epithelial cells in it?
a. repeat Gram stain
b. sputum culture
c. sputum sensitivity
d. obtain new sputum sample

 

 

ANS:  D

Many epithelial cells indicate that the sample is merely saliva and should be discarded because it will not reflect the type of infection occurring in the lung.

 

DIF:    Recall             REF:   p. 365            OBJ:   6

 

  1. An RT receives a doctors order to perform an ABG on a 71 year-old woman. Upon reviewing the patients chart, the RT notices that the patient has a platelet count of 110 x103 mc/L. What should the RT do?
  2. Perform ABG as normal.
  3. Refuse to perform the ABG.
  4. After ABG is performed, compress the puncture site for a longer time
  5. Recommend that an ABG should be performed on the patient only when it is absolutely necessary.
a. 2 and 4
b. 1
c. 3 and 4
d. 2 only

 

 

ANS:  C

In patients requiring arterial blood gas (ABG) testing, or who need nasotracheal suctioning, RT s must evaluate the clotting characteristics of the blood. For ABG testing, patients with an abnormally low platelet count, or an elevated PT and INR, will need to have the puncture site compressed for a longer time after the arterial sample is obtained to prevent bleeding and hematoma development. Patients with an extremely low platelet count should have an arterial puncture performed (or undergo nasotracheal sucti

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