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

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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
A C L A Ans Expl t com n cove a pneu occus pneu Whi ith seve ress? 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. -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 wer: D 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 Ans Expl of dysp ous press estive of ac ccurs when luid accumulation in the lungs (pulmonary edema) and peripheral edema. 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 patient? 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. 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 Expl press me (AR n lung v g lung r rea avail indic seco A A A A Answer: A what 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. 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) wer: D 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 venti or supp indu A P S P Ans Expl venti e risk o neur patie pers diap 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 Answer: B 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. -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) Mai oxyg d in septic influ A 40 depa terol inhal flow rate ( ost appr A mide) A In A Answer: D 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 ity. 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 Whi er inser A H H I Ans Expl s cath e vein, indic 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. 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. R Ans Expl spott the bact head mani meni itis may p h is more use conf ever, neck spott 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 2). 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). wer: B patie ure (PaO A pa mec ) level. asso the thera C P A I Ans 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. 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 wer: C 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. I D L A Ans Expl nt with A H2O. High keepQue
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