Therapist Multiple-Choice Examination
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1 Therapist Multiple-Choice Examination Effective: January 2015 Detailed Content Outline Items are linked to open cells. Each scored form will include 20-item pretests. I. PATIENT DATA EVALUATION AND RECOMMENDATIONS A. Evaluate Data in the Patient Record Patient history, for example, admission data progress notes orders DNR status / advance directives medications social history 2. Physical examination relative to the cardiopulmonary system 3. Drainage and access devices, for example, chest tube artificial airway 4. Laboratory results, for example, CBC culture and sensitivities electrolytes sputum Gram stain coagulation studies cardiac enzymes 5. Blood gas analysis results 6. Pulmonary function testing results 7. 6-minute walk test results 8. Cardiopulmonary stress testing results 9. Imaging study results, for example, chest radiograph MRI CT PET ultrasonography ventilation / perfusion scan 10. Maternal and perinatal / neonatal history, for example, Apgar scores L / S ratio gestational age social history 11. Metabolic study results, for example, O 2 consumption / CO 2 production respiratory quotient energy expenditure 12. Sleep study results 13. Trends in monitoring results a. fluid balance b. vital signs c. intracranial pressure d. weaning parameters e. pulmonary compliance, airways resistance, work of breathing f. noninvasive, for example pulse oximetry O 2 / CO Trends in cardiac monitoring results a. ECG b. hemodynamic parameters c. cardiac catheterization d. echocardiography B. Gather Clinical Information Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate b. level of pain c. presence of dyspnea, sputum production, and exercise tolerance d. smoking history e. environmental exposures f. activities of daily living 1 10/30/2014
2 g. learning needs, for example literacy culture preferred learning style 2. Performing inspection to assess a. general appearance b. characteristics of the airway, for example patency c. cough, sputum amount and character d. status of a neonate, for example Apgar score gestational age 3. Palpating to assess a. pulse, rhythm, force b. accessory muscle activity c. asymmetrical chest movements, tactile fremitus crepitus, tenderness, secretions in the airway, and tracheal deviation 4. Performing diagnostic chest percussion 5. Auscultating to assess a. breath sounds b. heart sounds and rhythm c. blood pressure 6. Reviewing lateral neck radiographs 7. Reviewing a chest radiograph to assess a. quality of imaging, for example patient positioning penetration b. presence and position of tubes and catheters c. presence of foreign bodies d. heart size and position e. presence of, or change in (i) cardiopulmonary abnormalities, for example pneumothorax pleural effusion consolidation pulmonary edema (ii) hemidiaphragms, mediastinum, or trachea C. Perform Procedures to Gather Clinical Information lead ECG 2. Noninvasive monitoring, for example pulse oximetry 3. Peak flow 4. Tidal volume, minute volume, and vital capacity 5. Screening spirometry 6. Blood gas sample collection 7. Blood gas analysis / hemoximetry 8. 6-minute walk test 9. Oxygen titration with exercise 10. Cardiopulmonary calculations, for example P(A-a)O 2 P / F V D / V T oxygenation index 11. Hemodynamic monitoring 12. Pulmonary compliance and airways resistance 13. Maximum inspiratory and expiratory pressures 14. Plateau pressure 15. Auto-PEEP determination 16. Spontaneous breathing trial 17. Apnea monitoring 18. Overnight pulse oximetry 19. CPAP / NPPV titration during sleep 2
3 20. Tracheal tube cuff pressure and / or volume 21. Sputum induction 22. Cardiopulmonary stress testing 23. Pulmonary function testing D. Evaluate Procedure Results lead ECG 2. Noninvasive monitoring, for example pulse oximetry 3. Peak flow 4. Tidal volume, minute volume, and vital capacity 5. Screening spirometry 6. Blood gas analysis / hemoximetry 7. 6-minute walk test 8. Oxygen titration with exercise 9. Cardiopulmonary calculations, for example P(A-a)O 2 P / F V D / V T oxygenation index 10. Hemodynamic monitoring 11. Pulmonary compliance and airways resistance 12. Maximum inspiratory and expiratory pressures 13. Plateau pressure 14. Auto-PEEP determination 15. Spontaneous breathing trial 16. Apnea monitoring 17. Overnight pulse oximetry 18. CPAP / NPPV titration during sleep 19. Tracheal tube cuff pressure and / or volume 20. Sputum induction 21. Cardiopulmonary stress testing 22. Pulmonary function testing E. Recommend Diagnostic Procedures Skin testing, for example TB allergy 2. Blood tests, for example electrolytes CBC 3. Imaging studies 4. Bronchoscopy 5. Bronchoalveolar lavage (BAL) 6. Sputum Gram stain, culture and sensitivities 7. Pulmonary function testing 8. Noninvasive monitoring, for example pulse oximetry 9. Blood gas analysis 10. ECG 11. Exhaled gas analysis, for example CO 2 NO (FENO) CO 12. Hemodynamic monitoring 13. Sleep studies 14. Thoracentesis II. TROUBLESHOOTING AND QUALITY CONTROL OF EQUIPMENT AND INFECTION CONTROL A. Assemble and Troubleshoot Equipment Oxygen administration devices 2. CPAP devices 3
4 3. Humidifiers 4. Nebulizers 5. Metered-dose inhalers (MDI), spacers, and valved holding chambers 6. Dry powder inhalers 7. Resuscitation devices 8. Mechanical ventilators 9. Intubation equipment 10. Artificial airways 11. Suctioning equipment, for example regulator tubing canister catheter 12. Gas delivery, metering, and clinical analyzing devices, for example concentrator gas cylinder liquid system blender flowmeter air compressor regulator 13. Blood analyzers, for example hemoximetry blood gas point-of-care 14. Patient breathing circuits 15. Incentive breathing devices 16. Airway clearance devices, for example high-frequency chest wall oscillation intrapulmonary percussive ventilation vibratory PEP insufflation/exsufflation device 17. Heliox delivery device 18. Nitric oxide (NO) delivery device 19. Spirometers hand-held and screening 20. Pleural drainage devices 21. Noninvasive monitoring devices, for example pulse oximeter capnometer 22. Gas analyzers 23. Bronchoscopes and light sources 24. Hemodynamic monitoring devices a. pressure transducers b. catheters, for example arterial pulmonary artery B. Ensure Infection Control Using high-level disinfection techniques 2. Selection of appropriate agent and technique for surface disinfection 3. Monitoring effectiveness of sterilization procedures 4. Proper handling of biohazardous materials 5. Adhering to infection control policies and procedures, for example Standard Precautions isolation C. Perform Quality Control Procedures Gas analyzers 2. Blood gas analyzers and hemoximeters 3. Point-of-care analyzers 4. Pulmonary function equipment 5. Mechanical ventilators 6. Gas metering devices, for example flowmeter 7. Noninvasive monitors, for example III. INITIATION AND MODIFICATION OF INTERVENTIONS A. Maintain a Patent Airway Including the Care of Artificial Airways Proper positioning of a patient 2. Recognition of a difficult airway 4
5 3. Establishing and managing a patient s airway a. nasopharyngeal airway b. oropharyngeal airway c. laryngeal mask airway d. esophageal-tracheal tubes / supraglottic airways, for example Combitube King e. endotracheal tube f. tracheostomy tube g. laryngectomy tube h. speaking valves 4. Performing tracheostomy care 5. Exchanging artificial airways 6. Maintaining adequate humidification 7. Initiating protocols to prevent ventilator associated pneumonia (VAP) 8. Performing extubation B. Perform Airway Clearance and Lung Expansion Techniques Postural drainage, percussion, or vibration 2. Suctioning, for example nasotracheal oropharyngeal 3. Mechanical devices, for example high-frequency chest wall oscillation intrapulmonary percussive ventilation vibratory PEP insufflation / exsufflation device 4. Assisted cough, for example huff quad 5. Hyperinflation, for example incentive spirometry IPPB 6. Inspiratory muscle training techniques C. Support Oxygenation and Ventilation Initiating and adjusting oxygen therapy, for example, low-flow high-flow 2. Minimizing hypoxemia, for example, patient positioning suctioning 3. Initiating and adjusting mask or nasal CPAP 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation b. noninvasive ventilation c. high-frequency ventilation d. alarms 5. Correcting patient-ventilator dyssynchrony 6. Utilizing ventilator graphics, for example, waveforms scales 7. Performing lung recruitment maneuvers 8. Liberating patient from mechanical ventilation (weaning) D. Administer Medications and Specialty Gases Aerosolized preparations, for example, MDI SVN 2. Dry powder preparations 3. Endotracheal instillation 4. Specialty gases, for example, heliox NO E. Ensure Modifications are Made to the Respiratory Care Plan Treatment termination, for example, life-threatening adverse event 2. Recommendations a. starting treatment based on patient response b. treatment of pneumothorax 5
6 c. adjustment of fluid balance d. adjustment of electrolyte therapy e. insertion or change of artificial airway f. liberating from mechanical ventilation g. extubation h. discontinuing treatment based on patient response 3. Recommendations for changes a. patient position b. oxygen therapy c. humidification d. airway clearance e. hyperinflation f. mechanical ventilation parameters and settings 4. Recommendations for pharmacologic interventions a. pulmonary vasodilators, for example, sildenafil inhaled NO prostacyclin b. bronchodilators c. antiinflammatory drugs d. mucolytics and proteolytics e. cardiovascular drugs f. antimicrobials g. sedatives and hypnotics h. analgesics i. neuromuscular blocking agents j. diuretics k. surfactants l. vaccines m. changes to drug, dosage, or concentration F. Utilize Evidence-Based Medicine Principles Determination of a patient s pathophysiological state 2. Recommendations for changes in a therapeutic plan when indicated 3. Application of evidence-based or clinical practice guidelines, for example, ARDSNet NAEPP G. Provide Respiratory Care Techniques in High-Risk Situations Emergency a. cardiopulmonary emergencies, for example, cardiac arrest obstructed / lost airway tension pneumothorax b. disaster management c. medical emergency team (MET) / rapid response team 2. Patient transport a. land / air between hospitals b. within a hospital H. Assist a Physician / Provider in Performing Procedures Intubation 2. Bronchoscopy 3. Thoracentesis 4. Tracheostomy 5. Chest tube insertion 6. Insertion of arterial or venous catheters 7. Moderate (conscious) sedation 8. Cardioversion Each scored form will include 20-item pretests. 6
7 9. Cardiopulmonary exercise testing 10. Withdrawal of life support I. Initiate and Conduct Patient and Family Education Safety and infection control 2. Home care and equipment 3. Smoking cessation 4. Pulmonary rehabilitation 5. Disease management a. asthma b. COPD c. sleep disorders Each scored form will include 20-item pretests
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