TMC

*C. 155 - 170 torr*

What is the PAO2 for a patient breathing 30% oxygen at sea level? A. 100 - 105 torr B. 120 - 140 torr C. 155 - 170 torr D. 210 - 220 torr

*B. 90 - 100 torr*

What is the normal PAO2 for a patient breathing room air at sea level? A. 50 - 65 torr B. 90 - 100 torr C. 120 - 140 tom D. 250 350 tor

*B. 2-4 L/min/m2*

What is the normal range for cardiac index in an adult? A. 0-2 L/min/m2 B. 2-4 L/min/m2 C. 4-6 L/min/m2 D. 6-8 L/min/m2

*D. 85-100 mm Hg*

What is the normal range for the mean arterial pressure in an adult? A. 2-6 mm Hg B. 10-20 mm Hg C. 60-80 mm Hg D. 85-100 mm Hg

*C. 9-18 mm Hg*

What is the normal range for the mean pulmonary artery pressure in an adult? A. 2-6 mm Hg B. 4-12 mm Hg C. 9-18 mm Hg D. 21-28 mm Hg

*D. 21-28 mm Hg*

What is the normal range for the pulmonary artery systolic pressure in an adult? A 2-6 mm Hg B. 4-12 mm Hg C. 9-18 mm Hg D. 21-28 mm Hg

*D. 3.0*

What tank factor is used to calculate how long an H cylinder will last when the pressure (PSI) and flowrate (LPM) are given? A. .003 B. .03 C. 0.3 D. 3.0

*B. 30 - 35 L/min*

What total flow is delivered to a patient if the air entrainment mask is set at 35% oxygen and the flowmeter is set at 6 L/min? A. 20 - 25 L/min B. 30 - 35 L/min C. 40 - 45 L/min D. 50 - 55 LUmin

*C. 35 - 40 L/min*

What total flow is delivered to a patient if the nebulizer is set to 40% oxygen and the flowmeter is set at 9 L/min? A. 15 - 20 L/min B. 25 - 30 L/min C. 35 - 40 L/min D. 45 50 L/min

*C. 260 mL/min*

What would be the oxygen consumption (VO2) for a patient with the following data: pH: 7.45 PaCO2: 39 torr PAO2: 94 torr HCO3: 29 mEq/liter BE: +1 SaO2: 96% Hb: 15.8 gms QT: 5.2 LPM CaO2: 19.3 vol% CvO2: 14.3 vol% A. 150 mL/min B. 210 mL/min C. 260 mL/min D. 380 mL/min

*B. tracheal deviation*

What would the therapist palpate when assessing a patient with a tension pneumothorax? A. hyperresonance B. tracheal deviation C. absent breath sounds D. increased work of breathing

*C. insert the airway in the same direction of its shape and into the airway and do not rotate.*

Which of the following is the most appropriate technique for insertion of a nasopharyngeal airway? A. insert the airway in the opposite direction of its shape and rotate 180 degrees B. insert the airway in the opposite direction of its shape and rotate 90 degrees C. insert the airway in the same direction of its shape into the airway and do not rotate D. insert the airway in the same direction of its shape and rotate 180 degrees

*C. 1 and 3 only*

Which of the following items should the respiratory therapist select prior to performing orotracheal intubation? 1. Various sizes of endotracheal tubes 2. Water-soluble lubricant 3. Stylet 4. Magill forceps A. 1 and 2 only B. 2 and 4 only C. 1 and 3 only D. 3 and 4 only

*A. 3 & 4 only*

Which of the following parameters are acceptable for weaning a patient from continuous mechanical ventilation? 1. VD/VT: 65% 2. MIP: -18 cm H2O 3. Qs/Qt: 10% 4. A-ADO2: 12 torr (21% oxygen) A. 3 & 4 only B. 1 & 2 only C. 1, 2 & 3 only D. 1, 2, 3 & 4

*D. Endobronchial ultrasound*

Which of the following procedures would be useful to provide real-time guidance for transbronchial needle aspiration of the lung? A. Magnetic resonance imaging B. Computed tomography C. Bronchoalveolar lavage D. Endobronchial ultrasound

*A. 1, 2 and 3 only*

Which of the following statements are TRUE concerning mechanical deadspace? 1. It will change the VDVT ratio. 2. It is contraindicated for a patient with a closed head injury. 3. It increases the work of breathing. 4. It should be used in the SIMV mode. A. 1, 2 and 3 only B. 1, 2 and 4 only C. 1, 3 and 4 only D. 2, 3, and 4 only

*B. Capillary PO2 will be lower than the arterial PO2*

Which of the following statements are true conceming capillary blood gas sampling versus arterial blood gas analysis? A. Capillary pH will be lower than the arterial pH B. Capillary PO2 will be lower than the arterial PO2 C. Capillary PCO2 will be higher than the arterial PCO2 D. Capillary HCO3 will be higher than the arterial HCO3

*C. 1 and 3 only*

Which of the following statements is/are true regarding an Esophageal Tracheal Combitube? 1. Used for pre-hospital airway management. 2. Placed in the trachea with a laryngoscope. 3. It should be replaced with an endotracheal tube as soon as possible. A. 3 only B. 2 and 3 only C. 1 and 3 only D. 1 and 2 only

*B. 50 psi*

Which of the following supply pressures would be appropriate for an air/oxygen proportioner? A. 30 psi B. 50 psi C. 100 psi D. 760 psi

*B. Continuous Positive Airway Pressure (CPAP)*

Which of the following therapies would be most appropriate for a spontaneously breathing patient who has atelectasis with a low SpO2 on an FIO2 of 1.0? A. Intermittent Positive Pressure Breathing (IPPB) B. Continuous Positive Airway Pressure (CPAP) C. Continuous Mechanical Ventilation (CMV) D. Intrapulmonary Percussive Ventilation (IPV)

*B. sensitivity*

Which of the following ventilator controls should NOT be adjusted if the I:E ratio alarm is activated with each mandatory breath? A. rate B. sensitivity C. volume D. flow

*A. decrease the inspiratory time*

Which of the following will decrease the mean airway pressure on a patient receiving continuous volume-cycled ventilation? A. decrease the inspiratory time B. decrease the peak flowrate C. decrease the expiratory time D. decrease the triggering effort

C. *systolic pressure - diastolic pressure*

Which of the following will determine the aortic pulse pressure? A. systolic + diastolic + diastolic / 3 B. diastolic + pulse pressure /3 C. systolic pressure - diastolic pressure D. stroke volume x heart rate x 10

*A. PAO2 - PaO2*

Which of the following will determine the oxygen gradient between the alveolus and the arterialized blood? A. PAO2 - PaO2 B. CaO2 - CvO2 C. (PaCO2 - PECO2) / PaCO2 D. Cc02- CaO2 / CcO2- CvO2

*D. (PB - PH20) FIO2 - (PacO2/0.8)*

Which of the following will determine the partial pressure of oxygen in the alveolus? A. (Hb x 1.34 x SaO2) + (PaO2 x .003) B. (PaCO2 - PECO2) / PaCO2 C. (PAO2 - PaO2) .003 / [(PAO2 - PaO2) .003] + C(a-v)O2 D. (PB - PH20) FIO2 - (PacO2/0.8)

*A. Arterial blood gas*

Which of the following would be most helpful in determining if a patient is developing ventilatory failure? A. Arterial blood gas B. Blood pressure C. Vital capacity D. Hematocrit

*A. Flow volume loop*

Which of the following would be the best test to evaluate a patient's partial vocal cord paralysis? A. Flow volume loop B. MVV C. SB nitrogen elimination D. DCO

*C. IRV + VT + ERV*

Which of the following would equal the vital capacity (VC)? A. VT + IRVM B. ERV + RV C. IRV + VT + ERV D. IRV + VT+ ERV + RV

*C. Breath sounds clear with coughing*

Which of the following would indicate that a patient is benefiting from PEP therapy? A. PaO2 increases B. Decreased work of breathing C. Breath sounds clear with coughing D. Minute ventilation decreases

*B. Pneumonia*

While assessing a patient's breath sounds the respiratory therapist notes that when the patient is instructed to say the letter "E", it comes through the stethescope sounding like "aaaahhh". This change in the sound is associated with which of the following conditions? A. Pleuritic inflammation B. Pneumonia C. Bronchospasm D. Epiglotitis

*B. Pneumonia*

While assessing a patient's breath sounds the respiratory therapist notes that when the patient says "ninety- nine", it sounds very loud through the stethescope. This would be associated with which of the following conditions? A. Pneumothorax B. Pneumonia C. Pleural effusion D. Epiglottitis

*B. transudate.*

While assisting a pulmonologist performing thoracentesis on a 58-year-old man, the respiratory therapist observes that the pleural fluid is clear with a light straw color. This fluid would best be described as A. exudate. B. transudate. C. purulent. D. serosanguineous.

*C. pericardial effusion.*

While evaluating the respiratory therapist notes the prethe A-P chest radiograph of a patient admitted to the Emergency Department with dyspnea, the respiratory therapist notes the presence of considerable cardiomegaly. This finding is most often associated with A. cardiogenic shock B. myocardial infarction C. pericardial effusion. D. pulmonary embolism

*C. prepare for synchronized cardioversion*

While performing a routine ventilator check on a patient in the ICU, the respiratory therapist notes that the patient's cardiac monitor shows ventricular tachycardia at a rate of 165. The therapist determines the presence of a carotid pulse, although the patient is hypotensive and unresponsive. Which of the following should the respiratory therapist recommend? A. prepare for defibrillation B. administer a precordial thump C. prepare for synchronized cardioversion D. administer 1mg/kg of lidocaine

*D. Mallampati Class IV.*

While performing an assessment of airway patency in a pre-operative patient, the respiratory therapist is only able to visualize the hard palate when the patient opens his mouth. The therapist should document this finding as A. Mallampati Class I. B. Mallampati Class II. C. Mallampati Class III. D. Mallampati Class IV.

*C. Stop the test, stabilize the patient, and notify the physician*

While performing an exercise stress test on a patient, the respiratory therapist observes a 6 mm depression in the ST segment. Which of the following should be done? A. Continue the test but at a slower pace B. Continue the test but monitor the patient closely C. Stop the test, stabilize the patient, and notify the physician D. Stop the test, let the patient for 5 minutes, then resume the test at the same work level

*D. inserting a nasopharyngeal airway*

While performing nasotracheal suctioning on a 64-year-old patient with pneumonia, the respiratory therapist notes that the patient's nares have developed redness and swelling. To prevent further irritation, the respiratory therapist should recommend? A. switching to orotracheal suctioning B. inserting an orotracheal tube C. administering an antibiotic to the site D. inserting a nasopharyngeal airway

*B. stop the procedure, manually ventilate the patient, and reposition the stylet.*

While performing orotracheal intubation for a patient in respiratory arrest, the respiratory therapist notices that the stylet has advanced from its original position. The respiratory therapist should A. continue with the intubation procedure. B. stop the procedure, manually ventilate the patient, and reposition the stylet. C. retract the stylet immediately. D. remove the stylet and continue with the procedure.

*A. Obstruction in the connecting line*

While performing oxygen rounds, the respiratory therapist enters a patient's room and hears a high pressure pop-off alarm sounding from a bubble humidifier. Which of the following is the most likely explanation for this? A. Obstruction in the connecting line B. Leak in the humidifier C. Problem with the valve seat in the flowmeter D. Flowmeter is uncompensated for back pressure

*B. recalibrate the electrode.*

While performing quality control procedures on a blood gas analyzer, the respiratory therapist notes that two consecutive data points for the pH electrode exceed the mean value by more than 2 standard deviations. The therapist should A. replace the electrode. B. recalibrate the electrode. C. flush the electrode. D. add buffer to the electrode.

*C. heating element is not functioning properly.*

While performing routine ventilator parameter checks on a patient on a microprocessor ventilator with a wick humidification system, the respiratory therapist notices there is very little condensation in the tubing. The most likely explanation is that the A. temperature probe is placed distal to the wye adapter. B. room temperature is lower than normal. C. heating element is not functioning properly. D. water level is just slightly above the refill line.

*B. Add 6 cm H20 PEEP*

While performing routine ventilator parameter checks on a patient weighing 80 kg (176 Ib), the respiratory therapist notes the following: Mode: VC, SIMV Set rate: 12 /min. Total rate: 12 /min. FIO2: 0.65 VT: 700 mL The arterial blood gas results are as follows: pH: 7.47 PaCO2: 34 torr PaO2: 55 torr HCO3: 23 mEq/L Which of the following should the therapist recommend at this time? A. Decrease rate to 10 /min. B. Add 6 cm H20 PEEP C. Increase FIO2 to 0.70 D. Decrease VT to 600 mL

*C. suction the patient*

While receiving postural drainage and percussion to her right lower lobe, a 44-year-old patient suddenly vomits and aspirates. The respiratory therapist should immediately A. place the patient in Fowlers position. B. encourage the patient to take deep breaths. C. suction the patient. D. administer acetylcysteine by SVN.

*D. Maintain current therapy*

While reviewing a patient's medical record the respiratory therapist notes that the patient has a Hb level of 14g/dL and an SpO2 of 94%. The patient is receiving oxygen by simple mask at 6 L/min. The respiratory therapist should recommend: A. Non-rebreather mask at 1O LPM B. A unit of whole blood C. CPAP therapy D. Maintain current therapy

*B. Administering whole blood*

While reviewing a patient's medical record the respiratory therapist notes that the patient has a Hb level of 6 g and SpO2 of 94%. The patient is receiving oxygen by simple mask & is complaining of shortness of breath. The respiratory therapist should recommend A. Changing to a non-rebreather mask B. Administering whole blood C. Initiating PEEP therapy D. Discontinuing oxygen therapy

*C. Anemia*

While reviewing a patient's medical record, the respiratory therapist notes that the patient has a Hb level of 6 g and a SpO2 of 94%. The patient is receiving oxygen by simple mask and is complaining of shortness of breath. The respiratory therapist would conclude that the patient has A. Hemophilia B. Hypematremia C. Anemia D. Hypokalemia

*C. anemia*

While reviewing a patient's medical record, the respiratory therapist notes that the patient has the following clinical data: pH: 7.45 PaCO2: 36 torr PaO2: 89 torr SpO2: 94% Na: 139 mEq/L K: 3.9 mEq/L Cl: 90 mEq/L Hb: 8 g/dL BUN: 15 mg/dL Glucose: 90 mg/dL The patient is receiving oxygen at 5 LPM via nasal cannula and is complaining of shortness of breath. The respiratory therapist would conclude that the patient has: A. hemophilia B. hypernatremia C. anemia D. hypokalemia

*B. Administering 100% oxygen*

While suctioning a patient who is being mechanically ventilated, the respiratory therapist notes the following ECG pattern on the monitor: Which of the following should the respiratory therapist recommend FIIRST? A. Administering lidocaine B. Administering 100% oxygen C. Administering atropine D. Administering epinephrine

*D. Additional length of suction tubing*

While suctioning an adult patient, the respiratory therapist notes that the vacuum regulator is set at 120 mm Hg but only registers 70 mm Hg on the manometer. Which of the following is the LEAST likely cause? A. Leak in the system B. Thumb not completely covering the port C. Loose connection in the collection bottle D. Additional length of suction tubing

*D. airway leak*

A "broken" flow/volume loop and/or volume/pressure loop will occur with: A. airway resistance B. overdistension C. auto PEEP D. airway leak

*C. Change the IPAP to 15 cm H2O.*

A 10-year-old child with muscular dystrophy is receiving non-invasive ventilation at an IPAP of 10 cm H2O and an EPAP of 5 cm H2O. The set rate is 15 br/min. with the following arterial blood gases: pH: 7.34 PCO2: 52 torr PO2: 58 torr HCO3: 26 mEq/L Which of the following should the respiratory therapist recommend? A. Switch to invasive ventilation. B. Decrease the set rate to 10 br/min. C. Change the IPAP to 15 cm H2O. D. Change the EPAP to 10 cm H2O.

*A. TCPCO2 and TCPO2 monitor*

A 1000 g neonate is stable in the NICU. Which of the following should the respiratory therapist use to monitor the neonate's overall cardiopulmonary status? A. TCPCO2 and TCPO2 monitor B. Arterial blood gas analysis Q4 hours C. SpO2 monitor D. Capillary gas analysis Q8 hours

A. decrease the tidal volume.

A 12-year-old girl weighing 40 kg (88 Ib) is receiving continuous mechanical ventilation following an accidental drug overdose. The respiratory therapist notes the following: Mode: VC, SIMV Set rate: 15 br/min. Total rate: 15 br/min. VT: 500 mL FIO2: 0.30 Arterial blood gases are as follows: pH: 7.58 PCO2: 23 torr PO2: 141 torr HCO3: 22 mEq/L The therapist should A. decrease the tidal volume. B. decrease the respiratory rate. C. decrease the FIO2. D. add mechanical deadspace.

*B. switch to a size 10 French catheter.*

A 14-year-old patient has a size 7 mm endotracheal tube placed orally. While suctioning this patient with size 12 French catheter you meet resistance while attempting to pass the catheter through the tube. The respiratory therapist should A. extubate and reintubate with a size 8 mm endotracheal tube. B. switch to a size 10 French catheter. C. instill mucomyst down the endotracheal tube D. lubricate the catheter with K-Y jelly prior to suctioning.

*D. Lorazepam*

A 15-year-old female patient who weighs 55 kg (121 Ib) was admitted to the ICU with multiple trauma from a four-wheeler accident and has developed ARDS. The respiratory therapist notes the following data: Mode: VC, SIMV Set rate: 12 br/min. Total rate: 14 br/min. FIO2: 0.60 PEEP: 10 cm H2O Vт: 350 mL The arterial blood gases are as follows: pH: 7.34 PCO2: 38 torr PO2: 79 torr HCO3: 21 mEq/L She appears agitated, is using her accessory muscles, and is attempting to pull out her IV lines. Which of the following should the therapist recommend at this time? A. Change to VC, A/C B. Pancuronium bromide C. Succinylcholine D. Lorazepam

*B. fenestrated tracheostomy tube*

A 16-year-old male patient involved in a motorcycle accident presents to the ER with massive maxillary and nasal trauma. Which of the following devices would be most appropriate for maintaining the patient's airway? A. nasal endotracheal tube B. fenestrated tracheostomy tube C. oral pharyngeal airway D. oral endotracheal tube

*A. Increase the PEEP to 8 cm H20*

A 1600 g neonate is on a pressure-limited, time-cycled ventilator at a pressure of 30 cm H2O, IMV rate of 26 Imin, FIO2 0.60 and a PEEP of 5 cm H20. Arterial blood gas results reveal: pH: 7.33 PaO2: 58 torr PaCO2: 45 torr SaO2: 89% Based upon these results, which of the following should the respiratory therapist recommend? A. Increase the PEEP to 8 cm H20 B. Increase the rate to 28/min C. Increase the FIO2 to 0.65 D. Increase the pressure to 32 cm H20

*B. low pressure*

A 22-year-old female patient with ARDS is on a volume-cycled ventilator. Her airway resistance and compliance has been gradually improving throughout the course of your shift. At the start of your shift her peak pressure was 35 cmH2O pressure; eight hours later her peak pressure is now 25 cmH2O pressure. Which of the following alarms would be most important to readjust at this time? A. low oxygen B. low pressure C. low tidal volume D. low exhaled minute volume

*B. Discontinue therapy, encourage deep breathing and coughing frequently on his own*

A 24-year-old post-operative male patient is receiving intermittent positive pressure therapy at 20 cm H2O. The patient complains that the machine is cycling off too soon. The patient's post-operative spontaneous vital capacity is 3.5 L. Which of the following should the respiratory therapist recommend? A. Increase the pressure to 25 cm H20 B. Discontinue therapy, encourage deep breathing and coughing frequently on his own C. Switch to a volume incentive spirometry device D. Recommend decreasing the flow

*A. Dynamic compliance is decreasing*

A 60-year-old male patient weighs 80 kg (176 Ib) and is on a volume-cycled ventilator at a set VT of 800 ml, a peak pressure reading of 65 cm H2O, exhaled VT measured at 760 mL, peak inspiratory flowrate is 60 L/min., a plateau pressure reading of 58 cm H2O and a PEEP of 5 cm H20. Which of the following is most likely Occurring at this time? A. Dynamic compliance is decreasing B. Static compliance is increasing C. Airway resistance is increasing D. Thoracic compliance is increasing

*D. 90%*

A 62-year-old female has the following arterial blood gas results on room air: pH: 7.37 PaCO2: 38 torr PaO2: 60 torr The co-oximeter is currently down for repair at this time. The physician has asked you to estimate the SaO2. You would estimate the SaO2 to be which of the following? A. 75% B. 80% C. 85% D. 90%

*B. atropine through the endotracheal tube.*

A 64-year-old patient is being resuscitated for full cardiopulmonary arrest. After several unsuccessful attempts, the patient is orally intubated with a size 7.0 mm endotracheal tube. The physician is unable to establish a peripheral or central intravenous line. The ECG monitor now shows the following rhythm: The respiratory therapist should recommend administration of A lidocaine by small volume nebulizer. B. atropine through the endotracheal tube. C. epinephrine by intra-cardiac injection. D. amiodarone by intraosseous injection.

*C. VT 700 mL, RR 20 /min, VD mech 50 mL*

A 65 kg (150 Ib) patient requires a minute alveolar ventilation of 10 L/min. Which of the following set of parameters would be most appropriate? A. VT 600 mL, RR 16 /min, VD mech 0 mL B. VT 650 mL, RR 18 /min, VD mech 50 mL C. VT 700 mL, RR 20 /min, VD mech 50 mL D. VT 900 mL, RR 12 /min, VD mech 100 mL

*B. Ethylene oxide*

A 66-year-old patient with tuberculosis treated with antibiotics is no longer considered contagious and is ready for discharge from the hospital. During his hospitalization, he received IPPB therapy using a Bird Mark VIl ventilator. What would be the most appropriate method of sterilizing the Bird Mark VII? A. Steam autoclave B. Ethylene oxide C. Alkaline glutaraldehyde D. Pasteurization

*B. 3.6 L/min*

A 68 kg (150 Ib) patient has a spontaneous tidal volume of 450 ml and is breathing at a rate of 12 breaths/min. What is their minute alveolar ventilation? A. 1.8 L/min B. 3.6 L/min C. 5.4 L/min D. 8.6 L/min

*D. 20/5*

A 70 kg (154 Ib) male is receiving non-invasive positive pressure ventilation (NIPPV) with a BIPAP ventilator set to 15/5. Arterial blood gases are as follows: pH: 7.33 PaCO2: 49 torr PaO2: 83 torr Which of the following IPAP / EPAP settings would best improve the patient's condition? A. 10/2 B. 15/10 C. 20/10 D. 20/5

*B. Congestive heart failure*

A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg): 12 PAP (mm Hg): 48/25 PCWP (mm Hg): 18 MAP (mm Hg): 69 Cardiac output (L/min): 3.1 Cardiac index (L/min/m2): 1.7 These results are consistent with: A. Hypervolemia B. Congestive heart failure C. Pulmonary hypertension D. Cor pulmonale

*C. 33 mm Hg*

A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg): 12 PAP (mm Hg): 49/25 PCWP (mm Hg): 18 MAP (mm Hg): 99 Cardiac output (L/min): 7.1 Cardiac index (L/min/m2): 3.7 What is the mean pulmonary artery pressure? A. 14 mm Hg B. 21 mm Hg C. 33 mm Hg D. 40 mm Hg

*D. 90 mm Hg*

A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg): 5 PAP (mm Hg): 29/8 PCWP (mm Hg): 8 BP (mm Hg): 130/70 Cardiac output (L/min): 5.1 Cardiac index (L/min/m2): 2.7 What is the mean arterial pressure? A. 15 mm Hg B. 21 mm Hg C. 33 mm Hg D. 90 mm Hg

*D. 500 dynes/sec/cm-5*

A patient in the intensive care unit has the following hemodynamic measurements: CVP: 16 mm Hg Mean PAP: 30 mm Hg PCWP: 5 mm Hg MAP: 81 mm Hg Cardiac output (QT): 4.0 L/min Cardiac index (QI): 2.1 L/min/m2 What is the pulmonary vascular resistance? A. 200 dynes/sec/cm-5 B. 300 dynes/sec/cm-5 C. 400 dynes/sec/cm-5 D. 500 dynes/sec/cm-5

*D. oxygen.*

A patient in the intensive care unit has the following hemodynamic measurements: CVP: 4 mm Hg PAP: 48/16 mm Hg PCWP: 8 mm Hg MAP: 92 mm Hg Cardiac Output: 5 L/min. Cardiac Index: 2.5 L/min/m2 The respiratory therapist should recommend the administration of A. bumex. B. dopamine. C. lidocaine. D. oxygen.

*C. 1600 dynes/s/cm-5*

A patient in the intensive care unit has the following hemodynamic measurements: CVP: 6 mm Hg Mean PAP: 13 mm Hg PCWP: 7 mm Hg MAP: 86 mm Hg Cardiac output (QT): 4.0 L/min Cardiac index (QI): 2.1 L/min/m2 What is the systemic vascular resistance? A 800 dynes/s/cm-5 B. 1300 dynes/s/cm-5 C. 1600 dynes/s/cm-5 D. 2400 dynes/s/cm-5

*C. pulmonary embolism.*

A patient in the intensive care unit has the following hemodynamic measurements: CVP: 9 mm Hg Mean PAP: 24 mm Hg PCWP: 9 mm Hg MAP: 93 mm Hg Cardiac output (QT): 5.4 L/min Cardiac index (QI): 2.9 L/min/m2 These results are consistent with A. right heart failure. B. left heart failure. C. pulmonary embolism. D. normal cardiac function.

*A. Hypervolemia*

A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg): 12 PAP (mm Hg): 48/25 PCWP (mm Hg): 18 MAP (mm Hg): 104 Cardiac output (L/min): 7.1 Cardiac index (L/min/m2): 3.7 These results are consistent with: A. Hypervolemia B. Congestive heart failure C. Pulmonary hypertension D. Cor pulmonale

*D. Hb*

A patient in the intensive care unit has the following lab results: pH: 7.41 PaCO2: 39 torr PaO2: 96 torr HCO3: 24 mEq/L SaO2: 97% Hb: 8 g/dL Which of the following would have the greatest impact on this patient's ability to deliver oxygen to the body tissue? A. pH B. PaO2 C. SaO2 D. Hb

*A. digitalis*

A patient in the intensive care unit is suffering left heart failure. Which of the following drugs will increase the strength of contraction and improve cardiac output? A. digitalis B. atropine C. isuprel D. lidocaine

*C. starting heparin therapy.*

A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. After administering 100% oxygen, the therapist should recommend A. a barium swallow. B. a CT of the chest. C. starting heparin therapy. D. starting lasix.

*B. a V/Q scan.*

A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. To determine the cause of the problem the respiratory therapist should recommend A. administering 100% oxygen. B. a V/Q scan. C. streptokinase. D. a STAT chest x-ray.

*B. Serum electrolytes*

A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric tube has been inserted to help relieve the nausea. The patient was started on lasix and nitroglycerin. Which of the following should the respiratory therapist monitor closely to identify side effects at this time? A Cardiac enzymes B. Serum electrolytes C. Arterial blood gases D. Digitalis levels

*C. Liquid system*

A patient is being discharged from the hospital. The physician has ordered portable oxygen therapy at home. The patient has been instructed to use the oxygen at 1-2 L/min during the day and PRN at night. Which of the following should the respiratory therapist recommend? A. E cylinders B. Concentrator C. Liquid system D. Molecular sieve

*D. changing to a non-rebreathing mask.*

A patient is receiving heliox therapy via a simple mask. The patient's work of breathing has not decreased and the physician asks the respiratory therapist for a recommendation. The therapist should recommend: A. increasing the flow to the mask. B. decreasing the flow to the mask. C. changing to a nasal cannula. D. changing to a non-rebreathing mask.

*A. Increase the PEEP*

A patient is receiving mechanical ventilation at the following settings: Mode: SIMV Mandatory rate: 12 Total rate: 12 FIO2: 0.50 Set VT: 650 mL Peak flow: 50 L/min PEEP: 5 cm H2O The following pressure-volume loop is observed. Which of the following should the therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decease the VT D. Increase the peak flow

*C. Decrease the VT*

A patient is receiving mechanical ventilation at the following settings: Mode: SIMV Mandatory rate: 12 Total rate: 12 FIO2: 0.50 VT: 750 ml Peak flow: 50 L/min. PEEP: 5 cmH2O The following volume-pressure loop is observed. Which of the following changes should the therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decrease the VT D. Increase the peak flow

*B. switch to inverse ratio ventilation.*

A 56-year-old male patient who weighs 90 kg (198 Ib) is receiving mechanical ventilation in the PC, SIMV mode and the following data is available: FO2: 1.00 Set rate: 20 /min. Total rate: 20 /min. PEEP: 18 cm H20 Peak pressure: 35 cm H2O Arterial blood gas results show: pH: 7.35 PaCO2: 45 torr PaO2: 43 torr HCO3: 22 mEq/L It would be appropriate for the respiratory therapist to A. increase the set rate to 25 /min. B. switch to inverse ratio ventilation. C. increase pressure to 40 cm H2O. D. increase PEEP to 25 cm H2O.

*A. independent lung ventilation.*

A 57-year-old male patient is being mechanically ventilated following removal of his right upper lobe. The chest radiograph shows right side consolidation. An arterial blood gas has been obtained. Ventilatory data and blood gas results are: Mode: VC, SIMV FIO2: 1.0 Set rate: 20 br/min Total rate: 20 br/min VT: 450 mL PIP: 55 cm H2O PEEP: 18 cm H20 pH: 7.41 PaCO2: 39 torr PaO2: 43 torr НСО3: 23 mEq/L BE: 0 mEq/L The respiratory therapist should recommend A. independent lung ventilation. B. inverse ratio ventilation. C. pressure support ventilation. D. pressure control ventilation.

*B. Increase the vacuum level*

A 57-year-old post-op patient is receiving volume control ventilation. The respiratory therapist is having difficulty removing secretions when suctioning. The patient weighs 85 kg (187 Ib), is orally intubated with a size 9.0 mm ID endotracheal tube, the vacuum level is set at 90 mm Hg and the suction catheter being used is a size 14 Fr. The therapist should A. switch to a larger catheter size. B. increase the vacuum level. C. switch to a Coude catheter. D. instill normal saline prior to suctioning.

*A. Replace the endotracheal tube with a larger size.*

A 58-year-old female patient who weighs 165 Ib (75 kg) is orally intubated with a size 6.0 mm endotracheal tube and is receiving volume-control ventilation. The tube is taped at the 23 cm mark at the patient's lips. The tube cuff pressure measures 38 mm Hg. When the respiratory therapist reduces the cuff pressure, the low exhaled volume alarm on the ventilator begins to sound. The therapist should A. replace the endotracheal tube with a larger size. B. maintain the cuff pressure at 38 mm Hg. C. deflate the cuff and advance the tube. D. adjust the low exhaled volume alarm.

*D. PEEP.*

A 58-year-old woman who weighs 65 kg (143 lb) arrives in the surgical ICU following surgical repair of an abdominal aortic neurysm. She has a 60 pack year history of cigarette smoking and is currently smoking 1 pack/day. The physician has written orders to initiate mechanical ventilation. Prior to starting mechanical ventilation for this patient, the respiratory therapist should set all of the following controls EXCEPT A. FIO2. B. tidal volume C. frequency. D. PEEP.

*D. Increase the peak flow*

A patient is receiving mechanical ventilation at the following settings: Mode: VC, SIMV Mandatory rate: 12 /min Total rate: 12 /min FIO2: 0.50 VT: 700 mL Peak flow: 40 L/min. PEEP: 5 cm H20 The following scalar graphic is observed. Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to pressure control mode C. Decrease the VT D. Increase the peak flow

*B. decrease the IPAP*

A patient is receiving non-invasive positive pressure assisted ventilation (NIPPV) with a Bi-level positive airway pressure ventilator at the following settings: IPAP: 25 cmH20 EPAP: 5 cmH2O Rate: 10 br/min Arterial blood gas results are: pH: 7.49 PaCO2: 29 torr PaO2: 110 torr HCO3: 25 mEq/L SaO2: 98% Which of the following should the therapist recommend? A. increase the IPAP B. decrease the IPAP C. increase the EPAP D. decrease the EPAP

*A. The patient is refilling the humidifier with tap water.*

A patient is receiving oxygen at home via a nasal cannula at 2 L/min connected to an oxygen concentrator. Humidification is being provided with a disposable bubble humidifier. The respiratory therapist is in the home for the patient's monthly visit and notices that the bubble humidifier is functioning properly, but the water in the humidifier reservoir appears to have a greenish tint. The patient is complaining of recurring infections. Which of the following should the therapist suspect? A. The patient is refilling the humidifier with tap water. B. There is a leak in the system. C. The water level is too high. D. The molecular sieve beds are obstructed.

*C. Switch to a nasal cannula at 6 L/min.*

A patient is receiving oxygen via a Venturi mask at an FIO2 of 0.45. The nurse is complaining that the patient keeps removing the Venturi mask from his face. The respiratory therapist should do which of the following at this time? A. Tape the Venturi mask to the patient's face B. Restrain the patient C. Switch to a nasal cannula at 6 L/min. D. Intubate the patient orally

*C. recommend morphine sulfate.*

A 59-year-old patient has been transferred from the post anesthesia care unit to the ICU following coronary artery bypass surgery and is receiving mechanical ventilation in the VC, A/C mode. He appears to be agitated and is triggering the ventilator at a fast rate, causing the high pressure alarm to sound repeatedly. The respiratory therapist should A. switch to SIMV mode. B. initiate pressure support. C. recommend morphine sulfate. D. recommend rocuronium bromide.

*A. initiate 4 cmH2O PEEP.*

A 6-year-old child who weighs 20 kg (44 Ib) is intubated and being mechanically ventilated following an accidental drug overdose at the following settings: Mode: VC, A/C FIO2: 0.80 Set rate: 12 br/min. Total rate: 15 br/min. Tidal volume: 175 mL Arterial blood gas results: pH: 7.48 PaCO2: 31 torr PaO2: 54 torr HCO3: 22 mEq/L The respiratory therapist should A. initiate 4 cmH2O PEEP. B. decrease the rate to 10 br/min. C. increase the tidal volume to 300 mL. D. increase the FIO2 to 0.85.

*A. lateral decubitus chest radiograph*

A patient is suspected of having a pleural effusion. Before performing a thoracentesis, what should the therapist recommend? A. lateral decubitus chest radiograph B. arterial blood gas analysis C. ventilation and perfusion scans D. flexible bronchoscopy

*B. Atrial flutter*

A patient presents to the Emergency Department with fatigue and occasional syncope. The following tracing is noted on the ECG monitor in Lead II: What is the correct interpretation of this ECG tracing? A. Sinus arrhythmia B. Atrial flutter C. Atrial fibrillation D. Ventricular flutter

*A. 2 ATA.*

A patient suffering from decompression sickness requires hyperbaric oxygen therapy. The respiratory therapist should initiate therapy at A. 2 ATA. B. 4 ATA. C. 6 ATA. D. 8 ATA.

*B. viral pneumonia.*

A patient who recently underwent a total abdominal hysterectomy is complaining of chills and producing yellow purulent sputum. Breath sounds reveal scattered crackles. The results of the CBC indicate a WBC count of 3,000 mil/mm3. The most likely diagnosis is that the patient has developed A. atelectasis. B. viral pneumonia. C. influenza. D. pleural effusion.

*D. bacterial infection*

A patient who recently underwent a total abdominal hysterectomy is complaining of chills and purulent sputum. Breath sounds reveal coarse rales and rhonchi. The results of the CBC indicate a WBC count of 19,000. The most likely diagnosis is that the patient has developed: A. atelectasis B. pneumonia C. hemothorax D. bacterial infection

*B. 5 LPM*

A patient will be away from their room for two hours while undergoing a special procedure in the radiology department. They will be using a full E cylinder. What is the maximum flow that the therapist could use without running out of oxygen? A. 2 LPM B. 5 LPM C. 8 LPM D. 10 LPM

*A Increase the flow.*

A patient with CO poisoning is recelving oxygen therapy by a non-rebreather mask at 10 Limin. The respiratory therapist notices that the reservoir bag on the mask is emptying completely on inspiration. The therapist should A Increase the flow. B. switch to a partial rebreather mask. C. initiate mask CPAP therapy. D. switch to a venturi-mask.

*B. antibiotic therapy*

A patient with COPD has been admitted for possible pneumonia. The patient is producing moderate amounts of thick yellow sputum and breath sounds are decreased in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of the following therapies should the respiratory therapist recommend? A. chest physical therapy B. antibiotic therapy C. incentive spirometry D. IPPB

*A. Increase the pressure support*

A patient with COPD is being weaned from the ventilator using SIMV and pressure support of 6 cm H20. The patient's spontaneous respiratory rate is 28/minute. Arterial blood gas results show: pH: 7.35 PaO2: 68 torr PaCO2: 56 torr SpO2: 92% Based upon these results, the respiratory therapist should recommend which of the following? A. Increase the pressure support B. Return to full ventilator support C. Increase the SIMV rate D. Increase the FIO2

*C. obstruction in the face mask*

A patient with a history of COPD is receiving 28% oxygen therapy via air-entrainment mask. While performing oxygen rounds, the respiratory therapist notes that the device is delivering 40% oxygen. Which of the following conditions is the most likely cause? A. increase in oxygen flow to the dilution jet B. increase in size of air entrainment ports C. obstruction in the face mask D. decrease in size of jet orifice

*C. tensilon challenge test*

A patient with a history of myasthenia gravis has just been admitted for increased muscle weakness. The respiratory therapist should recommend which of the following diagnostic tests to monitor the patient's drug therapy? A. polysomnography B. electroencephalography C. tensilon challenge test D. methacholine challenge test

*C. Observation of chest movement*

A patient with a size 8.5 mm oral endotracheal tube is transported from the ED to the ICU. The respiratory therapist suspects that the endotracheal tube has changed position during transport. Which of the following is the quickest way to assess the position of the tube? A. Chest radiograph B. Auscultation of the chest C. Observation of chest movement D. Diagnostic chest percussion

*A. add a spacer to the metered-dose inhaler.*

A patient with known reversible airway disease takes two puffs of albuterol from his metered-dose inhaler. The respiratory therapist measures the patient's peak flow following the administration of the medication and determines that the peak flow has increased only minimally. The therapist should A. add a spacer to the metered-dose inhaler. B. change the medication to levalbuterol C. administer the medication by small volume nebulizer. D. contact the physician concerning the care of this patient.

*C. Place on CPAP at an FIO2 0.45*

A patient with morbid obesity is being weaned from the ventilator following cholecystectomy. Arterial blood gas results reveal: pH: 7.40 PaO2: 96 torr PaCO2: 43 torr SaO2: 94% The patient's current ventilator settings are: Tidal volume 650 ml, SIMV mandatory rate 4 Imin, PEEP 5 cm H2O, and FIO2 0.35 even though she is not fully conscious. What should the respiratory therapist recommend at this time? A. Extubate B. Re-evaluate in 1 hour C. Place on CPAP at an FIO2 0.45 D. Repeat arterial blood gases in 30 minutes

*C. Decreased cardiac output*

A patient's Pv02 has decreased from 30 tor to 20 torr. This is indicative of a/an: A. Decreased SVR B. Increased cardiac index C. Decreased cardiac output D. Decreased PVR

*D. Non-rebreathing mask and blender*

A physician asks the respiratory therapist to deliver a precise FIO2 of 0.45 to a patient. Which of the following should the therapist recommend? A. Nasal cannula at 6 L/min B. Simple mask at 5 L/min C. Partial rebreather mask at 8 L/min D. Non-rebreathing mask and blender

*C. aneroid manometer*

A physician asks the respiratory therapist to measure a patient's ability to cough and clear secretions from his airway. Which of the following would the therapist utilize to evaluate the patient? A. wright respirometer B. flutter valve C. aneroid manometer D. spacer

*D. pulmonary edema.*

A pleural friction rub is associated with all of the following conditions EXCEPT A. pneumonia. B. tuberculosis. C. pleurisy. D. pulmonary edema.

*A. increased PaCO2.*

A post-operative craniotomy patient is receiving mechanical ventilation and has an increased intracranial pressure reading. The goals of mechanical ventilation for this patient include all of the following EXCEPT A. increased PaCO2. B. keep airway pressure to a minimum. C. hyperoxygenate. D. use minimum PEEP levels.

*D. Morphine*

A post-operative craniotomy patient was thrashing around while on a volume-cycled microprocessor ventilator. The physician has asked for your recommendation in the management of this patient to prevent him from harming himself and to also stabilize his ICP. Which of the following drugs would you recormmend administering at this time? A. Anectine B. Versed C. Valium D. Morphine

*A. repeating the arterial blood gas in 30 minutes.*

A post-operative thoracotomy patient is receiving mechanical ventilation in the recovery room with a tidal volume of 750 mL, SIMV mandatory rate 8/min, FIO2 of 0.40. Arterial blood gas results show: pH: 7.36 Pa02: 89 torr PaCO2: 45 torr SaO2: 95% The patient is breathing fast and shallow. Based upon this information, the respiratory therapist should recommend A. repeating the arterial blood gas in 30 minutes. B. increase SIMV mandatory rate to 10/min. C. sedating the patient. D. paralyzing the patient with pancuronium bromide (Pavulon).

*B. Draw an arterial blood gas sample*

A premature baby is receiving an FIO2 of 40 and CPAP at 5 cmH20. As the respiratory therapist increases the CPAP to 7 cmH20, the baby's respiratory rate increases to 58 per minute and the TCPCO2 reading increases with a stable SpO2 monitor reading. The respiratory therapist should recommend which of the following? A. Discontinue the CPAP B. Draw an arterial blood gas sample C. Increase the CPAP to 10 cmH2O D. Place the baby in an oxyhood at an FIO2 0.45

*C. Increase the rate*

A premature neonate with respiratory distress syndrome is being mechanically ventilated with a pressure- limited, time-cycled ventilator at the following settings: PIP: 25 cm H2O Rate: 24/min Flow: 7 L/min I time: 0.6 sec. FIO2: 0.45 PEEP: 4 cm H20 Arterial blood gas results from an umbilical artery line are as follows: pH: 7.29 PaCO2: 62 torr PaO2: 68 torr HCO3: 22 mEq/L The therapist should now recommend: A. Increase PEEP B. Increase the I time C. Increase the rate D. Decrease PIP

*B. Increase the I time*

A premature neonate with respiratory distress syndrome is being mechanically ventilated with a pressure- limited, time-cycled ventilator at the following settings: PIP: 25 cm H2O Rate: 28/min Flow: 7 L/min I time: 0.5 sec. FO2: 0.70 PEEP: 4 cm H2O Arterial blood gas results from an umbilical artery line are as follows: pH: 7.30 PaCO2: 59 torr PaO2: 66 torr HCO3: 22 mEq/L The therapist should now recommend: A. Increase PEEP B. Increase the I time C. Decrease the rate D. Decrease PIP

*C. discontinue the SBT.*

(165 Ib). Prior to initiating a spontaneous breathing trial, the respiratory therapist notes the following A 48-year-old patient is receiving mechanical ventilation following a hernia repair. He is 6' tall and weighs 75 kg Information: FIO2: 0.35 SIMV mandatory rate: 6 /min. Total rate: 14 /min. VT. 600 mL MIP: -26 cm H2O Spont. VT: 400 mL Arterial blood gas results show: pH: 7.39 PaCO2: 42 torr PaO2: 88 torr HCO3: 23 mEq/L The patient is to be placed on CPAP with an FIO2 of 0.40. Five minutes into the SBT, his respiratory rate increases to 28 /min., heart rate changes from 110 /min. to 135 /min. and blood pressure changes from 112/70 mm Hg to 140/88 mm Hg. At this time, the therapist should A. shorten the SBT by 5 minutes. B. continue the SBT. C. discontinue the SBT. D. increase the FiIO2 to 0.45.

*B. clamp the chest tube.*

A 24-year-old woman with multiple trauma from a motor vehicle accident requires mechanical ventilation in the ICU. Because of a tension pneumothorax, a chest tube was inserted in the right second intercostal space and attached to a three-bottle water-seal drainage system with suction. While performing an assessment of the patient-ventilator system, the respiratory therapist notes continuous bubbling in the water seal bottle. The therapist should A. increase the suction pressure. B. clamp the chest tube. C. reduce the tidal volume. D. add water to the suction control bottle.

*A. radiant warmer*

A 26-week gestational age infant requires intensive monitoring and care in the NICU. Which device would be most appropriate for maintaining a neutral thermal environment for this infant? A. radiant warmer B. lsolette C. croupette D. bassinet

*B. administer 100% oxygen*

A 26-year-old patient with shortness of breath is admitted to the emergency room. The patient states that he was running in Central Park with a friend and could not catch his breath. Bedside assessment reveals the following data: Pulse: 120 Respirations: 25 br/min Color: pale SpO2: 89% on room air Breath sounds: slightly diminished on the right The respiratory therapist should: A. request a STAT chest x-ray. B. administer 100% oxygen. C. insert a large bore needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert a chest tube into the 2nd intercostal space on the right side in the midclavicular line. Proceed

*A. request a STAT chest x-ray.*

A 26-year-old patient with shortness of breath is admitted to the emergency room. The patient states that he was running in Central Park with a friend and could not catch his breath. Bedside assessment reveals the following data: Pulse: 134 Respirations: 35 Color: pale SpO2: 91% on room air Breath sounds: diminished on the right The respiratory therapist should: A. request a STAT chest x-ray. B. recommend a V/Q scan C. insert a large bore needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert a chest tube into the 2nd intercostal space on the right side in the midclavicular line

*D. amplitude.*

A 27-week gestation age neonate with respiratory distress syndrome is receiving high frequency oscillatory ventilation at the following settings: PIP: 20 cm H20 Frequency: 12 Hz I time: 30% FO2: 0.55 PEEP: 4 cm H20 Blood gas results from an umbillical artery line are as follows: pH: 7.15 PaCO2: 62 torr PaO2: 46 torr HCO3: 22 mEq/L The respiratory therapist should increase the A. PEEP. B. FIO2. C. frequency. D. amplitude.

*B. PEEP to 7 cm H20.*

A 28-week gestational age infant with severe respiratory distress syndrome is being mechanically ventilated in the PC, SIMV mode at the following settings: Flow rate: 6 L/min Set rate: 32 br/min. PIP: 28 cmH2O FIO2: 0.70 PEEP: 5 cm H20 I time: 0.8 seconds Umbilical arterial blood gas results reveal: pH: 7.40 PCO2: 39 torr PO2: 42 torr HCO3: 23 mEq/L Based on the above information, the respiratory therapist should change the A. I time to 1.0 second. B. PEEP to 7 cm H20. C. FIO2 to 0.75. D. PIP to 30 cm H20.

*D. Administering theophylline*

A 28-week gestational age neonate is experiencing frequent apneic episodes with bradycardia. Which of the following should the respiratory therapist recommend? A. An FIO2 of 0.40 via oxyhood B. Suctioning the neonate during apnea episode C. Administering bedomethasone D. Administering theophylline

*B. obtain a size 4 French catheter*

A 2800 g neonate has just been orally intubated with a size 3.0 mm ID endotracheal tube. The respiratory therapist is preparing to suction the neonate and notices that there are size 6 French suction catheters at the bedside. The therapist should A. use the size 6 French catheters, B. obtain a size 4 French catheter. C. obtain a size 8 French catheter. D. obtain a size 10 French catheter.

*B. Bronchoscopy*

A 3-year-old child is admitted to the emergency room with a sudden, persistent, dry cough. Chest x-ray results reveal a normal inspiration with only one lung expanded on expiration. Which of the following would you recommend at this time? A. Endobronchial intubation B. Bronchoscopy C. Arterial blood gas analysis D. Lateral neck x-ray

*A. PEEP to 8 cm H2O.*

A 3-year-old child with cystic fibrosis is being mechanically ventilated at the following settings: PIP: 34 cm H20 I time: 1.0 second Rate: 22 /min. FIO2: 0.60 PEEP: 6 cm H20 Mode: PC, SIMV Arterial blood gas results show: pH: 7.36 PaCO2: 44 torr PaO2: 49 torr HCO3: 24 mEq/L The respiratory therapist should adjust the A. PEEP to 8 cm H2O. B. FIO2 to 0.65. C.set rate to 24 /min. D. PIP to 36 cm H2O.

*B. 6 liters/minute*

A 30-year-old male who weighs 68 kg (150 lbs.) has a minute ventilation of 9.0 liters/minute and a respiratory rate of 20 breaths/minute. What is his alveolar minute volume? A. 4 liters/minute B. 6 liters/minute C. 8 liters/minute D. 12 liters/minute

*D. resolution of a pneumothorax*

A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated. This would indicate A. atelectasis. B. bronchopulmonary dysplasia. C. fluid overload. D. resolution of a pneumothorax.

*A. insert a chest tube and connect to a pleural suction system.*

A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The respiratory therapist suspects that a pneumothorax has developed and performs transillumination, which reveals a brightly illuminated left thorax. The respiratory therapist's FIRST action should be to A. insert a chest tube and connect to a pleural suction system. B. perform a fiberoptic bronchoscopy. C. obtain a STAT chest film. D. suction the infant.

*A. confirm placement of the nasal prongs.*

A 32-week gestational age neonate is receiving CPAP by nasal prongs at 4 cm H2O. The respiratory therapist notices that the pressure manometer is now reading zero. The therapist should A. confirm placement of the nasal prongs. B. recalibrate the pressure manometer. C. remove condensation from the circuit. D. increase the flow to the neonate.

*C. Pulmonary hypertension*

A patient in the intensive care unit has the following hemodynamic measurements: CVP (cm H2O): 12 PAP (mm Hg): 48/25 PCWP (mm Hg): 8 MAP (mm Hg): 93 Cardiac output (L/min): 6.1 Cardiac index (Lmin/m2): 3.2 These results are consistent with: A. Hypervolemia B. Congestive heart failure C. Pulmonary hypertension D. Cor pulmonale

*C. insert a 14 gauge needle into the 2nd intercostal space on the right side in the midclavicular line.*

A 32-year-old patient with shortness of breath is admitted to the emergency room. The patient states that she was running with a friend and suddenly felt pain on the right side of her chest. Bedside assessment reveals the following data: Heart rate: 148 Respirations: 44 br/min Color: cyanotic SpO2: 70% on room air Breath sounds: absent on the right Palpation: trachea deviated to the left Percussion: tympany on the right side The respiratory therapist should first: A. request a STAT chest x-ray. B. administer IPPB stat. C. insert a 14 gauge needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert chest tube into the right side in the midclavicular line.

*B. drawing an arterial blood gas.*

A 32-year-old victim of a motor vehicle accident (weight 80 kg, 176 Ib) is on mechanical ventilation at the following settings: Tidal volume 700 mL, SIMV mandatory rate 10/min, and FIO2 0.65. As the PEEP level was increased from 17 cm H20 to 20 cm H20, the respiratory therapist observed that the heart rate changed from 128/min to 106/min. At this time, the therapist should recommend A. inserting a balloon tipped flow directed catheter. B. drawing an arterial blood gas. C. reassessing the patient in 20 minutes. D. decreasing the PEEP.

*D. VC, A/C, rate 12, tidal volume 500 mL*

A 32-year-old woman who is 165 cm (5' 6" inches) tall and weighs 100 kg (220 Ib) has chest trauma from a motorcycle accident. The patient has been intubated and is being manually ventilated with a resuscitation bag. She also received morphine sulfate and pancuronium bromide. The physician asks the respiratory therapist to determine initial ventilator settings for this patient. Which of the following is most appropriate? A. VC, A/C, rate 10, tidal volume 700 mL B. VC, SIMV, rate 24, tidal volume 400 mL C. VC, SIMV, rate 14, tidal volume 800 mL D. VC, A/C, rate 12, tidal volume 500 mL

*C. a oxygen hood set at 40%*

A 34-week gestation age infant has just been delivered. The one and five minute apgar scores are 4 and 6. The physician has written an order for 40% humidified oxygen. Which of the following would be the most appropriate device? A. an incubator set at 40% oxygen B. a radient warmer set at 40% C. a oxygen hood set at 40% D. a high humidity oxygen tent set at 40%

*D. Expected level for this patient*

A 40-year-old patient who smokes 2 packs of cigarettes per day has a carboxyhemoglobin level of 6.4%. These results are most consistent with A. Severe COPD B. History of dyspnea on exertion C. Need for supplemental oxygen D. Expected level for this patient

*C. 3.0 mm*

A 43-week gestational age infant has just been delivered and is stained with meconium. The physician has asked that the baby be intubated and suctioned immediately. The respiratory therapist should recommend intubating the baby with which of the following size endotracheal tubes? A. 2.0 mm B. 2.5 mm C. 3.0 mm D. 4.0 mm

*B. Place patient in prone position*

A 44 year-old patient with ARDS receives mechanical ventilation in the Pulmonary ICU at the following settings: Mode: PC, A/C Peak Pressure: 36 cm H2O Plateau Pressure: 30 cm H20 Mandatory Rate: 18/min Total Rate: 20/min FO2: 0.85 Mean Arterial Pressure: 88 mm Hg Despite increasing the PEEP, the patient's Spo2 remains at 84%. What additional therapy should the respiratory therapist recommend to improve the patient's condition? A. Administer surfactant replacement therapy B. Place patient in prone position C. Initiate extracorporeal membrane oxygenation D. Switch to independent lung ventilation

*D. has a metabolic alkalosis.*

A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 2 mEq/L Na+: 135 mEg/L CI-: 100 mEg/L HCO3: 32 mEq/L Urine output: 40 mL/hour Based upon this information, the respiratory therapist would conclude that the patient A. is hyperkalemic. B. requires increased fluid intake. C. is polycythemic. D. has a metabolic alkalosis.

*B. the patient requires decreased fluid intake*

A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 3 mEq/L. Na+: 115 mEq/L CI-: 80 mEq/L HCO3: 24 mEq/L Urine output: 60 mL/hour BP: 125/95 mm Hg Based upon this information the respiratory therapist would conclude A the patient is hyperkalemic B. the patient requires decreased fluid intake C. the patient is polycythemic D. the patient has a metabolic alkalosis

*C. extubating and monitoring the patient.*

A 45-year-old female patient who weighs 60 kg (132 Ib) remains intubated in the recovery room after an exploratory laparoscopy. She has been receiving 6 cm H2O of CPAP with an FIO2 of 0.35 for the past 2 hours. Arterial blood gases and vital signs are stable with the following information obtained: RR: 16 /min. MIP: -36 cm H20 VT: 400 mL VC: 1.2 L Based upon this information, the respiratory therapist should recommend A. maintaining the current therapy. B. decreasing the CPAP to 4 cm H2O. C. extubating and monitoring the patient. D. obtaining a portable chest x-ray.

*A. Decrease pressure support to 20 cm H20*

A 46-year-old female patient weighing 65 kg (143 lb) is on mechanical ventilation following a motor vehicle accident. Ventilator settings are as follows: FO2: 0.40 Mode: VC, SIMV Set rate: 10 br/min. Total rate: 16 br/min. VT: 500 ml Pressure support: 25 cm H2O Arterial blood gas results are as follows: pH: 7.51 PCO2: 29 torr PO2: 140 torr HCO3: 22 mEq/L Based upon this information, what should the respiratory therapist recommend at this time? A. Decrease pressure support to 20 cm H20 B. Decrease FIO2 to 0.30. C. Place on a T-piece at 50% oxygen. D. Decrease set rate to 8 br/min.

*A. airway resistance is Increasing.*

A 48-year-old female patient is intubated and being mechanically ventilated with a volume-cycled ventilator. The following parameters were obtained from the ventilator flow sheet: Time----Spo2---Peak Pressure---Plateau Pressure--PEEP 2:00pm--93%---------30----------------25-------------5 3:00pm--88%---------42----------------30------------10 Based on this information, the respiratory therapist should conclude that A. airway resistance is Increasing. B. compliance is decreasing. C. SpO2 measurement is inconsistent with the data obtained. D. a decrease in shunt is occurring.

*A. Oropharyngeal airway*

A 48-year-old postoperative patient in the recovery room is still unconscious. Vital signs are all stable and the SpO2 is 95%. Which of the following should the therapist recommend to prevent a soft tissue obstruction from occurring? A. Oropharyngeal airway B. Nasopharyngeal airway C. Laryngeal mask airway D. Esophageal obturator airway

*B. increase the respiratory rate.*

A 5' 2", 65 kg (143 Ib) female patient with a sub-arachnoid hemorrhage is being mechanically ventilated at the following settings: Mode: VC, A/C VT: 525 mL Set rate: 12 br/min Total rate: 12 br/min FIO2: 40 PEEP: 0 I:E Ratio: 1:2 The following information is available: pH: 7.35 PaCO2: 41 torr PaO2: 85 torr HCO3: 23 mEq/L SaO2: 94% Intracranial Pressure: 30 mm Hg The respiratory therapist should A. increase the tidal volume. B. increase the respiratory rate. C. add 50 ml of deadspace. D. add expiratory resistance.

*D. Nasal cannula*

A 5-year-old patient requires low-flow oxygen therapy. Which of the following devices should the respiratory therapist recommend? A. Oxygen tent B. Simple oxygen mask C. Oxygen hood D. Nasal cannula

*B. Decrease the VT to 600 mL.*

A 52-year-old, 5' 8" tall male patient weighs 70 kg (154 Ib) and is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are: Mode: VC, A/C FIO2: 0.40 Set rate: 16 br/min Total rate: 16 br/min VT: 700 mL PEEP: 5 cm H20 pH: 7.47 PaCO2: 31 torr PAO2: 87 torr Sa02: 97% HCO3: 23 mEq/L BE: 0 mEq/L Which of the following changes should be recommended at this time? A. Decrease the rate to 10. B. Decrease the VT to 600 mL. C. Increase the FIO2 to 0.45. D. Increase the PEEP to 8 cm H20.

*C. Decrease the mechanical deadspace*

A 52-year-old, 5' 9" tall male patient weighing 85 kg (187 Ib) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: Assist/Control FIO2: 0.40 Mandatory rate: 10 Total rate: 10 VT: 650 mL PEEP: 5 cm H2O Mechanical VD: 100 mL pH: 7.28 PaCO2: 74 torr PaO2: 57 torr SaO2: 86% HCO3: 23 mEq/L BE: 0 mEq/L Which of the following changes should be recommended at this time? A. Decrease the VT to 550 ml B. Decrease the mandatory rate to 8 C. Decrease the mechanical deadspace D. Decrease the FIO2 to 0.35

*D. Maintain current settings*

A 52-year-old, 5' 9" tall male patient weighing 85 kg (187 Ib) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: VC, A/C FIO2: 0.40 Mandatory rate: 16 /min Total rate: 16 /min VT: 800 mL PEEP: 5 cm H20 pH: 7.47 PaCO2: 31 torr PaO2: 87 torr SaO2: 96% HCO3: 23 mEq/L BE: 0 mEq/L Which of the following changes should be recommended at this time? A. Increase the rate to 20 /min B. Increase the PEEP to 10 cm H20 C. Add 200 mL of mechanical deadspace D. Maintain current settings

*B. set rate to 14 br/min.*

A 52-year-old, 5' 9" tall male patient who weighs 85 kg (187 Ib) is being mechanically ventilated. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: VC, A/C FIO2: 0.40 Set rate: 10 br/min Total rate: 10 br/min VT: 550 mL PEEP: 5 cm H20 Mechanical VD: 50 mL pH: 7.28 PaCO2: 74 torr PaO2: 57 torr SaO2: 86% HCO3: 23 mEq/L BE: 0 mEq/L The respiratory therapist should increase the A. VT to 700 mL. B. set rate to 14 br/min. C. FIO2 to 0.65. D. PEEP to 15 cm H20.

*A. Decrease the set rate to 10 br/min.*

A 52-year-old, 6' 1" tall male patient weighs 80 kg (176 Ib) and is being mechanically ventilated. Ventilatory data and blood gas results are below: Mode: VC, A/C FIO2: 0.40 Set rate: 14 br/min Total rate: 14 br/min VT: 750 mL PEEP: 10 cm H2O pH: 7.49 PaCO2: 28 torr PAO2: 87 torr SaO2: 96% HCO3: 25 mEq/L BE: +1 mEq/L Which of the following changes should be recommended at this time? A. Decrease the set rate to 10 br/min. B. Decrease the VT to 350 mL. C. Increase the PEEP to 15 cm H2O. D. Add 50 mL of mechanical deadspace.

*A. Deep breathing and coughing techniques*

A 53-year-old patient with a history of chronic bronchitis is expected to have difficulty clearing secretions during the post-op recovery days. The respiratory therapist should recommend which of the following to assist the patient with mobilization of their secretions? A. Deep breathing and coughing techniques B. IPPB with albuterol C. Aerosol therapy with racemic epinephrine D. MDI therapy with beclomethasone (Vanceril)

*B. 3.3 vol%*

A patient in the intensive care unit has the following blood gas results: Arterial pH: 7.42 PaCO2: 39 torr PaO2: 90 torr SaO2: 97% HCO3: 25 mEq/L BE: +1 mEq/L Hb: 14 g/dL Venous pH: 7.39 PVCO2: 46 torr PVO2: 50 torr SvO2: 80 % HCO3: 25 mEq/L BE: +1 mEq/L What should the respiratory therapist report as the patient's C(a-v)02? A. 1.8 vol% B. 3.3 vol% C. 5.2 vol% D. 7.3 vol%

*C. Pressure support ventilation*

A 70 kg (154 Ib) male patient is being mechanically ventilated following a triple coronary artery bypass graft. The chest radiograph shows bilateral radiolucency. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: SIMV FIO2: 0.40 Mandatory rate: 8 Total rate: 16 VT: 650 mL Spontaneous VT: 175 mL PIP: 29 cm H2O Plateau Pressure: 21 cm H2O PEEP: 5 cm H20 pH: 7.31 PaCO2: 54 torr PaO2: 83 torr HCO3: 23 mEq/L BE: 0 mEq/L Which of the following should the therapist recommend? A. Independent lung ventilation B. Pressure control ventilation C. Pressure support ventilation D. Inverse ratio ventilation

*B. increase the set rate to 12 br/min.*

A 70 kg (154 Ib) patient is receiving mechanical ventilation in the VC, A/C mode following cardiopulmonary arrest. The respiratory therapist notes the following data: Set rate: 10 br/min. Total rate: 10 br/min. FIO2: 0.65 VT: 650 mL The arterial blood gas results are as follows: pH: 7.30 PCO2: 56 torr PO2: 78 torr HCO3: 21 mEq/L The therapist should A. institute PEEP therapy at 5 cm H2O. B. increase the set rate to 12 br/min. C. increase the FIO2 to 0.70. D. increase the VT to 800 mL. is

*D. change to pressure control.*

A 80 kg (176 Ib) male suffering from acute respiratory distress syndrome is being mechanically ventilated at the following settings: Mode: VC, A/C Tidal Volume: 500 mL Set Rate: 10 br/min Total Rate: 10 br/min PIP: 68 cm H2O FIO2: 0.45 PEEP: 8 cm H2O The following patient information is available: pH: 7.37 PaCO2: 44 torr PaO2: 89 torr HCO3: 22 mEq/L The respiratory therapist should A. decrease PEEP. B. change to SIMV. C. add pressure support. D. change to pressure control.

*A. increasing the FIO2 to 60%.*

A 80 kg (176 Ib) patient with pulmonary fibrosis is being mechanically ventilated with a volume-controlled ventilator at the following settings: Mode: SIMV VT: 700 mL Mandatory rate: 15 Total rate: 15 FO2: 0.45 PEEP: +10 I:E Ratio: 1:2 PIP: 50 cmH2O Arterial Blood Gas analysis reveals the following: pH: 7.34 PaCO2: 42 torr PaO2: 55 torr HCO3: 22 mEq/L SaO2: 88% The respiratory therapist should recommend: A. increasing the FIO2 to 60%. B. decreasing the respiratory rate. C. increase the PEEP level to 20 cm H2O. D. changing to pressure control mode.

*A. CVP*

A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the proximal lumen? A. CVP B. PAP C. PWP D. MAP

*A. Asthma*

A bilateral wheeze would most likely indicate which of the following? A. Asthma B. Atelectasis C. Foreign body aspiration D. Epiglottitis

*A. pneumothorax*

A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased movement, and no vascular markings on the right side. These signs would be most likely associated with: A. pneumothorax B. pleural effusion C. pneumonia D. flail chest

*A. Pleural effusion*

A chest radiograph is taken in the lateral decubitus position in order to identify which of the following pathologies? A. Pleural effusion B. Pulmonary embolus C. Pneumothorax D. Pneumonia

*B. Oxygen at 2 LPM via nasal cannula*

A chronic hypercapnic patient enters the emergency room complaining of shortness of breath. The patient is coughing up inspissated, pale, yellow secretions. Which of the following would you recommend at this time? A. Sputum culture and sensitivity B. Oxygen at 2 LPM via nasal cannula C. A-P and lateral chest x-ray D. Arterial blood gases

*C. co-oximetry results*

A fireman is brought into the emergency room after being pulled from a burning warehouse and is found to be unconscious. What is the best way to assess the oxygenation status of this patient? A. Arterial blood gas results B. Hb & Hct levels C. co-oximetry results D. SpO2 monitoring

*D. arterial blood gases.*

A male infant born at 36 weeks gestation was delivered by Cesarean section. The newborn is exhibiting signs of respiratory distress including nasal flaring and mild retractions. Physical examination reveals HR 160/min. RR 52/min, BP 60/40 mm Hg. The chest radiograph indicates some scattered densities. The respiratory therapist should recommend A. nasal CPAP at 5 cm H20. B. BİPAP ventilation. C. 40% oxygen via hood. D. arterial blood gases.

*B. change to VC, SIMV.*

A male patient (6' 2" tall, 80 kg, 176 Ib) is being mechanically ventilated following an exploratory laporatomy at the following settings: Mode: VC, A/C Set rate: 12 /min. Total rate: 18 /min. FIO2: 0.50 VT: 700 mL PEEP: 6 cm H2O Arterial blood gas results are: pH: 7.49 PaCO2: 32 torr PaO2: 90 torr HCO3: 24 mEq/L Based on this information, the respiratory therapist should A. add mechanical deadspace. B. change to VC, SIMV. C. decrease the FIO2 to 0.45. D. initiate pressure support.

*B. reduce gas inlet flow.*

A mask CPAP system using a threshold resistor valve is not maintaining the desired pressure. To correct this problem, the respiratory therapist should do all of the following EXCEPT: A check the valve for proper function. B. reduce gas inlet flow. C. reposition the mask and check the seal. D. add a reservoir to the system.

*A. hypotension*

A multiple trauma victim with intermal hemorrhage is being monitored via pulse oximetry. Which of the following conditions would affect the accuracy of her SpO2 readings? A. hypotension B. hyperoxia C. hypocarbia D. hyperthermia

*B. conscious patient with an ineffective cough*

A nasopharyngeal airway is indicated for which of the following patients? A. unconscious patient with a closed head injury B. conscious patient with an ineffective cough C. alert patient who is expectorating a large amount of secretions D. uncooperative patient

*B. assisted ventilation*

A newborn infant born at 26 weeks is exhibiting signs of respiratory distress including nasal flaring and retractions. Physical examination reveals heart rate 180/min., respiratory rate 72/min., blood pressure 60/50 mm Hg. The chest radiograph indicates a reticulonodular appearance. The respiratory therapist should recommend: A. nasal CPAP at 10 cmH2O B. assisted ventilation C. 100% oxygen via hood D. Q1H monitoring

*C. This is a venous blood sample*

A pH of 7.38, PACO2 of 46 torr, PaO2 of 41 torr are obtained on a patient who appears to be healthy. There is no tachycardia, tachypnea, or cyanosis. Which of the following is an appropriate conclusion to draw on the basis of this information? A. The blood gas sample has a gas bubble B. The blood gas sample was not mixed or warmed prior to analysis C. This is a venous blood sample D. This patient has chronic lung disease

*A. 40% air entrainment mask*

A patient admitted to the emergency room for an acute exacerbation of asthma requires oxygen therapy. The patient has an irregular respiratory rate and pattern and is dyspneic. Which of the following oxygen administration devices would be the most appropriate? A. 40% air entrainment mask B. nasal cannula at 5 L/min. C. simple oxygen mask at 6 L/min. D. 40 % aerosol mask

*B. 415 torr*

A patient in the intensive care unit has the following data obtained: pH: 7.41 PaCO2: 40 torr PaO2: 235 torr SaO2: 99% HCO3: 23 mEq/L BE: +1 mEq/L FIO2: 1.0 VD/VT: 0.35 Hb: 15 g/dL RER: 0.8 PB: 747 What should the respiratory therapist report as the P(A-a)O2? A. 210 torr B. 415 torr C. 535 torr D. 620 torr

*B. utilize an inline suction catheter*

A patient being mechanically ventilated requires endotracheal suctioning. The patient is on high levels of PEEP therapy and has periods of hypotension. The respiratory therapist hyperoxygenates the patient before beginning the procedure. As the therapist disconnects the patient from the ventilator circuit, the above pattern is seen on the ECG monitor. Which of the following could the respiratory therapist recommend to prevent the patient's ECG pattern? A. increase the oxygenation time B. utilize an inline suction catheter C. perform nasotracheal suctioning D. discontinue suctioning the patient

*C. chronic respiratory acidosis*

A patient complaining of dyspnea has the following arterial blood gas results: pH: 7.36 PaCO2: 56 torr PaO2: 49 torr HCO3: 34 mEq/L SaO2: 80% FIO2: .21 These results are best described as: A. acute respiratory acidosis B. acute metabolic alkalosis C. chronic respiratory acidosis D. chronic metabolic alkalosis

*B. flush the catheter with saline.*

A patient complains of shortness of breath while receiving oxygen via transtracheal catheter. Her pulse oximeter reading has decreased from 92% to 85%. The respiratory therapist should first A. increase the flow to the catheter. B. flush the catheter with saline. C. administer metaproterenol via small volume nebulizer. D. replace the transtracheal catheter with a nasal cannula.

*A. non-rebreather mask.*

A patient has been admitted to the emergency department after being rescued from a house fire. The patient has second-degree bums on his neck and chest. The respiratory therapist should administer the oxygen therapy via A. non-rebreather mask. B. aerosol mask. C. face tent. D. transtracheal oxygen catheter.

*C. to establish a pressure of 20 mmHg*

A patient has been intubated in order to receive volume control ventilation. To inflate the endotracheal tube cuff, the respiratory therapist should add air to the cuff A. until no leak is heard during inspiration. B. and then remove it until a slight leak is heard at peak inspiration. C. to establish a pressure of 20 mmHg. D. to establish a pressure of 40 cmH20.

*D. FVC*

A patient has come to the pulmonary function lab for pre-op testing. The patient performs a maximum inspiration followed by a maximum forceful expiration. This procedure would measure: A. RV B. FRC C. TLC D. FVC

*D. hemoximetry.*

A patient in the Intensive Care Unit is monitored with pulse oximetry during administration of oxygen by nasal cannula at 3 L/min. The pulse oximeter displays an SpO2 of 75% with a heart rate of 55/minute. In order to confirm the accuracy of the pulse oximeter, the respiratory therapist should recommend A. capillary blood gas measurement. B. capnography. C. FENO measurement. D. hemoximetry.

*D. 2, 3, & 4 only*

A patient in the emergency department has frothy secretions, moist crackles, and tachypnea. The patient has marked dyspnea and a history of heart disease. Which of the following should the respiratory therapist recommend? 1. Suction immediately 2. Administer 100% oxygen 3. Place in Fowlers position 4. Administer furosemide A. 1,2 & 3 only B. 1, 3 & 4 only C. 1, 2 & 4 only D. 2, 3, & 4 only

*D. 19.59 vol%*

A patient is being mechanically ventilated in the intensive care unit. The following data is obtained: Mode: VC, SIMV Mandatory rate: 12 b/min Total rate: 18 b/min VT: 800 ml FO2: 0.60 PIP: 31 cm H2O PEEP: 10 cm H2O pH: 7.41 PaCO2: 40 torr PaO2: 95 torr SaO2: 96% HCO3: 23 mEq/L BE: +1 mEq/L PECO2: 30 torr НЬ: 15 g/dL What should the respiratory therapist report as the CaO2? A. 18.40 vol% B. 18.60 vol% C. 19.30 vol% D. 19.59 vol%

*C. 20%*

A patient is being ventilated with a Servo 300 ventilator in the intensive care unit. The following data is obtained: Mode: SIMV Mandatory rate: 12 b/min Total rate: 12 b/min VE: 8.6 L FIO2: 0.60 PIP: 31 cm H2O PEEP: 10 cm H20 pH: 7.41 PaCO2: 40 torr PaO2: 95 torr SaO2: 96% HCO3: 23 mEq/L BE: +1 mEq/L A-ADO2: 300 torr C(a-v)O2: 3.6 vol% What should the therapist report as the Qs/Qr? A. 15% B. 18% C. 20% D. 25%

*C. 19 L/min*

A patient is breathing a mixture of 70% He / 30% 02 via non-rebreather mask. The oxygen flowmeter indicates a flow of 12 L/min, What is the actual flow of gas to the mask? A. 12 L/min B. 16 L/min C. 19 L/min D. 22 L/min

*B. Double-lumen endobronchial tube*

A patient is diagnosed with a necrotizing pulmonary fistula in the right lung. The physician has requested that the right lung be ventilated at a pressure 10 cmH2O lower than the left lung. The respiratory therapist should recommend providing this type of ventilation via a: A. Transtracheal catheter device B. Double-lumen endobronchial tube C. Cricothyroidotomy D. 14 gauge endotracheal catheter

*B. Initially low, then rising*

A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would the respiratory therapist expect to observe on the monitor? A. Initially high, then falling B. Initially low, then rising C. Initially high, stays high D. Initially low, stays low

*B) metabolic acidosis*

A patient is observed to have an increased respiratory rate and depth of breathing. Their breath has a fruit-like aroma. This would most likely be associated with: A. head trauma B. metabolic acidosis C. drug overdose D. chronic obstructive lung disease

*A. Pull the covers down away from the mask and repeat the arterial blood gas in 30 minutes*

A patient is on a 28% Venturi mask with the bed covers pulled up over the mask. Arterial blood gas results on the 28% Venturi mask show the PaO2 is 168 torr. The physician asks the respiratory therapist for a recommendation. Which of the following should the therapist recommend? A. Pull the covers down away from the mask and repeat the arterial blood gas in 30 minutes B. Discontinue the oxygen therapy C. Switch the patient to a nasal cannula at 2 L/min D. Report the arterial blood gas results as is

*C. Increase the flow*

A patient is on a continuous flow CPAP system. The respiratory therapist notes that the pressure drops to zero during inspiration. The therapist should: A. Initiate mechanical ventilation B. Change to an IPAP/EPAP system C. Increase the flow D. Decrease the threshold resistor

*D. Pneumotachometer*

A patient is on a ventilator and is in the process of being weaned. What is the best way to continuously monitor the minute ventilation? A. Chest transducers B. Themistors C. Water seal spirometer D. Pneumotachometer

*C. Reposition the mask*

A patient is receiving BIPAP® therapy and is complaining of eye irritation. What should the therapist do to correct the problem? A. Decrease the pressure B. Reassure the patient C. Reposition the mask D. Intubate the patient

*A. increase the flowrate*

A patient is receiving CPAP therapy and the pressure is fluctuating between +5 and -8 cmH20. What should the therapist do to stailize the CPAP therapy? A. increase the flowrate B. decrease the pressure C. check for system leaks D. check for sticking valves

*A. increase the flow.*

A patient is receiving IPPB by mouthpiece. The therapist notes that the machine fails to cycle into the expiratory phase. The respiratory therapist should A. increase the flow. B. decrease the sensitivity. C. adjust the apnea timer. D. increase the pressure.

*A. increase the flow.*

A patient is receiving IPPB with a Bennett PR-2. The therapist notes that the patient is not reaching the pre-set pressure in an adequate amount of time. The respiratory therapist should A. increase the flow. B. increase the sensitivity. C. adjust the apnea timer. D. decrease the pressure.

*A. Decrease the suction time per pass.*

A patient is receiving continuous mechanical ventilation with 100% oxygen. While suctioning the patient, the respiratory therapist observes the following ECG pattem on the monitor: The therapist should A. decrease the suction time per pass. B. increase the oxygenation time. C. use a smaller suction catheter. D. decrease the suction pressure.

*B. continue subdiaphragmatic thrusts.*

A respiratory therapist is in the cafeteria when an adult visitor begins to choke. The therapist has administered 7 subdiaphragmatic thrusts without clearing the patient's airway, although the patient remains conscious. The therapist should A. administer 5 back blows. B. continue subdiaphragmatic thrusts. C. attempt to ventilate. D. check for presence of a pulse.

*C. wright respirometer*

A respiratory therapist is performing spirometry on a patient with chronic bronchitis. Which of the following equipment would produce an unreliable measurement? A. body plethysmograph B. water seal spirometer C. wright respirometer D. pressure differential pneumotachometer

*B. water seal spirometer*

A respiratory therapist is performing spirometry on a patient with chronic bronchitis. Which of the following equipment would the respiratory therapist need? A. ergometer B. water seal spirometer C. pneumogram D. turbine pneumotachometer

*C. 1, 3 & 4 only*

A respiratory therapist reviews a ventilator parameter sheet and finds that the peak inspiratory pressure has been gradually rising for the past several hours. Which of the following could be the cause for this change? 1. Bronchospasm 2. Increasing pulmonary compliance 3. Accumulation of secretions 4. Increasing airway resistance A. 2 only B. 1 & 3 only C. 1, 3 & 4 only D. 1, 2, 3 & 4

*B. facilitate orotracheal intubation*

A respiratory therapist working in the intensive care unit would use a stylet to: A. assist with phonation B. facilitate orotracheal intubation C. maintain a stoma opening D. provide protection to the unaffected lung

*B. Alveolar ventilation*

A spontaneously breathing 76-year-old patient who weighs 60 kg (132 lb) is on an FIO2 of 0.45 via a trach collar. He has had a change in his tidal volume from 600 mL to 300 mL and his respiratory rate went from 12 /min to 24 /min. Which of the following changed due to the change in the tidal volume and rate? A. Minute ventilation B. Alveolar ventilation C. Anatomical deadspace D. Mechanical deadspace

*D. Add a heating element to the aerosol*

A three day postoperative laryngectomy patient is receiving 50% oxygen with a cool aerosol via a tracheostomy collar. The secretions being suctioned by the therapist are thick and difficult to aspirate. The therapist should recommend: A Increase the frequency of suctioning B. Instill 2 ml. of normal saline prior to suctioning C. Decrease the oxygen to 45% D. Add a heating element to the aerosol

*A. 1 & 3 only*

A tympanic percussion note is usually present in which of the following conditions? 1. gastric distension 2. pleural effusion 3. pneumothorax 4. endocarditis A. 1 & 3 only B. 2 & 4 only C. 3 & 4 only D. 1, 2 & 3 only

*C. foreign body aspiration*

A unilateral wheeze would most likely indicate which of the folowing? A. asthma B. atelectasis C. foreign body aspiration D. epiglotitis

*C. Hb*

A47-vear-old patient admitted for sepsis has a CaO2 value of 12.5 vol%. The patient does not appear cyanotic. Which of the following would be the most important to further evaluate the patient's oxygenation status? A. Pa02 B. SaO2 C. Hb D. PAO2

*B. prepare for the transport immediately*

A2 kg (4.4 lb) neonate requires transportation to a tertiary care center for cardiac surgery. The infant has a heart rate of 140 and a BP of 60/30. The neonate is intubated with a size 2.5 mm uncuffed endotracheal tube and ventilation is being assisted manually at a rate of 40/min. Which of the following should the respiratory therapist recommend? A. postpone the transport until the neonate has spontaneous respirations B. prepare for the transport immediately C. delay the transport and stabilize the patient D. wait 24 hours and then reassess the patient

*D. recalibrate the oxygen analyzer.*

A2-month-old infant is receiving 40% oxygen via an oxygen hood. While performing oxygen rounds, the respiratory therapist analyzes the FiO2 inside the hood and discovers that the FIO2 is registering 0.50. The respiratory therapist calibrated the oxygen analyzer at the beginning of the shift. The respiratory therapist should A. check to see that the hood is sealed tightly around the infant's neck. B. decrease the flow to the hood. C. check to see that the temperature setting on the humidifier is at 34°C. D. recalibrate the oxygen analyzer.

*C. aspirated a foreign object*

A2-year-old child enters the emergency room. The mother states that the child was playing with friends and developed violent coughing and unilateral wheezing. Physical examination reveals a hyperresonant percussion note on the left and resonant percussion note on the right. Inspiratory and expiratory chest films indicate air trapping with no foreign bodies noted. The respiratory therapist should suspect that the child has A. pneumothorax. B. orthopnea C. aspirated a foreign object. D. tachyphylaxis.

*A. aerosol mask.*

A2-year-old child has been admitted to the pediatric unit with a barking cough and mild stridor at rest. The pulse oximeter displays an SpO2 of 87% on room air. The physician asks the respiratory therapist to recommend the most appropriate oxygen delivery device for this child. The therapist should recommend a/an A. aerosol mask. B. nasal cannula. C. oxygen hood. D. venturi-mask.

*B. Oral intubation*

A4-year-old child has been brought to the emergency room with an acute infection, high fever, marked stridor and drooling. Which of the following should the therapist recommend at this time? A. Arterial blood gas B. Oral intubation C. Lateral neck X-ray D. 40% oxygen via cool mist tent

*A. increase the flow.*

A44-year-old male patient is being mechanically ventilated with a volume cycled ventilator. The respiratory therapist observes that there is insufficient time for the patient to exhale completely. The therapist should A. increase the flow. B. decrease the minute volume. C. add expiratory retard. D. remove mechanical deadspace.

*D. sedating the patient.*

A5' 10", 80 kg (176 Ibs) male patient with multiple trauma from a motorcycle accident has developed ARDS and is being ventilated at the following settings: Mode: VC, SIMV VT: 500 ml Set Rate: 14 br/min. FO2: 0.60 PEEP: 12 cm H20 Arterial blood gas results reveal: pH: 7.35 PaO2: 72 torr PaCO2: 44 torr SpO2: 93% The patient is conscious and pulling on the IV lines and ventilator tubing. At this time, the respiratory therapist should recommend A. changing to assist/control mode. B. restraining the patient. C. increasing the set rate to 16 br/min. D. sedating the patient.

*D. Maintain current settings*

A6'2" tall, 80 kg (176 Ib) male patient with alpha 1 protease inhibitor deficiency is being mechanically ventilated at the following settings: Mode: VC, SIMV Set rate: 12 br/min. Total rate: 16 br/min. Tidal volume (set): 650 ml. Tidal volume (spontaneous): 320 ml Peak flow: 55 L/min FO2: 0.30 His vital signs are stable and he is sleeping comfortably. An arterial blood gas has been drawn with the following results: pH: 7.37 PaCO2: 51 torr PaO2: 68 torr HCO3: 29 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the set rate B. Decrease the tidal volume C. Increase the FIO2 D. Maintain current settings

*A. cardiac output is increasing.*

A6-year-old child involved in a swimming pool accident is in cardiac arrest. The patient has been intubated with a size 5.5 mm endotracheal tube and has an end-tidal CO2 monitor connected to the airway. During cardiac compression the respiratory therapist notes that the end-tidal CO2 is increasing. This would indicate that A. cardiac output is increasing. B. compression depth is too low. C. endotracheal tube is too large. D. ventilation should be increased

*D. Maintain the current settings.*

A75 kg (165 Ib) male patient is being mechanically ventilated following coronary artery bypass surgery. He is currently on the following settings: Mode: VC, SIMV Set rate: 10 br/min. Total rate: 14 br/min. FIO2: 0.40 VT: 650 mL PEEP: 8 cmH2O Arterial blood gas results show: pH: 7.41 PCO2: 44 torr PO2: 85 torr HCO3: 23 mEq/L You would recommend which of the following at this time? A. Decrease the FIO2. B. Decrease the set rate to 8 br/min. C. Increase the PEEP to 10 cmH2O. D. Maintain the current settings.

*B. Soak it in an acetic acid solution for 20 minutes and rinse with water.*

A75-year-old patient with COPD is receiving oxygen at home by nasal cannula with a bubble humidifier. How should the respiratory therapist instruct the patient to clean his humidifier? A. Place it on the top shelf of the dishwasher. B. Soak it in an acetic acid solution for 20 minutes and rinse with water. C. Rinse it with distilled water and allow to air dry. D. Soak it in an alkaline glutaraldehyde solution for 30 minutes and rinse with water.

*D. Inspiratory positive airway pressure (IPAP).*

A78-year-old male patient is being treated for obstructive sleep apnea with bilevel positive airway pressure at night. Arterial blood gas results reveal an elevated PaCO2 level. The respiratory therapist should recommend increasing the A. oxygen concentration. B. expiratory positive airway pressure (EPAP). C. inspiratory flow rate. D. Inspiratory positive airway pressure (IPAP).

*D. this is a normal wedge tracing.*

After injecting a small amount of air into the balloon of a pulmonary artery catheter, the respiratory therapist sees a small amplitude change with the mean pressure reading 2 points below the PA end-diastolic pressure. Based upon this information, the therapist should conclude that A. there is pressure dampening. B. the transducer is placed too high. C. there is an obstruction in the catheter. D. this is a normal wedge tracing.

*D. O 9 LPM air, 3 LPM oxygen*

An air flowmeter and an oxygen flowmeter are being used to deliver 40% oxygen to a patient via a non- rebreathing mask. A total flow of 12 LPM is required to prevent the non-rebreathing bag from deflating. How many liters of air and how many liters of oxygen should the therapist use? A. 2 LPM air, 6 LPM oxygen B. 4 LPM air, 8 LPM oxygen C. 6 LPM air, 6 LPM oxygen D. 9 LPM air, 3 LPM oxygen

*A. airway resistance has decreased*

All of the following could be causing the peak pressure alarm to sound on a volume-cycled ventilator EXCEPT: A. airway resistance has decreased B. the patient needs to be suctioned C. compliance has decreased D. an insufficient amount of time for exhalation

*A. endotracheal tube positioned in the right mainstem bronchus*

All of the following could cause a capnography reading to change from 36 torr to 30 torr EXCEPT A. endotracheal tube positioned in the right mainstem bronchus B. hyperventilation C. pulmonary emboli D. hypovolemia

*C. improved resting blood gases.*

All of the following would be appropriate goals for a pulmonary rehabilitation program for a patient with COPD EXCEPT A. increased exercise tolerance. B. decreased hypoxic symptoms. C. improved resting blood gases. D. improved activities of daily living.

*B. dull percussion*

All of the following would be associated with the presence of a pneumothorax EXCEPT: A. tracheal deviation B. dull percussion C. absent breath sounds D. respiratory distress

*A. Low oxygen inlet pressure*

An air/oxygen proportioner is used to provide an FIO2 of 0.55 by a non-rebreather mask. The blender alarm is sounding. Which of the following is the most likely cause? A. Low oxygen inlet pressure B. High air inlet pressure C. Faulty humidifier bottle connection D. Excessive flow to the non-rebreather mask

*C. The TCPO2 electrode temperature setting is too low.*

An 1800 g neonate in the NICU is being monitored with a TCPO2 electrode. The TCPO2 electrode is reading 42 torr with the temperature set at 38°C. The PO2 from an umbilical artery sample is 72 torr. Which of the following would best explain the difference in these readings? A. There was an error in the arterial blood gas results. B. The ToPO2 electrode needs to be repositioned. C. The TCPO2 electrode temperature setting is too low. D. The TOPO2 electrode has been dislodged.

*B. Increase the FIO2*

An 1800 g premature neonate is receiving 30% oxygen via an oxyhood with the following arterial blood gas results obtained: pH: 7.34 PaO2: 46 torr PaCO2: 47 torr HCO3: 22 mEq/L Based upon this information, which of the following should the respiratory therapist recommend at this time? A. Intubate and initiate mechanical ventilation B. Increase the FIO2 C. Administer CPAP via endotracheal tube D. Deliver noninvasive positive pressure ventilation

*B. initiate CPR*

An 8-month-old infant admitted to the pediatric unit is playing with marbles. The infant suddenly develops violent coughing and is unable to cry. The respiratory therapist administered series of back blows and chest thrusts, and the infant is now unresponsive. The therapist should A. continue back blow and chest thrusts. B. initiate CPR. C. perform a blind finger sweep. D. prepare to intubate.

*B. Use pressure support with SIMV*

An 8-year-old child is being weaned from volume-control ventilation. Each time the respiratory therapist attempts to wean by decreasing the SIMV rate by 2 breaths/min, the child develops diaphoresis and tachypnea. Which of the following should the therapist recommend? A. Attempt T-tube weaning trials B. Use pressure support with SIMV C. Increase the FIO2 by 10% during the weaning attempts D. Discontinue all weaning attempts

*D. Peak flow meter*

An 8-year-old patient with asthma has been receiving routine bronchodilator therapy at home. The degree of airflow response to the therapy is best assessed by which of the following? A. Wright respirometer B. Spo2 C. Vital capacity D. Peak flow meter

*B. 10 hours*

An H cylinder of oxygen has 1200 psi remaining in the tank. How long will it take to decrease to 200 psi if the flow is 5 LPM? A. 1 hour B. 10 hours C. 60 hours D. 600 hours

*C. increase the flowrate.*

An adolescent patient admitted with a drug overdose is being mechanically ventilated at the following settings: Mode: PC, A/C Set Rate: 16 br/min Flow: 25 L/min Pressure limit: 40 cm H2O FIO2: 0.30 Exhaled VT: 500 mL The respiratory therapist observes wide fluctuations on the pressure manometer during inspiration. The most appropriate action would be to A. sedate the patient. B. increase the pressure limit. C. increase the flowrate. D. decrease the trigger setting.

*B. Increase the drive pressure*

An infant on a high frequency jet ventilator (rate of 150 b/m) has the following arterial blood gases: pH: 7.30 PaO2: 60 torr PaCO2: 50 torr HCO3: 21 mEq/L Which of the following changes would best help to improve these results? A. Increase the inspiratory time B. Increase the drive pressure C. Increase the frequency to 190 br/min D. Increase the FIO2

*D. A patient with pulmonary fibrosis requiring long term oxygen therapy.*

An oxygen conservation cannula would be most appropriate for which of the following patients? A. A patient with pneumonia requiring low flow oxygen. B. A patient with emphysema who is experiencing increased shortness of breath. C. A patient with a severe exacerbation of asthma. D. A patient with pulmonary fibrosis requiring long term oxygen therapy.

*B. areas of discoloration.*

Assessment of skin integrity includes evaluation of all of the following EXCEPT A. overall health of the skin. B. areas of discoloration. C. pressure sores. D. area around tracheotomy stoma.

*B. record the distance he traveled in six minutes.*

During a 6 Minute Walk Test, the patient should be instructed to A. rest for six minutes every half hour. B. record the distance he traveled in six minutes. C. count how many steps he took in six minutes. D. measure his heart rate every six minutes.

*C. inspiratory effort is too strong.*

During an incentive spirometry treatment using a flow-sensing device, the float will not rise during inspiration. This may be due to all of the following EXCEPT A a crack in the casing. B. an obstructed mouthpiece. C. inspiratory effort is too strong. D. Inspiratory flow is too slow.

*D. inspiratory hold*

During an incentive spirometry treatment using a volume-oriented device, the patient inhales to TLC and exhales slowly to FRC. What other instructions would you give to improve distribution? A. continue with the current instructions B. switch to a flow orientated device C. initiate IPPB D. inspiratory hold

*D. Excessive oxygen flow*

During cardiopulmonary resuscitation of a 78-year-old patient, the respiratory therapist provides ventilation with a manual resuscitation bag attached to the patient's endotracheal tube. While squeezing the bag, the therapist observes inadequate chest movement. Which of the following is the LEAST likely cause? A. Missing inlet valve B. Defective endotracheal tube cuff C. Incorrect tube placement D. Excessive oxygen flow

*B. congestive heart failure*

Fine crepitant crackles are most commonly associated with which of the following conditions? A. bronchiectasis B. congestive heart failure C. pneumonia D. croup

*D. cerebral perfusion scan.*

Following blunt force head trauma, a 20 year-old male patient receives mechanical ventilation for seven days without improvement in neurologic function. Absence of respiratory movements is noted during an apnea test. To confirm a diagnosis of brain death, the respiratory therapist should recommend A. caloric reflex test. B. electroencephalogram. C. CT scan of brain. D. cerebral perfusion scan.

*D. PEP therapy.*

Following exploratory laparotomy, a 51-year-old man has retained secretions in his left lower lobe. The respiratory therapist should recommend A. blow bottles. B. NIPPV (BIPAPO). C. albuterol MDI with spacer. D. PEP therapy.

*C. Carbohydrates*

Following indirect calorimetry, a 66-year-old patient's RQ is calculated to be 1.01. What food group is being primarily metabolized by this patient? A. Proteins B. Fats C. Carbohydrates D. Amnio acids

*C. Change to SIMV mode and evaluate the patient*

Following mitral valve replacement surgery, a 29-year-old female patient is combative on a volume-control ventilator in the assist/control mode. The peak pressure alarm is sounding with each breath. The nurse practitioner has a STAT call in to the cardiovascular surgeon. She asks the respiratory therapist for an immediate recommendation. Which of the following should the therapist recommend? A. Increase the peak pressure alarm limit B. Order a STAT chest x-ray C. Change to SIMV mode and evaluate the patient D. Order a STAT arterial blood gas

*A. Yes (Varenicline), No (Naloxone), Yes (Bupropion HCI)*

In order to assist a patient with his efforts to quit smoking, the respiratory therapist could recommend -------Varenicline-----Naloxone-----Bupropion HCI A.--------Yes-------------No--------------Yes B.---------No-------------No--------------No C.---------Yes------------Yes--------------Yes D.---------No-------------Yes--------------No

*B. FECO*

In order to monitor compliance of hospital employees in a smoking cessation program, the respiratory therapist should monitor the employees' A. PaO2. B. FECO C. PETCO2. D. FENO.

*B. 160 beats/minute*

In preparing to perform a cardiopulmonary stress test on a 60-year-old man, the respiratory therapist must determine the target heart rate range for the patient. What is the patient's maximum heart rate? A. 130 beats/minute B. 160 beats/minute C. 190 beats/minute D. 220 beats/minute

*B. evaluate exercise tolerance.*

Indications for spirometry include all of the following EXCEPT A. quantify changes in pulmonary function. B. evaluate exercise tolerance. C. perform epidemioligic surveillance. D. document pulmonary disability.

*C. providing 100% oxygen at high flow rates.*

Oxygen concentrator operation involves all of the following EXCEPT A. removing nitrogen from the room air. B. electrically powered with limited portability. C. providing 100% oxygen at high flow rates. D. filters whích require routine care.

*A. normal spirometry.*

Pre- and post-bronchodilator spirometry study is performed on a patient with the following results: ----------Pre-Bronchodilator--------Post-Bronchodilator ------------% of predicted-------------% of predicted FVC-------------89----------------------------90 FEV1-------------81----------------------------82 FEF 200-1200---80----------------------------81 FEF25-75%------81----------------------------82 MVV------------85----------------------------85 Peak Flow------86----------------------------80 These results can best be described as: A. normal spirometry. B. obstructive only. C. restrictive only. D. both obstructive and restrictive.

*D. both obstructive and restrictive.*

Pre- and post-bronchodilator spirometry study is performed on a patient with the following results: ---------Pre-Bronchodilator---------Post-Bronchodilator ----------% of predicted---------------% of predicted FVC-----------69-----------------------------70 FEV1----------63-----------------------------81 FEF200-1200--75-----------------------------82 FEF25-75%----59-----------------------------79 MVV----------60-----------------------------75 Peak Flow-----76----------------------------80 These results can best be described as A. normal spirometry. B. obstructive only. C. restrictive only. D. both obstructive and restrictive.

*C. restrictive only.*

Pre- and post-bronchodilator spirometry study is performed on a patient with the following results: --------Pre-Bronchodilator---------Post-Bronchodilator ----------% of predicted----------------% of predicted FVC----------69--------------------------------70 FEV1---------83--------------------------------81 FEF200-1200-85-------------------------------82 FEF25-75%---81--------------------------------82 MVV--------- 70-------------------------------75 Peak Flow----82-------------------------------82 These results can best be described as A. normal spirometry. B. obstructive only. C. restrictive only. D. both obstructive and restrictive.

*B. 1 and 4 only*

Prior to performing spirometry on a pre-op patient, the respiratory therapist calibrates the spirometer using a 3.0 L super syringe. The three volumes achieved are: 2.80 L, 2.80 L, 2.79 L. Based upon the information obtained the therapist should conclude that the 1. spirometer is precise. 2. spirometer is accurate. 3. super syringe was advanced too slowly 4. spirometer may have a leak. A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 4 only

*D. 1, 2, and 3*

Routes of transmission of infections include 1. airborne droplet nuclei. 2. contact. 3. respiratory droplets. A. 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3

*D. Reintubate orally*

Shortly after extubating a patient, the therapist notes an increase in the patient's work of breathing, intercostal retractions, marked stridor and a decreased Sp02. The therapist should recommend: A. Cool aerosol therapy with 50% oxygen B. Assisted ventilation with resuscitation bag and mask C. CPAP therapy with 40% oxygen D. Reintubate orally

*A. The patient has significant non-ventilated lung volume*

The FRC (functional residual capacity) is measured on a patient using the helium dilution technique and the result is 3.0 liters. The same patient is then tested in a body box and the result is 4.5 liters. Which of the following would account for the difference? A. The patient has significant non-ventilated lung volume B. There was a leak during the helium dilution procedure C. The patient did not perform the maneuver properly D. Hysteresis is present

*C. utilizing a closed-suction catheter system.*

The ICU director wishes to implement a protocol to reduce the risk of ventilator-associated pneumonia (VAP) for patients requiring mechanical ventilation. The respiratory therapist should recommend that the protocol include A. placing the patient in the prone position. B. changing the ventilator circuit each day. C. utilizing a closed-suction catheter system. D. intubating the patient with a Carlens tube.

*A. allows the respiratory therapist to treat multiple patients simultaneously.*

The advantages of an electronic medical record include all of the following EXCEPT A. allows the respiratory therapist to treat multiple patients simultaneously. B. improves the accuracy of charting the results of therapy. C. data entry is more efficient. D. prevents unauthorized access to medical information.

*B. the transducer is placed too low.*

The blood pressure obtained from the arterial line is higher than the blood pressure obtained from a sphygmomanometer. Based upon this information, the respiratory therapist should conclude that A. non-compliant tubing is being used. B. the transducer is placed too low. C. the patient was lying flat during the measurement of the arterial line pressure. D. the transducer dome contained air bubbles.

*C. Utilizing a cuff pressure manometer*

Which of the following is the best method to minimize damage to the tracheal wall caused by an endotracheal tube cuff? A. Measuring the volume used to inflate the cuff B. Palpating the inflation of the pilot balloon C. Utilizing a cuff pressure manometer D. Using minimal occluding volume to seal the airway

*B. attempt to pass a suction catheter through the airway*

Which of the following is the best way to determine the patency of a nasopharyngeal airway? A. instill 5mL of normal saline into the airway B. attempt to pass a suction catheter through the airway C. listen for air flow through the airway D. recommend a sinus x-ray

*B. lung compliance is decreasing.*

The respiratory therapist reviews the ventilator flow sheet for a post- op patient. The ventilator settings have not changed during the past 24 hours. The peak and plateau pressures were recorded as follows: This information would indicate that A. airway resistance is increasing. B. lung compliance is decreasing. C. the patient needs to be suctioned. D. the patient can begin weaning.

*D. the PEEP should be increased.*

The respiratory therapist reviews the ventilator flow sheet for a post-op patient. The ventilator settings have not been changed during the past 24 hours. The peak and plateau pressures were recorded as follows: This information would indicate that A. airway resistance is increasing. B. lung compliance is increasing. C. the patient can begin weaning. D. the PEEP should be increased.

*B. PEEP*

Which of the following is NOT a primary ventilation parameter measured and displayed to create airway graphics of continuous mechanical ventilation? A. Flow B. PEEP C. Tidal volume D. Airway pressure

*B. proceed with the insertion of the catheter.*

The respiratory therapist is assisting the physician with the insertion of a pulmonary artery catheter. The therapist and physician have proper sterile gloves and gown, and a sterile field is arranged. As the therapist hands the pulmonary artery catheter to the physician, the therapist drops the catheter onto the sterile field. The respiratory therapist should A. run to get another sterile catheter. B. proceed with the insertion of the catheter. C. rinse the catheter with sterile water. D. visually inspect the catheter for any debris.

*C. Hb and Hct levels*

The respiratory therapist is called to the emergency department to evaluate a patient who was brought in via an ambulance due to a motor vehicle accident. The patient is cold and clammy with a blood pressure of 82/46 mm Hg. The ECG monitor shows sinus tachycardia with occasional PVC. Which of the following should the therapist evaluate at this time? A. Serum electrolytes B. Cardiac enzymes C. Hb and Hct levels D. 12 lead ECG

*A. MIP -20 cmH20*

Which of the following is NOT an indication for continuous mechanical ventilation? A. MIP -20 cmH20 B. acute ventilatory failure C. VT <5 mL/kg D. VC < 10 mL/kg

*B. check the transducer dome for air bubbles.*

The respiratory therapist notices a dampened waveform on a pulmonary arterial line. The therapist's first action should be to A. attempt to draw blood from the line. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. check the position of the transducer.

*D. Methemoglobinemia*

Which of the following is a potential side effect of inhaled nitric oxide therapy? A. Systemic hypotension B. Formation of nitrous oxide C. Oxygen toxicity D. Methemoglobinemia

*C. 1, 2 & 3 only*

The respiratory therapist notices that a mask CPAP system is unable to maintain the desired level of pressure. Which of the following might be causing the level to not be maintained? 1. Sticking valve in the system 2. Loose fitting mask 3. Faulty humidifier connection 4. Leak around the airway cuff A. 2 only B. 1 & 2 only C. 1, 2 & 3 only D. 1, 2, 3 & 4

*B. Trial 2*

The following values were measured on a patient in the pulmonary function lab: ----------------Trial 1------------Trial 2------------Trial3 FVC (L)---------3.3---------------3.4---------------3.5 FEV1 (L)--------2.3----------------2.5---------------2.3 FEF25-.75% (L/sec)-1.7------------1.2----------------1.3 Which one represents the "best test"? A. Trial 1 B. Trial 2 C. Trial 3 D. The results of Trial 1 do not meet ATS standards and should be repeated

*A. Pre- and post-ductal blood gas studies*

The following data has been obtained from a 28-week gestational age infant who was born premature: Color: Cyanotic Chest x-ray: Cardiac enlargement Chest Sounds: Systolic murmur Respiratory rate: 55 Br/min. Spo2: 80% Which of the following diagnostic tests should the respiratory therapist recommend? A. Pre- and post-ductal blood gas studies B. L/S ratio C. New Ballard Score D. Capillary blood gas

*D. 75%*

The following data was collected for a patient in the intensive care unit: pH: 7.38 PaCO2: 40 torr PaO2: 90 torr HCO3: 25 mEq/L BE: +1 mEq/L SaO2: 98% FIO2: .30 Hb: 15g/dl RER: 0.8 PB: 747 torr PECO2: 10 torr What should be reported as the patient's VDVT ratio? A. 20% B. 35% C. 50% D. 75%

*A. 70 torr*

The following data was collected for a patient in the intensive care unit: pH: 7.38 PaCO2: 40 torr PaO2: 90 torr HCO3: 25 mEq/L. BE: 41 mEq/L SaO2: 98% FIO2: .30 Hb: 15g/dl RER: 0.8 PB: 747 torr PECO2: 10 torr What should be reported as the patient's P(A-a)02? A. 70 torr B. 160 torr C. 210 torr D. 350 torr

*A. 210 torr*

The following data was collected for a patient in the intensive care unit: pH: 7.39 PaCO2: 40 torr PaO2: 90 torr HCO3: 24 mEq/L BE: +1 mEq/L SaO2: 95% FIO2: 50 Hb: 15g/dl RER: 0.8 PB: 747 torr PECO2: 20 torr What should be reported as the patient's P(A-a)O2? A. 210 torr B. 350 torr C. 500 torr D. 650 torr

*C. 50%*

The following data was collected for a patient in the intensive care unit: pH: 7.39 PacO2: 40 torr PaO2: 90 torr HCO3: 24 mEq/L BE: +1 mEq/L SaO2: 95% FO2: .50 Hb: 15g/dl RER: 0.8 PB: 747 torr PECO2: 20 torr What should be reported as the patient's VD/VT ratio? A. 20% B. 35% C. 50% D. 75%

*A. 25%*

The following data was collected for a patient in the intensive care unit: pH: 7.41 PaCO2: 40 torr PaO2: 200 torr HCO3: 25 mEq/L BE: +1 mEq/L SaO2: 98% FO2 1.0 Hb: 15g/dl RER: 0.8 PB: 747 torr PECO2: 30 torr What should be reported as the patient's VD/VT ratio? A. 25% B. 40% C. 55% D. 70%

*D. nasal CPAP.*

The following pneumogram is obtained while a 47-year-old undergoes polysomnography: The respiratory therapist should recommend that the patient receive A. doxapram. B. oxygen therapy. C. non-invasive ventilation. D. nasal CPAP.

*B. 6.1 L*

The following pulmanary function measurements have been determined for a 42-year-old male patient with asthma: VC: 5.1 L. FRC: 2.4 L. ERV: 1.4 L. VT: 0.5 L. IRV: 3.2 L. What should the therapist report as the total lung capacity (TLC)? A. 5.6 L B. 6.1 L C. 7.6L D. 8.3 L

*B. Shock*

The respiratory therapist is assessing a patient's vital signs and notes that the pulse feels weak and thready. This would most likely be associated with which of the following conditions? A. Hypervolemia B. Shock C. Increased cardiac output D. Increased systemic vascular resistance

*B. low pressure*

The peak inspiratory pressure on a pressure limited, time-cycled ventilator was changed from 20 cmH20 pressure to 25 cmH20 pressure. Which of the following alarms need to be adjusted at this time? A. PEEP B. low pressure C. peak pressure D. I:E ratio

*B. begin chest compressions.*

The respiratory therapist has been paged to the ICU to assist in the treatment of a 98 kg (215 lb) man. The patient is pale, diaphoretic, and suddenly loses consciousness. No palpable pulse or blood pressure is measured. The ECG monitor displays the following: The respiratory therapist should A. confirm the ECG in another lead. B. begin chest compressions. C. perform cardioversion. D. perform defibrillation.

*C. the patient needs suctioning.*

The respiratory therapist reviews the ventilator flow sheet for a post-op patient. The ventilator settings have not been changed during the past 24 hours. The peak and plateau pressures were recorded as follows: Time-------------7:00am-------9:00am-------11:00am----- Peak Pressure-----28------------35-------------50----- ---(cm H20)--- Plateau Pressure--23------------25-------------26----- ---(cm H20)--- This information would indicate that A. airway resistance is decreasing. B. lung compliance is increasing. C. the patient needs suctioning. D. the patient can begin weaning.

*C. pulmonary compliance is decreasing.*

The respiratory therapist reviews the ventilator parameter sheet for a patient receiving mechanical ventilation. The peak and plateau pressure readings are as follows: Time-----------7:00am-8:00am-9:00am-10:00am-11:00am Peak Pressure-----33------36------42------48-------54 ---(cm H20)--- Plateau Pressure--28------32-------36------43------48 ---(cm H20)--- Based upon this information, the therapist should conclude that A. airway resistance is increasing. B. water is building up in the tubing. C. pulmonary compliance is decreasing. D. minute volume is increasing.

*A. Pleural effusion on the left*

The results of a patient's chest radiograph reveal the presence of a left basilar free fluid accumulation with a meniscus formation. Physical examination of the chest indicates a dull percussion note on the left and trachea shifted to the right. These results are consistent with which of the following conditions? A. Pleural effusion on the left B. Basilar pneumonia of the left lung C. Atelectasis of the left lung D. Pneumothorax in the left lung

*A. right side pleural effusion*

The results of a patient's chest radiograph reveal the presence of a right side consolidation with a concave- shape appearance and a mediastinal shift to the left. Physical examination of the chest reveals decreased movement, flat percussion, and absent breath sounds over the right lower chest. These results are consistent with which of the following conditions? A. right side pleural effusion B. basilar pneumonia of the right lung C. atelectasis of the right lower lobe D. right side tension pneumothorax

*B. Pulmonary Fibrosis*

The results of a patient's spirometry are reported as follows: ---------------PREDICTED------------------OBSERVED FVC (liters)------3.00----------------------------1.90 FEV1 (liters)------2.09----------------------------1.85 FEF50 (liters/sec)-4.10---------------------------3.90 FRC (liters)-------2.50----------------------------1.70 TLC (liters)-------4.70----------------------------3.00 Which of the follow is the most appropriate interpretation? A. Normal B. Pulmonary Fibrosis C. Emphysema D. Chronic Bronchitis

*D. normal pulmonary function.*

The results of spirometry performed on a patient before and after the administration of aerosolized albuterol are as follows: ---------Pre-Bronchodilator---------Post-Bronchodilator -----------% of predicted--------------% of predicted----FVC-------------80%--------------------------93% FEV1------------80%--------------------------92% FEF25-75--------78%--------------------------91% FEF 200-1200----84%-------------------------95% Peak Flow--------71%-------------------------83% Based upon these results, your interpretation would be A. mild obstructive with no reversibility. B. mild restrictive with reversibility. C. mild obstructive with reversibility. D. normal pulmonary function.

*C. pulmonary artery*

The tip of a catheter used to measure the wedge pressure should be positioned in the: A. superior vena cava B. right atrium C. pulmonary artery D. pulmonary vein

*D. Vocal cords*

When performing a bronchoscopy on an intubated patient, which of the following CANNOT be visualized? A. Trachea B. Bronchus intermedius C. Carina D. Vocal cords

*A. The F02 of the gas delivered to the bag.*

When using a flow-inflating resuscitation bag during manual ventilation of a neonate, the FO2 received by the neonate is determined by A. the FO2 of the gas delivered to the bag. B. the size of the oxygen reservoir. C. the oxygen flow rate. D. how much the bag is compressed.

*C. oxyhood with a blender to adjust the FIO2*

Which of the foliowing would be the best method to deliver oxygen therapy to a full-term newborn? A. nasal cannula at 2 LPM B. croup tent at 30-40% oxygen C. oxyhood with a blender to adjust the FIO2 D. isolette with an oxygen bleed-in with a heated nebulizer

*D. 1, 2, and 3*

Which of the following are true statements concerning an automated medication dispensing system? 1. Maintains accurate information about when medication was dispensed. 2. Allows multiple practitioners to access patient medication. 3. Assists with management of medication inventory. A. 2 only B. 1 and 3 only C. 1 and 2 only D. 1, 2, and 3

*A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube*

Which of the following describes the proper technique when using a stylet? A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube B. The distal end should be positioned at the level of the beveled end C. The distal end should be proximal to the "Murphy's Eye" D. The distal end should be positioned proximal to the cuff

*C. heat moisture exchanger*

Which of the following devices would provide adequate humidity with minimal condensation in the ventilator tubing? A. heated cascade humidifier B. heated wick humidifier C. heat moisture exchanger D. ultrasonic nebulizer

*D. Sodium nitroprusside*

Which of the following drugs should the respiratory therapist recommend to lower a patient's blood pressure as well as decrease his ventricular afterload? A. Norepinephrine B. Propranolol C. Procainamide D. Sodium nitroprusside

*A. 1 and 2 only*

Which of the following factors would increase the difficulty of performing oral endotracheal intubation? 1. Small mouth opening 2. Macroglossia 3. Atrophy of thyroid 4. Mallampati Class II A. 1 and 2 only B. 3 and 4 only C. 1 and 3 only D. 2 and 4 only

*C. (tank pressure (PSI) x 0.3 / flowrate (LPM)] / 60*

Which of the following formulas will calculate the number of hours an E cylinder will provide oxygen to a patient? A. tank pressure (PSI) x 0.3 / flowrate (LPM) B. flowrate (LPM) x 0.3/ tank pressure (PSI) C. (tank pressure (PSI) x 0.3 / flowrate (LPM)] / 60 D. (flowrate (LPM) x 0.3/ tank pressure (PSI)) / 60

*A. loss of PEEP*

patient being mechanically ventilated requires endotracheal suctioning. The patient is on high levels of PEEP therapy and has periods of hypotension. The respiratory therapist hyperoxygenates the patient before beginning the procedure. As the therapist disconnects the patient from the ventilator circuit, the following pattern is seen on the ECG monitor: Which of the following could be the cause of this patient's ECG pattern? A. loss of PEEP B. inadequate hyperoxygenation time C. vagus nerve stimulation D. normal response to suctioning