Sills 6th edition (2015) Self-Study Questions Ch 1-18

9. A 17-year-old male patient is a quadriplegic after breaking his neck in an automobile accident. He has a tracheostomy tube, atelectasis, and retained secretions. What should be recommended to treat any atelectasis and to improve his cough? 1. Quad cough 2. IS 3. IPPB 4. Assisted inspiration A. 4 only B. 2 and 3 only C. 1 and 4 only D. 1, 2, and 3 only

C. 1 and 4 only

3. An order is received to set up a HFNC on a patient. What will be needed? 1. Humidifier 2. High-pressure oxygen source 3. Sterile saline 4. Blender 5. High-pressure air source A. 2, 4, and 5 only B. 2, 3, and 4 only C. 1, 2, 4, and 5 only D. 1, 2, 3, 4, 5

C. 1, 2, 4, and 5 only

4. An adult male patient is on the PC, SIMV mode with a ventilator VT of 600 mL and a backup rate of 10 times/min. His total rate is 18/min. The physician would like to evaluate the patient's readiness to wean from the ventilator. Which of the following parameters indicate that the ventilator can be discontinued? 1. Spontaneous VT of 5 mL/kg of ideal body weight 2. VD/VT ratio of 0.4 3. Intrapulmonary shunt of 10% 4. VC of 9 mL/kg of ideal body weight 5. MIP of −15 cm H2O A. 1 and 2 only B. 3, 4, and 5 only C. 1, 2, and 3 only D. 2, 3, 4, and 5 only

C. 1, 2, and 3 only

25. Immediate complications of an oral intubation include all of the following: 1. Tooth trauma 2. Esophageal intubation 3. Tracheoesophageal fistula 4. Bronchial intubation A. 3 and 4 only B. 2 and 3 only C. 1, 2, and 4 only D. 1, 2, 3, 4

C. 1, 2, and 4 only

43. Which of the following clinical conditions could result in a decreased CLT and increasing plateau pressure? 1. Pulmonary edema 2. Pneumonia 3. Emphysema 4. ARDS A. 1 and 2 only B. 2 and 3 only C. 1, 2, and 4 only D. 1, 2, 3, 4

C. 1, 2, and 4 only

27. A 10-year-old female patient with status asthmaticus has been admitted to the hospital. The physician plans to start her on continuous nebulization of a fast-onset rescue inhaled bronchodilator medication. Which of the following should be recommended as part of her care plan? 1. Admit her to the Intensive Care Unit. 2. She should be given salmeterol (Serevent). 3. She should be given levalbuterol (Xopenex). 4. ECG and pulse oximeter monitoring should be done. 5. She should be given an intravenous corticosteroid. A. 2 and 4 only B. 2, 4, and 5 only C. 1, 3, 4, and 5 only D. 1, 2, 3, 4, 5

C. 1, 3, 4, and 5 only

19. An intubated patient receiving mechanical ventilation will be transported from Chicago to Denver by an airplane with an unpressurized cabin. A pressure-cycled transport ventilator will be used. What should be monitored during the flight? 1. Increased cuff volume 2. Decreased tidal volume 3. Hypoxemia 4. Increased tidal volume 5. Fluid retention A. 2 and 3 only B. 1 and 4 only C. 1, 3, and 4 only D. 2, 3, and 5 only

C. 1, 3, and 4 only

11. A patient has been confirmed to have SARS. Which of the following should be implemented to prevent the disease from spreading? 1. The patient's health care workers must wear an N-95 face mask. 2. The patient must wear an N-95 face mask in his or her room. 3. Airborne precautions are used. 4. The patient is placed in a positive air pressure room. 5. Contact precautions are used. A. 2 and 5 only B. 1 and 4 only C. 1, 3, and 5 only D. 1, 2, 3, 4, 5

C. 1, 3, and 5 only

14. While working the night shift, a respiratory therapist is called to intubate an apneic patient. Which of the following would be needed for an emergency oral intubation? 1. Laryngoscope handle 2. Stylet 3. Proper laryngoscope blade 4. 10-mL syringe 5. Magill forceps A. 1 and 3 only B. 2 and 4 only C. 1, 2, 3, and 4 only D. 2, 3, 4, and 5 only

C. 1,2, 3, and 4 only

12. A patient is performing a stress test. Which of the following respiratory exchange ratio values would confirm that the patient has reached the anaerobic threshold? A. 0.8 B. 0.9 C. 1.0 D. 1.1

C. 1.0

11. A respiratory therapist is about to administer an aerosolized bronchodilator to an adult patient. The patient's pretreatment pulse rate before starting is 85 beats/min. The treatment should be stopped if the patient's pulse rate reaches: A. 90 beats/min B. 100 beats/min C. 110 beats/min D. 120 beats/min

C. 110 beats/min

7. A patient is using a flow-oriented IS device. With good coaching, the patient can raise a ball with 900 cc/s of flow and can keep it elevated for 1.5 seconds. What is the patient's IC? A. 450 mL B. 900 mL C. 1350 mL D. 1800 mL

C. 1350 mL

18. An 82-kg (180-pound) male is recovering after an accidental drug overdose. Because of hypoventilation and being semicomatose, he has developed bilateral atelectasis. Calculate the ideal minimum IPPB-delivered VT goal for him. His spontaneous VT is 600 mL. A. 700 mL B. 900 mL C. 1400 mL D. 3000 mL

C. 1400 mL

29. Interpret the following arterial blood gas drawn when the patient was breathing 30% oxygen: pH, 7.44; PaCO2, 25 mm Hg; PaO2, 65 mm Hg; HCO3 −, 17 mEq/L; and BE, −7 mEq/L; SaO2, 91%. 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Compensated respiratory alkalosis 4. Uncompensated respiratory alkalosis 5. Combined metabolic and respiratory acidosis A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 5 only

C. 2 and 3 only

27. The respiratory therapist is called to evaluate a female patient known to have advanced emphysema. She is wearing a nasal cannula at 6 L/min. The nurse says that she has become drowsy and less responsive since the oxygen was given to her an hour ago. Her ABG results on the oxygen show the following: PaO2, 84 torr PaCO2, 65 torr pH, 7.32 Which of the following should be recommended? 1. Leave her on the cannula. 2. Change her to 24% O2 on an air entrainment mask and repeat the ABG in 20 minutes. 3. Change her to a simple oxygen mask and repeat the ABG in 20 minutes. 4. Let her rest undisturbed. 5. Monitor her closely for becoming more alert. A. 1 and 4 only B. 3 and 4 only C. 2 and 5 only D. 3 and 5 only

C. 2 and 5 only

17. Which of the following can be successfully used with a 6-year-old child? 1. Autogenic drainage 2. Chest physiotherapy 3. Oscillatory positive expiratory pressure 4. ACBT 5. IPV A. 1 and 3 only B. 4 and 5 only C. 2, 3, and 4 only D. 1, 2, and 5 only

C. 2, 3 and 4 only

14. A respiratory therapist is assisting a physician in a percutaneous dilation tracheostomy (PDT) procedure. What are the most common complications to watch for? 1. Bleeding at the insertion site 2. Tracheal ring fracture 3. Pneumothorax 4. Tracheoesophageal fistula A. 2 only B. 1 and 3 only C. 2, 3, and 4 only D. 1, 2, and 3 only

C. 2, 3, and 4 only

20. Which of the following are true of the PF measurement? 1. It is usually seen at the end of the patient's FVC effort. 2. It increases with height. 3. It increases with age. 4. It decreases with age. 5. It is usually seen at the beginning of the patient's FVC effort. A. 4 and 5 only B. 1, 2, and 3 only C. 2, 4, and 5 only D. 1, 2, and 4 only

C. 2, 4, and 5 only

10. Calculate a patient's inspiratory time and expiratory time when he has an I:E ratio of 2:1 and a respiratory rate of 15/min. A. 1.3 seconds for inspiration and 2.7 seconds for expiration B. 1.7 seconds for inspiration and 3.3 seconds for expiration C. 2.7 seconds for inspiration and 1.3 seconds for expiration D. 3.3 seconds for inspiration and 1.7 seconds for expiration

C. 2.7 seconds for inspiration and 1.3 seconds for expiration

15. A patient with COPD has been receiving IPPB treatments on a Bird Mark 7 for 5 days. Expiratory retard was added 4 days ago. Because the retard has not been evaluated since then, the physician asks that it be done. The respiratory therapist proceeds to make the following adjustments in the retard cap settings and makes the following observations: Retard Cap Setting Exhaled Tidal Wheezing Patient Impression 1 (smallest) 850 None Exhalation too long 2 825 Some in Bases Exhalation too long 3 800 Some in Bases Comfortable 4 700 All lobes Lungs feel full Based on this information, which retard cap setting should be recommended? A. 1 B. 2 C. 3 D. 4

C. 3

54. Over the course of an 8-hour shift, the respiratory therapist notices that a patient receiving constant volume ventilation has had an increase in peak pressure from 25 to 40 cm water. What could have caused this change? 1. Airway resistance decreased 2. CLT increased 3. Airway resistance increased 4. CLT decreased A. 3 only B. 4 only C. 3 and 4 only D. 1 and 2 only

C. 3 and 4 only

6. Safety guidelines for the protection of the respiratory therapist who is drawing an ABG sample include which of the following? 1. Put a glove only on the hand used to draw the sample. 2. Put a glove only on the hand with which you feel the pulse. 3. Put gloves on both hands. 4. Wear goggles. A. 2 only B. 3 only C. 3 and 4 only D. 1 and 4 only

C. 3 and 4 only

1. A respiratory therapist is preparing a stainless-steel-type laryngoscope handle and blade for an anesthesiologist. The light does not shine. Which of the following should be done to fix the problem? 1. Get a smaller blade to fit the handle. 2. Get a larger blade to fit the handle. 3. Tighten the light bulb. 4. Replace the handle with a plastic one. 5. Replace the batteries. A. 4 only B. 2 only C. 3 and 5 only D. 1 and 4 only

C. 3 and 5 only

4. All of the following indicate the need for IPPB EXCEPT: A. A patient who cannot coordinate the use of a metered-dose inhaler or a hand-held nebulizer B. A comatose patient with atelectasis C. A patient with an IC of 8 mL/kg D. A cooperative patient with atelectasis

C. A patient with an IC of 8 mL/kg

11. Which of the following would describe the principle of operation of a capnometer? A. The same as that of the Clark electrode B. The proportionality between carbon dioxide and hydrogen ions C. Absorption of infrared light by carbon dioxide D. The same as that of the CO oximeter

C. Absorption of infrared light by carbon dioxide

1. A 15-year-old female patient with cystic fibrosis has copious amounts of secretions. She cannot tolerate postural drainage therapy because she gets a headache when tipped head-down. Aerosolized bronchodilators and mucolytic agents are ordered every 4 hours by SVN. What else should be recommended? A. Add incentive spirometry. B. Aerosolized medications by IPPB C. Add PEP therapy. D. Modify the PDT positions so her head is not lower than her body.

C. Add PEP therapy.

38. An adult male is recovering from a flail chest injury and the physician wants to wean him from the ventilator. The patient is intubated with a 7.0-mm-ID endotracheal tube and is breathing with support of the SIMV mode. When the set rate was decreased from 8 to 6/min, the patient became tired. How can the patient's WOB be decreased? A. Increase the flow through the ventilator during SIMV breaths. B. Nebulize a bronchodilator medication. C. Add automatic tube compensation. D. Maintain the set respiratory rate at 8 .

C. Add automatic tube compensation.

23. CPR steps have been under way for 15 minutes when an ABG sample is drawn and sent off for analysis. The following results are obtained with 100% oxygen being used to ventilate the patient: pH, 6.97 PaCO2, 30 torr PaO2, 210 torr HCO−3 , 8 mEq/L What should the therapist recommend at this time? A. Decrease the oxygen percentage. B. Decrease the respiratory rate. C. Administer IV sodium bicarbonate. D. Add mechanical dead space to the manual resuscitator.

C. Administer IV sodium bicarbonate.

1. Which of the following should the respiratory therapist evaluate to determine whether a patient's chest tube is functioning properly and removing pleural air? A. Fluid is present in the collection chamber. B. The vacuum level is set at −15 cm H2O. C. Air is bubbling in the water-seal chamber. D. Air is bubbling in the suction control chamber.

C. Air is bubbling in the water-seal chamber.

13. A respiratory therapist is assisting a physician with a surgical tracheostomy procedure on a patient with an oral endotracheal tube. When should the endotracheal tube be withdrawn? A. After the tracheostomy tube has been inserted B. After the cuff of the tracheostomy tube has been inflated C. As the tip of the tracheostomy tube is placed into the stoma D. Before the stoma is made

C. As the tip of the tracheostomy tube is placed into the stoma

4. An asthma patient is discontinuing systemic corticosteroid. The patient will continue taking aerosolized bronchodilator. The physician wants to know what should be recommended for an inhaled corticosteroid (ICS). A. Naloxone (Narcan) B. Neostigmine bromide (Prostigmin) C. Beclomethasone dipropionate (QVAR) D. Methylprednisolone (Solu-Medrol)

C. Beclomerhasone dipropionate (QVAR)

7. A physician has ordered PEP therapy with albuterol (AccuNeb). All of the following are needed to start the treatment EXCEPT: A. Variable orifice resistor B. Pressure manometer C. Bedside spirometer D. Nebulizer with reservoir

C. Bedside spirometer

3. A patient with ARDS is receiving mechanical ventilation in the PC, A/C mode with a tidal volume of 400 mL, rate of 24, 60% oxygen, and 15 cm H2O PEEP. After performing a lung recruitment maneuver, the respiratory therapist determines the lower inflection point at 20 cm H2O and the upper inflection point at 35 cm H2O. Where should the PEEP level be set? A. <15 cm H2O B. 15 cm H2O C. Between 20 and 35 cm H2O D. >35 cm H2O

C. Between 20 and 35 cm H2O

13. A patient has a nasal cannula and needs to be transported on a stretcher. The E-sized O2 cylinder will have to be laid flat under the stretcher. Which flowmeter should be recommended? A. Backpressure-compensated Thorpe B. Non-backpressure-compensated Thorpe C. Bourdon D. Backpressure-compensated kinetic

C. Bourdon

62. An apneic 60-kg (132-lb) patient is being ventilated with the PC, A/C mode. The patient's ventilator settings are: Tidal volume 400 mL Rate 10/min Oxygen 60% Mechanical dead space 100 mL The patient's ABG shows: pH 7.32 PaCO2 55 torr PaO2 66 torr HCO3 − 28 mEq/L Base excess +4 Considering this information, all of the following individual ventilator adjustments would improve the patient's ABG values EXCEPT: A. Increase the respiratory rate to 14/min. B. Increase the tidal volume to 500 mL. C. Change to SIMV with a rate of 10/min. D. Remove the mechanical dead space.

C. Change to SIMV with a rate of 10/min.

24. A 16-year-old young woman is receiving mechanical ventilation via a 7-mm ET. After she is suctioned with a 14-Fr catheter, the electrocardiograph monitor shows that she is bradycardic. What should be recommended? A. Administer 10 cm H2O PEEP. B. Limit suctioning to twice a shift. C. Change to a 10-Fr catheter. D. Use a catheter with a Coudé tip.

C. Change to a 10-Fr catheter.

27. A 16-year-old patient with severe asthma has been receiving nebulized albuterol (Proventil) treatments through the ventilator over the past 12 hours. What can the respiratory therapist recommend to best evaluate the patient's response? A. Breath sounds B. Chest radiograph C. Check airway resistance changes D. Check CLT changes

C. Check airway resistance changes

16. A mouth-to-valve resuscitation device is being used on an apneic patient. The respiratory therapist delivers a breath, but the patient's chest does not rise. What should be done next? A. Begin chest compressions. B. Request a lateral neck radiograph. C. Check the valve for proper position. D. Perform abdominal thrusts.

C. Check the valve for proper position.

11. A respiratory therapist is going to assist in the ambulance transport of a 25-year-old patient. The patient has an oral endotracheal tube, and bag/mask ventilation will be performed during the trip. Which of the following should be chosen to help ensure that the endotracheal tube stays properly placed within the trachea? A. Pulse oximeter B. Capnograph C. Colorimetric CO2 detector D. Electrocardiogram

C. Colorimerric CO2 detector

25. An adult patient receiving mechanical ventilation with 80% oxygen and 10 cm H2O PEEP experiences hypoxemia, tachycardia, and hypotension every time open-airway suctioning is performed. What should the respiratory therapist recommend to the physician? A. Increase the PEEP level to 15 cm H2O before suctioning. B. Reduce the duration of suctioning but do it more often. C. Discontinue suctioning until a closed-airway suctioning system can be set up. D. Turn up the oxygen level to 100% before the patient is suctioned.

C. Discontinue suctioning until a closed-airway suctioning system can be set up.

12. The respiratory therapist has received an order to perform postural drainage, percussion, and vibration on a 23-year-old female patient. The lateral and medial segments of the right middle lobe are among those that need to be treated. How should the procedure be performed? A. Drain, percuss, and vibrate the segments. B. Drain and vibrate the segments. C. Drain but not percuss or vibrate those segments. D. Drain and use a mechanical percussor.

C. Drain but not percuss or vibrate those segments.

11. A respiratory therapist is reviewing a patient's chart and looking for indications for postural drainage. All of the following would be included EXCEPT: A. A patient with bronchiectasis and retained secretions B. A patient with cystic fibrosis who has retained secretions C. Draining of an empyema D. Removal of an aspirated foreign body

C. Draining of an empyema

23. For drainage of the superior and inferior lingula segments, the patient should be positioned: 1. With the foot of the bed elevated 14 inches 2. One-fourth turn up from the front-down position on the bed 3. One-fourth turn up from the back-down position on the bed 4. With the foot of the bed elevated 30 degrees 5. Flat on his or her back A. 1 and 3 only B. 4 and 5 only C. 1 and 2 only D. 1 and 5 only

A. 1 only 3

9. Hypovolemia in an adult patient would be indicated by a PCWP of: A. 2 mm Hg B. 8 mm Hg C. 12 mm Hg D. 24 mm Hg

A. 2 mm Hg

22. A patient is receiving mechanical ventilation with a mandatory rate of 10/min. End-tidal carbon dioxide monitoring is being done and the following data are recorded: 4:00 pm 6:00 pm Set tidal volume 700 mL 700 mL Set rate 10 10 PETCO2 33 torr 41 torr PaCO2 42 torr 43 torr How can these data be explained? A. Alveolar ventilation has decreased. B. Pulmonary edema has developed. C. The patient is hyperventilating. D. The patient's CO has increased. 23. A patient has had an arterial line inserted

A. Alveolar ventilation has decreased.

9. A patient is positioned on the left side with the foot of the bed raised 18 inches. The patient would be draining which lung segment? A. Anterior basal B. Superior C. Lateral and medial lingular D. Posterior basal

A. Anterior basal

13. A patient is being discharged and will receive an aerosolized controller-type bronchodilator therapy at home. The best medication for this chronically sick but stable patient is: A. Arformoterol (Brovana) B. Metaproterenol (Alupent) C. Levalbuterol (Xopenex) D. Albuterol (Ventolin)

A. Arformoterol (Brovana)

41. The PCIRV mode is indicated in which of the following conditions? A. Asthma B. Chronic bronchitis C. Pulmonary contusion D. ARDS

A. Asthma

8. To help in the diagnosis of a patient with a questionable history of wheezing and possible asthma, which of the following would be the best test? A. Bronchoprovocation study B. Flow-volume loop C. Before-and-after bronchodilator study D. Airway resistance (Raw)

A. Bronchoprovocation study

22. An anxious 10-year-old asthma patient is being given a breathing treatment with levalbuterol (Xopenex). The patient's initial heart rate of 110 breaths/min has now increased to 120 breaths/min. What should be done? A. Continue the treatment as ordered. B. Stop the treatment and inform the physician. C. Change to albuterol and continue the treatment. D. Cut the medication dose in half and continue.

A. Continue the treatment as ordered.

7. A respiratory therapist is giving an IPPB treatment with a Bird Mark 7 unit. To give the patient 100% O2, the air-mix control knob is pushed in. What effect does this adjustment have on the flow rate to the patient? A. Decreases the flow of gas B. Increases the flow of gas C. No effect D. Increases the sensitivity

A. Decreases the flow of gas

22. A paramedic and a respiratory therapist are performing CPR procedures on an adult patient. Upon looking at the ECG monitor, the following rhythm strip is seen. What should be recommended in this situation? A. Defibrillate the patient. B. Increase the oxygen flow to the manual resuscitation bag and mask. C. Change ventilation and chest compression duties. D. Intubate the patient.

A. Defibrillate the patient

36. A patient with bilateral pneumonia is receiving mechanical ventilation with the following settings: Mode PC, SIMV Set tidal volume 650 mL Set rate 14 FIO2 0.50 I:E ratio 1:2 PEEP 10 cm H2O The nurse is concerned that the patient's SpO2 value drops from 94% to 85% when suctioned. How can this be prevented? A. Give 100% oxygen before suctioning. B. Perform suction only once an hour. C. Use the largest suction catheter available. D. Increase the PEEP level to 15 cm H2O before suctioning

A. Give 100% oxygen before suctioning.

9. A home care company has found that several of its tracheostomy patients have E. coli tracheal infections. What is the most likely cause of the infections? A. Poor hand-washing technique by visiting respiratory therapists B. Contaminated tracheostomy tubes from the manufacturer C. Contaminated bottles of sterile water from the manufacturer D. Poor hand-washing technique by patients' family members

A. Poor hand-washing technique by visiting respiratory therapists

22. A 17-year-old patient with an oral ET has just had open-airway suctioning performed. The respiratory therapist notes that bright red blood is removed, along with some clear secretions. What should be done? A. Stop the suctioning procedure and monitor the patient. B. Change to a closed-airway suctioning system. C. Instill 5 mL of normal saline and suction again to remove the saline and blood. D. Change to a nasal ET and suction normally.

A. Stop the suctioning procedure and monitor the patient.

16. The normal range for the P(a-et)CO2 gradient is: A. <1 torr B. 1-5 torr C. More than 15 torr D. About 40 torr

B. 1-5 torr

15. What is the duration of flow of an E cylinder with 1700 psig that is running at 5 L/min? A. 0.9 hour B. 1.6 hours C. 7.7 hours D. 13.7 hours

B. 1.6 hours

30. A 15-year-old patient with cystic fibrosis has large amounts of thick secretions. There is no sign of infection. What should be administered to help manage the secretion problem? A. Salmeterol (Serevent) B. 5% saline C. Normal (0.9%) saline D. Acetylcysteine (Mucomyst)

B. 5% saline

33. An unconscious adult patient has been received in the Emergency Department after suffering a stroke. The only ventilator available is an older volume-cycled unit. The physician asks the respiratory therapist for a recommendation on the initial set ventilator tidal volume to use with the patient, who weighs 73 kg (160 lb). What should be recommended? A. 1000 mL B. 700 mL C. 500 mL D. 320 mL

B. 700 mL

35. A 16-year-old patient with status asthmaticus is started on a 70% helium/30% oxygen (heliox) mix through a nonrebreather mask. It is noticed that the oxygen flowmeter shows the delivery of 8 L/min of gas. What is the actual heliox gas flow? A. 5 L/min B. 8 L/min C. 12.8 (13) L/min D. 14.4 (14) L/min

B. 8 L/min

32. A premature neonate is being mechanically ventilated in the neonatal Intensive Care Unit. The neonatologist believes that the patient has pulmonary hypertension. What should be recommended? A. Instill lucinactant (Surfaxin) into the lungs. B. Administer INOmax. C. Give aerosolized umeclidinium and vilanterol (Anoro). D. Give aerosolized aclidinium (Tudorza).

B. Administer INO max.

66. The measurements below are obtained on a patient while the patient is being mechanically ventilated: 6:00 pm 8:00 pm Total respiratory rate 14 14 PEEP, cm water 8 8 P plateau, cm water 15 15 P peak, cm water 30 45 Compliance, mL/cm water 40 40 In this situation, the most appropriate action would be to: A. Increase therapeutic PEEP. B. Administer a bronchodilating agent. C. Administer a diuretic agent. D. Administer a paralyzing agent.

B. Administer a bronchodilating agent.

26. After spirometry is performed, it is important that patient flow rates be reported at A. ATPS B. BTPS C. STPD D. ATPD

B. BTPS

12. All of the following should be monitored after a patient returns from having a tracheostomy tube placed EXCEPT: A. Cuff pressure B. Bowel sounds C. Breath sounds D. Excessive bleeding

B. Bowel sound

29. A respiratory therapist is about to assist in the bronchoscopy of a patient with COPD and suspected lung cancer. The patient is quite nervous before the procedure and conscious sedation will be done. All of the following drugs could be used to help in managing her sedation EXCEPT: A. Diazepam (Valium) B. Fluticasone (Flovent) C. Flumazenil (Romazicon) D. Midazolam (Versed)

B. Fluticasone (Flovent)

16. A patient with a tracheostomy has just returned from a series of radiography procedures. Suddenly, the patient develops respiratory distress and cannot breathe. A suction catheter cannot be passed through the tracheostomy tube. What should be done? A. Attempt to pass a smaller suction catheter. B. Remove the tracheostomy tube. C. Ventilate with a manual resuscitation bag. D. Insert an endotracheal tube.

B. Remove the tracheostomy tube.

10. How much active ingredient would be found in 0.6 mL of 2.25% racemic epinephrine (Micronefrin)? A. 0.0267 mg B. 13.5 mg C. 26,700 mg D. 13.5 g

B, 13.5 mg

13. A 47-year-old man who recently returned from a business trip to Hong Kong has a high fever and other signs and symptoms of pneumonia. SARS-CoV is among the conditions being investigated. While the patient is being evaluated, what preventative measures should be taken? 1. Standard precautions 2. Contact precautions 3. Droplet precautions 4. Airborne precautions A. 1 and 4 only B. 1 and 3 only C. 2 and 4 only D. 1, 2, 3, 4

B. 1 and 3 only

3. A patient with chronic bronchitis is being monitored with regular measurements of arterial blood gas values and capnometry. The following data are available: PaCO2 53 torr PaO2 67 torr PETCO2 33 torr PECO2 20 torr Calculate the patient's VD/VT. A. 0.30 B. 0.38 C. 0.62 D. 0.71

C. 0.62

28. After undergoing a thoracentesis in which 1400 mL of straw-colored yellow fluid was removed, the patient complains of shortness of breath and has increased heart and respiratory rates. What should the assisting respiratory therapist recommend to further evaluate the patient's reaction to the procedure? 1. Measure the pulse oximeter value. 2. Obtain a chest radiograph. 3. Send the fluid to the laboratory for analysis. 4. Remove additional fluid. A. 1 only B. 3 only C. 1 and 2 only D. 3 and 4 only

C. 1 and 2 only

11. Interpret the following arterial blood gas drawn from a patient who is breathing 21% O2: pH, 7.57; PaCO2, 20 torr; PaO2, 117 torr; bicarbonate, 24 mEq/L; and base excess, +1 mEq/L; SaO2, 98%. 1. Normal oxygenation 2. Excessively corrected hypoxemia 3. Uncompensated respiratory alkalosis 4. Uncompensated metabolic acidosis 5. Compensated respiratory and metabolic alkalosis A. 2 and 3 only B. 2 and 4 only C. 1 and 3 only D. 1 and 4 only

C. 1 and 3 only

50. A patient with pulmonary edema is receiving VC, A/C with the following clinical data: Set tidal volume is 700 mL. Corrected tidal volume is 600 mL. Peak pressure is 65 cm water. Plateau pressure is 48 cm water. There is 12 cm water of PEEP. Calculate the patient's static compliance. A. 13 mL/cm water B. 15 mL/cm water C. 17 mL/cm water D. 19 mL/cm water

C. 17 mL/cm water

70. A 17-year-old female has been admitted with status asthmaticus and placed on a microprocessor ventilator. The physician wants to know if she has any auto- PEEP. Which ventilator waveform would be best for determining this? A. Maximum Voluntary Ventilation tracing B. Flow/volume loop C. Flow/time tracing D. Pressure/time tracing

C. Flow/time tracing

67. When working with a patient who recently had a bowel resection and is receiving a paralyzing medication to prevent fighting against the ventilator, it is important to: A. Give the patient caffeine as a central nervous system stimulant. B. Give the patient a sedative medication for pain. C. Give the patient a medication for pain. D. Talk quietly because the patient is probably sleeping.

C. Give the patient a medication for pain.

19. An adult patient is in the Intensive Care Unit and is being monitored with a PAC. The patient has the following parameters: PAP of 35/20 mm Hg, PCWP of 9 mm Hg, CVP of 9 cm of water. The data show that the patient: A. Has right-ventricular failure/cor pulmonale B. Has left-ventricular failure C. Has increased PVR D. Is hypovolemic

C. Has increased PVR

33. During a CPR attempt, a pediatric patient had an oral endotracheal tube placed. To ensure that the endotracheal tube is placed properly, all of the following should be recommended EXCEPT A. Listen to the right upper lobe for breath sounds. B. Listen for bilateral lung sounds. C. Have a lateral neck radiograph taken. D. Have a chest radiograph taken

C. Have a lateral neck radiograph taken.C. Have a lateral neck radiograph taken.

16. A USN has a flashing couplant indicator light. The respiratory therapist notices that the output has decreased from what it was earlier. The most likely problem is: A. Too much water in the solution cup B. Too much water in the couplant chamber C. Not enough water in the couplant chamber D. A loose electrical cable

C. Not enough water in the couplant chamber

5. The risks of O2 therapy include all of the following EXCEPT: A. Pulmonary O2 toxicity B. Denitrogen absorption atelectasis C. O2-induced hyperventilation D. Retinopathy of prematurity

C. O2-induced hyperventilation

17. All of the following parameters indicate the need for intubation and mechanical ventilation EXCEPT: A. VC of less than 10 mL/kg of ideal body weight B. MIP of less than −15 cm H2O C. P(A-a)O2 on 100% O2 of 40 torr D. VD/VT of 0.7

C. P(A-a)O2 on 100% O2 of 40 torr

18. A patient with COPD is being given a new inhaled adrenergic bronchodilator medication by SVN. Within 3 minutes, the patient complains of palpitations. The patient's pulse rate was 85 beats/min before the treatment and is now 125 beats/min. What should be done? A. Change to a different medication. B. Discontinue the order. C. Stop the treatment. D. Add more saline to dilute the medication.

C. Stop the treatment

28. An alcoholic patient has been admitted with a high fever and a productive cough. A pulmonary abscess is suspected. What sputum characteristics should be evaluated to help assess the effectiveness of aerosol and other therapy? 1. Specific gravity 2. Smell 3. Consistency 4. Platelet count 5. Color A. 2 and 3 only B. 4 and 5 only C. 1, 2, and 3 only D. 2, 3, and 5 only

D. 2, 3, and 5 only

3. A patient with pulmonary edema has cyanotic lips and nail beds. What O2 percentage should be recommended for IPPB treatment? A. 21% B. 40% C. 80% D. 100%

D. 100%

19. A respiratory therapist has finished giving an 8-year-old female patient with asthma an IPPB treatment with 0.5 mL of albuterol (Proventil). It is noticed that the patient's heart rate has increased 15% from before the treatment. Her breath sounds are now clear. What should be recommended to the physician for the patient's next treatment? A. Give her 0.5 mL of metaproterenol (Alupent). B. Discontinue her treatments altogether. C. Add more normal saline to the Proventil. D. Decrease the Proventil to 0.3 mL.

D. Decrease the Proventil to 0.3 mL.

4. A respiratory therapist is making general rounds in the hospital and finds a patient whose reservoir tubing has fallen off his 40% T-piece. This would result in which of the following? A. Increased inspired O2 B. Increased inspired CO2 C. Decreased inspired CO2 D. Decreased inspired O2

D. Decreased inspired O2

20. A 56-year-old patient has been in the Trendelenburg position for 10 minutes receiving percussion and vibration. Tachycardia and dyspnea develop. Which of the following actions should be completed by the respiratory therapist? A. Continue for 5 minutes with gentle percussion. B. Turn the patient to the other side. C. Give the patient oxygen. D. Have the patient sit up.

D. Have the patient sit up.

31. A home care patient with asthma has finished a standard dose of 0.25 mL of albuterol (Ventolin). After waiting 15 minutes, the patient performs a peak flow measurement, which shows 65% of personal best. What should be done to improve the patient's condition? A. Decrease the dose of albuterol. B. Add an intravenous corticosteroid. C. Maintain the present therapy. D. Increase the dose of albuterol.

D. Increase the dose of albuterol

4. When a patient's chart is reviewed, it is important to look for contraindications to CPT. These would include all of the following EXCEPT: A. Increased intracranial pressure B. Recent stroke C. Small VC in a bedridden patient D. The patient has just eaten

C. Small VC in a bedridden patient

33. A patient with a history of COPD has been admitted. To help clarify the patient's diagnosis as emphysema or asthma, which of the following should the respiratory therapist recommend? A. Flow-volume loop B. Maximum voluntary ventilation C. Spirometry before and after an inhaled beta agonist D. Peak flow test

C. Spirometry before and after an inhaled beta agonist

3. A respiratory therapist has just assisted with the endotracheal intubation of a normotensive adult patient. To minimize the risk of soft-tissue injury to the trachea, the tube cuff pressure should be: A. Less than 20 cm H2O B. Less than 25 cm H2O C. Less than 30 cm H2O D. Less than 35 cm H2O

C. Less than 30 cm H2O

32. A 27-year-old patient with an unstable T-1 spinal cord injury has been admitted for treatment of bronchitis. A bedside assessment is performed and it is found that the patient cannot cough out the secretions. Bedside spirometry reveals the patient has a peak flow of 200 L/min (3.3 L/s). What treatment should be recommended? A. HFCWO B. Chest physiotherapy C. Mechanical insufflation-exsufflation D. Positive expiratory pressure

C. Mechanical insufflation-exsufflation

6. A physician calls a respiratory therapist to evaluate a 40-year-old patient with bronchitis and to make a recommendation for an aerosol delivery system. The patient's breath sounds indicate the presence of large-airway secretions. Despite a good cough effort, the patient has difficulty in raising them. What should be recommended? A. Use a hand-held nebulizer with 3 cc of normal saline every 4 hr. B. Place the patient into a mist tent. C. Start a continuous USN to an aerosol mask. D. Start a cascade-type humidifier to an aerosol mask.

C. Start a continuous USN to an aerosol mask.

25. A 14-year-old patient with severe asthma has just been given a new medication of inhaled corticosteroid by a DPI. After rapidly inhaling the medication, the patient begins to cough vigorously. Breath sounds reveal increased wheezing in all lung fields. What should be recommended? A. Have the patient inhale rapidly through the DPI to make sure all of the medication has been received. B. Have the patient inhale slowly through the DPI to make sure all of the medication has been received. C. Stop taking the DPI medication. D. Increase the dose of DPI medication until the patient's wheezing goes away.

C. Stop taking the DPI medication.

10. A respiratory therapist is giving an IPPB treatment when the patient complains of a sharp chest pain. After a few more deep breaths, the patient is short of breath. The therapist notices that the patient's breath sounds are now diminished on the left side. What should be done? A. Continue the treatment for the next 5 minutes to finish the ordered time. B. Decrease the peak pressure and complete the ordered treatment. C. Stop the treatment and notify the physician of the patient's complaints. D. Monitor the patient closely for the duration of the treatment.

C. Stop the treatment and notify the physician of the patient's complaints.

28. The respiratory therapist is working with a patient who begins to expectorate blood after being positioned for drainage of the superior segment of the left lower lobe. Percussion was provided with a mechanical device. After the patient has expectorated 50 mL of blood, what should be recommended as the best action? A. Continue the treatment because the patient has not lost a great deal of blood. B. Continue the treatment on only the upper and middle lobes. C. Stop the treatment, sit the patient up, and call the physician. D. Continue the treatment with manual percussion only

C. Stop the treatment, sit the patient up, and call the physician.

9. A 10-year-old cystic fibrosis patient has a pulmonary infection and thick secretions. What should be recommended to help the patient cough out the secretions? A. Nebulized 0.9% (normal) saline solution B. Instillation of acetylcysteine (Mucomyst) into the patient's lungs C. Nebulized dornase alfa (Pulmozyme) D. Nebulized acetylcysteine (Mucomyst

C. Nebulized dornase alfa (Pulmozyme)

21. An uncooperative 13-year-old patient with status asthmaticus is being treated in the Emergency Department. The physician has ordered the patient to receive a 70% helium/30% oxygen mix and continuous nebulized albuterol. What should be recommended as the best way to deliver this? A. Partial-rebreathing mask with reservoir bag B. HFNC C. Nonrebreathing mask with reservoir bag D. Through a mechanical ventilator

C. Nonrebreathing mask with reservoir bag

1. Ten minutes into a hand-held nebulizer treatment given to deliver albuterol (Proventil), the patient complains of dizziness and tingling fingers. What should be done? A. Advise the patient to breathe in the same pattern. B. Change the medication. C. Tell the patient to breathe more slowly. D. Advise the patient to breathe deeper and faster

C. Tell the patient to breathe more slowly.

65. Five adult patients are being weaned from mechanical ventilation. After a 30-minute spontaneous breathing trial, their bedside spirometry values are shown below. F Vt Vt FEV MIP (L) (mL) (mL/kg) -35 Patient 1 7 2.45 350 5 -35 Patient 2 12 5.44 501 10 -30 Patient 3 15 8.25 550 15 -20 Patient 4 37 11.1 300 13 -15 Patient 5 40 17.0 425 7 -15 Which of the patients are ready for extubation? A. Patients 1 and 2 B. Patients 1 and 4 C. Patients 2 and 3 D. Patients 3 and 5

C. Patients 2 and 3

15. A patient with obstructive airways disease should be taught all of the following cough techniques EXCEPT: A. Sit up and lean forward slightly. B. Breathe in a volume larger than the VT but less than the VC. C. Perform a normal cough. D. Perform a midinspiratory cough.

C. Perform a normal cough.

16. A 60-year-old patient with a smoking history and recurrent bouts of left lung pneumonia has a persistent chest radiograph shadow in the left lower lobe area. Despite 2 days of postural drainage with percussion and incentive spirometry, the haziness has not cleared. What should be recommended next? A. Nebulize a bronchodilator medication. B. Perform rigid-tube bronchoscopy. C. Perform flexible fiberoptic bronchoscopy. D. Nebulize hypertonic saline to induce a cough.

C. Perform flexible fiberoptic bronchoscopy.

57. In a patient with ARDS, the indication to switch from volume-cycled ventilation to pressure-cycled ventilation is: A. Peak pressure of 30 cm water or greater B. CLT less than 30 mL/cm water C. Plateau pressure of 30 cm water or greater D. Peak pressure and plateau pressure total >30 cm water

C. Plateau pressure of 30 cm water or greater

6. A 65-year-old patient has been successfully resuscitated in the Emergency Department after suffering an MI. The patient is still unstable with frequent PVCs and needs to be transported to the cardiac care unit for management. Which of the following would be most important for monitoring the patient during the transportation? A. Pulse oximeter B. Portable capnography unit C. Portable ECG machine with defibrillator D. 12-lead ECG unit to record any arrhythmias

C. Portable ECG machine with defibrillator

36. A socially active female patient with COPD requires 2 L/min of continuous oxygen. She wishes to go with her Better Breathers Club on a bus trip to shop in Chicago. What should be recommended for her in this situation? A. Use a portable LOX system at 2 L/min. B. Take a portable E tank of oxygen with her and run it at 2 L/min. C. Pre-position E tanks of oxygen for her use in the various stores. D. Take a portable E tank of oxygen with her and run it at 1 L/min.

C. Pre-position E tanks of oxygen for her use in the various stores.

17. Tactile fremitus would be reduced in all of the following conditions EXCEPT: A. Pneumothorax B. COPD C. Pulmonary edema D. Pleural effusion

C. Pulmonary edema

26. Defibrillation should be done immediately in which of the following patient situations? A. Second-degree heart block B. Atrial flutter C. Pulseless VT D. Sinus tachycardia

C. Pulseless VT

22. Which of the following will have the greatest impact on increasing the mean airway pressure? A. Increasing the inspiratory flow B. Adding 5 cm H2O PEEP C. Removing 0.5 second of inflation hold D. Increasing the expiratory time by 0.25 second

C. Removing 0.5 second of inflation hold

29. A 55-year-old, 77-kg (170-lb) ventilator-dependent male patient has returned from the operating room with a 6.0-mm-ID tracheostomy tube. The respiratory therapist determines the cuff pressure to be 35 mm Hg. The ventilator is delivering a tidal volume of 750 mL and returning a tidal volume of 650 mL, and a leak can be heard at the tracheostomy site. What should be done? A. Increase the tidal volume by 100 mL to restore the delivered tidal volume. B. Increase the cuff pressure to stop the tidal volume leak. C. Replace the tracheostomy tube with one that is 8.5-mm ID. D. Deflate the cuff enough to reduce the cuff pressure to 20 mm Hg.

C. Replace the tracheostomy tube with one that is 8.5-mm ID.

9. A 6-year-old patient has aspirated a tooth that was dislodged during a sporting event. The chest radiograph film shows the tooth to be lodged in the right mainstem bronchus; the neck radiograph film is normal. What should be recommended as the best way to quickly remove the tooth? A. Flexible fiberoptic bronchoscopy (FFB) B. Positive expiratory pressure breathing (PEP) C. Rigid-tube bronchoscopy D. Postural drainage therapy (PDT)

C. Rigid-tube bronchoscopy

5. The physician asks the respiratory therapist about which weaning method would be most successful in the patient with the weaning parameters listed in Question 4. The patient's spontaneous VT is 400 mL. Which of the following methods should be recommended? A. T-piece and extubation in 30 minutes B. Intermittent ventilator discontinuance C. SIMV weaning D. PCV

C. SIMV weaning

61. An adult female patient has the desire to breathe spontaneously and has a tidal volume that is 4 mL/kg of ideal body weight. Because of facial trauma from an automobile accident, she has a 6.5-mm-ID endotracheal tube. She also had lung contusions in the crash. Her PaO2 is 63 torr on 55% oxygen. What ventilator mode(s) should be recommended for her? A. A/C with flow sensitivity for triggering the ventilator B. Low-level Pressure Support Ventilation with PEEP C. SIMV with low-level Pressure Support and PEEP D. SIMV with high-level Pressure Support Ventilation (PSVmax)

C. SIMV with low-level Pressure Support and PEEP

1. If a patient complains of difficulty in starting the IPPB treatment, which control should be adjusted? A. Pressure B. Flow C. Sensitivity D. Terminal flow

C. Sensitivity

2. A patient is having difficulty keeping a tight seal around the mouthpiece. The patient complains that the breath is too long and takes out the mouthpiece. To help cycle off the PR-2, what should be adjusted? A. Pressure B. Flow C. Terminal flow D. Expiratory retard

C. Terminal flow

16. The respiratory therapist is called to draw an arterial blood sample from a patient who is wearing a 35% air entrainment mask. Upon entering the room, the therapist notices that the patient's covers are drawn up over the air entrainment ports of the mask. How would this affect the function of the mask? A. The total flow will be increased. B. There will be no effect. C. The O2 percentage will be increased. D. The O2 percentage will be decreased

C. The O2 percentage will be increased

9. It is noticed during a diagnostic ECG that the QRS complex is inverted on lead II. What would most likely cause this? A. An electrode is loose. B. The patient is shivering. C. The arm electrodes are reversed. D. The unit is out of calibration.

C. The arm electrodes are reversed.

27. A patient is performing a residual volume test on a water-seal spirometer in the pulmonary function laboratory. After breathing on the system for 1 minute, the patient takes out the mouthpiece and complains of being short of breath. What is the most likely problem in the pulmonary function system? A. The carbon dioxide absorber was accidentally left in the circuit. B. There is too much water around the spirometer bell. C. The carbon dioxide absorber has been left out of the circuit. D. Nose clips were left off of the patient.

C. The carbon dioxide absorber has been left out of the circuit.

24. A nitrogen washout test for residual volume has been performed on a patient for 7 minutes and has not reached the desired nitrogen percentage. What could explain this situation? A. There is an oxygen leak into the system. B. The patient has an abnormally high respiratory exchange ratio. C. The patient has severe air trapping. D. Nitrogen has been absorbed into the patient's tissues.

C. The patient has severe air trapping.

25. A 3-day postoperative open-heart surgery patient has an arterial catheter in the right radial artery for continuous BP measurements. Because of retained secretions, the respiratory therapist places the patient into a head-down position for postural drainage therapy. The nurse notices that the patient's BP is less than before being placed into this new position. After the patient is returned to the original position, the BP is the same as it was originally. How can the therapist explain the BP changes? A. There was an air bubble in the arterial catheter. B. There was a clot in the arterial catheter. C. The patient's body was below the level of the pressure transducer. D. Postural drainage positions always cause the BP to decrease.

C. The patient's body was below the level of the pressure transducer.

37. As the PFT lab respiratory therapist, you have received an order to perform exhaled nitric oxide (eNO) analysis, spirometry testing, and residual volume testing on a 10-year-old girl with a history of wheezing and chronic cough. First, you perform the eNO analysis and find the girl's eNO value to be 35 ppb. How should this information be interpreted? A. The value is within normal limits, and the other testing should continue. B. The analyzer must be recalibrated to room air and the test repeated. C. The patient's value is increased from normal. D. The patient's other tests need to be performed first and the eNO test repeated.

C. The patient's value is increased from normal.

15. A patient's breathing is being supported by a ventilator that has a circuit with an external exhalation valve. The nurse calls the respiratory therapist to evaluate the patient because the alarm is going off. Upon arrival, the therapist notices that the patient's chest is barely moving during a control breath, the peak pressure does not rise above 3 cm H2O, and the exhaled VT spirometer shows the set VT when the control breath is delivered. The most likely cause of these findings is: A. The machine is self-cycling. B. The inspiratory and expiratory limbs of the circuit are reversed. C. The tubing to the exhalation valve is disconnected. D. The spirometer is out of calibration.

C. The tubing to the exhalation valve is disconnected.

11. The physician has heard a heart murmur on a 24-yearold patient. A mitral valve regurgitation is suspected. What procedure should be performed to determine if that is the case? A. Right-heart catheterization B. Posteroanterior chest radiograph C. Echocardiogram D. Stress test

C. Echocardiogram

9. A patient has just been tested for CL in a body plethysmograph. The patient's compliance was determined to be 0.2 L (200 mL)/cm H2O. Based on this, the patient most likely has: A. Asthma B. Pulmonary fibrosis C. Emphysema D. Normal lungs

C. Emphysema

17. A respiratory therapist notices that water has collected at the low point of the large-bore tubing of your patient's heated aerosol system. The aerosol is "puffing" out of the end of the tubing. What should be done? A. Add water to the reservoir jar. B. Empty water from the reservoir jar. C. Empty the water from the large-bore tubing into a wastewater jar. D. Empty the water from the large-bore tubing into the reservoir jar so it is not wasted.

C. Empty the water form the large bore tubing into a wastewater

23. A 40-year-old female patient has been sick with the flu for 8 days and was admitted to the hospital with dehydration and pneumonia. Intravenous fluids and antibiotics were started. She was given an aerosol mask with 35% oxygen and continuous aerosol of normal saline nebulized through a USN system. An hour later, she reported worsening shortness of breath. Her breath sounds revealed crackles that were not there before this therapy was started. What is the most likely cause of these changes? A. The dehydration is worse. B. Her influenza is worse. C. Her secretions have swollen. D. She is allergic to the normal saline

C. Her ,secretions have swollen.

30. A patient with emphysema is receiving mechanical ventilation with the following settings: Mode VC, A/C Set tidal volume 600 mL Set rate 12 Total rate 12 FIO2 0.30 I:E ratio 1:2 During a ventilator check, you measure the patient's exhaled tidal volume at 500 mL. What can be done to help the patient exhale more completely? A. Change to the Pressure Control mode. B. Change to a larger endotracheal tube. C. Increase the expiratory time. D. Decrease inspiratory flow.

C. Increase the expiratory time.

30. The respiratory therapist is working with a patient who has a tracheal tumor. The patient is wearing a nonrebreathing mask with 70% helium and 30% oxygen mix. Pulse oximeter saturation is 96%. The patient says that it is getting harder to breathe and it is noticed that the reservoir bag has collapsed. The most appropriate action is to A. Decrease the flow of gas. B. Switch to a 28% air entrainment mask. C. Increase the flow of gas. D. Switch to a 60% helium and 40% oxygen mix.

C. Increase the flow of gas.

16. A 13-year-old patient with cystic fibrosis is receiving IPPB to deliver an aerosolized bronchodilator and mucolytic. The respiratory therapist notices that the pressure gauge needle is bouncing higher and lower as the patient takes a breath. What should be done? A. Increase the target pressure. B. Increase the sensitivity setting. C. Increase the flow. D. Tell the patient to inhale more quickly

C. Increase the flow.

19. A respiratory therapist is working with a patient with obstructive sleep apnea who is receiving bilevel NPPV through a nasal mask. During a sleep period, it is noticed that he is snoring. Which of the following ventilator adjustments should be made? A. Increase the respiratory rate. B. Increase the upper pressure level. C. Increase the lower pressure level. D. Loosen the nasal mask.

C. Increase the lower pressure level.

4. It is difficult to remove the tracheal secretions from an adult patient using −60 mm Hg of vacuum pressure.What should be done? A. Suction for 20 seconds. B. Suction more frequently. C. Increase the vacuum pressure to −80 mm Hg. D. Change from the central vacuum system to a portable one.

C. Increase the vacuum pressure to −80 mm Hg.

58. A 70-kg (154-lb) patient with a stroke and increased ICP is being mechanically ventilated in the A/C mode with the following settings: Minute ventilation 6.0 L I:E ratio 1:2 FIO2 0.35 Rate 12 The patient's ABG results are as follows: pH 7.39 PaCO2 43 torr PaO2 107 torr BE 0 SaO2 100% On the basis of this information, it would be most appropriate to recommend: A. Decreasing the FIO2 B. Decreasing the minute ventilation C. Increasing the respiratory rate D. Increasing the expiratory time

C. Increasing the respiratory rate

32. A patient who suffered facial burns and smoke inhalation has recovered enough to be extubated. Although the patient is receiving 40% oxygen with a bland aerosol, significant inspiratory stridor is noticed within 15 minutes. Following the inhalation of a vasoconstricting medication, the patient's breath sounds are improved. Thirty minutes later the patient's SpO2 level is 80% and the inspiratory stridor is more serious. The patient is very anxious and is pulling off the oxygen mask. What should the respiratory therapist recommend to best manage the patient's problem? A Draw an arterial blood gas sample for measurement. B. Increase the patient's oxygen to 50%. C. Intubate the patient. D. Administer a sedative medication.

C. Intubate the patient.

8. A USN would be recommended for aerosol therapy for the following reason: A. It delivers a wide variety of aerosol droplets. B. Its aerosol droplets are between 10 and 20 μm in diameter. C. It delivers a uniform aerosol droplet of about 3 μm in diameter. D. It can be used to nebulize bland aerosols and liquid medications into an aerosol.

C. It delivers a uniform aerosol droplet of about 3 pm in diameter.

2. When evaluating a patient's SV, which of the following is true? A. It is an indicator of the adequacy of perfusion of the body tissues. B. It is the output of blood for 1 minute. C. It has a range of 50-120 mL in the adult. D. It is the resistance to flow.

C. It has a range of 50-120 mL in the adult.

25. What would be expected of a patient's ventilation efforts during light exercise that progresses to moderate exercise? A. It decreases as V˙O2 increases. B. It decreases as carbon dioxide production increases. C. It increases as workload levels increase. D. It remains constant in normal subjects as workload levels increase.

C. It increases as workload levels increase.

35. A 3-day-old newborn is brought into the Emergency Department with the father after they were involved in an automobile accident. The newborn is showing signs of respiratory distress with cyanosis and tachycardia. What test would you recommend to determine whether the newborn has a pneumothorax? A. Arterial blood gases B. Apgar score C. Transillumination D. Thoracentesis

C. Transillumination

9. A patient has an endotracheal tube. Which of the following devices would be the least effective in reducing this patient's humidity deficit? A. Wick-type humidifier set at 35° C B. Membrane-type humidifier set at 35° C C. Unheated bubble-type humidifier D. Ultrasonic nebulizer

C. Unheated bubble-type humidifier

5. Counting from the left, the first and sixth rhythms on the ECG strip shown here represent A. Atrial flutter B. Second-degree heart block C. Unifocal PVCs D. Multifocal PVCs

C. Unifocal PVCs

12. A patient with advanced COPD is anxious and is feeling short of breath after returning from a medical procedure. What should the respiratory therapist recommend? A. Turn up the oxygen flow rate to the patient's nasal cannula. B. Inhale through the PFLEX inspiratory muscle trainer. C. Use pursed-lip breathing. D. Exhale through the Flutter valve unit.

C. Use pursed-lip breathing.

22. A 30-year-old patient with asthma has frequent business trips by airplane. What type of nebulizer should be recommended for her liquid medications? A. Breath-enhanced nebulizer B. Standard nebulizer C. Vibrating-mesh nebulizer D. Breath-activated nebulizer

C. Vibrating-mesh nebulizer

19. An adult patient with epilepsy has been having unpredictable seizure activity. What oral endotracheal tube should be suggested to provide a secure airway? A. Double lumen B. Preformed C. Wire reinforced D. Guidable

C. Wire reinforced

26. A 47-year-old woman with chronic obstructive pulmonary disease and pneumonia has copious amounts of thick secretions. Nasotracheal suctioning is being initiated because of her weak, ineffective cough. What is the maximum suctioning pressure that may be used? A. −100 mm Hg B. −125 mm Hg C. −150 mm Hg D. −175 mm Hg

C. −150 mm Hg

38. Before performing a lung diffusion test on a patient, which of the following should be measured? A. Exhaled carbon monoxide B. Exhaled carbon dioxide C. Exhaled nitric oxide D. Exhaled oxygen

A. Exhaled carbon monoxide

4. A 50-year-old male patient with throat cancer will be having a laryngectomy tomorrow with the placement of a voice prosthesis. What type of airway would best serve the patient's long-term needs? A. Fenestrated laryngectomy tube B. Single-cannula tracheostomy tube C. Fenestrated tracheostomy tube D. Tracheostomy button

A. Fenestrated laryngectomy tube

14. Atelectasis has been diagnosed by chest radiograph in an unconscious patient who had recent open heart surgery. Before surgery, the patient's best FVC value was 55% of the predicted. What should be recommended to treat the patient's atelectasis problem? A. IPPB B. IS C. Nasotracheal suctioning D. Flutter

A. IPPB

21. A 12-year-old patient with cystic fibrosis had PEP therapy started at 5 cm water. After a few minutes of use, the patient has a strong but unproductive cough. What should be done now? A. Increase the PEP level to 10 cm water. B. Increase the PEP level to 15 cm water. C. Change to incentive spirometry. D. Discontinue the treatment.

A. Increase the PEP level to 10 cm water.

29. A patient had a bronchoscopy procedure and biopsy taken of a suspected lung tumor. After the biopsy, uncontrolled bleeding occurs. What should be given to control the bleeding? A. Instill epinephrine through the bronchoscope at the site of the bleeding. B. Administer heparin by intravenous line. C. Administer nebulized albuterol (Proventil) by SVN. D. Administer lidocaine (Xylocaine) by an intravenous line.

A. Instill epinephrine through the bronchoscope at the site of the bleeding.

22. A patient with COPD is going home. After a hospital exercise test is conducted, it has been determined that the patient will require 1 L/min of supplemental oxygen only when exercising on a stationary bicycle or when the patient feels short of breath. Which of the following oxygen delivery systems should the respiratory therapist recommend? A. Molecular sieve oxygen concentrator B. Portable LOX system C. Semipermeable membrane oxygen concentrator D. Piston compressor

A. Molecular sieve oxygen concentrator

12. The physician asks the respiratory therapist which O2 delivery device would be best for a patient who needs about 75% O2. What should be recommended? A. Nonrebreathing mask B. 6 L/min nasal cannula C. Air entrainment mask D. Simple O2 mask

A. Nonrebreathing mask

2. What is the most likely problem to watch for in a patient with severe COPD who is receiving supplemental O2? A. Pulmonary edema from O2 toxicity B. Hypoventilation C. Retinopathy of prematurity D. Hyperventilation

A. Pulmonary edema from O2 toxicity

1. The waveform sequence seen during the insertion of a PAC is: A. RA, RV, PAP, PCWP B. RV, RA, PAP, PCWP C. RA, RV, PCWP, PAP D. Ao, RA, RV, PAP

A. RA, RV, PAP, PCWP

6. A patient was extubated 30 minutes ago. The patient is hoarse and complains of "tightness in my throat"; inspiratory stridor can be heard. The drug of choice for treating this problem is: A. Racemic epinephrine (MicroNefrin) B. Acetylcysteine (Mucomyst) C. Levalbuterol (Xopenex) D. Isoetharine (Isoetharine HCl)

A. Racemic epinephrine (MicroNefrin)

13. A ventilator-dependent patient required a vacuum pressure of −120 mm Hg to remove thick secretions. After treatment with a mucolytic drug, the patient's secretions are much easier to remove. What should be recommended? A. Reduce the vacuum pressure to −100 mm Hg and monitor the ease of secretion removal. B. Maintain the present vacuum level and suction less often. C. Increase the vacuum pressure to −140 mm Hg and suction less often. D. Reduce the vacuum pressure to −60 mm Hg and suction more often.

A. Reduce the vacuum pressure to −100 mm Hg and monitor the ease of secretion removal.

14. A patient has an order for an induced sputum sample to be analyzed for tuberculosis. The best medication for this is: A. Dornase alfa (Pulmozyme) B. 10% saline solution C. Acetylcysteine (Mucomyst) D. Isonicotinic acid hydrazide INH

B; 10% saline solution

17. Which of the following conditions is first treated by placing a large-bore needle at the midclavicular line through the second or third intercostal space? A. 5% pneumothorax B. Pleural effusion C. Hemothorax D. Tension pneumothorax

D. Tension pneumothorax

24. Calculate the maximum heart rate for a 55-year-old female who is about to undergo a stress test. A. 55 beats/min B. 174 beats/min C. 265 beats/min D. 275 beats/min

B. 174 beats/min

52. Calculate the Cdyn for this patient. A. 16 mL/cm water B. 19 mL/cm water C. 24 mL/cm water D. 32 mL/cm water

B. 19 mL/cm water

18. Which section of the spirometry tracing represents the expiratory reserve volume? A. 1 B. 2 C. 3 D. 4

B. 2

15. Blood gas analyzer calibration values are considered to be in control if they are within: A. 1 SD of the norm B. 2 SDs of the norm C. 3 SDs of the norm D. 4 SDs of the norm

B. 2 SDs of the norm

10. An adult patient has had a PAC inserted. A normal PAP pressure in this patient would be: A. 8 mm Hg B. 25/10 mm Hg C. 35/15 mm Hg D. 120/80 mm Hg

B. 25/10 mm Hg

15. Which section of the spirometry tracing represents the FVC? A. 2 B. 3 C. 4 D. 5

B. 3

12. A patient weighs 45 kg (100 lb). The patient's predicted VT would be: A. 250 mL B. 350 mL C. 450 mL D. 550 mL

B. 350 mL

13. A patient is using the Flutter and coughs productively. Later, the patient tries to use the device but finds that no air will go through it. What should be done? A. Have the patient breathe in harder. B. Check for an obstruction. C. Remove the steel ball to reduce the backpressure. D. Have the patient blow out harder.

B. Check for obstruction.

5. The results of a patient's pulmonary function tests show that the peak expiratory flow rate increased the most when an aerosolized sympathomimetic drug and an aerosolized anticholinergic drug were inhaled. The physician wants to know what should be recommended for this patient. A. Beclomethasone dipropionate (Vanceril) and montelukast (Singulair) B. Ipratropium and albuterol (Combivent Respimat) C. Ipratropium bromide (Atrovent) and cromolyn sodium (Intal) D. Salmeterol (Serevent) and fluticasone (Advair Diskus)

B. Ipratropium and albuterol (Combivent Respimat)

8. A 45-year-old female patient is brought into the Emergency Department from an automobile accident. She has facial trauma, including a broken nose and jaw. Because of heavy bleeding into her mouth, she is having difficulty breathing. Which of the following should be recommended to ensure a safe, effective airway? A. Place an oral airway. B. Place a tracheostomy tube. C. Place a nasopharyngeal airway. D. Place a nasal endotracheal tube.

B. Place a tracheostomy tube.

37. A 35-year-old patient has AIDS and was previously treated for P. carinii pneumonia. What can be used to prevent the infection from reoccurring? A. Trimethoprim and sulfamethoxazole (Bactrim) by pill B. Pentamidine (NebuPent) by SVN C. TOBI by small-volume inhaler D. Zanamivir (Relenza) by MDI

B. pentamidine (NebuPent) by SVN

3. The proper-size suction catheter should be no larger than what fraction of an adult ET's inner diameter? A. ¼ B. ½ C. ⅔ D. ¾

B. ½

6. At the start of IPPB treatment, at what level should the sensitivity control be set at on a Bird unit? A. 0 cm H2O B. −1 cm H2O C. −3 cm H2O D. −5 cm H2O

B. −1 cm H2O

10. While a respiratory therapist is preparing to suction a patient for a mucus sample it is noticed that the vacuum is not reaching the end of the catheter. Which of the following are possible causes? 1. The vacuum is not turned on. 2. All connections are airtight. 3 The catheter is plugged with foreign matter. 4. The specimen jar is not screwed tightly into the special lid. A. 2 and 3 only B. 2 and 4 only C. 1, 3, and 4 only D. 1, 2, 3, 4

C. 1, 3, and 4 only

21. Based on the listed conditions, what is the patient's P(A-a)O2 value? A. 41 torr B. 232 torr C. 243 torr D. 248 torr

C. 243 torr

22. The physician wants to know whether a new bronchodilator would be helpful to the patient with asthma. The physician orders a before-and-after bronchodilator study. The patient has the following peak flow values: 7.5 L/min before the medication and 9.4 L/min after the medication. Calculate the patient's percentage change. A. −25% B. 1.25% C. 25% D. 80%

C. 25%

26. The following values are found on an adult patient receiving volume-cycled ventilation with the VC, A/C mode: Tidal volume 500 mL Peak flow 45 L/min (0.75 L/s) Peak pressure 40 cm H2O Plateau pressure 20 cm H2O PEEP 5 cm H2O Calculate the patient's airway resistance (cm H2O/L/s). A. 0.4 B. 15 C. 27 D. 800

C. 27

3. How should manual vibration be performed as part of CPT? 1. On inspiration 2. At a rate of 20-30 cycles/s 3. On expiration 4. At a rate of 3 cycles/s 5. Throughout the breathing cycle A. 2 and 4 only B. 1 and 4 only C. 3 and 4 only D. 4 and 5 only

C. 3 and 4 only

10. A 59-kg (130-lb) woman must be intubated to initiate mechanical ventilation. What size tube should be used? A. 6.0-mm ID B. 6.5-mm ID C. 7.5-mm ID D. 9.0-mm ID

C. 7.5-mm ID

15. A patient is being mechanically ventilated and has a reflectance oximetry PAC in place. What SvO2 value would indicate the patient is oxygenating adequately? A. 40% B. 50% C. 75% D. 90%

C. 75%

26. A 65-year-old patient has been sick with vomiting and diarrhea for several days. Arterial and PACs are placed for monitoring blood gases and hemodynamic parameters. ABG values on 30% O2 show the following: PaO2, 80 torr; PaCO2, 41 torr; pH, 7.44; bicarbonate, 27 mEq/L. PAC parameters show the following: PAP, 22/8 torr; PCWP, 3 torr. In addition, serum electrolytes show the following: sodium, 156 mEq/L; potassium, 4.5 mEq/L; chlorine, 120 mEq/L. Based on these data, what should be recommended? A. Administer a diuretic. B. Increase the O2 percentage. C. Administer fluids intravenously. D. Give a chronotropic agent.

C. Administer fluids intravenously.

2. A 2-month-old infant has periods of apnea that result in bradycardia and cyanosis. What medication should be recommended to treat the apnea periods? A. Lidocaine (Xylocaine) B. Neostigmine (Prostigmin) C. Caffeine citrate (Cafcit) D. Albuterol (Proventil)

C. Caffeine citrate (Cafcit)

8. An order is received to administer 5 mL of albuterol (Proventil) by hand-held nebulizer. What should be done? A. Confirm that the order was written and give the treatment. B. Have the shift supervisor give the treatment. C. Call the physician to check on the medication dose. D. Give 0.5 mL of medication because the physician probably intended that dosage

C. Call the physician to check on the medication dose.

1. A patient is quite weak and is unable to raise the ball marker on a flow-oriented incentive spirometer to meet the set goal. The patient is becoming discouraged. What should be recommended? A. Have the patient continue trying. B. Recommend that the patient be switched to IPPB. C. Change the patient to a volume-oriented unit. D. Discontinue the treatment because it is not effective.

C. Change the patient to a volume-oriented unit.

35. A 50-year-old, 75-kg (165-lb), male patient has just returned from open heart surgery and has been placed on a microprocessor mechanical ventilator with the following settings: Mode VC, A/C Set tidal volume 500 mL Set rate 12 Total rate 12 FIO2 0.50 I:E ratio 1:3 After 45 minutes, he has the following arterial blood gas values: pH 7.50 PaCO2 30 torr PaO2 115 torr HCO3 − 22 mEq/L BE −2 mEq/L What should be done in this situation? A. Decrease the tidal volume to 400 mL. B. Decrease the oxygen to 40%. C. Decrease the respiratory rate to 10/min. D. Increase the respiratory rate to 14/min.

C. Decrease the respiratory rate to 10/min.

32. A patient has a suspected diagnosis of asthma. Which of the following tests would be the least helpful in assessing the patient for this condition? A. Before-and-after bronchodilator study B. Flow-volume loop C. Diffusion study D. Bronchoprovocation testing

C. Diffusion study

71. An adult female patient will be receiving NIV at night in her home for obstructive sleep apnea. The nasal mask has been applied and these NIV parameters have been set: IPAP 15 cm H2O, EPAP 4 cm H2O, rate 14/min, 30% oxygen. After trying the NIV system for 10 minutes, the patient states that she is not getting enough air. What is the first adjustment to make? A. Increase the rate to 16 per minute. B. Increase the oxygen to 40%. C. Increase the IPAP to 20 cm H2O. D. Increase the EPAP to 8 cm H2O.

C. Increase the IPAP to 20 cm H2O.

11. When a patient performs an MEP test, it is important that he or she: A. Blow out all air before starting the effort B. Breathe in a VT and blow out hard C. Inhale to TLC and blow out hard D. Exhale a VT breath and inhale as hard as possible

C. Inhale to TLC and blow out hard

14. Which of the following best indicates that a patient's tissues are adequately oxygenated? A. PaO2, 85 torr B. PvO2, 30 torr C. SvO2, 75% D. SaO2, 90%

C. SvO2, 75%

12. The pop-off valve is whistling on a patient's bubble humidifier to a 35% O2 air entrainment mask. What could be the problem? A. The reservoir jar is not screwed tightly into the top of the humidifier. B. The air entrainment mask should be set at 28% O2. C. The small-bore tubing is pinched. D. The air entrainment mask should be set at 40% O2.

C. The small-bore tubing is pinched.

16. If IS has been successful, which breath sounds should be heard in the areas where atelectasis was noted before the treatment was started? A. Bronchial B. Bronchovesicular C. Vesicular D. Tracheal

C. Vesicular

21. Which of the following medications can be administered down the endotracheal tube during a CPR attempt on an adult? 1. Epinephrine 2. Potassium chloride 3. Atropine 4. Lidocaine A. 1 only B. 2 and 3 only C. 1 and 4 only D. 1, 3, and 4 only

D 1, 3 , and 4 only.

28. A mechanically ventilated patient who has been paralyzed with a neuromuscular blocking agent should be given a sedative agent for what reason? A. Sustain the paralysis. B. Control pain. C. Improve patient-ventilator synchrony. D. Relieve anxiety.

D Relieve anxiety.

28. Interpret the following mixed venous blood gas drawn when the patient was breathing 40% oxygen: pH, 7.35; PvCO2, 46 torr; PvO2, 40 torr; SvO2, 75%. 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Metabolic acidosis 4. Normal acid-base balance 5. Respiratory acidosis A. 2 and 3 only B. 1 and 5 only C. 2 and 5 only D. 1 and 4 only

D. 1 and 4 only

24. The patient benefits from using the Flutter by which of the following? 1. Increased transpleural pressure 2. Airway vibrations 3. Increased intrapleural pressure 4. Rapid variation in airway pressure A. 1 and 2 only B. 2 and 3 only C. 3 and 4 only D. 2 and 4 only

D. 2 and 4 only

18. The physician wants a patient with a tracheostomy to inhale room air that is fully saturated at body temperature. The selected device must be able to meet the following criteria: 1. Deliver 40% RH 2. Deliver 100% RH 3. Provide 47 mm Hg vapor pressure 4. Provide 44 mm Hg vapor pressure 5. Deliver 44 mg/L AH A. 2 and 4 only B. 1, 3, and 5 only C. 1 and 4 only D. 2, 3, and 5 only

D. 2.3. and .5 only

10. An adult patient with chronic bronchitis has a normal temperature. To fully saturate the inhaled air, how much AH must be provided by the humidifier? A. 35° C B. 47 mm Hg C. 760 mm Hg D. 44 mg/L

D. 44 mg/L

17. Which section of the spirometry tracing represents the inspiratory reserve volume? A. 2 B. 3 C. 4 D. 5

D. 5

6. While assisting with a CPR attempt, the anesthesiologist asks for a properly sized endotracheal tube so that the patient's airway can be quickly intubated. The patient is a large, physically fit man. What tube would be best? A. A 7.0-mm-ID oral endotracheal tube B. A 10.0-mm-ID nasal endotracheal tube C. An 8.0-mm-ID nasal endotracheal tube D. A 9.0-mm-ID oral endotracheal tube

D. 9.0-mm-ID oral endotracheal tube

28. Bag/mask ventilation with oxygen is being provided to a 57-year-old adult at a rate of 12/min. The patient's other vital signs include heart rate of 52/min and blood pressure 95/55 mm Hg. What can be done to improve the patient's vital signs? A. Administer endotracheal lidocaine (Xylocaine). B. Begin chest compressions. C. Intubate the patient. D. Administer intravenous epinephrine (adrenaline).

D. Administer intravenous epinephrine (adrenaline).

20. A 65-year-old female patient with pulmonary edema is very short of breath and hypoxemic. She is ordered to have a nonrebreathing mask with 10 L/min of oxygen going to it. However, she keeps taking off her mask because of anxiety and claustrophobia. When she removes the mask, her pulse oximeter reading drops from 90% to 82%. What should be recommended to help manage the patient? A. Give her a nasal cannula at 10 L/min oxygen. B. Sedate the patient so that she will keep her nonrebreathing mask on. C. Initiate CPAP by mask at 8 cm water and 40% oxygen. D. Begin an HFNC at ≥10 L/min oxygen.

D. Begin an HFNC at ≥10 L/min oxygen.

Which of the following studies produces the most accurate determination of the TLC in a patient with severe emphysema? A. Single-breath nitrogen washout test B. Seven-minute nitrogen washout test C. Helium dilution test D. Body plethysmography test

D. Body plethysmography test

8. A patient has been using an inspiratory muscle-training device. The patient is currently on the third largest of six settings and has been breathing comfortably through it 4 days/week over the past 2 weeks. What should now be recommended? A. Keep breathing through the same inspiratory hole. B. Breathe through the smallest hole. C. Breathe through the largest hole. D. Breathe through the next smallest hole.

D. Breathe through the next smallest hole.

69. An 80-kg (176-lb) man with bilateral pneumonia is being ventilated in the PC, A/C mode. The following data are available: 8:00 pm 12:00 pm Set respiratory rate 12/min 12/min Total respiratory rate 16/min 26/min Exhaled tidal volume 800 mL 600 mL Inspiratory pressure 28 cm water 28 cm water What is the most appropriate thing to do at this time? A. Sedate the patient. B. Increase the set respiratory rate. C. Add Pressure Support. D. Increase the inspiratory pressure.

D. Increase the inspiratory pressure.

18. A ventilator-dependent patient is set up for routine ECG monitoring. Because of refractory hypoxemia, the physician orders 10 cm water of PEEP. Shortly after the PEEP therapy is added, it is noticed that sinus arrhythmia has developed. Which of the following is the best course of action to follow? A. Recommend the administration of atropine. B. Recommend synchronized cardioversion. C. Recommend decreasing the PEEP from 10 to 5 cm water. D. Make a record of the rhythm, and inform the nurse and physician of your observation.

D. Make a record of the rhythm and inform the nurse and physician of your observation

19. When a catheter OD is selected for suctioning through an infant's TT, it is important that the OD be: A. No more than 25% the ID of the tube B. No less than 40% the ID of the tube C. No less than 50% the ID of the tube D. No more than 70% the ID of the tube

D. No more than 70% the ID of the tube

2. A patient is being mechanically ventilated when the nurse calls the respiratory therapist to evaluate the patient's condition. It is discovered that the patient's breath sounds are absent over the left lung field, the left-sided percussion note is hyperresonant, and peak airway pressures have increased from 40 to 65 cm H2O. What would be recommended? A. Place a pleural chest tube into the right side. B. Increase the VT to better inflate the atelectatic left lung. C. Change the mode to Synchronous Intermittent Mechanical Ventilation from Assist/Control. D. Place a pleural chest tube into the left side.

D. Place a pleural chest tube into the left side.

6. A 25-year-old female postoperative patient is receiving mechanical ventilation. She is alert with a spontaneous VT of 200 mL and the desire to breathe on her own. Because of the emergency nature of her surgery, she has a smaller than normal endotracheal tube. Her PaO2 is 93 torr on 40% O2. What ventilator mode should be recommended for her? A. PS with PEEP B. MMV C. SIMV with PS and PEEP D. SIMV with PS

D. SIMV with PS

3. After a mechanical ventilator has been discontinued, what is the best method to sterilize the reusable mainflow bacteria filter? A. Wrapping it and soaking it in acetic acid B. Pasteurization C. Glutaraldehyde soak D. Steam autoclaving

D. Steam autoclaving

26. The respiratory therapist is doing quality assurance on the department's flowmeters. After a backpressure- compensated Thorpe flowmeter is plugged in, the flow is set at 10 L/min. The flowmeter outlet is partially and then completely obstructed. Which of the following should be expected? A. The float will stay at the 10-L/min mark. B. The float will move upward in the flowmeter. C. The float will move upward and then downward in the flowmeter. D. The float will move downward and then to the bottom of the flowmeter.

D. The float will move downward and then to the bottom of the flowmeter.

21. A respiratory therapist is having a patient perform the MIP test. His three attempts produce these results: −15 cm H2O, −45 cm H2O, and −20 cm H2O. The best explanation for these values is that: A. The patient is starting from the FRC. B. The equipment has a large leak. C. The patient is starting from the RV. D. The patient is not trying his best every time.

D. The patient is not trying his best every time.

34. Which of the flow-volume loops represents the most severe small-airway obstruction? A. Tracing A B. Tracing B C. Tracing C D. Tracing D

D. Tracing D

15. Blood for an ABG measurement needs to be drawn during a CPR attempt. Which site should be recommended for this? A. Carotid B. Radial C. Brachial D. Femoral

D. femoral

16. A mechanical percussor is ordered to assist with secretion clearance in a patient receiving CPT. The patient is positioned to drain the posterior basal segments of both lower lobes. The percussor is activated and applied to the patient's lower back. After 1 minute, the patient complains of skin discomfort. What should the respiratory therapist do? A. Have the patient sit up. B. Apply oxygen and check the pulse oximeter value. C. Increase the speed on the percussor. D. Change to another type of pad on the percussor.

D. Change to another type of pad on the percussor

37. A 40-year-old, 60-kg (132-lb) female patient is recovering from ARDS. Her current ventilator settings are as follows: Mode VC, A/C Set tidal volume 400 mL Set rate 12 Total rate 18 FIO2 0.40 I:E ratio 1:3 She has the following arterial blood gas values: pH 7.42 PaCO2 37 torr PaO2 85 torr HCO3 − 25 mEq/L BE +1 mEq/L She has no complications and is conscious and cooperative. Her spontaneous tidal volume is 300 mL and vital capacity is 800 mL. What should be recommended at this time? A. Change to the APRV mode. B. Increase the set rate. C. Decrease the tidal volume. D. Change to the PS mode.

D. Change to the PS mode.

28. A neonatal patient is suspected of having a ventricular septal defect. What could be done to confirm or rule out this condition? A. Perform capnography to monitor the PetCO2 level. B. Perform a VD/VT calculation. C. Check the PvO2 value from the pulmonary artery. D. Check the PvO2 value from the right atrium and right ventricle

D. Check the PvO2 value from the right atrium and right ventricle

15. The respiratory therapist is called to set up a suctioning system for a new patient in the Intensive Care Unit. To measure the vacuum pressure, what should be done? A. Check the manometer while occluding the catheter tip. B. Set the vacuum control to maximum. C. Close the thumb control valve on the catheter. D. Check the manometer while pinching off the connecting tubing.

D. Check the manometer while pinching off the connecting tubing.

30. A 10-year-old male patient with cystic fibrosis has large amounts of secretions. He cannot tolerate postural drainage because of nausea when he is tipped down. He is receiving aerosolized bronchodilator and mucolytic medications. To improve his condition, the respiratory therapist could recommend all of the following EXCEPT: A. OPEP therapy B. Quake unit C. HFCWO D. Continuous positive airway pressure

D. Continuous positive airway pressure

12. A respiratory therapist is about to give an asthmatic 16-year-old female patient her second IPPB treatment with a bronchodilator medication. When checking the equipment, it is noticed that the equipment is set with a rather fast inspiratory flow. Her chart had a note that she was very anxious when first admitted. She seems calmer now. How should the treatment be started? A. Increase the pressure setting to deliver a larger breath. B. Keep the flow the same to deliver a larger breath. C. Make the machine as sensitive as possible to easily trigger it. D. Decrease the flow on the machine.

D. Decrease the flow on the machine.

6. A patient is wearing a face tent because of recent facial surgery. It is set at 35% O2. The nurse moves the patient from an upright to a supine position in bed. What effect will this have on the patient's respiratory status? A. Increased VT B. Increased inspired O2 C. Increased inspired CO2 D. Decreased inspired O2

D. Decreased inspired O2

8. A respiratory therapist notices that a patient with a 28% air-entrainment mask is unresponsive to questions. The ECG rhythm seen below is noticed on the monitor. What should be recommended as a first reaction? A. Check the calibration on the ECG machine. B. Replace the ECG leads. C. Increase the O2 percentage because the patient is hypoxic. D. Defibrillate the patient.

D. Defibrillate the patient.

21. While connecting the suction catheter to the vacuum tubing, a respiratory therapist accidentally touches the tip of the catheter with the clean-gloved hand. What should be done? A. Discard the clean glove and start over. B. Suction the patient. C. Put a sterile glove over the clean glove and suction the patient. D. Discard the catheter and start over.

D. Discard the catheter and start over.

29. CPT (postural drainage, percussion, and vibration) has been performed for 5 days on a cooperative patient with bronchiectasis. During that time, the patient has been treated with antibiotics, well fed, and hydrated. The patient has produced a total of 20 mL of sputum during the past 24 hours. What should be recommended? A. Continue the current treatment program for 48 hours and evaluate the patient again. B. Add ultrasonic nebulizer treatments to the CPT to better liquefy the secretions. C. Add nasotracheal suctioning to the CPT to remove the secretions. D. Discontinue the CPT and follow the patient's progress.

D. Discontinue the CPT and follow the patient's progress.

39. A Wright respirometer can be used for all of the following bedside spirometry tests EXCEPT: A. Tidal volume B. Minute volume C. Vital capacity D. Forced vital capacity

D. Forced vital capacity

33. An intubated patient has been moved from the operating room to the Intensive Care Unit. Upon arrival there is concern that the endotracheal tube has moved. What is the best way to determine its location? A. Palpate the larynx. B. Listen to stomach sounds. C. Percuss the patient's chest. D. Get a chest radiograph.

D. Get a chest radiograph.

2. A 16-year-old postoperative appendectomy patient has clear breath sounds and normal vital signs. What should be recommended to prevent atelectasis? A. CPAP at 5 cm H2O B. PEP therapy C. IPPB D. IS

D. IS

9. A patient is wearing a partial-rebreathing mask. The reservoir bag almost totally collapses during inspiration. Which of the following should be done? A. Tell the patient to breathe more slowly. B. Put a standard nasal cannula on the patient. C. Tell the patient to breathe more rapidly. D. Increase the O2 flow.

D. Increase the O2 flow.

32. An adult patient with myasthenia gravis is receiving mechanical ventilation with these settings: Mode PC, A/C Set tidal volume 450 mL Set rate 10 Total rate 15 FIO2 0.40 Inspiratory flow 60 L/min The patient's blood gas values are all within the normal range. While performing patient-ventilator rounds, you notice that the patient is making 24 breathing efforts/min and is using inspiratory accessory muscles. What should be done? A. Increase the oxygen percentage. B. Increase the inspiratory flow. C. Increase the set rate to 15. D. Increase the flow sensitivity.

D. Increase the flow sensitivity.

18. A 58-year-old patient with advanced emphysema is admitted with an acute exacerbation of the condition. While breathing 2 L/min of oxygen through a transtracheal oxygen catheter, the patient has the following ABG results: pH, 7.38 PaCO2, 57 torr HCO3 −, 31 mEq/L PaO2, 47 torr SaO2, 80% Based on these findings, what should be done? A. Change the patient to 24% oxygen by an air entrainment mask. B. Initiate bilevel mask ventilation. C. Change the patient to a nonrebreathing mask with 10 L/min of oxygen. D. Increase the oxygen flow to the current system to 3 L/min.

D. Increase the oxygen flow to the current system to 3 L/min.

59. The chest radiograph of a patient receiving mechanical ventilation reveals atelectasis in both bases. In addition, the patient's breath sounds are diminished bilaterally, and she has a low-grade fever. Which of the following ventilator adjustments should the respiratory therapist recommend? A. Increase the flow rate B. Lengthen the expiratory time C. Increase the ventilator frequency D. Increase the ventilator sigh volume

D. Increase the ventilator sigh volume

55. A 45-year-old patient has developed pulmonary edema. The physician asks the respiratory therapist for the best ventilator adjustment to reduce the patient's intrapulmonary shunting. The therapist should recommend: A. Increasing the inspiratory time B. Increasing the sigh volume C. Decreasing the respiratory rate D. Increasing the PEEP

D. Increasing the PEEP

14. A patient has an FEV1% that is calculated to be 80% of his or her FVC. On the basis of this finding, the patient probably: A. Has COPD B. Has a laryngeal tumor C. Has a fibrotic lung disease D. Is clinically normal

D. Is clinically normal

1. All of the following statements about the use of a Lukens trap are true EXCEPT: A. A vacuum source is needed. B. All connections must be tight for it to work properly. C. Either a suction catheter or a bronchoscope is needed. D. It is indicated for a patient with a strong, productive cough.

D. It is indicated for a patient with a strong, productive cough.

18. A patient with advanced emphysema is admitted to the respiratory Intensive Care Unit. The patient is placed on a 24% Venturi-type mask and has a PAC inserted. The patient's initial PVR is 9 mm Hg/L/min and his PaO2 is 57 torr. The physician orders an increase to 28% oxygen. The resulting PVR is 5 mm Hg/L/min and PaO2 is 63 torr. Based on this information, what would you recommend? A. Decrease the oxygen to 24%. B. Place the patient on a ventilator. C. Administer a bronchodilating agent such as albuterol. D. Keep the patient on 28% oxygen.

D. Keep the patient on 28% oxygen.

23. A respiratory therapist is assisting an anesthesiologistin the direct-vision nasotracheal intubation of a patient. All of the following equipment will be needed EXCEPT: A. Magill forceps B. Laryngoscope handle with blade C. Sterile, water-soluble lubricant D. Lubricated hard stylet

D. Lubricated hard stylet

27. A respiratory therapist is assisting a physician performing a thoracentesis on a mechanically ventilated patient. The patient cannot sit up on the edge of the bed because of weakness. Which position should be recommended for the procedure? A. Lying with the abnormal side down on the bed B. Lying face down on the bed C. Supine on the bed with the head down 30 degrees D. Lying with the normal side down on the bed

D. Lying with the normal side down on the bed

3. A 3-year-old patient with asthma is about to be discharged and needs to take an inhaled bronchodilator medication at home. What device should be recommended? A. MDI B. SVN with mouthpiece C. DPI with VHC D. MDI with VHC

D. MDI with VHC

24. A patient has just been admitted through the Emergency Department with suspected CO poisoning. The physician wants the patient to receive the highest possible O2 percentage. What should be recommended? A. CPAP mask at 5 cm H2O and 40% O2 B. Simple mask at 6 L/min flow C. 50% air entrainment nebulizer to aerosol mask D. Nonrebreathing mask

D. Nonrebreathing mask

16. A respiratory therapist is working the night shift when a 17-year-old patient with status asthmaticus is admitted through the Emergency Department. The patient has already been given Combivent Respimat and an ICS medication. The intern on-call asks for your recommendation on what additional medication to give the patient. What should be recommended? A. Formoterol (Foradil) B. Terbutaline (Brethaire) C. Albuterol (Proventil) D. Theophylline (Aminophylline)

D Theophylline (Aminophylline)

20. The respiratory therapist is called to the recovery room to assist in the care of a patient who returned 2 hours ago from having a bowel resection. The patient is apneic and on a mechanical ventilator. Which medication(s) could be used to wean the patient from the machine? 1. Flumazenil (Romazicon) 2. Naloxone (Narcan) 3. Dopamine (Intropin) 4. Succinylcholine chloride (Anectine) 5. Diazepam (Valium) A. 5 only B. 1 and 4 only C. 2 and 3 only D. 1 and 2 only

D. 1 and 2 only

12. An intubated patient has thick secretions. The nurse has recommended that normal saline be instilled into the patient's trachea. What are the possible adverse effects of doing this? 1. Endotracheal tube biofilm is displaced 2. Hypoxemia 3. Bronchospasm 4. Excessive coughing A. 1 and 4 only B. 2 and 3 only C. 2, 3, and 4 only D. 1, 2, 3, 4

D. 1, 2, 3, 4

31. A properly performed FVC test will not have: 1. Any coughing or leaks 2. A weak patient effort 3. An unsatisfactory start to the test 4. Excessive variability among test results A. 1 and 2 only B. 2 and 3 only C. 1, 2, and 4 only D. 1, 2, 3, 4

D. 1, 2, 3, 4

7. A patient has COPD with a bronchospasm component. Which of the following classes of medications would be helpful? 1. SABA 2. ICS 3. LAAC 4. LABA A. 2 and 4 only B. 1 and 3 only C. 2, 3, and 4 only D. 1, 2, 3, 4

D. 1, 2, 3, 4

31. A patient is about to have an oral endotracheal tube inserted. What can be done during and/or after the procedure to determine its position within the trachea? 1. Get a chest radiograph. 2. Palpate the larynx during insertion. 3. Auscultate bilateral breath sounds. 4. Attach an EDD after the tube is placed. 5. Check for exhaled carbon dioxide. A. 1 and 4 only B. 2 and 3 only C. 1, 3, and 5 only D. 1, 2, 3, 4, 5

D. 1, 2, 3, 4, 5

34. A patient in the recovery room is found to have a tracheostomy tube cuff pressure of 35 mm Hg. If left unchanged, this cuff pressure could cause which of the following? 1. Tracheomalacia 2. Tracheoesophageal fistula 3. Innominate artery erosion 4. Damage to the vocal cords 5. Loss of venous flow through the tracheal soft tissues A. 2 and 4 only B. 3 and 5 only C. 1, 2, and 4 only D. 1, 2, 3, and 5 only

D. 1, 2, 3, and 5 only

14. To ensure that a manual ventilator is ready for use, what should be done? 1. Make sure that no gas escapes through the outlet port when it is closed off and the bag is squeezed. 2. Squeeze the bag, and make sure that the air/ O2 reservoir intake valve closes properly. 3. Squeeze the bag, and make sure the nonrebreathing valve opens properly. 4. Feel for air leaving the outlet port when the bag is squeezed. 5. Squeeze the bag, and make sure that the air/ O2 reservoir intake valve opens properly. A. 4 and 5 only B. 2 and 3 only C. 1, 2, and 5 only D. 1, 2, 3, and 4 only

D. 1, 2, 3. and 4 only

46. A patient having a spontaneous breathing trial for weaning should be carefully assessed. Weaning should be terminated when: 1. The patient's rapid, shallow breathing index is 120 2. Cardiac dysrhythmias occur 3. The patient's PaCO2 is 60 torr 4. The patient's PaO2 is 70 torr on 40% oxygen A. 1 and 3 only B. 2 and 4 only C. 2, 3, and 4 only D. 1, 2, and 3 only

D. 1, 2, and 3 only

18. Placing a suction catheter into a patient's trachea and applying vacuum pressure causes: 1. Transient hypoxemia 2. Removal of secretions 3. Stopping of the hypoxic drive because of vagal stimulation 4. Removal of air from the lungs A. 3 only B. 3 and 4 only C. 2 and 4 only D. 1, 2, and 4 only

D. 1, 2, and 4 only

6. A mechanically ventilated patient is going to have a flexible fiberoptic bronchoscopy performed. How might this affect the ventilator's function? 1. The VT must be monitored for a leak. 2. The inspiratory flow resistance will increase. 3. The inspiratory pressure will decrease. 4. The inspiratory pressure will increase. A. 1 and 2 only B. 3 only C. 2 and 3 only D. 1, 2, and 4 only

D. 1, 2, and 4 only

60. A patient with ARDS is receiving a smaller than normal tidal volume with resulting hypercarbia. What guidelines should be followed with permissive hypercapnia? 1. Bicarbonate may be given to increase the pH. 2. The carbon dioxide level is allowed to increase. 3. The pH should be kept between 7.45 and 7.35. 4. The pH should be kept greater than 7.25. 5. The PaCO2 should be kept between 40 and 50 torr. A. 3 and 5 only B. 2 and 4 only C. 2 and 5 only D. 1, 2, and 4 only

D. 1, 2, and 4 only

23. The respiratory therapist is attempting to calibrate a polarographic oxygen analyzer but finds that it cannot be done. Possible reasons for this include: 1. The membrane is torn on the probe. 2. The gas-sampling capillary tube is plugged with debris. 3. The electrode solution has evaporated. 4. The battery needs to be replaced. 5. Water has condensed on the membrane. A. 1 and 3 only B. 2 and 3 only C. 3, 4, and 5 only D. 1, 3, 4, and 5 only

D. 1, 3, 4, and 5 only

21. A conscious adult patient with atrial fibrillation is being prepared for synchronous cardioversion with a biphasic defibrillator. Which of the following should be recommended? 1. Administer midazolam (Versed) before starting. 2. Administer flumazenil (Romazicon) before starting. 3. Charge the defibrillator to 120 J. 4. Charge the defibrillator to 360 J. 5. Set the ECG machine to lead II. 6. Have a manual resuscitation bag on standby. A. 2 and 3 only B. 1, 2, and 4 only C. 1, 3, and 5 only D. 1, 3, 5, and 6 only

D. 1, 3, 5, and 6 only

23. A patient has had an arterial line inserted. What should be done to ensure that accurate BP readings are obtained? 1. Open the stopcock to room air to zero the transducer. 2. Make sure that air fills the transducer dome 3. Have the patient lie flat to measure the BP. 4. Fill the pressure tubing with a saline solution. A. 1 and 2 only B. 2 and 4 only C. 1, 2, and 3 only D. 1, 3, and 4 only

D. 1, 3, and 4 only

14. A patient's small-volume medication nebulizer is not putting out as much aerosol as it was a short time ago. To correct the problem, which of the following should be checked? 1. Make sure the fluid level is correct. 2. Make sure the one-way valve is patent. 3. Make sure the jet is patent. 4. Make sure the O2 can flow down the capillary tube. 5. Make sure the fluid can flow up the capillary tube. A. 1 and 2 only B. 3 and 4 only C. 2 and 4 only D. 1, 3, and 5 only

D. 1, 3, and 5 only

2. To get the best patient results, manual percussion should be performed with 1. The hand cupped 2. A tight, fixed-wrist position 3. The elbows relaxed 4. The hand flat 5. The wrist relaxed A. 3, 4, and 5 only B. 2, 3, and 4 only C. 2 and 4 only D. 1, 3, and 5 only

D. 1, 3, and 5 only

17. An NSR can be identified by: 1. A resting rate of 60-100 beats/min in an adult 2. A P wave before every QRS complex 3. A regular rhythm 4. A QRS complex after every P wave 5. An upright T wave in lead II A. 2 and 4 only B. 2, 3, and 4 only C. 1, 2, 3, and 5 only D. 1, 2, 3, 4, 5

D. 1,2 3,4,5

15. A patient has pneumonia and needs an inhaled antibiotic. What size particle generator should be recommended to treat the problem? A. 20-50 μm B. 10-20 μm C. 2-5 μm D. 1-3 μm

D. 1-3 um

14. An E cylinder of O2 needs to be prepared for transport of a patient. A regulator with which pinhole locations should be used? A. 1 and 5 B. 2 and 6 C. 3 and 5 D. 2 and 5

D. 2 and 5

3. Which of the following test results is/are needed to calculate TLC? 1. FRC 2. RV 3. VT 4. ERV 5. IC 6. VC A. 1 and 3 only B. 5 and 6 only C. 1 and 4 only D. 2 and 6 only

D. 2 and 6 only

12. A patient is being given an aerosolized beta-agonist (sympathomimetic) drug for the first time. Monitoring should be done for what possible adverse effects? 1. Bradycardia 2. Tremor 3. Headache 4. Nervousness and irritability 5. Tachycardia A. 1 and 2 only B. 2 and 4 only C. 3, 4, and 5 only D. 2, 3, 4, and 5 only

D. 2, 3, 4, and 5 only

35. A properly inserted Combitube will usually: 1. Intubate the trachea 2. Intubate the esophagus 3. Prevent vomiting 4. Maintain the airway A. 1 and 4 only B. 1 and 3 only C. 2 and 4 only D. 2, 3, and 4 only

D. 2, 3, and 4 only

11. In preparing for a mode change from A/C to SIMV, the following must be done: 1. Turn the sensitivity control off. 2. Inform the patient of the change. 3. Turn off the ventilator's sigh control. 4. Add 5 cm H2O of therapeutic PEEP. 5. Remove any mechanical dead space. A. 3 and 4 only B. 1, 3, and 4 only C. 2, 4, and 5 only D. 2, 3, and 5 only

D. 2, 3, and 5 only

12. Which of the following indicates that the patient is not tolerating PEEP? 1. Increased Cst 2. Decreased Cst 3. Increased intrapulmonary shunt 4. Decreasing dead space 5. Decreasing blood pressure A. 2 and 3 only B. 3 and 4 only C. 1, 3, and 5 only D. 2, 3, and 5 only

D. 2, 3, and 5 only

2. An oropharyngeal airway would be indicated under which of the following conditions? 1. Maintain the airway before a tracheostomy. 2. Seizure activity is expected or present. 3. Supine unconscious patient with an upper-airway obstruction 4. Patient with a traumatic jaw injury 5. An orally intubated patient is biting the tube. A. 3 and 5 only B. 4 and 5 only C. 1 and 4 only D. 2, 3, and 5 only

D. 2, 3, and 5 only

6. An order is received to perform postural drainage, percussion, and vibration on a patient. No segments are specified. On reviewing the chest X-ray film, the therapist notices infiltrates in the lower right lung field. Which of the following segments should be treated? 1. Apical 2. Lateral basal 3. Superior 4. Medial 5. Posterior basal A. 2 and 5 only B. 3, 4, and 5 only C. 1 and 4 only D. 2, 3, and 5 only

D. 2, 3, and 5 only

20. When doing patient rounds, a respiratory therapist notices that very little aerosol is going from an LVN to a patient's tracheostomy mask. Which of the following could be the problem? 1. The water level is above the refill line on the nebulizer's reservoir jar. 2. The nebulizer is not screwed tightly into the DISS connector on the flowmeter. 3. The nebulizer jet is obstructed. 4. The water level is below the refill line on the nebulizer's reservoir jar. 5. The capillary tube is obstructed. A. 1 and 2 only B. 3 and 4 only C. 1, 4, and 5 only D. 2, 3, 4, and 5 only

D. 2,3,4 and 5 only

6. The best positions in which to place a patient before nasotracheal suctioning are: 1. Supine 2. Trendelenburg 3. Sniff (neck and head hyperextended) 4. Semi-Fowler's A. 1 and 4 only B. 1 and 3 only C. 2 and 3 only D. 3 and 4 only

D. 3 and 4 only

1. Which of the following statements is/are true of the MEP test? 1. A pressure of −20 to −25 cm H2O usually is adequate. 2. A pressure of +20 to +25 cm H2O usually is adequate. 3. A pressure of +40 cm H2O is usually adequate. 4. It is a good indicator of the patient's ability to cough. 5. The patient should hold the effort for 1 to 3 seconds . A. 3 only B. 1 and 2 only C. 3 and 4 only D. 3, 4, and 5 only

D. 3, 4, and 5 only

19. The VC is made up of: 1. RV 2. FRC 3. ERV 4. VT 5. IRV A. 2 and 4 only B. 3 and 4 only C. 1, 2, and 3 only D. 3, 4, and 5 only

D. 3, 4, and 5 only

7. To minimize the risk of hypoxemia during a treatment or procedure, which of the following should be done? 1. Increase the O2 percentage by 20% above the normal setting before suctioning or changing equipment. 2. Keep the O2 percentage the same as if the patient were not hypoxemic at this time.term-179 3. Minimize the time that the patient would be breathing room air. 4. Increase the O2 percentage to 100% before suctioning. 5. Make sure the replacement equipment is working properly before you place it on the patient. A. 1 and 3 only B. 2 and 5 only C. 3 and 4 only D. 3, 4, and 5 only

D. 3, 4, and 5 only

51. Use the following information for questions 51 and 52: A mechanically ventilated patient has an exhaled tidal volume of 700 mL. Because of refractory hypoxemia, 6 cm of PEEP therapy is started. The peak pressure is 35 cm water, and the plateau pressure is 25 cm water. The compliance factor has been determined to be 4 mL/cm water. 51. Calculate the Cst for this patient. A. 19 mL/cm water B. 24 mL/cm water C. 28 mL/cm water D. 32 mL/cm water

D. 32 mL/cm water

13. A patient has an end-tidal CO2 pressure of 30 torr and a P(a-et)CO2 gradient of 4 torr. The alveolar to endtidal gradient is in the usual direction. Based on this, the patient's PaCO2 would be estimated as: A. 4 torr B. 26 torr C. 30 torr D. 34 torr

D. 34 torr

12. Calculate a patient's pulmonary artery diastolic- pulmonary capillary wedge pressure (PAd-PCWP) gradient if the PAP is 30/12 mm Hg and the PCWP is 8 mm Hg. A. 38 mm Hg B. 12 mm Hg C. 8 mm Hg D. 4 mm Hg

D. 4 mm Hg

10. A patient is referred for a sleep study. The attending physician wants to know which parameters are measured during the study. All of the following should be measured EXCEPT: A. SpO2 B. ECG C. Inspiratory and expiratory breathing efforts D. ABG values

D. ABG values

39. A 65-year-old, 70-kg (155-lb), male patient who suffered a heart attack is receiving mechanical ventilation with the following settings: Mode PC, SIMV, plus Pressure Support Set tidal volume 500 mL Set rate 12 Total rate 18 FIO2 0.70 The physician is concerned that the patient may be developing pulmonary edema. These arterial blood gas values were recorded while the patient was on the ventilator: pH 7.43 PaCO2 35 torr PaO2 50 torr HCO3 − 22 mEq/L BE −2 mEq/L What should be done to help manage the patient? A. Increase the oxygen to 100%. B. Add mechanical dead space. C. Increase the set rate to 18/min. D. Add 5 cm water PEEP therapy.

D. Add 5 cm water PEEP therapy.

7. A patient's humidity deficit is going to be the smallest under which of the following conditions? A. Breathing in regular hospital room air at 72° F and 40% RH B. Breathing in outside air at 80° F and 50% RH C. Breathing in 6 L/min of O2 through a nasal cannula running through an unheated bubble humidifier D. Breathing in 40% O2 at 95° F through a passover- type humidifier to an aerosol mask

D. Breathing in 40% O2 at 95° F through a pass-over-type humidifier to an aerosol mask

26. A hospitalized patient rapidly develops ventilatory failure because of an accidental overdose of morphine sulfate for pain control. The preferred way to quickly provide a safe, secure airway is to: A. Place an oropharyngeal airway. B. Hyperextend the patient's neck. C. Place a nasal endotracheal tube. D. Place an oral endotracheal tube.

D. Place an oral endotracheal cube.

29. After open heart surgery, a patient is receiving mechanical ventilation. The patient needs to have a pacemaker inserted in the cardiac procedures lab. It is expected that the patient will be back in the Intensive Care Unit within an hour or two. How should ventilator support be provided during this time? A. Microprocessor-type ventilator B. Manual ventilation with a resuscitation bag C. NIV D. Pressure-cycled transport ventilator

D. Pressure-cycled transport ventilator

22. An adult patient with a tracheostomy button and an attached speaking valve is complaining that it is difficult to breathe. You find that a 12-Fr suction catheter cannot be passed through the button. What should be done? A. Place a transtracheal oxygen catheter through the tracheostomy button. B. Force a larger suction catheter through the button. C. Remove the button and orally intubate the patient. D. Remove the speaking valve and assess the patient.

D. Remove the speaking valve and assess the patient

9. A respiratory therapist notices that a patient's Yankauer suction catheter is cracked. The best thing to do is: A. Continue to use it. B. Tape over the crack. C. Put lubricating jelly in the crack to seal it. D. Replace the catheter.

D. Replace the catheter.

7. An adult patient is recovering from ARDS. The mechanical ventilator is providing CPAP at 10 cm H2O CPAP and 40% O2 during a spontaneous breathing trial. In evaluating the patient after 1 hour, you notice the following: SpO2 has dropped from 95% to 90%, respiratory rate has increased from 14 to 23 breaths/min, and the patient is complaining of tiredness. What should be done? A. Continue for another hour and reevaluate. B. Raise the CPAP level to 13 cm H2O. C. Decrease the CPAP to 7 cm H2O because the patient is tired. D. Resume mechanical ventilation.

D. Resume mechanical ventilation.

23. Complete spirometry is performed on a 50-year-old patient, revealing the following data: Predicted Actual % Predicted TLC (L) 5.9 8.1 137 RV (L) 1.1 1.8 164 FVC (L) 5.0 2.6 52 FEF25%-75% (L/s) 4.2 1.5 36 FEV1/FVC 75% 20% 27 How should the data be interpreted? A. Mild restrictive lung disease B. Severe restrictive lung disease C. Mild obstructive lung disease D. Severe obstructive lung disease

D. Severe obstructive lung disease

40. A 42-year-old patient was accidentally given an overdose of morphine for pain after surgery. Because the drug caused hypoventilation, the patient was intubated and started on mechanical ventilation in the VC, A/C mode. The morphine now has been reversed and the patient is awake. The patient has the following bedside spirometry values: Respiratory rate 16/min Vital capacity 2300 mL Tidal volume 400 mL Maximum inspiratory pressure −55 cm H2O What should be done at this time? A. Reassess the patient in 4 hours. B. Change to the SIMV mode. C. Remove the endotracheal tube. D. Spontaneous breathing trial on a T-piece

D. Spontaneous breathing trial on a T-piece.

20. A conscious patient is recovering from Guillain-Barré syndrome and is able to breathe spontaneously off of the mechanical ventilator for several hours. The patient currently has a single-cannula 7.5-mm-ID tracheostomy tube. To help the patient's weaning process but enable the patient to be ventilated at night, what should be done? A. Remove the tracheostomy tube when the patient is off of the ventilator. B. Substitute a speaking-type tracheostomy tube. C. Replace the current tracheostomy tube with one that is 6.0-mm ID. D. Substitute a fenestrated tracheostomy tube.

D. Substitute a fenestrated tracheostomy tube.

17. A phone call is received from a home care patient. The patient reports that the high-pressure pop-off valve on the bubble humidifier to the transtracheal oxygen catheter is venting. In addition, the patient cannot flush out the catheter with saline or push the cleaning rod through it. What should the patient be told to do? A. Remove the humidifier and double the oxygen flow rate to the catheter. B. Force the saline through the catheter until the obstruction is cleared. C. Force the cleaning rod through the catheter until the obstruction is cleared. D. Switch oxygen from the transtracheal catheter to a nasal cannula.

D. Switch oxygen from the transtracheal catheter to a nasal cannula.

35. A 10-year-old boy with cystic fibrosis has been having recurrent episodes of P. aeruginosa pneumonia. What should be recommended to prevent further episodes? A. Instill pentamidine (Pentam) into the trachea by way of a suction catheter. B. Administer pentamidine (NebuPent) once a month by SVN. C. Isonicotinic acid hydrazide (INH) should be taken twice a week for 6 months. D. TOBI should be taken by SVN every other month

D. TOBI should be taken by SVN every other month.

5. A patient has just performed several excellent IS efforts. The patient complains of tingling fingers and dizziness. What should be done? A. Have the patient continue with additional IS maneuvers. B. Check the patient's fingers and forehead for cyanosis. C. Call the patient's physician to cancel the treatment order. D. Tell the patient to relax and breathe quietly

D. Tell the patient to relax and breathe quietly

29. An adult patient with congestive heart failure needs to have his fluid management and oxygen consumption monitored. What type of catheter should be used for these measurements? A. Radial arterial catheter B. Umbilical artery catheter C. Single-lumen CVP catheter D. Triple-lumen ScvO2 CVP catheter

D. Triple-lumen ScvO2 CVP catheter

3. If pulmonary function results are not available, what initial IS goal should be set? A. The IC measured at the bedside B. The VC measured at the bedside C. Three times the VT measured at the bedside D. Twice the VT measured at the bedside

D. Twice the VT measured at the bedside

2. A patient is being mechanically ventilated with 60% oxygen and 8 cm H2O of PEEP. The patient's SpO2 and blood pressure have decreased twice when removed from the ventilator for suctioning. What should be recommended to prevent this from happening again? A. Switch to a smaller suction catheter. B. Switch to a larger suction catheter. C. Increase the PEEP to 10 cm H2O before and after suctioning. D. Use a closed-system suction catheter.

D. Use a closed-system suction catheter.

7. A patient hospitalized with leg vein thrombosis experiences sudden shortness of breath. Which of the following should be recommended to evaluate the patient's situation? A. Lung compliance B. Electrocardiogram C. Chest radiograph D. VD/VT

D. VD/VT

19. IPV has been ordered for an adult patient with bronchiectasis. An aerosolized bronchodilator has also been7ordered. How should the two treatments be delivered? 1. Bronchodilator given before the IPV 2. Low pressure setting 3. Bronchodilator with IPV 4. High pressure setting 5. Bronchodilator after IPV A. 2 and 3 only B. 1 and 2 only C. 3 and 5 only D. 4 and 5 only

No answer

20. A respiratory therapist is working with an 80-kg (176-lb) patient who is apneic after abdominal surgery. The patient is being ventilated with the A/C mode and has the following settings: ˙ Vt E 5.6 L Rate 10/min I:E ratio 1:3 Inspired O2 35% Mechanical dead space 100 mL The ABG results show the following: pH 7.31 PaCO2 50 torr PaO2 70 torr HCO3 − 24 mEq/L BE 0 SaO2 95% Which of the following should be recommended? A. Remove the mechanical dead space. B. Decrease the patient's V˙ E. C. Change the I:E ratio to 1:2. D. Add 5 cm H2O PEEP.

No answer

5. A respiratory therapist replaces a patient's tracheostomy tube with another one of the same size and inflates the cuff with 5 mL of air as was done previously. Immediately, the patient has difficulty breathing and no air can be felt coming from the tube. What could be the problem? A. The tip of the tube has been placed into the subcutaneous tissues. B. The patient has closed the epiglottis over the trachea. C. More air must be added to the cuff to form a seal. D. The tube has accidentally been placed into the esophagus.

A. The tip of the tube has been subcutaneous tissues

47. An adult patient was receiving a tidal volume of 500 mL on the ventilator before going to the operating room for a left pneumonectomy. How should the patient's breathing be supported after surgery? A. Tidal volume less than before surgery. B. The same tidal volume as before surgery. C. A larger tidal volume than before surgery. D. CPAP should be used.

A. Tidal volume less than before surgery.

1. A 45-year-old female patient with sepsis is developing ARDS. She weighs 64 kg (141 lb) and has a ventilator tidal volume of 450 mL, rate of 13/min, and 10 cm water PEEP. Her arterial blood gas values are acceptable on 40% oxygen but her CLT is decreasing and plateau pressure is now 35 cm water. What should be recommended to the physician? A. Tidal volume of 300 mL and rate of 20/min B. Increase PEEP to 15 cm water. C. Tidal volume of 600 mL and rate of 10/min D. Continue to monitor the patient's condition

A. Tidal volume of 300 mL and rate of 20/min

31. A patient with heart failure had an ScvO2 value of 65% an hour ago. The patient is now showing an ScvO2 value of 60%. How should these results be interpreted? A. Tissue hypoxia B. Normal oxygenation C. Increased CO D. Decreased PVR

A. Tissue hypoxia

23. If a ventilator-dependent patient has a large amount of thick tracheal secretions, it is best to: A. Use a heated cascade-type humidifier. B. Use an HME for his or her humidity needs. C. Use no humidification system so that the secretions will dry. D. Nebulize normal saline every 2-4 hours.

A. Use a heated cascade-type humidifier.

17. An adult patient has been admitted for observation after suffering a concussion in a fall. The patient's arterial BP is found to be 115/78 mm Hg. How should these results be interpreted? A. Within normal limits B. Hypertension C. Hypotension D. Intracranial bleed

A. Within normal limits

21. A 64-year-old patient with a long smoking history and a diagnosis of chronic bronchitis has been admitted again with complaints of shortness of breath and productive cough. Which of the following questions should be asked to gain an understanding of the patient's problem to better guide aerosol therapy? 1. Has the volume of your secretions changed over the past week? 2. How many hours do you sleep a night? 3. Are there any medications that make your breathing easier? 4. How many flights of stairs can you climb without stopping? A. 1 and 3 only B. 2 and 4 only C. 1, 2, and 3 only D. 1, 2, 3, 4

.A. 1 and 3 only

2. A patient is being given a bronchodilator medication by SVN powered by 5 L/min of O2. While watching the patient breathe, the respiratory therapist notices that during each inspiration, the mist disappears from the downstream end of the SVN. What should be recommended? A. Add 100 mL of aerosol tubing as a reservoir. B. Increase the oxygen flow. C. Decrease the oxygen flow. D. Tell the patient not to breathe so deeply.

A Add 100 ml. of aerosol tubing as a reservoir.

14. A patient with bilateral pneumonia is positioned for drainage of the lateral and medial segments of the right middle lobe. After 5 minutes in this position, the patient complains of SOB. The electrocardiogram shows the patient to be having premature ventricular contractions. The most likely cause of this is: A. Hypoxemia from the position B. A full stomach is causing vagal stimulation C. Increased intracranial pressure D. Increased venous return to the heart

A Hypoxemia from the position

3. A respiratory therapist is working in the Emergency Department when an automobile crash victim arrives by ambulance. The patient is conscious, screaming, and hysterical from the extreme pain of a broken lower leg. What should be recommended for sedation? A. Morphine sulfate (Duramorph) B. Ibuprofen (Advil) C. Succinylcholine chloride (Anectine) D. Ipratropium bromide (Atrovent)

A Morphine sulfate (Duramorph)

15. A respiratory therapist is assisting with the extubation of an adult patient. At what point in the procedure should the tube be removed? A. At the end of a peak inspiratory effort B. At the end of a normal exhalation C. At the start of a peak inspiratory effort D. During a forced vital capacity effort

A, At the end of a peak inspiratory effort

7. Two respiratory therapists are performing chest compressions, manually ventilating an intubated patient during a resuscitation attempt. The nurse and physician are both unable to start an IV line to give medications. What should be recommended? A. Instill the medications down the endotracheal tube. B. Keep trying new sites from which to start the IV line. C. Nebulize the medications. D. Give the medications by subcutaneous injection.

A, Instill the medications down the endotracheal tube.

10. A 64-year-old woman was admitted with a diagnosis of MI. She was treated with a clot-dissolving medication and recovered quickly. What procedure should be performed to evaluate the condition of her coronary arteries? A. Left-heart catheterization B. Stress echocardiogram C. Right-heart catheterization D. 12-lead electrocardiogram

A, Left-heart catheterization

22. After several days of receiving postural drainage and percussion therapy to all lobes in the left lung, the patient's chest radiograph shows improvement except for the lateral basal segment of the left lower lobe. In what position should the patient now be placed for postural drainage? A. Right side down with the head of the bed down 30 degrees B. Right side down with the bed flat C. Left side down with the head of the bed down 30 degrees D. Flat on his back with the bed flat and a pillow beneath the knees

A, Right side with the head of the bed down with 30 degrees

35. An adult patient in Denver, Colorado, is receiving 50% oxygen through an air entrainment mask. The patient's arterial blood gas values are pH, 7.41; PaCO2, 38 torr; PaO2, 85 torr; bicarbonate, 25 mEq/L; and base excess, +1 mEq/L; SaO2, 96%. The local PB is 745 torr. The patient's P:F ratio would be calculated as which of the following? A. 0.05 B. 0.11 C. 0.76 D. 1.7

A. 0.05

21. How much medication solution is needed to give the patient 20 mg of the active ingredient? The solution contains 5% active ingredient. A. 0.1 mL B. 0.4 mL C. 1 mL D. 40 mL

A. 0.1 mL

18. A patient was found to have a V˙O2 value of 2000 mL and a V˙ CO2 value of 1700 mL during an exercise test. Calculate the patient's respiratory exchange ratio. A. 0.85 B. 1.18 C. 2000 D. 3700

A. 0.85

16. Which section of the spirometry tracing represents the VT? A. 1 B. 2 C. 3 D. 4

A. 1

12. A 48-year-old male patient has been admitted with a suspected MI. What blood tests should be performed to determine if he has had an MI? 1. CK-MB 2. Troponin I 3. d-Dimer 4. BUN 5. LDL A. 1 and 2 only B. 3 and 5 only C. 2, 3, and 4 only D. 1, 2, 3, and 5 only

A. 1 and 2 only

20. A 40-year-old patient receiving mechanical ventilation has an arterial line in place. It is noticed that there is a significant difference between the BP taken by cuff on the left arm and the BP taken by arterial line on the right arm. What could explain this difference? 1. A clot is at the tip of the catheter. 2. There is an air bubble in the arterial line. 3. The ventilator's peak pressure is too high. 4. The patient has a ventricular septal defect. A. 1 and 2 only B. 2 and 3 only C. 1, 3, and 4 only D. 1, 2, 3, 4

A. 1 and 2 only

33. A neonatal patient is receiving 40% oxygen in an oxyhood. The following capillary blood gas results have just been received: pH, 7.37; PCO2, 45 mm Hg; PO2, 60 mm Hg; HCO3 −, 22 mEq/L; and BE, −2 mEq/L; SO2, 91%. Which of the blood gas values can be reliably used clinically? 1. pH, 7.37 2. PCO2, 45 mm Hg 3. PO2, 60 mm Hg 4. SO2, 91% A. 1 and 2 only B. 3 and 4 only C. 1, 2, and 3 only D. 1, 2, 3, 4

A. 1 and 2 only

11. A patient's heated humidifier unit has a water reservoir temperature of 40° C. The humidified gas is traveling through large-bore tubing to the patient. Which of the following statements are true? 1. Condensation will occur. 2. The gas will warm and expand as it travels to the patient. 3. The gas will remain saturated. 4. The RH will decrease. 5. The RH will increase. A. 1 and 3 only B. 3 and 4 only C. 2, 3, and 5 only D. 1, 2, and 4 only

A. 1 and 3 only

11. An IPPB treatment should be stopped under which of the following conditions? 1. You suspect the patient has a pneumothorax. 2. The patient has difficulty keeping the lips sealed. 3. The patient feels faint and dizzy. 4. The patient coughs up blood. A. 1 and 4 only B. 2 and 3 only C. 1, 2, and 3 only D. 2, 3, and 4 only

A. 1 and 4 only

2. A respiratory therapist is working with a home care patient. How should the patient be instructed to clean her small-volume nebulizer? 1. Soak the equipment in white vinegar. 2. Put the equipment in the oven, and turn on the broiler for 10minutes. 3. Rinse a nebulizer in salt water after each use. 4. Wash the equipment in hot water with a detergent. A. 1 and 4 only B. 1 and 2 only C. 1, 3, and 4 only D. 1, 2, 3, 4

A. 1 and 4 only

12. Interpret the following arterial blood gas drawn from a patient who is breathing 60% O2: pH, 7.18; PaCO2, 50 torr; PaO2, 72 torr; bicarbonate, 18 mEq/L; and base excess, −10 mEq/L; SaO2, 94%. 1. Uncorrected hypoxemia 2. Corrected hypoxemia 3. Uncorrected respiratory acidosis 4. Uncorrected metabolic acidosis 5. Combined metabolic and respiratory acidosis A. 1 and 5 only B. 2 and 5 only C. 2 and 3 only D. 2 and 4 only

A. 1 and 5 only

44. MMV ventilation: 1. Is similar to the VC, A/C mode 2. Is indicated when a patient has an unstable respiratory drive 3. Ensures a minimum minute volume 4. Is a substitute for CPAP A. 1 only B. 3 only C. 2 and 3 only D. 1 and 4 only

A. 1 only

26. A patient is starting HFCWO to help mobilize secretions. Which of the following instructions should the patient be given for the initial treatment? 1. Lie on the side with secretions. 2. Sit up straight. 3. Set the controls at a low pressure. 4. Set the controls at a high pressure. 5. Set the unit for nebulization. A. 2 and 3 only B. 1 and 3 only C. 2, 4, and 5 only D. 1, 3, and 5 only

A. 2 and 3 only

21. It is noticed that a patient's peak pressure has increased from 20 to 40 cm water without a change in static pressure. Possible causes of this include which of the following? 1. Retained secretions 2. Pleural effusion 3. Bronchospasm 4. Pulmonary edema A. 2 and 4 only B. 1 and 2 only C. 1 and 3 only D. 3 and 4 only

A. 2 and 4 only

39. The Combitube has advantages over the standard LMA because: 1. It can be placed nasally. 2. A gastric tube can be placed through it to empty the stomach. 3. It is available in small pediatric sizes. 4. The patient can be ventilated whether it is placed into the esophagus or the trachea. A. 2 and 4 only B. 1 and 2 only C. 3 and 4 only D. 1 and 4 only

A. 2 and 4 only

30. A 40-year-old unconscious patient is in the Intensive Care Unit for treatment of congestive heart failure. You will be assisting the physician with the insertion of an arterial catheter. Which of the following medications would be appropriate for the procedure? 1. Naloxone (Narcan) 2. Fentanyl (Sublimaze) 3. Iodine (Betadine) 4. Lidocaine (Xylocaine) A. 3 and 4 only B. 1 and 2 only C. 2, 3, and 4 only D. 1, 2, 3, 4

A. 3 and 4 only

13. An order is received to calculate a patient's alveolar ventilation. The patient's respiratory rate is 16, and average VT is 580 mL. The patient weighs 170 lb. The patient's alveolar ventilation is: A. 410 mL B. 510 mL C. 750 mL D. 2720 mL

A. 410 mL

19. A respiratory therapist is working with a postanesthesia patient who is on a PtcCO2 monitor. The correlation factor between the PaCO2 and the PtcCO2 is 1.4. The patient's previous PtcCO2 level was 63 torr. The nurse has called you because it is now 75 torr. The patient's approximate PaCO2 value would be calculated as: A. 54 torr B. 63 torr C. 75 torr D. 105 torr

A. 54 torr

4. An order has arrived to perform an induced sputum procedure on a patient suspected of having tuberculosis. What should be the first choice to nebulize for the patient? A. 7% saline B. 0.9% saline C. 0.45% saline D. Distilled water

A. 7% saline

37. A 28-year-old patient is brought into the Emergency Department. The patient has a cervical spine injury from a diving accident and is wearing a neck brace. The patient is unconscious and inspiratory stridor can be heard. Arterial blood gases on 40% oxygen show the following: PaO2 57 mm Hg, PaCO2 56 mm Hg, and pH 7.30. The physician has decided to establish a secure airway. What device should be recommended? A. 7.0-mm nasotracheal tube B. Berman oral airway C. 8.5-mm Carlens orotracheal tube D. 9.0-mm nasotracheal tube

A. 7.0-mm nasotracheal tube

14. An oxygen blender has just been returned from the neonatal Intensive Care Unit. What agent should be used for surface disinfection? A. 70% ethyl alcohol B. Acid glutaraldehyde C. Ethylene oxide D. Alkaline glutaraldehyde

A. 70% ethyl alcohol

9. In observing an infant's chest configuration, the respiratory therapist notices that it is the same size in both the AP and the lateral dimensions. This would indicate that the patient has: A. A normal chest B. Funnel chest/pectus excavatum C. Pulmonary emphysema with air trapping D. Lordosis

A. A normal chest

31. A patient has acute respiratory distress syndrome and is significantly hypoxemic. It is likely that the patient will exhibit all the following EXCEPT: A. A normal respiratory rate B. Nasal flaring C. Intercostal retractions D. Use of accessory muscles of inspiration

A. A normal respiratory rate

2. A patient is brought into the Emergency Department after being rescued from a house fire. She is unconscious and has facial burns. The physician believes that she is suffering from smoke inhalation. What should be recommended as the best way to evaluate her? A. ABGs analyzed through a CO oximeter B. Standard pulse oximetry C. ABGs analyzed through a standard blood gas analyzer D. Continuous PtCO2 monitor

A. ABGs analyzed through a CO oximeter

48. A negative-pressure ventilator is indicated for all the following types of patients EXCEPT: A. ARDS B. Neuromuscular defects C. Kyphoscoliosis D. COPD in acute failure

A. ARDS

5. A retired home care patient living on a fixed income needs to be able to disinfect her respiratory therapy equipment. Which of the following would be best for her? A. Acetic acid B. Acid glutaraldehyde C. Ethylene oxide system D. Warm, soapy water

A. Acetic acid

19. A comatose patient is incubated and is receiving 35% 02 with aerosol through a T-piece. While watching the patient breathe, the therapist notices that during each inspiration, the mist disappears from the downstream end of the T-piece. What should be recommended? A. Add aerosol tubing to the end of the T-piece. B. Change the 02 to 30% and increase the flow. C. Change the 02 to 40% and decrease the flow D. Tell the patient not to breathe so deeply.19. A comatose patient is incubated and is receiving 35% 02 with aerosol through a T-piece. While watching the patient breathe, the therapist notices that during each inspiration, the mist disappears from the downstream end of the T-piece. What should be recommended? A. Add aerosol tubing to the end of the T-piece. B. Change the 02 to 30% and increase the flow. C. Change the 02 to 40% and decrease the flow D. Tell the patient not to breathe so deeply.

A. Add aerosol tubing to the end of the T-piece.

10. A patient has been ordered to start PEP therapy. During the initial instruction and patient practice, it is noticed that the pressure is 25 cm H2O and the patient's I:E ratio is 1:5. How should the procedure be revised? A. Adjust the PEP device to have the patient exhale through a larger hole. B. Have the patient continue but coach the patient to exhale faster. C. Adjust the PEP device to have the patient exhale through a smaller hole. D. Add a bronchodilator medication to the PEP device.

A. Adjust the PEP device to have the patient exhale through a larger hole.

56. A trauma patient has a pleural chest tube to the left lung. A microprocessor-type ventilator is delivering an inspiratory tidal volume of 800 mL. The expiratory tidal volume is shown to be 600 mL. What could best explain the volume difference? A. Air leak through the chest tube B. Deflated endotracheal tube cuff C. Miscalibrated spirometer D. Bronchospasm and auto-PEEP

A. Air leak through the chest tube

5. The respiratory therapist is called to help in the evaluation of a 55-year-old male patient. The following signs and symptoms are noted: oral temperature of 40° C (104.5° F), diaphoresis, respiratory rate of 22, the use of accessory muscles of respiration, and palpable rhonchi in the right lower lobe. You would suspect which of the following diagnoses? A. Bacterial pneumonia B. Heart attack C. Pneumothorax D. Viral pneumonia

A. Bacterial pneumonia

25. A 59-year-old patient is brought to the hospital with a complaint of sudden, severe substernal chest pain and dyspnea. What initial thing should the respiratory therapist recommend? A. Begin ECG monitoring. B. Draw an ABG sample. C. Get a chest radiograph. D. Get a capnometer value.

A. Begin ECG monitoring.

33. A respiratory therapist is assigned to the Emergency Department of a major medical center when a 24-yearold patient with status asthmaticus is transferred by ambulance from a small, rural hospital. The patient has been given continuous bronchodilator therapy and intravenous corticosteroids and aminophylline. The patient is becoming exhausted but refuses to allow intubation and mechanical ventilation. What should be recommended? A. Begin heliox therapy. B. Begin nitric oxide therapy. C. Intubate and ventilate the patient despite protests. D. Follow the patient's wishes.

A. Begin heliox therapy.

38. An adult female patient is recovering from her neuromuscular disease. She has a standard tracheostomy tube and requires mechanical ventilation only during the night when sleeping. The physician asks the respiratory therapist for a recommendation about what can be done to enable her to communicate during the day but be put on the ventilator at night. What should be recommended? A. Change her to a fenestrated tracheostomy tube. B. Put a tracheostomy button into her during the day. C. Put an uncuffed tracheostomy tube into her. D. Put the obturator into her current tracheostomy tube during the day.

A. Change her to a fenestrated tracheostomy tube.

1. A patient with a fluid overload problem has been given a dose of furosemide (Lasix) intravenously. Following rapid diuresis in the patient, an arrhythmia is noticed that did not exist before the medication was given. What should be recommended? A. Check the patient's potassium level. B. Give more furosemide. C. Defibrillate the patient's heart. D. Give the patient epinephrine

A. Check the patient's potassium level.

4. A 12-year-old patient with cystic fibrosis will be discharged to go home. What type of directed cough should be recommended to improve secretion removal without causing airway collapse? A. Chicken breath B. Quad C. Splinted D. Lateral chest compression

A. Chicken breath

28. A 2-year-old child admitted with severe croup has just been extubated after 2 days with an oral endotracheal tube. The child is given oxygen and aerosolized water through a heated large-volume nebulizer. Thirty minutes later, mild inspiratory stridor is heard over the child's throat area. What should be done first? A. Deliver nebulized racemic epinephrine. B. Reintubate the child. C. Perform a cricothyrotomy. D. Perform a tracheostomy

A. Deliver nebulized racemic epinephrine.

34. The results of a set of arterial blood gases and central venous blood gases have been received from a patient in the Intensive Care Unit. The results show that the PcvCO2 is 58 torr and the PaCO2 is 43 torr. How should these results be interpreted? A. Disregard owing to a preanalytic error with the PcvCO2. B. Low cardiac output. C. The patient is being hyperventilated. D. The patient is in ventilatory failure.

A. Disregard owing to a preanalytic error with the PcvCO2.

18. An 18-year-old woman has been admitted after being found unconscious from a drug overdose. She has severe atelectasis of the left lung caused by lying on her left side for 2 days. Her right lung is normal. She is going to require mechanical ventilation to open the atelectatic areas. What endotracheal tube should be suggested to properly treat the abnormal lung? A. Double lumen B. Standard C. Fenestrated tracheostomy D. Wire reinforced

A. Double lumen

24. All of the following are needed to assemble a free-standing CPAP system EXCEPT: A. Exhaled volume spirometer B. Disconnect alarm C. Water traps D. CPAP pressure device

A. Exhaled volume spirometer

4. A normal MEFV loop test would show: A. FEF50% less than FIF50% B. Predicted lung diffusion ability C. FEF50% greater than FIF50% D. A normal FRC

A. FEF50% less than FIF50%

25. The respiratory therapist is called to help assess a premature neonate. The patient is having difficulty breathing, and RDS is suspected. All of the following could be recommended EXCEPT: A. Flumazenil (Romazicon) B. Beractant (Survanta) C. Calfactant (Infasurf) D. Poractant alfa (Curosurf)

A. Flumazenil (Romazicon)

33. An adult patient is panicking and fighting against the mechanical ventilator. All of the following may be used to control the patient on the ventilator EXCEPT: A. Flumazenil (Romazicon) B. Pancuronium bromide (Pavulon) C. Succinylcholine (Anectine) D. Morphine sulfate (Duramorph)

A. Flumazenil (Romazicon)

38. A 58-year-old female patient with congestive heart failure is being treated with 40% oxygen and diuretics. Within 3 hours she has lost 1500 mL of urine and her pulse oximeter reading has improved from 84% to 93% saturation. Her electrocardiogram shows a heart rate of 110 beats/min with the new observation of premature ventricular contractions. Her recent serum electrolyte values show a potassium level of 3.1 mEq/L. What recommendation could be made in her care? A. Give her intravenous potassium. B. Decrease her oxygen to 35%. C. Continue her diuretic medications. D. Restrict her intake of potassium.

A. Give her intravenous potassium.

5. If a patient has a PaO2 of 65 mm Hg, the most important step to take to prevent hypoxemia during suctioning is to A. Give the patient 100% O2 before and after the procedure. B. Use a large catheter to remove the secretions quickly. C. Hyperextend the patient's neck and head. D. Use a small catheter so that the patient can breathe around it.

A. Give the patient 100% O2 before and after the procedure.

28. The respiratory therapist is assisting with a bronchoscopy to obtain a biopsy of a suspicious laryngeal node on a patient. Afterward, the patient complains of shortness of breath and a "tight" throat. Which of the following recommendations should be given to the physician? A. Give the patient an 80/20 heliox mix to breathe. B. Put the head of the bed down 30 degrees. C. Give the patient a carbogen mix to breathe. D. Do a 7-minute helium dilution test.

A. Give the patient an 80/20 heliox mix to breathe.

8. An anxious 68-year-old patient with congestive heart failure will not keep the nonrebreathing mask on. What should be recommended to treat the patient's hypoxemia? A. HFNC B. Partial rebreathing mask C. 50% air entrainment mask D. 40/60 heliox mix by nonrebreathing mask

A. HFNC

10. A respiratory therapist notices that two people in the Emergency Department waiting room are coughing regularly. All of the following should be done EXCEPT: A. Have the two coughing people sit near each other. B. Have each person wear a face mask while waiting. C. Give facial tissues to the two people. D. Have both people sit at least 3 feet away from anyone else.

A. Have the two coughing people sit near each other.

24. A 40-year-old patient has just been intubated and started on mechanical ventilation. It is anticipated that this will be needed for at least several days. What should be the first choice for humidification? A. Heated cascade-type humidifier B. SVN every 4 hr C. Heated heat-moisture exchanger D. VMN every 2 hr

A. Heated cascade type humidification

24. An unconscious 25-year-old patient is admitted with viral pneumonia, vomiting, and diarrhea. Mechanical ventilation is initiated and a flow-directed PAC is inserted. The following data are gathered: Pulmonary artery pressure 22/8 mm Hg Pulmonary capillary wedge pressure 3 mm Hg Central venous pressure 0 mm Hg Blood pressure 90/60 mm Hg Pulse 142 beats/min What is the most likely cause of these findings? A. Hypovolemia B. High ventilating pressures C. Bronchospasm D. Rupture of the balloon on the catheter

A. Hypovolemia

10. A 40-year-old cooperative female patient had her gallbladder removed 2 days ago. She now has a low-grade fever and her chest X-ray shows signs of atelectasis in the right lower lobe. What should be done first to treat the problem? A. IS B. PEP therapy C. Nasotracheal suctioning D. IPPB therapy

A. IS

19. Electrocardiogram monitoring is justified with a patient in the Intensive Care Unit in all of the following situations EXCEPT: A. If it is used to evaluate peripheral perfusion. B. If the patient has an electrolyte disturbance. C. If the patient has a history of arrhythmias. D. If the patient is being given a rapid infusion of potassium.

A. If is used to evaluate peripheral perfusion

27. A patient with heart failure and pulmonary edema has an initial PvO2 value of 35 torr. After the patient is mechanically ventilated and given digitalis, the PvO2 value is 41 torr. How should this be interpreted? A. Improved tissue oxygenation B. No clinical change C. Decreased tissue oxygenation D. Worsening heart failure

A. Improved tissue oxygenation

17. A patient has an IPPB VT goal of 900 mL but is exhaling only 700 mL. There is no air leak. What should be done to deliver a larger volume? A. Increase the delivered pressure. B. Decrease the flow. C. Add expiratory retard. D. Have the patient inhale more forcefully

A. Increase the delivered pressure.

42. A patient is receiving CPAP at 10 cm water pressure with 40% oxygen and a flow of 6 L/min. The nurse calls the respiratory therapist because the low-pressure alarm is periodically sounding off. The therapist finds the patient to be alert and breathing comfortably. The pressure gauge shows the CPAP pressure fluctuating between 10 and 6 cm water pressure. The low-pressure alarm is set at 8 cm water with a delay of 5 seconds. What should be done about this situation? A. Increase the flow. B. Sedate the patient. C. Increase the alarm delay to 10 seconds. D. Set the low-pressure alarm at 5 cm water.

A. Increase the flow.

31. After abdominal surgery, a female patient is awakening gradually from anesthesia. Her ventilator settings are as follows: Mode VC, SIMV Set tidal volume 550 mL Spontaneous tidal volume 400 mL when awake Set rate 12 Total rate 16 when awake FIO2 0.30 Inspiratory flow 40 L/min When awake, she uses accessory muscles and her breathing is not synchronized with the ventilator. What can be done to improve synchrony? A. Increase the inspiratory flow to 50 L/min. B. Decrease the set tidal volume. C. Give her more pain medication. D. Give her more oxygen.

A. Increase the inspiratory flow to 50 L/min.

27. Complications of bland aerosol therapy include all of the following EXCEPT: A. Increased humidity deficit B. Aerosol-induced bronchospasm C. Fluid overload in an infant D. Swollen secretions that may block airways

A. Increased humidity deficit

22. All of the following may be done by a respiratory therapist during a surgical tracheostomy procedure EXCEPT: A. Insert the tracheostomy tube into the new stoma. B. Disinfect the surgical site. C. Check for proper functioning of the tracheostomy tube. D. Withdraw the endotracheal tube when ordered.

A. Insert the tracheostomy tube into the new stoma.

34. A patient is in shock from an allergic reaction to a bee sting. In addition, the patient has inspiratory stridor from laryngeal edema. What is the best medication to use to help raise the patient's blood pressure and help her breathing? A. Intravenous epinephrine (Adrenalin) B. Oral ibuprofen (Advil) C. Nebulized racemic epinephrine (Nephron) D. Intravenous naloxone (Narcan)

A. Intravenous epinephrine (Adrenalin)

27. The respiratory therapist is called to the pediatrics department to help in the evaluation and care of a 4-year-old girl who has been sick with a bad cold for the past 2 days. In viewing a lateral neck radiograph of the child, the following are seen: (1) clear air column through the upper airway and (2) pointed narrowing of the tracheal air column below the larynx. What is the child's most likely condition? A. Laryngotracheobronchitis B. Aspirated a coin C. Epiglottitis D. Tonsillitis

A. Laryngotracheobronchitis

15. After finishing an aerosolized dose of acetylcysteine (Mucomyst), a patient has breath sounds that reveal wheezing. These were not present at the start of treatment. What medication should be given before the next Mucomyst treatment? A. Levalbuterol (Xopenex) B. Sterile water C. Salmeterol (Serevent) D. 0.9% saline solution

A. Levalbuterol (Xopenex)

21. A patient who is suffering respiratory distress would exhibit all of the following EXCEPT: A. Normal respiratory rate B. Nasal flaring C. Intercostal retractions D. Use of accessory muscles of inspiration

A. Normal respiratory rate

24. An unconscious 17-year-old patient has arrived in the Emergency Department. The patient was involved in an automobile accident, has a neck injury, and is wearing a neck brace. If the patient were to show signs of an upper-airway obstruction, all of the following could be used to maintain the airway EXCEPT: A. Oral endotracheal tube B. Nasopharyngeal airway C. Laryngeal mask airway D. Oropharyngeal airway

A. Oral endotracheal tube

17. A patient is recovering from a neuromuscular disease and the physician wishes to speed up the process of strengthening the patient's inspiratory muscles. What technique should the respiratory therapist recommend? A. PFLEX inspiratory muscle trainer B. Maximal inspiratory pressure C. Maximal expiratory pressure D. Trendelenburg positioning

A. PFLEX inspiratory muscle trainer

16. An intubated patient has pneumonia, and a sputum sample must be sent to the laboratory for culture and sensitivity testing. What is the most appropriate way to obtain a sample? A. Place a Lukens trap between the suction catheter and the vacuum tubing. B. Suction the oropharynx with a sterile Yankauer suction catheter. C. Place a Lukens trap between the vacuum tubing and the collection bottle. D. Suction the patient and place the catheter inside the Lukens trap.

A. Place a Lukens trap between the suction catheter and the vacuum tubing.

13. Auscultation of a recently intubated patient in respiratory failure reveals absent breath sounds on the left side of the chest. The most likely cause of this finding is: A. Placement of the endotracheal tube into the right mainstem bronchus B. Placement of the endotracheal tube into the left mainstem bronchus C. Placement of the endotracheal tube into the esophagus D. A pneumothorax on the right side

A. Placement of the endotracheal tube into the right mainstem bronchus

34. A 65-year-old patient with repeated episodes of congestive heart failure has a chest radiograph taken. The radiograph shows the left costophrenic angle to be blunted with an air/fluid level with a meniscus in the left lower-lung area. How should this be interpreted? A. Pleural effusion of the left lung B. Pulmonary edema of the left lung C. Pneumonia of the left lung D. Pulmonary embolism of the left lung

A. Pleural effusion of the left lung

15. An adult patient is complaining of localized pain over the lower right area of the chest while breathing. When you auscultate the patient's chest, a rasping noise is heard at the point of pain on both inspiration and expiration. This is most likely: A. Pleural friction rub B. Normal breath sounds C. Wheeze D. Rhonchi

A. Pleural friction rub

25. A pediatric patient is receiving volume-controlled ventilation with a tidal volume of 250 mL. The patient's breath sounds are clear, but the expiratory flow is seen on the monitor to not return to baseline before the next breath. How could this be interpreted? A. Presence of auto-PEEP B. Too small a tidal volume C. Decreasing CLT D. Decreased airway resistance

A. Presence of auto-PEEP

5. A stroke patient has been admitted and is in a coma. The physician is concerned that the patient may develop atelectasis and pneumonia. What should be recommended to help prevent these problems? A. Regular turning B. PEP therapy C. IPPB D. CPAP

A. Regular turning

13. An adult mechanically ventilated patient has had a tracheostomy tube placed while in the Intensive Care Unit. When the patient coughs vigorously, about 10 mL of blood is coughed into the ventilator circuit. What should be done? A. Replace the circuit with a new one. B. Flush the blood out of the circuit with normal saline. C. Sedate the patient to prevent more coughing. D. Nebulize a local anesthetic to reduce surgical pain.

A. Replace the circuit with a new one.

72. After suffering multiple traumas from an automobile accident, a 43-year-old male patient is recovering. Mechanical ventilation has been needed for 5 days, and weaning is being tried for the first time. After breathing on a T-piece for 40 minutes, the patient has the following arterial blood gas values while breathing 40% oxygen: pH 7.30 PaCO2 54 torr PaO2 65 torr HCO3 − 26 mEq/L BE +2 mEq/L SpO2 91% Bedside spirometry values are as follows: Start of Wean After 40 Minutes Vital capacity 1100 mL 700 mL Tidal volume 400 mL 300 mL Respiratory rate 14/min 28/min Maximum inspiratory Pressure −26 cm H2O −15 cm H2O Based on this information, what should be recommended? A. Return the patient to mechanical ventilation. B. Extubate and give the patient 50% oxygen. C. Extubate and begin PEP therapy treatments every 4 hours. D. Continue to monitor the patient's weaning trial.

A. Return the patient to mechanical ventilation.

24. An 18-month-old infant is diagnosed with bronchiolitis from RSV. Which medication should be recommended? A. Ribavirin (Virazole) B. Pentamidine isethionate (NebuPent) C. Gentamycin (Garamycin) D. Trimethoprim and sulfamethoxazole (Bactrim)

A. Ribavirin (Virazole)

8. Capnography will be used to monitor a patient's recovery from anesthesia. What gas should be used for the zero calibration? A. Room air for 0% carbon dioxide B. Room air for 21% oxygen C. 5% carbon dioxide D. The same concentration of anesthetic gas as used with the patient

A. Room air for 0% carbon dioxide

5. A 35-year-old patient in the Intensive Care Unit has the following hemodynamic data. Which of these data indicates a problem with the patient? A. SVR of 600 dyn/s/cm−5 B. CI of 3 L/min/m2 of body surface area C. PvO2 of 38 torr D. Shunt of 4%

A. SVR of 600 dyn/s/cm−5

15. All the following should be done when preparing to helicopter transport an adult patient requiring mechanical ventilation EXCEPT: A. Select a heated cascade-type humidification system. B. Calculate the duration of the oxygen cylinder that will be used. C. Select a ventilator that uses a demand-valve IMV system rather than one with an external-reservoir IMV system. D. Select a lightweight and portable ventilator

A. Select a heated cascade-type humidification system.

7. When preparing to suction a patient, all of the following should be done EXCEPT: A. Set the vacuum control to FULL. B. Screw a 500-mL collection bottle tightly onto the vacuum connector. C. Attach 3 feet of vacuum tubing to the tubing connector on the collection jar. D. Pinch closed the vacuum tubing when the vacuum is turned on to measure the vacuum level.

A. Set the vacuum control to FULL.

17. A 30-year-old postoperative patient with clear breath sounds is receiving mechanical ventilation. The patient was suctioned 2 hours ago with scant results. The nurse wants to suction the patient again before the shift change. What should be recommended? A. Shallow suctioning B. Suction with a Coudé tip catheter. C. Instill 5 mL of normal saline. D. Deep suctioning

A. Shallow suctioning

53. When preparing to ventilate a patient with HFJV, it is necessary to have all of the following EXCEPT: A. Spirometer to measure tidal volume B. Jet injector line C. High-pressure oxygen source D. Humidifier

A. Spirometer to measure tidal volume

3. A male patient comes into the Emergency Department appearing ashen gray and complaining of sudden, severe pain beneath his sternum and shortness of breath. He says this began after he exercised vigorously for 45 minutes. After putting an O2 mask on the patient, what should be done? A. Start ECG monitoring. B. Recommend that he begin a supervised exercise program at the hospital. C. Perform a peak flow test to check on exercise-induced asthma. D. Immediately draw an ABG sample.

A. Start ECG monitoring.

11. A patient is receiving mechanical ventilation through an 8-mm oral ET. Over the course of the shift, the patient is seen to have more tracheal secretions. What is the best course of action? A. Suction more often. B. Suction for longer periods. C. Change to the closed-suctioning technique. D. Administer nebulized atropine.

A. Suction more often.

9. A mechanically ventilated female patient with pulmonary edema has the following blood gas values on 40% O2: pH 7.43, PaCO2 35 torr, and PaO2 75 torr. She is on the VC, A/C mode with a backup rate of 10 breaths/min and is assisting for a total rate of 18 breaths/min. Her peak airway pressure is 50 cm H2O, and her plateau pressure is 40 cm H2O. She developed a pneumothorax and had a chest tube inserted. What should be suggested to the physician? A. Switch her to the PC, A/C mode. B. Switch her to the APRV mode. C. Switch her to the CPAP mode. D. Sedate her so that she does not assist.

A. Switch her to the PC, A/C mode.

15. The respiratory therapist is using a pneumatically powered mechanical percussor on a patient receiving CPT. The unit is powered by an E cylinder of O2 because piped-in O2 is unavailable. After a few minutes of operation, it is noticed that the percussor begins to slow down and then stops. What should be done? A. Switch to an electrically powered percussor. B. Make sure the cylinder is completely turned on. C. Check the unit's batteries. D. Check the electrical cord.

A. Switch to an electrically powered percussor

5. An adult patient with obstructive sleep apnea and frequent pulse oximetry desaturations is fitted with a nasal CPAP system. A pressure of 7 cm H2O is set. After the CPAP system is set up, the patient's SpO2 value stays above 90%. How should the results be interpreted? A. The CPAP system has corrected the patient's problem. B. Greater CPAP pressure is needed. C. Improved gas flow is needed through the CPAP system. D. The delivered oxygen percentage should be increased.

A. The CPAP system has corrected the patient's problem.

24. A premature neonate breathing room air has a PtcCO2 electrode placed on her right thigh and a PtCO2 electrode placed on her left thigh. Both have been showing stable readings over the past hour. After the patient was moved about for nursing care it is noticed that the PtCO2 electrode value has increased. The PtcCO2 electrode value is unchanged. What could explain this? A. The PtCO2 electrode has pulled loose from the skin. B. The inspired oxygen percentage has been decreased. C. The patient's pulmonary condition has improved. D. The patient is hyperventilating.

A. The PtCO2 electrode has pulled loose from the skin.

6. A patient has a flow-oriented type of IS device. The patient is attempting but is unable to inhale forcibly through it. What is the most likely problem? A. The inspiratory tube is obstructed. B. The patient is not really trying. C. The flow resistance is set too high. D. The bellows is in the locked-down position

A. The inspiratory tube is obstructed.

4. After a sleep study has been performed, a patient is given a diagnosis of obstructive sleep apnea. The patient's physician asks the respiratory therapist for advice. What should be recommended? A. The patient should use nasal CPAP when sleeping. B. The patient should sleep with an oropharyngeal airway. C. The patient should always sleep on the back. D. A tracheostomy should be performed.

A. The patient should use nasal CPAP when sleeping.

36. Tracing A represents a patient with asthmatic bronchitis, and tracing C represents the same patient 1 hour after receiving an inhaled bronchodilator medication. What conclusion can be reached? A. The patient's condition is treatable. B. The patient is not giving his or her best effort. C. The patient's condition has worsened. D. The patient needs another bronchodilator treatment.

A. The patient's condition is treatable

63. Indications that the patient is tolerating SIMV include all of the following EXCEPT: A. The respiratory rate is increased. B. The heart rate is stable. C. The blood gas results are stable. D. Accessory muscles of ventilation are not being used

A. The respiratory rate is increased.

18. A patient who is being instructed in PEP therapy complains that it is taking too long to breathe out. What should be done? A. Tell the patient to blow out harder. B. Change the expiratory resistance to a larger diameter orifice. C. Change the expiratory resistance to a smaller diameter orifice. D. Increase the flow of oxygen to the system.

B Change the expiratory, diameter orifice.

36. A newborn child with macroglossia is having moderate airway obstruction episodes. What could be done to help manage the current situation? 1. Place a nasopharyngeal airway. 2. Place a tracheostomy button. 3. Place the newborn in the prone position. 4. Place an oral endotracheal tube. A. 2 only B. 1 and 3 only C. 3 and 4 only D. 1, 2, and 4 only

B. 1 and 3 only

39. A patient has been diagnosed with severe COPD. The physician has asked for your recommendations on medications to optimize the patient's breathing. The patient says, "I don't want...to take medicine...all day long." What should be recommended to maximize bronchodilation and convenience? 1. Fluticasone and vilanterol (Breo) 2. Mometasone and formoterol (Dulera) 3. Ipratropium and albuterol (Combivent Respimat) 4. Umeclidinium and vilanterol (Anoro) 5. Tiotropium (Spiriva) A. 4 only B. 1 and 5 only C. 3 and 4 only D. 1, 3, and 5 only

B. 1 and 5 only

49. An adult patient with an acute lung injury has had an optimal PEEP study performed. Which of the following parameters found during the study would help determine the best PEEP setting? 1. Pulmonary compliance improves 2. PaO2 increases 3. Shunt percentage decreases 4. Pulmonary vascular resistance increases 5. Pulmonary vascular resistance decreases 6. Blood pressure decreases and heart rate increases A. 2, 4, and 6 only B. 1, 2, 3, and 5 only C. 2, 3, 5, and 6 only D. 1, 2, 3, and 4 only

B. 1, 2, 3, and 5 only

8. When preparing to assist the physician with the cardioversion of a patient, which of the following must be checked? 1. A strong R wave should be seen on the ECG monitor. 2. The charge level should be set as ordered. 3. The electric paddles should be kept clean for the best possible conduction. 4. Ensure that the ECG electrodes are attached properly. A. 1 and 3 only B. 1, 2, and 4 only C. 3 and 4 only D. 1, 2, 3, 4

B. 1, 2, and 4 only

20. After an exercise routine, a 59-year-old man experiences sudden chest pain with shortness of breath. ECG monitoring in the Emergency Department reveals the following rhythm strip. What should the respiratory therapist recommend? 1. Synchronized cardioversion 2. 12-lead ECG 3. Defibrillation 4. Administer oxygen 5. Angioplasty A. 1 and 5 only B. 2 and 4 only C. 2, 3, and 4 only D. 1, 2, 3, 4, 5

B. 2 and 4 only

9. While working in the neonatal Intensive Care Unit, a respiratory therapist is called to assist in the care of a 900-gram premature newborn. The neonatologist asks you to get the proper endotracheal tube for intubation. What would be the correct size tube? A. 1.5-mm ID B. 2.5-mm ID C. 3.5-mm ID D. 4.0-mm ID

B. 2.5-mm ID

34. A 6-year-old postoperative patient will be started on mechanical ventilation. What should be the initial respiratory rate? A. 14/min B. 20/min C. 50/min D. 80/min

B. 20/min

19. It is best to coach a patient to breathe in the following pattern for particle deposition in smaller airways and alveoli: 1. Inhale a VT. 2. Inhale rapidly. 3. Inhale an IC. 4. Hold the breath for up to 10 s before exhaling. 5. Inhale at a slow speed. A. 1 and 2 only B. 3, 4, and 5 only C. 1 and 5 only D. 1, 2, and 4 only

B. 3. 4, and 5 only

4. A 40-year-old patient recovering from ARDS is receiving mechanical ventilation with a tidal volume of 650 mL. The patient has an arterial line, a PAC, and capnometry for monitoring. The following information is gathered after a change in PEEP level: PaCO2 43 torr PaO2 79 torr PvO2 32 torr PETCO2 38 torr PECO2 22 torr Calculate the patient's VD. A. 273 mL B. 319 mL C. 338 mL D. 384 mL

B. 319 mL

31. An 8-year-old patient with asthma is going to be given a 30% oxygen and 70% helium mix of heliox through a nonrebreathing mask and reservoir bag. The physician has ordered the child to receive 7 L/min of the gas mix. Because it will be delivered through an oxygen flowmeter, what flow should be set? A. 3.9 L/min B. 4.4 L/min C. 9.8 L/min D. 11.2 L/min

B. 4.4 L/min

13. A 45-year-old female 50-kg (110-pound) patient is recovering after abdominal surgery. The physician has ordered IPPB to help correct her atelectasis after IS was found to be ineffective. Her spontaneous VT is 350 mL. Based on this information, at what level should her minimum initial IPPB VT be set? A. 350 mL B. 450 mL C. 700 mL D. 900 mL

B. 450 mL

2. An unconscious, apneic adult male patient with a drug overdose has been admitted through the Emergency Department. He will be placed onto an older ventilator that cannot compensate for compressed volume. His ideal body weight is 80 kg (176 lb). The most appropriate uncorrected ventilator VT would be: A. 950 mL B. 800 mL C. 550 mL D. 400 mL

B. 800 mL

1. A home care patient has a problem with his O2 concentrator and needs to change to the H tank of O2. If the patient's nasal cannula is receiving a flow of 3 L/min and the tank pressure is 1300 psig, how long can the patient receive O2? A. About 2 hours B. About 22 hours C. About 120 hours D. About 1300 hours

B. About 22 hours

31. A 12-year-old patient does not tolerate postural drainage for secretion clearance. The physician wishes to consider high-frequency airway oscillation. Which of the following options should be recommended first? A. HFCWO B. Acapella C. IPV D. ACBT

B. Acapella

8. In the Emergency Department, a respiratory therapist is giving an IPPB treatment with albuterol (AccuNeb) to an asthmatic male patient. During a break in the treatment, the patient complains that his lungs feel too full and he does not feel like all the IPPB volume is getting out. What should be done? A. Increase the flow. B. Add expiratory retard. C. Increase the system pressure. D. Change to 100% oxygen.

B. Add expiratory retard.

11. What O2 delivery device should be recommended for a patient who has a variable respiratory rate, I:E ratio, and VT? A. Nasal cannula B. Air entrainment mask C. Simple O2 mask D. Transtracheal catheter

B. Air entrainment mask

3. A respiratory therapist notices that air is bubbling through the water seal of the patient's pleural drainage system when she coughs. What does this indicate? A. The vacuum has to be increased. B. Air is still leaking through a tear in the lung. C. The proper level of vacuum has been set. D. There is a leak in the system.

B. Air is still leaking through a tear in the lung.

16. Expiratory retard would be indicated in a patient with: A. Pulmonary edema B. Air trapping C. Pleural effusion D. Pneumothorax

B. Air trapping

26. While performing a sleep study, the respiratory therapist notices the following: the respiratory inductive plethysmography reading indicates chest and abdominal movement, the nasal thermistor shows no air movement, and the patient's pulse oximeter value drops to 85%. After 35 seconds, the patient snores loudly, rolls on the side, and resumes normal breathing. What best describes the patient's problem? A. Central sleep apnea B. Airway obstruction C. Cheyne-Stokes respiration D. Hyperventilation

B. Airway obstruction

32. A 36-week gestational age neonate is hypoxemic despite mechanical ventilation and has clinical evidence of persistent pulmonary hypertension of the newborn. What can be done to correct the hypoxemia? A. Instill intratracheal surfactant. B. Begin nitric oxide therapy. C. Begin 10 cm water PEEP. D. Begin carbogen therapy.

B. Begin nitric oxide therapy.

25. A newborn infant with HLHS has just been transferred to the hospital. Mechanical ventilation is being instituted. What else can be done to help improve the neonate's heart function? A. Nitric oxide therapy B. Carbogen therapy C. Close the PDA D. Heliox therapy

B. Carbogen therapy

29. An adult patient who was rescued from a house fire is being received in the Emergency Department. The patient is wearing a simple oxygen mask at 5 L/min. The SpO2 value by pulse oximeter is 100%, and his SaO2 value from an ABG sample analyzed on a CO oximeter is 73%. What should be recommended at this time? A. Maintain the simple oxygen mask at the present flow. B. Change the patient to a nonrebreathing mask. C. Decrease the oxygen flow to the simple oxygen mask to 4 L/min. D. Maintain present therapy and recalibrate the CO oximeter.

B. Change the patient to a nonrebreathing mask.

28. A 75-year-old male with congestive heart failure has been receiving mechanical ventilation over the past 24 hours. The diuretic drug furosemide (Lasix) has been given several times. What is the best way to evaluate how the patient's lung function is responding? A. Compare the patient's admission weight versus current weight. B. Compare CLT measurements at the start of therapy and now. C. Compare airway resistance measurements at the start of therapy and now. D. Evaluate breath sound changes over the past 24 hours

B. Compare CLT measurements at the start of therapy and now.

34. A neonatal patient has primary pulmonary hypertension and is receiving mechanical ventilation. After the neonate receives 20 ppm of nitric oxide therapy, PVR returns to the normal range. What should be recommended at this time? A. Discontinue the nitric oxide therapy. B. Decrease the nitric oxide to 10 ppm. C. Add 1% carbogen to the nitric oxide mix. D. Increase the nitric oxide therapy to 30 ppm

B. Decrease the nitric oxide to 10 ppm.

4. Upon entering a patient's room, the respiratory therapist notices that the ECG monitor shows VT. A carotid pulse cannot be felt and the nurse says that he cannot find a blood pressure. What should be recommended? A. Check the other arm for a blood pressure. B. Defibrillate the patient. C. Intubate the patient and start the patient on a ventilator. D. Initiate synchronized cardioversion of the patient.

B. Defibriallat the patient

24. During a CPR attempt on a 50-year-old patient, the respiratory therapist successfully intubates the patient and begins ventilating with a manual resuscitator. The physician is unable to start an IV line. How should the CPR drugs be given? A. Intraosseous injection B. Endotracheal instillation C. Intracardiac injection D. Nasal spray

B. Endotracheal instillation

17. A 16-year-old female patient has severe and chronic asthma. Her physician wishes to change her medications to prevent her from having asthma attacks. All of the following medications would be helpful EXCEPT: A. Zileuton (Zyflo) B. Epinephrine (Adrenaline) C. Cromolyn sodium (Intal) D. Zafirlukast (Accolate)

B. Epinephrine (Adrenaline)

5. A respiratory therapist is ordered to give an IPPB treatment to a comatose patient who has lip ulcers. What patient-machine connection should be used? A. Mouthpiece B. Face mask C. Bennett seal with mouthpiece D. Nose clips and mouthpiece

B. Face mask

23. A 67-year-old woman who suffered a stroke is having difficulty swallowing her oral secretions. An order is written to perform oropharyngeal suctioning. What risks or hazards are associated with this procedure? A. Bradycardia B. Gagging C. Hypoxemia D. Tachycardia

B. Gagging

27. An infant daughter has just been delivered by cesarean section to an anesthetized mother. Because she is not breathing adequately, an endotracheal tube has been inserted. What can be done to improve the infant's condition and get her to breathe? A. Give IV epinephrine. B. Give IV naloxone (Narcan). C. Begin bag/mask ventilation with oxygen. D. Give endotracheal atropine (atropine sulfate).

B. Give IV naloxone (Narcan.).

13. A female patient is using a flow-oriented type of incentive spirometer at a rate of 20 times per minute. She is able to suspend the ball marker for 1 second at her targeted IC. How could the treatment be improved? A. Increase her target volume by 500 mL. B. Have her breathe at a slower rate and hold the volume longer. C. Have her exhale more rapidly. D. Lower her target volume by 100 mL and raise her respiratory rate to 25 times per minute.

B. Have her breathe at a slower rate and hold the volume longer.

29. The pulmonary function testing laboratory has recently acquired an exhaled nitric oxide analyzer. Which patient population should it be used with? A. History of COPD B. History of asthma attacks C. History of acute respiratory distress syndrome D. History of asbestos exposure

B. History of asthma attacks

7. During the transport of your patient with a pneumothorax, the chest tube drainage system is pulled off of the drainage tubing and cracked open. The best response is to: A. Clamp the tube near the patient's chest at once. B. Hold the distal end of the tubing a few centimeters below the surface of a bottle of sterile water or saline. C. Leave the tube open to the atmosphere. D. Have the patient perform the Valsalva maneuver until a new system can be set up.

B. Hold the distal end of the tubing a few centimeters below the surface of a bottle of sterile water or saline.

5. What breathing pattern should be recommended for an aerosolized medication to be deposited primarily in the larger airways? 1. Inhale a VT. 2. Inhale an IC. 3. Inhale slowly. 4. Inhale at a normal speed. 5. Breathe in a normal pattern. A. 2 and 3 only B. 1, 4, and 5 only C. 4 and 5 only D. 2 and 4 only

B. I, 4, and 5 only

11. A 75-year-old patient with a recent stroke causing right-sided weakness and dysphasia has a complication of atelectasis. The patient's IC is measured at 1.0 L. What therapy would be most appropriate to treat the patient's atelectasis? A. IS B. IPPB therapy C. PEP therapy D. Postural drainage therapy

B. IPPB therapy

73. An adult patient with ARDS has developed a pneumothorax during volume-controlled mechanical ventilation. The physician has decided to change the patient to HFO. The following HFO parameters have been set: Frequency 4 Hz Amplitude 20 cm water I:E ratio 1:2 Oxygen 60% PEEP 8 cm water After 50 minutes of HFO, the patient has the following blood gas values: pH 7.31 PaCO2 52 torr PaO2 66 torr HCO3 − 27 mEq/L BE +2 mEq/L SpO2 92% What should the respiratory therapist recommend? A. Increase the PEEP to 15 cm water. B. Increase the amplitude to 25 cm water. C. Change the I:E ratio to 1:1. D. Continue to monitor the patient.

B. Increase the amplitude to 25 cm water.

7. A spontaneously breathing patient's tracheostomy tube cuff pressure has been measured at 10 mm Hg. What would be recommended? A. Leave the cuff pressure as it is. B. Increase the cuff pressure to 15 mm Hg. C. Increase the cuff pressure to 30 cm water. D. Replace the tube with a larger one.

B. Increase the cuff pressure to 15 mm Hg.

68. A patient with a closed head injury and increased ICP is being ventilated mechanically in the VC, A/C mode with an FIO2 of 0.5, a rate of 12, and a tidal volume of 600 mL. The patient's ABG results are shown: pH 7.43 PaCO2 35 torr PaO2 195 torr HCO3 − 22 mEq/L Base excess −2 SaO2 100% The physician orders a PaCO2 of 25 torr for the patient. What should the respiratory therapist change on the ventilator to accomplish this? A. Add mechanical dead space. B. Increase the tidal volume. C. Decrease the oxygen percentage. D. Decrease the ventilator rate.

B. Increase the tidal volume.

14. A patient is known to have advanced COPD. When checking the patient's VD/VT ratio, what would be expected? A. Unaffected by patient's condition B. Increased C. Normal D. Decreased

B. Increased

6. A patient with a history of congestive heart failure is inadvertently given intravenous fluids of 2000 mL instead of the ordered amount of 200 mL. Which of the following is most likely to be seen? A. Decreased lung markings on chest radiograph B. Increased pulmonary capillary wedge pressure C. Increased PaO2 D. Decreased PAP

B. Increased pulmonary capillary wedge pressure

21. A semiconscious patient with many tracheal secretions will need frequent nasotracheal suctioning. What can be done to minimize trauma from the procedure? A. Insert a tracheostomy button with a speaking valve. B. Insert a nasopharyngeal airway. C. Sedate the patient and insert an oropharyngeal airway. D. Suction through a fenestrated tracheostomy tube.

B. Insert a nasopharyngeal airway

20. A mechanically ventilated patient is having a central venous line inserted by the subclavian vein route. The patient coughs vigorously. Within 1 minute the peak pressure on the ventilator increases significantly, and the SpO2 value is progressively decreasing. Chest percussion demonstrates a hyperresonant sound over the right side of the chest, and breath sounds are diminished on the right side. What is the most important thing to do at this time? A. Complete the insertion of the central venous pressure (CVP) line. B. Insert a pleural chest tube on the right side. C. Get a chest radiograph. D. Compare the peak and plateau pressures on the ventilator.

B. Insert a pleural chest tube on the right side.

23. During a surgical procedure, the anesthesiologist wishes to protect the patient's airway and provide mechanical ventilation, but does not want to place an endotracheal tube. What airway should be used? A. Combitube B. Laryngeal mask airway C. Oropharyngeal airway D. Nasopharyngeal airway in each nostril

B. Laryngeal mask airway

18. A patient with post-polio syndrome is being ventilated with NPPV and has an IPAP level of 15 cm water and an EPAP level of 5 cm water. The patient complains of being short of breath. The respiratory therapist checks the patient's VT and finds that it has dropped. How should the tidal volume be restored? A. Lower the IPAP level. B. Lower the EPAP level. C. Raise the IPAP level. D. Raise the EPAP level.

B. Lower the EPAP level.

20. During nasotracheal suctioning, it is important to: A. Lubricate the catheter with sterile water. B. Lubricate the catheter tip with a sterile, water-soluble lubricant jelly. C. Place the catheter in the refrigerator to make it firmer and easier to pass. D. Lubricate the catheter with a sterile, normal saline solution

B. Lubricate the catheter tip with a sterile, water-soluble lubricant jelly.

25. A patient has been scheduled for a battery of pulmonary function tests. He tells you that he is so nervous about the testing that he has smoked four cigarettes in the past 2 hours. Which of the following tests is most likely to be adversely affected by this? A. FRC B. Lung diffusion C. Raw D. FVC

B. Lung diffusion

8. All of the following are contraindications to percussion and vibration EXCEPT: A. Performing the procedure over the kidneys B. Mobilizing large amounts of secretions C. Performing the procedure over bare skin D. Performing the procedure over or near a surgical site

B. Mobilizing large amounts of secretions

30. As the respiratory therapist assigned to the Intensive Care Unit, you are helping in the care of the following four patients: Mr. Boone is a 28-year-old male being observed after an appendectomy. Mrs. Decker is a 74-year-old female with sepsis. Mrs. Dylan is a 48-year-old female with gastritis who is receiving intravenous fluids for dehydration. Mr. Zawinal is a 42-year-old male with diabetes. The following series of BP measurements (in mm Hg) were taken on these patients: 10:00 am 12:00 pm 2:00 am Mr. Boone 125/80 122/82 120/78 Mrs. Decker 90/60 105/40 85/45 Mrs. Dylan 88/70 94/75 105/78 Mr. Zawinal 135/98 129/94 125/89 Which of these patients should have an arterial line placed? A. Mr. Boone B. Mrs. Decker C. Mrs. Dylan D. Mr. Zawinal

B. Mrs. Decker

45. High-frequency ventilation would be indicated for all of the following situations EXCEPT: A. Laryngoscopy B. Near drowning C. Bronchopleural fistula D. Bronchoscopy

B. Near drowning

25. A 48-year-old woman had her gallbladder removed. What is most effective in preventing postoperative atelectasis? A. Blow bottles B. PEP therapy C. Mechanical chest percussor D. Inspiratory muscle training

B. PEP therapy

1. A fully compensatory pause is seen after which type of heartbeat? A. NSR B. PVC C. PAT D. VT

B. PVC

23. The laboratory results of a patient's sputum sample indicate that the patient has a gram-positive pulmonary infection. Which of the following medications should be recommended? A. Ribavirin (Virazole) B. Penicillin (Ampicillin) C. TOBI D. Gentamycin (Garamycin)

B. Penicillin (Arnpicillin)

30. Before a patient performs a forced vital capacity test, all of the following should be done to the water-sealed spirometer EXCEPT: A. Make sure the circuit is airtight. B. Place carbon dioxide-absorbing material in line with the circuit. C. Pump a 3-L volume into and out of the circuit to check for leaks. D. Check the kymograph speeds.

B. Place carbon dioxide-absorbing material in line with the circuit.

2. All the following are acceptable ways to ventilate a patient during CPR EXCEPT: A. Endotracheal tube B. Pneumatic (demand-valve) resuscitator C. Mouth-to-valve resuscitator D. Manual resuscitator

B. Pneumatic (demand-valve) resuscitator

30. An intubated and mechanically ventilated adult patient has been returned to the long-term care unit after being transported to the radiology department for an abdominal radiograph examination. The respiratory therapist observes that the patient's trachea is midline; however, the patient's left chest area does not rise with inspiration as much as the right chest area. The endotracheal tube is at the 28-cm mark at the patient's teeth. What should be done now? A. Check the abdominal radiograph for signs of vomiting and aspiration. B. Pull the endotracheal tube back about 4 cm. C. Check the patient's end-tidal carbon dioxide level. D. Deliver a larger tidal volume breath to inflate the left lung better.

B. Pull the endotracheal tube back about 4 cm.

21. An adult patient is receiving mechanical ventilation when the following data are gathered: 9:00 am 11:00 am PaO2 75 torr 53 torr Pulmonary vascular resistance 120 dyn/s/cm−5 340 dyn/s/cm−5 Pulmonary capillary wedge pressure 8 mm Hg 10 mm Hg Pulmonary artery pressure 25/10 mm Hg 42/21 mm Hg How should the results be interpreted? A. Pulmonary edema B. Pulmonary embolism C. Pneumonia D. Cardiac tamponade

B. Pulmonary embolism

64. A 55-kg (120-lb) female patient is being ventilated with the PC, SIMV mode and a rate of 10, tidal volume of 400 mL, 10 cm water of therapeutic PEEP, and 35% inspired oxygen. She has an 8.0-mm-inner diameter tracheostomy tube. Her spontaneous tidal volume is 300 mL, with a rate of 10/min. The most recent ABG shows: pH 7.40 PaCO2 41 torr PaO2 95 torr HCO3 − 24 mEq/L Base excess 0 What should be recommended? A. Reduce the SIMV rate to 3. B. Reduce the PEEP to 7 cm water. C. Increase the SIMV rate to 12. D. Add 10 cm of Pressure Support.

B. Reduce the PEEP to 7 cm water.

26. A 20-year-old asthmatic patient has received a standard dose of levalbuterol (Xopenex). Breath sounds reveal loud, bilateral wheezes. Over the course of the treatment, the patient's heart rate changed from 98 to 105 beats/min. What would you recommend? A. Stop the treatment and notify the physician. B. Repeat the treatment and monitor the patient. C. Switch the medication to albuterol (Ventolin). D. Add theophylline (aminophylline) to the intravenous line.

B. Repeat the treatment and monitor the patient.

14. A patient with pneumonia is receiving mechanical ventilation, and an HME is being used for humidification. After receiving an aerosolized bronchodilator treatment, the patient coughs secretions into the HME. The high-pressure alarm begins to sound off. What should be done? A. Reset the high-pressure alarm. B. Replace the HME. C. Stop the bronchodilator treatment. D. Suction the patient.

B. Replace the HME.

10. When checking a home care patient's reservoir-type nasal cannula, the therapist notices that the reservoir does not fill and empty in synchrony with the patient's breathing pattern. Based on this, what should be done? A. Increase the O2 flow. B. Replace the cannula. C. Decrease the O2 flow. D. Switch the patient to an air entrainment mask.

B. Replace the cannula.

36. A 4-month-old pediatric patient has chronic lung disease secondary to recovering from RDS. The patient now has pneumonia caused by RSV and is on a mechanical ventilator. What can be given to improve the patient's condition? A. Intravenous racemic epinephrine (MicroNefrin) B. Ribavirin (Virazole) by SPAG II nebulizer C. Intratracheal beractant (Survanta) D. Cromolyn sodium (Intal) by SVN

B. Ribavirin (Virazole) by SPAG II nebulizer

17. After a successful CPR attempt, a patient with an oral endotracheal tube is placed on a mechanical ventilator in the Intensive Care Unit. The respiratory therapist notices that the exhaled CO2 monitor is appropriately changing color with each breath cycle. The patient's breath sounds are present on the right side but diminished on the left side. What is the most likely cause of this situation? A. Left-sided pneumothorax B. Right bronchial intubation C. Malfunctioning exhaled CO2 monitor D. Delivered tidal volume is too small

B. Right bronchial intubation

14. A conscious patient requires nasotracheal suctioning. During the procedure, the patient's blood pressure decreases to 100/60 mm Hg, and the heart rate decreases from 110 to 60 beats/min. What should be done? A. Change to a catheter with a larger diameter. B. Shorten the suctioning time. C. Insert an oropharyngeal airway before suctioning. D. Squirt 5 mL of saline down the suction catheter into the patient's trachea.

B. Shorten the suctioning time.

27. A 70-year-old patient who had a stroke has aspirated and now has a fever and pulmonary secretions. The respiratory therapist notices on the anteroposterior and right lateral chest radiographs that the posterior segment of the right upper lobe is opaque. What postural drainage position should be used with this patient? A. On the right side, head down 30 degrees, onefourth turn up from face down B. Sitting upright and leaning forward 30 degrees C. Head down 15 degrees, pillow behind the right side to turn one-fourth turn up from flat D. Head down 15 degrees, pillow behind the left side to turn one-fourth turn up from flat

B. Sitting upright and leaning forward 30 degrees

11. A patient is performing an exercise test and has the following signs and symptoms: systolic blood pressure of 260 mm Hg, cyanosis, headache, and dizziness. Which of the following should be recommended? A. Continue until the respiratory exchange ratio reaches 1.1. B. Stop the test at this time. C. Continue until the patient complains of shortness of breath. D. Continue the test at a lower work level.

B. Stop the test at this time.

8. A patient has an HME in place for humidification purposes. The respiratory therapist notices that the peak pressure has increased by 10 cm H2O in the past hour. The nurse reported to you that the patient had thick secretions when last suctioned. What should be done in this situation? A. Switch to a cool pass-over-type humidifier. B. Switch to a heated wick-type humidifier. C. Instill normal saline before suctioning. D. Turn up the temperature on the HME

B. Switch to a heated wick-type humidifier.

9. While giving an IPPB treatment with a Vortran unit, a hissing sound is heard and the patient complains that the inspiratory time is too long. What is the most likely problem? A. The nebulizer hose is attached to the exhalation valve. B. The nebulizer medication jar is loose. C. The bacteria filter is missing. D. The inspiratory and expiratory hoses are reversed.

B. The nebulizer medication jar is loose.

27. Indications for oral intubation include all the following EXCEPT: A. The patient requires mechanical ventilation. B. The patient has a cervical spine injury. C. The patient requires frequent tracheal suctioning. D. The patient is at risk for vomiting and aspirating.

B. The patient has a cervical spine injury

35. Which of the flow-volume loops represents a fixed large-airway obstruction? A. Tracing A B. Tracing B C. Tracing C D. Tracing D

B. Tracing B

13. A humidity or aerosol system delivering body-temperature gas is used in all the following situations EXCEPT: A. Patient with a tracheostomy B. Twenty-month-old infant with laryngotracheobronchitis C. Patient with chronic obstructive pulmonary disease with thick secretions D. Hypothermic near-drowning victim

B. Twenty-month-old infant with laryngotracheobronchitis

13. While doing O2 equipment rounds, the respiratory therapist comes upon a cyanotic patient who is not breathing. After repositioning the patient and hyperextending the neck, it is noticed that the patient has open lip ulcers. What would be the best way to ventilate this patient? A. Perform mouth-to-mouth ventilation. B. Use a mouth-to-valve device stored in the room for this purpose. C. Run to the CPR crash cart and get a manual resuscitation bag and mask. D. Wait for the anesthesiologist to intubate the patient's airway, then use a manual resuscitation bag.

B. Use a mouth.to-valve device stored in the room for this purpose,

8. A 40-year-old patient has pneumonia in the left lower lobe with a large amount of secretions. What should be recommended for better suctioning? A. Use the largest diameter suction catheter available. B. Use a suction catheter with a Coudé tip. C. Use the longest suction catheter available. D. Suction for a longer period

B. Use a suction catheter with a Coudé tip.

26. A patient with congestive heart failure is having an exacerbation of the condition. The physician is going to support the patient's breathing with noninvasive ventilation while being aggressively treated. What should be recommended for humidification? A. Heat-moisture exchanger B. Wick-type of humidifier C. Large-volume nebulizer D. No need for added humidity

B. Wick-type of humidifier

10. The respiratory therapist has started a patient on the A/C mode and will be using pressure sensitivity for patient breath triggering. What should the control be set at? A. 0 cm H2O B. −1 to −2 cm H2O C. −5 cm H2O D. 1-2 cm H2O

B. −1 to −2 cm H2O

1. A 67-year-old male patient with a history of COPD and heart failure has arrived in the Emergency Department with a chief complaint of dyspnea. To help with the differential diagnosis, the physician orders the patient's blood to be tested for bacteremia, CK-MB, cTnI, cTnT, and BNP. All results are negative. What is the most likely cause of the patient's dyspnea? A. Exacerbation of COPD B. Myocardial infarction C. Pneumonia D. Congestive heart failure

A. Exacerbation of COPD

19. It is most important to ask a patient with a broken ankle from a recent slip on an icy sidewalk about which of the following? A. Level of pain B. Level of consciousness C. Work of breathing D. Emotional state

A. Level of pain

37. An elderly patient with congestive heart failure has been treated with the diuretic furosemide (Lasix). Which serum electrolyte is the most important to monitor in this situation? A. Potassium B. Chloride C. Calcium D. Sodium

A. Potassium

17. After working with a trauma patient in the Emergency Department, a respiratory therapist sees that there is blood on the patient's pulse oximeter. How should it be processed before being used with another patient? A. Wiped down with a bleach solution B. Low-level disinfection with an alcohol solution C. Sterilized by ethylene oxide D. High-level disinfection by glutaraldehyde

A. Wiped down with a bleach solution

16. After assisting in a bronchoscopy to inspect a patient's airways, the respiratory therapist needs to clean the bronchoscope. How should the unit be disinfected? 1. Glutaraldehyde solution 2. Iodine solution 3. Enzymatic detergent 4. Hot water wash A. 2 only B. 1 and 3 only C. 2 and 4 only D. 1, 2, and 3 only

B. 1 and 3 only

10. Interpret the following arterial blood gas drawn from a patient who is breathing 35% O2: pH, 7.29; PaCO2, 37 torr; PaO2, 86 torr; bicarbonate, 17 mEq/L; and base excess, −8 mEq/L; SaO2, 90%. 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Compensated metabolic acidosis 4. Uncompensated metabolic acidosis 5. Compensated respiratory acidosis A. 2 and 4 only B. 1 and 4 only C. 2 and 5 only D. 1 and 3 only

B. 1 and 4 only

11. In palpating a patient for symmetrical chest movements, it is noticed that the patient's left side does not move as much as the right side. This indicates that the patient has which condition or conditions? 1. Emphysema 2. Congestive heart failure 3. Left-sided pneumonia 4. Left-sided pneumothorax 5. Right-sided pneumonia A. 2 only B. 3 and 4 only C. 4 and 5 only D. 1 and 2 only

B. 3 and 4 only

14. A tension pneumothorax is identified by which of the following? 1. Chest X-ray film shows a shift of the mediastinum toward the affected lung. 2. Chest X-ray film shows elevation of the hemidiaphragm on the affected side. 3. The patient's vital signs suddenly deteriorate. 4. Chest X-ray film shows a depression of the hemidiaphragm on the affected side. 5. Chest X-ray film shows a shift of the mediastinum away from the affected lung. 6. Vital signs are essentially unchanged. A. 1, 2, and 6 only B. 3, 4, and 5 only C. 1, 2, and 3 only D. 1, 3, and 4 only

B. 3, 4, and 5 only

36. The respiratory therapist is assisting in the delivery of a high-risk neonate. At 1 minute after birth, the following are noted: • Heart rate is 90 beats/min. • There is a weak cry. • Arms and legs show some flexion. • The baby grimaces when a nasal catheter is inserted into a nostril. • Extremities are blue with a pink body (acrocyanosis). The neonate should be given an Apgar score of: A. 3 B. 5 C. 7 D. 9

B. 5

31. A spontaneously breathing neonate is in an incubator. The patient is being monitored with a transcutaneous carbon dioxide electrode on her right upper chest. An hour ago, the patient's carbon dioxide value was 45 torr, and now it is 5 torr. The nurse tells you that no change has occurred in the neonate's condition. What is the most likely explanation for this difference? A. The patient has a patent ductus arteriosus. B. Air has leaked under the electrode. C. The temperature inside the incubator has been increased. D. The patient's cardiac output and lung condition have improved.

B. Air has leaked under the electrode.

20. All of the following could result in a mediastinal shift on a chest X-ray film EXCEPT: A. Right-sided hemothorax B. Bilateral lower-lobe pneumonia C. Left-sided tension pneumothorax D. Right lower-lobe atelectasis

B. Bilateral lower-lobe pneumonia

17. A patient has Guillain-Barré syndrome and pneumonia. The patient has just been placed on 35% O2 by mask. The physician asks for your suggestion on the best way to evaluate the patient's overall ability to breathe. What should be recommended? A. Doing a full set of pulmonary function tests B. Drawing an arterial blood sample for analysis C. Performing pulse oximetry D. Performing a force vital capacity measurement

B. Drawing an arterial blood sample for analysis

22. An adult patient with a history of smoking has shown an increased anteroposterior diameter and depressed hemidiaphragms on a PA chest radiograph. It is most likely that the patient has: A. Pulmonary fibrosis B. Emphysema C. Taken too deep a breath D. Left-ventricular failure

B. Emphysema

7. A contaminated Bird Mark 7 intermittent positive- pressure breathing unit must be sterilized before use with another patient. What is the best method? A. Pasteurization B. Ethylene oxide C. 10-hour soak in glutaraldehyde D. Steam autoclave

B. Ethylene oxide

8. An acute rise in PaCO2 level from 40 to 50 torr would result in the following change in pH: A. Rise of 0.10 unit B. Fall of 0.05 unit C. Fall of 0.10 unit D. Rise of 0.05 unit

B. Fall of 0.05 unit

24. A 48-year-old patient with an extensive smoking history usually coughs out about 20 mL of sputum every day. The patient developed a "chest cold" 4 days ago and has noticed increased shortness of breath and thicker secretions. What should be done at this time? A. Have the patient increase the flow on his home oxygen concentrator. B. Get a sputum sample for a culture-and-sensitivity study. C. Have the patient perform a 6-minute walk test. D. Perform percussion to determine the hemidiaphragm positions.

B. Get a sputum sample for a culture-and-sensitivity study.

12. A home care respiratory therapist is setting up a continuous home oxygen system for a 52-year-old patient with congestive heart failure. In addition to teaching the patient about her condition and how to properly use the oxygen system, which of the following should the therapist recommend? A. Get the SARS vaccination. B. Get the Pneumovax vaccination if it has not been given already. C. Soak the nasal cannula in a glutaraldehyde solution for 1 hour every day. D. If the patient has already received the Pneumovax vaccination, she should get a booster.

B. Get the Pneumovax vaccination if it has not been given already.

16. A 65-year-old female patient has distended external jugular veins even though her head and body are raised 45 degrees above her legs. This would indicate that she: A. Is hypertensive B. Is fluid-overloaded C. Has emphysema D. Is dehydrated

B. Is fluid-overloaded

7. A 50-year-old patient has a PaO2 value of 72 torr when breathing room air. How should this be interpreted? A. Normal for a person of that age B. Mild hypoxemia C. Moderate hypoxemia D. Severe hypoxemia

B. Mild hypoxemia

1. Before drawing a blood gas sample from the radial artery, which test should be performed? A. Allen test B. Modified Allen test C. Blood pressure measurement D. Nail bed blanching

B. Modified Allen test

32. An adult patient with a history of COPD and left-ventricular failure has been hospitalized. A series of diagnostic procedures is being performed. The preferred radiographic position to minimize distortion of the heart is: A. Anteroposterior B. Posteroanterior C. Lateral D. Oblique

B. Posteroanterior

30. Which of the following clinical values indicates that a patient's tissues are hypoxemic? A. PaO2 of 55 torr B. PvO2 of 25 torr C. SvO2 of 80% D. SaO2 of 88%

B. PvO2 of 25 torr

10. In examining a patient, the respiratory therapist notices that the patient has greatly diminished breath sounds in the right lower lobe and the trachea has shifted to the right. These signs indicate which condition? A. Right-sided pneumothorax B. Right-sided atelectasis C. Left-sided pneumothorax D. Left-sided pneumonia

B. Right-sided atelectasis

After feeling a sudden chest pain and shortness of breath while lifting weights, a 37-year-old man drove himself to the Emergency Department. After starting oxygen therapy on the patient, the respiratory therapist performed a physical exam. Pertinent findings included a hyperresonant percussion note on the right side and tracheal shift to the left. Based on these findings, what is the patient's most likely problem? A. Broken ribs on the right side B. Right-sided pneumothorax C. Broken clavicle on the right side D. Acute myocardial infarction

B. Right-sided pneumothorax

1. A hospitalized patient who recovered from a C. botulinum infection received several respiratory care services. How should a nondisposable plastic pulmonary-function-testing mouthpiece be sterilized before being reused? A. Steam autoclave for 15minutes. B. Soak in glutaraldehyde solution for 10hours. C. Pasteurize for 20minutes. D. Soak in an alcohol solution for 15minutes.

B. Soak in glutaraldehyde solution for 10hours.

8. To help determine if a patient has orthopnea, which of the following should be asked? A. "How many flights of stairs can you climb?" B. "Do you know who the governor is?" C. "Do you need to use extra pillows when you sleep?" D. "Do any foods make it harder to cough up your secretions?"

C. "Do you need to use extra pillows when you sleep?"

18. A respiratory therapist is called to evaluate a patient who is using a pulse oximeter. Upon entering the room, it is noticed that the patient is an African- American woman with an oximeter probe on her right earlobe. The monitor shows a weak pulse signal and a fluctuating SpO2 value. Which of the following should be done in an attempt to correct the problem? 1. Try monitoring from a fingertip. 2. Switch to a probe over the bridge of the nose. 3. Cover the probe with an opaque wrap. 4. Switch the probe to the left earlobe. A. 2 only B. 3 only C. 1 and 3 only D. 2 and 4 only

C. 1 and 3 only

15. An annual influenza vaccination should be given to which of the following groups? 1. Health care workers 2. People 50 years of age and older 3. Children and adults with asthma 4. Infants younger than 6 months of age A. 1 and 2 only B. 3 and 4 only C. 1, 2, and 3 only D. 1, 2, 3, 4

C. 1, 2, and 3 only

2. The predicted FVC value for African-Americans is: A. 10% to 15% higher than that for Caucasians B. The same as for Caucasians C. 10% to 15% less than that for Caucasians D. 20% to 25% less than that for Caucasians

C. 10% to 15% less than that for Caucasians

13. Interpret the following arterial blood gas drawn from a patient who is breathing 24% O2: pH, 7.45; PaCO2, 22 torr; PaO2, 57 torr; bicarbonate, 16 mEq/L; and base excess, −6 mEq/L; SaO2, 91%. 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Compensated respiratory alkalosis 4. Uncompensated respiratory alkalosis 5. Combined metabolic and respiratory acidosis A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 5 only

C. 2 and 3 only

7. To help determine a patient's level of consciousness, which of the following questions should be asked? 1. "Do you know what day this is?" 2. "Can I see your identification wristband?" 3. "Do you know where you are?" 4. "How are you feeling today?" 5. "Do you know who the president is?" A. 3 only B. 5 only C. 2 and 4 only D. 1 and 3 only

C. 2 and 4 only

4. A respiratory therapist working in the Intensive Care Unit notices that an arterial blood sample has been sitting out for 40 minutes. It was not put in ice water. The blood gas analysis could be affected in which of the following ways? 1. Increased PaO2 2. Increased PaCO2 3. Decreased PaO2 4. Decreased PaCO2 5. Increased pH 6. Decreased pH A. 1, 2, and 6 only B. 3, 4, and 5 only C. 2, 3, and 6 only D. 3, 4, and 6 only

C. 2, 3, and 6 only

20. A 35-year-old patient with pneumonia is receiving mechanical ventilation with PEEP. Calculate and interpret the patient's P(A-a)O2 level. The following conditions exist: PB = 750 torr; normal is 760 torr for sea level Ph2o = 54 torr because your patient's temperature is 104° F/40° C; normal is 47 torr for a normal temperature FIO2 = 0.5 for 50% inspired oxygen; normal is 0.21 for room air PaCO2 = 36 torr PaO2 = 60 torr Respiratory exchange ratio = 0.8 PACO2 = [( PB − PH2O) FIO2 ] − PaCO2 0.8 Based on the listed conditions, what is the patient's PAO2 value? A. 95 torr B. 101 torr C. 303 torr D. 312 torr

C. 303 torr

7. Before a patient does an FVC test, the pneumotachometer should have the following done: A. The gas analyzer should be calibrated. B. A CO2-absorbing material should be placed in line with the circuit. C. A 3-L volume should be pumped into and out of the circuit. D. The kymograph speeds should be checked.

C. A 3-L volume should be pumped into and out of the circuit.

16. A 50-year-old patient with emphysema seems to be tiring 30 minutes into a weaning attempt on a Briggs adapter (T-piece). The best way to evaluate the patient's ventilatory status is by: A. Checking pH value B. Measuring a PtcCO2 value C. Checking PaCO2 value D. Measuring bedside vital capacity

C. Checking PaCO2 value

In listening to a patient's lungs, bronchial breath sounds are heard over the right lower lobe area. These would indicate which of the following? A. Normal lungs B. Pneumothorax C. Consolidation in the patient's right lower lobe D. Pleural effusion in the patient's right lower lobe

C. Consolidation in the patient's right

6. An order is received to perform the following bedside spirometry tests on a patient: tidal volume, FVC, and peak flow. Which device would you take with you to perform the tests? A. Stead-Wells water-seal spirometer B. Maximum inspiratory pressure manometer C. Differential-pressure pneumotachometer D. Body plethysmograph

C. Differential-pressure pneumotachometer

23. After 2 days of vomiting and diarrhea caused by the flu, a 50-year-old patient is admitted. The patient's ECG shows five PVCs in 1 minute and flat T waves. What laboratory test would you recommend? A. Urinalysis B. Arterial blood gas analysis C. Electrolytes D. Complete blood count

C. Electrolytes

6. Since being told of the diagnosis of cancer, a patient has become argumentative about the care received and threatens to hit the nurse and therapist. The patient should be evaluated for: A. Language barrier problems B. Hypercarbia C. Emotional state D. Hypoxemia

C. Emotional state

36. Because it is not possible to obtain an arterial blood gas sample on a newborn child, the physician orders blood gas analysis of an arterialized capillary blood sample. Which of the following should be selected as the preferred sampling site? A. Fingertip B. Earlobe C. Lateral area of the heel D. Toe tip

C. Lateral area of the heel

38. A newborn has been admitted to the neonatal Intensive Care Unit. The physician has determined the newborn to have a Silverman score of 5. How should this be interpreted? A. Within the normal range B. Suctioning is indicated C. Moderate respiratory distress D. Severe respiratory distress

C. Moderate respiratory distress

6. What is the most cost-effective way for a respiratory care department to disinfect large amounts of reusable plastic tubing and oxygen masks? A. 70% ethyl alcohol B. Steam autoclave C. Pasteurization D. Dry heat

C. Pasteurization

32. A 17-year-old patient is receiving mechanical ventilation because of apnea resulting from a drug overdose. While the patient is breathing 25% oxygen, the following ABG values are analyzed: PaO2 of 155 torr SaO2 of 100% pH of 7.42 PaCO2 of 41 torr BE of + 2 mEQ/L What action should now be taken? A. Reduce the patient to 21% oxygen. B. Maintain the present settings. C. Recheck the blood gas analyzer. D. Hyperventilate the patient.

C. Recheck the blood gas analyzer.

4. A batch of respiratory care equipment has gone through the gas sterilization process with ethylene oxide. Routine surveillance of the equipment shows that spores of B. subtilis have survived the process. What should be done next? A. Use the equipment because this organism does not cause illness. B. Aerate the gas as usual, and put into use. C. Resterilize the equipment, and check for destruction of the spores. D. Wipe off the equipment with 70% alcohol to remove the spores from the equipment.

C. Resterilize the equipment, and check for destruction of the spores.

12. A respiratory therapist is called to the Emergency Department to help evaluate a pediatric patient. Upon entering the room, a harsh, high-pitched sound is heard on the patient's inspiration. Which of the following is true? A. Sounds are tracheal. B. Sounds are bronchovesicular. C. Sounds are stridorous. D. Sounds are bronchial.

C. Sounds are stridorous.

23. A 50-year-old male patient is being treated for a pulmonary embolism. He is receiving 50% O2 by mask. The results of a P(A-a)O2 study indicate that his alveolar- arterial difference is 205 torr. What is the best interpretation of this study? A. The results are not physiologically possible. B. It is within the normal range. C. The alveolar-arterial difference is increased. D. The patient's condition is improving.

C. The alveolar-arterial difference is increased.

3. A respiratory therapist is ordered to draw a blood sample from your patient's radial artery. Before drawing the sample, a circulation test is performed by having the patient make a fist while pressure is applied over his ulnar and radial arteries. The patient's hand is then opened, and pressure is released from the ulnar artery. His hand color returns within 15 seconds. This would indicate that the patient's: A. Radial circulation is adequate B. Radial circulation is inadequate C. Ulnar circulation is adequate D. Ulnar circulation is inadequate

C. Ulnar circulation is adequate

18. A frail, thin patient known to have lung cancer is admitted to the hospital. The patient's family members are also present. What should be asked of them to make sure the proper level of care is delivered? A. The last time the patient ate B. The last time the patient had a bowel movement C. Whether any advance directives have been documented D. Whether the patient has brought home care medications

C. Whether any advance directives have been documented

5. An arterial puncture to obtain a sample for blood gas analysis should be recommended under which of the following conditions? 1. To measure the patient's PaO2 level after a change in the patient's inspired O2 concentration 2. Suspected CO poisoning 3. To measure the patient's PaCO2 level after a change in the patient's minute volume 4. After the patient with respiratory distress has been admitted to the Emergency Department with a tension pneumothorax A. 1 and 2 only B. 1 and 3 only C. 2, 3, and 4 only D. 1, 2, 3, 4

D. 1, 2, 3, 4

29. Patients with heart or lung disease commonly have shifting of mediastinal structures. In evaluating patients with cardiopulmonary disease, which of the following could result in a mediastinal shift being seen on a chest radiograph? 1. Right-sided hemothorax 2. Bilateral lower-lobe pneumonia 3. Left-sided tension pneumothorax 4. Left lower-lobe atelectasis 5. Fibrosis of the left lung A. 3 only B. 4 and 5 only C. 1, 2, and 3 only D. 1, 3, 4, and 5 only

D. 1, 3, 4, and 5 only

28. A young adult who had surgery for a deviated nasal septum was accidentally given 2 L of intravenous fluid in 1 hour. Which of the following signs would point to the patient being fluid-overloaded? 1. Tachycardia 2. Bradycardia 3. High urine specific gravity 4. Peripheral edema 5. Low urine specific gravity A. 3 and 4 only B. 1 and 3 only C. 2 and 5 only D. 1, 4, and 5 only

D. 1, 4, and 5 only

27. Interpret the following arterial blood gas drawn when the patient was breathing 45% oxygen: pH, 7.38; PaCO2, 59 torr; PaO2, 64 torr; HCO3 −, 39 mEq/L; and BE, +12 mEq/L; SaO2, 91% . 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Metabolic alkalosis 4. Compensated respiratory acidosis 5. Metabolic acidosis A. 1 and 4 only B. 1 and 3 only C. 2 and 5 only D. 2 and 4 only

D. 2 and 4 only

9. Interpret the following arterial blood gas drawn from a patient who is breathing 40% O2: pH, 7.37; PaCO2, 62 torr; PaO2, 54 torr; bicarbonate, 38 mEq/L; and base excess, +11 mEq/L; SaO2, 87%. 1. Corrected hypoxemia 2. Uncorrected hypoxemia 3. Metabolic alkalosis 4. Uncompensated metabolic acidosis 5. Compensated respiratory acidosis A. 1 and 4 only B. 1 and 3 only C. 2 and 4 only D. 2 and 5 only

D. 2 and 5 only

26. A 45-year-old patient has been admitted to the Emergency Department after having smoke inhalation from a house fire. The patient is wearing a nonrebreather mask set at 10 L/min of oxygen. The most appropriate way to evaluate the patient's oxygenation status is by: A. Pulse oximetry with a standard unit B. Transcutaneous oxygen monitor C. ABG sample run through a blood gas analyzer D. ABG sample run through a CO oximeter

D. ABG sample run through a CO oximeter

13. A respiratory therapist is called to evaluate a patient's breathing pattern. It is noticed that the patient's tidal volumes go from small to large to small and then stop for 10 seconds before starting up again. The pattern repeats itself. This patient's breathing pattern would best be called: A. Eupnea B. Obstructed expiration C. Kussmaul's respiration D. Cheyne-Stokes respiration

D. Cheyne-Stokes respiration

8. A 58-year-old patient had an exacerbation of his COPD related to spring allergies. As he is being prepared for discharge from the hospital, what should the respiratory therapist recommend? A. Get an influenza vaccination as soon as possible. B. Get a tuberculosis skin test as soon as possible. C. Have a throat swab performed to check on a possible Streptococcus infection. D. Get an influenza vaccination in the fall.

D. Get an influenza vaccination in the fall.

26. The respiratory therapist is assisting with the delivery of a high-risk infant. After being evaluated, the infant is given a 5-minute Apgar score of 8. What should be recommended to the assisting nurse and physician? A. Give the infant supplemental oxygen. B. Give the mother supplemental oxygen. C. Begin bag/mask rescue breathing on the infant. D. Give the infant to the mother for bonding.

D. Give the infant to the mother for bonding

5. A patient with a neuromuscular disease has been having serial bedside spirometry performed. Over the past 4 hours, her VC and MIP values have been decreasing. How should this be interpreted? A. Her strength is improving. B. She is not giving her best effort. C. She has undiagnosed asthma. D. Her condition is worsening.

D. Her condition is worsening.

22. How should the patient's P(A-a)O2 results be interpreted? A. Check for a blood gas analyzer error. B. Normal oxygenation and ventilation. C. Normal for a patient of this age. D. Larger than normal difference.

D. Larger than normal difference.

25. After a modified Allen test is performed on a patient's right wrist, it takes 25 seconds for the patient's hand to regain its color. What should be done now? A. Perform an Allen test on the right wrist. B. Draw an arterial blood sample on the right wrist. C. Draw an arterial blood sample on the left wrist. D. Perform a modified Allen test on the patient's left wrist.

D. Perform a modified Allen test on the patient's left wrist.

25. A recently home-delivered baby is brought in to the Emergency Department by the paramedics. The physician asks the respiratory therapist to help evaluate the newborn's condition. Normal vital signs for a term newborn include all of the following EXCEPT: A. Heart rate of 130/min B. Rectal temperature of 36.5° C C. Blood pressure of 64/40 mm Hg D. Respiratory rate of 20/min

D. Respiratory rate of 20/min

The respiratory therapist is called to the Emergency Department to help care for a patient who was in a car accident and has chest injuries, including broken ribs. Crepitations are felt while palpating the patient's neck. What is the most likely cause of this? A. The patient has a laryngeal tumor. B. Blood is in the back of the patient's throat. C. The patient has aspirated a tooth. D. The patient's lung has an air leak.

D. The patient's lung has an air leak.