TMC review

While ventilating an intubated patient with a bag-valve device during CPR, you observe a doctor insert a catheter in the right subclavian vein. Soon thereafter, you note that it is becoming increasingly difficult to ventilate the patient, and that there are no chest excursions on the right side. Which of the following is the most likely cause of this problem? Select one: A. right main stem intubation B. gastric distention C. broken ribs with flail chest D. right-sided pneumothorax

D. right-sided pneumothorax

Which of the following patient instructions for using a dry powder inhaler (DPI) is correct? Select one: A. hold device vertically after loading B. perform slow (3-4 sec) deep inhalation C. exhale back into the device D. seal lips tightly around mouthpiece

D. seal lips tightly around mouthpiece

The primary indication for overnight oximetry is: Select one: A. to assess patients' response to obstructive sleep apnea therapy B. to differentiate between obstructive and central sleep apnea syndromes C. to assess home care patients' compliance with nocturnal noninvasive ventilation D. to identify patients with obstructive sleep apnea syndrome

D. to identify patients with obstructive sleep apnea syndrome

In order to prevent a patient from compressing an oral endotracheal tube between the teeth, you would recommend: Select one: A. administration of a neuromuscular blocking agent B. administration of a strong narcotic-analgesic C. application of a Brigg's adapter ('T-tube') D. use of a 'bit block' or oropharyngeal airway

D. use of a 'bit block' or oropharyngeal airway

In inspecting an elderly female patient, you note that her spine has an abnormal anteroposterior (AP) curvature. Which of the following terms would you use in charting this observation? Select one: A. kyphosis B. scoliosis C. kyphoscoliosis D. pectus excavatum

kyphosis

Which of the following descriptions would be most consistent with sputum obtained from a patient with acute pulmonary edema? Select one: A. thick, dark red B. thin,clear C. thick, yellow D. watery, pink

D. watery, pink

Normal carbon dioxide production for a 70 kg male would be about: Select one: A. 200 mL/min B. 250 mL/min C. 300 mL/min D. 350 mL/min

A. 200 mL/min

You inspect a chest radiograph and observe the medial borders of the scapulae in the upper lung fields, the ribs positioned horizontally and the thoracic spine about 5 cm to the left of the sternum. Which of the following best describes this radiograph? Select one: A. Anterior-posterior (AP) view, improperly rotated B. Anterior-posterior (AP) view properly aligned C. Posterior-anterior (PA) view, improperly rotated D. Posterior-anterior (PA) view, properly aligned

A. Anterior-posterior (AP) view, improperly rotated

While interviewing a patient, you note obvious use of the neck muscles during regular inspiration, especially the scalenes. This finding is consistent with which of the following? Select one: A. COPD B. orthopnea C. pulmonary embolism D. myasthenia gravis

A. COPD

For which of the following sleep apnea treatments is objective compliance data usually available? Select one: A. CPAP/BiPAP B. oral appliances C. positional therapy D. aerobic exercise

A. CPAP/BiPAP

Which of the following types of equipment processing would you recommend for reusable PFT mouthpieces/tubing? Select one: A. high-level disinfection B. sterilization C. low-level disinfection D. soap and water wash

A. high-level disinfection

When preparing to administer therapy to a patient, you should first review the: Select one: A. history and chest physical examination B. pulmonary function results C. extent of pulmonary disability D. degree of hypoxemia

A. history and chest physical examination

The best way to assess a patient's level of consciousness is to: Select one: A. ask the patient to follow simple commands B. check vital signs C. check for reflex activity D. check pupil size and reactivity

A. ask the patient to follow simple commands

A 5-year-old patient is receiving volume control ventilation with a heat and moisture exchanger (HME) attached at the circuit "Y". Over the course of 4 hours, you notice that the peak pressure has increased by 12 cm H2O, but the plateau pressure is unchanged. It also has become more difficult to suction the patient's tracheal secretions. Which of the following actions would be appropriate at this time? Select one: A. change to a heated humidifier B. initiate postural drainage and percussion C. instill normal saline every half hour D. increase the set tidal volume to 500 mL

A. change to a heated humidifier

A patient is breathing spontaneously, but pressure above atmospheric is maintained at the airway opening throughout the breathing cycle. What mode of ventilatory support is being delivered? Select one: A. continuous positive airway pressure (CPAP) B. volume control assist/control ventilation C. pressure support ventilation (PSV) D. synchronous intermittent mandatory ventilation (SIMV)

A. continuous positive airway pressure (CPAP)

Your review of a patient's chart notes an admission diagnosis of fluid overload/overhydration. Which of the following findings would be most likely on bedside assessment of the patient? Select one: A. crackles on auscultation B. hypotension/tachycardia C. decreased skin turgor D. inspissated secretions

A. crackles on auscultation

An AP X-ray of a 3 year-old child with wheezing and stridor shows an area of prominent subglottic edema, but the lateral neck X-ray appears normal. What is the most likely problem? Select one: A. croup B. foreign body C. epiglottitis D. cystic fibrosis

A. croup

A 40-year-old male is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb). He is intubated with a size 8.5 mm ID endotracheal tube with the 22 cm mark at his teeth. The tidal volume is 700 mL, and the cuff pressure is 38 cm H2O. Which of the following should actions should you take? Select one: A. deflate the cuff until the pressure is 20-30 cm H2O B. reintubate the patient with a 10 mm endotracheal tube C. deflate the cuff until a minimal leak is heard at PIP D. advance the tube until the 25 cm mark is at the teeth

A. deflate the cuff until the pressure is 20-30 cm H2O

At rest, the normal tidal movement of the diaphragm is approximately: Select one: A. 6-10 cm B. 1-2 cm C. 30-40 cm D. 6-10 in

B. 1-2 cm

The gauge reading of a 50 pound home liquid oxygen system indicates that the cylinder is 1/3 full. What is the approximate duration of flow of this system at 2 L/min? Select one: A. 24 hours B. 48 hours C. 72 hours D. 95 hours

B. 48 hours

You obtain an SpO2 measurement on a patient of 80%. Assuming this is an accurate measure of hemoglobin saturation, what is the patient's approximate PaO2? Select one: A. 40 torr B. 50 torr C. 60 torr D. 70 torr

B. 50 torr

The normal range for the pulmonary capillary wedge pressure (PCWP) as measured via the distal port of a pulmonary artery or Swan-Ganz catheter (with the balloon inflated) is: Select one: A. 20 - 30 mm Hg B. 6 - 12 mm Hg C. 10 - 20 mm Hg D. 0 - 4 mm Hg

B. 6 - 12 mm Hg

When volume control A/C ventilation is to be initiated for a patient with normal lungs and no settings are specified, which of the following would be the most acceptable initial tidal volume setting? Select one: A. The patient's dead space x 3 B. 8 mL/kg predicted body weight C. 15% of the patient's VC D. 12 mL/kg predicted body weight

B. 8 mL/kg predicted body weight

Which of the following would you assess IMMEDIATELY after initiating invasive mechanical ventilation on a patient? Patient's Patient's Patient's Arterial airway vital signs appearance blood gases A. No Yes Yes Yes B. Yes Yes Yes No C. Yes Yes No Yes D. Yes No Yes Yes Select one: A. A B. B C. C D. D

B. B

You are asked by a physician to assist him in monitoring a patient during a fiberoptic bronchoscopy procedure. Which of the following would you recommend? Vital Heart Vital Pulse sat/ Signs rhythm/ECG Capacity SpO2 A. Yes No Yes No B. Yes Yes No Yes C. Yes Yes Yes Yes D. No Yes Yes Yes Select one: A. A B. B C. C D. D

B. B

Which of the following is used to estimate a newborn infant's gestational age after birth? Select one: A. Apgar score B. Ballard exam C. Glasgow scale D. Apache III

B. Ballard exam

You come upon a patient who is unresponsive and is not breathing. You had heard from her nurse that she had discussed a do not resuscitate (DNR) order with her physician. You should Select one: A. Check the patient's chart for a DNR order/advanced directive B. Immediately call a code and begin resuscitation efforts C. Contact the nurses' station and ask how best to proceed D. Call a "slow code," i.e., apply basic CPR, but not ACLS

B. Immediately call a code and begin resuscitation efforts

An echocardiogram on a 48 year-old patient with exertional dyspnea reveals high velocity tricuspid regurgitation, a dilated right ventricle, and an enlarged right atrium. Left ventricular anatomy and systolic/diastolic function are normal. Which of the following is the most likely problem? Select one: A. pulmonary arterial hypertension B. hypertrophic cardiomyopathy C. acute respiratory distress syndrome D. congestive heart failure

A. pulmonary arterial hypertension

When performing a percutaneous needle puncture of the radial artery, you get only a small spurt of blood. Which of the following is the best action at this time? Select one: A. slowly withdraw the needle until a pulsatile flow fills the syringe B. pull out entirely, use a different angle and then reinsert the needle C. slowly advance the needle until a pulsatile flow fills the syringe D. repeat the procedure with a fresh blood gas kit

A. slowly withdraw the needle until a pulsatile flow fills the syringe

An adult CCU patient on a nonrebreathing mask at 12 L/min complains of discomfort and feeling 'closed-in.' The doctor foresees the need to maintain a high FIO2 for at least 12 more hours. Which of the following would you recommend? Select one: A. switching to a high flow cannula at 15-20 L/min B. decreasing the nonrebreathing mask flow to 6 L/min C. switching to a 50% air-entrainment/venturi mask D. increasing the nonrebreathing mask flow to 'flush'

A. switching to a high flow cannula at 15-20 L/min

Which of the following questions would you ask to determine whether a patient has orthopnea? Select one: A. "Can you climb a flight of stairs without stopping?" B. "Do you have difficulty breathing when lying flat?" C. "Do you have any chest pain when walking?" D. "How much phlegm do you bring up when coughing?"

B. "Do you have difficulty breathing when lying flat?"

What is the normal range for intracranial pressure (ICP) in a supine adult? Select one: A. -2 to +6 mm Hg B. +7 to +15 mm Hg C. +16 to +24 mm Hg D. +25 to +33 mm Hg

B. +7 to +15 mm Hg

A patient's wife complains that her husband still snores when using a CPAP device with a well-fitting nasal interface. Which of the following would you recommend to overcome this problem? Select one: A. use a nasal saline spray at bedtime B. apply a chin strap to close the mouth C. change to a full oronasal face mask D. add a heated humidifier to the unit

B. apply a chin strap to close the mouth

Which of the following ACLS drugs is used to treat most bradycardias? A. vasopressin B. atropine C. amiodarone D. lidocaine

B. atropine

During an attempt to insert a nasopharyngeal airway in a patient, you encounter an obstruction to further movement. What is the most appropriate action at this time? Select one: A. use a stylet to force the nasopharyngeal airway in place B. attempt to pass the airway through the opposite naris C. insert the nasopharyngeal airway through the oral cavity D. use a tongue depressor to push the airway posteriorly

B. attempt to pass the airway through the opposite naris

When treating a patient with active tuberculosis, you note large amounts of bloody secretions. You should notify the: Select one: A. nearest relative B. attending physician C. department medical director D. respiratory supervisor

B. attending physician

A patient has an arterial pH of 7.25. What effect does this have on oxygen transport? Select one: A. hemoglobin's affinity for O2 will be higher than normal B. for a given PO2, the SaO2 will be less than normal C. the oxyhemoglobin saturation curve will shift to the left D. for a given PO2, the SaO2 will be greater than normal

B. for a given PO2, the SaO2 will be less than normal

Which of the following blood gas sampling errors would tend to result in a falsely low PO2 in a normal patient breathing room air? Select one: A. use of a plastic syringe B. delay in sample analysis C. air bubbles in the sample D. use of a short-bevel needle

B. delay in sample analysis

Small volume nebulizer therapy is indicated primarily to Select one: A. enhance airway humidification B. deliver medication to the airways C. improve arterial oxygenation D. increase alveolar ventilation

B. deliver medication to the airways

A patient's skin is damp to the touch with visible beads of moisture. Which of the following terms would you include in your written record of the patient's condition? Select one: A. hypervolemia B. diaphoresis C. mottling D. shock

B. diaphoresis

You are making equipment rounds to fill continuous-use nebulizers on a nursing unit. A large bottle of previously sterilized distilled water is dated as opened the prior day. You should: Select one: A. use the water, but only for new equipment setups B. discard the water and obtain an unopened sterile bottle C. ask the nurse if it is OK to use the water D. request a bottle of plain distilled water instead

B. discard the water and obtain an unopened sterile bottle

While reviewing the chart of an intubated patient receiving mechanical ventilation, you note both a progressive weight gain and a reduction in the hematocrit over the last four days. Which of the following is the most likely cause of this problem? Select one: A. inadequate humidification of the airway B. fluid retention due to mechanical ventilation C. a decrease in the patient's metabolic rate D. underproduction of antidiuretic hormone

B. fluid retention due to mechanical ventilation

Based on the following blood-gas report, what is the most likely acid-base diagnosis? pH = 7.42 pCO2 20 torr HCO3 12.6 mEq/L Select one: A. partially compensated respiratory alkalosis B. fully compensated respiratory alkalosis C. combined respiratory & metabolic alkalosis D. acute (uncompensated) respiratory alkalosis

B. fully compensated respiratory alkalosis

You need to perform nasotracheal suctioning on a patient with retained secretions. As compared to suctioning via a tracheal airway, which of the following complications are unique to this procedure? Select one: A. hypotension B. gagging/aspiration C. hypoxemia D. increased ICP

B. gagging/aspiration

A newborn is receiving O2 therapy via oxyhood. Which of the following should you select to check the accuracy of the air-oxygen blender? Select one: A. line pressure manometer B. galvanic cell analyzer C. pneumotachometer D. pulse oximeter

B. galvanic cell analyzer

Drugs from which of the following categories can impair secretion clearance? Select one: A. bronchodilators B. general anesthetics C. mucolytics D. expectorants

B. general anesthetics

Which of the following is a 'red flag' suggesting a potential biological warfare attack: Select one: A. a spike in the incidence of pneumonia and flu-like illness in the fall and winter B. groups of individuals developing a severe or rapidly fatal illness at the same time C. a group of people who develop gastrointestineal symptoms after eating at the same place D. development of an unexplained rash on a group of hikers returning from a trip

B. groups of individuals developing a severe or rapidly fatal illness at the same time

A patient who has no living relatives asks you whether her friend and neighbor can be responsible for her health care decisions should she become incapacitated. You would recommend that: Select one: A. she relinquish all decision-making to her attending physician B. her friend be given durable power of attorney for health care C. she relinquish all decision-making to her family lawyer D. her friend communicate her desires to her attending physician

B. her friend be given durable power of attorney for health care

Which of the following is TRUE regarding advance directives? Select one: A. not all states recognize a patient's right to have an advance directive B. hospitals must inform patients of their right to have an advance directive C. an advance directive is the same as a do not resuscitate order D. only a doctor can mandate following a patient's advance directives

B. hospitals must inform patients of their right to have an advance directive

During fiberoptic bronchoscopy, a patient receiving intravenous (IV) fentanyl exhibits signs of respiratory depression. Which of the following would you recommend? Select one: A. increase the O2 flow rate and continue monitoring B. immediately administer naloxone (Narcan) C. decrease the O2 flow rate and continue monitoring D. immediately administer neostigmine or prostigmine

B. immediately administer naloxone (Narcan)

You come upon an elderly patient who is unresponsive and is not breathing. You had heard from her nurse that she had discussed with her physician whether or not to a have a do not resuscitate (DNR) order in her chart. You should: Select one: A. check the patient's chart for a DNR order/advanced directive B. immediately call a code and begin resuscitation efforts C. contact the nurses' station and ask how best to proceed D. call a "slow code," i.e., apply basic CPR, but not ACLS

B. immediately call a code and begin resuscitation efforts

A patient with asthma is in acute respiratory distress and presents to the emergency department with markedly diminished breath sounds. Following bronchodilator therapy, auscultation of the chest reveals rhonchi and wheezing. This change suggests which of the following? Select one: A. development of a pneumothorax B. improvement of the air flow C. onset of pneumonia D. development of pulmonary edema

B. improvement of the air flow

Which of the following is a major limitations of the typical impedance-based apnea monitoring system? Select one: A. inability to detect tachypnea B. inability to detect obstructive apnea C. inability to detect bradypnea D. inability to detect periodic breathing

B. inability to detect obstructive apnea

Occlusion of the entrainment ports on an air-entrainment device will result in which of the following? Select one: A. increased total output flow B. increase in delivered O2% C. higher air:oxygen ratio D. decrease in delivered O2%

B. increase in delivered O2%

Increasing the amount of tubing between the "wye" connector of a dual limb ventilator breathing circuit and the patient's airway will have which of the following effects? Select one: A. increase in delivered volume B. increase in rebreathed volume C. decrease in circuit compliance D. decrease in inspired PCO2

B. increase in rebreathed volume

You are gathering a sputum specimen from a patient in isolation. In addition to applying appropriate transmission-based precautions, which of the following procedures should be followed in processing this specimen? Select one: A. mix the specimen with a fixative before sending it to the lab B. place the specimen cup in a sturdy container with a secure lid C. leave the specimen cup at the nursing station for transport D. have the specimen undergo sterilization before processing

B. place the specimen cup in a sturdy container with a secure lid

On an AP chest X-ray, a patient exhibits a blunted left costophrenic angle. Which of the following is the most likely problem? Select one: A. hepatomegaly B. pleural effusion C. hyperinflation D. pneumothorax

B. pleural effusion

The major goal of medication reconciliation is to: Select one: A. educate the patient B. prevent medication errors C. increase patient compliance D. reduce prescription costs

B. prevent medication errors

An intubated patient in ICU needs to undergo bedside bronchoscopy and is in need of short-term sedation. Which of the following agents would you recommend for this procedure? Select one: A. haloperidol (Haldol) B. propofol (Diprivan) C. lorazepam (Ativan) D. cisatracurium (Nimbex)

B. propofol (Diprivan)

In which of the following conditions would a ventilation scan be normal but a perfusion scan reveal areas of absent blood flow? Select one: A. lung cancer B. pulmonary embolism C. pneumonia D. emphysema

B. pulmonary embolism

The most common late complication of flexible fiberoptic bronchoscopy (FFB) is which of the following? Select one: A. laryngospasm B. pulmonary infection C. bronchospasm D. pneumothorax

B. pulmonary infection

A physician orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would be most appropriate to deliver this mixture? Select one: A. nebulizer set at 100% oxygen with aerosol mask B. tight-fitting nonrebreathing mask with competent valving C. simple oxygen mask set to deliver 15 L/min oxygen D. tight-fitting partial rebreathing mask at 12 L/min

B. tight-fitting nonrebreathing mask with competent valving

A patient has had a tracheostomy tube in place for three weeks. Over the last ten days, it has required higher and higher pressures in order to obtain an effective cuff seal. What is the most likely problem? Select one: A. T-E fistula B. tracheomalacia C. granulomas D. glottic edema

B. tracheomalacia

Which one of the following represents good educational practice in teaching skills to patients or caregivers in the home? Select one: A. give the patient/caregiver a technical manual B. provide an in-depth lecture for the patient/caregiver C. have the patient/caregiver give a return demonstration D. assess the patient/caregiver's anxiety via discussion

C. have the patient/caregiver give a return demonstration

In reviewing the chart of a 24 year old trauma patient, you note the following clinical signs and symptoms: decreased breath sounds, hyperresonance to percussion and chest pain. These findings are most consistent with what diagnosis? Select one: A. emphysema B. pleural effusion C. pneumothorax D. chronic bronchitis

C. pneumothorax

When auscultating a patient with chronic bronchitis you hear harsh, low-pitched sounds that are continuous in character. Which of the following terms would you use to describe these sounds in the patient's chart? Select one: A. wheezes B. crepitus C. rhonchi D. crackles

C. rhonchi

Upon inspection of a portable spirometer's FVC curve obtained on an adult outpatient, you observe that the breath last only 4 seconds and that the exhaled volume is still changing substantially during the last half second of the breath. Prior to repeating the maneuver, which of the following instructions would you provide to the patent? Select one: A. "Don't hesitate" B. "Blast out faster" C. "Blow out longer" D. "Deeper breath"

C. "Blow out longer"

A patient scheduled for a right lung pneumonectomy has a preoperative FEV1 of 2.0 L. A split lung quantitative V/Q study indicates a 55%/45% distribution of blood flow to the right and left lungs respectively. The patient's predicted postoperative (PPO) FEV1 would be: Select one: A. 1.10 L B. 1.00 L C. 0.90 L D. 0.80 L

C. 0.90 L

Which of the following of the following inspiratory/expiratory ratios would indicate an abnormally long expiratory time? Select one: A. 1:2 B. 1:3 C. 1:4 D. 2:1

C. 1:4

What percent decrease in FEV1 needs to occur to conclude that a methacholine challenge is positive for airway hyperreactivity? Select one: A. 10% B. 15% C. 20% D. 25%

C. 20%

An intubated patient is receiving volume control ventilation. The patient's condition has not changed, but you observe higher peak inspiratory pressures than before. Which of the following is the most likely cause of this problem? Select one: A. there is a leak in the patient-ventilator system B. the endotracheal tube cuff is deflated or burst C. the endotracheal tube is partially obstructed D. the endotracheal tube is displaced into the pharynx

C. the endotracheal tube is partially obstructed

During time-cycled, pressure-controlled ventilation, if the pressure limit is reached before the inspiratory time cycle is completed, which of the following will occur? Select one: A. the ventilator will cycle to end-inspiration B. the delivered volume will decrease C. the pressure will remain at the preset limit D. gas will continue to enter the patient's lungs

C. the pressure will remain at the preset limit

For which of the following would you recommend continuous waveform capnography? Select one: A. to replace blood sampling for PaCO2 analysis B. to assess a patient's readiness for weaning C. to verify placement of artificial airways D. to evaluate the adequacy of tissue oxygenation

C. to verify placement of artificial airways

Your patient is ordered to start breathing treatments with pentamidine isethionate (NebuPent). To minimize your risk of drug exposure, you should do which of the following? Select one: A. place an HME between the nebulizer and the mouthpiece B. use a metered dose inhaler+valved holding chamber C. use a SVN with nonrebreathing circuit+expiratory filter D. use a small-particle aerosol generator with a HEPA filter

C. use a SVN with nonrebreathing circuit+expiratory filter

Which of the following measures are acceptable for justifying Medicare reimbursement for home oxygen therapy? PaO2 of Nighttime SpO2 of 84% 55 torr drop in at rest at rest SaO2 from (room air) (room air) A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

C. C

Which of the following measures should be obtained and reviewed when assessing a patient's readiness to begin weaning from mechanical ventilation? [PaO2/FIO2] [Arterial] [Spontaneous] [Arterial Blood] [(P/F Ratio)] [Blood pH] [Breathing Efforts] [Pressure] A. Yes No Yes Yes B. No Yes Yes Yes C. Yes Yes No No D. Yes Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following monitored parameters indicate adequate cerebral perfusing pressure (CPP)? Mean Arterial Pressure (MAP) & Intracranial Pressure (ICP) A. MAP 60 mm Hg ICP 15 mm Hg B. MAP 70 mm Hg ICP 20 mm Hg C. MAP 80 mm Hg ICP 25 mm Hg D. MAP 90 mm Hg ICP 15 mm Hg Select one: A. A B. B C. C D. D

D. D

Which of the following options can be considered if a terminally ill, ventilator-dependent patient's family and the attending doctor agree to proceed with withdrawing ventilatory support? [Immediate] [Withdrawal] [Terminal] [extubation] [to T-tube] [weaning] A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following should be included in a patient's medication history? [Recreational] [Dietary] [Vitamins and] [Drug Use] [Supplements] [Herbal Products] A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

While caring for a patient receiving volume-controlled ventilation you note a sudden drop in the peak inspiratory pressure. Causes of this change could include which of the following? Tension Burst ET Exhalation pneumothorax tube cuff valve leak A. Yes Yes No B. Yes No Yes C. Yes Yes Yes D. No Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following would you consider as being a normal respiratory event during sleep? Select one: A. a decrease in breathing less than 50% that causes arousal from sleep B. a decrease in breathing greater than 50% below the baseline C. increasing respiratory effort that leads to an arousal from sleep D. a 5-8 second period of no airflow without respiratory effort

D. a 5-8 second period of no airflow without respiratory effort

Immediately after endotracheal tube extubation, an adult patient exhibit a high-pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend? Select one: A. a STAT heated aerosol treatment with saline B. careful observation of the patient for 6 hours C. immediate reintubation via the nasal route D. a STAT racemic epinephrine aerosol treatment

D. a STAT racemic epinephrine aerosol treatment

Which of the following types of nebulizers can produce the highest density aerosol suspension? Select one: A. a heated jet nebulizer B. a sidestream nebulizer C. a metered dose inhaler (MDI) D. an ultrasonic nebulizer

D. an ultrasonic nebulizer

During the assessment of a mechanically ventilated patient in the ICU you notice the following vital signs: Heart rate: 118/min BP: 135/90 Set resp rate: 8/min Total resp rate: 35/min Temp: 99.3 °F A surgical resident has just inserted a right pleural chest tube to drain a significant pleural effusion. At this point you should recommend that the resident: Select one: A. paralyze the patient B. reposition the chest tube C. ask the patient to relax D. assess for pain

D. assess for pain

The attending physician of a patient who is experiencing pain asks that you evaluate the intensity of her pain. The most objective way to do so would be to: Select one: A. Ask the patient "How much pain are you having" B. Observe the patient for facial expressions indicative of pain C. Measure the patient's pulse and respiratory rate D. Have the patient rate her pain on a numeric rating scale

D. Have the patient rate her pain on a numeric rating scale

To minimize the likelihood of infection, all patients with COPD should be immunized against: Influenza Pertussis Pneumonia A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

To avoid thermal injury when using a transcutaneous blood gas monitor to track an infant's PO2, you should: Select one: A. apply cortisone cream under the sensor B. maintain the sensor at body temperature C. place the sensor over a boney area D. carefully monitor sensor temperature

D. carefully monitor sensor temperature

When bench testing an indirect calorimeter connected to a ventilator set to 40% O2 and ventilating a test lung, you would expect the VO2 reading to be: Select one: A. 0 ml/min B. 200 mL/min C. 250 mL/min D. 400 mL/min

A. 0 ml/min

In order to ensure adequate humidification for a spontaneously breathing patient with an artificial tracheal airway, inspired gas should be: Select one: A. 100% saturated with water vapor at 34-41° C B. 80% saturated with water vapor at 32-35° C C. 100% saturated with water vapor at 30-35° C D. 100% saturated with water vapor at 110-120° F

A. 100% saturated with water vapor at 34-41° C

A time-cycled constant flow generator is set up with a flow of 50 L/min and an inspiratory time of 1.2 sec. What is the tidal volume? Select one: A. 1000 mL (1.0 L) B. 1500 mL (1.5 L) C. 750 mL (0.75 L) D. 1200 mL (1.2 L)

A. 1000 mL (1.0 L)

The upper limit of INPUT flow for most jet nebulizers driven by 50 psig source gas ranges from: Select one: A. 12-15 L/min B. 8-10 L/min C. 4-8 L/min D. 20-30 L/min

A. 12-15 L/min

On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 80/min; regular rhythm; normal P waves; P-R interval of 0.25 sec; normal QRS complexes. The most likely problem is: Select one: A. 1st degree heart block B. atrial fibrillation C. 2nd degree heart block D. 3rd degree heart block

A. 1st degree heart block

Which of the following channels normally are included in a full laboratory-based, attended polysomnography exam? Select one: A. 2 EEG, 2 EOG, 1 EMG, ECG, leg motion, airflow, respiratory effort, SpO2 B. ECG/heart rate, blood pressure, leg motion, airflow, respiratory effort, SpO2 C. 2 EEG, 2 EOG, 1 EMG, ECG, leg motion, airflow, expired CO2, SpO2 D. 1 EEG, 1 EOG, 1 EMG, ECG, leg motion, snoring (audio), airflow, SpO2

A. 2 EEG, 2 EOG, 1 EMG, ECG, leg motion, airflow, respiratory effort, SpO2

Approximately what lecithin/sphingomyelin ratio is associated with the onset of mature surfactant production in the fetus? Select one: A. 2:1 B. 20:1 C. 1:2 D. 1:20

A. 2:1

Which of the following values for arterial carbon dioxide tension is consistent with alveolar hyperventilation? Select one: A. 30 torr B. 40 torr C. 50 torr D. 60 torr

A. 30 torr

Equipment function that lay caregivers of patients receiving home mechanical ventilation should assess regularly include: Bag-valve Battery power Ventilator Tidal volume function levels alarm calibration function A. Yes Yes Yes No B. Yes Yes Yes Yes C. Yes No Yes No D. No Yes No Yes Select one: A. A B. B C. C D. D

A. A

In setting up a postural drainage treatment schedule for a patient, which of the following information would you try to obtain from the patient's nurse? Medication Meal Predicted schedule schedule body weight A. Yes Yes No B. No Yes Yes C. Yes Yes Yes D. Yes No Yes Select one: A. A B. B C. C D. D

A. A

Maintenance therapy with an inhaled corticosteroid for a patient with exercise-induced bronchoconstriction fails to control the condition. Which of the following drugs would you consider recommending be added to the treatment regimen to maintain better control? salmeterol montelukast albuterol (Serevent) (Singulair) (Proventil) A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

A. A

Which of the following are usually used in combination with a V/Q scan to help diagnose pulmonary embolism? Selected d-dimer Standard clinical findings blood test chest X-ray A. Yes Yes Yes B. Yes No Yes C. No Yes Yes D. Yes Yes No Select one: A. A B. B C. C D. D

A. A

Which of the following blood tests indicate potential renal failure? BUN Creatinine pH 58 mg/dl 4.3 mg/dL 7.54 A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

A. A

Which of the following infection control procedures would you recommend for a patient with COPD receiving home respiratory care? Avoiding visits Having Incinerating all by friends with caregivers disposable respiratory perform proper equipment infections hand hygiene and supplies A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

A. A

A patient has been intubated for cardiopulmonary failure and CPR is in progress. Which of the following should you INITIALLY perform to determine whether the endotracheal tube is in the proper position? Select one: A. Auscultate chest and abdomen B. Palpate the position of the trachea C. Look, listen and feel for breaths D. Observe chest wall movement

A. Auscultate chest and abdomen

Basic instructions for performing a maximum voluntary ventilation (MVV) maneuver would be to: Select one: A. Breathe as fast and deep as possible for 12 to 15 seconds B. Inhale maximally then forcefully exhale for at least 6 seconds C. Breathe as fast and deep as possible for a full minute D. Inhale and exhale rapidly but maintain a normal tidal volume

A. Breathe as fast and deep as possible for 12 to 15 seconds

Which of the following BiPAP settings would you initially select for a 165 lb COPD patient in hypercapnic respiratory failure needing NPPV in the emergency department? Select one: A. EPAP = 5 cm H2O; IPAP = 15 cm H2O; A/C (S/T) mode; rate 10 B. EPAP = 0 cm H2O; IPAP = 10 cm H2O; A/C (S/T) mode; rate 10 C. EPAP = 5 cm H2O; IPAP = 15 cm H2O; assist (spontaneous) mode only D. EPAP = 20 cm H2O; IPAP = 30 cm H2O; A/C (S/T) mode; rate 10

A. EPAP = 5 cm H2O; IPAP = 15 cm H2O; A/C (S/T) mode; rate 10

A doctor orders a directed coughing regimen to help a patient who recently underwent neurosurgery clear secretions. Which of the following techniques would you recommend be implemented? Select one: A. FET/"huff' coughing B. abdominal thrust C. autogenic drainage D. Valsalva maneuver

A. FET/"huff' coughing

A patient is asked to inhale as deeply as possible and blow out all his air as hard as they can until empty. What test is being performed? Select one: A. FVC B. IC C. TLC D. MVV

A. FVC

When using a numeric rating scale (NRS) to quantify a patient's pain intensity, the patient reports a level of 5 on the 10-point scale. You note that his last rating was a level of 2. Based on this rating and the reported change, you should: Select one: A. Immediately report the findings to the patient's physician B. Record your findings in the respiratory care progress notes C. Repeat the assessment to see if the results are reproducible D. Advise the patient to try and relax and focus on the positive

A. Immediately report the findings to the patient's physician

A 25-year-old comatose woman is seen in the emergency room. You observe that her respiratory rate is 24/min and her tidal volume is consistently large. No periods of apnea have been observed. Which of the following breathing patterns would be most consistent with these observations? Select one: A. Kussmaul's breathing B. Cheyne-Stokes breathing C. Biot's breathing D. eupnea

A. Kussmaul's breathing

Which of the following chart information must be checked before performing an artery puncture? Select one: A. serum electrolytes B. PT, PTT and INR values C. cardiac enzymes D. blood glucose levels

B. PT, PTT and INR values

When asking a patient if she knows where she is and the day of the week, you are trying to assess the patient's: Select one: A. Sensorium B. Reaction to chronic illness C. Understanding of the language D. Ability to cooperate

A. Sensorium

After a patient has been intubated during CPR, a chest x-ray is taken. It is important to inspect the x-ray film to observe: Select one: A. That the tip of the endotracheal tube is properly positioned B. If this chest x-ray film is different from the previous ones C. If the liver was damaged by chest compressions D. If the endotracheal tube cuff is properly inflated

A. That the tip of the endotracheal tube is properly positioned

Which of the following laboratory values is most consistent with a diagnosis of fluid overload (overhydration)? Select one: A. increased hematocrit B. decreased BUN C. increased serum osmolality D. increased urine specific gravity

B. decreased BUN

On visiting a home care patient receiving nasal O2 via concentrator, you note that the humidifier diffusing element is producing only a few small bubbles, and its pressure relief is sounding. What is the most likely problem? Select one: A. The nasal cannula has become mostly obstructed with secretions B. The diffusing element is occluded by mineral deposits C. The humidifier pressure relief valve is defective D. The humidifier diffusing element is defective

A. The nasal cannula has become mostly obstructed with secretions

Which of the following would provide the most information about a patient's orientation to time and place? Select one: A. The patient knows she is in a hospital B. The patient knows her diagnosis C. The patient recognizes her physician D. The patient says that she has been dizzy all day

A. The patient knows she is in a hospital

Which of the following procedures can be performed on a comatose patient? Select one: A. maximum voluntary ventilation (MVV) B. maximum inspiratory pressure (MIP) C. forced expiratory volume in 1 sec (FEV1) D. peak expiratory flow

B. maximum inspiratory pressure (MIP)

A patient has a pH of 7.22 and a PaCO2 of 38 torr. Based on these data, what is the primary acid-base disturbance? Select one: A. respiratory alkalosis B. metabolic acidosis C. respiratory acidosis D. metabolic alkalosis

B. metabolic acidosis

Which of the following is a true statement? Select one: A. VC = IRV + VT + ERV B. VC = FRC + VT C. VC = TV + IRV + RV D. FRC = TV + ERV

A. VC = IRV + VT + ERV

Which of the following echocardiogram findings are consistent with a diagnosis of diastolic heart failure? Select one: A. decreased LV ejection fraction (< 45%) B. decreased LV chamber compliance C. increased LV end-diastolic volume D. left bulging of the interatrial septum

B. decreased LV chamber compliance

You need to measure the forced vital capacity of an adult patient at the bedside. Which of the following devices would you select to make this measurement? Select one: A. a computerized electronic spirometer with flow sensor B. strain-gauge pressure transducer and amplifier C. mechanical turbine-type volumeter/Wright respirometer D. water-sealed bell spirometer with high speed kymograph

A. a computerized electronic spirometer with flow sensor

A patient with a normal PaO2 and cardiac output is exhibiting signs and symptoms of tissue hypoxia. What is the most likely cause of her hypoxia? Select one: A. a hemoglobin deficiency B. hypoventilation C. a R-L physiologic shunt D. a low ambient PO2

A. a hemoglobin deficiency

When setting up a 12-lead ECG on a patient, you cannot obtain any electrical signal. The batteries are fully charged and the device passed its power-on self-test. Which of the following is the most likely cause of this problem? Select one: A. a missing lead B. motion artifact C. improper filtering D. a corroded connector

A. a missing lead

You are assessing a patient's need for supplemental oxygen at home. Which of the following measures would justify Medicare reimbursement for this therapy? Select one: A. a resting arterial Hb saturation of 88% or less (room air) B. a nocturnal fall in arterial Hb saturation greater than 3% C. observable signs of hypoxemia such as confusion D. a resting arterial PO2 of 70 torr or less (room air)

A. a resting arterial Hb saturation of 88% or less (room air)

Based on the following blood-gas report, what is the most likely acid-base diagnosis? pH = 7.29 pCO2 = 55 mm Hg HCO3 = 25.8 mEq/L Select one: A. acute (uncompensated) respiratory acidosis B. combined respiratory & metabolic acidosis C. partially compensated metabolic acidosis D. partially compensated respiratory acidosis

A. acute (uncompensated) respiratory acidosis

To manually test a volume control ventilator's I:E ratio alarm, you would: Select one: A. adjust the peak flow B. occlude the circuit C. disconnect the circuit D. change the alarm setting

A. adjust the peak flow

When inspecting the monitor of an adult patient in ICU, you note a heart rate of 134/min with a regular rhythm. Which of the following is the most likely cause of this observation? Select one: A. adrenergic drug effects B. heavy patient sedation C. therapeutic hypothermia D. beta blocker drug effects

A. adrenergic drug effects

To create CPAP in a continuous flow "Wye" circuit requires: Select one: A. an expiratory threshold resistor B. an inspiratory flow restrictor C. an adjustable demand flow valve D. an inspiratory threshold resistor

A. an expiratory threshold resistor

In which of the following conditions are fine, late inspiratory crackles (rales) most likely to be heard on auscultation? Select one: A. atelectasis B. croup C. pleural effusion D. asthma

A. atelectasis

A higher than normal white blood cell count would be consistent with which of the following? Select one: A. bacterial infection B. respiratory acidosis C. lower than normal hemoglobin D. electrolyte imbalance

A. bacterial infection

In the lab results section of her medical record, you note an overall WBC of 22,000 for a febrile patient who appear acutely ill and in moderate respiratory distress. Which of the following is this patient's most likely diagnosis? Select one: A. bacterial pneumonia B. emphysema C. pulmonary embolus D. pulmonary fibrosis

A. bacterial pneumonia

A patient who exhibits a wasted appearance and has poor skin turgor can best be described as: Select one: A. cachectic B. febrile C. bulimic D. cyanotic

A. cachectic

A fuel cell oxygen analyzer is reading 18% when exposed to ambient air. The initial corrective action would be to: Select one: A. calibrate the sensor B. check the batteries C. replace the fuel cell D. replace the electrolyte

A. calibrate the sensor

Which one of the following measures could be used to evaluate changes in symptoms occurring among participants in a pulmonary rehabilitation program? Select one: A. changes in dyspnea scores B. changes in O2 consumption C. changes in blood pressure D. changes in O2 saturation

A. changes in dyspnea scores

Which one of the following measures could be used to evaluate changes in symptoms occurring among participants in a pulmonary rehabilitation program? Select one: A. changes in sputum production B. changes in O2 consumption C. changes in blood pressure D. changes in O2 saturation

A. changes in sputum production

On reviewing the blood gas report on a patient, you note a PaCO2 of 25 torr, a base excess (BE) of -10 mEq/L, and a pH of 7.35. You would characterize this acid-based abnormality as: Select one: A. compensated metabolic acidosis B. acute (uncompensated) metabolic acidosis C. compensated respiratory alkalosis D. acute (uncompensated) respiratory alkalosis

A. compensated metabolic acidosis

A COPD patient receiving volume controlled A/C ventilation develops auto-PEEP of 8-10 cm H2O. Which of the following would you recommend to correct this problem? Select one: A. decrease the I:E ratio B. add an inspiratory hold C. use an inverse I:E ratio D. use a decelerating flow pattern

A. decrease the I:E ratio

At low pressure levels, such as 5 cm H2O, pressure support ventilation (PSV) is used mainly to: Select one: A. decrease the imposed respiratory muscle work B. increase the functional residual capacity C. decrease the deadspace to tidal volume ratio D. restore tone to atrophied respiratory muscles

A. decrease the imposed respiratory muscle work

A 50 kg (110 lb) adult patient recovering from pulmonary edema is receiving pressure control A/C ventilation at a rate of 12/min with the pressure limit set to 25 cm H2O. Tidal volume is 400 mL. After vigorous diuresis, the delivered tidal volume increases to 700 mL. Which of the following changes would be appropriate in this case? Select one: A. decrease the pressure limit B. add mechanical deadspace C. decrease the mandatory rate D. increase the inspiratory time

A. decrease the pressure limit

Which of the following pulmonary function findings are common to patients with chronic bronchitis and also found in those with emphysema? Select one: A. decreased forced expiratory flows B. increased lung compliance C. decreased diffusing capacity D. decreased total lung capacity

A. decreased forced expiratory flows

Which of the following findings would you expect to observe on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema? Select one: A. decreased vascular markings B. elevated hemidiaphragms C. decreased radiolucency D. increased C/T ratio

A. decreased vascular markings

You note in the chart of a patient's who is receiving volume control ventilation that the plateau pressure has been increasing over the last 6 hours, while the PEEP levels remains constant. Which of the following would be the most likely cause of this change? Select one: A. development of pulmonary edema B. water accumulation in the ventilator circuit C. partial obstruction of the endotracheal tube D. development of bronchospasm

A. development of pulmonary edema

While reviewing the chart of a patient with a suspected pulmonary infection, which of the following would best confirm this diagnosis? Select one: A. high white blood cell count B. low red blood cell count C. low blood potassium D. high urine specific gravity

A. high white blood cell count

A 19-year-old cystic fibrosis patient is following the current plan at home: albuterol (Proventil) HFA: 4 times daily tobramycin (TOBI): 300 mg nebulized 2x/day High-frequency oscillation vest: 3 times daily x 15 mins The patient continues to have difficulty clearing sputum, complaining that "it's just too thick." Which of the following should you recommend? Select one: A. dornase alfa (Pulmozyme) once daily B. Acapella PEP 2 times/day x 20 min C. acetylcysteine (Mucomyst) 3 times/day D. Flutter Valve 4 times/day x 20 min

A. dornase alfa (Pulmozyme) once daily

Soon after undergoing a therapeutic thoracentesis, a patient exhibits hypotension. The most likely cause of this problem is: Select one: A. fluid shifts out of the vascular compartment B. a vasovagal reaction C. re-expansion pulmonary edema D. cardiovascular collapse

A. fluid shifts out of the vascular compartment

An adult patient is prescribed steroid administration via an MDI formulation. To help minimize pharyngeal deposition of the drug, which of the following would you recommend? Select one: A. have the patient use a holding chamber with the MDI B. have the patient use the closed mouth technique C. have the patient inhale the mist as rapidly as possible D. have the patient use a breath-actuated MDI with mask

A. have the patient use a holding chamber with the MDI

A physician requests transcutaneous blood gas monitoring on a premature infant in the NICU. Which of the following conditions would cause you to recommend against using this device to monitor this patient? Select one: A. hemodynamic instability B. congenital heart disease C. respiratory distress syndrome D. meconium aspiration

A. hemodynamic instability

A patient is receiving postural drainage and percussion in the Trendelenburg position. Therapy should be terminated if which of the following develops? Select one: A. hemoptysis B. productive coughing C. mild dyspnea D. flushing

A. hemoptysis

Which of the following would tend to decrease a patient's energy expenditure? Select one: A. hypothermia B. inflammation C. major trauma D. agitation/pain

A. hypothermia

The arterial blood gas results for a patient who is receiving an FIO2 of 0.70 are below: pH = 7.41 PaCO2 = 40 torr HCO3 = 24.5 mEq/L PaO2 = 50 torr Which of the following is the correct interpretation of these data? Select one: A. hypoxemia B. compensated respiratory acidosis C. acute metabolic alkalosis D. normal values

A. hypoxemia

A patient has an arterial pH of 7.58. What effect will this have on oxygen transport? Select one: A. impaired blood oxygen unloading at the tissues B. decreased affinity of hemoglobin for oxygen C. enhanced blood oxygen unloading at the tissues D. impaired blood oxygen uptake at the lung

A. impaired blood oxygen unloading at the tissues

Ideally, where should the tip of a properly positioned pulmonary artery catheter appear on an AP chest X-ray? Select one: A. in the lower lobe, posteriorly B. in the superior vena cava or right atrium C. in the lower lobe, anteriorly D. in the upper lobe, posteriorly

A. in the lower lobe, posteriorly

You are asked to position a patient for orotracheal intubation. You should place the patient's head: Select one: A. in the sniffing position B. straight with the torso, with the neck hyperextended C. tilted forward toward the chest D. turned to the right, with the neck hyperextended

A. in the sniffing position

A 45-year-old 70 kg male with severe bilateral infiltrates on X-ray is receiving volume controlled SIMV. Ventilator settings and arterial blood gas data are below. Which of the following should be recommended? Ventilator Settings: Mode Vol Ctrl SIMV Set Rate 6/min Total Rate 10/min VT 400 mL FIO2 0.65 PEEP 5 cm H2O Blood Gases: pH = 7.35 PaCO2 = 45 torr PaO2 = 55 torr SaO2 = 83% HCO3 = 24 mEq/L BE = -1 You should recommend which of the following? Select one: A. increase PEEP B. increase the rate C. increase the FIO2 D. add an inspiratory plateau

A. increase PEEP

In a patient with postoperative atelectasis, incentive spirometry is likely to result in which one of the following? Select one: A. increased FRC B. decreased V/Q ratio C. decreased compliance D. increased FEV1%

A. increased FRC

Which of the following is an accepted benefit of physical reconditioning in patients with chronic lung disease? Select one: A. increased endurance/maximum O2 consumption B. increased forced expiratory volumes/flows C. improved resting arterial blood gas values D. improved pulmonary diffusing capacity (DLco)

A. increased endurance/maximum O2 consumption

Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)? Select one: A. increased hematocrit B. decreased BUN C. decreased serum osmolality D. decreased urine specific gravity

A. increased hematocrit

Your review of a patient's chart notes an admission diagnosis of fluid depletion/dehydration. Which of the following findings would be most likely on bedside assessment of the patient? Select one: A. inspissated secretions B. pitting edema C. venous distension D. crackle on auscultation

A. inspissated secretions

Which of the following statements regarding cyanosis of the extremities (peripheral cyanosis; acrocyanosis) is TRUE? Select one: A. it may be a sign of inadequate tissue perfusion B. it is a reliable indicator of tissue hypoxia C. it will develop earlier in patients with anemia D. it will develop later in patients with polycythemia

A. it may be a sign of inadequate tissue perfusion

When inspecting a chest radiograph, you note that the heart is shifted to the patient's left. Which of the following is the most likely cause of this finding? Select one: A. left sided atelectasis/lung collapse B. left sided pleural effusion C. left sided tension pneumothorax D. right sided pneumonectomy

A. left sided atelectasis/lung collapse

A patient has a pulmonary capillary wedge pressure (PCWP) of 20 mm Hg. Which of the following does this measurement likely indicate? Select one: A. left ventricular failure B. tricuspid valve stenosis C. hypovolemic shock D. pulmonary vasodilation

A. left ventricular failure

On assessment of an acutely ill patient, you note all the following in the region of the left lower lobe: decreased expansion, a dull percussion note, and the absent of breath sounds/tactile fremitus. You also observe a shift in the trachea toward the left, more prominent during inspiration. These findings suggest: Select one: A. left-sided obstruction/atelectasis B. left-sided pneumothorax C. left-sided consolidation D. left-sided pleural effusion

A. left-sided obstruction/atelectasis

On assessment of an acutely ill patient, you note all the following in the region of the left lower lobe: decreased expansion, a dull percussion note, and the absent of breath sounds/tactile fremitus. You also observe a shift in the trachea toward the left, more prominent during inspiration. These findings suggest: Select one: A. left-sided obstruction/atelectasis B. left-sided pneumothorax C. left-sided consolidation D. left-sided pleural effusion

A. left-sided obstruction/atelectasis

Which of the following indicates that a patient is at risk for malnutrition? Select one: A. low BMI (< 18) B. recent weight gain C. high BMI (> 30) D. low carbohydrate diet

A. low BMI (< 18)

A 2nd year resident is preparing to intubate a patient admitted to the emergency department with a suspected cervical spine injury. Neither the equipment nor personnel are available to perform any special intubation procedures like fiberoptic intubation. Which of the following techniques would you recommend to the resident to minimize further trauma to the patient? Select one: A. manually immobilize the patient's head/neck B. tighten the patient's cervical collar C. place the patient in the sniffing position D. insert an oropharyngeal airway

A. manually immobilize the patient's head/neck

During a ventilator test, you determine that the delivered volume is substantially less than the set volume. To determine if the ventilator volume setting is out of calibration, you would: Select one: A. measure the volume delivered at the ventilator outlet using a calibrated volumeter B. perform a manual circuit leak test using a low volume and inspiratory pause C. compare a variety of inspiratory time settings against a digital stop watch D. measure the volume delivered at the patient connector using a calibrated volumeter

A. measure the volume delivered at the ventilator outlet using a calibrated volumeter

During an aerosol drug treatment, you instruct a patient to hold her breath at the end of inspiration. You should explain that this will enhance: Select one: A. medication delivery B. particle stability C. inertial impaction D. ciliary action

A. medication delivery

To assess for normal diaphragm activity, you should look for which of the following during inspiration? Select one: A. outward motion of the abdomen B. supraclavicular retractions C. intercostal retractions D. inward motion of the abdomen

A. outward motion of the abdomen

Which of the following would probably characterize the emotional state of a patient with a tension pneumothorax? Select one: A. panic B. anger C. euphoria D. depression

A. panic

Before preparing to administer therapy to a patient, you should first review the medical records for Select one: A. patient's medical history B. patient's blood type C. patient's economic status D. patient's marital status

A. patient's medical history

Once a doctor agrees that further medical care of patient would be futile, the decision to withdraw life support is made by the: Select one: A. patient, family or legal surrogate B. hospital ethics committee C. patient's attending physician D. patient or family lawyer

A. patient, family or legal surrogate

After a bronchoscopic biopsy, the physician asks that your properly process the metal forceps used to obtain the tissue sample. Which of the following processing methods should you use? Select one: A. steam autoclaving B. immersion in acetic acid C. pasteurization at 63 °C D. washing in a detergent

A. steam autoclaving

When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly expands during inspiration. Which of the following are potential causes of this problem? Select one: A. flail chest B. phrenic nerve paralysis C. acites D. kyphoscoliosis

B. phrenic nerve paralysis

During auscultation, you hear a creaking or grating sound which increases in intensity with deep breathing, but is not affected by coughing. Which of the following conditions best 'fits' this finding? Select one: A. pleurisy B. chronic bronchitis C. pulmonary edema D. atelectasis

A. pleurisy

A patient is stabilized with adequate oxygenation and ventilation on volume control ventilation (VC) with the following settings: rate = 15/min, tidal volume = 550 mL, peak inspiratory pressure (PIP) = 45 cm H2O, plateau pressure = 30 H2O and PEEP = 10 cm H2O. The doctor orders a changeover to pressure control ventilation (PC). Which of the following settings would you initially use to implement PC in this patient? Select one: A. pressure limit/PIP = 30 cm H2O; rate = 15/min; PEEP = 10 cm H2O B. pressure limit/PIP = 45 cm H2O; rate = 12/min; PEEP = 10 cm H2O C. pressure limit/PIP = 15 cm H2O; rate = 15/min; PEEP = 20 cm H2O D. pressure limit/PIP = 20 cm H2O; rate = 20/min; PEEP = 10 cm H2O

A. pressure limit/PIP = 30 cm H2O; rate = 15/min; PEEP = 10 cm H2O

Which of the following modes is indicated if the doctor's goal for her patient is to provide ventilatory support at lowest possible pressure, but guarantee a consistent tidal volume? Select one: A. pressure regulated volume control B. volume control assist-control C. airway pressure release ventilation D. pressure control SIMV

A. pressure regulated volume control

After a fiberoptic bronchoscopy procedure and return to his room, a patient exhibits an SpO2 of 88% on room air. Which of the following actions would you recommend? Select one: A. provide O2 therapy and reassess in 4 hours B. administer a benzodiazepine (e.g., Valium or Versed) C. administer a racemic epinephrine aerosol treatment D. have the patient refrain from eating or drinking

A. provide O2 therapy and reassess in 4 hours

The chest X-ray of a patient admitted to ICU exhibits a large area of consolidation in the left lung. Which of the following is a potential cause of this finding? Select one: A. pulmonary contusion B. pulmonary barotrauma C. tension pneumothorax D. interstitial emphysema

A. pulmonary contusion

In which of the following conditions are fine, late inspiratory crackles (rales) most likely to be heard on auscultation? Select one: A. pulmonary edema B. croup C. pleural effusion D. asthma

A. pulmonary edema

The most likely cause of bilateral fluffy infiltrates on a chest x-ray is: Select one: A. pulmonary edema B. neoplasm C. pleural effusion D. hemothorax

A. pulmonary edema

Which of the following abnormalities would appear as an area of increased radiodensity on a chest X-ray? Select one: A. pulmonary edema B. pneumopericardium C. hyperinflation D. pneumothorax

A. pulmonary edema

What type of sputum would be most common in a patient with an advanced bacterial infection of the respiratory tract? Select one: A. purulent sputum B. mucoid sputum C. bloody sputum D. frothy sputum

A. purulent sputum

A patient is admitted to the emergency room with an initial diagnosis of CO poisoning. ABGs are drawn with her breathing room air and show the following: pH = 7.46 PaCO2 = 32 torr PaO2 = 85 torr Based on this, what change would you recommend for the patient's respiratory care plan? Select one: A. put the patient on a nonrebreathing mask @ 12-15 L/min B. intubate and Institute mechanical ventilation with 50% O2 C. give the patient 28% O2 by an air-entrainment mask D. discharge her because she is not hypoxemic

A. put the patient on a nonrebreathing mask @ 12-15 L/min

Which of the following formula is used to calculate cardiac output? Select one: A. rate (f) x stroke volume (SV) B. stroke volume (SV)/rate (f) C. blood pressure (BP) x stroke volume (SV) D. blood pressure (BP)/stroke volume (SV)

A. rate (f) x stroke volume (SV)

Following airway clearance therapy, you auscultate a patient's chest and hear coarse, low-pitched, continuous sounds bilaterally around the upper chest. Which of the following terms would you record in the patient's chart or respiratory notes? Select one: A. rhonchi B. wheezes C. rales D. crackles

A. rhonchi

Inspection of a patient reveals jugular venous distention. Which of the following is the most likely cause of this observation? Select one: A. right heart failure B. hypovolemia C. pulmonary hypotension D. dehydration

A. right heart failure

On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 45; regular rhythm; normal P waves, P-R intervals, and QRS complexes. The most likely problem is: Select one: A. sinus bradycardia B. sinoatrial arrest C. 2nd degree heart block D. 1st degree heart block

A. sinus bradycardia

To properly disinfect a bronchoscope's instruments (e.g., biopsy forceps, specimen brushes) you would: Select one: A. send the instruments to central supply for steam autoclaving B. immerse the instruments in 70% isopropyl alcohol for 10 min C. send the instruments to central supply for pasteurization D. immerse the instruments in 3% glutaraldehyde for 30 min

A. send the instruments to central supply for steam autoclaving

When inspecting the X-ray of a patient in ICU, you note radiolucent streaks within the soft tissues of the chest wall/neck. Which of the following is the most likely problem? Select one: A. subcutaneous emphysema B. pneumomediastinum C. pneumothorax D. interstitial infiltration

A. subcutaneous emphysema

On examination of a normal patient's neck, the midline of the trachea should be directly below the center of the: Select one: A. suprasternal notch B. midclavicular line C. midaxillary line D. anterior axillary line

A. suprasternal notch

A doctor asks you to conduct an apnea test on an intubated patient suspected of being brain dead. Five minutes after removing the patient from the ventilator you begin observing intermittent chest excursions. Which of the following actions would be appropriate? Select one: A. terminate the test and restore ventilatory support B. draw an ABG and continue to observe the patient C. extubate the patient and provide O2 via nonrebreather D. recommend administration of a sedative/hypnotic

A. terminate the test and restore ventilatory support

A 40-year-old male is mechanically ventilated through an 8 mm ID endotracheal tube. The tube is taped at the patient's lips 17 cm from the tip. A leak is heard every time the ventilator delivers a breath. The addition of 10 mL of air does not correct the problem and the pilot balloon is firm. Which of the following is the most likely reason for this finding? Select one: A. the cuff is above the patient's vocal cords B. the patient has a right mainstem intubation C. the patient has a bronchopleural fistula D. the cuff requires more air

A. the cuff is above the patient's vocal cords

The best site for capillary puncture in an infant is: Select one: A. the lateral aspect of the heel's plantar surface B. the anterior curvature of the heel C. the medial aspect of the heel's plantar surface D. the posterior curvature of the heel

A. the lateral aspect of the heel's plantar surface

In assessing a patient's breathing pattern, you note a rate of 35/min and observe that his abdomen moves outward while the lower rib cage moves inward during inspiration. Which of the following conclusions can you draw from this finding? Select one: A. the patient has a high work of breathing/muscle fatigue B. the patient is suffering from hyperventilation syndrome C. the patient has increased lung or thoracic compliance D. the patient is responding to hypoxemic stimulation

A. the patient has a high work of breathing/muscle fatigue

Over a 3-hour period, the plateau pressure of a patient receiving volume controlled ventilation has remained stable, but her peak pressure has been steadily increasing. Which of the following is the best explanation for this observation? Select one: A. the patient's airway resistance has increased B. the patient is developing atelectasis C. the patient's compliance has decreased D. the patient is developing pulmonary edema

A. the patient's airway resistance has increased

You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data? **picture missing** Select one: A. this is a normal capnogram B. the capnogram indicates rebreathing C. the capnogram indicates a leak around the ET tube D. the capnogram indicates hypoventilation

A. this is a normal capnogram

Which of the following is most appropriate for managing an airway for a hospitalized patient with massive facial trauma involving the nose and mouth? Select one: A. tracheostomy tube B. nasotracheal tube C. oral endotracheal tube D. laryngeal mask airway

A. tracheostomy tube

To continuously monitor the adequacy of ventilation of a patient in ICU being supported by mask BiPAP, you would recommend which of the following? Select one: A. transcutaneous PCO2 B. pulse oximetry C. ABG analysis D. vital capacity

A. transcutaneous PCO2

Airborne precautions are indicated for which of the following? Select one: A. tuberculosis patient B. hepatitis patient C. patient with an open wound D. cancer patient

A. tuberculosis patient

Which of the following is an ABSOLUTE contraindications against conducting a cardiac stress test? Select one: A. uncontrolled hypertension B. 1st-degree heart block C. stable angina pectoris D. old myocardial infarction

A. uncontrolled hypertension

After three failed attempts at intubation, an anesthesiologist asks for your assistance in performing a retrograde intubation. After puncturing the cricothyroid membrane with an 18 gauge angiocath, she passes a long guidewire through the angiocath sheath toward the head of the patient. At this point you should: Select one: A. use forceps to pull the guidewire out the mouth and slide the ET tube over it B. apply downward pressure on the cricoid cartilage to help position the guidewire C. attach a high pressure oxygen source to the angiocath connector D. insert an oropharyngeal airway and suction the patient with a Yankauer tip

A. use forceps to pull the guidewire out the mouth and slide the ET tube over it

The maximum amount of air that can be exhaled from the maximum inspiratory level is defined as which of the following? Select one: A. vital capacity B. residual volume C. total lung capacity D. expiratory reserve volume

A. vital capacity

Bases on evaluation of the chest X-ray, a doctor want to increase the CPAP level on a infant receiving O2 via a high flow nasal cannula set to 8 L/min. To do so, you would: Select one: A. increase the system flow B. switch to larger nasal prongs C. decrease the system flow D. switch to smaller nasal prongs

B. switch to larger nasal prongs

Which of the following would be the most likely cause of stridor in a child? Select one: A. asthma B. epiglottitis C. pneumonia D. cystic fibrosis

B. epiglottitis

The major therapeutic indication for thoracentesis is: Select one: A. presence of pleural fluid of unknown etiology B. large pleural effusion restricting ventilation C. pressure reduction of a tension pneumothorax D. treatment of infectious pleural exudates

B. large pleural effusion restricting ventilation

Which of the following clinical findings are consistent with core pulmonale? Select one: A. high pulmonary artery wedge pressue B. low central venous pressure C. hepatic congestion/hepatomegaly D. left axis deviation on ECG

C. hepatic congestion/hepatomegaly

A patient receiving long-term positive pressure ventilatory support exhibits a progressive weight gain and a reduction in the hematocrit. Which of the following is the most likely cause of this problem? Select one: A. protein catabolism B. pulmonary hemorrhage C. water retention D. hypovolemia

C. water retention

A physician orders a "T-tube trial" for a patient receiving volume control A/C ventilation with an FIO2 of 0.40. What FIO2 would you deliver to the patient during her spontaneous breathing trial? Select one: A. 0.21 B. 0.30 C. 0.40 D. 0.50

D. 0.50

Which of the following VD/VT ratios is inconsistent with the ability of a patient to maintain adequate CO2 removal at a tolerable level of ventilation? Select one: A. 0.10 B. 0.30 C. 0.50 D. 0.70

D. 0.70

Which of the following ECG leads should be placed in the left midaxillary line? Select one: A. V3 B. V4 C. V5 D. V6

D. V6

Which of the following sites is preferred for percutaneous arterial blood sampling? Select one: A. femoral B. carotid C. brachial D. radial

D. radial

A resident physician has twice failed to orally intubate a patient requiring airway protection and mechanical ventilation. Which of the following non-surgical techniques would you recommend as an alternative? Select one: A. perform a cricothyrotomy B. insert a supraglottic airway C. perform retrograde intubation D. use video-assisted laryngoscopy

D. use video-assisted laryngoscopy

A doctor want a hospitalized patient to receive a long acting beta-agonist twice a day via small volume drug nebulizer. Which of the following drugs would you recommend? Select one: a. arformoterol (Brovana) b. levalbuterol (Xopenex) c. salmeterol (Serevent) d. tiotropium (Spiriva)

a. arformoterol (Brovana)

A trauma patient is admitted to the Emergency Department with a ridged cervical collar in place. The ED physician asks you to assist her in positioning the patient for oral intubation via direct laryngoscopy. You would: Select one: a. remove the entire collar and place the patient in the sniffing position b. keep the collar in place and push down on the cricoid cartilage c. remove the front of the collar and apply manual in-line stabilization d. keep the collar in place and apply traction on the patient's neck

c. remove the front of the collar and apply manual in-line stabilization

An Emergency Department doctor is having difficulty orally intubating a patient with suspected spinal trauma because you are applying manual in-line stabilization to the patient's head and neck. The patient is at risk of aspiration and will need ventilatory support. Which of the following would you recommend as the next step in securing the patient's airway? Select one: a. performing a cricothyrotomy and applying jet ventilation b. foregoing in-line stabilization and placing the patient in the sniffing position c. abandoning endotracheal intubation and inserting a laryngeal mask airway d. re-attempting intubation using a tube introducer/bougie or fiberoptic stylet

d. re-attempting intubation using a tube introducer/bougie or fiberoptic stylet

You notice that the blood pressure and pulse have gradually increased over the past few days on a patient receiving 2 L/min oxygen via nasal cannula. Which of the following is the most likely cause? Select one: A. hypoxemia B. cardiogenic shock C. hypothermia D. dehydration

hypoxemia

You would perform an apnea test to assist a doctor in determining Select one: A. hypoxic response B. brain death C. paralysis level D. diffusing capacity

B. brain death

Which of the following is a potential hazard of thoracentesis? Select one: A. barotrauma B. liver laceration C. pulmonary emboli D. peritonitis

B. liver laceration

Which of the following would indicate an obstruction in the endotracheal tube of a patient receiving volume control ventilation? High pressure Cannot pass High minute alarm suction volume alarm sounding catheter sounding A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

A. A

You are asked to assist a physician with nasotracheal intubation of an adult. Which of the following medications would you recommend to prepare the upper airway for tube insertion? Vasoconstrictor Local anesthetic Bronchodilator A. Yes Yes No B. No Yes Yes C. Yes Yes Yes D. Yes No Yes Select one: A. A B. B C. C D. D

A. A

A doctor institutes volume control A/C ventilation for an 80-kg ARDS patient. Which of the following is the maximum plateau pressure you should aim to achieve in this patient? Select one: A. 50 cm H2O peak pressure B. 30 cm H2O plateau pressure C. 40 cm H2O peak pressure D. 50 cm H2O plateau pressure

B. 30 cm H2O plateau pressure

An adequately hydrated patient should have on average an hourly urinary output of at least: Select one: A. 10-20 mL/hr B. 30-50 mL/hr C. 70-90 mL/hr D. 100-120 mL/hr

B. 30-50 mL/hr

A normal vital capacity for a female patient who is five feet two inches tall and weighs 50 kilograms would be approximately: Select one: A. 2500 mL B. 3500 mL C. 4500 mL D. 5500 mL

B. 3500 mL

Which of the following procedures require active patient cooperation to be effective? Select one: A. ventilator weaning B. breathing exercises C. mask CPAP D. mechanical cough assist

B. breathing exercises

Immediately following intubation of a patient's trachea, which of the following would yield the best information regarding ET tube position in the trachea? Select one: A. arterial blood gas analysis B. chest X-ray C. exhaled volume D. PETCO2

B. chest X-ray

Which of the following is typically NOT part of a patient's social history? Select one: A. tobacco use B. childhood diseases C. marital status D. education

B. childhood diseases

Which of the following would provide the best bedside assessment of the need for mechanical ventilation in a patient with Guillain-Barre syndrome? Select one: A. FRC B. VC C. airway resistance D. TLC

B. VC

A person who suddenly experiences an acute upper airway obstruction due to foreign body aspiration would likely show which of the following: Select one: A. depression B. twitching C. panic D. hyperoxia

C. panic

Which of the following equations best describes O2 delivery TO the tissues? Select one: A. arterial oxygen content x stroke volume B. arterial oxygen content x cardiac output C. cardiac output x arterial PO2 D. cardiac output x vascular resistance

B. arterial oxygen content x cardiac output

The first heart sound (S1) is created primarily by: Select one: A. closure of the semilunar valves B. closure of the atrioventricular valves C. opening of the semilunar valves D. opening of the atrioventricular valves

B. closure of the atrioventricular valves

The second heart sound (S2) is created primarily by: Select one: A. opening of the atrioventricular valves B. closure of the semilunar valves C. closure of the atrioventricular valves D. opening of the semilunar valves

B. closure of the semilunar valves

Patients with respiratory disease such as lung tumors, bronchiectasis, or pulmonary fibrosis often exhibit a bulbous swelling of the terminal phalanges of the fingers and toes. This clinical sign is called: Select one: A. cyanosis B. clubbing C. cor pulmonale D. Babinski's sign

B. clubbing

You are transporting a patient in an unpressurized airplane at a cruising altitude of 10000 ft (PB = 523 mm Hg). The patient was receiving 40% oxygen at sea level. What FIO2 should be provided to this patient at this cruising altitude? Select one: A. 0.30 B. 0.50 C. 0.60 D. 0.70

C. 0.60

Normal oxygen consumption for a 70 kg male would be about: Select one: A. 200 mL/min B. 250 mL/min C. 300 mL/min D. 350 mL/min

B. 250 mL/min

You are assisting a neonatologist performing orotracheal intubation of a 3.5 kg full-term newborn infant. Which of the following endotracheal tube sizes would you select for this patient? Select one: A. 2.0 mm B. 3.0 mm C. 4.0 mm D. 5.0 mm

B. 3.0 mm

While observing a patient's pattern of breathing, you note that the abdomen moves inward as the rib cage expands during inspiration. Which of the following descriptions would you note in the respiratory notes? Select one: A. "patient exhibits inspiratory retractions" B. "patient exhibits asynchronous breathing" C. "patient exhibits apneustic breathing" D. "patient exhibits normal breathing pattern"

B. "patient exhibits asynchronous breathing"

What initial energy dose would you recommend to defibrillate an adult patient in ventricular fibrillation when using a biphasic defibrillator? Select one: A. 20-100 J B. 120 to 200 J C. 240-320 J D. 320-400 J

B. 120 to 200 J

An infant on volume control A/C ventilation is breathing 75% O2, has a mean airway pressure (MAP) of 10 cm H2O and a PaO2 of 50 torr. What is her oxygenation index? Select one: A. 10 B. 15 C. 20 D. 25

B. 15

A patient has an FRC of 3000 mL, a VC of 4000 mL, and an ERV of 1500 mL. What is his functional residual volume (RV)? Select one: A. 4500 mL B. 1500 mL C. 2500 mL D. 7000 mL

B. 1500 mL

You obtain the following data on a patient receiving volume control ventilation: Peak pressure 50 cm H2O Plateau pressure 25 cm H2O PEEP 8 cm H2O Set tidal volume 700 mL Inspiratory flow 75 L/min What is the patient's inspiratory airway resistance? Select one: A. 17 cm H2O/L/sec B. 20 cm H2O/L/sec C. 25 cm H2O/L/sec D. 42 cm H2O/L/sec

B. 20 cm H2O/L/sec

A normal resting energy expenditure (REE) for a 70 kg male would be about: Select one: A. 1000 kcal/24 hr B. 2000 kcal/24 hr C. 3000 kcal/24 hr D. 4000 kcal/24 hr

B. 2000 kcal/24 hr

The best way to ensure that hospital healthcare workers are prepared to deal with disaster emergencies is to: Select one: A. educate the community on disaster management B. conduct regular emergency disaster drills C. run in-service classes on disaster management D. provide self-teaching materials on dealing with disasters

B. conduct regular emergency disaster drills

A physician asks you to assist her during a cardioversion procedure. The patient is undergoing moderate sedation with propofol (Diprivan) and receiving 60% oxygen via high flow nasal cannula. Which of the following parameters would you monitor during this procedure? [Expired CO2] [SpO2 (pulse] [Heart rate/] [(capnography)] [oximetry)] [rhythm (ECG)] A. Yes Yes No B. Yes Yes Yes C. Yes No Yes D. No Yes Yes Select one: A. A B. B C. C D. D

B. B

An adult patient with acute hypoxemia would likely exhibit which of the following clinical signs? [Tachycardia] [Wheezing] [Confusion] [Tachypnea] A. Yes Yes No Yes B. Yes No Yes Yes C. Yes Yes Yes Yes D. No Yes Yes No Select one: A. A B. B C. C D. D

B. B

An exercise test can help determine the cause of which of the following? Dyspnea Chronic Wheezing O2 cough desaturation A. No Yes No Yes B. Yes No Yes Yes C. Yes Yes Yes No D. Yes Yes Yes Yes Select one: A. A B. B C. C D. D

B. B

Clinical signs of postoperative atelectasis include which of the following? [Tachypnea] [Hyperresonance] [Decreased] [on percussion] [breath sounds] A. Yes Yes Yes B. Yes No Yes C. Yes Yes No D. No Yes Yes Select one: A. A B. B C. C D. D

B. B

In order to maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend? Fully stocked Staff trained Patient physical 'crash cart' in advance and ECG on site life support before test A. No Yes Yes B. Yes Yes Yes C. Yes Yes No D. Yes No Yes Select one: A. A B. B C. C D. D

B. B

Lower airway anesthesia for fiberoptic bronchoscopy can be achieved via which of the following routes of administration? Bronchoscopic Intravenous Nebulization instillation administration (via aerosol) A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

B. B

You are asked by a physician to assist in monitoring a patient during a chest tube insertion. Which of the following would you recommend to monitor this patient for this procedure? [Vital] [Heart] [Breath] [Pulse sat/] [signs] [rhythm/ECG] [sounds] [SpO2] A. Yes No Yes No B. Yes Yes Yes Yes C. Yes Yes No Yes D. No Yes Yes Yes Select one: A. A B. B C. C D. D

B. B

A patient who weighs 70 kg (154 lb) is receiving volume control A/C ventilation with an FIO2 of 0.8 and 5 cm H2O PEEP. His arterial blood gas results are below: pH = 7.53 PaCO2 = 32 torr HCO3 = 26 mEq/L BE = +1 PaO2 = 48 torr SaO2 = 83% You should FIRST do which of the following? Select one: A. Increase the minute ventilation B. Increase the PEEP C. Decrease the minute ventilation D. Increase the FIO2

B. Increase the PEEP

A patient is admitted to the ICU from a post-operative surgical unit with a hospital-acquired lobar pneumonia. A sputum Gram stain reveals small Gram-negative organisms. Which of the following is the most likely cause of the pneumonia? Select one: A. Streptococcus pneumoniae B. Klebsiella pneumoniae C. Bacillus anthracis D. Staphylococcus aureus

B. Klebsiella pneumoniae

During a bedside patient assessment, you hear vesicular breath sounds over the bases of the lungs. A note should be put into the chart that this represents: Select one: A. A sound caused by laryngeal edema B. Normal breath sounds C. Secretions in the large airways D. Decreased breath sounds

B. Normal breath sounds

When questioning a patient regarding his environmental exposure history, you need to obtain information on: Select one: A. commuting distance from home to work B. job tasks, location, materials, and agents used C. lines of authority/job reporting structure D. position title and hourly or annual salary

B. job tasks, location, materials, and agents used

Which of the following type of respiratory care equipment presents the greatest potential for spreading nosocomial infections? Select one: A. heated cascade humidifiers B. large reservoir jet nebulizers C. unheated oxygen humidifiers D. bag-mask resuscitators

B. large reservoir jet nebulizers

An emergency room resident is preparing to intubate a child using rapid sequence induction of anesthesia. The resident is concerned about causing a vagal-reflex bradycardia during laryngoscopy. Which of the following drugs would you recommend to premedicate this patient against a vagal response? Select one: A. succinylcholine (Anectine) B. atropine sulfate C. ketamine hydrochloride D. necuronium bromide (Norcuron)

B. atropine sulfate

A 20-year-old woman with diabetes who takes insulin has the following ABG results while breathing room air: Blood Gases pH = 7.19 PaCO2 = 27 torr HCO3 = 10 mEq/L PaO2 = 107 torr Based on this information, which of the following can be correctly concluded? Select one: A. The values are erroneous with a PaO2 > 100 torr at an FIO2 of 0.21 B. The patient has partially compensated metabolic acidosis C. The patient has partially compensated respiratory alkalosis D. The patient has combined respiratory and metabolic acidosis

B. The patient has partially compensated metabolic acidosis

Which of the following conditions is most likely to cause an elevated white blood count? Select one: A. pulmonary fibrosis B. bacterial bronchitis C. pneumothorax D. hypertension

B. bacterial bronchitis

When inspecting the chest of a patient with emphysema, you would most likely would observe which of the following? Select one: A. obesity B. barrel chest C. central cyanosis D. intercostal retractions

B. barrel chest

An adult patient with inspiratory stridor most likely has which of the following conditions? Select one: A. bronchospasm B. laryngeal edema C. retained secretions D. air trapping

B. laryngeal edema

After warming, positioning, suctioning and providing positive pressure ventilation for 30 seconds, a newborn infant's heart rate is 55/min. What should you do now? Select one: A. continue ventilation for another 30 seconds B. begin external cardiac chest compressions C. administer epinephrine and atropine D. provide supplemental O2, observe and monitor

B. begin external cardiac chest compressions

When using a transport ventilator with a single-limb breathing circuit, the low volume and low PEEP/CPAP alarms sound simultaneously. The most likely cause of this problem is: Select one: A. condensate buildup in the circuit B. a disconnected expiratory valve line C. a kink in the main tubing circuit D. blockage of the expiratory port

B. a disconnected expiratory valve line

On the physical assessment of a patient who appears acutely ill, you note the following: severely labored breathing, accessory muscle use, and stridor. These findings suggest: Select one: A. acute tension pneumothorax B. acute upper airway obstruction C. pneumonia with consolidation D. chronic airway obstruction

B. acute upper airway obstruction

Which two polysomnography channels are essential in differentiating obstructive from central sleep apneas? Select one: A. airflow + snoring (audio) B. airflow + respiratory effort C. respiratory effort + SpO2 D. airflow + leg motion

B. airflow + respiratory effort

The family of a ventilator-assisted home care patient who frequently desires to go outside on her wheelchair asks your advice regarding an appropriate ventilator system for this purpose. Which of the following would you recommend? Select one: A. a small pneumatically powered device with an 'E' cylinder B. an electrically powered device running off a marine battery C. an electrically powered device with a long extension cord D. a bag-valve-mask resuscitator with a portable LOX system

B. an electrically powered device running off a marine battery

To minimize risk of exacerbations, COPD patients should avoid which of the following triggers? Select one: A. warm, humidified air B. animal sheddings/danders C. unfiltered tap water D. nitrate-containing foods

B. animal sheddings/danders

When an adult develops acute upper airway obstruction likely due to foreign body aspiration, you should immediately: A. establish an airway and begin cardiopulmonary resuscitation B. apply a series of strong, external subdiaphragmatic compressions C. apply a forceful blow to the sternum D. lean the person forward and instruct him to inhale slowly

B. apply a series of strong, external subdiaphragmatic compressions

Which of the following would give the best indication of the adequacy of alveolar ventilation? Select one: A. maximum voluntary ventilation (MVV) B. arterial blood gas analysis C. vital capacity D. tidal volume

B. arterial blood gas analysis

When inspecting the monitor of an adult patient in ICU, you note a heart rate of 141/min with a regular rhythm. Which of the following is the most likely cause of this observation? Select one: A. beta-blocker adminstration B. arterial hypoxemia C. therapeutic hypothermia D. arterial hypertension

B. arterial hypoxemia

A doctor in the emergency department is managing a comatose patient and asks that you prepare a laryngeal mask airway for insertion. Select one: A. confirm no cuff leakage, inflate cuff to 30 mL, lubricate the laryngeal side B. confirm no cuff leakage, deflate until smooth and flat, lubricate pharyngeal side C. confirm no cuff leakage, inflate cuff to 30 mL, lubricate the pharyngeal side D. deflate cuff until smooth and flat, lubricate both the laryngeal and pharyngeal sides

B. confirm no cuff leakage, deflate until smooth and flat, lubricate pharyngeal side

In interviewing a patient with COPD you determine that she uses eastern meditation practices to deal with episodes of dyspnea. In consultation with the patient's doctor, you should: Select one: A. advice the patient against using alternative health practices B. consider including the mediation practices in the respiratory care plan C. suggest replacing meditation with standard breathing exercises D. recommend a prescription anxiolytic to help relieve the dyspnea

B. consider including the mediation practices in the respiratory care plan

On a pneumatically-powered IPPB device, switching the air-mix control to 100% oxygen will have which of the following effects on flow? Select one: A. make the flow dependent on patient effort B. decrease the flow to a lower level C. increase the flow to a higher level D. the change will have no effect on flow

B. decrease the flow to a lower level

When using a disposable CO2 indicator to confirm ET tube placement, a false negative (absence of color change even with proper tracheal positioning) can occur Select one: A. with metabolic acidosis B. during cardiac arrest C. with mainstem bronchial intubation D. during bag-valve ventilation

B. during cardiac arrest

You detect an irregular pulse and pulse deficit in a patient by palpation and auscultation, and suspect atrial fibrillation as the cause. Which of the following tests would you recommend to confirm if atrial fibrillation is the problem? Select one: A. cardiac catheterization B. electrocardiogram C. coronary angiogram D. echocardiogram

B. electrocardiogram

A patient with a chronic neuromuscular disorder requires nocturnal positive pressure ventilation over the long-term. Which of the following airways would you recommend for this patient? Select one: A. oral endotracheal tube B. fenestrated tracheostomy tube C. laryngeal mask airway D. standard tracheostomy tube

B. fenestrated tracheostomy tube

Which of the following findings would you expect to observe on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema? Select one: A. increased vascular markings B. flattening of the diaphragms C. decreased radiolucency D. increased C/T ratio

B. flattening of the diaphragms

While assessing a patient's radial pulse, you note that the pulse feels full and bounding. Which of the following conditions would be the most probable cause of this finding? Select one: A. hypovolemia B. hypertension C. cardiovascular shock D. low cardiac output

B. hypertension

In explaining to a terminally ill patient's family the available options for withdrawing ventilatory support from their loved one, which of the following information is essential to share? Select one: A. how often you will monitor the patient for distress B. if and when the ET tube will be removed C. how long they can expect the procedure to last D. how much sedation the patient will receive

B. if and when the ET tube will be removed

A pediatric patient with status asthmaticus is receiving volume control A/C ventilation. You observe on the ventilator's graphics screen that the expiratory flow fails to drop to zero before the next machine breath. What could you do to correct the situation? Select one: A. increase the set VT B. increase the expiratory time C. switch to pressure control D. increase the respiratory rate

B. increase the expiratory time

At 8:00 AM you estimate the airway resistance (Raw) of patient receiving volume control A/C ventilation to be 8 cm H2O/L/sec. Two hours later, his estimated Raw is 20 cm H2O/L/sec. Which of the following are possible causes of this change? Select one: A. pneumothorax B. increased secretions C. ascites D. laryngeal edema

B. increased secretions

A brain trauma patient is receiving volume control ventilation (true control mode) with a tidal volume of 600 mL (8 mL/kg), a rate of 20/min and an I:E ratio of 1:1. Due to a loss of vasomotor tone, the patient's blood pressure has been dropping. The doctor wants to minimize the effect of the positive pressure on the patient's cardiovascular system without changing the minute volume. You would recommend: Select one: A. increasing the inspiratory time B. increasing the inspiratory flow C. decreasing the expiratory time D. adding 5 cm H2O PEEP

B. increasing the inspiratory flow

Which of the following patient instructions for using a dry powder inhaler (DPI) is correct? Select one: A. hold the device vertically after loading B. inhale rapidly for 1-2 seconds C. blow slowly into the device D. breathe normally in/out of the device

B. inhale rapidly for 1-2 seconds

Diagnosis of myasthenia gravis may be confirmed via: Select one: A. assessment of the spinal fluid B. injection of edrophonium (Tensilon) C. biopsy of the anterior horn cells D. measurement of the vital capacity

B. injection of edrophonium (Tensilon)

A physician is having difficulty visualizing the airway of an obese patient during an emergency intubation procedure. He asks for your recommendation to quickly secure the airway and provide ventilation. You should recommend: Select one: A. a cricothyrotomy B. inserting an LMA C. sedating the patient D. using a double-lumen ET tube

B. inserting an LMA

Most IPPB devices are classified as pressure-cycled ventilators because: Select one: A. inspiration begins when a preset pressure limit is reached B. inspiration ends when a preset pressure limit is reached C. exhalation ends when a preset pressure limit is reached D. pressure is required to close the exhalation valve

B. inspiration ends when a preset pressure limit is reached

You are assisting a physician with a bronchoscopy procedure on a cardiac patient when suddenly endobronchial bleeding occurs. You should recommend which of the following? Select one: A. instilling Lidocaine (Xylocaine) B. instilling ice cold saline solution C. providing 100% O2 via nonrebreather D. instilling dilute epinephrine solution

B. instilling ice cold saline solution

Inspection of an AP chest film on a 44 year old homeless man with a history of alcoholism who is admitted for cold exposure reveals a circular area of central radiolucency with an air-fluid level. Which of the following is the most likely problem? Select one: A. bullous emphysema B. lung abscess C. pneuumothorax D. pleural effusion

B. lung abscess

While performing a maximal expiratory pressure (MEP) test using a valved T-piece, the patient blows out against the manometer, but no positive pressure is registered. What should be done to troubleshoot this problem? Select one: A. make sure both the inspiratory and expiratory valves are blocked B. make sure the inspiratory valve is patent and the expiratory valve is blocked C. make sure the inspiratory valve is blocked and the expiratory valve is patent D. make sure both the inspiratory and expiratory valves are patent

B. make sure the inspiratory valve is patent and the expiratory valve is blocked

In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'C' in the following figure. What type of abnormal respiratory event does this indicate? Select one: A. central sleep apnea B. mixed sleep apnea C. obstructive sleep apnea D. respiratory effort-related arousal

B. mixed sleep apnea

How would you characterize the degree of dyspnea of a patient who walks slower than people of the same age because of breathlessness? Select one: A. slight B. moderate C. severe D. very severe

B. moderate

Vesicular breath sounds indicate which of the following? Select one: A. pneumothorax B. normal lungs C. lung consolidation D. airways obstruction

B. normal lungs

During an interview with your patient you discover that he gets short of breath at night when he lays down so he often sleeps with several pillow propping his head up. What symptom is present? Select one: A. apnea B. orthopnea C. platypnea D. orthodeoxia

B. orthopnea

A patient exhibits respiratory alkalosis. Which of the following problems is most likely? Select one: A. hypothermia B. pain C. opiate overdose D. CNS depression

B. pain

Which of the following would cause a sudden increase in the peak pressure during volume controlled ventilation? Select one: A. decreased airway resistance B. paroxysms of coughing C. decreased inspiratory flow D. sudden increased in compliance

B. paroxysms of coughing

Which of the following would require that a bedside measure of a patient's forced vital capacity, be 'rejected' or deemed invalid? Select one: A. obtained value < 50% of predicted B. patient exerts inadequate effort C. peak flow occurs early in exhalation D. expiratory time is > 3 seconds

B. patient exerts inadequate effort

In addition to obtaining information on a patient's prescribed and over-the-counter medications, a good medication history should also include which of the following? Select one: A. total costs of prescriptions B. patient's medication knowledge C. family's use of prescription drugs D. generic vs. brand name drug use

B. patient's medication knowledge

A sleep study report should include which of the following information about blood oxygen levels? Select one: A. highest SpO2 during rapid eye movement sleep B. percent of sleep time with abnormally low SpO2 C. hourly arterial blood PO2 values D. before and after study HbCO saturation

B. percent of sleep time with abnormally low SpO2

While inspecting a spontaneously breathing adult patient's thorax, you note paradoxical movement of the right chest wall. This observation is most consistent with which of the following conditions? Select one: A. pulmonary emphysema B. phrenic nerve dysfunction C. pulmonary embolism D. pulmonary fibrosis

B. phrenic nerve dysfunction

When inspecting the x-ray of a premature infant in NICU receiving mechanical ventilation, you note a radiolucent band of air surrounding the heart. Which of the following is the most likely problem? Select one: A. subcutaneous emphysema B. pneumopericardium C. tension pneumothorax D. pulmonary interstitial emphysema

B. pneumopericardium

Which of the following would you recommend for a patient with obstructive sleep apnea for whom auto-CPAP does not resolve his symptoms? Select one: A. review the auto-CPAP records and switch the patient to standard CPAP B. re-evaluate the patient and recommend an attended CPAP titration sleep study C. review the auto-CPAP records and switch the patient to BiPAP D. re-evaluate the patient and recommend a home overnight oximetry study

B. re-evaluate the patient and recommend an attended CPAP titration sleep study

A physician orders 2 L/min O2 via simple mask to a 65 year-old patient with chronic hypercapnia. The correct action at this time would be to: Select one: A. recommend a flow of at least 5 L/min to wash out CO2 B. recommend that the mask be changed to a cannula at 2 L/min C. not apply the oxygen until contacting the medical director D. not carry out the order until the attending nurse agrees

B. recommend that the mask be changed to a cannula at 2 L/min

To avoid the risk of aspiration after a fiberoptic bronchoscopy procedure, you should recommend that the patient: Select one: A. be placed in the supine Trendelenburg position for 2 hours B. remain in a sitting position and NPO until sensation returns C. receive additional aerosolized lidocaine by nebulizer D. be continuously monitored for oxygenation through pulse oximetry

B. remain in a sitting position and NPO until sensation returns

To ensure accurate measurements, before attaching a transcutaneous blood gas monitor sensor to a patient, you should: Select one: A. place mineral oil inside the sensor fixation ring B. remove all oils/soaps from the sensor site C. pierce the sensor membrane to facilitate diffusion D. cool the sensor site with an ice pack

B. remove all oils/soaps from the sensor site

Simple spirometry CANNOT be used to measure the: Select one: A. vital capacity B. residual volume C. tidal volume D. inspiratory reserve volume

B. residual volume

Which of the following findings would you expect to see in an alert but anxious patient who has just been admitted to the ED in the early stages of an asthma attack? Select one: A. cor pulmonale B. respiratory alkalosis C. clubbing D. respiratory acidosis

B. respiratory alkalosis

While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation Select one: A. is consistent with the interstitial syndrome B. rules out an underlying pneumothorax C. indicates the presence of pleural adhesions D. confirms an underlying pneumothorax

B. rules out an underlying pneumothorax

During an interview with your patient, you determine that she is disoriented to time, place, and person. What may explain this finding? Select one: A. respiratory alkalosis B. severe hypoxemia C. metabolic acidosis D. hyperthermia

B. severe hypoxemia

You are evaluating a patient in the recovery room following an exploratory laparotomy. The patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine the patient's level of consciousness, you speak to the patient, who does not respond. Which of the following should you do FIRST? Select one: A. wait 1 hour and then repeat the attempt B. shake the patient's arm gently C. call for help D. administer a sternal rub

B. shake the patient's arm gently

Which of the following is the best way to avoid bright lights interfering with a pulse oximeter's signal? Select one: A. recheck and clean the site B. shield or cover the probe C. apply the probe more tightly D. replace the probe

B. shield or cover the probe

An anesthesiologist is planning a rapid sequence induction to intubate an adult trauma patient in the ED. In preparation for intubation, you are ventilating and oxygenating the patient with a bag-valve-mask. The anesthesiologist is concerned about the potential for gastric distention and aspiration before the tube is placed. To help avoid this problem, you would: Select one: A. place the patient in the lateral decubitus (side-lying) position B. sit the patient up and keep airway pressure < 20-25 cm H2O C. place gentle pressure on the the patient's upper epigastrium D. rotate the patient's head and neck forty-five degrees to the right

B. sit the patient up and keep airway pressure < 20-25 cm H2O

As measured on the Borg scale, which of the following exertion levels is appropriate for titrating a COPD patient's O2 flows to support exercise? Select one: A. weak/light exertion (rating of 2) B. somewhat strong exertion (rating of 4) C. very strong exertion (rating of 7) D. maximal exertion (rating of 10)

B. somewhat strong exertion (rating of 4)

Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL? Select one: A. ribs higher posteriorly than anteriorly at end-expiration B. sternocleidomastoid muscles used at rest C. costal angle of 90 degrees increases with inspiration D. respiratory rate of 18 breaths per minute

B. sternocleidomastoid muscles used at rest

While administering an IPPB treatment to a post-op abdominal surgery patient, you note that her neck veins become distended and her heart rate increases and becomes a bit irregular. What action would you take at this time? Select one: A. decrease the pressure setting B. stop the treatment/monitor the patient C. increase the delivered FIO2 D. increase the sensitivity setting

B. stop the treatment/monitor the patient

On palpating the neck region of a patient on a mechanical ventilator, you note a crackling sound and sensation. What is the most likely cause of this observation? Select one: A. upper bronchial obstruction B. subcutaneous emphysema C. pneumonia of the upper lobes D. atelectasis of the upper lobes

B. subcutaneous emphysema

By placing a patient in the prone position with a pillow under the abdomen and keeping the bed level, you would be targeting what segment in postural drainage? Select one: A. lateral basal segment of lower lobes B. superior segment of lower lobes C. apical segment of upper lobes D. posterior segment of upper lobes

B. superior segment of lower lobes

During a procedure in ICU, blood spills onto the outer plastic casing of an in-use ventilator. After cleaning the surface using gloves and disposable gauze pads, how would you decontaminate it? Select one: A. spray the area with a concentrated isopropyl alcohol solution B. swab the area with a tuberculocidal disinfectant or bleach solution C. take the ventilator out of service and have it sterilized D. wash the surface with a detergent and rinse with sterile water

B. swab the area with a tuberculocidal disinfectant or bleach solution

Which of the following terms best describes an adult pulse rate of 125 per minute? Select one: A. bradycardia B. tachycardia C. pulsus paradoxus D. pulsus alternans

B. tachycardia

During an extended self-test of a ventilator, you receive multiple failure warnings, but are allowed to bypass them and complete the test. Which of the following would be your best course of action? Select one: A. document the test results and limit the ventilator use to 'passed' functions only B. take the ventilator out of service and replace it with a fully functional device C. document the test results and make the ventilator available for full patient use D. enter the ventilator's setup program and change the self-test options

B. take the ventilator out of service and replace it with a fully functional device

If the rate of breathing increases without any change in total minute ventilation (VE constant): Select one: A. the alveolar ventilation per minute will increase B. the alveolar ventilation per minute will decrease C. the deadspace ventilation per minute will decrease D. the alveolar ventilation per minute will remain constant

B. the alveolar ventilation per minute will decrease

You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data? **picture missing** Select one: A. the capnogram indicates hyperventilation B. the capnogram indicates rebreathing C. the capnogram indicates a leak around the ET tube D. the capnogram indicates hypoventilation

B. the capnogram indicates rebreathing

While assisting a physician who is inserting a pulmonary artery catheter, you note a changeover on the monitor from pulsatile pressures of about 25/5 mm Hg to pulsatile pressures of 25/15 mm Hg. Which of the following has occurred? Select one: A. the catheter has advanced from right atrium to right ventricle B. the catheter has moved from right ventricle to pulmonary artery C. the catheter has advanced into the pulmonary wedge position D. the catheter has moved from the vena cava into the right atrium

B. the catheter has moved from right ventricle to pulmonary artery

A polysomnography report indicates an average of 12 mainly obstructive apnea/hypopnea events per hour. Which of the following statements is most consistent with this observation? Select one: A. since there are less than 15 events per hour, the findings are inconclusive B. the findings confirm a diagnosis of mild obstructive sleep apnea C. the findings confirm a diagnosis of moderate obstructive sleep apnea D. the findings confirm a diagnosis of severe obstructive sleep apnea

B. the findings confirm a diagnosis of mild obstructive sleep apnea

A average size (170 lb) adult male patient exhibits a total lung capacity of 3000 mL. What, if anything can you conclude from this test result? Select one: A. the patient has severe air trapping B. the patient has a restrictive pulmonary disorder C. the patient has an obstructive pulmonary disorder D. the patient has a decrease in lung compliance

B. the patient has a restrictive pulmonary disorder

You note in a patient's chart that the night shift respiratory therapist states the patient is "oriented x 3." This means: Select one: A. the patient is able to follow instructions B. the patient is alert with a normal sensorium C. the patient has adequate arterial oxygenation D. the patient is willing to cooperate

B. the patient is alert with a normal sensorium

Which of the following indicate that a three-chamber pleural drainage system is working properly? Select one: A. the water seal chamber level remains constant during breathing B. there is continuous bubbling in the suction control chamber C. there is continuous bubbling in the water seal chamber D. the suction control chamber level rises and falls with breathing

B. there is continuous bubbling in the suction control chamber

After insertion of a laryngeal mask airway (LMA) in the Emergency Department, an adult male patient regurgitates. You should immediately: Select one: A. completely deflate the LMA cuff and remove the tube B. turn the patient on his side and suction via the airway tube C. add an additional 10-15 mL of air to the LMA cuff D. apply epigastric pressure to decompress the stomach

B. turn the patient on his side and suction via the airway tube

Which of the following can be used to assess gestational age or fetal maturity before birth? Select one: A. Ballard score B. ultrasonography C. presence of lanugo D. recoil of extremities

B. ultrasonography

Gurgling and visible secretions are noted in the oropharynx of an unconscious stroke victim. Which of the following methods would you recommend to remove these secretions? Select one: A. insert a nasopharyngeal airway B. use a Yankauer suction tip C. insert an oropharyngeal airway D. perform endotracheal suctioning

B. use a Yankauer suction tip

You encounter resistance while trying to pass a 14 Fr suction catheter through a 6 mm ID endotracheal tube. Which of the following is the most appropriate action to take? Select one: A. pull the ET tube (mucus plug) B. use a smaller (10 Fr) catheter C. turn the patient's head to the right D. instill 5 mL normal saline solution

B. use a smaller (10 Fr) catheter

A resident physician has twice failed to orally intubate a patient requiring airway protection and mechanical ventilation. Which of the following non-surgical techniques would you recommend as an alternative? Select one: A. perform a cricothyrotomy B. use a tracheal tube introducer C. perform retrograde intubation D. insert a supraglottic airway

B. use a tracheal tube introducer

You home care assignment includes teaching the family of a child with cystic fibrosis how to properly position the patient for percussion and vibration. The chart indicates that the family does not speak English very well, and there is no one available to translate. Which of the following methods would you use to help overcome the language barrier? Select one: A. slowly explain the method and procedures over the phone B. use demonstration and supplemental diagrams to show the method C. provide written instructions on how to perform the procedure D. recommend purchasing a computer-assisted instructional program

B. use demonstration and supplemental diagrams to show the method

In obtaining a medication history from a patient admitted for an acute exacerbation of asthma, which of the following information would you consider least important? Select one: A. frequency of rescue inhaler usage B. use of generic vs. brand name medications C. patient understanding of controllers vs. relievers D. self-administration techniques

B. use of generic vs. brand name medications

You recommend against inserting a supraglottic airway (e.g., LMA, Combitube, King LT) in a patient: Select one: A. for whom ET intubation is difficult B. with known esophageal disease C. with a suspected cervical spine injury D. needing emergency ventilation

B. with known esophageal disease

To help minimize family distress, a doctor wants to avoid gurgling, sonorous breathing or stridor in a terminally ill patient who is scheduled for withdrawal of ventilatory support. Which of the following procedures would you recommend to help achieve the doctor's goal? A. immediate extubation to nasal cannula B. withdrawal to T-tube with humidified O2 C. IMV weaning followed by rapid extubation D. exchange the endotracheal tube for an LMA

B. withdrawal to T-tube with humidified O2

When testing a ventilator's operation, the actual oxygen concentrations delivered by the device should be within what percentage of that set on its FIO2 control? Select one: A. ±1% B. ±2% C. ±5% D. ±20%

B. ±2%

Total compliance of the respiratory system (lung + thorax) in normal subjects is about: Select one: A. 0.2 L/cm H20 B. 2.0 L/cm H20 C. 0.1 L/cm H20 D. 20 L/cm H20

C. 0.1 L/cm H20

The data below were obtained while an adult patient was receiving controlled mechanical ventilation with an FIO2 of 0.50 (PIP = peak pressure; BP = blood pressure) Time PIP PEEP PaO2 PvO2 BP cm H2O cm H2O torr torr mm Hg 5:00 40 0 43 28 140/90 5:20 45 6 53 39 130/90 5:40 46 8 58 43 120/90 6:00 50 10 65 45 120/80 6:20 52 12 75 42 105/70 Based on these date, which PEEP level would you recommend for this patient? Select one: A. 6 cm H2O B. 8 cm H2O C. 10 cm H2O D. 12 cm H2O

C. 10 cm H2O

A patient has a systolic arterial pressure of 145 mm Hg and a diastolic pressure of 100 mm Hg. Her estimated mean arterial pressure (MAP) is: Select one: A. 45 mm Hg B. 122 mm Hg C. 115 mm Hg D. 245 mm Hg

C. 115 mm Hg

A patient has a systolic arterial pressure of 180 mm Hg and a diastolic value of 90 mm Hg. What is his approximate mean arterial pressure? Select one: A. 100 mm Hg B. 110 mm Hg C. 120 mm Hg D. 130 mm Hg

C. 120 mm Hg

A portable spirometer requires that you enter the patient's height in cm in order to derive normal values. The patient tells you that she is 5 feet 6 inches tall. What value would you enter into the device? Select one: A. 26 cm B. 66 cm C. 168 cm D. 186 cm

C. 168 cm

In analyzing overnight oximetry data, a desaturation event represents a decrease in SpO2 of: Select one: A. 2% or more B. 3% or more C. 4% or more D. 5% or more

C. 4% or more

The minimum flow setting for a simple mask applied to an adult is: Select one: A. 3 L/min B. 4 L/min C. 5 L/min D. 6 L/min

C. 5 L/min

You are assisting a pediatrician performing orotracheal intubation of an 8 year-old child. Which of the following endotracheal tube sizes would you select for this patient? Select one: A. 4.0 mm B. 5.0 mm C. 6.0 mm D. 7.0 mm

C. 6.0 mm

A patient has an expired minute ventilation of 7500 mL and a ventilatory rate of 12/min. What is her average tidal volume? Select one: A. 930 mL B. 540 mL C. 625 mL D. 400 mL

C. 625 mL

You are assisting with the endobronchial intubation of an adult patient in the ICU. You confirm the presence of bilateral breath sounds. In order to properly assess tracheal tube placement you should recommend the following procedure: Select one: A. CAT scan B. laryngoscopy C. AP chest X-ray D. bedside spirometry

C. AP chest X-ray

Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL? Select one: A. inspiratory time is shorter than expiratory time B. ribs slope downward from spine at end-expiration C. AP diameter of thorax is equal to its transverse diameter D. thorax expands, abdomen rises during inspiration

C. AP diameter of thorax is equal to its transverse diameter

A patient is orally intubated and immediately started on pressure control A/C ventilation. Which of the following would you initially verify in assessing this patient';s airway? Cuff Tube Tube pressure position patency A. Yes No Yes B. Yes Yes No C. Yes Yes Yes D. No Yes Yes Select one: A. A B. B C. C D. D

C. C

A patient who recently underwent laryngectomy complains that her airway feels dry and her secretions are crusty. Which of the following would you recommend to help overcome her problem? Stomal Talking 'Mini' filter valve HME A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

C. C

At the end of each graded step of a cardiopulmonary exercise test, you normally would measure which of the following? Select one: A. physiologic deadspace B. intrapulmonary shunt C. Borg exertion rating D. pulmonary diffusing capacity

C. Borg exertion rating

A nurse requests you begin withdrawal of ventilatory support on a terminally ill patient. Before proceeding with the protocol you should confirm the presence of: A valid informed consent A palliative doctor's order of patient/family care team for withdrawal case review A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

C. C

A patient is admitted with signs and symptoms of pulmonary congestion and edema, but tests for CHF are all negative. However, because cardiac murmurs are heard on auscultation, the patient undergoes cardiac catheterization to assess for valve abnormalities. Which of the following valve abnormalities could be causing the patient's pulmonary congestion? Aortic Mitral Mitral regurgitation stenosis regurgitation A. Yes No Yes B. Yes Yes No C. Yes Yes Yes D. No Yes Yes Select one: A. A B. B C. C D. D

C. C

Procedures that can confirm a diagnosis of Pneumocystis carinii (jiroveci) pneumonia (PCP/PJP) include which of the following? [Lung] [Bronchoalveolar] [Chest] [Sputum] [Biopsy] [lavage] [radiograph] [induction] A. Yes No Yes Yes B. No Yes Yes No C. Yes Yes No Yes D. Yes Yes Yes Yes Select one: A. A B. B C. C D. D

C. C

The following four patients all exhibit acceptable ABGs during a spontaneous breathing trial. Cuff Leak Test Gag Reflex Max Exp Pressure A Pass Absent 0 cm H2O B Fail Present 20 cm H2O C Pass Present 70 cm H2O D Pass Absent 0 cm H2O Which one of these patients would you recommend be extubated? Select one: A. A B. B C. C D. D

C. C

Which of the following are key priorities in withdrawing a terminally ill, ventilator-dependent patient from ventilatory support? Keeping Supporting Maintaining the patient the needs of neuromuscular comfortable the family blockade A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

C. C

Which of the following can help confirm successful removal of an obstructing foreign body from a patient's airway? Return of Ability Return of normal color to speak consciousness A. Yes Yes No B. Yes No Yes C. Yes Yes Yes D. No Yes Yes Select one: A. A B. B C. C D. D

C. C

You have been asked to organize a patient/family education program as part of a discharge plan for a patient requiring home ventilatory support. Which of the following areas would you be sure to cover? Equipment Patient airway CPR/ operation assessment management emergency and and and clearance disinfection monitoring A. No Yes No Yes B. Yes No Yes Yes C. Yes Yes Yes Yes D. No Yes Yes No Select one: A. A B. B C. C D. D

C. C

FORCEFUL exhalation expels gas below the resting level. The amount of gas that can be exhaled below the resting expiratory level is the: Select one: A. RV B. FRC C. ERV D. VC

C. ERV

Which of the following formula can be used to estimate a patient's maximum voluntary ventilation (MVV)? Select one: A. FVC x 40 B. VCO2/VO2 C. FEV1 x 40 D. IRV/FRC

C. FEV1 x 40

Which of the following equipment might a doctor request to assist her in directing an endotracheal tube between the vocal cords during nasotracheal intubation? Select one: A. stylet B. light wand C. Magill forceps D. capnograph

C. Magill forceps

Prior to obtaining an arterial blood sample on a patient being treated for smoke inhalation, you perform a modified Allen's test on his right wrist. Following release of the patient's ulnar artery, the palm remains pale. Which of the following should you do NEXT? Select one: A. Obtain the sample from the right ulnar artery B. Obtain the sample from the left radial artery C. Repeat Allen's test on the patient's left wrist D. Use the SpO2 instead of the arterial saturation

C. Repeat Allen's test on the patient's left wrist

At 8:00 AM you estimate the airway resistance (Raw) of patient receiving volume control A/C ventilation to be 8 cm H2O/L/sec. Two hours later, his estimated Raw is 20 cm H2O/L/sec. Which of the following are possible causes of this change? Select one: A. pneumothorax B. laryngeal edema C. a mucous plug D. ascites

C. a mucous plug

Which of the following measures taken on adult patients indicate an unacceptably high ventilatory demands or work of breathing? Select one: A. breathing frequency of 22/min B. deadspace/tidal volume ratio of 0.45 C. VE of 17 L/min with PaCO2=45 mm Hg D. R-L pulmonary shunt fraction of 15%

C. VE of 17 L/min with PaCO2=45 mm Hg

Which of the following factors increase a patient's ventilatory demand? Select one: A. hypothermia B. metabolic alkalosis C. increased metabolic rate D. barbiturate overdose

C. increased metabolic rate

A patient's bedside spirometry results (as compared to normal) are as follows: FVC decreased FEV1 normal FEV1% increased What is the most likely problem? Select one: A. an obstructive disorder B. poor patient effort C. a restrictive disorder D. within normal limits

C. a restrictive disorder

Which of the following staining procedures is used specifically to help identify organisms in the genus Mycobacterium? Select one: A. phenol satin B. carbolfusin stain C. acid-fast stain D. Gram stain

C. acid-fast stain

Which of the following would be LEAST likely to increase intracranial pressure in a brain-injured patient? Select one: A. providing mechanical ventilation with PEEP B. giving IPPB treatments with high pressure C. administering a high concentration of O2 D. administering a 5% CO2 and 95% O2 mixture

C. administering a high concentration of O2

After assisting with chest tube insertion at the bedside of a patient receiving mechanical ventilation, you connect the tube to a pleural drainage system and apply -15 cm H2O suction. Five minute later you note crepitus occurring around the insertion site. This indicates: Select one: A. application of excessive suction B. proper re-expansion of the lung C. air leakage into the pleural space D. loss of the suction system water seal

C. air leakage into the pleural space

An infant born at 28 weeks gestation and weighing 1400 g requires continuous O2 therapy, Which of the following pulse oximeter alarm settings would you recommend for this infant? Setting Low High A 80% 85% B 85% 90% C. 90% 95% D. 95% Off Select one: A. alarm setting A B. alarm setting B C. alarm setting C D. alarm setting D

C. alarm setting C

To measure both a patient's slow and forced vital capacity (FVC) at the bedside, you would select: Select one: A. a mechanical spirometer B. a aneroid pressure manometer C. an electronic spirometer D. a Stead-Wells spirometer

C. an electronic spirometer

You normally should recommend AGAINST performing a diagnostic bronchoscopy procedure on a patient with Select one: A. suspicious sputum cytology results B. an X-ray indicating a pulmonary mass C. an uncorrected bleeding disorder D. unexplained dyspnea, wheezing and stridor

C. an uncorrected bleeding disorder

A patient exhibits respiratory alkalosis. Which of the following problems is most likely? Select one: A. hypothermia B. opiate overdose C. anxiety D. CNS depression

C. anxiety

After two attempts at securing the airway and ventilating an infant in respiratory arrest, you still cannot confirm adequate air movement. You suspect foreign body airway obstruction. At this point you should: A. apply six to ten strong abdominal thrusts B. try to ventilate again with smaller puffs C. apply back blows, followed by chest compressions D. go on to provide external cardiac compressions

C. apply back blows, followed by chest compressions

Lung tumors are revealed on a positron emission tomography (PET) scan as: Select one: A. areas of decreased metabolism ('dark spots') B. areas of increased radiolucency ('dark spots') C. areas of increased metabolism ('bright spots') D. areas of decreased radiolucency ('bright spots')

C. areas of increased metabolism ('bright spots')

On inspection of a patient's ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is: Select one: A. 2nd degree (Wenckebach) heart block B. ventricular fibrillation C. atrial fibrillation D. ventricular tachycardia

C. atrial fibrillation

An anesthesiologist is planning a rapid sequence intubation of a spontaneously breathing adult patient in the surgical ICU and asks that you pre-oxygenate the patient. Which of the following would be the best approach to assure that this patient is properly pre-oxygenated? Select one: A. bag the patient using a bag-valve-mask at 15 L/min for 30 seconds B. place the patient on a nonrebreathing mask at 5 L/min for 5 minutes C. bag the patient using a bag-valve-mask at 15 L/min for 5 minutes D. provide 100% O2 at 12 L/min via jet nebulizer + aerosol mask for 5 minutes

C. bag the patient using a bag-valve-mask at 15 L/min for 5 minutes

Which of the following could be done to help assure delivery of 70% O2 via a standard air-entrainment nebulizer to an intubated patient? Select one: A. increasing nebulizer input flow to 25-30 L/min B. heating the nebulizer water reservoir to 40° C C. bleeding in/titrating extra O2 via a T-adapter D. powering the nebulizer with an O2 blender

C. bleeding in/titrating extra O2 via a T-adapter

When are conducting a tracheostomy tube change at the bedside of a patient in ICU, you completely lose the stomal tract. After sealing the area around the external stoma with a Vaseline gauze pad and having your partner begin oronasal bag-mask ventilation your next action should be to: Select one: A. call a Code Blue/Code 99 B. call for emergency cricothyrotomy C. call for emergency intubation D. initiate transtracheal jet ventilation

C. call for emergency intubation

A COPD patient is receiving sustained-release theophylline treatments. Which of the following is a possible adverse effect of this therapy? Select one: A. hyperkalemia B. hypoglycemia C. cardiac arrhythmias D. respiratory alkalosis

C. cardiac arrhythmias

Pursed-lip breathing during exhalation would be observed most often among patients which of the following disorders? Select one: A. diffuse interstitial fibrosis B. consolidation of lung tissue C. chronic airways obstruction D. acute upper airway obstruction

C. chronic airways obstruction

To validate patient readings obtained from a transcutaneous blood gas monitor, you should: Select one: A. measure and compare the PtcO2 and PtcCO2 at three or more different sites B. compare the monitor's readings to a concurrent pulse oximetry reading C. compare the monitor's readings to those obtained via a concurrent ABG sample D. compare the patient reading to those obtained when calibrating the sensor

C. compare the monitor's readings to those obtained via a concurrent ABG sample

An intensivist decides to terminate a resuscitation effort on a 53-year-old woman who he had intubated at the start of the code. The patient's nurse asks that you remove the ET tube before the family comes in to see their loved one. You should: Select one: A. refuse to remove the tube because it must legally remain B. remove the tube and save it for any post-CPR audits C. confirm/document tube position before removing it D. cut the tube off at the patient's teeth so it does not protrude

C. confirm/document tube position before removing it

A patient with neuromuscular disease has been on ventilatory support for 4 months via standard cuffed tracheotomy tube. At this point, she requires only nighttime ventilator support. Which of the following artificial airways should you recommend? Select one: A. tracheostomy button B. Bivona (foam cuffed) trach tube C. cuffed, fenestrated trach tube D. uncuffed, standard trach tube

C. cuffed, fenestrated trach tube

Data for a 78 kg (172 lb) patient receiving ventilatory support with 12 cm PEEP are as follows: Ventilator Settings Mode SIMV vol ctrl VT 750 mL Rate 8 FIO2 0.45 PEEP 15 cm H2O Blood Gases: pH = 7.36 PaCO2 = 40 torr HCO3 = 22 mEq/L PaO2 = 155 mm Hg SaO2 = 99% Which of the following changes would you recommend at this time? Select one: A. lower the VT B. increase the rate C. decrease PEEP D. decrease the FIO2

C. decrease PEEP

Characteristic of all obstructive disorders is a: Select one: A. decrease in lung volumes B. increase in lung volumes C. decrease in flow rates D. decrease in work of breathing

C. decrease in flow rates

In assessing a patient in the acute phase of ARDS, you would expect to find: Select one: A. increased lung volumes B. high pulmonary wedge pressure C. decreased lung compliance D. metabolic alkalosis

C. decreased lung compliance

Which of the following would cause a patient to experience fluid depletion or dehydration? Select one: A. congestive heart failure B. cirrhosis of the liver C. diarrhea D. high sodium intake

C. diarrhea

Which of the following can help avoid the problem of arterial blood sample contamination with air? Select one: A. use a non-vented syringe B. mix before expelling air C. discard frothy samples D. use dry heparin

C. discard frothy samples

Which of the following statements are TRUE regarding cardioversion? Select one: A. discharges of 5-10 Joules/kg are used on children B. discharges are used to stop ventricular fibrillation C. discharges of 100-200 Joules used on adults D. discharges occur during the relative refractory period

C. discharges of 100-200 Joules used on adults

You are gathering a sputum specimen from a patient in isolation. In addition to applying appropriate transmission-based precautions, which of the following procedures should be followed in processing this specimen? Select one: A. mix the specimen with a fixative before sending it to the lab B. leave the specimen container at the nursing station for transport C. disinfect outside of specimen container if contaminated D. have the specimen undergo sterilization before processing

C. disinfect outside of specimen container if contaminated

You need to initiate an O2 protocol on a patient in isolation with a diagnosis of tuberculosis. In addition to standard precautions, you should: Select one: A. wear a sterile gown B. perform a surgical scrub C. don an N-95 respirator D. wear eye protection

C. don an N-95 respirator

A patient with symptomatic bradycardia does not respond to atropine. You would recommend: Select one: A. verapamil B. metoprolol C. dopamine D. propranolol

C. dopamine

When making routine equipment checks you hear the relief valve of a patient's bubble humidifier sounding. Which of the following is the most likely cause of this problem? Select one: A. clogged bubble/diffuser B. high wall outlet pressure C. excessive oxygen input flow D. decreased patient compliance

C. excessive oxygen input flow

Which of the following is an advantage of mainstream capnometry? Select one: A. decreased dead space B. no heating needed C. fast response time D. no calibration required

C. fast response time

After showing a patient how to perform incentive spirometry, the best way to confirm his ability to perform it correctly would be to: Select one: A. have him take a multiple choice quiz B. discuss the information with patient's family C. have him perform a return demonstration D. have him "teach" the information back to you

C. have him perform a return demonstration

A comatose patient breathing room air has an a/A ratio of 0.85 but is hypoxemic. What is the likely cause of the hypoxemia? Select one: A. laboratory error B. V/Q imbalance C. hypoventilation D. pulmonary shunting

C. hypoventilation

While reviewing the chart of a patient with lobar pneumonia, you note that the respiratory rate for the last 24 hours has increased from 18 to 38/min. Which of the following is the most likely cause of the increased respiratory rate? Select one: A. hypothermia B. hyperkalemia C. hypoxemia D. metabolic alkalosis

C. hypoxemia

Sodium bicarbonate administration during resuscitation would be most helpful in which of the following situations? Select one: A. in patients with hypoxic lactic acidosis B. in patients suffering drug overdose C. in patients with known hyperkalemia D. in patients suffering protracted arrest

C. in patients with known hyperkalemia

A respiratory effort-related arousal (RERA) is defined as: Select one: A. a decrease in breathing greater than 30% that causes desaturation B. a period ≥ 10 seconds of no airflow with increasing respiratory effort C. increasing respiratory effort that leads to an arousal from sleep D. a period ≥ 10 seconds of no airflow without respiratory effort

C. increasing respiratory effort that leads to an arousal from sleep

The gold standard for monitoring intracranial pressure (ICP) is the: Select one: A. intraparenchymal probe B. subarachnoid bolt C. intraventricular catheter D. epidural sensor

C. intraventricular catheter

Which of the following statements regarding CENTRAL cyanosis is TRUE? Select one: A. it is a reliable indicator of the severity of hypoxemia and hypoxia B. it is best observed in the extremities (finger/toe nailbeds) C. it results from excessive reduced Hb in the arterial blood D. its presence always signals inadequate O2 delivery to the tissues

C. it results from excessive reduced Hb in the arterial blood

Disadvantages of noninvasive ventilation include which one of the following? Select one: A. costs more than invasive ventilation B. requires heavy patient sedation C. limits direct access to lower airway D. increases the likelihood of VAP

C. limits direct access to lower airway

In examining the neck of a patient, you note that the trachea is not positioned in the midline. Which of the following conditions would be the mostly likely cause of this observation? Select one: A. pulmonary fibrosis B. chronic bronchitis C. lobar collapse D. pulmonary edema

C. lobar collapse

While assessing a patient receiving support via an ICU ventilator, you note that the monitored tidal volume is significantly lower than the preset tidal volume. To determine if this discrepancy is due to improper calibration or malfunction of the volume control system, you should measure the volume at the: Select one: A. patient connector B. exhalation valve C. machine outlet D. humidifier outlet

C. machine outlet

A 60 kg. (132 lb.) COPD patient is receiving SIMV with a VT of 500 mL at 9/min with an FIO2 of 0.35. Blood gases are as follows: pH = 7.36; PCO2 = 61 torr; HCO3 = 36 mEq/L; PaO2 = 64 torr. Which of the following changes would you recommend at this time? Select one: A. increase the IMV rate B. increase the FIO2 C. maintain settings D. increase the VT

C. maintain settings

Which of the following behavioral strategies would you recommend to help alleviate symptoms of a patient with sleep apnea? Select one: A. taking a late afternoon nap B. exercising strenuously before bed C. maintaining an active lifestyle D. having a cocktail before bed

C. maintaining an active lifestyle

A mechanically ventilated patient exhibits a sudden decrease in end-tidal CO2 levels. Which of the following is a possible cause of this change? Select one: A. rewarming after surgery B. release of a tourniquet C. massive pulmonary embolization D. increase in CO2 production

C. massive pulmonary embolization

Where in the medical record would one go to find information on a patient's understanding of the drugs they are taking and their methods of administration? Select one: A. medication record B. progress notes C. medication history D. admission/face sheet

C. medication history

In assessing a new adult admission to ICU, you note a spontaneous respiratory rate of 38/minute. The most likely cause of this observation is: Select one: A. therapeutic hypothermia B. CNS depression C. metabolic acidosis D. decreased CO2 production

C. metabolic acidosis

While listening to a patient's posterior lung bases, you hear low-pitched, soft sounds occurring mainly during inspiration. This finding is most consistent with which of the following? Select one: A. increased secretions B. hyperinflation C. normal lung function D. atelectasis

C. normal lung function

Which of the following would indicate proper positioning of a laryngeal mask airway (LMA)? Select one: A. absence of bowel sounds on abdominal auscultation B. clear visibility of the LMA cuff in the oral cavity C. observation of chest expansion during inspiration D. return of spontaneous circulation (ROSC)

C. observation of chest expansion during inspiration

In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'B' in the following figure. What type of abnormal respiratory event does this indicate? Select one: A. central sleep apnea B. mixed sleep apnea C. obstructive sleep apnea D. respiratory effort-related arousal

C. obstructive sleep apnea

A patient states that he has trouble sleeping unless he uses two pillows. This comment indicates which of the following conditions: Select one: A. dysphagia B. platypnea C. orthopnea D. tachypnea

C. orthopnea

When assisting a physician with needle thoracostomy for a patient with a confirmed pneumothorax, you should advise the physician that the needle should be inserted in what anatomic location? Select one: A. over the fourth rib, mid-sternal line B. over the fourth rib, mid-clavicular line C. over the second rib, mid-clavicular line D. under the fourth rib, laterally

C. over the second rib, mid-clavicular line

A patient involved in a motor vehicle accident presents with respiratory distress. A chest X-ray confirms the presence of multiple rib fractures on the left side. Which of the following physical findings would be expected during palpation of the chest? Select one: A. trachea deviated to the left B. paradoxical motion of the abdomen C. paradoxical motion of the left chest D. tympany over the right chest

C. paradoxical motion of the left chest

A physician is performing a blind nasotracheal intubation and believes that he has positioned the tube in the trachea. Which of the following is a preliminary sign that the tube has been properly placed? Select one: A. patient grimaces as tube is passed B. gastric contents appears in the tube C. patient coughs as tube is passed D. conscious patient is able to speak

C. patient coughs as tube is passed

Which of the following would be a key consideration in determining the content, level and type of educational activities for an adult patient participating in an asthma disease management program? Select one: A. patient's socioeconomic status B. patient's respiratory muscle strength C. patient's learning needs/preferences D. patient's exhaled carbon monoxide levels

C. patient's learning needs/preferences

Continuous bland aerosol poses the greatest risk for: Select one: A. patients with a tracheostomy B. adults with normal fluid balance C. patients with asthma D. patients with hypothermia

C. patients with asthma

A physician orders O2 titration via protocol for a postop patient in a surgical unit. Which of the following must be included in this order? Select one: A. the device flow in L/min B. the desired %O2/FIO2 C. physician notification criteria D. the specific O2 delivery equipment

C. physician notification criteria

You are working with a 55-year-old patient who had open heart surgery yesterday. He is awake and has stable vital signs and acceptable weaning parameters. After breathing spontaneously on a T-piece for 30 minutes, he starts to bleed heavily through his mediastinal chest tube. The nurse checks his vital signs and determines that his blood pressure is 90/50 mm Hg, heart rate is 130 beats/min, and respiratory rate is 28 breaths/min. The best action at this time would be to: Select one: A. keep him on the T piece for 20 more minutes B. draw an ABG sample to see if he is hypoxemic C. place him back on the ventilator D. switch the weaning protocol to SIMV

C. place him back on the ventilator

At their point of origin, contaminated sharps should be: Select one: A. placed in a puncture-resistant bag B. disassembled before discarding C. placed in a rigid sharps container D. broken or bent before discarding

C. placed in a rigid sharps container

In examining the neck of a patient, you note that the trachea is not positioned in the midline. Which of the following conditions would be the mostly likely cause of this observation? Select one: A. pulmonary fibrosis B. chronic bronchitis C. pleural effusion D. pulmonary edema

C. pleural effusion

A physician's order for a potent aerosol bronchodilator indicates three times the normal recommended dosage. Which of the following would be the appropriate action to take in this case? Select one: A. have the nurse responsible for this patient give the drug B. substitute a less potent aerosol bronchodilator agent C. postpone therapy until able to contact the ordering physician D. use the standard dosage listed in the package insert

C. postpone therapy until able to contact the ordering physician

After verifying that a patient found lying on the floor is unresponsive and pulseless, you call a code and ask for a defibrillator. Your next action should be to: A. call the supervisor and ask for assistance B. provide 2 breaths without pause C. provide 30 chest compressions D. open the patient's airway

C. provide 30 chest compressions

You are using an SIMV protocol to terminally wean a cancer patient from ventilatory support. When you decrease the rate from 6 to 3 breaths/min, you observe some agitation and labored breathing. Which of the following should you recommend? Select one: A. restore full ventilatory support B. remove the ventilator and extubate C. provide an IV push of sedating agents D. immediately decrease the rate to 0

C. provide an IV push of sedating agents

In reviewing the radiology report in a patient's chart, you note that the chest x-ray reveals flattened hemidiaphragms and hyperinflation. These findings are most consistent with which of the following disorders? Select one: A. bacterial pneumonia B. pulmonary embolism C. pulmonary emphysema D. chronic bronchitis

C. pulmonary emphysema

Prior to intubation in an emergency, injection of air into the pilot line fails to inflate the cuff. You should Select one: A. check the cuff for leaks B. check the valve on the pilot line C. replace the endotracheal tube D. inspect the pilot line for patency

C. replace the endotracheal tube

A mechanically ventilated patient is being transported to X-ray. You notice that the patient's heat and moisture exchanger (HME) has become clogged with secretions. Which of the following should you do to correct the problem? Select one: A. increase the flow through the heat moisture exchanger B. rinse the heat moisture exchanger with sterile water C. replace the heat moisture exchanger D. increase the relative humidity being delivered

C. replace the heat moisture exchanger

Negative inspiratory pressure (NIF; MIP) is useful in the determination of which of the following? Select one: A. airway resistance B. functional residual capacity C. respiratory muscle strength D. sustained maximal inspiration

C. respiratory muscle strength

A patient is prescribed Triamcinolone acetonide (Azmacort) via MDI 2 puffs TID. To decrease the likelihood of oral candidiasis, you would recommend that the patient: Select one: A. be prescribed an appropriate antibiotic B. decrease the frequency of inhalations to BID C. rinse her mouth and gargle with water after inhalation D. receive concurrent bronchodilator therapy

C. rinse her mouth and gargle with water after inhalation

In reviewing the chart of a 65 year-old patient diagnosed with COPD and chronic hypoxemia, you would expect to see which of the following findings? Select one: A. decreased A-P chest diameter B. chronic respiratory alkalosis C. secondary polycythemia D. FRC less than predicted

C. secondary polycythemia

The results of a patient's spirometry tests before and after bronchodilator therapy are below: Parameter Pre % Post % FVC (L) 48% 85% FEV1 (L) 32% 65% FEV1/FVC (%) 44% 60% Which of the following is the correct interpretation of these results? Select one: A. mild obstructive disease, no significant bronchodilator response B. mild restrictive disease, significant bronchodilator response C. severe obstructive disease, significant bronchodilator response D. severe restrictive disease, no significant bronchodilator response

C. severe obstructive disease, significant bronchodilator response

Which of the following is a contraindication against performing thoracentesis? A. large pleural effusion B. platelet count > 150,000/mm3 C. severe, uncorrectable coagulopathy D. mechanical ventilation with PEEP

C. severe, uncorrectable coagulopathy

In what position should you place an unconscious patient in order to facilitate a thoracentesis procedure? Select one: A. slighted rotated from supine with the affected side up near the edge of the bed B. prone position with foot of bed raised 12 inches C. slighted rotated from supine with the affected side down on the edge of the bed D. sitting at the edge of the bed leaning forward

C. slighted rotated from supine with the affected side down on the edge of the bed

Which of the following is an acceptable way to dispose of liquid biohazardous/infectious waste, such as blood or body fluids? Select one: A. place in a biohazard bag for disposal B. process in hot water cycle (pasteurization) C. steam autoclave using the liquid cycle D. transport in containers to sanitary landfill

C. steam autoclave using the liquid cycle

A patient with COPD is receiving 2.5 mg albuterol (Proventil) in 3 mL of normal saline three times a day to relieve airway obstruction. He complains of nervousness and tremors after most therapy sessions. You should consider recommending which of the following to the patient's doctor? Select one: A. substituting acetylcysteine (Mucomyst) for the albuterol B. decreasing the frequency of albuterol treatments C. substituting ipratropium (Atrovent) for the albuterol D. substituting budesonide (Pulmicort) for the albuterol

C. substituting ipratropium (Atrovent) for the albuterol

Instructions for an electrically-powered respirometer clearly specify that it cannot be immersed in water. What procedure would you recommend to decontaminate this piece of equipment before further processing? Select one: A. a quick wash in a flurocarbon-based liquid B. microwave heating at low energy for 3 minutes C. surface disinfection with 70% alcohol D. immersion in 2% glutaraldehyde for 10 minutes

C. surface disinfection with 70% alcohol

You are assisting a resident perform orotracheal intubation of a semiconscious adult patient in the emergency room. Despite three failed attempts by the resident to place the tube in the trachea, you still are able to provide the patient with adequate ventilation and oxygenation using a bag-valve-mask system. Which of the following would you recommend to the resident as the next course of action? Select one: A. try at least one more oral intubation attempt before abandoning the effort B. perform an emergency cricothyrotomy and position an ET tube in the stoma C. suspend intubation efforts, continue bagging the patient, consider alternatives D. switch to the nasal route and perform a blind nasotracheal intubation

C. suspend intubation efforts, continue bagging the patient, consider alternatives

A paralyzed trauma patient receiving volume control A/C ventilation is undergoing continuous metabolic monitoring, with a respiratory quotient (RQ) of 0.85. The doctor orders the patient's tidal volume decreased from 6 mL/kg to 4 mL/kg. What impact will this have on the patient's RQ? Select one: A. temporary rise in RQ above 1.0 B. permanent rise in RQ above 1.0 C. temporary fall in RQ below 0.70 D. permanent fall in RQ below 0.70

C. temporary fall in RQ below 0.70

The physician asks for your recommendation regarding chest tube placement for a patient with a pneumothorax. In what anatomic location should you recommend that the tube be inserted? Select one: A. the 8th intercostal space at the midclavicular line B. the 2nd or 3rd intercostal space at the midclavicular line C. the 4th or 5th intercostal space at the midaxillary line D. the 1st or 2nd intercostal space at the anterior axillary line

C. the 4th or 5th intercostal space at the midaxillary line

While assisting a physician who is inserting a pulmonary artery catheter, you note a changeover on the monitor from pulsatile pressures of about 32/18 mm Hg to a nonpulsatile pressures of 15 mm Hg. Which of the following has occurred? Select one: A. the catheter has slipped back into the right atrium and needs to be and re-inserted B. the catheter has moved from right ventricle into the pulmonary artery C. the catheter has advanced into the pulmonary wedge or occluded position D. the catheter is in Zone I and needs to be withdrawn and re-inserted

C. the catheter has advanced into the pulmonary wedge or occluded position

Which of the following statement is correct about performing compressions during CPR on a infant? A. compression depth should be at least two inches B. the compression/ventilation ratio should be 30:1 C. the compression rate should be greater than 100/min D. compressions should be applied to the manubrium

C. the compression rate should be greater than 100/min

Which of the following "on-mask" time report for patients receiving home CPAP therapy for sleep apnea indicates acceptable compliance/adherence to treatment? Select one: A. ≥ 2 hours of device use at least 3 nights per week B. ≥ 3 hours of device use at least 4 nights per week C. ≥ 4 hours of device use at least 5 nights per week D. ≥ 3 hours of device use at least 6 nights per week

C. ≥ 4 hours of device use at least 5 nights per week

Which of the characteristics of a patient's sputum should be assessed at the bedside and documented in the chart? Select one: A. density B. DNA content C. surface tension D. viscosity

D. viscosity

Signs of infant respiratory distress indicating a potential need for CPAP include which of the following? Cyanosis on Grunting Inspiratory O2 therapy on expiration retractions A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

In order to improve gas distribution, a physician requests that the inspiratory flow be lowered on a patient receiving volume control A/C ventilation (VC, A/C). What consequences might this action have? Air-trapping/ Increased Patient "flow auto-PEEP pleural pressures starvation" A. Yes No Yes B. Yes Yes No C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

A patient breathing 100% O2 has a P(A-a)O2 of 400 torr. What is her approximate % shunt? Select one: A. 5% B. 10% C. 15% D. 20%

D. 20%

A doctor institutes volume control ventilation for a 70 kg ARDS patient with a targeted tidal volume of 420 mL. To maintain adequate ventilation with this tidal volume, you would allow a machine respiratory rate as high as: Select one: A. 20/min B. 25/min C. 30/min D. 35/min

D. 35/min

A physician wants to calculate the static lung compliance for 110 kg patient receiving volume-cycled ventilation. Patient settings and monitoring data are as follows: VT 900 mL Rate 14/min Peak pressure 50 cm H2O Plateau pressure 35 cm H2O PEEP 10 cm H2O Mechanical dead space 100 mL The patient's static lung compliance is: Select one: A. 18 mL/cm H2O B. 26 mL/cm H2O C. 22mL/cmH2O D. 36 mL/cm H2O

D. 36 mL/cm H2O

A patient is receiving volume-controlled ventilation. The patient has a tidal volume of 500 mL. Based on this information, the low exhaled volume alarm should be set no lower than: Select one: A. 100 mL B. 200 mL C. 300 mL D. 400 mL

D. 400 mL

The normal range for vital capacity in a young healthy male of average size is: Select one: A. 5000 to 6000 ml B. 2000 to 3000 ml C. 3000 to 4000 ml D. 4000 to 5000 ml

D. 4000 to 5000 ml

A 65 year old patient with COPD is receiving O2 via a 28% air entrainment mask. With an O2 input of 4 L/min, what is the total output gas flow? Select one: A. 30 L/min B. 35 L/min C. 40 L/min D. 45 L/min

D. 45 L/min

What maximum flow would you apply to an infant receiving O2 therapy via a high flow nasal cannula? Select one: A. 2 L/min B. 4 L/min C. 6 L/min D. 8 L/min

D. 8 L/min

Assuming ideal conditions (lighting, skin color, normal Hb), central cyanosis FIRST manifests itself in adults when the arterial hemoglobin saturation drops below: Select one: A. 95% B. 90% C. 85% D. 80%

D. 80%

In patients with artificial tracheal airways, retention of secretions can be minimized by: Suctioning Re-positioning Providing the airway the patient adequate airway as needed frequently humidification A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Low to moderate oxygen concentrations (FIO2s between 0.21 and 0.50) are generally effective in treating hypoxemia caused by which of the following? Low Diffusion Moderate alveolar PO2 defect V/Q imbalance A. Yes No Yes B. Yes Yes No C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

A patient coughs productively after receiving airway clearance therapy. You note that the sputum sample is foul smelling and green. You would suspect that the patient has: Select one: A. Pulmonary edema B. Chronic bronchitis C. Pneumococcal pneumonia D. Bronchiectasis

D. Bronchiectasis

A doctor asks you to conduct an apnea test on a patient suspected of being brain dead. Before doing so you would want to assess the patient for: Major Recently Recently Acid-base or administered administered electrolyte CNS paralytic agents imbalances depressants A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

A patient's record indicates a history of substance abuse. Which of the following substances could be involved? [readily available] [prescription] [illicit/illegal] [chemicals] [medications] [drugs] A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

After arriving with the Medical Emergency Team in the room of an unresponsive patient, you immediately begin bag-valve-mask (BVM) ventilation with 100% O2. Which of the following signs would indicate difficulty with this patient's airway? Decrease Lack of chest Gastric in SpO2 movement dilatation A. Yes No Yes B. Yes Yes No C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

After setting up an intubated patient for ventilatory support, which of the following supplementary equipment would you require be available at the bedside? Suction source Backup Bag-valve with catheters artificial airway resuscitator A. Yes Yes No B. No Yes Yes C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

An 75-kg (165-lb) patient receiving mechanical ventilation is being considered for weaning. Which of the following measurements indicate readiness for a weaning assessment? [Rapid shallow] [Arterial] [Spontaneous] [PaO2/FIO2] [breathing index] [blood pH] [breathing rate] [(P/F ratio)] [= 80] [= 7.30] [= 32/min] [=300] A. Yes No Yes Yes B. No Yes Yes No C. Yes Yes No Yes D. Yes Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Asthma disease management includes which of the following components? Self- Environmental Pharmacologic management trigger therapy education control A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Endotracheal (ET) tube exchange would be indicated to replace a: standard tube smaller ET a failed ET with a double tube with tube, e.g. with lumen one a larger one a blown cuff A. Yes No Yes B. Yes Yes No C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

In order to formulate an exercise prescription, a doctor has scheduled an outpatient with COPD for a treadmill test the next morning. You would instruct her to: [take nothing] [stop all] [review all] [by mouth] [prescribed] [drugs with] [after midnight] [drugs at once] [the doctor] A. No Yes Yes B. Yes Yes No C. Yes Yes Yes D. Yes No Yes Select one: A. A B. B C. C D. D

D. D

Therapeutic indications for fiberoptic bronchoscopy include which of the following? [Removing] [Extracting] [Obtaining] [Aiding] [mucus] [foreign] [cytology] [endotracheal] [plugs] [bodies] [specimens] [intubation] A. No Yes No Yes B. Yes No Yes Yes C. Yes Yes Yes No D. Yes Yes No Yes Select one: A. A B. B C. C D. D

D. D

When respiratory care is being administered, and the patient demonstrates a poor level of cooperation, he should be evaluated for which of the following? [Language] [Influence of] [Fear or] [difficulties] [medications] [apprehension] A. Yes No Yes B. Yes Yes No C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following are potential complications of intermittent CPAP administered by mask to treat atelectasis? Respiratory Pulmonary Gastric alkalosis barotrauma insufflation A. Yes No Yes B. Yes Yes Yes C. Yes Yes No D. No Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following can cause errors in metabolic measurements made via indirect calorimetry on a patient receiving mechanical ventilation? [Bias flow] [Pressure] [High] [in circuit] [support] [FIO2 (> 60%)] A. Yes Yes No B Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following elements of a patient's social history would be relevant in planning a home-based disease management program? [Marital status/] [Living situation] [Cultural and] [family relations] [and social support] [religious influences] A. No Yes Yes B. Yes No Yes C. Yes Yes No D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

Which of the following would indicate the need for instituting ventilatory support for a woman with myasthenia gravis who weighs 55.5 kg (122 lb) and is 163 cm (5 ft 4 in) tall? VC MIP/NIF VT 200 mL 500 mL -14 cm H2O @ 30/min A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

You are called to the Emergency Department to assist with a difficult intubation of an adult patient. In addition to an intubation tray, bag-valve-mask and supplemental oxygen, which of the following equipment would you recommend be available? Laryngeal Transtracheal Cricothyrotomy mask jet ventilation kit airways setup A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

You measure the compliance of patient receiving volume control A/C ventilation at 11:00 AM to be 60 mL/cm H2O. Two hours later, it is 30 mL/cm H2O. Which of the following could cause this change? [Developing] [Acute Pulmonary] [Tension] [Atelectasis] [Edema] [Pneumothorax] A. Yes Yes No B. Yes No Yes C. No Yes Yes D. Yes Yes Yes Select one: A. A B. B C. C D. D

D. D

A physician has attempted on several occasions to insert a central venous catheter into the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator's high-pressure alarm sounds, the patient's blood pressure drops, and the SpO2 value drops from 96% to 84%. Breath sounds are greatly diminished over the right-lung field. What action should you recommend? A. Pull the ET back 2 - 3 cm into the trachea B. Insert a chest tube into the left pleural space C. Insert a pulmonary artery catheter D. Insert a chest tube into the right pleural space

D. Insert a chest tube into the right pleural space

During review of a patient's chart you note the following entry for the prior postural drainage treatment in the Respiratory Care notes: positions used, time in positions and the patient's subjective response to therapy. What critical information is missing? Select one: A. name of the patient's doctor B. ICD-9-CM procedure code(s) C. list of indications for therapy D. description of sputum production

D. description of sputum production

Which of the following information in a patient's medical history would be LEAST important to consider in evaluating the patient's pulmonary condition? Select one: A. smoking history B. occupational history C. prior pulmonary illnesses D. dietary habits

D. dietary habits

You assist a physician insert a pulmonary artery catheter via the subclavian venous route on a patient receiving volume control ventilation in the coronary care unit. Soon thereafter, the ventilator high pressure alarm begins sounding on each breath and the patient appears in acute respiratory distress. Which of the following would you recommend at this time? Select one: A. Taking a 12-lead ECG B. Withdrawing the catheter 2-3 cm C. Switching to pressure control D. Obtaining a STAT chest x-ray

D. Obtaining a STAT chest x-ray

A patient is admitted with obstructive lung disease. Which of the following would be most helpful in order to distinguish between asthma and emphysema as a diagnosis for this patient? Select one: A. Arterial blood gas analysis B. Maximal voluntary ventilation C. Sputum culture and sensitivity testing D. Spirometry before and after a bronchodilator

D. Spirometry before and after a bronchodilator

A patient is admitted to the ICU from a post-operative surgical unit with a hospital-acquired lobar pneumonia. A sputum Gram stain reveals Gram-positive organisms. Which of the following is the most likely cause of the pneumonia? Select one: A. Haemophilus influenzae B. Klebsiella pneumoniae C. Pseudomonas aeruginosa D. Staphylococcus aureus

D. Staphylococcus aureus

You obtain the following pre- and post-bronchodilator measures on a 29-year-old 6-foot 2 inches tall male patient with a chief complaint of exertional dyspnea who is undergoing disability evaluation: Parameter: Pre, Post FVC: 4.1 L, 3.0 L FEV1: 3.3 L, 2.3 L FEV1%: 80%, 77% Based on these values, which of the following is most likely? Select one: A. The results are normal for a man of this size B. The patient has airway obstruction C. The patient has a restrictive disorder D. The patient is not exerting sustained effort

D. The patient is not exerting sustained effort

Which of the following is TRUE regarding changes to a patient's advance directive? Select one: A. Close family members have the authority to change a patient's advanced directive B. Changes to an advanced directive must be made in writing in order to take effect C. Patients cannot change or cancel a duly notarized advance directive D. To change or cancel an advance directive, the patient must be of sound mind

D. To change or cancel an advance directive, the patient must be of sound mind

A small child is admitted to the Emergency Department with fever, difficulty swallowing, drooling, and stridor. An AP X-ray of the neck area is negative, but a lateral neck film indicates supraglottic swelling. Which of the following is the most likely diagnosis? Select one: A. asthma B. croup C. foreign body obstruction D. epiglottitis

D. epiglottitis

You are assessing a patient's need for supplemental oxygen at home. Which of the following measures would justify Medicare reimbursement for this therapy? Select one: A. a resting arterial Hb saturation of 93% or less (room air) B. a nocturnal fall in arterial Hb saturation greater than 3% C. observable signs of hypoxemia such as confusion D. a resting arterial PO2 of 55 torr or less (room air)

D. a resting arterial PO2 of 55 torr or less (room air)

Which of the following conditions represent the minimum humidification requirements for patients with artificial tracheal airways? Select one: A. relative humidity of at least 50% B. temperature between 30 to 32°C C. vapor pressure of at least 25 torr D. absolute humidity of at least 33 mg/L

D. absolute humidity of at least 33 mg/L

The purpose of an endotracheal tube stylet is to: Select one: A. help ascertain proper tube position B. monitor cuff integrity and pressure C. minimize mucosal trauma during insertion D. add rigidity and shape to ease insertion

D. add rigidity and shape to ease insertion

Data for a 80 kg (176 lb) patient receiving ventilatory support are: Ventilator Settings: Mode Vol Ctrl A/C VT 600 mL Set Rate 12/min Actual Rate 18/min FIO2 0.50 Blood Gases: pH = 7.57 PaCO2 = 25 torr HCO3 = 22 mEq/L PaO2 = 106 torr SaO2 = 98% Which of the following changes would be appropriate at this time? Select one: A. increasing the tidal volume B. decreasing the set (machine) rate C. adding 5 cm H2O PEEP D. adding mechanical deadspace

D. adding mechanical deadspace

What action would you recommend after carotid sinus massage fails to stop a persistent supraventricular tachycardia in an otherwise stable patient? A. immediate cardioversion B. lidocaine IV push C. a beta-blocker D. adenosine IV push

D. adenosine IV push

Which of the following is a prerequisite for successful application of noninvasive positive pressure ventilation (NPPV)? Select one: A. a PaO2 to FIO2 ratio (P/F) > 300 B. absence of abdominal paradox C. max inspiratory pressure > 25 cm H2O D. adequate bulbar muscle function

D. adequate bulbar muscle function

A patient receiving postural drainage and percussion for excessive secretions exhibits severe wheezing during treatment. Which of the following would you recommend to the ordering physician? Select one: A. discontinue the postural drainage and percussion B. administer a bland aerosol before therapy C. provide supplemental O2 during therapy D. administer a bronchodilator before therapy

D. administer a bronchodilator before therapy

Which of the following airway appliances would be appropriate for short-term application of bland aerosol therapy to a patient after extubation? Select one: A. face tent B. trach mask C. T-tube D. aerosol mask

D. aerosol mask

When inspecting the monitor of an adult patient in ICU, you note a heart rate of 138/min with a regular rhythm. Which of the following is the most likely cause of this observation? Select one: A. beta-blocker adminstration B. therapeutic hypothemia C. arterial hypertension D. anxiety or agitation

D. anxiety or agitation

A patient admitted to the Emergency Department after suffering several bee stings develops severe respiratory distress, accompanied by stridor and wheezing. Which of the following actions would you recommend? A. oral intubation B. cricothyrotomy C. Heimlich maneuver D. epinephrine

D. epinephrine

Upon visually inspecting the thorax of a 73-year-old male, you notice that his chest appears overinflated, with the ribs held in a horizontal position. Upon further inspection you observe that the transverse chest diameter almost equals the AP diameter. Which of the following terms best describes this thoracic configuration? Select one: A. kyphoscoliosis B. bucket-handle movement C. pectus excavatum D. barrel chest

D. barrel chest

You find an adult patient unresponsive with no pulse or respirations. After calling a code and asking for a defibrillator, your next action should be to: A. open the patinet's airway B. check for pupillary reactivity C. administer two breaths D. begin chest compressions

D. begin chest compressions

Gross observation of a patient's sputum specimen reveals purulent green sputum that has separated into layers and has a foul odor. Which of the following is most likely causing the patient to produce this type of sputum? Select one: A. tuberculosis B. emphysema C. aspiration D. bronchiectasis

D. bronchiectasis

Auscultation of a patient's chest revealing wheezes would indicate the presence of which of the following: Select one: A. pleural effusion B. pneumothorax C. laryngospasm D. bronchoconstriction

D. bronchoconstriction

A home care patient receiving ambulatory O2 therapy via a portable concentrator plans a 2-hour airline trip to visit her son and has the requisite physician's statement of need. Her unit is approved by the Federal Aeronautic Administration (FAA), and has sufficient battery power for the trip. Prior to traveling you would also want to confirm that the concentrator: Select one: A. is approved for reimbursement by Medicare/Medicaid B. includes a back-up/reserve supply of compressed oxygen C. has the capacity to operate in the pulse-dose mode D. can provide the desired FIO2 at the lower cabin pressure

D. can provide the desired FIO2 at the lower cabin pressure

Which of the following would be the most important data utilized to assess a patient's ability to perform metered dose inhaler (MDI) aerosol therapy? Select one: A. overall general appearance B. stable vital signs C. exercise tolerance D. capacity to follow instructions

D. capacity to follow instructions

The development of paradoxical pulse in a patient following trauma or cardiothoracic surgery, especially in connection with increasing venous pressure and heart rate, suggests: Select one: A. severe COPD B. pericarditis C. myocardial infarction D. cardiac tamponade

D. cardiac tamponade

While using a galvanic fuel cell to analyze the O2 concentration on a mechanically ventilated patient, you notice that the O2 percentage fluctuates during the mechanical breath. This could be caused by: Select one: A. a wet probe B. a weak battery C. high altitude D. changes in pressure

D. changes in pressure

Which of the following drugs would you recommend to paralyze a hemodynamically unstable patient requiring long-term controlled mechanical ventilation? Select one: A. pancuronium (Pavulon) B. succinylcholine (Anectine) C. vecuronium (Norcuron) D. cisatracurium (Nimbex)

D. cisatracurium (Nimbex)

On reviewing the results of the attending physician's physical examination of a patient's chest, you note 'a dull percussion note and bronchial breath sounds - LLL.' Which of the following is a potential problem? Select one: A. emphysema B. bronchospasm C. pneumothorax D. consolidation

D. consolidation

To periodically confirm the validity of blood gas analyzer or hemoximeter results, you would perform: Select one: A. internal statistical quality control B. instrument performance validation C. regular preventive maintenance D. control media calibration verification

D. control media calibration verification

Which of the following would be most likely in a patient with secondary polycythemia? Select one: A. paradoxical breathing B. subcutaneous emphysema C. left-to-right intrapulmonary shunt D. cyanosis of the lips and nail beds

D. cyanosis of the lips and nail beds

A patient in ICU develops a supraventricular tachycardia at a rate of 165/min. Which of the following effects would this have on cardiac function? Select one: A. increased end-diastolic volume B. mitral valve regurgitation C. increased stroke volume D. decreased end-diastolic volume

D. decreased end-diastolic volume

Data for a 55 kg (121 lb) patient receiving ventilatory support are: Ventilator Settings: Mode Press Ctrl A/C Press Limit 25 cm H2O Rate 18 FIO2 0.35 PEEP 0 cm H2O Blood Gases: pH = 7.54 PaCO2 = 24 mm Hg HCO3 = 22 mEq/L PaO2 = 75 mm Hg SaO2 = 93% Which of the following changes would be appropriate at this time? Select one: A. increasing the pressure limit B. increasing the rate C. decreasing the pressure limit D. decreasing the rate

D. decreasing the rate

In an elderly alert patient receiving IPPB therapy via mouthpiece and noseclips, you cannot get the device to cycle off to end inspiration. A circuit test indicates no system leakage. Which of the following airway adjuncts would you first consider to help overcome this problem? Select one: A. nasal trumpet B. oronasal mask C. Guedel airway D. flanged mouthpiece

D. flanged mouthpiece

Which of the following would tend to decrease intracranial pressure (ICP)? Select one: A. arterial hypertension B. hypoventilation C. hypoxemia D. head elevation

D. head elevation

Which type of disinfection inactivates all microorganisms except bacterial spores? Select one: A. surface active B. low-level C. intermediate-level D. high-level

D. high-level

The pressure setting during pressure control ventilation determines the: Select one: A. pressure at which inhalation ends B. pressure gradient from the ventilator to the alveoli C. pressure required to open the exhalation valve D. highest pressure achieved during inhalation

D. highest pressure achieved during inhalation

The pattern of arterial blood gases most common in bacterial pneumonias is: Select one: A. hypoxemia and respiratory acidosis B. hypoxemia and metabolic acidosis C. hyperoxia and respiratory alkalosis D. hypoxemia and respiratory alkalosis

D. hypoxemia and respiratory alkalosis

To properly disinfect a bronchoscope you would: Select one: A. send the scope and accessories to central supply for steam autoclaving B. wipe the exterior and perfuse all channels with 70% isopropyl alcohol C. send the scope and accessories to central supply for pasteurization D. immerse scope (up to handle) and perfuse channels with glutaraldehyde

D. immerse scope (up to handle) and perfuse channels with glutaraldehyde

A patient who complains of platypnea has difficulty breathing: Select one: A. all the time B. in the supine position C. on exertion D. in the standing position

D. in the standing position

Which of the following procedures require active patient cooperation to be effective? Select one: A. ventilator weaning B. tracheal suctioning C. mask CPAP D. incentive spirometry

D. incentive spirometry

Activity of the accessory muscles of ventilation at rest suggests: Select one: A. increased pulmonary compliance B. decreased airways resistance C. increased physiologic dead space D. increased work of breathing

D. increased work of breathing

You are assisting a resident perform orotracheal intubation of an semiconscious adult patient in the emergency room. After three failed attempts by the resident to place the tube in the trachea, your efforts to ventilate the patient using a bag-valve-mask system fail. Which of the following would you recommend to the resident as the next course of action? Select one: A. carry out at least one more intubation attempt B. perform a percutaneous dilational tracheotomy C. suspend intubation efforts and continue bagging D. insert a laryngeal mask airway

D. insert a laryngeal mask airway

You are assisting a physician with a bronchoscopy when the patient suddenly develops endobronchial bleeding. You should recommend which of the following? Select one: A. instilling Lidocaine (Xylocaine) B. providing 100% O2 via nonrebreather C. lavaging with warm normal saline D. instilling dilute epinephrine solution

D. instilling dilute epinephrine solution

While observing the breathing of a newborn infant, you note indrawing of chest wall muscle and tissue between the ribs during inspiration. Which of the following descriptions would you note in your respiratory chart entry? Select one: A. paradoxical breathing B. inspiratory grunting C. suprasternal retractions D. intercostal retractions

D. intercostal retractions

When performing posterior thoracic palpation of an adult, you note minimal left-side diaphragmatic movement as the patient takes a full, deep breath. Right-sided movement is normal. Which of the following conditions would best explain this finding? Select one: A. right-sided pleural effusion B. right lower lobe atelectasis C. pulmonary emphysema D. left phrenic nerve paralysis

D. left phrenic nerve paralysis

When inspecting a chest radiograph, you note that the heart is shifted to the patient's right. Which of the following is the most likely cause of this finding? Select one: A. right sided tension pneumothorax B. right sided pleural effusion C. left sided atelectasis/lung collapse D. left sided tension pneumothorax

D. left sided tension pneumothorax

A patient lying in a prone position with the bed flat is positioned to drain the: Select one: A. right middle lobe B. right lower lobe, anterior segment C. upper lobes, apical segments D. lower lobes, superior segments

D. lower lobes, superior segments

A patient is cachectic, exhibits generalized edema and dry skin, and appears listless. The most likely problem is: Select one: A. heart failure B. Addison's disease C. renal failure D. malnutrition

D. malnutrition

Auscultation of a patient's chest revealing wheezes would indicate the presence of which of the following: Select one: A. pleural effusion B. pneumothorax C. laryngospasm D. mucosal edema

D. mucosal edema

Which of the following observations indicate that an infant's work of breathing may be abnormally high? Select one: A. palor B. digital clubbing C. acrocyanosis D. nasal flaring

D. nasal flaring

Which of the following will tend to impair peripheral deposition of an inhaled aerosol in the lungs? Select one: A. slow breathing B. end-inspiratory pause C. deep breathing D. nose breathing

D. nose breathing

If initial assessment indicates that a patient does not appear oriented to time, place, or person, you should: Select one: A. call the shift supervisor for further instructions B. conduct an in-depth interview of the patient's family C. conduct an in-depth physical examination of the patient D. objectively determine the patient's level of consciousness

D. objectively determine the patient's level of consciousness

Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated? Select one: A. obtain and review the patient's past medical history B. ask the patient's nurse about the patient's prescriptions C. request that the lab run a comprehensive blood drug screen D. obtain the patient's current prescription vials from the family

D. obtain the patient's current prescription vials from the family

Which of the following is a diagnostic use of fiberoptic bronchoscopy? Select one: A. extracting foreign bodies B. aiding difficult intubations C. removing mucus plugs D. obtaining tissue biopsies

D. obtaining tissue biopsies

Which of the following aspects of a patient's social history is most important in the diagnosis of lung disease? Select one: A. marital status B. cultural background C. education D. occupational history

D. occupational history

A patient is asked to lie supine for postural drainage, but refuses to do so because of difficulty breathing when in this position. You would best describe the patient as exhibiting Select one: A. dyspnea B. eupnea C. hyperpnea D. orthopnea

D. orthopnea

Which of the following clinical data would help distinguish Guillain-Barré syndrome from myasthenia gravis in a patient with respiratory insufficiency? Select one: A. progressive dyspnea B. dysphagia/ loss of gag reflex C. decreased vital capacity D. pain or discomfort to touch

D. pain or discomfort to touch

A resident physician is planning a therapeutic thoracentesis on a patient suspected of having a pleural effusion. Which of the following would you recommend as the best way to help identify the location and size of the effusion? Select one: A. obtaining a lateral chest X-ray B. obtaining a PA chest X-ray C. obtaining a AP chest X-ray D. performing an ultrasound scan

D. performing an ultrasound scan

A doctor is considering performing a bedside diagnostic thoracentesis on a patient who has severe emphysema with blebs. You should recommend: Select one: A. postponing the procedure until the patient improves B. inserting a chest tube with drainage before thoracentesis C. giving the patient 100% oxygen to absorb pleural air D. performing ultrasound or CT-guided aspiration

D. performing ultrasound or CT-guided aspiration

Which of the following medications administered in a therapeutic range would be most likely to interfere with a patient's ability to cooperate? Select one: A. ampicillin B. furosemide (Lasix) C. theophylline (Aminophylline) D. phenobarbital

D. phenobarbital

You are interviewing a patient for the first time. Which of the following would be indicated by the patient's comment that he has more difficulty breathing upright than when lying down? Select one: A. hyperpnea B. orthopnea C. dyspnea D. platypnea

D. platypnea

While reviewing the lab chemistry of a patient in metabolic acidosis due to renal failure, you would expect the following electrolyte to be abnormally high: Select one: A. glucose B. bicarbonate C. chloride D. potassium

D. potassium

To ensure accurate measurements, before attaching a transcutaneous blood gas monitor sensor to a patient, you should: Select one: A. place mineral oil inside the sensor fixation ring B. apply local anesthetic cream to the sensor site C. pierce the sensor membrane to facilitate diffusion D. provide the manufactuer's specified warm-up time

D. provide the manufactuer's specified warm-up time

In reviewing the medical record of a 60 YO trauma patient, you note that a ventilation-perfusion scan was ordered. For what potential problem is the patient being evaluated? Select one: A. ARDS B. coronary artery blockage C. pulmonary edema D. pulmonary embolism

D. pulmonary embolism

To spot check a patient's oxygen saturation at the bedside you would select which of the following? Select one: A. oxygen analyzer B. hemoximeter C. transcutaneous monitor D. pulse oximeter

D. pulse oximeter

Upon palpating a patient's pulse, you note 85 unevenly spaced beats, with a marked decreased in pulse strength during inspiration. Which of the following describes the patient's pulse? Select one: A. thready pulse B. bounding pulse C. pulsus alternans D. pulsus paradoxus

D. pulsus paradoxus

Upon palpating a patient's radial artery for 1 minute, you note 90 unevenly spaced beats with decreased pulse strength during inspiration. Which of the following describes the patient's pulse? Select one: A. thready pulse B. bounding pulse C. pulsus alternans D. pulsus paradoxus

D. pulsus paradoxus

In inspecting a patient with pulmonary emphysema, which of the following would you most likely observe? Select one: A. obese body habitus B. dependent edema C. tachypnea D. pursed-lip breathing

D. pursed-lip breathing

A patient weighing 70 kg (154 lb) is being weaned via pressure support ventilation. After 30 minutes arterial blood gas results and related data are as follows: Mode Press support FIO2 0.35 Pressure limit 10 cm H2O Patient rate 36 VT 330 mL pH = 7.22 PaCO2 = 61 mm Hg PaO2 = 79 mm Hg HC03 = 25 mEq/L BE = +2 mEq/L Which of the following changes would be appropriate in this situation? Select one: A. increase the FIO2 to 0.40 B. increase the rate C. add 5 cm H2O PEEP D. raise the pressure support level

D. raise the pressure support level

In individuals with disorders causing an increased ELASTIC work of breathing, such as pulmonary fibrosis, which of the following breathing patterns results in the minimum work? Select one: A. slow and deep breathing B. slow and shallow breathing C. rapid and deep breathing D. rapid and shallow breathing

D. rapid and shallow breathing

While performing equipment rounds, you observe continuous bubbling in the humidifier of a standby oxygen setup. You also note that the flowmeter needle valve is completely closed. Which of the following should be done initially? Select one: A. change the humidifier B. check the wall line pressure C. check the wall valve seat D. replace the flowmeter

D. replace the flowmeter

When you make a return visit to a postoperative patient to assess her progress with incentive spirometry, she indicates that compared to yesterday her pain is preventing her from carry out the treatment. On a 10-point scale, she rates the effect of her pain on her activities as an '8.' You should Select one: A. coach her to go ahead with the incentive spirometry anyway B. tell the nurse to up the dosage of the patient's pain medication C. switch the patient to intermittent positive pressure breathing therapy D. report this finding to the patient's attending physician

D. report this finding to the patient's attending physician

After the most strenuous expiratory effort, air still remains in the lungs and cannot be removed voluntarily. This volume is known as the: Select one: A. expiratory reserve volume (IRV) B. functional residual capacity (FRC) C. vital capacity (VC) D. residual volume (RV)

D. residual volume (RV)

Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following? Select one: A. airway resistance B. functional residual capacity C. inspiratory capacity D. respiratory muscle strength

D. respiratory muscle strength

Soon after a resident inserts a catheter in the right subclavian vein of an apenic patient, you note that it is becoming increasingly difficult to squeeze the manual resuscitator and that there are no chest excursions on the right side. Which of the following complications would you warn the resident might have occurred? Select one: A. right main stem intubation B. gastric distention C. broken ribs with flail chest D. right-sided pneumothorax

D. right-sided pneumothorax

You measure the 6 minute walking distance (6MWD) of a 68 year-old male patient with COPD as being 125 meters. Based on this result, you would characterized this patient's exercise capacity as: Select one: A. normal for his age B. mildly impaired C. moderately impaired D. severely impaired

D. severely impaired

A loud, high-pitched continuous sound heard primarily over the larynx or trachea during inhalation (often with the unaided ear) in patients with upper airway obstruction best describes: Select one: A. rhonchi B. rales C. crackles D. stridor

D. stridor

An echocardiogram on a 64 year-old patient who experiences dyspnea and palpitations on exertion reveals the following left ventricular data: elevated end-diastolic pressure, elevated end-diastolic volume, and an ejection fraction of 38%. There is no evidence of valvular heart disease, intracardiac shunts, cardiac tamponade, or pericardial constriction. Which of the following is the most likely problem? Select one: A. constrictive cardiomyopathy B. diastolic heart failure C. pericardial effusion D. systolic heart failure

D. systolic heart failure

You note that a patient's respiratory rate is 35 per minute. Which of the following terms would you use to chart this finding? Select one: A. bradypnea B. tachycardia C. hyperventilation D. tachypnea

D. tachypnea

Which of the following breathing patterns would indicate the acute onset of hypoxemia in a spontaneously breathing adult patient following thoracic surgery? Select one: A. Cheyne-Stokes respiration B. abdominal respirations C. bradypnea, periods of apnea D. tachypnea, decreased tidal volume

D. tachypnea, decreased tidal volume

A manometer is being used to monitor a continuous flow CPAP device set at 10 cm H2O. Each time the patient exhales, the pressure increases to 17 cm H2O. Which of the following is the most likely cause of the problem? Select one: A. the flow of gas to the patient is insufficient B. there is a leak in the patient system C. the patient's endotracheal tube is too small D. the CPAP valve is creating high resistance

D. the CPAP valve is creating high resistance

You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data? **picture missing** Select one: A. the capnogram indicates hyperventilation B. the capnogram indicates rebreathing C. the capnogram indicates a leak around the ET tube D. the capnogram indicates hypoventilation

D. the capnogram indicates hypoventilation

The physician asks for your input regarding chest tube placement for a patient with a pneumothorax. In what anatomic location should you recommend that the tube be inserted? Select one: A. the second intercostal space at the midclavicular line B. the second or third intercostal space at the anterior axillary line C. the fourth or fifth intercostal space at the midclavicular line D. the fourth or fifth intercostal space at the anterior axillary line

D. the fourth or fifth intercostal space at the anterior axillary line

A patient has a PCO2 of 22 torr. Based on this information you may rightly conclude that: Select one: A. the patient is hypoventilating B. the patient's rate of breathing is faster than normal C. the patient's tidal volume is less than normal D. the patient is hyperventilating

D. the patient is hyperventilating

A patient with a neuromuscular condition exhibits reasonable inspiratory muscle function, but has an accompanying hypoxemia. The presence of this hypoxemia suggests: Select one: A. worsening of the primary restrictive process B. progressive inspiratory muscle weakness C. an increase in physiologic deadspace D. the presence of a complication like atelectasis

D. the presence of a complication like atelectasis

You should provide tracheostomy care whenever: Select one: A. measuring trach tube cuff pressure B. changing the ventilator circuit C. changing the heat and moisture exchanger D. the stoma dressing becomes soiled

D. the stoma dressing becomes soiled

Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL? Select one: A. inspiratory time is shorter than expiratory time B. ribs slope downward from spine at end-expiration C. AP diameter of thorax is less than its transverse diameter D. thorax expands, abdomen draws in during inspiration

D. thorax expands, abdomen draws in during inspiration

When turning on an H cylinder valve, gas leaks around the regulator connection to the cylinder. Your most appropriate action to correct the problem would be to: Select one: A. reduce the flow B. change the regulator C. replace the washer/seal D. tighten the cylinder connection

D. tighten the cylinder connection

Which of the following is used by the ultrasonic nebulizer to produce droplets from the water reservoir? Select one: A. heat B. steam C. baffling D. vibration

D. vibration