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1.  A patient is receiving pressure controlled A/C ventilation. Which of the following changes would occur if the patient’s compliance were to decrease?


A. inspiratory time will increase
B. PEEP level will decrease
C. peak pressure will increase
D. delivered volume will decrease


2.  When performing a routine ventilator check on a patient receiving volume controlled ventilation, you note that the peak airway pressure has decreased from a prior value of 50 cm H2O to 30 cm H2O. There has been no change in ventilator settings. Which of the following actions would be appropriate at this time?


A. increase the flow until the pressure equals 50 cm H2O
B. check the patient-ventilator circuit for system leaks
C. increase the volume until the pressure equals 50 cm H2O
D. check for increased secretions and suction if needed


3.  Which of the following patients has the most serious problem with the adequacy of oxygenation?


Patient FIO2    PaO2
A          1.00     85
B          0.70     90
C          0.40     95
D          0.28     65


A. A
B. B
C. C
D. D


4.  When used to monitor a patient’s oxygenation status, pulse oximetry has the following major disadvantage:


A. skin burns due to using incompatible probes
B. pressure sores at the measuring site
C. false results leading to incorrect decisions
D. electrical shock at the measuring site


5.  Oxygen exchange at the lung is considered adequate if the arterial hemoglobin saturation (SaO2) can be maintained above:


A. 65%
B. 70%
C. 75%
D. 90%


6.  Which of the following would likely cause an incorrect or misleading pulse oximetry reading?


A. Low Hb concentration
B. Incorrect probe size
C. Elevated body temperature
D. High cardiac output


7.  You obtain an SpO2 reading of 90% using an oximeter with an accuracy of ±5%. This could indicate a PO2 as low as:


A. 70 mm Hg
B. 65 mm Hg
C. 60 mm Hg
D. 55 mm Hg


8.  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?


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


9.  An unconscious patient admitted to the Emergency Department has a SpO2 of 94% but analysis of an arterial sample on a CO-oximeter reveals a SaO2 of 69%. Which of the following problems is most likely?


A. carbon monoxide poisoning
B. opiate drug overdose
C. diabetic ketoacidosis
D. acute pulmonary edema


10.  An adult patient with bilateral infiltrates on X-ray is receiving volume control (A/C) ventilation with 60% O2. He has a mean airway pressure (MAP) of 12 cm H2O and a PaO2 of 60 torr. What action would you recommend?


A. implementing the ARDSNet protocol
B. switching to high frequency oscillation
C. switching to pressure control SIMV
D. initiating a spontaneous breathing trial


11.  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?


A. an obstructive disorder
B. poor patient effort
C. a restrictive disorder
D. within normal limits


12.  A patient has a lower than normal mixed venous O2 content. Which of the following could cause this condition?


A. secondary polycythemia
B. cyanide (CN) poisoning
C. fever/hyperthermia
D. hypervolemia


13.  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?


A. a hemoglobin deficiency
B. hypoventilation
C. a R-L physiologic shunt
D. a low ambient PO2


14.  Which of the following would likely cause an incorrect or misleading pulse oximetry reading?


A. Low Hb concentration
B. Excessive probe movement
C. Elevated body temperature
D. High cardiac output


15.  A 43-year-old patient breathing room air in the emergency department has the following ABG results:


pH        7.43
PaCO2 41 torr
HCO3   26 mEq/L
PaO2   43 torr
SaO2   75%
SpO2   90%


These results most likely indicate which of the following?


A. the SaO2 is a lab error; the SpO2 should be used instead
B. the SpO2 indicates that the patient has low peripheral perfusion
C. the ABG results are accurate; the SpO2 should be disregarded
D. the variance between SaO2 and SpO2 is acceptable measurement error


16.  You obtain a bedside vital capacity (VC) of 450 ml on a cooperative 120 lb female patient receiving ventilatory support in the CMV mode. Which of the following conclusions can you draw from this finding?


A. the patient’s VC is normal for her size and weight
B. the patient cannot sustain prolonged spontaneous ventilation
C. the patient is in acute hypoxemic respiratory failure
D. the patient has a generalized obstructive disease process


17.  A patient is receiving volume control A/C ventilation. The patient has become increasingly agitated and the end-tidal CO2 has decreased from 39 to 28 torr over the last 2 hours. Which of the following is the most likely cause?


A. increased cardiac output
B. mainstem intubation
C. high body temperature
D. increased ventilation
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18.  A patient with viral pneumonia and bilateral infiltrates on X-ray is intubated and placed on pressure control ventilation with 40% O2 and 10 cm H2O PEEP. After 30 minutes of ventilatory support you obtain the following blood gas:


pH           7.49
PCO2     34 torr
PaO2     60 torr
SaO2     91%
HCO3   25 mEq/L
BE        +2 MEq/L


When asked by the patient’s doctor, you would describe her condition as being consistent with:


A. hemic hypoxia
B. mild ARDS
C. moderate ARDS
D. severe ARDS


19.  A patient has the pulmonary function results below:


VC                    54% of predicted
FEV1                56% of predicted
FEV1/FVC        82% of predicted
Peak Flow       112% of predicted
TLC                  70% of predicted


Which of the following would be the best interpretation of the results?


A. bronchitis
B. restrictive disease only
C. obstructive disease only
D. mixed restrictive and obstructive disease


20.  A 48-year-old male is orally intubated, receiving mechanical ventilation with an 8.0 mm endotracheal (ET) tube secured in place. Cuff pressure is measured at 36 cm H2O. You should:


A. Recommend reintubation with a smaller ET tube
B. Withdraw the tube 1-2 cm and reassess breath sounds
C. Recommend a percutaneous tracheotomy
D. Lower cuff pressure to < 30 cm H2O and assess for leaks


21.  When observing a patient’s arterial pressure waveform on a bedside monitor, you note little or no ‘notching’ and a markedly reduced pulse pressure. Palpation of the patient’s peripheral pulse indicates strong pulsations. The most likely cause of this problem is:


A. the possibility of a significant pulse deficit, probably due to atrial fibrillation
B. partial obstruction of the vascular line, causing damping of the pressure waveform
C. improper zeroing or calibration of the attached strain-gauge pressure transducer
D. improper positioning of the pressure transducer below the patient’s left ventricle


22.  The results of an arterial blood gas analysis for a patient who is breathing 100% oxygen are below:


pH        7.24
PCO2   38 torr
PaO2     610 torr
SaO2     100%
HCO3     23 mEq/L
BE        -1


Which of the following is the likely problem?


A. respiratory acidosis
B. large physiologic shunt
C. metabolic acidosis
D. laboratory error


23.  When performing bedside spirometry on a 35-year-old woman who is 5 feet 7 inches tall, you obtain a peak flow measurement of 2.3 L/sec. The best interpretation of this test result is:


A. the patient’s peak flow is normal
B. the patient has expiratory flow obstruction
C. the patient has poor gas distribution
D. the patient has low compliance


24.  The following spirogram shows the FVC maneuver for a patient before and after an albuterol (Proventil) treatment. Based on this information, you can conclude that the patient has:


A. no evidence of lung disease
B. severe restrictive lung disease
C. reversible airway obstruction
D. received no benefit from the medication

25.  When analyzing an arterial blood gas sample you obtained from a patient breathing room air, you measure the following values:


pH        7.43
PaCO2 47 torr
PaO2   165 torr


The patient’s blood gas results should be:


A. phoned to the unit clerk to report to the attending physician
B. phoned to the patient’s nurse to share with the respiratory therapist
C. discarded the sample and obtain a new one
D. phoned to both the attending physician and respiratory therapist


26.  Which of the following would cause an increase in a patient’s peak airway pressure while receiving volume control ventilation?


A. resolving pulmonary edema
B. bronchospasm
C. blown ET tube cuff
D. ventilator circuit leak


27.  You obtain an SpO2 reading of 100% on a patient receiving oxygen via a nonrebreathing mask. What range of arterial PO2s is possible in this patient?


A. 60-90 mm Hg
B. 90-100 mm Hg
C. 100-200 mm Hg
D. 100-600 mm Hg


28.  You obtain a sputum sample from a patient using hypertonic saline aerosol. Soon after receipt, the laboratory rejects it, indicating that it contains primarily squamous epithelial cells. Which of the following is the most likely reason for rejecting the sample?


A. the sample is contaminated with gastric fluid
B. the saline concentration was too high
C. the sample is contaminated with saliva
D. the collection container was not sterile


29.  On review of an apnea monitor’s event recording for a neonate with an estimated gestation age of 34 weeks you note a breathing pattern characterized by numerous respiratory pauses lasting 4-10 seconds with less than 20 seconds of respiration activity between pauses. During these events, there is no change in heart rate. The proper interpretation of this finding is:


A. apnea of prematurity
B. pathologic apnea
C. periodic breathing
D. motion/activity artifact


30.  A 63-year-old women who complains of shortness of breath has the following pulmonary function test results:


Actual  %         Predicted
FVC                  3.20 L              85%
FEV1                1.95 L              68%
FEV1/FVC                                61%    
FEF25-75%      1.1 L/sec         35%


These data are most consistent with which of the following clinical conditions?


A. empyema
B. kyphoscoliosis
C. idiopathic fibrosis


31.  A forced expiratory measurement obtained after the administration of a bronchodilator shows an increase in FEV1 from 60% to 80% of predicted. This indicates a


A. reversible airway obstruction
B. fixed airway obstruction
C. restrictive process
D. normal diffusion capacity


32.  Normally, an individual can maintain about what percent of their maximum voluntary ventilation (MVV) on maximum exercise?


A. 60-70%
B. 70-80%
C. 80-90%
D. 90-100%


33.  An apnea monitor alarm is sounding continuously but your initial assessment of the patient reveals that they are breathing normally. You next action should be to:


A. Check the electrode connections on the patient
B. Immediately obtain a replacement monitor
C. Silence the alarm and call the equipment supplier
D. Replace the lead wires and patient cable


34.  Which of the following would cause a sudden increase in the peak pressure during volume controlled ventilation?


A. auto-PEEP
B. pneumothorax
C. improved compliance
D. decreased flow


35.  Which of the following will tend to cause false LOW readings when using a pulse oximeter?


A. dark nail polish
B. high %HbCO
C. bright light
D. vascular dyes


36.  Ventilatory support may be indicated when the pulmonary R-L shunt fraction (Qs/Qt) rises above what level?


A. 3-5%
B. 5-10%
C. 10-15%
D. 20-25%


37.  You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data?


A. ventilator disconnection
B. hypoventilation
C. rebreathing
D. increased cardiac output


38.  Which of the following would most adversely affect the accuracy of pulse oximetry measurement?


A. coma
B. fever
C. tachycardia
D. shock


39.  Which of the following would likely cause an incorrect or misleading pulse oximetry reading?


A. High Hb concentration
B. presence of HbCO
C. Elevated body temperature
D. High cardiac output


40.  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:


A. 20 – 30 mm Hg
B. 6 – 12 mm Hg
C. 10 – 20 mm Hg
D. 0 – 4 mm Hg


41.  The following arterial blood gas data are available:


pH        7.40
PaCO2 40 torr
HCO3   24 mEq/L


If the patient’s SpO2 is 90%, what is the approximate PaO2?


A. 40 to 50 torr
B. 55 to 65 torr
C. 70 to 80 torr
D. 85 to 95 torr


42.  When you are performing a home care visit on a patient with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation program, which of the following would indicate that the patient’s physical condition is improving?


A. 6 minute walking distance has increased by 10%
B. Pulse oximetry value is unchanged
C. The patient has gained 5 lb in the last week
D. The patient has a positive outlook on life


43.  A patient with a history of nocturnal dyspnea has a FEV1 of 1.5 L before bronchodilator therapy and a FEV1 of 1.8 L fifteen minutes after treatment. These results indicate that the patient:


A. has airway obstruction that is unresponsive to treatment
B. is suffering from a combined obstructive and restrictive disorder
C. has at least partially reversible airway obstruction
D. is developing tolerance to the bronchodilator


44.  During capnography monitoring of a mechanically ventilated patient, you note that the end-tidal PCO2 (PetCO2) has dropped to 0 mm Hg. This finding may indicate:


A. increased cardiac output
B. decreased body temperature
C. complete airway obstruction
D. hyperventilation


45.  A doctor orders O2 titration with exercise for a patient with a chief complaint of dyspnea on exertion. The patient’s baseline SpO2 is 84% on room air. You would:


A. draw and analyze an arterial blood sample
B. terminate the protocol and contact the doctor
C. carefully proceed with the graded exercise
D. call for the medical emergency team
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