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1. The oxygen concentration delivered by an air entrainment nebulizer to a patient’s airway is usually higher that set. What is the reason for this discrepancy?
A. downstream resistance in the delivery tubing
B. inaccuracy of the air entrainment system
C. air leaks in the patient delivery tubing
D. excessive forward velocity of the source gas
2. When a ventilator is being used in the assist/control mode, the ventilator will trigger on in response to which of the following?
A. the patient’s inspiratory efforts only
B. either the patient’s inspiratory efforts or a timing mechanism
C. the timing mechanism of the ventilator only
D. the timing mechanism and the pressure settings on the ventilator
3. When performing a routine ventilator check, you note that the airway temperature indicator reads 26° C. The flowsheet indicates a prior temperature of 35° C. Which of the following best explains this discrepancy?
A. failure of the thermostat mechanism
B. increased patient minute ventilation
C. addition of deadspace to circuit
D. decreased patient minute ventilation
4. Which of the following is true regarding using a remote alarm unit in conjunction with a home apnea monitor?
A. activating the remote should disable the monitor’s alarm signals
B. the remote alarm should sound only for confirmed apnea events
C. use of a remote apnea monitor alarm is optional in the home setting
D. the remote alarm should sound whenever it goes out of monitor range
5. Which of the following portable O2 systems provides the greatest overall mobility and freedom for patients receiving long-term O2 therapy?
A. a small (B, C, D) oxygen cylinder
B. a portable oxygen concentrator
C. a portable liquid oxygen system
D. a concentrator/liquefier transfilling system
6. 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?
A. change the humidifier
B. check the wall line pressure
C. check the wall valve seat
D. replace the flowmeter
7. You are measuring the expired minute volume of a spontaneously breathing intubated patient in ICU using a mechanical volumeter (Wright respirometer) with a disposable one-way breathing valve and bacterial filter. After connecting this setup to the patient, you note that no volume whatsoever is recorded. Which of the following is the most likely cause of this problem?
A. the respirometer’s outlet is attached to the inspiratory side of the valve
B. the respirometer’s inlet is attached to the expiratory side of the valve
C. the respirometer’s outlet is attached tothe expiratory side of the valve
D. the bacterial filter is placed between the valve and respirometer
8. When performing emergency intubation on an infant, what type of laryngoscope blade would you normally select?
9. You note that a patient who is being mechanically ventilated has thick, mucoid secretions. It is determined that the wick humidifier is producing insufficient humidity. You should do which of the following?
A. remove the excess water in the humidifier
B. check/confirm proper temperature setting
C. increase the flow through the humidifier
D. shorten the tubing between the gas source and humidifier
10. Which of the following is characteristic of volume controlled ventilation?
A. it ends expiration after a preset volume is delivered.
B. it begins inspiration after a specific volume is inhaled.
C. it ends inspiration after the patient exhales a preset volume.
D. it ends inspiration after a preset volume is delivered by the ventilator
11. You observe a nurse changing a disposable oximeter probe on a patient whose SpO2 was 93% before the change. Immediately upon attaching the new probe, the oximeter low alarm sounds, with the SpO2 reading now 71%. There is no change in FIO2 or the patient’s condition. The most likely cause is that the:
A. oximeter unit needs to undergo recalibration
B. probe is taped too tightly and should be loosened
C. probe/probe site needs to be rewarmed to 42°C
D. oximeter unit has failed or is malfunctioning
12. A Thorpe tube flowmeter is pressure compensated if:
A. the needle valve is positioned before the float tube
B. with the valve open, the float jumps when attached to 50 psig
C. with the valve open, no gas comes through the float tube
D. with the valve closed, the float jumps when attached to 50 psig
13. You open the valve on an E cylinder which has a regulator attached and hear a hissing noise. The flowmeter/gauge is turned off. Which of the following corrective actions would you take first?
A. obtain a new E cylinder
B. tighten the regulator connection
C. turn the flowmeter/gauge on
D. replace the pressure regulator
14. The major function of the baffle in a nebulizer is to
A. entrain water from the capillary tube
B. remove larger particles from the suspension
C. mix aerosol particles with the main gas flow
D. promote particle evaporation
15. The reservoir bag of a nonrebreathing mask collapses completely during inspiration. You should do which of the following?
A. use an entrainment mask
B. increase the flow to the bag
C. remove the valve between the bag and the mask
D. loosen the mask around the patient’s face
16. A 2 year old child is admitted to the Emergency Department with severe asthmatic symptoms. The attending physician orders a bronchodilator that is available in solution and MDI preparations. Which of the following would be the best delivery system for this drug to this patient?
A. breath-actuated MDI with mask
B. small volume nebulizer (SVN) with mouthpiece
C. MDI with holding chamber and a mask
D. SVN using the “blow by” technique
17. A bubble humidifier is not bubbling during oxygen therapy, despite the flowmeter set and running at 6 L/min. You should check which of the following?
A. flowmeter-humidifier connection for leaks
B. humidifier outlet for obstruction
C. patient delivery tubing for leaks
D. 50 psi wall outlet for obstruction
18. An ambulatory home oxygen therapy patient complains that her portable liquid system (at 2 L/min) doesn’t last long enough for her to visit with her grandchildren. What might you recommend to overcome this limitation?
A. decrease the flow to 1 L/min
B. use an oxygen-conserving device
C. put a couple E cylinders in her car
D. put the large liquid unit in her car
19. What is the approximate duration of flow of an oxygen D-cylinder which is half empty running at 4 L/min?
A. 40 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
20. A nurse who just set up a pleural drainage system on a patient with a pneumothorax complains that there is no bubbling in the suction control chamber. After checking the suction control regulator to confirm that it is on, you would recommend that she:
A. withdraw the thoracotomy (chest) tube about 2-3 cm
B. switch the suction control regulator to intermittent
C. add more water to the unit’s suction control chamber
D. check the connecting tubing for leaks or obstructions
21. You are called by an ICU nurse to check on a patient receiving volume controlled A/C ventilation. You note that both the low tidal volume and high pressure limit alarm are sounding on each inspiration. You first action should be to:
A. call the attending physician for further patient information
B. increase the preset tidal volume to 1.5x the current setting
C. disconnect patient and provide manual ventilation with 100% O2
D. check the full patient-ventilator system for malfunctions
22. To provide a low to moderate concentration of oxygen to a patient receiving nasal BiPAP via a device that uses a turbine or blower to generated pressure, you would:
A. connect the BiPAP device to a 50 psi O2 outlet
B. bleed supplemental O2 from a flowmeter into the circuit
C. apply a nasal cannula to the patient under the mask
D. add a reservoir bag to the BiPAP breathing circuit
23. In comparing previously recorded values to those currently observed on a patient receiving volume control ventilation, you note a decrease in expired volume and a decreased airway pressure. There has been no change in ventilator settings. Which of the following best explains these findings?
A. increased airway resistance or decreased compliance
B. the presence of a leak in the patient-ventilator system
C. a decrease in patient-triggered respiratory frequency
D. malfunction of the Bennett monitoring spirometer
24. The purpose of the small refillable liquid oxygen tank that comes with many stationary home liquid oxygen reservoirs is:
A. to provide oxygen to ambulatory patients outside the home
B. to serve as a back-up should the primary reservoir fail
C. to collect and save gas vented by the primary reservoir
D. to provide higher flows for patients requiring high FIO2s
25. Which of the following must be included in the delivery circuit of an in-exsufflation (cough assist) device?
a. heat and moisture exchanger
b. balloon-type exhalation valve
c. HEPA bacterial filter
d. heated water humidifier
26. Which of the following valves in a typical high frequency oscillation ventilation (HFOV) is used to regulate the mean airway pressure?
A. Limit valve
B. Flush valve
C. Dump valve
D. Control valve
27. Which of the following devices would you select to condition inspired gas to 100% body humidity?
A. heated wick humidifier
B. bubble humidifier
C. pneumatic nebulizer
D. small volume nebulizer
28. 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?
A. a missing lead
B. motion artifact
C. improper filtering
D. a corroded connector
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29. The major hazard associated with the use of bag-valve resuscitator is:
A. decreased cardiac output
B. nosocomial infection
C. pulmonary barotrauma
D. fractured ribs
30. A large volume jet nebulizer is operating on 70% O2 at 12 L/min. You observe that the aerosol being delivered in short rapid puffs and note a gurgling sound in the system. Which of the following actions would be most appropriate?
A. reduce the water volume in the nebulizer reservoir
B. switch the nebulizer entrainment port to 40% O2
C. drain any accumulated water from the delivery tubing
D. increase the nebulizer input flow to 15 L/min
31. When checking on a patient receiving aerosol therapy via large volume jet nebulizer, you notice that the device is delivering ‘puffs’ of aerosol instead of a continuous aerosol stream. What is the likely cause of this problem?
A. Water has collected in the delivery tubing
B. The patient’s flow exceeds the total system flow
C. The O2 input flow is inadequate for the patient
D. More water needs to be added to the nebulizer reservoir
32. An adult patient requires frequent suctioning of oral secretions. Which of the following should be made available at the patient’s bedside?
A. bulb suction device
B. Coude catheter
C. Luken’s trap
D. Yankauer tip
33. While using a Yankauer device to orally suction an adult patient, you are unable to remove thick secretions. The regulator attached to the oropharyngeal suctioning device displays a reading of -70 mm Hg. Which of the following should you do at this time?
A. perform nasotracheal suctioning
B. replace the wall suction regulator
C. change to a flexible catheter
D. increase the suction pressure to -120 mm Hg
34. Which of the following types of breathing circuits would you select when assembling a home-care ventilator for use on a patient with a tracheotomy?
A. dual-limb heated wire “Y” circuit
B. single-limb circuit with expiratory balloon valve
C. single-limb circuit with leakage-type exhaust valve
D. single-limb circuit without any valve
35. 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:
A. increase the system flow
B. switch to larger nasal prongs
C. decrease the system flow
D. switch to smaller nasal prongs
36. The primary reason for selecting a high flow nasal cannula system for a patient would be to
A. provide CPAP therapy
B. increase inspired humidity
C. washout anatomic deadspace
D. assure a stable/fixed FIO2
37. When setting up a pneumatically-powered percussor at the bedside of a patient receiving postural drainage therapy, you note that regardless of the control settings the device cycles slowly and with inadequate force. To correct this problem you would:
A. check the bedside AC outlet to make sure it is properly grounded
B. make sure the source gas connection is not flow-restricted
C. check for/replace burned-out fuse or reset a the circuit breaker
D. remove and replace the device’s disposable pad with a new one
38. Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula?
A. increase in patient inspiratory flow
B. increase in patient inspiratory time
C. decrease in patient minute ventilation
D. decrease in patient tidal volume
39. An intubated post-op patient is receiving O2 via a T-tube and nebulizer set at 70%. With an O2 input of 12 L/min, what is the total output gas flow?
A. 24 L/min
B. 30 L/min
C. 19 L/min
D. 40 L/min
40. You note a sudden increase in PO2 measurement and decrease in the PCO2 measurement on a transcutaneous monitor. The most likely cause is:
A. a decrease in blood flow in the area of the probe
B. electrode temperature is too low
C. electrode temperature is too high
D. an air leak at the transducer site
41. Patients can control a flutter valve’s pressure by changing:
A. their inspiratory flow
B. the device’s spring tension
C. their expiratory flow
D. the expired volume
42. A patient is receiving oxygen via a nonrebreathing mask set at 12 L/min. You notice that the mask’s reservoir bag does not deflate at all during inspiration. Which of the following is the most likely cause of this problem?
A. the patient is nose-breathing
B. the mask is too loose on the face
C. the flowmeter setting is too low
D. the patient is mouth-breathing
43. A jet nebulizer is operating at an O2 input flow of 10 L/min on the 100% setting. If the input flow remains constant when the air-entrainment port is opened to the 40% O2 setting, which of the following would occur?
A. aerosol particle size (MMD) would decrease
B. aerosol weight density (mg/L) would increase
C. total aerosol output (mL/min) would decrease
D. total output flow (L/min) would remain constant
44. You are asked to transport a mechanically ventilated a patient to the MRI center. What type of ventilator would you recommend to support the patient during this procedure?
A. a pneumatically powered and controlled ventilator
B. a high frequency oscillator ventilator
C. a standard ICU microprocessor controlled ventilator
D. a piston-drive home care type ventilator
45. After changing the circuit on a patient receiving volume control ventilation, you note that the exhaled volume is 250 mL less than before and the peak inspiratory pressure is 8 cm H2O lower. Which of the following is the most likely source of the problem?
A. obstruction of the expiratory line
B. a mucous plug in the patient’s ET tube
C. a sensor port open to atmosphere
D. a decrease in patient compliance
46. All else being equal, which of the following statements is correct regarding a device that mixed air and oxygen using air-entrainment (Venturi principle)?
A. the greater the jet input flow, the higher the delivered FIO2
B. the smaller the jet orifice, the higher the delivered FIO2
C. the larger the air-entrainment ports, the lower the delivered FIO2
D. the larger the jet orifice, the more air will be entrained
47. A patient in the neurologic ICU requires aerosol bronchodilator therapy. The treatments have been administered with a mouthpiece. Since the last treatment, the patient has become very lethargic. You should:
A. continue the treatment using a mouthpiece
B. recommend discontinuing the therapy
C. change to an aerosol mask
D. administer the treatment using compressed air
48. A patient is connected via a tracheostomy collar to a large volume jet nebulizer set at 60% O2 with an input flow of 12 L/min. However, you measure an O2 concentration of 73% at the collar. What is the most likely cause of this discrepancy?
A. insufficient O2 flow into the nebulizer
B. large air leaks around the trach collar
C. condensate obstructing the circuit
D. excessive O2 flow into the nebulizer
49. Which of the following is a potential problem when using an air-entrainment nebulizer to deliver gas to an infant in an oxyhood?
A. increased potential for CO2 accumulation
B. difficulty in maintaining adequate humidification
C. difficulty in maintaining stable high FIO2s
D. production of harmful noise levels
50. In a patient with a brachial artery catheter in place, you note loss of a palpable radial pulse. Which of the following is the most likely cause of this problem?
A. blood loss into the subcutaneous tissues
B. blockage of the catheter by a blood clot
C. arterial thrombosis distal to the cannula
D. slippage of the catheter out of the artery
51. Which of the following is indicated by a sound of popping and whistling when the water bottle of a humidifier is tested by obstructing the gas outlet with the finger?
A. no leakage
B. a worn gasket
C. Broken tubing
D. a cracked bottle
52. Which of the following could be done to help assure delivery of 70% O2 via a standard air-entrainment nebulizer to an intubated patient?
A. hooking 2 nebulizers in parallel, both at max flow
B. heating the nebulizer water reservoir to 40° C
C. increasing nebulizer input flow to 25-30 L/min
D. powering the nebulizer with an O2 blender
53. You open the valve on an E cylinder which has a regulator attached and hear a hissing noise. The flowmeter/gauge is turned off. Which of the following corrective actions would you take first?
A. obtain a new E cylinder
B. turn the flowmeter/gauge on
C. replace the regulator washer
D. replace the pressure regulator
54. During ventilation of a child with a bag-valve resuscitator, the pressure relief valve/pop-off continually activates. Which of the following should be your first action?
A. Switch to a gas-powered resuscitator
B. Bypass the pressure relief valve
C. Squeeze the bag more slowly
D. Lower the PEEP valve level
55. A doctor orders 70% O2 with water aerosol for a spontaneously patient breathing at 25-30/min intubated with an 8 mm ET tube. Which of the following equipment would you select to meet this order?
A. air entrainment nebulizer set to 70% with O2 input flow of 25-30 L/min
B. ultrasonic nebulizer powered by blender set to 70% O2 at 15 L/min
C. gas-injection nebulizer with air+O2 mixed/titrated via high flow flowmeters
D. air entrainment nebulizer set to 100%, powered by blender set to 70% O2
56. Which of the following is used by the ultrasonic nebulizer to produce droplets from the water reservoir?
57. Mechanical ventilation in the home setting can be provided by which of the following methods?
A. positive pressure via an intact upper airway
B. nasal continuous positive airway pressure
C. positive pressure via an oral endotracheal tube
D. negative pressure via an oral endotracheal tube
58. At an FIO2 of 0.30, a pulse oximeter attached to the right index finger of a 6 week-old infant displays an SaO2 of 87% and a pulse of 64/min. A heart monitor reads a simultaneous heart rate of 120/min. Which of the following would be the most appropriate action?
A. reposition the pulse oximeter
B. increase the FIO2 to 0.40
C. ventilate the infant with 100% 02
D. suction the infant
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