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1.  The normal range for vital capacity in a young healthy male of average size is

A. 5000 to 6000 ml
B. 2000 to 3000 ml
C. 3000 to 4000 ml
D. 4000 to 5000 ml
2.  Pulmonary function parameters that signify an obstructive disease process include which of the following?
A. A
B. B
C. C
D. D
3.  The amount of gas that can be inhaled over and above that normally inhaled during quiet breathing is the:
A. IRV
B. FRC
C. ERV
D. VC
4.  The results of an arterial blood gas analysis are below:
Blood Gases
pH        7.28
PaCO2 22 torr
HCO3   10 mEq/L
BE        -15
PaO2   110 torr
These data indicate which of the following?
A. primary metabolic acidosis
B. primary metabolic alkalosis
C. primary respiratory alkalosis
D. primary respiratory acidosis
5.  While examining a patient in the ICU, you note that she appears somewhat edematous and the nurse has indicated that the patient’s urine output is “minimal.” In what section of the medical record would you check to determine the patient’s fluid balance (intake vs. output)?
A. physician orders
B. consent
C. lab results
D. nurses’ notes and flowsheet
6.  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?
A. beta-blocker adminstration
B. therapeutic hypothemia
C. arterial hypertension
D. anxiety or agitation
7.  In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example ‘A’ in the following figure. What type of abnormal respiratory event does this indicate?
A. central sleep apnea
B. mixed sleep apnea
C. obstructive sleep apnea
D. respiratory effort-related arousal
8.  The gold standard for monitoring intracranial pressure (ICP) is the:
A. intraparenchymal probe
B. subarachnoid bolt
C. intraventricular catheter
D. epidural sensor
9.  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:
A. 1st degree heart block
B. atrial fibrillation
C. 2nd degree heart block
D. 3rd degree heart block
10.  Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)?
A. increased hematocrit
B. decreased BUN
C. decreased serum osmolality
D. decreased urine specific gravity
11.  Which of the following blood tests indicate potential renal failure?
A. A
B. B
C. C
D. D
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12.  Which of the following pulmonary function findings are common to patients with chronic bronchitis and also found in those with emphysema?
A. decreased forced expiratory flows
B. increased lung compliance
C. decreased diffusing capacity
D. decreased total lung capacity
13.  A sleep study report should include which of the following information about blood oxygen levels?
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
14.  In assessing a patient in the acute phase of ARDS, you would expect to find:
A. increased lung volumes
B. refractory hypoxemia
C. increased compliance
D. metabolic alkalosis
15.  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?
A. respiratory alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. metabolic alkalosis
16.  Which of the following should be included in a patient’s medication history?
A. A
B. B
C. C
D. D
17.  Which of the following can cause errors in metabolic measurements made via indirect calorimetry on a patient receiving mechanical ventilation?
A. A
B. B
C. C
D. D
18.  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:
A. therapeutic hypothermia
B. CNS depression
C. metabolic acidosis
D. decreased CO2 production
19.  Which of the following information in a patient’s medical history would be LEAST important to consider in evaluating the patient’s pulmonary condition?
A. smoking history
B. occupational history
C. prior pulmonary illnesses
D. dietary habits
20.  A patient with a 10 year history of chronic bronchitis and an acute viral pneumonia exhibits the following blood gas results breathing room air:
pH = 7.22       PCO2 = 65 torr       HCO3 = 26 mEq/L
PO2 = 40 torr     P(A-a)O2 = 40 torr
Which of the following best describes this patient’s condition?
A. acute hypercapnic respiratory failure
B. chronic hypercapnic respiratory failure
C. acute hypoxemic respiratory failure
D. combined hypercapnic/hypoxemic respiratory failure
21.  Which of the following patients are at high risk for medications errors?
A. A
B. B
C. C
D. D
22.  A patient has an arterial pH of 7.25. What effect does this have on oxygen transport?
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
23.  The wife of a comatose patient asks you to cancel a previously approved DNR order. You should
A. record the request in the patient record
B. notify the attending physician of the request
C. explain that only her husband can cancel the order
D. notify the charge nurse of the request
24.  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?
A. pulmonary arterial hypertension
B. hypertrophic cardiomyopathy
C. acute respiratory distress syndrome
D. congestive heart failure
25.  A patient is receiving volume control SIMV with 35% O2 and has following arterial blood gas results. The blood gas results indicate:
A. acute hypoxemic failure
B. respiratory acidosis with hypoxemia
C. uncompensated respiratory alkalosis
D. hyperchloremic metabolic alkalosis
26.  A patient exhibits respiratory alkalosis. Which of the following problems is most likely?
A. hypoxemia
B. hypothermia
C. opiate overdose
D. CNS depression


27.  A patient experiencing acute postoperative dyspnea undergoes a V/Q scan, with results indicating an intermediate probability of pulmonary embolism (PE). Other than dyspnea, the only significant clinical findings are a moderate hypoxemia and tachycardia. Which of the following would you recommend?
A. additional testing
B. a repeat V/Q scan
C. vasodilator therapy
D. continued observation
28.  A trauma patient is admitted to ICU with an expanding subdural hematoma. Which of the following changes would you expect to see in the monitored intracranial pressure (ICP)?
A. decreased P2 waveform component
B. decreased ICP waveform amplitude
C. loss of clear P1 waveform component
D. decreased mean intracranial pressure
29.  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?
A. inspissated secretions
B. pitting edema
C. venous distension
D. crackle on auscultation
30.  Based on the following blood-gas report, what is the most likely acid-base diagnosis?
pH = 7.52                     pCO2 = 44 torr            HCO3 = 35.1 mEq/L
A. acute (uncompensated) metabolic alkalosis
B. combined respiratory & metabolic alkalosis
C. acute (uncompensated) respiratory alkalosis
D. fully compensated respiratory alkalosis
31.  In which of the following conditions would a ventilation scan be normal but a perfusion scan reveal areas of absent blood flow?
A. lung cancer
B. pulmonary embolism
C. pneumonia
D. emphysema
32.  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?
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
33.  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?
A. 0.10
B. 0.30
C. 0.50
D. 0.70
34.  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:
A. compensated metabolic acidosis
B. acute (uncompensated) metabolic acidosis
C. compensated respiratory alkalosis
D. acute (uncompensated) respiratory alkalosis
35.  A normal vital capacity for a female patient who is five feet two inches tall and weighs 50 kilograms would be approximately:
A. 2500 mL
B. 3500 mL
C. 4500 mL
D. 5500 mL
 
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36.  The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:
A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure
D. jugular venous pressure
37.  A patient with a neuromuscular condition exhibits reasonable inspiratory muscle function, but has an accompanying hypoxemia. The presence of this hypoxemia suggests:
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
38.  To meet quality assurance standards, the patient’s chart report of a blood gas or hemoximetry test result should include:
A. a statement by the technician performing the test regarding its validity
B. the date, time and results of the last machine calibration verification
C. the range of values used for statistical quality control data analysis
D. the date, time and results of the last external proficiency test
39.  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?
A. total costs of prescriptions
B. patient’s medication knowledge
C. family’s use of prescription drugs
D. generic vs. brand name drug use
40.  The maximum amount of air that can be exhaled from the maximum inspiratory level is defined as which of the following?
A. vital capacity
B. residual volume
C. total lung capacity
D. expiratory reserve volume
41.  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
A. partially compensated respiratory alkalosis
B. fully compensated respiratory alkalosis
C. combined respiratory & metabolic alkalosis
D. acute (uncompensated) respiratory alkalosis
42.  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?
A. A
B. B
C. C
D. D
43.  While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation
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
44.  A patient has a pH of 7.58 and a PaCO2 of 50 torr. Based on these data, what is the primary acid-base disturbance?
A. respiratory alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. metabolic alkalosis
45.  Which of the following equations best describes O2 delivery TO the tissues?
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
46.  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:
A. 1.10 L
B. 1.00 L
C. 0.90 L
D. 0.80 L
47.  Lung tumors are revealed on a positron emission tomography (PET) scan as:
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’)
48.  To what section of a patient’s chart should you refer to understand any important cultural or religious influences on the provision of care?
A. social history
B. advance directives
C. family disease history
D. chief complaint
49.  In reviewing a cardiac catheterization report on a patient being assessed for coronary artery disease (CAD), about what percent reduction in artery diameter would indicate the need to proceed with balloon angioplasty and/or stenting?
A. 10%
B. 30%
C. 50%
D. 70%
50.  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?
A. decreased A-P chest diameter
B. chronic respiratory alkalosis
C. secondary polycythemia
D. FRC less than predicted
51.  Which of the following would provide the largest alveolar ventilation for a 68 kg (150 lb) patient?
Frequency       Tidal Volume
A          30        400
B          10        600
C          20        600
D          10        800
A. A
B. B
C. C
D. D
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52.  A patient in ICU has sinus tachycardia. Which of the following are potential causes of this problem?
A. A
B. B
C. C
D. D
53.  Which of the following conditions is most likely to cause an elevated white blood count?
A. pulmonary fibrosis
B. bacterial bronchitis
C. pneumothorax
D. hypertension
54.  A polysomnography report indicates an average of 35 mainly obstructive apnea/hypopnea events per hour. Which of the following statements is most consistent with this observation?
A. since there are less than 40 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
55.  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:
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
56.  What is the normal range for arterial base excess (BE)?
A. 22 to 26 mEq/L
B. -2 to +2 mEq/L
C. 45 to 55 mEq/L
D. -10 to +10 mEq/L
57.  Where in the chart should you go to find information on a patient’s desire to allow or restrict therapies?
A. in the doctor’s progress notes
B. in the advance directive document
C. in the nurses progress notes
D. in the history and physical
58.  Which of the following 75 kg adult patients receiving ventilatory support is the best candidate for weaning?
A. A
B. B
C. C
D. D
59.  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?
A. Streptococcus pneumoniae
B. Klebsiella pneumoniae
C. Bacillus anthracis
D. Staphylococcus aureus
60.  A patient has a vital capacity of 3600 ml, a functional residual capacity of 6,000 ml and expiratory reserve volume of 1000 ml. What is her residual volume?
A. 9600 ml
B. 8600 ml
C. 7000 ml
D. 5000 ml
61.  According to the Joint Commission, which of the following charting abbreviations or methods is allowed or encouraged?
A. Q.D.
B. leading zeros, e.g. 0.5 mg
C. IU (international unit)
D. trailing zeros, e.g. 5.0 mg
62.  A patient exhibits respiratory alkalosis. Which of the following problems is most likely?
A. hypothermia
B. pain
C. opiate overdose
D. CNS depression
63.  An adult patient has an intracranial pressure (ICP) of 24 mm Hg. You can conclude that:
A. the ICP is normal
B. the ICP is below normal
C. the ICP is abnormally high
D. there is excessive CSF
64.  Which of the following laboratory values is most consistent with a diagnosis of fluid overload (overhydration)?
A. increased hematocrit
B. decreased BUN
C. increased serum osmolality
D. increased urine specific gravity
65.  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?
A. A
B. B
C. C
D. D
66.  A polysomnography report indicates an average of 2-3 mainly obstructive apnea/hypopnea events per hour. Which of the following statements is most consistent with this observation?
A. since there are less than 5 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
67.  Which of the following is a true statement?
A. VC = IRV + VT + ERV
B. VC = FRC + VT
C. VC = TV + IRV + RV
D. FRC = TV + ERV
68.  Which of the following elements of a patient’s social history would be relevant in planning a home-based disease management program?
A. A
B. B
C. C
D. D
69.  You review a sleep study report in a patient’s chart that includes the %time in sleep stages; frequency of arousals; frequency of apneas, hypopneas, and respiratory effort-related arousals; O2 saturation data; the frequency of periodic limb movements; the technician’s comments, and the physician’s interpretation/conclusions. What is missing from this report?
A. arterial blood gas values during patient arousals
B. complete capnography tracking data during apneas
C. diurnal variations in the patient’s body termperature
D. the relationship of any disordered breathing to sleep stages
70.  The first step in medication reconciliation is to:
A. contact the pharmacy for drug interaction information
B. obtain an accurate medication history from the patient
C. review the current nursing notes and flow sheets
D. obtain all prior medical records of the patient

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