1. The respiratory therapist is participating in the resuscitation of a patient. After 5 minutes of CPR, the ECG shows ventricular fibrillation. Attempted defibrillation with 200 joules has been ineffective. The therapist’s next recommendation should be to:
A. Perform a precordial thump.
B. Perform endotracheal intubation.
C. Implement cardioversion with 300 joules.
D. Implement defibrillation with 300 joules.

2. Mixed venous blood is obtained from the
A. Superior vena cava.
B. Pulmonary atery.
C. Pulmonary vein.
D. Left atrium.

3. A patient who is being mechanically ventilated using PEEP is switched to a continuous flow CPAP system for weaning. On initial evaluation, the manometer shows negative pressure during inspiration. The patient appears agitated and uncomfortable. Which of the following actions would be most appropriate?
A. Hyperoxygenate and suction the patient.
B. Reinstitute mechanical ventilation.
C. Increase CPAP by 2 cm H2O.
D. Increase system flow.

4. If a flow-directed, balloon tipped catheter is correctly placed, the tip will be located in the:
A. Right atrium.
B. Right ventricle.
C. Pulmonary artery.
D. Superior vena cava.

5. When applies to neonates, transcutaneous monitoring of oxygen tension will have a linear relationship with PaO2 tensions, under which of the following conditions?
I. Unstable neonate with beta-streptococcus sepsis.
II. RDS of the neonate.
III. Cardiac arrest.
IV. Intraventricular hemorrhage.
A. I and II only
B. I and III only
C. II and IV only
D. II, III and IV only

6. While assessing a patient who is receiving oxygen by nasal cannula at 1L/min, the patient tells the respiratory therapist where was someone hiding under her bed last night. The patient’s SpO2 is 86%. Which of the following actions should the therapist take?
I. Request an order to increase the flow of oxygen.
II. Check with the patient’s nurse about his mental status.
III. Chart that the patient is suffering from dementia.
IV. Report the SpO2 to the physician.
A. I and III only
B. I, II and IV only
C. I, III and IV only
D. II, III and IV only

7. A patient being mechanically ventilated is intubated with an 8mm endotracheal tube. While suctioning the patient with a 12 Fr catheter after pre-oxygenation, the respiratory therapist notes the patient becomes bradycardiac, and the oxygen saturation decreases. The therapist should recommend changing to a:
A. 10 mm catheter.
B. Closed-suction system.
C. 14 Fr whistle-tip catheter.
D. Suctioning frequency of q4h.

8. After obtaining an arterial blood example from a patient’s artery, the respiratory therapist notes a purple subcutaneous wheal developing at the puncture site. Which of the following would be the FIRST action to take?
A. Perform an Allen’s test.
B. Immediately notify the nurse.
C. Apply pressure to the puncture site.
D. Recommend subcutaneous epinephrine at the site.

9. A recent arterial blood gas report indicated an HC03 of 38 mEq/L and a PaC02 of 42 torr. The respiratory therapist should do which of the following?
A. Perform quality control procedures.
B. Review the serum electrolyte levels.
C. Review the patient’s complete medical history.
D. Recommend diuretic therapy for the patient.

10. The respiratory therapist is suctioning a mechanically ventilated patient q4h with a 12 Fr suction catheter. The patient has a 7.0 mm oral endotracheal tube in place. The amount of secretions seems to be increasing. Which of the following is the most appropriate action?
A. Suction more frequently.
B. Use a Coude suction catheter.
C. Use a size 14 Fr suction catheter.
D. Increase the suction pressure to-150mm Hg.

11. During initial assessment of a patient with a closed-head injury, the patient only opens his eyes in response to pain. On a follow-up examination, the patient opens his eyes to verbal commands. These observations indicate which of the following?
A. The level of consciousness is increased.
B. Intracranial pressure has increased.
C. Cerebral perfusion has decreased.
D. Seizure activity is increased.

12. The respiratory therapist performs an assessment prior to initiating aerosol and chest physiotherapy. During the interview, the patient states, “I seem to breath fast and lift my shoulders a lot, but I feel like I am getting enough air. I sleep through the night and only use one pillow.” The therapist can conclude that the patient likely has:
A. Dyspnea
B. Orthopnea
C. Increased work of breathing
D. A decreased level of consciousness

13. A patient using a demand oxygen conserving device complains that he is short of breath and the device does not trigger with inspiration. To determine the problem, the respiratory therapist should evaluate whether the:
I. Tubing is connected properly to the oxygen device.
II. Patient is inspiring though the nose.
III. Tubing is free from plugs.
IV. Oxygen device is set properly.
A. I and II only
B. II and III only
C. I, III and IV only
D. I, II, III and IV

14. An 80 kg (176lb) man with ARDS is receiving mechanical ventilation with PEEP. After increasing the PEEP setting from 10 to 15 cm H2O, which of the following should be monitored by the respiratory therapist in order to evaluate the patient’s response?
I. Heart rate
II. Fluid intake and output
III. Body temperature
IV. Blood pressure
A. II and III only
B. I, II and IV only
C. I, III and IV only
D. I, II, III and IV

15. The respiratory therapist is asked to assist a physician performing cardioversion on a spontaneously breathing patient with supraventricular tachycardia. The patient is alert and awake. In preparation for this procedure, which of the following steps should be taken by the therapist?
I. Set up oxygen therapy equipment.
II. Assemble suction and airway care equipment.
III Intubate the patient.
IV. Select and assemble a manual resuscitator.
A. I only
B. II and III only
C. I, II and IV only
D. I, II, III and IV

16. A 34-year-old patient with bronchiectasis wishes to continue an appropriate pulmonary hygiene program while maintaining full-time employment as an accountant. Which of the following devices would be best to assist the patient to obtain this goal?
A. Ultrasonic nebulizer
B. IPPB with bronchodilator
C. MDI with bronchodilator
D. Flutter mucus clearance device

17. A physician has requested that the respiratory therapist increase the ventilatory volume for a patient receiving high-frequency oscillation ventilation (HFOV). Which of the following settings should the therapist adjust?
A. Pressure
B. Bias flow
C. Tidal volume
D. Frequency (Hz)

18. A 36-year-old female was in a motor vehicle crash and sustained a flail chest injury. She is receiving mechanical ventilation. Auscultation reveals clear, but slightly diminished breath sounds. After 10 minutes, the patient becomes progressively tachycardiac and short of breath. In reevaluating breath sounds, the right lower lobe breath sounds are now very distant. The respiratory therapist should reassess the patient to rule out which of the following?
A. Pneumothorax
B. Mucous plugging
C. Pneumopericardium
D. Pulmonary contusion

19. A patient receiving mechanical ventilation has a C(a-v) O2 that increased from 5 mL/dL to 8 mL/dL. This change in condition is consistent with a decrease in which of the following?
A. Temperature
B. Cardiac output
C. Metabolic rate
D. Oxygen demand

20. While assisting with a therapeutic bronchoscopy for an adult patient, the physician is suddenly unable to view any anatomy because everything went black. Which of the following is a likely cause?
A. Mucous plug has blocked the tip of the scope.
B. The lung distal to the scope has collapsed.
C. The suction line has become disconnected.
D. The light source has become disconnected.

21. Five minutes after extubating a patient, the respiratory therapist observes marked stridor, labored breathing, intercostal retractions, and dropping SpO2. An aerosolized racemic epinephrine treatment has been delivered without effect. Which of the following should the therapist recommend at this time?
A. An aerosol treatment with dexamethasone (Decadron)
B. Manual ventilation with bad and mask
C. A cool aerosol treatment
D. Reintubation

22. A physician orders a graded exercise program for a pulmonary rehabilitation patient with paraplegia. The respiratory therapist should recommend using which of the following?
A. Treadmill
B. Arm ergometer
C. Stationary bike
D. Breathing exercises

23. Which of the following would be the correct midclavicular intercostal placement to insert a 14-gauge catheter-over-needle device to treat a symtomatic left tension pneumothorax?
A. Third intercostal space just below the bottom of the third rib on the right side.
B. Third intercostal space just below the bottom of the third rib on the left side.
C. Second intercostal space just above the top of the third rib on the left.
D. Second intercostal space just above the top of the third rib on the right.

24. While gathering equipment in the ICU to set up an arterial line ordered STAT by physician, the respiratory therapist notes that the only available noncompliant pressure tubing is in a sterile package, but the corner of the package is open. Which of the following would be the proper action?
A. Obtain an unopened, sterile pressure tubing.
B. Use the tubing if the expiration date has not yet passed.
C. Ask the physician if it is appropriate to use this tubing.
D. Ask the supervisor if it is appropriate to use this tubing.

25. While assessing a patient receiving oxygen by transtracheal oxygen catheter, the respiratory therapist notes that the patient appears cyanotic and the Sp02 is 70%. The therapist should:
A. Advance the catheter 2 cm.
B. Decrease the oxygen flow.
C. Flush the catheter with 1 mL sterile water.
D. Initiate oxygen by nasal cannula.

26. An 18-month-old infant is to receive 30% oxygen by mist tent. While performing a routine equipment check, the respiratory therapist notices that the oxygen analyzer inside the tent reads 25%. After calibrating the oxygen analyzer, it still indicates 25%. The therapist should:
I. Check for leaks.
II. Check the gas inlets for obstructions.
III. Add sterile water to the nebulizer reservoir.
A. I only
B. III only
C. I and III only
D. I, II and III

27. Monitoring serum potassium levels is indicated in patients who are receiving:
A. Neuromuscular blocking agents
B. Sedatives
C. Analgesics
D. Diuretics

28. Which of the following parameters should be monitored during cardiopulmonary stress testing?
I. Heart rate
II. Blood pressure
III. Cardiac output
IV. Oxygen saturation
A. I and III only
B. I, II and IV only
C. II, III and IV only
D. I, II, III and IV

29. An 8-year-old child is in the emergency department (ED) being prepared for transport to a tertiary care center. The child is being manually ventilated with 100% oxygen at 20 breaths/min. Heart rate is 55/min and blood pressure is 80/50 mm Hg. Which of the following would be the most appropriate action?
A. Initiate mechanical ventilation to improve oxygenation.
B. Transport to a tertiary care center as soon as possible.
C. Place the patient in a transport vehicle and reassess.
D. Delay the transport and stabilize the patient.

30. Cardiac output will be higher in individuals with which of the following characteristics?
I. Exercise
II. Male
III. Starvation
IV. Supine
A. I and IV only
B. II and III only
C. I, II and IV only
D. I, II, III and IV only

31. A patient with a diagnosis of pneumonia has received CPT and bronchodilator therapy for 48 hours. Sputum has decreased and the patient is now coughing up small amounts of thick, yellow to green sputum. Breath sounds are decreased in the left lower lobe with crackles noted over the left posterior, basal segments. Which of the following diagnostic studies should the respiratory therapist recommend?
A. Spirometry
B. Chest radiograph
C. Arterial blood gas analysis
D. Ventilation/perfusion scan

32. A physician has determined that a patient with chest trauma has a large left hemothorax. The respiratory therapist should anticipate that the physician will insert a:
A. Large diameter chest tube in the lower lateral pleural cavity of the left chest.
B. Relatively small diameter chest tube in the upper.
C. Large gauge needle into the lower left lateral pleural cavity
D. Small gauge needle into the upper left anterior pleural cavity.

33. A patient breathing room air has a Pa02 of 45 torr and a PaC02 of 30 torr. After receiving 35% oxygen for 30 minutes, the patient’s Pa02 rises to 90 torr. Which of the following would be the major cause of hypoxemia in this patient?
A. Ventilation/perfusion mismatch
B. Pulmonary A-F fistula
C. Hyperventilation
D. Hypoventilation

34. A 24-year-old patient receiving chest physiotherapy to all segments of the right lung. The PA chest radiograph shows a posterior basal right lower lobe atelectasis. For postural drainage, the patient should be placed in which of the following positions?
A. On his back with pillows under his knees.
B. Face down with the head of the bed down.
C. Left side down with the bed flat.
D. Left side down with the head of the bed down.

35. A patient who is 185 cm (6 ft 1 ) tall and weighs 90kg (198lb) has been intubated and receiving mechanical ventilation for 14 days following surgery. Over the past 4 days, the patient has been losing weight and requiring increased ventilator support. Which of the following would be the best way to evaluate the patient’s nutritional status?
A. Skinfold thickness
B. Muscle-to-fat ratio
C. Weight-to-height ratio
D. Metabolic energy expenditure

36. An incubator would be part of appropriate treatment for which of the following infants?
A. Infant receiving ECMO
B. Intubated infant with RDS
C. 16 week old infant with RSV
D. 3 months old infant with bronchiolitis

37. A “thready” and variable pulse is palpated on a patient with a history of arterial fibrillation. To further evaluate this clinical presentation, which of the following should the respiratory therapist recommend?
B. Chest radiograph
C. Cardiac ultrasound
D. Arterial blood gas analysis

38. A patient is receiving mechanical ventilation and has a chest tube to treat a persistent bronchopleural fistula. The patient continues to set off the low-pressure alarm. To measure volume loss through the chest tube, the respiratory therapist may:
I. Use a Wright respirometer
II. Subtract expired volume from the inspired volume.
III. Use a large volume spirometer.
A. II only
B. I and II only
C. I and III only
D. II and III only

39. The respiratory therapist has been asked to provide input on the department’s QA program. The assess the quality of the bronchodilator QA program, the therapist should monitor the:
A. Number of bronchodilator procedures ordered.
B. Number of bronchodilator procedures performed.
C. Average time it takes to deliver small volume nebulizer.
D. Average length-of-stay for patients receiving small volume nebulizers.

38. The respiratory therapist has received a report on a patient in the ICU who recently has a mycocardial infarction. The patient has a history of COPD and congestive heart failure. The therapist should monitor which of the following?
I. Sp02
IV. Input/output
A. I only
B. I, II and III only
C. I, II and IV only
D. II, III and IV only

39. A physician has ordered q2h small volume nebulizer therapy with 0.5 mL albuterol (Ventolin). The patient’s history shows congestive heart failure with 3+ pitting edema, no history of asthma, pneumonia, or smoking. There is moderate respiratory distress with expiratory wheezes. The respiratory therapist should recommend:
I. Intubation
II. Furosemide (Lasix)
III. Monitoring input/output
IV. Discontinuing the aerosol therapy.
V. PetCO2
A. I, II and IV only
B. I, IV and V only
C. II, III and IV only
D. II, III and V only

40. A patient is receiving oxygen at home from a liquid oxygen reservoir at 2 L/min. He complains that he does not feel gas coming out of the nasal cannula. Possible reasons for this complaint include which of the following?
I. The system is delivering a relatively low flow.
II. The tubing is not properly connected.
III. The electrical system has failed.
A. I only
B. III only
C. I and II only
D. I, II and III

41. A patient who is an IV drug abuser is intubated for a drug overdose and develops frequent PVC’s. Attempts to place peripheral or central catheters are unsuccessful. The respiratory therapist should recommend which of the following?
A. Defibrillation
B. Endotracheal atropine
C. Endotracheal epinephrine
D. Endotracheal lidocaine (Xylocaine)

42. When reviewing therapy for a home care patient who has COPD, the respiratory therapist notices that every time the patient uses the peak flowmeter, it consistently reads 100L/min. Which of the following is the most appropriate initial action for the therapist to take?
A. Recommend and increase in daily exercise.
B. Recommend complete pulmonary function studies.
C. Recheck the patient’s peak flow with a new peak flowmeter.
D. Continue to monitor the patient’s peak flow for 2 weeks.

43. All of the following are components of a HFJV system EXEPT:
A. An exhaled volume spirometer.
B. A pressure regulator.
C. An oxygen source.
D. An injector line.

44. A patient COPD is receiving oxygen at 2 L/min by nasal cannula at home. The patient’s Sp02 is usually 90%. When visiting the patient, the respiratory therapist finds the oxygen set at 4L/min, the patient is lethargic, and his oxygen saturation is 95%. The therapist should do which of the following?
A. Obtain a blood gas sample and notify the physician.
B. Contact the physician to arrange for hospital admission.
C. Change the oxygen flow to 2 L/min and observe the patient.
D. Discontinue oxygen until the patient’s mental status has improved and observed the patient.

45. An 8-year-old patient with cystic fibrosis is performing PEP therapy. The respiratory therapist notes that a PEP level of 15 cm H2O is achieved throughout exhalation. The therapist should do which of the following?
A. Continue the therapy.
B. Replace the one-way valve.
C. Change from a mouth-piece to a mask.
D. Increase the amount of expiratory resistance.

46. A patient who is 83 years old is complaining of shortness of breath following chest surgery. The patient is receiving 30% O2 by mask. The patient has a history of chronic bronchitis and coarse crackles are heard on auscultation. The physician asks the respiratory therapist for a recommendation. The therapist should recommend which of the following?
A. Bronchodilator therapy with deep breathing as tolerated.
B. Ultrasonic nebulizer therapy with chest percussion.
C. Bland aerosol therapy by hand-held nebulizer.
D. Incentive spirometry.

47. A patient with emphysema is continuing pulmonary rehabilitation at home. The patient informs the respiratory therapist that he is going on vacation to the mountains (8500 ft). The patient’s ability to carry out daily living activities has improved significantly since the beginning a graded exercise program. Current medication is limited to oral theophylline (Aminophylline), ipratropium bromide (Atrovent) by metered dose inhaler, and continuous oxygen by nasal cannula at 1L/min. The therapist should inform the patient to:
A. Double the current level of exercise.
B. Discontinue using theophylline upon arrival at his destination.
C. Increase the oxygen flow to 6 L/min upon arrival at his destination.
D. Reduce his current level of exercise upon arrival at his destination.

48. A patient who complains of dyspnea has a Raw measured at 2.6 cm H2O /L/sec at standard flow. The respiratory therapist should suspect that the patient may have:
A. Atelectasis
B. Pneumonia
C. Bronchitis
D. Guillain-Barre Syndrome

49. A patient with a size 8 mm endotracheal tube in place has been mechanically ventilated and unable to wean for the past 2 weeks. If there is no further improvement in ventilatory status, the patient will be sent to the OR for a tracheotomy procedure within the next 48 hours. The tracheostomy device will facilitate this patient’s care for which of the following reasons?
I. Dead space is decreased
II. Airway resistance is decreased
III. Lung compliance is decreased
IV. Work of breathing is unchanged
A. I and II only
B. I and IV only
C. II and III only
D. II and III and IV only

50. Following a motor vehicle crash, a patient in respiratory distress is intubated for airway patency. During the physical examination, the respiratory therapist palpates asymmetrical chest movement during inspiration, but no crepitus is noted. Breath sounds are diminished on the left. These findings indicate which of the following?
A. Atelectasis
B. Pneumothorax
C. Flail chest
D. Mainstem intubation

51. The respiratory therapist assesses a patient receiving supplemental oxygen by a trans-tracheal oxygen catheter. The patient is diaphoretic and has a higher than normal respiratory rate. Mucous membranes appear blue. Which of the following a possible explanation?
A. There is excess humidity in the transtracheal system.
B. The flow going to the transtracheal catheter is too high.
C. The transtracheal catheter is obstructed by mucous plug.
D. The transtracheal catheter is advanced too far into the airway.

52. Which of the following artificial airways would be most appropriate for patient who is postoperative, spontaneously breathing, still under the effects of anesthesia, and is exhibiting sign of loud snoring suggesting some obstruction?
A. Oropharyngeal airway
B. Endotracheal tube
C. Tracheostomy tube
D. Esophageal obturator airway

53. During respiratory care rounds in the ICU, respiratory therapist notices that a patient using a tracheostomy collar with 60% oxygen by a cool aerosol is unable to bring up any secretions. The small amount of secretions the patient coughed up earlier were very thick. The therapist should assesses the patient and suggest:
A. Changing the set up to a cool humidifier at 60% oxygen.
B. Keeping the cool aerosol, but decreasing the FiO2 to 0.40
C. Changing the set up to a heated humidifier at 60% oxygen.
D. Instilling 3 mL of normal saline followed by manual bag ventilation and suctioning q4h.

54. A 60 kg (132 lb) patient is receiving volume controlled ventilation. The respiratory therapist is asked to increase the tidal volume from 500 to 700 mL. Which of the following ventilator alarm settings should be changed?
I. Low exhaled tidal volume alarm.
II. High pressure limit alarm.
III. High minute volume alarm.
IV. Low pressure alarm.
A. I and III only
B. I and IV only
C. II and IV only
D. I, II and III only

55. A physician inserts an indwelling catheter into a patient’s internal jugular vein and positions the tip of the catheter in the superior vena cava at the level of the right atrium. What pressure may be monitored with the catheter?
A. Central venous pressure
B. Arterial blood pressure
C. Pulmonary artery pressure
D. Pulmonary capillary wedge pressure

56. While participating in a helicopter transport, the respiratory therapist notes that it is increasingly difficult to ventilate the patient with a manual resuscitation bag and the Sp02 is dropping. the trachea has shifted left and there is no chest excursion on the right. Which of the following should the therapist do?
A. Attempt to pass a suction catheter.
B. Pull the endotracheal tube back 2 cm.
C. Deflate the cuff and re-inflate it slowly
D. Insert a needle into the 2nd intercostal space on the right side.

57. The respiratory therapist sets up a spring-loaded CPAP device and notices that the pressure reading on the manometer is observed to be 5cm H20 higher than the set level. Which of the following is the probable cause?
A. The flow is too low.
B. The water lever is too high.
C. Secretions are in the the valve
D. There is a leak in the circuit.

58. Upon entering a patient’s room after lunch, the respiratory therapist discovers the patient unresponsive and lying in bed. The decision to perform the obstructed airway routine depends on the:
A. Pulse oximetry reading
B. Absence of a palpable pulse.
C. Chest rising after a rescue breath.
D. Passage of an esophageal obturator airway.

59. A 70 year old patient on a medical ward has retained secretions due to an ineffective cough and requires nasotracheal suctioning, for which a prn order is written. The patient is not receiving supplemental oxygen and has a room air Sp02 of 94%. Which of the following is required to safely perform this procedure?
I. Emergency code art
II. Supplemental oxygen
III. ECG monitoring
IV. A pulse oximeter
A. I only
B. III and IV only
C. I, II and III only
D. II, III and IV only

60. A heated moisture exchanger (HME) is found of lying open on a ventilator. The patient has no other humidification device in place. The respiratory therapist should do which of the following?
A. Visually inspect the HME and attach it to the endotracheal tube.
B. Open a new HME and attach it to the endotracheal tube.
C. Discard the HME and monitor airway pressure over time.
D. Insert the HME between the patient “Y” and the endotracheal tube.

61. A respiratory care protocol indicates that a ventilator-dependent patient should be weaned when his spontaneous tidal volume exceeds 3mL/lb lean body weight. Assessment of a spontaneous Ve reveals the following: Ve 6 L/min and rate 30. The patient’s ideal body weightis 68.2 kg ( 150 lb ). Which of the following is the best recommendation at this time?
A. Initiate weaning per protocol
B. Maintain current therapy
C. Consult the supervisor
D. Notify the physician

62. The respiratory therapist is attending the birth of a 35-week gestational age infant. The infant presents with a heart rate of 55/min. Which of the following would the therapist do FIRST?
A. Continue to monitor
B. Recommend IV epineprhine
C. Initiate chest compressions
D. Initiate manual ventilation with 100% oxygen

63. An 11 kg (24.2 lb) child is intubated. The respiratory therapist notes an air leak around the endotracheal tube during inspiration. Leak pressure is measured at 10cm H2O. Chest radiograph notes the tip of the endotracheal tube is 1.5 cm above the carina. Which of the following would be the most appropriate action?
A. Extubate and reintubate with a larger endotracheal tube.
B. Advance the endotracheal tube until the leak stops.
C. Withdraw the endotracheal tube 1 cm and retape.
D. Continue to ventilate and assess the patient.

64. The respiratory therapist reviews chart of a newborn and notes a 1 minute Apgar of 2 and a 5 minute Apgar of 3. Which of the following would be a high risk for this newborn?
I. Mental impairment
II. Croup
III. Bronchiolitis
IV. Increased mortality in the first month of life
A. I and IV only
B. II and IV only
C. III and IV only
D. I, II and III only

65. A patient has the following symptoms: heart rate 130/min, blood pressure 90/60 mm Hg, urine specific gravity of 1.05, 24 hour urine output of 300 mL, mental confusion, and decreased skin turgor. Which of the following would be the correct solution for these problems?
A. Recommend diuretics
B. Increase fluid intake
C. Recommend a chest radiograph
D. Decrease fluid and sodium intake

66. While ventilating a patient who is apneic with a pneumatic (demand-valve) resuscitator and mask, the respiratory therapist notes that the patient’s chest does not rise during inspiration. Appropriate actions include:
I. Repositioning the patient’s head.
II. Performing a cricothyroidotomy.
III. Switching to a manual resuscitator (bag-valve)
A. II only
B. III only
C. I and III only
D. I, II and III

67. After attaching a cardiac monitor to a patient’s chest, the respiratory therapist notes the ECG recording contains artifact. Which of the following could cause this situation?
I. Poor electrode contact
II. Improper electrode placement
III. The patient scratching the electrodes
A. I only
B. III only
C. I and II only
D. I, II and III

68. A 43-year-old patient with ARDS is receiving pressure-controlled ventilation. After changing the PEEP level from 12 cm H2O to 16 cm H2O, the respiratory therapist should monitor the patients:
A. Hemoglobin
B. Creatinine
C. Cardiac output
D. Serum potassium

69. Which of the following is the most common patient position while placing a chest tube to resolve a pneumothorax?
A. Prone
B. Supine
C. Affected side up
D. Affected side down

70. While checking the pressure of the oxygen outlets, the respiratory therapist notes the reading is 26 psig. The hospital utilizes a cylinder bank bulk oxygen system. What should the therapist recommend?
A. Check the lines for a leak.
B. Switch to the back-up bank of cylinders.
C. This situation requires no intervention.
D. Change all patients to portable E cylinders.

71. During a visit to a homebound patient who has arranged his tubing to allow kitchen activity, the respiratory therapist finds the oxygen concentrator running, but it is producing inadequate flow through the nasal cannula. Which of the following would most likely cause this problem?
A. A missing bacteria filter
B. Use of a bubble humidifier
C. Use of 75 feet of connecting tubing
D. Inadequate household current

72. An 82-year-old male with a history of chronic bronchitis is admitted to the ICU with pneumonia. The percussion note is dull over the left lower lung field with diminished lung sounds to auscultation. The complaints of being “exhausted” from coughing for the last 5 days, producing the moderate amount of thick, yellow sputum. He is tachypneic. Antibiotic and bronchial hygiene therapy is initiated. Three days later, which of the following would indicate that the care was effective?
A. No secretions
B. Thick, green secretions
C. Minimal clear secretions
D. Moderate yellow secretions

73. Which of the following key points are relevant to patient education for asthma care?
I. Begin educating the patient at the time of diagnosis.
II. Patients and families should be taught self-management concepts by all team members.
III. Promote open communication between patient, family, and healthcare provides to encourage adherence to care.
IV. Jointly develop treatment goals.
A. I and II only
B. I and III only
C. III and IV only
D. I. II, III and IV

74. A patient with an oral endotracheal tube is being suctioned using 80 mm Hg suction pressure. As suction is applied to the catherer, secretions enter the catheter, but do not advance more than 3cm. The respiratory therapist should:
A. Increase suction pressure.
B. Instill saline down the suction catheter.
C. Instruct the patient to cough during suctioning.
D. Apply intermittent suction pressure to the catheter.

75. A 34 week gestational age infant is receiving mechanical ventilation and the chest is being transilluminated. The transillumination device produces a small halo appearance at the point of contact with the skin. This indicates which of the following?
A. Pneumothorax
B. Pneumomediastinum
C. Pneumopericardium
D. Normal lung appearance

76. Which of the following adult urinary output values is considered abnormal?
A. 20 mL/hr
B. 30 mL/hr
C. 40 mL/hr
D. 50 mL/hr

77. Reviewing the chart of a newly admitted patient, the respiratory therapist finds that the patient has COPD, a 70 pack year smoking history, and was admitted for dyspnea. The patient is unresponsive and has a BP of 180/100 mm Hg and a respiratory rate of 40/min. Which of the following should the therapist review next?
A. Chest radiograph report
B. PaCO2
C. SpO2

78. An ultrasonic nebulizer, though showing aerosol in the chamber, is not delivering any aerosol to the patient. The most likely cause is:
A. The electrical cord is disconnected.
B. There is insufficient fluid in the cup.
C. The amplitude and frequency need adjustment.
D. The fan moving air through the chamber is not functioning.

79. A patient is receiving an IPPB treatment by mask. The desired preset pressure is not being achieved. The respiratory therapist should:
A. Increase the flow
B. Decrease the pressure
C. Decrease the terminal flow
D. Increase the sensitivity

80. Which of the following devices should be used to effectively deliver a 70% helium/ 30% oxygen mixture to a patient?
A. Simple mask
B. Oxygen hood
C. Nasal cannula
D. Nonrebreathing mask

81. A 67-year-old patient with COPD complains that she becomes breathless after brushing her hair and must sit down to catch her breath. This complaint is most closely related to which of the following?
A. increased work of breathing
B. cardiac tamponade
C. increased pulmonary reserve
D. orthopnea

82. Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL?
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

83. You are reviewing the chest X-ray of a 32-year-old female receiving ventilatory support via an oral endotracheal (ET) tube. To assure proper placement of the tube, you would look for its tip to be positioned
A. at the same level as the carina
B. not more than 2 cm above the carina
C. between the 2nd and 4th thoracic vertebra
D. level with the fifth cervical vertebra

84. Which of the following would be the most likely cause of stridor in a child?
A. asthma
B. pneumonia
C. croup
D. cystic fibrosis

85. Upon reviewing the patient’s chart, results of a chest x-ray indicate: “Complete opacification of the left chest with a shift of the trachea and mediastinum to the left.” These findings are consistent with which of the following?
A. pneumothorax of the right lung
B. atelectasis of the left lung
C. diffuse pulmonary emphysema
D. right-sided pleural effusion

86. A 55-year-old patient has been smoking 1-1/2 packs of cigarettes per day for 30 years. You would quantify and record his smoking history as:
A. 15 pack-years
B. 30 pack-years
C. 45 pack-years
D. 60 pack-years

87. 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?
A. right sided tension pneumothorax
B. right sided pleural effusion
C. left sided atelectasis/lung collapse
D. left sided tension pneumothorax

88. 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?
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

89. In observing a patient, you note that her breathing is extremely deep and fast. Which of the following terms would you use in charting this observation?
A. Kussmaul’s breathing
B. Biot’s breathing
C. Cheyne-Stokes breathing
D. apneustic breathing

90. 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?
A. increased vascular markings
B. flattening of the diaphragms
C. decreased radiolucency
D. increased C/T ratio

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

92. 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?
A. pleurisy
B. chronic bronchitis
C. pulmonary edema
D. atelectasis

93. 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?
A. increased end-diastolic volume
B. mitral valve regurgitation
C. increased stroke volume
D. decreased end-diastolic volume

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

95. Prior to initiating chest physiotherapy, the patient tell you that “I seem to breathe fast and lift my shoulders a lot, but l feel like I am getting enough air. I sleep through the night and use only one pillow.” You can conclude that the patient likely has:
A. dyspnea
B. orthopnea
C. increased work of breathing
D. a decreased level of consciousness

96. Which of the following methods could be used to assess the intensity of pain being experienced by an elderly, confused patient who is unable to express himself?
A. A
B. B
C. C
D. D

97. A patient’s record indicates a history of substance abuse. Which of the following substances could be involved?
A. A
B. B
C. C
D. D

98. A patient with paradoxical chest wall movement most likely has:
A. atopic asthma
B. chronic bronchitis
C. flail chest
D. tension pneumothorax

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

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


For the un-answered questions, you can find all the answers in the TMC Test Bank.