1. A patient is receiving aerosolized bronchodilator treatments with a small volume nebulizer. If the patient develops a nosocomial infection of the trachea involving Escherichia Coli, which of the following is the most likely cause?
     
    A. Failure to change the tubing frequently.
    B. Poor hand washing techniques by personnel.
    C. Placing unsterile water in the nebulizer.
    D. Contamination of disposable equipment.
    B
  2. Vesicular breath sounds indicate which of the following?
     
    A. Normal lungs
    B. Lung consolidation
    C. Small airways obstruction
    D. Acute bronchospasm
    A
  3. Which of the following would provide the most information about a patient’s orientation to time and place?
     
    I. The patient knows she is in a hospital.
    II. The patient knows her diagnosis.
    III. The patient recognizes her physician.
    IV. The patient correctly states the year.
     
    A. I and II only
    B. I and IV only
    C. I, II and III only
    D. II, III and IV only
    B
  4. A dyspneic patient who is in the emergency department (ED) is coughing up large amounts of frothy, pink sputum, and audible crackles are ausculutated. Which of the following would be the most appropriate treatment?
     
    A. Performing repeated nasotracheal suctioning to clear the airways.
    B. Administering positive-pressure ventilation with air.
    C. Administering an FiO2 of 0.35 by air-entrainment mask and suctioning.
    D. Administering mask CPAP with an Fi0O2 of 1.0
    D
  5. Before attaching an oxygen regulator to a cylinder, the respiratory therapist can prevent foreign matter from entering the regulator by manipulating the cylinder valve in that way?
     
    A. Clean it with water and carefully dry.
    B. Crack it open, then immediately close it.
    C. Lightly grease it with a non petroleum product.
    D. Wipe it clean with a dry towel and visually inspect it.
    B
  6. If a massive gas leak occurs from the wall oxygen outlet when a flowmeter is removed from the outlet, the first action would be to:
     
    A. Reinsert the flowmeter into the outlet.
    B. Activate the fire alarm.
    C. Evacuate the patients from the room.
    D. Locate the zone valve and turn it off.
    A
  7. A Wright respirometer has been used in the intensive care unit to monitor several patients. Cultures indicate that it is contaminated. Which of the following is the most practical way to prevent cross contamination?
     
    A. Sterilize the respirometer after each use.
    B. Replace the respirometer with a water-seal spirometer
    C. Attach a one-way valve so that only expired gas passes through the respirometer.
    D. Place the respirometer in hydrogen peroxide between uses.
    C
  8. During a 15 second suctioning procedure, a patients pulse decreases to 50/min and his blood pressure decreases from 120/80 to 80/50 mm Hg. Which of the following is the most likely cause of these changes?
     
    A. Abnormal ventilation/perfusion ratio
    B. Transient hypoxemia
    C. Sympathetic stimulation secondary to pain and trauma
    D. Stimulation of vagal reflex
    D
  9. Which of the following is the most significant factor leading to the development of tracheostenosis?
     
    A. Cuff pressure on the tracheal wall
    B. Trauma during intubation
    C. Intracuff volume
    D. Tube lenght
    A
  10. Compared with other types of humidifiers, what is a major advantage of the wick humidifier?
     
    A. Heating is not required.
    B. Both molecular and particulate water are produced.
    C. A 100% relative humidity is easily attainable.
    D. A baffle is not needed to produce the desired humidity.
    C
  11. A patient with bacterial pneumonia has received chest physiotherapy to all lung segments q.i.d. for 1 week. The pneumonia has cleared in all segments, with the exception of the left lower lobe. At this time, which of the following should the respiratory therapist do?
     
    A. Stop chest physiotherapy
    B. Increase the frequency
    C. Continue the present therapy regimen
    D. Limit the therapy to the involved segments
    D
  12. When mouth to mouth resuscitation is being preformed, it is most important to watch the patient’s:
     
    A. Eyes
    B. Chest
    C. Abdomen
    D. Tonque position
    B
  13. When adjusting the sensitivity control during pressure-cycled ventilation, the respiratory therapist would be altering the:
     
    A. Volume of gas available to the patient on inhalation.
    B. Effort required to cycle the machine off as the patient exhales.
    C. Maximum amount of pressure to be delivered to the patient.
    D. Effort required to activate the machine as the patient inhales.
    D
  14. The respiratory therapist notices that a nebulizer is delivering large water droplet down the large bore tube. To correct this problem, the therapist should:
     
    A. Replace the nebulizer.
    B. Add water to the nebulizer.
    C. Dismantle and clean the nebulizer.
    D. Add a heating collar to the nebulizer.
    A
  15. After completion of an aerosol bronschodilator treatment, which of the following is the most appropiate chart notation for the respiratory therapist to make?
     
    A. Over 15 minutes, treatment given as ordered; no aftertaste noted; chest clear on auscultation.
    B. Aerosol therapy given; pulse stable, respiratory rate same as pretreatment, no changes during therapy; well tolerated.
    C. Aerosol therapy given with 2.5 mg albuterol (Proventil) and 2 mL normal saline; vital signs stable; well tolerated.
    D. Aerosol therapy given with 2.5 mg abulterol (Proventil) and 2 mL normal saline; pulse stable at 72/min during therapy; nonproductive cough; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation.
    D
  16. A patient who is receiving an aerosol treatment with acetylcysteine (Mucomyst) and hypertonic saline by a hand-held nebulizer suddenly becomes dyspneic. The most likely cause of this problem is:
     
    A. Hypercarbia
    B. Bronchospasm
    C. Pneumothorax
    D. Fluid overload
    B
  17. The respiratory therapist reviews a ventilator flow sheet and finds that the peak inspiratory pressure has been gradually rising for the past several hours. Possible causes include which of the following?
     
    I. Increasing pulmonary compliance
    II. Bronchospasm
    III. Accumulation of secretions
     
    A. II only
    B. I and II only
    C. I and III only
    D. II and III only
    D
  18. A patient with a laryngeal tumor is presently receiving 80%/20% helium-oxygen by a nonrebreathing mask at 5 L/min. The patient is alert, but appears agitated. Vital signs indicate a pulse of 131/min, respirations 30/min, and blood pressure 140/90 mm Hg. Which of the following would be the most appropriate action to take?
     
    A. Recommend a sedative
    B. Recommend changing to an FiO2 of 1.0
    C. Increase the gas flow to the mask
    D. Administer racemic epinephrine
    C
  19. While using a Yankauer device to orally suction an adult patient, the respiratory therapist difficulty removing thick secretions. The regulator attached to the suction device displays a reading of -70 mm Hg. Which of the following should the therapist do at this time?
     
    A. Perform nasotracheal suctioning
    B. Replace the wall suction regulator
    C. Change to a flexible catheter
    D. Change the suction pressure to -120 mm Hg
    D
  20. A patient is receiving 0.40 oxygen by heated aerosol and a T-piece. During the breathing cycle, aerosol delivery is intermittently interrupted. To correct this situation, the respiratory therapist should:
     
    A. Refill the reservoir jar
    B. Shorten the reservoir tube
    C. Replace the heating element
    D. Empty the water in the large bore tubing
    D
  21. Palpable rhonchi in a patient who is being mechanically ventilated most likely indicate which of the following?
     
    A. Secretions
    B. Pneumothorax
    C. Bronchospasm
    D. Consolidation
    A
  22. After assisting the physician with a fiberoptic bronchoscopy and transbronchial lung biopsy on a patient receiving volume-controlled ventilation, the respiratory therapist notes a marked increase in peak inspiratory pressure. Possible causes of the pressure increase include which of the following?
     
    I. Bronchospasm
    II. Pneumothorax
    III. Pulmonary hemorrhage
    IV. Laryngospasm
     
    A. I and IV only
    B. II and III only
    C. I, II and III only
    D. I, II, III and IV
    C
  23. When attempting to obtain an arterial blood gas sample, an Allen’s test is performed on both of the patient’s wrists. The respiratory therapist finds that there is inadequate circulation through the patient’s left ulnar artery. The therapist should do which of the following?
     
    A. Obtain the sample from the left radial artery
    B. Obtain the sample from the right radial artery.
    C. Obtain the sample from the right ulnar artery.
    D. Obtain a pulse oximetry reading instead of the blood gas.
    B
  24. The respiratory therapist opens the valve on an E cylinder that has a regulator attached and hears a loud hissing noise. The flow meter is turned off. Which of the following actions might correct the problem?
     
    I. Turning on the flowmeter.
    II. Tightening the regulator connection.
    III. Changing the regulator washer
     
    A. I only
    B. I and II only
    C. II and III only
    D. I, II and III
    C
  25. Common complications associated with arterial punctures include which of the following:
     
    I. Fistula formation
    II. Hematoma formation
    III. Spasm of the vessel
     
    A. I only
    B. III only
    C. I and II only
    D. II and III only
    D
  26. A patient requires frequent suctioning of oral secretions. Which of the following should be made available at the patient’s bedside?
     
    I. Vacuum system
    II. Connecting tubing
    III. Yankauer suction device
    IV. Luken’s trap
     
    A. I and II only
    B. III and IV only
    C. I, II and III only
    D. I, II, III and IV
    C
  27. A patient is receiving a treatment with 2.5 mg of albuterol (Proventil) and 2.5 mL of normal saline in the emergency department (ED). Prior to therapy, the patient’s heart rate is 80/min and at the end of therapy, it is 138/min. The respiratory therapist should:
     
    A. Recommend decreasing the dosage of albuterol.
    B. Increase the amount of saline per treatment to 3 mL.
    C. Recommend changing to ipratropium bromide (Atrovent).
    D. Recommend adding acetylcysteine (Mucomyst) to the treatment.
    A
  28. A patient with severe facial trauma from a motor vehicle crash is brought into the emergency department (ED). The patient is obtunded and in respiratory distress due to swelling and blood in the naso- and oropharynx. Which of the following is indicated?
     
    A. Oropharyngeal airway
    B. Nasopharyngeal airway
    C. Tracheostomy tube
    D. Cricothyroid puncture
    C
  29. A patient who is being mechanically ventilated has just received vecuronium (Norcuron). Which of the following is the most important ventilator alarm to monitor to ensure patient safety?
     
    A. I:E ratio
    B. Circuit temperature
    C. High pressure
    D. Low pressure
    D
  30. A patient receiving continuous heated aerosol therapy with room air by a T-piece develops subcutaneous emphysema around the tracheostomy site, neck, and chest. After nothing unequal breath sounds, the most appropriate diagnostic procedure would be:
     
    A. A chest radiograph
    B. A maximum inspiratory pressure (MIP) measurement
    C. Timed forced expiratory volumes
    D. An arterial blood gas analysis
    A
  31. A patient with severe COPD who is receiving oxygen must be observed closely because which of the following may occur?
     
    A. Hypoventilation
    B. Pneumothorax
    C. Bronchospasm
    D. Pulmonary edema
    A
  32. During CPR in the emergency department (ED), a demand-valve resuscitator fails to deliver adequate tidal volumes. The respiratory therapist’s immediate response would be to:
     
    A. Inspect the unit
    B. Call for help
    C. Use a mechanical ventilator
    D. Change to a manual resuscitator
    D
  33. Which of the following pulmonary function parameter is LEAST dependent on patient effort?
     
    A. FEF 25-75%
    B. FEF 200-1200
    C. FVC
    D. PEF
    A
  34. A neonate is receiving oxygen therapy by a hood. Which of the following should the respiratory therapist select to check the accuracy of the air-oxygen blender?
     
    A. Line pressure manometer
    B. Galvanic cell analyzer
    C. Pneumotachometer
    D. Pulse oximeter
    B
  35. A patient is to receive incentive spirometry at home. When explaining the therapeutic goals to the patient’s family, the respiratory therapist should explain that the therapy:
     
    A. Helps resolve pneumonia
    B. Can decrease the chance of lung collapse
    C. Should decrease the frequency of the patient’s cough
    D. Should make breathing easier by causing bronchodilation
    B
  36. Extubation is performed during peak inspiration to:
     
    A. Prevent laryngospasm
    B. Ensure adequate oxygenation
    C. Provide volume to clear secretions
    D. Minimize vagal stimulation
    C
  37. A patient is receiving volume-controlled, flow limited ventilation. An inverse I:E ratio visual alert is observed during a routine ventilator check. Which of the following adjustment would be most appropriate to correct the problem?
     
    A. Increase the flow
    B. Increase the frequency setting
    C. Decrease the tidal volume
    D. Activate the ratio limit control
    A
  38. When using an infrared carbon dioxide analyzer the PetCO2 value will be affected by all of the following EXCEPT:
     
    A. Moisture
    B. Sensor temperature
    C. Barometric pressure
    D. Magnetic field interference
    D
  39. Which of the following would be most appropriate to recommend for a patient with dyspnea who has a 40% pneumothorax?
     
    A. Administer a nebulized bronchodilator
    B. Perform chest physiotherapy
    C. Insert an endotracheal tube
    D. Insert a chest tube
    D
  40. The respiratory therapist is explaining the objectives of a pulmonary rehabilitation program to a 55 year old patient with emphysema. Which of the following outcomes would allow the patient to participate in evaluating the achievement of the therapeutic plan?
     
    A. Reduction of airway resistance
    B. Improvement in arterial blood gas values
    C. Improvement in results of pulmonary function studies
    D. Increased ability to perform activities of daily living
    D
  41. A patient who is being mechanically ventilated has insufficient time to exhale completely. Which of the following ventilator changes might be appropriate to correct this problem?
     
    I. Increase the flow
    II. Decrease the ventilator rate
    III. Add mechanical dead space
    IV. Add inspiratory hold
     
    A. I and II only
    B. II and III only
    C. II, III and IV only
    D. I, II, III and IV
    A
  42. The respiratory therapist observes low exhaled volumes during volume-cycled, pressure-limited mechanical ventilation. To determine if the low volumes are caused by inaccurate ventilator volume control, the therapist should measure the tidal volume at the:
     
    A. Machine outlet
    B. Patient connector
    C. Exhalation vavle
    D. Spirometer
    A
  43. A patient with a head injury is heavily sedated. The patient requires positive pressure ventilation has a moderately increased intracranial pressure and a pulmonary capillary wedge pressure of 23 mm Hg. Appropriate recommendations include which of the following?
     
    I. Elevate the patient’s head to 30 degrees.
    II. Decrease the ventilatory rate
    III. Administer furosemide (Lasix)
     
    A. I and II only
    B. I and III only
    C. II and III only
    D. I, II and III
    B
  44. An adult patient is receiving volume-controlled ventilation and has a tidal volume of 700 mL. The patient’s pH is 7.38. The patient is switched to pressure-controlled ventilation and a pressure limit of 50 cm H20. An exhaled tidal volume of 850 mL is now measured. The respiratory therapist should recommend which of the following?
     
    A. Set the PEEP at 5 cm H2O
    B. Maintain the current settings
    C. Increase the inspiratory time
    D. Decrease the pressure setting to obtain previous tidal volume
    D
  45. A patient is receiving noninvasive positive pressure therapy. Pulmonary compliance has decreased over the past 4 hours. To increase the patient’s tidal volume, it would be most appropriate to:
     
    A. Suction the patient
    B. Change the CPAP
    C. Increase the low pressure level
    D. Increase the high pressure level
    D
  46. Which of the following would the respiratory therapist select to treat a patient who has obstructive sleep apnea?
     
    A. Nasal cannula
    B. Chest cuirass ventilator
    C. Bilevel positive airway pressure
    D. Airway pressure-release ventilation
    C
  47. Hemodynamic monitoring is initiated for a patient with multi-organ system failure. The patient is rapidly transfused with packed red blood cells. Following transfusion, the patient’s PvO2 increased from 33 torr to 38 torr. The respiratory therapist should conclude that:
     
    A. Cardiac output has decreased
    B. Intrapulmonary shunt has increased
    C. Additional transfusion are required
    D. Oxygen delivery to the tissues has improved
    D
  48. A manometer is being used to monitor a continuous flow CPAP device set at 10 cm H2O. Each time the patient inhales, the pressure decreases to 2 cm H2O, then returns to 10 cm H2O on exhalation. Which of the following is the most likely cause of the problem?
     
    A. The flow of gas to the patient system is insufficient.
    B. There is a leak in the patient system
    C. The patient’s endotracheal tube is too small for the inspiratory flow
    D. The CPAP pressure valve is too small for the patient’s size and weight
    A
  49. A patient with congestive heart failure is intubated and receiving mechanical ventilation in the emergency department (ED). Appropriate pharmacologic therapy is implemented. To assure a constant tidal volume delivery, which of the following ventilators should the respiratory therapist select for this patient?
     
    A. Pressure-cycled
    B. Time-cycled
    C. Patient-cycled
    D. Volume-cycled
    D
  50. A home care patient receiving O2 at 2 L/min states that he does not feel any oxygen coming from the cannula that is connected to a concentrator. Which of the following should the respiratory therapist do FIRST?
     
    A. Change the machine inlet filter
    B. Turn the flow meter up to 4 L/min
    C. Switch to a back-up liquid oxygen system
    D. Insert the cannula into water and check for bubbles.
    D
  51. An active 2 year old is to receive 35% to 50% oxygen. Which of the following devices is likely to be best tolerated by the child?
     
    A. Aerosol mask
    B. Partial re-breathing mask
    C. Air-entrainment mask
    D. Oxygen tent
    D
  52. Which of the following should the respiratory therapist recommend to prevent Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus (HIV):
     
    A. Rifampin (Rifadin)
    B. Pentamide isethionate (NebuPent)
    C. Vecuronium bromide (Norcuron)
    D. Chloramphenicol palmitate (Chloromycetin Palmitate)
    B
  53. A spontaneously breathing patient in intubated with a 6.0 mm endotracheal tube. Which of the following would decrease the patient’s work of breathing imposed by the endotracheal tube?
     
    A. CPAP
    B. Pressure support ventilation
    C. Flow-by ventilation
    D. Inspiratory pause
    B
  54. Chest auscultation of a recently intubated patient who is in respiratory failure reveals diminished breath sounds on the left side. The most likely cause of this finding is:
     
    A. Intubation of the right main stem bronchus.
    B. Placement of the endotracheal tube at the carina.
    C. Lobar atelectasis on the right side.
    D. A pneumothorax on the left side
    A
  55. After a motor vehicle crash, a patient is brought to the emergency department (ED) in obvious shock and with internal injuries. The physician asks the respiratory therapist to administer oxygen immediately. The therapist should institute treatment with a:
     
    A. Nasal cannula at 6 L/min
    B. 40% air-entrainment mask
    C. Non rebreathing mask
    D. Face tent
    C
  56. After a bland aerosol treatment rhonchi are detected. The respiratory therapist should:
     
    A. Encourage the patient to cough.
    B. Recommend administration of a bronchodilator.
    C. Recommend discontinuation of therapy.
    D. Discontinue the treatment and administer oxygen.
    A
  57. Which of the following would be consistent with an obstruction in the endotracheal tube of a patient who is being mechanically ventilated?
     
    I. High pressure is required to deliver the tidal volume.
    II. The low pressure alarm is sounding.
    III. A suction catheter cannot be passed.
     
    A. I only
    B. II only
    C. I and III only
    D. II and III only
    C
  58. 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
    A
  59. The primary purpose of cleaning and sterilize non disposable respiratory care equipment after each use is to:
     
    A. Extend the life of the equipment.
    B. Prevent cross-infection and reinfection of patients.
    C. Prevent contamination of other equipment.
    D. Protect the personnel who are handling the equipment.
    B
  60. Which of the following drugs would be the most appropriate to paralyze a sedated 30 year old patient with status asthmaticus who is being mechanically ventilated?
     
    A. D-tuborurarine
    B. Morphine sulfate
    C. Vecuonium (Norcuron)
    D. Succinylcholine (Anectine)
    C
  61. Which of the following flow settings is required to maintain an I:E of 1:3 and a respiratory rate of 15/min status asthmaticus who is being mechanically ventilated?
     
    A. 20 L/min
    B. 27 L/min
    C. 36 L/min
    D. 72 L/min
    C
  62. The respiratory therapist is monitoring the effects of mechanical ventilation on a patient in congestive heart failure. The therapist’s IMMEDIATE concern should be to:
     
    A. Obtain secretions for culture.
    B. Note changes in intra cranial pressure.
    C. Check the patient’s blood pressure.
    D. Obtain serial chest radiographs.
    C
  63. The respiratory therapist is preparing to suction a patient who has an endotracheal tube in place. Which of the following is a necessary step in the suctioning procedure?
     
    A. Oxygenate the patient before and after suctioning.
    B. Rinse the catheter with water before suctioning.
    C. Instill 3 mL 0.9% NaCI before suctioning.
    D. Lubricate the catheter with water soluble gel before suctioning.
    A
  64. If a patient’s pulse rate increases by 40/min during a respiratory care treatment, the respiratory therapist should do which of the following?
     
    A. Terminate the treatment and notify the physician of the patient’s reaction.
    B. Continue the treatment as ordered and and monitor the patient’s pulse.
    C. Shorten the duration of the treatment.
    D. Let the patient rest for 5 minutes and then continue the treatment as ordered.
    A
  65. To open an obstructed airway of a patient who has a possible cervical fracture, the respiratory therapist should:
     
    A. Perform a cricothyroid puncture with a 13-gauge needle.
    B. Flex the patient’s head after a cervical collar is in place.
    C. Hyperextend the patient’s head after a cervical collar is in place.
    D. Perform the jaw thrust maneuver.
    D
  66. When a patient develops an acute airway obstruction, the respiratory therapist should immediately do which of the following?
     
    A. Establish an airway and begin CPR
    B. Apply a series of strong, external sub diaphragmatic compressions.
    C. Apply a forceful blow to the sternum.
    D. Lean the person forward and instruct him to inhale slowly.
    B
  67. The respiratory therapist is interviewing a patient who is sitting in a chair. Which of the following term should be used to record the patient’s comment that he is not currently having difficulty breathing, but does have difficulty when lying down?
     
    A. Hyperpnea
    B. Orthopnea
    C. Dyspnea
    D. Hyperventilation
    B
  68. Oxygen administration devices that are most capable of meeting and/or exceeding a patient’s inspiratory flow include which of the following?
     
    I. Air entrainment mask
    II. Nasal cannula
    III. Non rebreathing mask
     
    A. II only
    B. III only
    C. I and II only
    D. I and III only
    D
  69. A patient is being mechanically ventilated. Several attempt to insert a central venous catheter into the patient’s right subclavain vein have been unsuccesful. The patient’s blood pressure suddenly drops, there is a significant increase in peak inspiratory pressure, and breath sounds are absent over the right upper chest. Which of the following should the respiratory therapist do?
     
    A. Increase the pressure limit.
    B. Decrease the inspiratory flow.
    C. Recommend inserting a chest tube.
    D. Obtain an arterial blood gas sample.
    C
  70. A patient is receiving volume-cycled mechanical ventilation. The high pressure alarm suddenly begins to sound. The corrective action would be to:
     
    A. Increase the pressure limit.
    B. Increase the flow
    C. Suction the airway
    D. Withdraw 5 mL of air from the endotracheal tube cuff.
    C
  71. A patient who is intubated with an 8 mm ID endotracheal tube required suctioning. A 14 Fr catheter and sterile tray are available. The vacuum setting is -120 mm Hg; however, the secretions are too thick to be aspirated effectively. The respiratory therapist should do which of the following?
     
    A. Change the catheter to a 12 Fr.
    B. Change the catheter to an 18 Fr.
    C. Instill 4 mL of normal saline and then attempt suctioning.
    D. Increase the vacuum setting to -180 mm Hg.
    C
  72. A patient complains of dizziness and a tingling sensation in the fingers during an IPPB treatment. Which of the following is the most likely cause?
     
    A. Increased cardiac output
    B. Increased CO2 retention
    C. Excessive CO2 elimination
    D. Excessive N2 elimination
    C
  73. A patient’s cardiac output decreases from 4 to 2 L/min after 15 cm H2O PEEP is initiated. Which of the following should the respiratory therapist recommend?
     
    A. Perform an arterial blood gas analysis to check the patient’s oxygenation.
    B. Maintain the present settings, and check arterial blood gases in 1 hour.
    C. Decrease the respiratory rate to extend cardiac filling time.
    D. Decrease PEEP to 10 cm H2O and recheck the cardiac output.
    D
  74. A 17 year old patient has sustained a cervical spine injury. He is conscious and spontaneously breathing. The patient weighs approximately 50 kg (110 lb) and his head has been stabilized with sandbags. Arterial blood gas results indicate that the patient is in acute ventilatory failure. To secure the patient’s airway, the respiratory therapist should select which of the following?
     
    A. 6.0 mm nasopharyngeal airway
    B. 7.0 mm nasotracheal tube
    C. 9.0 mm nasotracheal tube
    D. 37 Fr Carlens orotracheal tube
    B
  75. A home care patient who has COPD returns to the pulmonary rehabilitation clinic. Which of the following would indicate that he physical conditioning program has been effective?
     
    A. Resting pulse rate is the same after one month.
    B. Level-walking distance has increased by 15%.
    C. Vital capacity has increased by 5%.
    D. Respiratory rate has increased by 2/min.
    B
  76. A 35 year old postoperative is in no apparent distress and has clear breath sounds. Which of the following should the respiratory therapist select to prevent atelectasis?
     
    A. IPPV
    B. Incentive spirometer
    C. Mechanical chest percussor
    D. Aerosolized bronchodilator therapy
    B
  77. The respiratory therapist is reviewing a patient’s chart as part of the evaluation prior to tracheal extubation. Which of the following predicts the patient’s ability to cough effectively?
     
    I. Vital capacity.
    II. Maximum inspiratory pressure (MIP)
    III. Tidal volume
     
    A. I only
    B. I and II only
    C. II and III only
    D. I, II and III
    B
  78. A physician want to provide a patient with the physiologic affect of end-expiratory positive pressure, yet allow the patient to set her own spontaneous minute ventilation. Which of the following should the respiratory therapist recommend?
     
    A. EPAP
    B. CPAP
    C. IMV
    D. IPPB
    B
  79. A neonate is having a seizure and requires heavy sedation. After intubation, which of the following should the respiratory therapist recommend?
     
    A. CPAP
    B. Pressure support ventilation
    C. Pressure controlled ventilation
    D. Volume controlled ventilation
    C
  80. Approximately how many hours will it take to empty an H cylinder of oxygen that contains 1200 psig and is flowing at 12 L/min?
     
    A. 3
    B. 5
    C. 7
    D. 9
    B
  81. To demonstrate significant post bronchodilator improvement, a patient’s FEV1 must increase by a minimum of which of the following?
     
    A. 5%
    B. 15%
    C. 25%
    D. 40%
    B
  82. During mouth to mouth resuscitation, bilateral ventilation is most easily assessed by:
     
    A. Using a stethoscope
    B. Observing chest excursion
    C. Checking the patient’s pulse
    D. Checking the patient’s pupillary reaction.
    B
  83. Which of the following suction devices is specifically designed to facilitate left mainstem bronchial entry?
     
    A. Coude
    B. Whistle-tip
    C. Luken’s
    D. Ring-tip
    A
  84. A patient with neuromuscular disease has been receiving ventilatory support for 4 months by tracheostomy. The patient is being weaned during the day, but still mechanically ventilated at night. Which of the following devices will best meet both needs of the patient?
     
    A. Tracheostomy button
    B. Bivona tracheostomy tube
    C. Cuffed, fenestrated tracheostomy tube
    D. Uncuffed, standard tracheostomy tube
    C
  85. In reviewing a patient’s record, the respiratory therapist will most likely find which of the following problems as a result of continuous positive pressure ventilation?
     
    A. Hyperkalemia
    B. Decreased urine output
    C. Increased cardiac output
    D. Increased insensible water loss
    B
  86. All of the following statements about endotracheal intubation of an adult are correct EXCEPT:
     
    A. A curved blade is used to directly lift epiglottis.
    B. The patient’s head should be placed in the sniffing position.
    C. The patient should be hyper oxygenated before each intubation attempt.
    D. An intubation attempt should be discontinued after 10-20 seconds if unsuccessful and manual ventilation resumed.
    A
  87. A patient with multiple-trauma is intubated and receiving mechanical ventilation. The patient is extremely anxious, tachypneic, and complaining of severe pain. Which of the following drugs would slow the ventilatory rate and provide pain control:
     
    A. Morphine sulfate
    B. Diazepam (Valium)
    C. Neostigmine bromide (Prostigmin)
    D. Pancuronium bromide (Pavulon)
    A
  88. The best way to check the accuracy of a water-seal spirometer is to use a:
     
    A. 3-L syringe
    B. Pneumotachograph
    C. Vortex sensor
    D. Wright respirometer
    A
  89. A 25 year old patient is brought to the emergency department (ED) with respiratory depression caused by an acute drug overdose. An arterial blood gas analysis indicates a pH of 7.20 and a PaCO2 of 80 torr. The respiratory therapist is asked to initiate continuous mechanical ventilation. Which of the following should the therapist do?
     
    A. Recommend IPPB treatments q2h to reduce the patient’s PaCO2
    B. Adjust the ventilator so that the patient’s PaCO2 will be decreased to 40 torr very gradually over 36 hours.
    C. Adjust the ventilator so that the patient’s PaCO2 will be decreased to 40 torr within 1 hour.
    D. Adjust the ventilator so that the patient’s PaCO2 will be decreased to 60 torr to prevent respiratory alkalosis.
    C
  90. Which of the following should the respiratory therapist check to assess adequate cerebral perfusion during CPR?
     
    A. Deep tendon reflexes
    B. A Babinski reflex
    C. Intra cranial pressure of less than 20 mm Hg
    D. Pupillary reactions to light
    D
  91. Appropriate infection control procedures in the home include which of the following?
     
    I. Disinfecting equipment every 96 hours
    II. Rinse and drying equipment before storage
    III. Hand washing before and after therapy
     
    A. I and II only
    B. I and III only
    C. II and III only
    D. I, II and III
    C
  92. During CPR, the oxygen reservoir bag of the manual resuscitator collapses during the refill phase. The respiratory therapist can correct this problem by:
     
    A. Decreasing the bag refill time.
    B. Increasing oxygen flow to the bag.
    C. Increasing the ventilatory frequency.
    D. Performing mouth-to-mask resuscitation.
    B
  93. A 1000g neonate who is 6 hours old is receiving time-cycled, pressure limited ventilation. The neonate has signs of developing RDS, as evidenced on the chest radiograph, and severe hypoxemia is noted with an FiO2 of 0.80. Which of the following should the respiratory therapist recommend?
     
    A. Perform ECMO
    B. Change to volume ventilation
    C. Administer exogenous surfactant.
    D. Administer partial liquid ventilation (per fluorocarbon)
    C
  94. A physician orders an IPPB treatment with 35% oxygen. A properly functioning oxygen blender attached to a Bennett PR-2 ventilator, and a properly functioning analyzer is used to measure the gas mixture. The blender is set for 35%, and the air dilution control is set a 100%. The mixture is analyzed, and it is found to be 30% instead of 35%. This finding is most likely caused by which of the following control settings?
     
    A. Peak flow
    B. Sensitivity
    C. Terminal flow
    D. Pressure limit
    C
  95. In which of the following patient should pressure support be initiated?
     
    A. A patient with absent or depressed respiratory drives with an endotracheal tube in place.
    B. A patient receiving SIMV who exhibits signs of increased spontaneous ventilatory effort.
    C. A patient with low lung compliance, atelectasis, and severe refractory hypxemia.
    D. A patient in the postanesthesia care unit (PACU) who requires short-term ventilatory support.
    B
  96. Which of the following is most effective in destroying all micro organisms?
     
    A. Acetic acid
    B. Pasteurization
    C. Ethylene oxide
    D. Isopropyl alchohol
    C
  97. Initiation of noninvasive positive pressure would be appropriate in a patient with which of the following?
     
    A. Acute ARDS
    B. Interstitial fibrosis
    C. Cardiopulmonary arrest
    D. Post poliomyelitis syndrome
    D
  98. The respiratory therapist is calibrating a themal conductivity type helium analyzer. When calibrated in room air, what should the analyzer read?
     
    A. 0%
    B. 21%
    C. 79%
    D. 100%
    A
  99. Which of the following indicates the presence of pneumothorax on a chest radiograph?
     
    A. A “ground glass” appearance
    B. A white butterfly-shaped pattern
    C. Increased radio-opacity bilaterally
    D. A dark area with no lung markings present
    D
  100. A 20 year old patient with asthma is to receive 0.5 mL of Metaproterenol (Alupent) and 4 mL normal saline by hand-held nebulizer. During the treatment, the patient complains of tremors and palpitations. Which of the following should the respiratory therapist recommend for the next treatment?
     
    A. Change to 0.6 mL albuterol (Ventolin).
    B. Decrease the Alupent to 0.2 mL.
    C. Change to 3 pfuffs of beclomethasone (Vanceril).
    D. Administer the treatment with saline only.
    B
  101. When an oropharyngeal suction device becomes obstructed while suctioning vomitus from a patient’s mouth, the respiratory therapist should:
     
    A. Increase the vacuum pressure.
    B. Change to a suction catheter.
    C. Clear the device of particulate matter.
    D. Check the wall outlet vacuum pressure.
    C
  102. An afebrile patient who has been ventilated with a volume ventilator with a heat moisture exchanger for the past 24 hours is having progressive increases in peak inspiratory pressure. After suctioning the trachea and determining there is no pathological reason for the increased pressure, the respiratory therapist should do which of the following?
     
    A. Reduce the tidal volume.
    B. Change the flow pattern of the ventilator.
    C. Replace the heat moisture exchanger.
    D. Increase the heat moisture exchanger temperature.
    C
  103. The respiratory therapist is using a pulse oximeter to monitor SpO2 on a 54 year old man who was rescued from a fire. The electrode is placed on the left ear lobe. The measured SpO2 is 90%. However, the patient’s SaO2, obtained from an arterial blood sample analyzed by a co-ocimeter is 79%. Which of the following is the most likely explanation for the difference in saturation?
     
    A. Operator error
    B. Pigmentation of the patient’s skin
    C. Presence of increased COHb
    D. Oximeter out of calibration
    C
  104. A 21 year old man arrives at the emergency department (ED) after being rescued from a house fire. Physical examination reveals burns on the upper chest and face, and marked edema of the face and oropharynx. The results of an arterial blood gas example drawn while the patient was breathing room air are below:
     
    pH – 7.55
    PaCO2 – 26 torr
    PaO2 – 105 torr
    HCO3 – 22 mEq/L
    BE – 0 mEq/l

 

  1. The respiratory therapist is reviewing a postoperative patient’s care plan. The physician has changed the patient’s therapy from incentive spirometry to IPPB. What is the most likely goal, for this change?
     
    A. Delivery of aerosolized bronchodilators.
    B. Improvement in alveolar oxygenation.
    C. Prevention of lower lobe atelectasis.
    D. Promotion of airway clearance.
    D
  2. Which of the following humidifiers would most consistently deliver the highest water vapor to a patient’s airway?
     
    A. Passover
    B. Bubble
    C. Heated wick
    D. Heat moisture exchanger
    C
  3. A physician orders an FiO2 of 0.40 for premature infant in an Isolette. To deliver the prescribed FiO2 the respiratory therapist should select:
     
    A. A 40% air entertaiment mask.
    B. An oxygen blood
    C. An infant nasal cannula at 1 L/min
    D. A simple mask at 4 L/min
    B
  4. A 7 day old infant of 28 weeks gestational age is having frequent periods of apnea, with desaturation. The respiratory therapist should recommend which of the following?
     
    A. Racemic epinephrine (Vaponefrin)
    B. Naloxone (Narcan)
    C. Surfactant (Survanta)
    D. Theophylline (Aminophylline)
    D
  5. A conscious, spontaneously breathing patient is admitted to the emergency department (ED) with suspected carbon monoxide poisoning. The respiratory therapist’s most appropriate INITIAL action would be to:
     
    A. Perform an arterial blood gas analysis.
    B. Intubate and apply CPAP with 50% oxygen.
    C. Administer oxygen by a 40% air-entrainment mask.
    D. Administer 100% oxygen by a non rebreathing mask.
    D
  6. A patient presents in the emergency department (ED) with massive facial trauma involving the nose and mouth. Which of the following is most appropriate for managing the patient’s airway?
     
    A. Nasotracheal tube
    B. Tracheostomy tube
    C. Oral endotracheal tube
    D. Laryngeal mask airway
    B
  7. Which of the following allows immediate determination of the lowest FiO2 needed to achieve satisfactory oxygenation?
     
    A. Capillary refill
    B. Pulse oximetry
    C. Nail bed color
    D. Shunt studies
    B
  8. The pressure control knob on a pressure-cycled ventilator will determine the:
     
    A. Pressure at which inspiration ends.
    B. Gradient from the artificial airway to the alveoli.
    C. Effort required to initiate gas flow.
    D. Pressure required to activate the pop-off mechanism.
    A
  9. An 18 year old patient who is having a severe asthmatic episode is being mechanically ventilated. The pressure limit alarm is frequently sounding. The patient is very agitated, and his respiratory rate is 36/min. Bileteral breath sounds with minimal wheezing are noted. Which of the following should the respiratory therapist recommend?
     
    A. Midazolam (Versed)
    B. Beclomethasone (Vanceril)
    C. N-acetylcysteine (Mucomyst)
    D. Cromolyn (Intal)
    A
  10. All of the following are true concerning the use of a transcutaneous PO2 monitor EXCEPT:
     
    A. A low calibration point is done with a “zero” solution or gas.
    B. The site should be changed every 3 to 4 hours.
    C. Skin temperature control should be set at 37C.
    D. PtcO2 values should be correlated with arterial blood samples periodically.
    C
  11. The respiratory therapist is working with a patient with COPD who is in a smoking cessation program. The patient complains of irritability, anxiety, difficulty concentrating, craving for tobacco, and weight gain. The therapist should recommend which of the following?
     
    A. Using a sedative
    B. Using nicotine patches
    C. Returning to smoke, but only half as much as previously
    D. Continuing the program because these complaints are expected
    B
  12. A patient with neuromuscular disease has been receiving ventilatory support for 4 months by tracheostomy. The patient is being weaned during the day, but is still mechanically ventilated at night. Which of the following devices will best meet both needs of the patient?
     
    A. Tracheostomy button
    B. Bivona tracheostomy tube
    C. Cuffed, fenestrated tracheostomy tube
    D. Uncuffed, standard tracheostomy tube
    C
  13. When performing simple spirometry, which of the following results would best denote an obstructive pattern?
     
    A. Decreased FEV1/FVC Ratio
    B. Increased FEV1
    C. Increased tidal volume
    D. Decreased inspiratory reserve volume
    A
  14. During the weaning trial of a patient with a tracheostomy, the mist disappears at the T-piece early in inspiratory respiratory therapist should do which of the following?
     
    A. Add dead space between the T-Piece and the patient.
    B. Direct the patient to inhale more slowly.
    C. Decrease the length of tubing from the aerosol generator.
    D. Increase the flow the aerosol generator.
    D
  15. Moist, crepitant crackles indicate which of the following?
     
    A. Pulmonary edema
    B. Atelectasis
    C. Pleural effusion
    D. Asthma
    A
  16. Which of the following would be most important to assess a patient’s ability to perform metered dose inhaler (MDI) therapy?
     
    A. Ability to follow instructions
    B. Overall general appearance
    C. Adequacy of oxygenation
    D. Exercise tolerance
    A
  17. While administering acetyl cysteine (Mucomyst) with a hand-held nebulizer, the respiratory therapist notes that the patient is developing marked congestion with copious sputum production. The therapist’s most appropriate action would be to:
     
    A. Dilute the acetyl cysteine with saline.
    B. Terminate the therapy and clear secretions.
    C. Increase the dose of acetyl cysteine to help thin the secretions.
    D. Administer the acetyl cysteine with a positive pressure breathing machine
    B
  18. The addition of an inspiratory plateau during continuous mechanical ventilation may be CONTRAINDICATED in patient’s with:
     
    A. Hypoxemia
    B. Hypotension
    C. Poor gas distribution
    D. Pulmonary edema
    B
  19. When the respiratory therapist initiates an IPPB treatment, the patient’s pulse is 80/min. Five minutes after the therapy is started, the patient’s pulse increases to 95/min. The therapist should:
     
    A. Continue the treatment as ordered
    B. Terminate the treatment and notify the charge nurse
    C. Decreases the nebulizer output
    D. Decrease the system pressure
    A
  20. During manual bag-valve ventilation by an endotracheal tube, inadequate ventilation is noted. This may be caused by which of the following:
     
    I. Deflated endotracheal tube cuff
    II. Excessive oxygen flow
    III. Absent bag-valve diaphragm
    IV. Improper tube placement
     
    A. I and II only
    B. I and III only
    C. I, III and IV only
    D. II, III and IV only
    C

     

  21. The respiratory therapist is assisting the physician with a tracheostomy on a patient who is receiving mechanical ventilation. The therapist notes an increase in peak respiratory pressure and heart rate, a decrease in exhaled tidal volume, and distant breath sounds over the right chest. This most likely indicates a:
     
    A. Circuit air leak
    B. Right pneumothorax
    C. Lacerated blood vessel
    D. Unilateral intubation
    B
  22. The following pulmonary function results are obtained for a patient:
     
    FEV1/FVC – 95% of predicted
    FVC – 50% of predicted
     
    Based on these data, the patient most likely has which of the following?
    A. Pulmonary fibrosis
    B. Cystic fibrosis
    C. Emphysema
    D. Bronchitis
    A
  23. A 13 month old infant is apneic and cyanotic. The physician asks the respiratory therapist to prepare a tray for oral intubation. The therapist should select all of the following equipment EXCEPT:
     
    A. Magill forceps
    B. A Macintosh (curved) laryngoscope blade.
    C. A Miller (straight) laryngoscope blade
    D. A Yankauer suction tube
    A
  24. Which of the following is the most appropriate radiograph techniques to confirm the presence of free pleural fluid?
     
    A. Bronchogram
    B. Apical projection
    C. Decubitus projection
    D. Oblique projection
    C
  25. The most common complication associated with the placement of a pulmonary artery catheter is:
     
    A. Myocardial infarction
    B. Pulmonary artery rupture
    C. Pulmonary thrombosis
    D. Arrhythmias
    D
  26. While checking a ventilator that has a wick humidifier, the respiratory therapist notes that there is very little condensation in the tubing. The most likely explanation is that he:
     
    A. Minute ventilation is greater than 15 L/min
    B. Heating element is not functioning
    C. Flow is set too low
    D. Room temperature is lower than normal
    B
  27. Which of the following drugs would be most appropriate to recommend as a substitute for metaproterenol sulfate (Alupent) for a patient who has bronchospasm and whose cardiac rate increases by 60/beats/min with each treatment?
     
    A. Acetylcysteine (Mucomyst)
    B. Beclomethasone (Vanceril)
    C. Racemic epinephrine (Vaponephrin)
    D. Albuterol (Proventil)
    D
  28. The respiratory therapist is explaining the objectives of a pulmonary rehabilitation program to a 55 year old patient with emphysema. Which of the following outcomes would allow the patient to participate in evaluating the achievement of the therapeutic plan?
     
    A. Reduction of airway resistance
    B. Improvement in arterial blood gas values
    C. Improvement in results of pulmonary function studies
    D. Increased ability to perform activities of daily living
    D
  29. When administering an IPPB treatment with a pressure-cycled ventilator, the respiratory therapist observes that the patient’s tidal volume is adequate, but the inspiratory time is too long. To correct this situation, the therapist should:
     
    A. Increase the flow
    B. Increase the pressure
    C. Adjust the sensitivity
    D. Decrease the nebulizer flow
    A
  30. A patient is receiving oxygen by a non rebreathing mask at 8 L/min. The respiratory therapist notices that the reservoir bag on the mask empties during inspiration. The therapist should immediately:
     
    A. Change the partial rebreathing mask
    B. Remove the mask
    C. Increase the flow
    D. Intubate the patient
    C
  31. A patient with endotracheal tube in place is receiving oxygen enrichment by a heated all purpose nebulizer. Water is collecting in the delivery hose. The respiratory therapist should:
     
    A. Reduce the oxygen flow
    B. Drain the tubing frequently
    C. Unplug the theater
    D. Position the tubing so that the condensate drains back into the reservoir
    B
  32. The patient with a head injury is being mechanically ventilated at a rate of 18 /min. The delivered tidal volume is 900 mL. The patient’s current arterial blood gas results are below:
     
    pH – 7.50
    PaCO2 – 28 torr
    PaO2 – 90 torr
    HCO3 – 21 mEq/L
    BE – -1 mEq/L
     
    The most appropriate recommendation for this patient would be to:
     
    A. Maintain the present settings
    B. Decrease the ventilator rate
    C. Decrease the tidal volume
    D. Add mechanical dead space
    A
  33. At an FiO2 of 0.30 a pulse oximeter attached to the right index finger or a 6 week old neonate 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. Suction the neonate
    B. Increase the FiO2 to 0.40
    C Reposition the pulse oximeter
    D. Ventilate the neonate with 100% 02
    C
  34. A patient complains of sudden, right-sided chest pain. Breath sounds are absent over the right lung field and percussion reveals hyperresonance. The respiratory therapist should recommend:
     
    A. Placing the patient on her right ride and administering chest percussion.
    B. Initiating mechanical ventilation in the assist/control mode.
    C. Administering an IPPB treatment with a bronchodilator.
    D. Inserting a chest tube on the right side.
    D
  35. The respiratory therapist is asked to assess a patient with sleep apnea who is receiving CPAP by a nasal mask. The patient’s snoring is becoming progressively louder with longer periods of apnea. The therapist should initially do which of the following?
     
    A. Obtain a blood gas sample
    B. Decrease the gas flow
    C. Reposition the nasal mask
    D. Perform an ECG
    C
  36. A patient who is receiving mechanical ventilation requires an FiO2 of 0.70 and a PEEP of 10cm H2O to maintain an acceptable PaO2. The patient has become disconnected from the ventilator several times while trying to remove her restraints. During each period of disconnection, the patient experiences cardiac rhythm disturbances, which require additional treatment. The respiratory therapist should recommend:
     
    A. Sedating the patient
    B. Decreasing the PEEP level
    C. Extubating the patient and using a rebreathing mask.
    D. Attempting to wean the patient with a T-piece with an FiO2 of 0.80
    A
  37. The aerosol from an ultrasonic nebulizer is being produced in short, rapid puffs. To correct the problem, the respiratory therapist should:
     
    A. Reduce the volume of water in the reservoir.
    B. Increase the blower flow
    C. Clear the water from the delivery tube
    D. Replace the corrugated tubing with smooth bore tubing
    C
  38. A 90 kg (198 lb) patient remains intubated in the postanesthesia care unit (PACU) following abdominal surgery. The patient has no fully awakened from the anesthesia, although he is taking a few spontaneous breaths. The patient is currently being ventilated with a manual resuscitator. Which of the following should the therapist do?
     
    A. Continue manual ventilation until the patient is awake.
    B. Initiate 5 cm H2O CPAP.
    C. Initiate mechanical ventilation in the SIMV mode
    D. Initiate mechanical ventilation in the pressure support mode
    C
  39. A 1 week old neonate with RDS currently receiving 10 cm H2O CPAP through nasal sprongs with an FiO2 of 0.60. Evaluation reveals intercostal and sternal retractions and an SpO2 of 88%. The neonate is breathing at a rate of 68/min. Which of the following should the respiratory therapist recommend?
     
    A. Change to mask CPAP
    B. Institute mechanical ventilation
    C. Make no changes at the present time
    D. Increase the CPAC level to 12cm H2O
    B
  40. Reinserting a flow meter into an oxygen wall outlet has failed to correct a massive gas leak in a patient’s room. Which of the following should be done NEXT?
     
    A. Check the pressure relief valve on the humidifier reservoir.
    B. Evacuate the patients from the floor.
    C. Have engineering shut off the hospital’s master oxygen valve.
    D. Provide necessary supplemental oxygen and close the zone valve.
    D
  41. While administering an IPPB treatment, the respiratory therapist notices that the pressure rises slowly toward the set pressure, but reaches the set pressure only when the patient actively exhales. Which of the following is the most likely explanation?
     
    A. The inspiratory flow is too high.
    B. The nebulizer drive line is kinked.
    C. There is a leak in the expiratory valve.
    D. The expiratory valve sticks before opening.
    C
  42. The administration of aerosolized acetylcysteine (Mucomyst) would be most appropriate for the treatment of which of the following?
     
    A. Pulmonary therman injury
    B. Bronchospasm
    C. Humidity deficit
    D. Mucus plugs
    D
  43. A 25 year old patient is brought to the emergency department (ED) with respiratory depression caused by an acute drug overdose. An arterial blood gas analysis indicates a pH of 7.20 and a PaCO2 of 80 torr. The respiratory therapist is asked to initiate continuous mechanical ventilation. Which of the following should the therapist do?
     
    A. Recommend IPPB treatments q2h to reduce the patient’s PaCO2.
    B. Adjust the ventilators so that the patient’s PaCO2 will be decreased to 40 torr very gradually over 36 hours.
    C. Adjust the ventilator so that the patient’s PaCO2 will be decreased to 40 torr within 1 hour.
    D. Adjust the ventilator so that the patient’s PaCO2 will be decreased to 60 torr to prevent respiratory alkalosis.
    C
  44. A neonate is receiving pressure limited, time cycled mechanical ventilation. The PaO2 decreases from 65 to 50 torr and the physician request an increase in mean airway pressure. The respiratory therapist should recommend increasing the:
     
    I. Inspiratory time
    II. Pressure limit
    III. Expiratory time
     
    A. I only
    B. III only
    C. I and II only
    D. II and III only
    C
  45. When a Yankauer device becomes obstructed while suctioning vomitus from a patient’s mouth, the respiratory therapist should first:
     
    A. Increase the vacuum pressure
    B. Change to a suction catheter
    C. Clear the device of particulate matter
    D. Change the collection bottle
    C
  46. 60 year old, 68 kg (150 lb) woman arrives in the ICU after coronary bypass surgery. She has a 54 pack year history of smoking and currently smokes 2 packs a day. An order is written to initiate mechanical ventilation. Which of the following should the respiratory therapist adjust prior to initiating mechanical ventilation for the patient?
     
    I. Respiratory rate
    II. Expiratory resistance
    III. Oxygen concentration
    IV. Tidal volume
    V. Sighs per hour
     
    A. I and II only
    B. III and V only
    C. I, III and IV only
    D. II, IV, and V only
    C
  47. While performing postural drainage on a patient who is in a head-down position, the patient appears dyspneic due to severe prolonged coughing. The respiratory therapist should do which of the following?
     
    A. Perform percussion
    B. Turn the patient
    C. Administer oxygen
    D. Have the patient sit up
    D
  48. A pediatric patient with an acute upper airway obstruction would have which of the following physical signs?
     
    A. Unilateral lung expansion
    B. Expiratory wheezing
    C. Inspiratory stridor
    D. Inspiratory crackles
    C
  49. A tachypneic patient with pulmonary edema is brought to the emergency department (ED). Which of the following should be used to provide supplemental oxygen?
     
    A. Air entrainment mask
    B. Nasal cannula
    C. non rebreathing mask
    D. Partial rebreathing mask
    C
  50. While reviewing a patient’s chart, results of a chest radiograph indicate complete opacification of the left chest with a shift of the trachea and mediastinum to the left. These findings are consistent with:
     
    A. Pneumothorax of the right lung
    B. Atelectasis of the left lung
    C. Right sided pleural effusion
    D. Pulmonary embolus in the left lung
    B
  51. A physician orders 1 mg atropine by aerosol for a patient. If the concentration of atropine in a stock solution is 0.04%, how many mL of the atropine solution must be administered?
     
    A. 0.25
    B. 0.40
    C. 0.80
    D. 2.50
    D
  52. For a tracheal tube cuff to allow circulation to tracheal mucosa, the cuff pressure must be less than:
     
    A. Capillary pressure
    B. Pulmonary artery pressure
    C. Pulmonary capillary wedge pressure
    D. Central venous pressure
    A
  53. Three days postoperatively, a patient is febrile and the white blood cell count is 18.000/cu mm. A chest radiograph shows a patchy bilateral infiltrates with air bronchograms. Based on this information, which of the following is the most probable diagnosis?
     
    A. Pneumonia
    B. Atelectasis
    C. Pulmonary edema
    D. Pleural effusion
    A
  54. Common complications associated with arterial punctures include which of the following?
     
    I. Fistula formation
    II. Hematoma formation
    III. Spasm of the vessel
     
    A. I only
    B. III only
    C. I and II only
    D. II and III only
    D
  55. A patient is receiving volume controlled ventilation with a continuous flow IMV circuit added. The respiratory therapist notices that the PEEP level drops from the prescribed 8 to 4 cm H2O with each spontaneous breath. To correct this problem, the therapist should increase the:
     
    A. PEEP to 12 cm H2O
    B. Sensitively setting
    C. Peak inspiratory flow setting on the ventilator
    D. Flow to the continuous flow reservoir bag.
    B
  56. A 45 year old patient with mild kyphoscoliosis and postpolio syndrome requires noninvasive inspiratory assistance and is to be fitted with a chest cuirass. Which of the following should the respiratory therapist recommend regarding proper fit?
     
    I. A 2 to 3 inch air cushion between the shell and the patient’s maximum chest rise is required.
    II. A cast of the thorax may be made for the patient to accommodate structural abnormalities.
    III. A properly fitted cuirass shell should extend anteriorly from the clavicle to the bottom of the rib cage.
     
    A. I and II only
    B. I and III only
    C. II and III only
    D. I, II and III
    A
  57. Direct spirometry CANNOT be used to measure which of the following?
     
    A. Vital capacity
    B. Residual volume
    C. Tidal volume
    D. Inspiratory reserve volume
    B
  58. A patient has a chest tube placed anteriorly in the fourth intercostal space that is connected to an underwater seal drainage system with suction. The respiratory therapist observes that one of the chest tube side holes is now outside the chest wall. Correct statements about this situation include which of the following?
     
    I. The tube should be disconnected from suction.
    II. The tube should be clamped immediately.
    III. A pleurocataneous fistula exists.
    IV. A complete pneumothorax is possible.
     
    A. I and IV only
    B. II and III only
    C. III and IV only
    D. I, II and IV only
    C
  59. The respiratory therapist would instruct a patient which of the following conditions to use pursed lip breathing?
     
    A. Asthma
    B. Croup
    C. Emphysema
    D. Pneumonia
    C
  60. When selecting an endotracheal tube, the respiratory therapist should consider which of the following to minimize airflow resistance?
     
    I. Internal diameter
    II. External diameter
    III. Length of the tube
     
    A. I only
    B. II only
    C. I and III only
    D. II and III only
    C
  61. A patient is being sent home with an oxygen concentrator. To ensure the safely of the home environment which of the following should be assessed?
     
    A. Number of outlets
    B. Water supply
    C. Electrical load capacity
    D. Location of bedroom
    C
  62. An increase in the number of staphylococcal infections is noted among hospitalized patients receiving respiratory care. Which of the following is the most likely source of the infections?
     
    A. The ventilators
    B. The personnel
    C. Distilled water
    D. Disposable circuits
    B
  63. While assessing a patient’s radical pulse, the respiratory therapist notes that the pulse feels full and bounding. Which of the following conditions would be the most probable cause of this finding?
     
    A. Hypvolemia
    B. Hypertension
    C. Massive GI bleeding
    D. Low cardiac output
    B
  64. When performing oxygen rounds, the respiratory therapist notes cyanosis in a patient with COPD who is receiving oxygen at 2 L/min by nasal cannula. Morning laboratory results show a hematocrit of 60%. This is most consistent with which of the following?
     
    A. Anemia
    B. Leukopenia
    C. Methemoglobinemia
    D. Polycythemia
    D
  65. Upon completion of a ventilator check, the respiratory therapist notices that a mathematical error was made on the ventilator monitoring sheet. Which of the following would be the most appropriate course of action?
     
    A. Attempt to erase the error and write over it with the correction.
    B. Leave the error alone and complete the ventilator check.
    C. Copy the entire ventilator sheet over to correct the error.
    D. Line through the error, write the word “error”, correct and initial it.
    D
  66. After assisting the physician with a fiberoptic bronchoscopy and transbronchial lung biopsy on a patient receiving volume controlled ventilation, the respiratory therapist notes a marked increase in peak inspiratory pressure. Possible causes of the pressure increase include which of the following?
     
    I. Bronchospasm
    II. Pneumothorax
    III. Pulmonary hemorrhage
    IV. Laryngospasm
     
    A. I and IV only
    B. II and III only
    C. I, II and III only
    D. I, II, III and IV
    C
  67. When pneumatic aerosol generator is being used, the respiratory therapist should decrease the aerosol output for which of the following patients?
     
    I. A patient with dried, retained secretions who becomes dyspneic
    II. Infant who has pulmonary edema
    III. A patient who has just undergone a tracheotomy
     
    A. I only
    B. III only
    C. I and II only
    D. II and III only
    C
  68. Which of the following devices should be selected to administer nebulized bronchodilator therapy at home?
     
    A. Air compressor
    B. Oxygen concentrator
    C. E cylinder of oxygen
    D. Liquid oxygen system
    A
  69. Immediate electric countershock be recommend for which of the following cardiac dysrhytmias?
     
    A. Ventricular asystole
    B. Ventricular fibrillation
    C. Atrial fibrillation
    D. Atrioventricular block
    B
  70. The respiratory therapist notes that a patient who is being mechanically ventilated has thick, mucoid secretions. It is determined that the wick humidifier is producing insufficient relative humidity. The therapist should do which of the following?
     
    A. Remove the excess water in the humidifier.
    B. Increase the temperature setting
    C. Increase the flow through the humidifier
    D. Shorten the tubing connecting the gas source to the humidifier inlet.
    B
  71. In which of the following patient would the use of a heat moisture exchanger be acceptable?
     
    A. An adult breathing oxygen at 6 L/min by a nasal cannula.
    B. A patient with ARDS who is being mechanically ventilated.
    C. A mechanically ventilated patient during transport.
    D. A mechanically ventilated patient with thick secretions.C
    C
  72. The dynamic compliance of a patient with status asthmaticus requiring continuous mechanical ventilation has decreased sharply over a 1-hour period. Which of the following drugs may be expected to elicit the most rapid improvement in dynamic compliance?
     
    A. Acetylcysteine ( Mucomyst )
    B. Theophylline ( Aminophylline )
    C. Beclomethasone ( Vanceril )
    D. Albuterol ( Ventolin )
    D
  73. A 1 month old infant who is being ventilated with a time-cycled, pressure limited ventilator has a peak pressure of 36 cm H2O and a mean airway pressure of 21 cm H2O. The respiratory therapist shortens the inspiratory time. Which of the following responses would be expected?
     
    A. Increased peak pressure
    B. Increased tidal volume
    C. Decreased expiratory phase
    D. Decreased mean airway pressure
    D
  74. The high pressure alarm on a volume cycled ventilator should be set at least 10 cm H2O pressure above which of the following?
     
    A. Peak airway pressure
    B. Mean airway pressure
    C. High pressure pop-off
    D. Humidifier outlet
    A
  75. The respiratory therapist observes low exhaled volumes during volume-cycled, pressure-limited, mechanical ventilation. To determine if the low volumes are caused by inaccurate ventilator volume control, the therapist should measure the tidal volume at the:
     
    A. Machine outlet
    B. Patient connector
    C. Exhalation valve
    D. Humidifier outlet
    A
  76. A previously healthy 30 year old patient is hospitalized with chills and fever. A chest radiograph is consistent with pneumonia of the right upper lobe. Which of the following is most likely to aid in the patient’s management?
     
    A. Bronchial drainage of the right lung
    B. Incentive spirometry
    C. Aerosol therapy
    D. Spirometry before and after a bronchodilator
    A
  77. The respiratory therapist is preparing to initiate oxygen therapy by a nasal cannula at 2 L/min for a 58 year old patient who has admitted with chest pain. Upon entering the patient’s room, the therapist finds him slumped over in bed and unresponsive to verbal and tactile stimuli. The therapist should do which of the following first?
     
    A. Call for help
    B. Administer oxygen
    C. Begin external cardiac compression
    D. Deliver a precordial thump
    A
  78. A patient becomes febrile 24 hours after intubation. The respiratory therapist notes other signs of developing pneumonia. A sputum specimen for microbiological assessment should be obtained by:
     
    A. Swabbing the artificial airway
    B. Swabbing the airway humidifier device
    C. Using a sterile suction trap
    D. Using sputum suctioned from the upper airway
    C
  79. A year 21 old man arrives in the emergency department (ED) after being rescued from a house fire. Physical examination reveals burns on the upper chest and face, and marked edema of the face and oropharynx. The results of an arterial blood gas sample obtained while the patient was breathing room air are below:
     
    Ph – 7.55
    PaCO2 – 26 torr
    PaO2 – 105 torr
    HCO3 – 22 mEq/L
    BE – 0 mEq/L
     
    Based on the patient’s condition at this time, the respiratory therapist should recommend which of the following?
     
    A. Intubate the patient
    B. Administer IPPB with ethanol
    C. Administer metaproterenol ( Alupent )
    D. Administer aerosol therapy
    A
  80. While checking an aerosol mist tent, the respiratory therapist is unable to see any aerosol particles in the tent. The therapist should:
     
    A. Decrease the F, Oz setting on the aerosol-producing device.
    B. Check the patency of the jet and capillary tube on the aerosol device.
    C. Check the coolant level in the refrigeration unit.
    D. Empty any water that has collected in the condensation bottle.
    B
  81. A patient with hypoxemia is receiving 10 cm H2O PEEP with an FiO2 of 0.40. Shortly after increasing the PEEP to 15 cm H2O, the respiratory therapist notes that the cardiac output measurement decreased from 4.5 to 2.7 L.min. Which of the following is the most appropriate action?
     
    A. Maintain the present therapy and measure cardiac output in 1 hour.
    B. Decrease PEEP to 10 cm H2O and increase the FiO2 to 0.50
    C. Increase PEEP to 20 cm H20 and maintain the FiO2 at 0.40
    D. Discontinue PEEP and increase the FiO2 to 1.0
    B
  82. Which of the following devices would be most appropriate for the treatment of post operative microatelectasis in an alert, cooperative patient?
     
    A. IPPB
    B. Incentive spirometry
    C. Aerosol nebulizer
    D. Percussor
    B
  83. The respiratory therapist is called to the operating room because carbon dioxide is leaking from an E Cylinder. The therapist should do which of the following?
     
    I. Tighten all connections
    II. Check the outlet for the presence of foreign debris.
    III. Replace the washer between the cylinder and regulator connections.
    IV. Lubricate the connection where gas is leaking
     
    A. IV only
    B. I and II only
    C. III and IV only
    D. I, II and III only
    D
  84. Which of the following is the most appropriate device for calibrating volume measurement of a water-seal spirometer?
     
    A. A 3-L syringe
    B. An adult manual resuscitator bag
    C. A volume ventilator
    D. A pediatric flowmeter
    A
  85. A patient with a suspected head injury presents in the emergency department (ED). As the patient’s pupil are exposed to light, they constrict rapidly, indicating a:
     
    A. Comatoe state
    B. Normal response
    C. Neurological head injury
    D. Brain stem infarction
    B
  86. When setting up mask CPAP for an adult patient, which of the following alarms is the most important to ensure maintenance of therapy?
     
    A. High Fi02
    B. Low pressure
    C. High respiratory rate
    D. Pulse monitor
    B
  87. The respiratory therapist determined that a patient who is being mechanically ventilated has developed auto-PEEP due to dynamic airflow obstruction. Which of the following should the therapist do?
     
    A. Add inspiratory plateau
    B. Apply expiratory retard
    C. Increase respiratory rate
    D. Decrease inspiratory flow
    B
  88. If the ratio light alarm on a ventilator is illuminating on each breath, which of the following controls may be adjusted to remedy the problem?
     
    I. Volume
    II. Respiratory rate
    III. Sensitivity
    IV. Inspiratory flow
     
    A. I and II only
    B. II and III only
    C. III and IV only
    D. I, II and IV only
    D
  89. A 17 year old has sustained a cervical spine injury. He is conscious and spontaneously breathing. The patient weight approximately 50 kg ( 110 lb ) and his head bas been stabilized with sandbags. Arterial blood gas results indicate that the patient is in acute ventilatory failure. To secure the patient’s airway, the respiratory therapist should select which of the following?
     
    A. 6.0 mm nasopharyngeal airway
    B. 7.0 mm nasotracheal tube
    C. 9.0 mm nasotracheal tube
    D. 37 Fr Carlens orotraheal tube
    B
  90. To reduce fluctuations in pressure in a mask CPAP system with a threshold resistor valve, the respiratory therapist should do which of the following?
     
    A. Improve the mask seal
    B. Reduce gas flow
    C. Increase expiratory resistance
    D. Use a smaller reservoir
    A
  91. The respiratory therapist has just performed nasopharyngeal suctioning on a patient and is withdrawing the catheter. Suddenly, the patient slumps over in bed and becomes unresponsive. A pulse is not palpable. The therapist should:
     
    A. Reinsert the suction catheter and resume suctioning
    B. Reinsert the suction catheter and connect it to the oxygen source
    C. Go to the nursing station for help
    D. Initiate CPR
    D
  92. A patient is receiving mechanical ventilation with a tidal volume of 700 mL has just undergone a tracheostomy. The respiratory therapist notes a cuff pressure of 18 mm Hg and a leak of 25 mL. The therapist should:
     
    A. Add 10 mL of air to the cuff.
    B. Maintain the present cuff volume
    C. Advice the physician to insert a larger tracheostomy lube
    D. Withdraw air from the cuff until the pressure is less than 15 mm Hg.
    B
  93. Which of the following would be the most accurate method for determining the amount of volume loss through a chest tube in a patient who is being mechanically ventilated?
     
    A. Subtract the expired Vt from the inspired Vt.
    B. Note the difference between the peak and plateau pressures.
    C. Compare the volume delivered when the chest tube is open vs clamped.
    D. Measure the flow coming from the suction regulator.
    A
  94. While checking a patient’s progress notes, the respiratory therapist views a physician’s treatment plan that includes changes in respiratory care.. The therapist’s most appropriate action is to:
     
    A. Initiate the changes immediately.
    B. Confer with the patient’s nurse about when to implement the changes.
    C. Check to see if there are new respiratory care orders.
    D. Review the planned changes with the shift supervisor.
    C
  95. Findings consistent with chest percussion include which of the following?
     
    I. A well aerated lung produces a resonant sound on percussion.
    II. Atelectasis produces hyperresonance on percussion.
    III. Dullness is produced when percussion is performed over an area consolidated by pneumonia.
    IV. Hyper resonance normally occurs when percussion is performed over the heart.
     
    A. I and II only
    B. I and III only
    C. II and IV only
    D. III and IV only
    B
  96. A patient complains that after his last aerosolized bronchodilator treatment, he experienced nervousness and increased anxiety. The respiratory therapist’s best response would be which of the following?
     
    A. “The nervousness and increased anxiety are expected since the nebulizer is powered by pure oxygen.”
    B. “Increase your rate and depth of breathing to remove the excess CO2 from the aerosol mask.”
    C. “Relax and try to breath slowly and I will be here with you so that nothing goes wrong.”
    D. “There is no need to worry because all patient’s become nervous and anxious while taking this kind of treatment.”
    C
  97. The respiratory therapist is instructing an outpatient in the care of respiratory equipment. Which of the following steps should be included in the cleaning procedure?
     
    I. Wash thoroughly in mild detergent.
    II. Remove all soap by rinsing with water.
    III. Soak in vinegar solution for 20 minutes.
    IV. Drain dry without wiping.
     
    A. I and II only
    B. I, III and IV only
    C. II, III and IV only
    D. I, II, III and IV
    D
  98. When performing a leak test on volume ventilator, the respiratory therapist should do which of the following?
     
    A. Open the breathing circuit to the atmosphere.
    B. Use a circuit factor of more than 4 mL/cm H2O
    C. Set the flow control at maximum
    D. Set the high pressure limit at maximum
    D




  1. Which of the following specialized imaging tests would be most useful in diagnosing a pulmonary emboli?
    a. Chest X-ray
    b. Pulmonary function test (PFT)
    c. Ventilation-perfusion scan (V/Q scan)
    d. Arterial blood gas
    Ventilation-perfusion scan (V/Q scan)
     
    A chest X-ray and an ABG might be useful in detecting an abnormality, but not specifically a pulmonary emboli.  Pulmonary function tests (PFTs) may reveal abnormal flow and volumes/capacities but not perfusion problems inherent in a pulmonary emboli.  A ventilation-perfusion scan would show a lack of blood flow due to emboli (a clot) in the blood pulmonary circulation.  Ventilation to lung regions would be shown as well.
  2. While examining a patient in the ICU, you note that he 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 flow sheet
    Nurses’ notes and flow sheet
     
    A patient’s fluid balance is the relationship between fluid intake and outputs primarily from urination.  It is normally noted in the nurses’ notes and flow sheet section of the medical record.  The normal fluid intake and output for adults is 1-2 L/day. or 25-50 mL/hour.  A positive fluid balance results from excessive intake and/or decreased output and may contribute to pulmonary or peripheral edema and hypertension.  A negative fluid balance is generally due to insufficient hydration and/or excessive urination from medications such as diuretics or theophylline and may lead to hypotension and low cardiac output.
  3. Which of the following physical findings would you expect to see in an alert but anxious asthmatic who has just been admitted to the emergency department?
    a. Respiratory acidosis
    b. Respiratory alkalosis
    c. Clubbing
    d. Cor pulmonale
    Respiratory alkalosis
     
    Asthmatics typically prsent with respiratory alkalosis.  Shortness of breath and accompanying hypoxemia cause the patient to increase his rate of breathing and alkalosis occurs.  It is important to note here that once hypoxemia is relieved by the administration of supplemental oxygen, patient’s PaCO2 and pH will normalize.
  4. In the lab results sectino of a patient’s medical record, the overall WBC count is shown as 22,000 for a febrile patient who appears acutely ill and in moderate respiratory distress.  Which of the following is this patient’s most likely diagnosis?
    a. Bacterial pneumonia
    b. Emphysema
    c. Pulmonary embolus
    d. Pulmonary fibrosis
    Bacterial pneumonia
     
    The elecated WBCs suggest a bacterial infection.  The respiratory distress further points to a respiratory infection such as bacterial pneumonia.  In addition, the other choices are not infectious processes, and therefore you would not likely see elevated WBCs.
  5. A PET scan would be most useful in the diagnosis of which of the following conditions?
    a. Bronchogenic carcinoma
    b. Chronic bronchitis
    c. Pulmonary fibrosis
    d. Smoke inhalation
    Bronchogenic carcinoma
     
    A PET scan is a nuclear imaging technique used in the diagnosis/staging/management of tumors and cancer.  The answer choice bronchogenic carcinoma describes lung cancer.
  6. Negative inspiratory force (NIF) is useful in the determination of which of the following?
    a. Airway resistance
    b. Functional residual capacity
    c. Respiratory muscle strength
    d. Sustained maximal inspiration
    Respiratory muscle strength.
     
    Negative inspiratory force (NIF) or maximal inspiratory pressure (MIP) is used for the bedside assessment of respiratory muscle strength.  You probably know that it is a measurement of pressure only.  Since airway resistance is a measurement of pressure divided by flow, and since functional residual capacity and sustained maximal inspiration are measurements of volume, the process of elimination leaves muscle strength as the only correct answer.
  7. Assessment of a 28-year old trauma patient reveals diminished breath sounds, asymmetrical chest expansion, severe chest pain, and an SPO2 of 90%, despite receiving oxygen via cannula at 5 L/min.  These findings are most consistent with what diagnosis?
    a. Complete airway obstruction
    b. Pneumothorax
    c. Viral pneumonia
    D. Pleural effusion
    Pneumothorax
     
    Both viral pneumonia and pleural effusion can be ruled out as correct answers as they are not related to trauma.  Breath sounds, though diminished, can be heard, and chest expansion, though asymmetrical, is present;  both of these are not consistent with a complete airway obstruction.  The physical assessment is consistent with the corret answer, pneumothorax.
  8. A 23 year-old firefighter is admitted with suspected smoke inhalation.  You place him on a nonrebreathing mask.  What is the most appropriate method of monitoring his oxygenation?
    a. Arterial blood gas analysis
    b. CO-oximetry
    c. Pulse oximetry
    d. Calculation of P(A-a)02
    CO-oximetry
     
    In the case of smoke inhalation, carbon monoxide binds to the hemoglobin in place of oxygen.  Neither ABGs, pulse oximetry, or calculation of A-a gradient will indicate how much oxygen is bound to hemoglobin.  Any victim of suspected smoke inhalation must be monitored with CO-oximetry.
  9. The ratio of lecithin to sphingomyelin, or L/S ratio, is a test to determine fetal lung maturity.  Such a test may be done in the later stages of pregnancy. and the values will initially be noted in the lab results section of the mother’s medical record.  Approximately what ratio is associated with the onset of mature surfactant production?
    a. 2:1
    b. 20:1
    c. 1:2
    d. 1:20
    2:1
     
    The lecithin to sphingomyelin ratio, or L/S ratio, is used to determine fetal lung maturity.  Generally, this ratio reaches 2:1 (twice as much lethicin as sphingomyelin) near week 35 of gestation, which corresponds to the onset of mature surfactant production.  The L/S ratio will generally be noted in the lab results section of hte mother’s medical record.
  10. Sputum culture and sensitivity would be indicated in the evaluation of which of the following clinical conditions?
    a. Pulmonary edema
    b. Bacterial pneumonia
    c. Bronchiectasis
    d. Empyema
    Bacterial pneumonia
     
    Sputum culture and sensitivity are used to identify microorganisms and their most appropriate drug therapy.  Bacterial pneumonia is the obvious infectious process in the choice of answers.
  11. What is in the Admitting sheet/face sheet?
    Patient’s next-of-kin, address, religion, and employer; health insurance information
  12. What is in the patient history?
    Past and present medical history; family, social, and medical history, including at-home medications as well as demographics.
  13. What is in the progress notes?
    Discipline-specific notes on a patient’s progress and treatment plan, generally entered at frequent (daily) intervals by physicians and allied health professionals such as respiratory therapists, dieticians, and social workers.
  14. What is in the physicians’ orders?
    Doctors’ diagnostic and therapeutic orders, including those pertaining to respiratory care.  All incomplete or unclear orders should be clarified with the prescribing physician.
  15. What is in the informed consent?
    Consent forms signed by the patient (and witness) for various diagnostic and therapeutic procedures, including those for bronchoscopy and surgery.
  16. What is in the DNR/advanced directives?
    Properly signed and witnessed do-not-resuscitate (DNR), do-not-intubate (DNI), and/or advanced directives.
  17. What is in the lab results?
    CBC counts (including WBCs) ABGs,electrolytes, coagulation studies (PT and INR) and cultures (sputum, blood, and urine).
  18. What is in the Imaging studies (radiology and nuclear medicine)
    X-rays (including chest x-rays) and CT, MRI, angiography, PET, and V/Q scans.
  19. What is in the therapy/respiratory therapy?
    Respiratory therapy charting; results of PFTs and sleepy study results; as an alternative to being in lab results section, ABGs may also be in this section.  Documentation related to other disciplines, such as physical and occupational therapy, may be included.
  20. What is in the ECGs and ultrasound studies?
    The results of electrocardiograms (ECG/EKGs), echocardiograms, and general ultrasound studies.
  21. What is in the Nurses’ notes and flow sheet?
    Nurses’ subjective and objective record of the patient’s condition, including vital sign trending and fluid intake/outut (I&O) and hemodynamic monitoring such as CVP, PAP, and PCWP.
  22. An otherwise healthy 25-year-old male patient who took an overdose of sedatives is being supported on a ventilator.  Which of the following measures of total static compliance (lungs + thorax) would you expect in this patient?
    a. 100 mL/cm H20
    b. 10 mL/cm H20
    c. 1 mL/cm H20
    d. 0.1 mL/cm H20
    100 mL/cm H20
     
    To evaluate and monitor a patient, you need to know what is normal and what is abnormal.  This item tests your ability to recall normal static compliance.  It also separately assesses your ability to differentiate the common bedsite units used for this measure (mL/cm H20) from that typically employed in a pulmonary lab (L/cm H20)
  23. An adult patient receiving volume-oriented assist/control ventilation has a corrected tidal of 700 mL, a peak pressure of 50 cm H20 and a plateau pressure of 40 cm H20 and is receiving 5 cm H20 positive end-expiratory pressure (PEEP).  What is this patient’s static compliance?
    a. 200 mL/cm H20
    b. 20 mL/ cm H20
    c. 2 mL/ cm H20
    d. 0.2 mL/ cm H20
    This item tests your ability to apply a formula to a clinical situation (most formula-type questions are at the application level).  To answer it correctly, you need to “plug” the correct data into the formula for computing static compliance — i.e . C (ml)/cmH20) = delivered volume divided by (plateau pressure – peep).
  24. A patient in the intensive care unit with congestive heart failure receiving assist/control ventilation with a set volume of 650 mL exhibits the following data on three consecutive patient-ventilator checks.
     
    1:
    Time – 9:00 AM
    Peak pressure – 40
    Plateau pressure – 25
    Peep – 8
     
    2:
    Time – 10:00 AM
    Peak Pressure – 50
    Plateau Pressure – 35
    Peep – 8
     
    3:
    Time – 11:00 AM
    Peak Pressure – 60
    Plateau Pressure 45
    Peep – 8
     
    The patient also exhibits diffuse crackles at the bases and some wheezing.  Which of the following would you recommend for this patient?
    a. A diuretic
    b. A bronchodilator
    c. A mucolytic
    d. A steroid
    A diuretic
     
    This item assesses your ability to analyze monitoring data and apply this information to recommend a treatment approach for this patient.  First, you must analyze the data,m which should reveal that the patient is suffering form a progressive decrease in compliance (rising plateau – PEEP pressure difference).  Second, you need to recognize that in patients with congestive heart failure, the most common cause for a progressive decrease in compliance is the development of pulmonary edema.  Last, you need to apply these data and your knowledge of pathophysiology and pharmacology to recommend the correct course of action, in this case the administration of a diuretic like Lasix.
  25. Which of the following is true regarding patients in the early stages of an asthmatic attack?
    a. They all exhibit respiratory alkalosis
    b. They always have moderate hypoxemia
    c. They have decreased expiratory flows
    d. They never respond to beta adrenergics.
    They have decreased expiratory flows.
     
    In this hypothetical example, optionas A, B, and D all contain specific determiners or absolutes.  More often than not, options that use absolutes are false.  Generaly, you should avoid choosin any option that must be true or false every time.  In every case or without exception.  In this case, applyhing this strategy helps you easily zero in on the correct answer, the only one not containing an absolute.
  26. A patient’s advanced directive:
    a.  Is usually obtained at the time of admission.
    b. Can be found in the doctor’s progress notes.
    c. Represents a guideline, not a legal requirement.
    d. Cannot be altered after it is written and signed.
    Is usually obtained at the time of admission.
     
    Options that contain qualifiers usually represent good choices.  In this example, only option A contains a qualifier and is in fact the correct option.  As with absolutes, note that the NBRC minimizes the use of qualifiers in its exam questions, especially in question options.  Nonetheless, you need to be on the lookout for these key words and apply the appropriate strategy when needed.
  27. 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 in the most likely cause of this problem?
    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.
    Note that options A and B are equivalent because a deflated or burst endotracheal (ET) tube cuff represents a leak in the patient-ventilator system.  Usually when two items are very similar or equivalent to each other, they are distractors and should be eliminated from consideration.  Then make your choice from among the remaining two options (in this case option C is the correct choice).  By doing so, you immediately improve your odds of correctly answering this question from 25% to 50%.  As noted previously, this is exactly what test-wise candidates do.
  28. Over a 3-hour period, you note that a patient’s plateau pressure has remained stable, but her peak pressure has been steadily increasing.  Which of the following is the best explanation for this observation?
    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.
    In this example, options B, C, and D, are similar in that they all correspond to a decrease in the patient’s compliance.  When this occurs, turn your attention to the different or “Odd Man Out” option which is most likely the correct one (option A in this example.)
  29. You are assisting with the oral intubation of an adult patient.  After the ET tube has been placed, you note that breath sounds are decreased on the left compared with the right lung.  What is the most likely cause of this?
    a. The tip of the tube is in the right mainstem bronchus
    b. The cuff of the endotracheal tube has been overinflated
    c. The endotracheal tube has been inserted into the esophagus
    d. The tip of the tube is in the left mainstem bronchus.
    The tip of the tube is in the right mainstem bronchus
     
    In general, when you encounter two options that are opposites, chances are the correct choice is one of the two.  In this example, options A and D are literally mirror images of each other , and one of them is likely the correct answer.  Referral back to the scenario (breath soudns decreased on the left compared to the right) should help you decide which of these two responses is correct (A).
  30. A patient receiving long-term positive-pressure ventilatory support exhibits a progressive weight gain an da reduction in the hematocrit.  Which of the following is the most likely cause of this problem?
    a. Leukocytosis
    b. Chronic hypoxemia
    c. Water retention
    D. Leukocytopenia
    Water retention
     
    In this example, leukocytosis and leukocytpoenia are polar opposites.  Is one of them the correct choice, or are they both distractors?  To makethis decision often requires referring back to the scenario or stem (which are combined in this question).  Logically, both leukocytosis and leukocytopenia are more often the result of abnormal processes (such as infection) and less often the cause (a key word in the stem).  So here these two options are more likely both being used as distractors and should be eliminated.  Now, by selecting form the two remaining options, your odds of correctly answering this question have improved to 50-50.  If you also remember that chronic hypoxemia tends to increase and not decrease the hematocrit, you can now be almost certain of selecting the correct option (C).
  31. Which of the following are the most common sites for the percutaneous sampling of arterial blood for blood gas analysis?
    I. Earlobe
    II. Radial artery
    III. Brachial artery
    IV. Side of the heel
     
    A.II and III
    B.I and IV
    C.III and IV
    D.I and II
    A.II and III
     
    Specimens for arterial blood gas (ABG) analysis can be drawn from a peripheral artery by means of a percutaneous needle puncture or from an indwelling intravascular cannula. Blood is most often drawn from the radial, brachial, or femoral arteries or the dorsalis pedis artery of the foot.
  32. What is the primary indication for tracheal suctioning?
    A.presence of atelectasis
    B.retention of secretions
    C.ineffective coughing
    D.presence of pneumonia
    B.retention of secretions
     
    Excerpts from the AARC guideline (CPG 33-1), includes indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring
  33. What is the most common complication of suctioning?
    A.hypotension
    B.infection
    C.arrhythmias
    D.hypoxemia
    D.hypoxemia
     
    Excerpts from the AARC guideline (CPG 33-1), includes indications, contraindications, hazards and complications, assessmentof need, assessment of outcome, and monitoring
  34. Complications of tracheal suctioning include all of the following except:
    A.hyperinflation
    B.elevated intracranial pressure
    C.mucosal trauma
    D.bronchospasm
    A.hyperinflation
  35. How often should patients be suctioned?
    A.whenever they are moved or ambulated
    B.whenever the charge nurse requests it
    C.when physical findings support the need
    D.at least once every 2 to 3 hours
    C.when physical findings support the need
     
    A patient should never be suctioned according to a preset schedule.
  36. What is the normal range of negative pressure to use when suctioning an adult patient?
    A.–80 to –100 mm Hg
    B.–20 to –30 mm Hg
    C.–60 to –80 mm Hg
    D.–100 to –120 mm Hg
    D.–100 to –120 mm Hg
     
    For adults, a pressure of –100 to –120 mm Hg is usually adequate
  37. What is the normal range of negative pressure to use when suctioning children?
    a.–60 to –80 mm Hg
    b.–80 to –100 mm Hg
    c.–100 to –120 mm Hg
    d.–150 to –200 mm Hg
    For children, limit the suction pressure to –80 to –100 mm Hg
  38. You are about to suction a 10-year-old patient who has a 6-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case?
    A.8 Fr
    B.14 Fr
    C.10 Fr
    D.6 Fr
    B.14 Fr
     
    See Rule of Thumb 33-1
  39. You are about to suction a female patient who has an 8-mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter you would use in this case?
    A.10 Fr
    B.14 Fr
    C.12 Fr
    D.8 Fr
    B.14 Fr
     
    See Rule of Thumb 33-1
  40. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?
    A.Preoxygenate the patient with 100% oxygen.
    B.Have the patient hyperventilate for 2 minutes.
    C.Give the patient a bronchodilator treatment.
    D.Manually ventilate the patient with a resuscitator.
    A.Preoxygenate the patient with 100% oxygen.
     
    First, preoxygenation helps minimize the incidence of hypoxemia during suctioning
  41. To maintain positive end-expiratory pressure (PEEP) and high FIO2 when suctioning a mechanically ventilated patient, what would you recommend?
    A.Use a closed-system multiuse suction catheter.
    B.Use the smallest possible catheter.
    C.Limit suctioning to once an hour.
    D.Limit suction time to no more than 5 seconds.
    A.Use a closed-system multiuse suction catheter.
     
    Basic indications for the use of closed suction catheters can be found in Box 33-2.
  42. Total application time for endotracheal suction in adults should not exceed which of the following?
    A.15 to 20 seconds
    B.3 to 5 seconds
    C.10 to 15 seconds
    D.20 to 25 seconds
    C.10 to 15 seconds
     
    Keep total suction time to less than 10 to 15 seconds.
  43. While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. Which of the following actions would be most appropriate?
    A.Stop suctioning and immediately administer oxygen.
    B.Decrease the amount of negative pressure being used.
    C.Stop suctioning and report your findings to the nurse.
    D.Change to a smaller catheter and repeat the procedure.
    A.Stop suctioning and immediately administer oxygen.
     
    If any major change is seen in the heart rate or rhythm, immediately stop suctioning and administer oxygen to the patient, providing manual ventilation as needed
  44. Which of the following methods can help to reduce thelikelihood of atelectasis due to tracheal suctioning?
    1.Limit the amount of negative pressure used.
    2.Hyperinflate the patient before and after the procedure.
    3.Suction for as short a period of time as possible.
    A.1 and 3
    B.1, 2, and 3
    C.2 and 3
    D.1 and 2
    B.1, 2, and 3
     
    ANS:D
     
    Atelectasis can be caused by removal of too much air from the lungs. You can avoid this complication by (1) limiting the amount of negative pressure used, (2) keeping the duration of suctioning as short as possible, and (3) providing hyperinflation before and after the procedure.
  45. Which of the following can help to minimize the likelihood of mucosal trauma during suctioning?
    1.Use as large a catheter as possible.
    2.Rotate the catheter while withdrawing.
    3.Use as rigid a catheter as possible.
    4.Limit the amount of negative pressure.
    A.2 and 4
    B.1, 2, and 4
    C.3 and 4
    D.1 and 2
    A.2 and 4
     
    ANS:B
    To avoid this problem, limit the amount of negative pressure used and always rotate the catheter while withdrawing
  46. Absolute contraindication for nasotracheal suctioning includes which of the following?
    1.epiglottitis
    2.croup
    3.irritable airway
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    • ANS:A
    • Excerpts from the AARC guideline (CPG 33-2), includes indications, contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.
  47. Which of the following equipment is NOT needed to perform nasotracheal suctioning?
    a.suction kit (catheter, gloves, basin, etc.)
    b.laryngoscope with MacIntosh and Miller blades
    c.oxygen delivery system (mask and manual resuscitator)
    d.bottle of sterile water or saline solution
    • ANS:B
    • See Box 33-1
  48. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
    a.Perform a tracheotomy for better access to the lower airway.
    b.Discontinue nasotracheal suctioning for 48 hours and reassess.
    c.Stop the bleeding and use a nasopharyngeal airway for access.
    d.Orally intubate the patient for better access to the lower airway.
    • ANS:C
    • Placement of a nasopharyngeal airway can help minimize nasal trauma when repeated access is needed.
  49. Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?
    a.Secretions are still present and the patient should be suctioned again.
    b.The patient has hyperactive airways and has developed bronchospasm.
    c.A pneumothorax has developed and the patient needs a chest tube.
    d.The patient has developed a mucous plug and should undergo bronchoscopy
    • ANS:B
    • The bronchospastic response may be particularly strong in patients with hyperactive airway disease. These patients should be assessed for the development of wheezes associated with suctioning
  50. What general condition requires airway management?
    1.airway compromise
    2.respiratory failure
    3.need to protect the airway
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    ANS:D
     
    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
  51. Which of the following conditions require emergency tracheal intubation?
    1.upper airway or laryngeal edema
    2.loss of protective reflexes
    3.cardiopulmonary arrest
    4.traumatic upper airway obstruction
    A.3 and 4
    B.1, 2, 3, and 4
    C.1, 2, and 3
    D.1 and 4
    B.1, 2, 3, and 4
     
    ANS:D
    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
  52. Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
    1.hypotension
    2.bradycardia
    3.cardiac arrhythmias
    4.laryngospasm
    A.1 and 4
    B.1, 2, 3, and 4
    C.3 and 4
    D.1, 2, and 3
    B.1, 2, 3, and 4
     
    Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome; and monitoring.
  53. All of the followingindicate an inability to adequately protect the airway except:
    a.wheezing
    b.coma
    c.lack of gag reflex
    d.inability to cough
    • ANS:A
    • Excerpts from the AARC guideline (CPG 33-3), includes indications, contraindications, precautions, hazards, and/or possible complications, assessment of need and outcome, and monitoring.
  54. Which of the following types of artificial airways are inserted through the larynx?
    1. pharyngeal airwasy
    2. tracheostomy tubes
    3. nasotracheal tubes
    4. orotracheal tubes
     
    a. 1 and 4
    b. 1, 2 and 3
    c. 3 and 4
    d. 1, 2, 3, and 4
    ANS:C
     
    The two basic types of tracheal airways are endotracheal (translaryngeal) tubes and tracheostomy tubes. Endotracheal tubes are inserted through either the mouth or nose (orotracheal or nasotracheal), through the larynx, and into the trachea.
  55. Compared with the nasal route, the advantages of oral intubation include all of the following except:
    a.reduced risk of kinking
    b.less retching and gagging
    c.easier suctioning
    d.less traumatic insertion
    • ANS:B
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1
  56. Compared with the oral route, the advantages of nasal intubation include all of the following except:
    a.reduced risk of kinking
    b.less retching and gagging
    c.less accidental extubation
    d.greater long-term comfort
    • ANS:A
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1
  57. Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:
    a.greater patient comfort
    b.reduced risk of bronchial intubation
    c.no upper airway complications
    d.decreased frequency of aspiration
    • ANS:D
    • A summary of the advantages and disadvantages of each of these three approaches appears in Table 33-1.
  58. What is the standard size for endotracheal or tracheostomy tube adapters?
    a.22 mm external diameter
    b.15 mm external diameter
    c.15 mm internal diameter
    d.22 mm internal diameter
    • ANS:B
    • The proximal end of the tube is attached to a standard adapter with a 15-mm external diameter.
  59. What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?
    a.protect the airway against aspiration
    b.help ascertain proper tube position
    c.minimize mucosal trauma during insertion
    d.ensure gas flow if the main port is blocked
    • ANS:D
    • In addition to the beveled opening at the tip, there should be an additional side port or “Murphy eye,” which ensures gas flow if the main port should become obstructed.The tube cuff is permanently bonded to the tube body. Inflation of the cuff seals off the lower airway, either for protection from aspiration or to provide positive pressure ventilation.
  60. What is the purpose of a cuff on an artificial tracheal airway?
    a.to seal off and protect the lower airway
    b.to stabilize the tube and prevent its movement
    c.to provide a means to determine tube position via radiograph
    d.to help clinicians determine the depth of tube insertion
    ANS:A
  61. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
    a.to help ascertain proper tube position
    b.to minimize mucosal trauma during insertion
    c.to monitor cuff status and pressure
    d.to protect the airway against aspiration
    • ANS:C
    • A small filling-tube leads from the cuff to a pilot balloon, used to monitor cuff status and pressure once the tube is in place.
  62. Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
    1.length markings on the curved body of the tube
    2.imbedded radiopaque indicator near the tube tip
    3.additional side port (Murphy eye) near the tube tip
    a.1 and 2
    b.1 and 3
    c.2 and 3
    d.1, 2, and 3
    • ANS:A
    • Not shown, but included with most modern endotracheal tubes, is a radiopaque indicator that is embedded in the distal end of the tube body. This indicator allows for easy identification of tube position on radiograph.
  63. The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
    1.aid in routine tube cleaning and tracheostomy care
    2.prevent the tube from slipping into the trachea
    3.provide a patent airway should it become obstructed
    a.1 and 3
    b.2 and 3
    c.3
    d.1, 2, and 3
    • ANS:A
    • A removable inner cannula with a standard 15-mm adapter is normally kept in place within the outer cannula but can be removed for routine cleaning or if it becomes obstructed
  64. What is the purpose of a tracheostomy tube obturator?
    a.to minimize trauma to the tracheal mucosal during insertion
    b.to provide a patent airway should the tube become obstructed
    c.to help ascertain the proper tube position by radiograph
    d.to provide a means to inflate and deflate the tube cuff
    • ANS:A
    • An obturator with a rounded tip is used for tube insertion. Prior to insertion, the obturator is placed within the outer cannula, with its tip extending just beyond the far end of the tube. This minimizes mucosal trauma during insertion.
  65. In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?
    a.surgical tracheotomy
    b.orotracheal intubation
    c.nasotracheal intubation
    d.cricothyrotomy
    • ANS:B
    • Orotracheal intubation is the preferred route for establishing an emergency tracheal airway
  66. While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?
    1.obturator
    2.syringe(s)
    3.resuscitator bag or mask
    4.tube stylet
    a. 1, 2, and 3
    b. 2 and 4
    c. 2, 3, and 4
    d. 1, 2, 3, and 4
    • ANS:C
    • Box 33-3 lists the equipment necessary for intubation.
  67. Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
    1.laryngoscope light source
    2.endotracheal tube cuff
    3.suction equipment
    4.cardiac defibrillator
    a.1, 2, and 3
    b.2 and 4
    c.3 and 4
    d.1, 3, and 4
    • ANS:A
    • Before beginning an intubation procedure, the practitioner should confirm the operation of suction equipment, oxygen, airway equipment, monitors, and esophageal detectors and check position of the patient
  68. While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade “lights” but the MacIntosh blade does not. What should you do now?
    a.Swap the defective MacIntosh for the good Miller blade.
    b.Check and replace the bulb in the MacIntosh blade.
    c.Replace the batteries in the laryngoscope handle.
    d.Check and clean the laryngoscope handle electrical contact
    • ANS:B
    • If the light does not function, first check that the bulb is tight. If the scope still does not light, check the batteries or replace the bulb
  69. What size endotracheal tube would you select to intubate a 3-year-old child?
    a.3.0 to 4.0 mm
    b.4.5 to 5.0 mm
    c.5.5 to 6.0 mm
    d.6.0 to 7.0 mm
    • ANS:B
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age.
  70. What size endotracheal tube would you select to intubate a 1500-g newborn infant?
    a.2.5 mm
    b.3.0 mm
    c.3.5 mm
    d.4.0 mm
    • ANS:B
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age
  71. What size endotracheal tube would you select to intubate an adult female?
    a.6 mm
    b.7 mm
    c.8 mm
    d.9 mm
    • ANS:C
    • Table 33-4 lists recommended orotracheal tube sizes according to patient weight or age
  72. What is the purpose of an endotracheal tube stylet?
    a.It helps ascertain proper tube position.
    b.It adds rigidity and shape to ease insertion.
    c.It minimizes mucosal trauma during insertion.
    d.It protects the airway against aspiration
    • ANS:B
    • Some clinicians insert a stylet into the tube to add rigidity and maintain shape during insertion
  73. To make oral intubation easier, how should the patient’s head and neck be positioned?
    a.neck extended over the edge ofthe bed, with head dangling down
    b.neck extended, with head supported by towel and flexed forward
    c.both the neck and head fully extended, with neck supported by towel
    d.neck flexed, with head supported by towel and tilted back
    ANS:D
     
    You achieve this alignment by combining moderate cervical flexion with extension of the atlanto-occipital joint. Placement of one or more rolled towels under the patient’s head helps. You then flex the neck and tilt the head backward with your hand.