CRT Practice Questions:

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.

2. Vesicular breath sounds indicate which of the following?

A. Normal lungs
B. Lung consolidation
C. Small airways obstruction
D. Acute bronchospasm

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

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 FiO2 of 1.0

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.

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.

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.

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

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 lenghth

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.

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

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

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.

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.

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 is given with 2.5 mg albuterol (Proventil) and 2 mL normal saline; pulse stable at 72/min during therapy; a nonproductive cough; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation.

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

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

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

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

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

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

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

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.

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 valve
D. Spirometer

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

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

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

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

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

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

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

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.

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

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. Pentamidine isethionate (NebuPent)
C. Vecuronium bromide (Norcuron)
D. Chloramphenicol palmitate (Chloromycetin Palmitate)

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

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

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. Nonrebreathing mask
D. Face tent

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.

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

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

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 re-infection of patients.
C. Prevent contamination of other equipment.
D. Protect the personnel who are handling the equipment.

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. Vecuronium (Norcuron)
D. Succinylcholine (Anectine)

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

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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

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.

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

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.

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

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

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

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

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

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%

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.

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

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

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

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.

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)

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

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.

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

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

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.

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)

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

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.

96. Which of the following is most effective in destroying all micro organisms?

A. Acetic acid
B. Pasteurization
C. Ethylene oxide
D. Isopropyl alcohol

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

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%

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

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.

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.

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.

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

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

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.

105. 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

106. 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

107. 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)

108. 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 nonrebreathing mask.

109. 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

110. 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

111. 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.

112. 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)

113. 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.

114. 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

115. 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

116. 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

117. 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.

118. Moist, crepitant crackles indicate which of the following?

A. Pulmonary edema
B. Atelectasis
C. Pleural effusion
D. Asthma

119. 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

120. 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

121. 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

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. 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)

130. 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

131. 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

132. A patient is receiving oxygen by a nonrebreathing 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

133. 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

134. 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

135. 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

136. 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.

137. 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

138. 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

139. 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

140. 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

141. 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

142. 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.

143. 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.

144. 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

145. 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.

146. 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

147. 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

148. 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