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You can find the answers to these questions in the TMC Test Bank.

1. Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able exhale what percent of the FVC?

A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC

2. Simple spirometry CANNOT be used to measure the

A. vital capacity
B. residual volume
C. tidal volume
D. inspiratory reserve volume

3. Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated?

A. obtain and review the patient’s past medical history
B. ask the patient’s nurse about the patient’s prescriptions
C. request that the lab run a comprehensive blood drug screen
D. obtain the patient’s current prescription vials from the family

4. Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax?

A. presence of gliding sign
B. absence of A-lines
C. presence of barcode sign
D. presence of seashore sign

5. Which of the following would tend to increase insensible water loss?

A. hypothermia
B. bypassed upper airway
C. hypoventilation
D. diuretic administration

6. Which of the following would tend to decrease a patient’s energy expenditure?

A. hypothermia
B. inflammation
C. major trauma
D. agitation/pain

7. A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between:

A. + 6 mEq/L
B. – 6 mEq/L
C. +/- 2 mEq/L
D. +/- 8 mEq/L

8. Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack?

A. pH = 7.31 PCO2 = 50 torr PO2 = 60 torr
B. pH = 7.40 PCO2 = 50 torr PO2 = 50 torr
C. pH = 7.47 PCO2 = 32 torr PO2 = 60 torr
D. pH = 7.47 PCO2 = 40 torr PO2 = 50 torr

9. The Apgar score for a normal newborn infant ranges between

A. 1-4
B. 4-7
C. 7-10
D. 10-13

10. On inspection of a patient’s ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is:

A. 2nd degree (Wenckebach) heart block
B. ventricular fibrillation
C. atrial fibrillation
D. ventricular tachycardia

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

A. 5000 to 6000 ml
B. 2000 to 3000 ml
C. 3000 to 4000 ml
D. 4000 to 5000 ml

12. The amount of gas that can be inhaled over and above that normally inhaled during quiet breathing is the:

A. IRV
B. FRC
C. ERV
D. VC

13. The results of an arterial blood gas analysis are below:
Blood Gases
pH = 7.28
PaCO2 = 22 torr
HCO3 = 10 mEq/L
BE = -15
PaO2 = 110 torr
These data indicate which of the following?

A. primary metabolic acidosis
B. primary metabolic alkalosis
C. primary respiratory alkalosis
D. primary respiratory acidosis

14. While examining a patient in the ICU, you note that she appears somewhat edematous and the nurse has indicated that the patient’s urine output is “minimal.” In what section of the medical record would you check to determine the patient’s fluid balance (intake vs. output)?

A. physician orders
B. consent
C. lab results
D. nurses’ notes and flowsheet

15. When inspecting the monitor of an adult patient in ICU, you note a heart rate of 138/min with a regular rhythm. Which of the following is the most likely cause of this observation?

A. beta-blocker adminstration
B. therapeutic hypothemia
C. arterial hypertension
D. anxiety or agitation

16. The gold standard for monitoring intracranial pressure (ICP) is the:

A. intraparenchymal probe
B. subarachnoid bolt
C. intraventricular catheter
D. epidural sensor

17. On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 80/min; regular rhythm; normal P waves; P-R interval of 0.25 sec; normal QRS complexes. The most likely problem is:

A. 1st degree heart block
B. atrial fibrillation
C. 2nd degree heart block
D. 3rd degree heart block

18. Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)?

A. increased hematocrit
B. decreased BUN
C. decreased serum osmolality
D. decreased urine specific gravity

19. Which of the following pulmonary function findings are common to patients with chronic bronchitis and also found in those with emphysema?

A. decreased forced expiratory flows
B. increased lung compliance
C. decreased diffusing capacity
D. decreased total lung capacity

20. A sleep study report should include which of the following information about blood oxygen levels?

A. highest SpO2 during rapid eye movement sleep
B. percent of sleep time with abnormally low SpO2
C. hourly arterial blood PO2 values
D. before and after study HbCO saturation

21. In assessing a patient in the acute phase of ARDS, you would expect to find:

A. increased lung volumes
B. refractory hypoxemia
C. increased compliance
D. metabolic alkalosis

22. A patient has a pH of 7.22 and a PaCO2 of 38 torr. Based on these data, what is the primary acid-base disturbance?

A. respiratory alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. metabolic alkalosis

23. In assessing a new adult admission to ICU, you note a spontaneous respiratory rate of 38/minute. The most likely cause of this observation is:

A. therapeutic hypothermia
B. CNS depression
C. metabolic acidosis
D. decreased CO2 production

24. Which of the following information in a patient’s medical history would be LEAST important to consider in evaluating the patient’s pulmonary condition?

A. smoking history
B. occupational history
C. prior pulmonary illnesses
D. dietary habits

25. A patient with a 10 year history of chronic bronchitis and an acute viral pneumonia exhibits the following blood gas results breathing room air:
pH = 7.22
PCO2 = 65 torr
HCO3 = 26 mEq/L
PO2 = 40 torr
P(A-a)O2 = 40 torr
Which of the following best describes this patient’s condition?

A. acute hypercapnic respiratory failure
B. chronic hypercapnic respiratory failure
C. acute hypoxemic respiratory failure
D. combined hypercapnic/hypoxemic respiratory failure
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26. A patient has an arterial pH of 7.25. What effect does this have on oxygen transport?

A. hemoglobin’s affinity for O2 will be higher than normal
B. for a given PO2, the SaO2 will be less than normal
C. the oxyhemoglobin saturation curve will shift to the left
D. for a given PO2, the SaO2 will be greater than normal

27. The wife of a comatose patient asks you to cancel a previously approved DNR order. You should

A. record the request in the patient record
B. notify the attending physician of the request
C. explain that only her husband can cancel the order
D. notify the charge nurse of the request

28. An echocardiogram on a 48 year-old patient with exertional dyspnea reveals high velocity tricuspid regurgitation, a dilated right ventricle, and an enlarged right atrium. Left ventricular anatomy and systolic/diastolic function are normal. Which of the following is the most likely problem?

A. pulmonary arterial hypertension
B. hypertrophic cardiomyopathy
C. acute respiratory distress syndrome
D. congestive heart failure

29. A patient is receiving volume control SIMV with 35% O2 and has following arterial blood gas results:
pH = 7.53
PaCO2 = 29 torr
PaO2 = 84 torr
HCO3 = 22 mEq/L
BE = -1
The blood gas results indicate:

A. acute hypoxemic failure
B. respiratory acidosis with hypoxemia
C. uncompensated respiratory alkalosis
D. hyperchloremic metabolic alkalosis

30. A patient exhibits respiratory alkalosis. Which of the following problems is most likely?

A. hypoxemia
B. hypothermia
C. opiate overdose
D. CNS depression

31. A patient experiencing acute postoperative dyspnea undergoes a V/Q scan, with results indicating an intermediate probability of pulmonary embolism (PE). Other than dyspnea, the only significant clinical findings are a moderate hypoxemia and tachycardia. Which of the following would you recommend?

A. additional testing
B. a repeat V/Q scan
C. vasodilator therapy
D. continued observation

32. A trauma patient is admitted to ICU with an expanding subdural hematoma. Which of the following changes would you expect to see in the monitored intracranial pressure (ICP)?

A. decreased P2 waveform component
B. decreased ICP waveform amplitude
C. loss of clear P1 waveform component
D. decreased mean intracranial pressure

33. Your review of a patient’s chart notes an admission diagnosis of fluid depletion/dehydration. Which of the following findings would be most likely on bedside assessment of the patient?

A. inspissated secretions
B. pitting edema
C. venous distension
D. crackle on auscultation

34. Based on the following blood-gas report, what is the most likely acid-base diagnosis?
pH = 7.52 pCO2 = 44 torr HCO3 = 35.1 mEq/L

A. acute (uncompensated) metabolic alkalosis
B. combined respiratory & metabolic alkalosis
C. acute (uncompensated) respiratory alkalosis
D. fully compensated respiratory alkalosis

35. In which of the following conditions would a ventilation scan be normal but a perfusion scan reveal areas of absent blood flow?

A. lung cancer
B. pulmonary embolism
C. pneumonia
D. emphysema

36. In obtaining a medication history from a patient admitted for an acute exacerbation of asthma, which of the following information would you consider least important?

A. frequency of rescue inhaler usage
B. use of generic vs. brand name medications
C. patient understanding of controllers vs. relievers
D. self-administration techniques

37. Which of the following VD/VT ratios is inconsistent with the ability of a patient to maintain adequate CO2 removal at a tolerable level of ventilation?

A. 0.10
B. 0.30
C. 0.50
D. 0.70

38. On reviewing the blood gas report on a patient, you note a PaCO2 of 25 torr, a base excess (BE) of –10 mEq/L, and a pH of 7.35. You would characterize this acid-based abnormality as:

A. compensated metabolic acidosis
B. acute (uncompensated) metabolic acidosis
C. compensated respiratory alkalosis
D. acute (uncompensated) respiratory alkalosis

39. A normal vital capacity for a female patient who is five feet two inches tall and weighs 50 kilograms would be approximately:

A. 2500 mL
B. 3500 mL
C. 4500 mL
D. 5500 mL

40. The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:

A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure
D. jugular venous pressure

41. A patient with a neuromuscular condition exhibits reasonable inspiratory muscle function, but has an accompanying hypoxemia. The presence of this hypoxemia suggests:

A. worsening of the primary restrictive process
B. progressive inspiratory muscle weakness
C. an increase in physiologic deadspace
D. the presence of a complication like atelectasis

42. To meet quality assurance standards, the patient’s chart report of a blood gas or hemoximetry test result should include:

A. a statement by the technician performing the test regarding its validity
B. the date, time and results of the last machine calibration verification
C. the range of values used for statistical quality control data analysis
D. the date, time and results of the last external proficiency test

43. In addition to obtaining information on a patient’s prescribed and over-the-counter medications, a good medication history should also include which of the following?

A. total costs of prescriptions
B. patient’s medication knowledge
C. family’s use of prescription drugs
D. generic vs. brand name drug use

44. The maximum amount of air that can be exhaled from the maximum inspiratory level is defined as which of the following?

A. vital capacity
B. residual volume
C. total lung capacity
D. expiratory reserve volume

45. Based on the following blood-gas report, what is the most likely acid-base diagnosis?
pH 7.42 pCO2 20 torr HCO3 12.6 mEq/L

A. partially compensated respiratory alkalosis
B. fully compensated respiratory alkalosis
C. combined respiratory & metabolic alkalosis
D. acute (uncompensated) respiratory alkalosis

46. While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation

A. is consistent with the interstitial syndrome
B. rules out an underlying pneumothorax
C. indicates the presence of pleural adhesions
D. confirms an underlying pneumothorax

47. A patient has a pH of 7.58 and a PaCO2 of 50 torr. Based on these data, what is the primary acid-base disturbance?

A. respiratory alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. metabolic alkalosis

48. Which of the following equations best describes O2 delivery TO the tissues?

A. arterial oxygen content x stroke volume
B. arterial oxygen content x cardiac output
C. cardiac output x arterial PO2
D. cardiac output x vascular resistance

49. A patient scheduled for a right lung pneumonectomy has a preoperative FEV1 of 2.0 L. A split lung quantitative V/Q study indicates a 55%/45% distribution of blood flow to the right and left lungs respectively. The patient’s predicted postoperative (PPO) FEV1 would be:

A. 1.10 L
B. 1.00 L
C. 0.90 L
D. 0.80 L

50. Lung tumors are revealed on a positron emission tomography (PET) scan as:

A. areas of decreased metabolism (‘dark spots’)
B. areas of increased radiolucency (‘dark spots’)
C. areas of increased metabolism (‘bright spots’)
D. areas of decreased radiolucency (‘bright spots’)

51. To what section of a patient’s chart should you refer to understand any important cultural or religious influences on the provision of care?

A. social history
B. advance directives
C. family disease history
D. chief complaint

52. In reviewing a cardiac catheterization report on a patient being assessed for coronary artery disease (CAD), about what percent reduction in artery diameter would indicate the need to proceed with balloon angioplasty and/or stenting?

A. 10%
B. 30%
C. 50%
D. 70%

53. In reviewing the chart of a 65 year-old patient diagnosed with COPD and chronic hypoxemia, you would expect to see which of the following findings?

A. decreased A-P chest diameter
B. chronic respiratory alkalosis
C. secondary polycythemia
D. FRC less than predicted

You can find the answers to these questions in the TMC Test Bank.