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

1. An adult patient with cystic fibrosis cares for himself at home. The patient’s doctor has ordered postural drainage, percussion and vibration. Which of the following would your recommend to assist this patient in clearing his retained secretions during postural drainage?

A. a pneumatically powered percussor/vibrator
B. a high-frequency chest wall oscillation vest
C. an electrically powered percussor/vibrator
D. properly sized percussion cups or wand

2. Which of the following drugs would you NOT consider recommending for the long-term management of mild persistent asthma in an adult patient?

A. levalbuterol (Xopenex)
B. beclomethasone (Vanceril)
C. zafirlukast (Accolate)
D. cromolyn sodium (Intal)

3. Signs of sudden upper airway obstruction include which of the following?

A. Yes No Yes No
B. Yes Yes Yes Yes
C. Yes Yes Yes No
D. No Yes No Yes

A. A
B. B
C. C
D. D

4. A physician orders supplemental O2 for a patient via nasal cannula at a flow of 12 L/min. When you ask her what goal she has in mind, she states that she wants the patient to receive about 60% oxygen. Which of the following should you recommend?

A. that the cannula flow be set to 15 L/min instead of 12 L/min
B. that the O2 be given via a partial rebreathing mask at 10 L/min
C. that a nasal catheter at 12 L/min be used instead of the cannula
D. that the O2 be given via an air entrainment mask set at 60%

5. A patient whose asthma was well-controlled using a short-acting beta-agonist inhaler PRN and low dose inhaled corticosteroid BID reports that she recently has been experiencing shortness of breath almost daily and is awakened at night with wheezing episodes. Her peak flow, which had been 83% of her predicted normal is now at 66% of the predicted value. Which of the following would you recommend to the patient’s doctor as possible changes to the current drug regimen?

A. discontinue the short-acting beta agonist inhaler
B. add a leukotriene modifier to the regimen
C. switch the short-acting beta agonist from PRN to Q4H
D. switch from inhaled to oral corticosteroid therapy

6. In assessing a patient receiving ventilatory support, you note that her white blood cell count is 18,000/mm3 and her temperature is 102 °F. In addition, her secretions have become more tenacious and yellow over the past 24 hours. Which of the following would you suggest to the attending physician?

A. that her humidifier temperature be lowered to below 30 °C
B. that a regimen of aerosolized carbenicillin be started ASAP
C. that a sputum sample be obtained for culture and sensitivity
D. that the frequency of suctioning be increased to every half hour

7. A clinical condition characterized by a history of a productive cough for at least three months a year for two consecutive years best describes:

A. panlobular emphysema
B. status asthmaticus
C. centrilobular emphysema
D. chronic bronchitis

8. After bronchodilator therapy, you record the following PFT data on a 67 year-old male COPD patient with chronic cough and sputum production: FEV1/FVC = 65%; FEV1 = 82% predicted. You would characterize the stage of the patient’s COPD as:

A. mild
B. moderate
C. severe
D. very severe

9. A doctor institutes volume control ventilation for a 70 kg ARDS patient with a targeted tidal volume of 420 mL. To maintain adequate ventilation with this tidal volume, you would allow a machine respiratory rate as high as:

A. 20/min
B. 25/min
C. 30/min
D. 35/min

10.. Any sudden occurrence of pulmonary or cardiac distress in older, bed-ridden patients and those having undergone extensive abdominal or pelvic surgery suggest a diagnosis of:

A. coronary artery disease
B. pulmonary thromboembolism
C. anaphylatic shock
D. acute left ventricular failure

11. Which of the following is the most common indication for home CPAP therapy?

A. sleep apnea-hypopnea syndrome (SAHS)
B. bronchospasm associated with asthma
C. chronic hypoxemia
D. neuromuscular disorders

12. Inspection of a patient’s chest reveals severe kyphoscoliosis. Expected clinical findings would include which of the following?

A. A
B. B
C. C
D. D

13. 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

14. A patient whose asthma was well-controlled using a short-acting beta-agonist inhaler PRN and low dose inhaled corticosteroid BID reports that she recently has been experiencing shortness of breath almost daily and is awakened at night with wheezing episodes. Her peak flow, which had been 83% of her predicted normal is now at 66% of the predicted value. Which of the following would you recommend to the patient’s doctor as possible changes to the current drug regimen?

A. add a long-acting beta-agonist to the regimen
B. discontinue the short-acting beta agonist inhaler
C. switch the short-acting beta agonist from PRN to Q4H
D. switch from inhaled to oral corticosteroid therapy

15. A resident in ICU places a pulmonary artery catheter in a mechanically ventilated patient via the subclavian route. 5 minutes later, the attending nurse calls you to the bedside because the ventilator’s high pressure alarm is sounding and the patient appears to be rapidly deteriorating. You quickly note decreased breath sounds on the right side and severe hypotension. Which of the following conditions is most consistent with these findings?

A. pulmonary edema
B. pulmonary embolus
C. tension pneumothorax
D. gram-negative sepsis

16. You would recommend oxygen therapy to treat:

A. secondary polycythemia
B. chronic hypercapnia
C. acute myocardial infarction
D. absorption atelectasis



17. Which of the following clinical data would help distinguish Guillain-Barré syndrome from myasthenia gravis in a patient with respiratory insufficiency?

A. progressive dyspnea
B. dysphagia/ loss of gag reflex
C. decreased vital capacity
D. pain or discomfort to touch

18. 1-2 weeks after a mild upper respiratory infection, a patient develops lower extremity weakness and parasthesia which progresses within a few days to the upper extremities and face. Soon thereafter, marked respiratory muscle weakness occurs. A Tensilon (edrophonium) test is negative. What is the most likely diagnosis?

A. Myasthenia gravis
B. poliomyelitis
C. Guillain-Barre syndrome
D. amyotrophic lateral sclerosis

19. In managing a patient suffering from an acute asthma attack with O2 and bronchodilators, you note a rise in the PCO2 to 50 mm Hg, with a pH of 7.27. Although anxious, the patient remains alert and cooperative during therapy. Which of the following would you recommend at this time?

A. administer a beta adrenergic blocking agent
B. administer a CNS respiratory depressant
C. intubate and provide mechanical ventilation
D. continue current management with careful monitoring

20. A 56-year-old male is brought to the emergency room by ambulance complaining of tightness in his chest with radiating left shoulder pain. You should recommend:

A. obtaining an arterial blood gas sample
B. obtaining a stat chest X-ray
C. administering an albuterol treatment
D. administering supplemental oxygen

21. Which of the following drugs would NOT be appropriate for the initial management of a child during an acute asthmatic attack?

A. albuterol (Proventil)
B. cromolyn sodium (Intal)
C. terbutaline (Brethaire)
D. epinephrine

22. In reviewing the chart of a 57 year old patient with a 30 pack year history of smoking, you note that he has a history of increased sputum production, chronic respiratory acidosis, hypoxemia, and polycythemia. What is the most likely diagnosis?

A. chronic bronchitis
B. pneumonia
C. tuberculosis
D. asthma

23. Maintenance therapy with an inhaled corticosteroid for a patient with exercise-induced bronchoconstriction fails to control the condition. Which of the following drugs would you consider recommending be added to the treatment regimen to maintain better control?

A. Yes Yes No
B. Yes No Yes
C. No Yes Yes
D. Yes Yes Yes

A. A
B. B
C. C
D. D

24. A patient is receiving volume control A/C ventilation. Bilateral infiltrates are evident on the morning X-ray and the following arterial blood gas results are reported on an FIO2 of 0.60:

pH 7.40
PaCO2 41 torr
PaO2 49 torr
HCO3 25 mEq/L
BE +1

You should FIRST recommend which of the following?

A. initiate ARDS protocol
B. add mechanical dead space
C. Increase the FIO2 to 0.80
D. increase the tidal volume

25. A patient has been experiencing a moderate asthmatic attack for 20 minutes. Which of the following arterial blood gas results would be most consistent with this condition if the patient was breathing room air when the sample was drawn?

A 7.09 68 49
B 7.31 49 60
C 7.37 41 76
D 7.51 29 54

A. A
B. B
C. C
D. D

26. Twenty-four hours after a 34-year-old obese female underwent gastric bypass surgery, you are called to her bedside. You observe shallow breathing with diminished breath sounds at both lung bases and course rhonchi over the upper chest. Her SpO2 is 93% on 3 L/min nasal O2 and the morning X-ray indicates bilateral basal opacities. Which of the following are appropriate suggestions for this patient’s treatment?

A. Yes Yes Yes No
B. Yes Yes No No
C. Yes No Yes No
D. No No No Yes

A. A
B. B
C. C
D. D

27. An alert 23 year old patient is admitted with a history of bronchiectasis and significant purulent sputum production (not associated with cystic fibrosis). Her chest X-ray shows infiltrates in most segments of the right lower lobe with auscultation revealing course rhonchi and wheezing in the same area. On 3 L/min nasal O2 she has a SpO2 of 94%. In addition to antibiotic therapy, what treatment would you recommend?

A. albuterol via small volume nebulizer QID
B. airway clearance therapy of patient’s choosing
C. incentive spirometry to IC 10 breaths hourly
D. 35% oxygen by air-entrainment mask

28. For which one of the following conditions would you recommend IPPB therapy?

A. management of obstructive sleep apnea
B. treatment of interstitial pulmonary fibrosis
C. management of chronic asthma symptoms
D. acute cardiogenic pulmonary edema

29. A 73 year old nursing home patient is hospitalized with chills, fever and a productive cough. A chest X-ray indicates infiltrates in the right upper and middle lobes. Her SpO2 on room air is 85%. Which of the following is most likely to aid in the patient’s management?

A. O2 therapy titrated to achieve SpO2 > 90%
B. incentive spirometry 10 breaths per hour
C. bland heated aerosol therapy by mask QID
D. postural drainage and percussion QID

30. A patient with a neurologic disorder exhibits sleep apnea accompanied by Cheyne-Stokes breathing which is not resolved with CPAP. To overcome this problem you would recommend a trial of

A. volume control ventilation (VC)
B. adaptive servo ventilation (ASV)
C. bi-level positive airway pressure (BiPAP)
D. pressure control ventilation (PC)

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