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

1. Which of the following observations indicate that an infant’s work of breathing may be abnormally high?

palor
digital clubbing
acrocyanosis
nasal flaring

2. Which one of the following measures could be used to evaluate changes in symptoms occurring among participants in a pulmonary rehabilitation program?

changes in dyspnea scores
changes in O2 consumption
changes in blood pressure
changes in O2 saturation

3. During auscultation, you hear a creaking or grating sound which increases in intensity with deep breathing but is not affected by coughing. Which of the following conditions best ‘fits’ this finding?

pleurisy
chronic bronchitis
pulmonary edema
atelectasis

4. In examining the neck of a patient, you note that the trachea is not positioned in the midline. Which of the following conditions would be the mostly likely cause of this observation?

pulmonary fibrosis
chronic bronchitis
lobar collapse
pulmonary edema

5. A small child is admitted to the Emergency Department with fever, difficulty swallowing, drooling, and stridor. An AP X-ray of the neck area is negative, but a lateral neck film indicates supraglottic swelling. Which of the following is the most likely diagnosis?

asthma
croup
foreign body obstruction
epiglottitis

6. In individuals with disorders causing an increased ELASTIC work of breathing, such as pulmonary fibrosis, which of the following breathing patterns results in the minimum work?

slow and deep breathing
slow and shallow breathing
rapid and deep breathing
rapid and shallow breathing

7. You are reviewing the chest X-ray of a 32 year-old female receiving ventilatory support via an oral endotracheal (ET) tube. To assure proper placement of the tube, you would look for its tip to be positioned

at the same level as the carina
not more than 2 cm above the carina
between the 2nd and 4th thoracic vertebra
level with the fifth cervical vertebra

8. The chest X-ray of a patient admitted to ICU exhibits a large area of consolidation in the left lung. Which of the following is a potential cause of this finding?

pulmonary contusion
pulmonary barotrauma
tension pneumothorax
interstitial emphysema

9. An adult patient with inspiratory stridor most likely has which of the following conditions?

bronchospasm
laryngeal edema
retained secretions
air trapping

10. Bronchial breath sounds heard over the periphery indicate

normal lungs
lung consolidation
small airways obstruction
acute bronchospasm

11. Which of the characteristics of a patient’s sputum should be assessed at the bedside and documented in the chart?

density
DNA content
surface tension
viscosity

12. You are assisting a nurse in ICU measure a patient’s central venous pressure (CVP) with a strain-gauge pressure transducer. You note that the pressure transducer is positioned well above the middle of the patient’s lateral chest wall. What effect if any would this have on the CVP measurement?

it would not affect the measurement
it would underestimate the CVP
it would cause damping of the signal
it would overestimate the CVP

13. A patient has a systolic arterial pressure of 180 mm Hg and a diastolic value of 90 mm Hg. What is his approximate mean arterial pressure?

100 mm Hg
110 mm Hg
120 mm Hg
130 mm Hg

14. Sputum induction is performed on a trach patient to gather a sample for microbiological identification. The sample is collected using a Lukens trap. When applying suction after entering the airway, the mucus should

pass into the trap and then move on into the collection jar
pass through the wall tubing and then into the Lukens trap
pass through the suction catheter and then enter the Lukens trap
pass into the Lukens trap and then enter the suction catheter

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

15. Which of the following should be obtained and recorded when performing a bedside measure of vital capacity?

patient’s resting minute ventilation
patient’s heart rate before/after testing
patient’s actual and predicted body weight
patient’s height, gender and age

16. In analyzing overnight oximetry data, a desaturation event represents a decrease in SpO2 of:

2% or more
3% or more
4% or more
5% or more

17. A patient has a vital capacity of 3200 ml, a functional residual capacity of 4500 ml and expiratory reserve volume of 1200 ml. What is her residual volume (RV)?

8900 ml
2000 ml
3300 ml
5700 ml

18. A patient breathing 100% O2 has a P(A-a)O2 of 400 torr. What is her approximate % shunt?

5%
10%
15%
20%

19. When measuring a patient’s arterial pressure via A-line and monitor/transducer system, you note a damped pressure waveform. Which of the following is the most likely cause of this problem?

complete catheter occlusion
air bubbles in system
transducer positioned too low
stopcock off to patient

20. Which of the following ECG leads should be placed in the left midaxillary line?

V3
V4
V5
V6

21. A new medical resident asks for your help in calculating the static lung compliance for an ICU patient receiving volume controlled ventilation. The patient has the following settings and monitoring data:

18 mL/cm H2O
35 mL/cm H2O
22 mL/cm H2O
26 mL/cm H2O

22. For which of the following patients would you recommend extra precautions if undergoing a cardiopulmonary exercise test?

a patient being evaluated for coronary artery disease
a patient with a resting systolic BP > 200 mm Hg
a patient recommended for cardiac rehabilitation
a patient being assessed for cardiopulmonary disability

23. Before connecting the sample syringe to an adult’s arterial line stopcock, you would:

flush the line and stopcock with the IV solution
aspirate at least 5 mL fluid/blood using a waste syringe
align the stopcock off to the patient, on to the flush solution
increase the flush solution bag pressure by 20-30 mm Hg

24. Which of the following percent increases in FEV1 is the minimal required to indicate a clinically significant response to an aerosolized bronchodilator?

12%
30%
5%
25%

25. An apnea monitor alarm is sounding continuously but your initial assessment of the patient reveals that they are breathing normally. Your next action should be to:

Check the electrode connections on the patient
Immediately obtain a replacement monitor
Silence the alarm and call the equipment supplier
Replace the lead wires and patient cable

26. Pulse oximeter readings are generally unreliable at saturations below:

70%
80%
90%
95%

27. The normal end-tidal CO2 percentage as measured by capnography ranges between:

35-45%
3-4%
5-6%
7-8%

28. A patient with P/F ratio of 400 has:

normal oxygenation
mild ARDS
moderate ARDS
severe ARDS

29. A patient is receiving ventilatory support after thoracic surgery. You measure the patient’s maximum inspiratory pressure (MIP/NIF) as -33 cm H2O. Based on this value, the patient has:

a need for continued ventilatory support
a large leak in their endotracheal tube cuff
a normal maximum inspiratory pressure
adequate muscle strength to consider weaning

30. A patient has a maximum inspiratory pressure (MIP/NIF) of -15 cm H2O. This finding indicates:

muscle weakness
hypoventilation
inadequate tidal volume
airway obstruction

31. While assessing a patient receiving artificial ventilatory support, you note wide swings in the central venous pressure (CVP) during mechanical breaths. Which of the following is the most likely cause of this finding?

poor venous return
pulmonary barotrauma
decreased pleural pressure
respiratory alkalosis

32. A postoperative patient is receiving volume control A/C ventilation at the rate of 12/minute with 5 cm H2O PEEP. With the ventilator settings unchanged, you measure and record the following the data:

increased airway resistance
decreased airway resistance
increased lung compliance
decreased lung compliance

33. Oxygen exchange at the lung is considered adequate if the arterial hemoglobin saturation (SaO2) can be maintained above:

65%
70%
75%
90%

34. Capnometry can be used to:

A
B
C
D

35. The results of which of the following should be used to determine the return of a postoperative patient’s ability to breathe adequately after anesthesia?

mixed venous PO2
thoracic gas volume
maximum inspiratory pressure
maximal voluntary ventilation

36. A doctor wants your recommendation on how to monitor the cardiopulmonary status of a patient undergoing a bronchoscopy procedure during moderate sedation. You should recommend the following:

pulmonary function testing
noninvasive pulse oximetry
frequent ABGs via radial puncture
transcutaneous PaO2 monitoring

37. The ICU nurse calls you to assess a patient that became agitated and complains of difficulty breathing. The patient presents with decreased right chest excursion, absent breath sounds in the right upper lobe and slight tracheal deviation to the left. Which of the following procedures would you recommend be done FIRST?

stat chest X-ray
lab chemistry
right side thoracentesis
a bronchoscopy

38. A patient you are caring for is scheduled for a positron emission tomography (PET) chest scan. The most likely purpose of this test is to:

diagnose, stage and evaluate the treatment of non-small cell lung cancer
differentiate between infectious and noninfectious pulmonary infiltrates
detect and localize abnormalities of the pulmonary vascular circulation
quantify the size and location of pleural effusions

39. In patients with suspected pulmonary thromboembolism whose ordinary X-rays are negative, which of the following procedures can best help establish the diagnosis?

cardiac enzyme determinations
arterial blood gas analysis
cardiovascular stress testing
ventilation/perfusion scans

40. A patient in ICU is receiving a continuous IV drip of an opioid analgesic for sedation and pain relief. Which of the following would you recommend for monitoring this patient?

continuous blood pressure monitoring
intermittent arterial blood gas sampling
pulse oximetry/SpO2 monitoring
real-time waveform capnography

41. In which of the following circumstances would you recommend using pulse oximetry?

to assess changes in oxygenation during procedures that can cause hypoxemia
to monitor oxygenation in patients with poor peripheral perfusion
to obtain precise/accurate assessment of a patient’s blood oxygenation
to monitor for or warn of hyperoxemia in infants

42. A patient receiving volume control SIMV develops subcutaneous emphysema around the tracheostomy site, neck, and chest. To obtain additional pertinent data, the most appropriate diagnostic procedure would be which of the following?

NIF measurement
chest x-ray
timed forced expiratory volumes
arterial blood gases

43. Which of the following procedures would be least helpful in diagnosing pulmonary embolization?

computerized tomography (CT) scan
pulmonary angiography
ventilation-perfusion (V/Q) scan
standard AP chest X-ray

44. A 23 y/o firefighter is admitted with suspected smoke inhalation. You place him on a non-rebreathing mask. What is the most appropriate method of monitoring his oxygenation?

arterial blood gas analysis
co-oximetry
pulse oximetry
calculation of P(A-a)O2

45. When performing a routine ventilator check, you note that the airway temperature indicator reads 26° C. The flowsheet indicates a prior temperature of 35° C. Which of the following best explains this discrepancy?

failure of the thermostat mechanism
increased patient minute ventilation
addition of deadspace to circuit
decreased patient minute ventilation

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

46. The gauge on an E cylinder of oxygen reads 1800 psig. About how long would the contents of this cylinder last at a flow of 2 L/min?

4 hours, 10 minutes
6 hours, 20 minutes
2 hours, 50 minutes
1 hour, 40 minutes

47. In working with an electrically powered apparatus, you notice a slight tingling sensation when the metal parts of the equipment are touched. In this case, you should:

use this device only with non-electrically sensitive patients
immediately take the piece of equipment out of service
use an extension cord to increase electrical resistance
use a ‘cheater’ adapter to bypass the ground connection

48. What is the maximum flow range you can expect to achieve with a standard air entrainment nebulizer set to deliver 40% oxygen?

45-60 L/min
60-75 L/min
75-90 L/min
30-45 L/min

49. What approximate volume should be used to inflate the larger #1 cuff of an esophageal-tracheal Combitube® (ETC)?

12 – 15 mL
20 – 30 mL
40 – 60 mL
80 – 100 mL

50. When making routine equipment checks you hear the relief valve of a patient’s bubble humidifier sounding. Which of the following is the most likely cause of this problem?

clogged bubble/diffuser
delivery tube obstruction
high wall outlet pressure
rise in patient ventilation

51. When turning on an H cylinder valve, gas leaks around the regulator connection to the cylinder. Your most appropriate action to correct the problem would be to:

reduce the flow
change the regulator
replace the washer/seal
tighten the cylinder connection

52. Which of the following occurs when gas leaves a simple unheated bubble humidifier and is delivered to a patient?

the absolute humidity of the gas decreases
condensation occurs in the delivery tubing
the relative humidity of the gas decreases
the temperature of the gas increases

53. Which of the following types of nebulizers can produce the highest density aerosol suspension?

a heated jet nebulizer
a sidestream nebulizer
a metered dose inhaler (MDI)
an ultrasonic nebulizer

54. An intubated adult patient with severe expiratory airway obstruction requires ventilatory support. Which of the following capabilities would be most important in selecting a ventilator for this patient?

ability to compensate for airway interface leaks
variable flow control and adjustable I:E ratios
ability to run on 12 volt DC (battery) power
certification for use during MRI procedures

55. In order to assure a stable FIO2 under varying patient demands, an oxygen delivery system must:

provide all the gas needed by the patient during inspiration
have a reservoir system at least equal to the tidal volume
maintain flows at least equal to the patient’s peak flows
automatically change its flow in response to patient demands

56. A 65-year-old patient with COPD is receiving O2 via a 28% air entrainment mask. With an O2 input of 4 L/min, what is the total output gas flow?

30 L/min
35 L/min
40 L/min
45 L/min

57. Mechanical ventilation in the home setting can be provided by which of the following methods?

positive pressure via an intact upper airway
nasal continuous positive airway pressure
positive pressure via an oral endotracheal tube
negative pressure via an oral endotracheal tube

58. You are using a portable pressure-cycled ventilator with a heated humidifier and IPPB circuit to temporarily ventilate an intubated patient who is regaining consciousness in the recovery room. When you check the patient and ventilator, you notice that the inspiratory time is prolonged and the machine does not cycle off without active patient effort. How should you correct the problem?

increase the control pressure
switch the unit to 100% source gas
check/adjust ET tube cuff pressure
decrease the sensitivity setting

59. Which of the following is a consideration in selecting a fenestrated tracheostomy tube over a standard tracheostomy tube?

fenestrated tubes facilitate communication
fenestrated tubes reduce tracheal injury
fenestrated tubes minimize mucus encrustation
fenestrated tubes minimize the risk of contamination

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