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

1. A nondisposable tracheal airway cannot under go steam autoclaving but needs to be processed for re-use on other patients. Which of the following is an acceptable alternative for processing this device?

pasteurization at 63 °C for 30 minutes
exposure to micowave radiation for 20-30 min
surface disinfection with 70% ethyl alcohol
placement in a hot air (375 °F) chamber for 15 min

2. Which of the following devices is LEAST LIKELY to transmit pathogenic organisms to the patient?

small volume drug nebulizer
ultrasonic nebulizer
large volume jet nebulizer
wick-type humidifier

3. When reviewing statistical quality control data on a blood gas analyzer, you note a single pH measurement among 30 that falls below the ± 2 SD “in control” standard for your lab. Which of the following is the most likely cause of this error?

statistical probability/chance
contaminated buffer solutions
incorrect analysis procedures
failure of the pH electrode

4. When calibrating a portable computerized spirometer, its volume readings consistently fall outside the ± 3% range. Which of the following is the most likely cause of this problem?

failure to remove bacterial filter before calibration
incorrect temperature or pressure/altitude input
flow sensor tubing not connected to computer
incorrect selection of prediction equations

5. In most blood gas analyzers, what media is used to calibrate the pH electrode?

tonometered whole blood samples
commercial calibration control media
precision gas mixtures (O2/CO2)
standardized buffer solutions

6. Which of the following chest assessment procedures would help to determine whether an endotracheal tube has been properly positioned in a patient’s trachea?

percussion
palpation
auscultation
inspection

7. You would generally avoid inserting an oropharyngeal airway in a patient who:

requires manual ventilation
is less than 12 years old
is unconscious/unresponsive
has an active gag reflex

8. You recommend against inserting a supraglottic airway (e.g., LMA, Combitube, King LT) in a patient:

with an intact gag reflex
for whom ET intubation is difficult
with a suspected cervical spine injury
needing emergency ventilation

9. To exchange a King LT airway for an endotracheal (ET) tube, you would recommend

use an airway exchange catheter
thread the ET tube down the King LT
insert the ET tube around the King LT
remove the King LT, then implement RSI

10. After an intubated patient successfully completes a 90 minute trial of spontaneous breathing on a ventilator (CPAP with pressure support), the attending doctor requests that he be extubated. Which of the following would you want to confirm before agreeing to remove the patient’s ET tube?

A
B
C
D

11. You are assisting a physician in exchanging the ET tube of a patient using a fiberoptic bronchoscope (FOB) as the re-intubation guide. You would remove the old tube

immediately upon insertion of the FOB into the pharynx
only after confirming the FOB tip is just above the carina
prior to insertion of the FOB into the pharynx
only after the new tube is positioned in the trachea

12. Endotracheal (ET) tube exchange would be indicated to replace a:

A
B
C
D

13. An orally intubated patient is breathing asynchronously with the ventilator. Breath sounds are absent on the left, with dullness to percussion and a left shift of the trachea. Which of the following is the most likely explanation for the problem?

The patient is experiencing diffuse bronchospasm
The endotracheal tube is in the right mainstem bronchus
A tension pneumothorax has developed on the left
A tracheoesophageal fistula has developed

14. Application of heated humidification would pose the greatest potential hazard for a patient with:

hypothermia
retained secretions
hypovolemia
a high fever

15. Which of the following could be used as quality assurance outcome criteria to assess the effectiveness of airway clearance therapy?

increase minute ventilation
change in chest X-ray
decreased arterial PCO2
change in diffusing capacity

16. A patient still recovering from abdominal aortic surgery is having difficulty developing an effective cough. Which of the following actions would you consider to help this patient generate a more effective cough?

A
B
C
D

17. Which of the following will be observed when an incentive breathing device is being used properly?

sustained tidal volume
maximum sustained inspiration
maximal voluntary ventilation
vital capacity

18. On receiving a new incentive spirometry order, you should first

prepare the medication
start the treatment with low pressure
explain the treatment to the patient
review the patient’s chart

19. While performing a routine check on an intubated patient receiving pressure control SIMV, you feel course vibrations on his chest wall during both inspiration and expiration. You should do which of the following?

Perform endobronchial suctioning
Switch to volume control SIMV
Decrease the ventilator pressure limit
Recommend a bronchodilator treatment

20. Which of the following are appropriate instructions for a patient about to receive incentive spirometry?

exhale maximally after a normal inspiration
inhale maximally after a normal exhalation
exhale maximally after a maximal inspiration
inhale maximally after a maximal exhalation

21. Which of the following procedures would be most helpful in preventing atelectasis in a cooperative postoperative patient?

albuterol (Proventil) via SVN four times daily
inspiratory resistance exercises three times daily
incentive spirometry maneuver 10x per hour
pursed-lip breathing as needed (PRN)

22. The primary goal of O2 therapy is to:

improve tissue perfusion
decrease the work of breathing
correct arterial hypoxemia
decrease myocardial workload

23. An adult patient receiving ventilatory support via high-frequency jet ventilation (HFJV) has a PaO2 of 52 mm Hg with an FIO2 of 0.40. Which of the following control setting changes could be used to improve this patient’s oxygenation?

A
B
C
D

24. For which of the following patients would application of noninvasive positive pressure ventilation (NPPV) likely be most difficult?

a patient with acute exacerbation of COPD
a patient with Duchenne muscular dystrophy
a patient copious secretions requiring suctioning
D a patient with cardiogenic pulmonary edema

25. In order to verify the spontaneous rate of breathing of a patient receiving SIMV, you should:

subtract the preset machine rate from the total displayed rate
divide the total minute ventilation by the total frequency
observe actual chest motion and airway pressure deflections
add the preset machine rate to the total displayed rate

26. A patient breathing 40% O2 has a measured physiologic shunt of 20%. When the O2 concentration is increased to 100%, his shunt increases to 35%. Which of the following best explain the increased shunt?

decreased cardiac output
oxygen-induced hypoventilation
absorption atelectasis
pulmonary vasodilation

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

27. Factors affecting the FIO2 received by a patient via a nasal cannula include which of the following?

A
B
C
D

28. You are assessing an intubated patient receiving oxygen by T-piece via an air-entrainment nebulizer set at 0.40 with an input flow of 8 L/min O2.You observe no mist at the T-tube during inspiration. Which of the following actions is appropriate?

suction the patient via the endotracheal tube
change the nebulizer entrainment setting to 50%
increase the oxygen input flow to 12 L/min
drain the water from the aerosol delivery tubing

29. Which of the following modes of ventilatory support is indicated when a precise I:E ratio must be maintained?

assist-control ventilation
intermittent mandatory ventilation
control mode ventilation
pressure support ventilation

30. Which of the following represents the primary indication for and approved use of inhaled nitric oxide?

hypoxemia associated with obstructive sleep apnea
hypoxemia in neonates with persistent pulmonary hypertension
ventilatory failure in premature neonates Incorrect
hypoxemia associated with hyaline membrane disease

31. A major problem in applying ribavirin (Virazole) aerosol to children undergoing mechanical ventilation is:

loss of most of the drug content through evaporation
denaturation of the drug due to high circuit temperatures
reconcentration of the drug in the ventilator humidifier
drug precipitation in the circuit causing valves to jam

32. A patient with COPD is receiving 2.5 mg albuterol (Proventil) in 3 mL of normal saline three times a day to relieve airway obstruction. He complains of nervousness and tremors after most therapy sessions. You should consider recommending which of the following to the patient’s doctor?

substituting acetylcysteine (Mucomyst) for the albuterol
decreasing the frequency of albuterol treatments
substituting ipratropium (Atrovent) for the albuterol
substituting budesonide (Pulmicort) for the albuterol

33. The most important property of helium with respect to its use in helium-oxygen therapy is its:

density
viscosity
flammability
specific gravity

34. Which of the following drug would you recommend for a patient with acute bronchospasm?

racemic epinephrine
acetylcysteine (Mucomyst)
albuterol (Proventil)
cromolyn sodium (lntal)

35. An adult CCU patient on a nonrebreathing mask at 12 L/min complains of discomfort and feeling ‘closed-in.’ The doctor foresees the need to maintain a high FIO2 for at least 12 more hours. Which of the following would you recommend?

switching to a high flow cannula at 15-20 L/min
decreasing the nonrebreathing mask flow to 6 L/min
switching to a 50% air-entrainment/venturi mask
increasing the nonrebreathing mask flow to ‘flush’

36. A patient is receiving appropriate oxygen therapy via a simple mask at 5 L/min but complains that the mask is confining and interferes with eating. Which of the following oxygen-delivery devices is a suitable alternative?

nasal cannula at 4–5 L/min
nasal cannula at 2 L/min
nonrebreather mask at 10 L/min
a 28% venture mask at 10 L/min

37. Data for a 80 kg (176 lb) patient receiving ventilatory support are. Which of the following changes would be appropriate at this time?

increasing the tidal volume
decreasing the set (machine) rate
adding 5 cm H2O PEEP
adding mechanical deadspace

38. A patient with COPD is receiving volume controlled SIMV. Wheezing is present in all lung fields. During machine breaths, the peak pressure is 67 cm H2O and plateau pressure is 25 cm H2O with a set VT of 550 mL and a flow of 40 L/min. What of the following would be actions appropriate at this time?

change to noninvasive BiPAP at 20 cm H2O/5 cm H2O IPAP/EPAP
decrease the inspiratory flow to 30 L/min and monitor for auto-PEEP
administer ipratropium + albuterol (Combivent) inline via MDI + spacer
change to the pressure support mode at 45 cm H2O pressure

39. Continuous bland aerosol therapy would pose the greatest risk for a patient with:

post-extubation edema
a bypassed upper airway
laryngotracheobronchitis
airway hyperresponsiveness

40. You observe the following flow vs. time display on a patient receiving volume-control ventilation. Which of the following actions would be appropriate?

decrease the inspiratory flow
increase the expiratory time
decrease the PEEP level
increase the tidal volume

41. A 50 kg (110 lb) adult patient recovering from pulmonary edema is receiving pressure control A/C ventilation at a rate of 12/min with the pressure limit set to 25 cm H2O. Tidal volume is 400 mL. After vigorous diuresis, the delivered tidal volume increases to 700 mL. Which of the following changes would be appropriate in this case?

decrease the pressure limit
add mechanical deadspace
decrease the mandatory rate
increase the inspiratory time

42. For which of the following purposes would you recommend pressure support ventilation (PSV)?

to help manage hypoxemic respiratory failure
to control a patient’s minute ventilation
to increase the functional residual capacity
to boost spontaneous volumes during SIMV

43. What treatment would you recommend for a patient who has a 50% spontaneous pneumothorax?

increasing the patient’s FIO2
inserting of a chest tube
having the patient perform PEP therapy
initiating CPAP therapy at 10 cm H2O

44. The data below were obtained while an adult patient was receiving controlled mechanical ventilation with an FIO2 of 0.50 (PIP = peak pressure; BP = blood pressure)

6 cm H2O
8 cm H2O
10 cm H2O
12 cm H2O

45. Data for a 95 kg (209 lb) patient receiving ventilatory support are:

Ventilator Settings Blood Gases
Mode SIMV Vol Ctrl pH 7.40
VT 750 mL PaCO2 38 torr
Rate 8/min HCO3 23 mEq/L
FIO2 0.70 PaO2 43 torr
PEEP 0 cm H2O SaO2 78%

Which of the following changes would be appropriate at this time?

raise the VT to 900 mL
increase the rate to 12
apply 5 cm H2O PEEP
decrease the rate to 6

46. A 70 kg patient receiving mechanical ventilation has the following ventilator settings and arterial blood gas results. Which of the following should you recommend?

increasing the inspiratory time
increasing the tidal volume to 800 mL
decreasing the FIO2 to 0.50
increasing the SIMV rate

47. An adult patient who suffered a cerebral contusion and resulting cerebral edema from an automobile accident has just been placed on volume controlled A/C ventilation while in the Emergency Department. Initial ABG values are as follows:

pH 7.39
PaCO2 42 torr
HCO3 25 mEq/L
BE 0 mEq/L
PaO2 92 torr
SaO2 95%

What should you recommend in the management of this patient?

maintain the present settings and monitor the patient
increase the minute volume on the ventilator
increase the inspired O2 percentage
change to pressure control A/C ventilation

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

48. A patient with a large tension pneumothorax will usually exhibit:

A
B
C
D

49. Which of the following would you expect to see in a patient with “chronic” or compensated respiratory acidosis?

A
B
C
D

50. After insertion of an esophageal-tracheal Combitube® (ETC) in an adult patient in the Emergency Room, you cannot ventilate through either connector. In order to provide effective ventilation to this patient, you should:

deflate the #1 pharyngeal cuff and ventilate through connector #2
withdraw the tube 2-3 cm at a time while ventilating through connector #1
remove the ETC and re-establish the airway by any alternative means
deflate the #2 tracheal/esophageal cuff and ventilate through the connector #1

51. During properly performed chest compressions on children, the sternum should be compressed:

about 1/2 inch
about 1 inch
about 2 inches
about 3 inches

52. Which of the following is the most common sign associated with partial airway obstruction due to vomit, blood or secretions in a patient’s upper airway?

snoring
wheezing
gurgling
stridor

53. Inhalation of which of the following biological agents can result in the need for ventilatory support?

phosgene
botulism toxin
sarin
chlorine

54. In addition to vital signs, SpO2 and ECG, which of the following should be monitored during a cardiopulmonary exercise test?

maximum inspiratory pressure
physiologic deadspace and VD/VT
FEV1 and peak expiratory flow rate
patient’s perceived level of exertion

55. A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done BEFORE the tube itself is removed?

A
B
C
D

56. The most common late complication of flexible fiberoptic bronchoscopy (FFB) is which of the following?

laryngospasm
pulmonary infection
bronchospasm
pneumothorax

57. Which of the following is a potential hazard of thoracentesis?

barotrauma
liver laceration
pulmonary emboli
peritonitis

58. A home care patient calls and complains that the pulse-dose device connected to her liquid portable O2 unit is not “hissing” during inspiration. After confirming an adequate O2 supply and that the device is set to pulse-dose and is ON, you would recommend that she:

contact the pulse-dose unit’s manufacturer
remove and replace the unit’s air intake filter
make sure the delivery tubing is not kinked
immediately switch to a back-up O2 source

59. Which of the following measures could be used to evaluate the effectiveness of participation in a pulmonary rehabilitation program?

changes in forced expiratory volumes and flows
changes in perception of breathlessness/dyspnea
changes in resting pulse oxygen saturation (SpO2)
changes in complete blood count (CBC) values

60. In discussing the goals of a disease management program with a patient diagnosed with moderate sleep apnea, you explain that participation in the treatment plan should help resolve her daytime sleepiness. An additional goal you would share with the patient would be to:

correct acid-base imbalances
improve arterial oxygenation
increase exercise tolerance
improve the quality of life

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