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

1. At their point of origin, contaminated sharps should be:

placed in a puncture-resistant bag
disassembled before discarding
placed in a rigid sharps container
broken or bent before discarding

2. The first step in equipment processing is:

pasteurization
cleaning
disinfection
sterilization

3. You review the following quality control graph (Levy-Jennings chart) for one of a blood gas analyzer’s measurements, with each dot representing a control run and SD = standard deviation. Based on review of this chart, which of the following conclusions can you draw?

a shift may be coming
a trend has developed
the device is in control
there is excessive variability

4. When calibrating a Clark electrode O2 analyzer, you cannot get the unit to read higher than 80% when the sensor is exposed to 100% O2. Your first action should be to:

reset the alarms
replace the batteries
replace the membrane
replace the electrode

5. A patient with severe ARDS has an SpO2 of 84%, but analysis of a blood gas sample obtained by a first-year resident shows a PaO2 of 140 torr. Which of the following problems would you suspect?

use of glass syringe
delay before analysis
air bubbles in sample
venous blood sample

6. Which of the following should be done in preparation for switching from an esophageal-tracheal Combitube® (ETC) to an oral endotracheal tube?

make sure the ETC is positioned in the trachea
avoid aspirating the stomach before the switch
use the same equipment as for ET tube intubation
inflate the pharyngeal cuff before laryngoscopy

7. Continuous bland aerosol poses the greatest risk for

patients with a tracheostomy
adults with normal fluid balance
patients with asthma
patients with hypothermia

8. After a patient is intubated in the ER, your partner begins manual ventilation with 100% O2. During auscultation, you note decreased breath sounds on the left, while also observing reduced chest wall movement on the same side. Which of the following has most likely occurred?

the right mainstem bronchus has been intubated
there is a right-sided tension pneumothorax
the left mainstem bronchus has been intubated
the patient’s esophagus has been intubated

9. You should remove a supraglottic airway (e.g., LMA, Combitube, King LT) when

the patient’s MIP/NIF exceeds 30 cm H2O
the patient becomes unconscious
the patient’s protective reflexes return
the patient requires manual ventilation

10. A patient begins breathing and regains effective circulation after resuscitation but remains unconscious. What position should you place this patient in?

Trendelenburg
supine
prone
lateral recumbent

11. Which of the following is TRUE regarding humidification during high flow nasal cannula therapy?

an unheated large volume nebulizer with large-bore tubing is required
a simple unheated wick humidifier provides adequate humidification
both a heated humidifier and heated delivery circuit are required
extra humidity is not needed because the upper airway is not bypassed

12. Which of the following is true regarding the use of a tracheostomy tube obturator?

it is placed in the trach tube prior to insertion
it is used to dilate the stoma opening to fit the trach tube
it should be disposed of after trach tube insertion
it should be placed after trach tube insertion

13. To get a better view of the glottis before inserting an ET tube, you could ask the attending nurse to:

place downward pressure on the cricoid cartilage
maximally flex the patient’s neck and head
insert a second laryngoscope in the mouth
pass a suction catheter through the nasopharynx

14. To correctly size a tracheostomy button, the clinician must:

perform a cuff-leak test
determine the stoma depth
assess the gag reflex
measure the tracheal diameter

15. Your patient is on a ventilator in the volume control mode. After you perform endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?

lower peak pressure
smaller VT
lower plateau pressure
decreased inspiratory time

16. Which of the following patients is a poor candidate for IPPB therapy?

a post-op female patient with clinically diagnosed atelectasis
a chronically hypercapnic patient with full metabolic compensation
a patient being treated for acute cardiogenic pulmonary edema
a patient with acute-on-chronic respiratory acidosis

17. To increase the expiratory pressure level when using a threshold-type PEP device you would:

select and connect a larger orifice to the device
have the patient exhale more slowly
increase the spring tension on the device
raise the angle of the device above horizontal

18. Therapeutic gases being delivered to patients need to be humidified because they:

have low specific gravities
become less combustible when humidified
are supplied at low critical temperatures
are supplied in the anhydrous state

19. Which of the following therapeutic strategies can help minimize the likelihood of a patient developing postoperative atelectasis?

A
B
C
D

20. Which of the following can help prevent mucus plugging of a patient’s endotracheal tube?

A
B
C
D

21. Continuous positive airway pressure (CPAP) is indicated as a treatment for:

post-operative atelectasis
acute exacerbation of COPD
hypercapnic respiratory failure
acute pulmonary emboli

22. During volume control SIMV you adjust the proportion of ventilation assumed by the patient primarily by changing the:

PEEP level
mandatory rate
mandatory tidal volume
pressure support level

23. While doing a ventilator check on a patient recveiving volume controlled ventilation you observe ‘scalloping’ of the inspiratory airway pressure waveform (Paw) occurring after the beginning of each machine breath. Which of the following can explain this finding?

improper sensitivity setting
presence of auto-PEEP/air-trapping
a leak in the patient-ventilator system
inadequate inspiratory flow setting

24. A patient is receiving oxygen via a 28% air entrainment mask set at the manufacturer’s specified input flow of 5 L/min. Which of the following would occur if you were to increase the O2 input flow to 7 L/min?

the total outflow would increase
the delivered FIO2 would increase
the air to oxygen ratio would increase
the delivered FIO2 would decrease

25. A doctor requests that you increase the expiratory time on a patient receiving volume control ventilation, but not alter the minute ventilation. Which of the following settings would you adjust to fulfill the doctor’s request?

tidal volume
rate of breathing
trigger sensitivity
inspiratory flow

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

26. A doctor asks you to decrease the PaCO2 of a patient receiving high-frequency oscillation ventilation (HFOV). Which of the following should you consider adjusting?

decreasing the bias flow
increasing the frequency (Hz)
adding mechanical deadspace
increasing the power/amplitude

27. Which of the following conditions would represent a potential contraindication against performing a lung recruitment maneuver?

A
B
C
D

28. A physician wants a stable FIO2 of 0.50 for a newborn infant with severe hypoxemia. Which of the following systems would you select?

simple O2 mask/unheated humidifier set at 2 L/min
pediatric (“croup”) tent with O2 input of 8 L/min
oxygen hood with blender and unheated humidifier
oxygen hood with blender and heated humidifier

29. An ideal adult continuous flow CPAP system should be capable of maintaining a baseline pressure of:

+/- 2 cm H2O
+/- 4 cm H2O
+/- 6 cm H2O
+/- 8 cm H2O

30. When hypertonic saline solution (3-7%) is administered by aerosol, it is being used as a:

mucokinetic
antifoaming agent
diluent
decongestant

31. When administering aerosolized albuterol (Proventil) you should be on guard for which of the following adverse effects?

bradycardia
laryngospasm
tachycardia
vagovagal reflex

32. A postoperative patient develops bilateral wheezing. Which of the following is the most appropriate therapy for this condition?

incentive spirometry
mucolytic agent
chest physiotherapy
bronchodilator

33. Your supervisor gives you a multi-dose vial of an expensive medication for aerosol administration to patients on your shift. You note that the expiration date on the label was two days ago. The supervisor says that since the med is kept refrigerated, it is OK to use for another week or so. You should:

follow the supervisor’s instructions and use the medication
check with the pharmacist to see if the med needs refrigeration
ask the medical director if it is OK to use the medication
discard the medication and obtain a new unexpired vial

34. A patient complains to you that he is not getting any benefit from using his dry powder inhaler (DPI). You inspect the device and note a substantial amount of caked powder residue in its outlet. Which of the following would you recommend to the patient?

wash the device in a dilute detergent solution and let it drip dry
always shake the device for 20-30 sec after loading the drug dose
clean the outlet with a dry cloth and stored it capped in a dry place
after inhaling the drug powder, be sure to exhale back into the device

35. A patient is paced on volume controlled SIMV with a mandatory rate of 14/min and an FIO2 of 0.40. Arterial blood gas results after 30 minutes are as follows:

Blood Gases
pH 7.52
PaCO2 30 torr
HCO3 24 mEq/L
PaO2 85 torr

At this time, which of the following actions would be most appropriate?

add 100 mL of deadspace
increase the tidal volume
reduce the FIO2
reduce the mandatory rate

36. A spontaneously breathing premature infant is placed in a 70% oxygen hood. ABG results are as follows:

pH 7.38
PaCO2 37 torr
HCO3 21 mEq/L
PaO2 40 torr
SaO2 73%

Based on these data, you should change to which of the following?

mist tent
nasal CPAP
double-walled Isolette
mechanical ventilator

37. A patient suspected of an opiate narcotic overdose is barely breathing. Which of the following drugs would you recommend to increase ventilation?

pancuronium (Pavulon)
naloxone (Narcan)
diazepam (Valium)
midazolam (Versed)

38. A 59-year-old postoperative man who weighs 77 kg (169 lb) is receiving volume control A/C ventilation at a rate of 14/min with a tidal volume of 650 mL and an FIO2 of 0.4. Results of arterial blood gas analysis are as follows:

Blood Gases
pH 7.51
PaCO2 30 torr
HCO3 23 mEq/L
BE -1
PaO2 117 torr
SaO2 99%

Based on this information, you should recommend which of the following?

decrease the minute ventilation
discontinue mechanical ventilation
increase the peak flow setting
administer IV bicarbonate

39. The following data are obtained for a 50-kg (110-lb), 15 year-old postoperative female patient receiving volume control SIMV:

Ventilator Settings Blood Gases
FIO2 0.40 pH 7.52
Machine Rate 10/min PaCO2 28 torr
Total Rate 26/min PaO2 90 torr
VT 400 mL SaO2 93%
PEEP 5 cm H2O HCO3 22 mEq/L
PIP 30 cm H2O BE -1

The patient is anxious and biting on the ET tube. Which of the following should you recommend?

Administer midazolam (Versed)
Increase the FIO2
Decrease the mandatory rate
Administer vecuronium (Norcuron)

40. During postural drainage with percussion, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?

immediately discontinue the treatment and contact the physician
have the patient assume a sitting position and cough strenuously
place the patient in a head-down position and call the nurse
immediately institute tracheobronchial aspiration (suctioning)

41. While you are performing postural drainage and percussion on the superior segment of a patient’s left lower lobe, he coughs vigorously. You note that the sputum is mixed with a large amount of bright red blood. You would:

stop the treatment, stabilize the patient and inform the physician
continue the treatment and make a note of the sputum in the chart
give the patient O2 by simple mask and continue the treatment
quickly discard the sputum so the patient does not see it and become upset

42. A patient with airway obstruction due to laryngeal trauma is admitted to the ER. Based on the physician’s evaluation, the patient will need long-term ventilatory support. Which of the following would you recommend to establish a patent tracheal airway for this patient?

surgical tracheotomy
nasotracheal intubation
cricothyrotomy
orotracheal intubation

43. A doctor is considering weaning a patient from invasive mechanical ventilation. Which of the following approaches would you recommend to wean this patient?

airway pressure release ventilation
pressure control with PEEP
pressure support with CPAP
decreasing rate SIMV

44. A patient with chronic bronchitis is receiving volume controlled A/C ventilation. Wheezing is heard over all lung fields, rhonchial fremitus is felt over the central airways, and secretions are thick. The patient’s peak pressure is 45 cm H2O and plateau pressure is 20 cm H2O. Which of the following would be useful to treat the patient’s condition?

triamcinolone (Azmacort)
cromolyn sodium (Intal)
pancuronium bromide (Pavulon)
levalbuterol (Xopenex)

45. A patient in Intensive Care Unit with congestive heart failure receiving assist/control ventilation with a set volume of 650 mL exhibits the following data on three consecutive patient-ventilator checks. The patient also exhibits diffuse crackles at the bases and some wheezing. Which of the following would you recommend for this patient?

a diuretic
a bronchodilator
a mucolytic
a steroid

46. A patient able to maintain adequate spontaneous ventilation has PaO2 of 42 mm Hg while receiving oxygen via a nonrebreathing mask set at 12 L/min. Which of the following would you recommend to the patient’s physician?

initiate continuous positive airway pressure
increase the mask oxygen flow to 15 L/min
administer IPPB treatments q2h with 100% O2
switch to a partial rebreathing mask at 15 L/min

47. A patient receiving a bland ultrasonic nebulizer treatment begins to wheeze. Which of the following should you do at this time?

discontinue therapy, monitor patient and notify the physician
decrease the nebulizer output
add oxygen to the nebulizer circuit
continue therapy and reassure the patient

48. The unit resident orders oxygen therapy at 3 L/min via simple mask for a stable COPD patient with chronic hypercapnia. Which of the following would be the correct action at this time?

change the mask to a nasal cannula at 3 L/min
carry out the resident’s orders as written
increase the flow to 6 L/min to wash out CO2
suggest an air entrainment mask at 35%

49. Due to thick and tenacious secretions, a nurse is having difficulty suctioning a patient receiving ventilatory support via an 9 mm ET tube using a 14 French catheter. Humidification is being provided by an HME. Which of the following would you recommend to facilitate airway clearance in this patient?

A
B
C
D

50. A COPD patient is receiving sustained-release theophylline treatments. Which of the following is a possible adverse effect of this therapy?

hyperkalemia
hypoglycemia
cardiac arrhythmias
respiratory alkalosis

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

51. Due to traumatic upper airway injuries, a patient cannot be orally intubated and bag-mask ventilation fails. Which of the following actions would you recommend at this time?

nasotracheal tube insertion
laryngeal mask airway insertion
percutaneous tracheostomy
esophageal-tracheal tube insertion

52. A patient receiving pressure control SIMV at a mandatory rate of 14/min has the following ABGs on an FIO2 of 0.45: pH=7.58; PCO2=21 torr; PO2=88 torr. The physician requests that you try to normalize the pH. Which of the following actions would be appropriate?

decrease the mandatory (machine) rate
add mechanical deadspace to the circuit
decrease the inspiratory flow rate
increase the mandatory (machine) rate

53. A 165 lb (75 kg) patient is receiving volume control ventilation with a VT of 600 mL, a mandatory rate of 14 breaths/min, and 40% O2. Arterial blood gas analysis results are as follows:

pH 7.39
PaCO2 38 torr
HCO3 22 mEq/L
BE -1 mEq/L
PaO2 85 torr
SaO2 94%

The physician orders the patient be switched to pressure control (PC) ventilation with a pressure limit of 35 cm H2O, which results in a VT of 750 mL. What is the appropriate action at this time?

add 100 mL mechanical deadspace
maintain the present settings and monitor the patient
reduce the pressure limit to restore the prior VT
add 5 cm H2O PEEP

54. In reviewing the chart of a hypoxemic 70 year old patient with chronic bronchitis, you would expect to see which one of the following?

respiratory alkalosis
dry hacking cough
cor pulmonale
chronic anemia

55. A 70-year-old male patient in the emergency department complains of shortness of breath, chest pain, and diaphoresis. The ER physician asks you to begin an assessment. Your initial action should be to:

obtain an arterial sample for CO-oximetry
recommend obtaining a sputum sample
measure his maximum inspiratory pressure
administer oxygen and monitor his SpO2

56. Which of the following clinical findings are consistent with cor pulmonale?

left axis deviation on ECG
distention of the neck veins
high pulmonary artery wedge pressue
bilateral infiltrates on chest X-ray

57. A doctor institutes volume control A/C ventilation for an 80-kg ARDS patient. Which of the following is the maximum plateau pressure you should aim to achieve in this patient?

50 cm H2O peak pressure
30 cm H2O plateau pressure
40 cm H2O peak pressure
50 cm H2O plateau pressure

58. Your assessment of a postoperative patient indicates a weak cough and poor secretion clearance, with course rhonchi and ‘gurgling’ hear on auscultation. Which of the following should be considered for this patient’s respiratory care plan?

A
B
C
D

59. Which of the following drugs is indicated during an acute asthmatic episode?

beclomethasone (Vanceril)
albuterol (Proventil)
salmeterol (Serevent)
Cromolyn (Intal)

60. Which of the following drugs can be administered via an endotracheal tube during emergency life support?

Lidocaine Amiodarone Epinephrine Atropine
Yes Yes Yes No
Yes No Yes Yes
Yes Yes Yes No
No Yes No Yes

A
B
C
D

61. The cardinal feature of complete airway obstruction is:

the presence of sonorous breathing, stridor or wheezing
an absence of air movement despite efforts to breathe
the presence of peripheral cyanosis (acrocyanosis)
an abnormally low blood oxygen saturation (SpO2 < 90%)

62. You are asked to evaluate a home patient with a nasal CPAP mask for treatment of obstructive sleep apnea. The patient’s wife states that he has been snoring more loudly lately and having periods of apnea. You confirm this after observing the patient’s sleeping and breathing patterns for 2 hr. What would you do first to try to correct the problem?

have the patient go to the hospital emergency department
adjust the nasal mask to ensure a better fit with no pressure loss
switch him to a electrically-powered home mechanical ventilator
suggest that he sleep with both the CPAP and an oropharyngeal airway

63. Which of the following is NOT characteristic of a well-formulated disease management action plan goal?

the goal should be specific
the goal should be measurable
the goal should be realistic
the goal should be open-ended

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