1. Which of the following observations indicate that an infant’s work of breathing may be abnormally high?
B. digital clubbing
D. 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?
A. changes in dyspnea scores
B. changes in O2 consumption
C. changes in blood pressure
D. 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?
B. chronic bronchitis
C. pulmonary edema
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?
A. pulmonary fibrosis
B. chronic bronchitis
C. lobar collapse
D. 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?
C. foreign body obstruction
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?
A. slow and deep breathing
B. slow and shallow breathing
C. rapid and deep breathing
D. 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
A. at the same level as the carina
B. not more than 2 cm above the carina
C. between the 2nd and 4th thoracic vertebra
D. 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?
A. pulmonary contusion
B. pulmonary barotrauma
C. tension pneumothorax
D. interstitial emphysema
9. An adult patient with inspiratory stridor most likely has which of the following conditions?
B. laryngeal edema
C. retained secretions
D. air trapping
10. Bronchial breath sounds heard over the periphery indicate
A. normal lungs
B. lung consolidation
C. small airways obstruction
D. acute bronchospasm
11. Which of the characteristics of a patient’s sputum should be assessed at the bedside and documented in the chart?
B. DNA content
C. surface tension
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?
A. it would not affect the measurement
B. it would underestimate the CVP
C. it would cause damping of the signal
D. 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?
A. 100 mm Hg
B. 110 mm Hg
C. 120 mm Hg
D. 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
A. pass into the trap and then move on into the collection jar
B. pass through the wall tubing and then into the Lukens trap
C. pass through the suction catheter and then enter the Lukens trap
D. pass into the Lukens trap and then enter the suction catheter
15. Which of the following should be obtained and recorded when performing a bedside measure of vital capacity?
A. patient’s resting minute ventilation
B. patient’s heart rate before/after testing
C. patient’s actual and predicted body weight
D. patient’s height, gender and age
16. In analyzing overnight oximetry data, a desaturation event represents a decrease in SpO2 of:
A. 2% or more
B. 3% or more
C. 4% or more
D. 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)?
A. 8900 ml
B. 2000 ml
C. 3300 ml
D. 5700 ml
18. A patient breathing 100% O2 has a P(A-a)O2 of 400 torr. What is her approximate % shunt?
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?
A. complete catheter occlusion
B. air bubbles in system
C. transducer positioned too low
D. stopcock off to patient
20. Which of the following ECG leads should be placed in the left midaxillary line?
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:
A. 18 mL/cm H2O
B. 35 mL/cm H2O
C. 22 mL/cm H2O
D. 26 mL/cm H2O
22. For which of the following patients would you recommend extra precautions if undergoing a cardiopulmonary exercise test?
A. a patient being evaluated for coronary artery disease
B. a patient with a resting systolic BP > 200 mm Hg
C. a patient recommended for cardiac rehabilitation
D. a patient being assessed for cardiopulmonary disability
23. Before connecting the sample syringe to an adult’s arterial line stopcock, you would:
A. flush the line and stopcock with the IV solution
B. aspirate at least 5 mL fluid/blood using a waste syringe
C. align the stopcock off to the patient, on to the flush solution
D. 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?
25. An apnea monitor alarm is sounding continuously but your initial assessment of the patient reveals that they are breathing normally. You next action should be to:
A. Check the electrode connections on the patient
B. Immediately obtain a replacement monitor
C. Silence the alarm and call the equipment supplier
D. Replace the lead wires and patient cable
26. Pulse oximeter readings are generally unreliable at saturations below:
27. The normal end-tidal CO2 percentage as measured by capnography ranges between:
28. A patient with P/F ratio of 400 has:
A. normal oxygenation
B. mild ARDS
C. moderate ARDS
D. 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. a need for continued ventilatory support
B. a large leak in their endotracheal tube cuff
C. a normal maximum inspiratory pressure
D. adequate muscle strength to consider weaning
30. A patient has a maximum inspiratory pressure (MIP/NIF) of -15 cm H2O. This finding indicates:
A. muscle weakness
C. inadequate tidal volume
D. 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?
A. poor venous return
B. pulmonary barotrauma
C. decreased pleural pressure
D. 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:
A. increased airway resistance
B. decreased airway resistance
C. increased lung compliance
D. decreased lung compliance
33. Oxygen exchange at the lung is considered adequate if the arterial hemoglobin saturation (SaO2) can be maintained above:
34. Capnometry can be use to:
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?
A. mixed venous PO2
B. thoracic gas volume
C. maximum inspiratory pressure
D. 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:
A. pulmonary function testing
B. noninvasive pulse oximetry
C. frequent ABGs via radial puncture
D. 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?
A. stat chest X-ray
B. lab chemistry
C. right side thoracentesis
D. 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:
A. diagnose, stage and evaluate the treatment of non-small cell lung cancer
B. differentiate between infectious and noninfectious pulmonary infiltrates
C. detect and localize abnormalities of the pulmonary vascular circulation
D. 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?
A. cardiac enzyme determinations
B. arterial blood gas analysis
C. cardiovascular stress testing
D. 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?
A. continuous blood pressure monitoring
B. intermittent arterial blood gas sampling
C. pulse oximetry/SpO2 monitoring
D. real-time waveform capnography
41. In which of the following circumstances would you recommend using pulse oximetry?
A. to assess changes in oxygenation during procedures that can cause hypoxemia
B. to monitor oxygenation in patients with poor peripheral perfusion
C. to obtain precise/accurate assessment of a patient’s blood oxygenation
D. 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?
A. NIF measurement
B. chest x-ray
C. timed forced expiratory volumes
D. arterial blood gases
43. Which of the following procedures would be least helpful in diagnosing pulmonary embolization?
A. computerized tomography (CT) scan
B. pulmonary angiography
C. ventilation-perfusion (V/Q) scan
D. 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?
A. arterial blood gas analysis
C. pulse oximetry
D. 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?
A. failure of the thermostat mechanism
B. increased patient minute ventilation
C. addition of deadspace to circuit
D. decreased patient minute ventilation
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?
A. 4 hours, 10 minutes
B. 6 hours, 20 minutes
C. 2 hours, 50 minutes
D. 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:
A. use this device only with non-electrically sensitive patients
B. immediately take the piece of equipment out of service
C. use an extension cord to increase electrical resistance
D. 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?
A. 45-60 L/min
B. 60-75 L/min
C. 75-90 L/min
D. 30-45 L/min
49. What approximate volume should be used to inflate the larger #1 cuff of an esophageal-tracheal Combitube® (ETC)?
A. 12 – 15 mL
B. 20 – 30 mL
C. 40 – 60 mL
D. 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?
A. clogged bubble/diffuser
B. delivery tube obstruction
C. high wall outlet pressure
D. 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:
A. reduce the flow
B. change the regulator
C. replace the washer/seal
D. tighten the cylinder connection
52. Which of the following occurs when gas leaves a simple unheated bubble humidifier and is delivered to a patient?
A. the absolute humidity of the gas decreases
B. condensation occurs in the delivery tubing
C. the relative humidity of the gas decreases
D. the temperature of the gas increases
53. Which of the following types of nebulizers can produce the highest density aerosol suspension?
A. a heated jet nebulizer
B. a sidestream nebulizer
C. a metered dose inhaler (MDI)
D. 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?
A. ability to compensate for airway interface leaks
B. variable flow control and adjustable I:E ratios
C. ability to run on 12 volt DC (battery) power
D. certification for use during MRI procedures
55. In order to assure a stable FIO2 under varying patient demands, an oxygen delivery system must:
A. provide all the gas needed by the patient during inspiration
B. have a reservoir system at least equal to the tidal volume
C. maintain flows at least equal to the patient’s peak flows
D. 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?
A. 30 L/min
B. 35 L/min
C. 40 L/min
D. 45 L/min
57. Mechanical ventilation in the home setting can be provided by which of the following methods?
A. positive pressure via an intact upper airway
B. nasal continuous positive airway pressure
C. positive pressure via an oral endotracheal tube
D. 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?
A. increase the control pressure
B. switch the unit to 100% source gas
C. check/adjust ET tube cuff pressure
D. decrease the sensitivity setting
59. Which of the following is a consideration in selecting a fenestrated tracheostomy tube over a standard tracheostomy tube?
A. fenestrated tubes facilitate communication
B. fenestrated tubes reduce tracheal injury
C. fenestrated tubes minimize mucus encrustation
D. fenestrated tubes minimize the risk of contamination