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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?


A. pasteurization at 63 °C for 30 minutes
B. exposure to micowave radiation for 20-30 min
C. surface disinfection with 70% ethyl alcohol
D. 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?


A. small volume drug nebulizer
B. ultrasonic nebulizer
C. large volume jet nebulizer
D. 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?


A. statistical probability/chance
B. contaminated buffer solutions
C. incorrect analysis procedures
D. 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?


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


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


A. tonometered whole blood samples
B. commercial calibration control media
C. precision gas mixtures (O2/CO2)
D. 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?


A. percussion
B. palpation
C. auscultation
D. inspection


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


A. requires manual ventilation
B. is less than 12 years old
C. is unconscious/unresponsive
D. has an active gag reflex


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


A. with an intact gag reflex
B. for whom ET intubation is difficult
C. with a suspected cervical spine injury
D. needing emergency ventilation


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


A. use an airway exchange catheter
B. thread the ET tube down the King LT
C. insert the ET tube around the King LT
D. 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. A
B. B
C. C
D. 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


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


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


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


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


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


A. hypothermia
B. retained secretions
C. hypovolemia
D. a high fever


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


A. increase minute ventilation
B. change in chest X-ray
C. decreased arterial PCO2
D. 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. A
B. B
C. C
D. D


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


A. sustained tidal volume
B. maximum sustained inspiration
C. maximal voluntary ventilation
D. vital capacity


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


A. prepare the medication
B. start the treatment with low pressure
C. explain the treatment to the patient
D. 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?


A. Perform endobronchial suctioning
B. Switch to volume control SIMV
C. Decrease the ventilator pressure limit
D. Recommend a bronchodilator treatment

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


A. exhale maximally after a normal inspiration
B. inhale maximally after a normal exhalation
C. exhale maximally after a maximal inspiration
D. inhale maximally after a maximal exhalation


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


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


22.  The primary goal of O2 therapy is to:


A. improve tissue perfusion
B. decrease the work of breathing
C. correct arterial hypoxemia
D. 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. A
B. B
C. C
D. D
24.  For which of the following patients would application of noninvasive positive pressure ventilation (NPPV) likely be most difficult?


A. a patient with acute exacerbation of COPD
B. a patient with Duchenne muscular dystrophy
C. 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:


A. subtract the preset machine rate from the total displayed rate
B. divide the total minute ventilation by the total frequency
C. observe actual chest motion and airway pressure deflections
D. 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?


A. decreased cardiac output
B. oxygen-induced hypoventilation
C. absorption atelectasis
D. pulmonary vasodilation
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27.  Factors affecting the FIO2 received by a patient via a nasal cannula include which of the following?


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


A. suction the patient via the endotracheal tube
B. change the nebulizer entrainment setting to 50%
C. increase the oxygen input flow to 12 L/min
D. 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?


A. assist-control ventilation
B. intermittent mandatory ventilation
C. control mode ventilation
D. pressure support ventilation


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


A. hypoxemia associated with obstructive sleep apnea
B. hypoxemia in neonates with persistent pulmonary hypertension
C. ventilatory failure in premature neonates Incorrect
D. hypoxemia associated with hyaline membrane disease


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


A. loss of most of the drug content through evaporation
B. denaturation of the drug due to high circuit temperatures
C. reconcentration of the drug in the ventilator humidifier
D. 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?


A. substituting acetylcysteine (Mucomyst) for the albuterol
B. decreasing the frequency of albuterol treatments
C. substituting ipratropium (Atrovent) for the albuterol
D. substituting budesonide (Pulmicort) for the albuterol


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


A. density
B. viscosity
C. flammability
D. specific gravity


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


A. racemic epinephrine
B. acetylcysteine (Mucomyst)
C. albuterol (Proventil)
D. 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?


A. switching to a high flow cannula at 15-20 L/min
B. decreasing the nonrebreathing mask flow to 6 L/min
C. switching to a 50% air-entrainment/venturi mask
D. 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?


A. nasal cannula at 4–5 L/min
B. nasal cannula at 2 L/min
C. nonrebreather mask at 10 L/min
D. 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?


A. increasing the tidal volume
B. decreasing the set (machine) rate
C. adding 5 cm H2O PEEP
D. 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?


A. change to noninvasive BiPAP at 20 cm H2O/5 cm H2O IPAP/EPAP
B. decrease the inspiratory flow to 30 L/min and monitor for auto-PEEP
C. administer ipratropium + albuterol (Combivent) inline via MDI + spacer
D. 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:


A. post-extubation edema
B. a bypassed upper airway
C. laryngotracheobronchitis
D. 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?


A. decrease the inspiratory flow
B. increase the expiratory time
C. decrease the PEEP level
D. 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?


A. decrease the pressure limit
B. add mechanical deadspace
C. decrease the mandatory rate
D. increase the inspiratory time


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


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


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


A. increasing the patient’s FIO2
B. inserting of a chest tube
C. having the patient perform PEP therapy
D. 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)


A. 6 cm H2O
B. 8 cm H2O
C. 10 cm H2O
D. 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?


A. raise the VT to 900 mL
B. increase the rate to 12
C. apply 5 cm H2O PEEP
D. 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?


A. increasing the inspiratory time
B. increasing the tidal volume to 800 mL
C. decreasing the FIO2 to 0.50
D. 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?


A. maintain the present settings and monitor the patient
B. increase the minute volume on the ventilator
C. increase the inspired O2 percentage
D. change to pressure control A/C ventilation
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48.  A patient with a large tension pneumothorax will usually exhibit:


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


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


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


A. deflate the #1 pharyngeal cuff and ventilate through connector #2
B. withdraw the tube 2-3 cm at a time while ventilating through connector #1
C. remove the ETC and re-establish the airway by any alternative means
D. 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:


A. about 1/2 inch
B. about 1 inch
C. about 2 inches
D. 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?


A. snoring
B. wheezing
C. gurgling
D. stridor


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


A. phosgene
B. botulism toxin
C. sarin
D. chlorine


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


A. maximum inspiratory pressure
B. physiologic deadspace and VD/VT
C. FEV1 and peak expiratory flow rate
D. 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. A
B. B
C. C
D. D


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


A. laryngospasm
B. pulmonary infection
C. bronchospasm
D. pneumothorax


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


A. barotrauma
B. liver laceration
C. pulmonary emboli
D. 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:


A. contact the pulse-dose unit’s manufacturer
B. remove and replace the unit’s air intake filter
C. make sure the delivery tubing is not kinked
D. 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?


A. changes in forced expiratory volumes and flows
B. changes in perception of breathlessness/dyspnea
C. changes in resting pulse oxygen saturation (SpO2)
D. 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:


A. correct acid-base imbalances
B. improve arterial oxygenation
C. increase exercise tolerance
D. improve the quality of life


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