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1.  While reviewing the chart of a patient with lobar pneumonia, you note that the respiratory rate for the last 24 hours has increased from 18 to 38/min. Which of the following is the most likely cause of the increased respiratory rate?


A. hypothermia
B. hyperkalemia
C. hypoxemia
D. metabolic alkalosis


2.  A physician’s order for a potent aerosol bronchodilator indicates three times the normal recommended dosage. Which of the following would be the appropriate action to take in this case?


A. have the nurse responsible for this patient give the drug
B. substitute a less potent aerosol bronchodilator agent
C. postpone therapy until able to contact the ordering physician
D. use the standard dosage listed in the package insert


3.  Procedures that can confirm a diagnosis of Pneumocystis carinii (jiroveci) pneumonia (PCP/PJP) include which of the following?


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


4.  In reviewing the PFT results of a 67 year old smoker with an admitting diagnosis of emphysema and chronic bronchitis you would expect which of the following general findings?


A. increased airway resistance and decreased lung compliance
B. increased airway resistance and increased lung compliance
C. decreased airway resistance and decreased lung compliance
D. decreased airway resistance and increased lung compliance


5.  An adult patient has an intracranial pressure (ICP) of 24 mm Hg. You can conclude that:


A. the ICP is normal
B. the ICP is below normal
C. the ICP is abnormally high
D. there is excessive CSF


6.  A polysomnography report indicates an average of 12 mainly obstructive apnea/hypopnea events per hour. Which of the following statements is most consistent with this observation?


A. since there are less than 15 events per hour, the findings are inconclusive
B. the findings confirm a diagnosis of mild obstructive sleep apnea
C. the findings confirm a diagnosis of moderate obstructive sleep apnea
D. the findings confirm a diagnosis of severe obstructive sleep apnea


7.  The results of an arterial blood gas analysis are below:


Blood Gases
pH        7.28
PaCO2 22 torr
HCO3   10 mEq/L
BE        -15
PaO2   110 torr


These data indicate which of the following?


A. primary metabolic acidosis
B. primary metabolic alkalosis
C. primary respiratory alkalosis
D. primary respiratory acidosis


8.  The expected PaO2 for an 80 year old man who is otherwise in good health and breathing room air is about:


A. 90 torr
B. 70 torr
C. 80 torr
D. 60 torr


9.  When inspecting the X-ray of a patient with a history congestive heart failure being treated in the Emergency Department, you note patchy densities in the perihilar areas and in the gravity-dependent lower lung fields, with an increased CT ratio. Which of the following is the most likely problem?


A. pleural effusion
B. bacterial pneumonia
C. pulmonary edema
D. atelectasis


10.  In patients with chronic respiratory disease, pedal edema is a sign of:


A. impaired pulmonary diffusion
B. hypercapnia (impaired CO2 removal)
C. right ventricular hypertrophy/failure
D. systemic hypertension


11.  Which of the following terms best describes an adult pulse rate of 125 per minute?


A. bradycardia
B. tachycardia
C. pulsus paradoxus
D. pulsus alternans


12.  You are evaluating a patient in the recovery room following an exploratory laparotomy. The patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine the patient’s level of consciousness, you speak to the patient, who does not respond. Which of the following should you do FIRST?


A. wait 1 hour and then repeat the attempt
B. shake the patient’s arm gently
C. call for help
D. administer a sternal rub


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


A. palor
B. digital clubbing
C. chest wall retractions
D. acrocyanosis


14.  Upon palpating a patient’s pulse, you note 85 unevenly spaced beats, with a marked decreased in pulse strength during inspiration. Which of the following describes the patient’s pulse?


A. thready pulse
B. bounding pulse
C. pulsus alternans
D. pulsus paradoxus
15.  Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL?


A. ribs higher posteriorly than anteriorly at end-expiration
B. sternocleidomastoid muscles used at rest
C. costal angle of 90 degrees increases with inspiration
D. respiratory rate of 18 breaths per minute


16.  Which of the following findings would you expect to observe on the AP chest radiograph of a patient suffering from advanced stages of pulmonary emphysema?


A. increased vascular markings
B. flattening of the diaphragms
C. decreased radiolucency
D. increased C/T ratio


17.  When inspecting the x-ray of a premature infant in NICU receiving mechanical ventilation, you note a radiolucent band of air surrounding the heart. Which of the following is the most likely problem?


A. subcutaneous emphysema
B. pneumopericardium
C. tension pneumothorax
D. pulmonary interstitial emphysema


18.  Which of the following observations during inspection of the extremities indicate poor peripheral circulation?


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


19.  You palpate your patient’s neck and notice that the trachea is shifted to the patient’s left. Which of the following conditions could explain this finding?


A. left ventricular enlargement
B. left upper lobe collapse
C. right lower lobe collapse
D. pleural effusion on the left

20.  The attending physician of a patient who is experiencing pain asks that you evaluate the intensity of her pain. The most objective way to do so would be to:


A. Ask the patient “How much pain are you having”
B. Observe the patient for facial expressions indicative of pain
C. Measure the patient’s pulse and respiratory rate
D. Have the patient rate her pain on a numeric rating scale


21.  While observing a patient’s pattern of breathing, you note that the abdomen moves inward as the rib cage expands during inspiration. Which of the following descriptions would you note in the respiratory notes?


A. “patient exhibits inspiratory retractions”
B. “patient exhibits asynchronous breathing”
C. “patient exhibits apneustic breathing”
D. “patient exhibits normal breathing pattern”


22.  You obtain the following pre- and post-bronchodilator measures on a 29 year old 6-foot 2 inch tall male patient with a chief complaint of exertional dyspnea who is undergoing disability evaluation:


A. The results are normal for a man of this size
B. The patient has airway obstruction
C. The patient has a restrictive disorder
D. The patient is not exerting sustained effort


23.  The best site for capillary puncture in an infant is:


A. the lateral aspect of the heel’s plantar surface
B. the anterior curvature of the heel
C. the medial aspect of the heel’s plantar surface
D. the posterior curvature of the heel


24.  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 his total lung capacity (TLC)?


A. 8900 mL
B. 2000 mL
C. 3300 mL
D. 6500 mL


25.  During volume control ventilation, monitoring of airway pressure is useful because it best reflects changes in:


A. arterial carbon dioxide tension
B. arterial oxygen tension
C. intracranial pressure
D. pulmonary compliance
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26.  You obtain the following data on a patient receiving volume control ventilation:


Peak pressure             45 cm H2O
Plateau pressure         30 cm H2O
PEEP                            10 cm H2O
Set tidal volume         700 mL
Inspiratory flow          75 L/min


What is the patient’s inspiratory airway resistance?


A. 8 cm H2O/L/sec
B. 12 cm H2O/L/sec
C. 15 cm H2O/L/sec
D. 15 cm H2O/L/sec


27.  When using a point-of-care blood gas analyzer to measure a patient’s blood gas values in the ED, the device flags the results as being not reportable, even after repeating the analysis using a fresh sample and new cartridge. What action should you take at this time?


A. send sample to the central laboratory for analysis
B. repeat the analysis a third time using a fresh cartridge
C. check to confirm that the batteries are properly charged
D. repeat the analysis a third time using a fresh sample


28.  Under which of the following conditions would you recommend ending a cardiopulmonary exercise evaluation?


A. fall in systolic blood pressure > 20 mm Hg
B. heart rate increase from 88/min to 165/min
C. 5% decrease in SpO2 from baseline value
D. increase in patient’s level of dyspnea


29.  To assess gas exchange at the tissues you would sample blood from which of the following?


A. systemic artery
B. central vein
C. pulmonary artery
D. peripheral vein


30.  A patient receiving CMV with 12 cm H2O PEEP has a corrected VT of 550 ml, a peak pressure of 45 cm H2O and a plateau pressure of 37 cm H2O. What is her compliance?


A. 14 ml/cm H2O
B. 18 ml/cm H2O
C. 22 ml/cm H2O
D. 28 ml/cm H2O


31.  Basic instructions for performing a maximum voluntary ventilation (MVV) maneuver would be to:


A. Breathe as fast and deep as possible for 12 to 15 seconds
B. Inhale maximally then forcefully exhale for at least 6 seconds
C. Breathe as fast and deep as possible for a full minute
D. Inhale and exhale rapidly but maintain a normal tidal volume


32.  Before taking a spot reading with a pulse oximeter, you should:


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


33.  Which of the following equipment would you select to measure or adjust endotracheal tube cuff pressures at the bedside?


A. pneumotachometer
B. vane respirometer
C. aneroid manometer
D. pressure transducer


34.  During initial assessment of a patient with a closed-head injury, the patient opens his eyes in response to pain only. On a follow-up exam, the patient opens his eyes to verbal commands. These observations indicate which of the following?


A. intracranial pressure has increased
B. cerebral perfusion has decreased
C. the level of consciousness is improving
D. there is increased seizure activity


35.  A patient is receiving pressure controlled A/C ventilation. Which of the following changes would occur if the patient’s compliance were to decrease?


A. inspiratory time will increase
B. PEEP level will decrease
C. peak pressure will increase
D. delivered volume will decrease


36.  As compared to predicted normals, a patient has a normal FEV1%, but a reduced FEF25-75. Test results are repeatable. Which of the following is the most likely underlying problem?


A. combined restrictive and obstructive disease
B. peripheral (small) airway obstruction
C. a restrictive disorder of the chest wall
D. severe central (large) airway obstruction


37.  A patient in shock exhibits the following cardiovascular measures: a DECREASE in pulmonary artery pressure, an INCREASE in systemic vascular resistance, and a DECREASE in cardiac output. Given these data, the most likely type of shock is:


A. anaphylactic shock
B. neurogenic shock
C. hyperdynamic septic shock
D. hypovolemic shock


38.  A patient’s bedside spirometry results (as compared to normal) are as follows:


FVC normal
FEV1 decreased
FEV1% decreased


What is the most likely problem?


A. an obstructive disorder
B. poor patient effort
C. a restrictive disorder
D. a mixed (obstructive + restrictive) disorder


39.  You are monitoring the static compliance of a 95 kg patient receiving volume control ventilation with a tidal volume that remains constant at 900 mL. Which of the following data sets indicates the highest static compliance?


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


40.  Which of the following apnea monitor event recording patterns is most consistent with motion or activity artifact?


A. increased respirations, increased heart rate
B. decreased respirations, decreased heart rate
C. increased respirations, decreased heart rate
D. decreased respirations, increased heart rate


41.  Based on the results of cardiopulmonary exercise testing, which of the following patients most likely has a cardiovascular limitation to exercise?


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


42.  On reviewing an ECG print-out you note widen QRS complexes. Which of the following is the most likely cause of this problem?


A. atrial fibrillation
B. 1st degree heart block
C. sinus arrhythmia
D. bundle branch block


43.  The results of a patient’s spirometry tests before and after bronchodilator therapy are below


Parameter       Pre %   Post %
FVC (L)             48%     85%
FEV1 (L)          32%     65%
FEV1/FVC (%) 44%     60%


Which of the following is the correct interpretation of these results?


A. mild obstructive disease, no significant bronchodilator response
B. mild restrictive disease, significant bronchodilator response
C. severe obstructive disease, significant bronchodilator response
D. severe restrictive disease, no significant bronchodilator response


44.  A patient in shock exhibits the following cardiovascular responses: an INCREASED pulmonary artery pressure, an INCREASED systemic vascular resistance, and a DECREASED cardiac output. Given these data, the most likely type of shock is:


A. hypovolemic shock
B. neurogenic shock
C. septic shock
D. cardiogenic shock


45.  You would recommend an overnight oximetry evaluation to:


A. warn against any apparent life-threatening events
B. screen patients for sleep apnea-hypopnea syndrome
C. assess for paroxysmal nocturnal dyspnea/CHF
D. differentiate obstructive from central sleep apnea


46.  The most common application of angiography in pulmonary medicine is to:


A. diagnose, stage and evaluate non-small cell lung cancer
B. confirm the diagnosis and location of pulmonary embolism
C. quantify the size (volume) and location of pleural effusions
D. assess the relationship between ventilation and perfusion


47.  Results of an overnight oximetry test of a 62 year old male with complaints of daytime sleepiness reveal an Oxygen Desaturation Index (ODI) of 5 desaturations per hour. Which of the following would you recommend?


A. a full poysomnography exam
B. nocturnal O2 therapy
C. an O2 titration with exercise
D. nocturnal CPAP therapy


48.  A physician asks you to assess a patient’s respiratory muscle strength. Which of the following bedside measures would you recommend?


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


49.  For which of the following patients is bedside measurement of vital capacity contraindicated?


A. a patient with interstitial fibrosis
B. a patient with diminished consciousness
C. a patient with myasthenia gravis
D. a patient with a pulmonary infection

50.  A doctor asks your advice on the best way for his home care asthma patient to assess changes in her airway tone over time. You would recommend:


A. peak expiratory flow rate monitoring
B. methacholine challenge (provocation) test
C. carbon monoxide diffusing capacity (DLco)
D. pre/post bronchodilator spirometry
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51.  The wife of a patient receiving post-operative incentive spirometry asks if this therapy will help get rid of his snoring, daytime sleepiness, and morning headaches. In communicating this information to the patient’s surgeon, you would recommend which of the following diagnostic procedures?


A. lateral neck X-ray
B. arterial blood gas
C. polysomnography
D. diffusing capacity


52.  Which of the following spirometry tests would you recommend to evaluate the severity of an obstructive lung disorder?


A. forced vital capacity
B. inspiratory capacity
C. tidal volume
D. expiratory reserve volume


53.  You obtain an expired carbon monoxide (CO) reading of 18 ppm on a COPD patient participating in a pulmonary rehabilitation program. Based on this finding, you can conclude that the patient:


A. can be classified as a nonsmoker
B. has abstained for more than 12 hours
C. has been exposed to secondhand smoke
D. has smoked within the prior 12-24 hours


54.  To obtain the best measure of whole-body tissue oxygenation in a critically ill patient, you would recommend which of the following?


A. a transcutaneous monitor
B. a pulmonary artery catheter
C. a brachial artery line
D. a multi-wavelength pulse oximeter


55.  The best way to assess a patient’s compliance with a smoking cessation program would be to:


A. interview the patient
B. measure the patient’s SpO2
C. administer a questionnaire
D. measure the patient’s CO levels


56.  A nurse who just set up a pleural drainage system on a patient with a pneumothorax complains that there is no bubbling in the suction control chamber. After checking the suction control regulator to confirm that it is on, you would recommend that she:


A. withdraw the thoracotomy (chest) tube about 2-3 cm
B. switch the suction control regulator to intermittent
C. add more water to the unit’s suction control chamber
D. check the connecting tubing for leaks or obstructions


57.  In order to deliver as high a concentration of oxygen as possible with a self-inflating bag-valve unit (manual resuscitator), you would:


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


58.  Which of the following are components of a portable home suction unit?


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


59.  An 80 years old patient is having a problem using the mouthpiece attached the small volume nebulizer being used to administer her bronchodilator treatment. What action should you take?


A. change to a dry powder inhaler (DPI)
B. change to a MDI (MDI)
C. hold the nebulizer for the patient
D. change to an aerosol mask


60.  An electronic bedside spirometer should provide which of the following automated validity checks on the forced expiratory maneuver?


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


61.  Which of the following are power sources can be used with most portable O2 concentrators?


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


62.  Measurement of the O2 of an air entrainment mask results in an incorrect FIO2. You should


A. decrease the oxygen flow
B. add a humidification system
C. check the entrainment ports
D. increase the oxygen flow


63.  You would add a corrugated extension tubing to the standard circuit of an in-exsufflation (cough assist) device in order to:


a. decrease resistance
b. trap secretions
c. increase deadspace
d. trap condensate


64.  You are asked to transport a mechanically ventilated a patient to the MRI center. What type of ventilator would you recommend to support the patient during this procedure?


A. a pneumatically powered and controlled ventilator
B. a high frequency oscillator ventilator
C. a standard ICU microprocessor controlled ventilator
D. a piston-drive home care type ventilator


65.  What is the approximate duration of flow of an oxygen D-cylinder which is half empty running at 4 L/min?


A. 40 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes


66.  When setting up a 12-lead ECG on a patient, you cannot obtain any electrical signal. The batteries are fully charged and the device passed its power-on self-test. Which of the following is the most likely cause of this problem?


A. a missing lead
B. motion artifact
C. improper filtering
D. a corroded connector


67.  A patient is receiving continuous flow CPAP at 10 cm H2O. Each time the patient inhales, the pressure decreases to 2 cm H2O. It returns to 10 cm H2O on exhalation. Which of the following is the most likely cause of the problem?


A. the flow of gas to the patient system is insufficient
B. there is a leak in the patient system
C. the patient’s endotracheal tube is too small
D. the CPAP pressure is set too high for the patient


68.  When selecting an endotracheal tube, you should consider which of the following to minimize airflow resistance?


A. outside diameter (OD)
B. cuff compliance
C. inside diameter (ID)
D. component materials


69.  A 2-year old asthmatic child is placed on an inline small volume nebulizer while receiving volume control SIMV. Shortly after the treatment has started, an alarm on the servo-controlled humidifier is activated. Which of the following is the most likely cause for this alarm?


A. empty water reservoir
B. low gas temperature
C. decreased humidity output
D. clogged expiratory filter


70.  The purpose of an endotracheal tube stylet is to:


A. help ascertain proper tube position
B. monitor cuff integrity and pressure
C. minimize mucosal trauma during insertion
D. add rigidity and shape to ease insertion


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