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


A. placed in a puncture-resistant bag
B. disassembled before discarding
C. placed in a rigid sharps container
D. broken or bent before discarding


2.  The first step in equipment processing is:


A. pasteurization
B. cleaning
C. disinfection
D. 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. a shift may be coming
B. a trend has developed
C. the device is in control
D. 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:


A. reset the alarms
B. replace the batteries
C. replace the membrane
D. 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?


A. use of glass syringe
B. delay before analysis
C. air bubbles in sample
D. 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?


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


7.  Continuous bland aerosol poses the greatest risk for


A. patients with a tracheostomy
B. adults with normal fluid balance
C. patients with asthma
D. 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?


A. the right mainstem bronchus has been intubated
B. there is a right-sided tension pneumothorax
C. the left mainstem bronchus has been intubated
D. the patient’s esophagus has been intubated


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


A. the patient’s MIP/NIF exceeds 30 cm H2O
B. the patient becomes unconscious
C. the patient’s protective reflexes return
D. 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?


A. Trendelenburg
B. supine
C. prone
D. lateral recumbent


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


A. an unheated large volume nebulizer with large-bore tubing is required
B. a simple unheated wick humidifier provides adequate humidification
C. both a heated humidifier and heated delivery circuit are required
D. 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?


A. it is placed in the trach tube prior to insertion
B. it is used to dilate the stoma opening to fit the trach tube
C. it should be disposed of after trach tube insertion
D. 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:


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


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


A. perform a cuff-leak test
B. determine the stoma depth
C. assess the gag reflex
D. 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?


A. lower peak pressure
B. smaller VT
C. lower plateau pressure
D. decreased inspiratory time


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


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


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


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


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


A. have low specific gravities
B. become less combustible when humidified
C. are supplied at low critical temperatures
D. 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. A
B. B
C. C
D. D


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


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


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


A. post-operative atelectasis
B. acute exacerbation of COPD
C. hypercapnic respiratory failure
D. acute pulmonary emboli


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


A. PEEP level
B. mandatory rate
C. mandatory tidal volume
D. 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?


A. improper sensitivity setting
B. presence of auto-PEEP/air-trapping
C. a leak in the patient-ventilator system
D. 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?


A. the total outflow would increase
B. the delivered FIO2 would increase
C. the air to oxygen ratio would increase
D. 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?


A. tidal volume
B. rate of breathing
C. trigger sensitivity
D. inspiratory flow
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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?


A. decreasing the bias flow
B. increasing the frequency (Hz)
C. adding mechanical deadspace
D. increasing the power/amplitude


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


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


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


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


A. +/- 2 cm H2O
B. +/- 4 cm H2O
C. +/- 6 cm H2O
D. +/- 8 cm H2O


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


A. mucokinetic
B. antifoaming agent
C. diluent
D. decongestant


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


A. bradycardia
B. laryngospasm
C. tachycardia
D. vagovagal reflex


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


A. incentive spirometry
B. mucolytic agent
C. chest physiotherapy
D. 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:


A. follow the supervisor’s instructions and use the medication
B. check with the pharmacist to see if the med needs refrigeration
C. ask the medical director if it is OK to use the medication
D. 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?


A. wash the device in a dilute detergent solution and let it drip dry
B. always shake the device for 20-30 sec after loading the drug dose
C. clean the outlet with a dry cloth and stored it capped in a dry place
D. 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?


A. add 100 mL of deadspace
B. increase the tidal volume
C. reduce the FIO2
D. 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?


A. mist tent
B. nasal CPAP
C. double-walled Isolette
D. 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?


A. pancuronium (Pavulon)
B. naloxone (Narcan)
C. diazepam (Valium)
D. 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?


A. decrease the minute ventilation
B. discontinue mechanical ventilation
C. increase the peak flow setting
D. 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?


A. Administer midazolam (Versed)
B. Increase the FIO2
C. Decrease the mandatory rate
D. 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?


A. immediately discontinue the treatment and contact the physician
B. have the patient assume a sitting position and cough strenuously
C. place the patient in a head-down position and call the nurse
D. 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:


A. stop the treatment, stabilize the patient and inform the physician
B. continue the treatment and make a note of the sputum in the chart
C. give the patient O2 by simple mask and continue the treatment
D. 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?


A. surgical tracheotomy
B. nasotracheal intubation
C. cricothyrotomy
D. 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?


A. airway pressure release ventilation
B. pressure control with PEEP
C. pressure support with CPAP
D. 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?


A. triamcinolone (Azmacort)
B. cromolyn sodium (Intal)
C. pancuronium bromide (Pavulon)
D. 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. a diuretic
B. a bronchodilator
C. a mucolytic
D. 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?


A. initiate continuous positive airway pressure
B. increase the mask oxygen flow to 15 L/min
C. administer IPPB treatments q2h with 100% O2
D. 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?


A. discontinue therapy, monitor patient and notify the physician
B. decrease the nebulizer output
C. add oxygen to the nebulizer circuit
D. 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?


A. change the mask to a nasal cannula at 3 L/min
B. carry out the resident’s orders as written
C. increase the flow to 6 L/min to wash out CO2
D. 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. A
B. B
C. C
D. D


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


A. hyperkalemia
B. hypoglycemia
C. cardiac arrhythmias
D. respiratory alkalosis
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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?


A. nasotracheal tube insertion
B. laryngeal mask airway insertion
C. percutaneous tracheostomy
D. 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?


A. decrease the mandatory (machine) rate
B. add mechanical deadspace to the circuit
C. decrease the inspiratory flow rate
D. 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?


A. add 100 mL mechanical deadspace
B. maintain the present settings and monitor the patient
C. reduce the pressure limit to restore the prior VT
D. 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?


A. respiratory alkalosis
B. dry hacking cough
C. cor pulmonale
D. 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:


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


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


A. left axis deviation on ECG
B. distention of the neck veins
C. high pulmonary artery wedge pressue
D. 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?


A. 50 cm H2O peak pressure
B. 30 cm H2O plateau pressure
C. 40 cm H2O peak pressure
D. 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. A
B. B
C. C
D. D


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


A. beclomethasone (Vanceril)
B. albuterol (Proventil)
C. salmeterol (Serevent)
D. Cromolyn (Intal)


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


Lidocaine         Amiodarone    Epinephrine     Atropine
A.         Yes                  Yes                  Yes                  No
B.         Yes                  No                   Yes                  Yes
C.         Yes                  Yes                  Yes                  No
D.         No                   Yes                  No                   Yes


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


61.  The cardinal feature of complete airway obstruction is:


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


62.  A tachypneic patient with pulmonary edema is brought to the emergency room. Which of the following should be used to provide supplemental oxygen?


A. 28% venturi mask
B. 2 L/min via nasal cannula
C. 12 L/min via nonrebreathing mask
D. 8 L/min via partial rebreathing mask


63.  During two-person CPR applied to an adult, the proper ratio of compressions to ventilation is:


A. 5 compressions for every 1 breaths
B. 5 compressions for every 2 breaths
C. 15 compressions for every 1 breaths
D. 30 compressions for every 2 breaths


64.  You are called to assist a physician during an elective intubation on the orthopedic floor. The patient is alert and awake at this time. Which of the following steps should you do first in preparation for this procedure?


A. position the patient
B. pre-oxygenate and hyperventilate the patient
C. suction the patient’s airway
D. assemble and check the equipment


65.  You are assisting a medical resident performing an emergent intubation on a somewhat combative patient. The resident wants to briefly paralyze the patient to facilitate this procedure. Which drug would you recommend for this purpose?


A. pancuronium (Pavulon)
B. succinylcholine (Anectine)
C. vecuronium (Norcuron)
D. cisatracurium (Nimbex)


66.  While assisting a physician with fiberoptic bronchoscopy of an outpatient via the transnasal route, you observe her SpO2 dropping from 91% to 86%. Which of the following actions would be appropriate?


A. initiate bag-mask ventilation with oxygen
B. give oxygen through the scope’s open channel
C. recommend immediate withdrawal of the scope
D. apply suction through the scope’s open channel


67.  You are assisting a physician with a bronchoscopy procedure on a cardiac patient when suddenly endobronchial bleeding occurs. You should recommend which of the following?


A. instilling Lidocaine (Xylocaine)
B. instilling ice cold saline solution
C. providing 100% O2 via nonrebreather
D. instilling dilute epinephrine solution


68.  Which one of the following is a prerequisite to be considered in discharging a ventilator-dependent patient to the homecare setting?


A. whether the patient has adequate health insurance coverage
B. whether the patient can generate a vital capacity > 15 mL/kg
C. whether the patient will require frequent tracheobronchial suctioning
D. whether the patient is stable on low FIO2s and PEEP


69.  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?


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


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


A. the goal should be specific
B. the goal should be measurable
C. the goal should be realistic
D. the goal should be open-ended


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