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1.  A time-cycled constant flow generator is set up with a flow of 50 L/min and an inspiratory time of 1.2 sec. What is the tidal volume?

 

A. 1000 mL (1.0 L)
B. 1500 mL (1.5 L)
C. 750 mL (0.75 L)
D. 1200 mL (1.2 L)

 

2.  A patient receiving mechanical ventilation with 8 cm H2O PEEP has a balloon-tipped pulmonary artery catheter in place. To obtain an accurate measurement of her pulmonary capillary wedge pressure (PCWP) you would:

 

A. make the PCWP measurement at peak-inspiration
B. remove the patient from the ventilator and PEEP
C. level the transducer to 4th intercostal space/midaxillary line
D. withdraw the catheter 2-3 cm before measurement

 

3.  A ventilator that does not automatically correct for gas compression has a circuit attached with a 4 mL/cm H2O compliance factor. If the tidal volume is set to 800 mL, and the peak pressure is 50 cm H2O (PEEP = 0 cm H2O), what volume does the patient actually receive?

 

A. 1000 mL
B. 800 mL
C. 750 mL
D. 600 mL

 

4.  To validate the readings provided by a transcutaneous blood gas monitor, you should:

 

A. perform a two-point calibration of the monitor
B. compare the monitor’s readings to a concurrent ABG
C. change the placement of the sensor every 2–6 hours
D. re-membrane the sensor and adjust its temperature

 

5.  A 5-foot, 4-inch-tall 110-lb. woman with normal lungs has a tidal volume of 480 mL and is breathing at a rate of 14 breaths/min. What is her approximate alveolar ventilation?

 

A. 6.72 L/min
B. 3.42 L/min
C. 5.18 L/min
D. 15.4 L/min

 

6.  Which of the following bedside measurements require a conscious and cooperative patient?

 

A. spontaneous respiratory rate
B. maximum expiratory pressure
C. spontaneous tidal volume
D. maximum inspiratory pressure
7.  Your 5-year-old patient is being mechanically ventilated with a VT of 150 mL, rate of 20/min, and I:E ratio of 1:2. Based on these settings, what is the patient’s inspiratory time?

 

A. 1 sec
B. 1.5 sec
C. 2 sec
D. 3 sec

 

8.  Equipment/supplies required to perform an arterial puncture include which of the following?

 

A. local anesthetic
B. anticoagulant
C. sterile gloves
D. lancet

 

9.  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 severe pulmonary hypertension
C. a patient recommended for cardiac rehabilitation
D. a patient being assessed for cardiopulmonary disability

 

10.  Which of the following statements is TRUE regarding capillary blood gas sampling?

 

A. the puncture normally is performed on the ball of the foot
B. sample pH and PCO2 correlate well with standard ABGs
C. to obtain the sample, you need to milk/squeeze the puncture site
D. the sample must be drawn from the first drop of surface blood

 

11.  Significant overinflation of an endotracheal tube cuff may cause which of the following?

 

A. laryngospasm
B. silent aspiration
C. mucosal ischemia
D. air leakage

 

12.  In order for a tracheal tube cuff to allow circulation in tracheal mucosa, the cuff pressure must be directly related to the

 

A. capillary pressure
B. brachial artery pressure
C. pulmonary artery pressure
D. pulmonary capillary wedge pressure

 

13.  Which of the following ECG leads should be placed in the left midaxillary line?

 

A. V3
B. V4
C. V5
D. V6

 

14.  As measured on the Borg scale, which of the following exertion levels is appropriate for titrating a COPD patient’s O2 flows to support exercise?

 

A. weak/light exertion (rating of 2)
B. somewhat strong exertion (rating of 4)
C. very strong exertion (rating of 7)
D. maximal exertion (rating of 10)

 

15.  A patient has a peak expiratory flow rate (PEFR) of 4.7 L/sec before bronchodilator treatment and 5.1 L/sec after treatment. What percent change in PEFR occurred?

 

A. 5%
B. 9%
C. 18%
D. 24%

 

16.  You are gathering a sputum specimen from a patient in isolation. In addition to applying appropriate transmission-based precautions, which of the following procedures should be followed in processing this specimen?

 

A. mix the specimen with a fixative before sending it to the lab
B. leave the specimen container at the nursing station for transport
C. disinfect outside of specimen container if contaminated
D. have the specimen undergo sterilization before processing

 

17.  Which of the following syringes would you select for obtaining an arterial sample from a neonate?

 

A. 12-gauge, 1-3 mL syringe
B. 16-gauge, 1-3 mL syringe
C. 20-gauge, 5-10 mL syringe
D. 25-gauge, 1-3 mL syringe

 

18.  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

 

19.  Which of the following is the best way to control a patient’s exercise level during an oxygen titration test?

 

A. cycle ergometer
B. step test
C. adjustable treadmill
D. 6-minute walk test

 

20.  A patient is receiving volume controlled ventilation at a rate of 12/min. The expiratory time is 3.25 sec. What is the inspiratory time?

 

A. 1.25 sec
B. 1.50 sec
C. 1.75 sec
D. 2.00 sec

 

21.  You instruct a patient to take a deep breath and then exhale as quickly as possible. You then observe the recording of the fastest air movement. Which of the following is being measured?

 

A. peak flow
B. vital capacity
C. FEV1
D. FEF25-75%

 

22.  An patient on volume control A/C ventilation is breathing 80% O2, has a mean airway pressure (MAP) of 15 cm H2O and a PaO2 of 40 torr. What is his oxygenation index?

 

A. 10
B. 20
C. 30
D. 40

 

23.  Which of the following is needed to perform a capillary blood sample?

 

A. heparinized 1cc syringe
B. local anesthetic
C. lancet/lancing device
D. 25G buterfly needle

 

24.  Which of the following is a major limitations of the typical impedance-based apnea monitoring system?

 

A. inability to detect tachypnea
B. inability to detect obstructive apnea
C. inability to detect bradypnea
D. inability to detect periodic breathing

 

25.  A patient has a left ventricular stroke volume of 70 mL and a heart rate of 80. What is his cardiac output?

 

A. 11.4 L/min
B. 8.8 L/min
C. 5.6 L/min
D. 3.3 L/min

 

26.  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. parrtial catheter occlusion
B. catheter out of vessel
C. transducer positioned too high
D. stopcock off to patient

 

27.  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
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28.  Upon inspection of a portable spirometer’s FVC curve obtained on an adult outpatient, you determine that the time required to reach the peak expiratory flow is excessive. Prior to repeating the maneuver, which of the following instructions would you provide to the patent?

 

A. “Don’t hesitate”
B. “Blast out faster”
C. “Blow out longer”
D. “Deeper breath”

 

29.  After attaching an apnea monitor to a neonate and confirming good chest motion, you note a weak signal that causes intermittent alarming. Which of the following is the most likely cause of this problem?

 

A. sensor belt placed at the nipple line
B. lotion or powder on the skin or electrodes
C. apnea alarm time limit set too short
D. monitor sensitivity set too high


30.  You note on the arterial pressure monitor of a conscious patient in no apparent distress that the pressure waveform is absent (pressure reading = 0 mm Hg), and the alarm is sounding. Your first action should be to:

 

A. check the A-line stopcock position
B. call for the Rapid Response Team
C. get a new or replacement monitor
D. confirm that the monitor is set to zero/cal

 

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

 

A. 10 mm Hg rise in systolic blood pressure
B. heart rate increase from 88/min to 165/min
C. 10% decrease in SpO2 from baseline value
D. increase in patient’s level of dyspnea

 

32.  To avoid thermal injury when using a transcutaneous blood gas monitor to track an infant’s PO2, you should:

 

A. apply cortisone cream under the sensor
B. maintain the sensor at body temperature
C. relocate the sensor site on a regular basis
D. place the sensor over a boney area

 

33.  While performing a maximal expiratory pressure (MEP) test using a valved T-piece, the patient blows out against the manometer, but no positive pressure is registered. What should be done to troubleshoot this problem?

 

A. make sure both the inspiratory and expiratory valves are blocked
B. make sure the inspiratory valve is patent and the expiratory valve is blocked
C. make sure the inspiratory valve is blocked and the expiratory valve is patent
D. make sure both the inspiratory and expiratory valves are patent

 

34.  If the pulse pressure is 40 mm Hg and systolic pressure is 130 mm Hg, what is the diastolic pressure?

 

A. 170 mm Hg
B. 90 mm Hg
C. 70 mm Hg
D. 140 mm Hg

 

35.  A patient has a peak expiratory flow rate (PEFR) of 5.2 L/sec before bronchodilator treatment and 6.3 L/sec after treatment. What percent change in PEFR occurred?

 

A. 8%
B. 17%
C. 21%
D. 26%

 

36.  All spirometric values obtained under ambient conditions should be converted to:

 

A. ambient temperature and pressure, saturated (ATPS)
B. body temperature, ambient pressure, saturated (BTPS)
C. standard temperature and pressure, dry (STPD)
D. ambient temperature and pressure, dry (ATPD)

 

37.  Which of the following steps violate the recommended pre-analytic procedures for point-of-care testing of an arterial blood sample?

 

A. analyze the sample within 3 minutes
B. place the sample in an ice slush
C. thoroughly mix the sample
D. prevent sample exposure to air

 

38.  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

 

39.  Which of he following represents proper technique in the auscultatory method of measuring blood pressure?

 

A. inflate the cuff to 120 mm Hg pressure
B. place the cuff 3 inches below the brachial artery
C. deflate the cuff at a rate of 2 to 3 mm Hg per sec
D. place bell of stethoscope over the radial artery

 

40.  Which of the following devices would you select to adjust tracheal tube cuff pressures?

 

A. manometer
B. respirometer
C. volumeter
D. pneumotachometer

 

41.  An exercise test can help determine the cause of which of the following?

 

A. chronic cough
B. hemoptysis
C. wheezing on exertion
D. rhonchial fremitus

 

42.  When performing spirometry on an adult patient, which of the following would indicate invalid/unacceptable test results?

 

A. back extrapolated volume 100 mL
B. time to peak flow 500 msec
C. forced expiratory time > 6.0 sec
D. repeat FVCs match within 150 mL

 

43.  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

 

44.  You attach a patient in ICU to the pulse oximeter module on a multichannel bedside monitor. The best way to verify that you are getting a good reading would be to:

 

A. observe for a good pulse pressure waveform on the monitor’s display
B. compare the oximeter’s pulse rate to the ECG-monitored rate
C. assess the oximeter’s pulse strength/rate LED indicator lights
D. perform an Allen’s test on the extremity used to monitor the SpO2

 

45.  A patient is receiving volume controlled ventilation at a rate of 10/min. The percent inspiratory time (%I) control is set at 25%. What is the inspiratory time?

 

A. 1.00 sec
B. 1.25 sec
C. 1.50 sec
D. 1.75 sec

 

46.  To avoid preanalytic error caused by air contamination of a blood gas sample, you would:

 

A. place the sample in ice slush
B. discard the first 3 mL obtained
C. quickly plug the needle tip
D. mix only after expelling air

 

47.  After attaching an apnea monitor to a neonate and confirming good chest motion, you note a weak signal that causes intermittent alarming. Which of the following is the most likely cause of this problem?

 

A. sensor belt not fitted snugly enough
B. apnea alarm time limit set too short
C. recording memory capacity exceeded
D. monitor sensitivity set too high

 

48.  The proper infection control procedures to be used when drawing an arterial blood gas are:

 

A. hand washing and gloves only
B. apron and protective eyewear
C. mask and protective eyewear
D. all CDC standard precautions

 

49.  Upon inspection of a portable spirometer’s FVC curve obtained on an adult outpatient, you determine that the back extrapolated volume is excessive. Prior to repeating the maneuver, which of the following instructions would you provide to the patent?

 

A. “Don’t hesitate”
B. “Blast out faster”
C. “Blow out longer”
D. “Deeper breath”

 

50.  Which of the following is being measured if you instruct a patient to take a maximum deep breath and then exhale completely?

 

A. inspiratory force
B. vital capacity (VC)
C. total lung capacity (TLC)
D. residual volume (RV)

 

51.  Which of the following procedures can be performed on a comatose patient?

 

A. maximum voluntary ventilation (MVV)
B. maximum inspiratory pressure (MIP)
C. forced expiratory volume in 1 sec (FEV1)
D. peak expiratory flow

 

52.  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

 

52.  Bedside spirometry performed on a patient reveals the following:

 

Respiratory rate = 22
Tidal volume = 360 mL
Dead space = 150 mL
Inspiratory capacity = 1.0 L
Based on these data, what is the patient’s minute ventilation?

 

A. 3.3 L/min
B. 4.6 L/min
C. 7.9 L/min
D. 22.0 L/min

 

53.  To ensure accurate measurements, before attaching a transcutaneous blood gas monitor sensor to a patient, you should:

 

A. place mineral oil inside the sensor fixation ring
B. remove all oils/soaps from the sensor site
C. pierce the sensor membrane to facilitate diffusion
D. cool the sensor site with an ice pack

 

54.  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

 

55.  When running an arterial blood gas on a point-of-care analyzer, the device ‘flags’ the PCO2 results. You should:

 

A. repeat the analysis using a fresh sample and the same cartridge
B. repeat analysis using a fresh sample and new cartridge
C. send the sample to the central laboratory for analysis
D. repeat the analysis using the same sample and same cartridge

 

56.  To measure the strength of a patient’s respiratory muscle effort at the bedside, which of the following devices would you select?

 

A. ergometer
B. respirometer
C. peak flowmeter

D. pressure manometer

 

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