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1.  The major complication associated with endotracheal tube extubation is:


A. bradycardia
B. tracheomalacia
C. laryngospasm
D. aspiration


2.  A nasopharyngeal airway is useful in providing for or supporting which of the following?


A. mechanical ventilation
B. incentive spirometry
C. frequent suctioning
D. aerosol drug therapy


3.  A patient is receiving continuous mechanical ventilation. On auscultation, you suspect that the patient’s endotracheal tube is in the right main stem bronchus. You should


A. contact the patient’s physician for instructions
B. notify a nurse before leaving the unit
C. request a stat chest X-ray
D. request an arterial blood gas analysis


4.  Which of the following actions would be most effective in increasing the total humidity output of a large reservoir jet nebulizer?


A. increasing air entrainment
B. decreasing air entrainment
C. decreasing source gas flow
D. heating the nebulizer system


5.  You are reviewing the chest X-ray of a 26-year-old female patient who has an oral endotracheal tube in place. You can confirm proper placement of the tube by determining that its tip is located:


A. even with the carina
B. 4-6 cm above the carina
C. at the sixth intercostal space
D. level with the 5th cervical vertebra


6.  In which of the following situations is insertion of a esophageal-tracheal Combitube® contraindicated?


A. when the glottis is not visible
B. in patients who are comatose
C. in infants and small children
D. in patients with neck trauma


7.  During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far?


A. until the proximal (mouth) end of the tube is at the teeth
B. just far enough so that the tube cuff is no longer visible
C. until its cuff has passed the cords by two to three inches
D. until its cuff has passed the cords by two to three centimeters


8.  To estimate the appropriate length for a nasopharyngeal airway, you would:


A. subtract twice the diameter of the tube from its length
B. measure the distance from the earlobe to the ‘Adam’s Apple’
C. apply the estimating formula length (cm) = 12 + (age/2)
D. measure the distance from the earlobe to the tip of the nose
9.  When ventilating a patient with a bag-valve resuscitator through a laryngeal mask airway (LMA), you note significant air leakage. Which of the following should be your first approach to eliminating this leakage?


A. bag slowly to reduce peak pressure
B. add more air to LMA the cuff
C. pull the tube out 2–3 cm
D. lower the cuff pressure


10.  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


11.  Which of the following procedures would you recommend to quickly secure the airway and ventilate a patient admitted to the Emergency Department in a cervical collar?


A. insert a nasopharyngeal airway (‘trumpet’)
B. apply the head-tilt, chin-lift maneuver
C. perform blind nasotracheal intubation
D. orally intubate with manual in-line stabilization


12.  An unconscious apneic patient know to have a full stomach cannot be orally intubated in the emergency room. You would recommend


A. performing a percutaneous tracheotomy
B. intubating via the nasal route instead
C. inserting an esophageal-tracheal Combitube®
D. inserting a laryngeal mask airway (LMA)


13.  Which of the following conditions is most associated with the likelihood of a difficult airway?


A. morbid obesity
C. bacterial pneumonia
D. pleural effusion


14.  In order to provide long-term positive pressure ventilation, a cuffed artificial airway is needed to:


A. decrease airway resistance
B. decrease the work of breathing
C. prevent gas leaks and aspiration
D. facilitate removal of secretions


15.  In order to allow a patient with a tracheostomy button to talk and cough effectively, you need to


A. use spacers to position the button
B. attach a standard 15-mm connector
C. completely deflate the button cuff
D. attach a one-way inspiratory valve


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


A. for whom ET intubation is difficult
B. with known esophageal disease
C. with a suspected cervical spine injury
D. needing emergency ventilation


17.  Soon after insertion of a 90 mm (#4) oropharyngeal airway in an adult male, the patient gags and retches. Which of the following is the ideal consideration at this time?


A. remove the airway
B. insert a larger airway
C. use a reverse head-tilt
D. insert a bite block


18.  Which of the following can best help minimize the risk of nosocomial infection/VAP associated with mechanical ventilation?


A. changing the circuit every 24 hours
B. using active heated humidification
C. using disposable circuit components
D. using inline/closed suction catheters


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


A. requires manual ventilation
B. has foreign body obstruction
C. is less than 12 years old
D. is unconscious/unresponsive


20.  The primary indication for tracheostomy is:


A. when a patient loses pharyngeal or laryngeal reflexes
B. when a patient prone to hemorrhage need an artificial airway
C. when a patient has upper airway obstruction due to trauma
D. when a patient has a long-term need for an artificial airway


21.  An adult patient receiving cool mist therapy after extubation begins to develop stridor. Which of the following actions would you recommend?


A. change from cool mist to heated aerosol
B. administer a racemic epinephrine treatment
C. reintubate the patient immediately
D. draw and analyze an arterial blood gas


22.  After intubation, a trauma patient exhibits asymmetrical movement of the chest during manual inflation via a bag-valve resuscitator. Your partner reports diminished breath sounds on the left. No crepitus is noted. These findings are most indicative of which of the following?


A. atelectasis
B. mainstem intubation
C. pneumothorax
D. pleural effusion


23.  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
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24.  A recently intubated 55 kg female patient receiving volume controlled ventilation has no breath sounds over the left side of her chest. Her SpO2 on 40% O2 has quickly dropped from 96% to 82%. At the same time, the peak inspiratory pressure on the ventilator has increased from 35 cm H2O to 55 cm H2O. You note a tube length marking of 25 cm at the teeth. What action should you take?


A. increase the FIO2 and the flow rate
B. recommend a stat chest X-ray
C. administrator a bronchodilator
D. withdraw the ET tube 2-3 cm and reassess


25.  The average depth of proper oral endotracheal tube insertion from the teeth of an adult female is:


A. 23 cm from the patient’s teeth
B. 23 in from the patient’s teeth
C. 21 cm from the patient’s teeth
D. 32 cm from the patient’s teeth


26.  A patient has had a tracheostomy tube in place for three weeks. Over the last ten days, it has required higher and higher pressures in order to obtain an effective cuff seal. What is the most likely problem?


A. T-E fistula
B. tracheomalacia
C. granulomas
D. glottic edema

27.  The maximum time devoted to any intubation attempt should be no more than:


A. 60 seconds
B. 45 seconds
C. 30 seconds
D. 90 seconds


28.  Which of the following conditions represent the minimum humidification requirements for patients with artificial tracheal airways?


A. relative humidity of at least 50%
B. temperature between 30 to 32°C
C. vapor pressure of at least 25 torr
D. absolute humidity of at least 33 mg/L


29.  While assessing the airway of an intubated patient receiving positive pressure ventilation, you notice a large air leak throughout inspiration with a measured cuff pressure measured of 15 cm H2O. You should:


A. add 10 mL additional air to the ET tube cuff
B. reassess the cuff pressure during expiration
C. replace the endotracheal tube with a larger size
D. inflate the ET tube cuff to between 20 to 30 cm H2O


30.  To help minimize the risk of ventilator-associated pneumonia in patients receiving invasive ventilatory support you would:


A. use an HME or humidifier with heated wire circuit
B. keep the airway temperature above 45° Celsius
C. change the ventilator circuit every 24-48 hours
D. drain any circuit condensate back into the humidifier


31.  An orally intubated patient is paralyzed and receiving volume control ventilation. The high pressure alarm on the ventilator keeps sounding and the patient has markedly decreased breath sounds. Your first action should be to:


A. withdraw the ET tube 2-3 cm
B. raise the alarm pressure limit
C. try to pass a suction catheter
D. recommend a chest X-ray


32.  A doctor orders a nasopharyngeal airway for a conscious patient requiring frequent nasotracheal suctioning. On your initial attempt at insertion, you can only pass the airway about 2-3 cm into the patient’s nostril. Which of the following actions would be appropriate at this time?


A. Insert the airway in the other nostril
B. Recommend nasotracheal intubation
C. Rotate the airway 180° and try again
D. Switch to an oropharyngeal airway


33.  Under which of the following circumstances you should select an active heated water humidifier during mechanical ventilation instead of a heat and moisture exchanger (HME)?


A. patient intubated via the nasal route
B. patient with a high fever
C. patient with thick secretions
D. patient requiring intrahospital transport


34.  A patient has been intubated for cardiopulmonary failure and CPR is in progress. Which of the following should you INITIALLY perform to determine whether the endotracheal tube is in the proper position?


A. Auscultate chest and abdomen
B. Palpate the position of the trachea
C. Look, listen and feel for breaths
D. Observe chest wall movement


35.  As compared to standard laryngoscopy and endotracheal intubation, which of the following is TRUE regarding the laryngeal mask airway (LMA)?


A. it poses a greater risk of trauma than endotracheal intubation
B. it must be removed in order to insert an endotracheal tube
C. it can completely prevent aspiration of gastric contents
D. it can be inserted blindly without any special equipment


36.  Peak inspiratory pressures on an afebrile intubated patient receiving volume control A/C ventilation with a heat and moisture exchanger (HME) have been progressively rising for the past 24 hrs. After suctioning the trachea and finding secretions to be of normal volume and viscosity, you should do which of the following?


A. increase the HME temperature
B. decrease the respiratory rate
C. change to active heated humidification
D. change the HME


37.  When inserting or re-inserting a laryngectomy tube, which of the following measures should be used?


A. the patient should be preoxygenated
B. the neck should be hyperextended
C. an obturator should always be used
D. the patient should be sedated


38.  Which of the following would be the best method to confirm the proper size and position of a patient’s tracheostomy button?


A. cuff-leak test
B. laryngoscopy
C. bronchoscopy
D. occlusion pressure


39.  While checking a ventilator with a heated humidifier but unheated circuit, you note that there is very little condensation in the tubing and that water does not have to be drained. The most likely explanation is that the:


A. O2 concentration is very high
B. heating element is not functioning
C. inspiratory flow is set too low
D. room temperature is below normal


40.  Which of the following measures can reduce the incidence of infection associated with large volume heated humidifier systems?


A. change the humidifier/circuitry every 24 hours
B. drain any condensate back into the humidifer
C. maintain the airway temperature above 45° C
D. use a closed-feed sterile water reservoir system


41.  Which of the following devices would you select if the goal were to deliver the maximum water content by inhalation to a patient with dried secretions?


A. small volume jet nebulizer
B. heated wick humidifier
C. large volume jet nebulizer
D. ultrasonic nebulizer


42.  After a physician intubates a patient in the emergency room, your partner begins manual ventilation with 100% O2. On auscultation, you note the absence of breath sounds, but hear gurgling over the epigastrium. Which of the following has most likely occurred?


A. a right-sided tension pneumothorax
B. intubation of the left mainstem bronchus
C. intubation of the patient’s esophagus
D. intubation of the right mainstem bronchus


43.  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


44.  Which of the following airway appliances would be appropriate for short-term application of bland aerosol therapy to a patient after extubation?


A. face tent
B. trach mask
C. T-tube
D. aerosol mask


45.  In order to prevent a patient from compressing an oral endotracheal tube between the teeth, you would recommend:


A. administration of a neuromuscular blocking agent
B. administration of a strong narcotic-analgesic
C. application of a Brigg’s adapter (‘T-tube’)
D. use of a ‘bit block’ or oropharyngeal airway


46.  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


47.  You begin suctioning a patient orally intubated with an 6.5 mm ET tube using a 12 Fr catheter. You cannot pass the catheter beyond the tube tip. Which of the following is the most likely cause of this problem?


A. tube in right main bronchus
B. tube cuff torn or deflated
C. tube kinked or crimped
D. suction catheter too short


48.  In the absence of neck or facial injuries, the procedure of choice to establish a patent tracheal airway in an emergency is:


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


49.  Which of the following would you not recommend for a critically ill patient with signs and symptoms of fluid overload (overhydration)?


A. initiate diuretic therapy
B. restrict and closely monitor fluid intake
C. administer steroids
D. if renal failure, consider dialysis


50.  Which of the following is an indication for an oropharyngeal airway?


A. prevention of upper airway obstruction in an unconscious patient
B. prevention of aspiration in an unconscious patient
C. improvement of suctioning of the trachea
D. improvement of air flow in a conscious patient


51.  Oropharyngeal and nasopharyngeal airways helps restore airway patency by:


A. providing a secure route into the larynx and trachea
B. separating the tongue from the posterior pharyngeal wall
C. isolating/protecting the lower airway from aspiration
D. displacing the soft palate and uvula posteriorly


52.  Which of the following humidification devices would be appropriate for a patient receiving nasal oxygen therapy at 6 L/min?


A. unheated bubble humidifier
B. heated wick-type humidifier
C. heat and moisture exchanger (HME)
D. large volume jet nebulizer


53.  Continuous bland aerosol poses the greatest risk for


A. patients with a tracheostomy
B. adults with normal fluid balance
C. patients who are hypovolemic
D. infants and small children


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