1. All of the following approaches are recommended to assess the knowledge gained by a patient after an education episode EXCEPT:
A. Asking the patient nonthreatening questions about the information
B. Having the patient repeat in his or her own words the information given
C. Administering a written test or quiz covering the information
D. Observing behaviors resulting from the knowledge gain

2. Following a motor vehicle accident, a patient in respiratory distress is intubated to maintain airway patency. During the physical examination, you palpate asymmetrical movement of the chest during inspiration, but no crepitus is noted. Breath sounds are diminished. This is most indicative of which of the following’?
A. Atelectasis
B. Mainstem intubation
C. Pneumothora
D. Flail chest

3. Which of the following formula can be used to estimate a patient’s maximum voluntary ventilation (MVV)?
A. VCO2NO2
B. FVC x 35
C. FEV1 x 35
D. VEx 15

4. You are asked to assess a 16-year-old diabetic on 4 L./min of oxygen via nasal cannula. The patient IS alert and awake and is complaining of some minor nasal discomfort. His pulse oximeter reads 84% saturation_ What action should you take?
A. Decrease the 02 flow until the patient is more comfortable
B. Increase the 02 flow until the Sp02 equals or exceeds 90%
C. Change to a 28% Venturi mask and inform the nurse
D. Recommend an arterial blood gas before considering any changes

5. When properly positioned and with the cuff inflated, the mask of a laryngeal mask airway ([MA) seals off the:
A. Esophagus
B. Laryngeal inlet
C. Soft palate
D. Nasopharynx

6. Which of the following statements regarding CENTRAL cyanosis is FALSE?
A. It is an unreliable indicator of hypoxemia and hypoxia
B. It is best observed in the capillaries of the lips and gums
C. It results from excessive reduced Hb in the venous blood
D. It may occur even in the presence of adequate O2 delivery

7. Which of the following suggest that an ABG sample may in fact contain venous blood? 1. patient has no symptoms of hypoxemia 2. failure of syringe to fill by pulsations 3. abnormally low bedside Sp02
A. 1 only
B. 2 only
C. 1 and 2
D. 1, 2 and 3

8. Which of the following is the approximate total output flow delivered from a 40% air-entrainment mask operating at 12 L/min?
A. 12 L/min
B. 48 L/min
C. 52 L/min
D. 72 L/min

9. 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 (02/002)
D. Standardized buffer solutions

10. When inspecting the x-ray of a patient in ICU, you note a large area of radiolucency between the left lung border and chest wall and increased density of left lung. Which of the following is the most likely problem?
A. Pleural effusion
B. Pneumomediastinum
C. Pneumothorax
D. Interstitial infiltration

11. A patient who has been in a serious automobile accident is brought to the emergency room in obvious shock. He has internal injuries. A physician asks you to administer oxygen immediately. You should institute treatment with
A. An aerosol mask
B. A nasal cannula at 6 L/min
C. A 40% venturi mask
D. A nonrebreathing mask

12. An otherwise healthy 25-year-old male patient who took an overdose of sedatives is being supported on a ventilator. Which of the following measures of total static compliance (lungs + thorax) would you expect in this patient?
A. 100 mL/cm H20
B. 10 mL/cm H20
C. 10 mL/cm H20
D. 0.1 mL/cm H20

13. During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates:
A. Exhalation of mainly deadspace gas
B. Inspiration of fresh respiratory gas
C. Exhalation of mixed alveolar/deadspace gas
D. Exhalation of mainly alveolar gas

14. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

15. You are asked to position a patient for orotracheal intubation You should place the patient’s head
A. In the sniffing position
B. Straight with the torso, with the neck hyperextended
C. Tilted forward toward the chest
D. Turned to the right, with the neck hyperextended

16. In reviewing the chart of a 55-year-old male patient, you note the following symptoms: obesity, loud snoring and insomnia. These findings are most consistent with which of the following diagnoses?
A. Pulmonary emphysema
B. Acute asthma
C. Gullian-Barre syndrome
D. Obstructive sleep apnea

17. 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

18. To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you would:
A. Measure pressure during an end-inspiratory pause
B. Measure pressure at volume increments using a super syringe
C. Measure pressure during an end-expiratory pause
D. Measure expiratory flow before and after bronchodilator

19. The best way to routinely communicate a patient’s clinical status to the appropriate members of the health care team is by: The best way to routinely communicate a patient’s clinical status to the appropriate members of the health care team is by:
A. Reporting information to the respiratory therapy supervisor
B. Reporting information to the next shift of respiratory therapy staff
C. Recording information in the respiratory therapy department records
D. Recording information in the patient’s chart

20. To minimize the risk of aspiration of glottic secretions or cord damage during removal of an oral endotracheal tube, you should
A. Have the patient cough while you quickly pull the tube
B. Provide 100% oxygen for 1-2 minute before extubation
C. Keep the tube cuff pressure below 25-30 cm H20
D. Fully occlude the ET tube while you quickly it out

21. What maximum flow would you apply to an 8 year-old child receiving O2 therapy via a high flow nasal cannula?
A. 5 L/min
B. 10 L/min
C. 15 L/min
D. 20 L/min

22. Which of the following alarm conditions indicates a circuit obstruction when delivering volume-oriented ventilatory support?
A. High volume + low pressure
B. Low volume + high pressure
C. High volume + high pressure
D. Low volume + low pressure

23. A volume-cycled flow generator is being used to ventilate a patient in the CMV control mode. Which of the following changes would occur if the patient’s compliance were to decrease?
A. The expiratory time will increase
B. The flow rate will decrease
C. The system pressure will increase
D. The delivered volume will decrease

24. A patient is receiving ventilatory support in the CMV control mode via a volume-cycled ventilator. Changes in which of the following parameters will alter this patient’s PaCO2? I. tidal volume II. H02 III. rate IV. flow
A. II and IV only
B. I, II and III only
C. I and III only
D. II III and IV only

25. A patient’s ABG results before/after starting oxygen via nasal cannula at 3 L/min remain unchanged. Which of the following should be assessed? 1. breath sounds 2. pulse 3. patency of nasal pharynx 4. oxygen connections
A. 1 and 3 only
B. 2 and 4 only
C. 3 and 4 only
D. 1, 2 and 3 only

26. Which of the following is false regarding switching from an esophageal-tracheal Combitube® (ETC) to an oral endotracheal tube?
A. The equipment needed is the same as for endotracheal intubation
B. The patient’s stomach contents should be aspirate through the 42 tube
C. The body of the tube normally must be positioned in the trachea
D. The large 41 pharyngeal cuff must be deflated before laryngoscopy

27. Which of the following are FALSE regarding oropharyngeal airways’?
A. Incorrect placement can worsen airway obstruction
B. They are contraindicated for use with infants and children
C. They all consist of a flange, body and channel(s)
D. They should only be used by trained personnel

28. Which of the following types of equipment processing would you recommend for a reusable external facemask?
A. High-level disinfection
B. Sterilization
C. Low-level disinfection
D. Soap and water wash

29. When inspecting the X-ray of an out-patient with nephrotic syndrome, you note a homogeneous area of increased density that obscures the left costophrenic angle Which of the following is the most likely problem?
A. Pleural effusion
B. Bacterial pneumonia
C. Pulmonary edema
D. Atelectasis

30. The following figure is a statistical quality control plot for PCO2 measurements made by a blood gas analyzer using a control value of 40 mm Ng_ The horizontal (X) axis depicts 8-hour shifts. The vertical (Y) axis is PCO2 level, with 38 – 42 representing + 2 standard deviations_ What type of error is represented by the series of points labeled ‘B on the plot?
A. Instrument bias
B. Computation error
C. Instrument imprecision
D. Random error

31. Which of the following devices would you select to assess the output accuracy of a Bourdon gauge regulator used for 02 transport?
A. Calibrated manometer
B. Clark electrode
C. Infrared capnometer
D. Precision flowmeter

32. Which of the following best describe the key rationale for intubating nasally rather than orally’?
A. Nasal tubes are less likely to cause trauma
B. Nasal tubes offer less resistance to gas flow
C. Nasal tubes are less likely to cause infection
D. Nasal tubes are better tolerated by the patients

33. A patient has a minute volume of 7.50 L/min and is breathing at a rate of 16 breaths/min. What is his average tidal volume?
A. 120 mL
B. 215 mL
C. 350 mL
D. 470 mL

34. Normally, an individual can maintain about what percent of their maximum voluntary ventilation (MVV) on maximum exercise?
A. 60-70%
B. 70-80%
C. 80-90%
D. 90-100%

35. A 68-year-old female patient with severe COPD has been provided with educational materials describing essential self-management activities to help her control her disease. Which of the following additional support measures would you consider recommending? 1. counseling/behavior modification interventions 2. telephonic follow-up and/or home health visits 3. social services to address self-management barriers
A. 1 only
B. 1 and 2
C. 2 and 3
D. 1, 2 and 3

36. Which of the following is FALSE regarding the laryngeal mask airway?
A. It avoids laryngeal and tracheal trauma
B. It provides better ventilation than via face mask
C. No special equipment is needed to insert it
D. It prevents aspiration of gastric contents

37. All of the following would be essential medication history information to obtain for a patient admitted for an acute exacerbation of asthma EXCEPT:
A. Frequency of rescue inhaler usage
B. Use of generic vs brand name medications
C. Patient understanding of controllers vs_ relievers
D. Self-administration techniques

38. Following a myocardial infarction, a 60-year-old patient with congestive heart failure is being mechanically ventilated. The patient’s blood pressure is 95/60 mm Hg. Ventilator settings are as follows: FIO2 0.45 Rate 12 Tidal volume 600 mL PEEP 12 cm H20 While awaiting blood gas results, you obtain an Sp02 of 78%. Which of the following actions would you take at this time?
A. Increase the F102 to 1.0
B. Decrease the rate to 6
C. Increase the PEEP to 16 cm H20
D. Initiate inverse ratio ventilation

39. The use of pursed-lip breathing during exhalation would be most common among which of the following patient groups?
A. Diffuse interstitial fibrosis
B. Consolidation of lung tissue
C. Chronic airways obstruction
D. Acute upper airway obstruction

40. The following figure is a statistical quality control plot for PCO2 measurements made by a blood gas analyzer using a control value of 40 mm Hg. The horizontal (X) axis depicts 8-hour shifts. The vertical (Y)axis is PCO2 level, with 38 – 42 representing +-2 standard deviations. What type of error is represented by the point labeled “A” on the plot?
A. A bias error
B. A systematic error
C. A computation error
D. A random error

41. A patient’s response to an interview question is initially vague or unclear. Which of the following responses on your part would be most appropriate?
A. “Please go on”
B. “You seem to be anxious”
C. “I see why you are so upset”
D. “Please explain that to me again”

42. Causes of decreased or diminished breath sounds include all of the following EXCEPT:
A. Hyperinflation
B. Severe obesity
C. Deep breathing
D. Pleural effusion

43. Under which of the following conditions will the FIO2 of a 02 mask with reservoir bag vary? I. if the reservoir volume cannot meet inspired volume demand II if the input flow is less that the patient’s peak flow 111. if ambient air enters the system during inspiration
A. I and II only
B. II and III only
C. I and III only
D. I, II and III

44. On palpating the neck region of a patient on a mechanical ventilator, you note a crackling sound and sensation. What is the most likely cause of this observation?
A. Upper bronchial obstruction
B. Subcutaneous emphysema
C. Pneumonia of the upper lobes
D. Atelectasis of the upper lobes

45. Which of the following pre/post test changes would indicate a clinically significant response to an aerosolized bronchodilator?
A. An increase in peak flow from 300 to 350 L/sec
B. An increase in FVC from 4.0 to 4.3 L
C. An increase in FEV1% from 55% to 75%
D. An increase in FEF25-75 from 2.5 to 2.9 L/sec

46. You are called to the ED to provide a bronchodilator treatment for a patient having a severe asthma attack_ When quickly confirming the written order you find it contains some prohibited notations and thus could be read as either ‘.5 U albuterol by SVN or 5 c c albuterol by SVN” The prescribing physician is busy overseeing a code You should
A. Wait until the physician is done with the code so you can clarify the improper notation and the correct order
B. Administer the treatment using the standard dosage (0.5 mL) and clarify the order as soon as possible thereafter
C. Cross out the prohibited notations, provide the correct abbreviations and initial and date the changes
D. Have the nurse review the order and correct the improper notation

47. Which of the following statements would be most appropriate to use in explaining to a patient why it is necessary to cough after an aerosol treatment?
A. “If you don’t cough, you will get pneumonia”
B. “Coughing will help you keep your airways clear”
C. “I’ll have to suction you if you don’t cough”
D. “You might as well not be in the hospital if you don’t cooperate”

48. The upper limit of INPUT flow for most jet nebulizers driven by 50 psig source gas ranges from:
A. 12-15 L/min
B. 8-10 L/min
C. 4-8 L/min
D. 20-30 L/min

49. Proper technique in the auscultatory method of measuring blood pressure includes which of the following? 1. inflate the cuff to 30 mm Hg above brachial pulse stoppage 2. place the lower cuff edge 3 inches above the antecubital fossa 3. deflate the cuff at a rate of 2 to 3 mm Hg per second 4. place bell of stethoscope over the brachial artery
A. 1 and 3 only
B. 1, 2 and 3 only
C. 1, 3 and 4 only
D. 1, 2, 3 and 4

50. If the pH of a patient’s blood falls below normal: 1. the hemoglobin saturation for a given PO2 falls 2. the hemoglobin saturation for a given PO2 rises 3. the affinity of hemoglobin for O2 decreases
A. 2 and 3 only
B. 1 and 3 only
C. 3 only
D. 1, 2 and 3

51. A patient who is receiving 0.5 mL isoetharine (Bronkosol) in 3 mL of normal saline three times a day to relieve bronchospasm complains of nervousness and palpitations after therapy. You should consider recommending all of the following to the patient’s doctor EXCEPT:
A. Substituting levalbuterol (Xopenex) for the isoetharine
B. Decreasing the dose of isoethanne to 0.25 mL
C. Substituting budesonide (Pulmicort) for the isoethanne
D. Substituting albuterol (Proventil) for the isoetharine

52. If the rate of breathing increases without any change in total minute ventilation (VE constant):
A. The alveolar ventilation per minute will increase
B. The alveolar ventilation per minute will decrease
C. The deadspace ventilation per minute will decrease
D. The alveolar ventilation per minute will remain constant

53. A COPD patient is receiving sustained-release theophylline Adverse effects of this therapy that you should be on guard for include all of the following EXCEPT:
A. Cardiac arrhythmias
B. Nausea/vomiting
C. Hyperkalemia
D. Restlessness and tremors

54. Your patient had her spleen removed 2 days ago and is still reluctant to take a deep breath. The doctor asks for your recommendation to prevent the development of atelectasis. Which of the following would you suggest?
A. Bronchodilator therapy
B. Incentive spirometry
C. IPPB
D. Bedside spirometry

55. A patient has a pH of T58 and a PaCO2 of 25 torr. Based on these data, what is the primary acid-base disturbance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis

56. The normal apical impulse (PMI) usually is identified where?
A. 3rd right intercostal space, left sternal border
B. 3rd left intercostal space, anterior axillary line
C. 5th right intercostal space, midclavicular line
D. 5th left intercostal space, midclavicular line

57. Bronchial breath sounds heard over the periphery indicate
A. Normal lungs
B. Lung consolidation
C. Small airways obstruction
D. Acute bronchospasm

58. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

59. Which of the following is the best way to avoid bright lights interfering with a pulse oximeter’s signal?
A. Recheck and clean the site
B. Shield or cover the probe
C. Apply the probe more tightly
D. Replace the probe

60. A 55-year-old patient has been smoking 1-1/2 packs of cigarettes per day for 30 years. You would quantify and record his smoking history as:
A. 15 pack-years
B. 30 pack-years
C. 45 pack-years
D. 60 pack-years

61. As you are fitting him with a nonrebreathing mask, a 62 YO patient in the Emergency Department complains of severe chest pain. Which of the following tests would you first recommend for this patient
A. Arterial blood gas
B. Electrocardiogram (ECG)
C. V/Q scan
D. Bedside spirometry

62. A patient is admitted to the emergency department with severe trauma to the upper airway, including the hypopharynx and larynx. Which type of airway would you recommend for this patient?
A. Nasotracheal intubation
B. Laryngeal mask airway
C. Tracheostomy
D. Esophageal-tracheal Combitube

63. Which of the following would you recommend to provide graphic data useful in evaluating the ventilator-patient interface?
A. Capnography
B. Pulse oximetry
C. Hemoximetry
D. Electrocardiography

64. The gauge on an H cylinder of oxygen reads 450 psig. About how long would the contents of this cylinder last at a flow of 2 UL/min?
A. 10 hours, 40 minutes
B. 14 hours, 30 minutes
C. 9 hours, 10 minutes
D. 11 hours, 50 minutes

65. The best way to avoid arterial blood gas analysis errors associated with blood metabolism is to:
A. Analyze the sample immediately
B. Place the sample in an ice slush
C. Uncap the syringe to get rid of any air
D. Use dry (lithium) heparin

66. All of the following are TRUE regarding control mode ventilation EXCEPT:
A. Control mode is poorly tolerated by most patients
B. During control mode, patient efforts result in asynchrony
C. Patients in control mode may require heavy sedation/paralysis
D. Control mode cannot support inverse I:E ratio ventilation

67. The best way to assure the patency of a trach button is to
A. Pass a suction catheter through the tube
B. Insert a plug into the button’s opening
C. Attach a 15-mm connector to the button
D. Attach a one-way valve to the button’s opening

68. 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
D. Systemic hypertension

69. You observe the following on the bedside capnography display of a patient receiving ventilatory support. What is your interpretation of this display data?
A. The capnogram indicates hyperventilation
B. The capnogram indicates rebreathing
C. The capnogram indicates a leak around the E I tube
D. The capnogram indicates hypoventilation

70. 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? 1. suction the pharynx 2. preoxygenate the patient 3. confirm cuff inflation 4. suction the ET tube
A. 2 and 4 only
B. 1, 2 and 4 only
C. 3 and 4 only
D. 1, 2, 3 and 4

71. A patient has a minute volume of 7.50 L/min and is breathing at a rate of 16 breaths/min. What is his average tidal volume?
A. 120 mL
B. 215 mL
C. 350 mL
D. 470 mL

72. A normal vital capacity for a female patient who is five feet two inches tall and weighs 50 kilograms would be approximately:
A. 2500 mL
B. 3500 mL
C. 4500 mL
D. 5500 mL

73. Which of the following endotracheal tube malfunctions could require extubation and reintubation with a new tube to allow effective positive pressure ventilation of the patient? 1. a large leak in the cuff of the tube 2, obstruction of the tube that is unrelieved by suctioning 3. separation of the pilot tube from the endotracheal tube cuff
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2 and 3

74. At rest, the normal tidal movement of the diaphragm is approximately:
A. 6-10 cm
B. 1-2 cm
C. 30-40 cm
D. 6-10 in

75. A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between:
A. +6mEq/L
B. -6mEq/L
C. +/-2mEq/L
D. +/-8mEq/L

76. When checking for proper adult placement of an endotracheal or tracheostomy tube on chest X-ray, the distal tip of the tube should be positioned where?
A. 4 to 6 cm above the carina
B. 1 to 3 cm above the carina
C. 1 to 3 cm below the larynx
D. 23 cm from the base of the tongue

77. A galvanic oxygen analyzer is being used to monitor a mechanically ventilated patient The patient is receiving 100% oxygen, and the analyzer registers 104%. Which of the following is the most likely cause for this?
A. The analyzer requires calibration
B. The analyzer probe has water condensation on its surface
C. The ventilator’s blending unit requires adjustment
D. The batteries in the analyzer need to be changed

78. Patient cooperation is ESSENTIAL for effective participation in which two of the following procedures? 1. ventilator weaning 2. incentive spirometry 3. postural drainage 4. breathing retraining
A. 1 and 3
B. 1 and 4
C. 2 and 3
D. 2 and 4

79. A patient’s bedside spirometry results (as compared to normal) are as follows: FVC normal FEVI decreased FEVi% 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
A. An obstructive disorder
B. Poor patient effort
C. A restrictive disorder
D. A mixed (obstructive + restrictive) disorder

80. While using an ICU ventilator with its optional air compressor running, you note that the low air pressure alarm suddenly sounds. Which of the following would the best initial action in this situation? 1. adjust and analyze FIO2 2. connect to a 50 psig air source 3. replace the air compressor filters 4. replace the air compressor
A. 1 only
B. 2 only
C. 2 and 4 only
D. 3 and 4 only

81. An adult male patient on ventilatory support has just been intubated with a 7.0 mm oral endotracheal tube equipped with a high residual volume low-pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H20 What is the most likely problem?
A. The cuff pilot balloon and line is obstructed
B. The pressure manometer is out of calibration
C. The tube chosen is too small for the patient
D. The tube is in the right mainstem bronchus

82. All of the following cause false HIGH Sp02 readings when using a pulse oximeter EXCEPT
A. Dark nail polish
B. Intravenous dyes
C. Carboxyhemoglobin
D. Bright ambient light

83. Rule-based procedures designed to help detect, respond to and correct blood gas analyzer or hemoximeter errors over time best describe:
A. Statistical quality control
B. Machine calibration
C. Preventive maintenance
D. Control media verification

84. Which of the following specialized imaging tests would be most useful in diagnosing a pulmonary emboli?
A. Chest X-ray
B. Pulmonary function test (PFT)
C. Ventilation-perfusion scan (V/Q scan)
D. Arterial blood gas (ABG)

85. What maximum flow would you apply to an infant receiving 02 therapy via a high flow nasal cannula?
A. 2 L/min
B. 4 L/min
C. 6 L/min
D. 8 L/min

86. 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

87. All of the following are common causes of fluid overload (overhydration) in patients EXCEPT:
A. Congestive heart failure
B. Hemorrhage
C. Renal failure
D. Overinfusion of fluids

88. You design an air entrainment system which mixes air with oxygen at a fixed ratio of 1:3 (1 liter air to 3 liters oxygen). About what 02 concentration (FI02) will this device provide?
A. 25%
B. 33%
C. 40%
D. 80%

89. You hear bronchial breath sound over the patient’s right middle lobe. What condition is probably present?
A. Emphysema
B. Asthma
C. Pneumonia
D. Pleural effusion

90. Incentive spirometry is ordered for a female patient after abdominal surgery_ Which of the following statements would be the most appropriate initial explanation of the therapy?
A. “Your doctor has ordered this therapy to prevent atelectasis.”
B. “We are trying to improve your lung volume”
C. “This therapy will help you take deep breaths and expand your lungs”
D. “You may experience pain and lightheadedness from this therapy”

91. Which of the following alterations in ventilatory pattern will NOT enhance peripheral deposition of an inhaled aerosol?
A. Slow breathing
B. End-inspiratory pause
C. Deep breathing
D. Nose breathing

92. Which of the following humidification devices would be appropriate for a patient receiving nasal oxygen therapy at 6 Limn?
A. Unheated bubble humidifier
B. Heated wick-type humidifier
C. Heat and moisture exchanger (HME)
D. Large volume jet nebulizer

93. The radial site is preferred for arterial puncture or cannulation because.
A. The radial artery is the most superficial artery available
B. Other available arteries are too small to easily puncture
C. The radial artery has the highest systolic pressure available
D. Collateral circulation is provided through the ulnar artery

94. The methylene blue test is used to confirm:
A. Tracheal granuloma
B. “leakage” type aspiration
C. Infection with pneumococcus
D. Artificial airway obstruction

95. The diagnostic procedure most likely to confirm the presence of bronchogenic carcinoma is:
A. A normal chest radiograph
B. Tissue biopsy via fiberoptic bronchoscopy
C. Cytologic examination of the sputum
D. Computerized axial tomography

96. When using a disposable CO2 indicator confirm ET tube placement in airway, a false positive finding (misleading color change) can occur
A. With esophageal intubation
B. During cardiac arrest
C. With mainstem bronchial intubation
D. During BVM ventilation

97. The normal gradient between the arterial PCO2 and the end-tidal PCO2 as measured by capnography (PetCO2) is:
A. 1-5 mm Hg
B. 5-10 mm Hg
C. 10-15 mm Hg
D. 15-20 mm Hg

98. When open to the atmosphere, a manometer calibrated in cm H2O units should read:
A. 0 cm H2O
B. 1 atmosphere
C. 760 cm H2O
D. 1034 cm H2O

99. The methylene blue test is used to confirm:
A. Tracheal granuloma
B. “leakage” type aspiration
C. Infection with pneumococcus
D. Artificial airway obstruction

100. A patient suddenly loses consciousness. Which of the following is the first procedure you should perform to maintain an open airway in this patient?
A. Inserting a laryngeal mask airway
B. Applying the “jaw thrust” maneuver
C. Inserting an oropharyngeal airway
D. Applying the “head-tilt/chin-lift” maneuver

101. A doctor wants to provide full ventilatory support but use low tidal volumes and permissive hypercapnia in an ARDS patient. Which of the following modes of mechanical ventilation would you choose for this patient?
A. Control mode
B. Assist/control
C. Pressure support ventilation
D. SIMV

102. A patient with a tracheal airway exhibits severe respiratory distress. On quick examination you note the complete absence of breath sounds, and no gas flowing through the airway. What is the most likely problem?
A. Complete tube obstruction
B. Partial tube obstruction
C. Right sided pneumothorax
D. Vocal cord paralysis

103. To change the level of negative pressure delivered by a pleural drainage system, you would
A. Adjust the vacuum level on the suction regulator
B. Adjust the water level in the suction control chamber
C. Adjust the water level in the water seal chamber
D. Adjust the size of the atmospheric vent

104. When testing a ventilator’s operation, the actual oxygen concentrations delivered by the device should be within what percentage of that set on its FI02 control?
A. ±1%
B. ±2%
C. ±5%
D. ±20%

105. A patient who weighs 70 kg (154 lb) is being ventilated in the assist/control mode with an 1102 of 0.8 and 5 cm H20 PEEP_ His arterial blood gas results are below: Blood Gases pH 7.53 PaCO2 30 mm Hg HCO3 27 mEq/L BE +1 Pa02 48 mm Hg Sa02 81% The respiratory therapist should FIRST do which of the following?
A. Increase the minute ventilation
B. Increase the PEEP
C. Decrease the minute ventilation
D. Change to the IMV mode

106. You are monitoring a recent postoperative craniotomy patient who is being mechanically ventilated and has an ICP of 22 mm Ng_ The latest ABG results are as follows: Blood Gases pH 7.35 PaCO2 47 mm Hg HCO3 25 mEq/L BE 0 Pa02 89 mm Hg Sa02 96% Based on this information, which of the following is the most acceptable action?
A. Maintain the current settings
B. Decrease the tidal volume
C. Increase the minute ventilation
D. Add 10 cm H20 PEEP

107. Which of the following would deliver the most particulate water to a patient’s airway?
A. A bubble humidifier
B. A wick humidifier
C. An ultrasonic nebulizer
D. A jet nebulizer

108. When inspecting the X-ray of an out-patient with nephrotic syndrome, you note a homogeneous area of increased density that obscures the left costophrenic angle. Which of the following is the most likely problem?
A. Pleural effusion
B. Bacterial pneumonia
C. Pulmonary edema
D. Atelectasis

109. A patient has a pH of 7.58 and a PaCO2 of 25 torr. Based on these data, what is the primary acid-base disturbance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis

110. Which of the following parameters is affected when the air-mix control is changed to 100% oxygen on a pneumatically-powered IPPB device?
A. Pressure
B. Sensitivity
C. Peak flow
D. Nebulization

111. You hear a high-pitched sound coming from the pressure relief valve on a patient’s bubble-type humidifier. Gas can be felt coming from the valve. Which of the following could cause this problem? 1. the O2 delivery tubing is obstructed 2. the O2 flow is too high 3. the water reservoir jar lid is screwed on too tightly 4. the water reservoir jar lid is missing an O-ring
A. 1 and 3 only
B. 2 and 4 only
C. 1 and 4 only
D. 1 and 2 only

112. A patient receiving volume-limited ventilation with a tidal volume of 600 mL and 10 cm H20 PEEP has a peak pressure of 45 cm H20 and a plateau pressure of 30 cm H20. What is her static compliance’?
A. 13 mL/cm H20
B. 15 mL/cm H20
C. 20 mL/cm H20
D. 30 mL/cm H20

113. An apnea monitor on a premature infant indicates an abnormal decrease in respiratory rate and an abnormal increased in heart rate. What is the most likely cause of
A. Hypoxemia
B. Apnea of prematurity
C. Periodic breathing
D. Motion/activity artifact

114. The normal apical impulse (PMI) usually is identified where?
A. 3rd right intercostal space, left sternal border
B. 3rd left intercostal space, anterior axillary line
C. 5th right intercostal space, midclavicular line
D. 5th left intercostal space, midclavicular line

115. You determine that the output flow from a pneumatically powered IPPB machine operating in the air-mix mode is significantly reduced. Which of the following may be causing the problem? 1. the inlet filter is clogged 2. the high pressure hose is partially blocked 3. the ventilator is connected to air instead of oxygen
A. 2 only
B. 3 only
C. 1 and 2 only
D. 1, 2 and 3

116. Which of the following is false regarding switching from an esophageal-tracheal Combitube (ETC) to an oral endotracheal tube?
A. The equipment needed is the same as for endotracheal intubation
B. The patient’s stomach contents should be aspirate through the 42 tube
C. The body of the tube normally must be positioned in the trachea
D. The large 41 pharyngeal cuff must be deflated before laryngoscopy

117. A doctor orders the highest FIO2 possible for an adult patient receiving 100% O2 via a high flow nasal cannula. What flow setting would best achieve this goal?
A. 10 L/min
B. 15 L/min
C. 20 L/min
D. 30 L/min

118. If available in the assist/control or control modes of ventilatory support, an I:E limit should be set to:
A. 1:1
B. 1:2
C. 1:3
D. 1:4

119. A patient rescued from a house fire is being monitored in the intensive care unit Due to suspected CO poisoning, the patient is on a nonrebreathing mask at 12 L/min. A pulse oximeter reveals an Sp02 of 99%. An arterial blood sample is obtained and sent to the laboratory for gas analysis and hemoximetry (CO-oximetry). The lab results are as follows: Blood Gas Analysis pH 7.26 PaCO2 34 mm Hg Pa02 350 mm Hg HCO3 10 mEq/L Sa02 100% BE13 mEq/L Hemoximetry Hb02% 79% COH1D% 19% MetH1D% 2% Which result(s) give the best indication of the patient’s oxygenation?
A. Sa02
B. Hb02%
C. Sp02
D. Pa02

120. A patient in the emergency room exhibits signs of acute upper airway obstruction and is concurrently having severe seizures that make it impossible to open the mouth_ In this case, what would be the adjunct airway of choice?
A. Tracheostomy tube
B. Nasopharyngeal airway
C. Oral endotracheal tube
D. Oropharyngeal airway

121. To achieve the highest O2 concentration, you would select which of the following devices?
A. Venturi mask
B. Face tent
C. Nonrebreathing mask
D. Simple oxygen mask

122. A patient is being mechanically ventilated in the IMV mode with a continuous flow. The F102 is 0.4, the set rate is 5/min. and +7 cm H20 PEEP is being applied. The manometer needle is drawn down to +1 cm H20 whenever the patient inhales. On the basis of this information, it would be appropriate to increase the
A. PEEP
B. Mandatory rate
C. R02
D. Circuit flow

123. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

124. A paralyzed patient being mechanically ventilated in the volume control mode has an abnormally low PaCO2 and high pH. Which of the following would be the best way to increase the patient’s PaCO2 without changing the minute ventilation?
A. Decrease the tidal volume and increase the rate
B. Increase the tidal volume and decrease the rate
C. Add mechanical dead space to the ventilator circuit
D. Increase the inspiratory flow

125. Which of the following would invalidate a bedside measure of vital capacity, i.e., require that the measure be ‘rejected”? 1. obtained values less than 50% of predicted 2. nonreproducibility of the measurement 3. indication of poor patient effort
A. 1 only
B. 2 only
C. 2 and 3
D. 1, 2, and 3

126. In the lab results section of her medical record, you note an overall WBC of 22,000 for a febrile patient who appear acutely ill and in moderate respiratory distress. Which of the following is this patient’s most likely diagnosis?
A. Bacterial pneumonia
B. Emphysema
C. Pulmonary embolus
D. Pulmonary fibrosis

127. A patient’s respirations are characterized by a gradual increase and then a gradual decrease in the depth of breathing, followed by a period of apnea. This pattern is known as which of the following?
A. Blot’s breathing Ai
B. Cheyne-Stokes breathing
C. Kussmaul’s breathing
D. Apneustic breathing

128. During the administration of an aerosol treatment, the patient’s respiratory rate drops from 15 breaths/min to 6 breaths/min. Identify this breathing pattern.
A. Bradypnea
B. Biot’s breathing
C. Apnea
D. Hyperpnea

129. The proper positioning of an endotracheal tube in an adult is confirmed by which of the following?
A. 21-23 cm marks at teeth
B. Adequate airway seal
C. Chest X-ray
D. Neutral head position

130. Which of the following would provide the best bedside assessment of the need for mechanical ventilation in a patient with Guillain-Barre syndrome?
A. FRC
B. VC
C. Airway resistance
D. TLC

131. A patient has a pH of 7.58 and a PaCO2 of 25 torr Based on these data, what is the primary acid-base disturbance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis

132. During auscultation, you hear a creaking or grating sound which increases in intensity with deep breathing, but is not affected by coughing. Which of the following conditions best ‘fits’ this finding?
A. Pleurisy
B. Chronic bronchitis
C. Pulmonary edema
D. Atelectasis

133. What is the problem with input flows greater than 10-15 L/min in an infant oxyhood?
A. Increased potential for CO2 accumulation
B. Difficulty in maintaining adequate humidification
C. Difficulty in maintaining stable high FIO2s
D. Production of harmful noise levels

134. 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

135. Spirometry before and after the administration of an aerosolized bronchodilator is used to:
A. Assist in the diagnosis of cystic fibrosis
B. Prevent bronchospasm when an MVV is performed
C. Eliminate the need for supplemental oxygen during the tests
D. Determine the reversibility of the patient’s obstructive disease

136. You perform an arterial puncture to obtain blood for analysis of 02, CO2, and pH. What is the best way to care for the blood sample after it is obtained’?
A. Warm the sample to keep it at body temperature
B. Place it into a mix of ice and water
C. Put a cap over the needle
D. Place the sample in a refrigerator for one hour

137. Which one of the following is NOT required on a patient’s drug prescription?
A. Patient’s name
B. Drug name and dose
C. Frequency of administration
D. Contraindications

138. Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL’? 1. respiratory rate of 32 breaths per minute 2. ribs higher posteriorly than laterally at end expiration 3. left side of thorax expand more than right side 4. accessory ventilatory muscles used during quiet breathing 5. costal angle of 90 degrees increases with inspiration
A. 2, 3, 4 and 5
B. 1, 3 and 4
C. 2, 4 and 5 only
D. 1 2, 3, 4 and 5

139. Which of the following endotracheal tube malfunctions could require extubation and reintubation with a new tube to allow effective positive pressure ventilation of the patient? 1. a large leak in the cuff of the tube 2_ obstruction of the tube that is unrelieved by suctioning 3_ separation of the pilot tube from the endotracheal tube cuff
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2 and 3

140. To avoid preanalytic errors associated with air contamination of a blood gas sample, all of the following are appropriate EXCEPT:
A. Fully expel any bubbles
B. Mix only after bubbles expelled
C. Cap the syringe quickly
D. Place sample in ice slush

141. A laryngeal mask airway may be preferred over tracheal intubation in all of the following situation EXCEPT:
A. When there is a possibility of the patient having an unstable neck injury
B. When high pressures are required to maintain adequate ventilation
C. When the healthcare provider cannot position himself at the head of the patient
D. When the patient cannot be properly positioned for tracheal intubation

142. Which of the following is FALSE regarding assist/control mode ventilation?
A. Assist/control can result in hyperventilation at high triggering rates
B. Assist/control can cause asynchrony/increased work of breathing
C. Assist/control can worsen auto-PEEP, especially in COPD patients
D. Assist/control does not provide full ventilatory support

143. A patient suddenly loses consciousness. Which of the following is the first procedure you should perform to maintain an open airway in this patient?
A. Inserting a laryngeal mask airway
B. Applying the “jaw thrust” maneuver
C. Inserting an oropharyngeal airway
D. Applying the “head-tilt/chin-lift” maneuver

144. Directed coughing is useful in helping maintain bronchial hygiene in all of the following patients categories EXCEPT
A. Bronchiectasis
B. Acute asthma
C. Cystic fibrosis
D. Spinal cord injury

145. Which of the following will occur if you decrease the inspiratory flow setting during an IPPB treatment?
A. The tidal volume will decrease
B. The pressure will decrease
C. The expiratory time will decrease
D. The inspiratory time will increase

146. On a pneumatically-powered IPPB device, switching the air-mix control to 100% oxygen will have which of the following effects on flow?
A. Make the flow dependent on patient effort N.
B. Decrease the flow to a lower level
C. Increase the flow to a higher level
D. The change will have no effect on flow

147. To adjust the CPAP level generated by a simple water column, you would
A. Vary the depth of expiratory line under water
B. Increase the flow through the CPAP circuit
C. Vary the depth of inspiratory line under water
D. Decrease the flow through the CPAP circuit

148. The effect of the expiratory grunt in a newborn who is in respiratory distress would be to
A. Better humidify the inspired air
B. Counteract the production of secretions
C. Prevent atelectasis
D. Increase the PaCO2

149. Normal lung compliance is approximately:
A. 0.1 – 0.4 L/cm H20
B. 0.4 – 0.8 L/cm H20
C. 10 – 15 L/cm H20
D. 15 – 20 L/cm H20

150. Which of the following are acceptable changes in patient status during a traditional T-tube weaning trial? I. an increase in respiratory rates of 20/min II. an increase in cardiac rate of 15/min III. a 5 mm Hg rise in the arterial PCO2 IV. the development of paradoxical breathing
A. II and IV only
B. I, ll and Ill only
C. II and III only
D. I, II, Ill and IV

151. Which of the following endotracheal tube malfunctions could require extubation and reintubation with a new tube to allow effective positive pressure ventilation of the patient? 1. a large leak in the cuff of the tube 2. obstruction of the tube that is unrelieved by suctioning 3. separation of the pilot tube from the endotracheal tube cuff
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1 2 and 3

152. While assessing the endotracheal tube cuff pressure in an intubated patient, you confirm a leak at 18 cm H20 throughout most of inspiration. You should:
A. Add air to the cuff until a minimal leak is heard
B. Reassess the cuff pressure during expiration
C. Replace the endotracheal tube with a larger size
D. Inflate cuff until the leak ceases at < 25-30 cm H20

153. The following pulmonary function results are obtained for a patient FEV1/FVC = 95% of predicted FVC = 50% of predicted Based on these data, the patient most likely has
A. Pulmonary fibrosis
B. Cystic fibrosis
C. Emphysema
D. Bronchitis

154. While working in the intensive care unit, you notice the following airway pressures on a mechanically ventilated adult patient receiving 5 cm H20 PEEP: Plateau Peak Pressure Pressure Time cm H20 cm H20 0900 34 44 1000 38 49 1100 44 55 Knowing that no ventilator setting changes have been made, what is the most likely cause of these changes?
A. Endotracheal suctioning is needed
B. The patient’s lungs are becoming more compliant
C. The patient is developing pneumonia
D. The patient is developing bronchospasm

155. Which of the following is likely to increase the possibility of tracheal wall damage resulting from excessive endotracheal tube cuff pressures?
A. Using a low-volume, high-pressure cuff 1
B. Maintaining cuff pressures < 20 – 25 cm H20
C. Using the minimal leak technique
D. Monitoring cuff pressures every 8 hours

156. 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

157. Which of the following is false regarding switching from an esophageal-tracheal Combitube® (ETC) to an oral endotracheal tube?
A. The equipment needed is the same as for endotracheal intubation
B. The patient’s stomach contents should be aspirate through the #2 tube
C. The body of the tube normally must be positioned in the trachea
D. The large #1 pharyngeal cuff must be deflated before laryngoscopy

158. Which of the following is likely to increase the possibility of tracheal wall damage resulting from excessive endotracheal tube cuff pressures?
A. Using a low-volume, high-pressure cuff
B. Maintaining cuff pressures <20 – 25 cm H20
C. Using the minimal leak technique
D. Monitoring cuff pressures every 8 hours

159. The normal gradient between the arterial PCO2 and the end-tidal P002 as measured by capnography (PetCO2)is
A. 1-5 mm Hg
B. 5-10 mm Hg
C. 10-15 mmHg
D. 15-20 mm Hg

160. A patient is intubated with an appropriate size endotracheal tube and is being ventilated with a positive pressure ventilator_ During inspiration, air is heard at the mouth. Which of the following should be done?
A. Check the cuff inflation
B. Suction the patient
C. Order a chest X-ray
D. Replace the tube