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1. Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able exhale what percent of the FVC?

A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC

The normal range for the FEV1 as a percent of the FVC (FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed FEV% values, while patients with restrictive disorders will generally exhibit normal (or sometimes high) FEV% values.
The correct answer is: 70-83% of the FVC

2. Simple spirometry CANNOT be used to measure the

A. vital capacity
B. residual volume
C. tidal volume
D. inspiratory reserve volume

Residual volume (RV) is defined as the amount of air left in the lungs after a maximal exhalation. Because the RV cannot be exhaled, it cannot be measured by simple spirometry. And because the RV is a component of the FRC and TLC, simple spirometry also cannot measure these capacities.
The correct answer is: residual volume

3. Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated?

A. obtain and review the patient’s past medical history
B. ask the patient’s nurse about the patient’s prescriptions
C. request that the lab run a comprehensive blood drug screen
D. obtain the patient’s current prescription vials from the family

In patients with a depressed level of consciousness or severe agitation, the medication history may need to be obtained from the family members. In these cases, it also may be useful to either obtain information on the pharmacies where the patient has prescriptions filled, or request that a family member provide the hospital pharmacy with all the patient’s current prescription vials for review.
The correct answer is: obtain the patient’s current prescription vials from the family

4. Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax?

A. presence of gliding sign
B. absence of A-lines
C. presence of barcode sign
D. presence of seashore sign

Ultrasound findings consistent with the presence of an underlying pneumothorax include: absence of the gliding sign and B-lines, and the presence of A-lines and (on M-mode) the barcode sign. A lung point sign (or lead point) also may be present in patients with a pneumothorax, representing the transition between an area where pleural gliding is visible and where it stops (demarcating the beginning of air in the pleural space). The presence of the seashore sign on M-mode rules out pneumothorax.
The correct answer is: presence of barcode sign

5. Which of the following would tend to increase insensible water loss?

A. hypothermia
B. bypassed upper airway
C. hypoventilation
D. diuretic administration

The (invisible) evaporative loss through the skin and respiratory tract is called insensible water loss. Normally about 2/3rd of this is lost via the skin, with only about 1/3rd lost via the respiratory tract. Insensible water loss is increased by fever, hypermetabolism and hyperventilation. Insensible water also increases when the upper airway is bypassed and no supplemental humidification is provided.
The correct answer is: bypassed upper airway

6. Which of the following would tend to decrease a patient’s energy expenditure?

A. hypothermia
B. inflammation
C. major trauma
D. agitation/pain

Common factors decreasing metabolic rate and thus energy expenditure include sedation/ analgesics, muscle paralysis, shock/hypovolemia, hypothermia/cooling, hypothyroidism, antipyretics, starvation, and properly applied ventilatory support. Conversely, fever, Inflammation (including SIRS), sepsis, major trauma (including burns), shivering, seizures, agitation/anxiety/ pain, hyperthyroidism, adrenergic drugs and ventilator weaning all tend to increase energy expenditure.
The correct answer is: hypothermia

7. A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between:

A. + 6 mEq/L
B. – 6 mEq/L
C. +/- 2 mEq/L
D. +/- 8 mEq/L

In acute or uncompensated respiratory acidosis, the base excess (BE) should always fall within the normal range. On the other hand, when renal compensation is occurring in response to a chronic respiratory acidosis, the BE should rise above the normal range (due to the increased levels of plasma HCO3).
The correct answer is: +/- 2 mEq/L

8. Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack?

A. pH = 7.31 PCO2 = 50 torr PO2 = 60 torr
B. pH = 7.40 PCO2 = 50 torr PO2 = 50 torr
C. pH = 7.47 PCO2 = 32 torr PO2 = 60 torr
D. pH = 7.47 PCO2 = 40 torr PO2 = 50 torr

A mild asthma attack usually results in a respiratory alkalosis with hypoxemia. The only answer that matches this is the pH of 7.47, PaCO2 of 32 torr and the PaO2 of 60 torr.
The correct answer is: pH = 7.47 PCO2 = 32 torr PO2 = 60 torr

9. The Apgar score for a normal newborn infant ranges between

A. 1-4
B. 4-7
C. 7-10
D. 10-13

At birth, an Apgar score of 7-10 is considered normal. Scores of 4-6 are intermediate and usually dictate the need for more intensive support. Infants with Apgar scores of 0-3 usually undergo aggressive resuscitation. Needed interventions should never be delayed in order to obtain the Apgar score, nor should these scores dictate resuscitation procedures.
The correct answer is: 7-10

10. On inspection of a patient’s ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is:

A. 2nd degree (Wenckebach) heart block
B. ventricular fibrillation
C. atrial fibrillation
D. ventricular tachycardia

The most likely problem is atrial fibrillation, in which ectopic foci in the atria fire irregularly at rates greater than 350/min. P waves are replaced by irregular undulations of the isoelectric line. Since AV node transmission varies, the ventricular response is also irregular. With some contractions too weak to palpate peripherally, a pulse deficit (difference between the precordial and peripheral pulse rates) is often observed
The correct answer is: atrial fibrillation

1. In inspecting an elderly female patient, you note that her spine has an abnormal anterposterior (AP) curvature. Which of the following terms would you use in charting this observation?

A. kyphosis
B. scoliosis
C. kyphoscoliosis
D. pectus excavatum

An abnormal AP curvature of the spine is called kyphosis. Other common deformities are 1) pectus carinatum (abnormal anterior protrusion of the sternum); 2) pectus excavatum (depression of part or all of the sternum); 3) scoliosis (abnormal lateral curvature of the spinal); and 4) kyphoscoliosis (a combination of kyphosis and scoliosis which may produce a severe restrictive lung defect).
The correct answer is: kyphosis


2. During auscultation of a patient’s chest, you hear intermittent “bubbling” sounds at the lung bases. Which of the following chart entries best describe this finding?

A. “bronchial sounds heard at lung bases”
B. “wheezes heard at lung bases”
C. “rhonchi heard at lung bases”
D. “crackles (rales) heard at lung bases”

The preferred term for short, discontinuous adventitious lung sounds that are crackling or bubbling in nature is crackles. Many clinicians still use the term rales for these sounds. Crackles are caused either by movement of excessive secretions in the airways (course crackles), or by collapsed airways opening during inspiration ( fine crackles).
The correct answer is: “crackles (rales) heard at lung bases”

3. While assessing a patient’s radial pulse, you note that the pulse feels full and bounding. Which of the following conditions would be the most probable cause of this finding?

A. hypovolemia
B. hypertension
C. cardiovascular shock
D. low cardiac output

A ‘bounding’ pulse is characterized by forceful pulsations that quickly disappear, indicating a high systolic pressure without a rise in diastolic pressure (increased pulse pressure). A bounding pulse is normal during exercise or as a result of a ‘fight or flight’ release of epinephrine. A bounding pulse also can signal an abnormal condition, most commonly hypertension due to atherosclerosis or disorders causing increased stroke volume. Hypovolemia, shock, and low cardiac output usually result in decreased systolic and pulse pressures.
The correct answer is: hypertension


4. A patient is cachexic, exhibits generalized edema and dry skin, and appears listless. The most likely problem is:

A. heart failure
B. Addison’s disease
C. renal failure
D. malnutrition

A weak or emaciated appearance (cachexia); generalized edema (anasarca); cracked lips (cheilosis); dry, scaly skin; and listlessness are all physical signs associated with severe malnutrition
The correct answer is: malnutrition

5. Prior to giving an aerosol treatment, you find a note in the chart that states your patient had pink frothy secretions on admission to the ED. This is most indicative of:

A. cor pulmonale
B. left ventricular failure
C. an electrolyte imbalance
D. ARDS Incorrect

Frothy pink-tinged secretions are a hallmark sign of cardiogenic pulmonary edema, which is the result of left ventricular failure or CHF.
The correct answer is: le ventricular failure

6. During auscultation of a patient’s chest, you hear intermittent “bubbling” sounds at the lung bases. Which of the following chart entries best describe this finding?

A. “bronchial sounds heard at lung bases”
B. “wheezes heard at lung bases”
C. “rhonchi heard at lung bases”
D. “crackles (rales) heard at lung bases”

The preferred term for short, discontinuous adventitious lung sounds that are crackling or bubbling in nature is crackles. Many clinicians still use the term rales for these sounds. Crackles are caused either by movement of excessive secretions in the airways, or by collapsed airways opening during inspiration.
The correct answer is: “crackles (rales) heard at lung bases”


7. How would you characterize the degree of dyspnea of a patient who walks slower than people of the same age because of breathlessness?

A. slight
B. moderate
C. severe
D. very severe

You can assess a patient’s exercise tolerance via interview using the American Thoracic Society Breathlessness Scale. By inquiring as to when breathlessness is first noticed by the patient, you can assign a rating to the symptom, with a descriptive term for each level. In this case, a patient who walks slower than people of the same age on level ground because of breathlessness or has to stop for breath when walking at own pace on level ground would be characterized as having moderate dyspnea.
The correct answer is: moderate

8. Upon exam of an acutely dyspneic and hypotensive patient, you note the following – all on the left side of the chest: reduced chest expansion, hyperresonance to percussion, absent of breath sounds and tactile fremitus, and a tracheal shift to the right. These findings suggest:

A. left-sided pneumothorax
B. left-sided consolidation
C. left lobar obstruction/atelectasis
D. left-sided pleural effusion

An acutely ill patient with dyspnea, hypotension, unilateral findings of reduced chest expansion, a hyperresonant percussion note, absent of breath sounds and tactile fremitus, and a tracheal shift to the right has most likely suffered a large pneumothorax on the affected side. If the pneumothorax is severe enough to disrupt cardiac function, blood pressure will also fall.
The correct answer is: le -sided pneumothorax


9. 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”

When a patient’s response to a question is initially vague, one should seek clarification from the patient. Examples of clarification methods include questions such as “I don’t understand what you have just said – please explain that to me again”.
The correct answer is: “Please explain that to me again”

10. A patient is asked to inhale as deeply as possible and blow out all his air as hard as they can until empty. What test is being performed?

A. FVC
B. IC
C. TLC
D. MVV

When a patient performs a maximal exhalation after a maximal inhalation, he is performing the forced vital capacity (FVC) maneuver.
The correct answer is: FVC

1. You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data?

A. ventilator disconnection
B. hyperventilation
C. rebreathing
D. increased cardiac output

This capnogram shows a progressive reduction in expired CO2, most commonly indicating hyperventilation. Other problems that this display could indicate include hypothermia/reduced metabolism, or sedation/neuromuscular paralysis.
The correct answer is: hyperventilation

2. On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 150; regular rhythm; normal P waves, P-R intervals, and QRS complexes. The most likely problem is:

A. atrial utter
B. sinus tachycardia
C. ventricular tachycardia
D. atrial fibrillation

The most likely problem is sinus tachycardia. In this arrhythmia, the sinus node rate ranges from 100-160/min. e rhythm is regular, with normal P waves, P-R intervals, and QRS complexes. Many different factors can cause sinus tachycardia. Treatment aims at correcting the underlying cause. Drugs used to slow the heart rate include digitalis and beta-adrenergic blockers like propranolol.
The correct answer is: sinus tachycardia

3. On inspection of a 12-lead ECG, you note the absence of P waves and a variable R-R interval (> 0.12 sec). Which of the following is the most likely problem?

A. atrial hypertrophy
B. First-degree heart block
C. atrial fibrillation
D. sinus arrhythmia

A variable R-R interval (> 0.12 sec or > 10% variation) indicates either sinus arrhythmia or atrial fibrillation. e absence of P waves rules out sinus arrhythmia, making atrial fibrillation the most likely problem.
The correct answer is: atrial fibrillation

4. What percent decrease in FEV1 needs to occur to conclude that a methacholine challenge is positive for airway hyperreactivity?

A. 10%
B. 15%
C. 20%
D. 25%

The methacholine challenge assesses changes in airway caliber with increasing concentrations of methacholine. Patients with hyperreactive airways will show early changes at low dosages. A 20% decrease in FEV1 is considered a positive result. e methacholine concentration at which a 20% decrease in FEV1 occurs is called the “provocative concentration,” or PC20. The lower the PC20, the worse the airway hyperreactivity.
The correct answer is: 20%

5. A patient is receiving ventilatory support after thoracic surgery. You measure the patient’s maximum inspiratory pressure (MIP/NIF) as -33 cm H2O. Based on this value, the patient has:

A. a need for continued ventilatory support
B. a large leak in their endotracheal tube cu
C. a normal maximum inspiratory pressure
D. adequate muscle strength to consider weaning

The maximum inspiratory pressure (MIP/NIF) is a traditional measure used to assess readiness for weaning. The threshold level that has been used to indicate readiness to wean is a negative value below -25 to -30 cm H2O. e measured MIP (-33 cm H2O) here suggests that this patient may be ready for weaning. Of course, other consideration should be taken into account. If fact, current evidence suggests that the following are better indicators of weaning readiness than traditional bedside measures like MIP: 1) some reversal of the underlying cause of respiratory failure; and 2) adequate oxygenation (P/F > 150-200; PEEP ≤ 8 cm H2O, FIO2 ≤ 0.4-0.5); 3) an arterial pH ≥ 7.25; 4) presence of stable hemodynamics, e.g., no myocardial ischemia or significant hypotension; and 5) presence of spontaneous breathing effort.
The correct answer is: adequate muscle strength to consider weaning

6. 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

During a normal single-breath capnogram, the sharp downstroke and return to baseline that occurs after the end-tidal point indicates inhalation of fresh gas with zero carbon dioxide.
The correct answer is: inspiration of fresh respiratory gas

7. A patient is considered as having sufficient respiratory muscle strength to maintain adequate ventilation and prevent secretion retention when the maximum inspiratory pressure (MIP; NIF) is more negative than:

A. -5 cm H2O
B. -10 cm H2O
C. -15 cm H2O
D. -20 cm H2O

Most clinicians cite -20 to -25 cm H2O as the threshold level for the MIP/NIF, meaning that only patients who can generate values more negative than this (e.g., – 40 cm H2O) are likely able to maintain adequate ventilation and take breaths deep enough to facilitate coughing and secretion clearance. In the past, values more negative than -20 to -25 cm H2O (along with other bedside measures like the VC) also were used to indicate that a patient was ready for weaning.
The correct answer is: -20 cm H2O

8. Over a 3-hour period, the plateau pressure of a patient receiving volume controlled ventilation has remained stable, but her peak pressure has been steadily increasing. Which of the following is the best explanation for this observation?

A. the patient’s airway resistance has increased
B. the patient is developing atelectasis
C. the patient’s compliance has decreased
D. the patient is developing pulmonary edema

With a constant flow, differences between the peak and plateau pressure are directly proportional to the airway resistance. In this case, an increase in the peak – plateau pressure difference signals an INCREASE in airway resistance. All other choices suggest decreased compliance, which would affect the plateau – PEEP pressure difference, not the peak – plateau pressure. Remember “R-C-P”: R = Resistance (peak pressure); C = compliance (plateau pressure); P = PEEP (baseline pressure).
The correct answer is: the patient’s airway resistance has increased

9. On inspection of an adult patient’s 12-lead ECG, you note a regular R-R interval of 0.40 sec, with no other apparent abnormalities. Which of the following is the most likely problem?

A. ventricular tachycardia
B. sinus bradycardia
C. atrial fibrillation
D. sinus tachycardia

In an adult patient, the presence of a regular R-R interval of 0.40 sec (rate = 60/0.40 = 150/ min) indicates a sinus tachycardia. In sinus bradycardia, the R-R interval would be > 1.0 second (rate < 60/min). e ECG of patients with ventricular tachycardia typically reveals abnormally widened QRS complexes, whereas atrial fibrillation is characterized by an irregular rate.
The correct answer is: sinus tachycardia

10. Under ideal conditions, pulse oximeter readings patients usually fall with what percent of those obtained via invasive hemoximetry?

A. ±1-2%
B. ±2-3%
C. ±3-5%
D. ±5-7%

In terms of accuracy, pulse oximetry readings in sick patients usually fall within ±3-5% of those obtained via invasive hemoximetry. In general, the lower the actual SaO2, the less accurate and reliable the SpO2. Most clinicians consider pulse oximeter readings unreliable at saturations below 70%.
The correct answer is: ±3-5%

1. Prior to intubation in an emergency, injection of air into the pilot line fails to inflate the cuff. You should

A. check the cuff for leaks
B. check the valve on the pilot line
C. replace the endotracheal tube
D. inspect the pilot line for patency

A cuff that fails to inflate when injected with air has a large leak. The faulty ET tube should be replaced and the new tube tested in the same manner.
The correct answer is: replace the endotracheal tube

2. A 15-year-old with cystic fibrosis is receiving pressure control SIMV with pressure support due to a severe bilateral pneumonia. The pulmonologist asks you to administer aerosolized dornase alfa (Pulmozyme, DNase) in-line with the ventilator. Which of these devices would you select to administer this therapy?

A. dry powder inhaler (DPI)
B. vibrating mesh nebulizer
C. metered dose inhaler (MPI)
D. small volume nebulizer

Pulmozyme is available only as a liquid (ampule) preparation for single use and thus cannot be administered by either MDI or DPI. Pulmozyme normally is administered by FDA-approved jet nebulizers. However, in-line jet nebulization during mechanical ventilation can alter ventilator response (especially with spontaneous breathing) and cause inaccurate flow/volume measurement. For this reason, many clinicians are using vibrating mesh nebulizers for in-line ventilator drug aerosol therapy. ese devices do not add any flow to the circuit and thus do not affect ventilator function.
The correct answer is: vibrating mesh nebulizer

3. Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula?

A. decrease in patient inspiratory flow
B. increase in patient inspiratory time
C. increase in patient minute ventilation
D. decrease in patient tidal volume

With a low-flow device like a nasal cannula, the larger the tidal volume, the higher the inspiratory flow, the less the inspiratory time, or the greater the minute ventilation, the greater will be the amount of air diluting the O2 and the lower the FIO2. Conversely, with all else constant, the greater the input O2 flow during inhalation, the less air dilution occurs, and the higher the FIO2.
The correct answer is: increase in patient minute ventilation

4. You notice that a disposable nebulizer is delivering large water droplets down the large bore tube. To correct this problem, you should

A. add a heating collar to the nebulizer
B. replace the nebulizer
C. add water to the nebulizer
D. dismantle and clean the nebulizer

Nebulizers should deliver fine aerosol mists, not large water droplets. This situation indicates malfunction of the device. Since disposable devices cannot be disassembled and repaired, the unit should be replaced.
The correct answer is: replace the nebulizer

5. Shortly after you replace a jet nebulizer and tubing on a patient who has a tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout inspiration and expiration in the tracheostomy collar. Which of the following should you do first to resolve the situation?

A. Decrease the input flow to the nebulizer
B. Ask the patient to breath slower and deeper
C. Check the entrainment setting on the nebulizer
D. Obtain an arterial blood gas sample for analysis

In general, when troubleshooting oxygenation issues the first step always should be to check the O2 source and confirm that the proper FIO2 is being delivered. Because aerosol is visible throughout inspiration and expiration, the flow is adequate to meet patient needs and thus assure a stable FIO2. Given adequate flow, the only good explanation is that the FIO2 setting on the new nebulizer was not checked and is providing a lower O2 concentration than the prior setup. To correct the problem, readjust the entrainment setting to match the prescribed value.
The correct answer is: Check the entrainment setting on the nebulizer

6. Which of the following would you expect to occur AFTER an unheated bubble diffusion humidifier is set-up and operating?

A. the reservoir will be warmer than room temperature
B. the reservoir will be cooler than room temperature
C. the reservoir temperature will equal room temperature
D. water will condense on the inside of the delivery tubing

In all humidifiers, heat is lost due to evaporative cooling. is cooling lowers the temperature of the gas and its ability to carry water vapor. In unheated humidifiers, as water vaporizes into the gas, heat is lost and both the gas and the water are cooled. Thus, gas leaving the device is warmed by room conditions, the relative humidity drops, and no condensation occurs.
The correct answer is: the reservoir will be cooler than room temperature

7. During computerized setup of a ventilator, you are prompted to enter a circuit compliance factor. This information is needed to:

A. calibrate the flow sensors
B. complete the automated leak test
C. calibrate the pressure transducer
D. compensate for compressed volume loss

All disposable breathing circuits should come labeled with a compliance factor. This factor is required during computerized ventilator setup to program the device to compensate for compressed volume loss.
The correct answer is: compensate for compressed volume loss

8. A bubble humidifier is connected to a flowmeter set and running at 5 L/min. When you obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT sound. Which of the following is the most likely cause of this observation?

A. excessive flow through the humidifier
B. a leak in the humidifier/delivery system
C. diameter of delivery tubing is too small
D. the flowmeter is not pressure compensated

The pressure pop-off on a bubble humidifier normally sounds when the pressure in system exceeds a preset limit, e.g. 2 psi. Pressure in the system rises only when there is an obstruction to flow DISTAL to the downtube or bubble-diffuser. If the pop-off does not sound when you obstruct flow, either (1) there is no inlet flow, (2) there is a leak in the humidifier/ delivery system, or (3) the pop-off is malfunctioning.
The correct answer is: a leak in the humidifier/delivery system

9. Which of the following analyzers would you select if your objective were to continuously measure changes in the FIO2 in a ventilator circuit with the fastest possible response time?

A. physical (paramagnetic) analyzer
B. thermal conductivity analyzer
C. galvanic fuel cell analyzer
D. polarographic (Clark) analyzer

Only the polarographic and galvanic fuel cell analyzers can provide continuous sampling and measurement under dynamic conditions (as in ventilator circuits). However, with its current flow maintained solely by the chemical reaction itself, the galvanic fuel cell has a comparatively slow response time.
The correct answer is: polarographic (Clark) analyzer

10. To maximize the duration of flow/runtime outside the home, liquid portable O2 systems:

A. hold about three liters of liquid oxygen
B. can be refilled from a liquid O2 base unit
C. incorporate a pulse-dose delivery system
D. include a battery-powered contents indicator

Liquid portable O2 systems are used in conjunction with a home-based stationary unit, from which they are refilled. Because refilling requires a return to the base unit, it does not extend runtime outside the home. When full the typical unit holds 1-liter of liquid O2 and provides 3-4 hours continuous flow at a typical low flow setting of ‘2.’ A 3 liter unit would triple this duration of flow but would weigh over 12 lbs. and not be readily transportable. us the best way to maximize portable unit runtime is to incorporate a pulse dosing system that delivers small boluses of O2 only during inspiration.
The correct answer is: incorporate a pulse-dose delivery system

1. You run a control solution through a blood gas analyzer as part of daily quality control. The measured high PO2 value is 9 torr outside of the acceptable range. Prior runs were all in range. You should:

A. report results after compensating for the deviation
B. replace the PO2 electrode and recalibrate the analyzer
C. analyze another control solution for comparison
D. perform a two-point calibration and rerun the control

A single or sporadic value that falls outside the acceptable quality control range (typically ± 2 SD) is known as a random error. Whenever a random analysis error occurs, you should recalibrate the analyzer and rerun the control (using a solution). Should the repeat analysis yield the same results, the problem more likely is a more serious bias error, requiring that the analyzer be taken out of service and undergo full maintenance.
The correct answer is: perform a two-point calibration and rerun the control

2. Which of the following is true regarding calibration of exhaled nitric oxide (NO) gas analyzers?

A. inlet flows should mimic breathing (variable flow/pressure)
B. daily 2-point (zero/high %NO) calibration is required
C. room air can be used as the ‘zero’ calibrating gas
D. daily 1-point using a standardized NO% is sufficient

Exhaled nitric oxide (NO) gas analyzers should be calibrated daily using the 2-point method, i.e., measuring a ‘zero’ gas and a ‘high’ gas containing a standardized NO concentration. Since room air contains NO, it cannot be used to zero the analyzer. Instead, the zero gas is generated by removing NO from air (the ‘knockout’ method). Because analysis is very sensitive to changes in reaction chamber pressure, calibration (and sample analysis) always should be performed at a constant inlet sample flow.
The correct answer is: daily 2-point (zero/high %NO) calibration is required

3. When reviewing statistical quality control data on a blood gas analyzer, you note a single pH measurement among 30 that falls below the ± 2 SD “in control” standard for your lab. Which of the following is the most likely cause of this error?

A. statistical probability/chance
B. contaminated buffer solutions
C. incorrect analysis procedures
D. failure of the pH electrode

A single pH measurement among 30 that falls outside a lab’s ± 2 SD “in control” standard represents a random error or error of imprecision. Random errors in blood gas quality control usually are due to statistical probability (a chance occurrence), sample contamination or sample mishandling. Contaminated buffers, incorrect analysis procedures, component failure and incorrect calibrating gas concentrations are causes of systematic or bias errors.
The correct answer is: statistical probability/chance

4. You are analyzing quality control samples on a blood gas analyzer as part of a routine quality control program. Multiple but not successive PCO2 values fall above and below the two standard deviation limit. You should:

A. record the results as an acceptable
B. record the results as an acceptable after correcting for the difference in measurements
C. record the results as an acceptable if they are within +/- 2 SD of the mean
D. perform a two-point calibration and reanalyze the control sample

Frequent random errors like this indicate a lack of precision, i.e., poor repeatability of measurement. Any instrument that demonstrates poor repeatability over time is deemed “out- of-control.” In such cases, you would have to identify the problem, take appropriate corrective action and re-confirm that the analyzer is back in-control prior to the reporting results for any patient sample.
The correct answer is: perform a two-point calibration and reanalyze the control sample

5. Which of the following blood gas quality control procedures is designed to assure that the output of the analyzer is both accurate and linear across the range of measured values?

A. statistical quality control.
B. performance validation
C. control media verification
D. automated calibration

The blood gas quality control procedure designed to assure that the output of the analyzer is both accurate and linear across the range of measured values is called calibration. Blood gas analyzers regularly calibrate themselves by adjusting each electrode’s output signal when exposed to media having known values, usually precision gas mixtures and standard pH buffer solutions. Normally parameters are measured at two levels, usually a low and a high value.
The correct answer is: automated calibration

6. When calibrating a portable computerized spirometer, its volume readings consistently fall outside the ± 3% range. Which of the following is the most likely cause of this problem?

A. flow sensor misassembled or damaged
B. failure to remove bacterial filter before calibration
C. flow sensor tubing not connected to computer
D. incorrect selection of prediction equations

Likely causes for the volume readings of a portable spirometer consistently falling outside the ± 3% calibration range include the following: (1) an incorrect temperature or pressure/altitude input; (2) a loose connections or leak in system; (3) a misassembled or damaged flow sensor; or (4) a flow sensor that is obstructed with foreign matter. Neither prediction equation selection nor use of a bacterial filter during calibration should effect the volume measurement. On the other hand, if the flow sensor were not connected to computer, no volume whatsoever would be recorded.
The correct answer is: flow sensor misassembled or damaged

7. When reviewing statistical quality control data on a blood gas analyzer, you note a single PCO2 measurement among 30 that falls below the ± 2 SD “in control” standard for your lab. Which of the following is the most likely cause of this error?

A. contamination of the sample
B. incorrect calibrating gas %
C. incorrect analysis procedures
D. failure of the PCO2 electrode

A single pH measurement among 30 that falls outside a lab’s ± 2 SD “in control” standard represents a random error or error of imprecision. Random errors in blood gas quality control usually are due to statistical probability (a chance occurrence), sample contamination or sample mishandling. Contaminated buffers, incorrect analysis procedures, component failure and incorrect calibrating gas concentrations are causes of systematic or bias errors.
The correct answer is: contamination of the sample

8. Which blood gas analysis/hemoximetry quality control procedure involves plotting the results of control media analyses on a graph and comparing these plots against derived range limits?

A. machine calibration
B. statistical quality control
C. preventive maintenance
D. control media verification

Internal statistical quality control normally involves plotting the results of control media analyses on a graph and comparing these plots against statistically derived limits, usually ± 2 standard deviations. Control results that fall outside these limits indicate analytic error.
The correct answer is: statistical quality control

9. The reference procedure used to establish accuracy for blood PO2 and PCO2 measurements is:

A. hemolysis
B. manometry
C. equilibration
D. tonometry

Tonometry is the reference procedure to establish accuracy for blood PO2 and PCO2.
The correct answer is: tonometry

10. Based on a review of the following control chart data, which of the following is indicated?

A. single random error
B. negative bias error
C. multiple random errors
D. positive bias error

This Levy-Jennings control chart shows systematic error or bias. Note that the last 10 control runs reveal a downward trend in the measured values for the analyte. Over time, this particular trend is shifting the mean above the control value, causing a negative bias in measurement. Bias errors like these are serious, indicating either incorrect procedure or instrument component failure.
The correct answer is: negative bias error

1. When suctioning an adult patient using a DISS wall-mounted regulator system with collection bottle, you would initially set the vacuum pressure at:

A. -12 to -15 in Hg
B. -80 to -100 mm Hg
C. -5 to -7 in Hg
D. -100 to -120 mm Hg

DISS wall-mounted regulator suction systems are calibrated in mm Hg. When suctioning an adult patient using a bedside regulator suction system, you would initially set the vacuum pressure at -100 to -120 mm Hg. Always use the lowest amount of vacuum needed to effectively remove the secretions.
The correct answer is: -100 to -120 mm Hg

2. In which of the following clinical situations would a patient benefit most from deep breathing exercises?

A. myasthenic crisis
B. postop cholecystectomy
C. exacerbation of COPD
D. status asthmaticus

Deep breathing exercises, including incentive spirometry, are designed to prevent or treat postoperative atelectasis and help patients clear secretions by enhancing cough effectiveness. Although certain breathing exercises may aid in the management of stable COPD and asthma, they are not indicated during acute exacerbations of these conditions. Nor are breathing exercises indicated during a myasthenic crisis, when respiratory muscle paralysis often requires assisted ventilation to sustain life.
The correct answer is: postop cholecystectomy

3. What size suction catheter would you select to suction a patient with a 9.0 mm ID tracheostomy tube?

A. 10 Fr
B. 12 Fr
C. 14 Fr
D. 16 Fr

The external diameter of a suction catheter generally should never exceed 1/2 the internal diameter of the airway (2/3rd in infants). To quickly estimate the correct size, double the internal diameter (ID) of the ET tube and select the next smallest catheter size. In this case 2 x 9 = 18, next smallest catheter size = 16 Fr.
The correct answer is: 16 Fr

4. During postural drainage therapy, a patient’s heart rate remains stable at 92/min and the SpO2 is 97%. However, after you pre-oxygenate the patient and begin nasotracheal suctioning, the patient’s heart rate suddenly drops to 40/min. The most likely reason for this is:

A. severe mucus plugging
B. hypoxemia during suctioning
C. a vago-vagal reflex
D. postural hypotension

Sudden and severe bradycardia during suctioning is most often associated with strong vagal stimulation due to mechanical manipulation of the airway (a vago-vagal re ex). Hypoxemia (which would tend to cause tachycardia) is unlikely here due to pre-oxygenation.
The correct answer is: a vago-vagal reflex

5. If tolerated, a specified postural drainage position should be maintained for at least:

A. 3-5 minutes
B. 5-10 minutes
C. 10-20 minutes
D. 20-30 minutes

If tolerated, a specified drainage position should be maintained for at least 5-10 minutes, and longer if good sputum production results. During therapy, the therapist should observe the patient for signs of ill effects, and monitor the vital signs as needed. In general, total treatment time should not exceed 30-40 minutes.
The correct answer is: 5-10 minutes

6. You are about to suction an infant who has a 3.0 mm (ID) endotracheal tube in place. What is the MAXIMUM size catheter you would use in this case?

A. 6 Fr
B. 8 Fr
C. 5 Fr
D. 10 Fr

Too large a suction catheter can cause atelectasis and worsen hypoxemia. To help avoid this problem, the external diameter of catheters generally should never exceed 1/2 the internal diameter of the airway (2/3rd in infants). To quickly estimate the correct size, double the internal diameter (ID) of the ET tube and select the next smallest catheter size. In this case 2 x 3 = 6, next smallest catheter size = 5 Fr.
The correct answer is: 5 Fr

7. If a patient’s chest X-ray shows infiltrates in the posterior segments of the lower lobes, postural drainage should be performed in which of the following positions?

A. head down, patient prone with a pillow under her abdomen
B. head down, patient supine with a pillow under her knees
C. patient prone with a pillow under her head, bed at
D. patient supine with a pillow under her knees, bed at

The proper position to drain the posterior basal segments of the lower lobes is the prone Trendelenburg position (patient prone, head down 25° or more, with a pillow under the abdomen).
The correct answer is: head down, patient prone with a pillow under her abdomen

8. To increase a patient’s maximum expiratory ow when using a cough assist or mechanical in-exsufflation (MI-E) device, you would:

A. increase the inspiratory time
B. decrease the expiratory pressure
C. increase the expiratory time
D. increase the inspiratory pressure

Increasing the inspiratory or expiratory time does not affect the maximum expiratory flow achieved with a cough assist or MI-E device. To increase the maximum expiratory flow you can increase either the inspiratory or expiratory pressure, or both. Either change will increase the difference between alveolar and airway opening pressures, thereby enhancing flow (flow = ΔP/ resistance)
The correct answer is: increase the inspiratory pressure

9. Postural drainage would best be indicated for a patient with:

A. pleural effusion
B. asthma
C. pneumonia
D. cystic brosis

Postural drainage is used to help patients with retained secretions who have difficulty clearing them on their own. The best examples of patients likely to have this problem are those with cystic fibrosis, bronchiectasis or COPD with retained secretions. However, postural drainage (with directed coughing) is only one of airway clearance strategies and should only be chosen if it best meets the goals of treatment, is acceptable to the patient and is the most cost-effective option. Postural drainage cannot remove fluid that resides outside the lungs (pleural effusion) and there is no current evidence to support its application in patents with either asthma or those with pneumonia not complicated by retained secretions.
The correct answer is: cystic fibrosis

10. In discussing the goals of IPPB therapy with a postoperative patient, which of the following explanations would be most appropriate?

A. “This will prevent pneumonitis.”
B. “This will help you take deep breaths.”
C. “This will prevent atelectasis.”
D. “This will increase your intrathoracic pressure.”

When instructing a patient on any aspect of their therapy, it is important to do so in a supportive, plain language and non-threatening manner. Of the choices given, only “This will help you take deep breaths” fulfills these criteria.
The correct answer is: “This will help you take deep breaths.”

1. A patient who is receiving an aerosol treatment with acetylcysteine (Mucomyst) and hypertonic saline via a SVN suddenly becomes dyspneic. The most likely cause of this problem is:

A. hypercapnia
B. bronchospasm
C. pneumothorax
D. Fluid overload

A common side effect of acetylcysteine is bronchospasm. For this reason, acetylcysteine normally should be administered with a bronchodilator such as albuterol.
The correct answer is: bronchospasm

2. A physician orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would be most appropriate to deliver this mixture?

A. nebulizer set at 100% oxygen with aerosol mask
B. tight-fitting nonrebreathing mask with competent valving
C. simple oxygen mask set to deliver 15 L/min oxygen
D. tight-fitting partial rebreathing mask at 12 L/min

Because a tight-fitting nonrebreathing mask with competent valving and set at the appropriate flow rate can deliver close to 100% source gas, it approximates the characteristics of a fixed performance delivery system. For this reason, the well-designed nonrebreather is the system of choice for short-term administration of high concentrations of O2, as well as other premixed therapeutic gases. Alternatively, a high flow nasal cannula can be used to deliver heliox.
The correct answer is: tight-fitting nonrebreathing mask with competent valving

3. A doctor orders aerosol therapy for a patient receiving mechanical ventilation who is being provided humidification with a heat and moisture exchanger (HME). To assure effective therapy you must:

A. place the aerosol device proximal to the HME in the stream of flow
B. remove the HME before aerosol therapy and replace it afterward
C. place the aerosol device distal to the HME in the stream of flow
D. switch from an HME to an active heated the humidification system
Because an HME traps aerosol, you must you must remove it before aerosol therapy and replace it afterward
The correct answer is: remove the HME before aerosol therapy and replace it afterward

4. Which of the following is associated with the administration of aerosolized epinephrine?

A. tachycardia
B. bradycardia
C. laryngospasm
D. bronchospasm

Epinephrine can cause tachycardia owing to its strong beta-1 receptor stimulation.
The correct answer is: tachycardia

5. After completing an aerosol drug treatment, which of the following is the most appropriate chart notation for you to make?

A. Treatment given as ordered
B. Aerosol therapy given; pulse stable, no changes during therapy; well tolerated
C. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; vital signs stable; well tolerated
D. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation

After completing therapy, you should chart the drug and dose/strength, the patient’s pulse, blood pressure, respiratory rate, breath sounds and the extent to which the patient tolerated the therapy.
The correct answer is: Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation. 

6. A physician orders 2.5 mL ipratropium bromide (Atrovent) 0.2% TID for a COPD patient with recurrent bronchospasm. Which of the following methods would you use to deliver this drug?

A. small volume nebulizer with mask
B. ultrasonic nebulizer with mask
C. small volume nebulizer with mouthpiece
D. MDI

Ipratropium bromide aerosol can cause temporary blurring of vision as well as narrow-angle glaucoma or eye pain if the solution comes into direct contact with the eyes. Use of a nebulizer with a mouthpiece (rather than face mask) reduces the likelihood of the nebulizer solution reaching the eyes.
The correct answer is: small volume nebulizer with mouthpiece

7. Which of the following describes the ventilatory pattern that is best suited for maximum aerosol deposition in the small airways?

A. slow inhalation, pause, slow exhalation
B. slow inhalation, pause, rapid exhalation
C. rapid inhalation, pause, slow exhalation
D. rapid inhalation, pause, rapid exhalation

The ventilatory pattern that is best suited for maximum aerosol deposition in the small airways is a slow inhalation followed by a pause and then a slow exhalation.
The correct answer is: slow inhalation, pause, slow exhalation

8. A doctor orders a metered dose inhaler (MDI) bronchodilator for a patient receiving mechanical ventilation via a dual-limb breathing circuit. To maximize aerosol deposition, you would:

A. place the MDI directly in-line on the inspiratory side of the circuit
B. recommend that a small volume nebulizer be used instead of the MDI
C. place the MDI plus a spacer in-line on the inspiratory side of the circuit
D. place the MDI directly in-line on the expiratory side of the circuit

For patients receiving mechanical ventilation, who require aerosol drug therapy, proper positioning of the device in the circuit is critical to ensure good drug deposition in the lungs. With dual-limb circuits, place the SVN or MDI adaptor in the inspiratory limb. Position SVNs about 1 to 1-/1/2 feet from the patient. With MDIs you should place a spacer or holding chamber in-line in the ventilator circuit.
The correct answer is: place the MDI plus a spacer in-line on the inspiratory side of the circuit

9. Which of the following patient instructions for using a dry powder inhaler (DPI) is correct?

A. hold device vertically after loading
B. perform slow (3-4 sec) deep inhalation
C. exhale back into the device
D. seal lips tightly around mouthpiece

The following general guidelines apply to effective use of a DPI: (1) never use a spacer or VHC with a DPI; (2) lips must be tightly sealed around the mouthpiece; (3) after loading, most DPIs must be held horizontally (to avoid loss of drug); (4) patient should inhale rapidly (> 60 L/min or 1-2 sec) and deeply; and (5) patient must exhale to room (not back into the device).
The correct answer is: seal lips tightly around mouthpiece

10. An increase in a patient’s heart rate during aerosolized bronchodilator therapy is primarily a result of which of the following effects of the drug?

A. Alpha only
B. Beta1 only
C. Beta2 only
D. Beta1 and Beta2 only

An increase in a patient’s heart rate after the administration of an adrenergic bronchodilator is primarily due to Beta 1 receptor stimulation.
The correct answer is: Beta1 only


1. The doctor is concerned that his ARDS patient on pressure control ventilation has high plateau pressures (> 30 cm H2O) and that this may be causing further lung injury. Which of the following modes of ventilation would you consider as an alternative?

A. volume control ventilation
B. pressure support ventilation
C. airway pressure release ventilation
D. continuous positive airway pressure

Airway pressure release ventilation (APRV) is a good option to consider in patients with ARDS, especially when the plateau pressures needed to provide adequate ventilation exceed 30 cm H2O. APRV is also indicated to treat refractory hypoxemia due to collapsed alveoli and massive atelectasis.
The correct answer is: airway pressure release ventilation

2. After bronchodilator therapy, you record the following PFT data on a 67 year-old male COPD patient who reports dyspnea on exertion: FEV1/FVC = 64%; FEV1 = 66% predicted. You would characterize the stage of the patient’s COPD as:

A. mild
B. moderate
C. severe
D. very severe

Irreversible air ow obstruction is present when the FEV1/FVC ratio after bronchodilator treatment is less than 70% of predicted. e stage of COPD is then gauged by its impact on the predicted FEV1. If the FEV1 is < 80% but ≥ 50% of the patient’s predicted value and there is dyspnea on exertion, the stage is classified as moderate.
The correct answer is: moderate

3. The primary aim in treating cardiogenic pulmonary edema is to:

A. increase venous return to the heart
B. decrease right heart and systemic venous pressures
C. decrease left heart and pulmonary vascular pressures
D. increase pulmonary fluid and blood volume

The primary aim in treating cardiogenic pulmonary edema is to decrease left heart and pulmonary vascular pressures.
The correct answer is: decrease left heart and pulmonary vascular pressures

4. What is the most common arrhythmia seen with pulmonary disease?

A. sinus bradycardia
B. sinus tachycardia
C. atrial fibrillation
D. ventricular tachycardia

The most common arrhythmia seen in pulmonary disease is sinus tachycardia. Common causes of sinus tachycardia include hypoxemia, anxiety and hypotension.
The correct answer is: sinus tachycardia

5. The primary purpose of oxygen administration in the management of heart failure is to:

A. increase the force of ventricular contractions
B. decrease resistance to ventricular ejection
C. increase ventricular stroke volume
D. decrease the workload on the myocardium

O2 therapy can reduce myocardial workload in ventricular failure, especially when hypoxemia is present. Rest (either in bed or sitting in a chair) also decreases the work of the heart and promotes diuresis.
The correct answer is: decrease the workload on the myocardium

6. A doctor institutes volume control ventilation for an 80 kg ARDS patient. Which of the following is the maximum pressure you would 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

According to the NHLBI Protocol, the target volume for ARDS patients is 4-6 mL/kg, with a maximum plateau (alveolar) pressure of 30 cm H2O. The ventilator rate should initially be set to match the prior VE, but can be increased as needed up to a maximum of 35/min.
The correct answer is: 30 cm H2O plateau pressure

7. You would recommend against using noninvasive positive pressure ventilation (NPPV) for a patient with:

A. secretions requiring suctioning
B. the need for moderate sedation
C. facial burns or trauma
D. FIO2 needs greater than 40%

Absolute contraindications against using NPPV include the following: need for immediate intubation, hemodynamic instability, active cardiac arrhythmias or ischemia, active upper GI bleeding, uncooperative patient, facial burns or trauma, and the need for airway protection.
The correct answer is: facial burns or trauma

8. An alert patient with emphysema and an elevated CO2 level is given 50% O2 by an air-entrainment mask. One hour later the nurse calls you to evaluate the patient. He is now very lethargic. Which of the following is the most likely cause of this?

A. respiratory muscle fatigue
B. cerebral hypoxia
C. hypotension
D. O2-induced hypoventilation

Many patients with severe COPD are chronic CO2 retainers, characterized on blood gas analysis as a compensated respiratory acidosis. Such patients are prone to a phenomenon called O2- induced hypoventilation in which high blood PO2 levels alters the V/Q balance in the lungs, increasing deadspace ventilation and PaCO2. For these reasons, clinicians recommend titrating the FIO2 in these patients to keep their PaO2s in the 50 to 60 torr range, equivalent to an SpO2 85-90%. However, you must NEVER deprive O2 from a patient in need.
The correct answer is: O2-induced hypoventilation

9. Which of the following is a key therapeutic objective in the management of a patient who has closed head trauma and is receiving ventilatory support?

A. increase the minute ventilation
B. increase intrathoracic pressure
C. assure patient-ventilator synchrony
D. decrease cerebral perfusion pressure

The overall goal of managing patients with closed head trauma is to prevent secondary injury by maintaining adequate cerebral perfusion pressure (CPP) and brain oxygenation. Because CPP = mean arterial pressure (MAP) – intracranial pressure (ICP), ventilatory care should aim to (1) maximize arterial oxygenation and (2) avoid actions that would either increase ICP or lower MAP. Goals therefore include maintaining an SaO2 of 100%; keeping the PaCO2 between 35-40 mm Hg (hypercapnia increases ICP); keeping the PIP ≤ 30 cm H2O (minimally a ecting MAP); and assuring good patient-ventilator synchrony (helps prevent increases in intrathoracic pressure/ICP). Hyperventilation should only be considered if there is an acute deterioration in neurologic status that does not respond to standard brain trauma therapy, such as osmotic diuresis, CSF fluid drainage and sedation/neuromuscular blockage.
The correct answer is: assure patient-ventilator synchrony

10. In individuals with disorders characterized by an increase in airway resistance, such as emphysema, which of the following breathing patterns results in the minimum work?

A. deep breathing
B. slow breathing
C. shallow breathing
D. rapid breathing

An increase in airway resistance increases the frictional work of breathing, i.e. the pressure difference due to air flow. Decreasing the rate of breathing will decrease the pressure difference due to air flow. us in these patients a slow breathing pattern (decreased flows) will result in the minimum work.
The correct answer is: slow breathing


1. Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following?

A. airway resistance
B. functional residual capacity
C. inspiratory capacity
D. respiratory muscle strength

Inspiratory pressures (MIP/NIF) most accurately measure respiratory muscle strength. Normal values vary by age and gender but for all groups generally exceed 70 cm H2O (negative). When a patient’s MIP/NIF is less than 20 to 30 cm H2O (negative), muscle strength may not be sufficient to support adequate spontaneous ventilation. Although MIP/NIF has been used as a weaning measure, it is best applied to follow the progress of patients with neuromuscular disorders that impair respiratory muscle function.
The correct answer is: respiratory muscle strength

2. Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)?

A. increased hematocrit
B. decreased BUN
C. decreased serum osmolality
D. decreased urine specific gravity

Fluid depletion (dehydration) is indicated by an increase in one of more of the following lab
measures: hematocrit, BUN, serum osmolarlity and/or urine specific gravity.
The correct answer is: increased hematocrit

3. Which of the following would represent an abnormal V/Q scan suggesting pulmonary embolism?

A. large segmental areas with normal ventilation and normal perfusion
B. large segmental areas with no ventilation and no perfusion
C. large segmental areas with normal ventilation but no perfusion
D. large segmental areas with no ventilation but normal perfusion

A V/Q scan is considered abnormal if there is a mismatch of ventilation and perfusion. Pulmonary embolism is indicated when a perfusion defect exists in an area with normal ventilation. The degree of mismatch determines the probability of PE as the diagnosis.
The correct answer is: large segmental areas with normal ventilation but no perfusion

4. 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

Bradypnea is a less than normal rate of breathing; narcotic drug overdose is a common cause. Hypercapnia and hypoxemia are potential problems.
The correct answer is: bradypnea

5. You measure the blood pressure of an adult patient as 88/53 mm Hg. Which of the following chart entries would you use in describing this finding?

A. patient is hypertensive
B. patient is hypotensive
C. patient has low pulse pressure
D. patient has high pulse pressure

An adult blood pressure of 88/53 mm Hg is less than the lower limits of normal (95/60 mm Hg), and would be considered hypotension. Hypotension may result from peripheral vasodilation, left ventricular failure, or low blood volume. In any case, hypotension can cause a decrease in perfusion of vital body and thereby impair oxygen delivery to the tissues. On the other hand, the pulse pressure (systolic-diastolic) is 35 mm Hg (88-53), which is in the normal adult range of 30-40 mm Hg.
The correct answer is: patient is hypotensive

6. While assisting a physician with a transthoracic ultrasound exam, you observe gliding or shimmering of the pleural layer during breathing. This observation

A. is consistent with the interstitial syndrome
B. rules out an underlying pneumothorax
C. indicates the presence of pleural adhesions
D. confirms an underlying pneumothorax

As viewed during real-time ultrasonic imaging, gliding or shimmering of the visceral pleural layer during breathing (the gliding sign) is a normal finding. Lung gliding tends to be most prominent in lower thorax, when the greatest lung expansion occurs. Generally, the presence of lung gliding rules out pneumothorax in the area under the ultrasound probe. Lung gliding will be absent in patients who are apneic or who have a pneumothorax in the area under the probe. Gliding also will be absent in patients with pleural adhesions and when a lung is not ventilated, e.g., with mainstem intubation or occlusion.
The correct answer is: rules out an underlying pneumothorax

7. Your review of a patient’s chart notes an admission diagnosis of fluid depletion/ dehydration. Which of the following findings would be most likely on bedside assessment of the patient?

A. inspissated secretions
B. pitting edema
C. venous distension
D. crackle on auscultation

Common signs of fluid depletion (dehydration) include CNS disturbances (sleepiness, apathy, stupor, coma); tachycardia; collapsed veins; hypotension; thick, inspissated secretions; decreased skin turgor; sunken eyes and dry, coated tongue; and weight loss. Venous distension, pitting edema, and crackles are signs of fluid overload (overhydration).
The correct answer is: inspissated secretions

8. Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax?

A. presence of gliding sign
B. absence of A-lines
C. presence of barcode sign
D. presence of seashore sign

Ultrasound findings consistent with the presence of an underlying pneumothorax include: absence of the gliding sign and B-lines, and the presence of A-lines and (on M-mode) the barcode sign. A lung point sign (or lead point) also may be present in patients with a pneumothorax, representing the transition between an area where pleural gliding is visible and where it stops (demarcating the beginning of air in the pleural space). The presence of the seashore sign on M-mode rules out pneumothorax.
The correct answer is: presence of barcode sign

9. In observing a patient, you note that her breathing is extremely deep and fast. Which of the following terms would you use in charting this observation?

A. Kussmaul’s breathing
B. Biot’s breathing
C. Cheyne-Stokes breathing
D. apneustic breathing

Kussmaul’s breathing is an abnormal pattern characterized by deep and fast respirations. Kussmaul’s breathing is usually associated with the body’s attempt to compensate for a metabolic acidosis, as in diabetic ketoacidosis.
The correct answer is: Kussmaul’s breathing

10. Gross observation of a patient’s sputum specimen reveals purulent green sputum that has separated into layers and has a foul odor. Which of the following is most likely causing the patient to produce this type of sputum?

A. tuberculosis
B. emphysema
C. aspiration
D. bronchiectasis

The presence of green, layered sputum which has a foul odor suggests the presence of pseudomonas aeruginosa, which is a common finding in patients with bronchiectasis.
The correct answer is: bronchiectasis

1. Which of the following medication you would recommend to help quiet an ICU patient who is breathing asynchronously on a ventilator?

A. uoxetine (Prozac)
B. cisatracurium (Nimbex)
C. dextroamphetamine (Dexedrine)
D. propofol (Diprivan)

Common medications used to sedate mechanically ventilated patients include benzodiazepines like midazolam (Versed); hypnotics like propofol (Diprivan); and alpha-2 agonists like dexmetatomidine (Precedex) or clonidine (Catapres). Opioid analgesics like fentanyl (Sublimaze) or remifentanil (Ultiva) also can be used as sedating agents. Cisatracurium (Nimbex) is a neuromuscular blocking agent (not a sedative!), dextroamphetamine (Dexedrine) is a stimulant, and uoxetine (Prozac) an antidepressant.
The correct answer is: propofol (Diprivan)

2. When treating a patient with active tuberculosis, you note large amounts of bloody secretions. You should notify the:

A. nearest relative
B. attending physician
C. department medical director
D. respiratory supervisor

Hemoptysis unfortunately is a somewhat common and potentially serious finding with advanced tuberculosis. In this instance, the attending physician should be immediately notified of this complication.
The correct answer is: attending physician

3. Despite an intensive regimen of positive airway pressure and airway clearance therapy, a postoperative patient continues to exhibit clinical manifestations of atelectasis due to large airway obstruction. The best treatment approach in this case would be:

A. intubation and mechanical ventilation
B. bedside therapeutic bronchoscopy
C. transtracheal aspiration
D. aerosol therapy with acetylcysteine

Should intensive positive airway pressure and airway clearance therapy fail in treating atelectasis due to large airway obstruction, therapeutic bronchoscopy is indicated. is procedure can usually be performed at the bedside with moderate sedation.
The correct answer is: bedside therapeutic bronchoscopy

4. A home care patient with COPD has persistent dyspnea and exhibits signs of increased work of breathing even at rest, but little or no wheezing. The patient currently is receiving no medication. Which of the following drugs would you recommend for this patient?

A. salmeterol (Serevent) via MDI 2 pu s bid
B. prednisone (Deltasone) 5 mg tab od
C. theophylline (Theo-Dur) 150 mg tab bid
D. albuterol (Proventil) 0.5 mL via SVN qid

The diagnosis (COPD) and lack of wheezing suggests that the dyspnea is not caused by bronchospasm, but likely due to air-trapping. is would tend to rule out the use of inhaled bronchodilator therapy. On the other hand, slow release theophylline has been shown to decrease dyspnea, air trapping, and the work of breathing in COPD patients, in part by improving the contractility of the diaphragm. These improvements generally occur without any measurable change in pulmonary function. To avoid adverse effects, the drug should be titrated to maintain its therapeutic range of 10-20 mcg/mL.
The correct answer is: theophylline (Theo-Dur) 150 mg tab bid

5. Auscultation of an 18 year old female patient’s chest reveals diffuse wheezing and an irregular heart rate. Chart review indicates a history of frequent nighttime awakenings with dyspnea and cough. Which of the following aerosolized drugs would be most appropriate to administer?

A. albuterol (Proventil)
B. racemic epinephrine
C. acetylcysteine (Mucomyst)
D. atropine

The history and presence of wheezing suggests that this patient may well have asthma and is suffering from bronchospasm. The appropriate drug to reverse bronchospasm is a beta-adrenergic like albuterol. Albuterol has minimal beta-1 effects yet significant a beta-2 effect, which relaxes smooth muscle and causes bronchodilation. Racemic epinephrine can cause significant beta-1 stimulation and therefore is generally not appropriate for patients with an arrhythmia. Because asthmatics often have excessive secretions and atropine can significantly dry secretions, atropine is not indicated in this instance. Although acetylcysteine (Mucomyst) can thin secretions, its irritant properties can worsen bronchospasm.
The correct answer is: albuterol (Proventil)

6. You are asked to assess a 34-year-old homeless man admitted through the ER with an abrupt onset of chills and fever. He has bilateral rhonchi with a productive cough. His SpO2 is 88% on room air. What should you recommend?

A. intubate and provide mechanical ventilation with 40% O2
B. institute noninvasive positive pressure ventilation via nasal mask
C. provide O2 therapy, give an antibiotic, and obtain sputum for C&S
D. implement postural drainage and percussion with directed coughing

Based on the information provided, the likely problem is a bacterial pneumonia. Antibiotics and oxygen therapy are the initial treatment for bacterial pneumonias. The sputum sample is needed to help identify the causative organism. Postural drainage and percussion are not recommended for the routine treatment of uncomplicated pneumonia. If secretion retention is a problem, early mobilization and directed coughing should be implemented. Positive expiratory pressure (PEP) therapy might also be considered if secretion retention persists.
The correct answer is: provide O2 therapy, give an antibiotic, and obtain sputum for C&S

7. Which of the following are prerequisites for successful application of noninvasive positive pressure ventilation (NPPV) in the management of chronic neuromuscular disease?

A. intact upper airway function
B. MIP > 25 cm H2O (neg)
C. normal acid-base balance
D. SpO2 > 90% on room air

NPPV is often used in managing the progressive respiratory acidosis that occurs in chronic neuromuscular diseases such as muscular dystrophies, post-polio syndrome and multiple sclerosis. Successful application requires a cooperative and motivated patient with intact upper airway function and minimal secretions. If patients can maintain normal acid-base balance and oxygenation on their own, NPPV probably is not needed. Similarly, a MIP > 25 cm H2O (neg) often is cited as one measure indicating muscle strength sufficient to maintain spontaneous ventilation.
The correct answer is: intact upper airway function

8. You cannot maintain satisfactory oxygenation on an ARDS patient receiving 100% O2 and being ventilated with pressure control ventilation at a plateau pressure of 40 cm H2O and 15 cm H2O PEEP. Which of the following modes of ventilation would you recommend at this time?

A. synchronous intermittent mandatory ventilation (SIMV)
B. airway pressure release ventilation (APRV)
C. pressure regulated volume control (PRVC)
D. continuous positive airway pressure (CPAP)

Airway pressure release ventilation (APRV) is equivalent to CPAP with regular, brief, intermittent releases in airway pressure to baseline. Often referred to as “inverted IMV” (based on graphic appearance), APRV is indicated for patients with (1) ALI/ARDS, especially when Pplat > 30 cm H2O; (2) refractory hypoxemia due to collapsed alveoli; or (3) massive atelectasis
The correct answer is: airway pressure release ventilation (APRV)

9. A physician requests your advice in managing a 49 year-old obese male patient with confirmed obstructive sleep apnea. Which of the following would you recommend?

A. placement of a tracheal button
B. night placement of a tongue retainer
C. use of respiratory stimulants
D. nocturnal administration of CPAP

Among all sleep apnea treatment modalities, CPAP is generally the most successful, least hazardous, and best tolerated. CPAP, usually administered via a nasal device, distends the oropharynx, thereby preventing occlusion by the tongue and so palate.
The correct answer is: nocturnal administration of CPAP

10. A 56-year-old male is brought to the emergency room by ambulance complaining of tightness in his chest with radiating left shoulder pain. You should recommend:

A. obtaining an arterial blood gas sample
B. obtaining a stat chest X-ray
C. administering an albuterol treatment
D. administering supplemental oxygen

The patient’s presenting symptoms suggest a myocardial infarction (MI). In order to maximize myocardial oxygenation and decrease myocardial workload, any patient with a suspected MI should be given supplemental oxygen, usually in high concentrations (e.g., via a nonrebreathing mask).
The correct answer is: administering supplemental oxygen

TMC Test Bank

1001 Questions and Answers You Might See on the Board Exam