TMC Practice Exam

1. During the assessment of 60-year-old female patient, you note the following signs: dyspnea, hypotension, reduced chest expansion on the left side, hyperresonant percussion note and tactile fremitus on the left side, absent breath sounds on the left side, and a tracheal shift to the right. These findings suggest which of the following?

2. A 39-year-old male patient was admitted to the emergency department with a fever and an SpO2 of 87% on room air. Upon auscultation, rhonchi is heard and the patient has a productive cough. Which of the following would you recommend?

3. A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-controlled A/C ventilation. Upon assessment, you note that the patient’s cuff pressure is measured at 38 cm H2O. Which of the following would you recommend?

4. During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most likely cause of this finding?

5. A pre and post bronchodilator test was ordered on a 48-year-old female patient. The forced expiratory measurement that was obtained after the bronchodilator was given shows an increase in the patient’s FEV1 from 60% to 80% of the predicted value. This finding suggests which of the following?

6. A 58-year-old female patient is intubated and appears to be breathing asynchronously with the ventilator. Her breath sounds are absent on the left side and the trachea appears to be shifted to the left. The patient has a dull percussion note on the left side as well. Which of the following is the most likely explanation of these findings?

7. A 63-year-old female patient is intubated and receiving mechanical ventilation in the pressure controlled A/C mode. If the patient’s compliance were to decrease, which of the following would you expect to occur?

8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume controlled A/C mode. After performing endotracheal suctioning, which of the following would indicate the effective clearance of retained secretions?

9. An adult patient who is receiving mechanical ventilation suddenly started showing signs of tachypnea. Upon assessment, you note tracheal deviation to the right and decreased breath sounds and hyperresonance on the left. Which of the following would you recommend?

10. A 57-year-old female patient with acute pulmonary edema is dyspneic and appears to be wheezing. The resident physician has ordered an albuterol breathing treatment via SVN. Which of the following would you recommend?

11. A 39-year-old female patient who is intubate was admitted to the emergency department and the nurse was unable to start an intravenous line during CPR. It is believed that the patient is suffering from a narcotic overdose and the physician wants to administer Naloxone. Which of the following is an alternative route that can be used to deliver this medication?

12. A 176 lb male patient is intubated and receiving volume control A/C ventilation with the following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An ABG was analyzed and the following results were obtained:

Which of the following would you recommend?

13. An adult patient was admitted to the emergency department after involvement in a motor vehicle accident. The patient is hyperventilating and appears to have a flail chest. Which of the following ABG results would you expect for this patient?

14. A 51-year-old female patient with a history of asthma is receiving mechanical ventilation in the assist-control mode. Upon assessment, you note that she is struggling to initiate inspiration. Which of the following settings would you check first in order to resolve this problem?

15. The physician has requested the insertion of a nasopharyngeal airway on an adult patient. This type of airway is useful in supporting which of the following?

16. You would expect there to be difficultly establishing a patent airway for a patient with which of the following conditions?

17. A premature infant who is receiving positive pressure ventilation appears to be in acute respiratory distress with signs of hypotension and asymmetrical chest movement. Which of the following would you recommend first?

18. During the assessment of an adult patient who is receiving mechanical ventilation, you suddenly notice the simultaneous sounding of both the high pressure and low volume alarms. What is the most likely cause of this finding?

19. A 16-year-old male patient has been admitted to the emergency department and shows signs of poor body development. Upon assessment, you also note digital clubbing, hyperresonance to percussion, and a productive cough. It has also been reported that the patient has foul-smelling stools. These findings are consistent with which of the following?

20. During the assessment of a 56-year-old female patient, you noticed distinct distention of the jugular veins in the neck. Which of the following is the most likely cause of this finding?

21. An adult patient has performed an FVC maneuver with the following results:

How would you interpret this flow-volume loop tracing?

22. A 68-year-old male patient with COPD is receiving volume control SIMV with the following settings:
Tidal volume 480 mL
Rate 12/min
Pressure support 10 cm H2O
PEEP 5 cm H2O
During a spontaneous breathing trial via T-tube, the patient’s breathing rate increased drastically which required that he be placed back on the ventilator. Which of the following would you recommend during the next breathing trial?

23. An order was placed to collect a blood sample from a neonatal patient in the NICU. It is determined that you should obtain the sample from a capillary instead of an artery. Which of the following is true regarding a capillary blood gas sample?

24. A newly admitted adult patient with pneumonia has an oxygen saturation of 87% on a nasal cannula at 2 L/min. Which of the following is a potential cause of the patient’s hypoxemia?

25. A 59-year-old female postoperative patient is recovering from surgery that occurred less than 24 hours ago. Which of the following would you recommend for this patient in order to prevent atelectasis?

26. A 63-year-old male patient with a tracheostomy is being mechanically ventilated in the ICU. Upon assessment, you noticed that as the patient coughs, blood and secretions were blown back into the circuit. What action should you take at this time?

27. A 56-year-old male patient has been admitted and diagnosed with Guillain-Barré syndrome. In order to determine the patient’s need for ventilatory support, which of the following values is the most critical to monitor?

28. A 64-year-old female patient with a history of CHF has been admitted to the emergency department on a nasal cannula at 4 L/min. She is coughing up large amounts of pink, frothy secretions and presents the following ABG results:
pH 7.42
PaCO2 32 mm Hg
HCO3 19 mEq/L
BE -3 mEq/L
PaO2 46 mm Hg
SaO2 81%
Which of the following would you recommend?

29. While attempting to wean an adult patient from mechanical ventilation, you switched them from the volume control A/C mode over to CPAP with pressure support. 30 minutes later, the high respiratory rate alarm begins to sound and the patient breathing at a rate of 29 breath/min. Which of the following changes would you make to the ventilator settings?

30. A 57-year-old female patient who was admitted and diagnosed with emphysema displays the following ABG results:
pH 7.34
PaCO2 65 torr
PaO2 47 torr
HCO3 31 mEq/L
The patient appears to be dyspneic and inspiratory crackles can be heard during auscultation. Which of the following would you recommend?

31. A 43-year-old female patient in the emergency department was just orally intubated with an endotracheal tube. Which of the following would you INITIALLY recommend in order to confirm that the tube is in the proper position?

32. While assisting with the delivery of a newborn infant, the physician asks for you to obtain an Apgar score on the patient. Which of the following ranges is considered to be a normal score?

33. After orally intubating an adult patient in the ICU, you are asked to confirm that the tube is in the correct place. Upon auscultation, you note that the breath sounds are absent on the patient’s left side. Which of the following is the most appropriate action to take at this time?

34. A 58-year-old female patient has arrived in the emergency department with an extremely deep and fast breathing rate. Which of the following best classifies this type of breathing?

35. A 71-year-old male patient is receiving ventilatory support and it was noted that his secretions are yellow and have gotten thicker over the past 24 hours. The patient has a white blood cell count of 17,000/mm³ and a temperature of 102 °F. Which of the following would you suggest?

36. While reviewing the medical record of a 55-year-old female patient, you note that her FEV1/FVC ratio was reported as being severely decreased. Which of the following conditions would you expect to be present with this finding?

37. A 60-year-old female patient who in orally intubated is going through a spontaneous breathing trial. Which of the following would indicate the need to stop the trial and return the patient back to full ventilatory support?

38. The physician has requested the dynamic compliance measurement for an adult patient who is receiving mechanical ventilation. This value can be obtained by dividing the patient’s tidal volume by which of the following:

39. A 63-year-old male patient was admitted to the ICU. Upon auscultation, you note that bronchial breath sounds are present over the right lower lobe. This finding indicates which of the following?

40. An alert 59-year-old male patient is orally intubated with an endotracheal tube. During a weaning trial, the patient was switched to CPAP mode with an FiO2 of 40%. Within the first 5 minutes, the patient’s respiratory rate has increased from 22 to 31 breaths/min with increased usage of accessory muscles while breathing. Which of the following would you recommend?

41. After the administration of aerosolized albuterol to a 38-year-old female patient, which of the following side effects would you expect?

42. A 23-year-old male patient with a severe head cold is receiving oxygen via nasal cannula at 4 L/min. The pulse oximeter reveals an SpO2 of 85%. Which of the following would you recommend?

43. A stable adult patient who is receiving mechanical ventilation displays the following results:
pH 7.49
PaCO2 29 mm Hg
HCO3 24 mEq/L
BE +1
PaO2 87 mm Hg
SaO2 96%
Which of the following would you recommend?

44. A 68-year-old female patient in the ICU is receiving mechanical ventilation but appears to be breathing asynchronously with the ventilator. Which of the following medications would you recommend?

45. A 70-year-old male patient with COPD is receiving ventilatory support in a volume-controlled mode. Upon assessment, the high-pressure alarm suddenly begins to sound. Which of the following would recommend?

46. A 55-year-old female patient with pneumonia is receiving oxygen via nasal cannula at 4 L/min. The physician asks for your suggestion on the best way to evaluate the patient’s overall ability to breathe. Which of the following would you recommend?

47. While reviewing the chest x-ray of a 57-year-old male patient, you note that there is blunting of the left costophrenic angle. It’s also noted that the patient has a history of CHF. Which of the following best describes this patient’s condition?

48. A 69-year-old male patient is undergoing a spontaneous breathing trial for weaning from mechanical ventilation. Which of the following changes in the patient’s status would be acceptable?

49. An adult patient with fluid overload was given a dose of furosemide intravenously. After the drug was given, the patient displayed an arrhythmia on the EKG that was not present before. Which of the following would you recommend in this situation?

50. After the extubation of a 54-year-old male patient, he begins to complain of a sore throat. Which of the following drugs would you recommend for this patient?

51. An oropharyngeal airway is being used on a 39-year-old male patient. Within two minutes after insertion, the patient begins to gag. Which of the following would you recommend?

52. A 66-year-old female was admitted to the emergency department showing signs of dyspnea, shortness of breath, and chest tightness. Lab tests were ordered to check her troponin and BNP levels but the results were negative. Additionally, her ABG results indicated partially compensated respiratory acidosis. Which of the following is the most likely problem for this patient?

53. A 51-year-old male patient is receiving volume-controlled A/C mechanical ventilation while being monitored with a continuous pulse oximeter. He was briefly removed from the ventilator so that suctioning could be performed and his SpO2 dropped from 95% to 88%. Which of the following would you recommend?

54. During the assessment of an adult patient with chronic asthma, their results displayed the following:
SVC of 3,500 mL
FVC of 2,500 mL
What is the most likely reason for the difference in these values?

55. The physician has ordered acetylcysteine for a 66-year-old female patient with COPD who has a large amount of thick secretions. Upon assessment, you note that the patient has a weak, inadequate cough. Which of the following would you recommend?

56. On discharge, a 52-year-old male patient was prescribed an inhaled corticosteroid via MDI for two puffs twice a day. In order to decrease the likelihood of an oral infection, which of the following would you recommend?

57. A 60-year-old female patient is receiving assist-control mechanical ventilation. Which of the following is the most common problem associated with this ventilatory mode?

58. During the ventilator check of an adult patient who weighs 77 kg, you note the following settings:
Exhaled tidal volume 550 mL
PIP 35 cm H2O
High pressure limit 64 cm H2O
Low pressure alarm 25 cm H2O
Low tidal volume alarm 500 mL
Which of the following changes should be made at this time?

59. An adult patient undergoing a mild asthma attack was admitted to the ER. Which of the following ABG results would you expect to see?

60. A 61-year-old female patient has an FEV1/FVC ratio that is lower than the predicted value. Her FVC value is also lower than normal as well. What is the most likely cause of these findings?

61. Which of the following tidal volume settings for mechanical ventilation would be most appropriate for a 5’2″ female patient with normal lungs?

62. A 15-year-old male patient who has been diagnosed with asthma is in need of medications to help prevent future asthma attacks. All of the following drugs would be helpful EXCEPT:

63. The physician has chosen to use the SIMV mode of ventilation over the Assist/Control mode. Which of the following is an advantage of the SIMV mode?

64. A newly admitted adult patient in the emergency department who is intubated has copious amounts of pink frothy secretions. This is most likely indicates which of the following:

65. An adult patient has arrived to the emergency department in respiratory distress with diminished breath sounds. The patient has a history of asthma. After continuous bronchodilator therapy, wheezing is now heard during auscultation. This change suggests which of the following?

66. A 71-year-old female patient is intubated and receiving positive-pressure ventilation. In order to prevent barotrauma, you should strive to keep the plateau pressure below which of the following thresholds?

67. While monitoring a 67-year-old male patient who is receiving volume controlled SIMV, you note bilateral wheezes during auscultation with an increased peak airway pressure. Which of the following would you recommend for this patient?

68. A 61-year-old female was orally intubated and is now receiving positive pressure ventilatory support. A chest radiograph was ordered to confirm the proper placement of the endotracheal tube. Where should the tip of the tube be positioned?

69. An adult patient was admitted to the emergency department with an opiate narcotic overdose. The doctor asks for your recommendation to help reverse the effects of the drugs and enable the patient’s breathing to return to normal. Which of the following medications would you recommend?

70. Immediately after intubation, a 64-year-old female patient is showing signs of asymmetrical chest movement while being ventilated with a bag-valve resuscitator. After auscultation, you note that no breath sounds are heard on the left side. These findings are consistent with which of the following?

71. An adult patient with a tracheostomy in place is receiving ventilatory support in the volume-control SIMV mode with a set rate of 10/min. Upon assessment, the patient has started to use their accessory muscles during spontaneous breaths. Which of the following would you recommend?

72. While selecting the initial ventilatory settings for a newly intubated patient, which of the following is most important?

73. A 60-year-old male patient is receiving ventilatory support in the SIMV mode. A blood gas sample was collected and analysis shows a PaCO2 of 60 mmHg. Which of the following would you recommend?

74. An ABG was collected on a 71-year-old female patient with a history of chronic COPD. After reviewing the results, which of the following values would be most reflective of the severity of the patient’s chronic condition?

75. An adult patient in the emergency room is unconscious with an SpO2 of 95%. After re-checking with a CO-oximeter, it reveals that the patient’s SaO2 is 67%. Which of the following is the most likely cause of this discrepancy?

76. A 64-year-old female patient has arrived to the emergency department with chest tightness with radiating left shoulder pain. Which of the following would you recommend?

77. A comatose adult patient in the ICU is receiving mechanical ventilation. Which of the following pulmonary function tests can be performed at this time?

78. A 61-year-old male patient who is recovering from post-abdominal surgery has been on a high-flow nasal cannula at 20 L/min for three days. The patient’s ABG results are as follows:
pH 7.39
PaCO2 43 torr
PaO2 157 torr
SaO2 99%
HCO3 24 mEq/L
BE +2
Which of the following is the best action to take at this time?

79. A COPD patient is being discharged and the doctor wants to prescribe a controller-type bronchodilator for home use. Which of the following medications would you recommend?

80. Upon assessment of a high-risk infant, you note bradycardia and spells of apnea. Which of the following would you recommend?

81. During the assessment of a 1-week-old infant, which of the following signs would indicate the infant has an increased work of breathing?

82. The physician has ordered mechanical ventilation in the pressure control A/C mode for a 55 kg postoperative male patient. Which of the following initial settings would you choose?

83. A sweat chloride test can be used to diagnose which of the following conditions?

84. Which of the following respiratory signs would be considered abnormal in an adult patient who is at rest under normal conditions?

85. A 22-year-old female patient has been admitted to the emergency department with acute bronchospasm. Which of the following medications would you recommend?

86. A 54-year-old female patient is receiving ventilatory support in the volume control mode. After performing endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?

87. A 59-year old female patient with COPD is receiving supplemental oxygen via nasal cannula at 2 L/min. Her ABG results are as follows:
pH 7.37
PaCO2 58 torr
HCO3- 32 mEq/L
PaO2 58 torr
SaO2 85%
Based on this data, which of the following would you recommend?

88. A post-operative adult patient is being treated with incentive spirometry. The patient’s inspiratory capacity has decreased over the past few days and their level of dyspnea has been increasing. A chest x-ray reveals consolidation in the lung bases with no shift of the trachea. Which of the following has most likely developed?

89. While assessing a mechanically ventilated patient after a neurosurgical procedure, the patient has an intracranial pressure of 20 mmHg but is otherwise stable. The latest ABG results are as follows:
pH 7.31
PaCO2 48 mm Hg
HCO3 24 mEq/L
PaO2 88 mm Hg
SpO2 95%
Based on this information, which of the following would you recommend?

90. A newborn 28-week gestational age neonate is being treated in an oxygen hood with an FiO2 of 50%. The physician believes that the patient has infant respiratory distress syndrome. The following blood gas results were obtained:
pH 7.36
PaCO2 38 mm Hg
HCO3 25 mEq/L
BE 0 mEq/L
PaO2 46 mm Hg
Based on the results, what should you recommend?

91. A 56-year-old female patient’s bedside spirometry results are as follows:
FVC is decreased
FEV1 is normal
FEV1% is increased
What is the most likely problem?

92. An 11-year-old boy has just arrived in the ER with cystic fibrosis and a pulmonary infection. Upon assessment, you note very thick secretions. Which of the following drugs would you recommend for this patient?

93. A 64-year-old male patient is intubated and receiving ventilatory support in the volume-controlled SIMV mode. The physician anticipates that the patient will be on the ventilator for another 3–5 days. Which of the following would you recommend?

94. An adult patient in ICU who is receiving mechanical ventilation has been diagnosed with ARDS. Which of the following would you expect to find in this patient?

95. You were called to obtain a forced vital capacity maneuver on an adult patient with normal lungs. What percentage should the patient be able to exhale within the first second of the maneuver?

96. The physician has ordered 2.5 mL ipratropium bromide TID for a 70-year-old female patient with COPD and bronchospasm. Which of the following methods would you recommend in order to deliver the medication?

97. A 52 kg female patient is receiving volume control A/C mechanical ventilation with a tidal volume of 400 mL, a set rate of 10/min, and an FiO2 of 35%. Her blood gas results are as follows:
pH 7.31
PaCO2 49 torr
HCO3 24 mEq/L
BE -2 mEq/L
PaO2 74 torr
SpO2 95%
Based on the given information, which of the following changes is appropriate at this time?

98. An arterial blood gas sample needs to be obtained from a newborn infant. The physician ordered the sample from arterialized capillary blood because the artery would be too difficult to stick. Which of the following sites would you recommend?

99. Which of the following is true regarding the insertion of a laryngeal mask airway as compared to endotracheal intubation?

100. A neonate with meconium aspiration syndrome is receiving mechanical ventilation. If you were to increase the pressure limit, this would increase the risk of which of the following?

101. An adult patient is receiving mechanical ventilation with a PEEP setting of 10 cmH2O. The physician has requested that you increase the setting to 14 cmH2O. After making the adjustment, there is a rapid drop in the patient’s blood pressure and a significant increase in heart rate. Which of the following actions should you take?

102. After reviewing the results of a patient’s pulmonary function tests, you note that the FEV1, FVC, and total lung capacity are all reduced. The FEV1/FVC ratio is normal. What is the interpretation based on these findings?

103. While reviewing the chest x-ray of a 47-year-old male patient, you note that the heart is shifted to the patient’s right. Which of the following is the most likely cause of this finding?

104. An ABG was ordered for a 68-year-old female patient with a history of COPD. Before entering the patient’s room, you must first gather all the necessary supplies. Which of the following is required in order to perform an arterial puncture?

105. While assessing a 51-year-old male patient, you note definitive use of the neck muscles during normal breathing. This finding is consistent with which of the following?

106. A 58-year-old female is receiving volume control A/C ventilation at a rate of 12/min with a tidal volume of 450 mL. The FiO2 is set at 40% and her ABG results are as follows:
pH 7.35
PaCO2 44 torr
HCO3 22 mEq/L
BE 0
PaO2 91 torr
SaO2 97%
Based on this information, you should recommend which of the following?

107. You were called to perform a set of FVC tests on a 55-year-old male patient. While looking at the results of the first attempt, you determined that it took too long for the patient to reach the peak expiratory flow. Before another attempt is performed, which of the following instructions should you give the patient?

108. A 2-year-old girl is showing signs of a severe asthma attack. The physician has ordered a short-acting bronchodilator medication that is available in both MDI and SVN doses. Which of the following delivery methods would you recommend for this patient?

109. During the assessment of a 60-year-old male patient, you noticed reduced tactile fremitus. This finding is typical in all of the following conditions EXCEPT:

110. A 43-year-old male patient admitted to the emergency department with a suspected drug overdose. The patient is receiving oxygen via nonrebreather but is unconscious and isn’t making any respiratory efforts to breathe. The patient’s body weight is 57 kg and his ABG results are as follows:
pH 7.28
PCO2 74 torr
HCO3 20 mEq/L
PaO2 315 torr
Which of the following would you recommend?

111. A 63-year-old female patient is orally intubated with a size 7 endotracheal tube and is receiving ventilatory support. While attempting to suction the patient with a size 12 Fr catheter, you note that the catheter cannot pass beyond the tip of the tube. Which of the following is the most likely cause of this problem?

112. A patient in the ICU is receiving positive pressure ventilatory support but appears to be breathing asynchronously with the machine-delivered breaths. Which of the following medications would you recommend?

113. A 59-year-old female patient has a vital capacity of 3.4, functional residual capacity of 5.8, and an expiratory reserve volume of 1.2. What is the patient’s total lung capacity?

114. A 69-year-old male patient with tachypnea, dyspnea, and expiratory wheezes did not improve after receiving a bronchodilator treatment. Which of the following most likely describes the patient’s condition?

115. An adult patient was admitted to the emergency department with chest trauma after a motor vehicle accident. Upon assessment, you note crepitus in the upper chest area. This finding indicates which of the following?

116. During the assessment of a 64-year-old patient who is receiving volume-controlled ventilation, you note that the peak airway pressure has decreased from 36 to 19 cmH2O. There have been no changes to the ventilator settings. Which of the following would you recommend?

117. What is the maximum volume of air that can be inhaled after a normal quiet inspiration?

118. A 59-year-old male patient who weighs 75 kg is intubated and receiving mechanical ventilation. During a CPAP spontaneous breathing trial, the patient has a respiratory rate of 14 and exhaled tidal volume of 320 mL. The patient is awake but is unable to follow commands. Which of the following would you recommend at this time?

119. The physician has requested a mode of ventilation in which you can maintain a precise I:E ratio. Which of the following modes would you select?

120. While administering an adrenergic aerosol bronchodilator treatment to an adult female patient, you notice an increase in her pulse rate from 81 to 125 beats/min. Which of the following actions should you take?

121. You are called to review the electrolyte results of a 60-year-old female patient. Which of the following values is typical for serum potassium?

122. It is suspected that a 41-year-old female patient with wheezing has asthma but that diagnosis has not yet been confirmed. Which of the following tests would you recommend in order to obtain confirmation?

123. A 4-year-old child has been admitted to the emergency department with wheezing and stridor. An AP x-ray shows an area of prominent subglottic edema but the lateral neck x-ray appears normal. Which of the following is most likely the problem?

124. A 63-year-old female patient is receiving volume control A/C ventilation and has become agitated. Over the past 3 hours, her PaCO2 has decreased from 38 to 27 torr. Which of the following is the most likely cause of this problem?

125. A 64-year-old male patient is receiving an aerosol treatment with acetylcysteine and hypertonic saline via a small volume nebulizer. After only a few minutes, the patient suddenly becomes dyspneic. Which of the following is the most likely cause of this problem?

126. An adult patient who is receiving mechanical ventilation has a peak airway pressure of 60 cmH2O and a plateau pressure of 45 cmH2O. The ventilator flow rate is set at 60 L/min. What is the patient’s airway resistance?

127. A 69-year-old male patient with a severe obstructive airway disease is intubated and receiving ventilatory support. Which of the following capabilities would be the most important to consider when selecting a ventilator for this patient?

128. A 49-year-old male is intubated and receiving mechanical ventilation with a size 7.5 endotracheal tube. Over the past hour, the patient has been compressing the tube between his teeth. Which of the following would you recommend?

129. Hemodynamic data was collected on a 39-year-old male patient. Which of the following indicates that there is a problem with this patient?

130. A 65-year-old female patient with pulmonary edema was inadvertently given 1000 mL of IV fluids instead of the ordered amount of 100 mL. Which of the following would you expect to see in this case?

131. A post-operative patient using a mouthpiece positive pressure ventilator has an inspiratory time that is prolonged and the machine does not cycle off without an active patient effort. Which of the following would you recommend in order to correct this problem?

132. You are called to administer nebulized albuterol to a 47-year-old female patient that is receiving oxygen via nasal cannula at 2 L/min. Her pretreatment heart rate was recorded at 84 beats/min. You would stop the treatment once the patient’s heart rate reaches which of the following levels?

133. A 69-year-old female patient with advanced COPD is receiving supplemental oxygen. Which of the following is a problem that could arise under such circumstances?

134. Simple spirometry can be used to measure any of the following EXCEPT:

135. A 74 kg male patient is intubated and receiving volume control A/C ventilation with the following settings: FiO2 of 50%, set rate of 15, and tidal volume of 550 mL. The patient’s total respiratory rate is 29 breaths/min. His ABG results are as follows:
pH 7.53
PaCO2 27 torr
HCO3 23 mEq/L
BE -2
PaO2 82 torr
SaO2 97%
Which of the following would you recommend?

136. A high-flow nasal cannula has been ordered for a 44-year-old female patient. In order to set up this device, you would need all of the following EXCEPT?

137. A 53-year-old female patient was ordered to perform a 6-minute walk test during pulmonary rehabilitation. Which of the following instructions would you give?

138. You are called to increase the expiratory time of a patient receiving volume control ventilation without altering the minute ventilation. Which of the following settings would you adjust in order to fulfill this request?

139. Spirometry tests were performed on a 52-year-old female with the following results:

What is the interpretation of this data?

140. In order for a home-care patient to disinfect their respiratory care equipment, which of the following would you recommend?

141. A 66-year-old female patient is receiving ventilatory support in the SIMV mode with an FiO2 of 40% and a PEEP of 10 cmH2O. Over the past hour, her SpO2 has decreased from 94% to 81%. Which of the following would you recommend FIRST?

142. A 26-year-old female patient was admitted to the emergency department with signs of status asthmaticus. Which of the following drugs would you recommend for administration via nebulization?

143. While reviewing the chest x-ray of an adult patient, it shows that there is a shift of the trachea and mediastinum to the patient’s left side. There is also a complete opacification of the left side as well. These findings indicate which of the following?

144. A premature newborn infant with an Apgar score of 3 is showing signs of hypoxemia, grunting, and intercostal retractions. Which of the following would you recommend?

145. The physician has requested to change the airway of a patient from an endotracheal to a tracheostomy tube. Which of the following is the primary indication for the insertion of a tracheostomy?

146. The physician has requested to decrease the PaCO2 of a patient who is receiving high-frequency oscillation ventilation. Which of the following settings should you adjust?

147. While reviewing your patient work list, you notice that you have a patient who was diagnosed with chronic bronchitis and another patient with emphysema. Which of the following PFT findings would you expect for these patients?

148. While assisting with a bronchoscopy procedure, the physician requests a medication for direct instillation into the endotracheal tube. Which of the following would you recommend?

149. An 8-year-old girl has been diagnosed with asthma and was prescribed Proventil via metered dose inhaler for home use. Which of the following would you recommend in order to increase the deposition of the bronchodilator?

150. A 53-year-old female patient with COPD is receiving volume-controlled A/C ventilation. Rhonchal fremitus was felt over the central airways and wheezing was heard in all lung fields. The patient has thick secretions and has a peak pressure of 45 cm H2O and plateau pressure of 20 cm H2O. Which of the following would you recommend?

151. A 33-year-old male patient was admitted to the emergency department with carbon monoxide poisoning. In order to provide an adequate FiO2, which of the following would you recommend?

152. The physician has ordered a dry powder inhaler for an adult patient who is being discharged. The patient has never used an inhaler before. Which of the following instructions would you provide?

153. Which of the following instructions would you give an adult patient who is about to perform a maximum expiratory pressure test for the first time?

154. An EKG was performed on a newly admitted 66-year-old female patient. While reviewing the results, there are no identifiable P waves and the patient has an irregular ventricular rhythm. Which of the following is most likely the problem?

155. A 61-year-old female patient is receiving mechanical ventilatory support. Over the past three days, her fluid intake has stayed the same but her output fluid level measurements have been decreasing. Her peak airway pressure has been steadily increasing over this same time period. Which of the following is the most likely cause of this problem?

156. A 58-year-old postoperative male who weighs 172 lbs is receiving volume control A/C ventilation at a rate of 16/min, tidal volume of 550 mL, and FiO2 of 40%. His ABG results are as follows:
pH 7.51
PaCO2 30 torr
HCO3 23 mEq/L
BE -1
PaO2 117 torr
SaO2 99%
Based on this information, which of the following would you recommend?

157. A chest x-ray was ordered to confirm that the endotracheal tube is positioned in the correct place. Where should the tip of the tube be located?

158. An adult patient is receiving ventilatory support in the pressure control A/C mode at a rate of 10/min and peak pressure of 35 cm H2O. The following ABG results were obtained:
pH 7.31
PaCO2 49 torr
SaO2 96%
HCO3 23 mEq/L
BE -2 mEq/L
Which of the following would you recommend?

159. The physician has ordered ribavirin (Virazole) to be administered via aerosol to an infant with severe RSV. Which of the following devices would you recommend?

160. The status of a 56-year-old male patient has gotten worse over the past 2 hours. He was switched from an air entrainment mask to a nonrebreather, and is now receiving ventilatory support with the following settings:
Assist/Control rate 12
Tidal volume 650 mL
FiO2 100%
PIP 40 cmH2O
Plateau pressure 35 cmH2O
The patient’s arterial blood gas results are as follows:
pH 7.42
PaCO2 35 torr
PaO2 54 torr
SpO2 84%
HCO3- 23 mEq/L
Which of the following best represents the status of this patient?