TMC Practice Exam

1. You are called to examine an acutely dyspneic and hypotensive patient and you note the following: 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. What do these findings suggest?

2. You are asked to assess a 39-year-old man that was admitted through the emergency department with an abrupt onset of fever and chills. The man shows signs of bilateral rhonchi with a productive cough and his SpO2 is 88% on room air. What should you recommend?

3. A 50-year-old man is intubated and receiving mechanical ventilation with a size 8.0 mm endotracheal tube that is secured in place. The patient’s cuff pressure is measured at 36 cm H2O. What would you recommend in this situation?

4. While making a routine equipment check, you hear the patient’s bubble humidifier is making a whistling noise. Which of the following is the most likely cause of this problem?

5. A forced expiratory measurement obtained after the administration of a bronchodilator shows an increase in the patient’s FEV1 from 60% to 80% of the predicted value. What does this indicate?

6. You are called to assess an intubated patient that is breathing asynchronously with the ventilator. Her breath sounds are absent on the left, with dullness to percussion and a left shift of the trachea. Which of the following is the most likely explanation of the problem?

7. A 63-year-old female patient is receiving pressure controlled A/C mechanical ventilation. Which of the following changes would occur if her compliance were to decrease?

8. You are called to assess a patient on the ventilator that is currently in volume control mode. After performing endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?

9. You have a patient that complains of left-sided chest pain while receiving mechanical ventilation. While assessing the patient, you note tachypnea, a weak and thready pulse, tracheal deviation to the right, and decreased breath sounds and hyperresonance on the left. Which of the following would you recommend?

10. You received an order from a new resident to administer an albuterol treatment to a CHF patient with acute pulmonary edema for wheezing. What should you do in this case?

11. A 34-year-old female patient just arrived to the emergency room and the nurse is unable to start an intravenous line during CPR. The doctor wants to administer Naloxone because it is believed that the patient is suffering from a narcotic overdose. Which of the following is an appropriate alternative route of administration?

12. A 176 lb male patient is intubated and receiving volume control A/C ventilation. His settings are as follows: 40% FiO2 at a rate of 12/min and a VT of 550 mL. A blood gas was drawn and bedside measurements displays the following results:

Which of the following actions would be appropriate at this time?

13. A patient with a flail chest arrives to the emergency department and is hyperventilating. Which of the following ABG results would you expect to find for this patient?

14. A 51-year-old asthmatic patient is struggling to initiate inspiration on a mechanical ventilator that is operating in the assist-control mode. Which of the following settings would you first check in order to resolve of this problem?

15. The physician requests the insertion of a nasopharyngeal airway. This type of airway is useful in supporting which of the following?

16. In which of the following conditions would you most likely have a difficult time establishing a patent airway?

17. You are called to the NICU for the assessment of a premature infant. The infant is receiving positive pressure ventilation and exhibits the following: acute respiratory distress, hypotension, and asymmetrical chest motion. Which of the following procedures would you initially recommend?

18. You are called to assess a patient receiving mechanical ventilation and you suddenly notice the simultaneous sounding of the high pressure and low volume alarms. What is the most likely cause of this problem?

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

20. Upon entering a patient rooms for a routine assessment, you noticed distinct distention of the patient’s jugular vein in the neck. Which of the following is the most likely cause?

21. A patient performs an FVC maneuver and displays the following results:

How would you interpret this flow-volume loop tracing?

22. Which of the following is true regarding the synchronous intermittent mandatory ventilation (SIMV) mode of ventilation?

23. There is an order to obtain a blood sample from a neonate. It is determined that you should obtain the sample from a capillary instead of the artery. Which of the following is true regarding a capillary blood gas sample?

24. A new patient was admitted and has been diagnosed with pneumonia. The patient has an oxygen saturation of 87% on 2 L/min nasal cannula. Which of the following would cause the patient to be hypoxemic?

1. Capillary shunting
2. Diffusion defect
3. Alveolar consolidation
4. Hypoventilation

25. Which of the following procedures would be most beneficial in preventing atelectasis in a 59-year-old female patient that is less than 24 hours post-surgery?

26. A 63-year-old male patient with a tracheostomy is being mechanically ventilated in the ICU. When the patient was coughing, 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. You are called for the assessment of a 24-year-old female patient that is in respiratory distress. You would expect to find all of the following except:

29. In order to initiate weaning, you change the patient from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings?

30. A 57-year-old female patient with emphysema has the following ABG results:

pH 7.34
PaCO2 65 torr
PaO2 47 torr
HCO3 31 mEq/L
BE +6

She is showing signs of shortness and has inspiratory crackles on auscultation. Which of the following would you recommend for this patient?

31. A patient was just orally intubated with an endotracheal tube. Which of the following should you INITIALLY perform to confirm that the tube is in the proper position?

32. While assisting with the delivery of a newborn infant, the doctor asks you to obtain an Apgar score. Which of the following is considered a normal score?

33. After intubating a patient, you are asked to confirm proper tube placement. 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 new patient has arrived in the emergency department. Upon arrival, you noticed that her breathing is extremely deep and fast. Which of the following best classifies this type of breathing?

35. A patient that is receiving ventilatory support has a white blood cell count of 17,000/mm3 and a temperature of 102 °F. The patient’s secretions are yellow and have gotten thicker over the past 24 hours. Which of the following would you suggest at this time?

36. While reviewing the patient’s medical record, you note that the FEV1/FVC ratio is reported as being severely reduced. Which of the following is most consistent with this finding?

37. While monitoring a patient during a spontaneous breathing trial, which of the following observations would indicate that you need to stop the trial and return the patient back to full ventilatory support?

38. A 68-year-old female patient was admitted to the emergency department with shortness of breath and low blood pressure. Upon initial assessment, you note the following: Reduced chest expansion, hyperresonance to percussion, absent of breath sounds, tactile fremitus, and a tracheal shift to the right. Which of the following do these findings suggest?

39. A 63-year-old male patient was just admitted to the ICU. While auscultating his lungs, you hear bronchial breath sounds over the right lower lobe. This would indicate which of the following?

40. You are attempting to wean an alert intubated patient using CPAP with 40% oxygen. The patient’s respiratory rate increases from 23 to 30/min and you notice accessory muscle usage during the weaning attempt. What should you do at this time?

41. You are called to administer aerosolized albuterol to a 38-year-old patient. Which of the following side effects would you expect to see?

42. A nurse calls you to assess a 23-year-old male patient with a severe head cold that is receiving oxygen via nasal cannula at 4 L/min. The patient is complaining that he can’t breathe through his nose. The pulse oximeter reveals that his oxygen saturation is at 83%. Which of the following actions should you take at this time?

43. You are monitoring a stable patient that is receiving mechanical ventilation. His ABG results are as follows:

pH 7.49
PaCO2 29 mm Hg
HCO3 24 mEq/L
BE +1
PaO2 87 mm Hg
SaO2 96%

Based on the results, which of the following actions should you take at this time?

44. A 58-year-old female patient was recently intubated. Auscultation reveals that she has breath sounds over the left side of her chest. You also noted the fact that her SpO2 has dropped from 96% to 81% and her peak inspiratory pressure on the ventilator has increased from 33 to 53 cm H2O. The tube length marking is 26 cm at the lip. What action should you take at this time?

45. You have a patient that is receiving ventilator support in the volume-control mode when suddenly the high pressure alarm begins to sound. Which of the following would you select in order to fix this problem?

46. You are needed to help with the treatment of a patient with pneumonia that is receiving oxygen via nasal cannula at 4 L/min. The physician asks for your suggestion of the best way to evaluate the patient’s overall ability to breathe. What should you recommend?

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

48. While attempting a spontaneous breathing trial for weaning, which of the following changes in the patient’s status would be acceptable?

49. A patient with fluid overload was just given a dose of furosemide via IV. Afterwards, the patient displayed an arrhythmia on the EKG that was not there before the dose was given. Which of the following would you recommend at this time?

50. A 54-year-old male patient who was just extubated is complaining of a sore throat. Inspiratory stridor can be heard on auscultation. Which of the following drugs would you recommend in order to treat this problem?

51. An oropharyngeal airway has been inserted in a 39-year-old male patient. Within minutes after insertion, the patient begins to gag. What action should you take at this time?

52. A 66-year-old female patient arrives in the emergency room with chest tightness, dyspnea, and shortness of breath. The doctor ordered a blood test to check troponin and BNP but the results were negative. Her ABG results show partially compensated respiratory acidosis. Which of the following is likely the issue in this case?

53. You have a patient that is receiving mechanical ventilation in volume control mode that is being monitored with a continuous pulse oximeter. While temporarily removing the patient from the ventilator to perform suctioning, their SpO2 drops from 95% to 88%. Which of the following should be done in order to fix this problem?

54. You are assessing a patient with chronic asthma. She has an SVC of 3,500 mL and an FVC of 2,500 mL. Which of the following best explains this difference?

55. The physician has ordered acetylcysteine for a COPD patient with a large amount of secretions. Upon assessment, you noticed that the patient has an inadequate cough. Which of the following would you recommend?

56. A male patient was just 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 that the patient do?

57. Which of the following is the most common problem associated with the assist-control mode of ventilation?

58. While performing a routine ventilator check, you note the following settings: Exhaled tidal volume 550 mL, PIP of 35 cm H2O, High pressure limit 64 cm H2O, Low pressure alarm 25 cm H2O, and Low tidal volume alarm 500 mL. Which of the following change should you make at this time?

59. Which of the following ABG results would you most likely see for a patient who is having a mild asthma attack?

60. Your patient has an FEV1/FVC ratio that is lower than predicted. Her forced vital capacity is also lower than normal as well. What is the most likely cause of these findings?

61. You are called to administer acetylcysteine to a 66-year-old female patient. This drug can be helpful in treating which of the following conditions?

62. A 15-year-old male patient has been diagnosed with asthma and you are called to recommend medications to help prevent future asthma attacks. All of the following drugs would be helpful EXCEPT:

63. Which of the following is an advantage of the SIMV mode of ventilation over assist/control?

64. Upon assessment of a new patient who was just admitted, you noticed that they have pink frothy secretions. This is most likely indicates which of the following:

65. A patient that is having an asthma attack arrives to the emergency room in respiratory distress with diminished breath sounds. After continuous bronchodilator therapy, auscultation reveals wheezing. This change suggests which of the following?

66. Your patient is intubated and is receiving positive-pressure ventilation. You should strive to keep the patient’s plateau pressure below which of the following in order to prevent barotrauma?

67. While monitoring a 67-year-old patient that is receiving volume controlled SIMV, you note that the patient has bilateral wheezes upon auscultation with an increased peak pressure. Which of the following would be appropriate for this patient?

68. A 61-year-old female was just intubated and is now receiving ventilatory support via an oral endotracheal tube. You recommended a chest radiograph in order to confirm proper placement of the tube. Where should the tip of the tube be positioned?

69. A patient has arrived to the emergency department with an apparent opiate narcotic overdose. The doctor asks for your recommendation to help reverse the effects of the narcotic 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 shows asymmetrical chest movement while being ventilated with a bag-valve resuscitator. After auscultation, you note no breath sounds on the left. These findings are consistent with which of the following?

71. A male patient is being ventilated via a tracheostomy in volume control SIMV at a rate of 10/min. Upon assessment, you notice that the patient has started to use his accessory muscles during spontaneous breaths. What would you recommend to help this patient?

72. What is the most important consideration to make when selecting the initial ventilatory settings for a new patient?

73. After running an ABG sample, your patient that is on the ventilator in SIMV has a PaCO2 of 60 mm Hg. The physician asks for you to correct this problem. Which of the following actions would be most appropriate in this case?

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

75. An unconscious patient arrives to the emergency room 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 most likely the cause of this discrepancy?

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

77. A comatose patient in the ICU is receiving mechanical ventilation. Taking this into consideration, which of the following pulmonary function tests can be performed on this patient?

78. A 61-year-old male patient is post-abdominal surgery and 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 would you recommend?

80. Upon assessment, you note that an infant patient with bradycardia is having spells of apnea. Which of the following would you recommend?

81. Which of the following signs would indicate that an infant has an increased work of breathing?

82. The physician orders 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 at rest?

85. A 22-year-old female patient has just arrived 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. She has the following ABG results:

pH 7.37
PaCO2 58 torr
HCO3- 32 mEq/L
PaO2 58 torr
SaO2 85%

Based on these results, you should recommend which of the following?

88. A recent post-operative 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. The chest x-ray shows 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 brain surgery, 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 is should be done at this time?

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 from an umbilical artery sample:

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. You have a patient that is intubated and receiving ventilatory support via volume controlled SIMV. The physician anticipates that the patient will be on the ventilator for another 3–5 days. Which of the following actions would you recommend?

94. It has been determined that a patient in the ICU that is receiving mechanical ventilation has ARDS. Which of the following would you expect to find in this patient?

95. What percentage of the forced vital capacity should a patient with normal lungs be able to exhale within the first second of the maneuver?

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

97. Your services are requested to interpret the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. The patient has a tidal volume of 400 mL, a set rate of 10/min, and the FiO2 is set at 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 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 doctor ordered the sample from arterialized capillary blood because the artery would be too difficult to stick. Which of the following sites would you choose to obtain the sample?

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

100. A neonate that has 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. A patient is receiving mechanical ventilation with a PEEP setting of 10 cm H2O. The physician calls and orders you to increase the PEEP to 14 cm H2O. After making the adjustment, there is a rapid drop in the patient’s blood pressure and a significant rise 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. You were just called by the physician for a STAT ABG. 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 regular inspiration. Which of the following is this finding consistent with?

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 and an FiO2 of 40%. 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 are instructing a patient on how to perform an FVC maneuver. After looking at the results of an attempt, you determine that it took too long for the patient to reach the peak expiratory flow. Before another attempt, which of the following instructions should you give the patient?

108. A 2-year-old child is showing signs of a severe asthma attack. The physician orders a bronchodilator that is available in both MDI and SVN doses. Which of the following would be the best delivery system for this drug to this patient?

109. A patient would have reduced tactile fremitus in all of the following conditions except?

110. A 43-year-old 57 kg patient is admitted with a suspected drug overdose. The man is unconscious and isn’t making respiratory efforts to breathe. The ABG results on a nonrebreathing mask are as follows:

pH 7.28
PCO2 74 torr
HCO3 20 mEq/L
PaO2 315 torr

What should you recommend at this time?

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

112. A 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?

113. After obtaining a patient’s PFT results, they have a vital capacity of 3.4, functional residual capacity of 5.8, and a 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 was unresponsive to a bronchodilator treatment. Which of the following is most likely the patient’s condition?

115. A patient arrived to the emergency room after a motor vehicle accident with chest trauma. Upon assessment, you noted crepitus in the upper chest area. This most likely indicates which of the following?

116. While assessing a 64 year-old patient receiving volume controlled ventilation, you note that the peak airway pressure has decreased from 52 cm H2O to 32 cm H2O. There have been no other changes to the ventilator settings. Which of the following actions would be appropriate at this time?

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

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

119. The physician calls and asks you to select 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 beats/min to 125 beats/min after two minutes. Which of the following actions should you take?

121. You are called to review the electrolyte results of an adult 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. Which of the following tests would you recommend in order to confirm this diagnosis?

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 the most likely problem?

124. Your patient is receiving volume control A/C ventilation. You notice that she has become agitated and her PaCO2 has decreased from 38 to 27 torr over the last 3 hours. Which of the following is most likely the cause?

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 is?

126. A patient receiving mechanical ventilation has a PIP 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. An intubated adult 69-year-old male patient with a severe obstructive airway disease requires support via mechanical ventilation. Which of the following capabilities would be most important in 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 last 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. What should you do in order to correct this problem?

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

133. A patient with advanced COPD is receiving supplemental oxygen. Which of the following is the most likely problem that you should be aware of?

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

135. A 74 kg male patient intubated and receiving volume control A/C ventilation with the following settings: FiO2 of 50%, a set rate of 15, and a 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 is the best action to take at this time?

136. The physician put in a STAT order for a high-flow nasal cannula on 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 pulmonary rehabilitation patient was ordered to perform a 6-minute walk test. 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. A 72-year-old male home-care patient needs to be able to disinfect his respiratory care equipment in the home. Which of the following would you recommend?

141. A 66-year-old female patient is receiving SIMV mechanical ventilation in the ICU. Over the past hour, her SpO2 has decreased from 94% to 81%. She is currently receiving an FiO2 of 40% and a PEEP or 10. Which of the following would you recommend first?

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

143. While reviewing a patient’s chest x-ray, it shows that there is a shift of the trachea and mediastinum to the left side. There is also a complete opacification on 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. You are called to assist the physician with changing a patient from an endotracheal tube to a tracheostomy. Which of the following is the primary indication for the insertion of a tracheostomy?

146. You are called and asked to decrease the PaCO2 of a patient receiving high-frequency oscillation ventilation. Which of the following settings should you adjust?

147. After reviewing your work order for the day, you notice that you have a patient 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 down the endotracheal tube. Which of the following would you recommend?

149. You are called to instruct an 8-year-old girl with asthma on how to use an albuterol metered dose inhaler. Which of the following can be done 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 is felt over the central airways and wheezing is heard over all lung fields. She has ver thick secretions and her peak pressure is 45 cm H2O and plateau pressure is 20 cm H2O. Which of the following would be useful to treat this patient’s condition?

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

152. The physician has ordered a dry powder inhaler for a patient that is being discharged. The patient has never used an inhaler before. Which of the following instructions is correct for using a dry powder inhaler?

153. Your patient is about to perform a Maximum Expiratory Pressure test. Which of the following instructions should you give to the patient?

154. You are called to perform an EKG on a new patient. While reviewing the results, you note that there are no identifiable P waves with an irregular ventricular rhythm. Which of the following is most likely the problem?

155. A 61-year-old female patient is receiving mechanical ventilation. Over the last 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 14/min with a tidal volume of 650 mL and an FIO2 of 40%. You collected an ABG sample and obtained the following results:

pH 7.51
PaCO2 30 torr
HCO3 23 mEq/L
BE -1
PaO2 117 torr
SaO2 99%

Based on this information, you should recommend which of the following?

157. A chest X-ray was ordered to confirm that the endotracheal tube is positioned in the correct place. This can be done by determining that its tip of the tube is located where?

158. A patient is intubated and is receiving mechanical ventilation on the pressure control A/C mode at a rate of 10/min and peak pressure of 35 cm H2O. Her ABG results are as follows:

pH 7.31
PaCO2 49 torr
SaO2 96%
HCO3 23 mEq/L
BE -2 mEq/L

Which of the following actions should you take at this time?

159. An infant with severe RSV has just been admitted. The physician has ordered ribavirin (Virazole) to be administered by aerosol. Which of the following devices would you recommend in this situation?

160. A 56-year-old male patient’s status has gotten worse over the past 2 hours. He went from an air entrainment mask to a nonrebreather, and is now receiving positive pressure ventilation with the following settings:

Assist control rate of 12
Tidal volume 650 mL
FIO2 100%
PIP 40 cm H2O
Plateau pressure 35 cm H2

The patient’s arterial blood gas results are:

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?