TMC Practice Exam

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1. During the assessment of a 64-year-old female patient, you note the following signs: dyspnea, hypotension, and a tracheal shift to the right. The patient has absent breath sounds, reduced chest expansion, and a hyperresonant percussion note, all on the left side. These findings suggest which of the following?
A. Pleural effusion on the left side
B. Pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side

2. A 39-year-old male patient was admitted to the emergency department with a fever and 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?
A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity

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 cmH2O. Which of the following would you recommend?
A. Withdraw the tube 1-2 cm and reassess the patient’s breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cmH2O
D. Recommend ventilation via a tracheostomy instead

4. During the assessment of a 52-year-old female patient who is receiving oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise. What is the most likely cause of this finding?
A. There is an obstruction in the delivery tube
B. The patient’s ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high

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 shows an increase in the patient’s FEV1 from 60% to 80% of the predicted value. This suggests which of the following?
A. Fixed airway obstruction
B. Reversible airway obstruction
C. Normal diffusion capacity
D. Restrictive process

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 is 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?
A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm

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?
A. The delivered volume will decrease
B. The peak pressure will increase
C. The inspiratory time will increase
D. The PEEP level will decrease

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?
A. An increased tidal volume
B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure

9. An adult patient who is receiving mechanical ventilation suddenly started showing signs of tachypnea. Upon assessment, you noticed tracheal deviation to the right and decreased breath sounds and hyperresonance on the left. Which of the following would you recommend?
A. Endotracheal suctioning
B. Flexible bronchoscopy
C. The insertion of a chest tube
D. Thoracentesis

10. A 57-year-old female patient with acute pulmonary edema is dyspneic and shows signs of wheezing. The resident physician has ordered an albuterol breathing treatment via SVN. Which of the following would you recommend?
A. Administer acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Administer a diuretic and oxygen therapy

11. An intubated 39-year-old female patient was admitted to the emergency department, and the nurse could not 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?
A. Through the feeding tube
B. Aerosolized via SVN
C. Through the nasogastric tube
D. Through the endotracheal tube

12. An 80 kg male patient is receiving volume-controlled ventilation with an FiO2 of 40%, a rate of 12/min, and a set tidal volume of 500 mL. An ABG was analyzed with the following results: ABG Results: pH 7.38, PaCO2 38 mmHg, HCO3- 24 mEq/L, PaO2 108 mmHg. Ventilator Settings: Spontaneous Rate 23/min, Minute Ventilation 11.5 L/min, Vital Capacity 500 mL, MIP/NIF -15 cmH2O. Which of the following would you recommend?
A. Place the patient on a 40% T-piece and monitor closely
B. Switch the patient to SIMV at a rate of 5/min
C. Place the patient on CPAP and monitor closely
D. Maintain the current ventilator settings

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?
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2
C. Decreased pH and decreased SaO2
D. Decreased pH and increased SaO2

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 to resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP

15. The physician has requested the insertion of a nasopharyngeal airway in an adult patient. This type of airway is helpful in supporting which of the following?
A. Mechanical ventilation
B. Frequent suctioning
C. Incentive spirometry
D. Aerosol drug therapy

16. You would expect it to be difficult establishing a patent airway in a patient with which of the following conditions?
A. ARDS
B. Morbid obesity
C. Pleural effusion
D. Ventilator-associated pneumonia

17. A premature infant 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?
A. An arterial blood gas
B. A chest radiograph
C. A capillary heal stick
D. Chest transillumination

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?
A. There is a disconnection in the ventilator circuit
B. There is a leak in the ET tube cuff
C. There is a mucous plug in the ET tube
D. The patient has developed pneumonia

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 in which of the following?
A. Acute respiratory distress syndrome
B. Bronchiectasis
C. Chronic bronchitis
D. Cystic fibrosis

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?
A. Systolic hypertension
B. Hypovolemia
C. Obstruction of the pulmonary vein
D. Right ventricular failure

21. An adult patient performed an FVC maneuver. After reviewing the flow-volume loop tracing, the doctor describes the appearance of the loop as “tall” and “skinny.” Which of the following best describes the patient’s respiratory physiology?
A. Normal lungs
B. Small airway obstruction
C. Large airway obstruction
D. Restrictive disease

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 cmH2O
PEEP 5 cmH2O
During a spontaneous breathing trial via T-tube, the patient’s breathing rate increased drastically, requiring him to be placed back on the ventilator. Which of the following would you recommend during the subsequent breathing trial?
A. Increase the sedation dosage
B. CPAP with pressure support via ET tube
C. CPAP without pressure support via ET tube
D. Extubate and provide BiPAP via full face mask

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?
A. To obtain the sample, you need to milk the puncture site
B. The sample must be drawn from the first drop of surface blood
C. The pH and PaCO2 correlate well with arterial blood
D. The puncture is typically performed on the ball of the foot

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?
A. Fever and chills
B. Diffusion defect
C. Alveolar consolidation
D. Hypoventilation

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 to prevent atelectasis?
A. Albuterol via SVN four times daily
B. Pursed-lip breathing as needed
C. Inspiratory resistance exercises three times daily
D. Incentive spirometry 10 times per hour

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?
A. Flush the blood out of the circuit with normal saline
B. Sedate the patient to prevent more coughing
C. Nebulize a local anesthetic to reduce surgical pain
D. Replace the circuit with a new one

27. A 56-year-old male patient has been admitted and diagnosed with Guillain-Barré syndrome. To determine the patient’s need for ventilatory support, which of the following values is the most critical to monitor?
A. Residual volume
B. Inspiratory capacity
C. Peak inspiratory flow
D. Expiratory reserve volume

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 mmHg
HCO3 19 mEq/L
BE -3 mEq/L
PaO2 46 mmHg
SaO2 81%
Which of the following would you recommend?
A. Nonrebreathing mask at 15 L/min
B. Intrapulmonary percussive ventilation (IPV)
C. Continuous positive airway pressure (CPAP)
D. Intermittent positive pressure breathing (IPPB)

29. While attempting to wean an adult patient from mechanical ventilation, you switched them from the volume control A/C mode to CPAP with pressure support. 30 minutes later, the high respiratory rate alarm begins to sound, and the patient is breathing at a rate of 29 breaths/min. Which of the following changes would you make to the ventilator settings?
A. Increase the pressure support level
B. Increase the high-pressure alarm to 50 cmH2O
C. Increase the high rate alarm to 30–35 breaths/min
D. Switch the patient back to volume control A/C

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?
A. Nonrebreathing mask at 10 L/min
B. Air-entrainment mask at 28%
C. Albuterol via a small-volume nebulizer
D. Nasal cannula at 4 L/min

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?
A. Auscultate the patient’s chest and abdomen
B. Perform a STAT chest x-ray
C. Use capnography to verify exhaled CO2
D. Observe chest wall movement

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?
A. 1–4
B. 4–7
C. 7–10
D. 10–13

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?
A. Obtain a stat chest radiograph
B. Withdraw the endotracheal tube by 1–2 cm
C. Reintubate the patient
D. Insert a large-bore needle in the left upper chest

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

35. A 71-year-old male patient is receiving ventilatory support. 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?
A. Decrease the humidifier temperature
B. Administer an aerosolized bronchodilator
C. Schedule suctioning twice per hour
D. Obtain a sputum sample for culture and sensitivity

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?
A. Pulmonary hypertension
B. Morbid obesity
C. Chronic asthma
D. Pneumonia

37. An intubated 60-year-old female patient is undergoing 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?
A. An increase in heart rate from 96 to 114/min
B. An increase in respiratory rate from 17 to 27/min
C. An increase in arterial PCO2 from 44 to 52 torr
D. A decrease in SpO2 from 92% to 83%

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:
A. (Pplat – PEEP)
B. (PIP – PEEP)
C. (PIP – Paw)
D. (Paw – Pplat)

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?
A. The patient has normal lungs
B. A pneumothorax is present in the right lung
C. A pleural effusion is present in the right lower lobe
D. Consolidation is present in the right lower lobe

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?
A. Return the patient to full ventilatory support
B. Increase the FiO2 to 50%
C. Apply 5-10 cmH2O of pressure support
D. Extubate the patient and reassess

41. After administering aerosolized albuterol to a 38-year-old female patient, which of the following side effects would you expect?
A. Hypotension
B. Bradycardia
C. Bronchospasm
D. Shaking and tremors

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?
A. Increase the oxygen flow until the SpO2 equals or exceeds 90%
B. Decrease the oxygen flow until the patient is more comfortable
C. Switch to a simple mask
D. Recommend an ABG before considering any changes

43. A stable adult patient who is receiving mechanical ventilation displays the following results:
pH 7.49
PaCO2 29 mmHg
HCO3 24 mEq/L
BE +1
PaO2 87 mmHg
SaO2 96%
Which of the following would you recommend?
A. Add 10 cmH2O of PEEP
B. Increase the minute ventilation
C. Decrease the tidal volume
D. Maintain the current settings

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?
A. Fluoxetine (Prozac)
B. Lorazepam (Ativan)
C. Dextroamphetamine (Dexedrine)
D. Cisatracurium (Nimbex)

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 you recommend?
A. Increase the flow setting
B. Increase the pressure limit setting
C. Suction the airway
D. Remove air from the endotracheal tube cuff

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?
A. Perform pulse oximetry
B. Draw an arterial blood sample for analysis
C. Perform a forced vital capacity measurement
D. Perform a full set of pulmonary function tests

47. While reviewing the chest x-ray of a 57-year-old male patient, you note 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?
A. There is a pneumothorax on the left side
B. There is a pleural effusion on the left side
C. There is pulmonary edema in the left lung
D. There is pneumonia in the left lower lobe

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?
A. A decrease in SpO2 from 91% to 81%
B. An increased usage of the scalene muscles during breathing
C. An increase in heart rate from 97 to 115/min
D. A decrease in the systolic blood pressure from 115 to 76 mmHg

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?
A. Defibrillate the patient
B. Administer another dose of furosemide
C. Administer a dose of epinephrine
D. Check the patient’s potassium level

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?
A. Levalbuterol
B. Isoetharine
C. Racemic epinephrine
D. Acetylcysteine

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?
A. Perform the head-tilt, chin-lift maneuver
B. Insert a bite block
C. Remove the airway
D. Replace the current tube with a smaller airway

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?
A. Pneumonia
B. CHF
C. Exacerbation of COPD
D. Myocardial infarction

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?
A. Initiate PEEP at 5 cmH2O
B. Increase the FiO2 to 80%
C. Perform bedside hemodynamic monitoring
D. Change to an in-line suctioning catheter

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?
A. Increased compliance during a forced expiration
B. Poor instruction by the previous respiratory therapist
C. Muscle fatigue during a forced expiration
D. Air trapping during a forced exhalation

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?
A. Perform a bronchoalveolar lavage
B. Nasotracheal suctioning after the treatment
C. Postpone the therapy until the patient can cough effectively
D. Administer dornase alpha instead of acetylcysteine

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?
A. An antibiotic prescription
B. Decrease the frequency to once per day
C. A Bronchodilator before the corticosteroid
D. Rinse the mouth after inhalation

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?
A. Hypoventilation
B. Hyperventilation
C. The need for neuromuscular paralysis
D. Increased work of breathing

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 cmH2O
High-pressure limit 64 cmH2O
Low-pressure alarm 25 cmH2O
Low tidal volume alarm 500 mL
Which of the following changes should be made at this time?
A. Increase the set tidal volume to 700 mL
B. Increase the low tidal volume alarm to 600 mL
C. Decrease the high-pressure limit to 45-50 cmH2O
D. Decrease the low-pressure alarm to 10 cmH2O

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?
A. pH = 7.30 PaCO2 = 49 torr PaO2 = 61 torr
B. pH = 7.32 PaCO2 = 51 torr PaO2 = 51 torr
C. pH = 7.46 PaCO2 = 47 torr PaO2 = 52 torr
D. pH = 7.49 PaCO2 = 30 torr PaO2 = 62 torr

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?
A. Normal lungs
B. Restrictive lung disease
C. Obstructive lung disease
D. Combined obstructive and restrictive lung disease

61. Which of the following tidal volume settings for mechanical ventilation would be most appropriate for a 5’2″ female patient with normal lungs?
A. 200 mL
B. 400 mL
C. 600 mL
D. 700 mL

62. A 15-year-old male patient who has been diagnosed with asthma is in need of medication to help prevent future asthma attacks. All of the following drugs would be helpful EXCEPT:
A. Cromolyn sodium
B. Zafirlukast
C. Epinephrine
D. Zileuton

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?
A. SIMV maintains respiratory muscle strength
B. SIMV prevents hyperventilation
C. SIMV increases pleural pressures
D. SIMV increases the need for sedation

64. A newly admitted adult patient in the emergency department who is intubated appears to have copious amounts of frothy pink secretions. This most likely indicates which of the following:
A. ARDS
B. Cor pulmonale
C. Left ventricular failure
D. An electrolyte imbalance

65. An adult patient arrived at 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?
A. The onset of pneumonia
B. The development of a pneumothorax
C. The improvement of air flow
D. The development of pulmonary edema

66. A 71-year-old female patient is intubated and receiving positive-pressure ventilation. To prevent barotrauma, you should strive to keep the plateau pressure below which of the following thresholds?
A. 20 cmH2O
B. 30 cmH2O
C. 40 cmH2O
D. 50 cmH2O

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?
A. Suction the patient’s airway
B. Order a stat chest x-ray
C. Check the cuff pressure
D. Administer a bronchodilator

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?
A. No more than 2 cm above the carina
B. At the same level as the carina
C. Level with the fifth cervical vertebra
D. Between the 2nd and 4th thoracic vertebra

69. An adult patient was admitted to the emergency department with an opiate narcotic overdose. Which of the following medications would you recommend to help return the patient’s breathing back to normal?
A. Naloxone (Narcan)
B. Fentanyl (Sublimaze)
C. Indomethacin (Indocin)
D. Vecuronium (Norcuron)

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?
A. Pneumothorax
B. Atelectasis
C. Right mainstem intubation
D. Pleural effusion

71. An adult patient with a tracheostomy in place is receiving ventilatory support in the volume-controlled 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?
A. Increase the level of pressure support
B. Decrease the SIMV rate to 8/min
C. Switch the patient to pressure-controlled SIMV
D. Switch the patient to a pressure-limited mode

72. While selecting the initial ventilatory settings for a newly intubated patient, which of the following is most important?
A. The type of device that is being used
B. The quality and amount of nursing supervision
C. The patient’s size and clinical condition
D. The amount of spontaneous ventilatory effort

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?
A. Increase the frequency
B. Increase the FiO2
C. Increase the mechanical deadspace in the ventilator circuit
D. Decrease the tidal volume

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?
A. pH
B. PaCO2
C. HCO3-
D. PaO2

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?
A. Opiate drug overdose
B. Diabetic ketoacidosis
C. Acute pulmonary edema
D. Carbon monoxide poisoning

76. A 64-year-old female patient has arrived in the emergency department with chest tightness and radiating left shoulder pain. Which of the following would you recommend?
A. Obtain a stat chest x-ray
B. Provide 100% oxygen
C. Administer an albuterol treatment
D. Obtain an ABG sample

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?
A. Peak Expiratory Flow
B. Maximum Voluntary Ventilation
C. Maximum Inspiratory Pressure
D. Forced Expiratory Volume in 1 Second

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?
A. Decrease the flow
B. Decrease the FiO2
C. Decrease the flow and FiO2 together
D. Switch to a standard nasal cannula

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?
A. Albuterol
B. Levalbuterol
C. Metaproterenol
D. Brovana

80. Upon assessment of a high-risk infant, you note bradycardia and spells of apnea. Which of the following would you recommend?
A. Surfactant replacement therapy
B. Nasal CPAP
C. Aerosolized bronchodilator
D. Mechanical ventilation

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81. During the assessment of a 1-week-old infant, which of the following signs would indicate that the infant has an increased work of breathing?
A. Pallor
B. Nasal flaring
C. Digital clubbing
D. Acrocyanosis

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 recommend?
A. PIP = 25 cmH2O; Rate = 30/min; Inspiratory time = 1 second
B. PIP = 32 cmH2O; Rate = 12/min; Inspiratory time = 2 seconds
C. PIP = 40 cmH2O; Rate = 20/min; Inspiratory time = 1 second
D. PIP = 25 cmH2O; Rate = 12/min; Inspiratory time = 1 second

83. A sweat chloride test can be used to diagnose which of the following conditions?
A. Muscular dystrophy
B. Amyotrophic lateral sclerosis
C. Poliomyelitis
D. Cystic fibrosis

84. Which of the following respiratory signs would be considered abnormal in an adult patient who is at rest under normal conditions?
A. Respiratory rate of 18 breaths/min
B. Ribs higher posteriorly than anteriorly at end-expiration
C. Scalene muscle usage at rest
D. Costal angle of 90 degrees that increases with inspiration

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?
A. Albuterol (Proventil)
B. Racemic epinephrine
C. Cromolyn sodium (lntal)
D. Acetylcysteine (Mucomyst)

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?
A. A decreased inspiratory time
B. A smaller tidal volume
C. A lower plateau pressure
D. A lower peak pressure

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?
A. Increase the oxygen flow to 3 L/min
B. Switch to BiPAP with an FiO2 of 100%
C. Switch to a nonrebreathing mask at 10 L/min
D. Switch to an air entrainment mask at 24%

88. A postoperative 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?
A. Pneumonia
B. Pleural effusion
C. Atelectasis
D. Pneumothorax

89. A postoperative neurosurgical patient is receiving mechanical ventilation and has an intracranial pressure of 20 mmHg but is otherwise stable. Their ABG results are as follows:
pH 7.31
PaCO2 48 mmHg
HCO3 24 mEq/L
PaO2 88 mmHg
SpO2 95%
Based on this information, which of the following would you recommend?
A. Increase the minute ventilation
B. Add 10 cmH2O of PEEP
C. Decrease the tidal volume
D. Maintain the current settings

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 mmHg
HCO3 25 mEq/L
BE 0 mEq/L
PaO2 46 mmHg
Based on this information, which of the following would you recommend?
A. Start nasal CPAP at 5-8 cmH2O
B. Increase the oxygen hood concentration to 100%
C. Intubate and begin mechanical ventilation with PEEP
D. Obtain a chest X-ray to look for a pneumothorax

91. A 56-year-old female patient’s bedside spirometry results are as follows:
FVC is decreased
FEV1 is normal
FEV1% is increased
Which of the following best describes this patient?
A. Normal results
B. Obstructive disease
C. Poor patient effort
D. Restrictive disease

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?
A. Nebulized acetylcysteine
B. Nebulized dornase alpha
C. Nebulized 0.9% saline
D. Direct instillation of acetylcysteine into the lungs

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?
A. Switch the patient to NPPV
B. Switch from an ET tube to a tracheostomy
C. Maintain the endotracheal tube in place
D. Switch to a pressure-controlled mode

94. An adult patient in the ICU receiving mechanical ventilation has been diagnosed with ARDS. Which of the following would you expect to find in this patient?
A. Refractory hypoxemia
B. Metabolic alkalosis
C. Increased lung volumes
D. Increased compliance

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

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?
A. Dry powder inhaler
B. Ultrasonic nebulizer with a mask
C. Small volume nebulizer with a mask
D. Small volume nebulizer with a mouthpiece

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%
Which of the following changes would you recommend?
A. Increase the FiO2
B. Increase the tidal volume
C. Increase the set rate
D. Maintain the current settings

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?
A. The fingertip
B. The toe tip
C. The lateral area of the heel
D. The earlobe

99. Which of the following is true regarding the insertion of a laryngeal mask airway compared to endotracheal intubation?
A. It must be removed in order to insert an endotracheal tube
B. It poses a greater risk of trauma than endotracheal intubation
C. It can be inserted blindly without any special equipment
D. It can completely prevent the aspiration of gastric contents

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?
A. Pneumothorax
B. Oxygen toxicity
C. Tracheoesophageal fistula
D. Retinopathy of prematurity

101. An adult patient is receiving mechanical ventilation with a PEEP setting of 10 cmH2O, but the physician has requested to 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?
A. Increase the FiO2 by 10%
B. Lower the PEEP back to 10 cmH2O
C. Administer sodium bicarb
D. Obtain a stat EKG

102. After reviewing the results of a patient’s pulmonary function tests, you note that the FEV1, FVC, and total lung capacity are all decreased. The FEV1/FVC ratio is normal. Which of the following best describes these findings?
A. Restrictive lung disease
B. Obstructive lung disease
C. Combined obstructive-restrictive lung disease
D. The test is invalid

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?
A. Atelectasis of the left side
B. Tension pneumothorax on the left side
C. Tension pneumothorax on the right side
D. Pleural effusion on the right side

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?
A. Sterile gloves
B. Lancet
C. Local anesthetic
D. Anticoagulant

105. While assessing a 51-year-old male patient, you note the definitive use of neck muscles during normal breathing. This finding is consistent with which of the following?
A. Pulmonary embolism
B. Myasthenia gravis
C. COPD
D. Orthopnea

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?
A. Decrease the minute ventilation
B. Discontinue mechanical ventilation
C. Administer IV bicarbonate
D. Maintain the current settings

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?
A. “Take a deeper breath.”
B. “Don’t hesitate.”
C. “Blast the air out faster.”
D. “Blow out longer.”

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?
A. An SVN using the “blow by” technique
B. An MDI with a holding chamber and mask
C. A small volume nebulizer with a mouthpiece
D. A breath-actuated MDI with a mask

109. During the assessment of a 60-year-old male patient, you noticed increased tactile fremitus. This finding is typical in which of the following conditions?
A. Emphysema
B. Pneumothorax
C. Pulmonary edema
D. Chronic bronchitis

110. A 43-year-old male patient was 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
PaCO2 74 torr
HCO3 20 mEq/L
PaO2 315 torr
Which of the following would you recommend?
A. Apply BiPAP with: IPAP 20 cmH2O, EPAP 5 cmH2O, FiO2 30%
B. Intubate and apply: SIMV, tidal volume 600 mL, rate 6/min, FiO2 40%
C. Intubate and apply: A/C ventilation, tidal volume 450 mL, rate 12/min, FiO2 50%
D. Apply CPAP at 10 cmH2O and an FiO2 of 100%

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, the catheter cannot pass beyond the tip of the tube. Which of the following is the most likely cause of this problem?
A. There is a kink in the tube
B. The tube is in the right mainstem bronchus
C. The suction catheter is too short
D. The suction catheter size is too large

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?
A. Fluoxetine (Prozac)
B. Midazolam (Versed)
C. Dextroamphetamine (Dexedrine)
D. Cisatracurium (Nimbex)

113. A 59-year-old female patient has a vital capacity of 3.4, a functional residual capacity of 5.8, and an expiratory reserve volume of 1.2. What is the patient’s total lung capacity?
A. 5.9
B. 6.8
C. 8.0
D. 8.8

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?
A. Asthma
B. Chronic bronchitis
C. Congestive heart failure
D. Emphysema

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?
A. A mucus plug is present
B. Subcutaneous emphysema
C. Pleural effusion
D. Tactile fremitus

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?
A. Increase the tidal volume setting until the pressure equals 36 cmH2O
B. Increase the flow setting until the pressure equals 36 cmH2O
C. Check for increased secretions and suction if needed
D. Check the circuit for leaks

117. What is the maximum volume of air that can be inhaled after a normal, quiet inspiration?
A. FVC
B. FRC
C. IRV
D. ERV

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 an 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?
A. Extubate the patient
B. Pressure control ventilation
C. Pressure support ventilation
D. Volume control ventilation

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?
A. Synchronous Intermittent Mandatory Ventilation
B. Control Mode Ventilation
C. Assist-Control Ventilation
D. Pressure Support Ventilation

120. While administering an adrenergic aerosol bronchodilator treatment to an adult female patient, you notice an increase in pulse rate from 81 to 125 beats/min. Which of the following actions should you take?
A. Use half of the standard dosage next time
B. Add more diluent to the nebulizer chamber
C. Temporarily stop the treatment until the patient’s heart rate decreases
D. Stop the treatment and notify the physician

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?
A. 2.7 mEq/L
B. 3.2 mEq/L
C. 4.1 mEq/L
D. 5.8 mEq/L

122. A 41-year-old female patient is showing signs of wheezing. Asthma is suspected; however, a diagnosis has not yet been confirmed. Which of the following tests would you recommend in order to obtain confirmation?
A. Airway resistance
B. Flow-volume loop
C. Bronchoprovocation study
D. Pre-and-post bronchodilator study

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?
A. Cystic fibrosis
B. Foreign body
C. Epiglottitis
D. Croup

124. A 63-year-old female patient is receiving volume-controlled 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?
A. High body temperature
B. Increased ventilation
C. Increased cardiac output
D. Mainstem intubation

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?
A. Hypercapnia
B. Pneumothorax
C. Fluid overload
D. Bronchospasm

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?
A. 5 cmH2O/L/sec
B. 15 cmH2O/L/sec
C. 30 cmH2O/L/sec
D. 60 cmH2O/L/sec

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?
A. Approved for use during MRI procedures
B. The ability to compensate with tube flexibility
C. The ability to run on a 12 volt DC (battery) power
D. A variable flow control and adjustable I:E ratio

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?
A. The application of a Brigg’s adapter
B. The use of a bite block
C. The administration of a neuromuscular blocking agent
D. The administration of a strong narcotic analgesic

129. Hemodynamic data was collected on a 39-year-old male patient. Which of the following would be indicative of a potential problem?
A. Shunt of 3%
B. SVR of 500 dyn/s/cm-5
C. Cardiac Index of 3.7 L/min/m2
D. CVP of 5 cmH2O

130. A 65-year-old female patient with pulmonary edema was inadvertently administered 1,000 mL of IV fluids instead of the ordered amount of 100 mL. Which of the following would you expect to see in this case?
A. Increased PaO2
B. Decreased PAP
C. Increased PCWP
D. Decreased lung markings on the chest x-ray

131. A postoperative 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?
A. Increase the control pressure
B. Decrease the sensitivity setting
C. Check for a leak in the circuit or mouthpiece
D. Switch the unit to a 100% source gas

132. You are called to administer nebulized albuterol to a 47-year-old female patient who is receiving oxygen via nasal cannula at 2 L/min. Her pre-treatment 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?
A. 89 beats/min
B. 99 beats/min
C. 109 beats/min
D. 119 beats/min

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?
A. Hypoventilation
B. Hyperventilation
C. Retinopathy of prematurity
D. The development of pulmonary edema

134. Simple spirometry can be used to measure any of the following EXCEPT:
A. Tidal volume
B. Vital capacity
C. Inspiratory reserve volume
D. Residual volume

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, and 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?
A. Increase the FiO2
B. Increase the ventilator rate
C. Increase the tidal volume
D. Add mechanical deadspace

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?
A. Blender
B. Humidifier
C. Sterile saline
D. Air and oxygen source

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?
A. Walk as slow as possible for 6 minutes and record the distance covered
B. Walk as fast as possible for 6 minutes and record the distance covered
C. Walk as far as possible for 6 minutes and record the distance covered
D. Walk for 1 mile and record the time it took to cover that distance

138. You are called to increase the expiratory time of a patient receiving volume-controlled ventilation without altering the minute ventilation. Which of the following settings would you adjust?
A. Rate of breathing
B. Inspiratory flow
C. Tidal volume
D. Trigger sensitivity

139. Spirometry tests were performed on a 52-year-old female with the following results: TLC 136% predicted, RV 165% predicted, FVC 53% predicted, FEF25-75 37% predicted, and FEV1/FVC 28% predicted. What is the interpretation of this data?
A. Mild restrictive lung disease
B. Mild obstructive lung disease
C. Severe restrictive lung disease
D. Severe obstructive lung disease

140. In order for a home-care patient to disinfect their respiratory care equipment, which of the following would you recommend?
A. Warm, soapy water
B. Cool, soapy water
C. Ethylene oxide
D. Acetic acid

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?
A. Change to VC, A/C
B. Increase the PEEP
C. Increase the FiO2
D. Increase the flow

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 to be administered via nebulization?
A. Levalbuterol
B. Montelukast
C. Beclomethasone
D. Magnesium sulfate

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. These findings indicate which of the following?
A. Diffuse pulmonary emphysema
B. Right-sided pleural effusion
C. A pneumothorax of the right lung
D. Atelectasis of the left lung

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?
A. Suction the neonate
B. Nebulize albuterol
C. Provide supplemental oxygen
D. Instill surfactant into the airway

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?
A. When a patient loses pharyngeal or laryngeal reflexes
B. When a patient has a long-term need for mechanical ventilation
C. When a patient is susceptible to hemorrhaging
D. When a patient has upper airway obstruction due to trauma

146. The physician has requested to decrease the PaCO2 of a patient who is receiving high-frequency oscillatory ventilation. Which of the following settings should you adjust?
A. Increase the frequency
B. Decrease the bias flow
C. Increase the power/amplitude
D. Increase the mechanical deadspace

147. While reviewing your worklist, you noticed that one patient was diagnosed with chronic bronchitis and another with emphysema. Which of the following PFT findings would you expect for these patients?
A. Increased lung compliance
B. Decreased forced expiratory flows
C. Decreased total lung capacity
D. Decreased diffusing capacity

148. While assisting with a bronchoscopy procedure, the physician requests a drug for direct instillation into the endotracheal tube. Which of the following would you recommend?
A. Lidocaine
B. Liquid Heparin
C. Ipratropium bromide
D. Saline

149. An 8-year-old female with asthma was prescribed Proventil via metered dose inhaler for home use. Which of the following would you recommend for this patient?
A. Add a spacer or holding chamber to the MDI
B. Remove the mouthpiece from the MDI
C. Have the child inhale as quickly as possible
D. Switch from an MDI to a DPI

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, a peak pressure of 45 cmH2, and a plateau pressure of 20 cmH2O. Which of the following would you recommend?
A. Cromolyn sodium (Intal)
B. Triamcinolone (Azmacort)
C. Levalbuterol (Xopenex)
D. Pancuronium bromide (Pavulon)

151. A 33-year-old male patient was admitted after escaping a house fire. Which of the following would you recommend?
A. Nonrebreathing mask
B. CPAP mask at 8 cmH2O and 50% O2
C. Simple mask at 6 L/min
D. 60% air entrainment mask

152. The physician orders 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?
A. Blow slowly into the device
B. Hold the device vertically after loading
C. Inhale rapidly for 1–2 seconds
D. Breathe normally in and out of the device

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?
A. “Take a normal breath in, then blow out hard.”
B. “Inhale as much as you can, then blow out hard.”
C. “Exhale normally, then inhale as hard as possible.”
D. “Blow out all of your air before you begin.”

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?
A. Atrial fibrillation
B. Ventricular tachycardia
C. 1st-degree heart block
D. 2nd-degree heart block

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?
A. Ventilator-associated pneumonia
B. Acute respiratory distress syndrome
C. Pulmonary arterial hypertension
D. Cardiogenic pulmonary edema

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?
A. Discontinue mechanical ventilation
B. Administer IV bicarbonate
C. Increase the peak flow setting
D. Decrease the minute ventilation

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?
A. Even with the carina
B. Level with the 5th cervical vertebra
C. At the sixth intercostal space
D. 1–2 inches above the carina

158. An adult patient is receiving ventilatory support in the pressure-controlled A/C mode at a rate of 10/min and peak pressure of 35 cmH2O. 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?
A. Increase the FiO2
B. Increase the rate
C. Change the patient to CPAP
D. Make no changes at this time

159. The physician has ordered ribavirin (virazole) via aerosol for an infant with severe RSV. Which of the following devices would you recommend for administration?
A. Small particle aerosol generator
B. Small volume jet nebulizer
C. Vibrating mesh nebulizer
D. Dry powder inhaler

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?
A. Cystic fibrosis
B. Acute metabolic alkalosis
C. Hypoventilation from fatigue
D. Intrapulmonary shunting

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