CHAPTER 3 - Clinical Data Flashcards by Jam Ster

A patient is suspected of having an obstruction of the
upper airway. Which of the following tests would be
helpful in providing information about this condition?

A. flow-volume loop
B. single-breath N2 elimination
C. diffusing capacity
D. bronchial provocation

A. flow-volume loop

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A patient with a body temperature of 39ºC is breathing
room air and has a normal cardiac output. What would
be the expected SvO2 value?

A. greater than 70%
B. 75%
C. 85%
D. greater than 85%

A. greater than 70%

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A four-year old child who has a brassy, barking cough
and a muffled voice is brought to the emergency room.
The child is sitting up, leaning forward, and drooling.
What should the CRT recommend for this patient?

A. direct laryngoscopy
B. lateral neck radiograph
C. bronchodilator therapy
D. pharyngeal suctioning

B. lateral neck radiograph

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The CRT is reviewing the results of an amniocentesis
performed on a 24-year-old woman. The data indicate an
L/S ratio of 3:1. What does the value of this ratio mean?

A. that there is a high probability that the fetus is
likely to experience respiratory distress at birth
B. that the unborn child has mature lungs
C. that the unborn child has pulmonary prematurity
D. that the unborn child will likely have a low birth
weight

B. that the unborn child has mature lungs

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The CRT notices that the latest blood-chemistry report
in the patient’s chart indicates a hemoglobin concentration of 20 g%. What is the significance of this data?

A. The patient is polycythemic.
B. The patient is hypovolemic.
C. The patient has a pulmonary infection.
D. The patient displays decreased capillary refill

A. The patient is polycythemic.

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Which of the following cardiac features are generally
discernable from an echocardiogram?

I. hypokinesis of ischemic myocardium
II. left ventricular hypertrophy
III. regurgitant aortic valve
IV. atherosclerotic plaque in coronary vessels

A. I, IV only
B. I, II, III only
C. II, III, IV only
D. I, II, III, IV

B. I, II, III only

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While reviewing the chart of a patient who has severe
COPD, the CRT notices that the patient has cor
pulmonale. Which of the following hemodynamic
changes would be expected?

A. decreased pulmonary capillary wedge pressure
B. decreased central venous pressure
C. increased cardiac output
D. increased pulmonary artery diastolic pressure

D. increased pulmonary artery diastolic pressure

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A patient receiving mechanical ventilation is suspected of having pneumothorax. What procedure
should the CRT recommend to confirm the diagnosis?

A. arterial blood gas
B. chest radiograph
C. bronchoscopy
D. peak flow measurement

B. chest radiograph

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A newborn has a one-minute Apgar score of 5. What
type of intervention would be appropriate based on
this score?

A. temperature maintenance, drying, and airway clearance
B. endotracheal intubation and mechanical ventilation
C. increased FIO2s via bag-mask ventilation
D. cardiopulmonary resuscitation

C. increased FIO2s via bag-mask ventilation

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A 44-year-old male in a diabetic coma enters the emergency department. An arterial blood sample while the
patient breathed room air was obtained immediately.
Analysis of the sample revealed the following:

PaO2 110 torr
PaCO2 10 torr
pH 7.10
HCO3¯ 3 mEq/L
B.E. –21 mEq/L

Which of the following blood-gas interpretations is
correct?

A. partially compensated metabolic acidosis
B. mixed respiratory and metabolic acidosis
C. compensated respiratory alkalosis
D. fully compensated metabolic acidosis

A. partially compensated metabolic acidosis

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Which of the following factors affect the end-tidal CO2
measurements via capnography?

I. cardiac output
II. ventilation-perfusion ratio
III. fraction of inspired oxygen
IV. alveolar ventilation

A. II, III only
B. I, II, III only
C. I, II, IV only
D. I, II, III, IV

C. I, II, IV only

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Which of the following sections of the patient’s chart
would contain a physician’s assessment of the effectiveness of a respiratory care procedure being administered?

A. admission physical exam
B. respiratory care flow sheet
C. patient progress notes
D. patient history

C. patient progress notes

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Which of the following measurements are considered
vital signs?

I. sensorium
II. body temperature
III. ventilatory rate
IV. blood pressure

A. II, IV only
B. I, II, III only
C. I, II, IV only
D. II, III, IV only

D. II, III, IV only

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Which of the following diagnostic procedures provides data for assessing the degree of reversible airway
disease?

A. methacholine challenge
B. lung scan
C. before and after bronchodilator study
D. volume of Iso flow

C. before and after bronchodilator study

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Calculate a patient’s minute ventilation based on the
data given below.

FRC 2,400 cc
RV 1,400 cc
VT 700 cc
f 12 breaths/min.

A. 8,400 cc/min.
B. 4,500 cc/min.
C. 3,800 cc/min.
D. 3,600 cc/min.

A. 8,400 cc/min.

700 cc × 12 breaths/min. = 8,400 cc/min

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A physician wishes to determine whether a patient’s
pulmonary disease has a reversible component. What
procedure could the CRT recommend to ascertain this
phenomenon?

A. lung scan
B. nitrogen washout
C. single breath CO2 elimination
D. spirometry before and after bronchodilator

D. spirometry before and after bronchodilator

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A 53-year-old male enters the emergency department
expressing the following complaints:

orthopnea
paroxysmal noctural dyspnea
syncope
diaphoresis
night sweats

What should the CRT recommend at this time?

A. an electrocardiogram
B. an arterial puncture procedure
C. pulmonary artery catheterization
D. pulmonary function testing

A. an electrocardiogram

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Which of the following situations are indications for
capnography?

I. to evaluate mean exhaled CO2 levels
II. to assess the placement of an endotracheal tube
III. to determine the efficacy of mechanical ventilation
IV. to assess the degree of intrapulmonary shunting

A. II, III only
B. I, IV only
C. I, II, III only
D. I, II, III, IV

A. II, III only

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While reading a patient’s chart, the CRT is reviewing
an ECG tracing obtained earlier in the day. The ECG
data are listed.

HEART RATE: 68 bpm
P-R INTERVAL: 0.17 second
QRS INTERVAL: 0.11 second
S-T SEGMENT: isoelectric
T WAVE: upright and round

Based on these data, what should the CRT infer?

A. The patient had no ECG abnormalities.
B. The patient experienced sinus bradycardia.
C. The patient had an acute myocardial infarction.
D. The patient experienced premature ventricular contractions.

A. The patient had no ECG abnormalities.

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A patient who has congestive heart failure is being
seen by a physician. The physician asks the CRT to
recommend the most appropriate method of hemodynamic monitoring. Which of the following procedures
should the CRT recommend?

A. pulmonary artery catheter
B. central venous catheter
C. arterial cannulation
D. transcutaneous monitoring

A. pulmonary artery catheter

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While reviewing the chart of an ICU patient, the CRT
notices that the patient’s urine output has been progressively falling and is now 10 ml/hr. Which of the
following terms describes this condition?

A. uremia
B. anuria
C. polyuria
D. oliguria

D. oliguria

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The physician’s order for a respiratory care modality
should specify all of the following components EXCEPT

A. medication dosage.
B. duration of treatment.
C. possible side effects.
D. oxygen concentration

C. possible side effects.

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The CRT is attempting to determine on a COPD
patient the range of movement of the diaphragm via
percussion. She is having difficulty distinguishing
among the percussion notes to ascertain the diaphragm’s position. Which of the following procedures should she recommend determining diaphragmatic movement?

A. radiography
B. bronchoscopy
C. lung scan
D. pneumotachography

A. radiography

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How long should the maximum inspiratory pressure
measurement be made to ensure that an ICU patient
achieves a maximum diaphragmatic contraction?

A. 5 seconds
B. 10 seconds
C. 20 seconds
D. 40 seconds

C. 20 seconds

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Upon reviewing a patient’s chart, the CRT notes that the patient has neutrophilia with increased bands and an increased total white blood cell count. What condition is likely occurring with this patient? A. pneumonia B. COPD C. congestive heart failure D. pulmonary fibrosis

A. pneumonia

Under normal conditions, which of the following hemodynamic measurements are represented by the pulmonary capillary wedge pressure reading? I. left atrial pressure II. pulmonary artery pressure III. left ventricular end-diastolic pressure IV. pulmonary venous pressure A. II, III, IV only B. I, II, III only C. I, III, IV only D. I, II, III, IV

C. I, III, IV only I. left atrial pressure III. left ventricular end-diastolic pressure IV. pulmonary venous pressure

While reviewing a patient’s chart, the CRT observes that the patient’s VD/VT is 0.65. Which condition(s) might be responsible for this value? I. pneumonia II. pulmonary embolism III. diffuse atelectasis IV. positive pressure mechanical ventilation A. II only B. I, III only C. II, IV only D. I, II, III only

C. II, IV only

A physician wants to establish a route by which he can administer medications, maintain circulatory volume, and obtain mixed venous blood samples. Which of the following vascular access routes would be most appropriate? A. arterial cannulation B. intravenous line C. central venous line D. dorsalis pedis catheterization

C. central venous line

What respiratory data relating to lung mechanics would be useful to obtain from a neuromuscular disease patient? I. body plethysmography II. maximum inspiratory pressure III. maximum expiratory pressure IV. volume of Iso flow A. II, III only B. I, IV only C. I, II, IV only D. I, II, III only

A. II, III only

When evaluating airway resistance data obtained from a body plethysmograph, what range is accepted as normal? A. 0.5 to 1.5 cm H2O/L/sec B. 1.0 to 1.75 cm H2O/L/sec C. 0.6 to 2.4 cm H2O/L/sec D. 1.5 to 3.0 cm H2O/L/sec

C. 0.6 to 2.4 cm H2O/L/sec

High-frequency jet ventilation (HFJV) is to be initiated on an infant who has severe pulmonary interstitial emphysema (PIE). What type of monitoring would be critical to assure rapid selection and adjustment of ventilation settings? A. transcutaneous PO2 and PCO2 B. pulse oximetry C. pulmonary arterial pressure D. central venous pressure

A. transcutaneous PO2 and PCO2

Which of the following measurements obtained from an intubated and mechanically ventilated 55-kg patient indicate that this patient is a candidate for weaning from mechanical ventilation? I. vital capacity: 820 ml II. resting minute ventilation: 12 liters/minute III. maximum inspiratory pressure: –42 cm H2O IV. patient-ventilation system compliance of 45 ml/ cmH2O A. I, II only B. I, III only C. II, III, IV only D. I, II, III, IV

B. I, III only

In which patient scenario would a pulse oximeter render a falsely high SpO2 reading? A. a patient who had been breathing carbon monoxide B. a patient breathing oxygen C. a patient whose peripheral pulses cannot be detected D. a patient shivering

A. a patient who had been breathing carbon monoxide

The position at which the systolic thrust is palpable is called the A. point of maximal impulse. B. systolic gallop. C. substernal heave. D. systolic thrill.

A. point of maximal impulse.

Which of the following chest radiograph findings are associated with obstructive lung disease? I. increased opacity of all lung fields II. horizontal rib angles III. right hemidiaphragm elevated 2 cm higher than the left hemidiaphragm IV. increased anteroposterior diameter A. I, II, IV only B. I, III, IV only C. II, IV only D. III, IV only

C. II, IV only

An adult patient who is suspected of having a community-acquired pneumonia is about to be admitted to a hospital. Which of the following tests should be performed on this patient? I. gram stain of sputum sample II. blood chemistries III. cardiac enzymes IV. arterial blood gas analysis A. III, IV only B. I, II, IV only C. I, II, III only D. I, II, III, IV

B. I, II, IV only I. gram stain of sputum sample II. blood chemistries IV. arterial blood gas analysis

A neonate is receiving supplemental oxygen via an oxyhood and is having its oxygenation status monitored with a pulse oximeter. The pulse oximeter indicates an SpO2 of 100%. What action should the CRT take at this time? A. Continue present therapy and current monitoring. B. Obtain an arterial blood sample. C. Lower the FIO2 delivered by the oxyhood. D. Discontinue the oxyhood and administer oxygen through an isolette.

B. Obtain an arterial blood sample.

Which of the following pulmonary function tests can be used to evaluate the mechanical properties of the lungs and chest wall, particularly when airflow resistance is increased? A. diffusing capacity B. volume of isoflow C. maximum voluntary ventilation D. forced vital capacity maneuver

C. maximum voluntary ventilation

Which of the following laboratory results would be considered abnormal as they pertain to the medical history of a 35-year-old female patient? I. an arterial oxygen tension of 78 mm Hg on room air II. an arterial pH of 7.42 III. an oxyhemoglobin saturation of 88% IV. an arterial carbon dioxide tension of 44 mm Hg A. I, III only B. II, IV, V only C. I, III, IV only D. I, III, V only

A. I, III only NORMAL VALUES: * arterial oxygen tension: **80 to 100 mm Hg** * arterial carbon dioxide tension: **35 to 45 mm Hg** * oxyhemoglobin saturation: **95% to 98%** * arterial pH: **7.35 to 7.45** * bicarbonate: **22 to 26 mEq/liter**

A patient who has a central venous pressure (CVP) measurement of 15 torr would most likely have a favorable response to which medication? A. antidysrhythmic agent B. negative inotrope C. diuretic D. negative chronotrope

C. diuretic

An infant who is receiving mechanical ventilation displays a trend of increasing transcutaneous carbon dioxide tensions (PtcO2). Remembraning and calibrating the transcutaneous monitor does not result in a change, nor does suctioning the infant’s endotracheal tube. What information should be obtained next? A. chest X-ray B. arterial blood gases C. bronchoscopy D. echocardiography

C. bronchoscopy

A patient arrives at the emergency department with a presumed exacerbation of COPD. He is receiving oxygen by nasal cannula at 2 liters/minute and appears to be in moderate respiratory distress. What action should the CRT recommend? A. Obtain an arterial blood gas. B. Change to a non-rebreathing mask at 8 liters/ minute. C. Institute pulse oximetry. D. Intubate and mechanically ventilate

A. Obtain an arterial blood gas.

What is the normal I:E ratio for a spontaneously breathing adult? A. 1:3 B. 1:2 C. 2:1 D. 3:1

B. 1:2

A preterm, 900-gram neonate has a transcutaneous oxygen electrode placed on the right upper chest and has an umbilical artery catheter (UAC) in place. The transcutaneous PO2 is 55 mm Hg, while a blood gas drawn from the UAC reveals a PO2 of 40 mm Hg. What is the likely cause of the difference between these two measurements? A. An air bubble might have gotten under the transcutaneous sensor. B. The temperature of the transcutaneous electrode is too low. C. A right-to-left shunt might be present. D. The PO2 electrode on the blood-gas analyzer was recently replaced.

C. A right-to-left shunt might be present.

Which of the following urine characteristics generally appear in a routine urinalysis? I. specific gravity II. ketones III. pH IV. protein A. I, II, III, IV B. I, III, IV only C. II, III only D. I, IV only

A. I, II, III, IV

Which procedures should be performed during a physical examination of the chest? I. percussion II. vibration III. auscultation IV. palpation A. I, III, IV only B. III, IV only C. I, II only D. II, IV only

A. I, III, IV only I. percussion III. auscultation IV. palpation

Which of the following actions should the CRT perform first before instituting oxygen therapy on a newly admitted patient? A. Determine the SpO2. B. Verify the physician’s order. C. Perform an arterial blood gas puncture. D. Auscultate the patient’s thorax.

B. Verify the physician’s order.

While reviewing the chart of a post-myocardial infarction patient, the CRT notices that the patient’s myocardium has experienced a decreased compliance. What would be the result in this situation if the PCWP was used to estimate the patient’s left ventricular end-diastolic volume (LVEDV)? A. The PCWP would correlate well with the LEVDV. B. The PCWP would overestimate the LEVDV. C. The PCWP would underestimate the LVEDV. D. The PCWP would render fluctuating values for the LVEDV.

B. The PCWP would overestimate the LEVDV.

A patient who complains of frequent tightening of the chest and frequent coughing cannot perform a maximum forced expiratory maneuver. Which of the following tests should the CRT recommend to obtain appropriate data about this patient? A. seven-minute N2 washout B. body plethysmography C. diffusing capacity D. maximum voluntary ventilation

B. body plethysmography if a patient is unwilling or incapable of performing an FVC maneuver, body plethysmography is recommended

Which of the following measurements must be made to provide for the calculation of the VD/VT ratio? I. PVCO2 II. PECO2 III. PETCO2 IV. PaCO2 A. II, IV only B. I, II only C. II, III only D. III, IV only

A. II, IV only

The following arterial blood gas data were obtained from a patient having a normal respiratory quotient and breathing an FIO2 of 0.28 at sea level. PaO2 225 mm Hg PaCO2 44 mm Hg pH 7.35 HCO3 ¯ 24 mEq/L B.E. 0 mEq/L Which of the following statements describe the PaO2 value? A. Air bubbles contaminated the sample. B. The patient hyperventilated. C. The patient’s hypoxemia was overcorrected. D. An analytical error has occurred

D. An analytical error has occurred

Which of the following vital sign measurements are abnormal for a middle-aged adult patient at rest? I. body temperature of 36ºC II. heart rate of 100 beats/minute III. blood pressure of 130/100 mm Hg IV. ventilatory rate of 8 breaths/minute A. I only B. II, III, IV only C. I, III, IV only D. I, II, III, IV

C. I, III, IV only

How many anthropometric factors need to be known about a patient to determine the predicted normal FEV1? A. two B. three C. four D. five

C. four

During the calculation of the CcO2 while performing a shunt study on a patient, the partial pressure of oxygen in the pulmonary capillary blood (PcO2) is assumed to be equal to the A. PvO2 B. PAO2 C. PaO2 D. SvO2

B. PAO2

A physician wants to measure a patient’s FRC. She asks the CRT to recommend a diagnostic procedure that will yield the most accurate data, despite patient air-trapping. Which of the following tests should the CRT recommends? A. body plethysmography B. volume of Iso flow C. closed-circuit helium dilution D. open-circuit nitrogen washout

A. body plethysmography - Three procedures are available for measuring the functional residual capacity (FRC): (1) the closed-circuit helium dilution, (2) the open-circuit nitrogen washout, and (3) body plethysmography. The most accurate of these three procedures is body plethysmography

What is the amount of maximum inspiratory pressure that is generally sufficient to produce a vital capacity approximately equivalent to 15 ml/kg? A. –5 cm H2O B. –10 cm H2O C. –15 cm H2O D. –20 cm H2O

D. –20 cm H2O - An MIP of approximately –20 cm H2O is ordinarily sufficient to produce a vital capacity of about 15 ml/kg of ideal body weight

Approximately how much anatomic dead space does a 75-kg (IBW) person have? A. 165 cc B. 150 cc C. 130 cc D. 75 cc

A. 165 cc - 75 kg X 2.2 lbs/kg = 165 pounds

Which of the following measurements reflect volume change per unit of pressure change? A. compliance B. conductance C. resistance D. impedance

A. compliance

A patient who has an undiagnosed, recurring cough and receives ipratropium bromide, 2 puffs QID via an MDI, has been scheduled for a bronchoprovocation test. What is the recommended time for withholding this medication before the bronchoprovocation test? A. 24 hours before the bronchoprovocation B. 18 hours before the bronchoprovocation C. 12 hours before the bronchoprovocation D. 8 hours before the bronchoprovocation

C. 12 hours before the bronchoprovocation

Which of the following forms of oxygen monitoring would be most appropriate to use during a bronchoscopy procedure? A. pulse oximetry B. blood gas analysis C. transcutaneous monitoring D. co-oximetry

A. pulse oximetry

When would it be appropriate for the CRT to measure the peak expiratory flow rate in a pre-operative assessment? A. when the patient has had a chest X-ray within the last hour B. when the patient used an inhaled bronchodilator within the last hour C. when the patient had smoked a cigarette within the last hour D. when the patient had ingested a large meal within the last hour

A. when the patient has had a chest X-ray within the last hour

The CRT expects a patient to require numerous arterial blood samples obtained per day. Which of the following recommendations should the CRT make to the physician to minimize patient discomfort during the procedures? A. a pulmonary artery catheter B. transcutaneous oxygen monitoring C. a central venous pressure line D. an arterial line

D. an arterial line

Which of the following CVP values would be consistent with that of a patient receiving positive pressure mechanical ventilation with PEEP? A. 16 mm Hg B. 8 mm Hg C. 6 mm Hg D. 4 mm Hg

A. 16 mm Hg

Which of the following tests would possibly be adversely influenced if the subject smoked a cigarette an hour or less before performing the test? A. single-breath nitrogen elimination B. maximum voluntary ventilation C. body plethysmography D. diffusing capacity

D. diffusing capacity

Which of the following terms describes dyspnea that occurs while a patient sits or stands? A. orthopnea B. platypnea C. eupnea D. bradypnea

B. platypnea

While evaluating the chart of a normal subject who has just completed an exercise test, the CRT notes that the subject had a VO2 of 250 ml/min. and a cardiac output of 5 liters/min. What assessment of the C(a-v¯)O2 would be appropriate? A. normal B. increased C. decreased D. cannot be assessed

A. normal

The CRT notices that the latest lab data in the patient’s chart reveals a white blood cell count of 9,000/mm3. How should the CRT interpret this data? A. The patient has pneumonia. B. The patient has an empyema. C. A sputum culture and sensitivity test should be performed. D. The white blood cell count is normal.

D. The white blood cell count is normal

Which of the following pulmonary function tests should be recommended to evaluate the distribution of ventilation in a COPD patient? A. diffusing capacity B. body plethysmography C. maximum voluntary ventilation D. single-breath nitrogen elimination

D. single-breath nitrogen elimination

A patient is about to perform an exercise test. The physician asks the CRT to recommend a means for continuously monitoring the patient’s oxygenation status during the exercise test. Which of the following methods should the CRT recommend? A. pulse oximetry B. arterial blood gas sampling from an arterial line C. mixed venous blood gas sampling for a pulmonary artery catheter D. co-oximetry

A. pulse oximetry

The attending physician’s observations of the patient’s ongoing hospital course can be located in which section of the patient chart? A. history and physical exam B. physician orders C. progress notes D. graphic charts

C. progress notes

How does the PETCO2 correlate with the PaCO2 in a healthy adult subject? A. The PETCO2 exceeds the PaCO2. B. The PETCO2 is less than the PaCO2. C. The PETCO2 approximately equals the PaCO2. D. The PETCO2 varies inversely with the PaCO2

C. The PETCO2 approximately equals the PaCO2.

While reviewing a patient’s chart, the CRT notices that the patient’s latest blood pressure was 150/100 mm Hg. How should the CRT classify this recording? A. normal B. hypotension C. hypertension D. tachycardia

C. hypertension

A patient is suspected of having a pulmonary embolism. Which of the following diagnostic tests is appropriate to use to assist in the diagnosis? A. ventilation-perfusion lung scan B. CT scan C. MRI D. chest radiography

A. ventilation-perfusion lung scan

When should Apgar scores be assessed on newborns? A. 1 minute and 5 minutes after birth B. 1 minute and 3 minutes after birth C. 2 minutes and 5 minutes after birth D. 3 minutes and 6 minutes after birth

A. 1 minute and 5 minutes after birth

When obtaining the history of the present illness from a patient, what type of statement or question should the CRT avoid stating? A. “Tell me about your difficulty breathing.” B. “Your chest pain occurs only when you walk up stairs, right?” C. “What makes your pain feel worse?” D. “When did your coughing problem first begin?”

B. “Your chest pain occurs only when you walk up stairs, right?”

When is the most appropriate time to review a patient’s chest X-ray? A. any time before admission B. before obtaining the history of present illness C. before performing the physical examination D. after obtaining the history of present illness and after performing the physical examination

D. after obtaining the history of present illness and after performing the physical examination

An anterior protrusion of the sternum is called A. barrel chest. B. pectus excavatum. C. kyphosis. D. pectus carinatum.

D. pectus carinatum

When the CRT assesses a patient’s pulse rate, what features of the pulse rate need to be evaluated? I. rhythm II. pressure III. strength IV. rate A. III, IV only B. I, II, IV only C. I, III, IV only D. I, II, III, IV

C. I, III, IV only

A patient has been found to have a peripheral carcinoma of the lung. What diagnostic procedure would be most useful to help place a biopsy needle into the lesion? A. chest radiography B. lung scan C. CT scan D. pulmonary angiography

C. CT scan

The following respiratory data were obtained at the bedside from a 150-lb (IBW) patient. * maximum inspiratory pressure (MIP): –60 cm H2O * maximum expiratory pressure (MEP): 100 cm H2O * ventilatory rate (f): 12 breaths/minute * minute ventilation (VE ): 6.00 liters/minute Calculate this patient’s alveolar ventilation. A. 4.20 liters/minute B. 5.40 liters/minute C. 6.00 liters/minute D. 9.13 liters/minute

A. 4.20 liters/minute STEP 1: Determine the V˙D. VD = f x VD = (12 breaths/minute)(150 ml/breath) = 1,800 ml/minute, OR = 1.80 liters/minute STEP 2: Calculate the VA. VA = VE - VD = 6.00 liters/minute 1.80 liters/minute = 4.20 liters/minute

What does the designation G3, P2, Ab0 represent in the maternal history? A. three low Apgar scores, two pregnancies, and no Cesarean sections B. three pregnancies, two live births, and no abortions C. three live births, two currently alive children, and no abortions D. three pregnancies, two premature births, and no abdominal deliveries

C. three live births, two currently alive children, and no abortions

If a patient has chronic CO2 retention, she would be expected to have a(n) ____________________ PCO2 in the _____________ in comparison with a person who has a normal arterial blood gas and acid-base status. I. increased; cerebrospinal fluid II. increased; arterial blood III. decreased; cerebrospinal fluid IV. decreased; arterial blood A. I, II only B. IV only C. III, IV only D. I, IV only

A. I, II only

A patient’s chest roentgenogram reveals a number of hilar lung masses. A positive sputum cytology has been obtained. Which of the following diagnostic procedures should the CRT recommend for obtaining additional clinical data? A. flexible bronchoscopy B. ventilation-perfusion scan C. sputum sample D. complete blood count

A. flexible bronchoscopy

If a patient has a minute ventilation of 9.6 liters/minute and a ventilatory frequency of 10 breaths/minute, what is the patient’s tidal volume? A. 960.0 ml B. 96.0 ml C. 9.6 l D. 96.0 l

A. 960.0 ml

A sputum sample has been collected. Which of the following tests can be used to determine the reliability of the sputum sample? A. Ziehl-Neelsen acid-fast stain B. gram stain C. periodic acid-Schiff stain D. Gomori’s methenamine silver

B. gram stain

A physician asks the CRT to recommend a diagnostic test that will allow for the measurements Raw and SGaw. Which of the following tests should the CRT recommend? A. single-breath N2 elimination study B. bronchoprovocation C. body plethysmography D. CT scan

C. body plethysmography

What term best describes a patient’s condition that is associated with an arterial PCO2 of 25 mm Hg? A. hypoventilation B. tachypnea C. hyperventilation D. hyperpnea

C. hyperventilation

The tidal volume (VT) for a normal healthy individual is usually _____ ml/kg of IBW. A. 3 to 5 B. 5 to 7 C. 7 to 10 D. 10 to 15

B. 5 to 7

Questions #1 and #2 refer to the same patient. A 150-lb (IBW) patient has a tidal volume of 500 ml and a ventilatory rate of 12 breaths/min. 1. Calculate this patient’s minute ventilation. A. 1.8 liters/minute B. 2.3 liters/minute C. 4.2 liters/minute D. 6.0 liters/minute 2. Calculate this patient’s alveolar minute ventilation. Assume the absence of dead-space disease. A. 1.8 liters/minute B. 2.3 liters/minute C. 4.2 liters/minute D. 6.0 liters/minute

1. D. 6.0 liters/minute VE = 500 ml/breath x 12 breaths/minute = 6,000 ml/minute or 6.0 liters/minute 2. C. 4.2 liters/minute STEP 1: Determine the alveolar volume (VA). Use the guideline that states 1 ml of anatomic dead space exists for each pound of ideal body weight. Therefore, a 150-lb person (ideal body weight) has 150 ml of VD. VT = VD - VA Solving for VA, VA = VT – VD = 500 ml – 150 ml = 350 ml STEP 2: Multiply the VA by the ventilatory rate to calculate the alveolar minute ventilation (V˙A). VA = (VA)(f) = (350 ml)(12 breath/minute) = 4,200 ml/minute or 4.2 liters/minute

The CRT assesses a patient’s capillary refill and finds that approximately six seconds elapse before blood flow reappears to a nail bed following blanching of the fingernails. What is the significance of this finding? A. The patient is anemic. B. The patient is hypoxemic. C. The patient is hypotensive. D. The patient is hypervolemic.

C. The patient is hypotensive.

Which of the following features characterize digital clubbing? I. sponginess of the nail bed II. Angle between the nail bed and proximal skin becomes less than 180º. III. Ratio of distal phalangeal depth to interphalangeal depth becomes higher than one. IV. increased nail curvature A. I, II, III, IV B. II, III only C. I, II, III only D. I, III, IV only

D. I, III, IV only

The chest radiograph of a mechanically ventilated patient reveals a small opaque ball in the right hilar region, with the remainder of the right hemothorax being hypertranslucent. The left hemidiaphragm is displaced inferiorly. Palpation of this patient would likely reveal which of the following findings? A. symmetrical chest-wall movement B. bilateral reduction in tactile fremitus C. tracheal deviation to the left D. crepitations in the neck region

C. tracheal deviation to the left

A smoke-inhalation victim arrives in an ambulance at the emergency department. He is breathing an FIO2 of 1.0. An arterial blood gas sample indicates an SaO2 of 100%. How should the CRT evaluate this result? A. Accept the result as normal. B. View the result as being underestimated. C. View the result as being overestimated. D. Correlate this finding with a pulse oximeter.

C. View the result as being overestimated.

Which of the following respiratory conditions are sometimes associated with stridor? I. asthma II. laryngotracheobronchitis III. tracheomalacia IV. post-extubation edema A. II, III only B. I, IV only C. II, III, IV only D. I, II, III, IV

C. II, III, IV only

Assessment of the pulse should include all of the following factors EXCEPT I. rate. II. strength. III. flow. IV. rhythm. A. I, II, III only B. II, III only C. I only D. III only

D. III only

Which of the following signs represent a fairly sensitive indication of respiratory distress in infants but is usually apparent in adults (only when severe abnormality is present)? A. cyanosis B. tachypnea C. stridor D. retractions

D. retractions

A four-year-old child arrives at the emergency department with a high fever, marked respiratory distress, and drooling. What diagnostic procedures should the CRT recommends? A. arterial blood gas B. chest radiograph C. bronchoscopy D. lateral neck radiograph

D. lateral neck radiograph

A mechanically ventilated patient has been monitored via capnography. The patient’s PETCO2 measures 38 torr. Suddenly, the PETCO2 now reads 18 torr. Which of the following causes might have accounted for this change? A. The patient was given an albuterol treatment, and the drug has taken effect. B. The patient has experienced a decreased cardiac output. C. The patient is rebreathing carbon dioxide. D. The patient is experiencing a hypermetabolic state.

B. The patient has experienced a decreased cardiac output.

While interviewing a patient who has mild COPD, the CRT discovered that the patient has an FEV1 60% of predicted. The patient reveals her nutritional balance to be 15% protein, 55% carbohydrate, and 30% fat. How should this patient be advised about her diet? A. The present diet is appropriate for a patient with this type of pulmonary disease. B. The diet should consist of 10% protein, 65% carbohydrate, and 25% fat. C. The diet should entail 25% protein, 40% carbohydrate, and 35% fat. D. The diet should be comprised of 5% protein, 65% carbohydrate, and 30% fat.

A. The present diet is appropriate for a patient with this type of pulmonary disease.

What clinical finding would you expect to observe in a patient who has a hemoglobin concentration of 15 g% of which only 9 g% in total circulation is saturated with oxygen? A. cyanosis B. peripheral edema C. poor capillary refill D. digital clubbing

A. cyanosis

Which of the following findings is suggestive of a non-functional diaphragm? A. nasal flaring and sternal retractions B. use of accessory muscles of ventilation C. tracheal deviation D. gentle abdominal movement with respiration

B. use of accessory muscles of ventilation

Which of the following descriptions represents the measurement of the tidal volume? A. the volume of gas inspired in one minute B. the volume of gas exhaled during a forceful exhalation C. the volume of gas inspired during a forceful inspiration D. the volume of gas exhaled during normal breathing

D. the volume of gas exhaled during normal breathing

Which of the following conditions causes blunting of the costophrenic angle? A. pulmonary nodules B. atelectasis C. pulmonary interstitial emphysema D. pleural effusion

D. pleural effusion

While obtaining the blood pressure of a patient who is having an acute asthmatic episode in the emergency department, the CRT notes that the patient’s systolic pressure decreases 10 torr during each of the patient’s inspiratory efforts. What is this finding called? A. pulsus paradoxus B. respiratory alternans C. abdominal paradox D. pulsus alternans

A. pulsus paradoxus

While performing a ventilator check, the CRT obtains the following data: VT: 600 cc peak airway pressure: 25 cm H2O plateau pressure: 17 cm H2O PEEP: 5 cm H2O Calculate this patient’s static compliance. A. 0.075 L/cm H2O B. 0.050 L/cm H2O C. 0.035 L/cm H2O D. 0.030 L/cm H2O

B. 0.050 L/cm H2O

Cyanosis might be apparent whenever ______ g% of reduced hemoglobin exist. A. 1.5 B. 5.0 C. 15.0 D. 25.0

B. 5.0

Which of the following questions would be useful to obtain patient information related to sputum production? I. “Do you cough up a lot of secretions?” II. “What color are your secretions?” III. “When is your cough productive?” IV. “How long have you had a productive cough?” V. “Do your secretions have an odor?” A. I, II, V only B. II, III, V only C. I, II, III, IV only D. II, III, IV, V only

D. II, III, IV, V only

While performing a physical chest examination on a patient, the CRT hears a dull percussion note. Which of the following conditions is likely responsible for this finding? I. pulmonary consolidation II. subcutaneous emphysema III. pleural effusion IV. air trapping A. I, II, IV only B. I, II, III only C. I, III only D. III, IV only

C. I, III only

Which of the following disease entities display the steeple sign via neck radiography? I. croup II. laryngomalacia III. epiglottitis IV. subglottic stenosis A. II, IV only B. I, IV only C. II, III, IV only D. I, II, III only

B. I, IV only

Which of the following heart sounds would the CRT expect to hear during auscultation of the heart of a COPD patient who has cor pulmonale? A. P2 B. A2 C. M1 D. S1

A. P2

While performing auscultation on the chest of a patient, the CRT hears diminished breath sounds over the thorax. Which of the following conditions are consistent with these findings? I. pulmonary emphysema II. gross obesity III. pulmonary embolism IV. atelectasis A. I, II only B. III, IV only C. I, II, IV only D. I, II, III, IV

A. I, II only

A patient’s chest X-rays reveal the following findings: —large lung volumes —increased anterior air space (lateral view) —flattened diaphragms —enlarged intercostal spaces Which of the following pulmonary conditions is consistent with these radiographic features? A. pneumothorax B. hyperinflation C. interstitial pulmonary disease D. pleural effusion

B. hyperinflation

A patient complains of the following symptoms: —excessive daytime fatigue —headaches upon awakening —decreased ability to concentrate —loss of memory Which of the following tests is appropriate for this patient? A. bronchoscopy B. pre- and post-bronchodilator study C. sleep study D. bronchoprovocation

C. sleep study

The CRT performed a shunt study on a nonfebrile patient who was referred to the cardiopulmonary lab for this test. The patient claims to have “difficulty breathing when she does simple tasks around her house, such as throwing out the garbage, walking the dog, and climbing one flight of stairs.” Her arterial blood gas analysis, conducted 30 minutes following her breathing 100% oxygen, reveals the following data. PB 760 torr PaO2 560 torr PaCO2 42 torr pH 7.40 HCO3 ¯ 25 mEq/L B.E. +1 mEq/L The patient has a normal cardiac output and normal perfusion status. Her oxygen consumption is 250 ml/min, and her CO2 production is 200 ml/min. Based on these data and the arterial blood gas analysis, the calculated shunt fraction is 0.06. How should the CRT interpret this result? A. inconclusive B. abnormally high C. abnormally low D. normal

D. normal

Upon reviewing the chest roentgenogram of a patient who has just had a pulmonary artery catheter inserted, the CRT notices that the catheter tip resides near the right mediastinal border. What action must be taken in response to this radiographic finding? A. No action is necessary, because the catheter’s tip is correctly situated. B. Advance the catheter tip farther out into the pulmonary artery. C. Withdraw the catheter tip to just outside the right ventricle. D. Advance the catheter tip to just beyond the right mediastinal border.

A. No action is necessary, because the catheter’s tip is correctly situated.

Which lateral neck X-ray finding(s) is(are) characteristic of epiglottitis? I. steeple sign II. ballooning hypopharynx III. thumb sign A. I only B. III only C. II, III only D. I, III only

C. II, III only

The CRT observes that a patient has swelling from the ankles to just below the knees. What type of cardiovascular problem does this finding suggest? A. right ventricular failure B. left ventricular failure C. aortic insufficiency D. first-degree heart block

A. right ventricular failure

During inspection of a patient’s thorax, the CRT notices that the anteroposterior chest diameter is larger than its transverse diameter. What is the significance of this finding? A. This observation is a normal finding. B. This observation indicates a restrictive abnormality. C. This finding represents an obstructive disorder. D. This finding has no clinical significance

C. This finding represents an obstructive disorder.

Auscultation of the chest of a mechanically ventilated patient reveals a marked decrease in breath sounds on the left; however, both lungs remain clear. The CRT notes that the endotracheal tube appears to have been retaped since the last ventilator check. Palpation of the chest reveals decreased chest excursion on the left. Which of the following situations might have occurred? A. The cuff on the endotracheal tube has developed a leak. B. The endotracheal tube has slipped into the right mainstem bronchus. C. The patient has developed a humidity deficit. D. Too much volume has been injected into the cuff of the endotracheal tube.

B. The endotracheal tube has slipped into the right mainstem bronchus.

A patient’s chest radiograph reveals pulmonary infiltrates and consolidation. The patient’s right heart border is blurred. Where is the consolidation likely located? A. right upper lobe B. left lower lobe C. right middle lobe D. right lower lobe

C. right middle lobe

The CRT is performing a chest physical examination on a patient who states, “I’m having trouble breathing when I do things around the house.” Inspection reveals a transverse chest wall diameter greater than the A-P diameter. The ribs are at a 45-degree angle in relation to the spine. The patient’s stomach moves out slightly with each inspiration. These findings are consistent with a(n) A. obstructive abnormality. B. restrictive abnormality. C. mixed condition. D. normal condition.

D. normal condition.

Hyperinflation therapy is being given to a post-op thoracotomy patient in order to reverse atelectasis. Which of the following radiographic signs indicate the resolution of the atelectasis.? I. hyperinflation of adjacent lobes or contralateral lung II. absence of air bronchograms III. increased local radiolucency IV. increased size of rib interspaces over the affected lung A. I, II only B. III, IV only C. II, III, IV only D. I, II, III, IV

B. III, IV only III. increased local radiolucency IV. increased size of rib interspaces over the affected lung

Which of the following pulmonary diseases are often associated with digital clubbing? I. pulmonary edema II. bronchogenic carcinoma III. bronchiectasis IV. congenital heart disease A. I, IV only B. I, II, III only C. II, III, IV only D. I, II, III, IV

C. II, III, IV only

A patient who has an IBW of 160 lbs is breathing 16 times per minute. The patient has an alveolar ventilation of 4.0 liters per minute. Determine this patient’s minute ventilation. A. 1,440 liters/min. B. 2,560 liters/min. C. 3,670 liters/min. D. 6,560 liters/min

D. 6,560 liters/min VD = 160 cc x16 bpm = 2,560 L/min. Because VT = VA + VD, the minute volume (VE) equals VA + VD. That is, VE = VA + VD Knowing both the VA and the VD, one can calculate the VE. For example, VE = 2,560 L/min. + 4,000 L/min. = 6,560 L/min.

A patient’s chest radiograph indicates an elevation of the right hemidiaphragm. Which of the following conditions is likely the cause? A. pulmonary effusion in the left lung B. pulmonary fibrosis in the right lung C. pneumothorax on the right side D. neoplasm obstructing air flow in the left lung

B. pulmonary fibrosis in the right lung

A polysomnogram documented that a patient has obstructive sleep apnea. After this condition is diagnosed, what is the next action that should be taken to treat the patient? A. Train the patient to sleep on his side, rather than on his back. B. Initiate nocturnal CPAP breathing. C. Administer nocturnal oxygen via a nasal cannula. D. Identify the CPAP level, eliminating the snoring and the sleep apnea.

D. Identify the CPAP level, eliminating the snoring and the sleep apnea.

The CRT enters the NICU and notices a newborn infant demonstrating nasal flaring with each inspiratory effort. What is the significance of this sign? A. The infant requires supplemental oxygen. B. The infant has respiratory distress syndrome. C. The infant is attempting to achieve a larger tidal volume. D. This activity is the newborn’s method of sighing

C. The infant is attempting to achieve a larger tidal volume.

A patient has just been endotracheally intubated. The chest X-ray assessing the placement of the endotracheal tube was obtained while the patient’s neck was flexed and shows that the tube’s distal tip is 1 cm beyond the carina on the right. What should the CRT do at this time? A. Request another chest radiograph. B. Add 1 cc of air into the cuff of the endotracheal tube. C. Withdraw the tube 2 to 3 cm and resecure the tube. D. Place the patient’s neck in a neutral position.

C. Withdraw the tube 2 to 3 cm and resecure the tube.

A patient claims to sweat a lot during the night while sleeping. With which of the following diseases is this symptom (diaphoresis) often associated? A. tuberculosis B. pneumonia C. amyotrophic lateral sclerosis D. cystic fibrosis

A. tuberculosis

A loud, continuous, high-pitched sound heard during auscultation of the larynx and trachea is called A. wheezing. B. rhonchi. C. stridor. D. crackles.

C. stridor.

In a dark room, a fiberoptic light is placed against the thorax of a neonate. A lighted “halo” is observed around the point of contact with the neonate’s skin. What condition is likely present based on this finding? A. atelectasis B. pneumothorax C. consolidation D. a normal finding

D. a normal finding

A patient who does not smoke is receiving supplemental oxygen and has a pulse oximeter probe attached to her finger. The pulse oximeter indicates 100%. What is the patient’s corresponding arterial PO2? A. 120 torr B. 100 torr C. 95 torr D. The PO2 cannot be determined.

D. The PO2 cannot be determined.

Upon reviewing the chest radiograph of a patient who has just had a central venous pressure catheter inserted, the CRT notices that the tip of the catheter is situated against the wall of the superior vena cava. What action needs to be taken because of this finding? A. No action is necessary, because the catheter tip is correctly located. B. The catheter tip needs to be withdrawn until it leaves the superior vena cava. C. The catheter needs to be adjusted until the tip is situated away from the vessel wall. D. The catheter tip needs to be advanced until it enters the right ventricle

C. The catheter needs to be adjusted until the tip is situated away from the vessel wall.

How can the CRT most reliably identify that a patient has cyanosis? A. by inspection of the nail bed color B. by inspection of the mucous membranes C. by inspection of the skin color D. by inspection of the capillary refill time

B. by inspection of the mucous membranes

Which of the following chest configurations would you expect to observe in a patient who has pulmonary emphysema? A. pectus carinatum B. pectus excavatum C. barrel chest D. kyphoscoliosis

C. barrel chest

On admission, a patient having left ventricular failure displays the following chest radiographic features. —enlarged, prominent pulmonary vasculature in the upper lobes —right-sided pleural effusion —Kerley B lines along the right base Two days later, this patient’s chest X-ray reveals the following findings. —barely visible pulmonary vessels in the upper lobes —prominent pulmonary vessels in the lower lobes —disappearance of right-sided pleural effusion —disappearance of Kerley B lines What has accounted for the radiographic changes in this patient over the course of the two days following admission? A. The patient had a pneumothorax that was eventually relieved. B. The patient had pulmonary edema that resolved. C. The patient had lobar pneumonia that resolved. D. The patient had a foreign body aspiration that was removed.

B. The patient had pulmonary edema that resolved.

While palpating the thorax of a one-day, post-op lobectomy patient, the CRT hears a crackling sound and feels a crackling sensation. Which of the following conditions is most likely present? A. pneumothorax B. atelectasis C. subcutaneous emphysema D. pleural effusion

C. subcutaneous emphysema

Upon visually inspecting the chest of a 59-year-old factory worker who has smoked two packs of cigarettes a day for 40 years, the CRT notices that the patient’s chest appears to be in a permanent state of inspiration, while his ribs are held in a horizontal position. Further inspection reveals that the transverse chest diameter is almost equal to its anteroposterior diameter. While he breathes, the patient’s thorax moves up and down vertically as a whole. Which description best applies to the appearance of this patient’s chest? A. bucket-handle movement B. Pendelluft breathing C. barrel chest D. pectus carinatum

C. barrel chest

A patient is being monitored via capnography during CPR. What might account for a PETCO2 value rising and approaching that of the patient’s PaCO2? A. an increase in physiologic dead space B. hyperventilation C. another cardiac arrest D. an increased cardiac output

D. an increased cardiac output

How would a patient possibly describe sputum that is tenacious? A. frothy B. extremely sticky C. fetid D. copious

B. extremely sticky

What method of oxygen analysis is appropriate when a patient has a PaO2 of 125 torr? A. co-oximetry B. blood-gas analysis C. pulse oximetry D. spectrophotometry

B. blood-gas analysis

During inspection of a patient, the CRT notices swelling in both legs to a level just below the knees. What condition is the likely cause of this presentation? A. right ventricular failure B. left ventricular failure C. pulmonary embolism D. asthma

A. right ventricular failure

While performing auscultation on the chest of a patient, the CRT hears bronchial breath sounds where normal vesicular breath sounds were heard. Which of the following conditions could account for this auscultatory finding? I. pleural effusion II. atelectasis III. pneumonia IV. pneumothorax A. III, IV only B. II, IV only C. II, III only D. I, II only

C. II, III only II. atelectasis III. pneumonia

Which of the following clinical signs would the CRT notice in an infant who is experiencing respiratory distress? I. grunting II. retractions III. tachypnea IV. nasal flaring A. I, II only B. I, II, III only C. II, III only D. I, II, III, IV

D. I, II, III, IV

Which of the following signs can be assessed while observing the general appearance of the patient? I. diaphoresis II. accessory ventilatory muscle use III. ventilatory pattern IV. vital signs V. hypoxemia A. I, III only B. II, III, IV only C. I, II, IV, V only D. I, II, III only

D. I, II, III only

During a physical examination of the chest, the CRT hears discontinuous, high-pitched bubbling sounds on inspiration. Which of the following conditions are frequently associated with this type breath sound? I. pneumothorax II. pleural effusion III. pulmonary edema IV. pneumonia A. I, II only B. III, IV only C. II, III, IV only D. I, II, IV only

B. III, IV only

When calculating VA, what should the CRT use to measure the CO2 in the exhaled gas when the patient has severe pulmonary emphysema? A. capnography B. arterial blood gas analysis C. infrared absorber D. gas chromatography

B. arterial blood gas analysis

While palpating the chest wall of a febrile patient who coughs up rusty-colored sputum and complains of sharp, piercing pain when taking a deep breath, the CRT finds an absent vocal fremitus. Which of the following conditions is most likely present? A. pulmonary emphysema B. pneumonia C. atelectasis D. lung tumor

B. pneumonia

Periodic, prolonged, forceful coughing episodes can be best described as: A. acute B. chronic C. paroxysmal D. hacking

C. paroxysmal

While percussing a patient’s chest, the CRT hears a dull note over the lung bases. Which of the following statements best describes this finding? A. Dull percussion over the basilar areas of the lungs is normal during exhalation. B. Dull percussion is indicative of increased air in the lungs. C. Dull percussion occurs over an area of lung consolidation or fluid accumulation. D. Dull percussion indicates the presence of air trapping

C. Dull percussion occurs over an area of lung consolidation or fluid accumulation.

Immediately following endotracheal intubation, the patient is noted to have diminished air entry on auscultation of the left chest. Which of the following conditions is the likely cause of this condition? A. pneumothorax B. endobronchial intubation C. a mucous plug D. lobar atelectasis

B. endobronchial intubation

Which of the following pulmonary conditions usually cause bilateral reduction of thoracic expansion? I. COPD II. neuromuscular disease III. atelectasis IV. right middle-lobe pneumonia A. I, III only B. I, II only C. II, III, IV only D. I, II, IV only

B. I, II only I. COPD II. neuromuscular disease

Which of the following emotional states may be indicative of illness or pain? I. fear II. anxiety III. depression IV. anger A. I only B. II, III only C. I, II, III only D. I, II, III, IV

D. I, II, III, IV

While conducting a physical examination of a patient’s chest, the CRT hears rhonchi during expiration via auscultation. Which of the following pulmonary conditions are often associated with these findings? I. bronchospasm II. pulmonary fibrosis III. partial airway obstruction with thick secretions IV. atelectasis A. I, III only B. I, II only C. I, II, IV only D. II, III, IV only

A. I, III only

Which of the following situations would indicate that a patient is suffering from orthopnea? A. The patient avoids shortness of breath by propping a pillow under his back. B. The patient experiences waking episodes during the night because of dyspnea. C. The patient experiences swelling of the hands and feet upon rising. D. The patient awakens with fluttering or palpitations in the chest.

A. The patient avoids shortness of breath by propping a pillow under his back.

A patient’s chest radiograph demonstrates the following findings: * A blunted costophrenic angle on the right side * A partially obscured right hemidiaphragm Which of the following lung conditions is consistent with these radiologic findings? A. pleural effusion B. atelectasis C. pulmonary infiltrates D. consolidation

A. pleural effusion

While performing a chest physical examination on a 60-kg adult patient, the CRT observes the left hemithorax to move 3 cm and the right hemithorax to move 3 cm. What do these findings indicate? A. neuromuscular disease B. COPD C. right lower-lobe consolidation D. normal chest wall expansion

D. normal chest wall expansion

Which of the following terms describe vibrations produced by air at a high velocity moving through the airway? A. rales B. stridor C. rhonchi D. wheezing

D. wheezing

Which of the following conditions is associated with the presence of intercostal and sternal retractions? I. decreased lung compliance II. severe upper-airway obstruction III. severe restrictive disease IV. decreased pulmonary elastance A. II, III only B. I, IV only C. II, III, IV only D. I, II, III only

D. I, II, III only I. decreased lung compliance II. severe upper-airway obstruction III. severe restrictive disease

The CRT obtains a vital capacity of 220 ml and a tidal volume of 200 ml on a Guillain-Barré patient. These findings represent A. tachypnea. B. a reduction in ventilatory reserve. C. normal lung volumes. D. an associated lung pathology

B. a reduction in ventilatory reserve.

A CRT is using an in-line pressure monitor to measure the cuff pressure of an intubated patient. The cuff pressure indicates 27 mm Hg. Based on this pressure, which of the following actions should be taken by the CRT? A. Immediately increase the cuff pressure to 30 mm Hg. B. Slowly deflate the cuff until a small leak is heard around the cuff at the PIP. C. Reintubate the patient with a larger endotracheal tube. D. Reduce the cuff pressure to 10 to 12 mm Hg.

B. Slowly deflate the cuff until a small leak is heard around the cuff at the PIP.

While conducting a physical examination of a patient’s chest, the CRT hears inspiratory and expiratory wheezing. Which of the following conditions can cause this finding? I. bronchospasm II. mucosal edema III. pneumothorax IV. atelectasis A. II, III, IV only B. I, III only C. II, IV only D. I, II only

D. I, II only I. bronchospasm II. mucosal edema

While reviewing chest radiographic findings in a patient’s chart, the CRT notices that the latest inclusion indicates “. . . complete opacification of the right side of the thorax, accompanied by mediastinal and tracheal deviation to the right . . .” How should the CRT interpret these latest radiographic findings? A. The patient is experiencing consolidation on the right side of the chest. B. The patient has developed a right-sided pneumothorax. C. An empyema has developed in the patient’s right chest. D. The patient has an atelectatic right lung.

D. The patient has an atelectatic right lung.

To assure adequate tracheal blood flow, the cuffs of endotracheal tubes should be maintained at _____ cm H2O or less. A. 60 B. 40 C. 30 D. 15

C. 30

A patient who has a history of chronic bronchitis enters the hospital with an exacerbation of her disease. She is administered oxygen at 2 liters/minute via a nasal cannula. The CRT wishes to monitor the effect of the oxygen therapy on her hypoxic drive. The best method of monitoring the adequacy of her ventilation would be to perform which of the following tasks? A. Obtain an arterial blood gas. B. Employ pulse oximetry. C. Implement PtcO2 monitoring. D. Procure a mixed venous oxygen sample

A. Obtain an arterial blood gas.

What aspect of an ECG tracing is commonly associated with myocardial ischemia? A. ST segment depression B. widened QRS complexes C. lengthened P-R interval D. irregularly spaced QRS complexes

A. ST segment depression

While being interviewed, a patient states, “I have recently awakened during the night breathless. It goes away when I sit up in bed.” Which of the following terms best describes this patient’s experience? A. dyspnea B. platypnea C. orthopnea D. eupnea

C. orthopnea

The CRT notices that a 24-year-old mechanically ventilated patient has a shunt fraction of 0.4. What kind of P(A-a)O2 would the CRT expect to see this patient display while breathing 100% O2? A. a normal P(A-a)O2 B. a widened P(A-a)O2 C. a narrowed P(A-a)O2 D. Insufficient data are available to forecast the P(A-a)O2.

B. a widened P(A-a)O2

Which of the following adventitious sounds is heard with croup, epiglottitis, and post-extubation edema? A. rhonchus B. pleural friction rub C. stridor D. wheeze

C. stridor

When performing a VD/VT study on a COPD patient, why should the CRT not use the PETCO2 to substitute for the patient’s PaCO2? A. because the PETCO2 value fluctuates too much in a COPD patient B. because the PaCO2 is easier to measure in a COPD patient C. because the PETCO2 value inaccurately represents the PaCO2 in a COPD patient D. because a COPD patient has a high V˙CO2

C. because the PETCO2 value inaccurately represents the PaCO2 in a COPD patient

A patient who complains of “breathlessness while dressing, while walking from the house to get the newspaper on the sidewalk, and while walking up the front porch steps” is said to have a(n) A. obstructive lung disease. B. decrease in exercise tolerance. C. cardiovascular disease. D. decrease in activities of daily living

D. decrease in activities of daily living

A 25-year-old patient experiences a change in the VD/VT ratio from 0.3 to 0.5 immediately following the initiation of positive pressure mechanical ventilation. How should the CRT interpret these data? A. The patient has developed increased intrapulmonary shunting. B. The patient has experienced a normalization of the lung’s overall V˙/Q˙ ratio. C. Mechanical ventilation causes an increased dead space ventilation. D. The anatomic dead space has increased

C. Mechanical ventilation causes an increased deadspace ventilation.

The CRT is assessing a 20-year-old man in the emergency room. Upon auscultation, high-pitched sounds are heard during the expiratory phase throughout both lung fields. These abnormal sounds are described as follows: A. rhonchi B. rales C. wheezes D. crackles

C. wheezes

When performing respiratory impedance plethysmography, two coils of insulated wire are sewn into elastic cloth bands in a sinusoidal manner. Over what area(s) of the body are the sinusoidal bands placed? A. chest wall and abdomen B. abdomen C. chest wall D. airway opening

A. chest wall and abdomen

Having a subject inspire to total lung capacity, followed by a rapid, forceful, complete exhalation, provides for the measurement of the: A. FVC B. expiratory reserve volume C. inspiratory capacity D. residual volume

A. FVC

Which of the following terms is most likely to be identified by a patient without a medical background as being secretions from the tracheobronchial tree? A. lower respiratory tract secretions B. sputum C. phlegm D. spit

C. phlegm

A patient’s arterial blood gas and acid-base results are shown below. PO2 70mm Hg PCO2 54mm Hg pH 7.33; HCO3¯ 28 mEq/liter B.E. - 4 mEq/liter Which of the following interpretations correlates with these results? A. compensated respiratory alkalosis B. uncompensated metabolic acidosis C. partially compensated metabolic acidosis D. partially compensated respiratory acidosis

D. partially compensated respiratory acidosis

Using a Wright’s respirometer on a patient who is being considered for weaning from mechanical ventilation, the CRT has measured the exhaled volume during 2.75 minutes of spontaneous breathing. During this time, 32.7 liters are measured. What is this patient’s spontaneous minute ventilation? A. 4.8 liters/minute B. 6.9 liters/minute C. 11.9 liters/minute D. 32.7 liters/minute

C. 11.9 liters/minute volume expired x 60 seconds/minute / collection time in seconds x BTPS factor

When documenting breath sounds that were low-pitched, continuous, and cleared with a cough after a treatment, which of the following descriptions should be used by the CRT? A. vesicular breath sounds B. wheezes C. rhonchi D. rales

C. rhonchi

Which of the following activities requires the highest level of patient consciousness? A. physical movement to painful stimulus B. ability to follow commands C. orientation to place D. performance of simple math calculations

D. performance of simple math calculations

A spontaneously breathing adult patient is found to have an I:E of 1:4. How should the CRT interpret this finding? A. The patient likely has chronic obstructive airway disease. B. The patient likely has restrictive airway disease. C. The patient likely has mixed airway disease. D. The patient’s I:E ratio is normal

A. The patient likely has chronic obstructive airway disease.

The CRT has obtained a mixed venous blood sample from a patient who has had a pulmonary artery catheter inserted. The sample was analyzed, and the PvO2 was found to be 30 torr. Which interpretation(s) can be made based on this PvO2 value? I. The patient has a low cardiac output. II. The patient has polycythemia. III. The patient is experiencing left-to-right shunting. IV. The sample contained some arterial blood. A. I only B. II, III only C. I, III only D. I, II, III, IV

I. The patient has a low cardiac output.

Inspiratory stridor might be auscultated in patients who have which of the following diagnoses? I. epiglottitis II. croup III. pulmonary embolism IV. post-extubation inflammation A. II, III, IV only B. I, II, III only C. I, III, IV only D. I, II, IV only

D. I, II, IV only

How should the CRT interpret the following arterial blood gas and acid-base data obtained from a 56-year-old patient who is breathing room air? PO2 68mm Hg PCO2 52mm Hg pH 7.39 HCO3 ¯ 31 mEq/liter B.E. +7 mEq/L A. compensated respiratory acidosis with mild hypoxemia B. uncompensated metabolic acidosis with no hypoxemia C. compensated metabolic alkalosis with mild hypoxemia D. partially compensated respiratory acidosis with no hypoxemia

A. compensated respiratory acidosis with mild hypoxemia

While reviewing a patient’s chart, the CRT notices that the most recent room air blood-gas analysis revealed the following data: PO2 43 torr PCO2 36 torr pH 7.33 SO2 70% HCO3 ¯ 19 mEq/L B.E. -5 mEq/L At the same time the blood sample was obtained, the patient’s SpO2 was 95%. The patient’s ventilatory status was found to include the following: * ventilatory pattern: regular * tidal volume: 600 ml * ventilatory rate: 16 breaths/minute How should the CRT interpret these data? A. An air bubble contaminated the blood sample. B. The patient should be administered oxygen via a cannula at 2 liters/minute. C. The blood gas data reflect venous values. D. The pulse oximeter was out of calibration.

C. The blood gas data reflect venous values.

Which of the following teaching techniques are appropriate to use when teaching children therapeutic procedures? I. Be repetitious. II. Use terms that are understandable. III. Teach the parents first. IV. Have the patients actively participate. A. III, IV only B. I, II, IV only C. I, II, III only D. I, II, III, IV

B. I, II, IV only I. Be repetitious. II. Use terms that are understandable. IV. Have the patients actively participate.

While performing percussion during physical assessment of the chest, the CRT hears resonant sounds. Which of the following conditions is (are) associated with this finding? I. pneumothorax II. consolidation III. normal lungs IV. air trapping A. III only B. IV only C. I, IV only D. II, III only

A. III only

When performing percussion on a patient, how can interference imposed by the two scapulae be minimized? A. Have the patient take a deep breath and hold that breath for 10 seconds B. Have the patient exhale slowly to residual volume and hold that breath for five seconds. C. Have the patient raise both arms above the shoulders. D. Have the patient lean forward and hunch his back.

C. Have the patient raise both arms above the shoulders.

When teaching a patient a psychomotor skill, what teaching activity provides the patient with the greatest opportunity to perform the task? A. using visual aids B. having the patient practice the skill C. telling the patient how to perform the skill D. enabling the patient to ask questions about the task

B. having the patient practice the skill

While performing percussion of the thorax during physical chest assessment, the CRT hears hyperresonant percussion notes over the left lower lobe. What is the significance of this finding? A. pneumothorax B. pleural effusion C. normal breathing D. atelectasis

A. pneumothorax

The CRT is ready to perform percussion on a patient who is being evaluated for lung disease. In what order should the CRT proceed with percussion? A. Percussion should be performed from the apex to the base on one side of the chest, then from the apex to the base on the other side. B. Percussion should begin at the base and end in the apex on one side of the thorax, from the base to apex on the opposite side. C. Percussion should be performed on one side of the chest, then on the other side in the comparable area. D. Percussion should begin on the anterior aspect of one hemithorax, then on the posterior aspect of the same hemithorax, followed by percussion of the opposite lung.

C. Percussion should be performed on one side of the chest, then on the other side in the comparable area.

What are the domains within which learning occurs? I. psychomotor domain II. attitudinal domain III. affective domain IV. cognitive domain A. II, IV only B. I, II, III only C. I, III, IV only D. I, II, III, IV

C. I, III, IV only I. psychomotor domain III. affective domain IV. cognitive domain

A recent post-operative thoracotomy patient is experiencing incisional pain as the CRT is discussing the goals of incentive spirometry with the patient. What patient need must first be addressed before learning can take place? A. The patient must understand the disease process that warranted the surgery. B. The patient must know the difference between a flow- and a volume-incentive spirometer. C. The patient must have pain medication. D. The patient must know how incentive spirometry will improve his condition.

C. The patient must have pain medication.

A three-year-old child enters the emergency department with a partial upper-airway obstruction, producing inspiratory stridor. Which of the following diagnostic procedures will assist in differentiating croup from epiglottitis? A. chest radiography B. lateral neck radiograph C. responsiveness to a bronchodilator D. lung scan

B. lateral neck radiograph

A patient who has been recently diagnosed with asthma will be leaving the hospital in a couple days. Which of the following components need to comprise a lesson plan for teaching this patient to properly use an MDI, which dispenses a beta-2 agonist? I. when the MDI should be used II. how to add a spacer to the system III. why the MDI is used IV. how the medication acts on the bronchial smooth muscle A. I, IV only B. II, III only C. I, II, III only D. I, II, III, IV

D. I, II, III, IV

The following data have been obtained from a 70-yearold male who has been receiving incentive spirometry following upper abdominal surgery: ventilatory rate: 23 breaths/minute temperature: 100ºF heart rate: 105 beats/minute arterial PO2: 65 torr auscultation: crackles present in the bases inspiratory capacity: 25% of predicted chest X-ray interpretation: right lower lobe atelectasis with consolidation Which of the following therapeutic modalities is appropriate at this time? A. maintaining incentive spirometry B. instituting mechanical ventilation C. administering IPPB therapy D. administering bland aerosol therapy

C. administering IPPB therapy IPPB therapy is indicated when consolidation is present and when the patient has an inspiratory capacity (IC) of less than one-third of predicted.

A 30-year-old male enters the emergency department with a broken leg. The CRT notices that the patient is in severe pain and appears upset. The patient has a respiratory rate of 24 breaths/min. and a heart rate of 112 bpm. His room air arterial blood gas data are shown as follows. PaO2 107 torr PaCO2 26 torr HCO3 ¯ 23 mEq/L pH 7.56 SaO2 99% B.E. -1 mEq/L Interpret these arterial blood gas data. A. compensated respiratory alkalosis without hypoxemia B. uncompensated respiratory alkalosis without hypoxemia C. compensated respiratory acidosis without hypoxemia D. uncompensated metabolic alkalosis without hypoxemia

B. uncompensated respiratory alkalosis without hypoxemia

An adult patient is being prepared for bronchoscopy. What method of analysis is most suitable to monitor this patient’s oxygenation status? A. pulse oximetry B. arterial blood gas analysis C. co-oximetry D. transcutaneous O2 monitoring

A. pulse oximetry

A one-month-old infant is being monitored via a pulse oximeter. The SpO2 reads 95%. The infant has a high concentration of fetal hemoglobin. What will the infant’s actual SaO2 be compared to the SpO2? A. The SaO2 will be significantly lower. B. The SaO2 will be substantially higher. C. The SaO2 will correlate well with the SpO2. D. Because the SpO2 readings are spurious, the SaO2 is unpredictable.

C. The SaO2 will correlate well with the SpO2. Because fetal hemoglobin has absorption characteristics almost the same as adult hemoglobin, SpO2 values correlate well with SaO2 measurements. Pulse oximeters read falsely high in the presence of carboxyhemoglobin (HbCO) and methemoglobin (metHb). Hyperbilirubinemia has no effect on the accuracy of a pulse oximeter.

A pulmonary emphysema patient is performing a single-breath N2 elimination test to determine the distribution of ventilation. To what lung volume or capacity does the patient exhale before inspiring 100% O2 to total lung capacity? A. functional residual capacity B. end-tidal inspiration C. residual volume D. vital capacity

C. residual volume When performing a single-breath nitrogen elimination (SBN2) test, the patient must be instructed to exhale to residual volume before inspiring 100% O2 to total lung capacity

The following data pertain to an 80-kg (IBW) patient who has undergone upper abdominal surgery. The patient is receiving CPAP via an endotracheal tube. MIP: –25 cm H2O after 20 seconds VC: 1,600 cc VT: 625 cc CPAP: 10 cm H2O FIO2: 0.35 SpO2: 97.5% What action would be most appropriate for the CRT to take at this time? A. Discontinue the CPAP and administer an FIO2 of 0.3 via an air entrainment mask. B. Extubate the patient and administer O2 via a nasal cannula at 3 L/min. C. Decrease the CPAP to 8 cm H2O and maintain the FIO2 at 0.35. D. Make no changes and closely monitor the patient

C. Decrease the CPAP to 8 cm H2O and maintain the FIO2 at 0.35.

Before performing an arterial puncture procedure, the CRT often performs a modified Allen’s test. What is the correct interpretation of a modified Allen’s test? A. A positive test indicates that radial arterial blood flow is sufficient to perfuse the hand. B. A positive test indicates that pink color returns to the hand in fewer than 10 seconds. C. A negative test indicates adequate ulnar arterial blood flow to perfuse the hand. D. A positive test requires simultaneously compressing both radial and ulnar arteries and then releasing the ulnar first.

B. A positive test indicates that pink color returns to the hand in fewer than 10 seconds.

The CRT is working on a day-old, full-term neonate. The infant has a bilirubin concentration of 15 mg/dl and is being monitored via a pulse oximeter for oxygen administration through an oxyhood. The SpO2 reads 92%. How should the CRT interpret the SpO2? A. The SpO2 should be considered accurate. B. The SpO2 will be falsely high. C. The SpO2 will be falsely low. D. The correlation will be unpredictable, because SpO2 data will vary

A. The SpO2 should be considered accurate co-oximetry measurements do not correlate well with measured SaO2 values when bilirubin concentrations are greater than 20 mg/dl

Despite numerous increases in PEEP and FIO2 levels, the CRT is experiencing difficulty improving a mechanically ventilated patient’s oxygenation status. Which of the following maneuvers might be used to achieve this therapeutic objective? A. Institute an inspiratory hold. B. Apply expiratory resistance. C. Activate the sigh mode. D. Increase the PIP.

A. Institute an inspiratory hold.

The CRT is preparing to perform an arterial puncture procedure on a patient. The CRT notices a surgical shunt used for dialysis appearing on the patient’s left arm. What action should the CRT take at this time? A. Consider obtaining the arterial sample from the right arm. B. Obtain the arterial sample from the surgical shunt. C. Perform the arterial puncture on the left radial artery. D. Use a pulse oximeter to measure the SpO2 instead.

A. Consider obtaining the arterial sample from the right arm.

For a valid measurement of the peak expiratory flow rate, approximately what lung volume should be in the patient’s lungs immediately before making the measurement? A. total lung capacity B. vital capacity C. functional residual capacity D. inspiratory capacity

A. total lung capacity The peak expiratory flow rate should be measured after the patient has inspired maximally, i.e., total lung capacity

What would be the consequence if the percent predicted FEV1 were calculated by using an FEV1 measured at ATPS conditions and a predicted normal FEV1 at BTPS conditions? A. The % predicted normal value would be falsely low by 6 % to 9 %. B. The % predicted normal value would be falsely high by 6 % to 9 %. C. The % predicted normal value would be falsely high by 12 % to 15 %. D. The environmental conditions bear no consequence on the results.

A. The % predicted normal value would be falsely low by 6 % to 9 %. The primary difference between ATPS and BTPS conditions is the difference between ambient temperature (22ºC to 26ºC) and body temperature (37ºC). According to Charles’ law, gas volumes are directly related to temperature when the pressure and mass of the gas are constant. Failure to convert an FVC from ATPS to BTPS conditions would result in spirometric data that are decreased 6% to 9%

A 40-year-old patient who has a PaO2 of 58 torr on room air may be classified as having: A. normal oxygenation B. mild hypoxemia C. moderate hypoxemia D. severe hypoxemia

C. moderate hypoxemia 80–100 normal oxygenation 60–79 mild hypoxemia 40–59 moderate hypoxemia <40 severe hypoxemia

A carbon monoxide poisoning victim is brought into the emergency room wearing a nasal cannula operating at 3 liters/minute. What should the CRT do at this time? A. Perform a STAT arterial puncture procedure. B. Remove the cannula and replace it with a partial rebreathing mask set at 10 liters/minute. C. Immediately attach a pulse oximeter probe to the patient’s finger. D. Administer IPPB with 100 % oxygen.

B. Remove the cannula and replace it with a partial rebreathing mask set at 10 liters/minute.

What is the best indicator to determine the therapeutic effectiveness of a bronchodilator administered via an MDI? A. an increased maximum expiratory pressure B. an increased forced vital capacity C. an increased FEV25%–75% D. an increased FEV1

D. an increased FEV1

An infant who is receiving mechanical ventilation deteriorates abruptly. Assessment reveals positive transillumination of the left chest. What is the most likely diagnosis? A. left-sided pneumothorax B. left-sided hemothorax C. mucous plug in right mainstem bronchus D. left-sided diaphragmatic hernia

A. left-sided pneumothorax

What is the purpose for using 10 % helium in the single breath diffusing capacity test? A. measuring the total lung capacity B. enabling the diffusing capacity to be measured C. preventing alveolar collapse from the nitrogen being washed out D. enabling ventilation through partially obstructed airways to occur

A. measuring the total lung capacity - The purpose of the 0.3% CO is to measure the diffusing capacity, and the purpose of the 10% He is to help measure DLCO and the lung volume at which breath holding occurs.

A two-day-old, 24-week-gestation infant has increasing oxygen requirements accompanied by the accumulation of air in the pulmonary interstitium. What modification of respiratory management is most appropriate? A. Increase the PIP and decrease the ventilatory rate. B. Decrease the PEEP. C. Increase the inspiratory time. D. Decrease the PIP and increase the ventilatory rate

D. Decrease the PIP and increase the ventilatory rate - Reduction of PIP mean airway pressure (Paw) and increasing the respiratory rate has been shown to reduce barotrauma.

A 24-year-old motorcycle accident victim is receiving mechanical ventilation and suffers from multiple trauma. The CRT performs a P(A-a) O2 gradient using an FIO2 1.00. The patient’s PaO2 was 60 torr, and the P(A-a) O2 gradient was 375 torr. What should the CRT suggest at this time? A. Maintain the patient’s FIO2 at 1.0. B. Add PEEP to the mechanical ventilator. C. Determine the patient’s VD/VT ratio. D. Perform a shunt study on the patient.

D. Perform a shunt study on the patient. - When the P(A-a) O2 gradient widens, it is sometimes clinically useful to quantify the amount of shunt.

A patient receiving mechanical ventilation has an intracranial pressure of 20 torr. What change in the therapeutic plan is indicated? A. increasing the FIO2 B. increasing the I:E ratio C. increasing the ventilatory rate D. instituting positive end-expiratory pressure

C. increasing the ventilatory rate - The hyperventilation causes the arterial PCO2 to decrease, which in turn reduces cerebral perfusion via cerebral vasoconstriction. In situations such as these, the arterial PCO2 is generally maintained between 25 and 35 torr.

The CRT is paged to the emergency department. The physician there asks the CRT to recommend suitable instrumentation to measure the SaO2 of a smoke inhalation victim. What device should the CRT recommend? A. arterial blood gas analysis B. pulse oximetry C. co-oximeter D. transcutaneous oxygen monitor

C. co-oximeter

How should a subject be instructed to breathe during a maximum voluntary ventilation maneuver? A. Breathe from residual volume to total lung capacity for 12 seconds. B. Breathe from functional residual capacity to total lung capacity for 12 seconds. C. Breathe beyond the tidal volume and less than a vital capacity at a rate of 70 bpm. D. Breathe within the tidal volume range at a rate of 70 bpm.

C. Breathe beyond the tidal volume and less than a vital capacity at a rate of 70 bpm.

Which of the following pulmonary function data are consistent with a restrictive lung disease pattern? I. an FVC 70 % of predicted II. a TLC 68 % of predicted III. an FEV1/FVC ratio of 50 % A. I, II only B. II only C. I, IV only D. I, II, III

A. I, II only I. an FVC 70 % of predicted II. a TLC 68 % of predicted

A patient performs an FVC maneuver and a slow vital capacity (SVC) maneuver. The FVC is 700 cc less than the SVC. What condition accounts for this disparity? A. The FVC and SVC can normally be as much as 1.0 liter apart. B. A restrictive lung disease is present. C. An obstructive lung disease is present. D. The patient has a combination of restrictive and obstructive diseases.

C. An obstructive lung disease is present. - In normal subjects, the FVC equals the SVC. The FVC and SVC can actually differ by 200 cc. When the SVC exceeds the FVC by more than 200 cc, one of two situations can account for this disparity: (1) the patient’s effort was submaximal, or (2) airway obstruction is present

A teenage drug-overdose victim is admitted to the emergency department. Arterial blood gas data reveal: PO2: 59 torr PCO2: 82 torr pH: 7.13 HCO3 ¯: 27 mEq/liter B.E.: 3mEq/L SO2: 70% Which acid-base interpretation(s) and/or therapeutic intervention(s) would be appropriate? I. This patient has an uncompensated respiratory acidosis. II. Chronic ventilatory failure is present. III. The patient should likely be intubated and mechanically ventilated. IV. Nasal CPAP with an FIO2 of 0.50 would be indicated. A. I, II, III only B. I, III only C. IV only D. I, II, IV only

B. I, III only I. This patient has an uncompensated respiratory acidosis. III. The patient should likely be intubated and mechanically ventilated - This condition can be deceiving. The absorption of more drugs might worsen the situation quickly. Therefore, endotracheal intubation and mechanical ventilation are indicated. Arterial blood gas data reveal that this patient is experiencing an uncompensated respiratory acidosis, that is, acute ventilatory failure. The blood gas and acid-base condition resulted from CNSdepression caused by the drug abuse.

A 21-year-old automobile accident victim is receiving continuous mechanical ventilation with a PEEP of 8 cm H2O. The physician orders that the PEEP be raised to 12 cm H2O. Which of the following physiologic responses indicate that the PEEP is having a deleterious effect? I. Pulmonary compliance decreases. II. The peak inspiratory pressure increases. III. The plateau pressure increases. IV. The arterial-venous oxygen content difference increases. A. III, IV only B. I, IV only C. I, II only D. I, III, IV only

B. I, IV only The following physiologic responses are among the indices of an adverse reaction to the application of PEEP: * decreased cardiac output * decreased blood pressure * increased heart rate * increased arterial-venous oxygen content difference [C(a-v¯) O2] * decreased pulmonary compliance * decreased arterial PO2

While palpating the patient’s chest, the CRT notes a decreased chest expansion on one side. Noting the asymmetrical chest expansion, the CRT reviews the latest chest film. What disease might be present on the radiograph? I. lobar pneumonia II. lobar atelectasis III. large pleural effusion IV. pneumothorax A. I, II, III, IV B. II, III, IV only C. I, II, III only D. I, IV only

A. I, II, III, IV

A 30-year-old female was recently diagnosed with bronchiectasis. The physician has requested respiratory care services to evaluate the patient for therapy. The data obtained include the following breath sounds: * decreased in right lower lobe * rhonchi in right middle lobe pulse oximetry: * SpO2 85% in right lateral decubitus position * SpO2 94% in semi-Fowler’s position chest radiography: * right middle lobe infiltrates * right lower lobe infiltrates ventilatory mechanics: * vital capacity greater than 15 ml/kg Based on these findings, what therapeutic intervention should be recommended? A. IPPB B. incentive spirometry C. bronchodilator therapy via an MDI D. postural drainage

D. postural drainage - Postural drainage therapy is indicated when a diagnosis of bronchiectasis has been made. Patients who have bronchiectasis have airways that are abnormally dilated, which causes pooling of secretions; consequently, these patients expectorate large amounts of sputum. Postural drainage therapy mobilizes bronchia secretions, resulting in improved ventilation to the areas previously completely or partially blocked with mucus.

A patient who has a history of working in shipbuilding should be evaluated for the presence of which occupational lung disease? A. asbestosis B. silicosis C. byssinosis D. bagassosis

A. asbestosis

A patient who has bilateral pneumonia exhibits the following room air arterial blood gas data: PO2 60 torr PCO2 25 torr pH 7.53 HCO3 ¯20mEq/L BE –4mEq/L The patient is also diaphoretic, anxious, and dyspneic. Her blood pressure is 145/90 torr, heart rate 105 beats/minute, and ventilatory rate 30 breaths/minute. Which of the following therapeutic modalities would be appropriate for this patient? A. aerosol therapy B. chest physiotherapy C. oxygen therapy D. pre- and post-bronchodilator spirometry

C. oxygen therapy