Exam 1 Flashcards by Natalie Pearce

A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as

A.orthopnea.

B.platypnea.

C.eupnea.

D.Kussmaul breathing.

A.orthopnea.

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What size endotracheal tube would be appropriate for an adult female patient?

A.6.0 to 6.5 mm

B.6.5 to 7.0 mm

C.7.0 to 7.5 mm

D.7.5 to 8.0 mm

C.7.0 to 7.5 mm

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While providing patient education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT

A.liquid oxygen burns when refilling portable tanks.

B.how to properly secure oxygen cylinders for transport.

C.use of grounded 3-prong outlets for electrical equipment.

D.emergency procedure to deal with gas explosions.

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A home care patient calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to

A.tape the connection securely.

B.increase the flow to the catheter.

C.decrease the flow to the catheter.

D.switch to a nasal cannula.

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A trauma patient in the ED is spontaneously breathing oxygen via nasal cannula at 2 L/min. Vital signs are heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mmHg. The pulse oximeter is reading 88%. Which of the following should the respiratory therapist recommend to maximize the patient’s FIO2?

A.Simple oxygen mask at 8 L/min

B.Non-rebreathing mask at 15 L/min

C.CPAP at 10 cmH2O and 0.60 FIO2

D.NPPV of 18/5 cmH2O and 0.60 FIO2

B.Non-rebreathing mask at 15 L/min

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A 33 year-old patient with trauma has been ventilated at the current settings for 24 hours. While reviewing ventilator data from the patient, the respiratory therapist notes the following:

This information would indicate that

A.airway resistance is decreasing.

B.lung compliance is increasing.

C.the patient needs suctioning.

D.the patient can begin weaning.

C.the patient needs suctioning.

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Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea?

A.QS/QT of 10%

B.VD/VT of 60%

C.CL of 60 mL/cm H2O

D.RAW of 2.4 cm H2O/L/sec

B.VD/VT of 60%

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A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient’s SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST?

A.Initiate NIPPV

B.Titrate oxygen flow to the nasal cannula

C.Change to a simple mask

D.Change to a non-rebreather mask

B.Titrate oxygen flow to the nasal cannula

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After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow-volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an

A.normal tracing.

B.obstructive pattern.

C.restrictive pattern.

D.large airway obstruction.

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Upon review of the chest radiograph after an elective intubation, the respiratory therapist notes that the distal tip of the endotracheal tube is 3 cm above the carina. How should the therapist interpret this finding?

A.The tube is above the recommended position.

B.The tube is too long for this patient.

C.The tube is in the proper position.

D.The tube is below the proper position.

C.The tube is in the proper position.

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A patient with a history of asthma presents to the ED in severe respiratory distress and increased accessory muscle use. Vital signs are heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating

A.Xopenex® by MDI

B.Pulmacort® by small volume nebulizer

C.Salmeterol® by DPI

D.Ventolin ® by continuous nebulization

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The respiratory therapist is working with a patient with COPD in a smoking cessation program. The patient complains of recent weight gain. The therapist should explain that this is not unusual and is a result of

A.an increasing feeling of loss of self-control.

B.over-reliance on nicotine replacement therapy.

C.a need for a prescription for lorazepam.

D.a decrease in the patient’s metabolism.

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The primary source of infection in the health care setting is

A.use of medical equipment for multiple patients.

B.poor handwashing techniques of personnel.

C.food and/or water intake by the patient.

D.patient rooms not cleaned appropriately.

B.poor handwashing techniques of personnel.

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The physician has asked the respiratory therapist to monitor the effectiveness of bronchodilator therapy in a patient with asthma. What is the most appropriate parameter to monitor?

A.Improvement in level of dyspnea

B.Blood gas analysis results

C.Serial peak flow measurement

D.Improvement in chest x-ray

C.Serial peak flow measurement

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Which of the following short-acting beta agonists can be delivered via aerosol therapy?

A.levalbuterol (Xopenex®)

B.tiotropium (Spiriva®)

C.dornase alpha (Pulmozyme®)

D.salmeterol (Serevent®)

A.levalbuterol (Xopenex®)

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A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy procedure in which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT

A.hypoxemia.

B.pneumothorax.

C.pulmonary hemorrhage.

D.bronchospasm/laryngospasm.

A. hypoxemia.

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Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right?

A. Perform chest physiotherapy

B. Administer an IPPB treatment

C. Insert an endotracheal tube

D. Insert a chest tube

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All of the following are goals of bronchial hygiene therapy EXCEPT

A.reverse the underlying disease process.

B.improve mobilization of retained secretions.

C.improve pulmonary gas exchange.

D.reduce the work of breathing.

A.reverse the underlying disease process.

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Pre- and post-bronchodilator spirometry is performed on a patient and yields the following results:

The respiratory therapist should recommend the initiation of

A.continuous mechanical ventilation

B.intermittent positive pressure breathing

C.bronchodilator therapy

D.incentive spirometry

C.bronchodilator therapy

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At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned?

A.4 & 8

B.5 & 9

C.5 & 10

D.6 & 10

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While reviewing quality control data for the blood gas lab, the respiratory therapist notes the following data plot for the pH electrode:

Which of the following should the therapist recommend?

A.Repeat the previous control analysis

B.Remove the analyzer from service

C.Reset the analyzation module on the analyzer

D.Recalibrate the pH electrode

A.Repeat the previous control analysis

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Which of the following factors are determinants of cardiac output?

A.ventricular filling and heart rate

B.stroke volume and heart rate

C.stroke volume and respiratory rate

D.heart rate and tidal volume

B.stroke volume and heart rate

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A 52 year-old post-operative cholecystectomy patient’s breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend

A. continuing the therapy until breath sounds improve.

B. administering dornase alpha.

C. administering albuterol therapy.

D. deep breathing and coughing to clear secretions.

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A 19-year-old patient is brought to the emergency department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient?

A.Obtain a sputum specimen.

B.Obtain an ABG.

C.Measure peak expiratory flow.

D.Determine the Glasgow Coma Score.

B.Obtain an ABG.

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A patient in the ICU is being ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient’s SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should A.decrease the respiratory rate. B.decrease the PEEP. C.increase the expiratory time. D.decrease the inspiratory pressure.

D.decrease the inspiratory pressure.

Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B.A patient on SIMV with a set rate of 12/min and total rate of 24/min. C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support.

B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.

A pulse oximeter provides an accurate indication of a patient’s oxygenation status in which of the following situations? 1. Polycythemia 2. Pulmonary hypertension 3. Congestive heart failure 4. Carbon monoxide poisoning A.1 & 4 only B.2 & 3 only C.1, 2, & 3 only D.1, 2, 3, & 4

1. Polycythemia 2. Pulmonary hypertension 3. Congestive heart failure 4. Carbon monoxide poisoning C.1, 2, & 3 only

A 52 year-old post-operative patient’s chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? A.Head down, patient supine with a pillow under knees B.Patient prone with a pillow under head, bed flat C.Patient supine with a pillow under knees, bed flat D.Head down, patient prone with a pillow under hips

D.Head down, patient prone with a pillow under hips

Noninvasive Positive Pressure Ventilation (NPPV) is contraindicated in the management of which of the following conditions? A.Acute exacerbation of COPD B.Cardiogenic pulmonary edema C.Adult respiratory distress syndrome (ARDS) D.Premature extubation

C.Adult respiratory distress syndrome (ARDS)

A 36 year-old fireman was trapped and subsequently rescued from the collapse of a burning building. Which of the following devices would be appropriate to accurately assess his oxygenation status? A.capnograph B.pulse oximeter C.blood gas analyzer D.hemoximeter

D.hemoximeter

A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend? A.Helium dilution study B.DLCO C.Plethysmography D.Bronchial provocation

D.Bronchial provocation

A 59 year-old post CABG patient has a C(a-v)O2 that has increased from 5 mL/dL to 8 mL/dL. The respiratory therapist should report to the physician that the patient’s A.hemoglobin is increasing. B.cardiac output is decreasing. C.VD/VT ratio has increased. D.oxygen consumption has decreased.

B.cardiac output is decreasing.

A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of Keflex® as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? A.thoracentesis B.polysomnography C.flexible bronchoscopy D.plethysmography

C.flexible bronchoscopy

Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? A.20 torr B.30 torr C.40 torr D.50 torr

D.50 torr

What is the most appropriate position for a female patient who is 5’3” tall, weighs 200 kg and is complaining of difficulty breathing? A.Sims B.Trendelenburg C.lateral Fowlers D.Fowlers

C.lateral Fowlers

The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to A.notify the charge nurse. B.apply a pressure dressing. C.apply pressure to the site. D.perform a modified Allen’s test.

C.apply pressure to the site.

Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? A.8 Fr B.10 Fr C.12 Fr D.14 Fr

C.12 Fr

The physician asks the respiratory therapist to set a mechanically ventilated patient’s PEEP at an optimal level. The PEEP level is optimal when A.PEEP levels are less than 18 cm H2O. B.PaO2 is 60 torr or greater. C.Oxygen delivery to the tissues is maximal. D.C(a-v)O2 is decreasing.

C.Oxygen delivery to the tissues is maximal.

A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend? A.Leave the patient on the cannula and continue to monitor. B.Change to a 24% Venti-mask and repeat ABG. C.Change to a simple oxygen mask and repeat ABG. D.Prepare the patient for endotracheal intubation.

B.Change to a 24% Venti-mask and repeat ABG.

A sputum sample from an intubated patient with pneumonia has an offensive odor and is described as green and mucopurulent. The respiratory therapist should suspect that this condition is caused by A.a gram positive bacteria. B.respiratory syncytial virus. C.Pseudomonas aeruginosa. D.Pneumocystis jiroveci.

C.Pseudomonas aeruginosa.

Bronchial breath sounds heard over the lung periphery indicate A.narrowed airways. B.obstructed bronchi. C.lung consolidation. D.pulmonary edema.

C.lung consolidation.

A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? A.Insert a laryngeal mask airway (LMA) to facilitate suctioning. B.Discontinue nasotracheal suctioning for 24 hours and reassess the patient. C.Insert a nasopharyngeal airway after bleeding has been controlled. D.Insert an oral endotracheal tube to allow for better airway access

C.Insert a nasopharyngeal airway after bleeding has been controlled.

A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? A.Enough to achieve a pressure of 25-35 cmH2O. B.Enough to achieve a minimal occluding volume. C.A minimum of 20 mL. D.Until firm tension is felt in the pilot balloon.

A.Enough to achieve a pressure of 25-35 cmH2O.

A well-penetrated chest X-ray has which of the following qualities? A.Air bronchograms are prominently displayed. B.Heart borders and pleural spaces are clearly visible. C.Lung parenchyma is black without blood vessels. D.Vertebrae are just visible behind the heart.

D.Vertebrae are just visible behind the heart.

The respiratory therapist has just assisted the pulmonologist with a bedside fiberoptic bronchoscopy procedure in the ICU. In order to clean and disinfect the bronchoscope, the therapist should A.rinse with sterile water and steam autoclave for 15 minutes. B.wipe with Betadine and pasteurize for 30 minutes. C.sterilize with ethylene oxide. D.soak in alkaline glutaraldehyde for 10 hours.

D.soak in alkaline glutaraldehyde for 10 hours.

A patient’s breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? A.Diabetes insipidu B.Renal failure C.Metabolic acidosis D.Elevated intracranial pressure

D.Elevated intracranial pressure

The respiratory therapist obtains a SpO2 reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PO2 value of approximately A.55 torr B.60 torr C.65 torr D.70 torr

B.60 torr

A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of A.cardiac tamponade. B.severe pneumonia. C.congestive heart failure. D.large pleural effusion.

A.cardiac tamponade.

A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from A.pulmonary embolism. B.gastroesophageal reflux. C.myocardial infarction. D.valvular stenosis

C.myocardial infarction.

Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? A.flail chest on right thorax B.right tension pneumothorax C.endobronchial intubation D.subcutaneous emphysema

C.endobronchial intubation

A 44 year-old patient who suffered a cerebral vascular accident has been moved from Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min, respiratory rate is 42/min and his breath sounds are very diminished. The respiratory therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist should A.increase the suction pressure to 120 mm Hg. B.change to a 10 Fr suction catheter. C.replace the tracheostomy tube. D.orally intubate the patient.

C.replace the tracheostomy tube.

A 55 year-old male patient is being evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should A.reduce the speed of the bike B.administer supplemental oxygen. C.gradually reduce the workload and monitor closely. D.terminate the procedure immediately.

D.terminate the procedure immediately.

While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should A.replace the cracked humidifier. B.increase the FIO2 on the air-entrainment mask. C.increase the flow from the flowmeter. D.eliminate the bubble humidifier.

D.eliminate the bubble humidifier.

The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? A.0.25 mL B.0.50 mL C.1.25 mL D.2.5 mL

B.0.50 mL

A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist should recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: A.coordinating coughing with pain medication. B.performing serial coughs. C.applying pressure to patient’s abdomen during exhalation. D.“splinting” the incision area.

C.applying pressure to patient’s abdomen during exhalation.

Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min? A.intrapulmonary percussive ventilation B.autogenic drainage C.high-frequency chest wall compression device D.positive expiratory pressure breathing

A.intrapulmonary percussive ventilation

As the respiratory therapist assesses a patient who is in a semi-fowler position, he/she finds that the patient’s jugular vein extends approximately 7 cm above his sternal angle. The therapist should recommend initiation of which therapy? A.positive inotrope B.antibiotic C.long-acting Beta-agonist D.hyperinflation

A.positive inotrope

The respiratory therapist is assisting in the elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST? A.Check the inlet valve. B.Check the patient valve. C.Replace the manual resuscitation bag. D.Check for excessive oxygen flow.

C.Replace the manual resuscitation bag.

The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor 1. electrocardiogram. 2. electroencephalogram. 3. nasal air flow. 4. chest wall impedance. A.1 and 2 only B.3 and 4 only C.2, 3, and 4 only D.1, 2, and 3 only

1. electrocardiogram. 2. electroencephalogram. 3. nasal air flow. 4. chest wall impedance. B.3 and 4 only

A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity A. 1, 2, and 3 only B. 1, 2, and 4 only C. 1, 3, and 4 only D. 2, 3, and 4 only

1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity A. 1, 2, and 3 only

Which of the following physiologic values would be present in a patient who has proper fluid balance? A.PCWP of 22 mm Hg B.CVP between 3 and 6 mm Hg C.urine output of 20 mL/hr D.increase in body weight

B.CVP between 3 and 6 mm Hg

While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes? A.Upper airway obstruction B.Poor peripheral perfusion C.Air leak around the sensor D.Device is out of range

C.Air leak around the sensor

A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend 1. IV fluid challenge 2. positive inotropic agent 3. inhaled nitric oxide 4. diuretic therapy A.1 and 3 B.2 and 4 C.3 and 4 D.1 and 2

1. IV fluid challenge 2. positive inotropic agent 3. inhaled nitric oxide 4. diuretic therapy B.2 and 4

While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the A.peak flow meter is clogged. B.patient’s asthma has worsened. C.patient is fatigued. D.peak flow meter is accurate.

A.peak flow meter is clogged.

The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist’s first action should be to A.look for a kink in the circuit. B.change modes of ventilation. C.check the exhalation valve. D.suction the patient.

C.check the exhalation valve.

A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? A.5 L/min B.55 L/min C.88 L/min D.140 L/min

B.55 L/min

A 72 year-old female post stem cell transplant patient in the ICU is complaining of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient’s possible condition? A.severe heart failure B.respiratory distress syndrome C.severe renal failure D.moderate heart failure

D.moderate heart failure

A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? A.Initiate bronchial hygiene therapy. B.Obtain a sputum gram stain. C.Administer IPV. D.Insert a CASS tube.

B.Obtain a sputum gram stain.

The most serious complication associated with airway suctioning is A.hypoxemia. B.bradycardia. C.mucosal trauma. D.gag reflex stimulation.

A.hypoxemia.

An oxygen-dependent patient uses a nasal cannula at 3 L/min continuously at home. He complains that his liquid oxygen portable device runs out too quickly when he attends church services and prevents him from dining out in restaurants afterwards. Which of the following devices should the respiratory therapist recommend to resolve the issue? A.Use a pulse-dose oxygen delivery system. B.Take a backup E-size oxygen cylinder. C.Reduce the oxygen flow to 2 L/min during church. D.Insertion of a transtracheal oxygen catheter.

A.Use a pulse-dose oxygen delivery system.

A healthy adult female can exhale what portion of her forced vital capacity in the first second? A.50% B.60% C.70% D.80

C.70%

The respiratory therapist receives an order to administer a mixture of 80% helium/20% oxygen to a 40 year-old patient in an acute asthmatic episode. Which of the following devices would most effectively deliver the gas mixture to the patient? A.Simple oxygen mask B.Nonrebreathing mask C.Noninvasive ventilator D.Aerosol mask

B.Nonrebreathing mask

During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? A.a mild restrictive disorder B.a mild obstructive disorder C.normal lung function D.mixed obstructive/restrictive disorder

C.normal lung function

During chart review prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do? 1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. Hold pressure on the puncture site for a longer time after sample is collected. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary. A.2 and 4 only B.1 and 3 only C.3 and 4 only D.2 only

1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. Hold pressure on the puncture site for a longer time after sample is collected. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary. A.2 and 4 only

A 50 kg (110 lb) patient is being mechanically ventilated with the following settings: VC, A/C, VT 400 mL, respiratory rate 14/min, FIO2 0.60 and 10 cm H2O PEEP. The chest radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36, PaCO2 47 torr, PaO2 50 torr, and HCO3- 28 mEq/L. The respiratory therapist should increase the A.PEEP. B.FIO2. C.expiratory time. D.respiratory rate.

A.PEEP.

A patient receiving high frequency oscillation ventilation (HFOV) has demonstrated excess CO2 retention on a recent arterial blood gas. Which of the following could be adjusted to correct this situation? A.Mean airway pressure B.Amplitude (∆P) C.Inspiratory time D.Oxygen concentration

B.Amplitude (∆P)

The respiratory therapist has obtained a blood gas sample from the patient’s radial artery and applied pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is A.adding liquid heparin to the sample. B.placing the syringe in an ice bath. C.shaking the sample continuously. D.applying a pressure bandage.

B.placing the syringe in an ice bath.

The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 8 mEq/L; SaO2 95%; BE -15 mEq/L. The respiratory therapist should recommend A.initiating oxygen therapy via nasal cannula at 4 L/min. B.intubating and initiating mechanical ventilation. C.administering sodium bicarbonate intravenously D.initiating non-invasive ventilation.

C.administering sodium bicarbonate intravenously.

A mechanically ventilated patient with a tracheostomy tube is on the following settings: PC, SIMV, PIP 30 cmH2O, f 20/min, FIO2 0.60, PEEP 5 cmH2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely? A.The patient has been disconnected. B.Complete obstruction of the tracheostomy tube. C.Development of a left-sided pneumothorax. D.Partial obstruction of the tracheostomy tube.

D.Partial obstruction of the tracheostomy tube.

A 70-kg (154 lb) patient with emphysema is receiving mechanical ventilation. Current ventilator settings are as follows: VC, SIMV; VT 550 mL, respiratory rate 12/min, FIO2 0.30. The patient is awake and alert and does not appear to be in any distress. The total respiratory rate is 14/min. ABG results are as follows: pH 7.35, PaCO2 58 torr; PaO2 65 torr; HCO3 30 mEq/L. His SpO2 is 94% and MIP is -30 cm H2O. This patient is most likely A.ready for a spontaneous breathing trial. B.in an acute exacerbation. C.oversedated. D.in need of PEEP therapy.

A.ready for a spontaneous breathing trial.

The respiratory therapist prepares to assist with a bronchoscopy of a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT A.introduction of the bronchoscope will create increased resistance to flow. B.the tidal volume of the patient must be closely monitored during the procedure. C.the patient’s extrinsic PEEP levels will increase. D.peak inspiratory pressure on the ventilator will rise.

**C.the patient’s extrinsic PEEP levels will increase.**

The respiratory therapist has been asked to measure Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should A.initiate an inspiratory hold just after the next ventilator-delivered breath. B.initiate an expiratory hold just prior to the next ventilator-delivered breath. C.subtract Pplat from Pdyn. D.subtract set PEEP from the measured Pplat.

B.initiate an expiratory hold just prior to the next ventilator-delivered breath.

After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist has documented in the Progress Notes a need to change the patient’s treatment regimen. The respiratory therapist should A.continue the current treatment plan. B.report the change in treatment plan to the next shift. C.check the electronic medical record for new physician orders. D.disregard the information until notified by the shift supervisor.

C.check the electronic medical record for new physician orders.

A 16 year-old patient with cystic fibrosis attends public high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient? A.intrapulmonary percussive ventilation B.dornase alpha therapy C.vibratory / oscillatory PEP D.postural drainage and manual percussion

C.vibratory / oscillatory PEP

What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? A.VC limits and controls PIP. B.VC provides a constant minute ventilation. C.VC ensures better patient-ventilator synchrony. D.VC delivers a decelerating flow pattern.

B.VC provides a constant minute ventilation.

A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient? A.diuretics B.antibiotics C.lung expansion therapy D.thoracentesis

C.lung expansion therapy

A 13 year-old patient in the ED is complaining of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 28 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate? A.levalbuterol B.oxygen C.salmeterol D.PEP

B.oxygen

A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with A. liver failure. B.pulmonary embolism. C.heart failure. D.electrolyte imbalances.

heart failure.

An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is A.hypoventilation. B.shunt. C.ventilation/perfusion mismatch D.increased deadspace.

C.ventilation/perfusion mismatch.

What is normal urine output in an adult patient? A.10 mL/hr B.20 mL/hr C.30 mL/hr D.40 mL/hr

D.40 mL/hr

A patient with a closed head injury has had a cuffed tracheostomy tube in place for several weeks. The physician wishes to decannulate the patient but maintain the patency of the stoma for secretion removal. Which of the following devices would facilitate this request? A.fenestrated trach tube B.transtracheal catheter C.laryngectomy tube D.tracheostomy button

D.tracheostomy button

The respiratory therapist is preparing to administer inhaled nitric oxide to a neonate with respiratory distress syndrome. The most appropriate initial dose of iNO for this patient is A.5 ppm. B.10 ppm. C.15 ppm. D.20 ppm.

D.20 ppm.

A spontaneous breathing trial was initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 30 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient’s vital signs have remained stable throughout the trial. Which of the following is the most appropriate recommendation? A.Maintain current therapy. B.Initiate NPPV. C.Add 5 cm H2O CPAP. D.Extubate the patient

D.Extubate the patient

The respiratory therapist is preparing to assist in the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend? A.ketamine B.vecuronium C.rocuronium D.succinylcholine

D.succinylcholine

A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from A.pneumonia. B.pulmonary embolism. C.pleural effusion. D.bronchiolitis.

C.pleural effusion.

Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? A.Post-traumatic chest trauma B.Community-acquired pneumonia C.Spinal cord injury D.Chronic bronchitis

D.Chronic bronchitis

Sleep apnea can be defined as repeated episodes of complete cessation of airflow for A.5 seconds or longer. B.10 seconds or longer. C.15 seconds or longer. D.20 seconds or longer.

B.10 seconds or longer.

While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient’s heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient? A.Reduce the dose of albuterol. B.Discontinue the treatment. C.Change to 3 puffs of beclomethasone dipropionate (Vanceril®). D.Change to 0.63 mg of levalbuterol (Xopenex®).

A.Reduce the dose of albuterol.

A patient is being evaluated in the pulmonary clinic. He reports that he smoked a pack and a half of cigarettes (30 cigarettes) per day for 20 years. How should the respiratory therapist describe the patient’s smoking history? A.20 pack-years B.25 pack-years C.30 pack-years D.60 pack-years

C.30 pack-years

A pediatric patient on high-flow oxygen therapy is being continuously monitored with a finger pulse oximetry probe. There are frequent and repeated false low SpO2 alarms (less than 90%). Which of the following should the respiratory therapist recommend in this situation? A.Sedate the patient and restrain his arms. B.Reset the low alarm limit to the 80% to 85% range. C.Use a spot-check instead of continuous monitoring. D.Relocate the sensor to the forehead or ear lobe.

D.Relocate the sensor to the forehead or ear lobe.

The respiratory therapist should recommend home apnea monitoring for infants with all of the following situations EXCEPT A.preterm infant with significant apnea periods. B.sibling of a SIDS baby. C.APGAR scores of 4 and 6 at delivery. D.infant with a history of snoring.

C.APGAR scores of 4 and 6 at delivery.

The primary reason for the use of respiratory care protocols is to A.decrease the patient workload for therapists. B.standardize provision of care. C.enhance departmental efficiency. D.increase the autonomy of therapists.

B.standardize provision of care.

All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT A.minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. B.minimal leak technique allows a small leak at the end of inspiration. C.at minimal occlusion volume, air leakage around the tube cuff should cease. D.cuff pressure should not exceed 35 cmH2O in order to allow circulation to tracheal mucosa.

A.minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring.

Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV A.1 and 2only B.1 and 3 only C.2 and 4 only D.3 and 4 only

1. FEV1 2. PEFR 3. FRC 4. RV A.1 and 2only

Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time? A.cool mist aerosol treatment B.aerosolized racemic epinephrine C.manual ventilation with resuscitation bag and mask D. reintubation

D. reintubation

A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient’s C(a-v)O2. A. 2.5 vol% B. 4.0 vol% C. 5.0 vol% D. 5.5 vol%

C. 5.0 vol%

A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that A.the patient is disconnected from the ventilator. B.the patient is experiencing diffuse bronchospasm. C.the endotracheal tube has slipped into the right main stem bronchus. D.the patient has developed a left tension pneumothorax.

C.the endotracheal tube has slipped into the right main stem bronchus.

A 28 year-old female has just been admitted through the ED with suspected CO poisoning. She is receiving oxygen by non-rebreather mask at 10 L/min. Upon entering the patient’s room, the respiratory therapist notes that the reservoir bag of the mask collapses during inspiration. This is most likely the result of A.faulty one-way valves. B.tight seal between the mask and the patient’s face. C.presence of a bubble humidifier. D.insufficient flow to the reservoir bag.

D.insufficient flow to the reservoir bag.

A spontaneously breathing post-CVA patient has developed right lower lobe infiltrates on chest x-ray and has coarse breath sounds. When the respiratory therapist attempts to suction the patient by the nasotracheal route, she notes a gag reflex is present but the patient does not cough. Watery secretions are aspirated through the suction catheter. The therapist should A.insert an oral endotracheal tube. B.reposition the patient to a sniffing position. C.change to a larger suction catheter. D.insert an oropharyngeal airway.

B.reposition the patient to a sniffing position.

The respiratory therapist is instructing a postoperative abdominal surgery patient on how to perform incentive spirometry. The therapist should explain that the purpose of the treatment is to A.prevent microatelectasis. B.promote healing of the incision. C.prevent areas of lung collapse. D.prevent and treat pneumonia.

C.prevent areas of lung collapse.

A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? A.IS / SMI B.IPP B with normal saline C.postural drainage and percussion D. PEP therapy

B.IPPB with normal saline

A 75 kg (165 lb) patient with acute lung injury is being mechanically ventilated at the following settings: VC, A/C; VT 300 mL, respiratory rate 16/min, FIO2 0.50 and PEEP +5 cm H2O. The following arterial blood gas results are obtained: pH 7.30, PaCO2 58 torr, PaO2 79 torr, HCO3- 28 mEq/L. The patient’s condition should be described as A.venous admixture. B.ventilation/perfusion mismatching. C.hypoventilation. D.refractory hypoxemia.

C.hypoventilation.

A post-operative patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as A.a persistent bronchopleural fistula. B.a resolved pneumothorax. C.back-pressure from the suction chamber. D.normal function of the water seal chamber

A.a persistent bronchopleural fistula.

The respiratory therapist is providing patient education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will A.sterilize the equipment. B.retard bacterial growth. C.kill all micro-organisms and spores. D.extend the equipment life

B.retard bacterial growth.

In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a A.rotameter. B.3.0 L syringe. C.Wright respirometer. D.pneumotachometer.

B. 3.0 L syringe.

During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: What action should the therapist take? A.Initiate pressure support. B.Increase respiratory rate. C.Decrease inspiratory time. D.Add an inspiratory plateau.

C.Decrease inspiratory time.

A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A.Decrease the PEEP. B.Increase the FIO2. C.Initiation diuretic therapy. D.Continue to monitor closely.

B.Increase the FIO2.

Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend A.antiviral therapy. B.blood transfusion. C.SABA by small volume nebulizer. D.antibiotic therapy.

D.antibiotic therapy.

Evaluation of a spontaneously breathing patient reveals tachypnea, tracheal deviation to the right and an absence of breath sounds on the left. The most likely etiology would be A.bronchiectasis. B.myasthenia gravis. C.acute asthmatic attack. D.left tension pneumothorax.

D.left tension pneumothorax.

A patient has mild stridor immediately after extubation. This finding is most often associated with A.lower airway obstruction. B.secretions in the large airways. C.upper airway obstruction. D.bronchial spasm.

C.upper airway obstruction.

After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include 1. bronchospasm. 2. pneumothorax. 3. pulmonary hemorrhage. A.1 and 2 only B.1 and 3 only C.2 and 3 only D.1, 2, and 3

1. bronchospasm. 2. pneumothorax. 3. pulmonary hemorrhage. D.1, 2, and 3

What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern? A.10% and 100 mL B.12% and 200 mL C.15% and 100 mL D.20% and 200 mL

B.12% and 200 mL

Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? A.Transillumination B.APGAR score C.Ballard score D.Silverman score

D.Silverman score

A 65 year-old patient with end-stage COPD is admitted to the ED with an acute exacerbation. He has a DNI order in his chart. Physical exam reveals that the patient is febrile and has a weak, non-productive cough. Breath sounds reveal bilateral coarse crackles with scattered wheezes. The patient is started on bronchodilator therapy and antibiotics. Serial ABG results are: What should the respiratory therapist recommend? A.Initiate comfort care procedures. B.Decrease FIO2 to 0.35. C.Administer IPV. D.Initiate NPPV.

D.Initiate NPPV.

A 30 year old male with bronchitis has coarse bilateral rales with a SpO2 of 90%. Despite a good cough effort, he has great difficulty in removing his thick secretions. The respiratory therapist should initiate A.aerosol treatments with 3 cc normal saline every 4 hours. B.sputum induction for gram stain. C.a heated humidifier and oxygen therapy. D.continuous ultrasonic via aerosol mask.

C.a heated humidifier and oxygen therapy.

The high pressure alarm is sounding frequently on the ventilator of a 58 year-old patient who is being mechanically ventilated following major orthopedic surgery. The set rate on the ventilator is 12/min and auscultation reveals bilateral vesicular breath sounds. Current vital signs include: heart rate 130/min, respiratory rate 36/min, blood pressure 125/88 mmHg, temperature 37.1°C (98.8°F), and SpO2 96%. The patient appears quite agitated. The patient’s respiratory pattern is most likely the result of A.post-operative pain. B.a viral infection. C.hypoxemia. D.lactic acidosis.

A.post-operative pain.

The sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing is representative of A.tidal volume. B.pulmonary shunt. C.V/Q mismatch. D.alveolar gas that has participated in gas exchange.

D.alveolar gas that has participated in gas exchange.

All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT A. maintaining cuff pressures between 20 and 25 mm Hg. B. using the minimal leak technique for inflation. C. using a low-residual-volume, low-compliance cuff. D. monitoring intracuff pressures.

using a low-residual-volume, low-compliance cuff.

Adverse effects of inhaled NO include all of the following EXCEPT A.methemoglobinemia. B.aplastic anemia. C.rebound pulmonary hypertension. D.nitrogen dioxide toxicity.

B.aplastic anemia.

The respiratory therapist instructs a patient to take a maximal inspiration followed by a maximal exhalation without force. Which of the following values are being measured? A.expiratory reserve volume B.residual volume C.functional residual capacity D.slow vital capacity

D.slow vital capacity

Thirty minutes after extubation, a patient exhibits moderate stridor. Which of the following should the respiratory therapist recommend? A.Initiate a heated aerosol treatment with saline. B.Administer a racemic epinephrine aerosol treatment. C.Monitor the patient closely for the next hour. D.Immediately reinsert the endotracheal tube.

B.Administer a racemic epinephrine aerosol treatment.

A patient who has significant decreases in airflow during sleep but does not have a complete cessation of breathing is having what type of episodes? A.Obstructive sleep apnea B.Dyspnea C.Hypopnea D.Central sleep apnea

C.Hypopnea

A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a minimal occluding volume. This would indicate that the A.tube is not of the appropriate size. B.pilot balloon and line are obstructed. C.pressure manometer is defective. D.cuff has herniated over the tip of the tube.

A.tube is not of the appropriate size.

A patient receiving mechanical ventilation has a capnometer in-line at the Y-connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should A.replace the exhalation valve. B.decrease the humidifier temperature setting. C.remove the inline medication nebulizer. D.reattach the patient to the circuit.

D.reattach the patient to the circuit.

A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the A.left atrium. B.pulmonary vein. C.pulmonary artery. D.superior vena cava.

C.pulmonary artery.

A patient is on CPAP at 10 cmH2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur? 1. Excess water will rain out 2. Humidity deficit will occur 3. Relative humidity will decrease 4. Relative humidity will remain 100% A.2 only B.2 and 4 only C.1 and 3 only D.1 and 4 only

1. Excess water will rain out 2. Humidity deficit will occur 3. Relative humidity will decrease 4. Relative humidity will remain 100% D.1 and 4 only

Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation? 1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow. 3. Selecting a ventilator that incorporates an internal air compressor. A.1 and 2 only B.2 and 3only C.3 only D.1, 2, and 3

1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow. 3. Selecting a ventilator that incorporates an internal air compressor. A.1 and 2 only

A patient is receiving oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80, HCO3 38 mEq/L. The most likely explanation for these results is that A.the sample was not iced properly. B.there was excess heparin in the syringe. C.the numbers were not reported correctly. D.The sample contains venous blood.

C.the numbers were not reported correctly.

An ICU patient’s blood pressure is being continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure? A.Trendelenburg position causes an elevation in blood pressure. B.The tip of the catheter was below the transducer. C.The catheter needed flushing. D.The catheter was kinked.

B.The tip of the catheter was below the transducer.

A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might have accounted for these readings? A.The ventilator circuit has become disconnected. B.There is a leak around the endotracheal tube. C.There is an increase in alveolar dead space. D.The carbon dioxide absorber is exhausted.

A.The ventilator circuit has become disconnected.

While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? 1. pneumothorax 2. pleural effusion 3. pneumonia 4. atelectasis A.1 and 3 only B.2 and 4 only C.2, 3, and 4 only D.1, 2, 3, and 4

1. pneumothorax 2. pleural effusion 3. pneumonia 4. atelectasis C.2, 3, and 4 only

An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask? A.10 L/min B.13 L/min C.16 L/min D.18 L/min

C.16 L/min

A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient’s heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? A. Call for a STAT chest x-ray. B. Insert a chest tube into the left chest. C. Needle aspirate the 2nd left intercostal space. D. Activate the medical emergency team to intubate the patient.

Needle aspirate the 2nd left intercostal space.

A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? A.Pre/post bronchodilator study B.Ultrasonic nebulizer treatments C.Manually assisted coughing D.Regular coughing and deep breathing

D.Regular coughing and deep breathing

A 60 kg (132 lb) patient is being mechanically ventilated with the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient’s peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? A.Increase the frequency. B.Change to airway pressure release ventilation. C.Decrease the inspiratory time. D.Increase PEEP to 15 cm H2O.

B.Change to airway pressure release ventilation.

A 60 kg (132 lb) female patient with congestive heart failure is receiving NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as A.shunting. B.hypoventilation. C.hyperoxygenation. D.fluid overload.

C.hyperoxygenation.

A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? 1. Increase the pressure limit 2. Increase the sensitivity 3. Increase the mandatory rate 4. Decrease the inspiratory time A.1 and 4 only B.1 and 3 only C.2 and 3 only D.1, 2 and 4 only

B.1 and 3 only

The respiratory therapist is called to ICU to evaluate a patient on continuous flow CPAP (8 cm H2O, FIO2 0.30) who is showing signs of respiratory distress. The patient’s SpO2 has changed from 94% to 90%. The therapist observes that the CPAP pressure manometer displays negative pressure during inspiration. The therapist should A.place the patient back on the ventilator at the previous settings. B.increase inspiratory flow to the CPAP system. C.assess the patient for excess secretions. D.increase the CPAP to 10 cm H2O.

B.increase inspiratory flow to the CPAP system.

All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A.carbon monoxide poisoning. B.decompression sickness. C.anaerobic infections. D.pulmonary hypertension.

D.pulmonary hypertension.

A 58 year-old male patient is receiving mechanical ventilation in the ICU on the following settings: VC,SIMV, VT 650 mL, f 12/min, FIO2 0.65, PEEP 10 cmH2O. He has a large amount of thick, yellow secretions. How should the respiratory therapist suction this patient? A.Limit suction time to 5 seconds or less. B.Use a closed-system suction catheter. C.Suction Q1H and PRN. D.Use a 10 Fr suction catheter.

B.Use a closed-system suction catheter.

A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a A.high likelihood of excessive bleeding. B.normal clotting ability. C.propensity for increased clotting. D.decrease in bone marrow function.

A.high likelihood of excessive bleeding.

The patient in ICU Bed 6 is noted to have a meniscus in the left chest with a blunted left costophrenic angle on the morning chest radiograph. On physical exam, the respiratory therapist finds that the breath sounds are decreased on the left with a dull percussion note. What treatment should the therapist recommend? A.Insertion of an anterior chest tube. B.Bronchoalveolar lavage. C.Needle aspiration of the 4th left intercostal space. D.Perform a left posterior thoracentesis.

D.Perform a left posterior thoracentesis.

Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? A.Increased fremitus B.Decreased intensity of breath sounds C.Diminished diaphragmatic excursion D.Hyperresonance to

A.Increased fremitus

A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient’s static lung compliance? A.25 mL/cm H2O B.35 mL/cm H2O C.45 mL/cm H2O D. 50 mL/cm H2O

D. 50 mL/cm H2O

What value for the apnea–hypopnea index (AHI) is consistent with mild obstructive sleep apnea? A.Less than 5 B.5 to 15 C.16 to 30 D.Greater than

B.5 to 15

The respiratory therapist is completing oxygen rounds on the ward and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? A.70% ethyl alchohol B.Warm soapy water C.Bleach D.Acid glutaraldehyde

A.70% ethyl alchohol

The most probable cause of air bronchograms and increased density on a chest x-ray is A.pneumonia. B.pulmonary edema. C.pulmonary embolism. D.pleural effusion.

A.pneumonia.

The physician asks the respiratory therapist to set ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician’s request? A.Decelerating B.Square wave C.Constant D.Accelerating

A.Decelerating

A respiratory therapist is calibrating a thermal conductivity helium analyzer. What should the analyzer read when exposed to room air? A.100% B.79% C.21% D.0%

D.0%

Which of the following measurements is most indicative of pulmonary edema? A.Heart rate of 120/min B.Blood pressure of 92/72 mm Hg C.Pulmonary artery pressure of 25/10 mm Hg D.Pulmonary capillary wedge pressure of 30 mm Hg

D.Pulmonary capillary wedge pressure of 30 mm Hg