Individual Feedback:
NBRC CRT Self-Assessment Examination (Form E)
Student ID 53555383
On 7/10/2010 at 6:22:25 PM
1
Which of the following positions is most appropriate for a patient
being treated for extremely low blood pressure?
A. Trendelenburg
B. reverse Trendelenburg
C. Sims'
D. Fowler's
EXPLANATIONS:
(c) A. Trendelenburg position enhances venous return.
(h) B. Reverse Trendelenburg position decreases venous return.
(u) C. Sims' is a lateral position that does not enhance venous return.
(h) D. Fowler's is a head-up position that decreases venous return.
2
A respiratory therapist is assisting with a bronchoscopy for a patient
with a right middle lobe consolidation. Which of the following should
be routinely monitored during the procedure?
1. hemoximetry
2. ECG pattern
3. pulse oximetry
4. capnography
A. 1 and 2 only
B. 1 and 4 only
C. 2 and 3 only
D. 3 and 4 only
EXPLANATIONS:
1. False. Hemoximetry is a laboratory analytical procedure requiring
invasive arterial blood sampling. Hemoximetry is used to compute the
relative concentrations of multiple hemoglobin species. In this case,
there is no indication for hemoximetry.
2. True. Basic ECG monitoring is recommended during bronchoscopy.
3. True. Pulse oximetry monitoring is indicated during bronchoscopy.
4. False. The increased airways resistance will alter the sampling of
exhaled gases.
(u) A. Incomplete and incorrect response included
(u) B. Incorrect response
(c) C. Correct response
(u) D. Incomplete and incorrect response included
3
Immediately after initiating volume-controlled ventilation, an inverse
I:E ratio is noted. Which of the following does this indicate?
A. Inspiratory flow is low.
B. Pressure limit is high.
C. Tidal volume is low.
D. Mandatory rate is low.
EXPLANATIONS:
(c) A. A low inspiratory flow results in a high I:E ratio.
(u) B. A high pressure limit has no effect on I:E ratio.
(u) C. A low tidal volume will not contribute to a high I:E ratio.
(u) D. A low mandatory rate is unlikely to be the cause of a high I:E
ratio.
4
A 24-year-old female presents with seasonal nasal stuffiness and
episodes of daytime dyspnea and cough. Which of the following drug
classifications should the respiratory therapist recommend to control
the patient's symptoms?
A. leukotriene inhibitor
B. IgE immunoglobulin antagonist
C. beta-adrenergic agonist
D. short-acting antihistamine
EXPLANATIONS:
(c) A. The patient has allergic rhinitis and, at most, mild persistent
asthma. Leukotriene inhibitors, such as montelukast (Singulair), are
indicated to control of mild asthma and allergic rhinitis.
(h) B. IgE immunoglobulin antagonist, such as omalizumab (Xolair), is
indicated for severe allergic asthma and carries significant risk.
(u) C. Beta-adrenergic agonists are rescue drugs and are not used to
control asthma and would have no role in the treatment of allergic
rhinitis.
(u) D. Short-acting antihistamines produce too many side effects to be
useful in the control of asthma or allergic rhinitis.
5
Following endotracheal intubation, which of the following should a
respiratory therapist use to confirm proper tube placement?
A. galvanic analyzer
B. mass spectrometer
C. colorimetric capnometer
D. Severinghaus electrode
EXPLANATIONS:
(u) A. A galvanic analyzer is used to assess oxygen concentration.
(u) B. A mass spectrometer demonstrates chemical composition of a
substance.
(c) C. A colorimetric capnometer is used to confirm proper tube
placement by identifying the presence of CO2.
(u) D. A Severinghaus electrode is used to analyze PaCO2.
6
Following insertion of a central venous pressure (CVP) catheter, a
chest radiograph is taken to evaluate the position of the catheter.
While viewing the radiograph, a respiratory therapist notes the tip of
the catheter is in the lower portion of the superior vena cava. The
therapist should conclude the catheter
A. has been advanced too far.
B. is in the proper position.
C. has perforated a vessel.
D. is not advanced far enough.
EXPLANATIONS:
(u) A. A CVP catheter that has been advanced too far would be in the
right atrium or possibly in the right ventricle.
(c) B. When in proper position, the tip of the CVP catheter should be in
the lower portion of the superior vena cava.
(u) C. If the CVP catheter had perforated the vessel, the tip would be
located outside of the lumen of the vena cava.
(u) D. See explanation B.
7
Which of the following findings indicate a patient who is weaning
from mechanical ventilation has decreased muscle strength?
1. reduced maximum inspiratory pressure (MIP)
2. decreased tidal volume
3. decreased vital capacity
4. decreased PaCO2
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. Reduced MIP indicates decreased muscle strength.
2. True. Decreased tidal volume is a sign of decreased muscle
strength.
3. True. Decreased vital capacity is a sign of decreased muscle
strength.
4. False. Increased PaCO2 would indicate respiratory muscle fatigue
with a resulting hypercapnia.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incomplete and incorrect response included
8
A patient is receiving 80%/20% heliox using a standard oxygen
flowmeter. Which of the following is the correction factor to
determine the accurate flow?
A. 1.4
B. 1.6
C. 1.8
D. 2.4
EXPLANATIONS:
(u) A. See explanation C.
(u) B. See explanation C.
(c) C. The correction factor for 80% / 20% heliox is 1.8.
(u) D. See explanation C.
9
Which of the following is the best device to administer a controlled
oxygen concentration for a patient with a variable respiratory
pattern?
A. face tent
B. nasal cannula
C. partial rebreathing mask
D. air-entrainment mask
EXPLANATIONS:
(u) A. A face tent is a loose fitting device that allows an unknown
amount of air to be mixed with the oxygen being administered,
especially with a varying respiratory pattern.
(u) B. A varying inspiratory flow will result in fluctuating
concentrations of inspired oxygen when using a nasal cannula.
(u) C. A varying inspiratory flow will result in fluctuating
concentrations of inspired oxygen due to the changing amount of
rebreathed expired gas when using a partial rebreathing mask.
(c) D. The air-entrainment mask can provide a high enough total flow
to exceed the patient's peak inspiratory flow and ensure consistent
oxygen concentration.
10
The following arterial blood gas results are available for a patient 15
minutes after the initiation of oxygen therapy:
Which of the following is the most likely cause of these results?
A. renal tubular acidosis
B. hyperchloremic acidosis
C. lactic acidosis
D. multiple myeloma acidosis
EXPLANATIONS:
(u) A. Renal tubular acidosis is characterized by non-ion gap acidosis
and would not cause this acute change.
(h) B. Hyperchloremic acidosis is characterized by non-ion gap
acidosis and would not cause this acute change.
(c) C. Lactic acidosis is commonly from an acute process, such as
hypoxia, and is characterized by high ion gap acidosis.
(h) D. Multiple myeloma acidosis is characterized by low ion gap
acidosis and would not cause this acute change.
11
A respiratory therapist is instructing an outpatient in the care of
respiratory equipment. Which of the following steps should be
included in the cleaning procedure?
1. Wash thoroughly with 50% bleach.
2. Remove soap by rinsing with water.
3. Soak in a vinegar solution for 20 minutes.
4. Drain dry without wiping.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. False. Bleach should not be used for home respiratory equipment.
2. True. Soap should be rinsed away to prevent irritation to the
mucosa.
3. True. Vinegar is an effective disinfectant for common pathogens.
4. True. Air drying is less likely to result in contamination than wiping,
which can produce pathogens.
(u) A. Incorrect and incomplete response included
(u) B. Incorrect and incomplete response included
(u) C. Incorrect and incomplete response included
(c) D. Correct response
12
A patient with a tracheostomy is receiving heated aerosol therapy. A
respiratory therapist finds the FIO2 is 0.60 by oxygen analyzer when
the air-entrainment setting is 0.40. Which of the following could cause
these findings?
1. The analyzer could be improperly calibrated.
2. The tracheostomy tube could be partially occluded with
secretions.
3. The water level in the nebulizer could be too low.
4. Water in the tubing could be reducing the gas flow.
A. 1 and 2 only
B. 1 and 4 only
C. 2 and 3 only
D. 3 and 4 only
EXPLANATIONS:
1. True. The analyzer may need calibration.
2. False. A clogged tracheostomy tube does not affect FIO2.
3. False. Water level does not affect FIO2.
4. True. Water in the tubing imposes a back pressure on air
entrainment, resulting in a decrease in air entrainment and increased
FIO2.
(u) A. Incomplete and incorrect response included
(c) B. Correct response
(u) C. Incorrect response
(u) D. Incomplete and incorrect response included
13
A patient who is afebrile is receiving volume-controlled ventilation
with a heat moisture exchanger for the past 24 hours. There is a
progressive increase in peak inspiratory pressure. Auscultation
reveals scattered coarse crackles, and thick secretions are obtained
during suctioning. Which of the following should a respiratory
therapist do?
A. Instill 5 mL of saline.
B. Administer 3 mL of 10% acetylcysteine (Mucomyst) by aerosol.
C. Change to a heated humidifier.
D. Replace the heat moisture exchanger.
EXPLANATIONS:
(h) A. Instillation of 5 mL of normal saline has the potential to cause
ventilator-associated pneumonia.
(h) B. Aerosolized Mucomyst has been shown to be ineffective.
(c) C. Converting to a heated humidifier increases water vapor content
and improved mucociliary function.
(u) D. Replacing the heat moisture exchanger would perpetuate the
problem.
14
The best way to check the accuracy of a water-seal spirometer is to
use a
A. 3 L syringe.
B. pneumotachometer.
C. vortex sensor.
D. Wright respirometer.
EXPLANATIONS:
(c) A. A 3 L syringe is the only piece of equipment that provides
accurate volumes for calibration.
(u) B. A pneumotachometer measures flow and does not directly
measure volume.
(u) C. A vortex sensor spirometer measures flow integrated with time
and is not sufficiently accurate for calibration.
(u) D. A Wright respirometer is not sufficiently accurate to be used as a
volume standard.
15
A physiologic goal of CPAP in atelectasis is to increase
A. tidal volume.
B. functional residual capacity.
C. inspiratory capacity.
D. minute alveolar ventilation.
EXPLANATIONS:
(a) A. While spontaneous tidal volume may increase slightly with the
addition of CPAP, this is not the physiologic goal of CPAP therapy.
(c) B. CPAP increases functional residual capacity by stabilizing
alveoli at end-inspiration and preventing their collapse.
(u) C. CPAP does not increase inspiratory capacity or alveolar
ventilation.
(u) D. See explanation C.
16
A respiratory therapist notes an adverse change in a patient's
condition during the administration of routine therapy. Which of the
following should the therapist do?
1. Notify the nurse who is responsible for the patient.
2. Ask the patient's nurse to confirm the change in clinical
presentation.
3. Record the patient's reactions in the chart.
4. Contact the physician if a change in therapy seems warranted.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. The nurse must be informed about the patient's adverse
reaction.
2. False. The therapist should not need to ask the nurse to confirm the
patient's reaction to therapy.
3. True. The proper documentation of an adverse reaction is
appropriate.
4. True. The physician is responsible for making changes in therapy.
(u) A. Incomplete and incorrect response included
(u) B. Incomplete and incorrect response included
(c) C. Correct response
(u) D. Incomplete and incorrect response included
17
A patient with multiple trauma is intubated and receiving mechanical
ventilation. The patient is extremely anxious, tachypneic, and
complaining of severe pain. Which of the following drugs would
decrease the total rate and provide pain control?
A. morphine sulfate
B. diazepam (Valium)
C. neostigmine bromide (Prostigmin)
D. pancuronium bromide (Pavulon)
EXPLANATIONS:
(c) A. Morphine sulfate diminishes the effects of pain and acts as a
sedative.
(u) B. Diazepam is a good sedative, but does not control pain.
(u) C. Neostigmine bromide is used in myasthenia gravis patients.
(u) D. Pancuronium bromide paralyzes the patient, but does not
control the pain.
18
Which of the following should a respiratory therapist use to collect a
sputum specimen for culture and sensitivity from an intubated
patient?
A. Luken's trap
B. Carlen's tube
C. Yankauer tube
D. Pleur-evac
EXPLANATIONS:
(c) A. A Luken's trap is designed to collect sputum during suctioning.
(u) B. A Carlen's tube is a double-lumen endotracheal tube.
(u) C. A Yankauer tube is only used for oral secretions.
(u) D. A Pleur-evac is used to evacuate a pleural effusion.
19
A patient was awakened by shortness of breath. He has fine
inspiratory crackles bilaterally and a history of hypertension. Which
of the following should a respiratory therapist recommend?
A. prednisone
B. albuterol
C. furosemide (Lasix)
D. cromolyn sodium (Intal)
EXPLANATIONS:
(u) A. The history, signs, and symptoms point to congestive heart
failure. Prednisone, albuterol, and cromolyn sodium will not address
the cause of the patient's symptoms.
(u) B. See explanation A.
(c) C. Nocturnal dyspnea and coarse crackles are indications of
congestive heart failure. Hypertension can be an etiologic factor for
heart failure. Diuretics are useful in controlling water retention that can
lead to fluid accumulation and narrowing in airways.
(u) D. See explanation A.
20
Moderate amounts of thin, white sputum are obtained during the
suctioning procedure. Which of the following should the respiratory
therapist do with the next suction procedure?
A. Instill 3 mL sterile saline prior to suctioning.
B. Suction the patient then instill 5 mL sterile saline.
C. Instill 300 mg acetylcysteine (Mucomyst) 5 minutes prior to
suctioning.
D. Suction the patient without saline instillation.
EXPLANATIONS:
(h) A. Instilling saline may cause airway infection.
(h) B. Instilling saline may cause airway infection.
(h) C. Instillation of Mucomyst is not indicated in a patient with thin
secretions.
(c) D. Instilling saline is not necessary if secretions are easily removed
and it may cause airway infection.
21
A 44-year-old patient presents to the emergency department with
diabetic ketoacidosis. Which of the following respiratory patterns is
most consistent with this diagnosis?
A. irregular breathing with periods of apnea
B. regular, slow, deep breathing
C. rapid, deep breathing
D. slow, shallow breathing
EXPLANATIONS:
(u) A. Irregular breathing with periods of apnea is Cheyne-Stokes
breathing and does not occur with diabetic ketoacidosis.
(u) B. Regular, slow, deep breathing is not indicative of diabetic
ketoacidosis.
(c) C. An increase in rate and depth of breathing, called Kussmaul's
breathing, is most commonly the result of a diabetic
crisis/ketoacidosis.
(u) D. Slow, shallow breathing may be the result of a brain stem injury
and is often called hypopnea.
22
Which of the following is associated with the administration of
aerosolized pentamidine isethionate (NebuPent)?
A. tachycardia
B. bradycardia
C. bronchospasm
D. hypotension
EXPLANATIONS:
(u) A. No causal relationship between the use of NebuPent and
tachycardia or bradycardia has been established.
(u) B. See explanation A.
(c) C. Bronchospasm is the most frequently reported adverse effect
associated with the use of NebuPent.
(u) D. Hypotension is associated with the use of IV or IM pentamidine
isethionate (Pentam). It has not been shown to be a problem when the
drug is aerosolized.
23
A 28-year-old man has noticed an increase in urine output and
periods of insatiable thirst. The patient's arterial blood gas results are
as follows with an FIO2 of 0.21:
Which of the following is the most likely explanation?
A. diabetic ketoacidosis
B. hyperventilation
C. ventilatory failure
D. excessive diuretic therapy
EXPLANATIONS:
(c) A. These findings are consistent with diabetes causing metabolic
acidosis.
(u) B. Hyperventilation would cause respiratory alkalosis.
(u) C. Metabolic acidosis without severe hypoxemia is inconsistent
with ventilatory failure.
(u) D. Excessive diuretic therapy causes metabolic alkalosis.
24
A patient is receiving 35% oxygen through an air-entrainment mask.
With an appropriate flow, the oxygen concentration measured in the
mask is 42%. Which of the following should a respiratory therapist do
FIRST?
A. Replace the air-entrainment mask.
B. Decrease the oxygen flow.
C. Assess the patency of the air-entrainment port.
D. Calibrate the oxygen analyzer and remeasure.
EXPLANATIONS:
(u) A. There is no immediate indication the mask is defective.
(u) B. Small changes in the oxygen flow will not have a significant
effect on the FIO2.
(c) C. The determinants of FIO2 in this device are the jet size and the
size of the entrainment ports. Any obstruction to the air-entrainment
port will increase the FIO2 by decreasing the volume of air entrained.
(a) D. Calibration is an unnecessary action unless the entrainment port
has been checked and found to be unobstructed.
25
A patient is receiving continuous mechanical ventilation. A
respiratory therapist determines by auscultation that the patient's
endotracheal tube is in the right mainstem bronchus. After
withdrawing the tube until breath sounds are equal bilaterally, the
therapist should FIRST
A. record this action in the patient's chart.
B. obtain a blood gas analysis.
C. suction the patient's airway.
D. notify the physician.
EXPLANATIONS:
(c) A. This will document and communicate the event to the healthcare
team.
(u) B. The problem is resolved and this would be an unnecessary
procedure.
(u) C. There is no indication the patient requires suctioning.
(u) D. The physician needs to be notified; however, the first action is to
record the findings in the chart.
26
An adult patient in the ICU is receiving beta-blocker medication and
requires bronchodilator therapy. Which of the following should a
respiratory therapist recommend?
A. cromolyn sodium (Intal)
B. albuterol (Proventil)
C. triamcinolone acetonide (Azmacort)
D. ipratropium bromide (Atrovent)
EXPLANATIONS:
(u) A. Cromolyn sodium is a mast cell stabilizer and is not a
bronchodilator.
(u) B. Albuterol is a beta receptor stimulator and may show reduced
efficacy in the presence of beta-blocking agents.
(u) C. Glucocorticoids are anti-inflammatory drugs that do not directly
achieve bronchodilation.
(c) D. Ipratropium bromide uses a different mechanism of action to
achieve bronchodilation.
27
Intracuff pressures on the tracheal wall in excess of 30 torr will cause
obstruction of
1. capillary flow.
2. venous flow.
3. arterial flow.
4. lymphatic flow.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. Capillary pressure is usually less than 30 torr.
2. True. Venous pressure is usually less than 30 torr.
3. False. Arterial flow would not be obstructed.
4. True. Lymphatic pressure is usually considerably less than 30 torr.
(u) A. Incomplete and incorrect response included
(c) B. Correct response
(u) C. Incomplete and incorrect response included
(u) D. Incomplete and incorrect response included
28
While manually ventilating an intubated patient during transport, a
respiratory therapist observes a significant decrease in SpO2. Which
of the following should the therapist do FIRST?
A. Increase the frequency of breaths.
B. Instill saline down the endotracheal tube.
C. Verify oxygen delivery to the resuscitator.
D. Reposition the oximeter probe.
EXPLANATIONS:
(u) A. Increasing the frequency of breaths will not improve the patient's
oxygenation status.
(u) B. Instilling saline may cause airway infection.
(c) C. During transport, the oxygen tubing may have become
disconnected and the lack of oxygen would cause a decrease in SpO2.
(h) D. Repositioning the probe will not change the patient's
oxygenation status.
29
A 21-year-old male patient with a diagnosis of status asthmaticus is
intubated and has been receiving mechanical ventilation. There is a
sudden increase in airway pressures. The patient is hemodynamically
stable and breath sounds are clear, but significantly decreased on the
right. Which of the following should the respiratory therapist
recommend?
A. Turn the patient onto his left side.
B. Withdraw the endotracheal tube 4 cm.
C. Order a portable chest radiograph.
D. Add 5 cm H2O PEEP.
EXPLANATIONS:
(u) A. The findings are consistent with a pneumothorax and changing
the patient's position would not address the underlying problem. This
would delay diagnosing the problem.
(h) B. Breath sounds are clear; there is no indication the tube is
malpositioned.
(c) C. A chest radiograph is the definitive diagnostic procedure to
determine the presence of a pneumothorax. If the patient were
unstable, a needle decompression would be indicated.
(h) D. Adding PEEP will exacerbate the problem.
30
A respiratory therapist is preparing to administer pentamidine
(NebuPent) to a patient. Which of the following devices should the
therapist select for this treatment?
A. small-volume nebulizer
B. ultrasonic nebulizer
C. filtered exhalation nebulizer
D. hydronamic nebulizer
EXPLANATIONS:
(u) A. A standard small-volume nebulizer does not have the necessary
environmental filter.
(u) B. An ultrasonic nebulizer does not have the necessary
environmental filter.
(c) C. A filtered exhalation nebulizer prevents environmental
contamination.
(u) D. A hydronamic nebulizer is a large-volume nebulizer and does not
have the necessary environmental filter.
31
An adult patient is receiving mechanical ventilation. Which of the
following should be recommended to improve oxygenation and
recruit collapsed alveoli?
A. PEEP
B. IMV mode
C. mechanical dead space
D. in-line suction system
EXPLANATIONS:
(c) A. Application of PEEP minimizes the potential for end-expiratory
alveolar collapse and then maintains the alveoli in an open position
because it exceeds the force of surface tension.
(h) B. During spontaneous breaths, the patient breathes at ambient
pressure; therefore, there is no mechanism to prevent alveoli from
collapsing. Collapsed alveoli contribute to
mismatching,
decreasing the PaO2.
(h) C. The use of mechanical dead space may impact the patient's
PaCO2; however, it has no impact on oxygenation and the recruitment
of collapsed alveoli.
(a) D. An in-line suction system may allow the maintenance of PEEP
throughout the ventilatory cycle; however, its primary purpose is to
remove accumulated secretions.
32
A new blood gas analyzer is calibrated by the manufacturer at sea
level. Upon receiving the new analyzer at a higher altitude, a
respiratory therapist should
A. proceed to analyze patient samples.
B. set the barometric pressure at sea level.
C. replace the electrodes.
D. recalibrate the blood gas analyzer.
EXPLANATIONS:
(u) A. See explanation D.
(u) B. The proper barometric pressure is necessary to obtain accurate
results.
(u) C. Electrodes do not need to be replaced prior to use of a new
analyzer.
(c) D. New blood gas analyzers must be calibrated at the site of use
before analyzing blood.
33
While receiving an FIO2 of 1.0 and a tidal volume of 400 mL during
volume-controlled ventilation, a 60-kg (132-lb) patient is having
difficulty achieving adequate oxygenation. To improve oxygenation, a
respiratory therapist should manipulate ventilator settings to increase
which of the following?
A. mean airway pressure
B. peak pressure
C. trigger sensitivity
D. expiratory time
EXPLANATIONS:
(c) A. Increasing the mean airway pressure improves distribution of
ventilation.
(u) B. Peak pressure would not be set in volume-controlled ventilation.
(u) C. Increasing the sensitivity will not influence oxygenation.
(h) D. Increasing the expiratory time may decrease oxygenation by
decreasing mean airway pressure.
34
A patient is receiving postural drainage, lung expansion therapy, and
directed cough to treat obstructive atelectasis. Which of the following
diagnostic procedures should be recommended to evaluate the
patient's response to respiratory care?
A. chest radiograph
B. computed tomography (CT scanning)
C. peak expiratory flow measurement
D. body plethysmography
EXPLANATIONS:
(c) A. The chest radiograph would be useful to assess improvement
and/or reversal of the atelectasis.
(u) B. CT scanning is an expensive and unnecessary method to assess
improvement in atelectasis.
(u) C. Measurement of PEF is of minimal value in assessing
improvement in atelectasis.
(u) D. Use of body plethysmography to assess improvement is not
indicated.
35
Which of the following would limit the usefulness of pulse oximetry?
1. methemoglobin
2. carboxyhemoglobin
3. widened pulse pressure
4. hypertension
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
EXPLANATIONS:
1. True. The pulse oximeter does not differentiate methemoglobin and
carboxyhemoglobin from oxyhemoglobin.
2. True. See statement 1.
3. False. A widened pulse pressure does not impact pulse oximetry.
4. False. Hypertension does not impact pulse oximetry.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incorrect response
36
A chest tube has been placed in the right pleural space of a patient
receiving volume-controlled ventilation and there is vigorous
bubbling in the water seal chamber. The low exhaled volume alarm
begins to sound. The exhaled tidal volume is two-thirds of the set
tidal volume. Which of the following should the respiratory therapist
do?
A. Perform endotracheal suctioning.
B. Decrease the exhaled tidal volume alarm setting.
C. Recommend a chest radiograph.
D. Manually ventilate the patient with 100% O2.
EXPLANATIONS:
(u) A. Tracheobronchial secretions would cause a loss of tidal volume
only if the high pressure limit is reached and the remainder of the tidal
volume is vented to the atmosphere.
(h) B. Decreasing the alarm setting will not address the problem.
(c) C. A chest radiograph will confirm suspicion of a pneumothorax.
(u) D. Manual ventilation will not restore tidal volume.
37
A respiratory therapist is setting up a blender to administer 40%
oxygen in the PICU. When the oxygen hose is connected to the wall
outlet, the blender alarm is activated. When the air hose is attached to
the outlet, the alarm continues. Which of the following should the
therapist do?
A. Remove the blender from service.
B. Set blender to 100% oxygen.
C. Notify the supervisor.
D. Replace the oxygen hose.
EXPLANATIONS:
(c) A. The blender is defective and should be taken out of service.
(u) B. Setting to 100% oxygen will not resolve the alarm.
(u) C. Notifying the supervisor will not solve the immediate problem.
(u) D. Replacing the oxygen hose will not solve the immediate
problem.
38
Which of the following should a respiratory therapist select to
determine the rapid-shallow breathing index?
A. vane respirometer
B. peak flowmeter
C. pressure manometer
D. water-seal spirometer
EXPLANATIONS:
(c) A. A vane respirometer is portable and accurate for the
measurement of minute ventilation in this situation.
(u) B. Minute ventilation cannot be measured using a peak flowmeter.
(u) C. Minute ventilation cannot be measured using a pressure
manometer.
(u) D. A water-seal spirometer is not portable.
39
To assess the effectiveness of CPR, a respiratory therapist should
periodically
A. palpate for tracheal deviation.
B. suction to ensure airway patency.
C. auscultate for bilateral breath sounds.
D. check for carotid pulse.
EXPLANATIONS:
(u) A. Tracheal position is not related to the effectiveness of CPR.
(u) B. While airway patency is essential, it does not demonstrate the
effectiveness of CPR.
(u) C. Bilateral breath sounds indicate adequate air exchange, but do
not demonstrate cardiovascular support.
(c) D. The objective of CPR is to establish perfusion and checking the
carotid pulse would provide information about the effectiveness of
CPR.
40
What is a major advantage of a heated wick humidifier compared with
other types of humidifiers?
A. The wick filters exhaled contaminants.
B. Both molecular and particulate water are delivered.
C. A relative humidity of 100% is easily produced.
D. A baffle is not needed to produce the desired humidity.
EXPLANATIONS:
(u) A. Exhaled gas does not pass through the humidifier.
(u) B. A wick humidifier produces water vapor only.
(c) C. Due to heating and a large damp surface area, high humidity is
produced.
(u) D. Since particulate water is not produced, a baffle is not
necessary.
41
A patient is receiving noninvasive positive pressure ventilation.
Pulmonary compliance has decreased over the past 4 hours. To
increase the patient's tidal volume, it would be most appropriate to
A. permit patient-triggered breaths.
B. change to CPAP.
C. decrease the inspiratory time.
D. increase the IPAP.
EXPLANATIONS:
(u) A. The mode of triggering does not affect tidal volume.
(h) B. CPAP would increase the patient's work of breathing and would
not necessarily increase the tidal volume.
(h) C. Decreasing the inspiratory time reduces the tidal volume.
(c) D. Increasing the IPAP increases the pressure gradient, which
would increase tidal volume.
42
Which of the following indicates a physical conditioning program has
been effective for a patient with COPD?
A. Resting pulse rate is the same after 1 month.
B. Level-walking distance has increased by 15%.
C. Vital capacity has increased by 5%.
D. Respiratory rate has increased by 2/min.
EXPLANATIONS:
(u) A. Increased conditioning usually results in a lower resting pulse
rate.
(c) B. An important part of physical conditioning is an increase in
exercise tolerance, easily measured by increased walking distance.
(u) C. Pulmonary function results do not normally improve with
pulmonary rehabilitation.
(a) D. Small changes in respiratory rate are normal.
43
A patient with a 7.0 mm ID endotracheal tube has copious, thin
secretions. Two hours later, despite unchanged physical findings,
only very small amounts of sputum are aspirated when the patient is
suctioned with a 14 Fr catheter and a pressure of -120 mm Hg. Which
of the following is the most appropriate action?
A. Increase the suction pressure to -200 mm Hg.
B. Instill 5 mL normal saline.
C. Change to a 16 Fr catheter.
D. Evaluate patency of the suction system.
EXPLANATIONS:
(h) A. A vacuum level of -200 mm Hg may be harmful to the patient.
(h) B. Instilling saline may increase the risk of airway infection.
(u) C. A 16 Fr catheter is too large for a patient with a 7.0 mm ID
endotracheal tube.
(c) D. Assuring the patency of the suction system will facilitate mucus
removal.
44
A respiratory therapist is reviewing a chest radiograph and notes the
presence of a chest tube. The patient has a hemothorax. Which of the
following locations is most appropriate for this chest tube to be
placed?
A. second intercostal space in the mid-clavicular line
B. third intercostal space in the mid-clavicular line
C. third intercostal space in mid-axillary line
D. fifth intercostal space in mid-axillary line
EXPLANATIONS:
(u) A. The second intercostal space in the mid-clavicular line is more
appropriate for a pneumothorax.
(u) B. The third intercostal space is more appropriate for a
pneumothorax.
(u) C. The third intercostal space in the mid-axillary line is too high to
drain a hemothorax.
(c) D. The fifth intercostal space in the mid-axillary line is appropriate
for draining fluid from the chest. A tube placed any higher than the
thorax may not adequately drain the fluid.
45
During which of the following should apnea monitoring be used for
an infant?
1.
2.
3.
4.
night time
breast feeding
naps
bathing
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
EXPLANATIONS:
1. True. The infant should be monitored during any sleep or when not
being directly observed.
2. False. Infants are usually awake and being directly observed during
feeding.
3. True. The infant should be monitored during any sleep or when not
being directly observed.
4. False. The infant is being directly observed during bathing and
apnea monitoring is not necessary.
(u) A. Incomplete and incorrect response included
(c) B. Correct response
(h) C. Incorrect response
(h) D. Incomplete and incorrect response included
46
Which pharmacological agents should the respiratory therapist
recommend for a patient with a temperature of 40° C (104° F)?
1. acetaminophen
2. ibuprofen
3. ketorolac (Toradol)
4. celecoxib (Celebrex)
A. 1 and 2 only
B. 1 and 4 only
C. 2 and 3 only
D. 3 and 4 only
EXPLANATIONS:
1. True. Acetaminophen reduces elevated temperatures.
2. True. Ibuprofen is used to treat fever.
3. False. Ketorolac is an NSAID that does not treat fever.
4. False. Celecoxib is used to treat arthritis pain and does not treat
fever.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(h) C. Incomplete and incorrect response included
(h) D. Incorrect response
47
A physician orders an FIO2 of 0.40 for a premature infant in an open
bed with a radiant warmer. Which of the following delivery devices
should a respiratory therapist select?
A. air-entrainment mask
B. oxygen hood
C. infant nasal cannula
D. simple mask
EXPLANATIONS:
(h) A. The FIO2 delivered with an air-entrainment mask will be adequate,
but this is not the appropriate delivery system for an infant. The flow is
too high and will adversely affect body temperature.
(c) B. The oxygen hood will deliver a precise FIO2. It will allow
maintenance of a neutral thermal environment and allow access for
nursing care.
(u) C. The FIO2 of an infant nasal cannula is variable, based on minute
ventilation and liter flow.
(h) D. The FIO2 delivered with a simple mask is variable and could
exceed 40% in a premature infant.
48
A patient with COPD is receiving mechanical ventilation. The patient
continues to wheeze despite treatment with albuterol. Peak airway
pressure is increased with no change in plateau pressure. A
respiratory therapist should recommend
A. obtaining a chest radiograph.
B. administering furosemide (Lasix).
C. obtaining an arterial blood gas analysis.
D. administering ipratropium bromide (Atrovent).
EXPLANATIONS:
(u) A. A chest radiograph provides only anatomic abnormality
information, not evaluation of functional status.
(u) B. Furosemide is a diuretic and administration will not treat the
increased airways resistance.
(h) C. Information from an arterial blood gas analysis will not assist in
the treatment of the increased airways resistance.
(c) D. Ipratropium bromide treats bronchoconstriction by a mechanism
different from albuterol and should decrease airways resistance.
49
Prior to immersing equipment in alkaline glutaraldehyde, a
respiratory therapist checks the solution with a test strip. The test
strip indicates a failure when compared to the color chart on the
container. The therapist should
A. add 40 mEq/L of bicarbonate.
B. add 100 mL of sterile water.
C. reactivate the solution.
D. replace the solution.
EXPLANATIONS:
(h) A. Adding bicarbonate will not change the concentration of
glutaraldehyde and the solution will not sterilize the items.
(h) B. Adding sterile water will dilute the concentration of the
glutaraldehyde further and will not provide conditions necessary for
sterilization.
(u) C. There is no process for reactivating the solution.
(c) D. The failure indicates the concentration of glutaraldehyde is
below the minimum effective concentration and should be replaced.
50
Which of the following should be used to determine the return of a
postoperative patient's ability to breathe adequately after anesthesia?
A. venous PO2
B. MIP
C. MVV
D. pulse oximetry
EXPLANATIONS:
(u) A. Venous PO2 is primarily a function of cardiac output and oxygen
consumption.
(c) B. MIP is a measurement that reflects inspiratory muscle strength.
(a) C. Although MVV can assess the ability to ventilate, it requires too
much cooperation and effort for a patient in this setting.
(a) D. Pulse oximetry reflects adequacy of oxygenation, but not the
ability to ventilate.
51
A respiratory therapist is asked to position a patient for orotracheal
intubation. The therapist should place the patient's head
A. in the sniffing position.
B. with the neck hyperextended.
C. tilted forward toward the chest.
D. turned to the right.
EXPLANATIONS:
(c) A. The sniffing position provides optimal alignment of the upper
airway.
(u) B. Hyperextending the neck may result in partial occlusion of
visualization of the airway.
(u) C. Tilting the head toward the chest closes off access to the airway.
(u) D. Turning the head toward the right is not the optimal position for
intubation.
52
A spontaneously breathing adult patient is intubated with a 6.0 mm ID
endotracheal tube. Which of the following will decrease the patient's
work of breathing imposed by the endotracheal tube?
A. CPAP
B. pressure support
C. flow-by
D. inspiratory pause
EXPLANATIONS:
(u) A. CPAP is indicated for the treatment of refractory hypoxemia.
(c) B. PSV decreases the work of breathing while boosting
spontaneous VT.
(u) C. Flow-by allows for high flow availability during spontaneous
breathing, but does not decrease the work of breathing.
(u) D. Inspiratory pause allows for better distribution of ventilation.
53
Which of the following agents is appropriate to recommend for use in
the cleaning of home respiratory care equipment?
A. quaternary ammonium compound
B. alkaline glutaraldehyde
C. acetic acid
D. isopropyl alcohol
EXPLANATIONS:
(u) A. Quaternary ammonium and isopropyl alcohol are inadequate
disinfectants for home equipment.
(u) B. The caustic properties of glutaraldehyde make it undesirable for
home use.
(c) C. Vinegar (acetic acid) is effective and commonly recommended
for home use.
(u) D. See explanation A.
54
A patient is orally intubated with a size 7.0 mm ID endotracheal tube.
The respiratory therapist uses a size 14 Fr suction catheter to suction
the patient's airway. The suction setting is -100 mm Hg. The therapist
notices the patient's secretions are thick and tenacious and will not
aspirate through the suction catheter. Which of the following should
the therapist do FIRST?
A. Use a size 16 Fr catheter.
B. Administer acetylcysteine (Mucomyst).
C. Change the suction setting to -120 mm Hg.
D. Apply continuous suction to the patient's airway.
EXPLANATIONS:
(h) A. A size 16 Fr catheter is more than one-half the diameter of the ET
tube. The standard is to multiply the inner tube diameter by 2, then use
the next smallest size.
(a) B. Acetylcysteine (Mucomyst) should be considered after attempts
to clear the secretions with an increased vacuum pressure have not
been successful.
(c) C. A change in the vacuum pressure may improve aspiration of the
secretions through the catheter and should be attempted first.
(h) D. Continuous suction will cause suction-induced hypoxemia
because the patient is unable to inhale around the catheter.
55
A physician orders an FIO2 of 0.40 for a premature infant in an
incubator. Which of the following delivery devices should the
respiratory therapist select?
A. air-entrainment mask
B. oxygen hood
C. nasal cannula
D. simple mask
EXPLANATIONS:
(h) A. The FIO2 delivered with an air-entrainment mask will be adequate,
but this is not the appropriate delivery system for an infant. The flow is
too high and will decrease body temperature.
(c) B. The oxygen hood will deliver a precise FIO2. It will allow
maintenance of a neutral thermal environment and allow access for
nursing care.
(u) C. The FIO2 of a nasal cannula is variable, based on minute
ventilation and liter flow.
(h) D. The FIO2 delivered with a simple mask is variable and may
exceed 40% in a premature infant.
56
A 5-year-old child is receiving mechanical ventilation with the
following settings:
FIO2
0.21
Mandatory rate 25
Tidal volume
250 mL
A heat moisture exchanger is attached at the circuit Y and the peak
pressure increases while the plateau pressure remains stable. Which
of the following should be recommended at this time?
A. Change to a heated humidifier.
B. Initiate chest physiotherapy.
C. Increase the set tidal volume to 300 mL.
D. Increase the FIO2 to 0.35.
EXPLANATIONS:
(c) A. The heat moisture exchanger has resulted in increased
resistance in the breathing circuit. Changing to a heated humidifier will
correct the problem.
(u) B. An increase in the peak airway pressure alone is not an
indication for chest physiotherapy.
(h) C. Increasing the tidal volume will cause the peak pressure to rise
even further and expose the child to potential barotrauma and
hyperventilation.
(u) D. The FIO2 has nothing to do with the increase in peak airway
pressure and will do nothing to address the problem.
57
While assessing a patient who is receiving oxygen at 2 L/min through
a transtracheal catheter, the patient complains the supply tubing
keeps popping off of the catheter. Which of the following actions
should a respiratory therapist take to correct this problem?
A. Decrease the flow of oxygen.
B. Check the catheter for obstruction.
C. Perform endotracheal suctioning.
D. Tape the connection securely.
EXPLANATIONS:
(h) A. Decreasing the flow would not correct the problem and could
possibly affect the patient's oxygenation.
(c) B. The catheter is obviously obstructed with mucus or kinked,
resulting in significant back pressure causing the supply tube to pop
off.
(u) C. Endotracheal suctioning would not clear an obstruction in the
transtracheal catheter.
(h) D. Taping the connection would not correct the problem and could
be potentially harmful to the patient.
58
Digital clubbing can be most easily assessed by
A. palpating the proximal digital joints.
B. inspecting the angulation of the nail bed.
C. examining the fingers for evidence of hyperflexion.
D. comparing the symmetry fingers on one hand to the opposite
hand.
EXPLANATIONS:
(u) A. Clubbing does not involve the joints. Clubbing causes an
increased angle between the nailbed and the finger, as well as an
increase in the diameter of the terminal portion of the finger.
(c) B. In clubbing, the angle between the nail bed and the finger
becomes increased in the digits.
(u) C. Hyperflexion does not occur with clubbing of the digits.
(u) D. The symmetry of the fingers is not an accurate assessment of
digital clubbing.
59
Auscultation of the chest over a pneumothorax is most likely to
reveal
A. bronchial breathing.
B. diminished breath sounds.
C. vesicular breath sounds.
D. crackles.
EXPLANATIONS:
(u) A. Bronchial breath sounds are loud, high pitched, and tubular.
They are normally heard over the trachea and also heard when
atelectasis or consolidation is present.
(c) B. Diminished breath sounds are consistent with decreased
alveolar ventilation. Pneumothorax or air in the pleural space reduces
sound transmission through the chest wall.
(u) C. Vesicular breath sounds are normal soft, low-pitched breath
sounds heard over the alveoli in the periphery of the lungs.
(u) D. Crackles are abnormal breath sounds that are produced with the
presence of moisture or mucus in the small airways or by the opening
of peripheral airways or collapsed alveoli.
60
An adult patient is intubated after being pulseless for several
minutes. An exhaled CO2 detection device indicates 0.03% CO2
despite confirmation of tracheal placement with bilateral breath
sounds and chest rise. Which of the following should a respiratory
therapist recommend to rapidly confirm correct endotracheal tube
placement?
A. direct laryngoscopy
B. another CO2 detection device
C. stat chest radiograph
D. pulse oximetry
EXPLANATIONS:
(c) A. Direct visualization of the larynx with a laryngoscope will
confirm the tube has passed through the cords.
(h) B. It is unlikely that the CO2 detector is not functioning correctly.
Since the patient has been pulseless for several minutes, the amount
of CO2 exhaled will be significantly reduced as the pulmonary blood
flow is minimal.
(h) C. A chest radiograph would confirm placement of the endotracheal
tube, however an unacceptable amount of time would be required to
complete this procedure.
(h) D. Pulse oximetry would offer no guidance with this pulseless
patient.
61
Which of the following activities must occur as part of tracheostomy
decannulation in a 3-month-old infant?
1. Document airway patency during sleep and activity.
2. Add a Passy-Muir valve.
3. Insert a fenestrated tracheostomy tube.
4. Verify the time of last feeding.
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. True. The ability to ventilate adequately during sleep and periods of
wakefulness must be assessed and documented.
2. False. A Passy-Muir valve may increase the infant's work of
breathing and would not provide useful information.
3. False. A fenestrated tracheostomy tube is not available for infants.
4. True. The infant's stomach must be empty to minimize the risk of
aspiration during the procedure.
(u) A. Incomplete and incorrect response included
(c) B. Correct response
(u) C. Incorrect response
(u) D. Incomplete and incorrect response included
62
A respiratory therapist is assisting with an intubation of a morbidly
obese patient. Intubation is difficult and the airway is secured only
after many attempts. Which of the following medications should be
administered?
A. albuterol
B. cromolyn sodium (Intal)
C. dexamethasone (Decadron)
D. aspirin
EXPLANATIONS:
(u) A. There is no indication for albuterol.
(u) B. There is no indication for Intal.
(c) C. Steroid administration may be used for airway edema after
difficult intubation.
(u) D. NSAIDs are anti-inflammatory agents, however would not be
useful for airway edema.
63
A physician orders smoking cessation counseling for a 60-year-old
male newly diagnosed with COPD. He has returned for a 1 month
follow-up visit with the following ABG results:
Based on this information, a respiratory therapist should conclude
which of the following regarding the success of the smoking
cessation counseling?
A. Results reflect no smoking or environmental exposure.
B. Results reflect smoking or environmental exposure.
C. Results are inconclusive.
D. Results reflect inaccurate data.
EXPLANATIONS:
(u) A. See explanation B.
(c) B. A COHb of >3% is still indicative of smoking or environmental
exposure.
(u) C. See explanation B.
(u) D. See explanation B.
64
Which of the following should a respiratory therapist use to
determine a neonate's gestational age?
A. APGAR
B. Glasgow
C. Dubowitz
D. Silverman
EXPLANATIONS:
(u) A. The APGAR score assesses adaptation to extra-uterine life.
(u) B. The Glasgow score is a neurological assessment tool.
(c) C. The Dubowitz score uses physical characteristics to determine
gestational age.
(u) D. The Silverman scale indicates the level of respiratory distress.
65
A 20-year-old patient with an acute asthma exacerbation is receiving
2.5 mg of albuterol by hand-held nebulizer. During the treatment, the
patient complains of palpitations and has a heart rate of 140/min.
Which of the following should the respiratory therapist recommend
for the next treatment?
A. Change to a fluticasone propionate/salmeterol (Advair Diskus).
B. Change to 0.63 mg of levalbuterol (Xopenex).
C. Change to 3 puffs of beclomethasone (Vanceril).
D. Administer the treatment with saline.
EXPLANATIONS:
(h) A. Changing to a dry powder inhaler is not appropriate for a patient
with an acute exacerbation.
(c) B. Changing to levalbuterol should decrease the incidence of
tachycardia.
(u) C. Beclomethasone is not a bronchodilator and would not provide
acute relief to the patient.
(h) D. Administering saline will not provide treatment for this patient's
condition.
66
Which of the following is the most common side effect of aerosolized
albuterol?
A. tremor
B. tachypnea
C. dilated pupils
D. bradycardia
EXPLANATIONS:
(c) A. As a sympathomimetic agent, albuterol will stimulate not only
the bronchial muscle beta2-receptors, but will also stimulate the
peripheral neuromuscular receptors resulting in tremor.
(u) B. Albuterol does not cause an increased respiratory rate.
(u) C. Dilated pupils are not a side effect of albuterol.
(u) D. Albuterol will stimulate the beta1-receptors found mainly in heart
muscle and result in tachycardia, not bradycardia.
67
While interviewing a patient prior to starting therapy, a respiratory
therapist notes a patient arouses easily. This will help the therapist
determine the patient's
A. emotional state.
B. level of consciousness.
C. ability to protect the airway.
D. orientation to time, place, and person.
EXPLANATIONS:
(u) A. Emotional status is not related to arousability.
(c) B. Arousal reflects a person's consciousness.
(u) C. A patient may be arousable but may not be able to protect the
airway, such as in neuromuscular disease.
(u) D. A patient may be arousable but may not be oriented.
68
A patient with asthma presents in severe respiratory distress. The
patient has tachypnea and demonstrates accessory muscle use.
Breath sounds reveal bilateral expiratory wheezes and SpO2 is 87%. A
respiratory therapist should recommend a bronchodilator by
A. MDI with a spacer.
B. hand held nebulizer powered by oxygen.
C. MDI without a spacer.
D. updraft nebulizer powered by air.
EXPLANATIONS:
(u) A. A patient in severe distress will most likely be unable to
coordinate an MDI.
(c) B. The patient is in distress and SpO2 is 87%, and oxygen should be
used to power the nebulizer.
(u) C. A patient in severe distress will most likely be unable to
coordinate an MDI.
(u) D. Although an updraft nebulizer would be the best choice for
administering a bronchodilator, the patient has a SpO2 of 87%, so
oxygen should be administered.
69
Noninvasive positive pressure ventilation is most likely indicated for
a patient with respiratory failure from
A. ARDS.
B. drug overdose.
C. aspiration pneumonitis.
D. COPD.
EXPLANATIONS:
(a) A. While noninvasive positive pressure ventilation may be effective,
it would delay conventional therapy requiring intubation and PEEP.
(u) B. Drug overdose patients are prone to aspiration and require
intubation.
(u) C. In patients with aspiration pneumonitis, noninvasive ventilation
may lead to further aspiration.
(c) D. Patients with COPD may respond well to noninvasive positive
pressure ventilation by increasing alveolar ventilation.
70
An 80-kg (176-lb) patient who has undergone a pneumonectomy is
receiving volume-controlled ventilation with the following settings:
The following arterial blood gas results are available:
A respiratory therapist should recommend
A. changing to the SIMV mode.
B. initiating PEEP of 10 cm H2O.
C. maintaining current therapy.
D. increasing the tidal volume.
EXPLANATIONS:
(u) A. Changing to the SIMV mode and retaining the same settings
would likely result in a reduction in ventilation.
(h) B. PEEP of 10 cm H2O is not indicated because of the presence of a
bronchial stump.
(c) C. Although the patient has a mild respiratory acidosis, the values
are acceptable for this patient.
(h) D. Increasing the tidal volume is not indicated due to the presence
of a bronchial stump.
71
A patient with ARDS is receiving volume-controlled ventilation and
the following are observed:
Protective lung strategy is instituted with pressure control using a
PIP of 28 cm H2O, inspiratory time of 1.3 sec, and RR 14. Which of the
following alarms should be adjusted?
A. low tidal volume
B. low PEEP
C. line pressure
D. I:E ratio
EXPLANATIONS:
(c) A. With a decrease of 14 cm H2O in pressure, the tidal volume would
be lower.
(u) B. The PEEP has not been changed, therefore there is no indication
to adjust the alarm.
(u) C. The line pressure is internally set and is not adjustable.
(u) D. I:E is internally set and is not adjustable.
72
A respiratory therapist is evaluating a patient receiving pressurecontrolled ventilation with a mandatory rate of 18/min. The patient's
total respiratory rate is 32/min. Which of the following should slow
this patient's breathing frequency?
A. decreasing sensitivity
B. increasing inspiratory flow
C. decreasing expiratory pressure
D. increasing inspiratory pressure
EXPLANATIONS:
(u) A. Manipulating the sensitivity will alter the pressure at which the
machine responds to patient effort and will not decrease breathing
frequency for a spontaneously breathing patient.
(u) B. Inspiratory flow cannot be manipulated in pressure-controlled
ventilation.
(u) C. Decreasing the expiratory pressure will have no effect on the
patient's respiratory rate.
(c) D. Increasing the inspiratory pressure will increase the tidal
volume, which will meet the patient's demand and lead to a decrease in
breathing frequency.
73
A 70-kg (154-lb) patient has been weaned from mechanical ventilation
to a T-piece and aerosol with an FIO2 of 0.30. The patient is awake and
alert. The following information is available:
Which of the following is the most appropriate recommendation?
A. Maintain current therapy.
B. Initiate bronchodilator therapy.
C. Perform a dead space study.
D. Extubate the patient.
EXPLANATIONS:
(u) A. The patient's ventilatory parameters along with the
accompanying arterial blood gas results indicate that continuing
current therapy is unnecessary.
(u) B. There is no indication for bronchodilator therapy.
(u) C. A dead space study is time consuming and unnecessary based
on the ventilatory parameters and accompanying arterial blood gas
results.
(c) D. The ventilatory parameters and the accompanying arterial blood
gas results indicate the patient is ready for extubation.
74
A 32-week gestational age newborn presents to the NICU with the
following findings:
-Decreased breath sounds on the right side
-Hyperresonance on the right side of the chest
-Mediastinal shift to the left side
-Moderate dyspnea and central cyanosis
Which of the following are appropriate treatments at this time?
1. chest tube placement on the right side
2. chest tube placement on the left side
3. intubation and mechanical ventilation
4. 100% oxygen delivery
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. True. Insertion of a chest tube on the right side is indicated for right
pneumothorax.
2. False. Pneumothorax is on the right, not the left side.
3. False. There is no indication for mechanical ventilation at this time,
unless the patient does not improve after chest tube placement.
4. True. High FIO2 is indicated for treatment of central cyanosis.
(h) A. Incomplete and incorrect response included
(c) B. Correct response
(h) C. Incorrect response
(h) D. Incomplete and incorrect response included
75
While administering an IPPB treatment at 20 cm H2O to a patient with
COPD, a respiratory therapist notes the patient has suddenly become
very short of breath and cyanotic. The therapist's most appropriate
action is to
A. suction the patient.
B. terminate the treatment.
C. decrease the peak pressure to 10 cm H2O.
D. stop the treatment for 10 to 20 minutes.
EXPLANATIONS:
(h) A. There is neither evidence of increased secretions, nor the
patient's inability to cough effectively. Therefore, suctioning this
patient is not indicated.
(c) B. The treatment should be discontinued because the patient is
demonstrating severe respiratory distress of unknown etiology.
Determining the cause of the distress is of the utmost importance.
(h) C. Decreasing the peak pressure would not identify the cause of the
distress and may worsen the patient's condition.
(h) D. Temporarily stopping the treatment will not correct the problem.
76
Two hours after extubation, a patient develops inspiratory stridor and
respiratory distress. A treatment with aerosolized racemic
epinephrine decreases the inspiratory stridor and relieves the
patient's distress. The most likely source of the airway problem is
A. tracheal ulceration.
B. subglottic edema.
C. tracheal stenosis.
D. bronchospasm.
EXPLANATIONS:
(u) A. Tracheal ulceration will cause bleeding, not stridor.
(c) B. Subglottic edema can cause stridor and respiratory distress,
which may be relieved by the vasoconstrictor effects of racemic
epinephrine.
(u) C. Tracheal stenosis may cause both inspiratory and expiratory
wheezing, which are nonresponsive to racemic epinephrine.
(u) D. Bronchospasm causes wheezing, not stridor.
77
A 37-year-old, 80-kg (IBW) trauma patient is receiving mechanical
ventilation with the following settings:
The patient's total rate is 28/min with an average spontaneous tidal
volume of 225 mL. A respiratory therapist notes frequent high
pressure alarms and the HME has become contaminated with bloody
secretions. Bilateral breath sounds are diminished but clear. Which of
the following should the therapist do?
A. Replace the HME.
B. Instill 5.0 mL of acetylcysteine (Mucomyst).
C. Change to a heated wick humidifier.
D. Increase the high pressure alarm by 10 cm H2O.
EXPLANATIONS:
(u) A. The presence of bloody secretions is a contraindication for use
of an HME.
(h) B. The patient has clear breath sounds without any adventitious
sounds. Instillation of Mucomyst is not indicated and may worsen
hemoptysis.
(c) C. The presence of bloody secretions and small tidal volumes that
approach deadspace volumes are contraindications for use of an HME.
The humidification system should be modified by changing to a heated
wick humidifier.
(h) D. The high-pressure alarm sounding indicates that ventilation is
compromised. Increasing the alarm setting may place the patient in
danger of hypoventilation and hypoxemia.
78
While assisting a physician using a synchronous defibrillator for
cardioversion, the unit does not discharge. A respiratory therapist
should check the
1. charge level of the defibrillator.
2. presence of a P wave.
3. chest lead connections.
4. contact gel on the paddles.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. The defibrillator will not function if it is not properly charged.
2. False. The defibrillator must identify an R wave to synchronize the
discharge.
3. True. The defibrillator will not discharge if the chest leads are
disconnected.
4. True. Contact between the body surface and the paddles is
necessary to complete the circuit and allow discharge.
(u) A. Incomplete and incorrect response included
(u) B. Incomplete and incorrect response included
(c) C. Correct response
(u) D. Incomplete and incorrect response included
79
A patient who had a stroke missed a bronchodilator treatment
because he was in the physical therapy department. To assure that
the patient receives future treatments, a respiratory therapist should
A. coordinate the treatment schedules.
B. recommend continuous bronchodilator therapy.
C. inform the physician of the conflicting schedules.
D. defer respiratory therapy until the course of physical therapy is
completed.
EXPLANATIONS:
(c) A. Coordination of treatment schedules with other healthcare
providers ensures compliance with treatment requirements.
(h) B. Continuous bronchodilator therapy is not indicated and could be
harmful to the patient.
(u) C. The physician may be informed, but coordination of treatment
schedules by the therapist is a priority for patient compliance.
(h) D. Deferring treatment could be harmful to the patient.
80
A respiratory therapist auscultates a patient's chest and identifies the
presence of diffuse expiratory wheezing. This indicates
A. laryngeal edema.
B. bronchospasm.
C. vesicular breathing.
D. secretions.
EXPLANATIONS:
(u) A. Laryngeal edema will produce inspiratory stridor.
(c) B. Bronchospasm produces a wheezing sound as a result of gas
flow through narrowed airways.
(u) C. Vesicular breathing is normal.
(u) D. Secretions would be noted by the presence of coarse crackles.
81
A 30-year-old male is transported by EMS for a suspected drug
overdose. He is unresponsive with a respiratory rate of 10/min. A
respiratory therapist draws a sample of arterial blood for analysis and
obtains the following data:
Which of the following would most suggest the presence of acute
ventilatory failure in this patient?
A. PaCO2
B. PaO2
C. SaO2
D. COHgb
EXPLANATIONS:
(c) A. PaCO2 increase is the best indicator of ventilatory failure.
(u) B. PaO2 only an indirect indicator of ventilatory failure.
(u) C. SaO2 is only an indirect indicator of ventilatory failure, and is not
abnormal.
(u) D. COHgb doesn't indicate ventilatory failure, and is not abnormal.
82
At an FIO2 of 0.21, arterial blood gas results below are reported for a
patient with COPD and dyspnea:
The most appropriate oxygen therapy for this patient is
A. nasal cannula at 4 L/min.
B. simple mask at 8 L/min.
C. 28% air-entrainment mask.
D. 40% aerosol face tent.
EXPLANATIONS:
(h) A. The delivered FIO2 with a nasal cannula at 4 L/min may decrease
the patient's hypoxic drive and lead to further hypoventilation.
(h) B. A simple mask can provide an FIO2 of 0.40 to 0.60 and potentially
decrease the patient's hypoxic drive so that further hypoventilation
would occur.
(c) C. An air-entrainment mask can provide a consistent and reliable
FIO2. An FIO2 of 0.28 would reduce hypoxemia with minimal reduction
in hypoxic drive.
(h) D. An aerosol face tent can provide an FIO2 of up to 0.40 and
potentially decrease the patient's hypoxic drive so that further
hypoventilation would occur.
83
Which of the following devices is required for airborne precautions?
A. N-95 face mask
B. vinyl gloves
C. barrier gown
D. full face shield
EXPLANATIONS:
(c) A. An N-95 face mask will provide protection against airborne
microorganisms.
(u) B. Protection against inspiration of fine particles is not achieved by
vinyl gloves, a barrier gown, or a full face shield.
(u) C. See explanation B.
(u) D. See explanation B.
84
During IPPB therapy, a patient complains of dizziness and tingling
sensations in her fingers. Which of the following should a respiratory
therapist record in the patient's chart?
1. the family's reaction to the patient's complaint
2. the patient's vital signs before and after the treatment
3. the patient's symptoms
4. medication administered during the treatment
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. False. This information is not relevant to the patient's care.
2. True. Vital signs are needed to properly assess the effect of the
treatment on the patient's cardiovascular system.
3. True. Adverse events should be documented in the patient record.
4. True. It is a standard of care to document any administered
medications.
(u) A. Incomplete and incorrect response included
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(c) D. Correct response
85
Tracheal secretions tend to dry in an intubated patient when inspired
air has which of the following characteristics?
1. an absolute humidity of 25 mg/L
2. a water vapor pressure of 47 torr
3. a dew point of 37° C (98.6° F)
4. a relative humidity of 100% at 22° C (71.6° F)
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. True. Tracheal absolute humidity must be 30 mg/L.
2. False. A water vapor pressure of 47 torr provides 100% humidity at
body temperature.
3. False. A dew point of 37° C (98.6° F) indicates the gas is completely
saturated at that temperature.
4. True. The absolute humidity under these conditions is inadequate.
(u) A. Incomplete and incorrect response included
(c) B. Correct response
(u) C. Incorrect response
(u) D. Incomplete and incorrect response included
86
Which of the following is the maximum amount of air that can be
exhaled from the maximum inspiratory level?
A. vital capacity
B. residual volume
C. functional residual capacity
D. expiratory reserve volume
EXPLANATIONS:
(c) A. Vital capacity is the maximum volume exhaled after a maximum
inhalation.
(u) B. Residual volume is the volume remaining in the lungs and
airways after maximum exhalation.
(u) C. Functional residual capacity is the volume of gas remaining in
the lungs and airways at the end of a resting tidal exhalation.
(u) D. Expiratory reserve volume is the maximum volume of air that
can be exhaled from the end tidal volume.
87
What maximum inspiratory pressure (MIP) should a patient be able to
generate before attempting extubation?
A. -5 cm H2O
B. -10 cm H2O
C. -15 cm H2O
D. -20 cm H2O
EXPLANATIONS:
(u) A. This is below the suggested value for an extubation attempt.
(u) B. See explanation A.
(u) C. See explanation A.
(c) D. A MIP of -20 cm H2O is the suggested minimum value required to
sustain spontaneous ventilation following an extubation attempt.
88
IPPB therapy is initiated for a patient with a fenestrated tracheostomy
tube. A respiratory therapist notes the IPPB machine will not cycle
into the expiratory phase. Which of the following actions will most
effectively correct this problem and achieve therapeutic goals for this
patient?
A. Insert a larger tracheostomy tube and secure it to the patient's
neck.
B. Increase pressure in the cuff and increase the sensitivity
setting.
C. Increase the peak pressure and decrease the inspiratory flow.
D. Insert the nonfenestrated inner cannula and inflate the cuff.
EXPLANATIONS:
(u) A. A larger tracheostomy tube is not indicated at this time and will
not correct the leak.
(h) B. Increasing the pressure in the cuff will not close the open
fenestration and improperly set sensitivity would increase difficulty of
initiating a breath.
(u) C. Increasing the peak pressure and decreasing the inspiratory flow
will make it more difficult to cycle into the expiratory phase.
(c) D. The reason the device will not cycle into the expiratory phase is
that the fenestration creates a large leak. Inserting the nonfenestrated
inner cannula and inflating the cuff will close the sources of leak.
89
A patient receiving mechanical ventilation who has a total rate of
20/min and an I:E of 1:1.5 will have which of the following inspiratory
and expiratory times?
Inspiratory
Expiratory Time
(sec)
(sec)
A.
1.0
2.0
B.
1.2
1.8
C.
1.3
1.7
D.
1.5
3.0
EXPLANATIONS:
(u) A. See explanation B for correct calculation.
(c) B. The correct calculation is:
First divide 20/min into 60 sec, which indicates the total cycle time of 3
seconds per breath. Add the parts of the I:E ratio to obtain the number
of I:E units: 1 + 1.5 = 2.5 I:E units. Divide the total cycle time by the
number of I:E units. This gives you the inspiratory time (3 / 2.5 = 1.2
sec). Then, subtract inspiratory time from total cycle time to determine
the expiratory time: 3.0 - 1.2 = 1.8 sec.
(u) C. See explanation B for correct calculation.
(u) D. See explanation B for correct calculation.
90
A respiratory therapist observes a patient has no chest excursion
during the initial attempt to ventilate a patient while performing CPR.
The therapist should FIRST
A. give four back blows in rapid succession and sweep the
mouth.
B. intubate the patient and manually ventilate.
C. reposition the patient's head and attempt to ventilate again.
D. continue ventilations and compressions.
EXPLANATIONS:
(u) A. Back blows in rapid succession is not indicated initially.
Repositioning the head and reattempting ventilation is indicated.
(u) B. While intubation is an option, it is not indicated initially.
Repositioning the head and reattempting ventilation is indicated.
(c) C. During the initial attempt to ventilate a patient while performing
CPR, when observing no chest excursion, the first thing the therapist
should do is reposition the head and try to ventilate once again.
(h) D. Continuing to attempt ventilation in this situation could result in
serious hypoventilation on the part of the patient.
91
While analyzing an arterial blood gas sample from a patient breathing
air, the measured PaO2 value is 170 torr. Which of the following
should a respiratory therapist do FIRST?
A. Recommend sedating the patient.
B. Report the result to the physician.
C. Recalibrate the blood gas analyzer.
D. Correlate the accuracy of the PaO2 by pulse oximetry.
EXPLANATIONS:
(h) A. Sedating the patient may be harmful and will not correct the
analysis problem.
(u) B. The sample result should be questioned before reporting
potential inaccurate clinical data to the physician for decision making.
(c) C. The sum of PaCO2 and PaO2 cannot exceed 149 torr while
breathing air; therefore, a PaO2 of 170 is not possible.
(u) D. Pulse oximetry does not analyze PaO2 values.
92
An increase in which of the following will decrease the work of
breathing associated with spontaneous breathing through a ventilator
circuit?
A. peak flow
B. sensitivity
C. PEEP
D. pressure support
EXPLANATIONS:
(u) A. Changing the flow is not critical to this patient's respiratory
management because the patient is spontaneously breathing.
(u) B. This patient is breathing spontaneously. Increasing the
sensitivity setting may cause the ventilator to auto-trigger.
(u) C. Increasing the PEEP may increase the work of breathing in a
patient who is spontaneously breathing.
(c) D. Increasing the pressure support is useful to overcome the added
work of breathing imposed by artificial airways and the ventilator
circuit.
93
Which of the following is consistent with adequate respiratory muscle
strength for weaning from ventilatory support?
A.
of 35%
B. VD/VT of 35%
C. rapid shallow breathing index of 120
D. maximum inspiratory pressure (MIP) of -48 cm H2O
EXPLANATIONS:
(u) A. This is a measure of efficiency of oxygenation.
(u) B. This is a measure of dead space.
(u) C. This is a measure of respiratory muscle endurance. An index
less than 105 is associated with successful extubation.
(c) D. This is a measure of respiratory muscle strength. Any value
greater than -20 to -30 cm H2O indicates adequate muscle strength.
94
An adult patient is receiving volume-controlled ventilation and has a
tidal volume of 700 mL. The patient's pH is 7.38. The patient is
switched to pressure-controlled ventilation. Exhaled tidal volume is
now approximately 850 mL. A respiratory therapist should
recommend
A. setting the PEEP at 5 cm H2O.
B. maintaining the current settings.
C. increasing the inspiratory time.
D. decreasing the pressure setting.
EXPLANATIONS:
(u) A. Initiating PEEP is not indicated for this patient.
(h) B. Maintaining the settings could hyperventilate the patient.
(u) C. Tidal volume will be unaffected or increase with this change.
Acid-base status was normal before, so a similar VT is desired.
(c) D. Since the acid-base status was normal with the tidal volume of
700 mL, a reduction in the pressure limit is indicated to achieve the
similar tidal volume.
95
A patient with a laryngeal tumor is presently receiving 80%/20%
helium-oxygen by a nonrebreathing mask at 5 L/min. The patient is
alert, but appears agitated. Vital signs indicate a HR of 130/min, RR at
30/min, and a BP of 140/90 mm Hg. Which of the following is the most
appropriate action to take?
A. Recommend sedating the patient.
B. Change to 70/30% helium oxygen.
C. Increase the gas flow to the mask.
D. Recommend nebulized racemic epinephrine.
EXPLANATIONS:
(h) A. Initiating sedation could further reduce the patient's ability to
provide adequate ventilation.
(a) B. Increasing the FIO2 may improve oxygenation, but does not
address the insufficient flow to the mask.
(c) C. The flow to the mask is insufficient and will result in dilution of
both the oxygen and helium concentrations with air. Increasing the
flow will ensure the patient receives the desired gas mixture.
(h) D. Administering racemic epinephrine will have no effect on the
obstruction caused by the laryngeal tumor.
96
A patient who is a victim of a residential fire is brought to the
emergency department and is receiving oxygen by nasal cannula 8
L/min. The SpO2 is 100%. Arterial blood gas results are as follows:
A respiratory therapist should adjust the FIO2 and change the mode of
administration to
A. 0.28 with an air-entrainment mask system.
B. 0.50 with an air-entrainment mask system.
C. a simple O2 mask at 10 L/min.
D. a nonrebreathing mask at 15 L/min.
EXPLANATIONS:
(h) A. As high an FIO2 as possible is indicated to treat carbon monoxide
poisoning.
(h) B. See explanation A.
(u) C. See explanation A.
(c) D. CO poisoning is properly treated with as near 100% O2 as
possible.
97
When coordinating the sequence of the following therapies in
bronchopulmonary clearance, which of the following should a
respiratory therapist administer concurrently with high-frequency
chest wall oscillation?
A. bronchodilator aerosol therapy
B. postural drainage
C. in-exsufflator
D. vibratory PEP
EXPLANATIONS:
(c) A. Bronchodilator therapy is administered concurrently with high
frequency chest wall oscillation.
(u) B. Postural drainage, in-exsufflator, and vibratory PEP are not
administered concurrently with high-frequency chest wall oscillation.
(u) C. See explanation B.
(u) D. See explanation B.
98
Which of the following arterial blood gas results could have been
obtained from a patient breathing air?
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. The sum of PaO2 and PaCO2 cannot exceed 149 torr while
breathing air.
2. True. See statement 1.
3. True. See statement 1.
4. False. See statement 1.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incomplete and incorrect response included
99
A comatose patient is found in a car with the engine running in an
enclosed garage. Upon arrival in the emergency department, the
patient has a respiratory rate of 36/min, heart rate of 147/min, and an
SpO2 of 100% with oxygen at 15 L/min by nonrebreathing mask. Which
of the following should the respiratory therapist recommend?
1. capnography
2. arterial blood gas analysis
3. hemoximetry
4. tonometry
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. False. Capnography will not provide useful information in evaluating
the potential cause of the coma in this patient.
2. True. An ABG will indicate the patient's ventilatory status.
3. True. Hemoximetry will indicate the patient's carboxyhemoglobin
level, which is essential in CO poisoning, in addition to true oxygen
saturation.
4. False. Tonometry would not be used in this situation.
(u) A. Incomplete and incorrect response
(u) B. Incorrect response
(c) C. Correct response
(u) D. Incomplete and incorrect response
10
0
A respiratory therapist examines a patient and notes coarse crackles.
Which of the following does this most likely indicate?
A. subcutaneous emphysema
B. pleural adhesions
C. bronchospasm
D. secretions
EXPLANATIONS:
(u) A. Subcutaneous emphysema is demonstrated by the presence of
crepitus during chest wall palpation.
(u) B. Pleural adhesions produce a characteristic pleural friction rub.
(u) C. Bronchospasm is noted as a wheezing sound from narrowed
airways.
(c) D. Secretions in the airway produce low-pitched, discontinuous
lung sounds described as coarse crackles upon auscultation.
10
1
The primary purpose of cleaning and sterilizing nondisposable
respiratory care equipment after each use is to
A. extend the life of the equipment.
B. prevent crossinfection and reinfection of patients.
C. prevent contamination of other equipment.
D. protect the personnel who are handling the equipment.
EXPLANATIONS:
(u) A. Repetitive cleaning may shorten the life of the equipment.
(c) B. Contaminated equipment could cause nosocomial infections.
(u) C. Prevention of patient infection is more important than concerns
about cross-contamination of equipment.
(u) D. Protection of personnel is primarily assured by following
appropriate infection control policies.
10
2
The repeated administration of beclomethasone (Vanceril) by
inhalation is associated with which of the following adverse effects?
A. cardiac dysrhythmias
B. rebound congestion
C. oral candidiasis
D. dry mouth
EXPLANATIONS:
(u) A. Corticosteroids do not have direct cardiac effects.
(u) B. Rebound congestion is usually associated with overuse of nasal
decongestants.
(c) C. The opportunistic infection of the mouth with Candida albicans
is associated with beclomethasone.
(u) D. Dry mouth is associated with the use of parasympatholytics.
10
3
While reviewing a chest radiograph, proper positioning of a flowdirected balloon-tipped catheter to obtain a mixed venous sample is
confirmed when the tip is located in the
A. pulmonary artery.
B. right ventricle.
C. superior vena cava.
D. right atrium.
EXPLANATIONS:
(c) A. Either in the right or left pulmonary artery is the appropriate
position for drawing of a mixed venous sample.
(u) B. Full venous mixing does not occur in the right ventricle.
(u) C. Full venous mixing does not occur in the superior vena cava.
(u) D. Full venous mixing does not occur in the right atrium.
10
4
Administration of racemic epinephrine after extubation is used to
A. reduce bronchospasm.
B. prevent the accumulation of secretions.
C. stimulate alpha-receptors.
D. elicit a potent beta2 response.
EXPLANATIONS:
(u) A. The most likely post-extubation problem is mucosal edema and
not bronchospasm.
(u) B. Neither drug prevents accumulation of secretions.
(c) C. Racemic epinephrine stimulates the alpha-receptors.
(u) D. The desired effect is an alpha-response to prevent mucosal
edema.
10
5
A nurse contacts a respiratory therapist to initiate chest
physiotherapy for a newly admitted patient. Which of the following
should the therapist do FIRST?
A. Auscultate the patient's chest.
B. Review the patient's chest radiograph.
C. Obtain a medical history from the patient.
D. Confirm the order in the patient's chart.
EXPLANATIONS:
(u) A. Auscultation of the chest would be a later step in initiation of
therapy.
(u) B. Review of the radiograph would be a later step in the initiation of
therapy.
(u) C. Obtaining a history would be a later step in the initiation of
therapy.
(c) D. The first step in the initiation of therapy is to confirm a written
order.
10
6
An increase in a patient's heart rate during aerosolized
bronchodilator therapy is primarily a result of which of the following
drug effects?
A. alpha only
B. beta1 only
C. beta2 only
D. beta1 and beta2 only
EXPLANATIONS:
(u) A. The alpha effects of an aerosolized bronchodilator are primarily
on smooth muscle, not cardiac muscle.
(c) B. The beta1 effect of an aerosolized bronchodilator is primarily
increased heart rate.
(u) C. The beta2 effect of an aerosolized bronchodilator is primarily
relaxation of airway smooth muscle.
(u) D. While beta1 stimulation will increase the heart rate, beta2
stimulus will have little or no effect on heart rate.
10
7
A physician's order for the administration of oxygen to a hospitalized
patient should include which of the following specifications?
A. flow in L/min and/or the percentage of oxygen
B. humidification device
C. source of oxygen
D. length of time for the oxygen therapy
EXPLANATIONS:
(c) A. To provide the correct delivery of oxygen for a patient, the
physician must state the flow in L/min and/or the percentage of
oxygen.
(a) B. The type of humidification device will be determined by the
clinical circumstance.
(u) C. A respiratory therapist will determine the source of oxygen, wall
outlet, or small cylinder for transport.
(u) D. The duration time for oxygen delivery is not necessary in a
physician's order for oxygen.
10
8
The major component of pulmonary surfactant is
A. protein.
B. glucose.
C. phospholipid.
D. polysaccharide.
EXPLANATIONS:
(u) A. Protein is 7% of surfactant.
(u) B. No significant glucose content exists in surfactant.
(c) C. Phospholipid is 85% of surfactant.
(u) D. No significant independent polysaccharide exists in surfactant.
10
9
Rapid assessment of oxygenation status is best achieved by
A. an ECG.
B. pulse oximetry.
C. an arterial blood gas analysis.
D. transcutaneous monitoring.
EXPLANATIONS:
(u) A. An ECG would evaluate the electrical activity of the heart.
(c) B. Pulse oximetry would provide the most rapid assessment of
oxygenation status.
(a) C. Arterial blood gas analysis would provide accurate assessment
of oxygenation status, but would not provide the most rapid
turnaround time for results.
(u) D. Transcutaneous monitoring would not provide rapid assessment
of oxygenation status due to required calibration and equilibration.
11
0
The following data are obtained for a patient who is receiving volumecontrolled ventilation with a VT of 600 mL:
This information indicates
A. increased air trapping.
B. increased airways resistance.
C. decreased inspiratory flow.
D. decreased static compliance.
EXPLANATIONS:
(u) A. Increased auto-PEEP would cause decreased static (lung)
compliance.
(c) B. Increased transpulmonary pressures (PIP - Plateau pressure) are
indicative of increased airways resistance.
(u) C. Peak airway pressure would decrease if inspiratory flow were
decreased.
(u) D. Compliance equals change in volume divided by change in
pressure, and static or plateau pressures have stayed the same.
11
1
A respiratory therapist is ventilating a patient with a self-inflating bagvalve resuscitation device. Following each compression, the bag
refills slowly permitting no more than one breath every 10 seconds.
To correct this problem, the therapist should
A. increase oxygen flow to the device.
B. add a PEEP valve to the resuscitation device.
C. inspect the intake valve for proper function.
D. remove accumulated secretions from the patient connection.
EXPLANATIONS:
(u) A. Increasing oxygen to the device could be done, but increased
oxygen flow will not change the refill time of a self-inflating
resuscitator.
(u) B. Addition of a PEEP valve is not indicated and will not correct the
problem.
(c) C. The most likely cause of the slow refilling time is an obstructed
intake valve.
(h) D. Secretions may interfere with patient ventilation, but not with
bag refill.
11
2
A patient with status asthmaticus requires continuous mechanical
ventilation. The dynamic compliance value has decreased sharply
over a 1-hour period. Which of the following drugs may be expected
to elicit the most rapid improvement in dynamic compliance?
A. acetylcysteine (Mucomyst)
B. theophylline (Aminophylline)
C. beclomethasone (Vanceril)
D. albuterol (Ventolin)
EXPLANATIONS:
(h) A. Acetylcysteine is commonly used to thin and mobilize
secretions; one side effect is bronchospasm. Its administration would
probably detrimentally affect dynamic compliance in this patient.
(a) B. When given as a bolus and at an appropriate IV rate, theophylline
will work in a matter of hours; however, there are more rapid acting
agents that would be more appropriate.
(h) C. Beclomethasone is a steroid administered by inhalation and
commonly used in the long-term management of patients with asthma.
It would have little or no effect on dynamic compliance in this setting
and could be harmful.
(c) D. Albuterol is a rapid-acting bronchodilator and is appropriate for
use in this setting.
11
3
Which of the following could result in an increase in pulmonary
vascular resistance (PVR)?
A. hyperoxia
B. hypovolemia
C. excessive PEEP
D. decreased cardiac output
EXPLANATIONS:
(u) A. Hypoxemia would result in an increase in PVR.
(u) B. Hypovolemia would most likely result in a decrease in PVR.
(c) C. Excessive PEEP can compress the pulmonary vessels, resulting
in an increase in PVR.
(u) D. Marked increases in cardiac output would increase PVR.
11
4
A patient who is conscious with an intact gag reflex requires an
artificial airway to prevent obstruction of the upper airway by the
tongue. Which of the following types of airways is most appropriate
in this situation?
A. nasopharyngeal
B. oropharyngeal
C. oral endotracheal tube
D. tracheostomy tube
EXPLANATIONS:
(c) A. A nasopharyngeal airway may prevent obstruction of the upper
airway by the tongue without eliciting a gag reflex.
(h) B. An oropharyngeal airway may stimulate a gag reflex and cause
vomiting and aspiration in a conscious patient because it rests on the
base of the tongue.
(h) C. Oral endotracheal intubation is technically difficult in a patient
with an intact gag reflex and may provoke vomiting and aspiration.
(h) D. A tracheostomy tube requires surgery with risks of
complications greatly exceeding other procedures that are less
traumatizing.
11
5
A respiratory therapist observes the following volume-time graphic
while performing a routine patient ventilator check:
Which of the following is the therapist's most appropriate action?
A. Document set and exhaled tidal volumes.
B. Look for the source of a leak.
C. Recommend a bronchodilator.
D. Perform endotracheal suctioning.
EXPLANATIONS:
(u) A. The graphic demonstrates a loss of volume from the circuit. Not
identifying and correcting the leak may result in hypoventilation.
(c) B. The graphic demonstrates a loss of volume from the circuit and
the source of the leak must be identified and corrected.
(u) C. A bronchodilator is not indicated at this time.
(h) D. Suctioning is not indicated at this time.
11
6
While a respiratory therapist auscultates a patient's chest, the patient
repeats the words, one, two, three. An increase in vocal clarity and
intensity is noted in the right lower lobe compared to the other lung
fields. Which of the following does this most likely indicate?
A. pleural effusion
B. consolidation
C. pneumothorax
D. normal finding
EXPLANATIONS:
(u) A. Depending on the size, a pleural effusion would result in a
decrease or no change in vocal clarity.
(c) B. Consolidation increases density resulting in increased voice
sounds.
(u) C. A pneumothorax results in a decrease in voice sounds.
(u) D. An increase in voice sounds is abnormal because of an increase
in density.
11
7
Which of the following findings is expected in a patient with right
heart failure?
1. neck vein distention
2. atrophy of accessory ventilatory muscles
3. peripheral edema
4. blood-tinged sputum
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. True. There is venous distention with congestive heart failure.
2. False. Heart failure does not impact accessory ventilatory muscles.
3. True. With right-sided heart failure, there is evidence of liver and
spleen enlargement and peripheral edema is greater.
4. False. Blood-tinged sputum may be seen with left heart failure.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incorrect response
11
8
A patient with severe COPD continues to complain of dyspnea on a
home regimen that includes ipratropium bromide (Atrovent) and
fluticasone propionate/salmeterol (Advair Diskus). A respiratory
therapist should recommend adding
A. theophylline (Aminophylline).
B. montelukast (Singulair).
C. acetylcysteine (Mucomyst).
D. glyceryl guaiacolate (Guaifenesin).
EXPLANATIONS:
(c) A. The GOLD guidelines recommend the addition of theophylline
when a patient with severe COPD is not adequately controlled with the
use of beta-agonists, ipratropium, and inhaled corticosteroids.
(u) B. Montelukast is a leukotriene-modifying agent and there is no
documented clinical basis for its use in the management of severe
COPD.
(h) C. Acetylcysteine is a mucolytic agent and may promote additional
bronchospasm in the patient.
(u) D. Glyceryl guaiacolate is an over-the-counter expectorant. Its use
would not decrease symptoms of dyspnea.
11
9
An 8-year-old child with a history of severe kyphoscoliosis is
receiving volume-controlled ventilation in the PACU following an
appendectomy. The respiratory therapist notes that the compressible
volume is 50% of the set tidal volume on a 22 mm circuit. Which of
the following should the therapist do?
A. Increase the set tidal volume.
B. Change to a pediatric circuit.
C. Institute pressure-controlled ventilation.
D. Decrease the inspiratory flow.
EXPLANATIONS:
(h) A. Increasing the set tidal volume will increase the risk of
volutrauma.
(c) B. Changing to a pediatric circuit (15 mm) would decrease the
compressible volume loss and improve gas delivery to the patient.
(u) C. Pressure-controlled ventilation will still result in compressible
circuit volume loss.
(h) D. Although this would decrease inspiratory pressure, effective
alveolar ventilation will be reduced from the compressible volume
loss.
12
0
Which of the following drugs is the most appropriate to paralyze a
sedated 30-year-old patient with status asthmaticus who is receiving
mechanical ventilation?
A. d-tubocurarine
B. morphine sulfate
C. vecuronium (Norcuron)
D. succinylcholine (Anectine)
EXPLANATIONS:
(a) A. D-tubocurarine is a skeletal muscle relaxant that occasionally
can cause hypotension in patients who cannot tolerate histamine
release.
(h) B. Morphine sulfate is a sedative and alleviates pain.
(c) C. Vecuronium is a muscle paralyzing agent without the danger of
producing histamines and hypotension.
(u) D. Anectine is short-acting and will not sustain paralysis.
12
1
A patient is ordered to receive albuterol 5 mg and ipratropium
bromide (Atrovent) 0.5 mg every 20 minutes for three treatments. The
pharmacy provided two 0.083% albuterol unit dose vials and one
ipratropium bromide (Atrovent) unit dose vial for each treatment.
After the first 20 minutes, one-half of the volume remains in the
nebulizer. Which of the following should the respiratory therapist do
before the next treatment?
A. Add the next dose to the nebulizer.
B. Discard the unused portion of the first dose and administer the
second dose.
C. Request a more concentrated solution of albuterol from the
pharmacy.
D. Change to continuous nebulization of albuterol at 15 mg/hr.
EXPLANATIONS:
(h) A. This would only increase the volume in the nebulizer without
providing the prescribed medication dose. (h) B. This would result in
less than the prescribed medication dose.
(c) C. This would allow complete nebulization of the prescribed dose.
(h) D. Nebulization would still be prolonged due to diluted medication.
12
2
A 70-year-old male, who had smoked for 20 years but recently quit,
complains of shortness of breath for the past several days. Breath
sounds are clear but diminished bilaterally. The following arterial
blood gas results are obtained:
A respiratory therapist should recommend
A. administering oxygen.
B. obtaining chest radiograph.
C. monitoring SpO2.
D. obtaining spirometry.
EXPLANATIONS:
(c) A. PO2 indicates hypoxemia. Oxygen should be administered.
(u) B. While a chest radiograph would be helpful, the patient has
hypoxemia as evidenced by the ABG results, and should first receive
oxygen.
(a) C. ABG analysis is a more accurate reflection of oxygenation. SpO2
would not be most appropriate action, as the patient already has
confirmed hypoxemia but it would be helpful for titrating liter flow.
(u) D. Although spirometry would be useful information in someone
with a history of smoking, the patient is short of breath and has
documented hypoxemia.
While performing internal quality control on a blood gas analyzer for
12
3
PaCO2, a respiratory therapist notes a consistent trend of data points
approaching two standard deviations above the mean. Which of the
following actions is most appropriate?
A. Re-run the control.
B. Repeat analysis on a different instrument.
C. Proceed to sample analyses.
D. Replace the CO2 membrane.
EXPLANATIONS:
(h) A. Re-running the control is used for random errors. In this
situation, there is a bias or system error, and not correcting the
problem may place the patient at risk.
(u) B. While this may be a solution to the immediate problem of getting
a correct blood gas analysis, it will not correct the error in the faulty
instrument.
(h) C. Incorrect blood gas analysis may lead to incorrect treatment of
the patient.
(c) D. Trending of data points outside the statistical limit is a bias or
system error. Such errors mean there is something wrong with an
analyzer component, which may need repair or replacement.
12
4
Which of the following most consistently delivers the highest water
vapor content to a patient's airway?
A. passover humidifier
B. bubble humidifier
C. heated wick humidifier
D. heat moisture exchanger
EXPLANATIONS:
(u) A. A passover humidifier provides a limited amount of water vapor.
(u) B. A bubble humidifier provides a minimal amount of water vapor.
(c) C. The combination of heat and high surface area between the
water-saturated wick and the gas produces the most water vapor
among these devices.
(u) D. While a heat moisture exchanger is warmed by the patient's
exhaled gas, it is cooler than an externally heated device, resulting in
less water vapor.
12
5
A patient with COPD is receiving oxygen 2 L/min by nasal cannula at
home. The SpO2 is normally between 88-90% on 2 L/min. While
evaluating the patient, the respiratory therapist finds the patient to be
lethargic. The therapist also observes the concentrator is set at 4
L/min and the SpO2 is 96%. Which of the following should the
therapist immediately do?
A. Obtain a blood gas sample and notify the physician.
B. Contact the physician to request hospital admission.
C. Change the oxygen flow to 2 L/min and observe the patient.
D. Discontinue oxygen until the patient's mental status improves.
EXPLANATIONS:
(h) A. An arterial blood gas is unnecessary and would delay
intervention.
(u) B. Physician notification is important but will not treat the
immediate problem.
(c) C. This patient needs an adequate PaO2 but not high enough to
blunt the hypoxic drive.
(h) D. Discontinuing O2 therapy would lead to hypoxemia.
12
6
A respiratory therapist is administering 1.25 mg of albuterol by smallvolume nebulizer. The patient's heart rate increases from 110/min to
140/min 5 minutes after the treatment is started. Which of the
following should the therapist do?
A. Allow the patient to rest briefly and then continue the
treatment.
B. Continue the treatment after adding 1 mL of saline to the
nebulizer.
C. Recommend administering cromolyn sodium (Intal) for the
next treatment.
D. Terminate the treatment and monitor the patient's heart rate.
EXPLANATIONS:
(u) A. Resting briefly may not result in changing the HR as this is a
physiologic reaction to the medication.
(u) B. Adding saline would still administer the prescribed drug only
now over a longer period of time.
(u) C. There is no indication that the patient has asthma.
(c) D. Onset occurs within 5-15 minutes of inhalation and the effect
may persist for up to 6 hours.
12
7
A patient's
scan indicates normal ventilation with absent
perfusion in the left lower lobe. These results suggest
A. right-to-left shunt.
B. pulmonary embolism.
C. pneumonia.
D. hemothorax.
EXPLANATIONS:
(u) A. A right-to-left shunt is an anatomic shunt and is not diagnosed
with a
scan.
(c) B. This is the classic description of a pulmonary embolism where
the alveolar unit is normally ventilated, but pulmonary capillary blood
flow is impeded by the presence of a clot.
(u) C. The consolidated alveolar units associated with pneumonia
would inhibit ventilation and perfusion would be normal.
(u) D. A hemothorax would cause compression of the alveolar units
and decrease ventilation.
12
8
A respiratory therapist notices that a patient using a tracheostomy
collar with cool aerosol at 60% oxygen is unable to bring up any
secretions. The small amount of secretions the patient coughed up
earlier were very thick. After finding nothing else remarkable, the
therapist should recommend
A. changing to a cool humidifier.
B. decreasing the FIO2 to 0.40.
C. changing to a heated nebulizer.
D. instilling normal saline and suctioning every 4 hours.
EXPLANATIONS:
(u) A. A cool humidifier would not provide enough humidity to this
patient.
(u) B. A lower FIO2 might cause hypoxia and does not address the
humidity deficit.
(c) C. A heated nebulizer would increase the moisture content of the
delivered gas and improve removal of thick secretions.
(u) D. This is unnecessary if adequate humidity is provided and
suctioning should be performed as needed rather than scheduled.
12
9
Which of the following can a respiratory therapist do to increase
mean airway pressure?
A. Add mechanical dead space.
B. Decrease the mandatory rate.
C. Decrease the inspiratory time.
D. Add inspiratory plateau.
EXPLANATIONS:
(h) A. Adding mechanical dead space causes the patient to rebreathe
CO2 and would not increase mean airway pressure.
(h) B. Decreasing the mandatory rate or inspiratory time would
decrease mean airway pressure.
(h) C. See explanation B.
(c) D. Adding inspiratory plateau would increase mean airway
pressure.
13
0
A respiratory therapist is called to see a 59-year-old patient who has
been in a persistent vegetative state for several months following a
stroke. He is diaphoretic and has a pulse of 120/min and an SpO2 of
81% with a 28% tracheostomy collar. The therapist is unable to pass a
suction catheter. Which of the following should the therapist
immediately do?
A. Replace the tracheostomy tube.
B. Increase suction pressure by 20%.
C. Increase the FIO2 to 1.0.
D. Activate the emergency response system.
EXPLANATIONS:
(c) A. The patient appears to have an obstructed tracheostomy tube
and it must be replaced.
(h) B. Stronger suction pressure is unlikely to clear an obstruction and
allow a catheter to pass through the tube.
(u) C. The patient appears to have an obstructed tracheostomy;
increasing the FIO2 will be of little value.
(u) D. This might become a necessity, but only if the airway cannot be
cleared.
13
1
Upon entering a patient's room after lunch was served, a respiratory
therapist discovers the patient unresponsive and lying in bed. The
decision to perform the obstructed airway routine depends on the
A. pulse oximetry reading.
B. absence of a palpable pulse.
C. chest rising after a rescue breath.
D. observation of a partially eaten lunch.
EXPLANATIONS:
(u) A. The pulse oximeter reading, although important in assessing
respiratory status, cannot help determine which procedure is
indicated.
(u) B. Assessing the pulse is unrelated to determining airway patency.
(c) C. After determining unresponsiveness and breathlessness, the
next procedure is rescue breathing. The chest rising after a rescue
breath indicates a patent (not obstructed) airway, and therefore, CPR
should be implemented, not the obstructed airway routine.
(a) D. Observation of a partially eaten lunch does not indicate airway
obstruction.
13
2
When evaluating a patient receiving oxygen at an FIO2 of 0.60 from a
blender and heated wick humidifier, a respiratory therapist observes
an SpO2 of 84%. Breath sounds are clear bilaterally. The therapist
notes the absence of alarms when the oxygen high pressure hose is
disconnected from the wall outlet. Which of the following should the
therapist do?
A. Initiate beta-agonist therapy.
B. Suction the patient.
C. Replace the oxygen blender.
D. Increase the set FIO2 to 0.70.
EXPLANATIONS:
(u) A. Beta-agonist therapy is not indicated because the breath sounds
are clear.
(h) B. The patient has clear breath sounds without any adventitious
sounds. Suctioning of the airway is not indicated and may be harmful.
(c) C. The oxygen delivery system is not functioning properly and
needs to have the blender replaced because it is defective.
(u) D. Increasing the FIO2 in a nonfunctioning blender will have no
effect.
13
3
Which of the following should a respiratory therapist check while
preparing for a nasotracheal intubation procedure?
1. integrity of the cuff
2. availability of Magill forceps
3. presence of a stylet in the tube
4. availability of a water-based lubricant
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. Cuff integrity is essential.
2. True. McGill forceps are used to guide the tube during a blind
intubation.
3. False. Presence of a stylet would be hazardous.
4. True. Water-based lubricant assists in passing the tube through the
nasopharynx.
(h) A. Incomplete and incorrect response included
(c) B. Correct response
(h) C. Incomplete and incorrect response included
(h) D. Incomplete and incorrect response included
13
4
After attaching a cardiac monitor to a patient's chest, a respiratory
therapist notes the ECG recording contains artifact. Which of the
following could cause artifact in this situation?
1. inadequate electrode contact
2. improper electrode placement
3. the patient scratching the electrodes
4. disconnected leads
A. 1 and 3 only
B. 1 and 4 only
C. 2 and 3 only
D. 2 and 4 only
EXPLANATIONS:
1. True. Poor electrode contact could produce artifact.
2. False. Improper electrode placement could produce inappropriate
complexes for the lead displayed but not artifact.
3. True. The patient scratching or moving the electrodes could cause
artifact.
4. False. Disconnected leads would produce no variability in electrical
charge or a flat line, which is different than artifact.
(c) A. Correct response
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incorrect response
13
5
While performing a patient-ventilator check, a respiratory therapist
observes very little condensation in the heated wire circuit. The
heated wick humidifier contains an appropriate amount of water. The
most likely explanation is that the
A. minute ventilation is greater than 15 L/min.
B. patient circuit is operating normally.
C. flow is set at too low of a value.
D. room temperature is lower than normal.
EXPLANATIONS:
(u) A. The minute ventilation will not impact condensation in the
circuit.
(c) B. The heated wire circuit is designed to maintain gas temperature
to prevent condensation.
(u) C. Condensation is not significantly affected by low flow.
(u) D. Usual room temperature ranges will have no effect on
condensation.
13
6
During volume-controlled ventilation, the high pressure alarm should
be set at least 10 cm H2O above which of the following pressures?
A. peak airway
B. mean airway
C. plateau
D. PEEP
EXPLANATIONS:
(c) A. Setting the high pressure alarm 10 cm H2O of pressure above
peak airway pressure allows minor fluctuations in peak airway
pressure without allowing dangerous increases to go unnoticed.
(h) B. The mean airway pressure is always lower than the peak airway
pressure; therefore, the alarm would unnecessarily sound during
every mechanical breath.
(u) C. The plateau pressure is the pressure during inspiratory hold.
Setting the high pressure alarm limit 10 or more cm H2O higher than
the plateau pressure may result in premature breath termination of the
inspiratory cycle.
(u) D. Peak airway pressure is always higher than PEEP and the alarm
would unnecessarily sound during every mechanical breath.
13
7
During bronchoscopy with a biopsy, possible complications include
1. bronchorrhea.
2. laryngospasm.
3. pneumothorax.
4. hemoptysis.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. False. Bronchorrhea is not a complication of bronchoscopy.
2. True. Laryngospasm is a complication of bronchoscopy due to
laryngeal irritation.
3. True. Pneumothorax is a complication associated with biopsy.
4. True. Hemoptysis is a complication associated with biopsy.
(u) A. Incomplete and incorrect response included
(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(c) D. Correct response
13
8
A 43-year-old patient with ARDS is receiving pressure-controlled
ventilation. The PEEP level is changed from 12 to 16 cm H2O.
Immediately following this change, a respiratory therapist should
monitor
A. intake/output.
B. electrolytes.
C. cardiac rhythm.
D. vital signs.
EXPLANATIONS:
(u) A. A change in urine output would be delayed based on a reduction
in cardiac output from increasing PEEP.
(u) B. There is no direct association of electrolyte metabolism with
PEEP levels.
(u) C. Cardiac rhythm does not necessarily correlate with cardiac
output, which is the parameter that would be affected by any change in
PEEP.
(c) D. Vital signs need to be monitored because blood pressure can fall
rapidly after increasing PEEP.
13
9
A patient receiving mechanical ventilation requires frequent
suctioning. He has a history of developing PVCs during suctioning
procedures. A respiratory therapist should
1. limit the duration of the suctioning.
2. increase the FIO2 before, during, and after suctioning.
3. observe the patient's ECG monitor while suctioning.
4. request an anti-arrhythmic medication for the patient.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
EXPLANATIONS:
1. True. Limiting the duration of the suctioning will decrease the
likelihood of hypoxia.
2. True. Increasing FIO2 before and after suctioning will decrease the
likelihood of hypoxia.
3. True. Observation of ECG during suctioning will alert the therapist
to the development of an adverse event.
4. False. Adequate oxygenation should prevent arrhythmia occurrence.
(c) A. Correct response
(u) B. Incorrect and incomplete response included
(u) C. Incorrect and incomplete response included
(u) D. Incorrect and incomplete response included
14
What volume of a 1:200 dilution should a respiratory therapist use to
administer 2.5 mg of a medication?
0
A. 0.30 mL
B. 0.40 mL
C. 0.50 mL
D. 0.75 mL
EXPLANATIONS:
(u) A. See C for correct calculation.
(u) B. See C for correct calculation.
(c) C. The first step is to convert the drug strength to milligrams in
each milliliter (1:200 = 1 g /200 mL * 1000 mg / g = 1000 mg / 200 mL = 5
mg / mL).
The second step is to set up a proportion of the milligrams per
milliliter of the stock solution with the quantity for the specified dose
unknown (5 mg / 1 mL = 2.5 mg / x mL).
Rearrange by cross multiplying (5 mg * x mL = 2.5 mg * 1 mL).
Solve for the unknown (x = 2.5 / 5 x = 0.5 mL).
(u) D. See C for correct calculation.