Tutorial System TMC B

1. Which of the following is considered a sign of respiratory

distress in a newborn term infant?

O A: pulse rate: 130 beats/min

O B: 4 to 6 second periods of apnea

O C: respiratory rate: 47 breaths/min

O D: grunting

ANS: D. grunting

2. A patient is receiving VC, SIMV in the intensive care unit. To

reduce the patient's PaCO2, which of the following should

be suggested?

O A: increase PEEP

O B: decrease inspiratory time

O C: increase pressure support

O D: decrease FI02

ANS: C. increase pressure support

3. Air flow is heard at the mouth of an orally intubated patient

receiving mechanical ventilation. Which of the following

should the respiratory therapist do FIRST?

A. reinflate the cuff and check for leaks

B. initiate weaning procedures

C. reintubate the patient as the cuff is blown

D: pass a suction catheter through the tube to check

for accidental extubation

ANS: A. reinflate the cuff and check for leaks

4. The following data is available after pulmonary function

testing: VC is 91% of predicted value, FEV1.0 /FVC is 67% of

predicted value, and FEV1.0 is 58% of predicted value.

These results indicate the presence of

O A: restrictive disease.

O B: obstructive disease.

O C: decreased lung compliance.

O D: combined obstructive and restrictive disease.

ANS: B. obstructive disease

5. When performing an ECG, a considerable amount of artifact appears on the monitor screen. To help with this problem, the respiratory therapist should instruct the patient to do which of the following?

O A: hold your breath

O B: close your eyes

O C: cross your legs

O D: clench your fists

ANS: B. close your eyes

6. The pressure limit alarm is suddenly sounding with each

breath of a female patient receiving VC, SIMV. Breath

sounds are absent on the right and the patient's trachea has

shifted to the left. The patient's respiratory rate is 34/min, pulse is 130/min, and the SpO2 monitor indicates 78%. Which of the following should be recommended?

O A: arterial blood gas analysis

O B: chest radiograph

O C: needle decompression

O D: lung recruitment maneuver

ANS: C. needle decompression

7. A CHF patient is admitted to the ICU. Appropriate drug therapy includes which of the following?

1. nitroprusside sodium (Nipride)

2. digitalis

3. furosemide (Lasix)

4. flurazepam (Dalmane)

O A: 1,3, and 4 only

O B: 2,3, and 4 only

O C: 1,2, and 3 only

O D: 1, 2, and 4 only

ANS: C. 1, 2, and 3 only

8. Which of the following is a high flow oxygen delivery

system?

O A: 6 L/min nasal cannula

O B: 100% non-rebreathing mask

O C: pneumatic jet nebulizer

O D: 24% air-entrainment mask

ANS: D. 24% air- entrainment mask

9. A pressure manometer is being used to measure the cuff pressure of an endotracheal tube for a patient receiving mechanical ventilation. The manometer reading indicates an inflated cuff pressure of 21 cm H2O. Appropriate

maintenance of the airway should include

O A: increasing cuff pressure to 27 cm H20.

O B: decreasing cuff pressure to avoid tissue necrosis.

O C: maintenance of the cuff pressure at it's present

level.

O D: deflation and re-inflation of the cuff to a maximal

level of 18 mm Hg.

ANS: A. increasing cuff pressure to 27 cm H2O

10. He/02 therapy is being administered using an 80/20

mixture. If the oxygen flowmeter is set at 10L/min, what is

the actual flowrate of mixed gas?

O A: 10 L/min

O B: 12 L/min

O C: 16 L/min

O D: 18 L/min

ANS: D. 18 L/min

A 48-year-old woman with dyspnea has been admitted to

the medical floor of a community hospital. Pulmonary

function tests are ordered. After the patient completes

three spirometry tests, with no false starts, the following

data is obtained: Test 1: FEV1 2.31, FVC 4.20 Test 2: FEV1

2.38, FVC 4.15 Test 3: FEV1 2.42, FVC 3.98 Performance

standards require that the technologist report

O A: the test with the lowest FEV1/FVC ratio.

O B: the average value for FEV1 and FVC.

O C: results of the final test only.

O D: the highest value obtained for FEV1 and FVC.

ANS: D. the highest value obtained for FEV1 and FVC

A patient in the emergency room has been intubated and

placed on time triggered, volume cycled ventilation. If the

inspiratory flow is increased, which of the following

parameters would be decreased?

O A: peak inspiratory pressure

O B: I:E ratio

O C: mandatory rate

O D: tidal volume

ANS: B. I:E ratio

Arterial blood gas analysis yields the following data: pH

7.36, PaCO2 33 torr, Pa02 86 torr, bicarbonate 18 mEq/L,

Which of the following is indicated?

O A: acute respiratory alkalosis

O B: hypoxemia

O C: compensated metabolic acidosis

O D: hypoventilation

ANS: C. compensated metabolic acidosis

Following aggressive diuretic therapy to treat congestive

heart failure, a patient complains of continuing shortness of

breath and muscle weakness. An arterial blood gas sample

is obtained on room air and analyzed with the following

results: pH 7.54, PaCO, 37 torr, Pa0, 71 torr, HCO; 31

mEq/L. This patient's condition would most likely be

relieved with

O

A: supplemental oxygen.

O B: IV administration of potassium chloride.

O C: IV administration of sodium bicarbonate.

O D: bronchodilator therapy.

ANS: B. IV administratiom of potassium chloride

Auscultated breath sounds of an intubated patient

receiving mechanical ventilatory support are decreased.

Additionally, audible airflow is heard through the patient's

mouth and the low pressure alarm on the ventilator is

sounding. Cuff pressure is measured at 23 mm Hg. Which of

the following is clinically indicated?

O A: accidental extubation

O B: insufficient cuff pressure

O C: blown cuff

O D: tube obstruction

ANS: A. accidental extubation

Which of the following concentrations of oxygen is used for

the balance point in the calibration of the Clarke electrode

of an arterial blood gas analyzer?

O A: 12%

O B:0%

O C: 10%

O D: 20%

ANS: B. 0%

In pulmonary function testing, vital capacity (VC) is

equivalent to

O A: ERV + RV

O B: FRC+ IC

O C:TLC-IRV

O D:IC+ ERV

ANS: D. IC + ERV

With no spontaneous breathing evident in a heavily

sedated, post-operative patient on VC, SIMV, which of the

following would improve oxygenation?

O A: increasing the flowrate

O B: changing to A/C

O C: increasing the inspiratory time

O D: decreasing the mandatory rate

ANS: C. increasing inspiratory time

The cardiac monitor for a patient in the intensive care unit

indicates a PCWP of 14 mm Hg. Which of the following

disorders are most likely indicated?

O A: pulmonary embolism

O B: mitral valve stenosis

O C: hypovolemia

O D: excessive PEEP

ANS: B. mitral valve stenosis

A patient complains of fatigue, muscle weakness, and a

feeling of general malaise. Which of the following should

the respiratory therapist recommend FIRST?

O A: arterial blood gas analysis

O B: electrocardiogram

O C: serum electrolytes

O D: chest radiograph

ANS: C. serum electrolytes

Auscultation of an adult in the emergency room reveals S3

during diastole. This heart sound may be considered

O A: an indication of anemia.

O B: abnormal only in children.

O C: an indication of CHF.

O D: a hemic murmur.

ANS: C. an indication of CHF

A patient in the cardiac care unit is being monitored with a

flow-directed, baloon-tipped, pulmonary artery catheter

(Swan-Ganz). The presence of an intrapulmonary shunt

would be BEST indicated by an increase in

O A: cardiac output.

O B: mixed venous oxygen saturation.

O C: oxygen delivery.

O D: arterial to mixed venous content difference.

ANS: B. mixed venous oxygen saturation

Successive ventilator checks show a progressive increase in

an intubated patient's peak inspiratory pressure. Which of

the following should be suspected?

O A: increased compliance

O B: excessive secretions

O C: decreased resistance

O D: decreased flowrate

ANS: B. excessive secretions

The pulse oximetry readings from a probe placed on the

right hand of a neonate are higher than those taken from a

probe placed on the baby's right foot. In the presence of a

patent ductus arteriosus, this would indicate which of the

following?

O A: normal cardiopulmonary function

O B: left to right shunt

O C: malfunction of the pulse oximeter

O D: right to left shunt

ANS: B. left to right shunt

A capillary sample is obtained for blood gas analysis from a

40-week gestation newborn, 5 hours post-delivery with the

following results: pH 7.34, PCO2 39 torr, PO2 56 torr,

bicarbonate 21 mEq/L. This data indicates

O A: moderate hypoxemia.

O B: normal acid-base balance.

O C: metabolic alkalosis.

O D: hypoventilation.

ANS: B. normal acid-base balance.

Which of the following drugs is classified as a

parasympatholytic?

O A: ipatropium bromide (Atrovent)

O B: racemic epinephrine (Vaponefrin)

O C: albuterol (Ventolin)

O D: dornase alfa (Pulmozyme)

ANS: C. albuterol (Ventolin)

While viewing the ventilator graphics for a patient

receiving VC, A/C ventilation, the respiratory therapist

notices that the inspiratory phase begins before the

expiratory phase has reached baseline. To correct this

problem, which of the following should be increased?

O A: mandatory rate

O B: flowrate

O C: tidal volume

D: sensitivity

ANS: B. flowrate

Which of the following apply to apnea monitors? 1. Detect

heart rate 2. Detect respirations 3. Are used to monitor

infants at risk for RDS 4. Have audio and visual alarms

O A: 1,2, and 3 only

O B: 2, 3, and 4 only

O C: 1,3, and 4 only

O D: 1, 2, and 4 only

ANS: D. 1, 2, and 4 only

A 21-year-old female is brought to the emergency room

after experiencing severe shortness of breath. The patient

is in the 34th week of a difficult pregnancy and following

delivery of her infant, the mother requires mechanical

ventilatory support. Over the next several days she

develops severe ARDS. Hemodynamic data available

indicates the following: PAP 44 mm Hg, CVP 21 mm Hg,

PCWP 9 mm Hg. The patient's respiratory quotient is 1.2.

The physician orders arterial blood gas analysis which

yields the following results: pH 7.27, PaCO, 25 torr, PaO,94

torr, bicarbonate 11 mEq/L. The best therapeutic course

would be which of the following?

O A: increasing the respiratory rate

O B: administration of sodium bicarbonate

O C: shifting nutrient intake from carbohydrates to

fats

O D: administration of diuretics

ANS: C. shifting nutrient intake from carbohydrates to fats

A patient in the cardiovascular intensive care unit is been

monitored following coronary artery by-pass surgery. The

patient suddenly develops severe hypotension. The MOST

appropriate drug therapy would be IV administration of

O A: nitroprusside sodium (Nipride)

O B: epinephrine (Adrenaline)

O C: isoproterenol (Isuprel)

O D: dopamine (Intropin)

ANS: D. dopamine (Intropin)

Sporicidal action is accomplished using which of the

following infection control techniques?

O A: ethylene oxide

O B: 70% isopropyl alcohol

O C: handwashing

OD: pasteurization

ANS: A. ethylene oxide

A 55 kg (121 lb), 5-foot, 4-inch tall, female patient has been

placed on VC, SIMV following respiratory failure post-

delivery of a full term newborn. The following data is

obtained: (1) mandatory rate 10, spontaneous rate 8, tidalvolume 600 ml, FIO2 0.40, PEEP 5 cm H20, inspiratory flowrate 60 L/min. (2) pH 7.52, PaCO2 30 torr, Pa02 95 torr, bicarbonate 25 mEq/L. Based on these findings, the respiratory therapist should recommend which of the following?

O A: increase FI02

O B: decrease tidal volume

O C: decrease inspiratory flowrate

O D: decrease mandatory rate

ANS: B. decrease tidal volume

A patient is being evaluated for the presence of pulmonary disease. The following data has been obtained during pulmonary function testing: VC = 91% of predicted value FEV1/FVC = 67% of predicted value FEV10 = 58% of predicted value These results indicate which of the following?

O A restrictive disease

O B: obstructive disease

O C: decreased lung compliance

O D: combined obstructive and restrictive disease

ANS: B. obstructive disease

Following cardiac arrest, a 5-foot, 10-inch male patient weighing 75 kg (165 Ib) has been transferred to the intensive care unit. The patient is unconscious with no spontaneous breathing present. He has been intubated by the emergency room physician and is being resuscitated via bag-valve device with an FIO2 of 1.0. Upon placement on mechanical ventilation, which of the following settings should be recommended?

O A: VC, SIMV, mandatory rate 10, tidal volume 600

ml, FIO2 1.0, PEEP 5 cm H20

O B: VC, SIMV, mandatory rate 12, tidal volume 700

ml, FIO2 0.40, PEEP 5 cm H20

O C: VC, A/C, mandatory rate 12, tidal volume 600 ml,

FIO2 1.0, PEEP 5 cm H20

O D: VC, A/C, mandatory rate 8, tidal volume 750 ml,

FIO2 1.0, PEEP 10 cm H20

ANS: C. VC, A/C, mandatory rate 12, tidal volume 600ml, FIO2 1.0, PEEP 5 cm H20

Phase two of autogenic drainage is characterized by

diaphragmatic breathing using

A increased volumes to prepare for final coughing

and expulsion of secretions.

B: a maximum inspiration and directed coughing to

clear secretions.

C: two or three short expiratory bursts to clear

secretions.

D: middle lung volumes to collect secretions within

the middle airways.

ANS: D. middle lung volumes to collect secretions within the middle airways.

A large volume, heated jet nebulizer system is being used to deliver aerosol via T-tube to an intubated patient. An FI02 of 40% is ordered. The respiratory therapist notices that water has collected in the large bore tubing. The delivered FIO2 should be

O A: lower than ordered.

O B: unaffected by back pressure.

O C: higher than ordered.

O D: checked for accuracy.

ANS: C. higher than ordered

Increasing the inspiratory flowrate for a patient receiving VC, A/C ventilation will increase

O A: mean airway pressure.

O B: expiratory time.

O C: peak inspiratory pressure.

O D: tidal volume.

ANS: B. expiratory time.

In the evaluation of the skin appearance for a 38 year-old female patient suffering from severe anemia, which of the following would be MOST likely?

O A:jaundice

O B: pale

O C: cyanosis

O D: erythema

ANS: B. pale

Arterial blood gas analysis for a patient receiving

supplemental oxygen via a 28% air-entrainment mask

indicates the following: pH 7.38, PaCO2 42 torr, Pa02 230 torr, bicarbonate 24 mEq/L. These results indicate

O A: intrapulmonary shunt.

O B: air bubbles in the sampling syringe.

O C: oxygen toxicity.

O D: normal oxygenation.

ANS: D. normal oxygenation.

Evaluation of the L/S ratio of a newborn infant reveals a value of 1.5. With respect to RDS, this is an indication of

O A: stable surfactant production.

O B: decreased risk.

O C: increased risk.

O D: lung maturity.

ANS: C. increased risk

Which of the following blood serum levels would be

considered normal for sodium?

O A: 85 mEq/L

O B: 95 mEq/L

O C: 100 mEq/L

O D: 140 mEq/L

ANS: D. 140 mEq/L

The intervertebral discs are visible through the heart

shadow of a chest radiograph. This is an indication of which of the following?

A: underexposed film

B: proper film exposure

C: overexposed film

D: cardiomegaly

ANS: B. proper film exposure

Clinical conditions associated with an increase in central venous pressure (CVP) include which of the following?

O A: hypovolemia

O B: vasodilation

O C: diuretic therapy

O D: right heart failure

ANS: D. right heart failure

The best pulmonary function test for evaluation of a

restrictive disease process is which of the following?

O A: FEV1.0

O B: VC

O C: PEFR

O D: FEF25-75

ANS: B. VC

A 47-year-old male patient intubated with a fenestrated tracheostomy tube has been removed from mechanical ventilatory support. Which of the following steps should be taken to allow the patient to talk?

O A: deflate the cuff and plug the proximal opening of the tube

O B: remove the inner cannula, deflate the cuff, and

plug the proximal opening of the tube

O C: remove the inner cannula, deflate the cuff, plug

the proximal opening of the tube, and reinflate

the cuff to ensure a proper seal

O D: remove the inner cannula and deflate the cuff

ANS: B remove the inner cannula, deflate the cuff, and plug the proximal opening of the tube.

The following data is obtained for a patient receiving VC, SIMV: mandatory rate 6, spontaneous rate 14, tidal volume 600 ml, FIO2 0.35, PEEP 5 cm H2O. Arterial blood gas analysis has the following results: pH 7.41, PaCO2 36 torr, Pa02 90 torr, bicarbonate 22 mEq/L. Which of the following should be recommended?

O A: administer sodium bicarbonate

O B: place on CPAP at 5 cm H20

O C: increase mandatory rate

O D: increase FI02

ANS: B. place on CPAP at 5 cm H20

A patient has been brought to the emergency room

following an overdose of Tylenol. Which of the following drugs should be recommended?

O A: albuterol (Ventolin)

O B: epinephrine (Adrenalin)

O C: acetylsysteine (Mucomyst)

O D: furosemide (Lasix)

ANS: C. acetylsysteine (Mucomyst)

Kyphosis is BEST described as

O A: lateral curvature of the spine.

O B: anterior-posterior or convex curvature of the

spine.

O C: an anterior depression of the sternum.

O D: a combined lateral and convex spinal deformity.

ANS: B. anterior-posterior or convex curvature of the spine.

Complications that may arise when drawing a blood sample from a radial arterial catheter (A-line) include which of the following? 1. pulmonary embolism 2. infection 3. loosening a thrombus 4. arteriosclerosis

O A: 1 and 2 only

O B: 2 and 3 only

O C:3 and 4 only

O D: 1 and 4 only

ANS: B. 2 and 3 only

In the hospital environment, which of the following

provides the most important interruption of the spread of infection?

O A: disinfection

O B: universal precautions

O C: sterilization

O D: handwashing

ANS: D. handwashing

As determined by pulse oximetry, oxygen saturation levels for an elderly man rescued from a fire are 92%. Concurrent analysis of an arterial blood sample using co-oximetry indicates a Sa0, of 76%. The most likely explanation for this discrepancy is which of the following?

O A: excessive ambient light

O B: calibration error

O C: elevated carboxyhemoglobin

O D: spectral interference

ANS: C. elevated carboxyhemoglobin

During pulmonary function testing, the FEV1.0/FVC ratio for a patient is 80%. Which of the following disease processes may be ruled out?

O A: pulmonary edema

O B:ARDS

O C: COPD

O D: pneumonia

ANS: C. COPD

A nonrebreathing mask is being used to deliver a 80/20 mixture of helium-oxygen to a COPD patient. The respiratory therapist notices that the reservoir bag on the mask completely collapses on inspiration. Which of the following actions would most likely resolve this problem?

O A: tightening the mask seal on the patient

O B: removal of the one-way valves from the face mask

O C: increasing the flowrate of the helium-oxygen

mixture

O D: conversion to a 70/30 mixture of helium-oxygen

ANS: C. increasing the flowrate of the helium-oxygen mixture

A newborn has been placed on pressure control ventilation. With an FIO2 of 0.40, arterial blood gas results indicate the following results: pH 7.37, PaCO2 39 torr, Pa02 of 50 torr, bicarbonate 22 mEq/L. The respiratory therapist should recommend which of the following?

O A increasing PIP

O B: increasing inspiratory time (IT)

O C: decreasing respiratory rate

O D: weaning from mechanical ventilation

ANS: B. increasing the inspiratory time (IT)

Which of the following findings on a patient's chest

radiograph is the best indication of pulmonary fibrosis?

O A: fluffy infiltrates in a butterfly shape

O B: increased prominence of vascular markings

O C: ground glass appearance

O D: honeycombing or mesh-like pattern

ANS: D. honeycombing or mesh-like pattern

A 42-year-old male patient presents in the emergency department with an irregular pulse and a labored breathing pattern. Arterial blood gas analysis has the following results: pH 7.19, PaCO2 24 torr, Pa02 110 torr, bicarbonate 9 mEq/L. Which of the following disorders is suggested?

O A: acute respiratory failure

O B: drug overdose

C: hyperkalemia

O D: diabetes melitus

ANS: D. diabetes melitus

Cold and clammy skin, assessed by palpation BEST indicates

O A: hypoxia.

O B: poor perfusion.

O C: anxiety.

O D: hypothermia.

ANS: B. poor perfusion

An in-line end-tidal CO, monitor is being used with a

patient receiving mechanical ventilation in the intensive care unit. The following data is recorded during successive ventilator checks: 11:00 AM Respiratory rate 10, PaCO,41 torr, PECO, 36 torr 1:00 PM Respiratory rate 12, PaCO, 40 torr, PECO, 35 torr 3:00PM Respiratory rate 20, PaCO,44 torr, PECO, 22 torr This data BEST suggests which of the following?

A increased shunt

B: hypoventilation

C: decreased dead space

D: pulmonary embolus

ANS: D. pulmonary embolus

A patient with chest pain and a feeling of "impending doom" has been brought to the emergency room by family members. Which of the following should be done first?

O A: perform arterial blood gas analysis

O B: administer an electrocardiogram

O C: obtain a chest radiograph

O D: administer supplemental oxygen

ANS: D. administer supplemental oxygen

A post-coronary artery bypass surgery patient shows no apparent respiratory distress and is resting comfortably in the intensive care unit. The patient is breathing room air and has a heart rate of 74/min and respiratory rate of 16/min. The following data is obtained: pH 7.38, PCO2 42 torr, PO2 40 torr, SO2 70%. These results suggest

A: sampling error.

B: pulmonary embolism.

C: severe hypoxemia.

D: a mixed venous sample.

ANS: D. a mixed venous sample

61. During pressure control ventilation, a preset value for pressure is reached that ends inspiration. This variable is known as the

O A: limit variable.

O B: cycle variable.

O C: trigger variable.

O D: baseline variable.

ANS: B. cycle variable

62. In an area of pneumothorax, vascular markings on the chest radiograph would be

O A: increased.

O B: moderately obscure.

O C: absent.

O D: decreased.

ANS: C. Absent

63. A respiratory therapist enters a male patient's room to administer an albuterol bronchodilator treatment and finds the patient difficult to arouse. A nasal cannula is in place at 2L/min. The therapist palpates a weak pulse of 54 beats/min, and the patient's respirations are 10/min, shallow, with prolonged periods of apnea. Which of the following should be done?

O A: recommend administration of nasal CPAP

O B: administer bronchodilator treatment via mask

O C: activate the medical emergency team

O D: arterial blood gas analysis

ANS: C. activate the medical emergency team.

64. An unresponsive patient with no spontaneous respirations has been brought to the emergency department. The patient has been intubated in the field by the paramedic team and is receiving manual bag ventilation. She is a known IV drug-abuser and the emergency room physician orders mechanical ventilation. Which of the following modes should be recommended?

O A: VC, A/C ventilation

O B: VC, SIMV

O C: pressure support ventilation

O D: HFJV

ANS: A. VC, A/C ventilation

65. In the home-care setting, which of the following delivery systems is most appropriate for use by a COPD patient receiving supplemental oxygen therapy via nasal cannula at 1-2 L/minute?

OA: oxygen concentrator

O B: liquid oxygen

O C: cylinder manifold system

O D: bulk oxygen

ANS: A. oxygen concentrator

66. Simple spirometry is being used to measure the inspiratory capacity of a patient which is

O A: the maximum volume of gas that may be inhaled

following an inspired tidal volume.

O B: that volume of gas inhaled during normal, quiet

breathing.

O C: the maximum volume of gas that may be inhaled

following a normal quiet exhalation.

O D: equal to the sum of the inspiratory reserve

volume, the tidal volume, and the expiratory

reserve volume.

ANS: C. The maximum volume of gas that may be inhaled.following a normal quiet exhalation

67. A patient has been vomiting repeatedly. Which of the following should be anticipated with respect to this patient?

1. hyperchloremia 2. metabolic alkalosis 3. lactic acidosis 4. hypokalemia

O A: 1 and 2 only

O B: 2 and 4 only

O C: 1 and 3 only

O D: 3 and 4 only

ANS: B. 2 and 4 only

68. Pre-ductal transcutaneous monitoring 5 hours post-delivery of a 37-week gestation infant shows higher values for oxygenation than that of blood gas analysis of a sample obtained from the umbilical artery. No cyanosis is present. This is an indication of

A: septal defect.

O B: patent ductus arteriosus.

O C: tetrology of Fallot.

O D: respiratory distress syndrome.

ANS: B. patent ductus arteriosus

69. The following patient data is available: pH 7.29, PaCO2 26 torr, Pa02 94 torr, bicarbonate 12 mEq/L, pulse rate of 102/min, respiratory rate of 30/min. Based on these results, which of the following should be recommended?

O A: intubation and mechanical ventilation

O B: diuretic therapy

O C: bronchodilator treatments

O D: administration of sodium bicarbonate

ANS: D. administration of sodium bicarbonate

70. In a two-point calibration of the PCO2 electrode of a blood gas analyzer, which of the following percentage concentrations of carbon dioxide gas should be used for the slope point?

O Ai0

O B:5

O C: 10

O D: 12

ANS: C. 10

71. During emergency bag-valve-mask ventilation, airways used primarily to reposition the tongue away from the posterior pharyngeal wall include which of the following? 1.oral endotracheal tubes 2. nasal "trumpets" 3. oropharyngeal airways 4. nasal endotracheal tubes

O A: 1 and 2 only

O B: 1 and 4 only

O C:2 and 3 only

O D: 3 and 4 only

ANS: C. 2 and 3 only

72. Which of the following is a common response to

hypoxemia?

O A: decreased pulmonary vascular resistance

O B: Increased heart rate

O C: pulmonary hypotension

O D: decreased respiratory rate

ANS: B. Increased heart rate

73. When asked to assist with the intubation of an 8-month old child, which of the following endotacheal tube sizes should be recommend?

O A: 2.5 mm ID

O B: 3.5 mm ID

O C: 5.0 mm ID

O D: 6.0 mm ID

ANS: B. 3.5 mm ID

74. A pulse oximeter is being used to monitor a patient in the intensive care unit. Despite several attempts to appropriately place the oximeter probe, no waveform is observed on the monitor. Which of the following could be causing the pulse signal loss?

O A excessive ambient light

O B: severe anemia

O C: carbon monoxide poisoning

O D: hypertension

ANS: B. Severe anemia

75. During a routine ventilator check on a patient in the cardiovascular intensive care unit, the respiratory therapist on duty notes a pulmonary arterial pressure (PAP) of 24/9 mm Hg on the cardiac monitor. This is an indication ofwhich of the following?

A: normal PAP

O B: excessive PEEP

O C: pulmonary disorder

O D: cardiac disorder

ANS: A. normal PAP

76. Which of the following should be evaluated for a patient with suspected renal failure?

O A: sodium

O B: chloride

O C: creatine

O D: potassium

ANS: C. creatine

77. A patient in the intensive care unit is receiving volume ventilation with the following settings: mandatory rate of 12, tidal volume of 600 ml, FIO2 of 0.45, PEEP 5 cm H20. An arterial blood gas is drawn that shows the following: pH 7.30, PaCO2 53 torr, Pa02 95 torr, bicarbonate 24 mEq/L.What would be the most appropriate clinical response?

O A: decrease the mandatory rate

O B: increase the FI02

O C: decrease the tidal volume

O D: increase the mandatory rate

ANS: D. increase mandatory rate

78. A 65-year-old patient has been intubated following a cardiac arrest. Capnography color changes being used to assess tube placement are negative. Which of the followingshould be done next?

A: auscultate for bilateral breath sounds

O B: confirm placement with a chest radiograph

O C: extubate and reintubate patient

O D: visualize placement with laryngoscope

ANS: A. auscultate for bilateral breath sounds

79. Which of the following ventilator modes is most

appropriate for a patient with hypoxemia as the result of physiologic shunt?

O A: VC, SIMV

O B: pressure support ventilation

O C: VC, A/C ventilation

O D: CPAP

ANS: D. CPAP

80. A test volume of 2.0 liters is repeatedly injected into a spirometer that is being used for pulmonary function testing. All of the results are 2.5 liters which is an indication that the spirometer is

O A: accurate.

O B: precise.

O C: both precise and accurate.

O D: neither precise nor accurate.

ANS: B. precise

81. Data is collected during successive ventilator checks for a patient on VC, SIMV that indicates that airway resistance has remained stable, while lung compliance has decreased. Which of the following should be recommended?

O A: pressure control ventilation

O B: suctioning of the airway

O C: chest radiograph

O D: arterial blood gas analysis

ANS: C. chest radiograph

82. The use of CPAP or PEEP results in an increase in which of the following?

O A: inspiratory reserve volume

O B: tidal volume

O C: functional residual capacity

O D: inspiratory capacity

ANS: C. functional residual capacity

83. In the interpretation of a chest radiograph, the term opacity is normally used to describe an area on the film that is

A: black.

B. radiodense.

C: translucent.

D: air.

ANS: B. radiodense

84. A sedated patient with no spontaneous breathing is receiving A/C ventilation. Which of the following should be decreased to improve distribution of tidal volumes?

O A: sedation

O B: inspiratory time

O C: flowrate

O D: mandatory rate

ANS: C. flowrate

85. The following data is available for a patient receiving

mechanical ventilation in the intensive care unit: pH 7.49, PaCO2 32 torr, Pa02 164 torr. Which of the following changes to the ventilator settings would help to normalize these arterial blood gas results?

O A: increase the tidal volume and decrease the FI02

O B: decrease the respiratory rate and decrease the FIO2

O C: decrease the tidal volume and increase the FIO2

O D: increase the respiratory rate and decrease the

FIO2

ANS: B. decrease the respiratory rate and decrease the FIO2

86. Attending nurses and the emergency room physician have been unable to place an intravenous line in an intubated patient who is in full cardiac arrest. The respiratory therapist should recommend

O A: administration of subcutaneous epinephrine.

O B: defibrillation.

O C: instillation of medications via the endotracheal

tube.

O D: a precordial thump.

ANS: C. installation of medications via endoctracheal tube

87. PEP therapy involves

O A: the use of two-way valves.

O B: gradually decreased resistance to avoid patient

fatigue.

O C: passive exhalation against a resistor.

O D: inhalation of smaller than normal tidal volumes.

ANS: C. passsive exhalation against a resistor.

88. In the assessment of a patient, which of the following should be considered as possible symptoms of a disease?

O A: cyanosis

O B: nausea

O C: hypertension

O D: tracheal deviation

ANS: B. nausea

89. Which of the following should facilitate the removal of thick, tenacious secretions during suctioning of an intubated, adult patient?

O A: preoxygenation with 100% FI02

O B: increasing suction pressure to 140 mm Hg

O C: instillation of 3 ml normal saline lavage

O D: application of suction pressure for a period of 30 seconds

ANS: C. instillation.of 3 ml normal saline lavage

90. Which of the following are most important in the

evaluation of a smoke inhalation victim? 1. pulse oximetry 2. breath sounds 3. co-oximetry 4. skin color

O A: 1,2, and 3 only

O B: 2, 3, and 4 only

O C: 1,3, and 4 only

O D: 1,2, and 4 only

ANS: B. 2, 3, and 4 only

91. In an emergency, the airway of choice for a patient with cervical spine injuries is which of the following?

O A: nasal trumpet

O B: oral endotracheal tube

O C: nasal endotracheal tube

O D: transtracheal catheter

ANS: C. nasal endoctracheal tube

92. A patient's chest radiograph shows left side blunting of the costaphrenic angle. Which of the following should be recommended?

O A: anticoagulant therapy

O B: chest tube insertion

O C: cardiac enzymes

O D: thoracentesis

ANS: D. thoracentesis

93. Which of the following statements are true with respect to a nasal cannula?

O A: humidification is always required

O B: it delivers a fixed FIO2

O C: most commonly used oxygen delivery device

O D: it is a high-flow oxygen delivery system

ANS: C. most commonly used oxygen delivery device

94. Which of the following initial tidal volumes would be most appropriate for the mechanical ventilation of an adult weighing 70 kg (154 Ib)?

O A: 400 ml

O B: 550 ml

O C: 650 ml

O D: 800 ml

ANS: B. 550 ml

95. The following data is available for a patient whose chief complaint is shortness of breath: respiratory rate of 20/minute, FVC of 900 ml, tidal volume of 400 ml, and deadspace ventilation of 150 ml. Calculated alveolar minute ventilation for this patient is

O A: 3.0 L.

O B: 5.0 L.

O C:8.0L.

O D: 10.0 L.

ANS: B. 5.0 L.

96. Which of the following provides the BEST assessment of adequacy of respiratory muscle function?

O A: maximum voluntary ventilation (MVV)

O B: PaCO2

O C: tidal volume

O D: maximum inspiratory pressure (MIP)

ANS: D. maximum inspiratory pressure (MIP)

97. The following data is available for a patient receiving mechanical ventilatory support in the intensive care unit: Ventilating parameters: Assist/control, Rate 16 breaths/min, VT 650 ml, FIO, 50 %, PEEP 5 cm H,O. Arterial blood gas results: pH 7.42, PaO, 85 torr, PaCO, 39 torr. Hemodynamic measurements: PCWP 18 mm Hg, Cardiac output 2.9 L/min. Based on these findings, what would be

the most appropriate recommendation?

O A: increase PEEP

O B: increase flowrate

O C: decrease respiratory rate

O D: increase inspiratory time %

ANS: B. increase flowrate

98. Following two days of administration of aminophylline to an asthmatic, laboratory results indicate a serum theophylline level of 22 micrograms/ml. Which of the following should be

recommended?

O A: continue current medication dosage

O B: decrease medication dosage

O C: increase medication dosage

O D: discontinue medication

ANS: D. discontinue medication

99. Daily input totals for a mechanically ventilated patient have exceeded those for output by approximately 30%. Continuation of this problem may result in which of the following? 1. renal failure 2. decreased static compliance 3. elevated serum sodium 4. increased intrapulmonary shunt

O A: 1 and 2 only

O B: 3 and 4 only

O C: 1 and 3 only

O D: 2 and 4 only

ANS: D. 2 and 4 only

100. A preterm female has been born by Cesarean section and placed on an infant warmer. The baby is breathing spontaneously and has a heart rate of 80 beats/minute. The respiratory therapist assisting with the care of the infant should do which of the following?

O A: provide free flow oxygen

O B: evaluate color

O C: administer Dopamine IV

O D: initiate positive pressure ventilation (PPV)

ANS: D. initiate positive pressure ventilation (PPV)