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The patient's lung has an air leak Correct Answer: You are called to the emergency department to help care for a patient who was in a vehicle accident and has chest injuries including broken ribs. Crepitations are felt while palpitating the patient's neck. What is most likely the cause of this?
Reversible airway obstruction Correct Answer: A forced expiratory measurement obtained after the administration of a bronchodilator shows an increase in FEV from 60% to 80% of predicted. This indicates a:
complete airway obstruction Correct Answer: During capnography monitoring of a mechanically ventilated patient, you note that the end-tidal PCO2 (PetCO2) has dropped to 0 mm Hg. This finding may indicate:
inserting an esophageal-tracheal combitube Correct Answer: An unconscious apneic patient with a full stomach cannot be orally intubated in the emergency room. Which of the following would your recommend be?
patients size and clinical condition Correct Answer: While establishing initial ventilatory support settings for a new patient, the most important consideration is the:
Fever (hyperthermia) Correct Answer: A male patient has a lower than normal mixed venous O2 content. Which of the following is the most likely cause of this condition?
apply 5 - 10 cm H20 pressure support Correct Answer: You are trying to wean an alert intubated patient off full ventilatory support using the CPAP protocol with 40% O2. Early in the initial effort her respiratory rate increases from 24 to 30/min and you start to observe some use of her accessory muscles while breathing. Which of the following would be your first action at this time?
70 minutes Correct Answer: What is the approximate duration of flow of an oxygen E-cylinder at 1000 psi running at 4 L/min?
increase the suction pressure to - 120 mm Hg Correct Answer: While using a Yankauer device to suction an adult patient, you are unable to remove thick secretions. The regulator attached to the oropharyngeal suctioning device displays a reading of - 70 mm Hg. Which of the following actions should you take at this time?
a missing lead Correct Answer: While setting up a 12-lead EKG on a patient, you are unable obtain any electrical signal. The batteries are fully charged and the device was able to power-on. The most likely cause of this problem is which of the following?
atrial fibrillation Correct Answer: On inspection of a patient's EKG strip, you note that there are no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. What is the most likely problem?
Vital Capacity (VC) Correct Answer: Which of the following is the best bedside measurement for assessing the integrated function of the respiratory muscles and mechanical properties of the lungs and thorax?
Sinus Tachycardia Correct Answer: While inspecting an EKG rhythm strip from an adult patient, you note the following: rate of 148; regular rhythm; normal P waves, P-R intervals, and QRS complexes. What is most likely the problem?
whether the patient is stable on low FiO2s and PEEP Correct Answer: Which of the following is a prerequisite for discharging a ventilator-dependent patient to the homecare setting?
a large volume (3 L) calibration syringe Correct Answer: You would need which of the following equipment in order to calibrate a portable bedside spirometer?
Ventilator-associated pneumonia (VAP) Correct Answer: A physician orders a blind bronchoalveolar lavage procedure for a patient in intensive care unit. What is the most likely potential diagnosis that the doctor is trying to confirm with this procedure?
croup Correct Answer: An AP X-ray of a 4-year-old child with wheezing and stridor shows an area of prominent subglottic edema, but the lateral neck X-ray appears normal. The most likely problem is?
sternocleidomastoid muscles used at rest Correct Answer: If noted on inspiration, which of the following respiratory signs of an adult patient would be considered abnormal?
between the 2nd and 4th thoracic vertebra Correct Answer: While reviewing the chest X-ray of a 30-year-old male receiving ventilatory support via an oral endotracheal tube. To assure proper placement of the tube, you would look for its tip to be positioned
pulseless ventricular tachycardia Correct Answer: Defibrillation should be done immediately in which of the following patient situations?
variable flow control and adjustable I:E ratios Correct Answer: An intubated adult 65-year-old male patient with severe expiratory airway obstruction requires ventilatory support. Which of the following capabilities would be most important in selecting a ventilator for this patient?
the patient cannot sustain prolonged spontaneous ventilation Correct Answer: You are called to obtain a bedside vital capacity (VC) of 450 ml on a 122 lb female patient receiving ventilatory support in the CMV mode. Which of the following can you draw from this finding?
hyperventilation/hypocapnia Correct Answer: Which of the following is the most common problem encountered when applying assist-control mode during ventilation?
flowmeter-humidifier connection for leaks Correct Answer: A bubble humidifier is
inspissated secretions Correct Answer: After review a patient's chart, you note that an admission diagnosis of fluid depletion/dehydration. Which of the following findings would be most likely on bedside assessment of this patient?
it would underestimate the CVP Correct Answer: You are called to help a nurse in ICU measure a patient's central venous pressure (CVP) with a strain-gauge pressure transducer. The pressure transducer appears to be positioned well above the middle of the patient's lateral chest wall. What effect if any would this have on the measurement?
pneumothorax Correct Answer: Which of the following would cause a sudden increase in the peak pressure during volume controlled ventilation?
heated wick humidifier Correct Answer: Which of the following humidifier devices would you select in order to condition the inspired gas to 100% body humidity?
check the A-line stopcock position Correct Answer: While doing a normal patient assessment, you note that the arterial pressure monitor of a conscious patient in no apparent distress that the pressure waveform is absent and the alarm is sounding. What should your first action be?
Control Mode Ventilation (CMV) Correct Answer: Which of the following modes of ventilatory support is indicated when a precise I:E ratio must be maintained?
intubate/apply A/C ventilation, VT 400 mL, rate 12/min, FIO2 0.50 Correct Answer: A 43-year- old 52 kg patient is admitted to the emergency room after overdosing on heroin. The patient is unconscious and is making minimal respiratory efforts. ABG results on a nonrebreathing mask @ 12 L/min are as follows: pH 7.28 PCO2 74 torr HCO3 20 mEq/L PaO2 315 torr You should you recommend?
the presence of a leak in the patient-ventilator system Correct Answer: While comparing previously recorded values to those currently observed on a patient receiving volume control ventilation, you note a decrease in expired volume and a decreased airway pressure. There has been no change in ventilator settings. Which of the following best explains these findings?
the catheter has moved from right ventricle to pulmonary artery Correct Answer:
You are called to assist a physician who is inserting a pulmonary artery catheter. During the procedure, you note a changeover on the monitor from pressures of about 25/5 mm Hg to pressures of 25/15 mm Hg. Which of the following most likely has occurred?
CPAP titration at home or in the sleep lab Correct Answer: Based on an overnight oximetry test, a patient suspected of having sleep disordered breathing exhibits an oxygen desaturation index (ODI) of 48/hr. Which of the following would you recommend?
hypertension Correct Answer: While feeling a patient's radial pulse, you note that the pulse feels bounding and full. Which of the following conditions would likely be the cause of this finding?
increase the set rate Correct Answer: The physician calls you over to examine the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. Currently the patient has a tidal volume of 400 mL, rate of 10/min, and 35% O2. Her blood gas results are as follows: pH 7.31 PaCO2 49 torr HCO 24 mEq/L BE -2 mEq/L PaO2 74 torr SaO2 95% Based on these values, which of the following changes is appropriate?
decreased venous return to the heart Correct Answer: Your patient has a large pneumothorax and also displays hypotension. What is most likely the cause of this finding?
d-dimer Correct Answer: A patient in intensive care unit suddenly start to deteriorate. The attending physician wants to rule out an acute pulmonary embolism as the cause. Which of the following laboratory tests would you recommend?
the ventilator will automatically cycle to end inspiration Correct Answer: A ventilator operating in the volume controlled A/C mode incorporates an inspiratory time limit control as a safety backup to its normal cycling. If the time needed to deliver the volume increases to the preset limit, which of the following will occur?
secondary polycythemia Correct Answer: While reviewing the chart of a 63-year- old patient diagnosed with COPD and chronic hypoxemia, you would expect to find which of the following?
decreased forced expiratory flows Correct Answer: Which of the following PFT findings are common in patients with chronic bronchitis and also found in those with emphysema?
MDI with holding chamber and a mask Correct Answer: A 1-year-old child is admitted to the Emergency Department with severe asthmatic symptoms. The doctor orders a bronchodilator that is available in solution and MDI preparations. Which of the following would be the best delivery system for this drug to this patient?
a patient with a resting systolic BP > 200 mm Hg Correct Answer: Of the following patients undergoing a cardiopulmonary exercise test, for which would you recommend extra precautions?
draw and analyze an arterial blood gas Correct Answer: While reviewing the flow sheet of a patient receiving artificial ventilatory support, you note a progressive rise in heart rate over the last two hours. Which of the following actions would you recommend to help identify the cause of this problem?
use of generic vs. brand name medications Correct Answer: After obtaining a
atelectasis of the left lung Correct Answer: After reviewing the patient's chart, you note that results of a chest x-ray show: "Complete opacification of the left chest with a shift of the trachea and mediastinum to the left." These findings are most likely to indicate which of the following?
a hemoglobin deficiency Correct Answer: A patient with a normal cardiac output and PaO2 is exhibiting signs and symptoms of tissue hypoxia. Which of the following is the most likely cause?
post-extubation edema Correct Answer: The most likely cause of stridor in an adult patient would be which of the following?
high-resolution CT scanning Correct Answer: A patient is admitted with signs and symptoms, as well as a history consistent with bronchiectasis. You should recommend which of the following to confirm or rule out this diagnosis?
left sided tension pneumothorax Correct Answer: When reviewing a chest x-ray, you note that the heart is shifted to the patient's right. Which of the following is the most likely cause of this finding?
noninvasive pulse oximetry Correct Answer: A physician wants your recommendation on how to monitor the cardiopulmonary status of a patient that is undergoing a bronchoscopy procedure with moderate sedation. You would recommend which of the following:
pressure limit/PIP = 25 cm H2O; rate = 15/min; inspiratory time = 1 second Correct Answer: The physician orders A/C pressure control for a 55 kg postoperative male patient. Which of the following settings would you choose for this patient?
pass through the suction catheter and then enter the Lukens trap Correct Answer: You are called to perform a sputum induction on a trach patient to gather a sample for microbiological identification. The sample is collected using a Lukens trap. When applying suction after entering the airway, the mucus should:
Aspirated Foreign Body Correct Answer: You hear wheezing while auscultating a patient's chest. This may indicate the presence of which of the following?
decrease the high pressure limit to 45-50 cm H2O Correct Answer: While
performing a routine patient-ventilator check, you note the following settings and parameters: Exhaled tidal volume 650 mL Peak inspiratory pressure 33 cm H2O High pressure limit 60 cm H2O Low pressure alarm 20 cm H2O Low tidal volume alarm 500 mL Which of the following change would you make?
IPPB Correct Answer: Atelectasis has been diagnosed via a chest x-ray on an unconscious patient who had a recent open heart surgery. Before surgery, the patient's best FVC value was 55% of the predicted. What would you recommend in order to treat the patient's atelectasis?
assess the patient's need for suctioning Correct Answer: For your patient receiving volume control AC ventilation, you observe a flow-volume loop with a sawtooth pattern on exhalation. Which of the following actions would you consider most appropriate?
pressure limit/PIP = 30 cm H2O; rate = 15/min; PEEP = 10 cm H2O Correct Answer: A patient is stabilized with adequate oxygenation and ventilation on volume control ventilation (VC) with the following settings: rate = 15/min, tidal volume = 550 mL, peak inspiratory pressure (PIP) = 45 cm H2O, plateau pressure = 30 H2O and PEEP = 10 cm H2O. The doctor orders a changeover to pressure control ventilation (PC). Which of the following settings would you initially use to implement PC in this patient?
contact the patient's physician for instructions Correct Answer: Your patient is receiving continuous mechanical ventilation. On auscultation, you suspect that the patient's endotracheal tube is in the right main stem bronchus. Which action should you take at this time?
residual volume Correct Answer: Simple spirometry can be used to measure any of the following except:
carbon monoxide poisoning Correct Answer: An unconscious patient was admitted to the ER with an SpO2 of 94% but analysis of an arterial blood sample using a CO-oximeter reveals a SaO2 of 69%. Which of the following is most likely the problem?
"Can you explain to me what you would do if your symptoms worsen?" Correct Answer: While educating a 31-year-old patient with asthma, you explain to her how to recognize and respond to episodes of worsening symptoms. To confirm her understanding of this information you should ask:
capnography Correct Answer: Which of the following would you recommend to provide graphic data useful in evaluating the ventilator-patient interface?
morbid obesity Correct Answer: Which of the following conditions would most likely be associated with a difficult airway?
right-sided atelectasis Correct Answer: While examining a patient, you notice that the patient has greatly diminished breath sounds in the right lower lobe and
add or increase pressure support Correct Answer: A male patient with a smaller than normal trach tube is placed on volume control SIMV at a rate of 8/min. Over the last hour, you note the patient increasing use of his accessory muscles during spontaneous breaths, accompanied by some abdominal paradox. Which of the following would be the best way to overcome this problem?
replace the endotracheal tube Correct Answer: Before intubation in an emergency situation, injection of air into the pilot line fails to inflate the cuff. Which of the following should you do?
refractory hypoxemia Correct Answer: In assessing a patient in the acute phase of ARDS, which of the following would you expect to find?
check the connecting tubing for leaks or obstructions Correct Answer: A nurse who recently set up a pleural drainage system on a patient with a pneumothorax complains that she doesn't see any bubbling in the suction control chamber. After checking the suction control regulator to confirm that it is on, which of the following would you recommend that she do next?
prevent gas leaks and aspiration Correct Answer: To provide long-term positive pressure ventilation, a cuffed artificial airway is needed in order to:
kyphosis Correct Answer: While inspecting an elderly female patient, you note that she has an abnormal anteroposterior (AP) curvature of the spine. This best describes which of the following?
disconnect patient and provide manual ventilation with 100% O2 Correct Answer: You are called to check on a patient receiving volume controlled A/C ventilation. You note that both the low tidal volume and high pressure limit alarms are sounding on each inspiration. You first action should be which of the following?
lower peak pressure Correct Answer: A 54 year-old patient is on a ventilator in the volume control mode. After you perform endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?
pulmonary embolism Correct Answer: Which of the following conditions would a ventilation scan appear normal but a perfusion scan reveal areas of absent blood flow?
-20 cm H2O Correct Answer: A patient is considered to have sufficient respiratory muscle strength to maintain adequate ventilation and prevent secretion retention when the maximum inspiratory pressure (MIP; NIF) is more negative than which of the following?
