TMC Practice Questions A- Kettering exam sample with correct answers latest updated2024, Exams of Nursing

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TMC Practice Questions A- Kettering

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A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with A. liver failure. B. pulmonary embolism. C. heart failure. D. electrolyte imbalances. - correct answer C. A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? A. Call for a STAT chest x-ray. B. Insert a chest tube into the left chest. C. Needle aspirate the 2nd left intercostal space. D. Activate the medical emergency team to intubate the patient. - correct answerC. All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT A. maintaining cuff pressures between 20 and 25 mm Hg. B. using the minimal leak technique for inflation. C. using a low-residual-volume, low-compliance cuff. D. monitoring intracuff pressures. - correct answerC. A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend A. continuing the therapy until breath sounds improve. B. administering dornase alpha. C. administering albuterol therapy. D. deep breathing and coughing to clear secretions. - correct answerD. A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? A. IS / SMI

B. IPPB with normal saline C. postural drainage and percussion D. PEP therapy - correct answerB. A healthy adult female can exhale what portion of her forced vital capacity in the first second? A. 50% B. 60% C. 70% D. 80% - correct answerC. A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time?

1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity A. 1, 2, and 3 only B. 1, 2, and 4 only C. 1, 3, and 4 only D. 2, 3, and 4 only - correct answerA. Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? A. Perform chest physiotherapy B. Administer an IPPB treatment C. Insert an endotracheal tube D. Insert a chest tube - correct answerD. A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. A. 2.5 vol% B. 4.0 vol% C. 5.0 vol% D. 5.5 vol% - correct answerC. A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance? A. 25 mL/cm H2O

B. 35 mL/cm H2O C. 45 mL/cm H2O D. 50 mL/cm H2O - correct answerD. Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time? A. cool mist aerosol treatment B. aerosolized racemic epinephrine C. manual ventilation with resuscitation bag and mask D. reintubation - correct answerD. Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B. A patient on SIMV with a set rate of 12/min and total rate of 24/min. C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support. - correct answerB. A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? A. Initiate bronchial hygiene therapy. B. Obtain a sputum gram stain. C. Administer IPV. D. Insert a CASS tube. - correct answerB. Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing?

1. FEV
2. PEFR
3. FRC
4. RV A. 1 and 2 only B. 1 and 3 only C. 2 and 4 only D. 3 and 4 only - correct answerA.

The respiratory therapist is providing patient education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will A. sterilize the equipment. B. retard bacterial growth. C. kill all micro-organisms and spores. D. extend the equipment life. - correct answerB. A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from A. pneumonia. B. pulmonary embolism. C. pleural effusion. D. bronchiolitis. - correct answerC. Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? A. 8 Fr B. 10 Fr C. 12 Fr D. 14 Fr - correct answerC. A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that A. the patient is disconnected from the ventilator. B. the patient is experiencing diffuse bronchospasm. C. the endotracheal tube has slipped into the right main stem bronchus. D. the patient has developed a left tension pneumothorax. - correct answerC. The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to A. notify the charge nurse. B. apply a pressure dressing. C. apply pressure to the site. D. perform a modified Allen's test. - correct answerC.

A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? A. Diabetes insipidus B. Renal failure C. Metabolic acidosis D. Elevated intracranial pressure - correct answerD. What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? A. Less than 5 B. 5 to 15 C. 16 to 30 D. Greater than 30 - correct answerB. While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes? A. Upper airway obstruction B. Poor peripheral perfusion C. Air leak around the sensor D. Device is out of range - correct answerC. A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? A. 5 L/min B. 55 L/min C. 88 L/min D. 140 L/min - correct answerB. Which of the following measurements is most indicative of pulmonary edema? A. Heart rate of 120/min B. Blood pressure of 92/72 mm Hg C. Pulmonary artery pressure of 25/10 mm Hg D. Pulmonary capillary wedge pressure of 30 mm Hg - correct answerD. Sleep apnea can be defined as repeated episodes of complete cessation of airflow for A. 5 seconds or longer. B. 10 seconds or longer. C. 15 seconds or longer.

D. 20 seconds or longer. - correct answerB. A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy procedure in which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT A. hypoxemia. B. pneumothorax. C. pulmonary hemorrhage. D. bronchospasm/laryngospasm. - correct answerA. What size endotracheal tube would be appropriate for an adult female patient? A. 6.0 to 6.5 mm B. 6.5 to 7.0 mm C. 7.0 to 7.5 mm D. 7.5 to 8.0 mm - correct answerC. The respiratory therapist has been asked to measure Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should A.initiate an inspiratory hold just after the next ventilator-delivered breath. B.initiate an expiratory hold just prior to the next ventilator-delivered breath. C.subtract Pplat from Pdyn. D.subtract set PEEP from the measured Pplat. - correct answerB. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend

1. IV fluid challenge
2. positive inotropic agent
3. inhaled nitric oxide
4. diuretic therapy A. 1 and 3 B. 2 and 4 C. 3 and 4 D. 1 and 2 - correct answerB.

What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? A. VC limits and controls PIP. B. VC provides a constant minute ventilation. C. VC ensures better patient-ventilator synchrony. D. VC delivers a decelerating flow pattern. - correct answerB. Bronchial breath sounds heard over the lung periphery indicate A. narrowed airways. B. obstructed bronchi. C. lung consolidation. D. pulmonary edema. - correct answerC. During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? A. a mild restrictive disorder B. a mild obstructive disorder C. normal lung function D. mixed obstructive/restrictive disorder - correct answerC. A 55 year-old male patient is being evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should A. reduce the speed of the bike. B. administer supplemental oxygen. C. gradually reduce the workload and monitor closely. D. terminate the procedure immediately. - correct answerD. At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? A. 4 & 8 B. 5 & 9 C. 5 & 10 D. 6 & 10 - correct answerD.

The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? A. 0.25 mL B. 0.50 mL C. 1.25 mL D. 2.5 mL - correct answerB. After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist has documented in the Progress Notes a need to change the patient's treatment regimen. The respiratory therapist should A. continue the current treatment plan. B. report the change in treatment plan to the next shift. C. check the electronic medical record for new physician orders. D. disregard the information until notified by the shift supervisor. - correct answerC. A 60 kg (132 lb) patient is being mechanically ventilated with the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x- ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? A. Increase the frequency. B. Change to airway pressure release ventilation. C. Decrease the inspiratory time. D. Increase PEEP to 15 cm H2O. - correct answerB. In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a A. rotameter. B. 3.0 L syringe. C. Wright respirometer. D. pneumotachometer. - correct answerB. While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding?

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

B. 2 and 4 only C. 2, 3, and 4 only D. 1, 2, 3, and 4 - correct answerC. A post-operative patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as A. a persistent bronchopleural fistula. B. a resolved pneumothorax. C. back-pressure from the suction chamber. D. normal function of the water seal chamber. - correct answerA. A 19-year-old patient is brought to the emergency department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? A. Obtain a sputum specimen. B. Obtain an ABG. C. Measure peak expiratory flow. D. Determine the Glasgow Coma Score. - correct answerB. A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from A. pulmonary embolism. B. gastroesophageal reflux. C. myocardial infarction. D. valvular stenosis. - correct answerC. A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend? A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation - correct answerD. Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend

A. antiviral therapy. B. blood transfusion. C. SABA by small volume nebulizer. D. antibiotic therapy. - correct answerD. A tracheostomy tube has just been inserted percutaneously into a patient with a C fracture. How much air should the respiratory therapist initially inject into the cuff? A. Enough to achieve a pressure of 25-35 cmH2O. B. Enough to achieve a minimal occluding volume. C. A minimum of 20 mL. D. Until firm tension is felt in the pilot balloon. - correct answerA. All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A. carbon monoxide poisoning. B. decompression sickness. C. anaerobic infections. D. pulmonary hypertension. - correct answerD. Which of the following factors are determinants of cardiac output? A. ventricular filling and heart rate B. stroke volume and heart rate C. stroke volume and respiratory rate D. heart rate and tidal volume - correct answerB. The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 8 mEq/L; SaO2 95%; BE -15 mEq/L. The respiratory therapist should recommend A. initiating oxygen therapy via nasal cannula at 4 L/min. B. intubating and initiating mechanical ventilation. C. administering sodium bicarbonate intravenously. D. initiating non-invasive ventilation. - correct answerC. The physician asks the respiratory therapist to set ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request? A. Decelerating B. Square wave C. Constant D. Accelerating - correct answerA.

An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is A. hypoventilation. B. shunt. C. ventilation/perfusion mismatch. D. increased deadspace. - correct answerC. A 16 year-old patient with cystic fibrosis attends public high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient? A. intrapulmonary percussive ventilation B. dornase alpha therapy C. vibratory / oscillatory PEP D. postural drainage and manual percussion - correct answerC. A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as A. orthopnea. B. platypnea. C. eupnea. D. Kussmaul breathing. - correct answerA. A home care patient calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to A. tape the connection securely. B. increase the flow to the catheter. C. decrease the flow to the catheter. D. switch to a nasal cannula. - correct answerD. A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? A. Insert a laryngeal mask airway (LMA) to facilitate suctioning. B. Discontinue nasotracheal suctioning for 24 hours and reassess the patient. C. Insert a nasopharyngeal airway after bleeding has been controlled. D. Insert an oral endotracheal tube to allow for better airway access. - correct answerC.

The most probable cause of air bronchograms and increased density on a chest x-ray is A. pneumonia. B. pulmonary edema. C. pulmonary embolism. D. pleural effusion. - correct answerA. A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely. - correct answerB. The primary source of infection in the health care setting is A. use of medical equipment for multiple patients. B. poor handwashing techniques of personnel. C. food and/or water intake by the patient. D. patient rooms not cleaned appropriately. - correct answerB. A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? A. Pre/post bronchodilator study B. Ultrasonic nebulizer treatments C. Manually assisted coughing D. Regular coughing and deep breathing - correct answerD. The respiratory therapist has obtained a blood gas sample from the patient's radial artery and applied pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is A. adding liquid heparin to the sample. B. placing the syringe in an ice bath. C. shaking the sample continuously. D. applying a pressure bandage. - correct answerB. Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray?

A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion - correct answerA. A spontaneous breathing trial was initiated on an intubated, awake, and alert 70 kg ( lb) patient. After 30 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient's vital signs have remained stable throughout the trial. Which of the following is the most appropriate recommendation? A. Maintain current therapy. B. Initiate NPPV. C. Add 5 cm H2O CPAP. D. Extubate the patient. - correct answerD. After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include

1. bronchospasm.
2. pneumothorax.
3. pulmonary hemorrhage. A. 1 and 2 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3 - correct answerD. A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? A. Head down, patient supine with a pillow under knees B. Patient prone with a pillow under head, bed flat C. Patient supine with a pillow under knees, bed flat D. Head down, patient prone with a pillow under hips - correct answerD. A 72 year-old female post stem cell transplant patient in the ICU is complaining of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B- type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? A. severe heart failure

B. respiratory distress syndrome C. severe renal failure D. moderate heart failure - correct answerD. Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? A. flail chest on right thorax B. right tension pneumothorax C. endobronchial intubation D. subcutaneous emphysema - correct answerC. While reviewing quality control data for the blood gas lab, the respiratory therapist notes the following data plot for the pH electrode: Which of the following should the therapist recommend? A. Repeat the previous control analysis B. Remove the analyzer from service C. Reset the analyzation module on the analyzer D. Recalibrate the pH electrode - correct answerD. A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation?

1. Increase the pressure limit
2. Increase the sensitivity
3. Increase the mandatory rate
4. Decrease the inspiratory time A. 1 and 4 only B. 1 and 3 only C. 2 and 3 only D. 1, 2 and 4 only - correct answerB. A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient? A. diuretics B. antibiotics

C. lung expansion therapy D. thoracentesis - correct answerC. A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a minimal occluding volume. This would indicate that the A. tube is not of the appropriate size. B. pilot balloon and line are obstructed. C. pressure manometer is defective. D. cuff has herniated over the tip of the tube. - correct answerA. A patient is receiving oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80, HCO3 38 mEq/L. The most likely explanation for these results is that A. the sample was not iced properly. B. there was excess heparin in the syringe. C. the numbers were not reported correctly. D. The sample contains venous blood. - correct answerC. The respiratory therapist is completing oxygen rounds on the ward and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? A. 70% ethyl alchohol B. Warm soapy water C. Bleach D. Acid glutaraldehyde - correct answerA. Evaluation of a spontaneously breathing patient reveals tachypnea, tracheal deviation to the right and an absence of breath sounds on the left. The most likely etiology would be A. bronchiectasis. B. myasthenia gravis. C. acute asthmatic attack. D. left tension pneumothorax. - correct answerD. The most serious complication associated with airway suctioning is A. hypoxemia. B. bradycardia. C. mucosal trauma. D. gag reflex stimulation - correct answerA.

What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and is complaining of difficulty breathing? A. Sims B. Trendelenburg C. lateral Fowlers D. Fowlers - correct answerC. Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? A. 20 torr B. 30 torr C. 40 torr D. 50 torr - correct answerD. The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor

1. electrocardiogram.
2. electroencephalogram.
3. nasal air flow.
4. chest wall impedance. A. 1 and 2 only B. 3 and 4 only C. 2, 3, and 4 only D. 1, 2, and 3 only - correct answerB. All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT A. minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. B. minimal leak technique allows a small leak at the end of inspiration. C. at minimal occlusion volume, air leakage around the tube cuff should cease. D. cuff pressure should not exceed 35 cmH2O in order to allow circulation to tracheal mucosa. - correct answerA. The sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing is representative of A. tidal volume. B. pulmonary shunt. C. V/Q mismatch. D. alveolar gas that has participated in gas exchange. - correct answerD.

A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might have accounted for these readings? A. The ventilator circuit has become disconnected. B. There is a leak around the endotracheal tube. C. There is an increase in alveolar dead space. D. The carbon dioxide absorber is exhausted. - correct answerA. A patient has mild stridor immediately after extubation. This finding is most often associated with A. lower airway obstruction. B. secretions in the large airways. C. upper airway obstruction. D. bronchial spasm. - correct answerC. A trauma patient in the ED is spontaneously breathing oxygen via nasal cannula at 2 L/min. Vital signs are heart rate 110/min, respiratory rate 32/min, blood pressure 90/ mmHg. The pulse oximeter is reading 88%. Which of the following should the respiratory therapist recommend to maximize the patient's FIO2? A. Simple oxygen mask at 8 L/min B. Non-rebreathing mask at 15 L/min C. CPAP at 10 cmH2O and 0.60 FIO D. NPPV of 18/5 cmH2O and 0.60 FIO2 - correct answerB. The primary reason for the use of respiratory care protocols is to A. decrease the patient workload for therapists. B. standardize provision of care. C. enhance departmental efficiency. D. increase the autonomy of therapists. - correct answerB. What is normal urine output in an adult patient? A. 10 mL/hr B. 20 mL/hr C. 30 mL/hr D. 40 mL/hr - correct answerD. A patient with a closed head injury has had a cuffed tracheostomy tube in place for several weeks. The physician wishes to decannulate the patient but maintain the patency of the stoma for secretion removal. Which of the following devices would facilitate this request?

A. fenestrated trach tube B. transtracheal catheter C. laryngectomy tube D. tracheostomy button - correct answerD. A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of Keflex® as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? A. thoracentesis B. polysomnography C. flexible bronchoscopy D. plethysmography - correct answerC. A 60 kg (132 lb) female patient with congestive heart failure is receiving NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as A. shunting. B. hypoventilation. C. hyperoxygenation. D. fluid overload. - correct answerC. Which of the following physiologic values would be present in a patient who has proper fluid balance? A. PCWP of 22 mm Hg B. CVP between 3 and 6 mm Hg C. urine output of 20 mL/hr D. increase in body weight - correct answerB. The respiratory therapist prepares to assist with a bronchoscopy of a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT A. introduction of the bronchoscope will create increased resistance to flow. B. the tidal volume of the patient must be closely monitored during the procedure. C. the patient's extrinsic PEEP levels will increase. D. peak inspiratory pressure on the ventilator will rise. - correct answerC. Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? A. Post-traumatic chest trauma

B. Community-acquired pneumonia C. Spinal cord injury D. Chronic bronchitis - correct answerD. A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist should recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: A. coordinating coughing with pain medication. B. performing serial coughs. C. applying pressure to patient's abdomen during exhalation. D. "splinting" the incision area. - correct answerC. Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation?

1. Select a ventilator that uses demand valves rather than a reservoir IMV system.
2. Calculate oxygen cylinder duration of flow.
3. Selecting a ventilator that incorporates an internal air compressor. A. 1 and 2 only B. 2 and 3only C. 3 only D. 1, 2, and 3 - correct answerA. A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend? A. Leave the patient on the cannula and continue to monitor. B. Change to a 24% Venti-mask and repeat ABG. C. Change to a simple oxygen mask and repeat ABG. D. Prepare the patient for endotracheal intubation. - correct answerB. A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a A. high likelihood of excessive bleeding. B. normal clotting ability. C. propensity for increased clotting. D. decrease in bone marrow function. - correct answerA. A mechanically ventilated patient with a tracheostomy tube is on the following settings:

PC, SIMV, PIP 30 cmH2O, f 20/min, FIO2 0.60, PEEP 5 cmH2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely? A. The patient has been disconnected. B. Complete obstruction of the tracheostomy tube. C. Development of a left-sided pneumothorax. D. Partial obstruction of the tracheostomy tube. - correct answerD. The respiratory therapist is instructing a postoperative abdominal surgery patient on how to perform incentive spirometry. The therapist should explain that the purpose of the treatment is to A. prevent microatelectasis. B. promote healing of the incision. C. prevent areas of lung collapse. D. prevent and treat pneumonia. - correct answerC. A pulse oximeter provides an accurate indication of a patient's oxygenation status in which of the following situations?

1. Polycythemia
2. Pulmonary hypertension
3. Congestive heart failure
4. Carbon monoxide poisoning A. 1 & 4 only B. 2 & 3 only C. 1, 2, & 3 only D. 1, 2, 3, & 4 - correct answerC. What increase in FEV1 in post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern? A. 10% and 100 mL B. 12% and 200 mL C. 15% and 100 mL D. 20% and 200 mL - correct answerB. A patient with a history of asthma presents to the ED in severe respiratory distress and increased accessory muscle use. Vital signs are heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating A. Xopenex® by MDI

B. Pulmacort® by small volume nebulizer C. Salmeterol® by DPI D. Ventolin ® by continuous nebulization - correct answerD. A patient in the ICU is being ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient's SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should A. decrease the respiratory rate. B. decrease the PEEP. C. increase the expiratory time. D. decrease the inspiratory pressure. - correct answerD. An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask? A. 10 L/min B. 13 L/min C. 16 L/min D. 18 L/min - correct answerC. Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? A. Transillumination B. APGAR score C. Ballard score D. Silverman score - correct answerD. While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient? A. Reduce the dose of albuterol. B. Discontinue the treatment. C. Change to 3 puffs of beclomethasone dipropionate (Vanceril®). D. Change to 0.63 mg of levalbuterol (Xopenex®). - correct answerA. The respiratory therapist is preparing to assist in the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend? A. ketamine B. vecuronium

C. rocuronium D. succinylcholine - correct answerD. A patient receiving mechanical ventilation has a capnometer in-line at the Y-connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should A. replace the exhalation valve. B. decrease the humidifier temperature setting. C. remove the inline medication nebulizer. D. reattach the patient to the circuit. - correct answerD. A 28 year-old female has just been admitted through the ED with suspected CO poisoning. She is receiving oxygen by non-rebreather mask at 10 L/min. Upon entering the patient's room, the respiratory therapist notes that the reservoir bag of the mask collapses during inspiration. This is most likely the result of A. faulty one-way valves. B. tight seal between the mask and the patient's face. C. presence of a bubble humidifier. D. insufficient flow to the reservoir bag. - correct answerD. Pre- and post-bronchodilator spirometry is performed on a patient and yields the following results: Pre-Bronchodilator (% predicted) Post-Bronchodilator (% predicted) FVC 82 83 FEV1 46 66 FEF200-1200 51 68 FEF 25-75 49 70 MVV 65 75 The respiratory therapist should recommend the initiation of A. continuous mechanical ventilation B. intermittent positive pressure breathing C. bronchodilator therapy D. incentive spirometry - correct answerC. The physician asks the respiratory therapist to set a mechanically ventilated patient's PEEP at an optimal level. The PEEP level is optimal when A. PEEP levels are less than 18 cm H2O. B. PaO2 is 60 torr or greater. C. Oxygen delivery to the tissues is maximal. D. C(a-v)O2 is decreasing. - correct answerC.

Thirty minutes after extubation, a patient exhibits moderate stridor. Which of the following should the respiratory therapist recommend? A. Initiate a heated aerosol treatment with saline. B. Administer a racemic epinephrine aerosol treatment. C. Monitor the patient closely for the next hour. D. Immediately reinsert the endotracheal tube. - correct answerB. A 65 year-old patient with end-stage COPD is admitted to the ED with an acute exacerbation. He has a DNI order in his chart. Physical exam reveals that the patient is febrile and has a weak, non-productive cough. Breath sounds reveal bilateral coarse crackles with scattered wheezes. The patient is started on bronchodilator therapy and antibiotics. Serial ABG results are: 7 pm 8 pm FIO2 0.21 0.40 pH 7.30 7.21 PaCO2 70 torr 83 torr PaO2 48 torr 58 torr HCO3 34 mEq/ 34 mEq/L SpO2 78% 89% What should the respiratory therapist recommend? A. Initiate comfort care procedures. B. Decrease FIO2 to 0.35. C. Administer IPV. D. Initiate NPPV. - correct answerD. While providing patient education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT A. liquid oxygen burns when refilling portable tanks. B. how to properly secure oxygen cylinders for transport. C. use of grounded 3-prong outlets for electrical equipment. D. emergency procedure to deal with gas explosions. - correct answerD. A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the A. left atrium. B. pulmonary vein. C. pulmonary artery. D. superior vena cava. - correct answerC.

During chart review prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do?

1. Perform ABG as normal.
2. Refuse to perform the ABG.
3. Hold pressure on the puncture site for a longer time after sample is collected.
4. Recommend that an ABG should be performed on the patient only if absolutely necessary. A. 2 and 4 only B. 1 and 3 only C. 3 and 4 only D. 2 only - correct answerA. The respiratory therapist is assisting in the elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST? A. Check the inlet valve. B. Check the patient valve. C. Replace the manual resuscitation bag. D. Check for excessive oxygen flow. - correct answerC. During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: What action should the therapist take? A. Initiate pressure support. B. Increase respiratory rate. C. Decrease inspiratory time. D. Add an inspiratory plateau. - correct answerC. A patient is on CPAP at 10 cmH2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur?
5. Excess water will rain out
6. Humidity deficit will occur
7. Relative humidity will decrease
8. Relative humidity will remain 100% A. 2 only

B. 2 and 4 only C. 1 and 3 only D. 1 and 4 only - correct answerD. While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the A. peak flow meter is clogged. B. patient's asthma has worsened. C. patient is fatigued. D. peak flow meter is accurate. - correct answerA. The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist's first action should be to A. look for a kink in the circuit. B. change modes of ventilation. C. check the exhalation valve. D. suction the patient. - correct answerC. The respiratory therapist should recommend home apnea monitoring for infants with all of the following situations EXCEPT A. preterm infant with significant apnea periods. B. sibling of a SIDS baby. C. APGAR scores of 4 and 6 at delivery. D. infant with a history of snoring. - correct answerC. A patient is being evaluated in the pulmonary clinic. He reports that he smoked a pack and a half of cigarettes (30 cigarettes) per day for 20 years. How should the respiratory therapist describe the patient's smoking history? A. 20 pack-years B. 25 pack-years C. 30 pack-years D. 60 pack-years - correct answerC. Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min? A. intrapulmonary percussive ventilation B. autogenic drainage