21. Palpable rhonchi in a patient who is being mechanically ventilated most likely indicate which of the following?
A. Secretions
B. Pneumothorax
C. Bronchospasm
D. Consolidation
22. After assisting the physician with a fiberoptic bronchoscopy and transbronchial lung biopsy on a patient receiving volume-controlled ventilation, the respiratory therapist notes a marked increase in peak inspiratory pressure. Possible causes of the pressure increase include which of the following?
I. Bronchospasm
II. Pneumothorax
III. Pulmonary hemorrhage
IV. Laryngospasm
A. I and IV only
B. II and III only
C. I, II and III only
D. I, II, III and IV
23. When attempting to obtain an arterial blood gas sample, an Allen’s test is performed on both of the patient’s wrists. The respiratory therapist finds that there is inadequate circulation through the patient’s left ulnar artery. The therapist should do which of the following?
A. Obtain the sample from the left radial artery
B. Obtain the sample from the right radial artery.
C. Obtain the sample from the right ulnar artery.
D. Obtain a pulse oximetry reading instead of the blood gas.
24. The respiratory therapist opens the valve on an E cylinder that has a regulator attached and hears a loud hissing noise. The flow meter is turned off. Which of the following actions might correct the problem?
I. Turning on the flowmeter.
II. Tightening the regulator connection.
III. Changing the regulator washer
A. I only
B. I and II only
C. II and III only
D. I, II and III
25. Common complications associated with arterial punctures include which of the following:
I. Fistula formation
II. Hematoma formation
III. Spasm of the vessel
A. I only
B. III only
C. I and II only
D. II and III only
26. A patient requires frequent suctioning of oral secretions. Which of the following should be made available at the patient’s bedside?
I. Vacuum system
II. Connecting tubing
III. Yankauer suction device
IV. Luken’s trap
A. I and II only
B. III and IV only
C. I, II and III only
D. I, II, III and IV
27. A patient is receiving a treatment with 2.5 mg of albuterol (Proventil) and 2.5 mL of normal saline in the emergency department (ED). Prior to therapy, the patient’s heart rate is 80/min and at the end of therapy, it is 138/min. The respiratory therapist should:
A. Recommend decreasing the dosage of albuterol.
B. Increase the amount of saline per treatment to 3 mL.
C. Recommend changing to ipratropium bromide (Atrovent).
D. Recommend adding acetylcysteine (Mucomyst) to the treatment.
28. A patient with severe facial trauma from a motor vehicle crash is brought into the emergency department (ED). The patient is obtunded and in respiratory distress due to swelling and blood in the naso– and oropharynx. Which of the following is indicated?
A. Oropharyngeal airway
B. Nasopharyngeal airway
C. Tracheostomy tube
D. Cricothyroid puncture
29. A patient who is being mechanically ventilated has just received vecuronium (Norcuron). Which of the following is the most important ventilator alarm to monitor to ensure patient safety?
A. I:E ratio
B. Circuit temperature
C. High pressure
D. Low pressure
30. A patient receiving continuous heated aerosol therapy with room air by a T-piece develops subcutaneous emphysema around the tracheostomy site, neck, and chest. After nothing unequal breath sounds, the most appropriate diagnostic procedure would be:
A. A chest radiograph
B. A maximum inspiratory pressure (MIP) measurement
C. Timed forced expiratory volumes
D. An arterial blood gas analysis
31. A patient with severe COPD who is receiving oxygen must be observed closely because which of the following may occur?
A. Hypoventilation
B. Pneumothorax
C. Bronchospasm
D. Pulmonary edema
32. During CPR in the emergency department (ED), a demand-valve resuscitator fails to deliver adequate tidal volumes. The respiratory therapist’s immediate response would be to:
A. Inspect the unit
B. Call for help
C. Use a mechanical ventilator
D. Change to a manual resuscitator
33. Which of the following pulmonary function parameter is LEAST dependent on patient effort?
A. FEF 25-75%
B. FEF 200-1200
C. FVC
D. PEF
34. A neonate is receiving oxygen therapy by a hood. Which of the following should the respiratory therapist select to check the accuracy of the air-oxygen blender?
A. Line pressure manometer
B. Galvanic cell analyzer
C. Pneumotachometer
D. Pulse oximeter
35. A patient is to receive incentive spirometry at home. When explaining the therapeutic goals to the patient’s family, the respiratory therapist should explain that the therapy:
A. Helps resolve pneumonia
B. Can decrease the chance of lung collapse
C. Should decrease the frequency of the patient’s cough
D. Should make breathing easier by causing bronchodilation
36. Extubation is performed during peak inspiration to:
A. Prevent laryngospasm
B. Ensure adequate oxygenation
C. Provide volume to clear secretions
D. Minimize vagal stimulation
37. A patient is receiving volume-controlled, flow limited ventilation. An inverse I:E ratio visual alert is observed during a routine ventilator check. Which of the following adjustment would be most appropriate to correct the problem?
A. Increase the flow
B. Increase the frequency setting
C. Decrease the tidal volume
D. Activate the ratio limit control
38. When using an infrared carbon dioxide analyzer the PetCO2 value will be affected by all of the following EXCEPT:
A. Moisture
B. Sensor temperature
C. Barometric pressure
D. Magnetic field interference
39. Which of the following would be most appropriate to recommend for a patient with dyspnea who has a 40% pneumothorax?
A. Administer a nebulized bronchodilator
B. Perform chest physiotherapy
C. Insert an endotracheal tube
D. Insert a chest tube
40. The respiratory therapist is explaining the objectives of a pulmonary rehabilitation program to a 55-year-old patient with emphysema. Which of the following outcomes would allow the patient to participate in evaluating the achievement of the therapeutic plan?
A. Reduction of airway resistance
B. Improvement in arterial blood gas values
C. Improvement in results of pulmonary function studies
D. Increased ability to perform activities of daily living
41. A patient who is being mechanically ventilated has insufficient time to exhale completely. Which of the following ventilator changes might be appropriate to correct this problem?
I. Increase the flow
II. Decrease the ventilator rate
III. Add mechanical dead space
IV. Add inspiratory hold
A. I and II only
B. II and III only
C. II, III and IV only
D. I, II, III and IV
42. The respiratory therapist observes low exhaled volumes during volume-cycled, pressure-limited mechanical ventilation. To determine if the low volumes are caused by inaccurate ventilator volume control, the therapist should measure the tidal volume at the:
A. Machine outlet
B. Patient connector
C. Exhalation valve
D. Spirometer
43. A patient with a head injury is heavily sedated. The patient requires positive pressure ventilation and has a moderately increased intracranial pressure and a pulmonary capillary wedge pressure of 23 mm Hg. Appropriate recommendations include which of the following?
I. Elevate the patient’s head to 30 degrees.
II. Decrease the ventilatory rate
III. Administer furosemide (Lasix)
A. I and II only
B. I and III only
C. II and III only
D. I, II and III
44. An adult patient is receiving volume-controlled ventilation and has a tidal volume of 700 mL. The patient’s pH is 7.38. The patient is switched to pressure-controlled ventilation and a pressure limit of 50 cm H20. An exhaled tidal volume of 850 mL is now measured. The respiratory therapist should recommend which of the following?
A. Set the PEEP at 5 cm H2O
B. Maintain the current settings
C. Increase the inspiratory time
D. Decrease the pressure setting to obtain previous tidal volume
45. A patient is receiving noninvasive positive pressure therapy. Pulmonary compliance has decreased over the past 4 hours. To increase the patient’s tidal volume, it would be most appropriate to:
A. Suction the patient
B. Change the CPAP
C. Increase the low-pressure level
D. Increase the high-pressure level
46. Which of the following would the respiratory therapist select to treat a patient who has obstructive sleep apnea?
A. Nasal cannula
B. Chest cuirass ventilator
C. Bilevel positive airway pressure
D. Airway pressure-release ventilation
47. Hemodynamic monitoring is initiated for a patient with multi-organ system failure. The patient is rapidly transfused with packed red blood cells. Following transfusion, the patient’s PvO2 increased from 33 torr to 38 torr. The respiratory therapist should conclude that:
A. Cardiac output has decreased
B. Intrapulmonary shunt has increased
C. Additional transfusion are required
D. Oxygen delivery to the tissues has improved
48. A manometer is being used to monitor a continuous flow CPAP device set at 10 cm H2O. Each time the patient inhales, the pressure decreases to 2 cm H2O, then returns to 10 cm H2O on exhalation. Which of the following is the most likely cause of the problem?
A. The flow of gas to the patient system is insufficient.
B. There is a leak in the patient system
C. The patient’s endotracheal tube is too small for the inspiratory flow
D. The CPAP pressure valve is too small for the patient’s size and weight
49. A patient with congestive heart failure is intubated and receiving mechanical ventilation in the emergency department (ED). Appropriate pharmacologic therapy is implemented. To assure a constant tidal volume delivery, which of the following ventilators should the respiratory therapist select for this patient?
A. Pressure-cycled
B. Time-cycled
C. Patient-cycled
D. Volume-cycled
50. A home care patient receiving O2 at 2 L/min states that he does not feel any oxygen coming from the cannula that is connected to a concentrator. Which of the following should the respiratory therapist do FIRST?
A. Change the machine inlet filter
B. Turn the flow meter up to 4 L/min
C. Switch to a back-up liquid oxygen system
D. Insert the cannula into water and check for bubbles.
