When reviewing a chart, the comment, öriented x 3" is noted. This means:
B) Normal Sensorium
Who may change an Advanced Directive?
C) the patient and the person with power of attorney
Which should be asked while interviewing a pt to determine dyspnea?
B) Are you SOB?
A pt is receiving O2 at 3 lpm by cannula. Upon inspection, you note central cyanosis. Where do you notice this?
A) on the neck region & lips
A male COPD pt is being assessed in the ICU. You note his jugular vein is distended to the jaw line. This finding would indicate:
C) RH Failure
Upon inspection of the head, neck & thorax, you note the pt has respiratory distress & increased WOB. Which of the following would be present?
D) nasal flarring & intercostal retractions
19. A 23-yo male is in the ED for contusions sustained from a fall while pruning a tree. He is receiving 40% O2 by air-entrainment mask. It is noted that the patient's right chest sinks in during inspiration while the rest of the chest rises. What type of breathing pattern is this?
21. A 67 yo pt is in the ED complaining of pain & SOB following a coughing episode. Percussion reveals a tympanic sound emitted from the L lung & a resonant sound emitted from the R lung. Which of the following is present?
A) L-sided Pneumothorax
23. When admitted to the ICU for status asthmaticus, you note on the heart monitor the pt's BP drops during inspiration & increases during expiration. This is referred to as:
D) pulsus paradoxus
25. A 76 yo male has been admitted to the ICU with a dx of pulmonary edema from CHF. Which of the following breath sounds would you expect to hear during auscultation?
A) late crackles
27. Upon reviewing the chart prior to Rx, you note an entry that states the pt has a loud P2 heart sound. This would indicate the presence of:
A) pulmonary hypertension
29. During PE using palpation, an abnormal bilateral expansion of the chest wall is assessed. This would indicate:
31. Which of the following would be associated with an underexposed PA CXR?
A) loss of mid-thoracic intervertebral spaces
33. A pt in ICU from a MVA is receiving MV. An AP CXR shows the L hemidiaphragm higher than the right. Which of the following is the result of these findings?
B) L-Sided atelectasis
35. An AP CXR has returned on an adult, orally intubated pt with MV. It is noted the tip of the ET tube is 5cm above the carina. What should be recommended?
A) maintain current position
37. A 64 yo female is dx with bronchiectasis has been admitted for exacerbation of condition. PA CXR shows infiltrates along the R heart border. THe pt has lung drainage ordered. Upon which areas should the Rx be concentrated?
39. A frontal neck XR of a 4 yo child shows subglottic narrowing below the vocal cords. Based on this finding, the child should be Rx'd for:
41. An 18 month old child is seen in the ED & croup is dx. A dose of racemic epinephrine via SVN. What size particle is likely to deposit in the subglottic region?
D) 5-10 micron
43. Your are treating a pt with Pneumocystis pneumonia. What type of delivery device should you choose to administer the dose of pentamidine ordered by the physician?
D) Respirgard II
44. A pt carries an Albuterol MDI, which she claims to use every few weeks. She complains that her first dose actuated from the device seems to have no effect. What suggestions do you make?
D) discharge a waste dose before using
46. A pt with ARDS is ventilated with Vt = 6ml/kg (380ml). Pplat is 37cm H2O. RR is set at 35 bpm. The PaCO2 is 65 mm Hg & the pH is 7.22. Which of the following would you recommend?
A) remove the deadspace from the circuit
48. A pt with COPD is being ventilated using pressure support ventilation. When a jet nebulizer is placed into the circuit, the pt is unable to trigger. What is the most likely cause?
D) flow from the nebulizer
49. You are attempting to suction a pt with COPD. It is difficult to pass the catheter. Which of the following changes would you suggest?
B) replace the HME with a heated humidifier
50. You are managing a pt per the ARDSnet Protoctol. Ventilator mode is VCV, RR = 28, Vt = 360ml (6.2 mL/kg), PEEP = 10 cm H2O, FiO2 = 0.5. ABG's are pH 7.18, PaCO2 = 73 mm Hg, PaO2 = 74 mm Hg. What ventilatory change would you make?
C) increase RR to 32 bpm
52. You are managing a pt with NIV. The pt complains of dry mouth. You note the presence of auto-triggering. Which of the following is your most appropriate response?
B) change nasal mask to oronasal mask
54. You are managing a pt with cardiogenic pulmonary edema using NIV. The SpO2 is 87%. The pt's RR is 30 bpm. Ventilator settings are IPAP 8cm H2O, EPAP 4 cm H2O, FiO2 0.8. Which of the following is the most appropriate?
B) change EPAP to 8 cm H2O & IPAP to 12 cm H2O
56. You receive an order to administer IS on a 64 yo woman who is recovering from heart surgery. Even after through instructions, the pt is unable to accomplish a proper sustained inspiratory maneuver. Her predicted IC is 2.2 L & her achieved is 700 cc. Which is the most appropriate
A) administer IPPB
58. A 44 yo female pt is recovering from gallbladder surgery. She has been using her IS as instructed. You notice that she initiates a new breath before the piston plate returns to the bottom of the spirometer.
B) instruct her to slow breathing & pause between breaths
What is the appropriate psoition of the ETT on a chest radiograph?
A) just below the glottis, 5-7 cm above the carina
Which of the following is NOT a sign of fluid overload?
A) dry mucus membranes
Capnography can help assess which of the following?
A) All of the above
The volume of the anatomic deadspace is located in the:
A) mouth & pharynx
Cardiopulmonary rehab optimally incorporates:
D) nutritious diet & incremental increase of exercise over time
In a patient who is SOB, which position does NOT facilitate comfort?
Which of the following is an example of a condition that would cause an exudative pleural fluid?
D) bacterial infection
A patient sustained a pneumothorax as a result of an MVA. A chest tube is in place & it is noted that there is bubbling in the water seal chamber of the chest tube drainage system. What is the appropriate action?
C) Do nothing. This is the normal function of the system when a pneumo is present
A patient sustains a closed head injury. The patient's ICP is 22 mm Hg and the CPP is 62 mm Hg. What is the most appropriate action at this time?
B) reduce ICP to increase CPP
The Respiratory Quotient is:
D) the ratio of VCO2 to VO2
A) requires an expiratory effort of at least 10 seconds
Peak Flow measurements to determine a "personal best" for monitoring asthma should be:
A) done first thing in the morning; the hghest measurement over a 3-week period, and done before using an inhaled bronchodilator
The ATS/ERS standard for spirometry recommends use of reference equations from:
D) NHANES III
Which of the following are used as PFT's?
A) all of the above
Which of the following equipment is required for the Six-Minute Walk Test?
B) Countdown Timer
Which of the following results in an increased VD/VT ratio?
B) all answers correct
You note the inspiratory pressure waveform varies breath-by-breath during VCV. Which is the most likely cause?
What is the most rapid way to decrease Pplat?
C) decrease tidal flow
You note a decrease in VT during PCV. Which of the following are potential causes of this?
A) all of the above
Neck Vein Distension is most commonly associated with which of the following disorders?
Your patient has a mixed venous PO2 of 25 mm Hg (mixed venous O2 Sat of 55%). This is consistent with:
D) low cardiac output
Which of the following trach tube cuffs are filled with water?
What is the effect of spontaneous respiratory effort on alveolar distending pressure during PCV?
A) alveolar pressure is increased by spontaneous breathing
You are caring for a patient with ARDS. The patient's compliance is 20 mL/cm H2O. PEEP is increased from 12 to 15 cm H2O and compliance decreases to 15 mL/cm H2O. What is the best explanation for this?
D) alveolar recruitment
Which of the following affects peak inspiratory pressure during VCV?
D) all answers are correct
A sputum sample is obtained for gram staining. The stain used for a gram stain is:
C) red dye safronin counterstain
Which of the following microbial organisms is identified as an acid-fast stain?
B) mycobacterium tuberculosis
The term used to identify bacteria that are rod-shaped is:
A capnometer is not working. What alternative diagnostic monitor could be suggested?
D) transcutaneous monitor
A 10 YO is in the ED & was rescued from a house fire. THe chid is on 100% non-rebreather, but is tachypnic (RR=44bpm) and tachycardiac (HR = 168). His SaO2 reads 100%. What do you conclude?
C) There may be significant HBCO due to CO exposure in the fire
How is dyspnea assessed during the Six-Minute Walk Test?
B) Borg Scale
To decrease the risk of ventilator-induced lung injury, the Pplat should be kept less than:
D) 30 cm H2O
Which of the following is a normal arterial blood pressure for an adult?
Which of the following can be measured by a pulmonary artery catheter?
C) all of the answers
Monitoring of esophageal pressure is used for which of the following?
C) evaluation of pleural pressure
You should consider changing from CPAP to bilevel PAP in adults if the pressure exceeds ___?
D) 20 cm H2O
The Helium Dilution method for FRC requires all of the following EXCEPT?
C) 100% Oxygen
Vt + IRV =
Lung volumes differ from lung capacities because:
A) lung capacities are composed of more than one lung volume
The following test results are obtained. What is the next step?: Trial 1: FEV1 2.87L, FVC 3.22L; Trial 2: FEV1 1.90L, FVC 2.35L; and Trial 3: FEV1 2.84L, FVC 2.99L.
A) Perform another rest to meet reproducibility
Nitric oxide is used to measure the:
A) airway inflammation
A bacterial gram stain that results in purple staining on the sample is identified as:
B) gram positive
A 63 YO Female is admitted to the ED having been found unresponsive at the bottom of her stairs at home. She is intubated and the first exhalation after ventilation from the resuscitation bag indicates a normal end tidal CO2. You should:
B) delay interpretation of the end tidal CO2 until after 6 breaths
The following measurements are consistent with what condition? PAP 18/5mmHg, PCWP 12mmHg, BP 85/45, CO 8.5lpm.
A) septic shock
Thedistance walked during a Six-Minute Walk Test is:
D) used to compare pre- and post- Rx
Bedside monitoring of a 6 YO with ARDS being mechanically ventilated reveals: PtcCO2 50mmHg, PetCO2 30mmHg, SpO2 85%. An appropriate interpretation includes
C) decreased cardiac output
Indications for home apnea monitoring include: I apnea of prematurity, II apparent life threatening event, III familial hx of SIDS, IV technology dependency.
a. I, II, III
b. I, II, IV
c. I, III, IV
d. II, III, IV
A) b. I, II, IV
B) a. I, II, III
C) c. I, III, IV
D) d. II, III, IV
A) b. I, II, IV
Evaluation of a properly placed ETT: a colorimetric end tidal CO2 detector will display:
A) yellow with good perfusion
A cardiac stress test is used to evaluate:
An exercise bronchial challenge indicates airway hypersensitivity when the post exercise:
A) FEV1 is 10-15% less than the pre-exercise FEV1
The following measurements are consistent with what condition? PAP 15/5, PCWP 3 mm, BP 75/40, CO 2 LPM.
B) hypovolemic shock
True or False? a patient c/o chest pain radiating into the lower jaw & left arm should always have an ECG.
True or False? Transcutaneous monitoring of an adult undergoing general anesthesia has been shown to be reliable & accurate/
An ECG showing V-Fib exhibits occasional normal, P, QRD, & T waves.
What is the effect of spontaneous inspiratory effort on alveolar distending pressure during PCV?
B) alveolar distending pressure is increased by spontanous inspiratory efforts
According to the recent literature, ____ is the preferred Rx for OSA.
B) positive airway pressure
Bi-level PAP titration should start with IPAP/EPAP levels of:
B) 8-4cm H2O
The minimal difference in bilevel PAP between IPAP & EPAP should be:
D) 4cm H2O
CXR can be used to measure:
The most common way to measure FRC in a person with severe lung disease is:
B) He dilution
A patient with severe obstructive lung disease will most likely have the following finding:
A) Increased RV/TLC
D) requires an expiratory effort of at least 10 seconds
The ATS/ERS standard for spirometry recommends use of reference equations from:
D) NHANES III
Prior to a bronchoprovocation test, the baseline FEV1 should be greater than:
C) 70% of predicted
Diffusing capacity is NOT affected by:
A) respiratory rate
FENO can be artificially elevated by
B) increased cardiac output
To assure that values have reached a steady state, a blood gas should be done ____ minutes following a change in oxygen or ventilator settings.
B) 10-20 minutes
A 45 YO male is admitted to the ED c/o chest discomfort with deep inspiration. His ABG's on RA are: ph 7.50, pCO2 30, pO2 75, HCO3 23, sat 95%. The first intervention should be:
C) O2 Rx
A smoke-inhalation victim c/o dyspnea & nausea is admitted to the ED. THe pulse ox displays a good waveform, SpO2 98%, pulse 126. What should you recommend?
D) carboxyhemoglobin testing
Bedside monitoring with a 6 YO child with ARDS being mechanically ventilated reveals PtcO2 of 50mm Hg SpO2. An appropriate interpretation includes:
D) decreased cardiac output
Indications for home apnea monitoring include all EXCEPT:
A) family hx of SIDS
On exhalation, with a properly placed ETT, a colorimetric end tidal CO2 monitor will display:
D) yellow, with good perfusion
Neck vein distension is most consistent with which of the following?
Your patient has a mixed venous pO2 of 25mm Hg and a mixed venous Saturation of 55%. This is most consistent with:
B) Low Cardiac Output
Which of the following tracheostomy cuffs are filled with water?
You are evaluating a patient for TB. THe patient has a hx of conversion of skint tests. Which of the following is the most appropriate tool to determine TB in this patient?
Which of the following is NOT an indication for TB skin testing?
C) excessive vomiting
Which of the following allergens can be identified via allergy skin testing?
D) all are correct
A 22 YO female comes to the ED c/o pleuritic pain. What diagnostic test would be most useful for this patient?
True or False. THe diagnostic test which best assesses the cause of daytime fatigue is PFT?
True or False. A diagnostic bronchoscopy can be used to remove a sample of tissue from a suspected lung tumor.
True or False. BUN.Creatinine are blood chemistry tests that assess renal function.
True or False. The most efficient way to assess ventilation & oxygenation in mechanically-ventilated newborn infants is via a combination of pulse oxymetry and capnography.
True or False. The D-dimer test can be used to R/O the presence of a pulmonary emboli?
A _____ should be recommended for diagnosis of a possible pulmonary emboli.
A) V/Q Scan
A patient is admitted to the ED with a high fever, coughing up green sputum, with a white count which is significantly elevated. The most likely diagnosis for this patient is?
A) bacterial pneumonia
A patient has an MRI, which shows a mass of unknown composition present on the border of a RUL segmental bronchus. What would be the preferred way to attempt a diagnosis of this tumor?
D) diagnostic bronchoscopy
A patient recovering from 3rd degree burns, has been hospitalized on a ventilator for 24 hours. The physician wishes to start feeding the patient using TPN. In order to accomplish this, what procedure is necessary?
B) insert a CVP line
A patient has just returned from the Cath Lab with placement of 3 stents. The physician is concerned about low output cardiac failure. What should be recommended to enable monitoring of cardiac output?
B) placement of a pulmonary artery catheter
A patient is admitted with a sharply elevated BUN/Creatinine. The most likely explanation for this is:
A) renal failure
Your patient requires an ET cuff pressure of 40cm H2O to maintain a seal. Which of the following are likely causes?
C) all are correct
Which of the following can be measured from a pulmonary artery catheter?
B) all are correct
Mantoux skin test has been administered to a patient. The test shows a 17 mm diameter wheal. this result indicates:
A) a positive test for TB
Which of the following best describes a heart rate of 120 bpm in an adult?
In the OR, you are told that a capnograph is not working. What alternative diagnostic monitor should the therapist suggest to monitor arterial CO2?
A) transcutaneous monitor
A 10 YO is being treated in the ED following a house fire. The child is on a 100% non-breather. but is tachypnic (RR = 44bpm) & tachycardic (HR = 168) and appears to be in distress. His SaO2 reads 100%. What do you conclude?
C) the child may have sdignificant HbCO due to CO exposure in the fire
A patient with COPD is being ventilated using pressure support ventilation. When a jet nebulizer is placed into the ventilator circuit, the patient is unable to trigger. What is the most likely cause?
C) flow from the nebulizer
A patient at home calls to say his H cylinder reads 800 psi and he is using O2 at 2 lpm continuously. You inform the patient that:
D) you will have O2 delivered to him before 6 pm that same day
The transducer on a pulmonary artery catheter system is leveled at the phlebostatic axis while the patient is supine. THe nurse raises the HOB to 45 degrees. The result CYP reading is now:
B) inaccurately higher
The vacuum suddenly stops when you are suctioning a young patient. THe vacuum pressure reads 140 torr. Your first response is to:
A) empty the collection container
Which of these is not a method of determining orotracheal intubation?
A) secure tube in adults at 30-32 cm at the tip
Which describes the calculation of relative humidity?
D) water vapor content over water vapor capacity, x 100 at a certain temperature
The most efficient artificial noses, HME's & HCH's achieve about ____ mg/ml.
A) 32-34 mg/L
A face mask (versus nasal mask) would not be recommended in which of the following CPAP candidates?
D) patients who experience claustrophobia
Which of the following is considered a low-flow O2 device?
D) nasal cannula
Which of the following does not apply to bronchoscopy tests?
For a spirometry test to obtain repeatability criteria, the largest and second FVC and FEV1 manuevers must be within?
A) 150 ml
Which of the following can be corrected with PD&P?
B) retained secretions & mucus plugging
You are teaching a patient the proper technique for taking an ExPAP rx. Proper instructions would include:
A) do not let your cheeks balloon out & force as much out of your lungs as possible
Which of the following is a part of Stnadard Precautions?
C) hand hygiene before & after patient contact
Which of the following is a disinfectant?
A) all of the answers are correct
Risk of ventilator-associated pneumonia can be reduced with which of the following practices?
A) all of the answers are correct
To reduce the risk of ventilator-associated pneumonia, cuff pressures in the artificial airway should be kept at what level?
C) 20-30 cm H2O
From the perspective of VAP, how often should in-use ventilator circuits be changed?
D) when soiled or broken
Quality control limits come from two distinct areas:
B) manufacturer's recommendations & known standards
Which of the following is not assessed by co-oximetry?
A) acid-base balance
Most 3rd & 4th generation ventilators require _____ before being placed on a patient.
D) operational verification procedure (OVP)
All of the following are considered non-invasive, except:
The high and low end of a range of quality processes are known as:
D) control limits
Which is the correct way to determine the appropriate nasal pharyngeal airway size for placement?
A) measure from the ear tarsus to the corner of the lip
Which of the following are important in the evaluation prior to performing endotracheal intubation?
D) all answers are correct
Which of the following is NOT an advantage of orotracheal intubation?
C) increases gag reflex
Which of the following is NOT a reliable assessment in determining proper verification of endotracheal intubation?
C) change in function of the resuscitation hand-bag
Which of the following are clinical indications for tracheostomy?
B) all answers are correct
A patient is assessed prior to intubation for routine surgery. The patient is relatively healthy and the Mallampati score is 1. Which of the following can be expected?
D) an uncomplicated intubation
A pateint is assessed and assigned a Mallampati score of 4. Which of the following is the most appropriate?
C) utilize fiberoptic intubation or video laryngoscopy
An 18 YO has been admitted to the ICU for 4 days following smoke inhalation and facial burns from a house fire. He is intubated with a 6.5 ETT. There is a large leak around the inflated cuff. Which of the following is appropriate?
C) exchange the 6.5 ETT with a tube exchanger for an 8.0 ETT
Which of the following are significant precautions that should be used during use of a speaking valve?
A) all answers are correct
Which of the following is a viable method of preventing VAP in COPD patients?
C) low doses of anticiotics throughout the ICU stay
In patients spontaneously triggering the ventilator, mechanical dead space should be added in what situation?
Each 6 inches of adult ventilator circuit tubing, when placed in between the wye piece of the ventilator and the ETT, accounts for how much mechanical dead space?
A) 50 ml
Inappropriate application of mechanical ventilation can result in all of the following EXCEPT:
D) biochemical damage to the lung
A 68 YO man presents in the ED with pneumonia. RA Gases/VS are PaO2 47; PaCO2 49; pH 7.30; RR 38; HR 128; BP 160-110. NIV is started at PEEP 8; pressure support 10; FiO2 1.0. THe pt has a hard time tolerating NIV and 2 hours after initiation his Gases/VS are PaO2 70; PaCO2 50; pH 7.29; RR 36; Vt 320ml; HR 130; BP 168/112. He continues to use accessory muscles. The correct management is to:
D) intubate and invasively ventilate
A 5'9" tall 73 YO males has CHF & acute pulmonary edema but no hx of COPD. His RA gases on admission were pO2 65; pCO2 52; pH 7.28. Sixty minutes after the initiation of NIV, his gases are pO2 110; pCO2 44; and pH 7.34; RR 34 bpm; Vt 600ml. He appears to mistrigger many breaths on a regular basis and the ventilator rate is 26. THe correct decision is to:
B) decrease the pressure support level
To evaluate the presence of retrosternal air, which view should be obtained?
B) left lateral
A fluffy infiltrate with an enlarged heart & increased hilar markings are seen in the CXR of a patient with:
The silhouette sign obscures the R diaphragm. What does this indicate?
B) RLL atelectasis
During NIPPV, the Delta-P is 9 cm. Initial Vt on this pressure is 5-6ml/kg. 12 hours later the Vt is 8-10ml/kg. The most likely cause of the volume change is:
C) lung characteristics have improved
A pt on NIPPV has an IPAP at 12 cm. The P-T Waveform spikes to 14 cm at the end of inspiration & the ventilator immediately cycles to exhalation. The graphic may indicate:
A) the pt is actively exhaling
A male pt has been ventilated for 5 days for ARF 2o to sepsis. THe patient has been repositioned in the bed. THe lower SpO2 alarm and the high heart rate alarm activate. What do you check first?
B) check for ventilator disconnect
The high pressure alarm repeatedly ctivates and inspiration ends, during ventilation of an ICU pt. SpO2 decreases from 95% to 85%. What should you do first?
C) attempt to pass a suction catheter through the artificial airway to check for obstruction
A pt presents to the ED c/o SOB. Upon auscultation, you id diminished breath sounds & faint wheezing. Which of the following meds is indicated?
B) albuterol sulfate
A pt with CF is having difficulty clearing his sputum. What is the most appropriate for this pt?
A) dornase alfa
A newborn is diagnosed with a lethal heart condition. The physician wishes to reduce the PaO2 to keep the PDA open. It will be necessary to reduce the FiO2 below 0.21 to accomplish that. What is the most appropriate gas to deliver?
What should be done to increase the Vt delivered during IPPB?
A) increase peak pressure
A ventilated pt has a Vt of 500ml. The rate is 15 bpm and the Ti is 1.0 sec. Flow is constant. What is the rate of flow?
C) 30 lpm
A pt is ventilated on A/C volume ventilation. Vt = 600ml (7ml/kg), rate is 12 bpm. During inspiration, the P/T graphic has a concave appearance. BG's are OK. An appropriate action is:
B) increase flow
The physician would like to decrease Ti for an apenic ventilated pt to allow more Te without changing the minute ventilation. How do you accomplish this?
B) increase I:E for 1:2 to 1:3
What might a productive morning cough be indicative of?
A) smoking or COPD
During a pressure-controlled breath, a high flow causes the pt discomfort dur to the peak pressure being reached quickly. What can be adjusted?
C) rise time
Upon observing a new arrhythmia, you should: I assure adequate oxygenation; II evaluate the need for the treatment performed prior to the arrhythmia; III prepare for the potential to perform CPR; IV continue to perform ordered rx.
D) I, II, III
What factors should be considered to DC O2 rx in an adult? I decreased RR form 36 to 22; II SpO2 increased from 88 to 95; III sputum changed from thick brown to yellow; IV breath sounds change from wheezing to clear.
B) I, II, IV
A pt with acute bronchiectasis has breath sounds that have cleared from wheezing & is no longer in respiratory distress. What should be DC'd?
C) aerosol bronchodilator
Which of the following meds is most appropriate as a maintenance med?
After inhaling corticosteroids from a metered dose inhaler, it is important for the pt to:
D) rinse mouth with water
2.5mg albuterol is ordered to be given by nebulizer with diluent. How many ml ofactive med would you add to the diluent?
C) 0.5 ml
The primary key to successful NIV is:
B) correct ventilation
During NIV, peak pressures are usually limited to 20 cm to:
B) avoid gastric distension
The ideal interface for the initial application of NIV for an acute hypercapneic respiratory failure pt is:
B) standard face mask
Initial ventilator settings in ARDS should include all of the following except:
D) maintain Pplat >40
The single most important factor that is different between ventilator management of asthma & COPD is:
A) inspiratory time, which in asthma must be >1.0
Post extubation after successful trial of SBT, NIV should be applied to which of the following:
A) any pt who is at risk of reintubation
Which of the following are indications for intubation?
For which of the following reasons would you recommend a trach tube with extra proximal length?
D) large neck
A pt develops an arrhythmia during an inhaled bronchodilator treatment. Which would you recommend?
B) stop therapy & notify the physician
Which of the following decreases oxygen carrying capacity?
An elevation in which of the following is an increased in the presence of hypoxia?
Which of the following results in an increase in the anion gap?
A pt is receiving furosemide. Which side effects do you expect?
Selective pulmonary vasodilators are preferred over systemic vasodilators because:
D) they have fewer side effects
Which of the following in NOT an indication for pulmonary vasodilators?
Which of the following is an inhaled antibiotic to control p. aeruginosa in CF?
Which of the following is used for vasodilation & pain?
The nebulizer used to aerosolize ribavirin is the:
T/F Pts who use inhaled corticosteroids must rinse their mouths after treatment to avoid oral candidiasis.
T/F Corticosteroids increase the action of beta-agonists?
A low dose of this drug results in renal artery vasodilation.
This receptor is located in the bronchial smooth muscles & causes bronchodilation when stimulated.
A pt is experiencing moderate stridor following extubation. What do you recommend?
D) racemic epinephrine
This receptor is located in the bronchial smooth muscle & causes bronchodilation when it is blocked.
A 78 YO pt with COPD is seen in the ED. ABG's on RA PaO2 68 PCO2 60. Based onb this what do you recommend?
D) administer low flow O2 and observe
In setting up a blender, the alarm sounds when the O2 hose is connected. When the air hose is connected, the alarm stops. What should you do?
C) no action
You are caring for a pt with a severe L-sided infiltrate. Positioning pt on the R side would likely cause: I drainage of affected segments; II decreased PaO2; III increased V/Q mismatch; IV increased PaO2
B) I, II & IV
A heavily-sedated pt is on A/C volume vent with the following settings: Vt 350 (4ml); RR 12; FiO2 0.35. ABG'd are pH 7.31 pCO2 59 HCO3 25 PaO2 98. What changes would you make?
D) increase Vt to 550
A 12" piece of corregated tubing is positioned between the Y-connector and the ETT. Without this additional tubing, the ABG's were normal. After adding it, the gases were:
pH 7.34, pCO2 49, HCO3 25, PaO2 88. What do you do?
A) remove the device
The PEEP level on an ALI pt is increased from 12 to 15. In what parameter might you expect to see adverse effects?
A) decrease in BP
Which agent is the best short-acting agent used in bronchoconstricting disorders such as asthma?
B) albuuterol sulfate (ventolin)
All of the following are long-acting beta agonists EXCEPT:
A) levalbuterol (xopenex)
Digoxin (lanoxin) is used:
C) to increase the force of the contraction of the heart
All of the following are alernatives to corticosteroids EXCEPT:
B) mometasone/formoterol (dulera)
This agent can be used to treat a patient with an acetaminophen (tylenol) OD.
B) n-acetylcysteine (mucomyst)
All of the following are used to prevent or treat RDS EXCEPT:
B) ribavirin (virazole)
You are conducting rounds on the ortho floor. You note a post-op knee-replacement pt breathing shallow and slow. You determine the pt has OD'd on morphine. You recommend administration of:
D) naloxone (narcan)
A pt is experiencing SOB & diaphonresis. The pt is mildly xyanotic with 2 lpm O2 via nasal cannula & you note mild expiratory wheezes and fine crackles upon auscultation. The HR is tachycardic and her extremities display +2 pitting edema. What is the most appropriate med at this time?
The physician wishes to deliver a nebulized pulmonary vasodilator. Which of the following should you recommend?
Which of the following hemoglobin concentrations is consistent with anemia?
C) 10 g/dL
Which of the follow are increased with infection?
B) WBC Count
Which of the following serum electrolyte concentrations are affected by high doses of albuterol?
You are assessing humidification for an intubated, mechanically ventilated pt. Which of the following would indicate that the humidification is sufficient?
D) condensation in the proximal ETT
A hospitalized pt with a hx of asthma is receiving albuterol nebulizer qid. The pt's peal flow is normal & the chest is clear to auscultation. Which of the following do you recommend?
C) chg frequency of albuterol to prn & add inhaled controller med
Which criteria should a pt meet to conduct a SBT? I adequate oxygenation at a low FiO2 & PEEP; II ability to breathe spontaneously; III be receiving minimal non-continuous doses of sedatives; IV has a ph > 7.25; V is hemodynamically stable.
A) I, II, IV & V
What sputum characteristics should be monitored? I quantity; II taste; III consistency; IV color?
B) I, III & IV
Missed trigger efforts during controlled mechanical ventilation are often the result of: I an inapporpriate senisitvity setting; II presence of auto-PEEP; III low peak flow setting; IV a high mandatory rate.
C) I & II
The Vt for a ventilated pt is 250 ml. The flow is 60 lpm. The rate is 12 bpm. What is the inspiratory time in seconds?
C) 0.25 seconds
During volume ventilation, the set flow rate is increased. Which of the following is likely to occur?
D) Pplat will increase
A male pt with COPD & chronic CO2 retention is placed on ventilator support due to a pneumonia leading to ARF. He is 72" tall, weights 240 lbs. His PBW= 81kg. He is placed on SIMV volume ventilation with the following settings: Vt 550ml; rate 15 bpm total rate; PS 8 cm. ABG's are: pH 7.58; PaCO2 45; HCO3 41; PaO2 83 on 0.3 FiO2. Which of the following should be recommended?
C) reduce the RR to 12 bpm
Following OH Surgery, a 75 kg male is on the following settings: SIMV-VC; Vt 600ml; rate 10bpm, spontaneous rate is 5 bpm; PSV 8; spontaneous Vt 250; PEEP 5cm; FiO2 0.5. ABG's are pH 7.27; PaCO2 61; HCO2 27; PaO2 83. What changes should be made?
D) increase PS to 12
A woman (62" tall) involved in an MVA is on SIMV ventilation. Initial settings are: Vt 700; RR 10 bpm; total bpm of 15. ABG's are pH 7.50; PaCO2 30; HCO3 22.5. What should be changed?
A) reduce Vt to 400
A pt is on a nasal cannula at a flow rate of 2 lpm with a RR of 30 bpm and is anxious & taking shallow breaths. The current PaO2 is 45. What O2 delivery device & flow would likely be necessary to increase her FiO2?
C) 7 lpm high-flow nasal cannula
Which of the following may be used in place of a 35% ventimask, assuming normal breathing pattern & rate?
A) 4 lpm nasal cannula
You are assisting with R CVP placement for a mech vent pt in the ICU. During the procedure you note an acute drop in the SaO2 and increased peak pressures on the ventilator. Auscultation reveals absent breath sounds on the R. You should prepare for a?
B) chest tube placement
You are assisting with a bronch of a pt with suspected lung CA. He presents to the suite with extreme anxiety & nervousness regarding the procedure. The physician elects to use conscious sedation during the procedure. All of the following meds would assist in sedation mgmt EXCEPT:
D) budesonide (pulmicort)
Which of the following methods is best for checking ETT placement immediately post-intubation?
D) listen for bilateral, equal breath sounds
In which of the following situations would you terminate the exercise test?
B) the ECG demonstrates ischemic changes
To determine brain death, the pt must exhibit which of the following signs?
How much fluid per bolus per kg does the AHA suggest for adult & pediatric pts?
B) 20 ml/kg
The mathematical equation pV=k (where p stands for pressure, V for volume and k equals constant) is the formula for which gas law?
C) Boyle's Law
Which one of the following shock states is referred to as "warm shock"?
A) septic shock
When Return of Spontaneous Circulation occurs, significant increases in EtCO2 should occur in what range?
Q 26-week infant is born & the weight is noted to be 1 kg. Where should you initially secure the ETT at the lip?
A) 7 cm
You are going to intubate a 40-week infant prior to going to the OR. The consultant wants you to place an uncuffed tube. What size would you use?
C) 4.0 mm
Your are preparing to intubate a 6 YO for respiratory distress. What size uncuffed ETT us correct for this pt?
Most cases of RDS are seen in babies born before ___ weeks gestation.
Which of the following describes the medical emergency team?
B) to intervene at the time of pt deterioration to prevent an adverse outcome
Which of the following is NOT a primary concern when selecting a ventilator for use by a medical emergency team or for use in a mass casualty/disaster situation?
C) ability to deliver pressure support ventilation
A pt with asthma that is not well-controlled takes fluticasone/salmeterol 100/50 bid/ What nonpharmacologic changes to the plan of care should the therapist recommend? I the pt should receive a written asthma action plan; II the pt should attend pulmonary rehab; III the pt should receive instruction on peak flow monitoring; IV a review of environmental controls in the pt's home.
B) I, II, IV
Which of the following from a H&P would lead the therapist to conclude that a pt has myasthenia gravis? I ptosis; II presence of thymoma; III ascending paralysis; IV positive endophonium test?
D) I, II & IV
A pt with bronchiectasis is having difficulty mobilizing secretions. Until the presend time, the pt has been instructed to use huff coughing, but that is no longer effective. What do you recommend?
C) check the pt's SpO2
What is an example of an interdisciplinary care plan?
B) a ventilator bundle to help prevent VAP
What is the goal of an interdisciplinary care plan?
A) minimize care delay & resource use for a particular disorder
In pts with COPD, which of the following are primary concerns during invasive ventilatory support? I severe hypoxemia; II development of autoPEEP; III hemodynamic compromise; IV pt-ventilator synchrony; IV VAP
D) I, II,III, IV & V
The use of a spontaneous awakening trial in association with a spontaneous breathing trial results in which of the following? I shorter time of ventilatory support; II shorter time in the hospital; III shorter time in the ICU; IV a decrease in mortality.
A) I, II, III & IV
When should prone positioning be used in the management of severe ARDS?
C) only in pts with a PaO2/FiO2 ratio of <100 mm Hg
Initial ventilatory setting in ARDS should include all of the following EXCEPT:
A) maintain Pplat <40
Which of the following is most important to evaluate the home after discharge of a pt receiving 2 lpm continuous O2 with a concentrator?
D) evaluate the electrical system
Which of the following results is most likely to occur as a result of pulmonary rehab?
D) improvement in the quality of life
What is the most cost effective method of supplemental O2 when nasal O2 at 2 lpm is ordered for a bed-bound pt in a one story home?
A pt arrives for a cardiopulmonary exercise test. After assessment, it is noted that the pt is experiencing an acute asthma exacerbation. What is the appropriate action?
B) notify the physician, escort the pt to the ED and reschedule the test
A pt is participating in a cardiopulmonary exercise test. After 3 minutes, the pt demonstrates a loss of color and c/o dizziness, the SpO2 drops from 91 to 78 & the ECG shows ischemic changes. What do you do?
B) immediately stop the test & notify the physician
A 31 YO female is being mechanically ventilated in the ICU. She is not sedated or paralyzed but is unresponsive to verbal or painful stimuli. There is an absence of of motor, pupillary, gag & cough reflexes/ Her temperature is 34.5 degrees Celsius. EEG shows no activity. What is the most appropriate action?
A) return pt to normal temperature & then perform tests
Which of the following is the most important hazard associated with CVL insertion?
Checking the pleural drainage system after chest tube placement, the water seal compartment reveals bubbling: you should:
D) take no action: this is normal
While assisting at a bedside percutaneous trach, after the tube is placed, you note acute onset of sub-q emphysema in the neck & the pt becomes dyspneic. Your assessment, the tube is: