aarc mc

  1. When reviewing a chart, the comment, öriented x 3" is noted. This means:

    B) Normal Sensorium
  2. Who may change an Advanced Directive?

    C) the patient and the person with power of attorney
  3. Which should be asked while interviewing a pt to determine dyspnea?

    B) Are you SOB?
  4. 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
  5. 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
  6. 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
  7. 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?

    D) Kussmaul's
  8. 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
  9. 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
  10. 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
  11. 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
  12. 29. During PE using palpation, an abnormal bilateral expansion of the chest wall is assessed. This would indicate:

    D) COPD
  13. 31. Which of the following would be associated with an underexposed PA CXR?

    A) loss of mid-thoracic intervertebral spaces
  14. 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
  15. 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
  16. 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?

    C) RML
  17. 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:

    C) croup
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. What is the appropriate psoition of the ETT on a chest radiograph?

    A) just below the glottis, 5-7 cm above the carina
  30. Which of the following is NOT a sign of fluid overload?

    A) dry mucus membranes
  31. Capnography can help assess which of the following?

    A) All of the above
  32. The volume of the anatomic deadspace is located in the:

    A) mouth & pharynx
  33. Cardiopulmonary rehab optimally incorporates:

    D) nutritious diet & incremental increase of exercise over time
  34. In a patient who is SOB, which position does NOT facilitate comfort?

    A) Trendelenberg
  35. Which of the following is an example of a condition that would cause an exudative pleural fluid?

    D) bacterial infection
  36. 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
  37. 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
  38. The Respiratory Quotient is:

    D) the ratio of VCO2 to VO2
  39. Acceptable Spirometry:

    A) requires an expiratory effort of at least 10 seconds
  40. 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
  41. The ATS/ERS standard for spirometry recommends use of reference equations from:

  42. Which of the following are used as PFT's?

    A) all of the above
  43. Which of the following equipment is required for the Six-Minute Walk Test?

    B) Countdown Timer
  44. Which of the following results in an increased VD/VT ratio?

    B) all answers correct
  45. You note the inspiratory pressure waveform varies breath-by-breath during VCV. Which is the most likely cause?

    B) Asynchrony
  46. What is the most rapid way to decrease Pplat?

    C) decrease tidal flow
  47. You note a decrease in VT during PCV. Which of the following are potential causes of this?

    A) all of the above
  48. Neck Vein Distension is most commonly associated with which of the following disorders?

    B) CHF
  49. 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
  50. Which of the following trach tube cuffs are filled with water?

    C) tight-to-shaft
  51. What is the effect of spontaneous respiratory effort on alveolar distending pressure during PCV?

    A) alveolar pressure is increased by spontaneous breathing
  52. 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
  53. Which of the following affects peak inspiratory pressure during VCV?

    D) all answers are correct
  54. A sputum sample is obtained for gram staining. The stain used for a gram stain is:

    C) red dye safronin counterstain
  55. Which of the following microbial organisms is identified as an acid-fast stain?

    B) mycobacterium tuberculosis
  56. The term used to identify bacteria that are rod-shaped is:

    B) bacilli
  57. A capnometer is not working. What alternative diagnostic monitor could be suggested?

    D) transcutaneous monitor
  58. 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
  59. How is dyspnea assessed during the Six-Minute Walk Test?

    B) Borg Scale
  60. To decrease the risk of ventilator-induced lung injury, the Pplat should be kept less than:

    D) 30 cm H2O
  61. Which of the following is a normal arterial blood pressure for an adult?

    D) 120mmHg/80mmHg
  62. Which of the following can be measured by a pulmonary artery catheter?

    C) all of the answers
  63. Monitoring of esophageal pressure is used for which of the following?

    C) evaluation of pleural pressure
  64. You should consider changing from CPAP to bilevel PAP in adults if the pressure exceeds ___?

    D) 20 cm H2O
  65. The Helium Dilution method for FRC requires all of the following EXCEPT?

    C) 100% Oxygen
  66. Vt + IRV =

    D) IC
  67. Lung volumes differ from lung capacities because:

    A) lung capacities are composed of more than one lung volume
  68. 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
  69. Nitric oxide is used to measure the:

    A) airway inflammation
  70. A bacterial gram stain that results in purple staining on the sample is identified as:

    B) gram positive
  71. 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
  72. The following measurements are consistent with what condition? PAP 18/5mmHg, PCWP 12mmHg, BP 85/45, CO 8.5lpm.

    A) septic shock
  73. Thedistance walked during a Six-Minute Walk Test is:

    D) used to compare pre- and post- Rx
  74. 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
  75. 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
  76. Evaluation of a properly placed ETT: a colorimetric end tidal CO2 detector will display:

    A) yellow with good perfusion
  77. A cardiac stress test is used to evaluate:

    A) CAD
  78. An exercise bronchial challenge indicates airway hypersensitivity when the post exercise:

    A) FEV1 is 10-15% less than the pre-exercise FEV1
  79. The following measurements are consistent with what condition? PAP 15/5, PCWP 3 mm, BP 75/40, CO 2 LPM.

    B) hypovolemic shock
  80. True or False? a patient c/o chest pain radiating into the lower jaw & left arm should always have an ECG.
  81. True or False? Transcutaneous monitoring of an adult undergoing general anesthesia has been shown to be reliable & accurate/
  82. An ECG showing V-Fib exhibits occasional normal, P, QRD, & T waves.
  83. What is the effect of spontaneous inspiratory effort on alveolar distending pressure during PCV?

    B) alveolar distending pressure is increased by spontanous inspiratory efforts
  84. According to the recent literature, ____ is the preferred Rx for OSA.

    B) positive airway pressure
  85. Bi-level PAP titration should start with IPAP/EPAP levels of:

    B) 8-4cm H2O
  86. The minimal difference in bilevel PAP between IPAP & EPAP should be:

    D) 4cm H2O
  87. CXR can be used to measure:

    B) TLC
  88. The most common way to measure FRC in a person with severe lung disease is:

    B) He dilution
  89. A patient with severe obstructive lung disease will most likely have the following finding:

    A) Increased RV/TLC
  90. Acceptable Spirometry:

    D) requires an expiratory effort of at least 10 seconds
  91. The ATS/ERS standard for spirometry recommends use of reference equations from:

  92. Prior to a bronchoprovocation test, the baseline FEV1 should be greater than:

    C) 70% of predicted
  93. Diffusing capacity is NOT affected by:

    A) respiratory rate
  94. FENO can be artificially elevated by

    B) increased cardiac output
  95. 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
  96. 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
  97. 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
  98. 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
  99. Indications for home apnea monitoring include all EXCEPT:

    A) family hx of SIDS
  100. On exhalation, with a properly placed ETT, a colorimetric end tidal CO2 monitor will display:

    D) yellow, with good perfusion
  101. Neck vein distension is most consistent with which of the following?

    A) CHF
  102. 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
  103. Which of the following tracheostomy cuffs are filled with water?

    B) tight-to-shaft
  104. 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?

    C) CXR
  105. Which of the following is NOT an indication for TB skin testing?

    C) excessive vomiting
  106. Which of the following allergens can be identified via allergy skin testing?

    D) all are correct
  107. A 22 YO female comes to the ED c/o pleuritic pain. What diagnostic test would be most useful for this patient?

    B) CXR
  108. True or False. THe diagnostic test which best assesses the cause of daytime fatigue is PFT?
  109. True or False. A diagnostic bronchoscopy can be used to remove a sample of tissue from a suspected lung tumor.
  110. True or False. BUN.Creatinine are blood chemistry tests that assess renal function.
  111. 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.
  112. True or False. The D-dimer test can be used to R/O the presence of a pulmonary emboli?
  113. A _____ should be recommended for diagnosis of a possible pulmonary emboli.

    A) V/Q Scan
  114. 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
  115. 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
  116. 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
  117. 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
  118. A patient is admitted with a sharply elevated BUN/Creatinine. The most likely explanation for this is:

    A) renal failure
  119. 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
  120. Which of the following can be measured from a pulmonary artery catheter?

    B) all are correct
  121. 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
  122. Which of the following best describes a heart rate of 120 bpm in an adult?

    C) tachycardia
  123. 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
  124. 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
  125. 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
  126. 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
  127. 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
  128. 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
  129. Which of these is not a method of determining orotracheal intubation?

    A) secure tube in adults at 30-32 cm at the tip
  130. Which describes the calculation of relative humidity?

    D) water vapor content over water vapor capacity, x 100 at a certain temperature
  131. The most efficient artificial noses, HME's & HCH's achieve about ____ mg/ml.

    A) 32-34 mg/L
  132. A face mask (versus nasal mask) would not be recommended in which of the following CPAP candidates?

    D) patients who experience claustrophobia
  133. Which of the following is considered a low-flow O2 device?

    D) nasal cannula
  134. Which of the following does not apply to bronchoscopy tests?

    C) non-invasive
  135. For a spirometry test to obtain repeatability criteria, the largest and second FVC and FEV1 manuevers must be within?

    A) 150 ml
  136. Which of the following can be corrected with PD&P?

    B) retained secretions & mucus plugging
  137. 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
  138. Which of the following is a part of Stnadard Precautions?

    C) hand hygiene before & after patient contact
  139. Which of the following is a disinfectant?

    A) all of the answers are correct
  140. Risk of ventilator-associated pneumonia can be reduced with which of the following practices?

    A) all of the answers are correct
  141. 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
  142. From the perspective of VAP, how often should in-use ventilator circuits be changed?

    D) when soiled or broken
  143. Quality control limits come from two distinct areas:

    B) manufacturer's recommendations & known standards
  144. Which of the following is not assessed by co-oximetry?

    A) acid-base balance
  145. Most 3rd & 4th generation ventilators require _____ before being placed on a patient.

    D) operational verification procedure (OVP)
  146. All of the following are considered non-invasive, except:

    C) bronchoscopy
  147. The high and low end of a range of quality processes are known as:

    D) control limits
  148. 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
  149. Which of the following are important in the evaluation prior to performing endotracheal intubation?

    D) all answers are correct
  150. Which of the following is NOT an advantage of orotracheal intubation?

    C)  increases gag reflex
  151. 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
  152. Which of the following are clinical indications for tracheostomy?

    B) all answers are correct
  153. 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
  154. 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
  155. 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
  156. Which of the following are significant precautions that should be used during use of a speaking valve?

    A) all answers are correct
  157. Which of the following is a viable method of preventing VAP in COPD patients?

    C) low doses of anticiotics throughout the ICU stay
  158. In patients spontaneously triggering the ventilator, mechanical dead space should be added in what situation?

    C) never
  159. 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
  160. Inappropriate application of mechanical ventilation can result in all of the following EXCEPT:

    D) biochemical damage to the lung
  161. 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
  162. 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
  163. To evaluate the presence of retrosternal air, which view should be obtained?

    B) left lateral
  164. A fluffy infiltrate with an enlarged heart & increased hilar markings are seen in the CXR of a patient with:

    B) CHF
  165. The silhouette sign obscures the R diaphragm. What does this indicate?

    B) RLL atelectasis
  166. 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
  167. 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
  168. 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
  169. 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
  170. 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
  171. A pt with CF is having difficulty clearing his sputum. What is the most appropriate for this pt?

    A) dornase alfa
  172. 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?

    C) nitrogen
  173. What should be done to increase the Vt delivered during IPPB?

    A) increase peak pressure
  174. 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
  175. 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
  176. 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
  177. What might a productive morning cough be indicative of?

    A) smoking or COPD
  178. 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
  179. 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
  180. 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
  181. 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
  182. Which of the following meds is most appropriate as a maintenance med?

    B) formotorol
  183. After inhaling corticosteroids from a metered dose inhaler, it is important for the pt to:

    D) rinse mouth with water
  184. 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
  185. The primary key to successful NIV is:

    B) correct ventilation
  186. During NIV, peak pressures are usually limited to 20 cm to:

    B) avoid gastric distension
  187. The ideal interface  for the initial application of NIV for an acute hypercapneic respiratory failure pt is:

    B) standard face mask
  188. Initial ventilator settings in ARDS should include all of the following except:

    D) maintain Pplat >40
  189. 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
  190. 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
  191. Which of the following are indications for intubation?

    C) all
  192. For which of the following reasons would you recommend a trach tube with extra proximal length?

    D) large neck
  193. A pt develops an arrhythmia during an inhaled bronchodilator treatment. Which would you recommend?

    B) stop therapy & notify the physician
  194. Which of the following decreases oxygen carrying capacity?

    A) all
  195. An elevation in which of the following is an increased in the presence of hypoxia?

    D) lactate
  196. Which of the following results in an increase in the anion gap?

    D) all
  197. A pt is receiving furosemide. Which side effects do you expect?

    D) all
  198. Selective pulmonary vasodilators are preferred over systemic vasodilators because:

    D) they have fewer side effects
  199. Which of the following in NOT an indication for pulmonary vasodilators?

    A) CHF
  200. Which of the following is an inhaled antibiotic to control p. aeruginosa in CF?

    B) aztreonam
  201. Which of the following is used for vasodilation & pain?

    A) morphine
  202. The nebulizer used to aerosolize ribavirin is the:

    A) SPAG
  203. T/F  Pts who use inhaled corticosteroids must rinse their mouths after treatment to avoid oral candidiasis.
  204. T/F  Corticosteroids increase the action of beta-agonists?
  205. A low dose of this drug results in renal artery vasodilation.

    C) dopamine
  206. This receptor is located in the bronchial smooth muscles & causes bronchodilation when stimulated.

    B) beta-2
  207. A pt is experiencing moderate stridor following extubation. What do you recommend?

    D) racemic epinephrine
  208. This receptor is located in the bronchial smooth muscle & causes bronchodilation when it is blocked.

    C) muscarinic-3
  209. 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
  210. 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
  211. 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
  212. 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
  213. 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
  214. 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
  215. Which agent is the best short-acting agent used in bronchoconstricting disorders such as asthma?

    B) albuuterol sulfate (ventolin)
  216. All of the following are long-acting beta agonists EXCEPT:

    A) levalbuterol (xopenex)
  217. Digoxin (lanoxin) is used:

    C) to increase the force of the contraction of the heart
  218. All of the following are alernatives to corticosteroids EXCEPT:

    B) mometasone/formoterol (dulera)
  219. This agent can be used to treat a patient with an acetaminophen (tylenol) OD.

    B) n-acetylcysteine (mucomyst)
  220. All of the following are used to prevent or treat RDS EXCEPT:

    B) ribavirin (virazole)
  221. 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)
  222. 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?

    C) furosemide
  223. The physician wishes to deliver a nebulized pulmonary vasodilator. Which of the following should you recommend?

    B) iloprost
  224. Which of the following hemoglobin concentrations is consistent with anemia?

    C) 10 g/dL
  225. Which of the follow are increased with infection?

    B) WBC Count
  226. Which of the following serum electrolyte concentrations are affected by high doses of albuterol?

    D) potassium
  227. 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
  228. 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
  229. 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
  230. What sputum characteristics should be monitored?  I  quantity; II  taste; III consistency; IV  color?

    B) I, III & IV
  231. 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
  232. 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
  233. During volume ventilation, the set flow rate is increased. Which of the following is likely to occur?

    D) Pplat will increase
  234. 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
  235. 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
  236. 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
  237. 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
  238. Which of the following may be used in place of a 35% ventimask, assuming normal breathing pattern & rate?

    A) 4 lpm nasal cannula
  239. 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
  240. 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)
  241. Which of the following methods is best for checking ETT placement immediately post-intubation?

    D) listen for bilateral, equal breath sounds
  242. In which of the following situations would you terminate the exercise test?

    B) the ECG demonstrates ischemic changes
  243. To determine brain death, the pt must exhibit which of the following signs?

    D) all
  244. How much fluid per bolus per kg does the AHA suggest for adult & pediatric pts?

    B) 20 ml/kg
  245. 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
  246. Which one of the following shock states is referred to as "warm shock"?

    A) septic shock
  247. When Return of Spontaneous Circulation occurs, significant increases in EtCO2 should occur in what range?

    D) 34-45
  248. 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
  249. 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
  250. You ar
  251. Your are preparing to intubate a 6 YO for respiratory distress. What size uncuffed ETT us correct for this pt?

    C) 5.0
  252. Most cases of RDS are seen in babies born before ___ weeks gestation.

    B) 28
  253. Which of the following describes the medical emergency team?

    B) to intervene at the time of pt deterioration to prevent an adverse outcome
  254. 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
  255. 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
  256. 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
  257. 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
  258. What is an example of an interdisciplinary care plan?

    B) a ventilator bundle to help prevent VAP
  259. What is the goal of an interdisciplinary care plan?

    A) minimize care delay & resource use for a particular disorder
  260. 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
  261. 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
  262. 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
  263. Initial ventilatory setting in ARDS should include all of the following EXCEPT:

    A) maintain Pplat <40
  264. 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
  265. Which of the following results is most likely to occur as a result of pulmonary rehab?

    D) improvement in the quality of life
  266. 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?

    C) concentrator
  267. 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
  268. 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
  269. 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
  270. Which of the following is the most important hazard associated with CVL insertion?

    B) pneumothorax
  271. Checking the pleural drainage system after chest tube placement, the water seal compartment reveals bubbling: you should:

    D) take no action: this is normal
  272. 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:

    D) malpositioned
Card Set
aarc mc
multiple choice