rt103 final

1. The definition of “syllabus” is:
A. A part of a word which c stands for a complete thought
B. A summary for a course of study
C. A form of reasoning fror+ which a logical conclusion can be drawn
D. The first part of a professional lexicon

2. T or F The first Student Learning Outcome (SLO) revolves around the principles, indications, hazards, and monitoring of negative pressure ventilation.
True False

3. T or F The Student Learning Outcome(SLO) for this class includes an introduction to in monitoring of cardiac functions
True False

4. T or F The Mid Term and Final constitute approximately 40% of the grade for this class.
True False

5. According to the institutional classroom Standards, if you are going to be absent you are to
A. contact the instructor by SJVC email prior to your absence
B. Bring a note from your physician
C. Call Mr. Tom Serrano by phone prior to your absence

6. Missing deadline for homework and projects may result in
I. a 10% reduction in points
II no credit
III void the need for turning in the project
A. II or III
B. I or II or at the instructors discretion
C. I

7. Missed quizzes, including “pop” quizzes
A. Can be taken late in accordance with college policies
B. May not be taken later; you will get a zero for that quiz

8. To F It is okay to have coffee or soda in the classroom during lectures
True False

9. In the article “Competencies Needed by Graduate Respiratory Therapist in 2015 and Beyond” how many competencies were identified and agreed upon as being needed by both new grads and existing work force
A. 69
B. 49
C. 77
D. 7

10. All of the following competencies were identified as being needed except
A. They must be able to provide ventilator care based on protocol
B. Therapists must have a broad understanding of pharmacology for all organ systems and detailed knowledge of drugs delivered via intervenous methods
C. Graduate therapists must be able to fully operate ICU Ventilators and discuss all commonly used modes of ventilation as well as their indications and limitations
D. They must fully understand the tenets of evidence based medicine including the ability to critically read and critique the medical literature and discuss the meaning of stastical anaylsis

11. In Table 12, the responders evaluated the relative importance of the following categories of skills, which did they indicate most important
A. Physical examination — patient assesments
B. Diagnostic invasive procedures
C. Critical care
D. Emergency care

12. The importance of documenting competence and quality of care by administering national board speciality certifications examinations was first identified by other professions as early as
A. 1948
B. 1929
C. 1941
D. 1917

13. Which of the following participant groups identified that ther is a perfect storm of healthcare issues in our society, and that the respiratory care prefession is in a good position to assume new or expanding roles
A. NBRC leaders
B. Hospital Administrators
C. AARC leaders
D. Critical Care Physicians

14. Based on your reading of this article do you think that the ability to research apply and adapt to respiratory care patient care protols to specific patients needs will be of value
A. Moderately useful — the dept management will do the heavy work
B. Rarely — we’ll leave it up to the physicians to tell us everything we need to do
C. Very useful — because it’s at the bedside where the real issue of patiend safety and treatment efficacy are most important

15. “RTs in 2015 must assume greater responsibility for ______ in order to reduce the cost of healthcare.”
A. education of other healthcare workers in RT procedures
B. evidence-based medicine
C. acute and chronic disease management
D. establishing vascular access for invasive hemodynamic monitoring

1. A diagnosis of respiratory failure can be made if which of the following are present
I. PaO2 of 55, FiO2 .21 Pb 760
II. PaCO2 57, FiO2 .21 Pb 760
III. P(A-a) O2 45, FiO2 1.0 Pb 760
IV. PaO2/FiO2 400 Pb 750
A. I, II, III, and IV
B. I and II
C. III and IV
D. I, III, and IV

2. What is respiratory failure due to inadequate ventilation?
A. hypoxemic
B. hypercapnic
C. chronic
D. compensated

3. Hypercapnic (type II) respiratory fail terms?
A. shunt
B. diffusion impairment
C. ventilatory failure
D. V/Q mismatching

4. Hypoxemia can be caused by which of the following
I. diffusion impairment
II. alveolar hypoventilation
III. V/Q mismatch
IV. Intrapulmonary shunting
A. I, III, and IV
B. II III and IV
C. I, II, III, and IV
D. I, II, and III

5. Which of the following best describes t e difference between V/Q mismatch and shunt when supplemental oxygen is administered?
A. Both will respond equally well.
B. V/Q mismatch will not respond but shunt will respond well.
C. V/Q mismatch will respond well but shunt will not.
D. Neither will respond to the administration of supplemental oxygen.

6. Which of the following clinical signs is most often associated with hypoxemia due to shunt?

7. A patient with interstitial lung disease ho presents with hypoxemia due to diffusion def have which of the following clinical signs?
I. fine bibasilar crackles
II. clubbing of the finger nail beds
III. jugular venous distention
IV. increased P2
A. I, III, and IV
B. I, II, III, and IV
C. III and IV
D. I and II

8. What type of disease is associated with perfusion/diffusion impairment?
A. renal disease
B. pancreatic disease
C. neuromuscular disease
D. vascular disease

9. What is the most common cause of low mixed venous oxygen?
A. cardiac disease, with low cardiac output
B. liver disease
C. peripheral vascular disease
D. neuromuscular disease

10. What is the normal P (A—a) 02 range while breathing room air?
A. greater than 25 mmHg
B. 25 mmHg to 50 mmHg
C. less than 10 mmHg
D. l0 mmHg to 25 mmHg

11. What is the normal P (A—a) 02 with V/Q mismatch and shunt?
A. increases with V/Q mismatch and decreases with shunt
B. decreases with both V/Q mismatch and shunt
C. increases with both V/Q mismatch and shunt
D. it does not change

12. What is the optimal treatment of intrapulmonary shunt?
A. alveolar recruitment
B. surgery
C. decrease the FiO2
D. increase the FiO2

13. A patient with an opiate drug overdose blood gas results breathing room air: pH 7.19, PCO2 89, HCO3 27, PO2 48
Which of the following best describe the patient’s condition?
A. acute hypersonic respiratory failure
B. acute hypoxemic respiratory failure
C. chronic hypoxemic respiratory failure
D. chronic hypersonic respiratory failure

4. All of the following would tend to cause hypersonic respiratory failure except
A. opiate drug overdose
B. smoke inhalation
C. chronic obstructive pulmonary disease
D. hypothyroidism

15. Which of the following are associate with hypercapnic respiratory failure due to decreased ventilatory drive?
I. brainstem lesions
II. encephalitis
III. hypothyroidism
IV. asthma
A. III and IV
B. II and IV
C. I, II, III, and IV
D. I, II, and III

16. All of the following are associated with respiratory muscle weakness or fatigue
A. myasthenia gravis
B. hyperthyroidism
C. Guillian Barre syndrome
D. amyotrophic lateral sclerosis

17. Which of the following is a feature of Guillian Barre
A. limited to trunk
B. limited to lower extremities
C. descending muscle weakness
D. ascending muscle weakness

18. All of the following are associated with increased work of breathing except:
A. myasthenia gravis
B. asthma
C. obesity
D. kyphoscoliosis

19. Which of the following information be respiratory failure from acute hypercapnea
A. kidneys retaining bicarbonate to elevate the blood pH
B. forced expiratory volume in I second of forced vital capacity ratio is less than 75% predicted
C. physical signs of hypoxemia, such as cyanosis and clubbing
D. long-standing dyspnea that worsen

20. Which of the following is the cardinal sign of increased work of breathing
A. hyperventilation
B. bradycardia
C. tachypnea
D. retractions

21. In patients suffering from acute respiratory failure below what pH level is intubation and ventilatory support generally considered
A. 7.30
B. 7.15
C. 7.20
D. 7.26

22. Which of the following patients has the most serious problem with the adequacy of oxygenation?
A. 0.28 65
B. 0.40 95
C. 0.70 90
D. 1.00 85

23. A need for some form of ventilatory support is usually indicated when an adult’s rate
of breathing rises above what level?
A. 35/mm
B. 25/mm
C. 20/mm
D. 30/mm

24. Which of the following measures is useful indicators in assessing the adequacy of a patient’s oxygenation?
I. PAO2 – PaO2
II. PaO2 to FiO2 ratio
III. VD/VT
A. I and II
B. II and III
C. I, II, and III
D. I and III

25. Which of the following measures taken on adult patients indicate unacceptably high demands or work of breathing?
A. VE of 17 L/min
B. VD/VT of 0.45
C. breathing rate of 22/mm
D. MIP of -40 cm H

26. Ventilatory support may be indicated when the VC falls below what level?
A. 65m1/kg
B. 45 ml/kg
C. 30m1/kg
D. 10ml/Ikg

27. What is the normal range of maximum inspiratory pressure, or MIP (also called negative inspiratory force, or NIF), generated by adults?
A -80 to –l00
B. -50 to -80
C. -30 to -50
D. -20 to -30

8. Which of the following MIP measure taken on an adult patient indicates inadequate
respiratory muscle strength?
A. –l5
B. -40
C. -70
D. -90

29. Common bedside measures used to assess the adequacy of lung expansion include all of the following except
A. VD/VT
B. respiratory rate
C. VT
D. VC

30. You determine that an acutely ill patient can generate an MIP of -18. Based on this information, what might you conclude?
A. The patient has inadequate respiratory muscle strength.
B. The patient has an unstable or irregular ventilatory drive.
C. The patient has inadequate alveolar ventilation.
D. The patient has an excessive work of breathing.

31. Breathing 100% 02, a patient has a PA 2 of 60mm Hg. Based on this information, what might you conclude?
A. The patient has acceptable oxygenation.
B. The patient has an excessive work of breathing.
C. The patient has severe hypoxemia.
D. The patient has inadequate ventilation.

32. What is the normal range for Pa02?
A. 75 to 150
B. 150 to 250
C. >400
D. 250 to 350

33. Which of the following measures should be used in assessing the adequacy of a patient’s alveolar ventilation?
1. Pa02
II. arterial pH
III. PaC0
A. II and III
B. I and II
C. I, II and III
D. I and III

34. A patient with a 10-year history of chronic bronchitis for, with an acute viral pneumonia for the last 3 days now exhibits the following blood gas pH= 7.22; PCO =67; HCO= 26 PCO2 = 60 which of the following best describes the patient’s condition?
A. chronic hypercapnic respiratory failure
B. chronic hypoxemic respiratory failure
C. acute hypercapnic respiratory failure
D. acute hypoxemic respiratory failure

35. cause an elevated PaCO2 increases ventilatory drive in normal subjects , the clinical presence of hypercapnia indicates which of the following?
I. inability of the stimulus to get to the muscles
II. weak or missing central nervous system
III. pulmonary muscle fatigue
A. II and III
B. I, or II, or III
C. I or III
D. I and II

36. Which of the following indicators are useful in assessing respiratory muscle strength
I. maximum voluntary ventilation (MVV)
II. forced vital capacity (FVC)
III. dead space to tidal volume ratio (VD/VT)
IV. Maximum inspiratory pressure (MIP)
A. I and III
B. II and IV
C. III and IV
D. I, II, and IV

37. A reversible impairment in the response of an overload best describes which of the following
A. central respiratory muscle fatigue
B. contractile respiratory muscle fatigue
C. chronic respiratory muscle fatigue
D. transmission respiratory muscle fatigue

38. Which of the following modes of ventilatory support would you recommend for a mild hypoxemic patient from congestive heart
A. high-level pressure support ventilation
B. continuous positive airway pressure
C. intermittent mandatory ventilation
D. inverse-ratio pressure control ventilation

39. Which of the following patients are at greatest risk for developing auto PEEP during mechanical ventilation?
A. those with bilateral pneumonia
B. those with COPD
C. those with acute lung injury
D. those with congestive heart failure

40. What are some causes of dynamic hyperinflation.
I. increased expiratory time
II. increased airway resistance
III. decreased expiratory flow rate
A. II and III
B. I and III
C. II and II
D. I, II, and III

26. It is important to monitor ventilatory parameters in addition to arterial blood gases because:
A. monitoring of ventilatory parameters can be done without a physician’s order, whereas arterial blood gas monitoring requires a physician’s order.
B. it is easier and more cost-effective to monitor ventilatory parameters.
C. monitoring of the ventilatory parameters does not require specialized equipment and can be done more quickly.
D. changes will occur in ventilator parameters before they are seen in arterial blood gases.

27.Ventilatory measurements routinely monitored at the bedside include all of the following except:
A. fractional gas concentrations.
B. lung volumes and flows.
C. oxygen consumption and carbon dioxide production.
D. airway pressures.

28. It is important to monitor lung volumes in patients on ventilators because they:
a affect gas exchange in the lung.
b. reflect changes in the patient’s clinical status.
c. indicate response to therapy and any problems that may arise.
d. All of the above

29. Which of the following is/are true about the tidal volume?
A. It is usually 10 to 15 mLlkg ideal body weight.
B. It is usually about 25% to 30% of total lung capacity.
C. It is made up of two components: alveolar volume and dead space volume.
D. All of the above

30. In healthy, spontaneously breathing patients, an occasional increase in tidal volume to three or four times the normal level, which normally occurs about six to ten times each hour is the defnition of a:
A. sneeze.
B. sigh.
C. cough.
D. forced vital capacity.

31. If intubated and mechanically ventilated patients are given shallow tidal volumes without sighs, which of the following is most likely to occur?
A. Coughing
B. Respiratory arrest
C. Atelectasis
D. Increase in secretion production

32. In mechanically ventilated patients, normal tidal volumes are not usually used without positive end-expiratory pressure (PEEP) because they will cause:
A. an increase in intrapulmonary shunting.
B. a reduction in functional residual capacity.
C. a decrease in the partial pressure of arterial oxygen (Pa0
D. All of the above

33. The “stacking” of breaths, often seen in mechanically ventilated patients with severe obstruction, can be caused by:
A. a respiratory rate that is too low.
B. a low-measured tidal volume.
C. an insufficient expiratory time.
D. ventilator malfunction.

34. The amount of force needed to maintain a mechanical tidal volume breath in the patient’s lungs is known as:
A. continuous positive airway pressure.
B. positive end-expiratory pressure.
C. peak pressure.
D. static pressure.

35. Compliance is defined as:
A. elasticity.
B. pressure change per unit of volume.
C. volume change per unit of pressure.
D. Both a and b

36. ARDS, pneumonia, and pulmonary edema are likely to cause a decrease in lung compliance. This is evidenced in a mechanically ventilated patient by:
A. an increase in inspiratory time.
B. an increase in dynamic pressure.
C. an increase in expiratory time.
D. an increase in static pressure.

37. If auto-PEEP is present, it is most likely to be detected if the expiratory limb of th patient circuit is occluded at what point in the cycle?
a. At the end of exhalation
b. In the middle of inhalation
c. In maximal inhalation
d. All of the above

38. In the ICU, the airway resistance (Raw) of a mechanically ventilated patient can b easily estimated by which of the following formulas?
A. (flow - inspiratory time)/60
B. (peak pressure - static pressure)/flow
C. (peak pressure - static pressure)/2
D. (ET tube diameter - static pressure)/peak airway pressure

39. All of the following are likely to increase the mean airway pressure (MAP) except
a. an increase in flow rate.
b. an increase in PEEP levels.
c. an increase in peak pressure.
d. an increase in expiratory time.

40. When a patient’s mechanical ventilator has a graphic display screen, which of the following waveforms could be used to determine whether there is any leak in the
system and the amount of the leak?
A. Pressure/time
B. Flow/time
C. Volume/time
D. Pressure/flow

41. A pre-use check on the Servo i contains which of the following:
A. Circuit leak check
B. Measurement of compressible volume factor
C. 02 cell check
D. All of the above are correct
E. The Servo I does not have a pre use check

42. How long will the Oxygen Breath button deliver 100% 02 on the Servo i?
A. 2 minutes
B. 1 minute
C. 5 minutes
d Until you turn it off

43. The Servo i has the option of compensating for circuit compressible volume (aka. Tube Compliance Factor, TCF).
a. True
b. False

44. Which of the following is NOT controlled by a direct access knob on the user interface in Volume Control mode:
a. Fi02
b. Respiratory Rate
c Inspiratory Time
d. PEEP
e. All of the above can be directly controlled in Volume Control mode.

45. When the Automode is activated it will allow the patient to increase the inspiratory flow rate above the set flow rate, and shorten the Ti.
a. True
b. False

46. The criteria for the clinical diagnosis of brain death includes all of the following except:
a. Doll’s eyes
b. no cough response to deep tracheal suction
c .intact spinal reflexes
d. persistent apnea after 7-10 minutes

47. For the end results of the APNEA TEST to be valid, the PaCO2 must be greatei than:
a. 30torr
b. 40torr
c. 50torr
d 60torr

48. Apnea Test “exclusion criteria” to rule out potentially reversible causes of coma thai mimic brain death, include all of the following except:
A. Hypertension
B. Sedative drugs
C. Hypothermia
D. NMBs

49. Acute dyspnea can be caused by which of the following ventilator setting:
I. High pressure control setting
II. Setting the tidal volume low enough that the peak airway pressure is kept <30 cm H20
III The assist-control back-up rate is set so that the patient must trigger th ventilator
IV. A long inspiratory time
A. I, II, IV
B. I, II, III
C. I, III, IV
D. All of the above can cause dyspnea

50. True or False
Ventilator settings that “exercise” the patient can cause patient-ventilator dys synchrony.
True False

51. pH 7.46 PCO 25 HCO 17
A. Chronic Respiratory Acidosis
B. Mixed Metabolic & Respiratory Alkalosis
C. Chronic Respiratory Alkalosis
D. Acute Metabolic Acidosis
E. Combined Respiratory & Metabolic Acidosis

52. pH 7.33 PCO 70 HCO 36
A. Chronic Respiratory Acidosis
B. Combined Respiratory & Metabolic Acidosis
C. Chronic Respiratory Alkalosis
D. Acute Metabolic Acidosis
E. Mixed Metabolic & Respiratory Alkalosis

53. pH 7.11 PCO 16 HCO 5
A. Chronic Respiratory Alkalosis
B. Chronic Respiratory Acidosis
C. Combined Respiratory & Metabolic Acidosis
D. Mixed Metabolic & Respiratory Alkalosis
E. Acute Metabolic Acidosis

55. pH 7.15 PCO 50 HCO 17
A. Combined Respiratory & Metabolic Acidosis
B. Acute Metabolic Acidosis
C. Chronic Respiratory Acidosis
D. Mixed Metabolic & Respiratory Alkalosis
E. Chronic Respiratory Alkalosis

56. pH 7.61 PCO 33 HCO 29
A. Normal Acid Base balance
B. Chronic Respiratory Acidosis
C. Combined Metabolic & Respiratory Alkalosis
D. Respiratory Alkalosis correcting Metabolic Acidosis
E. Combined Respiratory & Metabolic Acidosis

57. pH 7.35 PCO 20 HCO 12
A. Normal Acid Base balance
B. Respiratory Alkalosis correcting Metabolic Acidosis
C. Chronic Respiratory Acidosis
D. Combined Respiratory & Metabolic Acidosis
E. Combined Metabolic & Respiratory Alkalosis

58. pH7.30 PCO31 HCO15
A. Respiratory Alkalosis correcting Metabolic Acidosis
B. Normal Acid Base balance
C. Combined Metabolic & Respiratory Alkalosis
D. Chronic Respiratory Acidosis
E. Combined Respiratory & Metabolic Acidosis

59. pH 7.40 PCO 33 HCO 50
A. Normal Acid Base balance
B. Respiratory Alkalosis correcting Metabolic Acidosis
C. Combined Metabolic & Respiratory Alkalosis
D. Combined Respiratory & Metabolic Acidosis
E. Chronic Respiratory Acidosis

60. pH 7.26 PCO 50 HCO 22
A. Normal Acid Base balance
B. Respiratory Alkalosis correcting Metabolic Acidosis
C. Combined Respiratory & Metabolic Acidosis
D. Combined Metabolic & Respiratory Alkalosis
E. Chronic Respiratory Acidosis

61. While monitoring patients, signals, or values are susceptible to variability due to all of the following, except
A. fictitious events
B. artifacts
C. instrument drift
D. seasonal variation

62. Temporary variation in pulmonary artery pressure readings due to movement of the hemodynamic monitoring line is an example of what type of variability?
A. instrument drift
B. physiologic variation
C. artifact
D. fictitious event

63. Which of the following are the reasons monitors are needed?
I. continuous assessment
II. analysis of vital signs
III. measurement of values that caregivers cannot detect
A. I and III
B. I and II
C. I, II, and III
D. I only

64. Which of the following parameters is NOT a major factor in determining tissu oxygenation?
A. R/Q ratio
B. arterial oxygenation
C. tissue perfusion
D. oxygen uptake

65. In low-perfusion patients, what site would be best for monitoring Sp0
A. forehead
B. nose
C. finger
D. earlobe

66 The setting of the alarm threshold for the minute ventilation (Ve) may be too high if it allows the natient to double their current Ve.
A. True
B. False

67. Which of the following is NOT likely to cause errors in SpO2 readings?
A. anemia
B. motion due to shivering
C. deeply pigmented skin
D. significant tachycardia

68. What is the normal approximate value for oxygen consumption?
A. 200 ml/mm
B. 250 ml/mm
C. 300 ml/min
D. 150 ml/mm

69. What method(s) is/are used to measure oxygen consumption?
I. Fick method
II. analysis of inspired and expired gases
III. V/Q scans
A. I and II
B. I and III
C. I, II, and III
D. I only

70. What is the best measure of the efficiency of gas exchange in the lung?
A. PaCO
B. PaCO
C. VD/VT
D. end-tidal PCO

71. In which of the following disorders would an increased VD/VT ratio be likely?
A. hypothalamus tumor
B. acute lung injury
C. pulmonary embolism
D. congestive heart failure

72. What is the normal range for lung compliance?
A. 60 to 100
B. 80 to 120
C. 40 to 60
D. 100 to 120

73. Which of the following conditions is associated with an increased lung compliance measurement?
A. pneumonia
B. bronchial intubation
C. emphysema
D. atelectasis .

74. Which of the following is NOT a cause of increased airway resistance?
A. increased secretions
B. small endotracheal tube
C. suctiomng
D. high gas flow

75. What is the upper limit for plateau airway pressure that is recommended during mechanical ventilation?
A. depends on the patient
B. 60 to 80
C. less than 30
D. 40 to 50

76. Which of the following factors is not associated with an increased risk for auto-PEEP
A. mechanical ventilation of a patient with obstructive lung disease
B. high minute volume during mechanical ventilation
C. acute respiratory distress syndrome (ARDS) patients
D pulmonary fibrosis

77. Which of the following is NOT associated with auto-PEEP?
A. hemodynamic compromise
B. erroneous calculation of static lung compliance
C. effective trigger sensitivity
D. barotraumas

78. What is the normal range for the percent of oxygen consumption consumed by the , muscles?
A 2% to 5%
B. 5%tolO%
C. l0%tol5%
D. 20%to25%

79. Which of the following breathing patterns suggests respiratory muscle decompensation?
A. slow and deep breaths
B. slow and shallow breaths
C. rapid and shallow breaths
D. rapid and deep breaths

80. Which of the following is NOT a common purpose of using ventilator graphics?
A. to detect auto-PEEP
B. to determine patient ventilator synchrony
C. to determine best FIO
D. to assess effects of bronchodilators

81. What medication is associated with dilated and fixed pupils in the intensive care unit patient?
A. aminophylline
B. atropine
C. vanceril
D. lidocaine

82. At what level of intracranial pressure will venous drainage be impeded and cerebral edema develop in uninjured tissue?
A. l0 to l5mmHg
B. 20 to 30 mm Hg
C. 40 to 45mmHg
D. 30 to 35mmHg

83. What is the Glasgow Coma Scale (GCS) score that requires intracranial
pressure monitoring?
A less than 8
B. less than 9
C. less than l0
D. less than 11

84. Which of the following should be considered if medical and mechanical problems have been e and the patient continues to fight the ventilator or exhibit high levels of agitation or distress?
A. anesthetics
B. narcotics
C. paralytics
D. sedatives

85. What type of internal compressor is used by the Cardinal AVEA ventilator?
A. Rotary
B. Piston
C. Scroll pump
D. Diaphragm

86. On the Cardinal AVEA, the pressure-support ventilation (PSV) Tmax setting provides which of the following?
A. Maximum flow setting for flow-cycling
B. Maximum pressure support level during airway pressure-release ventilation
C. Time-cycling for spontaneous breaths
D. Pressure-limit setting for PSV mode
(APRV)

87. Which of the following represent the neonatal modes of ventilation available
on the Cardinal AVEA?
I. Pressure-regulated volume control (PRVC) A/C
II. Time-cycled, pressure-limited (TCPL) SIMV
III. APRV/BiPhasic
IV. CPAP PSV
A. I and III
B. I and II
C. III and IV
D. II and IV

88. The Cardinal AVEA can deliver which of the following gases to a patient?
I. Room air
II. Nitrous oxide
III. 70/30 heliox
IV. 80/20 heliox
A. II and III
B. I and IV
C. II and IV
D. I and III

89. The respiratory mechanics maneuver on the Cardinal AVEA ventilator that is used to determine a patient’s work of breathing is:
A. MIP
B. P100
C. Pflex
D. Esophageal pressure

90. To achieve the set volume in the PRVC mode, the Cardinal AVEA will increase or decrease the pressure by ____ cm H
A. 2
B. 4
C. 3
D. 1

2. Transport ventilators have not been shown to provide a more constant minute ventilation than manual ventilation during short term in-house patient transports.
A. True
B. False

3. Contraindications to in-house transports include:
I. inability to provide adequate oxygenation
II. inability to maintain acceptable hemodynamic performance during transport
III. inability to adequately monitor patient cardiopulmonary status during transport,
IV. inability to maintain artificial airway control
A. I, II
B. I, II, III
C. I
D. I, II, III, IV

4. Loss of the artrncial airway is potential risk during in-hospital transport.
A. True
B. False

5. In one major study regarding in-hospital transport, approximately 70% of the in-hospital transports caused significant physiologic events lasting at least 5 minutes.
A. True
B. False

1. PRVC uses what flow pattern to deliver a breath?
A. Square wave
B. Decelerating wave
C. Sine wave
D. Constant flow
E. None of the above

2. A pre-use check on the Servo i contains which of the following:
A. Circuit leak check
B. Measurenicnt of compressible volume factor
C. 02 cell check
D. All of the above are correct
E. The Servo I does not have a preuse cheek

3. How long will the Oxygen Breath button deliver 100% 02 on the Servo I?
A. 1 minute
B. 2 minutes
C. 5 minutes
d Until you turn it off

4 The Servo i has the option of compensating for circuit compressible volume (aka. Tube Compliance Factor, TCP).
A. True
B. False

5. Which of the following is NOT controlled by a direct access knob on the user interface in Volume Control mode:
A. Fi02
B. Respiratory Rate
C. Inspiratory Time
D. PEEP
E. All of the above can be directly controlled in volume Control mode.

6. Which of the following statements is true about the Servo I?
A. The ventilator can be used for transport with gas cylinder attached
B. The ventilator has a backup battery power source for its compressor
C. The ventilator cannot freeze (save) pressure volume loops
D. The ventilator can on be used on adult patients

7. Which mode of ventilation on the Servo i adjusts the pressure support level automatically for the spontaneously breathing patient?
A. Pressure Regulated Volume Control
B. Volume Control
C. Volume Support
D. Pressure Support

8. The Servo i has the option for monitoring the end-tidal PCO2 (PetCO2), and calculating the VCO2, which is half of the respiratory quotient.
A. True
B. False

9. When the Automode is activated it will allow the patient to increase the inspiratory flow rate above the set flow rate, and shorten the Ti.
A. True
B. False

10. The default flow pattern in all volume modes is a decelerating waveform;
A. True
B. False

1. What was the initial stated purpose for using Adaptive Pressure Control mode of ventilation?
A. To replace PSV because it over ventilated too many patients
B. To support COPD patients, and reduce their work of breathing
C. To be used as an Auto-wean mode in the post-OP population
D. To support ARDS patients, and protect from excessive pressures

2. Which of the following ventilators dropped to Ojoules of support as the patient’s work of breathing increased?
a PB 840 VC+
b. Drager Auto Flow
c. Hamilton Galileo
d. Servo-i

3. From this, and other, articles we now know the following:
A. If the ventilator shows a measured Vt higher than the set Vt, the patient is not receiving much (if any) pressure support, and may be inspiratory flow starved.
B. Most ventilators work about the same in APC mode
C. This mode of ventilation always meets the patient’s inspiratory flow demand.

4. According to another article quoted, which of the following modes was the least comfortable for spontaneous breathing normal patients?
A. Pressure support
B. Volume control
C. APC

5. Among ARDS patients, which of the following modes of ventilation supported the patient’s WOB best?
A. Volume control
B. Pressure support
C. APC

1. List 3 medical conditions which have been confirmed to have an association with obstructive sleep apnea.

2. Compared with data of the general US population, patients with obstructive sleep apnea/hypopnea syndrome may have _______ as much hypertension, ______as much ischemic heart diease, and ______as much cerebrovascular disease.

3. Hypertrophy of the right and left ventricles of the heart tends to occur with obstructive sleep apnea. What is the suspected mechanism?

4. Patients with obstructive breathing disorders are more prone to depression, anxiety, and sexual dysfunction.
A. True
B. False

5. (Fill in the blank) Studies demonstrate excess mortality rates due to obstructive sleep apnea of ____ % over 5-8 years, with most deaths attributed to _________________

2. Pleuritic chest pain is often sharp, localized pain, most often at the periphery of the chest, and increases with deep breathing, coughing, sneezing or movement. Musculoskeletal trauma would be a good example.
A. True
B. False

3. Unrelieved pain has no relationship to the pulmonary signs of decreased flows and volumes, atelectasis, shunting & hypoxemia, decreased effectiveness of cough, or sputum retention.
A. True
B. False

4. We should notify the physician or nurse if the initial, or subsequent, pain medication orders are inadequate or breakthrough pain occurs.
A. True
B. False

5. FLACC scale (face-legs-activity-cry-consolability) can be used for children 0-5 years of age or children who cannot self-report pain.
A. True
B. False

6. Morphine is often used to treat dyspnea, but it can depress the central respiratory center.
A. True
B. False

7. Pain increases gastric and bowel motility.
A. True
B. False

8. Aggressive Respiratory Care, in the form of frequent moving of the patient and encouraging coughing, should be avoided in chest trauma patients.
A. True
B. False

9. Visceral chest pain often leads us to the conclusion that the pain is gastric in origin, even though the exact cause of this type of pain remains poorly understood.
A. True
B. False

10. Morphine and fentanyl both can cause rigidity of the chest wall muscles at high doses.
A. True
B. False

What is the most common cause of pleural effusion in the clinical setting?
a. acute renal failure
b. congestive heart failure
c, liver disease
d. lungcancer

2. The pleural effusions associated with heart failure are rarely drained.
a. true
b. false

3. What is a common complication of pleurodynia (pleural pain)?
A. pneumothorax
B. pneumonia
C. atelectasis
D. insomnia

4. what is the most common cause of hemothorax?
A. malignancy
B. surgery
C. pulmonary embolism
D. chest trauma

5. what is a common clinical finding even with small pleural effusions?
A. arrhythmias
B. tachycardia
C. dyspnea
D. air bronchograms

6. What are the functions of a chest tube in a patient with chest trauma that causes bleeding and pneumothorax?
I. to measure the rate of bleeding
II. to improve ventilation
III. to allow lung re-expansion
A. III only
B. I and II
C. I, II and III
D. II and III

7. Chest tubes should be directed toward the base of the lung to evacuate a pneumothorax.
a. true
b. false

8. At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension pneumothorax?
A. just superior to the second rib
B. just inferior to the third rib
C. just superior to the fourth rib
D. just inferior to the second rib

9. A quick diagnosis based on clinical presentation can significantly improve the survival rates in patients with tension pneumothorax.
a. true
b. false

10. What complication often occurs following rapid lung re-expansion due to the evacuation of air or fluid from the pleural space?
A. pulmonary edema
B. arrhythmias
C. systemic hypotension
D. pulmonary emboli

11. The administration of oxygen to a patient with a pneumothorax will speed the rate at which resolution occurs once the leak has stopped.
a. true
b. false

12. What method of chest tube removal has been associated with the lowest level of pneumothorax recurrence?
A. Remove the chest tube as soon as the air leak resolves.
B. Remove the chest tube 48 hours after the air leak resolves.
C. Clamp chest tube for 24 hours; if clinically stable, remove the tube.
D. Clamp the chest tube for 4 hours; if chest radiograph is good, remove the tube.

13. Which type of chest tube has the least complication rate?
a. Small tubes
b. Large tubes.

14. Which of the following complications is present both early and late in the clinical use of chest tubes?
A. Infections around the tube
B. Nonfunctional tubes.
C. Laceration of the lung.
D. Tube placement not in the pleural space.

15. Signs of broncho-pleural fistula may include which of the following?
Loss of returned tidal volumes
I Actively bubbling Pleur-evac device
II Life-threatening respiratory acidosis
IV Auto-cycling of the ventilator
V Persistent atelectasis
A. I, II, III,
B. I, II, III, IV
C. I, II, IV, V
D. I,III,IV,V

1. A patient-ventilator system check must include both the set and observed ventilator frequency, and the delivered tidal volume (either measured or calculated).
a. true
b. false

2. All of the following complications are possible if you disconnect a patient, except
A. Hypoxemia
B. Bradycardia
C. Hyperventilation
D. Hypotension

3. When should you drain the ventilator tubing?
A. During the ventilator check so you demonstrate the effects of removing the condensation.
B. We don’t need to remove an condensation because it’s sterile.
C. After the ventilator check so you demonstrate the effects of the condensation.
D. Before the ventilator check so the condensation doesn’t influence the readings and calculations.

4. What is the minimum time that it takes to begin to gel an accurate plateau pressure?
A. 0.2 seconds
B. 5.0 seconds
C. 0.5 seconds
D. 2.0 seconds

5. Which of the following are reasons to do a Patient-Ventilator Check?
I. Routine — Q 2-4 hrs.
II. Before each ABO.
III. With ventilator orders/settings changes.
IV. With any acute change in patient conditions
V. Upon arrival back from a transport to MIRJ for 2 lirs.
VI. Whenever the ventilator performance is questionable.
A. I, II, III, IV, VI
B. I, II, III only
C. I, II, III, IV only
D. I, II, III, IV, V, VI

6. Patient vital signs belong p in the Nursing Notes, not in our Patient-Ventilator Check charting.
a. true
b. false

7. An ‘error of omission” in charting can be grounds for malpractice.
a. true
b. false

8. Spelling errors and math errors have no effect on the perception of our professionalism; the other Healthcare Workers understand the complexities and time constraints.
a. true
b. false

9. Brief narratives regarding the clinical observations of the patient’s response to the current mechanical ventilator settings are not necessary, according to the AARC — CPG on Patient- Ventilator Check.
a. true
b. false

10. All of the following are direct complications of suctioning except:
A. Cardiac-Respiratory arrest
B. Infection (patient and/or caregiver)
C. Cardiac dysrhythmias
D. Mesenteric isehemia
E. Bronchoconstrictionl/bronchospasm

11. All of the following are considered evidence of effective suctioning, except:
A. Decreased static compliance
B. A narrowing of PIP - Pplateau
C. Increased tidal volume delivery during pressure-limited ventilation
D. Increased dynamic compliance
E. Decreased peak inspiratory pressure (PIP)

12. One of the stated reasons for doing a Patient-Ventilator Systems Check, according to the AARC CPG, is to verify and document that the ventilator alarms are appropriate and active.
a. true
b. false

13. According to the AARC CPG, an acceptable order for mechanical ventilation cannot be solely based on the desired blood gas results or ranges, leaving you to manipulate the settings to obtain these desired results.
a. true
b. false

l4 According to the AARC CPG, the volume monitoring devices should have an accuracy of within ± 10% of the set Vt, and the oxygen analyzer accuracy should be within ±3% of actual concentrations.
a. true
b. false

15. According to the AARC CPG, the routine patient-ventilator check should do which of the following?
I. Prevent untoward incidents
II. Warn of impending events
III. Assure proper ventilator functioning
IV. Match the physician’s orders
A. I, III, IV
B. II, III, IV
C. I, II, III
D. I, II, III, IV

1. Acute dyspnea can be caused by which of the following ventilator setting:
I. High pressure control setting
II Setting the tidal volume low enough that the peak airway pressure is kept <30 cm H20
III The assist-control back-up rate is set so that the patient must trigger the ventilator
IV. A long inspiratory time
A. I, II, IV
B. I, II, III
C. I, II IV
D. all of the above can cause dyspnea

2. Venilator settings that “exercise” the patient can cause patient-ventilator dys-synchrony.
a. true
b. false

3. The setting of the alarm threshold for the minute ventilation (ye) may be too high if it allows the patient to double their current ye.
a. true
b. false

4. Delirium can cause patient distress sufficient to cause adverse patient- ventilator interactions.
a. true
b. false

5. Ventilator alarm systems will always alert you to a ventilator malfunction.
a. true
b. false

6. Malposition of the ETT down the mainstem bronchus will always trigger a high peak airway alarm.
a. true
b. false

7. Slow cuff leaks most often lead to which of the following problems?
I. Hypoventilation
II. Hypoxemia
III. Aspiration
IV. High peak airway pressures
A. I, II, III, IV
B. I, II, III
C. I, III
D. II, III, IV

8. Assuming normal pulmonary compliance and resistance, and properly set alarms, a new onset of Kussmaul’s breathing while on a ventilator should cause a low minute ventilation alarm.
a. true
b. false

9. One of the first steps in responding to high peak airway pressures alarms is to confirm that the artificial airway is not obstructed by trying to suction down the tube.
a. true
b. false

10. The ventilator alarms will always alert us to increasing expiratory airway resistance due to HMEs.
a. true
b. false

11. Which of the following is not a potential cause of dyspnea?
A. acidemia
B. central apnea
C. hypercapnia
D. hypoxemia

12. Tachypnea (rapid breathing) is always a good indicator that the patient is dyspnic.
a. true
b. false

13 Most patients’ can sense the magnitude of inspiratory effort neces5 to take a breath, which becomes the basis for their sense of breathlessness.
a. true
b. false

14. Dyspnea is an objective sign, which is easy to measure and treat.
a. true
b. false

15. Our “hypoxic drive” is mediated through our central chemoreceptors.
a. true
b. false

16. Morphine is the drug of choice to treat a dyspnic emphysema patient.
a. true
b. false

17 Paroxysmal nocturnal dyspnea (PND) is most often associated with congestive heart failure I pulmonary edema.
a. true
b. false

18. In addition to history taking, it is often necessary to do both pulmonary function tests and a cardiac stress test to quantify the severity of dyspnea on exertion (DOE), particularly if the patient is seeking disability insurance.
a. true
b. false

19. In patients with cardiogenic pulmonary edema (CPE), dyspnea is seldom a major symptom at the time of presentation in ER.
a. true
b. false

20. Fanning air across the patient’s face is totally ineffective for the relief of dyspnea in COPD and cancer patients.
a. true
b. false