CRT Test 2

The respiratory therapist is reviewing a postoperative patient's care plan. The physician has changed the patient's therapy from incentive spirometry to IPPB. What is the most likely goal, for this change?

A. Delivery of aerosolized bronchodilators.
B. Improvement in alveolar oxygenation.
C. Prevention of lower lobe atelectasis.
D. Promotion of airway clearance.

Which of the following humidifiers would most consistently deliver the highest water vapor to a patient's airway?

A. Passover
B. Bubble
C. Heated wick
D. Heat moisture exchanger

A physician orders an FiO2 of 0.40 for premature infant in an Isolette. To deliver the prescribed FiO2 the respiratory therapist should select:

A. A 40% air entertaiment mask.
B. An oxygen blood
C. An infant nasal cannula at 1 L/min
D. A simple mask at 4 L/min

A 7 day old infant of 28 weeks gestational age is having frequent periods of apnea, with desaturation. The respiratory therapist should recommend which of the following?

A. Racemic epinephrine (Vaponefrin)
B. Naloxone (Narcan)
C. Surfactant (Survanta)
D. Theophylline (Aminophylline)

A conscious, spontaneously breathing patient is admitted to the emergency department (ED) with suspected carbon monoxide poisoning. The respiratory therapist's most appropriate INITIAL action would be to:

A. Perform an arterial blood gas analysis.
B. Intubate and apply CPAP with 50% oxygen.
C. Administer oxygen by a 40% air-entrainment mask.
D. Administer 100% oxygen by a non rebreathing mask.

A patient presents in the emergency department (ED) with massive facial trauma involving the nose and mouth. Which of the following is most appropriate for managing the patient's airway?

A. Nasotracheal tube
B. Tracheostomy tube
C. Oral endotracheal tube
D. Laryngeal mask airway

Which of the following allows immediate determination of the lowest FiO2 needed to achieve satisfactory oxygenation?

A. Capillary refill
B. Pulse oximetry
C. Nail bed color
D. Shunt studies

The pressure control knob on a pressure-cycled ventilator will determine the:

A. Pressure at which inspiration ends.
B. Gradient from the artificial airway to the alveoli.
C. Effort required to initiate gas flow.
D. Pressure required to activate the pop-off mechanism.

An 18 year old patient who is having a severe asthmatic episode is being mechanically ventilated. The pressure limit alarm is frequently sounding. The patient is very agitated, and his respiratory rate is 36/min. Bileteral breath sounds with minimal wheezing are noted. Which of the following should the respiratory therapist recommend?

A. Midazolam (Versed)
B. Beclomethasone (Vanceril)
C. N-acetylcysteine (Mucomyst)
D. Cromolyn (Intal)

All of the following are true concerning the use of a transcutaneous PO2 monitor EXCEPT:

A. A low calibration point is done with a "zero" solution or gas.
B. The site should be changed every 3 to 4 hours.
C. Skin temperature control should be set at 37C.
D. PtcO2 values should be correlated with arterial blood samples periodically.

The respiratory therapist is working with a patient with COPD who is in a smoking cessation program. The patient complains of irritability, anxiety, difficulty concentrating, craving for tobacco, and weight gain. The therapist should recommend which of the following?

A. Using a sedative
B. Using nicotine patches
C. Returning to smoke, but only half as much as previously
D. Continuing the program because these complaints are expected

A patient with neuromuscular disease has been receiving ventilatory support for 4 months by tracheostomy. The patient is being weaned during the day, but is still mechanically ventilated at night. Which of the following devices will best meet both needs of the patient?

A. Tracheostomy button
B. Bivona tracheostomy tube
C. Cuffed, fenestrated tracheostomy tube
D. Uncuffed, standard tracheostomy tube

When performing simple spirometry, which of the following results would best denote an obstructive pattern?

A. Decreased FEV1/FVC Ratio
B. Increased FEV1
C. Increased tidal volume
D. Decreased inspiratory reserve volume

During the weaning trial of a patient with a tracheostomy, the mist disappears at the T-piece early in inspiratory respiratory therapist should do which of the following?

A. Add dead space between the T-Piece and the patient.
B. Direct the patient to inhale more slowly.
C. Decrease the length of tubing from the aerosol generator.
D. Increase the flow the aerosol generator.

Moist, crepitant crackles indicate which of the following?

A. Pulmonary edema
B. Atelectasis
C. Pleural effusion
D. Asthma

Which of the following would be most important to assess a patient's ability to perform metered dose inhaler (MDI) therapy?

A. Ability to follow instructions
B. Overall general appearance
C. Adequacy of oxygenation
D. Exercise tolerance

While administering acetyl cysteine (Mucomyst) with a hand-held nebulizer, the respiratory therapist notes that the patient is developing marked congestion with copious sputum production. The therapist's most appropriate action would be to:

A. Dilute the acetyl cysteine with saline.
B. Terminate the therapy and clear secretions.
C. Increase the dose of acetyl cysteine to help thin the secretions.
D. Administer the acetyl cysteine with a positive pressure breathing machine

The addition of an inspiratory plateau during continuous mechanical ventilation may be CONTRAINDICATED in patient's with:

A. Hypoxemia
B. Hypotension
C. Poor gas distribution
D. Pulmonary edema

When the respiratory therapist initiates an IPPB treatment, the patient's pulse is 80/min. Five minutes after the therapy is started, the patient's pulse increases to 95/min. The therapist should:

A. Continue the treatment as ordered
B. Terminate the treatment and notify the charge nurse
C. Decreases the nebulizer output
D. Decrease the system pressure

During manual bag-valve ventilation by an endotracheal tube, inadequate ventilation is noted. This may be caused by which of the following:

I. Deflated endotracheal tube cuff
II. Excessive oxygen flow
III. Absent bag-valve diaphragm
IV. Improper tube placement

A. I and II only
B. I and III only
C. I, III and IV only
D. II, III and IV only

The respiratory therapist is assisting the physician with a tracheostomy on a patient who is receiving mechanical ventilation. The therapist notes an increase in peak respiratory pressure and heart rate, a decrease in exhaled tidal volume, and distant breath sounds over the right chest. This most likely indicates a:

A. Circuit air leak
B. Right pneumothorax
C. Lacerated blood vessel
D. Unilateral intubation

The following pulmonary function results are obtained for a patient:

FEV1/FVC - 95% of predicted
FVC - 50% of predicted

Based on these data, the patient most likely has which of the following?
A. Pulmonary fibrosis
B. Cystic fibrosis
C. Emphysema
D. Bronchitis

A 13 month old infant is apneic and cyanotic. The physician asks the respiratory therapist to prepare a tray for oral intubation. The therapist should select all of the following equipment EXCEPT:

A. Magill forceps
B. A Macintosh (curved) laryngoscope blade.
C. A Miller (straight) laryngoscope blade
D. A Yankauer suction tube

Which of the following is the most appropriate radiograph techniques to confirm the presence of free pleural fluid?

A. Bronchogram
B. Apical projection
C. Decubitus projection
D. Oblique projection

The most common complication associated with the placement of a pulmonary artery catheter is:

A. Myocardial infarction
B. Pulmonary artery rupture
C. Pulmonary thrombosis
D. Arrhythmias

While checking a ventilator that has a wick humidifier, the respiratory therapist notes that there is very little condensation in the tubing. The most likely explanation is that he:

A. Minute ventilation is greater than 15 L/min
B. Heating element is not functioning
C. Flow is set too low
D. Room temperature is lower than normal

Which of the following drugs would be most appropriate to recommend as a substitute for metaproterenol sulfate (Alupent) for a patient who has bronchospasm and whose cardiac rate increases by 60/beats/min with each treatment?

A. Acetylcysteine (Mucomyst)
B. Beclomethasone (Vanceril)
C. Racemic epinephrine (Vaponephrin)
D. Albuterol (Proventil)

The respiratory therapist is explaining the objectives of a pulmonary rehabilitation program to a 55 year old patient with emphysema. Which of the following outcomes would allow the patient to participate in evaluating the achievement of the therapeutic plan?

A. Reduction of airway resistance
B. Improvement in arterial blood gas values
C. Improvement in results of pulmonary function studies
D. Increased ability to perform activities of daily living

When administering an IPPB treatment with a pressure-cycled ventilator, the respiratory therapist observes that the patient's tidal volume is adequate, but the inspiratory time is too long. To correct this situation, the therapist should:

A. Increase the flow
B. Increase the pressure
C. Adjust the sensitivity
D. Decrease the nebulizer flow

A patient is receiving oxygen by a non rebreathing mask at 8 L/min. The respiratory therapist notices that the reservoir bag on the mask empties during inspiration. The therapist should immediately:

A. Change the partial rebreathing mask
B. Remove the mask
C. Increase the flow
D. Intubate the patient

A patient with endotracheal tube in place is receiving oxygen enrichment by a heated all purpose nebulizer. Water is collecting in the delivery hose. The respiratory therapist should:

A. Reduce the oxygen flow
B. Drain the tubing frequently
C. Unplug the theater
D. Position the tubing so that the condensate drains back into the reservoir

The patient with a head injury is being mechanically ventilated at a rate of 18 /min. The delivered tidal volume is 900 mL. The patient's current arterial blood gas results are below:

pH - 7.50
PaCO2 - 28 torr
PaO2 - 90 torr
HCO3 - 21 mEq/L
BE - -1 mEq/L

The most appropriate recommendation for this patient would be to:

A. Maintain the present settings
B. Decrease the ventilator rate
C. Decrease the tidal volume
D. Add mechanical dead space

At an FiO2 of 0.30 a pulse oximeter attached to the right index finger or a 6 week old neonate displays an SaO2 of 87% and a pulse of 64/min. A heart monitor reads a simultaneous heart rate of 120/min. Which of the following would be the most appropriate action?

A. Suction the neonate
B. Increase the FiO2 to 0.40
C Reposition the pulse oximeter
D. Ventilate the neonate with 100% 02

A patient complains of sudden, right-sided chest pain. Breath sounds are absent over the right lung field and percussion reveals hyperresonance. The respiratory therapist should recommend:

A. Placing the patient on her right ride and administering chest percussion.
B. Initiating mechanical ventilation in the assist/control mode.
C. Administering an IPPB treatment with a bronchodilator.
D. Inserting a chest tube on the right side.

The respiratory therapist is asked to assess a patient with sleep apnea who is receiving CPAP by a nasal mask. The patient's snoring is becoming progressively louder with longer periods of apnea. The therapist should initially do which of the following?

A. Obtain a blood gas sample
B. Decrease the gas flow
C. Reposition the nasal mask
D. Perform an ECG

A patient who is receiving mechanical ventilation requires an FiO2 of 0.70 and a PEEP of 10cm H2O to maintain an acceptable PaO2. The patient has become disconnected from the ventilator several times while trying to remove her restraints. During each period of disconnection, the patient experiences cardiac rhythm disturbances, which require additional treatment. The respiratory therapist should recommend:

A. Sedating the patient
B. Decreasing the PEEP level
C. Extubating the patient and using a rebreathing mask.
D. Attempting to wean the patient with a T-piece with an FiO2 of 0.80

The aerosol from an ultrasonic nebulizer is being produced in short, rapid puffs. To correct the problem, the respiratory therapist should:

A. Reduce the volume of water in the reservoir.
B. Increase the blower flow
C. Clear the water from the delivery tube
D. Replace the corrugated tubing with smooth bore tubing

A 90 kg (198 lb) patient remains intubated in the postanesthesia care unit (PACU) following abdominal surgery. The patient has no fully awakened from the anesthesia, although he is taking a few spontaneous breaths. The patient is currently being ventilated with a manual resuscitator. Which of the following should the therapist do?

A. Continue manual ventilation until the patient is awake.
B. Initiate 5 cm H2O CPAP.
C. Initiate mechanical ventilation in the SIMV mode
D. Initiate mechanical ventilation in the pressure support mode

A 1 week old neonate with RDS currently receiving 10 cm H2O CPAP through nasal sprongs with an FiO2 of 0.60. Evaluation reveals intercostal and sternal retractions and an SpO2 of 88%. The neonate is breathing at a rate of 68/min. Which of the following should the respiratory therapist recommend?

A. Change to mask CPAP
B. Institute mechanical ventilation
C. Make no changes at the present time
D. Increase the CPAC level to 12cm H2O

Reinserting a flow meter into an oxygen wall outlet has failed to correct a massive gas leak in a patient's room. Which of the following should be done NEXT?

A. Check the pressure relief valve on the humidifier reservoir.
B. Evacuate the patients from the floor.
C. Have engineering shut off the hospital's master oxygen valve.
D. Provide necessary supplemental oxygen and close the zone valve.

While administering an IPPB treatment, the respiratory therapist notices that the pressure rises slowly toward the set pressure, but reaches the set pressure only when the patient actively exhales. Which of the following is the most likely explanation?

A. The inspiratory flow is too high.
B. The nebulizer drive line is kinked.
C. There is a leak in the expiratory valve.
D. The expiratory valve sticks before opening.

The administration of aerosolized acetylcysteine (Mucomyst) would be most appropriate for the treatment of which of the following?

A. Pulmonary therman injury
B. Bronchospasm
C. Humidity deficit
D. Mucus plugs

A 25 year old patient is brought to the emergency department (ED) with respiratory depression caused by an acute drug overdose. An arterial blood gas analysis indicates a pH of 7.20 and a PaCO2 of 80 torr. The respiratory therapist is asked to initiate continuous mechanical ventilation. Which of the following should the therapist do?

A. Recommend IPPB treatments q2h to reduce the patient's PaCO2.
B. Adjust the ventilators so that the patient's PaCO2 will be decreased to 40 torr very gradually over 36 hours.
C. Adjust the ventilator so that the patient's PaCO2 will be decreased to 40 torr within 1 hour.
D. Adjust the ventilator so that the patient's PaCO2 will be decreased to 60 torr to prevent respiratory alkalosis.

A neonate is receiving pressure limited, time cycled mechanical ventilation. The PaO2 decreases from 65 to 50 torr and the physician request an increase in mean airway pressure. The respiratory therapist should recommend increasing the:

I. Inspiratory time
II. Pressure limit
III. Expiratory time

A. I only
B. III only
C. I and II only
D. II and III only

When a Yankauer device becomes obstructed while suctioning vomitus from a patient's mouth, the respiratory therapist should first:

A. Increase the vacuum pressure
B. Change to a suction catheter
C. Clear the device of particulate matter
D. Change the collection bottle

60 year old, 68 kg (150 lb) woman arrives in the ICU after coronary bypass surgery. She has a 54 pack year history of smoking and currently smokes 2 packs a day. An order is written to initiate mechanical ventilation. Which of the following should the respiratory therapist adjust prior to initiating mechanical ventilation for the patient?

I. Respiratory rate
II. Expiratory resistance
III. Oxygen concentration
IV. Tidal volume
V. Sighs per hour

A. I and II only
B. III and V only
C. I, III and IV only
D. II, IV, and V only

While performing postural drainage on a patient who is in a head-down position, the patient appears dyspneic due to severe prolonged coughing. The respiratory therapist should do which of the following?

A. Perform percussion
B. Turn the patient
C. Administer oxygen
D. Have the patient sit up

A pediatric patient with an acute upper airway obstruction would have which of the following physical signs?

A. Unilateral lung expansion
B. Expiratory wheezing
C. Inspiratory stridor
D. Inspiratory crackles

A tachypneic patient with pulmonary edema is brought to the emergency department (ED). Which of the following should be used to provide supplemental oxygen?

A. Air entrainment mask
B. Nasal cannula
C. non rebreathing mask
D. Partial rebreathing mask

While reviewing a patient's chart, results of a chest radiograph indicate complete opacification of the left chest with a shift of the trachea and mediastinum to the left. These findings are consistent with:

A. Pneumothorax of the right lung
B. Atelectasis of the left lung
C. Right sided pleural effusion
D. Pulmonary embolus in the left lung

A physician orders 1 mg atropine by aerosol for a patient. If the concentration of atropine in a stock solution is 0.04%, how many mL of the atropine solution must be administered?

A. 0.25
B. 0.40
C. 0.80
D. 2.50

For a tracheal tube cuff to allow circulation to tracheal mucosa, the cuff pressure must be less than:

A. Capillary pressure
B. Pulmonary artery pressure
C. Pulmonary capillary wedge pressure
D. Central venous pressure

Three days postoperatively, a patient is febrile and the white blood cell count is 18.000/cu mm. A chest radiograph shows a patchy bilateral infiltrates with air bronchograms. Based on this information, which of the following is the most probable diagnosis?

A. Pneumonia
B. Atelectasis
C. Pulmonary edema
D. Pleural effusion

Common complications associated with arterial punctures include which of the following?

I. Fistula formation
II. Hematoma formation
III. Spasm of the vessel

A. I only
B. III only
C. I and II only
D. II and III only

A patient is receiving volume controlled ventilation with a continuous flow IMV circuit added. The respiratory therapist notices that the PEEP level drops from the prescribed 8 to 4 cm H2O with each spontaneous breath. To correct this problem, the therapist should increase the:

A. PEEP to 12 cm H2O
B. Sensitively setting
C. Peak inspiratory flow setting on the ventilator
D. Flow to the continuous flow reservoir bag.

A 45 year old patient with mild kyphoscoliosis and postpolio syndrome requires noninvasive inspiratory assistance and is to be fitted with a chest cuirass. Which of the following should the respiratory therapist recommend regarding proper fit?

I. A 2 to 3 inch air cushion between the shell and the patient's maximum chest rise is required.
II. A cast of the thorax may be made for the patient to accommodate structural abnormalities.
III. A properly fitted cuirass shell should extend anteriorly from the clavicle to the bottom of the rib cage.

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

Direct spirometry CANNOT be used to measure which of the following?

A. Vital capacity
B. Residual volume
C. Tidal volume
D. Inspiratory reserve volume

A patient has a chest tube placed anteriorly in the fourth intercostal space that is connected to an underwater seal drainage system with suction. The respiratory therapist observes that one of the chest tube side holes is now outside the chest wall. Correct statements about this situation include which of the following?

I. The tube should be disconnected from suction.
II. The tube should be clamped immediately.
III. A pleurocataneous fistula exists.
IV. A complete pneumothorax is possible.

A. I and IV only
B. II and III only
C. III and IV only
D. I, II and IV only

The respiratory therapist would instruct a patient which of the following conditions to use pursed lip breathing?

A. Asthma
B. Croup
C. Emphysema
D. Pneumonia

When selecting an endotracheal tube, the respiratory therapist should consider which of the following to minimize airflow resistance?

I. Internal diameter
II. External diameter
III. Length of the tube

A. I only
B. II only
C. I and III only
D. II and III only

A patient is being sent home with an oxygen concentrator. To ensure the safely of the home environment which of the following should be assessed?

A. Number of outlets
B. Water supply
C. Electrical load capacity
D. Location of bedroom

An increase in the number of staphylococcal infections is noted among hospitalized patients receiving respiratory care. Which of the following is the most likely source of the infections?

A. The ventilators
B. The personnel
C. Distilled water
D. Disposable circuits

While assessing a patient's radical pulse, the respiratory therapist notes that the pulse feels full and bounding. Which of the following conditions would be the most probable cause of this finding?

A. Hypvolemia
B. Hypertension
C. Massive GI bleeding
D. Low cardiac output

When performing oxygen rounds, the respiratory therapist notes cyanosis in a patient with COPD who is receiving oxygen at 2 L/min by nasal cannula. Morning laboratory results show a hematocrit of 60%. This is most consistent with which of the following?

A. Anemia
B. Leukopenia
C. Methemoglobinemia
D. Polycythemia

Upon completion of a ventilator check, the respiratory therapist notices that a mathematical error was made on the ventilator monitoring sheet. Which of the following would be the most appropriate course of action?

A. Attempt to erase the error and write over it with the correction.
B. Leave the error alone and complete the ventilator check.
C. Copy the entire ventilator sheet over to correct the error.
D. Line through the error, write the word "error", correct and initial it.

After assisting the physician with a fiberoptic bronchoscopy and transbronchial lung biopsy on a patient receiving volume controlled ventilation, the respiratory therapist notes a marked increase in peak inspiratory pressure. Possible causes of the pressure increase include which of the following?

I. Bronchospasm
II. Pneumothorax
III. Pulmonary hemorrhage
IV. Laryngospasm

A. I and IV only
B. II and III only
C. I, II and III only
D. I, II, III and IV

When pneumatic aerosol generator is being used, the respiratory therapist should decrease the aerosol output for which of the following patients?

I. A patient with dried, retained secretions who becomes dyspneic
II. Infant who has pulmonary edema
III. A patient who has just undergone a tracheotomy

A. I only
B. III only
C. I and II only
D. II and III only

Which of the following devices should be selected to administer nebulized bronchodilator therapy at home?

A. Air compressor
B. Oxygen concentrator
C. E cylinder of oxygen
D. Liquid oxygen system

Immediate electric countershock be recommend for which of the following cardiac dysrhytmias?

A. Ventricular asystole
B. Ventricular fibrillation
C. Atrial fibrillation
D. Atrioventricular block

The respiratory therapist notes that a patient who is being mechanically ventilated has thick, mucoid secretions. It is determined that the wick humidifier is producing insufficient relative humidity. The therapist should do which of the following?

A. Remove the excess water in the humidifier.
B. Increase the temperature setting
C. Increase the flow through the humidifier
D. Shorten the tubing connecting the gas source to the humidifier inlet.

In which of the following patient would the use of a heat moisture exchanger be acceptable?

A. An adult breathing oxygen at 6 L/min by a nasal cannula.
B. A patient with ARDS who is being mechanically ventilated.
C. A mechanically ventilated patient during transport.
D. A mechanically ventilated patient with thick secretions.C

The dynamic compliance of a patient with status asthmaticus requiring continuous mechanical ventilation has decreased sharply over a 1-hour period. Which of the following drugs may be expected to elicit the most rapid improvement in dynamic compliance?

A. Acetylcysteine ( Mucomyst )
B. Theophylline ( Aminophylline )
C. Beclomethasone ( Vanceril )
D. Albuterol ( Ventolin )

A 1 month old infant who is being ventilated with a time-cycled, pressure limited ventilator has a peak pressure of 36 cm H2O and a mean airway pressure of 21 cm H2O. The respiratory therapist shortens the inspiratory time. Which of the following responses would be expected?

A. Increased peak pressure
B. Increased tidal volume
C. Decreased expiratory phase
D. Decreased mean airway pressure

The high pressure alarm on a volume cycled ventilator should be set at least 10 cm H2O pressure above which of the following?

A. Peak airway pressure
B. Mean airway pressure
C. High pressure pop-off
D. Humidifier outlet

The respiratory therapist observes low exhaled volumes during volume-cycled, pressure-limited, mechanical ventilation. To determine if the low volumes are caused by inaccurate ventilator volume control, the therapist should measure the tidal volume at the:

A. Machine outlet
B. Patient connector
C. Exhalation valve
D. Humidifier outlet

A previously healthy 30 year old patient is hospitalized with chills and fever. A chest radiograph is consistent with pneumonia of the right upper lobe. Which of the following is most likely to aid in the patient's management?

A. Bronchial drainage of the right lung
B. Incentive spirometry
C. Aerosol therapy
D. Spirometry before and after a bronchodilator

The respiratory therapist is preparing to initiate oxygen therapy by a nasal cannula at 2 L/min for a 58 year old patient who has admitted with chest pain. Upon entering the patient's room, the therapist finds him slumped over in bed and unresponsive to verbal and tactile stimuli. The therapist should do which of the following first?

A. Call for help
B. Administer oxygen
C. Begin external cardiac compression
D. Deliver a precordial thump

A patient becomes febrile 24 hours after intubation. The respiratory therapist notes other signs of developing pneumonia. A sputum specimen for microbiological assessment should be obtained by:

A. Swabbing the artificial airway
B. Swabbing the airway humidifier device
C. Using a sterile suction trap
D. Using sputum suctioned from the upper airway

A year 21 old man arrives in the emergency department (ED) after being rescued from a house fire. Physical examination reveals burns on the upper chest and face, and marked edema of the face and oropharynx. The results of an arterial blood gas sample obtained while the patient was breathing room air are below:

Ph - 7.55
PaCO2 - 26 torr
PaO2 - 105 torr
HCO3 - 22 mEq/L
BE - 0 mEq/L

Based on the patient's condition at this time, the respiratory therapist should recommend which of the following?

A. Intubate the patient
B. Administer IPPB with ethanol
C. Administer metaproterenol ( Alupent )
D. Administer aerosol therapy

While checking an aerosol mist tent, the respiratory therapist is unable to see any aerosol particles in the tent. The therapist should:

A. Decrease the F, Oz setting on the aerosol-producing device.
B. Check the patency of the jet and capillary tube on the aerosol device.
C. Check the coolant level in the refrigeration unit.
D. Empty any water that has collected in the condensation bottle.

A patient with hypoxemia is receiving 10 cm H2O PEEP with an FiO2 of 0.40. Shortly after increasing the PEEP to 15 cm H2O, the respiratory therapist notes that the cardiac output measurement decreased from 4.5 to 2.7 L.min. Which of the following is the most appropriate action?

A. Maintain the present therapy and measure cardiac output in 1 hour.
B. Decrease PEEP to 10 cm H2O and increase the FiO2 to 0.50
C. Increase PEEP to 20 cm H20 and maintain the FiO2 at 0.40
D. Discontinue PEEP and increase the FiO2 to 1.0

Which of the following devices would be most appropriate for the treatment of post operative microatelectasis in an alert, cooperative patient?

A. IPPB
B. Incentive spirometry
C. Aerosol nebulizer
D. Percussor

The respiratory therapist is called to the operating room because carbon dioxide is leaking from an E Cylinder. The therapist should do which of the following?

I. Tighten all connections
II. Check the outlet for the presence of foreign debris.
III. Replace the washer between the cylinder and regulator connections.
IV. Lubricate the connection where gas is leaking

A. IV only
B. I and II only
C. III and IV only
D. I, II and III only

Which of the following is the most appropriate device for calibrating volume measurement of a water-seal spirometer?

A. A 3-L syringe
B. An adult manual resuscitator bag
C. A volume ventilator
D. A pediatric flowmeter

A patient with a suspected head injury presents in the emergency department (ED). As the patient's pupil are exposed to light, they constrict rapidly, indicating a:

A. Comatoe state
B. Normal response
C. Neurological head injury
D. Brain stem infarction

When setting up mask CPAP for an adult patient, which of the following alarms is the most important to ensure maintenance of therapy?

A. High Fi02
B. Low pressure
C. High respiratory rate
D. Pulse monitor

The respiratory therapist determined that a patient who is being mechanically ventilated has developed auto-PEEP due to dynamic airflow obstruction. Which of the following should the therapist do?

A. Add inspiratory plateau
B. Apply expiratory retard
C. Increase respiratory rate
D. Decrease inspiratory flow

If the ratio light alarm on a ventilator is illuminating on each breath, which of the following controls may be adjusted to remedy the problem?

I. Volume
II. Respiratory rate
III. Sensitivity
IV. Inspiratory flow

A. I and II only
B. II and III only
C. III and IV only
D. I, II and IV only

A 17 year old has sustained a cervical spine injury. He is conscious and spontaneously breathing. The patient weight approximately 50 kg ( 110 lb ) and his head bas been stabilized with sandbags. Arterial blood gas results indicate that the patient is in acute ventilatory failure. To secure the patient's airway, the respiratory therapist should select which of the following?

A. 6.0 mm nasopharyngeal airway
B. 7.0 mm nasotracheal tube
C. 9.0 mm nasotracheal tube
D. 37 Fr Carlens orotraheal tube

To reduce fluctuations in pressure in a mask CPAP system with a threshold resistor valve, the respiratory therapist should do which of the following?

A. Improve the mask seal
B. Reduce gas flow
C. Increase expiratory resistance
D. Use a smaller reservoir

The respiratory therapist has just performed nasopharyngeal suctioning on a patient and is withdrawing the catheter. Suddenly, the patient slumps over in bed and becomes unresponsive. A pulse is not palpable. The therapist should:

A. Reinsert the suction catheter and resume suctioning
B. Reinsert the suction catheter and connect it to the oxygen source
C. Go to the nursing station for help
D. Initiate CPR

A patient is receiving mechanical ventilation with a tidal volume of 700 mL has just undergone a tracheostomy. The respiratory therapist notes a cuff pressure of 18 mm Hg and a leak of 25 mL. The therapist should:

A. Add 10 mL of air to the cuff.
B. Maintain the present cuff volume
C. Advice the physician to insert a larger tracheostomy lube
D. Withdraw air from the cuff until the pressure is less than 15 mm Hg.

Which of the following would be the most accurate method for determining the amount of volume loss through a chest tube in a patient who is being mechanically ventilated?

A. Subtract the expired Vt from the inspired Vt.
B. Note the difference between the peak and plateau pressures.
C. Compare the volume delivered when the chest tube is open vs clamped.
D. Measure the flow coming from the suction regulator.

While checking a patient's progress notes, the respiratory therapist views a physician's treatment plan that includes changes in respiratory care.. The therapist's most appropriate action is to:

A. Initiate the changes immediately.
B. Confer with the patient's nurse about when to implement the changes.
C. Check to see if there are new respiratory care orders.
D. Review the planned changes with the shift supervisor.

Findings consistent with chest percussion include which of the following?

I. A well aerated lung produces a resonant sound on percussion.
II. Atelectasis produces hyperresonance on percussion.
III. Dullness is produced when percussion is performed over an area consolidated by pneumonia.
IV. Hyper resonance normally occurs when percussion is performed over the heart.

A. I and II only
B. I and III only
C. II and IV only
D. III and IV only

A patient complains that after his last aerosolized bronchodilator treatment, he experienced nervousness and increased anxiety. The respiratory therapist's best response would be which of the following?

A. "The nervousness and increased anxiety are expected since the nebulizer is powered by pure oxygen."
B. "Increase your rate and depth of breathing to remove the excess CO2 from the aerosol mask."
C. "Relax and try to breath slowly and I will be here with you so that nothing goes wrong."
D. "There is no need to worry because all patient's become nervous and anxious while taking this kind of treatment."

The respiratory therapist is instructing an outpatient in the care of respiratory equipment. Which of the following steps should be included in the cleaning procedure?

I. Wash thoroughly in mild detergent.
II. Remove all soap by rinsing with water.
III. Soak in vinegar solution for 20 minutes.
IV. Drain dry without wiping.

A. I and II only
B. I, III and IV only
C. II, III and IV only
D. I, II, III and IV

When performing a leak test on volume ventilator, the respiratory therapist should do which of the following?

A. Open the breathing circuit to the atmosphere.
B. Use a circuit factor of more than 4 mL/cm H2O
C. Set the flow control at maximum
D. Set the high pressure limit at maximum