The nurse contact the respiratory therapist to perform chest physiotherapy for a newly admitted patient. Which of the following should the therapist do FIRST?
D.
Trendelenburg's position for postural drainage is CONTRAINDICATED after a patient has had:
A. Intra cranial surgery
B. Hip surgery
C. A pneumonectomy
D. Cardiovascular surgery
A
Which of the following would be the most appropriate device to facilitate suctioning of a patient who has a wired jaw?
A. Oropharyngeal airway
B. Transtracheal catheter
C. Nasopharyngeal airway
D. Yankauer tube
C
A patient presents with dyspnea and a productive cough. The patient has a history of emphysema. Which of the following is the most likely chest configuration for this patient?
A. Barrel chest
B. Pigeon breast
C. Kyphoscoliosis
D. Pectus excavatum
A
Which of the following transdermal preparations could help a patient stop smoking?
A. Nitro-Dur
B. Nicoderm
C. Estraderm
D. Transderm Scop
B
During an ultra sonic aerosol treatment for inspissated secretions, transient dyspnea might develop because the:
A. Aerosol particles are crystallizing
B. Secretions are expanding as they become hydrated.
C. Aerosol is occluding the terminal ways.
D. Aerosol is mechanically displacing the available oxygen molecules.
B
In a volume-cycled ventilator, the inspiratory time is primarily a function of:
A. The flow
B. Sensitivity
C. The expiratory time
D. The oxygen concentration
A
A patient has been receiving continuous ventilatory support for 45 days. Several weaning attempts have failed. The respiratory therapist should recommend which of the following modes of ventilation of facilitate weaning?
A. Inverse ratio
B. Pressure control
C. Pressure support
D. High frequency jet
C
Which of the following will interfere with automatic calibration of a blood gas analyzer?
I. Inadequate amount of buffer solution
II. Waste container below the full line
III. Low supply of calibration gas
A. I and II only
B. I and III only
C. II and III only
D. I, II and III
B
To asses a patient's tidal volume, the respiratory therapist would measure which of the following?
A. Total volume of gas inhaled in 1 minute
B. Volume of gas exhaled by forced exhalation
C. Volume of gas exhaled during normal ventilation
D. Volume of gas inhaled with maximum effort
C
Which of the following procedures is most appropriate to determine the degree of reversibility of a patient's airway disease?
A. Bronchoscopy
B. Chest auscultation
C. Methacholine challenge
D. Spirometry before and after bronchodilator
D
After completing a radial artery puncture on a patient who has normal coagulation, the respiratory therapist should apply manual pressure to the puncture site for a minimum of how many minutes?
A. 1
B. 5
C. 8
D. 15
B
A chest radiograph that shows blunting of the costophrenic angle is compatible with:
A. Pulmonary fibrosis
B. Pleural effusion
C. Bilateral pneumonia
D. Atelectasis
B
To determine the effectiveness of chest compressions during CPR, the respiratory therapist should do which of the following?
A. Evaluate pupillary response
B. Obtain an arterial blood gas sample
C. Obtain a 12 lead ECG
D. Palpate a carotid pulse
D
A patient is confined to his home and requires low flow oxygen therapy. Which of the following should the respiratory therapist recommend?
A. Manifold system
B. Bulk oxygen system
C. Oxygen concentrator
D. Liquid oxygen system
C
Which of the following might be indicated by the frequent sounding of a high pressure alarm on a volume cycled ventilator?
I. The patient needs to be suctioned
II. There is an occlusion in the tubing system
III. There is insufficient time for complete exhalation
A. I only
B. I and III only
C. II and III only
D. I, II and III
D
A 45 year old patient with pneumonia develops a sudden, sharp, left sided chest pain after receiving an albuterol (Ventolin) treatment. A pneumothorax is suspected. While waiting for the physician to arrive, the respiratory therapist should do which of the following?
A. Administer 100% oxygen
B. Allow the patient to breath room air spontaneously
C. Place the patient in a prone position
D. Encourage the patient to deep breath and cough
A
The peak pressure on a volume ventilator is 60cm H2O. The respiratory therapist decreases the inspiratory flow. If the patient's ventilation is being controlled, this change will:
A. Decrease the tidal volume
B. Alter the I:E ratio
C. Lengthen the expiratory time
D. Have no effect on mean airway pressure
B
After abdominal surgery, which of the following is the best position to facilitate a patient's ventilation?
A. Prone
B. Supine
C. Lateral
D. Semi Fowler's
D
To orally intubate a newborn, the respiratory therapist should prepare which of the following?
I. Straight laryngoscope blade
II. Curved laryngoscope blade
III. Magill forceps
IV. Suction catheter
A. II only
B. I and III only
C. I and IV only
D. II, III and IV only
C
The respiratory therapist is assisting the physician with a thoracentesis. How should the therapist position the patient for this procedure?
A. Supine with feet elevated
B. Sitting erect, slightly forward
C. Semi Fowler's, affected side up
D. Lateral decubitus, affected side up
B
A 45 year old patient with asthma is receiving 0.3 mL of albuterol (Proventil) in 3mL normal saline by a small volume nebulizer. Before initiating the treatment, the respiratory therapist notes that the patient's pulse is 136/min. The therapist should do which of the following?
A. Administer the treatment as ordered
B. Defer the treatment and notify the physician
C. Increase the normal saline to 4 mL and administer the treatment
D. Decrease the albuterol to 0.2 mL and administer the treatment
B
When a mask CPAP system is not maintaining the desired CPAP, the respiratory therapist should:
A. Suction the patient
B. Eliminate any system leaks
C. Replace sticking valves in the system
D. Reposition the patient's head and neck
B
An adult patient in the CIU is receiving betablocker medication and requires bronchodilator therapy. Which of the following should the respiratory therapist recommend?
A. Cromolyn sodium (Intal)
B. Albuterol (Proventil)
C. Triamcinolone acetonide (Azmacort)
D. Epinephrine
B
A patient is to receive oxygen by nasal cannula at 5 L/min. A pressure compensated flowmeter is used to adjust oxygen flow. If gas flow is obstructed downstream from the flowmeter, which of the following will occur?
A. The delivered FiO2 will increase
B. Albuterol (Proventil)
C. Triamcinolone acetonide (Azmacort)
D. Epinephrine
B
A patient is to receive oxygen by nasal cannula at 5 L/min. A pressure compensated flowmeter is used to adjust oxygen flow. If gas flow is obstructed downstream from the flowmeter, which of the following will occur?
A. The delivered FiO2 will increase
B. Bubbling in the humidifier will cease
C. Indicated gas flow will be greater than 3 L/min
D. The pressure relief valve on the flowmeter will be activated
C
A patient is admitted to the hospital with asthma triggered by a pulmonary infection. The patient has coughed up mucus plugs. It would be most appropriate to administer which of the following?
A. Bronchodilator with strong alpha stimulation
B. Aerosolized ipratropium bromide (Atrovent)
C. Mucolytic therapy followed by high humidity
D. Bronchodilator followed by high humidity
D
Which of the following information would be necessary to determine the volume of gas that is actually delivered to a patient by a volume preset ventilator?
I. Compliance of the circuit to the exhalation valve
II. Volume of the circuit to the exhalation valve
III. Peak inspiratory pressure
IV. Exhaled tidal volume
A. II only
B. I and II only
C. III and IV only
D. I, III and IV only
D
Which of the following would most likely cause an increase in flow to a patient who is being mechanically ventilated in the SIMV mode with a Siemens Servo 900C?
A. Decreased frequency
B. Decreased pause percent
C. Increased the tidal volume
D. Increased inspiratory time percent
C
Which of the following is the best method to monitor equipment sterilization?
A. Heat sensitive tape
B. Chemical sensitive indicators
C. Biologic indicators
D. Time and temperature graphs
C
A 36 year old male patient underwent laparoscopic cholecystectomy. The patient is receiving supplemental oxygen through a nasal cannula at 2 L/min. Which of the following is the most appropriate method for the respiratory therapist to evaluate the patient's response to the oxygen therapy?
A. Measure the SpO2
B. Perform arterial blood gas analysis
C. Observe the patient cyanosis
D. Evaluate the patient for respiratory distress
A
Which of the following would facilitate clearance of pulmonary secretions in a patient with cystic fibrosis?
I. Acetylcysteine ( Mucomyst )
II. Flutter valve
III. Room humidifier
IV. DNase
A. I and III only
B. II and IV only
C. I, II and IV only
D. II, III and IV only
C
A galvanic oxygen analyzer is being used to monitor a mechanically ventilated patient. the patient is receiving 100% oxygen, and the analyzer register 103%. Which of the following would correct this situation?
A. Calibrating the analyzer
B. Replacing the galvanic cell
C. Changing the membrane on the electrode
D. Changing the blender setting to 97%
A
Which of the following hand positions is used in chest percussion to loosen bronchial secretions?
A. Hand slightly cupped with fingers and thumb closed
B. Hand flat with fingers and thumb closed
C. Fingers cubbed and thumb open
D. Fingers and thumb open
A
Within 2 to 3 minutes of extubation, a patient develops inspiratory stridor. Which of the following should be administered as an aerosol?
A. Terbutaline (Brethine)
B. Racemic epinephrine
C. Metaproterenol (Alupent)
D. Cromolyn sodium (Intal)
B
A 45 year old male with a diagnosis of bilateral pneumonia is receiving volume controlled ventilation in the assist/control mode. Despite an adequate rate and volume, his PaO2 falls below 60 torr with an FiO2 of 0.60. Which of the following should be recommended to improve oxygenation?
A. Initiate PEEP
B. Insititute SIMV
C. Increase the FiO2
D. Add an inspiratory plateau
A
All of the following are complications of external cardiac compression EXCEPT:
A. Liver laceration
B. Gastric distension
C. Cardiac contusions
D. Costal cartilage dislocation
B
A 68 year old with a history of COPD is admitted to the hospital for increasing shortness of breath and a nonproductive cough. Chest auscultation revels expiratory wheezes. Which of the following would be most appropriate to improve the patient's clinical condition?
A. Beclomethasone ( Vanceril )
B. Ipratropium bromide ( Atrovent )
C. Amoxicillin ( Augmentin )
D. Cromolyn sodium ( Intal )
B
Which of the following respiratory care equipment is the most likely cause of bacterial contamination?
A. Wick humidifier
B. Ventilator circuit
C. Large volume nebulizer
D. Manual resuscitator
C
To ensure the safety of a patient's home environment prior to discharge with an oxygen concentrator, the respiratory therapist should assess which of the following?
A. Domestic water supply system
B. Electrical load capacity
C. Number of bedrooms
D. Type of bed
B
A tidal volume of 800 mL is delivered at a constant flow of 60 L/min to a mechanically ventilated patient. the respiratory pressure 35 cm H2O, Plateau pressure 28 cm H2O. What is the patient's airway resistance (in cm H2O/L/sec)?
A. 0.12
B. 7.0
C. 22.8
D. 28.6
B
A resonant percussion note would normally be heard over the:
A. Lungs
B. Heart
C. Liver
D. Diaphragm
A
The respiratory therapist discovers that the PEEP level is not being maintained. Which of the following might be causing the loss of positive pressure?
I. Leak in the tubing
II. Faulty exhalation valve
III. Leak around the airway cuff
IV. Loose humidifier connection
A. I and II only
B. I and III only
C. II and IV only
D. I, II, III and IV
D
A patient with status asthmaticus is being mechanically ventilated in the volume control mode. The patient's peak inspiratory pressure has risen to 80 cm H2O. Which of the following ventilator techniques would be most appropriate to reduce peak inspiratory pressure in this situation?
A. High frequency
B. Pressure control
C. Pressure support
D. Airway pressure release
B
A patient who inhaled chlorine gas during an industrial plan accident is brought to the emergency department. He is dyspneic and has copious, foamy secretions. Lung examination reveals diffuse wheezing. Initial treatment should include the use of which of the following?
I. A bronchodilator
II. A mucolytic agent
III. IPPB
IV. 100% oxygen
A. I and IV only
B. III and IV only
C. I, II and III only
D. I, II and IV only
A
Which of the following is an advantage of using a pulse oximeter with a plethysmographic waveform?
A. It indicates that no met hemoglobin is present
B. It eliminates inaccuracies caused by motion artifact
C. It provides a visual indication of an arterial pulse
D. It synchronizes measurements with the R wave of the electrocardiogram
C
A 65 year old male with a history of COPD is brought to the emergency department because of respiratory distress. The patient is receiving oxygen by a simple mask at 5 L/min. Upon examination, the respiratory therapist notes the patient has shallow breathing and is difficult to arouse. Which of the following should the therapist do?
A. Initiate pulse oximetry
B. Request a chest radiograph
C. Intubate and initiate mechanical ventilation
D. Perform an arterial blood gas analysis
D
Calibration of a blood gas analyzer is being performed using a gas mixture that consist of 10% O2, 12% CO2, and 78% n2. If the barometric pressure is 747 torr and water vapor pressure is 47 torr, what is the calibration point for the PC02 electrode?
A. 12 torr
B. 70 torr
C. 84 torr
D. 90 torr
C
When preparing a double lumen endotracheal tube prior to intubation, the respiratory therapist should do which of the following?
I. Insert a stylet in each lumen.
II. Check the tracheal cuff
III. Check the bronchial cuff
IV. Apply a water soluble lubricat
A. I and IV only
B. II and III only
C. II, III and IV only
D. I, II, III and IV
C
In the emergency department, which of the following should the respiratory therapist use to quickly and safely remove excessive oral secretions?
A. Oropharyngeal airway
B. Whistle tip suction catheter
C. Bulb aspirator with a 50 mL syringe
D. Tonsil suction tip (Yankauer)
D
Which of the following will improve the efficacy of a metered dose inhaler (MDI) when used by a 5 year old child with asthma?
A. Adding a spacer to the MDI
B. Using a mouth piece for MDI delivery
C. Actuating the MDI twice for each inhalation by the child
D. Instructing the child to exhale through pursed lips
A
A patient is being mechanically ventilated with a volume ventilator in the assist/control mode. The measured exhaled tidal volume is consistently less than expected from the settings. Which of the following is the most likely cause?
A. Dislodged temperature probe
B. Water in the tubing
C. Inadequate inspiratory flow
D. Sensitivity set too high
A
The results of a sleep apnea study reveal that a patient has obstructive sleep apnea with marked oxygen desaturation. Which of the following therapies should be recommended for the patient while he is sleeping?
A. Nasal CPAP
B. Oxygen at 2 L/min by nasal cannula
C. Head of the bed elevated 45 degrees
D. Oropharyngeal airway
A
The respiratory therapist is administering oxygen to an adult patient by a nasal cannula. What is the recommend maximum flow through this device?
A. 2 L/min
B. 4 L/min
C. 6 L/min
D. 8 L/min
C
A patient presents to the emergency department after being rescued from a fire. The patient is comatose upon arrival. After assessing airway patency, which of the following should the respiratory therapist do first?
A. Measure SPO2
B. Initiate 100% oxygen
C. Obtain an arterial blood gas analysis
D. Request a stat chest radiograph
B
To ensure a safe environment in a home with an oxygen cylinder, the respiratory therapist should instruct the patient to:
A. Clean the cylinder valve with alcohol daily
B. Check the cylinder markings at the time of delivery
C. Secure the cylinder with a chain, cord, or stand
D. Store the cylinder in a closet
C
A patient with dyspnea is breathing 60% oxygen through a T-Piece and reservoir system. A heated air entrainment nebulizer is connected to a flowmeter set at 12 L/min. The aerosol mist disappears from the reservoir outlet during each inspiration. Which of the following should the respiratory therapist do?
A. Shorten the reservoir tubing
B. Increase the FiO2 to 0.70
C. Add a second nebulizer
D. Remove the heater
C
A 48 year old trauma patient is receiving oxygen by nasal cannula at 2 L/min. SPO2 is 86% by pulse oximetry. This indicates that the:
A. Patient is probably hyperventilating
B. FiO2 is inadequate
C. Result is not accurate
D. Result is within normal range
B
A patient in the ICU is receiving an FiO2 of 0.40 by air entrainment mask. The SPO2 suddenly decreases to 65%. The heart rate is unchanged at 100/min on the ECG monitor. The heart rate read out from the pulse oximeter does not correlate with the ECG monitor. The respiratory therapist should do which of the following?
A. Increase the FiO2 to 0.60
B. Change the nonrebreathing mask at 12 L/min
C. Reposition the pulse oximeter probe
D. Obtain an arterial blood gas example
C
A patient who had upper abdominal surgery is receiving incentive spirometry for the treatment of atelectasis. Which of the following indicates improvements in the condition?
I. The respiratory rate increases from 16/min to 20/min
II. Auscultation reveals vesicular breath sounds with increased air movements.
III. The forced vital capacity increases from 1.2 L to 1.8 L
A. I and II only
B. I and III only
C. II and III only
D. I, II and III
C
A patient is receiving continuous mechanical ventilation. the respiratory therapist hears a large leak during positive pressure inspirations. On examination, chest expansion is equal bilaterally. The therapist should first:
A. Replace the tracheal tube
B. Request a chest radiograph, stat
C. Notify a nurse before leaving the patient
D. Add air to the tube cuff until the leak stops
D
A patient is receiving a small volume nebulizer treatment with 0.5 mL of albuterol (Proventil) and 2 mL of NaCI. He is experiencing tachycardia and tremors. Which of the following should be recommended to alleviate the patient's reactions?
A. Administer the treatment with oxygen
B. Decrease the dosage of the bronchodilator
C. Instruct the patient to exhale completely between breaths
D. Instruct the patient to perform an end inspiratory hold maneuver
B
A patient is receiving IPPB therapy, and the machine is cycling 30 times per minute. Which of the following is the most likely cause?
A. The patient hypoxic during the treatment
B. The machine sensitivity is inappropriately set
C. The terminal flow is too high
D. The patient is hypoventilating
B
The respiratory therapist is to place a cap on the end of a patient's fenestrated tracheostomy tube so that the patient might breath through her upper airway and speak. Before applying the cap to the tube, the therapist should do which of the following?
A. Remove the inner cannula and assure proper cuff infliation
B. Remove the inner cannula and deflate the cuff
C. Replace the inner cannula and deflate the cuff
D. Replace the inner cannula and assure proper cuff inflation
B
A patient who presents with intercostal and sternal retrachtions most likely has:
A. Pulmonary emboli
B. Upper airway obstruction
C. Increased pulmonary compliance
D. Severe restrictive pulmonary defect
B
A 2 year old child is receiving oxygen by a croup tent. The FiO2 fluctuates inside the canopy. The respiratory therapist should do which of the following?
A. Increase the oxygen flow
B. Switch to a smaller canopy
C. Seal the leaks in the canopy
D. Increase the aerosol output
C
An order is received to institute continuous ultrasonic nebulization by mask for a patient with very thick secretions. Which of the following should be monitored during the treatment?
I. Breath sounds
II. Respiratory rate and pattern
III. Patient's subjective response to therapy
A. I and II only
B. I and III only
C. I and III only
D. I, II and III
D
Tracheal suctioning should be terminated immediately with the occurrence of:
A. Coughing
B. Diaphoresis
C. Bradycardia
D. Patient discomfort
C
A patient is receiving aerosol by a large volume nebulizer. Insufficient aerosol to the patient may be the result of which of the following?
I. Water accumulation in the aerosol tubing
II. Insufficient flow
III. An empty nebulizer reservoir
IV. A clogged capillary tube
A. I and II only
B. II and III only
C. I, III and IV only
D. I, II, III and IV
D
Which of the following techniques should be recommended to begin weaning?
A. CPAP
B. SIMV with pressure support
C. Pressure controlled ventilation
D. Assist/control mode at a rate of 6/min
B
An 80 kg ( 176 lb ) patient with COPD has the arterial blood gas results below:
Which of the following would be the most appropriate tidal volume and rate for controlled mechanical ventilation in this situation?
Tidal Volume - Rate
(mL) - (breaths/min)
A. 1000 - 14
B. 800 - 12
C. 900 - 15
D. 700 - 20
B
Which of the following ventilator controls could be adjusted if the I:E alarm is activated with each mandatory breath?
I. Volume
II. Respiratory rate
III. Sensitivity
IV. Inspiratory flow
A. I and II only
B. I and III only
C. III and IV only
D. I, II and IV only
D
The respiratory therapist should coordinate the timing of chest physiotherapy with all of the following types of therapy EXCEPT:
A. IPPB
B. Oxygen
C. Mucolytic
D. Intermittent bland aerosol
B
During chest palpation of a patient who recently underwent a thoracotomy, the respiratory therapist feels a dry, crackling sensation in the clavicular region. This most likely indicates which of the following?
A. Bronchospasm
B. Tactile fremitus
C. Secretions in the airway
D. Subcutaneous emphysema
D
The respiratory therapist notices a loss visible aerosol mist through the patient's T-piece reservoir tube during the inspiratory breathing phase. Which of the following should the therapist do to correct the problem?
A. Shorten the reservoir tube
B. Increase the aerosol flow to the patient
C. Increase the humidification temperature
D. Check the artificial airway placement
B
Which of the following would interfere with the proper functioning of an air entrainment aerosol nebulizer?
I. Inadequate gas flow
II. Water in the inspiratory limb
III. Obstruction of the air entrainment ports
IV. Presence of a reservoir in the expiratory limb
A. I and III only
B. II and IV only
C. I, II and III only
D. I, II, III and IV
C
A patient with COPD is being mechanically ventilated. Despite treatment with albuterol (Proventil), the patient continuous to wheeze. Peak airway pressure is increased with no change in plateau pressure. The respiratory therapist should recommend:
A. Obtaining a chest radiograph
B. Administering furosemide (Lasix)
C. Obtaining an arterial blood gas analysis
D. Administering ipratropium bromide (Atrovent)
D
The upper limit for a normal PR interval on an ECG tracing is:
A. 0.12 sec
B. 0.20 sec
C. 0.25 sec
D. 0.30 sec
B
The respiratory therapist cannot arouse a previously alert patient. The therapist's next action would be to:
A. Call for help
B. Check for a pulse
C. Open the patient's airway
D. Determine whether the patient is breathing
A
A patient demonstrates refractory hypoxemia while receiving oxygen by a nonrebreathing mask. Which of the following should the respiratory therapist recommend to improve arterial oxygenation?
A. PEP mask therapy
B. A 60% air entrainment mask
C. CPAP therapy
D. Intubation and mechanical ventilation
C
A newborn is receiving 8 cm H2O nasal CPAP. The following information is obtained:
The respiratory therapist should recommend which of the following?
A. Increase the FiO2 to 0.70
B. Increase the nasal CPAP to 12 cm H2O
C. Intubate and administer 8 cm H2O CPAP
D. Intubate and initiate mechanical ventilation
D
During a fiberoptic bronchoschopy, a patient develops bleeding following tissue biopsy. Which of the following should be instilled though the bronchoschopy to alleviate this problem?
A. Vitamin K
B. Epinephrine
C. Normal saline
D. Bicarbonate solution
B
Which of the following devices should the respiratory therapist use to obtain a maximum inspiratory pressure (MIP)?
A. Respirometer
B. Aneroid manometer
C. Sphygmomanometer
D. Peak flowmeter
B
Which of the following is most appropriate for a patient who requires volume controlled ventilation only at night?
A. Kistner tube
B. Tracheostomy button
C. Uncuffed tracheostomy tube
D. Fenestrated tracheostomy tube
D
The respiratory therapist is checking a jet nebulizer with an entrainment setting of 35%. The oxygen analyzer reads 45%. Which of the following best explains this finding?
A. Water in the tubing
B. Inadequate flow through the jet
C. Obstructed jet orifice
D. Oxygen analyzer need calibration
A
A disposable ventilator circuit was used for a patient who requires ventilatory support for pulmonary tuberculosis. How should the respiratory therapist handle the circuit after use?
A. Double bag it plastic
B. Dispose of it with regular waste
C. Place it in a biohazard waste bag
D. Wipe it with isopropyl alcohol and incinerate
C
A patient who was recently extubated is receiving a bronchodilator by metered dose inhaler (MDI). He develops inspiratory stridor. How should the respiratory therapist modify the aerosol delivery system to deliver racemic epinephrine to this patient?
A. Add a spacer to the MDI
B. Switch to an ultrasonic nebulizer
C. Change to a small volume nebulizer
D. Use a small particle aerosol generator (SPAG)
