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Science/ Medicine/ Pulmonology A patient with ARDS is recciving mechanical ventilatory support. An end-tidal CO2 monitor shows a PetCO2 of 59 torr. The therapist should A, increase minute ventilation LB. obtain an arterial blood gas C. recalibrate the capnography D. continue current therapy and ventilator settings — The correct answer is fA Which of following parameters indicale a patient is ready lo wean? A, A-abDO2 af 410 mm Ilg B. PEEP of 10 cm [120 C. pulmonary shunt af 16% D, MIP of —18 cm 1120 — The correct answer is ie Which of the following data is needed to calculate minute alveolar ventilation? A. IBW, VD/VT 3, PECO2, VT C. RR, VT, weight in Ibs >. RSBI, VD/VT — The correct answer is i A respiratory therapist notes a pressure-volume loop on a patient recciving mechanical ventilation has a pronounced beak. What strategy is uscful in this case? A. increasing PEEP B. decreasing Lidal valume C. decreasing flow D, increasing flow — The correct answer is A] The respiratory therapist is making a plan of care for a palient with mycoplasma pneumonia who needs assistance with airway clearance of scerctions. In which order should therapy be performed? A. percussion, postural drainage, bronchodilator, coach coughing B. bronchodilator, percussion, postural drainage, coach coughing C. coach coughing, bronchodilator, percussion, postural drainage D. postural drainage, percussion, bronchodilator, coach coughing — The correct answer is = Which of the following is an appropriate strategy when caring for a paticnt with ARDS who is receiving mechanical ventilation? A. strive for C.I. valucs less than 2.0 L/min/m2 B. keep the patient in reverse trendelenburg position C. keep PEEP as high as possible D. keep F102 at 60% or below if possible — The correct answer is 0] Which of the following is an important strategy when caring for a patient with adult respiratory distress syndrome? A. ventilate in Control mode with paralytics An adult paticnt with asthma is recciving Xopenex by small volume nebulizer TID. at a dosage of 1.25 mg. The patient complains of dizziness, tingling in his fingers, and anxiely with each treatment. The therapist should A. switch to Pulmicort 0.5 mg B. decrease frequency lo BID C. increase dose to 1.88 mg D, change dose to 0.63 mg — The correct answer is po} A decreasing A—aD0O2 is most closely related ta which of the following? A. Increased pulmonary shunting B. increasing venous admixture C. decreasing atclectasis D. refractory hypoxemia — The correct answer is na Which of the following would be most helpful in determining if a patient regularly smokes tobacco products? A, COHb B. DLCO C. end-tidal carbon dioxide D. pulse oximetery — The correct answer is iA A 75-kg (165-Ib) male is recciving mechanical ventilation by a volumce— controlled ventilator in the assisl/control mode on the following settings: Mandatory rate 12/min VT 500 ml. 1102 0.6 PEEP 8 em H20 Artcrial bload gas results: pH 7.30 PaCO2 52 mm Hg PO2 65 mm Hg HCO3— 27 miia/L. BE +3 mlig/L. Which of the following represents the most appropriate action? A, increase FIO2 to 1.0 B, increase rate lo 14 C. increase PEEP to 10 cmI120 D, increase tidal volume io 600 mI. — The correct answer is A] A pulmonary rchabilitation patient is having difficulty complying with a smoking cessation program. A physical and psychological screen reveals a heavy physiological dependence and a low psychological dependence on smoking. Which of the following is appropriate? A. Vorsed B. nicotine replacement therapy C. psychological counscling D, Valium — The correct answer is BB A COPD patient is receiving oxygen at 2 I./min by a pulsc—dose oxygen delivery device. The patient complains of shortness of breath and feels she is nal getting enough oxygen. The home care respiratory therapist should A, switch to a Venturi mask at 40% D. hospital administrators — The correct answer is iA A respiratory therapist notices the cuff pressure on an cndotrachcal tube is 10 em H20, After introducing 10.0 mL of air, the cuff pressure is 5 em H2Q. The palient is receiving positive pressure ventilation. The therapist should recommend A, monitoring Lhe patient B. replacing the ET tube C. clamping the pilot tube D. initiating high frequency jet ventilation — The correct answer is BB A patient is in the intensive care unil following the repair of a hip fracture. Within 2 hours after surgery, the paticnt is hypotensive and is increasingly short of breath. Heart rate has risen from 90 to 110 bpm. Which of the following test results would be most helpful at this Lime? A, Arterial blood gases B. Ub and [ICT C, Creatinine D, COIIb — The correct answer is A] A patient is in the emergency room (ER) with paradoxical chest movement on the right side. The trachea is deviated from mid—line. Which of the following should the respiratory therapist suspect? A. pleural effusion B. pulmonary embolism C, fractured ribs and a pneumothorax D. pulmonary cdema — The correct answer is na A patient with a history of hyper—rcactive airway discasce is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recammend? A. Spiriva (Liotropium bromide) B. Acetylcysteine (mucomyst) C. Solu-Mederal D, Beclamethasone (Beclovenl) — The correct answer is A A physician suspects a palient has a canceraus mass in the right lobe as identified by a PA chest radiography. Which of the following should the therapist recommend to examine the nature and size of the mass? A. scrics of oblique chest radiographs B. A-P chest radiograph C. V/Q scan D. pulmonary angiography — The correct answer is A A patient recciving volume—controlled ventilation weighs 75 kg (165 Ib) andis 5 ft, 7 in (170 cm) tall and within ideal body weight. The following clinical data is available: Made SIMV Mandatory rate 12 Total rate 32 TFIO2 0.40 VT 500 mL [xhaled minute volume 9.6 L pH 7.44 C, inerease the total flow of gas mixture to the mask D. switch to a Venturi mask sect at the highest possible F102 setting — The correct answer is ba A physician has ordered the administration of 80% / 20% hcliox therapy to a spontancously breathing paticnt. Which of the following gas delivery devices should the respiratory therapist plan on using? A, air—centrainment mask B. simple mask C. nasal cannula D. nonrebreathing mask — The correct answer is 0] A patient in the intensive care unit has an artcrial catheter in place. The respiratory therapist naticcs that the blood pressure from the arterial linc was 95/70 mmHg. Blood pressure taken by a sphygmomanomctecr reads 110/78 mmHg. The patient is asymptomatic. The therapist should A. record the arterial linc bload pressure B. record the sphygmomanometer blood pressure C, discard the blood pressure cuff D. calibrate the blood pressure cuff — The correct answer is At Refractory hypoxcmia is associated with which of the following discascs? A, Pleural effusion B. Rocky Mountain Spotted Fever C. ARDS D. Chronic bronchitis — The correct answer is i A physician suspects a paticnt has a restrictive pulmonary defect. Which of the following tests would be mast helpful in determining this? A. Fevl.0 LB. Slow vital capacity C. Forced vital capacity D. Fev1.0/FVC% — The correct answer is A] A patient with cystic fibrosis complains of shortness of breath during postural drainage and percussion treatment after the head of the bed is down for 10 minutes. A bronchogram has revealed consolidation of secretions in the lateral basal segment of the left lower lobc. Which way should the respiratory therapist modify the therapy? A, Use a pneumatic precursor B, Reduce the time in Trendelenburg position C. Switch ta IPPB therapy D. Utilize reverse Trendelenburg position — The correcl answer is = While administering an acrosolized bronchodilator with IPPB, the therapist notices that Lhe pressure manometer has a significant negalive deflection with each breath. The patient appears ta be showing signs of fatiguc. The respiratory therapist should A, increase sensitivity 3. decrease pressure C, increase inspiratory flow rate D, increase pressure — The correct answer is Mm The respiratory therapist working in a clinic reccives a call from a paticnt who has asthma and is only able to achicve 60% of their normal bascline peak flaw measurement. The therapist shauld advise the patient to A, check flows again in one hour, call if less than 50%af expected B, take a rescue medication every 15 minutes for 2 hours, recheck flaws C. call the doctor immediately D, take a rescue medication, check flows in one hour — The correct answer is Eo] A 32-year-old 81-kg (178—lb) adult male is receiving mechanical ventilalory support. Settings are as follows: Mode Assist/control Mandatory rate 10 Total rate 18 Tidal volume 450 mi. VIO2 0.6 PEEP 5 cm H20 The patient is cyanotic and anxious. Which of the following will the respiratory therapist recommend? A. increase FIOZ B, decrease mandatory rate C, increase lidal volume 1D, increase inspiratory flow rate — The correct answer is ie A patient who is receiving volume—controlled ventilation has the following arterial blood gas and clinical data: Mode Assist/control Rate 14/min FIO2 0.50 (analyzed) VT 500 mL Artcrial blood gas analysis was donc at standard temperature and pressure (STP). Pressure (1120) is 47 em 1120 pil 7.40 PaCO2 41 torr PaOZ 358 torr HCO3— 25 mEq/I. BE +1 mEg/I. Which of the following can the respiratory therapist conclude? A. The PaQ2 result is errorancous LB. There is a fault in the Sanz electrode C, There is increased permeability in the alycolar capillary membranc D. The patient has a significant shunt — The correct answer is fA A patient recciving volume—controlled ventilation has a balloon—tipped pulmonary artery catheter in place. The respiratory therapist notices the PA waveform is ascending and descending with inflection points at 25 and 2 mmHg, Based on this information, Lhe therapist should recommend A, deflaling the catheter balloon B. monitoring the palient closely C, advancing the catheter D. rotating the catheter — The correct answer is na B. evaluate color of sputum C. ABG D. temperature — The correct answer is PE ) A COPD patient is in the emergency room, A quick assessment reveals a respiratory rate of 28, spontancous tidal volume of 200 ml, use of accessory muscles, and venous distension. The patient is receiving oxygen by nasal cannula al 2 L/min and oxygen saturation by pulse oximetry is 88%. Which of the following would provide most help to the patient at this time? A, flutter valve therapy B. non-rebreathing mask C. NIPPV D. adult mechanical ventilation — The correct answer is Ea A patient recciving mechanical ventilator support is on the following scttings and has the following clinical data: Made SIMV Mandatory rate 14 VT 500 mL, 1102 0.65 PEEP 20 em H20 Artcrial blood gas results DH 7.38 PaCO2 43 torr PaO2 68 torr HCO3— 26 miia/L. BE +2 miig/L. Which of the following should the respiratory therapist recommend? A, increase FIO2 to 1.0 B. increase PEEP to 22 cm H20 C. increase FIO2 to 0.8 D. decrease PEEP to 18 cm H20, increase F102 to 1.0 — The correct answer is : The respiratory therapist notices the PtcO2 valuc on a transcutancous monitor has suddenly jumped within the last minute. The therapist should suspect a problem with A. Devclopment of skin burns LB. Adherence of the electrode to the skin C. Overheating of the clectrode D. Insufficient heating of the clectrode — The correct answer is iB The following pulmonary function data are obtained from a 65-ycar—old adult male who is 5 ft 2 in (157 cm) tall and weighs 120 Ibs (55 kg). Percent (%) of Predicted SVC 75 FVC 72 FEV1.0 39 FEF25—-75 52 FEEF200—1200 76 DLCO 89 Which of the following most accuratcly represents the patient's condition? C. helium/oxygen mixture 70%/30% D. increase oxygen to 4 1./min — The correct answer is Aa A chest x-ray radiology report indicates that the radio—opaquc line's end on an oral endotracheal tube rests 1 cm above the carina. The respiratory therapist should suggest A. advance the ET tube 2 cm B. withdraw the ET tube 2 cm C. advance the ET tube 1 cm D. withdraw the IT tube 5 cm — The correct answer is At To assist in preventing ventilator—acquircd pneumonia (VAP), you should: A. Use the minimal leak technique to inflate the tracheal tube cuff B. Change the ventilator circuit and humidifier every 48 hours C. Maintain the paticnt in the prone position whenever passible D. Implement daily sedation vacations or SBT's — The correct answer is 0] Which of the following devices would be uscd to obtain a PCWP measurement? A, pulmonary artery catheter B. indwelling arterial catheter C. double lumen catheter D. central venous catheter — The correct answer is A A patient with adult respiratory distress syndrome is recciving mechanical ventilation with a pressurc—cycled ventilator. Which of the following alarms is most important? A. I:If ratio alarm B. low pressure alarm C. high pressure alarm D. low-volume alarm — The correct answer is 0] A pulmonary function study reveals a forced vital capacity (IVC) that is greater than a slow vilal capacity (SVC). To which of the following can this be attributed? A. chronic air—trapping B, partial diaphragmatic paralysis C. poor patient effort on the SVC maneuver D, excessive effort on the FVC maneuver — The correct answer is Eo] An infant born 24 hours prior is experiencing frequent periods of apnea lasting more than 60 seconds. Which of the following medications would help stimulate the infant's respiratory drive? A, Fluticasone B. hormone C. Aminophylline D. Exosurf — The correct answer is Aa Whilc transporting a paticnt from a helicopter landing pad to the emergency department (ED), the respiratory therapist notices the ET tube has become unsecured. To best confirm to lacalion of the ET tube, the therapist should recommend A, auscultate breath sounds LB. observe chest rise 
