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259 Cards in this Set
- Front
- Back
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1. Which of the following is NOT a purpose of the interview? |
to identify plans for payment
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2. What term is used to describe difficult breathing in the reclining position?
a. Orthopnea b. Platypnea c. Eupnea d. Apnea |
orthopnea
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3. What term is used to describe sputum that has pus in it?
a. Fetid b. Mucoid c. Purulent d. Tenacious |
purulent
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4. Which of the following terms is used to describe coughing up blood streaked sputum?
a. Hematemesis b. Hemoptysis c. Hemolysis d. Hematoectasis |
hemoptysis
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5. All of the following are critical elements of a patient’s past medical history except:
a. Childhood diseases b. Prior major illnesses or surgery c. Maritial status d. Drugs and immunizations |
marital status
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6. Which of the following is associated with tripodding?
a. Severe pulmonary hyperinflation b. Congestive heart disease c. Pneumonia d. Pulmonary fibrosis |
severe pulmonary hyperinflation
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7. Your patient has an abnormal sensorium. Which of the following is most likely true?
a. He knows his name b. He is confused about where he is c. He is aware of the correct day d. He knows the name of the hospital he has been taken to |
he is confused about where he is
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8. Which of the following is a common cause of pulsus paradoxus?
a. Acute asthma attack b. Severe pneumonia c. Congestive heart failure d. Myocardial infarction |
acute asthma attack
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9. Which of the following is NOT a common cause of tachypnea?
a. Hypoxemia b. Exercise c. Narcotic overdose d. Metabolic acidosis |
narcotic overdose
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10. What artery is most often used to assess arterial blood pressure?
a. Femoral b. Radial c. Ulnar d. Brachial |
brachial
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11. What is the advantage of COPD patients breathing through pursed lips during exhalation?
a. Helps the patient focus on their breathing b. Promotes more complete emptying of the lungs c. Reduces the patient’s anxiety level d. Improves arterial pH levels |
promotes more complete emptying of the lungs
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12. What is the most common cause of jugular venous distention (JVD)?
a. Right sided heart failure b. Arterial hypoxemia c. Tension pneumothorax d. Acute systemic hypertension |
right sided heart failure
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13. What disease is associated with a barrel chest?
a. Emphysema b. Heart failure c. Pneumonia d. Pleural effusion |
emphysema
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14. While observing a patient’s breathing, you not that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?
a. Apneustic breathing b. Cheyne stokes breathing c. Biot’s breathing d. Paradoxical breathing |
Cheyne Strokes breathing
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15. A patient with asthma would tend to exhibit which of the following?
a. Prolonged inhalation b. Slow and shallow breathing c. Prolonged exhalation d. Deep and fast breathing |
prolonged exhalation
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16. What breathing pattern is associated with diabetic ketoacidosis?
a. Kussmaul breathing b. Apneustic breathing c. Biot’s breathing d. Apnea |
Kussmaul breathing
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17. What is indicated by the breathing pattern known as abdominal paradox?
a. Obstructive lung disease b. Restrictive lung disease c. Heart failure d. Diaphragm fatigue |
diaphragm fatigue
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18. On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is the most likely cause of this observation?
a. Subcutaneous emphysema b. Upper bronchial obstruction c. Pneumonia of the upper lobes d. Atelectasis of the upper lobes |
subcutaneous emphysema
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19. While percussing a patient’s chest wall, you detect an abnormal increase in resonance. Which of the following are possible causes of this finding?
I. Asthma II. Pneumothorax III. Emphysema IV. pneumonia |
I, II, and III
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20. during auscultation of a patient’s chest, you hear abnormal discontinuous “bubbling” sounds at the lung bases. Which of the following chart entries best describes this finding?
a. “bronchial sounds heard at lung bases” b. “wheezes heard at lung bases” c. “crackles heart at lung bases” d. “rhonchi heard at lung bases” |
"Crackles heard at lung bases"
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21. What does the presence of stridor indicate?
a. Lower airway obstruction b. Increased secretions in the large airways c. Upper airway obstruction d. Bronchial spasm |
upper airway obstruciton
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22. During auscultation of a patient’s chest, you hear coarse crackles throughout both inspiration and expiration. These sounds clear when the patient coughs. Which of the following is the most likely cause of these adventitious sounds?
a. Opening of closed smaller airways or alveoli b. Opening of collapsed large, proximal airways c. Variable obstruction to flow in the upper airway d. Movement of excessive secretions in the airways |
movement of excessive secretions in the airways
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23. Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified?
a. Third right intercostals space, left sterna border b. Fifth left intercostals space, midclavicular line c. Third left intercostals space, anterior axillary line d. Fifth right intercostals space, midclavicular line |
fifth left intercostal space, midclavicular line
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24. Normal heart sounds are created primarily by which of the following?
a. Opening of the heart valves b. Rush of blood during systole c. Closing of the heart valves d. Electrical conduction in the heart |
closing of the heart valves
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25. In patients with chronic respiratory disease, what does pedal edema indicate?
a. Right ventricular failure b. Impaired pulmonary diffusion c. Systemic hypertension d. Left ventricular hypertrophy |
right ventricular failure
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26. Which of the following phases constitute the course of drug action from dose to effect?
I. Drug administration II. Pharmacognosy III. Pharmacokinetic IV. pharmacodynamic |
I, III, and IV
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27. Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
I. Dry powder inhaler II. Metered dose inhaler III. Small volume nebulizer IV. Slip stream nebulizer |
I, II, and III
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28. Which of the following is the usual neurotransmitter in the sympathetic system?
a. Atropine b. Acetylcholine c. Norepinephrine d. Dopamine |
norepinephrine
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29. Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?
a. Inhaled corticosteroids b. Adrenergic bronchodilators c. Mucus controlling agents d. Anticholinergic bronchodilators |
adrenergic bronchodilators
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30. Proventil and Ventolin are brand names for which of the following β-adrenergic bronchodilators?
a. Albuterol b. Isoetharine c. Terbutaline d. Metaproterenol |
albuterol
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31. Short acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?
a. Anti-inflammatory b. Rescue c. Controller d. Mucolytic |
rescue
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32. Which of the following is NOT a side effect of newer, more β2 selective bronchodilators?
a. Tremor b. Insomnia c. Nervousness d. Bradycardia |
bradycardia
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33. Which of the following are assessment features for evaluating patient response to bronchodilator therapy?
I. Reversibility of airflow obstruction II. changes in flow rates using a peak flowmeter or portable spirometry III. changes in vital signs IV. changes in ventilation and oxygenation V. the patient’s subjective reaction to treatment |
all the above
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34. What are some common side effects seen with ipratropium bromide (Atrovent)?
a. Tachycardia b. Blood pressure increase c. Cough and dry mouth d. Tolerance |
cough and dry mouth
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35. Which of the following are indications for the use of acetylcysteine (Mucomyst)?
I. treatment of acetaminophen overdose II. treatment of excessive, viscous mucus secretions III. treatment of aspirin overdose IV. treatment of purulent mucus secretions by breaking up DNA |
I and II only
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36. Which of the following prophylactic therapies is recommended to reduce the irritant effect of acetylcysteine?
a. Administration of anticholinergics b. Administration of dornase alfa c. Administration of corticosteroids d. Administration of adrenergic bronchodilator |
administration of adrenergic bronchodilator
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37. Which of the following are indications for aerosolized administration of dornase alfa?
I. presence of nonpurulent mucoid secretions II. management of cystic fibrosis III. reduction of the frequency of exacerbations due to respiratory infection IV. management of bronchospasm |
II and III only
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38. Which of the following are TRUE regarding glucocorticoids?
I. they work through activation of intracellular receptors II. relief is immediate III. daily compliance is essential to controlling inflammation in asthma IV. they work in a similar fashion to adrenergic bronchodilators |
I and III
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39. How does cromolyn sodium work?
a. Produce anti-inflammatory enzymes within cells b. Inhibits degranulation of mast cells c. Prevents arachidonic acid formation from activation of mast cell membrane phospholipase A2 d. Provides leuktriene inhibition |
inhibits degranulation of mast cells
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40. Which of the following best defines an aerosol?
a. Suspension of liquid droplets in a gas b. Suspension of particulate matter in a gas c. Molecular water dispersed throughout a carrier gas d. Suspension of liquid or solid particles in a gas |
suspension of liquid or solid paricles in a gas
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41. What measure is used to identify the particle diameter, which corresponds to the most typical settling behavior of an aerosol?
a. Mean mass velocity coefficient (MMVC) b. Logarithmic standard diameter (LSD) c. Mean mass aerodynamic diameter (MMAD) d. Geometric standard deviation (GSD) |
mean mass aerodynamic diameter (MMAD)
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42. What is the primary mechanism for central airway deposition of particles in the 1- to 5 - µm range?
a. Impaction b. Sedimentation c. Diffusion d. Brownian motion |
sedimentation
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43. Which of the following techniques will increase aerosol deposition by sedimentation in the lungs?
a. High inspiratory flow b. Short inspiratory time c. 10 second breath hold d. Short expiratory time |
10 second breath hold
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44. A physician wants to deliver a therapeutic aerosol to the upper airway (nose, larynx, trachea). To help ensure maximum deposition in this area, you would select an aerosol generator with an MMAD in what range?
a. 5 to 50 µm b. 2 to 5 µm c. 1 to 3 µm d. Less than 1 µm |
5 to 50 mm
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45. What is the process by which aerosol suspension changes over time?
a. Evaporation b. Deposition c. Aging d. Sublimation |
aging
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46. All of the following drugs or drug categories have been associated with increased airway resistance and bronchospasm during aerosol administration except:
a. Steroids b. Albuterol c. Acetylcysteine d. Antibiotics |
albuterol
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47. When fired inside the mouth, what percentage of the drug dose delivered by a simple metered dose inhaler (MDI) deposits in the oropharynx?
a. About 20% b. About 40% c. About 60% d. About 80% |
about 80%
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48. Proper use of dry power inhaler (DPI) requires that the patient be able to do which of the following?
a. Generate inspiratory flows of 60L/min or higher b. Exhale forcibly through the device before drug delivery c. Inhale slowly (less than 0.5L/sec) and perform a breath hold d. Coordinate firing of the DPI with inspiration |
genrate inspiratory flows of 60 L/min or higher
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49. What happens as the pressure or flow delivered through a small volume jet nebulizer gets higher?
I. treatment time becomes shorter II. particle size becomes smaller III. aerosol output becomes greater |
I, II, and III
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50. A patient with an acute exacerbation of asthma is not responding to the standard dose and frequency of an aerosolized bronchodilator and is now receiving small volume jet nebulizer (SVN) therapy every 30 minutes. Which of the following would you recommend to the patient’s physician at this time?
a. Discontinue the aerosolized bronchodilator b. Increase the frequency of SVN therapy to every 10 minutes c. Consider continuous nebulization of the drug d. Add more diluents to the SVN to extend treatment time |
consider continuous nebulization of the drug
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51. A physician has ordered the antiviral agent ribavirin (Virazole) to be administered by aerosol to an infant with bronchiolitis. Which of the following devices would you recommend in this situation?
a. Hydrodynamic (Babbington) nebulizer b. Small particle aerosol generator (SPAG) c. Ultrasonic (piezoelectric) nebulizer d. Large volume heated jet nebulizer |
small particle aerosol genrator (SPAG)
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52. A normal cough reflex includes which of the following phases?
I. irritation II. Inspiration III. compression IV. expulsion |
all the above
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53. Which of the following can provoke a cough?
I. anesthesia II. foreign bodies III. infection IV. irritating gases |
II, III, and IV
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54. Partial airway obstruction can result in all of the following except:
a. Increased work of breathing b. Air trapping or overdistention c. Increased expiratory flows d. Ventilation/perfusion ratio (V/Q) imbalances |
increased expiratory flows
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55. A patient with a tracheostomy tube is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
a. Irritation b. Inspiration c. Compression d. Expulsion |
compression
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56. All of the following can impair mucociliary clearance in intubated patients except:
a. Use of respiratory stimulants b. Tracheobronchial suctioning c. Inadequate humidification d. High inspired oxygen concentrations |
use of respiratory stimulants
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57. All of the following conditions impair secretion clearance by affecting the cough reflex except:
a. Muscular dystrophy b. Amyotrophic lateral sclerosis c. Chronic bronchitis d. Cerebral palsy |
chronci bronchitis
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58. All of the following are goals of bronchial hygiene therapy except:
a. Reverse the underlying disease process b. Help mobilize retained secretion c. Improve pulmonary gas exchange d. Reduce the work of breathing |
reverse the underlying disease process
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59. In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?
a. 30 ml/day b. 20 ml/day c. 15 ml/day d. 10 ml/day |
30ml/day
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60. Which of the following clinical signs indicate that a patient is having a problem with retained secretions?
I. lack of sputum production II. Labored breathing III. development of a fever IV. increased inspiratory and expiratory crackles |
all the above
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61. The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
a. Breathing exercises b. Postural drainage therapy c. Hyperinflation therapy d. Directed coughing |
postural drainage therapy
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62. In which of the following patients would you consider modifying any head down positions used for postural drainage?
I. a patient with unstable blood pressure II. a patient with a cerebrovascular disorder III. a patient with systemic hypertension IV. a patient with orthopnea |
all the above
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63. If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
a. Head down, patient supine with a pillow under the knees b. Patient prone with a pillow under head, bed flat c. Patient supine with a pillow under knees, bed flat d. Head down, patient prone with a pillow under abdomen |
head down, patient prone with a pillow under abdomen
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64. If tolerated, a specified postural drainage position should be maintained for at least how long?
a. 1 to 2 minutes b. 3 to 5 minutes c. 20 to 30 minutes d. 3 to 15 minutes |
3 to 15 minutes
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65. During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?
a. Put the patient in a sitting position and have him or her cough strenuously b. Place the patient in a head down position and call the nurse c. Immediately perform nasotracheal suctioning of the patient d. Stop therapy, sit the patient up, give O2, and contact the physician |
stop therapy, sit the patient up, give O2, and contact physician
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66. Which of the following should be charted after completing a postural drainage treatment?
I. amount and consistency of sputum produced II. patient tolerance of procedure III. position(s) used (including time) IV. any untoward effects observed |
all the above
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67. Percussion should NOT be performed over which of the following areas?
I. surgery sites II. bony prominences III. fractured ribs |
all the above
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68. What factors can hinder effective coughing?
I. artificial airways II. neuromuscular disease III. systemic dehydration IV. pain or fear of pain V. use of expectorants |
all the above
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69. You are asked to administer 1 ml of 1% solution of Racemic epinephrine to a pt.. How many mgs of drug is this?
a. 1 mg b. 10mg c. 100mg d. 1000mg |
10 mg
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70. How many mls of H2O are needed to dilute 10ml of a 20% solution of Mucomyst to a 5% concentration?
a. 40 b. 60 c. 50 d. 20 |
40
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71. The physician order reads “Administer 75mg Decadron via HHN”. How many mls of a 2.5% solution should you use?
a. 2.2 b. 0.5 c. 3 d. 1.5 |
3
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72. The usual dosage of Albuterol sulfate is 0.5 ml of a 0.5% strength solution. How many mgs is this?
a. 5.0 b. 2.5 c. 1.25 d. 0.50 |
2.5
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73. Which of the following is false about invasive versus noninvasive monitoring?
a. Invasive procedures require insertion of a device into the body b. Laboratory analysis of gas exchange is usually noninvasive in nature c. Physiologic monitoring can be either invasive or noninvasive d. Invasive procedures provide more accurate data but carry greater risks |
Laboratory analysis of gas exchange is usually nonivasive in nature
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74. All of the following sites are used for arterial blood sampling by percutaneous needle puncture except:
a. Femoral b. Radial c. Brachial d. Carotid |
carotid
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75. Why is the radial artery the preferred site for arterial blood sampling?
I. it is near the surface and easy to palpate and stabilize II. the ulnar artery normally provides good collateral circulation III. the radial artery is not near any large veins |
all the above
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76. Precautions and/or possible complications of arterial puncture include which of the following?
I. arteriospasm II. emboliztion III. infection IV. hemorrhage |
all the above
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77. Patient parameters that should be assessed as part of arterial blood sampling include all of the following except:
a. Blood pressure b. Temperature c. Position or activity level d. Clinical appearance |
blood pressure
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78. Which of the following Centers of Disease Control and Prevention (CD) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture?
I. gloves II. protective eyewear III. gown or apron |
I and II
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79. What size needle would you recommend to obtain an ABG sample through percutaneous puncture of an infant?
a. 18 gauge b. 20 gauge c. 22 gauge d. 25 gauge |
25 gauge
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80. What chart information should be checked before performing artery puncture?
I. patient’s primary diagnosis and history II. presence of bleeding disorders or blood borne infections III. anticoagulant or thrombolytic drug prescriptions IV. respiratory care orders (e.g O2 therapy) |
all the above
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81. How long should you wait before drawing an ABG on a chronic obstructive pulmonary disease (COPD) patient whose FiO2 has just been changed?
a. 5 to 10 minutes b. 10 to 15 minutes c. 15 to 50 minutes d. 20 to 30 minutes |
20 to 30 minutes
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82. When performing a modified Allen test on the left hand of a patient, you notice that the palm, fingers, and thumb remain blanched for more than 15 seconds after pressure on the ulnar artery is released. What should you do?
a. Use the brachial site for sampling b. Sample from the contralateral radial artery c. Use the femoral site for sampling d. Perform the Allen test on the right hand |
perform the Allen test on the right hand
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83. If patient pain or anxiety occurs during arterial puncture, which of the following will probably occur?
a. Hypoventilation b. Hyperventilation c. Respiratory acidosis d. Hypoxemia |
hyperventilation
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84. Which of the following changes would occur if an arterial blood sample of a patient breathing room air were exposed to a large air bubble?
I. decreased PCO2 II. decreased pH III. increased PO2 |
I and III
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85. All of the following must be charted after obtaining an ABG sample through the brachial artery except:
a. Patient’s temperature, position, activity level b. Date, time and site of sampling c. Inspired O2 concentration or ventilator settings d. Results of the modified Allen test |
results of the modified Allen test
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86. A PaO2 below what value would be considered severe hypoxemia?
a. 60 mm Hg b. 50 mm Hg c. 40 mm Hg d. Depends on the FiO2 |
40 mm Hg
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87. A blood gas analyzer measures all of the following except:
a. HCO3 b. PCO2 c. PO2 d. pH |
HCO3
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88. oximetry is the measurement of blood hemoglobin saturations using what technique?
a. Electrochemical dissociation b. Photoplethysmograhy c. Photochemical reactions d. Spectrophotometry |
spectrophotometry
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89. Which of the following can cause false high readings when using a pulse oximeter?
a. Fetal hemoglobin b. Intravascular dyes c. Carboxyhemoglobin d. Presence of metHb |
carboxyhemoglobin
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90. What is the measurement of CO2 in respiratory gases called?
a. Oximetry b. Capnometry c. Optometry d. Barometry |
capnometry
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91. At the very beginning of exhalation, the PETCO2 normally should be at what level?
a. 0 mm Hg b. 15 mm Hg c. 25 mm Hg d. 40 mm Hg |
0 mm Hg
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92. During a single breath capnogram, what does the occurrence of a plateau indicate?
a. Exhalation of mainly dead space gase b. Inspiration of fresh respiratory gas c. Exhalation of mixed alveolar and dead space gas d. Exhalation of mainly alveolar gas |
exhalation of mainly alveolar gas
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93. How often should patients be suctioned?
a. At least once every 2 to 3 hours b. Whenever they are moved or amulated c. When physical findings support the need d. Whenever the charge nurse requests it |
when physical findings support the need
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94. You are about to suction a female patient who has and 8 mm (internal diameter) endrotracheal tube in place. What is the maximum size of catheter you would use in this case?
a. 8 Fr b. 10 Fr c. 12Fr d. 14 Fr |
14 Fr
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95. To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?
a. Manually ventilate the patient with a resuscitator b. Preoxygenate the patient with 100% oxygen c. Give the patient a bronchodilator treatment d. Have the patient hyperventilate for 2 minutes |
preoxygenate the patient with 100% oxygen
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96. Total application time for endotracheal suction in adults should not exceed which of the following?
a. 20 to 25 seconds b. 15 to 20 seconds c. 10 to 15 seconds d. 3 to 5 seconds |
10 to 15 seconds
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97. After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
a. Perform a tracheostomy for better access to the lower airway b. Discontinue nasotracheal suctioning for 48 hours and reassess c. Stop the bleeding and use a nasopharyngeal airway to access d. Orally intubate the patient for better access to the lower airway |
stop the bleeding and use a nasopharyngeal airway for access
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98. Which of the following conditions require emergency tracheal intubation?
I. upper airway or laryngeal edema II. loss of protective reflexes III. cardiopulmonary arrest IV. traumatic upper airway obstruction |
all the above
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99. All of the following indicate an inability to adequately protect the airway except:
a. Wheezing b. Coma c. Lack of gag reflex d. Inability to cough |
wheezing
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100. What is the standard size for endotracheal or tracheostomy tube adapters?
a. 22 mm external diameter b. 15 mm external diameter c. 15 mm internal diameter d. 22 mm internal diameter |
15 mm external diameter
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101. What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?
a. Protect the airway against aspiration b. Help ascertain proper tube position c. Minimize mucosal trauma during insertion d. Ensure gas flow if the main port is blocked |
ensure gas flow if the main port is blocked
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102. What is the purpose of a cuff on an artificial tracheal airway?
a. Seal off and protect the lower airway b. Stabilize the tube and prevent its movement c. Provide a means to determine tube position via radiograph d. Help clinicians determine the depth of tube insertion |
seal off and protect the lower airway
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103. What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
a. Help ascertain proper tube position b. Minimize mucosal trauma during insertion c. Monitor cuff status and pressure d. Protect the airway against aspiration |
monitor cuff status and pressure
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104. Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
I. length markings on the curved body of the tube II. imbedded radiopaque indicator near the tube tip III. additional side port (Murphy eye) near the tube tip |
I and II
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105. What is the purpose of a tracheostomy tube obturator?
a. Minimize trauma to the tracheal mucosal during insertion b. Provide a patent airway should the tube become obstructed c. Help ascertain the proper tube position by radiograph d. Provide a means to inflate and deflate the tube cuff |
minimize trauma to the tracheal mucosal during insertion
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106. In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?
a. Surgical tracheotomy b. Orotracheal intubation c. Nasotracheal intubation d. Cricothyrotomy |
orotracheal intubation
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107. Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
a. Laryngoscope light source b. Endotracheal tube cuff c. Suction equipment d. Cardiac defibrillator |
I, II and III
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108. What is the purpose of an endotracheal tube stylet?
a. Helps ascertain proper tube position b. Adds rigidity and shape to ease insertion c. Minimizes mucosal trauma during insertion d. Protects the airway against aspiration |
adds rigidity and shape to ease insertion
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109. What should be the maximum time devoted to any intubation attempt?
a. 30 seconds b. 60 seconds c. 90 seconds d. 2 minutes |
30 seconds
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110. Which of the following statements are FALSE about methods used to displace the epiglottis during oral intubation?
a. Regardless of the blade used, the laryngoscope is lifted up and forward b. The curved (MacIntosh) blade lifts the epiglottis indirectly c. The straight (Miller) blade lifts the epiglottis directly d. Levering the laryngoscope against the teeth can aid displacement |
Levering the laryngoscope against the teeth and aid displacement
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111. Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned about how far above the carina?
a. 1 to 3 cm b. 4 to 6 cm c. 7 to 9 cm d. 4 to 6 inches |
4 to 6 cm
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112. When using a bulb type esophageal detection device (EDD) during an intubation attempt, how do you know that the endotracheal tube is in the esophagus?
a. The bulb fails to reexpand upon release b. The bulb quickly reexpands upon release c. The bulb cannot be completely squeezed closed d. The bulb cannot be attached to the endotracheal tube |
the bulb fails to reexpand upon release
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113. When using capnometry or colorimetry to differentiate esophageal from tracheal placement of an endotracheal tube, which of the following conditions can result in a false negative finding (i.e, no CO2 present even when the tube is in the trachea)?
a. Cardiac arrest b. Gastric CO2 diffusion c. Right mainstem intubation d. Delivery of a high FiO2 |
caridac arrest
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114. What is the primary indication for tracheostomy?
a. When a patient loses pharyngeal or laryngeal reflexes b. When a patient has a long term need for an artificial airway c. When a patient has been orally intubated for more than 24 hours d. When a patient has upper airway obstruction due to secretions |
when a patient has a long term need for an artificial airway
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115. Soon after endotracheal tube extubation, an adult patient exhibits a high pitched inspiratory noise, heard without a stethoscope. Which of the following actions would you recommend?
a. STAT heated aerosol treatment with saline b. STAT recemic epinephrine aerosol treatment c. Careful observation of the patient for 6 hours d. Immediate reintubation via the nasal route |
STAT racemic epinephrine aerosol treatment
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116. Which of the following is false about cuff inflation techniques (MOV = minimal occluding volume; MLT = minimal leak technique)?
a. The MLT approach negates the need for pressure monitoring b. The MLT allows a small leak at peak or end of inspiration c. At MOV, air leakage around the tube cuff should cease d. With MLT, secretions tend to be blown upward during inflation |
The MLT approach negates the need for pressure monitoring
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117. Which of the following equipment would you gather before assisting in extubation of a patient?
I. suctioning apparatus II. Oxygen or aerosol therapy equipment III. manual resuscitator and mask IV. nebulizer with racemic epinephrine V. intubation tray |
all the above
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118. Key points to consider in planning fiberoptic bronchoscopy include which of the following
I. equipment preparation II. premedication III. airway preparation IV. monitoring |
all the above
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119. What is the point in the respiratory track where inspired gas reaches body temperature, ambient pressure, saturated (BTPS) conditions?
a. Point of thermal equilibrium b. Hygroscopic saturation boundary c. Thermal inversion boundary d. Isothermic saturation boundary |
isothermic saturation boundary
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120. What is the primary goal of humidity therapy?
a. Decrease airway reactivity to cold b. Maintain normal physiologic conditions c. Deliver drugs to the airway d. Reduce upper airway inflammation |
maintain normal physiologicla conditions
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121. Which of the following inspired conditions should be maintained when delivering medical gases directly into the trachea through an endotracheal tube or a tracheostomy tube?
a. 50% relative humidity (RH) at 20 to 22 C b. 100% RH at 37 to 42 C c. 95% RH at 29 to 32 C d. 100% RH at 32 to 35 C |
100% RH at 32 to 35C
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122. What device adds molecular water to gas?
a. Agitator b. Humidifier c. Nebulizer d. atomizer |
humidifier
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123. the greater the temperature of the gas, the:
a. more water vapor it can hold b. less water vapor it can hold c. less efficient the humidifier is d. more water vapor is lost |
more water vapor it can hold
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124. what are some types of Passover humidifiers?
I. simple reservoir II. membrane III. wick |
all the above
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125. which type of humidifier “traps” the patient’s body heat and expired water vapor to raise the humidity of inspired gas?
a. Membrane b. Bubble c. Heat moisture exchanger d. passover |
heat moisture exchanger
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126. an ideal heat moisture exchanger (HME) should have an efficiency rating of at least which of the following?
a. 30% b. 50% c. 70% d. 90% |
70%
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127. A patient has been supported by a mechanical ventilator using a heat moisture exchanger for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions is indicated?
a. Increase the hygroscopic condenser humidifier temperature b. Reassess the patient’s secretions over the next 24 to 48 hours c. Replace the hygroscopic condenser humidifier with a new one d. Switch the patient to a large volume heated humidifier |
switch the patient to a large volume heated humidifier
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128. When using water traps to help minimize the problems caused by condensation in a heated humidifier ventilator circuit, where would you place the traps?
a. In the expiratory limb only, at a high point in the circuit b. In both the expiratory and inspiratory limbs, at high points in the circuit c. In the expiratory limb only, at a low point in the circuit d. In both the expiratory and inspiratory limbs, at low points in the circuit |
in both the expiratory and inspiratory limbs, at low points int he circuit
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129. What is the most common device used to generate bland aerosols?
a. Small volume jet nebulizer b. Ultrasonic nebulizer c. Large volume jet nebulizer d. Spinning disk nebulizer |
large volume jet nebulizer
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130. What is the total water output of unheated large volume jet nebulizers?
a. 10 to 16 mg H20/L b. 16 to 25 mg H20/L c. 26 to 35 mg H20/L d. 33 to 55 mg H20/L |
26 to 35 mg H2O/L
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131. For what should sputum collected be aerosol therapy induction be inspected?
I. color II. volume III. odor IV. consistency |
all the above
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132. In general, to deliver oxygen to the upper airway, a bubble humidifier is required only when the gas flow exceeds which of the following?
a. 1L/min b. 2L/min c. 3L/min d. 4L/min |
4L/min
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133. Which of the following is consistent with the radiographic appearance after prolonged exposure to O2?
a. Air bronchograms b. Pulmonary abscess c. Patchy infiltrates d. pneumothorax |
patchy infiltrates
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134. a patient with chronic hypercapnia placed on an FiO2 of 0.6 starts hypoventilating. What is the probable cause of this phenomenon?
a. Decreased cardiac output b. O2 toxicity c. O2 induced hypoventilation d. Absorption atelectasis |
O2 induced hypoventilation
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135. Retinopathy of prematurity (ROP) is potentially serious management problem mainly in the care of whom?
a. Premature or low birth weight infants b. Cystic fibrosis patients c. Children with asthma d. Patients with acute respiratory distress syndrome (ARDS) |
premature or low birth weight infants
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136. To ensure a stable FiO2 under varying patient demands, what must an O2 delivery system do?
a. Have a reservoir system at least equal to the Vt b. Provide all the gas needed by the patient during inspiration c. Maintain flows that are at least equal to the patient’s peak flows d. Be able to deliver an O2 concentration from 21% to 100% |
provide all the gas needed by the patient during inspiration
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137. A cooperative and alert postoperative patient taking food orally requires a small increment in FiO2 to be provided continuously. Precise FiO2 concentration are not needed. Which of the following devices would be best achieve this end?
a. Simple O2 mask b. Air entrainment mask c. Nasal cannula d. Nonrebreathing mask |
nasal cannula
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138. Which of the following factors will decrease the FiO2 delivered by a low flow O2 system?
I. short inspiratory time II. fast rate of breathing III. lower O2 input IV. large minute ventilation |
all the above
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139. What is the minimum flow setting for a simple mask applied to an adult?
a. 3L/min b. 5L/min c. 8L/min d. 10L/min |
5L/min
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140. You design an air entrainment system that mixes air with O2 at a fixed ratio of 1:7 (1L air to 7L O2). About what O2 will this device provide?
a. 33% b. 40% c. 80% d. 90% |
90%
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141. A 45 year old patient with congestive heart failure is receiving O2 through a 35% air entrainment mask. With an O2 input of 6L/min, what is the total output gas flow?
a. 16 L/min b. 24L/min c. 28L/min d. 34L/min |
28L/min
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142. Physiologic effects of hyperbaric oxygen (HBO) therapy include all of the following except:
a. Neovascularizaiton b. Bubble reduction c. Enhanced immune function d. Systemic vasodilation |
systemic vasodilation
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143. At what level of carbonxyhemoglobin saturation is hyperbaric oxygen (HBO) therapy indicated for an adult patient?
a. Greater than 10% b. Greater than 15% c. Greater than 20% d. Greater than 25% |
greater than 25%
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144. Physiologic effects of inhaled nitric oxide (NO) include all of the following except:
a. Recruitment of collapsed alveoli b. Improved blood flow to ventilated alveoli c. Decreased pulmonary vascular resistance d. Reduced intrapulmonary shunting |
recruitment of collapsed alveoli
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145. Before administering a helium O2 mixture to a patient with large airway obstruction, what should you do?
a. Analyze the helium concentration of the mixture b. Heat the cylinder to ensure complete mixing of contents c. Analyze the O2 concentration of the mixture d. Roll the cylinder to ensure complete mixing of contents |
analyze the O2 concentration of the mixture
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146. How do all modes of lung expansion therapy aid lung expansion?
a. Increasing the transpulmonary pressure gradient b. Decreasing the transthoracic pressure gradient c. Increasing the pressure in the pleural space d. Decreasing the pressure in the alveoli |
increasing the transpulmonary pressure gradient
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147. Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include with of the following?
I. incentive spirometry (IS) II. positive end expiration pressure therapy III. intermittent positive pressure breathing (IPPB) IV. expiratory positive airway pressure (EPAP) |
II, III, and IV
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148. A postoperative patient using incentive spirometry complains of dizziness and numbness around the mouth after therapy sessions. What is the most likely cause of these symptoms?
a. Gastric insufflations b. Hyperventilation c. Pulmonary barotraumas d. Respiratory acidosis |
hyperventilation
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149. Which of the following patient groups should be considered for lung expansion therapy using intermittent positive pressure breathing (IPPB)?
I. patients with clinically diagnosed atelectasis who are not responsive to other therapies II. patients at high risk of atelectasis who cannot cooperate with other methods III. all obese patients who have undergone abdominal surgery |
I and II
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150. When checking a patient’s intermittent positive pressure breathing (IPPB) breathing circuit before use, you notice that the device will not cycle off, even when you occlude the mouthpiece. What would be the most appropriate action in this case?
a. Secure a new IPPB ventilator b. Check the circuit for leaks c. Decrease the flow setting d. Increase the pressure setting |
check the circuit for leaks
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151. Which of the following mechanisms probably contribute to the beneficial effects of continuous positive airway pressure (CPAP) in treating atelectasis?
I. recruitment of collapsed alveoli II. decreased work of breathing III. improved distribution of ventilation IV. increased efficiency of secretion removal |
all the above
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152. During administration of a continuous positive airway pressure flow mask to a patient with atelectasis, you find it difficult to maintain the prescribed airway pressure. Which of the following is the most common explanation?
a. System or mask leaks b. Outflow obstruction c. Inadequate system flow d. Inadequate trigger |
system or mask leaks
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1. Characteristics that influence pulmonary function include all of the following, except:
a. Age b. Gender c. Height d. Diet |
diet
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2. Which of the following methods allows indirect measure of RV and capacities containing it?
I. Helium dilution II. End-tidal CO2 III. Nitrogen washout IV. Body plethysmography |
I, III, IV
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3. Which of the following methods is based on Boyle’s law?
a. Helium dilution b. End tidal CO2 c. Nitrogen washout d. Body plethysmography |
Body plethysmography
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4. Which of the following classifications is associated with increased FRC and RV?
a. Obstructive b. Restrictive c. Mixed d. Idiopathic |
obstructive
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5. Which of the following mechanisms primarily explains the increased WOB in obstructive diseases?
a. Loss of elastance b. Increased airway resistance c. Loss of compliance d. Increased airflow |
increased airway resistance
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6. Which of the following mechanisms primarily explains the increased WOB in restrictive diseases?
a. Loss of elastance b. Increased airway resistance c. Loss of compliance d. Increased airflow |
loss of compliance
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7. Which of the following concepts apply to FVC?
I. It is the most frequently performed pulmonary function test. II. It provides much information about large and small airway function. III. It is an effort-dependent test. IV. A valid test is assumed if the person can repeat three FVC maneuvers with a variation no greater than 10%. |
I, II, III
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8. Which of the following does the MVV asses?
I. Overall integrated function of the ventilatory apparatus. II. Muscle strength III. Endurance IV. Airway diameter, lung compliance, and neural control mechanisms. |
all the above
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9. Which of the following are indications for assessing pulmonary function?
I. Screen for pulmonary disease II. Evaluate patients for surgical risk III. Assess the progression of disease IV. Assist in determining pulmonary disability V. Modify the therapeutic approach to patient care |
all the above
|
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10. Which of the following is typically elevated in restrictive lung disease?
a. Lung compliance b. Lung volumes c. Pressure needed to expand the lung d. Airway’s resistance |
pressure needed to expand the lung
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11. All of the following pulmonary function devices directly collect and measure gas volumes except:
a. Water-sealed spirometer b. Dry rolling-seal spirometer c. Bellows spirometer d. Pneumotachometer |
pneumotachometer
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12. To what does the range or limit of a device’s measuring ability refer?
a. Capacity b. Accuracy c. Error d. Precision |
capacity
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13. How closely a device measures a certain reference value refers to what quality?
a. Capacity b. Accuracy c. Linearity d. Precision |
accuracy
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14. What would you use to determine the accuracy of a water-sealed spirometer in measuring lung volumes?
a. Calibrated high-flow flowmeter b. Computer-generated flow patterns c. Calibrated 3-L syringe d. Standard subject with known volumes |
calibrated 3L syringe
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15. While checking the accuracy of a portable spirometer for volumetric measures with a calibrated super syringe, you obtain a mean measured value of 2.7 L. What is the percent error of this instrument?
a. 1% b. 10% c. 30% d. 90% |
10%
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16. What is the ability of a measuring device to consistently provide the same measure of the same quantity?
a. Capacity b. Accuracy c. Linearity d. Precision |
precision
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17. What is the American Thoracic Society standard for volumetric accuracy of spirometers?
a. +/- 1% error, or within 10 ml of the reference value b. +/- 3% error, or within 50 ml of the reference value c. +/- 5% error, or within 100 ml of the reference value d. +/- 10% error, or within 500 ml of the reference value |
+/- 3% error, or within 50 ml of the reference value
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18. What is the American Thoracic Society standard for accuracy when measuring flows during pulmonary function testing?
a. 90% accuracy or within 0.30 L/sec, whichever is greater b. 95% accuracy or within 0.20 L/sec, whichever is greater c. 97% accuracy or within 0.10 L/sec, whichever is greater d. 99% accuracy or within 0.05 L/sec, whichever is greater |
95% accuracy or within 0.20L/sec, whichever is greater
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19. Tests of pulmonary mechanics include all of the following except:
a. Maximum voluntary ventilation (MVV) b. Functional residual capacity (FRC) c. Forced expiratory flows (FEFs) d. Forced expiratory volumes (FEVs) |
functional residual capacity
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20. What is the most common measurement of pulmonary mechanics during pulmonary function testing?
a. Tidal volume b. Forced vital capacity c. Residual volume d. Inspiratory reserve volume |
forced vital capacity
|
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21. To ensure validity of the forced vital capacity (FVC) measurement, how many attempts should the patient perform?
a. Just one good one b. Two that are nearly the same c. Three that are acceptable d. At least four |
three that are acceptable
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22. What pulmonary function test presents the highest risk for fainting?
a. Slow vital capacity b. Tidal volume per minute c. Maximum voluntary ventilation d. Total lung capacity |
maximum vonluntary ventilation
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23. What is the minimum percent of the forced vital capacity that healthy people can exhale in the first 1 second?
a. 50% b. 60% c. 70% d. 80% |
70%
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24. When evaluating a forced vital capacity maneuver post bronchodilator use to determine the reversibility of any airway obstruction, what percent increase in FEV1 is needed to be able to say the treatment was effective?
a. 5% b. 10% c. 15% d. 20% |
15%
|
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25. After a resting expiration, air still remains in the lungs. What is this volume called?
a. Functional residual capacity (FRC) b. Vital capacity (VC) c. Residual volume (RV) d. Expiratory reserve volume (ERV) |
expiratory reserve volume (ERV)
|
|
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26. Which of the following is equal to total lung capacity (TLC)?
a. VT + ERV + IRV + RV b. IC + VT + ERV c. VC + ERV d. FRC + IRV |
VT + ERV + IRV + RV
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27. What is the amount of gas that can be inhaled over and above that which is normally inhaled during quiet breathing?
a. Functional residual capacity (FRC) b. Expiratory reserve volume (ERV) c. Inspiratory reserve volume (IRV) d. Vital capacity (VC) |
inspiratory reserve volume (IRV)
|
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28. A patient has an expired minute ventilation of 14.2 L and a ventilator rate of 25/min. What is the average VT?
a. 568 ml b. 635 ml c. 725 ml d. 410 ml |
568 ml
|
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29. A patient has a vital capacity of 4200 ml, a functional residual capacity (FRC) of 3300 ml, and an expiratory reserve volume (ERV) of 1500 ml. What is the residual volume (RV)?
a. 5700 ml b. 2700 ml c. 1800 ml d. 7500 ml |
1800 ml
|
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30. What percent of the total lung capacity (TLC) does the residual volume (RV) normally represent?
a. 10% b. 20% c. 30% d. 40% |
20%
|
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31. What is the gas normally used to measure the diffusing capacity of the lung?
a. O2 b. CO c. CO2 d. He |
CO
|
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32. The DLCO would be decreased in all of the following except:
a. Pulmonary emphysema b. Secondary polycythemia c. Severe anemia d. Pulmonary fibrosis |
secondary polycythemia
|
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36. Which of the following is NOT a goal of noninvasive positive-pressure ventilation (NPPV) in the acute care setting?
a. Avoid intubation b. Decrease incidence of ventilation-associated pneumonia c. Decrease length of stay d. Improve mobility |
improve mobility
|
|
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37. Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?
a. Noninvasive positive-pressure ventilation (NPPV) b. Continuous positive airway pressure (CPAP) c. Mechanical ventilation d. Positive end-expiratory pressure |
continuous positive airway pressure (CPAP)
|
|
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38. All of the following are potential benefits of using noninvasive positive-pressure ventilation (NPPV) during weaning except reduced:
a. Length of intensive care unit (ICU) stay b. Incidence of nosocomial pneumonia c. Mortality rate d. Incidence of pulmonary embolism |
incidence of pulmnary embolism
|
|
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39. Which of the following restrictive thoracic diseases are successfully managed with noninvasive positive-pressure ventilation (NPPV)?
I. Postpolio syndrome II. Neuromuscular disease III. Spinal cord injuries IV. Severe kyphoscoliosis |
all the above
|
|
|
40. Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive positive-pressure ventilation (NPPV)?
a. Hypoxic b. Hypercarbic c. Acidotic d. Hypocarbic |
hypercarbic
|
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41. Which of the following findings ins NOT and exclusion criterion for using noninvasive positive-pressure ventilation (NPPV) in the patient with acute respiratory failure?
a. Apnea b. Hemodynamic or cardiac instability c. Low risk of aspiration d. Lack of cooperation by the patient |
low risk of aspiration
|
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42. Which of the following does not predict successful use of noninvasive positive-pressure ventilation (NPPV) in the respiratory failure patient?
a. Minimal air leak b. Low severity of illness c. Improvement in gas exchange within 30 minutes d. pH = 7.20 |
pH = 7.20
|
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43. which of the following are contraindications for the use of noninvasive positive-pressure ventilation (NPPV)?
I. Nonsupportive family II. Lack of financial resources III. Copious amounts of secretions IV. Uncooperative behavior on the part of the patient |
all the above
|
|
|
44. Which of the following interfaces is most commonly used to apply noninvasive positive-pressure ventilation (NPPV) in the acute setting?
I. Nasal or full face mask II. Mouthpiece III. Endotracheal tube IV. Nasal pillows |
I and II
|
|
|
45. Which of the following is a potential risk of overtightening the straps of the mask?
a. Absence of an air leak b. Tissue necrosis c. Eye irritation d. Claustrophobia |
tissue necrosis
|
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46. Compared with nasal masks, full-face masks are associated with all of the following, except:
a. Increase in dead space b. Risk of aspiration c. Claustrophobia d. Hypocapnia |
hypocapnia
|
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|
47. Which of the following interfaces should be used in greater than 90% of the patients with hypoventilation?
a. Full face mask b. Nasal mask c. Nasal pillows d. Oral mask |
full face mask
|
|
|
48. Which of the following ventilators is not used for noninvasive positive-pressure ventilation (NPPV)?
a. Critical care b. Portable c. Noninvasive d. Negative pressure |
negative pressure
|
|
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49. Which of the following are characteristics of most noninvasive ventilators?
I. Electrically powered II. Blower driven III. Microprocessor controlled IV. Double-circuit design |
I, II and III
|
|
|
50. Which of the following is required for noninvasive ventilators to work properly?
a. Exhalation valve b. Pressure alarm c. Leak d. Blender |
leak
|
|
|
51. What mode of ventilation is most often used for noninvasive positive-pressure ventilation (NPPV) when a critical care ventilator is in use?
a. Pressure support ventilation (PSV) b. Continuous positive airway pressure c. Synchronized intermittent mandatory ventilation d. Control |
pressure support ventilation (PSV)
|
|
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52. Your patient is being ventilated with a common critical care ventilator using pressure support ventilation (flow cycled) with a nasal mask. A leak is present that is preventing the appropriate termination of the inspiratory cycle. What is the best response?
a. Switch to volume control mode b. Switch to time-cycled mode c. Switch to nasal pillows d. Switch to full face mask |
switch to time cycled mode
|
|
|
53. What physiologic effect will raising the expiratory positive airway pressure have in the patient receiving noninvasive positive-pressure ventilation?
a. Increase the functional residual capacity b. Increase the tidal volume c. Decrease the PCO2 d. Lower the mean airway pressure |
increase the functional residual capacity
|
|
|
54. Which of the following is likely to occur when decreasing the expiratory positive airway pressure in the patient being ventilated using noninvasive positive-pressure ventilation?
a. Improved PaO2 b. Increased functional residual capacity c. Increased tidal volume d. Increased inspiratory positive airway pressure |
increase tidal volume
|
|
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55. What is the best option for the patient in respiratory failure who continues to deteriorate 30 minutes after the initiation of noninvasive positive-pressure ventilation?
a. Wait another 30 minutes and monitor the patient b. Begin continuous positive airway pressure c. Intubate and begin mechanical ventilation d. Ventilate the patient using a bag-valve-mask |
intubate and begin mechanical ventilation
|
|
|
56. Emphysema is defined as:
a. Chronic productive cough b. Conducting airway enlargement c. Destruction of alveolar walls without fibrosis d. Hemoptysis associated with productive cough and alveolar capillary membrane destruction |
destruction of alveolar walls without fibrosis
|
|
|
57. Which complaint is most closely associated with the diagnosis of chronic bronchitis?
a. Airway enlargement b. Chronic productive cough c. Dyspnea on exertion d. Hemoptysis |
chronci productive cough
|
|
|
58. Which form of COPD is most common?
a. Chronic bronchitis b. Emphysema |
chronic bronchitis
|
|
|
59. What is the leading risk factor for the development of COPD?
a. Air pollution b. α-1 antitrypsin deficiency c. cigarette smoking d. second hand smoke |
cigarette smoking
|
|
|
60. what percentage of all cases of COPD is caused by an α-1 antitrypsin deficiency?
a. 2% to 3% b. 10% to 15% c. 25% to 40% d. 50% to 75% |
2% to 3%
|
|
|
61. Which airways are most susceptible to airway obstruction in patients with COPD?
a. Large b. Medium c. Small |
small
|
|
|
62. It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma? |
normalization of the FEV1 after use of a bronchodilator
|
|
|
63. A patient is experiencing an exacerbation of COPD. He is 65 years old, fairly slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.29. Which of the following therapies would be most indicated?
a. Intrapulmonary percussive ventilation b. Intubation and mechanical ventilation c. Nasal CPAP d. Noninvasive ventilation |
noninvasive ventilation
|
|
|
64. What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD?
a. Improve exercise tolerance b. Improves FEV1 c. Improves lung function d. Improves survival |
improves exercise tolerance
|
|
|
65. What treatment for patients with COPD has been shown to improve long term survival?
a. Bronchodilators b. Corticosteroids c. Mechanical ventilation d. Oxygen |
oxygen
|
|
|
66. What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease?
a. Hyperactivity of the airways b. Hyperinflation of the lung parenchyma c. Inflammation of the airways d. Mucus plugging of the airways |
inflammation of the airways
|
|
|
67. Which of the following symptoms is NOT a classic symptom of asthma?
a. Cough b. Shortness of breath c. Chest tightness d. Chest pain |
chest pain
|
|
|
68. What stimulus is most commonly used in bronchoprovocation testing in the patient suspected to have asthma?
a. Acetylcysteine b. Leukotriene inhibitors c. Methacholine d. Methylprednisolone |
methacholine
|
|
|
69. A patient is admitted to the emergency department with an acute asthma exacerbation. Base on the following blood gas results, how severe is the asthma attack? pH 7.35, PaO2 58mm Hg, PaCO2 46 mm Hg, HCO3 18mEq/L, SaO2 89%
a. Mild b. Moderate c. Severe |
moderate
|
|
|
70. What finding of the arterial blood gas suggests a more severe attack of asthma and impending respiratory failure?
a. PCO2 32 mm Hg b. PaCO2 42 mm Hg c. pH 7.5 d. PO2 59 mm Hg |
PaCO2 42 mm Hg
|
|
|
71. What does the National Asthma Education Project (NAEP) recommend be measured at home in patients with moderate to severe asthma?
a. Arterial blood gases b. Degree of pulmonary shunt c. DLCO d. Peak expiratory flow |
peak expiratory flow
|
|
|
72. Identify the drug whose regular use in the treatment of asthma may worsen control or even increase the risk of death by asthma.
a. Anticholinergic b. Anti-inflammatory c. Β2 agonists d. Corticosteroid |
B2 agonists
|
|
|
73. Which medication is an anticholinergic bronchodilator?
a. Ipratropium bromide b. Pirbuterol c. Salmeterol d. Terbutaline |
ipratropium bromide
|
|
|
74. Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?
I. allow peak inspiratory pressures to go as high as required II. permissive hypercapnia III. prolonged inspiratory time IV. small tidal volumes |
II adn IV
|
|
|
75. What etiologic factor is associated with the onset of nocturnal asthma?
a. Aspiration of gastric acid at night b. Supine postion c. Variation in acetylcholine secretion at night d. Variation in the secretion of insulin at night |
aspiration of gastric acid at night
|
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76. Identify the hallmark symptom of bronchiectasis
a. Evidence of cystic spaces and tram tracks on the chest radiograph b. Hemoptysis c. Large amounts of purulent sputum d. Variable dyspnea |
large amounts of purulent sputum
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77. Which of the following major categories of ventilator function are useful in classifying ventilators?
I. control scheme II. power conversion III. ventilator output |
all the above
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78. A ventilator can derive its input power from which of the following sources?
I. alternating current (AC) electricity II. battery III. pneumatic |
all the above
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79. For which of the following uses might you consider the use of a purely pneumatically powered ventilator?
I. as a backup to electrically powered ventilators II. when electrical device cannot be used (e.g., magnetic resonance imaging) III. during certain types of patient transport |
all the above
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80. Which of the following equations best describes the pressure (P) necessary to drive gas into the airway and inflate the lungs?
a. P=(Elastance x Volume) + (Resistance x Flow) b. P= (Elastance –Volume) + (Resistance ÷ Flow) c. P = (Volume + Compliance) + (Resistance ÷ Flow) d. P= (Volume ÷ Compliance) – (Resistance x Flow) |
P = (Elastance x Volume) + (Resistance x Flow)
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81. According to the equation of motion of the respiratory system, a ventilator can control all of the following variables except:
a. Volume b. Resistance c. Pressure d. Flow |
resistance
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82. During mechanical ventilation, what variable causes a breath to begin?
a. Limit b. Cycle c. Trigger d. Baseline |
trigger
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83. If a patient initiates a ventilator breath, the trigger variable could be all of the following except:
a. Pressure b. Flow c. Time d. Volume |
time
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84. When you adjust the pressure drop necessary to trigger a breath on a ventilator, what are you adjusting on the machine?
a. Sensitivity b. Pressure limit c. Mode setting d. Positive end-expiratory pressure (PEEP) level |
sensitivity
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85. A volume cycled ventilator provides gas under positive pressure during inspiration until what point?
a. A preselected volume of gas is received by the patient b. An adjustable, preselected airway pressure is reached c. The inspiratory time equals or exceeds the expiratory time d. A preselected volume of gas is expelled from the device |
A preselected volume of gas is expelled from the device
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86. What is the application of pressure above atmospheric at the airway throughout expiration during mechanical ventilation?
a. Positive end expiratory pressure (PEEP) b. Pressure support ventilation c. Continuous mandatory ventilation (CMV) d. Continuous positive airway pressure (CPAP) |
positive end expiratory pressure (PEEP)
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87. While observing a patient receiving ventilator support, you notice that all delivered breaths are initiated or terminated by the machine. Which of the following modes of ventilator support is in force?
a. Intermittent mandatory ventilation b. Partial ventilator support c. Continuous mandatory ventilation d. Continuous spontaneous ventilation |
continuous mandatory ventilation
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88. While observing a patient receiving ventilator support, you notice that some delivered breaths are begun or ended by the machine, whereas others are begun and ended by the patient. Which of the following modes of ventilator support is in force?
a. Intermittent mandatory ventilation (IMV) b. Pressure support ventilation c. Continuous mandatory ventilation (CMV) d. Airway pressure release ventilation |
intermittent mandatory ventilation (IMV)
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89. During volume-targeted ventilation, which of the following settings determine the machine delivered minute volume?
I. volume II. flow III. rate |
I and III
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90. Which of the following is the primary parameter used to alter the breath size in pressure controlled?
a. Positive inspiratory pressure (PIP) – positive end expiratory pressure (PEEP) b. Continuous positive airway pressure (CPAP) c. Tidal volume d. Flow |
positive inspiratory pressure (PIP) - positive end expiratory pressure (PEE)
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91. Spontaneous breath modes include all of the following except:
a. Pressure support ventilation (PSV) b. Continuous positive airway pressure (CPAP) c. Bilevel CPAP (BiPAP) d. Continuous mandatory ventilation assist control |
continuous mandatory ventilation assist control
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92. What is the mode of ventilator support in which patient’s inspiratory efforts are augmented with a set amount of positive airway pressure?
a. Intermittent mandatory ventilation b. Continuous mandatory ventilation (CMV) c. Pressure support ventilation (PSV) d. Positive end expiratory pressure (PEEP) |
pressure support ventilation (PSV)
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93. Physiological goals of artificial ventilator support include which of the following?
I. support or manipulate gas exchange II. reduce or manipulate the work of breathing III. increase lung volume |
all the above
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94. What goal(s) does the practitioner hope to achieve when selecting initial ventilator support settings?
I. optimize oxygenation II. optimize ventilation III. maintain acid base balance IV. avoid harmful side effects |
all the above
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95. What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?
a. 5% b. 15% c. 25% d. 33% |
25%
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96. What is the recommended range for the tidal volume for the initial ventilator setting in the volume control mode?
a. 5 to 7 ml/kg b. 8 to 10 ml/kg c. 10 to 12 ml/kg d. 12 to 15 ml/kg |
8 to 10 ml/kg
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97. Which of the following represents a clinical situation where partial ventilator support is commonly used?
a. Patient with head trauma b. During weaning from continuous mandatory ventilation c. While ventilating an asthmatic d. In a drug overdose case |
during weaning from continuous mandatory ventilation
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98. When a patient is initially started on mechanical ventilation common orders from the physician in the patient’s chart include all of the following except:
a. FiO2 b. Mode c. Sensitivity d. Tidal volume |
sensitivity
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99. Which of the following statements is NOT true regarding ventilation is the assist control mode?
a. Every breath is supported by the ventilator b. Usually ensures a minimum safe level of ventilation is given c. Assist control mode is typically applied using the volume control mode d. It is usually applied with a backup rate of 5 to 8 breaths/min |
it is usually applied with a backup rate of 5 to 8 breaths/min
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100. Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV)?
a. The machine breath is typically time cycled to inspiration b. The patient can breathe spontaneously between machine breaths c. SIMV is easy to apply d. SIMV may help maintain ventilatory muscle strength |
the machine breath is typically time cycled to inspiration
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101. A ventilator has separate rate and VT controls. If you set a VT of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?
a. 7800 ml/min (7.8L/min) b. 8500 ml/min (8.7L/min) c. 9600 ml/min (9.6L/min) d. 10,200 ml/min (10.2L/min) |
10,200 ml/min (10.2L/min)
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102. On a ventilator that has separate rate and minute ventilation (VE) controls, the rate is set at 13/min and the VE at 11L/min. About what VT is the patient receiving?
a. 700 ml b. 850 ml c. 1000 ml d. 1200 ml |
850 ml
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103. A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation assist control mode for a 125-lb adult woman with normal lungs. Which of the following initial settings would you recommend?
Rate VT a. 10/min 1000ml b. 12/min 500ml c. 12/min 1000 ml d. 18/min 800ml |
12/min 500ml
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104. On some ventilators, what can trigger setting that is too sensitive cause?
a. Auto-cycling b. Flow dyssynchrony c. Barotrauma d. Increased workload |
auto cycling
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105. For adults with otherwise normal lungs who are receiving ventilator support in the continuous mandatory ventilation control or assist control mode, inspiratory flow should be set to provide what I:E?
a. 2:1 b. 3:1 c. 1:1 d. 1:2 |
1:2
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106. Which of the following would you assess immediately after a patient is placed on a ventilator support device?
I. ABGs II. patient’s airway III. patient’s vital signs |
all the above
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107. What is considered to be the single best indicator of effective ventilation?
a. PaO2 b. SaO2 c. PaCO2 d. pH |
PaCO2
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108. a patient receiving control mode continuous mandatory ventilation has the following ABGs on an FiO2 of 0.4: pH = 7.51; PCO2 = 30 mm Hg; HCO3 = 25 mm Hg. Her current minute ventilation (VE) is 7.9L/min. What new VE would you recommend?
a. 9.0L/min b. 6.7L/min c. 7.5L/min d. 5.9L/min |
5.9L/min
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109. A patient receiving control mode continuous mandatory ventilation has the following ABGs on an FiO2 of 0.5: pH = 7.23; PCO2 = 61 mm Hg; HCO3 = 26 mm Hg. The current minute ventilation (VE) is 9.2L/min. What new VE would you recommend?
a. 10.6L/min b. 14.0L/min c. 12.4L/min d. 5.8L/min |
14.0L/min
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110. Which of the following would decrease PaCO2 when ventilating a patient using synchronized intermittent mandatory ventilation with pressure support?
a. Increase the level of pressure support b. Decrease the tidal volume c. Decrease the mechanical rate d. Increase the FiO2 |
increase the level of pressure support
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