1. During the assessment of a 64-year-old female value. This suggests which of the following?

patient, you note the following signs: dyspnea, A. Fixed airway obstruction
hypotension, and a tracheal shift to the right. The B. Reversible airway obstruction
patient has absent breath sounds, reduced chest C. Normal diffusion capacity
expansion, and a hyperresonant percussion note, D. Restrictive process
all on the left side. These findings suggest which
of the following? 6. A 58-year-old female patient is intubated and
A. Pleural effusion on the left side appears to be breathing asynchronously with the
B. Pneumothorax on the left side ventilator. Her breath sounds are absent on the
C. Atelectasis on the left side left side, and the trachea is shifted to the left. The
D. Consolidation on the left side patient has a dull percussion note on the left side
as well. Which of the following is the most likely
2. A 39-year-old male patient was admitted to the explanation of these findings?
emergency department with a fever and SpO2 of A. A tracheoesophageal fistula has developed
87% on room air. Upon auscultation, rhonchi is B. A tension pneumothorax has developed on the left
heard, and the patient has a productive cough. side
Which of the following would you recommend? C. The endotracheal tube is in the right mainstem
A. Intubate and provide mechanical ventilation with bronchus
40% oxygen D. The patient is experiencing diffuse bronchospasm
B. Provide noninvasive positive pressure ventilation
using a full face mask 7. A 63-year-old female patient is intubated and
C. Implement postural drainage and percussion with receiving mechanical ventilation in the
directed coughing pressure-controlled A/C mode. If the patient’s
D. Provide oxygen therapy and obtain a sputum compliance were to decrease, which of the
sample for culture and sensitivity following would you expect to occur?
A. The delivered volume will decrease
3. A 50-year-old male patient is intubated with a B. The peak pressure will increase
size 8 endotracheal tube and is receiving C. The inspiratory time will increase
volume-controlled A/C ventilation. Upon D. The PEEP level will decrease
assessment, you note that the patient’s cuff
pressure is measured at 38 cmH2O. Which of the 8. A 70-year-old male patient is intubated and
following would you recommend? receiving mechanical ventilation in the
A. Withdraw the tube 1-2 cm and reassess the volume-controlled A/C mode. After performing
patient’s breath sounds endotracheal suctioning, which of the following
B. Recommend reintubation with a smaller would indicate the effective clearance of retained
endotracheal tube secretions?
C. Lower the cuff pressure to < 30 cmH2O A. An increased tidal volume
D. Recommend ventilation via a tracheostomy instead B. A decreased inspiratory time
C. A decreased plateau pressure
4. During the assessment of a 52-year-old female D. A decreased peak pressure
patient who is receiving oxygen via nasal cannula
at 4 L/min, you hear the bubble humidifier making 9. An adult patient who is receiving mechanical
a whistling noise. What is the most likely cause of ventilation suddenly started showing signs of
this finding? tachypnea. Upon assessment, you noticed
A. There is an obstruction in the delivery tube tracheal deviation to the right and decreased
B. The patient’s ventilation has increased breath sounds and hyperresonance on the left.
C. There is a clogged system diffuser Which of the following would you recommend?
D. The flowmeter pressure is set too high A. Endotracheal suctioning
5. A pre and post-bronchodilator test was ordered B. Flexible bronchoscopy
on a 48-year-old female patient. The forced C. The insertion of a chest tube
expiratory measurement that was obtained after D. Thoracentesis
the bronchodilator shows an increase in the
patient’s FEV1 from 60% to 80% of the predicted
10. A 57-year-old female patient with acute assist-control mode. Upon assessment, you note
pulmonary edema is dyspneic and shows signs of that she is struggling to initiate inspiration. Which
wheezing. The resident physician has ordered an of the following settings would you check first to
albuterol breathing treatment via SVN. Which of resolve this problem?
the following would you recommend? A. Tidal volume
A. Administer acetylcysteine instead of albuterol B. Pressure limit
B. Perform the therapy with supplemental oxygen C. Sensitivity
C. Perform the treatment as ordered D. PEEP
D. Administer a diuretic and oxygen therapy
15. The physician has requested the insertion of a
11. An intubated 39-year-old female patient was nasopharyngeal airway in an adult patient. This
admitted to the emergency department, and the type of airway is helpful in supporting which of
nurse could not start an intravenous line during the following?
CPR. It is believed that the patient is suffering A. Mechanical ventilation
from a narcotic overdose, and the physician wants B. Frequent suctioning
to administer Naloxone. Which of the following is C. Incentive spirometry
an alternative route that can be used to deliver D. Aerosol drug therapy
this medication?
A. Through the feeding tube 16. You would expect it to be difficult establishing
B. Aerosolized via SVN a patent airway in a patient with which of the
C. Through the nasogastric tube following conditions?
D. Through the endotracheal tube A. ARDS
B. Morbid obesity
12. An 80 kg male patient is receiving C. Pleural effusion
volume-controlled ventilation with an FiO2 of D. Ventilator-associated pneumonia
40%, a rate of 12/min, and a set tidal volume of
500 mL. An ABG was analyzed with the following 17. A premature infant receiving positive pressure
results: ABG Results: pH 7.38, PaCO2 38 mmHg, ventilation appears to be in acute respiratory
HCO3- 24 mEq/L, PaO2 108 mmHg. Ventilator distress with signs of hypotension and
Settings: Spontaneous Rate 23/min, Minute asymmetrical chest movement. Which of the
Ventilation 11.5 L/min, Vital Capacity 500 mL, following would you recommend first?
MIP/NIF -15 cmH2O. Which of the following would A. An arterial blood gas
you recommend? B. A chest radiograph
A. Place the patient on a 40% T-piece and monitor C. A capillary heal stick
closely D. Chest transillumination
B. Switch the patient to SIMV at a rate of 5/min
C. Place the patient on CPAP and monitor closely 18. During the assessment of an adult patient who
D. Maintain the current ventilator settings is receiving mechanical ventilation, you suddenly
notice the simultaneous sounding of both the
13. An adult patient was admitted to the high pressure and low volume alarms. What is the
emergency department after involvement in a most likely cause of this finding?
motor vehicle accident. The patient is A. There is a disconnection in the ventilator circuit
hyperventilating and appears to have a flail chest. B. There is a leak in the ET tube cuff
Which of the following ABG results would you C. There is a mucous plug in the ET tube
expect for this patient? D. The patient has developed pneumonia
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2 19. A 16-year-old male patient has been admitted
C. Decreased pH and decreased SaO2 to the emergency department and shows signs of
D. Decreased pH and increased SaO2 poor body development. Upon assessment, you
also note digital clubbing, hyperresonance to
14. A 51-year-old female patient with a history of percussion, and a productive cough. It has also
asthma is receiving mechanical ventilation in the been reported that the patient has foul-smelling
stools. These findings are consistent in which of C. The pH and PaCO2 correlate well with arterial
the following? blood
A. Acute respiratory distress syndrome D. The puncture is typically performed on the ball of
B. Bronchiectasis the foot
C. Chronic bronchitis
D. Cystic fibrosis 24. A newly admitted adult patient with
pneumonia has an oxygen saturation of 87% on a
20. During the assessment of a 56-year-old female nasal cannula at 2 L/min. Which of the following is
patient, you noticed distinct distention of the a potential cause of the patient’s hypoxemia?
jugular veins in the neck. Which of the following is A. Fever and chills
the most likely cause of this finding? B. Diffusion defect
A. Systolic hypertension C. Alveolar consolidation
B. Hypovolemia D. Hypoventilation
C. Obstruction of the pulmonary vein
D. Right ventricular failure 25. A 59-year-old female postoperative patient is
21. An adult patient performed an FVC maneuver. recovering from surgery that occurred less than
After reviewing the flow-volume loop tracing, the 24 hours ago. Which of the following would you
doctor describes the appearance of the loop as recommend for this patient to prevent atelectasis?
“tall” and “skinny.” Which of the following best A. Albuterol via SVN four times daily
describes the patient’s respiratory physiology? B. Pursed-lip breathing as needed
A. Normal lungs C. Inspiratory resistance exercises three times daily
B. Small airway obstruction D. Incentive spirometry 10 times per hour
C. Large airway obstruction
D. Restrictive disease 26. A 63-year-old male patient with a
tracheostomy is being mechanically ventilated in
22. A 68-year-old male patient with COPD is the ICU. Upon assessment, you noticed that as the
receiving volume control SIMV with the following patient coughs, blood and secretions were blown
settings: back into the circuit. What action should you take
Tidal volume 480 mL at this time?
Rate 12/min A. Flush the blood out of the circuit with normal saline
Pressure support 10 cmH2O B. Sedate the patient to prevent more coughing
PEEP 5 cmH2O C. Nebulize a local anesthetic to reduce surgical pain
During a spontaneous breathing trial via T-tube, D. Replace the circuit with a new one
the patient’s breathing rate increased drastically,
requiring him to be placed back on the ventilator. 27. A 56-year-old male patient has been admitted
Which of the following would you recommend and diagnosed with Guillain-Barré syndrome. To
during the subsequent breathing trial? determine the patient’s need for ventilatory
A. Increase the sedation dosage support, which of the following values is the most
B. CPAP with pressure support via ET tube critical to monitor?
C. CPAP without pressure support via ET tube A. Residual volume
D. Extubate and provide BiPAP via full face mask B. Inspiratory capacity
C. Peak inspiratory flow
23. An order was placed to collect a blood sample D. Expiratory reserve volume
from a neonatal patient in the NICU. It is
determined that you should obtain the sample 28. A 64-year-old female patient with a history of
from a capillary instead of an artery. Which of the CHF has been admitted to the emergency
following is true regarding a capillary blood gas department on a nasal cannula at 4 L/min. She is
sample? coughing up large amounts of pink, frothy
A. To obtain the sample, you need to milk the secretions and presents the following ABG results:
puncture site pH 7.42
B. The sample must be drawn from the first drop of PaCO2 32 mmHg
surface blood HCO3 19 mEq/L
BE -3 mEq/L A. 1–4
PaO2 46 mmHg B. 4–7
SaO2 81% C. 7–10
Which of the following would you recommend? D. 10–13
A. Nonrebreathing mask at 15 L/min 33. After orally intubating an adult patient in the
B. Intrapulmonary percussive ventilation (IPV) ICU, you are asked to confirm that the tube is in
C. Continuous positive airway pressure (CPAP) the correct place. Upon auscultation, you note
D. Intermittent positive pressure breathing (IPPB) that the breath sounds are absent on the
patient’s left side. Which of the following is the
29. While attempting to wean an adult patient most appropriate action to take at this time?
from mechanical ventilation, you switched them A. Obtain a stat chest radiograph
from the volume control A/C mode to CPAP with B. Withdraw the endotracheal tube by 1–2 cm
pressure support. 30 minutes later, the high C. Reintubate the patient
respiratory rate alarm begins to sound, and the D. Insert a large-bore needle in the left upper chest
patient is breathing at a rate of 29 breaths/min.
Which of the following changes would you make 34. A 58-year-old female patient has arrived in the
to the ventilator settings? emergency department with an extremely deep
A. Increase the pressure support level and fast breathing rate. Which of the following
B. Increase the high-pressure alarm to 50 cmH2O best classifies this type of breathing?
C. Increase the high rate alarm to 30–35 breaths/min A. Apneustic breathing
D. Switch the patient back to volume control A/C B. Kussmaul breathing
C. Biot’s breathing
30. A 57-year-old female patient who was D. Cheyne-Stokes breathing
admitted and diagnosed with emphysema
displays the following ABG results: 35. A 71-year-old male patient is receiving
pH 7.34 ventilatory support. His secretions are yellow and
PaCO2 65 torr have gotten thicker over the past 24 hours. The
PaO2 47 torr patient has a white blood cell count of
HCO3 31 mEq/L 17,000/mm3 and a temperature of 102 °F. Which of
The patient appears to be dyspneic and the following would you suggest?
inspiratory crackles can be heard during A. Decrease the humidifier temperature
auscultation. Which of the following would you B. Administer an aerosolized bronchodilator
recommend? C. Schedule suctioning twice per hour
A. Nonrebreathing mask at 10 L/min D. Obtain a sputum sample for culture and sensitivity
B. Air-entrainment mask at 28% 36. While reviewing the medical record of a
C. Albuterol via a small-volume nebulizer 55-year-old female patient, you note that her
D. Nasal cannula at 4 L/min FEV1/FVC ratio was reported as being severely
decreased. Which of the following conditions
31. A 43-year-old female patient in the emergency would you expect to be present with this finding?
department was just orally intubated with an A. Pulmonary hypertension
endotracheal tube. Which of the following would B. Morbid obesity
you INITIALLY recommend in order to confirm C. Chronic asthma
that the tube is in the proper position? D. Pneumonia
A. Auscultate the patient’s chest and abdomen
B. Perform a STAT chest x-ray 37. An intubated 60-year-old female patient is
C. Use capnography to verify exhaled CO2 undergoing a spontaneous breathing trial. Which
D. Observe chest wall movement of the following would indicate the need to stop
the trial and return the patient back to full
32. While assisting with the delivery of a newborn ventilatory support?
infant, the physician asks for you to obtain an A. An increase in heart rate from 96 to 114/min
Apgar score on the patient. Which of the following B. An increase in respiratory rate from 17 to 27/min
ranges is considered to be a normal score?
C. An increase in arterial PCO2 from 44 to 52 torr C. Switch to a simple mask
D. A decrease in SpO2 from 92% to 83% D. Recommend an ABG before considering any
changes
38. The physician has requested the dynamic
compliance measurement for an adult patient 43. A stable adult patient who is receiving
who is receiving mechanical ventilation. This mechanical ventilation displays the following
value can be obtained by dividing the patient’s results:
tidal volume by which of the following: pH 7.49
A. (Pplat – PEEP) PaCO2 29 mmHg
B. (PIP – PEEP) HCO3 24 mEq/L
C. (PIP – Paw) BE +1
D. (Paw – Pplat) PaO2 87 mmHg
SaO2 96%
39. A 63-year-old male patient was admitted to the Which of the following would you recommend?
ICU. Upon auscultation, you note that bronchial A. Add 10 cmH2O of PEEP
breath sounds are present over the right lower B. Increase the minute ventilation
lobe. This finding indicates which of the following? C. Decrease the tidal volume
A. The patient has normal lungs D. Maintain the current settings
B. A pneumothorax is present in the right lung
C. A pleural effusion is present in the right lower lobe 44. A 68-year-old female patient in the ICU is
D. Consolidation is present in the right lower lobe receiving mechanical ventilation but appears to
be breathing asynchronously with the ventilator.
40. An alert 59-year-old male patient is orally Which of the following medications would you
intubated with an endotracheal tube. During a recommend?
weaning trial, the patient was switched to CPAP A. Fluoxetine (Prozac)
mode with an FiO2 of 40%. Within the first 5 B. Lorazepam (Ativan)
minutes, the patient’s respiratory rate has C. Dextroamphetamine (Dexedrine)
increased from 22 to 31 breaths/min with D. Cisatracurium (Nimbex)
increased usage of accessory muscles while
breathing. Which of the following would you 45. A 70-year-old male patient with COPD is
recommend? receiving ventilatory support in a
A. Return the patient to full ventilatory support volume-controlled mode. Upon assessment, the
B. Increase the FiO2 to 50% high-pressure alarm suddenly begins to sound.
C. Apply 5-10 cmH2O of pressure support Which of the following would you recommend?
D. Extubate the patient and reassess A. Increase the flow setting
B. Increase the pressure limit setting
41. After administering aerosolized albuterol to a C. Suction the airway
38-year-old female patient, which of the following D. Remove air from the endotracheal tube cuff
side effects would you expect?
A. Hypotension 46. A 55-year-old female patient with pneumonia
B. Bradycardia is receiving oxygen via nasal cannula at 4 L/min.
C. Bronchospasm The physician asks for your suggestion on the best
D. Shaking and tremors way to evaluate the patient’s overall ability to
breathe. Which of the following would you
42. A 23-year-old male patient with a severe head recommend?
cold is receiving oxygen via nasal cannula at 4 A. Perform pulse oximetry
L/min. The pulse oximeter reveals an SpO2 of 85%. B. Draw an arterial blood sample for analysis
Which of the following would you recommend? C. Perform a forced vital capacity measurement
A. Increase the oxygen flow until the SpO2 equals or D. Perform a full set of pulmonary function tests
exceeds 90%
B. Decrease the oxygen flow until the patient is more 47. While reviewing the chest x-ray of a
comfortable 57-year-old male patient, you note blunting of the
left costophrenic angle. It’s also noted that the were ordered to check her troponin and BNP
patient has a history of CHF. Which of the levels, but the results were negative. Additionally,
following best describes this patient’s condition? her ABG results indicated partially compensated
A. There is a pneumothorax on the left side respiratory acidosis. Which of the following is the
B. There is a pleural effusion on the left side most likely problem for this patient?
C. There is pulmonary edema in the left lung A. Pneumonia
D. There is pneumonia in the left lower lobe B. CHF
C. Exacerbation of COPD
48. A 69-year-old male patient is undergoing a D. Myocardial infarction
spontaneous breathing trial for weaning from
mechanical ventilation. Which of the following 53. A 51-year-old male patient is receiving
changes in the patient’s status would be volume-controlled A/C mechanical ventilation
acceptable? while being monitored with a continuous pulse
A. A decrease in SpO2 from 91% to 81% oximeter. He was briefly removed from the
B. An increased usage of the scalene muscles during ventilator so that suctioning could be performed,
breathing and his SpO2 dropped from 95% to 88%. Which of
C. An increase in heart rate from 97 to 115/min the following would you recommend?
D. A decrease in the systolic blood pressure from 115 A. Initiate PEEP at 5 cmH2O
to 76 mmHg B. Increase the FiO2 to 80%
C. Perform bedside hemodynamic monitoring
49. An adult patient with fluid overload was given D. Change to an in-line suctioning catheter
a dose of furosemide intravenously. After the
drug was given, the patient displayed an 54. During the assessment of an adult patient
arrhythmia on the EKG that was not present with chronic asthma, their results displayed the
before. Which of the following would you following:
recommend in this situation? SVC of 3,500 mL
A. Defibrillate the patient FVC of 2,500 mL
B. Administer another dose of furosemide What is the most likely reason for the difference
C. Administer a dose of epinephrine in these values?
D. Check the patient’s potassium level A. Increased compliance during a forced expiration
B. Poor instruction by the previous respiratory
50. After the extubation of a 54-year-old male therapist
patient, he begins to complain of a sore throat. C. Muscle fatigue during a forced expiration
Which of the following drugs would you D. Air trapping during a forced exhalation
recommend for this patient?
A. Levalbuterol 55. The physician has ordered acetylcysteine for a
B. Isoetharine 66-year-old female patient with COPD who has a
C. Racemic epinephrine large amount of thick secretions. Upon
D. Acetylcysteine assessment, you note that the patient has a weak,
inadequate cough. Which of the following would
51. An oropharyngeal airway is being used on a you recommend?
39-year-old male patient. Within two minutes A. Perform a bronchoalveolar lavage
after insertion, the patient begins to gag. Which of B. Nasotracheal suctioning after the treatment
the following would you recommend? C. Postpone the therapy until the patient can cough
A. Perform the head-tilt, chin-lift maneuver effectively
B. Insert a bite block D. Administer dornase alpha instead of acetylcysteine
C. Remove the airway
D. Replace the current tube with a smaller airway 56. On discharge, a 52-year-old male patient was
prescribed an inhaled corticosteroid via MDI for
52. A 66-year-old female was admitted to the two puffs twice a day. In order to decrease the
emergency department showing signs of dyspnea, likelihood of an oral infection, which of the
shortness of breath, and chest tightness. Lab tests following would you recommend?
A. An antibiotic prescription C. 600 mL
B. Decrease the frequency to once per day D. 700 mL
C. A Bronchodilator before the corticosteroid
D. Rinse the mouth after inhalation 62. A 15-year-old male patient who has been
diagnosed with asthma is in need of medication to
57. A 60-year-old female patient is receiving help prevent future asthma attacks. All of the
assist-control mechanical ventilation. Which of following drugs would be helpful EXCEPT:
the following is the most common problem A. Cromolyn sodium
associated with this ventilatory mode? B. Zafirlukast
A. Hypoventilation C. Epinephrine
B. Hyperventilation D. Zileuton
C. The need for neuromuscular paralysis
D. Increased work of breathing 63. The physician has chosen to use the SIMV
mode of ventilation over the Assist/Control mode.
58. During the ventilator check of an adult patient Which of the following is an advantage of the
who weighs 77 kg, you note the following settings: SIMV mode?
Exhaled tidal volume 550 mL A. SIMV maintains respiratory muscle strength
PIP 35 cmH2O B. SIMV prevents hyperventilation
High-pressure limit 64 cmH2O C. SIMV increases pleural pressures
Low-pressure alarm 25 cmH2O D. SIMV increases the need for sedation
Low tidal volume alarm 500 mL
Which of the following changes should be made at 64. A newly admitted adult patient in the
this time? emergency department who is intubated appears
A. Increase the set tidal volume to 700 mL to have copious amounts of frothy pink
B. Increase the low tidal volume alarm to 600 mL secretions. This most likely indicates which of the
C. Decrease the high-pressure limit to 45-50 cmH2O following:
D. Decrease the low-pressure alarm to 10 cmH2O A. ARDS
B. Cor pulmonale
59. An adult patient undergoing a mild asthma C. Left ventricular failure
attack was admitted to the ER. Which of the D. An electrolyte imbalance
following ABG results would you expect to see?
A. pH = 7.30 PaCO2 = 49 torr PaO2 = 61 torr 65. An adult patient arrived at the emergency
B. pH = 7.32 PaCO2 = 51 torr PaO2 = 51 torr department in respiratory distress with
C. pH = 7.46 PaCO2 = 47 torr PaO2 = 52 torr diminished breath sounds. The patient has a
D. pH = 7.49 PaCO2 = 30 torr PaO2 = 62 torr history of asthma. After continuous
bronchodilator therapy, wheezing is now heard
60. A 61-year-old female patient has an FEV1/FVC during auscultation. This change suggests which
ratio that is lower than the predicted value. Her of the following?
FVC value is also lower than normal as well. What A. The onset of pneumonia
is the most likely cause of these findings? B. The development of a pneumothorax
A. Normal lungs C. The improvement of air flow
B. Restrictive lung disease D. The development of pulmonary edema
C. Obstructive lung disease
D. Combined obstructive and restrictive lung disease 66. A 71-year-old female patient is intubated and
receiving positive-pressure ventilation. To prevent
61. Which of the following tidal volume settings barotrauma, you should strive to keep the
for mechanical ventilation would be most plateau pressure below which of the following
appropriate for a 5’2″ female patient with normal thresholds?
lungs? A. 20 cmH2O
A. 200 mL B. 30 cmH2O
B. 400 mL C. 40 cmH2O
D. 50 cmH2O
 B. Decrease the SIMV rate to 8/min
67. While monitoring a 67-year-old male patient C. Switch the patient to pressure-controlled SIMV
who is receiving volume-controlled SIMV, you note D. Switch the patient to a pressure-limited mode
bilateral wheezes during auscultation with an
increased peak airway pressure. Which of the 72. While selecting the initial ventilatory settings
following would you recommend for this patient? for a newly intubated patient, which of the
A. Suction the patient’s airway following is most important?
B. Order a stat chest x-ray A. The type of device that is being used
C. Check the cuff pressure B. The quality and amount of nursing supervision
D. Administer a bronchodilator C. The patient’s size and clinical condition
D. The amount of spontaneous ventilatory effort
68. A 61-year-old female was orally intubated and
is now receiving positive pressure ventilatory 73. A 60-year-old male patient is receiving
support. A chest radiograph was ordered to ventilatory support in the SIMV mode. A blood gas
confirm the proper placement of the endotracheal sample was collected, and analysis shows a PaCO2
tube. Where should the tip of the tube be of 60 mmHg. Which of the following would you
positioned? recommend?
A. No more than 2 cm above the carina A. Increase the frequency
B. At the same level as the carina B. Increase the FiO2
C. Level with the fifth cervical vertebra C. Increase the mechanical deadspace in the
D. Between the 2nd and 4th thoracic vertebra ventilator circuit
D. Decrease the tidal volume
69. An adult patient was admitted to the
emergency department with an opiate narcotic 74. An ABG was collected on a 71-year-old female
overdose. Which of the following medications patient with a history of chronic COPD. After
would you recommend to help return the reviewing the results, which of the following
patient’s breathing back to normal? values would be most reflective of the severity of
A. Naloxone (Narcan) the patient’s chronic condition?
B. Fentanyl (Sublimaze) A. pH
C. Indomethacin (Indocin) B. PaCO2
D. Vecuronium (Norcuron) C. HCO3-
D. PaO2
70. Immediately after intubation, a 64-year-old
female patient is showing signs of asymmetrical 75. An adult patient in the emergency room is
chest movement while being ventilated with a unconscious with an SpO2 of 95%. After
bag-valve resuscitator. After auscultation, you re-checking with a CO-oximeter, it reveals that
note that no breath sounds are heard on the left the patient’s SaO2 is 67%. Which of the following
side. These findings are consistent with which of is the most likely cause of this discrepancy?
the following? A. Opiate drug overdose
A. Pneumothorax B. Diabetic ketoacidosis
B. Atelectasis C. Acute pulmonary edema
C. Right mainstem intubation D. Carbon monoxide poisoning
D. Pleural effusion
76. A 64-year-old female patient has arrived in the
71. An adult patient with a tracheostomy in place emergency department with chest tightness and
is receiving ventilatory support in the radiating left shoulder pain. Which of the
volume-controlled SIMV mode with a set rate of following would you recommend?
10/min. Upon assessment, the patient has started A. Obtain a stat chest x-ray
to use their accessory muscles during spontaneous B. Provide 100% oxygen
breaths. Which of the following would you C. Administer an albuterol treatment
recommend? D. Obtain an ABG sample
A. Increase the level of pressure support
77. A comatose adult patient in the ICU is 82. The physician has ordered mechanical
receiving mechanical ventilation. Which of the ventilation in the pressure control A/C mode for a
following pulmonary function tests can be 55 kg postoperative male patient. Which of the
performed at this time? following initial settings would you recommend?
A. Peak Expiratory Flow A. PIP = 25 cmH2O; Rate = 30/min; Inspiratory time =
B. Maximum Voluntary Ventilation 1 second
C. Maximum Inspiratory Pressure B. PIP = 32 cmH2O; Rate = 12/min; Inspiratory time =
D. Forced Expiratory Volume in 1 Second 2 seconds
C. PIP = 40 cmH2O; Rate = 20/min; Inspiratory time =
78. A 61-year-old male patient who is recovering 1 second
from post-abdominal surgery has been on a D. PIP = 25 cmH2O; Rate = 12/min; Inspiratory time =
high-flow nasal cannula at 20 L/min for three 1 second
days. The patient’s ABG results are as follows:
pH 7.39 83. A sweat chloride test can be used to diagnose
PaCO2 43 torr which of the following conditions?
PaO2 157 torr A. Muscular dystrophy
SaO2 99% B. Amyotrophic lateral sclerosis
HCO3 24 mEq/L C. Poliomyelitis
BE +2 D. Cystic fibrosis
Which of the following is the best action to take at
this time? 84. Which of the following respiratory signs would
A. Decrease the flow be considered abnormal in an adult patient who is
B. Decrease the FiO2 at rest under normal conditions?
C. Decrease the flow and FiO2 together A. Respiratory rate of 18 breaths/min
D. Switch to a standard nasal cannula B. Ribs higher posteriorly than anteriorly at
end-expiration
79. A COPD patient is being discharged, and the C. Scalene muscle usage at rest
doctor wants to prescribe a controller-type D. Costal angle of 90 degrees that increases with
bronchodilator for home use. Which of the inspiration
following medications would you recommend?
A. Albuterol 85. A 22-year-old female patient has been
B. Levalbuterol admitted to the emergency department with
C. Metaproterenol acute bronchospasm. Which of the following
D. Brovana medications would you recommend?
A. Albuterol (Proventil)
80. Upon assessment of a high-risk infant, you B. Racemic epinephrine
note bradycardia and spells of apnea. Which of C. Cromolyn sodium (lntal)
the following would you recommend? D. Acetylcysteine (Mucomyst)
A. Surfactant replacement therapy
B. Nasal CPAP 86. A 54-year-old female patient is receiving
C. Aerosolized bronchodilator ventilatory support in the volume control mode.
D. Mechanical ventilation After performing endotracheal suctioning, which
of the following would indicate effective clearance
81. During the assessment of a 1-week-old infant, of retained secretions?
which of the following signs would indicate that A. A decreased inspiratory time
the infant has an increased work of breathing? B. A smaller tidal volume
A. Pallor C. A lower plateau pressure
B. Nasal flaring D. A lower peak pressure
C. Digital clubbing
D. Acrocyanosis 87. A 59-year-old female patient with COPD is
receiving supplemental oxygen via nasal cannula
at 2 L/min. Her ABG results are as follows:
pH 7.37 A. Start nasal CPAP at 5-8 cmH2O
PaCO2 58 torr B. Increase the oxygen hood concentration to 100%
HCO3- 32 mEq/L C. Intubate and begin mechanical ventilation with
PaO2 58 torr PEEP
SaO2 85% D. Obtain a chest X-ray to look for a pneumothorax
Based on this data, which of the following would
you recommend? 91. A 56-year-old female patient’s bedside
A. Increase the oxygen flow to 3 L/min spirometry results are as follows:
B. Switch to BiPAP with an FiO2 of 100% FVC is decreased
C. Switch to a nonrebreathing mask at 10 L/min FEV1 is normal
D. Switch to an air entrainment mask at 24% FEV1% is increased
Which of the following best describes this patient?
88. A postoperative adult patient is being treated A. Normal results
with incentive spirometry. The patient’s B. Obstructive disease
inspiratory capacity has decreased over the past C. Poor patient effort
few days, and their level of dyspnea has been D. Restrictive disease
increasing. A chest x-ray reveals consolidation in
the lung bases with no shift of the trachea. Which 92. An 11-year-old boy has just arrived in the ER
of the following has most likely developed? with cystic fibrosis and a pulmonary infection.
A. Pneumonia Upon assessment, you note very thick secretions.
B. Pleural effusion Which of the following drugs would you
C. Atelectasis recommend for this patient?
D. Pneumothorax A. Nebulized acetylcysteine
B. Nebulized dornase alpha
89. A postoperative neurosurgical patient is C. Nebulized 0.9% saline
receiving mechanical ventilation and has an D. Direct instillation of acetylcysteine into the lungs
intracranial pressure of 20 mmHg but is otherwise
stable. Their ABG results are as follows: 93. A 64-year-old male patient is intubated and
pH 7.31 receiving ventilatory support in the
PaCO2 48 mmHg volume-controlled SIMV mode. The physician
HCO3 24 mEq/L anticipates that the patient will be on the
PaO2 88 mmHg ventilator for another 3–5 days. Which of the
SpO2 95% following would you recommend?
Based on this information, which of the following A. Switch the patient to NPPV
would you recommend? B. Switch from an ET tube to a tracheostomy
A. Increase the minute ventilation C. Maintain the endotracheal tube in place
B. Add 10 cmH2O of PEEP D. Switch to a pressure-controlled mode
C. Decrease the tidal volume
D. Maintain the current settings 94. An adult patient in the ICU receiving
mechanical ventilation has been diagnosed with
90. A newborn 28-week gestational age neonate is ARDS. Which of the following would you expect to
being treated in an oxygen hood with an FiO2 of find in this patient?
50%. The physician believes that the patient has A. Refractory hypoxemia
infant respiratory distress syndrome. The B. Metabolic alkalosis
following blood gas results were obtained: C. Increased lung volumes
pH 7.36 D. Increased compliance
PaCO2 38 mmHg 95. You were called to obtain a forced vital
HCO3 25 mEq/L capacity maneuver on an adult patient with
BE 0 mEq/L normal lungs. What percentage should the patient
PaO2 46 mmHg be able to exhale within the first second of the
Based on this information, which of the following maneuver?
would you recommend? A. 35-50% of the FVC
B. 50-70% of the FVC D. It can completely prevent the aspiration of gastric
C. 70-83% of the FVC contents
D. 84-93% of the FVC
100. A neonate with meconium aspiration
96. The physician has ordered 2.5 mL ipratropium syndrome is receiving mechanical ventilation. If
bromide TID for a 70-year-old female patient with you were to increase the pressure limit, this
COPD and bronchospasm. Which of the following would increase the risk of which of the following?
methods would you recommend in order to A. Pneumothorax
deliver the medication? B. Oxygen toxicity
A. Dry powder inhaler C. Tracheoesophageal fistula
B. Ultrasonic nebulizer with a mask D. Retinopathy of prematurity
C. Small volume nebulizer with a mask 101. An adult patient is receiving mechanical
D. Small volume nebulizer with a mouthpiece ventilation with a PEEP setting of 10 cmH2O, but
the physician has requested to increase the
97. A 52 kg female patient is receiving volume setting to 14 cmH2O. After making the
control A/C mechanical ventilation with a tidal adjustment, there is a rapid drop in the patient’s
volume of 400 mL, a set rate of 10/min, and an blood pressure and a significant increase in heart
FiO2 of 35%. Her blood gas results are as follows: rate. Which of the following actions should you
pH 7.31 take?
PaCO2 49 torr A. Increase the FiO2 by 10%
HCO3 24 mEq/L B. Lower the PEEP back to 10 cmH2O
BE -2 mEq/L C. Administer sodium bicarb
PaO2 74 torr D. Obtain a stat EKG
SpO2 95%
Which of the following changes would you 102. After reviewing the results of a patient’s
recommend? pulmonary function tests, you note that the FEV1,
A. Increase the FiO2 FVC, and total lung capacity are all decreased. The
B. Increase the tidal volume FEV1/FVC ratio is normal. Which of the following
C. Increase the set rate best describes these findings?
D. Maintain the current settings A. Restrictive lung disease
B. Obstructive lung disease
98. An arterial blood gas sample needs to be C. Combined obstructive-restrictive lung disease
obtained from a newborn infant. The physician D. The test is invalid
ordered the sample from arterialized capillary
blood because the artery would be too difficult to 103. While reviewing the chest x-ray of a
stick. Which of the following sites would you 47-year-old male patient, you note that the heart
recommend? is shifted to the patient’s right. Which of the
A. The fingertip following is the most likely cause of this finding?
B. The toe tip A. Atelectasis of the left side
C. The lateral area of the heel B. Tension pneumothorax on the left side
D. The earlobe C. Tension pneumothorax on the right side
D. Pleural effusion on the right side
99. Which of the following is true regarding the
insertion of a laryngeal mask airway compared to 104. An ABG was ordered for a 68-year-old female
endotracheal intubation? patient with a history of COPD. Before entering
A. It must be removed in order to insert an the patient’s room, you must first gather all the
endotracheal tube necessary supplies. Which of the following is
B. It poses a greater risk of trauma than endotracheal required in order to perform an arterial puncture?
intubation A. Sterile gloves
C. It can be inserted blindly without any special B. Lancet
equipment C. Local anesthetic
D. Anticoagulant
 This finding is typical in which of the following
105. While assessing a 51-year-old male patient, conditions?
you note the definitive use of neck muscles during A. Emphysema
normal breathing. This finding is consistent with B. Pneumothorax
which of the following? C. Pulmonary edema
A. Pulmonary embolism D. Chronic bronchitis
B. Myasthenia gravis
C. COPD 110. A 43-year-old male patient was admitted to
D. Orthopnea the emergency department with a suspected drug
overdose. The patient is receiving oxygen via
106. A 58-year-old female is receiving volume nonrebreather but is unconscious and isn’t
control A/C ventilation at a rate of 12/min with a making any respiratory efforts to breathe. The
tidal volume of 450 mL. The FiO2 is set at 40%, and patient’s body weight is 57 kg, and his ABG results
her ABG results are as follows: are as follows:
pH 7.35 pH 7.28
PaCO2 44 torr PaCO2 74 torr
HCO3 22 mEq/L HCO3 20 mEq/L
BE 0 PaO2 315 torr
PaO2 91 torr Which of the following would you recommend?
SaO2 97% A. Apply BiPAP with: IPAP 20 cmH2O, EPAP 5 cmH2O,
Based on this information, you should FiO2 30%
recommend which of the following? B. Intubate and apply: SIMV, tidal volume 600 mL, rate
A. Decrease the minute ventilation 6/min, FiO2 40%
B. Discontinue mechanical ventilation C. Intubate and apply: A/C ventilation, tidal volume
C. Administer IV bicarbonate 450 mL, rate 12/min, FiO2 50%
D. Maintain the current settings D. Apply CPAP at 10 cmH2O and an FiO2 of 100%

107. You were called to perform a set of FVC tests 111. A 63-year-old female patient is orally
on a 55-year-old male patient. While looking at the intubated with a size 7 endotracheal tube and is
results of the first attempt, you determined that receiving ventilatory support. While attempting to
it took too long for the patient to reach the peak suction the patient with a size 12 Fr catheter, the
expiratory flow. Before another attempt is catheter cannot pass beyond the tip of the tube.
performed, which of the following instructions Which of the following is the most likely cause of
should you give the patient? this problem?
A. “Take a deeper breath.” A. There is a kink in the tube
B. “Don’t hesitate.” B. The tube is in the right mainstem bronchus
C. “Blast the air out faster.” C. The suction catheter is too short
D. “Blow out longer.” D. The suction catheter size is too large

108. A 2-year-old girl is showing signs of a severe 112. A patient in the ICU is receiving positive
asthma attack. The physician has ordered a pressure ventilatory support but appears to be
short-acting bronchodilator medication that is breathing asynchronously with the
available in both MDI and SVN doses. Which of the machine-delivered breaths. Which of the following
following delivery methods would you medications would you recommend?
recommend for this patient? A. Fluoxetine (Prozac)
A. An SVN using the “blow by” technique B. Midazolam (Versed)
B. An MDI with a holding chamber and mask C. Dextroamphetamine (Dexedrine)
C. A small volume nebulizer with a mouthpiece D. Cisatracurium (Nimbex)
D. A breath-actuated MDI with a mask
113. A 59-year-old female patient has a vital
109. During the assessment of a 60-year-old male capacity of 3.4, a functional residual capacity of
patient, you noticed increased tactile fremitus. 5.8, and an expiratory reserve volume of 1.2. What
is the patient’s total lung capacity? exhaled tidal volume of 320 mL. The patient is
A. 5.9 awake but is unable to follow commands. Which
B. 6.8 of the following would you recommend at this
C. 8.0 time?
D. 8.8 A. Extubate the patient
B. Pressure control ventilation
114. A 69-year-old male patient with tachypnea, C. Pressure support ventilation
dyspnea, and expiratory wheezes did not improve D. Volume control ventilation
after receiving a bronchodilator treatment. Which
of the following most likely describes the patient’s 119. The physician has requested a mode of
condition? ventilation in which you can maintain a precise I:E
A. Asthma ratio. Which of the following modes would you
B. Chronic bronchitis select?
C. Congestive heart failure A. Synchronous Intermittent Mandatory Ventilation
D. Emphysema B. Control Mode Ventilation
C. Assist-Control Ventilation
115. An adult patient was admitted to the D. Pressure Support Ventilation
emergency department with chest trauma after a
motor vehicle accident. Upon assessment, you 120. While administering an adrenergic aerosol
note crepitus in the upper chest area. This finding bronchodilator treatment to an adult female
indicates which of the following? patient, you notice an increase in pulse rate from
A. A mucus plug is present 81 to 125 beats/min. Which of the following
B. Subcutaneous emphysema actions should you take?
C. Pleural effusion A. Use half of the standard dosage next time
D. Tactile fremitus B. Add more diluent to the nebulizer chamber
C. Temporarily stop the treatment until the patient’s
116. During the assessment of a 64-year-old heart rate decreases
patient who is receiving volume-controlled D. Stop the treatment and notify the physician
ventilation, you note that the peak airway
pressure has decreased from 36 to 19 cmH2O. 121. You are called to review the electrolyte
There have been no changes to the ventilator results of a 60-year-old female patient. Which of
settings. Which of the following would you the following values is typical for serum
recommend? potassium?
A. Increase the tidal volume setting until the pressure A. 2.7 mEq/L
equals 36 cmH2O B. 3.2 mEq/L
B. Increase the flow setting until the pressure equals C. 4.1 mEq/L
36 cmH2O D. 5.8 mEq/L
C. Check for increased secretions and suction if
needed 122. A 41-year-old female patient is showing signs
D. Check the circuit for leaks of wheezing. Asthma is suspected; however, a
diagnosis has not yet been confirmed. Which of
117. What is the maximum volume of air that can the following tests would you recommend in
be inhaled after a normal, quiet inspiration? order to obtain confirmation?
A. FVC A. Airway resistance
B. FRC B. Flow-volume loop
C. IRV C. Bronchoprovocation study
D. ERV D. Pre-and-post bronchodilator study

118. A 59-year-old male patient who weighs 75 kg 123. A 4-year-old child has been admitted to the
is intubated and receiving mechanical ventilation. emergency department with wheezing and
During a CPAP spontaneous breathing trial, the stridor. An AP x-ray shows an area of prominent
patient has a respiratory rate of 14 and an subglottic edema, but the lateral neck x-ray
appears normal. Which of the following is most endotracheal tube. Over the past hour, the
likely the problem? patient has been compressing the tube between
A. Cystic fibrosis his teeth. Which of the following would you
B. Foreign body recommend?
C. Epiglottitis A. The application of a Brigg’s adapter
D. Croup B. The use of a bite block
C. The administration of a neuromuscular blocking
124. A 63-year-old female patient is receiving agent
volume-controlled A/C ventilation and has D. The administration of a strong narcotic analgesic
become agitated. Over the past 3 hours, her
PaCO2 has decreased from 38 to 27 torr. Which of 129. Hemodynamic data was collected on a
the following is the most likely cause of this 39-year-old male patient. Which of the following
problem? would be indicative of a potential problem?
A. High body temperature A. Shunt of 3%
B. Increased ventilation B. SVR of 500 dyn/s/cm-5
C. Increased cardiac output C. Cardiac Index of 3.7 L/min/m2
D. Mainstem intubation D. CVP of 5 cmH2O

125. A 64-year-old male patient is receiving an 130. A 65-year-old female patient with pulmonary
aerosol treatment with acetylcysteine and edema was inadvertently administered 1,000 mL
hypertonic saline via a small volume nebulizer. of IV fluids instead of the ordered amount of 100
After only a few minutes, the patient suddenly mL. Which of the following would you expect to
becomes dyspneic. Which of the following is the see in this case?
most likely cause of this problem? A. Increased PaO2
A. Hypercapnia B. Decreased PAP
B. Pneumothorax C. Increased PCWP
C. Fluid overload D. Decreased lung markings on the chest x-ray
D. Bronchospasm
131. A postoperative patient using a mouthpiece
126. An adult patient who is receiving mechanical positive pressure ventilator has an inspiratory
ventilation has a peak airway pressure of 60 time that is prolonged, and the machine does not
cmH2O and a plateau pressure of 45 cmH2O. The cycle off without an active patient effort. Which of
ventilator flow rate is set at 60 L/min. What is the the following would you recommend in order to
patient’s airway resistance? correct this problem?
A. 5 cmH2O/L/sec A. Increase the control pressure
B. 15 cmH2O/L/sec B. Decrease the sensitivity setting
C. 30 cmH2O/L/sec C. Check for a leak in the circuit or mouthpiece
D. 60 cmH2O/L/sec D. Switch the unit to a 100% source gas

127. A 69-year-old male patient with a severe 132. You are called to administer nebulized
obstructive airway disease is intubated and albuterol to a 47-year-old female patient who is
receiving ventilatory support. Which of the receiving oxygen via nasal cannula at 2 L/min. Her
following capabilities would be the most pre-treatment heart rate was recorded at 84
important to consider when selecting a ventilator beats/min. You would stop the treatment once
for this patient? the patient’s heart rate reaches which of the
A. Approved for use during MRI procedures following levels?
B. The ability to compensate with tube flexibility A. 89 beats/min
C. The ability to run on a 12 volt DC (battery) power B. 99 beats/min
D. A variable flow control and adjustable I:E ratio C. 109 beats/min
D. 119 beats/min
128. A 49-year-old male is intubated and receiving
mechanical ventilation with a size 7.5
133. A 69-year-old female patient with advanced the distance covered
COPD is receiving supplemental oxygen. Which of D. Walk for 1 mile and record the time it took to cover
the following is a problem that could arise under that distance
such circumstances?
A. Hypoventilation 138. You are called to increase the expiratory time
B. Hyperventilation of a patient receiving volume-controlled
C. Retinopathy of prematurity ventilation without altering the minute
D. The development of pulmonary edema ventilation. Which of the following settings would
you adjust?
134. Simple spirometry can be used to measure A. Rate of breathing
any of the following EXCEPT: B. Inspiratory flow
A. Tidal volume C. Tidal volume
B. Vital capacity D. Trigger sensitivity
C. Inspiratory reserve volume
D. Residual volume 139. Spirometry tests were performed on a
52-year-old female with the following results: TLC
135. A 74 kg male patient is intubated and 136% predicted, RV 165% predicted, FVC 53%
receiving volume control A/C ventilation with the predicted, FEF25-75 37% predicted, and FEV1/FVC
following settings: FiO2 of 50%, set rate of 15, and 28% predicted. What is the interpretation of this
tidal volume of 550 mL. The patient’s total data?
respiratory rate is 29 breaths/min, and his ABG A. Mild restrictive lung disease
results are as follows: B. Mild obstructive lung disease
pH 7.53 C. Severe restrictive lung disease
PaCO2 27 torr D. Severe obstructive lung disease
HCO3 23 mEq/L
BE -2 140. In order for a home-care patient to disinfect
PaO2 82 torr their respiratory care equipment, which of the
SaO2 97% following would you recommend?
Which of the following would you recommend? A. Warm, soapy water
A. Increase the FiO2 B. Cool, soapy water
B. Increase the ventilator rate C. Ethylene oxide
C. Increase the tidal volume D. Acetic acid
D. Add mechanical deadspace
141. A 66-year-old female patient is receiving
136. A high-flow nasal cannula has been ordered ventilatory support in the SIMV mode with an
for a 44-year-old female patient. In order to set up FiO2 of 40% and a PEEP of 10 cmH2O. Over the
this device, you would need all of the following past hour, her SpO2 has decreased from 94% to
EXCEPT? 81%. Which of the following would you
A. Blender recommend FIRST?
B. Humidifier A. Change to VC, A/C
C. Sterile saline B. Increase the PEEP
D. Air and oxygen source C. Increase the FiO2
D. Increase the flow
137. A 53-year-old female patient was ordered to
perform a 6-minute walk test during pulmonary 142. A 26-year-old female patient was admitted to
rehabilitation. Which of the following instructions the emergency department with signs of status
would you give? asthmaticus. Which of the following drugs would
A. Walk as slow as possible for 6 minutes and record you recommend to be administered via
the distance covered nebulization?
B. Walk as fast as possible for 6 minutes and record A. Levalbuterol
the distance covered B. Montelukast
C. Walk as far as possible for 6 minutes and record
C. Beclomethasone C. Decreased total lung capacity
D. Magnesium sulfate D. Decreased diffusing capacity

143. While reviewing the chest x-ray of an adult 148. While assisting with a bronchoscopy
patient, it shows that there is a shift of the procedure, the physician requests a drug for
trachea and mediastinum to the patient’s left direct instillation into the endotracheal tube.
side. There is also a complete opacification of the Which of the following would you recommend?
left side. These findings indicate which of the A. Lidocaine
following? B. Liquid Heparin
A. Diffuse pulmonary emphysema C. Ipratropium bromide
B. Right-sided pleural effusion D. Saline
C. A pneumothorax of the right lung
D. Atelectasis of the left lung 149. An 8-year-old female with asthma was
prescribed Proventil via metered dose inhaler for
144. A premature newborn infant with an Apgar home use. Which of the following would you
score of 3 is showing signs of hypoxemia, grunting, recommend for this patient?
and intercostal retractions. Which of the following A. Add a spacer or holding chamber to the MDI
would you recommend? B. Remove the mouthpiece from the MDI
A. Suction the neonate C. Have the child inhale as quickly as possible
B. Nebulize albuterol D. Switch from an MDI to a DPI
C. Provide supplemental oxygen
D. Instill surfactant into the airway 150. A 53-year-old female patient with COPD is
receiving volume-controlled A/C ventilation.
145. The physician has requested to change the Rhonchal fremitus was felt over the central
airway of a patient from an endotracheal to airways, and wheezing was heard in all lung fields.
a tracheostomy tube. Which of the following is the The patient has thick secretions, a peak pressure
primary indication for the insertion of a of 45 cmH2, and a plateau pressure of 20 cmH2O.
tracheostomy? Which of the following would you recommend?
A. When a patient loses pharyngeal or laryngeal A. Cromolyn sodium (Intal)
reflexes B. Triamcinolone (Azmacort)
B. When a patient has a long-term need for C. Levalbuterol (Xopenex)
mechanical ventilation D. Pancuronium bromide (Pavulon)
C. When a patient is susceptible to hemorrhaging
D. When a patient has upper airway obstruction due 151. A 33-year-old male patient was admitted
to trauma after escaping a house fire. Which of the following
would you recommend?
146. The physician has requested to decrease the A. Nonrebreathing mask
PaCO2 of a patient who is receiving B. CPAP mask at 8 cmH2O and 50% O2
high-frequency oscillatory ventilation. Which of C. Simple mask at 6 L/min
the following settings should you adjust? D. 60% air entrainment mask
A. Increase the frequency
B. Decrease the bias flow 152. The physician orders a dry powder inhaler for
C. Increase the power/amplitude an adult patient who is being discharged. The
D. Increase the mechanical deadspace patient has never used an inhaler before. Which
of the following instructions would you provide?
147. While reviewing your worklist, you noticed A. Blow slowly into the device
that one patient was diagnosed with chronic B. Hold the device vertically after loading
bronchitis and another with emphysema. Which of C. Inhale rapidly for 1–2 seconds
the following PFT findings would you expect for D. Breathe normally in and out of the device
these patients?
A. Increased lung compliance 153. Which of the following instructions would you
B. Decreased forced expiratory flows give an adult patient who is about to perform a
maximum expiratory pressure test for the first B. Level with the 5th cervical vertebra
time? C. At the sixth intercostal space
A. “Take a normal breath in, then blow out hard.” D. 1–2 inches above the carina
B. “Inhale as much as you can, then blow out hard.”
C. “Exhale normally, then inhale as hard as possible.” 158. An adult patient is receiving ventilatory
D. “Blow out all of your air before you begin.” support in the pressure-controlled A/C mode at a
rate of 10/min and peak pressure of 35 cmH2O.
154. An EKG was performed on a newly admitted The following ABG results were obtained:
66-year-old female patient. While reviewing the pH 7.31
results, there are no identifiable P waves, and the PaCO2 49 torr
patient has an irregular ventricular rhythm. SaO2 96%
Which of the following is most likely the problem? HCO3 23 mEq/L
A. Atrial fibrillation BE -2 mEq/L
B. Ventricular tachycardia Which of the following would you recommend?
C. 1st-degree heart block A. Increase the FiO2
D. 2nd-degree heart block B. Increase the rate
C. Change the patient to CPAP
155. A 61-year-old female patient is receiving D. Make no changes at this time
mechanical ventilatory support. Over the past
three days, her fluid intake has stayed the same, 159. The physician has ordered ribavirin (virazole)
but her output fluid level measurements have via aerosol for an infant with severe RSV. Which of
been decreasing. Her peak airway pressure has the following devices would you recommend for
been steadily increasing over this same time administration?
period. Which of the following is the most likely A. Small particle aerosol generator
cause of this problem? B. Small volume jet nebulizer
A. Ventilator-associated pneumonia C. Vibrating mesh nebulizer
B. Acute respiratory distress syndrome D. Dry powder inhaler
C. Pulmonary arterial hypertension
D. Cardiogenic pulmonary edema 160. The status of a 56-year-old male patient has
gotten worse over the past 2 hours. He was
156. A 58-year-old postoperative male who weighs switched from an air entrainment mask to a
172 lbs is receiving volume control A/C ventilation nonrebreather and is now receiving ventilatory
at a rate of 16/min, tidal volume of 550 mL, and support with the following settings:
FiO2 of 40%. His ABG results are as follows: Assist/Control rate 12
pH 7.51 Tidal volume 650 mL
PaCO2 30 torr FiO2 100%
HCO3 23 mEq/L PIP 40 cmH2O
BE -1 Plateau pressure 35 cmH2O
PaO2 117 torr The patient’s arterial blood gas results are as
SaO2 99% follows:
Based on this information, which of the following pH 7.42
would you recommend? PaCO2 35 torr
A. Discontinue mechanical ventilation PaO2 54 torr
B. Administer IV bicarbonate SpO2 84%
C. Increase the peak flow setting HCO3- 23 mEq/L
D. Decrease the minute ventilation Which of the following best represents the status
of this patient?
157. A chest x-ray was ordered to confirm that the A. Cystic fibrosis
endotracheal tube is positioned in the correct B. Acute metabolic alkalosis
place. Where should the tip of the tube be C. Hypoventilation from fatigue
located? D. Intrapulmonary shunting
A. Even with the carina