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A 30-year-old male with bronchiectasis has coarse bilateral rales with a SpO2 of 90%. Despite good cough effort, he has great difficulty in removing his thick secretion. The respiratory therapist should initiate: A. Chest physiotherapy and oxygen B. A heated humidifier and oxygen therapy C. Bronchodilator therapy D. Aerosolized antibiotics Correct Answer: B. A heated humidifier and oxygen therapy Rationale: Heated humidity helps thin thick secretions, making them easier to clear in patients with bronchiectasis. Following CABG, a 59-year-old’s C(a-v)O₂ increases from 5 to 8. The RT should report to the physician that this patient’s: A. Cardiac output is increasing B. Oxygen consumption is decreasing C. Cardiac output is decreasing D. Pulmonary function is improving Correct Answer: C. Cardiac output is decreasing Rationale: An increase in the arteriovenous oxygen difference indicates reduced cardiac output and less blood flow to the tissues. The respiratory therapist obtains a SpO₂ reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PaO₂ of approximately: A. 45 torr B. 60 torr C. 75 torr D. 90 torr Correct Answer: B. 60 torr Rationale: A SpO₂ of 90% correlates with a PaO₂ of approximately 60 torr on the oxyhemoglobin dissociation curve.
NPPV is contraindicated in: A. COPD exacerbation B. Obstructive sleep apnea C. ARDS D. Neuromuscular disease Correct Answer: C. ARDS Rationale: NPPV is contraindicated in ARDS due to the severity of hypoxemia and likelihood of needing intubation. A 68-year-old patient with advanced emphysema is on 1L/min nasal cannula. ABG: pH 7.34, PaCO₂ 65, PaO₂ 55, HCO₃ 35. What should the respiratory therapist recommend FIRST? A. Begin BiPAP B. Intubate the patient C. Titrate oxygen flow to the nasal cannula D. Administer bronchodilators Correct Answer: C. Titrate oxygen flow to the nasal cannula Rationale: The goal is to maintain SpO₂ at 90% by adjusting oxygen before more invasive steps. To clean and disinfect a bronchoscope, the therapist should: A. Wipe with alcohol B. Soak in alkaline glutaraldehyde for 10 hours C. Autoclave the instrument D. Rinse with saline Correct Answer: B. Soak in alkaline glutaraldehyde for 10 hours Rationale: High-level disinfection requires soaking in an appropriate disinfectant like glutaraldehyde. A CPAP patient’s manometer displays negative pressure during inspiration and SpO₂ drops from 94% to 90%. The therapist should: A. Decrease CPAP pressure B. Add supplemental oxygen C. Increase inspiratory flow to the CPAP system D. Switch to BiPAP Correct Answer: C. Increase inspiratory flow to the CPAP system Rationale: Negative pressure indicates insufficient flow; increasing it ensures proper CPAP delivery.
A. In need of increased FiO₂ B. Ready for a spontaneous breathing trial C. Retaining CO₂ dangerously D. Too weak for weaning Correct Answer: B. Ready for a spontaneous breathing trial Rationale: Normal pH and stable vitals indicate readiness for weaning despite chronic CO₂ retention. Significant airflow reduction during sleep without full apnea is called: A. Obstructive apnea B. Central apnea C. Hypopnea D. Sleep paralysis Correct Answer: C. Hypopnea Rationale: Hypopnea is a partial reduction in airflow during sleep. Pulse and BP variations with respiration in ED patient suggest: A. Pulmonary edema B. Cardiac tamponade C. CHF D. COPD Correct Answer: B. Cardiac tamponade Rationale: Pulsus paradoxus (pulse/BP variation with breathing) is characteristic of tamponade. Maximal inspiration followed by a slow maximal exhalation measures: A. FVC B. PEFR C. MVV D. Slow vital capacity Correct Answer: D. Slow vital capacity Rationale: This maneuver measures slow VC, a key indicator in restrictive lung disease. Initial dose of inhaled nitric oxide (INO) for neonate with RDS is: A. 5 ppm B. 10 ppm C. 15 ppm
D. 25 ppm Correct Answer: C. 15 ppm Rationale: Starting dose for INO therapy in neonates is commonly 15 ppm. Vent settings: VC/AC, VT 400mL, RR 14, FiO₂ 60%, PEEP 10. ABG: pH 7.36, PaCO₂ 47, PaO₂ 50. RT should increase: A. VT B. RR C. PEEP D. FiO₂ Correct Answer: D. FiO₂ Rationale: Low PaO₂ indicates need for increased oxygenation before adjusting other settings. Best device to deliver 80/20 helium-oxygen mixture during acute asthma attack: A. Simple mask B. Nasal cannula C. Nonrebreathing mask D. Venturi mask Correct Answer: C. Nonrebreathing mask Rationale: Nonrebreather allows maximum delivery of Heliox mixture without air entrainment. Low pressure alarm sounds, and manometer reads 6 cmH₂O during inspiration. First action: A. Check for leaks B. Suction airway C. Check exhalation valve D. Reconnect oxygen source Correct Answer: C. Check exhalation valve Rationale: Faulty or stuck exhalation valve may prevent pressure buildup. Home apnea monitoring is NOT indicated in: A. Siblings of SIDS victims B. Infants with apnea of prematurity C. Infants with severe GERD D. APGAR scores of 4 and 6 at delivery Correct Answer: D. APGAR scores of 4 and 6 at delivery Rationale: Low APGARs alone without apnea or other issues don't justify home monitoring.
Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100–250/min? A. Chest physiotherapy B. Positive expiratory pressure (PEP) therapy C. Intrapulmonary percussive ventilation D. Mechanical insufflation-exsufflation Correct Answer: C. Intrapulmonary percussive ventilation Rationale: IPV uses rapid gas bursts to mobilize mucus and improve airway clearance in patients with retained secretions. During review of the medical record prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm³. Based on this finding, what should the therapist do? A. Perform the ABG as normal B. Refuse to perform the ABG C. Hold pressure on the puncture site for a longer time after the sample is collected D. Recommend that an ABG should be performed on the patient only if absolutely necessary Correct Answer: 2 and 4 only Rationale: A platelet count below normal (thrombocytopenia) increases the risk of bleeding. ABGs should be done only if essential, and caution is advised. The respiratory therapist assists with elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. What should the therapist do FIRST? A. Attempt endotracheal suctioning B. Replace the manual resuscitation bag C. Call for physician assistance D. Check for airway obstruction Correct Answer: B. Replace the manual resuscitation bag Rationale: Difficulty compressing the bag suggests malfunction or blockage. The safest and fastest first step is to replace it immediately. A patient receives CPAP at 10 cm H₂O and 0.30 FiO₂ with a heated humidifier set at 40°C. As the gas is delivered to the patient through large bore tubing, which of the following will occur?
- Excess water will rain out
- Humidity deficit will occur
- Relative humidity will decrease
- Relative humidity will remain 100% Correct Answer: 1 and 4 only Rationale: As humidified gas cools in long tubing, condensation (rainout) occurs even though the gas maintains 100% relative humidit While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the A. peak flow meter is clogged. B. patient's asthma has worsened. C. patient is fatigued. D. peak flow meter is accurate.
- ANSWER peak flow meter is clogged. An ICU patient's blood pressure is being continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure? A. Trendelenburg position causes an elevation in blood pressure. B. The tip of the catheter was below the transducer. C. The catheter needed flushing. D. The catheter was kinked.
- ANSWER B. The tip of the catheter was below the transducer.
A 36 year-old fireman was trapped and subsequently rescued from the collapse of a burning building. Which of the following devices would be appropriate to accurately assess his oxygenation status? A. capnograph B. pulse oximeter C. blood gas analyzer D. hemoximeter
- ANSWER D. hemoximeter The patient in ICU Bed 6 is noted to have a meniscus in the left chest with a blunted left costophrenic angle on the morning chest radiograph. On physical exam, the respiratory therapist finds that the breath sounds are decreased on the left with a dull percussion note. What treatment should the therapist recommend? A. Insertion of an anterior chest tube. B. Bronchoalveolar lavage. C. Needle aspiration of the 4th left intercostal space. D. Perform a left posterior thoracentesis.
- ANSWER D. Perform a left posterior thoracentesis. While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should A. replace the cracked humidifier.
B. increase the FIO2 on the air-entrainment mask. C. increase the flow from the flowmeter. D. Remove the bubble humidifier.
- ANSWER D. Remove the bubble humidifier A 44 year old who patient who suffered a cerebral vascular accident has been moved from the Neuro- ICU to the step down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95-88% on a 32% trach collar. His heart rate is 115/min, RR 42/min, and his breath sounds are very diminished. The RT is unsuccessful in attempting to pass a 12Fr suction catheter, the RT should - ANSWER Replace the tracheostomy tube A well-penetrated chest X-ray has which of the following qualities? A. Air bronchograms are prominently displayed. B. Heart borders and pleural spaces are clearly visible. C. Lung parenchyma is black without blood vessels. D. Vertebrae are just visible behind the heart.
- ANSWER D. Vertebrae are just visible behind the heart. A 13 year-old patient in the ED is complaining of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate? A. levalbuterol B. oxygen C. salmeterol D. PEP
B. Take a backup E-size oxygen cylinder. C. Reduce the oxygen flow to 2 L/min during church. D. Insertion of a transtracheal oxygen catheter.
- ANSWER Use a pulse-dose oxygen delivery system. A 48-year-old female is admitted to the ED with diaphoresis jugular venous distention and 3+ pitting edema in the ankles. These findings are consistent with? A. Liver failure B. pulmonary embolism C.Heart failure D. Electrolyte imbalance - ANSWER C. Heart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers breathsounds are absent in the left chest with a hyperresonant percussion note. the trachea is shifted to the right. The patient Hr is 45 bpm respiratory rate is 30 bpm and blood pressure is 60/40 what action to the therapist recommend first? A. Call for a STAT CXR B. Insert a chest tube into the left chest C. Needle aspirate the 2nd intercostal space D. Activate the medical emergency team to intubate - ANSWER C. Needle aspirate the second left intercostal space Emergency situation of a pleural effusion so needle aspirate first and then set up a chest tube all of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa except? A. maintaining cuff pressures between 20- 25 B. Using the minimal leak technique for inflation C. using a low residual volume, low compliance cuff
D. Monitoring intracuff pressures - ANSWER C. Using a low residual volume, low compliance cuff A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend A. continuing the therapy until breath sounds improve. B. administering dornase alpha. C. administering albuterol therapy. D. deep breathing and coughing to clear secretions. - ANSWER D. deep breathing and coughing to clear secretions. A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predictive value what bronchial hygiene therapy would be most appropriate initially? A. Incentive spirometry B. IPPB C. Postural drainage and percussion D. PEP therapy - ANSWER B. IPPB A healthy adult female can ask her what portion of her forced vital capacity in the first second? A.50% B. 60% C. 70% D. 80% - ANSWER D. 80% A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time?
Which of the following patient would most likely benefit from pressure support ventilation? - ANSWER A patient on SIMV with a mandatory rate of 12 and total rate of 24 A patient receiving mechanical ventilation has developed a temperature of 99.9 with prurulent secretions over the last 12 hours. The respiratory therapist has also noticed a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? - ANSWER Obtain a sputum gram stain due to fever and purulent secretions Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing?
- FEV
- PEFR
- FRC
- RV - ANSWER 1. FEV
- PEFR The Respiratory Therapist provide education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar water solution is that the solution will.. - ANSWER Retard bacterial growth A patient who complains of dyspnea is noted to have a dry nonproductive cough. On physical examination breathsounds are diminished on the right, tactile fremitus is decreased and there is a dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from what? - ANSWER Pleural effusion which of the following suction catheters would be appropriate to use for a patient with a size 8.0 endotracheal tube? - ANSWER ID size x 3/ 12 Fr
A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breathsounds are markedly diminished on the left. There is a dullness to percussion on the left, and the trachea a shift to the left. The most likely explanation for the problem is that? - ANSWER The endotracheal tube has slipped into the right mainstem bronchus The Respiratory Therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. Immediate response is to? - ANSWER apply pressure to the site A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to one minute. Which of the following conditions is most likely the cause of this problem? - ANSWER Elevated intracranial pressure what value for the apnea hypoxia index is consistent with mild obstructive sleep apnea? - ANSWER 515 Wall monitoring a newborn, utilizing a transcutaneous monitor the Respiratory Therapist notices a change in PTO2 from 60 to 142 and simultaneously the PTCO2 changes from 37 to 2. What is the most likely explanation for this changes? - ANSWER air leak around the sensor A patient on the general medical word receives oxygen via 28% Air entrainment mask with the flow meter set at 5 L/minute. What is the total flow delivered to the patient? - ANSWER 55L/min Total flow = factor x flow meter setting 28%=10:1 factor of 11 11 x Which of the following measurements is most indicative of congestive heart failure? A. Hr of 120 B. BP 92/ C. PAP 25/
- IV fluid challenge
- positive inotropic agent
- inhaled nitric oxide
- diuretic therapy - ANSWER IV fluid challenge Due to decreased CVP (hypovolemia) What is the primary advantage of volume control ventilation as compared to pressure control ventilation? - ANSWER VC provides a constant minute ventilation bronchial breathsounds heard over the lung periphery indicate what - ANSWER Lung consolidation during a pre-operative evaluation, bedsides barometer he results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted, FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? - ANSWER Normal lung function A 55-year-old male patient is evaluated for pulmonary rehab. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100 bpm and a respiratory rate of 20 breaths per minute. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should. - ANSWER Terminate the procedure immediately Due to increase of hr of 20 At one minute post delivery a newborn has blue extremities with a pink body heart rate of 90 respiratory rate of 20 with a weak cry. Cough reflex is present and there is some flexion in the extremities at five minutes post delivery the infant is completely pink heart rate is 140 respiratory 40 cough reflex is present in the baby is active with a strong cry. What Apgar scores should be assigned? - ANSWER 6 and 10 APGAR Appearance- cyanosis Pulse- <100 > Grimace- coughing and crying Activity- strong or limp
Respirations- regular/crying or slow The Respiratory Therapist is asked to administer 2.5 mg of Albuterol to a patient by a small volume nebulizer. Medication is available in a 0.5% solution. What volume of albuterol should be administered? - ANSWER 0.50 mL A 60 kg patient is mechanically ventilated at the following settings VC AC tidal, volume 500 respiratory rate 12, FiO2 1.0 and peep 10. The patient's peak airway pressure is 60 and his SPO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates Which of the following is the most appropriate action in order to reduce the peak airway pressure? - ANSWER change to airway pressure release ventilation In order to verify the accuracy of a lab, a spirometer device, the respiratory therapist should utilize a - ANSWER 3.0mL syringe while performing diagnostic test, percussion the Respiratory Therapist notes decreased resonance to percussion, which of the following are potential causes of this finding?
- Pneumothorax 2.Pleural effusion
- Pneumonia
- Atelectasis - ANSWER 2.Pleural effusion
- Pneumonia
- Atelectasis Following thoracotomy, a patient on volume control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the waterseal chamber during the inspiratory phase. The respiratory therapist should report this to the physician as: - ANSWER A persistent bronchoplural fistula
