A patient with two rib fractures on the right side complains of severe pain on inspiration while performing an incentive spirometry procedure. The respiratory therapist should:

a. stop the therapy and inform the physician

b. continue the therapy anyway

c. tell the patient to relax until the pain goes away and continue the therapy

d. change the type of incentive spirometer being used

When receiving a new IPPB order, the respiratory therapist should first:

a. prepare the medication

b. start the treatment with low pressure

c. explain the treatment to the patient

d. review the patient's chart

Which of the following is the correct maneuver for performing Incentive spirometry?

a. perform a peak inspiratory flow

b. perform a sustained maximal inspiration

c. perform a sustained maximal expiration

d. perform ten rapid and deep breaths

As the patient inhales, the effort required to activate an IPPB machine (cycle it on) is called:

a. sensitivity

b. flow

c. inhalation trigger

d. pressure setting

While using the Bird Mark VII for an intermittent positive pressure breathing treatment you notice the delivered tidal volume is not sufficient. What changes can you make to correct the problem?

a. increase the sensitivity

b. increase the pressure

c. increase the volume

d. increase the flow

A decrease in PC02 can be caused by an increase in all of the following except:

a. rate

b. Tidal Volume

c. Alveolar Volume

d. Physiologic Dead - Space

Which of the following best describes the Coanda effect?

a. The parallel flow of a gas through a tube owing to its laminar characteristics

b. The movement of a gas through a tube owing to negative pressure

c. The increase in gas velocity owing to an increased driving force

d. The increase in gas flow owing to a decrease in tube diameter

e. The attachment of a gas to a wall owing 'o turbulence

Tidal volume would be best defined as:

a. Peak flow divided by I time

b. Minute ventilation divided by peak flow

c. Minute ventilation times respiratory rate

d.Inspiratory time times peak flow

A patient is being mechanically ventilated with a ventilator classified as a pressure controller. How will the patient's tidal volume be affected if the patient's lung compliance decreases?

a. The tidal volume will be unaffected

b. The tidal volume will increase

c.The tidal volume will decrease

d. The tidal volume will fluctuate with each breath

A patient is being mechanically ventilated on a volume-cycled ventilator in the control mode. The low pressure alarm is sounding. This may be the result of which one of the following?

a. Water in the tubing

b. Patient disconnected from the ventilator

c. Secretions in the patient's airway

d. Kink in the ventilator tubing

If a patient on a ventilator is set up in such a way for the inverse I:E ratio alarm to be activated, what ventilator change could be made to correct this breathing pattern?

a. Decrease flowrate

b. Increase flowrate

c. Increase tidal volume

d. Increase respiratory rate

A patient is breathing spontaneously on a 60% aerosol mask with the following   arterial blood gas results:

pH - 7.36           v PC02 - 43 torr HC03 - 24 mEq/L P02 - 48 torr   11-11

Based on this information, the respiratory care practitioner should recommend which of the following?

a. Place on CPAP

b. Increase oxygen percentage to 80%

c. Place on nonrebreathing mask

d. Intubate and place on tidal volume of 800 ml.

A patient is being mechanically ventilated on the following settings:

Tidal volume - 750 ml Respiratory rate - 12/min Mode - assist - control PEEP - 10 cm H2O ' F102-0.60 U00

Arterial blood gas results on these settings are:

PH - 7.41 PC02 - 38 torr P02 -174 torr

Based on the above information, what would be appropriate ventilator change?

a. Decrease PEEP    b Decrease F102

c. Increase mechanical dead space    d. Decrease tidal volume

What is the most sensitive indicator of acid/base balance?

a. PH

b. HC03

c. PC02

d. Base excess

Which of these airway changes will affect the delivered tidal volume on a pressure-limited ventilator?

I.          decreased lung compliance

II.          increased lung compliance

III.      increased airway resistance

a. I only   b. I and II only c.  I and III only    d. I, II and III

An increase in airway resistance will cause:

a. both the peak and plateau pressures to increase

b. both the peak and plateau pressure to decrease

c. peak pressure to increase and allow the plateau pressure to remain unchanged

d. peak pressure to decrease and plateau pressure to increase

Humidity for an intubated patient who is breathing spontaneously would be best provided by:

a. cool aerosol

b. heated ultrasonic nebulizer

c. high humidity diffuser 

d. heated large reservoir jet nebulizer

Peep is used to:

1. decrease the QS/QT

2. decrease venous return

3. increase the Pa02

4. increase the FRC

5. increase the tidal volume

a. 1,2,4 and 5      b. 1 and 2        c. 1,2 and 4        d. 1,3 and 4

Vesicular breath sounds during mechanical ventilation are most compatible with:

a. normal respiration
b. pneumothorax

c. atelectasis

d. consolidation

Before placing the patient on a mechanical ventilator the practitioner should set the:

1 tidal volume

2 respiratory rate

3 Fi02

4 low pressure limit

5 high pressure limit

a. 1,2,3 and 5    b. 1,2 and 4     c. 1 and 2 only   d. 1,2and3

When observing your mechanically ventilated patient at the bedside, you notice that the patient appears to be trying to continue to exhale when the next ventilator breath begins. You suspect that auto-PEEP is occurring. Which of the following would NOT be recommended to treat auto-PEEP?

a. Lower the tidal volume

b. Reduce the mechanical respiratory rate

c. Increase inspiratory time

d. Increase inspiratory flow rate

If the high rate alarm is sounding on the mechanical ventilator what should the practitioner be most concerned about:

a. metabolic alkalosis

b. increased venous return

c. increased hyperinflation (air trapping)

d. hypoventilation

A postoperative patient who is awake and alert has just been removed from mechanical ventilation. The patient has the following values:

tidal volume 350 ml: respiratory rate of 16 vital capacity of 2.6 L

You would suggest:

a. CPT

b. CMV 

c.  IS

d. IPPB with saline

If the tidal volume is 900 ml, the respiratory rate is 1,2 and the peak flow is set at 60 Ipm. What is the I-E ratio? 

a. 1-2.2

b. 1-3.4

c. 1-4.5

d. 1-5.2

A patient with head trauma is on the Bear 2 ventilator in the control mode. To maintain intracranial pressure within normal limits, the respiratory care practitioner should recommend which of the following?

I. maintain Paco2 at 25 to 30 torr

II. use short inspiratory times

III. use high peak pressure

a. I only    b. I only     c. I and Il only    d. II and III only

A patient is admitted to the emergency room in respiratory distress with respiratory rate = 40/min., Vt = 280ml, PaCO2 = 50, Pa02 = 45, F102 = 0.21. You would recommend:

a. mask CPAP

b. mechanical ventilation

c. oxygen therapy

d. bronchodilator therapy

An 80 kg patient has a tidal volume of 1250 cc and a respiratory rate of 8.ABG's show: PH 7.53, PC02 27, HC03 22 and P02 92. You would suggest:

a. decrease the respiratory rate  

b. decrease the tidal volume

c. decrease the peep    

d. decrease the Fi02

A 66 kg patient is on a ventilator with a tidal volume of 900 ml, respiratory rate of 8, an F102 of 80% and a peep of 5 cm/ H2O. ABG's show:

Ph7.31   PC02 54 mm/hg   HC03 26 meq/1   Pa02 51

You would suggest:

a. increase the tidal volume and increase the F102

b. increase the peep to 10 cm/h20 and increase the F102 90%

c. increase the F102 to 100%

d. increase the peep to 10 cm/h20 and increase the rate to 10

Objective findings to be charted in SOAP format following chest physiotherapy would include:

1 the patients feeling of well being

2 the patients complaint of shortness of breath

3amount and color of sputum produced

4 pre and post spirometry

5 auscultation of breath sounds

a. 1,2 and 5     b. 1 and 2      c. 4 only        d. 3,4 and 5

A volume ventilator is set to cycle on at a respiratory rate of 12 BPM. The LE ratio is 1:1.5. Which of the following inspiratory and expiratory times are correct?

Inspiratory                 Expiratory

a. 1.0 seconds        2.5 seconds

b. 1.5 seconds        3.0 seconds

c. 2.0 seconds        3.0 seconds

d. 2.5 second          2.5 seconds

A patient is being mechanically ventilated via an endotracheal tube. The patient seems to be in distress,the "first" thing that you should do is:

a. check the volume of the cuff

b. manually ventilate

c. suction the airway

d. extubate the patient

. If you are preparing to place a 50 year old 57 kg female patient onto mechanics' ventilation what tidal volume would you suggest.

a. 500 cc

b. 700 cc

c. 900cc

d. 1000 cc

The patient is considered to be able to be weaned from the ventilator with which of the following values:

VC                        MIP                   Vd/Vt

a. 12-14 cc/kg            -32 cm/h2o            72%

b. 6-9                         -24                       42%

c. 10-15                     -20                        38%

d. 15-18                    -12                         50%

A spirometer is reading 850 ml and represents the volume delivered from the ventilator. The ventilator compliance factor is 4.5 ml per cm H2O, and the peak pressure is 45 cm H2O. The approximate delivered volume to the patient is: 

a. 850 ml       b. 750 ml      c. 650 ml       d. 550 ml

Your patient is instituted onto mechanical ventilation. You notice the patients secretions have decreased dramatically. You would suggest:

1. heated humidification     2. CPT when indicated    3. suction PRN

a. 1 only          b. 2 and 3         c. 1,2 and 3       d. 3 only

Your patient is on CPAP with the following ABGs:

Ph 7.27     PC02 59mm/hg      HC03 26 meq/1       P02 47

What would you suggest?

a. increase the level of CPAP     b. CMV with peep

c. increase the FI02      d. continuous mechanical ventilation

The data shown in the following table were obtained by the RRT monitoring a patient who was receiving volume-cycled positive-pressure ventilation:

TIME             PIP            Pplateau

0700     30 cm H2O        20 cm H2O

0800     32 cm H2O        20 cm H2O

0900     34 cm H2O        20 cm H2O

1000     38 cm 17-12O    20 cm H2O

1100     40 cm H2O        20 cm H2O

How should the RRT evaluate these data?

a. the patient is experiencing retained secretions

b. the patient's lungs are becoming more difficult to inflate

c. the patient is developing intrapulmonary shunting

d. the patient should be given conscious sedation

When you add mechanical dead space to the ventilator circuit:

1. tidal volume will increase

2. rebreathed volume will increase

3. the I-E ratio will decrease

4. inspired C02 will increase

a.   1 and 2       b.  2 and 4         c.  2,3 and 4       d. 1 ,2,3 and 4

What Pa02 would you expect from a 42 year old patient breathing 40% oxygen while on mechanical ventilation:

a. 100 mm/hg 

b. 200 mm/hg

c. 300 mm/hg

d. 400 mm/hg

A 77 kg patient is being mechanically ventilated in the assist-control mode. The tidal volume is set at 750 ml, the rate is 10 and the FI02 is 100%. The ABGs are:

Ph 7.31 - I" PC02 50 mm/hg Pa02 48 mm/hg

You would suggest:

1. increase the tidal volume     2. add 5 cm/h2o PEEP

3. switch to the IMV mode

a. 1 only       b. 1 and 2       c. 1,2 and 3       d. 3 only

Which of the following clinical signs are included in the Apgar score for clinically evaluating a neonate?

I. heart rate

II. ventilatory rate

III. color

IV. reflex irritability

V. muscle tone

a I, II, III, IV, and V        b. I, II and III only     

c. II, IV and V only        d. I, II, IV and V only

The circuit of a mechanical ventilator does all of the following except:

a. allow gas to flow from the ventilator to the patient.

b. adds to the compressible volume of the circuit

c. decreases the actual tidal volume delivered to the patient 

d. changes the FI02 delivered to the patient

While on a mechanical ventilator a patient has an ABG of pH 7.39, PC02 42 mm/hg and a P02 of 84 mm/hg. Following extubation the blood gases change to Ph 7.22, PC02 of 66 mm/hg and the P02 remains 84 mm/hg. The practitioner should realize that his change will:

a. allow the affinity of Hemoglobin for oxygen to decrease

b. make less oxygen available at the tissue level

c. cause the oxyhemoglobin curve to shift to the left

d. have no effect on the oxyhemoglobin curve

While you are administering chromolyn sodium to a patient the patient complains of dyspnea. You should consider adding:

a. albuterol

b. atrovent

c. aerobid

d. asteroid

When using cidex to clean a non disposable ventilator circuit all of the following are true except:

a. It is cidal if soaked for 10 hours

b. it is cidal if heated to 60 degrees centigrade

c. the solution length of time should be monitored

d. equipment should be rinsed in sterile water before use

A patient who has a pulmonary artery catheter inserted has the following arterial and mixed venous blood gas data

Arterial                 Mixed Venous

Sa02 95%             Sv02 70%

Pa02 100 torr        Pv02 40 torr

PaC02 45 torr        PVC02 46 torr

pH 7.40          pH 7.36

HC03 24 mEq/L      HC03 24mEq/L

BE OmEq/L          B.E. OmEq/L

The patient also has a [Hb] of 15 g%

Calculate this patient's C(a-v) 02

a. 4.5 vol%      b. 5.2 vol%       c. 5.9 vol%       d. 6.3 vol%

If an intubated patient has a MIP of 18 cm/h2o you would suggest:

a. CMV     b. IPPB       c.I/S     d. CPAP

While on mechanical ventilation assist control mode rate of 12, tidal volume 850 ml, F102 70%. You notice a total rate of 18. The blood gases are:

Ph 7.51

PC02 29 mm/hg    P02 76 mm/hg      Sat 94% '

You would suggest:

a add deadspace

b. decrease the Fi02

c. increase the flow rate

d. decrease the rate

Which of the following would be required to obtain the Ca02?

1 Ph     2 PaC02      3 Pa02      4 Hb     5 Sa02

a. 3, 4 and 5          b. 4 and 5         c. 1, 3 and 4      d. 4 only

During cardiopulmonary resuscitation, a patient continues to display ventricular fibrillation on the cardiac monitor despite having been defibrillated twice. The physcian is considering defibrillating the patient for a third time and asks the RRT assisting in the resuscitation to recommend an appropriate energy level for the defibrillation. What energy level should the RRT recommend at this time?

a. 200 joules     b. 275 joules     c. 330 joules     d. 360 joules

Cyanosis can be associated with:

a. poor perfusion

b. lack of hemoglobin

c. a high percentage of arterial saturation

If, during suctioning, while on mechanical ventilation you notice the patient' secretions are thick and tenacious you could suggest:

a. mucolytic      

b. bronchodilator

c. albuterol       

d. atrovent

If during an arterial blood gas you notice the patient has practically no reflex this could be defined as:

a. confused

b. stuperous

c. comatose

d. asleep

When a patient is CO poisoned which of the following values would you most expect to remain in the normal range?

a. 02 Saturation   

b. Pa02

c. P A-a 02

d. PC02

Your patient is on mechanical ventilation; the blood gas results show a respiratory acidosis. You should consider:

a. increasing the peak flow rate

b. adding mechanical deadspace 

c. increasing the minute ventilation

 d. changing to the SIMV mode

While adjusting the sensitivity on a mechanical ventilator you are adjusting the:

a. inspiratory time 

b. inspiratory threshold

c. expiratory time

d. peak flow rate

Which of the following would most likely violate the high pressure limit on a mechanical ventilator?

1 increase in minute ventilation

2 decrease in lung compliance

3 endo tracheal tube occlusion

4 increase in inflation of the endo tracheal tube cuff

5 cough

a. 1,2 and 3          b. 1 only           c. 2, 3,4 and 5        d. 5 only

When the practitioner increase the PEEP on a mechanical ventilator, which of the following alarms should also be considered:

a. low flow alarm           

b. high pressure alarm

c. high rate alarm          

d. high FI02

An RRT working in the adult, surgical ICU has been performing ventilator rounds and has charted the ventilator data in the following table from a postoperative laparotomy patient who is receiving mechanical ventilatory support via a microprocessor ventilator.

Time           Peak Inspiratory            Static Pressure Pressure

3:00 pm       30 cm H2O                  19 cm H2O

4:00 pm       33 cm H2O                  18 cm H2O

5:15 pm       35 cm H2O                   20 cm H2O

6:10 pm       37 cm H2O                   19 cm H2O

7:05pm        42 cm H2O                   19 cm H2O

The patient has the following ventilator settings:

tidal volume: 900 cc FI02: 0.40

mode: synchronized intermittent mandatory ventilation (SIMV) ventilatory rate: 6 breaths/minute

What intervention should be implemented at this time?

a. endotrachial suctioning

b. pilot balloon cuff inflation

c. insertion of chest tubes

d. restriction of the high pressure limit

The use of PEEP during mechanical ventilation should:

1 increase lung compliance

2 increase resistance

3 improve arterial blood gases­

4 decrease blood pressure

a. 1 and 4        

b. 2,3 and 4

c. 3 and 4

d. 1,3 and 4

If a patients lung compliance decreases while on mechanical ventilation while on a Seimens 9000 ventilator, you would expect:

a. peak pressure would decrease

b. peak pressure would increase

c. peak flow would decrease

d. peak flow would increase

Which of the following would be a hazard of PEEP?

a. oxygen toxicity

b. absorption atelectasis

c. hypotension     

d. hypercarbia

Cardiac output will decrease during mechanical ventilation when there is:

1 short I

2 long I

3 low pressure

4 high pressure

a. 1 and 3         b. 2 and 4        c. 2 and 3         d. 1 and 4

A patient has the following blood gas:

Ph 7.53

PC02 42 mm/hg HC03 34 meq/1 f nt v­P02 102 mm/hg ?

This would suggest:

a. metabolic alkalosis               b. metabolic acidosis

c. respiratory alkalosis             d. respiratory acidosis

You have been trying to wean a patient from mechanical ventilation. The patient is currently on PSV rate of 12. The patient has the following blood gases:

Ph 7.41      PC02 36 mm/hg     HC03 22 meq/1       P02 67 mm/hg

You would suggest:

a. CMV rate 10

b. CPAP 5 cm/h2o

c. SIMV 8 PEEP 10 cm/h2o

d. CMV rate 5

The respiratory mechanics parameter that measures the elastic resistance of the lungs and chest wall to inflation is:

a. work of breathing

b. airway resistance

c. peak inspiratory pressure

d. compliance

e. vital capacity

Optimum PEEP often correlates best with the maximum:

a. respiratory rate

b. peak inspiratory pressure

c. dynamic compliance

d. end-expiratory pressure 

e. airway resistance

Intermittent mandatory ventilator (IMV) means:

a. volume and rate of all breaths are preset

b. patient breathes preset volumes at his/her own rate

c. positive pressure is maintained throughout the respiratory cycle

d. only part of the inspired breaths are metered and preset

e. the patient is connected to the ventilator by a face mask

The expiratory phase of a patient on a mechanical ventilation might need to be prolonged, thus decreasing the inspiratory / expiratory time ratio, if the patient has:

a. apnea due to a severe head injury

b. neuromuscular paralysis due to botulism (food poisoning)

c. advanced emphysema

d. marked obesity

e. cyanotic congenital heart disease

A patient with respiratory failure caused by which one of the following could have normal lungs:

a. emphysema

b. bronchopneumonia

c. asthma

d. pulmonary fibrosis

e. barbituate overdose

If a patient becomes disconnected from a mechanical ventilator which of the following alarms should alert the practitioner:

1 high pressure

2 low pressure

3 low FI02

4 low exhaled volume

a. 2 only           b. 1,2,3 and 4      c. 2 and 4        d. 2,3 and 4

A mechanically ventilated patient has the following values:

Peak pressure 56 Plateau pressure 22 PEEP 5 cm/h2o Peak flow 801pm Tidal volume 1000m1

What is the static compliance in cc/cmH20 in this case?

a. 30

b. 40

c. 50

d. 60

A patient while being mechanically ventilated has a reduced chest excursion and reduced breath sounds. You would consider adding:

1) PEEP

2) Mechanical Vd

3) Tidal volume

4) Peak flow

a. 1 and 2         b. 1 and 3       c. 4 only           d. 3 and 4

Impedance to airflow would almost certainly be evident in a patient with:

a. head injury

b. bronchospasm

c. muscular dystrophy

d. morphine overdose

e. cervical cord injury

When the 7200 ventilator is in the CPAP mode all the patient breaths are:

a. controlled     

b. spontaneous

c. assisted    

d. prolonged

e. sine wave contoured

A patient is exhaling a tidal volume of 800 ml at a peak inspiratory flow rate of 40 lpm. The peak pressure reading is 24 cmH20, the plateau pressure is 20 cmH20. On the basis of these data the static compliance would be:

a. 40 ml/cmH20

b. 60 ml/cmH20

c. 80 ml/cmH20

d. 100 ml/cmH20

e. 120 ml/cmH20

Calculate the I:E ratio of a patient receiving 1000 ml volumes 10 times a minute at a peak inspiratory flow rate of 30 lpm: 

a. 1/1   

b. 1/2       

c. 1/3

d. 1/4   

e. 1/5

The I:E ratio may have to be very low (about 1/6) for satisfactory ventilation of a patient with:

a. brain disease       

b. obesity        

c. pulmonary fibrosis

d. severe kyphoscoliosis (hunchback)   

e. advanced emphysema

In which ventilator mode would the most work be contributed by the patient:

a. CPAP  

b. Assist/Control

c. SIMV           

d. Pressure Support Control

In control mode with square waveform setting, which Waveform shows a straight -2 0      horizontal line in the inspiratory phase?

a. flow/time     

b. pressure/time

c. pressure/volume      

d. volume/time

e. none of these