A patient who weighs 80 kg (1801b) is receiving volume-cycled ventilation in the SIMV mode with the following parameters:

Set Vt   800 mL      Set rate 12     PEEP   10 cm water

Pressure support           4 cm water        Spontaneous rate          15

Spontaneous Vt            150 mL

What should the respiratory therapist recommend to minimize the patient's work of breathing (WOB)?

A add an inspiratory hold of .5 second

 B increase the tidal volume

C decrease the set peep value

D increase the pressure support

The flow-triggering option is being used to let the patient initiate SIMV breaths on a volume-cycled ventilator. The PEEP level is set at 10 cm water, and the baseline flow through the circuit is 25 L/min. The respiratory therapist notices that the actual PEEP level is 12 cm water when the patient exhales. What should be done to correct this problem?

A increase the set peep

B decrease the base flow of the flow triggering (flow by)

C increase the peak flow

D decrease the peak flow

When a pulmonary function test is performed on an adult patient, the following results are found:

Tidal volume     500 mL,

IRV       1800 mL

FRC      4000 mL

ERV     1200 mL

Based on this information, what is the patient's total lung capacity (TLC)?

A 5200 ml      B 2800 ml       C 4700 ml      D 6300 ml

A patient diagnosed with Pseudomonas pneumonia is having her respiratory care equipment changed. Her nondisposable large-volume nebulizer must be disinfected. What is the best way to do this?

A send it to autoclave

B wipe it down with 70% alcohol

C wrap it in a bag and place it in gluteraldehyde

D place it in the paterurization machine

An adult patient has an 8-mm ID tracheostomy tube in place. What is the largest suction catheter that should be used to remove secretions?

A 18 fr

B 12 fr

C 10 fr

D  8 fr

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

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 an absolute contraindication for IPPB therapy?

A. subcutaneous emphysema

B. untreated tension pneumothorax

C. tuberculosis

D. closed head injury

E. hemoptysis

The Pressure Control mode is being used to mechanically ventilate a 60-kg (132-1b) patient. The following are noticed during a routine ventilator check:     Set respiratory rate        12/min

Actual respiratory rate    25/min

Exhaled tidal volume     250 mL

Set pressure         20 cm water

Pressure support      5 cm water

What is the best ventilator adjustment to make at this time?

A remove the pressure support

B increase the set rate to 25

C increase the set pressure level

D increase the pressure support to 10 cm h2o

A respiratory therapist is working in the pulmonary function testing laboratory. A calibration check must be performed on a spirometer. Which of the following should be performed?

I. Check the temperature in the laboratory

II. Check for air leaks in the system

III. Check the barometric pressure in the laboratory

IV. Check the volume accuracy with a super syringe .

A. I and II        B. II and IV       C. I, II and III     D. I,II,III and IV

A 45-year-old patient is receiving 10 cm water CPAP by face mask and sitting in the semi-Fowler's position. While the patient is assessed, tracheal deviation to the right and absent breath sounds over the left lung are found. What could be the cause?

A endo tube migrated into right main stem

B a leak in the CPAP

C pneumonia of the left lung

D pneumothorax

While doing equipment rounds, the respiratory therapist hears a high-pitched whistling sound coming from the bubble humidifier connected to the patient's 24% air­entrainment mask. The 02 flowmeter is set at 10 L/min. What should be done?

I. Add water to the humidifier.

 II. Turn down the oxygen flow.

III. Tighten all tubing and equipment connections.

IV. Remove the bubble humidifier.

A I only    B II only    C I and III    D IV only

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

To explain the purpose of an IBE (incentive breathing exercise) to a post-operative abdominal surgery patient, the therapist should tell the patient that the procedure will:

A. prevent pneumonia

B. prevent areas of the lung from collapsing

C. prevent a pneumothorax

D. improve the ventilation to the top of the lungs

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

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

While taking an IPPB treatment with Albuterol medication, the patient starts to complain of feeling dizzy, lightheaded, with tingling in the fingers. What action should the therapist take to correct this problem?

A. tell the patient to breath deeper

B. have the patient hold his breath at peak inspiration

C. tell the patient to wait longer between breaths

D. reduce the FI02 to room air

E. change to another medication

Which of the following is a correct definition of (IPPB) intermittent positive pressure breathing therapy?

A. long-term breathing treatment using above atmospheric pressures with a volume­limited ventilator

B. short-term breathing treatment using sub-atmospheric pressures with a pressure­limited ventilator

C, short-term breathing treatment using above atmospheric pressures with a pressure­limited ventilator

D. short-term breathing treatment using sub-atmospheric pressures with a volume-limited ventilator

Which of the following is NOT correct concerning the delivered tidal volume when administering IPPB therapy?

A.         the IPPB device should deliver tidal volumes of 12 to 15 ml/kg of (IBW) ideal body weight

B.         the delivered tidal volume is dependent on the patient's lung compliance and airway resistance

C.       the delivered tidal volume may be measured with a Wright's respirometer

D.        an increased lung compliance will decrease the delivered tidal volume

What is the function of the terminal flow control on the Bennett PR-2 ventilator?

A: helps cycle the unit off in case of gas leaks

 B. reduces the gas flow to the patient

C. increases the oxygen percentage to the patient

D. helps operate the nebulizer control for the administration of medication

E. it adjusts the peak inspiratory pressure

While performing an IPPB treatment, the patient suddenly complains of right sided chest pain and becomes very short of breath. Upon assessing the patient you note decreased breath sounds on the right side, with tracheal deviation towards the left side. Which of the following disorders would these findings suggest?

A. atelectasis of the right lung

B. right-sided tension pneumothorax

C. apical spontaneous pneumothorax

D. left-sided tension pneumothorax

E. bilateral pleural effusions

Which of the following positions should the patient be placed in to perform (IBE) Incentive Breathing Exercises?

A. supine

B. Sims position

C. semi-Fowlers

D. prone

E. laterally

After assembling the circuit to the Bird Mark VII ventilator, you are unable to make the machine cycle off when occluding the mouthpiece. Which of the following is the most likely cause?

A the gas inlet is plugged

B. there is a leak in the circuit

C. the machine is defective

D. the air/mix control is pulled out

At what point should the respiratory therapist recommend changing from IBE therapy to IPPB therapy for a deteriorating post-op patient?

A. minute ventilation is greater than 15 liters per minute

B. negative inspiratory force becomes less than -35 cmH20

C. vital capacity becomes less than 12 ml / kg

D. the patient is no longer spontaneously breathing

E. oxygen saturations drop below 90%

Incentive spirometry is designed to mimic which aspect of the normal respiratory pattern?

A. grunting

B. sighing

C. coughing

D. breath holding

When using the Bird Mark 7, increasing the flow rate will:

A. increase inspiratory time 

B. decrease inspiratory time

C. no change inspiratory time

D. decrease the delivered pressure

Which of the following are indications for Incentive spirometry?

I. presence of pulmonary atelectasis

II. upper-abdominal surgery

III. thoracic surgery

IV. surgery in patients with chronic obstructive pulmonary disease (COPD)

V. presence of a restrictive lung defect associated with quadraplegia

A. I and II       B. I, II and III       C. 1, II and IV     D, all of the above

Which of the following should not be turned on when setting up the Bird Mark 7 for IPPB therapy?

A. flowrate control

B. sensitivity control

C. inspiratory pressure control

D. expiratory timing device

Which of the following is not a hazard or complication of Incentive spirometry?

A. barotrauma in emphysematous lungs

B. chest discomfort

C. hyperventilation

D. exacerbation of bronchospasms

E. hypoxia, if oxygen therapy is interrupted

If the inspiratory flow of a mechanical ventilator in the pressure control mode is set too high, which ventilation parameter will be adversely affected?

A. Tidal volume

B. Peak inspiratory pressure

C. Mean airway pressure

 D. Trigger sensitivity

E. FI02 will be decreased

Which of the following is a hazard associated with incentive spirometry?

A. Oxygen toxicity

B. Hypercapnia

C. Hypoxemia

D. Hypocapnia

E. Hypovolemia

In reference to "sensitivity" in mechanical ventilation the following is usually meant:

A. The sensitivity of the device to gas flow

B. The sensitivity of the device to pressure changes within the patient's lungs

C. The effort required by the patient to stop the gas flow

D. None of the above

Your patient complains that it is difficult for her to start the IPPB treatment. You would adjust which of the following controls?

A. pressure

B. flow

C. sensitivity

D. expiratory retard

Your patient is having a difficult time keeping a tight seal around the mouthpiece. He complains that the breath is too long and takes the mouthpiece out. To help the PR-II cycle off, you would adjust which of the following?

A. air mix

B. flow

C. sensitivity

D. expiratory retard

Your patient had her spleen removed 2 days ago and is awake and cooperative but is still reluctant to take a deep breath. The physician asks for your recommendation to prevent the development of atelectasis. You would suggest which of the following?

A. small-volume nebulizer with a bronchodilator

B. incentive spirometry

C. intermittent positive pressure breathing

D. bedside spirometry

For incentive spirometry to be most effective, the following should be done:

A. The patient should exhale maximally and hold it for several seconds B. The patient should inhale and hold a vital capacity for 10 seconds

C. A maximum inspiratory capacity breath should be held for several seconds

D. Maximum inspiratory and expiratory efforts should be performed of 10 to 15 seconds

When starting a new IPPB treatment on a patient, you notice that at first the manometer needle on the Bird Mark 7 is in the negative range. It moves into the positive range later during inspiration just before the machine cycles off. What would you do to correct this problem?

A. Increase the flow rate

B. Increase the pressure setting

C. Push the air-mix knob in

D. Tell the patient to inhale faster

An automobile crash victim has a closedrhead injury and increased intracranial pressure. Mechanical ventilation is started with 40% oxygen, a mandatory rate of 16/min and a tidal volume of 850 mL. ABG results on these settings show:

pH 7.48     PaC02 28 torn   Pa02 97 torr

HC03 25 mEq/L       BE 1 mEq/L     Sa02 97%

What should the respiratory therapist recommend at this time?

A decrease the set tidal volume

B decrease the set rate

C decrease the set FI02

D keep the current settings

A decrease in lung compliance 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

A transcutaneous oxygen monitor (Ptc02) is set to operate at body temperature. The probe is placed on the patient's right upper chest. The monitor shows a reading of 50 torr. An ABG sample shows these results:

pH 7.39      PaC02  43 torn       Pa02  95 torr

HC03  26 mEq/L       BE 1 mEq/L     Sa02 97%

What should be recommended to the physician?

A. Heat the probe to above body temp

B. take the Ptc02 value as correct

C. move the probe to the right arm

D. cool the probe to below body temp

A 40-year-old patient is receiving mechanical ventilation with a volume-cycled ventilator. The patient has high resistance to inspiratory air flow, and the physician wants to know what can be done to distribute the tidal volume more evenly. The respiratory therapist should recommend:

A. increase the peak flow

B. add peep

C. consider a brief inspiratory hold

D. change to pressure ventilation

Volume-cycled ventilation is being used to manage an adult patient. When the flow­time curve is evaluated, it is seen that the next tidal volume breath is started before the expiratory flow curve has returned to baseline. Which of the following actions could be taken to correct this ?

I. Increase expiratory time.

II. Decrease the set respiratory rate.

III. Increase the I:E ratio.

IV. Increase the peak flow rate.

V. Remove any mechanical dead space.

A I and II

B II and V

C I, II and IV

D III, IV and V

You are called to assist with the emergency delivery of a preterm infant. After the baby is born, the physician asks you to determine an APGAR score. The respiratory therapist evaluates all of the following except:

A heart rate

B muscle tone 

C breathing pattern

D reflex irritability

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

An adult patient is receiving constant-volume ventilation. The physician wants to assess the patient's airway resistance and lung compliance changes. To do so, the following data are collected:

                                          12 pm        2pm

Exhaled tidal volume         700 mL      700 ml,

PEEP (cm H2O)                 7                 7

Inspiratory flow                   50 L/min    50 L/min

I:E ratio                              1:4             1:4

Peak pressure (cm water)    35              45

Static pressure (cm water)   25              35

How should these data be best interpreted?

A an increase in airway resistance caused the peak pressure to be elevated

B an increase in lung compliance caused the peak pressure to elevate

C a decrease in lung compliance is the cause

D a standard dose of a bronchodialator should be given

A 33-year-old car-accident victim has a flow-directed pulmonary artery (Swan­Ganz) catheter in place. Initial mixed venous blood gas values show the following:

Pv02     26 torr Sv02 52%

Because the patient is hypotensive, the physician orders a blood transfusion and increased intravenous fluids. The next set of mixed venous blood gas values show:

Pv02 36 torr Sv02 70%

How has the patient's condition changed?

A tissue hypoxia has increased

B cardiac output has decreased

C tissue oxygenation has improved

D ventilation has increased

If the tidal volume is 800 ml, the respiratory rate is 12 and the peak flow is set at 60 lpm. What is the I-E ratio

A. 1-2.3

B. 1-3.2

C.  1-5

D.  1-8

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

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

A patient is admitted to the emergency room in respiratory distress with respiratory rate = 40/min., Vt = 280ml, PaC02 = 50,

Pa02 = 45, F102 = 0.21. You would recommend:

A. mask CPAP

B. mechanical ventilation

C. oxygen therapy

D. bronchodilator therapy

A volume ventilator is set to cycle on at a respiratory rate of 12 BPM. The I:E 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 seconds      2.5 seconds

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

A mechanically ventilated patient is hypoxic. The physician orders PEEP to increase the mean airway pressure. Doing this also results in:

A intrapulmonary shunting

B anatomical deadspace

C increase in IRV

D Increase in FRC

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                    P plateau

0700     30 cm H2O        20 cm H2O

0800     32 cm H2O        20 cm H2O

0900     34 cm H2O        20 cm H2O

1000     38 cm H2O        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

After reviewing an X-ray of a portable system you notice the clavicles are asymmetrically spaced around the sternum and the center of the body. You should immediately suspect:

A. body rotation

B. fluid in the thoracic space

C. a left-sided tension pneumothorax

D. a right-sided tension pneumothorax

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 Insp Pressure           Static Pressure

3:00 pm         30 cm H2O          19 cm H2O

4:00 pm         33 cm H2O          18 cm H2O

5:15 pm         3 5 cm H2O         20 cm H2O

6:10 pm         37 cm H2O          19 cm H2O

7:05 pm          42 cm H2O          19 cm H2O

The patient has the following ventilator settings:

tidal volume: 900 cc F102: 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

A patient is receiving Pressure Controlled ventilation. The physician asks the respiratory therapist to interpret the following patient information:

10 AM   2 PM

Exhaled tidal volume 800 mL     650 mL

Respiratory rate 12/min  12/min

Peak pressure   40 cm water      40 cm water

PEEP   7 cm water        7 cm water

How should this information be interpreted?

A lung compliance has improved

B there is probably a leak in the system

C there has been a decrease in lung compliance

D humidity should be added to the system

A patient with ARDS has had a flow-directed balloon-tipped catheter inserted to evaluate her cardiovascular status. To confirm that it is properly positioned, a chest radiograph could show the catheter tip in the:

I. Left atrium

II. Left pulmonary artery

III. Right atrium

IV. Right ventricle

A II only      B I and III      C III only      D I and IV

A stable patient is receiving mechanical ventilation with 21 % oxygen while in the postanesthesia recovery room. An ABG sample is drawn with these results:

pH 7.41              PaC02 38 torr           Pa02 185 torr   

HC03 26 mEq/L      BE 1 mEq/L           Sa02 100%

Because you ran the analysis, what is the first thing that should be done?

A repeat the sample

B recalibrate the analyzer

C report the result to the chart

D change the electrode in the machine

A patient is on a bi - pap system - following study you find the Sa02 is 84% with an IPAP of 16cm H2O and an EPAP of 5cm H2O. Which of the following should the respiratory therapist recommend to improve arterial oxygenation?

I. decreasing IPAP to 13 cm H2O

II. increasing EPAP to 8 cm H2O

III. adding supplemental oxygen

IV. setting inspiratory rise time to 10%

A. I and II only    B. I and IV only     C. II and III only   D. III and IV only

Because of facial trauma, a 77-kg (170-1b) adult patient was given an emergency tracheostomy and had a 6-mm ID tracheostomy tube placed. Mechanical ventilation was started with a tidal volume of 800 mL because of apnea. The respiratory therapist notices that the intracuff pressure is 60 cm water with a 100-mL tidal volume leak. What should be done to correct this situation?

A plan to reintubate with a larger endo tube

B inflate the cuff until the leak stops

C increase the tidal volume on the ventilator to compensate for the leak D add therapeutic peep

During transport of a patient who is receiving mechanical ventilation, the respiratory therapist is asked to add l Ocm H2O PEEP to a fludic transport ventilator. How could this be done?

A. increase oxygen flow through the breathing circuit

B. add a Heimlich valve proximal to the exhalation valve

C. add a threshold resistor distal to the exhalation valve

D. increase entrained air flow through the breathing circuit

To increase the E - in BiPap should increase:

A. the Pa02

B. the tidal volume

C. the expiratory time

D. the inspiratory time

A patient who weighs 80 kg (180 lb) is receiving volume-cycled ventilation in the SIMV mode with the following parameters:

Set Vt   800 mL      Set rate 12

PEEP   10 cm water

Pressure support           4 cm water

Spontaneous rate          15

Spontaneous Vt            150 mL

What should the respiratory therapist recommend to minimize the patient's work of breathing (WOB)?

A increase the set rate

B decrease the peep

D increase the pressure support

E add a one second inspiratory hold

After a successful CPR effort, an adult patient requires mechanical ventilation. He is apneic, 183 cm (6 ft.) tall, and weighs 73 kg (160 lb). The physician requests that you select the ventilator settings. Which of the following should be used?

Mode    Tidal volume     Rate     Oxyizen

A. SIMV 1000 10 100%

B. AC 750 10 60%

C. SIMV 500 8 40%

D. CPAP 800 10 50%

The Pressure Control mode is being used to mechanically ventilate a 60-kg (132-1b) patient. The following are noticed during a routine ventilator check:

Set respiratory rate        12/min

Actual respiratory rate    25/min

Exhaled tidal volume     250 mL

Set pressure     20 cm water

Pressure support           5 cm water

What is the best ventilator adjustment to make at this time?

A increase the pressure support

B add peep

C increase the set rate

D add deadspace

To increase the set I -in BiPap should increase

A the Pa02

B the expiratory time

C the tidal volume 

D the FRC

A patient with status asthmaticus will be given an 80%/20% heliox mix to a nonrebreather mask. A standard oxygen flowmeter will be used to set the gas flow. The physician has ordered an initial heliox flow of 12 L/min. What should be set on the oxygen flowmeter?

A  6.61 / min

B  8.5

C  12

D  16.2

The flow-triggering option is being used to let the patient initiate SIMV breaths on a volume-cycled ventilator. The PEEP level is set at 10 cm water, and the baseline   flow through the circuit is 25 L/min. The respiratory therapist notices that the actual PEEP level is 12 cm water when the patient exhales. What should be done to correct this problem?

A increase the base flow - set in the flow by

B increase the peep

C add mechanical dead space

D decrease the amount of base flow

A patient with an 8-mm ID fenestrated tracheostomy tube is to receive IPPB treatments for unresolved atelectasis. After the patient initiates a breath, it is found that the machine does not cycle off to allow exhalation. After manually stopping the delivered breath, what should be done to resolve the problem?

A inflate the cuff and insert the inner cannula

B increase the pressure on the machine

C change to an endo tracheal tube

D decrease the set flow rate on the machine

An adult patient is receiving volume-cycled ventilation with the following settings:

Vt         800 mL

Set rate 14

PEEP   10 cm water

Peak pressure   45 cm water

Plateau pressure           30 cm H2O

Pressure support           6 cm H2O

What is the patient's static compliance value?

A 26.6 cc/cm h2o

B 40.1

C 44.2

D 17.7

Which of the following is best treated with Pressure Control ventilation (PCV)?

A Carbon Monoxide poisoning

B ARDS following a motor vehicle accident

C Asthma

D Neuro muscular disorder

A 70 kg (154-1b) patient with advanced emphysema is being cared for on a volume ventilator. The following settings and blood gases have been recorded:

                         10:00 am           11:00 am

Tidal volume     600 ml              600 mL

Rate                  10/min               13/min

Oxygen              35%                   35%

Pa02                  71 torr                64 torr

PaC02               64 torr                 71 torr

pH                     7.31                    7.28

HC03                36 mEq/L            36 mEq/L

Based on this information, which of the following would you recommend to correct the blood gases?

A increase the tidal volume

B increase the Fio2

C add 5 cm peep

D add mechanical dead space

It is noticed that a mechanically ventilated patient's Sp02 value decreases from 94% to 87% when she is disconnected from the ventilator during suctioning. Currently the patient's ventilator settings are as follows: tidal volume, 750 mL; rate, 14; 60% oxygen; and 6 cm water PEEP. What should be done to correct this situation?

A increase the Fio2

B increase the peep level

C change to a closed circuit suction system

D decrease the suction pressure to 100 mm hg

An elderly patient has been given a diuretic to help treat her congestive heart failure. It is noticed on her ECG monitor that she is having occasional premature ventricular contractions. It is most important to monitor which of the following electrolyte values?

A potassium

B calcium

C sodium

D bicarbonate

You are helping in a resuscitation attempt of a 200-pound man who is in ventricular fibrillation. The physician has just attempted defibrillation with 200 joules (watt-seconds) of power. Because the ECG monitor shows the patient still to be in ventricular fibrillation, what should you recommend?

A repeat the defibrillation with 300 joules

B increase the defibrillation to 420 joules

C repeat the defibrillation with 200 joules

D place the defibrillator in the sync mode

A 49-year-old patient has been admitted to the hospital with shortness of breath. The following information is available on his cardiovascular condition: blood pressure, 122/78 mm Hg; PAP, 26/11 mm Hg; PCWP, 7 mm Hg. How should the patient's cardiovascular status be interpreted?

A severe pulmonary hypertension

B severe systemic hypertension

C Congestive heart failure

D 'Normal

If a patient is being mechanically ventilated and needs an increase in alveolar ventilation, what is the best way to accomplish this?

A increase the tidal volume

B increase the rate

C increase the peep level

D add mechanical dead space

A ventilated patient is in the SIMV mode - the tidal breaths being returned on the flow sheet show a machine tidal volume of 800 ml and a spontaneous tidal volume of 300 ml - The blood gases show a respiratory acidosis - you could correct this by:

A increasing the peep level

B increasing the Fio2

C increasing the pressure support level

D adding dead space

An apneic 55-kg (120-1b) patient is being ventilated with a volume ventilator on the assist/control mode. Her ventilator settings are as shown:

Tidal volume     550 mL

Rate     12

Oxygen 60%

Mechanical dead space 75 mL

Her arterial blood gases show:

Pa02     56 torr

PaC02  52 torr

pH        7.32

Base excess     +3

Considering this information, all these individual ventilator adjustments would improve her arterial blood gas values except:

A remove the mechanical dead space   B increase the tidal volume

C increase the respiratory rate

D change to IMV mode with 10 cm of pressure support

A patient has a -15 cm water pressure maximum inspiratory pressure (MIP) during a bedside test. What can you conclude from this result?

I. The patient has weak inspiratory muscles.

II. The patient has restrictive lung disease.

III. The patient has obstructive airways disease.

A I only     B I and II    C III only     D All of the above

Your patient has adult respiratory distress syndrome (ARDS) and is being managed on a volume ventilator. What is the best way to reduce the patient's intrapulmonary shunting?

A increase the peep level to the therapeutic range 

B increase the tidal volume

C increase the respiratory rate

D add a brief inspiratory hold

A 42-year-old female patient has Guillain-Barre syndrome. Which of the following bedside spirometry tests is most important to monitor to determine her need for mechanical ventilation?

A decreased peak flow

B decreased expiratory reserve

C increased residual volume

D decreased tidal volume

When administering a bronchodilator using an IPPB device, lower gas flows will have what effect on aerosol deposition?

A greater upper airway deposition

B less peripheral deposition

C greater peripheral deposition

D it will have no effect on medication deposition

You have placed an unconscious 80 kg (176-1b) postoperative thoracotomy patient on the ventilator with these settings:

Mode SIMV Rate 12/min Oxygen 40% Tidal volume        1100 mL

Arterial blood gases after 20 minutes show:

Pa02     93 torr       PaC02  29 torr      pH        7.52

HC03    25 mEq/L

Based on this information, what would you recommend?

A increase the level of peep

B add mechanical dead space

C change to the assist control mode

D increase the Fio2

A neonate is being mechanically ventilated on the IMV mode. During the last 2 hours, the patient's Pa02 has decreased from 60 to 45 mm Hg. The physician orders an increase in the mean airway pressure. Which of the following would you recommend to accomplish this?

I. Increase expiratory time

II. Increase the pressure limit if it is being reached during the IMV breaths

III.  Increase inspiratory time

A. I only      B. II and III     C. III only     D. II only

A 35-year-old, 300-pound patient with obstructive sleep apnea is being managed with a bilevel CPAP while on mechanical ventilation delivered through a nasal mask (or non invasive His arterial blood gases show a PaC02 of 50 mm Hg. When sleeping, he still has episodes of obstructive apnea. Ventilator settings are:

Mode CPAP Pressure support   15 cm h2o CPAP 5cmh2o Oxygen 30%

All the following ventilator adjustments would be appropriate except:

A increase the pressure support to 20 cm h20

B increase the cpap setting to 10 cm h2o

C add mechanical dead space

D transfer the patient to a bi pap device

For which of the following patients is hyperinflation therapy best indicated for?

A. a patient with severe COPD

B. a patient in (CHF) congestive heart failure

C. a patient recovering from a drug overdose

D. a post-op patient recovering from upper abdominal surgery

Which of the following lung volumes is an IBE maneuver a measurement of?

A. inspiratory capacity

B. functional residual capacity

C. total lung capacity

D. tidal volume

E. peak flow

You have just received an order to begin IPPB therapy on a new patient. Which of the following are appropriate for the initial settings?

1. sensitivity -2

II. pressure between 45 to 55 cmH20

III. I:E ratio of 1:2

IV. moderate flow

V. 16 to 21 breaths per minute

A. I, III and IV    B. I, II and V    C. II, III and IV    D. all of the above

Which of the following ventilator graphic curves are most commonly used to detect auto-PEEP?

I. volume-time II. pressure-time III. flow-volume IV. pressure-volume

A. I and II only    B. I and III only    C. II and IV only    D. III and IV only

Serial peak flows are performed on an asthmatic patient. It is planed to give a bronchodialator to measure pre and post performance. The three consecutive peak flow measurements are as follows: 255 L/min, 265 L/min, and 285 L/min. Based on the ATS standards, the respiratory therapist should:

A. select the best measurement

B. perform an additional peak flow

C. report the peak flow as 255 L/min

D. average the three measurements and divide by 3