LINDSEY JONES PRACTICE EXAM
QUESTIONS WITH EXPLANATIONS AND
ANSWERS
The low ventilator alarm is sounding on a 28-year old patient with myasthenia gravis.
The respiratory therapist notes the oral endotracheal tube cuff is failing to hold pressure.
The ET tube is positioned at 22 cm at the teeth. The RRT should:
a. increase the tidal volume
b. decrease the low tidal volume alarm
c. replace the ET tube
d. send to surgery for placement of a tracheostomy - ANSWER-your answer: C
correct answer: C
An ET tube whose cuff is failing to retain air is considered defective and should be
replaced.
The following ECG tracing suddenly presents on a patient in the emergency department
(ED) who was admitted for chest pain. The tracing is confirmed in two leads. The
therapist should immediately:
[asystole tracing]
A. administer Lidocaine
B. defibrillate at 360 joules with synchronization set to OFF
C. administer sublingual nitroglycerin (Isordil)
D. begin chest compressions - ANSWER-Your answer was : D
The correct answer is : D
Explanation :
After confirming this rhythm (asystole) in 2 leads, the primary treatment is chest
compressions.
The expired air over one minute that participates in active gas exchange is one's
A. anatomical gas exchange.
B. alveolar ventilation.
C. respiratory quotient.
D. minute ventilation.
Your answer was : B
The correct answer is : B - ANSWER-Explanation :
, The total expired air over 1 minute is known as minute ventilation. Not all of this air
participates in gas exchange due to anatomical dead space. Once anatomical
deadspace is removed, the remaining ventilation is known as alveolar minute ventilation
or simply alveolar ventilation.
An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the
oxygen coming from the end of the tubing and finds it is 60%. Which of the following
most likely explains this finding?
A. excess water in the tubing
B. leak in the tubing
C. low flow through the jet orifice
D. poorly calibrated analyzer - ANSWER-Explanation :
When administering oxygen by any device that has a venturi mechanism, back
pressure on the venturi will slow the speed of gas, decrease room air entrainment, and
result in an increase in FIO2. Of the options offered, only excess water in the tubing
would cause this type of back pressure.
A patient has been diagnosed with central sleep apnea. Which of the following would be
helpful and most appropriate in the further treatment of the patient?
A. full nocturnal ventilatory support
B. weight loss
C. surgical remove of soft tissue
D. bi-level therapy with a rate - ANSWER-Your answer was : D
The correct answer is : D
Explanation :
A patient with central sleep apnea either needs mechanical ventilatory support or
medication that stimulates ventilation. Dopram is such a medication. Mechanical
ventilatory support can be achieved with bilevel therapy in conjunction with a rate.
Immediately after oral intubation of an apneic patient, the respiratory therapist begins
manual ventilation with a bag-valve assembly. The patient is simultaneously connected
to an end-tidal carbon dioxide monitor. Which of the following should the respiratory
therapist expect to observe when looking at the capnographic waveform?
A. stair-step shifts in the CO2 tracing
B. steady CO2 reading
C. fall in CO2 followed by a subtle rise
D. first a rise, then a fall in CO2 - ANSWER-Your answer was : A
The correct answer is : D
Explanation :
, Initial ventilation attempts after a patient has been apneic will show reduced end-tidal
CO2 followed by a steady rise as ventilation is provided. Ultimately, as ventilation
continues the end-tidal CO2 will begin to decrease.
At patient is receiving heliox therapy at a mixture of 70% / 30%. The gas mixture is
flowing through an oxygen flow meter at 10 L/min. The actual flow to the patient is
A. 18 L
B. 16 L
C. 10 L
D. 12 L - ANSWER-Your answer was : B
The correct answer is : B
Explanation :
Helium-oxygen mixtures that are run through an oxygen flowmeter are less viscous
than oxygen. This causes an error in the indicated flow rate on the oxygen flow meter.
Essentially, the total flow is higher than is indicated. Each helium-oxygen mixture has a
correction factor. A 70%/30% helium-oxygen mixture has a correction factor of 1.6. This
means the 10 L/min indicated flow should be multiplied by 1.6 to determine the total gas
flow. In this case, the total gas flow is 16 L/min.
Which of the following equations would determine cardiac index?
A. C.O. / BSA
B. C.O. x BSA
C. stroke volume x heart rate
D. C.O. / ejection fraction - ANSWER-Your answer was : A
The correct answer is : A
Explanation :
Cardiac index can be calculated by dividing the cardiac output by the body surface
area. The body surface area is given in units of millimeters squared. Body surface area
rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we
could take cardiac output and divide it by two to get cardiac index. This can be done
even if the body surface area of the patient is unknown. For example, if the cardiac
output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8,
cardiac output could be estimated to be 3.6 L/min.
A couple is found drowsy while driving on a long car trip. The highway patrol officer
reports both the driver and the passenger were confused. The emergency room
physician suspects carbon monoxide poisoning. Which of the following
recommendations is most helpful at this time?
A. IV injection of solu-mederol
, B. administration of Narcan
C. high-flow oxygen
D. administration of Dopram (doxapram) - ANSWER-Your answer was : D
The correct answer is : C
Explanation :
The treatment for suspected carbon monoxide poisoning is to drastically increase
alveolar oxygen tension. This can best be accomplished by administering high-flow
supplemental oxygen, preferably at 100%. Additional therapy that may be helpful is
hyperbaric oxygen therapy.
A respiratory therapist is suctioning a patient who is receiving positive pressure
ventilation through a non-fenestrated tracheostomy tube when it is discovered that the
suction catheter will not pass beyond the end of the tracheostomy tube. The patient is
cyanotic and in obvious respiratory distress. After the therapist evacuates the cuff, the
catheter passes easily. The therapist should first do which of the following?
A. extubate the patient
B. increase the pressure limit on the ventilator, monitor exhaled volumes
C. remove the inner cannula and cap the tube
D. inflate the cuff and resume positive pressure ventilation - ANSWER-Your answer
was : C
The correct answer is : A
Explanation :
Because the catheter passes easily after the tracheostomy tube cuff is deflated, the
most likely problem is that the tracheostomy tube cuff has become damaged and has
herniated over the end of the tracheostomy tube. This means the tracheostomy tube
should be changed to one that is not damaged. This starts with extubating the patient
and providing ventilation and oxygenation, and generally ensuring the stability of the
patient.
A patient with significant pulmonary shunting is receiving volume-controlled ventilation
on the following settings and has the following arterial blood gas results:
Mode: assist/control
Mandatory Rate: 18
VT: 500 mL
FiO2: 0.70
PEEP: 25 cm H2O
C.O.: 3.2 L/min
HR: 118
pH: 7.36
PaCO2: 45 torr
PaO2: 54 torr
HCO3: 26 mEq/L
QUESTIONS WITH EXPLANATIONS AND
ANSWERS
The low ventilator alarm is sounding on a 28-year old patient with myasthenia gravis.
The respiratory therapist notes the oral endotracheal tube cuff is failing to hold pressure.
The ET tube is positioned at 22 cm at the teeth. The RRT should:
a. increase the tidal volume
b. decrease the low tidal volume alarm
c. replace the ET tube
d. send to surgery for placement of a tracheostomy - ANSWER-your answer: C
correct answer: C
An ET tube whose cuff is failing to retain air is considered defective and should be
replaced.
The following ECG tracing suddenly presents on a patient in the emergency department
(ED) who was admitted for chest pain. The tracing is confirmed in two leads. The
therapist should immediately:
[asystole tracing]
A. administer Lidocaine
B. defibrillate at 360 joules with synchronization set to OFF
C. administer sublingual nitroglycerin (Isordil)
D. begin chest compressions - ANSWER-Your answer was : D
The correct answer is : D
Explanation :
After confirming this rhythm (asystole) in 2 leads, the primary treatment is chest
compressions.
The expired air over one minute that participates in active gas exchange is one's
A. anatomical gas exchange.
B. alveolar ventilation.
C. respiratory quotient.
D. minute ventilation.
Your answer was : B
The correct answer is : B - ANSWER-Explanation :
, The total expired air over 1 minute is known as minute ventilation. Not all of this air
participates in gas exchange due to anatomical dead space. Once anatomical
deadspace is removed, the remaining ventilation is known as alveolar minute ventilation
or simply alveolar ventilation.
An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the
oxygen coming from the end of the tubing and finds it is 60%. Which of the following
most likely explains this finding?
A. excess water in the tubing
B. leak in the tubing
C. low flow through the jet orifice
D. poorly calibrated analyzer - ANSWER-Explanation :
When administering oxygen by any device that has a venturi mechanism, back
pressure on the venturi will slow the speed of gas, decrease room air entrainment, and
result in an increase in FIO2. Of the options offered, only excess water in the tubing
would cause this type of back pressure.
A patient has been diagnosed with central sleep apnea. Which of the following would be
helpful and most appropriate in the further treatment of the patient?
A. full nocturnal ventilatory support
B. weight loss
C. surgical remove of soft tissue
D. bi-level therapy with a rate - ANSWER-Your answer was : D
The correct answer is : D
Explanation :
A patient with central sleep apnea either needs mechanical ventilatory support or
medication that stimulates ventilation. Dopram is such a medication. Mechanical
ventilatory support can be achieved with bilevel therapy in conjunction with a rate.
Immediately after oral intubation of an apneic patient, the respiratory therapist begins
manual ventilation with a bag-valve assembly. The patient is simultaneously connected
to an end-tidal carbon dioxide monitor. Which of the following should the respiratory
therapist expect to observe when looking at the capnographic waveform?
A. stair-step shifts in the CO2 tracing
B. steady CO2 reading
C. fall in CO2 followed by a subtle rise
D. first a rise, then a fall in CO2 - ANSWER-Your answer was : A
The correct answer is : D
Explanation :
, Initial ventilation attempts after a patient has been apneic will show reduced end-tidal
CO2 followed by a steady rise as ventilation is provided. Ultimately, as ventilation
continues the end-tidal CO2 will begin to decrease.
At patient is receiving heliox therapy at a mixture of 70% / 30%. The gas mixture is
flowing through an oxygen flow meter at 10 L/min. The actual flow to the patient is
A. 18 L
B. 16 L
C. 10 L
D. 12 L - ANSWER-Your answer was : B
The correct answer is : B
Explanation :
Helium-oxygen mixtures that are run through an oxygen flowmeter are less viscous
than oxygen. This causes an error in the indicated flow rate on the oxygen flow meter.
Essentially, the total flow is higher than is indicated. Each helium-oxygen mixture has a
correction factor. A 70%/30% helium-oxygen mixture has a correction factor of 1.6. This
means the 10 L/min indicated flow should be multiplied by 1.6 to determine the total gas
flow. In this case, the total gas flow is 16 L/min.
Which of the following equations would determine cardiac index?
A. C.O. / BSA
B. C.O. x BSA
C. stroke volume x heart rate
D. C.O. / ejection fraction - ANSWER-Your answer was : A
The correct answer is : A
Explanation :
Cardiac index can be calculated by dividing the cardiac output by the body surface
area. The body surface area is given in units of millimeters squared. Body surface area
rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we
could take cardiac output and divide it by two to get cardiac index. This can be done
even if the body surface area of the patient is unknown. For example, if the cardiac
output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8,
cardiac output could be estimated to be 3.6 L/min.
A couple is found drowsy while driving on a long car trip. The highway patrol officer
reports both the driver and the passenger were confused. The emergency room
physician suspects carbon monoxide poisoning. Which of the following
recommendations is most helpful at this time?
A. IV injection of solu-mederol
, B. administration of Narcan
C. high-flow oxygen
D. administration of Dopram (doxapram) - ANSWER-Your answer was : D
The correct answer is : C
Explanation :
The treatment for suspected carbon monoxide poisoning is to drastically increase
alveolar oxygen tension. This can best be accomplished by administering high-flow
supplemental oxygen, preferably at 100%. Additional therapy that may be helpful is
hyperbaric oxygen therapy.
A respiratory therapist is suctioning a patient who is receiving positive pressure
ventilation through a non-fenestrated tracheostomy tube when it is discovered that the
suction catheter will not pass beyond the end of the tracheostomy tube. The patient is
cyanotic and in obvious respiratory distress. After the therapist evacuates the cuff, the
catheter passes easily. The therapist should first do which of the following?
A. extubate the patient
B. increase the pressure limit on the ventilator, monitor exhaled volumes
C. remove the inner cannula and cap the tube
D. inflate the cuff and resume positive pressure ventilation - ANSWER-Your answer
was : C
The correct answer is : A
Explanation :
Because the catheter passes easily after the tracheostomy tube cuff is deflated, the
most likely problem is that the tracheostomy tube cuff has become damaged and has
herniated over the end of the tracheostomy tube. This means the tracheostomy tube
should be changed to one that is not damaged. This starts with extubating the patient
and providing ventilation and oxygenation, and generally ensuring the stability of the
patient.
A patient with significant pulmonary shunting is receiving volume-controlled ventilation
on the following settings and has the following arterial blood gas results:
Mode: assist/control
Mandatory Rate: 18
VT: 500 mL
FiO2: 0.70
PEEP: 25 cm H2O
C.O.: 3.2 L/min
HR: 118
pH: 7.36
PaCO2: 45 torr
PaO2: 54 torr
HCO3: 26 mEq/L
