Which of the following is needed to calculate alveolar oxygen tension?
A. VD/VT, PAO2
B. BP and FiO2
C. PetCO2 and PaO2
D. QS/QT, deadspace - ANSWER B.
Barometric pressure, FiO2, and PaO2 are all included in the formula (BP stands for baromet-
ric pressure)
L/min/m2 is the unit of measure for:
A. Systemic vascular resistance
B. Cardiac output
C. Cardiac index
D. Stroke volume - ANSWER C.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.38 PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 mEq/L
Which of the following supplemental oxygen levels is most appropriate?
A. 2 L/min nasal cannula
B. 5 L/min nasal cannula
C. non-rebreathing mask
D. Venturi mask at 30% - ANSWER B.
1
,A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the pa-
tient is not a COPD patient and the situation is not an emergency, then the proper supple-
mental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available
only 5 L/min nasal cannula will approach this. Other options are either insufficient or too
much.
Left heart failure would be manifested in which of the following values?
A. CVP and mPAP
B. mPAP and wedge pressure
C. MAP and SVR
D. cardiac output and wedge pressure - ANSWER D.
The function of the left heart, specifically the left ventricle, is best assessed hemodynami-
cally by looking at those values that precede and come after the left heart. In this case pul-
monary capillary wedge pressure and cardiac output (or cardiac index) are the values found
before and after the left heart.
Which of the following findings is most closely associated with increased airway resistance?
A. reduced SpO2
B. accessory muscle use
C. altered P50
D. increased PetCO2 - ANSWER B.
Of the options given, use of accessory muscles is most closely associated with an increase in
airway resistance. This is especially true with patients who have asthma or other types of
upper airway inflammation or bronchoconstriction.
For a patient receiving volume-controlled mechanical ventilation, the lower inflection point
on a pressure-volume loop can best be described as:
A. amount of pressure required to keep the alveoli and small airways open
B. optimal PEEP
C. minimal PEEP
D. upper limit of residual volume - ANSWER A.
2
,The lowest inflection point on a pressure-volume ventilator graphic is an indication of the
minimum pressure needed to keep alveoli open.
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radio-
graph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has
A. fluid overload
B. ARDS
C. a pulmonary embolism
D. pneumonia - ANSWER C.
A VQ scan that shows poor perfusion but adequate ventilation is most closely associated
with a pulmonary embolism. Supportive data is found in the radiological report of wedge-
shaped infiltrates.
The respiratory therapist notes in the medical record of a 65-year-old male that the patient
is ordered to receive bronchodilator therapy with Albuterol. The therapist also notes the pa-
tient is receiving beta-blocker medication. The therapist should recommend
A. Administer Dexamethasone (Decadron) in place of Albuterol
B. Add Xopenex to the bronchodilator regimen
C. Replace Albuterol with Beclamethasone (Beclovent)
D. Switch from Albuterol to ipratropium bromide (Atrovent) - ANSWER D.
Because albuterol is a beta-agonist medication, patients who are taking beta-blockers should
utilize other bronchodilation medication.
A hospital has an extremely low incidence of ventilator-associated pneumonia. To which of
the following reasons may this be attributed?
A. periodic discontinuation of sedation
B. use of respiratory precautions with the population
C. diversion of infectious patients to other facilities
D. broad use of prophylactic antibiotics - ANSWER A.
3
, The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed sys-
tem suction catheter, periodically discontinuing sedation, keeping the patient and semi-
Fowler's position, and proper handwashing among caregivers. All are correct.
A pressure-volume loop ventilator graphic shows no rise in pressure for the first 200 mL of
delivered volume. The therapist should
A. increase inspiratory flow rate
B. increase PEEP
C. decrease tidal volume
D. decrease inspiratory flow rate - ANSWER B.
In this question the description of the pressure volume loop would indicate a flat bottom as
manifested by no rise in pressure with the first 200 mL of delivered volume. We call this a
"flat football". The solution is to increase PEEP to a level that the pressure begins to rise im-
mediately as volume is introduced.
Which of the following would be the most effective, appropriate method for resolving ate-
lectasis in a spontaneously breathing, post operative patient who is under the influence of
sedation and will not respond to verbal stimuli?
A. IPPB
B. sustained maximal inhalation (incentive spirometer)
C. deep breathing coaching
D. intubation and mechanical ventilation - ANSWER A.
A postoperative patient under sedation, and possibly in pain, may be tempted to breathe
less, causing respiratory acidosis and atelectasis. To correct this problem, IPPB therapy is
most appropriate. Incentive spirometry would also help but the patient is unable to respond
to verbal stimuli. This alone is an indication for IPPB therapy.
After performing minimum occluding volume technique with a 65-kg (143-lb) patient who is
orally intubated with a 7.0-mm ET tube, the respiratory therapist should NEXT
A. check ET tube cuff pressure
B. perform tracheal palpation
4
A. VD/VT, PAO2
B. BP and FiO2
C. PetCO2 and PaO2
D. QS/QT, deadspace - ANSWER B.
Barometric pressure, FiO2, and PaO2 are all included in the formula (BP stands for baromet-
ric pressure)
L/min/m2 is the unit of measure for:
A. Systemic vascular resistance
B. Cardiac output
C. Cardiac index
D. Stroke volume - ANSWER C.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.38 PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 mEq/L
Which of the following supplemental oxygen levels is most appropriate?
A. 2 L/min nasal cannula
B. 5 L/min nasal cannula
C. non-rebreathing mask
D. Venturi mask at 30% - ANSWER B.
1
,A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the pa-
tient is not a COPD patient and the situation is not an emergency, then the proper supple-
mental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available
only 5 L/min nasal cannula will approach this. Other options are either insufficient or too
much.
Left heart failure would be manifested in which of the following values?
A. CVP and mPAP
B. mPAP and wedge pressure
C. MAP and SVR
D. cardiac output and wedge pressure - ANSWER D.
The function of the left heart, specifically the left ventricle, is best assessed hemodynami-
cally by looking at those values that precede and come after the left heart. In this case pul-
monary capillary wedge pressure and cardiac output (or cardiac index) are the values found
before and after the left heart.
Which of the following findings is most closely associated with increased airway resistance?
A. reduced SpO2
B. accessory muscle use
C. altered P50
D. increased PetCO2 - ANSWER B.
Of the options given, use of accessory muscles is most closely associated with an increase in
airway resistance. This is especially true with patients who have asthma or other types of
upper airway inflammation or bronchoconstriction.
For a patient receiving volume-controlled mechanical ventilation, the lower inflection point
on a pressure-volume loop can best be described as:
A. amount of pressure required to keep the alveoli and small airways open
B. optimal PEEP
C. minimal PEEP
D. upper limit of residual volume - ANSWER A.
2
,The lowest inflection point on a pressure-volume ventilator graphic is an indication of the
minimum pressure needed to keep alveoli open.
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radio-
graph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has
A. fluid overload
B. ARDS
C. a pulmonary embolism
D. pneumonia - ANSWER C.
A VQ scan that shows poor perfusion but adequate ventilation is most closely associated
with a pulmonary embolism. Supportive data is found in the radiological report of wedge-
shaped infiltrates.
The respiratory therapist notes in the medical record of a 65-year-old male that the patient
is ordered to receive bronchodilator therapy with Albuterol. The therapist also notes the pa-
tient is receiving beta-blocker medication. The therapist should recommend
A. Administer Dexamethasone (Decadron) in place of Albuterol
B. Add Xopenex to the bronchodilator regimen
C. Replace Albuterol with Beclamethasone (Beclovent)
D. Switch from Albuterol to ipratropium bromide (Atrovent) - ANSWER D.
Because albuterol is a beta-agonist medication, patients who are taking beta-blockers should
utilize other bronchodilation medication.
A hospital has an extremely low incidence of ventilator-associated pneumonia. To which of
the following reasons may this be attributed?
A. periodic discontinuation of sedation
B. use of respiratory precautions with the population
C. diversion of infectious patients to other facilities
D. broad use of prophylactic antibiotics - ANSWER A.
3
, The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed sys-
tem suction catheter, periodically discontinuing sedation, keeping the patient and semi-
Fowler's position, and proper handwashing among caregivers. All are correct.
A pressure-volume loop ventilator graphic shows no rise in pressure for the first 200 mL of
delivered volume. The therapist should
A. increase inspiratory flow rate
B. increase PEEP
C. decrease tidal volume
D. decrease inspiratory flow rate - ANSWER B.
In this question the description of the pressure volume loop would indicate a flat bottom as
manifested by no rise in pressure with the first 200 mL of delivered volume. We call this a
"flat football". The solution is to increase PEEP to a level that the pressure begins to rise im-
mediately as volume is introduced.
Which of the following would be the most effective, appropriate method for resolving ate-
lectasis in a spontaneously breathing, post operative patient who is under the influence of
sedation and will not respond to verbal stimuli?
A. IPPB
B. sustained maximal inhalation (incentive spirometer)
C. deep breathing coaching
D. intubation and mechanical ventilation - ANSWER A.
A postoperative patient under sedation, and possibly in pain, may be tempted to breathe
less, causing respiratory acidosis and atelectasis. To correct this problem, IPPB therapy is
most appropriate. Incentive spirometry would also help but the patient is unable to respond
to verbal stimuli. This alone is an indication for IPPB therapy.
After performing minimum occluding volume technique with a 65-kg (143-lb) patient who is
orally intubated with a 7.0-mm ET tube, the respiratory therapist should NEXT
A. check ET tube cuff pressure
B. perform tracheal palpation
4
