An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After the pa-
tient is placed on the system, the respiratory therapist notices that the pressure falls to 2 cm
H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system - ANSWER Increase the flow through the sys-
tem
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. Increasing the
flow should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing. Severe su-
prasternal, subcostal and substernal retraction are observed. The child has a harsh, barking
cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma - ANSWER Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral ill-
ness. The barky cough is a classic finding for patients experiencing croup.
1
,The polysomnography sleep laboratory is full scheduled for several weeks. The physician
wants to know if there is another option to determine if a patient has sleep apnea. What
should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison - ANSWER Overnight pulse
oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected obstructive
sleep apnea. The patient's oxygen saturation is found to decrease during apnea episodes.
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old female
who was admitted 12 hours ago for an aspirin overdose. The following information is ob-
tained as the patient breathes air:
HR 89/min
RR 15/min
BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site - ANSWER Validate the Sp02 reading at
a different site
Explain: The saturation may not be accurate and should be measured at a different site.
2
,A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration of CPAP.
The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A respiratory ther-
apist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP - ANSWER Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypopnea epi-
sodes, standard protocol is to incrementally increase the CPAP level until this occurs.
An arterial puncture has been performed to obtain blood for analysis of 02, C02, and pH.
What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood - ANSWER Place it into a mix of ice and
water
Explain: Placing the blood sample into ice water will prevent the blood from consuming the
O2 within the sample.
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle crash.
The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving volume-con-
trolled ventilation. Twenty-four hours later, the patient has clear breath sounds but cannot
tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H20 pressure
support. The respiratory therapist should recommend.
3
, a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube - ANSWER Reintubating with a larger
endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of in-
creased airways resistance. This can be resolved only by a larger tube or extubation.
During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough. Watery se-
cretions are aspirated through the catheter. Which of the following should the respiratory
therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
d. Increase the suction pressure and repeat the procedure - ANSWER Hyperextend the
patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oro-
pharynx or the esophagus. Hyperextending the neck will better direct the catheter to the
trachea.
A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dysp-
nea, and a cough that occurs every summer. Which of the following drug classifications
should a respiratory therapist recommend to control the patient's symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
4
tient is placed on the system, the respiratory therapist notices that the pressure falls to 2 cm
H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system - ANSWER Increase the flow through the sys-
tem
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. Increasing the
flow should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing. Severe su-
prasternal, subcostal and substernal retraction are observed. The child has a harsh, barking
cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma - ANSWER Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral ill-
ness. The barky cough is a classic finding for patients experiencing croup.
1
,The polysomnography sleep laboratory is full scheduled for several weeks. The physician
wants to know if there is another option to determine if a patient has sleep apnea. What
should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison - ANSWER Overnight pulse
oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected obstructive
sleep apnea. The patient's oxygen saturation is found to decrease during apnea episodes.
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old female
who was admitted 12 hours ago for an aspirin overdose. The following information is ob-
tained as the patient breathes air:
HR 89/min
RR 15/min
BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site - ANSWER Validate the Sp02 reading at
a different site
Explain: The saturation may not be accurate and should be measured at a different site.
2
,A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration of CPAP.
The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A respiratory ther-
apist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP - ANSWER Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypopnea epi-
sodes, standard protocol is to incrementally increase the CPAP level until this occurs.
An arterial puncture has been performed to obtain blood for analysis of 02, C02, and pH.
What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood - ANSWER Place it into a mix of ice and
water
Explain: Placing the blood sample into ice water will prevent the blood from consuming the
O2 within the sample.
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle crash.
The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving volume-con-
trolled ventilation. Twenty-four hours later, the patient has clear breath sounds but cannot
tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H20 pressure
support. The respiratory therapist should recommend.
3
, a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube - ANSWER Reintubating with a larger
endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of in-
creased airways resistance. This can be resolved only by a larger tube or extubation.
During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough. Watery se-
cretions are aspirated through the catheter. Which of the following should the respiratory
therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
d. Increase the suction pressure and repeat the procedure - ANSWER Hyperextend the
patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oro-
pharynx or the esophagus. Hyperextending the neck will better direct the catheter to the
trachea.
A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dysp-
nea, and a cough that occurs every summer. Which of the following drug classifications
should a respiratory therapist recommend to control the patient's symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
4
