Page 1 of 51
,1. A 68-year-old patient with a history of severe COPD is admitted to the emergency
department in acute respiratory distress. The patient is using accessory muscles and has
diminished breath sounds bilaterally. Arterial blood gas results on a 28% Venturi mask
reveal a pH of 7.25, PaCO2 of 68 mmHg, PaO2 of 48 mmHg, and HCO3- of 29 mEq/L. Which
of the following is the most appropriate initial intervention?
A) Increase the FiO2 to 40% via Venturi mask
B) Initiate noninvasive positive pressure ventilation – Correct answer
C) Administer a bronchodilator via metered-dose inhaler
D) Perform immediate endotracheal intubation
2. A physician orders a lung compliance measurement for a mechanically ventilated patient.
The respiratory therapist notes the high-pressure alarm is sounding frequently despite the
patient receiving a low tidal volume. Which of the following conditions would most likely
cause a decrease in static compliance?
A) Tension pneumothorax – Correct answer
B) Kinked endotracheal tube
C) Increased airway resistance
D) Bronchospasm
3. A 45-year-old patient is receiving volume-controlled ventilation. The exhaled tidal volume
is consistently 100 mL less than the set tidal volume. The peak inspiratory pressure has
decreased from 35 cm H2O to 20 cm H2O. Which of the following is the most likely cause
of these findings?
A) Worsening pulmonary edema
B) Right mainstem bronchus intubation
C) Disconnection or leak in the patient circuit – Correct answer
D) Increased lung compliance
4. A neonate born at 30 weeks gestation presents with tachypnea, nasal flaring, and
grunting. A chest radiograph reveals a diffuse reticulogranular pattern with air
bronchograms. Which of the following pathophysiological mechanisms is the primary
cause of this neonate's respiratory distress?
A) Meconium aspiration leading to airway obstruction
B) Surfactant deficiency leading to alveolar collapse – Correct answer
C) Persistent pulmonary hypertension of the newborn
D) Congenital diaphragmatic hernia causing pulmonary hypoplasia
5. A respiratory therapist is reviewing a polysomnography report for a patient suspected of
having obstructive sleep apnea. The report indicates the patient experiences frequent
episodes of absent airflow lasting more than 10 seconds, during which continuous
respiratory effort is observed. How should these events be classified?
A) Central sleep apnea
B) Mixed sleep apnea
C) Obstructive sleep apnea – Correct answer
D) Cheyne-Stokes respiration
Page 2 of 51
,6. A patient with acute severe asthma is unresponsive to continuous albuterol nebulization
and intravenous corticosteroids. The patient is agitated, diaphoretic, and speaking in
single words. Arterial blood gas analysis reveals a PaCO2 of 45 mmHg. What is the most
appropriate next step in management?
A) Increase the albuterol dosage
B) Administer intravenous magnesium sulfate
C) Initiate noninvasive ventilation
D) Proceed with endotracheal intubation – Correct answer
7. Which of the following pulmonary function test parameters is most specific for
differentiating obstructive from restrictive lung disease?
A) Forced vital capacity (FVC)
B) Peak expiratory flow rate (PEFR)
C) Total lung capacity (TLC) – Correct answer
D) Maximum voluntary ventilation (MVV)
8. A patient is on pressure support ventilation at 10 cm H2O and PEEP of 5 cm H2O. The
respiratory therapist observes that the delivered tidal volume is decreasing over the last
hour. The patient's respiratory rate has increased from 18 to 28 breaths/min. Which of the
following is the most likely explanation?
A) The patient is waking up from sedation
B) The ventilator trigger sensitivity is set too low
C) The patient is developing respiratory muscle fatigue – Correct answer
D) The pressure support level is too high
9. A blood gas sample is drawn from a hypothermic patient with a core temperature of 32°C.
The blood gas analyzer warms the sample to 37°C for analysis. How will the reported
values compare to the patient's actual in vivo values?
A) The reported pH will be higher and the reported PaCO2 will be higher than in vivo
B) The reported pH will be lower and the reported PaCO2 will be higher than in vivo –
Correct answer
C) The reported pH will be higher and the reported PaCO2 will be lower than in vivo
D) The reported pH and PaCO2 will be identical to in vivo values
10. Select-All-That-Apply: A patient is suspected of having a pulmonary embolism. Which of
the following clinical findings are typically associated with this condition?
A) Increased PA-aO2 gradient – Correct answer
B) Decreased cardiac output
C) Tachypnea – Correct answer
D) Hemoptysis – Correct answer
E) Deep tendon hyperreflexia
11. A patient with a tracheostomy tube is being mechanically ventilated. The respiratory
therapist notices a significant leak around the tracheostomy tube, causing a loss of
delivered tidal volume. The cuff pressure is measured at 10 cm H2O. What is the most
appropriate action?
A) Add 1-2 mL of air to the cuff to achieve a seal – Correct answer
B) Deflate the cuff completely to prevent tracheal necrosis
Page 3 of 51
, C) Replace the tracheostomy tube with a larger diameter tube
D) Increase the set tidal volume to compensate for the leak
12. A patient is receiving 40% oxygen via a simple face mask at 5 L/min. The patient's SpO2 is
88%. The respiratory therapist increases the flow to 8 L/min. What is the primary rationale
for this adjustment?
A) To increase the FiO2 delivered to the patient
B) To flush carbon dioxide from the mask to prevent rebreathing – Correct answer
C) To decrease the work of breathing
D) To provide humidification to the airway
13. A 55-year-old patient with congestive heart failure is receiving oxygen via a non-
rebreather mask at 12 L/min. The reservoir bag collapses completely during inspiration.
What should the respiratory therapist do?
A) Increase the oxygen flow rate – Correct answer
B) Decrease the oxygen flow rate
C) Switch to a simple face mask
D) Tighten the mask straps to prevent room air entrainment
14. A mechanically ventilated patient has a set tidal volume of 600 mL and a peak inspiratory
pressure of 35 cm H2O. The plateau pressure is 15 cm H2O. What is the patient's static
compliance?
A) 20 mL/cm H2O
B) 30 mL/cm H2O
C) 40 mL/cm H2O – Correct answer
D) 60 mL/cm H2O
15. Which of the following is the most reliable indicator of adequate ventilation in a patient
with severe COPD?
A) PaO2
B) PaCO2 – Correct answer
C) SpO2
D) Bicarbonate level
16. A patient is being weaned from mechanical ventilation using a T-piece trial. After 30
minutes, the patient exhibits diaphoresis, tachycardia, and paradoxical abdominal
breathing. Which of the following weaning indices would most likely predict this outcome?
A) Rapid shallow breathing index less than 80
B) Negative inspiratory force of -35 cm H2O
C) Spontaneous tidal volume of 6 mL/kg
D) Rapid shallow breathing index greater than 105 – Correct answer
17. A respiratory therapist is performing a bronchoscopy assist. The physician requests a
medication to suppress the cough reflex locally during the procedure. Which of the
following medications should the therapist prepare?
A) Lidocaine – Correct answer
B) Epinephrine
C) Atropine
Page 4 of 51
,1. A 68-year-old patient with a history of severe COPD is admitted to the emergency
department in acute respiratory distress. The patient is using accessory muscles and has
diminished breath sounds bilaterally. Arterial blood gas results on a 28% Venturi mask
reveal a pH of 7.25, PaCO2 of 68 mmHg, PaO2 of 48 mmHg, and HCO3- of 29 mEq/L. Which
of the following is the most appropriate initial intervention?
A) Increase the FiO2 to 40% via Venturi mask
B) Initiate noninvasive positive pressure ventilation – Correct answer
C) Administer a bronchodilator via metered-dose inhaler
D) Perform immediate endotracheal intubation
2. A physician orders a lung compliance measurement for a mechanically ventilated patient.
The respiratory therapist notes the high-pressure alarm is sounding frequently despite the
patient receiving a low tidal volume. Which of the following conditions would most likely
cause a decrease in static compliance?
A) Tension pneumothorax – Correct answer
B) Kinked endotracheal tube
C) Increased airway resistance
D) Bronchospasm
3. A 45-year-old patient is receiving volume-controlled ventilation. The exhaled tidal volume
is consistently 100 mL less than the set tidal volume. The peak inspiratory pressure has
decreased from 35 cm H2O to 20 cm H2O. Which of the following is the most likely cause
of these findings?
A) Worsening pulmonary edema
B) Right mainstem bronchus intubation
C) Disconnection or leak in the patient circuit – Correct answer
D) Increased lung compliance
4. A neonate born at 30 weeks gestation presents with tachypnea, nasal flaring, and
grunting. A chest radiograph reveals a diffuse reticulogranular pattern with air
bronchograms. Which of the following pathophysiological mechanisms is the primary
cause of this neonate's respiratory distress?
A) Meconium aspiration leading to airway obstruction
B) Surfactant deficiency leading to alveolar collapse – Correct answer
C) Persistent pulmonary hypertension of the newborn
D) Congenital diaphragmatic hernia causing pulmonary hypoplasia
5. A respiratory therapist is reviewing a polysomnography report for a patient suspected of
having obstructive sleep apnea. The report indicates the patient experiences frequent
episodes of absent airflow lasting more than 10 seconds, during which continuous
respiratory effort is observed. How should these events be classified?
A) Central sleep apnea
B) Mixed sleep apnea
C) Obstructive sleep apnea – Correct answer
D) Cheyne-Stokes respiration
Page 2 of 51
,6. A patient with acute severe asthma is unresponsive to continuous albuterol nebulization
and intravenous corticosteroids. The patient is agitated, diaphoretic, and speaking in
single words. Arterial blood gas analysis reveals a PaCO2 of 45 mmHg. What is the most
appropriate next step in management?
A) Increase the albuterol dosage
B) Administer intravenous magnesium sulfate
C) Initiate noninvasive ventilation
D) Proceed with endotracheal intubation – Correct answer
7. Which of the following pulmonary function test parameters is most specific for
differentiating obstructive from restrictive lung disease?
A) Forced vital capacity (FVC)
B) Peak expiratory flow rate (PEFR)
C) Total lung capacity (TLC) – Correct answer
D) Maximum voluntary ventilation (MVV)
8. A patient is on pressure support ventilation at 10 cm H2O and PEEP of 5 cm H2O. The
respiratory therapist observes that the delivered tidal volume is decreasing over the last
hour. The patient's respiratory rate has increased from 18 to 28 breaths/min. Which of the
following is the most likely explanation?
A) The patient is waking up from sedation
B) The ventilator trigger sensitivity is set too low
C) The patient is developing respiratory muscle fatigue – Correct answer
D) The pressure support level is too high
9. A blood gas sample is drawn from a hypothermic patient with a core temperature of 32°C.
The blood gas analyzer warms the sample to 37°C for analysis. How will the reported
values compare to the patient's actual in vivo values?
A) The reported pH will be higher and the reported PaCO2 will be higher than in vivo
B) The reported pH will be lower and the reported PaCO2 will be higher than in vivo –
Correct answer
C) The reported pH will be higher and the reported PaCO2 will be lower than in vivo
D) The reported pH and PaCO2 will be identical to in vivo values
10. Select-All-That-Apply: A patient is suspected of having a pulmonary embolism. Which of
the following clinical findings are typically associated with this condition?
A) Increased PA-aO2 gradient – Correct answer
B) Decreased cardiac output
C) Tachypnea – Correct answer
D) Hemoptysis – Correct answer
E) Deep tendon hyperreflexia
11. A patient with a tracheostomy tube is being mechanically ventilated. The respiratory
therapist notices a significant leak around the tracheostomy tube, causing a loss of
delivered tidal volume. The cuff pressure is measured at 10 cm H2O. What is the most
appropriate action?
A) Add 1-2 mL of air to the cuff to achieve a seal – Correct answer
B) Deflate the cuff completely to prevent tracheal necrosis
Page 3 of 51
, C) Replace the tracheostomy tube with a larger diameter tube
D) Increase the set tidal volume to compensate for the leak
12. A patient is receiving 40% oxygen via a simple face mask at 5 L/min. The patient's SpO2 is
88%. The respiratory therapist increases the flow to 8 L/min. What is the primary rationale
for this adjustment?
A) To increase the FiO2 delivered to the patient
B) To flush carbon dioxide from the mask to prevent rebreathing – Correct answer
C) To decrease the work of breathing
D) To provide humidification to the airway
13. A 55-year-old patient with congestive heart failure is receiving oxygen via a non-
rebreather mask at 12 L/min. The reservoir bag collapses completely during inspiration.
What should the respiratory therapist do?
A) Increase the oxygen flow rate – Correct answer
B) Decrease the oxygen flow rate
C) Switch to a simple face mask
D) Tighten the mask straps to prevent room air entrainment
14. A mechanically ventilated patient has a set tidal volume of 600 mL and a peak inspiratory
pressure of 35 cm H2O. The plateau pressure is 15 cm H2O. What is the patient's static
compliance?
A) 20 mL/cm H2O
B) 30 mL/cm H2O
C) 40 mL/cm H2O – Correct answer
D) 60 mL/cm H2O
15. Which of the following is the most reliable indicator of adequate ventilation in a patient
with severe COPD?
A) PaO2
B) PaCO2 – Correct answer
C) SpO2
D) Bicarbonate level
16. A patient is being weaned from mechanical ventilation using a T-piece trial. After 30
minutes, the patient exhibits diaphoresis, tachycardia, and paradoxical abdominal
breathing. Which of the following weaning indices would most likely predict this outcome?
A) Rapid shallow breathing index less than 80
B) Negative inspiratory force of -35 cm H2O
C) Spontaneous tidal volume of 6 mL/kg
D) Rapid shallow breathing index greater than 105 – Correct answer
17. A respiratory therapist is performing a bronchoscopy assist. The physician requests a
medication to suppress the cough reflex locally during the procedure. Which of the
following medications should the therapist prepare?
A) Lidocaine – Correct answer
B) Epinephrine
C) Atropine
Page 4 of 51
