RRT PRACTICE TEST #1-7-13
QUESTIONS WITH CORRECT ANSWERS
A patient having a severe asthmatic episode requires VC ventilation. The high pressure
limit alarm is sounding frequently, and the patient is very agitated with a respiratory rate
of 36/min. Bilateral breath sounds with minimal wheezing are noted. Which of the
following should the respiratory therapist recommend?
A. midazolam HCl (Versed)
B. budesonide (Pulmicort)
C. morphine sulfate
D. cromolyn sodium (Intal) - ANSWER-EXPLANATIONS:
(c) A. Midazolam will relieve the patient's anxiety.
(u) B. Budesonide is not usually needed for status asthmaticus requiring ventilatory
support since systemic steroids are the primary anti-inflammatory drug used.
(u) C. Morphine sulfate will sedate the patient, but also depress respiration.
(u) D. Cromolyn sodium is not used for status asthmaticus requiring ventilatory support
since systemic steroids are the primary anti-inflammatory drug used.
A patient is suspected of having Severe Acute Respiratory Syndrome (SARS). What
precautions must be taken for the care of this patient?
1. positive pressure room
2. gown
3. goggles
4. N-95 mask
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only - ANSWER-EXPLANATIONS:
1. False. A negative pressure room is needed to prevent droplets from entering the hall.
2. True. Transmission of SARS is by both direct contact and airborne routes. Gowns
must be worn to prevent contamination of clothing and body of healthcare workers.
3. True. Goggles are needed to prevent contact of droplets with the eyes and mucous
membranes.
4. True. The spread is airborne and an N-95 mask must be worn by healthcare workers.
(h) A. Incorrect and incomplete response included
(h) B. Incorrect and incomplete response included
(h) C. Incorrect and incomplete response included
(c) D. Correct response
,A patient who is oxygen-dependent travels using oxygen from an E cylinder secured in
the back seat. He carries a spare cylinder in the trunk of his car when he plans to be out
for longer periods of time. A respiratory therapist should inform the patient he should
A. not transport cylinders in his car.
B. open the trunk approximately 1 inch when transporting the spare cylinder.
C. secure the spare cylinder in the back seat.
D. wrap the spare cylinder in a blanket when transporting it in the trunk. - ANSWER-
EXPLANATIONS:
(u) A. It is acceptable to transport oxygen cylinders in the car when it is done safely.
See explanation C.
(u) B. Leaving the trunk open 1 inch is not acceptable. See explanation C.
(c) C. According to the Compressed Gas Association, cylinders should not be
transported in the trunk of an automobile. It is acceptable to carry a cylinder in a secure
carrier in the back seat of an automobile.
(u) D. No matter how the cylinders are stored, they should not be transported in the
trunk of an automobile. See explanation C.
A patient has been receiving VC ventilation for 24 hours with an FIO2 of 0.80. The
following arterial blood gas results are obtained:
pH 7.38
PaCO2 41 torr
PaO2 61 torr
HCO3 23 mEq/L
BE +1 mEq/L
During a routine patient assessment, a respiratory therapist also notices patient-
ventilator dyssynchrony. Which of the following should the therapist recommend?
1. PEEP
2. PS
3. SIMV
4. inspiratory hold
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only - ANSWER-EXPLANATIONS:
1. True. PEEP might reduce the P(A-a)O2 gradient.
2. True. Pressure support would reduce the effort associated with the spontaneous
breaths and help to synchronize the patient's breathing pattern with the ventilator.
3. True. SIMV would help to synchronize the patient's breathing pattern with the
ventilator.
4. False. Inspiratory hold would do little to reduce patient/ventilator dyssynchrony and/or
improve oxygenation.
(c) A. Correct response
,(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incomplete and incorrect response included
During initial assessment of a patient with a closed-head injury, the patient opens his
eyes only in response to painful stimuli. On a follow-up examination, the patient opens
his eyes to verbal commands. These observations indicate which of the following?
A. The level of consciousness is increased.
B. Intracranial pressure has increased.
C. Cerebral perfusion has decreased.
D. Seizure activity is increased. - ANSWER-EXPLANATIONS:
(c) A. Purposeful activity in response to a verbal command indicates an increase in the
level of consciousness.
(u) B. Increased intracranial pressure would impair the patient's response to verbal
commands.
(u) C. Decreased cerebral perfusion would impair the patient's response to verbal
commands.
(u) D. Increased seizure activity would impair the patient's response to verbal
commands.
A respiratory therapist is evaluating a patient with ARDS who is receiving VC, A/C
ventilation with 15 cm H2O PEEP. A slight leak is heard from the patient's mouth
throughout the ventilation cycle. A chest radiograph shows the tip of the endotracheal
tube is 5 cm above the carina. The cuff pressure is 18 cm H2O. Which of the following
should the therapist do FIRST?
A. Suction the patient's airway.
B. Advance the endotracheal tube 2 cm.
C. Reintubate the patient with a larger tube.
D. Add air to the cuff. - ANSWER-EXPLANATIONS:
(u) A. There is no indication that there are secretions in the central airway.
(u) B. The endotracheal tube is in a satisfactory position.
(u) C. See explanation D. Cuff inflation is not optimal; therefore, a larger tube is not
indicated.
(c) D. Air needs to be added to the cuff to achieve proper minimal occluding volume.
Safe inflation pressure is up to 25 cm H2O, well above the measured pressure for this
patient.
A patient who weighs 70 kg (154 lb) and is 173 cm (5 ft 8 in) tall is receiving ventilation
with the following settings:
FiO2 35%
Mandatory Rate 18
Tidal Volume 600ml
Results of a blood gas analysis are below:
, pH 7.58
PaCO2 26 torr
PaO2 95 torr
HCO3 24 mEq/L
BE +2 mEq/L
FiO2 VT
A. 0.25 700
B. 0.35 400
C. 0.50 550
D. 1.00 450 - ANSWER-EXPLANATIONS:
(h) A. Increasing the tidal volume will further increase the hyperventilation.
(c) B. Decreasing the tidal volume to 400 will increase the PaCO2.
(u) C. Oxygenation is adequate and an increase in FIO2 is not indicated. The decrease
in tidal volume to 550 will not significantly increase the PaCO2.
(u) D. There is no indication to change the FIO2 at this time.
A chest radiograph of a premature neonate displays air bronchograms and a diffuse
reticulogranular pattern. The neonate receives surfactant replacement therapy. Two
hours later, the neonate's FIO2 requirements have decreased from 0.70 to 0.35 and a
repeat chest radiograph is performed. The repeat chest radiograph would show
A. a decrease in atelectasis.
B. resolution of a pneumothorax.
C. improvement in a pleural effusion.
D. a decrease in size of the cardiac shadow. - ANSWER-EXPLANATIONS:
(c) A. The presence of air bronchograms and a diffuse reticulogranular pattern on the
chest radiograph is consistent with alveolar collapse (atelectasis), which is present
during newborn RDS. The repeat radiograph should show a decrease in these findings.
(u) B. Air bronchograms and a reticulogranular pattern are not indicative of a
pneumothorax.
(u) C. There is no blunting of the costophrenic angles present or other signs of a pleural
effusion.
(u) D. Air bronchograms and a reticulogranular pattern are not indicative of the size of
the cardiac shadow.
While assisting with a therapeutic bronchoscopy for an adult patient, a physician is
suddenly unable to view any anatomy because everything went black. Which of the
following is a likely cause?
A. A mucus plug is blocking the tip of the scope.
B. The lung collapsed distal to the scope.
C. The suction line is disconnected.
D. The light source is disconnected. - ANSWER-EXPLANATIONS:
(u) A. A mucus plug will still allow for limited light to be transmitted.
(u) B. The collapsed lung could still be seen.
(u) C. A disconnected suction line will have no effect on what is observed.
(c) D. Without the light source, nothing can be seen.
QUESTIONS WITH CORRECT ANSWERS
A patient having a severe asthmatic episode requires VC ventilation. The high pressure
limit alarm is sounding frequently, and the patient is very agitated with a respiratory rate
of 36/min. Bilateral breath sounds with minimal wheezing are noted. Which of the
following should the respiratory therapist recommend?
A. midazolam HCl (Versed)
B. budesonide (Pulmicort)
C. morphine sulfate
D. cromolyn sodium (Intal) - ANSWER-EXPLANATIONS:
(c) A. Midazolam will relieve the patient's anxiety.
(u) B. Budesonide is not usually needed for status asthmaticus requiring ventilatory
support since systemic steroids are the primary anti-inflammatory drug used.
(u) C. Morphine sulfate will sedate the patient, but also depress respiration.
(u) D. Cromolyn sodium is not used for status asthmaticus requiring ventilatory support
since systemic steroids are the primary anti-inflammatory drug used.
A patient is suspected of having Severe Acute Respiratory Syndrome (SARS). What
precautions must be taken for the care of this patient?
1. positive pressure room
2. gown
3. goggles
4. N-95 mask
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only - ANSWER-EXPLANATIONS:
1. False. A negative pressure room is needed to prevent droplets from entering the hall.
2. True. Transmission of SARS is by both direct contact and airborne routes. Gowns
must be worn to prevent contamination of clothing and body of healthcare workers.
3. True. Goggles are needed to prevent contact of droplets with the eyes and mucous
membranes.
4. True. The spread is airborne and an N-95 mask must be worn by healthcare workers.
(h) A. Incorrect and incomplete response included
(h) B. Incorrect and incomplete response included
(h) C. Incorrect and incomplete response included
(c) D. Correct response
,A patient who is oxygen-dependent travels using oxygen from an E cylinder secured in
the back seat. He carries a spare cylinder in the trunk of his car when he plans to be out
for longer periods of time. A respiratory therapist should inform the patient he should
A. not transport cylinders in his car.
B. open the trunk approximately 1 inch when transporting the spare cylinder.
C. secure the spare cylinder in the back seat.
D. wrap the spare cylinder in a blanket when transporting it in the trunk. - ANSWER-
EXPLANATIONS:
(u) A. It is acceptable to transport oxygen cylinders in the car when it is done safely.
See explanation C.
(u) B. Leaving the trunk open 1 inch is not acceptable. See explanation C.
(c) C. According to the Compressed Gas Association, cylinders should not be
transported in the trunk of an automobile. It is acceptable to carry a cylinder in a secure
carrier in the back seat of an automobile.
(u) D. No matter how the cylinders are stored, they should not be transported in the
trunk of an automobile. See explanation C.
A patient has been receiving VC ventilation for 24 hours with an FIO2 of 0.80. The
following arterial blood gas results are obtained:
pH 7.38
PaCO2 41 torr
PaO2 61 torr
HCO3 23 mEq/L
BE +1 mEq/L
During a routine patient assessment, a respiratory therapist also notices patient-
ventilator dyssynchrony. Which of the following should the therapist recommend?
1. PEEP
2. PS
3. SIMV
4. inspiratory hold
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only - ANSWER-EXPLANATIONS:
1. True. PEEP might reduce the P(A-a)O2 gradient.
2. True. Pressure support would reduce the effort associated with the spontaneous
breaths and help to synchronize the patient's breathing pattern with the ventilator.
3. True. SIMV would help to synchronize the patient's breathing pattern with the
ventilator.
4. False. Inspiratory hold would do little to reduce patient/ventilator dyssynchrony and/or
improve oxygenation.
(c) A. Correct response
,(u) B. Incomplete and incorrect response included
(u) C. Incomplete and incorrect response included
(u) D. Incomplete and incorrect response included
During initial assessment of a patient with a closed-head injury, the patient opens his
eyes only in response to painful stimuli. On a follow-up examination, the patient opens
his eyes to verbal commands. These observations indicate which of the following?
A. The level of consciousness is increased.
B. Intracranial pressure has increased.
C. Cerebral perfusion has decreased.
D. Seizure activity is increased. - ANSWER-EXPLANATIONS:
(c) A. Purposeful activity in response to a verbal command indicates an increase in the
level of consciousness.
(u) B. Increased intracranial pressure would impair the patient's response to verbal
commands.
(u) C. Decreased cerebral perfusion would impair the patient's response to verbal
commands.
(u) D. Increased seizure activity would impair the patient's response to verbal
commands.
A respiratory therapist is evaluating a patient with ARDS who is receiving VC, A/C
ventilation with 15 cm H2O PEEP. A slight leak is heard from the patient's mouth
throughout the ventilation cycle. A chest radiograph shows the tip of the endotracheal
tube is 5 cm above the carina. The cuff pressure is 18 cm H2O. Which of the following
should the therapist do FIRST?
A. Suction the patient's airway.
B. Advance the endotracheal tube 2 cm.
C. Reintubate the patient with a larger tube.
D. Add air to the cuff. - ANSWER-EXPLANATIONS:
(u) A. There is no indication that there are secretions in the central airway.
(u) B. The endotracheal tube is in a satisfactory position.
(u) C. See explanation D. Cuff inflation is not optimal; therefore, a larger tube is not
indicated.
(c) D. Air needs to be added to the cuff to achieve proper minimal occluding volume.
Safe inflation pressure is up to 25 cm H2O, well above the measured pressure for this
patient.
A patient who weighs 70 kg (154 lb) and is 173 cm (5 ft 8 in) tall is receiving ventilation
with the following settings:
FiO2 35%
Mandatory Rate 18
Tidal Volume 600ml
Results of a blood gas analysis are below:
, pH 7.58
PaCO2 26 torr
PaO2 95 torr
HCO3 24 mEq/L
BE +2 mEq/L
FiO2 VT
A. 0.25 700
B. 0.35 400
C. 0.50 550
D. 1.00 450 - ANSWER-EXPLANATIONS:
(h) A. Increasing the tidal volume will further increase the hyperventilation.
(c) B. Decreasing the tidal volume to 400 will increase the PaCO2.
(u) C. Oxygenation is adequate and an increase in FIO2 is not indicated. The decrease
in tidal volume to 550 will not significantly increase the PaCO2.
(u) D. There is no indication to change the FIO2 at this time.
A chest radiograph of a premature neonate displays air bronchograms and a diffuse
reticulogranular pattern. The neonate receives surfactant replacement therapy. Two
hours later, the neonate's FIO2 requirements have decreased from 0.70 to 0.35 and a
repeat chest radiograph is performed. The repeat chest radiograph would show
A. a decrease in atelectasis.
B. resolution of a pneumothorax.
C. improvement in a pleural effusion.
D. a decrease in size of the cardiac shadow. - ANSWER-EXPLANATIONS:
(c) A. The presence of air bronchograms and a diffuse reticulogranular pattern on the
chest radiograph is consistent with alveolar collapse (atelectasis), which is present
during newborn RDS. The repeat radiograph should show a decrease in these findings.
(u) B. Air bronchograms and a reticulogranular pattern are not indicative of a
pneumothorax.
(u) C. There is no blunting of the costophrenic angles present or other signs of a pleural
effusion.
(u) D. Air bronchograms and a reticulogranular pattern are not indicative of the size of
the cardiac shadow.
While assisting with a therapeutic bronchoscopy for an adult patient, a physician is
suddenly unable to view any anatomy because everything went black. Which of the
following is a likely cause?
A. A mucus plug is blocking the tip of the scope.
B. The lung collapsed distal to the scope.
C. The suction line is disconnected.
D. The light source is disconnected. - ANSWER-EXPLANATIONS:
(u) A. A mucus plug will still allow for limited light to be transmitted.
(u) B. The collapsed lung could still be seen.
(u) C. A disconnected suction line will have no effect on what is observed.
(c) D. Without the light source, nothing can be seen.
