LINDSAY JONES QUESTIONS AND
ANSWERS (GRADED A+)
A patient demonstrates signs of air-hunger while receiving mechanical ventilatory
support. The most recent chest radiograph shows the end the ET tube 1 inch above the
carina. The respiratory therapist should
A. advance the ET tube 1 cm.
B. replace the ET tube.
C. evaluate for other causes of air-hunger.
D. withdraw the ET tube by 2 inches. - ANSWER-C. evaluate for other causes of air-
hunger.
Which of the following would result in an increase in anatomical airway resistance?
A. water build up in the ventilator circuit
B. autoPEEP
C. an undersized endotracheal tube
D. pulmonary secretions - ANSWER-D. pulmonary secretions
Explanation : Airway resistance is increased in the presence of pulmonary secretions
and bronchoconstriction. The other examples listed are not anatomically related.
A patient with pneumococcal pneumonia is having difficulty expectorating sputum that is
thick and tenacious. Which of the following would most effectively help thin secretions?
A. aerosolized albuterol treatments
B. aerosolized acetylcysteine, once daily
C. instillation of saline into the airway
D. IV fluids - ANSWER-D. IV fluids
Explanation : The most effective way to thin secretions is by increasing the overall fluid
status of the patient. This is most effectively done through IV fluid administration and by
oral consumption of water (and other fluids).
Two hours after abdominal surgery, an orally intubated patient with no history of
pulmonary disease is alert and agitated and is repeatedly attempting to pull on on the
ET tube. Current ventilator settings are: SIMV, rate 10/min, VT 450 mL, FIO2 0.4, PEEP
5 cm H2O, PS 5 cm H2O. The respiratory therapist should consider
A. sedation of the patient.
B. application of a soft hand restraint system.
C. spontaneous breathing trials.
D. extubation. - ANSWER-D. extubation.
A respiratory therapist is transporting a closed biohazard container of used, disposable
needles for sterilization. Which method is most appropriate to sterilize the used
needles?
A. Irradiation followed by ethylene oxide
, B. Acid Gluteraldehyde
C. Incineration
D. Alkaline Gluteraldehyde - ANSWER-C. Incineration
Explanation : Incineration is the best sterilizing technique for non-disposable equipment
such as blood-laden needles. Incineration, of course, will destroy the equipment but will
sterilize the material.
Which of the following methods can be used to assess the anticipated difficulty level for
oral intubation on an adult patient?
A. Miller
B. Henderson
C. Mallampati
D. Fick - ANSWER-C. Mallampati
Explanation : The Mallampati classification system can be used to assess potential
intubation difficulty on an adult patient.
Despite three days of antibiotic therapy for the treatment of a pneumonia patient who
has a gram-positive pulmonary infection, white blood cell count is not significantly
decreasing and consolidation in the lungs remains largely unchanged. Which of the
following would be most helpful toward diminishing the patient's infection?
A. begin ambulation, 3 times a day for 10 minutes
B. administer anti-viral medication as well
C. initiate chest physiotherapy
D. sputum culture and sensitivity studies - ANSWER-D. sputum culture and sensitivity
studies
During the placement of a pulmonary artery catheter, the respiratory therapist observes
the waveform on the monitor and notices it is repeatedly rising and falling from 0 mmHg
to 25 mmHg, which is an indication that the tip of the catheter is in the right ventricle of
the heart. Based on this information, the respiratory therapist will recommend
A. rotate the catheter to achieve a dicrotic notch in the waveform
B. inflate the catheter balloon to sail the tip to the proper location
C. withdraw the catheter back to the upper vena cava
D. suture the catheter in place - ANSWER-B. inflate the catheter balloon to sail the tip
to the proper location
Explanation : The pulmonary catheter should be terminated in the pulmonary artery,
which is beyond the right ventricle. Therefore, advancing the catheter is appropriate.
The catheter may be advanced by sailing it into position, which is done by inflating the
catheter balloon and allowing blood flow to carry the catheter into position and then
deflating the balloon once it is in the proper position.
A patient indicates he has been smoking an average of 1.5 packs per day for 30 years.
Which of the following accurately summarizes the patient's history of smoking?
A. 10 pack-years
B. 60 pack-years
C. 30 pack-years
,D. 45 pack-years - ANSWER-D. 45 pack-years
Explanation : Pack-years are calculated by: Average packs per day X number of years.
What would be considered a prominent sign consistent with pulmonary tuberculosis?
A. cavitation(s) in the upper lobe(s)
B. patchy, diffuse infiltrates
C. increased trans-thoracic distance of the cardiac shadow
D. expanded hilar area - ANSWER-A. cavitation(s) in the upper lobe(s)
Explanation : Cavitations, especially in the upper lobes, are associated with
tuberculosis.
A therapist is setting up a large-volume nebulizer for a patient in need of continuous
aerosol therapy for the purpose of hydration. The respiratory therapist should do which
of the following to guard against the risk of nosocomial infection?
1. Avoid touching the internal surfaces of the device2. Change the device out every 8
hours3. Record the date and time of the device setup4. Check package integrity prior to
opening
A. 1, 2, and 3 only
B. 3 and 4 only
C. 1, 2, 3, and 4
D. 1, 3, and 4 only - ANSWER-D. 1, 3, and 4 only
Explanation : Guarding against nosocomial infection when using a large-volume
nebulizer is about maintaining a sterile technique when assembling and installing the
device. Avoiding touching internal surfaces of the device and checking package integrity
prior to opening the package, are key methods. It is also helpful to note the date and
time of installation on the piece of equipment so that subsequent respiratory therapists
who are taking care of the patient will be aware of the need to change the device when
appropriate.
Which of the following is most likely to contribute to spreading of nosocomial infection in
a hospital?
A. continuous use of an HME for 96 hours
B. use of multiple dose bottle and dropper for bronchodilator administration
C. use of a minimum leak technique when sealing ET tube cuffs
D. avoidance of touching internal surfaced of a large volume nebulizer - ANSWER-B.
use of multiple dose bottle and dropper for bronchodilator administration
Explanation : Of the options offered the most likely cause of nosocomial infection would
be use of a multiple dose bottle or dropper for bronchodilator administration among
multiple patients. The other methods shown would help to decrease incidence of
nosocomial infection.
A respiratory therapist is monitoring a patient's maximal inhalation and exhalation
repeatedly over a period of 15 seconds. The therapist is attempting to observe which of
the following?
A. MVV
B. inspiratory capacity
, C. minute ventilation
D. alveolar ventilation - ANSWER-A. MVV
Explanation : Maximum voluntary ventilation (MVV) is determined by having the patient
breathe maximally in and out for a period of either 12 seconds or 15 seconds and then
multiplying that volume by five or by four respectively.
A patient receiving oxygen therapy at home complains the oxygen concentrator is not
working and that the flow feels insufficient. The respiratory therapist should
A. instruct the patient use back-up E cylinders until the concentrator can be examined
B. tell the patient everything is normal
C. instruct the patient to check the flow with a calibration tube
D. tell the patient to call the manufacturer - ANSWER-A. instruct the patient use back-
up E cylinders until the concentrator can be examined
Explanation : Anytime a patient complains that they are not receiving enough oxygen, or
that they worry that the oxygen concentrator or other oxygen delivery equipment is not
operating properly, the first most appropriate action is to ensure proper oxygen delivery
to the patient by changing modalities. In this case, having the patient switch to an E
cylinder is most appropriate.
A patient in a current myasthenic crisis is being monitored every 2 hours. The following
data is available:
1 pm 3 pm 5 pm VC (L) 2.8 2.4 1.6VT (mL) 500 485 400MIP (cm H2O) -48 -35 -30
The respiratory therapist should recommend
A. manually ventilate with a bag-valve-mask
B. administer Tensilon
C. intubate and initiate mechanical ventilatory support
D. continue to monitor the patient closely - ANSWER-D. continue to monitor the patient
closely
Explanation : A patient with myasthenia gravis experiences progressive paralysis of the
muscles associated with ventilation, especially the diaphragm. This data shows a
gradual decrease in ventilatory ability. However, the patient has a vital capacity well
over 1 L, indicating that mechanical ventilatory support is not yet needed. However, this
patient should be monitored closely for further degradation in the ventilation status.
Once VC falls below 1 L, mechanical ventilatory support is indicated.
The following data is obtained from the patient's ventilator flow sheet:
3 am 9 am 3 pm Peak pressure(cm H2O) 20 21 25Plateau pressure (cm H2O) 14 14
20VT (L) 0.5 0.5 0.5PEEP (cm H2O) 5 5 10
Which of the following can be accurately stated?
A. decreasing shunt
B. static compliance remains steady
C. decreasing ventilation/perfusion mismatch
D. dynamic compliance is steady - ANSWER-B. static compliance remains steady
Explanation : Static compliance is monitored by examining the plateau pressures over
time. Observation of these data appear to suggest an increase in plateau pressures,
which is associated with a decrease in pulmonary compliance. However, closer
ANSWERS (GRADED A+)
A patient demonstrates signs of air-hunger while receiving mechanical ventilatory
support. The most recent chest radiograph shows the end the ET tube 1 inch above the
carina. The respiratory therapist should
A. advance the ET tube 1 cm.
B. replace the ET tube.
C. evaluate for other causes of air-hunger.
D. withdraw the ET tube by 2 inches. - ANSWER-C. evaluate for other causes of air-
hunger.
Which of the following would result in an increase in anatomical airway resistance?
A. water build up in the ventilator circuit
B. autoPEEP
C. an undersized endotracheal tube
D. pulmonary secretions - ANSWER-D. pulmonary secretions
Explanation : Airway resistance is increased in the presence of pulmonary secretions
and bronchoconstriction. The other examples listed are not anatomically related.
A patient with pneumococcal pneumonia is having difficulty expectorating sputum that is
thick and tenacious. Which of the following would most effectively help thin secretions?
A. aerosolized albuterol treatments
B. aerosolized acetylcysteine, once daily
C. instillation of saline into the airway
D. IV fluids - ANSWER-D. IV fluids
Explanation : The most effective way to thin secretions is by increasing the overall fluid
status of the patient. This is most effectively done through IV fluid administration and by
oral consumption of water (and other fluids).
Two hours after abdominal surgery, an orally intubated patient with no history of
pulmonary disease is alert and agitated and is repeatedly attempting to pull on on the
ET tube. Current ventilator settings are: SIMV, rate 10/min, VT 450 mL, FIO2 0.4, PEEP
5 cm H2O, PS 5 cm H2O. The respiratory therapist should consider
A. sedation of the patient.
B. application of a soft hand restraint system.
C. spontaneous breathing trials.
D. extubation. - ANSWER-D. extubation.
A respiratory therapist is transporting a closed biohazard container of used, disposable
needles for sterilization. Which method is most appropriate to sterilize the used
needles?
A. Irradiation followed by ethylene oxide
, B. Acid Gluteraldehyde
C. Incineration
D. Alkaline Gluteraldehyde - ANSWER-C. Incineration
Explanation : Incineration is the best sterilizing technique for non-disposable equipment
such as blood-laden needles. Incineration, of course, will destroy the equipment but will
sterilize the material.
Which of the following methods can be used to assess the anticipated difficulty level for
oral intubation on an adult patient?
A. Miller
B. Henderson
C. Mallampati
D. Fick - ANSWER-C. Mallampati
Explanation : The Mallampati classification system can be used to assess potential
intubation difficulty on an adult patient.
Despite three days of antibiotic therapy for the treatment of a pneumonia patient who
has a gram-positive pulmonary infection, white blood cell count is not significantly
decreasing and consolidation in the lungs remains largely unchanged. Which of the
following would be most helpful toward diminishing the patient's infection?
A. begin ambulation, 3 times a day for 10 minutes
B. administer anti-viral medication as well
C. initiate chest physiotherapy
D. sputum culture and sensitivity studies - ANSWER-D. sputum culture and sensitivity
studies
During the placement of a pulmonary artery catheter, the respiratory therapist observes
the waveform on the monitor and notices it is repeatedly rising and falling from 0 mmHg
to 25 mmHg, which is an indication that the tip of the catheter is in the right ventricle of
the heart. Based on this information, the respiratory therapist will recommend
A. rotate the catheter to achieve a dicrotic notch in the waveform
B. inflate the catheter balloon to sail the tip to the proper location
C. withdraw the catheter back to the upper vena cava
D. suture the catheter in place - ANSWER-B. inflate the catheter balloon to sail the tip
to the proper location
Explanation : The pulmonary catheter should be terminated in the pulmonary artery,
which is beyond the right ventricle. Therefore, advancing the catheter is appropriate.
The catheter may be advanced by sailing it into position, which is done by inflating the
catheter balloon and allowing blood flow to carry the catheter into position and then
deflating the balloon once it is in the proper position.
A patient indicates he has been smoking an average of 1.5 packs per day for 30 years.
Which of the following accurately summarizes the patient's history of smoking?
A. 10 pack-years
B. 60 pack-years
C. 30 pack-years
,D. 45 pack-years - ANSWER-D. 45 pack-years
Explanation : Pack-years are calculated by: Average packs per day X number of years.
What would be considered a prominent sign consistent with pulmonary tuberculosis?
A. cavitation(s) in the upper lobe(s)
B. patchy, diffuse infiltrates
C. increased trans-thoracic distance of the cardiac shadow
D. expanded hilar area - ANSWER-A. cavitation(s) in the upper lobe(s)
Explanation : Cavitations, especially in the upper lobes, are associated with
tuberculosis.
A therapist is setting up a large-volume nebulizer for a patient in need of continuous
aerosol therapy for the purpose of hydration. The respiratory therapist should do which
of the following to guard against the risk of nosocomial infection?
1. Avoid touching the internal surfaces of the device2. Change the device out every 8
hours3. Record the date and time of the device setup4. Check package integrity prior to
opening
A. 1, 2, and 3 only
B. 3 and 4 only
C. 1, 2, 3, and 4
D. 1, 3, and 4 only - ANSWER-D. 1, 3, and 4 only
Explanation : Guarding against nosocomial infection when using a large-volume
nebulizer is about maintaining a sterile technique when assembling and installing the
device. Avoiding touching internal surfaces of the device and checking package integrity
prior to opening the package, are key methods. It is also helpful to note the date and
time of installation on the piece of equipment so that subsequent respiratory therapists
who are taking care of the patient will be aware of the need to change the device when
appropriate.
Which of the following is most likely to contribute to spreading of nosocomial infection in
a hospital?
A. continuous use of an HME for 96 hours
B. use of multiple dose bottle and dropper for bronchodilator administration
C. use of a minimum leak technique when sealing ET tube cuffs
D. avoidance of touching internal surfaced of a large volume nebulizer - ANSWER-B.
use of multiple dose bottle and dropper for bronchodilator administration
Explanation : Of the options offered the most likely cause of nosocomial infection would
be use of a multiple dose bottle or dropper for bronchodilator administration among
multiple patients. The other methods shown would help to decrease incidence of
nosocomial infection.
A respiratory therapist is monitoring a patient's maximal inhalation and exhalation
repeatedly over a period of 15 seconds. The therapist is attempting to observe which of
the following?
A. MVV
B. inspiratory capacity
, C. minute ventilation
D. alveolar ventilation - ANSWER-A. MVV
Explanation : Maximum voluntary ventilation (MVV) is determined by having the patient
breathe maximally in and out for a period of either 12 seconds or 15 seconds and then
multiplying that volume by five or by four respectively.
A patient receiving oxygen therapy at home complains the oxygen concentrator is not
working and that the flow feels insufficient. The respiratory therapist should
A. instruct the patient use back-up E cylinders until the concentrator can be examined
B. tell the patient everything is normal
C. instruct the patient to check the flow with a calibration tube
D. tell the patient to call the manufacturer - ANSWER-A. instruct the patient use back-
up E cylinders until the concentrator can be examined
Explanation : Anytime a patient complains that they are not receiving enough oxygen, or
that they worry that the oxygen concentrator or other oxygen delivery equipment is not
operating properly, the first most appropriate action is to ensure proper oxygen delivery
to the patient by changing modalities. In this case, having the patient switch to an E
cylinder is most appropriate.
A patient in a current myasthenic crisis is being monitored every 2 hours. The following
data is available:
1 pm 3 pm 5 pm VC (L) 2.8 2.4 1.6VT (mL) 500 485 400MIP (cm H2O) -48 -35 -30
The respiratory therapist should recommend
A. manually ventilate with a bag-valve-mask
B. administer Tensilon
C. intubate and initiate mechanical ventilatory support
D. continue to monitor the patient closely - ANSWER-D. continue to monitor the patient
closely
Explanation : A patient with myasthenia gravis experiences progressive paralysis of the
muscles associated with ventilation, especially the diaphragm. This data shows a
gradual decrease in ventilatory ability. However, the patient has a vital capacity well
over 1 L, indicating that mechanical ventilatory support is not yet needed. However, this
patient should be monitored closely for further degradation in the ventilation status.
Once VC falls below 1 L, mechanical ventilatory support is indicated.
The following data is obtained from the patient's ventilator flow sheet:
3 am 9 am 3 pm Peak pressure(cm H2O) 20 21 25Plateau pressure (cm H2O) 14 14
20VT (L) 0.5 0.5 0.5PEEP (cm H2O) 5 5 10
Which of the following can be accurately stated?
A. decreasing shunt
B. static compliance remains steady
C. decreasing ventilation/perfusion mismatch
D. dynamic compliance is steady - ANSWER-B. static compliance remains steady
Explanation : Static compliance is monitored by examining the plateau pressures over
time. Observation of these data appear to suggest an increase in plateau pressures,
which is associated with a decrease in pulmonary compliance. However, closer
