Latest Version: 6.0

Question: 1

Which of the following characteristics of pulmonary function studies would not be expected in a patient who has asthma?

A. Decreased FEV1/FVC

B. Decreased FEV1

C. Decreased FVC

D. Decreased RV

Explanation:

Answer: D

RV (residual volume) will be increased in a patient who has asthma, not decreased. The FEV1 (forced expiratory volume over one second), FVC (forced vital capacity), and FEV1/FVC are all expected to be decreased in patients with asthma

Question: 2

The respiratory therapist is evaluating the ABG of a preterm infant who is being oxygenated using a nasal cannula at 3 L/min and who is one hour old. The patient's ABG is as follows:

• pH 7.33

• PaCO2 47 mm Hg

• PaO2 81 mm Hg

• HCO3- 19 mEq/l

• BE -4

Which of the following interventions is necessary for this patient?

A. Intubate the patient and begin mechanical ventilation

B. Begin providing oxygen using an oxygen hood instead of a nasal cannula

C. Decrease or turn of the nasal cannula

D. No intervention is needed

Explanation:

Answer: C

Retinopathy of Prematurity (ROP) is caused by hyperoxygenation of a newborn. The goal PaO2 to avoid ROP should be less than 80 mm Hg. A preterm infant who is one hour old should have PaO2 of 52–69 mm Hg typically, making the nasal cannula likely to be unnecessary for this patient. All the other ABG values are normal for a preterm infant who is one hour old.

Question: 3

Which of the following is the most concerning condition that should be monitored for in a patient with a penetrating chest trauma?

A. Traumatic brain injury (TBI)

B. Tension pneumothorax

C. Acute costochondritis

D. Hemothorax

Explanation:

Answer: B

A tension pneumothorax occurs when the pleural lesion of a penetrating chest trauma acts as a one-way valve, allowing air to enter into the pleural space and progressively expanding the pleural cavity. The unilateral increase in pressure can result in a mediastinal shift and lead to cardiovascular collapse and death. A hemothorax is an accumulation of blood in the pleural cavity and may be caused by penetrating chest trauma. While concerning, it is not as serious as a tension pneumothorax. Acute costochondritis is inflammation of the cartilage that connects the ribs to the sternum and, while uncomfortable, is not a serious concern. Traumatic brain injury (TBI) is a serious concern that could lead to depression of respiratory centers but is not a condition that should be monitored for in patients with a penetrating chest trauma unless other traumatic injuries have also occurred.

Question: 4

What is the intended purpose of a high-frequency chest wall compression device?

A. It provides a non-invasive technique for improving sputum clearance

B. It provides positive expiratory pressure that manages secretions

C. It provides cardiopulmonary circulation during a cardiac arrest

D. It provides intrapulmonary percussive ventilation

Answer: A

Explanation:

High-frequency chest wall compression devices are used to externally provide airway high-frequency airway oscillations that loosen secretions and improve airway clearance. The chest wall compressions are not sufficient to provide cardiopulmonary circulation during a cardiac arrest and the frequency is much higher than would be used during a cardiac arrest. Intrapulmonary percussive ventilation and positive expiratory pressure are different forms of therapy that are used to manage secretions.

Question: 5

The respiratory therapist is performing a two-point calibration on a blood gas analyzer when one result is outside the control limits. What is the best action to take?

A. Rerun the calibration and compare to previous control media analyses

B. If none of the other controls are outside the control limits, continue to use the analyzer

C. Have the analyzer serviced

D. Change the frequency of two-point calibrations to once every four hours until the result is within the control limits

Answer: A

Explanation:

Random errors can occur when an isolated result is outside the control limits and thus it does not mean that there is an error with the control media or with the analyzer. The calibration can be rerun, but the record of previous analyses should be evaluated to ensure that the frequency of random errors is not increasing. The analyzer should be serviced if the repeat calibration continues to be outside the control limits or if previous control media analyses indicate an increasing frequency of errors. The analyzer should not continue to be used until it is verified that this was a random error. Calibrating more frequently is not correct.

Question: 6

For which of the following procedures would a rigid bronchoscopy be favored over a flexible bronchoscopy?

A. Large volume tissue biopsy

B. Evaluation of burn-related airway injury

C. Suspected upper airway obstruction

D. Staging of bronchogenic carcinoma

Explanation:

Answer: A

Rigid bronchoscopy is preferred for obtaining biopsies of large volumes of tissues as the large diameter of the rigid bronchoscopy allows for retrieval of the large tissue volumes. Evaluation of burn-related airway injuries, staging of bronchogenic carcinomas, and evaluating or treating suspected upper airway obstructions are all indications that are better served with a flexible bronchoscopy.

Question: 7

The respiratory therapist is performing an EKG on a patient who has a history of an above-knee amputation (AKA) of the right leg. What are the implications this history has on the placement of lead on the right leg?

A. A normal EKG cannot be performed on this patient

B. The lead for the right leg should be placed on the very tip of the stump

C. The lead for the right leg should be placed on the right lower abdomen

D. The right leg lead should be placed over soft tissue as far down the stump as possible

Answer: A

Explanation:

The limb leads should be placed as distally as possible for the best results. Leads should be applied over fatty tissues or muscle for the best conductivity. Placing the lead on the abdomen is not best if the lead can be placed more distally. Placing the lead on the tip of the stump will position it over bone and a scar, which will not provide ideal conduction. A normal EKG can still be performed on this patient, but the right leg lead placement will be modified.

Question: 8

You are helping care for a 24-year-old male who has an abnormal respiratory pattern that is caused by diabetic ketoacidosis (DKA). Which of the following breathing patterns would you expect to see?

A. Rapid, deep breaths at regular intervals

B. Irregular breathing with varied depth and rate with periods of apnea

C. Rapid, shallow breaths at regular intervals

D. Deep breaths that are irregularly spaced, but still tachypneic

Answer: A

Explanation:

Kussmaul breathing is an abnormal breathing pattern that occurs with severe metabolic acidosis as can occur with DKA. Kussmaul breathing attempts to compensate for hypercapnia with deep, rapid breaths. Rapid, shallow breathing is typically associated with lung inflammation or stiffness. Deep breaths that are irregularly spaced, but still tachypneic, is considered a type of periodic breathing. Irregular breathing with varied depth and rate with periods of apnea describes Cheyne-Stokes respiration.

Question: 9

Which of the following is not a direct injury that can trigger Acute Respiratory Distress Syndrome (ARDS)?

A. Transfusion-Related Acute Lung Injury (TRALI)

B. Near-drowning

C. Gastric aspiration

D. Smoke inhalation

Explanation:

Answer: A

While Transfusion-Related Acute Lung Injury (TRALI) can trigger Acute Respiratory Distress Syndrome (ARDS), it is an indirect, not a direct, injury. Near-drowning, gastric aspiration, and smoke inhalation are all direct lung injuries that can tigger ARDS.

Question: 10

The respiratory therapist is providing a respiratory treatment to a patient with pneumonia who has an active Clostridium difficile infection. Which of the following infection preventions should be utilized when providing treatment to this patient?

1. Gloves

2. Hand-washing with soap and water

3. Hand-washing with alcohol

4. Gowns

5. Face mask

A. 1, 2, and 3

B. 1, 2, and 4

C. 1, 2, 3, and 4

D. 1, 2, 3, 4, and 5

Explanation:

Answer: B

Clostridium difficile (C. difficile) infections require precautions that are sometimes referred to as "contact plus" precautions. C. difficile creates spores that can only be removed using soap and water, meaning that hand-washing using alcohol-based hand sanitizers is ineffective. For these patient gloves, hand-washing with soap and water, and gowns are needed.