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1. The respiratory therapist is monitoring a patient with myasthenia gravis and finds that the maximum inspiratory pressure (MIP) has changed from 35 cm H20 four hours ago to -10 cm H20. Based on this change, the therapist should recommend which of the following?

Measuring maximum voluntary ventilation (MVV)
Administering oxygen via partial rebreathing mask
Administering oxygen via nasal cannula at 5 L/min
Obtaining an arterial blood gas analysis

2. A patient who is febrile and has severe pneumonia is admitted to the hospital, at an F1O2 of 0.21, his arterial blood gas results are as follows:
pH 7.44
PaCO2 37.0 torr
PaO2 40.0 torr
HCO3 21.0 mEq/L
Based on this information, all of the following are indicated for this patient EXCEPT

Administering oxygen therapy with an F1O2 of 0.40
Administering an antipyretic
Intubating and ventilating the patient
Administering an antibiotic

3. During auscultation, the respiratory therapist notes fine crackles. Which of the following is most likely?

Pleural effusion
Hemothorax
Asthma
Pulmonary edema

4. A 43-year-old patient has an arterial blood sample obtained in the emergency department while breathing room air. The results are below:
pH 7.43
PaCO2 41.0 torr
PaO2 43.0 torr
HCO3 26.0 mEq/L
SaO2 75%
SpO2 90%
These results most likely indicate which of the following?

The SaO2 is consistent with a laboratory error; the SpO2 should be used to assess oxygenation.
The SpO2 reading indicates that the patient has a low peripheral perfusion
The arterial blood gas results accurately reflect the patient's oxygenation status; the SpO2 should be disregarded
The difference between the SaO2 and the SpO2 is within the standard error of measurement

5. Aerosol delivery is intermittently interrupted during the breathing cycle of a patient receiving 0.40 oxygen via heated aerosol and a T-piece. To correct this situation, the respiratory therapist should

Refill the reservoir jar
Shorten the reservoir tube
Replace the heating element
Empty the water in the large bore tubing

6. The respiratory therapist is checking the laryngoscope and blades on the code cart. The Miller blade is attached and the light shines bright white. The Macintosh blade is attached, but the light fails to turn on. The therapist should initially

Replace the batteries
Replace the Macintosh blade with a new blade
Tighten the bulb on the Macintosh blade
Take the Macintosh blade to the department for repair

7. The respiratory therapist is called to the emergency department to assist in the selection and placement of an artificial airway in a patient currently being resuscitated during cardiac arrest. It is anticipated that continued ventilatory assistance will be required. Which of the following would be the airway of choice in this situation?

A tracheostomy button with IPPB adapter
An oral endotracheal tube
A nasotracheal tube
A tracheostomy tube

8. A patient with asthma is in acute respiratory distress and presents to the emergency department with markedly diminished breath sounds. Following bronchodilator therapy, auscultation of the chest reveals rhonchi and wheezing. This change suggests which of the following?

A development of a pneumothorax
Improvement of the air flow
Onset of pneumonia
Development of pulmonary edema

9. A 4 day old, 35-week gestational age infant with symptoms of respiratory distress syndrome is receiving an F1O2 of 0.28 and nasal CPAP at 8 cm H20. His vital signs, appearance, and fluid output have been stable for 12 hours. The results of a blood gas analysis sample obtained from an umbilical artery catheter are below:
pH 7.43
PaCO2 42.0 torr
PaO2 129.0 torr
HCO3 27.0 mEq/L
Based on this information, the respiratory therapist should recommend which of the following?

Decrease CPAP to 5 cm H20
Decrease the F1O2 to 0.21
Maintain the present therapy and monitor the infant
Discontinue CPAP and increase the F1O2 to 0.40

10. Which of the following drugs would be most appropriate to recommend as a substitute for isoetharine (Bronkosol) for a patient who has bronchospasm and whose cardiac rate increases by 60 beats/min with each treatment?

Acetylcysteine (Mucomyst)
Beclomethasone (Vanceril)
Racemic epinephrine
Albuterol (Proventil)

11. During aerosolized beta-antagonist therapy, an increase in the patient's blood pressure and heart rate is noted. Which of the following is the most likely cause?

Drug absorption causing systemic effects
Relief of bronchial constriction by the drug
Increased oxygenation
Tachyphylaxis

12. The respiratory therapist is preparing to suction a patient who has an endotracheal tube in place. Which of the following is a necessary step in the suctioning procedure?

Oxygenate the patient before and after suctioning
Rinse the catheter with water before suctioning
Instill 3 ml 0.9% NaCl before suctioning
Lubricate the catheter with water-soluble gel before suctioning

13. Pursed-lip breathing would be most beneficial for a patient who has:

Emphysema
Pneumonia
Asthma
Croup

14. A mechanically ventilated patient is breathing asynchronously with the ventilator. Breath sounds are absent on the left, with dullness to percussion and a left shift of the trachea. Which of the following is the most likely explanation of the problem?

The patient is experiencing diffuse bronchospasm
The endotracheal tube is in the right mainstem bronchus
A tension pneumothorax has developed on the left
A tracheoesophageal fistula has developed

15. A patient who is comatose presents to the emergency department with a suspected drug overdose. Rapid assessment indicates a heart rate of 40/min and a respiratory rate of 5/min with shallow, irregular respirations. That patient has just vomited. The most appropriate INITIAL action is to:

Administer bag-and-mask ventilation
Insert an oral airway
Clear the patient's airway
Intubate the patient