Advanced Respiratory Therapy
Mock Exam
Course Introduction
Advanced Respiratory Therapy delves into the complex assessment, management, and treatment of patients with acute and chronic cardiopulmonary disorders. The course emphasizes advanced therapeutic techniques, critical care interventions, and the interpretation of diagnostic tests such as arterial blood gases and pulmonary function studies. Students will explore mechanical ventilation strategies, airway management, and non-invasive respiratory support, while honing skills in evidence-based patient care and interprofessional collaboration. Ethical considerations and emerging trends in respiratory care are also covered, preparing students for leadership roles in clinical practice.
Recommended Textbook
Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by J M Cairo
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707 Verified Questions
707 Flashcards
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Chapter 1: Basic Terms and Concepts of Mechanical
Ventilation
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36 Verified Questions
36 Flashcards
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Sample Questions
Q1) Calculate airway resistance (R )for a ventilator patient,in cm H O/L/sec,when the peak inspiratory pressure (PIP)is 50 cm H O,the plateau pressure (P )is 15 cm H O,and the flow rate is 60 L/min.
A) 0.58R<sub>aw</sub>
B) 1.2R<sub>aw</sub>
C) 35R<sub>aw</sub>
D) 50R<sub>aw</sub>
Answer: C
Q2) During spontaneous inspiration alveolar pressure (PA)is about:
A) -1 cm H O
B) +1 cm H O
C) 0 cm H O
D) 5 cm H O
Answer: A
Q3) Which of the following conditions causes pulmonary compliance to increase?
A) Asthma
B) Kyphoscoliosis
C) Emphysema
D) Acute respiratory distress syndrome (ARDS)
Answer: C
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Chapter 2: How Ventilators Work
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Sample Questions
Q1) The function of the exhalation valve is to do which of the following?
A) Adjust the flow going to the patient.
B) Close during exhalation to vent patient gas.
C) Seal the external circuit during inspiration.
D) Determine the volume being delivered.
Answer: C
Q2) A ventilator for which the primary power source generates a gas flow that compresses another mechanism and causes the gas from inside the mechanism to be delivered to the patient is known as which of the following?
A) Single-circuit
B) Double-circuit
C) Closed loop
D) Open loop
Answer: B
Q3) Which of the following is an example of a flow control valve?
A) Linear piston
B) Spring-loaded bellows
C) Solenoid
D) Rotary drive piston
Answer: C
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Chapter 3: How a Breath Is Delivered
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Sample Questions
Q1) The ventilator that can provide a negative pressure during the very beginning of the exhalation phase is which of the following?
A) Servo<sup>i</sup>
B) VIASYS Avea
C) Puritan Bennett 840
D) Cardiopulmonary Venturi
Answer: D
Q2) The ventilator variable that begins inspiration is which of the following?
A) Cycle
B) Limit
C) Trigger
D) Baseline
Answer: C
Q3) The equation of motion describes the relationships between which of the following?
A) Pressure and flow during a mechanical breath
B) Pressure and volume during a spontaneous breath
C) Flow and volume during a mechanical or spontaneous breath
D) Flow, volume, and pressure during a spontaneous or mechanical breath
Answer: D
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Page 5
Chapter 4: Establishing the Need for Mechanical Ventilation
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Sample Questions
Q1) A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate 120 beats/min and regular; blood pressure 146/88 mm Hg; temperature 38° C; respiratory rate 28 breaths/min shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The ABG on room air is: pH 7.52; PaCO<sub>2</sub> 30 mm Hg; PaO<sub>2</sub> 42 mm Hg; Hb-O<sub>2</sub> 80%; HCO<sub>3</sub><sup>-</sup> 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50-pack-year history of smoking. The most appropriate action for the respiratory therapist to take is which of the following?
A) Intubate and initiate positive-pressure ventilation.
B) Initiate noninvasive positive pressure ventilation.
C) Administer oxygen via a high flow nasal cannula.
D) Initiate bronchodilator and mucolytic therapy.
Q2) Respiratory failure due to inadequate ventilation is known as which of the following?
A) Hypoxemic
B) Hypercapnic
C) Compensated
D) Chronic
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6
Chapter 5: Selecting the Ventilator and the Mode
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Sample Questions
Q1) A patient with acute respiratory distress syndrome (ARDS)has developed a pneumothorax from elevating peak and plateau pressures.The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode with a set rate of 12 breaths/min.However,the patient is triggering the ventilator at a rate of 25 breaths/min.The arterial blood gas reveals ventilator-induced hyperventilation with corrected hypoxemia.The most appropriate recommendation to manage this patient on the ventilator is which of the following?
A) Sedate the patient.
B) Decrease the set ventilator rate.
C) Switch the mode to pressure-controlled intermittent mandatory ventilation (PC-IMV).
D) Switch the mode to pressure-controlled continuous mandatory ventilation (PC-CMV).
Q2) A patient triggered,pressure limited,flow cycled breath describes which of the following?
A) Spontaneous breath
B) Pressure-support breath
C) Volume-control breath
D) Pressure-control breath
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Chapter 6: Initial Ventilator Settings
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Sample Questions
Q1) A mechanically ventilated patient is going to be placed on pressure support ventilation following an acceptable spontaneous weaning trial.The patient is a 5'9" male who weighs 185 lb.During volume-controlled continuous mandatory ventilation (VC-CMV)his average peak inspiratory pressure (PIP)was about 26 cm H O and the plateau pressure (P<sub>Plateau</sub>)was 16 cm H O.What initial pressure support level should be set?
A) 5 cm H O
B) 10 cm H O
C) 15 cm H O
D) 20 cm H O
Q2) Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR)of 12 breaths/min.
A) 120 mL
B) 833 mL
C) 1000 mL
D) 1200 mL
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Chapter 7: Final Considerations in Ventilator Setup
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Sample Questions
Q1) A 70-year-old,61-inch-tall female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD).After 12 hours of oxygen therapy,bronchodilator therapy,and intravenous corticosteroids,the patient began to show signs of clinical deterioration.Her chest X-ray revealed an enlarged heart and bilateral infiltrates.Her arterial blood gas shows acute on chronic respiratory failure.It is decided that this patient requires intubation and mechanical ventilation.The most appropriate ventilator settings for this patient include which of the following?
A) Volume-controlled continuous mandatory ventilation (VC-CMV) rate 15, V 200 mL, F O 1.0, positive end-expiratory pressure (PEEP) 5 cm H O
B) VC-CMV rate 12, V 400 mL, F O 0.4, PEEP 3 cm H O
C) Pressure-controlled intermittent mandatory ventilation (PC-IMV) rate 10, peak inspiratory pressure (PIP) 30 cm H O, F O 0.60, PEEP 3 cm H O
D) PC-IMV rate 12, PIP 35 cm H O, F O 0.30, PEEP 8 cm H O
Q2) What is the range for setting flow triggering?
A) 1-10 L/min
B) 10-15 L/min
C) 12-16 L/min
D) 20-30 L/min
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Chapter 8: Initial Patient Assessment
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Sample Questions
Q1) The pressure at which large numbers of alveoli are recruited in a patient with acute respiratory distress syndrome (ARDS)is located on the static pressure-volume curve at which of the following points?
A) Upper inflection point
B) Lower inflection point
C) Peak inspiratory pressure
D) Between the lower and upper inflection points
Q2) An increasing PIP may indicate which of the following?
A) Decreasing lung compliance
B) Decreasing airway resistance
C) Leak in the ventilator circuit
D) Increasing dynamic compliance
Q3) How can the amount of cuff volume/pressure lost in the connecting tube be minimized during cuff measurement using a three-way stopcock,a manometer,and a syringe?
A) Using a four-way stopcock
B) Overinflating the cuff prior to measurement
C) Simultaneously inflating the cuff and manometer
D) Pressurizing the manometer to 25 mm Hg prior to use
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Page 10
Chapter 9: Ventilator Graphics
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Sample Questions
Q1) The type of flow curve produced by volume ventilation with constant flow is which of the following?
A) Sinusoidal
B) Rectangular
C) Descending ramp
D) Exponential decay
Q2) The most important factor to affect the degree of resistance in the airways is which of the following?
A) Flow rate of the gas
B) Viscosity of the gas
C) Length of the airways
D) Diameter of the airways
Q3) An inadequate flow setting during volume ventilation will cause which of the following to occur?
A) The volume curve will drop below the zero baseline.
B) The volume curve will not drop to the zero baseline.
C) The exhaled flow will take longer to rise to the zero baseline.
D) The pressure-time curve will appear concave during inspiration.
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11
Chapter 10: Assessment of Respiratory Function
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Sample Questions
Q1) A patient-ventilator system check reveals the following information: peak inspiratory pressure (PIP)27 cm H O,positive end-expiratory pressure (PEEP)5 cm H O,plateau pressure (P )14 cm H O,inspiratory time (T )0.75 second,and set frequency 20/minute.Calculate the mean airway pressure.
A) 6.75 cm H O
B) 7.75 cm H O
C) 11.75 cm H O
D) 12.37 cm H O
Q2) During calibration of a transcutaneous monitor the respiratory therapist notices a signal drift.The respiratory therapist should do which of the following?
A) Increase the probe temperature.
B) Replace the monitor and call for repair.
C) Add more electrolyte gel to the patient's skin.
D) Change the electrolyte and sensor's membrane.
Q3) To measure plateau pressure,inspiration should be held for how many seconds?
A) 1-2
B) 2-3
C) 3-4
D) 4-5
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Page 12
Chapter 11: Hemodynamic Monitoring
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Sample Questions
Q1) Which of the following can occur with excessive pulmonary artery catheter movement?
A) Catheter whip
B) Balloon rupture
C) Catheter knotting
D) Dampened waveform
Q2) A pulmonary artery catheter must be wedged in which of the following locations?
A) Zone 1
B) Zone 2
C) Zone 3
D) Doesn't matter
Q3) Which of the following disorders can cause an increase in systemic vascular resistance?
A) Lung collapse
B) Hypervolemia
C) Chronic bronchitis
D) Cardiogenic pulmonary edema
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Chapter 12: Methods to Improve Ventilation in Patient-Ventilator Management
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Sample Questions
Q1) Which of the following can cause metabolic acidosis?
A) Overdose with salicylate
B) Diuretic administration
C) Nasogastric suctioning
D) Lactate administration
Q2) When using an SVN or pMDI with NPPV,where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition?
A) Before the leak port
B) Anywhere in the circuit
C) Between the NPPV and the humidifier
D) Between the leak port and the face mask
Q3) A patient with CHF is being mechanically ventilated.The patient's current P CO = 28 mm Hg,and the ventilator set rate is 16 per minute.The desired P CO for this patient is 40 mm Hg.To what should the set rate be changed?
A) 7/min
B) 11/min
C) 14/min
D) 18/min
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Chapter 13: Improving Oxygenation and Management of ARDS
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Sample Questions
Q1) The level of applied PEEP should be set at what point on the pressure-volume curve?
A) At the upper inflection point of the inflation curve.
B) Above the lower inflection point of the deflation curve.
C) At the peak inspiration point of the inflation curve.
D) Above the upper inflection point of the deflation curve.
Q2) The patient with which of the following assessment findings meets the criteria for beginning weaning from PEEP?
A) P CO = 85 mm Hg; F O = 0.6; C = 20 mL/cm H O; PEEP = 12 cm H O
B) P CO = 100 mm Hg; F O = 0.9; C = 22 mL/cm H O; PEEP = 10 cm H O
C) P CO = 150 mm Hg; F O = 0.7; C = 25 mL/cm H O; PEEP = 12 cm H O
D) P CO = 95 mm Hg; F O = 0.3; C = 30 mL/cm H O; PEEP = 15 cm H O
Q3) How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?
A) 5 minutes
B) 15 minutes
C) 25 minutes
D) 40 minutes
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Page 15
Chapter 14: Ventilator-Associated Pneumonia
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Sample Questions
Q1) According to the Centers for Disease Control (CDC)and National Healthcare Safety Network (NHSN),the proposed and updated definition for VAP includes which of the following?
1)Objective data
2)Patient's family history
3)A clearly defined time criteria
4)Chest radiograph images
A) 1 and 3 only
B) 2 and 3 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4
Q2) Pneumonia that was not incubating at the time of admission is one that develops a minimum of how many hours after admission?
A) 12 hours
B) 24 hours
C) 48 hours
D) 72 hours
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Chapter 15: Sedatives, Analgesics, and Paralytics
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Sample Questions
Q1) The train-of-four response is used to assess a patient's level of paralysis during high-frequency oscillatory ventilation,and the patient's foot twitches four times.The most appropriate evaluation of this circumstance is which of the following?
A) Nothing need be done; paralysis is adequate.
B) The paralyzing agent is moderately effective.
C) The paralyzing agent needs to be readministered.
D) Propofol needs to be added to enhance the effect.
Q2) What range of scores on the Ramsay Sedation Scale indicates adequate sedation?
A) 1-3
B) 2-4
C) 3-5
D) 5-6
Q3) A patient who is receiving mechanical ventilation in the ICU is found to be wildly agitated.The most appropriate drug to control this delirium is which of the following?
A) Propofol
B) Fentanyl
C) Haloperidol
D) Lorazepam
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17
Chapter 16: Extrapulmonary Effects of Mechanical
Ventilation
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Sample Questions
Q1) Which of the following patient conditions is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?
A) ARDS
B) Emphysema
C) Kyphoscoliosis
D) Third-degree chest wall burns
Q2) The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?
A) CPAP
B) IMV
C) IMV with PEEP
D) VC-CMV with PEEP
Q3) Malnutrition during mechanical ventilation can cause which of the following?
A) Increased oxygen consumption
B) Increased carbon dioxide production
C) Increased work of breathing
D) Increased spontaneous ventilation
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Page 18
Chapter 17: Effects of Positive Pressure Ventilation on the
Pulmonary System
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Sample Questions
Q1) Assessment of a mechanically ventilated patient reveals use of accessory muscles and a respiratory rate of 26 breaths/min.The mode is CPAP with 5 cm H O and an F O of 0.4.The most appropriate action is which of the following?
A) Return the patient to full ventilatory support.
B) Add pressure support to the CPAP.
C) Increase the CPAP to 8 cm H O.
D) Deflate the cuff of the ET tube.
Q2) What is the minimum transpulmonary pressure that has been associated with lung injury in animals?
A) 30 cm H O
B) 40 cm H O
C) 50 cm H O
D) 60 cm H O
Q3) What is the minimum range of time constants necessary for the lungs to empty 98% of the inspired volume?
A) 1-2
B) 2-3
C) 3-4
D) 4
Page 19
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Chapter 18: Troubleshooting and Problem Solving
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Sample Questions
Q1) During ventilation with VC-CMV,pleural drainage leaks sometimes can be compensated for by increasing which of the following?
A) The number of chest tubes
B) The set tidal volume
C) The set pressure limit
D) The set peak inspiratory flow
Q2) When an alarm is activated on a ventilator,the respiratory therapist's first priority is to ______________.
A) assess the patient's level of consciousness
B) ensure adequate ventilation and oxygenation
C) assess lung compliance and airway resistance
D) ensure that bilateral and equal breath sounds are present
Q3) An increased arterial-to-end-tidal partial pressure CO<sub>2</sub> gradient can help identify which of the following?
A) Pulmonary embolism
B) Dynamic hyperinflation
C) Cardiogenic pulmonary edema
D) Noncardiogenic pulmonary edema
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Chapter 19: Basic Concepts of Noninvasive
Positive-Pressure Ventilation
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Sample Questions
Q1) A patient with central sleep apnea uses a nasal mask with NIV at night.The patient complains of nasal congestion.What action should the respiratory therapist take?
A) Reduce the EPAP.
B) Add a heated humidifier.
C) Switch to a mouthpiece.
D) Add a heat/moisture exchanger.
Q2) Negative-pressure ventilators cause air to enter the lungs by increasing ______________ pressure.
A) transairway
B) transpulmonary
C) transrespiratory
D) transthoracic
Q3) Which of the following is the most efficient means of delivering a medicated aerosol during NIV?
A) Nebulizer placed between the leak port, located in the circuit, and the mask
B) MDI placed between the leak port, located in the circuit, and the mask
C) Use of both high inspiratory and high expiratory pressures
D) MDI placed in the circuit with the leak port in the mask
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Chapter 20: Weaning and Discontinuation from Mechanical Ventilation
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Sample Questions
Q1) How long does a tracheostomy site typically take to mature?
A) 2-4 days
B) 4-6 days
C) 7-12 days
D) 10-15 days
Q2) If a patient who has failed an SBT still meets the criteria for discontinuation of ventilation,an SBT should be performed every _______ hours to determine weanability.
A) 6
B) 12
C) 24
D) 36
Q3) Which of the following is considered a closed loop mode used for weaning from mechanical ventilation?
A) Pressure support ventilation
B) Adaptive support ventilation
C) Continuous positive airway pressure
D) Intermittent mandatory ventilation
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Page 22
Chapter 21: Long-Term Ventilation
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Sample Questions
Q1) Which site for mechanical ventilation of patients provides the least patient independence and quality of life?
A) Intensive care unit
B) Skilled nursing facility
C) Long-term care hospital
D) Chronic assisted ventilator unit
Q2) A patient with muscular dystrophy currently receiving ventilatory support with VC-IMV is being prepared for discharge home.The case manager asks the respiratory therapist to recommend a ventilator that will meet the patient's needs with the least complexity and at the lowest cost.The respiratory therapist should recommend which of the following ventilators?
A) PLV 102
B) LP-6 Plus
C) LTV 1000
D) Lifecare PLV 100
Q3) Glossopharyngeal breathing is beneficial for patients with which condition?
A) Tracheomalacia
B) Postpolio syndrome
C) Muscular dystrophy
D) Pierre-Robin syndrome
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Chapter 22: Neonatal and Pediatric Ventilation
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Q1) The number of time constants for almost complete equilibration of alveolar pressure in a normal infant's lungs is___________.
A) 1-3
B) 2-4
C) 3-5
D) 4-7
Q2) The maximum percent leak that may be allowed around a cuffless endotracheal tube is which of the following?
A) 6%
B) 12%
C) 19%
D) 25%
Q3) A mechanically ventilated pediatric patient in the process of being weaned is switched to PC-IMV with PS.The respiratory therapist notes that every PS breath is being time cycled.The most likely cause of this is which of the following?
A) The PS setting is too high.
B) The flow cycle setting is too low.
C) This is the normal cycle for PS.
D) A large leak is present around the cuffless ET tube.
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Chapter 23: Special Techniques in Ventilatory Support
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Sample Questions
Q1) The P<sub>a</sub>CO<sub>2</sub> can be reduced during HFOV by doing which of the following?
A) Decreasing the amplitude
B) Increasing the frequency
C) Increasing the T %
D) Decreasing the cuff leak
Q2) Compared with pressure-controlled inverse ratio ventilation,APRV does which of the following?
A) Decreases the cardiac index
B) Reduces the need for sedation
C) Increases the peak airway pressure
D) Increases the central venous pressure
Q3) An 80% He:20% O mixture is being delivered to an asthmatic patient by a nonrebreather mask through an oxygen flow meter set at 8 L/min.What is the actual flow delivered to the patient?
A) 10 L/min
B) 12 L/min
C) 14 L/min
D) 18 L/min
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