Pulmonary and Critical Care Medicine Test Bank - 684 Verified Questions

Pulmonary and Critical Care Medicine Test

Bank

Course Introduction

Pulmonary and Critical Care Medicine is a comprehensive course focusing on the diagnosis, treatment, and management of diseases affecting the respiratory system and critically ill patients. The course covers foundational knowledge in pulmonary physiology, pathophysiology, and clinical manifestations of common and rare respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases, and pulmonary vascular disorders. In the critical care component, students learn principles of managing acute and life-threatening conditions including respiratory failure, sepsis, shock, and multi-organ dysfunction. Emphasis is placed on diagnostic techniques, ventilatory support, evidence-based therapeutics, and interdisciplinary teamwork in intensive care settings. Through case-based learning and practical sessions, students develop essential skills to provide advanced care for patients with complex pulmonary and critical illnesses.

Recommended Textbook

Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by J M Cairo

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23 Chapters

684 Verified Questions

684 Flashcards

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Page 2

Chapter 1: Basic Terms and Concepts of Mechanical

Ventilation

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35 Verified Questions

35 Flashcards

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Sample Questions

Q1) Calculate the static compliance (C_S),in mL/cm H₂O,when PIP is 47 cm H₂O,plateau pressure (P_plateau)is 27 cm H₂O,baseline pressure is 10 cm H₂O,and exhaled tidal volume (V_T)is 725 mL.

A) 43 C_S

B) 36 C_S

C) 20 C_S

D) 0.065 C_S

Answer: A

Q2) Calculate airway resistance (R_aw )for a ventilator patient,in cm H₂O/L/sec,when the peak inspiratory pressure (PIP)is 50 cm H₂O,the plateau pressure (P_plateau)is 15 cm H₂O,and the set flow rate is 60 L/min.

A) 0.58 R_aw

B) 1.2 R_aw

C) 35 R_aw

D) 50 R_aw

Answer: C

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Chapter 2: How Ventilators Work

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11 Verified Questions

11 Flashcards

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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) The type of compressors that are used by hospitals to supply wall compressed air has which of the following?

A) Piston

B) Bellows

C) Rotating blades

D) Moving diaphragm

Answer: A

Q3) The respiratory therapist enters modes and parameters into the ventilator with which of the following?

A) Control logic

B) Input power

C) User interface

D) Drive mechanism

Answer: C

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Chapter 3: How a Breath Is Delivered

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31 Flashcards

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Sample Questions

Q1) The ventilator variable that begins inspiration is which of the following?

A) Cycle

B) Limit

C) Trigger

D) Baseline

Answer: C

Q2) An increase in airway resistance during pressure-targeted ventilation will have which of the following effects?

A) Volume decrease

B) Flow increase

C) Pressure increase

D) Rate decrease

Answer: A

Q3) The ventilator that can provide a negative pressure during the very beginning of the exhalation phase is which of the following?

A) Servoⁱ

B) VIASYS Avea

C) Puritan Bennett 840

D) Cardiopulmonary Venturi

Answer: D

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Chapter 4: Establishing the Need for Mechanical Ventilation

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Sample Questions

Q1) An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home.The patient is responsive only to painful stimuli.She has a peripheral IV and a feeding tube in place.Physical examination reveals: pulse 98 bpm,respiratory rate 24 and shallow,blood pressure 100/48,and temperature 39.2° C.Auscultation reveals decreased breath sounds with crackles in the bases.The patient has an occasional weak,nonproductive cough.Arterial blood gas on NC 4 L/min is pH 7.42,partial pressure of carbon dioxide (P_aCO₂)38 mmHg,partial pressure of oxygen (P_aO₂)40 mm Hg,arterial oxygen saturation (S_aO₂)76%,bicarbonate (HCO₃^-)24 mEq/L.A portable chest x-ray shows patchy basilar infiltrates in both lungs.The most appropriate action to take at this time is which of the following?

A) Intubate and initiate mechanical ventilation.

B) Administer a bronchodilator and mucolytic.

C) Initiate noninvasive positive pressure ventilation.

D) Change the nasal cannula to a nonrebreather mask.

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Chapter 5: Selecting the Ventilator and the Mode

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Sample Questions

Q1) Partial ventilatory support can be provided by which of the following ventilator modes?

1)Pressure Controlled Continuous Mandatory Ventilation (PC-CMV)set rate 8 breaths/minute

2)Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV)set rate 4 breaths/minute

3)Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV)set rate 10 breaths/minute

4)VC- MMV set V_e8 L/minute

A) 1 and 2 only

B) 2 and 3 only

C) 2 and 4 only

D) 3 and 4 only

Q2) The ventilator mode that allows the patient to breathe spontaneously between operator selected time-triggered volume or pressure-targeted breaths is which of the following?

A) Pressure Support Ventilation (PSV)

B) Continuous Mandatory Ventilation (CMV)

C) Synchronized Intermittent Mandatory Ventilation (SIMV)

D) Airway Pressure Release Ventilation (APRV)

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Chapter 6: Initial Ventilator Settings

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Sample Questions

Q1) Slow flow rates will cause which of the following to occur?

A) Poor gas exchange

B) Increase peak pressures

C) Shorten expiratory time

D) Decrease mean airway pressure

Q2) A 65-year-old,73-inch-tall,195 lb male patient was admitted 2 days ago for renal failure.The patient has a history of Chronic Obstructive Pulmonary Disease (COPD)and has a pulse of 122 bpm,BP 153/88,and temperature 37° C.The patient is intubated for acute-on-chronic respiratory failure with hypoxemia.The physician requests volume-controlled continuous mandatory ventilation (VC-CMV).The initial settings for the ventilator should be which of the following?

A) V_T = 700 mL,rate = 12 bpm,PEEP = 3 cm H₂O

B) V_T = 900 mL,rate = 10 bpm,PEEP = 5 cm H₂O

C) V_T = 450 mL,rate = 20 bpm,PEEP = 8 cm H₂O

D) V_T = 800 mL,rate = 15 bpm,PEEP = 10 cm H₂O

Q3) With which flow waveform pattern will the mean airway pressure be the highest?

A) Sine

B) Square

C) Ascending ramp

D) Descending ramp

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Chapter 7: Final Considerations in Ventilator Setup

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Sample Questions

Q1) The mechanical ventilator event that is considered potentially life-threatening or a level 2 event is which of the following?

A) Intrinsic positive-end-expiratory pressure (PEEP)

B) High respiratory rate

C) Humidifier malfunction

D) Exhalation valve failure

Q2) A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

A) 10 mg H₂O/L at 35° C to 37° C

B) 20 mg H₂O/L at 31° C to 35° C

C) 30 mg H₂O/L at 31° C to 35° C

D) 47 mg H₂O/L at 35° C to 37° C

Q3) Essential capabilities of an adult intensive care unit (ICU)ventilator include all of the following except:

A) Expiratory pause

B) Pressure control modes

C) Flow rates up to 250 L/min.

D) Respiratory rates up to 60 breaths/min.

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9

Chapter 8: Initial Patient Assessment

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35 Flashcards

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Sample Questions

Q1) In a patient receiving mechanical ventilation with a constant tidal volume,an airway resistance increase is indicated by which of the following?

A) Increased peak inspiratory pressure (PIP)and transairway pressure (P_TA)

B) Increased static compliance

C) Increased plateau pressure (P_plateau)and stable PIP

D) Decreased dynamic compliance

Q2) The first step in the assessment and documentation of patient-ventilator interaction following the placement of a patient on a mechanical ventilator is which of the following?

A) Verifying physician's orders

B) Verifying a passing operational verification procedure

C) Checking the integrity of the ventilator circuit and the humidifier system

D) Assessment of the patient's vital signs,breath sounds,and level of consciousness

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Chapter 9: Ventilator Graphics

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31 Verified Questions

31 Flashcards

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Sample Questions

Q1) 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

Q2) An increase in airway resistance during pressure ventilation will result in which of the following?

A) Plateau pressure (P_Plateau)will increase.

B) Volume curve will resemble an igloo.

C) Inspiration will end prior to flow tapering to zero.

D) Pressure curve will become concave on inspiration.

Q3) Which of the following conditions causes a pressure-volume loop during volume-controlled continuous mandatory ventilation (VC-CMV)to extend farther to the right and flatten out?

A) Asthma

B) Bronchitis

C) Emphysema

D) Pneumonia

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Chapter 10: Assessment of Respiratory Function

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54 Flashcards

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Sample Questions

Q1) During which phase of a capnogram does inhalation occur?

A) Phase 1

B) Phase 2

C) Phase 3

D) Phase 4

Q2) What type of electrode is used by a transcutaneous partial pressure of oxygen (PtcO₂)device?

A) Galvanic

B) Polarographic

C) Paramagnetic

D) Stow-Severinghaus

Q3) Calculate the airway resistance given the following clinical data: flow rate 60 L/min,peak inspiratory pressure (PIP)42 cm H₂O,plateau pressure (P_plateau)15 cm H₂O,positive-end-expiratory pressure (PEEP)5 cm H₂O.

A) 10 cm H₂O/L/sec

B) 30 cm H₂O/L/sec

C) 37 cm H₂O/L/sec

D) 42 cm H₂O/L/sec

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Page 12

Chapter 11: Hemodynamic Monitoring

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Sample Questions

Q1) Calculate the systemic vascular resistance (SVR)given the following measurements obtained during a hemodynamic study: pulmonary artery pressure (PAP)= 40/22 mm Hg,pulmonary artery occlusion pressure (PAOP)= 12 mm Hg,blood pressure (BP)= 156/80 mm Hg,central venous pressure (CVP)= 19 mm Hg,cardiac output (C.O. )= 4.8 L/min,and heart rate (HR)= 68 beats/min.

A) 150 dyne x sec x cm^-5

B) 267 dyne x sec x cm^-5

C) 317 dyne x sec x cm^-5

D) 1,496 dyne x sec x cm^-5

Q2) Which of the following can be used to estimate the contractility of the ventricles?

A) Ejection fraction

B) Systemic vascular resistance

C) Pulmonary vascular resistance

D) Right and left ventricular end-diastolic pressure

Q3) The main component of a hemodynamic monitoring system is which of the following?

A) Plethysmograph

B) Pneumotachometer

C) Sphygmomanometer

D) Strain gauge transducer

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Chapter 12: Methods to Improve Ventilation in Patient-Ventilator

Management

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33 Verified Questions

33 Flashcards

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Sample Questions

Q1) A patient with pneumonia and underlying COPD is being mechanically ventilated in the VC-CMV mode with V_T650 mL.The resulting PaCO₂ is 62 mm Hg.What change should be made to the V_T to obtain a desired PaCO₂ of 50 mm Hg for this patient?

A) 400 mL

B) 800 mL

C) 1000 mL

D) 1200 mL

Q2) Metabolic acidosis may be caused by which of the following?

A) Overdose with salicylate

B) Diuretic administration

C) Nasogastric suctioning

D) Lactate administration

Q3) If respiratory acidosis persists after alveolar ventilation of a patient has been increased,which of the following could be the cause?

A) Chronic obstructive pulmonary disease

B) Pulmonary embolism

C) Pulmonary edema

D) Low PEEP levels

Page 14

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Chapter 13: Improving Oxygenation and Management of Ards

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30 Verified Questions

30 Flashcards

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Sample Questions

Q1) To perform a slow-flow (quasi-static)technique for determining the appropriate PEEP level,the most appropriate ventilator flow setting is which of the following?

A) 2 L/min

B) 6 L/min

C) 10 L/min

D) 14 L/min

Q2) During mechanical ventilation of a patient with CHF,the PaO₂ = 38 mm Hg and the F_IO₂ = 0.6.If the desired PaO₂ is 60 mm Hg,the F_IO₂ needs to be changed to which of the following?

A) 0.65

B) 0.75

C) 0.85

D) 0.95

Q3) Patients with which of the following clinical disorders may benefit from PEEP?

A) COPD

B) Asthma

C) ARDS

D) Cystic fibrosis

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Chapter 14: Ventilator-Associated Pneumonia

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Sample Questions

Q1) Patients with chronic obstructive pulmonary disease (COPD)are at higher risk for infection with which of the following organisms?

1)Haemophilus influenzae

2)Pseudomonas aeruginosa

3)Moraxella catarrhalis

4)Staphylococcus aureus

A) 1 and 2 only

B) 1 and 3 only

C) 2 and 4 only

D) 3 and 4 only

Q2) Sixty percent of all VAP infections are caused by which of the following?

A) Aerobic gram-negative bacilli

B) Anaerobic gram-negative bacilli

C) Aerobic gram-negative rods

D) Anaerobic gram-positive cocci

Q3) The main strategy for the management of VAP focuses on which of the following?

A) Pharmacological treatment

B) Early diagnosis and treatment

C) Prophylactic antibiotic therapy

D) Reduction of host-related risk factors

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Chapter 15: Sedatives,Analgesics,and Paralytics

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Sample Questions

Q1) 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

Q2) The drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours is which of the following?

A) Lorazepam (Ativan)

B) Midazolam (Versed)

C) Diazepam (Valium)

D) Propofol (Diprivan)

Q3) Which of the following is the sedation scale that uses a graduated single category?

A) Comfort Scale

B) Motor Activity Assessment Scale

C) Ramsay Sedation Scale

D) Sedation-Agitation Scale

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17

Chapter 16: Extrapulmonary Effects of Mechanical

Ventilation

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Sample Questions

Q1) Normovolemic patients experience decreases in cardiac output above what level of PEEP?

A) 5 cm H₂O

B) 8 cm H₂O

C) 12 cm H₂O

D) 15 cm H₂O

Q2) A patient with which of the following 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

Q3) High tidal volumes and/or high levels of PEEP cause which of the following?

A) Improvement in pulmonary blood flow

B) Increased right ventricular afterload

C) Interventricular septum shifts to the right

D) Increased myocardial perfusion

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Page 18

Chapter 17: Effects of Positive Pressure Ventilation on the

Pulmonary System

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Sample Questions

Q1) What is the minimum range of time constants necessary for the lungs to empty 98% of the inspired volume?

A) 1 to 2

B) 2 to 3

C) 3 to 4

D) 4 to 5

Q2) Biotrauma is caused directly by which of the following?

A) High oxygen levels

B) Overdistention of alveoli

C) Long expiratory times

D) Fast respiratory rates

Q3) Lung injury is more likely to occur with which of the following with normal lung tissue?

A) P_A = 25 cm H₂O;P_pl = 18 cm H₂O

B) P_A = 29 cm H₂O;P_pl = 10 cm H₂O

C) P_A = 30 cm H₂O;P_pl = 21 cm H₂O

D) P_A = 45 cm H₂O;P_pl = 34 cm H₂O

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Page 19

Chapter 18: Troubleshooting and Problem Solving

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Sample Questions

Q1) Use of an externally powered,small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following?

1)High V_T alarm activation

2)Triggering difficulties

3)Low pressure alarm activation

4)Ventilator inoperative alarm

A) 1 and 2

B) 2 and 3

C) 3 and 4

D) 1 and 4

Q2) Reduction of preload and afterload is important in the management of which of the following?

A) Pulmonary embolism

B) Dynamic hyperinflation

C) Cardiogenic pulmonary edema

D) Noncardiogenic pulmonary edema

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20

Chapter 19: Basic Concepts of Noninvasive Positive

Pressure Ventilation

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Sample Questions

Q1) A patient has acute pulmonary edema from left-sided heart failure and acute hypoxemic respiratory failure that has not responded to conventional pharmacologic and oxygen therapy.As the next line of therapy,the respiratory therapist should recommend which of the following?

A) Noninvasive positive pressure ventilation

B) Continuous positive airway pressure

C) Intubation and mechanical ventilation

D) Bronchial hygiene therapy

Q2) Negative pressure ventilators cause air to enter the lungs by increasing ______________ pressure.

A) transairway

B) transpulmonary

C) transrespiratory

D) transthoracic

Q3) A patient with acute cardiogenic pulmonary edema is to be placed on CPAP.What should the initial setting be?

A) 3 to 5 cm H₂O

B) 5 to 7 cm H₂O

C) 10 to 12 cm H₂O

D) 15 to 20 cm H₂O

Page 21

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Chapter 20: Discontinuation and Weaning From Mechanical Ventilation

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Sample Questions

Q1) The closed loop mode used for weaning from mechanical ventilation is which of the following?

A) Pressure support ventilation

B) Adaptive support ventilation

C) Continuous positive airway pressure

D) Intermittent mandatory ventilation

Q2) All of the following patients are intubated and receiving mechanical ventilation.The patient most likely to require slow liberation from mechanical ventilation is which of the following?

A) A patient who overdosed on diazepam

B) A postoperative patient who had knee surgery

C) A patient with a severe exacerbation of asthma

D) A patient with chest contusions from an accident

Q3) A recently extubated patient develops a partial upper airway obstruction,which causes stridor.What action can the respiratory therapist take to improve the patient's condition?

A) Aerosolize 11.25 mg of racemic epinephrine.

B) Put a nonrebreathing mask on the patient.

C) Place the patient on NPPV.

D) Suggest the use of lorazepam (Ativan).

Page 22

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Chapter 21: Long Term Ventilation

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Sample Questions

Q1) In-hospital evaluation of ventilator-assisted infants should be performed how often for the first 2 years of life?

A) Once a month

B) Once every 2 to 3 months

C) Once every 4 to 6 months

D) Once a year

Q2) One of the goals of long-term mechanical ventilation (LTMV)in the home or alternative care site is which of the following?

A) Permit lung healing

B) Reduce hospitalizations

C) Relieve respiratory distress

D) Improve pulmonary gas exchange

Q3) A VAI patient has expressed the desire to be able to speak.The most appropriate speaking device to use in-line with this ventilator patient is which of the following?

A) Voice TT

B) Passy-Muir

C) Portex Speaking TT

D) Pittsburgh Talking TT

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Chapter 22: Neonatal and Pediatric Ventilation

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Sample Questions

Q1) The inspiratory time setting for an infant with RDS,airway resistance of 30 cm H₂O/L/sec,and lung compliance of 0.002 L/cm H₂O should be which of the following?

A) 0.25 sec

B) 0.30 sec

C) 0.45 sec

D) 0.55 sec

Q2) The gas flow rate for a noncommercial bubble CPAP device should be set at _______ L/min.

A) 3

B) 5

C) 8

D) 10

Q3) Oxygen delivery and tissue perfusion may be evaluated clinically by which of the following?

A) Mucus membrane color

B) Skin color and tone

C) Capillary refill

D) Chest x-ray

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Page 24

Chapter 23: Special Techniques in Ventilatory Support

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Sample Questions

Q1) Which variable in APRV is responsible for the removal of CO₂ from the body?

A) T_low

B) T_high

C) P_low

D) P_high

Q2) A patient with ALI is being ventilated using APRV with the following settings: P_high = 30 cm H₂O;P_low = 2 cm H₂O;T_high = 6 sec;T_low = 0.8 sec;F_IO₂ = 0.4.The patient's spontaneous rate is 12 breaths/min.The current ABG values are: PaO₂= 61 mm Hg;PaCO₂ = 43 mm Hg.What change should the respiratory therapist recommend for this patient?

A) Decrease the P_high to 25 mm Hg.

B) Increase the T_high to 8 seconds.

C) Decrease the T_low to 0.5 seconds.

D) Increase the P_low to 5 cm H₂O.

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