Respiratory Care Procedures
Exam Materials
Course Introduction
Respiratory Care Procedures is a course designed to provide students with foundational knowledge and hands-on skills necessary for managing and treating patients with cardiopulmonary disorders. The course covers essential topics such as oxygen delivery systems, airway management, basic mechanical ventilation, aerosol and humidity therapy, and infection control procedures. Emphasis is placed on proper assessment techniques, safe operation of respiratory equipment, and adherence to clinical guidelines and safety standards. Through a combination of classroom instruction and laboratory practice, students gain practical experience in delivering respiratory therapies and interventions to diverse patient populations across healthcare settings.
Recommended Textbook
Basic Clinical Lab Competencies for Respiratory Care An Integrated Approach 5th Edition by Gary
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851 Verified Questions
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Chapter 1: Basics of Asepsis
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Sample Questions
Q1) A patient with extensive burns requires oxygen therapy via face tent with a large volume nebulizer.What type of precautions should the respiratory care practitioner use in caring for the patient?
Answer: A large volume nebulizer with sterile water should be used for the cool aerosol to humidify the oxygen therapy.The face tent and the large bore tubing to deliver the oxygen must be aseptic and handled carefully.The therapist's stethoscope should be free of microorganisms.Personal protective equipment should be worn to protect the patient from being contaminated with microorganisms from the practitioner.Gloves should also be worn before contact with mucous membranes or broken or non-intact skin.A health care provider should wear a mask to protect the patient from being splashed or sprayed by contaminated body secretions.A cover gown or special scrubs prevent the spread of microorganisms to the patient via the contact transmission route.
Q2) What is defined as a microorganism capable of causing disease in humans?
A) Pathogenic microorganism
B) Hospital-acquired infection
C) Virulent microorganism
D) Cross-contamination
Answer: A
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Chapter 2: Basic Patient Assessment: Vital Signs and Breath
Sounds
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Q1) A patient comes to the emergency department in respiratory distress.What should be evaluated to assess the patient's distress?
Answer: Immediate evaluation of the patient should be done through observation of the patient's general appearance,color,respiratory effort,diaphoresis,neck vein distension,peripheral edema,clubbing of the digits,nasal flaring,breath sounds,and chest movement.The vital signs should be assessed quickly to determine the patient's heart rate,respiratory rate and pattern,blood pressure,body temperature,and pulse oximetry.An ECG and a chest x-ray can be performed to help determine if the distress is from pulmonary or cardiac causes though there is a time element due to proper personnel notification.These can all be assessed quickly and non-invasively.Next,invasive techniques should used to help determine the cause of the distress.Blood evaluation that can be done to determine the cause of the distress include arterial blood gases,white blood cell count,electrolytes,and complete blood count.A sputum sample can be sent to the lab for culture.
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4
Chapter 3: Advanced Patient Assessment: Inspection, Palpation, and Percussion
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Q1) What is defined as the presence of air beneath the skin in the subcutaneous tissues?
A) Tension pneumothorax
B) Subcutaneous emphysema
C) Pleural effusion
D) Fibrosis
Answer: B
Q2) Upon percussing the patient's chest,a dull percussion note is heard over the left lower lobe.What other findings would be expected to be found over the left lower lobe? Answer: A dull percussion note is heard over areas containing a greater proportion of tissue or fluid than of air.This occurs in the lungs as a result of consolidation,atelectasis,or the presence of fluid in the pleural space.Breath sounds would be diminished in the area of the dull percussion note.There would be increased vocal fremitus.Chest movement would lag on the left side of the thoracic cavity due to diminished air entry.
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5
Chapter 4: Radiologic Assessment
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Q1) Air appears dark on the chest radiograph.What type(s)of pathology would appear dark on the chest x-ray?
Q2) Which of the following views is also called a portable chest x-ray?
A) Posterior-anterior (PA) view
B) Lateral view
C) Lateral decubitus view
D) Anterior-posterior (AP) view
Q3) By comparing which views of the chest can a three-dimensional image be created?
A) Posterior-anterior film, lateral film
B) Lordotic film, anterior-posterior film
C) Anterior-posterior film, posterior-anterior film
D) Lordotic film, lateral film
Q4) What can be evaluated on a chest radiograph besides the heart and lungs?
Q5) On a chest x-ray interpretation from a patient's chart,the radiologist notes that the right costophrenic angle is blunted.What does this indicate?
A) A right pleural effusion
B) Atelectasis of the right lung
C) Consolidation in the right lower lobe
D) Subcutaneous emphysema in the right lung
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Chapter 5: Pulmonary Function Testing
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Sample Questions
Q1) Which of the following are limitations to spirometry testing?
I.Spirometry is an effort-dependent test that requires careful instruction and the cooperation of the test subject.
II.Inability to perform acceptable maneuvers may be due to poor subject motivation or failure to understand instructions.
III.Physical impairment and young age (e.g.,<5 years of age)may also limit the subject's ability to perform spirometric maneuvers.
A) I and III
B) II and III
C) I, II, and III
D) I and II
Q2) A flow-volume loop plots _____ along the vertical axis and _______ along the horizontal axis
A) Vt, RR
B) PEF, FVC
C) flow, volume
D) FVC, RV
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Chapter 6: Electrocardiography
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Sample Questions
Q1) Which of the following waves in an ECG tracing represents atrial depolarization?
A) 'P' wave
B) 'QRS'complex
C) 'T' wave
D) 'U' wave
Q2) Leads I,II,and III and the augmented leads are _______ containing both a positive and negative electrode whereas the precordial leads are _________ and are helpful in the diagnosis of a myocardial infarction.
A) bipolar; unipolar
B) unipolar; bipolar
C) tripolar; bipolar
D) synchronized; asynchronized
Q3) What is caused by poor electrical contact between the patient and the electrodes placed on the patient to record the ECG?
A) Patient motion
B) Wandering baseline
C) 60 Hz artifact
D) Atrial fibrillation
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8
Chapter 7: Phlebotomy
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Q1) If the vacuum tube is pushed in too soon or attached to the needle too soon,what would happen?
A) Unnecessary contamination will occur at the draw site.
B) The angle of the needle stick should be increased.
C) A larger needle needs to be used.
D) The negative pressure stored in the tube will be lost.
Q2) Which of the following is NOT a therapist's obligation to themselves related to the performance of phlebotomy?
A) Knowing what is to be done for their own protection
B) Preparing for the phlebotomy procedure by assembling the correct materials
C) Performing the phlebotomy procedure step-by-step
D) Using proper aseptic technique when preparing the skin for venipuncture.
Q3) Which of the following needle sizes is the smallest size?
A) 25 gauge
B) 23 gauge
C) 21 gauge
D) 19 gauge
Q4) A tourniquet can be used to enhance vein distension to ease the location of a good vein for a venous draw.What would happen if the tourniquet were left on too long?
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Chapter 8: Arterial Blood Gas Sampling
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Sample Questions
Q1) If the modified Allen's test is negative on one hand what should the practitioner do at this time?
A) Hold the patient's hand above the level of the heart for 30 to 60 seconds.
B) Release the pressure on the radial artery and determine if circulation returns.
C) Perform the modified Allen's test on the other hand.
D) Perform the arterial stick anyway because of the poor perfusion.
Q2) When an air bubble is present in a blood gas sample that was drawn on room air,what will happen to the PCO of the blood gas sample?
A) The PCO will remain the same.
B) The PCO will increase.
C) The PCO will decrease.
Q3) If a blood gas sample cannot be analyzed immediately and the sample is not iced,how much time can elapse before blood gas samples will start to change due to further metabolism of the blood dramatically?
A) 5 minutes
B) 15 minutes
C) 25 minutes
D) 35 minutes
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Chapter 9: Hemodynamic Monitoring
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Sample Questions
Q1) What is defined as a device that converts one form of energy to another?
A) Transducer
B) Thermister
C) Phlebostatic axis
D) Catheter
Q2) When should the pulmonary artery pressure be measured?
A) Measured at end diastole
B) Measured during systole
C) Measured at end exhalation
D) Measured during a premature ventricular contraction
Q3) The hemodynamic data are recorded from a pulmonary artery catheter on a patient who is being mechanically ventilated.
\( \begin{array}{lc}\text { Cardiac Output } & 7.0 \mathrm{~L} / \mathrm{min} \\ \mathrm{PAP} & 50 / 30 \mathrm{mmHg} \\ \text { PCWP } & 12 \mathrm{mmHg} \\ \text { CVP } & 3 \mathrm{mmHg} \\ \text { HR } & 125 / \mathrm{min}\end{array} \)
How would the practitioner interpret this data and what should be recommended?
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Chapter 10: Noninvasive Monitoring
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Q1) What has greatly reduced the number of arterial blood gas (ABG)samples drawn in the acute care setting?
A) Capnography
B) Pulmonary artery pressure monitoring
C) Noninvasive monitoring
D) Transcutaneous P02 monitoring
Q2) Pressure sores are a potential hazard of __________________.
A) pulse oximetry monitoring.
B) transcutaneous CO monitoring.
C) transcutaneous O monitoring.
D) end-tidal CO monitoring.
Q3) Which electrode does the transcutaneous CO monitor incorporate into its design?
A) Clark electrode
B) Severinghaus electrode
C) Sanz electrode
D) Reference electrode
Q4) How does the pulse oximeter measure O saturation in the capillary bed?
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Chapter 11: Documentation and Goals Assessment
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Q1) How is the history of the patient obtained by the physician?
A) From the patient
B) From the physical examination
C) From the patient's family
D) a and c
Q2) What is the method of charting that usually employs fill-in-the-blank forms where only data that change are documented?
A) Clinical goal charting
B) Charting by exception
C) Objective data charting
D) Progress notes
Q3) What are measurable,demonstrated outcomes that can be assessed following patient treatment or intervention?
A) Goals
B) Objectives
C) Assessments
D) Procedures
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13
Chapter 12: Oxygen Supply Systems
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Sample Questions
Q1) What happens to a cylinder if it fails hydrostatic testing?
A) The vessel is filled with water to 5/3 of the service pressure.
B) It is filled with another gas.
C) It is destroyed.
D) It is retested.
Q2) You attach a pressure reducing valve to a 'M' sized gas cylinder.When you open the cylinder valve you hear gas leaking from of near the valve-cylinder connection.What should you do?
Q3) Hydrostatic testing is required for all cylinders every _____________
A) year.
B) 5 to 10 years.
C) 10 to 15 years.
D) 15 to 20 years.
Q4) The most common service pressure indicated on an oxygen cylinder that is followed by a (+)sign is ___________.
A) 50 psi
B) 2200 psi
C) 2015 psi
D) 2 psi
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Chapter 13: Oxygen Administration
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Q1) Which type of oxygen analyzer uses an oxidation-reduction reaction to measure the FO of an oxygen sample?
A) Galvanic oxygen analyzer
B) Polarographic oxygen analyzer
C) Electrical oxygen analyzer
D) a and b
Q2) Before analysis of oxygen percentage,the analyzer should be calibrated to which percentage?
A) 21%
B) 50%
C) 100%
D) a and c
Q3) A respiratory care practitioner sets up an oxygen device on a patient.How should the practitioner document the oxygen?
A) The flowrate or FI0<sub>2</sub>
B) The oxygen device
C) Date and time of set-up
D) All of these
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Chapter 14: Introduction to Respiratory Care Pharmacology
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Q1) What immunoglobulin antibody sensitizes the mast cell?
A) Leukotrienes
B) IgE
C) Histamine
D) Prostaglandins
Q2) A sympathomimetic drug would cause ________________
A) bronchodilation.
B) bronchoconstriction.
C) Histamine release.
D) Vagus nerve stimulation.
Q3) Which of the following drugs stabilize mast cells?
A) Ipratropium
B) Cromolyn sodium
C) Albuterol
D) Fluticasone
Q4) An aerosol drug is ordered on a patient in MDI form.The propellant causes a reflex bronchospasm in the patient.What can be done?
Q5) A small volume nebulizer is ordered for a patient on a mechanical ventilator.To prevent condensation and secretions from draining into the nebulizer and contaminating it,what could be done?
Page 16
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Chapter 15: Humidity and Aerosol Therapy
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Sample Questions
Q1) Connection of a large-volume nebulizer to the correct type flowmeter is ensured because the connection incorporates a:
A) PISS fitting at the top of the unit.
B) ASSS fitting at the top of the unit.
C) DISS fitting at the top of the unit.
D) 15 mmID fitting at the top of the unit
Q2) Which of the following situations would be a contraindication for Heat-Moisture Exchanger (HME)use to provide humidification to a mechanically ventilated patient?
A) Body temperature of 34°C
B) Inspired Vt 600ml, expired Vt 400 ml
C) Spontaneous minute volume of 8 LPM
D) a and b
Q3) Which of the following defines body humidity?
A) 37°C, 100 mmHg partial press [H2O], and 47% saturation
B) 37°C, 44 mmHg partial press [H2O], and 100% saturation
C) 37°C, 47 mmHg partial press [H2O], and 100% saturation
D) 47°C, 37 mmHg partial press [H2O], and 100% saturation
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Chapter 16: Bronchial Hygiene Therapy
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Q1) Postural drainage therapy is indicated for adult patients with secretion production of at least _______________
A) 10-15 ml per day.
B) 15-20 ml per day.
C) 20-25 ml per day.
D) 25-30 ml per day.
Q2) A patient who is receiving postural drainage and percussion desaturates during therapy,complains of dizziness,and states he cannot tolerate the treatment any longer.What should the practitioner do?
Q3) During bronchial hygiene therapy in the Trendelenburg position,the patient's SpO decreases from 92% on a 35% Venturi mask to 80% during the first 5 minutes of the therapy.What intervention would be the most correct for the Respiratory Care Practitioner to take at this time?
A) Administer 100% oxygen, stop therapy immediately, return the patient to original resting position, and consult the physician.
B) Administer 100% oxygen and consult the physician.
C) Administer 100% oxygen and continue the therapy with the patient flat in bed.
D) Stop therapy immediately and return patient to original resting position.
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Chapter 17: Hyperinflation Therapy
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Q1) A surgeon orders lung expansion therapy for an obtunded 68-year-old,170-lb (77.3 kg,IBW)man who has developed atelectasis after thoracic surgery.On baseline assessment,the patient cannot perform an IC or VC maneuver,but has no evidence of retained secretions.Which type of hyperinflation therapy would you recommend?
Q2) A patient with atelectasis is ordered to have IPPB therapy.The patient is recovering from a motor vehicle accident in which he suffered a concussion.During the therapy,the patient exhibits bulging around the eye orbits and his sensorium decreases.Which of the following could be happening to the patient?
A) Increased intracranial pressure
B) Tension pneumothorax
C) Subcutaneous emphysema
D) Decreased cardiac output
Q3) During IPV,what happens to the peak pressures during percussion when the source pressure is increased?
A) The peak pressures decrease
B) The peak pressures increase
C) Nothing, but the frequency of the percussion increases
D) The peak pressures remain the same as preset at the factory
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Chapter 18: Bronchoscopy Assisting
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Q1) Which type of brush/needle/mechanical device is/are used to sample an area of interest that lies on the opposite side of the bronchial wall from where the bronchoscope is located?
A) Sheathed cytology brush
B) Unsheathed cytology brush
C) Forceps
D) Wang needle
Q2) A patient has just had a bronchoscopy procedure performed.What precautions and instructions should you give the patient following the procedure?
Q3) ______________ is performed to obtain lower respiratory tract secretions or tissue samples for cytological,histological,or microbiological study.
A) Therapeutic bronchoscopy
B) Diagnostic bronchoscopy
C) Bronchoalveolar lavage
D) Rigid bronchoscopy
Q4) What instructions would you give a patient who is to have a bronchoscopy procedure?
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Chapter 19: Equipment Processing and Surveillance
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Q1) What is defined as the complete destruction of vegetative forms of pathogenic microorganisms?
A) Antisepsis
B) Sterilization
C) Disinfection
D) Pasteurization
Q2) Which of the following processes are disinfection methods?
I.Steam autoclaving
II.Pasteurization
III.Ethylene oxide
IV.Glutaraldehyde
V.Quaternary ammonium compounds
A) I, III, IV
B) II and V
C) III, IV, V
D) I only
Q3) The practitioner has just performed a bedside pulmonary function test on a patient who tests positive for tuberculosis.This is detected only 1 hour before the next test is to be performed.What should be done?
Q4) What types of vaccines should a health care worker undergo routinely?
Page 21
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Chapter 20: Emergency Airway Management
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Q1) Defibrillation is contraindicated when immediate danger to the rescuers is present due to: I.the environment.
II.the patient's condition.
III.the patient's location.
A) II and III
B) I, II, III
C) III only
D) I and II
Q2) A respiratory care practitioner is attempting to place an oral endotracheal tube in a patient.The attempt is unsuccessful.What should be done before attempted reintubation?
A) Reventilation
B) Reoxygenation
C) Suctioning the airway
D) a and b
Q3) Partial upper airway obstruction is characterized by ________________
A) bronchospasm.
B) asymmetrical chest movement.
C) noisy inspiratory efforts.
D) no sound of air movement.
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Chapter 21: Artificial Airway Care
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Q1) Which of the following are absolute contraindications for nasotracheal suctioning?
A) Croup
B) Laryngospasm
C) Epiglottitis
D) a and c
Q2) What is defined as the removal of a tracheostomy tube?
A) Decannulation
B) Leak technique
C) Invagination
D) Wash-out volume
Q3) Which of the following would help the patient with a tracheostomy talk?
A) Single cuff tracheostomy tube
B) Passy-Muir valve
C) Minimal occluding volume
D) Minimal leak technique
Q4) You cannot pass the suction catheter down the endotracheal tube on an intubated patient.What should you do and how would you correct the problems?
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Chapter 22: Chest Tubes
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Q1) A patient with a chest tube in place suddenly develops chest pain and severe respiratory distress.What could be causing this?
Q2) A patient is admitted to the emergency department after being involved in a motor vehicle accident.The patient has massive chest trauma and the physician is suspicious that he has a pneumothorax,though the patient has bilateral chest movement.Where on the chest radiograph would you look to find a smaller pneumothorax?
A) Base of the lung
B) Lateral periphery of the lung
C) Apex of the lung
D) Mediastinum
Q3) If the water level in the water seal chamber is too low,what can be the hazard to the patient?
A) More vacuum is applied to the patient's thoracic cavity
B) Increases the risk of entry of atmospheric air into the patient's thoracic cavity
C) It makes it more difficult for air or fluid to drain
D) A leak can occur in the drainage system
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Chapter 23: Insertion and Maintenance of Intravenous Lines
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Q1) You are asked to start an IV on a 94 year-old,115 lb (52.3 kg)patient.What precautions,if any,should you take with this geriatric patient?
Q2) What is another name for 0.9% sodium chloride in water?
A) Normal or physiologic saline
B) Lactated Ringer's solution
C) D5W
D) Plasma
Q3) A patient with an IV complains of pain and tenderness at the IV site.The practitioner notes swelling at the IV site.Why should these findings be investigated thoroughly?
A) The IV has infiltrated
B) Cellulitis is developing in the surrounding tissue
C) The possibility of thrombus formation
D) Inflammation of the vein
Q4) What happens to the small air bubbles that pass through the IV tubing and enter into the patient?
Q5) What is the purpose of transparent dressings on a IV?
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Chapter 24: Noninvasive Positive-Pressure Ventilation
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Q1) How do patients with chronic obstructive pulmonary disease (COPD)benefit the most from noninvasive positive-pressure ventilation?
A) By increasing PaO levels
B) By avoiding intubation
C) By decreasing the patient's pH
D) By extending the patient's ventilatory muscle endurance
Q2) The respiratory care practitioner is called to the medical intensive care unit to evaluate a pneumonia patient for impending ventilatory failure.Arterial blood gases (ABGs)are drawn and the results are as follows: PaO 49 mmHg,PaCO 58 mmHg,pH 7.24,HCO 23 mEq/L,FIO 0.6.What do the patient's ABGs indicate?
A) The patient has impending ventilatory failure.
B) The patient has normal PaO status for an increased FIO .
C) The patient has chronic ventilatory failure.
D) The patient's RSBI needs to be measured to determine ventilatory status.
Q3) A patient on a full face mask on noninvasive positive-pressure ventilation (NPPV)is swallowing air and having trouble exhaling due to a leak around the naso-gastric (NG)tube.What can be done?
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26
Chapter 25: Continuous Mechanical Ventilation
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Q1) What equipment procedure should be done prior to using a mechanical ventilator on a patient?
A) Perform a ventilator operational verification procedure
B) Identify patient insurance coverage
C) Perform a static compliance measurement
D) Determine alveolar ventilation
Q2) The purpose of a patient ventilator system check (vent check)is all of the following EXCEPT ___________________
A) to assess patient response to mechanical ventilation.
B) to verify the correct operation of the ventilation.
C) to assure use for billing purposes.
D) to verify patient settings and alarms are correct.
Q3) Type I respiratory failure is which of the following?
A) PaCO greater than 50 mmHg and PaO within normal levels
B) PaCO greater than 50 mmHg and PaO less than 50 mmHg with pH below 7.35
C) High PaCO with a low PO but a normal pH
D) PaO of less than 59 mmHg with a normal PaCO
Q4) How is tubing compliance determined?
Q5) What is the difference in calculating dynamic compliance vs static compliance?
Page 27
Q6) How does a practitioner perform a system leak test?
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Chapter 26: Advanced Modes of Mechanical Ventilation
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Q1) Rapid shallow breathing index is used _______________________
A) to measure effectiveness of oxygenation.
B) to identify the settings used in high frequency ventilation.
C) in assessment of neonates and infants.
D) to quantify the relationship between tidal volume and respiratory rate.
Q2) What is the auto-set-point control?
Q3) Volume ventilation is causing high pressures for a patient with ARDS.The practitioner would like to use a pressure mode but is concerned about the changing compliance.Which of the following should be considered for this purpose?
A) SIMV
B) PRVC
C) Automode with volume support ventilation
D) Inverse ratio ventilation
Q4) Benefits of APRV are which of the following?
A) Increased secretion mobilization
B) Improved gas exchange, reduced dead space, less sedation
C) Reduction of ventilating pressures
D) Reversal of bronchospasm
Q5) What is proportional assist ventilation?
Q6) How does a respiratory care practitioner assess the patient's work of breathing?
Page 28
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Chapter 27: Wave Form Analysis
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Q1) A mechanical breath that rises and then remains at the same cmH O pressure for the same length of time is which type of mechanical breath?
A) SIMV
B) Volume control
C) Pressure support
D) Pressure control
Q2) The respiratory care practitioner determines that a patient has increased airway resistance.How was this identified?
A) On the flow-volume loop by evaluating the shape of the curve
B) On the flow-volume loop by identifying the maximum delivered volume
C) On the pressure-volume loop by the amount of beaking
D) On the pressure-volume loop by the amount of bowing
Q3) You have just place a patient with early ARDS onto a mechanical ventilator.Using ventilator graphics how will you monitor the patient's changing lung compliance?
Q4) Which graphic displays can indicate adequacy of inspiratory flow during a ventilator inspiration and how are they used?
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Chapter 28: Weaning and Discontinuance of Mechanical Ventilation
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30 Verified Questions
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Sample Questions
Q1) What should the respiratory therapist do if the patient does not pass the SBT?
Q2) The respiratory therapist notices the mechanically ventilated patient's work of breathing is increased due to the resistance caused by the artificial airway.This problem can be reduced using _______________
A) BiPAP.
B) ATC.
C) PRVC.
D) PEEP.
Q3) Which of the following is true regarding a protocol?
A) It prevents non-therapists from performing respiratory care.
B) It reduces the need for continual physician input and involvement.
C) It can lengthen the time a patient spends on a ventilator.
D) It gives the respiratory care practitioner a duty that nurses are not allowed to perform.
Q4) What four general questions should the respiratory care practitioner assess prior to weaning from mechanical ventilation?
Q5) How do cardiovascular problems result in ventilator dependence?
Q6) How do neurological problems result in ventilator dependence?
Q7) How do respiratory conditions result in ventilator dependence?
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Chapter 29: Neonatal Mechanical Ventilation
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34 Verified Questions
34 Flashcards
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Sample Questions
Q1) Which of the following is true of I:E ratio?
A) Refers to inspiratory flow to expiratory flow
B) Inspiration is always longer than expiration
C) Long time constants need greater than 1:2 ratio
D) Higher I:E ratios are better tolerated with short time constants
Q2) Which of the following is a complication due to high PaO levels?
A) Barotrauma
B) Retinopathy of prematurity
C) Reduced intracranial pressure
D) Subcutaneous emphysema
Q3) Which of the following is true of a "lifespan" ventilator?
A) This is the term used when a ventilator is used on a comatose patient.
B) It provides pressure and volume ventilation.
C) It can be used on infants, pediatric, or adult patients.
D) It is the brand name of mechanical ventilators.
Q4) What is the significance of urine output in neonatal ventilation?
A) Identifies the adequacy of oxygenation
B) Identifies metabolic function
C) Indicates function of vital organs
D) Decrease can indicate renal impairment due to ventilating pressures
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