A 2 – breathmh.net

Question 1:

You have obtained an arterial blood gas sample from a 68-year-old patient’s indwelling radial arterial catheter. Upon removal of the syringe, brisk bleeding is noted at the puncture site. After applying firm digital pressure to achieve hemostasis, which of the following time intervals represents the most appropriate period to re-inspect the site?

A) 1 minute
B) 5 minutes
C) 10 minutes
D) 20 minutes

Correct Answer: B) 5 minutes

Explanation: After performing an arterial blood gas (ABG) sampling, it is crucial to apply direct pressure to the puncture site to ensure proper hemostasis and prevent complications such as hematoma formation. The most appropriate time to check for persistent bleeding is after 5 minutes, which allows sufficient time for initial clot formation but is early enough to address any ongoing bleeding promptly.

Question 2:

A 32-year-old woman with severe asthma is receiving continuous albuterol. Which therapy mitigates a potential side effect of prolonged albuterol?

A) Furosemide
B) Potassium chloride supplements
C) Ipratropium bromide nebulization
D) Intravenous magnesium sulfate

Correct Answer: B) Potassium chloride supplements

Explanation: Albuterol, a beta-agonist, can cause hypokalemia (low potassium levels) as a side effect. To counteract this, potassium chloride supplements are often used to prevent or treat hypokalemia, which can be dangerous if left uncorrected.

Question 3:

During the evaluation of a 55-year-old patient, your auscultative examination of the precordium reveals a strikingly resonant accentuation of the second heart sound (P2). Based on this cardinal auscultatory finding, which of the following pathophysiologic derangements represents the most probable underlying etiology?

A) Chronic mitral valve regurgitation
B) Pulmonary arterial hypertension
C) Acute anterior wall myocardial infarction
D) Critical aortic valve stenosis

Correct Answer: B) Pulmonary arterial hypertension

Explanation: An accentuated P2 (pulmonic component of the second heart sound) is typically associated with elevated pulmonary artery pressures, which occur in conditions like pulmonary arterial hypertension. The louder sound is due to the pulmonic valve closing more forcefully against the higher pressure in the pulmonary circulation.

Question 4:

You are called to the emergency department for the urgent airway management of a critically ill patient. To ensure a successful tracheal intubation while minimizing the risk of airway trauma, which of the following stylet techniques is most appropriate?

A) Fully insert the stylet, then remove it BEFORE laryngoscopy.
B) Pre-bend the stylet into a hockey-stick shape.
C) Insert the stylet so its tip extends 2-3 cm past the end of the tube.
D) Coat the entire stylet with lubricant before inserting it.

Correct Answer: B) Pre-bend the stylet into a hockey-stick shape

Explanation: Pre-bending the stylet into a hockey-stick shape is the most effective technique to optimize tracheal intubation. This configuration enhances control and maneuverability of the endotracheal tube, particularly when navigating challenging airways. It allows the tube to follow the curvature of the airway more precisely, minimizing trauma and increasing the likelihood of a successful intubation. Extending the stylet tip beyond the tube, as in option C, increases the risk of airway injury and is not recommended.

Question 5:

Asthma patient’s lung function test shows which pattern if SMALL airways are mainly affected?

A) Preserved FEV1/FVC, reduced FEV1
B) Reduced FEV1 more than FEV3
C) Normal FEV1 & FEV3, reduced FEV25%-75%
D) All flows (FEV1, FEV3, FEV6) reduced

Correct Answer: C) Normal FEV1 & FEV3, reduced FEV25%-75%

Explanation: In asthma, if the small airways are primarily affected, the FEV25%-75% is often the first parameter to show abnormality. In this case, both FEV1 and FEV3 may be normal, while FEV25%-75% will be reduced, indicating early small airway involvement.

Question 6:

What’s the BEST way to clean around a tracheostomy tube to avoid skin problems?

A) Hot soapy water
B) Salt water (like contact lens solution)
C) Hydrogen peroxide
D) Alcohol rub

Correct Answer: C) Hydrogen peroxide

Explanation: Hydrogen peroxide is effective in cleaning around a tracheostomy site because it helps disinfect the area and remove any dried secretions or debris that could lead to infection or skin breakdown, while still being safe for the surrounding skin.

Question 7:

During post-discharge cleaning of a patient room, a large blood spill is identified on the floor. According to established hospital infection control protocols, which of the following solutions is the most appropriate choice for decontamination?

A) A quaternary ammonium compound-based disinfectant cleaner
B) A 1:10 dilution of 5.25% household chlorine bleach
C) 70% isopropyl alcohol
D) A phenolic disinfectant solution

Correct Answer: B) A 1:10 dilution of 5.25% household chlorine bleach

Explanation: A 1:10 dilution of household chlorine bleach (5.25% sodium hypochlorite) is recommended for cleaning large blood spills. This solution is effective against a wide range of pathogens, including hepatitis B and HIV, and is compliant with CDC and OSHA guidelines for decontaminating surfaces exposed to blood.

Question 8:

When placing a blood pressure cuff, where should it be positioned in relation to the antecubital fossa (inner aspect of the elbow)?

A) Directly on the antecubital fossa
B) 1 inch below the antecubital fossa
C) 1 inch above the antecubital fossa
D) 2 inches above the antecubital fossa

Correct Answer: C) 1 inch above the antecubital fossa

Explanation: The blood pressure cuff should be placed 1 inch above the antecubital fossa. This positioning ensures that the cuff is not obstructed by the elbow joint and that the artery is properly compressed, leading to more accurate blood pressure readings.

Question 9:

What should be checked before performing a bedside tracheostomy?

A) Subcutaneous tracheostomy
B) Last ABG result
C) Hematocrit value
D) Coagulation profile

Correct Answer: D) Coagulation profile

Explanation: Before performing a bedside tracheostomy, it is critical to check the patient’s coagulation profile. This ensures that the patient does not have an increased risk of bleeding during the procedure, as tracheostomies can be associated with significant bleeding complications.

Question 10:

A 4-year-old child presents to the emergency department after swallowing a small coin. To best visualize the location of the coin, which X-ray view should primarily be obtained?

A) AP (Anteroposterior) chest X-ray
B) Lateral chest X-ray
C) AP abdominal X-ray
D) Ultrasound

Correct Answer: B) Lateral chest X-ray

Explanation: A lateral chest X-ray is preferred to locate the coin’s position in the esophagus or trachea. It can help differentiate if the object is in the airway (trachea) or the digestive tract (esophagus).

Question 11:

A 68-year-old woman presents to the ER with shortness of breath and swollen legs and ankles. What is the most likely diagnosis?

A) Congestive heart failure
B) Deep vein thrombosis
C) Pulmonary embolism
D) Chronic obstructive pulmonary disease (COPD)

Correct Answer: A) Congestive heart failure

Explanation: The combination of dyspnea (shortness of breath) and bilateral lower extremity swelling points to congestive heart failure, where inefficient heart pumping leads to fluid build-up in the lungs and peripheral tissues.

Question 12:

A 45-year-old patient was admitted to the ICU after a motor vehicle accident. The patient appears sick and has breathing asynchrony. During the physical examination, you find paradoxical breathing and crepitus on the right side of the chest. What is the most likely diagnosis?

A) Flail chest
B) Pneumothorax
C) Pulmonary embolism
D) Congestive heart failure

Correct Answer: A) Flail chest

Explanation: Paradoxical breathing, where part of the chest wall moves in the opposite direction during breathing, along with crepitus, points to flail chest. This occurs after multiple rib fractures, which destabilizes a section of the rib cage.

Question 13:

In the context of the nitrogen washout test, it is necessary to determine the appropriate endpoint for the test. At what point should the nitrogen washout test be stopped?

A) When the patient begins to feel discomfort.
B) When the exhaled nitrogen concentration falls below 2%.
C) After exactly 10 minutes of testing.
D) When the oxygen saturation drops below 90%.

Correct Answer: B) When the exhaled nitrogen concentration falls below 2%.

Explanation: The nitrogen washout test is used to assess lung function. The test is complete when exhaled nitrogen concentration falls below 2%, indicating effective lung clearance of nitrogen.

Question 14:

What needle size would you use to take a femoral arterial blood gas (ABG)?

A) 27G
B) 17G
C) 22G
D) 26G

Correct Answer: C) 22G

Explanation: A 22G needle is ideal for femoral arterial blood gas sampling, as it is large enough to allow adequate blood flow while minimizing trauma to the artery.

Question 15:

When measuring blood pressure using the auscultatory technique, which of the following arteries is typically used for auscultation?

A) Radial artery
B) Femoral artery
C) Brachial artery
D) Carotid artery

Correct Answer: C) Brachial artery

Explanation: The brachial artery is the standard site for blood pressure measurement because of its accessibility and the accuracy of readings it provides in the upper arm.

Question 16:

While auscultating a 42-year-old male patient, you hear a grating sound on both inspiration and expiration. The patient has been complaining of pain over his lungs. Which of the following is the most likely cause of this problem?

A) Bronchoconstriction
B) Secretions in the airways
C) Pleural friction rub
D) Exacerbation of COPD

Correct Answer: C) Pleural friction rub

Explanation: A pleural friction rub is a harsh, grating sound caused by inflammation of the pleura. It is heard in conditions like pleurisy, where the inflamed pleura rub together during respiration.

Question 17:

A 65-year-old patient is admitted with shortness of breath and is found to have an elevated central venous pressure (CVP) on monitoring. Which of the following conditions is the most likely cause of this patient’s elevated CVP?

A) pneumonia
B) Pericardial effusion
C) Cor pulmonale
D) Hypovolemic shock

Correct Answer: C) Cor pulmonale

Explanation: Cor pulmonale, or right-sided heart failure caused by pulmonary hypertension, leads to elevated CVP due to the inability of the right heart to pump blood effectively.

Question 18:

A 28-year-old male is brought to the emergency department following a motor vehicle collision. He is conscious but confused. Which of the following positions should be AVOIDED when positioning this patient due to the potential for increased intracranial pressure?

A) Semi-Fowler’s position
B) Lateral decubitus position
C) Supine position
D) Trendelenburg position

Correct Answer: D) Trendelenburg position

Explanation: The Trendelenburg position, where the head is lower than the feet, can increase intracranial pressure and should be avoided in patients with head injuries or suspected increased intracranial pressure (ICP).

Question 19:

What is the name of the test used to assess how long pilots can stay awake in a quiet place?

A) Multiple Sleep Latency Test (MSLT)
B) Maintenance Wakefulness Test (MWT)
C) Apnea Hypopnea Index (AHI)
D) Polysomnogram (PSG)

Correct Answer: B) Maintenance Wakefulness Test (MWT)

Explanation: The Maintenance Wakefulness Test (MWT) assesses how well a person can stay awake in a low-stimulus environment. It is often used for pilots and others in safety-sensitive positions to ensure they can remain awake when required.

Question 20:

A newborn baby is delivered in a hospital. Immediately after birth, the healthcare team needs to perform a quick assessment to evaluate the baby’s overall health and determine if any immediate interventions are required.

A) Apgar score
B) Neonatal Behavioral Assessment Scale (NBAS)
C) Neonatal Oral-Motor Assessment Scale (NOMAS)
D) Bayley Scales of Infant and Toddler Development

Correct Answer: A) Apgar score

Explanation: The Apgar score is a rapid assessment tool used immediately after birth to evaluate a newborn’s overall well-being. It assesses five critical areas: Appearance, Pulse, Grimace, Activity, and Respiration.

Question 21:

A neonate with respiratory distress syndrome (RDS) is being treated with surfactant therapy. The healthcare team is deciding on the best dosing strategy to ensure the surfactant is distributed evenly in the lungs and to minimize side effects.

A) As a single dose
B) As two divided doses
C) As three divided doses
D) As four divided doses

Correct Answer: C) As three divided doses

Explanation: Administering surfactant in three divided doses is the optimal strategy. This approach allows for better distribution throughout the alveoli and minimizes complications.

Question 22:

A newborn is undergoing percutaneous PaCO2 monitoring using a membrane sensor placed on the chest. The healthcare team is monitoring the infant closely and is concerned about possible complications that could interfere with the accuracy of the readings.

A) Skin irritation at the membrane site
B) Infant’s respiratory rate
C) Infant’s body temperature
D) Infant’s feeding schedule

Correct Answer: A) Skin irritation at the membrane site

Explanation: Skin irritation at the site of the sensor can impact the accuracy of PaCO2 readings and increase the risk of infection. Regular inspection is necessary.

Question 23:

A 40-year-old man has been diagnosed with obstructive sleep apnea (OSA). He is advised to start using a Continuous Positive Airway Pressure (CPAP) machine during sleep. The goal is to improve the quality of his sleep by increasing a specific stage that OSA tends to disrupt.

A) NREM sleep
B) REM sleep
C) Stage 1 sleep
D) Stage 2 sleep

Correct Answer: B) REM sleep

Explanation: Obstructive sleep apnea frequently disrupts REM sleep, the stage associated with dreaming and restorative sleep. CPAP therapy helps restore normal sleep cycles.

Question 24:

On the Borg Dyspnea Scale, what numerical value corresponds to severe breathlessness?

A) 2
B) 3
C) 4
D) 5

Correct Answer: C) 4

Explanation: A score of 4 on the Borg Dyspnea Scale represents severe breathlessness, a critical level indicating significant respiratory distress.

Question 25:

A respiratory therapist is preparing to conduct a bronchodilator reversibility test in a patient with suspected asthma. What parameter should be measured pre- and post-bronchodilator administration?

A) FVC
B) FEV1
C) PEF
D) FEF25%-75%

Correct Answer: B) FEV1

Explanation: FEV1 is the most reliable parameter for assessing bronchodilator reversibility in patients with suspected asthma, as it reflects airway obstruction.

Question 26:

According to evidence-based guidelines for infection prevention and control, which type of isolation precautions should be implemented when caring for hospitalized patients with confirmed respiratory syncytial virus (RSV) infection?

A) Standard precautions alone
B) Airborne precautions
C) Droplet precautions
D) Contact precautions

Correct Answer: C) Droplet precautions

Explanation: RSV is primarily transmitted through large respiratory droplets. Droplet precautions are essential to prevent the spread of infection.

Question 27:

Which of the following is the most appropriate solution to use for high-level disinfection of flexible bronchoscopes after use?

A) Quaternary ammonium compounds
B) 3% hydrogen peroxide solution
C) 2% glutaraldehyde solution
D) 0.5% sodium hypochlorite (bleach) solution

Correct Answer: C) 2% glutaraldehyde solution

Explanation: Glutaraldehyde is a highly effective high-level disinfectant for reprocessing semi-critical devices like bronchoscopes.

Question 28:

For patients diagnosed with measles, which type of isolation precautions should be implemented to prevent the spread of the infection?

A) Standard precautions alone
B) Contact precautions
C) Droplet precautions
D) Airborne precautions

Correct Answer: D) Airborne precautions

Explanation: Measles is highly contagious and spreads via airborne transmission. Negative pressure rooms and N95 respirators are necessary.

Question 29:

When caring for a patient with varicella (chickenpox), what personal protective equipment (PPE) should healthcare workers use to prevent transmission?

A) Surgical mask and gloves
B) N95 respirator, gown, and gloves
C) Face shield and gown
D) Surgical mask, gown, and gloves

Correct Answer: B) N95 respirator, gown, and gloves

Explanation: Varicella spreads through airborne droplets and direct contact with lesions, requiring an N95 respirator, gown, and gloves.

Question 30:

When caring for a patient diagnosed with Clostridioides difficile (C. difficile) infection, which type of isolation precautions should be observed?

A) Standard precautions
B) Airborne precautions
C) Droplet precautions
D) Contact precautions, including hand hygiene with soap and water

Correct Answer: D) Contact precautions, including hand hygiene with soap and water

Explanation: C. difficile spores are resistant to alcohol-based sanitizers, so hand washing with soap and water is essential along with contact precautions.

Question 31:

You are assessing a 68-year-old patient’s readiness for liberation from mechanical ventilation in the intensive care unit. According to evidence-based guidelines, what is the maximum recommended duration for a spontaneous breathing trial (SBT) in this patient?

A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes

Correct Answer: D) 120 minutes

Explanation: The maximum duration for an SBT is 120 minutes to evaluate the patient’s ability to breathe independently without inducing fatigue.

Question 32:

Which ventilator setting adjustment can help to correct hypercapnia (high PaCO2) in a mechanically ventilated patient?

A) Decrease respiratory rate
B) Increase tidal volume
C) Decrease FiO2
D) Increase PEEP

Correct Answer: B) Increase tidal volume

Explanation: Increasing tidal volume enhances alveolar ventilation, promoting CO₂ removal and correcting hypercapnia.

Question 33:

What is the primary reason for initiating prone positioning in a patient with ARDS (Acute Respiratory Distress Syndrome)?

A) To decrease cardiac preload
B) To improve oxygenation
C) To reduce respiratory rate
D) To alleviate pulmonary hypertension

Correct Answer: B) To improve oxygenation

Explanation: Prone positioning redistributes lung perfusion and ventilation, improving oxygenation in ARDS patients.

Question 34:

A patient with a chest tube has continuous bubbling in the water seal chamber. What does this indicate?

A) Normal operation of the chest tube
B) Excessive pleural drainage
C) A leak in the system
D) Air leak or pneumothorax

Correct Answer: D) Air leak or pneumothorax

Explanation: Continuous bubbling in the water seal chamber suggests the presence of an air leak, commonly due to a pneumothorax or a disconnection in the system.

Question 35:

A 40-year-old patient presents with a pleural effusion confirmed on imaging. The healthcare provider decides to perform chest tube insertion to drain the fluid. Which is the most appropriate site for the chest tube placement?

A) Second intercostal space, midclavicular line
B) Fourth intercostal space, anterior axillary line
C) Sixth or seventh intercostal space, midaxillary line
D) First intercostal space, sternal border

Correct Answer: C) Sixth or seventh intercostal space, midaxillary line

Explanation: The sixth or seventh intercostal space at the midaxillary line is the preferred site for chest tube placement to drain pleural fluid. This area is the most dependent portion of the pleural space where fluid collects, ensuring optimal drainage. The second intercostal space is typically used for pneumothorax management, not fluid drainage.

Question 36:

What is the primary goal of PEEP (Positive End-Expiratory Pressure) in ventilated patients?

A) Reduce respiratory rate
B) Prevent alveolar collapse
C) Increase oxygen consumption
D) Decrease airway resistance

Correct Answer: B) Prevent alveolar collapse

Explanation: PEEP helps maintain alveolar recruitment, preventing collapse during expiration and improving oxygenation.

Question 37:

During bag-valve-mask ventilation, what is the most common cause of inadequate ventilation?

A) Poor mask seal
B) Airway obstruction
C) Insufficient oxygen flow
D) Overinflation of the bag

Correct Answer:

A) Poor mask seal

Explanation:

Poor mask seal is the most common cause of inadequate ventilation during bag-valve-mask use, as an improper seal prevents effective delivery of air to the patient’s lungs. Ensuring a tight mask fit is crucial for optimal ventilation.

Question 38:

A 55-year-old male patient with a history of heart failure and recent pulmonary edema is admitted to the emergency department with complaints of severe shortness of breath and a feeling of chest tightness. He was placed on BiPAP therapy due to worsening respiratory distress.

Clinical Findings:

RR: 21 breaths/min
HR: 110 bpm
BP: 140/90 mmHg
SpO2: 94% on BiPAP 12/6 with FiO2 40%
ABG: pH 7.44, PaCO2 35 mmHg, PaO2 80 mmHg
CXR: Congested lungs, consistent with pulmonary edema

What is the most appropriate intervention for this patient?

A) Diuretic
B) Increase PEEP
C) Switch to invasive ventilation
D) Administration of fluids

Correct Answer: A) Diuretic

Explanation: A congested chest X-ray (CXR) in a patient on BiPAP often indicates pulmonary edema, commonly due to fluid overload. Administering a diuretic is the appropriate intervention as it reduces fluid overload and alleviates respiratory distress caused by pulmonary congestion.

Question 39:

Which parameter is most reliable for assessing the weaning readiness of a ventilated patient?

A) PaCO2 < 60 mmHg
B) Rapid Shallow Breathing Index (RSBI) < 105
C) Negative Inspiratory Force (NIF) < -20 cmH2O
D) Tidal Volume > 5 mL/kg

Correct Answer: B) Rapid Shallow Breathing Index (RSBI) < 105

Explanation: RSBI < 105 is a key indicator of weaning success, reflecting adequate respiratory mechanics and endurance.

Question 40:

What is the most common complication of suctioning a mechanically ventilated patient?

A) Hypoxemia
B) Infection
C) Hemodynamic instability
D) Airway trauma

Correct Answer: D) Airway trauma

Explanation: Repeated or forceful suctioning can cause airway trauma, bleeding, and discomfort in ventilated patients.

Question 41:

What is the primary indication for ECMO (Extracorporeal Membrane Oxygenation)?

A) Hypoxemic respiratory failure unresponsive to conventional treatment
B) Ventilator-associated pneumonia
C) Mild ARDS
D) Stable COPD

Correct Answer: A) Hypoxemic respiratory failure unresponsive to conventional treatment

Explanation: ECMO provides cardiopulmonary support for patients with severe, refractory respiratory failure.

Question 42:

A patient with severe COPD is receiving oxygen therapy via Venturi mask. What is the main advantage of this delivery method?

A) It is less expensive
B) It provides a variable oxygen concentration
C) It delivers a precise oxygen concentration
D) It is more comfortable

Correct Answer: C) It delivers a precise oxygen concentration

Explanation: The Venturi mask ensures accurate and consistent oxygen delivery, essential for COPD patients to prevent hypoxemia or hypercapnia.

Question 43:

A patient on mechanical ventilation develops a sudden increase in peak airway pressure. What is the most likely cause?

A) Cuff leak
B) Bronchospasm
C) Mucus plug
D) Hypovolemia

Correct Answer: C) Mucus plug

Explanation: A mucus plug can obstruct the airway, increasing airway resistance and causing a rise in peak airway pressure.

Question 44:

In patients with COPD, what is the most common cause of hypercapnia during oxygen therapy?

A) Decreased respiratory drive
B) Ventilation-perfusion mismatch
C) Increased oxygen consumption
D) Hypovolemia

Correct Answer: A) Decreased respiratory drive

Explanation: In patients with COPD, administering high levels of oxygen can suppress the hypoxic respiratory drive. This leads to a decrease in respiratory rate and minute ventilation, which results in CO₂ retention and hypercapnia.

Question 45:

A patient receiving oxygen therapy with a nasal cannula reports dry nasal passages. What is the best intervention?

A) Increase oxygen flow
B) Use a humidifier
C) Switch to a Venturi mask
D) Apply nasal spray

Correct Answer: B) Use a humidifier

Explanation: Adding a humidifier to oxygen therapy prevents dryness and irritation of the nasal mucosa.

Question 46:

Which ventilator setting directly controls the amount of CO2 removed during mechanical ventilation?

A) Respiratory rate
B) PEEP
C) FiO2
D) Tidal volume

Correct Answer: D) Tidal volume

Explanation: Tidal volume directly affects the amount of CO2 removed by influencing alveolar ventilation. Increasing tidal volume increases the amount of CO2 expelled during exhalation. While other parameters like respiratory rate play a role, tidal volume has the most direct influence on CO2 removal efficiency during mechanical ventilation.

Question 47:

Which is the most common complication associated with endotracheal intubation?

A) Tracheal stenosis
B) Airway infection
C) Vocal cord injury
D) Barotrauma

Correct Answer: C) Vocal cord injury

Explanation: Vocal cord injury is a common complication of intubation, often caused by trauma during insertion or prolonged intubation.

Question 48:

What is the primary reason for using a cuffed endotracheal tube in adults?

A) Prevent aspiration
B) Reduce vocal cord damage
C) Increase airflow
D) Allow easier suctioning

Correct Answer: A) Prevent aspiration

Explanation: The cuff creates a seal that prevents aspiration of secretions and ensures effective ventilation.

Question 49:

Which ventilator mode provides full support by delivering a set volume or pressure for every breath, whether initiated by the patient or machine?

A) SIMV
B) Assist-Control (AC)
C) Pressure Support (PSV)
D) CPAP

Correct Answer: B) Assist-Control (AC)

Explanation: Assist-Control mode provides full ventilatory support, delivering consistent breaths based on preset parameters.

Question 50:

A patient presents with Supraventricular Tachycardia (SVT). The patient is stable with normal blood pressure. Adenosine has been administered. What is the next appropriate step?

A) Synchronized cardioversion
B) Vagal maneuvers
C) Administer another dose of adenosine
D) Initiate beta-blocker therapy

Correct Answer: B) Vagal maneuvers

Explanation: If adenosine does not successfully convert the rhythm, vagal maneuvers are the next step in managing stable SVT. These techniques, such as the Valsalva maneuver or carotid sinus massage, can help terminate the arrhythmia. Synchronized cardioversion is considered for unstable patients or when non-invasive methods fail.

Question 51:

During a spontaneous breathing trial, which parameter is most indicative of successful extubation?

A) FiO2 requirement < 0.6
B) Negative inspiratory pressure (NIP) > -20 cm H2O
C) Respiratory rate > 30 breaths/min
D) Minute ventilation < 5 L/min

Correct Answer: B) Negative inspiratory pressure (NIP) > -20 cm H2O

Explanation: NIP > -20 cm H₂O indicates sufficient respiratory muscle strength to sustain spontaneous breathing after extubation.

Question 52:

What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in ARDS management?

A) Reduce barotrauma
B) Increase minute ventilation
C) Improve oxygenation
D) Decrease lung compliance

Correct Answer: C) Improve oxygenation

Explanation: PEEP prevents alveolar collapse and enhances oxygenation in ARDS patients by maintaining end-expiratory lung volume.

Question 53:

A 60-year-old patient with COPD is on 4 L/min oxygen via nasal cannula. The patient becomes very drowsy (somnolent). What is the most likely cause?

A) Hyperoxia
B) Hypercapnia
C) Hypoxemia
D) Oxygen toxicity

Correct Answer: B) Hypercapnia

Explanation: High oxygen flow in COPD patients can suppress their hypoxic drive, leading to CO₂ retention and hypercapnia, causing drowsiness (somnolence).

Question 54:

What is the purpose of high-frequency oscillatory ventilation (HFOV)?

A) Reduce peak airway pressures
B) Improve oxygenation in ARDS
C) Increase tidal volume
D) Enhance CO2 removal

Correct Answer: B) Improve oxygenation in ARDS

Explanation: HFOV uses very small tidal volumes and high frequencies to maintain alveolar recruitment and improve oxygenation in ARDS patients.

Question 55:

What is the maximum flow rate recommended for a nasal cannula to avoid mucosal drying?

A) 4 L/min
B) 6 L/min
C) 8 L/min
D) 10 L/min

Correct Answer: A) 4 L/min

Explanation: Flow rates above 4 L/min can lead to mucosal drying and discomfort. If higher flow rates are necessary, humidification should be added to minimize this effect.

Question 56:

Which condition is associated with flat diaphragms and hyperinflated lungs on a chest X-ray?

A) Pneumonia
B) Emphysema
C) ARDS
D) Pleural effusion

Correct Answer: B) Emphysema

Explanation: Emphysema causes lung hyperinflation and a flattened diaphragm due to alveolar overdistension.

Question 57:

What is the primary goal of non-invasive ventilation (NIV) in acute respiratory failure?

A) Reduce oxygen consumption
B) Avoid intubation
C) Increase sedation requirements
D) Increase airway resistance

Correct Answer: B) Avoid intubation

Explanation: NIV supports ventilation and oxygenation, reducing the need for intubation and its associated risks in acute respiratory failure.

Question 58:

Which ventilator mode allows the patient to initiate breaths, with the ventilator providing support only during inspiration?

A) Assist-Control (AC)
B) Pressure Support Ventilation (PSV)
C) Synchronized Intermittent Mandatory Ventilation (SIMV)
D) Continuous Positive Airway Pressure (CPAP)

Correct Answer: B) Pressure Support Ventilation (PSV)

Explanation: PSV supports the patient’s spontaneous breaths by providing pressure assistance during inspiration.

Question 59:

A patient is intubated and receiving volume-controlled ventilation. The nurse notes high peak airway pressures. What is the initial step?

A) Increase PEEP
B) Check for tube kinks or obstructions
C) Increase tidal volume
D) Adjust respiratory rate

Correct Answer: B) Check for tube kinks or obstructions

Explanation: High peak pressures often indicate mechanical issues, such as tube kinks or secretions, which should be addressed first.

Question 60:

Which of the following can cause auto-PEEP in mechanically ventilated patients?

A) Decreased tidal volume
B) Short expiratory time
C) Low respiratory rate
D) Decreased inspiratory time

Correct Answer: B) Short expiratory time

Explanation: Auto-PEEP occurs when there is insufficient time for exhalation, leading to air trapping in the lungs.

Question 61:

Which device provides the most accurate oxygen delivery?

A) Nasal cannula
B) Venturi mask
C) Non-rebreather mask
D) Simple face mask

Correct Answer: B) Venturi mask

Explanation: A Venturi mask delivers precise oxygen concentrations by mixing air with oxygen through adjustable ports.

Question 62:

What is the first-line treatment for acute asthma exacerbation?

A) Inhaled corticosteroids
B) Short-acting beta-agonists (SABA)
C) Long-acting beta-agonists (LABA)
D) Leukotriene receptor antagonists

Correct Answer: B) Short-acting beta-agonists (SABA)

Explanation: SABAs, such as albuterol, are the first-line treatment for rapid bronchodilation during acute asthma exacerbations.

Question 63:

A patient on high-flow nasal cannula (HFNC) therapy shows signs of respiratory distress. What should be the next step?

A) Increase flow rate
B) Increase oxygen concentration
C) Transition to non-invasive ventilation (NIV)
D) Transition to simple face mask

Correct Answer: C) Transition to non-invasive ventilation (NIV)

Explanation: If a patient fails HFNC therapy, transitioning to NIV provides better support for oxygenation and ventilation.

Question 64:

What is the primary goal of prone positioning in patients with ARDS?

A) Improve oxygenation
B) Increase cardiac output
C) Decrease lung compliance
D) Reduce pulmonary edema

Correct Answer: A) Improve oxygenation

Explanation: Prone positioning redistributes ventilation, improves alveolar recruitment, and enhances oxygenation in ARDS patients.

Question 65:

What is a common complication of high PEEP in mechanically ventilated patients?

A) Hypercapnia
B) Hypovolemia
C) Barotrauma
D) Pneumonia

Correct Answer: C) Barotrauma

Explanation: High PEEP can overdistend alveoli, leading to barotrauma, including pneumothorax or subcutaneous emphysema.

Question 66:

A patient with COPD is started on long-term oxygen therapy (LTOT). What is the main indication for LTOT?

A) PaO2 < 80 mmHg
B) PaO2 ≤ 55 mmHg
C) SpO2 > 94%
D) FiO2 ≥ 50%

Correct Answer: B) PaO2 ≤ 55 mmHg

Explanation: LTOT is indicated for COPD patients with a PaO2 ≤ 55 mmHg or SpO2 ≤ 88% to improve survival and reduce complications.

Question 67:

Which ventilator mode allows for spontaneous breathing while providing a set number of mandatory breaths?

A) SIMV (Synchronized Intermittent Mandatory Ventilation)
B) Assist-Control (AC)
C) CPAP (Continuous Positive Airway Pressure)
D) Pressure Support Ventilation (PSV)

Correct Answer: A) SIMV (Synchronized Intermittent Mandatory Ventilation)

Explanation: SIMV delivers a set number of mandatory breaths while allowing the patient to breathe spontaneously between these breaths.

Question 68:

What is the main advantage of using a heated humidifier with mechanical ventilation?

A) Prevent airway drying
B) Increase oxygen delivery
C) Decrease airway resistance
D) Reduce infection risk

Correct Answer: A) Prevent airway drying

Explanation: Heated humidifiers add moisture to the ventilator circuit, preventing airway drying and maintaining mucociliary function.

Question 69:

Which parameter best assesses oxygenation in a mechanically ventilated patient?

A) Tidal volume
B) PaO2
C) PaCO2
D) Peak inspiratory pressure

Correct Answer: B) PaO2

Explanation: PaO2 reflects the efficiency of oxygenation and is a key parameter in assessing oxygenation status.

Question 70:

What is the expected FiO2 when using a simple face mask at 6 L/min?

A) 28%
B) 40%
C) 60%
D) 70%

Correct Answer: B) 40%

Explanation: A simple face mask at 6 L/min typically delivers an FiO2 of approximately 40%.

Question 71:

Which condition is commonly associated with a tracheal shift away from the affected side?

A) Pleural effusion
B) Tension pneumothorax
C) Atelectasis
D) Lung consolidation

Correct Answer: B) Tension pneumothorax

Explanation: Tension pneumothorax causes a tracheal shift away from the affected side due to increased intrathoracic pressure.

Question 72:

A patient on mechanical ventilation has a low tidal volume and high respiratory rate. What is the most likely cause?

A) Increased lung compliance
B) Metabolic acidosis
C) Acute respiratory distress syndrome (ARDS)
D) Decreased ventilatory drive

Correct Answer: C) Acute respiratory distress syndrome (ARDS)

Explanation: ARDS is characterized by reduced lung compliance, leading to lower tidal volumes and a compensatory increase in respiratory rate.

Question 73:

Which of the following oxygen delivery devices provides the highest concentration of oxygen?

A) Simple face mask
B) Nasal cannula
C) Venturi mask
D) Non-rebreather mask

Correct Answer: D) Non-rebreather mask

Explanation: A non-rebreather mask can deliver up to nearly 100% oxygen, making it the most efficient high-flow oxygen delivery device.

Question 74:

What is the hallmark symptom of carbon monoxide (CO) poisoning?

A) Cyanosis
B) Dyspnea
C) Hypotension
D) Cherry-red skin coloration

Correct Answer: D) Cherry-red skin coloration

Explanation: CO poisoning typically results in cherry-red skin coloration due to carboxyhemoglobin formation, even though oxygen levels may be critically low.

Question 75:

Which mode of ventilation is ideal for patients with severe ARDS?

A) Volume-controlled ventilation
B) Pressure-controlled ventilation
C) CPAP
D) BiPAP

Correct Answer: B) Pressure-controlled ventilation

Explanation: Pressure-controlled ventilation minimizes lung injury by avoiding overdistension of alveoli in patients with low lung compliance, such as in ARDS.

Question 76:

A patient with COPD has a baseline PaCO2 of 55 mmHg. What should the target oxygen saturation (SpO2) be?

A) 88-92%
B) 90-94%
C) 94-96%
D) 96-98%

Correct Answer: A) 88-92%

Explanation: In COPD patients with chronic hypercapnia, targeting SpO2 between 88-92% avoids worsening CO2 retention while ensuring adequate oxygenation.

Question 77:

What is the primary diagnostic tool for detecting pulmonary embolism (PE)?

A) CT pulmonary angiography
B) Chest X-ray
C) V/Q scan
D) Echocardiogram

Correct Answer: A) CT pulmonary angiography

Explanation: CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, providing detailed images of the pulmonary vasculature.

Question 78:

A patient undergoing a spontaneous breathing trial shows a rapid shallow breathing index (RSBI) of 90. What does this indicate?

A) Likely extubation failure
B) Readiness for extubation
C) Need for increased ventilatory support
D) Risk of airway obstruction

Correct Answer: B) Readiness for extubation

Explanation: An RSBI below 105 indicates adequate respiratory mechanics and likely success with extubation.

Question 79:

A 4-year-old child presents with stridor and a barking cough. What is the most likely diagnosis?

A) Epiglottitis
B) Foreign body aspiration
C) Croup
D) Asthma

Correct Answer: C) Croup

Explanation: Croup is characterized by stridor, a barking cough, and hoarseness, commonly due to viral infection causing subglottic swelling.

Question 80:

What is the primary goal of administering hypertonic saline in patients with cystic fibrosis?

A) Reduce inflammation
B) Improve mucociliary clearance
C) Prevent bacterial infection
D) Decrease sputum viscosity

Correct Answer: B) Improve mucociliary clearance

Explanation: Hypertonic saline hydrates the airway surface and improves mucociliary clearance, helping to reduce mucus buildup in cystic fibrosis.

Question 81:

A patient with severe asthma exacerbation is not responding to albuterol. What is the next step in management?

A) Increase the dose of albuterol
B) Administer intravenous magnesium sulfate
C) Start oral corticosteroids
D) Intubate the patient immediately

Correct Answer: B) Administer intravenous magnesium sulfate

Explanation: Intravenous magnesium sulfate is used as an adjunct therapy in severe asthma exacerbations when beta-agonists and steroids are insufficient. It helps to relax bronchial smooth muscle.

Question 82:

Which of the following is the hallmark finding in tension pneumothorax?

A) Mediastinal shift away from the affected side
B) Hyperresonance on percussion
C) Tracheal deviation to the opposite side
D) Diminished breath sounds on the affected side

Correct Answer: C) Tracheal deviation to the opposite side

Explanation: Tension pneumothorax causes significant pressure buildup, resulting in tracheal deviation away from the affected side, along with other findings like hyperresonance and absent breath sounds.

Question 83:

What is the best initial diagnostic test for a suspected pleural effusion?

A) CT scan
B) Chest X-ray
C) Ultrasound
D) Thoracentesis

Correct Answer: C) Ultrasound

Explanation: Ultrasound is highly effective as an initial diagnostic test for pleural effusion. It reliably detects both small and large pleural effusions and can differentiate between pleural fluid and solid tissue. Additionally, ultrasound is particularly useful for guiding thoracentesis in cases of loculated or small effusions, making it a superior initial choice compared to a chest X-ray.

Question 84:

What is the preferred position for thoracentesis to remove a pleural effusion?

A) Sitting upright, leaning forward
B) Supine with head elevated
C) Prone position
D) Trendelenburg position

Correct Answer: A) Sitting upright, leaning forward

Explanation: The upright, forward-leaning position allows fluid to collect in the lower posterior thorax, providing better access for thoracentesis.

Question 85:

A 60-year-old patient with a history of smoking presents with hemoptysis and weight loss. What is the most likely diagnosis?

A) Chronic bronchitis
B) Tuberculosis
C) Lung cancer
D) Bronchiectasis

Correct Answer: C) Lung cancer

Explanation: Lung cancer is a common cause of hemoptysis, particularly in smokers, often accompanied by systemic symptoms like weight loss.

Question 86:

A patient on high-flow oxygen therapy complains of dry nasal passages. What is the best solution?

A) Switch to a non-rebreather mask
B) Add humidification to the oxygen delivery
C) Reduce oxygen flow
D) Use a nasal decongestant

Correct Answer: B) Add humidification to the oxygen delivery

Explanation: Humidification helps prevent dryness and irritation caused by high-flow oxygen therapy.

Question 87:

Which test is most sensitive for detecting pulmonary hypertension?

A) Chest X-ray
B) CT scan
C) Pulmonary function test
D) Right heart catheterization

Correct Answer: D) Right heart catheterization

Explanation: Right heart catheterization directly measures pulmonary artery pressures, making it the gold standard for diagnosing pulmonary hypertension.

Question 88:

Which intervention is recommended to prevent ventilator-associated pneumonia (VAP)?

A) Frequent chest physiotherapy
B) Elevate the head of the bed
C) Routine bronchoscopy
D) Change ventilator tubing daily

Correct Answer: B) Elevate the head of the bed

Explanation: Keeping the head of the bed elevated to 30–45 degrees reduces the risk of aspiration, a major cause of ventilator-associated pneumonia.

Question 89:

A patient with pneumonia has a PaO2/FiO2 ratio of 250. What does this indicate?

A) Normal oxygenation
B) Mild ARDS
C) Moderate ARDS
D) Severe ARDS

Correct Answer: B) Mild ARDS

Explanation: A PaO2/FiO2 ratio between 200–300 indicates mild ARDS, suggesting early-stage oxygenation impairment requiring supportive care.