A 5

Question 1:

Where is the leak if you clamp the chest tube and the bubbling continues?

• A) Between the chest tube and the pleural space
• B) Between the chest tube and the drainage system
• C) In the pleural cavity
• D) Within the chest tube itself

Correct Answer: B) Between the chest tube and the drainage system

Explanation: If bubbling persists after clamping the chest tube, the source of the leak is between the chest tube and the drainage system. This suggests a disconnection or breach in the drainage apparatus, ruling out issues in the pleural space or within the chest tube itself.

Question 2:

How many hours are typically required before a chest tube can be removed?

• A) 12-24 hours
• B) 24-48 hours
• C) 48-72 hours
• D) 72-96 hours

Correct Answer: B) 24-48 hours Explanation: Chest tubes are generally removed after 24-48 hours, depending on the patient’s condition and the resolution of the underlying issue (e.g., pneumothorax, pleural effusion). The timing is determined based on clinical assessments and radiographic evidence showing that the problem has resolved.

Question 3:

When should IPPB be considered instead of IS?

• A) When the patient is in pain
• B) When the patient is unable to use IS
• C) When the patient has a fever
• D) When the patient is sedated

Correct Answer: B) When the patient is unable to use IS Explanation: Incentive Spirometry (IS) is used to encourage deep breathing to prevent atelectasis. If a patient is unable to effectively use IS due to pain, weakness, or lack of cooperation, Intermittent Positive Pressure Breathing (IPPB) can be considered as an alternative to assist in lung expansion and improve ventilation.

Question 4:

You are called for the assessment of a chest radiograph for a patient suffering from advanced stages of emphysema. Upon observation, which of the following would you expect to see?

• A) Increased cardiac shadow
• B) Pleural effusion
• C) Flattening of the diaphragm
• D) Consolidation

Correct Answer: C) Flattening of the diaphragm Explanation: In advanced stages of emphysema, one of the hallmark radiographic signs is the flattening of the diaphragm. This occurs due to the hyperinflation of the lungs and the loss of lung elasticity, which pushes the diaphragm downward.

Question 5:

A 3-month-old girl with asthma is receiving volume control SIMV mechanical ventilation with an inline small volume nebulizer in place. After the treatment was started, the alarm of the heated humidifier was activated. Which of the following is the most likely cause of this alarm?

• A) High gas temperature
• B) Low gas temperature
• C) Increased airway resistance
• D) High humidity levels

Correct Answer: B) Low gas temperature Explanation: The alarm of the heated humidifier is likely triggered by a low gas temperature. This can occur if the nebulizer treatment causes a decrease in the temperature of the gas being delivered, or if there is a malfunction in the heating element of the humidifier.

Question 6:

What medication is used during an asthma attack?

• A) Short-acting beta-agonists (SABA)
• B) Long-acting beta-agonists (LABA)
• C) Leukotriene modifiers
• D) Anticholinergics

Correct Answer: A) Short-acting beta-agonists (SABA) Explanation: Short-acting beta-agonists (SABA), such as albuterol, are the first-line treatment for quick relief during an asthma attack. They work by rapidly relaxing the airway muscles, relieving bronchoconstriction and improving airflow.

Question 7:

A patient on a ventilator needs to be disconnected for troubleshooting. What should you do?

• A) Disconnect the ventilator and bag the patient simultaneously
• B) Call a nurse to bag the patient while you troubleshoot the ventilator

Correct Answer: A) Disconnect the ventilator and bag the patient simultaneously Explanation: When a ventilator issue arises that requires disconnection, the respiratory therapist should immediately bag the patient with a manual resuscitation bag (Ambu bag) to ensure continuous ventilation and oxygenation while troubleshooting the ventilator. This ensures patient safety and prevents hypoxemia.

Question 8:

A patient has a tracheal shift to the right and diminished breath sounds on the left side. What is the most likely diagnosis?

• A) Pleural effusion
• B) Pneumothorax
• C) Consolidation
• D) Atelectasis

Correct Answer: B) Pneumothorax Explanation: A tracheal shift to one side with diminished breath sounds on the opposite side is indicative of a pneumothorax. The air in the pleural space on the affected side causes a shift of the mediastinum and trachea away from the affected side, leading to decreased breath sounds.

Question 9:

A spontaneously breathing patient has atelectasis. What should be done?

• A) Chest Physiotherapy (CPT)
• B) Incentive Spirometer
• C) Racemic epinephrine
• D) IPPB

Correct Answer: B) Incentive Spirometer Explanation: Incentive spirometry helps re-expand collapsed lung areas by encouraging deep breathing and improving lung function.

Question 10:

For which condition is High-Frequency Chest Wall Oscillation (HFCWO) primarily used?

• A) Asthma
• B) Chronic Obstructive Pulmonary Disease (COPD)
• C) Cystic Fibrosis
• D) Pneumonia

Correct Answer: C) Cystic Fibrosis Explanation: High-Frequency Chest Wall Oscillation (HFCWO) is primarily used for patients with cystic fibrosis. This therapy helps to mobilize and clear thick mucus from the airways, improving lung function and reducing the risk of respiratory infections.

Question 11:

A patient uses SVN (small volume nebulizer) and holds their breath for 4 seconds during treatment. What is the appropriate response?

• A) This practice aligns with recommended guidelines
• B) Holding the breath should be longer for better absorption
• C) It’s advisable not to hold the breath during treatment
• D) Hold the breath for 1 to 3 seconds for optimal delivery

Correct Answer: D) Hold the breath for 1 to 3 seconds for optimal delivery Explanation: According to guidelines, the correct practice is to hold the breath for 1 to 3 seconds during SVN treatment for optimal medication delivery.

Question 12:

A 65-year-old male presents to the emergency department with complaints of shortness of breath and pink frothy sputum. On examination, he has bilateral crackles on auscultation and an elevated jugular venous pressure. What is the most likely diagnosis?

• A) Chronic Obstructive Pulmonary Disease (COPD)
• B) Asthma
• C) Left Heart Failure
• D) Pneumonia

Correct Answer: C) Left Heart Failure Explanation: The presence of pink frothy sputum is a classic sign of pulmonary edema, which often results from left heart failure. The elevated jugular venous pressure and bilateral crackles further support this diagnosis.

Question 13:

A respiratory therapist is calibrating a blood gas analyzer and needs to verify the PCO2 measurements. Which electrode is used to measure PCO2?

• A) Clark electrode
• B) pH electrode
• C) Severinghaus electrode
• D) Silver-silver chloride electrode

Correct Answer: C) Severinghaus electrode Explanation: The Severinghaus electrode is specifically designed for measuring PCO2 in blood gas analysis.

Question 14:

An asthmatic patient is currently only using a beta2 adrenergic agonist inhaler for symptom management. What additional medication should be prescribed?

• A) Montelukast
• B) Theophylline
• C) Budesonide
• D) Cromolyn sodium

Correct Answer: C) Budesonide Explanation: Budesonide, an inhaled corticosteroid, is recommended to reduce inflammation and improve asthma control when used in conjunction with a beta2 agonist.

Question 15:

A patient is admitted to the hospital with fever and dry cough. After 72 hours, the patient is transferred to the ICU, and physical examination reveals productive cough, fever, and a dull note on percussion. What is the most likely diagnosis?

• A) Community-acquired pneumonia (CAP)
• B) Hospital-acquired pneumonia (HAP)
• C) Aspiration pneumonia
• D) Tuberculosis

Correct Answer: B) Hospital-acquired pneumonia (HAP) Explanation: The transition from a dry to productive cough, along with the fever and dull percussion note, suggests pneumonia acquired during the hospital stay, indicating HAP.

Question 16:

During a preoperative assessment, a patient is evaluated for airway management using the Mallampati classification. What does a Mallampati score of Class 1 indicate?

• A) Difficult intubation
• B) Moderate intubation difficulty
• C) Easy intubation
• D) Impossible intubation without adjuncts

Correct Answer: C) Easy intubation Explanation: A Mallampati Class 1 score indicates that the soft palate, uvula, and pillars are completely visible, suggesting an easy intubation.

Question 17:

On central line insertion, suddenly the patient is desaturating. What should you do?

• A) Needle aspiration
• B) Chest tube insertion
• C) Reposition the central line
• D) Increase oxygen flow

Correct Answer: A) Needle aspiration Explanation: Sudden desaturation during central line insertion can indicate a pneumothorax. Needle aspiration should be performed immediately to relieve the tension pneumothorax.

Question 18:

A patient with Guillain-Barré Syndrome (GBS) had a Negative Inspiratory Force (NIF) of 15 and a low Vital Capacity (VC). After management with plasmapheresis and intravenous immunoglobulin, VC improves and NIF is 30. What should you do?

• A) Extubate
• B) Withhold extubation
• C) Continue mechanical ventilation
• D) Start non-invasive ventilation

Correct Answer: A) Extubate Explanation: Extubation is appropriate when the NIF is greater than -20 cm H2O and the patient shows clinical improvement, indicating sufficient respiratory muscle strength.

Question 19:

A patient with Pneumocystis jiroveci pneumonia and HIV. Which of the following medications do you recommend?

• A) Pentamidine
• B) Amoxicillin
• C) Acyclovir
• D) Erythromycin

Correct Answer: A) Pentamidine Explanation: Pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia, especially in patients who cannot tolerate first-line treatment such as TMP-SMX (Trimethoprim-Sulfamethoxazole).

Question 20:

A patient with pulmonary embolism (PE) on FiO2 100%, 6 cm H2O PEEP, and still hypoxemic. What should you do?

• A) Increase PEEP
• B) Decrease FiO2
• C) Start bronchodilators
• D) Initiate diuretics

Correct Answer: A) Increase PEEP Explanation: Increasing PEEP can help improve oxygenation in patients with hypoxemia by preventing alveolar collapse and improving ventilation-perfusion matching.

Question 21:

A patient with metabolic acidosis and the physician notices an acetone odor on breath. What condition does the patient likely have?

• A) Diabetic Ketoacidosis (DKA)
• B) Pleural friction rub
• C) Pleural inflammation
• D) Renal failure

Correct Answer: A) Diabetic Ketoacidosis (DKA) Explanation: An acetone odor on the breath is a classic sign of DKA, which results from the accumulation of ketones due to uncontrolled diabetes.

Question 22:

Chest X-ray (CXR) has good exposure in relation to which of the following?

• A) Trachea
• B) Heart
• C) Ribs
• D) Vertebrae

Correct Answer: D) Vertebrae Explanation: Good exposure on a chest X-ray is indicated by the ability to barely see the vertebral bodies through the heart shadow, reflecting proper penetration.

Question 23:

A physician informs you that a patient’s sputum sample has epithelial cells, not pus. What will you recommend?

• A) Antibiotics with an increased dose of corticosteroids
• B) Antibiotics
• C) Antivirals
• D) Continue current treatment

Correct Answer: A) Antibiotics with an increased dose of corticosteroids Explanation: The presence of epithelial cells indicates contamination of the sample rather than a true infection. Adjusting the treatment to include corticosteroids might be necessary if there is an underlying condition that requires it.

Question 24:

Patient on tracheostomy only needs oxygen during the daytime. What type of tracheostomy tube (TT) do you recommend?

• A) Fenestrated/uncuffed
• B) Cuffed
• C) Unfenestrated/uncuffed
• D) Metal tracheostomy tube

Correct Answer: A) Fenestrated/uncuffed Explanation: A fenestrated/uncuffed tracheostomy tube allows for better speech and more natural breathing when the patient only needs supplemental oxygen during the day, providing comfort and facilitating communication.

Question 25:

When should a physician consider chest tube removal if the volume is less than?

• A) 50 ml
• B) 100 ml
• C) 150 ml
• D) 200 ml

Correct Answer: A) 50 ml Explanation: A chest tube can typically be considered for removal when the drainage volume is less than 50 ml over 24 hours, indicating that the pleural space has adequately resolved.

Question 24:

What will you do in order to confirm suction pressure is good?

• A) Occlude tip of catheter and see manometer of vacuum pressure
• B) Occlude thumb port and see manometer of vacuum pressure
• C) Check the vacuum source directly
• D) Use a pressure gauge without occluding

Correct Answer: B) Occlude thumb port and see manometer of vacuum pressure

Explanation: Occluding the thumb port of the suction catheter allows the manometer to accurately measure the vacuum pressure. This ensures the suction pressure is within the desired range for safe and effective suctioning, minimizing the risk of tissue damage.

Question 27:

Patient appears to be asleep but responds properly when stimulated. What is their condition?

• A) Lethargic
• B) Comatose
• C) Stuporous
• D) Alert

Correct Answer: A) Lethargic Explanation: Lethargy is characterized by a state of tiredness or fatigue in which the patient can be easily aroused with minimal stimulation.

Question 28:

You observe a patient with low blood pressure. What medication will you recommend?

• A) Dopamine
• B) Atropine
• C) Epinephrine
• D) Lidocaine

Correct Answer: A) Dopamine Explanation: Dopamine is commonly used to treat hypotension because it increases cardiac output and improves blood pressure by stimulating beta-1 adrenergic receptors.

Question 29:

In the infant population, what is the most popular mode?

• A) High-Frequency Oscillatory Ventilation (HFOV)
• B) SIMV
• C) CPAP
• D) BiPAP

Correct Answer: A) High-Frequency Oscillatory Ventilation (HFOV) Explanation: HFOV is often used in neonates and infants, particularly for those with severe respiratory distress syndrome, as it provides effective ventilation with minimal lung injury.

Question 30:

Based on RSBI (Rapid Shallow Breathing Index): Data:

• Patient A: RR = 20, TV = 0.3 L (RSBI = 65)
• Patient B: RR = 36, TV = 0.25 L (RSBI = 144)
• Patient C: RR = 30, TV = 0.25 L (RSBI = 120)
• Patient D: RR = 32, TV = 0.24 L (RSBI = 133)

What is the best RSBI for weaning?

• A) RSBI = 144
• B) RSBI = 120
• C) RSBI = 133
• D) RSBI = 65

Correct Answer: D) RSBI = 65 Explanation: An RSBI less than 105 indicates suitability for weaning or extubation. Among the given values, 65 is the only RSBI below 105, making it the best choice for weaning.

Question 31:

An infant case with vitally stable BP, normal SpO2, normal HR, and intubated with ETT 2.5 uncuffed needs to be transported. What should you do?

• A) Prepare the transport equipment
• B) Delay until he stabilizes
• C) Refuse to transport
• D) Monitor without transport

Correct Answer: A) Prepare the transport equipment Explanation: Given that the infant is vitally stable with normal BP, SpO2, and HR, the appropriate action is to prepare the transport equipment for safe transfer.

Question 32:

A patient with elevated peak pressures and triggering the ventilator has an ABG showing alkalosis (indicating CO2 washout). The patient is on VC/AC. What do you suggest?

• A) Sedate the patient
• B) Switch to SIMV
• C) Switch to PC/SIMV
• D) Increase ventilation rate

Correct Answer: C) Switch to PC/SIMV Explanation: Switching to pressure control (PC) with synchronized intermittent mandatory ventilation (SIMV) helps address elevated peak pressures and CO2 washout while improving patient-ventilator synchrony.

Question 33:

A patient is triggering the ventilator by 2 bpm with the following settings: Set TV = 450 mL, Set RR = 18. Calculate the RSBI.

• A) 44
• B) 40
• C) 0.6
• D) 0.4

Correct Answer: A) 44 Explanation: RSBI = (Total RR) ÷ (TV in liters). The total RR = 18 + 2 = 20 bpm; TV = 450 mL = 0.45 L. RSBI = 20 ÷ 0.45 ≈ 44.44.

Question 34:

A flow-time graph indicates intrinsic PEEP. How should you resolve this issue?

• A) Increase inspiratory time
• B) Increase expiratory time
• C) Decrease inspiratory flow
• D) Decrease expiratory time

Correct Answer: B) Increase expiratory time Explanation: Increasing the expiratory time allows more complete exhalation, reducing air trapping and intrinsic PEEP.

Question 35:

An ARDS patient on high mechanical ventilation settings has an ABG showing worsening oxygenation with a PaO2 less than 60 mmHg. What should you suggest?

• A) Perform a recruitment maneuver
• B) Increase tidal volume
• C) Increase PEEP
• D) Decrease FiO2

Correct Answer: A) Perform a recruitment maneuver Explanation: Recruitment maneuvers help reopen collapsed alveoli, improving oxygenation in severe ARDS cases.

Question 36:

A doctor inquires about the risks associated with performing a recruitment maneuver on an ARDS patient. What is a significant risk?

• A) Cardiac instability
• B) Hypoventilation
• C) Hyperventilation
• D) Increased mucus production

Correct Answer: A) Cardiac instability Explanation: Recruitment maneuvers can cause cardiovascular effects like reduced cardiac output and hypotension, posing a risk of cardiac instability.

Question 37:

In a mass casualty situation in the ER, which of the following patients would you prioritize?

• A) High pulse
• B) Unequal pupils
• C) Tracheal deviation
• D) Contusion on the side area

Correct Answer: C) Tracheal deviation Explanation: Tracheal deviation suggests a life-threatening condition like tension pneumothorax, which requires immediate intervention.

Question 38:

A 75 kg female patient is receiving volume-controlled ventilation with an FiO2 of 40%, TV: 500 mL, RR: 12. An ABG shows normal results. What would you recommend?

• A) Place her on a 40% T-piece and monitor closely
• B) Switch her to SIMV at a rate of 5/min
• C) Maintain the ventilator settings
• D) Place her on CPAP and monitor closely

Correct Answer: C) Maintain the ventilator settings Explanation: If the ABG results are normal, maintaining the current ventilator settings is appropriate, indicating adequate ventilation and oxygenation.

Question 39:

A patient is on BiPAP with IPAP 14 and EPAP 5. What is the level of ventilation?

• A) 9
• B) 14
• C) 5
• D) 19

Correct Answer: A) 9 Explanation: The level of ventilation, or pressure support, is calculated as the difference between IPAP and EPAP. Here, 14 – 5 = 9 cm H2O.

Question 40:

A sputum culture was ordered. Which of the following is the best way to obtain it?

• A) The trap should be connected between the suction catheter and vacuum tubing
• B) The patient should cough deeply and spit into a sterile container
• C) Use of a nasal swab
• D) Collection from a tracheostomy stoma directly

Correct Answer: A) The trap should be connected between the suction catheter and vacuum tubing Explanation: Proper placement of the suction trap ensures effective collection of sputum for culture without contamination.

Question 41:

A patient with pneumonia is being treated with tobramycin and gentamicin. Lab results show a creatinine level of 300. What do you suggest?

• A) Stop the treatment as tobramycin causes renal damage
• B) Send the patient for renal dialysis
• C) Reduce the dose
• D) Switch to another medication

Correct Answer: A) Stop the treatment as tobramycin causes renal damage Explanation: Elevated creatinine levels indicate renal impairment. Tobramycin and gentamicin are nephrotoxic, so discontinuing their use is essential to prevent further damage.

Question 42:

During a bronchoscopy, the doctor notices the airway is blurry and asks the RT to instill saline to clear the view, but it fails. What should you do?

• A) Stop the procedure
• B) Replace the bronchoscope
• C) Check the light source
• D) Check the eyepiece

Correct Answer: C) Check the light source Explanation: A blurry view may be caused by an issue with the light source. Verifying and fixing the light source can resolve the problem.

Question 43:

A chest tube shows no fluctuation in the water seal chamber. What is the most likely cause?

• A) Suction pressure too low
• B) Obstruction in the tube
• C) Lung has fully re-expanded
• D) Water seal chamber is completely empty

Correct Answer: B) Obstruction in the tube Explanation: Lack of fluctuation typically indicates an obstruction in the chest tube, preventing air or fluid from moving through it.

Question 44:

Which of the following medications is a first-line treatment for tuberculosis (TB)?

• A) Amoxicillin
• B) Azithromycin
• C) Rifampin
• D) Ciprofloxacin

Correct Answer: C) Rifampin Explanation: Rifampin is a key medication in the standard four-drug regimen for treating active tuberculosis. It works by inhibiting bacterial RNA synthesis, effectively killing Mycobacterium tuberculosis.

Question 45:

A 28-week premature neonate is intubated and receiving mechanical ventilation. The physician orders surfactant administration. Which medication is most appropriate in this case?

• A) Calfactant
• B) Albuterol
• C) Racemic Epinephrine
• D) Ipratropium Bromide

Correct Answer: A) Calfactant Explanation: Calfactant is a commonly used surfactant for premature infants to treat or prevent respiratory distress syndrome (RDS). The other options are not surfactants.

Question 46:

What is the approximate FiO2 delivered by a nasal cannula at a flow rate of 3 liters per minute (L/min)?

• A) 24%
• B) 28%
• C) 32%
• D) 36%

Correct Answer: C) 32% Explanation: Each liter of oxygen flow through a nasal cannula increases the FiO2 by approximately 4%. With a flow rate of 3 L/min, the estimated FiO2 is around 32%.

Question 47:

A 70-year-old male intubated patient has a measured endotracheal tube (ETT) cuff pressure of 38 cm H₂O. Which action is most appropriate?

• A) Maintain the current cuff pressure
• B) Increase the cuff pressure > 40 cm H₂O
• C) Lower the cuff pressure to < 30 cm H₂O
• D) Deflate the cuff completely

Correct Answer: C) Lower the cuff pressure to < 30 cm H₂O Explanation: Prolonged high cuff pressures (>30 cm H₂O) can injure the tracheal mucosa. The recommended range is usually 20–30 cm H₂O to ensure sealing without vascular compromise.

Question 48:

A patient experiences post-extubation stridor. What is the recommended treatment?

• A) Heliox (Helium-Oxygen mixture)
• B) Normal Saline Nebulization
• C) Dexamethasone (Steroid)
• D) Racemic Epinephrine (Vasoconstriction)

Correct Answer: D) Racemic Epinephrine (Vasoconstriction) Explanation: Racemic epinephrine helps reduce laryngeal edema through vasoconstriction, rapidly alleviating post-extubation stridor.

Question 49:

During a mass casualty event, which of the following patients should be triaged with the highest priority?

• A) A patient with a fractured femur
• B) A patient with a large laceration and bleeding
• C) A patient with a suspected spinal cord injury
• D) A patient with tracheal deviation

Correct Answer: D) A patient with tracheal deviation Explanation: Tracheal deviation suggests a tension pneumothorax, a life-threatening condition that requires immediate intervention.

Question 50:

Which of the following safety features is used to prevent the accidental attachment of incorrect regulators to an E cylinder?

• A) Pressure relief valve
• B) Pin index system
• C) Color-coding
• D) Cylinder valve

Correct Answer: B) Pin index system Explanation: The pin index system uses a specific arrangement of pins and holes on the cylinder valve and regulator to ensure that only the correct type of regulator can be attached, preventing the delivery of the wrong gas.

Question 51:

A 55-year-old patient presents to the emergency department with frothy secretions and shortness of breath. A chest X-ray reveals a butterfly pattern, suggesting a condition related to fluid overload. What is the most appropriate intervention for this patient?

• A) Bronchodilator
• B) Furosemide
• C) Antibiotics
• D) Corticosteroids

Correct Answer: B) Furosemide Explanation: The patient’s symptoms and chest X-ray findings indicate fluid overload, and furosemide, a diuretic, is recommended to manage and reduce the excess fluid.

Question 52:

An infant with percutaneous PaCO2 monitoring is under your care. As a healthcare professional, what should you regularly check and monitor in this patient?

• A) Skin integrity
• B) Fluid balance
• C) Respiratory rate
• D) Oxygen saturation

Correct Answer: A) Skin integrity Explanation: In an infant with percutaneous PaCO2 monitoring, checking the skin integrity around the monitoring site is crucial to prevent irritation or skin breakdown.

Question 53:

A patient on high-dose steroids develops high blood glucose levels. What is the most appropriate management strategy?

• A) Stop steroids immediately
• B) Switch to an inhaled corticosteroid
• C) Start insulin therapy
• D) Reduce steroid dosage gradually

Correct Answer: C) Start insulin therapy Explanation: Steroid-induced hyperglycemia is managed with insulin therapy while continuing necessary steroid treatment.

Question 54:

A 65-year-old male patient has just been transported to the ICU after experiencing a significant drop in blood pressure and showing signs of hemodynamic instability. Which is the best device to accurately measure the systemic blood pressure in this hemodynamically unstable patient?

• A) Arterial catheter (A-Line)
• B) Sphygmomanometer
• C) Automated blood pressure cuff
• D) Doppler ultrasound

Correct Answer: A) Arterial catheter (A-Line) Explanation: An arterial catheter provides continuous and accurate measurement of systemic blood pressure, essential for managing hemodynamically unstable patients.

Question 55:

During a bronchoscopy, you notice significant bleeding at the biopsy site. What is the most appropriate immediate action?

• A) Administer cold saline lavage
• B) Stop the procedure immediately
• C) Administer adrenaline through the bronchoscope
• D) Apply positive pressure ventilation

Correct Answer: C) Administer adrenaline through the bronchoscope Explanation: Adrenaline reduces bleeding by vasoconstriction and is the immediate intervention for managing biopsy site bleeding during bronchoscopy.

Question 56:

A physician ordered the wrong drug prescription, and you administered the treatment. The patient experienced severe adverse effects and subsequently died. Who is responsible for the error?

• A) The physician
• B) The respiratory therapist (RT)
• C) All team members
• D) The pharmacist

Correct Answer: C) All team members Explanation: Responsibility for the error falls on all team members as patient safety is a collective responsibility, emphasizing the importance of communication and verification.

Question 57:

A patient is using a peak expiratory flow (PEF) meter, and her personal best value is 420 L/min. During a recent test, she achieved 360 L/min. What should the respiratory therapist do in this situation?

• A) Add a short-acting beta-agonist (SABA) to the plan
• B) Add inhaled corticosteroids to the plan
• C) Continue on the same plan
• D) Recommend a long-acting beta-agonist (LABA)

Correct Answer: C) Continue on the same plan Explanation: A PEF reading of 360 L/min is approximately 86% of the patient’s personal best, indicating that her asthma is well-controlled. Continuing on the same treatment plan is appropriate.

Question 58:

A patient using an incentive spirometer every 10 minutes experiences dizziness and tingling. What is the most likely cause of these symptoms?

• A) Hyperventilation
• B) Hypoxemia
• C) Low tidal volume usage
• D) Mucus plugging

Correct Answer: A) Hyperventilation Explanation: Excessive or rapid incentive spirometer use can lead to hyperventilation, lowering CO₂ levels in the blood (hypocapnia), which may cause dizziness or tingling.

Question 59:

A patient receiving Intermittent Positive Pressure Breathing (IPPB) therapy complains of dizziness. What is the most likely cause?

• A) Hyperventilation
• B) Anxiety
• C) Mucus plugging
• D) Improper positioning of the mouthpiece

Correct Answer: A) Hyperventilation Explanation: During IPPB, patients often breathe more deeply/frequently, which can lower CO₂ levels (hypocapnia) and lead to dizziness or lightheadedness.

Question 60:

Which oxygen delivery device is most suitable for a patient who needs supplemental oxygen at home and wants to remain active?

• A) Nasal cannula with stationary concentrator
• B) Portable oxygen concentrator
• C) Non-rebreather mask
• D) Liquid oxygen system

Correct Answer: B) Portable oxygen concentrator Explanation: A portable oxygen concentrator is lightweight, provides a continuous oxygen supply, and grants patients the freedom to move around, making it ideal for an active home setting.

Question 61:

A patient presents with pulmonary edema. What is the most common primary cause?

• A) Left heart failure
• B) Renal artery stenosis
• C) COPD exacerbation
• D) Pulmonary embolism

Correct Answer: A) Left heart failure Explanation: Pulmonary edema commonly results from elevated pulmonary capillary pressure due to left-sided heart failure, causing fluid to accumulate in the lungs.

Question 62:

Which of the following medications is a first-line treatment for tuberculosis (TB)?

• A) Amoxicillin
• B) Azithromycin
• C) Rifampin
• D) Ciprofloxacin

Correct Answer: C) Rifampin Explanation: Rifampin is one of the key drugs in the standard four-drug regimen for active TB, inhibiting bacterial RNA synthesis and effectively targeting Mycobacterium tuberculosis.

Question 63:

A 28-week premature neonate is intubated and requires surfactant administration. Which medication is most appropriate in this scenario?

• A) Calfactant
• B) Albuterol
• C) Racemic Epinephrine
• D) Ipratropium Bromide

Correct Answer: A) Calfactant Explanation: Calfactant is a commonly used surfactant for premature infants at risk for or experiencing respiratory distress syndrome (RDS). It helps reduce alveolar surface tension, improving lung compliance.

Question 64:

What is the approximate FiO₂ delivered by a nasal cannula at a flow rate of 3 liters per minute (L/min)?

• A) 24%
• B) 28%
• C) 32%
• D) 36%

Correct Answer: C) 32% Explanation: Each additional liter of nasal cannula flow adds about 4% FiO₂ above room air (21%). At 3 L/min, the total is around 32%.

Question 65:

A 70-year-old male intubated patient has a measured endotracheal tube (ETT) cuff pressure of 38 cm H₂O. Which action is most appropriate?

• A) Maintain the current cuff pressure
• B) Increase the cuff pressure > 40 cm H₂O
• C) Lower the cuff pressure to < 30 cm H₂O
• D) Deflate the cuff completely

Correct Answer: C) Lower the cuff pressure to < 30 cm H₂O Explanation: Prolonged high cuff pressures (>30 cm H₂O) can injure the tracheal mucosa. The recommended range is usually 20–30 cm H₂O to ensure sealing without vascular compromise.

Question 66:

A patient experiences stridor after extubation. What is the recommended initial treatment?

• A) Heliox (He-O₂ mixture)
• B) Normal Saline Nebulization
• C) Dexamethasone (Steroid)
• D) Racemic Epinephrine (Vasoconstriction)

Correct Answer: D) Racemic Epinephrine (Vasoconstriction) Explanation: Racemic epinephrine helps reduce laryngeal edema through vasoconstriction, rapidly alleviating post-extubation stridor.

Question 67:

During a mass casualty incident, which patient should be given the highest priority for treatment?

• A) A patient with a fractured femur
• B) A patient with heavy bleeding from a large laceration
• C) A patient with a suspected spinal injury
• D) A patient showing tracheal deviation

Correct Answer: D) A patient showing tracheal deviation Explanation: Tracheal deviation is a hallmark of tension pneumothorax, an immediately life-threatening condition requiring urgent decompression.

Question 68:

Which safety feature helps prevent attaching the wrong regulator to an E cylinder?

• A) Pressure relief valve
• B) Pin index system
• C) Color-coding
• D) Cylinder valve

Correct Answer: B) Pin index system Explanation: The pin index system ensures that each regulator can only fit the correct gas-specific cylinder valve, preventing accidental misconnection.

Question 69:

After intubating a patient with suspected COVID-19, you need to send the used stylet to the Central Sterile Services Department (CSSD). Which type of bag should you use for disposal?

• A) Triple yellow bag
• B) Single yellow bag
• C) Single red bag
• D) Triple red bag

Correct Answer: B) Single yellow bag

Explanation: Infection control protocols recommend using a single yellow bag for disposing of infectious or contaminated waste. This ensures proper handling and segregation of biohazard materials to prevent contamination and facilitate safe disposal in compliance with health regulations.

Question 70:

For a patient with Obstructive Sleep Apnea (OSA) receiving noninvasive ventilation, what is the highest recommended Inspiratory Positive Airway Pressure (IPAP)?

• A) 20 cmH₂O
• B) 25 cmH₂O
• C) 30 cmH₂O
• D) 35 cmH₂O

Correct Answer: C) 30 cmH₂O Explanation: IPAP values above 30 cmH₂O may risk barotrauma or decreased tolerance. Typically, 30 cmH₂O is considered the upper safe limit for OSA therapy.