A 8

Question 1:

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) by driving potassium into cells. Potassium chloride supplementation prevents or treats dangerous hypokalemia.

Question 2:

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 finding, which pathophysiologic derangement is most likely?

• 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: A loud P2 is commonly linked to elevated pulmonary artery pressures, as seen in pulmonary arterial hypertension. The pulmonic valve closes more forcefully against high pulmonary pressure.

Question 3:

You are called to the emergency department for urgent airway management of a critically ill patient. To optimize tracheal intubation success while minimizing trauma, which stylet usage approach is most appropriate?

• A. Fully insert stylet, then remove it BEFORE laryngoscopy
• B. Pre-bend the stylet into a hockey-stick shape
• C. Insert stylet so its tip sticks out 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

Question 4:

A COPD patient routinely checks lung function. Which test best detects problems in the small airways?

• A. FEV1/FVC
• B. FEV3
• C. FEV25%–75%
• D. FEV1

Correct Answer: C. FEV25%–75%

Explanation: The mid-expiratory flow rate (FEV25%–75%) is sensitive to small airway changes, often abnormal in early or mild small airway disease.

Question 5:

An 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: Early small airway involvement typically manifests as a reduced FEV25%–75%, while FEV1 and FEV3 may still be normal.

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 effectively cleans and disinfects around a tracheostomy site, helping to remove crusted secretions and reduce infection risk.

Question 7:

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

• A. A quaternary ammonium compound-based disinfectant
• 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 bleach solution is recommended for large blood spills, effectively inactivating pathogens (e.g., hepatitis B, HIV) and meeting CDC/OSHA guidelines.

Question 8:

When placing a blood pressure cuff, where should it be positioned relative to the antecubital fossa?

• 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: Positioning the cuff about 1 inch above the antecubital fossa avoids elbow joint interference and ensures accurate compression of the brachial artery.

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: Verifying coagulation status is crucial to minimize bleeding complications during a bedside tracheostomy procedure.

Question 10:

A 4-year-old child presents to the ED after swallowing a small coin. To best locate 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 distinguishes whether a foreign object is in the esophagus or trachea by offering better spatial detail compared to an AP view.

Question 11:

A 68-year-old woman presents to the ER with shortness of breath and bilateral leg swelling. What is the most likely diagnosis?

• A. Congestive heart failure
• B. Deep vein thrombosis
• C. Pulmonary embolism
• D. COPD

Correct Answer: A. Congestive heart failure

Explanation: Dyspnea with bilateral pedal edema strongly suggests CHF, where ineffective cardiac pumping leads to fluid accumulation in the lungs and peripheral tissues.

Question 12:

A 45-year-old patient admitted to the ICU after a motor vehicle accident exhibits breathing asynchrony. On exam, paradoxical breathing and crepitus on the right chest are noted. 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 chest movement and crepitus typically signify flail chest from multiple rib fractures, destabilizing a portion of the thoracic cage.

Question 13:

In the context of the nitrogen washout test, at what point should the test be stopped?

• A. When the patient reports discomfort
• B. When exhaled nitrogen concentration is <2%
• C. After exactly 10 minutes
• D. When oxygen saturation <90%

Correct Answer: B. When exhaled nitrogen concentration is <2%

Explanation: The nitrogen washout test concludes once exhaled nitrogen drops below 2%, indicating adequate clearance of nitrogen from the lungs.

Question 14:

What needle size is typically used for a femoral arterial blood gas (ABG)?

• A. 27G
• B. 17G
• C. 22G
• D. 26G

Correct Answer: C. 22G

Explanation: A 22-gauge needle is large enough for sufficient blood flow and small enough to reduce arterial trauma during femoral ABG collection.

Question 15:

A respiratory therapist is teaching an intern how to take blood pressure via sphygmomanometer. The RT asks, “What phase represents decreased blood flow after phase 1 while the cuff is inflated?”

• A. Phase 2
• B. Phase 3
• C. Phase 4
• D. Phase 5

Correct Answer: B. Phase 3

Explanation: In Korotkoff sounds, Phase 3 corresponds to reduced arterial flow after Phase 1, reflecting further changes in blood flow under cuff pressure.

Question 16:

When measuring blood pressure using the auscultatory technique, which artery is typically used?

• A. Radial artery
• B. Femoral artery
• C. Brachial artery
• D. Carotid artery

Correct Answer: C. Brachial artery

Explanation: The brachial artery is standard for blood pressure measurement due to its accessibility and reliability in capturing arterial pulsations.

Question 17:

While auscultating a 42-year-old male patient, you hear a harsh, grating sound on both inspiration and expiration. He reports chest pain. Which is the most likely cause?

• A. Bronchoconstriction
• B. Airway secretions
• C. Pleural friction rub
• D. COPD exacerbation

Correct Answer: C. Pleural friction rub

Explanation: A pleural friction rub results from inflamed pleural surfaces rubbing, creating a coarse sound and typically causing pleuritic chest pain.

Question 18:

A 28-year-old male with head trauma is conscious but confused. Which position should be avoided due to the potential for increased intracranial pressure (ICP)?

• A. Semi-Fowler’s
• B. Lateral decubitus
• C. Supine
• D. Trendelenburg

Correct Answer: D. Trendelenburg

Explanation: The Trendelenburg position places the head below the feet, raising ICP in head injury patients and thus should be avoided.

Question 19:

A newborn baby is delivered. Immediately post-birth, a quick assessment is needed to evaluate the baby’s overall health and determine immediate intervention needs.

• A. Apgar score
• B. Neonatal Behavioral Assessment Scale
• C. Neonatal Oral-Motor Assessment Scale
• D. Bayley Scales of Infant Development

Correct Answer: A. Apgar score

Explanation: The Apgar score (Appearance, Pulse, Grimace, Activity, Respiration) is performed at 1 and 5 minutes after birth to quickly assess a newborn’s status and need for urgent care.

Question 20:

A neonate with respiratory distress syndrome (RDS) is on surfactant therapy. The healthcare team is debating an optimal dosing strategy to ensure even lung distribution and minimize side effects.

• A. Single dose
• B. Two divided doses
• C. Three divided doses
• D. Four divided doses

Correct Answer: C. Three divided doses

Explanation: Administering surfactant in three divided doses provides better alveolar distribution and limits complications compared to a single large dose.

Question 21:

A newborn is undergoing percutaneous PaCO2 monitoring via a membrane sensor placed on the chest. Which complication can affect the accuracy of 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 disrupts proper sensor contact, compromising PaCO2 measurements and risking infection.

Question 22:

A 40-year-old man with obstructive sleep apnea (OSA) starts using CPAP therapy. The goal is to improve sleep quality by boosting which sleep stage that OSA commonly disrupts?

• A. NREM
• B. REM
• C. Stage 1
• D. Stage 2

Correct Answer: B. REM

Explanation: OSA commonly fragments REM sleep. CPAP helps keep airways open, restoring normal sleep architecture and REM duration.

Question 23:

During a bronchoscopy, a patient starts coughing severely. What immediate measure reduces coughing so the procedure can continue safely?

• A. Administer a bronchodilator
• B. Increase sedation
• C. Administer topical anesthetic
• D. Withdraw the bronchoscope slightly

Correct Answer: C. Administer topical anesthetic

Explanation: Topical anesthetics reduce airway irritability and cough reflex, facilitating a smoother bronchoscopy.

Question 24:

A patient with chronic asthma seeks long-term control. Which therapy is most effective for symptom control and preventing exacerbations?

• A. Regular use of short-acting beta-agonist
• B. Inhaled corticosteroid
• C. Systemic corticosteroid therapy
• D. Strict avoidance of physical activity

Correct Answer: B. Inhaled corticosteroid

Explanation: Inhaled corticosteroids are the cornerstone of persistent asthma management due to their anti-inflammatory properties.

Question 25:

After multiple failed intubations and a ruptured ETT cuff, resulting in dropping oxygen levels, what is the next best action?

• A. Surgical cricothyrotomy
• B. Blind nasal intubation
• C. Emergency tracheostomy
• D. ETT exchange using an exchanger

Correct Answer: D. ETT exchange using an exchanger

Explanation: Using an airway exchanger allows safe and efficient replacement of the damaged ETT, maintaining ventilation while avoiding further complications.

Question 26:

You are managing a 45-year-old patient with a severe neuromuscular disorder. Which tests are most valuable for guiding respiratory treatment decisions?

• A. Forced Expiratory Volume in 1 second (FEV1)
• B. Maximum Inspiratory Pressure (MIP) and Vital Capacity (VC)
• C. Diffusing Capacity of the Lungs for CO (DLCO)
• D. Peak Expiratory Flow Rate (PEFR)

Correct Answer: B. Maximum Inspiratory Pressure (MIP) and Vital Capacity (VC)

Explanation: MIP and VC assess respiratory muscle strength and lung capacity, essential for neuromuscular disease management.

Question 27:

A patient using a metered-dose inhaler (MDI) for asthma complains of oral thrush. What measure helps prevent this complication?

• A. Rinse the mouth with water after MDI use
• B. Switch to dry powder inhaler
• C. Discontinue the medication
• D. Gargle with antiseptic before MDI use

Correct Answer: A. Rinse the mouth with water after MDI use

Explanation: Rinsing removes residual medication from the oropharynx, reducing fungal overgrowth and thrush.

Question 28:

Parents of a child with cystic fibrosis ask how often PEP therapy should be performed to optimize airway clearance. Which frequency is most appropriate?

• A. 2–3 times/day
• B. 4–6 times/day
• C. 8–10 times/day
• D. 12–14 times/day

Correct Answer: B. 4–6 times/day

Explanation: Performing PEP therapy 4–6 times per day helps mobilize mucus effectively in cystic fibrosis, improving airway clearance.

Question 29:

A 45-year-old patient with a known Mycobacterium infection has a suspicious lung mass on imaging. Which procedure is best for obtaining samples for both microbiological and histological examination?

• A. Tracheal washing
• B. Tracheal brushing
• C. Endotracheal biopsy
• D. Transbronchial biopsy

Correct Answer: D. Transbronchial biopsy

Explanation: Transbronchial biopsy yields tissue samples suitable for microbiological and histopathological tests, aiding accurate diagnosis.

Question 30:

You lead a code team that has intubated a critically ill patient. What is the most immediate method to confirm correct endotracheal tube placement?

• A. Bilateral breath sound auscultation
• B. Qualitative colorimetric end-tidal CO2 detection
• C. Portable AP chest X-ray
• D. Direct laryngoscopic visualization

Correct Answer: B. Qualitative colorimetric end-tidal CO2 detection

Explanation: EtCO2 detectors confirm tracheal placement within seconds by identifying exhaled CO2. A chest X-ray or auscultation follows for final confirmation.

Question 31:

When managing a patient with acute hepatitis B infection in a hospital, which isolation precautions must be followed?

• A. Standard precautions only
• B. Airborne transmission-based precautions
• C. No extra precautions beyond standard hygiene
• D. Contact precautions using PPE

Correct Answer: D. Contact precautions using PPE

Explanation: Acute hepatitis B can be transmitted via blood or body fluids. Contact precautions with appropriate PPE minimize healthcare worker exposure.

Question 32:

According to evidence-based guidelines for infection prevention, which isolation precautions are needed for hospitalized patients with confirmed RSV infection?

• A. Standard precautions only
• B. Airborne precautions
• C. Droplet precautions
• D. Contact precautions

Correct Answer: C. Droplet precautions

Explanation: RSV spreads via large droplets. Droplet precautions (mask, eye protection, cohorting) limit transmission.

Question 33:

When caring for a patient with COPD in the hospital, which measure helps limit the spread of respiratory pathogens?

• A. Negative pressure isolation room
• B. Wearing a surgical mask (standard precaution)
• C. Allowing unrestricted ambulation
• D. Advising the patient to avoid coughing

Correct Answer: B. Wearing a surgical mask (standard precaution)

Explanation: Standard precautions, including a surgical mask, reduce the risk of transmitting respiratory pathogens to and from COPD patients.

Question 34:

Which solution is most appropriate for high-level disinfection of flexible bronchoscopes?

• A. Quaternary ammonium compound
• B. 3% hydrogen peroxide solution
• C. 2% glutaraldehyde solution
• D. 0.5% sodium hypochlorite

Correct Answer: C. 2% glutaraldehyde solution

Explanation: Glutaraldehyde is a high-level disinfectant effective against a broad range of organisms, making it suitable for sensitive equipment like bronchoscopes.

Question 35:

For patients diagnosed with measles, which isolation precautions are required to prevent infection spread?

• A. Standard precautions only
• B. Contact precautions
• C. Droplet precautions
• D. Airborne precautions

Correct Answer: D. Airborne precautions

Explanation: Measles is highly contagious and transmitted via airborne particles, necessitating N95 masks and negative-pressure rooms.

Question 36:

While caring for a patient with varicella (chickenpox), which PPE should healthcare workers wear 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 is airborne and contact-spread; an N95 respirator, gown, and gloves safeguard against inhalation and direct contact with lesions.

Question 37:

What isolation precautions are implemented for a patient with confirmed methicillin-resistant Staphylococcus aureus (MRSA)?

• A. Standard precautions
• B. Airborne precautions
• C. Droplet precautions
• D. Contact precautions

Correct Answer: D. Contact precautions

Explanation: MRSA spreads by direct contact with colonized or infected surfaces; gloves and gowns protect healthcare workers and other patients.

Question 38:

For a patient diagnosed with Clostridioides difficile (C. difficile), which precautions must be observed?

• A. Standard precautions
• B. Airborne precautions
• C. Droplet precautions
• D. Contact precautions with soap-and-water hand hygiene

Correct Answer: D. Contact precautions with soap-and-water hand hygiene

Explanation: C. difficile spores resist alcohol-based sanitizers, requiring thorough hand washing and contact precautions.

Question 39:

You are assessing a 68-year-old ICU patient for weaning from mechanical ventilation. According to guidelines, what is the maximum recommended duration for a spontaneous breathing trial (SBT)?

• A. 30 minutes
• B. 60 minutes
• C. 90 minutes
• D. 120 minutes

Correct Answer: D. 120 minutes

Explanation: SBTs generally should not exceed 120 minutes to prevent fatigue and complications while assessing readiness for extubation.

Question 40:

You plan a spontaneous breathing trial (SBT) for a 54-year-old on mechanical ventilation. According to guidelines, what is the minimum recommended SBT duration?

• A. 15 minutes
• B. 20 minutes
• C. 30 minutes
• D. 45 minutes

Correct Answer: C. 30 minutes

Explanation: A 30-minute minimum allows adequate assessment of the patient’s ability to sustain spontaneous ventilation.

Question 41:

A 42-year-old male ICU patient needs a CVP monitor for accurate hemodynamic measurement. Where must the transducer be placed for reliable readings?

• A. Level of the feet
• B. Patient’s eye level
• C. Aligned with the tip of the nose
• D. Mid-chest level (phlebostatic axis)

Correct Answer: D. Mid-chest level (phlebostatic axis)

Explanation: Aligning with the mid-chest (fourth intercostal space at the mid-axillary line) ensures accurate CVP measurements correlating to right atrial pressure.

Question 42:

A patient with OSA is using CPAP at 12 cmH2O. During exhalation, the pressure drops to 6 cmH2O, even though the mask seal is good. Which action is most appropriate?

• A. Increase CPAP flow rate
• B. Switch from oronasal mask to nasal mask
• C. Raise the CPAP pressure setting
• D. Recommend bilevel positive airway pressure (BiPAP)

Correct Answer: A. Increase CPAP flow rate

Explanation: A drop in pressure on exhalation likely indicates insufficient flow. Increasing flow helps maintain the prescribed pressure throughout the respiratory cycle.

Question 43:

A patient on mechanical ventilation triggers a high-pressure alarm, with increased PIP, decreased tidal volume, and visible breathing effort. What is the most probable cause?

• A. Circuit disconnection
• B. Pneumothorax
• C. Obstruction
• D. Ventilator malfunction

Correct Answer: C. Obstruction

Explanation: Airway obstruction from mucus plugging or a kinked tube raises airway resistance, causing high-pressure alarms and reduced tidal volume.

Question 44:

A respiratory therapist obtains an ABG sample but does not roll the syringe before analysis. Which type of error is this?

• A. Pre-analytical
• B. Post-analytical
• C. Analytical
• D. Peri-analytical

Correct Answer: A. Pre-analytical

Explanation: Failing to mix the sample properly before testing can cause an uneven distribution of gases, distorting ABG results.

Question 45:

A respiratory therapist takes an ABG sample but omits rolling the syringe prior to analysis. What type of error is this?

• A. Pre-analytical
• B. Post-analytical
• C. Analytical
• D. Peri-analytical

Correct Answer: A. Pre-analytical

Explanation: Not mixing an ABG sample is a pre-analytical error, leading to potential inaccuracies in measured CO2, O2, and pH.

Question 46:

A patient with Acute Respiratory Distress Syndrome (ARDS) is on high ventilator settings and shows a PaO2 < 60 mmHg. What is the most suitable next step?

• A. Perform a recruitment maneuver
• B. Increase sedation
• C. Switch to non-invasive ventilation
• D. Administer diuretics

Correct Answer: A. Perform a recruitment maneuver

Explanation: A recruitment maneuver briefly applies higher pressures to reopen collapsed alveoli, improving oxygenation in severely hypoxemic ARDS patients.

Question 47:

A physician receives ABG results over the phone from a respiratory therapist. Miscommunication here exemplifies which error type?

• A. Pre-analytical
• B. Post-analytical
• C. Analytical
• D. Peri-analytical

Correct Answer: B. Post-analytical

Explanation: Post-analytical errors occur during reporting or interpreting test results, such as phone miscommunication.

Question 48:

The physician wonders about potential risks of a recruitment maneuver for a 45-year-old with ARDS. Which is a recognized risk?

• A. Cardiac instability
• B. Elevated infection risk
• C. Pulmonary embolism
• D. Reduced lung compliance

Correct Answer: A. Cardiac instability

Explanation: Recruitment maneuvers may transiently increase intrathoracic pressure, reducing venous return and causing hemodynamic instability.

Question 49:

In a mass casualty scenario, you must triage patients in the ER. Which patient is most urgent?

• A. High pulse
• B. Unequal pupils
• C. Tracheal deviation
• D. Chest wall contusion

Correct Answer: C. Tracheal deviation

Explanation: Tracheal deviation strongly suggests tension pneumothorax—a life-threatening emergency requiring immediate attention.

Question 50:

A sputum culture has been ordered. Which method best ensures a proper sample?

• A. Place a collection trap between suction catheter and vacuum tubing
• B. Connect between suction bottle and suction tubing
• C. Dismiss the sputum culture
• D. Have the patient cough into tissue

Correct Answer: A. Place a collection trap between suction catheter and vacuum tubing

Explanation: This setup effectively collects uncontaminated sputum for accurate microbiological analysis.

Question 51:

A nurse caring for a Guillain-Barré Syndrome patient consults the admitting doctor before providing detailed information to the family. Which ethical principle is demonstrated?

• A. Role fidelity
• B. Professional boundary violation
• C. Conflict of interest
• D. Informed consent

Correct Answer: A. Role fidelity

Explanation: Role fidelity involves recognizing one’s professional limits and ensuring patients or families receive accurate, authoritative information from the appropriate provider.

Question 52:

A patient refuses a prescribed nebulizer treatment despite explanations. You document the refusal. Which ethical principle is upheld here?

• A. Autonomy
• B. Beneficence
• C. Confidentiality
• D. Non-maleficence

Correct Answer: A. Autonomy

Explanation: Autonomy respects the patient’s right to accept or refuse medical treatments, even if refusal may not be in their best interest.

Question 53:

Which safety system is typically used with E cylinders?

• A. Safety system
• B. Pin Index Safety System (PISS)
• C. Diameter Index Safety System (DISS)
• D. Flow Control System

Correct Answer: B. Pin Index Safety System (PISS)

Explanation: PISS ensures gas-specific pin arrangements on E cylinders, preventing incorrect regulator attachment.

Question 54:

During a patient transfer, which flowmeter type is commonly used?

• A. Venturi flowmeter
• B. Bourdon gauge
• C. Rotameter
• D. Oxygen concentrator

Correct Answer: B. Bourdon gauge

Explanation: A Bourdon gauge flowmeter reads pressure and accurately measures flow in any cylinder orientation, ideal for transport.

Question 55:

A patient presents with chronic cough, frequent infections, and foul-smelling sputum, diagnosed as bronchiectasis. Which characteristic finding is associated with bronchiectasis?

• A. Minimal sputum production
• B. Dry cough
• C. Foul-smelling secretions
• D. Decreased breath sounds

Correct Answer: C. Foul-smelling secretions

Explanation: Bronchiectasis causes chronic airway dilation, encouraging mucus stasis and bacterial overgrowth, often producing foul-smelling sputum.

Question 56:

A patient’s interview reveals shortness of breath only when lying flat. What is this condition called?

• A. Hyperpnea
• B. Orthopnea
• C. Dyspnea
• D. Hyperventilation

Correct Answer: B. Orthopnea

Explanation: Orthopnea indicates breathing difficulty in the supine position, commonly associated with heart failure or obesity.

Question 57:

Which position relieves orthopnea?

• A. Supine
• B. Prone
• C. Lateral decubitus
• D. Upright

Correct Answer: D. Upright

Explanation: Sitting upright alleviates orthopnea by reducing diaphragmatic pressure and improving lung expansion.

Question 58:

A pediatric patient with Down syndrome requires daytime oxygen only. Which tracheostomy tube type is suitable?

• A. Cuffed
• B. Uncuffed/fenestrated
• C. Uncuffed/non-fenestrated
• D. Nasal cannula

Correct Answer: B. Uncuffed/fenestrated

Explanation: A fenestrated, uncuffed tracheostomy tube allows spontaneous breathing, phonation, and intermittent oxygen delivery without over-inflation.

Question 59:

A patient on mechanical ventilation has an HME attached at the circuit wye. The dynamic lung compliance rises while static compliance stays the same. What should you do?

• A. Replace the HME
• B. Suction hourly
• C. Initiate chest physiotherapy
• D. Increase tidal volume

Correct Answer: A. Replace the HME

Explanation: Increased dynamic compliance but unchanged static compliance often indicates secretion accumulation or inadequate humidification. Replacing the HME enhances moisture delivery and airway patency.

Question 60:

While using a manual resuscitator (Ambu bag), it collapses during inspiration. Which corrective action is needed?

• A. Decrease flow
• B. Increase flow
• C. Check for mask leaks
• D. Replace the bag

Correct Answer: B. Increase flow

Explanation: A collapsing bag suggests insufficient oxygen flow. Increasing flow ensures the reservoir bag fills adequately between breaths.

Question 61:

The Ambu bag fills and collapses rapidly. What is the probable cause?

• A. O2 inlet valve malfunction
• B. Bag material defect
• C. Excessive patient airway resistance
• D. Mask seal leak

Correct Answer: A. O2 inlet valve malfunction

Explanation: A faulty oxygen inlet valve can cause unregulated flow, leading to rapid fill/collapse of the manual resuscitator.

Question 62:

In polysomnography, sawtooth waveforms typically appear in which sleep stage?

• A. REM sleep
• B. Stage 1
• C. Stage 2
• D. Stage 3

Correct Answer: A. REM sleep

Explanation: Sawtooth waves are an EEG hallmark of REM sleep, reflecting high brain activity similar to wakefulness.

Question 63:

A patient arrived at the ER after a motor vehicle accident with chest trauma. The doctor states subcutaneous emphysema is present. Which sign is likely on examination?

• A. Mucus plugging
• B. Crepitus
• C. Expiratory wheeze
• D. Tactile fremitus

Correct Answer: B. Crepitus

Explanation: Subcutaneous emphysema presents as a crackling (crepitus) sensation under the skin when palpated.

Question 64:

The hospital acquires a large liquid oxygen container as a precaution against shortage. What type of hazard prevention does this represent?

• A. Preparedness
• B. Mitigation
• C. Recovery
• D. Response

Correct Answer: A. Preparedness

Explanation: Having a liquid O2 reserve is a proactive measure (preparedness) to ensure adequate oxygen supply during emergencies.

Question 65:

Which factor can make a capillary blood gas (CBG) sample resemble venous or lymph fluid, creating inaccuracies?

• A. Insufficient site warming
• B. Excessive squeezing of the puncture site
• C. Using a needle that’s too large
• D. Slow sample collection

Correct Answer: B. Excessive squeezing of the puncture site

Explanation: Over-squeezing forces venous/lymph fluid into the sample, distorting actual arterialized capillary values.

Question 66:

After three failed intubation attempts, with successful bag-valve-mask ventilation in between, what is the best next step?

• A. Administer a paralytic and retry
• B. Perform cricothyrotomy
• C. Insert a laryngeal mask airway (LMA)
• D. Continue bag-valve-mask indefinitely

Correct Answer: C. Insert a laryngeal mask airway (LMA)

Explanation: Following multiple failed attempts, placing an LMA is recommended to secure the airway while preparing alternative approaches.

Question 67:

What is the purpose of a combi tube (ETC)?

• A. It helps avoid aspiration and can ventilate one lung in transplants
• B. Used for tracheostomy placement
• C. Used for CPAP therapy
• D. Used for transesophageal echocardiography

Correct Answer: A. It helps avoid aspiration and can ventilate one lung in transplants

Explanation: The combi tube (ETC) is a dual-lumen device, serving as a backup airway that protects against aspiration and can isolate one lung if needed.

Question 68:

A pulse oximeter measures oxygen saturation by which principle?

• A. Ultrasound
• B. Spectrophotometry
• C. Blood pressure sensing
• D. Respiratory rate estimation

Correct Answer: B. Spectrophotometry

Explanation: Pulse oximetry uses light absorption differences between oxyhemoglobin and deoxyhemoglobin to calculate SpO2.

Question 69:

If increasing negative pressure (IPAP/EPAP) raises the Apnea-Hypopnea Index (AHI), what might be the cause?

• A. Decreased airway resistance
• B. Turbulent flow
• C. Improved airway patency
• D. Reduced respiratory effort

Correct Answer: B. Turbulent flow

Explanation: Raising negative pressure can create turbulent airflow, potentially worsening obstructive events and increasing the AHI.

Question 70:

In a neonate intubated with an uncuffed size 3 ETT two months ago, a persistent low ventilator alarm continues despite troubleshooting. The neonate weighs 4 kg. What should be checked first?

• A. Replace the uncuffed ETT with a cuffed size 3.5 ETT
• B. Increase FiO2
• C. Check for ETT displacement or obstruction
• D. Administer a bronchodilator

Correct Answer: C. Check for ETT displacement or obstruction

Explanation: Continuous low-pressure alarms frequently arise from partial tube displacement or blockage. Verifying placement and patency is crucial before changing equipment.

Question 71:

You order spirometry with a reversibility test for an asthmatic patient. What is the purpose?

• A. Oxygen therapy
• B. Assessment and monitoring
• C. Chest X-ray evaluation
• D. Thoracic CT scan

Correct Answer: B. Assessment and monitoring

Explanation: Spirometry with bronchodilator reversibility helps confirm the diagnosis of asthma and evaluate therapy efficacy.

Question 72:

A neonate with a neck fracture is in respiratory distress. Which procedure/tool is appropriate?

• A. Bronchoscope
• B. Neck brace
• C. Laryngoscope
• D. Nasogastric tube

Correct Answer: A. Bronchoscope

Explanation: In cases of suspected cervical spine injury, using a bronchoscope can safely visualize and secure the airway while minimizing neck movement.

Question 73:

Which laryngoscope blade is commonly used for intubating neonates?

• A. Macintosh
• B. Miller
• C. McCoy
• D. King Vision

Correct Answer: B. Miller

Explanation: The Miller (straight) blade is preferred for neonatal intubation, offering better exposure of the anterior airway in infants.

Question 74:

When weaning a patient off Airway Pressure Release Ventilation (APRV), which adjustment is recommended?

• A. Abruptly stop APRV
• B. Decrease P high while increasing T high
• C. Increase respiratory rate and reduce T high
• D. Switch immediately to SIMV

Correct Answer: B. Decrease P high while increasing T high

Explanation: Weaning from APRV involves lowering the high pressure (P high) and lengthening T high, reducing support progressively.

Question 75:

What is the recommended suction time limit when suctioning an endotracheal tube?

• A. 15 seconds
• B. 30 seconds
• C. 1 minute
• D. 2 minutes

Correct Answer: A. 15 seconds

Explanation: Prolonged suctioning (>15 seconds) can cause hypoxia and mucosal injury. Short, effective passes minimize complications.

Question 76:

In a standard intubation attempt, what is the maximum allowed duration per attempt?

• A. 10 seconds
• B. 30 seconds
• C. 2 minutes
• D. 3 minutes

Correct Answer: B. 30 seconds

Explanation: Limiting intubation attempts to 30 seconds helps avoid hypoxemia. If unsuccessful, re-oxygenate before trying again.

Question 77:

A patient’s chest tube setup shows continuous bubbling in the water seal chamber after clamping. What does this indicate?

• A. Normal system function
• B. An air leak (e.g., tension pneumothorax)
• C. Low water level in the chamber
• D. Incorrect chest tube positioning

Correct Answer: B. An air leak (e.g., tension pneumothorax)

Explanation: Continuous bubbling signals air leaking into the pleural space or system, consistent with a pneumothorax or system leak.

Question 78:

Before removing a chest tube, which criterion is essential?

• A. In place for ≥7 days
• B. Afebrile for 48 hours
• C. Drainage <50 ml/24 hours for 24–48 hours
• D. Respiratory rate <20/min

Correct Answer: C. Drainage <50 ml/24 hours for 24–48 hours

Explanation: Minimal chest tube output for 24–48 hours suggests resolution of the pleural process, supporting safe tube removal.

Question 79:

For air drainage in a pneumothorax, where should a chest tube typically be inserted?

• A. 2nd–4th intercostal spaces in the midclavicular line
• B. 4th–6th intercostal spaces in the midclavicular line
• C. 7th–9th intercostal spaces in the midclavicular line
• D. 1st–3rd intercostal spaces in the midclavicular line

Correct Answer: A. 2nd–4th intercostal spaces in the midclavicular line

Explanation: Air in the pleural space accumulates high; thus, a tube placed in the 2nd–4th intercostal spaces at the midclavicular line effectively evacuates it.

Question 80:

For draining fluid in the pleural space, where is chest tube placement most appropriate?

• A. 2nd–4th intercostal spaces
• B. 4th–6th intercostal spaces
• C. 7th–9th intercostal spaces in the midaxillary line
• D. 8th–11th intercostal spaces

Correct Answer: C. 7th–9th intercostal spaces in the midaxillary line

Explanation: Fluid pools in lower pleural areas; thus, placing a chest tube at the 7th–9th intercostal spaces midaxillary line optimizes fluid drainage.

Question 81:

A 65-year-old requires thoracentesis for pleural effusion drainage. Which position is generally used?

• A. Supine
• B. Lateral decubitus
• C. Sitting upright
• D. Prone

Correct Answer: C. Sitting upright

Explanation: Sitting upright facilitates fluid collection at the lung base, providing safe access for thoracentesis and minimizing risk of lung injury.

Question 82:

What chest X-ray sign is characteristic of emphysema?

• A. Consolidation
• B. Narrowed rib spaces
• C. Flattened diaphragms
• D. Elevated hemidiaphragm

Correct Answer: C. Flattened diaphragms

Explanation: Emphysema leads to hyperinflated lungs and a flattened diaphragmatic contour on X-ray.

Question 83:

What is the approximate FiO2 delivered by a nasal cannula at 3 L/min?

• A. 21%
• B. 25%
• C. 32%
• D. 45%

Correct Answer: C. 32%

Explanation: Each liter per minute via nasal cannula adds ~4% FiO2 above room air (21%). At 3 L/min, FiO2 is ~32%.

Question 84:

A postoperative patient develops respiratory distress. Which initial step is most appropriate?

• A. Increase oxygen flow
• B. Call a rapid response
• C. Assess airway patency and breathing
• D. Intubate immediately

Correct Answer: C. Assess airway patency and breathing

Explanation: Always evaluate airway, breathing, and circulation (ABCs) first when encountering respiratory distress.

Question 85:

A patient on mechanical ventilation with high PEEP develops hypotension. What mechanism explains this?

• A. Hypovolemia
• B. Increased intrathoracic pressure
• C. Pulmonary embolism
• D. Pneumothorax

Correct Answer: B. Increased intrathoracic pressure

Explanation: Elevated intrathoracic pressure from high PEEP hampers venous return, reducing cardiac output and causing hypotension.

Question 86:

A mechanically ventilated patient suddenly becomes bradycardic and hypotensive. What immediate step should be taken?

• A. Administer fluids
• B. Increase FiO2
• C. Disconnect the ventilator and bag the patient
• D. Give atropine

Correct Answer: C. Disconnect the ventilator and bag the patient

Explanation: Potentially high intrathoracic pressure or ventilator malfunction can cause bradycardia/hypotension. Manual ventilation relieves pressure and stabilizes the patient.

Question 87:

A COPD patient on 4 L/min nasal cannula develops headache and confusion. What is the most likely cause?

• A. Hypercapnia
• B. Hypoxemia
• C. Hyperoxia
• D. Hypocapnia

Correct Answer: A. Hypercapnia

Explanation: Excessive oxygen administration in COPD can blunt respiratory drive, leading to CO2 retention (hypercapnia) manifested as headache and confusion.

Question 88:

Which oxygen device provides precise O2 concentration for a COPD patient?

• A. Nasal cannula
• B. Simple mask
• C. Non-rebreather mask
• D. Venturi mask

Correct Answer: D. Venturi mask

Explanation: A Venturi mask delivers exact FiO2 via controlled air entrainment, critical for COPD patients to avoid excessive oxygen.

Question 89:

A patient on mechanical ventilation has a PaCO2 of 55 mmHg. Which ventilator change helps lower PaCO2?

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

Correct Answer: A. Increase tidal volume

Explanation: Increasing tidal volume enhances alveolar ventilation, removing more CO2 and lowering PaCO2.

Question 90:

A patient on pressure control ventilation develops high peak airway pressures. Which is most likely?

• A. Cuff leak
• B. Bronchospasm
• C. Hypovolemia
• D. Metabolic alkalosis

Correct Answer: B. Bronchospasm

Explanation: High peak pressures often stem from increased airway resistance, e.g., bronchospasm, secretions, or tube kinks.

Question 91:

A patient on a non-rebreather mask at 15 L/min continues to desaturate. What is the next most appropriate step?

• A. Increase flow rate further
• B. Switch to BiPAP
• C. Intubate
• D. Decrease FiO2

Correct Answer: B. Switch to BiPAP

Explanation: When a patient remains hypoxemic on maximum-flow NRB, transitioning to noninvasive positive-pressure ventilation (BiPAP) helps improve oxygenation and ventilation.

Question 92:

A patient is being weaned from mechanical ventilation, and an SBT is underway. Which measure best indicates readiness for extubation?

• A. PaCO2 of 60 mmHg
• B. Tidal volume 4 mL/kg
• C. Negative inspiratory force (NIF) of -25 cmH2O
• D. Respiratory rate of 35 breaths/min

Correct Answer: C. Negative inspiratory force (NIF) of -25 cmH2O

Explanation: An NIF of at least -20 cmH2O (more negative = better) suggests adequate respiratory muscle strength for extubation.

Question 93:

A patient with ARDS is on mechanical ventilation. Which strategy minimizes ventilator-induced lung injury (VILI)?

• A. High tidal volumes (8–10 mL/kg)
• B. Low tidal volumes (4–6 mL/kg)
• C. High PEEP plus high FiO2
• D. Low PEEP plus low FiO2

Correct Answer: B. Low tidal volumes (4–6 mL/kg)

Explanation: Using low tidal volumes (4–6 mL/kg IBW) prevents overdistension of alveoli in ARDS, reducing barotrauma risk.

Question 94:

Which ventilator mode is most appropriate for a patient requiring full ventilatory support?

• A. SIMV
• B. CPAP
• C. Pressure Support Ventilation (PSV)
• D. Assist-Control (AC) ventilation

Correct Answer: D. Assist-Control (AC) ventilation

Explanation: AC ventilation provides full support for each breath, whether triggered by the patient or the ventilator, making it suitable for those who cannot sustain spontaneous ventilation.