A 9

Question 1:

In a patient with traumatic brain injury, which of the following is a common physiological response that can help reduce intracranial pressure?

• A. Bradycardia
• B. Hyperventilation
• C. Hypotension
• D. Hyperglycemia

Correct Answer: B. Hyperventilation

Explanation: Hyperventilation helps reduce ICP by decreasing blood CO2 levels, causing cerebral vasoconstriction, and reducing cerebral blood volume.

Question 2:

In a patient with acute respiratory distress syndrome (ARDS) receiving neuromuscular blockade and mechanical ventilation, which of the following parameters would be most appropriate to monitor for potential complications?

• A. End-tidal CO2
• B. Plateau pressure
• C. Minute ventilation
• D. Rapid shallow breathing index

Correct Answer: B. Plateau pressure

Explanation: Plateau pressure monitoring helps prevent barotrauma and indicates alveolar pressure, which should stay below 30 cmH2O.

Question 3:

A patient with acute respiratory distress syndrome (ARDS) is receiving lung-protective ventilation with a tidal volume of 6 mL/kg and a PEEP of 10 cmH2O. The patient’s oxygen saturation remains below 90% despite an FiO2 of 1.0. Which intervention would be most appropriate?

• A. Increase the PEEP to 15 cmH2O
• B. Increase the tidal volume to 8 mL/kg
• C. Initiate prone positioning
• D. Increase the respiratory rate

Correct Answer: C. Initiate prone positioning

Explanation: Prone positioning improves ventilation-perfusion matching, promotes alveolar recruitment, and reduces mortality in severe ARDS.

Question 4:

A patient with severe acute respiratory distress syndrome (ARDS) is receiving veno-venous extracorporeal membrane oxygenation (ECMO) support. Which of the following ventilator settings would be most appropriate for lung-protective ventilation during ECMO?

• A. High tidal volumes and low PEEP
• B. Low tidal volumes and high PEEP
• C. High respiratory rates and high FiO2
• D. Pressure control ventilation with auto-PEEP

Correct Answer: B. Low tidal volumes and high PEEP

Explanation: Low tidal volumes and high PEEP promote lung rest, minimize ventilator-induced injury, and allow lung healing.

Question 5:

A patient with severe acute respiratory distress syndrome (ARDS) is receiving neuromuscular blockade and lung-protective ventilation. Despite optimized ventilator settings, the patient’s oxygenation remains poor. Which intervention would be most appropriate?

• A. Increase the PEEP
• B. Initiate prone positioning
• C. Initiate inhaled nitric oxide therapy
• D. Initiate high-frequency oscillatory ventilation

Correct Answer: B. Initiate prone positioning

Explanation: Prone positioning improves oxygenation, redistributes ventilation, and promotes alveolar recruitment.

Question 6:

To continuously monitor the adequacy of ventilation of a patient in ICU being supported by mask BiPAP, would you recommend which of the following?

• A. Arterial blood gasses (ABGs)
• B. Pulse oximetry
• C. End-tidal CO2 monitoring
• D. Chest X-ray

Correct Answer: C. End-tidal CO2 monitoring

Explanation: End-tidal CO2 monitoring provides continuous, non-invasive, real-time assessment of ventilation adequacy.

Question 7:

For testing purposes, you instruct a patient to take a deep breath and then exhale as quickly as possible. You then observe the recording of the fastest air movement. Which of the following tests is being measured?

• A. Forced expiratory volume in one second (FEV1)
• B. Peak expiratory flow rate (PEFR)
• C. Vital capacity (VC)
• D. Maximum voluntary ventilation (MVV)

Correct Answer: B. Peak expiratory flow rate (PEFR)

Explanation: Peak expiratory flow rate (PEFR) measures the highest speed of expiration after a maximal inhalation, commonly used in asthma management.

Question 8:

While at the bedside of a patient receiving volume control ventilation, you suddenly notice the simultaneous sounding of the high pressure and low volume alarms. Which of the following is the most likely cause of this problem?

• A. Equipment malfunction
• B. Patient-ventilator asynchrony
• C. Tubing disconnection
• D. Mucous plug in the ET tube

Correct Answer: D. Mucous plug in the ET tube

Explanation: Simultaneous high pressure and low volume alarms typically indicate an airway obstruction, such as a mucous plug in the endotracheal (ET) tube.

Question 9:

While feeling a patient’s radial pulse, you note that the pulse feels bounding and full. Which of the following conditions would likely be the cause of this finding?

• A. Dehydration
• B. Heart failure
• C. Hypovolemia
• D. Hypertension

Correct Answer: D. Hypertension

Explanation: A bounding and full pulse can be associated with hypertension, which increases arterial pressure and causes the pulse to feel stronger.

Question 10:

The physician calls you over to examine the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. Currently, the patient has a tidal volume of 400 mL, rate of 10/min, and 35% O2. Her blood gas results are as follows:
pH 7.31, PaCO2 49 torr, HCO3 24 mEq/L, BE -2 mEq/L, PaO2 74 torr, SaO2 95%. Based on these values, which of the following changes is appropriate?

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

Correct Answer: B. Increase the respiratory rate

Explanation: The patient’s ABG results indicate respiratory acidosis (low pH and high PaCO2). Increasing the respiratory rate will help to lower the PaCO2 by increasing the minute ventilation.

Question 11:

A patient in the intensive care unit suddenly starts to deteriorate. The attending physician wants to rule out an acute pulmonary embolism as the cause. Which of the following laboratory tests would you recommend?

• A. D-dimer test
• B. Complete blood count (CBC)
• C. Arterial blood gases (ABGs)
• D. B-type natriuretic peptide (BNP)

Correct Answer: A. D-dimer test

Explanation: A D-dimer test helps rule out pulmonary embolism by detecting elevated levels of thrombus-related markers.

Question 12:

A patient is being mechanically ventilated in the volume-controlled assist-control (A/C) mode. If the set tidal volume delivery reaches the preset inspiratory time limit, what will happen?

• A. The ventilator will cycle into the expiratory phase, delivering a lower tidal volume
• B. The ventilator will continue to deliver the set tidal volume, increasing the inspiratory time
• C. The ventilator will alarm and switch to a pressure-controlled mode
• D. The ventilator will deliver a higher peak inspiratory pressure to achieve the set tidal volume

Correct Answer: A. The ventilator will cycle into the expiratory phase, delivering a lower tidal volume

Explanation: If the inspiratory time limit is reached, the ventilator cycles into expiration to prevent excessive pressure buildup, resulting in a lower tidal volume.

Question 13:

Which of the following findings would you expect in a patient with COPD and chronic hypoxemia?

• A. Elevated hemoglobin and hematocrit levels (secondary polycythemia)
• B. Normal arterial blood gas values
• C. Prescription for long-term oxygen therapy
• D. History of frequent hospitalizations for respiratory failure

Correct Answer: A. Elevated hemoglobin and hematocrit levels (secondary polycythemia)

Explanation: Chronic hypoxia in COPD stimulates the production of red blood cells, leading to elevated hemoglobin and hematocrit levels (secondary polycythemia).

Question 14:

Which Pulmonary Function Test (PFT) finding is common in both chronic bronchitis and emphysema?

• A. Decreased FEV1/FVC ratio
• B. Increased Total Lung Capacity (TLC)
• C. Decreased Diffusing Capacity for Carbon Monoxide (DLCO)
• D. Increased FEV1

Correct Answer: A. Decreased FEV1/FVC ratio

Explanation: Both chronic bronchitis and emphysema are obstructive lung diseases, which reduce the FEV1/FVC ratio.

Question 15:

A patient with COPD shows >12% reversibility after a bronchodilator. Which long-acting beta-agonist (LABA) would you recommend for home treatment?

• A. Brovana
• B. Albuterol
• C. Levalbuterol
• D. Survatna

Correct Answer: A. Brovana

Explanation: Brovana (arformoterol) is a long-acting beta-agonist (LABA), suitable for long-term maintenance in COPD. Albuterol and Levalbuterol are short-acting agents.

Question 16:

A 45-year-old male patient was admitted to the hospital with a traumatic pneumothorax and had a chest tube inserted. During your shift, you notice continuous bubbling in the water seal chamber of the chest tube drainage system. What does this continuous bubbling most likely indicate?

• A. The chest tube is functioning normally.
• B. There is an air leak in the system.
• C. The patient has developed a pleural effusion.
• D. The patient has a persistent pneumothorax.

Correct Answer: B

B. There is an air leak in the system.

Explanation:

Question 17:

During the use of an arterial blood gas (ABG) machine, you notice blood drops on the machine. What should you use to clean the blood drops?

• A. Alcohol wipes
• B. Dry cloth
• C. Soap and water
• D. Bleach solution

Correct Answer: D. Bleach solution

Explanation: Bleach solution (sodium hypochlorite) is recommended for cleaning blood spills because it has broad-spectrum antimicrobial activity and can effectively inactivate pathogens, including HIV and Hepatitis B and C. The CDC recommends a 1:10 dilution of bleach for such tasks.

Question 18:

In infection control, for how many seconds should you clean your hands?

• A. 10 seconds
• B. 20 seconds
• C. 30 seconds
• D. 40 seconds

Correct Answer: B. 20 seconds

Explanation: The CDC and WHO recommend washing hands for at least 20 seconds to effectively remove germs and prevent the spread of infection in healthcare settings.

Question 19:

A patient in the intensive care unit has been successfully extubated following a surgical procedure. However, after approximately 30 minutes, the patient starts experiencing stridor and difficulty in breathing. You suspect the development of post-extubation laryngeal edema. Which of the following medications should you consider using as a first-line treatment?

• A. Racemic epinephrine via nebulizer
• B. Intravenous corticosteroids (e.g., dexamethasone)
• C. Nebulized budesonide
• D. Heliox therapy

Correct Answer: A. Racemic epinephrine via nebulizer

Explanation: Racemic epinephrine via nebulizer is the first-line treatment for post-extubation laryngeal edema. It provides immediate relief by reducing airway swelling and improving airflow.

Question 20:

Which mode is time-cycled, volume-targeted, and provides breathing with minimal ventilatory support?

• A. Assist-Control (AC)
• B. Synchronized Intermittent Mandatory Ventilation (SIMV)
• C. Continuous Positive Airway Pressure (CPAP)
• D. Pressure-Regulated Volume Control (PRVC)

Correct Answer: D. Pressure-Regulated Volume Control (PRVC)

Explanation: PRVC delivers a preset tidal volume (volume-targeted) within a specific time (time-cycled) while adjusting the pressure to achieve that volume. This mode provides minimal ventilatory support by maintaining a consistent volume with variable pressure adjustments.

Question 21:

A patient presents with acute pulmonary edema and requires continuous positive airway pressure (CPAP) therapy. The healthcare team needs to determine the initial CPAP setting to start the patient on. What should the initial setting be?

• A. 3 to 5 cm H2O
• B. 5 to 7 cm H2O
• C. 10 to 12 cm H2O
• D. 15 to 20 cm H2O

Correct Answer: C. 10 to 12 cm H2O

Explanation: The initial CPAP setting for a patient with acute cardiogenic pulmonary edema should be 10 to 12 cm H2O. This setting helps to improve oxygenation and reduce the work of breathing by providing enough positive pressure to keep the airways open and reduce fluid accumulation in the lungs.

Question 22:

A patient with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen at 2 L/min via nasal cannula. The patient’s oxygen saturation is 88%. Which of the following actions would you take next?

• A. Increase the oxygen flow rate to 3 L/min
• B. Switch to a non-rebreather mask
• C. Perform an arterial blood gas (ABG) analysis
• D. Encourage the patient to breathe deeper

Correct Answer: C. Perform an arterial blood gas (ABG) analysis

Explanation: ABG analysis is necessary to assess oxygen and CO2 levels before adjusting oxygen therapy, especially in COPD patients to avoid suppressing respiratory drive.

Question 23:

An asthmatic patient is struggling to initiate inspiration on a ventilator operating in the assist-control mode. Which of the following ventilator settings would you first check in order to resolve this problem?

• A. Inspiratory flow rate
• B. Positive end-expiratory pressure (PEEP)
• C. Trigger sensitivity
• D. Fractional inspired oxygen (FiO2)

Correct Answer: C. Trigger sensitivity

Explanation: Adjusting trigger sensitivity is key to reducing the effort required by the patient to initiate a breath on the ventilator.

Question 24:

You need to determine the accuracy of a water-sealed spirometer in measuring lung volumes. Which of the following tools or methods would you use?

• A. Calibrated high-flow flowmeter
• B. Computer-generated flow patterns
• C. Calibrated 3-L syringe
• D. Standard subject with known volumes

Correct Answer: C. Calibrated 3-L syringe

Explanation: A calibrated 3-L syringe is the standard tool used to check the accuracy of spirometers by providing a known volume.

Question 25:

A male patient has a lower than normal mixed venous O2 content. Which of the following is the most likely cause of this condition?

• A. Increased oxygen consumption
• B. Decreased cardiac output
• C. Increased hemoglobin level
• D. Increased pulmonary blood flow

Correct Answer: B. Decreased cardiac output

Explanation: Decreased cardiac output leads to reduced oxygen delivery to tissues, resulting in lower mixed venous oxygen content.

Question 26:

You are trying to wean an alert intubated patient off full ventilatory support using the CPAP protocol with 40% O2. Early in the initial effort her respiratory rate increases from 24 to 30/min and you start to observe some use of her accessory muscles while breathing. Which of the following would be your first action at this time?

• A. Increase the CPAP level
• B. Decrease the FiO2
• C. Return to full ventilatory support
• D. Administer a bronchodilator

Correct Answer: C. Return to full ventilatory support

Explanation: Signs of respiratory distress during weaning indicate the need to return to full ventilatory support to prevent further deterioration.

Question 27:

While using a Yankauer device to suction an adult patient, you are unable to remove thick secretions. The regulator attached to the oropharyngeal suctioning device displays a reading of -70 mm Hg. Which of the following actions should you take at this time?

• A. Increase the suction pressure
• B. Decrease the suction pressure
• C. Use a larger-bore suction catheter
• D. Consider instilling normal saline

Correct Answer: A. Increase the suction pressure

Explanation: A suction pressure of -70 mm Hg is too low; increasing it to the recommended range of -100 to -120 mm Hg is necessary for effective suctioning.

Question 28:

While setting up a 12-lead EKG on a patient, you are unable to obtain any electrical signal. The batteries are fully charged and the device was able to power on. The most likely cause of this problem is which of the following?

• A. Loose lead wire connections
• B. Incorrect lead placement
• C. Interference from nearby electrical devices
• D. Patient has no cardiac electrical activity

Correct Answer: A. Loose lead wire connections

Explanation: Loose lead wire connections are the most common cause of an absent signal in a functioning EKG machine.

Question 29:

While monitoring a patient during a spontaneous breathing trial, which of the following observations would cause you to stop the trial and return the patient to ventilatory support?

• A. Respiratory rate of 28 breaths per minute
• B. Heart rate of 110 beats per minute
• C. Use of accessory muscles
• D. Arterial oxygen saturation of 92%

Correct Answer: C. Use of accessory muscles

Explanation: The use of accessory muscles indicates respiratory distress or fatigue, suggesting that the patient is unable to tolerate spontaneous breathing and should be returned to ventilatory support.

Question 30:

A physician orders a blind bronchoalveolar lavage procedure for a patient in the intensive care unit. What is the most likely potential diagnosis that the doctor is trying to confirm with this procedure?

• A. Pneumonia
• B. Pulmonary embolism
• C. Lung cancer
• D. Asthma

Correct Answer: A. Pneumonia

Explanation: A bronchoalveolar lavage (BAL) is commonly used to diagnose pneumonia by identifying pathogens in the lower respiratory tract, especially in critically ill patients.

Question 31:

An AP X-ray of a 4-year-old child with wheezing and stridor shows an area of prominent subglottic edema, but the lateral neck X-ray appears normal. The most likely problem is?

• A. Epiglottitis
• B. Croup
• C. Foreign body aspiration
• D. Bacterial tracheitis

Correct Answer: B. Croup

Explanation: Croup is characterized by subglottic edema, which is a hallmark finding in young children presenting with stridor and a barking cough.

Question 32:

While reviewing the chest X-ray of a 30-year-old male receiving ventilatory support via an oral endotracheal tube, to assure proper placement of the tube, you would look for its tip to be positioned:

• A. At the carina
• B. In the right mainstem bronchus
• C. 2-3 cm above the carina
• D. In the left mainstem bronchus

Correct Answer: C. 2-3 cm above the carina

Explanation: The ideal placement for the endotracheal tube tip is 2-3 cm above the carina to ensure both lungs are ventilated properly and to prevent complications like intubation into the right mainstem bronchus or accidental extubation.

Question 33:

When performing lung recruitment maneuvers on a patient with acute respiratory distress syndrome (ARDS), which of the following parameters should be closely monitored?

• A. End-tidal CO2
• B. Peak inspiratory pressure
• C. Minute ventilation
• D. Functional residual capacity

Correct Answer: B. Peak inspiratory pressure

Explanation: During lung recruitment maneuvers, monitoring peak inspiratory pressure is critical to avoid exceeding safe limits, as high pressures can lead to barotrauma or hemodynamic compromise.

Question 34:

A patient is being treated for a pulmonary embolism with intravenous heparin. Which of the following lab values would indicate an increased risk of bleeding complications?

• A. Increased prothrombin time (PT)
• B. Decreased activated partial thromboplastin time (aPTT)
• C. Elevated platelet count
• D. Low fibrinogen level

Correct Answer: A. Increased prothrombin time (PT)

Explanation: Heparin prolongs the aPTT, but an increased PT suggests an issue with clotting factors and an increased risk of bleeding, which could indicate excessive anticoagulation or an underlying clotting disorder.

Question 35:

Which of the following techniques is recommended for optimizing lung compliance and reducing atelectasis in a ventilated patient?

• A. Positive end-expiratory pressure (PEEP)
• B. High inspiratory flow rates
• C. Low tidal volumes
• D. Increased respiratory rate

Correct Answer: A. Positive end-expiratory pressure (PEEP)

Explanation: PEEP helps keep alveoli open at the end of expiration, improving lung compliance and reducing atelectasis. The other options do not directly help with lung compliance or atelectasis prevention.

Question 36:

A patient with severe emphysema is receiving supplemental oxygen via nasal cannula at 4 liters per minute. Which of the following findings would be of most concern?

• A. PaCO2 of 70 mmHg
• B. PaO2 of 65 mmHg
• C. pH of 7.32
• D. HCO3- of 28 mEq/L

Correct Answer: A. PaCO2 of 70 mmHg

Explanation: In severe emphysema, a PaCO2 of 70 mmHg indicates significant CO2 retention and worsening respiratory failure, which is a major concern. Increased supplemental oxygen can impair the patient’s ability to ventilate effectively, leading to respiratory acidosis.

Question 37:

In a patient with acute respiratory failure, which of the following arterial blood gas findings would indicate the need for mechanical ventilation?

• A. pH 7.40, PaCO2 35 mmHg, PaO2 70 mmHg
• B. pH 7.32, PaCO2 60 mmHg, PaO2 55 mmHg
• C. pH 7.45, PaCO2 30 mmHg, PaO2 80 mmHg
• D. pH 7.38, PaCO2 45 mmHg, PaO2 65 mmHg

Correct Answer: B. pH 7.32, PaCO2 60 mmHg, PaO2 55 mmHg

Explanation: The combination of respiratory acidosis (pH 7.32), hypercapnia (PaCO2 60 mmHg), and hypoxemia (PaO2 55 mmHg) indicates respiratory failure, which typically requires mechanical ventilation.

Question 38:

During a spontaneous breathing trial, a patient’s rapid shallow breathing index (RSBI) is calculated to be 120 breaths/min/L. Which of the following actions would be most appropriate?

• A. Proceed with extubation
• B. Reinstitute full ventilatory support
• C. Increase supplemental oxygen
• D. Change to a different weaning mode

Correct Answer: B. Reinstitute full ventilatory support

Explanation: An RSBI greater than 105 suggests the patient is at high risk for weaning failure. The appropriate action is to reinstitute full ventilatory support rather than proceeding with extubation or adjusting oxygen.

Question 39:

A patient with chronic obstructive pulmonary disease (COPD) is admitted with an acute exacerbation. Which of the following findings would suggest the presence of cor pulmonale?

• A. Elevated jugular venous pressure
• B. Presence of wheezing on auscultation
• C. Hypoxemia with PaO2 of 55 mmHg
• D. Hyperinflated lung fields on chest X-ray

Correct Answer: A. Elevated jugular venous pressure

Explanation: Cor pulmonale is right-sided heart failure secondary to chronic lung disease and pulmonary hypertension. Elevated jugular venous pressure is a key sign of right-sided heart strain.

Question 40:

Which of the following is the most appropriate method for confirming the proper placement of a small-bore feeding tube in an intubated patient?

• A. Auscultation of air insufflation
• B. Aspiration of gastric contents
• C. Chest X-ray
• D. Measurement of pH of aspirated fluid

Correct Answer: C. Chest X-ray

Explanation: The most reliable method to confirm the placement of a feeding tube is a chest X-ray. It provides visual confirmation that the tube is correctly positioned in the stomach or small intestine.

Question 41:

A patient with a history of asthma is admitted to the intensive care unit with an acute asthma exacerbation. Which of the following findings would be most indicative of impending respiratory failure?

• A. Tachypnea and use of accessory muscles
• B. Wheezing on auscultation
• C. PaCO2 of 45 mmHg
• D. Peak expiratory flow rate of 200 L/min

Correct Answer: A. Tachypnea and use of accessory muscles

Explanation: Tachypnea and the use of accessory muscles indicate increased work of breathing and impending respiratory failure. These findings suggest respiratory muscle fatigue.

Question 42:

When managing a patient with permissive hypercapnia during mechanical ventilation, which of the following would be an appropriate target arterial pH range?

• A. 7.35 – 7.45
• B. 7.20 – 7.30
• C. 7.45 – 7.55
• D. 7.10 – 7.20

Correct Answer: B. 7.20 – 7.30

Explanation: Permissive hypercapnia allows higher levels of CO2 to avoid lung injury from high ventilator pressures. The target arterial pH range balances minimizing acidemia while avoiding ventilator-induced lung damage.

Question 43:

A 65-year-old patient receives midazolam for sedation during a minor surgical procedure. After the procedure, the patient exhibits prolonged sedation. Which of the following antidotes should be administered to reverse the sedative effects of midazolam?

• A. Naloxone
• B. Protamine sulfate
• C. Flumazenil
• D. Vitamin K

Correct Answer: C. Flumazenil

Explanation: Flumazenil is the specific antidote for benzodiazepines like midazolam, acting by antagonizing their sedative effects.

Question 44:

Prostacyclin (prostaglandin I2) is primarily indicated for the treatment of which of the following conditions?

• A. Bronchial asthma
• B. Acute respiratory distress syndrome (ARDS)
• C. Pulmonary hypertension
• D. Interstitial lung disease

Correct Answer: C. Pulmonary hypertension

Explanation: Prostacyclin is most commonly used to treat pulmonary hypertension by dilating pulmonary arteries, reducing pressure in the lungs, and enhancing heart function.

Question 45:

A patient has an FVC (Forced Vital Capacity) of 76% and an FEV1 (Forced Expiratory Volume in 1 second) of 53%. Based on these values, the recommended treatment would be:

• A. Bronchodilators and pulmonary rehabilitation
• B. Corticosteroids and supplemental oxygen therapy
• C. Pulmonary rehabilitation and supplemental oxygen therapy
• D. Bronchodilators and corticosteroids

Correct Answer: A. Bronchodilators and pulmonary rehabilitation

Explanation: Bronchodilators improve airflow obstruction (low FEV1), while pulmonary rehabilitation helps enhance breathing capacity and quality of life.

Question 46:

You are an RT in a delivery room unit. The doctor calls you to assess Mr. Johnson, who recently had abdominal surgery. You need to educate him on using an incentive spirometer (IS) for pulmonary rehabilitation. When instructing Mr. Johnson on the proper technique for using the IS, which of the following should you emphasize?

• A. Take shallow, rapid breaths
• B. Inhale through mouth, exhale through nose
• C. Maintain a slow, deep inhalation to raise the indicator
• D. Use the IS only once daily

Correct Answer: C. Maintain a slow, deep inhalation to raise the indicator

Explanation: A slow, deep inhalation ensures full lung expansion and helps prevent postoperative complications like atelectasis.

Question 47:

During the assessment of a 60-year-old female patient, you note the following signs: dyspnea, hypotension, reduced chest expansion on the left side, hyperresonant percussion note and tactile fremitus on the left side, absent breath sounds on the left side, and a tracheal shift to the right. These findings suggest which of the following?

• A. Pleural effusion on the left side
• B. Pulmonary embolism
• C. A pneumothorax on the left side
• D. Left-sided pneumonia

Correct Answer: C. A pneumothorax on the left side

Explanation: The presence of hyperresonant percussion, absent breath sounds, and a tracheal shift suggests air in the pleural space, which is consistent with a pneumothorax.

Question 48:

A 72-year-old male patient with a history of COPD is receiving home oxygen therapy. Which of the following actions should be recommended to ensure safety?

• A. Avoid smoking near the oxygen tank
• B. Keep the oxygen tank in a horizontal position
• C. Store the oxygen tank in a closed cabinet
• D. Use any type of lubricants on oxygen connections

Correct Answer: A. Avoid smoking near the oxygen tank

Explanation: Smoking or having open flames near oxygen increases the risk of fire or explosion due to the highly flammable nature of oxygen.

Question 49:

A patient with Guillain-Barré syndrome is hospitalized for monitoring and management. Which of the following pulmonary function tests is most critical to monitor in this patient?

• A. Vital capacity (VC)
• B. Total lung capacity (TLC)
• C. Diffusing capacity (DLCO)
• D. Functional residual capacity (FRC)

Correct Answer: A. Vital capacity (VC)

Explanation: Monitoring vital capacity is crucial in patients with Guillain-Barré syndrome to detect early respiratory muscle weakness and prevent respiratory failure.

Question 50:

A patient presents with acute chest pain and shortness of breath. A spiral CT scan of the chest confirms a pulmonary embolism. Which medication is typically initiated as the first-line treatment?

• A. Aspirin
• B. Clopidogrel
• C. Heparin
• D. Warfarin

Correct Answer: C. Heparin

Explanation: Heparin is the first-line anticoagulant used to treat pulmonary embolism by preventing further clot formation and allowing the body’s natural fibrinolytic processes to resolve the existing clot.

Question 51:

A patient is receiving mechanical ventilation. During a routine check, you notice the high-pressure alarm sounding and the patient’s tidal volume is decreasing. What is the most likely cause?

• A. Obstruction in the airway (e.g., mucous plug)
• B. Disconnection of the ventilator circuit
• C. Decreased patient compliance
• D. Leak in the ventilator circuit

Correct Answer: A. Obstruction in the airway (e.g., mucous plug)

Explanation: High-pressure alarms often indicate increased resistance or decreased compliance, commonly caused by airway obstruction such as a mucous plug.

Question 52:

How would you best explain using an MDI (Metered Dose Inhaler) to a 14-year-old?

• A. Shake, breathe out all the way, lips on mouthpiece, press and breathe in slow and deep, hold breath for 10 seconds, breathe out slowly.
• B. Forceful breath in, press and inhale quickly, breathe out immediately.
• C. Breathe out all the way, lips on mouthpiece, press while exhaling slowly, hold breath for 10 seconds, breathe in slowly.
• D. Shake, forceful breath in, press while exhaling, breathe out slowly.

Correct Answer: A. Shake, breathe out all the way, lips on mouthpiece, press and breathe in slow and deep, hold breath for 10 seconds, breathe out slowly.

Explanation: Option A provides the correct technique for using an MDI, ensuring that the medication reaches the lungs effectively and is properly absorbed.

Question 53:

If a patient has a pneumothorax with a 25% involvement, what is the appropriate course of action or management?

• A. Observation and monitoring
• B. Needle aspiration or chest tube insertion
• C. Administration of bronchodilators
• D. Initiation of antibiotic therapy

Correct Answer: B. Needle aspiration or chest tube insertion

Explanation: A 25% pneumothorax often requires intervention, such as needle aspiration or chest tube insertion, to remove the air from the pleural space, allowing the lung to re-expand.

Question 54:

In a patient’s vital sign assessment, all measurements are recorded except for the blood pressure, which is unreadable. What should be done in this situation?

• A. Repeat the blood pressure measurement using a different cuff size or technique
• B. Estimate the blood pressure based on the pulse rate and other vital signs
• C. Document the blood pressure as unreadable and inform the healthcare provider
• D. Disregard the blood pressure measurement and focus on other vital signs

Correct Answer: A. Repeat the blood pressure measurement using a different cuff size or technique

Explanation: Ensuring accurate blood pressure readings by adjusting the cuff size or technique is critical. Estimating or disregarding the measurement could lead to mismanagement.

Question 55:

You are a medical resident in the cardiology unit managing a patient with hypertension. The patient requires inotropic support. Which of the following medication classes is commonly used in combination with inotropes for the management of hypertension?

• A. ACE inhibitors
• B. Beta-blockers
• C. Calcium channel blockers
• D. Diuretics

Correct Answer: B. Beta-blockers

Explanation: Beta-blockers are often used with inotropes to manage heart rate and contractility, minimizing the risk of blood pressure spikes caused by inotropic agents.

Question 56:

The drug Dornase alfa (Mucomyst) is primarily indicated for the management of which condition?

• A. Asthma
• B. Chronic obstructive pulmonary disease (COPD)
• C. Cystic fibrosis
• D. Pulmonary embolism

Correct Answer: C. Cystic fibrosis

Explanation: Dornase alfa is a mucolytic agent used primarily in cystic fibrosis to break down thick mucus in the lungs, improving lung function and reducing infections.

Question 57:

You’re assessing patients for readiness to wean from mechanical ventilation. Which of the following patients is most suitable for weaning based on their respiratory rate (RR) and tidal volume (Vt)?

• A. RR: 15, Vt: 500 mL
• B. RR: 30, Vt: 250 mL
• C. RR: 25, Vt: 200 mL
• D. RR: 20, Vt: 300 mL

Correct Answer: A. RR: 15, Vt: 500 mL

Explanation: Patient A has a low Rapid Shallow Breathing Index (RSBI), calculated as RR/Vt. An RSBI under 105 is typically considered favorable for weaning from mechanical ventilation.

Question 58:

Which of the following statements is correct regarding the relative sizes of a cell and an organism?

• A. A cell is always larger than an organism
• B. An organism is always larger than a cell
• C. A cell and an organism are equal in size
• D. The relative sizes depend on the specific cell and organism being compared

Correct Answer: B. An organism is always larger than a cell

Explanation: Organisms are composed of one or more cells, making them inherently larger than individual cells.

Question 59:

Pentamidine is indicated for the treatment of which of the following diseases?

• A. Tuberculosis
• B. Pneumocystis pneumonia
• C. HIV/AIDS
• D. Malaria

Correct Answer: B. Pneumocystis pneumonia

Explanation: Pentamidine is primarily used to treat Pneumocystis pneumonia (PCP), a serious infection that occurs in immunocompromised patients, such as those with HIV/AIDS.

Question 60:

A 24-year-old female patient is intubated with a 6.5mm endotracheal tube (ETT). You notice a persistent cuff leak that doesn’t resolve with inflation. What’s the likely cause, and how would you address it?

• A. The cuff is overinflated and ruptured. Deflate and consider replacing the ETT.
• B. The ETT is too small for the patient’s airway. Replace it with a larger size.
• C. There’s a mechanical defect in the cuff. Replace the ETT.
• D. The leak is due to tracheal injury. Evaluate for damage and consider alternatives.

Correct Answer: B. The ETT is too small for the patient’s airway. Replace it with a larger size.

Explanation: An ETT that is too small may not allow the cuff to seal properly against the trachea, resulting in persistent air leaks. Replacing the tube with a larger size can resolve the issue.

Question 61:

What is the Mallampati classification used for in the field of anesthesia?

• A. Assessing the risk of postoperative complications
• B. Evaluating the patient’s airway difficulty prior to intubation
• C. Determining the patient’s pain tolerance level
• D. Assessing the patient’s response to anesthesia medications

Correct Answer: B. Evaluating the patient’s airway difficulty prior to intubation

Explanation: The Mallampati classification is a tool used to predict the difficulty of intubation by assessing the visibility of the oropharyngeal structures.

Question 62:

Which of the following structures is assessed in the Mallampati classification?

• A. Tongue size and position
• B. Pharyngeal wall appearance
• C. Thyroid cartilage prominence
• D. Laryngeal vocal cord movement

Correct Answer: A. Tongue size and position

Explanation: The Mallampati classification focuses on the size and position of the tongue relative to the oropharyngeal structures, which helps predict the ease of airway management during intubation.

Question 63:

A 46-year-old patient presents for a preoperative evaluation. The anesthesiologist asks the patient to open their mouth and protrude their tongue without phonating. The uvula, soft palate, and fauces are visible, but the pillars are not. What is the Mallampati classification for this patient?

• A. Class I
• B. Class II
• C. Class III
• D. Class IV

Correct Answer: B. Class II

Explanation: In Mallampati Class II, the uvula, soft palate, and fauces are visible, but the pillars are not. This classification helps in predicting the potential difficulty of endotracheal intubation.

Question 64:

How is the Mallampati classification determined?

• A. By evaluating the patient’s ability to phonate
• B. By measuring the patient’s neck circumference
• C. By assessing the patient’s ability to swallow
• D. By visualizing the patient’s oropharyngeal structures during a specific posture or maneuver

Correct Answer: D. By visualizing the patient’s oropharyngeal structures during a specific posture or maneuver

Explanation: The Mallampati classification is determined by having the patient open their mouth wide and protrude their tongue without phonating. The visibility of the oropharyngeal structures is then assessed to classify the airway.

Question 65:

A 62-year-old female patient reports, “When I breathe, I feel like I am getting enough air, but I seem to breathe fast and lift my shoulders a lot. I sleep through the night and use only one pillow.” Which of the following is the most likely finding?

• A. Orthopnea
• B. Dyspnea
• C. Obstructive sleep apnea
• D. Increased work of breathing

Correct Answer: D. Increased work of breathing

Explanation: The patient’s description of rapid breathing and the use of accessory muscles (lifting shoulders) indicates increased work of breathing. Her ability to sleep through the night and the absence of other symptoms make conditions like orthopnea or obstructive sleep apnea less likely.

Question 66:

For a post-intubated patient for whom you have started following the VAP (Ventilator-Associated Pneumonia) Bundle, what should the bed head elevation be according to the bundle guidelines?

• A. 10-20 degrees
• B. 20-30 degrees
• C. 30-45 degrees
• D. 45-60 degrees

Correct Answer: C. 30-45 degrees

Explanation: Per VAP Bundle guidelines, the head of the bed should be elevated between 30-45 degrees to reduce the risk of aspiration and subsequent ventilator-associated pneumonia.

Question 67:

For a patient with a tracheostomy who has excessive secretions, which action best facilitates effective suctioning?

• A. Remove the inner cannula and perform suctioning
• B. Leave the inner cannula in place and perform suctioning
• C. Administer bronchodilators before suctioning
• D. Increase the suction pressure for better clearance

Correct Answer: A. Remove the inner cannula and perform suctioning

Explanation: Removing the inner cannula provides better access to the tracheal lumen, allowing for more effective suctioning of secretions.

Question 68:

A 58-year-old patient with a long-standing history of bronchiectasis is hospitalized due to an acute exacerbation with thick, excessive respiratory secretions. Which airway clearance technique is most appropriate?

• A. Circulatory respiratory devices
• B. Positive expiratory pressure (PEP) therapy
• C. High-frequency chest wall oscillation (HFCWO)
• D. Intrapulmonary percussive ventilation (IPV)

Correct Answer: B. Positive expiratory pressure (PEP) therapy

Explanation: PEP therapy is highly effective for patients with bronchiectasis as it helps mobilize thick secretions by creating positive pressure during exhalation, making it easier for the patient to clear secretions through coughing.

Question 69:

A patient in the ICU has thick, copious respiratory secretions. Which ventilator circuit and humidification system is best for managing this?

• A. Heated wire circuit with a heated humidifier
• B. Conventional circuit with a heat and moisture exchanger (HME)
• C. Heated wire circuit with a heat and moisture exchanger (HME)
• D. Conventional circuit with a heated humidifier

Correct Answer: A. Heated wire circuit with a heated humidifier

Explanation: A heated wire circuit with a heated humidifier provides the best option for thinning and mobilizing thick secretions because it maintains constant warmth and moisture, which helps in secretion management.

Question 70:

If an air bubble is inadvertently introduced when drawing an arterial blood gas (ABG) sample and it is not expelled before analysis, which parameter in the ABG results would be affected?

• A. pH
• B. Partial pressure of oxygen (PaO2)
• C. Partial pressure of carbon dioxide (PaCO2)
• D. Oxygen saturation (SaO2)

Correct Answer: B. Partial pressure of oxygen (PaO2)

Explanation: An air bubble in the ABG sample can cause a falsely elevated PaO2, as the oxygen content in the air bubble will artificially increase the oxygen level in the sample.

Question 71:

A postoperative patient has been instructed to use an Incentive Spirometer (IS). However, you observe that the patient is using the IS with a quick rhythm during both inhalation and exhalation phases. Which of the following complications is most likely to occur due to this incorrect usage?

• A. Hyperventilation and respiratory alkalosis
• B. Hypoventilation and respiratory acidosis
• C. Increased risk of atelectasis
• D. Decreased risk of pulmonary complications

Correct Answer: A. Hyperventilation and respiratory alkalosis

Explanation: Using an Incentive Spirometer too quickly can lead to hyperventilation, causing a reduction in carbon dioxide levels, which can result in respiratory alkalosis.

Question 72:

During a post-operative assessment, you notice diminished breath sounds in the left lower lobe of a patient. A chest X-ray confirms the presence of atelectasis in that area. Which device would be most appropriate to recommend to this patient to aid in respiratory recovery?

• A. Incentive Spirometer
• B. High-frequency Chest Wall Oscillation
• C. Continuous Positive Airway Pressure (CPAP) machine
• D. Oxygen mask

Correct Answer: A. Incentive Spirometer

Explanation: An Incentive Spirometer is the best device for post-operative patients with atelectasis because it encourages deep breaths, promoting lung re-expansion and preventing further collapse.

Question 73:

You start a patient on nasal cannula at 2 LPM, but the patient’s oxygen requirement increases, and you plan to increase the flow rate to 6 LPM. At this flow rate, you should start humidification. What type of humidifier would you use in this situation?

• A. Heated humidifier
• B. Bubble humidifier
• C. Wick humidifier
• D. Ultrasonic humidifier

Correct Answer: B. Bubble humidifier

Explanation: At flow rates above 4 LPM, the inspired oxygen can dry out the airways. A bubble humidifier is commonly used for flow rates between 4-10 LPM to provide adequate humidification and prevent airway irritation.

Question 74:

A patient’s condition worsens after taking a prescribed medication. Who is responsible for this mistake?

• A. The physician
• B. The nurse
• C. The respiratory therapist
• D. The entire healthcare team

Correct Answer: D. The entire healthcare team

Explanation: Patient safety is a shared responsibility among all members of the healthcare team, including physicians, nurses, respiratory therapists, and pharmacists. When a medication-related issue arises, the entire process, from prescription to administration, should be reviewed. A collaborative approach ensures the identification of errors and the provision of appropriate care.

Question 75:

How would you measure carbon monoxide (CO) levels in a patient after exposure to fire?

• A. Pulse oximetry
• B. Capnography
• C. Co-oximetry
• D. Arterial blood gas analysis

Correct Answer: C. Co-oximetry

Explanation: Co-oximetry is the most accurate method to measure carboxyhemoglobin levels, which indicate carbon monoxide exposure. Unlike pulse oximetry, co-oximetry can differentiate between oxygenated hemoglobin and hemoglobin bound to carbon monoxide.

Question 76:

What type of sedation would you give during intubation?

• A. Midazolam
• B. Propofol
• C. Succinylcholine
• D. Ketamine

Correct Answer: C. Succinylcholine

Explanation: Succinylcholine is a fast-acting neuromuscular blocking agent used during intubation to induce temporary paralysis, facilitating the procedure. Its rapid onset and short duration make it ideal for this purpose.

Question 77:

A patient presents with severe shortness of breath and low oxygen saturation. How would you manage this case?

• A. Administer oral bronchodilators
• B. Initiate positive pressure ventilation
• C. Perform chest physiotherapy
• D. Start intravenous corticosteroids

Correct Answer: B. Initiate positive pressure ventilation

Explanation: In cases of severe shortness of breath and low oxygen saturation, positive pressure ventilation is critical to improve oxygenation and ventilation. This intervention stabilizes the patient’s breathing and prevents further respiratory compromise.

Question 78:

A 36-year-old male patient is stable, and you plan to initiate postural drainage. However, after beginning the positioning, the patient develops shortness of breath. What would be the appropriate action?

• A. Continue the procedure
• B. Stop the procedure immediately
• C. Administer bronchodilators
• D. Increase supplemental oxygen flow

Correct Answer: B. Stop the procedure immediately

Explanation: If a patient develops shortness of breath during postural drainage, the procedure should be stopped immediately. Continuing may worsen the patient’s respiratory distress, so the priority is to discontinue the procedure and assess the patient’s condition.

Question 79:

Which type of oxygen cylinder can provide oxygen for a longer duration?

• A. Aluminum cylinder
• B. Steel cylinder
• C. Liquid oxygen cylinder
• D. Portable oxygen concentrator

Correct Answer: C. Liquid oxygen cylinder

Explanation: Liquid oxygen cylinders can store oxygen in a liquefied form, allowing them to hold a larger volume in a compact container. This enables them to provide oxygen for a longer period compared to gas cylinders, making them ideal for extended use.

Question 80:

You are performing a 6-Minute Walk Test (6MWT) with a patient, but the patient can only walk for 1 minute before stopping. What should you advise the patient to do next?

• A. Stop the test immediately
• B. Walk for an additional 5 minutes
• C. Rest and try again after a break
• D. Continue at the patient’s own pace

Correct Answer: D. Continue at the patient’s own pace

Explanation: The 6MWT is designed to assess functional exercise capacity, and patients should be encouraged to continue walking at their own pace, even if they need to rest. The goal is to complete the 6 minutes in total, and the distance walked, including any rest periods, is recorded.

Question 81:

After explaining the proper technique for using a Metered-Dose Inhaler (MDI), you ask the patient to demonstrate it, but the patient still doesn’t understand. What would be the appropriate next step?

• A. Repeat the explanation verbally
• B. Provide written instructions
• C. Demonstrate the technique again
• D. Refer the patient to a respiratory therapist

Correct Answer: C. Demonstrate the technique again

Explanation: If a patient struggles with understanding after an initial explanation, demonstrating the technique allows for better visual learning. This hands-on approach is often more effective than verbal or written instructions alone.

Question 82:

After a tracheostomy procedure, a patient develops a new sound that could indicate an injury to the thoracic cavity. What is the most likely sound you might hear?

• A. Stridor
• B. Wheezing
• C. Rhonchi
• D. Subcutaneous emphysema (crackling sound)

Correct Answer: D. Subcutaneous emphysema (crackling sound)

Explanation: Subcutaneous emphysema can result from air leaking into the subcutaneous tissue near the tracheostomy site, creating a crackling sound upon palpation. This may occur due to injury or air dissection into the thoracic cavity.

Question 83:

A physician asks you to prepare for a tracheostomy procedure on an 8-year-old pediatric patient. Which size tracheostomy tube would you typically use for a child of this age?

• A. 3.0 mm
• B. 4.0 mm
• C. 5.0 mm
• D. 6.0 mm

Correct Answer: D. 6.0 mm

Explanation: To calculate the appropriate tracheostomy tube size for a pediatric patient, you can use the formula: (Age / 4) + 4. For an 8-year-old: (8 / 4) + 4 = 6. So, a typical size would be around 6.0 mm.

Question 84:

You are called to the emergency department to help care for a patient who was in a vehicle accident and has chest injuries, including broken ribs. While palpating the patient’s neck, you feel crepitations (crackling sounds). What is the most likely cause of this finding?

• A. Pneumothorax
• B. Subcutaneous emphysema
• C. Hemothorax
• D. Pulmonary contusion

Correct Answer: B. Subcutaneous emphysema

Explanation: Crepitations or crackling sounds detected upon palpation of the neck are typically due to subcutaneous emphysema, which occurs when air leaks from the lungs or airways into the surrounding tissues, often following chest trauma.

Question 85:

A patient’s forced expiratory volume in 1 second (FEV1) increases from 60% to 80% of predicted after the administration of a bronchodilator. This indicates:

• A. Restrictive lung disease
• B. Obstructive lung disease
• C. Normal lung function
• D. Pulmonary hypertension

Correct Answer: B. Obstructive lung disease

Explanation: An increase in FEV1 after a bronchodilator suggests the presence of obstructive lung disease, such as asthma or COPD, where bronchodilator therapy improves airflow by reducing airway obstruction.

Question 86:

During capnography monitoring of a mechanically ventilated patient, you note that the end-tidal PCO2 (PetCO2) has dropped to 0 mm Hg. This finding may indicate:

• A. Adequate ventilation
• B. Hypoventilation
• C. Hyperventilation
• D. Disconnection or leak in the sampling line

Correct Answer: D. Disconnection or leak in the sampling line

Explanation: A PetCO2 reading of 0 mm Hg usually indicates a disconnection or leak in the sampling line. This prevents the capnograph from detecting the patient’s exhaled carbon dioxide, which would not be the case with other ventilation issues.

Question 87:

An unconscious patient with a full stomach cannot be orally intubated in the emergency room. Which of the following would you recommend as the most appropriate airway management approach?

• A. Nasotracheal intubation
• B. Laryngeal mask airway (LMA)
• C. Cricothyroidotomy
• D. Needle decompression

Correct Answer: C. Cricothyroidotomy

Explanation: In an emergency where oral intubation is contraindicated due to the risk of aspiration, and alternative methods are not viable, performing a cricothyroidotomy is the best option to quickly secure the airway.

Question 88:

While establishing initial ventilatory support settings for a new patient, the most important consideration is:

• A. Tidal volume
• B. Respiratory rate
• C. Oxygen concentration
• D. Inspiratory time

Correct Answer: A. Tidal volume

Explanation: When initiating mechanical ventilation, setting an appropriate tidal volume is critical to prevent ventilator-induced lung injury (VILI). Low tidal volumes (around 6 mL/kg of predicted body weight) minimize the risk of lung overdistension and barotrauma. Once the tidal volume is set, other parameters like respiratory rate and oxygen concentration can be adjusted based on the patient’s condition.

Question 89:

A terminally ill patient refuses potentially life-saving treatment. What ethical principle is most relevant?

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

Correct Answer: A. Autonomy

Explanation: Autonomy refers to the patient’s right to make their own healthcare decisions, including the choice to refuse treatment, even if it contradicts medical advice. Respecting this decision is paramount in upholding the ethical principle of autonomy.

Question 90:

A doctor recommends an experimental treatment that may have significant side effects but could potentially cure a patient’s rare disease. Which ethical principle is the doctor primarily following?

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

Correct Answer: B. Beneficence

Explanation: Beneficence involves acting in the best interest of the patient to promote their well-being. In this scenario, the doctor is suggesting a treatment that could greatly benefit the patient, even though it carries risks, with the intention of achieving the best possible outcome.

Question 91:

A surgeon decides not to perform a high-risk procedure on a critically ill patient due to the likelihood of complications. Which ethical principle guides this decision?

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

Correct Answer: C. Non-maleficence

Explanation: Non-maleficence means “do no harm.” The surgeon is prioritizing the avoidance of harm by not proceeding with a procedure that could pose significant risks or worsen the patient’s condition.

Question 92:

A hospital implements a triage system during a pandemic to allocate limited resources. Which ethical principle is this addressing?

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

Correct Answer: D. Justice

Explanation: Justice refers to fairness in the allocation of healthcare resources. The triage system is designed to ensure that resources are distributed equitably, particularly during times of scarcity, such as a pandemic.

Question 93:

A nurse refuses to discuss a patient’s condition with their curious neighbor. Which ethical principle is the nurse upholding?

• A. Autonomy
• B. Confidentiality
• C. Beneficence
• D. Justice

Correct Answer: B. Confidentiality

Explanation: Confidentiality involves protecting a patient’s private information. By refusing to share details about the patient’s condition, the nurse is upholding this ethical principle and ensuring the patient’s right to privacy.

Question 94:

A 45-year-old male patient presents to the emergency department with significant bleeding from the mouth following a traumatic injury. He is conscious but in distress, and there is concern about airway obstruction due to the bleeding. During the attempt to intubate the patient, the vocal cords cannot be visualized due to the heavy bleeding. The decision is made to secure the airway. Which airway device would you use?

• A. Standard endotracheal tube
• B. Double-lumen endotracheal tube
• C. Cuffed endotracheal tube
• D. Laryngeal Mask Airway (LMA)

Correct Answer: D. Laryngeal Mask Airway (LMA)

Explanation: In cases of significant oral bleeding where visualization of the vocal cords is difficult, an LMA is a good option as it can be inserted blindly. It forms a seal around the laryngeal inlet and secures the airway without requiring direct visualization of the vocal cords.

Question 95:

A patient requires oxygen therapy with Hilox gas, a high-concentration oxygen-heliox mixture used to enhance oxygen delivery and reduce airway resistance. Which oxygen mask is commonly used with Hilox gas?

• A. Simple Oxygen Mask
• B. Venturi Mask
• C. Non-Rebreather Mask
• D. Partial Rebreather Mask

Correct Answer: C. Non-Rebreather Mask

Explanation: Hilox gas, a mixture of oxygen and helium, is most effectively delivered using a non-rebreather mask. This type of mask can provide high concentrations of oxygen (up to 100%) and prevents the rebreathing of exhaled gases, making it ideal for patients with severe airway obstruction.

Question 96:

A patient in the ER requires immediate intubation and is at risk for aspiration pneumonia. Which tube would you use to minimize the risk of aspiration?

• A. Endotracheal tube
• B. Combitube
• C. Nasogastric tube
• D. Laryngeal tube

Correct Answer: B. Combitube

Explanation: The Combitube is designed for emergency airway management and is particularly useful when there is a high risk of aspiration. It can be inserted quickly without advanced laryngoscopy skills and provides an effective seal to prevent aspiration into the lungs.

Question 97:

A patient has had a chest tube inserted, and bubbling is observed in the water seal chamber. The healthcare team needs to interpret this finding to ensure proper patient management. What does this bubbling indicate?

• A. The presence of air leak in the chest cavity
• B. Normal functioning of the chest tube
• C. Adequate drainage of fluid from the chest
• D. Proper placement of the chest tube

Correct Answer: A. The presence of air leak in the chest cavity

Explanation: Bubbling in the water seal chamber after chest tube insertion is often a sign that air is being removed from the pleural space, indicating that the chest tube is functioning properly. Continuous and excessive bubbling, however, may indicate an air leak.

Question 98:

A patient presents with a prolonged PR interval on their electrocardiogram (ECG). What condition or abnormality is most likely to be present?

• A. First-degree atrioventricular block
• B. Bundle branch block
• C. Wolff-Parkinson-White syndrome
• D. Atrial fibrillation

Correct Answer: A. First-degree atrioventricular block

Explanation: A prolonged PR interval is a hallmark of first-degree atrioventricular (AV) block, which indicates a delay in the electrical conduction between the atria and ventricles. This condition is usually benign and does not always require treatment.

Question 99:

A patient presents with thick, sticky, foul-smelling secretions mixed with old blood. What is the most likely associated condition or diagnosis?

• A. Bronchiectasis
• B. Pulmonary embolism
• C. Pneumonia
• D. Tuberculosis

Correct Answer: A. Bronchiectasis

Explanation: Thick, sticky, foul-smelling sputum, often mixed with old blood, is characteristic of bronchiectasis. This chronic condition leads to the dilation of the airways, recurrent infections, and the production of large amounts of purulent sputum.

Question 100:

In the case of a neonate experiencing bradypnea or apnea episodes, what medication would be appropriate for management?

• A. Epinephrine
• B. Naloxone
• C. Caffeine
• D. Atropine

Correct Answer: C. Caffeine

Explanation: Caffeine citrate is the first-line treatment for apnea of prematurity in neonates. It stimulates the central nervous system and respiratory centers, thereby improving respiratory drive and reducing the frequency of apnea episodes.

Question 101:

What kind of humidification will we use during shifting a patient?

• A. Heated humidification
• B. Cold humidification
• C. Passive humidification
• D. HME (Heat and Moisture Exchanger)

Correct Answer: D. HME (Heat and Moisture Exchanger)

Explanation: Heat and Moisture Exchangers (HMEs) are portable and provide effective humidification by using the patient’s own exhaled air. They are ideal for short-term use, such as during patient transfers, to maintain adequate humidification of the airways.

Question 102:

A patient needs to be transferred over a distance of 900 km. How will you shift the patient?

• A. Ground ambulance
• B. Air ambulance
• C. Train
• D. Private vehicle

Correct Answer: B. Air ambulance

Explanation: For a long-distance transfer of 900 km, using an air ambulance is the most appropriate choice as it is faster and better equipped for managing critical patients over long distances.

Question 103:

What type of medication is typically prescribed for a patient with cystic fibrosis?

• A. Albuterol
• B. Prednisone
• C. Azithromycin
• D. Dornase alpha

Correct Answer: D. Dornase alpha

Explanation: Dornase alpha is a mucolytic enzyme that is a mainstay of cystic fibrosis treatment. It works by breaking down the thick, sticky mucus that accumulates in the lungs of cystic fibrosis patients, helping to improve breathing and reduce the risk of infections.

Question 104:

What medication would you administer to a patient with asthma who frequently experiences asthma attacks due to their work environment?

• A. Antihistamines
• B. Long-acting beta-agonists (LABA)
• C. Short-acting beta-agonists (SABA)
• D. Corticosteroids

Correct Answer: C. Short-acting beta-agonists (SABA)

Explanation: Short-acting beta-agonists (SABA), such as albuterol, are used for quick relief of asthma symptoms during acute attacks. They are essential for patients who frequently experience asthma symptoms in response to environmental triggers, providing rapid bronchodilation.

Question 105:

If a patient has a high body temperature, in which direction will the oxygen dissociation curve shift?

• A. To the left
• B. To the right
• C. No shift
• D. It depends on other factors

Correct Answer: B. To the right

Explanation: A high body temperature causes the oxygen dissociation curve to shift to the right. This rightward shift indicates that hemoglobin has a decreased affinity for oxygen, which facilitates the release of oxygen to the tissues. This is crucial for meeting the increased metabolic demands associated with higher temperatures, where tissues require more oxygen.