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Question 1:

A patient presents with a chest X-ray showing pleural effusion. What is the appropriate immediate management?

• A) Administer diuretics
• B) Perform a thoracentesis
• C) Start antibiotics
• D) Monitor and reassess in 24 hours

Correct Answer: B) Perform a thoracentesis

Explanation: Thoracentesis is the procedure of choice for managing pleural effusion, as it allows for both diagnostic and therapeutic benefits. It helps relieve symptoms by removing excess fluid and also provides the opportunity for fluid analysis to determine the underlying cause.

Question 2:

Which oxygen cylinder is most commonly used for home care due to its portability?

• A) E-cylinder
• B) H-cylinder
• C) M-cylinder
• D) D-cylinder

Correct Answer: A) E-cylinder Explanation: The E-cylinder is commonly used in home care settings because it is portable and provides an adequate oxygen supply for intermittent or short-term use. Its size makes it convenient for patients who require oxygen therapy at home.

Question 3:

A patient’s cuff is fully inflated, but there is still an air leak. What is the next appropriate step?

• A) Add more air to the cuff
• B) Replace the tube with a larger one
• C) Check for cuff puncture
• D) Adjust the patient’s position

Correct Answer: B) Replace the tube with a larger one Explanation: If the cuff is fully inflated and a leak persists, the tube may be too small, leading to an inadequate seal in the trachea. Replacing the tube with a larger one ensures a better seal, preventing air leaks and improving ventilation.

Question 4:

A doctor requests to convert a BiPAP machine to work like a CPAP machine. How would you adjust the settings?

• A) Increase IPAP level
• B) Decrease IPAP level to match EPAP level
• C) Adjust the rise time
• D) Change the mask

Correct Answer: B) Decrease IPAP level to match EPAP level Explanation: To convert a BiPAP machine to work like a CPAP machine, you must decrease the Inspiratory Positive Airway Pressure (IPAP) to match the Expiratory Positive Airway Pressure (EPAP). This creates a single continuous pressure, effectively simulating CPAP.

Question 5:

A patient with cystic fibrosis has thick secretions. Which therapy would be most effective in mobilizing and clearing these secretions?

• A) Incentive spirometry
• B) Postural drainage
• C) High-Frequency Chest Wall Oscillation (HFCWO)
• D) Nebulized saline

Correct Answer: C) High-Frequency Chest Wall Oscillation (HFCWO) Explanation: High-Frequency Chest Wall Oscillation (HFCWO) is highly effective in cystic fibrosis patients. The vibrating vest helps loosen and mobilize thick secretions, making it easier for the patient to cough them out and clear the airways.

Question 6:

A patient arrives at the ER after a fire, unconscious with complete facial burns. Which method is most appropriate for establishing an artificial airway?

• A) Endotracheal intubation
• B) Nasotracheal intubation
• C) Cricothyrotomy
• D) Tracheostomy

Correct Answer: C) Cricothyrotomy Explanation: In emergency situations with severe facial burns, where conventional intubation is not possible due to airway swelling or damage, cricothyrotomy is the preferred first-line method. It provides a rapid and effective way to secure an airway, especially in life-threatening scenarios. Tracheostomy is typically performed later, if needed, as a more definitive airway.

Question 7:

A “fish tail” appearance is seen on the volume-pressure loop of a ventilator in a patient intubated on pressure control (PC) mode. What does this indicate?

• A) High compliance
• B) Low sensitivity
• C) Excessive tidal volume
• D) Airway obstruction

Correct Answer: B) Low sensitivity Explanation: The “fish tail” appearance on the volume-pressure loop suggests low sensitivity, meaning the ventilator is not adequately recognizing the patient’s inspiratory efforts. Adjusting the sensitivity will improve the synchronization between the patient and the ventilator.

Question 8:

A patient experiences chest pain during a 6-minute walk test (6MWT). What should be your immediate action?

• A) Continue the test with caution
• B) Offer water and encourage rest
• C) Stop the test immediately and monitor the patient
• D) Slow down the walking pace and reassess

Correct Answer: C) Stop the test immediately and monitor the patient Explanation: Chest pain during a 6MWT could be a sign of a serious cardiac event. The test should be stopped immediately, and the patient should be closely monitored and further evaluated.

Question 9:

A patient with severe scoliosis is undergoing pulmonary function testing (PFT). Which pulmonary function value is most likely to be reduced in this patient?

• A) FEV1
• B) PEFR
• C) TLC
• D) FEV1/FVC ratio

Correct Answer: C) TLC Explanation: Severe scoliosis leads to a restrictive lung pattern, primarily reducing lung volumes such as Total Lung Capacity (TLC). The chest wall deformity restricts lung expansion, leading to a significant reduction in TLC.

Question 10:

In a patient with a neuromuscular disorder struggling to clear secretions, what is the best option to facilitate the removal of secretions?

• A) Chest physiotherapy
• B) Mechanical insufflation-exsufflation (MIE)
• C) Suctioning
• D) Nebulized saline

Correct Answer: B) Mechanical insufflation-exsufflation (MIE) Explanation: Mechanical insufflation-exsufflation (MIE), also known as a cough assist device, is particularly effective for patients with neuromuscular disorders. It helps generate stronger coughs by alternating positive and negative pressure.

Question 11:

What is the preferred muscle relaxant used during rapid sequence intubation (RSI) due to its quick onset and short duration of action?

• A) Vecuronium
• B) Rocuronium
• C) Succinylcholine
• D) Pancuronium

Correct Answer: C) Succinylcholine Explanation: Succinylcholine is the preferred choice because it takes effect very quickly (within seconds) and its effects are short-lived, which are ideal traits for the rapid and controlled nature of RSI procedures.

Question 12:

If a Nurse Sneezes on Her Arm and Does Not Wash It Afterwards, What is the Most Appropriate Action in Terms of Infection Control?

• A) Ignore the incident as it poses no significant risk
• B) Advise the nurse to wash her arm and hands immediately
• C) Report the incident to the hospital infection control team
• D) Provide the nurse with hand sanitizer only

Correct Answer: B) Advise the nurse to wash her arm and hands immediately Explanation: Hand and arm washing is essential after such an incident to prevent the spread of pathogens. This immediate action aligns with infection control guidelines that prioritize thorough cleaning to maintain a safe healthcare environment.

Question 13:

After Teaching a Patient How to Use a Peak Flow Meter, the Patient Refuses to Use It. What is the Most Appropriate Next Step?

• A) Insist that the patient complies without further discussion
• B) Document the refusal in the patient’s medical record and inform the doctor
• C) Ignore the patient’s refusal and proceed with other activities
• D) Try to convince the patient by explaining the benefits again

Correct Answer: B) Document the refusal in the patient’s medical record and inform the doctor Explanation: Documenting the refusal and informing the doctor are crucial steps. They ensure the patient’s decision is respected while maintaining professional responsibility and communication within the healthcare team.

Question 14:

When a low pressure (P) alarm activates on a pneumatic ventilator during patient transport, and the patient’s oxygen saturation begins to drop, what is the most likely reason?

• A) Power failure of the ventilator
• B) Blockage in the ventilator tubing
• C) Leak in the ventilator circuit or patient’s airway connection
• D) Over-sedation of the patient

Correct Answer: C) Leak in the ventilator circuit or patient’s airway connection Explanation: A low-pressure alarm plus dropping oxygen saturation often indicates a circuit or airway leak (e.g., disconnection or loose connection).

Question 15:

If a patient uses an H cylinder of oxygen at a pressure of 2000 PSI and a flow rate of 5 L/min, how long will the oxygen last? Correct Answer: The oxygen in the H cylinder will last approximately 21 hours. Explanation: For an H cylinder, the cylinder factor is 3.14. Using the standard formula:

Question 16:

Which oxygen delivery device is most suitable for a patient who can perform activities at home and requires oxygen therapy?

• A) Nasal cannula with stationary concentrator
• B) O2 portable concentrator
• C) Non-rebreather mask
• D) Liquid oxygen system

Correct Answer: B) O2 portable concentrator Explanation: A portable oxygen concentrator is lightweight and designed to provide mobility, making it ideal for patients performing daily activities at home while ensuring a continuous oxygen supply.

Question 17:

If an arterial line used to monitor pulmonary capillary wedge pressure (PCWP) gives inaccurate readings, what is the appropriate next step?

• A) Recalibrate the arterial line system
• B) Check for and resolve any kinks or obstructions in the line
• C) Switch to a central venous catheter
• D) Obtain a transthoracic echocardiogram

Correct Answer: B) Check for and resolve any kinks or obstructions in the line Explanation: Physical issues like kinks or obstructions in the line should be addressed first to ensure accurate pressure readings. Proper positioning and system calibration may also be necessary if initial corrections do not resolve the issue.

Question 18:

After administering hypertonic saline for an induced sputum culture, a patient develops bronchospasm. What is the appropriate management for this complication?

• A) Discontinue the hypertonic saline and observe
• B) Administer a bronchodilator
• C) Increase the concentration of hypertonic saline
• D) Provide supplemental oxygen only

Correct Answer: B) Administer a bronchodilator Explanation: Bronchospasm is a known side effect of hypertonic saline. A bronchodilator will help to open up the airways and relieve the bronchospasm.

Question 19:

A patient on mechanical ventilation suddenly develops a high-pressure alarm, decreased breath sounds on one side, and tracheal deviation. What is the most likely cause of these findings?

• A) Pulmonary edema
• B) Pneumothorax
• C) Bronchospasm
• D) Mucus plugging

Correct Answer: B) Pneumothorax Explanation: The combination of a high-pressure alarm, decreased breath sounds on one side, and tracheal deviation strongly suggests a pneumothorax. Air has entered the pleural space, causing the lung to collapse.

Question 20:

What is the primary function of surfactant in the lungs?

• A) To facilitate gas exchange
• B) To reduce surface tension in the alveoli
• C) To fight infection
• D) To transport oxygen in the blood

Correct Answer: B) To reduce surface tension in the alveoli Explanation: Surfactant is a liquid produced in the lungs that coats the alveoli (tiny air sacs) and reduces surface tension. This prevents the alveoli from collapsing during exhalation, making breathing easier.

Question 21:

A patient presents with coarse crackles heard during auscultation. What is the most likely underlying cause?

• A) Bronchospasm
• B) Atelectasis
• C) Secretions
• D) Pleural Effusion

Correct Answer: C) Secretions Explanation: Coarse crackles are low-pitched, bubbling sounds typically heard during auscultation and are most commonly associated with the presence of secretions in the larger airways.

Question 22:

Which of the following conditions is most likely to cause an increase in Central Venous Pressure (CVP)?

• A) Vasodilation
• B) Dehydration
• C) Inadequate circulation
• D) Hypervolemia

Correct Answer: D) Hypervolemia Explanation: Hypervolemia (fluid overload) leads to increased blood volume, which raises Central Venous Pressure (CVP).

Question 23:

What is the most effective method to prevent nasal irritation and complications when using a nasopharyngeal airway?

• A) Use a smaller size airway
• B) Lubricate the airway
• C) Secure the airway properly
• D) Change the airway frequently

Correct Answer: B) Lubricate the airway

Explanation: Lubricating the nasopharyngeal airway before insertion reduces friction and minimizes nasal irritation. It helps prevent trauma to the mucosa, decreasing the risk of bleeding or complications. This is an essential step to ensure patient comfort and safety during airway management.

Question 24:

How would you describe a patient who is sleepy but easy to arouse and responds appropriately?

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

Correct Answer: B) Lethargic Explanation: A lethargic patient is drowsy but can be easily awakened and responds properly to stimuli.

Question 25:

What is the highest recommended level of Inspiratory Positive Airway Pressure (IPAP) for patients with Obstructive Sleep Apnea (OSA)?

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

Correct Answer: C) 30 cmH2O Explanation: Typically, a maximum IPAP setting of about 30 cmH2O is recommended for effective ventilation while minimizing barotrauma risk in OSA.

Question 26:

A patient presents with upper right chest pain and moderate respiratory distress, suspected of having a spontaneous pneumothorax. Which of the following signs would you expect?

• A) Increased breath sounds on the affected side
• B) Hyperresonance on percussion
• C) Decreased tracheal deviation
• D) Bilateral chest expansion

Correct Answer: B) Hyperresonance on percussion Explanation: Hyperresonance on percussion is a key sign of a spontaneous pneumothorax, along with decreased breath sounds on the affected side.

Question 27:

How can subcutaneous emphysema be detected in a patient after a tracheostomy procedure?

• A) Inspecting the stoma visually
• B) Auscultating the chest
• C) Palpating around the stoma
• D) Measuring oxygen saturation

Correct Answer: C) Palpating around the stoma Explanation: Subcutaneous emphysema presents as a characteristic crackling sensation under the skin (crepitus) upon palpation, indicating air in the subcutaneous tissue.

Question 28:

What is a common cause of aspiration pneumonia in an intubated patient?

• A) Poor oral hygiene
• B) High ventilator settings
• C) Reflux of gastric contents
• D) Use of humidified oxygen

Correct Answer: C) Reflux of gastric contents Explanation: Aspiration pneumonia often results from the reflux of gastric contents into the airway, which can happen in intubated or sedated patients.

Question 29:

What factor would delay weaning from mechanical ventilation?

• A) Vital Capacity (VC): 8 mL/kg
• B) Mean Airway Pressure (MAP): -22
• C) Maximum Inspiratory Pressure (MIP): -22 cmH₂O
• D) Respiratory Rate (RR): 27

Correct Answer: A) Vital Capacity (VC): 8 mL/kg Explanation: A vital capacity below about 10–15 mL/kg indicates insufficient respiratory reserve, which would delay safe weaning from mechanical ventilation.

Question 30:

A patient with a tracheostomy is using a jet nebulizer and exhibits increased airway resistance (Raw) and bronchospasm. The patient does not require mechanical ventilation or supplemental oxygen, and there are no thick secretions present. What is the most appropriate intervention to improve the patient’s respiratory status?

• A) Perform suctioning
• B) Provide supplemental oxygen
• C) Change to a heat and moisture exchanger (HME)
• D) Increase the flow of the jet nebulizer

Correct Answer: D) Increase the flow of the jet nebulizer Explanation: Increasing the flow rate helps deliver medication more effectively, which can alleviate bronchospasm and reduce airway resistance.

Question 31:

What is the recommended method for disinfecting vegetative bacteria and spores on respiratory equipment?

• A) Glutaraldehyde
• B) Ethanol
• C) Chlorine bleach (sodium hypochlorite)
• D) Hydrogen peroxide

Correct Answer: A) Glutaraldehyde Explanation: Glutaraldehyde is a high-level disinfectant effective against a broad spectrum of microorganisms, including spores.

Question 32:

A patient presents with symptoms of a diazepam overdose. Which medication should be administered to reverse the effects of diazepam?

• A) Naloxone
• B) Flumazenil
• C) Atropine
• D) Epinephrine

Correct Answer: B) Flumazenil Explanation: Flumazenil is a benzodiazepine antagonist used to reverse the sedative effects of drugs like diazepam.

Question 33:

A pediatric patient self-extubates. Attempts at reintubation are unsuccessful, and the patient develops stridor due to airway swelling. Which treatment option is the most appropriate initial step to relieve the swelling?

• A) Jet nebulizer with saline
• B) Cool mist therapy
• C) Jet nebulizer with albuterol
• D) Jet nebulizer with ipratropium bromide

Correct Answer: B) Cool mist therapy Explanation: Cool mist therapy can help reduce airway swelling and inflammation in a pediatric patient who self-extubates and develops stridor.

Question 34:

A patient with neuromuscular disease presents with a MIP of -34 cmH2O. After 4 hours, the MIP decreases to -19 cmH2O, but FVC is also decreasing. What is the most appropriate action?

• A) Intubate
• B) Initiate NIV (Non-invasive Ventilation)
• C) Keep the same treatment
• D) Increase supplemental oxygen

Correct Answer: A) Intubate Explanation: A significantly worsening MIP (more positive than -20 cmH2O) and decreasing FVC suggest impending respiratory failure, necessitating intubation.

Question 35:

A device that provides 30–50 cm H2O of positive pressure to the airway, then holds this pressure before switching to -30 to -50 cm H2O of negative pressure?

• A) Positive Expiratory Pressure (PEP)
• B) Intermittent Positive Pressure Ventilation (IPPV)
• C) High-Frequency Oscillatory Ventilation (HFOV)
• D) Mechanical Insufflation-Exsufflation (MIE)

Correct Answer: D) Mechanical Insufflation-Exsufflation (MIE) Explanation: Mechanical Insufflation-Exsufflation (MIE), also called a cough assist device, alternates positive and negative pressures to help mobilize and clear secretions.

Question 36:

A 20-year-old patient with cystic fibrosis is experiencing difficulty clearing thick airway secretions. A respiratory therapy device is used that delivers rapid bursts of air at a frequency of 110–225 cycles per minute to loosen secretions while allowing the patient to breathe spontaneously through the device. Which of the following devices is being used?

• A) Intrapulmonary Percussive Ventilator (IPV)
• B) Continuous Positive Airway Pressure (CPAP)
• C) High Frequency Oscillatory Ventilation (HFOV)
• D) Mechanical Insufflation-Exsufflation (MIE)

Correct Answer: A) Intrapulmonary Percussive Ventilator (IPV) Explanation: IPV delivers high-frequency bursts of air (110–225 cycles per minute) and allows spontaneous breathing to help loosen thick secretions in conditions like cystic fibrosis.

Question 37:

A patient experiences dizziness and tingling during the use of an incentive spirometer (IS). What is the most likely cause of these symptoms and the appropriate treatment?

• A) Hyperventilation; advise slower, controlled breathing sessions
• B) Allergic reaction to the device; discontinue use
• C) Low blood pressure; administer fluids
• D) Neurological disorder; refer to a neurologist

Correct Answer: A) Hyperventilation; advise slower, controlled breathing sessions Explanation: Excessively frequent or deep breathing can lower CO₂ (hypocapnia), leading to dizziness and tingling. Slowing the breathing rate helps alleviate these symptoms.

Question 38:

A patient using Positive Expiratory Pressure (PEP) therapy developed shortness of breath (SOB) and tachycardia. What is the most appropriate intervention?

• A) Use a larger orifice in the PEP device
• B) Use a smaller orifice in the PEP device
• C) Administer oxygen in conjunction with PEP therapy
• D) Discontinue PEP therapy immediately

Correct Answer: A) Use a larger orifice in the PEP device Explanation: A larger orifice reduces expiratory resistance, making it easier to exhale and relieving symptoms such as SOB and tachycardia.

Question 39:

A patient develops respiratory acidosis during mechanical ventilation. What is the most appropriate ventilator adjustment to correct this condition?

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

Correct Answer: A) Increase the respiratory rate Explanation: Increasing the respiratory rate helps remove more CO₂, thereby correcting respiratory acidosis.

Question 40:

A patient receiving mechanical ventilation is found to have high peak airway pressures and high plateau pressures. What is the most likely cause of this issue?

• A) Bronchospasm
• B) Hypoxemia
• C) Hyperventilation
• D) Low lung compliance

Correct Answer: D) Low lung compliance Explanation: When both peak and plateau pressures are high, it typically indicates low lung compliance, as in conditions like ARDS or pulmonary fibrosis.

Question 41:

A patient undergoing mechanical ventilation has a PaO2 of 55 mmHg despite an FiO2 of 60%. What is the most appropriate adjustment to improve oxygenation?

• A) Increase the FiO2 to 100%
• B) Increase the PEEP
• C) Increase the tidal volume
• D) Decrease the respiratory rate

Correct Answer: B) Increase the PEEP Explanation: If the patient remains hypoxemic despite a relatively high FiO2, increasing the PEEP can help by preventing alveolar collapse and improving oxygenation.

Question 42:

A patient on mechanical ventilation shows signs of air trapping (auto-PEEP). What is the best ventilator adjustment to address this?

• A) Increase the inspiratory time
• B) Decrease the respiratory rate
• C) Increase the tidal volume
• D) Decrease the FiO2

Correct Answer: B) Decrease the respiratory rate Explanation: Auto-PEEP occurs when there is insufficient time for exhalation before the next breath. Decreasing the respiratory rate provides a longer exhalation time and helps prevent air trapping.

Question 43:

A patient with COPD is being weaned from mechanical ventilation. What is the preferred mode to aid in weaning?

• A) Controlled Mandatory Ventilation (CMV)
• B) Assist-Control Ventilation (ACV)
• C) Synchronized Intermittent Mandatory Ventilation (SIMV)
• D) Pressure Support Ventilation (PSV)

Correct Answer: D) Pressure Support Ventilation (PSV) Explanation: PSV allows the patient to breathe spontaneously with support on each breath, reducing the work of breathing—particularly helpful for COPD patients transitioning off the ventilator.

Question 44:

A patient with ARDS is on mechanical ventilation with high PEEP and FiO2 settings but continues to have low oxygenation. What strategy could be considered to improve oxygenation?

• A) Prone positioning
• B) Increase FiO2 to 100%
• C) Decrease the tidal volume
• D) Switch to CPAP

Correct Answer: A) Prone positioning Explanation: Prone positioning helps improve oxygenation by redistributing blood flow and improving lung recruitment in ARDS.

Question 45:

A 48-year-old male patient is admitted to the ICU after experiencing severe sepsis, leading to the development of Acute Respiratory Distress Syndrome (ARDS). The patient is intubated and started on mechanical ventilation. What is the most appropriate initial tidal volume setting for this patient to reduce the risk of ventilator-induced lung injury?

• A) Low tidal volume (4–6 mL/kg of predicted body weight)
• B) High tidal volume (10–12 mL/kg of predicted body weight)
• C) High respiratory rate (20–25 breaths per minute)
• D) High plateau pressure

Correct Answer: A) Low tidal volume (4–6 mL/kg of predicted body weight) Explanation: In ARDS, lung-protective ventilation using low tidal volumes (4–6 mL/kg PBW) helps minimize alveolar overdistension and barotrauma.

Question 46:

A patient on mechanical ventilation develops hypotension after an increase in PEEP. What is the most likely cause of this hypotension?

• A) Decreased venous return
• B) Increased cardiac output
• C) Hyperventilation
• D) Hypoxemia

Correct Answer: A) Decreased venous return Explanation: Higher levels of PEEP increase intrathoracic pressure, reducing venous return and leading to decreased cardiac output and hypotension.

Question 47:

A patient using BiPAP therapy has elevated PaCO2 levels. What is the most appropriate adjustment to correct this condition?

• A) Increase the EPAP
• B) Decrease the IPAP
• C) Increase the IPAP
• D) Decrease the EPAP

Correct Answer: C) Increase the IPAP Explanation: Increasing the IPAP (pressure support) leads to larger tidal volumes, enhancing CO₂ elimination and correcting hypercapnia.

Question 48:

A patient develops dizziness during Intermittent Positive Pressure Breathing (IPPB) therapy. What is the most likely cause?

• A) Hyperventilation
• B) Mucus plugging the airway
• C) Anxiety related to the treatment
• D) Incorrect positioning of the mouthpiece

Correct Answer: A) Hyperventilation Explanation: IPPB can prompt patients to breathe faster or deeper than normal, lowering CO₂ levels (hypocapnia) and causing dizziness or tingling.

Question 49:

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

• Respiratory Rate (RR): 21 breaths/min
• Heart Rate (HR): 110 bpm
• Blood Pressure (BP): 140/90 mmHg
• SpO₂: 94% on BiPAP 12/6 with FiO₂ 40%
• pH: 7.44
• PaCO₂: 35 mmHg
• PaO₂: 80 mmHg
• Chest X-ray (CXR): Congested lungs, consistent with pulmonary edema.

What is the most appropriate intervention for this patient?

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

Correct Answer: A) Diuretic Explanation: A congested CXR in a patient on BiPAP often indicates pulmonary edema secondary to fluid overload. Administering a diuretic reduces fluid overload, alleviating respiratory distress.

Question 50:

A premature infant born at 32 weeks gestation shows signs of cyanosis, nasal flaring, and grunting. Which condition is most likely?

• A) Neonatal sepsis
• B) Respiratory Distress Syndrome (RDS)
• C) Congenital heart defect
• D) Meconium aspiration syndrome

Correct Answer: B) Respiratory Distress Syndrome (RDS) Explanation: RDS is common in premature infants due to insufficient surfactant production and immature lungs, leading to respiratory distress.

Question 51:

A patient undergoing a spontaneous breathing trial (SBT) develops respiratory distress. How long should you wait before reattempting another SBT?

• A) 6 hours
• B) 12 hours
• C) 24 hours
• D) 48 hours

Correct Answer: C) 24 hours Explanation: Guidelines recommend waiting at least 24 hours after a failed SBT to allow for recovery and any necessary interventions.

Question 52:

A patient using a home nasal cannula connected to an oxygen concentrator asks how often the cannula should be replaced. What is the recommended frequency?

• A) Every 4 days
• B) Every 14 days
• C) Every 21 days
• D) Every 30 days

Correct Answer: B) Every 14 days Explanation: Replacing the nasal cannula every 1–2 weeks helps maintain hygiene and prevent bacterial or mucus buildup that could reduce oxygen delivery efficiency.

Question 53:

What is the physiological effect of administering a beta-2 agonist to a patient with asthma?

• A) Bronchodilation
• B) Bronchoconstriction
• C) Decreased mucus production
• D) Increased respiratory rate

Correct Answer: A) Bronchodilation Explanation: Beta-2 agonists relax smooth muscle in the airways, improving airflow by reducing bronchoconstriction.

Question 54:

A patient undergoing bronchoscopy develops blurred visualization after saline instillation. What is the first action to take?

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

Correct Answer: B) Check the light source Explanation: A malfunctioning or poorly adjusted light source is a common cause of blurred visualization. Ensuring the light source is functional is the first step.

Question 55:

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

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

Correct Answer: A) Left heart failure Explanation: Pulmonary edema is often caused by left-sided heart failure, which leads to fluid accumulation in the lungs.

Question 56:

During a mechanical ventilation setup, the exhalation waveform does not return to baseline. What does this indicate?

• A) Airway obstruction
• B) Air trapping (auto-PEEP)
• C) High inspiratory flow rate
• D) Circuit leak

Correct Answer: B) Air trapping (auto-PEEP) Explanation: Failure of the flow to return to baseline before the next breath suggests incomplete exhalation, leading to air trapping (auto-PEEP).

Question 57:

A mechanically ventilated patient in the ICU requires continuous monitoring of CO₂ levels to evaluate the adequacy of ventilation in real time. Which method is the most appropriate for this purpose?

• A) Pulse oximetry
• B) Arterial blood gas (ABG) analysis
• C) Capnography (EtCO₂)
• D) Spirometry

Correct Answer: C) Capnography (EtCO₂) Explanation: Capnography provides real-time, non-invasive measurement of exhaled CO₂, making it ideal for continuous monitoring of ventilation.

Question 58:

A patient with COPD exhibits an FEV1/FVC ratio of 59%. According to the GOLD criteria, what is the severity of their condition?

• A) Mild
• B) Moderate
• C) Severe
• D) Very severe

Correct Answer: B) Moderate Explanation: An FEV1/FVC ratio <70% confirms COPD. With an FEV1 ~50–79% of predicted, the GOLD criteria classify it as moderate.

Question 59:

What is the primary purpose of the QRS complex on an ECG?

• A) Atrial depolarization
• B) Ventricular repolarization
• C) Ventricular depolarization
• D) Sinoatrial node impulse

Correct Answer: C) Ventricular depolarization Explanation: The QRS complex reflects the electrical activation (depolarization) of the ventricles, causing their contraction.

Question 60:

A patient with ARDS is on mechanical ventilation. Prone positioning is recommended. What is the primary purpose of this intervention?

• A) Improve oxygenation
• B) Decrease airway resistance
• C) Reduce CO2 levels
• D) Stabilize hemodynamics

Correct Answer: A) Improve oxygenation Explanation: Prone positioning redistributes blood flow, improving alveolar recruitment and oxygenation in ARDS.

Question 61:

During suctioning, a patient’s ECG shows abnormal changes. What should you do first?

• A) Continue suctioning
• B) Stop suctioning immediately and administer oxygen
• C) Increase suction pressure
• D) Notify the physician

Correct Answer: B) Stop suctioning immediately and administer oxygen Explanation: ECG changes may indicate hypoxia or cardiac stress. Stopping suctioning and providing oxygen is critical to patient safety.

Question 62:

A patient using a non-rebreather mask shows no deflation of the reservoir bag during inspiration. What is the most likely issue?

• A) Mask is not fitted properly
• B) Oxygen flow rate is too high
• C) Patient is not breathing adequately
• D) There is a leak in the system

Correct Answer: C) Patient is not breathing adequately Explanation: If the bag does not deflate at all, it suggests minimal or absent inspiratory effort (hypoventilation or apnea).

Question 63:

A baby born to a mother taking morphine exhibits lethargy and poor respiratory effort. What is the most appropriate intervention?

• A) Provide supplemental oxygen
• B) Administer naloxone
• C) Perform gastric lavage
• D) Initiate intravenous fluids

Correct Answer: B) Administer naloxone Explanation: Naloxone is an opioid antagonist that reverses the effects of morphine, improving respiratory drive and consciousness.

Question 64:

Which nebulizer is most suitable for delivering iloprost to a patient with pulmonary arterial hypertension?

• A) Hudson nebulizer
• B) Pari nebulizer
• C) I-neb (mesh nebulizer)
• D) Respirgard nebulizer

Correct Answer: C) I-neb (mesh nebulizer) Explanation: The I-neb (mesh) nebulizer is designed for highly efficient delivery of iloprost, used in pulmonary arterial hypertension therapy.

Question 65:

What does assessment of the jugular venous pressure (JVP) provide information about?

• A) Level of dehydration
• B) Right atrial pressure
• C) Left ventricular function
• D) Blood glucose levels

Correct Answer: B) Right atrial pressure Explanation: The JVP reflects right atrial pressure, giving insights into right heart function and overall fluid status.

Question 66:

Where should the V1 lead be placed when setting up a standard ECG?

• A) Fourth intercostal space, right sternal border
• B) Fifth intercostal space, midclavicular line
• C) Fourth intercostal space, left sternal border
• D) Second intercostal space, right sternal border

Correct Answer: A) Fourth intercostal space, right sternal border Explanation: Proper placement of V1 is essential for accurate cardiac electrical activity measurement of the right ventricle.

Question 67:

Which of the following gas therapies can reduce the work of breathing (WOB) in patients with respiratory distress?

• A) Oxygen therapy
• B) Nitric oxide therapy
• C) Heliox (helium-oxygen mixture) therapy
• D) Nitrogen therapy

Correct Answer: C) Heliox (helium-oxygen mixture) therapy Explanation: Heliox has lower density than air, reducing turbulent flow and work of breathing, especially in obstructive airway conditions.

Question 68:

What is an absolute contraindication for performing a diagnostic bronchoscopy?

• A) Wheezing
• B) Hemoptysis
• C) Hypertension
• D) Severe hypoxemia

Correct Answer: D) Severe hypoxemia Explanation: Severe hypoxemia poses significant risks during bronchoscopy due to potential worsening oxygenation under sedation and airway manipulation.

Question 69:

A large volume nebulizer (LVN) is taken out of isolation and needs to be sterilized before use. Which method is recommended?

• A) Autoclave for 15 minutes
• B) Boiling in hot water for 5 minutes
• C) Chemical disinfection using alcohol wipes
• D) Ultraviolet (UV) light sterilization for 10 minutes

Correct Answer: A) Autoclave for 15 minutes Explanation: Autoclaving with pressurized steam is the most reliable sterilization method for medical equipment, effectively killing all microorganisms.

Question 70:

What is the preferred method for delivering aerosol to a 2-year-old patient?

• A) O2 tent
• B) Small Volume Nebulizer (SVN)
• C) MDI (Metered-Dose Inhaler) with a spacer
• D) Nasal cannula with nebulizer attached

Correct Answer: B) Small Volume Nebulizer (SVN) Explanation: For a toddler, an SVN is often the best choice because it does not rely on the child’s coordination or cooperation (as with an MDI+spacer), ensuring adequate medication delivery.

Question 71:

A patient requires frequent suctioning. What is the most appropriate type of suctioning in this case?

• A) Oral suction
• B) Tracheal suction
• C) Nasal suction
• D) Pharyngeal suction

Correct Answer: C) Nasal suction Explanation: Nasal suctioning is less invasive than tracheal suction and is generally better tolerated for frequent secretion removal in the upper airway—assuming no need for deep tracheal access.

Question 72:

A patient has a urine output of 15 ml/h. What does this low urine output indicate?

• A) Hypervolemia
• B) Hypernatremia
• C) Euvolemia
• D) Hypovolemia

Correct Answer: D) Hypovolemia Explanation: Low urine output (oliguria) often indicates reduced renal perfusion due to decreased intravascular volume (hypovolemia).

Question 73:

Which condition is an indication for using BiPAP (Bilevel Positive Airway Pressure)?

• A) Pneumothorax
• B) Respiratory arrest
• C) Simple snoring
• D) Neuromuscular disorders

Correct Answer: D) Neuromuscular disorders Explanation: BiPAP can provide ventilatory support in neuromuscular disorders by reducing the work of breathing and improving ventilation.

Question 74:

What is the most effective breathing technique for managing COPD symptoms?

• A) Diaphragmatic breathing
• B) Pursed-lip breathing
• C) Incentive spirometry
• D) Deep breathing exercises

Correct Answer: B) Pursed-lip breathing Explanation: Pursed-lip breathing prolongs exhalation, prevents airway collapse, and helps reduce air trapping in COPD patients.

Question 75:

During PSV (Pressure Support Ventilation), a patient exhibits hypoventilation. What is the most appropriate adjustment?

• A) Decrease the pressure support level
• B) Increase the pressure support level
• C) Switch to a different ventilation mode
• D) Increase the respiratory rate

Correct Answer: B) Increase the pressure support level Explanation: Increasing the pressure support level augments tidal volume and helps correct hypoventilation by improving ventilation efficiency.

Question 76:

While using a suction catheter, how can you confirm adequate suction pressure?

• A) Listen for air suction sound
• B) Check tubing for condensation
• C) Observe respiratory effort during suctioning
• D) Occlude the thumb port and observe the manometer

Correct Answer: D) Occlude the thumb port and observe the manometer Explanation: Occluding the thumb port and checking the pressure gauge ensures the system is delivering the correct amount of negative pressure.

Question 77:

A 3 L syringe measures 2.7 L during calibration. What is the percentage error?

• A) 3%
• B) 9%
• C) 10%
• D) 27%

Correct Answer: C) 10% Explanation: Percentage error = (|2.7 – 3.0| / 3.0) × 100% = 10%.

Question 78:

A patient presents with jugular venous distention (JVD), pedal edema, and low hematocrit. What is the most appropriate initial management?

• A) Diuretic therapy
• B) Fluid restriction
• C) Albumin infusion
• D) Vasopressor therapy

Correct Answer: A) Diuretic therapy Explanation: JVD, pedal edema, and low hematocrit suggest fluid overload. Diuretic therapy helps remove excess fluid, alleviating symptoms and improving circulating hematocrit.

Question 79:

A patient undergoing pulmonary function testing in a plethysmography chamber needs communication. What is the best method?

• A) Sign language
• B) Intercom system
• C) Hand gestures
• D) Writing on a board

Correct Answer: B) Intercom system Explanation: An intercom allows two-way voice communication without interrupting the test or requiring the patient to leave the chamber.

Question 80:

A 45-year-old man with type 1 diabetes presents with muscle cramps, weakness, and irregular heartbeat. What is the most likely cause?

• A) Hyperglycemia
• B) Hypokalemia
• C) Hyperlipidemia
• D) Hyperthyroidism

Correct Answer: B) Hypokalemia Explanation: Insulin can drive potassium into cells, leading to hypokalemia, which causes muscle weakness and arrhythmias.

Question 81:

A patient presents with worsening respiratory distress and hypoxemia. Which intervention is most urgently indicated?

• A) Bronchoscopy
• B) Intubation
• C) Tracheostomy
• D) Non-invasive ventilation

Correct Answer: B) Intubation Explanation: In severe or rapidly worsening respiratory distress with significant hypoxemia, securing the airway via intubation is critical.

Question 82:

A patient with congestive heart failure presents with frothy sputum, crackles, and bilateral pulmonary infiltrates. Which therapy is most appropriate?

• A) Inhaled bronchodilators
• B) Diuretics
• C) CPAP (Continuous Positive Airway Pressure)
• D) Steroid therapy

Correct Answer: C) CPAP (Continuous Positive Airway Pressure) Explanation: CPAP helps reduce venous return (preload) and improves oxygenation by recruiting alveoli, thus alleviating pulmonary edema.

Question 83:

A patient with a lung mass undergoes bronchoscopy. What is the primary purpose of this procedure?

• A) Airway clearance
• B) Therapeutic intervention
• C) Biopsy
• D) Diagnostic imaging

Correct Answer: C) Biopsy Explanation: Bronchoscopy is commonly performed to obtain tissue samples (biopsy) for diagnosing suspected lung masses.

Question 84:

A patient with acute hypoxemic respiratory failure due to severe pneumonia is on NIV. What is the maximum recommended expiratory positive airway pressure (EPAP)?

• A) 8 cmH2O
• B) 10 cmH2O
• C) 12 cmH2O
• D) 25 cmH2O

Correct Answer: D) 25 cmH2O Explanation: Higher EPAP (up to ~25 cmH2O) can be used in severe hypoxemia to increase functional residual capacity (FRC) and improve oxygenation.

Question 85:

What is the maximum amount of fluid used per lavage during BAL (Bronchoalveolar Lavage)?

• A) 20–60 ml
• B) 60–100 ml
• C) 100–150 ml
• D) 150–200 ml

Correct Answer: A) 20–60 ml Explanation: According to standard references, 20–60 ml of saline is typically instilled per lavage in BAL, then suctioned for diagnostic analysis.