Which of the following activities is not part of the role of RTs in patient assessment? A) Assist physician with diagnostic reasoning skills. B) Help physician select appropriate PFTs C) Interpret ABG values & suggest ventilation change D) Document patient diagnosis in the patient’s chart.

Feedback: RTs are not qualified to make an official diagno-sis. This is the role of the attending physician. Correct Answer(s): D

What should the RT do if the patient suffers serious side effects during Tx? A) Stop the Tx & notify the supervisor or physician. B) Continue but monitor the patient more closely. C) Go get the head nurse. D) Call a code.

Feedback: Serious side effects call for the RT to stay at the bedside, stop the Tx, & monitor the patient closely. The supervisor and/or the attending physician should be in-formed after the patient stabilizes. Correct Answer(s): A

Elevator is full, but standing next to you is the RT who is scheduled to relieve you. He turns to you & asks about Mr. Copper? How should you respond? A) “He took a turn for the worse” B) “He is fine” C) “Let’s talk later in the report room” D) “He is on a ventilator & will keep you very busy”

Feedback: The patient’s right to privacy prevents care pro-viders from discussing a patient’s clinical status in public places. All answers other than “c” are unethical & could put you in legal trouble & get you fired. Correct Answer(s): C

In 1996, Congress passed the HIPAA. What does the letter “P” stand for? A) Patient B) Payment C) Portability D) Personal

Feedback: HIPAA stands for Health Insurance Portability & Accountability Act. Correct Answer(s): C

What does the phrase “Universal Precautions” refer to? A) Protecting the patient from hospital germs & microbes B) Protecting care givers from contagious diseases patient may have C) Policies intended to prevent transmission of disease D) Use of potent antibiotics prevent disease transmission

Feedback: Universal precautions is all about requiring care givers to protect themselves by assuming that all patients are infected until proven otherwise & by wearing protec-tive garb. Correct Answer(s): B

Which sequence best describes cough mechanism? A) Inspiration, closure of glottis, forceful opening of glottis B) Opening glottis, relaxation of diaphragm, closure glottis C) Inspiration, forceful opening of glottis, contraction of diaphragm D) Opening of glottis, contraction of diaphragm, explosive release of trapped intrathoracic air

Feedback: The cough mechanism can be divided into three phases: 1. Inspiratory phase: 2. Compression phase: 3. Expiratory phase: Correct Answer(s): A

Which of the following is the best definition of sputum? A) Secretions B) Thick tenacious secretions C) Secretions from the lungs & lower airways D) Secretions from nose, mouth, & tracheobronchial tree

Feedback: Sputum is the substance expelled from the tra-cheobronchial tree, pharynx, mouth, sinuses, & nose by coughing or clearing the throat. Correct Answer(s): D

A patient presents in the emergency department with blood-tinged sputum. Term associated with such sputum: A) gelatinous. B) hemoptysis. C) hematemesis. D) mucopurulent.

Feedback: Hemoptysis, expectoration of sputum that con-tains blood, varies in severity from slight streaking to frank bleeding. Correct Answer(s): B

An inability to breathe while lying down is known as: A) dyspnea. B) platypnea. C) orthopnea. D) paroxysmal nocturnal dyspnea.

Feedback: Orthopnea is the inability to breathe when lying down. Correct Answer(s): C

One milliliter (ml) is equal to how many drops (gtts) of liq-uid? A) 4 B) 8 C) 16 D) 20

Feedback: Orders in respiratory care may often involve drops, such as 4 drops of racemic epi, with 2.5 cubic cen-timeters (cc) of distilled water. The following equivalence is used: 16 drops (gtts) = 1 milliliter (ml) Correct Answer(s): C

One cubic centimeter is equivalent to how many millili-ters? A) 0.1 B) 1 C) 10 D) 100

Feedback: One cubic centimeter (cc) is equivalent to 1 mil-liliter (ml): 1 cc = 1 ml Correct Answer(s): B

You have atropine 0.4 mg/ml in a vial of liquid. How many milliliters will be needed for a 1.0-mg dose? A) 0.25 B) 2.5 C) 5 D) 10

Feedback: Correct Answer(s): B

How many cubic centimeters do you need for a 2.5-mg dose of terbutaline sulfate, using a 0.1% solution? A) 2.5 B) 25 C) 0.25 D) 0.025

Feedback: Correct Answer(s): A

If dehydration is suspected in a patient, which of the fol-lowing parameters should be monitored often? A) Height B) Weight C) Fluid intake & output D) BP

Feedback: If a question arises regarding dehydration or fluid overload, fluid intake & output (I & O) & weight may be recorded each shift until the patient’s fluid balance is stable. Correct Answer(s): C

The patient’s general clinical presentation indicates to RT that patient is in distress. The RT’s first step should be to: A) call a code & stand by to assist with CPR. B) do complete physical exam to determine precise cause C) evaluate problem quickly & intervene or locate some-one to assist patient D) follow procedure learned in class to introduce himself

Feedback: If the patient is in distress, the priorities are to evaluate the problem in the most efficient & rapid way possible & to intervene or locate someone who can assist the patient. Correct Answer(s): C

The normal range for oral body temperature in most peo-ple is _____ °F to _____ °F. A) 97.0; 99.5 B) 96.7; 98.5 C) 98.7; 100.5 D) 97.7; 98.5

Feedback: Normal body temperature for most persons is approx. 98.6° F (37° C), with a normal range from 97.0° F to 99.5° F & daily variations of 1° F to 2° F. Correct Answer(s): A

You administer an inhaled bronchodilator that is known to have adrenergic side effects on the heart. What clinical sign should you watch for in your patient? A) Bradycardia B) Tachycardia C) Bradypnea D) Tachypnea

Feedback: The adrenergic effect on the heart is excitatory, leading to an increase in HR. The muscles of respiration are under somatic control. Correct Answer(s): B

What is the adrenergic effect on bronchial smooth muscle? A) Constriction B) Dilation (relaxation) C) Both D) Neither

Feedback: The effect of sympathetic (adrenergic) stimula-tion of the bronchi is relaxation & dilation of airway diame-ter. Correct Answer(s): B

Your patient is accidentally given a large dose of a para-sympathomimetic drug. What side effects of parasympa-thetic overstimulation do you expect to see? I. Salivation II. Lacrimation III. Urination IV. Defecation A) I only B) I & II only C) I, II, & III only D) I, II, III, & IV

Feedback: Overstimulation of the parasympathetic branch would render the body incapable of violent action & would result in what is termed the SLUD syndrome: salivation, lacrimation, urination, & defecation. Correct Answer(s): D

Your patient is suffering from bradycardia. Which type of drug do you recommend? A) Sympatholytic B) Sympathomimetic C) Parasympathomimetic D) Both A & C

Feedback: A sympatholytic drug would work to block “fight or flight” response & prevent increase in HR. A sympatho-mimetic drug would induce “fight or flight” response & cause increase in HR. A parasympathomimetic response would involve slowing rate of sinoatrial (SA) node conduc-tion as well as decreasing atrioventricular (AV) node con-duction. Correct Answer(s): B

Epi stimulates which of the following receptor sites? A) a B) b1 C) b2 D) All of the above

Feedback: Epi stimulates both a & b sites equally. Correct Answer(s): D

The stimulation of which receptor sites produces bronchial smooth muscle relaxation? A) b1 B) b2 C) a D) b1and b2

Feedback: Stimulation of b1 receptors increases the force & rate of cardiac contraction. Stimulation of b2 receptors relaxes bronchial smooth muscle as well as the vascular beds of skeletal muscle. Stimulation of a receptors results in the vasoconstriction of peripheral blood vessels. Correct Answer(s): B

You are treating a patient for bronchospasm. Albuterol is only aerosolized agent being administered at this time. What other type of aerosolized drug might u recommend? A) An anticholinergic bronchodilator B) A sympatholytic C) Both A & B D) Neither A nor B

Feedback: Two classes of drugs modify smooth airway muscle tone: adrenergic bronchodilators & anticholinergic bronchodilators. A sympatholytic drug would act to negate the effects of an adrenergic bronchodilator such as albut-erol. Correct Answer(s): A

You are treating an asthmatic who also happens to be tak-ing propranolol (a b blocker) for a history of cardiac ar-rhythmias. What effect would albuterol have on patient? A) Antagonistic effect B) A synergistic effect C) Little or no effect D) An additive effect

Feedback: As a b blocker, propranolol would prevent al-buterol (a b agonist) from inducing the desired effect of bronchodilation. Propranolol & albuterol are not synergis-tic drugs, but actually compete for the same receptor sites. Correct Answer(s): C

Adrenergic bronchodilators mimic the actions of: A) Norepi B) Acetylcholine C) Penicillin D) Epi

Feedback: Penicillin is antibiotic, not bronchodilator. Ad-renergic bronchodilators are either catecholamines or de-rivatives of catecholamines. Mimic actions of epi relatively precisely, causing tachycardia, elevated BP, smooth muscle relaxation of bronchioles & skeletal muscle blood vessels, glycogenolysis, skeletal muscle tremor & CNS stimulation. Correct Answer(s): D

Relaxation of smooth airway muscle in the presence of reversible airflow obstruction is a general indication for the use of: A) Mucolytics B) Adrenergic bronchodilators C) Antiinfective agents D) Steroids

Feedback: Short-acting b2 agonists are for relief of acute reversible airflow obstruction. Although mucolytics may help reduce mucus, they wont reverse bronchocon-striction. Antiinfective agents help fight infections, do not reverse airflow obstruction. Steroids fight inflammation; are not fast-acting & cannot reverse airflow obstruction. Correct Answer(s): B

Disease states that could benefit from the use of adrener-gic bronchodilators include which of the following? I. Asthma II. Bronchitis III. Emphysema IV. Bronchiectasis V. Pleural effusion A) I & III only B) II, IV, & V only C) I, II, III, & IV only D) I, II, III, IV, & V

Feedback: Adrenergic bronchodilators will not reverse pleural effusion. The general indication for use of adrener-gic bronchodilator is relaxation of airway smooth muscle in presence of reversible airflow obstruction associated with acute & chronic asthma, bronchitis, emphysema, bronchi-ectasis, & other obstructive airway diseases. Correct Answer(s): C

Short-acting b2 agonists are indicated for: A) Reduction of airway edema B) Relief of acute reversible airflow obstruction C) Maintenance of bronchodilation D) Thinning of secretions

Feedback: Steroids, not b agonists, are useful in reducing airway swelling. Short-acting b2 agonists such as albuterol, levalbuterol, or pirbuterol are indicated for relief of acute reversible airflow obstruction in asthma or other obstruc-tive airway diseases. Long-acting b agonists are used for maintenance bronchodilation. b Agonists are not mucus-controlling agents. Correct Answer(s): B

Your patient is diagnosed with persistent asthma. Which type of drug would you recommend for maintenance bronchodilation & control of bronchospasm? A) Short-acting adrenergic agent B) Long-acting adrenergic agent C) a-Adrenergic agent D) Mucolytic agent

Feedback: Short-acting adrenergics don’t provide long-term relief with nocturnal asthma symptoms. Long-acting agents are for maintenance bronchodilation & control of bronchospasm & nocturnal symptoms. Adrenergics may not provide b-specific bronchodilation. Mucolytics do not produce bronchodilation; may actually cause bronchocon-striction as side effect. Correct Answer(s): B

Your patient presents with postextubation stridor. You recommend racemic epi for its: A) a-Adrenergic vasoconstricting effect B) Short-acting b2-adrenergic effect C) Long-acting b2-adrenergic effect D) b1-Adrenergic effect

Feedback: Racemic epi often used inhaled or direct into lung for its strong a-adrenergic vasoconstricting, to reduce swelling after extubation or during epiglottitis, croup or to control bleeding during endoscopy. This provides short-term bronchodilation, but little relief from airway edema. Is a-adrenergic vasoconstrictive response that would slow progress of airway edema. Correct Answer(s): A

You enter room of a 2-year-old who presents with charac-teristic “barking cough” found with croup. Once the diag-nosis is confirmed, you may recommend which medica-tions to help provide relief from subglottic swelling? A) Albuterol B) Terbutaline C) Racemic epi D) Salmeterol

Feedback: Although effective bronchodilator, albuterol provides little relief from swelling. Terbutaline won’t pro-duce a-adrenergic vasoconstriction. Racemic epi used ei-ther inhaled or direct into lung for its strong a-adrenergic vasoconstricting effect, to reduce airway swelling after extubation or in epiglottitis, croup, bronchiolitis or to con-trol bleeding during endoscopy. Correct Answer(s): C

Epi stimulates which sites? I. a II. b1 III. b2 IV. Cholinergic A) II only B) IV only C) I, II, & III only D) II, III, & IV only

Feedback: Epi is a potent catecholamine bronchodilator that stimulates both a & b receptors. Because epi lacks b2-receptor specificity, there is a high prevalence of side ef-fects such as tachycardia, BP increase, tremor, headache, & insomnia. Correct Answer(s): C

Epi would be indicated for all of the following except: A) Tx of infections B) Systemic hypersensitivity reactions C) Acute asthma episodes D) Cardiac stimulation

Feedback: Epi occurs naturally in adrenal medulla & has rapid onset but short duration because of metabolism by catechol O-methyltransferase (COMT). Used by inhalation & subQ to treat patients with acute asthma. Also used as heart stimulant due to strong b1 effect. Self-administered, intramuscular injectable doses of 0.3 & 0.15 mg are to con-trol systemic hypersensitivity reactions. Correct Answer: A

Long-acting b2 agonists are indicated for: A) Acute asthma attacks B) Mucus reduction C) Treating infections D) Maintenance therapy for asthmatics

Feedback: onset of action of many long-acting bronchodi-lators unsuitable as rescue meds. b2 Agonists used mostly for bronchodilatory effects & are not antiinfective. Although b2 agonists affect some mucociliary clearance, do not reduce mucus production. Long-acting bronchodila-tors useful in controlling nocturnal symptoms while provid-ing more convenient dosing. Correct Answer(s): D

The bronchodilating action of adrenergic drugs is due to stimulation of: A) a Receptors B) Cholinergic receptors C) b1 Receptors D) b2 Receptors

Feedback: a-Receptor stimulation has a vasocon-striction/vasopressor effect. Stimulation of cholinergic re-ceptors may cause bronchoconstriction. b1 Stimulation increases myocardial conductivity, HR (HR), & contractile force. The bronchodilating action of the adrenergic drugs is due to stimulation of b2 receptors located on bronchial smooth muscle. Correct Answer(s): D

b1 Receptor stimulation will: A) Cause vasoconstriction B) Provide upper airway decongestion C) Increase HR & contractile force D) Relax bronchiole smooth muscle

Feedback: a-Receptor stimulation causes vasoconstriction & vasopressor effect; in upper airway this can provide de-congestion. b1-Receptor stimulation causes increased my-ocardial conductivity & increased HR & increased contrac-tile force. b2-Receptor stimulation causes relaxation of bronchial smooth muscle, with some inhibition of inflam-matory & stimulation of clearance. Correct Answer(s): C

Inhalation is the preferred route of administering cate-cholamines for which of the following reasons? I. Rapid onset of action II. Smaller dosage III. Reduced side effects IV. Drug delivered to tar-get organ V. Safe & painless route A) I & II only B) III & IV only C) I, III, & V only D) I, II, III, IV, & V

Feedback: Inhalation is the preferred route for administer-ing b-adrenergic drugs for all the following reasons: 1. Onset is rapid. 2. Smaller doses needed compared with those for oral use. 3. Side effects such as tremor & tachycardia are reduced. 4. Drugs delivered directly to target organ (i.e., lung). 5. Inhalation is painless & safe. Correct Answer(s): D

Continuous nebulization of inhaled b agonists has been used for: A) Severe asthma B) Pneumonia C) Cystic fibrosis D) Emphysema

Feedback: The Guidelines recommend 2.5 to 5 mg of al-buterol by neb every 20 min. x 3, as well as 10-15 mg/hr. by neb. Because neb Tx takes approx. 10 min., giving three Tx every 20 min. requires repeated RT attendance. Contin-uous admin by neb may simplify this. Correct Answer(s): A

You are ordered to extubate a mechanically ventilated pa-tient who has recently undergone open heart surgery. On postextubation assessment you note that the patient has stridor with mild retractions. Pharmacologically, you would recommend: A) b2 Adrenergic B) a Adrenergic C) Anticholinergic D) Sympatholytic

Feedback: Of the drug classes listed, it is the a-adrenergic vasoconstricting effect of racemic epi that allows it to re-duce swelling in the airway. Correct Answer(s): B

Patient with glottic edema is in mild distress. Which medi-cation would be of benefit in this situation? A) Albuterol B) Ipratropium bromide C) Racemic epi D) Theophylline

Feedback: Racemic epi is indicated for postextubation swelling of the airway because of its strong a-adrenergic vasoconstricting effect. Correct Answer(s): C

The only anticholinergic that is approved by the U.S. Food & Drug Administration (FDA) for aerosolization is: A) Ipratropium bromide B) Albuterol sulfate C) Glycopyrrolate D) Atropine

Feedback: Ipratropium has been approved by the FDA spe-cifically for use in the Tx of chronic obstructive pulmonary disease (COPD), although the drug is also prescribed for Tx of asthma. Correct Answer(s): A

Combivent is a combination drug including which agents? A) Albuterol & Serevent B) Serevent & Atrovent C) Albuterol & Atrovent D) Maxair & Atrovent

Feedback: Ipratropium & albuterol (Combivent) is a com-bination MDI product, with the usual doses of each agent (18 mg/puff of ipratropium, 90 mg/puff of albuterol). Correct Answer(s): C

Patients using ipratropium aerosols should be instructed to avoid allowing the aerosol in contact with their: A) Hair B) Nose C) Eye D) Ear

Feedback: Ipratropium nasal spray is useful in a variety of cases & may cause pupillary dilation & lens paralysis. Ipratropium has no known effect on human hair or the human ear. Correct Answer(s): C

What is the primary purpose of the respiratory system? A) continuous absorption of O2 & excretion of CO2 B) filtering to prevent allergens & microbes reaching lungs C) transport O2ated blood to the tissues D) warm & humidify inspired gas

Feedback: The respiratory system's primary function is the continuous absorption of O2 & the excretion of CO2. Correct Answer(s): A

By what mechanism does gas exchange across the lung occur? A) active transport B) facilitated diffusion C) facilitated transport D) simple diffusion

Feedback: This close “match” of gas & blood across a large but extremely thin blood-gas barrier membrane enables efficient gas exchange to occur by simple diffusion. Correct Answer(s): D

What is the function of the thorax? A) facilitate digestion B) heat, humidify, & filter gases C) protect the vital organs D) vocalization

Feedback: The thorax is a cone-shaped cavity that houses the lungs & the contents of the mediastinum (Figure 8-16). It functions to protect the vital organs within & has the capability of changing shape to enable air to be moved into & out of the lungs. Correct Answer(s): C

What is the name of the thin serous membrane that covers the inner layer of the thoracic wall? A) cupula B) mesothelioma C) parietal pleura D) visceral pleura

Feedback: The inner layer of the thoracic wall is lined with a serous membrane called the parietal pleura. Correct Answer(s): C

The intercostal arteries, veins, & nerves run through which of the following? A) costal groove on the top of each rib B) costal groove on the bottom of each rib C) fibers of the intercostal musculature D) surface of the parietal pleura

Feedback: Just below each rib is a thoracic artery, vein, & nerve that supply blood flow & nerve communications to that region of the chest wall (Figure 8-17). Correct Answer(s): B

Which of the following muscles are considered primary muscles of ventilation? I. diaphragm II. intercostals III. scalenes IV sternomastoid A) I, III, & IV B) I & II C) III only D) I, II, III, & IV

Feedback: The diaphragm & intercostal muscles are the primary muscles of ventilation. Correct Answer(s): B

The diaphragm is innervated by which of the following nerves? A) glossopharyngeal B) phrenic C) seventh cranial D) vagus

Feedback: Functionally, the diaphragm is divided into a right & left hemidiaphragm. Each hemidiaphragm is inner-vated by a phrenic nerve that arises from branches of spi-nal nerves C3, C4, & C5. Correct Answer(s): B

When a COPD patient leans forward braced in a tripod po-sition, this lends particular advantage to which accessory muscles of inspiration? A) external intercostals B) pectoralis C) scalenes D) sternocleidomastoids

Feedback: Major & minor pectoralis muscles broad fan-shaped muscles of upper anterior chest. Pectoralis major originates on humerus & inserts onto clavicle & sternum. The pectoralis minor originates on scapula & inserts on anterior portions of ribs 3 - 5. Correct Answer(s): B

What is the function of the very small amount of pleural fluid that is found in the pleural space? A) composes part of anatomic shunt B) liquid barrier for pathogens C) part of pulmonary blood flow D) reduces friction

Feedback: The small volume of pleural fluid is spread out over the entire surface of both lungs & functions as a lub-ricant to reduce friction as the lungs move within the thor-ax & as an airtight seal that adheres together the two pleu-ral membranes. Correct Answer(s): D

What is the mediastinum? A) membranous sac surrounding the heart & great vessels B) middle layer of muscle fibers constituting the heart C) point of division of the trachea into the bronchi D) structure separating the right & left thoracic cavities

Feedback: The mediastinum lies between the left & right pleural cavities that contain the lungs (Figure 8-16). Correct Answer(s): D

What is the name of the negative feedback reflex associat-ed with the termination of inspiration? A) carotid sinus B) Head’s paradoxical C) Hering-Breuer D) vasovagal

Feedback: Pulmonary stretch receptors progressively dis-charge during lung inflation & are linked to inhibition of further inflation. This is a type of negative feedback known as the inflation reflex or the Hering-Breuer inflation reflex. Correct Answer(s): C

What is your primary concern if you discover that a patient does not have a gag reflex? A) fear of aspiration of bacteria or food B) that their tonsilar tissues are grossly swollen C) that they will not be able to breathe adequately D) tracheal collapse

Feedback: Reflexes of the mouth, pharynx, & larynx help to protect the lower respiratory tract during swallowing. The-se protective functions can be severely compromised dur-ing anesthesia or unconsciousness. Loss or compromise of these important reflexes can result in aspiration of bacte-ria colonized saliva or food & can cause pulmonary infec-tion & asphyxiation in severe cases. Correct Answer(s): A

Into what structure do the eustachian tubes drain? A) larynx B) nasopharynx C) oropharynx D) vestibule

Feedback: In the lateral nasopharynx, there are two open-ings into the left & right eustachian tubes that link the up-per airway with the middle ear (Figure 8-36). The eusta-chian tubes drain fluid out of the middle ear & allows gas to move in or out of the middle to equalize pressure on either side of the tympanic membrane. Correct Answer(s): B

What is a primary function of the larynx? A) cover the glottic opening during forced expiration B) house Waldeyer’s ring of tonsilar material for airway defense C) protect airway during eating or drinking D) provide a common passageway for food & gas

Feedback: Generally, it functions to protect the respiratory tract during eating & drinking & in phonation. Correct Answer(s): C

At what point does the trachea branch into two mainstem bronchi? A) carina B) cricoid cartilage C) glottis D) manubrium

Feedback: At the base of the trachea, the last cartilaginous ring that forms the bifurcation for the two bronchi is called the carina. The carina is an important landmark that is used to identify the level at which the two mainstem bron-chi branch off from the trachea. Correct Answer(s): A

Which of the following is not a function of mucus in the body? A) Lubrication B) Improvement of gas exchange C) Waterproofing D) Protection from inflammation

Feedback: Mucus lubricates airways, acts to “waterproof” airways by forming gel layer that floats over water pericili-ary layer & provides protection from inflammation by forming a boundary between airway & potential irritants. Mucus does not act to improve gas exchange; in fact, overproduction or difficulty clearing mucus may prove det-rimental to gas exchange. Correct Answer(s): B

You have a patient with chronic obstructive pulmonary disease (COPD) who is struggling to expel viscid mucus plugs. What would you recommend for the problem? A) Dopamine B) Acetylcysteine C) Cromolyn sodium D) Albuterol

Feedback: As a mucolytic, acetylcysteine has been used in the Tx of conditions associated with viscous mucus secre-tions (although this is not an approved use of the drug). Neither dopamine, cromolyn sodium, nor albuterol is a mucus-controlling agent. Correct Answer(s): B

Most of the muscle mass of the heart is located in which chamber? A) left atrium (LA) B) left ventricle (LV) C) right atrium (RA) D) right ventricle (RV)

Feedback: The two lower heart chambers, or ventricles, make up the bulk of the heart’s muscle mass & do most of the pumping that circulates the blood (Figure 9-2). The mass of the left ventricle is approx. two thirds larger than that of the right ventricle & has a spherical appearance when viewed in anteroposterior cross section. Correct Answer(s): B

The mitral (bicuspid) valve does which of the following? A) prevents atrial backflow during ventricular contraction B) separates the right atrium & the left atrium C) separates the right atrium & the right ventricle D) separates the right ventricle & the pulmonary artery

Feedback: The valve between the left atrium & ventricle is the bicuspid, or mitral, valve. The AV valves close during systole (contraction of the ventricles), thereby preventing backflow of blood into the atria. Correct Answer(s): A

Which represent normal order of structures encountered by blood flowing from vena cava to aorta? A) RA, tricuspid, RV, pulmonary artery, mitral, LV, aortic B) RA, tricuspid, RV, aortic, LA, mitral, LV, pulmonary valve C) RA, tricuspid, LV, pulmonary, veins, LA, mitral, RV, aortic D) RA, tricuspid, RV, pulmonary valve, pulmonary artery, pulmonary veins, LA, mitral, LV, aortic valve

Feedback: DeO2ed blood enters right atrium from superior vena cava. Then blood flows over tricuspid valve into right ventricle. Pumps blood through pulmonary valve, to pul-monary arteries & to lungs. O2ed, blood returns to left atrium through pulmonary veins. Pumps blood over mitral valve to left ventricle. Blood pumped through aortic valve into aorta. Correct Answer(s): D

The temperature at which a solid converts to a liquid is the _____ point. A) Freezing B) Melting C) Boiling D) Critical

Feedback: This is the definition of melting point. Freezing is the change of a substance from a liquid to a solid. Melt-ing is the change from a solid to a liquid. The temperature at which a liquid converts to a gaseous state is the boiling point. The critical point is used to describe the critical temperature & critical pressure of a substance. Correct Answer(s): B

Boyle’s law describes the relationship between which of the following? A) Pressure & temperature B) Volume & temperature C) Volume & pressure D) Pressure & density

Feedback: Boyle’s law states that at a constant tempera-ture, the volume of a gas varies inversely proportional to pressure [V = 1/P]. The relationship between volume & temperature is expressed in Charles’ law. The relationship between pressure & temperature is described by Gay-Lussac’s law. Correct Answer(s): C

The relationship of how the volume of a gas varies with temperature is known as _____ law. A) Gay-Lussac’s B) Newton’s C) Charles’ D) Boyle’s

Feedback: The relationship between pressure & volume is described by Boyle’s law, between volume & temperature, by Charles’ law; between pressure & temperature, by Gay-Lussac’s law. Newton detailed the many relationships of gravitational force & motion. Correct Answer(s): C

Which gas law describes the relationship between the temperature & pressure of a gas when volume is constant? A) Gay-Lussac’s law B) Charles’ law C) Dalton’s law D) Boyle’s law

Feedback: Gay-Lussac expressed the relationship between pressure & temperature. Correct Answer(s): A

The sum of the partial pressures of a gas mixture equals the total gas pressure of the system. This statement repre-sents which of the following laws? A) Dalton’s law B) Avogadro’s law C) The-combined gas law D) Boltzmann’s Universal Gas Constant

Feedback: Partial pressure of gas within gas mixture can be calculated by multiplying total pressure of mixture by per-centage of mixture it occupies. Correct Answer(s): A

Which of the following terms does not describe a pattern of flow? A) Tubular B) Laminar C) Turbulent D) Transitional

Feedback: Tubular is the only word in the list that does not describe a pattern of flow. Correct Answer(s): A

What is the international color code for compressed air? A) Gray B) Black C) Yellow D) Black & white

Feedback: The international color code for compressed air is black & white. Yellow is the color set by the U.S. National Formulary. Correct Answer(s): D

What are the pin positions for an E size O2 cylinder? A) 2 & 4 B) 2 & 5 C) 2 & 6 D) 3 & 5

Feedback: See Figure 2-9. Correct Answer(s): B

Which of the following E size O2 cylinders will last longest? Pressure Flow (psig) (L/min) A) 1600 3 B) 1400 2.5 C) 800 2 D) 400 1

Feedback: This answer was derived from the following formula: 1400 ´ 0.28 = 392/2.5 L/min = 156.8 min.. 1400 psig at 2.5 L/min will last the longest compared with the other 3. Correct Answer(s): B

If the air-entrainment port on a Venturi mask is occluded, which of the following will happen? I. A decrease in flow II. A decrease in FIO2 III. An increase in flow IV. An increase in FIO2 A) I & II B) I & III C) I & IV D) None of the choices

Feedback: Partial obstruction of O2 flow downstream of the jet orifice or partial obstruction of the entrainment ports will decrease the amount of room air entrained, thus raising the FIO2 of the delivered gas. Correct Answer(s): C

If a Venturi mask is set at 28% & the liter flow is set above the set liter flow prescribed on the device, what FIO2 is being delivered? A) 28% B) 32% C) 100% D) 80%

Feedback: The flow of O2 to the nozzle is constant, so an obstruction will increase the FIO2, but not the flow. Correct Answer(s): A

Patient has SpO2 of 75% on a nonrebreathing mask. You notice that mask is hooked to bubble humidifier. The hu-midifier is whistling & expanded. What is your next action? A) Change the bubble humidifier; it’s defective. B) Check for kinks in tubing. C) Remove NRB mask from humidifier & run off of O2. D) Place a Venturi mask on the patient.

Feedback: The humidity bottle is not designed for high flows. When it is set to a high flow, the humidity bottle expands & whistles; in turn there is a greater likelihood that the O2 flowmeter will pop off from the pressure source. Correct Answer(s): C

The total flow for a 35% air-entrainment mask running at 10 L/min is _____ L/min. A) 43 B) 53 C) 60 D) 65

Feedback: 100% O2 – 35% FIO2 = 65%. 20% air – 35% FIO2 = 15. Ratio: 15:65 = 1:4.3. For every 1 L/min of O2, there is 4.3 L/min air being entrained. 1 + 4.3 = 5.3 ´ 10 = 53 L/min total flow. Correct Answer(s): B

______ law states that if the temperature of a gas remains constant, the volume of a gas is inversely related to its pressure. A) Henry’s B) Boyle’s C) Dalton’s D) Laplace’s

Feedback: Boyle's law states that if the temperature of a gas remains constant, the volume of a gas is inversely re-lated to its pressure. Therefore, as pressure is exerted on a container, the gas volume within the container decreases. Correct Answer(s): B

Dalton’s law states that: A) The total pressure of a gas mixture equals the sum of the partial pressures of each constituent gas in the mixture B) The pressure within a liquid sphere is influenced by the surface tension forces of the liquid & the size of the sphere C) Is direct relationship between pressure of gas & temp D) The volume of a gas is inversely related to its pressure

Feedback: Dalton’s law states that the sum of the partial pressures of a gas mixture equals the total pressure of the system. Correct Answer(s): A

A patient is receiving 0.30 FIO2 with a barometric pressure at 750 mm Hg. The partial pressure of CO2 (PCO2) for this patient is 70 mm Hg; the partial pressure of arterial O2 (PaO2) is 60 mm Hg. The PAO2 for this patient is __mm Hg. A) 100.2 B) 123.4 C) 160.0 D) 181.7

Feedback: Formula: PAO2 = (Barometric pressure [PB] – pressure of water vapor [PH2O]) FIO2 – PaCO2 (1.25). PAO2 = (750 mm Hg – 47) 0.30 – 70 (1.25). PAO2 = 210.9 – 87.5. PAO2 = 123.4 mm Hg. Correct Answer(s): B

At 37° C, water vapor exerts a partial pressure of ____ mm Hg & contains _____ mg H2O/L. A) 43.9; 47 B) 47; 43.9 C) 44; 44 D) 100; 100

Feedback: At sea level, a gas at body temperature (37° C), at a pressure of 47 mm Hg, & at a saturation of 100% will contain 43.9 mg of water per liter of gas. Correct Answer(s): B

A nosocomial infection is best defined as a: A) Respiratory system–borne pathogen B) Hospital-acquired pathogen C) Bacterial or viral organism D) Blood-borne pathogen

Feedback: A nosocomial infection is one that is acquired in a hospital setting. Respiratory system–borne pathogens & blood-borne pathogens can be acquired in the community. Correct Answer(s): B

The primary indication for lung expansion therapy is: A) Asthma B) Atelectasis C) Chronic bronchitis D) Respiratory distress

Feedback: Lung expansion therapy is used to either pre-vent or treat atelectasis. Correct Answer(s): B

Indication for IS includes: A) Post abdominal surgery B) Respiratory muscle weakness C) Optimization of bronchodilator therapy D) Inability to effectively deep-breathe

Feedback: Abdominal surgery predisposes a patient to the development of pulmonary atelectasis. Patients with res-piratory muscle weakness or the inability to effectively deep-breathe will not be able to perform IS & therefore will not benefit from its use. IS is not used to optimize bronchodilator therapy. Correct Answer(s): A

When instructing patients on use of volume-displacement incentive spirometer, RT should inform patients to do what A) Inhale deeply & hold for 3 to 5 seconds. B) Exhale as fast as possible into the mouthpiece. C) Inhale & exhale rapidly through the mouthpiece. D) Perform 30 sustained maximum inspirations every 15 min.

Feedback: After patients have achieved the maximum vol-ume, they should be instructed to hold this volume con-stant for 3 to 5 seconds. The other choices are not tech-niques for use with IS. Correct Answer(s): A

A patient reports that during IS she becomes dizzy & must stop the maneuver when this happens. The most probable cause of this situation is: A) Hypoventilation B) Hyperventilation C) Patient fatigue D) Bronchospasm

Feedback: The patient’s lightheadedness is caused by hy-perventilation. This is a common complication of IS. Correct Answer(s): B

Side effects of aerosolized steroid use include all of the following except: A) Cough B) Osteoporosis C) Dysphonia D) Oral thrush

Feedback: Cough, dysphonia, & oral thrush are potential local side effects seen with the administration of aeroso-lized corticosteroids. No data have demonstrated clearly the effect of inhaled glucocorticoids on bone density & osteoporosis. Correct Answer(s): B

The brand name for cromolyn sodium is: A) Tilade B) Accolate C) Intal D) Singulair

Feedback: Tilade is the brand name for nedocromil sodi-um. Accolate is the brand name for zafirlukast. Intal is the brand name for cromolyn sodium, & Singulair is the brand name for montelukast. Correct Answer(s): C

Cromolyn sodium is effective in preventing bronchospasm by: A) Inhibiting mast cell degranulation B) Blocking cholinergic receptor sites C) Enhancing mast cell degranulation D) Stimulating b2-adrenergic sites

Feedback: As a mast cell stabilizer, cromolyn sodium works to prevent bronchospasm by inhibiting the degranulation of mast cells, thereby blocking release of the chemical me-diators of inflammation. It has no bronchodilatory effects. Correct Answer(s): A

The primary goal of acid-base homeostasis is to maintain which of the following? A) normal HCO3- B) normal PCO2 C) normal pH D) normal PO2

Feedback: Acid-base balance refers to physiological mech-anisms that keep the H+ ion concentration of body fluids in a range compatible with life. Correct Answer(s): C

What is the normal arterial blood pH range? A) 7.25 to 7.35 B) 7.35 to 7.45 C) 7.45 to 7.55 D) 7.55 to 7.65

Feedback: To sustain life, the body must maintain the pH of fluids within a narrow range, from 7.35 to 7.45. Correct Answer(s): B

Which organ system maintains the normal level of HCO3- at 24 mEq/L? A) liver B) lung C) renal D) spleen

Feedback: Normally, the kidneys maintain an arterial bi-carbonate concentration of approx. 24 mEq/L, whereas lung ventilation maintains an arterial PCO2 of approx. 40 mm Hg. Correct Answer(s): C

What is the primary chemical event in respiratory acidosis? A) decrease in blood CO2 levels B) decrease in blood HCO3- levels C) increase in blood CO2 levels D) increase in blood HCO3- levels

Feedback: A high PaCO2 increases dissolved CO2, lowering the pH: Respiratory disturbances causing acidemia are called respiratory acidosis. Correct Answer(s): C

An increase in the H+ ion concentration [H+] of the blood due only to an increase in the arterial PCO2 (hypercapnia) best describes which of the following? A) metabolic acidosis B) metabolic alkalosis C) respiratory acidosis D) respiratory alkalosis

Feedback: For example, if the pH was lower than 7.35 (de-noting an acidosis) & the PaCO2 was higher than 45 mm Hg, according to the H-H equation, the high PaCO2 would indeed lower the pH (i.e., produce an acidosis). Therefore, the respiratory system is at least in part, if not entirely, responsible for the acidosis. Correct Answer(s): C

An ABG result shows pH 7.56 & HCO3- 23 mEq/L. Which of the following is the most likely disorder? A) metabolic acidosis B) metabolic alkalosis C) respiratory acidosis D) respiratory alkalosis

Feedback: If HCO3- is in the normal range in the presence of alkalosis, then the alkalosis probably is of respiratory origin. Correct Answer(s): D

What is the normal range for BE? A) ±2 mEq/L B) ±4 mEq/L C) ±6 mEq/L D) ±24 mEq/L

Feedback: A normal BE is ±2 mEq/L. A “positive BE” (great-er than +2 mEq/L) indicates a gain of base or loss of acid from nonrespiratory causes. A “negative BE” (less than –2 mEq/L) indicates a loss of base or a gain of acid from non-respiratory causes. Correct Answer(s): A

In acute respiratory acidosis, what would you expect the BE range to be? A) –4 to –6 mEq/L B) +2 to –2 mEq/L C) +4 to +6 mEq/L D) +22 to +26 mEq/L

Feedback: In cases of acute (uncompensated) respiratory acidosis, the BE commonly would be within the normal range, indicating correctly that the disturbance is purely respiratory in origin. Correct Answer(s): B

What is the first step in basic life support? A) Open the airway. B) Activate the EMS system. C) Determine unresponsiveness. D) Restore circulation.

Feedback: Check for movement or response. Correct Answer(s): C

You enter woman’s room & find her collapsed on floor near bed. When you shake her shoulder & shout “Are you OK?” there is no response. What should your next step be? A) Open her airway. B) Call for help (call a code). C) Begin chest compressions. D) Determine pulselessness.

Feedback: Whatever the location, the victim’s level of con-sciousness should be assessed quickly by checking for signs of life, e.g., movement & breathing. The rescuer should call for help & activate the emergency medical services (EMS) system if the patient is not moving or breathing. Correct Answer(s): B

What is the most common cause of airway obstruction in unconscious patients? A) foreign body lodged in the upper airway B) oral or nasal secretions blocking the pharynx C) tongue falling back into the pharynx D) severe spasm of the laryngeal musculature

Feedback: The most common cause of airway obstruction is loss of muscle tone, which causes the tongue to fall back into the pharynx, thereby blocking airflow. Correct Answer(s): C

Which of the following are legitimate reasons for discon-tinuing basic life support measures? I. if spontaneous breathing & a palpable pulse return II. if a physician pronounces the arrest victim dead III. if advanced life support measures become available A) II & III B) I & II C) I, II, & III D) I & III

Feedback: Rescue attempts continue until (1) advanced life support is available, (2) the rescuers note spontaneous pulse & breathing, or (3) a physician pronounces the victim dead. Correct Answer(s): C