RESPIRATORY LICENSURE EXAMINATIONS COMPILED QUESTIONS

1. Ms. Teevee, a licensed respiratory therapist, have finished charting on her patient when
she notice that an error was made. Ms. Teevee should do which of the following?
A. Tell the nurse so that she will tell the physician.
B. Tell the nurse so that she will chart the correct information.
C. Place a line through the error, initial it, and write in the correct information.
D. Have your supervisor chart the correct information.
C. From a legal point of view, a charting error should never be obliterated. Simply correct and
initial the correct information. Only the person making the error should correct it.

2. Ms. Teevee was doing a respiratory assessment in the patient. In listening to a patient's
lungs, she notice bronchial breath sounds in the right lower lobe. These would indicate
which of the following?
A. Normal lungs
B. Pneumothorax
C. Consolidation in her right lower lobe
D. Pleural effusion in her right lower lobe
C. Bronchial breath sounds are not normal in the right lower lobe and indicate consolidation of
the alveoli. Neither pneumothorax nor pleural effusion can be identified by bronchial breath
sounds.

3. To help Ms.Teevee determine whether your patient has orthopnea, she would ask which
of the following?

A.“How many flights of stairs can you climb before you become short of breath?”
B.“Do you know who the governor is?”
C.“Do you need to use extra pillows behind your head and back to keep from
getting short of breath when you sleep?”
D.“Do any particular foods seem to make it harder for you to cough up your
secretions?”

C. Orthopnea relates to the patient's inability to lie down and breathe comfortably. Extra pillows
are needed to raise the head and body. The other questions relate to other areas of assessment.

4. In observing an infant's chest configuration, you notice that it is the same size in both the
AP and lateral dimensions. This would indicate that the patient has

A.A normal chest

B.Funnel chest/pectus excavatum
C.Pulmonary emphysema with air trapping
D.Lordosis
A. An infant's chest is basically round in dimension.
 5. Mr. Myco is called to evaluate a patient's breathing pattern. He notice that the patient's
tidal volumes go from small to large to small and then stop for 10 seconds before starting
up again. The pattern repeats itself. This patient's breathing pattern would best be called

A. Eupnea
B. Obstructed expiration
C. Kussmaul's respiration
D. Cheyne-Stokes respiration

D. Only Cheyne-Stokes respiration fits the description.

6. Nina Sta. Ana has distended external jugular veins, even though her head and body are
raised 45 degrees above her legs. This would indicate that Nina Sta. Ana:

A.Is hypertensive
B.Is fluid overloaded
C.Has emphysema
D.Is dehydrated

B. Fluid overload causes the jugular veins to be distended. Dehydration may result in the jugular
veins being flat. Emphysema and hypertension should not have any effect on the jugular veins.

7. When assessing for a client, you did a Tactile Fremitus. Tactile fremitus would be
reduced in all of the following conditions EXCEPT
A. Pneumothorax
B. COPD
C. Pulmonary edema
D. Pleural effusion

C. Tactile fremitus would be reduced in pneumothorax and COPD because the lung is
overinflated. A pleural effusion would block and decrease the sounds coming from the lung.

8. A physician in the CardioPulmonary Unit requested for a blood gas analysis. The
Respiratory Therapist knows that before drawing a blood gas sample from the radial
artery, you should perform which test of adequate perfusion?

A. Allen's test
B. Modified Allen's test
C. Blood pressure measurement
D.P(A-a)O2

B. A modified Allen's test is used to determine whether adequate perfusion exists through the
ulnar artery in case the radial artery should become occluded. This would ensure that the hand is
still well perfused. The Allen's test is used to determine adequate perfusion through the radial
artery. Adequate arm blood pressure does not ensure adequate perfusion of the hand, should the
radial artery become blocked. The P(A-a)O2 test does not measure local perfusion.

9. Patient Maria Leonora hospitalized with leg vein thrombosis experiences sudden
shortness of breath. Which of the following should be recommended to evaluate the
Maria Leonora's situation?

A. Lung compliance
B. Electrocardiogram
C. Chest radiograph
D.VD/VT
D. The patient's history and current situation suggest that a pulmonary embolism has developed.
The VD/VT test should be performed to determine whether the patient's dead space has increased.
If it has, this will match the clinical suspicion of a pulmonary embolism. It is doubtful that the
patient's lung compliance will change if a pulmonary embolism occurred. There is no specific
change in the electrocardiogram that corresponds with a pulmonary embolism or other sudden
cause of shortness of breath. Chest radiograph changes are unlikely soon after a pulmonary
embolism has occurred.

10. Mr. Teeveehun is called to the Emergency Department to help care for a patient who was
in a car accident and has chest injuries, including broken ribs. While palpating her neck,
Mr.Teeveehun feel a crepitation. What is the most likely cause of this?

A. She has a laryngeal tumor.

B. Blood is in the back of her throat.
C. She has aspirated a tooth.
D. She has an air leak from her lung.

D. The patient's history of injury and crepitus indicates air under the skin. The air under her skin
would have to come from a lung tear.

11. Irvy, a licensed respiratory therapist, is called to start a new aerosolized medication
treatment. After reading the physician's order, she notice that the drug dosage is outside
the normal department guidelines. She should do which of the following?

A. Give the treatment as ordered.

B. Contact the physician to confirm that the order is indeed correct.
C. Give the treatment as ordered, and leave a note in the chart asking for
clarification for the next treatment.
D. Have the nurse rewrite the order.
B. Never give an overdose of a medication. Personally contact the physician to clarify the error.
(Rarely, a larger than usual dose of medication is given under special circumstances. The
physician must make it clear that he or she is aware of the large dose and wants it delivered.)
 12. Since being told of the diagnosis of cancer, a patient has become argumentative about his
care and threatens to hit the nurse and therapist. He should be evaluated for

A. Language barrier problems

B. Hypercarbia
C. Emotional state
D. Hypoxemia

C. The patient is reacting with anger to his diagnosis of cancer. He should be evaluated for
emotional state. The other problems should not cause anger

13. To help determine your patient's level of consciousness, you should ask which of the
following questions?

1.“Do you know what day this is?”

2.“Can I see your identification wristband?”
3.“Do you know where you are?”
4.“How are you feeling today?”
5.“Do you know who the president is?”

A.2, 4
B.3
C.5
D.1, 3
A. The correct two questions relate to the patient's level of consciousness and understanding. The
first question relates to the patient's understanding of time. The third question relates to the
patient's understanding of place. The fifth question relates to the patient's understanding of
person.

14. In palpating your patient for symmetrical chest movements, you notice that his left side
does not move as much as his right side. This indicates that he has which condition or
conditions?

1. Emphysema
2. Congestive heart failure
3. Left-sided pneumonia
4. Left-sided pneumothorax
5. Right-sided pneumonia

A.1, 2
B.3, 4
C.4, 5
D.2
B. Left-sided pneumonia and pneumothorax both result in decreased movement on that side.
Emphysema and congestive heart failure would not cause a one-sided change in movement.
Right-sided pneumonia would result in less movement on the right side.

15. Maria Leonora noticed that patient Y has a tension pneumothorax. Maria Leonora knew
that a tension pneumothorax is identified by which of the following?

1. Chest x-ray film shows a shift of the mediastinum toward the affected lung.
2. Chest x-ray film shows elevation of the hemidiaphragm on the affected side.
3. The patient's vital signs suddenly deteriorate.
4. Chest x-ray film shows a depression of the hemidiaphragm on the affected side.
5. Chest x-ray film shows a shift of the mediastinum away from the affected lung.
6. Vital signs are essentially unchanged.

A.1, 2, 6
B.3, 4, 5
C.1, 2, 3
D.1, 3, 4

B. The high air pressure found with a tension pneumothorax causes the mediastinal contents to
be shifted to the opposite side and the diaphragm on the affected side to be depressed. These
drastic changes can cause the patient's vital signs to deteriorate rapidly.

16. It is most important to ask a patient with a broken ankle from a recent slip on an icy
sidewalk about which of the following?

A. Level of pain
B. Level of consciousness
C. Work of breathing
D. Emotional state
A. It is important to assess the patient's level of pain from the broken ankle. Severe pain should
be managed with increased medication. The other issues are less important to assess unless there
is an apparent problem.

17. A hospitalized patient who recovered from a Clostridium botulinum infection received
several respiratory care services. How should a nondisposable plastic pulmonary function
testing mouthpiece be sterilized before being reused?

A. Steam autoclave for 15 minutes.

B. Soak in glutaraldehyde solution for 10 hours.
C. Pasteurize for 20 minutes.
D. Soak in an alcohol solution for 15 minutes.

B. A glutaraldehyde solution soak for 10 hours is the only way listed to sterilize plastic
equipment without damaging it. Putting plastic equipment into a steam autoclave causes it to
melt and be destroyed. Pasteurization or soaking the equipment in an alcohol solution disinfects
but does not sterilize the equipment as needed.

18. A retired home care patient living on a fixed income needs to be able to disinfect her
respiratory therapy equipment. Which of the following would be best for her?

A.Acetic acid
B.Acid glutaraldehyde
C.Ethylene oxide system
D.Warm, soapy water
A. Acetic acid is found in white vinegar. It is inexpensive and available in any grocery store.
Realize that acetic acid is not a powerful disinfectant and does not kill most pulmonary
pathogens. Acid glutaraldehyde and ethylene oxide systems are too expensive to use in a home.
Warm, soapy water can be used to clean secretions from equipment but does not disinfect it.

19. You are assisting a physician with a surgical tracheostomy procedure on a patient with an
oral endotracheal tube. When should you withdraw the endotracheal tube?

A. After the tracheostomy tube has been inserted

B. After the cuff of the tracheostomy tube has been inflated
C. As the tip of the tracheostomy tube is placed into the stoma
D. Before the stoma is made

C. The endotracheal tube should be removed from the patient as the tracheostomy tube is to be
placed into the stoma. This ensures that the patient has a secure airway throughout the procedure.

20. An unconscious 17-year-old patient has arrived in the emergency department. She was
involved in an automobile accident, has a neck injury, and is wearing a neck brace. If she
were to show signs of an upper airway obstruction, all but one of the following could be
easily used to maintain the airway:
A. Oral endotracheal tube
B. Nasopharyngeal airway
C. Laryngeal mask airway
D. Oropharyngeal airway

A. It could be challenging to place an oral endotracheal tube because the patient has a neck
brace. Because of the neck injury, her head cannot be hyperextended. An anesthesiologist would
need to be called to perform the intubation. A nasopharyngeal airway, oropharyngeal airway, or
LMA can be easily inserted into the patient without the need to hyperextend her neck.
 21. All but one of the following statements about the use of a Lukens trap are true:
A. A vacuum source is needed.
B. All connections must be tight for it to work properly.
C. Either a suction catheter or a bronchoscope is also needed.
D. It is used to collect a sputum sample from a patient with a strong, productive
cough.

D. Lukens traps are used only to get a sputum sample from a patient who cannot cough
productively.

22. Removing the tracheal secretions from your adult patient is difficult when you use −60
mm Hg of vacuum pressure. What should you do?
A. Suction for 20 seconds
B. Suction more frequently
C. Increase the vacuum pressure to −80 mm Hg
D. Change from the central vacuum system to a portable one

C. Increasing the vacuum pressure from −60 to −80 mm Hg will result in the secretions being
removed more quickly. The whole suctioning procedure usually is limited to 15 seconds.
Suctioning for 20 seconds will remove more secretions but is also likely to cause hypoxemia.
Suctioning more frequently will not prove effective if the suctioning level is too low at −60 mm
Hg. A hospital's central vacuum system is more powerful than a portable one and will suction
more effectively.

23. While working the night shift, you are called to intubate an apneic patient. Which of the
following would you need for an emergency oral intubation?
1. Laryngoscope handle
2. Stylet
3. Proper laryngoscope blade
4. 10-mL syringe
5. Magill forceps

A. 1, 2
B. 1, 2, 5
C. 1, 2, 3, 4
D. 2, 4, 5

C. Everything listed except the Magill forceps would be needed. These forceps are only used
during a nasal intubation procedure.

24. Your patient is an 18-year-old woman who was found unconscious from a drug overdose.
She has severe atelectasis of the left lung caused by lying on her left side for 2 days. Her
right lung is normal. She is going to require mechanical ventilation to open the atelectatic
areas. What endotracheal tube would you suggest should be used to properly treat the
abnormal lung?
A. Double-lumen
B. Standard
 C. Fenestrated tracheostomy
D. Wire-reinforced

A. A double-lumen tube is indicated because she can receive independent lung ventilation
through it. This mode of ventilation would allow her lung with atelectasis to be ventilated
differently than her normal lung. None of the other tubes offer this option.

25. Your patient has epilepsy and has been having unpredictable seizure activity. What oral
endotracheal tube would you suggest should be used to provide a secure airway?
A. Double-lumen
B. Preformed
C. Wire-reinforced
D. Guidable
C. A wire-reinforced (armored) tube would prevent her from biting and collapsing the tube
during a seizure. None of the other tubes offer this security.

26. A conscious patient is recovering from Guillain-Barré syndrome and is able to breathe
spontaneously off of the mechanical ventilator for several hours. She currently has a
standard 7.5-mm-ID tracheostomy tube. To help her weaning process but to enable her to
be ventilated at night, what should be done?
A. Remove the tracheostomy tube when she is off of the ventilator.
B. Substitute a speaking-type tracheostomy tube.
C. Replace the current tracheostomy tube with one that is 6.0-mm ID.
D. Substitute a fenestrated tracheostomy tube.
D. Substituting a fenestrated tracheostomy tube for the standard tube allows her to breathe
spontaneously through the upper airway when the inner cannula is removed. This allows her to
talk, which can have a very positive emotional impact on the patient. It is probably going too far
to remove the tracheostomy tube when she is off of the ventilator. This necessitates removing the
tube, covering the stoma, and reinserting the tube later in the day. This can lead to damage to the
tracheal tissue. In addition, if the patient's condition suddenly deteriorates while the
tracheostomy tube is removed, no secure airway is available. Although a speaking-type
tracheostomy tube allows her to speak while on the ventilator, it does not enable her to breathe
through her upper airway when she is off of the ventilator as a fenestrated tube allows. Replacing
the current 7.5-mm-ID tracheostomy tube with one that is 6.0-mm ID greatly increases the
patient's work of breathing. This can fatigue the patient and delay her recovery.

27. A semiconscious patient with many tracheal secretions will need frequent nasotracheal
suctioning. What can be done to minimize trauma from the procedure?
A. Insert a tracheostomy button with a speaking valve.
B. Insert a nasopharyngeal airway.
C. Sedate the patient and insert an oropharyngeal airway.
D. Suction through a fenestrated tracheostomy tube.
B. A nasopharyngeal airway can be inserted to protect the nasal passage from damage by the
suction catheter. An oropharyngeal airway should only be used in unconscious patients and does
not protect the nasal passage. There was no mention of the patient having a tracheostomy.
 28. Your patient who has a tracheostomy button with attached speaking valve is complaining
that it is difficult to breathe. You find that a 12Fr suction catheter cannot be passed
through the button. What should be done?
A. Place a transtracheal oxygen catheter through the tracheostomy button.
B. Force a larger suction catheter through the button.
C. Remove the button and orally intubate the patient.
D. Remove the speaking valve and assess the patient.
D. It is best to remove the speaking valve to determine if that is the cause of the dyspnea. If the
patient can now breathe comfortably, attach a new speaking valve to the button. If the patient
still cannot breathe comfortably, remove the tracheostomy button and reassess the patient.

29. During a surgical procedure, the anesthesiologist wishes to protect the patient's airway
and provide mechanical ventilation, but does not want to place an endotracheal tube.
What airway should be used?
A. Combitube
B. Laryngeal mask airway
C. Oropharyngeal airway
D. Nasopharyngeal airway in each nostril
B. A laryngeal mask airway is commonly used in the operating room to provide a secure airway
without an endotracheal tube. The Combitube is an emergency airway and is not employed in the
operating room. Oropharyngeal and nasopharyngeal airways do not provide a secure airway.
There is no indication for two nasopharyngeal airways to be used at once.

30. You are called to the delivery room to assist in the care of a newborn diagnosed with
macroglossia. What should a respiratory therapist be prepared to do in this situation?
A. Maintain a patent upper airway.
B. Instill surfactant.
C. Initiate mechanical ventilation.
D. Provide supplemental oxygen.
A. A newborn with macroglossia has a very enlarged tongue and is at risk of upper airway
obstruction. The immediate situation may require a respiratory therapist to hold the jaw forward
or insert an oropharyngeal or nasopharyngeal airway to maintain a patent airway. Surfactant,
mechanical ventilation, and supplemental oxygen are not needed because newborns with
macroglossia have normal lung function.

31. After assisting in an emergency oral intubation procedure of an adult patient, you assess
his breath sounds and find them absent in the left lung area. The tube depth marking
shows it is at the 29-cm mark at the patient's front teeth. What do you recommend be
done?
A. Check the chest radiograph results for the tube's placement.
B. Pull the tube back to the 24-cm mark.
C. Push the tube down to the 32-cm mark.
D. Listen for inspiratory sounds over the stomach area.
B. Absent breath sounds over the left lung and a tube depth mark of 29 cm both indicate that the
endotracheal tube is inserted too deep. It has entered the right mainstem bronchus. The cuff
should be deflated, the tube pulled back to the 24-cm mark at the front teeth, and the cuff
reinflated. Check again for bilateral breath sounds to confirm that the tip of the tube is within the
trachea. It is not necessary to check the chest radiograph to know that the tube is in the right
mainstem bronchus. Pushing the tube deeper will only make it go further into the right mainstem
bronchus. It is generally recommended that listening over the epigastric area be done after
listening over the lung areas for breath sounds. While there is nothing wrong with listening over
the stomach area, there is enough clinical evidence given to confirm the tip of the tube is in the
right mainstem bronchus.

32. A fully compensatory pause is seen after which type of heartbeat?

A. Normal sinus rhythm

B. PVC
C. Paroxysmal atrial tachycardia
D. VT

B. PVC has a fully compensatory pause, Normal Sinus rhythm is the normal heartbeat,
Paroxysmal atrial tachycardia and VT (Ventricular Tachycardia) are emergency cases that are
life-threatening but doesn’t have a fully compensatory pause. .

33. All the following are acceptable ways to ventilate a patient during CPR EXCEPT:

A. Endotracheal tube
B. Pneumatic (demand-valve) resuscitator
C. Mouth-to-valve resuscitator
D. Manual resuscitator

B. Current CPR guidelines state that effective ventilation can be achieved by an endotracheal
tube, mouth-to-valve resuscitator, or manual resuscitator. A pneumatic (demand-valve)
resuscitator is not recommended for use because it is difficult to control the delivered tidal
volume and air tends to be forced into the patient's stomach.

34. A patient comes into the Emergency Department appearing ashen gray and complaining
of sudden, severe pain beneath his sternum and shortness of breath. He says this began
after he exercised vigorously for 45 minutes. After putting an O2 mask on the patient,
what should you do?

A. Start ECG monitoring.

B. Recommend that he begin a supervised exercise program at the hospital.
C. Perform a peak flow test to check on exercise-induced asthma.
D. Immediately draw an ABG sample.

A. ECG monitoring is justified because the patient's signs and symptoms could indicate a cardiac
problem. An exercise program is not indicated in this situation and could be dangerous for the
patient. A peak flow test is not indicated now and would not help with the diagnosis of exercise-
induced asthma. It is best to wait at least 10 minutes after putting O2 on a patient before drawing
an ABG sample to check on the patient's O2 level.
 35. The nurse calls you into a patient's room. You notice from the ECG monitor that the
patient is in ventricular tachycardia. You cannot find a carotid pulse, and the nurse says
that he cannot find a blood pressure. What would you recommend?

A. Check the other arm for a blood pressure.

B. Defibrillate the patient.
C. Intubate the patient and start her on a ventilator.
D. Initiate synchronized cardioversion of the patient.

B. Defibrillation is indicated if the patient has VT and is without pulse or blood pressure. The
patient should then be evaluated for full CPR efforts. The other options would delay effective
treatment.

36. Counting from the left, the first and sixth rhythms on the ECG strip shown here represent:

A. Atrial flutter
B. Second-degree heart block
C. Unifocal PVCs
D. Multifocal PVCs

C. Unifocal means that all of the PVCs originate from a single area. Multifocal means that PVCs
originate from more than one area.

37. A 65-year-old patient has been successfully resuscitated in the Emergency Department
after suffering an MI. He is still unstable with frequent PVCs. He needs to be transported
to the cardiac care unit for management. Which of the following would be most
important for monitoring him during the transportation?

A. Pulse oximeter
B. Portable capnography unit
C. Portable ECG machine with defibrillator
D.12-lead ECG unit to record any arrhythmias

C. A portable defibrillator must be with the patient in case it is needed. The other items are
useful for monitoring but offer no way to treat a life-threatening arrhythmia.
 38. You are performing chest compressions during a resuscitation attempt while another
therapist is manually ventilating the intubated patient. The nurse and physician are both
unable to start an IV line to give medications. What would you recommend?

A.Instill the medications down the endotracheal tube.

B.Keep trying new sites from which to start the IV line.
C.Nebulize the medications.
D.Give the medications by subcutaneous injection.

A. Direct instillation into the patient's airways and lungs offers the fastest way to administer the
medications when an IV line is not available.

39. You are doing O2 rounds on patients in the coronary care unit. You notice that the patient
whose 28% venturi mask you are checking is unresponsive to your questions. Looking
up, you see the ECG rhythm strip shown here. What would you recommend as a first
reaction?

A.Check the calibration on the ECG machine.

B.Replace the ECG leads.
C.Increase the O2 percentage because the patient is hypoxic.
D.Defibrillate the patient.

D. Defibrillation should be performed as quickly as possible when a patient is in VF. Figure 11-
40 shows another example. All of the other options delay effective treatment.

40. You notice during a diagnostic ECG that the QRS complex is inverted on lead II. What
would most likely cause this?

A.An electrode is loose.

B.The patient is shivering.
C.The arm electrodes are reversed.
D.The unit is out of calibration.

C. Reversing the arm electrodes results in the heart's electrical signal being received by the ECG
machine in the opposite direction of normal. This results in reversal of the ECG signal. A loose
electrode or shivering would cause different types of artifacts. Miscalibration would not cause
inversion of the QRS complex
 41. You enter a patient's room to check on her nasal cannula. She is slumped over in her
chair and appears cyanotic. Your first reaction would be to:

A.Open the airway.

B.Determine whether the patient is responsive.
C.Begin mouth-to-mouth ventilation.
D.Check for a pulse.

B. The first step in a suspected CPR situation is to assess the patient. CPR should be performed
only when needed.

42. You are working in the Emergency Department when an automobile accident victim is
brought in. You suspect that the driver has a cervical spine injury. What is the best way to
open the airway?

A.Tracheostomy
B.Head-tilt/chin-lift maneuver
C.Jaw-thrust maneuver
D.Nasal intubation

C. The jaw-thrust maneuver should be a safe way to open the airway of a patient with a known
or suspected cervical spine injury. The patient's head should not be tilted back because of the
possibility of spine injury. Nasal intubation and tracheostomy should be performed, if needed,
only after the jaw-thrust maneuver has been tried.

43. To determine breathlessness, it is best to:

1.Feel for air movement with your cheek by the victim's mouth.
2.Feel the chest rise and fall with your hand.
3.Listen for air movement with your ear by the victim's mouth.
4.Look at the victim's chest for a rising and falling movement.
5.Look at the victim's face for nasal flaring.

A.1, 2
B.3, 5
C.1, 3, 4
D.4, 5

C. “Look, listen, and feel” for air movement to determine breathlessness. Feeling with a hand for
chest movement is helpful. However, both hands should be used to hyperextend and support the
patient's neck and head.

44. The best way to determine pulselessness in a 10-month-old infant is by checking:

A.Brachial pulse for 5 to 10 sec

B.Carotid pulse for 3 to 5 sec
C.Femoral pulse for 3 to 5 sec
 D.Brachial pulse for 3 to 5 sec

A. A 5- to 10-second check of the brachial pulse should be done to determine pulselessness

because an infant's pulse is more difficult to check at the carotid or femoral sites.

45. While doing O2 equipment rounds, you come upon a cyanotic patient who is not
breathing. As you reposition the patient and hyperextend his neck, you notice that he has
open lip ulcers. What would be the best way to ventilate this patient?

A.Perform mouth-to-mouth ventilation.

B.Use a mouth-to-valve device stored in the room for this purpose.
C.Run to the CPR crash cart and get a manual resuscitation bag and mask.
D.Wait for the anesthesiologist to intubate the patient's airway, then use a manual
resuscitation bag.

B. A mouth-to-valve device allows for quick ventilations without risk to the rescuer from the
patient. Mouth-to-mouth ventilation should be avoided if possible in this situation. The other
options would unnecessarily delay ventilations.

46. When one rescuer is performing CPR on an unintubated adult, what chest
compression:ventilation ratio should be used?

A.5 : 1
B.5 : 2
C.15 : 2
D.30 : 2

D. The current BCLS guidelines indicate a compression:ventilation of 30 : 2 for one rescuer. The
other three options do not follow current guidelines with an adult. With an unintubated infant or
child, two rescuers would use a compression:ventilation ratio of 15 : 2.

47. Your patient with chronic obstructive pulmonary disease (COPD) is starting a pulmonary
rehabilitation program and taking her first 6-minute walk test. If she should desaturate, at
what pulse oximeter reading would supplemental oxygen be indicated?
A. <96%
B. <90%
C. <88%
D. <84%

C. Current guidelines recommend that supplemental oxygen be used during exercise when a
patient's SpO2 value drops <88%. Values between 96% and 90% are within the normal range. A
value of <84% shows serious hypoxemia. The patient should not be allowed to become this
hypoxemic if possible.
 48. In attempts to determine the daily exercise tolerance of a male COPD patient, all of the
following questions might be asked EXCEPT
A. How far can you walk your pet dog around the yard?
B. Are you able to shave every day?
C. Is your wife or a relative able to drive you to the grocery store?
D. How many flights of stairs can you climb before you have to stop?
C. A patient's exercise tolerance is not evaluated by determining if a relative can drive the patient
somewhere. Exercise tolerance can be assessed by determining the patient's ease or difficulty in
performing specific tasks.

49. The main goal of a pulmonary rehabilitation program should be to

A. Reduce the amount of sputum coughed out every day
B. Return the patient to his or her highest possible level of functioning
C. Reduce the amount of supplemental O2 needed
D. Increase the patient's appetite to achieve weight gain
B. Restoring the patient to his or her highest possible functional capacity is the main goal of a
rehabilitation program. All other goals are secondary to this.

50. You are working with a 10-year-old cystic fibrosis patient with a pulmonary infection
and thick secretions. What would you recommend to help him cough out the secretions?

A. Nebulized 0.9% (normal) saline solution

B. Instillation of acetylcysteine (Mucomyst) into his lungs
C. Nebulized dornase alfa (Pulmozyme)
D. Nebulized acetylcysteine (Mucomyst)

C. Pulmozyme is indicated in patients with cystic fibrosis who have pulmonary infection and
thick secretions. A normal saline solution is not the most effective option for liquefying
secretions. Mucomyst has no effect against purulent secretions with bacterial DNA. In addition,
Mucomyst is not currently recommended by aerosol or tracheal instillation in this patient with
cystic fibrosis.

51. A patient was diagnosed with diastolic dysfunction. As a licensed respiratory therapist
you know that the main risk factor for diastolic dysfunction?

A. Diabetic heart disease

B. Hypertrophic cardiomyopathy
C. Hypertension
D. Coronary heart disease

C. Hypertension
Major risk factors include: HTN (major), HOCM, CAD, diabetic heart disease ,
restrictive cardiomyopathy.
 52. Which of the following changes occurs in compensated pressure loaded cardiac
hypertrophy?

A. Diffuse fibrosis
B. Decreased sarcomeres
C. Hyperplasia
D. Ventricular dilation

A. Diffuse fibrosis

Compensated cardiac hypertrophy results in

- diffuse fibrosis
- decrease in the capillary-to-myocyte ratio
- increase in the number and mutations of the sarcomeres
- synthesis of abnormal and dysfunctional proteins
- extreme hypertrophy

Because adult cardiac myocytes are not able to divide, hyperplasia DOES NOT develop.
In response to PRESSURE load failure there is development of a concentric increase in
the THICKNESS of the ventricular WALL (i.e., CONCENTRIC HYPERTHROPHY).

In contrast, in VOLUME load HF where there is dilation of the ventricle with NORMAL,
INCREASED or DECREASED thickness of the ventricular wall.

53. A patient was diagnosed with fungal endocarditis. The respiratory therapist on duty
learned on her class in pathophysiology that the common cause of fungal endocarditis is:

A. Actinomyces
B. Aspergillus
C. Cryptococcus
D. Candida

D. Candida

The vegetations caused by fungal organisms tend to be larger than those caused by
bacterial infections.

54. Sarah Geronimo who just got her licensed in respiratory therapy was assigned at the
neonatal unit of the hospital. Sarah was incorrect when she say that this characteristic is
one of the features of Tetralogy of Fallot.

A. Obstruction of the right ventricular outflow tract

B. Right ventricular hypertrophy
C. Subpulmonary stenosis
D. ASD
 D. Atrial Septal Defect. Tetralogy of Fallot’s characteristics are the following:
Ventricular Septal Defect, Overriding Aorta, Right Ventricular Obstruction and Right
Ventricular Hypertrophy.

55. In which of the following stages of patient–clinician interaction is the review of physician
orders carried out?
A. Treatment stage
B. Introductory stage
C. Preinteraction stage
D. Initial assessment stage

ANS: C
Physician orders should be reviewed in the patient’s chart before the physician sees the
patient.

56. Which of the following activities is not part of the role of respiratory therapists (RTs) in
patient assessment?
A. Assist the physician with diagnostic reasoning skills.
B. Help the physician select appropriate pulmonary function tests.
C. Interpret arterial blood gas values and suggest mechanical ventilation changes.
D. Document the patient diagnosis in the patient’s chart.

ANS: D
RTs are not qualified to make an official diagnosis. This is the role of the attending
physician.

57. You are riding in an elevator at the hospital where you are employed as an RT. The
elevator is full, but standing next to you is Joe, the RT who is scheduled to relieve you.
He turns to you and asks, “How is Mr. Copper doing?” Earlier in the day, Mr. Copper
had a cardiac arrest, and he is now being mechanically ventilated. How should you
respond to Joe?
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 and will keep you very busy.”

ANS: C
The patient’s right to privacy prevents care providers from discussing a patient’s clinical
status in public places. All answers other than “c” are unethical; giving such answers
could cause an RT to be in legal trouble and get fired.
58. A respiratory care student returns from a clinical experience, excited that she has had the
opportunity to perform cardiopulmonary resuscitation (CPR) for the first time. She
immediately goes to her Facebook page and describes her day. Which of the following
entries would be a violation of HIPAA standards?

A. “At clinical today got to do CPR on a patient on the 6th floor of Mercy
Hospital. Patient survived! What a rush!!”
B. “Got to do CPR for the first time today. Patient survived!! What a
rush!”
C. “Got to do CPR for the first time in clinical today! What a rush!!”
D. All of the above

ANS: D
Patient Health Information (PHI) must not be shared in a public location. Facebook is
considered a public forum. Although the student did not give specific identifiers in
answers a, b, or c, there was enough information that someone familiar with either the
patient or the student could possibly have deduced the identity of the patient.

59. The therapist enters the room of a 6-year-old victim of an automobile accident who is
unconscious and receiving ventilation therapy. The therapist assesses the patient, gives a
treatment, and suctions the patient. The patient’s mother then asks in a worried voice, “Is
he going to be all right?” The appropriate response for the therapist would be:

A. “I just looked at the CT scan of his brain, and I believe the swelling is going
down. He should recover within the next couple of weeks.”
B. “I’m unable to give you any information about your child’s condition.”
C. “I am just the respiratory therapist, and I really do not know anything.”
D. “I’m sorry, but our policy is that only the doctor can give you information
about your child’s prognosis. Let me step out and find out when the doctor
will be back in the unit.”

ANS: D
Response “a” is inappropriate because it is not within the scope of practice of an RT to
render medical opinions about a patient’s condition to the family. Answer “b,” while
correct, is unnecessarily abrupt. Answer “c” is both abrupt and is probably not true.
Answer “d” meets HIPAA and hospital policy requirements while also providing good
patient care and customer service.
60. A male therapist is discussing a treatment plan with a female patient who is sitting up in
bed, dressed in a hospital gown and wearing a full head covering with only her face
showing. Her husband is in the room, and from previous encounters it is clear that she
defers to him. The most effective way to present this treatment plan would be for the
therapist to:
A. Present the patient with a written summary of the plan and ask her to look it
over.
B. Ask the woman’s husband to step out of the room while the plan is being
discussed with the patient.
C. Explain the plan to the patient, maintaining eye contact with her at all times
and encouraging her to ask any questions she might have.
D. Explain the plan to the patient and her husband, and encourage both to ask any
questions they might have.

ANS: D
From the woman’s dress and previous behavior, it is likely that she is Muslim, with
traditional values and customs. Therefore, both she and her husband will find it
inappropriate, if not offensive, that he not be included in discussions of treatment.
Cultural values must be taken into account if truly effective patient treatment is to occur.