215 Module 1-3

O2 Delivery/Oxygenation

100

During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most likely cause of this finding?

A. There is an obstruction in the delivery tube

B. The patient’s ventilation has increased

C. There is a clogged system diffuser

D. The flowmeter pressure is set too high

There is an obstruction in the delivery tube

200

A 23-year-old male patient with a severe head cold is receiving oxygen via nasal cannula at 4 L/min. The pulse oximeter reveals an SpO2 of 85%. Which of the following would you recommend?

A. Increase the oxygen flow until the SpO2 equals or

exceeds 90%

B. Decrease the oxygen flow until the patient is more

comfortable

C. Switch to a simple mask

D. Recommend an ABG before considering any changes

C. Switch to a simple mask

300

A newly admitted adult patient with pneumonia has an

oxygen saturation of 87% on a nasal cannula at 2 L/min.

Which of the following is a potential cause of the patient’s

hypoxemia?

A. Fever and chills

B. Diffusion defect

C. Alveolar consolidation

D. Hypoventilation

Alveolar consolidation

400

An adult patient in the emergency room is unconscious with

an SpO2 of 95%. After re-checking with a CO-oximeter, it

reveals that the patient’s SaO2 is 67%. Which of the following

is the most likely cause of this discrepancy?

A. Opiate drug overdose

B. Diabetic ketoacidosis

C. Acute pulmonary edema

D. Carbon monoxide poisoning

Carbon monoxide poisoning

500

You are called to administer 70/30 heliox on an 11-year-old girl

in the emergency department. Which of the following would

you use to deliver the therapy?

A. Aerosol mask

B. Venturi mask

C. Nonrebreathing mask

D. Binasal cannula

C. Nonrebreathing mask

Patient Assessment

100

A 58-year-old female patient has arrived in the emergency department with an extremely deep and fast breathing rate. Which of the following best classifies this type of breathing?

A. Apneustic breathing

B. Kussmaul breathing

C. Biot’s breathing

D. Cheyne-Stokes breathing

Kussmaul breathing

200

A 71-year-old male patient is receiving ventilatory support and it was noted that his secretions are yellow and have gotten thicker over the past 24 hours. The patient has a white blood cell count of 17,000/mm3 and a temperature of 102 °F. Which of the following would you suggest?

A. Decrease the humidifier temperature

B. Administer an aerosolized bronchodilator

C. Schedule suctioning twice per hour

D. Obtain a sputum sample for culture and sensitivity

Obtain a sputum sample for culture and sensitivity

300

While reviewing the chest x-ray of a 57-year-old male patient,

you note that there is blunting of the left costophrenic angle.

It’s also noted that the patient has a history of CHF. Which of

the following best describes this patient’s condition?

A. There is a pneumothorax on the left side

B. There is a pleural effusion on the left side

C. There is pulmonary edema in the left lung

D. There is pneumonia in the left lower lobe

B. There is a pleural effusion on the left side

400

A 64-year old female patient was admitted and the physician

suspects that a pneumothorax is present. Which of the

following percussion notes would you expect to find in this

patient?

62

A. Increased resonance

B. Flat percussion note

C. Dull percussion note

D. Hyperresonant percussion note

Hyperresonant percussion note

500

You are called for the assessment of a child in the

emergency department. It has been noted that the child has

stridor. Which of the following conditions would you expect?

A. Croup

B. Asthma

C. Pneumonia

D. Cystic fibrosis

Croup

Patient Assessment

100

A female patient who was in a motor vehicle accident arrives

to the emergency department with broken ribs. While

palpitating the patient’s neck, crepitations were felt. What is

most likely the cause of this finding?

A. The patient has a laryngeal tumor

B. The patient has a pneumothorax

C. Blood is in the back of the patient’s throat

D. The patient has aspirated a tooth

The patient has a pneumothorax

200

While performing a routine chest percussion, you noticed

that a 57-year-old male patient has a flat percussion note.

Which of the following does this finding indicate?

A. Pneumonia

B. Pneumothorax

83

C. COPD

D. Atelectasis

Atelectasis

300

A 59-year-old female patient has arrived to the emergency

department in respiratory distress due to severe hypoxemia.

She would most likely exhibit all of the following signs

except?

A. Diaphoresis

B. Cyanosis

C. Bradycardia

D. Tachypnea

Bradycardia

400

After reviewing the chart of a 55-year-old female patient, you

note that she had an admission diagnosis of dehydration.

Which of the following findings would you expect for this

patient?

A. Pitting edema

B. Venous distension

C. Inspissated secretions

D. Crackles on auscultation

Inspissated secretions

500

You are called for the assessment of a chest radiograph for a

patient suffering from advanced stages of emphysema.

Upon observation, which of the following would you expect

to see?

A. An increased C/T ratio

B. Increased vascular markings

C. Decreased radiolucency

D. Flattening of the diaphragm

Flattening of the diaphragm

PFTS

100

While reviewing the medical record of a 55-year-old female patient, you note that her FEV1/FVC ratio was reported as being severely decreased. Which of the following conditions would you expect to be present with this finding?

A. Pulmonary hypertension

B. Morbid obesity

C. Chronic asthma

D. Pneumonia

Chronic asthma

200

A pre and post bronchodilator test was ordered on a 48-yearold

female patient. The forced expiratory measurement that

was obtained after the bronchodilator was given shows an

increase in the patient’s FEV1 from 60% to 80% of the

predicted value. This finding suggests which of the following?

A. A fixed airway obstruction

B. A reversible airway obstruction

C. A normal diffusion capacity

D. A restrictive process

 A reversible airway obstruction

300

An adult patient has performed an FVC maneuver with the

following results:

How would you interpret this flow-volume loop tracing?

A. Normal lungs

B. Small airway obstruction

C. Large airway obstruction

D. Restrictive disease

D. Restrictive disease

400

A 56-year-old male patient has been admitted and

diagnosed with Guillain-Barré syndrome. In order to

determine the patient's need for ventilatory support, which

of the following values is the most critical to monitor?

A. Residual volume

B. Inspiratory capacity

C. Peak inspiratory flow

D. Expiratory reserve volume

B. Inspiratory capacity

500

A 56-year-old female patient’s bedside spirometry results are

as follows:

FVC is decreased

FEV1 is normal

FEV1% is increased

What is the most likely problem?

A. Normal results

B. An obstructive disease

C. Poor patient effort

D. A restrictive disease

A restrictive disease

PFTS

100

If you were to take the total of the maximum volume of air

that can be exhaled from the maximum inspiratory level, this

can be defined as which of the following?

A. Residual volume

B. Expiratory reserve volume

C. Vital capacity

D. Total lung capacity

Vital capacity

200

Other than obtaining the results from a vital capacity

maneuver, what else should be obtained and noted from the

patient?

A. The patient’s resting minute ventilation

B. The patient’s height, gender, and age

C. The patient’s heart rate before/after testing

D. The patient’s actual and predicted body weight

B. The patient’s height, gender, and age

300

A 54-year-old female patient’s spirometry results show an

FEV1 that is calculated to be 80% of her forced vital capacity.

This finding suggests that the patient probably has which of

the following?

A. Chronic bronchitis

B. Emphysema

C. An obstructive lung disease

D. Clinically normal values

Clinically normal values

400

A 29-year-old female patient with suspected asthma needs

to undergo pulmonary function testing to confirm the

diagnosis. Which of the following tests would be the least

helpful in this situation?

A. Lung diffusion study

B. Flow-volume loop

C. Bronchoprovocation testing

D. Pre- and post-bronchodilator testing

Lung diffusion study

500

You are about to perform a pulmonary function test on a 65-

year-old male patient after providing a bronchodilator

breathing treatment. It is suspected that the patient has

COPD. His results are as follows:

FEV1/FVC ratio = 64%

FEV1 = 86% predicted

How would you would characterize this patient?

A. Normal

B. Mild COPD

C. Moderate COPD

D. Severe COPD

Mild COPD

Infection Control/Quality Control

100

A BiPAP machine that was used in the emergency

department was just returned for cleaning. Which of the

following agents would you use for surface disinfection?

A. Ethylene oxide

B. 70% ethyl alcohol

C. Alkaline glutaraldehyde

D. Acetic acid

70% ethyl alcohol

200

A patient was admitted to the ICU with a severe case of

influenza. Before entering the patient’s rooms, in addition to

standard precautions, what else must be used?

A. Droplet precautions

B. Universal precautions

C. Contact precautions

D. Airborne precautions

Droplet precautions

300

After auscultating a patient in the emergency department,

you noticed blood on the head of your stethoscope. How

should it be cleaned before use on another patient?

A. Sterilized with ethylene oxide

B. Wiped with a bleach solution

C. High-level disinfection with glutaraldehyde

D. Wiped with an alcohol solution

Wiped with a bleach solution

400

All spirometry values obtained under ambient conditions

should be converted to which of the following?

A. Standard temperature and pressure, dry (STPD)

B. Ambient temperature and pressure, dry (ATPD)

C. Ambient temperature and pressure, saturated (ATPS)

D. Body temperature, ambient pressure, saturated (BTPS)

Body temperature, ambient pressure, saturated (BTPS)

500

Which of the following infection control procedures is to be

used when drawing an arterial blood gas?

A. Hand washing and gloves only

B. Gown and protective eyewear

C. Mask and protective eyewear

D. All CDC standard precautions

All CDC standard precautions

Trouble Shoot

100

After obtaining results from a transcutaneous blood gas

monitor, you are asked to validate the readings. You should

do which of the following?

A. Perform a two-point calibration of the monitor

B. Change the placement of the sensor every 2–6 hours

C. Compare the monitor’s readings to an ABG

D. Re-membrane the sensor and adjust its temperature

Compare the monitor’s readings to an ABG

200

You are needed to assess a 61-year-old male patient that is

conscious and appears to be in no apparent distress. You

note on the arterial pressure monitor that the pressure

waveform is absent and the alarm is sounding. What should

your first action be?

A. Call for the Rapid Response Team

B. Replace the broken monitor

C. Check the stopcock position

D. Confirm that the monitor is set to zero/cal

Check the stopcock position

300

After collecting an ABG sample, you are about the analyze

the sample using a point-of-care analyzer. During the

process, the device flags the PaCO2 results. Which of the

following should you do at this time?

A. Send the sample to the central lab for analysis

B. Repeat the analysis using a fresh sample and the same

cartridge

C. Repeat analysis using a fresh sample and new cartridge

D. Repeat the analysis using the same sample and same

cartridge

A. Send the sample to the central lab for analysis

400

After drawing an ABG sample, you notice that the blood

appears to be darker in color. You suspect that obtained

sample is actually venous blood. Which of the following

would be the best way to confirm this suspicion?

A. Get a second opinion from the attending physician

B. Compute the alveolar-arterial O2 gradient

C. Compute the patient’s P/F ratio

D. Cross-check the results against the patient’s SpO2

Cross-check the results against the patient’s SpO2

500

You are called to provide a STAT bronchodilator treatment

for a male patient that is having a severe asthma attack.

While confirming the physician’s written order, you are not

sure if the note says “5 mL of Albuterol” or “0.5 mL of

Albuterol.” The prescribing doctor is busy overseeing a code

and is unable to respond. What action should you take?

A. Have the nurse review the note and clarify the order

B. Cross out the prohibited notations and initial and date

the changes

C. Wait until the physician is done with the code so that you

can clarify the improper notation and the correct order

D. Administer the treatment using the standard albuterol

dosage of 0.5 mL and clarify the order as soon as possible

thereafter

Administer the treatment using the standard albuterol

dosage of 0.5 mL and clarify the order as soon as possible

thereafter

Procedures

100

You are called to assist with needle decompression for a

patient with a tension pneumothorax. Which of the following

is the correct placement for this procedure?

A. Second intercostal space in the anterior axillary line

B. Second intercostal space in the midclavicular line

C. Third intercostal space in the anterior axillary line

D. Third intercostal space in the midclavicular line

Second intercostal space in the midclavicular line

200

After instructing a patient on how to perform diaphragmatic

breathing, which of the following can you observe to

recognize if they are performing it properly?

A. The use of pursed-lip breathing

B. The abdomen rising on exhalation

C. The abdomen rising on inspiration

D. The use of intercostal muscles during inspiration

The abdomen rising on inspiration

300

A 58-year-old male patient in the ICU just had a chest tube

inserted to drain the fluid from a pleural effusion. He is

receiving mechanical ventilation with basic settings and

displays the following vital signs:

Heart rate: 120/min

Blood pressure: 137/95

Set respiratory rate: 10/min

Total respiratory rate: 29/min

Body temperature: 99.2 F

113

Taking everything into consideration, you should

recommend which of the following?

A. Assess the patient for pain

B. Paralyze the patient

C. Ask the patient to relax

D. Reposition the chest tube

Assess the patient for pain

400

Which of the following EKG leads should be placed in the 5th

intercostal space at the midclavicular line?

A. V1

B. V2

C. V3

D. V4

V4

500

A 61-year-old male patient is scheduled to undergo

cardiopulmonary exercise testing. In which of the following

would you recommend extra precautions before the

performing the test?

A. A patient with a resting systolic BP > 200 mm Hg

B. A patient being evaluated for coronary artery disease

C. A patient recommended for cardiac rehabilitation

D. A patient being assessed for a cardiopulmonary disability

A patient with a resting systolic BP > 200 mm Hg

Miscl.

100

The husband of a comatose patient asks you to cancel a

previously approved DNR order. How should you proceed?

A. Record the request in the patient record

B. Explain that only her husband can cancel the order

C. Notify the charge nurse of the request

D. Notify the attending physician of the request

Notify the attending physician of the request

200

A 52-year-old female patient has been smoking 1.5 packs of

cigarettes per day for 30 years. Her smoking history would be

recorded as:

A. 15 pack-years

B. 30 pack-years

C. 45 pack-years

D. 60 pack-years

45 pack-years

300

Which of the following is a major disadvantage of using a

pulse oximeter to monitor a patient’s oxygenation status?

A. Skin burns due to using incompatible probes

B. Erroneous results leading to inappropriate treatment

C. Electrical shocks at the measuring site

D. Pressure sores at the measuring site

Erroneous results leading to inappropriate treatment

400

The physician requests a humidifier device that can

condition the inspired gas to 100% body humidity. Which of

the following would you recommend?

A. Bubble humidifier

B. Pneumatic nebulizer

C. Heated wick humidifier

D. Heat and moister exchanger

Heated wick humidifier

500

A 56-year-old male patient with pneumonia has a moderate

amount of oral secretions. Which of the following would you

recommend for suctioning at the patient’s bedside?

A. Lukens trap

B. Coude catheter

C. Yankauer

D. Bulb suction

Yankauer