1.  In general, how often should a patient be instructed to use the Incentive Spirometer?

            A.  5 breaths every 4 hours around the clock

            B.  5 breaths every 4 hours while awake

            C.  10 breaths every 2 hours while awake

            D.  10 breaths every 1 hour while awake

            D.  10 breaths every 1 hour while awake

2.  Which is not a clinical manifestation of atelectasis?

            A.  Fever

            B.  Hypoxemia

            C.  Decreased respiratory rate

            D.  Abnormal breath sounds

1. Which therapy helps with the elimination of CO from the blood at a faster rate?

a. Heliox

b. Nitric Oxide

c. Hyperbaric Oxygen Therapy

d. Carbogen

2. Which hemoglobin(s) can be life-threatening and aren’t detected by pulse-oximetry?

a. Methemoglobin

b. Oxyhemoglobin

c. Carboxyhemoglobin

d. a and c

3. Which 2 of the following arteries provide collateral circulation to the hand?

I. brachial

II. ulnar

III. radial

IV. femoral

A. I and II

B. I and III

C. II and III

D. II and IV

5. Expelling the excess air from a sample, as well as chilling the sample in ice, are both

done to prevent what?

A. anaerobic respiration in the sample

B. blood clotting in the syringe

C. continued metabolism of sample

D. contamination of sample

6. TRUE or FALSE: Hyperbaric Oxygen Therapy delivers 80% oxygen to the patient in

an enclosed environment.

8. Which is not a possible complication of an ABG puncture?

A. nerve damage

B. hematoma

C. trauma

D. infection

E. all of the above are possible complications

9. If a patient presents with an upper airway obstruction, which therapy would you

suggest if pharmacological agents have been used unsuccessfully?

a. Heliox

b. Nitric Oxide

c. Hyperbaric Oxygen Therapy

d. Carbogen

10. Which is not an indication for arterial puncture?

A. evaluation of ventilation

B. evaluation of students technique

C. evaluation of oxygenation

D. evaluation of a patient’s response to therapy

E. evaluation of disease progression

1. Compression of (or closing of) the glottis has what effect on the alveolar pressure?

A.  Decreases

B.  Increases

C.  Remains the same

1. Secretions can cause obstructions or restrictions to the airways.  This can lead to which of the following?

            I.    Atelectasis

            II.   Impaired oxygenation

            III. Decrease work of breathing

            IV. V/Q mismatch

A.  I  and  II

B.  III  and  IV

C.  I,  II  and  III

D.  I,  II  and  IV

E.  I,  II,  III  and  IV

1. TRUE or FALSE:  CPT to the lower lobes is effective, even if the patient cannot be placed in the Trendelenburg (head down) position.

1. Some indications for CPT are:

            I.   Promote bronchial hygiene

            II.  Therapeutic massage

            III. Asthma

            IV. Cystic Fibrosis

             V. COPD

A.  I,  II and III

B.  II,  III,  IV  and  V

C.  I,  II,  III  and IV

D.  I,  III,  IV  and  V

You receive an order for CPT for a patient with lobar pneumonia.  What sequence       

        would you choose to correctly complete the order?

            I.   Perform CPT

            II.  Review the x-ray

            III. Check the order & review the chart for current signs,

                        symptoms and history

            IV. Wash your hands

A.  II,  III,  I  and IV

B.  III,  II,  IV,  I  and  IV

C.  IV,  I,  III,  II  and  IV

D.  IV,  III,  II,  I  and  IV

.  Which alternative to CPT might be better suited for patients that are mobile?

A.  PEP

B.  Flutter

C.  Vest

D.  All the above

TRUE or FALSE:  The Huff cough is beneficial because if helps to prevent

   floppy airways as well as airway collapse.

TRUE or FALSE:  Patients that exercise can improve the oxygen uptake of their

 muscle cells.

Which mucus clearing device(s) may be used simultaneously with aerosolized     

         medications?

                  I.   PEP

                  II.  Flutter

                  III. In-exsufflator

                  IV. Vest

                   V.  IPV

             A.  I,  II,  IV  and  V

            B.  II,  III  and  IV

            C.  I,  IV  and  V

            D.  I,  III,  IV  and  V

Which of the following means of CPT utilizes High Frequency Chest Wall Compression, or HFCWC?

I.   Vest therapy

 II.  Flutter

 III. PEP valve therapy

 IV. In-exsufflator

 V. Intrapulmonary Percussive Ventilation

                        A.  I,  II  and  III

                        B.  I,  II  and  V

                        C.  II  and  V

                        D.  I  and  V

Of the pharmacological adjunct therapies, which of the following are mucolytics?

                                    I.   Acetylcysteine

                                    II.  Ipratropium bromide

                                    III. Pulmozyme

                                    IV. Budesonide

                                     V.  Normal saline

                        A.  I,  III  and  V

                        B.  I  and  III

                        C.  II,  IV  and  V

                        D.  III  and  V

Which of the following is not a contraindication for Postural Drainage?

A.  Hemoptosis

            B.  Empyema

            C.  Increased intracranial pressure

            D.  Skin grafts or burns to the chest

            E.  Rib fractures

Which of the following is not a possible adverse effect of CPT?

A.  Hemorrhage

            B.  Rib fracture

C.  Cardiac arrhythmia

            D.  Headache

This airway clearance device is dependent on the proper positioning of the device by

        the patient in order to be effective:

            A.  Flutter

            B.  Vest

            C.  Acapella

            D.  IPV

TRUE or FALSE:  Nutrition plays an important role in lung function.

This airway clearance device delivers mini bursts of gas into the lungs at between

       100 to 300 breaths per minute:

            A.  Flutter

            B.  Vest

            C.  Acapella

            D.  IPV

This airway clearance device is particularly effective in patients with neuromuscular

       disorders which may effect diaphragm strength:

            A.  Vest

            B.  IPV

            C.  Cough Assist

            D.  TheraPEP

This airway clearance device has a visual aid in order to help the patient perform the

       therapy more effectively:

            A.  Acapella

            B.  Flutter

            C.  Vest

            D.  TheraPEP

This airway clearance device  uses “directional stroking technology” to loosen mucus

       and move it to where the user selects via a red directional arrow:

            A.  Flimm Fighter

            B.  IPV

            C.  Cough Assist

            D.  TheraPEP

This airway clearance device combines PEP and airway vibrations to help clear  

       secretions, and isn’t position-dependent:

            A.  Flutter

            B.  TheraPEP

            C.  Vest

            D.  Acapella

This airway clearance device has controls to set frequency, pressure and treatment

       time, is technique independent, and requires no pneumatic gas source:

            A.  Cough Assist

            B.  Vest

            C.  Flimm Fighter

            D.  IPV   

Of the following mucus clearance therapies, which one cannot be used at the same 

       time as an aerosolized medication?

            A.  Vest

            B.  Flutter

            C.  PEP

            D.  IPV

When teaching a patient to use an Incentive Spirometer, the therapist should look

        for?

            A.  Sustained maximal inspiration

            B.  Sustained maximal exhalation

            C.  Sustained mobilization of secretions

            D.  Sustained coughing episodes

You are assessing an adult outpatient for bronchial hygiene therapy, and you note the

       following:  1) no history of Cystic Fibrosis or bronchiectasis; 2) sputum production

       of 30 to 50 ml/day;  3) an effective cough and 4) good hydration.  Which of the

       following airway clearance therapies would you recommend?

            A.  CPT with postural drainage and vibration

            B.  PEP therapy

            C.  In-Exsufflation

            D.  IPV

What is the most common alternative site for health care for RTs?

            A.  Skilled Nursing Facilities

            B.  In the home

            C.  Nursing homes

            D.  Rehab programs

Which one of the following services/therapies receives the most frequent use by

     patients in the alternative care setting?

            A.  CPAP

            B.  Breathing medications

            C.  Oxygen therapy

            D.  Home mechanical ventilation

Why do so many people use home oxygen in the United States?

            A.  It’s very cheap

            B.  There are many people with pulmonary problems in the U.S.

            C.  It’s readily available and easy to transport

            D.  Survival and improved quality of life

How many liters of liquid oxygen are there per pound?

            A.  344 L/lb

            B.  308 L/lb

            C.  2000 L/lb

            D.  3.14 L/lb

A patient is on liquid oxygen at home at 2 L/min. He weighs his portable liquid

     oxygen container and sees that there are 5 pounds of oxygen remaining. How long will

     his portable supply last?

            A.  5 hours

            B.  12.8 hours

            C.  14.3 hours

            D.   860 hours

.  In order for a patient to qualify for home oxygen during ambulation, sleep or exercise,

     their SaO₂ must be below  _______% .

            A.  85

            B.  89

            C.  92

            D.  95

What’s the most important way to prevent spread of infection in the home setting?

            A.  Use of disposable equipment

            B.  Proper cleaning of home equipment

            C.  Proper handwashing

            D.  Limiting visits by those who may have respiratory infections

.  (From “What does the NBRC say?” section)  A patient who is using oxygen at home

     occasionally needs to go out for health care appointments. What type of portable

     system would you recommend for this patient?

            A.  E cylinder with standard flowmeter

            B.  E cylinder with conserving device

            C.  Small liquid oxygen reservoir

            D.  Patients can go out for short periods without supplemental oxygen

Which of the following oxygen supply systems is the cheapest to use in the alternative

     care setting?

            A.  Oxygen cylinders

            B.  Liquid oxygen

            C.  Oxygen concentrators

Which of the following oxygen supply systems can provide the largest volumes of

       oxygen?

            A.  Oxygen cylinders

            B.  Liquid oxygen

            C.  Oxygen concentrators 

Which of the following oxygen supply systems is not portable?

            A.  Oxygen cylinders

            B.  Liquid oxygen

            C.  Oxygen concentrators

Which of the following oxygen supply systems can store oxygen indefinitely?

            A.  Oxygen cylinders

            B.  Liquid oxygen

            C.  Oxygen concentrators

(From “What does the NBRC say?” section)    A patient with a tracheostomy is to

       receive humidification via a nebulizer in his home.  With regard to water for the

       nebulizer, which of the following would be the most appropriate choice for the home

       setting?

            A.  Sterile distilled water should be obtained from the DME (durable medical

                  equipment) provider

            B.  Tap water is sufficient for the home setting if the nebulizer is properly cleaned

            C.  Bottled water can be used as long as it is distilled

Which one is not part of the process of cleaning a home nebulizer?

            A.  Disassemble the equipment

            B.  Soak, then wash in soapy water

            C.  Air dry

            D.  Disinfect in microwave oven

Which activities should be avoided while on home oxygen therapy?

            A.  Welding

            B.  Setting off fireworks

            C.  Smoking

            D.  All of the above       

Which of the following is not a goal of NPPV in the acute care setting?

            A.  Avoid intubation

            B.  Maximize patient comfort

            C.  Decrease length of stay

            D.  Improve mobility

Patients with which of the following respiratory diseases are least likely to benefit

     from NPPV?

            A.  COPD

            B.  Community-acquired pneumonia (CAP)

            C.  Acute cardiogenic pulmonary edema

            D.  Pneumonia in a COPD patient

Your patient has acute pulmonary edema from left heart failure. Which therapy should

      be tried first?

            A.  NPPV

            B.  CPAP

            C.  PEEP

            D.  Mechanical ventilation

Which of the following conditions are criteria for the use of NPPV?

            A.  pH < 7.35

            B.  PaCO₂  > 40 mmHg

            C.  Accessory muscle use

            D.  A, B and C

            E.  A and C 

Which of the following predicts successful use of NPPV in a patient with respiratory

     failure?

            A.  Minimal air leak

            B.  Low severity of illness

            C.  Improvement in gas exchange in 30 minutes

            D.  All the above

TRUE or FALSE: Small leaks around masks are not acceptable in the use of NPPV 

What is the recommended initial IPAP setting to be used with NPPV?

            A.  2 to 5 cmH₂O

            B.  5 to 8 cmH₂O

            C.  8 to 12 cmH₂O

            D.  12 to 15 cmH₂O

What is the best option for the respiratory failure patient who continues to deteriorate

     rapidly after 30 minutes of NPPV therapy?

            A.  Wait another 30 minutes and monitor the patient

            B.  Change to CPAP

            C.  Intubate and begin mechanical ventilation

What physiologic effect will increasing the EPAP have on the NPPV patient?

            A.  Increase the FRC

            B.  Increase the Vt

            C.  Decrease the PaCO₂

            D.  Lower the mean airway pressure

How will the changed physiological effect due to the increased EPAP have a

       positive impact on the patient?

            A.  The pH will start to normalize

            B.  The PaCO₂ will increase

            C.  The PaO₂ will increase

            D.  A and B are correct

Which of the following conditions would exclude a patient from NPPV therapy?

            A.  Very low blood pressure

            B.  A PCO₂ of 99 mmHg

            C.  Severe exacerbation of COPD

            D.  A pH of 7.25

Which of the following can be achieved by CPAP therapy?

            A.  Maintain airway patency

            B.  Increase lung compliance

            C.  Reverse atelactasis

            D.  Improve alveolar ventilation and therefore oxygenation

            E.  All the above

Which of the following modes have a similar function?

            A.  IPAP, PEEP, PS

            B.  PEEP, CPAP, IPAP

            C.  CPAP, EPAP, PEEP

            D.  IPAP, PS, CPAP 

In which of the following settings is initiating NPPV acceptable?

            A.  Emergency department

            B.  Intensive care unit

            C.  Hospital ward or general floor

            D.  A and B only

            E.  All of the above

TRUE or FALSE:  It isn’t necessary to re-check a patient’s technique with a therapy

Learning that involves understanding facts or concepts would be in the:

                        A.  Cognitive Domain

                        B.  Psychomotor Domain

                        C.  Affective Domain

.  Learning that involves a patient’s attitude or motivational level would be in the:

                         A.  Cognitive Domain

                         B.  Psychomotor Domain

                         C.  Affective Domain

Learning that involves a patient’s ability to perform a physical task involves the:

                         A.  Cognitive Domain

                         B.  Psychomotor Domain

                         C.  Affective Domain

TRUE or FALSE: Research shows that 70% of smokers asked stated that they would

                                    like to quit smoking.

TRUE or FALSE:  Research also shows that the more frequently smokers are asked

Which is not a long-term benefit of pulmonary rehabilitation?

            A.  improved appetite

            B.  increased physical capacity

            C.  decreased frequency of hospitalization

            D.  improved pulmonary function test results

            E.  reduced resting heart rate

Prior to performing an arterial blood gas analysis, a Modified Allen’s Test is done on

     the left wrist/hand and the test is negative. The therapist should now….

            A.  proceed with the arterial puncture

            B.  draw blood from the brachial artery

            C.  perform the Modified Allen’s Test on the right wrist/hand

            D.  chart the negative test and contact the physician

You are called to the ICU to draw an ABG on a patient who is weaning on mechanical

      ventilation. What is the first thing you should do in obtaining the sample?

            A.  wash your hands

            B.  perform Modified Allen’s Test

            C.  check the order

            D.  check the patient’s ID wrist band

Your patient is cyanotic, tachypneic and tachycardic.  Their SpO2 is reading 85%   

        with a good waveform.  You draw ABG’s and the PaO2 is 98 mmHg. What is the  

        most likely cause for this ABG result?

            A.  the patient is hyperventilating

            B.  the sample was not iced

            C.  the patient was afebrile

All of the following are advantages of pursed-lip breathing except ?

            A.  can shorten expiration

            B.  can decrease respiratory rate

            C.  can decrease alveolar collapse

            D.  can increase tidal volume

All are characteristics of diaphragmatic breathing training except ?

            A. allows for relaxation of upper chest and shoulder muscles

              B.  improves conditioning of lower chest and abdominal muscles

            C.  abdomen falls on inspiration           

D.  works well in combination with pursed-lip breathing

(From the CRT.)  Which of the following indicates a physical conditioning

       program has been effective in a patient with COPD?

            A.  Resting pulse rate is the same after one month.

            B.  Level-walking distance has increased by 15%

            C.  Vital capacity has increased by 5%.

            D.  Respiratory rate has decreased by 2/min.

Which of the following disciplines are not involved in pulmonary rehab?

            A.  Physician                     

            B.  Pharmacy                  

            C.  Social work

D.  Nursing

How long should you wait to perform an ABG after an FiO2 change has been made?

            A.  10 to 20 minutes

            B.  20 to 30 minutes

            C.  at least 30 minutes

            D.  5 minute