RT practice questions
NBRC · RT · 300 questions
Original practice questions for the NBRC Respiratory Therapy Examination (CRT/RRT single exam, effective January 2027) exam, covering every domain of the official exam outline.
This course contains the use of artificial intelligence.
About the RT exam
- Questions
- 185 multiple-choice items (160 scored + 25 pretest); 100 Breadth of Knowledge + 60 Depth of Clinical Judgment scored
- Passing score
- Two cut scores: low cut = CRT, high cut = RRT; numeric cut scores not published
- Format
- Computer-based, single-answer multiple choice, 4 hours, linear-on-the-fly from minipools
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Exam details published by the vendor, checked 3 November 2026. Vendors change fees and formats without notice — confirm on the vendor's own page before you book.
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Test your knowledge with standard 20-question practice sets.
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Breadth of Knowledge: Patient Data (25 of 160 items) · 47 questions
- A ventilated 70-year-old shows three-day positive fluid balance of 4 L, rising central venous pressure, new peripheral edema, RSBI rising from 68 to 118, vital capacity falling, and intracranial pressure 22 mm Hg with coughing. Which conclusion about ventilator liberation readiness best integrates fluid balance, hemodynamics, and pulmonary mechanics trends?
- A 60-year-old on volume control ventilation shows peak pressure 38 cm H2O, plateau 28 cm H2O, PEEP 8 cm H2O, with prolonged exhalation and missed trigger efforts. The circuit is unkinked and secretions are minimal. Which measurement sequence should the therapist perform to assess compliance, resistance, plateau pressure and auto-PEEP?
- In pulmonary clinic a 55-year-old with chronic dyspnea and wheezing has normal chest radiograph and pulse oximetry 96% on room air, and the physician asks respiratory therapy what diagnostic testing to order next. History suggests variable airflow limitation. Which diagnostic recommendation best evaluates airflow limitation and gas exchange for this stable outpatient?
- A 68-year-old in septic shock has blood pressure 90/60 mm Hg, heart rate 112, central venous pressure 14 mm Hg, and cool mottled extremities despite fluids and norepinephrine. The team asks whether perfusion pressure is adequate. Which hemodynamic evaluation should the therapist provide using cardiopulmonary calculations?
- A 65-year-old with COPD exacerbation has a chart noting sulfa allergy with rash, home warfarin and albuterol, a new order for trimethoprim-sulfamethoxazole, a signed DNR order, and no documented influenza vaccination. Which medication reconciliation and order conflict should the therapist clarify first before treatment?
- A 60-year-old with sudden dyspnea after central line placement has diminished right breath sounds, tachypnea and SpO2 90%. The therapist is asked to perform focused palpation before imaging. Which palpation finding for pulse, asymmetry, crepitus, fremitus and tracheal deviation best clarifies this presentation?
- A 64-year-old with acute dyspnea and COPD has labs showing WBC 14,200 with neutrophilia, potassium 2.9 mEq/L, INR 2.8 on warfarin, and troponin mildly elevated with tachycardia and accessory muscle use. Which laboratory interpretation best informs respiratory relevance and immediate priorities?
- A 62-year-old with unexplained dyspnea, snoring with daytime sleepiness, and a small unilateral pleural effusion has basic spirometry that is inconclusive, and the team asks for advanced diagnostic guidance. Which diagnostic recommendation best matches exhaled gas, hemodynamic, sleep, and pleural evaluation needs for this patient?
- A 64-year-old intubated for pneumonia is on pressure support 5 cm H2O with PEEP 5 cm H2O for 30 minutes, with RSBI 78, SpO2 95%, hemodynamically stable, strong cough, and minimal secretions. Arterial blood gas is near baseline. Which spontaneous breathing trial interpretation should the therapist document to recognize pass/fail criteria?
- A 65-year-old with fever, productive cough and right-sided chest pain has decreased right base breath sounds with crackles and tachycardia with systolic murmur. The student must link sounds to disease. Which auscultation interpretation relating breath and heart sounds to pathology best explains these findings?
- A 62-year-old is on day 3 of ventilation for pneumonia in a 12-bed ICU, now on pressure support 5 with PEEP 5 and FiO2 0.40 for 30 minutes. Rate 22, tidal volume 480 mL, RSBI 46, SpO2 94%, hemodynamically stable, and continuous apnea monitoring shows no central apnea alarms. Which SBT outcome interpretation best integrates apnea monitoring and apnea test readiness?
- A 68-year-old ventilated patient in the ICU has stable SpO2 93-94% on FiO2 0.40, cuff pressure 24 cmH2O, flat capnography at 39 mmHg, but transcutaneous CO2 rising from 52 to 69 mmHg over 3 hours with increasing sedation and small tidal volumes. Which transcutaneous monitoring interpretation best confirms worsening hypoventilation?
- In the ICU a comatose patient after catastrophic brain injury has absent brainstem reflexes, is normothermic and normotensive, and is preoxygenated on 100% oxygen with baseline ABG documented before testing for brain death. Which apnea test procedure best gathers valid clinical information for brain death determination?
- A 58-year-old mechanically ventilated patient develops fever, leukocytosis and increased purulent secretions. Portable AP chest radiograph shows dense left lower lobe opacity with visible air bronchograms, sharp costophrenic angles, no visceral pleural line, and endotracheal tube tip 4 cm above the carina. Which radiographic interpretation should the therapist document for this consolidation finding?
- A respiratory therapist assesses a 72-year-old patient with community-acquired pneumonia on a medical-surgical unit. The patient sits upright leaning forward, alert but anxious, reports pleuritic chest pain 6/10 and dyspnea 6/10, has a frequent strong cough with greenish sputum, and shows intercostal retractions with nasal flaring. Which assessment summary best documents general appearance, mental status, pain, dyspnea, cough, sputum, and work of breathing?
- A 64-year-old with ventilator-associated pneumonia has sputum Gram stain showing many gram-negative rods with few epithelial cells, culture growing Pseudomonas aeruginosa, and sensitivities showing resistance to ceftriaxone but susceptibility to cefepime. Which interpretation of Gram stain, culture, and sensitivity best guides respiratory antibiotic therapy?
- A newly admitted older adult with pneumonia has a chart showing penicillin allergy, home metoprolol and apixaban, a new order for ceftriaxone, a signed DNR bracelet note, and missing influenza and pneumococcal vaccine records. Which record evaluation best reconciles history, orders, medications, code status, and vaccines?
- A 49-year-old tracheostomized patient in a long-term unit produces scant saliva-like secretions from suction, has a cuff pressure of 12 cm H2O with audible air leak, and new low-grade fever with questionable infiltrate. Which evaluation of sputum sample characteristics and cuff status best guides next action?
- A 68-year-old with COPD on 2 L/min by nasal cannula has resting SpO2 93%, heart rate 88/min, and no chest pain. The physician orders a 6-minute walk test with exercise oxygen titration to evaluate exertional desaturation. The corridor is 30 meters, turnaround cones are placed, and continuous pulse oximetry is available. Which exercise oxygen titration procedure should the therapist follow during the 6-minute walk test?
- A 31-year-old barista with six weeks of dry cough, wheeze, and chest tightness reports daily menthol vaping, weekend hookah, candle-making at home with fragrances, and evening shifts in a dusty roasting room without a mask. Symptoms ease on vacation. Which exposure history best identifies vaping, smoking, occupational, and environmental contributors?
- A 55-year-old admitted with fever, productive cough, tachypnea, and pleuritic chest pain has WBC 18,000 with neutrophilia and left shift, hemoglobin 9.1 g/dL, potassium 3.0 mEq/L, INR 1.1, D-dimer mildly elevated, and troponin mildly elevated with tachycardia and hypotension. Which integrated CBC, electrolyte, coagulation, and cardiac biomarker interpretation best explains the respiratory relevance?
- A 64-year-old on telemetry after COPD exacerbation develops sudden palpitations, blood pressure 118/74 mm Hg, and shortness of breath. The bedside rhythm strip shows a narrow-complex tachycardia at 172/min with no visible P waves and regular R-R intervals. Which ECG interpretation should the respiratory therapist report to guide immediate management?
- A 42-year-old with headache, confusion, and cherry-red appearance after garage exposure has ABG pH 7.40, PaCO2 40 mmHg, PaO2 92 mmHg on room air with co-oximetry showing carboxyhemoglobin 28% and oxyhemoglobin 68%. Which interpretation best explains the arterial blood gas and co-oximetry findings in suspected carbon monoxide exposure?
- A 66-year-old with pulmonary fibrosis on 2 L/min nasal cannula reports dyspnea climbing stairs, resting SpO2 94%, exercise SpO2 84% after 320 meters on a 6-minute walk, and rapid recovery to 92% with rest. Which interpretation of oxygen titration and walk results should the therapist document?
- A ventilated adult with new fever, purulent secretions, and left-lobe infiltrate has sputum Gram stain showing many neutrophils with gram-negative rods and pending culture, plus a respiratory pathogen panel detecting rhinovirus. Which interpretation best guides respiratory isolation and secretion management?
- A 5-year-old with status asthmaticus is on continuous albuterol, tachypneic with prolonged expiration, SpO2 93% on 2 L cannula, and an attached capnography cannula shows a shark-fin waveform with a sloping alveolar plateau and rising ETCO2 to 48 mm Hg. Blood pressure and perfusion are normal. Which noninvasive monitoring interpretation should guide the next respiratory action?
- A 58-year-old former smoker with progressive dyspnea completes pulmonary function testing showing reduced FEV1/FVC ratio, increased total lung capacity and residual volume, and markedly reduced DLCO with normal hemoglobin. Which pattern interpretation should the therapist document for obstructive disease with diffusion impairment?
- A 46-year-old with six months of dyspnea on exertion has spirometry showing FVC 62% predicted with normal FEV1/FVC ratio, no bronchodilator response, and normal oximetry at rest. The physician suspects respiratory muscle weakness versus interstitial disease and orders complete pulmonary function and muscle strength assessment. Which pulmonary function testing sequence should the therapist perform to distinguish muscle weakness from parenchymal restriction?
- A 48-year-old with stridor and a neck mass is evaluated for urgent intubation, with muffled voice, limited mouth opening, Mallampati class IV view, and trachea deviated rightward on palpation and chest film. Oxygenation is borderline on room air. Which airway patency assessment best guides safe management of Mallampati class and tracheal shift?
- A 52-year-old with severe OSA is on in-lab CPAP titration at 10 cm H2O. Snoring resolved but the tracing shows persistent hypopneas, REM-related desaturation to 84%, and residual AHI 18/hour with mouth leak noted. Pressure tolerance is good and central events are rare. Which titration adjustment best addresses residual obstruction on this sleep study?
- A 34-year-old rescued from a house fire is confused with headache, SpO2 94% by pulse oximeter, ABG pH 7.40, PaCO2 38, PaO2 96 on room air, calculated SaO2 97%, and CO-oximetry showing COHb 29%, MetHb 0.8%, O2Hb 68%. Carboxyhemoglobin is markedly high while PaO2 appears normal. Which interpretation best explains these arterial blood gas and CO-oximetry findings?
- A 48-year-old intubated for 5 days is triggering the ventilator and the team requests spontaneous ventilation parameters to assess weaning readiness. The patient is alert, afebrile, hemodynamically stable and on minimal pressure support. Which measurement technique should the therapist use to obtain a reliable maximum inspiratory pressure for weaning assessment?
- An intubated adult needs cuff pressure verification and a febrile ventilated neighbor needs diagnostic mini-BAL for suspected pneumonia, while a ward patient with weak cough needs sputum induction for tuberculosis testing. Which procedure selection and technique best gathers clinical information safely?
- A term newborn at 1 minute has heart rate 95, slow irregular respirations, some flexion of extremities, grimace to suction, and blue extremities with pink trunk. At 5 minutes tone and color improve with routine care. Which clinical assessment correctly interprets APGAR, gestational age, and cardiopulmonary status?
- A 54-year-old with sudden pleuritic chest pain and dyspnea after knee surgery has tachycardia, clear lungs, SpO2 90% on room air, and a chest radiograph without infiltrate, plus a high-probability V/Q scan showing mismatched perfusion defects with normal ventilation. ECG shows sinus tachycardia without ST elevation. Which imaging and ECG interpretation best guides immediate respiratory management for suspected embolism?
- A 26-year-old nursing student with prior BCG vaccination had close classroom exposure to active pulmonary tuberculosis, has no cough, fever, or weight loss, and has a normal chest radiograph. Which TB test should the therapist recommend to screen for latent infection in this BCG-vaccinated contact?
- A 72-year-old with prolonged BiPAP use, nasogastric tube, and recent tracheostomy develops redness under the mask bridge, ear groove pressure from oxygen tubing, sacral moisture redness from supine positioning, and peristomal irritation. Which assessment best evaluates skin integrity related to devices, positioning, and stomas?
- A 52-year-old with loud snoring, witnessed apneas and daytime sleepiness undergoes split-night titration with baseline SpO2 88% and transcutaneous CO2 52 mm Hg, with residual events and mask leak on CPAP 8 cm H2O. Which overnight titration and monitoring strategy best optimizes CPAP/NPPV and gas exchange?
- A 36-week infant is delivered after maternal fever and prolonged rupture of membranes, the L/S ratio is 1.4 with absent phosphatidylglycerol, 1-minute APGAR is 5 for tone, color, and reflexes, and gestational age suggests borderline lung maturity. Which perinatal history interpretation best guides immediate neonatal respiratory assessment?
- A 62-year-old former smoker completes outpatient pulmonary function testing for progressive dyspnea. Results show reduced FEV1, reduced FEV1/FVC ratio, increased residual volume and total lung capacity, and reduced DLCO corrected for hemoglobin. Which PFT pattern interpretation best fits these spirometry, lung volume, and DLCO findings?
- A 62-year-old with COPD exacerbation needs a radial arterial blood gas to guide ventilation. The therapist performs Allen testing, cleans with chlorhexidine, uses a preheparinized syringe, and notes a small air bubble after a brisk arterial puncture. The sample must travel 10 minutes to the lab on ice. Which sampling technique for arterial blood gas collection best avoids pre-analytic error?
- A 55-year-old with ARDS is on FiO2 0.60 with PaO2 90 mm Hg, PaCO2 45 mm Hg, SpO2 93% and PEEP 10 cm H2O. The team needs a standardized oxygenation metric to track severity and ventilator response over the next day. Which calculation of P/F ratio, oxygenation index or related index best quantifies oxygenation impairment?
- A 28-year-old single parent with asthma has two ED visits in three months, missed refills, night-shift work, limited bus access, low health literacy, and shared housing with indoor smoking. Inhaler technique is rushed and teach-back is incomplete. Which evaluation of learning needs and social determinants best guides discharge planning?
- A 58-year-old woman has acute pleuritic chest pain, tachycardia, and hypoxemia after knee surgery. Chest radiograph shows a wedge-shaped peripheral opacity, ECG shows sinus tachycardia with nonspecific T-wave changes, and CT angiography is delayed. Which imaging interpretation best explains her presentation while awaiting definitive CT?
- A 52-year-old with loud snoring and daytime sleepiness has a sleep study showing apnea-hypopnea index 22 events per hour with nadir SpO2 84% and fragmented sleep. The record notes no central events. Which sleep study interpretation of apnea-hypopnea index best guides therapy planning?
- A 45-year-old former smoker with exertional dyspnea completes pulmonary function testing showing FEV1 68% predicted, FEV1/FVC 0.62, TLC 108% predicted, and DLCO 58% predicted without anemia, with repeatable efforts and reference values matched for age, height, and sex. Peak flow diary shows 15% diurnal variability. Which interpretation best evaluates these peak flow, spirometry, and DLCO results?
- A 63-year-old with prolonged fever, productive cough and right upper lobe cavitation has three negative sputum smears, persistent infiltrate after antibiotics and new neutropenia limiting expectoration in a medical ICU. CT shows bronchiectasis with mucus plugging. Which diagnostic recommendation best obtains lower airway samples for this nonresolving pneumonia?
Breadth of Knowledge: Management of Devices and Patient Safety Procedures (25 of 160 items) · 47 questions
- A 68-year-old postoperative patient on a general floor wears a simple oxygen mask at 6 L/min but SpO2 stays 88%, respiratory rate is 26/min, the mask sits loosely with open side gaps, and the tubing is unkinked with audible flow. Which troubleshooting action best restores effective oxygen mask gas delivery?
- In pulmonary clinic, a 9-year-old with persistent asthma uses a dry-powder inhaler for maintenance but reports poor control. The caregiver notes the child exhales into the mouthpiece, inhales slowly and gently, stores the device in a steamy bathroom and never checks the dose counter. Technique review shows no breath-hold. Which troubleshooting correction for the DPI technique restores drug delivery?
- In a busy pulmonary function lab, reusable mouthpieces, spacers and nebulizer cups from stable outpatients must be reprocessed between uses. Staff are debating rinse-only versus full disinfection. Which disinfection policy for reusable respiratory equipment should the therapist apply to ensure safety?
- An adult with ARDS on volume ventilation starts inhaled nitric oxide from a cylinder system with scavenging, but the therapist notes a low-delivery alarm, fluctuating ppm readings, and rising nitrogen dioxide on the monitor. Cylinders, power, and ventilator function appear intact. Which troubleshooting action should the therapist perform first to restore safe nitric oxide delivery?
- A 55-year-old with a cuffed tracheostomy has a persistent low-pressure alarm, audible peritubal leak, and cuff manometer reading falling from 25 to 12 cm H2O after inflation. Tubing and pilot balloon connections appear intact but the pilot valve feels loose. Which troubleshooting step best addresses suspected cuff and manometer system leak?
- In a 20-bed medical ICU ventilator-associated events have increased, oral care and head-of-bed elevation are inconsistent, and sedation vacations are often missed on night shift. The quality committee asks respiratory therapy to lead prevention. Which ventilator-associated event prevention protocol should the therapist initiate first to reduce harm?
- A night-shift therapist must dispose of suction canisters with bloody secretions, used suction catheters and a leaking specimen bag on a medical unit with limited housekeeping. Which safe handling of biohazardous materials should the therapist perform to protect staff and patients?
- A pulmonary function lab reports inconsistent FVC results on a portable spirometer, with failed daily calibration checks using a 3-L syringe, variable room temperatures, and recent transport between clinics. Patients show good effort and coaching. Which troubleshooting step should the therapist perform to restore accurate spirometry?
- A respiratory therapist obtains an arterial sample with visible air bubbles, excess liquid heparin, delayed icing, and a result that conflicts with pulse oximetry and clinical status on high FiO2. Which troubleshooting action best resolves suspected preanalytic blood gas and CO-oximetry analyzer error?
- A 72-year-old on home oxygen reports increased dyspnea, the concentrator shows low-output alarm, the flowmeter ball bounces, tubing is 50 feet long and coiled under furniture, and the inlet filter looks gray with dust. Which troubleshooting step best restores concentrator and flowmeter delivery?
- In the ED a term newborn is apneic with poor tone, and the team uses a T-piece resuscitator with a tight mask seal. The manometer shows no pressure rise, the chest does not move, and the gas supply and flowmeter are on with audible flow. Which T-piece resuscitator troubleshooting step should be completed first to restore effective ventilation?
- In the emergency department an adult with pneumonia wears a Venturi mask prescribed at 28% with the manufacturer-matched flowmeter setting, but SpO2 is 84%, the jet nozzle is cracked, the diluter window is misaligned, and room air hisses loudly around loose connections. The prescription must stay at 28%. Which troubleshooting action should the therapist take first to restore accurate gas delivery?
- A postoperative patient in a four-bed step-down unit has a chest tube to water-seal drainage with tidaling absent, continuous bubbling in the water-seal chamber, and a pulse oximeter showing intermittent low signal with poor waveform during shivering. Which troubleshooting sequence best addresses chest drainage and noninvasive monitor function?
- A skilled nursing facility reports several concentrators alarming low purity, one liquid oxygen base venting vapor, and flowmeters that drift between settings on a busy evening with limited backup cylinders. You are asked to troubleshoot the bulk gas supply chain. Which troubleshooting sequence best restores safe concentrators, liquid, flowmeters, and analyzers?
- A home-care teenage patient reports the high-frequency chest wall vest runs but chest vibration feels weak, therapy takes longer to raise sputum, with new hissing at the hose connectors and a looser vest after weight loss. Which troubleshooting sequence should the therapist perform first to restore hyperinflation and secretion clearance?
- A heated high-flow nasal cannula at 50 L/min alarms for low airway temperature with heavy condensate in the circuit and cool aerosol. The reservoir has low water, the probe is dislodged, and the circuit sags below the bed. Which troubleshooting sequence best restores heated high-flow humidifier performance?
- Your ICU blood gas analyzer, end-tidal CO2 monitor, bedside spirometer, ventilator, and pulse oximeter all drifted after a power outage before morning rounds. Which quality control process best verifies analyzers, pulmonary function equipment, ventilators, and monitors are safe to use?
- In the ICU a volume-controlled ventilated patient suddenly has a high-pressure alarm, decreased exhaled volume, tachycardia, and asymmetric breath sounds after repositioning with intact power and oxygen supply. Which ventilator, alarm, and circuit troubleshooting action best restores safe ventilation?
- A 68-year-old in the emergency department is on bilevel NPPV with an oronasal mask for cardiogenic edema, with persistent high unintentional leak, eye irritation, and falling tidal volumes despite adequate pressure settings and an awake cooperative patient. Which mask interface correction should the therapist prioritize to control unintentional leak during NPPV?
- An adult with pneumonia is on heated high-flow nasal cannula at 60 L/min, FiO2 0.60, set temp 37C, in a cool step-down room. The circuit has dependent-loop rainout, the chamber water is full, and the display shows low airway temperature with cool mist. Which troubleshooting action best restores heated high-flow humidification performance?
- A 68-year-old patient is intubated in the medical ICU on day 2 for pneumonia, stable on assist-control ventilation with continuous sedation and a standard endotracheal tube without subglottic port. The head of bed is flat for a procedure and oral secretions are pooling. Which VAE prevention protocol should the respiratory therapist initiate first to reduce aspiration risk?
- An adult with pulmonary hypertension on inhaled nitric oxide via the ventilator injector module develops a sudden low delivery alarm, FiO2 drift upward, and NO2 rising after a circuit change for transport, with systemic pressure dropping. Backup cylinder and battery power are available. Which device troubleshooting action best restores safe inhaled nitric oxide delivery?
- During bronchoscopy in a 54-year-old with hemoptysis, the image suddenly darkens, suction is weak, and the arterial pressure waveform on the bedside monitor is damped with loss of dicrotic notch after line flushing. Which troubleshooting action should the therapist prioritize for the devices involved?
- In the emergency department a 45-year-old requires urgent intubation for airway protection. The video laryngoscope powers on but the screen image is dim, flickering, and intermittently blank, while the conventional direct laryngoscope and backup airway equipment are at bedside. The blade appears seated, the room lights are bright, and no trauma to the device is reported. Which troubleshooting action should the respiratory therapist take first to restore video laryngoscope function?
- In a busy outpatient PFT lab, a portable spirometer reports FVC 18% below the patient's recent lab value, flow-volume loops show jagged expiratory limbs, and the 3-L calibration syringe check fails low on two trials at different flows. No new symptoms are reported. Which troubleshooting action best restores portable spirometer and PFT lab accuracy?
- A hospitalized adult with cardiogenic pulmonary edema is on bilevel NPPV with high unintentional leak, dry eyes, falling tidal volumes, and persistent SpO2 87% despite intact headgear and a full-face mask fitted yesterday. Which troubleshooting sequence best resolves CPAP/NPPV leak and interface failure?
- A 26-year-old with suspected tuberculosis needs sputum induction in a negative-pressure room, requiring gown, gloves, N95 respirator and face shield for droplet and airborne risks. Which donning and doffing sequence best applies Standard Precautions with isolation?
- A 12-year-old with asthma uses a metered-dose inhaler with valved holding chamber but continues coughing, has poor symptom control, white residue on the tongue, and actuates multiple puffs in rapid succession without inhaling slowly. Which inhaler technique correction should the therapist teach to improve drug delivery from a pressurized inhaler and chamber?
- A 70-year-old with pneumonia on a nonrebreather mask at 15 L/min remains at SpO2 86% with the reservoir bag fully collapsing on inspiration, mask loosely fitting, and tachypnea at 32/min. Blood pressure is stable and the flowmeter is confirmed open. Which troubleshooting step best restores effective oxygen delivery?
- An ICU nurse reports a water-seal chest drainage system shows continuous vigorous bubbling in the water-seal chamber, tidaling absent, and a portable SpO2 monitor reads 78% with good waveform while the patient is alert and pink with no distress. Suction is set at -20 cm H2O. Which troubleshooting sequence best resolves chest drain and pulse oximeter dysfunction?
- A mechanically ventilated adult has gurgling around the cuff, tidal volume loss on exhaled measurement, low-pressure cuff alarm, and weak suction with collapsed tubing during inline suctioning. Cuff pressure reads 14 cm H2O and pilot balloon stays flat after inflation attempts. Which device troubleshooting sequence best resolves artificial airway and suction failure?
- An outpatient pulmonary clinic reuses mouthpieces, spacers, and resuscitation masks between patients and currently wipes all items with a damp cloth at day's end. The manager asks how to correct reprocessing. Which disinfection policy should the therapist recommend for these reusable respiratory items?
- A home-care patient reports a 5-L stationary oxygen concentrator alarming with low output and the flowmeter ball bouncing at 2 L despite a 2-L prescription. Tubing is 25 feet, humidifier bottle is attached and power is on. Which troubleshooting sequence should the therapist perform first for this concentrator and flow delivery system?
- In an ICU a self-inflating resuscitator compressed for an intubated adult fails to re-expand, the oxygen reservoir remains attached, the PEEP valve is in place, the air intake is covered by a blanket, and exhaled air leaks around the bag valves. Which troubleshooting action best restores resuscitator function during assembly?
- A 24-year-old with asthma uses an albuterol metered-dose inhaler with a valved holding chamber but reports poor relief. Observation shows rapid multiple actuations into the chamber, immediate exhalation without a breath-hold, and failure to check priming or the dose counter. Which troubleshooting correction best restores effective metered-dose inhaler delivery through the spacer?
- A respiratory therapist obtains PaO2 210 mm Hg on FiO2 0.40 with normal SpO2 96%, plus erratic CO-oximetry carboxyhemoglobin readings and point-of-care analyzer QC failures on repeated samples with air bubbles and delayed iced analysis. Which analyzer troubleshooting approach best ensures reliable blood gas results?
- In a medical ICU a therapist assembles a fiberoptic bronchoscope with weak suction and an arterial line monitor showing a damped waveform after flushing, with the transducer leveled at the phlebostatic axis and zeroed to air and all stopcocks closed to air. Bedside check finds no kinked tubing and a small air bubble near the transducer dome. Which troubleshooting sequence best corrects the bronchoscope and arterial catheter monitor performance?
- An adult with pneumonia is on heated high-flow nasal cannula at 50 L/min, FiO2 0.60 with target 37 C. The circuit shows heavy rainout, chamber is overfilled, temperature reads 31 C and the low-temperature alarm sounds. Tubing drapes below the bed with condensate draining toward the patient. Which troubleshooting step for heated high-flow humidification best restores warm humidification?
- In a busy emergency department a sputum trap from a tuberculosis isolation patient cracks and leaks purulent secretions onto the bedside table, and the nurse asks for help while two intubated patients wait nearby. The spill kit, red bags, disinfectant and puncture-proof sharps box are stocked. Which biohazard containment action best handles leaking respiratory secretions safely?
- In the emergency department a 3-kg neonate remains apneic and bradycardic. The team assembles a T-piece resuscitator set to 20/5 cm H2O with 10 L/min gas flow, but the manometer shows no PEEP, the chest does not rise, and the mask seal appears tight. Which resuscitator troubleshooting action best restores T-piece function?
- An adult volume-controlled ventilated patient in the ICU suddenly triggers a high peak pressure alarm with low exhaled tidal volume. The circuit is newly assembled, the patient is biting the tube, and secretions are present. Which ventilator circuit troubleshooting step best resolves this high-pressure low-volume alarm?
- A 60-year-old man on volume-controlled ventilation suddenly triggers repeated high-pressure alarms at 45 cm H2O with delivered volume falling from 450 to 210 mL. The circuit shows dependent water pooling, the patient is biting the tube, and suction yields thick plugs. Which ventilator-circuit troubleshooting sequence best resolves these high-pressure alarms?
- A pulmonary lab performs morning quality control on a portable spirometer using a 3-L calibration syringe, with repeated volumes reading 2.68 L despite correct technique, proper connections, and stable room temperature. Patients are scheduled for pre-operative testing. Which quality-control action should the therapist take for the spirometer before patient use?
- In the ICU an adult with stridor and morbid obesity requires urgent intubation for a difficult airway. The therapist assembles a video laryngoscope with detachable monitor and tests it at bedside. The monitor powers on, the blade light is bright, the battery shows full charge, but the screen shows no airway image. Which troubleshooting step for video laryngoscope signal connection should the therapist perform first?
- A 30-year-old patient with cystic fibrosis using a positive expiratory pressure mask and oscillatory vest at home reports poor sputum clearance, prolonged treatment time, and intermittent low-pressure alarms on the vest, with thick yellow secretions and SpO2 92%. Equipment appears assembled but filters look damp and hoses have visible condensation. Which device troubleshooting action best restores hyperinflation and secretion clearance?
- In an emergency department a therapist must enter the room of an adult with suspected tuberculosis with cough and fever to administer a breathing treatment, with an N95 respirator, gown, gloves, and eye protection available at the doorway and hand hygiene stations nearby. The unit requires airborne plus Standard Precautions and safe disposal. Which sequence best applies Standard Precautions, isolation, and donning and doffing for this encounter?
- A 58-year-old with OSA on nasal CPAP at 10 cm H2O reports morning dry eyes, mouth leaks, machine shows leak 45 L/min, residual AHI 12, and red marks from overtight straps. The cushion is 2 years old, the wrong size, and the humidifier is empty. Which CPAP interface troubleshooting step to control leaks best restores effective therapy?
Breadth of Knowledge: Initiation and Modification of Interventions (50 of 160 items) · 94 questions
- A 62-year-old is on volume control ventilation day 4 for pneumonia, now afebrile with FiO2 0.40, PEEP 5, stable pressure, alert and triggering breaths with adequate cough and minimal secretions. The team wants to advance liberation today during daytime staffing. Which liberation strategy should the therapist initiate to assess readiness for extubation?
- A 68-year-old post-surgical adult is stable on a medical floor, breathing comfortably on 2 L/min nasal cannula with SpO2 97%, respiratory rate 16 and clear lungs. The hospital respiratory-driven protocol targets SpO2 92-96% for stable non-ICU patients and allows titration without new orders. Which respiratory-driven protocol step for oxygen titration should the therapist implement next?
- In the delivery room a term newborn is limp and apneic after drying and stimulation, heart rate is 55 bpm by stethoscope, and effective positive-pressure ventilation has been given for 30 seconds with chest rise and good seal. The warmer, suction, and code medications are available with a team present. Which neonatal resuscitation intervention should the team implement next for this bradycardic newborn?
- An adult with COPD on volume assist-control shows expiratory flow not returning to zero, rising peak pressures, and a scooped inspiratory pressure scalar with patient effort. Blood pressure is soft and breath stacking is seen. Which ventilator adjustment best corrects auto-PEEP with inspiratory flow starvation shown on scalars?
- A 42-year-old needs emergent intubation for airway protection with morbid obesity, short thick neck, limited mouth opening, beard, and prior difficult intubation noted. Stridor is present and bag-mask seal is poor. Which difficult airway recognition finding should the therapist report first to prepare the airway team?
- A 68-year-old post-stroke patient on a medical floor is lethargic, coughs weakly, pools oral secretions, has right-sided weakness, a diminished gag reflex, and SpO2 91% on room air. Which patient position best optimizes airway patency for secretion drainage?
- A 71-year-old is obtunded after stroke with preserved gag, noisy upper airway obstruction, edentulous mouth, and inability to protect secretions during transport to CT. Vital signs are stable but SpO2 is 89%. Which airway device selection and management step should the therapist implement to maintain a patent airway?
- On a medical-surgical floor a patient develops sudden stridor and hypotension after antibiotics, the medical emergency team is activated, and multiple responders give overlapping verbal orders in a noisy room. The respiratory therapist is assigned airway management. Which team communication technique should the therapist use to ensure safe execution of emergency orders?
- A 24-year-old with cystic fibrosis admitted for exacerbation has thick retained secretions, wheezing, and prescriptions for albuterol, dornase alfa, inhaled tobramycin, and airway clearance. Treatments are clustered and time is limited. Which aerosol medication sequence should the therapist select to maximize deposition and clearance?
- A 45-year-old requiring urgent intubation in the emergency department has a short thick neck, limited mouth opening of 2 cm, Mallampati class IV view, beard obscuring landmarks, and a history of prior failed intubation. Which difficult airway recognition action best prepares the team before induction?
- A 40-year-old with pneumonia is intubated on PEEP 10 cmH2O and FiO2 0.60 with PaO2 120 mmHg, bilateral infiltrates and no heart failure. The team debates ARDS presence and level. Which severity classification for ARDS using Berlin criteria should the therapist report?
- A 58-year-old with moderate ARDS on 6 mL/kg predicted body weight has PaO2/FiO2 135 on FiO2 0.70 and PEEP 10 cm H2O, plateau 27 cm H2O, and no pneumothorax or hypotension. The team considers recruitment. Which lung-protective ventilation approach best supports oxygenation during ARDS with recruitment precautions?
- A 55-year-old in the ICU needs an endotracheal tube exchange for a cuff leak with a known anterior airway, full stomach, and SpO2 93% on FiO2 0.60. The team has a video laryngoscope, bougie, and tube exchanger available. Which adjunct strategy should the therapist recommend to use tube exchangers, video laryngoscopes and bougies safely?
- A 55-year-old with ARDS and echocardiographic right-ventricular strain remains hypoxemic with elevated pulmonary pressures despite lung-protective ventilation, prone positioning, and stable systemic pressure. The team requests an inhaled pulmonary vasodilator trial. Which delivery method should the therapist select to improve ventilation-perfusion matching?
- In a crowded emergency department during a mass-casualty surge, a term newborn is limp, apneic and cyanotic after delivery with no response to drying and stimulation. Staff and warmers are limited. Which high-risk response for neonatal resuscitation and disaster triage should the therapist prioritize first?
- A 62-year-old ventilated for pneumonia is now afebrile, hemodynamically stable, on minimal pressure support, with RSBI 58, strong cough, adequate mentation, and a passed 60-minute spontaneous breathing trial on CPAP. Which liberation step best advances mechanical ventilation discontinuation after this successful trial?
- A 60-year-old intubated patient with pneumonia on volume control ventilation, PEEP 10 cm H2O and FiO2 0.60, must move from the ICU to CT scan across the hospital with elevators and a 20-minute transport. The patient is sedated but hemodynamically stable. Which transport preparation best ensures safe movement of this ventilated patient within the hospital?
- A 58-year-old in the ED is obtunded from overdose, breathing spontaneously with snoring respirations, clenched teeth, and an intact gag and cough. Pulse oximetry is 89% on room air and repositioning alone does not open the airway. Which artificial airway selection best maintains patency with an intact gag reflex?
- A 24-year-old with cystic fibrosis is admitted with thick tenacious sputum, wheezing, and prior bronchospasm during mucolytic therapy, requiring daily dornase alfa and scheduled albuterol plus inhaled tobramycin for Pseudomonas colonization. Which aerosol medication sequence should the therapist select to deliver bronchodilators, mucolytics and antimicrobials?
- You join a rapid response for a deteriorating patient with stridor where the team leader orders epinephrine, airway equipment, and a room change amid loud overlapping talk. Which closed-loop communication technique best ensures emergency team orders are completed safely during resuscitation?
- After a morning rapid-response call where a ward asthma patient required emergency BiPAP and ICU transfer, the mixed nurse-physician-therapist team feels shaken, accounts of delays differ, and family concerns arise. The event ended safely an hour ago. Which debriefing leadership approach should the respiratory therapist initiate first to strengthen safety culture?
- A 54-year-old intubated patient in a busy emergency department needs topical anesthesia before fiberoptic bronchoscopy through the endotracheal tube, with copious secretions cleared, preoxygenation completed, and monitoring in place. Which endotracheal instillation technique best delivers medication while preserving oxygenation and sterility?
- A 62-year-old ICU patient with a known difficult airway needs exchange of a damaged 7.5 endotracheal tube but must maintain continuous airway access and oxygenation. The team has a video laryngoscope, bougie, and airway exchange catheter available. Which adjunct technique best facilitates safe endotracheal tube exchange in a difficult airway?
- On a step-down unit a 58-year-old with a week-old tracheostomy has thick dried crusting at the stoma, low-volume thick secretions, and a soiled reusable inner cannula with intact skin and stable vitals. Which tracheostomy care and humidification action best maintains a patent airway?
- A pulmonology team plans bedside bronchoscopy with endobronchial ultrasound in a procedure suite for a middle-aged adult with a right hilar mass, requiring topical anesthesia, moderate sedation monitoring, and multiple needle passes with rapid onsite evaluation. You are assigned to assist. Which assisting action best supports safe intubation-style airway management and EBUS sampling?
- A 62-year-old in the ICU after mitral valve repair has pulmonary hypertension, RV dilation on echo, hypoxemia on lung-protective ventilation, and no active bleeding. The team orders a trial of inhaled nitric oxide with continuous monitoring. Which delivery principle should guide inhaled nitric oxide for pulmonary hypertension in this ventilated patient?
- A 68-year-old with a cuffed tracheostomy on day 3 has thick tenacious secretions, crusted stoma, low tidal volume alarms on the ventilator, and dry inspired gas. The inner cannula is disposable and humidification is bypassed. Which tracheostomy care routine best restores patency, humidification, and infection control?
- A 6-year-old with severe upper airway obstruction in a pediatric emergency bay needs heliox to reduce work of breathing, and a neonate with persistent pulmonary hypertension in the NICU nearby is prescribed inhaled nitric oxide with methemoglobin monitoring. Which administration principle best ensures safe heliox and inhaled nitric oxide delivery?
- A 55-year-old on volume control ventilation with PEEP 10 and FiO2 0.60 needs CT across the hospital for suspected pulmonary embolism with only one respiratory therapist and one nurse available. Which intra-hospital transport preparation best maintains safe ventilation and monitoring en route?
- On a medical floor a 45-year-old with retained secretions in the left lower lobe is alert with stable vitals, adequate hydration, and no hemoptysis, fractures, or increased intracranial pressure. Which postural drainage, percussion, and vibration technique best clears this lobe?
- A 34-year-old asthmatic in an outpatient clinic develops severe wheezing, stridor, chest pain, SpO2 86%, tachycardia 132, and hypotension minutes after starting a nebulized medication with tachyphylaxis unrelieved by repositioning. Which care-plan change best addresses termination for severe adverse events?
- In a telemetry unit an adult with a new tracheostomy is gurgling with visible secretions, SpO2 89%, coarse rhonchi, and weak cough but is alert with intact gag and no nasal obstruction or bleeding. Which suctioning approach best clears the airway while limiting harm?
- An emergency physician prepares for ultrasound-guided thoracentesis on a dyspneic adult with a large right pleural effusion, with consent signed, platelets borderline low, and SpO2 90% on 2 L nasal cannula. You are asked to assist. Which assisting action best supports safe thoracentesis and chest drainage preparation?
- A 28-week preterm infant on mechanical ventilation has increasing FiO2 needs with classic ground-glass appearance and low lung compliance, and the neonatologist orders surfactant replacement through the endotracheal tube during a sterile bedside procedure. Which endotracheal instillation technique should the therapist perform to deliver surfactant?
- After a failed emergency intubation with hypoxemia that resolved, the interprofessional team is shaken and blaming each other in the hallway. Which debriefing leadership approach best promotes learning, safety culture, and team recovery after this adverse event?
- A 52-year-old with bronchiectasis has coarse crackles and heavy sputum localized to both lung bases, weak spontaneous cough, and stable vitals. The provider orders airway clearance for lower lobe segments. Which postural drainage position with percussion and vibration best targets lower lobe secretions?
- A 5-year-old with severe viral croup and inspiratory stridor shows increased work of breathing, barky cough, and poor nebulizer tolerance on room air, and the team requests a low-density gas to reduce airway resistance while maintaining oxygenation. Which heliox and nitric oxide administration setup should the therapist select to relieve obstruction?
- A 19-year-old with cystic fibrosis is admitted with increased purulent sputum, SpO2 91% on room air, and fatigue with manual chest physiotherapy. The patient has weak expiratory effort, cannot sustain a huff cough, and peak cough flow is 140 L/min. Vital signs are stable and there is no hemoptysis or pneumothorax. Which airway clearance modality should the therapist select to provide insufflation-exsufflation support?
- A 70-year-old with bronchiectasis was started on twice-daily postural drainage with percussion 3 days ago for copious purulent sputum. Today sputum is less than 5 mL per day, breath sounds are clear, cough is nonproductive, and SpO2 is 96% on room air. Which change to airway clearance therapy should the therapist recommend based on this response?
- In the ICU a team is placing a radial arterial line and starting moderate sedation for a dyspneic adult needing frequent gases, with continuous pulse oximetry, cardiac monitoring, and nasal cannula oxygen in place. The physician asks respiratory therapy to assist the sterile procedure and sedation. Which assistance action best supports safe arterial catheter insertion with moderate sedation?
- A pulmonologist plans bedside bronchoscopy with endobronchial ultrasound for a 58-year-old outpatient with a right hilar mass, mild hypoxemia on 2 L nasal cannula, and no coagulopathy. The team asks respiratory therapy to assist with airway and sampling setup. Which assistance action best supports safe EBUS-guided sampling during the procedure?
- A 59-year-old intubated patient in the ICU has coarse rhonchi, visible secretions in the endotracheal tube, and a transient desaturation after coughing, with a sterile suction kit and closed-system catheter available at bedside. Which suctioning technique should the therapist use to clear an artificial airway while preserving oxygenation and sterility?
- A tachyarrhythmic adult in the ICU is scheduled for synchronized cardioversion, and in the next room a family has chosen withdrawal of life support with comfort measures only. Respiratory therapy is asked to assist both teams today. Which assistance action best supports safe cardioversion readiness?
- A 32-year-old with C5 spinal cord injury has weak inspiratory and expiratory muscles, peak cough flow 155 L/min, retained secretions, and SpO2 90% on room air. The patient is alert, can follow commands, has no bulbar dysfunction or contraindication to manual assistance, and needs a bedside cough strategy before suctioning. Which assisted cough and hyperinflation technique should the therapist apply to improve cough effectiveness?
- A 48-year-old on mechanical ventilation develops sudden pleuritic pain, unilateral absent breath sounds, hypotension, tracheal shift, and serum sodium 128 mEq/L with fluid overload from excess hypotonic fluids. Which care plan change best addresses pneumothorax, fluid balance and electrolytes together?
- A 67-year-old with COPD receives a first albuterol-ipratropium nebulizer and within minutes develops severe bronchospasm with silent chest, SpO2 81%, hypotension, and widespread hives after an antibiotic change. The mask is still running. Which care plan action best terminates treatment for this severe adverse event?
- A 28-year-old with Duchenne muscular dystrophy has recurrent atelectasis, a weak peak cough flow of 150 L/min, difficulty clearing secretions during colds, intact swallowing, and fatigue with manual chest physiotherapy. Which oscillatory or cough-assist intervention best improves secretion clearance for this weak cough?
- A 70-year-old intubated patient in the medical ICU after 16 days of ventilation is scheduled for bedside percutaneous tracheotomy. The surgeon requests bronchoscopic guidance, the patient is sedated on volume-control ventilation, and the team is assembling sterile instruments with emergency airway equipment available. Which assisting responsibility should the respiratory therapist prioritize during this tracheotomy insertion?
- A 58-year-old intubated for pneumonia has improved infiltrates, is alert, cough is strong, secretions are scant, RSBI 68, passed 30-minute spontaneous breathing trial on pressure support, and cuff leak is audible. Which airway liberation recommendation best fits this extubation readiness?
- A 34-year-old with high cervical spinal cord injury has weak inspiratory effort, ineffective cough with peak cough flow 140 L/min, retained secretions, and recurrent atelectasis but intact bulbar function and cooperative participation. Which assisted cough and lung expansion approach should the therapist teach for secretion clearance and volume recruitment?
- At shift change in a busy ICU, a therapist must hand off a ventilated adult with ARDS on lung-protective settings, prone-positioning schedule, norepinephrine infusion, and a planned spontaneous breathing trial in the morning. Which handoff communication best ensures continuity and timely escalation of concerns?
- A 71-year-old with right middle lobe pneumonia has SpO2 87% on 2 L/min, coarse crackles on the right, productive cough with thick sputum, and ability to turn with assistance. Chest X-ray shows dense right-sided infiltrate without effusion, hemodynamics are stable, and the good left lung is normal. Which positioning and airway clearance combination should the therapist use to minimize hypoxemia?
- A 60-year-old in the ICU needs radial arterial line placement for hourly gases and blood pressure monitoring, is alert with a palpable radial pulse, normal Allen test, and no wrist infection. The physician asks respiratory therapy to assist with setup and moderate sedation monitoring if needed. Which assistance sequence best supports safe arterial catheter insertion?
- A 55-year-old with acute bronchospasm receives albuterol MDI with spacer, but 30 minutes later wheeze, accessory muscle use and PEF 55% of personal best persist, with heart rate 112 and tremor. The order allows titration. Which therapy change based on response best addresses persistent bronchospasm?
- A young adult refugee with limited English proficiency, prior ICU trauma, and worsening asthma needs inhaler teaching before discharge in a crowded emergency department with family present. Which communication approach best demonstrates patient-centered, trauma-informed, culturally aware care?
- A 45-year-old with bronchiectasis has thick purulent sputum, wheezing, oxygen need 3 L/min, pulmonary pressures elevated, and poor response to albuterol alone in the step-down unit. Which inhaled medication recommendation best targets secretions, inflammation and vascular tone?
- A 59-year-old with community-acquired pneumonia has SpO2 86% on 6 L/min nasal cannula, respiratory rate 32/min, increased work of breathing, PaO2 58 mmHg on oxygen, and no hypercapnia or altered mentation. The patient can protect the airway, has no facial trauma or obstruction, and remains hypotensive-free with adequate perfusion. Which oxygenation support should the therapist initiate and titrate to correct refractory hypoxemia?
- A 62-year-old postoperative patient on mechanical ventilation develops sudden right-sided chest pain, absent breath sounds on the right, tracheal shift left, hypotension, and SpO2 84%. Chest x-ray confirms large right tension pneumothorax with mediastinal shift. Labs show K+ 2.8 mEq/L and ionized Ca++ low. Which care-plan change best addresses tension pneumothorax with electrolyte disturbance?
- A 62-year-old in the ICU with unstable atrial fibrillation is scheduled for elective synchronized cardioversion. The team asks respiratory therapy to assist at bedside with airway equipment, oxygen and monitoring during procedural sedation. Which bedside assistance step should the therapist complete immediately before shock delivery for safe cardioversion support?
- A 68-kg predicted body weight adult with ARDS is on volume assist-control rate 20, VT 550 mL, PEEP 8 cm H2O, FiO2 0.70 with plateau 32 cm H2O, PaO2 68 mm Hg and pH 7.32. Lung-protective goals and oxygenation both remain unmet despite sedation. Which invasive ventilation adjustment best balances lung protection and oxygenation?
- A 58-year-old with right lower lobe pneumonia is hypoxemic at 88% on 4-L nasal cannula, alert, with coarse crackles and thick sputum he cannot clear, and chest x-ray shows dense right basal opacity without pneumothorax. Turning is tolerated and hemodynamics are stable. Which positioning and airway clearance strategy best minimizes hypoxemia from retained secretions and mismatch?
- A 68-year-old in septic shock on norepinephrine remains hypotensive with MAP 58 mm Hg, lactate 4.2 mmol/L, adequate fluids by dynamic indices, new rapid atrial fibrillation at 150/min, and oliguria with crackles and rising creatinine. Cultures are pending and broad-spectrum antibiotics were started within one hour. Which care-plan medication change best balances perfusion, rhythm, and volume in this shock?
- A 58-year-old intubated for pneumonia after 9 days has improving infiltrates, FiO2 0.35, PEEP 5, hemodynamic stability, strong cough, minimal secretions, and passed a 30-minute spontaneous breathing trial with RSBI 68, negative inspiratory force -28 cm H2O, and alert mentation. The cuffed endotracheal tube shows minor cuff leak. Which care-plan change best advances artificial airway liberation and extubation?
- In an outpatient clinic a 32-year-old with persistent asthma vapes daily, shares a home nebulizer with a sibling, rinses the cup with tap water, air-dries rarely, and misses doses during colds. The patient wants fewer flare-ups without judgment. Which infection-control, equipment, and cessation education bundle should the therapist provide first?
- A 66-year-old with pneumonia is tachypneic and hypoxemic with SpO2 86% on 6-L nasal cannula, alert, protecting the airway, with no hypercapnia or hypotension, in a monitored step-down unit with close supervision. The team wants to avoid intubation if possible while improving oxygenation and work of breathing. Which oxygenation support initiation best improves oxygenation while reducing intubation risk?
- A night-shift therapist notes a postoperative patient with rising respiratory rate from 18 to 30, increased work of breathing and SpO2 89% on 4 L after being stable at 94%. The nurse is busy and the rapid response criteria are nearly met. Which handoff and escalation communication should the therapist initiate to address this deteriorating respiratory status?
- A 64-year-old ventilated two days after coronary bypass remains on a propofol infusion, RASS -4, hypotensive requiring norepinephrine, with no spontaneous efforts and no awakening trial. The team wants to assess readiness to wean. Which sedative adjustment should the therapist recommend to facilitate weaning evaluation?
- In the emergency department, a 69-year-old with severe community-acquired pneumonia was placed on bilevel noninvasive ventilation for hypoxemia and tachypnea. After one hour, RR is 34, SpO2 87% on FiO2 0.60, accessory muscles are active, mentation is drowsy, secretions are copious and blood pressure is 88/54 mm Hg. Which criterion confirms noninvasive ventilation failure requiring escalation?
- A 34-year-old with moderate persistent asthma presents with wheezing, prolonged expiration, peak flow 65% of personal best, SpO2 94%, and thick mucus plugging despite good inhaler technique. The patient uses albuterol frequently without controller therapy. Which pharmacologic care-plan change best recommends bronchodilators, anti-inflammatories, mucolytics, and vasodilators?
- A 68-year-old with severe COPD on 2 L home oxygen is referred to pulmonary rehabilitation after two exacerbations, reports avoiding walking for fear of breathlessness, demonstrates poor metered-dose inhaler technique without a spacer, and asks how rehab will help daily life. Which pulmonary rehabilitation education strategy best supports COPD self-management and functional improvement for this patient?
- A 70-kg predicted body weight adult with ARDS is on volume control ventilation with VT 650 mL, plateau 34 cm H2O, SpO2 86% on FiO2 0.8 and PEEP 8 cm H2O, with bilateral infiltrates and no pneumothorax. ABG shows PaO2 58 mm Hg with permissive hypercapnia tolerated. Which invasive ventilation adjustment best improves oxygenation while ensuring lung protection?
- A 34-year-old with prior traumatic intubation is now anxious, tearful and declining a needed nebulizer treatment, citing fear of choking and mistrust of procedures. The therapist has limited time before the next scheduled medication. Which culturally aware, trauma-informed communication should the therapist use to support acceptance of this respiratory treatment?
- A 70-year-old in septic shock with pneumonia develops hypotension MAP 58 mmHg, atrial fibrillation with rapid rate, crackles with volume overload, and rising creatinine despite 30 mL/kg fluids and norepinephrine. Cultures are pending and potassium is elevated. Which medication care-plan change best recommends vasoactives, antiarrhythmics, antimicrobials, and diuretics?
- A 55-year-old with obesity and loud snoring is drowsy after sedation for a procedure, breathing spontaneously at 10/min with SpO2 89%, soft stridor, and posterior tongue obstruction noted on exam. No cervical spine injury or vomiting is present. Which positioning maneuver best maintains a patent airway in this spontaneously breathing adult?
- A 16-year-old with cystic fibrosis and F508del mutation has frequent exacerbations, declining FEV1, chronic Pseudomonas colonization, and difficult asthma-like wheezing despite inhaled steroids. The team discusses advanced therapies including surfactant history, biologics, and modulators. Which medication recommendation best targets the underlying CFTR defect in this CF?
- A 2-kg infant with respiratory distress syndrome is on high-frequency oscillatory ventilation with FiO2 0.6 and mean airway pressure 14 cmH2O, with persistent hypoxemia and a low-volume chest radiograph. The high-pressure and low-volume alarms sound briefly during suctioning and repositioning. Which alarm management strategy best supports oxygenation during high-frequency ventilation?
- A 68-year-old with COPD exacerbation is on bilevel noninvasive ventilation for hypercapnic failure with pH 7.30 and PaCO2 68. After two hours pressures were titrated and mask leak is minimal, but accessory use worsens and mentation declines. Which noninvasive ventilation failure sign indicates need to escalate to invasive ventilation?
- A 68-year-old with COPD exacerbation receives albuterol 5 mg nebulizer every 2 hours, with persistent mild wheeze but new tremor, HR 128 and potassium 3.1, and the nurse asks about the next aerosol. History includes frequent ectopy on telemetry. Which aerosol drug adjustment best balances continued bronchodilation with systemic beta-agonist toxicity?
- A 54-year-old man with a BMI of 41 needs urgent intubation for hypercapnic failure. Bedside exam notes Mallampati class IV, thyromental distance under 6 cm, rigid cervical collar, full beard, and loud habitual snoring with witnessed apneas. Which difficult airway recognition conclusion best guides preparation for this intubation?
- A 68-year-old with COPD on 2 L home oxygen continues to vape and reports recurrent bronchitis. The apartment smells of cigarettes, the concentrator filter is dusty, tubing lies on the floor, and grandchildren visit weekly. The patient wants practical steps to stay safe at home. Which education plan on infection control, home equipment and smoking cessation best protects this household?
- In a surgical ICU a mechanically ventilated adult with agitation and ventilator dyssynchrony receives continuous midazolam and fentanyl without a pain assessment, daily interruption, or train-of-four monitoring, now with prolonged somnolence, hypotension, and weak cough after vecuronium was added for shivering. The team considers prolonged blockade and oversedation risks. Which recommendation best addresses sedatives, analgesics, reversal agents, and neuromuscular blockers for this patient?
- A 55-year-old patient with ARDS on volume assist-control ventilation at 450 mL, rate 18, PEEP 10 cmH2O, and flow 60 L/min is agitated, with double-triggered breaths, rising peak pressures, and ventilator rate exceeding set rate on the monitor. Sedation is light, pH is 7.32, and there is no circuit leak or auto-PEEP on exam. Which ventilator adjustment best corrects this patient-ventilator dyssynchrony?
- A 67-year-old man with a permanent tracheal stoma after total laryngectomy arrives obtunded and hypoxemic. He has no palpable laryngeal prominence, breath sounds are absent at the mouth, and a fenestrated tracheostomy tube is displaced. Upper airway attempts fail to ventilate. Which airway device management choice best secures ventilation for this laryngectomy anatomy?
- A 64-year-old with moderate COPD, frequent wheeze, and a new tracheostomy with home ventilator dependence completes pulmonary rehabilitation intake. The patient misuses inhalers, avoids activity from fear, and family feels unprepared for suctioning and emergency changes. Which education focus on rehabilitation, COPD, asthma overlap, and tracheostomy-ventilator care best builds safety?
- A 71-year-old with COPD exacerbation is on 4 L nasal cannula with SpO2 95%, accessory muscle use resolved and ABG pH 7.36 with PaCO2 52, and the respiratory-driven oxygen titration protocol targets 88% to 92% to avoid hyperoxia. The nurse asks if oxygen should stay high for safety. Which protocol-based oxygen titration action best follows evidence-based weaning?
- In an adult pulmonary clinic a 32-year-old with severe eosinophilic asthma has two exacerbations and one hospitalization in the past year despite high-dose inhaled corticosteroid plus long-acting beta-agonist, correct technique, and adherence, with blood eosinophils 420 cells per microliter and nasal polyps. A preterm infant and a cystic fibrosis teen are managed separately. Which recommendation best addresses surfactant, asthma biologics, and CFTR modulators for this asthma patient?
- A 62-year-old patient with COPD on assist-control ventilation shows scalloped inspiratory pressure-time scalars, concave inspiratory flow with persistent patient effort, and a pressure-volume loop with widened hysteresis, while expiratory flow fails to return to zero with rising intrinsic PEEP. Which ventilator graphics interpretation best identifies the primary problem requiring correction?
- A 900-g preterm infant on high-frequency oscillatory ventilation has decreasing chest wiggle, SpO2 82% and a low mean airway pressure alarm. The piston is running, but the circuit shows a leak at the humidifier and the endotracheal tube is mid-trachea. Which high-frequency ventilation response best restores oxygenation and ventilation?
- A 48-year-old patient with moderate ARDS from pneumonia has PaO2/FiO2 145 on FiO2 0.7 and PEEP 10 cmH2O, plateau pressure 28 cmH2O, driving pressure 18 cmH2O, and bilateral infiltrates with no pneumothorax or hypotension. The team considers lung recruitment for refractory hypoxemia. Which lung recruitment and lung-protective ventilation strategy best balances oxygenation and safety?
- A 58-year-old with pneumonia is on volume control with FiO2 0.60, PEEP 10 cm H2O, PaO2 72 mm Hg and bilateral opacities not explained by effusion or collapse after fluids. The team asks for ARDS severity to guide prognosis and referral. Which Berlin severity classification best fits this oxygenation defect on PEEP?
- An obese adult with suspected sleep apnea arrives obtunded with loud snoring, SpO2 86%, chin falling to chest in a supine flat bed, and no cervical trauma. The nurse has an oral airway and positioning aids ready, and the physician requests optimal positioning before assisted ventilation. Which patient positioning technique to optimize the airway best relieves this obstruction?
- In a medical ward a 58-year-old with moderate asthma uses albuterol metered-dose inhaler two puffs every four hours with poor relief, nocturnal awakenings, and tremor, with correct spacer technique, normal potassium, and no chest pain. The provider asks respiratory therapy to optimize bronchodilator therapy within protocol. Which adjustment best addresses drug, dose, frequency, mode, or concentration for this patient?
- A 45-year-old woman with angioedema requires oral endotracheal tube exchange for a damaged cuff. She has limited mouth opening, anterior larynx, and a Cormack-Lehane grade III view on direct laryngoscopy with desaturation on prior attempts. Which tube exchanger, video laryngoscope, and bougie strategy best ensures safe tube exchange?
- An adult on assist-control ventilation shows double-triggered breaths with two stacked ventilator cycles per effort, high tidal volumes and patient distress. Sedation is light, inspiratory time is short, and flow demand is high. Which ventilator adjustment best corrects this patient-ventilator dyssynchrony?
Depth of Clinical Judgment (60 of 160 items) · 112 questions
- An overnight medical-surgical therapist is called for a 63-year-old with heart failure who developed new dyspnea, RR 26, SpO2 90% on room air, bibasilar crackles and 2+ edema after 1 L IV fluids. Chest film shows vascular congestion and BNP is elevated. Which assessment cluster best interprets gathered information about fluid-related gas exchange impairment?
- A 68-year-old with COPD exacerbation is alert, decisionally capable, and refuses intubation after informed discussion of risks, benefits, and alternatives. His daughter demands intubation and cites family consensus. The advance directive supports comfort-focused care. Which ethical response best applies medical ethics reasoning to this refusal of life support?
- In the delivery room a full-term newborn is limp and apneic after drying and stimulation, heart rate is 80/min by stethoscope, and no cry or effective breathing is present. The warmer is on and airway is positioned open. Which neonatal resuscitation intervention should the team initiate first for this apneic bradycardic newborn?
- A 62-year-old with severe COPD exacerbation shows worsening hypercapnia with pH 7.22, altered mentation, accessory muscle use, and inability to tolerate BiPAP due to copious secretions despite maximal bronchodilators, steroids, and antibiotics. Which invasive ventilation strategy best manages this COPD exacerbation requiring intubation?
- A 28-week preterm infant at 2 hours of life has grunting, nasal flaring, retractions, tachypnea, and increasing FiO2 need on nasal CPAP, with classic ground-glass appearance and air bronchograms on chest film. The team plans surfactant replacement through the airway. Which surfactant management approach should the therapist support for neonatal respiratory distress syndrome?
- A 55-year-old with COPD exacerbation has received 3 days of bronchodilators, steroids and controlled oxygen with improved wheezing, lower respiratory rate from 28 to 20, SpO2 92% and stronger cough. The physician asks whether bronchodilator frequency should change. Which therapy decision about adding, modifying, continuing or discontinuing therapy best fits this improving patient?
- A 30-week, 1250-g preterm infant in the NICU is intubated and on pressure-limited ventilation for worsening RDS with tachypnea, nasal flaring, low lung volumes, and FiO2 rising from 0.30 to 0.55 to maintain SpO2 above 90%. Blood gases show respiratory acidosis and hypoxemia despite optimal PEEP and short inspiratory times. Which surfactant replacement approach best manages neonatal respiratory distress syndrome for this intubated preterm infant?
- A 70-year-old with known COPD and hypercapnia presents with increased dyspnea, wheeze, pH 7.32 with PaCO2 58 mm Hg, alert mentation, manageable secretions, and good mask fit without hypotension or vomiting. Which combined noninvasive ventilation and medical treatment best manages this chronic lung exacerbation?
- A home-care therapist visits a 72-year-old with COPD on 2 L/min concentrator who reports increased dyspnea, SpO2 88% on current flow, spare E-cylinder low, and a long transport to clinic in winter. Power and roads are stable. Which out-of-hospital judgment for home care and transport best protects this patient?
- A 58-year-old post-abdominal surgery patient develops fever, increased work of breathing, and diminished bases on auscultation, with new opacities on portable film and borderline hypotension. Multiple therapies are possible and the team needs focus. Which information-gathering priority should the therapist choose to interpret the acute change?
- A 29-year-old with severe asthma exacerbation is obtunded, hypercapnic, and acidemic despite continuous bronchodilators, magnesium, and steroids, with silent chest and inability to tolerate bilevel. After intubation, peak pressures are high and exhalation is prolonged. Which invasive ventilation strategy best manages intubated status asthmaticus?
- A 58-year-old with COPD exacerbation on 2 L nasal cannula shows improved wheezing, SpO2 94%, pH 7.38, PaCO2 48 mm Hg after bronchodilators and steroids, but remains mildly dyspneic on exertion. The physician asks about next respiratory therapy. Which therapy decision should the therapist recommend to decide to add, modify, continue or discontinue therapy?
- A home-care therapist visits a 74-year-old on 2 L concentrator with chronic hypercapnia, morning headaches, and daytime sleepiness. Power is unreliable, backup E-cylinders are empty, and transport to clinic is a 40-minute bumpy ride. Which out-of-hospital judgment should the therapist apply for home care, transport and emergency response?
- In the emergency department a 68-year-old with COPD exacerbation is tachypneic, using accessory muscles, SpO2 88% on 2 L, and is alert but anxious with a limited history available. Multiple orders compete for attention. Which information-gathering priority should the respiratory therapist choose first to interpret severity and guide next assessment?
- A 78-year-old with end-stage COPD and documented do-not-resuscitate order develops respiratory distress, and family demands intubation despite the patient previously refusing it when competent. The care team is conflicted. Which medical ethics reasoning in this clinical scenario should guide the therapist's actions?
- A 64-year-old with COPD exacerbation is alert, tachypneic, using accessory muscles, pH 7.31, PaCO2 68 mm Hg, and hypoxemic on 2 L, with no apnea, shock, or inability to protect airway. Which noninvasive ventilation and medical treatment combination best manages hypercapnic COPD exacerbation without intubation criteria?
- A 66-year-old with severe COPD stabilizes after an exacerbation, still walks 120 feet before severe dyspnea, uses inhalers incorrectly, smokes half a pack daily, lives alone, and has no follow-up or action plan. Which outpatient discharge and rehabilitation plan best supports long-term chronic lung management?
- A 45-year-old with asthma exacerbation received three albuterol-ipratropium treatments, systemic steroids, and oxygen, now with normalized work of breathing, peak flow 85% of personal best, saturation 96% on room air, and minimal wheeze. The emergency team considers next respiratory orders. Which therapy decision should the therapist recommend for continued care?
- A 58-year-old smoker with 30 pack-years reports progressive exertional dyspnea, chronic productive morning cough for three years, prolonged expiration with wheezes, and two winter bronchitis episodes yearly without prior spirometry. Which evaluation best establishes a new diagnosis of chronic lung disease?
- A 66-year-old with severe COPD is ready for discharge after an exacerbation, still dyspneic on exertion, on inhalers with poor technique, smoking, and anxious about home management. Which outpatient discharge and rehabilitation plan best supports long-term chronic lung disease management?
- A 79-year-old with end-stage COPD and documented DNI wishes is in severe distress, but the adult child demands intubation while the patient Mouths no and shakes head. The care team is divided and time is limited. Which ethical reasoning step should the therapist prioritize to apply medical ethics in this scenario?
- A ventilator-dependent child on home noninvasive ventilation faces an interfacility ground transport of 90 minutes with limited portable oxygen, battery constraints, and a history of mucus plugging. The family asks about safety planning. Which out-of-hospital judgment should the therapist prioritize for safe transport and emergency response?
- On a surgical ward a 70-year-old post-lobectomy patient on 2 L nasal cannula now has SpO2 97%, clear breath sounds, normal ABGs, and walks hallways without dyspnea for two days. The nurse asks if oxygen should continue indefinitely. Which therapy decision best applies add, modify, continue, or discontinue logic for this stable patient?
- A 58-year-old with severe asthma exacerbation is intubated after failing bronchodilators, magnesium and BiPAP with pH 7.18 and PaCO2 78. Peak pressures are high, wheezing is diffuse, and auto-PEEP is 12 cm H2O. Which invasive ventilation strategy best limits dynamic hyperinflation while maintaining safe oxygenation?
- In the ICU a 62-year-old with severe COPD exacerbation on BiPAP is obtunded with paradoxical abdominal motion, ABG shows pH 7.18 with PaCO2 92 mm Hg, and copious secretions prevent NIV seal despite bronchodilators and steroids. Which invasive ventilation strategy best manages this COPD exacerbation requiring intubation?
- A 45-year-old after a motor vehicle crash has right-sided rib fractures with paradoxical chest motion, severe pleuritic pain, tachypnea, and hypoxemia on 2 L. Chest radiograph shows contusion without large pneumothorax. Which respiratory management strategy best supports ventilation for flail chest with paradoxical motion?
- A 67-year-old with known COPD presents with increased dyspnea, wheeze, pH 7.31, PaCO2 62, and persistent accessory muscle use after albuterol-ipratropium, steroids, and antibiotics. He is alert, handling secretions, and hemodynamically stable. Which combined noninvasive ventilation and medical treatment plan best manages this hypercapnic exacerbation?
- A 63-year-old with a 35 pack-year history reports daily productive cough for the last three winters, exertional dyspnea, and repeated bronchitis, with no known asthma and normal alpha-1 testing pending, and post-bronchodilator spirometry scheduled today. Which diagnostic evaluation best confirms a new diagnosis of chronic lung disease?
- You arrive by ambulance to a rural home where a school-age child with asthma has severe wheeze, accessory-muscle use, and SpO2 89% on room air, and the parent reports a depleted albuterol inhaler and a long driveway blocking quick hospital return. Oxygen and a transport nebulizer are available. Which out-of-hospital judgment best stabilizes the child for transport and emergency response?
- A 78-year-old with end-stage COPD in a 200-bed community hospital refuses intubation despite hypercapnic failure, is alert and understands risks after discussion, while family urges intubation and the team believes ventilation could prolong life briefly. Which medical ethics reasoning best guides respect for autonomy with beneficence and nonmaleficence?
- In the ED a 68-year-old with COPD exacerbation is alert with accessory muscle use, ABG shows pH 7.30 with PaCO2 62 mm Hg, SpO2 86% on 2 L, and wheezes with poor bronchodilator response so far. Which combined noninvasive ventilation and medical treatment plan best manages this exacerbation?
- A 64-year-old with severe COPD is ready for discharge after a hypercapnic exacerbation treated with steroids, now stable on home oxygen with continued smoking and poor inhaler technique. Which outpatient discharge and rehabilitation plan best reduces readmission and improves function?
- A 59-year-old suddenly becomes dyspneic with pleuritic pain, tachycardia, tachypnea, hypoxemia unresponsive to oxygen, hypotension, and jugular distension after knee surgery. ECG shows sinus tachycardia and bedside echo suggests right strain. Which cardiopulmonary support approach best manages suspected massive pulmonary embolism with obstructive shock?
- A 42-year-old after a motor vehicle crash has right-sided rib fractures with paradoxical chest motion, severe pleuritic pain, shallow breathing, hypoxemia, and suspected pulmonary contusion in a monitored trauma unit. Which chest trauma management approach best stabilizes ventilation for flail chest?
- A 58-year-old with severe COPD exacerbation in a 15-bed rural emergency department shows worsening hypercapnia, obtundation, and paradoxical breathing despite bronchodilators, steroids, and a failed BiPAP trial due to aspiration risk and copious secretions. Which intubation and invasive ventilation strategy best balances ventilation with air-trapping risk?
- On a busy medical unit a supervisor asks a new therapist to chart a bronchodilator treatment as given when it was missed because of staffing, saying quality scores will suffer and no harm occurred since the patient is stable. The patient has capacity and expects accurate records. Which medical ethics reasoning should guide the therapist response to the charting request?
- A 52-year-old with six months of progressive exertional dyspnea, chronic productive cough, wheezing, and 20 pack-year smoking history has normal cardiac exam and no acute infection. Which diagnostic evaluation best establishes a new diagnosis of chronic lung disease and its severity?
- A 34-year-old with Guillain-Barre syndrome shows progressive limb weakness, dysphagia, vital capacity falling from 38 to 22 mL/kg, MIP weakening to -28 cm H2O, and tachypnea with weak cough over 6 hours. Blood gases remain near normal. Which monitoring and ventilation timing decision best manages impending neuromuscular respiratory failure?
- A 66-year-old with chronic hypercapnic COPD and frequent exacerbations presents to a 30-bed ward with increased dyspnea, PaCO2 58, pH 7.32, alert mentation, and ability to cooperate and protect the airway. Which noninvasive ventilation and medical treatment combination best manages this chronic lung disease presentation?
- In a pulmonary clinic a 66-year-old with stable severe COPD on daily inhalers reports two recent exacerbations, exertional dyspnea, continued smoking, and incomplete inhaler technique with no current hypoxemia at rest. Which outpatient management, discharge, and rehabilitation plan best prevents future events?
- A 66-year-old two days after hip surgery develops sudden pleuritic chest pain, tachycardia, tachypnea, hypoxemia, hypotension, jugular distension, and right heart strain on bedside ultrasound suggesting obstructive shock. Which cardiopulmonary management priority should the therapist implement for suspected pulmonary embolism with shock?
- In an outpatient clinic a 58-year-old smoker reports chronic cough with sputum for three winters, progressive exertional dyspnea, and wheezing relieved partly by albuterol with no acute fever or chest pain. Which evaluation best establishes a new diagnosis of chronic lung disease?
- A 68-year-old with known COPD presents with severe exacerbation, drowsiness, ABG pH 7.22 with PaCO2 78, and accessory-muscle fatigue despite maximal bronchodilators, steroids, and BiPAP with worsening mentation. Which management decision best addresses COPD exacerbation requiring intubation and invasive ventilation?
- A 62-year-old with chronic hypercapnic COPD, morning headaches, and daytime sleepiness tolerates an acute illness recovery but retains PaCO2 55 with nocturnal desaturation, and is reluctant about tracheostomy or intubation. Which chronic management plan best combines noninvasive ventilation and medical treatment for stable disease?
- A 45-year-old after a motor vehicle crash has right-sided rib fractures with paradoxical chest movement, severe splinting pain, hypoxemia, and small pneumothorax on imaging. Which management strategy best stabilizes chest trauma with rib fractures and flail chest while preventing complications?
- A 63-year-old with moderate COPD, 40 pack-year history, two exacerbations last year, SpO2 93% on room air, and limited exercise tolerance is ready for discharge from a suburban 80-bed hospital to home with a spouse caregiver. Which outpatient management, discharge, and rehabilitation plan best reduces future exacerbations?
- A 27-year-old with severe traumatic brain injury has elevated intracranial pressure, headache, hypertension, bradycardia, PaCO2 48 mm Hg, and PaO2 72 mm Hg on current ventilation. The team wants both brain and lung protection. Which ventilation strategy best controls intracranial pressure effects while maintaining cerebral perfusion?
- A 38-year-old with Guillain-Barre in the step-down ICU shows ascending weakness over 12 hours, VC falling from 28 to 16 mL/kg, MIP weakening from -45 to -22 cm H2O, and weak cough with desaturation on effort. ABGs are still normal on 2 L nasal cannula. Which ventilation timing decision based on MIP/VC monitoring best manages neuromuscular respiratory failure?
- A 58-year-old former smoker reports progressive exertional dyspnea for 18 months, morning cough with sputum, two bronchitis episodes last winter, and spirometry shows persistent airflow limitation with reduced FEV1/FVC after bronchodilator. Which evaluation step best confirms a new diagnosis of chronic lung disease in this patient?
- A 54-year-old after a motor vehicle crash has right-sided rib fractures 4-8, paradoxical chest motion, respiratory rate 30/min, SpO2 89% on 4 L/min, and severe pain on inspiration with splinting and weak cough. Chest X-ray shows pulmonary contusion without large pneumothorax, blood pressure is stable, and arterial blood gas shows hypoxemia with normocapnia. Which flail chest management strategy should the therapist prioritize to restore ventilation?
- A 72-year-old with acute decompensated heart failure has bilateral crackles, SpO2 88% on 4 L cannula, respiratory rate 30, and a chest film showing pulmonary edema without infiltrate. Blood pressure is 178/102 mm Hg and the patient cannot tolerate lying flat. Which respiratory intervention best manages acute cardiogenic pulmonary edema while medical therapy starts?
- A 58-year-old two days after bowel surgery develops fever to 38.6C, productive cough with purulent sputum, right basilar crackles, leukocytosis, new infiltrate on chest film, and SpO2 88% on room air with shallow breathing from incisional pain. Which respiratory management strategy best addresses pneumonia hypoxemia and secretion retention?
- A 29-year-old with severe traumatic brain injury has an ICP monitor reading 24 mm Hg, MAP 88 mm Hg, PaCO2 48 mm Hg on assist-control ventilation after suctioning with head flat and neck flexed. Pupils are equal and reactive. Which ventilation strategy best manages brain injury and intracranial pressure effects on ventilation?
- A 66-year-old with severe COPD, two recent exacerbations, exertional desaturation to 86%, and anxiety about breathlessness is medically stable for discharge from a community hospital with home oxygen evaluation pending. Which outpatient plan best promotes long-term disease control, safe discharge, and rehabilitation?
- A 34-year-old with Guillain-Barre syndrome is on the ward with progressive limb weakness, vital capacity 14 mL/kg, maximal inspiratory pressure -22 cm H2O, and intact mentation. Swallowing is weak with poor cough and a rising PaCO2 of 48 mm Hg. Which ventilation decision best manages impending neuromuscular respiratory failure?
- A 62-year-old with sudden dyspnea, pleuritic chest pain, tachycardia 128/min, hypotension 88/56 mmHg, SpO2 88% on 4 L/min, and unilateral leg swelling has CT confirmation of large pulmonary embolism without active bleeding. Bedside echo suggests right ventricular strain, lungs are clear, and the patient remains anxious but alert. Which cardiopulmonary support strategy should the therapist prioritize for obstructive shock from pulmonary embolism?
- A 58-year-old former smoker reports progressive exertional dyspnea, chronic productive cough for two winters, and wheeze unrelieved by a borrowed albuterol inhaler, with prolonged expiration and distant breath sounds on exam. Which evaluation approach best establishes a new diagnosis of chronic lung disease?
- A 58-year-old fell from a ladder, sustaining left ribs 5-8 fractures with visible paradoxical motion, severe pleuritic pain, splinting, SpO2 88% on 2 L nasal cannula, and tachypnea at 28/min. Blood pressure is stable and no pneumothorax is seen. Which initial respiratory management strategy should the therapist recommend for flail chest with hypoxemia?
- A 55-year-old with pneumonia-derived ARDS on volume control has PaO2/FiO2 110 on FiO2 0.70, PEEP 12 cm H2O, plateau pressure 29 cm H2O, and bilateral infiltrates without cardiogenic edema, remaining severely hypoxemic after 12 hours. Which lung-protective escalation should the therapist recommend for moderate-severe ARDS with refractory hypoxemia?
- A 71-year-old admitted with fever, productive cough and right lower lobe consolidation shows SpO2 89% on 2 L, increased work of breathing, and thick purulent secretions. Sputum cultures are pending and influenza is circulating. Which pneumonia management priority best addresses infectious disease and gas exchange?
- A 26-year-old with severe traumatic brain injury is intubated with an intracranial pressure monitor reading 24 mm Hg, blood pressure 138/82 mm Hg, PaCO2 42 mm Hg, and SpO2 94% on volume control ventilation. Serum sodium is normal and sedation is adequate with head of bed at 15 degrees. Which ventilator-related adjustment best manages elevated intracranial pressure?
- A 62-year-old with sudden dyspnea, tachycardia, hypotension, jugular venous distension, clear lungs, right ventricular strain on ECG, and swollen tender calf after long travel develops worsening hypoxemia. Which management priority best addresses suspected pulmonary embolism with shock?
- A 41-year-old with Guillain-Barre syndrome shows progressive ascending weakness, vital capacity falling from 38 to 18 mL/kg over 8 hours, negative inspiratory force weakening from -45 to -22 cm H2O, tachypnea, weak cough, and difficulty handling secretions. Blood gases show borderline hypercapnia, the patient is alert, and bulbar signs are emerging. Which neuromuscular monitoring and ventilation timing decision should the therapist recommend?
- A 62-year-old with obesity hypoventilation syndrome, BMI 44, presents with daytime hypercapnia, nocturnal desaturation, and acute-on-chronic hypoxemic respiratory failure precipitated by cellulitis without neutropenia or new drug exposure. Which ventilatory management should the therapist prioritize for obesity-related hypoventilation with atelectasis and hypercapnia?
- A 62-year-old with pneumonia develops moderate-severe ARDS with PaO2/FiO2 118 on FiO2 0.70, bilateral opacities, plateau 29 cm H2O on 6 mL/kg predicted body weight and PEEP 12 cm H2O. No contraindication to positioning exists. Which lung-protective strategy with proning and recruitment best manages ARDS?
- A 62-year-old with COPD is scheduled for open upper-abdominal surgery tomorrow, smokes daily, and has weak cough with thick secretions. Vitals are stable and SpO2 is 93% on room air. The surgeon requests preoperative optimization to limit atelectasis. Which pre- and post-operative respiratory care plan best prevents atelectasis after upper-abdominal surgery?
- A 68-year-old admitted with community-acquired pneumonia has fever, purulent sputum, right lower lobe crackles and SpO2 91% on 2 L. The patient is alert, coughs weakly and retains thick secretions despite hydration and antibiotics. Which secretion clearance intervention should the therapist recommend to improve mobilization in this pneumonia patient?
- A 24-year-old with severe traumatic brain injury is intubated in the trauma ICU with ICP monitor 22 mm Hg, CPP 58 mm Hg, PaCO2 44 mm Hg and SpO2 94% on assist-control ventilation. Head of bed is flat and suctioning triggers coughing and ICP spikes to 30 mm Hg. Which ventilation and positioning strategy best controls intracranial pressure effects on ventilation?
- A 58-year-old is in the ED after a truck crash with multiple left rib fractures, paradoxical chest wall motion, SpO2 88% on 4 L, severe splinting pain, and CT showing pulmonary contusion without pneumothorax. Pain limits cough and deep breathing despite supplemental oxygen. Which ventilatory support approach best manages flail chest with underlying pulmonary contusion?
- A 71-year-old with known heart failure presents with crackles, pink frothy sputum, SpO2 84% on room air, BP 88/54, cool mottled skin, lactate 4.2, and chest x-ray showing pulmonary edema without infiltrate. Fluids have been held and ECG shows no STEMI. Which cardiopulmonary support strategy best manages cardiogenic shock with acute pulmonary edema?
- A 48-year-old with chemotherapy-induced neutropenia, morbid obesity, and recent amiodarone therapy develops progressive hypoxemic failure, bilateral infiltrates, fever, and increased work of breathing despite oxygen. The patient requires intubation planning with lung-protective strategy and etiologic workup. Which clinical judgment best manages immunocompromised obesity-related drug-toxicity respiratory failure?
- A 29-year-old with Guillain-Barre syndrome in the ICU is alert but reports dyspnea and weak cough. Serial bedside values show vital capacity falling from 28 to 14 mL/kg, MIP weakening from -45 to -22 cm H2O, tachypnea at 32/min, and paradoxical abdominal motion. Bulbar function is intact and gases show early CO2 retention. Which ventilation timing decision best manages this neuromuscular respiratory failure?
- A 71-year-old intubated for 6 days develops fever 38.6 C, purulent secretions, new left infiltrate, leukocytosis, PaO2/FiO2 210 and suspected ventilator-associated pneumonia with septic hypotension. Cultures are pending and local resistance is high. Which infectious disease management approach best addresses pneumonia in this ventilated patient?
- A 55-year-old with pneumonia-related ARDS has PaO2/FiO2 112 on FiO2 0.70, PEEP 12 and volume control 6 mL/kg predicted body weight with plateau 28 cm H2O. Chest film shows bilateral infiltrates and bedside ultrasound excludes failure. Which lung-protective strategy adjustment should the therapist advocate to improve oxygenation in this ARDS patient?
- A 4-year-old with known moderate persistent asthma presents to the emergency department with 2 days of rhinorrhea and wheezing after a viral cold, now with accessory muscle use, SpO2 91% on room air, and poor response to home albuterol. Lungs have diffuse expiratory wheezes without stridor or focal crackles. Which pediatric asthma exacerbation management approach best stabilizes airway obstruction and oxygenation?
- A 54-year-old woman with obesity and severe OSA scheduled for total knee arthroplasty uses CPAP at home, snores loudly, has a morning headache, and reports poor sleep adherence. Anesthesia plans for general anesthesia with opioids. Which perioperative respiratory plan best manages pre- and post-operative risk for this OSA patient?
- A 24-year-old with severe traumatic brain injury has ICP 26 mm Hg, CPP 55 mm Hg, PaCO2 48 mm Hg on volume control, and transient desaturation during suctioning. Pupils are sluggish, sedation is light, and head of bed is flat for a procedure. The team needs stable ventilation without raising intracranial pressure. Which ventilation adjustment best manages brain injury with intracranial hypertension?
- A 55-year-old with pneumonia has PaO2/FiO2 110 on FiO2 0.80, PEEP 12 cm H2O, bilateral infiltrates, VT 6 mL/kg PBW, plateau 28 cm H2O and no cardiac failure after fluids and workup. Proning and recruitment are being considered. Which ARDS strategy best applies lung protection, proning and recruitment?
- A 42-year-old with Guillain-Barre syndrome shows progressive weakness, vital capacity falling from 38 to 18 mL/kg over six hours, MIP weakening to -22 cm H2O, tachypnea, weak cough, and ABG pH 7.32 with PaCO2 52. Swallow is impaired and secretions pool despite coaching. Which monitoring and ventilation timing decision best manages impending neuromuscular respiratory failure?
- A 14-month-old former 26-week, 780-g preterm infant with moderate bronchopulmonary dysplasia attends pulmonary clinic on 0.5 L/min home oxygen. The child is active, taking solids, gaining weight along the curve, with mild tachypnea, clear lungs, and 97% SpO2 awake on oxygen. Parents ask to stop oxygen for travel. Which evaluation should the therapist recommend first to guide oxygen weaning for chronic lung disease of prematurity?
- A 71-year-old with COPD presents with fever, productive cough, tachypnea, hypoxemia, and right lower lobe consolidation with leukocytosis and CURB-65 score of 3. Sputum culture is pending, influenza test is negative, and blood pressure is borderline. Oxygen needs are rising despite low-flow cannula. Which pneumonia management strategy best addresses severity, oxygenation, and infection control?
- A 52-year-old with BMI 46 on recent chemotherapy presents with fever, neutropenia, bilateral infiltrates and hypercapnic hypoxemic failure from obesity hypoventilation plus suspected drug toxicity. The patient is tachypneic, drowsy but arousable and protecting the airway. Which respiratory support plan should the therapist recommend to stabilize this immunocompromised obese patient with mixed failure?
- A 4-year-old with known asthma and a 10-month-old with rhinovirus bronchiolitis arrive together with wheezing, cough, retractions, and SpO2 90-92% on room air. The asthmatic has prior steroid response; the infant has poor feeding and nasal congestion. A third child has suspected congenital heart disease with cyanosis. Which management best addresses pediatric asthma, bronchiolitis, and congenital defects?
- A 60-year-old scheduled for open upper abdominal surgery has a 30 pack-year smoking history, BMI 34 and baseline atelectasis. The surgeon requests preoperative respiratory input to lower pulmonary complications. Which preoperative teaching bundle should the therapist deliver to reduce postoperative atelectasis for this high-risk surgical patient?
- A 48-year-old with chemotherapy neutropenia, fever and hypoxemia, plus a 140-kg patient with obesity hypoventilation and a patient with amiodarone lung toxicity all present with respiratory failure on the medical ward. Which tailored support best manages immunocompromised, obesity-related and drug-toxicity respiratory failure?
- A 29-year-old with severe traumatic brain injury is intubated with ICP 24 mm Hg, MAP 88, CPP 64, PaCO2 46, PaO2 72, and SpO2 93% on assist-control ventilation. The head is flat, suctioning is prolonged, and fever is present. Which ventilation strategy best controls intracranial pressure while maintaining cerebral perfusion after brain injury?
- A 54-year-old with pneumonia develops moderate ARDS with PaO2/FiO2 135 on FiO2 0.70, bilateral opacities, PEEP 10 cm H2O, and plateau pressure 29 cm H2O. Ventilation is volume control at 8 mL/kg predicted body weight with persistent dyssynchrony. No improvement after 12 hours and hemodynamics tolerate positioning. Which lung-protective strategy with proning and recruitment best manages this ARDS?
- A term newborn is limp and apneic immediately after birth with no cry, heart rate 80 beats/min after drying and stimulation, and no meconium obstruction, in a delivery room with warm towels, suction, and a Neonatal Resuscitation Program team present. The cord is clamped and the warmer is on. Which neonatal resuscitation sequence best restores heart rate and ventilation?
- A 4-year-old with known asthma presents to the ED with 2 days of viral upper respiratory symptoms, now with wheezing, accessory muscle use, SpO2 92% on room air and a moderate asthma score. Parents report albuterol at home helped briefly. Which assessment-driven management should the therapist implement for this pediatric asthma exacerbation with likely viral trigger?
- A 68-year-old admitted with fever, productive cough, right lower lobe consolidation, WBC 18,000, PaO2 58 on room air, and increased work of breathing is diagnosed with severe community-acquired pneumonia. Sputum cultures are pending and antibiotics were just started. Which respiratory management strategy best supports treatment of severe pneumonia with hypoxemia?
- A 52-year-old with BMI 51 is admitted with daytime headache, polycythemia and PaCO2 58 on room air after chemotherapy for lymphoma left him neutropenic, and overnight oximetry shows prolonged desaturation with snoring. Morning ABG shows pH 7.32 with hypoxemia that corrects with arousal. Which noninvasive strategy best manages obesity-related hypoventilation with hypercapnic failure?
- A 30-week preterm infant at 4 hours of age has tachypnea, grunting, nasal flaring, intercostal retractions, FiO2 0.55 on CPAP 6 cm H2O, and chest film shows diffuse ground-glass opacities with air bronchograms and low lung volumes. Which surfactant therapy decision best manages this neonatal respiratory distress syndrome progression?
- In a level III NICU a 27-week preterm infant at 36 weeks postmenstrual age remains oxygen-dependent on low-flow nasal cannula, shows poor weight gain, increased work of breathing, and chest radiograph with hazy streaky changes after prolonged ventilation and sepsis. Fluids are restricted and feeds are fortified. Which management strategy best addresses chronic lung disease of prematurity for this infant?
- A 68-year-old patient scheduled for upper abdominal laparotomy has a 40 pack-year history, productive cough, and baseline SpO2 93% on room air, with atelectasis on chest radiograph and weak cough effort. Surgery is in two days and the surgeon requests respiratory optimization. Which pre- and post-operative respiratory care plan best prevents complications?
- In a delivery room a term infant is apneic and limp after drying, warming, and stimulation, with heart rate 80 beats per minute, poor tone, and no cry at 60 seconds despite a clear airway and proper positioning. The team has pulse oximetry and blended oxygen available and a skilled resuscitation leader present. Which neonatal resuscitation action best follows current resuscitation principles for this infant?
- A 4-year-old with known moderate persistent asthma presents to the emergency department with two days of viral upper respiratory symptoms, now with expiratory wheezing, barking cough, nasal flaring, SpO2 91% on room air, and poor response to home albuterol. Chest radiograph shows hyperinflation without focal consolidation. Which pediatric asthma and bronchiolitis management decision best guides acute respiratory care?
- A 45-year-old with known asthma arrives in the ED with wheezing after albuterol at home, speaks in short phrases, has accessory muscle use, SpO2 93% on room air, and no recent peak flow, arterial blood gas, or sputum assessment documented. Which additional assessment best completes information gathering for clinical judgment?
- A 48-year-old woman with pneumonia meets moderate ARDS criteria with PaO2/FiO2 135 on PEEP 10 cm H2O and FiO2 0.70. She is receiving volume control at 6 mL/kg predicted body weight with plateau 27 cm H2O and is deeply sedated. Which lung-protective ARDS management strategy best improves oxygenation while limiting ventilator-induced lung injury?
- A former 27-week infant at 37 weeks postmenstrual age has bronchopulmonary dysplasia with crackles, tachypnea, and needs 0.5 L nasal cannula to keep SpO2 90-95%. Chest film shows hazy hyperinflation, feeds are advancing, and the infant is off ventilation on caffeine. Parents ask about long-term breathing care. Which management strategy for chronic lung disease of prematurity best supports recovery?
- A 64-year-old scheduled for open cholecystectomy has a 30 pack-year history, BMI 34 and baseline SpO2 94%, and the surgeon requests preoperative respiratory input to prevent postoperative atelectasis and pneumonia. The patient can follow commands and has no bullous disease. Which pre- and post-operative respiratory care bundle best reduces pulmonary complications?
- A 45-year-old with asthma receives three albuterol-ipratropium treatments for wheezing with peak flow 55% predicted. Wheeze persists, accessory use remains, but SpO2 is 94% on room air and speech is full sentences. Which therapy decision best applies continue-modify-discontinue judgment for bronchodilator treatment?
- A former 27-week premature infant now 36 weeks postmenstrual age remains oxygen-dependent on nasal cannula, with coarse lung markings, hyperinflation, frequent desaturations with handling, poor weight gain, and echocardiographic pulmonary hypertension. The NICU team plans discharge teaching for bronchopulmonary dysplasia. Which chronic lung disease of prematurity management plan best supports safe growth and ventilation?
- A 14-month-old with runny nose and cough for 3 days now has tachypnea, subcostal retractions, poor feeding and SpO2 89% on room air with diffuse crackles and wheeze in a crowded pediatric unit during RSV season. The infant is alert with no apnea or cyanosis. Which supportive management strategy best addresses moderate bronchiolitis with hypoxemia?
- In a NICU a 28-week preterm infant at 2 hours of life develops grunting, nasal flaring, retractions, tachypnea, and hypoxemia on CPAP, with chest radiograph showing granular ground-glass appearance and air bronchograms and no pneumothorax. The team prepares for intubation and has surfactant available with cardiorespiratory monitoring. Which management approach best addresses neonatal respiratory distress syndrome and surfactant therapy for this infant?
- A term newborn is limp and apneic after drying and warming with a heart rate of 80/min, poor tone, and no cry at 60 seconds. The warmer is on, airway is positioned, secretions are cleared, and stimulation has failed. Monitors show falling SpO2 despite free-flow oxygen. Which neonatal resuscitation intervention best follows the correct sequence for this infant?
- A 34-year-old woman with acute myeloid leukemia, profound neutropenia, and BMI 44 develops fever, dry cough, and hypoxemia. She takes amiodarone for atrial fibrillation, has bilateral ground-glass opacities, and snores heavily with morning headaches. Which respiratory failure management priority best addresses her immunocompromised, obesity-related, and drug-toxicity risks?
- A former 27-week infant now 37 weeks postmenstrual age remains on nasal cannula 0.5 L with SpO2 90% to 94%, tachypnea, crackles and poor weight gain despite adequate calories, with a clear chest film except hyperinflation. Diuretics and caffeine were discussed on rounds in a busy NICU. Which chronic lung disease strategy best supports growth while minimizing oxygen toxicity?
- A home-care ventilator-dependent child must be moved by ambulance across town for imaging with portable oxygen, battery power and a manual resuscitator available. Traffic may delay arrival and the caregiver is anxious. Which out-of-hospital judgment best ensures safe transport and emergency readiness?
- A 68-year-old man with COPD and a 40 pack-year history is scheduled for elective open upper abdominal aortic aneurysm repair. He wheezes mildly, produces morning sputum, and has a baseline SpO2 of 92% on room air. Which pre- and post-operative respiratory care plan best reduces his pulmonary complication risk?
- In a busy emergency department an older adult presents with acute dyspnea, wheezing, leg swelling, and fatigue, with history of COPD and heart failure, oxygen saturation 89%, scattered wheezes, bibasilar crackles, and 2+ edema. Labs and chest radiograph are pending and albuterol has not yet been given. Which information-gathering priority best demonstrates choosing what to assess and interpreting gathered information for this patient?
- A term infant born through meconium-stained fluid is limp and apneic at birth with bradycardia at 80 beats/min, poor tone, and no effective respirations after initial drying and stimulation in a community hospital delivery room with a warmed bed and resuscitation equipment ready. Which neonatal resuscitation sequence best follows current resuscitation priorities?
- A 29-week preterm infant at 2 hours has grunting, nasal flaring, retractions, FiO2 0.45 on CPAP 6 cm H2O, with ABG showing hypoxemia and chest film showing ground-glass with air bronchograms. The team suspects neonatal respiratory distress syndrome from surfactant deficiency. Which surfactant therapy strategy for respiratory distress syndrome best improves outcomes?
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