1. Blood Gas Sampling, Analysis, Monitoring, and Interpretation
CRT 7%
RRT 6%

2. Mechanical ventilation End tidal CO2 monitoring Shunt assessment
The respiratory therapist has just completed an uneventful bronchodilator treatment for a male patient admitted to the hospital after collapsing during a marathon race. The patient suddenly complains of difficulty breathing and chest pain. His heart rate increases from 70 to 115 bpm and he is tachypneic. To further evaluate this patient the therapist should immediately institute:
Mechanical ventilation
End tidal CO2 monitoring
Shunt assessment
CPAP therapy at 100%
Answer B

3. Which of the following should the respiratory therapist recommend?
A 38-week gestation neonate has the following capillary blood gas results:
pH 7.34
PCO2 47 torr
PO2 43 torr
HCO3- 24mEq/L
Which of the following should the respiratory therapist recommend?
An oxyhood with 50% oxygen
Mechanical ventilation
CPAP with nasal prongs at 5 cmH2O
No therapy is indicated at this time
Answer C

4. Based on these results the respiratory therapist should recommend:
An arterial blood gas was drawn in the surgical intensive care unit and the syringe was left on the counter for the lab tech to take to the lab. Forty minutes later, the results are recorded as follows?:
pH 7.48
PaCO2 24 torr
PaO torr
HCO mEq/L
Based on these results the respiratory therapist should recommend:
Institute mechanical ventilation
Begin bi-level ventilation at an IPAP of 20 cmH2O and EPAP of 8 CmH2O
Repeat the arterial blood gas
Recalibration of the blood gas machine
Answer C

5. The following data is available on a recently admitted patient:
HR 88/min
RR 18 bpm
SaO2 91%
A-a gradient 175 torr
BS coarse rales
BP 137/88
Based on this information the respiratory therapist should suggest:
Oxygen therapy
Mechanical ventilation
Noninvasive PPV
Nothing until more information is obtained
Answer A

6. Which PEEP level provides optimum benefit for this patient? 10 cmH2O
During pulmonary rounds in the intensive care unit, the respiratory therapist decides to perform an optimal PEEP study on a patient. The following data is recorded:
Which PEEP level provides optimum benefit for this patient?
10 cmH2O
15 cmH2O
20 cmH2O
25 cmH2O
PEEP level
PaO2
C(a-v)O2 HR
0900
10 cmH2O
70 torr
5 cmH2O
88 bpm
0930
15 cmH2O
85 torr
78 bpm
1000
20 cmH2O
93 torr
7 cmH2O
89 bpm
1030
25 cmH2O
100 torr
95 bpm
Answer B

7. To increase a low PaO2 Increase FiO2 by 5-10% (up to 60%)
Increase PEEP by 2-5 cmH2O
Until:
Acceptable oxygenation is achieved, or
Unacceptable side-effects occur
↓ compliance
↓ cardiac function
Barotrauma
↑ C(a-v)O2
Closed head injury or low BP: Increase FiO2 instead of PEEP. Keep pressures low!

8. Maintain current settings Administration of bicarbonate
A 30-year-old-male patient is receiving volume control ventilation due to complications of a surgical procedure to drain a lung abscess. The patient weighs 98 kg (215 lb) and is 6 feet (185 cm) tall. His ventilator settings are: SIMV mode, Vt 830 mL, set f 14 bpm, total f 15 bpm, FiO Arterial blood gases drawn after thirty minutes show the following:
pH 7.46
PaCO2 32 torr
PaO2 90 torr
HCO mEq/L
Which of the following should the respiratory therapist recommend at this time?
Maintain current settings
Administration of bicarbonate
Add mechanical dead space
Decrease frequency
Answer D

9. To normalize a low PaCO2 Decrease respiratory rate
Decrease tidal volume
Increase deadspace
Target PaCO2 for closed head injury patients should be torr

10. Which of the following should the respiratory therapist recommend?
A 74 kg (163 lb) male patient has been on volume control ventilation for the past four days at the following settings: A/C mode, Vt 700 mL, set f 10 bpm, total f 10 bpm, FiO The most recent arterial blood gas data is recorded as follows:
pH PaO torr
PaCO torr HCO mEq/L
Which of the following should the respiratory therapist recommend?
Increase frequency to 14 bpm
Switch to SIMV mode
Increase FiO2 0.65
Add 5 cmH2O of pressure support
1 and 4
2, 3, and 4
1 and 3
2 and 4
Answer C

11. To normalize a high PaCO2
Decrease or remove deadspace
Increase tidal volume
Increase the respiratory rate

12. Which of the following should the respiratory therapist recommend?
A 24-year-old male patient is in the Emergency Department after being involved in a motor cycle accident. It is estimated the patient is 5 foot 10 inches (178 cm) tall and weighs 80 kg (176 lb). After a quick bedside assessment the patient is intubated and placed on volume control ventilation at the following settings: SIMV mode, f 10 bpm, Vt 770 mL, FiO2 0.6, PEEP 10 cmH2O. After twenty minutes his arterial blood gas shows the following results:
pH PaO torr
PaCO torr HCO mEq/L
Which of the following should the respiratory therapist recommend?
Increase tidal volume to 800 mL
Switch to assist control mode
Increase the FiO2 to 0.7
Increase PEEP to 15 cmH2O
Answer D

13. After reviewing the data the respiratory therapist should recommend:
A 65 kg (143 lb) female patient is in the surgical intensive care unit after surgery to relieve a sub-arachnoid hemorrhage. She is on volume cycled ventilation at the following settings: A/C mode, set f 12 bpm, total f 12 bpm, Vt 800 mL, FiO Available arterial blood gas information is recorded as:
pH PaO torr
PaCO torr HCO mEq/L
After reviewing the data the respiratory therapist should recommend:
Increase the tidal volume
Increase the frequency
Add PEEP
Add mechanical dead space
Answer B

14. While performing quality control procedures on a blood gas machine, it is determined that the PCO2 electrode has a mean value of 32 torr. The next three control run values are recorded as 31 torr, 37 torr, and 34 torr. Which of the following would best explain these results?
In control
Out of control
Random error
Displaying a trend
Answer C