Discuss how endothelial mediators may cause the vasoconstriction and vascular remodeling characteristic of pulmonary arterial hypertension.

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Question 1 1 pts 
A 40-year-old woman has well-controlled asthma. What is her risk of morbidity from anesthesia compared to that of a patient who does not have asthma? 
Much higher 
Higher 
The same 
Lower 
 
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Question 2 1 pts Skip to question text. 
A previously healthy patient presents to the emergency department with symptoms of pneumonia. He had a bout of seasonal influenza, but the symptoms resolved several weeks before the current illness. What is the likelihood that the etiology of his community acquired pneumonia will be determined? 
20% 
30% 
40% 
50% 
 
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Question 3 1 pts 
Which of the following endothelial mediators may cause the vasoconstriction and vascular remodeling characteristic of pulmonary arterial hypertension? 
I. Endothelin 
II. Prostacyclin 
III. Thromboxane 
I 
I and II 
II and III 
I, II, and III 
 
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Question 4 1 pts Skip to question text. 
All of the following are advantages of enteral tube feedings compared with total parenteral nutrition in the postoperative patient except 
I. Increased integrity of the gastrointestinal system 
II. Increased immune defenses 
III. Decreased nosocomial infections 
I only 
II only 
I and II 
I, II, and III 
 
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Question 5 1 pts 
Which of the following drug therapies are effective therapies for acute respiratory distress syndrome (ARDS)? 
None 
Antibiotics 
Antiinflamatories 
Corticosteroids 
 
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Question 6 1 pts 
The respiratory therapist needs to collect a sputum specimen from a patient who has not been able to produce an adequate amount. Which of the following is the first step in collecting an induced sputum sample? 
Brushing teeth and gums 
Gargling 
Inhale 3% saline for 20 minutes 
Cough every five minutes 
 
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Question 7 1 pts 
Which of the following are found in high quantities in the BAL fluid in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS)? 
Erythrocytes 
Eosinophils 
Neutrophils 
Platelets 
 
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Question 8 1 pts 
A patient is brought to the emergency department after inhaling chemical vapors. What is the likelihood that she will develop symptoms of acute respiratory distress syndrome (ARDS) within the next 24 hours? 
25% 
50% 
75% 
100% 
 
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Question 9 1 pts 
A male patient arrives at the emergency department after being struck in the chest with a ball during the company softball game. The highest rate of mortality for ALI occurs within what period after onset. 
24 hours 
48 hours 
72 hours 
96 hours 
 
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Question 10 1 pts 
Why is Haemophilis influenzae a gram-negative bacterium? 
It turns brown when exposed to alcohol in Gram staining. 
The ions turn negative when exposed to alcohol in Gram staining. 
It loses its stain when exposed to alcohol in Gram staining. 
The organism dies when exposed to alcohol in Gram staining. 
 
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Question 11 1 pts 
Which of the following is a goal of the treatment of pulmonary hypertension that results from cardiac disease? 
Anticoagulation 
Bronchodilators 
Treatment of pulmonary hypertension 
Treatment of the underlying cardiac defect 
 
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Question 12 1 pts 
For mild cases of postoperative atelectasis, which of the following are effective forms of therapy? 
I. Coughing 
II. Deep breathing 
III. Ambulation 
I 
I, II, and III 
I and III 
II and III 
 
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Question 13 1 pts 
A patient presents at the emergency department with fatigue, tachypnea, exertional dydpnea, and cough. Examination of the lower extremities shows pitting edema. The patient is likely to have 
COPD 
Cor pulmonale 
Pulmonary arterial hypertension 
Pulmonary embolism 
 
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Question 14 1 pts Skip to question text. 
A patient has been treated for exacerbations related to cystic fibrosis. An antibiotoc course of treatment was included in this round of therapy. Which of the following types of testing should occur towards the end of therapy to ensure effectiveness of the therapy? 
Chest radiograph 
ECG 
Pulmonary function 
Puls oximetry 
 
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Question 15 1 pts 
Which of the following is the preferred hypoglycemic agent for the treatment of cystic fibrosis-related diabetes (CRFD)? 
Exenatide 
Insulin 
Pramlintide 
Victoza 
 
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Question 16 1 pts 
Mean airway pressure, FIO2, and Pa O2 are used the in acute respiratory syndrome (ARDS) to calculate the 
Operating index 
Opportunistic infection 
Oxygen initiation 
Oxygenation index 
 
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Question 17 1 pts 
Which of the following is an adverse effect of using calcium channel blockers on patients with pulmonary arterial hypertension? 
Constipation 
Dizziness 
Hypotension 
Hypertension 
 
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Question 18 1 pts 
All of the following are advantages of patient-controlled analgesia (PCA) EXCEPT 
Active patient involvement 
Addiction 
Better pain control 
Rapid analgesic action 
 
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Question 19 1 pts 
All of the following are indications for inferior vena cava filter placement except 
Contraindications to anticoagulation 
Cor pulmonale 
Deep vein thrombosis 
Recurrent embolism 
 
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Question 20 1 pts 
All of the following persistent chest radiographic abnormalities would be present in a patient with cystic fibrosis EXCEPT 
Atelectasis 
Bronchiectasis 
Granuloma 
Hyperinflation 
 
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Question 21 1 pts 
Which of the following is the most accurate diagnostic test for pulmonary embolism? 
Chest computed tomographic angiography 
Echocardiography 
ECG 
Pulmonary angiography 
 
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Question 22 1 pts 
A patient has been in the hospital for 10 days and is now presenting with fever, chills, and cough productive of yellow sputum. The chest radiograph shows diffuse infiltrates. Which of the following organisms should the respiratory therapist suspect? 
Haemophilus influenzae 
Legionella pneumophilia 
Proteus mirabilis 
Pseudomonas aeruginosa 
 
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Question 23 1 pts 
The use of inhaled aminoglycosides for Pseudomonas aeruginosa has which of the following benefits? 
Achieving high drug levels in proximal airway secretions 
Creates systemic levels of toxicity 
Distal secretions are also exposed. 
High risk of antimicrobial resistance 
 
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Question 24 1 pts Skip to question text. 
A patient presents to the emergency department with nonbacterial pneumonia. The patient asks for an antibiotic, and the physician refuses to prescribe one. Which of the following are reasons why? 
I) Antibiotics are not effective against nonbacterial infections. 
II) There is a risk of developing antibiotic-resistant pathogens. 
III) The patient will do better with hospital admission and intubation. 
I only 
II only 
I and II 
I, II, and III 
 
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Question 25 1 pts 
Which of the following is the most important factor to predict the risk of postoperative pulmonary complications? 
Duration of surgery 
Fluid management 
Surgical incision site 
Type of anesthesia 
 
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Question 26 1 pts 
In the immediate post-operative period, which of the following suggests that the diaphragm is functional and airway protection is sufficient? 
She is speaking. 
She lift her head for 5 seconds. 
She is breathing. 
She can move her extremities. 
 
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Question 27 1 pts 
When treating a patient with idiopathic pulmonary arterial hypertension, which international normalized ratio (INR) of wafarin is considered therapeutic? 
0.5 – 1.0 
1.0 – 2.0 
1.5 – 2.0 
1.5 – 2.5 
 
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Question 28 1 pts Skip to question text. 
A 30-year-old woman has been diagnosed with community-acquired pneumonia. The physician determines, based on the Pneumonia Severity Index (PSI), that she can be treated as an outpatient. Which of the following risk classes is the patient likely to be in? 
I. Risk class I 
II. Risk class II 
III. Risk class III 
I 
I and II 
II and III 
I, II, and III 
 
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Question 29 1 pts 
A patient has smoked two packs of cigarettes per day for 20 years. He is being prepared for surgery. How many pack years would this represent? 
10 
20 
30 
40 
 
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Question 30 1 pts 
A patient presents at the hospital with acute respiratory distress syndrome (ARDS). If the medical team wants to rule out cardiogenic causes for pulmomary edema, which measurement should it take using a pulmonry artery catheter? 
Forced expiratory volume 
Inspiratory capacity 
Positive end expiratory pressure 
Pulmonary artery wedge pressure 
 
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Question 31 1 pts 
A patient with COPD presents to the emergency department with an exacerbation. He does not have S pneumonae or H influenzae. The respiratory therapist should suspect organism? 
Escheria coli 
Lactobacillus 
Moraxella catarrhalis 
Staphalococcus salivarius 
 
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Question 32 1 pts 
The airway secretions of cystic fibrosis patients are difficult to clear because of 
I. Lower viscosity 
II. Higher viscosity 
III. Lower tenacity 
IV. Higher tenacity 
I and III 
I and IV 
II and III 
III and IV 
 
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Question 33 1 pts 
Which of the following are often found on the chest radiographs of patients with acute respiratory distress syndrome (ARDS)? 
Silhouette sign 
Bilateral opacities 
Increased vascular markings 
Unilateral whiteout 
 
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Question 34 1 pts Skip to question text. 
A 30-year-old athletic male presenta to the emergency department with swelling, pain, and discoloration of the lower left leg. The respiratory therapist suspects there is little risk of acute DVT or PE. Which of the following laboratory tests could rule out these conditions? 
Arterial blood gas 
Basic metabolic panel 
D-dimer 
Hematocrit 
 
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Question 35 1 pts 
A 30-year-old woman with cystic fibrosis presents to the emergency department with chest pain, dyspnea, and blood-stained sputum. It is likely that the patient will need to be treated for? 
Pulmonary Exacerbation 
Hemoptysis 
Pneumothorax 
Respiratory failure 
 
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Question 36 1 pts 
Which of the following causes of pulmonary hypertension are the result of hypoxemia? 
Familial pulmonary arterial hypertension 
Human immunideficiency virus 
Hypoventilation and sleep-disordered breathing 
Left-sided vavular heart disease 
 
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Question 37 1 pts 
A patient C is receiving unfractionated heparin by continuous IV infusion. What laboratory test is used to monitor the therapy? 
Activated partial thromboplastin time (aPTT) 
Infusion rate 
INR 
Patient’s weight 
 
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Question 38 1 pts 
All of the following airway clearance techniques used for cystic fibrosis patients can be used independently EXCEPT 
Active cycle of breathing 
Autogenic drainage 
High frequency chest wall compressions 
Percussion 
 
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Question 39 1 pts 
A patient receives ciprofloxacin to prevent infection by Pseudomonas aeruginosa. How long does it take for resistant Pseudomonas aeruginosa to develop? 
1-2 weeks 
3-4 weeks 
5-6 weeks 
this can not be predicted 
 
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Question 40 1 pts 
If a patient is suffering from massive bleeding due to hemoptysis, which of the following procedures is the therapy of choice? 
Antibiotics 
Bronchial artery embolization 
Laser therapy 
Surgery 
 
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Question 41 1 pts 
A respiratory therapist is evaluating a patient for pneumonia. Which of the following should her sputum specimen contain before subjecting it to a Gram stain? 
10 or more neutrophils and up to 5 epithelial cells per microscopic field 
15 or more neutrophils and up to 5 epithelial cells per microscopic field 
20 or more neutrophils and up to 10 epithelial cells per microscopic field 
25 or more neutrophils and up to 10 epithelial cells per microscopic field 
 
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Question 42 1 pts 
A 50-year-old man is 5 feet, 5 inches tall and weighs 275 pounds. He is scheduled to have bariatric surgery. The medical team should treat this patient as someone who is 
Normal weight 
Overweight 
Obese 
Morbidly obese 
 
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Question 43 1 pts 
A post-operative patient has serum albumin level of 1.8 g/dL and she appears malnourished. Which of the following options is most likely to be effective? 
High calorie diet 
Enteral tube feeding 
Total parenteral nutrition 
Liquid diet 
 
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Question 44 1 pts 
A patient is undergoing lung-protective ventilation because of acute respiratory distress syndrome (ARDS). Which of the following is the ideal setting for tidal volume (VT)? 
2 to 4 mL/kg ideal body weight 
4 to 8 mL/kg ideal body weight 
8 to 12 mL/kg ideal body weight 
10 to 15 mL/kg ideal body weight 
 
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Question 45 1 pts Skip to question text. 
A patient with an FEV1 of 22% of predicted has respiratory failure . The patient is not being considered for lung transplant at this time. If the patient were to be intubated and mechanically ventilated, what is the likelihood that the patient will ever be successfully liberated from mechanical ventilation? 
None 
Very low 
Low 
High 
 
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Question 46 1 pts 
Which of the following scans are virtually diagnostic when acute PE is clinically likely? 
Chest radiograph 
Chest computed tomograhic angiography 
Echocardiography 
High probability V ?/Q ? scans 
 
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Question 47 1 pts 
All of the following are complications of placing a patient with acute respiratory distress syndrome (ARDS) in the prone position EXCEPT 
Aspiration of stomach contents 
Ocular injury 
Pressure necroses 
Removal of tubes and lines 
 
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Question 48 1 pts 
Research shows that alveolar stretch can propagate systemic inflation and eventually lead to which of the following? 
Atelectasis 
COPD 
Lung cancer 
Multiple organ dysfunction 
 
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Question 49 1 pts 
A patient has HIV/AIDS with a CD4 count below 200/?L. Which of the following types of pneumonia is the respiratory therapist likely to have to treat the patient for? 
Bacterial pneumonia 
Mycobacterial pneumonia 
Pneumocystis pneumonia 
Tuberculosis 
 
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Question 50 1 pts 
A patient has acute respiratory distress syndrome (ARDS). Which of the following positions would be most effective in restoring ventilation to the dorsal areas of the patient’s lungs? 
Fowler’s 
Left lateral recumbent 
Prone 
Supine 
 
Question 51 1 pts 
Which of the following are nonpharmacological treatments for chronic cardiac failure? 
I. Sodium restriction 
II. Exercise 
III. Reduce or eliminate alcohol consumption 
IV. Treatment of comorbidities 
I, II, and III 
I, III, and IV 
II, III, and IV 
I, II, III, and IV 
 
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Question 52 1 pts 
Which treatment consists primarily of either balloon angioplasty or placement of stents in occluded or stenotic coronary arteries? 
Coronary revascularization 
Heart transplantation 
Percutaneous coronary intervention 
Pharmacotherapy 
 
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Question 53 1 pts 
A patient has been referred to the sleep clinic because his wife complains of his excessive snoring. The patient undergoes an 8-hour polysomnography, and his apnea-hypopnea index is 15. This means the patient’s sleep apnea is 
Nonexistent 
Mild 
Moderate 
Severe 
 
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Question 54 1 pts 
Which technique for monitoring cardiac function uses a catheter inserted into the pulmonary artery? 
Computed tomographic angiography 
Echocardiography 
Hemodynamic monitoring 
Radionucleotide imaging 
 
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Question 55 1 pts 
In which patients with obstructive sleep apnea is uvulopalatopharyngoplasty most effective? 
Patients with mild to moderate sleep apnea 
Overweight patients with mild to moderate sleep apnea 
Patients with severe apnea 
Overweight patients with severe apnea 
 
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Question 56 1 pts 
How might the use of antidepressants help patients who have obstructive sleep apnea? 
I. They increase REM sleep time. 
II. They decrease REM sleep time. 
III. They reduce upper airway narrowing. 
IV. They stimulate ventilation 
I, II, and III 
I, II, and IV 
II, III, and IV 
I, II, III, and IV 
 
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Question 57 1 pts 
A patient D has unilateral diaphragm weakness following cardiac surgery. How well is the patient expected to be able to tolerate this condition? 
The patient should tolerate the condition well. 
The patient may need ventilatory support at night. 
The patient will need ventilatory support during exercise. 
The patient will need continuous ventilatory support. 
 
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Question 58 1 pts 
Which of the following is a test of central respiratory drive that is independent of underlying respiratory mechanics? 
Noninvasive ventilation 
Inspired partial pressure of O2 
P0.1 
VO2 max 
 
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Question 59 1 pts 
What is the product of stroke volume and heart rate? 
Blood pressure 
Cardiac output 
Preload 
Venous return 
 
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Question 60 1 pts 
Why is overnight pulse oximetry an important evaluation tool to diagnose neuromuscular dysfunction? 
Patients with neuromuscular dysfunction often have sleep disorders, too. 
People breathe differently at night than they do during the day. 
The patient is easier to monitor when he/she is sleeping. 
Sleep-related breathing disorders often precede changes in daytime gas exchange abnormalities. 
 
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Question 61 1 pts 
Which of the following are nonmedical treatments for obstructive sleep apnea? 
I. Treatment for hypothyroidism 
II. Weight loss 
III. Sleeping in a nonsupine position 
IV. Smoking cessation 
I, II, and III 
I, III, and IV 
II, III, and IV 
I, II, III, and IV 
 
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Question 62 1 pts 
Which of the following factors might result in a false-negative polysomnogram? 
I. Inadequate amount of sleep 
II. Reduced REM sleep 
III. Sleeping in a supine position 
IV. Recent weight loss 
I, II, and III 
I, II, and IV 
II, III, and IV 
I, II, III, and IV 
 
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Question 63 1 pts 
The most commonly used diuretic used for cardiac failure is 
Carbonic anyhrdase inhibitors 
Digitalis 
Loop diuretics 
Potassium-sparing 
 
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Question 64 1 pts 
What is the maximum peak alveolar pressure that should be applied in a patient with cardiac failure who is mechanically ventilated? 
10 cm H2O 
20 cm H2O 
30 cm H2O 
40 cm H2O 
 
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Question 65 1 pts 
For clinical purposes, which of these is a reasonable estimate of afterload? 
Diastolic blood pressure 
Arterial blood pressure 
Venous blood pressure 
Systolic blood pressure 
 
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Question 66 1 pts 
When using bilevel positive airway pressure airway machines, what is usually the difference between between the set inspiratory and expiratory pressures? 
About 2 cm H2O 
About 4 cm H2O 
About 6 cm H2O 
About 8 cm H2O 
 
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Question 67 1 pts 
A patient is undergoing polysomnography at the sleep clinic. The respiratory therapist records the number of apneas, hyponeas, and respiratory arousals during each hour of sleep. This combined number is known as the 
Apnea index 
Apnea-hyponea index 
Respiratory disturbance index 
Respiratory effort-related arousals index 
 
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Question 68 1 pts 
Which type of positive airway pressure titrating machine detects airway narrowing and adjusts the pressure until airflow becomes normal again? 
Auto-titrating positive airway pressure machines 
Continuous positive airway pressure machines 
Expiratory positive airway pressure machines 
Inspiratory positive airway pressure machines 
 
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Question 69 1 pts 
Which of the following are goals of treatment for chronic cardiac failure? 
I. Symptom control 
II. Improvement of quality of life 
III. Return to normal heart function 
IV. Prevent or delay complications 
I, II, and III 
I, II, and IV 
II, III, and IV 
I, II, III, and IV 
 
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Question 70 1 pts 
At which percentage of predicted maximum inspiratory mouth pressure does hypercapnia ensue? 
20% 
30% 
40% 
50% 
 
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Question 71 1 pts 
What is the most commonly used CPAP pressure range for treating obstructive sleep apnea (OSA)? 
Between 6 and 8 cm H2O 
Between 8 and 10 cm H2O 
Between 10 and 12 cm H2O 
Between 12 and 14 cm H2O 
 
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Question 72 1 pts 
Which of the following is the most common neuromuscular transmission disorder? 
Amyotrophic lateral sclerosis 
Gullian-Barré syndrome 
Muscular dystrophy 
Myasthenia gravis 
 
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Question 73 1 pts 
Which diagnostic technique provides direct imaging of the coronary arteries and is used to assess the extent and severity of coronary artery disease? 
Computed tomographic angiography 
Coronary angiography 
Echocardiography 
Radionucleotide imaging 
 
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Question 74 1 pts 
A condition characterised by continued chest and abdominal efforts to breathe during periods of airflow cessation is known as 
Complex apnea 
Central apnea 
Mixed apnea 
Obstructive apnea 
 
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Question 75 1 pts 
Basilar infiltrates with pulmonary vascular redistribution on a patient’s chest radiograph is indicative of which condition? 
Atelectasis 
COPD 
Pneumothorax 
Pulmonary edema 
 
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Question 76 1 pts 
Which of following is the greatest challenge in the detection of respiratory muscle weakness? 
Detecting the disease early enough 
Preventing aspiration 
Preventing cor pulmonale 
Preventing recurrent respiratory infections 
 
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Question 77 1 pts 
In a patient with ambulatory multiple sclerosis, what is the exected pulmonary function test results? 
Severely abnormal 
Below normal 
Normal 
Above normal 
 
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Question 78 1 pts 
Which of the following is the best indicator of the possibility of sleep apnea in a patient, indicating a need for further testing? 
Body mass index 
Cholesterol 
Neck circumference 
Weight 
 
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Question 79 1 pts Skip to question text. 
Which of the following sleep-related breathing disorders, identifiable from a sleep study, are common in patients with neuromuscular disease? 
I. Increased awakenings 
II. Inhibition of inspiratory muscle activity during REM sleep 
III. Sleep fragmentation 
I 
I and II 
II and III 
I, II, and III 
 
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Question 80 1 pts 
What is one problem associated with auto-titrating positive airway pressure machines for a patient with obstructive sleep apnea? 
The mask covers only the nose. 
They are less expensive than conventional CPAP machines. 
They may not be able to treat a patient with central apnea. 
They can overcompensate if there is leakage around the mask or if the mouth is open. 
 
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Question 81 1 pts 
Which of the following abnormalities commonly occurs in patients with moderately advanced neuromuscular disease? 
Low functional residual capacity 
High PaO2 
Low vital capacity 
High residual capacity 
 
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Question 82 1 pts 
What percentage of patients with obstructive sleep apnea use continuous positive airway pressure regularly? 
35% 
45% 
55% 
65% 
 
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Question 83 1 pts 
What level of continuous positive airway pressure (CPAP) should be used for a patient who presents with acute cardiogenic pulmonary edema? 
1-5 cm H2O 
5-10 cm H2O 
10-15 cm H2O 
15-20 cm H2O 
 
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Question 84 1 pts 
Which form of positive airway pressure therapy applies constant flow during sleep from an airflow generator? 
Bilevel positive airway pressure 
Continuous positive airway pressure 
Expiratory positive airway pressure 
Inspiratory positive airway pressure 
 
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Question 85 1 pts 
All of the following are mechanisms of pulmonary edema EXCEPT 
Decreased capillary permeability 
Decreased blood oncotic pressure 
Increased capillary permeability 
Increased pulmonary capillary pressure 
 
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Question 86 1 pts 
An elderly women occassionally experiences fatigue, dyspnea, and angina when engaging in normal activities. According the the New York Heart Association’s classification of symptoms, what class of heart disease does this patient have? 
Class I 
Class II 
Class III 
Class IV 
 
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Question 87 1 pts 
A flow-volume loop that shows sawtoothing of the flow contour can be evidence of which disease? 
Amyptrophic lateral sclerosis 
Gullian-Barré syndrome 
Muscular dystrophy 
Parkinson’s disease 
 
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Question 88 1 pts 
Why would measurement of maximal ventlation be dangerous for patients with myastenia gravis? 
It may precipitate acute respiratory failure. 
The maneuver will not give an accurate reading in patients with myasthenia gravis. 
The maneuver is used to test respiratory muscle endurance. 
The patient’s diaphragm may rupture. 
 
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Question 89 1 pts 
Why are arterial blood gas measurements unreliable as a tool for diagnosing neuromuscular dysfunction for patients who are not on ventilatory support? 
Abnormalities in arterial blood gas values occur late in the disease process. 
Hypoxemia is a normal part of neuromuscular dysfunction. 
Pulse oximetry is an insensitive indicator of hypoventilation. 
Hypercarbia does not occur until late in the disease process. 
 
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Question 90 1 pts 
Which of the following is the major reason for the failure of positive airway pressure therapy? 
Difficulty in setting proper inspiratory and expiratory pressures 
Lack of patient compliance 
Patient gets entangled in equipment 
Patient develops rhinorrhea

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