[HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Question 1.** Which breath sound is most indicative of fluid in the alveoli? A) Stridor B)
Wheeze C) Crackles D) Pleural rub **Answer:** C **Explanation:** Crackles (rales) are
produced by the sudden opening of fluid‑filled alveoli.
**Question 2.** A patient’s SpO₂ is 85% on 2 L/min NC. The most appropriate next step is: A)
Increase to 4 L/min NC B) Switch to a simple face mask at 6 L/min C) Initiate high‑flow nasal
cannula D) Intubate immediately **Answer:** C **Explanation:** HFNC delivers heated,
humidified O₂ at high flow, rapidly improving oxygenation without invasive ventilation.
**Question 3.** In ABG analysis, a primary metabolic alkalosis with appropriate compensation
shows which PaCO₂ range? A) 20‑25 mmHg B) 30‑35 mmHg C) 45‑50 mmHg D) 55‑60 mmHg
**Answer:** C **Explanation:** For metabolic alkalosis, the lungs retain CO₂; PaCO₂ rises
~0.7 mmHg for each 1 mEq/L increase in HCO₃⁻.
**Question 4.** The P/F ratio is most useful for: A) Determining ventilator mode B) Grading
severity of ARDS C) Calculating tidal volume D) Monitoring cuff pressure **Answer:** B
**Explanation:** PaO₂/FiO₂ (P/F) ratio categorizes ARDS severity (mild = 200‑300,
moderate = 100‑200, severe < 100).
**Question 5.** Which cuff pressure range minimizes tracheal injury while preventing
aspiration? A) 5‑10 cmH₂O B) 10‑15 cmH₂O C) 20‑30 cmH₂O D) 35‑45 cmH₂O **Answer:** C
**Explanation:** 20‑30 cmH₂O maintains cuff seal without compromising mucosal perfusion.
**Question 6.** The optimal size for an oropharyngeal airway in an adult is: A) 70 mm B)
80 mm C) 90 mm D) 100 mm **Answer:** B **Explanation:** Adult OPA size is roughly the
distance from the corner of the mouth to the angle of the mandible (~80 mm).
**Question 7.** Which device delivers aerosol with the highest lung deposition in a
spontaneously breathing adult? A) Jet nebulizer B) Ultrasonic nebulizer C) Metered‑dose inhaler
,[HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
with spacer D) Dry powder inhaler **Answer:** C **Explanation:** An MDI with a spacer
reduces oropharyngeal loss and improves distal deposition.
**Question 8.** The most common cause of auto‑PEEP in mechanically ventilated patients is:
A) Low tidal volume B) High respiratory rate C) Excessive humidification D) Low FiO₂
**Answer:** B **Explanation:** Rapid breathing can trap air, creating intrinsic PEEP.
**Question 9.** In a patient with COPD, the initial ventilator tidal volume should be: A)
4‑6 mL/kg IBW B) 6‑8 mL/kg IBW C) 8‑10 mL/kg IBW D) 10‑12 mL/kg IBW **Answer:** A
**Explanation:** Low tidal volumes (4‑6 mL/kg) reduce risk of barotrauma in obstructive lung
disease.
**Question 10.** The Rapid Shallow Breathing Index (RSBI) is calculated as: A) RR ÷ VT (L) B)
VT ÷ RR (L) C) RR × VT (L) D) RR − VT (L) **Answer:** A **Explanation:** RSBI = respiratory rate
(breaths/min) divided by tidal volume (L); values < 105 predict successful weaning.
**Question 11.** Which of the following is a contraindication to the use of a nasopharyngeal
airway? A) Unconscious patient B) Facial trauma C) Intact gag reflex D) Oral bleeding
**Answer:** B **Explanation:** Nasopharyngeal airways can worsen basilar skull fractures or
facial trauma.
**Question 12.** The most appropriate initial step in neonatal resuscitation when the newborn
is apneic and cyanotic? A) Immediate intubation B) Bag‑mask ventilation with 21% O₂ C) Chest
compressions D) Administer epinephrine **Answer:** B **Explanation:** Provide positive
pressure ventilation with a bag‑mask before escalating to advanced interventions.
**Question 13.** In a chest X‑ray, a “silhouette sign” most commonly indicates which
pathology? A) Pneumothorax B) Pleural effusion C) Consolidation D) Pulmonary embolism
,[HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Answer:** C **Explanation:** Loss of the cardiac or diaphragmatic silhouette suggests
adjacent alveolar consolidation.
**Question 14.** Which laboratory value is most directly related to the need for aerosolized
bronchodilator therapy? A) PaCO₂ B) Serum potassium C) Peak expiratory flow D) Hemoglobin
**Answer:** C **Explanation:** Low peak expiratory flow indicates airflow obstruction
amenable to bronchodilators.
**Question 15.** The primary purpose of a heat‑moisture exchanger (HME) in a ventilated
patient is to: A) Increase FiO₂ B) Provide humidification C) Reduce dead space D) Measure
airway pressure **Answer:** B **Explanation:** HMEs capture exhaled heat and moisture,
returning it to the inspiratory circuit.
**Question 16.** Which ventilator mode provides a set tidal volume with the lowest possible
inspiratory pressure? A) Assist‑Control (A/C) B) Synchronized Intermittent Mandatory
Ventilation (SIMV) C) Pressure‑Regulated Volume Control (PRVC) D) Pressure Support
Ventilation (PSV) **Answer:** C **Explanation:** PRVC delivers a target tidal volume while
adjusting inspiratory pressure to the minimum required.
**Question 17.** A patient on mechanical ventilation develops a high‑pressure alarm. The most
likely cause is: A) Disconnected circuit B) Kinked endotracheal tube C) Decreased lung
compliance D) Patient‑ventilator asynchrony **Answer:** C **Explanation:** Reduced
compliance (e.g., stiff lungs) raises airway pressures, triggering the alarm.
**Question 18.** Which of the following is the best indicator of adequate oxygen delivery to
tissues? A) PaO₂ B) SaO₂ C) Hemoglobin concentration D) Mixed venous O₂ saturation (SvO₂)
**Answer:** D **Explanation:** SvO₂ reflects the balance between oxygen delivery and
consumption.
, [HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Question 19.** In an adult with severe asthma exacerbation, the initial ventilator strategy
should be: A) High tidal volume B) Low respiratory rate C) High PEEP D) Low FiO₂ **Answer:** B
**Explanation:** A low respiratory rate allows for prolonged expiratory time, reducing air
trapping.
**Question 20.** Which of the following is the most accurate method for confirming
endotracheal tube placement? A) Auscultation of bilateral breath sounds B) Observation of
chest rise C) Capnography D) Direct visualization of the tube passing vocal cords **Answer:** C
**Explanation:** Continuous waveform capnography provides reliable confirmation of tracheal
intubation.
**Question 21.** The normal range for PaCO₂ in arterial blood is: A) 20‑30 mmHg B)
35‑45 mmHg C) 50‑60 mmHg D) 65‑75 mmHg **Answer:** B **Explanation:** Normal PaCO₂
reflects appropriate ventilation.
**Question 22.** Which of the following is the most common cause of a pleural friction rub? A)
Pulmonary embolism B) Pneumothorax C) Pleuritis D) Congestive heart failure **Answer:** C
**Explanation:** Inflammation of the pleural surfaces produces a friction rub.
**Question 23.** In a ventilated patient with ARDS, the recommended initial PEEP strategy is:
A) 0‑5 cmH₂O B) 5‑8 cmH₂O C) 10‑15 cmH₂O D) >20 cmH₂O **Answer:** C **Explanation:**
Moderate PEEP (10‑15 cmH₂O) improves oxygenation while minimizing barotrauma.
**Question 24.** Which of the following is an indication for the use of a high‑flow nasal
cannula (HFNC) in pediatric patients? A) Mild bronchiolitis B) Severe stridor C) Post‑operative
apnea D) Chronic hypercapnia **Answer:** A **Explanation:** HFNC provides heated,
humidified O₂ and some positive pressure, suitable for mild to moderate bronchiolitis.
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Question 1.** Which breath sound is most indicative of fluid in the alveoli? A) Stridor B)
Wheeze C) Crackles D) Pleural rub **Answer:** C **Explanation:** Crackles (rales) are
produced by the sudden opening of fluid‑filled alveoli.
**Question 2.** A patient’s SpO₂ is 85% on 2 L/min NC. The most appropriate next step is: A)
Increase to 4 L/min NC B) Switch to a simple face mask at 6 L/min C) Initiate high‑flow nasal
cannula D) Intubate immediately **Answer:** C **Explanation:** HFNC delivers heated,
humidified O₂ at high flow, rapidly improving oxygenation without invasive ventilation.
**Question 3.** In ABG analysis, a primary metabolic alkalosis with appropriate compensation
shows which PaCO₂ range? A) 20‑25 mmHg B) 30‑35 mmHg C) 45‑50 mmHg D) 55‑60 mmHg
**Answer:** C **Explanation:** For metabolic alkalosis, the lungs retain CO₂; PaCO₂ rises
~0.7 mmHg for each 1 mEq/L increase in HCO₃⁻.
**Question 4.** The P/F ratio is most useful for: A) Determining ventilator mode B) Grading
severity of ARDS C) Calculating tidal volume D) Monitoring cuff pressure **Answer:** B
**Explanation:** PaO₂/FiO₂ (P/F) ratio categorizes ARDS severity (mild = 200‑300,
moderate = 100‑200, severe < 100).
**Question 5.** Which cuff pressure range minimizes tracheal injury while preventing
aspiration? A) 5‑10 cmH₂O B) 10‑15 cmH₂O C) 20‑30 cmH₂O D) 35‑45 cmH₂O **Answer:** C
**Explanation:** 20‑30 cmH₂O maintains cuff seal without compromising mucosal perfusion.
**Question 6.** The optimal size for an oropharyngeal airway in an adult is: A) 70 mm B)
80 mm C) 90 mm D) 100 mm **Answer:** B **Explanation:** Adult OPA size is roughly the
distance from the corner of the mouth to the angle of the mandible (~80 mm).
**Question 7.** Which device delivers aerosol with the highest lung deposition in a
spontaneously breathing adult? A) Jet nebulizer B) Ultrasonic nebulizer C) Metered‑dose inhaler
,[HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
with spacer D) Dry powder inhaler **Answer:** C **Explanation:** An MDI with a spacer
reduces oropharyngeal loss and improves distal deposition.
**Question 8.** The most common cause of auto‑PEEP in mechanically ventilated patients is:
A) Low tidal volume B) High respiratory rate C) Excessive humidification D) Low FiO₂
**Answer:** B **Explanation:** Rapid breathing can trap air, creating intrinsic PEEP.
**Question 9.** In a patient with COPD, the initial ventilator tidal volume should be: A)
4‑6 mL/kg IBW B) 6‑8 mL/kg IBW C) 8‑10 mL/kg IBW D) 10‑12 mL/kg IBW **Answer:** A
**Explanation:** Low tidal volumes (4‑6 mL/kg) reduce risk of barotrauma in obstructive lung
disease.
**Question 10.** The Rapid Shallow Breathing Index (RSBI) is calculated as: A) RR ÷ VT (L) B)
VT ÷ RR (L) C) RR × VT (L) D) RR − VT (L) **Answer:** A **Explanation:** RSBI = respiratory rate
(breaths/min) divided by tidal volume (L); values < 105 predict successful weaning.
**Question 11.** Which of the following is a contraindication to the use of a nasopharyngeal
airway? A) Unconscious patient B) Facial trauma C) Intact gag reflex D) Oral bleeding
**Answer:** B **Explanation:** Nasopharyngeal airways can worsen basilar skull fractures or
facial trauma.
**Question 12.** The most appropriate initial step in neonatal resuscitation when the newborn
is apneic and cyanotic? A) Immediate intubation B) Bag‑mask ventilation with 21% O₂ C) Chest
compressions D) Administer epinephrine **Answer:** B **Explanation:** Provide positive
pressure ventilation with a bag‑mask before escalating to advanced interventions.
**Question 13.** In a chest X‑ray, a “silhouette sign” most commonly indicates which
pathology? A) Pneumothorax B) Pleural effusion C) Consolidation D) Pulmonary embolism
,[HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Answer:** C **Explanation:** Loss of the cardiac or diaphragmatic silhouette suggests
adjacent alveolar consolidation.
**Question 14.** Which laboratory value is most directly related to the need for aerosolized
bronchodilator therapy? A) PaCO₂ B) Serum potassium C) Peak expiratory flow D) Hemoglobin
**Answer:** C **Explanation:** Low peak expiratory flow indicates airflow obstruction
amenable to bronchodilators.
**Question 15.** The primary purpose of a heat‑moisture exchanger (HME) in a ventilated
patient is to: A) Increase FiO₂ B) Provide humidification C) Reduce dead space D) Measure
airway pressure **Answer:** B **Explanation:** HMEs capture exhaled heat and moisture,
returning it to the inspiratory circuit.
**Question 16.** Which ventilator mode provides a set tidal volume with the lowest possible
inspiratory pressure? A) Assist‑Control (A/C) B) Synchronized Intermittent Mandatory
Ventilation (SIMV) C) Pressure‑Regulated Volume Control (PRVC) D) Pressure Support
Ventilation (PSV) **Answer:** C **Explanation:** PRVC delivers a target tidal volume while
adjusting inspiratory pressure to the minimum required.
**Question 17.** A patient on mechanical ventilation develops a high‑pressure alarm. The most
likely cause is: A) Disconnected circuit B) Kinked endotracheal tube C) Decreased lung
compliance D) Patient‑ventilator asynchrony **Answer:** C **Explanation:** Reduced
compliance (e.g., stiff lungs) raises airway pressures, triggering the alarm.
**Question 18.** Which of the following is the best indicator of adequate oxygen delivery to
tissues? A) PaO₂ B) SaO₂ C) Hemoglobin concentration D) Mixed venous O₂ saturation (SvO₂)
**Answer:** D **Explanation:** SvO₂ reflects the balance between oxygen delivery and
consumption.
, [HAADRespTherapist] HAAD RespTherapist
DOH Licensureination for Respiratory
Therapist Certification Review Guide
**Question 19.** In an adult with severe asthma exacerbation, the initial ventilator strategy
should be: A) High tidal volume B) Low respiratory rate C) High PEEP D) Low FiO₂ **Answer:** B
**Explanation:** A low respiratory rate allows for prolonged expiratory time, reducing air
trapping.
**Question 20.** Which of the following is the most accurate method for confirming
endotracheal tube placement? A) Auscultation of bilateral breath sounds B) Observation of
chest rise C) Capnography D) Direct visualization of the tube passing vocal cords **Answer:** C
**Explanation:** Continuous waveform capnography provides reliable confirmation of tracheal
intubation.
**Question 21.** The normal range for PaCO₂ in arterial blood is: A) 20‑30 mmHg B)
35‑45 mmHg C) 50‑60 mmHg D) 65‑75 mmHg **Answer:** B **Explanation:** Normal PaCO₂
reflects appropriate ventilation.
**Question 22.** Which of the following is the most common cause of a pleural friction rub? A)
Pulmonary embolism B) Pneumothorax C) Pleuritis D) Congestive heart failure **Answer:** C
**Explanation:** Inflammation of the pleural surfaces produces a friction rub.
**Question 23.** In a ventilated patient with ARDS, the recommended initial PEEP strategy is:
A) 0‑5 cmH₂O B) 5‑8 cmH₂O C) 10‑15 cmH₂O D) >20 cmH₂O **Answer:** C **Explanation:**
Moderate PEEP (10‑15 cmH₂O) improves oxygenation while minimizing barotrauma.
**Question 24.** Which of the following is an indication for the use of a high‑flow nasal
cannula (HFNC) in pediatric patients? A) Mild bronchiolitis B) Severe stridor C) Post‑operative
apnea D) Chronic hypercapnia **Answer:** A **Explanation:** HFNC provides heated,
humidified O₂ and some positive pressure, suitable for mild to moderate bronchiolitis.
