KETTERING CSE PRACTICE QUESTIONS & ANSWERS
You are the respiratory therapist working in a 600-bed urban medical center and your
assignment includes providing care to patients on the general medical floor. You are
asked to assist in the care of a recently admitted 32-year-old male patient who is 180
cm (5'11") tall and weighs 53 kg (117 lb). The patient is pale and complains of persistent
cough and fever for over a week. The hospitalist asks you to evaluate the patient and
report your findings. You arrive in the patient's room, introduce yourself, and explain the
purpose of your visit. Which of the following should you include in your assessment? -
Answer -Vital Signs/ Pulse oximetry/ Breath sounds/ Respiratory pattern/ General
appearance/ Past medical history/ Diagnostic chest percussion/ History of present
illness
You report your findings to the hospitalist, who asks for your recommendation. Based
on your assessment, which of the following would you recommend? - Answer -
Administer oxygen by nasal cannula at 5 L/min
The hospitalist asks what additional testing may be indicated. You should recommend -
Answer -Arterial blood gas/ Complete blood count/ chest radiograph/ 12-lead ECG/
Sputum culture/ Sputum acid-fast stain/ drug toxicology/ serum electrolytes/ urinalysis/
An ELISA test confirms a diagnosis of HIV and a sputum acid fast stain is negative.
Sputum culture confirms the presence of Pneumocystis jiroveci. What additional therapy
would you recommend at this time? - Answer -Pentamidine
Four hours later, arterial blood gas analysis on 40% oxygen reveals: pH 7.20, PaCO2
60 torr, PaO2 64 torr, HCO3- 24 mEq/L, BE Zero, SaO2 (calc) 91%. Breath sounds are
diminished with bilateral wheezing. Which of the following would you recommend? -
Answer -Initiate mechanical ventilation
The physician asks you to recommend initial ventilator settings. Which of the following
would you suggest? - Answer -VC/SIMV, VT 450 mL, f 12/min, FIO2 0.50, PEEP 3 cm
H2O
You are the respiratory therapist working at a 330-bed suburban medical center. You
are called to Labor and Delivery to assist in the care of a 1500 g (3.3 lb) female neonate
born at 30 weeks of gestation.The neonate has been dried and placed on a radiant
warmer. Her heart rate is 120/min, respiratory rate is 45/min, there is no activity or
response to suctioning, and she is cyanotic. You should now - Answer -Administer
oxygen
Two hours later you are called to the NICU to evaluate the neonate. She is currently
receiving 50% oxygen via oxyhood. Vital signs are: temperature 36.3° C (97.3° F), pulse
166/min, respirations 40/min, BP 75/59 mm Hg, SpO2 81%. Auscultation reveals
diminished breath sounds. Umbilical artery blood gas results are: pH 7.32, PaCO2 45
, torr, PaO2 49 torr, HCO3- 23 mEq/L, BE -1, SaO2 (calc) 79%. Which of the following
should you now recommend to the neonatologist? - Answer -Initiate nasal CPAP
An A-P chest radiograph reveals a ground glass appearance with diffuse bilateral
radiopacities. Which of the following would you recommend at this time? - Answer -
Surfactant replacement therapy
Four hours later, you are asked to reassess the neonate. She is currently receiving 4
cm H2O CPAP therapy via nasal prongs with 50% oxygen, Umbilical artery blood gas
results are: pH 7.19, PaCO2 57 torr, PaO2 41 torr, HCO3- 22 mEq/L, BE -2, SaO2
(calc) 73%. You should now recommend - Answer -Initiate mechanical ventilation
The neonatologist asks for your recommendation for initial ventilator settings. You
should now recommend - Answer -PC/SIMV, PIP 27 cm H2O, rate 29/min, FIO2 0.50,
PEEP 4 cm H2O
You are the respiratory therapist working at a 350-bed suburban hospital. You receive a
call from the Emergency Department to assist in the care of a 53 year-old female patient
who drove herself to the ED after completing a high intensity exercise class. The patient
presents with shortness of breath, nausea, lightheadedness and an uncomfortable
fullness in the center of her chest. She is 163 cm (5' 4") tall and weighs 70 kg (154 lb).
The ED physician asks you to evaluate the patient and report your findings. - Answer -
Level of consciousness/ Vital signs/ Electrolytes/ Pulse oximetry/ General appearance/
ECG monitor/ Breath sounds/ ABG results/ Diagnostic chest percussion/ CBC/
Troponin/ CXR
The ED physician asks for your recommendation. Which of the following would you
recommend? - Answer -40% O2 via air-entrainment mask/ Continuous ECG monitor/
Aspirin therapy
The patient has been transferred to the Cardiac Cath Lab where a percutaneous
cardiac catheterization has been performed. The result of the catheterization indicated
two blocked coronary vessels that have been stented. During the procedure, the patient
experienced a sudden decrease in heart rate, blood pressure and oxygen saturation.
The patient was successfully resuscitated and arrives in the Cardiac Care Unit intubated
and being manually ventilated. The intensivist asks you to recommend initial ventilator
settings. Which of the following should you suggest? - Answer -VC/AC, VT 450 mL, f
12/min, FIO2 0.50, PEEP 3 cm H2O/ or VC/SIMV, VT 500 mL, f 10/min, FIO2 0.50,
PEEP 8 cmH2O
Thirty minutes later the patient has the following blood gas results. pH 7.50, PaCO2 30
torr, PaO2 150 torr, HCO3- 24 mEq/L, BE Zero, SaO2 (calc) 99%. A chest radiograph
reveals small bilateral basilar infiltrates. You should now recommend - Answer -
Decrease the set tidal volume/ or decrease the respiratory rate
You are the respiratory therapist working in a 600-bed urban medical center and your
assignment includes providing care to patients on the general medical floor. You are
asked to assist in the care of a recently admitted 32-year-old male patient who is 180
cm (5'11") tall and weighs 53 kg (117 lb). The patient is pale and complains of persistent
cough and fever for over a week. The hospitalist asks you to evaluate the patient and
report your findings. You arrive in the patient's room, introduce yourself, and explain the
purpose of your visit. Which of the following should you include in your assessment? -
Answer -Vital Signs/ Pulse oximetry/ Breath sounds/ Respiratory pattern/ General
appearance/ Past medical history/ Diagnostic chest percussion/ History of present
illness
You report your findings to the hospitalist, who asks for your recommendation. Based
on your assessment, which of the following would you recommend? - Answer -
Administer oxygen by nasal cannula at 5 L/min
The hospitalist asks what additional testing may be indicated. You should recommend -
Answer -Arterial blood gas/ Complete blood count/ chest radiograph/ 12-lead ECG/
Sputum culture/ Sputum acid-fast stain/ drug toxicology/ serum electrolytes/ urinalysis/
An ELISA test confirms a diagnosis of HIV and a sputum acid fast stain is negative.
Sputum culture confirms the presence of Pneumocystis jiroveci. What additional therapy
would you recommend at this time? - Answer -Pentamidine
Four hours later, arterial blood gas analysis on 40% oxygen reveals: pH 7.20, PaCO2
60 torr, PaO2 64 torr, HCO3- 24 mEq/L, BE Zero, SaO2 (calc) 91%. Breath sounds are
diminished with bilateral wheezing. Which of the following would you recommend? -
Answer -Initiate mechanical ventilation
The physician asks you to recommend initial ventilator settings. Which of the following
would you suggest? - Answer -VC/SIMV, VT 450 mL, f 12/min, FIO2 0.50, PEEP 3 cm
H2O
You are the respiratory therapist working at a 330-bed suburban medical center. You
are called to Labor and Delivery to assist in the care of a 1500 g (3.3 lb) female neonate
born at 30 weeks of gestation.The neonate has been dried and placed on a radiant
warmer. Her heart rate is 120/min, respiratory rate is 45/min, there is no activity or
response to suctioning, and she is cyanotic. You should now - Answer -Administer
oxygen
Two hours later you are called to the NICU to evaluate the neonate. She is currently
receiving 50% oxygen via oxyhood. Vital signs are: temperature 36.3° C (97.3° F), pulse
166/min, respirations 40/min, BP 75/59 mm Hg, SpO2 81%. Auscultation reveals
diminished breath sounds. Umbilical artery blood gas results are: pH 7.32, PaCO2 45
, torr, PaO2 49 torr, HCO3- 23 mEq/L, BE -1, SaO2 (calc) 79%. Which of the following
should you now recommend to the neonatologist? - Answer -Initiate nasal CPAP
An A-P chest radiograph reveals a ground glass appearance with diffuse bilateral
radiopacities. Which of the following would you recommend at this time? - Answer -
Surfactant replacement therapy
Four hours later, you are asked to reassess the neonate. She is currently receiving 4
cm H2O CPAP therapy via nasal prongs with 50% oxygen, Umbilical artery blood gas
results are: pH 7.19, PaCO2 57 torr, PaO2 41 torr, HCO3- 22 mEq/L, BE -2, SaO2
(calc) 73%. You should now recommend - Answer -Initiate mechanical ventilation
The neonatologist asks for your recommendation for initial ventilator settings. You
should now recommend - Answer -PC/SIMV, PIP 27 cm H2O, rate 29/min, FIO2 0.50,
PEEP 4 cm H2O
You are the respiratory therapist working at a 350-bed suburban hospital. You receive a
call from the Emergency Department to assist in the care of a 53 year-old female patient
who drove herself to the ED after completing a high intensity exercise class. The patient
presents with shortness of breath, nausea, lightheadedness and an uncomfortable
fullness in the center of her chest. She is 163 cm (5' 4") tall and weighs 70 kg (154 lb).
The ED physician asks you to evaluate the patient and report your findings. - Answer -
Level of consciousness/ Vital signs/ Electrolytes/ Pulse oximetry/ General appearance/
ECG monitor/ Breath sounds/ ABG results/ Diagnostic chest percussion/ CBC/
Troponin/ CXR
The ED physician asks for your recommendation. Which of the following would you
recommend? - Answer -40% O2 via air-entrainment mask/ Continuous ECG monitor/
Aspirin therapy
The patient has been transferred to the Cardiac Cath Lab where a percutaneous
cardiac catheterization has been performed. The result of the catheterization indicated
two blocked coronary vessels that have been stented. During the procedure, the patient
experienced a sudden decrease in heart rate, blood pressure and oxygen saturation.
The patient was successfully resuscitated and arrives in the Cardiac Care Unit intubated
and being manually ventilated. The intensivist asks you to recommend initial ventilator
settings. Which of the following should you suggest? - Answer -VC/AC, VT 450 mL, f
12/min, FIO2 0.50, PEEP 3 cm H2O/ or VC/SIMV, VT 500 mL, f 10/min, FIO2 0.50,
PEEP 8 cmH2O
Thirty minutes later the patient has the following blood gas results. pH 7.50, PaCO2 30
torr, PaO2 150 torr, HCO3- 24 mEq/L, BE Zero, SaO2 (calc) 99%. A chest radiograph
reveals small bilateral basilar infiltrates. You should now recommend - Answer -
Decrease the set tidal volume/ or decrease the respiratory rate
