NBRC CSE EXAM QUESTIONS WITH
CORRECT ANSWERS LATEST UPDATE
GRADED A+
Information Gathering - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) --ANSWER--LEVEL I : Productive cough, often with blood, digital
clubbing of the nail beds, significant history if infections (recurrent)
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—generally normal
Sputum culture—gram negative bacteria
LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in winter
pattern"
Decision Making - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) --ANSWER--Anything that promotes good pulmonary hygiene such
as chest physiotherapy, hydration therapy when sputum is thick.
Page 1 of 526
,Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy. May have to consider surgical intervention
on some highly affected segments
Information Gathering - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a combination
of the two (mixed). --ANSWER--LEVEL I : Spouse or bed partner will
complain of snoring and will often report witnessing periods of apnea that
exceed 10 seconds. Excessive upper airway tissue, obesity, thick neck (greater
than 16 inch collar size. Ability to fall asleep quickly
Sleepiness during daytime and while watching TV or in front of a computer
LEVEL II : Dyspnea, Frequent urination during sleeping hours
LEVEL III : ABGs—could be normal or very slight respiratory acidosis and
hypoxemia
LEVEL IV : Polysomnography (sleep study) - determines if obstructive or
central, If no nasal flow AND no chest movement—then CENTRAL sleep
apnea. If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep
apnea
Decision Making - OSA
(Defined: the cessation of breathing during sleep.
Page 2 of 526
,Is usually obstructive in nature but sometimes can be central or a combination
of the two (mixed). --ANSWER--If central, ventilatory stimulant medication
may be used, If obstructive, nocturnal nasal or full-face CPAP or BiPAP
(NIPPV) is usually initially indicated with follow-up weight loss or upper
airway tissue removal through surgery.
Problem must be corrected immediately, so even if discharging, send devices
home with
patient. In the absence of a titration study, initially ordered pressure should be
10 to 20 cmH20.
Information Gathering - Emphysema:
(Abnormal condition of the alveoli resulting destruction and loss of elasticity.) -
-ANSWER--LEVEL I : Cyanosis, Barrel chest, increased A-P diameter,
Accessory muscle use, Digital clubbing of the nail beds, Significant history of
smoking and/or occupational exposure to smoke or other pulmonary irritant
LEVEL II : Dyspnea, Wheezing breath sounds
LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished
pulmonary vascular markings.
CBC—polycythemia, increased WBC due to possible infection.
ABGs—Compensated respiratory acidosis (high PaCO2, normal pH), moderate
to severe hypoxemia.
Sputum culture—often positive for bacteria.
Page 3 of 526
, LEVEL IV : FT—flows are decreased especially middle sized airways (FEF 25-
75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20).
Descision Making - Empysema:
(Abnormal condition of the alveoli resulting destruction and loss of elasticity.) -
-ANSWER--Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal
cannula
Oxygen conserving devices such as liquid oxygen or trans-tracheal oxygen
Home care education on devices and equipment cleaning
Rehabilitation efforts (specifics not usually required)
Aids to help quit smoking such as nicotine replacement therapy
Bronchodilation medication via MDI or aerosol nebulizers
Antibiotics for infection
Smoking cessation products (nicotine replacement therapy).
Information Gathering - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of the year
for at least two consecutive years.) --ANSWER--LEVEL I : Productive cough,
purulent sputum production
Exposure to pulmonary irritants, like history of smoking
Frequent infections
Page 4 of 526
CORRECT ANSWERS LATEST UPDATE
GRADED A+
Information Gathering - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) --ANSWER--LEVEL I : Productive cough, often with blood, digital
clubbing of the nail beds, significant history if infections (recurrent)
LEVEL II : Dyspnea
LEVEL III : Chest X-ray—generally normal
Sputum culture—gram negative bacteria
LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in winter
pattern"
Decision Making - Bronchiectasis
(Defined: Abnormal condition where the bronchi
secrete large volumes of pus during abnormal
dilation.) --ANSWER--Anything that promotes good pulmonary hygiene such
as chest physiotherapy, hydration therapy when sputum is thick.
Page 1 of 526
,Fluid therapy if dehydrated.Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy. May have to consider surgical intervention
on some highly affected segments
Information Gathering - OSA
(Defined: the cessation of breathing during sleep.
Is usually obstructive in nature but sometimes can be central or a combination
of the two (mixed). --ANSWER--LEVEL I : Spouse or bed partner will
complain of snoring and will often report witnessing periods of apnea that
exceed 10 seconds. Excessive upper airway tissue, obesity, thick neck (greater
than 16 inch collar size. Ability to fall asleep quickly
Sleepiness during daytime and while watching TV or in front of a computer
LEVEL II : Dyspnea, Frequent urination during sleeping hours
LEVEL III : ABGs—could be normal or very slight respiratory acidosis and
hypoxemia
LEVEL IV : Polysomnography (sleep study) - determines if obstructive or
central, If no nasal flow AND no chest movement—then CENTRAL sleep
apnea. If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep
apnea
Decision Making - OSA
(Defined: the cessation of breathing during sleep.
Page 2 of 526
,Is usually obstructive in nature but sometimes can be central or a combination
of the two (mixed). --ANSWER--If central, ventilatory stimulant medication
may be used, If obstructive, nocturnal nasal or full-face CPAP or BiPAP
(NIPPV) is usually initially indicated with follow-up weight loss or upper
airway tissue removal through surgery.
Problem must be corrected immediately, so even if discharging, send devices
home with
patient. In the absence of a titration study, initially ordered pressure should be
10 to 20 cmH20.
Information Gathering - Emphysema:
(Abnormal condition of the alveoli resulting destruction and loss of elasticity.) -
-ANSWER--LEVEL I : Cyanosis, Barrel chest, increased A-P diameter,
Accessory muscle use, Digital clubbing of the nail beds, Significant history of
smoking and/or occupational exposure to smoke or other pulmonary irritant
LEVEL II : Dyspnea, Wheezing breath sounds
LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished
pulmonary vascular markings.
CBC—polycythemia, increased WBC due to possible infection.
ABGs—Compensated respiratory acidosis (high PaCO2, normal pH), moderate
to severe hypoxemia.
Sputum culture—often positive for bacteria.
Page 3 of 526
, LEVEL IV : FT—flows are decreased especially middle sized airways (FEF 25-
75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20).
Descision Making - Empysema:
(Abnormal condition of the alveoli resulting destruction and loss of elasticity.) -
-ANSWER--Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal
cannula
Oxygen conserving devices such as liquid oxygen or trans-tracheal oxygen
Home care education on devices and equipment cleaning
Rehabilitation efforts (specifics not usually required)
Aids to help quit smoking such as nicotine replacement therapy
Bronchodilation medication via MDI or aerosol nebulizers
Antibiotics for infection
Smoking cessation products (nicotine replacement therapy).
Information Gathering - Chronic Bronchitis
(Defined: Condition where the patient has a productive cough 25% of the year
for at least two consecutive years.) --ANSWER--LEVEL I : Productive cough,
purulent sputum production
Exposure to pulmonary irritants, like history of smoking
Frequent infections
Page 4 of 526
