NBRC EXAM, Part I Questions With Verified
Solutions
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia
Endotracheal tube positioned in right mainstem bronchus is a problem but the co2 reading would not
change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation
6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle activity is
absent. _______ conditions can be imposed with an inspiratory pause when a patient is sedated and
mechanically ventilated.
Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions, when non-
intubated patient breathes spontaneously.
Dynamic Compliance
A balloon tipped flow directed catheter is positioned in the pulmonary artery with the balloon
deflated. Which of the following pressures will be measured by the proximal lumen:
a. Cvp
b. Pap
c. Pwp
d. Map
ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant
Gas will pass through and out of a long sampling line before reaching analyzer so, low sampling flow
will not give you enough information for a good reading, and condensation as a rule is always a
problem especially in analyzers. Dessicant removes moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following should the
respiratory therapist use to monitor the neonates overall cardiopulmonary status.
,a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8
Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or 8 hour),
Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis
You wouldn't have asthma on just one side (unilateral), atelectasis would cause diminished breath
sounds, with epiglottitis you would get stridor, since you are only hearing wheezing on one side, you
are hearing it on the side where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress
With pneumothorax you would hear a high pitch hyperresonnance, breath sounds would be absent,
and respiratory distress could be present. Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine
Multiple pvc's coming from multiple locations (multifocal) is a real problem and you should administer
oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but
would not be first option, atropine is used for bradycardia and cardiac irregularities but not pvc's,
epinephrine is emergency drug not for pvc's but more for pulseless ventricular tachycardia or
ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg
Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea. The patient has
marked dyspnea and a history of heart disease. Which of the following should the respiratory
therapist recommend.
1.suction immediately
2.administer 100% oxygen
,3.place in Fowlers position
4.administer furosemide
This is an emergency, they are having heart problems, dyspnea, frothy secretions indicating severe
pulmonary edema, etc. so 100% oxygen immediately, having the patient in the Fowlers position (an
upright position) will help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic)
which gets rid of excess fluid. You do NOT suction someone with frothy secretions and heart
problems, this just delays appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup
Crackles are associated with fluid so a, b, and c would be good answers, but "fine crepitant" crackles
indicates fluid entering alveoli (pulmonary edema) which is most often caused by heart failure so the
best ANSWER is B. (with croup you would hear more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally intubated
with an EtCO2 monitor attached. Which of the following EtCO2 patterns would the respiratory
therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
c. Initially high, stays high
d. Initially low, stays low
Full cardiac arrest will cause the CO2 in the lungs to slowly dissipate out because no blood is flowing,
then during CPR when you get blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure obtained from a
sphygmomanometer (cuff pressure). Based upon this information, the respiratory therapist should
conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles
Arterial line BP and cuff pressure should be the same, so there is a problem. Non-compliant tubing is a
good thing because it's a stiff tubing, if transducer is placed too high (above the heart), the flood will
have to go uphill and you will get a lower pressure; transducer dome contained air bubbles would give
you erratic readings but not a higher reading, but if the transducer is placed too low (below heart),
the blood is flowing downhill & will give a higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was playing with
friends and developed violent coughing and unilateral wheezing. Physical examination reveals a
hyperresonant percussion note on the left and resonant percussion on the right. Inspiratory and
expiratory chest films indicate air trapping with no foreign bodies "noted." The respiratory therapist
should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis
Unilateral wheezing indicates aspirated object and fact that the child was playing with friends causes
you to believe the child inhaled a small toy or something, hyperresonant percussion indicates air
trapping, so you are thinking foreign object but x-ray says no foreign bodies "noted." Just because it
, says "noted" does not mean something is not there, it just means it could not be seen on the xray,
also if the child had swallowed a small plastic toy, "plastic" does not show up on xrays (radiolucent).
The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric tube has been
inserted to help relieve the nausea. The patient was started on Lasix and nitroglycerin. Which of the
following should be monitored to closely identify side effects at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels
Since the patient received Lasix and nasogastric tube, they are losing fluids, and a side effect of fluid
loss is a decrease in electrolytes, so ANSWER is B (there isn't enough evidence of heart attack to
justify cardiac enzymes, also they are used to confirm a heart attack).
Which of the following will determine aortic pulse pressure.
a. systolic + systolic + diastolic/3
b. diastolic + pulse pressure/3
c. systolic pressure - diastolic pressure
d. stroke volume x heart rate x 10.
Aortic pulse pressure is just the difference between systolic and diastolic pressure, so ANSWER is C
A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease.
The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph
reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated.
This would indicate
A. atelectasis.
B. bronchopulmonary dysplasia.
C. fluid overload.
D. resolution of a pneumothorax.
bilateral means both sides, radiolucency refers to dark, midline mediastinum is right where is should
be, the right hemidiaphragm slightly elevated is normal; so this actually indicates everything is
normal. With atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary
dysplasia it would look similar to ARDS, with fluid overload you would see pattern similar to butterfly
or batwing similar to pulmonary edema, so the best
ANSWER is D and the pneumothorax has resolved.
A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased movement, and no
vascular markings on the right side. These signs would be most likely associated with:
A. pneumothorax
B. pleural effusion
C. pneumonia
D. flail chest
The flat hemidiaphram indicates pneumothorax, so the ANSWER is A.
What is the normal range for the pulmonary artery systolic pressure in an adult?
A. 2-6 mm Hg
B. 4-12 mm Hg
C. 9-18 mm Hg
D. 21-28 mm Hg
The normal pressure is 25 mm Hg, so the ANSWER is D 21-28 mm Hg
Solutions
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia
Endotracheal tube positioned in right mainstem bronchus is a problem but the co2 reading would not
change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation
6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle activity is
absent. _______ conditions can be imposed with an inspiratory pause when a patient is sedated and
mechanically ventilated.
Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions, when non-
intubated patient breathes spontaneously.
Dynamic Compliance
A balloon tipped flow directed catheter is positioned in the pulmonary artery with the balloon
deflated. Which of the following pressures will be measured by the proximal lumen:
a. Cvp
b. Pap
c. Pwp
d. Map
ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant
Gas will pass through and out of a long sampling line before reaching analyzer so, low sampling flow
will not give you enough information for a good reading, and condensation as a rule is always a
problem especially in analyzers. Dessicant removes moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following should the
respiratory therapist use to monitor the neonates overall cardiopulmonary status.
,a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8
Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or 8 hour),
Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis
You wouldn't have asthma on just one side (unilateral), atelectasis would cause diminished breath
sounds, with epiglottitis you would get stridor, since you are only hearing wheezing on one side, you
are hearing it on the side where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress
With pneumothorax you would hear a high pitch hyperresonnance, breath sounds would be absent,
and respiratory distress could be present. Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine
Multiple pvc's coming from multiple locations (multifocal) is a real problem and you should administer
oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but
would not be first option, atropine is used for bradycardia and cardiac irregularities but not pvc's,
epinephrine is emergency drug not for pvc's but more for pulseless ventricular tachycardia or
ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg
Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea. The patient has
marked dyspnea and a history of heart disease. Which of the following should the respiratory
therapist recommend.
1.suction immediately
2.administer 100% oxygen
,3.place in Fowlers position
4.administer furosemide
This is an emergency, they are having heart problems, dyspnea, frothy secretions indicating severe
pulmonary edema, etc. so 100% oxygen immediately, having the patient in the Fowlers position (an
upright position) will help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic)
which gets rid of excess fluid. You do NOT suction someone with frothy secretions and heart
problems, this just delays appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup
Crackles are associated with fluid so a, b, and c would be good answers, but "fine crepitant" crackles
indicates fluid entering alveoli (pulmonary edema) which is most often caused by heart failure so the
best ANSWER is B. (with croup you would hear more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally intubated
with an EtCO2 monitor attached. Which of the following EtCO2 patterns would the respiratory
therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
c. Initially high, stays high
d. Initially low, stays low
Full cardiac arrest will cause the CO2 in the lungs to slowly dissipate out because no blood is flowing,
then during CPR when you get blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure obtained from a
sphygmomanometer (cuff pressure). Based upon this information, the respiratory therapist should
conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles
Arterial line BP and cuff pressure should be the same, so there is a problem. Non-compliant tubing is a
good thing because it's a stiff tubing, if transducer is placed too high (above the heart), the flood will
have to go uphill and you will get a lower pressure; transducer dome contained air bubbles would give
you erratic readings but not a higher reading, but if the transducer is placed too low (below heart),
the blood is flowing downhill & will give a higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was playing with
friends and developed violent coughing and unilateral wheezing. Physical examination reveals a
hyperresonant percussion note on the left and resonant percussion on the right. Inspiratory and
expiratory chest films indicate air trapping with no foreign bodies "noted." The respiratory therapist
should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis
Unilateral wheezing indicates aspirated object and fact that the child was playing with friends causes
you to believe the child inhaled a small toy or something, hyperresonant percussion indicates air
trapping, so you are thinking foreign object but x-ray says no foreign bodies "noted." Just because it
, says "noted" does not mean something is not there, it just means it could not be seen on the xray,
also if the child had swallowed a small plastic toy, "plastic" does not show up on xrays (radiolucent).
The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric tube has been
inserted to help relieve the nausea. The patient was started on Lasix and nitroglycerin. Which of the
following should be monitored to closely identify side effects at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels
Since the patient received Lasix and nasogastric tube, they are losing fluids, and a side effect of fluid
loss is a decrease in electrolytes, so ANSWER is B (there isn't enough evidence of heart attack to
justify cardiac enzymes, also they are used to confirm a heart attack).
Which of the following will determine aortic pulse pressure.
a. systolic + systolic + diastolic/3
b. diastolic + pulse pressure/3
c. systolic pressure - diastolic pressure
d. stroke volume x heart rate x 10.
Aortic pulse pressure is just the difference between systolic and diastolic pressure, so ANSWER is C
A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease.
The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph
reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated.
This would indicate
A. atelectasis.
B. bronchopulmonary dysplasia.
C. fluid overload.
D. resolution of a pneumothorax.
bilateral means both sides, radiolucency refers to dark, midline mediastinum is right where is should
be, the right hemidiaphragm slightly elevated is normal; so this actually indicates everything is
normal. With atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary
dysplasia it would look similar to ARDS, with fluid overload you would see pattern similar to butterfly
or batwing similar to pulmonary edema, so the best
ANSWER is D and the pneumothorax has resolved.
A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased movement, and no
vascular markings on the right side. These signs would be most likely associated with:
A. pneumothorax
B. pleural effusion
C. pneumonia
D. flail chest
The flat hemidiaphram indicates pneumothorax, so the ANSWER is A.
What is the normal range for the pulmonary artery systolic pressure in an adult?
A. 2-6 mm Hg
B. 4-12 mm Hg
C. 9-18 mm Hg
D. 21-28 mm Hg
The normal pressure is 25 mm Hg, so the ANSWER is D 21-28 mm Hg
