NBRC TMC Practice questions with
rationales/already graded answers/latest
1. An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After
the patient is placed on the system, the respiratory therapist notices that the pressure
falls to 2 cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system: Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. In- creasing the flow
should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
2. A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing.
Severe suprasternal, subcostal and substernal retraction are ob- served. The child has a
harsh, barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma: Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral illness.
The barky cough is a classic finding for patients experiencing croup.
3. The polysomnography sleep laboratory is full scheduled for several weeks. The
physician wants to know if there is another option to determine if a patient has sleep
apnea. What should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison: Overnight pulse
oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected obstructive sleep
apnea. The patient's oxygen saturation is found to decrease during apnea episodes.
,4. A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-
old female who was admitted 12 hours ago for an aspirin overdose. The following
information is obtained as the patient breathes air:
HR
89/min
RR
15/min
BP 110/70 mm Hg Sp02
86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site: Validate the Sp02 reading at a
different site
Explain: The saturation may not be accurate and should be measured at a different site.
5. A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration
of CPAP. The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A
respiratory therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP: Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypop- nea
episodes, standard protocol is to incrementally increase the CPAP level until this occurs.
6. An arterial puncture has been performed to obtain blood for analysis of 02, C02,
and pH. What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood: Place it into a mix of ice and water
,Explain: Placing the blood sample into ice water will prevent the blood from consum- ing the O2
within the sample.
7. A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle
crash. The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving
volume-controlled ventilation. Twenty-four hours later, the pa- tient has clear breath
sounds but cannot tolerate weaning the mandatory rate below 8 in the SIMV mode with 15
cm H20 pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube: Reintubating with a larger
endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of increased
airways resistance. This can be resolved only by a larger tube or extubation.
8. During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough.
Watery secretions are aspirated through the catheter. Which of the following should the
respiratory therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
d. Increase the suction pressure and repeat the procedure: Hyperextend the
patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oropharynx
or the esophagus. Hyperextending the neck will better direct the catheter to the trachea.
9. A 24-year-old female presents with a history of nasal stuffiness, episodes of
daytime dyspnea, and a cough that occurs every summer. Which of the following drug
classifications should a respiratory therapist recommend to control the patient's
symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
, d. Anticholinergic: Leukotriene inhibitor
Explain: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene
inhibitor, such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis
10. A patient with pulmonary edema receives furosemide (Lasix), dopamine
(Intropin), and 02. Flattened T-waves and occasional PVC's are observed on the monitor.
Which of the following should a respiratory therapist initially recommend to evaluate the
effect of these medications?
1. End-tidal C02
2. Pulse oximetry
3. Echocardiogram
4. Electrolytes
Choose the best answer
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only: 2 and 4 only
Explain:
1. False. End-tidal CO2 would not be related to diuresis, electrolyte imbalance, or
hypoxemia.
2.True. Myocardial hypoxia may contribute to cardiac arrythmia.
3. False. An echocardiogram may document the heart failure but does not relate to the
consequences of diuresis.
4. True. Electrolytes will help evaluate any changes associated with renal potassium loss
from the use of furosemide (Lasix).
11. When instructing a patient on the administration of umeclidinium/vi- lanterol
(Anoro Ellipta), Which of the following is most important to empha- size?
a. Gargle immediately after use
b. Inhale slowly with a breath hold
c. Breathe in fast and deep
d. Shake medication vigorously before use: Breathe in fast and deep
rationales/already graded answers/latest
1. An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After
the patient is placed on the system, the respiratory therapist notices that the pressure
falls to 2 cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system: Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. In- creasing the flow
should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
2. A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing.
Severe suprasternal, subcostal and substernal retraction are ob- served. The child has a
harsh, barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma: Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral illness.
The barky cough is a classic finding for patients experiencing croup.
3. The polysomnography sleep laboratory is full scheduled for several weeks. The
physician wants to know if there is another option to determine if a patient has sleep
apnea. What should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison: Overnight pulse
oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected obstructive sleep
apnea. The patient's oxygen saturation is found to decrease during apnea episodes.
,4. A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-
old female who was admitted 12 hours ago for an aspirin overdose. The following
information is obtained as the patient breathes air:
HR
89/min
RR
15/min
BP 110/70 mm Hg Sp02
86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site: Validate the Sp02 reading at a
different site
Explain: The saturation may not be accurate and should be measured at a different site.
5. A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration
of CPAP. The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A
respiratory therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP: Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypop- nea
episodes, standard protocol is to incrementally increase the CPAP level until this occurs.
6. An arterial puncture has been performed to obtain blood for analysis of 02, C02,
and pH. What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood: Place it into a mix of ice and water
,Explain: Placing the blood sample into ice water will prevent the blood from consum- ing the O2
within the sample.
7. A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle
crash. The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving
volume-controlled ventilation. Twenty-four hours later, the pa- tient has clear breath
sounds but cannot tolerate weaning the mandatory rate below 8 in the SIMV mode with 15
cm H20 pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube: Reintubating with a larger
endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of increased
airways resistance. This can be resolved only by a larger tube or extubation.
8. During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough.
Watery secretions are aspirated through the catheter. Which of the following should the
respiratory therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
d. Increase the suction pressure and repeat the procedure: Hyperextend the
patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oropharynx
or the esophagus. Hyperextending the neck will better direct the catheter to the trachea.
9. A 24-year-old female presents with a history of nasal stuffiness, episodes of
daytime dyspnea, and a cough that occurs every summer. Which of the following drug
classifications should a respiratory therapist recommend to control the patient's
symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
, d. Anticholinergic: Leukotriene inhibitor
Explain: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene
inhibitor, such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis
10. A patient with pulmonary edema receives furosemide (Lasix), dopamine
(Intropin), and 02. Flattened T-waves and occasional PVC's are observed on the monitor.
Which of the following should a respiratory therapist initially recommend to evaluate the
effect of these medications?
1. End-tidal C02
2. Pulse oximetry
3. Echocardiogram
4. Electrolytes
Choose the best answer
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only: 2 and 4 only
Explain:
1. False. End-tidal CO2 would not be related to diuresis, electrolyte imbalance, or
hypoxemia.
2.True. Myocardial hypoxia may contribute to cardiac arrythmia.
3. False. An echocardiogram may document the heart failure but does not relate to the
consequences of diuresis.
4. True. Electrolytes will help evaluate any changes associated with renal potassium loss
from the use of furosemide (Lasix).
11. When instructing a patient on the administration of umeclidinium/vi- lanterol
(Anoro Ellipta), Which of the following is most important to empha- size?
a. Gargle immediately after use
b. Inhale slowly with a breath hold
c. Breathe in fast and deep
d. Shake medication vigorously before use: Breathe in fast and deep
