CRT/RRT (NBRC) 2024 COMPLETE QUESTIONS AND
VERIFIED ANSWERS|ACTUAL EXAM| ACCURATE
SOLUTIONS WITH RATIONALES/ALREADY GRADED
A+
Ascites - ✔✔ANSWER✔✔>>accumulation of fluid in the abdomen caused by LIVER
FAILURE
IPPB Indications - ✔✔ANSWER✔✔>>-Prevent or correct atelectasis in patients unable
to take a deep breath
-prevent/decrease pulmonary edema
-decrease WOB
-mechanical bronchodilation
-distribute aerosols more evenly
-Hazards include: hyperventilation (breathe slower), Impeding venous return,
pneumothorax
-contraindications: pulmonary hemorrhage, untreated pneumothorax
Bird Mark 7 - ✔✔ANSWER✔✔>>-Pressure Cycled
-increase flow = decrease i-time
-Air mix off = 100% source gas, low flow rate because air not entrained, increase flow
setting when air mix off
-pressure limit controls volume
-
Bird Mark 7 changes that affect FiO2 - ✔✔ANSWER✔✔>>-increase pressure will
increase FiO2
-decrease flow will increase FiO2
-Air mix off will give 100% FiO2
-use of nebulize will increase FiO2 on PR-II
-Use of terminal flow on PR-2 will decrease FiO2
Bird Mark 7 control changes that affect volume - ✔✔ANSWER✔✔>>-increasing
pressure will increase volume
-decreasing flow will increase volume
-increasing the flow will decrease volume
,Bird Mark 7 control changes that affect the I:E ratio - ✔✔ANSWER✔✔>>-increased
pressure will increase i-time and change I:E
-increased flow will decrease i-time
-increased rate will decrease e-time
IPPB Troubleshooting - ✔✔ANSWER✔✔>>-Loss of pressure = leak, low flow
-Excessive pressure = obstruction, excessive flow
-fail to cycle into inspiration = sensitivity, seal around mouthpiece
-fail to cycle into expiration = leak (mouthpiece, cuff, trach tube, loose connection)
-Pressure does not rise normally (needle reads low or negative) = insufficient flow
Mask CPAP - ✔✔ANSWER✔✔>>-short term, temporary use
-CO poisoning
-pneumonia
-post-op atelectasis, etc.
Nasal CPAP - ✔✔ANSWER✔✔>>-neonates since they are obligate nose breathers
-readjust nasal prongs if losing CPAP
Troubleshooting CPAP - ✔✔ANSWER✔✔>>-loss of pressure = leak, insufficient flow
-increased pressure = obstruction, excessive flow
Non-Invasive PPV (NPPV) - ✔✔ANSWER✔✔>>-avoid intubation in patients with
COPD, CHF, and pulmonary edema
-long term ventilation at home
-periodic support with NMD, restrictive chest wall, sleep apneas
General Considerations of NPPV - ✔✔ANSWER✔✔>>-patient with uncomplicated
obstructive sleep apnea started @ EPAP of 5-10 cmH2O
-patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary
-patients with NMD @ 10-15 cmH2O
-low level of EPAP (5cmH2O) prevents small airway collapse on exhalation
-oxygen must be titrated into the system to achieve desired FiO2
-IPAP always greater than EPAP
-I:E of 1:2 preferred
Capillary Samples - ✔✔ANSWER✔✔>>-should not be used to monitor oxygen therapy
-PO2 values DO NOT correlate very well with arterial blood, especially when arterial
PO2 is >60 torr
Air Bubbles in ABG sample - ✔✔ANSWER✔✔>>-PaCO2 decreases toward 0 torr
-PaO2 increases to 150 torr
-pH increases
Improper cooling of ABG sample - ✔✔ANSWER✔✔>>-PaCO2 increases
,-PaO2 decreases
-pH decreases
Too much heparin in ABG sample - ✔✔ANSWER✔✔>>-pH decreases towards 7.0
-PaCO2 decreases toward 0
-PaO2 increases towards room air
Severinghaus Electrode - ✔✔ANSWER✔✔>>Measures PCO2
Clark Electrode - ✔✔ANSWER✔✔>>Measures PO2
Sanz Electrode - ✔✔ANSWER✔✔>>Measures pH
Levey Jennings Charts - ✔✔ANSWER✔✔>>-detecting a machine that is out of control
-±2 Standard Deviations
-If random error = do nothing
A-a Gradient interpretations - ✔✔ANSWER✔✔>>-25-65 mmHg on 100% = Normal
-66-300 mmHg = V/Q Mismatch
->300 mmHg = shunting
each 100 mmHg = 5% shunt + 5% normal shunt
C(a-v)O2 interpretations - ✔✔ANSWER✔✔>>-CvO2 values will decrease when cardiac
output decreases
-SvO2 values also decrease when cardiac output decreases
-C(a-v)O2 difference will increase when the CvO2 is decreasing and would indicate a
decreasing cardiac output
PaO2/FiO2 ratio interpretations - ✔✔ANSWER✔✔>>->380 torr = normal
-<300 torr = ALI
-<200 torr = ARDS
OHDC curve LEFT - ✔✔ANSWER✔✔>>-increased oxygen affinity
-increase pH
-decrease CO2
-decrease Temp
-decrease 2-3 DPG
OHDC curve RIGHT - ✔✔ANSWER✔✔>>-decreased oxygen affinity
-decrease pH
-increase CO2
-increase Temp
-increase 2-3 DPG
, Spirometers - ✔✔ANSWER✔✔>>-Measures Volumes and flow rates
Dry-rolling seal - ✔✔ANSWER✔✔>>-horizontal piston spirometer
-measures volume and time
Water-seal - ✔✔ANSWER✔✔>>-Collins, Stead-Wells spirometer
-measures colume and time
-most accurate and best to check accuracy of PFT equipment
Pneumotachometers - ✔✔ANSWER✔✔>>-measures flow
-turbine device (Wright respirometer
-measures flow and may display volume
-Pressure Differential (Fleisch) measures flow
-can continuously measure VE
Plethysmograph - ✔✔ANSWER✔✔>>-Body Box
-Measures thoracic gas volume (TGV) which is the same as FRC and also Raw
-accurately measure FRC with COPD
3L syringe - ✔✔ANSWER✔✔>>-accuracy must be ±3.5%
-2.9 - 3.1
-Calibrate with flows between 2 and 12 L/sec
Galvani fuel cell - ✔✔ANSWER✔✔>>-creates electron flow as a result of the
oxidation/reduction of O2 (current)
-change fuel cell
-can be affected by water on sensor, high pressures, and altitude
-must be 2% of known value
Polarographic - ✔✔ANSWER✔✔>>-similar to galvanic except for the presence of a
battery used to polarize the electrodes
-change batter and check electrolyte level
-can be affected by water on sensor, high pressures, and altitude
-must be 2% of known value
SVC - ✔✔ANSWER✔✔>>-Slow Vital Capacity
-provides the important VOLUMES used to identify RESTRICTIVE DISEASES
Restrictive Disease - ✔✔ANSWER✔✔>>Decreased Volumes
Obstructive Disease - ✔✔ANSWER✔✔>>-Decreased Flows
-FEV1
-FEF 200-1200
-FEF 25-75
VERIFIED ANSWERS|ACTUAL EXAM| ACCURATE
SOLUTIONS WITH RATIONALES/ALREADY GRADED
A+
Ascites - ✔✔ANSWER✔✔>>accumulation of fluid in the abdomen caused by LIVER
FAILURE
IPPB Indications - ✔✔ANSWER✔✔>>-Prevent or correct atelectasis in patients unable
to take a deep breath
-prevent/decrease pulmonary edema
-decrease WOB
-mechanical bronchodilation
-distribute aerosols more evenly
-Hazards include: hyperventilation (breathe slower), Impeding venous return,
pneumothorax
-contraindications: pulmonary hemorrhage, untreated pneumothorax
Bird Mark 7 - ✔✔ANSWER✔✔>>-Pressure Cycled
-increase flow = decrease i-time
-Air mix off = 100% source gas, low flow rate because air not entrained, increase flow
setting when air mix off
-pressure limit controls volume
-
Bird Mark 7 changes that affect FiO2 - ✔✔ANSWER✔✔>>-increase pressure will
increase FiO2
-decrease flow will increase FiO2
-Air mix off will give 100% FiO2
-use of nebulize will increase FiO2 on PR-II
-Use of terminal flow on PR-2 will decrease FiO2
Bird Mark 7 control changes that affect volume - ✔✔ANSWER✔✔>>-increasing
pressure will increase volume
-decreasing flow will increase volume
-increasing the flow will decrease volume
,Bird Mark 7 control changes that affect the I:E ratio - ✔✔ANSWER✔✔>>-increased
pressure will increase i-time and change I:E
-increased flow will decrease i-time
-increased rate will decrease e-time
IPPB Troubleshooting - ✔✔ANSWER✔✔>>-Loss of pressure = leak, low flow
-Excessive pressure = obstruction, excessive flow
-fail to cycle into inspiration = sensitivity, seal around mouthpiece
-fail to cycle into expiration = leak (mouthpiece, cuff, trach tube, loose connection)
-Pressure does not rise normally (needle reads low or negative) = insufficient flow
Mask CPAP - ✔✔ANSWER✔✔>>-short term, temporary use
-CO poisoning
-pneumonia
-post-op atelectasis, etc.
Nasal CPAP - ✔✔ANSWER✔✔>>-neonates since they are obligate nose breathers
-readjust nasal prongs if losing CPAP
Troubleshooting CPAP - ✔✔ANSWER✔✔>>-loss of pressure = leak, insufficient flow
-increased pressure = obstruction, excessive flow
Non-Invasive PPV (NPPV) - ✔✔ANSWER✔✔>>-avoid intubation in patients with
COPD, CHF, and pulmonary edema
-long term ventilation at home
-periodic support with NMD, restrictive chest wall, sleep apneas
General Considerations of NPPV - ✔✔ANSWER✔✔>>-patient with uncomplicated
obstructive sleep apnea started @ EPAP of 5-10 cmH2O
-patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary
-patients with NMD @ 10-15 cmH2O
-low level of EPAP (5cmH2O) prevents small airway collapse on exhalation
-oxygen must be titrated into the system to achieve desired FiO2
-IPAP always greater than EPAP
-I:E of 1:2 preferred
Capillary Samples - ✔✔ANSWER✔✔>>-should not be used to monitor oxygen therapy
-PO2 values DO NOT correlate very well with arterial blood, especially when arterial
PO2 is >60 torr
Air Bubbles in ABG sample - ✔✔ANSWER✔✔>>-PaCO2 decreases toward 0 torr
-PaO2 increases to 150 torr
-pH increases
Improper cooling of ABG sample - ✔✔ANSWER✔✔>>-PaCO2 increases
,-PaO2 decreases
-pH decreases
Too much heparin in ABG sample - ✔✔ANSWER✔✔>>-pH decreases towards 7.0
-PaCO2 decreases toward 0
-PaO2 increases towards room air
Severinghaus Electrode - ✔✔ANSWER✔✔>>Measures PCO2
Clark Electrode - ✔✔ANSWER✔✔>>Measures PO2
Sanz Electrode - ✔✔ANSWER✔✔>>Measures pH
Levey Jennings Charts - ✔✔ANSWER✔✔>>-detecting a machine that is out of control
-±2 Standard Deviations
-If random error = do nothing
A-a Gradient interpretations - ✔✔ANSWER✔✔>>-25-65 mmHg on 100% = Normal
-66-300 mmHg = V/Q Mismatch
->300 mmHg = shunting
each 100 mmHg = 5% shunt + 5% normal shunt
C(a-v)O2 interpretations - ✔✔ANSWER✔✔>>-CvO2 values will decrease when cardiac
output decreases
-SvO2 values also decrease when cardiac output decreases
-C(a-v)O2 difference will increase when the CvO2 is decreasing and would indicate a
decreasing cardiac output
PaO2/FiO2 ratio interpretations - ✔✔ANSWER✔✔>>->380 torr = normal
-<300 torr = ALI
-<200 torr = ARDS
OHDC curve LEFT - ✔✔ANSWER✔✔>>-increased oxygen affinity
-increase pH
-decrease CO2
-decrease Temp
-decrease 2-3 DPG
OHDC curve RIGHT - ✔✔ANSWER✔✔>>-decreased oxygen affinity
-decrease pH
-increase CO2
-increase Temp
-increase 2-3 DPG
, Spirometers - ✔✔ANSWER✔✔>>-Measures Volumes and flow rates
Dry-rolling seal - ✔✔ANSWER✔✔>>-horizontal piston spirometer
-measures volume and time
Water-seal - ✔✔ANSWER✔✔>>-Collins, Stead-Wells spirometer
-measures colume and time
-most accurate and best to check accuracy of PFT equipment
Pneumotachometers - ✔✔ANSWER✔✔>>-measures flow
-turbine device (Wright respirometer
-measures flow and may display volume
-Pressure Differential (Fleisch) measures flow
-can continuously measure VE
Plethysmograph - ✔✔ANSWER✔✔>>-Body Box
-Measures thoracic gas volume (TGV) which is the same as FRC and also Raw
-accurately measure FRC with COPD
3L syringe - ✔✔ANSWER✔✔>>-accuracy must be ±3.5%
-2.9 - 3.1
-Calibrate with flows between 2 and 12 L/sec
Galvani fuel cell - ✔✔ANSWER✔✔>>-creates electron flow as a result of the
oxidation/reduction of O2 (current)
-change fuel cell
-can be affected by water on sensor, high pressures, and altitude
-must be 2% of known value
Polarographic - ✔✔ANSWER✔✔>>-similar to galvanic except for the presence of a
battery used to polarize the electrodes
-change batter and check electrolyte level
-can be affected by water on sensor, high pressures, and altitude
-must be 2% of known value
SVC - ✔✔ANSWER✔✔>>-Slow Vital Capacity
-provides the important VOLUMES used to identify RESTRICTIVE DISEASES
Restrictive Disease - ✔✔ANSWER✔✔>>Decreased Volumes
Obstructive Disease - ✔✔ANSWER✔✔>>-Decreased Flows
-FEV1
-FEF 200-1200
-FEF 25-75
