NBRC TMC/CRT/RRT EXAM LATEST QUESTIONS AND
CORRECT ANSWERS |AGRADE
The respiratory therapist notes in the medical record of a 65-year-old male that the
patient is ordered to receive bronchodilator therapy with Albuterol. The therapist also
notes the patient is receiving beta-blocker medication. The therapist should recommend
A. Administer Dexamethasone (Decadron) in place of Albuterol
B. Add Xopenex to the bronchodilator regimen
C. Replace Albuterol with Beclamethasone (Beclovent)
D. Switch from Albuterol to ipratropium bromide (Atrovent) - D.
Because albuterol is a beta-agonist medication, patients who are taking beta-blockers
should utilize other bronchodilation medication.
A hospital has an extremely low incidence of ventilator-associated pneumonia. To which
of the following reasons may this be attributed?
A. periodic discontinuation of sedation
B. use of respiratory precautions with the population
C. diversion of infectious patients to other facilities
D. broad use of prophylactic antibiotics - A.
The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed
system suction catheter, periodically discontinuing sedation, keeping the patient and
semi-Fowler's position, and proper handwashing among caregivers. All are correct.
A pressure-volume loop ventilator graphic shows no rise in pressure for the first 200 mL
of delivered volume. The therapist should
A. increase inspiratory flow rate
B. increase PEEP
C. decrease tidal volume
D. decrease inspiratory flow rate - B.
In this question the description of the pressure volume loop would indicate a flat bottom
as manifested by no rise in pressure with the first 200 mL of delivered volume. We call
this a "flat football". The solution is to increase PEEP to a level that the pressure begins
to rise immediately as volume is introduced.
Which of the following would be the most effective, appropriate method for resolving
atelectasis in a spontaneously breathing, post operative patient who is under the
influence of sedation and will not respond to verbal stimuli?
A. IPPB
B. sustained maximal inhalation (incentive spirometer)
C. deep breathing coaching
D. intubation and mechanical ventilation - A.
A postoperative patient under sedation, and possibly in pain, may be tempted to breathe
less, causing respiratory acidosis and atelectasis. To correct this problem, IPPB therapy
,is most appropriate. Incentive spirometry would also help but the patient is unable to
respond to verbal stimuli. This alone is an indication for IPPB therapy.
After performing minimum occluding volume technique with a 65-kg (143-lb) patient who
is orally intubated with a 7.0-mm ET tube, the respiratory therapist should NEXT
A. check ET tube cuff pressure
B. perform tracheal palpation
C. order a chest radiograph
D. document ET tube markings at the lips - A.
The ET tube cuff pressure may be adjusted correctly by several techniques including
minimum leak technique (also called minimum occluding volume, minimal seal
technique, and the use of a pressure manometer called a cuffalator. If minimum seal or
minimal leak technique is used, the respiratory therapist is still required to monitor the
pressure after the technique is performed. Although this is often not done in real life, it is
technically part of the procedure.
The respiratory therapist observes an ECG wave form on a patient that is consistent
with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea.
The respiratory therapist should recommend
A. unsynchronized defibrillation
B. Atropine sulfate
C. epinephrine
D. cardioversion - D.
Non-deadly arrhythmias, such as this one, may be addressed through cardioversion.
Cardioversion is a form of defibrillation with low wattage and with the synchronization
set to "active". This allows the shock to be synchronized to the R wave.
A 38-year-old male presents in the emergency department (ED) complaining of frequent
vomiting. The following laboratory data is available: Arterial blood gases
pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0
mEq/LCl- 95 mEq/LNa+ 135 mEq/L
Which of the following should the respiratory therapist recommend?
A. administer NaCL
B. administer NaHCO3-
C. administer KCL
D. administer volume-expanding fluids - C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However,
the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the
alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to
administer potassium chloride or KCl.
Which of the following is needed to calculate alveolar oxygen tension?
A. VD/VT, PAO2
B. BP and FiO2
C. PetCO2 and PaO2
D. QS/QT, deadspace - B.
,Barometric pressure, FiO2, and PaO2 are all included in the formula (BP stands for
barometric pressure)
L/min/m2 is the unit of measure for:
A. Systemic vascular resistance
B. Cardiac output
C. Cardiac index
D. Stroke volume - C.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.38 PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 mEq/L
Which of the following supplemental oxygen levels is most appropriate?
A. 2 L/min nasal cannula
B. 5 L/min nasal cannula
C. non-rebreathing mask
D. Venturi mask at 30% - B.
A patient who is showing signs of hypoxemia should receive supplemental oxygen. If
the patient is not a COPD patient and the situation is not an emergency, then the proper
supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options
available only 5 L/min nasal cannula will approach this. Other options are either
insufficient or too much.
Left heart failure would be manifested in which of the following values?
A. CVP and mPAP
B. mPAP and wedge pressure
C. MAP and SVR
D. cardiac output and wedge pressure - D.
The function of the left heart, specifically the left ventricle, is best assessed
hemodynamically by looking at those values that precede and come after the left heart.
In this case pulmonary capillary wedge pressure and cardiac output (or cardiac index)
are the values found before and after the left heart.
Which of the following findings is most closely associated with increased airway
resistance?
A. reduced SpO2
B. accessory muscle use
C. altered P50
D. increased PetCO2 - B.
Of the options given, use of accessory muscles is most closely associated with an
increase in airway resistance. This is especially true with patients who have asthma or
other types of upper airway inflammation or bronchoconstriction.
For a patient receiving volume-controlled mechanical ventilation, the lower inflection
point on a pressure-volume loop can best be described as:
A. amount of pressure required to keep the alveoli and small airways open
B. optimal PEEP
, C. minimal PEEP
D. upper limit of residual volume - A.
The lowest inflection point on a pressure-volume ventilator graphic is an indication of
the minimum pressure needed to keep alveoli open.
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest
radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most
likely has
A. fluid overload
B. ARDS
C. a pulmonary embolism
D. pneumonia - C.
A VQ scan that shows poor perfusion but adequate ventilation is most closely
associated with a pulmonary embolism. Supportive data is found in the radiological
report of wedge-shaped infiltrates.
A patient is receiving volume-controlled ventilation following bariatric surgery for obesity.
Which of the following medications should the respiratory therapist recommend to
ensure the patient's comfort and assist in ventilator management?
A. Pronestyl
B. morphine sulfate
C. vecuronium bromide (Norcuron)
D. Mestinon - B.
Morphine sulfate is one of the best medications to administer to patients receiving
mechanical ventilatory support to help the patient rest pain-free and to generally sedate
and relax the patient.
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - C.
CORRECT ANSWERS |AGRADE
The respiratory therapist notes in the medical record of a 65-year-old male that the
patient is ordered to receive bronchodilator therapy with Albuterol. The therapist also
notes the patient is receiving beta-blocker medication. The therapist should recommend
A. Administer Dexamethasone (Decadron) in place of Albuterol
B. Add Xopenex to the bronchodilator regimen
C. Replace Albuterol with Beclamethasone (Beclovent)
D. Switch from Albuterol to ipratropium bromide (Atrovent) - D.
Because albuterol is a beta-agonist medication, patients who are taking beta-blockers
should utilize other bronchodilation medication.
A hospital has an extremely low incidence of ventilator-associated pneumonia. To which
of the following reasons may this be attributed?
A. periodic discontinuation of sedation
B. use of respiratory precautions with the population
C. diversion of infectious patients to other facilities
D. broad use of prophylactic antibiotics - A.
The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed
system suction catheter, periodically discontinuing sedation, keeping the patient and
semi-Fowler's position, and proper handwashing among caregivers. All are correct.
A pressure-volume loop ventilator graphic shows no rise in pressure for the first 200 mL
of delivered volume. The therapist should
A. increase inspiratory flow rate
B. increase PEEP
C. decrease tidal volume
D. decrease inspiratory flow rate - B.
In this question the description of the pressure volume loop would indicate a flat bottom
as manifested by no rise in pressure with the first 200 mL of delivered volume. We call
this a "flat football". The solution is to increase PEEP to a level that the pressure begins
to rise immediately as volume is introduced.
Which of the following would be the most effective, appropriate method for resolving
atelectasis in a spontaneously breathing, post operative patient who is under the
influence of sedation and will not respond to verbal stimuli?
A. IPPB
B. sustained maximal inhalation (incentive spirometer)
C. deep breathing coaching
D. intubation and mechanical ventilation - A.
A postoperative patient under sedation, and possibly in pain, may be tempted to breathe
less, causing respiratory acidosis and atelectasis. To correct this problem, IPPB therapy
,is most appropriate. Incentive spirometry would also help but the patient is unable to
respond to verbal stimuli. This alone is an indication for IPPB therapy.
After performing minimum occluding volume technique with a 65-kg (143-lb) patient who
is orally intubated with a 7.0-mm ET tube, the respiratory therapist should NEXT
A. check ET tube cuff pressure
B. perform tracheal palpation
C. order a chest radiograph
D. document ET tube markings at the lips - A.
The ET tube cuff pressure may be adjusted correctly by several techniques including
minimum leak technique (also called minimum occluding volume, minimal seal
technique, and the use of a pressure manometer called a cuffalator. If minimum seal or
minimal leak technique is used, the respiratory therapist is still required to monitor the
pressure after the technique is performed. Although this is often not done in real life, it is
technically part of the procedure.
The respiratory therapist observes an ECG wave form on a patient that is consistent
with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea.
The respiratory therapist should recommend
A. unsynchronized defibrillation
B. Atropine sulfate
C. epinephrine
D. cardioversion - D.
Non-deadly arrhythmias, such as this one, may be addressed through cardioversion.
Cardioversion is a form of defibrillation with low wattage and with the synchronization
set to "active". This allows the shock to be synchronized to the R wave.
A 38-year-old male presents in the emergency department (ED) complaining of frequent
vomiting. The following laboratory data is available: Arterial blood gases
pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0
mEq/LCl- 95 mEq/LNa+ 135 mEq/L
Which of the following should the respiratory therapist recommend?
A. administer NaCL
B. administer NaHCO3-
C. administer KCL
D. administer volume-expanding fluids - C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However,
the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the
alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to
administer potassium chloride or KCl.
Which of the following is needed to calculate alveolar oxygen tension?
A. VD/VT, PAO2
B. BP and FiO2
C. PetCO2 and PaO2
D. QS/QT, deadspace - B.
,Barometric pressure, FiO2, and PaO2 are all included in the formula (BP stands for
barometric pressure)
L/min/m2 is the unit of measure for:
A. Systemic vascular resistance
B. Cardiac output
C. Cardiac index
D. Stroke volume - C.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.38 PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 mEq/L
Which of the following supplemental oxygen levels is most appropriate?
A. 2 L/min nasal cannula
B. 5 L/min nasal cannula
C. non-rebreathing mask
D. Venturi mask at 30% - B.
A patient who is showing signs of hypoxemia should receive supplemental oxygen. If
the patient is not a COPD patient and the situation is not an emergency, then the proper
supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options
available only 5 L/min nasal cannula will approach this. Other options are either
insufficient or too much.
Left heart failure would be manifested in which of the following values?
A. CVP and mPAP
B. mPAP and wedge pressure
C. MAP and SVR
D. cardiac output and wedge pressure - D.
The function of the left heart, specifically the left ventricle, is best assessed
hemodynamically by looking at those values that precede and come after the left heart.
In this case pulmonary capillary wedge pressure and cardiac output (or cardiac index)
are the values found before and after the left heart.
Which of the following findings is most closely associated with increased airway
resistance?
A. reduced SpO2
B. accessory muscle use
C. altered P50
D. increased PetCO2 - B.
Of the options given, use of accessory muscles is most closely associated with an
increase in airway resistance. This is especially true with patients who have asthma or
other types of upper airway inflammation or bronchoconstriction.
For a patient receiving volume-controlled mechanical ventilation, the lower inflection
point on a pressure-volume loop can best be described as:
A. amount of pressure required to keep the alveoli and small airways open
B. optimal PEEP
, C. minimal PEEP
D. upper limit of residual volume - A.
The lowest inflection point on a pressure-volume ventilator graphic is an indication of
the minimum pressure needed to keep alveoli open.
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest
radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most
likely has
A. fluid overload
B. ARDS
C. a pulmonary embolism
D. pneumonia - C.
A VQ scan that shows poor perfusion but adequate ventilation is most closely
associated with a pulmonary embolism. Supportive data is found in the radiological
report of wedge-shaped infiltrates.
A patient is receiving volume-controlled ventilation following bariatric surgery for obesity.
Which of the following medications should the respiratory therapist recommend to
ensure the patient's comfort and assist in ventilator management?
A. Pronestyl
B. morphine sulfate
C. vecuronium bromide (Norcuron)
D. Mestinon - B.
Morphine sulfate is one of the best medications to administer to patients receiving
mechanical ventilatory support to help the patient rest pain-free and to generally sedate
and relax the patient.
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - C.
