Page 1 of 222
NBRC TMC EXAM PRACTICE QUESTIONS
WITH VERIFIED SOLUTIONS NEWLY
MODIFIED EXAM QUESTIONS TESTED AND
APPROVED
An adult patient with asthma is receiving Albuterol by small volume nebulizer Q.I.D. at a
dosage of 0.5 mL. The patient complains of dizziness, tingling in his fingers, and anxiety
with each treatment. The therapist should
A. increase dosage to 1.0 mL
B. decrease dosage to 0.15 mL
C. switch to Xopenex 0.63 mg
D. switch to Mucomyst 20% -- ANSWER--C.
When a patient experiences an adverse reaction, the first step is to stop the therapy and then
modify the therapy to accomplish the same objective. In this case, decreasing the dose of
Xopenex is suitable because 0.63 mg is still in the adult therapeutic range.
Which of the following conditions would benefit most from a thoracentesis?
A. atelectasis
B. complete opacification of the right lung
C. small pneumothorax
D. pericardial contusion -- ANSWER--C.
A thoracentesis is a procedure that removes air or fluid from the pleural space. This would be
appropriate with a small pneumothorax. A large pneumothorax, however, would require chest
tubes.
, Page 2 of 222
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 -- ANSWER--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 -- ANSWER--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.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
, Page 3 of 222
B. exogenous surfactant
C. Tobramycin and albuterol
D. cromolyn sodium -- ANSWER--B.
A patient with adult respiratory distress syndrome could benefit from surfactant therapy to
decrease the surface tension of the alveoli.
The respiratory therapist should look to which of the following clinical data to determine the
effectiveness of incentive spirometry?
A. Arterial blood gas analysis pre and post treatment
B. Breath sounds before and after every treatment
C. Inspiratory capacity predicted volume
D. Maximum voluntary ventilation done periodically -- ANSWER--B.
The effectiveness of incentive spirometry can best be determined by auscultating breath
sounds before and after the treatment and noting changes in air movement. While achieving
inspiratory capacity is the goal, the real goal is to increase lung volume, improve alveolar
recruitment, and prevent consolidation of sputum in the lungs.
increased labor of breathing. The mandatory rate is 14/min. Which of the following would
most likely help the patient?
A. Use of pressure support
B. Switch to pressure control ventilation
C. Increase the machine flow rate
D. Increase PEEP -- ANSWER--A.
During ventilator weaning, a patient must maintain a moderately low respiratory rate, an
adequate sized tidal volume, and low work of breathing. In this case, the patient is
experiencing increased labor of breathing and an increase in respiratory rate. This is likely
due to a reduced spontaneous tidal volume. Although this data is not shown, this condition
, Page 4 of 222
can be assumed. The solution for a low spontaneous tidal volume and increased work of
breathing during weaning is to provide pressure support.
When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a
blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the
patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem,
the therapist should
A. adjust blender setting to 60%
B. increase total flow to the oxyhood
C. obtain a smaller oxyhood
D. change the nebulizer entrainment port to 100% -- ANSWER--D.
When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen
control on the nebulizer should be set to 100%. This will prevent additional entrainment of
room air which will cause a decrease in FIO2.
Following the insertion of a tracheostomy tube, the patient is found to have diffuse crackles
upon auscultation secondary to subcutaneous emphysema. Which of the following
radiographic findings would be expected with this condition?
A. Hyperlucency in the soft tissues
B. Diffuse pulmonary hyperlucency
C. Tracheal shift from midline
D. Scattered patchy infiltrates -- ANSWER--A.
Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air
located in the soft tissue, as seen with subcutaneous emphysema would result in a
hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not shift the
trachea from midline. Scattered patchy infiltrates are associated with ARDS, not
subcutaneous emphysema.
NBRC TMC EXAM PRACTICE QUESTIONS
WITH VERIFIED SOLUTIONS NEWLY
MODIFIED EXAM QUESTIONS TESTED AND
APPROVED
An adult patient with asthma is receiving Albuterol by small volume nebulizer Q.I.D. at a
dosage of 0.5 mL. The patient complains of dizziness, tingling in his fingers, and anxiety
with each treatment. The therapist should
A. increase dosage to 1.0 mL
B. decrease dosage to 0.15 mL
C. switch to Xopenex 0.63 mg
D. switch to Mucomyst 20% -- ANSWER--C.
When a patient experiences an adverse reaction, the first step is to stop the therapy and then
modify the therapy to accomplish the same objective. In this case, decreasing the dose of
Xopenex is suitable because 0.63 mg is still in the adult therapeutic range.
Which of the following conditions would benefit most from a thoracentesis?
A. atelectasis
B. complete opacification of the right lung
C. small pneumothorax
D. pericardial contusion -- ANSWER--C.
A thoracentesis is a procedure that removes air or fluid from the pleural space. This would be
appropriate with a small pneumothorax. A large pneumothorax, however, would require chest
tubes.
, Page 2 of 222
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 -- ANSWER--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 -- ANSWER--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.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
, Page 3 of 222
B. exogenous surfactant
C. Tobramycin and albuterol
D. cromolyn sodium -- ANSWER--B.
A patient with adult respiratory distress syndrome could benefit from surfactant therapy to
decrease the surface tension of the alveoli.
The respiratory therapist should look to which of the following clinical data to determine the
effectiveness of incentive spirometry?
A. Arterial blood gas analysis pre and post treatment
B. Breath sounds before and after every treatment
C. Inspiratory capacity predicted volume
D. Maximum voluntary ventilation done periodically -- ANSWER--B.
The effectiveness of incentive spirometry can best be determined by auscultating breath
sounds before and after the treatment and noting changes in air movement. While achieving
inspiratory capacity is the goal, the real goal is to increase lung volume, improve alveolar
recruitment, and prevent consolidation of sputum in the lungs.
increased labor of breathing. The mandatory rate is 14/min. Which of the following would
most likely help the patient?
A. Use of pressure support
B. Switch to pressure control ventilation
C. Increase the machine flow rate
D. Increase PEEP -- ANSWER--A.
During ventilator weaning, a patient must maintain a moderately low respiratory rate, an
adequate sized tidal volume, and low work of breathing. In this case, the patient is
experiencing increased labor of breathing and an increase in respiratory rate. This is likely
due to a reduced spontaneous tidal volume. Although this data is not shown, this condition
, Page 4 of 222
can be assumed. The solution for a low spontaneous tidal volume and increased work of
breathing during weaning is to provide pressure support.
When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a
blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the
patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem,
the therapist should
A. adjust blender setting to 60%
B. increase total flow to the oxyhood
C. obtain a smaller oxyhood
D. change the nebulizer entrainment port to 100% -- ANSWER--D.
When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen
control on the nebulizer should be set to 100%. This will prevent additional entrainment of
room air which will cause a decrease in FIO2.
Following the insertion of a tracheostomy tube, the patient is found to have diffuse crackles
upon auscultation secondary to subcutaneous emphysema. Which of the following
radiographic findings would be expected with this condition?
A. Hyperlucency in the soft tissues
B. Diffuse pulmonary hyperlucency
C. Tracheal shift from midline
D. Scattered patchy infiltrates -- ANSWER--A.
Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air
located in the soft tissue, as seen with subcutaneous emphysema would result in a
hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not shift the
trachea from midline. Scattered patchy infiltrates are associated with ARDS, not
subcutaneous emphysema.
