COMPREHENSIVE NBRC TMC/CRT/RRT
EXAMINATION PREP QUESTIONS AND
ANSWERS
1. A 58-year-old male with a history of CHF presents with a pH of 7.48, PaCO2 of 32 mmHg,
PaO2 of 58 mmHg, and HCO3 of 24 mEq/L on room air. Which of the following is the most
likely cause of these results?
A. Acute respiratory acidosis
B. Compensated respiratory alkalosis
C. Chronic metabolic alkalosis
D. Alveolar hyperventilation due to hypoxemia
Answer: D
Conceptual Explanation: The pH is alkaline and PaCO2 is low, indicating respiratory
alkalosis. The low PaO2 (58 mmHg) indicates hypoxemia, which triggers peripheral
chemoreceptors to increase minute ventilation, leading to CO2 washout.
,2. While monitoring a patient in the ICU with a pulmonary artery catheter, you note the
following: CVP 12 mmHg, PAP 45/25 mmHg, PCWP 22 mmHg, and Cardiac Index 1.8
L/min/m2. These findings are most consistent with:
A. Hypovolemic shock
B. Septic shock
C. Pulmonary embolism
D. Left heart failure
Answer: D
Conceptual Explanation: Elevated PCWP (>18 mmHg) and low Cardiac Index (<2.0
L/min/m2) suggest left heart failure or cardiogenic shock. CVP and PAP are also secondary
elevations due to back-pressure from the left heart.
3. A 70-kg (154 lb) male patient is being mechanically ventilated in Volume Control (VC)
mode. The settings are: Vt 500 mL, Rate 12, FiO2 0.50, PEEP 5 cmH2O. The peak inspiratory
pressure (PIP) is 35 cmH2O and the plateau pressure (Pplat) is 20 cmH2O. What is the
patient’s dynamic compliance?
A. 14 mL/cmH2O
B. 33 mL/cmH2O
C. 25 mL/cmH2O
D. 16 mL/cmH2O
, Answer: D
Conceptual Explanation: Dynamic Compliance = Vt / (PIP - PEEP). 500 / (35 - 5) = 500 /
30 = 16.67 mL/cmH2O.
4. A 24-year-old female is admitted to the ER with status asthmaticus. She is receiving 2.5 mg
of Albuterol via SVN every 20 minutes. Her breath sounds indicate very little air movement.
Which of the following should the respiratory therapist recommend next?
A. Decrease the frequency of Albuterol
B. Intubate and initiate mechanical ventilation
C. Initiate Heliox therapy
D. Switch to a Dry Powder Inhaler (DPI)
Answer: C
Conceptual Explanation: Heliox (Helium-Oxygen mixture) reduces gas density and work
of breathing in cases of severe airway obstruction, potentially buying time for
pharmacological treatments to work and avoiding intubation.
5. A patient with ARDS is being ventilated with a PEEP of 15 cmH2O and FiO2 of 0.80. The
therapist notes a sudden drop in SpO2 to 82% and a significant decrease in blood pressure.
The most appropriate immediate action is to:
A. Increase FiO2 to 1.0
B. Perform a recruitment maneuver
EXAMINATION PREP QUESTIONS AND
ANSWERS
1. A 58-year-old male with a history of CHF presents with a pH of 7.48, PaCO2 of 32 mmHg,
PaO2 of 58 mmHg, and HCO3 of 24 mEq/L on room air. Which of the following is the most
likely cause of these results?
A. Acute respiratory acidosis
B. Compensated respiratory alkalosis
C. Chronic metabolic alkalosis
D. Alveolar hyperventilation due to hypoxemia
Answer: D
Conceptual Explanation: The pH is alkaline and PaCO2 is low, indicating respiratory
alkalosis. The low PaO2 (58 mmHg) indicates hypoxemia, which triggers peripheral
chemoreceptors to increase minute ventilation, leading to CO2 washout.
,2. While monitoring a patient in the ICU with a pulmonary artery catheter, you note the
following: CVP 12 mmHg, PAP 45/25 mmHg, PCWP 22 mmHg, and Cardiac Index 1.8
L/min/m2. These findings are most consistent with:
A. Hypovolemic shock
B. Septic shock
C. Pulmonary embolism
D. Left heart failure
Answer: D
Conceptual Explanation: Elevated PCWP (>18 mmHg) and low Cardiac Index (<2.0
L/min/m2) suggest left heart failure or cardiogenic shock. CVP and PAP are also secondary
elevations due to back-pressure from the left heart.
3. A 70-kg (154 lb) male patient is being mechanically ventilated in Volume Control (VC)
mode. The settings are: Vt 500 mL, Rate 12, FiO2 0.50, PEEP 5 cmH2O. The peak inspiratory
pressure (PIP) is 35 cmH2O and the plateau pressure (Pplat) is 20 cmH2O. What is the
patient’s dynamic compliance?
A. 14 mL/cmH2O
B. 33 mL/cmH2O
C. 25 mL/cmH2O
D. 16 mL/cmH2O
, Answer: D
Conceptual Explanation: Dynamic Compliance = Vt / (PIP - PEEP). 500 / (35 - 5) = 500 /
30 = 16.67 mL/cmH2O.
4. A 24-year-old female is admitted to the ER with status asthmaticus. She is receiving 2.5 mg
of Albuterol via SVN every 20 minutes. Her breath sounds indicate very little air movement.
Which of the following should the respiratory therapist recommend next?
A. Decrease the frequency of Albuterol
B. Intubate and initiate mechanical ventilation
C. Initiate Heliox therapy
D. Switch to a Dry Powder Inhaler (DPI)
Answer: C
Conceptual Explanation: Heliox (Helium-Oxygen mixture) reduces gas density and work
of breathing in cases of severe airway obstruction, potentially buying time for
pharmacological treatments to work and avoiding intubation.
5. A patient with ARDS is being ventilated with a PEEP of 15 cmH2O and FiO2 of 0.80. The
therapist notes a sudden drop in SpO2 to 82% and a significant decrease in blood pressure.
The most appropriate immediate action is to:
A. Increase FiO2 to 1.0
B. Perform a recruitment maneuver
