NBRC TMC/CRT/RRT COMPREHENSIVE
EXAM QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic COPD presents to the emergency department with
increased dyspnea and productive cough. ABG results on 2L/min nasal cannula: pH 7.28,
PaCO2 68 mmHg, PaO2 54 mmHg, HCO3 32 mEq/L. Which of the following is the most
appropriate initial action?
A. Increase oxygen to 4 L/min via nasal cannula
B. Initiate Non-Invasive Positive Pressure Ventilation (NIV)
C. Intubate and initiate mechanical ventilation
D. Administer a dose of IV methylprednisolone
Answer: B
Conceptual Explanation: The patient is experiencing an acute-on-chronic respiratory
failure with significant respiratory acidosis. NIV is the first-line treatment for COPD
exacerbations to reduce the work of breathing and avoid invasive intubation.
,2. While monitoring a patient in the ICU with a pulmonary artery catheter, the respiratory
therapist notes a Pulmonary Artery Pressure (PAP) of 45/25 mmHg and a Pulmonary Capillary
Wedge Pressure (PCWP) of 8 mmHg. These findings are most consistent with:
A. Pulmonary embolism
B. Hypovolemia
C. Left heart failure
D. Mitral valve stenosis
Answer: A
Conceptual Explanation: A high PAP with a normal PCWP indicates a lung-related
pathology rather than a heart-related one, such as pulmonary hypertension or pulmonary
embolism.
3. A patient receiving volume-controlled ventilation has an increased peak inspiratory
pressure (PIP) from 30 cmH2O to 45 cmH2O, while the plateau pressure remains constant at
20 cmH2O. This indicates:
A. Increased airway resistance
B. Decreased lung compliance
C. Development of a pneumothorax
D. Patient dyssynchrony
Answer: A
, Conceptual Explanation: When the difference between PIP and Plateau pressure
increases, it indicates an increase in airway resistance (e.g., secretions, bronchospasm).
4. Calculate the Dynamic Compliance for a patient with the following settings: VT 500 mL, PIP
35 cmH2O, PEEP 5 cmH2O, Plateau 25 cmH2O.
A. 14 mL/cmH2O
B. 25 mL/cmH2O
C. 20 mL/cmH2O
D. 16.7 mL/cmH2O
Answer: D
Conceptual Explanation: Dynamic Compliance = VT / (PIP - PEEP). 500 / (35 - 5) = 16.66
mL/cmH2O.
5. Which of the following PFT results most strongly suggests an obstructive lung disease?
A. FEV1/FVC ratio of 62%
B. FVC of 65% predicted
C. TLC of 70% predicted
D. DLCO of 50% predicted
Answer: A
Conceptual Explanation: A decreased FEV1/FVC ratio (typically < 70%) is the hallmark of
obstructive lung disease.
EXAM QUESTIONS AND ANSWERS
1. A 65-year-old patient with chronic COPD presents to the emergency department with
increased dyspnea and productive cough. ABG results on 2L/min nasal cannula: pH 7.28,
PaCO2 68 mmHg, PaO2 54 mmHg, HCO3 32 mEq/L. Which of the following is the most
appropriate initial action?
A. Increase oxygen to 4 L/min via nasal cannula
B. Initiate Non-Invasive Positive Pressure Ventilation (NIV)
C. Intubate and initiate mechanical ventilation
D. Administer a dose of IV methylprednisolone
Answer: B
Conceptual Explanation: The patient is experiencing an acute-on-chronic respiratory
failure with significant respiratory acidosis. NIV is the first-line treatment for COPD
exacerbations to reduce the work of breathing and avoid invasive intubation.
,2. While monitoring a patient in the ICU with a pulmonary artery catheter, the respiratory
therapist notes a Pulmonary Artery Pressure (PAP) of 45/25 mmHg and a Pulmonary Capillary
Wedge Pressure (PCWP) of 8 mmHg. These findings are most consistent with:
A. Pulmonary embolism
B. Hypovolemia
C. Left heart failure
D. Mitral valve stenosis
Answer: A
Conceptual Explanation: A high PAP with a normal PCWP indicates a lung-related
pathology rather than a heart-related one, such as pulmonary hypertension or pulmonary
embolism.
3. A patient receiving volume-controlled ventilation has an increased peak inspiratory
pressure (PIP) from 30 cmH2O to 45 cmH2O, while the plateau pressure remains constant at
20 cmH2O. This indicates:
A. Increased airway resistance
B. Decreased lung compliance
C. Development of a pneumothorax
D. Patient dyssynchrony
Answer: A
, Conceptual Explanation: When the difference between PIP and Plateau pressure
increases, it indicates an increase in airway resistance (e.g., secretions, bronchospasm).
4. Calculate the Dynamic Compliance for a patient with the following settings: VT 500 mL, PIP
35 cmH2O, PEEP 5 cmH2O, Plateau 25 cmH2O.
A. 14 mL/cmH2O
B. 25 mL/cmH2O
C. 20 mL/cmH2O
D. 16.7 mL/cmH2O
Answer: D
Conceptual Explanation: Dynamic Compliance = VT / (PIP - PEEP). 500 / (35 - 5) = 16.66
mL/cmH2O.
5. Which of the following PFT results most strongly suggests an obstructive lung disease?
A. FEV1/FVC ratio of 62%
B. FVC of 65% predicted
C. TLC of 70% predicted
D. DLCO of 50% predicted
Answer: A
Conceptual Explanation: A decreased FEV1/FVC ratio (typically < 70%) is the hallmark of
obstructive lung disease.
