NBRC Study Guide (National Board of Respiratory Care) Questions With Complete Solutions

The four steps for respiratory mgmt correct answer: 1. tx *ventilation *first (should problem exist) 2. *oxygenation* 3. *circulation* 4. *perfusion* problems at one step will adversely affect each process that follows it within sequence External respiration vs. Internal respiration correct answer: External = exchange of O2 and CO2 across AC membrane - depends on diffusion capacity of AC membrane & ventilation Internal = exchange of O2 & CO2 across blood and tissue cells - depends on circulation Signs vs. Symptoms correct answer: *Signs = Objective information*; can be seen, measured, heard, or felt - Color, pulse, edema *Symptoms = Subjective information* - Dyspnea, pain, nausea Steps in Assessment: correct answer: 1. *Visual examination* - General appearance, sensorum, chest movement, posture, skin color 2. *Bedside exam* - BS, VS, auscultate, percussion, PMH, cap refill 3. *Lab exam * - ABG, CBC, CXR, lytes 4. *Specials* - urinalysis, gram stain, MIP, VC Skin Appearance - color - condition correct answer: - *Normal:* Race specific - *Decrease in color* = ashen, pallor → anemia, blood loss - *Jaundice: *↑ bilirubin levels → liver failure - *Erythema: *Redness of the skin → *hypercarbia, COHb, inflammation* - *Cyanosis: *Bluish → Hypoxia (this is a poor assessment of hypoxia bc it shows up late! Only appears after 5 gram% of Hb is desaturated...) - *diaphroesis:* sweating - *turgor*: slowed response shows dehydration → either through hypernatremia or/and hypovolemia Smoking history - Calculating Pack-year - Verifying if pt is compliant w/smoking cessation program correct answer: Pack Years = *(packs per day) x (# years smoked)* Measure pt's COHb to see if they actually are quitting smoking COHb be levels should ↓ from their baseline to non-smoking normals of < 1% Terms for Describing Sensorium/Neuro (LOC) - Conscious - Confused - Disoriented - Lethargic - Obtunded - Stuporous - Comatose correct answer: - *Conscious*: alert to time, place, and person; responds appropriately -* Confused: *can't think clearly, responds inappropriately -* Disoriented: *disoriented to time/place; starting loss of conscience -* Lethargic: *sleepy, but will wake; still oriented (can be early sign of increased ICP) -* Obtunded:*hard to wake; slowed response but appropriate - *Stuporous: *doesn't awaken completely; only responds to painful stimuli - *Comatose*: unconscious; doesn't respond to any stimuli Glasgow Coma Scale (GCS) correct answer: To measure level of consciousness (LOC) *Eye opening:* spontaneous 4, in response to voice 3, respond to pain 2, none 1 *Verbal response:* oriented 5, confused 4, inappropriate words 3, incomprehensible words 2, none 1 *Motor response:* obeys commands 6, localizes 5, withdraws 4, flexes (decorticate) 3, extends (decerebrate) 2, none 1 • > 13 minor impairment • 9-12 moderate impairment • < 8 severe impairment iatrogenic correct answer: of or relating to illness caused by medical examination or treatment Jugular Vein Distension (JVD) correct answer: - Occurs with *CHF and pneumothorax* - most commonly bc of right vent fail due to chronic hypoxemia and CHF pleurodesis correct answer: pleural space is artificially obliterated - requires a hemostat, and 3 way stop cock macroglossia correct answer: swelling or enlargement of the tongue - bc of trauma, or congenital (ie Down's Syndrome)