NBRC TMC/CRT/RRT EXAM LATEST QUESTIONS AND CORREC
m m m m m m
T ANSWERS |AGRADE
m m
Themrespiratorymtherapistmnotesmin mthemmedical mrecordmof mam65-year-
oldmmalemthatmthempatientmismorderedmtomreceivembronchodilatormtherapymwith mAlbuterol.mT
hemtherapistmalsomnotesmthempatientmismreceivingmbeta-
blockermmedication.mThemtherapistmshouldmrecommend
mA.mAdministermDexamethasone m(Decadron)min mplacemof mAlbuterol
mB.mAddmXopenexmtomthembronchodilatormregimen
mC.mReplace mAlbuterol mwith mBeclamethasone m(Beclovent)
mD.mSwitch mfrommAlbuterol mtomipratropiummbromide m(Atrovent)m-mD.
Becausemalbuterol mismambeta-agonistmmedication,mpatientsmwhomaremtakingmbeta-
blockersmshouldmutilizemothermbronchodilation mmedication.
Amhospital mhasman mextremelymlow mincidencemof mventilator-
associatedmpneumonia.mTomwhich mof mthemfollowingmreasonsmmaymthismbemattributed?
mA.mperiodicmdiscontinuation mof msedation
mB.musemof mrespiratorymprecautions mwith mthempopulation
mC.mdiversion mof minfectiousmpatientsmtomothermfacilities
mD.mbroadmusemof mprophylacticmantibioticsm-mA.
Themincidencemof mventilator-
associatedmpneumonia,mormVAP,mismloweredmbymusingmamclosedmsystemmsuction mcatheter,
mperiodically mdiscontinuing msedation,mkeeping mthempatientmandmsemi-
Fowler'smposition,mandmpropermhandwashingmamongmcaregivers.mAllmaremcorrect.
Ampressure-
volumemloopmventilatormgraphicmshowsmnomriseminmpressuremformthemfirstm200mmLmof mdelive
redmvolume.mThemtherapistmshould
mA.mincrease minspiratorymflow mrate
mB.mincrease mPEEP
mC.mdecrease mtidal mvolume
mD.mdecrease minspiratorymflow mratem-mB.
In mthismquestionmthemdescriptionmofmthempressuremvolumemloopmwouldmindicatemamflatmbotto
mmasmmanifestedmbymnomriseminmpressuremwith mthemfirstm200mmLmof mdeliveredmvolume.mWe
mcall mthismam"flatmfootball".mThemsolution mismtomincreasemPEEP mtomamlevel mthatmthempressure
mbeginsmtomrisemimmediatelymasmvolumemismintroduced.
Which mofmthemfollowingmwouldmbemthemmostmeffective,mappropriatemmethodmformresolvingma
telectasismin mamspontaneouslymbreathing,mpostmoperativempatientmwhomismundermtheminflue
ncemof msedation mandmwillmnotmrespondmtomverbal mstimuli?
mA.mIPPB
mB.msustained mmaximal minhalation m(incentive mspirometer)
mC.mdeepmbreathing mcoaching
mD.mintubation mandmmechanical mventilation m-mA.
Ampostoperativempatientmundermsedation,mandmpossiblyminmpain,mmaymbemtemptedmtombreat
hemless,mcausingmrespiratorymacidosismandmatelectasis.mTomcorrectmthismproblem,mIPPBmthe
rapy
,ismmostmappropriate.mIncentivemspirometrymwouldmalsomhelpmbutmthempatientmismunablemtomr
espondmtomverbal mstimuli.mThismalonemisman mindication mformIPPBmtherapy.
Aftermperformingmminimummoccludingmvolumemtechniquemwith mam65-kgm(143-
lb)mpatientmwhomismorallymintubatedmwith mam7.0-
mmmETmtube,mthemrespiratorymtherapistmshouldmNEXT
mA.mcheckmETmtubemcuff mpressure
mB.mperformmtracheal mpalpation
mC.mordermamchestmradiograph
mD.mdocumentmETmtubemmarkingsmatmthemlipsm-mA.
ThemETmtubemcuff mpressuremmaymbemadjustedmcorrectlymbymseveralmtechniquesmincludingm
minimummleakmtechniquem(alsomcalledmminimummoccludingmvolume,mminimalmsealmtechniq
ue,mandmthemusemof mampressuremmanometermcalledmamcuffalator.mIf mminimummseal mormmini
malmleakmtechniquemismused,mthemrespiratorymtherapistmismstillmrequiredmtommonitormthempre
ssuremaftermthemtechniquemismperformed.mAlthoughmthismismoften mnotmdoneminmreal mlife,mitmism
technicallympartmof mthemprocedure.
Themrespiratorymtherapistmobservesman mECGmwavemformmonmampatientmthatmismconsistentm
with matrial mtachycardia.mThempatientmismcomplainingmof mchestmpain,mdizziness,mandmnause
a.mThemrespiratorymtherapistmshouldmrecommend
mA.munsynchronized mdefibrillation
mB.mAtropine msulfate
mC.mepinephrine
mD.mcardioversion m-mD.
Non-
deadlymarrhythmias,msuchmasmthismone,mmaymbemaddressedmthrough mcardioversion.mCa
rdioversion mismamformmof mdefibrillationmwithmlowmwattagemandmwithmthemsynchronization m
setmtom"active".mThismallowsmthemshockmtombemsynchronizedmtomthemRmwave.
Am38-year-
oldmmalempresentsminmthememergencymdepartmentm(ED)mcomplainingmofmfrequentmvomiting
.mThemfollowingmlaboratorymdatamismavailable:mArterial mbloodmgases
pHm7.55mPaCO2m42mtorrPaO2m85mtorrHCO3-m31mmEq/LBEm+7mmEq/LFIO2m0.21K+m3.0
mEq/LCl-m95mmEq/LNa+m135mmEq/L
Which mof mthemfollowingmshouldmthemrespiratorymtherapistmrecommend?
mA.madministermNaCL
mB.madministermNaHCO3-
mC.madministermKCL
mD.madministermvolume-expanding mfluidsm-mC.
ThismpatientmhasmamCO2mofm42mmmHg,mwhichmsuggestsmadequatemventilation.mHowever,m
themhighmpH mismassociatedmwithmalkalosis.mBecausemthemCO2mismnormal,mthemcausemof mthe
malkalosismmustmbemmetabolicminmnature.mOnemtreatmentmformmetabolicmalkalosismismtomad
ministermpotassiummchloridemormKCl.
Which mof mthemfollowingmismneededmtomcalculatemalveolarmoxygen mtension?
A. VD/VT,mPAO2
B. BPmandmFiO2
C. PetCO2mandmPaO2
D. QS/QT,mdeadspacem-mB.
,Barometricmpressure,mFiO2,mandmPaO2maremallmincludedminmthemformulam(BPmstandsmformb
arometricmpressure)
L/min/m2mismthemunitmof mmeasuremfor:
A. Systemicmvascularmresistance
B. Cardiacmoutput
C. Cardiacmindex
D. Strokemvolumem-mC.
Amspontaneouslymbreathingmpatientmhasmthemfollowingmarterial mbloodmgasmresults
:mpH m7.38mPaCO2m42mmmHgPaO2m76mmmHgHCO3-
m24mmEq/LBE m0mmEq/LmWhichmof mthemfollowingmsupplemental moxygenmlevelsmis
mmostmappropriate?
mA.m2mL/min mnasal mcannula
mB.m5mL/min mnasal mcannula
mC.mnon-rebreathing mmask
mD.mVenturi mmaskmatm30%m-mB.
Ampatientmwhomismshowingmsignsmofmhypoxemiamshouldmreceivemsupplemental moxygen.mIf m
thempatientmismnotmamCOPD mpatientmandmthemsituationmismnotmanmemergency,mthen mthempro
permsupplemental moxygenmismanmadultmtherapeuticmdose,mwhichmism40%mtom55%.mOf mthemo
ptionsmavailablemonlym5mL/min mnasalmcannulamwill mapproachmthis.mOthermoptionsmaremeithe
rminsufficientmormtoommuch.
Leftmheartmfailuremwouldmbemmanifestedmin mwhich mof mthemfollowingmvalues?
mA.mCVP mandmmPAP
mB.mmPAP mandmwedgempressure
mC.mMAP mandmSVR
mD.mcardiacmoutputmandmwedge mpressure m-mD.
Themfunctionmofmthemleftmheart,mspecificallymthemleftmventricle,mismbestmassessedmhemodyn
amicallymbymlookingmatmthosemvaluesmthatmprecedemandmcomemaftermthemleftmheart.mIn mthism
casempulmonarymcapillarymwedgempressuremandmcardiacmoutputm(ormcardiacmindex)maremth
emvaluesmfoundmbeforemandmaftermthemleftmheart.
Which mofmthemfollowingmfindingsmismmostmcloselymassociatedmwithmincreasedmairwaymresist
ance?
mA.mreduced mSpO2
mB.maccessorymmusclemuse
mC.malteredmP50
mD.mincreased mPetCO2 m-mB.
Of mthemoptionsmgiven,musemofmaccessorymmusclesmismmostmcloselymassociatedmwith man min
creasemin mairwaymresistance.mThismismespeciallymtruemwith mpatientsmwhomhavemasthmamorm
othermtypesmof muppermairwayminflammation mormbronchoconstriction.
Formampatientmreceivingmvolume-
controlledmmechanical mventilation,mthemlowerminflection mpointmon mampressure-
volumemloopmcan mbestmbemdescribedmas:
mA.mamountmof mpressure mrequired mtomkeepmthemalveoli mandmsmall mairwaysmopen
mB.moptimal mPEEP
, mC.mminimal mPEEP
mD.muppermlimitmof mresidual mvolumem-mA.
Themlowestminflection mpointmon mampressure-
volumemventilatormgraphicmismanmindicationmofmthemminimummpressuremneededmtomkeepm
alveoli mopen.
Themresultsmof mamV/Qmscanmshowsmpoormperfusionmwithmadequatemventilation.mAmchestmra
diograph mshowsmamwedge-
shapedminfiltratemovermthemrightmlungmfield.mThempatientmmostmlikelymhas
mA.mfluidmoverload
mB.mARDS
mC.mampulmonarymembolism
mD.mpneumonia m-mC.
AmVQmscan mthatmshowsmpoormperfusionmbutmadequatemventilation mismmostmcloselymassoci
atedmwith mampulmonarymembolism.mSupportivemdatamismfoundminmthemradiological mreportmof
mwedge-shaped minfiltrates.
Ampatientmismreceivingmvolume-
controlledmventilationmfollowingmbariatricmsurgerymformobesity.mWhichmofmthemfollowingmmed
icationsmshouldmthemrespiratorymtherapistmrecommendmtomensuremthempatient'smcomfortman
dmassistmin mventilatormmanagement?
mA.mPronestyl
mB.mmorphinemsulfate
mC.mvecuroniummbromidem(Norcuron)
mD.mMestinon m-mB.
Morphinemsulfatemismonemof mthembestmmedicationsmtomadministermtompatientsmreceivingmme
chanical mventilatorymsupportmtomhelpmthempatientmrestmpain-
freemandmtomgenerallymsedatemandmrelaxmthempatient.
Ampatientmhasmidiopathicmpneumoniamwith mconsolidationminmthemrightmlowermlobe.mThemphy
sician msuspectsmambacterialminfection.mWhichmof mthemfollowingmwillmprovidemconclusivemdat
amtomrulemoutmthemphysician'smsuspicions?
mA.mWBC
mB.mcolormof msputum
mC.msputummacid-fastmstain
mD.moral mtemperature m-mA.
Ambacterial minfectionmismdiagnosedmprimarilymbymexaminingmthemwhitembloodmcell mcount,mals
omcalledmthemleukocytemcount.mAnmelevatedmtemperaturemandmyellow msputummindicatemthem
possibilitymof man minfection mbutmaremnotmconfirmingmin mnature.
Aftermmakingmthemuniversal msignmofmchoking,mampersonmcollapses.mThemobservermshouldmFI
RST
mA.mcheckmformampulse
mB.mcall mformhelp
mC.mperformmabdominal mthrusts
mD.madministerm2mrescuembreathsm-mC.
m m m m m m
T ANSWERS |AGRADE
m m
Themrespiratorymtherapistmnotesmin mthemmedical mrecordmof mam65-year-
oldmmalemthatmthempatientmismorderedmtomreceivembronchodilatormtherapymwith mAlbuterol.mT
hemtherapistmalsomnotesmthempatientmismreceivingmbeta-
blockermmedication.mThemtherapistmshouldmrecommend
mA.mAdministermDexamethasone m(Decadron)min mplacemof mAlbuterol
mB.mAddmXopenexmtomthembronchodilatormregimen
mC.mReplace mAlbuterol mwith mBeclamethasone m(Beclovent)
mD.mSwitch mfrommAlbuterol mtomipratropiummbromide m(Atrovent)m-mD.
Becausemalbuterol mismambeta-agonistmmedication,mpatientsmwhomaremtakingmbeta-
blockersmshouldmutilizemothermbronchodilation mmedication.
Amhospital mhasman mextremelymlow mincidencemof mventilator-
associatedmpneumonia.mTomwhich mof mthemfollowingmreasonsmmaymthismbemattributed?
mA.mperiodicmdiscontinuation mof msedation
mB.musemof mrespiratorymprecautions mwith mthempopulation
mC.mdiversion mof minfectiousmpatientsmtomothermfacilities
mD.mbroadmusemof mprophylacticmantibioticsm-mA.
Themincidencemof mventilator-
associatedmpneumonia,mormVAP,mismloweredmbymusingmamclosedmsystemmsuction mcatheter,
mperiodically mdiscontinuing msedation,mkeeping mthempatientmandmsemi-
Fowler'smposition,mandmpropermhandwashingmamongmcaregivers.mAllmaremcorrect.
Ampressure-
volumemloopmventilatormgraphicmshowsmnomriseminmpressuremformthemfirstm200mmLmof mdelive
redmvolume.mThemtherapistmshould
mA.mincrease minspiratorymflow mrate
mB.mincrease mPEEP
mC.mdecrease mtidal mvolume
mD.mdecrease minspiratorymflow mratem-mB.
In mthismquestionmthemdescriptionmofmthempressuremvolumemloopmwouldmindicatemamflatmbotto
mmasmmanifestedmbymnomriseminmpressuremwith mthemfirstm200mmLmof mdeliveredmvolume.mWe
mcall mthismam"flatmfootball".mThemsolution mismtomincreasemPEEP mtomamlevel mthatmthempressure
mbeginsmtomrisemimmediatelymasmvolumemismintroduced.
Which mofmthemfollowingmwouldmbemthemmostmeffective,mappropriatemmethodmformresolvingma
telectasismin mamspontaneouslymbreathing,mpostmoperativempatientmwhomismundermtheminflue
ncemof msedation mandmwillmnotmrespondmtomverbal mstimuli?
mA.mIPPB
mB.msustained mmaximal minhalation m(incentive mspirometer)
mC.mdeepmbreathing mcoaching
mD.mintubation mandmmechanical mventilation m-mA.
Ampostoperativempatientmundermsedation,mandmpossiblyminmpain,mmaymbemtemptedmtombreat
hemless,mcausingmrespiratorymacidosismandmatelectasis.mTomcorrectmthismproblem,mIPPBmthe
rapy
,ismmostmappropriate.mIncentivemspirometrymwouldmalsomhelpmbutmthempatientmismunablemtomr
espondmtomverbal mstimuli.mThismalonemisman mindication mformIPPBmtherapy.
Aftermperformingmminimummoccludingmvolumemtechniquemwith mam65-kgm(143-
lb)mpatientmwhomismorallymintubatedmwith mam7.0-
mmmETmtube,mthemrespiratorymtherapistmshouldmNEXT
mA.mcheckmETmtubemcuff mpressure
mB.mperformmtracheal mpalpation
mC.mordermamchestmradiograph
mD.mdocumentmETmtubemmarkingsmatmthemlipsm-mA.
ThemETmtubemcuff mpressuremmaymbemadjustedmcorrectlymbymseveralmtechniquesmincludingm
minimummleakmtechniquem(alsomcalledmminimummoccludingmvolume,mminimalmsealmtechniq
ue,mandmthemusemof mampressuremmanometermcalledmamcuffalator.mIf mminimummseal mormmini
malmleakmtechniquemismused,mthemrespiratorymtherapistmismstillmrequiredmtommonitormthempre
ssuremaftermthemtechniquemismperformed.mAlthoughmthismismoften mnotmdoneminmreal mlife,mitmism
technicallympartmof mthemprocedure.
Themrespiratorymtherapistmobservesman mECGmwavemformmonmampatientmthatmismconsistentm
with matrial mtachycardia.mThempatientmismcomplainingmof mchestmpain,mdizziness,mandmnause
a.mThemrespiratorymtherapistmshouldmrecommend
mA.munsynchronized mdefibrillation
mB.mAtropine msulfate
mC.mepinephrine
mD.mcardioversion m-mD.
Non-
deadlymarrhythmias,msuchmasmthismone,mmaymbemaddressedmthrough mcardioversion.mCa
rdioversion mismamformmof mdefibrillationmwithmlowmwattagemandmwithmthemsynchronization m
setmtom"active".mThismallowsmthemshockmtombemsynchronizedmtomthemRmwave.
Am38-year-
oldmmalempresentsminmthememergencymdepartmentm(ED)mcomplainingmofmfrequentmvomiting
.mThemfollowingmlaboratorymdatamismavailable:mArterial mbloodmgases
pHm7.55mPaCO2m42mtorrPaO2m85mtorrHCO3-m31mmEq/LBEm+7mmEq/LFIO2m0.21K+m3.0
mEq/LCl-m95mmEq/LNa+m135mmEq/L
Which mof mthemfollowingmshouldmthemrespiratorymtherapistmrecommend?
mA.madministermNaCL
mB.madministermNaHCO3-
mC.madministermKCL
mD.madministermvolume-expanding mfluidsm-mC.
ThismpatientmhasmamCO2mofm42mmmHg,mwhichmsuggestsmadequatemventilation.mHowever,m
themhighmpH mismassociatedmwithmalkalosis.mBecausemthemCO2mismnormal,mthemcausemof mthe
malkalosismmustmbemmetabolicminmnature.mOnemtreatmentmformmetabolicmalkalosismismtomad
ministermpotassiummchloridemormKCl.
Which mof mthemfollowingmismneededmtomcalculatemalveolarmoxygen mtension?
A. VD/VT,mPAO2
B. BPmandmFiO2
C. PetCO2mandmPaO2
D. QS/QT,mdeadspacem-mB.
,Barometricmpressure,mFiO2,mandmPaO2maremallmincludedminmthemformulam(BPmstandsmformb
arometricmpressure)
L/min/m2mismthemunitmof mmeasuremfor:
A. Systemicmvascularmresistance
B. Cardiacmoutput
C. Cardiacmindex
D. Strokemvolumem-mC.
Amspontaneouslymbreathingmpatientmhasmthemfollowingmarterial mbloodmgasmresults
:mpH m7.38mPaCO2m42mmmHgPaO2m76mmmHgHCO3-
m24mmEq/LBE m0mmEq/LmWhichmof mthemfollowingmsupplemental moxygenmlevelsmis
mmostmappropriate?
mA.m2mL/min mnasal mcannula
mB.m5mL/min mnasal mcannula
mC.mnon-rebreathing mmask
mD.mVenturi mmaskmatm30%m-mB.
Ampatientmwhomismshowingmsignsmofmhypoxemiamshouldmreceivemsupplemental moxygen.mIf m
thempatientmismnotmamCOPD mpatientmandmthemsituationmismnotmanmemergency,mthen mthempro
permsupplemental moxygenmismanmadultmtherapeuticmdose,mwhichmism40%mtom55%.mOf mthemo
ptionsmavailablemonlym5mL/min mnasalmcannulamwill mapproachmthis.mOthermoptionsmaremeithe
rminsufficientmormtoommuch.
Leftmheartmfailuremwouldmbemmanifestedmin mwhich mof mthemfollowingmvalues?
mA.mCVP mandmmPAP
mB.mmPAP mandmwedgempressure
mC.mMAP mandmSVR
mD.mcardiacmoutputmandmwedge mpressure m-mD.
Themfunctionmofmthemleftmheart,mspecificallymthemleftmventricle,mismbestmassessedmhemodyn
amicallymbymlookingmatmthosemvaluesmthatmprecedemandmcomemaftermthemleftmheart.mIn mthism
casempulmonarymcapillarymwedgempressuremandmcardiacmoutputm(ormcardiacmindex)maremth
emvaluesmfoundmbeforemandmaftermthemleftmheart.
Which mofmthemfollowingmfindingsmismmostmcloselymassociatedmwithmincreasedmairwaymresist
ance?
mA.mreduced mSpO2
mB.maccessorymmusclemuse
mC.malteredmP50
mD.mincreased mPetCO2 m-mB.
Of mthemoptionsmgiven,musemofmaccessorymmusclesmismmostmcloselymassociatedmwith man min
creasemin mairwaymresistance.mThismismespeciallymtruemwith mpatientsmwhomhavemasthmamorm
othermtypesmof muppermairwayminflammation mormbronchoconstriction.
Formampatientmreceivingmvolume-
controlledmmechanical mventilation,mthemlowerminflection mpointmon mampressure-
volumemloopmcan mbestmbemdescribedmas:
mA.mamountmof mpressure mrequired mtomkeepmthemalveoli mandmsmall mairwaysmopen
mB.moptimal mPEEP
, mC.mminimal mPEEP
mD.muppermlimitmof mresidual mvolumem-mA.
Themlowestminflection mpointmon mampressure-
volumemventilatormgraphicmismanmindicationmofmthemminimummpressuremneededmtomkeepm
alveoli mopen.
Themresultsmof mamV/Qmscanmshowsmpoormperfusionmwithmadequatemventilation.mAmchestmra
diograph mshowsmamwedge-
shapedminfiltratemovermthemrightmlungmfield.mThempatientmmostmlikelymhas
mA.mfluidmoverload
mB.mARDS
mC.mampulmonarymembolism
mD.mpneumonia m-mC.
AmVQmscan mthatmshowsmpoormperfusionmbutmadequatemventilation mismmostmcloselymassoci
atedmwith mampulmonarymembolism.mSupportivemdatamismfoundminmthemradiological mreportmof
mwedge-shaped minfiltrates.
Ampatientmismreceivingmvolume-
controlledmventilationmfollowingmbariatricmsurgerymformobesity.mWhichmofmthemfollowingmmed
icationsmshouldmthemrespiratorymtherapistmrecommendmtomensuremthempatient'smcomfortman
dmassistmin mventilatormmanagement?
mA.mPronestyl
mB.mmorphinemsulfate
mC.mvecuroniummbromidem(Norcuron)
mD.mMestinon m-mB.
Morphinemsulfatemismonemof mthembestmmedicationsmtomadministermtompatientsmreceivingmme
chanical mventilatorymsupportmtomhelpmthempatientmrestmpain-
freemandmtomgenerallymsedatemandmrelaxmthempatient.
Ampatientmhasmidiopathicmpneumoniamwith mconsolidationminmthemrightmlowermlobe.mThemphy
sician msuspectsmambacterialminfection.mWhichmof mthemfollowingmwillmprovidemconclusivemdat
amtomrulemoutmthemphysician'smsuspicions?
mA.mWBC
mB.mcolormof msputum
mC.msputummacid-fastmstain
mD.moral mtemperature m-mA.
Ambacterial minfectionmismdiagnosedmprimarilymbymexaminingmthemwhitembloodmcell mcount,mals
omcalledmthemleukocytemcount.mAnmelevatedmtemperaturemandmyellow msputummindicatemthem
possibilitymof man minfection mbutmaremnotmconfirmingmin mnature.
Aftermmakingmthemuniversal msignmofmchoking,mampersonmcollapses.mThemobservermshouldmFI
RST
mA.mcheckmformampulse
mB.mcall mformhelp
mC.mperformmabdominal mthrusts
mD.madministerm2mrescuembreathsm-mC.
