NBRC TMC EXAM QUESTIONS AND
ANSWERS
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - ANSWER-A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - ANSWER-C.
When a person indicates the universal sign of choking, they are unable to verbalize
because there is likely something caught in their airway. The person responding must
first focus on removing the obstruction, which is done by performing abdominal thrusts.
Administering rescue breaths would not be appropriate because the airway is
obstructed. Calling for help is tempting but is only related to two-man CPR. The patient
is not yet at that point. Performing abdominal thrusts is a one-man maneuver and
therefore obtaining additional help is not the first concern.
A home care patient calls into the clinic and complains that his oxygen concentrator is
not working even though the machine is plugged in and the switch is in the 'on'.
Position. After ensuring the patient is receiving oxygen from a reliable alternate source,
the therapist should advise the patient to
A. check and replace the internal in-line fuse
B. find the reset switch in the machine and press it
C. ensure the circuit breaker is in the on position
D. change the filters and cycle the machine off then on again - ANSWER-C.
When a homecare patient reports a problem with their oxygen concentrator, the first
action should be to ensure the patient is receiving oxygen from an alternate source (an
E cylinder). After that is accomplished, the respiratory therapist may instruct the patient
in some basic troubleshooting. This includes ensuring the device is plugged in,
changing the filter, and checking the circuit breaker. All other troubleshooting should be
done by a professional.
,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.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
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 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.
Placement of a pulmonary artery catheter is associated with which of the following most
common complications?
A. hypotension
B. pulmonic valve damage
C. cardiac arrhythmias
D. internal bleeding - ANSWER-C.
Several complications may arise from the placement of a pulmonary artery catheter,
otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the
most common complication of the options offered. Another serious complication is
perforation of a vessel or cardiac muscle during the insertion.
A galvanic fuel cell oxygen analyzer may read erroneously high under which of the
following conditions?
A. when the analyzer batteries are depleted
, B. during a sudden increase in the partial pressure of oxygen
C. when a volume-controlled ventilator at high inspiratory pressures
D. when liquid gets on the membrane - ANSWER-C.
A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures
change significantly, such as when a patient is receiving high inspiratory pressure or
when a patient changes altitude quickly.
Results of a quality control maneuver for a spirometer using a 3.0 L calibration syringe
as follows:
Volume 1 2.65 L Volume 2 2.68 LVolume 3 2.66 L
According to ATS Standards, the spirometer is
A. inaccurate
B. proof that the syringe requires calibration
C. lacking in precision
D. operating correctly - ANSWER-A.
These calibration results are all very close together, indicating the machine is very
precise. However, the results are too far from the 3.0 L of gas introduced by the
calibration syringe. The maximum variance is 2.85 L - 3.15 L. Therefore, although the
machine is precise, it is considered inaccurate and should not be used for patient
testing and reporting.
Which of the following will be most helpful at preventing complications for a 48-year-old
male patient who has just undergone bariatric surgery for obesity?
A. Incentive spirometry every hour
B. Small volume nebulizer therapy with Albuterol every 4 hours
C. Ambulation twice a day
D. IPPB with 3.0 mL normal saline every 4 hours - ANSWER-A.
One of the best methods to prevent postoperative complications is the use of incentive
spirometry, also called maximal sustained inspiration or SMI.
Which of the following results should the respiratory therapist evaluate to determine the
adequacy of oxygen transport on a patient who is diagnosed with carbon monoxide
poisoning and is being treated with FIO2 of 1.0?
A. arterial-venous oxygen content difference
B. cardiac output
C. arterial oxygen content
D. oxygen consumption at the tissues - ANSWER-C.
Oxygen transport refers to the ability for blood to carry oxygen from the alveoli to the
tissues. In a case involving carbon monoxide poisoning, it is transport that is most
affected. This is true because hemoglobin becomes occupied with carbon monoxide
rather than oxygen. Hemoglobin is 19 times more attracted to carbon monoxide
compared to oxygen. Of the options listed, the best method to monitor the adequacy of
oxygen transport would be to evaluate the arterial oxygen content. This value takes into
account the amount of oxygen tied to the hemoglobin as well as the oxygen dissolved in
the plasma of the blood
ANSWERS
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - ANSWER-A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - ANSWER-C.
When a person indicates the universal sign of choking, they are unable to verbalize
because there is likely something caught in their airway. The person responding must
first focus on removing the obstruction, which is done by performing abdominal thrusts.
Administering rescue breaths would not be appropriate because the airway is
obstructed. Calling for help is tempting but is only related to two-man CPR. The patient
is not yet at that point. Performing abdominal thrusts is a one-man maneuver and
therefore obtaining additional help is not the first concern.
A home care patient calls into the clinic and complains that his oxygen concentrator is
not working even though the machine is plugged in and the switch is in the 'on'.
Position. After ensuring the patient is receiving oxygen from a reliable alternate source,
the therapist should advise the patient to
A. check and replace the internal in-line fuse
B. find the reset switch in the machine and press it
C. ensure the circuit breaker is in the on position
D. change the filters and cycle the machine off then on again - ANSWER-C.
When a homecare patient reports a problem with their oxygen concentrator, the first
action should be to ensure the patient is receiving oxygen from an alternate source (an
E cylinder). After that is accomplished, the respiratory therapist may instruct the patient
in some basic troubleshooting. This includes ensuring the device is plugged in,
changing the filter, and checking the circuit breaker. All other troubleshooting should be
done by a professional.
,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.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
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 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.
Placement of a pulmonary artery catheter is associated with which of the following most
common complications?
A. hypotension
B. pulmonic valve damage
C. cardiac arrhythmias
D. internal bleeding - ANSWER-C.
Several complications may arise from the placement of a pulmonary artery catheter,
otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the
most common complication of the options offered. Another serious complication is
perforation of a vessel or cardiac muscle during the insertion.
A galvanic fuel cell oxygen analyzer may read erroneously high under which of the
following conditions?
A. when the analyzer batteries are depleted
, B. during a sudden increase in the partial pressure of oxygen
C. when a volume-controlled ventilator at high inspiratory pressures
D. when liquid gets on the membrane - ANSWER-C.
A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures
change significantly, such as when a patient is receiving high inspiratory pressure or
when a patient changes altitude quickly.
Results of a quality control maneuver for a spirometer using a 3.0 L calibration syringe
as follows:
Volume 1 2.65 L Volume 2 2.68 LVolume 3 2.66 L
According to ATS Standards, the spirometer is
A. inaccurate
B. proof that the syringe requires calibration
C. lacking in precision
D. operating correctly - ANSWER-A.
These calibration results are all very close together, indicating the machine is very
precise. However, the results are too far from the 3.0 L of gas introduced by the
calibration syringe. The maximum variance is 2.85 L - 3.15 L. Therefore, although the
machine is precise, it is considered inaccurate and should not be used for patient
testing and reporting.
Which of the following will be most helpful at preventing complications for a 48-year-old
male patient who has just undergone bariatric surgery for obesity?
A. Incentive spirometry every hour
B. Small volume nebulizer therapy with Albuterol every 4 hours
C. Ambulation twice a day
D. IPPB with 3.0 mL normal saline every 4 hours - ANSWER-A.
One of the best methods to prevent postoperative complications is the use of incentive
spirometry, also called maximal sustained inspiration or SMI.
Which of the following results should the respiratory therapist evaluate to determine the
adequacy of oxygen transport on a patient who is diagnosed with carbon monoxide
poisoning and is being treated with FIO2 of 1.0?
A. arterial-venous oxygen content difference
B. cardiac output
C. arterial oxygen content
D. oxygen consumption at the tissues - ANSWER-C.
Oxygen transport refers to the ability for blood to carry oxygen from the alveoli to the
tissues. In a case involving carbon monoxide poisoning, it is transport that is most
affected. This is true because hemoglobin becomes occupied with carbon monoxide
rather than oxygen. Hemoglobin is 19 times more attracted to carbon monoxide
compared to oxygen. Of the options listed, the best method to monitor the adequacy of
oxygen transport would be to evaluate the arterial oxygen content. This value takes into
account the amount of oxygen tied to the hemoglobin as well as the oxygen dissolved in
the plasma of the blood
