NBRC EXAM, PART 1 QUESTIONS AND
ANSWERS
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels - ANSWER-Since the patient received Lasix and nasogastric tube,
they are losing fluids, and a side effect of fluid loss is a decrease in electrolytes, so
ANSWER is B (there isn't enough evidence of heart attack to justify cardiac enzymes,
also they are used to confirm a heart attack).
Which of the following will determine aortic pulse pressure.
a. systolic + systolic + diastolic/3
b. diastolic + pulse pressure/3
c. systolic pressure - diastolic pressure
d. stroke volume x heart rate x 10. - ANSWER-Aortic pulse pressure is just the
difference between systolic and diastolic pressure, so ANSWER is C
A 32-week gestational age infant is receiving mechanical ventilation for hyaline
membrane disease. The patient required a chest tube for a persistent pneumothorax.
Two days later the chest radiograph reveals bilateral radiolucency, midline
mediastinum, and the right hemidiaphragm slightly elevated. This would indicate
A. atelectasis.
B. bronchopulmonary dysplasia.
C. fluid overload.
D. resolution of a pneumothorax. - ANSWER-bilateral means both sides, radiolucency
refers to dark, midline mediastinum is right where is should be, the right hemidiaphragm
slightly elevated is normal; so this actually indicates everything is normal. With
atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary
dysplasia it would look similar to ARDS, with fluid overload you would see pattern
similar to butterfly or batwing similar to pulmonary edema, so the best
ANSWER is D and the pneumothorax has resolved.
A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased
movement, and no vascular markings on the right side. These signs would be most
likely associated with:
A. pneumothorax
B. pleural effusion
C. pneumonia
,D. flail chest - ANSWER-The flat hemidiaphram indicates pneumothorax, so the
ANSWER is A.
What is the normal range for the pulmonary artery systolic pressure in an adult?
A. 2-6 mm Hg
B. 4-12 mm Hg
C. 9-18 mm Hg
D. 21-28 mm Hg - ANSWER-The normal pressure is 25 mm Hg, so the ANSWER is D
21-28 mm Hg
While assessing a patient's breath sounds the respiratory therapist notes that when the
patient is instructed to say the letter "E", it comes through the stethescope sounding like
"aaaahhh". This change in the sound is associated with which of the following
conditions?
A. Pleuritic inflammation
B. Pneumonia
C. Bronchospasm
D. Epiglotitis - ANSWER-The sound aaaaahhhhh is egotheny and is associated with
consolidation in the lung, so the ANSWER is B pneumonia. Pleural inflammation would
be a crackling crunching sound, bronchospasm would sound like wheezing, and
epiglottitis would be stridor.
An 1800 g neonate in the NICU is being monitored with a TcPO2 electrode. The TcPO2
electrode is reading 42 torr with the temperature set at 38oC. The PO2 from an
umbilical artery sample is 72 torr. Which of the following would best explain the
difference in these readings?
A. There was an error in the arterial blood gas results.
B. The TcPO2 electrode needs to be repositioned.
C. The TcPO2 electrode temperature setting is too low.
D. The TcPO2 electrode has been dislodged. - ANSWER-TcPO2 should be set at 43-45
C so the electrode is not hot enough to make the device work. There is not enough
profusion with the electrode so you need to raise the temperature on the electrode, so
the ANSWER is C, TcPO2 electrode temperature setting is too low.
A multiple trauma victim with internal hemorrhage is being monitored via pulse oximetry.
Which of the following conditions would affect the accuracy of her SpO2 readings?
A. hypotension
B. hyperoxia
C. hypocarbia
D. hyperthermia - ANSWER-Since the SpO2 measures the color of the blood and the
ability to shine a light through the blood, the only answer that would affect the accuracy
of the SpO2 reading would be ANSWER A hypotension because hypotension causes
less profusion (needed for the SpO2 reading)
A patient with COPD has been admitted for possible pneumonia. The patient is
producing moderate amounts of thick yellow sputum and breath sounds are decreased
,in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of
the following therapies should the respiratory therapist recommend?
A. chest physical therapy
B. antibiotic therapy
C. incentive spirometry
D. IPPB - ANSWER-The priority in this case is the infection and only the antibiotic
treatment can get rid of the infection, so the ANSWER is B, Antibiotic treatment.
A premature baby is receiving an FIO2 of .40 and CPAP at 5 cmH2O. As the respiratory
therapist increases the CPAP to 7 cmH2O, the baby's respiratory rate increases to 58
per minute and the TcPCO2 reading increases with a stable SpO2 monitor reading. The
respiratory therapist should recommend which of the following?
A. Discontinue the CPAP
B. Draw an arterial blood gas sample
C. Increase the CPAP to 10 cmH2O
D. Place the baby in an oxyhood at an FIO2 0.45 - ANSWER-Drawing an ABG would
give us more information and since this is not an emergency that is the best ANSWER
B, arterial blood gas.
A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the
patient has the following laboratory findings:
K+: 3 mEq/L
Na+: 115 mEq/L
Cl-: 80 mEq/L
HCO3-: 24 mEq/L
Urine output: 60 mL/hour
BP: 125/95 mm Hg
Based upon this information the respiratory therapist would conclude
A. the patient is hyperkalemic
B. the patient requires decreased fluid intake
C. the patient is polycythemic
D. the patient has a metabolic alkalosis - ANSWER-Hyperkalemic is high potassium,
polycythemic has extra red blood cells, and we do not have Hb measurement, metabolic
alkalosis is associated with low potassium but the bicarb is normal (and it would be high
with low potassium), the urine output is high so the best ANSWER is B, patient requires
reduced fluid intake.
A 55-year-old patient is admitted to CCU with chest pain. While assembling an oxygen
mask, the respiratory therapist notes the following ECG pattern: Ventricular fibrillation
The patient is now unconscious, unresponsive and has no palpable pulse. The
therapist's first response should be to:
A. administer oxygen by non-rebreather mask.
B. deliver a pre-cordial thump.
C. recommend intravenous amiodarone.
D. perform synchronized cardioversion. - ANSWER-Since you are actually witnessing a
ventricular fibrillation, the very first thing you can do is try to get their heart started again
, by doing ANSWER B, deliver a pre-cordial thump which is a good thump right in the
center of their sternum.
The respiratory therapist notices a dampened waveform on a pulmonary arterial line.
The therapist's first action should be to
A. attempt to draw blood from the line.
B. check the transducer dome for air bubbles.
C. flush the catheter with heparin solution.
D. check the position of the transducer. - ANSWER-Dampened wave form is when you
aren't getting a nice sharp reading, you should get a clear systolic and diastolic pattern;
the most common cause is a blood clot, flushing the catheter with heparin might push
the blood clot into the lung at this point (not a good idea), another common cause of a
dampened wave form is air bubbles in the transducer dome, so the ANSWER is B.
A patient in the intensive care unit is suffering left heart failure. Which of the following
drugs will increase the strength of contraction and improve cardiac output?
A. digitalis
B. atropine
C. isuprel
D. lidocaine - ANSWER-Atropine is used for bradycardia and increases output but not
strength, Isuprel treats bradycardia and output but not strength, Lidocaine reduces
irritability of heart, but Digitalis is a cardiac glycoside that increases cardiac output and
strengthens cardiac contraction, so ANSWER is A
The results of a patient's chest radiograph reveal the presence of a left basilar free fluid
accumulation with a meniscus formation. Physical examination of the chest indicates a
dull percussion note on the left and trachea shifted to the right. These results are
consistent with which of the following conditions?
A. Pleural effusion on the left
B. Basilar pneumonia of the left lung
C. Atelectasis of the left lung
D. Pneumothorax in the left lung - ANSWER-Miniscus formation means accumulation is
curling and going up the side, dull percussion can be solid or fluid filled (not just
consolidation), since its pushing to the right it has to be a problem outside the lung, so
the ANSWER is A.
The respiratory therapist has been paged to the ICU to assist in the treatment of a 98 kg
(215 lb) man. The patient is pale, diaphoretic, and suddenly loses consciousness. No
palpable pulse or blood pressure is measured. The ECG monitor displays the following
sinus bradycardia with a rate of 45): The respiratory therapist should:
A. confirm the ECG in another lead.
B. begin chest compressions.
C. perform cardioversion.
D. perform defibrillation. - ANSWER-ECG is showing sinus bradycardia with a rate of
45, all this leads up to begin chest compressions, so ANSWER is B. Do not perform
ANSWERS
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels - ANSWER-Since the patient received Lasix and nasogastric tube,
they are losing fluids, and a side effect of fluid loss is a decrease in electrolytes, so
ANSWER is B (there isn't enough evidence of heart attack to justify cardiac enzymes,
also they are used to confirm a heart attack).
Which of the following will determine aortic pulse pressure.
a. systolic + systolic + diastolic/3
b. diastolic + pulse pressure/3
c. systolic pressure - diastolic pressure
d. stroke volume x heart rate x 10. - ANSWER-Aortic pulse pressure is just the
difference between systolic and diastolic pressure, so ANSWER is C
A 32-week gestational age infant is receiving mechanical ventilation for hyaline
membrane disease. The patient required a chest tube for a persistent pneumothorax.
Two days later the chest radiograph reveals bilateral radiolucency, midline
mediastinum, and the right hemidiaphragm slightly elevated. This would indicate
A. atelectasis.
B. bronchopulmonary dysplasia.
C. fluid overload.
D. resolution of a pneumothorax. - ANSWER-bilateral means both sides, radiolucency
refers to dark, midline mediastinum is right where is should be, the right hemidiaphragm
slightly elevated is normal; so this actually indicates everything is normal. With
atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary
dysplasia it would look similar to ARDS, with fluid overload you would see pattern
similar to butterfly or batwing similar to pulmonary edema, so the best
ANSWER is D and the pneumothorax has resolved.
A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased
movement, and no vascular markings on the right side. These signs would be most
likely associated with:
A. pneumothorax
B. pleural effusion
C. pneumonia
,D. flail chest - ANSWER-The flat hemidiaphram indicates pneumothorax, so the
ANSWER is A.
What is the normal range for the pulmonary artery systolic pressure in an adult?
A. 2-6 mm Hg
B. 4-12 mm Hg
C. 9-18 mm Hg
D. 21-28 mm Hg - ANSWER-The normal pressure is 25 mm Hg, so the ANSWER is D
21-28 mm Hg
While assessing a patient's breath sounds the respiratory therapist notes that when the
patient is instructed to say the letter "E", it comes through the stethescope sounding like
"aaaahhh". This change in the sound is associated with which of the following
conditions?
A. Pleuritic inflammation
B. Pneumonia
C. Bronchospasm
D. Epiglotitis - ANSWER-The sound aaaaahhhhh is egotheny and is associated with
consolidation in the lung, so the ANSWER is B pneumonia. Pleural inflammation would
be a crackling crunching sound, bronchospasm would sound like wheezing, and
epiglottitis would be stridor.
An 1800 g neonate in the NICU is being monitored with a TcPO2 electrode. The TcPO2
electrode is reading 42 torr with the temperature set at 38oC. The PO2 from an
umbilical artery sample is 72 torr. Which of the following would best explain the
difference in these readings?
A. There was an error in the arterial blood gas results.
B. The TcPO2 electrode needs to be repositioned.
C. The TcPO2 electrode temperature setting is too low.
D. The TcPO2 electrode has been dislodged. - ANSWER-TcPO2 should be set at 43-45
C so the electrode is not hot enough to make the device work. There is not enough
profusion with the electrode so you need to raise the temperature on the electrode, so
the ANSWER is C, TcPO2 electrode temperature setting is too low.
A multiple trauma victim with internal hemorrhage is being monitored via pulse oximetry.
Which of the following conditions would affect the accuracy of her SpO2 readings?
A. hypotension
B. hyperoxia
C. hypocarbia
D. hyperthermia - ANSWER-Since the SpO2 measures the color of the blood and the
ability to shine a light through the blood, the only answer that would affect the accuracy
of the SpO2 reading would be ANSWER A hypotension because hypotension causes
less profusion (needed for the SpO2 reading)
A patient with COPD has been admitted for possible pneumonia. The patient is
producing moderate amounts of thick yellow sputum and breath sounds are decreased
,in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of
the following therapies should the respiratory therapist recommend?
A. chest physical therapy
B. antibiotic therapy
C. incentive spirometry
D. IPPB - ANSWER-The priority in this case is the infection and only the antibiotic
treatment can get rid of the infection, so the ANSWER is B, Antibiotic treatment.
A premature baby is receiving an FIO2 of .40 and CPAP at 5 cmH2O. As the respiratory
therapist increases the CPAP to 7 cmH2O, the baby's respiratory rate increases to 58
per minute and the TcPCO2 reading increases with a stable SpO2 monitor reading. The
respiratory therapist should recommend which of the following?
A. Discontinue the CPAP
B. Draw an arterial blood gas sample
C. Increase the CPAP to 10 cmH2O
D. Place the baby in an oxyhood at an FIO2 0.45 - ANSWER-Drawing an ABG would
give us more information and since this is not an emergency that is the best ANSWER
B, arterial blood gas.
A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the
patient has the following laboratory findings:
K+: 3 mEq/L
Na+: 115 mEq/L
Cl-: 80 mEq/L
HCO3-: 24 mEq/L
Urine output: 60 mL/hour
BP: 125/95 mm Hg
Based upon this information the respiratory therapist would conclude
A. the patient is hyperkalemic
B. the patient requires decreased fluid intake
C. the patient is polycythemic
D. the patient has a metabolic alkalosis - ANSWER-Hyperkalemic is high potassium,
polycythemic has extra red blood cells, and we do not have Hb measurement, metabolic
alkalosis is associated with low potassium but the bicarb is normal (and it would be high
with low potassium), the urine output is high so the best ANSWER is B, patient requires
reduced fluid intake.
A 55-year-old patient is admitted to CCU with chest pain. While assembling an oxygen
mask, the respiratory therapist notes the following ECG pattern: Ventricular fibrillation
The patient is now unconscious, unresponsive and has no palpable pulse. The
therapist's first response should be to:
A. administer oxygen by non-rebreather mask.
B. deliver a pre-cordial thump.
C. recommend intravenous amiodarone.
D. perform synchronized cardioversion. - ANSWER-Since you are actually witnessing a
ventricular fibrillation, the very first thing you can do is try to get their heart started again
, by doing ANSWER B, deliver a pre-cordial thump which is a good thump right in the
center of their sternum.
The respiratory therapist notices a dampened waveform on a pulmonary arterial line.
The therapist's first action should be to
A. attempt to draw blood from the line.
B. check the transducer dome for air bubbles.
C. flush the catheter with heparin solution.
D. check the position of the transducer. - ANSWER-Dampened wave form is when you
aren't getting a nice sharp reading, you should get a clear systolic and diastolic pattern;
the most common cause is a blood clot, flushing the catheter with heparin might push
the blood clot into the lung at this point (not a good idea), another common cause of a
dampened wave form is air bubbles in the transducer dome, so the ANSWER is B.
A patient in the intensive care unit is suffering left heart failure. Which of the following
drugs will increase the strength of contraction and improve cardiac output?
A. digitalis
B. atropine
C. isuprel
D. lidocaine - ANSWER-Atropine is used for bradycardia and increases output but not
strength, Isuprel treats bradycardia and output but not strength, Lidocaine reduces
irritability of heart, but Digitalis is a cardiac glycoside that increases cardiac output and
strengthens cardiac contraction, so ANSWER is A
The results of a patient's chest radiograph reveal the presence of a left basilar free fluid
accumulation with a meniscus formation. Physical examination of the chest indicates a
dull percussion note on the left and trachea shifted to the right. These results are
consistent with which of the following conditions?
A. Pleural effusion on the left
B. Basilar pneumonia of the left lung
C. Atelectasis of the left lung
D. Pneumothorax in the left lung - ANSWER-Miniscus formation means accumulation is
curling and going up the side, dull percussion can be solid or fluid filled (not just
consolidation), since its pushing to the right it has to be a problem outside the lung, so
the ANSWER is A.
The respiratory therapist has been paged to the ICU to assist in the treatment of a 98 kg
(215 lb) man. The patient is pale, diaphoretic, and suddenly loses consciousness. No
palpable pulse or blood pressure is measured. The ECG monitor displays the following
sinus bradycardia with a rate of 45): The respiratory therapist should:
A. confirm the ECG in another lead.
B. begin chest compressions.
C. perform cardioversion.
D. perform defibrillation. - ANSWER-ECG is showing sinus bradycardia with a rate of
45, all this leads up to begin chest compressions, so ANSWER is B. Do not perform
