NBRC CSE Practice Exam Review Questions And
Answers Verified 100% Correct
Information Gathering - Head Trauma
(Defined: Physical Trauma to the head) - ANSWER -LEVEL I : Sometimes trauma
is visible with blood contusions on the head, History is trauma related, often
automobile accident
LEVEL II : Looks and acts sleepy, difficult to arouse
Respiratory rate and pattern is low and/or shallow and irregular
Pupillary response to light may be unequal or inadequate
LEVEL IV : If intracranial pressure monitor is in place, may see ICP greater than
20cm H2O
Decision Making - Head Trauma
(Defined: Physical Trauma to the head)
**Unique to this simulation is the need to monitor ICP readings and avoid
anything that increases MAP. You will likely need to suction this patient to keep
peak
pressures down but the very act of doing so my elevate ICPs. - ANSWER -Must
constrict vessels in the head by keeping PaCO2 between 25-30 mm Hg.
Adjust FIO2 to maintain high normal levels (PaO2 of 100 mm Hg).
Avoid increased ICP by minimizing PEEP usage.
Suction only when needed, due to elevating peak pressures.
Avoid anything that will increase mean arterial pressure (MAP).
Sedation is important, but should monitor exhaled volumes and pressures closely
Use of drugs such as Mannitol (cerebral diuretic medication) when ICP is above 20
cm
H20
Use Dilantin and establish an airway if grand mal seizure activity is observed
Information Gathering - Chest Trauma
(Defined: May be any trauma leading to fractured ribs or flail chest.) - ANSWER -
LEVEL I : Circumstantial history (motor vehicle accident, etc)
Respiratory rate and pattern is fast and shallow due to pain
May have obvious trauma (bruising) on chest wall
,LEVEL II : Sharp chest pain, especially at the top of each breath
Paradoxical chest movement if ribs are broken in two places (flail chest)
Pneumothorax is possible (see signs and symptoms of pneumothorax)
LEVEL III : Chest x-ray—may reveal broken ribs, usually isolated in same area
Decision Making - Chest Trauma
(Defined: May be any trauma leading to fractured ribs or flail chest.)
**This case is usually easy to recognize. You may be tempted by options that
address the broken ribs when, in fact, you simply need to address ventilation. Very
commonly, this case will lead to pneumothorax or partial pneumothorax or
hemothorax. - ANSWER -Anything that encourages deep (adequate) breathing in
spite of pain such as IPPB, incentive
spirometry, coughing.
Watch for ventilatory fatigue and eventual ventilatory failure
Mechanically support ventilation when it is evident ventilatory failure is
impending. If possible
do not wait until full ventilatory failure.
Treat partial pneumothorax if greater than 20% - ie insert chest tubes
Treat hemothorax, with chest tubes or thoracentesis
Treat tension pneumothorax with a large-bore needle
Information Gathering - Hemothorax/Pneumothorax
(Defined: Defined: Loss of adherence of the lung to the
pleural wall causing the space to be filled with air or fluid (bloody). ) - ANSWER -
LEVEL I : Rapid and shallow respirations
LEVEL II : Percussion: hyperresonant if pneumothorax, dull if hemothorax,
Tracheal shift: to affected side if pneumothorax, away if tension pneumothorax,
Severe dyspnea, Very diminished or absent breath sounds, Pulses paradoxes
LEVEL III : Chest x-ray—definitive—show hyperlucency, tracheal or mediastinal
shift
Decision Making - Hemothorax/Pneumothorax
(Defined: Defined: Loss of adherence of the lung to the
pleural wall causing the space to be filled with air or fluid (bloody). )
,**Pneumothorax, hemothorax, tension pneumothorax occurs very frequently on
the exam. May include the troubleshooting of chest tube drainage devices -
ANSWER -Usual treatment is insertion of chest tubes
Upper anterior chest tube placement for pneumothorax (involving air)
Lower chest tube placement for hemothroax (involving blood and body fluid)
Treat partial pneumothorax if greater than 20% - insert chest tubes
Treat hemothorax, with chest tubes or thoracentesis
Treat tension pneumothorax with a large-bore needle
Information Gathering : Thoracic Surgery
(Defined: Can have a variety of complications from thoracic surgery.) - ANSWER
-LEVEL II : Always monitoring chest tube drainage adequacy
Looking for potential complications: Hypovolemic shock, low hemodynamic
values including blood pressure, Subcutaneous emphysema, Elevated ventilatory
pressures
LEVEL III : Chest x-ray—to confirm proper re-inflation of the lung and proper
placement of chest tubes
Decision Making : Thoracic Surgery
(Defined: Can have a variety of complications from thoracic surgery.)
**Your ability to deal with and troubleshoot chest tube
maintenance is tested in this simulation. Sometimes this case is combined with
chest trauma. - ANSWER -Anything that promotes expansion of the lungs
including incentive spirometry, IPPB, and positive pressure mechanical ventilation.
If a lobectomy or pneumonectomy, ventilatory volumes should set lower. Fluid
therapy if volume is a problem (often is). If mechanical ventilation is used, use VT
of 8-9 mL/kg to reduce ventilatory pressures.
Information Gathering : Neck/Spinal Injury
(Defined: Any trauma threatening the physical structure of the neck. Can include
neck or spinal surgery.) - ANSWER -LEVEL I : Historical relevance, some sort of
accident such as diving, automobile. Visible damage to the neck. Altered conscious
level. Pulse must be palpated brachially or femorally
LEVEL II : Vt, VC, PEFR, and other ventilatory volumes may quickly deteriorate
LEVEL III : Neck x-ray—will show injury
, Decision Making : Neck/Spinal Injury
(Defined: Any trauma threatening the physical structure of the neck. Can include
neck or spinal surgery.)
**Your knowledge of special intubation techniques is what is being tested in this
type of simulation. - ANSWER -Always be prepared to quickly assist and/or
promote ventilation.
If intubation is required, always use MODIFIED jaw thrust.
If given option, always intubate with a bronchoscope so damage can be visualized
and care can be taken to avoid inflicting further damage.
Alternatively, a blind nasal intubation is acceptable to prevent neck manipulation
and further
injury
Information Gathering : Abdominal Surgery
(Defined: Surgery in the abdominal area for various
reasons.) - ANSWER -LEVEL I : All general visual assessments
LEVEL II : All general beside assessment including all vitals
LEVEL III : Ventilatory volumes (VC, Vt, FEV1) compared to pre-surgery
baselines
Decision Making : Abdominal Surgery
(Defined: Surgery in the abdominal area for various
reasons.)
**Abdominal surgery is usually a very general, non-complicated case involving
preventative care and follow-up. - ANSWER -Establishing baselines in pulmonary
function testing flows and volumes.
Start patient on incentive spirometry prior to surgery, every hour after surgery
Initial IS goal is 1/2 of the preoperative inspiratory capacity value.
Use positive pressure (IPPB) if needed after surgery if patient is unconscious.
Information Gathering : ARDS
(Defined: A condition that results in significantly
decrease lung compliance and consequent profound
Answers Verified 100% Correct
Information Gathering - Head Trauma
(Defined: Physical Trauma to the head) - ANSWER -LEVEL I : Sometimes trauma
is visible with blood contusions on the head, History is trauma related, often
automobile accident
LEVEL II : Looks and acts sleepy, difficult to arouse
Respiratory rate and pattern is low and/or shallow and irregular
Pupillary response to light may be unequal or inadequate
LEVEL IV : If intracranial pressure monitor is in place, may see ICP greater than
20cm H2O
Decision Making - Head Trauma
(Defined: Physical Trauma to the head)
**Unique to this simulation is the need to monitor ICP readings and avoid
anything that increases MAP. You will likely need to suction this patient to keep
peak
pressures down but the very act of doing so my elevate ICPs. - ANSWER -Must
constrict vessels in the head by keeping PaCO2 between 25-30 mm Hg.
Adjust FIO2 to maintain high normal levels (PaO2 of 100 mm Hg).
Avoid increased ICP by minimizing PEEP usage.
Suction only when needed, due to elevating peak pressures.
Avoid anything that will increase mean arterial pressure (MAP).
Sedation is important, but should monitor exhaled volumes and pressures closely
Use of drugs such as Mannitol (cerebral diuretic medication) when ICP is above 20
cm
H20
Use Dilantin and establish an airway if grand mal seizure activity is observed
Information Gathering - Chest Trauma
(Defined: May be any trauma leading to fractured ribs or flail chest.) - ANSWER -
LEVEL I : Circumstantial history (motor vehicle accident, etc)
Respiratory rate and pattern is fast and shallow due to pain
May have obvious trauma (bruising) on chest wall
,LEVEL II : Sharp chest pain, especially at the top of each breath
Paradoxical chest movement if ribs are broken in two places (flail chest)
Pneumothorax is possible (see signs and symptoms of pneumothorax)
LEVEL III : Chest x-ray—may reveal broken ribs, usually isolated in same area
Decision Making - Chest Trauma
(Defined: May be any trauma leading to fractured ribs or flail chest.)
**This case is usually easy to recognize. You may be tempted by options that
address the broken ribs when, in fact, you simply need to address ventilation. Very
commonly, this case will lead to pneumothorax or partial pneumothorax or
hemothorax. - ANSWER -Anything that encourages deep (adequate) breathing in
spite of pain such as IPPB, incentive
spirometry, coughing.
Watch for ventilatory fatigue and eventual ventilatory failure
Mechanically support ventilation when it is evident ventilatory failure is
impending. If possible
do not wait until full ventilatory failure.
Treat partial pneumothorax if greater than 20% - ie insert chest tubes
Treat hemothorax, with chest tubes or thoracentesis
Treat tension pneumothorax with a large-bore needle
Information Gathering - Hemothorax/Pneumothorax
(Defined: Defined: Loss of adherence of the lung to the
pleural wall causing the space to be filled with air or fluid (bloody). ) - ANSWER -
LEVEL I : Rapid and shallow respirations
LEVEL II : Percussion: hyperresonant if pneumothorax, dull if hemothorax,
Tracheal shift: to affected side if pneumothorax, away if tension pneumothorax,
Severe dyspnea, Very diminished or absent breath sounds, Pulses paradoxes
LEVEL III : Chest x-ray—definitive—show hyperlucency, tracheal or mediastinal
shift
Decision Making - Hemothorax/Pneumothorax
(Defined: Defined: Loss of adherence of the lung to the
pleural wall causing the space to be filled with air or fluid (bloody). )
,**Pneumothorax, hemothorax, tension pneumothorax occurs very frequently on
the exam. May include the troubleshooting of chest tube drainage devices -
ANSWER -Usual treatment is insertion of chest tubes
Upper anterior chest tube placement for pneumothorax (involving air)
Lower chest tube placement for hemothroax (involving blood and body fluid)
Treat partial pneumothorax if greater than 20% - insert chest tubes
Treat hemothorax, with chest tubes or thoracentesis
Treat tension pneumothorax with a large-bore needle
Information Gathering : Thoracic Surgery
(Defined: Can have a variety of complications from thoracic surgery.) - ANSWER
-LEVEL II : Always monitoring chest tube drainage adequacy
Looking for potential complications: Hypovolemic shock, low hemodynamic
values including blood pressure, Subcutaneous emphysema, Elevated ventilatory
pressures
LEVEL III : Chest x-ray—to confirm proper re-inflation of the lung and proper
placement of chest tubes
Decision Making : Thoracic Surgery
(Defined: Can have a variety of complications from thoracic surgery.)
**Your ability to deal with and troubleshoot chest tube
maintenance is tested in this simulation. Sometimes this case is combined with
chest trauma. - ANSWER -Anything that promotes expansion of the lungs
including incentive spirometry, IPPB, and positive pressure mechanical ventilation.
If a lobectomy or pneumonectomy, ventilatory volumes should set lower. Fluid
therapy if volume is a problem (often is). If mechanical ventilation is used, use VT
of 8-9 mL/kg to reduce ventilatory pressures.
Information Gathering : Neck/Spinal Injury
(Defined: Any trauma threatening the physical structure of the neck. Can include
neck or spinal surgery.) - ANSWER -LEVEL I : Historical relevance, some sort of
accident such as diving, automobile. Visible damage to the neck. Altered conscious
level. Pulse must be palpated brachially or femorally
LEVEL II : Vt, VC, PEFR, and other ventilatory volumes may quickly deteriorate
LEVEL III : Neck x-ray—will show injury
, Decision Making : Neck/Spinal Injury
(Defined: Any trauma threatening the physical structure of the neck. Can include
neck or spinal surgery.)
**Your knowledge of special intubation techniques is what is being tested in this
type of simulation. - ANSWER -Always be prepared to quickly assist and/or
promote ventilation.
If intubation is required, always use MODIFIED jaw thrust.
If given option, always intubate with a bronchoscope so damage can be visualized
and care can be taken to avoid inflicting further damage.
Alternatively, a blind nasal intubation is acceptable to prevent neck manipulation
and further
injury
Information Gathering : Abdominal Surgery
(Defined: Surgery in the abdominal area for various
reasons.) - ANSWER -LEVEL I : All general visual assessments
LEVEL II : All general beside assessment including all vitals
LEVEL III : Ventilatory volumes (VC, Vt, FEV1) compared to pre-surgery
baselines
Decision Making : Abdominal Surgery
(Defined: Surgery in the abdominal area for various
reasons.)
**Abdominal surgery is usually a very general, non-complicated case involving
preventative care and follow-up. - ANSWER -Establishing baselines in pulmonary
function testing flows and volumes.
Start patient on incentive spirometry prior to surgery, every hour after surgery
Initial IS goal is 1/2 of the preoperative inspiratory capacity value.
Use positive pressure (IPPB) if needed after surgery if patient is unconscious.
Information Gathering : ARDS
(Defined: A condition that results in significantly
decrease lung compliance and consequent profound
