NBRC CSE PRACTICE EXAM REVIEW STUDY
GUIDE LATEST 2025-2026 UPDATE
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Answer-LEVEL I : Accessory muscle use, Tachycardia
LEVEL II : Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL III : ABGs—possible respiratory acidosis, could be hypoxic,
Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
In allergic cases, may see elevated eosinophil count which can cause
yellow sputum
LEVEL IV : PFT—Decreased flows in FEV1 but diffusion is normal as
manifested by DLCO
Decision Making - Asthma
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Answer-Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy
Continuous bronchodilator therapy, Albuterol (7-10 mg/hr)
Xanthine medication given IV (Aminophylline, etc)
Promote pulmonary hygiene
,Inhaled sterioids such as oral or IV prednisone
Information Gathering - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation
therapy,usually persists more
than 24 hours.) - Answer-LEVEL I : Historically non-responsive to
bronchodilators. Patient will report the need to take many bronchodilator
treatments before feeling better. Accessory muscle use and retractions
Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL II : Pulses paradoxus
LEVEL III : ABGs—possible respiratory acidosis when tiring, alkalosis
at first due to anxiety, could be hypoxic
Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
Decision Making - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation
therapy,usually persists more
than 24 hours.) - Answer-May deteriorate quickly, so if progression is
shown, intubate, mechanically ventilate before full ventilatory failure.
Use subcutaneous epinephrine—1 mL of 1:1000 strength. May need to
give every 20—30 minutes for up to three consecutive doses (if no
improvement between doses)
Continuous beta II agonist (bronchodilator medication). Albuterol 7-10
mg/hr.
,Information Gathering : Myasthenia Gravis
(Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.) - Answer-LEVEL I : May have a history of
Myasthenia Gravis if not a new onset, Droopy facial muscles and eyelids
(Ptosis)
LEVEL II : Patient will describe slowly feeling weakness generally but
feels better with rest. Double vision (diplopia)
Dysphagia (difficulty swallowing) Drooping eyelid (Ptosis)
Shrinking Vt, VC, MIP
LEVEL IV : Tensilon Challenge Test—positive for Myasthenic crisis if
improvement is noted upon the administration of Tensilon.
Decision Making : Myasthenia Gravis
(Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.) - Answer-If Tensilon improves condition then,
anticholinesterase therapy is indicated including: Neostigmine
(prostigmine), Mestinon (pyridostigmine) Ok to do additional Tensilon
challenge test to observe progression. If symptoms improve with
Tensilon and then worsen, must reverse with Atropine. This condition is
termed a cholinergic crisis. Always monitor spontaneous ventilatory
volumes (Vt and VC) as well as MIP. Never treat Myasthenia gravis
, with Tensilon—only use to diagnose. Use the above mentioned drugs to
provide maintenance.
Be totally prepared to intubate and mechanically ventilate prior to
Tensilon challenge since it could take out the respiratory drive
When VC falls off rapidly (especially if below 1.0 L) , then intubate and
mechanically ventilate.
Information Gathering : Drug Overdose
(Defined: Potential loss of ventilatory drive as a
result of drug overdose (usually a narcotic). ) - Answer-LEVEL I :
Historical drug use as told by previous admissions or family, Sometimes
poor self-hygiene, emaciated
LEVEL II : Looks and acts sleepy, difficult to arouse, Respiratory rate
and pattern is low and/or shallow
LEVEL III : ABG—often show pure respiratory acidosis and/or
ventilatory failure
Decision Making : Drug Overdose
(Defined: Potential loss of ventilatory drive as a
result of drug overdose (usually a narcotic). )
**The most important part of this simulation is the need for immediate
intubation while recognizing that there may not be a need to
mechanically ventilate
GUIDE LATEST 2025-2026 UPDATE
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Answer-LEVEL I : Accessory muscle use, Tachycardia
LEVEL II : Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL III : ABGs—possible respiratory acidosis, could be hypoxic,
Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
In allergic cases, may see elevated eosinophil count which can cause
yellow sputum
LEVEL IV : PFT—Decreased flows in FEV1 but diffusion is normal as
manifested by DLCO
Decision Making - Asthma
(Defined: Abnormal constriction of the bronchials
resulting in sputum productionand narrowed
airways. - Answer-Oxygen therapy for hypoxemia
Aerosolized bronchodilator therapy
Continuous bronchodilator therapy, Albuterol (7-10 mg/hr)
Xanthine medication given IV (Aminophylline, etc)
Promote pulmonary hygiene
,Inhaled sterioids such as oral or IV prednisone
Information Gathering - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation
therapy,usually persists more
than 24 hours.) - Answer-LEVEL I : Historically non-responsive to
bronchodilators. Patient will report the need to take many bronchodilator
treatments before feeling better. Accessory muscle use and retractions
Dyspnea, Wheezing, Congested cough, Wet, clammy skin
LEVEL II : Pulses paradoxus
LEVEL III : ABGs—possible respiratory acidosis when tiring, alkalosis
at first due to anxiety, could be hypoxic
Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms.
Decision Making - Status Asthmaticus
(Defined: Asthma that will not respond to bronchodilation
therapy,usually persists more
than 24 hours.) - Answer-May deteriorate quickly, so if progression is
shown, intubate, mechanically ventilate before full ventilatory failure.
Use subcutaneous epinephrine—1 mL of 1:1000 strength. May need to
give every 20—30 minutes for up to three consecutive doses (if no
improvement between doses)
Continuous beta II agonist (bronchodilator medication). Albuterol 7-10
mg/hr.
,Information Gathering : Myasthenia Gravis
(Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.) - Answer-LEVEL I : May have a history of
Myasthenia Gravis if not a new onset, Droopy facial muscles and eyelids
(Ptosis)
LEVEL II : Patient will describe slowly feeling weakness generally but
feels better with rest. Double vision (diplopia)
Dysphagia (difficulty swallowing) Drooping eyelid (Ptosis)
Shrinking Vt, VC, MIP
LEVEL IV : Tensilon Challenge Test—positive for Myasthenic crisis if
improvement is noted upon the administration of Tensilon.
Decision Making : Myasthenia Gravis
(Defined: Neuromuscular abnormality where muscles
experience paralysis starting from the head down to the feet including
ventilatory muscles.) - Answer-If Tensilon improves condition then,
anticholinesterase therapy is indicated including: Neostigmine
(prostigmine), Mestinon (pyridostigmine) Ok to do additional Tensilon
challenge test to observe progression. If symptoms improve with
Tensilon and then worsen, must reverse with Atropine. This condition is
termed a cholinergic crisis. Always monitor spontaneous ventilatory
volumes (Vt and VC) as well as MIP. Never treat Myasthenia gravis
, with Tensilon—only use to diagnose. Use the above mentioned drugs to
provide maintenance.
Be totally prepared to intubate and mechanically ventilate prior to
Tensilon challenge since it could take out the respiratory drive
When VC falls off rapidly (especially if below 1.0 L) , then intubate and
mechanically ventilate.
Information Gathering : Drug Overdose
(Defined: Potential loss of ventilatory drive as a
result of drug overdose (usually a narcotic). ) - Answer-LEVEL I :
Historical drug use as told by previous admissions or family, Sometimes
poor self-hygiene, emaciated
LEVEL II : Looks and acts sleepy, difficult to arouse, Respiratory rate
and pattern is low and/or shallow
LEVEL III : ABG—often show pure respiratory acidosis and/or
ventilatory failure
Decision Making : Drug Overdose
(Defined: Potential loss of ventilatory drive as a
result of drug overdose (usually a narcotic). )
**The most important part of this simulation is the need for immediate
intubation while recognizing that there may not be a need to
mechanically ventilate
