NBRC TMC LATEST UPDATE 2025 PRACTICE WITH RATIONALES (100% ACCURATE
SOLUTIONS)
An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After the
patient is placed on the system, the respiratory therapist notices that the pressure falls to 2
cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system
Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. Increasing the
flow should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing. Severe
suprasternal, subcostal and substernal retraction are observed. The child has a harsh,
barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
,d. Asthma
Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral
illness. The barky cough is a classic finding for patients experiencing croup.
The polysomnography sleep laboratory is full scheduled for several weeks. The physician
wants to know if there is another option to determine if a patient has sleep apnea. What
should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison
Overnight pulse oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation is found to decrease during apnea
episodes.
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old female
who was admitted 12 hours ago for an aspirin overdose. The following information is
obtained as the patient breathes air:
HR 89/min
RR 15/min
,BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site
Validate the Sp02 reading at a different site
Explain: The saturation may not be accurate and should be measured at a different site.
A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration of CPAP.
The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A respiratory
therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP
Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypopnea
episodes, standard protocol is to incrementally increase the CPAP level until this occurs.
, An arterial puncture has been performed to obtain blood for analysis of 02, C02, and pH.
What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood
Place it into a mix of ice and water
Explain: Placing the blood sample into ice water will prevent the blood from consuming the
O2 within the sample.
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle crash.
The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving volume-
controlled ventilation. Twenty-four hours later, the patient has clear breath sounds but
cannot tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H20
pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube
Reintubating with a larger endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of
increased airways resistance. This can be resolved only by a larger tube or extubation.
SOLUTIONS)
An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After the
patient is placed on the system, the respiratory therapist notices that the pressure falls to 2
cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system
Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow. Increasing the
flow should meet the patient's inspiratory flow needs and stabilize the CPAP pressure.
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing. Severe
suprasternal, subcostal and substernal retraction are observed. The child has a harsh,
barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
,d. Asthma
Croup
Explain: The patient has some degree of upper airway obstruction caused by some viral
illness. The barky cough is a classic finding for patients experiencing croup.
The polysomnography sleep laboratory is full scheduled for several weeks. The physician
wants to know if there is another option to determine if a patient has sleep apnea. What
should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison
Overnight pulse oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation is found to decrease during apnea
episodes.
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old female
who was admitted 12 hours ago for an aspirin overdose. The following information is
obtained as the patient breathes air:
HR 89/min
RR 15/min
,BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site
Validate the Sp02 reading at a different site
Explain: The saturation may not be accurate and should be measured at a different site.
A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration of CPAP.
The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A respiratory
therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP
Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and hypopnea
episodes, standard protocol is to incrementally increase the CPAP level until this occurs.
, An arterial puncture has been performed to obtain blood for analysis of 02, C02, and pH.
What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood
Place it into a mix of ice and water
Explain: Placing the blood sample into ice water will prevent the blood from consuming the
O2 within the sample.
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle crash.
The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving volume-
controlled ventilation. Twenty-four hours later, the patient has clear breath sounds but
cannot tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H20
pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube
Reintubating with a larger endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because of
increased airways resistance. This can be resolved only by a larger tube or extubation.
