NBRC Written RRT Self-Assessment Examination (Form D)
1 Shortly after the respiratory therapist caps a patient's tracheostomy
tube, the patient appears agitated, and the respiratory rate and heart
rate have increased. The SpO2 has fallen from 97% to 93%. Which of
the following should the therapist do first?
A. Ask the patient to speak.
B. Inflate the pilot balloon of the tracheostomy tube.
C. Remove the tracheostomy and insert another.
D. Increase the FIO2.
EXPLANATIONS:
(c) A. If the patient can speak, then the patient needs to be reassured
that it is difficult to breathe around the tube, but it is OK. The
respiratory therapist should remove the cap if the patient does not
speak and the condition does not improve.
(h) B. If the balloon were inflated, the patient would not be able to
breathe.
(h) C. This is unnecessary in this situation.
(u) D. This may help the situation, but it would not correct the problem.
2 The respiratory therapist is reviewing the most recent report from a
patient's PA chest radiograph. The right heart border can be identified
and the right diaphragm is obscured. How should the patient be
positioned for postural drainage and percussion over the affected
area?
A. supine with pillow under the knees
B. lying on left side with head down 15 degrees and rotated 1/4
turn backward
C. in a semi-Fowler's position
D. in a prone position with head down 25 degrees
EXPLANATIONS:
(u) A. Supine with a pillow under the knees drains the anterior
segments of the upper lobe.
(u) B. Lying on left side with head down 15 degrees and twisted 1/4 turn
backward drains the right middle lobe.
(u) C. A semi-Fowler's position drains the apical segments of the upper
lobes.
(c) D. The obscured right diaphragm indicates a process in the right
lower lobe. Lying in prone position with head down 25 degrees drains
the posterior basal segments of the lower lobes.
,3 A patient's fluid balance is relevant because it provides information
about
I. renal function.
II. congestive heart failure.
III. pulmonary hypertension.
IV. pulmonary edema.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
EXPLANATIONS:
I. True. A major component of renal function is maintenance of fluid
balance. Therefore, impaired function would be monitored by using
fluid balance measurements.
II. True. Careful fluid balance is essential to the appropriate
management of any patient in whom there is difficulty with
spontaneous maintenance of fluid and electrolytes.
III. False. There is little relationship between fluid balance and
secondary pulmonary hypertension.
IV. True. See statement II.
(u) A. Incomplete and incorrect response included.
(c) B. Correct response.
(u) C. Incomplete and incorrect response included.
(u) D. Incomplete and incorrect response included.
4 Which of the following would the respiratory therapist use to confirm
the presence of auto-PEEP during volume-controlled ventilation?
A. square-wave inspiratory flow
B. end-expiratory hold
C. plateau pressure
D. PSV mode
EXPLANATIONS:
(u) A. Auto-PEEP is not detected during the inspiratory phase.
(c) B. Auto-PEEP is detected at the end of the expiratory phase.
Expiratory hold permits pressure to be equilibrated throughout the
ventilator circuit and the patient's airway, allowing estimation of
alveolar pressure.
(u) C. Plateau pressure is an end-inspiratory measurement. See
explanation A.
(u) D. Auto-PEEP cannot be accurately detected during expiratory hold
in a spontaneously breathing patient.
,5 A 34-week gestational age infant is receiving mechanical ventilation
and the chest is being transilluminated. The transillumination device
produces a small halo appearance at the point of contact with the
skin. Which of the following does this indicate?
A. pneumothorax
B. pneumomediastinum
C. pneumopericardium
D. normal lung appearance
EXPLANATIONS:
(u) A. When there is excessive air or fluid present, light transmission
will be increased. Transillumination of the air-filled chest in the neonate
with a pneumothorax results in lighting up the affected side of the
chest.
(u) B. Transillumination will light up the chest in patients with
pneumomediastinum. See explanation A.
(u) C. Transillumination is not used to determine pneumopericardium.
(c) D. The halo appearance is produced by a normal, inflated lung
absorbing the light.
6 The respiratory therapist is called to deliver a second dose of 5 mg
aerosolized albuterol to a patient with acute asthma. The patient had
wheezing audible without a stethoscope after the first treatment 20
minutes ago. Auscultation now demonstrates no wheezing with very
decreased breath sounds. The patient is receiving oxygen by nasal
cannula at 3 L/min and the SpO2 is 88%. Which of the following has
MOST likely occurred?
A.
Th B. The airways obstruction has worsened.
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C. The SpO2 value was inaccurate.
D. The first treatment was ineffective.
EXPLANATIONS:
(u) A. Reversal of bronchospasm would result in improved breath
sounds. The decreased breath sounds are caused by lack of air
exchange from worsened bronchospasm.
(c) B. This patient is not ventilating enough to produce wheezing. The
decreased breath sounds and absent wheezing reflect the lack of air
exchange.
(u) C. The patient's SpO2 is likely low because of inadequate air
exchange.
(u) D. This patient is not ventilating enough to produce wheezing. The
decreased breath sounds and absent wheezing reflect worsening of the
patient's bronchospasm, regardless of the previous treatment.
7 A patient receiving aerosolized bronchodilator treatments with a small
volume nebulizer develops a tracheal infection involving Escherichia
coli. Which of the following is the most likely cause of the infection?
A. failure to change the tubing frequently
B. inadequate handwashing techniques
C. placing unsterile water in the nebulizer
D. contamination of disposable equipment
EXPLANATIONS:
(u) A. Failure to change the tubing frequently would most probably
result in multiple organism contamination of the tubing.
(c) B. Escherichia coli, a gram-negative organism generally found in the
intestine, is primarily transmitted by infrequent or inadequate
handwashing.
(u) C. Using unsterile water would rarely result in gram-negative
contamination.
(u) D. The possibility of contamination of disposable equipment by
Escherichia coli is remote.
8 A 42-year-old patient is receiving volume-controlled ventilation in the
assist/control mode with an F O of 0.45, a tidal volume of 800 mL, and
I 2
a mandatory rate of 10. The patient is anxious and has a total
respiratory rate of 30/min. Arterial blood gases are:
1 Shortly after the respiratory therapist caps a patient's tracheostomy
tube, the patient appears agitated, and the respiratory rate and heart
rate have increased. The SpO2 has fallen from 97% to 93%. Which of
the following should the therapist do first?
A. Ask the patient to speak.
B. Inflate the pilot balloon of the tracheostomy tube.
C. Remove the tracheostomy and insert another.
D. Increase the FIO2.
EXPLANATIONS:
(c) A. If the patient can speak, then the patient needs to be reassured
that it is difficult to breathe around the tube, but it is OK. The
respiratory therapist should remove the cap if the patient does not
speak and the condition does not improve.
(h) B. If the balloon were inflated, the patient would not be able to
breathe.
(h) C. This is unnecessary in this situation.
(u) D. This may help the situation, but it would not correct the problem.
2 The respiratory therapist is reviewing the most recent report from a
patient's PA chest radiograph. The right heart border can be identified
and the right diaphragm is obscured. How should the patient be
positioned for postural drainage and percussion over the affected
area?
A. supine with pillow under the knees
B. lying on left side with head down 15 degrees and rotated 1/4
turn backward
C. in a semi-Fowler's position
D. in a prone position with head down 25 degrees
EXPLANATIONS:
(u) A. Supine with a pillow under the knees drains the anterior
segments of the upper lobe.
(u) B. Lying on left side with head down 15 degrees and twisted 1/4 turn
backward drains the right middle lobe.
(u) C. A semi-Fowler's position drains the apical segments of the upper
lobes.
(c) D. The obscured right diaphragm indicates a process in the right
lower lobe. Lying in prone position with head down 25 degrees drains
the posterior basal segments of the lower lobes.
,3 A patient's fluid balance is relevant because it provides information
about
I. renal function.
II. congestive heart failure.
III. pulmonary hypertension.
IV. pulmonary edema.
A. I, II, and III only
B. I, II, and IV only
C. I, III, and IV only
D. II, III, and IV only
EXPLANATIONS:
I. True. A major component of renal function is maintenance of fluid
balance. Therefore, impaired function would be monitored by using
fluid balance measurements.
II. True. Careful fluid balance is essential to the appropriate
management of any patient in whom there is difficulty with
spontaneous maintenance of fluid and electrolytes.
III. False. There is little relationship between fluid balance and
secondary pulmonary hypertension.
IV. True. See statement II.
(u) A. Incomplete and incorrect response included.
(c) B. Correct response.
(u) C. Incomplete and incorrect response included.
(u) D. Incomplete and incorrect response included.
4 Which of the following would the respiratory therapist use to confirm
the presence of auto-PEEP during volume-controlled ventilation?
A. square-wave inspiratory flow
B. end-expiratory hold
C. plateau pressure
D. PSV mode
EXPLANATIONS:
(u) A. Auto-PEEP is not detected during the inspiratory phase.
(c) B. Auto-PEEP is detected at the end of the expiratory phase.
Expiratory hold permits pressure to be equilibrated throughout the
ventilator circuit and the patient's airway, allowing estimation of
alveolar pressure.
(u) C. Plateau pressure is an end-inspiratory measurement. See
explanation A.
(u) D. Auto-PEEP cannot be accurately detected during expiratory hold
in a spontaneously breathing patient.
,5 A 34-week gestational age infant is receiving mechanical ventilation
and the chest is being transilluminated. The transillumination device
produces a small halo appearance at the point of contact with the
skin. Which of the following does this indicate?
A. pneumothorax
B. pneumomediastinum
C. pneumopericardium
D. normal lung appearance
EXPLANATIONS:
(u) A. When there is excessive air or fluid present, light transmission
will be increased. Transillumination of the air-filled chest in the neonate
with a pneumothorax results in lighting up the affected side of the
chest.
(u) B. Transillumination will light up the chest in patients with
pneumomediastinum. See explanation A.
(u) C. Transillumination is not used to determine pneumopericardium.
(c) D. The halo appearance is produced by a normal, inflated lung
absorbing the light.
6 The respiratory therapist is called to deliver a second dose of 5 mg
aerosolized albuterol to a patient with acute asthma. The patient had
wheezing audible without a stethoscope after the first treatment 20
minutes ago. Auscultation now demonstrates no wheezing with very
decreased breath sounds. The patient is receiving oxygen by nasal
cannula at 3 L/min and the SpO2 is 88%. Which of the following has
MOST likely occurred?
A.
Th B. The airways obstruction has worsened.
e
alb
ute
rol
rev
ers
ed
the
bro
nc
ho
spa
, sm.
C. The SpO2 value was inaccurate.
D. The first treatment was ineffective.
EXPLANATIONS:
(u) A. Reversal of bronchospasm would result in improved breath
sounds. The decreased breath sounds are caused by lack of air
exchange from worsened bronchospasm.
(c) B. This patient is not ventilating enough to produce wheezing. The
decreased breath sounds and absent wheezing reflect the lack of air
exchange.
(u) C. The patient's SpO2 is likely low because of inadequate air
exchange.
(u) D. This patient is not ventilating enough to produce wheezing. The
decreased breath sounds and absent wheezing reflect worsening of the
patient's bronchospasm, regardless of the previous treatment.
7 A patient receiving aerosolized bronchodilator treatments with a small
volume nebulizer develops a tracheal infection involving Escherichia
coli. Which of the following is the most likely cause of the infection?
A. failure to change the tubing frequently
B. inadequate handwashing techniques
C. placing unsterile water in the nebulizer
D. contamination of disposable equipment
EXPLANATIONS:
(u) A. Failure to change the tubing frequently would most probably
result in multiple organism contamination of the tubing.
(c) B. Escherichia coli, a gram-negative organism generally found in the
intestine, is primarily transmitted by infrequent or inadequate
handwashing.
(u) C. Using unsterile water would rarely result in gram-negative
contamination.
(u) D. The possibility of contamination of disposable equipment by
Escherichia coli is remote.
8 A 42-year-old patient is receiving volume-controlled ventilation in the
assist/control mode with an F O of 0.45, a tidal volume of 800 mL, and
I 2
a mandatory rate of 10. The patient is anxious and has a total
respiratory rate of 30/min. Arterial blood gases are:
