NBRC TMC Practice with rationales
UPDATED Study Guide QUESTIONS
AND CORRET ANSWSER
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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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.
During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough. Watery secretions
are aspirated through the catheter. Which of the following should the respiratory therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
, d. Increase the suction pressure and repeat the procedure - CORRECT ANSWERS
Hyperextend the patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oropharynx or
the esophagus. Hyperextending the neck will better direct the catheter to the trachea.
A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dyspnea, and a
cough that occurs every summer. Which of the following drug classifications should a respiratory
therapist recommend to control the patient's symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
d. Anticholinergic - CORRECT ANSWERS Leukotriene inhibitor
Explain: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene inhibitor,
such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis.
A patient with pulmonary edema receives furosemide (Lasix), dopamine (Intropin), and 02. Flattened
T-waves and occasional PVC's are observed on the monitor. Which of the following should a
respiratory therapist initially recommend to evaluate the effect of these medications?
1. End-tidal C02
2. Pulse oximetry
3. Echocardiogram
4. Electrolytes
Choose the best answer
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only - CORRECT ANSWERS 2 and 4 only
Explain:
UPDATED Study Guide QUESTIONS
AND CORRET ANSWSER
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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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.
During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough. Watery secretions
are aspirated through the catheter. Which of the following should the respiratory therapist do next?
a. Insert an oropharyngeal airway and repeat the procedure
b. Hyperextend the patient's next when passing the catheter
c. Ask the patient to swallow while passing the catheter
, d. Increase the suction pressure and repeat the procedure - CORRECT ANSWERS
Hyperextend the patient's next when passing the catheter
Explain: Aspiration of watery secretions would indicate catheter position in either the oropharynx or
the esophagus. Hyperextending the neck will better direct the catheter to the trachea.
A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dyspnea, and a
cough that occurs every summer. Which of the following drug classifications should a respiratory
therapist recommend to control the patient's symptoms?
a. Leukotriene inhibitor
b. IgE immunoglobulin antagonist
c. Beta-adrenergic agonist
d. Anticholinergic - CORRECT ANSWERS Leukotriene inhibitor
Explain: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene inhibitor,
such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis.
A patient with pulmonary edema receives furosemide (Lasix), dopamine (Intropin), and 02. Flattened
T-waves and occasional PVC's are observed on the monitor. Which of the following should a
respiratory therapist initially recommend to evaluate the effect of these medications?
1. End-tidal C02
2. Pulse oximetry
3. Echocardiogram
4. Electrolytes
Choose the best answer
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only - CORRECT ANSWERS 2 and 4 only
Explain:
