Which of the following equipment is most helpful at measuring FRC in a patient who has sig-
nificant non-ventilated lung spaces?
A. nitrogen analyzer for a nitrogen washout test.
B. helium analyzer for a helium dilution test.
C. plethysmograph.
D. peak flow meter. - ANSWER C. plethysmograph.
Explanation : You can determine FRC in three different ways - body box, nitrogen washout,
or helium dilution. If someone has non-ventilated lung space, nitrogen washout and helium
dilution are not helpful and may be inaccurate. FRC determined by body box will be higher
because it can access non-ventilated lung space and therefore is more accurate.
The respiratory therapist is making a home visit to evaluate an oxygen-dependent patient.
The patient has 3+ pitting peripheral edema and has not followed the physician's orders to
limit fluid intake. You would expect which of the following hemodynamic values?
A. elevated PCWP with a low cardiac output.
B. low mean arterial pressure.
C. elevated right sided preload with a normal to low right ventricular after load.
D. reduced cardiac index. - ANSWER C. elevated right sided preload with a normal to
low right ventricular after load.
Explanation : Right-sided preload is another name for CVP (central venous pressure). Periph-
eral edema is one of the signs associated with right heart failure, which results in an ele-
vated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right ventricular af-
terload.
1
,A ventilator-dependent patient is scheduled for an MRI, which will require a transport of 90
minutes. The patient is receiving humidification with a heated- humidification system. A
transport ventilator is available. How should a respiratory therapist assure that humidifica-
tion will be provided to the patient during the MRI procedure?
A. Provide a pass-over humidifier.
B. Provide an HME.
C. Provide ventilation with a manual resuscitator.
D. Use the same humidification system in use on the primary ventilator. - ANSWER B.
Provide an HME.
Explanation : A heat moisture exchanger (HME) is appropriate for a transport of only 90 min.
Furthermore, the scenario does not suggest that the patient has thick, retained secretions,
therefore an HME may be applied.
Which of the following conditions would benefit most from polysomnography?
A. COPD.
B. congestive heart failure.
C. suspected increased airway resistance.
D. obesity with increased day-time sleepiness. - ANSWER D. obesity with increased
day-time sleepiness.
Explanation : Polysomnography is another word for sleep study. An obese patient who has
daytime sleepiness would benefit most from polysomnography. Keep in mind that Poly-
somnography is the study of the problem - not the solution. But it must be done for diagnos-
tic purposes and in order to find the adequate CPAP setting.
Which of the following can accurately be stated about a widening alveolar-arterial oxygen
gradient?
2
,A. decreased venous admixture.
B. onset of oxygen toxicity.
C. increased intrapulmonary shunting.
D. improving V/Q mismatch. - ANSWER C. increased intrapulmonary shunting.
Explanation : A normal alveolar arterial oxygen gradient is below 65 mmHg. When that gradi-
ent rises to 200, 300, 400, or more, then you have what is called shunting. If the A-a gradient
is less than 300 it's technically called a ventilation perfusion (VQ) mismatch. But generally
speaking, as the gradient widens it can properly be said that there is an increase in pulmo-
nary shunting.
How many hours will an H cylinder with 1400 psi last for a patient receiving oxygen at 7 lpm?
A. 6 hours
B. less than 1 hour
C. 10 hours
D. 4 hours - ANSWER C. 10 hours
Explanation : And H cylinder has a tank factor of 3.14. 3.14x1400 PSI = 4396 L. 4396 L / 7 L
per minute = 628 min. 628 min./ 60 min.= 10.4 hours, or about 10 hours. When you get an
answer that is not exact, pick the closest number possible. It is common on the exam not
see the exact answer from your calculation. This is because the NBRC knows that you're esti-
mating.
The respiratory therapist notes a fall in pulse from 80/min to 60/min with a proportional
drop in blood pressure during a suction procedure. Which of the following would be the
most likely cause of these observations?
A. Copious secretions.
B. Vagal reflex.
3
, C. Transient hypoxemia.
D. Suction pressure is too high. - ANSWER B. Vagal reflex.
Explanation : During suctioning, a patient's heart rate may fall. This is a normal physiological
response associated with the vagal reflex, or the vagal nerve response. This response will
also lower blood pressure.
A bronchopleural fistula on a patient receiving mechanical ventilation with a chest tube
drainage system in place would be most likely be indicated by which of the following obser-
vations?
A. occasional low-exhaled volume alarm.
B. high pressure ventilator alarm.
C. excess bubbling in the water seal chamber.
D. I:E ratio alarms. - ANSWER C. excess bubbling in the water seal chamber.
Explanation : A bronchopleural fistula is essentially a leak from the airway in the lungs to the
pleural space. This condition can result in two things - one) a low-pressure or low-volume
alarm, 2) excess bubbling in the water seal chamber of the chest tube drainage system.
When you look at the answers, a leak would not cause a high pressure alarm.
The best test determination for a forced vital capacity maneuver is done by which of the fol-
lowing calculations?
A. FEV1 + FVC.
B. SVC + FVC.
C. TLC - FVC.
D. FEV1/FVC. - ANSWER A. FEV1 + FVC.
4
nificant non-ventilated lung spaces?
A. nitrogen analyzer for a nitrogen washout test.
B. helium analyzer for a helium dilution test.
C. plethysmograph.
D. peak flow meter. - ANSWER C. plethysmograph.
Explanation : You can determine FRC in three different ways - body box, nitrogen washout,
or helium dilution. If someone has non-ventilated lung space, nitrogen washout and helium
dilution are not helpful and may be inaccurate. FRC determined by body box will be higher
because it can access non-ventilated lung space and therefore is more accurate.
The respiratory therapist is making a home visit to evaluate an oxygen-dependent patient.
The patient has 3+ pitting peripheral edema and has not followed the physician's orders to
limit fluid intake. You would expect which of the following hemodynamic values?
A. elevated PCWP with a low cardiac output.
B. low mean arterial pressure.
C. elevated right sided preload with a normal to low right ventricular after load.
D. reduced cardiac index. - ANSWER C. elevated right sided preload with a normal to
low right ventricular after load.
Explanation : Right-sided preload is another name for CVP (central venous pressure). Periph-
eral edema is one of the signs associated with right heart failure, which results in an ele-
vated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right ventricular af-
terload.
1
,A ventilator-dependent patient is scheduled for an MRI, which will require a transport of 90
minutes. The patient is receiving humidification with a heated- humidification system. A
transport ventilator is available. How should a respiratory therapist assure that humidifica-
tion will be provided to the patient during the MRI procedure?
A. Provide a pass-over humidifier.
B. Provide an HME.
C. Provide ventilation with a manual resuscitator.
D. Use the same humidification system in use on the primary ventilator. - ANSWER B.
Provide an HME.
Explanation : A heat moisture exchanger (HME) is appropriate for a transport of only 90 min.
Furthermore, the scenario does not suggest that the patient has thick, retained secretions,
therefore an HME may be applied.
Which of the following conditions would benefit most from polysomnography?
A. COPD.
B. congestive heart failure.
C. suspected increased airway resistance.
D. obesity with increased day-time sleepiness. - ANSWER D. obesity with increased
day-time sleepiness.
Explanation : Polysomnography is another word for sleep study. An obese patient who has
daytime sleepiness would benefit most from polysomnography. Keep in mind that Poly-
somnography is the study of the problem - not the solution. But it must be done for diagnos-
tic purposes and in order to find the adequate CPAP setting.
Which of the following can accurately be stated about a widening alveolar-arterial oxygen
gradient?
2
,A. decreased venous admixture.
B. onset of oxygen toxicity.
C. increased intrapulmonary shunting.
D. improving V/Q mismatch. - ANSWER C. increased intrapulmonary shunting.
Explanation : A normal alveolar arterial oxygen gradient is below 65 mmHg. When that gradi-
ent rises to 200, 300, 400, or more, then you have what is called shunting. If the A-a gradient
is less than 300 it's technically called a ventilation perfusion (VQ) mismatch. But generally
speaking, as the gradient widens it can properly be said that there is an increase in pulmo-
nary shunting.
How many hours will an H cylinder with 1400 psi last for a patient receiving oxygen at 7 lpm?
A. 6 hours
B. less than 1 hour
C. 10 hours
D. 4 hours - ANSWER C. 10 hours
Explanation : And H cylinder has a tank factor of 3.14. 3.14x1400 PSI = 4396 L. 4396 L / 7 L
per minute = 628 min. 628 min./ 60 min.= 10.4 hours, or about 10 hours. When you get an
answer that is not exact, pick the closest number possible. It is common on the exam not
see the exact answer from your calculation. This is because the NBRC knows that you're esti-
mating.
The respiratory therapist notes a fall in pulse from 80/min to 60/min with a proportional
drop in blood pressure during a suction procedure. Which of the following would be the
most likely cause of these observations?
A. Copious secretions.
B. Vagal reflex.
3
, C. Transient hypoxemia.
D. Suction pressure is too high. - ANSWER B. Vagal reflex.
Explanation : During suctioning, a patient's heart rate may fall. This is a normal physiological
response associated with the vagal reflex, or the vagal nerve response. This response will
also lower blood pressure.
A bronchopleural fistula on a patient receiving mechanical ventilation with a chest tube
drainage system in place would be most likely be indicated by which of the following obser-
vations?
A. occasional low-exhaled volume alarm.
B. high pressure ventilator alarm.
C. excess bubbling in the water seal chamber.
D. I:E ratio alarms. - ANSWER C. excess bubbling in the water seal chamber.
Explanation : A bronchopleural fistula is essentially a leak from the airway in the lungs to the
pleural space. This condition can result in two things - one) a low-pressure or low-volume
alarm, 2) excess bubbling in the water seal chamber of the chest tube drainage system.
When you look at the answers, a leak would not cause a high pressure alarm.
The best test determination for a forced vital capacity maneuver is done by which of the fol-
lowing calculations?
A. FEV1 + FVC.
B. SVC + FVC.
C. TLC - FVC.
D. FEV1/FVC. - ANSWER A. FEV1 + FVC.
4
