NBRC CSE NEWEST EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES A NEW UPDATED
VERSION LATEST UPDATES 2026-2027 ( VERIFIED ANSWERS)
ALREADY GRADED A+
Question 1
A 58-year-old male with a 40-pack-year lsmoking history presents with worsening dyspnea and a
chronic productive cough. Spirometry shows FEV₁/FVC 0.65 and FEV₁ 48% predicted. What is the
most likely diagnosis?
A) Asthma
B) Restrictive lung disease
C) Chronic obstructive pulmonary disease (COPD)
D) Pulmonary fibrosis
Rationale: The fixed ratio FEV₁/FVC <0.70 and reduced FEV₁ indicate airflow obstruction. Asthma
typically shows reversibility; restrictive diseases show normal/reduced FVC with normal FEV₁/FVC.
Question 2
A 72-year-old patient post abdominal surgery develops sudden shortness of breath, tachycardia, and
hypoxia. What is the first diagnostic test to order?
A) Chest X-ray
B) D-dimer
C) CT pulmonary angiography
D) V/Q scan
Rationale: CT pulmonary angiography is definitive for pulmonary embolism. D-dimer is sensitive but
not specific. CXR rules out other causes but not PE.
,Question 3
During a CSE, you order a nebulizer treatment with albuterol. The patient’s heart rate increases from
88 to 120 bpm. Next step?
A) Discontinue albuterol immediately
B) Administer beta-blocker
C) Continue treatment and monitor for symptoms
D) Switch to ipratropium
Rationale: Mild tachycardia is a known side effect of beta-agonists. If asymptomatic, continue; severe
or symptomatic tachycardia warrants discontinuation.
Question 4
A patient with status asthmaticus is on continuous albuterol. ABG: pH 7.25, PaCO₂ 55, PaO₂ 70, HCO₃
24. What is the priority intervention?
A) Increase FiO₂
B) Initiate noninvasive or invasive ventilation
C) Administer IV steroids
D) Repeat ABG in 30 minutes
Rationale: Hypercapnia (PaCO₂ >45) with acidosis in asthma indicates impending respiratory failure;
mechanical support is indicated.
Question 5
Which finding on a chest X-ray is most consistent with tension pneumothorax?
A) Deep sulcus sign
B) Tracheal deviation away from the affected side
C) Hyperlucent lung fields
D) Blunted costophrenic angle
Rationale: Tension pneumothorax causes mediastinal shift and tracheal deviation away. The deep
sulcus sign is supine pneumothorax. Hyperlucency alone is simple pneumothorax.
,Question 6
You are evaluating a patient for weaning from mechanical ventilation. Which parameter best predicts
successful extubation?
A) MIP <-20 cmH₂O
B) *RSBI <105 breaths/min/L*
C) Vital capacity >10 mL/kg
D) PaO₂/FiO₂ >200
Rationale: Rapid Shallow Breathing Index (RSBI) <105 is most predictive of weaning success. MIP
and VC are supportive but less sensitive.
Question 7
A neonate with respiratory distress syndrome has worsening hypoxemia despite increasing FiO₂ to
100%. Next best step?
A) Increase PEEP
B) Administer surfactant
C) Switch to HFOV
D) Inhaled nitric oxide
Rationale: Surfactant deficiency is the primary defect in RDS; exogenous surfactant is indicated when
hypoxemia persists on high FiO₂.
Question 8
A 45-year-old with pneumonia has a PaO₂ 55 mmHg on room air. What is the initial oxygen delivery
device?
A) Nasal cannula at 2 L/min
B) Venturi mask at 28%
C) Non-rebreather mask
D) Simple oxygen mask
Rationale: Venturi mask delivers precise FiO₂; target SpO₂ 88-92% in COPD or 94-98% otherwise.
Nasal cannula may be insufficient.
, Question 9
Which ventilator setting directly affects the inspiratory-to-expiratory ratio in volume-controlled
ventilation?
A) Tidal volume
B) Flow rate
C) PEEP
D) Sensitivity
Rationale: Inspiratory time = tidal volume / flow rate. Changing flow alters I:E ratio. PEEP does not
affect I:E.
Question 10
A patient on pressure support ventilation has a respiratory rate of 35 breaths/min. What adjustment is
most appropriate?
A) Increase pressure support
B) Decrease pressure support
C) Increase PEEP
D) Add flow trigger
Rationale: High respiratory rate suggests inadequate support (too low) or tachypnea from
over-assistance. Try decreasing PS to reduce hypocapnia-driven tachypnea.
Question 11
Which arterial blood gas finding is consistent with acute respiratory alkalosis?
A) pH 7.32, PaCO₂ 50, HCO₃ 28
B) pH 7.50, PaCO₂ 28, HCO₃ 24
C) pH 7.40, PaCO₂ 40, HCO₃ 24
D) pH 7.25, PaCO₂ 30, HCO₃ 14
Rationale: Acute respiratory alkalosis → high pH, low PaCO₂, normal HCO₃ (no renal compensation
yet).
DETAILED ANSWERS WITH RATIONALES A NEW UPDATED
VERSION LATEST UPDATES 2026-2027 ( VERIFIED ANSWERS)
ALREADY GRADED A+
Question 1
A 58-year-old male with a 40-pack-year lsmoking history presents with worsening dyspnea and a
chronic productive cough. Spirometry shows FEV₁/FVC 0.65 and FEV₁ 48% predicted. What is the
most likely diagnosis?
A) Asthma
B) Restrictive lung disease
C) Chronic obstructive pulmonary disease (COPD)
D) Pulmonary fibrosis
Rationale: The fixed ratio FEV₁/FVC <0.70 and reduced FEV₁ indicate airflow obstruction. Asthma
typically shows reversibility; restrictive diseases show normal/reduced FVC with normal FEV₁/FVC.
Question 2
A 72-year-old patient post abdominal surgery develops sudden shortness of breath, tachycardia, and
hypoxia. What is the first diagnostic test to order?
A) Chest X-ray
B) D-dimer
C) CT pulmonary angiography
D) V/Q scan
Rationale: CT pulmonary angiography is definitive for pulmonary embolism. D-dimer is sensitive but
not specific. CXR rules out other causes but not PE.
,Question 3
During a CSE, you order a nebulizer treatment with albuterol. The patient’s heart rate increases from
88 to 120 bpm. Next step?
A) Discontinue albuterol immediately
B) Administer beta-blocker
C) Continue treatment and monitor for symptoms
D) Switch to ipratropium
Rationale: Mild tachycardia is a known side effect of beta-agonists. If asymptomatic, continue; severe
or symptomatic tachycardia warrants discontinuation.
Question 4
A patient with status asthmaticus is on continuous albuterol. ABG: pH 7.25, PaCO₂ 55, PaO₂ 70, HCO₃
24. What is the priority intervention?
A) Increase FiO₂
B) Initiate noninvasive or invasive ventilation
C) Administer IV steroids
D) Repeat ABG in 30 minutes
Rationale: Hypercapnia (PaCO₂ >45) with acidosis in asthma indicates impending respiratory failure;
mechanical support is indicated.
Question 5
Which finding on a chest X-ray is most consistent with tension pneumothorax?
A) Deep sulcus sign
B) Tracheal deviation away from the affected side
C) Hyperlucent lung fields
D) Blunted costophrenic angle
Rationale: Tension pneumothorax causes mediastinal shift and tracheal deviation away. The deep
sulcus sign is supine pneumothorax. Hyperlucency alone is simple pneumothorax.
,Question 6
You are evaluating a patient for weaning from mechanical ventilation. Which parameter best predicts
successful extubation?
A) MIP <-20 cmH₂O
B) *RSBI <105 breaths/min/L*
C) Vital capacity >10 mL/kg
D) PaO₂/FiO₂ >200
Rationale: Rapid Shallow Breathing Index (RSBI) <105 is most predictive of weaning success. MIP
and VC are supportive but less sensitive.
Question 7
A neonate with respiratory distress syndrome has worsening hypoxemia despite increasing FiO₂ to
100%. Next best step?
A) Increase PEEP
B) Administer surfactant
C) Switch to HFOV
D) Inhaled nitric oxide
Rationale: Surfactant deficiency is the primary defect in RDS; exogenous surfactant is indicated when
hypoxemia persists on high FiO₂.
Question 8
A 45-year-old with pneumonia has a PaO₂ 55 mmHg on room air. What is the initial oxygen delivery
device?
A) Nasal cannula at 2 L/min
B) Venturi mask at 28%
C) Non-rebreather mask
D) Simple oxygen mask
Rationale: Venturi mask delivers precise FiO₂; target SpO₂ 88-92% in COPD or 94-98% otherwise.
Nasal cannula may be insufficient.
, Question 9
Which ventilator setting directly affects the inspiratory-to-expiratory ratio in volume-controlled
ventilation?
A) Tidal volume
B) Flow rate
C) PEEP
D) Sensitivity
Rationale: Inspiratory time = tidal volume / flow rate. Changing flow alters I:E ratio. PEEP does not
affect I:E.
Question 10
A patient on pressure support ventilation has a respiratory rate of 35 breaths/min. What adjustment is
most appropriate?
A) Increase pressure support
B) Decrease pressure support
C) Increase PEEP
D) Add flow trigger
Rationale: High respiratory rate suggests inadequate support (too low) or tachypnea from
over-assistance. Try decreasing PS to reduce hypocapnia-driven tachypnea.
Question 11
Which arterial blood gas finding is consistent with acute respiratory alkalosis?
A) pH 7.32, PaCO₂ 50, HCO₃ 28
B) pH 7.50, PaCO₂ 28, HCO₃ 24
C) pH 7.40, PaCO₂ 40, HCO₃ 24
D) pH 7.25, PaCO₂ 30, HCO₃ 14
Rationale: Acute respiratory alkalosis → high pH, low PaCO₂, normal HCO₃ (no renal compensation
yet).
