NBRC TMC/CRT/RRT COMPREHENSIVE
EXAMINATION STUDY BANK
QUESTIONS AND ANSWERS
1. A 65-year-old male with COPD presents with a pH of 7.28, PaCO2 of 62 mmHg, and PaO2 of
54 mmHg. The most appropriate immediate action is:
A. Intubate and initiate mechanical ventilation
B. Increase oxygen flow rate via nasal cannula to 6 L/min
C. Initiate Non-Invasive Positive Pressure Ventilation (NIV)
D. Administer intravenous bicarbonate
Answer: C
Conceptual Explanation: NIV is the first-line treatment for acute-on-chronic respiratory
failure in COPD patients to avoid the complications of intubation while correcting pH and
reducing PaCO2.
2. Which of the following hemodynamic parameters is most indicative of Left Heart Failure or
Pulmonary Edema?
A. Increased PCWP and increased PAP
B. Increased CVP with normal PCWP
,C. Decreased SVR and increased CO
D. Increased PVR with normal PCWP
Answer: A
Conceptual Explanation: Pulmonary Capillary Wedge Pressure (PCWP) measures left-
sided heart pressure; elevation suggests left heart failure or pulmonary edema, which
subsequently increases Pulmonary Artery Pressure (PAP).
3. A patient on Volume Control (VC) ventilation has a Peak Inspiratory Pressure (PIP) that
increased from 25 to 40 cmH2O, while the Plateau Pressure (Pplat) remained at 20 cmH2O.
What is the most likely cause?
A. Decreasing lung compliance
B. Increased airway resistance
C. Pneumothorax development
D. Pulmonary edema
Answer: B
Conceptual Explanation: An increase in PIP with a stable Pplat indicates an increase in
transairway pressure, which is characteristic of increased airway resistance (e.g.,
secretions, bronchospasm, or tube kinking).
, 4. During a bedside PFT, a patient shows a FEV1/FVC ratio of 60%. This result is most
consistent with:
A. Restrictive lung disease
B. Chest wall deformity
C. Normal pulmonary function
D. Obstructive lung disease
Answer: D
Conceptual Explanation: A FEV1/FVC ratio less than 70% is a primary diagnostic
indicator for obstructive lung diseases like asthma or COPD.
5. A neonatal patient has a Lecithin/Sphingomyelin (L/S) ratio of 1.2:1. This indicates:
A. Mature lungs
B. Normal lung development for 38 weeks gestation
C. High risk of Respiratory Distress Syndrome (RDS)
D. Effective surfactant production
Answer: C
Conceptual Explanation: An L/S ratio of less than 2:1 indicates immature lungs and a high
risk of RDS in the newborn.
6. In a patient with ARDS, which ventilator strategy is prioritized to prevent Volutrauma?
A. High Tidal Volumes (10-12 mL/kg)
EXAMINATION STUDY BANK
QUESTIONS AND ANSWERS
1. A 65-year-old male with COPD presents with a pH of 7.28, PaCO2 of 62 mmHg, and PaO2 of
54 mmHg. The most appropriate immediate action is:
A. Intubate and initiate mechanical ventilation
B. Increase oxygen flow rate via nasal cannula to 6 L/min
C. Initiate Non-Invasive Positive Pressure Ventilation (NIV)
D. Administer intravenous bicarbonate
Answer: C
Conceptual Explanation: NIV is the first-line treatment for acute-on-chronic respiratory
failure in COPD patients to avoid the complications of intubation while correcting pH and
reducing PaCO2.
2. Which of the following hemodynamic parameters is most indicative of Left Heart Failure or
Pulmonary Edema?
A. Increased PCWP and increased PAP
B. Increased CVP with normal PCWP
,C. Decreased SVR and increased CO
D. Increased PVR with normal PCWP
Answer: A
Conceptual Explanation: Pulmonary Capillary Wedge Pressure (PCWP) measures left-
sided heart pressure; elevation suggests left heart failure or pulmonary edema, which
subsequently increases Pulmonary Artery Pressure (PAP).
3. A patient on Volume Control (VC) ventilation has a Peak Inspiratory Pressure (PIP) that
increased from 25 to 40 cmH2O, while the Plateau Pressure (Pplat) remained at 20 cmH2O.
What is the most likely cause?
A. Decreasing lung compliance
B. Increased airway resistance
C. Pneumothorax development
D. Pulmonary edema
Answer: B
Conceptual Explanation: An increase in PIP with a stable Pplat indicates an increase in
transairway pressure, which is characteristic of increased airway resistance (e.g.,
secretions, bronchospasm, or tube kinking).
, 4. During a bedside PFT, a patient shows a FEV1/FVC ratio of 60%. This result is most
consistent with:
A. Restrictive lung disease
B. Chest wall deformity
C. Normal pulmonary function
D. Obstructive lung disease
Answer: D
Conceptual Explanation: A FEV1/FVC ratio less than 70% is a primary diagnostic
indicator for obstructive lung diseases like asthma or COPD.
5. A neonatal patient has a Lecithin/Sphingomyelin (L/S) ratio of 1.2:1. This indicates:
A. Mature lungs
B. Normal lung development for 38 weeks gestation
C. High risk of Respiratory Distress Syndrome (RDS)
D. Effective surfactant production
Answer: C
Conceptual Explanation: An L/S ratio of less than 2:1 indicates immature lungs and a high
risk of RDS in the newborn.
6. In a patient with ARDS, which ventilator strategy is prioritized to prevent Volutrauma?
A. High Tidal Volumes (10-12 mL/kg)
