NBRC Therapist Multiple Choice Self Assessment - Exam Questions and Answers 2020 B | 2024/2025

NBRC Therapist Multiple Choice Self Assessment - Exam Questions and Answers 2020 B | 2024/2025. Following placement of a tracheostomy tube for long-term mechanical ventilation, which of the following patient positions best prevents ventilator-associated pneumonia? A. prone B. Trendelenburg C. supine D.√ semi-Fowler EXPLANATIONS: (h) A. Prone positioning is contraindicated following tracheostomy placement. (h) B. Use of Trendelenburg positioning may increase the risk of aspiration. (u) C. A decreased incidence of ventilator-associated pneumonia has been observed with an elevated head of bed as compared to supine. (c) D. Routine use of semi-Fowler positioning with the head of the bed elevated at an angle of 30-45 degrees has been shown to decrease rates of ventilator-associated pneumonia. √ 4. Which of the following is used to monitor the partial pressure of transcutaneous carbon dioxide? A. red-light absorption sensor B. electromechanical transducer C. infrared analyzer D.√ Stow-Severinghaus electrode EXPLANATIONS: (u) A. A red-light absorption sensor is used in a pulse oximeter. (u) B. An electromechanical transducer measures airway pressure. (u) C. An infrared analyzer is used in a capnometer. (c) D. A Stow-Severinghaus blood gas electrode is used in transcutaneous monitors. √ 5. An adult patient requires frequent blood sampling and medication administrations through an IV for 1 month. The preferred vascular access is a A.√ peripherally inserted central catheter. B. subclavian central vascular line. C. standard peripheral IV line. D. internal jugular catheter. EXPLANATIONS: (c) A. A PICC is the best choice for long-term IV access and allows for blood sampling. (u) B. A subclavian central vascular line is recommended for short-term use and should be removed as soon as feasible to avoid infection. (u) C. A standard peripheral IV line is not meant for long-term use. (u) D. An internal jugular catheter is recommended for short-term use and should be removed as soon as feasible to avoid infection. √ 6. A 170-cm (5-ft 7-in), 69-kg (152-lb) male with ARDS has the following ABG analysis results: pH 7.37 PCO2 43 mm Hg PO2 95 mm Hg HCO3 - 25 mEq/L BE -1 mEq/L SO2 (calc) 97% The patient is receiving VC, A/C ventilation with the following settings: FIO2 0.70 Mandatory rate 12 VT 450 mL PEEP 8 cm H2O Which of the following is most appropriate? A.√ Decrease the F IO2 to 0.60. B. Change the PEEP to 5 cm H 2O. C. Increase the minute ventilation. D. Maintain the current settings. EXPLANATIONS: (c) A. Since the PaO2 is adequate, it is now appropriate to decrease the F IO2. (u) B. The PEEP needs to be maintained to prevent derecruitment of alveoli. (u) C. There is no indication for changing the minute ventilation. The patient's ventilation is appropriate. (u) D. The FIO2 needs to be decreased to minimize oxygen-induced lung injury. √ 7. Following an emergent C-section, a 35 year old is receiving VC, A/C ventilation. The following pressure-volume loop is observed: Which of the following ventilator settings should be adjusted? A. PEEP B. flow rate C. tidal volume D.√ trigger sensitivity EXPLANATIONS: (u) A. Adjusting the PEEP is not indicated and does not address the dyssynchrony. (u) B. A flow rate that is too low is represented by a scooped inspiratory flow curve. There are no indications to adjust the flow rate. (u) C. There are no indications that the tidal volume is inadequate. The patient's trigger sensitivity should be adjusted so less negative force is needed to trigger a breath. (c) D. The patient is having difficultly triggering the breath, which is shown by the significant negative force created before the breath is delivered. The trigger should be adjusted to be more sensitive to improve the patient's ability to trigger a breath. √ 8. Which of the following techniques is preferred for a quadriplegic patient having difficulty expectorating secretions? A. pursed lip breathing B.√ abdominal thrust C. PEP therapy D. inspiratory muscle training EXPLANATIONS: (u) A. Pursed lip breathing is used as an expiratory maneuver to stabilize airways typically with COPD patients and not as a cough assist. (c) B. An abdominal thrust is used to assist patients with decreased respiratory muscle function, such as quadriplegics, to more forcefully cough out secretions. (u) C. PEP therapy is used by patients who can spontaneously take a deep breath and follow-up with a forced cough effort. (u) D. Inspiratory muscle training is used to enhance inspiratory muscle strength typically with COPD patients and not for quadriplegic patients. √ 9. A patient with a history of hypertension was awakened by cough and shortness of breath. He has fine inspiratory crackles bilaterally. Which of the following should a respiratory therapist recommend? A. prednisone B. albuterol C.√ furosemide (Lasix) D. guaifenesin (Mucinex) EXPLANATIONS: (u) A. The history, signs, and symptoms point to CHF. Prednisone will not address the cause of the patient's symptoms. (u) B. The history, signs, and symptoms point to CHF. Albuterol will not address the cause of the patient's symptoms. (c) C. Nocturnal dyspnea and coarse crackles are indications of CHF. Hypertension can be an etiologic factor for heart failure. A diuretic, such as furosemide (Lasix), is useful in controlling water retention that can lead to fluid accumulation and narrowing in airways. (u) D. The history, signs, and symptoms point to CHF. Guaifenesin (Mucinex) will not address the cause of the patient's symptoms. √ 10. The preferred suction device to remove large amounts of secretions from the oral cavity of an adult patient is a A.√ Yankauer device. B. DeLee suction trap. C. whistle-tip catheter. D. Coudé catheter. EXPLANATIONS: (c) A. Yankauer suction devices are designed specifically to suction secretions from the mouth in an efficient way. (u) B. A DeLee suction trap is common in neonatal care, but would likely be unable to adequately remove large amounts of secretions from an adult. (a) C. While it is possible to use a 14 Fr catheter for adult suctioning of the oral cavity, the Yankauer is designed for it. A 14 Fr catheter would possibly get easily occluded by large secretions and be ineffective. (u) D. There is no reason to use a catheter designed to enter the left mainstem bronchus selectively on an oral suction procedure. It would be costly, and just like the 14 Fr whistle-tip, not as effective as the Yankauer. √ 11. A respiratory therapist examines a patient and notes coarse crackles over both lung fields. Which of the following does this most likely indicate? A. subcutaneous emphysema B. pleurisy C. bronchospasm D.√ secretions EXPLANATIONS: (u) A. Subcutaneous emphysema is demonstrated by the presence of crepitus during chest wall palpation. (u) B. Pleurisy is a symptom of pain while breathing, typically associated with inspiration. There are often no physical findings for pleurisy. (u) C. Bronchospasm is noted as a wheezing sound from narrowed airways. (c) D. Secretions in the airway produce low-pitched, discontinuous lung sounds described as coarse crackles upon auscultation. √ 12. A 28-year-old patient is being evaluated by a respiratory therapist after a trauma. The patient is receiving VC ventilation with the following settings: FIO2 0.65 Mandatory rate 14 VT 450 mL PEEP 8 cm H2O The therapist notes the following pressure-volume tracing: The therapist should recommend decreasing the A. mandatory rate. B. PEEP. C.√ VT. D. expiratory time. EXPLANATIONS: (h) A. Decreasing the mandatory rate will not resolve the "bird-beak" pattern caused by excessive tidal volume. (h) B. The lungs are already being hyperinflated with each breath. Decreasing PEEP will potentially exacerbate the hyperinflation. (c) C. "Bird-beak" patterns are a result of hyperinflation. Decreasing the tidal volume will correct the hyperinflation. (h) D. Decreasing the expiratory time will cause an increase in tidal volume and exacerbate the hyperinflation (autoPEEP). √ 13. A 74-year-old female patient is admitted for management of community-acquired pneumonia. The patient's chest radiograph and CT scan show an RLL infiltrate with a nonloculated, significant pleural effusion on the right side. Which of the following should the therapist anticipate? A. echocardiogram B.√ thoracentesis C. V̇/Q̇scan D. bronchoscopy EXPLANATIONS: (u) A. A diagnostic tool, such as an echocardiogram, will not treat the patient's pleural effusion. (c) B. Thoracentesis is indicated based on the patient's chest radiograph and clinical findings. (u) C. A diagnostic tool, such as a V̇/Q̇scan, will not treat the patient's pleural effusion. (u) D. The patient's pleural effusion requires treatment, which cannot be addressed through a bronchoscope in the patient's airways. A thoracentesis is required to access the patient's pleural space and drain the effusion. √ 14. Which of the following is typically associated with bilateral, fluffy infiltrates on a chest radiograph?