NBRC EXAM SOLUTIONS GRADE A+
GUARANTEED
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia
Endotracheal tube positioned in right mainstem bronchus is a problem
but the co2 reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation
6-8 ml/kg (of ideal body weight) This is new strategy as of January
2015
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Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all
ventilatory muscle activity is absent. _______ conditions can be
imposed with an inspiratory pause when a patient is sedated and
mechanically ventilated.
Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______
conditions, when non-intubated patient breathes spontaneously.
Dynamic Compliance
A balloon tipped flow directed catheter is positioned in the
pulmonary artery with the balloon deflated. Which of the following
,pressures will be measured by the proximal lumen:
a. Cvp
b. Pap
c. Pwp
d. Map
ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant
Gas will pass through and out of a long sampling line before reaching
analyzer so, low sampling flow will not give you enough information
for a good reading, and condensation as a rule is always a problem
especially in analyzers. Dessicant removes moisture from the gas,
which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of
the following should the respiratory therapist use to monitor the
neonates overall cardiopulmonary status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8
Since the baby is stable, go less invasive, also go continuous
monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous
monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis
You wouldn't have asthma on just one side (unilateral), atelectasis
would cause diminished breath sounds, with epiglottitis you would get
stridor, since you are only hearing wheezing on one side, you are
hearing it on the side where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a
pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
,c. Absent breath sounds
d. Respiratory distress
With pneumothorax you would hear a high pitch hyperresonnance, breath
sounds would be absent, and respiratory distress could be present.
Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine
Multiple pvc's coming from multiple locations (multifocal) is a real
problem and you should administer oxygen FIRST, so ANSWER is B.
lidocaine will help reduce irritability of heart and help with pvc's
but would not be first option, atropine is used for bradycardia and
cardiac irregularities but not pvc's, epinephrine is emergency drug
not for pvc's but more for pulseless ventricular tachycardia or
ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an
adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg
Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles,
and tachypnea. The patient has marked dyspnea and a history of heart
disease. Which of the following should the respiratory therapist
recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide
This is an emergency, they are having heart problems, dyspnea, frothy
secretions indicating severe pulmonary edema, etc. so 100% oxygen
immediately, having the patient in the Fowlers position (an upright
position) will help pull fluid down away from the lungs, furosemide
is a lasix (loop diuretic) which gets rid of excess fluid. You do NOT
suction someone with frothy secretions and heart problems, this just
delays appropriate therapy. So ANSWER is 2,3,4
, Fine crepitant crackles are most commonly associated with which of
the following conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup
Crackles are associated with fluid so a, b, and c would be good
answers, but "fine crepitant" crackles indicates fluid entering
alveoli (pulmonary edema) which is most often caused by heart failure
so the best ANSWER is B. (with croup you would hear more of a stridor
sound).
A patient is found in full cardiopulmonary arrest. CPR is started and
the patient is orally intubated with an EtCO2 monitor attached. Which
of the following EtCO2 patterns would the respiratory therapist
expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
c. Initially high, stays high
d. Initially low, stays low
Full cardiac arrest will cause the CO2 in the lungs to slowly
dissipate out because no blood is flowing, then during CPR when you
get blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than
the blood pressure obtained from a sphygmomanometer (cuff pressure).
Based upon this information, the respiratory therapist should
conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line
pressure
d. Transducer dome contained air bubbles
Arterial line BP and cuff pressure should be the same, so there is a
problem. Non-compliant tubing is a good thing because it's a stiff
tubing, if transducer is placed too high (above the heart), the flood
will have to go uphill and you will get a lower pressure; transducer
dome contained air bubbles would give you erratic readings but not a
higher reading, but if the transducer is placed too low (below heart),
the blood is flowing downhill & will give a higher pressure reading,
so ANSWER is B
A 2-year old child enters the emergency room. The mother states that
the child was playing with friends and developed violent coughing and
unilateral wheezing. Physical examination reveals a hyperresonant
percussion note on the left and resonant percussion on the right.
GUARANTEED
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia
Endotracheal tube positioned in right mainstem bronchus is a problem
but the co2 reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation
6-8 ml/kg (of ideal body weight) This is new strategy as of January
2015
Previous
Play
Next
Rewind 10 seconds
Move forward 10 seconds
Unmute
0:00
/
0:15
Full screen
Brainpower
Read More
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all
ventilatory muscle activity is absent. _______ conditions can be
imposed with an inspiratory pause when a patient is sedated and
mechanically ventilated.
Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______
conditions, when non-intubated patient breathes spontaneously.
Dynamic Compliance
A balloon tipped flow directed catheter is positioned in the
pulmonary artery with the balloon deflated. Which of the following
,pressures will be measured by the proximal lumen:
a. Cvp
b. Pap
c. Pwp
d. Map
ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
c. Condensation in the tubing
d. Use of desiccant
Gas will pass through and out of a long sampling line before reaching
analyzer so, low sampling flow will not give you enough information
for a good reading, and condensation as a rule is always a problem
especially in analyzers. Dessicant removes moisture from the gas,
which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of
the following should the respiratory therapist use to monitor the
neonates overall cardiopulmonary status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8
Since the baby is stable, go less invasive, also go continuous
monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous
monitoring of CO2 and O2 is the best. Answer is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis
You wouldn't have asthma on just one side (unilateral), atelectasis
would cause diminished breath sounds, with epiglottitis you would get
stridor, since you are only hearing wheezing on one side, you are
hearing it on the side where you aspirated something,
so ANSWER is C
All of the following would be associated with the presence of a
pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
,c. Absent breath sounds
d. Respiratory distress
With pneumothorax you would hear a high pitch hyperresonnance, breath
sounds would be absent, and respiratory distress could be present.
Dull percussion would NOT be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine
Multiple pvc's coming from multiple locations (multifocal) is a real
problem and you should administer oxygen FIRST, so ANSWER is B.
lidocaine will help reduce irritability of heart and help with pvc's
but would not be first option, atropine is used for bradycardia and
cardiac irregularities but not pvc's, epinephrine is emergency drug
not for pvc's but more for pulseless ventricular tachycardia or
ventricular fibrilation where heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an
adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg
Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles,
and tachypnea. The patient has marked dyspnea and a history of heart
disease. Which of the following should the respiratory therapist
recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide
This is an emergency, they are having heart problems, dyspnea, frothy
secretions indicating severe pulmonary edema, etc. so 100% oxygen
immediately, having the patient in the Fowlers position (an upright
position) will help pull fluid down away from the lungs, furosemide
is a lasix (loop diuretic) which gets rid of excess fluid. You do NOT
suction someone with frothy secretions and heart problems, this just
delays appropriate therapy. So ANSWER is 2,3,4
, Fine crepitant crackles are most commonly associated with which of
the following conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup
Crackles are associated with fluid so a, b, and c would be good
answers, but "fine crepitant" crackles indicates fluid entering
alveoli (pulmonary edema) which is most often caused by heart failure
so the best ANSWER is B. (with croup you would hear more of a stridor
sound).
A patient is found in full cardiopulmonary arrest. CPR is started and
the patient is orally intubated with an EtCO2 monitor attached. Which
of the following EtCO2 patterns would the respiratory therapist
expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
c. Initially high, stays high
d. Initially low, stays low
Full cardiac arrest will cause the CO2 in the lungs to slowly
dissipate out because no blood is flowing, then during CPR when you
get blood flowing, the CO2 should slowly rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than
the blood pressure obtained from a sphygmomanometer (cuff pressure).
Based upon this information, the respiratory therapist should
conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line
pressure
d. Transducer dome contained air bubbles
Arterial line BP and cuff pressure should be the same, so there is a
problem. Non-compliant tubing is a good thing because it's a stiff
tubing, if transducer is placed too high (above the heart), the flood
will have to go uphill and you will get a lower pressure; transducer
dome contained air bubbles would give you erratic readings but not a
higher reading, but if the transducer is placed too low (below heart),
the blood is flowing downhill & will give a higher pressure reading,
so ANSWER is B
A 2-year old child enters the emergency room. The mother states that
the child was playing with friends and developed violent coughing and
unilateral wheezing. Physical examination reveals a hyperresonant
percussion note on the left and resonant percussion on the right.
