NBRC TMC PRACTICE EXAM
QUESTIONS WITH COMPLETE
ANSWERS
The respiratory therapist observes an ECG wave form on a patient that is consistent
with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea.
The respiratory therapist should recommend
A. unsynchronized defibrillation
B. Atropine sulfate
C. epinephrine
D. cardioversion - ANSWER-D.
Non-deadly arrhythmias, such as this one, may be addressed through cardioversion.
Cardioversion is a form of defibrillation with low wattage and with the synchronization
set to "active". This allows the shock to be synchronized to the R wave.
A 38-year-old male presents in the emergency department (ED) complaining of frequent
vomiting. The following laboratory data is available: Arterial blood gases
pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0
mEq/LCl- 95 mEq/LNa+ 135 mEq/L
Which of the following should the respiratory therapist recommend?
A. administer NaCL
B. administer NaHCO3-
C. administer KCL
D. administer volume-expanding fluids - ANSWER-C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However,
the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the
alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to
administer potassium chloride or KCl.
A patient is receiving volume-controlled ventilation following bariatric surgery for obesity.
Which of the following medications should the respiratory therapist recommend to
ensure the patient's comfort and assist in ventilator management?
A. Pronestyl
B. morphine sulfate
C. vecuronium bromide (Norcuron)
D. Mestinon - ANSWER-B.
Morphine sulfate is one of the best medications to administer to patients receiving
mechanical ventilatory support to help the patient rest pain-free and to generally sedate
and relax the patient.
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
, A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - ANSWER-A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - ANSWER-C.
When a person indicates the universal sign of choking, they are unable to verbalize
because there is likely something caught in their airway. The person responding must
first focus on removing the obstruction, which is done by performing abdominal thrusts.
Administering rescue breaths would not be appropriate because the airway is
obstructed. Calling for help is tempting but is only related to two-man CPR. The patient
is not yet at that point. Performing abdominal thrusts is a one-man maneuver and
therefore obtaining additional help is not the first concern.
A home care patient calls into the clinic and complains that his oxygen concentrator is
not working even though the machine is plugged in and the switch is in the 'on'.
Position. After ensuring the patient is receiving oxygen from a reliable alternate source,
the therapist should advise the patient to
A. check and replace the internal in-line fuse
B. find the reset switch in the machine and press it
C. ensure the circuit breaker is in the on position
D. change the filters and cycle the machine off then on again - ANSWER-C.
When a homecare patient reports a problem with their oxygen concentrator, the first
action should be to ensure the patient is receiving oxygen from an alternate source (an
E cylinder). After that is accomplished, the respiratory therapist may instruct the patient
in some basic troubleshooting. This includes ensuring the device is plugged in,
changing the filter, and checking the circuit breaker. All other troubleshooting should be
done by a professional.
An adult patient with asthma is receiving Albuterol by small volume nebulizer Q.I.D. at a
dosage of 0.5 mL. The patient complains of dizziness, tingling in his fingers, and anxiety
with each treatment. The therapist should
A. increase dosage to 1.0 mL
B. decrease dosage to 0.15 mL
C. switch to Xopenex 0.63 mg
D. switch to Mucomyst 20% - ANSWER-C.
,When a patient experiences an adverse reaction, the first step is to stop the therapy and
then modify the therapy to accomplish the same objective. In this case, decreasing the
dose of Xopenex is suitable because 0.63 mg is still in the adult therapeutic range.
Which of the following conditions would benefit most from a thoracentesis?
A. atelectasis
B. complete opacification of the right lung
C. small pneumothorax
D. pericardial contusion - ANSWER-C.
A thoracentesis is a procedure that removes air or fluid from the pleural space. This
would be appropriate with a small pneumothorax. A large pneumothorax, however,
would require chest tubes.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
B. exogenous surfactant
C. Tobramycin and albuterol
D. cromolyn sodium - ANSWER-B.
A patient with adult respiratory distress syndrome could benefit from surfactant therapy
to decrease the surface tension of the alveoli.
The respiratory therapist should look to which of the following clinical data to determine
the effectiveness of incentive spirometry?
A. Arterial blood gas analysis pre and post treatment
B. Breath sounds before and after every treatment
C. Inspiratory capacity predicted volume
D. Maximum voluntary ventilation done periodically - ANSWER-B.
The effectiveness of incentive spirometry can best be determined by auscultating breath
sounds before and after the treatment and noting changes in air movement. While
achieving inspiratory capacity is the goal, the real goal is to increase lung volume,
improve alveolar recruitment, and prevent consolidation of sputum in the lungs.
increased labor of breathing. The mandatory rate is 14/min. Which of the following
would most likely help the patient?
A. Use of pressure support
B. Switch to pressure control ventilation
C. Increase the machine flow rate
D. Increase PEEP - ANSWER-A.
During ventilator weaning, a patient must maintain a moderately low respiratory rate, an
adequate sized tidal volume, and low work of breathing. In this case, the patient is
experiencing increased labor of breathing and an increase in respiratory rate. This is
likely due to a reduced spontaneous tidal volume. Although this data is not shown, this
condition can be assumed. The solution for a low spontaneous tidal volume and
increased work of breathing during weaning is to provide pressure support.
, When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with
a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35%
near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct
the problem, the therapist should
A. adjust blender setting to 60%
B. increase total flow to the oxyhood
C. obtain a smaller oxyhood
D. change the nebulizer entrainment port to 100% - ANSWER-D.
When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen
control on the nebulizer should be set to 100%. This will prevent additional entrainment
of room air which will cause a decrease in FIO2.
Following the insertion of a tracheostomy tube, the patient is found to have diffuse
crackles upon auscultation secondary to subcutaneous emphysema. Which of the
following radiographic findings would be expected with this condition?
A. Hyperlucency in the soft tissues
B. Diffuse pulmonary hyperlucency
C. Tracheal shift from midline
D. Scattered patchy infiltrates - ANSWER-A.
Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air
located in the soft tissue, as seen with subcutaneous emphysema would result in a
hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not
shift the trachea from midline. Scattered patchy infiltrates are associated with ARDS,
not subcutaneous emphysema.
Placement of a pulmonary artery catheter is associated with which of the following most
common complications?
A. hypotension
B. pulmonic valve damage
C. cardiac arrhythmias
D. internal bleeding - ANSWER-C.
Several complications may arise from the placement of a pulmonary artery catheter,
otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the
most common complication of the options offered. Another serious complication is
perforation of a vessel or cardiac muscle during the insertion.
A galvanic fuel cell oxygen analyzer may read erroneously high under which of the
following conditions?
A. when the analyzer batteries are depleted
B. during a sudden increase in the partial pressure of oxygen
C. when a volume-controlled ventilator at high inspiratory pressures
D. when liquid gets on the membrane - ANSWER-C.
A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures
change significantly, such as when a patient is receiving high inspiratory pressure or
when a patient changes altitude quickly.
QUESTIONS WITH COMPLETE
ANSWERS
The respiratory therapist observes an ECG wave form on a patient that is consistent
with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea.
The respiratory therapist should recommend
A. unsynchronized defibrillation
B. Atropine sulfate
C. epinephrine
D. cardioversion - ANSWER-D.
Non-deadly arrhythmias, such as this one, may be addressed through cardioversion.
Cardioversion is a form of defibrillation with low wattage and with the synchronization
set to "active". This allows the shock to be synchronized to the R wave.
A 38-year-old male presents in the emergency department (ED) complaining of frequent
vomiting. The following laboratory data is available: Arterial blood gases
pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0
mEq/LCl- 95 mEq/LNa+ 135 mEq/L
Which of the following should the respiratory therapist recommend?
A. administer NaCL
B. administer NaHCO3-
C. administer KCL
D. administer volume-expanding fluids - ANSWER-C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However,
the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the
alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to
administer potassium chloride or KCl.
A patient is receiving volume-controlled ventilation following bariatric surgery for obesity.
Which of the following medications should the respiratory therapist recommend to
ensure the patient's comfort and assist in ventilator management?
A. Pronestyl
B. morphine sulfate
C. vecuronium bromide (Norcuron)
D. Mestinon - ANSWER-B.
Morphine sulfate is one of the best medications to administer to patients receiving
mechanical ventilatory support to help the patient rest pain-free and to generally sedate
and relax the patient.
A patient has idiopathic pneumonia with consolidation in the right lower lobe. The
physician suspects a bacterial infection. Which of the following will provide conclusive
data to rule out the physician's suspicions?
, A. WBC
B. color of sputum
C. sputum acid-fast stain
D. oral temperature - ANSWER-A.
A bacterial infection is diagnosed primarily by examining the white blood cell count, also
called the leukocyte count. An elevated temperature and yellow sputum indicate the
possibility of an infection but are not confirming in nature.
After making the universal sign of choking, a person collapses. The observer should
FIRST
A. check for a pulse
B. call for help
C. perform abdominal thrusts
D. administer 2 rescue breaths - ANSWER-C.
When a person indicates the universal sign of choking, they are unable to verbalize
because there is likely something caught in their airway. The person responding must
first focus on removing the obstruction, which is done by performing abdominal thrusts.
Administering rescue breaths would not be appropriate because the airway is
obstructed. Calling for help is tempting but is only related to two-man CPR. The patient
is not yet at that point. Performing abdominal thrusts is a one-man maneuver and
therefore obtaining additional help is not the first concern.
A home care patient calls into the clinic and complains that his oxygen concentrator is
not working even though the machine is plugged in and the switch is in the 'on'.
Position. After ensuring the patient is receiving oxygen from a reliable alternate source,
the therapist should advise the patient to
A. check and replace the internal in-line fuse
B. find the reset switch in the machine and press it
C. ensure the circuit breaker is in the on position
D. change the filters and cycle the machine off then on again - ANSWER-C.
When a homecare patient reports a problem with their oxygen concentrator, the first
action should be to ensure the patient is receiving oxygen from an alternate source (an
E cylinder). After that is accomplished, the respiratory therapist may instruct the patient
in some basic troubleshooting. This includes ensuring the device is plugged in,
changing the filter, and checking the circuit breaker. All other troubleshooting should be
done by a professional.
An adult patient with asthma is receiving Albuterol by small volume nebulizer Q.I.D. at a
dosage of 0.5 mL. The patient complains of dizziness, tingling in his fingers, and anxiety
with each treatment. The therapist should
A. increase dosage to 1.0 mL
B. decrease dosage to 0.15 mL
C. switch to Xopenex 0.63 mg
D. switch to Mucomyst 20% - ANSWER-C.
,When a patient experiences an adverse reaction, the first step is to stop the therapy and
then modify the therapy to accomplish the same objective. In this case, decreasing the
dose of Xopenex is suitable because 0.63 mg is still in the adult therapeutic range.
Which of the following conditions would benefit most from a thoracentesis?
A. atelectasis
B. complete opacification of the right lung
C. small pneumothorax
D. pericardial contusion - ANSWER-C.
A thoracentesis is a procedure that removes air or fluid from the pleural space. This
would be appropriate with a small pneumothorax. A large pneumothorax, however,
would require chest tubes.
ASK***** A patient with ARDS and asthma could benefit from which of the following
medications?
A. Spiriva and decadron
B. exogenous surfactant
C. Tobramycin and albuterol
D. cromolyn sodium - ANSWER-B.
A patient with adult respiratory distress syndrome could benefit from surfactant therapy
to decrease the surface tension of the alveoli.
The respiratory therapist should look to which of the following clinical data to determine
the effectiveness of incentive spirometry?
A. Arterial blood gas analysis pre and post treatment
B. Breath sounds before and after every treatment
C. Inspiratory capacity predicted volume
D. Maximum voluntary ventilation done periodically - ANSWER-B.
The effectiveness of incentive spirometry can best be determined by auscultating breath
sounds before and after the treatment and noting changes in air movement. While
achieving inspiratory capacity is the goal, the real goal is to increase lung volume,
improve alveolar recruitment, and prevent consolidation of sputum in the lungs.
increased labor of breathing. The mandatory rate is 14/min. Which of the following
would most likely help the patient?
A. Use of pressure support
B. Switch to pressure control ventilation
C. Increase the machine flow rate
D. Increase PEEP - ANSWER-A.
During ventilator weaning, a patient must maintain a moderately low respiratory rate, an
adequate sized tidal volume, and low work of breathing. In this case, the patient is
experiencing increased labor of breathing and an increase in respiratory rate. This is
likely due to a reduced spontaneous tidal volume. Although this data is not shown, this
condition can be assumed. The solution for a low spontaneous tidal volume and
increased work of breathing during weaning is to provide pressure support.
, When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with
a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35%
near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct
the problem, the therapist should
A. adjust blender setting to 60%
B. increase total flow to the oxyhood
C. obtain a smaller oxyhood
D. change the nebulizer entrainment port to 100% - ANSWER-D.
When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen
control on the nebulizer should be set to 100%. This will prevent additional entrainment
of room air which will cause a decrease in FIO2.
Following the insertion of a tracheostomy tube, the patient is found to have diffuse
crackles upon auscultation secondary to subcutaneous emphysema. Which of the
following radiographic findings would be expected with this condition?
A. Hyperlucency in the soft tissues
B. Diffuse pulmonary hyperlucency
C. Tracheal shift from midline
D. Scattered patchy infiltrates - ANSWER-A.
Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air
located in the soft tissue, as seen with subcutaneous emphysema would result in a
hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not
shift the trachea from midline. Scattered patchy infiltrates are associated with ARDS,
not subcutaneous emphysema.
Placement of a pulmonary artery catheter is associated with which of the following most
common complications?
A. hypotension
B. pulmonic valve damage
C. cardiac arrhythmias
D. internal bleeding - ANSWER-C.
Several complications may arise from the placement of a pulmonary artery catheter,
otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the
most common complication of the options offered. Another serious complication is
perforation of a vessel or cardiac muscle during the insertion.
A galvanic fuel cell oxygen analyzer may read erroneously high under which of the
following conditions?
A. when the analyzer batteries are depleted
B. during a sudden increase in the partial pressure of oxygen
C. when a volume-controlled ventilator at high inspiratory pressures
D. when liquid gets on the membrane - ANSWER-C.
A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures
change significantly, such as when a patient is receiving high inspiratory pressure or
when a patient changes altitude quickly.
