NBRC TMC PRACTICE QUESTIONS
WITH CORRECT ANSWERS
Which yof ythe yfollowing yis yneeded yto ycalculate yalveolar yoxygen ytension?
A. yVD/VT, yPAO2
B. yBP yand yFiO2
C. yPetCO2 yand yPaO2
D. yQS/QT, ydeadspace y- ycorrect yanswers y-B.
Barometric ypressure, yFiO2, yand yPaO2 yare yall yincluded yin ythe yformula y(BP ystands
yfor ybarometric ypressure)
L/min/m2 yis ythe yunit yof ymeasure yfor:
A. ySystemic yvascular yresistance
B. yCardiac youtput y
C. yCardiac yindex
D. yStroke yvolume y- ycorrect yanswers y-C.
A yspontaneously ybreathing ypatient yhas ythe yfollowing yarterial yblood ygas yresults:
pH y7.38 yPaCO2 y42 ymmHgPaO2 y76 ymmHgHCO3- y24 ymEq/LBE y0 ymEq/L
,Which yof ythe yfollowing ysupplemental yoxygen ylevels yis ymost yappropriate?
yA. y2 yL/min ynasal ycannula
yB. y5 yL/min ynasal ycannula
yC. ynon-rebreathing ymask
yD. yVenturi ymask yat y30% y- ycorrect yanswers y-B. y
A ypatient ywho yis yshowing ysigns yof yhypoxemia yshould yreceive ysupplemental
yoxygen. yIf ythe ypatient yis ynot ya yCOPD ypatient yand ythe ysituation yis ynot yan
yemergency, ythen ythe yproper ysupplemental yoxygen yis yan yadult ytherapeutic ydose,
ywhich yis y40% yto y55%. yOf ythe yoptions yavailable yonly y5 yL/min ynasal ycannula ywill
yapproach ythis. yOther yoptions yare yeither yinsufficient yor ytoo ymuch.
Left yheart yfailure ywould ybe ymanifested yin ywhich yof ythe yfollowing yvalues?
yA. yCVP yand ymPAP
yB. ymPAP yand ywedge ypressure
yC. yMAP yand ySVR
yD. ycardiac youtput yand ywedge ypressure y- ycorrect yanswers y-D. y
The yfunction yof ythe yleft yheart, yspecifically ythe yleft yventricle, yis ybest yassessed
yhemodynamically yby ylooking yat ythose yvalues ythat yprecede yand ycome yafter ythe
yleft yheart. yIn ythis ycase ypulmonary ycapillary ywedge ypressure yand ycardiac youtput
y(or ycardiac yindex) yare ythe yvalues yfound ybefore yand yafter ythe yleft yheart.
Which yof ythe yfollowing yfindings yis ymost yclosely yassociated ywith yincreased yairway
yresistance?
yA. yreduced ySpO2
yB. yaccessory ymuscle yuse
yC. yaltered yP50
yD. yincreased yPetCO2 y- ycorrect yanswers y-B.
Of ythe yoptions ygiven, yuse yof yaccessory ymuscles yis ymost yclosely yassociated ywith
yan yincrease yin yairway yresistance. yThis yis yespecially ytrue ywith ypatients ywho yhave
yasthma yor yother ytypes yof yupper yairway yinflammation yor ybronchoconstriction.
For ya ypatient yreceiving yvolume-controlled ymechanical yventilation, ythe ylower
yinflection ypoint yon ya ypressure-volume yloop ycan ybest ybe ydescribed yas:
yA. yamount yof ypressure yrequired yto ykeep ythe yalveoli yand ysmall yairways yopen
yB. yoptimal yPEEP
yC. yminimal yPEEP
yD. yupper ylimit yof yresidual yvolume y- ycorrect yanswers y-A. y
The ylowest yinflection ypoint yon ya ypressure-volume yventilator ygraphic yis yan
yindication yof ythe yminimum ypressure yneeded yto ykeep yalveoli yopen.
The yresults yof ya yV/Q yscan yshows ypoor yperfusion ywith yadequate yventilation. yA
ychest yradiograph yshows ya ywedge-shaped yinfiltrate yover ythe yright ylung yfield. yThe
ypatient ymost ylikely yhas
yA. yfluid yoverload
yB. yARDS
yC. ya ypulmonary yembolism
,yD. ypneumonia y- ycorrect yanswers y-C. y
A yVQ yscan ythat yshows ypoor yperfusion ybut yadequate yventilation yis ymost yclosely
yassociated ywith ya ypulmonary yembolism. ySupportive ydata yis yfound yin ythe
yradiological yreport yof ywedge-shaped yinfiltrates.
The yrespiratory ytherapist ynotes yin ythe ymedical yrecord yof ya y65-year-old ymale ythat
ythe ypatient yis yordered yto yreceive ybronchodilator ytherapy ywith yAlbuterol. yThe
ytherapist yalso ynotes ythe ypatient yis yreceiving ybeta-blocker ymedication. yThe
ytherapist yshould yrecommend
yA. yAdminister yDexamethasone y(Decadron) yin yplace yof yAlbuterol
yB. yAdd yXopenex yto ythe ybronchodilator yregimen
yC. yReplace yAlbuterol ywith yBeclamethasone y(Beclovent)
yD. ySwitch yfrom yAlbuterol yto yipratropium ybromide y(Atrovent) y- ycorrect yanswers y-
D.
Because yalbuterol yis ya ybeta-agonist ymedication, ypatients ywho yare ytaking ybeta-
blockers yshould yutilize yother ybronchodilation ymedication.
A yhospital yhas yan yextremely ylow yincidence yof yventilator-associated ypneumonia.
yTo ywhich yof ythe yfollowing yreasons ymay ythis ybe yattributed?
yA. yperiodic ydiscontinuation yof ysedation
yB. yuse yof yrespiratory yprecautions ywith ythe ypopulation
yC. ydiversion yof yinfectious ypatients yto yother yfacilities
yD. ybroad yuse yof yprophylactic yantibiotics y- ycorrect yanswers y-A. y
The yincidence yof yventilator-associated ypneumonia, yor yVAP, yis ylowered yby yusing
ya yclosed ysystem ysuction ycatheter, yperiodically ydiscontinuing ysedation, ykeeping
ythe ypatient yand ysemi-Fowler's yposition, yand yproper yhandwashing yamong
ycaregivers. yAll yare ycorrect.
A ypressure-volume yloop yventilator ygraphic yshows yno yrise yin ypressure yfor ythe yfirst
y200 ymL yof ydelivered yvolume. yThe ytherapist yshould
yA. yincrease yinspiratory yflow yrate
yB. yincrease yPEEP
yC. ydecrease ytidal yvolume
yD. ydecrease yinspiratory yflow yrate y- ycorrect yanswers y-B.
In ythis yquestion ythe ydescription yof ythe ypressure yvolume yloop ywould yindicate ya
yflat ybottom yas ymanifested yby yno yrise yin ypressure ywith ythe yfirst y200 ymL yof
ydelivered yvolume. yWe ycall ythis ya y"flat yfootball". yThe ysolution yis yto yincrease
yPEEP yto ya ylevel ythat ythe ypressure ybegins yto yrise yimmediately yas yvolume yis
yintroduced.
Which yof ythe yfollowing ywould ybe ythe ymost yeffective, yappropriate ymethod yfor
yresolving yatelectasis yin ya yspontaneously ybreathing, ypost yoperative ypatient ywho yis
yunder ythe yinfluence yof ysedation yand ywill ynot yrespond yto yverbal ystimuli?
yA. yIPPB
yB. ysustained ymaximal yinhalation y(incentive yspirometer)
yC. ydeep ybreathing ycoaching
, yD. yintubation yand ymechanical yventilation y- ycorrect yanswers y-A. y
A ypostoperative ypatient yunder ysedation, yand ypossibly yin ypain, ymay ybe ytempted yto
ybreathe yless, ycausing yrespiratory yacidosis yand yatelectasis. yTo ycorrect ythis
yproblem, yIPPB ytherapy yis ymost yappropriate. yIncentive yspirometry ywould yalso yhelp
ybut ythe ypatient yis yunable yto yrespond yto yverbal ystimuli. yThis yalone yis yan
yindication yfor yIPPB ytherapy.
After yperforming yminimum yoccluding yvolume ytechnique ywith ya y65-kg y(143-lb)
ypatient ywho yis yorally yintubated ywith ya y7.0-mm yET ytube, ythe yrespiratory ytherapist
yshould yNEXT
yA. ycheck yET ytube ycuff ypressure
yB. yperform ytracheal ypalpation
yC. yorder ya ychest yradiograph
yD. ydocument yET ytube ymarkings yat ythe ylips y- ycorrect yanswers y-A.
The yET ytube ycuff ypressure ymay ybe yadjusted ycorrectly yby yseveral ytechniques
yincluding yminimum yleak ytechnique y(also ycalled yminimum yoccluding yvolume,
yminimal yseal ytechnique, yand ythe yuse yof ya ypressure ymanometer ycalled ya
ycuffalator. yIf yminimum yseal yor yminimal yleak ytechnique yis yused, ythe yrespiratory
ytherapist yis ystill yrequired yto ymonitor ythe ypressure yafter ythe ytechnique yis
yperformed. yAlthough ythis yis yoften ynot ydone yin yreal ylife, yit yis ytechnically ypart yof
ythe yprocedure.
The yrespiratory ytherapist yobserves yan yECG ywave yform yon ya ypatient ythat yis
yconsistent ywith yatrial ytachycardia. yThe ypatient yis ycomplaining yof ychest ypain,
ydizziness, yand ynausea. yThe yrespiratory ytherapist yshould yrecommend
yA. yunsynchronized ydefibrillation
yB. yAtropine ysulfate
yC. yepinephrine
yD. ycardioversion y- ycorrect yanswers y-D. y
Non-deadly yarrhythmias, ysuch yas ythis yone, ymay ybe yaddressed ythrough
ycardioversion. yCardioversion yis ya yform yof ydefibrillation ywith ylow ywattage yand ywith
ythe ysynchronization yset yto y"active". yThis yallows ythe yshock yto ybe ysynchronized yto
ythe yR ywave.
A y38-year-old ymale ypresents yin ythe yemergency ydepartment y(ED) ycomplaining yof
yfrequent yvomiting. yThe yfollowing ylaboratory ydata yis yavailable: yArterial yblood
ygases
pH y7.55 yPaCO2 y42 ytorrPaO2 y85 ytorrHCO3- y31 ymEq/LBE y+7 ymEq/LFIO2 y0.21K+
y3.0 ymEq/LCl- y95 ymEq/LNa+ y135 ymEq/L
Which yof ythe yfollowing yshould ythe yrespiratory ytherapist yrecommend?
yA. yadminister yNaCL
yB. yadminister yNaHCO3-
yC. yadminister yKCL
yD. yadminister yvolume-expanding yfluids y- ycorrect yanswers y-C.
This ypatient yhas ya yCO2 yof y42 ymmHg, ywhich ysuggests yadequate yventilation.
yHowever, ythe yhigh ypH yis yassociated ywith yalkalosis. yBecause ythe yCO2 yis ynormal,
WITH CORRECT ANSWERS
Which yof ythe yfollowing yis yneeded yto ycalculate yalveolar yoxygen ytension?
A. yVD/VT, yPAO2
B. yBP yand yFiO2
C. yPetCO2 yand yPaO2
D. yQS/QT, ydeadspace y- ycorrect yanswers y-B.
Barometric ypressure, yFiO2, yand yPaO2 yare yall yincluded yin ythe yformula y(BP ystands
yfor ybarometric ypressure)
L/min/m2 yis ythe yunit yof ymeasure yfor:
A. ySystemic yvascular yresistance
B. yCardiac youtput y
C. yCardiac yindex
D. yStroke yvolume y- ycorrect yanswers y-C.
A yspontaneously ybreathing ypatient yhas ythe yfollowing yarterial yblood ygas yresults:
pH y7.38 yPaCO2 y42 ymmHgPaO2 y76 ymmHgHCO3- y24 ymEq/LBE y0 ymEq/L
,Which yof ythe yfollowing ysupplemental yoxygen ylevels yis ymost yappropriate?
yA. y2 yL/min ynasal ycannula
yB. y5 yL/min ynasal ycannula
yC. ynon-rebreathing ymask
yD. yVenturi ymask yat y30% y- ycorrect yanswers y-B. y
A ypatient ywho yis yshowing ysigns yof yhypoxemia yshould yreceive ysupplemental
yoxygen. yIf ythe ypatient yis ynot ya yCOPD ypatient yand ythe ysituation yis ynot yan
yemergency, ythen ythe yproper ysupplemental yoxygen yis yan yadult ytherapeutic ydose,
ywhich yis y40% yto y55%. yOf ythe yoptions yavailable yonly y5 yL/min ynasal ycannula ywill
yapproach ythis. yOther yoptions yare yeither yinsufficient yor ytoo ymuch.
Left yheart yfailure ywould ybe ymanifested yin ywhich yof ythe yfollowing yvalues?
yA. yCVP yand ymPAP
yB. ymPAP yand ywedge ypressure
yC. yMAP yand ySVR
yD. ycardiac youtput yand ywedge ypressure y- ycorrect yanswers y-D. y
The yfunction yof ythe yleft yheart, yspecifically ythe yleft yventricle, yis ybest yassessed
yhemodynamically yby ylooking yat ythose yvalues ythat yprecede yand ycome yafter ythe
yleft yheart. yIn ythis ycase ypulmonary ycapillary ywedge ypressure yand ycardiac youtput
y(or ycardiac yindex) yare ythe yvalues yfound ybefore yand yafter ythe yleft yheart.
Which yof ythe yfollowing yfindings yis ymost yclosely yassociated ywith yincreased yairway
yresistance?
yA. yreduced ySpO2
yB. yaccessory ymuscle yuse
yC. yaltered yP50
yD. yincreased yPetCO2 y- ycorrect yanswers y-B.
Of ythe yoptions ygiven, yuse yof yaccessory ymuscles yis ymost yclosely yassociated ywith
yan yincrease yin yairway yresistance. yThis yis yespecially ytrue ywith ypatients ywho yhave
yasthma yor yother ytypes yof yupper yairway yinflammation yor ybronchoconstriction.
For ya ypatient yreceiving yvolume-controlled ymechanical yventilation, ythe ylower
yinflection ypoint yon ya ypressure-volume yloop ycan ybest ybe ydescribed yas:
yA. yamount yof ypressure yrequired yto ykeep ythe yalveoli yand ysmall yairways yopen
yB. yoptimal yPEEP
yC. yminimal yPEEP
yD. yupper ylimit yof yresidual yvolume y- ycorrect yanswers y-A. y
The ylowest yinflection ypoint yon ya ypressure-volume yventilator ygraphic yis yan
yindication yof ythe yminimum ypressure yneeded yto ykeep yalveoli yopen.
The yresults yof ya yV/Q yscan yshows ypoor yperfusion ywith yadequate yventilation. yA
ychest yradiograph yshows ya ywedge-shaped yinfiltrate yover ythe yright ylung yfield. yThe
ypatient ymost ylikely yhas
yA. yfluid yoverload
yB. yARDS
yC. ya ypulmonary yembolism
,yD. ypneumonia y- ycorrect yanswers y-C. y
A yVQ yscan ythat yshows ypoor yperfusion ybut yadequate yventilation yis ymost yclosely
yassociated ywith ya ypulmonary yembolism. ySupportive ydata yis yfound yin ythe
yradiological yreport yof ywedge-shaped yinfiltrates.
The yrespiratory ytherapist ynotes yin ythe ymedical yrecord yof ya y65-year-old ymale ythat
ythe ypatient yis yordered yto yreceive ybronchodilator ytherapy ywith yAlbuterol. yThe
ytherapist yalso ynotes ythe ypatient yis yreceiving ybeta-blocker ymedication. yThe
ytherapist yshould yrecommend
yA. yAdminister yDexamethasone y(Decadron) yin yplace yof yAlbuterol
yB. yAdd yXopenex yto ythe ybronchodilator yregimen
yC. yReplace yAlbuterol ywith yBeclamethasone y(Beclovent)
yD. ySwitch yfrom yAlbuterol yto yipratropium ybromide y(Atrovent) y- ycorrect yanswers y-
D.
Because yalbuterol yis ya ybeta-agonist ymedication, ypatients ywho yare ytaking ybeta-
blockers yshould yutilize yother ybronchodilation ymedication.
A yhospital yhas yan yextremely ylow yincidence yof yventilator-associated ypneumonia.
yTo ywhich yof ythe yfollowing yreasons ymay ythis ybe yattributed?
yA. yperiodic ydiscontinuation yof ysedation
yB. yuse yof yrespiratory yprecautions ywith ythe ypopulation
yC. ydiversion yof yinfectious ypatients yto yother yfacilities
yD. ybroad yuse yof yprophylactic yantibiotics y- ycorrect yanswers y-A. y
The yincidence yof yventilator-associated ypneumonia, yor yVAP, yis ylowered yby yusing
ya yclosed ysystem ysuction ycatheter, yperiodically ydiscontinuing ysedation, ykeeping
ythe ypatient yand ysemi-Fowler's yposition, yand yproper yhandwashing yamong
ycaregivers. yAll yare ycorrect.
A ypressure-volume yloop yventilator ygraphic yshows yno yrise yin ypressure yfor ythe yfirst
y200 ymL yof ydelivered yvolume. yThe ytherapist yshould
yA. yincrease yinspiratory yflow yrate
yB. yincrease yPEEP
yC. ydecrease ytidal yvolume
yD. ydecrease yinspiratory yflow yrate y- ycorrect yanswers y-B.
In ythis yquestion ythe ydescription yof ythe ypressure yvolume yloop ywould yindicate ya
yflat ybottom yas ymanifested yby yno yrise yin ypressure ywith ythe yfirst y200 ymL yof
ydelivered yvolume. yWe ycall ythis ya y"flat yfootball". yThe ysolution yis yto yincrease
yPEEP yto ya ylevel ythat ythe ypressure ybegins yto yrise yimmediately yas yvolume yis
yintroduced.
Which yof ythe yfollowing ywould ybe ythe ymost yeffective, yappropriate ymethod yfor
yresolving yatelectasis yin ya yspontaneously ybreathing, ypost yoperative ypatient ywho yis
yunder ythe yinfluence yof ysedation yand ywill ynot yrespond yto yverbal ystimuli?
yA. yIPPB
yB. ysustained ymaximal yinhalation y(incentive yspirometer)
yC. ydeep ybreathing ycoaching
, yD. yintubation yand ymechanical yventilation y- ycorrect yanswers y-A. y
A ypostoperative ypatient yunder ysedation, yand ypossibly yin ypain, ymay ybe ytempted yto
ybreathe yless, ycausing yrespiratory yacidosis yand yatelectasis. yTo ycorrect ythis
yproblem, yIPPB ytherapy yis ymost yappropriate. yIncentive yspirometry ywould yalso yhelp
ybut ythe ypatient yis yunable yto yrespond yto yverbal ystimuli. yThis yalone yis yan
yindication yfor yIPPB ytherapy.
After yperforming yminimum yoccluding yvolume ytechnique ywith ya y65-kg y(143-lb)
ypatient ywho yis yorally yintubated ywith ya y7.0-mm yET ytube, ythe yrespiratory ytherapist
yshould yNEXT
yA. ycheck yET ytube ycuff ypressure
yB. yperform ytracheal ypalpation
yC. yorder ya ychest yradiograph
yD. ydocument yET ytube ymarkings yat ythe ylips y- ycorrect yanswers y-A.
The yET ytube ycuff ypressure ymay ybe yadjusted ycorrectly yby yseveral ytechniques
yincluding yminimum yleak ytechnique y(also ycalled yminimum yoccluding yvolume,
yminimal yseal ytechnique, yand ythe yuse yof ya ypressure ymanometer ycalled ya
ycuffalator. yIf yminimum yseal yor yminimal yleak ytechnique yis yused, ythe yrespiratory
ytherapist yis ystill yrequired yto ymonitor ythe ypressure yafter ythe ytechnique yis
yperformed. yAlthough ythis yis yoften ynot ydone yin yreal ylife, yit yis ytechnically ypart yof
ythe yprocedure.
The yrespiratory ytherapist yobserves yan yECG ywave yform yon ya ypatient ythat yis
yconsistent ywith yatrial ytachycardia. yThe ypatient yis ycomplaining yof ychest ypain,
ydizziness, yand ynausea. yThe yrespiratory ytherapist yshould yrecommend
yA. yunsynchronized ydefibrillation
yB. yAtropine ysulfate
yC. yepinephrine
yD. ycardioversion y- ycorrect yanswers y-D. y
Non-deadly yarrhythmias, ysuch yas ythis yone, ymay ybe yaddressed ythrough
ycardioversion. yCardioversion yis ya yform yof ydefibrillation ywith ylow ywattage yand ywith
ythe ysynchronization yset yto y"active". yThis yallows ythe yshock yto ybe ysynchronized yto
ythe yR ywave.
A y38-year-old ymale ypresents yin ythe yemergency ydepartment y(ED) ycomplaining yof
yfrequent yvomiting. yThe yfollowing ylaboratory ydata yis yavailable: yArterial yblood
ygases
pH y7.55 yPaCO2 y42 ytorrPaO2 y85 ytorrHCO3- y31 ymEq/LBE y+7 ymEq/LFIO2 y0.21K+
y3.0 ymEq/LCl- y95 ymEq/LNa+ y135 ymEq/L
Which yof ythe yfollowing yshould ythe yrespiratory ytherapist yrecommend?
yA. yadminister yNaCL
yB. yadminister yNaHCO3-
yC. yadminister yKCL
yD. yadminister yvolume-expanding yfluids y- ycorrect yanswers y-C.
This ypatient yhas ya yCO2 yof y42 ymmHg, ywhich ysuggests yadequate yventilation.
yHowever, ythe yhigh ypH yis yassociated ywith yalkalosis. yBecause ythe yCO2 yis ynormal,
