NBRC THERAPIST objective ASSESSMENT UPDATED 2025/2026 COMPLETE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS.100% GUARANTEED PASS||A+ GRADED<<BRAND NEW VERSION>>

NBRC THERAPIST objective ASSESSMENT UPDATED 2025/2026 COMPLETE EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS.100% GUARANTEED PASS||A+ GRADED&lt;&lt;BRAND NEW VERSION&gt;&gt; ECG: Tachycardia - ANSWER HR ≥150 BPM If symptoms persist... - Adenosine if narrow QRS - sedate & synchronized cardioversion - β-blocker or Calcium channel blocker - Vagal maneuvers ECG: Bradycardia - ANSWER HR &lt; 50 BPM If symptoms persist... - Atropine - Trancutaneous pacing - Dopamine IV - Epinephrine IV ECG: 1st degree heart block - ANSWER Long PR intervals tx: Antiarrhythmics - Procainamide - Amiodarone - Sotalol ECG: 2nd degree heart block (Mobitz type 1 / Wenckebach) - ANSWER PQ gets longer and longer until QRS is dropped tx: Antiarrhythmics - Procainamide - Amiodarone - Sotalol ECG: 2nd degree heart block (Mobitz type 2) - ANSWER Long PR interval of equal length with random QRS dropped tx: Antiarrhythmics - Procainamide - Amiodarone - Sotalol ECG: 3rd degree heart block - ANSWER P and QRS waves are completely disjointed; P waves has its own rhythm and so does QRS tx: Antiarrhythmics - Procainamide - Amiodarone - Sotalol ECG: Atrial flutter - ANSWER Sawtooth; distinct QRS though ECG: Atrial fibrillation - ANSWER P wave quivers randomly; less sawtooth; distinct QRS though ECG: Premature ventricular contractions (PVC) - ANSWER Random big lumps - can be unifocal or multifocal tx: Antiarrhythmics - Procainamide - Amiodarone - Sotalol ECG: Ventricular tacycardia (Vtach) - ANSWER *Pulse present: *Sedate & synchronized cardiovert @ 100J (for wide & regular) *Pulseless: *Defibrilate, CPR - Epinephrine 1mg, Amiodarone 300 mg then 150 mg ECG: Ventricualr fibrillation (Vfib) - ANSWER *ALWAYS PULSELESS* Defibrillate, CPR - Epinephrine 1 mg, Amiodarone 300 mg then 150 mg ECG: Asystole - ANSWER Confirm in 2 leads first & check gains - CPR, Epinephrine ECG: Pulseless Electrical Activity (PEA) - ANSWER Can be any rhythm on the monitor, even NSR (normal sinus rhythm). But PULSELESS! meaning heart is exceptionally weak & not circulating blood at all. - CPR, epinephrine Information Gathering - Emphysema: (Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - ANSWER LEVEL I : Cyanosis, Barrel chest, increased A-P diameter, Accessory muscle use, Digital clubbing of the nail beds, Significant history of smoking and/or occupational exposure to smoke or other pulmonary irritant LEVEL II : Dyspnea, Wheezing breath sounds LEVEL III : Chest X-ray—flattened diaphragms, hyperlucency, diminished pulmonary vascular markings. CBC—polycythemia, increased WBC due to possible infection. ABGs—Compensated respiratory acidosis (high PaCO2, normal pH), moderate to severe hypoxemia. Sputum culture—often positive for bacteria. LEVEL IV : FT—flows are decreased especially middle sized airways (FEF 25- 75%) Fev1 and Fev1/FVC%, reduced DLCO (less than 20). Descision Making - Empysema: (Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - ANSWER Oxygen therapy—low FIO2 (0.24 to 0.28) or 1 to 2 lpm nasal cannula Oxygen conserving devices such as liquid oxygen or trans-tracheal oxygen Home care education on devices and equipment cleaning Rehabilitation efforts (specifics not usually required) Aids to help quit smoking such as nicotine replacement therapy Bronchodilation medication via MDI or aerosol nebulizers Antibiotics for infection Smoking cessation products (nicotine replacement therapy). Information Gathering - Chronic Bronchitis (Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - ANSWER LEVEL I : Productive cough, purulent sputum production Exposure to pulmonary irritants, like history of smoking Frequent infections LEVEL II : Dyspnea LEVEL III : Chest X-ray—could be normal, or may show hyperlucency, diminished, pulmonary markings. CBC—possibly increased WBC due to possible infection. ABGs—could be normal or very slight respiratory acidosis and hypoxemia LEVEL IV : PFT—flows are decreased especially middle sized airways (FEF 25- 75%) FEV1, Normal DLCO Decision Making - Chronic Bronchitis (Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - ANSWER Anything that promotes good pulmonary hygiene such as chest physiotherapy, hydration therapy when sputum is thick. Fluid therapy if dehydrated.Oxygen therapy for hypoxemia Aerosolized bronchodilator therapy, Antibiotic Tetracycline may be preferable Information Gathering - Bronchiectasis (Defined: Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation.) - ANSWER LEVEL I : Productive cough, often with blood, digital clubbing of the nail beds, significant history if infections (recurrent) LEVEL II : Dyspnea LEVEL III : Chest X-ray—generally normal Sputum culture—gram negative bacteria LEVEL IV : Bronchogram is the primary test. Characterized by a "tree in winter pattern" Decision Making - Bronchiectasis (Defined: Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation.) - ANSWER Anything that promotes good pulmonary hygiene such as chest physiotherapy, hydration therapy when sputum is thick. Fluid therapy if dehydrated.Oxygen therapy for hypoxemia Aerosolized bronchodilator therapy. May have to consider surgical intervention on some highly affected segments Information Gathering - OSA (Defined: the cessation of breathing during sleep. Is usually obstructive in nature but sometimes can be central or a combination of the two (mixed). - ANSWER LEVEL I : Spouse or bed partner will complain of snoring and will often report witnessing periods of apnea that exceed 10 seconds. Excessive upper airway tissue, obesity, thick neck (greater than 16 inch collar size. Ability to fall asleep quickly Sleepiness during daytime and while watching TV or in front of a computer LEVEL II : Dyspnea, Frequent urination during sleeping hours LEVEL III : ABGs—could be normal or very slight respiratory acidosis and hypoxemia LEVEL IV : Polysomnography (sleep study) - determines if obstructive or central, If no nasal flow AND no chest movement—then CENTRAL sleep apnea. If no nasal flow WITH chest movement—then OBSTRUCTIVE sleep apnea Decision Making - OSA (Defined: the cessation of breathing during sleep. Is usually obstructive in nature but sometimes can be central or a combination of the two (mixed). - ANSWER If central, ventilatory stimulant medication may be used, If obstructive, nocturnal nasal or full-face CPAP or BiPAP (NIPPV) is usually initially indicated with follow-up weight loss or upper airway tissue removal through surgery. Problem must be corrected immediately, so even if discharging, send devices home with patient. In the absence of a titration study, initially ordered pressure should be 10 to 20 cmH20. Information Gathering - Asthma (Defined: Abnormal constriction of the bronchials resulting in sputum productionand narrowed airways. - ANSWER LEVEL I : Accessory muscle use, Tachycardia LEVEL II : Dyspnea, Wheezing, Congested cough, Wet, clammy skin LEVEL III : ABGs—possible respiratory acidosis, could be hypoxic, Chest Xray—hyperinflation, scattered infiltrates, flattened diaphragms. In allergic cases, may see elevated eosinophil count which can cause yellow sputum LEVEL IV : PFT—Decreased flows in FEV1 but diffusion is normal as manifested by DLCO Decision Making - Asthma (Defined: Abnormal constriction of the bronchials resulting in sputum productionand narrowed airways. - ANSWER Oxygen therapy for hypoxemia Aerosolized bronchodilator therapy Continuous bronchodilator therapy, Albuterol (7-10 mg/hr) Xanthine medication given IV (Aminophylline, etc) Promote pulmonary hygiene Inhaled sterioids such as oral or IV prednisone Information Gathering - Status Asthmaticus (Defined: Asthma that will not respond to bronchodilation therapy,usually persists more than 24 hours.) - ANSWER LEVEL I : Historically non-responsive to bronchodilators. Patient will report the need to take many bronchodilator treatments before feeling better. Accessory muscle use and retractions Dyspnea, Wheezing, Congested cough, Wet, clammy skin LEVEL II : Pulses paradoxus LEVEL III : ABGs—possible respiratory acidosis when tiring, alkalosis at first due to anxiety, could be hypoxic Chest X-ray—hyperinflation, scattered infiltrates, flattened diaphragms. Decision Making - Status Asthmaticus (Defined: Asthma that will not respond to bronchodilation therapy,usually persists more than 24 hours.) - ANSWER May deteriorate quickly, so if progression is shown, intubate, mechanically ventilate before full ventilatory failure. Use subcutaneous epinephrine—1 mL of 1:1000 strength. May need to give every 20—30 minutes for up to three consecutive doses (if no improvement between doses) Continuous beta II agonist (bronchodilator medication). Albuterol 7-10 mg/hr. Information Gathering : Myasthenia Gravis (Defined: Neuromuscular abnormality where muscles experience paralysis starting from the head down to the feet including ventilatory muscles.) - ANSWER LEVEL I : May have a history of Myasthenia Gravis if not a new onset, Droopy facial muscles and eyelids (Ptosis) LEVEL II : Patient will describe slowly feeling weakness generally but feels better with rest. Double vision (diplopia) Dysphagia (difficulty swallowing) Drooping eyelid (Ptosis) Shrinking Vt, VC, MIP LEVEL IV : Tensilon Challenge Test—positive for Myasthenic crisis if improvement is noted upon the administration of Tensilon. Decision Making : Myasthenia Gravis (Defined: Neuromuscular abnormality where muscles experience paralysis starting from the head down to the feet including ventilatory muscles.) - ANSWER If Tensilon improves condition then, anticholinesterase therapy is indicated including: Neostigmine (prostigmine), Mestinon (pyridostigmine) Ok to do additional Tensilon challenge test to observe progression. If symptoms improve with Tensilon and then worsen, must reverse with Atropine. This condition is termed a cholinergic crisis. Always monitor spontaneous ventilatory volumes (Vt and VC) as well as MIP. Never treat Myasthenia gravis with Tensilon—only use to diagnose. Use the above mentioned drugs to provide maintenance. Be totally prepared to intubate and mechanically ventilate prior to Tensilon challenge since it could take out the respiratory drive When VC falls off rapidly (especially if below 1.0 L) , then intubate and mechanically ventilate. Information Gathering : Drug Overdose (Defined: Potential loss of ventilatory drive as a result of drug overdose (usually a narcotic). ) - ANSWER LEVEL I : Historical drug use as told by previous admissions or family, Sometimes poor self-hygiene, emaciated LEVEL II : Looks and acts sleepy, difficult to arouse, Respiratory rate and pattern is low and/or shallow LEVEL III : ABG—often show pure respiratory acidosis and/or ventilatory failure Decision Making : Drug Overdose (Defined: Potential loss of ventilatory drive as a result of drug overdose (usually a narcotic). ) **The most important part of this simulation is the need for immediate intubation while recognizing that there may not be a need to mechanically ventilate until ventilatory status deteriorates. - ANSWER Important priority is to protect the airway through intubation, prevent aspiration of stomach contents, and facilitate manual ventilation. If narcotic overdose (usually is) then use narcotic reversing medication such a Narcan (Nalaxon) Support ventilation until drugs are out of system. Information Gathering : Other Neuromuscular (Defined: Other neuromuscular diseases or states include: Poliomyelitis, Tetanus, Muscular dystrophy, and even botulism poisoning.) - ANSWER LEVEL I : History of illness LEVEL II : Shrinking Vt, VC, MIP Decision Making : Other Neuromuscular (Defined: Other neuromuscular diseases or states include: Poliomyelitis, Tetanus, Muscular dystrophy, and even botulism poisoning.) **If faced with these diseases, simply apply general respiratory monitoring principles and facilitate ventilation when needed. These are somewhat rare. - ANSWER Monitor for ventilatory failure generally through Vt, VC, MIP and ABGs As VC falls below 1.0 L, consider intubation and mechanical ventilatory support. Paralytics are indicated if conditions, such as locked-jaw or other muscle contractions are present due to Tetanus or Botulism. Information Gathering - Head Trauma (Defined: Physical Trauma to the head) - ANSWER LEVEL I : Sometimes trauma is visible with blood contusions on the head, History is trauma related, often automobile accident LEVEL II : Looks and acts sleepy, difficult to arouse Respiratory rate and pattern is low and/or shallow and irregular Pupillary response to light may be unequal or inadequate LEVEL IV : If intracranial pressure monitor is in place, may see ICP greater than 20cm H2O