NBRC EXAM, Part I
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 16-year-old male patient involved in a motorcycle accident presents to the ER with
massive maxillary and nasal trauma. Which of the following devices would be most
appropriate for maintaining the patient's airway?
A. nasal endotracheal tube
B. fenestrated tracheostomy tube
C. oral pharyngeal airway
D. oral endotracheal tube - --------------------Patient with massive maxillary and nasal
trauma would be difficult to intubate; you might need to bypass the face completely,
so ANSWER is B, fenestrated tracheostomy tube (could be fenestrated or not
fenestrated, either would work).
A 2 kg (4.4 lb) neonate requires transportation to a tertiary care center for cardiac
surgery. The infant has a heart rate of 140 and a BP of 60/30.The neonate is
intubated with a size 2.5 mm uncuffed endotracheal tube and ventilation is being
assisted manually at a rate of 40/min. Which of the following should the respiratory
therapist recommend?
A. postpone the transport until the neonate has spontaneous respirations
B. prepare for the transport immediately
C. delay the transport and stabilize the patient
D. wait 24 hours and then reassess the patient - --------------------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. Inspiratory and expiratory chest films indicate air
trapping with no foreign bodies "noted." The respiratory therapist should suspect the
child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
,d.tachyphylaxis - --------------------Unilateral wheezing indicates aspirated object and
fact that the child was playing with friends causes you to believe the child inhaled a
small toy or something, hyperresonant percussion indicates air trapping, so you are
thinking foreign object but x-ray says no foreign bodies "noted." Just because it says
"noted" does not mean something is not there, it just means it could not be seen on
the xray, also if the child had swallowed a small plastic toy, "plastic" does not show
up on xrays (radiolucent). The ANSWER is C
A 24-year-old post-operative male patient is receiving intermittent positive pressure
therapy at 20 cm H2O. The patient complains that the machine is cycling off too
soon. The patient's post-operative spontaneous vital capacity is 3.5 L. Which of the
following should the respiratory therapist recommend?
A. Increase the pressure to 25 cm H2O
B. Discontinue therapy, encourage deep breathing and coughing frequently on his
own
C. Switch to a volume incentive spirometry device
D. Recommend decreasing the flow - --------------------The key is that the patient's
post-operative spontaneous vital capacity is 3.5L, which shows he can take a pretty
good deep breath on his own, so the simplest, easiest ANSWER is B, discontinue
therapy, encourage deep breathing and coughing frequently on his own. If they can
do it on their own, that's the best therapy of all.
A 26-week gestational age infant requires intensive monitoring and care in the NICU.
Which device would be most appropriate for maintaining a neutral thermal
environment for this infant?
A. radiant warmer
B. isolette
C. croupette
D. bassinet - --------------------Both the isolette and the radiant warmer can be neutral
thermal environments. The key to this question, making one better than the other, is
access to the patient since this baby requires continuous monitoring. Supposedly,
the radiant warmer provides better access to the baby than the isolette.
A 26-year-old patient with shortness of breath is admitted to the emergency room.
The patient states that he was running in Central Park with a friend and could not
catch his breath. Bedside assessment reveals the following data:
Pulse: 120
Respirations: 25 br/min
Color: pale
SpO2: 89% on room air
Breath sounds: slightly diminished on the right
The respiratory therapist should:
A. request a STAT chest x-ray.
B. administer 100% oxygen.
,C. insert a large bore needle into the 2nd intercostal space on the right side in the
midclavicular line.
D. insert a chest tube into the 2nd intercostal space on the right side in the
midclavicular line. - --------------------Request a STAT x-ray is good but the patient
currently has shortness of breath and is uncomfortable, so what would you do
FIRST, ANSWER is B, administer 100% oxygen
A 27-week gestation age neonate with respiratory distress syndrome is receiving
high frequency oscillatory ventilation at the following settings:
PIP: 20 cm H2O
Frequency: 12 Hz
I time: 30%
FIO2: 0.55
PEEP: 4 cm H2O
Blood gas results from an umbillical artery line are as follows:
pH: 7.15
PaCO2: 62 torr
PaO2: 46 torr
HCO3-: 22 mEq/L
The respiratory therapist should increase the
A. PEEP.
B. FIO2.
C. frequency.
D. amplitude. - --------------------This baby is not being ventilated or oxygenated
properly. Always fix ventilation first or the oxygen won't get where it is supposed to
anyway. Amplitude means "pressure",
so ANSWER is D, Increase Amplitude
A 28-week gestational age infant with severe respiratory distress syndrome is being
mechanically ventilated in the PC, SIMV mode at the following settings:
Flow rate: 6 L/min
Set rate: 32 br/min.
PIP: 28 cmH2O
FIO2: 0.70
PEEP: 5 cm H2O
I time: 0.8 seconds
Umbilical arterial blood gas results reveal:
, pH: 7.40
PCO2: 39 torr
PO2: 42 torr
HCO3-: 23 mEq/L
Based on the above information, the respiratory therapist should change the
A. I time to 1.0 second.
B. PEEP to 7 cm H2O.
C. FIO2 to 0.75.
D. PIP to 30 cm H2O. - --------------------Ventilation is good on baby, PO2 is bad (less
than 60), so we have an oxygenation problem. Baby is already on high level of
oxygen and they are already on PEEP therapy, but they are still shunting (they are
on 70% FiO2 and still bad oxygenation with good ventilation) so inch up the PEEP
(never above 8),
so ANSWER is B, PEEP to 7 cm H2O.
A 28-week gestational age neonate is experiencing frequent apneic episodes with
bradycardia. Which of the following should the respiratory therapist recommend?
A. An FIO2 of 0.40 via oxyhood
B. Suctioning the neonate during apnea episode
C. Administering beclomethasone
D. Administering theophylline - --------------------Answer is D. Beclomethasone is a
steroid given to mother before birth to get more surfactant for the child so wouldn't
help with stimulating the baby to breath. Theophylline is a respiratory stimulant so
would help the baby with apnea.
A 3-year-old child with cystic fibrosis is being mechanically ventilated at the following
settings:
PIP: 34 cm H2O
I time: 1.0 second
Rate: 22 /min.
FIO2: 0.60
PEEP: 6 cm H2O
Mode: PC, SIMV
Arterial blood gas results show:
pH: 7.36
PaCO2: 44 torr
PaO2: 49 torr
HCO3-: 24 mEq/L
The respiratory therapist should adjust the
A. PEEP to 8 cm H2O.
B. FIO2 to 0.65.
C. set rate to 24 /min.
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 16-year-old male patient involved in a motorcycle accident presents to the ER with
massive maxillary and nasal trauma. Which of the following devices would be most
appropriate for maintaining the patient's airway?
A. nasal endotracheal tube
B. fenestrated tracheostomy tube
C. oral pharyngeal airway
D. oral endotracheal tube - --------------------Patient with massive maxillary and nasal
trauma would be difficult to intubate; you might need to bypass the face completely,
so ANSWER is B, fenestrated tracheostomy tube (could be fenestrated or not
fenestrated, either would work).
A 2 kg (4.4 lb) neonate requires transportation to a tertiary care center for cardiac
surgery. The infant has a heart rate of 140 and a BP of 60/30.The neonate is
intubated with a size 2.5 mm uncuffed endotracheal tube and ventilation is being
assisted manually at a rate of 40/min. Which of the following should the respiratory
therapist recommend?
A. postpone the transport until the neonate has spontaneous respirations
B. prepare for the transport immediately
C. delay the transport and stabilize the patient
D. wait 24 hours and then reassess the patient - --------------------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. Inspiratory and expiratory chest films indicate air
trapping with no foreign bodies "noted." The respiratory therapist should suspect the
child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
,d.tachyphylaxis - --------------------Unilateral wheezing indicates aspirated object and
fact that the child was playing with friends causes you to believe the child inhaled a
small toy or something, hyperresonant percussion indicates air trapping, so you are
thinking foreign object but x-ray says no foreign bodies "noted." Just because it says
"noted" does not mean something is not there, it just means it could not be seen on
the xray, also if the child had swallowed a small plastic toy, "plastic" does not show
up on xrays (radiolucent). The ANSWER is C
A 24-year-old post-operative male patient is receiving intermittent positive pressure
therapy at 20 cm H2O. The patient complains that the machine is cycling off too
soon. The patient's post-operative spontaneous vital capacity is 3.5 L. Which of the
following should the respiratory therapist recommend?
A. Increase the pressure to 25 cm H2O
B. Discontinue therapy, encourage deep breathing and coughing frequently on his
own
C. Switch to a volume incentive spirometry device
D. Recommend decreasing the flow - --------------------The key is that the patient's
post-operative spontaneous vital capacity is 3.5L, which shows he can take a pretty
good deep breath on his own, so the simplest, easiest ANSWER is B, discontinue
therapy, encourage deep breathing and coughing frequently on his own. If they can
do it on their own, that's the best therapy of all.
A 26-week gestational age infant requires intensive monitoring and care in the NICU.
Which device would be most appropriate for maintaining a neutral thermal
environment for this infant?
A. radiant warmer
B. isolette
C. croupette
D. bassinet - --------------------Both the isolette and the radiant warmer can be neutral
thermal environments. The key to this question, making one better than the other, is
access to the patient since this baby requires continuous monitoring. Supposedly,
the radiant warmer provides better access to the baby than the isolette.
A 26-year-old patient with shortness of breath is admitted to the emergency room.
The patient states that he was running in Central Park with a friend and could not
catch his breath. Bedside assessment reveals the following data:
Pulse: 120
Respirations: 25 br/min
Color: pale
SpO2: 89% on room air
Breath sounds: slightly diminished on the right
The respiratory therapist should:
A. request a STAT chest x-ray.
B. administer 100% oxygen.
,C. insert a large bore needle into the 2nd intercostal space on the right side in the
midclavicular line.
D. insert a chest tube into the 2nd intercostal space on the right side in the
midclavicular line. - --------------------Request a STAT x-ray is good but the patient
currently has shortness of breath and is uncomfortable, so what would you do
FIRST, ANSWER is B, administer 100% oxygen
A 27-week gestation age neonate with respiratory distress syndrome is receiving
high frequency oscillatory ventilation at the following settings:
PIP: 20 cm H2O
Frequency: 12 Hz
I time: 30%
FIO2: 0.55
PEEP: 4 cm H2O
Blood gas results from an umbillical artery line are as follows:
pH: 7.15
PaCO2: 62 torr
PaO2: 46 torr
HCO3-: 22 mEq/L
The respiratory therapist should increase the
A. PEEP.
B. FIO2.
C. frequency.
D. amplitude. - --------------------This baby is not being ventilated or oxygenated
properly. Always fix ventilation first or the oxygen won't get where it is supposed to
anyway. Amplitude means "pressure",
so ANSWER is D, Increase Amplitude
A 28-week gestational age infant with severe respiratory distress syndrome is being
mechanically ventilated in the PC, SIMV mode at the following settings:
Flow rate: 6 L/min
Set rate: 32 br/min.
PIP: 28 cmH2O
FIO2: 0.70
PEEP: 5 cm H2O
I time: 0.8 seconds
Umbilical arterial blood gas results reveal:
, pH: 7.40
PCO2: 39 torr
PO2: 42 torr
HCO3-: 23 mEq/L
Based on the above information, the respiratory therapist should change the
A. I time to 1.0 second.
B. PEEP to 7 cm H2O.
C. FIO2 to 0.75.
D. PIP to 30 cm H2O. - --------------------Ventilation is good on baby, PO2 is bad (less
than 60), so we have an oxygenation problem. Baby is already on high level of
oxygen and they are already on PEEP therapy, but they are still shunting (they are
on 70% FiO2 and still bad oxygenation with good ventilation) so inch up the PEEP
(never above 8),
so ANSWER is B, PEEP to 7 cm H2O.
A 28-week gestational age neonate is experiencing frequent apneic episodes with
bradycardia. Which of the following should the respiratory therapist recommend?
A. An FIO2 of 0.40 via oxyhood
B. Suctioning the neonate during apnea episode
C. Administering beclomethasone
D. Administering theophylline - --------------------Answer is D. Beclomethasone is a
steroid given to mother before birth to get more surfactant for the child so wouldn't
help with stimulating the baby to breath. Theophylline is a respiratory stimulant so
would help the baby with apnea.
A 3-year-old child with cystic fibrosis is being mechanically ventilated at the following
settings:
PIP: 34 cm H2O
I time: 1.0 second
Rate: 22 /min.
FIO2: 0.60
PEEP: 6 cm H2O
Mode: PC, SIMV
Arterial blood gas results show:
pH: 7.36
PaCO2: 44 torr
PaO2: 49 torr
HCO3-: 24 mEq/L
The respiratory therapist should adjust the
A. PEEP to 8 cm H2O.
B. FIO2 to 0.65.
C. set rate to 24 /min.
