NBRC STUDY TMC ASH NEWEST ACTUAL 140 EXAM COMPLETE
ALL QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+.
QUESTION
A 16-year-old male has been receiving volume-controlled (VC), assist-control (A/C)
ventilation for 24 hours following admission for a drug overdose. The patient is alert
and oriented, and has been weaned to pressure support ventilation (PSV) of 5 cm H₂O
and an FiO₂ of 0.40. The following data are collected after 30 minutes:
pH: 7.47
PaCO₂: 34 mm Hg
PaO₂: 121 mm Hg
HCO₃⁻: 25 mEq/L
BE: +2 mEq/L
SaO₂ (calc): 98%
Spontaneous VT: 465 mL
MIP: -36 cm H₂O
HR: 98/min
RR: 18/min
Which of the following should a respiratory therapist recommend?
a. Continue PSV with current settings.
b. Return to VC, A/C ventilation.
c. Decrease PS to 3 cm H₂O.
d. Extubate the patient.
CORRECT ANS: d. Extubate the patient.
EXPERT RATIONALE
The patient meets all criteria for successful extubation. The spontaneous tidal volume of
465 mL is adequate (typically >5 mL/kg of ideal body weight). The maximum inspiratory
pressure (MIP) of -36 cm H₂O indicates sufficient respiratory muscle strength (typically
,<-20 cm H₂O is adequate). The patient is alert and oriented, has a stable respiratory rate
of 18 breaths/min, and maintains adequate oxygenation (PaO₂ 121 mm Hg on FiO₂
0.40). The ABG results demonstrate a mild respiratory alkalosis (pH 7.47, PaCO₂ 34 mm
Hg), which is acceptable and likely due to anxiety or mild hyperventilation. The patient
does not require continued ventilatory support, and extubation is the most appropriate
recommendation. Continuing PSV, returning to A/C, or decreasing PS would
unnecessarily prolong mechanical ventilation.
QUESTION
Neck and chest palpation reveals crepitus in a patient receiving positive pressure
ventilation. A respiratory therapist should assess the patient for which of the following
conditions?
a. Hepatomegaly
b. Pleural effusion
c. Pneumothorax
d. Pulmonary edema
CORRECT ANS: c. Pneumothorax
EXPERT RATIONALE
Crepitus on palpation of the neck and chest, also known as subcutaneous emphysema,
is a classic sign of air leakage into the subcutaneous tissues. In a patient receiving
positive pressure ventilation, this finding is most concerning for a pneumothorax, which
can occur due to barotrauma or volutrauma. The air from a ruptured alveolus can
dissect along the fascial planes and present as crepitus. Hepatomegaly is associated
with liver enlargement, pleural effusion presents with dullness to percussion and
decreased breath sounds, and pulmonary edema presents with crackles and increased
work of breathing. Pneumothorax is the most likely cause of crepitus in this scenario
and requires immediate evaluation and intervention.
QUESTION
When extubating an adult patient, which of the following should a respiratory therapist
do FIRST?
,a. Deflate the cuff.
b. Remove the tube holder from the patient's face.
c. Position the patient in an upright position.
d. Suction while the patient coughs.
CORRECT ANS: c. Position the patient in an upright position.
EXPERT RATIONALE
Before extubation, the patient should first be positioned in an upright or semi-Fowler's
position. This position optimizes respiratory mechanics, facilitates lung expansion,
reduces the risk of aspiration, and allows the patient to take a deep breath prior to
extubation. After the patient is positioned, the therapist should suction the oropharynx
and endotracheal tube, deflate the cuff, remove the tube holder, and then remove the
endotracheal tube. The upright position is the priority because it ensures patient safety
and readiness for the procedure. Positioning the patient first also allows the therapist to
assess the patient's ability to maintain airway patency and breathe spontaneously once
extubated.
QUESTION
Which of the following is associated with an optimally exposed chest radiograph?
a. Pleural spaces and heart borders are well defined.
b. Vertebrae and lung markings are clearly visible.
c. Pulmonary vascular markings are absent.
d. Air bronchograms are easily identified.
CORRECT ANS: b. Vertebrae and lung markings are clearly visible.
EXPERT RATIONALE
An optimally exposed chest radiograph allows visualization of the vertebrae through the
cardiac shadow and clearly demonstrates lung markings (bronchovascular markings)
throughout the lung fields. This indicates that the penetration and exposure are
appropriate. In an underexposed image, the lungs appear too white, and lung markings
are obscured. In an overexposed image, the lungs appear too black, and fine details are
lost. Pleural spaces and heart borders being well defined indicates a quality image but is
not the primary indicator of optimal exposure. Absence of pulmonary vascular markings
is abnormal and suggests conditions such as pulmonary edema or hyperinflation. Air
bronchograms are a sign of pathology, not an indicator of image quality.
, QUESTION
Which of the following is the definitive method of monitoring the effectiveness of
equipment sterilization?
a. Heat sensitive tape
b. Chemical sensitive indicator
c. Biologic indicator
d. Time and temperature graph
CORRECT ANS: c. Biologic indicator
EXPERT RATIONALE
Biologic indicators (BIs) are the most reliable method for monitoring the effectiveness of
sterilization processes. BIs contain highly resistant bacterial spores (such as Geobacillus
stearothermophilus for steam sterilization) that are killed only when proper sterilization
conditions are achieved. Heat-sensitive tape and chemical indicators indicate that the
item has been exposed to the sterilization process but do not confirm that the process
was effective in killing microorganisms. Time and temperature graphs document the
cycle parameters but do not directly confirm sterility. Biologic indicators provide direct
evidence that the sterilization process is capable of killing the most resistant organisms,
making them the gold standard for quality assurance.
QUESTION
The amount of air that can be maximally exhaled from maximum inspiration is called
the:
a. Expiratory reserve volume.
b. Residual volume.
c. Functional residual capacity.
d. Vital capacity.
CORRECT ANS: d. Vital capacity.
EXPERT RATIONALE
Vital capacity (VC) is defined as the maximum volume of air that can be exhaled from
the lungs after a maximal inspiration. It is the sum of the inspiratory reserve volume,
ALL QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED A+.
QUESTION
A 16-year-old male has been receiving volume-controlled (VC), assist-control (A/C)
ventilation for 24 hours following admission for a drug overdose. The patient is alert
and oriented, and has been weaned to pressure support ventilation (PSV) of 5 cm H₂O
and an FiO₂ of 0.40. The following data are collected after 30 minutes:
pH: 7.47
PaCO₂: 34 mm Hg
PaO₂: 121 mm Hg
HCO₃⁻: 25 mEq/L
BE: +2 mEq/L
SaO₂ (calc): 98%
Spontaneous VT: 465 mL
MIP: -36 cm H₂O
HR: 98/min
RR: 18/min
Which of the following should a respiratory therapist recommend?
a. Continue PSV with current settings.
b. Return to VC, A/C ventilation.
c. Decrease PS to 3 cm H₂O.
d. Extubate the patient.
CORRECT ANS: d. Extubate the patient.
EXPERT RATIONALE
The patient meets all criteria for successful extubation. The spontaneous tidal volume of
465 mL is adequate (typically >5 mL/kg of ideal body weight). The maximum inspiratory
pressure (MIP) of -36 cm H₂O indicates sufficient respiratory muscle strength (typically
,<-20 cm H₂O is adequate). The patient is alert and oriented, has a stable respiratory rate
of 18 breaths/min, and maintains adequate oxygenation (PaO₂ 121 mm Hg on FiO₂
0.40). The ABG results demonstrate a mild respiratory alkalosis (pH 7.47, PaCO₂ 34 mm
Hg), which is acceptable and likely due to anxiety or mild hyperventilation. The patient
does not require continued ventilatory support, and extubation is the most appropriate
recommendation. Continuing PSV, returning to A/C, or decreasing PS would
unnecessarily prolong mechanical ventilation.
QUESTION
Neck and chest palpation reveals crepitus in a patient receiving positive pressure
ventilation. A respiratory therapist should assess the patient for which of the following
conditions?
a. Hepatomegaly
b. Pleural effusion
c. Pneumothorax
d. Pulmonary edema
CORRECT ANS: c. Pneumothorax
EXPERT RATIONALE
Crepitus on palpation of the neck and chest, also known as subcutaneous emphysema,
is a classic sign of air leakage into the subcutaneous tissues. In a patient receiving
positive pressure ventilation, this finding is most concerning for a pneumothorax, which
can occur due to barotrauma or volutrauma. The air from a ruptured alveolus can
dissect along the fascial planes and present as crepitus. Hepatomegaly is associated
with liver enlargement, pleural effusion presents with dullness to percussion and
decreased breath sounds, and pulmonary edema presents with crackles and increased
work of breathing. Pneumothorax is the most likely cause of crepitus in this scenario
and requires immediate evaluation and intervention.
QUESTION
When extubating an adult patient, which of the following should a respiratory therapist
do FIRST?
,a. Deflate the cuff.
b. Remove the tube holder from the patient's face.
c. Position the patient in an upright position.
d. Suction while the patient coughs.
CORRECT ANS: c. Position the patient in an upright position.
EXPERT RATIONALE
Before extubation, the patient should first be positioned in an upright or semi-Fowler's
position. This position optimizes respiratory mechanics, facilitates lung expansion,
reduces the risk of aspiration, and allows the patient to take a deep breath prior to
extubation. After the patient is positioned, the therapist should suction the oropharynx
and endotracheal tube, deflate the cuff, remove the tube holder, and then remove the
endotracheal tube. The upright position is the priority because it ensures patient safety
and readiness for the procedure. Positioning the patient first also allows the therapist to
assess the patient's ability to maintain airway patency and breathe spontaneously once
extubated.
QUESTION
Which of the following is associated with an optimally exposed chest radiograph?
a. Pleural spaces and heart borders are well defined.
b. Vertebrae and lung markings are clearly visible.
c. Pulmonary vascular markings are absent.
d. Air bronchograms are easily identified.
CORRECT ANS: b. Vertebrae and lung markings are clearly visible.
EXPERT RATIONALE
An optimally exposed chest radiograph allows visualization of the vertebrae through the
cardiac shadow and clearly demonstrates lung markings (bronchovascular markings)
throughout the lung fields. This indicates that the penetration and exposure are
appropriate. In an underexposed image, the lungs appear too white, and lung markings
are obscured. In an overexposed image, the lungs appear too black, and fine details are
lost. Pleural spaces and heart borders being well defined indicates a quality image but is
not the primary indicator of optimal exposure. Absence of pulmonary vascular markings
is abnormal and suggests conditions such as pulmonary edema or hyperinflation. Air
bronchograms are a sign of pathology, not an indicator of image quality.
, QUESTION
Which of the following is the definitive method of monitoring the effectiveness of
equipment sterilization?
a. Heat sensitive tape
b. Chemical sensitive indicator
c. Biologic indicator
d. Time and temperature graph
CORRECT ANS: c. Biologic indicator
EXPERT RATIONALE
Biologic indicators (BIs) are the most reliable method for monitoring the effectiveness of
sterilization processes. BIs contain highly resistant bacterial spores (such as Geobacillus
stearothermophilus for steam sterilization) that are killed only when proper sterilization
conditions are achieved. Heat-sensitive tape and chemical indicators indicate that the
item has been exposed to the sterilization process but do not confirm that the process
was effective in killing microorganisms. Time and temperature graphs document the
cycle parameters but do not directly confirm sterility. Biologic indicators provide direct
evidence that the sterilization process is capable of killing the most resistant organisms,
making them the gold standard for quality assurance.
QUESTION
The amount of air that can be maximally exhaled from maximum inspiration is called
the:
a. Expiratory reserve volume.
b. Residual volume.
c. Functional residual capacity.
d. Vital capacity.
CORRECT ANS: d. Vital capacity.
EXPERT RATIONALE
Vital capacity (VC) is defined as the maximum volume of air that can be exhaled from
the lungs after a maximal inspiration. It is the sum of the inspiratory reserve volume,
