NBRC CSE PRACTICE EXAM REVIEW EXAM
WITH CORRECT ACTUAL QUESTIONS AND
CORRECTLY WELL DEFINED ANSWERS
LATEST ALREADY GRADED A+ 2025 - 2026
Readiness to wean:REVIEW
What are the parameters used to determine the readiness to wean?
VT >5 mL/kg
VC > 10 mL/gh
MIP > - 20 cm H2O
Rate 8 to 20 breaths per minute
RSBI < 106 (RR / Vt(L))
Vd/Vt ratio < 60%
% Shunt < 20%
ABGs adequate oxygenation and ventilation (or same as before ventilator)
Underlying condition needs to be resolved (if ventilatory related)
Adult Ventilator Weaning :
Weaning Failure:
A patient fails if any of what values fall below acceptable limits?
Pulse > 20 bpm from baseline (prior to weaning)
BP > 20 torr from baseline
PaCO2 >10 torr from baseline
RR >10 from baseline OR is > 30 breaths per minute
Also, weaning fails if there is a significant change in the patient's status
,generally (ie confusion,
lethargy, unresponsiveness).
Adult Ventilator Weaning :
Successful Weaning:
While there are no explicit expectations on what methods should be used for
weaning, what are
some limitations on how far you need to go....
If SIMV rate 4 is accomplished, there is no need to decrease to 2
No need to decrease FIO2 below 0.40
No need to decrease PEEP below 5 cm H2O
Remember, cessation of mechanical ventilation does not mean extubation.
One can stay on a
ventilator on a heated aerosol and be extubated another day.
Ventilator Troubleshooting :
High pressure alarm : Patient vs Machine
Patient =
Patient coughing, need suctioning?
Patient resisting inspiration , need sedation?
Pneumothorax, check for signs
ET tube cogged by sputum or herniated cuff?
Machine =
Accumulated water in the circuit?
Pinched circuit?
Recent change in alarm limits or settings?
Ventilator Troubleshooting :
Low pressure alarm : Patient vs Machine
Patient
Chest tube leakage
Patient inadvertently partially extubated (not always obvious)
,Cuff is under-inflated or deflated
Machine
Circuit is disconnected from the patient
Circuit has come apart or has a leak
On some ventilators, flow rate may not be sufficient (pressure cycled
machines)
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).
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.
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 X-ray—
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.
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.)
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.)
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
WITH CORRECT ACTUAL QUESTIONS AND
CORRECTLY WELL DEFINED ANSWERS
LATEST ALREADY GRADED A+ 2025 - 2026
Readiness to wean:REVIEW
What are the parameters used to determine the readiness to wean?
VT >5 mL/kg
VC > 10 mL/gh
MIP > - 20 cm H2O
Rate 8 to 20 breaths per minute
RSBI < 106 (RR / Vt(L))
Vd/Vt ratio < 60%
% Shunt < 20%
ABGs adequate oxygenation and ventilation (or same as before ventilator)
Underlying condition needs to be resolved (if ventilatory related)
Adult Ventilator Weaning :
Weaning Failure:
A patient fails if any of what values fall below acceptable limits?
Pulse > 20 bpm from baseline (prior to weaning)
BP > 20 torr from baseline
PaCO2 >10 torr from baseline
RR >10 from baseline OR is > 30 breaths per minute
Also, weaning fails if there is a significant change in the patient's status
,generally (ie confusion,
lethargy, unresponsiveness).
Adult Ventilator Weaning :
Successful Weaning:
While there are no explicit expectations on what methods should be used for
weaning, what are
some limitations on how far you need to go....
If SIMV rate 4 is accomplished, there is no need to decrease to 2
No need to decrease FIO2 below 0.40
No need to decrease PEEP below 5 cm H2O
Remember, cessation of mechanical ventilation does not mean extubation.
One can stay on a
ventilator on a heated aerosol and be extubated another day.
Ventilator Troubleshooting :
High pressure alarm : Patient vs Machine
Patient =
Patient coughing, need suctioning?
Patient resisting inspiration , need sedation?
Pneumothorax, check for signs
ET tube cogged by sputum or herniated cuff?
Machine =
Accumulated water in the circuit?
Pinched circuit?
Recent change in alarm limits or settings?
Ventilator Troubleshooting :
Low pressure alarm : Patient vs Machine
Patient
Chest tube leakage
Patient inadvertently partially extubated (not always obvious)
,Cuff is under-inflated or deflated
Machine
Circuit is disconnected from the patient
Circuit has come apart or has a leak
On some ventilators, flow rate may not be sufficient (pressure cycled
machines)
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).
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.
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 X-ray—
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.
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.)
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.)
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
