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NBRC: EXAM 2025 | ALL CURRENT
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1. What should a helium analyzer read when calibrated at room air? A. 21% B. 100% C. Zero D. 50% ✅ Correct Answer: C. Zero Rationale: Room air contains no helium; therefore, the analyzer should read zero when properly calibrated. 2. How do you instruct a patient to perform a Vital Capacity (VC) maneuver at bedside? A. Inhale and exhale quickly through the nose B. Inhale slightly, then exhale forcefully C. Inhale deeply, then exhale slowly and completely through the mouthpiece D. Take shallow breaths repeatedly ✅ Correct Answer: C. Inhale deeply, then exhale slowly and completely through the mouthpiece Rationale: VC is measured after a maximal inhalation followed by a slow, complete exhalation. 3. A decreased VC (and TLC) may be the result of which condition? A. Emphysema B. Asthma C. Pulmonary fibrosis D. Bronchitis ✅ Correct Answer: C. Pulmonary fibrosis Rationale: Restrictive diseases like fibrosis reduce lung compliance, leading to decreased VC and TLC. 4. TLC increases in which of the following conditions? A. Atelectasis
B. Pneumonia C. Emphysema D. Kyphoscoliosis ✅ Correct Answer: C. Emphysema Rationale: Obstructive diseases like emphysema cause air trapping, increasing total lung capacity.
5. How do you measure exhaled minute ventilation (Ve) at the bedside? A. Use a stethoscope to count breaths B. Use a thermometer C. Use a respirometer and measure for 1 minute D. Use pulse oximetry ✅ Correct Answer: C. Use a respirometer and measure for 1 minute Rationale: Minute ventilation is best measured using a respirometer during normal tidal breathing over one minute. 6. What is the best indicator to differentiate obstructive vs. restrictive disorders? A. Peak flow B. Tidal Volume C. FEV1/FVC ratio (FEV1%) D. Minute ventilation ✅ Correct Answer: C. FEV1/FVC ratio (FEV1%) Rationale: A reduced FEV1% is typical in obstructive diseases; it's usually normal or increased in restrictive conditions. 7. What is the Methacholine Challenge test used for? A. Detecting pneumonia B. Measuring oxygen levels C. Testing for asthma or airway hyperreactivity D. Measuring lung compliance ✅ Correct Answer: C. Testing for asthma or airway hyperreactivity Rationale: Methacholine provokes bronchoconstriction to assess airway sensitivity in asthma. 8. What do gram-negative organisms often cause in the lungs? A. Chronic bronchitis B. Necrotizing pneumonia C. Pleural effusion D. Asthma ✅ Correct Answer: B. Necrotizing pneumonia Rationale: Gram-negative organisms like Legionella and Serratia are linked to severe, necrotizing lung infections.
14. What is the most effective measure of oxygen-carrying capacity of blood? A. PaO B. SpO C. CaO D. PvO ✅ Correct Answer: C. CaO Rationale: CaO2 (arterial oxygen content) reflects oxygen bound to hemoglobin and dissolved in plasma. 15. What is the maximum FiO2 obtainable via nasal cannula? A. 21% B. 40% C. 60% D. 90% ✅ Correct Answer: B. 40% Rationale: Nasal cannula delivers up to 40% FiO₂ at high flow rates depending on the patient's breathing pattern. 16. What happens if the entrainment port on a Venturi mask is occluded? A. FiO₂ decreases B. Flow remains constant C. FiO₂ increases D. Nothing changes ✅ Correct Answer: C. FiO ₂ increases Rationale: Occluding the port reduces room air entrainment, thus increasing delivered O₂ concentration. 17. How do you calculate total flow using an air-entrainment mask? A. FiO₂ x time B. AEF x O₂ flow rate C. RR x Vt D. Vt ÷ time ✅ Correct Answer: B. AEF x O ₂ flow rate Rationale: Multiply the air entrainment factor (AEF) by the oxygen flow to get total delivered flow. 18. What humidifier delivers nearly 100% humidity? A. Bubble humidifier B. Passover humidifier C. Wick and cascade humidifier D. Heat moisture exchanger ✅ Correct Answer: C. Wick and cascade humidifier
Rationale: These heated humidifiers provide nearly complete humidity saturation at body temperature.
19. What is the most likely source of nosocomial infections in aerosol/humidity therapy? A. Humidifiers B. Nebulizers C. Oxygen tanks D. Air entrainment masks ✅ Correct Answer: B. Nebulizers Rationale: Nebulizers can harbor bacteria due to moisture and improper cleaning, leading to infection. 20. What should be done if a patient using an HME develops thick secretions? A. Increase oxygen flow B. Suction the patient C. Replace the HME D. Switch to heated humidifier ✅ Correct Answer: D. Switch to heated humidifier Rationale: Heated humidifiers improve secretion mobilization compared to HMEs. 21. What is the shortcut formula to calculate weight of liquid oxygen (O ₂ )? A. Weight in lbs ÷ 344 = liters B. 344 × weight in pounds = remaining liters C. Volume ÷ 344 = weight D. 344 ÷ weight = hours remaining ✅ Correct Answer: B. 344 × weight in pounds = remaining liters Rationale: This shortcut estimates how many liters of gas are left from the weight of liquid oxygen. 22. What is the next step if a patient is adequately ventilating but still hypoxic on ≥ 60% O ₂? A. Switch to nasal cannula B. Increase O₂ to 100% C. Apply CPAP D. Start antibiotics ✅ Correct Answer: C. Apply CPAP Rationale: CPAP improves oxygenation by increasing mean airway pressure in cases of refractory hypoxemia. 23. What is the correct oxygen device and FiO ₂ for a patient with carbon monoxide poisoning? A. 60% via Venturi mask B. 40% via nasal cannula
28. How do you calculate inspiratory flow (IF)? A. IF = Vt ÷ RR B. IF = Vt ÷ inspiratory time C. IF = FIO₂ × RR D. IF = Vt ÷ expiratory time ✅ Correct Answer: B. IF = Vt ÷ inspiratory time Rationale: Inspiratory flow is the volume per breath divided by the inspiratory time (then convert to L/min). 29. What indicates sufficient flow with an aerosol mask? A. RR less than 20 B. Color change in tubing C. Mist visible at all times D. No condensation ✅ Correct Answer: C. Mist visible at all times Rationale: Continuous mist indicates adequate aerosol delivery and flow rate. 30. What is the simplified shortcut for calculating PAO ₂ (alveolar oxygen)? A. 760 × FIO₂ – PaCO₂ B. 700 × FIO₂ – PaCO₂ + 10 C. FIO₂ × 100 – PaCO₂ D. PaCO₂ × 0.8 – FIO₂ ✅ Correct Answer: B. 700 × FIO ₂ – PaCO ₂ + 10 Rationale: A simplified estimate of PAO₂ at sea level with a barometric pressure of ~700 mmHg. 31. Which factor applies to heliox at 80/20? A. Multiply O₂ flow × 1. B. Multiply O₂ flow × 1. C. Divide flow by 1. D. Subtract 10 from flow ✅ Correct Answer: B. Multiply O ₂ flow × 1. Rationale: Heliox is lighter than O₂; flow needs correction using the proper factor. 32. What should a helium analyzer read when calibrated in room air? A. 21% B. 100% C. 50% D. 0 (Zero) ✅ Correct Answer: D. 0 (Zero) Rationale: Since room air has no helium, the analyzer should read zero.
33. What is the objective of humidity therapy? A. To reduce PaCO₂ B. To improve airway resistance C. To replace water loss from dry gas or bypassed upper airway D. To increase respiratory rate ✅ Correct Answer: C. To replace water loss from dry gas or bypassed upper airway Rationale: Humidity helps maintain mucociliary function and prevents airway drying. 34. Fully saturated air at 37°C holds how much water and exerts what vapor pressure? A. 47 mg/L, 44 mmHg B. 44 mg H₂O, 47 mmHg C. 37 mg/L, 37 mmHg D. 50 mg H₂O, 40 mmHg ✅ Correct Answer: B. 44 mg H ₂ O, 47 mmHg Rationale: Fully saturated air at body temperature holds 44 mg/L water vapor and has a pressure of 47 mmHg. 35. How do you test unheated humidifiers for leaks? A. Shake the container B. Disconnect from the wall C. Kink the tubing and listen for pop-off D. Use a water manometer ✅ Correct Answer: C. Kink the tubing and listen for pop-off Rationale: This test ensures the pressure relief valve functions properly, indicating no leaks. 36. What is the most likely source of infection in aerosol or humidity therapy? A. Heat moisture exchanger B. Passover humidifier C. Nebulizers D. Oxygen concentrator ✅ Correct Answer: C. Nebulizers Rationale: Due to stagnant water and aerosol generation, nebulizers are common sources of contamination. 37. What should you do if a patient using an HME develops thick secretions? A. Increase suctioning B. Give mucolytics C. Switch to a heated humidifier D. Replace HME
✅ Correct Answer: C. During maximal inspiration Rationale: Full inspiration gives the best visualization of lung fields and diaphragm.
43. Where should the tip of an endotracheal tube be located on CXR? A. At the carina B. Below the clavicle C. 2–5 cm above the carina D. In the esophagus ✅ Correct Answer: C. 2–5 cm above the carina Rationale: Proper ETT placement is 2–5 cm above the carina to ensure bilateral ventilation and avoid mainstem intubation. What are therapeutic serum levels for theophylline? - ANSWER 10 - 20 mg/l How do you reverse the paralizing effects of non-depolarizing agents (Pancuronium, Roc, Vec)? - ANSWER Tensilon or Prostigmin Succs and Propofol are NOT reversible What is the primary indication for inhaled steroids? - ANSWER Intiinflammatory maintenance therapy for mild to moderate persistent asthma Fluticasone, budesonide (pulmicort), Dex, Beclomethasone What education is critical for MDI tx? - ANSWER To rinse after use due to potential of Candida Drug calculation What is % strength of 1:2000 solution - ANSWER (1/2000) x 100 = 0.05% What is most recommended for cleaning of home respiratory equipment? - ANSWER 1) Clean first with mild soap Vinegar may be suggested as alternative in NBRC exam Nebulize 10ml of 3 part water/1part vinegar or soak for 30 min. What are 3 FRC tests? - ANSWER Functional Reserve Capacity (FRC) 1) Helium Dilution
- Nitrogen (NO2) washout
- Body Pleth (may read higher than other 2) Level of the 4th rib or 4th thoracic vertebra What is the effect of a fever on O2 and CO2? - ANSWER ↑O ↑CO ↑WOB May be critical/acute with COPD Pt What is a common result of metabolic alkalosis? - ANSWER Hypochloremia ↓Cl- What may happen if you Sxn Pt with increased PT or PTT? - ANSWER Hemorrhaging What is the best method to obtain a sputum sample from the LEFT lung? - ANSWER Use a Coude sxn cath What are proper cuff pressures? - ANSWER 25 mmHg 30 - 35 cmH2O What is the primary indication for ETT? - ANSWER 1) Pt cannot protect airway Obtunded, drugs, loss of reflexes, neuro, paralysis etc. What is the MAX time for any ETT placement attempt? - ANSWER 15 - 20 seconds Else, remove blade and bag with 100% O What is the cause/result of an ETT being inserted TOO FAR? - ANSWER Right mainstem intubation What can happen to CO2 detection during resuscitation? - ANSWER Even with proper ETT placement, the reading may be near 0; b/c QT, BP and gas exchange are all reduced What is the average distance teeth to carina? Males: Females: - ANSWER Males: 27cm (tape 22 - 25)
What are the primary indications for CPT? - ANSWER 1) Pt who produce >30ml secretions per day
- Have trouble clearing airway For postural drainage, where is the good lung positioned? - ANSWER Good lung DOWN (GLD: b/c it increases perfusion to the lung that can best support the body) What is the indication for EzPAP? - ANSWER For Pt with vital capacity: VC <10 ml/kg IBW e.g. they do NOT meet the required >10ml/kg IBW for IS What are alternatives for chest percussion and/or postural drainage? - ANSWER Autogenic drainage Intrapulmonary percussive ventilation HFCWO (vest) PEP Flutter What is the most common use of a 12-lead ECG? - ANSWER Long-term such as in ICU What is your assessment if all ECG observations are within normal limits? - ANSWER Assume NSR What is the arrythmia when every other beat on the ECG is a PVC? - ANSWER Bigeminy Dangerous rhythm What is the result of A-fib? - ANSWER 1) Decreased blood supply to ventricles 2) Decreased QT
- May cause pulmonary emboli (PE) Major Arrhythmia What is the result of A-flutter (sawtooth)? - ANSWER Blockade of atrial impulses 2:!, 3:1, 4:1 block What is the position of the manometer for measurement of CVP? - ANSWER Level with heart
PEEP and CVP - ANSWER 1) To measure effects of PEEP on CVP, measure with PEEP ON ---else measure without PEEP
- Critical lung patients cannot be removed from PEEP What is normal QT? How do you convert from ml/dl to ml/L? - ANSWER 1) Normal QT 4 - 8 l/min
- Convert from ml/dl to ml/L; use O2 content difference and multiply x 10 (CaO2 - CvO2) x 10 In what patients is PCWP elevated?*** - ANSWER 1) Elevated: Cardiogenic pulmonary edema Note: PCWP will be NORMAL in Noncardiogenic pulmonary edema What is the NORMAL arteriovenous difference? C(a - v)O2 - ANSWER 4 - 6 ml/dl (vol%) What is the use of C(a - v)O2? - ANSWER Determine the effects of PEEP on QT and the need for additional circulatory support What is a NORMAL intrapulmonary shunt? - ANSWER 2 - 5% (anatomic shunt) What causes increased shunt? - ANSWER 1) PNA
- PTX
- PE
- Atelectasis Shortcut to calculate shunt*** - ANSWER (A-a ÷ 20) +4% a) <10% = Normal b) 10 - 20 = no clinical significance c) 20 - 30 significant, may be life threatening d) >30% requires aggressive cardiopulmonary support What is the O2 consumption formula*** - ANSWER VO2 = (QT x {C(a-v)O2} ) x 10
How do you calculate inspiratory time?*** I:E ratio? ???-check back of book - ANSWER Vt: 800ml (.8L) RR: 12/min Flow: 40 L/min I:E = Flow/(Vt x RR) = 40/9.6l/m = 4.2 (minus 1) = I:E of 1:3. I-time = Total cycle time/4. What Pt best benefit with the adjustment of RR to manage PaCO2? - ANSWER Pt on A/C sedated (NOT ARDS) and those on SIMV) Action: Pt with normal or low PaCO2 with hypoxemia and PEEP & FIO2 are HIGH>...***
- ANSWER Increase I-Time to increase PaO b/c ↑Ti = ↑MAP = ↑PaO What is the most common adjustment to correct inverse I:E?*** - ANSWER Increase flow Basic Vent settings - ANSWER Mode: A/C or SIMV Vt: 6 - 8 ml/kg IBW RR: 8 - 12 FiO2: same as before vent (COPD 30 - 40% if possible) Minimum MIP? - ANSWER 1) MIP < - 20 cmH2O What is the MOST cost effective method of preventing cross contamination of Pt? - ANSWER Hand-washing Is it OK to add deadspace to spontaneous breathing PT (other than A/C)? - ANSWER No What action do you take if Pt has ↑PaCO2 and has ADDED deadspace in vent circuit? - ANSWER Remove deadspace (Do NOT increase Vt or RR)
Static Compliance Calc (Cs)*** - ANSWER VT ÷ (Plat - PEEP) Note: always use actual vent Vt...NOT exhaled Vt Resistance Calc (Raw)?*** - ANSWER (PIP - Plat) ÷ (flow l/s) Remember to convert flow from L/min to L/s (÷ 60) Normal: <12 cmH20 for ventilated Pt Optimal PEEP (page 131) - ANSWER 1) Optimal PEEP is level of PEEP that produces HIGHEST Cs***
- Subtract PEEP from Plat, lowest number = optimal
- If Qt is also given, calc optimal PEEP BEFORE drop in QT Is Hyperventilation indicated for elevated ICP? - ANSWER Exams allow hyperventilation for elevated ICP How do you decrease PaCO2 in PT with HIGH ICP? - ANSWER Always ↑ RR (not Vt) b/c and increase in Vt may ↑ ICP and decrease return of venous blood to heart further Key weaning parameters - ANSWER 1) VC >10 ml/kg IBW
- Vt > 4-6 ml/KG
- Ve <10-15 l/min
- MIP > - 20
- Vd/Vt <.6 (norm = .3)
- P(A-a)O2 <350 @ 100% O
- RISB <
- RR < 9)PEEP < 8
- PaO2/FIO2 >200 (90/.21) = p/f ratio If PaO2 ≥ 70torr & PaCO2 ↑increasing after Pt with COPD begins receiving O2 then...? - ANSWER 1) Pt ventilatory drive is suppressed
- or...↑V/Q mismatch***
- Action: decrease O2% Severe COPD: Maintain PaO2 at 50 - 65 torr
Infant rating scales - ANSWER 1) Silverman: Respiratory
- Ballard: Gestational Age 3) ??? What O2 device is best for an active 3 y/o? - ANSWER Nasal Cannula HIGH O2 in infants may cause? - ANSWER BPD (pulmonary tissue damage) ROP (blindness)
- Keep O2 @ 50 - 60%
- Use CPAP before increased FIO
- PaO2 NO HIGHER than 80 torr (50 - 80 torr) Any condition with ↑PVR may cause?*** - ANSWER PPHN Maintaining low PaCO2 levels in newborns results in?*** - ANSWER 1) Less blood flow through DA and FO Note: if shunting is occuring, PaO2 levels ↑during this test Maintain these levels only for the first few days to help reverse PPHN A PDA may produce what type of shunt? - ANSWER Left to right May lead to CHF/PE What is Dexamethasone (Decadron)? What does it tx? - ANSWER 1) Steroid + Anti-inflammatory
- Tx: Asthma & Glottic Edema (NOT PE) Drugs and Receptors - ANSWER Alpha: Vaso and broncho constriction B1: ↑HR, ↑QT, Arrhythmias B2: Smooth muscle relax Vasodilation ↑CNS (jitters) What is the IDEAL Bronchodilator? - ANSWER Pure B Adrenergic receptor stimulator What drug class best PREVENTS asthma attacks? - ANSWER Leukotriene modifiers e.g. Singulair What is the minimum and preferred sampling rate? - Ans - Min 200Hz; Preferred 500Hz
Which respiratory equipment is used to measure apneas? - Ans - Thermistor/thermocouple What are some common troubleshooting issues for the thermistor? - Ans - Warm the room, remove fan, moisture on the sensor, battery needs to be changed What is considered the gold standard for measuring respiratory effort? - Ans - RIP belts What equipment is used to measure RERAs and Hypopneas? - Ans - nasal pressure transducer (PTAF) What is some common troubleshooting issues for the PTAF? - Ans - rhinorrhea, position of the sensor, mouthbreathing, LFF can cause a dampened waveform Normal ETCO2 in mmHg and percent - Ans - 30 torr and 3-5% What are common issues that can affect the TCOM reading? - Ans - skin thickness, anemia, decreased perfusion How do you calibrate the TCOM? - Ans - with RA What will happen to the readings if the TCOM has a leak? - Ans - PO2 will increase to room PO2, PCO2 will decrease to zero The snore mic is used to detect what? - Ans - Bruxism What are the scores of Epworth Sleepiness scale? - Ans - 0 - 5 low-normal daytime sleepiness 6 - 10 high-normal daytime sleepiness 11 - 12 Mild EDS 13 - 15 Moderate EDS 16+ Severe EDS What does STOP-BANG stand for? - Ans - Snoring? Tired during the day? Observed apneas Pressure (HTN)? BMI Age (>50) Neck size (males 17in/43cm; females 16in/41cm) Gender (male) What does answering yes to 2 or less questions on the STOP BANG questionnaire suggest? - Ans - low risk for OSA
