NBRC TMC B 2024/2025 QUESTIONS & ANSWERS., Exams of Nursing

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Science/ Medicine/ Pulmonology A patient with a PBW of 55 kg (121 lb) is receiving VC, A/C ventilation. Ventilator scttings and blood gas analysis results arc: VIO2 0.70 Mandatory rate 14 VT 350 mL PEEP 5 cm H20 pH 7.35 PaCO2 35 mm Hg PaO2 40 mm Hg HCO3— 19 mEq/L BE —6 mlid/I. SO2 (calc) 74% A respiralory therapist should recommend: A, changing lo SIMV made. B, Increasing to 10 cm II2O0 PEEP. C, Changing to 5 em H20 CPAP. D. Increasing to 400 mL VT. — ANS—v v BUIBGEOaSIne On Oen ED ONP Ina) When instructing a paticnt on the administration of umcclidinium/vilantcrol (Anoro Ellipta), which of the following is most important to emphasize? > . Gargle immediately after use. 3. Inhale slowly with a breath hold. C. Breathe in fast and deep. D, Shake medication vigorously before usc. — ANS- vv @iiireathonnastand decp. Which of the following is used lo monilor the partial pressure of Lransculaneous carbon dioxide? A, Red-light absorption sensor 3. Electromechanical transducer C, Infrared analyzer D. Stow—Severinghaus electrode — ANS- WWD. Stow-Severinghaus clectrode An adult paticnt requires frequent blood sampling and medication administrations through an IV for 1 month. The preferred vascular access is a A, Peripherally inserted central catheter. B. Subclavian central vascular linc. C, Standard peripheral IV line. D. Internal jugular catheter. — ANS— vv AIDGHDpRGrallyinser ted |eentralleatnoren B. Change the PEEP to 5 cm H20. C. Increase the minute ventilation. D. Maintain the current settings. — ANS-WVWA, Decrease the F102 to 0.60. Following an emergent C-section, a 35 year old is recciving VC, A/C ventilation. The following pressure-volume loop is observed: Which of the following ventilator sellings should be adjusted? A, PEEP B. Flaw rate C. Tidal volume D. Trigger sensitivity — ANS- WWD. Trigger sensitivity Which of the following techniques is preferred for a quadriplegic patient having difficulty expectorating secretions? A, Pursed lip breathing 3. Abdominal thrust C. PEP therapy ). Inspiratory muscle training — ANS- vv BIAbdominalenrust A patient with a history of hypertension was awakened by cough and shortness of breath. He has fine inspiratory crackles bilaterally. Which of the following should a respiratory therapist recommend? A, Prednisone B. Albuterol C. Furosemide (Lasix) 1D. Guaifenesin (Mucinex) — ANS-vVv G9RULOSeMIenDaSIe) The preferred suction device to remove large amounts of secretions fram the oral cavity of an adult paticnt is a A.Yankaucr device. B. DeLee suction trap. C, Whistle—tip catheter. D. Coud6 catheter. - ANS-v vw Aljanauendeviee! A respiratory therapist examines a paticnt and notes coarse crackles over both lung ficlds. Which of the follawing does this mast likely indicale? A. Subcutaneaus emphysema B. Pleurisy A, Echocardiogram LB. Thoracentesis C. V/Q scan D. Bronchoscopy — ANS-WWL. Thoracentesis Which of the following is typically associated with bilateral, fluffy infiltrates on a chest radiograph? > . Pulmonary edema x . Neoplasm a . Pleural effusion ). Hemothorax — ANS-WWA, Pulmonary cdema Which of the follawing should a respiratory Lherapist use to confirm the presence of auto—PEEP during VC ventilation? A, Square—wave inspiratory flow B. Iind-expiratory hold C, Plateau pressure D. PSV mode — ANS-WWB. [ind-expiratory hold Which of the following best maintains airway patency during bag—mask ventilation in an unconscious patient? A, Cricoid pressure B. Oropharyngeal airway C, Trendelenburg position D. Neck hyperflexion —- ANS-WW1L. Oropharyngeal airway Which of the following can result in an increase in PVR? > . Hyperoxia 3. Hypovolemia C. Excessive PEEP 3. Decreased cardiac oulput —- ANS-WWC. Excessive PEEP Which of the following is a charactcristic of pulsc—dose oxygen—conserving devices? A, Flow is constant regardless of tubing length, GB. Gas delivery is synchronized with the beginning of cxhalation. C. It is preferred for patients who need more than 2 L/min of oxygen. D. Most of the oxygen delivery occurs during the first quarter of inhalation, — ANS-WVWD. Most of the oxygen delivery occurs during the first quarter of inhalation, Which of the following best describes VC ventilation? A, Inspiration ends alter delivery af a presel volume. B. Inspiration ends after the patient exhales a targeted volume. TFIO2 1.0VD/VT 0.45Respiratory exchange rate 0.8PB 747 mm Hg pH 7.42PaCO2 38 mm HgPaO2 152 mm HgHCO3— 25 miiq/LBIE +1 miiq/LSa02 (meas) 99% What is the P(A—a)O2 (mm Hg)? D, 200 — ANS-WWC., 500 A patient complaining of dyspnea has a heart rate of 112/min and a respiratory rate of 28/min. The following ABG analysis results are obtained while the patient is recciving oxygen at 5 I./min by nasal cannula: pH 7.47PCO2 33 mm HgPO2 48 mm HgHCO3— 24 miiq/LBE +1 miiq/LSO2 (calc) 83% Which of the following should be done FIRST? A. Increase the oxygen flow to 7 L/min. B. Switch to a nonrebreathing mask. C, Initiate mechanical ventilation. 3. Iniliate 3 em 1120 CPAP. — ANS-WWB. Switch to a nonrebreathing mask. A patient who is receiving mechanical ventilation is scheduled for a fiberaptic bronchoscopy. Which of the following is the primary threat to adequate ventilation during the procedure? A. Secretion production x . Elevaled airway pressure C. Loss of consciousness o . Airway obstruction — ANS-WWD. Airway obstruction A 178-cm (5—-ft 10-in), 80-kg (176-lb), 23-ycar—old male is admitted to an ICU following a drug overdose. VC, A/C ventilation is initialed with the following settings: l102 0.30Mandatory rate 16Total rate 18VT 550 mLInspiratory flow 25 L/minPressure limit 45 cm H20 The high pressure alarm is sounding frequently, and wide fluctuations in pressure are nated. A respiratory therapist's most appropriate action is to A, Scdate the patient. 3. Decrease the tidal volume. C, Increase the pressure limit. D. Increase the flow. - ANS-WWD. Increase the flow. 1B. Remove and replace the tracheostomy tube. C, Irrigate the airway with normal saline. D, Attempt to suction the airway. - ANS-WWA, Place the patient supine before assessing tube position, An adult paticnt's heart rate drops from 82 to 40/min immediately after a suction catheter is inserted inta the trachea and before suction is applied lo the airway. Which of the following is the mast probable cause? A. Hypoxcmia B. Vagal reflex C. Mucosal trauma D. Hypercapnia — ANS-WW 13. Vagal reflex A 31-year-old female who is a victim of a residential fire is brought to the I) and is receiving oxygen by nasal cannula at 8 I./min. SpO2 is 100%. The following dala are observed: pH 7.31PCO2 32 mm HgPO2 205 mm HgHCO3— 16 miiq/LBE —9 mEq/LSO2 (meas) 99%O2Hb 78%COHb 21%Hb 14.5 g/dl. A respiratory therapist should recommend A. Changing to 0.50 with an air—entrainment mask system. B. Administering an [102 of 0.60 with an HHI?NC. C, Maintaining current oxygen therapy. D. Switching to a nonrebreathing mask at 15 L/min. - ANS-WWD. Switching to a nonrebreathing mask at 15 L/min. The major component of pulmonary surfactant is A, Protein. x . Glucose. a . Phospholipid. o . Polysaccharide. —- ANS-WWC. Phospholipid. The following capnography tracing is observed following intubation: This waveform is consistent with A, Cardiac arrest. 3. Normal exhalation, C. Air leak. ). Airflow obstruction. - ANS-WWD. Airflow Obstruction. A patient's V/Q scan indicates an excess of ventilation comparcd to perfusion in the left lower lobe. These results suggest While administering an IPV treatment at 20 cm H20 to a patient with cystic fibrosis, a respiratory therapist notcs the paticnt has suddenly become very short of breath and cyanotic. The therapist's most appropriate action is to A, Suction the patient. B. Terminate the treatment. C. Deerease the peak pressure to 10 em H20, D. Stop the treatment for 10 to 20 minutes — ANS-WWB. Terminate the treatment. A 28-year-old female patient with a burn injury is being monitored in the ICU. She is 165 cm (5 ft 5 in) tall and weighs 61 kg (134 Ib). A respiratory therapist notes the follawing dala: Py"02 43 mm Ig PCWP 4 mm IIg PPA 11 mm Hg CVP 4 cm H20 Urine output 6 mL/hr The therapist should conclude the patient is A. Hypovolemic. LB. Fluid overloaded. C, Clinically stable. D. Acidotic. - ANS-WWA, Hypavelemic. A respiratory therapist is caring for a patient recciving mechanical ventilation and observes the following waveform: The therapist should conclude the waveform shows A. Evidence of auto—PEEP. B. The presence of airway secretions. C. A leak in the system, D. Inadequale inspiratory flow rate. - ANS-WWB. The presence of airway secretions. A respiratory therapist is evaluating a 43—ycar—old female who reports a history of nausea and insomnia since she started using 21 mg nicotine (Nicoderm CQ) patches 1 week ago. The most appropriate action for a respiralary therapist is to A, Suggest lhe patient try an equivalent dose of aral nicaline replacement. B. Explain these effects are expected for nicotine replacement therapy. C. Suggest switching to a lower—dosce nicotine patch, D. Recommend the patient begin Laking an antiemelic. - ANS-WWC. Suggest switching to a lower—dosce nicotine patch. [xtreme weather conditions have caused extended and widespread power outages. Many paticnts who depend on respiratory devices at home are secking care in the ID. The hospital is overwhelmed with paticnts who ran out of supplemental oxygen at home or have depleted ventilator battcrics. According to CDC guidclines, a respiratory therapist should FIRST A. Prioritize patients showing signs of acute respiratory distress. B. Refer patients with a chronic discase to other facilitics. C, Set up oxygen tanks and regulators in the waiting room. D. Centralize a charging station for medical devices. - ANS-WWA, Prioritize paticnts showing signs of acute respiratory distress. A male paticnt who is 180 cm (5 ft 11 in) tall and weighs 80 kg (176 Ib) is orally intubated with a 7.0—mm ID endotracheal tube. Mechanical ventilation was initialed with an IIME in the circuil. After 7 days, the patient's secretions are more difficult to suction. A respiratory therapist should FIRST A. Use a smaller suction catheter. 3. Recommend changing to a larger endotracheal tube. C. Replace the HMIE with a heated humidifier. D. Administer dornase alfa (Pulmozyme). — ANS-WWC. Replace the HME with a heated humidifier. Which of the following should a respiratory therapist instruct a paticnt to usc when cleaning the home CPAP mask and connecting tubing? > . Acctic acid 3. Hydrogen peroxide C. Dishwashing soap ). Isoprapyl alcahal - ANS-WWC, Dishwashing soap Which of the following valucs are necded to determine a patient's physiologic dead space? A, Expired PCO2 and Py CO2 3. Arterial PCO2 and expired PCOZ C. Py CO2 and arterial PO2 ). Arterial PO2 and arterial PCO2 — ANS—WwW 3. Arterial PCO2 and expired PCO2 Given a normal oxyhemoglobin dissociation curve, an SpO2 of 75% should be associated with a PaOQ2 of A. 47 mm Hg. 3. 61 mm Hg. C. 55 mm IIg. 9. 36 mm IIg. - ANS-WWA. 47 mm Ilg. A patient lost an unknown quantity of blood as a result of a motor vchicle crash, To fully assess oxygen delivery, a respiratory therapist should recommend