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NBRC TMC EXAM-Y, NBRC TMC EXAM-O
QUESTIONS & ANSWERS
Science/ Medicine/ Nursing NBRC TMC EXAM-Y, NBRC TMC EXAM-O QUESTIONS & ANSWERS Quality control matcrial has published valucs for pH of 7.30, PO2 of 85 mm Hg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results arc as follows: pH PO2 (mmHg) Run 1 7.33 83 Run 2 7.25 86 Run 3 7.29 80 Which quality control runs indicatc the machine is out of control? A, 2 and 3 B. 1, 2, and 3 C. 1 and 2 D. 1 and 3 — The correct answer is A Quality control data for an artcrial blood gas analyzer is plotted on a graph that has a range of 4 standard deviations (2 SD up and 2 SD down). Points on the graph show a gradual risc from below the mean to abave the mean. All points arc within 2 SD of the mean, The respiratory supervisor should A, remove this machine from service B. call the medical director for direction C. monitor this machine clascly D. replace the electrodes — The correct answer is i The sudden sounding of a high-pressure ventilator alarm is noted on a patient recciving volume controlled mechanical ventilation. The respiratory therapist notes the endotracheal tube is at 27 cm at the tecth and that breath sounds are absent when auscultating the left hemithorax. The therapist should immediately A, withdraw the endotracheal tube until breath sounds are bilateral B. advance the endotracheal tube until breath sounds can be auscultated over the left chest C. prepare for insertion of chest tubes in the left thorax D. check the air pressure of the tube cuff — The correct answer is A Which of the following ventilator circuit change frequencics is important to minimize nosocomial infeclions among palienlts receiving mechanical ventilation? A, every 14 days B. monthly C. daily D. when soiled — The correct answer is ED} In which of the following silualions should an IIME be replaced with heated humidity? C. PAO2 and tidal volume D. VD/VT and PAO2 — The correct answer is BA A female paticnt who is morbidly obese has an 8.0 mm trachcostomy tube. She has been placed on an ulcer prevention mattress in the Intensive Care Unit. Following transport to the new bed, the nurse calls a respiratory therapist to assess her because she is complaining of air hunger. Diffuse dry crackles are auscultated with crepitus noted upon palpation. These findings are mast closely associated with A, secretions in the airway B. pneumothorax C. atelectasis D. subcutaneous emphysema — The correct answer is bo When inspecting the X-ray of an outpatient with nephrotic syndrome, you note a homogeneous area of increased densily that obscures the left costophrenic angle. Which of the following is the mast likely problem? A, Pleural effusion 3. Bacterial pncumonia C. Pulmonary cdema ). Atclectasis — The correct answer is iA A paticnt has a scrum potassium level of 3.5 mIiq/L. Which of the following diuretic would you recommend for this patient? A. Amiloride (Midamor) B. Chlorothiazide (Diuril) C. Quinncthazone (Hydromax) D. Acctazolamide (Diamox) — The correct answer is MA Which pH level is expected for a COPD patient having an acute on chronic exacerbation? A, 7.35 B, 7.49 C. 7.44 D. 7.30 — The correct answer is fe A patient with a history of asthma reports lo the emergency department alter self—treating bronchoconstriction for the past 3 days. Periodic rclicf has been achicved but the paticnt is in current distress and is wheezing bilaterally. Which of the following treatment actions would be most appropriate? A. administer Sublimaze, PO B. continuous aerosolized bronchodilator at 7 mg/hr C. sildenafil, IV D. full pulmonary function testing with DILCO measurement — The correct answer is §B While performing routine oxygen raunds, the respiratory therapist noles a COPD patient who is recciving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min. The therapist should FIRST A. increase flow to 4 L/min by nasal cannula LB. obtain an arterial blood gas C. proximal to the inlet valve D. between the bag and patient interface — The correct answer is Er] Which of the following valucs are required to determine a patient's inspiratory capacity (IC)? A. VC and RV B. ERV and IRV C. VT and IRV D. RV and ERV — The correct answer is fe A patient shows signs of hypoxemia while on a heated acrasol sct at 40% with the flow rale set to 8 L/min. The patient's minute ventilation is 38.0 L. Which of the following changes should be madc? A. increase flow rate to 10 L/min B. decrease F102 to 28%, maintain flow rate C, inerease FIO2 to 0.5, maintain flow rate D. increase to F102 to 1.0 with a flow rate to 15 L/min — The correct answer is : Which of the following paramcters is NOT consistent with weaning from mechanical ventilation? A. VT to 500 mL B. VD/VT of 0.50 C. A-aDO2 of 320 mmHg D. RSBI of 86 — The correct answer is Ee A respiratory therapist begins manual resuscitation on a paticnt who is found apneic for several minutes. Capnography with an infrared device is instituted. Which of the follawing initial capnographic trends will the therapisl expect lo see? A. steady hypocapnia B, gradual decrease in end-tidal CO2 C. steady hypercapnia D, rise in end-tidal COZ — The correct answer is ED] Several hours alter oral endotracheal extubation of an 8.0—mm Lube, an adult paticnt begins to demonstrate inspiratory stridor. Which of the following would be most helpful to the patient? A. heated acrosol by mask B. racemic epinephrine C. Atropine sulfate D. Albutcrol — The correct answer is EE] An adult paticnt is intubated with an 8.0 mm endotracheal tube. The high— pressure alarm is sounding. The tube is noted to be positioned at 28—cm at the lips. Chest rise is asymmetrical. What procedure should the respiratary therapist recommend? A, extubation LB. stat chest radiograph C. arterial blood gas D. suction with a directional—tip catheter — The correct answer is EE] Which of the following may be helpful at relieving upper airway inflammation follawing endotracheal extubation? A 75-kg (165-lb) paticnt with mycoplasma pneumonia is recciving mechanical ventilator support by a PB 840 ventilator on the following scttings with corresponding arterial blaad gas values: Mode assist/control Mandatory rate 10/min VT 525 mL FIO2 0.6 pH 7.29 PaCO2 51 mmHg PaQ2 78 mmHg HCO3— 23 miia/L. BE -1 mEq/L Which of the following actions is most appropriate? A, increase VT B. increase FIO2 C. institute PEEP D. increase mandatory rate — The correct answer is 0] A patient is undergoing a full cardiopulmonary arrest. The paticnt is intubated and is being monitored with an infrared capnographic device. PetCO2 data is showing 3%, Which of the follawing best explains this value? A. increased PAQ2 B. decreased C(a—v) 02 C. poor alvcolar perfusion D. poor systemic perfusion — The correct answer is ba Which of the following should be looked at FIRST to assess for proper placement of an oral endotracheal tube? A, chest radiograph B. breath sounds C. left chest symmetry D, lateral neck radiograph — The correcl answer is fe Which of the following data, if observed, would indicate improper positioning of an oral endotracheal tube? A. symmctrical chest rise B. ET tube markings at 29 cm C, radiologist reports the ET tube is level with the aortic arch 1D. chest radiograph shows tube 2 cm above the carina — The correct answer is : Which of the following can be done to most effectively increase the efficiency of suctioning through an endotracheal tube? A, increase suclion pressure B, increase suction catheter diameter (size) C. apply intermittent suction pressure during withdrawal of the catheler D, increase suction time — The correct answer is = Which of the following is an important clement of instruction to a home care patient who will be receiving conlinuous oxygen therapy at 2 1./min by nasal cannula? A. do not change flow rate without a physician order A post-op adult paticnt achicved an inspiratory capacity of 1800 ce with an incentive spirometer prior to surgery. After the surgery, the paticnt appears to be confused on how to use the incentive spirometer. The therapist notes the patient is having difficulty gctting the balls to rise. The therapist should A, switch to a volume—type device B. coach the patient more diligently C. assess the patient for the cause of the confusion D. administer oxygen at 5 L/min nasal cannula — The correct answer is A lor which of the following conditions is PIP therapy most bencficial? A. pncumonia B. myasthenia gravis C. ARDS D. Postoperative recovery — The correct answer is fA Which of the following is associated with hypokalemia? A, inverted P waves LB. flattened T waves C, respiratory acidosis D, significant Q waves — The correct answer is AE] Which of the follawing equations would determine cardiac index? A. C.O. / ejection fraction B. stroke volume x heart rate C.C.0. x BSA D. C.0. / BSA — The correct answer is JB While running quality control material through a blood gas analyzer, the therapist notes that 4 consecutive data points are beyond 2 SD from the mean, The therapist will A. monitor the machine closely for several days B. report the problem to the medical director C. remove the machine from service D. continue running quality control material until corrected — The correct answer is JG Which of the following chest radiograph obscrvations is most closcly associated with pleural cffusion? A. reticulogranular pattern LB. concave interface border C. complete opacification D. tree-in-wintler pallern — The correct answer is A] Which of the following cxams provides the best diagnostic information for an obstructive defect in a COPD patient? A. DLCO B. Fev 1/FVC% C. SVC D, FEF 200-1200 — The correct answer is JB partially with cach breath. Respiratory rate has fallen from 28/min to 10/min. The therapist should respond by A. increasing flow to the NRB mask B. beginning mechanical ventilation C,. continuing current therapy D, assisting ventilation with a manual resuscilator — The correct answer is ie Which of the following laboratory cxaminations would be helpful in further assessing a paticnt with diabctic ketoacidosis? A, PD50 B. glucose level C. P50 D. creatinine — The correct answer is i. A patient with CHI has the following input/output history Yesterday: IN — 1900 ml. OUT — 1000 ml. Today: IN — 2100 mL OUT — 1100 ml. Which of the following clinical findings is most likcly to be observed? A. bronchial wheezing LB. friction rub C. decreased cgophony D. moist crepitant rales — The correct answer is 0] A patient with congestive heart failure, who is demonstrating moist crepitant rales upon auscultation, would bencfit most from A. PEP therapy B, administration of aminoglycacide medication C. postural drainage and percussion D, Lasix — The correct answer is bo) A 35-year-old female paticnt presents to the emergency reom with droopy eyelids and facial muscles. She camplains of frequent faligue that improves with rest, but then returns. Which of the following diagnostic procedures are not indicated? A, nitrogen washout B. Tensilon challenge C. arterial blood gases D. basic spirometry — The correct answer is a A patient reports to the emergency department with shortness of breath, bilateral wheezing, and a law—grade fever. This condilion has persisted for several days. The patient has had multiple breathing treatments with only temporary relief. Which of the following is appropriate to recommend? A. IV Sublimaze LB. oral antibiotics C,. continuous bronchodilator therapy D. IV Doxapram (Dopram) — The correct answer is na C, vital capacity D. breath sounds — The correct answer is A What is the primary purpose for a nitrogen washout test? A, directly measure TLC B. evaluate evenness of pulmonary gas distribution C. determine closing volume D. determine FRC — The correct answer is At Which of the following paticnts would bencfit most from an inverse J: ratio ventilation? A, chronic bronchitis B. ARDS C. kyphoscoliosis D. COPD — The correct answer is Et A 62-year-old male has ventricular tachycardia. The patient is not alert and will not respond to verbal stimuli, A pulse is palpable. The respiratory therapist will respond by A. administering methyl prednisone, IV B. administering Isuprel (isoproterenol) C. defibrillaling the patient D. performing cardioversion — The correct answer is bo) A respiratory therapist is monitoring the volume of gas a paticnt can inhale after a passive exhalation of tidal volume. The therapist is attempting to observe which of the following? A, inspiratary capacily B. vilal capacity C. inspiratory reserve volume D. talal lung capacity — The correcl answer is mm A respiralory therapist is measuring the gas volume from a palient who exhales maximally aftcr inhaling to inspiratory rescrve volume, Which of the following volumes is the respiratory therapist attempting to observe? A. total lung capacity B. expiratory reserve volume C, inspiratory reserve volume D. vital capacity — The correct answer is 0] Which of the following do NOT contribute to total airway resistance for a mechanically ventilated palienl with an endatracheal Lube? A. upper half of the trachea B. main bronchi C. bronchoconstriction D. endotracheal tube — The correct answer is fA Hypervolemia would first be manifested in which of the following values? A. SVR B. CVP