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NBRC TMC QUESTIONS AND ANSWERS
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A 31-year-old male is intubated afler a motor vehicle crash. A respiratory therapist palpates asymmctrical chest movement during cach inspiration when the manual resuscitator is squeezed, but no crepitus. Breath sounds are diminished on the left. Which of the following should the therapist do FIRST? A.Perlform calorimetric capnomeltry. B.Administer a bronchodilator. C.Obtain an artcrial blood gas sample. D.Assess depth of endotracheal tube insertion. — Correct AnsworliD A respiratory therapist is asked to review a newborn's history. The following information is available about the first few minutes after birth: 1 minute 5 minutes Appearance acrocyanosis pink Heart rate 70/min 110/min Reflexcough cough Muscle tone weak active motion Respiratory rate 20/min 40/min Which of the following APGAR scares should the therapist expect to sce for this infant? 1-minute 5—minute 1.48 2.58 3.610 4.710 All B.2 C.3 D.4 — Correct Answer-@y) The APGAR scoring system consists of the following: Score 012Appearance pale or blue acrocyanosis campletlely pinklleart rate absent < 100 per minute > 100 per minutcReflex no response grimace cry, cough, sneezeMusele tone limp some flexion active motionRespiratory rate absent slow, irregular good cry A 58-year-old female was diagnosed with bronchiectasis 3 ycars ago. She reports increased caugh and difficulty clearing secretions for Lhe past 4 weeks. A chest radiograph shows no significant changes. Which of the following should the respiratory therapist recommend FIRST? A.transtrachcal aspiration GB.airway clearance therapy (c) A. In PC ventilation, increasing the inspiratory pressure will result in an increased tidal volume and minute ventilation, potentially causing a decrease in the PCO2, A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin saturation in which of the following clinical conditions? 1, congestive heart failure 2, polycythemia 3. pulmonary hypertension 4, carbon monoxide poisoning A.1, 2, and 3 only 3.2, 3, and 4 only C.1, 2, and 4 only D.1, 3, and 4 only — Correct Answcr—Ayiindialonly, (c) A. Carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish oxyhemoglebin from carboxyhemoglobin, which will lcad to a falsely clevated SpO2 reading. Mechanical ventilation was initialed for a palient, afler which the PaCO2 decreased from 53 to 40 mm Hg. A respiratory therapist should expect which of the following will incrcasc? A.HCO3— B.pH C.PETCO2 D.VD/VT — Correct Answer-BMipo (c) B. Carbon dioxide and pH move in opposite directions, so a decrease in carbon dioxide will result in an increase in pH. According to CLIA standards, quality control must be performed for blood gas analyzers every A.8 hours, 3.48 hours. C.72 hours. D.24 hours. — Correct Answcr-AlBihours! (c) A. Eight hours is the CLIA—approved time frame for quality control of blood gas analyzers. While performing a paticnt—ventilator assessment, a respiratory therapist observes very little condensation in the heated wire circuit. The reservoir of the heated wick humidificr is full of water. The most likely explanation is that the A.minute ventilation is greater than 15 L/min. B.patient circuit is operating normally. C.flow is sct at too low of a valuc. D.room temperature is lower than normal — Correct Answer—B.¥ patient circuit is operating normally. MIP —32 cm H20 [ixhaled VT 420 ml. The best weaning method for this patient is A.a spontancous breathing trial. B.SIMV mode, mandatory rate 14, and sct tidal volume 600 mL. C.PS ventilation at 20 cm H20, D.PC ventilation at 25 cm H20 and mandatory rate of 12, — Correct Answer— A.¥ a spontaneous breathing trial. (c) A. The patient is alert and has very good inspiratory muscle cffort. A spontancous breathing trial will provide the best method for rapid weaning. Following placement of a subclavian venous catheter, the high pressure alarm on a patient's ventilator begins sounding. Aftcr 10 minutes, the paticnt's peak inspiratory pressure has incrcased from 40 to 60 cm H20 and mean artcrial pressure decreased [rom 80 ta 40 mm IlIg. A respiralory therapist should FIRST A.inereasc the peak flow. B.suggest administcring a vasopressor. C.suction the endotracheal tube. D.recommend needle decompression. — Correct Answer—-D./ recommend needle decompression, (c) D. Tension pneumothorax is a possible complication of venous cathcter insertion and can result in increased airway pressure. This would sound the high pressure alarm and decrease artcrial pressure. Necdle decompression is indicated. While counscling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the paticnt's concern by explaining that this is partially the result of A.decreased metabolism. B.increased loss of self-control. C.recliance on nicotine replacement therapy. D.lack of available aversive conditioning. — Correct Answer—A.¥ decreased metabolism. (c) A. Mctabolism deercascs when nicotine is withdrawn. If dictary intake remains unaltered and exercise is not included, there may be a resulting weight gain, While assessing an adult male receiving invasive mechanical ventilalion, a respiratory therapist notes breath sounds suddenly arc markedly decreased, the cuff pressure is 5 em H20, and airflow is coming from the paticnt's mouth during each positive pressure breath. The tube depth remains at 22 cm at the lip. Air is added to the cuff, but the cuff pressure is not maintained. Which of the following should the therapist recommend? A.Perform an ABG analysis. B.Increase the tidal volume setting on the ventilator. C.Reintubate using an cndotracheal tube exchanger. (c) B. Caffeine citrate is used to treat apneic conditions and indicates the need for home apnea monitoring. A DLCO measuring device requires evaluation after being taken out of service because of erroneous values. Which of the follawing is crilical lo evaluate? A. linearity of pressure drops B.verification of shutter response C.vecrification of He percentage D.linearity of analyzed gas concentrations — Correct Answer—D.¥ linearity of analyzed gas concentrations (c) D. The integrity of the gas analysis system and its ability to return expected results are critical clements in DILCO measurement, An adult paticnt is recciving PC, SIMV and the following data arc observed: FIO2 0.80 Mandatory rate 15 Spontaneous rate 32 Sel inspiratory pressure 20 cm [120 PEEP 10 cm 1120 SpO2 92% On inspection, the patient demonstrates suprasternal retractions during spontancous breaths. Which of the following should a respiratory therapist do NEXT? A.Decrease the rise lime selling. B.Switch to A/C mode. C.Increase the F102 to 0.90. D.Change set inspiratory pressure lo 25 cm I120. — Correct Answer—B.¥ Switch to A/C mode. (c) B. The suprastcrnal retractions arc indicative of increased work of breathing and may be resolved by changing the mode to A/C. The respiratory rate may also come down. Which of the following is the mast significant factor lcading to the devclopment of trachcomalacia? A.cuff pressure B.trauma during intubation C. intracuff volume D. tube length — Correct Answer—A.¥ cuff pressure (c) A. Excessive cuff pressure will obstruct mucosal blood flow to the tracheal wall. The resulting ischemia weakens the tracheal wall and trachcomalacia develops. VIO2 0,80 Mandatory rate 12 VT 600 mL Inspiratory time 1.0 sec PEEP 14 cm H20 PIP 40 cm H20 Pplat $4 em H20 An ABG analysis shaws: pll 7.37 PCO2 43 mm Ilg PO2 62 mm IIg [ICO3— 25 mEd/I. BE -1 mlid/I. S02 (calc) 92% According to ARDSnct, the therapist should A.inerease the FIO2, B.deercase PEEP. C.inerease the inspiratory time. D.decrease the tidal volume. — Correct Answer—D.¥ decrease the tidal volume. (c) D. Given a plateau pressure of greater than 30 cm H2Q, the next step in the ARDSnct protocol is to decrease the tidal volume in 1 mL/kg PBW increments (to a minimum of 4 ml1./kg of PBW) until plateau pressure is less than 30 cm [120. Which of the following is a side effect of inhaled nitric oxide? A.decreased cardiac output B.methemoglobinemia C.systemic hypotension D.inereased WBC count — Correct Answer—B.¥ methomoglobinemia (c) B. As inhaled nitric oxide breaks down, methemoglobin is formed. This may lead to methemoglobinemia. Which of the following types of nebulizer can be used to deliver acrosolized medications Lo a ventilator circuil withoul altering delivered tidal volume? A.vibraling mesh B.air entrainment C.small—volume jet D.breath actuated — Correct Answer—A.¥ vibrating mesh (c) A. Vibrating mesh nebulizers place only the acrosolized medications into the circuit A.The plunger was pushed too slowly. .The spirometer is ready for patient testing. C.The time scale was incorrectly calibrated. D.The calibration is outside the accepted range. — Correct Answer—D.¥ The calibration is oulside the accepted range. (c) D. A leak is the likely cause for the difference of 400 ml. and is onc of the reasons for checking spirometers with a calibrated syringe. In the last 6 manths, a patient with bronchieclasis who uses postural drainage al home has had three exacerbations requiring hospitalization. Which of the following should a respiratory therapist recommend? A. insufflation/exsufflation device B.nebulized ipratropium (Atrovent) C.inhaled corticosteroid D.LHFCWO — Correct Answer—D.¥ UFCWO (c) D. HFCWO provides an effective method to loosen and mobilize airways secretions. Which of the following values is the best indicator of an individual's response to inhaled bronchodilators? A.FVC B.FEVI C.FEF200—1200 D.diffusing capacity — Correct Answer—-B.¥ FEV1 (c) B. FEV1 is the best indicator of reversible airway obstruction in response to inhaled bronchodilators. A 61-year-old male with dyspnea and nonproductive cough has the following examination results noted over the right lower lung field: — dullness to percussion — decreased tactile fremitus — diminished breath sounds Which of the following is most likely to produce these findings? A.pulmonary embolism B.pncumonia C.pneumothorax D.pleural cffusion — Correct Answer—D.¥ pleural cffusion (c) D. These findings are consistent with a pleural cffusion. A respiratory therapist is evaluating a 57—ycar—old male with the following vital signs: BP 140/90 mm Hg Sp02 90% Which of the following is a respiratory therapist's most appropriate action? A.Recommend scdating the patient. B.Change to 70/30 heliox. C.Inerease the gas flow to the mask. D.Recommend nebulized racemic epinephrine. — Correct Answer—-C.¥ Increase the gas flow to the mask. (c) C. The flow to the mask is insufficient and will result in dilution of both the oxygen and helium concentrations with air. Increasing Lhe flaw will ensure Lhe paticnt reccives the desired gas mixture. A 165-cm (5—-ft 5-in), 70-kg (154-lb) female is undergoing an SBT by a T— picee with an ['IO2 of 0.30. The patient is awake and alert. The following information is available: VT 400 mL Vilal capacily 1200 mL MIP —42 cm H20 pH 7.39 PaCO2 42 mm Hg PaO2 78 mm Hg HCO3— 25 mla/L. BE 0 miiq/L SaO02 (calc) 96% Which of the following is a respiratory therapist's most appropriate recommendation? A.Maintain current therapy. B.Iniliate bronchodilator therapy. C.Switch to PS ventilation. D.Extubate the patient. - Correct Answer—D.¥ Extubate the patient. (c) D. The ventilatory parameters and the accompanying ABG analysis results indicate the paticnt is ready for extubation. A respiralory therapist is evalualing Lhe recent polysomnography report in the medical record of a patient with a BMI of 23 kg/m2. The report notes an AHI of 28. Which of the following should the therapist expect to sce in the patient's care plan? A.PAP therapy B.low—flow oxygen therapy C.oral appliance therapy D.weight loss — Correct Answer—A.¥ PAP therapy (c) A. An AIIl of 28 is categorized as moderate to severe sleep apnea. PAP therapy is the treatment of choice. These flaw—volume loops show the results of FYC mancuvers by a patient before and after an albuterol treatment: graph shows little obstrcuct to bigger 
