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2024/2025 NBRC TMC/CRT/RRT EXAM ACTUAL EXAM
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After a patient undergoes a thoracentesis, the respiratory therapist notes that the obtained pleural fluid is clear with a slight straw color. This fluid is most likely the result of A. empyema. B. congestive heart failure. C. lung carcinoma. D. hemothorax. - ANSWER- B. congestive heart failure. Which of the following would be most important to evaluate for a patient who is entering a smoking cessation program? A. Height B. Smoking history C. Weight D. Diet - ANSWER- B. Smoking history The respiratory therapist is calibrating a spirometer and checking the volume with a 3. liter super syringe. The volumes recorded are: 2.85 L, 2.8 L, and 2.8 L. Based upon the information obtained which of the following is a correct statement? A. Another syringe needs to be used B. Spirometer is accurate C. The plunger was advanced too slowly D. Spirometer may have a leak - ANSWER- D. Spirometer may have a leak Which of the following is an indication for high frequency jet ventilation? A. Bronchopleural fistula B. Wilson Mikity syndrome C. Necrotizing lesion of right lung D. Centrilobular emphysema - ANSWER- A. Bronchopleural fistula
A 43 - year-old female patient has just undergone a total abdominal hysterectomy. The patient arrives in the post anesthesia care unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient? A. Initiate assisted ventilation B. Insert oropharyngeal airway C. Obtain positron emission tomography D. Initiate noninvasive capnography - ANSWER- B. Insert oropharyngeal airway A 44 week gestational age infant has just been delivered via C-section and is gasping, grunting, and has tachycardia and tachypnea. At one minute his Apgar score is 4 and at 5 minutes the score is 5. The infant is most likely suffering from A. transient tachypnea of the newborn. B. meconium aspiration. C. bronchopulmonary dysplasia. D. apnea of prematurity. - ANSWER- B. meconium aspiration. What is the normal VD/VT ratio for a patient breathing room air? A. 5 - 15% B. 20 - 40% C. 45 - 55% D. 65 - 75% - ANSWER- B. 20 - 40% A heat moisture exchanger is indicated for humidification in which of the following situations? A. Mechanical ventilation in a long-term care facility. B. Transport to a tertiary care center. C. Patient with tenacious secretions. D. Delivery of aerosolized bronchodilators. - ANSWER- B. Transport to a tertiary care center. All of the following could cause a patient's right-hemidiaphragm to be elevated, EXCEPT A. right lower lobe atelectasis. B. right side hyperlucency, absent vascular markings. C. hepatomegaly. D. right lower lobe consolidation with air bronchograms. - ANSWER- B. right side hyperlucency, absent vascular markings
D. Cell hydration level - ANSWER- B. Serum electrolytes While instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to A. exhale to residual volume and inhale to inspiratory capacity. B. inhale to total lung capacity then exhale to residual volume. C. exhale normally then inhale to total lung capacity. D. inhale normally then exhale to functional residual capacity. - ANSWER- B. inhale to total lung capacity then exhale to residual volume. A patient involved in an automobile accident is brought to the ED with tachypnea, tracheal deviation to the right, splinting, asymmetrical chest movement, and decreased breath sounds on the left side. The respiratory therapist should initially A. insert a chest tube. B. administer 100% oxygen via mask. C. perform endotracheal intubation. D. initiate non-invasive positive pressure ventilation. - ANSWER- B. administer 100% oxygen via mask. A 77 - year-old male patient is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following? A. Pulmonary edema B. Pulmonary interstitial emphysema C. Pneumothorax D. Emphysema - ANSWER- A. Pulmonary edema Which of the following formulas will determine the total flow being delivered to a patient with a 28% venturi mask running at 6 L/min? A. total flow = 6 x 2 B. total flow = 6 x 4 C. total flow = 6 x 5 D. total flow = 6 x 11 - ANSWER- D. total flow = 6 x 11 Fine crepitant crackles are most commonly associated with which of the following conditions? A. Bronchitis B. Pulmonary edema C. Pneumonia D. Foreign body aspiration - ANSWER- B. Pulmonary edema
A patient with end-stage pulmonary fibrosis is receiving oxygen at 2 L/min via a transtracheal oxygen catheter. The patient experiences an increased work of breathing and shortness of breath. The respiratory therapist should A. manually ventilate the patient with a resuscitation bag. B. increase the flow to the transtracheal catheter to 6 L/min. C. evaluate the SpO2 with a pulse oximeter. D. flush the transtracheal device with isotonic saline. - ANSWER- D. flush the transtracheal device with isotonic saline. During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first A. verify the position of the transducer. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. attempt to draw blood from the arterial line. - ANSWER- B. check the transducer dome for air bubbles. An optimal PEEP study is initiated on a patient receiving mechanical ventilation. The respiratory therapist first places the patient on a PEEP of 10 cm H2O for 20 minutes with no adverse effects. The PEEP is increased to 15 cm H2O and the patient's heart rate rises significantly with a severe fall in the blood pressure. Based upon the above information, the therapist should conclude that the patient is suffering from A. peripheral vasoconstriction. B. hypovolemia. C. increased venous return. D. increased SVR - ANSWER- B. hypovolemia. A post-operative thoracotomy patient is receiving incentive spirometry therapy Q2H. Breath sounds are diminished in the bases of the lungs with scattered crackles. The patient's inspiratory capacity has decreased over the past 2 days. A chest radiograph indicates thin-layered basilar densities. Which of the following has most likely occurred? A. Atelectasis B. Pneumonia C. Pulmonary edema D. Consolidation - ANSWER- A. Atelectasis A patient is in full cardiopulmonary arrest and after several attempts, the patient is orally intubated with a size 7 mm ID endotracheal tube. The nurse is unable to establish IV access. The ECG monitor shows sinus bradycardia. Which of the following drugs should be administered through the endotracheal tube?
Total rate 18 b/min VT 800 mL FIO2 0. PIP 31 cm H2O PEEP 10 cm H2O pH 7. PaCO2 40 torr PaO2 95 torr SaO2 96% HCO3- 23 mEq/L BE +1 mEq/L PECO2 30 torr Hb 15 g/dL What should the respiratory therapist report as the VD/VT ratio? A. 15% B. 25% C. 40% D. 50% - ANSWER- B. 25% What is the air-to-oxygen ratio for an air entrainment device delivering 60% oxygen? A. 1: B. 3: C. 4: D. 10:1 - ANSWER- A. 1: Following surgery to correct an abdominal aortic aneurysm, a 54 - year-old female patient suddenly develops intense substernal chest pain with severe dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The patient appears pale, cold and clammy. Which of the following should the respiratory therapist recommend for initial assessment of this patient? A. Serum electrolytes B. Chest x-ray C. Complete blood cell count D. Electrocardiograph - ANSWER- D. Electrocardiograph An adult patient is intubated with a 7.0 mm ID endotracheal tube. What size suction catheter should be used to suction this patient? A. 8 French B. 10 French
C. 12 French D. 14 French - ANSWER- B. 10 French Which of the following would be the most appropriate test to evaluate partial vocal cord paralysis in a patient complaining of difficulty swallowing? A. SB nitrogen elimination B. Maximum voluntary ventilation C. Flow volume loop D. Diffusing capacity - ANSWER- C. Flow volume loop In order to reduce a patient's PaCO2 from 40 torr to 32 torr, all of the following could be increased EXCEPT A. tidal volume. B. alveolar ventilation. C. respiratory rate. D. physiologic deadspace - ANSWER- D. physiologic deadspace While examining the chest drainage system of a mechanically-ventilated patient following thoracotomy, the respiratory therapist observes bubbling in the water-seal chamber during inspiration. This would indicate A. a leak in the chest drainage system. B. air leaving the pleural space. C. excessive pressure from the suction regulator. D. inadequate water level in the water-seal chamber. - ANSWER- B. air leaving the pleural space. A patient develops ascites and shortness of breath. Where is tissue edema most likely to show up first? A. Ankles B. Abdomen C. Thorax D. Hands - ANSWER- B. Abdomen An acceptable level of PEEP therapy can be identified by all of the following EXCEPT A. the lower inflection point of a volume-pressure loop graphic. B. acceptable oxygenation without cardiovascular side effects. C. increasing oxygenation with increasing plateau pressure. D. increasing static compliance with acceptable oxygenation - ANSWER- C. increasing oxygenation with increasing plateau pressure.
A. CVP
B. PAP
C. PCWP
D. MAP - ANSWER- B. PAP
A pre-op patient who is at high risk for post-operative complications should be evaluated by obtaining the results of A. VD/VT study. B. diffusion studies. C. basic spirometry. D. indirect calorimetry. - ANSWER- C. basic spirometry. A patient is receiving noninvasive positive pressure ventilation by mask. Current settings and arterial blood gas results are as follows: IPAP 10 cm H2O EPAP 5 cm H2O Respiratory rate 12 /min pH 7. PaCO2 56 torr PaO2 63 torr HCO3 25 mEq/L BE +1 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the EPAP to 10 cm H2O B. Decrease the EPAP to 3 cm H2O C. Increase the IPAP to 20 cm H2O D. Decrease the IPAP to 5 cm H2O - ANSWER- C. Increase the IPAP to 20 cm H2O During recovery from resection of an aortic aneurysm, a 65-year-old female patient suddenly develops severe substernal chest pain with grave dyspnea. The physician describes the bilateral breath sounds as basilar moist crepitant crackles. The patient appears pale, cool and diaphoretic. Which of the following should the respiratory therapist recommend as part of the initial assessment of this patient? A. ECG B. CBC C. Serum electrolytes D. Lateral decubitus radiograph - ANSWER- A. ECG
A patient is diagnosed with unilateral lung disease. The physician has requested that the effected lung be ventilated at a pressure 10 cm H2O lower than the normal lung. The respiratory therapist should recommend providing this type of ventilation via A. cricothyroidotomy. B. esophageal combi-tube. C. transtracheal catheter. D. double-lumen endobronchial tube. - ANSWER- D. double-lumen endobronchial tube. Which of the following techniques measures total lung capacity?
- Helium dilution
- Body plethysmography
- Single breath nitrogen elimination A. 1 & B. 2 only C. 3 only D. 1 & 3 - ANSWER- A. 1 & A 30 - year-old male who weighs 68 kg (150 lb) has a minute ventilation of 9 L/min. and a respiratory rate of 20/min. What is his alveolar minute volume? A. 4 L/min. B. 6 L/min. C. 8 L/min. D. 12 L/min. - ANSWER- B. 6 L/min. During a cardiopulmonary stress test on a 55 - year-old man, the respiratory therapist notes the following changes: Heart rate increases Blood pressure increases VD/VT ratio decreases Respiratory rate increases The therapist should A. continue the test. B. terminate the test. C. contact the physician. D. administer amiodarone. - ANSWER- A. continue the test. The respiratory therapist receives an order to administer bronchodilator therapy with albuterol. To reduce the chance of cross contamination, the therapist should
Cardiac Output: 8.0 L/min. Cardiac Index: 4.7 L/min/m Which of the following should the respiratory therapist recommend? A. Oxygen B. Dopamine C. Lidocaine D. Furosemide - ANSWER- D. Furosemide The following pulmonary function data was reported for a 45 year old pre-op patient: TLC - 5.4 L RV - 1.0 L IRV - 2.6 L VC - 4.2 L ERV - 1.0 L VT - 0.6 L FRC - 2.0 L IC - 3.2 L Which of the above capacities is incorrect? A. TLC B. VC C. FRC D. IC - ANSWER- A. TLC A 16-year-old patient involved in a motorcycle accident has been admitted to the emergency department. The paramedic indicates that the patient was not wearing a helmet. To assess the patient's neurologic status the respiratory therapist would assess the patient's A. vital capacity. B. pupillary response. C. herring bruer reflex. D. moro reflexes. - ANSWER- B. pupillary response. The peak inspiratory pressure on a pressure-cycled ventilator is 30 cm H2O. The respiratory therapist decreases the inspiratory flow. This change would affect the A. rate. B. PEEP. C. expiratory time. D. I:E ratio. - ANSWER- D. I:E ratio. A patient recently underwent a coronary artery bypass and is now receiving Incentive Spirometry QID. The patient's inspiratory capacity has diminished over the past several days and the patient is becoming increasingly short of breath. Chest radiograph shows
left lower lobe consolidation with air bronchograms. The respiratory therapist would conclude that the patient has developed A. pleural effusion. B. atelectasis. C. pneumothorax. D. pneumonia. - ANSWER- D. pneumonia. A patient has a tracheostomy tube in place. The measured cuff pressure is 24 mm Hg. Which of the following statements is true of this situation? A. The pressure is appropriate for minimal tracheal occlusion. B. This pressure will most likely cause arterial occlusion. C. At this pressure, there is a significant risk of VAP. D. The pressure will cause tracheal necrosis if maintained. - ANSWER- A. The pressure is appropriate for minimal tracheal occlusion. The respiratory therapist receives an order for postural drainage and vibration. With the bed flat, the therapist places the patient in a prone position with pillows under his hips. Which lung segments are being treated with this position? A. Anterior segments of the upper lobes B. Superior segments of the upper lobes C. Posterior basal segments of the lower lobes D. Superior segments of the lower lobes - ANSWER- D. Superior segments of the lower lobes A patient has been admitted to the emergency department via ambulance. The cardiac monitor indicates sinus tachycardia. The patient is orally intubated with a size 7.5 mm ID endotracheal tube and is being manually ventilated. What other point of care monitoring should the respiratory therapist recommend for this patient? A. Arterial blood gas analysis B. Transcutaneous monitoring C. Pulse oximetry D. Serum electrolyte analysis - ANSWER- C. Pulse oximetry A patient has 2 mediastinal chest tubes following a thoracotomy. The respiratory therapist notes that there is continuous bubbling in the water seal chamber of the chest drainage system. The therapist should A. check for a leak in the system. B. add water to the water seal chamber. C. increase the amount of suction. D. advance the chest tube 2 cm. - ANSWER- A. check for a leak in the system.
- Hyperextended neck
- Stridor
- Unilateral wheeze A. 1,3, B. 4 C. 1, 2, 3 D. 2, 4 - ANSWER- C. 1, 2, 3 A spontaneous breathing trial has been initiated for a 64-year-old, intubated, post-op patient. Oxygen is being administered by T-piece at an FIO2 of 0.50 via heated air- entrainment nebulizer at a flow of 12 L/min and a temperature of 37.0oC. The respiratory therapist notices that the aerosol mist disappears from the reservoir outlet during the patient's inspiration. The therapist should consider all the following EXCEPT A. lenghtening the reservoir tubing. B. adding an additional nebulizer. C. increasing the flow to 15 L/min. D. increasing the temperature to 39C. - ANSWER- D. increasing the temperature to 39.0oC. A 62 - year-old patient with a history of emphysema (body weight 50 kg, 110 lb) requires mechanical ventilation because of acute respiratory failure. The respiratory therapist notes the following: Mode VC, SIMV Set rate 10 br/min. Total rate 16 br/min VT 400 mL FIO2 0. Arterial blood gases are as follows: pH 7. PCO2 56 torr PO2 65 torr HCO3- 32 mEq/L The respiratory therapist should A. increase the set rate to 8 br/min. B. increase the FIO2 to 0.30. C. maintain the current settings. D. increase the VT to 650 mL. - ANSWER- C. maintain the current settings.
A patient with a history of cardiovascular disease has been brought to the emergency department. He is intubated and is being manually ventilated. The ECG monitor shows a sinus rhythm with a rate of 50 beats/min. The patient's pulse is weak and irregular. The nurse has been unable to place a central or peripheral venous catheter. The therapist should recommend endotracheal instillation of A. atropine. B. lidocaine. C. epinephrine. D. naloxone. - ANSWER- A. atropine. The following values are measured on a patient in the outpatient pulmonary function testing center:
- 4 FVC (L) 3.3 3.4 3.5 3. FEV1 (L) 2.3 2.5 2.3 2. FEF 25-75% (L/sec) 1.4 1.2 1.3 1. Which trial should be recorded as the best test? A. Trial 1 B. Trial 2 C. Trial 3 D. Trial 4 - ANSWER- B. Trial 2 A patient is receiving IPPB with a Bird Mark-7. The respiratory therapist notes that the patient is generating negative pressure at the beginning of inspiration although the machine does not switch into the inspiratory phase. The respiratory therapist should A. decrease the flow. B. increase the sensitivity. C. adjust the apnea timer. D. decrease the pressure. - ANSWER- B. increase the sensitivity. A patient is receiving continuous mechanical ventilation through an oral endotracheal tube. The respiratory therapist notes that the high pressure alarm sounds continuously during inspiration and the patient appears to be biting down on the ET tube. Which of the following should the therapist recommend? A. Change to a nasal endotracheal tube B. Add air to the cuff C. Add water to the humidifier D. Insert an oral pharyngeal airway - ANSWER- D. Insert an oral pharyngeal airway
Which of the following would indicate that the lung compliance of a patient on a volume- cycled ventilator is increasing? A. Plateau pressure begins to decrease B. Peak pressure begins to increase C. Blood pressure decreases D. Arterial PCO2 decreases - ANSWER- A. Plateau pressure begins to decrease Heliox therapy is indicated for treatment of patients with post extubation stridor because of the A. ability to effectively deliver humidity. B. low density of the gas mixture. C. high molecular weight of the gas mixture. D. low risk of bronchospasm. - ANSWER- B. low density of the gas mixture. A 17 year-old patient is receiving 40% oxygen via a Venturi mask following a motor vehicle accident. He suddenly develops acute shortness of breath, is diaphoretic and SpO2 is 85%. Breath sounds are vesicular on the right and extremely diminished on the left. The respiratory therapist should evaluate the patient for the presence of A. atelectasis. B. a pneumothorax. C. arterial hypertension. D. a myocardial infarction. - ANSWER- B. a pneumothorax. Which of the following would NOT be required to perform a nasal intubation? A. Magill forceps B. Stylet C. Laryngoscope D. Endotracheal tube - ANSWER- B. Stylet Which of the following formulas will determine the amount of physiologic deadspace for a patient? A. PAO2 - PaO B. CaO2 - CvO C. (PaCO2 - PECO2) / PaCO D. CcO2 - CaO2 / CcO2 - CvO2 - ANSWER- C. (PaCO2 - PECO2) / PaCO A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon inflated. Which of the following pressures will be measured by the distal lumen? A. CVP B. PAP
C. PCWP
D. MAP - ANSWER- C. PCWP
Airways resistance (Raw) of 1.8 cm H2O/L/sec is measured for a patient receiving mechanical ventilation. The respiratory therapist should suspect that the patient may have A. asthma. B. ARDS. C. neuromuscular disease. D. normal airways. - ANSWER- D. normal airways. What is the normal range for central venous pressure in an adult? A. 2 - 6 mm Hg B. 4 - 12 mm Hg C. 9 - 18 mm Hg D. 21 - 28 mm Hg - ANSWER- A. 2 - 6 mm Hg A patient has just been intubated with a naso-tracheal tube and is being manually ventilated. As the respiratory therapist ventilates the patient, he notices that there is no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed. A chest x-ray has determined that the endotracheal tube is in the correct position. What is the most likely cause of this situation? A. The tube is in the esophagus. B. The patient has developed a tracheoesophageal fistula from the intubation process. C. The cuff ruptured during intubation. D. The cuff has herniated over the end of the tube. - ANSWER- C. The cuff ruptured during intubation. A patient is receiving 40% oxygen via a Venturi mask at 8 L/min. While performing oxygen rounds, the respiratory therapist notes that the flowmeter setting has been changed to 12 L/min. How would this change affect the accuracy of this device? A. FIO2 will remain unchanged B. FIO2 will decrease to 0. C. air entrainment factor will decrease D. FIO2 will increase to 0.50 - ANSWER- A. FIO2 will remain unchanged Blood gas results from an apparently healthy patient reveal a pH of 7.37, PaCO2 of 15 torr, PaO2 of 140 torr. The patient is breathing room air and displays no tachycardia, tachypnea, or adventitious breath sounds. Which of the following is an appropriate conclusion to draw on the basis of this information? A. A venous blood sample was drawn.
