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NBRC TMC PRACTICE
QUESTIONS AND ANSWERS
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Which_of_the_following_is_needed_to_calculate_alveolar_oxygen_tension? A._VD/VT,_PAO B._BP_and_FiO C._PetCO2_and_PaO D._QS/QT,deadspace-_Correct_answer~_B. Barometric_pressure,FiO2,and_PaO2_are_all_included_in_the_formula(BP_stands_for barometric_pressure) L/min/m2_is_the_unit_of_measure_for: A._Systemic_vascular_resistance B.Cardiac_output C._Cardiac_index D.Stroke_volume-_Correct_answer~C. A_spontaneously_breathing_patient_has_the_following_arterial_blood_gas_results: pH_7.38_PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 _mEq/L
Which_of_the_following_supplemental_oxygen_levels_is_most_appropriate? A. 2 _L/min_nasal_cannula B. 5 _L/min_nasal_cannula _C._non-rebreathing_mask _D.Venturi_mask_at_30%-_Correct_answer~B. A_patient_who_is_showing_signs_of_hypoxemia_should_receive_supplemental_oxygen._If _the_patient_is_not_a_COPD_patient_and_the_situation_is_not_an_emergency,_then_the _proper_supplemental_oxygen_is_an_adult_therapeutic_dose,_which_is_40%_to_55%._Of the_options_available_only 5 _L/min_nasal_cannula_will_approach_this.Other_options are_either_insufficient_or_too_much. Left_heart_failure_would_be_manifested_in_which_of_the_following_values? _A._CVP_and_mPAP _B._mPAP_and_wedge_pressure _C._MAP_and_SVR _D.cardiac_output_and_wedge_pressure-_Correct_answer~D. The_function_of_the_left_heart,_specifically_the_left_ventricle,is_best_assessed_hemody namically_by_looking_at_those_values_that_precede_and_come_after_the_left_heart.In this_case_pulmonary_capillary_wedge_pressure_and_cardiac_output(or_cardiac_index)_a re_the_values_found_before_and_after_the_left_heart. Which_of_the_following_findings_is_most_closely_associated_with_increased_airway_resis tance? _A._reduced_SpO _B._accessory_muscle_use _C._altered_P _D.increased_PetCO2-_Correct_answer~_B.
_A.Administer_Dexamethasone(Decadron)_in_place_of_Albuterol _B._Add_Xopenex_to_the_bronchodilator_regimen _C.Replace_Albuterol_with_Beclamethasone(Beclovent) D.Switch_from_Albuterol_to_ipratropium_bromide(Atrovent)-_Correct_answer~_D. Because_albuterol_is_a_beta-agonist_medication,_patients_who_are_taking_beta- blockers_should_utilize_other_bronchodilation_medication. A_hospital_has_an_extremely_low_incidence_of_ventilator- associated_pneumonia._To_which_of_the_following_reasons_may_this_be_attributed? _A._periodic_discontinuation_of_sedation _B._use_of_respiratory_precautions_with_the_population _C._diversion_of_infectious_patients_to_other_facilities _D.broad_use_of_prophylactic_antibiotics-_Correct_answer~A. The_incidence_of_ventilator- associated_pneumonia,_or_VAP,_is_lowered_by_using_a_closed_system_suction_catheter, _periodically_discontinuing_sedation,_keeping_the_patient_and_semi- Fowler's_position,_and_proper_handwashing_among_caregivers.All_are_correct. A_pressure- volume_loop_ventilator_graphic_shows_no_rise_in_pressure_for_the_first 200 _mL_of_del ivered_volume._The_therapist_should _A._increase_inspiratory_flow_rate _B._increase_PEEP _C._decrease_tidal_volume _D.decrease_inspiratory_flow_rate-_Correct_answer~B. In_this_question_the_description_of_the_pressure_volume_loop_would_indicate_a_flat_b ottom_as_manifested_by_no_rise_in_pressure_with_the_first 200 _mL_of_delivered_volu me.We_call_this_a"flat_football"._The_solution_is_to_increase_PEEP_to_a_level_that_th e_pressure_begins_to_rise_immediately_as_volume_is_introduced.
Which_of_the_following_would_be_the_most_effective,_appropriate_method_for_resolvin g_atelectasis_in_a_spontaneously_breathing,_post_operative_patient_who_is_under_the_i nfluence_of_sedation_and_will_not_respond_to_verbal_stimuli? _A._IPPB _B.sustained_maximal_inhalation(incentive_spirometer) _C._deep_breathing_coaching _D.intubation_and_mechanical_ventilation-_Correct_answer~A. A_postoperative_patient_under_sedation,_and_possibly_in_pain,_may_be_tempted_to_br eathe_less,_causing_respiratory_acidosis_and_atelectasis._To_correct_this_problem,IPPB therapy_is_most_appropriate._Incentive_spirometry_would_also_help_but_the_patient_is unable_to_respond_to_verbal_stimuli.This_alone_is_an_indication_for_IPPB_therapy. After_performing_minimum_occluding_volume_technique_with_a 65 - kg(143- lb)_patient_who_is_orally_intubated_with_a_7.0- mm_ET_tube,_the_respiratory_therapist_should_NEXT _A._check_ET_tube_cuff_pressure _B._perform_tracheal_palpation _C._order_a_chest_radiograph _D.document_ET_tube_markings_at_the_lips-_Correct_answer~_A. The_ET_tube_cuff_pressure_may_be_adjusted_correctly_by_several_techniques_including minimum_leak_technique(also_called_minimum_occluding_volume,_minimal_seal_tech nique,_and_the_use_of_a_pressure_manometer_called_a_cuffalator._If_minimum_seal_or _minimal_leak_technique_is_used,_the_respiratory_therapist_is_still_required_to_monitor _the_pressure_after_the_technique_is_performed._Although_this_is_often_not_done_in_r eal_life,_it_is_technically_part_of_the_procedure. The_respiratory_therapist_observes_an_ECG_wave_form_on_a_patient_that_is_consistent _with_atrial_tachycardia._The_patient_is_complaining_of_chest_pain,_dizziness,_and_naus ea._The_respiratory_therapist_should_recommend
_C.vecuronium_bromide(Norcuron) _D.Mestinon-_Correct_answer~B. Morphine_sulfate_is_one_of_the_best_medications_to_administer_to_patients_receiving mechanical_ventilatory_support_to_help_the_patient_rest_pain- free_and_to_generally_sedate_and_relax_the_patient. A_patient_has_idiopathic_pneumonia_with_consolidation_in_the_right_lower_lobe.The physician_suspects_a_bacterial_infection._Which_of_the_following_will_provide_conclusiv e_data_to_rule_out_the_physician's_suspicions? _A._WBC _B._color_of_sputum _C._sputum_acid-fast_stain _D.oral_temperature-_Correct_answer~A. A_bacterial_infection_is_diagnosed_primarily_by_examining_the_white_blood_cell_count, _also_called_the_leukocyte_count._An_elevated_temperature_and_yellow_sputum_indicat e_the_possibility_of_an_infection_but_are_not_confirming_in_nature. After_making_the_universal_sign_of_choking,_a_person_collapses.The_observer_should FIRST _A._check_for_a_pulse _B._call_for_help _C._perform_abdominal_thrusts _D.administer 2 rescue_breaths-_Correct_answer~_C. When_a_person_indicates_the_universal_sign_of_choking,they_are_unable_to_verbalize because_there_is_likely_something_caught_in_their_airway._The_person_responding_mus t_first_focus_on_removing_the_obstruction,_which_is_done_by_performing_abdominal_th rusts.Administering_rescue_breaths_would_not_be_appropriate_because_the_airway_is obstructed._Calling_for_help_is_tempting_but_is_only_related_to_two- man_CPR._The_patient_is_not_yet_at_that_point._Performing_abdominal_thrusts_is_a_on e-man_maneuver_and_therefore_obtaining_additional_help_is_not_the_first_concern.
A_home_care_patient_calls_into_the_clinic_and_complains_that_his_oxygen_concentrator is_not_working_even_though_the_machine_is_plugged_in_and_the_switch_is_in_the'on '._Position._After_ensuring_the_patient_is_receiving_oxygen_from_a_reliable_alternate_so urce,_the_therapist_should_advise_the_patient_to _A._check_and_replace_the_internal_in-line_fuse _B._find_the_reset_switch_in_the_machine_and_press_it _C._ensure_the_circuit_breaker_is_in_the_on_position _D.change_the_filters_and_cycle_the_machine_off_then_on_again-_Correct_answer~_C. When_a_homecare_patient_reports_a_problem_with_their_oxygen_concentrator,the_firs t_action_should_be_to_ensure_the_patient_is_receiving_oxygen_from_an_alternate_sourc e(an_E_cylinder)._After_that_is_accomplished,_the_respiratory_therapist_may_instruct_t he_patient_in_some_basic_troubleshooting._This_includes_ensuring_the_device_is_plugge d_in,_changing_the_filter,_and_checking_the_circuit_breaker.All_other_troubleshooting_s hould_be_done_by_a_professional. An_adult_patient_with_asthma_is_receiving_Albuterol_by_small_volume_nebulizer_Q.I.D. at_a_dosage_of_0.5_mL._The_patient_complains_of_dizziness,_tingling_in_his_fingers,_an d_anxiety_with_each_treatment._The_therapist_should _A._increase_dosage_to_1.0_mL _B._decrease_dosage_to_0.15_mL _C._switch_to_Xopenex_0.63_mg _D.switch_to_Mucomyst_20%-_Correct_answer~_C. When_a_patient_experiences_an_adverse_reaction,_the_first_step_is_to_stop_the_therap y_and_then_modify_the_therapy_to_accomplish_the_same_objective._In_this_case,_decr easing_the_dose_of_Xopenex_is_suitable_because_0.63_mg_is_still_in_the_adult_therape utic_range. Which_of_the_following_conditions_would_benefit_most_from_a_thoracentesis? _A._atelectasis
_A._Use_of_pressure_support _B._Switch_to_pressure_control_ventilation _C._Increase_the_machine_flow_rate _D.Increase_PEEP-_Correct_answer~A. During_ventilator_weaning,_a_patient_must_maintain_a_moderately_low_respiratory_rate ,_an_adequate_sized_tidal_volume,_and_low_work_of_breathing._In_this_case,_the_patie nt_is_experiencing_increased_labor_of_breathing_and_an_increase_in_respiratory_rate._T his_is_likely_due_to_a_reduced_spontaneous_tidal_volume._Although_this_data_is_not_s hown,_this_condition_can_be_assumed.The_solution_for_a_low_spontaneous_tidal_volu me_and_increased_work_of_breathing_during_weaning_is_to_provide_pressure_support. When_analyzing_the_FIO2_for_an_infant_in_an_oxygen_hood_receiving_oxygen_therapy with_a_blender_set_at_50%,the_respiratory_therapist_notes_an_oxygen_concentration of_35%_near_the_patient's_mouth.The_jet_nebulizer_entrainment_setting_is_set_to 50 %._To_correct_the_problem,_the_therapist_should _A._adjust_blender_setting_to_60% _B._increase_total_flow_to_the_oxyhood _C._obtain_a_smaller_oxyhood _D.change_the_nebulizer_entrainment_port_to_100%-_Correct_answer~_D. When_administering_oxygen_by_oxygen_hood_with_a_blender_and_a_nebulizer,_the_oxy gen_control_on_the_nebulizer_should_be_set_to_100%._This_will_prevent_additional_ent rainment_of_room_air_which_will_cause_a_decrease_in_FIO2. Following_the_insertion_of_a_tracheostomy_tube,_the_patient_is_found_to_have_diffuse _crackles_upon_auscultation_secondary_to_subcutaneous_emphysema._Which_of_the_fol lowing_radiographic_findings_would_be_expected_with_this_condition? _A._Hyperlucency_in_the_soft_tissues _B._Diffuse_pulmonary_hyperlucency _C._Tracheal_shift_from_midline _D.Scattered_patchy_infiltrates-_Correct_answer~_A.
Hyperlucency,_seen_on_a_chest_x- ray_is_darker_in_color._Air_is_radiolucent._Therefore,_air_located_in_the_soft_tissue,as seen_with_subcutaneous_emphysema_would_result_in_a_hyperlucent_X- ray_over_soft_tissue_areas._Subcutaneous_emphysema_by_itself_will_not_shift_the_trach ea_from_midline._Scattered_patchy_infiltrates_are_associated_with_ARDS,not_subcutane ous_emphysema. Placement_of_a_pulmonary_artery_catheter_is_associated_with_which_of_the_following most_common_complications? _A._hypotension _B._pulmonic_valve_damage _C._cardiac_arrhythmias _D.internal_bleeding-Correct_answer~C. Several_complications_may_arise_from_the_placement_of_a_pulmonary_artery_catheter, otherwise_called_a_Swan- Ganz_catheter._The_development_of_cardiac_arrhythmias_is_the_most_common_complic ation_of_the_options_offered.Another_serious_complication_is_perforation_of_a_vessel or_cardiac_muscle_during_the_insertion. A_galvanic_fuel_cell_oxygen_analyzer_may_read_erroneously_high_under_which_of_the_f ollowing_conditions? _A._when_the_analyzer_batteries_are_depleted _B._during_a_sudden_increase_in_the_partial_pressure_of_oxygen _C._when_a_volume-controlled_ventilator_at_high_inspiratory_pressures _D.when_liquid_gets_on_the_membrane-_Correct_answer~_C. A_galvanic_fuel- cell_oxygen_analyzer_may_read_erroneously_when_ambient_pressures_change_significant ly,_such_as_when_a_patient_is_receiving_high_inspiratory_pressure_or_when_a_patient_c hanges_altitude_quickly.
_D.oxygen_consumption_at_the_tissues-_Correct_answer~C. Oxygen_transport_refers_to_the_ability_for_blood_to_carry_oxygen_from_the_alveoli_to the_tissues._In_a_case_involving_carbon_monoxide_poisoning,_it_is_transport_that_is_m ost_affected._This_is_true_because_hemoglobin_becomes_occupied_with_carbon_monoxi de_rather_than_oxygen.Hemoglobin_is 19 times_more_attracted_to_carbon_monoxide compared_to_oxygen._Of_the_options_listed,_the_best_method_to_monitor_the_adequac y_of_oxygen_transport_would_be_to_evaluate_the_arterial_oxygen_content._This_value_t akes_into_account_the_amount_of_oxygen_tied_to_the_hemoglobin_as_well_as_the_oxyg en_dissolved_in_the_plasma_of_the_blood A_patient_complains_of_shortness_of_breath_during_a_nebulizer_treatment_is_hypertoni c_saline._The_respiratory_therapist_should_do_which_of_the_following? _A._Discontinue_therapy_and_notify_the_physician _B._Add_Albuterol_to_the_nebulizer_treatment _C._Switch_to_normal_saline _D.Switch_to_hypotonic_saline-_Correct_answer~_A. Adverse_reactions_during_any_therapy_should_be_responded_to_initially_by_discontinuin g_therapy_and_notifying_the_physician. In_preparation_for_a_helium_dilution_study,_a_respiratory_therapist_is_calibrating_the_h elium_analyzer._While_exposing_the_analyzer_to_ambient_room_air,_what_will_the_analy zer_read_for_helium_concentration? _A._21% _B._0% _C._2% _D.79%-_Correct_answer~_B. To_calibrate_a_helium_analyzer,_sometimes_called_a_Wheatstone_Bridge,_the_device_m ust_be_calibrated_to_room_air_for_the_low_calibration_and_to_a_known_level_of_heliu m_for_the_high_calibration._Because_room_air_has_no_significant_level_of_helium,_heliu m_analyzers_should_read_0%_when_exposed_to_ambient_room_air_conditions.
Which_of_the_following_will_result_in_a_decrease_in_mean_airway_pressure_for_a_patie nt_on_a_mechanical_ventilator_in_the_assist/control_mode? _A._use_of_expiratory_retard _B._institution_of_a_1.0_sec_inspiratory_plateau _C._decrease_in_inspiratory_time _D.decreasing_inspiratory_flow-_Correct_answer~_C. Decreasing_inspiratory_time_will_lower_the_amount_of_time_a_patient_is_exposed_to_p ositive_pressure_and_will_therefore_result_in_a_decrease_in_mean_airway_pressure._Use _of_expiratory_retard,_increasing_inspiratory_flow,_and_institution_of_an_inspiratory_plat eau_will_all_lead_to_increased_mean_airway_pressure. A_chest_radiograph_of_an_abdominal_post- operative_patient_shows_abnormal_elevation_of_the_left_hemidiaphragm._Which_of_the _following_conditions_explains_the_observation? _A._pneumothorax_on_the_left _B._herniation_of_the_left_hemidiaphragm _C._hemothorax _D.atelectasis_in_the_left_lower_lobe-_Correct_answer~_D. Abnormal_elevation_of_the_left_hemidiaphragm_is_an_indication_that_the_lung_on_that _side_is_smaller_for_some_reason._This_could_be_due_to_a_partial_pneumothorax_or_p rofound_atelectasis._Oftentimes,_atelectasis_can_develop_as_a_result_of_surgery._Theref ore,_the_raised_hemidiaphragm,_combined_with_the_postoperative_status_of_the_patien t,_indicate_the_most_likely_problem_is_atelectasis_in_the_left_lower_lobe. Immediately_following_oral_endotracheal_intubation,_the_respiratory_therapist_should_c onfirm_proper_placement_by_doing_which_of_the_following? _A._Assess_end-tidal_CO2_with_a_colorimetric_capnometer _B._Obtain_a_anterior-posterior_chest_radiograph
- _pH:_7.
- PaCO2: 50 _mmHg
- PaO2: 82 _mmHg
- HCO3-: 24 _mEq/L
- BE: 0 _mEq/L
- RR: 24 _breaths_per_min
- VT: 260 _mL The_respiratory_therapist_should_recommend_which_of_the_following: A._Intubate,_VC,A/C_ventilation B._Oral_intubation,CPAP 5 _cm_H2O,PS 6 _cm_H2O C.Non-invasive_ventilation_with_IPAP 10 _cm_H2O,EPAP 5 cm_H2O D.Manual_resuscitation_administer_Narcan(naloxone)-_Correct_answer~B. Which_of_the_following_is_an_emergency_and_requires_that_the_patient_receive_100% oxygen_supplementation? A._Impending_ventilatory_failure B.Massive_loss_of_blood C.Ventilatory_failure D.Vital_capacity_below_1.0_L-_Correct_answer~B. Which_of_the_following_is_an_indication_for_the_use_of_FiO2_1.0_on_a_patient? A.Evidence_of_pulmonary_embolism B._Ventilatory_failure
C.Impending_ventilatory_failure D.Myasthenia_gravis-_Correct_answer~A. Of_the_options_listed,_only_the_suspicion_and_evidence_of_pulmonary_embolism_is_sug gestive_of_and_emergency_and_necessitates_the_use_of_FiO2_1. For_a_patient_who_is_unconscious,_due_to_ingestional_error_of_barbiturates,which_of the_following_assessments_is_the_most_important? A.Arterial_blood_gas_analysis B.The_patient's_ability_to_protect_their_airway C._Tension_test D.A_drug_toxicology_screen-_Correct_answer~_B. Which_of_the_following_types_of_patients_are_most_often_good_candidates_for_alveola r_recruitment_maneuvers? 1.Post-surgical 2.Acute_lung_injury 3._Pulmonary_emphysema 4.Acute_respiratory_distress_syndrome 5.Tuberculosis A._1,_2,_3,and 4 only B._1,_2,and 3 only C._1,_3,and 5 only D._3,_4,and 5 only-_Correct_answer~_A. Which_of_the_following_is_most_attributed_to_effective_alveolar_recruitment?
Effective_alveolar_recruitment_will_be_manifested_by_which_of_the_following_clinical_ou tcomes? 1._Decrease_in_the_A-a 2.Increase_in_PF_ratio 3._Decrease_in_VT 4._Decrease_in_Qs/Qt A.1,2,and 4 only B. 1 and 4 only C. 2 and 3 _only D._1,_2,_3,and 4 _-_Correct_answer~_A. Which_of_the_following_PEEP_levels,_set_above_the_patient's_plateau_pressure,is_appr opriate_as_an_initial_setting_during_alveolar_recruitment_maneuvers? A. 10 cm_H2O B. 40 cm_H2O C. 30 cm_H2O D. 20 cm_H2O-_Correct_answer~_A. Which_of_the_following_ventilator_modes_is_most_suitable_to_help_recruit_alveoli? A._PRVC B._PCV C._APRV D.Inverse_positive_pressure_ventilation-_Correct_answer~_C.
To_qualify_for_ventilator_weaning,_a_patient's_Qs/Qt_should_be_below A.60% B.5% C.10% D.20%-Correct_answer~D. A_patient_receiving_VC_SIMV_ventilation_has_a_spontaneous_tidal_volume_of 500 mL and_a_respiratory_rate_of_20/min_when_removed_momentarily_from_the_ventilator.W hat_is_the_RSBI_value? A. 10 B. 25 C. 40 D.0.025-Correct_answer~C. RSBI_is_calculated_by_RR/VT(L). RSBI= 20 /0.5_L RSBI= 40 To_be_considered_for_weaning_from_VC_A/C_ventilation,a_patient's_A- aDO2_should_be_less_than: A. 100 mm_Hg B. 65 mm_Hg C. 300 mm_Hg D. 200 mm_Hg-_Correct_answer~C.
