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NBRC TMC PRACTICE QUESTIONS AND VERIFIED CORRECT ANSWERS
"For a patient receiving volume-controlled mechanical ventilation, the lower inflection point on a pressure-volume loop can best be described as: A. amount of pressure required to keep the alveoli and small airways open B. optimal PEEP C. minimal PEEP
D. upper limit of residual volume - CORRECT ANSWER A.
The lowest inflection point on a pressure-volume ventilator graphic is an indication of the minimum pressure needed to keep alveoli open." "The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has A. fluid overload B. ARDS C. a pulmonary embolism
D. pneumonia - CORRECT ANSWER C.
A VQ scan that shows poor perfusion but adequate ventilation is most closely associated with a pulmonary embolism. Supportive data is found in the radiological report of wedge-shaped infiltrates." "The respiratory therapist notes in the medical record of a 65-year-old male that the patient is ordered to receive bronchodilator therapy with Albuterol. The therapist also notes the patient is receiving beta-blocker medication. The therapist should recommend 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 38-year-old male presents in the emergency department (ED) complaining of frequent vomiting. The following laboratory data is available: Arterial blood gases pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0 mEq/LCl- 95 mEq/LNa+ 135 mEq/L Which of the following should the respiratory therapist recommend? A. administer NaCL B. administer NaHCO3- C. administer KCL
D. administer volume-expanding fluids - CORRECT ANSWER C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However, the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to administer potassium chloride or KCl." "A patient is receiving volume-controlled ventilation following bariatric surgery for obesity. Which of the following medications should the respiratory therapist recommend to ensure the patient's comfort and assist in ventilator management? A. Pronestyl B. morphine sulfate 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 conclusive 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 indicate the possibility of an infection but are not confirming in nature." "The respiratory therapist should look to which of the following clinical data to determine the effectiveness of incentive spirometry? A. Arterial blood gas analysis pre and post treatment B. Breath sounds before and after every treatment C. Inspiratory capacity predicted volume
"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 complication 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 following 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 significantly, such as when a patient is receiving high inspiratory pressure or when a patient changes altitude quickly." "The physician orders mechanical ventilator settings: Mode assist/control VT 600 mLMandatory rate 10/minI:E 1:2FIO2 0.40PEEP 5 cm H2O Which of the following represents the minimum inspiratory flow setting the respiratory therapist should select? A. 24 L/min B. 60 L/min C. 18 L/min
D. 40 L/min - CORRECT ANSWER C.
There are several methods to determine the minimum flow needed to accomplish specific minimum flow settings on a mechanical ventilator. One shortcut method is to add the I:E ratio numbers together and multiply it by the minute ventilation. In this case, 1+2 = 3. Minute ventilation = (.6L x rate of 10) = 6.0 L. 6.0 L x 3 = 18 L/min. This is the minimum flow. When answering this question if the exact number is not available in the options, the correct choice would be the next highest number. For instance, if 18 L per minute was not an available option, the next best answer in this question would be 24 L per minute." "A 65-kg (143-lb) male patient is in the intensive care unit after being found unconscious and unresponsive with a suspected drug overdose. The following ABG and clinical data are observed.
- 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 suggestive of and emergency and necessitates the use of FiO2 1.0" "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 alveolar recruitment maneuvers?
- Post-surgical
- Acute lung injury
- Pulmonary emphysema
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 appropriate 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. What 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.
An A-aDO2 greater than 300 mm Hg would suggest that the patient requires PEEP to maintain adequate PaO2." "Which of the following generally represents the quickest, most effective method for ventilator liberation?
- APRV
- Cold cessation and extubation
- SBT
4. Gradual decrease in rate and pressure support - CORRECT ANSWER C."
"What postural drainage position is most conducive to draining the basal, anterior, and lateral segments? A. Prone B. Supine C. Lateral side, quarter turn
D. Trendelenburg - head down 30 degrees - CORRECT ANSWER D."
"A patient is in the ICU for treatment of right-sided pneumonia and cor pulmonale. What patient positioning would optimize gas exchange? A. Supine B. Semi-Fowler's C. Lying on the right side with the left lung up
D. Lying on the left side with the right lung up - CORRECT ANSWER C.
For optimal gas exchange, the unaffected lung should be kept up high" "Which of the following would indicate that the prescribed airway clearance efforts are effective? A. Expectoration of secretions dissipates B. Patient develops rhonchi during clearance procedure C. Patient indicates they can breathe better
D. Breath sounds become less diminished - CORRECT ANSWER B"
"Which of the following conditions would contraindicate chest percussion for the purpose of airway clearance?
When planning appropriate staffing levels for patient care, frequency of therapy, type of therapy ordered, and the individual skills of the staff are all important considerations. Department budgetary goals should not affect staffing." "A respiratory therapist is preparing a patient who will be transferred home and will be ventilator dependent during the night. Which of the following devices would be most helpful to ensure adequate hydration of the patient's airway during the night? A. Large volume nebulizer B. Cascade humidifier C. Heat moisture exchanger (HME)
D. Heated wire ventilator circuit with water traps - CORRECT ANSWER C.
An HME device is intended for short-term use. Patients who are ventilator-dependent during the night may use this device." "After noting profuse bubbling in the water-seal chamber of a disposable three-chamber chest drainage system, the RT places a clamp on the chest tube proximal to the patient. In doing so, the bubbling dissipates and stops. What can be concluded? A. The leak must be in the tubing leading to the chest drainage system B. Suction pressure at the wall is excessive C. The patient may have perforation in lung tissue
D. Leaking is most likely occurring inside the three-chamber system - CORRECT ANSWER
C."
"A 22-year-old, 6-ft, 3-in Caucasian male is in the ER for sudden, unexplained onset of tachypnea. Chest radiography shows hyper lucency in the left chest, dominated by a large dark area over the entire left lung field. The physican decides to install a chest tube drainage system and asks for your recommendation on chest tube placement. You will suggest which of the following? A. Right side, mid-axillary line, 5th intercostal space B. Right side, left side, 4th intercostal space, mid-clavicular line C. Left side, mid-axillary line, 5th intercostal space
D. Left side, 2nd intercostal space, mid-clavicular line - CORRECT ANSWER D."
"In a patient with a partial pneumothorax, what percent of collapse is the threshold that indicates the need for chest tube insertion? A. 50% B. 20% C. 10%
D. 15% - CORRECT ANSWER B."
"By what route is Xolair (omalizumab) administered? A. Subcutaneously B. Aerosolized C. IV
D. Intra-muscular - CORRECT ANSWER A."
"How many milliliters of aerosolized medication should be prepared to deliver 30 mg of that same drug if the strength is 1.5% A. 2.0 mL B. 4.5 mL C. 20 mL
D. 45 mL - CORRECT ANSWER A.
Strength of 1.5% x 10 = 15 mg/mL 30 mg / 15 mg/mL = 2.0 mL" "An aerosolized bronchodilator is being administered to a patient. The dose is 5.0 mL and the drug strength is 2.0%. How many milligrams of the drug will be administered? A. 2.5 mg B. 0.4 mg C. 100 mg
D. 10 mg - CORRECT ANSWER C.
Strength of 2.0% x 10 = 20 mg/mL 5.o mL x 20 mg/mL = 100 mg" "A bronchodilator medication whose strength is 0.5% must be delivered by continuous bronchodilator therapy at 10 mg/hr for 2.5 hours. How many mL will be required to be added to the nebulizer? A. 25 mL B. 5.0 mL C. 1.25 mL
D. 10 mL - CORRECT ANSWER B.
Strength of 0.5% x 10 = 5 mg/mL 2.5 x 10 = 25 total milligrams
of mL needed = 25 total mg / 5 mg/mL = 5.0 mL"
"While suctioning blood from the trachea with a bronchoscope following tissue extraction, the scope suddenly demonstrates no suction pressure at the end of the scope. The RT should check the: A. Suction pressure at the wall B. Integrity of the suction line C. Bodai adapter
D. Suction channel on the scope - CORRECT ANSWER D.
The suction channel is most likely clogged and is the cause of the problem" "Which of the following may be used to facilitate a bronchoscopy while providing mechanical ventilatory support? A. King airway B. Bodai adapter C. Fenestrated tracheostomy tube
D. Combitube - CORRECT ANSWER B.
Device which attaches to the end of the ETT and has a 90-degree connection for the ventilator and a port that allows insertion of a bronchoscope straight into the airway" "Blood is found in the exudate retrieved during a thoracentesis. This is most likely associated with: A. Infection B. Cancer C. Pleural effusion
D. Tuberculosis - CORRECT ANSWER A."
"A thoracentesis is performed by inserting a large bore needle into the pleural space between the: A. 5th and 6th ribs B. 7th and 8th ribs C. 3rd and 4th riibs
D. 10th and 11th ribs - CORRECT ANSWER B"
"When adjusting the mandatory rate on a volume control ventilator of a patient who has COPD, the RT should monitor which of the following to ensure adequate ventilation? A. HCO B. PaCO
C. pH
D. PaO2 - CORRECT ANSWER C."
"In case of a ventilation emergency, the COPD patient should receive: A. Oxygen not to exceed 35% B. 50% oxygen C. 100% oxygen
D. No more than 2 L/min by nasal cannula - CORRECT ANSWER C."
"What would be the most likely shape of a flow-volume pulmonary function loop on a patient with COPD? A. Short and narrow B. Tall and narrow C. Short and wide
D. Tall and wide - CORRECT ANSWER C.
Because a COPD patient has difficulty expiring, the flow volume loop will be wide as they require longer to exhale. Consequently, the volume will be reduced, causing the loop to be short (low in volume indicated on the Y axis)" "While doing an ECG on a patient who is asymptomatic, the RT notes pronounced 'Q' waves on the ECG. The RT should: A. Look for a detached chest lead B. Note the observation, otherwise take no immediate action C. Begin treatment protocols for myocardial infarction
D. Call a code - CORRECT ANSWER B"
"While performing a routine check of a patient receiving mechanical ventilatory support, the respiratory therapist makes a small adjustment to the ET tube cuff pressure by injecting 2.0 cc of air into the cuff. Immediately after, the high-pressure alarm on the ventilator is activated. The therapist should A. silence the alarm and monitor the patient closely. B. remove the ET tube. C. readjust the cuff using the minimal leak technique.
D. attempt to pass a suction catheter through the ET tube. - CORRECT ANSWER D.
The activation of the high-pressure alarm is an indication of an occlusion. Since this occurred immediately after adding air to the ET tube cuff, the therapist should suspect the possibility of cuff herniation. To rule this suspicion in or out, a suction catheter should be inserted into the airway to determine if there is an obstruction near the distal end of the tube."
"Into which interspace should a chest tube be inserted for the purpose of draining serosanguinous fluid from the pleural space and for the re-expansion of lung tissue? A. 2nd interspace B. 5th interspace C. 4th interspace
D. 8th interspace - CORRECT ANSWER B.
If fluid is anticipated, chest tubes should be place in the 5th interspace, mid-axillary line." "The following volume-pressure graphic is observed on a patient who is receiving VC A/C ventilation. The respiratory therapist should Image is a very flat pressure-volume loop A. switch to PC ventilation B. determine average inspiratory plateau pressures C. change the scale volume axis of the graph
D. determine the patient's static compliance - CORRECT ANSWER C.
Although this pressure-volume graphic appears to be 'lying down", which is usually associated with decreasing pulmonary compliance, closer observation reveals that the scaling on the volume axis of the graphic is not appropriate. In other words, the graphic appears as it does due to improper scaling. Once corrected, the graphic is likely to show normal compliance." "Which of the following conditions could cause a tracheal shift to the right?
- atelectasis in the left2. sputum consolidation on the right3. pneumothorax on the right4. lobectomy on the right. A. 1 and 3 only B. 1 and 4 only C. 2 and 4 only
D. 1, 2, and 4 only - CORRECT ANSWER C.
Sputum consolidation on the right and a lobectomy on that same side would cause a tracheal shift to the right. Other options would shift the trachea to the left." "Corticosteroids help support bronchodilation by: A. Decreasing airway inflammation B. Augmenting the action of rescue medication C. Promoting relaxation of smooth muscle tissue
D. Significantly reducing sputum production - CORRECT ANSWER A."
"What side effects are associated with the use of dornase alpha? A. Rash and laryngitis B. Candidiasis and thrombocytopenia
C. Diplopia and dysphagia
D. Pulmonary infection and pneumonia - CORRECT ANSWER A."
"Immediately after the administration of succinylcholine (Anectine) in preparation for intubation, the RT should watch for which of the following to determine when the drug has taken effect and when the intubation procedure may commence. A. The acute development of petechia on the skin near the mandible B. Muscle fasciculations (twitching) about the face and neck C. Spontaneous respiratory rate < 8/min
D. A sudden spike in blood pressure - CORRECT ANSWER B."
"A patient has a pulmonary artery catheter in place and is being monitored hemodynamically. Currently, CVP, mPAP, and PCWP are all elevated. Which of the following would help lower these hemodynamic pressures? A. IV normal saline B. Montelukast C. Furosemide
D. Mannitol - CORRECT ANSWER C."
"A 45-year-old male patient with CHF has peripheral pitting edema rated at a +4. Which of the following medications would be helpful in correcting this tendency toward third-spacing in the periphery? A. D5W fluid B. Nitroprusside (Nipride) C. Osmitrol (Mannitol)
D. Acetazolamide (Diamox) - CORRECT ANSWER D.
Acetazolamide is especially useful in addressing peripheral pitting edema" "Which of the following agents promotes fluid retention? A. DDAVP B. Furosemide C. Acetazlamide
D. Osmitrol - CORRECT ANSWER A."
"Desmopressin is an agent that helps prevent: A. Third-spacing B. Fluid retention
D. Electrical conductivity - CORRECT ANSWER B."
"A medication is said to have inotropic properties. What function of the heart is most likely changed when these types of drugs are administered? A. Contraction strength B. Regurgitation C. Contraction rate
D. Left-to-right shunting - CORRECT ANSWER A."
"What kind of anti-ischemic medications would cause dilation of the coronary vessels? A. Platelet glycoprotein B. Anti-platelet C. Nitrates
D. Aminoglycoside - CORRECT ANSWER C."
"After attempting to treat a patient's gram-positive bacteria infection with amoxicillin with very little efficacy, the culture and sensitivity report from microbiology shows the patient is penicillin-resistant. Which of the following agents is most likely to be more helpful in eradicating the patient's bacterial infection? A. Vancomycin B. Cephalexin C. Penicillin
D. Oxacillin - CORRECT ANSWER D.
Nafcillin, oxacillin, and methicillin are special "cillin" class antimicrobials that are more effective when the patient is penicillin-resistant" "Which of the following agents would be most helpful at controlling a gram-positive bacterial infection in a patient who is allergic to penicillin? A. Gentamycin B. Cephalexin (Keflex) C. Methicillin
D. Carbenicillin - CORRECT ANSWER B."
"Which of the following medications is both a vasoconstrictor and an agent that increases the strength of cardiac contraction (positive inotropic)? A. Phenylephrine (neo-synephrine)
B. Atropine C. Nitroprusside (Nipride)
D. Dobutamine (Dobutrex) - CORRECT ANSWER D."
"The administration of vasoconstrictor medication would most likely result in: A. Hypotension B. Decreased PVR C. Increased SVR
D. Cardiac vessel dilation - CORRECT ANSWER C."
"A patient with angina and suspected pulmonary hypertension should receive which of the following medications that will also promote a decrease in SVR? A. Rocuronium (Zemuron) B. Sublingual nitroglycerin C. Dobutamine (Dobutrex)
D. Fentanyl (Sublimaze) - CORRECT ANSWER B."
"BID is a common frequency order for which of the following respiratory medications? A. Albuterol B. Flovent C. Ativan
D. Xopenex - CORRECT ANSWER B.
Flovent (fluticasone) is a corticosteroid used generally to prevent and relieve inflammation of airway walls. Inflammation is one of the components of asthma so corticosteroids are key in treatment. The frequency is twice per day or b.i.d. Flovent may cause Candidiasis, (oral yeast infection), which may be prevented by judiciously rinsing the mouth after inhaler use." "A high frequency jet ventilator system includes which of the following items? A. Clark electrode B. flow interrupter C. nitrogen analyzer
D. pop-off spring valve - CORRECT ANSWER B.
Of the options offered, only a flow interrupter is a control associated with high-frequency jet ventilation." "A post-op adult patient achieved an inspiratory capacity of 1800 cc with an incentive spirometer prior to surgery. After the surgery, the patient appears to be confused on how to use the incentive spirometer. The therapist notes the patient is having difficulty getting the balls to rise. The therapist should
