TMC 2019 NBRC Qs
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| Dullness to percussion, decreased tactile fremitus and diminished breath sounds are associated with | Pleural Effusion
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| What is associated with an optimally exposed chest radiograph? | Vertebrae and lung markings are clearly visible.
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| The use of respiratory accessory muscles is frequently the result of | Airway resistance
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| Drug dosage calculation | Change % to decimal. Divide desired dosage by the actual concentration.
Ex: desires 1mg / .4mg/ml = 2.5mL
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| A pulsoximeter cannot provide an accurate indication of the oxyhemoglobin saturation in what clinical condition | Carbon monoxide poisoning
Explanation: carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish their differences resulting in high SpO2 readings.
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| Portable ventilators for pt. Transport within the hospital should have the ability to | Sound a disconnect alarm
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| A patient that states they feel they can breathe better when they sleep sitting in a chair is indicative of | Orthopnea
Likely related to CHF
Orthopnea is dyspnea that occurs when a patient supine
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| This determines a persons rapid-shallow breathing index | Vane Respirometer
RSB Index is calculated using the formula:
RR/(minute volume)(RR)
the vane respirometer determines the minute volume
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| What may be suspected in a trauma patient with multiple fractures to multiple adjacent ribs | Flail chest
-During Inspiration, muscled move the chest wall out and the decreased intrapleural pressure pulls in the flail segment creating a paradoxical movement.
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| Absent airflow without chest or abdominal movement indicates what | Central sleep apneas.
BiPAP is indicated to provide pressure support augmenting ventilation.
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| Which mask should be used to deliver 70% helium 30% oxygen effectively | Non rebreather
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| What is used to assess the severity of CO poisoning? | Hemoximetry
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| Evaluation of Lung Infiltrates requires further diagnostic studies like | Flexible Bronchoscopy
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| This is a mucolytic that may cause irritation and bronchospasm | N - acetylcysteine
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| This drug is an anticholinergic and provides minimal bronchospasm relief | Ipatropium Bromide
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| This drug is a beta2-agonist and is an appropriate substitute for Albuterol | Levalbuterol
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| A decrease in plateau pressures represents | Improvement in lung compliance
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| An increasing difference between peak and plat pressures indicates | An increase in airway resistance.
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| Pale or blue color, absent HR, no reflex irritability, limp muscle tone and absent respirations indicates what APGAR score? | 0 for each section
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| Baby is pink, HR >100, cry cough sneezing, active, strong cry indicates are related to APGAR scores of | 2 for dad he section
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| Color shows acrocyanosis, HR <100, grimace, some flexion, slow or irregular respirations is APGAR scoring of | 1 for each section
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| FVC and FEV1 May be obtained from a | Forced expiratory spirogram
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| Exacerbation of asthma associated with respiratory distress is best treated with | Continuous albuterol nebulizer
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| Cores crackles over both lung fields indicates | Secretions
Secretions produce low pitched discontinuous lung sounds
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| Subcutaneous emphysema is demonstrated by the presence of | Crepitus
During chest wall palpation
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| Wheezing sound from narrowed airways | Bronchospasm
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| When in proper position, the tip of the CVP catheter should be in the | lower portion of the superior vena cava.
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| The patient's condition continues to deteriorate, based on increased oxygen requirements and an elevated PaCO2, indicating | NIV or need for assisted ventilation
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| A patient with a history of chronic bronchitis complains of SOB following thoracic surgery. The patient is receiving 30% O2. Rhonchi in the right lower lobe are heard. What therapy is recommended? | Vibratory PEP
Deep breathing accompanied by PEP therapy will provide optimal bronchial hygiene to clear secretions
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| Initiation of an expiratory hold just prior to the next ventilator-delivered breath facilitates the measurement of | auto-PEEP
Auto-PEEP is measured by subtracting set PEEP from the measured pressure during an expiratory hold.
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| A 65-year-old patient who is post-CABG was extubated 4 hours ago and complains of increasing shortness of breath. Breath sounds are decreased over the right lung field. Wh at should be recommended NEXT? | chest radiograph
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| Patient is diaphoretic and has a pulse of 120 and an SpO2 of 81% with a 28% tracheostomy collar. The therapist is unable to pass a suction catheter. Which of the following should the therapist do FIRST? | Replace the tracheostomy tube.
Unable to pass catheter is the key phrase here. Obstructed tube.
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| A decreasing cardiac output will result in | increasing oxygen extraction and an increased C(a-v̄)O2.
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| A previously healthy 30-year-old patient is hospitalized with chills and fever. A chest radiograph is consistent with right upper lobe pneumonia. What is most likely to aid in the patient's management? | Coughing and deep breathing
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| the most appropriate device to administer a controlled oxygen concentration for a patient with a variable respiratory pattern? | Venti Mask
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| Decreasing the peak pressure should result in a decreased | tidal volume and minute ventilation
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| most effective for destroying microorganisms on patient care equipment? | Autoclave
Autoclaving uses super-heated steam under pressure and will kill almost all microorganisms.
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| There is no response to bronchodilator therapy. In this instance, in evaluation of a patient who is short of breath, further _____ is required | Further Lunch Measurments
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| the purpose of incentive spirometry after abdominal surgery | Prevent lung collapse
The goals of incentive spirometry are to prevent and treat postoperative atelectasis
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| Capnography waveforms resembling shark fins indicates | Airway Obstruction
The lack of a plateau and upward sloping shape of the curves demonstrate unequal distribution of inspired gas associated with obstruction
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| A patient with asthma is receiving a treatment with 2.5 mg of albuterol. During the treatment, the patient's heart rate increases from 80 to 138. A respiratory therapist should | Decrease dosage of albuterol
as HR increase is likely secondarily related
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| After extubation, marked stridor, labored breathing, intercostal retractions, and an SpO2 of 85% is observed. Aerosolized racemic epinephrine has been delivered without benefit. Which of the following should the therapist recommend | reintubation
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| VT x RR = | Minute Ventilation
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| A patient who is receiving mechanical ventilation is scheduled for a fiberoptic bronchoscopy. Which of the following is the primary threat to adequate ventilation during the procedure? | Airway obstruction
Scope may obstruct the tube
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| While administering an IPV treatment at 20 cm H2O to a patient with cystic fibrosis, a respiratory therapist notes the patient has suddenly become very short of breath and cyanotic. The therapist's most appropriate action is to | Terminate the therapy
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| There is no indication for NPPV for a patient in a | Compensated Respiratory Acidosis
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| While counseling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the patient's concern by explaining that this is partially the result of | Decreased Metabolism
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| An elevated pulmonary capillary wedge pressure is an indicator of | Left heart failure caused by edema
treat with diuretics
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| Normal (PCWP) Pulm Cap Wedge Pressure | 12 to 16
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| Where is the radial artery located | The Wrist
"rad wrist"
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| Where is the brachial artery located | Inside arm
"Brach your arm"
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| The right radial artery should not be punctured when there is insufficient collateral circulation through the | ulnar artery
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| side effect of inhaled nitric oxide | methemoglobinemia
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| the maximum flow during a forced exhalation. | Peak Flow
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| "Bird-beak" patterns are a result of hyperinflation. Decreasing what, will decrease the tidal volume and correct the hyperinflation | Inspiratory also known as Peak pressure
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| The best way to check the accuracy of a spirometer is to use a | 3mL syringe
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| A wait of a few minutes should be expected after application of a transcutaneous electrode before values stabilize. This is associated with | capillary dilatation
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| For a patient receiving noninvasive ventilation through a dual-limb circuit, an increase in what, will most likely reduce the respiratory effort associated with spontaneous breathing? | Pressure Support
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| Pv̄O2 values below this number are too low and related to the need for cardiac output measurement | 35
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| Medication used to treat apneic conditions and indicates the need for home apnea monitoring in infants | caffeine citrate daily
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| most common side effect of aerosolized albuterol | Tremor
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| Critical infection control step in the home setting | handwashing
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| The treatment for carbon monoxide poisoning is high concentration of oxygen (close as possible to 100%) administered with | nonrebreather mask
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| The most commonly used bedside measurement to monitor the progression of ventilatory impairment in a patient with Guillain-Barré syndrome is | vital capacity
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| A patient complains of a productive cough that started approximately four months ago. The patient most likely has | bronchitis
Bronchitis is characterized by cough and sputum production. While pneumonia is similar it is often not chronic.
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| able to directly measure various forms of hemoglobin saturation, including oxyhemoglobin, carboxyhemoglobin, and methemoglobin | hemoximeter
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| Based on an oxyhemoglobin disassociation curve, an SpO2 of 90% with a normal pH is approximately a PaO2 of | 60
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| A patient is suspected of having an upper airway obstruction. Which test should a respiratory therapist recommend to detect this abnormality | flow volume loop
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| While testing the proper function of a flow-inflating bag, the bag does not fully inflate with occlusion of the patient connector. Which of the following may be the cause of the problem? | open flow control valve
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| Three liters of air are injected into a spirometer from a certified-volume standard syringe. The measured value is 2.6 L. Which of the following should a respiratory therapist conclude? | Leak
Difference of 400mL in this instance indicating outside acceptable calibration range
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| History of nasal stuffiness, episodes of daytime dyspnea, and a cough that occurs every summer. Which of the following drug classifications should a respiratory therapist recommend to control the patient's symptoms? | leukotriene inhibitor like montelukast known as Singulair
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| Low PCWP and CVP coupled with a low urine output is characteristic of | Hypovolemia
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| The patient is exhibiting refractory wheezing., diminished breath sounds after the multiple treatments, indicating worsening obstruction, what should be done | increased dosage continuous nebulized bronchodilator therapy
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| The flow-volume loop obtained after bronchodilator administration demonstrates a significant improvement in expiratory flow. What should be recommended? | inhaled bronchodilator therapy
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| A patient was diagnosed with bronchiectasis 3 years ago. The patient reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows cavitary disease. What is recommended? | airway clearance therapy
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| At the beginning of exhalation, the sharp rise in exhaled CO2 on a capnographic tracing represents | washout of dead space
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| A fast-acting beta2-agonist is the appropriate treatment for | acute bronchospasm
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| Which of the following is the most effective aerosolized bronchodilator for a patient with an acute asthma exacerbation | albuterol
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| mechanically ventilated patient developed auto-PEEP. What ventilator settings change should take place | Decrease the rate
thereby increasing the expiratory time which in turn decreases air trapping
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| Static Compliance formula | Vt / PEEP (Pplat - PEEP)
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| severe obstructive lung disease is characterized by an FEV1/FVC less than | 70% predicted
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| severe obstructive lung disease is characterized by an FEV1/FVC less than 70% and an FEV1 of | 30 to 50% predicted
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| If a patient becomes tachycardic during albuterol treatment, what drug should be recommended next treatment? | Levalbuterol Xopenex
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| What medication should be used to anesthetize a patient's airway prior to a flexible bronchoscopy procedure? | lidocaine HCl Xylocaine
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| Ventilated pt. has a steady increase in the peak inspiratory pressure over a 12-hour shift. The patient has developed a fever and purulent pulmonary secretions. Which of the following should a respiratory therapist recommend FIRST? | Obtain a sputum Gram stain
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| SBT with a T-piece have been initiated for 4 weeks. With each trial, the patient becomes agitated, dyspneic, and tachypneic, and must be returned to the ventilator. Which of the following should the respiratory therapist recommend? | Pressure Support
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| A premature neonate with RDS receives the first dose of surfactant replacement therapy. Two hours later, FIO2 requirements have increased from 0.35 to 0.70. Which of the following should a respiratory therapist recommend FIRST? | chest radiograph
Increase in O2 requirements and the recent administration of surfactant, chest radiograph will help determine the cause of deterioration.
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| Which of the following should be recommended to determine the site of bleeding in a patient with hemoptysis? | bronchoscopy
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| Monitoring serum electrolytes is indicated in patients who are receiving | diuretics
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| For a spontaneously breathing patient, which of the following will provide an elevated baseline pressure during inspiration and expiration? | CPAP
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| After obtaining an arterial blood gas sample, a respiratory therapist should handle the sample by | removing all air from the syringe
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| A gas is saturated with 100% relative humidity at 32.2º C (90º F). As the gas cools to 26.7º C (80º F), the relative humidity will | remain 100% and excess water will rain out
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| Administering dornase alfa Pulmozyme, a patient is developing marked congestion with copious sputum production. The most appropriate action is to pause the treatment and | allow the patient to clear secretions
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| HR 142, RR 24 and BP 78/55 mm Hg. Examining the patient's chest, a respiratory therapist notes an absence of breath sounds in the left chest with a hyperresonant percussion note. What should be done? | Insert a 14-gauge needle in the left chest
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| Hypotension is an adverse effect of | PEEP
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| An increase in the difference between PIP - plateau pressure is | indicative of increased airways resistance
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| During nasotracheal suctioning, a patient exhibits a gag reflex but does not cough. Watery secretions are aspirated through the catheter. Which of the following should a respiratory therapist do before repeating the procedure? | Sniffing position
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| What score is used to determine a neonate's gestational age? | Ballard
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| A respiratory therapist is calibrating a helium analyzer. What should the analyzer read when calibrated in air? | Air contains essentially no helium; therefore, it should read zero
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| What drug is appropriate for the sedation of a 30-year-old patient with status asthmaticus and hypotension who is receiving mechanical ventilation? | lorazepam Ativan
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| The standard frequency for dosing of inhaled tiotropium (Spiriva) is every | 24hrs
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| A right-sided pneumothorax will result in diminished breath sounds on the right and possibly a tracheal shift to the | left
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| Total flow = | air to oxygen entrainment factor X set liter flow to the device
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| A respiratory therapist is asked to position a patient for orotracheal intubation. The therapist should place the patient's head | in the sniffing position
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| Changes in the level of the bed relative to the transducer will make both systolic and diastolic pressures move | same direction
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| drug is most appropriate to paralyze a sedated patient in status asthmaticus who is receiving mechanical ventilation | rocuronium bromide Zemuron
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| What should be done for patient with facial burns, oropharynx edema indicating upper airway burns and the potential for worsening edema and airway obstruction | Intubation
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| Moderate stridor with retractions is noted immediately after extubation of a patient. A respiratory therapist should recommend | nebulized racemic epinephrine
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| Peak expiratory flow measurements are indicated for the measurement of | airways obstruction and asthma
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| A patient's VQ scan indicates an excess of ventilation compared to perfusion in the left lower lobe. These results suggest | pulmonary embolism
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| What classically presents as alveolar unit is normally ventilated, but pulmonary capillary blood flow is impeded causing poor perfusion | pulmonary embolism
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| characteristic during VC ventilation? | Inspiration ends after delivery of a preset volume
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