NBRC TMC Exam A

A respiratory therapist is assisting a physician with endotracheal intubation. Which of the following should be used INITIALLY to confirm tracheal intubation?

A. cm marking of the endotracheal tube

B. observable condensation in the tube

C. pulse oximetry

D. colorimetric capnography

D. colorimetric capnography

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

Reflex cough cough

Muscle tone weak active motion

Respiratory rate 20/min 40/min

Which of the following APGAR scores should the therapist expect to see for this infant?

1-minute 5-minute

1. 4 8

2. 5 8

3. 6 10

4. 7 10

D. 4

A 58-year-old female was diagnosed with bronchiectasis 3 years ago. She reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows no significant changes. Which of the following should the respiratory therapist recommend FIRST?

A. transtracheal aspiration

B. airway clearance therapy

C. bronchodilator treatments

D. respiratory isolation

B. airway clearance therapy

A 24-year-old female is diagnosed with exercise-induced asthma and albuterol prn is ordered. A respiratory therapist should NEXT

A. refer the patient for allergy skin testing.

B. educate the patient on obtaining daily peak flow measurements. C. instruct the patient to use albuterol 15 minutes before exercising. D. suggest the patient use pursed lip breathing while exercising.

C. instruct the patient to use albuterol 15 minutes before exercising.

Patient understanding of their disease process and triggers is important part of patient education, as well as knowing when and which medication should be taken. In which of the following circumstances will tracheal secretions tend to dry in an intubated patient?

A. a water vapor pressure of 47 mm Hg

B. a relative humidity of 100% at 22°

C (71.6° F) C. a dew point of 37° C (98.6° F)

D. an absolute humidity of 44 mg/L

B. a relative humidity of 100% at 22°

Prior to suctioning the endotracheal tube of an adult patient who is receiving ventilation with an FIO2 of 0.40, a respiratory therapist should FIRST

A. lubricate the catheter.

B. hyperoxygenate the patient.

C. cleanse the catheter with water.

D. administer an FIO2 of 0.40 by T-piece

B. hyperoxygenate the patient

A 25-year-old patient with apnea is receiving PC ventilation. ABG analysis results are as follows:

pH 7.20 PCO2 65 mm Hg

PO2 70 mm Hg

HO3 25 mEq/L

BE -4 mEq/L

SO2 (calc) 94%

A respiratory therapist should recommend increasing the

A. set inspiratory pressure.

B. expiratory time.

C. sensitivity.

D. peak flow.

A. set inspiratory pressure.

A 68-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. The following data are available while the patient receives 4-L oxygen by nasal cannula:

HR 103/min RR 27/min BP 155/90 mm Hg SpO2 90%

Which of the following studies should a respiratory therapist recommend FIRST?

A. bedside spirometry

B. chest CT with contrast

C. ventilation/perfusion scan

D. chest radiograph

D. chest radiograph

Which of the following medications should a respiratory therapist use to anesthetize a patient's airway prior to a flexible bronchoscopy procedure?

A. lidocaine HCl

B. midazolam HCl (Versed)

C. ketamine (Ketalar)

D. vecuronium bromide (Norcuron)

A. lidocaine HCl

A respiratory therapist is evaluating a 75-kg (165-lb), 180-cm (5-ft 11-in) male who is receiving

VC, SIMV. The following patient data are obtained:

FIO2 0.40

Mandatory rate 8 Total rate 8

VT 550 mL

PEEP 8 cm H2O

pH 7.27

PaCO2 55 mm Hg

PaO2 94 mm Hg

HCO3 - 25 mEq/L

BE -3 mEq/L

SaO2 (calc) 97%

Which of the following should the therapist recommend?

A. Maintain current settings.

B. Increase the mandatory rate to 12.

C. Decrease the FIO2 to 0.30.

D. Decrease the tidal volume to 450 mL.

B. Increase the mandatory rate to 12.

A 63-year-old patient with COPD is seen in the pulmonary clinic for a routine appointment. The analysis results of an ABG sample drawn while the patient is breathing air are:

pH 7.40

PCO2 57 mm Hg

PO2 42 mm Hg

HCO3 - 35 mEq/L

BE +8 mEq/L

SO2 (calc) 77%

Which of the following is the most appropriate NEXT step?

A. Schedule polysomnography.

B. Initiate supplemental oxygen.

C. Perform a 6-minute walk test.

D. Coach on deep breathing.

B. Initiate supplemental oxygen.

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

B. 2, 3, and 4 only

C. 1, 2, and 4 only

D. 1, 3, and 4 only

A. 1, 2, and 3 only

A patient receiving mechanical ventilation by a portable ventilator is being transported from the ED to radiology. Which of the following is required during transport?

A. bag-valve mask resuscitator

B. point-of-care blood gas analyzer

C. demand valve respirator

D. crash cart

A. bag-valve mask resuscitator

Mechanical ventilation was initiated for a patient, after which the PaCO2 decreased from 53 to 40 mm Hg. A respiratory therapist should expect which of the following will increase?

A. HCO3 -

B. pH

C. PETCO2

D. VD/VT

B. pH

According to CLIA standards, quality control must be performed for blood gas analyzers every

A. 8 hours.

B. 48 hours.

C. 72 hours.

D. 24 hours.

A. 8 hours.

While performing a patient-ventilator assessment, a respiratory therapist observes very little condensation in the heated wire circuit. The reservoir of the heated wick humidifier 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 set at too low of a value.

D. room temperature is lower than normal.

B. patient circuit is operating

normally.

Which of the following devices must be used to comply with airborne precautions?

A. N95 face mask

B. vinyl gloves

C. barrier gown

D. full face shield

A. N95 face mask

Which of the following imaging techniques is preferred when identifying metastatic disease associated with non-small cell lung cancer?

A. PET scan

B. chest radiograph

C. ultrasound

D. ventilation scan

A. PET scan

A patient has been receiving mechanical ventilation through a tracheostomy tube for 16 days. The patient begins to thrash about in the bed following withdrawal of a druginduced coma. The patient's tracheostomy tube has become dislodged. After the patient is pharmacologically sedated, a respiratory therapist should NEXT

A. obtain an ABG sample.

B. perform nasal intubation.

C. reinsert the tracheostomy tube.

D. initiate oxygen therapy.

C. reinsert the tracheostomy tube.

Following a bariatric surgery procedure 2 days ago, a patient with a PBW of 55 kg (121 lb) remains hospitalized with signs of sepsis. The patient is intubated and receiving VC, A/C ventilation with the following settings:

FIO2 0.50

Mandatory rate 18/min

VT 350 mL

PEEP 12 cm H2O

After returning from radiology, the patient's

peak inspiratory pressure is 45 cm H2O and

plateau pressure is 35 cm H2O.

ABG analysis reveals:

pH 7.39

PCO2 38 mm Hg

PO2 49 mm Hg

HCO3 - 23 mEq/L

BE -2 mEq/L

SO2 (calc) 84%

A respiratory therapist should recommend

A. increasing the mandatory rate.

B. decreasing the tidal volume.

C. inline bronchodilator therapy.

D. a lung recruitment maneuver.

D. a lung recruitment maneuver.