TMC Short Set

What instructions should be given to a patient when conducting a bedside PFT? A. "Take as deep a breath in as possible and forcefully blow out all of the air." B. "Take a deep breath in and hold it." C. "Attempt to inhale as forcefully as possible against a closed system." D. "Breath in slowly from a resting exhalation as deeply as possible"

The correct answer is : A Explanation : A bedside pulmonary function test (PFT) may include primarily FVC, SVC, PEFR and MVV. Of the possible choices only "take as deep a breath in as possible & forcefully blow out all of the air" would apply (FVC).

A Bronchogram would be most helpful in evaluating and diagnosing which of the following? A. bronchiectasis B. chronic bronchitis C. mycoplasma pneumonia D. ARDS

The correct answer is : A Explanation : A bronchogram is a procedure used to diagnose bronchiectasis - not helpful for Mycoplasma pneumonia, chronic bronchitis, or adult respiratory distress syndrome.

A patient has a fenestrated tracheostomy tube configured to allow speech. In preparation for a positive pressure breathing treatment, the respiratory therapist should do which of the following? A. remove the cap, inflate the cuff, insert the inner cannula B. remove the inner cannula, deflate the cuff, place the cap C. remove the cap, deflate the cuff and replace the inner cannula D. inflate the cuff, insert the inner cannula, remove the cap

The correct answer is : A Explanation : A fenestrated tracheostomy tube has two potential configurations. The first configuration allows the patient to speak. The second configuration allows the patient to receive positive pressure ventilation. When transitioning from a speaking configuration to a positive pressure ventilation configuration, several things must be done in the right order to ensure the patient can breathe through the change. In this case, the first step is to remove the cap, then inflate the cuff, and finally, insert the inner cannula. Doing this in any different order could present a time where the patient is unable to breathe freely.

A patient with a high PAP and a low PCWP has reduced blood flow in the A. lungs. B. left heart. C. kidneys. D. right heart.

The correct answer is : A Explanation : A high PAP followed by a low or normal PCWP suggests that blood is having difficulty flowing through the pulmonary vasculature. Therefore, the most likely problem is in the lungs.

The measurement of a patient's FRC is 50% higher when measured by body box compared to the results when measured by helium dilution method. Which of the following is the likely reason for the difference in this patient? A. increased non-ventilated lung space B. presence or choanale atresia C. small leak during the helium dilution maneuver D. poor patient effort during the helium dilution

The correct answer is : A Explanation : A patient with COPD has significant non-ventilated lung space. The measurement of total lung capacity, FRC, and RV done by helium dilution and nitrogen washout will likely be less accurate and show a smaller FRC compared to pulmonary function testing done by a body box. A body box can indirectly measure non-ventilated alveolar space.

A patient with adult respiratory distress syndrome is receiving mechanical ventilation with a pressure-cycled ventilator. Which of the following alarms is most important? A. low-volume alarm B. I:E ratio alarm C. low pressure alarm D. high pressure alarm

The correct answer is : A Explanation : A pressure-cycled ventilator delivers a breath at a specific set pressure in spite of the volume achieved. The machines focuses on pressure without regard to delivered volume. Therefore, the respiratory therapist should be focused on volume. The most important alarm on a pressure-cycled ventilator is a low return volume alarm.

Which of the following should be monitored for a ventilator-dependent newborn with IRDS? A. fluid input and output B. gas distribution (SBN2) in the lungs C. urine specific gravity D. pH

The correct answer is : A Explanation : All choices are indicated while monitoring a critically ill neonate receiving mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the artificial airway are also essential.

A patient undergoing pulmonary function testing in a body box has an airway resistance (Raw) of 2.7 cm H2O/L/sec. The respiratory therapist should provide which of the following interpretations? A. asthma B. normal results C. restrictive pulmonary disease D. Guillain-Barre Syndrome

The correct answer is : A Explanation : An airway resistance of 2.7 cmH2O/L/sec is considered high. Elevated airway resistance is associated with asthma.

A respiratory therapist is attempting to sterilize a non-disposable IPPB circuit from a patient who has confirmed active tuberculosis. The sterilizing material is acid gluteralderhyde (Sonacide). For how long must the therapist soak the circuit to achieve sterilization? A. 10 hours B. 20 minutes C. unable to achieve sterilization with this chemical D. 10 minutes

The correct answer is : A Explanation : Sterilization may be achieved with acid glutaraldehyde by soaking equipment for a minimum of 10 hours in the solution.

A respiratory therapist is monitoring the volume of gas a patient can inhale after a passive exhalation of tidal volume. The therapist is attempting to observe which of the following? A. inspiratory capacity B. vital capacity C. total lung capacity D. inspiratory reserve volume

The correct answer is : A Explanation : The volume achieved when the patient inhales maximally after a passive exhalation of tidal volume is called inspiratory capacity. Comparatively, the maximum volume inhaled after complete active exhalation is called vital capacity.

A respiratory therapist is measuring the gas volume from a patient who exhales maximally after inhaling to inspiratory reserve volume. Which of the following volumes is the respiratory therapist attempting to observe? A. vital capacity B. inspiratory reserve volume C. expiratory reserve volume D. total lung capacity

The correct answer is : A Explanation : The volume exhaled maximally after a maximum inhalation is called vital capacity.

Which of the following is required to determine RAW in a spontaneously breathing ambulatory patient? A. plethysmograph B. helium analyzer C. nitrogen analyzer D. galvanic oxygen analyzer

The correct answer is : A Explanation : To determine airway resistance, otherwise known as RAW, a body box is needed. Another name for a body box is a plethysmogaph.

A patient admitted to the hospital for pneumonia is receiving oxygen therapy by transtracheal catheter. Twenty minutes after the completion of a meal, the patient complains of shortness of breath and expresses the device is not working properly. The respiratory therapist should first A. initiate oxygen by air-entrainment mask B. apply suction to the catheter C. increase the oxygen flow rate to the catheter D. remove the catheter

The correct answer is : A Explanation : When a problem is encountered with one oxygen delivery modality, the first best response is to initiate oxygen therapy with a different modality and then troubleshoot the problem.

A patient is on 70%/30% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? A. 16 L/min B. 5 L/min C. 8 L/min D. 18 L/min

The correct answer is : A Explanation : When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentage. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 70/30% mixture factor of 1.6 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 16 L/min.

A pulmonary function study reveals a forced vital capacity (FVC) that is greater than a slow vital capacity (SVC). To which of the following can this be attributed? A. poor patient effort on the SVC maneuver B. chronic air-trapping C. partial diaphragmatic paralysis D. excessive effort on the FVC maneuver

The correct answer is : A Explanation : When the patient exhales slowly they are able to breathe out more air than if they were to exhale quickly. For this reason, and FVC should always be less than an SVC. If FVC is noted to be higher than the SVC, this is clear evidence that the patient's effort during the SVC maneuver was poor or insufficient.

A patient is experiencing shortness of breath. The radiological AP view of the chest shows a blunt costophrenic angle in the left lower lobe. This would indicate A. atelectasis. B. pleural effusion. C. pneumonia. D. pulmonary embolus.

The correct answer is : B Explanation : A chest X-ray reveals a pleural effusion if we see descriptors such as "blunt or obliterated costophrenic angles", or "concave superior interface".

A patient has a fenestrated tracheostomy tube in place. To prepare the patient for speech therapy, the therapist should do which of the following prior to placing a cap on the tracheostomy tube? A. insert the inner cannula B. ensure the cuff is deflated C. insert the obturator D. ensure cuff seal with minimum leak technique

The correct answer is : B Explanation : A fenestrated tracheostomy tube is capable of two different configurations. One configuration allows the patient to speak through a hole in the outer cannula of the tube. However, when the inner cannula is in place and the cuff is inflated, the tube may be used for positive pressure breathing. When changing from one configuration to another, several steps must be taken. Those steps include removing the inner cannula, deflating the cuff, and installing a tracheal button. This will allow the redirection of airflow over the vocal folds which are required for speech.

Which of the following should be monitored for a patient diagnosed with Guillain-Barre Syndrome who is breathing spontaneously? A. MVV, FEF200-1200 B. VC, VT, MIP C. PaO2, P50, Fev1 D. MEP, SVC, Fev1/FVC%

The correct answer is : B Explanation : A patient with Guillain-Barré has muscular paralysis that prevents ventilation. As ventilation slowly degrades, the patient should be monitored for the point that he or she can no longer sustain life. Parameters should be monitored, include vital capacity, maximum inspiratory pressure, and tidal volume.

For which of the following is the respiratory therapist evaluating if examining phase IV of a single-breath nitrogen test (SBN2)? A. Evenness of gas distribution B. Closing volume C. Pure deadspace gases D. Mixed deadspace and alveolar gases

The correct answer is : B Explanation : A single-breath nitrogen elimination test (SBN2) is used to determine the adequacy of distribution of gases and the evenness of that distribution. A patient breathes out a single breath and the nitrogen is analyzed in four phases. The first phase is pure dead space. The second phase is a mixture of dead space and alveolar gas. The third phase represents pure alveolar gas and is the stage where gas distribution is truly assessed. Phase 4 is called closing volume.

A patient is receiving volume-controlled ventilation in the assist/control mode. The respiratory therapist discovers that autoPEEP is increasing and that the patient is not completing exhalation before the inspiratory phase starts. Which of the following adjustments to the ventilator is most appropriate? A. Decrease mechanical deadspace B. Increase flow C. Add expiratory retard D. Decrease the mandatory rate

The correct answer is : B Explanation : AutoPEEP occurs when the patient fails to exhale all gases before the next mechanical breath begins. This promotes air-trapping and will expand the alveoli and result in many other negative effects that are associated with positive pressure ventilation. AutoPEEP can be corrected by allowing more time for exhalation. This can be accomplished by increasing inspiratory flow and decreasing inspiratory time. Additionally, AutoPEEP may be decreased by decreasing mandatory rate, but this is not a appropriate as increasing the flow because it will result in a shift in minute ventilation and may adjust PaCO2 negatively.

A respiratory therapist has provided Albuterol treatments via SVN to a patient in the emergency room for shortness of breath. The patient now has bleeding gums and epistaxis. What should the physician check? A. sinus X-ray B. allergic response to Albuterol C. arterial blood gas D. prothrombin time

The correct answer is : B Explanation : Bleeding from the mouth, nose, or gums is a rare but serious symptom of an allergic response to albuterol.

Which of the following can be used to determine fetal lung maturity A. Blood glucose B. PC level (phosphatydlchloride) C. Glasgow D. APAGAR

The correct answer is : B Explanation : Blood glucose is not helpful in assessing infant pulmonary maturity.

A 70-kg (154-lb) female patient is receiving mechanical ventilation on the following settings: Mode: assist/control Mandatory rate 14 Total rate 14 VT 500 mL FIO2 0.55 PEEP 12 cmH2O Arterial blood gases reveal pH 7.49 PaCO2 32 mmHg PaO2 109 mmHg HCO3- 24 mEq/L The respiratory therapist should A. increase mandatory rate B. decrease PEEP C. decrease mandatory rate D. decrease FIO2

The correct answer is : B Explanation : In this question there are two problems. The patient is over oxygenating AND hyperventilating. Over oxygenation should be addressed before hyperventilation. To address over-oxygenation one can either change the PEEP or the FIO2. You will always want to lower the FIO2 below 60% before changing PEEP. In this problem FIO2 is already below 60%. Therefore PEEP can be decreased. This is the best answer.

Which of the following calculations can be used to determine FRC? A. RV + ERV + VT B. TLC - IRV - VT C. TLC - ERV - RV D. VC - RV

The correct answer is : B Explanation : One must be familiar with all of the components of total lung capacity in order to answer this question. This kind of question can be time consuming because the calculation possibilities are limitless. To answer this type of question, one must simply calculate each answer until the correct calculation is found. In this case, FRC can be determined by subtracting inspiratory reserve volume (IRV) and tidal volume (VT) from total lung capacity (TLC). It is a good idea to memorize the chart of components that make up total lung capacity.

The physician orders oxygen for a 1-day-old neonate by hood with the use of an oxygen blender connected to a heated large-volume nebulizer set at 100%. The reason for this setup is primarily A. noise management for the nursery. B. noise management for the baby. C. FIO2 management. D. temperature control.

The correct answer is : B Explanation : Powering the hood with a blender permits the respiratory therapist to control the FIO2 without opening the air-entrainment port of a large-volume nebulizer, which drastically reduces the sound associated with delivering humidified oxygen to the infant. A baby may become very restless due to constant loud noise if receiving oxygen from a large-volume nebulizer directly with the air-entrainment port opened.

A 28-week gestational age infant is requiring high ventilatory pressures on the ventilator. Transillumination shows a halo-effect bilaterally. A recent chest radiogram shows a honeycomb pattern. Which of the following mostly likely represents the patient's condition? A. Patent ductus arteriosis B. IRDS C. Transposition of the great vessels D. Diaphragmatic hernia

The correct answer is : B Explanation : The honeycomb pattern seen on an infant's chest x-ray, in addition to the fact that the infant is premature, is an indication of underdeveloped lungs. The term for this condition is called infant respiratory distress syndrome or IRDS. Transillumination that shows a halo effect bilaterally is an indication that a pneumothorax is not present.

A patient who is being mechanically ventilated in the intensive care unit had a complete pulmonary function test one-month prior. SVC was 75% of predicted. FRC was 70% of predicted. The patient is now experiencing an increase in A-a gradient. The use of mechanical PEEP in this patient would A. decrease oxygenation. B. increase FRC. C. decrease MAP. D. not affect lung capacities.

The correct answer is : B Explanation : The use of mechanical PEEP would increase functional residual capacity (FRC).

A respiratory therapist is having difficulty effectively removing secretions through endotracheal suctioning of a 7-year-old child with cystic fibrosis. The ET tube size is 6.0-mm. The suction pressures is set at 75 mmHg and the suction catheter size is an 8 Fr. The therapist should do which of the following to increase the efficacy of suctioning? A. instill 20 cc of normal saline prior to each suction attempt B. increase suction pressure to 80 mmHg C. increase suction during per pass D. increase catheter size to 10 Fr

The correct answer is : B Explanation : There are three ways to increase suction efficiency. In order: 1) increase suction catheter size 2) increase suction pressure 3) increase suction time. However, prior to any of these three one must first ensure adequate minimal pressure for the patient's age is being used. This is a pediatric patient and suction pressure range should be between 80 and 100 mmHg. However, the suction pressure is only set at 75 mmHg. So, this should be corrected first before considering any other action to improve suction efficiency.

A patient with tuberculosis had a bronchoscopy procedure. To properly clean the bronchoscope, the equipment must be soaked in Cidex (Alkaline Gluteraldehyde) for a minimum of how many minutes? A. 1 hour B. 20 minutes C. 10 minutes D. 12 hours

The correct answer is : B Explanation : This is an infection control problem and is really a memorization of how long it takes to kill the tubercle bacilli. Minimum time is 20 min.

Which of the following values are required to determine a patient's inspiratory capacity (IC)? A. VC and RV B. VT and IRV C. ERV and IRV D. RV and ERV

The correct answer is : B Explanation : To answer this question, one must look at every option and mentally determine if the desired result can be reached. In this case, tidal volume can be added to inspiratory reserve volume (VT + IRV) to achieve inspiratory capacity (IC).

Which of the following best describes the maneuver most suited to evaluate a patient's vocal cord paralysis? A. pant for 6-8 seconds followed by a maximum inhalation and hold B. maximum inhalation followed by a complete exhalation followed by maximum inhalation C. maximum inhalation with a 3-5 second breath hold, followed by a quick exhalation D. maximum inhalation followed by maximum exhalation, repeated for 12-15 seconds

The correct answer is : B Explanation : Vocal cord paralysis and other causes of upper airway obstruction is best diagnosed through a pulmonary function test, specifically a flow-volume loop. The answer that most closely resembles a flow-volume loop is "maximum inhalation followed by complete exultation followed by maximum inhalation". These are the actual instructions given to the patient for the maneuver.

Which of the following would result in an increase in CVP? A. hypokalemia B. hypervolemia C. increased SVR D. decreased PVR

The correct answer is : B Explanation : When the body retains fluid all hemodynamic values are increased especially CVP. By itself a high CVP most likely indicates fluid retention and hypervolemia.

Administration of a 60/40% helium-oxygen mixture requires which of the following masks? A. air-entrainment B. face tent C. nonrebreather D. aerosol

The correct answer is : C Explanation : Because helium oxygen therapy consists of administration of predetermined mixtures of gases, additional air-entrainment is not desirable. Therefore, use of a nonrebreather mask is most appropriate.

A patient is receiving continuous oxygen by transtracheal catheter with a flow rate of 1 L/min. The patient complains that he is not getting enough air. Which of the following is most appropriate? A. remove the catheter B. place the patient on a nasal cannula at 1 L/min C. place the patient on a nasal cannula at 2 L/min D. flush the catheter with saline

The correct answer is : C Explanation : Before troubleshooting the transtracheal oxygen catheter is appropriate to switch the patient to a more reliable oxygen source. When switching from a transtracheal oxygen catheter to a nasal cannula, the flowrate should be doubled. This will approximate the FIO2 achieved by the transtracheal catheter.

Which of the following pulmonary function volume calculations may be used to determine functional residual capacity (FRC)? A. ERV-RV B. VC - ERV C. TLC - IC D. VT + ERV + RV

The correct answer is : C Explanation : FRC may be calculated in a variety of ways by adding and subtracting specific lung volumes. To answer this question, one must take each option and do the calculation to determine if the desired volume can be achieved. In this case, FRC may be calculated by subtracting inspiratory capacity (IC) from total lung capacity (TLC).

Hypovolemia would first be manifested in which of the following values? A. PVR B. PCWP C. CVP D. PAP

The correct answer is : C Explanation : Hypovolemia is shown hemodynamically by a reduction in all hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP is the first and most significant indicator when fluid levels in the body are high or low. Remember, CVP may be known by other names such as, right atrial pressure, right side preload, right ventricular filling pressure, and right ventricular end-diastolic pressure.

Which of the following would best decrease the work of breathing for a spontaneously breathing patient with a fixed upper airway obstruction? A. bi-level therapy B. nitric oxide C. mechanical ventilation with pressure support D. heliox therapy

The correct answer is : D Explanation : A patient with fixed upper airway obstruction has significant airway resistance. This may be overcome through Heliox therapy. Helium is less viscous than nitrogen and therefore when combined with oxygen, is easier to breathe.

Which of the following flowrates represents the minumum flow rate for a patient on volume-cycled mechanical ventilation with the following settings? VE 10.0 L/min Rate 12 I:E 1:3 Flow waveform square FIO2 0.50 PEEP 8 cm H2O A. 50 L/min B. 30 L/min C. 40 L/min D. 60 L/min

The correct answer is : C Explanation : Minimum flow rate on a ventilator is determined by the following formula: (I+E) x minute ventilation. In this case, (1 + 3) = 4. Minute ventilation = 10 L. Minimum flow = 4 x 10 L = 40 L. Of the options offered, 40 L/min, 45 L/min, and 50 L/min will exceed the inspiratory demand of the patient.

An end-expiratory chest radiograph is best used to assess for which of the following? A. overall pulmonary aeration B. diaphragmatic hernia C. small pneumothorax D. pulmonary vascular disease

The correct answer is : C Explanation : Normally, we prefer to observe a chest x-ray at full inhalation. However, an end-expiratory chest radiograph is helpful at identifying a small pneumothorax.

Which of the following hemodynamic values is associated with the function of the left heart? A. mean pulmonary artery pressure B. central venous pressure C. pulmonary capillary wedge pressure D. systemic vascular resistance

The correct answer is : C Explanation : Of the four hemodynamic pressures, pulmonary capillary wedge pressure is most related to the function of the left heart. Central venous pressure is most related to the right heart and the general fluid status of the patient.

Which of the following calculations can be used to determine TLC? A. RV + ERV + VT B. RV + ERV + VT + IC C. IC + FRC D. FRC + VT + IC

The correct answer is : C Explanation : One must be familiar with all of the components of total lung capacity in order to answer this question. This kind of question can be time consuming because the calculation possibilities are limitless. To answer this type of question, one must simply calculate each answer until the correct calculation is found.

Which of the following can be done to most effectively increase the efficiency of suctioning through an endotracheal tube? A. increase suction time B. increase suction pressure C. increase suction catheter diameter (size) D. apply intermittent suction pressure during withdrawal of the catheter

The correct answer is : C Explanation : The proper way to increase suctioning effectiveness to an endotracheal tube is to first increase suction catheter size or diameter followed by increasing suction pressure and then increasing suction time. Therefore, the best answer is to increase the suction catheter diameter or size.

A chest radiograph on an adult indicates a concave superior boarder. This finding is most closely associated with which of the following? A. lobular pneumonia B. complete pneumothorax C. pleural effusion D. pulmonary edema

The correct answer is : C Explanation : The radiological description of a chest x-ray that indicates the presence of a "concave superior border", sometimes called a "superior border interface", is most closely associated with a pleural effusion.

Which of the following would suggest that ventilation liberation should not be attempted? A. VC of 10 mL/kg B. MIP -31 cmH2O C. VD/VT ratio > 60% D. spontaneous Vt of 6 mL/kg

The correct answer is : C Explanation : To be a candidate for ventilator weaning, deadspace-tidal volume ratio must be less than 60% while on the ventilator.

The respiratory therapist reviews the results of a patient diagnosed with mixed restrictive and obstructive pulmonary defects. Which of the following data is NOT associated with this diagnosis? A. FEF 200-1200 of 74% of predicted B. FEV1 of 75% of predicted C. FEV1/FVC% of 78% D. SVC of 68% of predicted

The correct answer is : C Explanation : To be considered restrictive, the patient must have a slow file capacity or forced vital capacity of less than 80% of predicted. To be considered obstructive a patient must have an FEV1 of less than 80% of predicted or an FEV1/FVC% of less than 75%

A patient is receiving volume-controlled ventilation after a myocardial infarction where significant cardiac injury was sustained. The patient's SVO2 is being monitored as well as several hemodynamic indicators such as cardiac index, mPAP, CVP, and PCWP. While observing the pulmonary artery catheter waveform, the therapist notices the waveform shows a systolic pressure of 24 mmHg and a diastolic pressure of 7 mmHg. Based on this information, which of the follow represents a good estimation of PCWP? A. 17 mmHg B. 24 mmHg C. 7 mmHg D. 31 mmHg

The correct answer is : C Explanation : To obtain a pulmonary capillary wedge pressure (PCWP) measurement, the balloon at the distal end of the pulmonary artery catheter is inflated momentarily and pressure is measured on the distal side. However, in lieu of measuring the PCWP by inflating the balloon, the value may be estimated by examining the diastolic portion of the PAP. The systolic-diastolic PAP value is 25 mmHg/7 mmHg. We can estimate PCWP to be 7 mmHg.

A homecare patient indicates that she is not getting enough air from her transtracheal oxygen catheter. The therapist should instruct the patient to A. increase the flow of oxygen to the catheter. B. flush the catheter with saline. C. use a nasal cannula. D. remove the catheter.

The correct answer is : C Explanation : When a patient reports difficulty getting air or oxygen through one oxygen delivery device, before troubleshooting, the most appropriate first action is to ensure adequate ventilation by changing to a different, reliable device. In this case, switching to a nasal cannula is most appropriate.

What is the relative humidity if there is only 11 mg of water/L of gas in the ambient air? A. 50% B. 75% C. 25% D. 100%

The correct answer is : C Explanation : When relative humidity is 100% the ambient air is holding 44 mg/H2O/L of gas. If only 11 mg/H2O/L of gas exists, the relative humidity can be determined by dividing the 11 mg present by the 44 mg total. In this case, the relative humidity is 25%.

A chemical indicator tape found inside the sealed, packaged disposable mask helps determine which of the following? A. if microorganisms remain viable on the equipment B. if the package has remained closed C. if the equipment is sterile D. if the equipment has been properly sterilized

The correct answer is : D Explanation : A chemical indicator tape inside a sterialized package does not actually indicate the presence or absence of viable spores. It does, however, indicate if the equipment has been through the sterilization process.

A 32 year-old female patient reports to the emergency room complaining of a sudden onset of coughing. She indicates the coughing started when she was eating. Which of the following would most definitively rule out a cancerous mass in the lungs: A. lateral neck radiograph B. V/Q scan C. BUN D. spiral CT scan

The correct answer is : D Explanation : A sudden onset of coughing while the patient was eating is most likely associated with foreign body aspiration (food in the main stem bronchus). However, nonproductive coughing could also be caused by a cancerous mass in the upper airway. To rule this out a procedure that shows the upper airway with three dimensionality is most appropriate. A ventilation perfusion scan and a BUN blood test would not do this. It may be tempting to get a lateral neck x-ray, but the results are not three dimensional and therefore would not be as confirming in nature. The most confirming examination would be a spiral CT scan.

A respiratory therapist is disinfecting reusable mouthpieces in Sonacide. For how long should the equipment soak to achieve disinfection? A. 2 minutes B. 6 minutes C. 8 minutes D. 10 minutes

The correct answer is : D Explanation : Acid glutaraldehyde, like its counterpart glutaraldehyde, has the ability to disinfect and sterilize. However, soak times are different. The acid version can disinfect in 10 min. but can sterilize in only one hour. In this question, we are asked to merely disinfect the reusable mouthpieces.

How many hours will an H cylinder with 1400 psi last for a patient receiving oxygen at 7 lpm? A. 4 hours B. 6 hours C. less than 1 hour D. 10 hours

The correct answer is : D Explanation : And H cylinder has a tank factor of 3.14. 3.14x1400 PSI = 4396 L. 4396 L / 7 L per minute = 628 min. 628 min./ 60 min.= 10.4 hours, or about 10 hours. When you get an answer that is not exact, pick the closest number possible. It is common on the exam not see the exact answer from your calculation. This is because the NBRC knows that you're estimating.

A radiographic image shows an upper lobe cavitation. Which of the following conditions is most closely associated with this finding? A. Bronchiectasis B. Pneumonia C. Asbestosis D. Tuberculosis

The correct answer is : D Explanation : Cavitations in the upper lobes are generally associated with tuberculosis. Bronchiectasis is a condition affecting the bronchioles or airways and is seen throughout the lung. Pneumonia is not a cavitation and can also be seen throughout the lung on X-ray. Asbestosis is seen throughout the lung with reduced lucency.

Following a difficult intubation and 24 hours of mechanical ventilation, an oxygen- dependent female patient who is recovering from a drug overdose is unable to speak. Bronchoscopy reveals no movement of her vocal cords. In order to treat the patient's hypoxemia, the respiratory therapist should consider A. heated aerosol. B. tracheostomy. C. venturi mask. D. heliox therapy.

The correct answer is : D Explanation : Helium is a light gas that has the ability to bypass upper-airway obstructions, and therefore when mixed with oxygen helps deliver oxygen through narrow upper airways resulting from paralysis of the vocal cords.

The following data is available for a 62-year old patient with COPD. MAP 93 torr CVP 3 torr mPAP 16 torr PCWP 8 torr Q.T. 4.0 L/min PEEP 5 cm H2O C.I. 2.0 L/min/m2 The physician asks the therapist to determine pulmonary vascular resistance and record the findings in the patient's medical record. The therapist will record which of the following values? A. 320 dynes B. 1800 dynes C. 80 dynes D. 160 dynes

The correct answer is : D Explanation : Pulmonary vascular resistance is calculated by subtracting the PCWP from PAP and then dividing by cardiac output. In this case (16-8 = 8). In this question, cardiac output is provided and is called QT. To finish, (8/4 = 2). Finally, we must multiply the result by 80 to obtain the measurement in dynes. PVR = 2 x 80 = 160 dynes.

Which of the following chest radiograph observations is most associated with ARDS? A. obliterated costophrenic angles B. hyper radiolucency C. concave interface border D. scattered patchy infiltrates

The correct answer is : D Explanation : Scattered patchy infiltrates is associated with adult respiratory distress syndrome. Hyper radiolucency is associated with chronic air trapping, such as seen in COPD. A concave interface border is associated with the pleural effusion.

A respiratory therapist takes report on a neonatal patient who is in an incubator, receiving humidity and oxygen therapy. The therapist notices the "red-flag" warning device is in use. Which of the following can the therapist conclude? A. The patient is in strict isolation B. The incubator is sealed and should not be opened. C. The humidity reservoir is low or out of sterile water D. FIO2 is 1.0

The correct answer is : D Explanation : The "red-flag" warning system on incubators indicates the use of 100% oxygen. Continual use of high FIO2 can result in retinopathy of prematurity or ROP.

A 35-year-old female patient presents to the emergency room with droopy eyelids and facial muscles. She complains of frequent fatigue that improves with rest, but then returns. Which of the following diagnostic procedures are not indicated? A. basic spirometry B. Tensilon challenge C. arterial blood gases D. nitrogen washout

The correct answer is : D Explanation : The patient is showing signs of myasthenia gravis for which basic spirometry, a Tensilon challenge, and an arterial blood gas are indicated. A nitrogen washout would detect lung volume changes associated with chronic obstructive pulmonary disease, but has little to no value for a patient with myasthenia gravis.

What is the primary purpose for a helium dilution test? A. quantify alveolar deadspace B. determine alveolar diffusion capacity C. directly measure TLC D. determine FRC

The correct answer is : D Explanation : The purpose of the helium dilution test is to determine lung volumes such as TLC, RV, and FRC. On the NBRC exam the primary purpose of the helium dilution (and nitrogen washout) test is to determine FRC.

Which of following calculations will determine residual volume (RV)? A. TLC + IC B. IRV + ERV - VT C. FRC - IRV D. TLC - IC - ERV

The correct answer is : D Explanation : These types of questions can be difficult. Memorizing pulmonary function volume chart is a good place to start. To find a solution to this problem you generally have to take each answer one by one, do the calculation, and determine if the correct result can be achieved. In this case the question is which of the following calculations will help determine the RV. When you subtract IC and ERV from TLC you get residual volume.

A patient's tissue oxygen consumption has increased and cardiac output has decreased. Which of the following is also likely true? A. A-aDO2 has decreased B. cardiac index has increased C. SaO2-SVO2 has decreased D. C(a-v)O2 has increased

The correct answer is : D Explanation : When cardiac output decreases, the speed of blood flow across the tissue bed is also decreased. As blood flows slower over tissues, the tissues have less ability and time to absorb oxygen molecules and therefore will demonstrate increased oxygen consumption. As oxygen consumption increases, the difference in arterial oxygenation and venous oxygenation also increases. Thus, an increase in C(a-v)O2 is observed.

A 90-kg male is receiving mechanical ventilation through a 7.5 ET tube. Bronchial hygiene has been difficult due to thick secretions. The patient is being suctioned with a 10 Fr. catheter at a pressure of 110 mmHg. Which of the following can be done to increase the effectiveness of suctioning: A. change to a 12 Fr. catheter B. administer sodium bicarbonate C. increase suction pressure to 130 mmHg D. change to an 8.5 ET tube and 12 Fr. catheter

The correct answer is : D Explanation : When having difficulty with bronchial hygiene, there are three things that one should check. In this order - appropriate suction catheter size, adequate suction pressure, and appropriate suction time. The correct suction catheter size is determined by taking the ET tube size and dividing it by 2. You then take that number and multiply it by three to get the catheter size in French units. In this case the best option is to increase the ET tube size so that you may use a larger suction catheter. Generally speaking a 10 French catheter size is too small for an adult.

The respiratory therapist notes the following results of an arterial blood gas on a patient on 40% Venturi mask: pH 7.40 PaCO2 41 torr PaO2 260 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should A. report the blood gas values to the physician B. discontinue supplemental oxygen C. decrease FIO2 to 28% D. run the blood sample on another blood gas analyzer

The correct answer is : D Explanation : When looking at these blood gases, the extremely high PaO2 should be in question since the patient is only on 40% oxygen. Determining the maximum possible alveolar oxygen tension reveals a maximum possible PAO2 of 230 mmHg. It would be impossible for the arterial oxygen tension (PaO2), to be higher than this.

Low-volume alarms are most important in which of the following situations? A. pediatric volume-cycled ventilation B. adult IPPB with bronchodilators C. adult volume-cycled ventilation D. infant time cycled, pressure-limited ventilation

The correct answer is : D Explanation : When providing mechanical ventilation to an infant with a time-cycled, pressure-limited ventilator, the low-volume alarms are critically important because a leak, or a change in lung compliance could easily result in a significant lack of sufficient ventilation.

Dynamic compliance is calculated by

dividing VT by the peak inspiratory pressure minus the PEEP