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NBRC TMC/CRT/RRT EXAM || 2025 - 2026|| | REAL
EXAM VERSIONS WITH A STUDY GUIDE |
ACCURATE SOLUTIONS WITH RATIONALES
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A severe COPD CLIENT arrives in the emergency department on a 2 L/min nasal cannula. Arterial blood gas results follow: pH: 7. PaCO2: 67 mmHg PaO2: 62 mmHg HCO3: 38 mEq/L Which of the following is the most appropriate recommendation? A. Increase the liter flow to 4 L/min B. Maintain the current O2 level C. Institute noninvasive positive pressure ventilation (NPPV) D. Place on a NRB mask at 12 L/min B. Maintain the current O2 level The physician has ordered O2 to be set up on a CLIENT who has a spontaneous tidal volume of 500 mL and an inspiratory time of 1 second. Which of the following O2 delivery devices will deliver a flow that meets or exceeds this CLIENT's inspiratory flow? A. 35% air-entrainment mask at 6 L/min B. 60% aerosol mask at 12 L/min C. NRB mask at 15 L/min D. Simple O2 mask at 10 L/min Rationale: 500 mL = 0.5 L 0.5/1 = 0.5 L/s (change L/s to ?/min by multiplying by 60 0.5 L x 60= 30 L/min Select the device that delivers a flow of at least 30L/min A. 35% air-entrainment mask at 6 L/min CLIENT breathing 50% oxygen has a PaO2 of 248 torr. Which of the following should the RT recommend? A. Discontinue O2 therapy B. Decrease the oxygen to 30%
C. Titrate oxygen to maintain an SpO2 > 93% D. Repeat the blood gases because the PaO2 is not possible on this FiO2. C. Titrate oxygen to maintain an SpO2 > 93% Rationale: A PaO2 of 250 torr is normal on 50% O2. Remember, to determine the normal PaO2 on any given O2%, multiply the O2% by 5. This is an approximation. If titrate was not a choice, then you would discontinue the oxygen. A CLIENT is receiving 30% oxygen via an air-entrainment mask at a flow of 5 L/min. The total flow delivered by this device is which of the following? A. 36 L/min B. 45 L/min C. 54 L/min D. 60 L/min Rationale: (Use 21 with O2 % less than 40%) (100- 30%)/ (30%-21) = 70/9 = 8/1 or 8:1 ratio 8+1= 9 9x5 = 45 L/min B. 45 L/min Secretions tend to become thicker if the inspired air has which of the following characteristics? A. A relative humidity of 100% at body temperature B. 32 mg H2O per liter of gas C. A water vapor pressure of 47 mmHg D. 48 mg H2O per liter of gas B. 32 mg H2O per liter of gas A CLIENT receiving 38 mg H2O per liter of gas from a nebulizer has a humidity deficit of which of the following? A. 6 mg/L B. 9 mg/L C. 12 mg/L D. 18 mg/L 44 - 38= 6 A. 6 mg/L
A. Place the CLIENT on CPAP Given the following data, what is the CLIENT's total arterial O2 content? pH: 7. PaCO2: 37 mmHg PaO2: 88 mmHg HCO3: 26 mEq/L SaO2: 95% Hb: 14 g/dL A. 12 mL/dL B. 14 mL/dL C. 16 mL/dL D. 18 mL/dL Rationale: (Hb x 1.36 x SaO2) + (0.003 x PaO2) (14 x 1.36 x 0.95) + (0.003 x 88) 18.088 + 0. = 18. Ans:>>D. 18 mL/dL The respiratory therapist receives an order to set up a moderate level of O2 on a CLIENT who arrives in the ED breathing at a rate of 35 breaths/min. Which of the following O delivery devices is most appropriate to use in this situation? A. Simple O2 mask at 10 L/min B. Nasal cannula at 4 L/min C. NRB Mask at 15 L/min D. Air-entrainment mask at 40% O D. Air-entrainment mask at 40% O After connecting a nasal cannula to the humidifier outlet, you kink the tubing and hear a whistling noise coming from the humidifier. Which of the following most likely has caused this? A. The humidifier jar is cracked B. The capillary tube in the humidifier is disconnected C. The humidifier has no leaks D. The top of the humidifier is not screwed on tightly C. The humidifier has no leaks
You notice that the CLIENT's secretions have become thicker and more difficult to suction since the ventilator humidifier was replaced with an HME. The RT should recommend which of the following? A. Increase inspiratory flow B. Decrease the temperature to the HME C. Replace with a new HME D. Replace the HME with a conventional heated humidifier D. Replace the HME with a conventional heated humidifier Which of the following are indications for cool, bland aerosol therapy?
- A cough must be induced for sputum collection
- Mobilization of secretions must be improved
- Postextubation inflammation of the upper airway must be treated A. 1 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3 D. 1, 2, and 3 You notice that very little mist is being produced by a nebulizer attached to an aerosol mask. Which of the following could be responsible for this?
- The liter flow is too high
- The nebulizer jet is clogged with lint
- The filter on the capillary tube is obstructed A. 1 only B. 2 only C. 1 and 3 only D. 2 and 3 only D. 2 and 3 only An autoimmune compromised CLIENT is to be placed on oxygen with a humidity/aerosol device. Which of the following devices is most likely to deliver contaminated water to the CLIENT? A. Heated cascade humidifier B. Bubble humidifier C. Heated wick humidifier D. Heated jet nebulizer
B. Hypopnea C. Eupnea D. Bradypnea A. Orthopnea A CLIENT enters the emergency department, and on initial examination the RT observes paradoxical chest movement. Which of the following should the therapist suspect? A. Pulmonary edema B. Pneumonia C. Flail chest D. Pleural effusion C. Flail chest Perfusion in the extremities may best be determined by which of the following methods? A. Obtaining ABG studies and determining PaO2 level B. Assessing the CLIENTs SpO C. Assessing capillary refill D. Palpating a brachial pulse C. Assessing capillary refill While palpating the chest, the RT determines that there is decreased fremitus over the right lower lobe. This may be the result of which of the following?
- Pneumothorax
- Pleural effusion
- Pneumonia A. 1 only B. 2 only C. 1 and 2 only D. 2 and 3 only C. 1 and 2 only A chest x-ray film obtained after intubation shows that the tip of the ET tube is resting at the fourth rib. Which of the following actions should be taken? A. The tube should be advanced 2 cm B. The tube should be advanced until equal breath sounds are heard C. The tube should remain at this level D. The tube should be withdrawn 3 cm
D. The tube should be withdrawn 3 cm The RT is reviewing the chart of a CLIENT suspected of having congestive heart failure. This condition would best be indicated with an elevation in which of the following cardiac biomarkers? A. Troponin B. Myoglobin C. Creatine kinase (CK) D. B-type natriuretic peptide (BNP) BNP > 500 = CHF D. B-type natriuretic peptide (BNP) A CLIENT is suspected of suffering acute myocardial infarction. Which of the following lab values would be increased in the CLIENT's blood? A. Hematocrit B. CK-MB C. BNP D. Albumin B. CK-MB The RT notes a respiratory rate of 36 breaths/min in an adult CLIENT's chart. The CLIENT's breathing pattern is best described by which of the following? A. Hyperventilation B. Dyspnea C. Hypoventilation D. Tachypnea D. Tachypnea The RT is assessing a CLIENT with severe emphysema and observes pedal edema and jugular venous distention. The therapist should note in the CLIENT's chart that these signs are most likely the result of: A. Systemic hypertension B. Hypercapnia C. Pulmonary infection D. Right ventricular hypertrophy D. Right ventricular hypertrophy
B. Instill enough air to maintain a cuff pressure of 30 mm Hg. C. Instill air into the cuff to a pressure of 20 - 30 cm H2O. D. Instill enough air until only a slight audible leak is heard. C. Instill air into the cuff to a pressure of 20 - 30 cm H2O. You want to pass a suction catheter into the CLIENT's left lung to obtain a sputum specimen. What is the most appropriate method of accomplishing this? A. Have the CLIENT turn his or her head to the left B. Have the CLIENT turn his or her head to the right C. Use a coude suction catheter D. Use a catheter that is one half the internal diameter of the CLIENT's airway C. Use a coude suction catheter The RT is using a 12 - French suction catheter to suction a female CLIENT who is intubated with a 7.0-mm ET tube and is having difficulty removing the thick secretions. The suction pressure used is - 120 mm Hg. Which of the following should be recommended to correct this problem? A. Increase the suction pressure to - 140 mm Hg B. Instill 5 mL of normal saline down the ET tube C. Change to a 14 French suction catheter D. Change to a coude-tipped suction catheter A. Increase the suction pressure to - 140 mm Hg The RT is called to pediatric ICU to suction a 6 - year-old ventilator CLIENT with pneumonia who is intubated with a 5.0 mm ET tube. Which of the following represents the most appropriate catheter size and suction pressure to use on this CLIENT? A. 8 - Fr catheter, - 100mm Hg B. 10 - Fr catheter, - 60mm Hg C. 8 - Fr catheter, - 60mm Hg D. 10 - Fr catheter, - 100mm Hg A. 8 - Fr catheter, - 100mm Hg Which of the following will increase the possibility of the ET tube cuff causing tracheal mucosa damage?
- Maintaining intracuff pressure of 38 cm H2O
- Using minimal leak technique
- Using a low-volume, high-pressure cuff
- Using minimal occluding volume technique A. 1 and 3 only
B. 2 and 4 only C. 1, 3 and 4 only D. 2, 3, and 4 A. 1 and 3 only An intubated CLIENT begins exhibiting severe respiratory distress, and the RT auscultates no breath sounds and determines that there is no gas flow passing through the end of the ET tube. The high pressure alarm is sounding on the ventilator. Which of the following should the therapist do at this time? A. Instill 5 mL of saline down the ET tube and suction B. Extubate and manually ventilate the CLIENT C. Obtain an arterial blood gas D. Recommend a stat chest x-ray B. Extubate and manually ventilate the CLIENT Which of the following are complications associated with bronchoscopy?
- Pulmonary hemorrhage
- Pneumothorax
- Hypoxemia A. 1 only B. 2 only C. 1 and 3 only D. 1, 2, and 3 D. 1, 2, and 3 While assisting with a bronchoscopy, you note that the physician is having difficulty entering the trachea. This may be the result of which of the following? A. Pneumothorax B. Tracheomalacia C. Laryngospasm D. Pulmonary hemorrhage C. Laryngospasm After a bronchoscopy, the RT notes that it is taking more ventilator pressure to ventilate the CLIENT's lungs than before the procedure. This could be caused by which of the following?
- Bronchospasm
- Pneumothorax
- Hypoxemia
A. 35
B. 40
C. 27
D. 70
D. 70
A CLIENT is seen in the Emergency Department for complaints of nausea and vomiting. A nasogastric tube has been inserted and the CLIENT is started on lasix. Which of the following should the respiratory therapist monitor? A. Cardiac enzymes B. Serum electrolytes C. Arterial blood gases D. Cell hydration level B. Serum electrolytes While instructing a CLIENT prior to a vital capacity maneuver, the respiratory therapist should direct the CLIENT to A. exhale to residual volume and inhale to inspiratory capacity. B. inhale to total lung capacity then exhale to residual volume. C. exhale normally then inhale to total lung capacity. D. inhale normally then exhale to functional residual capacity. B. inhale to total lung capacity then exhale to residual volume. A CLIENT involved in an automobile accident is brought to the ED with tachypnea, tracheal deviation to the right, splinting, asymmetrical chest movement, and decreased breath sounds on the left side. The respiratory therapist should initially A. insert a chest tube. B. administer 100% oxygen via mask. C. perform endotracheal intubation. D. initiate non-invasive positive pressure ventilation. B. administer 100% oxygen via mask. A 77-year-old male CLIENT is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following? A. Pulmonary edema B. Pulmonary interstitial emphysema
C. Pneumothorax D. Emphysema A. Pulmonary edema Which of the following formulas will determine the total flow being delivered to a CLIENT with a 28% venturi mask running at 6 L/min? A. total flow = 6 x 2 B. total flow = 6 x 4 C. total flow = 6 x 5 D. total flow = 6 x 11 D. total flow = 6 x 11 Fine crepitant crackles are most commonly associated with which of the following conditions? A. Bronchitis B. Pulmonary edema C. Pneumonia D. Foreign body aspiration B. Pulmonary edema A CLIENT with end-stage pulmonary fibrosis is receiving oxygen at 2 L/min via a transtracheal oxygen catheter. The CLIENT experiences an increased work of breathing and shortness of breath. The respiratory therapist should A. manually ventilate the CLIENT with a resuscitation bag. B. increase the flow to the transtracheal catheter to 6 L/min. C. evaluate the SpO2 with a pulse oximeter. D. flush the transtracheal device with isotonic saline. D. flush the transtracheal device with isotonic saline. During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first A. verify the position of the transducer. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. attempt to draw blood from the arterial line. B. check the transducer dome for air bubbles.
A. normal lung function. B. sarcoidosis. C. acute bronchitis. D. cystic fibrosis. B. sarcoidosis. The respiratory therapist is in charge of transporting a CLIENT with multiple trauma to a regional trauma center in a fixed wing aircraft. Which of the following should the therapist be most concerned about during the transport? A. Tissue oxygenation B. Pneumothorax C. Pulmonary embolus D. Humidification of the inspired gas A. Tissue oxygenation Transcutaneous monitoring of PO2 values will correlate well with arterial blood gas PO values in which of the following situations?
- Hypotension
- Hypothermia
- Pneumonia A. 1 only B. 3 only C. 1 and 2 only D. 2 and 3 only B. 3 only A CLIENT is being ventilated in the intensive care unit. The following data is obtained: Mode VC, SIMV Mandatory rate 12 b/min Total rate 18 b/min VT 800 mL FIO2 0. PIP 31 cm H2O PEEP 10 cm H2O pH 7. PaCO2 40 torr
PaO2 95 torr SaO2 96% HCO3- 23 mEq/L BE +1 mEq/L PECO2 30 torr Hb 15 g/dL What should the respiratory therapist report as the VD/VT ratio? A. 15% B. 25% C. 40% D. 50% B. 25% What is the air-to-oxygen ratio for an air entrainment device delivering 60% oxygen? A. 1: B. 3: C. 4: D. 10: A. 1: Following surgery to correct an abdominal aortic aneurysm, a 54-year-old female CLIENT suddenly develops intense substernal chest pain with severe dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The CLIENT appears pale, cold and clammy. Which of the following should the respiratory therapist recommend for initial assessment of this CLIENT? A. Serum electrolytes B. Chest x-ray C. Complete blood cell count D. Electrocardiograph D. Electrocardiograph An adult CLIENT is intubated with a 7.0 mm ID endotracheal tube. What size suction catheter should be used to suction this CLIENT? A. 8 French B. 10 French C. 12 French D. 14 French
C. increasing oxygenation with increasing plateau pressure. D. increasing static compliance with acceptable oxygenation C. increasing oxygenation with increasing plateau pressure. While suctioning a CLIENT who is being mechanically ventilated, the respiratory therapist notes the following ECG pattern on the monitor: Suctioning is stopped and the CLIENT is returned to the ventilator. Which of the following drugs should the respiratory therapist recommend FIRST? A. 100% oxygen B. atropine C. lidocaine D. epinephrine A. 100% oxygen Adjusting the inspiratory flow during an IPPB treatment will result in a change in A. respiratory rate. B. peak pressure. C. tidal volume. D. inspiratory time D. inspiratory time A CLIENT in the intensive care unit has the following hemodynamic measurements: CVP 4 mm Hg PAP 48/16 mm Hg PCWP 8 mm Hg MAP 92 mm Hg Cardiac Output 5 L/min. Cardiac Index 2.5 L/min/m These results are most consistent with A. normal cardiac function B. pulmonary hypertension C. left heart failure D. hypovolemia B. pulmonary hypertension A CLIENT who is suspected of having a flail chest has been intubated and mechanically ventilated with PEEP therapy. The CLIENT has just received pancuronium bromide. Which of the following
ventilator alarms would be most important to set correctly for this CLIENT? A. Peak pressure alarm B. Low PEEP pressure alarm C. I:E ratio alarm D. Low exhaled volume alarm B. Low PEEP pressure alarm A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the distal lumen? A. CVP B. PAP C. PCWP D. MAP B. PAP A pre-op CLIENT who is at high risk for post-operative complications should be evaluated by obtaining the results of A. VD/VT study. B. diffusion studies. C. basic spirometry. D. indirect calorimetry. C. basic spirometry. A CLIENT is receiving noninvasive positive pressure ventilation by mask. Current settings andarterial blood gas results are as follows: IPAP 10 cm H2O EPAP 5 cm H2O Respiratory rate 12 /min pH 7. PaCO2 56 torr PaO2 63 torr HCO3 25 mEq/L BE +1 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the EPAP to 10 cm H2O B. Decrease the EPAP to 3 cm H2O
