NBRC EXAM REVIEW QUESTIONS AND ANSWERS, RATED A+/ VERIFIED/[LATEST EXAM UPDATES]

NBRC EXAM REVIEW QUESTIONS AND ANSWERS, RATED A+/ VERIFIED/ Information Gathering - Emphysema: (Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - -LEVEL I: Cyanosis, Barrel chest, ↑ A-P diameter, Accessory muscle use, Digital clubbing of the nail beds, Significant hx of smoking and/or occupational exposure to smoke or other pulmonary irritant -LEVEL II: Dyspnea, Wheezing BS -LEVEL III: Chest X-ray—flattened diaphragms, hyperlucency, diminished pulmonary vascular markings. CBC—polycythemia, ↑ WBC due to possible infection. ABGs—Compensated respiratory acidosis (high PaCO2, normal pH), moderate to severe hypoxemia. Sputum culture—often positive for bacteria. -LEVEL IV : FT—flows are ↓ especially middle sized airways (FEF 25-75%) Fev1 and Fev1/FVC%, ↓ DLCO (less than 20). Descision Making - Empysema: (Abnormal condition of the alveoli resulting destruction and loss of elasticity.) - -Oxygen therapy— low FiO2 (0.24 to 0.28) or 1 to 2 lpm NC -O2 conserving devices such as liquid O2 or trans-tracheal oxygen -Home care education on devices and equipment cleaning -Rehab efforts -Aids to help quit smoking such as nicotine replacement therapy -Bronchodilation medication via MDI or aerosol nebulizers -Antibiotics for infection -Smoking cessation products (nicotine replacement therapy). Information Gathering - Chronic Bronchitis (Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - -LEVEL I: Productive cough, purulent sputum production; Exposure to pulmonary irritants, (hx. of smoking); Frequent infections -LEVEL II: Dyspnea -LEVEL III: Chest X-ray—could be normal, or may show hyperlucency, diminished, pulmonary markings. CBC—possibly ↑ WBC due to possible infection. ABGs—could be normal or very slight respiratory acidosis and hypoxemia -LEVEL IV: PFT—flows are ↓ especially middle sized airways (FEF 25-75%) FEV1, Normal DLCO Decision Making - Chronic Bronchitis (Defined: Condition where the patient has a productive cough 25% of the year for at least two consecutive years.) - Anything that promotes good pulmonary hygiene such as: -chest physiotherapy -hydration therapy when sputum is thick. -fluid therapy if dehydrated -oxygen therapy for hypoxemia -aerosolized bronchodilator therapy, -antibiotic tetracycline may be preferable Information Gathering - Bronchiectasis (Defined: Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation.) - -LEVEL I: Productive cough, often with blood; digital clubbing of the nail beds; sig. hx of infections (recurrent) -LEVEL II: Dyspnea -LEVEL III: Chest X-ray—generally normal Sputum culture—gram negative bacteria Bronchogram: Primary test. "tree in winter pattern" -LEVEL IV: Bronchogram is the primary test. Characterized by a "tree in winter pattern" Decision Making - Bronch