Conquer Part I of the NBRC Exam:
Essential Prep Tips
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia -
\Endotracheal tube positioned in right mainstem bronchus is a problem but the co2
reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation -
\6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle
activity is absent. _______ conditions can be imposed with an inspiratory pause when a
patient is sedated and mechanically ventilated. -
\Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions,
when non-intubated patient breathes spontaneously. -
\Dynamic Compliance
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 proximal
lumen:
a. Cvp
b. Pap
c. Pwp
d. Map -
\ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
,c. Condensation in the tubing
d. Use of desiccant -
\Gas will pass through and out of a long sampling line before reaching analyzer so, low
sampling flow will not give you enough information for a good reading, and
condensation as a rule is always a problem especially in analyzers. Dessicant removes
moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following
should the respiratory therapist use to monitor the neonates overall cardiopulmonary
status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8 -
\Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or
8 hour), Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer
is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis -
\You wouldn't have asthma on just one side (unilateral), atelectasis would cause
diminished breath sounds, with epiglottitis you would get stridor, since you are only
hearing wheezing on one side, you are hearing it on the side where you aspirated
something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress -
\With pneumothorax you would hear a high pitch hyperresonnance, breath sounds
would be absent, and respiratory distress could be present. Dull percussion would NOT
be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine -
,\Multiple pvc's coming from multiple locations (multifocal) is a real problem and you
should administer oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability
of heart and help with pvc's but would not be first option, atropine is used for
bradycardia and cardiac irregularities but not pvc's, epinephrine is emergency drug not
for pvc's but more for pulseless ventricular tachycardia or ventricular fibrilation where
heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg -
\Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea.
The patient has marked dyspnea and a history of heart disease. Which of the following
should the respiratory therapist recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide -
\This is an emergency, they are having heart problems, dyspnea, frothy secretions
indicating severe pulmonary edema, etc. so 100% oxygen immediately, having the
patient in the Fowlers position (an upright position) will help pull fluid down away from
the lungs, furosemide is a lasix (loop diuretic) which gets rid of excess fluid. You do
NOT suction someone with frothy secretions and heart problems, this just delays
appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following
conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup -
\Crackles are associated with fluid so a, b, and c would be good answers, but "fine
crepitant" crackles indicates fluid entering alveoli (pulmonary edema) which is most
often caused by heart failure so the best ANSWER is B. (with croup you would hear
more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally
intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would
the respiratory therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
, c. Initially high, stays high
d. Initially low, stays low -
\Full cardiac arrest will cause the CO2 in the lungs to slowly dissipate out because no
blood is flowing, then during CPR when you get blood flowing, the CO2 should slowly
rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure
obtained from a sphygmomanometer (cuff pressure). Based upon this information, the
respiratory therapist should conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles -
\Arterial line BP and cuff pressure should be the same, so there is a problem. Non-
compliant tubing is a good thing because it's a stiff tubing, if transducer is placed too
high (above the heart), the flood will have to go uphill and you will get a lower pressure;
transducer dome contained air bubbles would give you erratic readings but not a higher
reading, but if the transducer is placed too low (below heart), the blood is flowing
downhill & will give a higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was
playing with friends and developed violent coughing and unilateral wheezing. Physical
examination reveals a hyperresonant percussion note on the left and resonant
percussion on the right. Inspiratory and expiratory chest films indicate air trapping with
no foreign bodies "noted." The respiratory therapist should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis -
\Unilateral wheezing indicates aspirated object and fact that the child was playing with
friends causes you to believe the child inhaled a small toy or something, hyperresonant
percussion indicates air trapping, so you are thinking foreign object but x-ray says no
foreign bodies "noted." Just because it says "noted" does not mean something is not
there, it just means it could not be seen on the xray, also if the child had swallowed a
small plastic toy, "plastic" does not show up on xrays (radiolucent). The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels -
Essential Prep Tips
PATIENT ASSESSMENT:
All the following could cause capnography to go from 3 6 to 30 EXCEPT:
A. Endotracheal tube positioned in the right mainstream bronchus
B. Hyperventilation
C. pulmonary emboli
D. Hypovolemia -
\Endotracheal tube positioned in right mainstem bronchus is a problem but the co2
reading would not change, so
ANSWER is A.
What is the target Vt for individual on mechanical ventilation -
\6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015
Is the following Static OR Dynamic Compliance:
Means flow throughout the respiratory system has stopped and all ventilatory muscle
activity is absent. _______ conditions can be imposed with an inspiratory pause when a
patient is sedated and mechanically ventilated. -
\Static Compliance
Is the following Static OR Dynamic Compliance:
Flow at airway opening is zero. Mechanics are evaluated under ______ conditions,
when non-intubated patient breathes spontaneously. -
\Dynamic Compliance
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 proximal
lumen:
a. Cvp
b. Pap
c. Pwp
d. Map -
\ANSWER is A. Cvp = deflated/proximal lumen
Pap = deflated/distal
Pwp = inflated/wedged
All of the following will affect the accuracy of a capnography EXCEPT
a. Long sampling line
b. Low sampling flow
,c. Condensation in the tubing
d. Use of desiccant -
\Gas will pass through and out of a long sampling line before reaching analyzer so, low
sampling flow will not give you enough information for a good reading, and
condensation as a rule is always a problem especially in analyzers. Dessicant removes
moisture from the gas, which is a good thing, so
ANSWER is D
A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following
should the respiratory therapist use to monitor the neonates overall cardiopulmonary
status.
a. TcPCO2 and TcPO2 monitor
b. Arterial blood gas analysis Q4
c. SpO2 monitor
d. Capillary gas analysis Q8 -
\Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or
8 hour), Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer
is A
A unilateral wheeze would most likely indicate which of the following.
a. Asthma
b. Atelectasis
c. Foreign body aspiration
d. Epiglottitis -
\You wouldn't have asthma on just one side (unilateral), atelectasis would cause
diminished breath sounds, with epiglottitis you would get stridor, since you are only
hearing wheezing on one side, you are hearing it on the side where you aspirated
something,
so ANSWER is C
All of the following would be associated with the presence of a pneumothorax EXCEPT
a. Tracheal deviation
b. Dull percussion
c. Absent breath sounds
d. Respiratory distress -
\With pneumothorax you would hear a high pitch hyperresonnance, breath sounds
would be absent, and respiratory distress could be present. Dull percussion would NOT
be present,
so ANSWER is B.
What should you recommend FIRST for a patient with multifocal pvc's
a. Administration of lidocaine
b. Administration of 100% oxygen
c. Administration of atropine
d. Administration of epinephrine -
,\Multiple pvc's coming from multiple locations (multifocal) is a real problem and you
should administer oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability
of heart and help with pvc's but would not be first option, atropine is used for
bradycardia and cardiac irregularities but not pvc's, epinephrine is emergency drug not
for pvc's but more for pulseless ventricular tachycardia or ventricular fibrilation where
heart is not responding .
What is the normal range for the mean pulmonary artery pressure in an adult
a. 2-6 mm Hg
b. 4-12 mmHg
c. 9-18 mmHg
d. 21-28 mmHg -
\Mean pulmonary artery pressure in an adult should be in the teens
so best ANSWER is C
A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea.
The patient has marked dyspnea and a history of heart disease. Which of the following
should the respiratory therapist recommend.
1.suction immediately
2.administer 100% oxygen
3.place in Fowlers position
4.administer furosemide -
\This is an emergency, they are having heart problems, dyspnea, frothy secretions
indicating severe pulmonary edema, etc. so 100% oxygen immediately, having the
patient in the Fowlers position (an upright position) will help pull fluid down away from
the lungs, furosemide is a lasix (loop diuretic) which gets rid of excess fluid. You do
NOT suction someone with frothy secretions and heart problems, this just delays
appropriate therapy. So ANSWER is 2,3,4
Fine crepitant crackles are most commonly associated with which of the following
conditions.
a. Bronchiectasis
b. Congestive heart failure
c. Pneumonia
d. Croup -
\Crackles are associated with fluid so a, b, and c would be good answers, but "fine
crepitant" crackles indicates fluid entering alveoli (pulmonary edema) which is most
often caused by heart failure so the best ANSWER is B. (with croup you would hear
more of a stridor sound).
A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally
intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would
the respiratory therapist expect to observe on the monitor?
a. Initially high, then falling
b. Initially low, then rising
, c. Initially high, stays high
d. Initially low, stays low -
\Full cardiac arrest will cause the CO2 in the lungs to slowly dissipate out because no
blood is flowing, then during CPR when you get blood flowing, the CO2 should slowly
rise back up;
so ANSWER is B
If the blood pressure obtained from the arterial line is higher than the blood pressure
obtained from a sphygmomanometer (cuff pressure). Based upon this information, the
respiratory therapist should conclude that.
a. Non-compliant tubing is being used
b. Transducer is placed too low
c. Patient was lying flat during the measurement of the arterial line pressure
d. Transducer dome contained air bubbles -
\Arterial line BP and cuff pressure should be the same, so there is a problem. Non-
compliant tubing is a good thing because it's a stiff tubing, if transducer is placed too
high (above the heart), the flood will have to go uphill and you will get a lower pressure;
transducer dome contained air bubbles would give you erratic readings but not a higher
reading, but if the transducer is placed too low (below heart), the blood is flowing
downhill & will give a higher pressure reading, so ANSWER is B
A 2-year old child enters the emergency room. The mother states that the child was
playing with friends and developed violent coughing and unilateral wheezing. Physical
examination reveals a hyperresonant percussion note on the left and resonant
percussion on the right. Inspiratory and expiratory chest films indicate air trapping with
no foreign bodies "noted." The respiratory therapist should suspect the child has.
a.pneumothorax
b.orthopnea
c.aspirated a foreign object
d.tachyphylaxis -
\Unilateral wheezing indicates aspirated object and fact that the child was playing with
friends causes you to believe the child inhaled a small toy or something, hyperresonant
percussion indicates air trapping, so you are thinking foreign object but x-ray says no
foreign bodies "noted." Just because it says "noted" does not mean something is not
there, it just means it could not be seen on the xray, also if the child had swallowed a
small plastic toy, "plastic" does not show up on xrays (radiolucent). The ANSWER is C
A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric
tube has been inserted to help relieve the nausea. The patient was started on Lasix and
nitroglycerin. Which of the following should be monitored to closely identify side effects
at this time.
a. Cardiac enzymes
b. Serum electrolytes
c. Arterial blood gases
d. Digitalis levels -
