NBRC TMC/CRT/RRT Exam |Actual Exam| Latest 160
Questions And Correct Answers with Rationale
2024/2025|+A grade| Version 2 (V2)
VERSION 2 (V2) 160 QUESTIONS| ACTUAL EXAM
1. During The Assessment Of A 64-Year-Old Female Patient, You Note The Following
Signs: Dyspnea, Hypotension, And A Tracheal Shift To The Right. The Patient Also Has
Absent Breath Sounds, Reduced Chest Expansion, And A Hyperresonant Percussion Note All
On The Left Side. These Findings Suggest Which Of The Following?
A. A Pleural Effusion On The Left Side
B. A Pneumothorax On The Left Side
C. Atelectasis On The Left Side
D. Consolidation On The Left Side
ANS: B.
Rationale: The Signs Indicate Air Accumulation In The Pleural Space, Which Leads To
Hypotension, Tracheal Deviation, And Hyperresonance On Percussion. Absent Breath
Sounds Support This Diagnosis.
2. A 39-Year-Old Male Patient Was Admitted To The Emergency Department With A Fever
And An Spo2 Of 87% On Room Air. Upon Auscultation, Rhonchi Is Heard And The Patient
Has A Productive Cough. Which Of The Following Would You Recommend?
A. Intubate And Provide Mechanical Ventilation With 40% Oxygen
B. Provide Noninvasive Positive Pressure Ventilation Using A Full Face Mask
C. Implement Postural Drainage And Percussion With Directed Coughing
D. Provide Oxygen Therapy And Obtain A Sputum Sample For Culture And Sensitivity
ANS: D.
Rationale: The Patient Shows Signs Of Possible Infection (Fever, Productive Cough).
Oxygen Therapy Is Crucial For Hypoxemia, And Obtaining A Sputum Sample Is Necessary
For Diagnosing The Underlying Infection.
3. A 50-Year-Old Male Patient Is Intubated With A Size 8 Endotracheal Tube And Is
Receiving Volume-Controlled A/C Ventilation. Upon Assessment, You Note That The
Patient's Cuff Pressure Is Measured At 38 Cm H2o. Which Of The Following Would You
Recommend?
,A. Withdraw The Tube 1-2 Cm And Reassess The Patient's Breath Sounds
B. Recommend Reintubation With A Smaller Endotracheal Tube
C. Lower The Cuff Pressure To < 30 Cm H2o
D. Recommend Ventilation Via A Tracheostomy Instead
ANS: C.
Rationale: Cuff Pressures Above 30 Cm H2o Can Compromise Blood Flow To The Tracheal
Wall, Leading To Ischemia. Lowering The Pressure To Below This Threshold Is Advisable.
4. During The Assessment Of A 52-Year-Old Female Patient That Is Receiving Oxygen Via
Nasal Cannula At 4 L/Min, You Hear The Bubble Humidifier Making A Whistling Noise.
Which Of The Following Is The Most Likely Cause Of This Finding?
A. There Is An Obstruction In The Delivery Tube
B. The Patient's Ventilation Has Increased
C. There Is A Clogged System Diffuser
D. The Flowmeter Pressure Is Set Too High
ANS: A.
Rationale: A Whistling Noise Often Indicates A Flow Limitation Due To An Obstruction.
The Sound Is Generated By Air Passing Through A Narrowed Area In The System.
5. A Pre And Post Bronchodilator Test Was Ordered On A 48-Year-Old Female Patient. The
Forced Expiratory Measurement That Was Obtained After The Bronchodilator Was Given
Shows An Increase In The Patient's Fev1 From 60% To 80% Of The Predicted Value. This
Finding Suggests Which Of The Following?
A. A Fixed Airway Obstruction
B. A Reversible Airway Obstruction
C. A Normal Diffusion Capacity
D. A Restrictive Process
ANS: B.
Rationale: An Increase In Fev1 After Bronchodilator Administration Indicates That The
Airway Obstruction Is Responsive To Treatment, Characteristic Of Conditions Like Asthma.
6. A 58-Year-Old Female Patient Is Intubated And Appears To Be Breathing Asynchronously
With The Ventilator. Her Breath Sounds Are Absent On The Left Side And The Trachea
Appears To Be Shifted To The Left. The Patient Has A Dull Percussion Note On The Left
Side As Well. Which Of The Following Is The Most Likely Explanation Of These Findings?
A. A Tracheoesophageal Fistula Has Developed
B. A Tension Pneumothorax Has Developed On The Left Side
,C. The Endotracheal Tube Is In The Right Mainstem Bronchus
D. The Patient Is Experiencing Diffuse Bronchospasm
ANS: C.
Rationale: The Absence Of Breath Sounds On The Left Side And Tracheal Shift Suggests
That The Tube Has Likely Entered The Right Mainstem Bronchus, Preventing Airflow Into
The Left Lung.
7. A 63-Year-Old Female Patient Is Intubated And Receiving Mechanical Ventilation In The
Pressure-Controlled A/C Mode. If The Patient's Compliance Were To Decrease, Which Of
The Following Would You Expect To Occur?
A. Her Delivered Volume Will Decrease
B. Her Peak Pressure Will Increase
C. Her Inspiratory Time Will Increase
D. Her Peep Level Will Decrease
ANS: A.
Rationale: Decreased Compliance Means That The Lungs Are Stiffer, Requiring More
Pressure To Deliver The Same Volume, Thus Resulting In A Decrease In The Tidal Volume
Delivered.
8. A 70-Year-Old Male Patient Is Intubated And Receiving Mechanical Ventilation In The
Volume-Controlled A/C Mode. After Performing Endotracheal Suctioning, Which Of The
Following Would Indicate The Effective Clearance Of Retained Secretions?
A. An Increased Tidal Volume
B. A Decreased Inspiratory Time
C. A Decreased Plateau Pressure
D. A Decreased Peak Pressure
ANS: D.
Rationale: Effective Clearance Of Secretions Typically Results In A Decrease In Peak
Airway Pressures As The Airway Resistance Is Lowered.
9. An Adult Patient Who Is Receiving Mechanical Ventilation Suddenly Started Showing
Signs Of Tachypnea. Upon Assessment, You Note Tracheal Deviation To The Right And
Decreased Breath Sounds And Hyperresonance On The Left. Which Of The Following
Would You Recommend?
A. The Patient Needs Suctioning
B. The Patient Needs A Bronchoscopy
C. The Insertion Of A Chest Tube
, D. The Patient Needs A Thoracentesis
ANS: C.
Rationale: The Signs Suggest A Tension Pneumothorax, Which Requires Immediate
Decompression Via Chest Tube Placement.
10. A 57-Year-Old Female Patient With Acute Pulmonary Edema Is Dyspneic And Appears
To Be Wheezing. The Resident Physician Has Ordered An Albuterol Breathing Treatment
Via Svn. Which Of The Following Would You Recommend?
A. Recommend Acetylcysteine Instead Of Albuterol
B. Perform The Therapy With Supplemental Oxygen
C. Perform The Treatment As Ordered
D. Recommend A Diuretic And Oxygen Therapy
ANS: D.
Rationale: In Acute Pulmonary Edema, Addressing Fluid Overload With Diuretics And
Improving Oxygenation Is Critical, While Bronchodilators May Be Secondary.
11. A 39-Year-Old Female Patient Who Is Intubated Was Admitted To The Emergency
Department And The Nurse Was Unable To Start An Intravenous Line During Cpr. It Is
Believed That The Patient Is Suffering From A Narcotic Overdose And The Physician Wants
To Administer Naloxone. Which Of The Following Is An Alternative Route That Can Be
Used To Deliver This Medication?
A. Through The Feeding Tube
B. Aerosolized Via Svn
C. Through The Nasogastric Tube
D. Through The Endotracheal Tube
ANS: D.
Rationale: Naloxone Can Be Administered Via The Endotracheal Route When Iv Access Is
Unavailable, As It Can Rapidly Act On The Opioid Receptors.
12. A 176 Lb Male Patient Is Intubated And Receiving Volume Control A/C Ventilation
With The Following Settings: Fio2 Of 40%, Rate Of 12/Min, And Tidal Volume Of 550 Ml.
An Abg Was Analyzed And The Following Results Were Obtained: Ph 7.39, Paco2 37, Hco3
23, Pao2 107. Which Of The Following Would You Recommend?
A. Place The Patient On A 40% T-Piece And Monitor Closely
B. Switch The Patient To Simv At A Rate Of 5/Minute
C. Place The Patient On Cpap And Monitor Closely
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