NBRC RRT Exam Questions

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21.

When labeling equipment that is being autoclaved, which of the following is NOT a detail that is necessary to include?

  • The steam pressure and temperature used during processing

  • The time and date of processing

  • What equipment is being processed

  • Who prepared the equipment for processing

Correct answer: The steam pressure and temperature used during processing

The steam pressure and temperature used during processing for a specific cycle may be recorded in the autoclave's log, but is not included on the packaging label. 

The time and date of processing, what equipment was processed, and who prepared the equipment for processing should all be included on the packaging label.

22.

How much of the initial dose of an MDI will actually reach the lower airways if correct technique is used?

  • 10%

  • 30%

  • 50%

  • 80%

Correct answer: 10%

Only 10% of the full dose of an MDI administration will actually reach the lower airways. Optimizing delivery and ensuring that the correct technique is followed is vital, given the small percentage that actually acts on the target site.

23.

Which of the following conditions would make use of a dry powder inhaler ineffective?

  • Bronchospasms

  • Chronic obstructive pulmonary disorder (COPD)

  • Asthma

  • Pulmonary embolism (PE)

Correct answer: Bronchospasms

Bronchospasms significantly impede airflow and reduce a patient's inspiratory flow ability beyond the threshold needed for dry powder inhalers (DPIs) to be effective (60L/min). 

Asthma typically affects expiratory flow ability more than inspiratory and does not have enough of an effect to render a DPI ineffective except for in extreme situations. COPD also does not affect inspiratory flow to such an extent that DPI would likely be ineffective. While DPI would not be used to treat a PE, a PE does not affect the use of a DPI.

24.

The respiratory therapist is helping provide care to a patient who is in cardiac arrest. Which of the following medications should NOT be administered via the patient's endotracheal (ET) tube?

  • Amiodarone

  • Vasopressin

  • Epinephrine

  • Lidocaine

Correct answer: Amiodarone

Amiodarone should not be administered via an ET tube. 

The drugs that can be administered via an ET tube can be remembered through the acronym NAVEL and include Naloxone, Atropine, Vasopressin, Epinephrine, and Lidocaine.

25.

The respiratory therapist administers an adrenergic bronchodilator to a patient and notes a 20% improvement in FEV1 using spirometry immediately after the treatment. Should the respiratory therapist report that this patient has a reversible airflow obstruction?

  • Data about the volume increase in FEV1 is needed to make this determination.

  • The patient does not have a reversible airflow obstruction.

  • The patient does have a reversible airflow obstruction.

  • The FEV1 will need to be measured one hour after the treatment to make this determination.

Correct answer: Data about the volume increase in FEV1 is needed to make this determination.

In order to determine if an airflow obstruction is reversible, the respiratory therapist should look for a rise in the forced expiratory volume over one second (FEV1) of at least 12% and at least 200 mL. The volume must be taken into consideration because patients with a very small FEV1 may have large percentage changes without meaningful volume changes. 

The FEV1 should not be evaluated an hour later to make this determination, but additional data is needed.

26.

Which of the following radiographic features is NOT indicative of an alveolar process?

  • Cysts

  • Air bronchograms

  • Acinar nodules

  • Fluffy opacities

Correct answer: Cysts

Cysts are a radiographic finding that is indicative of interstitial lung disease. The interstitium of the lung represents the framework of scaffolding of the lung that supports the vessels and bronchi, and interstitial lung diseases have different radiographic features from alveolar lung diseases, which are diseases that affect the alveoli. 

Air bronchograms, acinar nodules, and fluffy opacities are all radiographic features of alveolar lung processes.

27.

Which of the following is a consideration when using intrapulmonary percussive ventilation?

  • Bronchodilating or mucolytic agents can be given during therapy

  • The patient must be intubated

  • Therapist technique has a significant influence on the effectiveness of this therapy

  • The patient must be able to tolerate the fixed length of each percussive cycle

Correct answer: Bronchodilating or mucolytic agents can be given during therapy

A patient who is receiving intrapulmonary percussive ventilation can receive bronchodilating or mucolytic agents during therapy. 

Intubation is not necessary to receive intrapulmonary percussive ventilation. Intrapulmonary percussive ventilation is not affected by therapist technique, and the length of each percussive cycle can be directly controlled by the patient.

28.

Which of the following Glasgow Coma Scores (GCSs) means that the patient is comatose but not completely unresponsive?

  • 6

  • 3

  • 14

  • 1

Correct answer: 6

The Glasgow Coma Score (GCS) is a score that is used to evaluate a patient's neurological function. This score is obtained by evaluating three criteria: best eye response, best verbal response, and best motor response. Each criterion is graded on a scale where 1 is the lowest, and the high end ranges between 4 and 6, depending upon the criteria. The worst score a patient can have is 3, and the best is 15. 

A GCS of 8 or less means that the patient is comatose, while a GCS of 3 indicates the patient is totally unresponsive. A GCS of 4-8 meets the specifications described in the question, and 6 is the only answer choice within that range.

29.

Which of the following is NOT a desired benefit of using permissive hypercapnia to treat acute respiratory distress syndrome (ARDS)?

  • Change in intracranial pressure (ICP)

  • Sedation

  • Shift in the oxyhemoglobin dissociation curve

  • Decrease in the production of inflammatory chemical mediators

Correct answer: Change in intracranial pressure (ICP)

Hypercapnia does lead to an increase in intracranial pressure (ICP); however, increased ICP is not normally a desired outcome. 

Permissive hypercapnia does increase sedation and does cause a shift in the oxyhemoglobin dissociation curve to the right, increasing oxygen delivery to tissues. Hypercapnia also decreases the production of inflammatory chemical mediators.

30.

The respiratory therapist is administering positive expiratory pressure (PEP) therapy, and it does not seem to be effective. Which of the following changes should the respiratory therapist make?

  • Increase the PEP by 3-5 cm H2O

  • Increase the PEP in increments of 10 cm H2O

  • No changes are needed; therapy will be effective even when it seems not to be

  • Switch to a different type of therapy

Correct answer: Increase the PEP by 3-5 cm H2O

During positive expiratory pressure (PEP) therapy, PEP can be increased by 3 to 5 cm H2O if the therapy seems to be ineffective; however, the patient should continue to be monitored. 

Increasing the PEP in increments of 10 cm H2O would be too much of a change and could be poorly tolerated. The effectiveness of therapy will be evident based on the patient's response, their increased coughing as secretions are mobilized, and the productiveness of their cough. Switching to another form of therapy would be necessary if the patient were unable to tolerate higher PEP, but the PEP should be adjusted before other options are considered.

31.

Which chest radiograph position is MOST commonly used?

  • Posteroanterior (PA)

  • Anteroposterior (AP)

  • Lateral

  • Oblique

Correct answer: Posteroanterior (PA)

The posteroanterior (PA) position is the most commonly used position. In this position, the x-ray passes through the patient from the back to the anterior chest. 

An anteroposterior (AP) position is the same as the PA position but reversed, with the x-ray passing through the chest from the front of the chest to film behind the patient's back. A lateral position is obtained from the patient's side and passes through the chest laterally. The oblique position is obtained with the patient turned 45 degrees to either the right or left.

32.

When transporting a patient with cystic fibrosis from their room to a CT scan, the respiratory therapist places a mask on the patient. Which of the following is the rationale for this?

  • The patient likely has pathogens that can be transmitted to other patients

  • There is no correct rationale for this, this patient does not require a face mask

  • Cystic fibrosis is contagious and a face mask can reduce transmission of this condition

  • The mask is necessary due to the immunocompromised state of the patient

Correct answer: The patient likely has pathogens that can be transmitted to other patients

Patients with cystic fibrosis (CF) are at risk for recurrent respiratory infection, developing bronchiectasis, and acquiring resistant pathogens. CF guidance recommends that patients with CF wear masks whenever they are outside their hospital room to avoid transmitting infections to other compromised patients. 

Mask use for this patient does have a rationale and is necessary. CF is not contagious, and a face mask does not lower the risk of others acquiring this condition. CF patients may wear masks to protect themselves, but this is not due to an immunocompromised state. The primary rationale is to protect other potentially compromised patients from organisms they are likely carrying.

33.

The respiratory therapist is filling the reservoirs of mist tents on a pediatric floor. Which of the following actions is INCORRECT?

  • Only using sterile water when topping off partially full reservoirs

  • Waiting until immediately before use to fill a mist tent's reservoir

  • Only using sterile water to fill an unused reservoir

  • Keeping track of how long it has been since the water has been changed in each reservoir

Correct answer: Only using sterile water when topping off partially full reservoirs

Partially full reservoirs should be emptied and refilled with sterile water. Topping off reservoirs, even with sterile water, can give the old water time to grow pathogens and is not considered good infection prevention. 

Waiting until immediately before use to fill a reservoir, only using sterile water, and keeping track of how long it has been since the last water change are all good ways to prevent infection.

34.

Use the following scenario to answer this question.

Which of the following are LIKELY true regarding the patient's pneumonia?  

(SELECT AS MANY as you consider indicated.)

  • It may be unclear where she got it from

  • Accidently inhaling some bacteria while swimming could have been a potential cause

  • Accidently inhaling some bacteria while eating could have been a potential cause

  • Accidently inhaling some bacteria while at the dentist could have been a potential cause

  • Exposure to respiratory infection while working in a doctor's office may have been a potential cause

Community-acquired pneumonia is acquired outside of a healthcare setting. Accidently inhaling some bacteria while swimming or eating could have been potential causes of community-acquired pneumonia. It may also be unclear where it came from. 

Exposure to infectious organisms during dental procedures or while working in a healthcare setting would more likely be considered nosicomial pneumonia, not community-acquired pneumonia.

35.

Which of the following conditions is NOT a potential contraindication for pulmonary rehab?

  • Pregnancy

  • Need for cardiovascular monitoring due to cardiovascular instability

  • Pulmonary malignancy

  • Severe arthritis

Correct answer: Pregnancy 

Pregnancy is not a potential contraindication for pulmonary rehab. 

The need for cardiovascular monitoring due to cardiovascular instability or a pulmonary malignancy are normally contraindications for pulmonary rehab. Pulmonary rehab may be contraindicated for patients with severe arthritis, and these patients should be considered on a case-by-case basis.

36.

Which of the following could cause a sudden decrease in PETCO2 in a patient who is being monitored using capnography?

  • Leakage in the circuit

  • Hyperventilation

  • Decreased pulmonary perfusion

  • Injection of sodium bicarbonate

Correct answer: Leakage in the circuit

A leakage in the circuit is the only one of these options that would lead to a decrease in CO2 levels that occurs suddenly. 

Hyperventilation and decreased pulmonary perfusion would both lead to decreased PETCO2 levels, but this change would be gradual, not sudden. An injection of sodium bicarbonate would lead to a sudden increase, not a sudden decrease in CO2 levels.

37.

The respiratory therapist is treating a patient who has cystic fibrosis when the patient asks why they developed cystic fibrosis. Which of the following factors causes cystic fibrosis?

  • Genetics

  • Infection

  • Smoking

  • Scarring

Correct answer: Genetics

Cystic fibrosis is a genetic condition that can occur when both the patient's biological parents are carriers or have the disease. Genetic transmission is the only way of acquiring cystic fibrosis. 

Infection and smoking will not cause cystic fibrosis to develop. Pulmonary fibrosis can result from scarring on the lungs, but is separate from cystic fibrosis, which is not caused by scarring.

38.

Which of the following conditions would be LEAST likely to cause a heart murmur when auscultating the patient's heart sounds?

  • Atrial fibrillation

  • Aortic valve disease

  • Mitral valve disease

  • Tricuspid valve insufficiency

Correct answer: Atrial fibrillation

Heart murmurs occur when blood flows in a turbulent fashion through heart structures that are narrowed. Heart murmurs are caused by incomplete closure of heart valves in most situations. Aortic valve disease, mitral valve disease, and tricuspid valve insufficiency are all conditions affecting the heart valves and all can lead to heart murmurs. 

Atrial fibrillation is related to the electrical conduction of the heart and will not result in a heart murmur, but will cause an abnormal heart rhythm.

39.

When a piece of equipment from an isolation room needs to be sterilized, what action should the respiratory therapist take when transporting it to the area where the equipment will be sterilized?

  • The piece of equipment should be placed in one bag in the isolation room, then placed into a second bag outside the isolation room.

  • The piece of equipment should be placed in two bags in the isolation room prior to transporting.

  • The piece of equipment only needs to be placed into one bag, but that bag cannot enter the room.

  • The piece of equipment should be sanitized in the room.

Correct answer: The piece of equipment should be placed in one bag in the isolation room, then placed into a second bag outside the isolation room.

The piece of equipment should be placed in one bag in the isolation room. Someone outside the isolation room should have a second bag that the first bag can be dropped into without contacting the outside environment. This allows the equipment to be double-bagged while not contaminating the outside environment. 

Double bagging the piece of equipment inside the room would spread the infectious organism outside the room. The item should be double bagged. Sanitizing the equipment at the bedside is not typically feasible and would not be sanitary within an isolation room.

40.

You are the respiratory therapist monitoring a comatose patient who is being transported by air. Which of the following considerations is MOST important?

  • ET tube cuff pressure will increase with higher altitudes

  • An untreated pneumothorax will increase in size as the aircraft descends

  • Patient monitoring will be more difficult in fixed-wing aircraft than in helicopters

  • O2 concentrations may need to be decreased when traveling in an unpressurized aircraft that is ascending

Correct answer: ET tube cuff pressure will increase with higher altitudes

As altitude increases, atmospheric pressures become lower, making the pressure in any sealed container increase. This will lead to an increase in pressure in an ET tube cuff as the aircraft ascends. 

The same principle will lead to a decrease, not an increase, in the size of an untreated pneumothorax when the aircraft descends. Patient monitoring is more difficult in helicopters than it is in fixed-wing aircraft due to non-linear flight patterns and increased noise levels. O2 concentrations may need to be increased when traveling in an unpressurized aircraft that is ascending as the atmospheric pressure and PO2 will decrease.