NBRC RRT Exam Questions

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61.

When recommending the initial VT setting for a patient with ARDS, the respiratory therapist understands that which of the following is TRUE?

  • VT should be set lower than normal

  • VT should be set higher than normal

  • VT should be set at normal levels

  • VT should be calculated using adjusted body weight instead of ideal body weight

Correct answer: VT should be set lower than normal

Tidal volume (VT) should be set lower than normal for patients who have acute respiratory distress syndrome (ARDS) due to the decreased airway space these patients experience. 

The VT should always be calculated using ideal body weight (IBW).

62.

Which of the following is a consideration when choosing between the use of oral steroids and inhaled steroids?

  • Inhaled steroids have fewer systemic effects than oral steroids

  • Oral steroids will not treat airway inflammation

  • Both oral steroids and inhaled steroids have similar systemic effects

  • Inhaled steroids have fewer localized effects than oral steroids

Correct answer: Inhaled steroids have fewer systemic effects than oral steroids

Inhaled steroids do create less systemic effects than oral steroids but are more likely to cause localized effects in the mouth, such as causing dryness or increased risk of fungal infections. 

Oral steroids do treat airway inflammation.

63.

Which of the following aerosolized mucolytics works by increasing the pH of sputum, making it more viscous?

  • Sodium bicarbonate (2% NaHCO3)

  • Dornase alfa (Pulmozyme)

  • Acetylcysteine (Mucomyst)

  • Mannitol (Bronchitol)

Correct answer: Sodium bicarbonate (2% NaHCO3)

Sodium bicarbonate (2% NaHCO3) increases the pH of sputum, making it more alkaline and increasing its viscosity. 

Dornase alfa works by enzymatically breaking down sputum. Acetylcysteine cleaves sulfide bonds in sputum, liquifying it. The mechanism of action for mannitol is not fully understood.

64.

Use the following scenario to answer this question.

Which of the following interventions are NOT immediately indicated for this patient?

(SELECT AS MANY as you consider indicated.)

  • EKG

  • Attempting to awaken the patient

  • Defibrillation

  • Manual ventilation using a BVM

  • Chest compressions

If the patient does not have a palpable pulse and has bradypnea that could be considered agonal breathing, then chest compressions and manual ventilation should be started. 

Attempting to awaken the patient or performing an EKG are not correct interventions. Defibrillation is not indicated for pulseless electrical activity (PEA).

65.

Use the following scenario to answer this question.

Which of the following medications would the respiratory therapist anticipate that the patient may be discharged with as new prescriptions?

(SELECT AS MANY as you consider indicated.)

  • Steroids

  • Bronchodilators

  • PO antibiotics

  • Home oxygen

  • Lasix

Depending on the patient's condition at discharge, steroids, bronchodiators, and PO antibiotics may all be potential new prescriptions. Steroids could be used to decrease tracheal inflation, bronchodilators may be prescribed as a rescue medication for tracheal stenosis exacerbation, and PO antibiotics may be used to continue treatment for pneumonia. 

Home oxygen is very unlikely to be prescribed, as treated pneumonia or tracheal stenosis are both unlikely to result in the ongoing need for oxygen therapy at home. Lasix may be an existing prescription given the patient's history of heart failure, but should not be a new prescription based on the patient's course of hospitalization.

66.

Which of the following is NOT a factor when evaluating a patient's APGAR score?

  • Grasp

  • Appearance

  • Pulse

  • Activity

Correct answer: Grasp

The APGAR score is used to assess the general condition of a newborn after birth and is assessed at 1 minute and 5 minutes after birth. The APGAR score uses a score of 0-10 and evaluates:

  • Appearance (0 for generalized pale and blue, 1 for pink body but blue extremities, and 2 for completely pink)
  • Pulse (0 for no pulse, 1 for < 100 beats/minute, and 2 for > 100 beats/minute)
  • Grimace (0 for no response to irritation, 1 for grimace, and 2 for a sneeze, cough, or cry)
  • Activity (0 for limp, 1 for some flexion, and 2 for active flexion)
  • Respiration (0 for absent respiration, 1 for slow and irregular respirations, and 2 for strong cry)

Grasp is not a component of the APGAR score.

67.

A respiratory therapist with a fever, cough, and rhinitis decides to stay home from work instead of working their scheduled shift. This is an example of breaking which part of the chain of infection?

  • Reservoir

  • Portal of exit

  • Vulnerable host

  • Transmission

Correct answer: Reservoir

The reservoir is the source of a pathogen in the chain of infection. Any patient, visitor, or staff member who has an illness is a potential reservoir. By staying home with symptoms that indicate an infection, the respiratory therapist is removing a potential reservoir from the clinical environment.

68.

The respiratory therapist notes that a ventilated patient has an accumulation of condensation in their breathing circuit. What is the BEST way to take care of this condensation?

  • Dispose of it in an infectious waste container

  • Drain it back into the reservoir to conserve fluid

  • Dispose of it by pouring it down a sink

  • Dispose of it by pouring it down a toilet

Correct answer: Dispose of it in an infectious waste container

Condensation that accumulates in a breathing circuit should be considered as potentially infectious and should be disposed of accordingly. Best practice is to dispose of this in an infectious waste container, following the infectious waste guidelines of the specific institution. 

Draining condensation back into the reservoir would create an infection risk and should be avoided.

69.

Use the following scenario to answer this question.

How long would treatment for this patient be anticipated to take?

(CHOOSE ONLY ONE.)

  • 6-9 months

  • 12-18 months

  • 6-12 weeks

  • 1-3 weeks

Correct answer: 6-9 months

Treatment of drug-susceptible tuberculosis will typically take about six to nine months. If tuberculosis is drug-resistant, treatment can take much longer.

70.

The respiratory therapist is treating a 14-year-old male with asthma using an adrenergic bronchodilator. Which of the following is NOT a likely adverse effect of adrenergic bronchodilator use?

  • Hyperkalemia

  • Dizziness

  • Nausea

  • Tolerance

Correct answer: Hyperkalemia

There are several potential adverse effects of adrenergic bronchodilator use; these include dizziness, hypokalemia, loss of bronchoprotection, nausea, and tolerance to the medication. Hypokalemia, not hyperkalemia, is one of these adverse effects.

71.

When interpreting an EKG, the respiratory therapist recognizes that the P wave represents which of the following?

  • Depolarization of the atria

  • Depolarization of the ventricles

  • Repolarization of the atria

  • Repolarization of the ventricles

Correct answer: Depolarization of the atria

The P wave represents depolarization of the atria and correlates with atrial contraction. 

Depolarization of the ventricles is indicated by the QRS complex. Repolarization of the atria occurs concurrently with depolarization of the ventricles, and the electrical signal this causes it is obscured by the QRS complex. Repolarization of the ventricles is indicated by the T wave.

72.

Which of the following BEST describes an infection in the lung that is characterized by a localized accumulation of pus and destruction of the surrounding tissue?

  • Lung abscess

  • Tubercle

  • Pneumonia

  • Granuloma 

Correct answer: Lung abscess

An infection in the lung that is characterized by a localized accumulation of pus and destruction of the surrounding tissue describes a lung abscess. 

Pneumonia is an acute inflammation of the lung parenchyma caused by infectious organisms. A granuloma or a tubercle are interchangeable terms describing lung lesions caused by tuberculosis, and describe an area of encapsulated bacilli.

73.

Which of the following humidifiers is NOT an active humidifier?

  • Heat and moisture exchanger

  • Bubble humidifier

  • Vaporizer

  • Pass-over humidifier

Correct answer: Heat and moisture exchanger

Heat and moisture exchangers are a type of passive humidifier that recycles heat and humidity from the patient. 

Active humidifiers actively add heat, water, or both to the device-patient interface and include bubble humidifiers, vaporizers, and pass-over humidifiers.

74.

Use the following scenario to answer this question.

Which of the following would make the respiratory therapist suspect that the data obtained may be incorrect?

(CHOOSE ONLY ONE.)

  • The ABG was not labeled, but remained in the patient's room until it was ready to be analyzed 

  • The patient's oxygen saturation was taken on his ear, not his finger

  • The ABG sample sat for 42 minutes before it was actually tested

  • The radiology technician that took the chest X-ray only had three months of experience

Correct answer: The ABG was not labeled, but remained in the patient's room until it was ready to be analyzed 

Failure to label laboratory tests, such as an ABG, can result in the samples being attributed to the wrong patient. 

An SpO2 may be taken on a patient's ear and still be accurate. An ABG may be run up to 60 minutes after being drawn if stored correctly. Just because a member of the clinical staff is new does not necessarily mean that the results of tests they perform are likely to be inaccurate.

75.

Which of the following is NOT a benefit of using a closed suctioning system when compared to open suctioning?

  • Lower risk of increased airway resistance

  • Lower risk of infection

  • Less time spent on the ventilator

  • Less risk of cardiac arrhythmias

Correct answer: Lower risk of increased airway resistance

One risk of using a closed suctioning system is the risk of the catheter migrating into the airway, causing increased airway resistance. This risk is not present with open suctioning. 

Lower risk of infections due to the sterility of closed systems, less time spent on the ventilator, and less risk of cardiac arrhythmias due to less risk of hypoxia are all potential benefits of using a closed suctioning system.

76.

Which of the following is NOT a possible cause of a false high-temperature reading for a heated humidifier?

  • Temperature overshoot due to flow changes

  • Thermistor probe too close to the Y adapter

  • Damaged or defective thermistor probe

  • Thermistor probe is in a radiant warmer

Correct answer: Temperature overshoot due to flow changes

A temperature overshoot due to flow changes is a true high temperature and may indicate the need for intervention, or may be transient, depending upon the circumstances. 

A thermistor probe too close to the Y adapter, a damaged or defective thermistor probe, or a thermistor probe that is in a radiant warmer would all cause false high-temperature readings.

77.

Which of the following variables does NOT significantly affect the function of a humidifier?

  • Gas composition

  • Thermal mass

  • Contact time

  • Surface area

Correct answer: Gas composition

There are four variables that affect the function of a humidifier. These include the thermal mass, contact time, surface area, and the temperature. 

The gas composition does not significantly affect how the humidifier functions.

78.

Use the following scenario to answer this question.

Which of the following recommendations are MOST appropriate for this patient?

(SELECT AS MANY as you consider indicated.)

  • Intubating the patient

  • Transferring the patient to the ICU

  • Having a head CT ordered

  • Increasing the oxygen to 6L per NC

  • Having the patient evaluated by a general surgeon

The patient's declining respiratory status combined with symptoms that indicate septic shock is likely make intubating the patient and having them transferred to the ICU correct interventions. While it may be less likely that the patient's condition is related to a neurological process, neurological changes do still make a head CT appropriate. 

Increasing the oxygen to 6L per NC is unlikely to adequately address the patient's change in respiratory function. Having the patient evaluated by a general surgeon is not relevant to their change in condition.

79.

A 55-year-old female with a 45 pack-year smoking history presents with shortness of breath. She has no medical history but states that she doesn't go to doctors. The following ABG result is obtained:

pH 7.39

PaCO2 71 torr

PaO2 71 torr

HCO3- 37 mEq/L

BE +16

Which of the following conditions are these values consistent with?

  • Chronic respiratory acidosis

  • Acute respiratory acidosis

  • Chronic metabolic alkalosis

  • Acute metabolic alkalosis

Correct answer: Chronic respiratory acidosis

A normal pH with an abnormal PaCO2 and HCO3- indicates that the patient's blood gas level is compensated, which further indicates the underlying condition is chronic. The patient presents with risk factors for COPD, which is a common cause of respiratory acidosis, and no history that would suggest a chronic metabolic alkalosis. The patient's pH also leans more towards acidosis than alkalosis, albeit only slightly. These findings, taken together, make chronic respiratory acidosis the best answer.

80.

You are called to evaluate a patient who has what is described as Cheyne-Stokes respiration. Which of the following conditions is NOT likely to cause Cheyne-Stokes respiration?

  • Pulmonary embolism (PE)

  • Congestive heart failure (CHF)

  • Encephalopathy

  • Opioid overdose

Correct answer: Pulmonary embolism (PE)

Cheyne-Stokes respiration is a breathing period that involves a pattern of breathing that increases and decreases in depth and rate with periods of apnea. Common causes of Cheyne-Stokes respiration include congestive heart failure, encephalopathy, and drug overdose (especially central nervous system depressants). 

Pulmonary embolisms are not typically a cause of Cheyne-Stokes respiration.