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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 10 of 25

181.

You are called to evaluate a patient who may have a complete upper airway obstruction. Which of the following is NOT expected to be present if the patient has a complete upper airway obstruction?

  • Stridor on inspiration

  • Cyanosis

  • Extreme panic

  • Sternal retractions

Correct answer: Stridor on inspiration

Stridor is a crowing, tasing sound on inspiration caused by a partial upper airway obstruction. The presence of stridor indicates that there is still some airflow in the upper airways and that the obstruction is not complete. 

Cyanosis is certainly possible with complete upper airway obstruction. A conscious patient with a complete upper airway obstruction will exhibit extreme panic and will have sternal, intercostal, and epigastric retractions until respiratory arrest occurs.

182.

Which of the following terms BEST describes paradoxical respirations?

  • Respirations in which the chest moves in on inspiration and out on expiration

  • Respirations in which the respiratory rate oscillates between periods of rapid, deep breaths and slow, shallow breaths

  • Respirations in which series of breaths alternate between using the diaphragm and the rib cage muscles

  • Respirations that cause no movement of the chest or abdomen

Correct answer: Respirations in which the chest moves in on inspiration and out on expiration

Paradoxical respirations are respirations in which the chest moves opposite of normal, meaning that it moves in on inspiration and out on expiration. 

Respirations in which the respiratory rate oscillates between periods of rapid, deep breaths and slow, shallow breaths indicate a periodic breathing pattern, not paradoxical respirations. Respirations in which series of breaths alternate between using the diaphragm and rib cage muscles describes respiratory alternans. There is no condition in which respirations occur that cause no movement of the chest or abdomen.

183.

Which of the following conditions does NOT require additional consideration when administering an anticholinergic agent?

  • Diarrhea

  • Narrow-angle glaucoma

  • Bladder neck obstruction

  • Bowel obstruction

Correct answer: Diarrhea

Anticholinergic agents inhibit acetylcholine receptors, reducing muscle activity. This can have rare, but potentially negative, effects on conditions that are related to muscle tone. These include narrow-angle glaucoma, bladder neck obstruction, and bowel obstruction. 

Constipation would be a concern, but the effects of an anticholinergic agent on diarrhea may actually be positive.

184.

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.

185.

Which of the following inhaled medications has the SHORTEST duration of therapeutic effect?

  • Levalbuterol

  • Salmeterol

  • Formoterol 

  • Olodaterol

Correct answer: Levalbuterol

Levalbuterol is a short-acting adrenergic bronchodilating agent (SABA). Salmeterol, formoterol, and olodaterol are all long-acting adrenergic bronchodilating agents (LABAs). Levalbuterol has a duration of 5 to 8 hours, while salmeterol, formoterol, and olodaterol have a duration of 12 hours.

186.

A nurse calls you to evaluate a patient who has begun exhibiting Biot's respiration. Which of the following is MOST likely to cause Biot's respiration?

  • Stroke

  • Metabolic acidosis

  • Status asthmaticus

  • Acute respiratory distress syndrome (ARDS)

Correct answer: Stroke

Biot's respiration is a chaotic breathing pattern that creates frequent irregularities in rate and tidal volume. This respiratory pattern eventually deteriorates into agonal breathing, then apnea. Biot's respiration is normally caused by damage to the medulla or pons. A stroke, or brain attack, is the only condition listed that could cause damage to these neurological structures.

187.

The respiratory therapist is reviewing the history of a 45-year-old male who has emphysema. The patient reports that he never smoked, but that COPD runs in his family. Which of the following is MOST likely true about this patient?

  • He has an alpha-1 antitrypsin deficiency

  • He is hiding his smoking history

  • His diagnosis of emphysema may be a misdiagnosis

  • His emphysema is likely secondary to a cancerous pathology

Correct answer: He has an alpha-1 antitrypsin deficiency 

While emphysema is most often caused by smoking, it can also be caused by an alpha-1 antitrypsin deficiency. Patients who have an alpha-1 antitrypsin deficiency will often develop emphysema in the fourth to fifth decade of life, compared to those who develop emphysema from smoking, who typically develop symptoms in the sixth to seventh decade of life. Patients with alpha-1 antitrypsin deficiency also tend to have a family history of alpha-1 antitrypsin deficiency. 

It is possible that he is hiding a smoking history, but an alpha-1 antitrypsin deficiency is more likely, given the other factors described. There is nothing to indicate that his emphysema may have been misdiagnosed or that it is secondary to a malignancy.

188.

The respiratory therapist is helping select the appropriate endotracheal (ET) tube for a 29-year-old female. Which of the following tube sizes would be BEST for this patient?

  • 7.5 mm

  • 8.5 mm 

  • 6.5 mm 

  • 6.0 mm 

Correct answer: 7.5 mm

The correct ET tube size for an adult female is between 7.5-8.0 mm inner diameter. 

An ET tube that is 8.5 mm would fall into the 8.0-9.0 mm size that is better for adult male patients. An ET tube that is 6.5 mm could be used for patients between the ages of 8 and 18 years of age. An ET tube that is 6.0 mm could be used for patients between the ages of 6 and 12 years old.

189.

The respiratory therapist is reviewing a patient's chart and notes that the patient's recent creatine level is elevated. What impact does this have on the patient's respiratory care?

  • This could indicate renal impairment that could lead to impaired pulmonary gas exchange.

  • This could indicate decreased myocardial circulation, which could affect systemic circulation.

  • This indicates anaerobic metabolism from decreased oxygen supply to tissues.

  • This abnormality has no impact on the patient's respiratory care.

Correct answer: This could indicate renal impairment that could lead to impaired pulmonary gas exchange.

Creatinine is a waste product that is removed by the kidneys and is an indicator of kidney function. Renal impairment could lead to congestive heart failure and pulmonary edema, which could subsequently lead to impaired pulmonary gas exchange. 

Creatinine may be elevated during anaerobic metabolism, as renal perfusion is affected by the cause of the anaerobic metabolism, but is not a good indicator of anaerobic metabolism. Creatinine levels are not related to myocardial circulation.

190.

Which of the following BEST describes what D-dimer is?

  • A protein fragment that is found in the blood when a fibrin clot is dissolving

  • A test that determines how long clot formation takes using a specific clotting pathway

  • An enzyme that is produced to dissolve a pulmonary embolism (PE) or other fibrin clot

  • A variable test that is calculated into an international normalized ratio (INR) to describe coagulation timing

Correct answer: A protein fragment that is found in the blood when a fibrin clot is dissolving

D-dimer is a protein fragment that is found in the blood when a fibrin clot is dissolving and can indicate the presence of a pulmonary embolism (PE), deep vein thrombosis (DVT), or disseminated intravascular coagulation (DIC). 

D-dimer is a protein fragment that results from a fibrin clot dissolving, and is not an enzyme that promotes this process. Prothrombin time (PT) or partial thromboplastin time (PTT) are used to evaluate how long clot formation takes using two different specific clotting pathways. PT results are variable, and the test is calculated into an international normalized ratio (INR) to describe coagulation timing of that clotting pathway.

191.

The respiratory therapist is treating a patient who is suspected to be in septic shock. Which of the following laboratory tests would NOT be used to evaluate for septic shock?

  • Lactate dehydrogenase (LDH)

  • Procalcitonin

  • White blood cells (WBC)

  • Lactic acid

Correct answer: Lactate dehydrogenase (LDH)

Lactate dehydrogenase (LDH) is an enzyme that is used to assess for tissue damage that can occur with many conditions. LDH is not used to evaluate for septic shock. 

Lactic acid builds up as a byproduct of anaerobic cellular metabolism and is elevated when oxygen delivery to peripheral tissues is insufficient. Lactic acid levels are used to evaluate for septic shock. Procalcitonin is released in response to bacterial infections, especially in the case of sepsis. Procalcitonin levels correlate with the severity of the infection and are used to evaluate for sepsis. White blood cell (WBC) levels increase as part of the immune response to infection or stress and elevated WBC level is an indicator of sepsis.

192.

Which of the following processes describes the process of autoclaving a piece of equipment?

  • The piece of equipment is heated with pressurized steam

  • The piece of equipment is immersed in hot water for several hours

  • The piece of equipment is exposed to ethylene oxide gas for a prolonged period

  • The piece of equipment is immersed in glutaraldehyde for several hours

Correct answer: The piece of equipment is heated with pressurized steam

Autoclaving a piece of equipment involves exposing the piece of equipment to heat by using pressurized steam. 

Immersing a piece of equipment in hot water for a period of time is called pasteurization. Chemicals like ethylene oxide gas and glutaraldehyde can be used to sterilize equipment, but this does not describe the process of autoclaving.

193.

Which of the following is NOT a component of the Silverman scoring system?

  • Expiratory wheezing

  • Intercostal retractions

  • Nasal flaring

  • Xiphoid retractions

Correct answer: Expiratory wheezing

The Silverman scoring system scores five criteria, with a score of 0 being the best and a score of 10 being the worst. The five criteria the score is based on are intercostal retractions, xiphoid retractions, chest lag or paradoxical breathing, nasal flaring, and an expiratory grunt.

194.

A lesion found during a patient's chest CT is described as a nodule. What is TRUE about this finding?

  • The lesion is less than 3 cm in diameter

  • The patient likely has lung cancer

  • A transthoracic needle biopsy is needed to further evaluate this lesion

  • The lesion has a diameter of at least 14 mm

Correct answer: The lesion is less than 3 cm in diameter

A nodule is a lesion seen on a CT that is less than 3 cm in diameter, while a mass is a lesion that is greater than 3 cm. 

A nodule does not necessarily mean that a patient has lung cancer and further information is needed about the nodule to make this determination. A transthoracic needle biopsy could be needed if further evaluation of this lesion is indicated, but this requires consideration of the broader clinical context. The presence of a nodule does not indicate that the lesion is at least 14 mm; however, a wall thickness of 14 mm or greater for a cavitary lesion may represent cancer.

195.

Which of the following is LEAST likely to increase the risk of bronchopulmonary dysplasia (BPD) for a newborn patient?

  • Hypoxia

  • Barotrauma

  • Volutrauma

  • Aspiration

Correct answer: Hypoxia

There are several possible causes for bronchopulmonary dysplasia (BPD), but it primarily occurs with prolonged positive pressure ventilation and supplemental oxygen use. Hypoxia is not a known cause of BPD. 

Barotrauma, volutrauma, and aspiration are all possible causes of BPD.

196.

Which of the following is NOT an advantage of active heated humidity over passive heat and moisture exchangers?

  • They have lower cost

  • They have wide applications

  • They offer control over a range of temperatures

  • They provide optional absolute humidity 

Correct answer: They have lower cost

There are many advantages and disadvantages when comparing passive heat and moisture exchangers and active heated humidity. Some of the advantages of active heated humidity include their wide applications, the offer of control over a range of temperatures, and the fact that they provide optional absolute humidity. They are, however, more expensive than passive heat and moisture exchangers.

197.

The respiratory therapist is called to evaluate a 25-year-old male who is in the emergency department for a broken tibia and has an SpO2 reading of 82%. The patient has a normal respiratory rate, is not using accessory muscles, and has normal coloration. 

Which of the following interventions is BEST for this patient?

  • Check and adjust the pulse oximeter probe

  • Place the patient on 35% O2 via an air-entrainment mask

  • No intervention is needed

  • Obtain an ABG

Correct answer: Check and adjust the pulse oximeter probe

The patient's condition is not congruent with the oximeter reading and likely indicates that the SpO2 reading is incorrect. The pulse oximeter probe should be checked and adjusted to obtain an accurate reading. 

Placing the patient on oxygen is not necessary unless it has been verified that the reading is correct, which would be unlikely. While the patient's condition does not seem to warrant any treatments, adjusting the misreading pulse oximeter is still necessary. An ABG would not be necessary unless the SpO2 reading is verified as being correct.

198.

Which of the following laboratory values may be significantly affected by continuous nebulization therapy using beta-agonists?

  • Potassium

  • Sodium

  • Calcium

  • Magnesium

Correct answer: Potassium

Beta-agonists can increase serum glucose levels and decrease serum potassium levels. This will not typically be noticeable with lower levels of beta-agonist use, but with continuous nebulization therapy or with prolonged therapy that combines short and long-acting beta-agonists, this effect can be clinically significant.

199.

The respiratory therapist is evaluating a 62-year-old female and notes digital clubbing. Which of the following diseases does this finding indicate the patient could have?

  • Any disease that causes chronic hypoxemia

  • Chronic obstructive pulmonary disease (COPD)

  • Emphysema

  • Any disease that causes chronic hypercapnia

Correct answer: Any disease that causes chronic hypoxemia

While chronic obstructive pulmonary disease (COPD) is the most common cause of digital clubbing, it is by no means the only condition that causes this. Other causes can include bronchogenic cancer, bronchiectasis, interstitial lung disease, liver disease, inflammatory bowel disease, and cystic fibrosis. Digital clubbing occurs due to chronic hypoxemia (not hypercapnia), and any disease that causes chronic hypoxemia should be considered.

200.

When using a pressurized Metered Dose Inhaler (pMDI), which of the following is NOT a potential benefit of using a spacer?

  • It increases the dose that the pMDI provides

  • It eliminates hand-breathing coordination problems

  • It reduces oropharyngeal deposition of the drug

  • It helps patients with small tidal volumes to get the full dose

Correct answer: It increases the dose that the pMDI provides

While a spacer increases the percentage of small particles that are produced by a dose, it does not actually increase the dose that a pMDI provides. 

Use of a spacer does eliminate hand-breathing coordination problems by eliminating the need to synchronize inhalation and attenuation. It also reduces oropharyngeal deposition of the drug and helps patients with small tidal volumes to get the full dose.

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