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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 2 of 25

21.

Which of the following correctly describes obligate aerosol transmission of a disease?

  • Transmission only occurs through airborne aerosols

  • Transmission occurs through multiple routes, but airborne transmission dominates

  • Transmission occurs through multiple routes, but airborne transmission is possible in some situations

  • Airborne transmission is only possible under artificial conditions

Correct answer: Transmission only occurs through airborne aerosols

Obligate aerosol transmission describes transmission that only occurs through airborne aerosols. 

Transmission that occurs through multiple routes, but in which airborne transmission dominates is called preferential aerosol transmission. Transmission that occurs through multiple routes, but in which airborne transmission is possible in some situations describes opportunistic aerosol transmission.

22.

When administering medications using a pressurized metered dose inhaler (pMDI), what does the "tail-off effect" refer to?

  • Variability in the amount of the drug dispensed toward the end of the life of the canister

  • Variability in the pressure dispensed toward the end of the life of the canister

  • Decreased dosage experienced when actuating too late during inspiration

  • Decreased dosage experienced when a pMDI is used at a lower temperature

Correct answer: Variability in the amount of the drug dispensed toward the end of the life of the canister

The tail-off effect refers to the variability in the amount of the drug dispensed toward the end of the life of the canister. This variability will occur after the maximum recommended doses have been given, and doses that are variable should not be administered. 

While decreased dosages are experienced if actuation is out of phase with inspiration or if the pMDI canister is cold, the tail-off effect does not describe these conditions.

23.

Which of the following BEST describes the mechanism of action of aerosolized acetylcysteine (Mucomyst)?

  • Breaks the sulfide bonds in sputum

  • Increases the pH of sputum

  • Dilates bronchials by stimulating beta-2 receptors

  • Dilutes sputum, decreasing its viscosity

Correct answer: Breaks the sulfide bonds in sputum

Acetylcysteine (Mucomyst) works by breaking the sulfide bonds in sputum, decreasing its viscosity. 

Acetylcysteine does not change the pH of sputum, but is more efficacious at higher pH levels. Acetylcysteine is not a bronchodilator and does not work by diluting sputum.

24.

Which of the following is NOT a potential hazard that the respiratory therapist should consider when using an ultrasonic nebulizer?

  • Thickening of secretions

  • Bronchospasms

  • Swelling of secretions

  • Electrical shock

Correct answer: Thickening of secretions

When using an ultrasonic nebulizer, bronchospasms are a potential hazard, as with any aerosol therapy. Ultrasonic nebulizers can hydrate secretions at a faster rate than other nebulizers. This can lead to swelling of secretions and possible airway obstruction. Ultrasonic nebulizers also must be plugged in to be operated, increasing the risk of electrical shock. 

Because ultrasonic nebulizers can hydrate secretions, they are unlikely to cause secretions to thicken.

25.

Which of the following, if done 30 minutes prior to an exhaled nitric oxide (FENO) analysis, will NOT influence FENO levels?

  • Incentive spirometry

  • Alcohol use

  • Exercise

  • Smoking

Correct answer: Incentive spirometry

NO is produced as a gas by macrophages, eosinophils, and endothelial and epithelial cells. NO increases when airway inflammation occurs, but can also be increased by exercise, alcohol use, certain foods and medications, and by smoking. These should all be avoided in the hour prior to testing. 

Incentive spirometry will not increase NO levels.

26.

The respiratory therapist is helping a doctor determine the prognosis of a patient who has ventilator-associated Pneumonia (VAP). Which of the following factors does NOT lead to increased mortality rates in patients with VAP?

  • Surgical diagnosis

  • Renal failure

  • P. aeruginosa infection

  • Inappropriate antibiotic therapy

Correct answer: Surgical diagnosis

A non-surgical diagnosis, not a surgical diagnosis, is associated with higher mortality rates in patients with VAP. 

Increased mortality rates are associated with certain comorbidities that include renal failure, with certain infectious organisms that include P. aeruginosa, and with inappropriate use of antibiotic therapy.

27.

You are the respiratory therapist treating a patient who has bronchiolitis. Which of the following is MOST likely to cause bronchiolitis?

  • Respiratory syntactical virus (RSV)

  • Smoking

  • Exposure to asbestos

  • Pneumonia

Correct answer: Respiratory syntactical virus (RSV)

Bronchiolitis is an inflammation of the bronchioles that is most commonly seen in children two years or younger. Bronchiolitis is most commonly caused by an RSV infection, but can be caused by influenza or adenovirus infections. 

Bronchitis, not bronchiolitis, is likely to be caused by smoking. Exposure to asbestos is not associated with an increased risk of bronchiolitis. Pneumonia is also not associated with the development of bronchiolitis.

28.

How often should the respiratory therapist schedule suctioning for a patient with sepsis who has an endotracheal tube and is on a mechanical ventilator?

  • Suctioning should not be scheduled for this patient

  • Not enough factors are known to know how frequently the patient should be suctioned

  • Every two hours

  • Every four hours

Correct answer: Suctioning should not be scheduled for this patient

While the assessment of the need for suctioning can and should be regularly scheduled, suctioning should not be regularly scheduled. The potential negative effects of suctioning make it an intervention that should only be performed when medically indicated.

29.

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.

30.

The respiratory therapist is preparing to administer a dry powder inhaler (DPI). Which of the following inspiratory flow rates is the minimum inspiratory flow rate that a patient should be able to generate to use this medication?

  • 40 L/min

  • 20 L/min

  • 30 L/min

  • 50 L/min

Correct answer: 40 L/min

A patient must have an inspiratory flow rate of at least 40 L/min to produce a respirable powder aerosol. Higher flow rates are preferred; however, a flow rate lower than this is not likely to fully aerosolize the medication, decreasing its effectiveness.

31.

When considering the respiratory rate (RR) setting on a mechanical ventilator, the RR should be set lower for which of the following conditions?

  • COPD

  • ALS

  • ARDS

  • Meconium aspiration syndrome

Correct answer: COPD

RR should be set to 10-12 breaths/min for patients with chronic obstructive pulmonary disease (COPD) to allow for permissive hypercapnia in these patients. 

The RR for a patient with amyotrophic lateral sclerosis (ALS) should be set at a normal initial setting of 10-16 breaths/min. Acute respiratory distress syndrome (ARDS) will require a higher respiratory rate than normal. A patient with meconium aspiration syndrome will be ventilated at a normal rate for their age.

32.

Which of the following types of nebulizer has the LONGEST treatment time?

  • Jet nebulizer

  • Ultrasonic nebulizer

  • Mesh nebulizer

  • Smart nebulizer

Correct answer: Jet nebulizer

A jet nebulizer provides the longest treatment time. 

The treatment time using an ultrasonic nebulizer is more intermediate when compared to other nebulizer treatment lengths. Mesh nebulizers and smart nebulizers have relatively short treatment times.

33.

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.

34.

Which of the following causes hyperresonance with percussion?

  • A greater proportion of air than tissues under the area being percussed

  • An equal proportion of air and tissues under the area being percussed

  • A greater proportion of tissues than air under the area being percussed

  • Only air without tissues under the area being percussed

Correct answer: A greater proportion of air than tissues under the area being percussed

Hyperresonance is caused by a greater proportion of air than tissues under the area that is being percussed.  

Equal proportions of air and tissues cause resonance with percussion. A greater proportion of tissues than air causes dullness with percussion. Areas that contain only air without tissues will cause tympany with percussion.

35.

Which of the following aerosolized mucolytics is unstable at room temperature, requiring additional storage considerations that include refrigeration and protection from light?

  • Dornase alfa (Pulmozyme)

  • Acetylcysteine (Mucomyst)

  • Sodium bicarbonate (2% NaHCO3)

  • Mannitol (Bronchitol)

Correct answer: Dornase alfa (Pulmozyme)

Dornase alfa is an enzyme that selectively cleaves DNA found in mucus. This makes the mucus less viscous and easier to mobilize. This enzyme is fragile compared to many other molecules used in aerosolized mucolytics and requires additional storage considerations including refrigeration and protection from light.

36.

The respiratory therapist is called to evaluate a patient who has just been brought into the Emergency Department after being involved in a motor vehicle accident (MVA). Which of the following considerations is TRUE?

  • The role of the respiratory therapist includes tailoring the support of respiratory function

  • Trauma only requires respiratory support if it involves the airway

  • The presentation of trauma is normally homogenous

  • If the patient has a GCS less than 11, they are likely to have poorer post-injury quality of life

Correct answer: The role of the respiratory therapist includes tailoring the support of respiratory function

The role of the respiratory therapist in treating acute trauma includes identifying life-threatening problems and tailoring the support of respiratory function. 

Respiratory support during trauma is complex and may include many other components beyond managing a patient's airway. The presentation of trauma is normally heterogeneous, not homogenous. Patients with traumatic brain injury and a Glasgow Coma Score (GCS) less than 8 who require endotracheal intubation are likely to have poorer post-injury quality of life, but a GCS of less than 11 by itself is not an indicator.

37.

When using co-oximetry, which of the following can cause a falsely high HbO2?

  • Elevated bilirubin

  • Sickle cell anemia

  • Recent use of IV methylene blue

  • Recent parenteral nutrition with lipids

Correct answer: Elevated bilirubin

An elevated bilirubin level can cause a falsely high HbO2 reading when using co-oximetry (also called hemoximetry). 

Sickle cell anemia, recent use of IV methylene blue, and recent parenteral nutrition with lipids can cause a falsely low, not a falsely high, HbO2.

38.

The respiratory therapist is reviewing the chart of a patient with Kussmaul breathing. Which of the following laboratory values is LEAST likely to be abnormal in a patient with this breathing pattern?

  • Hemoglobin

  • Glucose

  • Anion gap

  • Total carbon dioxide

Correct answer: Hemoglobin

A patient with Kussmaul breathing has metabolic acidosis. This is typically due to diabetic ketoacidosis (DKA). A patient with DKA will normally have high glucose, a low total carbon dioxide level, and an elevated anion gap. 

DKA does not typically affect hemoglobin levels.

39.

Autogenic drainage uses three phases of breathing to loosen secretions and move them into the larger airways. What is the correct order of these three phases?

  1. The patient increases VT to moderate volumes for several breaths.
  2. The patient uses a VT to low to moderate volumes for several breaths.
  3. The patient takes the deepest breath possible followed by several low-volume breaths.

  • 3, 2, then 1

  • 3, 1, then 2

  • 2, 3, then 1

  • 2, 1, then 3

Correct answer: 3, 2, then 1

Autogenic drainage involves the following phases of breathing: 

Phase 1: The patient starts by taking the deepest breath possible followed by several low-volume breaths. 

Phase 2: The patient increases VT to low to moderate volumes for several breaths.

Phase 3: The patient increases VT to moderate volumes for several breaths.

Upon completing these three phases, the patient is asked to cough.

40.

The respiratory therapist suspects that a patient's pulse oximeter is not reading correctly. Which of the following is NOT a correct intervention to fix this problem?

  • Check the patient's hemoglobin levels

  • Try another pulse oximeter

  • Check that there is no excessive ambient light

  • Try the probe on another site

Correct answer: Check the patient's hemoglobin levels 

A pulse oximeter measures the percentage of hemoglobin that is carrying oxygen. The concentration of hemoglobin in the patient's blood will not affect this value. 

Trying another pulse oximeter, checking that there is no excessive ambient light, and trying the probe on another site are all interventions that could fix a pulse oximeter that is not reading correctly.

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