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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 3 of 25

41.

A patient has dropped their dry powder inhaler (DPI) into a sink full of water and asks the respiratory therapist if it is still okay to use. Which of the following is TRUE for this situation?

  • The DPI should not be used.

  • The DPI can be wiped dry and used.

  • The DPI can be used after airing out for 24 hours.

  • The ability to continue using the DPI depends on the type of drug container it uses.

Correct answer: The DPI should not be used.

The dry powder inhaler (DPI) should not be used. DPIs are very sensitive to humidity, and should not be stored in a humid area. Any exposure to water or especially emersion in water can cause the medication to clump and can lead to the medication becoming ineffectively aerosolized.

42.

Which of the following is NOT a criterion when evaluating a patient's Glasgow Coma Score (GCS)?

  • Best sensory response

  • Best eye response

  • Best verbal response

  • Best motor response

Correct answer: Best sensory response

The GCS uses three criteria to evaluate a patient's level of consciousness. These three areas include best eye response, best verbal response, and best motor response. 

Best sensory response is not a criterion used in the GCS, but sensory response is evaluated through both eye and verbal response.

43.

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).

44.

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.

45.

A 35-year-old female has a maximum inspiratory pressure of 140 cm H2O. Given the patient's age and gender, how does this reading compare to the expected value?

  • It is high

  • It is normal

  • It is low

  • It is dangerously low

Correct answer: It is high

A female who is 19 to 50 years old should have a maximum inspiratory pressure PIMAX of 91 with a standard deviation of 25. A PIMAX of 140 would be higher than would be expected for this patient given their age and gender.

46.

Which of the following can NOT be determined from a flow-volume loop?

  • MEP

  • PIF

  • FVC

  • FEV1

Correct answer: MEP

A flow-volume loop is a graph that represents the flow generated during an FVC maneuver followed by a forced inspiratory volume maneuver; both are plotted against volume change. Maximum expiratory pressure (MEP) cannot be determined from a flow-volume loop, as this graph does not give pressure-related data. 

Peak inspiratory flow (PIF), forced vital capacity (FVC), and forced expiratory volume over one second (FEV1) can all be ascertained from a flow-volume loop.

47.

You are the respiratory therapist evaluating a patient who is eating and suddenly begins to choke on a piece of food and is unable to speak or clear their airway. Which of the following interventions should you FIRST perform?

  • Administer abdominal thrusts

  • Suction the patient's airway

  • Intubate the patient

  • Prepare for a cricothyrotomy

Correct answer: Administer abdominal thrusts

Also called the Heimlich maneuver, abdominal thrusts should be the first intervention administered to a patient who has a foreign body airway obstruction (FBAO). 

Suctioning the patient's airway, intubating the patient, and preparing for a cricothyrotomy are all potential interventions, but are not the first intervention that should be considered for a conscious patient that has just begun choking.

48.

The respiratory therapist is preparing to analyze an ABG specimen that has been chilled since it was drawn 72 minutes ago. Which of the following actions by the respiratory therapist is CORRECT?

  • Discard the specimen and redraw

  • Run the specimen, but note that the results could be inaccurate

  • Run the specimen as normal

  • Run the specimen, but know that only PaO2 will be valid

Correct answer: Discard the specimen and redraw

A specimen that is over 60 minutes old should be discarded and redrawn. There is some debate about whether a specimen that is on ice can be run after 60 minutes but, regardless of the answer to this, a specimen this old will not provide current clinical information. 

The specimen should not be run as normal, run with a notation, or only run for one value, as there is a risk of inaccurate results with each scenario.

49.

A patient has recently been extubated, and the respiratory therapist notices that they have developed inspiratory stridor. Which of the following conditions is this MOST likely to be?

  • Glottic edema

  • Laryngospasm

  • Tracheal stenosis

  • Vocal cord ulceration

Correct answer: Glottic edema

Inspiratory stridor is the major clinical sign of glottic edema, and this condition should be suspected. Mild to moderate glottic edema can be treated with cool aerosol and a vasoconstrictor such as racemic epinephrine; however, severe glottic edema may require reintubation. 

Laryngospasm, tracheal stenosis, and vocal cord ulceration do not typically cause inspiratory stridor.

50.

Which of the following factors is UNLIKELY to affect dry-powder inhaler drug delivery?

  • Patient's expiratory flow ability

  • Patient's inspiratory flow ability

  • Humid environment

  • Technique

Correct answer: Patient's expiratory flow ability

Drug delivery when using a Dry Powder Inhaler (DPI) depends on a variety of factors that all impact what percentage of the dose will actually reach the lower airway. The patient's inspiratory flow ability is a major contributing factor, and a peak flow inspiratory rate of at least 60L/min is necessary for most DPIs. The emitted dose of a DPI decreases in a humid environment, likely due to clumping of the powder. Technique is a major factor when utilizing a DPI, and poor technique can significantly impact drug delivery. 

Expiratory flow ability does not impact the degree of penetration of the powder during inspiration and is not a significant factor of DPI drug delivery.

51.

When treating a mechanically ventilated patient, the respiratory therapist understands that use of high concentrations of oxygen in adult patients over a prolonged period of time can cause which of the following?

  • Thickening of the alveolar membranes

  • Barotrauma

  • Decreased surfactant production

  • Ciliary dysfunction

Correct answer: Thickening of the alveolar membranes

The prolonged use of high oxygen concentrations can lead to pulmonary O2 toxicity and may result in ARDS. One of the characteristics of pulmonary O2 toxicity is thickening of the alveolar membranes. 

Pulmonary O2 toxicity leads to increased, not decreased, surfactant production. Barotrauma is a result of excessive airway pressure, not high O2 concentrations. Ciliary dysfunction is not caused by high O2 levels.

52.

The respiratory therapist is selecting an in-line suction catheter for a 7.5mm ET tube. Which sized suction catheter should be used?

  • 14 Fr

  • 16 Fr

  • 12 Fr

  • 10 Fr

Correct answer: 14 Fr

To estimate the proper suction catheter size, the internal diameter of the ET should be doubled, then the next smallest catheter size should be used. In this scenario, 7.5 x 2 = 15. The next smallest size is 14 Fr.

53.

Which of the following is NOT a potential complication of chest physical therapy (CPT) that should be considered by the respiratory therapist?

  • Pneumothorax

  • Increased intracranial pressure (ICP)

  • Rib fractures

  • Decreased cardiac output

Correct answer: Pneumothorax

Complications of CPT can include increased ICP from positioning in the Trendelenburg position or from prolonged coughing. Decreased cardiac output can be caused by positional hypotension and intrathoracic pressure changes. Rib fractures can be caused by overly vigorous percussion, especially in patients who are frail. 

Pneumothorax is not likely to be caused by chest percussion except in very rare circumstances and is not a complication that should typically be considered.

54.

The respiratory therapist is providing care for a patient with acute respiratory distress syndrome (ARDS). Which of the following should be avoided for this patient? 

  • Hyperoxia

  • Hypercapnia

  • Low VT

  • Mechanical ventilation

Correct answer: Hyperoxia

Hyperoxia can be noxious to the lungs and can actually be a trigger of acute respiratory distress syndrome (ARDS). Hyperoxia should be avoided during treatment of ARDS. 

Permissive hypercapnia, low tidal volume, and mechanical ventilation are important components of treating ARDS.

55.

The respiratory therapist is preparing to assist with a percutaneous dilation tracheostomy. Which of the following is NOT a potential contraindication for this intervention?

  • History of cirrhosis

  • History of difficult intubations

  • Coagulopathy

  • Age of 10 years old

Correct answer: History of cirrhosis

History of cirrhosis does not affect a patient's ability to have a percutaneous dilation tracheostomy. 

Percutaneous dilation tracheostomy should be avoided in patients who are 12 years old or younger, who have a history of being difficult to intubate, or who have coagulopathy, although it is not absolutely contraindicated for these patients.

56.

Which of the following factors will NOT decrease the affinity of hemoglobin for O2?

  • HbCO

  • Hypercapnia

  • Acidosis

  • Hyperthermia

Correct answer: HbCO

HbCO, carboxyhemoglobin, increases the affinity of hemoglobin (Hb) for O2, shifting the oxyhemoglobin dissociation curve to the left. 

Hypercapnia, acidosis, and hyperthermia all decrease the affinity of Hb for O2, shifting the oxyhemoglobin dissociation curve to the right.

57.

The respiratory therapist is evaluating a patient who was extubated ten days previously and is complaining of hoarseness since he was extubated. The respiratory therapist understands that which of the following is TRUE for this patient?

  • The patient likely has vocal cord ulceration

  • Hoarseness this long after extubation is normal

  • The patient likely has vocal cord paralysis

  • The patient should be examined for a laryngotracheal web

Correct answer: The patient likely has vocal cord ulceration

Hoarseness is a normal complication after extubation but should resolve within seven days. Hoarseness that persists after this likely indicates vocal cord ulceration. 

Vocal cord paralysis would cause effects to the speech other than hoarseness or would cause muteness. Hoarseness is not indicative of a laryngotracheal web.

58.

How frequently should positive expiratory pressure (PEP) therapy be used?

  • The frequency should be determined by individual patient response

  • 2 to 4 times each day

  • 4 to 6 times each day

  • At least 4 times per day and no more than 12 times daily

Correct answer: The frequency should be determined by individual patient response

While positive expiratory pressure (PEP) therapy is often performed about 2 to 4 times each day, the frequency should ultimately be determined by each patient's individual response to therapy rather than based on a fixed frequency range.

59.

Which of the following would NOT be a correct clinical use for aerosol therapy?

  • Treating atelectasis

  • Inducing a cough

  • Treating laryngotracheobronchitis 

  • Administering medication

Correct answer: Treating atelectasis

Aerosol therapy may be used to manage secretions that increase the risk of atelectasis or in administering medications that help to manage or prevent atelectasis, but is not used directly as a treatment for atelectasis. 

Aerosol therapy is used to induce coughing, treat laryngotracheobronchitis, and administer medications.

60.

The respiratory therapist is preparing to check a patient's PtO2 levels. Which of the following is TRUE when assessing PtO2 levels?

  • PtO2 can be continuously monitored.

  • PtO2 provides data on the patient's systemic oxygenation.

  • Direct arterial access is needed to check a PtO2 level.

  • The process used to assess a PtO2 will also provide a HbCO level.

Correct answer: PtO2 can be continuously monitored.

PtO2 (tissue O2) levels are obtained by a probe that is inserted into organs, tissues, or body fluids. PtO2 provides continuous readings, allowing for continuous monitoring. 

PtO2 monitors provide data on the oxygenation of local tissues, not on systemic oxygenation. Direct arterial access is not needed to check a PtO2 level, but is to check a PaO2 level. Hemoximetry, not tissue oxygen monitoring, is used to obtain HbCO (carboxyhemoglobin) levels.

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