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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 5 of 25

81.

In which of the following situations would it be BEST to extubate a patient to non-invasive ventilation?

  • The patient has hypercapnic respiratory failure, a tracheostomy, and is unlikely to tolerate weaning well

  • The patient is unable to tolerate the presence of the endotracheal tube

  • The patient is being ventilated using SIMV mode

  • The patient is weaning from a ventilator

Correct answer: The patient has hypercapnic respiratory failure, a tracheostomy, and is unlikely to tolerate weaning well

Transitioning to non-invasive ventilation (NIV) following mechanical ventilation is ideal for patients who are unable to tolerate weaning well and who have hypercapnic respiratory failure. 

If the patient is unable to tolerate the presence of the endotracheal tube, the patient should be medicated appropriately if mechanical ventilation is still necessary, not extubated to NIV. The use of synchronized intermittent mandatory ventilation (SIMV) mode does not indicate the patient should be extubated to NIV. NIV is not used for all patients weaning from a ventilator.

82.

Which of the following is the CORRECT description of proficiency testing?

  • Outside samples with an unknown value are analyzed and reported

  • The analyzer automatically adjusts output signals based on exposure to media with a known value

  • A respiratory therapist runs a certain number of samples under supervision and is signed off as being proficient in the skill

  • Statistical, rule-based procedures are used to identify and correct instrument errors

Correct answer: Outside samples with an unknown value are analyzed and reported

Proficiency testing involves having outside samples with unknown values analyzed and then compared to the actual sample values. Proficiency testing is typically done three times per year with five samples. 

Automated calibration describes the process through which an analyzer automatically adjusts output signals based on exposure to media with a known value. Internal Statistical Quality Control refers to the process through which statistical, rule-based procedures are used to identify and correct instrument errors. The process through which a clinician's skills are verified can be called many things, depending on the facility, but is different from proficiency testing.

83.

What is the benefit of having a patient with chronic emphysema use pursed lip breathing?

  • It moves the EPP toward the larger airways

  • It moves the EPP toward the smaller airways

  • It increases dynamic compression of the airways

  • It reduces the respiratory rate

Correct answer: It moves the EPP toward the larger airways

Exhaling through pursed lips changes pressure at the airway opening, creating back pressure that moves the equal pressure point (EPP) toward the larger airways, avoiding collapse of the small airways. This reduces dynamic compression of the airways and allows better ventilation of the alveoli. 

While pursed lip breathing may reduce the respiratory rate, this is not the desired benefit.

84.

The respiratory therapist is caring for a patient who has chronic obstructive pulmonary disease (COPD), but claims that they have never smoked. Which of the following explanations for this claim is NOT likely?

  • The patient has a history of significant formaldehyde exposure

  • The patient has an alpha-1 antitrypsin deficiency

  • The patient has a history of significant second-hand smoke exposure

  • The patient is not disclosing a smoking history

Correct answer: The patient has a history of significant formaldehyde exposure 

Formaldehyde exposure, especially over long periods of time, can lead to asthma or lung cancer, but is not likely to cause COPD. 

An alpha-1 antitrypsin deficiency, exposure to second-hand smoke, or a smoking history that is not disclosed can all be potential causes of COPD that could be considered for a patient who claims not to have a smoking history.

85.

Which of the following is NOT a potential complication of mechanical ventilation?

  • Cardiomegaly

  • Atelectasis

  • Decreased venous blood return to the heart

  • Decreased urine output

Correct answer: Cardiomegaly 

Cardiomegaly is not a potential complication of mechanical ventilation that is normally encountered. 

Decreased venous blood return to the heart is a possible complication caused by positive airway pressures being transferred to the large veins returning to the heart, decreasing cardiac output. This can lead to decreased urine output as a secondary effect. Atelectasis can also be a complication of mechanical ventilation.

86.

Which of the following is NOT a side effect that is likely to be caused by an inhaled corticosteroid?

  • Airway edema

  • Oropharyngeal fungal infections

  • Hoarseness

  • Bronchoconstriction

Correct answer: Airway edema

Inhaled corticosteroids will suppress inflammation in the airways. This will have the effect of reducing airway edema, not causing it. 

Oropharyngeal fungal infections can be caused by the localized immunosuppression that inhaled corticosteroids cause in the oral cavity. Hoarseness and bronchoconstriction can be side effects of inhaled corticosteroid due to the irritation they can cause.

87.

Which of the following infants has the GREATEST risk of developing respiratory distress syndrome (RDS)?

  • An infant born at 31 weeks gestation

  • An infant with an APGAR score of 2 at one minute after birth

  • An infant whose amniotic fluid was meconium-stained

  • An infant with a congenital cardiac malformation

Correct answer: An infant born at 31 weeks gestation

Preterm birth that is prior to 35 weeks gestation is one of the main risk factors for respiratory distress syndrome (RDS). 

An infant with RDS may have an APGAR score of 2, but an APGAR score of 2 does not increase the risk of RDS. Meconium-stained amniotic fluid and congenital cardiac malformation may lead to post-birth complications, but do not cause RDS.

88.

Which of the following heart rhythms are considered lethal?

  1. Ventricular fibrillation
  2. Atrial fibrillation
  3. Supraventricular tachycardia
  4. Ventricular tachycardia

  • 1 & 4

  • 1, 3, & 4

  • Only 1

  • 1 & 2

Correct answer: 1 & 4

The rhythms listed here that are considered to be lethal arrhythmias are ventricular fibrillation and ventricular tachycardia. Both of these rhythms can cause inadequate or no contraction of the ventricles, leading to cardiac arrest. 

Atrial fibrillation causes no contraction of the atria, which may lead to decreased cardiac output, but this is not typically fatal. Supraventricular tachycardia is tachycardia that originates in the conduction system of the heart prior to the ventricles and may be harmful depending on the circumstances, but is not considered to be a lethal rhythm.

89.

When evaluating the position of the trachea, which of the following is TRUE?

  • The trachea shifts toward the unaffected side in patients who have massive atelectasis

  • The trachea shifts away from the unaffected side in patients who have massive atelectasis

  • The trachea shifts toward the unaffected side in patients who have tension pneumothorax

  • The trachea never shifts in patients who have massive atelectasis

Correct answer: The trachea shifts toward the unaffected side in patients who have massive atelectasis

Massive atelectasis can cause deviation of the trachea toward the affected side and away from the unaffected side. 

Tension pneumothorax will shift the trachea away from the unaffected side and toward the affected side. The statement that the trachea never shifts in patients who have massive atelectasis is incorrect as tracheal shifts can occur.

90.

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.

91.

Which of the following laboratory findings is MOST likely to make ventilator weaning more difficult?

  • Hyponatremia

  • Hypernatremia

  • Hyperkalemia

  • Hypocloremia

Correct answer: Hyponatremia

Hyponatremia, or low blood sodium levels, can cause muscle weakness. Hypokalemia, or low blood potassium levels, can also cause muscle weakness. These electrolyte imbalances should be considered before beginning ventilator weaning, as muscle weakness can make weaning more difficult. 

Hypernatremia, hyperkalemia, and hypochloremia (low chloride levels) are not likely to negatively impact ventilator weaning.

92.

An EKG is being performed on a patient who has a normal QRS complex, but who does not appear to have a femoral pulse. Which of the following interventions should the respiratory therapist perform next?

  • Begin providing chest compressions

  • Assess the patient's apical pulse

  • Assess for possible restrictions affecting the femoral artery

  • Ask the provider to consider testing for a deep vein thrombosis

Correct answer: Begin providing chest compressions

A QRS complex can occur during pulseless electrical activity (PEA). Just because electrical activity consistent with normal heart activity is present does not mean that this electrical activity is causing contraction of the myocardium. If the patient does not have a femoral pulse, chest compressions should be started regardless of the presence of a normal QRS complex. 

The femoral pulse is a good indicator of if the patient has a pulse and checking an apical pulse is redundant. Assessing for possible restrictions affecting the femoral artery will delay CPR if it is necessary, and it is unlikely that femoral arterial occlusion is the problem. A deep vein thrombosis is unlikely to occlude the femoral artery as it is more likely that the patient does not have a pulse.

93.

The respiratory therapist is providing instructions on how to store a dry powder inhaler (DPI). In which of the following locations should a DPI NOT be stored?

  • Bathroom cabinet

  • Bedside drawer

  • Kitchen cabinet with other medications

  • Car glovebox

Correct answer: Bathroom cabinet

DPIs are quite susceptible to humidity, which can cause the powder to clump. Any moisture in a DPI will decrease aerosol delivery. Because of the sensitivity of DPIs to humidity, they should never be stored in bathrooms, as bathrooms are often more humid than other living environments. 

DPIs may be stored in a bedside drawer as long as they are out of reach of children. They may also be stored in a kitchen cabinet with other medications or in a car glovebox.

94.

The respiratory therapist is performing an EKG on a patient who has a history of an above-knee amputation (AKA) of the right leg. What implication does this history have on the placement of the lead on the right leg?

  • The right leg lead should be placed over soft tissue as far down the stump as possible

  • The lead for the right leg should be placed on the right lower abdomen

  • The lead for the right leg should be placed on the very tip of the stump

  • A normal EKG cannot be performed on this patient

Correct answer: The right leg lead should be placed over soft tissue as far down the stump as possible

The limb leads should be placed as distally as possible for the best results. Leads should be applied over fatty tissues or muscle for the best conductivity. 

Placing the lead on the abdomen is not best if the lead can be placed more distally. Placing the lead on the tip of the stump will position it over bone and a scar, which will not provide ideal conduction. A normal EKG can still be performed on this patient, but the right leg lead placement will be modified.

95.

The respiratory therapist is evaluating a 12-year-old with cystic fibrosis. Which of the following findings is NOT expected for this patient?

  • Frequent, dry cough

  • Increased A-P chest diameter

  • Digital clubbing

  • Intercostal retractions

Correct answer: Frequent, dry cough

The pathophysiology of cystic fibrosis causes thick mucus to be secreted into the airways, leading to airway obstruction and the promotion of bacterial growth. While a cough is common in patients with cystic fibrosis, the cough typically results in thick mucus production. 

An increased A-P chest diameter, digital clubbing, and intercostal retractions are all common findings for patients who have cystic fibrosis.

96.

A decreased VC is LEAST likely to be caused by which of the following?

  • Pulmonary embolism

  • Kyphoscoliosis

  • Lung cancer

  • Pulmonary fibrosis

Correct answer: Pulmonary embolism

Pulmonary embolisms do not occupy space in the airways and, therefore, do not decrease vital capacity (VC). Pulmonary embolisms can lead to pulmonary edema, which would be a potential cause of decreased VC. 

Kyphoscoliosis, lung cancer, and pulmonary fibrosis can all decrease VC.

97.

In which of the following situations would priming a pressurized meter-dose inhaler (pMDI) be UNNECESSARY?

  • Before a routine dose using the pMDI

  • When the pMDI has not been used for several days

  • Before the first use of the pMDI

  • When the operator is unsure if the pMDI is working

Correct answer: Before a routine dose using the pMDI

A pressurized meter-dose inhaler (pMDI) should always be primed before the first use and when it has not been used for several days. This helps to eliminate the dead space that may reduce the dosage of medication administered. The operator of the pMDI can also prime it to evaluate its function and ensure that a dose is still being delivered correctly. 

Priming a pMDI before a routine dose is not necessary if there is no indication for priming.

98.

When the respiratory therapist is performing a before-and-after bronchodilator study, which of the following will be used?

  • Peak flow measurements

  • MIP measurements

  • Aneroid manometer

  • FENO measurement

Correct answer: Peak flow measurements

In a before-and-after bronchodilator study, peak flow measurements are taken before and after a bronchodilator is administered, and the percentage of improvement is reported. 

Maximum inspiratory pressure (MIP) is not used. An aneroid manometer is used to measure MIP, not to measure peak flow. A FENO (fraction of expired nitric oxide) measurement would not be used for this test, either.

99.

Which of the following is NOT used as a mucolytic?

  • Hypertonic saline

  • Mannitol (Bronchitol)

  • Sodium bicarbonate

  • Dornase alfa (Pulmozyme)

Correct answer: Hypertonic saline

Hypertonic saline is an expectorant when administered as an aerosolized medication, not a mucolytic. Mucolytics facilitate the breakdown of mucus, while expectorants increase the output of thin respiratory secretions, helping to liquify mucus.

100.

The respiratory therapist is preparing to collect induced sputum. Which of the following is NOT a good method for sputum induction?

  • Obtaining a sample when the patient has blunted cough reflexes

  • Obtaining a sample when the patient has thick secretions

  • Obtaining a sample when the patient is unable to produce sputum spontaneously

  • Avoiding the use of bronchoscopy

Correct answer: Obtaining a sample when the patient has blunted cough reflexes

Sputum induction does require that the patient be able to cough, and the respiratory therapist should not attempt to induce sputum in a patient with blunted cough reflexes. 

Inducing sputum is indicated for obtaining a sputum sample when the patient has thick secretions as induction thins the secretions and makes them more mobile. Sputum induction is ideal for obtaining a sample when the patient is unable to produce sputum spontaneously and can be used to avoid the use of bronchoscopy.

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