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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 7 of 25

121.

Which of the following findings on a patient who is being treated with mechanical ventilation is the BEST indicator that barotrauma has occurred?

  • Chest wall crepitus

  • Hypotension

  • White, frothy secretions

  • Decreased respiratory effort

Correct answer: Chest wall crepitus

Chest wall crepitus is a tactile indicator of subcutaneous emphysema which can occur with a pneumothorax. Pneumothorax is one of the most common forms of barotrauma caused by mechanical ventilation. 

Hypotension indicates decreased cardiac output, not barotrauma. White, frothy secretions can be an indicator of pulmonary edema. Decreased respiratory effort can indicate a wide range of conditions or complications.

122.

Which of the following is NOT a risk factor for increased mortality for a patient who has community-acquired pneumonia (CAP)?

  • Female gender

  • Temperature < 35º C

  • Atrial pH < 7.35

  • Kidney disease

Correct answer: Female gender

Males, not females, are at a higher risk of mortality from community-acquired pneumonia (CAP). 

The risk of mortality with CAP does also increase with patient temperatures of less than 35º C or greater than 40º C, with an atrial pH of less than 7.35, or with certain comorbidities including kidney disease.

123.

Which of the following is an advantage to using intrapulmonary percussive ventilation?

  • Fatigue and therapist technique will not affect this form of therapy

  • The patient will never need to be engaged to perform this form of therapy

  • This form of therapy is significantly more effective at breaking up secretions than postural drainage and percussion

  • This form of therapy only takes 2 to 5 minutes

Correct answer: Fatigue and therapist technique will not affect this form of therapy

Intrapulmonary percussive ventilation is not affected by fatigue or therapist technique. 

The patient does need to be engaged when performing this form of therapy as they often control the length of each percussive cycle. This form of therapy is as effective at breaking up secretions as postural drainage and percussion, but is not significantly more effective. This form of therapy typically takes 15 to 20 minutes.

124.

The respiratory therapist wants to change the amount of positive expiratory pressure (PEP) provided using a flutter valve. How is PEP adjusted for this device?

  • By changing the angle at which the device is held

  • By adjusting the orifice size

  • By using a different flutter valve device with a different PEP

  • By adjusting the movable slider that changes the internal resistance of the device

Correct answer: By changing the angle at which the device is held

The flutter valve is a pipe-shaped device that contains a stainless steel ball. When the angle at which the device is held is changed, the effects of gravity on the stainless steel ball are also changed, altering the PEP of the device. 

Use of a different device is not necessary and there is no way to manually adjust the orifice or internal resistance of the device besides changing the angle at which the device is held.

125.

In what situation is capillary blood gas sampling typically used?

  • For infants and small children

  • For any patient who is concerned about the pain caused by direct arterial access

  • For patients with poor perfusion

  • When the PaO2 is needed STAT and obtaining direct access is likely to be slow

Correct answer: For infants and small children

Capillary blood gas sampling is typically used in small children or infants who may not tolerate direct arterial access well and whose arteries are more difficult to access due to their small size. 

Capillary blood gas sampling is not routinely used instead of direct arterial access for pain consideration. Good perfusion is necessary to use capillary blood gas sampling. Capillary blood gas sampling does not provide useful information about a patient's PaO2 and would not be used in place of direct access.

126.

The respiratory therapist is preparing a patient for transfer via EMS to another hospital. The patient is intubated and on a mechanical ventilator, and the trip is expected to take 30 minutes. 

Which of the following is the BEST method for providing humidification for this patient?

  • Heat and Moisture Exchanger (HME)

  • Heated-wire humidifier

  • Small (< 0.3mL) doses of normal saline administered down the ET tube every 5 minutes

  • No humidification is necessary for this 30-minute trip

Correct answer: Heat and Moisture Exchanger (HME)

A Heat and Moisture Exchanger (HME) is portable and passive, making it so that no power is necessary for the device to work. An HME is recommended for transportation purposes, but should not be used long-term. 

A heated-wire humidifier is ideal for long-term use, but is not practical during an EMS transportation in most circumstances. Small doses of normal saline administered down the ET tube is not an appropriate way to provide humidification. The patient should not go 30 minutes without humidification.

127.

The respiratory therapist is screening a patient for obstructive sleep apnea (OSA). Which of the following questions is NOT a part of the STOP-BANG questionnaire?

  • Do you notice that you suddenly wake up in the night?

  • Do you snore loudly?

  • Has anyone observed you stop breathing during sleep?

  • Do you have high blood pressure?

Correct answer: Do you notice that you suddenly wake up in the night?

The STOP-BANG questionnaire consists of eight points that can indicate OSA if a patient scores positive on three or more. These eight points include:

  • Do you Snore loudly?
  • Do you often feel Tired, fatigued, or sleepy during the daytime?
  • Has anyone Observed you stop breathing during sleep?
  • Do you have or are you being treated for high blood Pressure?
  • Is your BMI greater than 35?
  • Is your Age older than 50 years?
  • Is your Neck circumference greater than 40 cm?
  • Is your Gender male?

128.

The respiratory therapist is evaluating a patient who is 45 pack-year smoker and has dyspnea with exertion, uses accessory muscles when breathing, and has an increased A-P chest diameter. 

Which of the following conditions should the respiratory therapist suspect?

  • Emphysema

  • Bronchitis

  • Asthma

  • Chronic pneumonia

Correct answer: Emphysema 

The patient's symptoms are most consistent with emphysema. While some of the patient's symptoms are nonspecific, the increased A-P chest diameter is most commonly seen with emphysema, and is unlikely to occur with bronchitis, asthma, or chronic pneumonia.

129.

Which of the following interventions could help to correct a systemic error when performing internal statistical quality controls on an ABG analyzer?

  • Performing a function check of the electrodes

  • Rerunning the control

  • Repeating the analysis on another instrument

  • Rerunning the analysis on the same instrument

Correct answer: Performing a function check of the electrodes

Systemic errors (also called bias errors) during internal statistical quality controls are caused by a problem with the testing process or device. Performing a function check of the electrodes could help to correct this type of error. 

Rerunning the control, repeating the analysis on another instrument, and rerunning the analysis on the same instrument would all be correct interventions if the error was an imprecision, or random, error.

130.

Correct use of routine autoclave sterilization can be used to clean equipment that has been used in patients who have which of the following diseases?

  1. Creutzfeldt-Jakob Disease
  2. Cystic Fibrosis
  3. Pneumonia
  4. Tuberculosis
  5. Dandy-Walker Syndrome

  • 2, 3, 4, & 5

  • 1, 2, 3, 4, & 5

  • 1 & 5

  • 1, 2, 3, & 4

Correct answer: 2, 3, 4, & 5

Correct use of routine autoclave sterilization will eliminate all viruses, bacteria, and spores. The only transmissible pathogens that are not adequately treated with autoclave sterilization are prions, which are infectious proteins. Creutzfeldt-Jakob Disease is a prion disease caused by the same pathogen that causes bovine encephalopathy, or "mad cow disease," in cattle. 

Pneumonia and tuberculosis are caused by viral or bacterial organisms that will be eliminated by autoclave sterilization. Cystic Fibrosis and Dandy-Walker Syndrome are not infections but do predispose patients to infection. Autoclave sterilization will treat pathogens from all four of these diseases.

131.

Which of the following peripheral arterial sites is NOT a common site for placing an arterial line?

  • Ulnar artery

  • Radial artery

  • Brachial artery

  • Femoral artery

Correct answer: Ulnar artery

The radial artery, brachial artery, and femoral artery are the three most commonly used sites for establishing an arterial line. 

The ulnar artery is not routinely used for this type of access and use of this artery would never be indicated.

132.

When adjusting the RR settings on a mechanical ventilator, which of the following are affected?

  1. I:E ratio
  2. PEEP
  3. VE
  4. PaCO2
  5. VT

  • 1, 3, & 4

  • 2, 3, & 5

  • 3 & 4

  • 1, 4, & 5

Correct answer: 1, 3, & 4

Adjusting the respiratory rate (RR) on a mechanical ventilator will change expiratory time, affecting the I:E ratio. It will also change the minute volume and PaCO2 levels. 

It will not directly affect PEEP or VT.

133.

Fomites are a common means of transmission for infectious pathogens. Which of the following is an example of a fomite?

  • A stethoscope

  • A pond

  • A tick

  • A turkey sandwich

Correct answer: A stethoscope

Fomites are inanimate objects that can transfer infectious pathogens when contaminated, such as clothes, surfaces, or equipment. 

A pond could be a source of a water-borne illness, and a turkey sandwich could be the source of a food-borne illness. While, technically, a pond and a sandwich are inanimate objects, both transfer infection when ingested. Fomites typically play a more passive role in transmission. A tick would be an example of a vector, not a fomite.

134.

Which of the following can a transilluminator be used for in a newborn patient?

  • Diagnosing a pneumothorax

  • Diagnosing pneumonia

  • Treating hyperbilirubinemia 

  • Providing data on blood oxygenation

Correct answer: Diagnosing a pneumothorax 

A transilluminator can be used to evaluate for the increased transmission of light in the chest cavity, which can be an indicator of a pneumothorax. 

A transilluminator is not useful for diagnosing pneumonia. Hyperbilirubinemia is treated using phototherapy, but a transilluminator is not used to provide this therapy. A pulse oximeter can provide data on blood oxygenation, but a transilluminator will not.

135.

Which of the following is NOT a therapeutic effect of positive expiratory pressure (PEP)?

  • It prolongs expiration

  • It prevents expiratory airway collapse

  • It improves the distribution of inspired volumes

  • It generates pressure distally to the site of mucus obstructions

Correct answer: It prolongs expiration

Positive expiratory pressure (PEP) doesn't necessarily always prolong expiration, and prolonged expiration would not be considered a therapeutic effect of PEP. 

Therapeutic effects of PEP do include the prevention of airway collapse, the improved distribution of inspired volumes through collateral air channels, and the generation of pressure distally to the site of mucus obstructions.

136.

Which of the following interventions should be recommended to reduce a patient's likelihood of developing epiglottitis?

  • Following routine vaccination schedules

  • Avoiding sugary or spicy foods

  • Taking prophylactic antibiotics

  • Breastfeeding as long as possible

Correct answer: Following routine vaccination schedules

Epiglottitis is caused by bacterial infections. Haemophilus influenzae type B is the most common organism that causes epiglottitis, but the risk of developing this infection is significantly reduced when routine vaccination schedules are followed. 

Epiglottitis is not caused by diet and avoiding certain foods is not a good recommendation to avoid epiglottitis. While epiglottitis is caused by bacterial infections, using prophylactic antibiotics is not recommended. There are several benefits to breastfeeding, but it is not known to decrease the risk of epiglottitis.

137.

The respiratory therapist is providing instructions to a patient on how to perform diaphragmatic breathing. Which of the following instructions is CORRECT?

  • "Concentrate on moving the abdomen upward while inspiring."

  • "Concentrate on moving the abdomen upward while expiring."

  • "Concentrate on moving the affected area of your lung upward while expiring."

  • "Inhale through the nose and exhale through pursed lips."

Correct answer: "Concentrate on moving the abdomen upward while inspiring."

Diaphragmatic breathing teaches patients to breathe using diaphragmatic, not accessory, muscles. Diaphragmatic breathing will cause the abdomen to move out while inspiring, not while expiring. 

Segmental breathing focuses on expanding the affected area of a lung with inspiration. Pursed-lip breathing is the breathing technique where a patient inhales through the nose and exhales through pursed lips.

138.

A patient who is being monitored using sidestream capnography suddenly has an increase in PETCO2 levels. Which of the following factors would NOT cause this to occur?

  • Hypoventilation

  • Injection of sodium bicarbonate

  • Release of a tourniquet that has been on for several minutes

  • Starting an aortic balloon pump

Correct answer: Hypoventilation

Hypoventilation would typically lead to a gradual increase in PETCO2 levels, not to a sudden increase. 

An injection of sodium bicarbonate and the release of a tourniquet could both cause a sudden increase in CO2 levels. Starting an aortic balloon pump would lead to a sudden increase in cardiac output, which would lead to a sudden increase in CO2 levels.

139.

The respiratory therapist is called to the emergency department to help treat a 34-year-old male who is thought to have overdosed on heroin. The patient is breathing spontaneously, is unresponsive to painful stimuli, and is snoring. 

Which of the following artificial airways is BEST to use first to protect this patient's airway?

  • Oropharyngeal airway

  • Nasopharyngeal airway

  • Endotracheal (ET) tube

  • Double-lumen airway

Correct answer: Oropharyngeal airway

The patient is unconscious but is breathing spontaneously. Snoring indicates that the patient may have difficulty maintaining a patent airway, and an oropharyngeal airway (OPA) may be adequate to maintain patency of the airway. A nasopharyngeal airway (NPA) is better used to provide a means of suctioning or ensure patency with upper airway swelling, and an OPA is likely to better treat this patient. 

More invasive airways, such as an ET tube or a double-lumen airway, are not necessary while the patient is breathing spontaneously and is adequately protecting his airway. These airways have higher risks and should only be used if necessary.

140.

The American National Standards Institute (ANSI) has recommended a minimum absolute humidity for patients, which is used as a standard by respiratory therapists. Which of the following is the ANSI's recommended minimum absolute humidity?

  • 30 mg/L

  • 25 mg/L

  • 37 mg/L

  • 44 mg/L

Correct answer: 30 mg/L

While the ideal humidity for a patient is certainly higher than 30 mg/L, the minimum absolute humidity at ANSI recommends is 30 mg/L. Respiratory therapists will almost always provide humidity levels that are higher than this standard, but should never provide a lower humidity.

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