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Quiz Session - Attempts With Random Questions

NBRC CRT Exam Questions

Page 9 of 25

161.

The respiratory therapist administers an adrenergic bronchodilator to a patient and notes a 20% improvement in FEV1 using spirometry immediately after the treatment. Should the respiratory therapist report that this patient has a reversible airflow obstruction?

  • Data about the volume increase in FEV1 is needed to make this determination.

  • The patient does not have a reversible airflow obstruction.

  • The patient does have a reversible airflow obstruction.

  • The FEV1 will need to be measured one hour after the treatment to make this determination.

Correct answer: Data about the volume increase in FEV1 is needed to make this determination.

In order to determine if an airflow obstruction is reversible, the respiratory therapist should look for a rise in the forced expiratory volume over one second (FEV1) of at least 12% and at least 200 mL. The volume must be taken into consideration because patients with a very small FEV1 may have large percentage changes without meaningful volume changes. 

The FEV1 should not be evaluated an hour later to make this determination, but additional data is needed.

162.

Which of the following BEST describes a pleural friction rub?

  • A creaking or grating sound that typically occurs during inspiration and is usually localized to a discreet site on the chest wall

  • A creaking or grating sound that typically occurs during expiration and is usually localized to a discreet site on the chest wall

  • A creaking or grating sound that typically occurs during inspiration and is localized to one lobe, but not usually to a discreet site

  • A creaking or grating sound that typically occurs during expiration and is localized to one lobe, but not usually to a discreet site

Correct answer: A creaking or grating sound that typically occurs during inspiration and is usually localized to a discreet site on the chest wall

A pleural friction rub is a creaking or grating sound that is typically heard during inspiration, not expiration. It may be heard during both in some cases, but will be more prominent during inspiration. 

Pleural friction rubs are usually localized to the specific, discreet site on the chest wall where the friction between the pleural surfaces is occurring.

163.

Which of the following conditions would be LEAST likely to cause a heart murmur when auscultating the patient's heart sounds?

  • Atrial fibrillation

  • Aortic valve disease

  • Mitral valve disease

  • Tricuspid valve insufficiency

Correct answer: Atrial fibrillation

Heart murmurs occur when blood flows in a turbulent fashion through heart structures that are narrowed. Heart murmurs are caused by incomplete closure of heart valves in most situations. Aortic valve disease, mitral valve disease, and tricuspid valve insufficiency are all conditions affecting the heart valves and all can lead to heart murmurs. 

Atrial fibrillation is related to the electrical conduction of the heart and will not result in a heart murmur, but will cause an abnormal heart rhythm.

164.

A respiratory therapist is providing a patient with 8 L/min of O2 using an H cylinder that contains 1600 psig. How long will it take the cylinder to reach a level of 400 psig?

  • 7.9 hrs

  • 471 hrs

  • 15.8 hrs

  • 62.8 hrs

Correct answer: 7.9 hrs

The minutes remaining in a cylinder can be calculated using the following equation: cylinder pressure*cylinder factor / flow rate. 

An H cylinder has a cylinder factor of 3.14 L/psig, while an E cylinder has a cylinder factor of 0.28 L/psig. 

For this question, the calculation would be (1600 psig - 400 psig*3.14 L/psig / 8 L/min = 471 min = 7.9 hrs.

165.

The respiratory therapist is evaluating a patient by percussion of the chest wall and notes dullness. Which of the following could cause dullness upon percussion of the chest wall? 

  • Pulmonary edema

  • Normal lung tissue

  • Emphysema

  • Tension pneumothorax

Correct answer: Pulmonary edema

Dullness is a sound of medium intensity and pitch of short duration. It is produced over areas that contain a higher proportion of tissue or fluid than air. Pulmonary edema would cause dullness due to the accumulation of fluid in the lungs. 

Normal lung tissue would create resonance with percussion. Emphysema would likely cause hyperresonance. A tension pneumothorax would likely cause tympany.

166.

What pressure should be maintained within the cuff of a tracheal tube in typical adult patients?

  • 20-30 cm H2O

  • 10-20 cm H2O

  • 30-40 cm H2O

  • The lowest pressure that results in the smallest air leak

Correct answer: 20-30 cm H2O

The correct range for cuff pressures in a tracheal tube is 20-30 cm H2O. Less than 20 cm H2O can result in leaks around the cuff which can lead to bacterial contamination of the lower airways. This is also the reason that the pressure that results in the smallest air leak should not be used. Any air leak can lead to client aspiration of pharyngeal secretions. The perfusion pressure of the tracheal mucosal capillaries is about 30 cm H2O, and pressures exceeding this range can lead to decreased blood flow to the mucosa, which can result in tissue damage.

167.

Which of the following steps is NOT part of a modified Allen test?

  • Releasing pressure on the radial artery to see if flushing occurs

  • Applying pressure to the radial and ulnar artery simultaneously

  • Having the patient clench their hand while circulation to the hand is obstructed

  • Checking for restoration of circulation to the hand within 5 to 10 seconds

Correct answer: Releasing pressure on the radial artery to see if flushing occurs

A modified Allen test is performed by applying pressure to the ulnar and radial arteries while the patient's hand is clenched. The patient then relaxes their hand; the palm and fingers will be blanched. Pressure on the ulnar artery is then released, allowing circulation to be restored. The entire hand should be flushed within 5 to 10 seconds. This test is used to ensure adequate collateral circulation via the ulnar artery. 

The collateral circulation of the radial artery does not need to be assessed as this will not be the artery being accessed.

168.

The respiratory therapist is administering an aerosolized medication that targets the patient's upper airways. What sized aerosol particles are BEST to target this location?

  • 5-50µm

  • 2-5µm

  • 1-3µm

  • < 0.1µm

Correct answer: 5-50µm

Smaller aerosolized particles penetrate deeper into the respiratory tract, while larger aerosolized particles will deposit earlier. The largest aerosolized particles should be used for medications that target the upper airways.

169.

The respiratory therapist is reviewing the laboratory results of a patient with a new cough and notices that the patient's sputum culture shows the presence of Candida growth. Which of the following does this likely indicate?

  • Contamination

  • Community-acquired pneumonia (CAP)

  • Septicemia

  • Nosocomial infection

Correct answer: Contamination

Candida is a bacteria that typically lives in the body and does not normally cause infections. The finding of Candida growth likely indicates contamination of the sputum sample and does not require further action. 

Community-acquired pneumonia (CAP) is not normally caused by Candida. Septicemia and nosocomial infection are certainly not a reasonable inference from this result.

170.

Which of the following ventilator modes or techniques is BEST used for weaning?

  • SIMV mode

  • A/C mode

  • Prone ventilation

  • Control mode

Correct answer: SIMV mode

Synchronized intermittent mandatory ventilation (SIMV) mode allows for spontaneous breathing along with positive pressure ventilator breaths. This makes it an ideal setting for weaning patients. 

A/C mode can be used to wean patients but is not as ideal as SIMV mode. Control mode provides breaths without consideration for patient-triggered efforts, making it a poor weaning mode. Prone ventilation is not used as a weaning support technique.

171.

The respiratory therapist is evaluating a COPD patient who has chronic hypercapnia. How will this affect their SaO2?

  • The patient will have a right shift of the oxyhemoglobin dissociation curve, creating a lower SaO2 for a given PaO2.

  • The patient will have a right shift of the oxyhemoglobin dissociation curve, creating a greater SaO2 for a given PaO2.

  • The patient will have a left shift of the oxyhemoglobin dissociation curve, creating a lower SaO2 for a given PaO2.

  • The patient will have a left shift of the oxyhemoglobin dissociation curve, creating a greater SaO2 for a given PaO2.

Correct answer: The patient will have a right shift of the oxyhemoglobin dissociation curve, creating a lower SaO2 for a given PaO2.

Hypercapnia decreases the affinity of hemoglobin for O2. This creates a right shift in the oxyhemoglobin dissociation curve and means that for any given PaO2, the SaO2 will be lower than it would have been in the absence of hypercapnia. 

The other answers are incorrect.

172.

The respiratory therapist is evaluating the ABG of a preterm infant who is being oxygenated using a nasal cannula at 3 L/min and who is one hour old. The patient's ABG is as follows:

  • pH 7.33
  • PaCO2 47 mm Hg
  • PaO2 81 mm Hg
  • HCO3- 19 mEq/l
  • BE -4

Which of the following interventions is necessary for this patient?

  • Decrease or turn of the nasal cannula

  • Intubate the patient and begin mechanical ventilation

  • Begin providing oxygen using an oxygen hood instead of a nasal cannula

  • No intervention is needed

Correct answer: Decrease or turn off the nasal cannula

Retinopathy of Prematurity (ROP) is caused by hyperoxygenation of a newborn. The goal PaO2 to avoid ROP should be less than 80 mm Hg. A preterm infant who is one hour old should have PaO2 of 52 to 69 mm Hg typically, making the nasal cannula likely to be unnecessary for this patient. 

All the other ABG values are normal for a preterm infant who is one hour old.

173.

Which of the following is TRUE for a patient who is not on comfort care and who has a Glasgow Coma Score (GCS) of 7?

  • The patient must have their airway secured, preferably by endotracheal intubation if possible

  • The patient should be evaluated for the ability to protect their airway and only endotracheally intubated if they are unable to do so

  • The patient should be closely monitored, as endotracheal intubation will likely be necessary if the GCS is lower than 7

  • No intervention or advanced monitoring is needed for this patient

Correct answer: The patient must have their airway secured, preferably by endotracheal intubation if possible

Any patient who has a GCS of lower than 8 and has not opted out of life-saving interventions should have their airway secured. A GCS of lower than 8 is a sufficient reason to intubate a patient. 

If the patient does not require further evaluation, a GCS of less than 8 is sufficient evaluation to determine that intubation is necessary. The statement that a GCS of less than 7 requires intubation is incorrect; it is at a GCS of less than 8 that this becomes necessary. The statement that no intervention or advanced monitoring is needed for this patient is incorrect.

174.

The respiratory therapist is assessing a patient with a tracheal tube. The patient's family member asks if it is possible for the patient to use a speaking valve so they can communicate. Which of the following is NOT a consideration for using a speaking valve for this patient?

  • The tracheal tube cuff will need to be partially deflated.

  • The tracheal tube must be a tracheostomy tube.

  • The patient should be able to attempt to speak.

  • A speaking valve could be used while ventilated.

Correct answer: The tracheal tube cuff will need to be partially deflated.

When using a speaking valve, the cuff must be fully, not partially deflated. A speaking valve will allow air to enter but not exit through a tracheostomy, making complete deflation of the cuff necessary. 

The tracheal tube must be a tracheostomy tube, as other tracheal tubes do not allow full and free movement of the vocal cords. The patient should be able to attempt to speak to use the speaking valve. A speaking valve can be used while ventilated if the proper equipment is present.

175.

The respiratory therapist is preparing to administer an inhaled medication that will stimulate the patient's beta-2 adrenergic receptors. Which of the following is NOT affected by beta-2 adrenergic receptor stimulation?

  • Heart

  • Pulmonary blood vessels

  • Bronchial blood vessels

  • Submucosal glands

Correct answer: Heart

The heart contains beta-1 adrenergic receptors and reacts to stimulation of these receptors by increasing heart rate and force of contraction. 

Beta-2 adrenergic receptors do affect pulmonary blood vessels by causing vasodilation, bronchial blood vessels by causing vasodilatation, and submucosal glands by causing increased fluid secretion.

176.

The respiratory therapist is teaching a patient coughing techniques and teaches the patient to splint using a pillow when coughing. Which of the following effects does splinting using a pillow have when coughing?

  • It improves cough effort

  • It has a purely psychological effect

  • It moves secretions into the larger airways

  • It helps the patient to avoid aspirating while coughing

Correct answer: It improves cough effort

Splinting the abdomen increases cough effort and helps to reduce the pain that may be caused by sudden intra-abdominal pressure changes. 

It does not have a purely psychological effect and does not help to avoid aspiration while coughing. Coughing will move secretions into the larger airways, but splinting itself will not. 

177.

A respiratory therapist with a fever, cough, and rhinitis decides to stay home from work instead of working their scheduled shift. This is an example of breaking which part of the chain of infection?

  • Reservoir

  • Portal of exit

  • Vulnerable host

  • Transmission

Correct answer: Reservoir

The reservoir is the source of a pathogen in the chain of infection. Any patient, visitor, or staff member who has an illness is a potential reservoir. By staying home with symptoms that indicate an infection, the respiratory therapist is removing a potential reservoir from the clinical environment.

178.

When performing an arterial puncture, which of the following BEST describes a pre-analytical error?

  • Air is in the sample

  • The analyzer loses power in the middle of analyzing the sample

  • The results are reported on the wrong patient

  • The analyzer is not correctly calibrated

Correct answer: Air is in the sample

Pre-analytical errors are errors that occur prior to analyzing the sample. Air in the sample would be an example of a pre-analytical error.

Problems with the analyzer itself, such as incorrect calibration or loss of power, would be analytical errors. Errors that occur after analysis, such as reporting errors, are examples of post-analytical errors.

179.

Why is it important to clean physical debris from equipment using soap and water prior to autoclaving the equipment?

  • The debris can shield pathogens from the autoclaving process

  • While the equipment will be sterile, unsightly debris can decrease confidence in the equipment's cleanliness

  • Autoclaving as a process is insufficient to clean equipment

  • Equipment does not need to be cleaned with soap and water prior to autoclaving

Correct answer: The debris can shield pathogens from the autoclaving process

Physical debris can provide protection to pathogens during autoclaving, making the equipment non-sterile even after autoclaving. 

The cleaning of physical debris using soap and water is not purely aesthetic. All equipment should be cleaned with soap and water prior to autoclaving.

180.

The respiratory therapist is teaching a student respiratory therapist about capnography when the student asks what mainstream capnography is. Which of the following answers is BEST?

  • It is an analysis chamber in the patient's ventilator circuit that detects CO2 concentrations in exhaled air

  • It is CO2 monitoring that is obtained when air is pumped from the ventilator circuit into an analyzer

  • Blood is drawn from a main artery, then is analyzed for CO2 concentrations

  • A chemical reaction between CO2 and a pH sensitive material is used to continuously monitor the patient's exhaled CO2 levels

Correct answer: It is an analysis chamber in the patient's ventilator circuit that detects CO2 concentrations in exhaled air

Mainstream capnography is obtained by using an analysis chamber within the patient's ventilator circuit that detects CO2 concentrations in exhaled air using photometric measurements. 

CO2 monitoring that is obtained when air is pumped from the ventilator circuit into an analyzer is sidestream capnography. Blood is drawn from a main artery, then is analyzed for CO2 concentrations describes an ABG. Colorimetric capnography uses the reaction between CO2 and a pH sensitive material to assess for the presence of exhaled CO2 after intubation, but is not used to continuously monitor a patient.

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