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Quiz Session - Attempts With Random Questions

NBRC RRT Exam Questions

Page 1 of 30

1.

Use the following scenario to answer this question.

Which of the following BEST describes why a bronchoalveolar lavage would be performed on this patient?

(CHOOSE ONLY ONE.)

  • To better diagnose the patient's condition

  • To reduce the burden of irritants that may be causing the patient's condition

  • A bronchoalveolar lavage should not have been performed on this patient

  • To better understand the efficacy of treatments that have been implemented

Correct answer: To better diagnose the patient's condition

A bronchoalveolar lavage is a diagnostic procedure and is performed to better diagnose the patient's condition. 

A bronchoalveolar lavage will not meaningfully reduce the burden of irritants causing the patient's condition and will not typically yield information about the efficacy of treatments. 

2.

When diluting a bronchodilating agent, which of the following solutions is BEST for stimulating coughing and inducing sputum production?

  • Hypertonic saline (1.8% NaCl)

  • Hypotonic saline (0.4% NaCl)

  • Normal saline (0.9% NaCl)

  • Sterile distilled water

Correct answer: Hypertonic saline (1.8% NaCl)

The higher concentration of the solution creates larger aerosol particles. These particles irritate the airway, inducing sputum production and stimulating coughing. The higher the concentration of NaCl that a solution has, the larger the aerosol particles will be.

3.

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.

4.

Use the following scenario to answer this question.

Based on the information provided, which of the following interventions are BEST to recommend for this patient?

(SELECT AS MANY as you consider indicated.)

  • Chest X-ray

  • Sputum culture

  • EKG

  • ABG

  • Ultrasound evaluation of the patient's pulmonary arteries 

Chest X-ray and sputum culture are both indicated for a suspected pulmonary infection. 

An EKG is unlikely to be relevant for a complaint that consists solely of a persistent cough and fever. An ABG will be painful and invasive, and is not likely necessary given the information provided about this patient. Ultrasound evaluation of a patient's pulmonary arteries is not routinely performed or practical. 

5.

The respiratory therapist is planning for the post-surgical care of a 59-year-old female who is having a left total knee arthroplasty (TKA) and has a history of asthma. Which of the following factors is NOT an important consideration for post-surgical complications related to the patient's asthma?

  • The presence of exercise-induced asthma

  • The degree of airflow obstruction

  • Recent use of oral corticosteroids

  • The severity of the patient's airway hyperreactivity

Correct answer: The presence of exercise-induced asthma 

The presence of exercise-induced asthma specifically is not an important consideration for post-surgical complications related to the patient's asthma. 

The degree of airflow obstruction and the severity of the patient's airway hyperreactivity both influence the possibility of post-surgical complications. Planning for and reducing the likelihood of post-surgical complications does include administering perioperative corticosteroids, so understanding whether corticosteroids have been used recently is important. 

6.

The respiratory therapist is preparing to administer 2.5mg of dornase alfa (Pulmozyme) via a small-volume nebulizer. Which of the following assessments would indicate that this is contraindicated?

  • FEV1 is 30% less than predicted

  • FEV1 is 30% more than predicted

  • Excessive coughing during therapy is likely

  • Mechanical suctioning is likely to be necessary following therapy

Correct answer: FEV1 is 30% less than predicted 

If FEV1 is 25% less than predicted or lower, it becomes difficult to mobilize and expectorate secretions. Administering a mucolytic to this patient would be contraindicated. 

An elevated FEV1 would not be a contraindication. Coughing during or following mucolytic therapy is expected and desirable. Mechanical suctioning may be necessary following administration of a mucolytic and is not a contraindication.

7.

Which of the following lung volumes or lung capacities CANNOT be measured directly?

  • RV

  • VC

  • ERV

  • IRV

Correct answer: RV

Residual Volume (RV) is the volume of air that remains in the lungs following maximum expiration; this volume cannot be measured directly. 

Inspiratory Reserve Volume (IRV) is the volume of air that can be inhaled beyond tidal volume, while Expiratory Reserve Volume (ERV) is the volume of air that can be exhaled beyond tidal volume. Vital Capacity (VC) is the greatest volume of air that can be exhaled after maximum inspiration.

8.

Prior to performing an arterial puncture, the respiratory therapist performs a modified Allen test. What is the purpose of this test?

  • This test ensures that there is collateral circulation distal to the site of the puncture.

  • This test ensures that excessive bleeding will not occur.

  • This test ensures that the puncture will be arterial and not venous.

  • This test is not used prior to arterial punctures.

Correct answer: This test ensures that there is collateral circulation distal to the site of the puncture.

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 modified Allen test is not used to ensure that excessive bleeding will not occur or that the puncture site will be arterial.

9.

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.

10.

Use the following scenario to answer this question.

Which of the following ventilator settings should be adjusted based on the patient's ABG results?

(CHOOSE ONLY ONE.)

  • FIO2

  • No adjustment is needed

  • VT

  • Mandatory rate

Correct answer: FIO2

The patient's ABG shows mild hypoxia. This could potentially be corrected by increasing the PEEP; however, increasing the FIO2 is a correct response. 

Increasing the mandatory rate or VT would be unlikely to be effective.

11.

The respiratory therapist is caring for a patient whose respiratory rate has doubled, but their minute ventilation is the same. The physiologic dead space is unchanged. What does this imply?

  • V̇A is decreasing

  • VT is increasing

  • This is not possible, the minute ventilation should be reassessed

  • V̇A is increasing

Correct answer: V̇A is decreasing

For the minute volume to remain unchanged with an increasing respiratory rate, the tidal volume (VT) must be decreasing. This means that alveolar ventilation (V̇A) is decreasing, not increasing.

VT cannot be increasing. The finding described in the question prompt is certainly possible.

12.

The respiratory therapist is suctioning a patient who has frequent cardiac arrhythmias during the suctioning. Abnormalities with which of the following electrolytes would be MOST likely to cause cardiac arrhythmias?

  • Potassium

  • Sodium

  • Calcium

  • Magnesium

Correct answer: Potassium

Potassium levels must be tightly maintained within their specific range. Even small abnormalities in potassium levels can cause cardiac arrhythmias in compromised patients, and severe changes in potassium levels can lead to arrhythmias in previously healthy patients. 

Sodium, calcium, and magnesium all play a role in regulating cardiac rhythms, but changes in the levels outside of their normal ranges do not commonly cause cardiac arrhythmias unless these changes are quite severe.

13.

You are called to the Emergency Department for a 26-year-old male who was impaled by a nail from a nail gun in the right chest wall. His coworkers removed the nail at the scene and he now has a decreased level of consciousness and tracheal deviation to the left. 

Which of the following interventions is MOST necessary?

  • Emergency needle thoracentesis

  • Endotracheal intubation

  • Bag-valve-mask ventilation

  • Emergency thoracotomy

Correct answer: Emergency needle thoracentesis

The patient is symptomatic for a tension pneumothorax and has a history that suggests this is likely. Emergency needle thoracentesis will relieve pressure in the pleural space. 

Endotracheal intubation may be necessary but will not help to resolve a tension pneumothorax. Bag-valve-mask ventilation may also be necessary, but may worsen the building pressure in the pleural space. An emergency thoracotomy would relieve pressure in the pleural space, but is invasive and would typically be less practical or timely than an emergency needle thoracentesis. An emergency needle thoracentesis will be the preferred treatment.

14.

Which of the following methods for diagnosing obstructive sleep apnea is considered the "gold standard"?

  • A full-night polysomnogram (PSG) in a sleep laboratory monitored by a sleep technologist

  • A full-night polysomnogram (PSG) that is monitored by a sleep technologist regardless of the location

  • Any direct observation of OSA by a clinician, whether in a sleep laboratory or while a patient is sleeping in a hospital setting

  • A home sleep apnea test (HSAT)

Correct answer: A full-night polysomnogram (PSG) in a sleep laboratory monitored by a sleep technologist

The "gold standard" for diagnosing OSA is a polysomnogram (PSG) that covers the patient's entire night of sleep and is administered in a sleep lab and monitored by a sleep technologist. 

Having a PSG that is administered in a sleep laboratory is considered superior to other locations; thus, location is a factor. Direct observation of OSA could be used to diagnose it but, typically, a more comprehensive study is used. A home sleep apnea test (HSAT) may be used to diagnose OSA and is becoming increasingly common due to its convenience over other, more complicated tests. An HSAT is, however, not the  "gold standard" for diagnosing OSA.

15.

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.

16.

The respiratory therapist is evaluating a patient who has a BMI of 29.4. Which of the following BEST describes this patient's weight?

  • The patient is overweight

  • The patient is a healthy weight

  • The patient is obese

  • The patient is morbidly obese

Correct answer: The patient is overweight 

The BMI categories are:

  • < 18.5, underweight
  • 18.5-24.9, healthy weight
  • 25.0-29.9, overweight
  • > 30, obese
  • > 35, morbidly obese

The patient's BMI of 29.4 makes the patient overweight, but not obese.

17.

Which of the following factors can cause a false high HbCO when hemoximetry is used?

  • The presence of high levels of fetal hemoglobin

  • Recent exposure to smoke in a house fire

  • Long-term cigarette use

  • Acute lymphocytic leukemia

Correct answer: The presence of high levels of fetal hemoglobin

The presence of high levels of fetal hemoglobin can cause a falsely high HbCO level. 

Exposure to smoke in a house fire or long-term cigarette use will both likely cause an elevated HbCO level, but this will be a true high, not a false high. Acute lymphocytic leukemia should not affect the HbCO level.

18.

Which of the following inhaled glucocorticoids is given as an inactive compound that is then converted into active metabolites by intracellular enzymes? 

  • Ciclesonide (Alvesco)

  • Budesonide (Pulmicort Flexhaler)

  • Fluticasone propionate (Flovent HFA)

  • Flunisolide hemihydrate (Aerospan)

Correct answer: Ciclesonide (Alvesco) 

Ciclesonide (Alvesco) is a prodrug, an inactive compound that is metabolized by the body into an active medication. Ciclesonide is the only glucocorticoid that is a prodrug. 

Budesonide, fluticasone propionate, and flunisolide hemihydrate are all glucocorticoids that are administered in their active forms.

19.

Use the following scenario to answer this question.

Which of the following radiographic signs would indicate a diagnosis of laryngotracheobronchitis?

(CHOOSE ONLY ONE.)

  • Steeple sign

  • Thumb sign

  • Honeycomb sign

  • Bat wing sign

Correct answer: Steeple sign

Steeple sign indicates subglottic narrowing, as is typically diagnostic for laryngotracheobronchitis (croup). 

Thumb sign is an indication of epiglotitis. Honeycomb sign indicates interstitial fibrosis. Bat wing sign can indicate a number of different conditions, but is not indicative of croup.

20.

Which of the following conditions does NOT require additional consideration when administering an anticholinergic agent?

  • Diarrhea

  • Narrow-angle glaucoma

  • Bladder neck obstruction

  • Bowel obstruction

Correct answer: Diarrhea

Anticholinergic agents inhibit acetylcholine receptors, reducing muscle activity. This can have rare, but potentially negative, effects on conditions that are related to muscle tone. These include narrow-angle glaucoma, bladder neck obstruction, and bowel obstruction. 

Constipation would be a concern, but the effects of an anticholinergic agent on diarrhea may actually be positive.

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