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Quiz Session - Attempts With Random Questions

NBRC RRT Exam Questions

Page 5 of 30

81.

Which of the following describes the condition in which O2 is more likely to disassociate from hemoglobin in the presence of elevated CO2 levels?

  • Bohr effect

  • Hamburger phenomenon

  • Haldane effect

  • Left shift of the oxyhemoglobin dissociation curve

Correct answer: Bohr effect

The Bohr effect occurs when elevated CO2 levels decrease the affinity of hemoglobin for oxygen. 

The Haldane effect describes the effect when the release of CO2 is enhanced by the combination of O2 with hemoglobin. The Hamburger phenomenon describes the shift of chloride ions from the plasma into erythrocytes. A left shift of the oxyhemoglobin dissociation curve occurs when the affinity of hemoglobin for O2 increases, not when it decreases.

82.

Use the following scenario to answer this question.

Which of the following is MOST a risk factor for tuberculosis in this patient?

(CHOOSE ONLY ONE.)

  • Living location

  • Recent travel

  • History of childhood asthma

  • History of MI

Correct answer: Living location

The patient has just spent two months living in a developing country where exposure to tuberculosis is more likely. 

Traveling, by itself, is not likely to significantly increase the risk of exposure to tuberculosis. A history of childhood asthma or an MI does not significantly increase the risk of developing tuberculosis.

83.

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.

84.

Autogenic drainage uses three phases of breathing to loosen secretions and move them into the larger airways. What is the correct order of these three phases?

  1. The patient increases VT to moderate volumes for several breaths.
  2. The patient uses a VT to low to moderate volumes for several breaths.
  3. The patient takes the deepest breath possible followed by several low-volume breaths.

  • 3, 2, then 1

  • 3, 1, then 2

  • 2, 3, then 1

  • 2, 1, then 3

Correct answer: 3, 2, then 1

Autogenic drainage involves the following phases of breathing: 

Phase 1: The patient starts by taking the deepest breath possible followed by several low-volume breaths. 

Phase 2: The patient increases VT to low to moderate volumes for several breaths.

Phase 3: The patient increases VT to moderate volumes for several breaths.

Upon completing these three phases, the patient is asked to cough.

85.

When distinguishing between asthma and chronic obstructive pulmonary disease (COPD), which of the following is TRUE?

  • Asthma often has its onset during childhood

  • A family history of COPD is normally present

  • Asthma is normally associated with a long smoking history

  • Asthma is a largely irreversible airflow limitation 

Correct answer: Asthma often has its onset during childhood

The onset of symptoms can be a distinguishing factor between asthma and COPD as asthma often has its onset during childhood or early in life, while COPD typically has an onset later in life. 

A family history of asthma is normally present, but a family history of COPD is not normally as significant a factor as the patient's environment. COPD is normally associated with a long smoking history, while asthma is less likely to be associated with a long smoking history, although this is still a possibility. Asthma is a largely reversible airflow limitation, not an irreversible one.

86.

Which of the following mass median aerodynamic diameter (MMAD) is recommended for aerosolized medications that target the parenchyma?

  • < 0.1µm

  • 1-3µm

  • 2-5µm

  • 5-50µm

Correct answer: < 0.1µm

Smaller aerosolized particles will penetrate deeper into the airways and better reach the parenchyma. 

Particles of 1-3µm target the alveolar regions, particles that are 2-5µm are recommenced for the lower airways, and particles that are 5-50µm will work best when treating the upper airways.

87.

The respiratory therapist anticipates providing treatments to a 53-year-old male with active tuberculosis. These treatments are anticipated to induce coughing. Which of the following considerations for this patient is INCORRECT?

  • Precautions should be maintained until the procedure is over

  • Cough-inducing treatments should be performed in air-tight enclosures when possible

  • Cough-inducing treatments can be done in a negative pressure room if it meets airborne infection control standards

  • Cough-inducing treatments should be avoided when possible

Correct answer: Precautions should be maintained until the procedure is over

Precautions for this patient should be maintained until the procedure is over and the patient is no longer coughing. 

Cough-inducing treatments should be performed in air-tight enclosures when possible for patients with airborne respiratory illnesses, but can be performed in negative pressure rooms that meet airborne infection control standards. Cough-inducing treatments should be avoided when possible for this patient, but may still be necessary.

88.

When performing Internal Statistical Quality Control on an ABG analyzer, bias (systemic) errors can occur. Which of the following is NOT a cause of bias errors?

  • Statistical variations

  • Incorrect gas concentrations

  • Component failure

  • Contaminated buffers

Correct answer: Statistical variations

Bias errors, also known as systemic errors, are errors during statistical quality control that are indicated by a recurrent shift of data points outside the statistical limits. Bias errors are caused by a problem with the testing process or device. 

Statistical variations can occur where a value is randomly outside the accepted standard deviations. Statistical variations are an example of an imprecision or random error, not a bias error.

89.

The respiratory therapist is planning the home care of a patient who is receiving pulmonary rehab. Which of the following is NOT a consideration for this patient's oxygen concentrator?

  • The air inlet filters should be cleaned every two to three weeks

  • It should not be placed near a heat vent

  • It should be placed where air can be drawn freely in

  • The respiratory therapist should check the concentrator every routine visit

Correct answer: The air inlet filters should be cleaned every two to three weeks

The air inlet filters should be cleaned weekly by the patient or their caregiver. 

An oxygen concentrator should not be placed near a heat vent to avoid damage to the machine and to avoid air that is less dense and that may contain contaminants. It should be placed in a location where air can be drawn freely in. The respiratory therapist should check the concentrator every routine visit.

90.

What information about a patient's PaCO2 levels can be inferred from their SpO2 readings?

  • Nothing about the PaCO2 can be inferred from the SpO2

  • A high SpO2 tends to indicate a normal PaCO2

  • A low SpO2 tends to indicate a high PaCO2

  • The SpO2 by itself cannot give information about the PaCO2, but when it is coupled with the patient's anion gap and hemoglobin level, the PaCo2 can be calculated

Correct answer: Nothing about the PaCO2 can be inferred from the SpO2

The SpO2 does not correlate with the PaCO2 in a way that can yield any clinically useful inferences. 

There is no correlation between a high or low SpO2 level and a normal or high PaCO2 level. The SpO2 cannot give information about the PaCO2 level, even if the anion gap and hemoglobin are known.

91.

Which of the following types of nebulizer has the LONGEST treatment time?

  • Jet nebulizer

  • Ultrasonic nebulizer

  • Mesh nebulizer

  • Smart nebulizer

Correct answer: Jet nebulizer

A jet nebulizer provides the longest treatment time. 

The treatment time using an ultrasonic nebulizer is more intermediate when compared to other nebulizer treatment lengths. Mesh nebulizers and smart nebulizers have relatively short treatment times.

92.

Which of the following should the respiratory therapist consider when administering ribavirin?

  • It should not be used to treat bacterial infections.

  • It is recommenced for routine RSV infections.

  • It is administered using a small-volume nebulizer (SVN).

  • It cannot be administered to a patient on a mechanical ventilator.

Correct answer: It should not be used to treat bacterial infections.

Ribavirin is an antiviral and can only be used to treat viral, not bacterial, infections. 

Ribavirin is not recommenced for routine RSV infections but may be considered in life-threatening infections. Ribavirin is administered using a special large-reservoir nebulizer called a small-particle aerosol generator (SPAG), not by using an SVN. Ribavirin can be administered to patients on mechanical ventilators.

93.

Use the following scenario to answer this question.

Which of the following is CORRECT about the sputum culture that was performed? 

(SELECT AS MANY as you consider indicated.)

  • It may take over four weeks for results

  • It is the gold standard for diagnosing tuberculosis

  • It will take 24 hours for results to be available

  • It will provide an indication of whether a pulmonary embolism is present

  • It cannot be performed after the patient has received antibiotics

A sputum culture is the gold standard for diagnosing tuberculosis; however, results may take 4 to 6 weeks, as it may take that long for M. tuberculosis to grow. 

It will generally take far longer than 24 hours for results. A sputum culture will not provide an indication of whether a pulmonary embolism is present. A sputum culture can be performed after administration of antibiotics, but becomes less likely to detect infectious organisms afterward.

94.

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.

95.

Use the following scenario to answer this question.

What is the BEST response when the patient says they are not sure if they can handle a diagnosis of obstructive sleep apnea?

(CHOOSE ONLY ONE.)

  • "Are you considering killing yourself?"

  • "What is causing you stress about it?"

  • "It won't be that bad getting it treated."

  • "Let me show you how easy treatment will be."

Correct answer: "Are you considering killing yourself?"

The patient's statement, especially when combined with a history of suicidal ideation, may be taken to mean they are considering self harm. The patient should be asked directly to clarify their statement. 

Other answers may be appropriate but are not best.

96.

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.

97.

The respiratory therapist is called to assess a patient with an acute asthma exacerbation who has an FEV1 that is 30% below their normal baseline. Which of the following adrenergic bronchodilators should NOT be used to treat this patient's exacerbation?

  • Salmeterol

  • Levalbuterol

  • Albuterol

  • Racemic epinephrine

Correct answer: Salmeterol 

Salmeterol is a long-acting adrenergic bronchodilating agent (LABA). Levalbuterol, albuterol, and racemic epinephrine are all short-acting adrenergic bronchodilating agents (SABAs). Only SABAs should be used for acute asthma exacerbation. 

LABAs are indicated for control, not for relief. While racemic epinephrine may not be preferred for this patient due to its lack of adrenergic receptor preference, it will still be preferred over salmeterol.

98.

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.

99.

What is the ideal size for aerosolized particles?

  • 1.0-5.0 µm

  • < 5.0 µm

  • 5.0-10.0 µm

  • < 10.0 µm

Correct answer: 1.0-5.0 µm

Particles that are 1.0-5.0 µm have the best chance of reaching the lower airways, and about 50% of aerosolized particles are in this range. 

Smaller particles are unlikely to follow a linear pattern, making them deposit prematurely. Larger particles are heavier and will deposit prematurely due to gravitational effects and inertial impaction.

100.

Use the following scenario to answer this question.

What is the advantage of a polysomnogram performed in a laboratory over a home sleep apnea test?

(CHOOSE ONLY ONE.)

  • It allows for a higher degree of monitoring

  • It better mimics natural conditions

  • It allows the technician the ability to control the patient's sleep cycle

  • There are no advantages to one particular type of sleep test

Correct answer: It allows for a higher degree of monitoring

A polysomnogram performed in a sleep laboratory allows for a much higher degree of monitoring than a home sleep apnea test does. 

A polysomnogram performed in a sleep laboratory is less natural than a test performed at home. A patient's sleep cycle can not be controlled by a technician, even in a laboratory setting.

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