NBRC RRT Exam Questions

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141.

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.

142.

How long will it take for a full H cylinder to reach 1000 psig if O2 is administered at 2 L/min?

  • 31.4 hrs

  • 15.7 hrs

  • 62.8 hrs

  • 57.6 hrs

Correct answer: 31.4 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 (2200 psig-1000 psig)*3.14 L/psig / 2 L/min = 1884 min = 31.4 hrs.

143.

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.

144.

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.

145.

Which of the following descriptions of a biological indicator for infection control is CORRECT?

  • Bacterial spores are permitted to go through the sterilization process and are evaluated to see if growth occurs afterward

  • A chemical changes color when exposed to the cleaning process that is specific to a particular method of sterilization

  • A sterile swab is used to sample equipment that has been sterilized, then is incubated to see if growth occurs

  • A reservoir is rinsed, and the liquid is tested to see if bacterial growth occurs

Correct answer: Bacterial spores are permitted to go through the sterilization process and are evaluated to see if growth occurs afterward

Biological indicators use known bacterial spores impregnated into paper strips that go through the sterilization process. These spores are then exposed to growth media, and growth indicates that sterilization was insufficient.

A chemical indicator changes color when exposed to the cleaning process that is specific to a particular method of sterilization and does not indicate that sterilization occurred, but that the correct process occurred. Equipment may be cultured to see if growth occurs, but this is distinct from a biological indicator.

146.

Use the following scenario to answer this question.

Which of the following makes a normal home discharge impossible?

(CHOOSE ONLY ONE.)

  • A discharge home under these conditions is possible

  • The patient lives alone without available support

  • The patient must use stairs to get to his place of residence 

  • The patient will be exposed to cat dander

Correct answer: A discharge home under these conditions is possible

If the patient's pneumonia has resolved and the tracheal stenosis has been treated, there are no contraindications to him returning home. Living alone, having to use a flight of stairs, or being exposed to cat dander will not affect resolved pneumonia or treated tracheal stenosis.

147.

The respiratory therapist suspects that a patient's community-acquired pneumonia (CAP) is caused by an Actinomyces infection. Which of the following tests would help to identify the presence of this infectious organism?

  • Anaerobic culture

  • Fungal stain and culture

  • WBC

  • Respiratory virus Polymerase Chain Reaction (PCR) panel

Correct answer: Anaerobic culture

Actinomyces is an anaerobic bacteria that will be specifically identified using an anaerobic culture.

A fungal stain and culture and a respiratory virus polymerase chain reaction (PCR) panel will both not identify any bacterial infections. A white blood cell count (WBC) can indicate if infection is present, but will not identify Actinomyces.

148.

The respiratory therapist is caring for a three-year-old female who was found unconscious in a shallow pond. Which of the following interventions is INCORRECT for this patient?

  • Position the patient supine for best visualization and management of their airway

  • Begin mechanical ventilation if acute respiratory distress syndrome (ARDS) develops

  • Clear the airway using bronchoalveolar lavage if foreign matter has been aspirated

  • Manage the patient's temperature

Correct answer: Position the patient supine for best visualization and management of their airway

Management of a near-drowning patient includes positioning the patient in the prone position if possible to facilitate airway clearance. 

Near-drowning patients should be mechanically ventilated if ARDS develops. Bronchoalveolar lavage may be necessary for this patient, as aspiration of foreign materials is common in drownings where sand, mud, or dirt may be present in the water, as would be likely in a shallow pond. Temperature management is necessary as hypothermia can quickly develop when a patient is submerged.

149.

The respiratory therapist is setting up a heated humidifier system for a neonatal breathing circuit. If this patient is in an incubator, which of the following is TRUE when setting this system up?

  • The temperature probe and the heating wire must both be outside of the incubator

  • The temperature probe and the heating wire can both be inside of the incubator

  • The temperature probe can be inside of the incubator but the heating wire must be outside

  • The temperature probe must be outside of the incubator but the heating wire can be inside

Correct answer: The temperature probe and the heating wire must both be outside of the incubator

The temperature probe must only detect the heat that is from the heated gas. Having the temperature probe inside the incubator would cause readings to be affected by the ambient heat provided by the incubator. The heating wire must also not be present in the incubator, as the radiant heat can further heat gases, increasing the final temperature of the gas that is delivered and overheating it.

150.

Which of the following is NOT a normal necessary component for a negative-pressure room?

  • An internal and external barometer that compares the pressure differences inside and outside the room

  • The ability of the air system to perform 6 to 12 air changes per hour

  • A high-efficiency particulate air filter system if recirculated air is used

  • A safe external air discharge if recirculated air is not used

Correct answer: An internal and external barometer that compares the pressure differences inside and outside the room

While negative-pressure rooms do need an indicator if the negative pressure is on or not, an internal and external barometer that compares the pressure differences inside and outside the room is not necessary. 

Negative pressure rooms should have the ability to perform 6 to 12 air changes per hour. A high-efficiency particulate air filter system should be used if recirculated air is used. If recirculated air is not used, then air from the room should be discharged into the outside environment safely.

151.

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.

152.

How frequently should positive expiratory pressure (PEP) therapy be used?

  • The frequency should be determined by individual patient response

  • 2 to 4 times each day

  • 4 to 6 times each day

  • At least 4 times per day and no more than 12 times daily

Correct answer: The frequency should be determined by individual patient response

While positive expiratory pressure (PEP) therapy is often performed about 2 to 4 times each day, the frequency should ultimately be determined by each patient's individual response to therapy rather than based on a fixed frequency range.

153.

When using a double-lumen endotracheal (ET) tube, which of the following is NOT an important consideration for this specialized airway?

  • This type of airway cannot be used on lung transplant patients

  • The tube is stiffer and bulkier to insert than standard ET tubes

  • The tube must be rotated during insertion

  • Flexible bronchoscopy should be used to ensure correct placement

Correct answer: This type of airway cannot be used on lung transplant patients

A double-lumen endotracheal (ET) tube can be used on patients who have had a lung transplant and this is a potential indication for this type of airway.

Double-lumen ET tubes are stiffer and bulkier to insert than standard ET tubes and must be rotated during insertion to facilitate placement. Flexible bronchoscopy should be used to verify that placement is correct after insertion.

154.

Which of the following is LEAST likely to be a cause of dyspnea in adults?

  • Deficiency of pulmonary surfactant

  • Increased airway resistance

  • Abnormal chest wall

  • Anxiety

Correct answer: Deficiency of pulmonary surfactant

Deficiency of pulmonary surfactant is primarily a respiratory condition affecting neonates or young infants and is very uncommon in adults. 

Increased airway resistance, an abnormal chest wall, and anxiety are all possible causes of dyspnea in adults.

155.

The respiratory therapist is preparing to suction a patient and adjusts the suction level to -40 mm Hg. Which of the following patient groups is this suction appropriate for?

  • This is not an appropriate suction level.

  • Infants

  • Children

  • Adults

Correct answer: This is not an appropriate suction level.

This is not an appropriate suction level for any of the three groups listed. 

The appropriate suction level for infants is -60 to -80 mm Hg. For children it is -80 to -100 mm Hg, and for adults it is -100 to -120 mm Hg. A suction level of -40 mm Hg would not be effective for most patients.

156.

Use the following scenario to answer this question.

Which of the following conditions BEST fits the patient's symptoms?

(CHOOSE ONLY ONE.)

  • Tracheal stenosis

  • Pneumonia

  • Pulmonary contusion

  • Acute asthma exacerbation

Correct answer: Tracheal stenosis

Tracheal stenosis causes dyspnea, stridor, hypoxia, hypercapnia, and diminished breath sounds. This condition can also occur due to scarring of the trachea, which may have occurred secondary to the facial burns or, more likely, due to scarring caused by the recently discontinued tracheostomy. 

Pneumonia is unlikely to cause bilateral breath sound changes or stridor. Pulmonary contusion does not fit the symptoms well, and there is no history of recent blunt chest trauma. An acute asthma exacerbation is unlikely when there is no previous history of asthma. While asthma may fit these symptoms, the background of a tracheostomy that was recently discontinued and the absence of a history of asthma makes tracheal stenosis more likely.

157.

Use the following scenario to answer this question.

Which of the following should be inferred from the patient's ABG?

(SELECT AS MANY as you consider indicated.)

  • Acid-base imbalance with a respiratory cause

  • Acidosis

  • Hypoxia

  • Acid-base imbalance with a metabolic cause

  • Alkalosis

The low pH, elevated PaCO2, and normal HCO3 all indicate uncompensated respiratory acidosis. The patient's PaO2 is low and indicates hypoxia.

158.

Which of the following BEST describes the flow of conduction through a healthy human heart?

  • SA node > AV node > Bundle of His > Purkinje fibers

  • AV node > SA node > Bundle of His > Purkinje fibers

  • AV node > SA node > Purkinje fibers > Bundle of His 

  • SA node > AV node > Purkinje fibers > Bundle of His

Correct answer: SA node > AV node > Bundle of His > Purkinje fibers

Electrical conduction in the heart begins with the SA node and is transmitted to the AV node through internal atrial conduction tracts, depolarizing the atria and causing them to contract. Conduction is delayed in the AV node, then is transmitted through the Bundle of His into the Purkinje fibers where ventricular contraction is stimulated.

159.

Which of the following occupations and industries can increase a patient's risk of developing asthma?

  1. Dairy farming
  2. Sawmill workers
  3. Cosmetology
  4. Rubber processing
  5. Plastics industry

  • 1, 2, 3, 4, & 5

  • 1, 2, 4, & 5 only

  • 2, 4, & 5 only

  • 1, 4, & 5 only

Correct answer: 1, 2, 3, 4, & 5

All the industries and occupations listed increase an individual's risk of developing asthma. Dairy farming can cause asthma through exposure to storage mites. Sawmill workers can acquire asthma through exposure to wood dust. Cosmetology can cause asthma through exposure to persulfate. Rubber processing can cause asthma through exposure to formaldehyde and ethylenediamine. The plastics industry can cause asthma through exposure to toluene diisocyanate and trimellitic anhydride.

160.

Which of the following correctly describes obligate aerosol transmission of a disease?

  • Transmission only occurs through airborne aerosols

  • Transmission occurs through multiple routes, but airborne transmission dominates

  • Transmission occurs through multiple routes, but airborne transmission is possible in some situations

  • Airborne transmission is only possible under artificial conditions

Correct answer: Transmission only occurs through airborne aerosols

Obligate aerosol transmission describes transmission that only occurs through airborne aerosols. 

Transmission that occurs through multiple routes, but in which airborne transmission dominates is called preferential aerosol transmission. Transmission that occurs through multiple routes, but in which airborne transmission is possible in some situations describes opportunistic aerosol transmission.