Board Exams CRT and RRT - Respiratory Therapy Files

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Board Exam
Preparation
Written Exams
CRT and RRT
Be Prepared!
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WHAT to study
WHERE to study
WHEN to study
HOW to study
What to Study
 Know Your Enemy: The Board Exams
 You must understand the structure and
content of the board exams and apply this
knowledge to your study plan.
 REVIEW THE MATRIX FOR THE CRT,
RRT, CSE
 ALL FOUND ON WWW.NBRC.ORG
The EXAM
 Part one: Study all content, take plenty of
practice exams, schedule your CRT
exam and layout a study plan
 After completing the CRT schedule your
Written RRT and Clinical Simulation
exam. You may take both the same day
or seperate
Exam Structure
 CRT
 160 questions
 140 actual test questions
 20 additional questions
that are NOT scored
 3 hours
 Passing score 75% (105
correct)*
 RRT Written
 115 questions
 100 actual test questions
 15 additional questions
that are NOT scored
 2 hours
 Passing score 70% (70
correct)*
•Computer based testing
•No calculators allowed
•A pencil and paper will be provided for you
Exam Structure
 CSE (Clinical Simulation Exam)
 PART 2 of the RRT
 Consists of 11 scenarios (only 10 are
graded)
 Covers all areas from the CRT and WRRT
 Typically you will get disease management
scenarios for: COPD, Trauma,
Cardiovascular disease, Neuromuscular,
Peds, Neonates, and others (page 450)
Exam Content
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Content Outline
Candidate Handbook
www.nbrc.org
All items on the exam are developed
from these outlines
 Categorized by cognitive level
 Recall
 Application
 Analysis
Recall: the ability to recall or
recognize specific information
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Facts
Definitions
Normal values
Principles
Equations…
Recall
 Involves remembering memorized
information
 You either know it or you don’t
 If you don’t know the answer, eliminate
answers that you think are impossible,
and then guess from the remaining
options.
Recall Example
An otherwise healthy
25-year-old male
patient who took an
overdose of sedatives
is being supported on a
ventilator. Which of the
following measures of
total static compliance
would you expect in
this patient?
A.
B.
C.
D.
100 mL/cmH2O
10 mL/cmH2O
1 mL/cmH2O
0.1 mL/cmH2O
 Answer A
 To evaluate and monitor a patient, you
need to know what is normal and what is
abnormal. This item tests your ability to
recall normal static compliance. It also
separately assesses your ability to
differentiate the common bedside units
used for this measure (mL/cmH2O) from
that typically employed in a pulmonary
lab (L/cmH2O).
Application: the ability to
comprehend or apply knowledge
to new or changing conditions
 Tests your understanding of principles,
practices, and procedures involved in
respiratory care
Application Example
An adult patient receiving
volume-oriented
assist/control ventilation
has a corrected tidal
volume of 700 mL, a peak
pressure of 50 cmH2O,
and a plateau pressure of
40 cmH2O and is receiving
5 cmH2O of PEEP. What
is the patient’s static
compliance?
A.
B.
C.
D.
200 mL/cmH2O
20 mL/cmH2O
2 mL/cmH2O
0.2 mL/cmH2O
 Answer B
 This item tests your ability to apply a
formula to a clinical situation (most
formula-type questions are at the
application level). To answer it correctly,
you need to “plug” the correct data into
the formula for computing static
compliance Vt/(Ppl-PEEP)
Analysis: the ability to analyze
information, to put information
together to arrive at solutions,
and/or to evaluate the usefulness of
the solutions
 They begin the question with facts that you need to
analyze and interpret to come to a conclusion.
 They may ask what is wrong, or they may ask what do
you want to do about it.
 Analysis: 10% of the exam. analyze or interpret
information in order to solve a problem.
Analysis Example
A patient is receiving
volume cycled mechanical
ventilation in the control
mode. The following ABG
data were obtained:pH
7.56, PaCO2 25 torr, PaO2
93 torr, HCO3- 22 mEq/L
Which ventilator
adjustments should be
made at this time?
A. Institute 5 cmH20 PEEP
B. Increase the FiO2
C. Increase the tidal
volume
D. Decrease the
ventilatory rate
 Answer D
 This item assesses your ability to analyze
monitoring data and apply this
information to recommend a treatment
approach for this patient. First, youmust
analyze the data, which should reveal
that the patient has uncompensated
respiratory alkalosis. Second, you need
to recognize that this can be due to overventilation. Last, you need to apply this
data and your knowledge of mechanical
ventilation to recommend the correct
course of action
The “NBRC Hospital”
 Treat the exam matrix as the policy
manual for the NBRC hospital
 Focus on the things that you do not typically
do at your clinic site
 As you study, identify things that are
different that what you typically do
 Do not be afraid to use your independent
judgement.
The “NBRC Hospital”
• You “enter” the NBRC hospital every time you take an
NBRC exam.
• This hospital may or may not function the same as the
clinical site or sites you are at, it represents an
idealized institution.
• The NBRC RC department always relies of generally
accepted knowledge based on various practice
guidelines
• Their “procedure manual” is based upon broad national
agreement among clinicians and educators as to what
common skills the average therapist performs
• So upon entering the NBRC hospital, you may be
expected to know and do different things from those
you were trained to do.
Your Textbook
 Bold Topic Headings
 Evaluate the patient’s general
appearance (Code: IB1a) [Difficulty:
ELE: R, Ap; WRE: An)
 The code refers to a section of the matrix
 ELE: entry level exam
 WRE: written registry exam
 R: recall, Ap: Application, An: Analysis
Your Text Book
 Read xv through xxi
 For every chapter take the pre-test
(answers and explanations are at the end
of each chapter) and review the content
areas specific for the exam
 Use the Jones and Bartlett Learning
companion website
 REVIEW THE TEST TAKING TIPS AND
TECHNIQUES APPENDIX page 511
Where and When to Study
 Choose a quiet, distraction free
environment
 Establish and follow a strict study
schedule
How to Study
 Prepare yourself mentally and physically
 Be organized
 Organize your resources
 Create a “battle plan”
 Create a list of problem areas to focus on
 Use reflections to help with this!
 Get psyched!
 Create and maintain a positive attitude toward
test preparation and test taking
 http://dus.psu.edu/academicsuccess/studyskills.html
Test Taking Tips
 Pace yourself
 So that you have time to get through all
questions
 “bookmark” questions
 Do not leave any blanks
 Completely read each question
 Determine what you are really being asked
Test Taking Tips cont.
 Separate the important information
 From that which is not important
 Do not read beyond the question
 Use only what is given to you
 Carefully read each answer
 Pick the best answer offered
 Even if you don’t like it
Test Taking Tips cont.
 Multiple multiples
1. Find an option that you know is incorrect
and cross off any of the answers that
contain it
2. Find an option that you know to be correct
and cross off any answers that do not
contain it
3. Find the remaining answer
Test Taking Tips cont.
 Again, answer every question
 Take practice exams
 Evaluate your strengths and weaknesses
 Use reflection to help with this!
 Spend time studying your weak areas
Maximize Exam Prep Time
 Spend the Majority of your time studying
the most heavily tested areas:
 Mechanical Ventilation of the Adult
 Patient Assessment
 Bedside and Advanced
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Arterial Blood Gases
Oxygen and Medical Gas Therapy
Pharmacology
Airway Management
Maximize Exam Prep Time
cont.
 Review the exam hints in all chapters
 ABG interpretation is a must!
 In order to answer mechanical ventilation
and oxygen therapy questions
 Mechanical ventilation of the adult is the
most heavily questioned content.
 You MUST understand mechanical
ventilation to do well on the exams
Taking the Test!
Know What to Expect When
Reporting to the Testing
Center
 Arrive early
 Relax before the exam
 If you are more than 15 minutes late you
will have to reschedule
 Bring two forms of ID
 You may only bring your wallet and keys
into the testing center
 You will be provided with a pencil and
scratch paper
Know What to Expect
 There will be a short practice test
 Once you begin, you cannot ask
questions
 You are allowed to take breaks
 Break time counts against your exam
time
 Take the practice tests on-line at
www.nbrc.org
During the Test
 Get comfortable
 Answer all questions
 Budget your time
 Monitor your pace
 Answer easy questions first
 Bookmark difficult item and return to them
later
 Use all the available time
Test Preparation
“… the most valuable
resource you possess
is your own ability and
determination to
succeed.”
Malley, W., Clinical Blood Gases: Application and Noninvasive Alternatives, W.B.
Saunders Co., Philadelphia, PA, 1990.
Elements of an NBRC
Multiple-Choice Question
 Scenario: Brief description of the clinical
situation
 Stem: The statement that asks the
question or specifies the problem
 Options: Possible answers to the
question or solutions to the problem
 Keyed response: The correct answer
 Distracters: Wrong answers
An 80 kg adult male patient with aspiration pneumonia
receiving volume-oriented SIMV has the following ventilator
settings and blood gas results:
Mode SIMV
Vt 500 mL
Rate 12
FiO2 0.50
PEEP 5 cmH2O
pH 7.29
PaCO2 52 mmHg
HCO3- 25 mEq/L
PaO2 63 mmHg
SaO2 91%
The respiratory therapist should do which of the following
first?
A. Increase the FiO2
B. Increase the tidal volume
C. Add pressure support
D. Increase PEEP
The Scenario
• Briefly describes a clinical situation that you need to
assess.
• Thoroughly review the scenario before even looking
at the stem or options
• Sometimes the scenario and stem are combined
and must be reviewed together
• Look for the following critical information
• Look for the following information:
• The location or setting (ICU, outpatient clinic,
patient’s home)
• The available resources (equipment being used or
at hand)
• Ventilator capable of volume SIMV
• The patient’s general characteristics (age, size,
disease process, mental status)
• Adult, male, 80kg, aspiration pneumonia
• Relevant objective data (ABG, PFT…)
The Stem
• Asks the question or directs your attention.
• Often contains key words or phrases that may help
you choose the correct answer
• Priority: first, initially, best, priority, safest, most,
least
• Put a value on each option and place them in
rank order
• Sequence: before, after, next
• Apply procedural knowledge or logic to place
options in proper sequence
• Absolutes: always, never
• Find the only option that would be correct in
every case every time
The Stem
• Negative polarity: not, except, contraindicated,
unacceptable, avoid
• Switch from being concerned with what is
correct or true to what is false
• Verbal associations: word or phrase in the stem
that is identical or similar to a word in the correct
answer
• Select the option that includes wording similar
to that found in the stem
• What is the key word in the sample question?
• First
• A priority clue directing you to choose the action
most immediately needed
• The primary/most severe problem is respiratory
acidosis
• Keyed option B increase tidal volume
The Stem
 Do not overanalyze!
 The simplest interpretation is generally the correct
one.
 Anticipate the answer
 Before looking at the options available
 Options
 Every question has 4 options
The Stem
Stem Wording A
Which of the following
assessment
procedures would help
determine proper
positioning of an
endotracheal tube in
the patient’s trachea?
Stem Wording B
Which of the following
assessment
procedures would help
confirm proper
positioning of an
endotracheal tube in
the patient’s trachea?
• A tiny variation in wording makes a huge
difference
• A: breath sounds, capnography, tube
insertion length, esophageal detection
device, CXR…
• B: CXR
• Do not overanalyze!
• The simplest interpretation is generally the
correct one.
• Anticipate the answer
• Before looking at the options available
Options
 Every question has 4 options
 When you are sure of the correct
response, select it and move on
 Do not panic when you encounter
questions that appear difficult or
unfamiliar to you
•
•
•
All exam candidates encounter dozens of these questions
Instead of getting flustered, get resourceful and use some of the following option
selection strategies
• Always look for the best option not just the correct one
• Two or more options may be correct but one likely is most correct in the
particular circumstances or with the specific patient described
• When you are unsure of the correct option, switch from finding the right
answer to finding the wrong answer(s)
• Eliminate options you know to be incorrect; each time you eliminate a
distracter, you increase your chances of answering the question correctly
• When in doubt, give each option a “true-false” test as compared with the
stem (the true statement is usually the best answer)
• Be wary of options that are totally unfamiliar to you; more often than not
unfamiliar options are distracters
• If you encounter a “double negative” in a stem and option, remember that
it creates the equivalent positive statement
• Avoid impulsively selecting an option simply because it provides correct
information as an option can provide correct information but still be the
wrong choice because it does not answer the question asked
Let’s look at some more specific strategies…
Which of the following is true regarding
patients in the early stages of an asthmatic
attack?
A. They all exhibit respiratory alkalosis
B. They always have moderate hypoxemia
C. They have decreased expiratory flows
D. They never respond to beta adrenergics
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Absolutes
Correct answer: C
Always, never, all, every, none, only
These key words indicate that the option has no
exceptions
More often than not, options that use absolutes are
false
Generally you should avoid choosing an option that
must be true or false every time without exception
You do not see this very frequently in the board exams
Some absolutes , especially this efounded in rules or
standards, may be a correct option
• “ you must always properly identify the patient
before treatment” holds without exception
A patient’s advance directive:
A. Is usually obtained at the time of
admission
B. Can be found in the doctor’s progress
notes
C. Represents a guideline, not a legal
requirement
D. Cannot be altered after it is written and
signed
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Qualifiers
Correct answer A
A qualifier is the opposite of an absolute
Usually, probably, often, generally, may,
frequently, seldom
• Options that contain qualifiers usually
represent good choices
• The NBRC minimizes its use of qualilfiers
An intubated patient is receiving volume control
ventilation. The patient’s condition has not
changed, but you observe higher peak
inspiratory pressures than before. Which of
the following is t he most likely cause of this
problem?
A. There is a leak in the patient-ventilator system
B. The endotracheal tube cuff is deflated
C. The endotracheal tube is partially obstructed
D. The endotracheal tube is displaced into the
pharynx
 Equally Plausible Options
• Correct answer C
• You will often see question that contain
two options that are very similar to
equivalent to each other
• Options A and B are equivalent because
they both represent a leak in the system
• Usually when two items are very similar
or equivalent, they are distracters and
should be eliminated
Over a 3 hour period, you note that a
patient’s plateau pressure has remained
stable, but her peak pressure has been
steadily increasing. Which of the
following is the best explanation for this
observation?
A. The patient’s airway resistance has
increased
B. The patient is developing atelectasis
C. The patient’s compliance has decreased
D. The patient is developing pulmonary
edema
 Equally Plausible Options
• Correct answer A
• B,C, and D all represent decreases in
compliance thus are equivalent
• The “odd man out” is the correct answer
You are assisting with the oral intubation of an
adult patient. After the ET tube has been
placed, you note that breath sounds are
decreased on the left compared with the right
lung. What is the most likely cause of this?
A. The tip of the tube is in the right mainstem
bronchus
B. The cuff of the endotracheal tube has been
overinflated
C. The endotracheal tube has been inserted into
the esophagus
D. The tip of the tube is in the left mainstem
bronchus
 Opposite Options
• Correct answer A
• In general, when you encounter two
options that are opposites, chances are
the correct choice is one of the two
• A and D are opposites, one of them is
most likely the correct answer
• There are exceptions to this strategy
A patient receiving long-term positivepressure ventilatory support exhibits a
progressive weight gain and a reduction
in the hematocrit. Which of the following
is the most likely cause if this problem?
A. Leukocytosis
B. Chronic hypoxemia
C. Water retention
D. Leukocytopenia
 Opposite Options
• Correct answer C
• A and D are opposites but in this case
they are distractors
In reviewing the PFT results of a 67-yearold smoker with an admitting diagnosis of
emphysema and chronic bronchitis, you
would expect which of the following
general findings?
A. Increased airway resistance and
decreased lung compliance
B. Increased airway resistance and
increased lung compliance
C. Decreased airway resistance and
decreased lung compliance
D. Decreased airway resistance and
increased lung compliance
 Duplicate Facts in Options
• Correct answer B
• This question’s options contain two contrasting
statements: increased/decreased resistance
and increased/decreased compliance.
• Identify any statement that you know is either
true or false.
• If you know that patients with emphysema and
chronic bronchitis typically have increased
airway resistance you can eliminate options C
and D.
When instructing a patient how to breathe
during a small-volume nebulizer drug
treatment, the respiratory therapist
coaches the patient to hold his breath at
the end of inspiration. The purpose of
this maneuver is to improve:
A. Drug delivery
B. Particle stability
C. Aerosol penetration
D. Inertial impaction
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Global Options
Correct answer A
A is the most general or global alternative
B, C, and D are all factors that fall under
the broader concept of enhanced drug
delivery, making option A the best
choice.
You obtain an SpO2 measurement on a
patient of 80%. Assuming this is an
accurate measure of hemoglobin
saturation, what is the patient’s
approximate PaO2?
A. 40 torr
B. 50 torr
C. 60 torr
D. 70 torr
 Options Constituting a Range
• Correct answer B
• Item writers often try to mask the correct
choice by placing it within a set of higher
and lower values.
• Consider eliminating the highest and
lowest values and choosing an option in
the middle.
• “40-50-60/70-80-90”
A portable spirometer requires that you
enter the patient’s height in centimeters
in order to derive normal values. The
patient tells you that she is 5 feet 6
inches tall. What value would you enter
into the device?
A. 26 cm
B. 66 cm
C. 168 cm
D. 186 cm
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•
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Math Problems
Correct answer C
66 in x 2.54
Or approximately 2 x 66 + ½ 66 =
66+66+33 = 168
• 66/2.54 = 26 answer choice A is a good
distracter
• Use scratch paper
• Ste up the problem properly
• Try estimating the answer without
calculating
• Do your computation twice to confirm the
answer
• Many distracters are based on common
formula or computation errors, do not
immediately select an answer that
matches your calculation
• If you absolutely do not know choose
from the answers in the middle
During postural drainage of the left lower
lobe, a patient complains of acute chest
pain. Which of the following would you
do?
A. Give the patient supplemental oxygen
B. Continue the treatment with the bed flat
C. Ask the nurse to administer pain
medication
D. Discontinue the treatment and monitor
the patient
 The Triple S Rule
• Correct answer D
• If a patient gets worse while you are
giving therapy…
• Stop, stabilize, stay
• Stop what you are doing
• Stabilize the patient
• Stay with the patient
A 45-year-old patient with asthma is prescribed
0.3 mL of albuterol (Proventil) in 3 mL normal
saline via small-volume nebulizer. Before
initiating therapy, you note from chart review
that the patient is severely hypertensive and
has been experiencing episodes of
supraventricular tachycardia. You should do
which of the following?
A. Administer the treatment as ordered
B. Postpone the treatment and notify the
physician
C. Dilute the albuterol with extra normal saline
D. Decrease the amount of albuterol
administered
 The Triple S Rule (part 2)
• Correct answer B
• A corollary to the triple S rule is to never
start therapy if the patient is exhibiting
abnormal signs ir symptoms that could
be worsened by your action
A patient is admitted to the emergency
department comatose with suspected
smoke inhalation. After confirming
airway patency, which of the following
should you do first?
A. Measure the SpO2
B. Initiate 100% Oxygen
C. Obtain an arterial blood gas
D. Request a STAT chest X-ray
 Act First, Ask Questions Later
• Correct answer B
• Obtaining additional information is
important but given that the patient is
suspected of smoke inhalation 100%
oxygen should be administered
immediately
You are called to the bedside of a patient by her
ICU nurse to check the attached volume
ventilator. You note that both the low-volume
and high-pressure limit alarms are sounding on
each breath, Your first action should be to:
A. Disconnect patient and manually ventilate with
100% oxygen
B. Call the attending physician for further patient
information
C. Check the patient’s chart for the original
ventilator orders
D. Ask the nurse about how recently the patient
was suctioned
 Act First, Ask Questions Later
• Correct answer A
• B,C, and D nay help you evaluate the
problem but they waste precious time.
• Your priority os patient safety
A 60-kg (132-lb) COPD patient is receiving
SIMV with a Vt of 500 mL at a rate of
9/min with an FiO2 of 0.35. Blood gases
are as follows: pH = 7.36; PaCO2 = 61
torr; HCO3- = 36 mEq/L; PaO2 = 64 torr.
Which of the following changes would
you recommend at this time?
A. Increase the IMV rate
B. Increase the FiO2
C. Maintain settings
D. Increase the Vt
 If It Ain’t Broke, Don’t Fix It!
• Correct answer C
A 30-kg (66-lb) child is being mechanically
ventilated in the SIMV mode. The following
data are available: Ventilator settings: FiO2
0.45; mandatory rate 18; total rate 23; Vt 350
mL; PEEP 12 cmH2O. Blood gases: pH 7.38;
PaCO2 42 toor; PaO2 110 torr; HCO3- 23
mEq/L, BE 0 mEq/L. Based on these data,
which of the following should you do?
A. Decrease the tidal volume
B. Reduce the PEEP
C. Decrease the rate
D. Lower the FiO2
 Back Off Bad!
• Correct answer B
The following data are available for a patient:
Blood Gas Analyzer
Co-Oximeter
pH 7.35
OxyHb 97%
PaCO2 28 torr
CarboxyHb 1%
HCO3- 14 mEq/L
MetHb 1%
BE -10 mEq/L
Hb 18.8 g/dl
PaO2 40 torr
SaO2 73%
You should do which of the following?
A. Report the SaO2 value at 73%
B. Report the SaO2 value as 97%
C. Recommend administration of bicarbonate
D. Recalibrate the instruments and repeat the
analysis
 Data Just Don’t Jive
• Correct answer D
• Large discrepancy between PaO2, SaO2
and OxyHb
The results of an arterial blood gas
analysis for a patient who is breathing
100% oxygen are below: pH 7.27; PaCo2
44 torr; HCO3- 23 mEq/L; BE +1; PaO2
598 torr; SaO2 100%. Which of the
following is the likely problem?
A. Respiratory acidosis
B. Large physiologic shunt
C. Metabolic acidosis
D. Laboratory error
 Errors, Errors, Everywhere!
• Correct answer D
• When ever you have laboratory error as
an option, always check the numbers
• PaO2 is normal (use alveolar air
equation)
• Acid base status is impossible based on
theHenderson-Hasselbach equation
A doctor asks you to assess if a 75-kg (165-lb)
patient with a neuromuscular disorder being
mechanically ventilated in the SIMV mode is
ready for weaning. You obtain the following
data during a bedside ventilatory assessment:
spontaneous Vt 250 mL; Minute ventilation 10
L/min; Vital Capacity 750 mL; MIP -28 cm2O.
Based on thus information, which of the
following would you recommend?
A. Begin a spontaneous breathing T-piece trial
B. Postpone weaning and reevaluate the patient
C. Begin weaning using a pressure support
protocol
D. Begin weaning by decreasing the SIMV rate
Don’t Know What You’re Missing!
Correct answer B
VC and MIP are borderline adequate
But Vt and VE suggest a major problem
Spontaneous rate = 10 L/min / 250
mL/breath = 40 breaths/ minute
• RSBI = 40/0.25 – 160
• Review the numbers to see what is
missing!
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•
•
•
•
A surgeon orders an increase in PEEP from 6 to
10 cmH2O for a post-op patient receiving
mechanical ventilation. After you adjust the
PEEP setting, you note a rapid fall in the
patient’s arterial blood pressure and a rapid
rise in her heart rate. Which of the following
actions would you recommend to the surgeon?
A. Increase the FiO2 by 10%
B. Administer a vasopressor
C. Return The PEEP to 6 cmH2O
D. Obtain a STAT blood gas
 Jump Back, Jack!
• Correct answer C
• When things go bad, many times your
action immediately preceded things going
bad
• The best course of action is the reverse
course and undo what you have just
done
• One of the adverse effects of PEEP is
decreased cardiac output
• Due to increased pleural pressure and
decreased venous return
Manual ventilation of a patient with a selfinflating bag-valve-mask device fails to
inflate the patient’s chest adequately.
You should do which of the following?
A. Intubate and mechanically ventilate the
patient
B. Switch to a gas-powered resuscitator
with mask
C. Reposition the patient’s head, neck, and
mask
D. Insert a laryngeal mask airway (LMA)
 KISS It!
• Correct answer C
• The simplest and should be tried before
moving on to more aggressive options
When checking a ventilator, you discover
that the set PEEP level cannot be
maintained. Which of the following might
be causing this problem?
I. Leak in the tubing
II. Faulty exhalation valve
III. Leak around the airway cuff
IV. Loose humidifier connection
A. I and II
B. I and III
C. II and IV
D. I, II, III, and IV
 Gas Goes In,
Gas Comes Out
• Correct answer D
• You will be asked questions that ask you
to differentiate between a leak and an
obstruction
• Leaks prevent pressure buildup
• Obstructions cause pressure buildup
At the bedside of a patient receiving
volume-oriented mechanical ventilation,
you suddenly observe that simultaneous
sounding of the high-pressure and lowvolume alarms. Which of the following is
the most likely cause of this problem?
A. A leak in the ET tube cuff
B. A mucous plug in the ET tube
C. Ventilator circuit disconnection
D. Development of pulmonary edema
 Gas Goes In,
Gas Comes Out
• Correct answer B
• Obstructions can be more difficult to
identify because they can either be
partial or complete
• High pressure/low volume = obstruction
• Low pressure/low volume = leak
• B and D both cause obstruction but the
one that would arise suddenly is the
mucus plug
Which of the following would facilitate
clearance of pulmonary secretions in a
patient with cystic fibrosis?
I. Mucomyst
II. Flutter valve
III. Atropiene
IV. DNase
A. I and III
B. II and IV
C. I, II, and IV
D. II, III, and IV
 Love Those Multiple Multiples!
• Correct answer C
During a short pause from resuscitation of a child
in the emergency department, you cannot
palpate a carotid pulse but observe the
following rhythm on the ECG monitor (next
slide)
Which of the following actions should you take at
this time?
A. Resume cardiac compressions and ventilation
B. Discontinue compressions and monitor the
patient
C. Recommend cardioversion at 100 Joules
D. Recommend epinephrine administration
 Treat the Patient,
Not the Monitor!
• Correct answer A
• They will give you scenarios where the
patient and monitor data conflict
• Pulse oximetry data
• ECG
• PEA
• Remember the ECG only represents
electrical activity and a patient with no
pulse requires resuscitation
A physician has ordered albuterol
(Proventil) and deoxyribonuclease
(DNase) by aerosol for a cystic fibrosis
patient who also receives postural
drainage 3 times a day. You should
administer these therapies in which of the
following sequences?
A. DNase, postural drainage, albuterol
B. Albuterol, DNase, postural drainage
C. Postural drainage, albuterol, DNase
D. DNase, albuterol, postural drainage

•
•
•
•
Keeping Order
Correct answer B
Open ‘em up
Thin ‘em down
Clear ‘em out
A 90-kg (198-lb) patient is being ventilated in the
postanesthesia care unit (PACU) following upper
abdominal surgery. Ventilator settings and arterial
blood gas date are as follows:
Ventilator Settings:
Blood Gases:
Mode SIMV
pH 7.51
Vt 800 mL
PaCO2 31 torr
Set rate 14/min
HCO3- 24 mEq/L
Total rate 14/min
BE +1
FiO2 0.40
PaO2 115 torr
PEEP 5 cmH2O
SaO2 99%
You should recommend which of the following?
A. Increase the FiO2
B. Decrease the rate
C. Decrease the tidal volume
D. Discontinue PEEP
 Give me a V; Give me an O!
• Correct answer B
• You must be able to interpret blood
gases
• You must be able to differentiate
between an ventilation problem versus
an oxygenation problem
A 45-year-old 70-kg (154-lb) male with a diagnosis of
bilateral pneumonia is receiving volume-controlled
ventilation in the SIMV mode. Ventilator settings and
blood gas data are below:
Ventilator Settings:
Blood Gases:
Mode SIMV
pH 7.35
Vt 700 mL
PaCO2 345 torr
Set rate 6/min
HCO3- 23 mEq/L
Total rate 10/min
BE -1
FiO2 0.65
PaO2 55 torr
PEEP 5 cmH2O
SaO2 83%
Which of the following shoud be recommended?
A. Increase PEEP
B. Increase the rate
C. Increase the FiO2
D. Add an inspiratory plateau
 Give Me a V; Give Me an O!
• Correct answer A
• Hypoxemia is present so both A and C
would help
• Use the 60/60 rule
• PaO2 > 60 & FiO2 < 0.60 maldistribution of
ventilation = increase FiO2
• PaO2 < 60 & FiO2 > 0.60 physiologic
shunting = add/increase PEEP/CPAP
A nurse tells you that his patient is
scheduled to start chest physiotherapy
four times a day this morning and that he
would like you to get started before she
goes to radiology for a CT scan. Which
of the following should you do first?
A. Auscultate and percuss the patient’s
chest
B. Initiate therapy after reviewing the X-ray
C. Interview the patient to obtain a history
D. Confirm the doctor’s order in the chart
 Who’s in Charge Here?
• Correct answer D
GOOD LUCK!
Resources
 Scanlan et. Al. Certified Respiratory
Therapist Exam Review Guide. 2010.
Jones and Bartlett.
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