NBRC Registered Respiratory Therapist (RRT) Exam — Questions and Answers

Question 1: A neonate is born at 28 weeks gestation with grunting, nasal flaring, and retractions. Chest X-ray shows diffuse ground-glass opacification. The primary treatment is:

Systemic corticosteroids
Broad-spectrum antibiotics
High-frequency jet ventilation immediately
Intratracheal surfactant administration (Correct answer)

Correct answer: Intratracheal surfactant administration

Infant respiratory distress syndrome (IRDS) from surfactant deficiency is treated with exogenous surfactant replacement therapy administered intratracheally.

Question 2: Which type of patients might require continuous positive airway pressure (CPAP)?

Patients with high blood pressure
Patients with sleep apnea (Correct answer)
Patients with allergies
Patients with broken bones

Correct answer: Patients with sleep apnea

CPAP is commonly used to treat sleep apnea by providing continuous airflow to keep the airway open.

Question 3: What is the primary risk factor for developing retinopathy of prematurity (ROP) from a respiratory therapy perspective?

Exposure to excessive supplemental oxygen (hyperoxia) (Correct answer)
High PEEP settings
Prolonged mechanical ventilation
Use of surfactant replacement therapy

Correct answer: Exposure to excessive supplemental oxygen (hyperoxia)

Hyperoxia causes retinal vasoconstriction and abnormal vessel proliferation in premature neonates whose retinal vasculature is incompletely developed.

Question 4: A barrel chest deformity observed during patient inspection is best characterized by:

Flail chest with paradoxical chest wall movement
Increased AP-to-transverse diameter ratio approaching or exceeding 1:1 (Correct answer)
Pectus excavatum with decreased chest wall compliance
Kyphosis with markedly decreased lung volumes

Correct answer: Increased AP-to-transverse diameter ratio approaching or exceeding 1:1

Barrel chest results from chronic air trapping (e.g., emphysema), causing the anteroposterior diameter to increase until it approaches or equals the transverse diameter.

Question 5: What does the term 'air trapping' refer to in pulmonary function testing?

Elevated DLCO
Reduced FVC with normal FEV1
Elevated RV and RV/TLC ratio indicating incomplete exhalation (Correct answer)
Elevated TLC with normal RV

Correct answer: Elevated RV and RV/TLC ratio indicating incomplete exhalation

Air trapping is diagnosed by an elevated RV and increased RV/TLC ratio (>35%), reflecting incomplete emptying of alveoli in obstructive diseases.

Question 6: Which of the following is the MOST appropriate initial FiO2 for a patient with COPD presenting with acute exacerbation and mild hypoxemia?

1.0 (100%)
0.60 (60%)
0.28 (28%) (Correct answer)
0.40 (40%)

Correct answer: 0.28 (28%)

COPD patients should receive controlled low-flow oxygen (24-28%) to avoid suppressing hypoxic drive.

Question 7: Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA) and is used in COPD maintenance therapy?

Salmeterol xinafoate
Tiotropium bromide (Correct answer)
Formoterol fumarate
Ipratropium bromide

Correct answer: Tiotropium bromide

Tiotropium is a once-daily LAMA that provides sustained bronchodilation by blocking M3 muscarinic receptors, used as COPD maintenance therapy.

Question 8: Which condition is associated with a decreased DLCO (diffusing capacity) with normal spirometry?

Asthma
Pulmonary hypertension (Correct answer)
Obesity
Neuromuscular disease

Correct answer: Pulmonary hypertension

Pulmonary hypertension reduces the pulmonary capillary blood volume available for gas exchange, lowering DLCO despite normal airflow.

Question 9: During a 6-minute walk test, a patient's SpO2 drops from 97% to 84%. This finding indicates:

Mild hypoxemia not clinically significant
Significant exercise-induced desaturation requiring supplemental oxygen evaluation (Correct answer)
Equipment artifact that should be disregarded
Normal physiologic response to exercise

Correct answer: Significant exercise-induced desaturation requiring supplemental oxygen evaluation

A drop in SpO2 to below 88–90% during exertion is significant exercise-induced desaturation that typically warrants supplemental oxygen therapy prescription.

Question 10: Egophony, used to assess for pulmonary consolidation, is best described as:

The change of a spoken 'E' sound to an 'A' sound heard over consolidated tissue (Correct answer)
Disappearance of breath sounds over a pleural effusion
Transmission of bowel sounds into the lung field
Increased resonance of whispered words over hyperinflated lung

Correct answer: The change of a spoken 'E' sound to an 'A' sound heard over consolidated tissue

Egophony is the transformation of a spoken 'E' into an 'A' sound when auscultated over consolidated lung tissue, because solid tissue changes the acoustic properties of transmitted sound.

Question 11: What is the primary indication for inhaled nitric oxide (iNO) therapy?

Pulmonary embolism
Status asthmaticus
COPD exacerbation
Pulmonary arterial hypertension in neonates with hypoxic respiratory failure (Correct answer)

Correct answer: Pulmonary arterial hypertension in neonates with hypoxic respiratory failure

Inhaled nitric oxide selectively dilates pulmonary vasculature, reducing pulmonary vascular resistance in neonates with hypoxic respiratory failure and PPHN.

Question 12: A ventilated patient has PaCO2 of 55 mmHg and pH of 7.28. What ventilator change is most appropriate?

Decrease inspiratory time
Decrease PEEP
Increase FiO2
Increase respiratory rate or tidal volume to increase minute ventilation (Correct answer)

Correct answer: Increase respiratory rate or tidal volume to increase minute ventilation

Increasing minute ventilation (via rate or tidal volume) increases CO2 elimination, correcting respiratory acidosis.

Question 13: During inspection, skin visibly sinking inward between the ribs during inspiration is correctly termed:

Suprasternal retractions
Substernal retractions
Intercostal retractions (Correct answer)
Subcostal retractions

Correct answer: Intercostal retractions

Intercostal retractions are the visible inward movement of skin between the ribs during inspiration, indicating elevated work of breathing and highly negative intrathoracic pressure.

Question 14: Which respiratory rate would be classified as tachypnea in an adult patient?

10 breaths/min
12 breaths/min
16 breaths/min
24 breaths/min (Correct answer)

Correct answer: 24 breaths/min

Tachypnea is defined as a respiratory rate exceeding 20 breaths per minute in adults, making 24 breaths/min the correct answer.

Question 15: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 0.80. The best next step is to:

Increase FiO2 to 1.0
Apply PEEP of 10 cmH2O (Correct answer)
Administer inhaled nitric oxide
Switch to pressure control ventilation

Correct answer: Apply PEEP of 10 cmH2O

Increasing PEEP recruits alveoli and improves oxygenation in ARDS more effectively than simply raising FiO2 beyond 0.80.

Question 16: The normal P50 for adult hemoglobin (the PaO2 at which Hgb is 50% saturated) is approximately:

47 mmHg
27 mmHg (Correct answer)
17 mmHg
37 mmHg

Correct answer: 27 mmHg

The normal P50 for adult hemoglobin is approximately 27 mmHg, representing the midpoint of the oxyhemoglobin dissociation curve.

Question 17: What is the recommended tidal volume for neonatal mechanical ventilation using lung-protective strategy?

6–8 mL/kg IBW
4–6 mL/kg IBW (Correct answer)
8–10 mL/kg IBW
2–4 mL/kg IBW

Correct answer: 4–6 mL/kg IBW

Neonatal lung-protective ventilation targets tidal volumes of 4–6 mL/kg IBW to minimize volutrauma in the immature, surfactant-deficient lung.

Question 18: The Modified Medical Research Council (mMRC) dyspnea scale is specifically used to:

Assess ventilatory muscle strength via maximal inspiratory pressure
Classify severity of airflow obstruction by FEV1 percentage
Grade oxygenation impairment based on PaO2/FiO2 ratio
Quantify the degree of breathlessness in relation to activities of daily living (Correct answer)

Correct answer: Quantify the degree of breathlessness in relation to activities of daily living

The mMRC scale grades dyspnea from 0 (no breathlessness) to 4 (too breathless to leave the house), quantifying functional disability caused by shortness of breath.

Question 19: What is the purpose of incentive spirometry?

To improve lung function (Correct answer)
To measure heart rate
To monitor blood sugar
To assess kidney function

Correct answer: To improve lung function

Incentive spirometry helps patients improve lung function and prevent respiratory complications.

Question 20: Total lung capacity (TLC) is defined as:

Total volume of air in the lungs at maximal inhalation (Correct answer)
Volume of air remaining after normal exhalation
Volume of air inhaled during a normal breath
Maximum volume exhaled from full inhalation

Correct answer: Total volume of air in the lungs at maximal inhalation

TLC is the sum of all lung volumes (RV + ERV + TV + IRV) and represents the maximum amount of air the lungs can hold.

Question 21: Which condition is MOST likely to cause a normal chest X-ray in a patient with severe hypoxemia?

Cardiogenic pulmonary edema
Lobar pneumonia
ARDS
Pulmonary embolism (Correct answer)

Correct answer: Pulmonary embolism

Pulmonary embolism obstructs blood flow without direct parenchymal changes, often leaving the CXR normal or near-normal despite severe hypoxemia.

Question 22: A maximum inspiratory pressure (MIP or NIF) of -20 cmH2O in a neuromuscular disease patient suggests what?

Normal respiratory function
Severely reduced inspiratory muscle strength with high intubation risk (Correct answer)
Obstructive lung disease
Adequate inspiratory muscle strength for extubation

Correct answer: Severely reduced inspiratory muscle strength with high intubation risk

A MIP less negative than -20 to -25 cmH2O indicates critically weak inspiratory muscles, predicting respiratory failure in neuromuscular disease.

Question 23: What is the purpose of a pulmonary function test?

To test blood sugar levels
To assess kidney function
To measure heart rate
To evaluate lung function (Correct answer)

Correct answer: To evaluate lung function

Pulmonary function tests measure how well the lungs are working and can help diagnose respiratory conditions.

Question 24: A COPD patient has chronic hypercapnia with pH 7.38, PaCO2 58 mmHg, HCO3 33 mEq/L. Administering high-flow oxygen may cause hypoventilation because:

Bicarbonate excretion is stimulated
The hypoxic drive is abolished (Correct answer)
Oxygen is toxic to the respiratory center
Oxygen increases airway resistance

Correct answer: The hypoxic drive is abolished

In some COPD patients chronically reliant on hypoxic drive, supplemental oxygen can blunt the stimulus to breathe, causing hypoventilation.

Question 25: What is the purpose of a chest physiotherapy treatment?

Massaging the abdomen
Loosening mucus in the lungs (Correct answer)
Treating heart conditions
Stimulating hair growth

Correct answer: Loosening mucus in the lungs

Chest physiotherapy involves techniques to help mobilize and clear mucus from the lungs.

Question 26: In pediatric resuscitation, what is the correct compression-to-ventilation ratio for two-rescuer CPR?

30:1
15:2 (Correct answer)
5:1
30:2

Correct answer: 15:2

Two-rescuer pediatric CPR uses a 15:2 ratio to provide more frequent ventilations, as pediatric arrests are more often respiratory in origin.

Question 27: Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA) used in COPD management?

Tiotropium (Correct answer)
Formoterol
Salmeterol
Budesonide

Correct answer: Tiotropium

Tiotropium is a once-daily LAMA that blocks M3 muscarinic receptors, reducing bronchoconstriction in COPD.

Question 28: A patient with a tracheostomy tube in place develops subcutaneous emphysema around the stoma site and decreased breath sounds. The MOST likely cause is:

Tracheoesophageal fistula
False passage or paratracheal tube placement (Correct answer)
Tracheomalacia
Tracheal stenosis

Correct answer: False passage or paratracheal tube placement

Subcutaneous emphysema with decreased breath sounds after tracheostomy placement suggests the tube has created a false passage outside the trachea.

Question 29: During a spontaneous breathing trial (SBT), which finding suggests the patient is NOT ready for extubation?

SpO2 of 96% on 40% FiO2
Stable heart rate and blood pressure
Rapid shallow breathing index (RSBI) of 120 (Correct answer)
Respiratory rate of 18 breaths/min

Correct answer: Rapid shallow breathing index (RSBI) of 120

An RSBI (f/VT) above 105 indicates a high likelihood of extubation failure due to inefficient, rapid, and shallow breathing.

Question 30: Which of the following conditions might a respiratory therapist treat?

Broken bones
Diabetes
Vision problems
Asthma (Correct answer)

Correct answer: Asthma

Asthma is a common respiratory disorder that respiratory therapists often treat.

Question 31: Which of the following is a respiratory therapist's responsibility in the case of a premature newborn with underdeveloped lungs?

Administering allergy medication
Performing a dental exam
Recommending contact lenses
Assisting with intubation (Correct answer)

Correct answer: Assisting with intubation

Premature newborns with underdeveloped lungs might require intubation and ventilator support, which respiratory therapists can assist with.

Question 32: A sputum Gram stain shows gram-positive diplococci. The most likely pathogen is:

Klebsiella pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Streptococcus pneumoniae (Correct answer)

Correct answer: Streptococcus pneumoniae

Gram-positive diplococci (paired cocci) are the hallmark morphology of Streptococcus pneumoniae, the most common bacterial pneumonia pathogen.

Question 33: What does "H&P" stand for in medical documentation?

Hypertension and Palpitations
Health and Performance
Hospitalization and Payment
History and Progress (Correct answer)

Correct answer: History and Progress

In medical documentation, H&P stands for History and Physical. This is a comprehensive document created upon a patient's admission or initial visit, detailing their medical history, current symptoms, and findings from a physical examination. The H&P provides a foundational understanding of the patient's health status, guiding diagnosis and treatment planning.

Question 34: Which combination of findings is most consistent with a pleural effusion on physical assessment?

Tympany to percussion and bronchial breath sounds
Dullness to percussion and decreased or absent breath sounds (Correct answer)
Hyperresonance to percussion and decreased tactile fremitus
Dullness to percussion and markedly increased tactile fremitus

Correct answer: Dullness to percussion and decreased or absent breath sounds

Pleural effusion produces dullness to percussion (fluid displaces air) and decreased or absent breath sounds because the fluid layer blocks transmission of lung sounds to the chest wall.

Question 35: During a routine examination, the patient becomes apneic and then asystolic. The respiratory therapist observes that the patient's records says that the patient has a code status of "Do not resuscitate." What should the respiratory therapist do out of these options?

Begin chest compressions.
Report this to the charge nurse as soon as possible. (Correct answer)
Call for emergency intubation, and initiate mechanical ventilation.
Begin bag-mask ventilation with an FiO2 of 1.00 and a flow of 15 L/min.

Correct answer: Report this to the charge nurse as soon as possible.

The duty is to notify the charge nurse as soon as possible if the patient gets asystolic and then becomes apneic. Resuscitation procedures including chest compressions, intubation, and bag-mask breathing are all against the wishes of this patient, as shown by their ""do not resuscitate"" code status.

Question 36: What immediate action should be taken if a ventilated patient triggers a high-pressure alarm?

Increase FiO2 to 100%
Increase set tidal volume
Manually ventilate with bag-mask and assess for cause (secretions, bronchospasm, pneumothorax) (Correct answer)
Administer a sedative

Correct answer: Manually ventilate with bag-mask and assess for cause (secretions, bronchospasm, pneumothorax)

Disconnecting and manually ventilating while assessing the patient allows safe oxygenation while investigating the cause of increased airway resistance or compliance change.

Question 37: Which of the following conditions might require the use of a ventilator?

Ear infection
Sprained ankle
Pneumonia (Correct answer)
Common cold

Correct answer: Pneumonia

Pneumonia is an infection that can lead to difficulty breathing and may require ventilator support.

Question 38: What is the recommended head-of-bed elevation to reduce ventilator-associated pneumonia (VAP) risk?

30–45 degrees (Correct answer)
Positioning has no effect on VAP
60–90 degrees (upright)
0–15 degrees (supine)

Correct answer: 30–45 degrees

Elevating the head of bed 30–45 degrees reduces aspiration of gastric contents and oropharyngeal secretions, decreasing VAP risk.

Question 39: A patient with a tracheostomy tube is being weaned from ventilator support. Which device allows vocalization while maintaining airway access?

Passy-Muir speaking valve (Correct answer)
Fenestrated tracheostomy tube alone
Metal inner cannula
Capped tracheostomy tube

Correct answer: Passy-Muir speaking valve

A Passy-Muir valve is a one-way valve placed on the tracheostomy hub that directs exhaled air upward through the vocal cords to allow speech.

Question 40: What is the normal range for airway resistance (Raw) in a healthy adult?

10–20 cmH2O/L/s
5–10 cmH2O/L/s
0.6–2.4 cmH2O/L/s (Correct answer)
0.5–1.0 cmH2O/L/s

Correct answer: 0.6–2.4 cmH2O/L/s

Normal airway resistance in adults is approximately 0.6–2.4 cmH2O/L/s, measured via body plethysmography.

Question 41: What is the primary purpose of a nasal cannula?

Measuring blood pressure
Treating skin rashes
Administering pain medication
Delivering oxygen (Correct answer)

Correct answer: Delivering oxygen

A nasal cannula is a device used to deliver supplemental oxygen to patients.

Question 42: Which maneuver is used to assess expiratory flow limitation and auto-PEEP during mechanical ventilation?

Pressure-time product calculation
Recruitment maneuver
Expiratory hold (end-expiratory occlusion) (Correct answer)
Inspiratory hold (plateau pressure)

Correct answer: Expiratory hold (end-expiratory occlusion)

An expiratory hold occludes the expiratory valve at end-exhalation, allowing trapped pressure (auto-PEEP) to equilibrate and be measured.

Question 43: A patient with a left-sided tension pneumothorax would most likely demonstrate:

Tracheal deviation to the left and absent breath sounds on the right
Tracheal deviation to the right and absent breath sounds on the left (Correct answer)
Tracheal deviation to the left and absent breath sounds on the left
Bilateral absent breath sounds with central trachea

Correct answer: Tracheal deviation to the right and absent breath sounds on the left

In left-sided tension pneumothorax, the increasing pressure shifts the mediastinum (and trachea) away from the affected side—toward the right—while breath sounds are absent on the left.

Question 44: What flow rate is typically used with a simple pediatric oxygen mask to prevent CO2 rebreathing?

6–10 L/min (Correct answer)
12–15 L/min
3–4 L/min
1–2 L/min

Correct answer: 6–10 L/min

Pediatric simple face masks require a minimum of 6 L/min to flush exhaled CO2 from the mask and prevent rebreathing.

Question 45: Which finding on spirometry is most characteristic of asthma?

Reversible airflow obstruction with significant post-bronchodilator improvement (Correct answer)
Fixed obstructive defect unresponsive to bronchodilators
Reduced TLC with normal FEV1/FVC
Isolated reduction in DLCO

Correct answer: Reversible airflow obstruction with significant post-bronchodilator improvement

Asthma is defined by reversible airflow obstruction; a positive bronchodilator response (≥12% and ≥200 mL FEV1 improvement) is a hallmark finding.

Question 46: What does "HIPAA" stand for in healthcare?

Healthcare Information Privacy and Access Act
Hospital Incident Prevention and Assessment Act
Health Insurance Portability and Accountability Act (Correct answer)
Health Insurance Payment and Authorization Act

Correct answer: Health Insurance Portability and Accountability Act

HIPAA stands for the Health Insurance Portability and Accountability Act, a landmark U.S. federal law enacted in 1996. Its primary purpose is to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. HIPAA sets national standards for the security of electronic protected health information and ensures patient privacy.

Question 47: A non-rebreather mask at 15 L/min delivers approximately what FiO2?

0.40–0.50
0.55–0.65
0.90–1.00
0.60–0.80 (Correct answer)

Correct answer: 0.60–0.80

A properly fitted non-rebreather mask at 15 L/min delivers an FiO2 of approximately 0.60–0.80 depending on patient's inspiratory flow.

Question 48: What does PEEP stand for and what is its primary purpose in mechanical ventilation?

Peak End-Expiratory Pressure; reduces work of breathing
Positive Expiratory End Pressure; increases tidal volume
Positive End-Expiratory Pressure; prevents alveolar collapse at end-expiration (Correct answer)
Peak Expiratory Effort Pressure; measures respiratory muscle strength

Correct answer: Positive End-Expiratory Pressure; prevents alveolar collapse at end-expiration

PEEP maintains a baseline positive pressure at end-expiration to recruit collapsed alveoli and improve oxygenation.

Question 49: A patient is given pulmonary function testing to support or disprove a COPD diagnosis. The test is to be run both before and after bronchodilator. What minimal alteration in forced vital capacity (FVC) must occur before we can say that the bronchodilator has significantly changed things?

10%
12% (Correct answer)
4%
8%

Correct answer: 12%

The other options are too insignificant to be taken seriously. This figure represents the best practices-established percentage.

Question 50: When performing nasotracheal suctioning, the catheter should be inserted to what approximate depth in an adult?

22–26 cm
10–12 cm
6–8 cm
16–20 cm (Correct answer)

Correct answer: 16–20 cm

The nasotracheal catheter is advanced approximately 16–20 cm past the naris to reach the trachea in most adults.

Question 51: High-frequency oscillatory ventilation (HFOV) is characterized by which of the following?

Intermittent sighing breaths at set intervals
Very small tidal volumes at high frequency (3–15 Hz) (Correct answer)
Large tidal volumes at low frequency
Normal tidal volumes with high PEEP

Correct answer: Very small tidal volumes at high frequency (3–15 Hz)

HFOV uses tidal volumes smaller than anatomical dead space delivered at 3–15 Hz, relying on non-convective gas transport mechanisms.

Question 52: Which flow-volume loop pattern is characteristic of a fixed upper airway obstruction?

Normal scooped appearance on expiration
Flattening of the inspiratory limb only
Flattening of the expiratory limb only
Flattening of both inspiratory and expiratory limbs (Correct answer)

Correct answer: Flattening of both inspiratory and expiratory limbs

Fixed upper airway obstruction (e.g., tracheal stenosis) produces plateauing (flattening) of both the inspiratory and expiratory limbs of the flow-volume loop.

Question 53: Whispered pectoriloquy is a positive finding when assessing for pulmonary consolidation. It is defined as:

Clear, distinct transmission of whispered words heard through the stethoscope over consolidated tissue (Correct answer)
Muffling of normal breath sounds to whisper-level intensity over a pleural effusion
Increased resonance of percussion note over a consolidated segment
Inability to hear any whispered sounds over consolidated lung

Correct answer: Clear, distinct transmission of whispered words heard through the stethoscope over consolidated tissue

Whispered pectoriloquy is the abnormally clear and loud transmission of whispered words (e.g., '1-2-3') over consolidated lung, because solid tissue transmits high-frequency sounds better than air-filled lung.

Question 54: A patient receiving heliox therapy for croup would MOST likely receive which mixture?

50% helium / 50% oxygen
70% helium / 30% oxygen (Correct answer)
60% helium / 40% oxygen
80% helium / 20% oxygen

Correct answer: 70% helium / 30% oxygen

70:30 heliox is the most commonly used mixture for upper airway obstruction, balancing low-density gas benefit with adequate oxygen delivery.

Question 55: Which pediatric airway emergency presents with a 'steeple sign' on anteroposterior neck X-ray?

Croup (laryngotracheobronchitis) (Correct answer)
Bacterial tracheitis
Foreign body aspiration
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Croup causes subglottic narrowing visible on AP neck X-ray as a 'steeple sign' due to subglottic edema from viral infection (usually parainfluenza).

Question 56: During patient assessment, digital clubbing is most commonly associated with which underlying condition?

Hyperventilation syndrome
Obesity hypoventilation syndrome
Acute asthma exacerbation
Chronic hypoxemia from pulmonary fibrosis or cystic fibrosis (Correct answer)

Correct answer: Chronic hypoxemia from pulmonary fibrosis or cystic fibrosis

Digital clubbing is associated with chronic hypoxemia and chronic lung diseases such as pulmonary fibrosis, cystic fibrosis, bronchiectasis, and lung cancer.

Question 57: Which Apgar score component assesses a newborn's respiratory effort?

Color
Heart rate
Grimace/reflex irritability
Respiration (Correct answer)

Correct answer: Respiration

The Apgar score evaluates respiration (absent=0, slow/irregular=1, strong cry=2) at 1 and 5 minutes to assess transition to extrauterine life.

Question 58: A neonate born at 28 weeks gestation develops grunting, nasal flaring, and intercostal retractions within 2 hours of birth. What is the most likely diagnosis?

Meconium aspiration syndrome
Congenital diaphragmatic hernia
Transient tachypnea of the newborn
Respiratory distress syndrome (RDS) (Correct answer)

Correct answer: Respiratory distress syndrome (RDS)

Premature neonates lack surfactant, leading to RDS with classic signs of increased work of breathing shortly after birth.

Question 59: What does "PRN" stand for in medical terminology?

Primary Response Notification
Proactive Rehabilitation Network
Prescription Required Now
Pro Re Nata (as needed) (Correct answer)

Correct answer: Pro Re Nata (as needed)

In medical terminology, PRN is an abbreviation for the Latin phrase 'pro re nata,' which translates to 'as needed.' This instruction on a prescription indicates that a medication should be administered only when the patient experiences specific symptoms or conditions. It allows for flexible dosing based on the patient's current requirements.

Question 60: Which of the following medical professionals specializes in treating disorders of the nervous system?

Hematologist
Neurologist (Correct answer)
Rheumatologist
Gynecologist

Correct answer: Neurologist

A neurologist is a medical professional who specializes in the diagnosis and treatment of disorders affecting the nervous system. This complex system includes the brain, spinal cord, and all the nerves throughout the body. Neurologists manage conditions such as strokes, epilepsy, Parkinson's disease, multiple sclerosis, and headaches.

Question 61: A patient has the following ABG: pH 7.35, PaCO2 55 mmHg, HCO3 30 mEq/L. This result is MOST consistent with:

Mixed respiratory and metabolic acidosis
Acute respiratory acidosis
Metabolic alkalosis with respiratory compensation
Chronic respiratory acidosis (compensated) (Correct answer)

Correct answer: Chronic respiratory acidosis (compensated)

A near-normal pH with elevated PaCO2 and elevated HCO3 indicates chronic respiratory acidosis with full metabolic compensation (1 mEq/L HCO3 rise per 10 mmHg PaCO2 rise).

Question 62: In a neonate, which blood gas finding is most consistent with persistent pulmonary hypertension (PPHN)?

Hypercarbia with normal oxygenation
Low PaO2 that improves dramatically with supplemental oxygen
Metabolic alkalosis with low PaCO2
Severe hypoxemia that responds poorly to 100% FiO2 (Correct answer)

Correct answer: Severe hypoxemia that responds poorly to 100% FiO2

PPHN causes right-to-left shunting through fetal channels; hypoxemia is refractory to oxygen because blood bypasses the lungs entirely.

Question 63: What is the normal range for static lung compliance in a mechanically ventilated adult?

5–10 mL/cmH2O
10–20 mL/cmH2O
60–100 mL/cmH2O (Correct answer)
150–200 mL/cmH2O

Correct answer: 60–100 mL/cmH2O

Normal static compliance in a mechanically ventilated patient is approximately 60–100 mL/cmH2O, reflecting lung-chest wall elasticity.

Question 64: A patient in the ICU has a pulmonary capillary wedge pressure (PCWP) of 22 mmHg and bilateral infiltrates. This presentation is MOST consistent with:

ARDS (non-cardiogenic pulmonary edema)
Cardiogenic pulmonary edema (Correct answer)
Pneumonia without heart failure
Pulmonary embolism

Correct answer: Cardiogenic pulmonary edema

PCWP > 18 mmHg with bilateral infiltrates indicates cardiogenic (hydrostatic) pulmonary edema, distinguishing it from ARDS (PCWP ≤ 18 mmHg).

Question 65: Which assessment finding would be LEAST expected in a patient with advanced COPD?

Decreased breath sound intensity bilaterally
Barrel chest
Prolonged expiratory phase
Inspiratory stridor (Correct answer)

Correct answer: Inspiratory stridor

Inspiratory stridor is associated with upper airway obstruction (e.g., croup, foreign body), not COPD, which is a lower airway disease characterized by air trapping, prolonged expiration, and decreased breath sounds.

Question 66: A patient receiving mechanical ventilation develops sudden hypotension, decreased breath sounds on the left, and tracheal deviation to the right. The priority action is:

Obtain a stat chest X-ray
Administer IV fluid bolus
Increase PEEP
Perform needle decompression of the left chest (Correct answer)

Correct answer: Perform needle decompression of the left chest

These signs indicate tension pneumothorax, which requires immediate needle decompression before imaging.

Question 67: What is the purpose of performing the nitrogen washout test?

Evaluate respiratory muscle strength
Assess bronchodilator responsiveness
Measure lung volumes including FRC when a body box is unavailable (Correct answer)
Measure diffusing capacity

Correct answer: Measure lung volumes including FRC when a body box is unavailable

The nitrogen washout test measures FRC by diluting resident nitrogen with 100% oxygen, calculating the original volume from the exhaled nitrogen concentration.

Question 68: A mechanically ventilated patient's plateau pressure rises from 22 to 35 cmH2O with no change in peak pressure. This suggests:

Bronchospasm
Increased airway resistance
Decreased lung compliance (Correct answer)
Mucus plugging

Correct answer: Decreased lung compliance

A rise in plateau pressure without a change in the peak-to-plateau difference indicates a compliance problem, not a resistance problem.

Question 69: What is the primary goal of lung-protective ventilation in ARDS?

Achieve normocapnia at all times
Maximize tidal volume to clear CO2
Limit tidal volume to 6 mL/kg IBW to prevent volutrauma (Correct answer)
Use the highest PEEP possible

Correct answer: Limit tidal volume to 6 mL/kg IBW to prevent volutrauma

The ARDSNet protocol recommends tidal volumes of 4–6 mL/kg IBW to prevent ventilator-induced lung injury from overdistension.

Question 70: The recommended tidal volume for lung-protective ventilation in ARDS is:

6-8 mL/kg ideal body weight (Correct answer)
10-12 mL/kg ideal body weight
4-5 mL/kg actual body weight
8-10 mL/kg ideal body weight

Correct answer: 6-8 mL/kg ideal body weight

ARDSNet protocol recommends 6 mL/kg IBW (with allowance to 8 mL/kg) to minimize ventilator-induced lung injury.

Question 71: Which medical imaging technique uses strong magnets and radio waves to create detailed images of internal structures?

X-ray
Ultrasound
CT scan
MRI (Correct answer)

Correct answer: MRI

MRI, or Magnetic Resonance Imaging, is an advanced medical imaging technique that uses a powerful magnetic field and radio waves to create highly detailed images of organs and soft tissues inside the body. Unlike X-rays or CT scans, MRI does not use ionizing radiation. It is particularly useful for visualizing the brain, spinal cord, joints, and internal organs with excellent soft tissue contrast.

Question 72: Which of the following correctly describes high-frequency oscillatory ventilation (HFOV)?

Uses tidal volumes smaller than anatomical dead space at very high frequencies (Correct answer)
Requires patient to trigger every breath
Provides pressure support with each spontaneous breath
Delivers large tidal volumes at low rates

Correct answer: Uses tidal volumes smaller than anatomical dead space at very high frequencies

HFOV delivers very small tidal volumes (1-3 mL/kg) at frequencies of 3-15 Hz, keeping mean airway pressure constant while oscillating around it.

Question 73: What is the primary indication for prone positioning in a mechanically ventilated patient?

Acute exacerbation of COPD
Cardiogenic pulmonary edema
Pulmonary embolism
Moderate-to-severe ARDS with P/F ratio < 150 (Correct answer)

Correct answer: Moderate-to-severe ARDS with P/F ratio < 150

Prone positioning improves V/Q matching and oxygenation in moderate-to-severe ARDS (P/F < 150 on adequate PEEP).

Question 74: Pulsus paradoxus during patient assessment is best described as:

An irregular pulse alternating between strong and weak beats
A decrease in systolic BP >10 mmHg during normal inspiration (Correct answer)
A consistently elevated diastolic pressure
An increase in blood pressure during inspiration

Correct answer: A decrease in systolic BP >10 mmHg during normal inspiration

Pulsus paradoxus is an exaggerated decrease in systolic blood pressure greater than 10 mmHg during normal inspiration, commonly seen in cardiac tamponade and severe asthma.

Question 75: Which inhaled corticosteroid is commonly used for long-term control of asthma in the US?

Dexamethasone
Prednisone
Hydrocortisone
Fluticasone (Correct answer)

Correct answer: Fluticasone

Fluticasone is a commonly prescribed inhaled corticosteroid that reduces airway inflammation for long-term asthma control.

Question 76: Which ventilator mode delivers a guaranteed tidal volume regardless of lung compliance changes?

Airway Pressure Release Ventilation (APRV)
Continuous Positive Airway Pressure (CPAP)
Pressure Support Ventilation (PSV)
Volume-Controlled Ventilation (VCV) (Correct answer)

Correct answer: Volume-Controlled Ventilation (VCV)

Volume-controlled ventilation delivers a set tidal volume with each breath by adjusting pressure, ensuring consistent minute ventilation regardless of compliance.

Question 77: Increased airway resistance (Raw) on body plethysmography is most consistent with which condition?

Pleural effusion
Pulmonary fibrosis
COPD or asthma (Correct answer)
Pneumothorax

Correct answer: COPD or asthma

COPD and asthma cause airway narrowing from inflammation, mucus, and bronchospasm, increasing airway resistance measured by body plethysmography.

Question 78: Which condition is characterized by a diffusion defect rather than a V/Q mismatch as the primary mechanism of hypoxemia?

Pulmonary embolism
Atelectasis
Pneumonia
Pulmonary fibrosis (Correct answer)

Correct answer: Pulmonary fibrosis

Pulmonary fibrosis thickens the alveolar-capillary membrane, impairing oxygen diffusion across it.

Question 79: During neonatal resuscitation, what initial FiO2 is recommended for term infants?

0.40
0.60
0.21 (room air) (Correct answer)
1.0 (100% oxygen)

Correct answer: 0.21 (room air)

Current NRP guidelines recommend starting resuscitation of term neonates with room air (FiO2 0.21) and titrating based on pre-ductal SpO2 targets.

Question 80: A 32-week premature neonate presents with grunting, nasal flaring, and retractions within 2 hours of birth. Chest X-ray shows diffuse bilateral ground-glass opacities. The MOST likely diagnosis is:

Meconium aspiration syndrome
Congenital diaphragmatic hernia
Transient tachypnea of the newborn
Neonatal respiratory distress syndrome (RDS) (Correct answer)

Correct answer: Neonatal respiratory distress syndrome (RDS)

Neonatal RDS is caused by surfactant deficiency in premature infants and presents with early respiratory distress and bilateral ground-glass infiltrates on X-ray.

Question 81: Which neonatal respiratory condition is characterized by unilateral absent breath sounds and persistent pulmonary hypertension?

Respiratory distress syndrome
Transient tachypnea of the newborn
Congenital diaphragmatic hernia (CDH) (Correct answer)
Bronchopulmonary dysplasia

Correct answer: Congenital diaphragmatic hernia (CDH)

CDH involves herniation of abdominal organs through a diaphragmatic defect, causing ipsilateral lung hypoplasia and pulmonary hypertension.

Question 82: Which of the following is a contraindication to non-invasive positive pressure ventilation (NIPPV)?

Cardiogenic pulmonary edema
Hypoxemic respiratory failure from pneumonia
COPD exacerbation with hypercapnia
Inability to protect airway due to altered mental status (Correct answer)

Correct answer: Inability to protect airway due to altered mental status

Patients unable to protect their airway due to decreased consciousness are at high risk for aspiration and should be intubated.

Question 83: Crackles (rales) heard on auscultation are most commonly caused by:

Pleural surfaces rubbing against each other
Turbulent airflow through a narrowed upper airway
Bronchospasm narrowing the lower airways
Sudden opening of collapsed alveoli or fluid in small airways (Correct answer)

Correct answer: Sudden opening of collapsed alveoli or fluid in small airways

Crackles are discontinuous, non-musical sounds produced by the sudden popping open of collapsed small airways or alveoli, or by movement of secretions in peripheral airways.

Question 84: What is the purpose of a control group in a clinical trial?

To conduct experiments without supervision
To serve as a comparison for the treatment group (Correct answer)
To provide emotional support
To determine patient preferences

Correct answer: To serve as a comparison for the treatment group

In a clinical trial, a control group is essential for establishing a baseline and isolating the effects of the treatment being studied. This group typically receives a placebo or the standard treatment, allowing researchers to compare its outcomes with those of the treatment group. This comparison helps determine whether the new treatment is truly effective and not just due to other factors.

Question 85: Plateau pressure minus total PEEP (intrinsic + extrinsic) equals:

Compliance pressure
Mean airway pressure
Peak airway pressure
Driving pressure (Correct answer)

Correct answer: Driving pressure

Driving pressure (ΔP) = Plateau pressure − total PEEP, reflecting the stress applied to the respiratory system with each breath; ΔP > 15 cmH2O is associated with increased ARDS mortality.

Question 86: A patient on mechanical ventilation develops sudden hypotension and absent breath sounds on the left. The most likely diagnosis is:

Right mainstem intubation
Left tension pneumothorax (Correct answer)
ARDS exacerbation
Pulmonary embolism

Correct answer: Left tension pneumothorax

Absent breath sounds on one side plus sudden hypotension in a ventilated patient indicates tension pneumothorax requiring immediate needle decompression.

Question 87: A 35-year-old woman's family brings her into the emergency department. They worry that she might have abused heroin. The doctor requests an ABG to assess for potential hypoventilation caused by a decreased respiratory drive. What is the best order to complete these steps?

Check patient ID, perform Allen’s test, check for written order, wash hands, glove, prepare ABG draw kit, clean site with alcohol swab, draw sample.
Check for written order, check patient ID, perform Allen’s test, wash hands, glove, prepare ABG draw kit, clean site with alcohol swab, draw sample. (Correct answer)
Check for written order, check patient ID, prepare ABG draw kit, perform Allen’s test, wash hands, glove, clean site with alcohol swab, draw sample.
Perform Allen’s test, check for written order, check patient ID, prepare ABG draw kit, wash hands, glove, clean puncture site with alcohol swab, draw sample.

Correct answer: Check for written order, check patient ID, perform Allen’s test, wash hands, glove, prepare ABG draw kit, clean site with alcohol swab, draw sample.

The order must be written, approved, and the patient's identity verified using two different patient identities before collecting an ABG. Prior to putting on gloves, carrying out an Allen's test to check hand perfusion, assembling the kit, cleaning the location, and taking the sample, hand hygiene must first be practiced.

Question 88: Transient tachypnea of the newborn (TTN) is caused by:

Congenital pneumonia
Surfactant deficiency
Delayed clearance of fetal lung fluid (Correct answer)
Meconium aspiration

Correct answer: Delayed clearance of fetal lung fluid

TTN results from retained fetal lung fluid that was not adequately cleared during labor, causing mild respiratory distress that resolves within 24–72 hours.

Question 89: Tracheal deviation toward the right side in a patient would most likely be caused by:

Left-sided tension pneumothorax pushing structures rightward (Correct answer)
Bilateral pulmonary hyperinflation from acute asthma
Right-sided pleural effusion pushing structures rightward
Right-sided tension pneumothorax pushing structures rightward

Correct answer: Left-sided tension pneumothorax pushing structures rightward

Tracheal deviation away from the midline shifts toward the side opposite the pressure source; a left-sided tension pneumothorax creates pressure that pushes the trachea to the right.

Question 90: What is the purpose of a bag-valve-mask (BVM) device?

Treating ear infections
Administering eye drops
Testing blood sugar levels
Delivering oxygen to the lungs (Correct answer)

Correct answer: Delivering oxygen to the lungs

A BVM device is used to manually provide positive pressure ventilation and deliver oxygen to a patient's lungs.

Question 91: Which arterial blood gas pattern is expected during the initial compensatory response to metabolic acidosis?

Elevated bicarbonate
Elevated PaCO2
Decreased PaCO2 (Correct answer)
Decreased pH with normal PaCO2

Correct answer: Decreased PaCO2

The respiratory system compensates for metabolic acidosis by increasing ventilation to blow off CO2, lowering PaCO2.

Question 92: Which of the following healthcare professionals primarily focuses on diagnosing and treating skin disorders?

Cardiologist
Dermatologist (Correct answer)
Urologist
Gynecologist

Correct answer: Dermatologist

A dermatologist is a physician who specializes in diagnosing and treating conditions related to the skin, hair, and nails. They manage a wide range of issues, from common skin problems like acne, eczema, and psoriasis to more serious conditions such as skin cancer. Dermatologists also perform cosmetic procedures and biopsies.

Question 93: Which breathing pattern is characterized by cyclic, gradually increasing and then decreasing tidal volumes separated by periods of apnea?

Kussmaul breathing
Apneustic breathing
Biot's breathing
Cheyne-Stokes breathing (Correct answer)

Correct answer: Cheyne-Stokes breathing

Cheyne-Stokes breathing features a waxing and waning tidal volume with intervening apneic periods, often seen in severe heart failure or neurological injury.

Question 94: In prone positioning for ARDS, the primary mechanism of improved oxygenation is:

Redistribution of perfusion to better-ventilated dorsal lung units (Correct answer)
Increased tidal volume delivery
Increased FRC
Reduced pulmonary edema

Correct answer: Redistribution of perfusion to better-ventilated dorsal lung units

Proning redistributes pulmonary blood flow to the dorsal (now dependent) lung regions, which are better ventilated, improving V/Q matching.

Question 95: Which of the following medical professionals specializes in performing surgeries and procedures involving the female reproductive system?

Urologist
Obstetrician
Dermatologist
Gynecologist (Correct answer)

Correct answer: Gynecologist

A gynecologist is a medical professional who specializes in the health of the female reproductive system. This includes diagnosing and treating conditions related to the uterus, ovaries, fallopian tubes, and vagina, often involving surgical procedures. While an obstetrician focuses specifically on pregnancy and childbirth, a gynecologist covers the broader spectrum of women's reproductive health.

Question 96: A patient's ABG shows pH 7.28, PaCO2 55 mmHg, HCO3 25 mEq/L. What is the primary disturbance?

Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis (Correct answer)

Correct answer: Respiratory acidosis

Elevated PaCO2 with low pH and normal HCO3 indicates uncompensated respiratory acidosis.

Question 97: Which parameter is used to assess auto-PEEP (intrinsic PEEP) in a mechanically ventilated patient?

Mean airway pressure
Plateau pressure
Peak inspiratory pressure
End-expiratory pause pressure (Correct answer)

Correct answer: End-expiratory pause pressure

An end-expiratory pause maneuver on the ventilator reveals auto-PEEP by measuring pressure trapped at end expiration.

Question 98: What is the best initial ventilator setting for FiO2 when initiating mechanical ventilation?

1.0 (100%), then titrate down (Correct answer)
0.40
0.21 (room air)
0.60

Correct answer: 1.0 (100%), then titrate down

Starting at FiO2 1.0 ensures adequate oxygenation during the initial unstable period; it is then titrated to the lowest level maintaining SpO2 ≥92%.

Question 99: A patient has a total lung capacity (TLC) of 6.0 L, a residual volume (RV) of 2.4 L, and an RV/TLC ratio of 40%. This pattern is MOST consistent with:

Restrictive lung disease
Obstructive lung disease (Correct answer)
Mixed obstructive-restrictive disease
Normal lung function

Correct answer: Obstructive lung disease

An elevated RV/TLC ratio above 35% indicates air trapping characteristic of obstructive lung disease such as emphysema or severe asthma.

Question 100: Which clinical presentation is most consistent with hypercapnia (elevated PaCO2)?

Fever, productive cough, and pleuritic chest pain
Headache, drowsiness, flushed skin, and diaphoresis (Correct answer)
Cyanosis and acute restlessness
Carpopedal spasm and perioral tingling

Correct answer: Headache, drowsiness, flushed skin, and diaphoresis

Hypercapnia causes CO2-mediated vasodilation and CNS depression, producing headache, drowsiness, flushed skin, and diaphoresis; severe hypercapnia leads to CO2 narcosis.

Question 101: A patient on volume control ventilation has a plateau pressure of 32 cmH2O. What is the appropriate action?

Switch to pressure control mode
Decrease tidal volume to reduce lung injury risk (Correct answer)
Increase tidal volume to improve ventilation
Increase PEEP to improve oxygenation

Correct answer: Decrease tidal volume to reduce lung injury risk

Plateau pressures above 30 cmH2O indicate overdistension risk; reducing tidal volume lowers plateau pressure and prevents barotrauma.

Question 102: During a helium-oxygen (heliox) therapy session, the therapist notices significant improvement in a patient's stridor. What does this indicate?

The obstruction is in the upper airway (large airway) (Correct answer)
Heliox improved alveolar gas exchange
Heliox has reduced pulmonary vascular resistance
The patient's asthma is responding to treatment

Correct answer: The obstruction is in the upper airway (large airway)

Heliox reduces turbulent flow in large, obstructed upper airways; its benefit implies the obstruction is in a region where flow is turbulent.

Question 103: A patient with pulmonary hypertension requires inhaled nitric oxide (iNO) therapy. The primary mechanism of action is:

Systemic vasodilation reducing afterload on the right ventricle
Bronchodilation improving V/Q matching
Inhibition of hypoxic pulmonary vasoconstriction reflexes
Selective pulmonary vasodilation by activating guanylate cyclase in vascular smooth muscle (Correct answer)

Correct answer: Selective pulmonary vasodilation by activating guanylate cyclase in vascular smooth muscle

iNO diffuses into pulmonary vascular smooth muscle, activates soluble guanylate cyclase, raises cGMP, and causes selective pulmonary vasodilation without systemic effects.

Question 104: Which ventilator mode provides a guaranteed tidal volume while allowing variable inspiratory flow to meet patient demand?

Synchronized Intermittent Mandatory Ventilation (SIMV)
Airway Pressure Release Ventilation (APRV)
Volume-Assured Pressure Support (VAPS) (Correct answer)
Pressure Control Ventilation (PCV)

Correct answer: Volume-Assured Pressure Support (VAPS)

Volume-assured pressure support (VAPS/AVAPS) automatically adjusts pressure support to guarantee a target tidal volume while still allowing demand-driven flow delivery.

Question 105: Orthopnea, a common complaint assessed in patients with cardiac disease, is defined as:

Breathlessness that occurs specifically when lying flat and is relieved by sitting upright (Correct answer)
Shortness of breath that awakens the patient from sleep several hours after lying down
Positional dyspnea relieved by lying on one side
Dyspnea that is worsened only with physical exertion

Correct answer: Breathlessness that occurs specifically when lying flat and is relieved by sitting upright

Orthopnea is dyspnea that occurs when lying flat due to increased venous return and fluid redistribution to the lungs in heart failure, promptly relieved by sitting upright.

Question 106: All of the following patients should wait to have pulmonary function testing, with the exception of:

33-year-old female, two broken ribs from a fall three days ago
71-year-old male, status/post cerebrovascular accident (CVA) one week
15-year-old male, recent respiratory infection (Correct answer)
17-year-old female, recent CXR showing right-sided pneumothorax

Correct answer: 15-year-old male, recent respiratory infection

Pulmonary function testing is not contraindicated in young people who are otherwise healthy and have recently had a respiratory infection.

Question 107: Which finding during inspection is the most classic sign of accessory muscle recruitment in a distressed patient?

Pursed-lip breathing on exhalation
Intercostal retractions during inspiration
Sternocleidomastoid muscle use during inspiration (Correct answer)
Abdominal paradox during expiration

Correct answer: Sternocleidomastoid muscle use during inspiration

Active use of the sternocleidomastoid muscles during inspiration is a hallmark sign of accessory muscle recruitment, indicating significantly increased work of breathing.

Question 108: The respiratory therapist decides to evaluate the patient's peripheral circulation and capillary refill after having trouble getting a reading with a pulse oximeter's finger probe. After a brief compression, the nail bed on the right index finger turns pink once more after one second. Which of the following is suggested by this?

anemia
insufficient blood flow to extremities
normal peripheral circulation and capillary refill (Correct answer)
cyanosis

Correct answer: normal peripheral circulation and capillary refill

In less than two seconds, the nail bed will turn pink once more under normal circulation and perfusion. The nail bed would be bluish if there was cyanosis. Anemia has no impact on this particular test unless the anemia is severe, in which case the nail bed would not ""pink up.""

Question 109: A patient with a tracheostomy tube has a plugged inner cannula causing acute respiratory distress. What is the FIRST action the therapist should take?

Call the physician
Remove and replace the inner cannula (Correct answer)
Apply 100% oxygen via mask
Deflate the cuff and remove the tracheostomy tube

Correct answer: Remove and replace the inner cannula

Removing and replacing (or cleaning) the inner cannula immediately relieves the obstruction caused by secretion plugging.

Question 110: During cardiac arrest, which ventilation strategy is recommended by current AHA guidelines?

Bag-mask at a ratio of 30:2
1 breath every 6 seconds asynchronous to compressions (Correct answer)
100% oxygen at 15 L/min without positive pressure
Hyperventilation at 20-24 breaths/min

Correct answer: 1 breath every 6 seconds asynchronous to compressions

After advanced airway placement, AHA recommends asynchronous ventilation at 10 breaths/min (one every 6 seconds) without interrupting compressions.

Question 111: What is the hallmark chest X-ray finding in neonatal respiratory distress syndrome (RDS)?

Unilateral whiteout with mediastinal shift
Diffuse ground-glass opacity with air bronchograms (Correct answer)
Perihilar streaky infiltrates
Hyperinflation with flattened diaphragms

Correct answer: Diffuse ground-glass opacity with air bronchograms

RDS presents with bilateral diffuse ground-glass opacification and air bronchograms on CXR due to widespread microatelectasis from surfactant deficiency.

Question 112: Which lung volume cannot be measured by spirometry alone?

Functional residual capacity (Correct answer)
Tidal volume
Inspiratory reserve volume
Expiratory reserve volume

Correct answer: Functional residual capacity

FRC contains the residual volume, which cannot be measured by spirometry and requires body plethysmography or gas dilution.

Question 113: What does the term "Sterile Technique" refer to in clinical practice?

Maintaining a clean workspace
Preventing infections by using aseptic methods (Correct answer)
Using harsh chemicals for disinfection
Minimizing patient contact

Correct answer: Preventing infections by using aseptic methods

Sterile technique is a critical set of practices used in healthcare to prevent contamination and infection. It involves using specific methods to keep an area or objects free from all microorganisms, including bacteria, viruses, and fungi. This is essential during procedures like surgery, catheter insertion, or wound dressing to protect patients from harmful pathogens.

Question 114: What is the purpose of a differential diagnosis?

To diagnose only rare conditions
To narrow down potential diagnoses (Correct answer)
To list all possible diagnoses
To identify a single definitive diagnosis

Correct answer: To narrow down potential diagnoses

A differential diagnosis is a systematic diagnostic method used to identify the presence of a disease where multiple alternatives are possible. It involves listing all potential conditions that could explain a patient's symptoms and then systematically ruling them out through further tests and examinations. The purpose is to narrow down the possibilities to arrive at the most accurate diagnosis.

Question 115: A 70 kg patient on volume control ventilation has a tidal volume of 500 mL, rate of 14, I:E ratio of 1:2, and peak flow of 60 L/min. What is the inspiratory time?

1.43 seconds
1.0 seconds
0.50 seconds (Correct answer)
0.33 seconds

Correct answer: 0.50 seconds

Inspiratory time = tidal volume (L) ÷ peak flow (L/s) = 0.5 L ÷ (60/60 L/s) = 0.5 seconds.

Question 116: In pressure-controlled ventilation, what happens to tidal volume if lung compliance decreases?

Tidal volume increases
Tidal volume decreases (Correct answer)
Respiratory rate automatically increases
Tidal volume stays the same

Correct answer: Tidal volume decreases

In pressure-controlled mode, the driving pressure is fixed; decreased compliance results in smaller tidal volumes delivered per breath.

Question 117: What is the primary purpose of "palliative care"?

Providing comfort and relief to patients with serious illnesses (Correct answer)
Curing diseases
Administering anesthesia
Preventing infections

Correct answer: Providing comfort and relief to patients with serious illnesses

Palliative care is a specialized approach focused on providing comfort and improving the quality of life for patients and their families facing serious illnesses. Its primary goal is to prevent and relieve suffering by addressing physical, psychological, social, and spiritual needs, rather than solely aiming to cure the disease. This holistic care is provided alongside curative treatments or as the main focus of care.

Question 118: Which diuretic is most commonly used to reduce pulmonary edema in patients with congestive heart failure?

Furosemide (Correct answer)
Spironolactone
Mannitol
Hydrochlorothiazide

Correct answer: Furosemide

Furosemide is a loop diuretic that rapidly reduces intravascular volume and preload, relieving pulmonary congestion in CHF.

Question 119: Use of sternocleidomastoid and scalene muscles during quiet, resting breathing in an adult patient indicates:

Severe respiratory distress requiring increased muscular effort (Correct answer)
Normal resting breathing mechanics
Anxiety-induced tachypnea without true distress
Hypocapnia from mild hyperventilation

Correct answer: Severe respiratory distress requiring increased muscular effort

Accessory muscle use (sternocleidomastoid, scalene) during quiet breathing indicates that primary respiratory muscles are insufficient and the patient is in severe respiratory distress.

Question 120: What is the purpose of "medical triage" in emergency situations?

Assessing and prioritizing patients based on severity of condition (Correct answer)
Providing advanced medical treatment
Conducting routine health check-ups
Treating minor injuries and illnesses

Correct answer: Assessing and prioritizing patients based on severity of condition

Medical triage in emergency situations is the process of assessing and prioritizing patients based on the severity of their condition and the likelihood of survival. Its purpose is to allocate limited resources effectively to maximize the number of lives saved. Patients with life-threatening injuries or illnesses are treated first, while those with less severe conditions may wait.

Question 121: What is the primary purpose of adding pressure support in SIMV mode?

To guarantee a backup rate
To overcome the work of breathing imposed by the endotracheal tube and circuit (Correct answer)
To set a maximum tidal volume
To trigger mandatory breaths

Correct answer: To overcome the work of breathing imposed by the endotracheal tube and circuit

Pressure support in SIMV reduces the inspiratory work of breathing through the high-resistance ETT during spontaneous breaths.

Question 122: Which acid-base disorder is associated with prolonged nasogastric suctioning?

Metabolic alkalosis (Correct answer)
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis

Correct answer: Metabolic alkalosis

Loss of gastric HCl via NG suction removes acid, leaving a net alkalotic state—metabolic alkalosis.

Question 123: Which of the following is the MOST effective method to confirm correct endotracheal tube placement after intubation?

Continuous waveform capnography (Correct answer)
Auscultation of breath sounds bilaterally
Fogging of the ETT
Chest rise observation

Correct answer: Continuous waveform capnography

Continuous waveform capnography (ETCO2) with a consistent rectangular waveform is the gold standard for confirming and monitoring ETT placement.

Question 124: Which parameter is used to calculate the driving pressure in mechanical ventilation?

Plateau pressure minus PEEP (Correct answer)
Mean airway pressure minus PEEP
Peak pressure minus PEEP
Peak pressure minus plateau pressure

Correct answer: Plateau pressure minus PEEP

Driving pressure = plateau pressure − PEEP, reflecting the tidal stress placed on the respiratory system with each breath.

Question 125: A patient produces rusty-colored sputum during assessment. This finding is most classically associated with which condition?

Pulmonary edema
Bronchiectasis
Lung abscess
Pneumococcal pneumonia (Correct answer)

Correct answer: Pneumococcal pneumonia

Rusty or prune-juice–colored sputum is a classic hallmark of pneumococcal (Streptococcus pneumoniae) pneumonia, caused by red blood cell breakdown products in the consolidated tissue.

Question 126: When a patient's SpO2 falls from 90% to 85% while they are being monitored in the telemetry unit, an alarm is triggered. The patient is equipped with a disposable inner cannula, a No. 6 Shiley tracheostomy tube, and a deflated cuff. What is the first thing you have to do when you walk into her room?

Check that the FiO2 setting on the entrainment device is set properly, as ordered.
Attempt to pass a suction catheter through the tracheostomy tube to remove accumulated secretions and to ensure that the tube is patent.
Assess the patient for signs of distress and check the pulse oximetry probe to see that it is securely in place. (Correct answer)
Begin bag-mask ventilation with 100% oxygen at 15 L/min.

Correct answer: Assess the patient for signs of distress and check the pulse oximetry probe to see that it is securely in place.

The patient must be evaluated when an oxygen saturation warning goes off since pulse oximetry requires precise skin contact and is frequently erroneous because to patient movement, skin hair, patient diaphoresis, or sensor connections. Check the location of the pulse oximetry probe and observe the patient for any indications of respiratory distress. The next action would be to suction the tracheostomy tube if the patient showed signs of distress.

Question 127: What does a shift of the oxyhemoglobin dissociation curve to the RIGHT indicate?

Metabolic alkalosis
Decreased release of oxygen to tissues
Increased hemoglobin affinity for oxygen
Decreased hemoglobin affinity for oxygen and increased tissue oxygen delivery (Correct answer)

Correct answer: Decreased hemoglobin affinity for oxygen and increased tissue oxygen delivery

A rightward shift (Bohr effect) decreases hemoglobin-O2 affinity, promoting oxygen release to tissues; caused by acidosis, hyperthermia, or elevated 2,3-DPG.

Question 128: Which chest X-ray finding is MOST consistent with a right-sided pleural effusion?

Air-fluid level at the right base with surrounding consolidation
Blunting of the right costophrenic angle with opacification (Correct answer)
Increased opacity at the right apex with tracheal deviation
Hyperlucency of the right hemithorax

Correct answer: Blunting of the right costophrenic angle with opacification

Pleural effusion typically presents as blunting of the costophrenic angle and a meniscus sign on upright chest X-ray.

Question 129: During a 6-minute walk test, which finding would prompt the RT to immediately stop the test?

SpO2 drops from 98% to 93%
Patient reports mild dyspnea at 3 minutes
Heart rate increases by 20 bpm
SpO2 drops to 85% with chest pain (Correct answer)

Correct answer: SpO2 drops to 85% with chest pain

SpO2 below 88% or the presence of chest pain are absolute indications to stop a 6-minute walk test.

Question 130: Which maneuver is used to assess intrinsic PEEP (auto-PEEP) in a mechanically ventilated patient?

Inspiratory pause maneuver
Maximum inspiratory pressure measurement
End-expiratory hold (Correct answer)
End-inspiratory hold

Correct answer: End-expiratory hold

An end-expiratory hold occludes the expiratory valve at end-exhalation, allowing trapped pressure to equilibrate and be measured as auto-PEEP.

Question 131: Which inhaled medication is classified as an anticholinergic bronchodilator and is commonly used in COPD maintenance therapy?

Tiotropium (Correct answer)
Fluticasone
Budesonide
Albuterol

Correct answer: Tiotropium

Tiotropium is a long-acting muscarinic antagonist (LAMA) that blocks M3 receptors to produce sustained bronchodilation in COPD.

Question 132: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 0.80. Which ventilator strategy is MOST appropriate?

Decrease PEEP to reduce barotrauma risk
Apply permissive hypercapnia with low tidal volumes (Correct answer)
Increase tidal volume to 10 mL/kg IBW
Switch to pressure control with high peak pressures

Correct answer: Apply permissive hypercapnia with low tidal volumes

Lung-protective ventilation in ARDS uses low tidal volumes (6 mL/kg IBW) and accepts permissive hypercapnia to minimize ventilator-induced lung injury.

Question 133: A patient with neuromuscular disease shows a maximum inspiratory pressure (MIP) of -18 cmH2O. What does this suggest?

Mild respiratory muscle weakness only
Excellent respiratory muscle strength
Normal respiratory function
Significant respiratory muscle weakness requiring monitoring for ventilatory failure (Correct answer)

Correct answer: Significant respiratory muscle weakness requiring monitoring for ventilatory failure

MIP less negative than -20 cmH2O indicates severe inspiratory muscle weakness and risk of ventilatory failure.

Question 134: Which ventilator waveform indicates auto-PEEP (intrinsic PEEP)?

Declining tidal volumes on pressure control
Flow not returning to zero before the next breath begins (Correct answer)
A square pressure waveform
Increasing peak airway pressure over time

Correct answer: Flow not returning to zero before the next breath begins

Auto-PEEP occurs when expiratory flow does not reach zero before the next breath, indicating air trapping and incomplete exhalation.

Question 135: Which condition requires immediate needle decompression in a mechanically ventilated patient with sudden hemodynamic collapse?

Tension pneumothorax (Correct answer)
Atelectasis
Pulmonary embolism
Right mainstem intubation

Correct answer: Tension pneumothorax

Tension pneumothorax causes mediastinal shift, impairs venous return, and leads to cardiovascular collapse; needle decompression is lifesaving.

Question 136: The P/F ratio (PaO2/FiO2) threshold for classifying severe ARDS is:

< 150 mmHg
< 200 mmHg
< 100 mmHg (Correct answer)
< 300 mmHg

Correct answer: < 100 mmHg

Per the Berlin Definition, severe ARDS is defined by a P/F ratio less than 100 mmHg on PEEP ≥ 5 cmH2O.

Question 137: What is the MOST common complication of endotracheal suctioning?

Hypoxemia (Correct answer)
Pneumothorax
Tracheomalacia
Subcutaneous emphysema

Correct answer: Hypoxemia

Suctioning removes oxygen along with secretions, making hypoxemia the most frequent complication, especially if pre-oxygenation is omitted.

Question 138: During cardiopulmonary resuscitation (CPR), what ventilation-to-compression ratio is recommended for a single rescuer performing adult CPR without an advanced airway?

1 breath per 15 compressions
1 breath per 5 compressions
2 breaths per 30 compressions (Correct answer)
Continuous compressions without ventilation

Correct answer: 2 breaths per 30 compressions

Current AHA guidelines recommend a 30:2 compression-to-ventilation ratio for single-rescuer adult CPR prior to advanced airway placement.

Question 139: Which arterial blood gas pattern is consistent with acute respiratory acidosis?

pH 7.30, PaCO2 58, HCO3 27 (Correct answer)
pH 7.48, PaCO2 30, HCO3 22
pH 7.35, PaCO2 48, HCO3 28
pH 7.52, PaCO2 28, HCO3 22

Correct answer: pH 7.30, PaCO2 58, HCO3 27

Acute respiratory acidosis shows low pH and elevated PaCO2 with near-normal bicarbonate (little renal compensation yet).

Question 140: The tripod position observed during patient assessment of a breathless patient is best described as:

Patient supine with legs elevated above heart level
Patient seated and leaning forward with hands on knees or a support surface (Correct answer)
Patient prone with head turned to the side to open the airway
Patient standing with arms raised overhead to expand the thorax

Correct answer: Patient seated and leaning forward with hands on knees or a support surface

The tripod position (sitting forward, bracing hands on knees or a table) stabilizes the shoulder girdle so accessory muscles can assist breathing more effectively and increases functional residual capacity.

Question 141: What is the primary purpose of a "DNR" order in a medical context?

Do Not Resuscitate (Correct answer)
Documenting New Research
Directing Nursing Resources
Determining Natural Recovery

Correct answer: Do Not Resuscitate

A DNR (Do Not Resuscitate) order is a medical instruction written by a doctor that informs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops beating or they stop breathing. This order is typically made by patients or their legal proxies who wish to avoid aggressive life-sustaining treatments. Its primary purpose is to respect a patient's end-of-life wishes and ensure a dignified passing.

Question 142: Which of the following represents a normal mixed venous oxygen saturation (SvO2)?

95-100%
85-90%
40-55%
60-80% (Correct answer)

Correct answer: 60-80%

Normal SvO2 is 60-80%, reflecting adequate tissue oxygen delivery relative to consumption; values below 60% suggest inadequate delivery or increased extraction.

Question 143: What is residual volume (RV) and how is it measured?

Volume remaining after maximal expiration; measured by body plethysmography or gas dilution (Correct answer)
Volume after a normal expiration; measured by spirometry
Volume inhaled during a normal breath; measured by spirometry
Volume exhaled in the first second; measured by spirometry

Correct answer: Volume remaining after maximal expiration; measured by body plethysmography or gas dilution

Residual volume is the air remaining in the lungs after maximal exhalation; it cannot be measured by spirometry alone, requiring body plethysmography or gas dilution techniques.

Question 144: A patient with Guillain-Barré syndrome has FVC declining toward 15 mL/kg. The appropriate action is:

Administer bronchodilators
Obtain a pulmonary function test
Begin prophylactic intubation (Correct answer)
Initiate non-invasive positive pressure ventilation

Correct answer: Begin prophylactic intubation

The '20-30-40 rule' (FVC <20 mL/kg, MIP >-30 cmH2O, MEP <40 cmH2O) triggers prophylactic intubation before respiratory failure occurs.

Question 145: A patient with pulmonary fibrosis would most likely show which spirometry result?

Normal FVC with markedly reduced FEV1
FEV1/FVC ratio <0.70 with normal FVC
Elevated TLC with air trapping
Reduced FVC, reduced FEV1, normal or elevated FEV1/FVC ratio (Correct answer)

Correct answer: Reduced FVC, reduced FEV1, normal or elevated FEV1/FVC ratio

Pulmonary fibrosis causes a restrictive pattern with reduced FVC and FEV1, but FEV1/FVC is preserved or increased because fibrosis stiffens the lung aiding forced expiration.

Question 146: Which ventilator mode is most appropriate for a patient in early weaning who has some spontaneous effort?

Controlled Mandatory Ventilation (CMV)
Assist-Control (A/C)
Apneustic ventilation
Pressure Support Ventilation (PSV) (Correct answer)

Correct answer: Pressure Support Ventilation (PSV)

PSV augments spontaneous breaths with a set pressure, encouraging patient effort while unloading respiratory muscles during weaning.

Question 147: Which of the following is an example of a "non-invasive" medical procedure?

Colonoscopy
Surgery
X-ray
Blood draw (Correct answer)

Correct answer: Blood draw

A non-invasive medical procedure is one that does not involve penetrating the skin or entering the body through an incision or natural orifice. While a blood draw involves a needle breaking the skin, it is generally considered minimally invasive compared to surgery or a colonoscopy. An X-ray is also non-invasive as it uses external radiation without physical entry into the body.

Question 148: Which opioid analgesic can suppress respiratory drive and requires careful monitoring in ventilated patients?

Ketorolac
Fentanyl (Correct answer)
Ketamine
Propofol

Correct answer: Fentanyl

Fentanyl is a potent opioid that binds mu receptors in the brainstem, reducing respiratory rate and tidal volume, requiring careful titration.

Question 149: Which spirometric pattern is characteristic of a patient with pulmonary fibrosis?

Reduced FEV1/FVC ratio with increased TLC
Reduced FEV1 with air trapping
Normal FEV1/FVC ratio with reduced TLC and FVC (Correct answer)
Normal FEV1 and FVC with reduced DLCO only

Correct answer: Normal FEV1/FVC ratio with reduced TLC and FVC

Restrictive diseases like pulmonary fibrosis reduce all lung volumes (TLC, FVC) while preserving or increasing the FEV1/FVC ratio.

Question 150: What diagnostic tests might a respiratory therapist perform?

Hearing tests
Blood pressure measurement
X-rays (Correct answer)
Urine analysis

Correct answer: X-rays

Respiratory therapists may assist in performing X-rays to diagnose lung and chest conditions.

Question 151: Which of the following might a respiratory therapist do during a bronchoscopy?

Administer anesthesia (Correct answer)
Conduct a hearing test
Perform a skin biopsy
Set a broken bone

Correct answer: Administer anesthesia

Anesthesia is often administered during a bronchoscopy to ensure patient comfort.

Question 152: What is the primary responsibility of a medical transcriptionist?

Converting audio dictation into written medical records (Correct answer)
Preparing patients for appointments
Assisting in surgery
Translating medical documents

Correct answer: Converting audio dictation into written medical records

A medical transcriptionist's core function is to convert spoken medical reports, dictated by healthcare professionals, into accurate written documents. This process ensures that patient records, reports, and correspondence are precisely documented for legal, clinical, and administrative purposes. They use specialized knowledge of medical terminology, anatomy, and pharmacology to produce high-quality, error-free text.

Question 153: An 18-year-old new immigrant from the Philippines is your patient. The doctor has tentatively diagnosed the patient with tuberculosis and admitted him to the hospital after reviewing the results of his CXR and the symptoms he first complained of. He also ordered more tests and the proper isolation measures. Which PPE is required to be worn while interacting with this patient?

surgical mask, gown, gloves
gown, gloves
N-95 mask, gown, gloves, bonnet, booties
N-95 mask, gown, gloves (Correct answer)

Correct answer: N-95 mask, gown, gloves

Isolated tuberculosis is regarded as airborne.

Question 154: What is the primary mechanism of action of albuterol?

Beta-2 adrenergic agonism (Correct answer)
Muscarinic antagonism
Alpha-1 adrenergic agonism
Beta-1 adrenergic agonism

Correct answer: Beta-2 adrenergic agonism

Albuterol selectively stimulates beta-2 adrenergic receptors on bronchial smooth muscle, causing bronchodilation.

Question 155: Which finding on a chest X-ray is MOST consistent with a right pleural effusion?

Blunting of the right costophrenic angle (Correct answer)
Bilateral perihilar infiltrates
Hyperinflation with flattened diaphragm
Air bronchograms in the right lower lobe

Correct answer: Blunting of the right costophrenic angle

Blunting of the costophrenic angle occurs when at least 150–200 mL of fluid accumulates in the pleural space.

Question 156: Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA)?

Ipratropium bromide
Salmeterol
Albuterol
Tiotropium (Correct answer)

Correct answer: Tiotropium

Tiotropium (Spiriva) is a once-daily LAMA used for COPD maintenance, providing bronchodilation lasting 24 hours.

Question 157: What is the formula for calculating minute ventilation?

FiO2 × PaCO2
Tidal volume × PEEP
Inspiratory time × Flow rate
Respiratory rate × Tidal volume (Correct answer)

Correct answer: Respiratory rate × Tidal volume

Minute ventilation (VE) = respiratory rate × tidal volume, representing the total volume of gas exchanged per minute.

Question 158: What is the primary responsibility of a phlebotomist?

Preparing surgical instruments
Drawing blood for testing (Correct answer)
Managing medical record
Administering anesthesia

Correct answer: Drawing blood for testing

A phlebotomist is a healthcare professional specifically trained to draw blood from patients for laboratory testing, transfusions, donations, or research. Their primary responsibility involves venipuncture, ensuring patient comfort, proper specimen collection, and accurate labeling. This role is crucial for diagnostic processes across various medical fields.

Question 159: The recommended initial tidal volume for lung-protective ventilation in ARDS is:

8–10 mL/kg IBW
10–12 mL/kg IBW
4–5 mL/kg IBW
6–8 mL/kg IBW (Correct answer)

Correct answer: 6–8 mL/kg IBW

The ARDSNet protocol recommends 6 mL/kg ideal body weight (IBW) with a goal plateau pressure ≤ 30 cmH2O.

Question 160: Dullness to percussion over a lung field is most consistent with:

Pneumothorax with air in the pleural space
Hyperresonant lung from air trapping
Emphysema with hyperinflation
Pleural effusion or pulmonary consolidation (Correct answer)

Correct answer: Pleural effusion or pulmonary consolidation

Dullness on percussion indicates reduced air content, which occurs when fluid (pleural effusion) or solid material (consolidation in pneumonia) replaces normal aerated lung tissue.

NBRC Registered Respiratory Therapist (RRT) Exam

This exam certifies individuals as Registered Respiratory Therapists, assessing their knowledge and skills in respiratory care.

160

Questions

180 min

Time Limit

75%

To Pass

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