NBRC Respiratory Therapist 3 — Questions and Answers
Question 1: A patient with suspected obstructive sleep apnea undergoes a polysomnogram. Which finding is diagnostic of severe OSA?
- AHI of 10–14 events/hour
- AHI ≥ 30 events/hour (Correct answer)
- Oxygen desaturation to 88% once
- Snoring index > 50%
Correct answer: AHI ≥ 30 events/hour
Severe OSA is defined by an apnea-hypopnea index (AHI) of 30 or more events per hour of sleep.
Question 2: During a spontaneous breathing trial (SBT), which finding is an indication to ABORT the trial?
- SpO2 95% on 40% FiO2
- Respiratory rate of 28 breaths/min sustained for 5 minutes (Correct answer)
- Heart rate increase from 78 to 90 bpm
- Mild use of accessory muscles at the start
Correct answer: Respiratory rate of 28 breaths/min sustained for 5 minutes
A sustained respiratory rate above 35 breaths/min during an SBT indicates failure and the trial should be stopped.
Question 3: What is the primary goal of prone positioning in patients with severe ARDS?
- Reduce ventilator-associated pneumonia risk
- Improve V/Q matching and oxygenation (Correct answer)
- Decrease PaCO2 levels
- Lower peak airway pressures
Correct answer: Improve V/Q matching and oxygenation
Prone positioning redistributes lung perfusion to better-ventilated dorsal regions, improving ventilation-perfusion matching and oxygenation.
Question 4: A patient requires aerosol therapy via small-volume nebulizer during mechanical ventilation. Where should the nebulizer be placed in the circuit?
- In the expiratory limb
- 15 cm from the patient Y-piece on the inspiratory limb (Correct answer)
- Directly at the endotracheal tube adapter
- In the humidifier chamber
Correct answer: 15 cm from the patient Y-piece on the inspiratory limb
Placing the SVN 15 cm from the Y-piece on the inspiratory limb allows aerosol to accumulate in the circuit between breaths, increasing delivery.
Question 5: Which pulmonary function test finding is characteristic of a restrictive lung disease pattern?
- FEV1/FVC < 70% with normal TLC
- Reduced TLC with normal or elevated FEV1/FVC ratio (Correct answer)
- Increased RV with air trapping
- Decreased DLCO with obstructive pattern
Correct answer: Reduced TLC with normal or elevated FEV1/FVC ratio
Restrictive disease reduces lung volumes (TLC, VC, FRC) while the FEV1/FVC ratio remains normal or elevated due to proportional reductions.
Question 6: A term neonate is born with poor respiratory effort, heart rate 90 bpm, and central cyanosis. After initial warming and stimulation, no improvement occurs. What is the next step?
- Administer epinephrine via umbilical catheter
- Begin positive pressure ventilation with 21% oxygen (Correct answer)
- Perform chest compressions immediately
- Intubate and administer surfactant
Correct answer: Begin positive pressure ventilation with 21% oxygen
NRP guidelines direct positive pressure ventilation as the primary intervention when a neonate fails to respond to initial stabilization steps.
Question 7: An RT is calibrating a blood gas analyzer. The two-point calibration uses:
- Room air and 100% oxygen
- Low and high standard gas concentrations (Correct answer)
- Patient blood and known reference values
- Distilled water and isotonic saline
Correct answer: Low and high standard gas concentrations
Two-point calibration establishes the analyzer's linearity using certified low-concentration and high-concentration reference gas mixtures.
NBRC Respiratory Therapist 3
A patient with suspected obstructive sleep apnea undergoes a polysomnogram.
Which finding is diagnostic of severe OSA?