NBRC Respiratory Therapist 5 — Questions and Answers
Question 1: A patient on BiPAP for acute hypercapnic respiratory failure has the following settings: IPAP 14, EPAP 6. What is the pressure support being delivered?
- 6 cmH2O
- 8 cmH2O (Correct answer)
- 14 cmH2O
- 20 cmH2O
Correct answer: 8 cmH2O
Pressure support on BiPAP equals IPAP minus EPAP (14 - 6 = 8 cmH2O), which drives tidal volume during spontaneous breaths.
Question 2: An RT reviews a patient's chart and notes a P/F ratio of 180 mmHg on FiO2 of 0.60. According to the Berlin Definition, this represents:
- Mild ARDS
- Moderate ARDS (Correct answer)
- Severe ARDS
- Acute lung injury (ALI), not ARDS
Correct answer: Moderate ARDS
The Berlin Definition classifies ARDS as mild (P/F 200–300), moderate (P/F 100–200), or severe (P/F < 100), all requiring PEEP ≥ 5 cmH2O.
Question 3: Which of the following is the most appropriate initial tidal volume setting for lung-protective ventilation in a 70 kg IBW patient with ARDS?
- 700 mL (10 mL/kg IBW)
- 560 mL (8 mL/kg IBW)
- 420 mL (6 mL/kg IBW) (Correct answer)
- 280 mL (4 mL/kg IBW)
Correct answer: 420 mL (6 mL/kg IBW)
The ARDSNet protocol recommends initiating mechanical ventilation at 6 mL/kg IBW to limit volutrauma and improve mortality.
Question 4: A patient develops fever, productive cough, and a new infiltrate on CXR after 72 hours of mechanical ventilation. The MOST likely diagnosis is:
- Community-acquired pneumonia
- Pulmonary embolism
- Ventilator-associated pneumonia (VAP) (Correct answer)
- Acute respiratory distress syndrome
Correct answer: Ventilator-associated pneumonia (VAP)
Pneumonia developing ≥48–72 hours after endotracheal intubation is classified as ventilator-associated pneumonia.
Question 5: Which medication is a phosphodiesterase-5 inhibitor used to treat pulmonary arterial hypertension?
- Bosentan
- Sildenafil (Correct answer)
- Epoprostenol
- Ambrisentan
Correct answer: Sildenafil
Sildenafil inhibits PDE-5, increasing cGMP levels and producing pulmonary vasodilation without significant systemic effects.
Question 6: An RT is setting up a transport ventilator for an ICU patient being moved to CT. Which consideration is MOST critical?
- Use the same ventilator brand as in the ICU
- Ensure adequate oxygen cylinder volume for the entire transport duration (Correct answer)
- Switch the patient to manual ventilation during elevator travel
- Increase PEEP by 2 cmH2O to compensate for position changes
Correct answer: Ensure adequate oxygen cylinder volume for the entire transport duration
Running out of oxygen supply during transport is a life-threatening risk; calculate required cylinder volume based on FiO2, flow, and estimated transport time.
Question 7: A patient with myasthenia gravis crisis has a negative inspiratory force (NIF) of -18 cmH2O. How should the RT interpret this finding?
- Adequate respiratory reserve; continue monitoring
- Borderline; repeat in 2 hours
- Insufficient respiratory reserve; prepare for intubation (Correct answer)
- Normal finding for neuromuscular disease
Correct answer: Insufficient respiratory reserve; prepare for intubation
A NIF less negative than -20 to -25 cmH2O indicates severely compromised respiratory muscle strength and high risk of ventilatory failure.
NBRC Respiratory Therapist 5
A patient on BiPAP for acute hypercapnic respiratory failure has the following settings: IPAP 14, EPAP 6.
What is the pressure support being delivered?