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

Question 1: 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
Normal lung function
Mixed obstructive-restrictive disease
Obstructive lung disease (Correct answer)

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 2: The normal range for PaO2 in a healthy adult breathing room air at sea level is:

100-120 mmHg
50-60 mmHg
60-70 mmHg
75-100 mmHg (Correct answer)

Correct answer: 75-100 mmHg

Normal PaO2 for a healthy adult at sea level breathing room air is 75-100 mmHg.

Question 3: What is the best initial ventilator setting for FiO2 when initiating mechanical ventilation?

0.21 (room air)
1.0 (100%), then titrate down (Correct answer)
0.40
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 4: A ventilated patient has PaCO2 of 55 mmHg and pH of 7.28. What ventilator change is most appropriate?

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

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

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

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

Ultrasound
MRI (Correct answer)
CT scan
X-ray

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 7: Paramedics take a 20-year-old female patient to the emergency room (ED) after she briefly lost consciousness following a collision with another basketball player. The patient's SpO2 is 98% on room air upon arrival, and her heart rate is 95. Her respiratory rate is also 16. Hematocrit is 44 and hemoglobin is 11.0, according to the venous blood draw. How should these findings be presented?

Patient is saturating well on room air and has a normal heart rate and respiratory rate. Hemoglobin and hematocrit are within normal limits.
Patient is saturating well on room air and is tachypneic with a normal heart rate. Hemoglobin and hematocrit are within normal limits.
Patient is saturating well on room air and has a normal heart rate and respiratory rate. Hemoglobin is low at 11.0, and hematocrit is within normal limits. (Correct answer)
Patient is saturating well on room air and is tachycardic at 95 with a normal respiratory rate. Hemoglobin is high at 11.0, and hematocrit is within normal limits.

Correct answer: Patient is saturating well on room air and has a normal heart rate and respiratory rate. Hemoglobin is low at 11.0, and hematocrit is within normal limits.

Hematocrit, SpO2, heart rate, and respiratory rate are all within normal ranges. Low hemoglobin levels. SpO2 94%-99%, pulse 60-80 bpm, respiratory rate 12-20 rpm, hemoglobin 12-15 g/dL, and hematocrit 37%-46% are considered to be within normal ranges.

Question 8: Which respiratory rate would be classified as tachypnea in an adult patient?

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

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

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

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 10: Which blood gas result is consistent with acute respiratory alkalosis?

pH 7.52, PaCO2 28, HCO3 22 (Correct answer)
pH 7.38, PaCO2 40, HCO3 24
pH 7.30, PaCO2 42, HCO3 16
pH 7.28, PaCO2 58, HCO3 26

Correct answer: pH 7.52, PaCO2 28, HCO3 22

A pH above 7.45 with a low PaCO2 and near-normal HCO3 indicates acute respiratory alkalosis (hyperventilation without renal compensation).

Question 11: Whispered pectoriloquy is a positive finding when assessing for pulmonary consolidation. It is defined as:

Inability to hear any whispered sounds over consolidated lung
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

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 12: Which condition causes a LEFT shift of the oxyhemoglobin dissociation curve?

2,3-DPG elevation
Alkalosis (Correct answer)
Hypercapnia
Fever

Correct answer: Alkalosis

Alkalosis decreases 2,3-DPG effect and increases hemoglobin's affinity for oxygen, shifting the curve left (Hgb holds O2 more tightly).

Question 13: What is the purpose of "sterile gloves" in medical procedures?

To provide extra grip
To prevent the spread of infections to patients (Correct answer)
To enhance dexterity
To keep hands warm

Correct answer: To prevent the spread of infections to patients

Sterile gloves are crucial in medical procedures to prevent the transmission of microorganisms and reduce the risk of healthcare-associated infections. They create a protective barrier between the healthcare provider's hands and the patient's body, ensuring an aseptic environment. This practice is fundamental for patient safety, especially during invasive procedures where infection risk is high.

Question 14: A patient receiving mechanical ventilation develops sudden hypotension, decreased breath sounds on the left, and tracheal deviation to the right. The priority action is:

Increase PEEP
Administer IV fluid bolus
Obtain a stat chest X-ray
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 15: A mechanically ventilated patient has sudden increase in peak airway pressure with no change in plateau pressure. The MOST likely cause is:

Pulmonary edema
Endotracheal tube obstruction
Bronchospasm (Correct answer)
Pneumothorax

Correct answer: Bronchospasm

An increase in peak pressure with unchanged plateau pressure indicates increased airway resistance, most commonly from bronchospasm or secretion buildup in the airway.

Question 16: Which medical professional is responsible for administering anesthesia during surgery?

Radiologist
Pathologist
Anesthesiologist (Correct answer)
Surgeon

Correct answer: Anesthesiologist

An anesthesiologist is a medical doctor who specializes in administering anesthesia and managing pain during surgical procedures. They are responsible for monitoring the patient's vital signs, ensuring their comfort, and maintaining a stable physiological state throughout the operation. Their expertise is crucial for patient safety and successful surgical outcomes.

Question 17: Which combination of findings is most consistent with a pleural effusion on physical assessment?

Dullness to percussion and decreased or absent breath sounds (Correct answer)
Tympany to percussion and bronchial breath sounds
Dullness to percussion and markedly increased tactile fremitus
Hyperresonance to percussion and decreased 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 18: Which condition is MOST likely to cause a decreased diffusing capacity (DLCO)?

Asthma
Obesity
Polycythemia
Pulmonary fibrosis (Correct answer)

Correct answer: Pulmonary fibrosis

Pulmonary fibrosis thickens the alveolar-capillary membrane, impairing gas diffusion and reducing DLCO.

Question 19: In a neonate, which blood gas finding is most consistent with persistent pulmonary hypertension (PPHN)?

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

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 20: What is the recommended educational background for becoming a licensed respiratory therapist in most countries?

Associate's degree in respiratory therapy (Correct answer)
High school diploma
Master's degree in respiratory therapy
Bachelor's degree in any field

Correct answer: Associate's degree in respiratory therapy

An associate's degree in respiratory therapy is the typical educational requirement to become a licensed respiratory therapist in many countries.

Question 21: What is the purpose of performing the nitrogen washout test?

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

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

Dermatologist
Urologist
Gynecologist (Correct answer)
Obstetrician

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 23: Which parameter best reflects the adequacy of alveolar ventilation?

SpO2
End-tidal CO2 (EtCO2)
PaCO2 (Correct answer)
PaO2

Correct answer: PaCO2

PaCO2 is the gold standard for assessing alveolar ventilation; elevated PaCO2 indicates hypoventilation.

Question 24: Which of the following correctly describes high-frequency oscillatory ventilation (HFOV)?

Requires patient to trigger every breath
Provides pressure support with each spontaneous breath
Uses tidal volumes smaller than anatomical dead space at very high frequencies (Correct answer)
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 25: A 45-year-old girl who began smoking at age 15 is the first patient we see today for an examination. She claims to smoke 1.5 packs a day and to have given up smoking for a year while carrying each of her two children. Her hubby smokes as well. How should this smoking history be entered into the patient's record?

Patient suffers from a nicotine addiction and smokes too much.
Patient is currently a heavy smoker.
Patient smokes about 30 cigarettes a day and has for almost 30 years.
Patient is currently a daily cigarette smoker, 1.5 packs per day, with a 42-pack-year history. (Correct answer)

Correct answer: Patient is currently a daily cigarette smoker, 1.5 packs per day, with a 42-pack-year history.

This is the succinct, accepted method of reporting this data, which is most helpful for evaluating the patient and her current condition. It is widely acknowledged as the recognized metric for determining smoking history. <br> Pack-years = number of packs per day x number of years smoked <br> The other responses lack specificity.

Question 26: Hypoxic pulmonary vasoconstriction (HPV) serves what physiological purpose?

Reduces systemic vascular resistance
Diverts blood away from poorly ventilated lung regions (Correct answer)
Increases cardiac output during exercise
Promotes surfactant production

Correct answer: Diverts blood away from poorly ventilated lung regions

HPV constricts pulmonary arterioles in hypoxic lung units, redirecting blood to better-ventilated regions to optimize V/Q matching.

Question 27: Increased airway resistance (Raw) on body plethysmography is most consistent with which condition?

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

Correct answer: COPD or asthma

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

Question 28: During a physical examination of a 20-year-old male, high-pitched wheezing was audible throughout the lung field. The patient claims that while his wheezing is audible, it doesn't bother him much and that he feels a bit out of breath. He observes that it typically occurs after mowing the yard. Which of the following could we suggest to the doctor?

The patient’s respiratory health is uncertain and would be better understood by performing basic spirometry and a methacholine challenge test. (Correct answer)
Send the patient for a chest X-ray (CXR) and full pulmonary function tests (PFTs).
The best course is to “wait and see” for this minor problem.
Write a prescription for an albuterol inhaler to use when necessary (pro re nata [PRN]).

Correct answer: The patient’s respiratory health is uncertain and would be better understood by performing basic spirometry and a methacholine challenge test.

Despite not being particularly severe, the general wheezing in the lung field raises the potential of asthma. The connection between these episodes and grass mowing lends weight to this as a potential diagnosis. The methacholine challenge test and fundamental spirometry will confirm or disprove the diagnosis of asthma. The albuterol inhaler may help with the wheezing, but it won't reveal much about the cause.

Question 29: A patient with cystic fibrosis is ordered high-frequency chest wall oscillation (HFCWO). The primary mechanism of mucus clearance with this therapy is:

Increasing mucociliary transport by ciliary stimulation
Creating oscillating airflow that alters mucus rheology and facilitates clearance (Correct answer)
Generating negative intrathoracic pressure to mobilize secretions
Delivering aerosolized DNase directly to airways

Correct answer: Creating oscillating airflow that alters mucus rheology and facilitates clearance

HFCWO generates rapid chest wall compressions that create oscillating airflow, thinning mucus and moving it toward central airways.

Question 30: A mechanically ventilated patient has an end-tidal CO2 (EtCO2) of 28 mmHg and a PaCO2 of 44 mmHg. The arterial-to-end-tidal CO2 gradient of 16 mmHg MOST likely indicates:

Metabolic alkalosis
Increased dead space ventilation (Correct answer)
Accurate capnography calibration
Hyperventilation

Correct answer: Increased dead space ventilation

A large PaCO2–EtCO2 gradient (normally ≤5 mmHg) indicates increased dead space ventilation, where exhaled CO2 is diluted by non-perfused alveolar gas.

Question 31: A newborn has Apgar scores of 3 at 1 minute and 5 at 5 minutes. The FIRST priority intervention is:

Perform chest compressions immediately
Stimulate and open the airway with positive pressure ventilation if needed (Correct answer)
Establish vascular access
Administer epinephrine

Correct answer: Stimulate and open the airway with positive pressure ventilation if needed

Neonatal resuscitation begins with warmth, stimulation, and airway management; PPV is initiated if HR <100 or inadequate breathing.

Question 32: A patient with pulmonary fibrosis would most likely show which spirometry result?

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

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 33: Which drug is used to reverse neuromuscular blockade in patients receiving non-depolarizing agents?

Atracurium
Succinylcholine
Vecuronium
Neostigmine (Correct answer)

Correct answer: Neostigmine

Neostigmine inhibits acetylcholinesterase, increasing acetylcholine levels at the neuromuscular junction to reverse non-depolarizing blockade.

Question 34: Egophony, used to assess for pulmonary consolidation, is best described as:

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

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 35: What does the term "ARDS" stand for in respiratory care?

Acute Respiratory Distress Syndrome (Correct answer)
Airway Restriction Disorder System
Automated Respiratory Documentation Software
Advanced Radiology Diagnosis System

Correct answer: Acute Respiratory Distress Syndrome

ARDS is a severe lung condition that causes rapid breathing, difficulty getting enough air, and low blood oxygen levels.

Question 36: A patient's flow-volume loop shows a fixed plateau on both inspiration and expiration. This pattern is most consistent with:

Variable extrathoracic obstruction
Asthma
Fixed upper airway obstruction (Correct answer)
Emphysema

Correct answer: Fixed upper airway obstruction

A fixed upper airway obstruction truncates both the inspiratory and expiratory limbs equally, producing a box-shaped flow-volume loop.

Question 37: Pulsus paradoxus during patient assessment is best described as:

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

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

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

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

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

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 40: During a bronchoscopy-guided BAL (bronchoalveolar lavage), the respiratory therapist should maintain SpO2 above what minimum threshold throughout the procedure?

90% (Correct answer)
85%
95%
88%

Correct answer: 90%

SpO2 should be maintained at or above 90% during BAL; supplemental oxygen should be increased pre-procedure and the procedure paused if desaturation occurs.

Question 41: What is the primary purpose of a "CPR" certification?

Cardiovascular Progress Reporting
Clinical Performance Ranking
Cardiopulmonary Resuscitation (Correct answer)
Conducting Patient Reviews

Correct answer: Cardiopulmonary Resuscitation

CPR stands for Cardiopulmonary Resuscitation, an emergency life-saving procedure performed when someone's heart or breathing has stopped. CPR certification teaches individuals how to combine chest compressions and rescue breaths to maintain blood flow to the brain and other vital organs until professional medical help arrives. Its primary purpose is to bridge the gap between collapse and advanced medical care, significantly increasing survival rates.

Question 42: What is the significance of the "Apgar score" given to newborns?

It evaluates the baby's physical appearance.
It measures the newborn's intelligence.
It assesses the baby's future career prospects.
It assesses the baby's overall well-being and vital signs. (Correct answer)

Correct answer: It assesses the baby's overall well-being and vital signs.

The Apgar score is a quick and standardized assessment performed on newborns at one and five minutes after birth. It evaluates five key criteria: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort). This score provides a rapid indication of the baby's overall well-being and vital signs, helping identify those who may need immediate medical attention.

Question 43: What is the purpose of the "Glasgow Coma Scale"?

To assess patients' pain levels
To determine patients' blood pressure
To measure patients' intelligence
To evaluate patients' mental status and level of consciousness (Correct answer)

Correct answer: To evaluate patients' mental status and level of consciousness

The Glasgow Coma Scale (GCS) is a standardized neurological assessment tool used to objectively evaluate a person's level of consciousness after a traumatic brain injury or other acute medical conditions. It assesses three components: eye opening, verbal response, and motor response. The GCS score helps healthcare providers monitor changes in a patient's neurological status and predict outcomes.

Question 44: What does "IDDM" stand for in the context of diabetes?

Intra-Diabetes Diet Management
Internal Digestive Disease Measurement
Insulin-Dependent Diabetes Mellitus (Correct answer)
Intermittent Diabetic Disorder Management

Correct answer: Insulin-Dependent Diabetes Mellitus

IDDM stands for Insulin-Dependent Diabetes Mellitus, which is an older term for Type 1 Diabetes. This condition is characterized by the body's inability to produce insulin, a hormone necessary for glucose uptake by cells. Individuals with IDDM require daily insulin injections to manage their blood sugar levels.

Question 45: What does "PO" stand for in medication administration?

Per Os (by mouth) (Correct answer)
Preoperative Observation
Postoperative Recovery
Pediatric Oncology

Correct answer: Per Os (by mouth)

In medication administration, PO stands for the Latin phrase 'per os,' meaning 'by mouth.' This is a common route for administering medications, indicating that the drug should be taken orally. It differentiates from other routes such as intravenous (IV) or intramuscular (IM) administration.

Question 46: Which of the following best describes the Fick principle as applied to cardiac output measurement?

CO = stroke volume / heart rate
CO = O2 consumption / (CaO2 - CvO2) (Correct answer)
CO = mean arterial pressure / SVR
CO = tidal volume × respiratory rate

Correct answer: CO = O2 consumption / (CaO2 - CvO2)

The Fick principle states cardiac output equals oxygen consumption divided by the arteriovenous oxygen content difference.

Question 47: Which of the following is NOT a duty of a respiratory therapist?

Providing dental cleanings (Correct answer)
Administering oxygen therapy
Managing ventilators
Assisting in intubation

Correct answer: Providing dental cleanings

Providing dental cleanings is not within the scope of practice for respiratory therapists.

Question 48: What does the term "EHR" stand for?

Enforced Healthcare Regulation
Emergency Health Report
Essential Health Records
Electronic Health Record (Correct answer)

Correct answer: Electronic Health Record

EHR stands for Electronic Health Record, which is a digital version of a patient's paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. They are designed to be shared across different healthcare settings, improving coordination of care and patient outcomes.

Question 49: What is the significance of the "Nursing Process" in clinical care?

Providing meals to patients
Monitoring patients' social media activity
Assessing, diagnosing, planning, implementing, and evaluating patient care (Correct answer)
Conducting patient rounds

Correct answer: Assessing, diagnosing, planning, implementing, and evaluating patient care

The Nursing Process is a systematic, five-step framework used by nurses to provide comprehensive and individualized patient care. It involves assessing the patient's condition, diagnosing their health problems, planning appropriate interventions, implementing those plans, and then evaluating the effectiveness of the care provided. This structured approach ensures organized, patient-centered, and evidence-based practice.

Question 50: A patient with ARDS on mechanical ventilation has a PaO2/FiO2 ratio of 85. According to the Berlin Definition, this classifies as which severity?

Not ARDS
Severe ARDS (Correct answer)
Moderate ARDS
Mild ARDS

Correct answer: Severe ARDS

A PaO2/FiO2 ratio less than 100 mmHg with PEEP ≥5 cm H2O classifies as severe ARDS per the Berlin Definition.

Question 51: A patient on mechanical ventilation develops sudden hypotension and absent breath sounds on the left. The most likely diagnosis is:

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

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

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

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 53: 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 54: A size 8.0 endotracheal tube has an internal diameter of 8 mm. What is its approximate resistance compared to a 7.0 tube?

Resistance depends only on tube length
Resistance is lower in the 8.0 tube (Correct answer)
Resistance is equal between both sizes
Resistance is higher in the 8.0 tube

Correct answer: Resistance is lower in the 8.0 tube

Airway resistance is inversely proportional to the fourth power of the radius (Poiseuille's Law), so the larger 8.0 mm tube has significantly lower resistance.

Question 55: Which parameter is used to calculate the driving pressure in mechanical ventilation?

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

Correct answer: Plateau pressure minus PEEP

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

Question 56: Which medication is used to treat methemoglobinemia in patients with toxic oxygen levels?

Sodium thiosulfate
Methylene blue (Correct answer)
Vitamin K
Hydroxocobalamin

Correct answer: Methylene blue

Methylene blue reduces methemoglobin back to functional hemoglobin by acting as an electron donor via the NADPH-dependent pathway.

Question 57: Which of the following is a respiratory therapist's responsibility in the case of a premature newborn with underdeveloped lungs?

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

Correct answer: Assisting with intubation

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

Question 58: Which assessment finding would be LEAST expected in a patient with advanced COPD?

Prolonged expiratory phase
Decreased breath sound intensity bilaterally
Barrel chest
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 59: A patient with a tracheostomy tube is being weaned from ventilator support. Which device allows vocalization while maintaining airway access?

Metal inner cannula
Fenestrated tracheostomy tube alone
Passy-Muir speaking valve (Correct answer)
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 60: A patient with asthma shows significant improvement in FEV1 after bronchodilator administration. What percentage increase is considered significant?

20% and 300 mL
5% and 100 mL
8% and 150 mL
12% and 200 mL (Correct answer)

Correct answer: 12% and 200 mL

A post-bronchodilator increase of ≥12% and ≥200 mL in FEV1 is considered a significant positive bronchodilator response, suggesting reversible obstruction.

Question 61: The P/F ratio (PaO2/FiO2) threshold for classifying severe ARDS is:

< 100 mmHg (Correct answer)
< 200 mmHg
< 300 mmHg
< 150 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 62: A study of the doctor's prescriptions for a patient with chronic obstructive pulmonary disease (COPD) exacerbation who was admitted to an acute care unit reveals that Combivent q4h and DuoNeb q4h were among the drugs prescribed. Which of these tasks is the respiratory therapist's responsibility?

Contact the ordering physician to verify orders. (Correct answer)
Dispense/administer medication as ordered.
Do not administer whichever medication is contraindicated.
Alternate medications every two hours.

Correct answer: Contact the ordering physician to verify orders.

A respiratory therapist is not permitted to alter doctor's orders, ignore them, or merely modify them. However, despite having distinct names and dosage forms, Combivent and DuoNeb are the same drugs (albuterol plus atrovent). The respiratory therapist should get in touch with the doctor to let them know about the duplicate and ask for more advice.

Question 63: Which maneuver is used to assess intrinsic PEEP (auto-PEEP) in a mechanically ventilated patient?

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

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

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

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

Lung abscess
Bronchiectasis
Pneumococcal pneumonia (Correct answer)
Pulmonary edema

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

Ipratropium bromide
Albuterol
Salmeterol
Tiotropium (Correct answer)

Correct answer: Tiotropium

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

Question 67: During a 6-minute walk test, which finding would prompt the RT to immediately stop the test?

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

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

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

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

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

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

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

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 71: Which medical professional specializes in diagnosing and treating conditions related to the kidneys and urinary system?

Podiatrist
Ophthalmologist
Nephrologist (Correct answer)
Gastroenterologist

Correct answer: Nephrologist

A nephrologist is a medical doctor who specializes in the diagnosis and treatment of kidney diseases and conditions affecting the urinary system. They manage chronic kidney disease, acute kidney injury, electrolyte imbalances, and hypertension related to kidney dysfunction. Nephrologists also oversee dialysis treatments and kidney transplantation care.

Question 72: Which condition is characterized by a diffusion defect rather than a V/Q mismatch as the primary mechanism of hypoxemia?

Pneumonia
Atelectasis
Pulmonary fibrosis (Correct answer)
Pulmonary embolism

Correct answer: Pulmonary fibrosis

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

Question 73: Which ventilator mode is most appropriate for a patient in early weaning who has some spontaneous effort?

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

Correct answer: Pressure Support Ventilation (PSV)

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

Question 74: Plateau pressure minus total PEEP (intrinsic + extrinsic) equals:

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

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 75: Which ventilator waveform finding is most consistent with auto-PEEP (intrinsic PEEP)?

Inspiratory flow that never returns to zero
Expiratory flow that does not return to zero before the next breath (Correct answer)
Decreased tidal volume with constant pressure
A spike in airway pressure at end-inspiration

Correct answer: Expiratory flow that does not return to zero before the next breath

Auto-PEEP occurs when expiratory flow is still present when the next breath begins, indicating incomplete exhalation.

Question 76: Which spirometric measure has the highest day-to-day variability and is least recommended for diagnosing obstruction?

Peak expiratory flow (PEF) (Correct answer)
FEV1
FVC
FEV1/FVC ratio

Correct answer: Peak expiratory flow (PEF)

Peak expiratory flow is highly effort-dependent and variable, making it useful for home monitoring but not for definitive diagnosis of airflow obstruction.

Question 77: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 0.80. Which ventilator strategy is MOST appropriate?

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

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

Cardiogenic pulmonary edema (Correct answer)
Pneumonia without heart failure
ARDS (non-cardiogenic pulmonary edema)
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 79: What is residual volume (RV) and how is it measured?

Volume inhaled during a normal breath; measured by spirometry
Volume remaining after maximal expiration; measured by body plethysmography or gas dilution (Correct answer)
Volume exhaled in the first second; measured by spirometry
Volume after a normal expiration; 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 80: 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?

0.50 seconds (Correct answer)
1.0 seconds
1.43 seconds
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 81: What is "informed consent" in a clinical context?

Requesting feedback after an appointment
Asking for permission after treatment
Obtaining permission before treatment with full understanding of risks and benefits (Correct answer)
Obtaining permission after surgery

Correct answer: Obtaining permission before treatment with full understanding of risks and benefits

Informed consent is a fundamental ethical and legal principle in healthcare, requiring that a patient gives voluntary permission for a medical procedure or treatment. This permission must be given after the patient has been fully informed about the nature of the procedure, its potential risks and benefits, and any available alternatives. It ensures patient autonomy and shared decision-making in their care.

Question 82: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 0.80. The best next step is to:

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

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

80% helium / 20% oxygen
70% helium / 30% oxygen (Correct answer)
60% helium / 40% oxygen
50% helium / 50% 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 84: What is the main role of a respiratory therapist?

Diagnosing heart conditions
Treating respiratory disorders (Correct answer)
Performing surgeries
Administering medications

Correct answer: Treating respiratory disorders

Respiratory therapists specialize in treating patients with breathing and cardiopulmonary disorders.

Question 85: What immediate action should be taken if a ventilated patient triggers a high-pressure alarm?

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

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

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

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

Apneustic breathing
Biot's breathing
Kussmaul 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 88: During a spontaneous breathing trial (SBT), which finding is the MOST reliable predictor of successful extubation?

Heart rate below 100 bpm throughout SBT
Absence of secretions for 2 hours prior
Rapid Shallow Breathing Index (RSBI) below 105 (Correct answer)
SpO2 above 95% on FiO2 0.40

Correct answer: Rapid Shallow Breathing Index (RSBI) below 105

An RSBI (f/VT) below 105 breaths/min/L is the best validated predictor of successful extubation following an SBT.

Question 89: During patient assessment, digital clubbing is most commonly associated with which underlying condition?

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

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 90: What oxygen saturation target is recommended for preterm neonates to reduce the risk of retinopathy of prematurity (ROP)?

91–95% (Correct answer)
100%
96–99%
85–89%

Correct answer: 91–95%

Targeting SpO2 of 91–95% in preterm neonates balances the risk of ROP from hyperoxia against mortality and morbidity from hypoxia.

Question 91: Tracheal deviation toward the right side in a patient would most likely be caused by:

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

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

Dexamethasone
Prednisone
Fluticasone (Correct answer)
Hydrocortisone

Correct answer: Fluticasone

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

Question 93: Which finding on a capnography waveform suggests esophageal intubation?

Prolonged plateau phase
Elevated baseline
Shark fin appearance
Absent CO2 waveform (near zero reading) (Correct answer)

Correct answer: Absent CO2 waveform (near zero reading)

Esophageal intubation produces no sustained CO2 waveform since there is no alveolar CO2 being exhaled through the tube.

Question 94: Use of sternocleidomastoid and scalene muscles during quiet, resting breathing in an adult patient indicates:

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

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

Cardiogenic pulmonary edema
Pulmonary embolism
Acute exacerbation of COPD
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 96: A barrel chest deformity observed during patient inspection is best characterized by:

Increased AP-to-transverse diameter ratio approaching or exceeding 1:1 (Correct answer)
Pectus excavatum with decreased chest wall compliance
Flail chest with paradoxical chest wall movement
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 97: A patient on volume control ventilation has a plateau pressure of 32 cmH2O. What is the appropriate action?

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

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 98: Which bronchodilator is classified as a short-acting beta-2 agonist (SABA)?

Albuterol (Correct answer)
Formoterol
Tiotropium
Salmeterol

Correct answer: Albuterol

Albuterol is a SABA with onset of action within minutes and duration of 4-6 hours.

Question 99: A patient with a left-sided tension pneumothorax would most likely demonstrate:

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

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

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

Correct answer: 0.28 (28%)

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

Question 101: A patient with cystic fibrosis benefits MOST from which airway clearance technique using an oscillating PEP device?

Incentive spirometry
Postural drainage and percussion
CPAP therapy
Flutter valve therapy (Correct answer)

Correct answer: Flutter valve therapy

Flutter (oscillating PEP) devices generate high-frequency oscillations that loosen mucus and maintain airway patency, making them effective in CF.

Question 102: What is the primary purpose of adding PEEP during mechanical ventilation?

Prevent alveolar collapse at end-expiration (Correct answer)
Reduce PaCO2
Eliminate air trapping
Increase tidal volume delivery

Correct answer: Prevent alveolar collapse at end-expiration

PEEP maintains positive pressure at end-expiration to prevent alveolar derecruitment and improve oxygenation.

Question 103: Which condition requires immediate needle decompression in a mechanically ventilated patient with sudden hemodynamic collapse?

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

Correct answer: Tension pneumothorax

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

Question 104: During inspection, skin visibly sinking inward between the ribs during inspiration is correctly termed:

Intercostal retractions (Correct answer)
Substernal retractions
Suprasternal retractions
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 105: What does "IV" stand for in medical terminology?

Internal Valve
Intravenous (inside a vein) (Correct answer)
Intra Visceral
Intermittent Vibration

Correct answer: Intravenous (inside a vein)

IV stands for Intravenous, which literally means 'inside a vein.' This term refers to a route of administration where medication or fluids are delivered directly into a patient's bloodstream through a vein. IV administration allows for rapid and complete distribution of substances throughout the body, making it effective for emergencies or when precise dosing is needed.

Question 106: High-frequency oscillatory ventilation (HFOV) is characterized by which of the following?

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

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 107: 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 108: What is the role of a respiratory therapist in pulmonary rehabilitation programs?

Developing exercise plans (Correct answer)
Leading yoga classes
Offering nutritional counseling
Providing massage therapy

Correct answer: Developing exercise plans

Respiratory therapists play a role in designing exercise programs to improve lung function and overall health.

Question 109: Crackles (rales) heard on auscultation are most commonly caused by:

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

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 110: Despite wearing a venturi mask that provides a FiO2 of 0.45 and a SpO2 of 87%, the patient in your care has proper tidal volumes, clean bilateral breath sounds throughout his lung fields, a normal CBC, and no signs or symptoms of infection. Although he is not currently taking an anticoagulant, the patient's file indicates a history of a clotting condition. Which examination would you advise getting done next?

CXR
ventilation-perfusion (V/Q) scan (Correct answer)
prothrombin time (PT) and international normalized ratio (INR)
ultrasound exam of aorta and echocardiogram

Correct answer: ventilation-perfusion (V/Q) scan

The patient's medical history and present state point to a ventilation/perfusion issue, possibly a pulmonary embolism. Calculating the Pa and Pa difference reveals this. The clotting disorder suggests that PE might exist. The results of the other tests are not likely to show the existence or absence of a pulmonary embolism.

Question 111: Which arterial blood gas pattern is expected during the initial compensatory response to metabolic acidosis?

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

Correct answer: Decreased PaCO2

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

Question 112: What is the primary responsibility of a phlebotomist?

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

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 113: Which parameter best reflects the adequacy of alveolar ventilation?

PaCO2 (Correct answer)
PaO2
SaO2
SpO2

Correct answer: PaCO2

PaCO2 directly reflects CO2 elimination and is the gold-standard measure of alveolar ventilation adequacy.

Question 114: What is the purpose of "sterile dressing" in wound care?

To protect the wound from infection (Correct answer)
To absorb excess moisture
To prevent the formation of scars
To add color to the wound

Correct answer: To protect the wound from infection

The primary purpose of a sterile dressing in wound care is to create a barrier that protects the wound from external contamination. This barrier prevents bacteria and other microorganisms from entering the wound, thereby reducing the risk of infection. Sterile dressings also help maintain a moist environment conducive to healing and absorb exudate.

Question 115: The tripod position observed during patient assessment of a breathless patient is best described as:

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

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

Classify severity of airflow obstruction by FEV1 percentage
Grade oxygenation impairment based on PaO2/FiO2 ratio
Assess ventilatory muscle strength via maximal inspiratory pressure
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 117: What is the purpose of a code of ethics in clinical practice?

To eliminate competition
To ensure maximum profitability
To enforce strict rules and regulations
To guide ethical decision-making (Correct answer)

Correct answer: To guide ethical decision-making

A code of ethics in clinical practice serves as a set of guiding principles that dictate how healthcare professionals should conduct themselves. Its primary purpose is to guide ethical decision-making, ensuring that patient welfare, autonomy, and confidentiality are prioritized. This framework helps professionals navigate complex moral dilemmas and uphold the integrity of their profession.

Question 118: What is the recommended maximum suction pressure for an adult patient during endotracheal suctioning?

-150 to -200 mmHg
-80 to -120 mmHg
-100 to -150 mmHg (Correct answer)
-60 to -80 mmHg

Correct answer: -100 to -150 mmHg

AARC guidelines recommend suctioning pressure of -100 to -150 mmHg for adults to effectively clear secretions while minimizing trauma.

Question 119: Which ventilator mode delivers a guaranteed tidal volume regardless of lung compliance changes?

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

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

Pulmonary embolism
COPD exacerbation
Status asthmaticus
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 121: A patient is prescribed heliox (70% He / 30% O2) for severe upper airway obstruction. The PRIMARY benefit of helium in this mixture is:

Enhanced mucociliary clearance
Increased oxygen-carrying capacity
Reduced gas density improving flow through narrow airways (Correct answer)
Bronchodilation of small airways

Correct answer: Reduced gas density improving flow through narrow airways

Helium's low density reduces turbulent flow resistance in obstructed upper airways, improving gas delivery until definitive treatment.

Question 122: Orthopnea, a common complaint assessed in patients with cardiac disease, is defined as:

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

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

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

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

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

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 125: Diffusing capacity for carbon monoxide (DLCO) is reduced in which condition?

Obesity
Asthma
Emphysema (Correct answer)
Respiratory muscle weakness

Correct answer: Emphysema

Emphysema destroys alveolar walls and capillaries, reducing the surface area available for gas exchange and lowering DLCO.

Question 126: What is the primary responsibility of a medical transcriptionist?

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

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

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

Correct answer: Administer anesthesia

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

Question 128: Which of the following medical professionals specializes in treating disorders of the nervous system?

Neurologist (Correct answer)
Hematologist
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 129: 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:

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

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 130: A patient with cystic fibrosis is admitted with acute exacerbation. Which airway clearance technique has the strongest evidence for routine use?

Incentive spirometry
Nasotracheal suctioning
Airway oscillating devices (flutter/Acapella) (Correct answer)
Postural drainage with manual percussion

Correct answer: Airway oscillating devices (flutter/Acapella)

Oscillating positive expiratory pressure devices (flutter valve, Acapella) are well-supported for mucus mobilization in cystic fibrosis and offer patient-administered convenience.

Question 131: Which of the following devices might a respiratory therapist use to deliver a precise amount of oxygen to a patient?

Cane
Nebulizer
Venturi mask (Correct answer)
Walker

Correct answer: Venturi mask

A Venturi mask delivers a specific oxygen concentration to a patient and is commonly used in respiratory therapy.

Question 132: A patient on volume-controlled ventilation has a sudden rise in peak airway pressure with no change in plateau pressure. What is the most likely cause?

Increased secretions in the airway (Correct answer)
Decreased lung compliance
Auto-PEEP
Pneumothorax

Correct answer: Increased secretions in the airway

A rise in peak pressure with an unchanged plateau pressure indicates increased airway resistance, most commonly from secretions.

Question 133: 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 134: What does PEEP stand for and what is its primary purpose in mechanical ventilation?

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

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

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

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 136: Which of the following is a common respiratory condition that involves the inflammation of the airways and difficulty breathing?

Chronic obstructive pulmonary disease (COPD) (Correct answer)
Gastroesophageal reflux disease (GERD)
Arthritis
Migraine

Correct answer: Chronic obstructive pulmonary disease (COPD)

COPD is characterized by inflammation and narrowing of the airways, leading to breathing difficulties.

Question 137: A patient's ABG shows pH 7.28, PaCO2 55 mmHg, HCO3 25 mEq/L. What is the primary disturbance?

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

Correct answer: Respiratory acidosis

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

Question 138: 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 139: Racemic epinephrine is primarily used via nebulization to treat which condition in pediatric patients?

Bronchiolitis
Croup (laryngotracheobronchitis) (Correct answer)
Asthma exacerbation
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Racemic epinephrine reduces subglottic edema in croup through alpha-adrenergic-mediated vasoconstriction, relieving stridor.

Question 140: Which bronchodilator class acts by blocking muscarinic receptors to relax airway smooth muscle?

Leukotriene modifiers
Short-acting beta-2 agonists
Methylxanthines
Anticholinergics (Correct answer)

Correct answer: Anticholinergics

Anticholinergics such as ipratropium block muscarinic receptors, preventing bronchoconstriction mediated by the parasympathetic nervous system.

Question 141: Which finding on spirometry is most characteristic of asthma?

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

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 142: When calculating the alveolar-arterial (A-a) oxygen gradient, which formula is used to find PAO2?

PAO2 = FiO2 × PB
PAO2 = FiO2 (PB - PH2O) - PaCO2/RQ (Correct answer)
PAO2 = PaO2 + PaCO2
PAO2 = PaO2 / FiO2

Correct answer: PAO2 = FiO2 (PB - PH2O) - PaCO2/RQ

The alveolar gas equation: PAO2 = FiO2(PB − 47) − PaCO2/0.8 is used to calculate alveolar oxygen tension.

Question 143: What is the normal range for static lung compliance in a mechanically ventilated adult?

5–10 mL/cmH2O
150–200 mL/cmH2O
60–100 mL/cmH2O (Correct answer)
10–20 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 144: Dornase alfa (Pulmozyme) is specifically indicated for improving pulmonary function in which condition?

Cystic fibrosis (Correct answer)
Bronchiectasis
Pulmonary fibrosis
COPD

Correct answer: Cystic fibrosis

Dornase alfa cleaves extracellular DNA in the thick mucus of cystic fibrosis patients, reducing sputum viscosity and improving airway clearance.

Question 145: What is the primary purpose of "palliative care"?

Curing diseases
Administering anesthesia
Providing comfort and relief to patients with serious illnesses (Correct answer)
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 146: A patient post-lobectomy develops subcutaneous emphysema and a persistent air leak from the chest tube. The most likely cause is:

Atelectasis
Bronchopleural fistula (Correct answer)
Pulmonary embolism
Pleural effusion

Correct answer: Bronchopleural fistula

A bronchopleural fistula is an abnormal communication between the bronchial tree and the pleural space, causing persistent air leak.

Question 147: A maximum inspiratory pressure (MIP or NIF) of -20 cmH2O in a neuromuscular disease patient suggests what?

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

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

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

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.

Question 149: A patient with neuromuscular disease shows a maximum inspiratory pressure (MIP) of -18 cmH2O. What does this suggest?

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

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

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

Correct answer: 27 mmHg

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

Question 151: Which bronchodilator class works by inhibiting acetylcholine receptors to reduce bronchoconstriction?

Anticholinergics (Correct answer)
Beta-2 agonists
Methylxanthines
Leukotriene modifiers

Correct answer: Anticholinergics

Anticholinergics such as ipratropium block muscarinic receptors, preventing acetylcholine-mediated bronchoconstriction.

Question 152: What is the formula for calculating minute ventilation?

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

Correct answer: Respiratory rate × Tidal volume

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

Question 153: Heliox therapy improves breathing effort primarily by doing what?

Increasing oxygen partial pressure
Reducing gas density to decrease airflow resistance (Correct answer)
Delivering a bronchodilator more effectively
Improving diffusion capacity

Correct answer: Reducing gas density to decrease airflow resistance

Helium-oxygen mixture (heliox) has lower density than air, reducing turbulent airflow resistance and work of breathing in upper airway obstruction.

Question 154: Which of the following is NOT a common route for medication administration?

Intransigent (IG) (Correct answer)
Intravenous (IV)
Oral (by mouth)
Intradermal (ID)

Correct answer: Intransigent (IG)

Intransigent (IG) is not a recognized route for medication administration in medicine. Common routes include oral (by mouth), intravenous (into a vein), intramuscular (into a muscle), subcutaneous (under the skin), and intradermal (into the skin). The term 'intransigent' means unwilling or refusing to change one's views or to agree about something, which is unrelated to drug delivery.

Question 155: A patient is receiving aerosolized albuterol. The therapist notes the patient's HR increases from 78 to 118 bpm. What is the BEST course of action?

Switch to ipratropium and continue the same dose
Continue the treatment; tachycardia is always expected
Double the dose to enhance bronchodilation
Discontinue the treatment and notify the physician (Correct answer)

Correct answer: Discontinue the treatment and notify the physician

A HR > 20% above baseline or exceeding 110–120 bpm is a criterion to stop albuterol therapy and report to the physician.

Question 156: Which finding on a chest X-ray is MOST consistent with a right pleural effusion?

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

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 157: Which healthcare professional focuses on assessing and treating musculoskeletal conditions and injuries?

Neurologist
Orthopedic surgeon (Correct answer)
Ophthalmologis
Nephrologist

Correct answer: Orthopedic surgeon

An orthopedic surgeon specializes in the diagnosis, treatment, and prevention of disorders of the musculoskeletal system. This includes bones, joints, ligaments, tendons, muscles, and nerves. They treat conditions ranging from fractures and sprains to chronic degenerative diseases, often employing both surgical and non-surgical methods.

Question 158: A patient with myasthenia gravis is in respiratory failure. Which measurement BEST indicates the need for intubation?

RR > 20 breaths/min
Vital capacity < 15 mL/kg (Correct answer)
PaO2 < 60 mmHg on room air
SpO2 < 95% on 2 L/min O2

Correct answer: Vital capacity < 15 mL/kg

The 20-30-40 rule in neuromuscular disease: VC < 20 mL/kg, MIP weaker than -30 cmH2O, or MEP < 40 cmH2O indicate impending failure.

Question 159: What is the role of a "Wound Care Nurse"?

Performing surgery
Providing postoperative care
Treating and managing wound healing (Correct answer)
Managing medical billing

Correct answer: Treating and managing wound healing

A Wound Care Nurse is a specialized healthcare professional who focuses on the assessment, treatment, and management of various types of wounds. Their role involves developing individualized care plans, applying advanced wound care techniques, and educating patients and families on proper wound management. They aim to promote healing, prevent complications, and improve patient quality of life.

Question 160: Which drug is used to reverse neuromuscular blockade caused by vecuronium?

Protamine
Neostigmine (Correct answer)
Naloxone
Flumazenil

Correct answer: Neostigmine

Neostigmine (an anticholinesterase) reverses non-depolarizing neuromuscular blockers like vecuronium.

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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