Board Exam

Preparation
Written Exams
CRT and RRT

Be Prepared!

WHAT to study
WHERE to study
WHEN to study
HOW to study

What to Study
Know Your Enemy: The Board Exams
You must understand the structure and
content of the board exams and apply this
knowledge to your study plan.
REVIEW THE MATRIX FOR THE CRT, RRT,
CSE
ALL FOUND ON WWW.NBRC.ORG

The EXAM
Part one: Study all content, take plenty of
practice exams, schedule your CRT
exam and layout a study plan
After completing the CRT schedule your
Written RRT and Clinical Simulation
exam. You may take both the same day
or seperate

Exam Structure
CRT
160 questions
140 actual test questions
20 additional questions that are
NOT scored

3 hours
Passing score 75% (105
correct)*

RRT Written
115 questions
100 actual test questions
15 additional questions
that are NOT scored

2 hours
Passing score 70% (70
correct)*
Computer based testing
No calculators allowed
A pencil and paper will be provided for you

Exam Structure
CSE (Clinical Simulation Exam)

PART 2 of the RRT

Consists of 11 scenarios (only 10 are graded)
Covers all areas from the CRT and WRRT
Typically you will get disease management
scenarios for: COPD, Trauma, Cardiovascular
disease, Neuromuscular, Peds, Neonates,
and others (page 450)

Exam Content
Content Outline
Candidate Handbook
www.nbrc.org
All items on the exam are developed from
these outlines
Categorized by cognitive level

Recall
Application
Analysis

Recall: the ability to recall or

recognize specific information

Facts
Definitions
Normal values
Principles
Equations

Recall
Involves remembering memorized
information
You either know it or you dont
If you dont know the answer, eliminate
answers that you think are impossible,
and then guess from the remaining
options.

Recall Example
An otherwise healthy
25-year-old male
patient who took an
overdose of sedatives
is being supported on a
ventilator. Which of the
following measures of
total static compliance
would you expect in
this patient?

A.
B.
C.
D.

100 mL/cmH2O
10 mL/cmH2O
1 mL/cmH2O
0.1 mL/cmH2O

 Answer A
To evaluate and monitor a patient, you need
to know what is normal and what is abnormal.
This item tests your ability to recall normal
static compliance. It also separately
assesses your ability to differentiate the
common bedside units used for this measure
(mL/cmH2O) from that typically employed in a
pulmonary lab (L/cmH2O).

Application: the ability to

comprehend or apply knowledge
to new or changing conditions
Tests your understanding of principles,
practices, and procedures involved in
respiratory care

Application Example
An adult patient receiving
volume-oriented
assist/control ventilation
has a corrected tidal
volume of 700 mL, a peak
pressure of 50 cmH2O,
and a plateau pressure of
40 cmH2O and is receiving
5 cmH2O of PEEP. What
is the patients static
compliance?

A.
B.
C.
D.

200 mL/cmH2O
20 mL/cmH2O
2 mL/cmH2O
0.2 mL/cmH2O

 Answer B
This item tests your ability to apply a
formula to a clinical situation (most
formula-type questions are at the
application level). To answer it correctly,
you need to plug the correct data into
the formula for computing static
compliance Vt/(Ppl-PEEP)

Analysis: the ability to analyze

information, to put information
together to arrive at solutions,
and/or to evaluate the usefulness of
the solutions
They begin the question with facts that you need to
analyze and interpret to come to a conclusion.
They may ask what is wrong, or they may ask what do
you want to do about it.
Analysis: 10% of the exam. analyze or interpret
information in order to solve a problem.

Analysis Example
A patient is receiving
volume cycled mechanical
ventilation in the control
mode. The following ABG
data were obtained:pH
7.56, PaCO2 25 torr, PaO2
93 torr, HCO3- 22 mEq/L
Which ventilator
adjustments should be
made at this time?

A.
B.
C.

Institute 5 cmH20 PEEP

Increase the FiO2
Increase the tidal
volume
D. Decrease the ventilatory
rate

Answer D
This item assesses your ability to analyze monitoring
data and apply this information to recommend a
treatment approach for this patient. First, youmust
analyze the data, which should reveal that the
patient has uncompensated respiratory alkalosis.
Second, you need to recognize that this can be due
to over-ventilation. Last, you need to apply this data
and your knowledge of mechanical ventilation to
recommend the correct course of action

The NBRC Hospital

Treat the exam matrix as the policy
manual for the NBRC hospital
Focus on the things that you do not typically
do at your clinic site
As you study, identify things that are different
that what you typically do

Do not be afraid to use your independent

judgement.

The NBRC Hospital

You enter the NBRC hospital every time you take an NBRC
exam.
This hospital may or may not function the same as the clinical
site or sites you are at, it represents an idealized institution.
The NBRC RC department always relies of generally accepted
knowledge based on various practice guidelines
Their procedure manual is based upon broad national
agreement among clinicians and educators as to what
common skills the average therapist performs
So upon entering the NBRC hospital, you may be expected to
know and do different things from those you were trained to do.

Your Textbook
Bold Topic Headings
Evaluate the patients general
appearance (Code: IB1a) [Difficulty:
ELE: R, Ap; WRE: An)
The code refers to a section of the matrix
ELE: entry level exam
WRE: written registry exam
R: recall, Ap: Application, An: Analysis

Your Text Book

Read xv through xxi
For every chapter take the pre-test (answers
and explanations are at the end of each
chapter) and review the content areas specific
for the exam
Use the Jones and Bartlett Learning companion
website
REVIEW THE TEST TAKING TIPS AND
TECHNIQUES APPENDIX page 511

Where and When to

Study
Choose a quiet, distraction free
environment
Establish and follow a strict study
schedule

How to Study
Prepare yourself mentally and physically
Be organized

Organize your resources

Create a battle plan
Create a list of problem areas to focus on
Use reflections to help with this!

Get psyched!
Create and maintain a positive attitude toward
test preparation and test taking
http://dus.psu.edu/academicsuccess/studyskills.html

Test Taking Tips

Pace yourself
So that you have time to get through all
questions
bookmark questions
Do not leave any blanks

Completely read each question

Determine what you are really being asked

Test Taking Tips cont.

Separate the important information
From that which is not important

Do not read beyond the question

Use only what is given to you

Carefully read each answer

Pick the best answer offered
Even if you dont like it

Test Taking Tips cont.

Multiple multiples
1. Find an option that you know is incorrect
and cross off any of the answers that
contain it
2. Find an option that you know to be correct
and cross off any answers that do not
contain it
3. Find the remaining answer

Test Taking Tips cont.

Again, answer every question
Take practice exams
Evaluate your strengths and weaknesses
Use reflection to help with this!

Spend time studying your weak areas

Maximize Exam Prep

Time
Spend the Majority of your time studying the
most heavily tested areas:
Mechanical Ventilation of the Adult
Patient Assessment
Bedside and Advanced

Arterial Blood Gases

Oxygen and Medical Gas Therapy
Pharmacology
Airway Management

Maximize Exam Prep

Time cont.
Review the exam hints in all chapters
ABG interpretation is a must!
In order to answer mechanical ventilation
and oxygen therapy questions

Mechanical ventilation of the adult is the

most heavily questioned content.
You MUST understand mechanical
ventilation to do well on the exams

Taking the Test!

Know What to Expect

When Reporting to the
Testing Center

Arrive early
Relax before the exam
If you are more than 15 minutes late you
will have to reschedule
Bring two forms of ID
You may only bring your wallet and keys
into the testing center
You will be provided with a pencil and
scratch paper

Know What to Expect

There will be a short practice test
Once you begin, you cannot ask
questions
You are allowed to take breaks
Break time counts against your exam
time
Take the practice tests on-line at
www.nbrc.org

During the Test

Get comfortable
Answer all questions
Budget your time
Monitor your pace
Answer easy questions first
Bookmark difficult item and return to them
later
Use all the available time

Test Preparation

 the most
valuable resource
you possess is your
own ability and
determination to
succeed.
Malley, W., Clinical Blood Gases: Application and Noninvasive Alternatives , W.B.
Saunders Co., Philadelphia, PA, 1990.

Elements of an NBRC
Multiple-Choice
Question
Scenario: Brief description of the clinical

situation
Stem: The statement that asks the
question or specifies the problem
Options: Possible answers to the
question or solutions to the problem
Keyed response: The correct answer
Distracters: Wrong answers

An 80 kg adult male patient with aspiration pneumonia

receiving volume-oriented SIMV has the following ventilator
settings and blood gas results:
Mode SIMV
Vt 500 mL
Rate 12
FiO2 0.50
PEEP 5 cmH2O

pH 7.29
PaCO2 52 mmHg
HCO3- 25 mEq/L
PaO2 63 mmHg
SaO2 91%

The respiratory therapist should do which of the following

first?
A. Increase the FiO2
B. Increase the tidal volume
C. Add pressure support
D. Increase PEEP

The Scenario

Briefly describes a clinical situation that you need to assess.

Thoroughly review the scenario before even looking at the stem or options
Sometimes the scenario and stem are combined and must be reviewed together
Look for the following critical information
Look for the following information:
The location or setting (ICU, outpatient clinic, patients home)
The available resources (equipment being used or at hand)
Ventilator capable of volume SIMV
The patients general characteristics (age, size, disease process, mental status)
Adult, male, 80kg, aspiration pneumonia
Relevant objective data (ABG, PFT)
Vt may be low for weight
FiO2 is on higher end of safe range
Respiratory acidosis
Low but adequate Po2
Relevant subjective data (signs and symptoms)

The Stem
Asks the question or directs your attention.
Often contains key words or phrases that may help you
choose the correct answer
Priority: first, initially, best, priority, safest, most, least
Put a value on each option and place them in
rank order
Sequence: before, after, next
Apply procedural knowledge or logic to place
options in proper sequence
Absolutes: always, never
Find the only option that would be correct in
every case every time

The Stem

Negative polarity: not, except, contraindicated, unacceptable, avoid

Switch from being concerned with what is correct or true to what is false
Verbal associations: word or phrase in the stem that is identical or similar to a
word in the correct answer
Select the option that includes wording similar to that found in the stem
What is the key word in the sample question?
First
A priority clue directing you to choose the action most immediately needed
The primary/most severe problem is respiratory acidosis
Keyed option B increase tidal volume

Do not overanalyze!
The simplest interpretation is generally the correct one.
Anticipate the answer
Before looking at the options available
Options
Every question has 4 options

The Stem
Do not overanalyze!
The simplest interpretation is generally the correct
one.
Anticipate the answer
Before looking at the options available
Options
Every question has 4 options

The Stem
Stem Wording A
Which of the following
assessment
procedures would help
determine proper
positioning of an
endotracheal tube in
the patients trachea?

Stem Wording B
Which of the following
assessment
procedures would help
confirm proper
positioning of an
endotracheal tube in
the patients trachea?

 A tiny variation in wording makes a huge difference

A: breath sounds, capnography, tube insertion
length, esophageal detection device, CXR
B: CXR
Do not overanalyze!
The simplest interpretation is generally the correct one.

Anticipate the answer

Before looking at the options available

Options
Every question has 4 options
When you are sure of the correct
response, select it and move on
Do not panic when you encounter
questions that appear difficult or
unfamiliar to you

All exam candidates encounter dozens of these questions

Instead of getting flustered, get resourceful and use some of the following option
selection strategies
Always look for the best option not just the correct one
Two or more options may be correct but one likely is most correct in the
particular circumstances or with the specific patient described
When you are unsure of the correct option, switch from finding the right
answer to finding the wrong answer(s)
Eliminate options you know to be incorrect; each time you eliminate a
distracter, you increase your chances of answering the question correctly
When in doubt, give each option a true-false test as compared with the
stem (the true statement is usually the best answer)
Be wary of options that are totally unfamiliar to you; more often than not
unfamiliar options are distracters
If you encounter a double negative in a stem and option, remember that
it creates the equivalent positive statement
Avoid impulsively selecting an option simply because it provides correct
information as an option can provide correct information but still be the
wrong choice because it does not answer the question asked
Lets look at some more specific strategies

Which of the following is true regarding

patients in the early stages of an asthmatic
attack?
A. They all exhibit respiratory alkalosis
B. They always have moderate hypoxemia
C. They have decreased expiratory flows
D. They never respond to beta adrenergics

 Absolutes
Correct answer: C
Always, never, all, every, none, only
These key words indicate that the option has no exceptions
More often than not, options that use absolutes are false
Generally you should avoid choosing an option that must be true or
false every time without exception
You do not see this very frequently in the board exams
Some absolutes , especially this efounded in rules or standards,
may be a correct option
you must always properly identify the patient before treatment
holds without exception

A patients advance directive:

A. Is usually obtained at the time of
admission
B. Can be found in the doctors progress
notes
C. Represents a guideline, not a legal
requirement
D. Cannot be altered after it is written and
signed

 Qualifiers
Correct answer A
A qualifier is the opposite of an absolute
Usually, probably, often, generally, may,
frequently, seldom
Options that contain qualifiers usually
represent good choices
The NBRC minimizes its use of qualilfiers

An intubated patient is receiving volume control

ventilation. The patients condition has not
changed, but you observe higher peak
inspiratory pressures than before. Which of
the following is t he most likely cause of this
problem?
A. There is a leak in the patient-ventilator system
B. The endotracheal tube cuff is deflated
C. The endotracheal tube is partially obstructed
D. The endotracheal tube is displaced into the
pharynx

 Equally Plausible Options

Correct answer C
You will often see question that contain two options
that are very similar to equivalent to each other
Options A and B are equivalent because they both
represent a leak in the system
Usually when two items are very similar or
equivalent, they are distracters and should be
eliminated

Over a 3 hour period, you note that a

patients plateau pressure has remained
stable, but her peak pressure has been
steadily increasing. Which of the
following is the best explanation for this
observation?
A. The patients airway resistance has
increased
B. The patient is developing atelectasis
C. The patients compliance has decreased
D. The patient is developing pulmonary
edema

Equally Plausible Options

Correct answer A
B,C, and D all represent decreases in
compliance thus are equivalent
The odd man out is the correct answer

You are assisting with the oral intubation of an

adult patient. After the ET tube has been
placed, you note that breath sounds are
decreased on the left compared with the right
lung. What is the most likely cause of this?
A. The tip of the tube is in the right mainstem
bronchus
B. The cuff of the endotracheal tube has been
overinflated
C. The endotracheal tube has been inserted into
the esophagus
D. The tip of the tube is in the left mainstem
bronchus

 Opposite Options
Correct answer A
In general, when you encounter two options
that are opposites, chances are the correct
choice is one of the two
A and D are opposites, one of them is most
likely the correct answer
There are exceptions to this strategy

A patient receiving long-term positivepressure ventilatory support exhibits a

progressive weight gain and a reduction
in the hematocrit. Which of the following
is the most likely cause if this problem?
A. Leukocytosis
B. Chronic hypoxemia
C. Water retention
D. Leukocytopenia

Opposite Options
Correct answer C
A and D are opposites but in this case
they are distractors

In reviewing the PFT results of a 67-yearold smoker with an admitting diagnosis of

emphysema and chronic bronchitis, you
would expect which of the following
general findings?
A. Increased airway resistance and
decreased lung compliance
B. Increased airway resistance and
increased lung compliance
C. Decreased airway resistance and
decreased lung compliance
D. Decreased airway resistance and
increased lung compliance

 Duplicate Facts in Options

Correct answer B
This questions options contain two contrasting
statements: increased/decreased resistance and
increased/decreased compliance.
Identify any statement that you know is either true or
false.
If you know that patients with emphysema and
chronic bronchitis typically have increased airway
resistance you can eliminate options C and D.

When instructing a patient how to breathe

during a small-volume nebulizer drug
treatment, the respiratory therapist
coaches the patient to hold his breath at
the end of inspiration. The purpose of
this maneuver is to improve:
A. Drug delivery
B. Particle stability
C. Aerosol penetration
D. Inertial impaction

Global Options
Correct answer A
A is the most general or global alternative
B, C, and D are all factors that fall under
the broader concept of enhanced drug
delivery, making option A the best choice.

You obtain an SpO2 measurement on a

patient of 80%. Assuming this is an
accurate measure of hemoglobin
saturation, what is the patients
approximate PaO2?
A. 40 torr
B. 50 torr
C. 60 torr
D. 70 torr

 Options Constituting a Range

Correct answer B
Item writers often try to mask the correct
choice by placing it within a set of higher
and lower values.
Consider eliminating the highest and lowest
values and choosing an option in the middle.
40-50-60/70-80-90

A portable spirometer requires that you

enter the patients height in centimeters
in order to derive normal values. The
patient tells you that she is 5 feet 6
inches tall. What value would you enter
into the device?
A. 26 cm
B. 66 cm
C. 168 cm
D. 186 cm

 Math Problems
Correct answer C
66 in x 2.54
Or approximately 2 x 66 + 66 = 66+66+33 = 168
66/2.54 = 26 answer choice A is a good distracter
Use scratch paper
Ste up the problem properly
Try estimating the answer without calculating

 Do your computation twice to confirm the

answer
Many distracters are based on common
formula or computation errors, do not
immediately select an answer that
matches your calculation
If you absolutely do not know choose
from the answers in the middle

During postural drainage of the left lower

lobe, a patient complains of acute chest
pain. Which of the following would you
do?
A. Give the patient supplemental oxygen
B. Continue the treatment with the bed flat
C. Ask the nurse to administer pain
medication
D. Discontinue the treatment and monitor
the patient

The Triple S Rule

Correct answer D
If a patient gets worse while you are
giving therapy
Stop, stabilize, stay

Stop what you are doing

Stabilize the patient
Stay with the patient

A 45-year-old patient with asthma is prescribed

0.3 mL of albuterol (Proventil) in 3 mL normal
saline via small-volume nebulizer. Before
initiating therapy, you note from chart review
that the patient is severely hypertensive and
has been experiencing episodes of
supraventricular tachycardia. You should do
which of the following?
A. Administer the treatment as ordered
B. Postpone the treatment and notify the
physician
C. Dilute the albuterol with extra normal saline
D. Decrease the amount of albuterol
administered

The Triple S Rule (part 2)

Correct answer B
A corollary to the triple S rule is to never
start therapy if the patient is exhibiting
abnormal signs ir symptoms that could
be worsened by your action

A patient is admitted to the emergency

department comatose with suspected
smoke inhalation. After confirming
airway patency, which of the following
should you do first?
A. Measure the SpO2
B. Initiate 100% Oxygen
C. Obtain an arterial blood gas
D. Request a STAT chest X-ray

Act First, Ask Questions Later

Correct answer B
Obtaining additional information is
important but given that the patient is
suspected of smoke inhalation 100%
oxygen should be administered
immediately

You are called to the bedside of a patient by her

ICU nurse to check the attached volume
ventilator. You note that both the low-volume
and high-pressure limit alarms are sounding on
each breath, Your first action should be to:
A. Disconnect patient and manually ventilate with
100% oxygen
B. Call the attending physician for further patient
information
C. Check the patients chart for the original
ventilator orders
D. Ask the nurse about how recently the patient
was suctioned

Act First, Ask Questions Later

Correct answer A
B,C, and D nay help you evaluate the
problem but they waste precious time.
Your priority os patient safety

A 60-kg (132-lb) COPD patient is receiving

SIMV with a Vt of 500 mL at a rate of
9/min with an FiO2 of 0.35. Blood gases
are as follows: pH = 7.36; PaCO2 = 61
torr; HCO3- = 36 mEq/L; PaO2 = 64 torr.
Which of the following changes would
you recommend at this time?
A. Increase the IMV rate
B. Increase the FiO2
C. Maintain settings
D. Increase the Vt

 If It Aint Broke, Dont Fix It!

Correct answer C

A 30-kg (66-lb) child is being mechanically

ventilated in the SIMV mode. The following
data are available: Ventilator settings: FiO2
0.45; mandatory rate 18; total rate 23; Vt 350
mL; PEEP 12 cmH2O. Blood gases: pH 7.38;
PaCO2 42 toor; PaO2 110 torr; HCO3- 23
mEq/L, BE 0 mEq/L. Based on these data,
which of the following should you do?
A. Decrease the tidal volume
B. Reduce the PEEP
C. Decrease the rate
D. Lower the FiO2

 Back Off Bad!

Correct answer B

The following data are available for a patient:

Blood Gas Analyzer
Co-Oximeter
pH 7.35
OxyHb 97%
PaCO2 28 torr
CarboxyHb 1%
HCO3- 14 mEq/L
MetHb 1%
BE -10 mEq/L
Hb 18.8 g/dl
PaO2 40 torr
SaO2 73%
You should do which of the following?
A. Report the SaO2 value at 73%
B. Report the SaO2 value as 97%
C. Recommend administration of bicarbonate
D. Recalibrate the instruments and repeat the
analysis

Data Just Dont Jive

Correct answer D
Large discrepancy between PaO2, SaO2
and OxyHb

The results of an arterial blood gas

analysis for a patient who is breathing
100% oxygen are below: pH 7.27; PaCo2
44 torr; HCO3- 23 mEq/L; BE +1; PaO2
598 torr; SaO2 100%. Which of the
following is the likely problem?
A. Respiratory acidosis
B. Large physiologic shunt
C. Metabolic acidosis
D. Laboratory error

Errors, Errors, Everywhere!

Correct answer D
When ever you have laboratory error as
an option, always check the numbers
PaO2 is normal (use alveolar air equation)
Acid base status is impossible based on
theHenderson-Hasselbach equation

A doctor asks you to assess if a 75-kg (165-lb)

patient with a neuromuscular disorder being
mechanically ventilated in the SIMV mode is
ready for weaning. You obtain the following
data during a bedside ventilatory assessment:
spontaneous Vt 250 mL; Minute ventilation 10
L/min; Vital Capacity 750 mL; MIP -28 cm2O.
Based on thus information, which of the
following would you recommend?
A. Begin a spontaneous breathing T-piece trial
B. Postpone weaning and reevaluate the patient
C. Begin weaning using a pressure support
protocol
D. Begin weaning by decreasing the SIMV rate

Dont Know What Youre Missing!

Correct answer B
VC and MIP are borderline adequate
But Vt and VE suggest a major problem
Spontaneous rate = 10 L/min / 250 mL/breath
= 40 breaths/ minute
RSBI = 40/0.25 160
Review the numbers to see what is missing!

A surgeon orders an increase in PEEP from 6 to

10 cmH2O for a post-op patient receiving
mechanical ventilation. After you adjust the
PEEP setting, you note a rapid fall in the
patients arterial blood pressure and a rapid
rise in her heart rate. Which of the following
actions would you recommend to the surgeon?
A. Increase the FiO2 by 10%
B. Administer a vasopressor
C. Return The PEEP to 6 cmH2O
D. Obtain a STAT blood gas

 Jump Back, Jack!

Correct answer C
When things go bad, many times your action
immediately preceded things going bad
The best course of action is the reverse course and
undo what you have just done
One of the adverse effects of PEEP is decreased
cardiac output
Due to increased pleural pressure and decreased venous
return

Manual ventilation of a patient with a selfinflating bag-valve-mask device fails to

inflate the patients chest adequately.
You should do which of the following?
A. Intubate and mechanically ventilate the
patient
B. Switch to a gas-powered resuscitator
with mask
C. Reposition the patients head, neck, and
mask
D. Insert a laryngeal mask airway (LMA)

KISS It!
Correct answer C
The simplest and should be tried before
moving on to more aggressive options

When checking a ventilator, you discover

that the set PEEP level cannot be
maintained. Which of the following might
be causing this problem?
I. Leak in the tubing
II. Faulty exhalation valve
III. Leak around the airway cuff
IV. Loose humidifier connection
A. I and II
B. I and III
C. II and IV
D. I, II, III, and IV

 Gas Goes In,

Gas Comes Out
Correct answer D
You will be asked questions that ask you to
differentiate between a leak and an
obstruction
Leaks prevent pressure buildup
Obstructions cause pressure buildup

At the bedside of a patient receiving

volume-oriented mechanical ventilation,
you suddenly observe that simultaneous
sounding of the high-pressure and lowvolume alarms. Which of the following is
the most likely cause of this problem?
A. A leak in the ET tube cuff
B. A mucous plug in the ET tube
C. Ventilator circuit disconnection
D. Development of pulmonary edema

 Gas Goes In,

Gas Comes Out
Correct answer B
Obstructions can be more difficult to identify
because they can either be partial or complete
High pressure/low volume = obstruction
Low pressure/low volume = leak
B and D both cause obstruction but the one that
would arise suddenly is the mucus plug

Which of the following would facilitate

clearance of pulmonary secretions in a
patient with cystic fibrosis?
I. Mucomyst
II. Flutter valve
III. Atropiene
IV. DNase
A. I and III
B. II and IV
C. I, II, and IV
D. II, III, and IV

 Love Those Multiple Multiples!

Correct answer C

During a short pause from resuscitation of a child

in the emergency department, you cannot
palpate a carotid pulse but observe the
following rhythm on the ECG monitor (next
slide)
Which of the following actions should you take at
this time?
A. Resume cardiac compressions and ventilation
B. Discontinue compressions and monitor the
patient
C. Recommend cardioversion at 100 Joules
D. Recommend epinephrine administration

 Treat the Patient,

Not the Monitor!
Correct answer A
They will give you scenarios where the patient and
monitor data conflict
Pulse oximetry data
ECG

PEA
Remember the ECG only represents electrical activity
and a patient with no pulse requires resuscitation

A physician has ordered albuterol

(Proventil) and deoxyribonuclease
(DNase) by aerosol for a cystic fibrosis
patient who also receives postural
drainage 3 times a day. You should
administer these therapies in which of
the following sequences?
A. DNase, postural drainage, albuterol
B. Albuterol, DNase, postural drainage
C. Postural drainage, albuterol, DNase
D. DNase, albuterol, postural drainage

Keeping Order
Correct answer B
Open em up
Thin em down
Clear em out

A 90-kg (198-lb) patient is being ventilated in the

postanesthesia care unit (PACU) following upper
abdominal surgery. Ventilator settings and arterial
blood gas date are as follows:
Ventilator Settings:
Blood Gases:
Mode SIMV
pH 7.51
Vt 800 mL
PaCO2 31 torr
Set rate 14/min
HCO3- 24 mEq/L
Total rate 14/min
BE +1
FiO2 0.40
PaO2 115 torr
PEEP 5 cmH2O
SaO2 99%
You should recommend which of the following?
A. Increase the FiO2
B. Decrease the rate
C. Decrease the tidal volume
D. Discontinue PEEP

Give me a V; Give me an O!
Correct answer B
You must be able to interpret blood
gases
You must be able to differentiate between
an ventilation problem versus an
oxygenation problem

A 45-year-old 70-kg (154-lb) male with a diagnosis of

bilateral pneumonia is receiving volume-controlled
ventilation in the SIMV mode. Ventilator settings and
blood gas data are below:
Ventilator Settings:
Blood Gases:
Mode SIMV
pH 7.35
Vt 700 mL
PaCO2 345 torr
Set rate 6/min
HCO3- 23 mEq/L
Total rate 10/min
BE -1
FiO2 0.65
PaO2 55 torr
PEEP 5 cmH2O
SaO2 83%
Which of the following shoud be recommended?
A. Increase PEEP
B. Increase the rate
C. Increase the FiO2
D. Add an inspiratory plateau

 Give Me a V; Give Me an O!
Correct answer A
Hypoxemia is present so both A and C would
help
Use the 60/60 rule
PaO2 > 60 & FiO2 < 0.60 maldistribution of
ventilation = increase FiO2
PaO2 < 60 & FiO2 > 0.60 physiologic shunting =
add/increase PEEP/CPAP

A nurse tells you that his patient is

scheduled to start chest physiotherapy
four times a day this morning and that he
would like you to get started before she
goes to radiology for a CT scan. Which
of the following should you do first?
A. Auscultate and percuss the patients
chest
B. Initiate therapy after reviewing the X-ray
C. Interview the patient to obtain a history
D. Confirm the doctors order in the chart

 Whos in Charge Here?

Correct answer D

GOOD LUCK!

Resources
Scanlan et. Al. Certified Respiratory
Therapist Exam Review Guide. 2010.
Jones and Bartlett.