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Registered Respiratory Therapist Adult Critical Care Specialist Practice Test

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RRT-ACCS
NBRC Registered Respiratory Therapist
Adult Critical Care Specialist (RRT-ACCS)
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Question: 489
A patient with community-acquired pneumonia is started on empiric antibiotic
therapy. Which of the following antibiotic regimens provides coverage for the
most common pathogens causing community-acquired pneumonia?
A. Ampicillin-sulbactam
B. Ceftriaxone
C. Levofloxacin
D. Azithromycin plus ceftriaxone
Answer: D
Explanation: Azithromycin plus ceftriaxone provides coverage for the most
common pathogens causing community-acquired pneumonia. Azithromycin
covers atypical pathogens such as Mycoplasma pneumoniae and Legionella
pneumophila, while ceftriaxone covers typical pathogens such as Streptococcus
pneumoniae.
Question: 490
Which of the following ventilator modes is most appropriate for a patient with
severe chronic obstructive pulmonary disease (COPD) and respiratory distress?
A. Assist-Control Volume Ventilation (ACVV)
B. Pressure Support Ventilation (PSV)
C. Synchronized Intermittent Mandatory Ventilation (SIMV)
D. Pressure Control Ventilation (PCV)
Answer: D
Explanation: Patients with severe COPD and respiratory distress often require a
ventilator mode that allows for adequate time for exhalation and minimizes air
trapping. Pressure Control Ventilation (PCV) provides control over inspiratory
pressure and allows for longer expiratory times, making it suitable for patients
with COPD.
Question: 491
A 70-year-old female with a history of chronic heart failure presents to the
emergency department with acute worsening of dyspnea, orthopnea, and
bilateral lower extremityedema. On physical examination, she has elevated
jugular venous pressure, crackles on lung auscultation, and hepatomegaly.
Which of the following is the most likely diagnosis?
A. Acute exacerbation of chronic obstructive pulmonary disease (COPD)
B. Pulmonary embolism
C. Acute respiratory distress syndrome (ARDS)
D. Acute decompensated heart failure
Answer: D
Explanation: The patient's history of chronic heart failure, acute worsening of
dyspnea, orthopnea, bilateral lower extremity edema, elevated jugular venous
pressure, crackles on lung auscultation, and hepatomegaly are highly suggestive
of acute decompensated heart failure. Acute decompensated heart failure occurs
when there is an acute exacerbation of heart failure symptoms, leading to fluid
accumulation in the lungs (pulmonary edema) and peripheral edema.
Question: 492
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with a high positive end-expiratory pressure (PEEP)
strategy. Which of the following is a potential benefit of high PEEP in this
patient?
A. Reduced risk of barotrauma
B. Improved cardiac output
C. Decreased pulmonary vascular resistance
D. Enhanced alveolar recruitment
Answer: D
Explanation: One potential benefit of using a high positive end-expiratory
pressure (PEEP) strategy in a patient with acute respiratory distress syndrome
(ARDS) is enhanced alveolar recruitment. High PEEP levels help maintain
lung volume during expiration, preventing alveolar collapse and promoting
lung recruitment. This can Improve oxygenation and increase the surface area
available for gas exchange.
Question: 493
When assessing a patient's pulmonary function testing flow-volume curve, what
indicator would suggest that the patient may have coughed during the first
second of exhale during one of the trials?
A. A jagged interruption or dip in the curve during exhale
B. A steep slope of the line during the expiratory phase of the maneuver
C. An unusually high value for FVC1
D. A diminished value for FVC1
Answer: A
Explanation: If a patient coughs during the first second of exhale, it can lead to
a jagged interruption or dip in the flow-volume curve during that time period.
Coughing can cause a sudden decrease in airflow, resulting in an abnormal
pattern in the curve. Therefore, option A is the correct indicator to suggest
coughing during the exhalation phase of the maneuver. Options B, C, and D are
not directly related to coughing during the first second of exhale and can be
considered incorrect choices in this scenario.
Question: 494
A patient with neuromuscular disease requires long-term mechanical
ventilation. Which of the following ventilator modes is most appropriate for
supporting respiratory muscle function and reducing the risk of ventilator-
induced diaphragmatic dysfunction?
A. Assist-control ventilation (ACV)
B. Pressure support ventilation (PSV)
C. Synchronized intermittent mandatory ventilation (SIMV)
D. Proportional assist ventilation (PAV)
Answer: D
Explanation: Proportional assist ventilation (PAV) is the most appropriate
ventilator mode for supporting respiratory muscle function and reducing the
risk of ventilator-induced diaphragmatic dysfunction in a patient with
neuromuscular disease. PAV uses sophisticated algorithms to assist the
patient's spontaneous breaths in proportion to their effort. It provides
personalized support to match the patient's respiratory drive, promoting
diaphragmatic function and improving patient-ventilator synchrony.
Question: 495
Which of the following is an appropriate target range for mean arterial pressure
(MAP) in patients with septic shock?
A. 40-50 mmHg
B. 60-70 mmHg
C. 80-90 mmHg
D. 100-110 mmHg
Answer: B
Explanation: A target range of 60-70 mmHg for mean arterial pressure (MAP)
is appropriate in patients with septic shock. Septic shock is characterized by
systemic vasodilation and hypotension, leading to inadequate tissue perfusion.
Maintaining an adequate MAP is essential to ensure organ perfusion and
oxygen delivery. A target range of 60-70 mmHg is generally recommended in
septic shock, although individual patient factors and comorbidities may
influence the specific target.
Question: 496
A 40-year-old female with a history of asthma presents to the emergency
department with acute dyspnea and wheezing. She has been using her albuterol
inhaler every 4 hours without significant relief. Her initial peak expiratory flow
rate (PEFR) is 40% of her predicted value. Which of the following is the most
appropriatenext step in managing this patient?
A. Administer a short-acting anticholinergic inhaler (e.g., ipratropium bromide)
B. Administer intravenous magnesium sulfate
C. Initiate continuous nebulized albuterol therapy
D. Administer systemic corticosteroids (e.g., prednisone)
Answer: D
Explanation: The patient's presentation with acute dyspnea, wheezing, and poor
response to short-acting bronchodilators suggests a severe exacerbation of
asthma. The most appropriate next step in management is to administer
systemic corticosteroids (option D) to reduce airway inflammation and improve
symptoms. Systemic corticosteroids are recommended early in the treatment of
severe asthma exacerbations. Administering a short-acting anticholinergic
inhaler (option A) such as ipratropium bromide can be considered as an
adjunctive therapy to bronchodilators but is not the initial step. Intravenous
magnesium sulfate (option B) is also an adjunctive treatment option for severe
asthma exacerbations but is not the first-line intervention. Continuous nebulized
albuterol therapy (option C) may be used in severe exacerbations that do not
respond to intermittent nebulized therapy, but systemic corticosteroids are the
priority.
Question: 497
Which of the following is a potential complication of central venous catheter
insertion?
A. Arterial puncture
B. Hypernatremia
C. Hypoglycemia
D. Increased platelet count
Answer: A
Explanation: Arterial puncture is a potential complication of central venous
catheter insertion. Central venous catheterization involves accessing a large
vein, such as the internal jugular, subclavian, or femoral vein, for various
indications, including monitoring central venous pressure, administering
medications, or obtaining blood samples. However, inadvertent arterial
puncture can occur during the procedure, leading to bleeding and hematoma
formation. Proper technique, real-time ultrasound guidance, and knowledge of
vascular anatomy can help minimize the risk of arterial puncture during central
venous catheter insertion.
Question: 498
A 70-year-old male presents with acute-onset confusion, fever, and neck
stiffness. On physical examination, he has nuchal rigidity, positive Kernig's
sign, and a petechial rash. What is the most likely diagnosis?
A. Meningitis
B. Subarachnoid hemorrhage
C. Migraine headache
D. Rocky Mountain spotted fever
Answer: D
Explanation: The most likely diagnosis in this patient is Rocky Mountain
spotted fever (RMSF). RMSF is a tick-borne infectious disease caused by the
bacterium Rickettsia rickettsii. It typically presents with acute-onset fever,
headache, myalgias, and a characteristic petechial rash. Neurologic
manifestations can occur and may include confusion, neck stiffness, and
meningeal signs such as nuchal rigidity and positive Kernig's sign. Meningitis
may present with fever, confusion, and neck stiffness, but the petechial rash is
more specific to RMSF. Subarachnoid hemorrhage would not typically cause
confusion or a petechial rash. Migraine headache would not present with fever,
neck stiffness, or a petechial rash. Therefore, option D, Rocky Mountain
spotted fever, is the most likely diagnosis.
Question: 499
A patient with severe respiratory distress is receiving mechanical ventilation.
The arterial blood gas (ABG) results show a pH of 7.28, PaCO of 58 mmHg,
2
and PaO of 70 mmHg. Which of the following ventilator settings should be
2
adjusted to Improve oxygenation?
A. Increase the FiO 2
B. Increase the respiratory rate
C. Decrease the tidal volume
D. Decrease the PEEP
Answer: A
Explanation: To Improve oxygenation in a patient with severe respiratory
distress, increasing the fraction of inspired oxygen (FiO ) is the appropriate
2
intervention. It helps increase the oxygen concentration delivered to the
patient's lungs and subsequently improves the arterial oxygen partial pressure
(PaO ).
2
Question: 500
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with a high positive end-expiratory pressure (PEEP)
level. The respiratory therapist is concerned about the risk of ventilator-
associated pneumonia (VAP). Which of the following interventions should the
therapist implement to reduce the risk of VAP?
A. Change the ventilator circuit every 24 hours.
B. Perform routine oral care with an antiseptic solution.
C. Administer prophylactic antibiotics.
D. Increase the fraction of inspired oxygen (FiO ).
2
Answer: B
Explanation: To reduce the risk of ventilator-associated pneumonia (VAP) in a
patient receiving mechanical ventilation, the respiratory therapist should
implement routine oral care with an antiseptic solution. Maintaining good oral
hygiene helps reduce the colonization of bacteria in the oropharynx, which can
contribute to the development of VAP. Changing the ventilator circuit every 24
hours is a common practice but is not the most effective intervention for
preventing VAP. Administering prophylactic antibiotics is not recommended as
a routine measure for VAP prevention. Increasing the fraction of inspired
oxygen (FiO ) is not directly related to VAP prevention.
2
Question: 501
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with a tidal volume of 6 mL/kg of predicted body
weight (PBW). Which of the following is an appropriate strategy to minimize
ventilator-induced lung injury (VILI) in this patient?
A. Increasing the respiratory rate
B. Decreasing the positive end-expiratory pressure (PEEP)
C. Limiting the plateau pressure to less than 30 cmH O
2
D. Administering inhaled bronchodilators
Answer: C
Explanation: To minimize ventilator-induced lung injury (VILI) in a patient
with ARDS, it is important to limit the plateau pressure to less than 30 cmH O.
2
High plateau pressures can lead to barotrauma and further lung injury, so
keeping them within a saferange is crucial.
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