NBRC Board Exam Practice Problem

RT Jaime
Apr 10, 2022
2 min read

Hey there! Welcome to the RTRC! So in this blog post I will go through a Ventilator Titration and Clinical Scenario. These types of problems are all over the board exam to gain your RRT credential. Now, I will start by saying, that all exams have components of content (knowing), and strategy (knowing what THEY want you to know.) These problems are designed to better prepare new grad RT's in clinic, but may also be useful in familiarizing yourself with the NBRC board exam. I do not go over test taking strategies though, that is a separate beast. So, let's begin!

1. You are taking care of a 78 y/o male patient in the ED who was just intubated for hypoxemic respiratory failure. This patient has a medical history of hypertension, diabetes, and dementia. You ask the family if the patient has any history of pulmonary disease, and they say he doesn’t. The patient is moderately sedated and riding the vent. You set the patient up on ACPC FiO2 50%, RR 12, PC 15, PEEP 8, I-time 0.9s. You draw an ABG 30 minutes later and the gas is the following.

ABG: pH, PaCO2, PaO2, HCO3-

ABG: 7.3, 50, 78, 23

List any changes you would make to the ventilator according to this ABG and explain why you chose to make those changes.

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1.Answer

A. Okay, so in this synopsis the important information you should gather is that this patient has otherwise healthy lungs. So, this is a good thing for us and one less issue for the patient as a whole.

B. This ABG is an uncompensated respiratory acidosis with mild hypoxemia. Mild Hypoxemia based on the textbook. However, any PaO2 value above 60 mmHg in an actual ICU is acceptable and doesn’t require any oxygenation intervention due to the oxyhemoglobin dissociation curve.

C. Okay, so if we are in ACPC in order to fix a respiratory acidosis we would increase either the PC up from 15 or the RR up from 12 bpm. Making either of these changes will increase the patient’s minute ventilation, which will blow off PaCO2. When you make changes to the ventilator, it is important to only make one change at a time, then get a follow-up gas to make sure you landed in the right spot. This helps prevent overshooting your goals and then having to backtrack.