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Pass The RRT Board Exam https://www.rtboardexam.com The Best RRT Board Exam Preparatory Courses! Wed, 18 Dec 2019 19:32:41 +0000 en-US hourly 1 https://wordpress.org/?v=5.2.5 Five tips to pass the NBRC clinical simulation exam on the first attempthttps://www.rtboardexam.com/five-tips-to-pass-the-nbrc-clinical-simulation-exam-on-the-first-attempt/ Wed, 09 Jan 2019 19:38:34 +0000 https://www.rtboardexam.com/?p=6417 The NBRC clinical simulation exam is known as one of the most feared and difficult exams to pass of all credentialed allied health fields. In fact, almost half of all respiratory graduates fail the CSE exam on their first attempt! This can be pretty devastating for new graduates after investing so much time, money and […]

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The NBRC clinical simulation exam is known as one of the most feared and difficult exams to pass of all credentialed allied health fields. In fact, almost half of all respiratory graduates fail the CSE exam on their first attempt! This can be pretty devastating for new graduates after investing so much time, money and effort into becoming a respiratory therapist. The cost of retaking the exam, in addition to the potential lost wages these graduates realize from delaying their entrance into the workforce can be financially devastating as well.

As a test prep company devoted solely to helping respiratory students pass their credentialing exams we’ve discovered five tips we believe will help respiratory therapy graduates pass their clinical simulations on the first attempt.

Tip #1

Don’t do what your clinical preceptor did. This isn’t to say that your preceptor did the wrong thing. It just means that the NBRC hospital functions a lot differently than a real world hospital.  

respiratory therapist

Tip #2

When gathering information, if your not sure about choosing a particular test or assessment, just don’t do it! This is really important because choosing an incorrect answer actually gives you negative points! Negative points are way worse than missed points! So, the bottom line is if you don’t know what a test is, don’t select it.

Tip #3

You can order anything in the NBRC hospital. Do not shy away from ordering a chest tube or intubation. You may not be able to order such things at your hospital, however at the NBRC you can order whatever you’d like (as long as it’s indicated).

Tip #4

Do not order time consuming tests for unstable patients. This may kill your patient and your test scores. For example, if your patient is unresponsive with a heart rate of 8 bpm, do not order a chest X-ray, or ABG, or pulmonary function test. This patient needs an immediate intervention, AKA CPR!

Sloth

Tip #5

Our last tip comes from the famous wizard Gandalf from the movie Lord of the Rings. As Gandalf says “IF YOU DON’T STUDY YOU SHALL NOT PASS!” We couldn’t agree more with Gandalf. So we’ve made it easy to get started with your studies. 

Gandalf

To much to do? Not enough time? Don't know where to begin?

We help struggling RRT students who are short on time and have trouble with test taking and memorization build confidence so they can excel in class and pass their NBRC RRT Board Exams!

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Tips for passing the RRT clinical simulation examhttps://www.rtboardexam.com/tips-for-passing-the-rrt-clinical-simulation-exam/ Sat, 13 Oct 2018 12:38:10 +0000 https://www.rtboardexam.com/?p=6387 The NBRC clinical simulation exam is known as one of the most feared and difficult exams to pass of all credentialed allied health fields. In fact, almost half of all respiratory graduates fail the CSE exam on their first attempt! This can be pretty devastating for new graduates after investing so much time, money and […]

The post Tips for passing the RRT clinical simulation exam appeared first on Pass The RRT Board Exam.

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The NBRC clinical simulation exam is known as one of the most feared and difficult exams to pass of all credentialed allied health fields. In fact, almost half of all respiratory graduates fail the CSE exam on their first attempt! This can be pretty devastating for new graduates after investing so much time, money and effort into becoming a respiratory therapist. The cost of retaking the exam, in addition to the potential lost wages these graduates realize from delaying their entrance into the workforce can be financially devastating as well.

As a test prep company devoted solely to helping respiratory students pass their credentialing exams we’ve discovered five tips we believe will help respiratory therapy graduates pass their clinical simulations on the first attempt.

Tip #1

Don’t do what your clinical preceptor did. This isn’t to say that your preceptor did the wrong thing. It just means that the NBRC hospital functions a lot differently than a real world hospital.  

respiratory therapist

Tip #2

Choosing the wrong answer while gathering information will count against you more than not choosing an answer that is correct. So, the bottom line is if you don’t know what a test is, don’t select it.

Tip #3

You can order anything in the NBRC hospital. Do not shy away from ordering a chest tube or intubation. You may not be able to order such things at your hospital, however at the NBRC you can order whatever you’d like (as long as it’s indicated 🙂

Tip #4

Do not order time consuming tests for unstable patients. This may kill your patient and your test scores. For example, is unresponsive with a heart rate of 8 bpm, do not order a chest X-ray, or ABG, or pulmonary function test. This patient needs an immediate intervention, AKA CPR!

Sloth

Tip #5

We couldn’t agree more with Gandalf. The fact of the matter is, if you don’t study “YOU SHALL NOT PASS.” This applies to the clinical simulations in particular. Fortunately, we have two free practice simulations available for those ready to get started. 

Gandalf

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Waveform Analysishttps://www.rtboardexam.com/waveform-analysis/ Wed, 08 Aug 2018 17:47:25 +0000 https://www.rtboardexam.com/?p=6371 Ventilator Waveform Analysis Interpreting ventilator waveforms is an important skill to acquire before taking the NBRC RRT board exams. I’ve always been amazed at how much you can learn about your patient’s condition just by looking at the waveforms. Of course, there’s so much to know that it can be a bit overwhelming and difficult […]

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Ventilator Waveform Analysis

Interpreting ventilator waveforms is an important skill to acquire before taking the NBRC RRT board exams. I’ve always been amazed at how much you can learn about your patient’s condition just by looking at the waveforms. Of course, there’s so much to know that it can be a bit overwhelming and difficult to understand at first.

That’s why I decided to break down ventilator waveforms in a simple way, without overwhelming you with too much information.

So in this video, you will learn how to identify secretions in the airway, the need for a bronchodilator, patient triggered vs. machine triggered breaths, and if the patient is not receiving enough flow.

I hope you enjoy it, and please leave a comment below if there are any other NBRC RRT board exam review topics you’d like me to cover.

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NBRC RRT board exam changes for 2020https://www.rtboardexam.com/nbrc-rrt-board-exams-changes-for-2020/ Sun, 29 Jul 2018 17:11:45 +0000 https://www.rtboardexam.com/?p=6345 Following a job analysis review of respiratory therapy competencies, the NBRC has made adjustments to future versions of both the TMC-RRT exam and the clinical simulation (CSE) exam. These exam changes are scheduled to take effect in January, 2020. TMC RRT exam changes Beginning in January, 2020, each TMC exam will include between 2 and […]

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Following a job analysis review of respiratory therapy competencies, the NBRC has made adjustments to future versions of both the TMC-RRT exam and the clinical simulation (CSE) exam. These exam changes are scheduled to take effect in January, 2020.

TMC RRT exam changes

Beginning in January, 2020, each TMC exam will include between 2 and 5 neonatal patient items, and 3 to 8 pediatric items. Each item will include questions regarding recall, application, and analysis.

According to the NBRC horizons newsletter: “Three items will appear on each test form that engage candidates’ evaluations of ethical principles in addition to content domain and cognitive level linkages.”

 

Clinical Simulation Exam Changes

The NBRC will continue its’ practice of administering different CSE examination forms to different candidates.

However, in an effort to improve the fairness of exam content, they have decided to use the same mix of patients regardless of the exam form the candidate receives. Currently, exam candidates receive different test forms that contain different mixes of patients.

In addition, though the following conditions may be included in the current CSE exam, they will become a mandatory part of the exam beginning in January, 2020. The current CSE exam may, or may not include patients with these conditions:

  1. Asthma
  2. ARDS
  3. Infections
  4. Bronchiectasis
  5. Cystic fibrosis

 

If your ready to begin studying for the NBRC RRT clinical simulations, or simply want to take a look at how the exam functions, check out our free simulation exams.

 

 

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NBRC RRT Board Exam Reviewhttps://www.rtboardexam.com/nbrc-rrt-board-exam-review/ Sun, 22 Jul 2018 14:22:40 +0000 https://www.rtboardexam.com/?p=6288 Choosing initial ventilator settings Selecting initial ventilator settings is frequently tested on both the TMC-RRT and clinical simulation board exams. Therefore, it is crucial that respiratory therapy students have a thorough understanding of initial ventilator setting selection. Before we get started, an important concept to understand is that acceptable initial ventilator settings are different than […]

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Choosing initial ventilator settings

Selecting initial ventilator settings is frequently tested on both the TMC-RRT and clinical simulation board exams. Therefore, it is crucial that respiratory therapy students have a thorough understanding of initial ventilator setting selection.

Before we get started, an important concept to understand is that acceptable initial ventilator settings are different than the ventilator settings used when making changes. This is because when choosing initial ventilator settings we don’t yet have arterial blood gas, or lung compliance data to guide our choices.

For example, the recommended initial mandatory rate is 10 to 20 breaths per minute. However, we may increase this rate beyond 20 once we’re able to analyze arterial blood gas, airway pressures, and hemodynamic data collected while the patient is on the ventilator.

With that said, let’s review initial ventilator settings.

Mode

Students should take comfort that initial mode selection is not emphasized by the NBRC to determine if an answer is correct or not. This is probably due to the vast number of ventilator modes that exist. Also, there is no universal naming system for ventilator modes. This creates confusion as similar modes may have entirely different names depending on the manufacturer.

Furthermore, patients can be effectively ventilated using any form of volume or pressure control. As long as the tidal volume is set appropriately when using volume control (6-8 ml/kg of predicted body weight), or the inspiratory pressure is set appropriately when using pressure control (20-30 cm H2O), any of these modes will work. Therefore, modes such as A/C, SIMV, PRVC and pressure control are all acceptable initial modes of ventilation on the RRT board exam.

Modes such as high frequency oscillation and Jet ventilation are also not used as an initial mode of ventilation. CPAP delivered through an advanced airway may be used if the patient does not require ventilatory support.

Tidal volume

First, be sure to base the tidal volume on the patient’s predicted body weight (PBW). This is important because a patient’s lung capacity does not change as they gain or lose weight. Using an overweight patient’s given weight in the exam question could provide a dangerously high tidal volume. Therefore, any time the patient’s height is given in the exam question, be sure to calculate the patient’s predicted body weight.

Use 6-8 ml/kg of predicted body weight (PBW) for most patients

Use 4-6 ml/kg of predicted body weight for patients suspected of ARDS

Forumula:

PBW male: 50 + 2.3(inches tall – 60)

PBW female: 45.5 + 2.3(inches tall – 60)

Example: Calculate the predicted body weight of a 65 inch male patient

50 + 2.3(65-60)

50 + 2.3(5)

50 + 11.5

PBW = 61.5 kg

Mandatory rate

10-20 breaths/minute

An important point to keep in mind when selecting the mandatory rate is to ensure the patient receives an adequate minute ventilation. For example, if you choose a tidal volume of 400 ml and a mandatory rate of 10 breaths per minute, the minute ventilation would be only 4 LPM. This is below the recommended minute ventilation of at least 5 LPM. So when using a low tidal volume, you should also consider using a mandatory rate that is high enough to provide at least 5 LPM minute ventilation.

FiO2

Selecting the correct FiO2 can be a bit of a mystery on the RRT board exams. However, if you keep these bullet points in mind, you should be successful:

  • Try to avoid using a high FiO2 in patient’s with COPD
  • Use 100% oxygen following intubation due to emergencies.
  • If following intubation the SpO2 is 100%, you can use a lower FiO2.
  • Generally 100% is a good starting point for most patients until we can see how their SpO2 and arterial blood gases respond.

PEEP

2-6 cm H2O

If the patient is suspected of having ARDS, it is acceptable to use a therapeutic level of PEEP beginning as high as 10 cm H2O. Keep in mind, the patient’s hemodynamics should be stable to use a high PEEP.

  • Do not use a high PEEP level in patient’s with unstable cardiac function. For example, a patient who has just undergone CPR should not receive PEEP greater than 5 cm H2O.
  • If the patient was on CPAP prior to intubation, set the PEEP level the same as the CPAP level.
  • If the patient was on BiPAP prior to intubation, set the PEEP level the same as the EPAP level.

Now apply these guidelines to the following example simulation question. What would you choose?

Free NBRC clinical simulation exam

If you chose the last choice: VC, A/C ventilation, FiO2 0.60, mandatory rate 18, Vt 450 mL, PEEP 10 cm H2O you are correct!

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RRT Board Exam Questionshttps://www.rtboardexam.com/rrt-board-exam-questions/ Sat, 03 Jun 2017 20:41:33 +0000 https://www.rtboardexam.com/?p=5846 If you take the paid version of the NBRC self-assessment exam (SAE), you’ll realize a couple things pretty quickly. The first thing you will notice will probably be, wow…this is a long test. The second thing you might notice is there are a lot of pharmacology questions. I counted 23 questions in the version I took. […]

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If you take the paid version of the NBRC self-assessment exam (SAE), you’ll realize a couple things pretty quickly.

The first thing you will notice will probably be, wow…this is a long test. The second thing you might notice is there are a lot of pharmacology questions. I counted 23 questions in the version I took.

However, the most important thing you should notice is that the NBRC pharmacology exam questions bear no resemblance to the pharmacology class you took in respiratory school. For example, there was not one question on the exam regarding catecholamines, or polyvalent anions of DNA.

Despite spending long frustrating hours trying to wrap my head around this type of stuff in school, it wasn’t even on the test.

The reality is, getting down to the cellular level of pharmacology to prepare for your board exams just isn’t necessary. In fact, it’s probably a huge waste of time.

So how should you prepare for pharmacology questions?

  1. Understand what each drug does (I know this sounds simple, but it’s a huge helps rule out incorrect answers. For example, if you know what mannitol and tensilon are, you can rule them out as treatments for central sleep apnea).
  2. Understand which bronchodilators can be mixed together
  3. Understand the NBRC will purposefully not give you the answer you want.

 

Here’s a couple example practice questions to help get you on the road to earning your RRT.

Example 1: Heart rate problems

A patient in the emergency room is given 2.5 mg albuterol nebulizer to treat an acute exacerbation of asthma. The therapist notices the patient’s heart rate has increased from 65 to 90 beats/minute. The patient is still wheezing. After discontinuing the therapy, what should the respiratory therapist do next?

  1. Change to Levalbuterol (Xopenex)
  2. Decrease the dose of albuterol to 1.25 mg
  3. Change to Ipratropium bromide
  4. Give tensilon

Answer (with rationale)

  1. Best answer. Levalbuterol has less cardiac side effects as compared to albuterol, and the patient still needs a fast acting beta-2 agonist to treat his acute wheezing.
  2. Next best answer. Decreasing the dosage is a possible answer, however, only if choice A was not available.
  3. Incorrect. Ipratropium is often times a great addition to albuterol. However, it is not a good replacement for a patient having an acute exacerbation of asthma. Ipratropium takes too long to work.
  4. Incorrect. This is a good example of how simply knowing your drugs will help rule out wrong answers.


Example 2: Status asthmaticus

A patient with persistent wheezing has received three consecutive unit doses of albuterol. Peak flow measurements show some improvement. Breath sounds were initially diminished, and now reveal bilateral wheezing. What should the respiratory therapist recommend next?

  1. 10 mg/hr continuous albuterol nebulizer
  2. Ipratropium bromide
  3. Mannitol
  4. Advair

Answer (with rationale)

  1. Correct. The patient is responding to albuterol. Breath sounds that change from diminished to wheezing, indicate airflow is has increased. Just think of it this way: Some breath sounds, even if it’s wheezing, are better than no breath sounds.
  2. Incorrect. Though it would be a good addition to albuterol, ipratropium bromide should not replace albuterol during an acute asthma exacerbation.
  3. Incorrect. Mannitol is a diuretic (this is a good example of how simply knowing your drugs will help rule out wrong answers).
  4. Incorrect. Advair contains a long acting beta agonist and a corticosteroid. Neither of these are indicated to treat acute exacerbations of asthma.

If you’re ready to start practicing for your board exams, or simply want to be a better therapist, check out our fully online board exam preparatory courses. Or, sign up to our newsletter for more free tips and tricks to pass the NBRC RRT board exams!

 

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Free RRT Board Exam Practice Questions: Physical Examhttps://www.rtboardexam.com/free-rrt-board-exam-practice-questions-physical-exam/ Sun, 12 Feb 2017 20:27:54 +0000 https://www.rtboardexam.com/?p=5670 The following practice questions were developed using the new NBRC testing matrix released in 2020. The questions also mirror the content on the NBRC self- assessment exams. These questions give you immediate feedback and allow you to determine how well prepared you are for specific content on the exam. Practicing and learning at the same […]

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The following practice questions were developed using the new NBRC testing matrix released in 2020. The questions also mirror the content on the NBRC self- assessment exams.

These questions give you immediate feedback and allow you to determine how well prepared you are for specific content on the exam. Practicing and learning at the same time is a great way to prepare for the TMC-RRT exam.

 

Practice Question 1

Increased tactile fremitus is noted in the patient’s right lower lobe. Which of the following conditions would explain this?

  1. Pneumothorax
  2. Pneumonia
  3. Pleural effusion
  4. COPD

Answer

  1. Incorrect. Pneumothorax is associated with decreased fremitus due to excessive air in the pleural space.
  2. Correct. Consolidations such as pneumonia transmit vibrations very well.
  3. Incorrect. Pleural effusions lack an attached or conducting airway to transmitvibrations.
  4. Incorrect. COPD is associated with decreased fremitus due to air trapping.

 

Practice Question 2

Palpation of the patient’s trachea reveals a tracheal shift to the right side. Which of the following would most likely cause this finding?

  1. Right side atelectasis
  2. Right side pneumothorax
  3. Right side pleural effusion
  4. Left side pneumonia

Answer

  1. Correct. Lung problems inside the lung pull the trachea toward them.
  2. Incorrect. Lung problems outside the lung push the trachea away.
  3. Incorrect. Lung problems outside the lung push the trachea away.
  4. Incorrect. Lung problems inside the lung pull the trachea toward them

 

 

Practice Question 3

A patient with multiple right sided rib fractures would present with which the following findings?

  1. Dull percussion on right side
  2. See-saw chest movement
  3. Symmetrical chest expansion
  4. Flail chest

Answer

  1. Incorrect. Percussion is not assessed on a patient with broken ribs. In addition, percussion may or may not be affected depending on if the lung is affected or there is excessive bleeding.
  2. Incorrect. See-saw chest movement is a sign of diaphragm fatigue rather than chest trauma.
  3. Incorrect. Chest expansion would be asymmetrical in a patient with broken ribs.
  4. Correct. Flail chest is associated with severe chest wall trauma.

 

Practice Question 4

Auscultation of a patient’s lungs reveals coarse bilateral crackles. This is most likely due to?

  1. Secretions
  2. Pulmonary edema
  3. Pulmonary fibrosis
  4. Atelectasis

Answer

  1. Correct. Coarse crackles are associated with secretions.
  2. Incorrect. Pulmonary edema is associated with fine crackles.
  3. Incorrect. Pulmonary fibrosis is associated with fine crackles.
  4. Incorrect. Atelectasis is associated with fine crackles.

 

Practice Question 5

Auscultation of a 3-year-old child’s lungs reveals unilateral wheezing. This patient most likely has?

  1. Asthma
  2. Secretions in the airway
  3. Foreign body airway obstruction
  4. Pneumonia

Answer

  1. Incorrect. Asthma would produce bilateral wheezing.
  2. Incorrect. Secretions in the airways produce coarse crackles.
  3. Correct. A child with unilateral wheezing is highly suspicious for foreign bodyairway obstruction.
  4. Incorrect. Pneumonia would produce bronchial breath sounds.

 

Practice Question 6

Increased accessory muscle use is most often due to?

  1. Hyperventilation
  2. Increased airway resistance
  3. Increased lung compliance
  4. Poor cardiac output

Answer

  1. Incorrect. Patients can hyperventilate without increasing their accessory muscles use.
  2. Correct. Increased airway resistance is the most common cause of increased accessory muscle use.
  3. Incorrect. Increased lung compliance does not increase accessory muscle use. Decreased lung compliance may increase accessory muscle use.
  4. Incorrect. Cardiac output does not affect accessory muscle use.

 

 

Practice Question 7

Auscultation and percussion of a hemodynamically unstable patient’s left lung reveals distant breath sounds and hyperresonance. The respiratory therapist suspects a pneumothorax. What should the therapist recommend NEXT?

  1. Obtain an ABG
  2. Order a chest X-ray
  3. Needle decompression
  4. Chest tube insertion

Answer

  1. Incorrect. An arterial blood gas cannot confirm or rule out a pneumothorax.
  2. Incorrect. A chest X-ray could help confirm the presence of a pneumothorax, however, this patient needs an immediate intervention because they areunstable. A chest X-ray takes too long to obtain and would delay care of thisunstable patient.
  3. Correct. This patient is unstable and needs an immediate intervention.Needle decompression is the quickest and most appropriate intervention.
  4. Incorrect. Chest tube insertion will be needed, however, this takes too longand delays care to an unstable patient needing an immediate intervention.

 

Practice Question 8

Following endotracheal intubation, chest assessment reveals breath sounds on the left side are distant and resonant to percussion. This is most likely due to?

  1. Right mainstem intubation
  2. Left side pneumothorax
  3. Large pleural effusion
  4. Esophageal intubation

Answer

  1. Correct. Distant breath sounds on the left side following an intubation procedure is consistent with right mainstem intubation.
  2. Incorrect. Pneumothorax would be hyperresonant to percussion.
  3. Incorrect. Pleural effusions would be dull to percussion.
  4. Incorrect. There are no signs of esophageal intubation.

 

 

Practice Question 9

While auscultating voice sounds the therapist hears the soft A sound, or ahhhh, when the patient says the letter “E”. This change in sound is associated with which of the following conditions?

A. Pneumothorax
B. Pneumonia
C. Pulmonary Edema D. COPD

Answer

  1. Incorrect. Increased air does not alter voice sounds as they pass through the lungs.
  2. Correct. Pneumonia is a consolidation that alters sounds as it passes through.
  3. Incorrect. Pulmonary edema is not a consolidation and does not alter soundas it passes through.
  4. Incorrect. COPD is associated with air trapping. Air does not alter voicesounds as they pass through the lungs.

 

Practice Question 10

A patient receiving mechanical ventilation has distant breath sounds on the left side with a tracheal shift to the right. The therapist should suspect?

  1. Right mainstem intubation
  2. Left side pneumothorax
  3. Left upper lobe pneumonia
  4. Pulmonary embolus

Answer

  1. Incorrect. A right mainstem intubation would not shift the trachea.
  2. Correct. Pneumothorax causes the trachea to shift away from it.
  3. Incorrect. Unlike a pneumothorax, pneumonia occurs inside the lungs andtherefore the trachea is pulled towards the pneumonia.
  4. Incorrect. Pulmonary embolus does not cause a tracheal shift.

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