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!