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2025 TMC PRACTICE LATEST EXAM ACTUAL
QUESTIONS AND CORRECT ANSWERS|A
GRADED 202 5 - 2026
A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with
- ANSWER>>heart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? - ANSWER>>Needle aspirate the 2nd left intercostal space All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT - ANSWER>>using a low residual volume, low compliance cuff A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend - ANSWER>>deep breathing & coughing to clear secretions A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? - ANSWER>>IPPB A healthy adult female can exhale what portion of her forced vital capacity in the first second? -
ANSWER>>70%
A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time?
- Tidal volume
- respiratory rate
- inspiratory flow
- sensitivity - ANSWER>>1, 2, and 3 only Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? - ANSWER>>insert a chest tube Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. - ANSWER>>5.0 vol % A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance? - ANSWER>> mL/cm H2O Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 76%. Which of the following would be most appropriate at this time? - ANSWER>>Reintubation Which of the following patients would most likely benefit from pressure support ventilation? - ANSWER>>A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min.
The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to - ANSWER>>apply pressure to the site A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? - ANSWER>>elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - ANSWER>>5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes? - ANSWER>>air leak around the sensor A patient on the general medical ward receives oxygen via 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? - ANSWER>>55 L/min Which of the following measurements is most indicative of congestive heart failure? - ANSWER>>pulmonary capillary wedge pressure of 30 mmHg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for - ANSWER>>10 seconds or longer A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT - ANSWER>>hypoxemia
What size endotracheal tube would be appropriate for an adult female patient? - ANSWER>>7.0 to 7.5 mm The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should - ANSWER>>initiate an expiratory hold just prior to the next ventilator-delivered breath. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PCWP 4 mm Hg PAP (mean) 8 mm Hg CVP 2 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend - ANSWER>>IV fluid challenge What is the primary advantage of volume-controlled ventilation as compared to pressurecontrolled ventilation? - ANSWER>>VC provides a constant minute ventilation Bronchial breath sounds heard over the lung periphery indicate - ANSWER>>lung consolidation During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25- 75 81% of predicted. How should the respiratory therapist interpret these results? - ANSWER>>Normal lung function
While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding?
- Pneumothorax
- Pleural effusion
- Pneumonia
- Atelectasis - ANSWER>>2, 3, and 4 only Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as - ANSWER>>a persistent bronchopleural fistula A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? - ANSWER>>obtain an ABG A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from - ANSWER>>myocardial infarction A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? - ANSWER>>bronchial provocation Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend - ANSWER>>antibiotic therapy
A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? - ANSWER>>enough to achieve a pressure of 25-35 cm H2O All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT - ANSWER>>pulmonary hypertension Which of the following factors are determinants of cardiac output? - ANSWER>>stroke volume and heart rate The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 10 mEq/L; SaO2 95%; BE - 15 mEq/L. The respiratory therapist should recommend - ANSWER>>administering sodium bicarbonate. The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request? - ANSWER>>decelerating An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is - ANSWER>>ventilation/perfusion mismatch A 16 year-old patient with cystic fibrosis attends high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient?
ANSWER>>Vibratory/oscillatory PEP
following should be recommended for management of this patient? - ANSWER>>regular coughing and deep breathing The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is - ANSWER>>placing the syringe in an ice bath Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? - ANSWER>>increased fremitus A spontaneous breathing trial is initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 40 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient's vital signs remained stable throughout the trial. Which of the following is the most appropriate recommendation? - ANSWER>>extubate the patient After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include
- bronchospasm.
- pneumothorax.
- pulmonary hemorrhage. - ANSWER>>1, 2 and 3 A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? - ANSWER>>Head down, patient prone with a pillow under hips A 72 year-old female post stem cell transplant patient in the ICU complains of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray.
The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? - ANSWER>>moderate heart failure Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? - ANSWER>>Endobronchial intubation The respiratory therapist performs the quality control procedures for the blood gas analyzer in the NICU and notices a single data point that is 3 standard deviations from the mean value for the pH electrode. The therapist should - ANSWER>>perform another control run A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation?
- Increase the pressure limit
- Increase the sensitivity
- Increase the mandatory rate
- Decrease the inspiratory time - ANSWER>>1 and 3 only A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient?
- ANSWER>>lung expansion therapy A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to
All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT A. minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. B. minimal leak technique allows a small leak at the end of inspiration. C. at minimal occlusion volume, air leakage around the tube cuff should cease. D. cuff pressure should not exceed 35 cm H2O in order to allow circulation to tracheal mucosa. - ANSWER>>A A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated every - ANSWER>>8 hours A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might account for these readings? - ANSWER>>The ventilator circuit has become disconnected. A patient has mild stridor immediately after extubation. This finding is most often associated with - ANSWER>>upper airway obstruction A patient who suffered multiple trauma in a car accident receives oxygen via nasal cannula at 2 L/min. Vital signs are: heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mm Hg. The pulse oximeter reads 78%. Which of the following should the respiratory therapist recommend to maximize the patient's FIO2? - ANSWER>>Non-rebreathing mask at 15 L/min The primary reason for the use of respiratory care protocols is to - ANSWER>>standardize provision of care What is normal urine output in an adult patient? - ANSWER>>40 mL/hr
A patient with a closed head injury has had a cuffed tracheostomy tube in place for several weeks. The physician wishes to decannulate the patient but maintain the patency of the stoma for secretion removal. Which of the following devices would facilitate this request? - ANSWER>>Tracheostomy button A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of antibiotics as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? - ANSWER>>flexible bronchoscopy A 60 kg (132 lb) female patient with congestive heart failure receives NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as - ANSWER>>hyperoxygenation Which of the following physiologic values would be present in a patient who has proper fluid balance? - ANSWER>>CVP between 3 and 6 mmHg The respiratory therapist prepares to assist with bronchoscopy for a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT - ANSWER>>the patient's extrinsic PEEP levels will increase. Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? - ANSWER>>chronic bronchitis A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist could recommend all of the following
A pulse oximeter provides an accurate indication of a patient's oxygenation status in which of the following situations? 1. Polycythemia
- Pulmonary hypertension
- Congestive heart failure
- Carbon monoxide poisoning - ANSWER>>1,2 & 3 only What increase in FEV1 during post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern? - ANSWER>>12% and 200 mL A patient with a history of asthma presents to the ED in severe respiratory distress with increased accessory muscle use. Vital signs are: heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating - ANSWER>>albuterol A patient in the ICU is ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient's SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should - ANSWER>>decrease the inspiratory pressure An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask? - ANSWER>>16 L/min Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? - ANSWER>>Silverman score While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient? - ANSWER>>reduce the dose of albuterol
The respiratory therapist prepares to assist with the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend? - ANSWER>>Succinylcholine A patient receiving mechanical ventilation has a capnometer in-line at the Y- connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should - ANSWER>>reattach the patient to the circuit A 28 year-old female has been admitted through the ED with suspected CO poisoning. She receives oxygen by non-rebreather mask at 10 L/min. Upon entering the patient's room, the respiratory therapist notes that the reservoir bag of the mask collapses during inspiration. This is most likely the result of - ANSWER>>insufficient flow to the reservoir bag. Pre- and post-bronchodilator spirometry is performed on a patient and yields the following results: Pre-Bronchodilator (% predicted) FVC 82 FEV1 46 FEF200-1200 51 FEF 25-75 49 MVV 65 Post-Bronchodilator (% predicted) FVC 83 FEV1 66 FEF200-1200 68 FEF 25-75 70 MVV 75
While providing education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT A. liquid oxygen burns when refilling portable tanks. B. how to properly secure oxygen cylinders for transport. C. use of grounded 3-prong outlets for electrical equipment. D. emergency procedure to deal with gas explosions. - ANSWER>>D A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the - ANSWER>>pulmonary artery During review of the medical record prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do?
- Perform ABG as normal.
- Refuse to perform the ABG.
- Hold pressure on the puncture site for a longer time after sample is collected.
- Recommend that an ABG should be performed on the patient only if absolutely necessary. - ANSWER>>2 and 4 only The respiratory therapist assists with elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST? - ANSWER>>replace the manual resuscitation bag decrease inspiratory time - ANSWER>>During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: What action should the therapist take?
A patient receives CPAP at 10 cm H2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur? 1. Excess water will rain out
- Humidity deficit will occur
- Relative humidity will decrease
- Relative humidity will remain 100% - ANSWER>>1 and 4 only While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the - ANSWER>>peak flow meter is clogged The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist's first action should be to - ANSWER>>check the exhalation valve The respiratory therapist should recommend home apnea monitoring for infants with all of the following situations EXCEPT A. preterm infant with significant apnea periods. B. sibling of a SIDS baby. C. APGAR scores of 4 and 6 at delivery. D. a history of snoring. - ANSWER>>C A patient being evaluated in the Pulmonary Clinic reports that he smoked a pack and a half of cigarettes (30 cigarettes) per day for 20 years. How should the respiratory therapist describe the patient's smoking history? - ANSWER>>30 pack- years Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at
