TMC EXAM C 140 QUESTIONS WITH VERIFIED ANSWERS 2023/2024 GUARANTEED SUCCESS, Exams of Nursing

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TMC EXAM C 140 QUESTIONS WITH

VERIFIED ANSWERS 2023/

GUARANTEED SUCCESS

a. manual dexterity Correct Answer: The respiratory therapist should evaluate which of the following to develop a teaching plan for a patient who will be using a small volume nebulizer at home? a. manual dexterity b. highest grade level achieved in school c. spousal support d. English speaking proficiency d. bronchoscopy Correct Answer: Which of the following would be most beneficial in resolving microatelectasis? a. chest tubes b. percutaneous ventilation c. thoracentesis d. bronchoscopy b. oropharyngeal airway Correct Answer: A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should recommend a(n) a. double-lumen endobronchial tube b. oropharyngeal airway c. bite block d. nasopharyngeal airway d. Run 2 only Correct Answer: Quality control material has published values for pH of 7.20, PO2 of 65 mmHg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results are as follows: Run 1: pH 7.19, PO2 64 Run 2: pH 7.10, PO2 69 Run 3: pH 7.21, PO2 65 Which quality control run(s) indicate the machine is out of control? a. Run 1 and 2 b. Run 2 and 3

c. Run 3 only d. Run 2 only a. ABG and alveolar oxygen tension Correct Answer: A respiratory therapist is considering a patient's readiness to wean from mechanical ventilation. To determine the A-aDO2, the therapist will need which of the following? a. ABG and alveolar oxygen tension b. VD/VT and PAO c. CaO2 and PAO d. VD/VT and ABG c. heliox therapy Correct Answer: A patient with increased airway resistance from a fixed upper airway obstruction would benefit most from which of the following? a. bronchodilator therapy b. epinephrine c. heliox therapy d. aerosolized atropine d. inspiratory muscle strength Correct Answer: Evaluating MIP (maximum inspiratory pressure) is most useful in evaluating which of the following? a. presence of a restrictive pulmonary defect b. effectiveness of cough c. presence of obstructive pulmonary defect d. inspiratory muscle strength b. excess water in the tubing Correct Answer: An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? a. poorly calibrate analyzer b. excess water in the tubing c. low flow through the jet orifice d. leak in the tubing a. examine the ventilator circuit for proper connections Correct Answer: During a preoperational test of the ventilator with a test lung, the respiratory therapist notes a return tidal volume of 600 cc. Ventilator settings are: Mode: Assist/control FiO2: 0. Mandatory rate: 10 VT: 750 mL What action should the therapist take? a. examine the ventilator circuit for proper connections b. obtain a larger test lung c. increase the set tidal volume to 900 mL d. obtain a smaller test lung

d. change the fuel cell Correct Answer: During the preoperational test of the ventilator, the respiratory therapist notices the galvanic analyzer on the ventilator is reading erroneously low. Which of the following can the respiratory therapist do to correct the problem? a. replace the analyzer batteries b. replace the electrolyte solution in the analyzer c. tag the ventilator as non-functional and avoid placing it in service d. change the fuel cell b. poor hand washing among staff Correct Answer: Which of the following is most likely to increase nosocomial infection in a hospital? a. use of an HME for 48 hours b. poor hand washing among staff c. frequent disconnection in the ventilator circuit d. use of alcohol-based hand cleaners b. disconnected thermistor line Correct Answer: While monitoring a patient receiving mechanical ventilation, the respiratory therapist notices the low-pressure and low exhaled volume alarms are sounding. Which of the following could be the cause? a. kinked endotracheal tube b. disconnected thermistor line c. excess water in the inspiratory limb of the circuit d. herniated endotracheal tube cuff a. a fracture in the plastic wye Correct Answer: A patient receiving positive pressure ventilation has a low-pressure alarm sounding. Which of the following could be the cause? a. a fracture in the plastic wye b. herniated cuff c. excess secretions in the airway d. kinked ET tube a. provide manual ventilation Correct Answer: The high pressure alarm is sounding on a patient receiving volume controlled ventilation. The respiratory therapist should FIRST a. provide manual ventilation b. suction the patient c. observe the alarm panel to determine source d. cancel the alarm d. Anectine (succinylcholine chloride) Correct Answer: Which of the following medications is shown to have sufficient affect when facial muscle twitching is observed? a. Halcion b. Curare (d-turbo curare) c. Romazicon d. Anectine (succinylcholine chloride) d. respirometer Correct Answer: A respiratory therapist is preparing to measure SVC on a patient in the emergency department. Which of the following equipment is required?

a. Collins water-seal spirometer b. Geissler tube c. Wheatstone bridge d. respirometer b. pressure manometer Correct Answer: A respiratory therapist is asked to determine a patient's inspiratory muscle strength. Which of the following equipment is required for this evaluation? a. Fleischpneumotrachometer b. pressure manometer c. respirometer d. peak flow meter b. peak flow meter Correct Answer: A respiratory therapist is ordered to do a bedside assessment of the effectiveness of a bronchodilator on a patient with an acute asthmatic episode. Which of the following equipment will be needed to perform this evaluation? a. maximum inspiratory pressure manometer b. peak flow meter c. Collins water-seal spirometer d. respirometer a. 25/8 mmHg Correct Answer: Which of the following pressures is most consistent with a normal pulmonary artery pressure (PAP)? a. 25/8 mmHg b. 12/8 mmHg c. 120/80 mmHg d. 25/4 mmHg d. change to an 80%/20% heliox mixture Correct Answer: A patient receiving heliox therapy at 70%/30% mixture by non-rebreathing mask has the following arterial blood gas results: pH 7.35 / PaCO2 45 / PaO2 110 / HCO3 24 / BE 0 Which of the following actions is appropriate? a. change to a heliox mixture of 60%/40% b. discontinue heliox therapy c. switch to a partial rebreathing mask d. change to an 80%/20% heliox mixture c. use an air-entrainment mask set at 28% Correct Answer: A COPD patient complains of shortness of breath while exercising with a 2 L/min nasal cannula. During exercise, SPO2 is noted to fall to 84%. Which of the following would be most helpful to the patient during exercise? a. decrease flow to 1 L/min nasal cannula b. avoid exercising c. use an air-entrainment mask set at 28% d. use a non-rebreathing mask

a. place the patient on a non-rebreathing mask Correct Answer: A patient in the emergency room is receiving oxygen by nasal cannula at 3 L/min. Blood gases reveal the following: pH 7.53 / PaCO2 30 / PaO2 51 / HCO3 23 / BE - 1 The respiratory therapist should immediately a. place the patient on a non-rebreathing mask b. decrease flow to 1 L/min c. increase flow to 5 L/min d. place the patient on a Venturi mask at 40% d. increase PEEP to 22 cmH2O Correct Answer: An 80-kg (176-lb) female patient is receiving mechanical ventilation on the following settings: Mode: assist/control Mandatory rate: 14/min Total rate: 14/min VT: 550 mL FiO2: 0. PEEP: 20 cmH2O ABG: pH 7.38 / PaCO2 42 / PaO2 62 / HCO3 26 / BE + The respiratory therapist should a. increase the FIO2 to 0. b. order a chest radiograph c. increase FiO2 to 1. d. increase PEEP to 22 cmH2O b. increase flow to 15 L/min Correct Answer: A patient is showing signs of respiratory distress with a respiratory rate to 30/min and a spontaneous tidal volume of 800 mL. The patient is receiving oxygen at 60% by large volume nebulizer with the flow set at 10 L/min. The respiratory therapist should suggest to a. increase FiO2 to 1.0 and the flow to 15 L/min b. increase flow to 15 L/min c. sedate the patient d. decrease the FiO2 to 0. d. decrease inspiratory time Correct Answer: The physician orders a change in I:E ratio from 1: to 1:4 for a COPD patient receiving volume-cycled mechanical ventilation. Which of the following accommodates the physician's request if the mandatory rate is not changed? a. increase the inspiratory time b. decrease the inspiratory flow rate c. decrease expiratory time d. decrease inspiratory time

a. autoPEEP Correct Answer: For a patient receiving volume-controlled ventilation in the assist/control mode, the starting of the inhalation cycle before the expiratory flow rate returns to zero would result in which of the following? a. autoPEEP b. atelectasis c. alveolar collapse d. decreased FRC c. epinephrine Correct Answer: While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? a. Heparin b. atropine c. epinephrine d. cold normal saline d. Bodai adapter Correct Answer: A respiratory therapist is asked to assist a physician with a bronchoscopy procedure on a patient who is ventilator dependent and requires high levels of PEEP. Which of the following equipment should be used? a. closed in-line suction catheter b. manual PEEP valve c. Magill forceps d. Bodai adapter b. reduce future treatment dosage to 0.25 mL Correct Answer: A patient receiving 0.5 mL Albuterol by small volume nebulizer complains of tingling fingers, nervousness, and heart palpitations. The therapist should a. decrease dosage to 0.15 mL b. reduce future treatment dosage to 0.25 mL c. have the patient pause at the top of each breath d. instruct the patient in performing shallow inspirations a. cancerous mass in the lung Correct Answer: For which of the following is the respiratory therapist observing if obtaining a series of oblique chest radiographs? a. cancerous mass in the lung b. pneumonia c. pneumothorax d. pleural effusion d. mass in the left lobe Correct Answer: A spiral CT scan would be most helpful in evaluating which of the following? a. atelectasis b. asbestosis c. pneumonia d. mass in the left lobe

b. decrease tidal volume Correct Answer: A 65-kg (143-lb) patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode: assist/control Mandatory rate: 10/min VT: 700 mL FiO2: 0. pH 7.48 / PaCO2 33 / PaO2 98 / HCO3 24 / BE 0 Which of the following actions is most appropriate? a. increase tidal volume b. decrease tidal volume c. decrease FiO d. decrease mandatory rate b. increase alveolar ventilation Correct Answer: A patient is undergoing a full cardiopulmonary arrest. The patient is intubated and is being monitored with an infrared capnographic device. PetCO2 data is showing 3%. Which of the following is most appropriate? a. obtain PaCO2 by a Douglas bag b. increase alveolar ventilation c. recalibrate the capnometer d. clean the infrared device c. ET tube markings at the lips Correct Answer: Which of the following can be examined to initially determine the approximate position of the oral endotracheal tube? a. chest radiograph b. lateral neck radiograph c. ET tube markings at the lips d. diaphragmatic excursion a. radiologist reports the ET tube is 1 inch above the carina Correct Answer: Which of the follow data, if observed, would indicate proper positioning of an oral endotracheal tube? a. radiologist reports the ET tube is 1 inch above the carina b. end of ET tube 2 cm below the aortic knob c. end of ET tube is 6 cm above the carina d. poor left chest symmetry d. racemic epinephrine Correct Answer: A child has been extubated and is demonstrating mild stridor. Which of the following agents would be most helpful to administer by aerosol? a. albuterol b. Atropine c. Aminophylline d. racemic epinephrine

b. ventilator circuit bronchoscopy adapter Correct Answer: A respiratory therapist is asked to assist a physician for a diagnostic bronchoscopy on a mechanically ventilated patient. What special equipment should be brought to the room? a. laryngoscope and blade b. ventilator circuit bronchoscopy adapter c. ventilator circuit endotracheal tube wedge d. Wrights respirometer d. stroke volume Correct Answer: Which of the following data is needed to calculate cardiac output? a. VO b. QS/QT c. A-aDO d. stroke volume c. IC Correct Answer: Which of the following volumes is being observed when a patient is using a volume-type incentive spirometer? a. ERV b. TLC c. IC d. IRV b. cystic fibrosis Correct Answer: For which of the following conditions is chest wall oscillation therapy most beneficial? a. ARDS b. cystic fibrosis c. drug overdose d. Guillain-Barre syndrome a. hemoglobin Correct Answer: Which of the following is needed to determine C(a-v)O2? a. hemoglobin b. VD/VT c. PvO d. PaO c. combined metabolic and respiratory acidosis Correct Answer: Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7.10 / PaCO2 52 / PaO2 65 / HCO3 15 / BE - 9 Which of the following represents an accurate interpretation of these results? a. metabolic compensated respiratory acidosis b. metabolic acidosis c. combined metabolic and respiratory acidosis d. respiratory acidosis

a. report the problem to the supervisor Correct Answer: In spite of repeated attempts, a respiratory therapist is unable to obtain successful quality control values on a blood gas analyzer. The therapist should a. report the problem to the supervisor b. continue running quality control samples c. inform the medical director d. place the machine in service but monitor closely b. change the electrode Correct Answer: A therapist is unable to obtain a reading with a galvanic-type oxygen analyzer when attempting to measure oxygen percentage inside an isolette while the red warning flag is active. The therapist should? a. replace the batteries b. change the electrode c. discontinue the red-flag warning system d. replace the electrolyte solution b. administer 2 units of blood Correct Answer: Four hours after a quadruple coronary artery bypass graft, a patient's blood pressure is 90/50 mmHg and the patient is ashen in color. The following data is also available: PAP: 10 mmHg PCWP: 5 mmHg CVP: 1 mmHg The patient could benefit most from which of the following? a. adminster normal saline, IV b. administer 2 units of blood c. an echocardiogram d. Lasix (furosemide) a. decrease EPAP only Correct Answer: A patient is receiving non-invasive positive pressure ventilation by mask with an IPAP of 16 cmH2O and an EPAP of 8 cmH2O. Corresponding blood gas data is as follows: pH 7.29 / PaCO2 51 / PaO2 108 / HCO3 24 / BE 0 Which adjustment is most appropriate? a. decrease EPAP only b. increase IPAP and EPAP c. increase IPAP only d. decrease EPAP and IPAP b. decreasing pulmonary vascular resistance Correct Answer: A patient has the following input/output history and other clinical information: Yesterday --> Today IN: 1900 cc --> 1600 cc OUT: 2200 cc --> 1900 cc C.O.: 6.1 L/min --> 3.7 L/min BP: 120/78 --> 120/

CVP: 3 --> 3

PAP: 12 --> 12

PCWP: 7 --> 7

These data would result in which of the following? a. decrease in V/Q mismatching b. decreasing pulmonary vascular resistance c. increase in left end-diastolic pressure d. increase in CVP b. loop diuretics Correct Answer: A patient with fulminating pulmonary edema has the following data obtained from a Swan-Ganz pulmonary artery catheter: CVP: 10 mmHg PAP: 25 mmHg PCWP: 15 mmHg C.O.: 3.9 L/min The patient would benefit most from which of the following? a. blood expanding agents b. loop diuretics c. Penicillin-class antibiotics d. administration of whole blood c. aerosolized Albuterol and Atrovent Correct Answer: An adult patient in the emergency room is wheezing bilaterally after multiple metered dose inhaler treatments with Albuterol at home. The patient may best benefit from which of the following? a. continous bronchodilator therapy with Albuterol at 3 mg/hr b. aerosolized Pulmicort( (Budesonide) c. aerosolized Albuterol and Atrovent d. aerosolized Atropine c. cardiac index Correct Answer: L/min/m2 is the unit of measure for a. stroke volume b. cardiac output c. cardiac index d. systemic vascular resistance a. 5 L/min nasal cannula Correct Answer: A spontaneously breathing patient has the following arterial blood gas results: pH 7.38 / PaCO2 42 / PaO2 76 / HCO3 24 / BE 0 Which of the following supplemental oxygen levels is most appropriate? a. 5 L/min nasal cannula b. Venturi mask at 30% c. non-rebreathing mask d. 2 L/min nasal cannula

d. spontaneous tidal volume Correct Answer: Which of the following is considered objective information? a. dysphagia b. chest pain c. dyspnea d. spontaneous tidal volume b. determine FRC Correct Answer: What is the primary purpose for a helium dilution test? a. quantify alveolar deadspace b. determine FRC c. directly measure TLC d. determine alveolar diffusion capacity a. discontinue ventilatory support Correct Answer: A patient with myasthenia gravis receiving volume-controlled ventilation is able to exhale a vital capacity of 2.4 L, has a spontaneous VT of 450 mL and is able to achieve - 3 8 cmH2O on the MIP manometer. As the patient becomes alert, the respiratory therapist should recommend a. discontinue ventilatory support b. adminster a maintenance dose of Tensilon c. sedating the patient. continuing to monitor d. checking VC q4 hours c. ARDS Correct Answer: Which of the following patients or conditions would benefit most from pressure control ventilation? a. COPD b. myasthenia gravis c. ARDS d. pneumonia b. performing a defribrillation at 150 joules biphasic Correct Answer: A 74-year old male has ventricular tachycardia. The patient is not alert and will not respond to verbal commands. A pulse is not palpable. The respiratory therapist will respond by a. adminstering aminophylline, IV b. performing a defribrillation at 150 joules biphasic c. cardioverting the patient at 100 joules d. administering sodium bicarbonate c. pulmonary hypertension Correct Answer: A patient in the cardiac intensive care unit has a Swan-Ganz pulmonary artery catheter in place. The following data is available: CVP: 6 torr mPAP: 18 torr PCWP: 8 torr C.I.: 2.0 L/min/m Which of the following most likely represents the patient's condition? a. dehydration b. corpulmonale

c. pulmonary hypertension d. left heart failure c. CVP Correct Answer: Hypovolemia would first be manifested in which of the following values? a. PCWP b. PAP c. CVP d. PVR d. cardiac output and wedge pressure Correct Answer: Left heart failure would be manifested in which of the following values? a. MAP and SVR b. CVP and mPAP c. mPAP and wedge pressure d. cardiac output and wedge pressure a. pulmonary capillary wedge pressure Correct Answer: Which of the following hemodynamic values is associated with the function of the left heart? a. pulmonary capillary wedge pressure b. systemic vascular resistance c. mean pulmonary artery pressure d. central venous pressure c. 14 L/min Correct Answer: A patient is on 60%/40% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? a. 18 L/min b. 10 L/min c. 14 L/min d. 16 L/min c. 500 mL Correct Answer: A post-operative patient was able to achieve an inspiratory capacity of 2000 mL prior to surgery. After repeated attempts, the patient is only able to achieve 400 mL. Which of the following represents an appropriate patient goal? a. 1000 mL b. 1600 mL c. 500 mL d. 400 mL a. increase flow Correct Answer: A patient receiving oxygen by non-rebreathing mask is breathing rapidly and deeply. The reservoir bag collapses completely with each inspiration. The therapist should a. increase flow b. check for adequate mask seal c. switch to a Venturi mask at 50%

d. continue current therapy b. HME Correct Answer: A patient will be receiving short-term mechanical ventilatory support after surgery. Which of the following methods of humidification is appropriate? a. cool, passover humidification b. HME c. centrifugal nebulizer d. large volume nebulization b. switch to a 9.0-mm ET tube Correct Answer: A 100-kg (220-lb), 6-ft, 2-in (188-cm) adult male is orally intubated with a 7.0-mm endotracheal tube. The therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The respiratory therapist will FIRST a. increase suction pressure to 130 mmHg b. switch to a 9.0-mm ET tube c. lubricate the suction catheter d. decrease suction pressure to 100 mmHg d. 20 mmHg Correct Answer: Which pressure should not be exceeded when adding air to an oral endotracheal tube cuff? a. 30 mmHg b. 15 mmHg c. 25 mmHg d. 20 mmHg b. intubate with a bronchoscope Correct Answer: A 4-year-old patient in the emergency room (E.R.) shows significant signs of respiratory distress including inspiratory stridor and tachypnea. The patient is drooling. The physician feels the patient has acute epiglottitis and orders intubation. Which of the following methods of intubation would be most appropriate? a. perform oral intubation with stylet b. intubate with a bronchoscope c. visualize the orpharynx with a tonsil suction device d. nasal intubation with magill forceps b. add air to the cuff Correct Answer: While performing minimum occluding volume technique on an 80-kg (176-lb) male with an 8.0-mm tube, the therapist auscultates a high-pitched sound over the neck at the top of each mechanical breath. The therapist should a. record results and monitor the patient b. add air to the cuff c. remove air from the cuff d. obtain a new ET tube d. try a different location with the pulse ox probe Correct Answer: A patient on the medical floor is receiving supplemental oxygen at 4 L/min by nasal cannula. A pulse oximeter is showing an SPO2 of 74% with a heart rate of 68 bpm. The respiratory therapist determines the pulse by palpation is 98 bpm. The therapist should

a. increase the flow rate to 5 L/min b. switch the patient to 50% Venturi mask c. replace the electrode with a new one d. try a different location with the pulse ox probe d. increase minute ventilation Correct Answer: A patient receiving volume-controlled ventilation has an infrared CO2 detector attached at the end of the ET tube. The capnograph shows a PetCO2 of 47 torr. The respiratory therapist should a. continue current therapy b. increase expiratory time c. increase inspiratory flow rate d. increase minute ventilation d. development of confusion or disorientation Correct Answer: Which of the following would be a sufficient reason to discontinue a spontaneous breathing trials a. respiratory rate increases from 18 to 26 b. heart rate increases from 78 to 92 bpm c. blood pressure increases from 110/80 to 118/88 mmHg d. development of confusion or disorientation c. BP and FIO2 Correct Answer: Which of the following is needed to calculate alveolar oxygen tension? a. VD/VT, PAO b. QS/QT, deadspace c. BP and FIO d. PetCO2 and PaO b. increase inspriatory flow rate Correct Answer: A patient with COPD is receiving volume- controlled ventilation with an I:E ratio of 1:3. A chest radiograph shows increased air-trapping. The physician orders a change in the I:E ratio to decrease air-trapping. Which of the following will accomplish this? a. increase inspiratory time b. increase inspriatory flow rate c. decrease expiratory time d. decrease inspiratory flow rate a. airway is too long Correct Answer: Immediately after inserting a nasal pharyngeal airway, the patient begins to cough uncontrollably. Which of the following is the most likely cause? a. airway is too long b. airway diameter is too large c. too much water-soluble lubricant was used d. patient has significant sputum in the upper airway c. increased CVP, decreased PAP Correct Answer: Which of the following is most indicative of right heart failure? a. increased PAP, decreased cardiac output

b. increased PAP, decreased PCWP c. increased CVP, decreased PAP d. decreased CVP, decreased PAP d. confirm asystole in a second lead Correct Answer: A patient in the emergency department (ED) becomes unconscious and has a cardiac rhythm consistent with asystole. The respiratory therapist should IMMEDIATELY a. begin chest compressions b. administer epinephrine c. adminster Atropine d. confirm asystole in a second lead d. switch to Albuterol Correct Answer: An adult patient with asthma is receiving Xopenex by small volume nebulizer T.I.D. at a dosage of 0.63 mg. The patient complains of dizziness, tingling in his fingers, and anxiety with each treatment. The therapist should a. switch to Atropine sulfate b. decrease dosage to 0.31 mg c. switch to cromolyn sodium (Intal) d. switch to Albuterol c. add 50 mL deadspace Correct Answer: An 84-kg (185-lb) 6-ft 1-in (185-cm) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate: 16 VT: 600 mL FIO2: 0. PEEP: 10 cmH2O ABGs pH 7.46 / PaCO2 34 / PO2 100 / HCO3 24 / BE 0 Which of the following represents the most appropriate action? a. decrease PEEP b. decrease rate to 10 c. add 50 mL deadspace d. decrease VT to 500 mL a. increase rate to 20 Correct Answer: An 84-kg (185-lb) 6-ft 1-in (185-cm) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate: 18.min VT: 600 mL FIO2: 0. PEEP: 5 cmH2O ABGs

pH 7.28 / PaCO2 56 / PO2 71 / HCO3 27 / BE + Which of the following represents the most appropriate action? a. increase rate to 20 b. increase FIO2 to 0. c. increase VT to 650 d. increase PEEP to 8 cmH2O d. TLC - FRC Correct Answer: Which of following calculations will determine inspiratory capacity (IC)? a. IRV - TLC - RV b. ERV + VT + IRV c. TLC - VT - ERV d. TLC - FRC d. auscultate breath sounds Correct Answer: While transporting at patient from the emergency department (ED) to the intensive care unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed position. The quickest way to assess the ET tube position would be to a. analyze end-tidal CO b. obtain a chest x-ray c. visualize diaphragmatic excursion d. auscultate breath sounds c. 20 mL/cmH2O Correct Answer: A pressure-volume ventilator graphic is observed on a patient receiving mechanical ventilation. The patient's estimated dynamic compliance is (see second pic) a. 50 mL/cmH2O b. 44 mL/cmH2O c. 20 mL/cmH2O d. 32 ml/cmH2O a. diligent hand washing Correct Answer: Which of the following represents the most effective method of preventing nosocomial infections in a hospital setting? a. diligent hand washing b. use of sterile gloves c. use of N-95 respirators d. use of alcohol wipes on equipment a. low gas pressure in tanks Correct Answer: While transporting a patient on a fixed-wing aircraft, the therapist notices the actual respiratory rate of the transport ventilator is less than the set rate and is gradually decreasing. Which of the following is the likely cause? a. low gas pressure in tanks b. effects of altitude on the ventilator c. effects of pressure associated with the curvature of the earth d. defective ventilator

d. C(a-v)O2 Correct Answer: Which of the following would be most helpful at identifying optimal PEEP? a. A-aDO b. VD/VT c. CVP d. C(a-v)O a. normal cardiac response, abnormal blood pressure response Correct Answer: A patient is undergoing a maximal exercise tolerance test. During the exam, as workload is increased, an increase in heart rate from 90 to 120 bpm while blood pressure remained steady at 110/88 mmHg is noted. Which of the following can be correctly stated about the exam results? a. normal cardiac response, abnormal blood pressure response b. abnormal cardiac response, normal blood pressure response c. normal cardiac response, normal blood pressure response d. abnormal cardiac response, abnormal blood pressure response d. daily peak flow measurements Correct Answer: A respiratory therapist is designing a regimen for a patient with asthma in an attempt to minimize episodes of bronchoconstriction. Which of the following should be included in the regimen a. IGE blocker b. routine alveolar diffusion testing c. cromolyn sodium (Intal) d. daily peak flow measurements d. increase pressure support to 10 cmH2O Correct Answer: A 60 kg (132 lb) male patient is undergoing weaning from mechanical ventilation. The following clinical and laboratory data is available: Mode: SIMV Mandatory rate: 4 Total rate: 28 FIO2: 0. VT (set): 400 mL VT (spont): 280 mL Pressure support: 5 cmH2O pH 7.44 / PaCO2 35 / PaO2 82 / HCO3 24 / BE + The respiratory therapist should recommend which of the following changes? a. administer sedative medication b. discontinue mechanical ventilation c. switch to pressure-control ventilation d. increase pressure support to 10 cmH2O d. reduce the total flow of gas mixture to the patient Correct Answer: A patient is receiving heliox therapy with a mixture of 70% / 30% by nonrebreathing mask to reduce airway resistance. The therapist also observes the reservoir bag is not collapsing at all with each inspiration. After ensuring the face mask is sealed around the face properly, the therapist should

a. obtain a partial rebreathing mask b. discard the valve between the mask and the reservoir c. obtain an arterial blood gas d. reduce the total flow of gas mixture to the patient a. PEEP Correct Answer: A patient with ARDS is showing signs of refractory hypoxemia after 22 days of volume controlled ventilation. Which of the following ventilator controls is most effective at combating refractory hypoxemia? a. PEEP b. Tidal volume c. injector line d. amplitude c. suction for less than 10 seconds Correct Answer: A patient is being suctioned by the respiratory therapist. The therapist suctions the patient by inserting the catheter for 10- 15 seconds and applying intermittent suction while withdrawing the catheter. During the last several attempts, the therapist notices multiple PVCs on the ECG monitor during the procedure. Which of the following can the therapist do to correct the problem? a. apply continuous suctioning when withdrawing the catheter b. decrease suction pressure c. suction for less than 10 seconds d. switch to a larger catheter b. myocardial ischemia and infarction Correct Answer: Immediately after performing a 12-lead ECG, the respiratory therapist notices "flipped" T waves and elevation of S-T segments. The therapist should conclude the patient is experiencing a. hypokalmeia and ischemia b. myocardial ischemia and infarction c. premature ventricular contractions d. hyperkalemia and infarction b. ensure the caregiver understands all instructions to perform the therapy Correct Answer: As part of the instruction of a 5-year-old child who will be using a small volume nebulizer at home, the respiratory therapist should also a. provide the patient with a telephone number that can be used to ask questions b. ensure the caregiver understands all instructions to perform the therapy c. have the patient record the treatments in a daily journal d. remind the child of the consequences of abusing the medication a. withdraw the endotracheal tube by several centimeters Correct Answer: Immediately after oral intubation, the respiratory therapist notes the endotracheal tube marking are at 28 cm at the lips. Additionally, chest movement is asymmetrical. The first recommendation of the therapist should be to a. withdraw the endotracheal tube by several centimeters b. perform diagnostic chest percussion bilaterally c. obtain a chest radiogram

d. advance the endotracheal tube until chest movement is symmetrical c. take rescue medication, check flows in one hour Correct Answer: The respiratory therapist working in a clinic receives a call from a patient who has asthma and is only able to achieve 75% of their normal baseline peak flow measurement. The therapist should advise the patient to a. call their doctor immediately b. check flows again in one hour, call if less than 50% of expected c. take rescue medication, check flows in one hour d. take rescue medication every 15 minutes for 2 hours, recheck flows c. increase tidal volume Correct Answer: A 45-year-old 74-kg (163-lb) adult female is receiving mechanical ventilatory support. Settings are as follows: Mode: assist/control Mandatory rate: 12 Total rate: 16 Tidal volume: 400 mL FIO2: 0. PEEP: 5 cmH2O The patient is appears to be anxious. SpO2 is 86%. The respiratory therapist will recommend which of the following? a. increase inspiratory flow rate b. increase FIO c. increase tidal volume d. decrease mandatory rate c. idiopathic pulmonary fibrosis Correct Answer: A 68-year-old male patient has the following pulmonary function values: Fev1/FVC% : 79% FVC: 62% of predicted FEF 25-75: 81% of predicted FEF 200-1200: 84% of predicted Which of the following could represent the patient's diagnosis? a. bronchiectasis b. chronic bronchitis c. idiopathic pulmonary fibrosis d. chronic asthma d. in mixed venous oxygen saturation Correct Answer: A left-to-right cardiac shunt, due to a leak in the septum wall of the heart, would be best indicated by an increase a. in PCWP b. in mPAP c. in arterial to venous oxygen content difference d. in mixed venous oxygen saturation

a. these are normal findings Correct Answer: A 38-week gestational age infant is receiving supplemental oxygen by oxyhood. An air/oxygen blender is set at 40% and the heated large volume aerosol is set at 100%. A capillary blood sample reveals the following values: pH 7.45 / PcCO2 35 / PcO2 47 / HCO3 22 / BE - 2 SpO2 is reading 97% and the patient appears to have good color. The therapist should conclude which of the following? a. these are normal findings b. nasal CPAP of 4 cmH2O should be implemented c. FIO2 should be increased d. the air/oxygen blender should be set to 100% c. decreasing pulmonary compliance Correct Answer: The following data is available for a patient receiving volume-controlled mechanical ventilation: 6am --> 9am Ppeak: 20 --> 32 Pplat: 13 --> 25 Set VT: 0.6 --> 0. PEEP: 5 --> 5 Which of the following is most consistent with these data? a. bronchoconstriction b. kyphoscoloiosis c. decreasing pulmonary compliance d. increasing dynamic airway resistance a. chest radiograph Correct Answer: Which of the following should the respiratory therapist use to determine the effectiveness of hyperinflation therapy of a patient who is post operative for a partial lobectomy and who has atelectasis? a. chest radiograph b. FEF 25- 75 c. FEF 200- 1200 d. DLCO measurements a. begin CPR Correct Answer: During the administration of an IPPB treatment, the patient becomes unresponsive and develops the ECG rhythm as shown below. Which of the following is the best initial action? a. begin CPR b. connect a pacemaker c. arterial blood gas analysis d. defibrillate at 50 joules b. order a chest radiograph Correct Answer: A respiratory therapist is helping transport a patient from the helicopter to the intensive care unit. During the transport, the therapist notices the endotracheal tube securing devices have become unsecure. The BEST way for the therapist to determine the position of the tube is to a. auscultate breath sounds b. order a chest radiograph

c. examine tube markings d. inspect symmetry of chest rise b. increase IPAP to 20, EPAP to 8 cmH2O Correct Answer: A patient with rocky mountain spotted fever is receiving non-invasive positive pressure breathing by mask at the following settings: IPAP: 18 cmH2O EPAP: 6 cmH2O Corresponding blood gases are: pH 7.36 / PaCO2 43 / PaO2 72 / HCO3 24 / BE 0 FiO2: 0.60 The respiratory therapist should recommend which of the following change(s)? a. increase EPAP to 10 cmH2O b. increase IPAP to 20, EPAP to 8 cmH2O c. increase FIO2 to 0.7 d. increase IPAP to 22 cmH2O b. nonrebreathing mask Correct Answer: A patient with pulmonary fibrosis has the following arterial blood gas results while receiving supplemental oxygen via nasal cannula at 5 L/min: pH 7.35 / PaCO2 45 / PaO2 42 / HCO3 24 / BE - 1 The respiratory therapist should recommend changing to which of the following devices? a. simple mask set to 7 L/min b. nonrebreathing mask c. Venturi mask d. partial rebreathing mask b. stroke volume x heart rate Correct Answer: A therapist working in the cardiac care unit is asked to determine a patient's cardiac output. Which of the following calculations can best provide an estimate of cardiac output? a. VO2 x CaO2 x 10 b. stroke volume x heart rate c. ejection fraction x stroke volume d. C(a-v)O2 / cardiac index c. poor patient effort Correct Answer: The following pulmonary function data is obtained from a 32 - year-old male with a history of pulmonary fibrosis: SVC: 62% of predicted FVC: 69% of predicted FEV1.0: 80% of predicted FEF25-75: 79% of predicted FEV200-1200: 82% of predicted DLCO: 91% of predicted The respiratory therapist should interpret this data as a. severe restrictive disease

b. moderate diffusion impairment c. poor patient effort d. mild obstructive defect c. pulmonary emphysema Correct Answer: The following pulmonary function data is obtained from a 72-year-old male: SVC: 81% of predicted FVC: 79% of predicted FEV1/FEV: 70% FEF25-75: 69% of predicted FEF200-1200: 63% of predicted DLCO: 16% The respiratory therapist should interpret this data as a. asthma b. sarcoidosis c. pulmonary emphysema d. severe diffusion impariment c. perforation in the lung tissue Correct Answer: An adult male patient who is receiving volume- controlled ventilation has a chest tube drainage system in place with a chest tube in the right anterior lung. Suction pressure at the wall is set to 120 mmHg. The therapist notices profuse bubbling in the water seal chamber. The low volume alarm is sounding and the digital display on the ventilator indicates a return volume of 220 mL. Which of the following clinical conditions should the respiratory therapist suspect? a. leak in the tubing between the patient and the fluid collection chamber b. leak in the tubing between the fluid collection and water seal chambers c. perforation in the lung tissue d. leak in the ventilator circuit a. administer Survanta Correct Answer: The respiratory therapist is caring for a 28-week-old gestational age infant currently receiving mechanical ventilatory support on the following settings: PIP: 30 cmH2O FIO2: 0.70 PEEP: 5 cmH2O Mandatory rate: 40 A chest radiograph shows bilateral haziness. Arterial blood gas analysis shows pH 7.22 / PaCO2 67 / PaO2 44 / HCO3 27 / BE +1 The most appropriate recommendation would be to a. administer Survanta b. increase PIP c. increase FIO2 d. decrease mandatory rate

c. decrease rate and/or increase flow Correct Answer: A physician is concerned about autoPEEP developing in a patient receiving volume-controlled ventilation on the following settings: Mode: assist/control VT: 600 mL Rate: 16 FIO2: 1.0 PEEP: 10 cmH2O Insp flow: 50 L/min I:E : 1:2 Which of the following adjustments will reduce autoPEEP? a. increase PEEP b. increase VT c. decrease rate and/or increase flow d. decrease PEEP b. withdraw the ET tube by 4 cm Correct Answer: A radiology report of a chest x-ray indicates the oral endotracheal tube is 1 cm beyond the carina, in the right mainstem bronchus. The respiratory therapist should a. withdraw the ET tube by 2 cm b. withdraw the ET tube by 4 cm c. advance the ET tube by 1 cm d. withdraw the ET tube by 1 cm d. place the infant on supplemental oxygen Correct Answer: A neonate delivered 3 minutes ago has an APGAR score of 5. The therapist should do which of the following? a. perform CPR b. obtain umbilical cord blood gas values c. get an arterial blood gas d. place the infant on supplemental oxygen d. serum electrolytes Correct Answer: A 42-year-old female presents in the emergency department (ED) complaining of body aches and general malaise. The patient reports sickness over the last two days with excessive vomiting and diarrhea. Which of the following laboratory tests should the respiratory therapist suggest? a. arterial blood gas b. blood urea nitrogen (BUN) c. theophylline level d. serum electrolytes a. emphysema Correct Answer: The following flow volume loop is obtained from a 59-year-old farmer who works in a granary. Which of the following could represent the patient's diagnosis? a. emphysema b. asthma c. chronic bronchitis d. pulmonary fibrosis

a. distal end of the pulmonary artery catheter Correct Answer: A respiratory therapist is preparing to obtain a mixed venous sample for the purpose of PvO2 measurement. From which of the following locations should the sample be taken? a. distal end of the pulmonary artery catheter b. capillary bed c. proximal end of the PA catheter d. right atrium c. epinpherine Correct Answer: While performing a biopsy of a tissue extracted from a patient's right mainstem bronchus with a bronchoscope, the physician reports sudden bleeding from the site. Which of the following should the respiratory therapist have ready to instill? a. atropine sulfate b. racemic epinephrine c. epinpherine d. normal saline b. decreased PAO2 Correct Answer: A mountain hiker is air-lifted off a mountain from an altitude of 19,000 ft. The patient was found complaining of shortness of breath. The patient is anxious, cyanotic, and is exhibiting signs of pulmonary edema. The most likely explanation for these signs and symptoms is a. altitude sickness b. decreased PAO2 c. hypercapnia d. oxygen toxicity d. magnetic resonance imaging (ME) Correct Answer: Which of the following diagnostic procedures should the respiratory therapist recommend to more clearly identify what looks like a mass in the upper right lung field? a. PA chest radiograph b. transesophagus echocardiogram (TE) c. AP chest radiograph d. magnetic resonance imaging (ME) b. pursed-lip breathing Correct Answer: A respiratory therapist is providing instruction to a home-care patient regarding different methods of increasing the effectiveness of airway clearance. The therapist may suggest all of the following techniques EXCEPT a. serial coughing b. pursed-lip breathing c. autogenic drainage d. huff coughing c. suction the mouth Correct Answer: Immediately upon delivery of a 40-week gestational age infant, the respiratory therapist notices a straw color stain about the infant's face. Which of the following actions should the therapist take next? a. provide ventilation with a bag-valve mask b. clean the infant's face, then reassess

c. suction the mouth d. obtain a one-minute APGAR score d. obtain a chest radiograph Correct Answer: 2pm --> 5 pm Peak airway pressure: 45 --> 56 static airway pressure: 35 --> 46 PEEP: 5 --> 5 delivered tidal volume: 750 --> 750 inspiratory flow: 55 --> 5 5 What is the next action the respiratory therapist should take? a. perform bronchial hygiene b. decrease tidal volume c. increase inspiratory flow d. obtain a chest radiograph d. sodium bicarbonate administration Correct Answer: The following arterial blood gas results are recorded for a patient during cardiopulmonary resuscitation: pH 7.10 / PaCO2 46 / PaO2 208 / HCO3 12 / FiO2 1.0 On the basis of these values and the following ECG waveform, the respiratory therapist should recommend a. administer sodium nitroprusside b. increase manual ventilation rate c. decrease FiO2 d. sodium bicarbonate administration c. decreasing dynamic compliance Correct Answer: A patient is receiving volume-controlled ventilation in the assist/control mode. The following data are available: 2pm --> 5pm --> 7pm Peak Pressure: 35 -->53 --> 55 Plateau Pressure: 22-->24 --> 23 Exhaled VT: 696 --> 702 --> 700 The respiratory therapist would categorize the most significant problem noted from this data as a. decreasing static compliance b. increasing dynamic compliance c. decreasing dynamic compliance d. increasing static compliance b. Ballard Correct Answer: Which of the following should be used to determine the gestational age of a neonate? a. lung compliance b. Ballard c. APGAR d. request the information from the mother c. proximal to the tip Correct Answer: The balloon on a balloon-tipped, flow-directed pulmonary artery catheter may be found