TMC Exam TEST BANK FINAL EXAM QUESTIONS LATEST VERSION |NEW UPDATE |GUARANTEED PASS|2024, Exams of Nursing

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TMC TEST BANK FINAL EXAM QUESTIONS

|LATEST VERSION |NEW UPDATE

|GUARANTEED PASS|2024-2025 |BEST

STUDYING MATERIAL WITH 150+

QUESTIONS

A physician orders 2 L/min O2 via simple mask to a 33 year-old post-op female patient with moderate hypoxemia breathing room air (PaO2 = 52 mm Hg). The correct action at this time would be to: Select one: A. carry out the physician's prescription exactly as written B. recommend a flow of at least 5 L/min to wash out CO C. recommend that the mask be changed to a cannula at 2 L/min D. not apply the oxygen until contacting the medical director

• ANSWER B. recommend a flow of at least 5 L/min to wash out CO After PEEP was changed from 5 cm H2O to 10 cm H2O, a patient's blood pressure dropped from 120/ mm Hg to 100/70 mm Hg, and the SpO2 increased from 87% to 91% with an FIO2 of 0.60. Which of the following should you do? Select one: A. Increase the FIO2 to 1. B. Return the PEEP to 5 cm H2O C. Decrease the PEEP to 0 cm H2O D. Maintain PEEP at 10 cm H2O
• ANSWER D. Maintain PEEP at 10 cm H2O

A 59-year-old postoperative man who weighs 77 kg (169 lb) is receiving volume control A/C ventilation at a rate of 14/min with a tidal volume of 650 mL and an FIO2 of 0.4. Results of arterial blood gas analysis are as follows: Blood Gases pH = 7. PaCO2 = 30 torr HCO3 = 23 mEq/L BE = - 1 PaO2 = 117 torr SaO2 = 99% Based on this information, you should recommend which of the following? Select one: A. decrease the minute ventilation B. discontinue mechanical ventilation C. increase the peak flow setting D. administer IV bicarbonate

• ANSWER A. decrease the minute ventilation After weaning and extubation, a patient on a cool aerosol mask at 40% O2 develops moderate hypoxemia and hypercapnia, with a falling pH. Which of the following actions would you recommend at this time? Select one: A. increase the nebulizer oxygen concentration to 60% B. apply bi-level positive airway pressure via mask C. administer 50 mEq IV sodium bicarbonate D. re-intubate and apply volume control ventilation

• ANSWER B. apply bi-level positive airway pressure via mask A neonate born 10 weeks premature is developing signs of respiratory distress syndrome (RDS). On standard volume controlled SIMV with 90% O2, he is still severely hypoxemic, exhibits sternal retractions, and has bilateral infiltrates and air bronchograms on his chest X-ray. What should you recommend? Select one: A. Instill surfactant through the endotracheal tube B. Nebulize albuterol (Proventil) through a SVN C. Change to a high-frequency ventilator D. Add 10 cm H2O PEEP
• ANSWER A. Instill surfactant through the endotracheal tube Prior to beginning an adrenergic aerosol bronchodilator treatment on an adult patient, you record a resting heart rate of 132/min. Which of the following would be the correct action in this case? Select one: A. double the drug diluent and prolong the administration time B. have the patient self-administer the aerosol treatment C. postpone therapy until able to contact the ordering physician D. use half the standard dosage listed in the package insert
• ANSWER C. postpone therapy until able to contact the ordering physician The intracranial pressure (ICP) of a patient with closed head trauma receiving volume control A/C ventilation has risen from 18 mm Hg to 26 mm Hg despite aggressive treatment with osmotic diuresis, CSF fluid drainage, sedation and neuromuscular blockade. Which of the following short-term ventilatory strategies would you recommend to help manage this patient? Select one: A. decelerating flows B. inspiratory hold

C. hyperventilation D. high PEEP

• ANSWER C. hyperventilation When treating a patient with active tuberculosis, you note large amounts of bloody secretions. You should notify the: Select one: A. nearest relative B. attending physician C. department medical director D. respiratory supervisor
• ANSWER B. attending physician A doctor asks you to assess if a 65 kg (143 lb) patient with a neuromuscular disorder receiving volume control SIMV is ready for weaning. You obtain the following data during a bedside ventilatory assessment: Spontaneous tidal volume: 250 mL Minute ventilation: 8.5 L/min Vital capacity: 700 mL Max inspiratory pressure: - 28 cm H2O Based on this information, which of the following would you recommend? Select one: A. begin a spontaneous breathing T-piece trial B. postpone weaning and re-evaluate the patient C. begin weaning using a pressure support protocol D. begin weaning by decreasing the SIMV rate

• ANSWER B. postpone weaning and re-evaluate the patient A doctor wants to apply pressure control ventilation but maintain consistent tidal volumes for an intubated patient likely to exhibit changes in compliance and resistance. What mode of ventilation would you recommend? Select one: A. pressure regulated volume control B. pressure control A/C ventilation C. pressure control SIMV ventilation D. airway pressure release ventilation
• ANSWER A. pressure regulated volume control Which of the following treatments can increase a patient's susceptibility to infection? Select one: A. immunosuppressives B. supplemental O C. bronchodilators D. vasopressors
• ANSWER A. immunosuppressives A premature infant being mechanically ventilated with an FIO2 of 0.65 and 10 cm H2O PEEP exhibits intercostal retractions and tachypnea. The X-ray shows bilateral dense infiltrates with air bronchograms and the SpO2 is 78%. Which of the following would you recommend for this infant? Select one: A. ribavirin (Virazole) B. beractant (Survanta) C. indomethacin (Indocin)

D. albuterol (Proventil)

• ANSWER B. beractant (Survanta) A patient with a fever and severe cough is producing small amounts of yellow-white sputum with blood streaks. Which of the following disorders is most likely? Select one: A. bronchiectasis B. bacterial pneumonia C. bronchial asthma D. bronchogenic carcinoma
• ANSWER B. bacterial pneumonia Chronically ill respiratory patients are at risk for complications such as venous stasis and muscular atrophy due to: Select one: A. decreased hydration B. prolonged hypoventilation C. relative inactivity D. decreased hematocrit
• ANSWER C. relative inactivity Two days after upper abdominal surgery, a patient develops a low-grade fever, dyspnea, tachypnea and signs of infiltrates/consolidation in the lower lobes. The most likely cause of this problem is: Select one: A. pleural effusion B. pulmonary edema C. ARDS

D. atelectasis

• ANSWER D. atelectasis Minimum monitoring of critically ill patients undergoing transport should include the following: Select one: A. periodic pulse oximetry B. continuous ECG C. periodic capnography D. continuous blood pressure
• ANSWER B. continuous ECG In order to assess the circulatory status of an infant during basic life support, which of the following pulses would you palpate? Select one: A. brachial B. ulnar C. carotid D. popliteal
• ANSWER A. brachial During the initial attempt to ventilate a patient during CPR with a bag-valve-mask system and oropharyngeal airway, you observe that the patient has no chest excursions. Your most appropriate INITIAL action would be to: Select one: A. give 4 back blows in rapid succession B. intubate the patient C. reposition the patient's head/neck and retry

D. continue ventilation and compressions

• ANSWER C. reposition the patient's head/neck and retry When assessing a patient after a treatment, you note a significant deterioration in vital signs. The most appropriate action in this case is to: Select one: A. call for the institution's rapid response team B. report the findings to the next shift of respiratory therapy staff C. chart the findings as an unexpected response to therapy D. orally communicate the findings to the patient's physician
• ANSWER A. call for the institution's rapid response team You are assisting a physician during cardioversion of a patient with unstable atrial flutter. The patient is receiving oxygen via a nonrebreather mask at this time. After the initial shock has been delivered, the patient's SpO2 drops to 85%, respirations become slow and shallow, and the heart rate is now 82/min with normal sinus rhythm. The next immediate action should be: Select one: A. open the airway and ventilate with 100% O B. administer 2 mg IV naloxone (Narcan) C. deliver another synchronized 100 J shock D. intubate and initiate mechanical ventilation - ANSWER A. open the airway and ventilate with 100% O If a low posterior thoracentesis tap (eighth intercostal space or lower) is performed with the patient sitting and leaning forward, which of the following organs are most likely to be punctured or injured? Select one: A. spleen B. heart

C. bladder D. colon - ANSWER A. spleen You are assisting a physician with a bronchoscopy procedure on a cardiac patient when suddenly endobronchial bleeding occurs. You should recommend which of the following? Select one: A. instilling Lidocaine (Xylocaine) B. instilling ice cold saline solution C. providing 100% O2 via nonrebreather D. instilling dilute epinephrine solution - ANSWER B. instilling ice cold saline solution You are asked by a physician to assist him in monitoring a patient during a fiberoptic bronchoscopy procedure. Which of the following would you recommend? Vital Heart Vital Pulse sat/ signs rhythm/ECG capacity SpO A. Yes No Yes No B. Yes Yes No Yes C. Yes Yes Yes Yes D. No Yes Yes Yes Select one: A. A B. B C. C D. D - ANSWER B. B

Which of the following would you recommend as the solution used to fill a bubble-type humidifier used for home oxygen therapy? Select one: A. sterile water B. distilled water C. 0.9% saline D. tap water - ANSWER B. distilled water Emergency situations that home mechanical ventilation caregivers must be trained to recognize and manage include which one of the following? Select one: A. tension pneumothorax B. ventilator or power failure C. ventricular tachycardia D. pulmonary hemorrhage - ANSWER B. ventilator or power failure You are asked to help setup a pulmonary rehabilitation program to help decrease readmission of COPD patients to your hospital. You would recommend that the program include which of the following components? Self-management Exercise Pyschosocial education training support A. No Yes Yes B. Yes Yes No C. Yes No Yes D. Yes Yes Yes

Select one: A. A B. B C. C D. D - ANSWER D. D The maximum amount of air that can be exhaled from the maximum inspiratory level is defined as which of the following? Select one: A. vital capacity B. residual volume C. total lung capacity D. expiratory reserve volume - ANSWER A. vital capacity A prescription for an aerosolized drug for a patient under your care is missing the actual prescribed drug dosage. Which of the following would be the appropriate action for you to take? Select one: A. use the standard dosage listed in the package insert B. ask your medical director to rewrite the prescription C. contact the ordering physician to seek clarification D. postpone the therapy until the following day - ANSWER C. contact the ordering physician to seek clarification When observing the monitored intracranial pressure (ICP) of a patient with traumatic brain injury receiving pressure control A/C ventilation, you note first rhythmic ICP oscillations occurring every 1- 2 minutes, followed by a spike in ICP from 21 to 48 mm Hg that lasts for several minutes. Which of the following actions would you take? Select one:

A. switch to volume control A/C ventilation B. immediately contact the patient's physician C. wait to see if the ICP pattern repeats D. immediately conduct a neurologic exam - ANSWER B. immediately contact the patient's physician When assessing a patient, which of the following histories would be of primary interest to you? Occupational Medical Environmental Smoking A. Yes No Yes Yes B. No Yes Yes Yes C. Yes Yes Yes Yes D. Yes Yes No No Select one: A. A B. B C. C D. D - ANSWER C. C Where in the medical record would one go to find information on a patient's understanding of the drugs they are taking and their methods of administration? Select one: A. medication record B. progress notes C. medication history D. admission/face sheet - ANSWER C. medication history

The major goal of medication reconciliation is to: Select one: A. educate the patient B. prevent medication errors C. increase patient compliance D. reduce prescription costs - ANSWER B. prevent medication errors Which of the following information in a patient's medical history would be LEAST important to consider in evaluating the patient's pulmonary condition? Select one: A. smoking history B. occupational history C. prior pulmonary illnesses D. dietary habits - ANSWER D. dietary habits The primary indication for monitoring intracranial pressure (ICP) is: Select one: A. post-craniotomy B. traumatic brain injury C. meningitis D. drug overdose - ANSWER B. traumatic brain injury During an interview with your patient, you determine that she is disoriented to time, place, and person. What may explain this finding? Select one:

A. respiratory alkalosis B. severe hypoxemia C. metabolic acidosis D. hyperthermia - ANSWER B. severe hypoxemia Upon visually inspecting the thorax of a 73-year-old male, you notice that his chest appears overinflated, with the ribs held in a horizontal position. Upon further inspection you observe that the transverse chest diameter almost equals the AP diameter. Which of the following terms best describes this thoracic configuration? Select one: A. kyphoscoliosis B. bucket-handle movement C. pectus excavatum D. barrel chest - ANSWER D. barrel chest Which of the following respiratory signs noted on inspection of an adult patient would be considered ABNORMAL? Select one: A. inspiratory time is shorter than expiratory time B. ribs slope downward from spine at end-expiration C. AP diameter of thorax is equal to its transverse diameter D. thorax expands, abdomen rises during inspiration - ANSWER C. AP diameter of thorax is equal to its transverse diameter You note that a patient's respiratory rate is 35 per minute. Which of the following terms would you use to chart this finding? Select one: A. bradypnea

B. tachycardia C. hyperventilation D. tachypnea - ANSWER D. tachypnea Vesicular breath sounds indicate which of the following? Select one: A. Pneumothorax B. Normal lungs C. Lung consolidation D. Small airways obstruction - ANSWER B. Normal lungs Which of the following would tend to cause decreased or diminished breath sounds? Select one: A. deep breathing B. consolidation C. hyperinflation D. cardiomegaly - ANSWER C. hyperinflation A 55 year old patient has been smoking 1-1/2 packs of cigarettes per day for 30 years. You would quantify and record his smoking history as: Select one: A. 15 pack-years B. 30 pack-years C. 45 pack-years D. 60 pack-years - ANSWER C. 45 pack-years

When inspecting the X-ray of a patient in ICU, you note radiolucent streaks in the soft tissues outlining the aortic knob. Which of the following is the most likely problem? Select one: A. subcutaneous emphysema B. pneumomediastinum C. pneumothorax D. interstitial infiltration - ANSWER B. pneumomediastinum Which one of the following measures could be used to evaluate changes in symptoms occurring among participants in a pulmonary rehabilitation program? Select one: A. changes in sputum production B. changes in O2 consumption C. changes in blood pressure D. changes in O2 saturation - ANSWER A. changes in sputum production Auscultation of a patient's chest revealing wheezes would indicate the presence of which of the following: Select one: A. pleural effusion B. pneumothorax C. laryngospasm D. mucosal edema - ANSWER D. mucosal edema Which of the following procedures require active patient cooperation to be effective? Select one:

A. ventilator weaning B. breathing exercises C. mask CPAP D. mechanical cough assist - ANSWER B. breathing exercises When questioning a patient regarding his environmental exposure history, you need to obtain information on: Select one: A. commuting distance from home to work B. job tasks, location, materials, and agents used C. lines of authority/job reporting structure D. position title and hourly or annual salary - ANSWER B. job tasks, location, materials, and agents used In which of the following conditions are fine, late inspiratory crackles (rales) most likely to be heard on auscultation? Select one: A. atelectasis B. croup C. pleural effusion D. asthma - ANSWER A. atelectasis Upon inspection of a portable spirometer's FVC curve obtained on an adult outpatient, you determine that the time required to reach the peak expiratory flow is excessive. Prior to repeating the maneuver, which of the following instructions would you provide to the patent? Select one: A. "Don't hesitate" B. "Blast out faster"

C. "Blow out longer" D. "Deeper breath" - ANSWER B. "Blast out faster" For which of the following patients is weaning from ventilatory support likely to be most difficult? Select one: A. a patient with an acute CNS injury altering the respiratory drive B. a patient with chronic obstructive pulmonary disease C. a patient recovering from coronary artery bypass surgery D. a patient regaining consciousness after a drug overdose - ANSWER A. a patient with an acute CNS injury altering the respiratory drive You have only one mainstream capnometer available in ICU, but the attending doctor has asked that you make end-tidal CO2 (PetCO2) measurements on several different patients before morning rounds. In order to obtain these measurements while minimizing the risk of cross infection to you patients, which of the following actions would be most appropriate? Select one: A. Gas sterilize the sensor between patient B. Provide an individual airway adapter for each patient C. Sterilize the capnometer between patient uses D. Substitute arterial blood gas analysis for infected patients - ANSWER B. Provide an individual airway adapter for each patient When measuring a patient's arterial pressure via A-line and monitor/transducer system, you note a damped pressure waveform. Which of the following is the most likely cause of this problem? Select one: A. parrtial catheter occlusion B. catheter out of vessel C. transducer positioned too high D. stopcock off to patient - ANSWER A. parrtial catheter occlusion

When monitoring an active infant via a transcutaneous blood gas system, you note a rapid rise in PtcO from 63 mm Hg to 145 mm Hg. During the same time, the PtcCO2 drops from 35 mm Hg to 7 mm Hg. What is the most appropriate action in this case? Select one: A. perform a quick assessment of the infant's airway B. stabilize the infant and call for emergency assistance C. check the sensor for air leaks or dislodgment D. remove the sensor and recalibrate the instrument - ANSWER C. check the sensor for air leaks or dislodgment After three minutes of peak activity during an oxygen titration test, a patient's SpO2 drops from 90% to 87%. Which of the following actions is indicated? Select one: A. continue the test for another three minutes at the same liter flow B. increment the O2 flow by 1 liter per minute and continue the test C. immediately terminate the test and assess the patient's vital signs D. increment the O2 flow by 1 liter per minute and terminate the test - ANSWER B. increment the O flow by 1 liter per minute and continue the test A 150-lb. patient has a tidal volume of 600 mL, an arterial PCO2 (PaCO2) of 50 torr, and a mixed expired PCO2 of 35 torr. What is the patient's physiologic deadspace? Select one: A. 240 mL B. 300 mL C. 180 mL D. 350 mL - ANSWER C. 180 mL

Which of the following bedside measurements require a conscious and cooperative patient? Select one: A. spontaneous respiratory rate B. maximum expiratory pressure C. spontaneous tidal volume D. maximum inspiratory pressure - ANSWER B. maximum expiratory pressure To ensure accurate measurements, before attaching a transcutaneous blood gas monitor sensor to a patient, you should: Select one: A. place mineral oil inside the sensor fixation ring B. apply local anesthetic cream to the sensor site C. pierce the sensor membrane to facilitate diffusion D. provide the manufactuer's specified warm-up time - ANSWER D. provide the manufactuer's specified warm-up time Which of the following should be obtained and recorded when performing a bedside measure of vital capacity? Select one: A. patient's resting minute ventilation B. patient's heart rate before/after testing C. patient's actual and predicted body weight D. patient's height, gender and age - ANSWER D. patient's height, gender and age You need to measure the forced vital capacity of an adult patient at the bedside. Which of the following devices would you select to make this measurement?

Select one: A. a computerized electronic spirometer with flow sensor B. strain-gauge pressure transducer and amplifier C. mechanical turbine-type volumeter/Wright respirometer D. water-sealed bell spirometer with high speed kymograph - ANSWER A. a computerized electronic spirometer with flow sensor The attending physician in the Emergency Department asks that you immediately obtain and run a point- of-care arterial blood gas with electrolytes on a COPD patient in respiratory failure. To obtain accurately measure these parameters on this patient using a point-of-care analyzer, you would need: Select one: A. quality control media (3 levels) B. sensor electrolyte gel C. high and low calibrating gases D. the appropriate analysis cartridge - ANSWER D. the appropriate analysis cartridge At 8:00 AM you estimate the airway resistance (Raw) of patient receiving volume control A/C ventilation to be 8 cm H2O/L/sec. Two hours later, his estimated Raw is 20 cm H2O/L/sec. Which of the following are possible causes of this change? Select one: A. pneumothorax B. laryngeal edema C. a mucous plug D. ascites - ANSWER C. a mucous plug You obtain an SpO2 measurement on a patient of 80%. Assuming this is an accurate measure of hemoglobin saturation, what is the patient's approximate PaO2? Select one:

A. 40 mm Hg B. 50 mm Hg C. 60 mm Hg D. 70 mm Hg - ANSWER B. 50 mm Hg A patient in shock exhibits the following cardiovascular responses: an INCREASED pulmonary artery pressure, an INCREASED systemic vascular resistance, and a DECREASED cardiac output. Given these data, the most likely type of shock is: Select one: A. hypovolemic shock B. neurogenic shock C. septic shock D. cardiogenic shock - ANSWER D. cardiogenic shock A postoperative patient is receiving volume control A/C ventilation at the rate of 12/minute with 5 cm H2O PEEP. With the ventilator settings unchanged, you measure and record the following the data: Peak Plateau Exhaled Inspiratory Pressure Tidal Pressure (cm H2O) (cm H2O) Volume(mL) 7AM 35 25 600 8AM 43 24 600 9AM 50 26 600 These changes indicate which of the following? Select one:

A. increased airway resistance B. decreased airway resistance C. increased lung compliance D. decreased lung compliance - ANSWER A. increased airway resistance Which portion of a capnogram most closely corresponds to true alveolar gas? Select one: A. gas sampled at the middle of exhalation B. gas sampled at the very end of exhalation C. gas sampled at the beginning of exhalation D. gas sampled at the very end of inhalation - ANSWER B. gas sampled at the very end of exhalation Which of the following data sets reveals the highest effective static compliance for a 71 kg (157 lbs) male patient receiving volume control A/C ventilation with a tidal volume of 500 mL? Data PIP Pplat PEEP Set (cm H2O) (cm H2O) (cm H2O) A. 30 25 5 B. 35 25 10 C. 40 30 10 D. 35 30 5 Select one: A. Data set A B. Data set B C. Data set C D. Data set D - ANSWER B. Data set B

A patient in shock exhibits the following cardiovascular measures: a DECREASE in pulmonary artery pressure, an INCREASE in systemic vascular resistance, and a DECREASE in cardiac output. Given these data, the most likely type of shock is: Select one: A. anaphylactic shock B. neurogenic shock C. hyperdynamic septic shock D. hypovolemic shock - ANSWER D. hypovolemic shock A patient receiving ventilatory support with 10 cm H2O PEEP has a C(a-v)02 of 7.9 mL/dL. Which of the following is the most likely cause of this finding? Select one: A. PEEP has impaired cardiac output B. This is the optimum PEEP level C. PEEP has caused hyperventilation D. The PEEP level is too low - ANSWER A. PEEP has impaired cardiac output When performing bedside spirometry on a 46-year-old man who is 6 feet tall, you obtain a peak flow measurement of 3.3 L/sec. The best interpretation of this test result is: Select one: A. the patient's peak flow is normal B. the patient is not exerting full effort C. the patient has poor gas distribution D. the patient has low compliance - ANSWER B. the patient is not exerting full effort

A patient has a minute volume of 8.25 L/min and is breathing at a rate of 22 breaths/min. What is his average tidal volume? Select one: A. 182 mL B. 375 mL C. 275 mL D. 435 mL - ANSWER B. 375 mL In reviewing the ventilator flow sheet for a patient who is being mechanically ventilated, the following data are noted: Dynamic lung compliance = 38 mL/cm H2O; Static lung compliance = 33 mL/cm H2O. Based on these data, you can conclude which of the following? Select one: A. the calculations are erroneous B. airway resistance is 5 cm H2O/L/sec C. a bronchopleural fistula has developed D. the patient has significant airway obstruction - ANSWER A. the calculations are erroneous Which of the following would you recommend to detect the presence of auto-PEEP on a patient receiving volume control A/C ventilation? Select one: A. pressure-volume loop B. flow-volume loop C. inspiratory hold or pause D. pressure vs. time scalar - ANSWER B. flow-volume loop A patient is admitted with signs and symptoms and a history consistent with bronchiectasis. Which of the following tests would you recommend to confirm or rule out this diagnosis?