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TMC FINAL PAPER 2026 FULL STUDY GUIDE
◉ Which of the following factors are determinants of cardiac output? A. ventricular filling and heart rate B. stroke volume and heart rate C. stroke volume and respiratory rate D. heart rate and tidal volume. 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 8 mEq/L; SaO2 95%; BE - 15 mEq/L. The respiratory therapist should recommend A. initiating oxygen therapy via nasal cannula at 4 L/min. B. intubating and initiating mechanical ventilation. C. administering sodium bicarbonate intravenously. D. initiating non-invasive ventilation.. Answer: administering sodium bicarbonate intravenously.
◉ The physician asks the respiratory therapist to set 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? A. Decelerating B. Square wave C. Constant D. Accelerating. 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 A. hypoventilation. B. shunt. C. ventilation/perfusion mismatch. D. increased deadspace.. Answer: ventilation/perfusion mismatch. ◉ A 16 year-old patient with cystic fibrosis attends public high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient?
A. tape the connection securely. B. increase the flow to the catheter. C. decrease the flow to the catheter. D. switch to a nasal cannula.. Answer: switch to a nasal cannula. ◉ A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? A. Insert a laryngeal mask airway (LMA) to facilitate suctioning. B. Discontinue nasotracheal suctioning for 24 hours and reassess the patient. C. Insert a nasopharyngeal airway after bleeding has been controlled. D. Insert an oral endotracheal tube to allow for better airway access.. Answer: Insert a nasopharyngeal airway after bleeding has been controlled. ◉ The most probable cause of air bronchograms and increased density on a chest x-ray is A. pneumonia. B. pulmonary edema.
C. pulmonary embolism. D. pleural effusion.. Answer: pneumonia. ◉ A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely.. Answer: Increase the FIO2. ◉ The primary source of infection in the health care setting is A. use of medical equipment for multiple patients. B. poor handwashing techniques of personnel. C. food and/or water intake by the patient. D. patient rooms not cleaned appropriately.. Answer: poor handwashing techniques of personnel.
◉ Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion. Answer: Increased fremitus ◉ A spontaneous breathing trial was initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 30 minutes on an FIO 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 have remained stable throughout the trial. Which of the following is the most appropriate recommendation? A. Maintain current therapy. B. Initiate NPPV. C. Add 5 cm H2O CPAP. D. Extubate the patient.. 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? A. Head down, patient supine with a pillow under knees B. Patient prone with a pillow under head, bed flat C. Patient supine with a pillow under knees, bed flat D. Head down, patient prone with a pillow under hips. Answer: Head down, patient prone with a pillow under hips ◉ A 72 year-old female post stem cell transplant patient in the ICU is complaining 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?
- Increase the sensitivity
- Increase the mandatory rate
- Decrease the inspiratory time. Answer: 1 and 3 ◉ 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? A. diuretics B. antibiotics C. lung expansion therapy D. thoracentesis. 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 achieve a minimal occluding volume. This would indicate that the A. tube is not of the appropriate size. B. pilot balloon and line are obstructed. C. pressure manometer is defective.
D. cuff has herniated over the tip of the tube.. Answer: tube is not of the appropriate size. ◉ A patient is receiving oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80, HCO3 38 mEq/L. The most likely explanation for these results is that A. the sample was not iced properly. B. there was excess heparin in the syringe. C. the numbers were not reported correctly. D. The sample contains venous blood.. Answer: the numbers were not reported correctly. ◉ The respiratory therapist is completing oxygen rounds on the ward and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? A. 70% ethyl alchohol B. Warm soapy water C. Bleach D. Acid glutaraldehyde. Answer: 70% ethyl alchohol
D. Fowlers. Answer: lateral Fowlers ◉ Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? A. 20 torr B. 30 torr C. 40 torr D. 50 torr. Answer: 50 torr ◉ The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor
- electrocardiogram.
- electroencephalogram.
- nasal air flow.
- chest wall impedance.. Answer: 2, 3, and 4 ◉ 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 cmH2O in order to allow circulation to tracheal mucosa.. Answer: minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. ◉ The sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing is representative of A. tidal volume. B. pulmonary shunt. C. V/Q mismatch. D. alveolar gas that has participated in gas exchange.. Answer: alveolar gas that has participated in gas exchange. ◉ 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 have accounted for these readings? A. The ventilator circuit has become disconnected. B. There is a leak around the endotracheal tube.
A. 10 mL/hr B. 20 mL/hr C. 30 mL/hr D. 40 mL/hr. 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? A. fenestrated trach tube B. transtracheal catheter C. laryngectomy tube D. tracheostomy button. 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 Keflex® as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? A. thoracentesis B. polysomnography
C. flexible bronchoscopy D. plethysmography. Answer: flexible bronchoscopy ◉ A 60 kg (132 lb) female patient with congestive heart failure is receiving 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 A. shunting. B. hypoventilation. C. hyperoxygenation. D. fluid overload.. Answer: hyperoxygenation ◉ Which of the following physiologic values would be present in a patient who has proper fluid balance? A. PCWP of 22 mm Hg B. CVP between 3 and 6 mm Hg C. urine output of 20 mL/hr D. increase in body weight. Answer: CVP between 3 and 6 mm Hg
recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: A. coordinating coughing with pain medication. B. performing serial coughs. C. applying pressure to patient's abdomen during exhalation. D. "splinting" the incision area.. Answer: applying pressure to patient's abdomen during exhalation. ◉ Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation?
- Select a ventilator that uses demand valves rather than a reservoir IMV system.
- Calculate oxygen cylinder duration of flow.
- Selecting a ventilator that incorporates an internal air compressor.. Answer: 1 and 2 only ◉ A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO 35 mEq/L. Which of the following should the therapist recommend?
A. Leave the patient on the cannula and continue to monitor. B. Change to a 24% Venti-mask and repeat ABG. C. Change to a simple oxygen mask and repeat ABG. D. Prepare the patient for endotracheal intubation.. Answer: Change to a 24% Venti-mask and repeat ABG. ◉ A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a A. high likelihood of excessive bleeding. B. normal clotting ability. C. propensity for increased clotting. D. decrease in bone marrow function.. Answer: high likelihood of excessive bleeding. ◉ A mechanically ventilated patient with a tracheostomy tube is on the following settings: PC, SIMV, PIP 30 cmH2O, f 20/min, FIO2 0.60, PEEP 5 cmH2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely?
