TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 TMC PRACTICE EXAM 100 QUESTIONS W, Exams of Nursing

Download TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 TMC PRACTICE EXAM 100 QUESTIONS W and more Exams Nursing in PDF only on Docsity! TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able to exhale what percent of the FVC? A. 35-50% of the FVC B. 50-70% of the FVC C. 70-83% of the FVC D. 84-93% of the FVC Correct Answer: c. 70-83% of FVC Simple spirometry CANNOT be used to measure the A. vital capacity B. residual volume C. tidal volume D. inspiratory reserve volume Correct Answer: b. residual volume Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated? A. obtain and review the patient's past medical history B. ask the patient's nurse about the patient's prescriptions C. request that the lab run a comprehensive blood drug screen D. obtain the patient's current prescription vials from the family Correct Answer: d. obtain the patient's current prescription vials from the family Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax? A. presence of gliding sign B. absence of A-lines C. presence of barcode sign D. presence of seashore sign Correct Answer: c. presence of barcode lines Which of the following would tend to increase insensible water loss? A. hypothermia B. bypassed upper airway C. hypoventilation D. diuretic administration Correct Answer: b. bypassed upper airway Which of the following would tend to decrease a patient's energy expenditure? A. hypothermia B. inflammation C. major trauma D. agitation/pain Correct Answer: a. hypothermia TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between: A. + 6 mEq/L B. - 6 mEq/L C. +/- 2 mEq/L D. +/- 8 mEq/L Correct Answer: c. +/- 2 mEq/L Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack? A. pH = 7.31 PCO2 = 50 torr PO2 = 60 torr B. pH = 7.40 PCO2 = 50 torr PO2 = 50 torr C. pH = 7.47 PCO2 = 32 torr PO2 = 60 torr D. pH = 7.47 PCO2 = 40 torr PO2 = 50 torr Correct Answer: c. pH= 7.47 PCO2= 32 torr PO2= 60 torr The Apgar score for a normal newborn infant ranges between A. 1-4 B. 4-7 C. 7-10 D. 10-13 Correct Answer: c. 7-10 On inspection of a patient's ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is: A. 2nd degree (Wenckebach) heart block B. ventricular fibrillation C. atrial fibrillation D. ventricular tachycardia Correct Answer: c. atrial fibrillation In inspecting an elderly female patient, you note that her spine has an abnormal anterposterior (AP) curvature. Which of the following terms would you use in charting this observation? A. kyphosis B. scoliosis C. kyphoscoliosis D. pectus excavatum Correct Answer: a. kyphosis During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung bases. Which of the following chart entries best describe this finding? A. "bronchial sounds heard at lung bases" B. "wheezes heard at lung bases" C. "rhonchi heard at lung bases" TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 What percent decrease in FEV1 needs to occur to conclude that a methacholine challenge is positive for airway hyperreactivity? A. 10% B. 15% C. 20% D. 25% Correct Answer: c. 20% A patient is receiving ventilatory support after thoracic surgery. You measure the patient's maximum inspiratory pressure (MIP/NIF) as -33 cm H2O. Based on this value, the patient has: A. a need for continued ventilatory support B. a large leak in their endotracheal tube cuff C. a normal maximum inspiratory pressure D. adequate muscle strength to consider weaning Correct Answer: d. adequate muscle strength to consider weaning During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates: A. exhalation of mainly deadspace gas B. inspiration of fresh respiratory gas C. exhalation of mixed alveolar/deadspace gas D. exhalation of mainly alveolar gas Correct Answer: b. inspiration of fresh respiratory gas A patient is considered as having sufficient respiratory muscle strength to maintain adequate ventilation and prevent secretion retention when the maximum inspiratory pressure (MIP; NIF) is more negative than: A. -5 cm H2O B. -10 cm H2O C. -15 cm H2O D. -20 cm H2O Correct Answer: d. -20 cm H2O Over a 3 hour period, the plateau pressure of a patient receiving volume controlled ventilation has remained stable, but her peak pressure has been steadily increasing. Which of the following is the best explanation for this observation? A. the patient's airway resistance has increased B. the patient is developing atelectasis C. the patient's compliance has decreased D. the patient is developing pulmonary edema Correct Answer: a. the patient's airway resistance has increased On inspection of an adult patient's 12-lead ECG, you note a regular R-R interval of 0.40 sec, with no other apparent abnormalities. Which of the following is the most likely problem? TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 A. ventricular tachycardia B. sinus bradycardia C. atrial fibrillation D. sinus tachycardia Correct Answer: d. sinus tachycardia Under ideal conditions, pulse oximeter readings patients usually fall with what percent of those obtained via invasive hemoximetry? A. ±1-2% B. ±2-3% C. ±3-5% D. ±5-7% Correct Answer: +/- 3-5% Prior to intubation in an emergency, injection of air into the pilot line fails to inflate the cuff. You should: A. check the cuff for leaks B. check the valve on the pilot line C. replace the endotracheal tube D. inspect the pilot line for patency Correct Answer: c. replace the endotracheal tube A 15-year-old with cystic fibrosis is receiving pressure control SIMV with pressure support due to a severe bilateral pneumonia. The pulmonologist asks you to administer aerosolized dornase alfa (Pulmozyme, DNase) in-line with the ventilator. Which of these devices would you select to administer this therapy? A. dry powder inhaler (DPI) B. vibrating mesh nebulizer C. metered dose inhaler (MPI) D. small volume nebulizer Correct Answer: b. vibrating mesh nebulizer Which of the following conditions will cause a DECREASE in the FIO2 delivered to a patient receiving oxygen at 4 L/min via a nasal cannula? A. decrease in patient inspiratory flow B. increase in patient inspiratory time C. increase in patient minute ventilation D. decrease in patient tidal volume Correct Answer: c. increase in patient minute ventilation You notice that a disposable nebulizer is delivering large water droplets down the large bore tube. To correct this problem, you should: A. add a heating collar to the nebulizer B. replace the nebulizer C. add water to the nebulizer D. dismantle and clean the nebulizer Correct Answer: b. replace the nebulizer TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 Shortly after you replace a jet nebulizer and tubing on a patient who has a tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout inspiration and expiration in the tracheostomy collar. Which of the following should you do first to resolve the situation? A. Decrease the input flow to the nebulizer B. Ask the patient to breath slower and deeper C. Check the entrainment setting on the nebulizer D. Obtain an arterial blood gas sample for analysis Correct Answer: c. check the entrainment setting on the nebulizer Which of the following would you expect to occur AFTER an unheated bubble diffusion humidifier is set-up and operating? A. the reservoir will be warmer than room temperature B. the reservoir will be cooler than room temperature C. the reservoir temperature will equal room temperature D. water will condense on the inside of the delivery tubing Correct Answer: b. the reservoir will be cooler than room temperature During computerized setup of a ventilator, you are prompted to enter a circuit compliance factor. This information is needed to: A. calibrate the flow sensors B. complete the automated leak test C. calibrate the pressure transducer D. compensate for compressed volume loss Correct Answer: d. compensate for compressed volume loss A bubble humidifier is connected to a flowmeter set and running at 5 L/min. When you obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT sound. Which of the following is the most likely cause of this observation? A. excessive flow through the humidifier B. a leak in the humidifier/delivery system C. diameter of delivery tubing is too small D. the flowmeter is not pressure compensated Correct Answer: b. a leak in the humidifier/delivery system Which of the following analyzers would you select if your objective were to continuously measure changes in the FIO2 in a ventilator circuit with the fastest possible response time? A. physical (paramagnetic) analyzer B. thermal conductivity analyzer C. galvanic fuel cell analyzer D. polarographic (Clark) analyzer Correct Answer: d. polarographic (clark) analyzer TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 When suctioning an adult patient using a DISS wall-mounted regulator system with collection bottle, you would initially set the vacuum pressure at: A. -12 to -15 in Hg B. -80 to -100 mm Hg C. -5 to -7 in Hg D. -100 to -120 mm Hg Correct Answer: d. -100 to -120 mm Hg In which of the following clinical situations would a patient benefit most from deep breathing exercises? A. myasthenic crisis B. postop cholecystectomy C. exacerbation of COPD D. status asthmaticus Correct Answer: b. postop cholecystectomy What size suction catheter would you select to suction a patient with a 9.0 mm ID tracheostomy tube? A. 10 Fr B. 12 Fr C. 14 Fr D. 16 Fr Correct Answer: d. 16 Fr During postural drainage therapy, a patient's heart rate remains stable at 92/min and the SpO2 is 97%. However, after you pre-oxygenate the patient and begin nasotracheal suctioning, the patient's heart rate suddenly drops to 40/min. The most likely reason for this is: A. severe mucus plugging B. hypoxemia during suctioning C. a vago-vagal reflex D. postural hypotension Correct Answer: c. a vago-vagal reflex If tolerated, a specified postural drainage position should be maintained for at least: A. 3-5 minutes B. 5-10 minutes C. 10-20 minutes D. 20-30 minutes Correct Answer: b. 5-10 minutes You are about to suction an infant who has a 3.0 mm (ID) endotracheal tube in place. What is the MAXIMUM size catheter you would use in this case? A. 6 Fr B. 8 Fr C. 5 Fr TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 D. 10 Fr Correct Answer: c. 5 Fr If a patient's chest X-ray shows infiltrates in the posterior segments of the lower lobes, postural drainage should be performed in which of the following positions? A. head down, patient prone with a pillow under her abdomen B. head down, patient supine with a pillow under her knees C. patient prone with a pillow under her head, bed flat D. patient supine with a pillow under her knees, bed flat Correct Answer: a. head down, patient prone with a pillow under her abdomen To increase a patient's maximum expiratory flow when using a cough assist or mechanical in- exsufflation (MI-E) device, you would: A. increase the inspiratory time B. decrease the expiratory pressure C. increase the expiratory time D. increase the inspiratory pressure Correct Answer: d. increase the inspiratory pressure Postural drainage would best be indicated for a patient with: A. pleural effusion B. asthma C. pneumonia D. cystic fibrosis Correct Answer: d. cystic fibrosis In discussing the goals of IPPB therapy with a postoperative patient, which of the following explanations would be most appropriate? A. "This will prevent pneumonitis." B. "This will help you take deep breaths." C. "This will prevent atelectasis." D. "This will increase your intrathoracic pressure." Correct Answer: b. "This will help you take deep breaths." A patient who is receiving an aerosol treatment with acetylcysteine (Mucomyst) and hypertonic saline via a SVN suddenly becomes dyspneic. The most likely cause of this problem is: A. hypercapnia B. bronchospasm C. pneumothorax D. fluid overload Correct Answer: b. bronchospasm A physician orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would be most appropriate to deliver this mixture? TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 A. nebulizer set at 100% oxygen with aerosol mask B. tight-fitting nonrebreathing mask with competent valving C. simple oxygen mask set to deliver 15 L/min oxygen D. tight-fitting partial rebreathing mask at 12 L/min Correct Answer: b. tight-fitting nonrebreathing mask with competent valving A doctor orders aerosol therapy for a patient receiving mechanical ventilation who is being provided humidification with a heat and moisture exchanger (HME). To assure effective therapy you must: A. place the aerosol device proximal to the HME in the stream of flow B. remove the HME before aerosol therapy and replace it afterward C. place the aerosol device distal to the HME in the stream of flow D. switch from an HME to an active heated the humidification system Correct Answer: b. remove the HME before aerosol therapy and replace it afterward Which of the following is associated with the administration of aerosolized epinephrine? A. tachycardia B. bradycardia C. laryngospasm D. bronchospasm Correct Answer: a. tachycardia After completing an aerosol drug treatment, which of the following is the most appropriate chart notation for you to make? A. Treatment given as ordered B. Aerosol therapy given; pulse stable, no changes during therapy; well tolerated C. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; vital signs stable; well tolerated D. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation Correct Answer: d. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation A physician orders 2.5 mL ipratropium bromide (Atrovent) 0.2% TID for a COPD patient with recurrent bronchospasm. Which of the following methods would you use to deliver this drug? A. small volume nebulizer with mask B. ultrasonic nebulizer with mask C. small volume nebulizer with mouthpiece D. MDI Correct Answer: c. small volume nebulizer with mouthpiece TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 Any sudden occurrence of pulmonary or cardiac distress in older, bed-ridden patients and those having undergone extensive abdominal or pelvic surgery suggest a diagnosis of: A. coronary artery disease B. pulmonary thromboembolism C. anaphylactic shock D. acute left ventricular failure Correct Answer: b. pulmonary thromboembolism Which of the following is the most common indication for home CPAP therapy? A. sleep apnea-hypopnea syndrome (SAHS) B. bronchospasm associated with asthma C. chronic hypoxemia D. neuromuscular disorders Correct Answer: a. sleep apnea-hypopnea syndrome (SAHS) The doctor is concerned that his ARDS patient on pressure control ventilation has high plateau pressures (> 30 cm H2O) and that this may be causing further lung injury. Which of the following modes of ventilation would you consider as an alternative? A. volume control ventilation B. pressure support ventilation C. airway pressure release ventilation D. continuous positive airway pressure Correct Answer: c. airway pressure release ventilation Which of the following observations indicate that an infant's work of breathing may be abnormally high? A. palor B. digital clubbing C. acrocyanosis D. nasal flaring Correct Answer: d. nasal flaring The primary aim in treating cardiogenic pulmonary edema is to: A. increase venous return to the heart B. decrease right heart and systemic venous pressures C. decrease left heart and pulmonary vascular pressures D. increase pulmonary fluid and blood volume Correct Answer: c. decrease left heart and pulmonary vascular pressures What is the most common arrhythmia seen with pulmonary disease? A. sinus bradycardia B. sinus tachycardia C. atrial fibrillation D. ventricular tachycardia Correct Answer: b. sinus tachycardia TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 The primary purpose of oxygen administration in the management of heart failure is to: A. increase the force of ventricular contractions B. decrease resistance to ventricular ejection C. increase ventricular stroke volume D. decrease the workload on the myocardium Correct Answer: d. decrease the workload of the myocardium A doctor institutes volume control ventilation for an 80 kg ARDS patient. Which of the following is the maximum pressure you would aim to achieve in this patient? A. 50 cm H2O peak pressure B. 30 cm H2O plateau pressure C. 40 cm H2O peak pressure D. 50 cm H2O plateau pressure Correct Answer: b. 30 cm H2O plateau pressure You would recommend against using noninvasive positive pressure ventilation (NPPV) for a patient with: A. secretions requiring suctioning B. the need for moderate sedation C. facial burns or trauma D. FIO2 needs greater than 40% Correct Answer: c. facial burns or trauma An alert patient with emphysema and an elevated CO2 level is given 50% O2 by an air entrainment mask. One hour later the nurse calls you to evaluate the patient. He is now very lethargic. Which of the following is the most likely cause of this? A. respiratory muscle fatigue B. cerebral hypoxia C. hypotension D. O2-induced hypoventilation Correct Answer: d. O2-induced hypoventilation Which of the following is a key therapeutic objective in the management of a patient who has closed head trauma and is receiving ventilatory support? A. increase the minute ventilation B. increase intrathoracic pressure C. assure patient-ventilator synchrony D. decrease cerebral perfusion pressure Correct Answer: c. assure patient-ventilator synchrony In individuals with disorders characterized by an increase in airway resistance, such as emphysema, which of the following breathing patterns results in the minimum work? A. deep breathing B. slow breathing TMC PRACTICE EXAM 100 QUESTIONS WITH ANSWERS 2023-2024 C. shallow breathing D. rapid breathing Correct Answer: b. slow breathing Which of the following is true regarding patients in the early stages of an asthmatic attack? A. they all exhibit respiratory alkalosis B. they always have moderate hypoxemia C. they have decreased expiratory flows D. they never respond to beta adrenergics Correct Answer: c. they have decreased expiratory flows Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following? A. airway resistance B. functional residual capacity C. inspiratory capacity D. respiratory muscle strength Correct Answer: d. respiratory muscle strength Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)? A. increased hematocrit B. decreased BUN C. decreased serum osmolality D. decreased urine specific gravity Correct Answer: a. increased hematocrit Which of the following would represent an abnormal V/Q scan suggesting pulmonary embolism? A. large segmental areas with normal ventilation and normal perfusion B. large segmental areas with no ventilation and no perfusion C. large segmental areas with normal ventilation but no perfusion D. large segmental areas with no ventilation but normal perfusion Correct Answer: c. large segmental areas with normal ventilation but no perfusion During the administration of an aerosol treatment, the patient's respiratory rate drops from 15 breaths/min to 6 breaths/min. Identify this breathing pattern. A. bradypnea B. Biot's breathing C. apnea D. hyperpnea Correct Answer: a. bradypnea You measure the blood pressure of an adult patient as 88/53 mm Hg. Which of the following chart entries would you use in describing this finding? A. patient is hypertensive