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TMC Practice Exam Questions With
Correct Answers
A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with A. liver failure. B. pulmonary embolism. C. heart failure. D. electrolyte imbalances - ๐โโโHeart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? A. Call for a STAT chest x-ray. B. Insert a chest tube into the left chest. C. Needle aspirate the 2nd left intercostal space. D. Activate the medical emergency team to intubate the patient. - ๐โโโNeedle aspirate the 2nd left intercostal space. All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT A. maintaining cuff pressures between 20 and 25 mm Hg.
B. using the minimal leak technique for inflation. C. using a low-residual-volume, low-compliance cuff. D. monitoring intracuff pressures. - ๐โโโmonitoring intracuff pressures. A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend A. continuing the therapy until breath sounds improve. B. administering dornase alpha. C. administering albuterol therapy. D. deep breathing and coughing to clear secretions. - ๐โโโdeep breathing and coughing to clear secretions. A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? A. IS / SMI B. IPPB with normal saline C. postural drainage and percussion D. PEP therapy - ๐โโโIPPB with normal saline A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time?
- Tidal volume
- Respiratory Rate
- Inspiratory flow
- Sensitivity - ๐โโโ 1 , 2 , and 3 only
Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time? A. cool mist aerosol treatment B. aerosolized racemic epinephrine C. manual ventilation with resuscitation bag and mask D. reintubation - ๐โโโreintubation Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B. A patient on SIMV with a set rate of 12/min and total rate of 24/min. C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support. - ๐โโโA patient on SIMV with a set rate of 12/min and total rate of 24/min. A patient receiving mechanical ventilation has developed a temperature of 99.9ยฐ F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? A. Initiate bronchial hygiene therapy. B. Obtain a sputum gram stain. C. Administer IPV. D. Insert a CASS tube. - ๐โโโObtain a sputum gram stain. Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing?
- FEV
2. PEFR
3. FRC
- RV - ๐โโโ 1 and 2 only The respiratory therapist is providing patient education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will A. sterilize the equipment. B. retard bacterial growth. C. kill all micro-organisms and spores. D. extend the equipment life. - ๐โโโRetard bacterial growth A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from A. pneumonia. B. pulmonary embolism. C. pleural effusion. D. bronchiolitis. - ๐โโโpleural effusion Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? A. 8 Fr B. 10 Fr C. 12 Fr D. 14 Fr - ๐โโโ 12 Fr
C. 16 to 30 D. Greater than 30 - ๐โโโ 5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes? A. Upper airway obstruction B. Poor peripheral perfusion C. Air leak around the sensor D. Device is out of range - ๐โโโAir leak around the sensor A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? A. 5 L/min B. 55 L/min C. 88 L/min D. 140 L/min - ๐โโโ 55 /Lmin Which of the following measurements is most indicative of pulmonary edema? A. Heart rate of 120/min B. Blood pressure of 92/72 mm Hg C. Pulmonary artery pressure of 25/10 mm Hg D. Pulmonary capillary wedge pressure of 30 mm Hg - ๐โโโPulmonary capillary wedge pressure of 30 mm Hg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for
A. 5 seconds or longer. B. 10 seconds or longer. C. 15 seconds or longer. D. 20 seconds or longer. - ๐โโโ 10 seconds or longer A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy procedure in which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT A. hypoxemia. B. pneumothorax. C. pulmonary hemorrhage. D. bronchospasm/laryngospasm. - ๐โโโhypoxemia What size endotracheal tube would be appropriate for an adult female patient? A. 6.0 to 6.5 mm B. 6.5 to 7.0 mm C. 7.0 to 7.5 mm D. 7.5 to 8.0 mm - ๐โโโ7.0 to 7.5 mm The respiratory therapist has been asked to measure Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should A. initiate an inspiratory hold just after the next ventilator-delivered breath. B. initiate an expiratory hold just prior to the next ventilator-delivered breath. C. subtract Pplat from Pdyn. D. subtract set PEEP from the measured Pplat. - ๐โโโinitiate an expiratory hold just prior to the next ventilator-delivered breath.
C. lung consolidation. D. pulmonary edema. - ๐โโโlung consolidation. During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? A. a mild restrictive disorder B. a mild obstructive disorder C. normal lung function D. mixed obstructive/restrictive disorder - ๐โโโnormal lung function A 55 year-old male patient is being evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should A. reduce the speed of the bike. B. administer supplemental oxygen. C. gradually reduce the workload and monitor closely. D. terminate the procedure immediately. - ๐โโโterminate the procedure immediately. At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? A. 4 & 8 B. 5 & 9 C. 5 & 10 D. 6 & 10 - ๐โโโ 6 & 10
The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? A. 0.25 mL B. 0.50 mL C. 1.25 mL D. 2.5 mL - ๐โโโ0.50 mL After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist has documented in the Progress Notes a need to change the patient's treatment regimen. The respiratory therapist should A. continue the current treatment plan. B. report the change in treatment plan to the next shift. C. check the electronic medical record for new physician orders. D. disregard the information until notified by the shift supervisor. - ๐โโโcheck the electronic medical record for new physician orders. A 60 kg (132 lb) patient is being mechanically ventilated with the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? A. Increase the frequency. B. Change to airway pressure release ventilation. C. Decrease the inspiratory time. D. Increase PEEP to 15 cm H2O. - ๐โโโChange to airway pressure release ventilation. In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a
A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend? A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation - ๐โโโBronchial provocation Twenty-four hours after a patient was intubated, she develops a fever of 99.9ยฐF, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend A. antiviral therapy. B. blood transfusion. C. SABA by small volume nebulizer. D. antibiotic therapy. - ๐โโโantibiotic therapy. A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? A. Enough to achieve a pressure of 25-35 cmH2O. B. Enough to achieve a minimal occluding volume. C. A minimum of 20 mL. D. Until firm tension is felt in the pilot balloon. - ๐โโโEnough to achieve a pressure of 25 - 35 cmH 2 O. All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A. carbon monoxide poisoning.
B. decompression sickness. C. anaerobic infections. D. pulmonary hypertension. - ๐โโโpulmonary hypertension. 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 - ๐โโโstroke 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; PaO 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. - ๐โโโadministering 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 - ๐โโโDecelerating
B. increase the flow to the catheter. C. decrease the flow to the catheter. D. switch to a nasal cannula. - ๐โโโswitch 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. - ๐โโโInsert 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. - ๐โโโpneumonia. 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. - ๐โโโIncrease the FIO 2.
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. - ๐โโโpoor handwashing techniques of personnel. A 36 year-old patient is admitted to the ED with a temperature of 38.5ยฐ C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? A. Pre/post bronchodilator study B. Ultrasonic nebulizer treatments C. Manually assisted coughing D. Regular coughing and deep breathing - ๐โโโRegular coughing and deep breathing The respiratory therapist has obtained a blood gas sample from the patient's radial artery and applied pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is A. adding liquid heparin to the sample. B. placing the syringe in an ice bath. C. shaking the sample continuously. D. applying a pressure bandage. - ๐โโโplacing the syringe in an ice bath. 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
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? A. severe heart failure B. respiratory distress syndrome C. severe renal failure D. moderate heart failure - ๐โโโmoderate heart failure Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? A. flail chest on right thorax B. right tension pneumothorax C. endobronchial intubation D. subcutaneous emphysema - ๐โโโendobronchial intubation A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation?
- Increase the pressure limit
- Increase the sensitivity
- Increase the mandatory rate
- Decrease the inspiratory time - ๐โโโ 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 - ๐โโโlung 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. - ๐โโโtube 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. - ๐โโโthe 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
