TMC Practice Exam
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 - ANSWER Heart 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. - ANSWER Needle
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. - ANSWER monitoring 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. - ANSWER deep 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?
,TMC Practice Exam
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy - ANSWER IPPB 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?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity - ANSWER 1, 2, and 3 only
Which of the following would be the most appropriate therapy for a dyspneic patient who
has crepitus with tracheal deviation to the left and absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube - ANSWER Insert a chest tube
A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50,
PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous
blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate
the patient's C(a-v)O2.
A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% - ANSWER 5.0 vol%
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm
H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O - ANSWER 50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes
increasing respiratory distress with intercostal retractions and marked stridor. The SpO2
,TMC Practice Exam
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 - ANSWER reintubation
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. - ANSWER A
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 99.9° 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. - ANSWER Obtain a sputum gram stain.
Which of the following information may be obtained from a FVC maneuver during
bedside pulmonary function testing?
1. FEV1
2. PEFR
3. FRC
4. RV - ANSWER 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. - ANSWER Retard bacterial growth
, TMC Practice Exam
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. - ANSWER pleural 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 - ANSWER 12 Fr
A patient who is receiving continuous mechanical ventilation is fighting the ventilator.
His breath sounds are markedly diminished on the left, there is dullness to percussion
on the left, and the trachea is shifted to the left. The most likely explanation for the
problem is that
A. the patient is disconnected from the ventilator.
B. the patient is experiencing diffuse bronchospasm.
C. the endotracheal tube has slipped into the right main stem bronchus.
D. the patient has developed a left tension pneumothorax. - ANSWER the endotracheal
tube has slipped into the right main stem bronchus
The respiratory therapist notes a developing hematoma after an arterial blood gas was
drawn from the right radial artery. The immediate response is to
A. notify the charge nurse.
B. apply a pressure dressing.
C. apply pressure to the site.
D. perform a modified Allen's test. - ANSWER apply pressure to the site.
A patient's breathing pattern irregularly increases and decreases and is interspersed
with periods of apnea up to 1 minute. Which of the following conditions is the most likely
cause of this problem?
A. Diabetes insipidus
B. Renal failure
C. Metabolic acidosis
D. Elevated intracranial pressure - ANSWER Elevated intracranial pressure
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 - ANSWER Heart 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. - ANSWER Needle
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. - ANSWER monitoring 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. - ANSWER deep 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?
,TMC Practice Exam
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy - ANSWER IPPB 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?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity - ANSWER 1, 2, and 3 only
Which of the following would be the most appropriate therapy for a dyspneic patient who
has crepitus with tracheal deviation to the left and absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube - ANSWER Insert a chest tube
A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50,
PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous
blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate
the patient's C(a-v)O2.
A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% - ANSWER 5.0 vol%
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm
H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O - ANSWER 50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes
increasing respiratory distress with intercostal retractions and marked stridor. The SpO2
,TMC Practice Exam
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 - ANSWER reintubation
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. - ANSWER A
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 99.9° 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. - ANSWER Obtain a sputum gram stain.
Which of the following information may be obtained from a FVC maneuver during
bedside pulmonary function testing?
1. FEV1
2. PEFR
3. FRC
4. RV - ANSWER 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. - ANSWER Retard bacterial growth
, TMC Practice Exam
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. - ANSWER pleural 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 - ANSWER 12 Fr
A patient who is receiving continuous mechanical ventilation is fighting the ventilator.
His breath sounds are markedly diminished on the left, there is dullness to percussion
on the left, and the trachea is shifted to the left. The most likely explanation for the
problem is that
A. the patient is disconnected from the ventilator.
B. the patient is experiencing diffuse bronchospasm.
C. the endotracheal tube has slipped into the right main stem bronchus.
D. the patient has developed a left tension pneumothorax. - ANSWER the endotracheal
tube has slipped into the right main stem bronchus
The respiratory therapist notes a developing hematoma after an arterial blood gas was
drawn from the right radial artery. The immediate response is to
A. notify the charge nurse.
B. apply a pressure dressing.
C. apply pressure to the site.
D. perform a modified Allen's test. - ANSWER apply pressure to the site.
A patient's breathing pattern irregularly increases and decreases and is interspersed
with periods of apnea up to 1 minute. Which of the following conditions is the most likely
cause of this problem?
A. Diabetes insipidus
B. Renal failure
C. Metabolic acidosis
D. Elevated intracranial pressure - ANSWER Elevated intracranial pressure
