TMC EXAM A| 160 QUESTIONS| WITH
COMPLETE SOLUTION (18 PAGES)
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 Correct 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? Correct 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 Correct Answer: using a low residual volume, low compliance cuff
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
Correct Answer: deep breathing & coughing to clear secretions
A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his
predicted value. What bronchial hygiene therapy would be most appropriate initially? Correct
Answer: IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first second?
Correct Answer: 70%
A patient on VC ventilation demonstrates 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 Correct 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? Correct
Answer: insert a chest tube
Following cardiac surgery, a 55 year-old 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. Correct 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? Correct 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 on 40% oxygen is
noted to be 76%. Which of the following would be most appropriate at this time? Correct
Answer: Reintubation
Which of the following patients would most likely benefit from pressure support ventilation?
Correct Answer: A patient on SIMV with a mandatory 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? Correct 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 Correct Answer: 1 & 2 only
The respiratory therapist provides 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 Correct Answer: retard
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 Correct 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? Correct 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 Correct
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 Correct 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? Correct Answer: elevated intracranial pressure
, What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?
Correct Answer: 5 to 15
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices
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? Correct Answer: air leak around the
sensor
A patient on the general medical ward receives oxygen via 28% air entrainment mask with the
flowmeter set at 5 L/min. What is the total flow delivered to the patient? Correct Answer: 55
L/min
Which of the following measurements is most indicative of congestive heart failure? Correct
Answer: pulmonary capillary wedge pressure of 30 mmHg
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for Correct
Answer: 10 seconds or longer
A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during
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 Correct Answer: hypoxemia
What size endotracheal tube would be appropriate for an adult female patient? Correct Answer:
7.0 to 7.5 mm
The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving
mechanical ventilation. In order to do this, the therapist should Correct Answer: initiate an
expiratory hold just prior to the next ventilator-delivered breath.
A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary
artery catheter has been placed and the following data is available:
PCWP 4 mm Hg
PAP (mean) 8 mm Hg
CVP 2 cm H2O
Cardiac Output 3L/min
The respiratory therapist should recommend Correct Answer: IV fluid challenge
What is the primary advantage of volume-controlled ventilation as compared to pressure-
controlled ventilation? Correct Answer: VC provides a constant minute ventilation
Bronchial breath sounds heard over the lung periphery indicate Correct Answer: lung
consolidation
COMPLETE SOLUTION (18 PAGES)
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 Correct 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? Correct 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 Correct Answer: using a low residual volume, low compliance cuff
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
Correct Answer: deep breathing & coughing to clear secretions
A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his
predicted value. What bronchial hygiene therapy would be most appropriate initially? Correct
Answer: IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first second?
Correct Answer: 70%
A patient on VC ventilation demonstrates 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 Correct 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? Correct
Answer: insert a chest tube
Following cardiac surgery, a 55 year-old 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. Correct 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? Correct 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 on 40% oxygen is
noted to be 76%. Which of the following would be most appropriate at this time? Correct
Answer: Reintubation
Which of the following patients would most likely benefit from pressure support ventilation?
Correct Answer: A patient on SIMV with a mandatory 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? Correct 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 Correct Answer: 1 & 2 only
The respiratory therapist provides 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 Correct Answer: retard
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 Correct 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? Correct 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 Correct
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 Correct 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? Correct Answer: elevated intracranial pressure
, What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?
Correct Answer: 5 to 15
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices
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? Correct Answer: air leak around the
sensor
A patient on the general medical ward receives oxygen via 28% air entrainment mask with the
flowmeter set at 5 L/min. What is the total flow delivered to the patient? Correct Answer: 55
L/min
Which of the following measurements is most indicative of congestive heart failure? Correct
Answer: pulmonary capillary wedge pressure of 30 mmHg
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for Correct
Answer: 10 seconds or longer
A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during
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 Correct Answer: hypoxemia
What size endotracheal tube would be appropriate for an adult female patient? Correct Answer:
7.0 to 7.5 mm
The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving
mechanical ventilation. In order to do this, the therapist should Correct Answer: initiate an
expiratory hold just prior to the next ventilator-delivered breath.
A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary
artery catheter has been placed and the following data is available:
PCWP 4 mm Hg
PAP (mean) 8 mm Hg
CVP 2 cm H2O
Cardiac Output 3L/min
The respiratory therapist should recommend Correct Answer: IV fluid challenge
What is the primary advantage of volume-controlled ventilation as compared to pressure-
controlled ventilation? Correct Answer: VC provides a constant minute ventilation
Bronchial breath sounds heard over the lung periphery indicate Correct Answer: lung
consolidation
