TMC EXAM 2| 140 QUESTIONS WITH
COMPLETE SOLUTIONS| 45 PAGES
A patient with CHF has the following input/output history
Yesterday Today
IN 1900 mL 2100 mL
OUT 1000 mL 1100 mL
Which of the following clinical findings is most likely to be observed?
A. bronchial wheezing
B. friction rub
C. decreased egophony
D. moist crepitant rales Correct Answer: The correct answer is : D
Explanation : This CHF patient is obviously retaining fluid because he is receiving more fluid in
that he is putting out. The clinical finding most associated with fluid retention is moist crepitant
rales. Fine rales are associated with atelectasis but moist rales is associated with fluid retention,
especially congestive heart failure (CHF).
An infant born 24 hours prior is experiencing frequent periods of apnea lasting more than 60
seconds. Which of the following medications would be helpful in stimulating the infant's
respiratory drive?
A. Aminophylline
B. Fluticasone
C. hormone
D. Exosurf Correct Answer: The correct answer is : A
Explanation : An infant who experiences apnea periods greater than 60 seconds may need
respiratory stimulation. This may be accomplished by administering the medication
Aminophylline. Aminophlylline is only intended for ventilatory stimulation in infants. The same
medication is used for long-term bronchodilation in adults.
A respiratory therapist is having difficulty advancing a suction catheter down a fenestrated
tracheostomy tube while the inner cannula is removed. The cannula appears to meet resistance
within a few inches from insertion. The therapist should
A. remove the tracheostomy tube
B. twist the catheter while attempting to advance
C. inflate the cuff
D. obtain a smaller suction catheter Correct Answer: The correct answer is : B
,Explanation : When suctioning somebody with a fenestrated tracheostomy tube, it must be
remembered that the suction catheters can sometimes get stuck on the fenestration hole inside the
tube. The best remedy for this is to twist the suction catheter until the end is clear of the hole.
The following flow volume loop (loop is tall and skinny) is obtained from a 62-year-old factory
worker. Which of the following could represent the patient's diagnosis?
A. pulmonary fibrosis
B. emphysema
C. cystic fibrosis
D. chronic bronchitis Correct Answer: The correct answer is : A
Explanation : The flow volume loop is tall and skinny, indicating normal flows but abnormal
volumes. This is consistent with a restrictive lung defect. The best answer is the disease that is
restrictive in nature. In this case, only pulmonary fibrosis qualifies.
Which of the following should be monitored for a ventilator-dependent newborn with IRDS?
A. gas distribution (SBN2) in the lungs
B. urine specific gravity
C. pH
D. fluid input and output Correct Answer: The correct answer is : D
Explanation : All choices are indicated while monitoring a critically ill neonate receiving
mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the
artificial airway are also essential.
Which of the following is an important element of instruction to a home care patient who will be
receiving continuous oxygen therapy at 2 L/min by nasal cannula?
A. check oxygen concentrator flow rate once a week
B. run a flow calibration check once monthly
C. do not change flow rate without a physician order
D. increase flow rate during exercise Correct Answer: The correct answer is : C
Explanation : When instructing a home care patient on the use of their oxygen concentrator, and
using oxygen in general, the respiratory therapist must include those things that are appropriate
for the patient. In this question no open flames, use of grounded plugs only, and a restriction on
changing the flow rate without a physician order are appropriate instructions. It is inappropriate
to ask the patient to check or calibrate the concentrator's flow rate once a week. This sort of
maintenance should be done by a respiratory therapist.
Which of the following parameters is NOT consistent with weaning from mechanical
ventilation?
A. A-aDO2 of 320 mmHg
,B. VT to 500 mL
C. VD/VT of 0.50
D. RSBI of 86 Correct Answer: The correct answer is : A
Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must
be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal
volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a
gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high
and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the
patient is not ready to wean from the ventilator.
A respiratory therapist is alerted by a low-volume ventilator alarm on a patient who has a chest
tube drainage system in place. Set tidal volume is 600 mL while return tidal volume is 190 mL.
The therapist should FIRST
A. increase tidal volume to compensate
B. insert an additional chest tube
C. clamp the chest tube near the patient
D. disconnect the chest tube from wall suction pressure Correct Answer: The correct answer is :
C
Explanation : A patient who is receiving mechanical ventilation, and has a chest tube drainage
system in place, must be monitored carefully for lost volume through the lung through the chest
tube drainage system. The clinical evidence of this is found in the return tidal volumes. If the
volume administered is far greater than the return volume, volume must be being lost in the
system somewhere. A loss of volume may be noticed by the excessive bubbling in the water seal
compartment. To determine how it is being lost, the first step would be to clamp the chest tube
near the patient. If bubbling in the water seal compartment stops, the volume being lost is most
likely coming from a perforation in the lung. The patient requires surgery to repair this.
While performing routine oxygen rounds, the respiratory therapist notes a COPD patient who is
receiving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min.
The therapist should FIRST
A. switch to FIO2 1.0
B. increase flow to 4 L/min by nasal cannula
C. obtain an arterial blood gas
D. go get help Correct Answer: The correct answer is : A
Explanation : Even though a COPD patient should rarely receive more than 2 L/min oxygen,
there are emergency circumstances that would dictate more supplemental oxygen. The use of the
word "markedly" is an indication of an emergency. In this case the patient is markedly cyanotic
and therefore has an oxygenation emergency. Switching to 100% oxygen is appropriate.
, A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After
introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive
pressure ventilation. The therapist should recommend
A. replacing the ET tube
B. clamping the pilot tube
C. monitoring the patient
D. initiating high frequency jet ventilation Correct Answer: The correct answer is : A
Explanation : The ET tube cuff that fails to increase in pressure after introducing additional air is
most likely damaged. When a part of an ET tube is damaged, the only acceptable option is to
replace it.
Which of the following laboratory examinations would be helpful in further assessing a patient
with diabetic ketoacidosis?
A. creatinine
B. PD50
C. glucose level
D. P50 Correct Answer: The correct answer is : C
Explanation : A patient with diabetic ketoacidosis primarily has a problem with the blood
glucose level. Further assessment therefore can be done by examining the glucose level.
What would most likely be indicated by an elevated CVP?
A. pulmonary embolism
B. fluid overload
C. left heart failure
D. increased pulmonary vascular resistance Correct Answer: The correct answer is : B
Explanation : Hypervolemia (fluid overload) is shown hemodynamically by an increase in all
hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP
is the first and most significant indicator when fluid levels in the body are high or low.
Remember, CVP may be known by other names such as, right atrial pressure, right side preload,
right ventricular filling pressure, and right ventricular end-diastolic pressure.
For which of the following conditions is PEP therapy most beneficial?
A. Postoperative recovery
B. ARDS
C. pneumonia
D. myasthenia gravis Correct Answer: The correct answer is : C
Explanation : PEP therapy is beneficial at removing secretions. Of the options given, only
pneumonia is a disease where secretions are a primary concern.
COMPLETE SOLUTIONS| 45 PAGES
A patient with CHF has the following input/output history
Yesterday Today
IN 1900 mL 2100 mL
OUT 1000 mL 1100 mL
Which of the following clinical findings is most likely to be observed?
A. bronchial wheezing
B. friction rub
C. decreased egophony
D. moist crepitant rales Correct Answer: The correct answer is : D
Explanation : This CHF patient is obviously retaining fluid because he is receiving more fluid in
that he is putting out. The clinical finding most associated with fluid retention is moist crepitant
rales. Fine rales are associated with atelectasis but moist rales is associated with fluid retention,
especially congestive heart failure (CHF).
An infant born 24 hours prior is experiencing frequent periods of apnea lasting more than 60
seconds. Which of the following medications would be helpful in stimulating the infant's
respiratory drive?
A. Aminophylline
B. Fluticasone
C. hormone
D. Exosurf Correct Answer: The correct answer is : A
Explanation : An infant who experiences apnea periods greater than 60 seconds may need
respiratory stimulation. This may be accomplished by administering the medication
Aminophylline. Aminophlylline is only intended for ventilatory stimulation in infants. The same
medication is used for long-term bronchodilation in adults.
A respiratory therapist is having difficulty advancing a suction catheter down a fenestrated
tracheostomy tube while the inner cannula is removed. The cannula appears to meet resistance
within a few inches from insertion. The therapist should
A. remove the tracheostomy tube
B. twist the catheter while attempting to advance
C. inflate the cuff
D. obtain a smaller suction catheter Correct Answer: The correct answer is : B
,Explanation : When suctioning somebody with a fenestrated tracheostomy tube, it must be
remembered that the suction catheters can sometimes get stuck on the fenestration hole inside the
tube. The best remedy for this is to twist the suction catheter until the end is clear of the hole.
The following flow volume loop (loop is tall and skinny) is obtained from a 62-year-old factory
worker. Which of the following could represent the patient's diagnosis?
A. pulmonary fibrosis
B. emphysema
C. cystic fibrosis
D. chronic bronchitis Correct Answer: The correct answer is : A
Explanation : The flow volume loop is tall and skinny, indicating normal flows but abnormal
volumes. This is consistent with a restrictive lung defect. The best answer is the disease that is
restrictive in nature. In this case, only pulmonary fibrosis qualifies.
Which of the following should be monitored for a ventilator-dependent newborn with IRDS?
A. gas distribution (SBN2) in the lungs
B. urine specific gravity
C. pH
D. fluid input and output Correct Answer: The correct answer is : D
Explanation : All choices are indicated while monitoring a critically ill neonate receiving
mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the
artificial airway are also essential.
Which of the following is an important element of instruction to a home care patient who will be
receiving continuous oxygen therapy at 2 L/min by nasal cannula?
A. check oxygen concentrator flow rate once a week
B. run a flow calibration check once monthly
C. do not change flow rate without a physician order
D. increase flow rate during exercise Correct Answer: The correct answer is : C
Explanation : When instructing a home care patient on the use of their oxygen concentrator, and
using oxygen in general, the respiratory therapist must include those things that are appropriate
for the patient. In this question no open flames, use of grounded plugs only, and a restriction on
changing the flow rate without a physician order are appropriate instructions. It is inappropriate
to ask the patient to check or calibrate the concentrator's flow rate once a week. This sort of
maintenance should be done by a respiratory therapist.
Which of the following parameters is NOT consistent with weaning from mechanical
ventilation?
A. A-aDO2 of 320 mmHg
,B. VT to 500 mL
C. VD/VT of 0.50
D. RSBI of 86 Correct Answer: The correct answer is : A
Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must
be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal
volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a
gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high
and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the
patient is not ready to wean from the ventilator.
A respiratory therapist is alerted by a low-volume ventilator alarm on a patient who has a chest
tube drainage system in place. Set tidal volume is 600 mL while return tidal volume is 190 mL.
The therapist should FIRST
A. increase tidal volume to compensate
B. insert an additional chest tube
C. clamp the chest tube near the patient
D. disconnect the chest tube from wall suction pressure Correct Answer: The correct answer is :
C
Explanation : A patient who is receiving mechanical ventilation, and has a chest tube drainage
system in place, must be monitored carefully for lost volume through the lung through the chest
tube drainage system. The clinical evidence of this is found in the return tidal volumes. If the
volume administered is far greater than the return volume, volume must be being lost in the
system somewhere. A loss of volume may be noticed by the excessive bubbling in the water seal
compartment. To determine how it is being lost, the first step would be to clamp the chest tube
near the patient. If bubbling in the water seal compartment stops, the volume being lost is most
likely coming from a perforation in the lung. The patient requires surgery to repair this.
While performing routine oxygen rounds, the respiratory therapist notes a COPD patient who is
receiving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min.
The therapist should FIRST
A. switch to FIO2 1.0
B. increase flow to 4 L/min by nasal cannula
C. obtain an arterial blood gas
D. go get help Correct Answer: The correct answer is : A
Explanation : Even though a COPD patient should rarely receive more than 2 L/min oxygen,
there are emergency circumstances that would dictate more supplemental oxygen. The use of the
word "markedly" is an indication of an emergency. In this case the patient is markedly cyanotic
and therefore has an oxygenation emergency. Switching to 100% oxygen is appropriate.
, A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After
introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive
pressure ventilation. The therapist should recommend
A. replacing the ET tube
B. clamping the pilot tube
C. monitoring the patient
D. initiating high frequency jet ventilation Correct Answer: The correct answer is : A
Explanation : The ET tube cuff that fails to increase in pressure after introducing additional air is
most likely damaged. When a part of an ET tube is damaged, the only acceptable option is to
replace it.
Which of the following laboratory examinations would be helpful in further assessing a patient
with diabetic ketoacidosis?
A. creatinine
B. PD50
C. glucose level
D. P50 Correct Answer: The correct answer is : C
Explanation : A patient with diabetic ketoacidosis primarily has a problem with the blood
glucose level. Further assessment therefore can be done by examining the glucose level.
What would most likely be indicated by an elevated CVP?
A. pulmonary embolism
B. fluid overload
C. left heart failure
D. increased pulmonary vascular resistance Correct Answer: The correct answer is : B
Explanation : Hypervolemia (fluid overload) is shown hemodynamically by an increase in all
hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP
is the first and most significant indicator when fluid levels in the body are high or low.
Remember, CVP may be known by other names such as, right atrial pressure, right side preload,
right ventricular filling pressure, and right ventricular end-diastolic pressure.
For which of the following conditions is PEP therapy most beneficial?
A. Postoperative recovery
B. ARDS
C. pneumonia
D. myasthenia gravis Correct Answer: The correct answer is : C
Explanation : PEP therapy is beneficial at removing secretions. Of the options given, only
pneumonia is a disease where secretions are a primary concern.
