TMC Practice Questions| 444 QUESTIONS| WITH
COMPLETE SOLUTIONS (viii) 43 PAGES
Which of the following is typically NOT part of a patient's social history? Correct Answer: B.
childhood diseases
Which of the following is typically part of a patient's social history? Correct Answer: A. tobacco
use
C. marital status
D. education
In observing the intracranial pressure (ICP) monitor of a patient receiving volume control A/C
ventilation, you note that the ICP rises by about 3-5 mm Hg during each positive pressure breath.
You can conclude that: Correct Answer: D. this is normal variation in ICP
Normal variations in ICP occur with both the cardiac and respiratory cycles. Respiratory cycle
variations are similar to those observed with CVP and PAWP measures, i.e., falling during
spontaneous inspiration but rising with positive pressure breaths. Correct Answer: True
An echocardiogram on a one day-old infant with refractory hypoxemia finds no evidence of
congenital heart disease but reveals right-to-left shunting through a patent ductus arteriosus,
tricuspid valve regurgitation and an enlarged right ventricle. Which of the following is the most
likely problem? Correct Answer: C. persistent pulmonary hypertension
A patient has an arterial pH of 7.58. What effect will this have on oxygen transport? Correct
Answer: A. impaired blood oxygen unloading at the tissues
Alkalosis shifts the oxyhemoglobin curve to the left, which increases the affinity of hemoglobin
for oxygen. Although this shift increases the arterial Hb saturation and CaO2 (and enhances
blood O2 uptake at the lung), it impairs O2 unloading at the tissues. Correct Answer: True
A patient has a pH of 7.58 and a PaCO2 of 50 torr. Based on these data, what is the primary acid-
base disturbance? Correct Answer: D. metabolic alkalosis
To determine the primary acid-base disturbance, first determine whether the pH is low (< 7.35 =
academia) or high (> 7.45 = alkalemia). After judging the pH, you then assess the PaCO2. If the
pH is low, the primary disturbance must be either respiratory acidosis (PaCO2 > 45 torr) or
metabolic acidosis (PaCO2 £ 45 torr). With a high pH, the primary disturbance must be either
respiratory alkalosis (PaCO2 < 35 torr) or metabolic alkalosis (PaCO2 ³ 35 torr). Correct
Answer: True
Results of a sleep study on a 57 year old female reveal an average of 2 apneic periods/hr, each
lasting about 6 seconds, and all associated with snoring. During apneic spells, the patient tries to
breathe. Which of the following conclusions can you draw from this information? Correct
Answer: C. the results of this sleep study are within normal limits
,Sleep apnea refers to episodic cessation of breathing during sleep. Since brief apneic periods are
normal during sleep, the sleep apnea syndrome is strictly defined as the occurrence of 5 or more
apneic periods per hour, each lasting at least 10 seconds. Moreover, these episodes must manifest
themselves in clinically signs or symptoms, such as polycythemia or day time hypersomnolence.
Correct Answer: True
Which of the following would tend to cause a patient to experience fluid overload
(overhydration)? Correct Answer: B. congestive heart failure
Common causes of fluid overload (overhydration) in patients include congestive heart failure,
renal failure, high sodium intake, cirrhosis of the liver and overinfusion of fluids. On the other
hand, diarrhea, vomiting, sweating/fever, hemorrhage, diuretics and excessive urination all can
cause fluid depletion (dehydration). Correct Answer: True
You come upon a patient who is unresponsive and is not breathing. You had heard from her
nurse that she had discussed a do not resuscitate (DNR) order with her physician. You should
Correct Answer: B. Immediately call a code and begin resuscitation efforts
On entering a patient's room, you notice that his lips and nailbeds are blue-gray. This finding is a
sign of: Correct Answer: A. Hypoxemia
The blue-gray color of this patient's face and hands is called cyanosis, which is generally caused
by low blood oxygen or hypoxemia. Correct Answer: True
A patient's respirations are characterized by a gradual increase and then a gradual decrease in the
depth of breathing, followed by a period of apnea. This pattern is known as which of the
following? Correct Answer: B. Cheyne-Stokes breathing
Cheyne-Stokes breathing is characterized by a gradual increase and then a gradual decrease in
tidal volume, followed by periods of apnea. This pattern is associated with brain injuries,
especially to the respiratory centers in the brainstem (pons and medulla). It also is observed in
some patients with chronic heart failure. Correct Answer: True
You are evaluating a patient in the recovery room following an exploratory laparotomy. The
patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine
the patient's level of consciousness, you speak to the patient, who does not respond. Which of the
following should you do FIRST? Correct Answer: B. shake the patient's arm gently
After you decide to conduct an interview, the next step should be to: Correct Answer: D. review
the patient's medical record
At one minute after birth, a newborn infant's extremities appear cyanotic, her heart rate is
80/min, her respirations are gasping, she exhibits some flexion of the extremities and grimaces
when stimulated. What is her Apgar score? Correct Answer: C. 5
,The Apgar score typically is performed at 1 and 5 minutes after birth and assesses the following
5 elements, each on a scale of 0 to 2: Appearance (color), Pulse/heart rate, Grimace (response to
stimulation), Activity (muscle tone), and Respiratory effort (note the A-P-G-A-R mnemonic) .
As described in this scenario, each of these 5 elements would be scored 1, for a total Apgar score
of 5. At 1 minute an Apgar score of 7-10 is considered normal (10 being the maximum). Scores
of 4-6 (as here) are intermediate and usually dictate the need for more intensive support. Infants
with Apgar scores of 0-3 usually undergo aggressive resuscitation. Needed interventions should
never be delayed in order to obtain the Apgar score, nor should these scores dictate resuscitation
procedures. Correct Answer: True
Which of the following abnormalities would appear as an area of increased radiodensity on a
chest X-ray? Correct Answer: A. pulmonary edema
The following conditions would appear as areas of increased radiodensity on a chest X-ray:
atelectasis, consolidation, interstitial lung disease, pulmonary infiltrates/edema, pleural effusion,
lung/mediastinal tumors, and calcification Correct Answer: True
An abnormal decrease in density or (aka increased radiolucency) would be observed anywhere
air replaces tissue, such as with hyperinflation, pneumothorax or pneumopericardium Correct
Answer: True
Vesicular breath sounds indicate which of the following? Correct Answer: B. normal lungs
The second heart sound (S2) is created primarily by: Correct Answer: B. closure of the
semilunar valves
Normal heart sounds are created by closure of the heart valves. The first heart sound (S1) is
produced by the closure of the mitral and tricuspid valves (atrioventricular) during ventricular
contraction. When systole ends, the semilunar valves (pulmonic and aortic) close, creating the
second heart sound (S2). Correct Answer: True
You encounter a patient who is sleepy but arouses easily and responds appropriately when
stimulated. Which of the following terms best describes her level of consciousness? Correct
Answer: lethargic
When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly
expands during inspiration. Which of the following are potential causes of this problem? Correct
Answer: A. diaphragm fatigue
Inward motion of the abdomen as the rib cage expands during inspiration is termed abdominal
paradox Correct Answer: True
Assuming ideal conditions (lighting, skin color, normal Hb), central cyanosis FIRST manifests
itself in adults when the arterial hemoglobin saturation drops below: Correct Answer: D. 80%
, In general, central cyanosis does not appear until there is an average of at least 5 gm/dL de-
oxygenated (aka reduced) Hb in the capillaries. Assuming a normal Hb content of 15 gm/dL, and
a normal C(a-v)O2 of 5 ml/dL, a mean of 5 gm/dL de-oxygenated Hb in the capillaries will occur
when the arterial O2 saturation (SaO2) drops below 80%. An SaO2 of 80% corresponds to a
PaO2 of about 45-50 torr Correct Answer: True
Activity of the accessory muscles of ventilation at rest suggests: Correct Answer: D. increased
work of breathing
Any abnormality that increases the work of breathing may cause the accessory muscles of
ventilation to become active, even at rest. This is common in acute and chronic airway
obstruction, acute upper airway obstruction, and when lung compliance is reduced. Correct
Answer: True
Which of the following respiratory signs noted on inspection of an adult patient would be
considered ABNORMAL? Correct Answer: B. sternocleidomastoid muscles used at rest
An adult's breathing rate should be between 10-20/min; the ribs should be higher posteriorly than
anteriorly at end-expiration; both side of thorax should expand equally, and the costal angle
should be about 90° but increase with inspiration. The accessory muscles of respiration
(scalenes, sternocleidomastoids, pectoralis major) should NOT be used during quiet breathing.
Correct Answer: True
Before connecting the sample syringe to an adult's arterial line stopcock, you would: Correct
Answer: B. aspirate at least 5 mL fluid/blood using a waste syringe
To help ensure that the SpO2 readings provided by a pulse oximeter are accurate, you should:
Correct Answer: B. choose the correct sensor size
Significant overinflation of an endotracheal tube cuff may cause which of the following? Correct
Answer: C. mucosal ischemia
Overinflating the cuff of an endotracheal tube (above 30 cm H2O) can decrease or occlude
capillary blood flow, resulting in mucosal ischemia and tissue damage to the tracheal wall. Air
leakage and 'silent' aspiration of pharyngeal secretions are complications of LOW cuff pressures,
i.e., below 20 cm H2O. Correct Answer: True
You obtain the following pre- and post-bronchodilator measures on a 29 year old 6-foot 2 inch
tall male patient with a chief complaint of exertional dyspnea who is undergoing disability
evaluation: Correct Answer: D. The patient is not exerting sustained effort
An adult patient is receiving 60% oxygen at 40 L/min via a high flow nasal cannula. Blood gas
results are as follows:
pH 7.52
COMPLETE SOLUTIONS (viii) 43 PAGES
Which of the following is typically NOT part of a patient's social history? Correct Answer: B.
childhood diseases
Which of the following is typically part of a patient's social history? Correct Answer: A. tobacco
use
C. marital status
D. education
In observing the intracranial pressure (ICP) monitor of a patient receiving volume control A/C
ventilation, you note that the ICP rises by about 3-5 mm Hg during each positive pressure breath.
You can conclude that: Correct Answer: D. this is normal variation in ICP
Normal variations in ICP occur with both the cardiac and respiratory cycles. Respiratory cycle
variations are similar to those observed with CVP and PAWP measures, i.e., falling during
spontaneous inspiration but rising with positive pressure breaths. Correct Answer: True
An echocardiogram on a one day-old infant with refractory hypoxemia finds no evidence of
congenital heart disease but reveals right-to-left shunting through a patent ductus arteriosus,
tricuspid valve regurgitation and an enlarged right ventricle. Which of the following is the most
likely problem? Correct Answer: C. persistent pulmonary hypertension
A patient has an arterial pH of 7.58. What effect will this have on oxygen transport? Correct
Answer: A. impaired blood oxygen unloading at the tissues
Alkalosis shifts the oxyhemoglobin curve to the left, which increases the affinity of hemoglobin
for oxygen. Although this shift increases the arterial Hb saturation and CaO2 (and enhances
blood O2 uptake at the lung), it impairs O2 unloading at the tissues. Correct Answer: True
A patient has a pH of 7.58 and a PaCO2 of 50 torr. Based on these data, what is the primary acid-
base disturbance? Correct Answer: D. metabolic alkalosis
To determine the primary acid-base disturbance, first determine whether the pH is low (< 7.35 =
academia) or high (> 7.45 = alkalemia). After judging the pH, you then assess the PaCO2. If the
pH is low, the primary disturbance must be either respiratory acidosis (PaCO2 > 45 torr) or
metabolic acidosis (PaCO2 £ 45 torr). With a high pH, the primary disturbance must be either
respiratory alkalosis (PaCO2 < 35 torr) or metabolic alkalosis (PaCO2 ³ 35 torr). Correct
Answer: True
Results of a sleep study on a 57 year old female reveal an average of 2 apneic periods/hr, each
lasting about 6 seconds, and all associated with snoring. During apneic spells, the patient tries to
breathe. Which of the following conclusions can you draw from this information? Correct
Answer: C. the results of this sleep study are within normal limits
,Sleep apnea refers to episodic cessation of breathing during sleep. Since brief apneic periods are
normal during sleep, the sleep apnea syndrome is strictly defined as the occurrence of 5 or more
apneic periods per hour, each lasting at least 10 seconds. Moreover, these episodes must manifest
themselves in clinically signs or symptoms, such as polycythemia or day time hypersomnolence.
Correct Answer: True
Which of the following would tend to cause a patient to experience fluid overload
(overhydration)? Correct Answer: B. congestive heart failure
Common causes of fluid overload (overhydration) in patients include congestive heart failure,
renal failure, high sodium intake, cirrhosis of the liver and overinfusion of fluids. On the other
hand, diarrhea, vomiting, sweating/fever, hemorrhage, diuretics and excessive urination all can
cause fluid depletion (dehydration). Correct Answer: True
You come upon a patient who is unresponsive and is not breathing. You had heard from her
nurse that she had discussed a do not resuscitate (DNR) order with her physician. You should
Correct Answer: B. Immediately call a code and begin resuscitation efforts
On entering a patient's room, you notice that his lips and nailbeds are blue-gray. This finding is a
sign of: Correct Answer: A. Hypoxemia
The blue-gray color of this patient's face and hands is called cyanosis, which is generally caused
by low blood oxygen or hypoxemia. Correct Answer: True
A patient's respirations are characterized by a gradual increase and then a gradual decrease in the
depth of breathing, followed by a period of apnea. This pattern is known as which of the
following? Correct Answer: B. Cheyne-Stokes breathing
Cheyne-Stokes breathing is characterized by a gradual increase and then a gradual decrease in
tidal volume, followed by periods of apnea. This pattern is associated with brain injuries,
especially to the respiratory centers in the brainstem (pons and medulla). It also is observed in
some patients with chronic heart failure. Correct Answer: True
You are evaluating a patient in the recovery room following an exploratory laparotomy. The
patient appears to be asleep. His respiratory rate is 14/min and heart rate is 84/min. To determine
the patient's level of consciousness, you speak to the patient, who does not respond. Which of the
following should you do FIRST? Correct Answer: B. shake the patient's arm gently
After you decide to conduct an interview, the next step should be to: Correct Answer: D. review
the patient's medical record
At one minute after birth, a newborn infant's extremities appear cyanotic, her heart rate is
80/min, her respirations are gasping, she exhibits some flexion of the extremities and grimaces
when stimulated. What is her Apgar score? Correct Answer: C. 5
,The Apgar score typically is performed at 1 and 5 minutes after birth and assesses the following
5 elements, each on a scale of 0 to 2: Appearance (color), Pulse/heart rate, Grimace (response to
stimulation), Activity (muscle tone), and Respiratory effort (note the A-P-G-A-R mnemonic) .
As described in this scenario, each of these 5 elements would be scored 1, for a total Apgar score
of 5. At 1 minute an Apgar score of 7-10 is considered normal (10 being the maximum). Scores
of 4-6 (as here) are intermediate and usually dictate the need for more intensive support. Infants
with Apgar scores of 0-3 usually undergo aggressive resuscitation. Needed interventions should
never be delayed in order to obtain the Apgar score, nor should these scores dictate resuscitation
procedures. Correct Answer: True
Which of the following abnormalities would appear as an area of increased radiodensity on a
chest X-ray? Correct Answer: A. pulmonary edema
The following conditions would appear as areas of increased radiodensity on a chest X-ray:
atelectasis, consolidation, interstitial lung disease, pulmonary infiltrates/edema, pleural effusion,
lung/mediastinal tumors, and calcification Correct Answer: True
An abnormal decrease in density or (aka increased radiolucency) would be observed anywhere
air replaces tissue, such as with hyperinflation, pneumothorax or pneumopericardium Correct
Answer: True
Vesicular breath sounds indicate which of the following? Correct Answer: B. normal lungs
The second heart sound (S2) is created primarily by: Correct Answer: B. closure of the
semilunar valves
Normal heart sounds are created by closure of the heart valves. The first heart sound (S1) is
produced by the closure of the mitral and tricuspid valves (atrioventricular) during ventricular
contraction. When systole ends, the semilunar valves (pulmonic and aortic) close, creating the
second heart sound (S2). Correct Answer: True
You encounter a patient who is sleepy but arouses easily and responds appropriately when
stimulated. Which of the following terms best describes her level of consciousness? Correct
Answer: lethargic
When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly
expands during inspiration. Which of the following are potential causes of this problem? Correct
Answer: A. diaphragm fatigue
Inward motion of the abdomen as the rib cage expands during inspiration is termed abdominal
paradox Correct Answer: True
Assuming ideal conditions (lighting, skin color, normal Hb), central cyanosis FIRST manifests
itself in adults when the arterial hemoglobin saturation drops below: Correct Answer: D. 80%
, In general, central cyanosis does not appear until there is an average of at least 5 gm/dL de-
oxygenated (aka reduced) Hb in the capillaries. Assuming a normal Hb content of 15 gm/dL, and
a normal C(a-v)O2 of 5 ml/dL, a mean of 5 gm/dL de-oxygenated Hb in the capillaries will occur
when the arterial O2 saturation (SaO2) drops below 80%. An SaO2 of 80% corresponds to a
PaO2 of about 45-50 torr Correct Answer: True
Activity of the accessory muscles of ventilation at rest suggests: Correct Answer: D. increased
work of breathing
Any abnormality that increases the work of breathing may cause the accessory muscles of
ventilation to become active, even at rest. This is common in acute and chronic airway
obstruction, acute upper airway obstruction, and when lung compliance is reduced. Correct
Answer: True
Which of the following respiratory signs noted on inspection of an adult patient would be
considered ABNORMAL? Correct Answer: B. sternocleidomastoid muscles used at rest
An adult's breathing rate should be between 10-20/min; the ribs should be higher posteriorly than
anteriorly at end-expiration; both side of thorax should expand equally, and the costal angle
should be about 90° but increase with inspiration. The accessory muscles of respiration
(scalenes, sternocleidomastoids, pectoralis major) should NOT be used during quiet breathing.
Correct Answer: True
Before connecting the sample syringe to an adult's arterial line stopcock, you would: Correct
Answer: B. aspirate at least 5 mL fluid/blood using a waste syringe
To help ensure that the SpO2 readings provided by a pulse oximeter are accurate, you should:
Correct Answer: B. choose the correct sensor size
Significant overinflation of an endotracheal tube cuff may cause which of the following? Correct
Answer: C. mucosal ischemia
Overinflating the cuff of an endotracheal tube (above 30 cm H2O) can decrease or occlude
capillary blood flow, resulting in mucosal ischemia and tissue damage to the tracheal wall. Air
leakage and 'silent' aspiration of pharyngeal secretions are complications of LOW cuff pressures,
i.e., below 20 cm H2O. Correct Answer: True
You obtain the following pre- and post-bronchodilator measures on a 29 year old 6-foot 2 inch
tall male patient with a chief complaint of exertional dyspnea who is undergoing disability
evaluation: Correct Answer: D. The patient is not exerting sustained effort
An adult patient is receiving 60% oxygen at 40 L/min via a high flow nasal cannula. Blood gas
results are as follows:
pH 7.52
