(Answered)TMC EXAM A latest distinction exam
solutions./ Respiratory therapist TMC 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
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?
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
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
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?
IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first
second?
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
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?
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.
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?
,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?
Reintubation
Which of the following patients would most likely benefit from pressure support
ventilation?
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?
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
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
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
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?
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
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
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?
elevated intracranial pressure
, What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep
apnea?
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?
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?
55 L/min
Which of the following measurements is most indicative of congestive heart failure?
pulmonary capillary wedge pressure of 30 mmHg
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for
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
hypoxemia
What size endotracheal tube would be appropriate for an adult female patient?
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
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
IV fluid challenge
What is the primary advantage of volume-controlled ventilation as compared to
pressure-controlled ventilation?
VC provides a constant minute ventilation
Bronchial breath sounds heard over the lung periphery indicate
lung consolidation
During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88%
of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81%
of predicted. How should the respiratory therapist interpret these results?
Normal lung function
A 55 year-old male patient is 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
solutions./ Respiratory therapist TMC 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
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?
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
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
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?
IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first
second?
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
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?
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.
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?
,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?
Reintubation
Which of the following patients would most likely benefit from pressure support
ventilation?
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?
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
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
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
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?
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
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
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?
elevated intracranial pressure
, What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep
apnea?
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?
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?
55 L/min
Which of the following measurements is most indicative of congestive heart failure?
pulmonary capillary wedge pressure of 30 mmHg
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for
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
hypoxemia
What size endotracheal tube would be appropriate for an adult female patient?
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
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
IV fluid challenge
What is the primary advantage of volume-controlled ventilation as compared to
pressure-controlled ventilation?
VC provides a constant minute ventilation
Bronchial breath sounds heard over the lung periphery indicate
lung consolidation
During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88%
of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81%
of predicted. How should the respiratory therapist interpret these results?
Normal lung function
A 55 year-old male patient is 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
