TMC PRACTICE QUESTIONS AND
ANSWERS 2024
1. The physician orders a 35% aerosol mask to be set up for a patient who
requires an inspiratory flow of 42L/min. What is the minimum flow rate to
which the flowmeter must be set to meet this patient's inspiratory flow
demands? a. 6L/min
b. 8L/min
c. 10L/min
d. 12L/min: b. 8L/min
2. A premature infant is receiving O2 via a 50% O2 hood and has a PaO2 of 43
torr and a PaCO2 of 40 torr. The RT should recommend which of the
following? a. Increase the O2 to 70%
b. Intubate and institute mech. ventilation
c. Initiate CPAP of 4cm H2O and 50% O2
d. Increase the O2 to 100%: c. Initiate CPAP of 4cm H2O and 50% O2
As with adults, if the infant is hypoxemic with a normal or low PaCO2, increase the
PaO2 by increasing oxygen to no more than 60%. Studies show that oxygen levels
exceeding 60% increase damage to the lungs. If 60% doesn't reverse the
hypoxemia, place the infant on CPAP
3. A patient arrives in the ED after being pulled from a burning house. The RT
should recommend obtaining which of the following measurements to best
determine the severity of the patient's smoke inhalation? a. SpO2
b. HbCO
c. PaO2
d. Hb: b. HbCO
,To best determine the severity of smoke inhalation, an HbCO level should be
determined with a co-oximeter.
4. The physician has ordered O2 to be administered to an active 3 year old
with an SpO2 of 86%. Which of the following delivery devices would you
recommend for this patient?
a. 1 to 2 L NC
b. Air Entrainment Mask
c. Simple O2 Mask
d. O2 Hood: a. 1 to 2 L NC
An active 3-year-old generally tolerates a cannula much better than any kind of
mask and is too large for an O2 hood.
5. The ability of the patient to follow instructions would be indicated by
which of the following?
a. Orientation to person
b. Performance of task when asked.
c. Ability to feed himself
d. Awareness of time: b. Performance of task when asked
If the patient is able to perform simple tasks when asked, this best determines his
or her ability to follow instructions. This is important before administering an
incentive spirometry or IPPB treatment, which requires the patient to be able to
follow instructions well or the treatment will not be effective
6. You suspect a patient may have a pulmonary embolism. Which of the
following would be the most appropriate recommendation for diagnosis of
this condition?
a. Bronchoscopy
b. V/Q Lung Scan
c. Coagulation Studies
,d. Shunt Study: b. V/Q Lung Scan
The best diagnostic test to determine whether a pulmonary embolism is present is
the V/Q lung scan.
7. To most effectively increase a sedated, paralyzed patient's alveolar minute
ventilation while the patient is on volume controlled ventilation in the assist-
control mode, you would recommend increasing which of the following?
a. PEEP
b. Insp. Flow
c. Vt
d. Ventilator Rate: c. Vt
Alveolar minute ventilation = (VT - VD) × respiratory rate
It represents the volume actually reaching the alveoli per minute. It takes into
account anatomic dead space (VD), which is approximately 1 mL/lb of body weight.
Anatomic VD is that portion of the airway where no gas exchange occurs. If a
patient's alveolar minute ventilation is to be increased, the VT must be increased. If
only the ventilator rate is increased, the same VT is delivered, even though the
minute ventilation (VT × RR) increases.
8. Failure to hyperoxygenate a patient on a ventilator before ET suctioning
may result in
1. Hypocapnia
2. Hpoxemia
3. Hypertension4. Bradycardia
a. 2 only
b. 1 and 2
c. 2 and 3
d. 2 and 4: a. 2 only
It is important during ET suctioning that the PaO2 be maintained within a normal
range. This requires increasing the oxygen percentage during the procedure.
Failure to hyperoxygenate may cause hypoxemia, resulting in cardiac arrhythmias.
, 9. The most reliable method of determining whether the lungs of a patient
receiving mechanical ventilation are getting stiffer and harder to ventilate is
by measuring the
a. Static Lung Compliance
b. Dynamic Lung Compliance
c. Spont. Vt
d. PaO2: a. Static Lung Compliance
When lungs get stiffer and harder to ventilate, greater pressure is required to
move the same volume of air. (peak inspiratory pressure increases when RAW
increases) This pressure does not reflect how stiff the lungs actually are. We
determine the plateau or static pressure by holding the volume in the patient's
lungs for 1 to 2 seconds. This pressure closely relates to alveolar pressure. PEEP
(if used) is subtracted from the plateau pressure and this number is divided into
the VT. The results determine how compliant the lungs are.
10. A 60kg (132lb) 52 year old man is admitted to the ICU for treatment of
refractory hypoxemia. He is currently on volume controlled ventilation and
pressure support of 10cmH2O with an FiO2 of 60%. Other pertinent data are
below:
pH = 7.49
CO2 = 30
PaO2 = 59
HR = 120
RR = 26
Spont Vt = 400mL
Which of the following should the RT recommend at this time?
a. Increase the pressure support level to 15cmH2O
b. Institute 5cmH2O of PEEP
c. Increase the FiO2 to 75%
d. Initiate SIMV 60% FiO2, with a Vt of 600mL on a Rate of 10.: b. Institue
5cmH2O
ANSWERS 2024
1. The physician orders a 35% aerosol mask to be set up for a patient who
requires an inspiratory flow of 42L/min. What is the minimum flow rate to
which the flowmeter must be set to meet this patient's inspiratory flow
demands? a. 6L/min
b. 8L/min
c. 10L/min
d. 12L/min: b. 8L/min
2. A premature infant is receiving O2 via a 50% O2 hood and has a PaO2 of 43
torr and a PaCO2 of 40 torr. The RT should recommend which of the
following? a. Increase the O2 to 70%
b. Intubate and institute mech. ventilation
c. Initiate CPAP of 4cm H2O and 50% O2
d. Increase the O2 to 100%: c. Initiate CPAP of 4cm H2O and 50% O2
As with adults, if the infant is hypoxemic with a normal or low PaCO2, increase the
PaO2 by increasing oxygen to no more than 60%. Studies show that oxygen levels
exceeding 60% increase damage to the lungs. If 60% doesn't reverse the
hypoxemia, place the infant on CPAP
3. A patient arrives in the ED after being pulled from a burning house. The RT
should recommend obtaining which of the following measurements to best
determine the severity of the patient's smoke inhalation? a. SpO2
b. HbCO
c. PaO2
d. Hb: b. HbCO
,To best determine the severity of smoke inhalation, an HbCO level should be
determined with a co-oximeter.
4. The physician has ordered O2 to be administered to an active 3 year old
with an SpO2 of 86%. Which of the following delivery devices would you
recommend for this patient?
a. 1 to 2 L NC
b. Air Entrainment Mask
c. Simple O2 Mask
d. O2 Hood: a. 1 to 2 L NC
An active 3-year-old generally tolerates a cannula much better than any kind of
mask and is too large for an O2 hood.
5. The ability of the patient to follow instructions would be indicated by
which of the following?
a. Orientation to person
b. Performance of task when asked.
c. Ability to feed himself
d. Awareness of time: b. Performance of task when asked
If the patient is able to perform simple tasks when asked, this best determines his
or her ability to follow instructions. This is important before administering an
incentive spirometry or IPPB treatment, which requires the patient to be able to
follow instructions well or the treatment will not be effective
6. You suspect a patient may have a pulmonary embolism. Which of the
following would be the most appropriate recommendation for diagnosis of
this condition?
a. Bronchoscopy
b. V/Q Lung Scan
c. Coagulation Studies
,d. Shunt Study: b. V/Q Lung Scan
The best diagnostic test to determine whether a pulmonary embolism is present is
the V/Q lung scan.
7. To most effectively increase a sedated, paralyzed patient's alveolar minute
ventilation while the patient is on volume controlled ventilation in the assist-
control mode, you would recommend increasing which of the following?
a. PEEP
b. Insp. Flow
c. Vt
d. Ventilator Rate: c. Vt
Alveolar minute ventilation = (VT - VD) × respiratory rate
It represents the volume actually reaching the alveoli per minute. It takes into
account anatomic dead space (VD), which is approximately 1 mL/lb of body weight.
Anatomic VD is that portion of the airway where no gas exchange occurs. If a
patient's alveolar minute ventilation is to be increased, the VT must be increased. If
only the ventilator rate is increased, the same VT is delivered, even though the
minute ventilation (VT × RR) increases.
8. Failure to hyperoxygenate a patient on a ventilator before ET suctioning
may result in
1. Hypocapnia
2. Hpoxemia
3. Hypertension4. Bradycardia
a. 2 only
b. 1 and 2
c. 2 and 3
d. 2 and 4: a. 2 only
It is important during ET suctioning that the PaO2 be maintained within a normal
range. This requires increasing the oxygen percentage during the procedure.
Failure to hyperoxygenate may cause hypoxemia, resulting in cardiac arrhythmias.
, 9. The most reliable method of determining whether the lungs of a patient
receiving mechanical ventilation are getting stiffer and harder to ventilate is
by measuring the
a. Static Lung Compliance
b. Dynamic Lung Compliance
c. Spont. Vt
d. PaO2: a. Static Lung Compliance
When lungs get stiffer and harder to ventilate, greater pressure is required to
move the same volume of air. (peak inspiratory pressure increases when RAW
increases) This pressure does not reflect how stiff the lungs actually are. We
determine the plateau or static pressure by holding the volume in the patient's
lungs for 1 to 2 seconds. This pressure closely relates to alveolar pressure. PEEP
(if used) is subtracted from the plateau pressure and this number is divided into
the VT. The results determine how compliant the lungs are.
10. A 60kg (132lb) 52 year old man is admitted to the ICU for treatment of
refractory hypoxemia. He is currently on volume controlled ventilation and
pressure support of 10cmH2O with an FiO2 of 60%. Other pertinent data are
below:
pH = 7.49
CO2 = 30
PaO2 = 59
HR = 120
RR = 26
Spont Vt = 400mL
Which of the following should the RT recommend at this time?
a. Increase the pressure support level to 15cmH2O
b. Institute 5cmH2O of PEEP
c. Increase the FiO2 to 75%
d. Initiate SIMV 60% FiO2, with a Vt of 600mL on a Rate of 10.: b. Institue
5cmH2O
