TMC Exam (Latest 2024/ 2025 Update) Questions and
Verified Answers| 100% Correct| Grade A
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
A. liver failure.
B. pulmonary embolism.
C. heart failure.
D. electrolyte imbalances - ANSWERHeart 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?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient. - ANSWERNeedle
aspirate the 2nd left intercostal space.
All of the following strategies are likely to decrease the likelihood of damage to the
tracheal mucosa EXCEPT
A. maintaining cuff pressures between 20 and 25 mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
D. monitoring intracuff pressures. - ANSWERmonitoring intracuff pressures.
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
A. continuing the therapy until breath sounds improve.
B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions. - ANSWERdeep breathing and
coughing to clear secretions.
,A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity
is 30% of his predicted value. What bronchial hygiene therapy would be most
appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy - ANSWERIPPB with normal saline
A patient on VC ventilation has demonstrated 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 - ANSWER1, 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?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube - ANSWERInsert a chest tube
A 55 year-old post cardiac surgery 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.
A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% - ANSWER5.0 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
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
,D. 50 mL/cm H2O - ANSWER50 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 86%. Which of the following would
be most appropriate at this time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation - ANSWERreintubation
Which of the following patients would most likely benefit from pressure support
ventilation?
A. An intubated patient with an absent respiratory drive.
B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.
C. A patient with acute lung injury.
D. A patient who requires short-term post-operative ventilatory support. - ANSWERA
patient on SIMV with a set 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?
A. Initiate bronchial hygiene therapy.
B. Obtain a sputum gram stain.
C. Administer IPV.
D. Insert a CASS tube. - ANSWERObtain 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 - ANSWER1 and 2 only
The respiratory therapist is providing patient 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
A. sterilize the equipment.
B. retard bacterial growth.
, C. kill all micro-organisms and spores.
D. extend the equipment life. - ANSWERRetard 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
A. pneumonia.
B. pulmonary embolism.
C. pleural effusion.
D. bronchiolitis. - ANSWERpleural effusion
Which of the following suction catheters would be appropriate to use for a patient
with a size 8.0 mm ID endotracheal tube?
A. 8 Fr
B. 10 Fr
C. 12 Fr
D. 14 Fr - ANSWER12 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
A. the patient is disconnected from the ventilator.
B. the patient is experiencing diffuse bronchospasm.
C. the endotracheal tube has slipped into the right main stem bronchus.
D. the patient has developed a left tension pneumothorax. - ANSWERthe
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
A. notify the charge nurse.
B. apply a pressure dressing.
C. apply pressure to the site.
D. perform a modified Allen's test. - ANSWERapply 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?
A. Diabetes insipidus
B. Renal failure
C. Metabolic acidosis
Verified Answers| 100% Correct| Grade A
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
A. liver failure.
B. pulmonary embolism.
C. heart failure.
D. electrolyte imbalances - ANSWERHeart 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?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient. - ANSWERNeedle
aspirate the 2nd left intercostal space.
All of the following strategies are likely to decrease the likelihood of damage to the
tracheal mucosa EXCEPT
A. maintaining cuff pressures between 20 and 25 mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
D. monitoring intracuff pressures. - ANSWERmonitoring intracuff pressures.
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
A. continuing the therapy until breath sounds improve.
B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions. - ANSWERdeep breathing and
coughing to clear secretions.
,A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity
is 30% of his predicted value. What bronchial hygiene therapy would be most
appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy - ANSWERIPPB with normal saline
A patient on VC ventilation has demonstrated 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 - ANSWER1, 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?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube - ANSWERInsert a chest tube
A 55 year-old post cardiac surgery 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.
A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% - ANSWER5.0 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
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
,D. 50 mL/cm H2O - ANSWER50 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 86%. Which of the following would
be most appropriate at this time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation - ANSWERreintubation
Which of the following patients would most likely benefit from pressure support
ventilation?
A. An intubated patient with an absent respiratory drive.
B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.
C. A patient with acute lung injury.
D. A patient who requires short-term post-operative ventilatory support. - ANSWERA
patient on SIMV with a set 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?
A. Initiate bronchial hygiene therapy.
B. Obtain a sputum gram stain.
C. Administer IPV.
D. Insert a CASS tube. - ANSWERObtain 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 - ANSWER1 and 2 only
The respiratory therapist is providing patient 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
A. sterilize the equipment.
B. retard bacterial growth.
, C. kill all micro-organisms and spores.
D. extend the equipment life. - ANSWERRetard 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
A. pneumonia.
B. pulmonary embolism.
C. pleural effusion.
D. bronchiolitis. - ANSWERpleural effusion
Which of the following suction catheters would be appropriate to use for a patient
with a size 8.0 mm ID endotracheal tube?
A. 8 Fr
B. 10 Fr
C. 12 Fr
D. 14 Fr - ANSWER12 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
A. the patient is disconnected from the ventilator.
B. the patient is experiencing diffuse bronchospasm.
C. the endotracheal tube has slipped into the right main stem bronchus.
D. the patient has developed a left tension pneumothorax. - ANSWERthe
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
A. notify the charge nurse.
B. apply a pressure dressing.
C. apply pressure to the site.
D. perform a modified Allen's test. - ANSWERapply 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?
A. Diabetes insipidus
B. Renal failure
C. Metabolic acidosis
