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TMC Mock Exam 100% Correct la
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Questions and Answers
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Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia
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begins to exhibit hypotension and decreased consciousness. Which of the following
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actions would you recommend at this time?
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immediately initiate CPR
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apply cardioversion
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administer epinephrine
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defibrillate the patient. Ans- apply cardioversion
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*If drug management fails, if the ventricular rate exceeds 150/min, or if the patient
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becomes hemodynamically unstable, synchronous cardioversion is indicated.
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A physician orders intubation and volume-controlled A/C ventilation for a 6-foot, 3-inch
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tall 190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator
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settings would you aim for to support this patient?
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rate/min: 10; VT (mL): 800
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rate/min: 15; VT (mL): 500
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rate/min: 20; VT (mL): 900
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rate/min: 8; VT (mL): 1200. Ans- rate/min: 15; VT (mL): 500
la
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Tidal volume 6ml/kg IBW
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Sp
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6ft 3= 85kg IBW
la
Vt= 500
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Rate= 10 to 20
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A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a
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targeted tidal volume of 420 mL To maintain adequate ventilation with this tidal volume,
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the maximum respiratory rate you would allow is:
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25/min
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35/min
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20/min
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30/min. Ans- 35/min
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la
Which of the following PaCO2 levels would be considered a positive result for brain
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death determination at the end of an apnea test?
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Sp
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-at least 50 mm Hg
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Sp
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, ne
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-at least 45 mm Hg la
-at least 60 mm Hg
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-at least 55 mm Hg. Ans- at least 60 mm Hg
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or 20+ from baseline CO2
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la
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A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of
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650 mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives
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would you recommend to help overcome this problem?
1. add an end-inspiratory pause
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2. switch to SIMV and decrease the rate
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3. increase the inspiratory flow
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2 and 3 only
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1, 2, and 3
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1 and 3 only
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1 and 2 only. Ans- 2 and 3 only
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* Adding an end-inspiratory pause would cause more airtrapping
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A patient who just underwent major thoracic surgery is placed on pressure-controlled
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A/C ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water
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seal chamber of his pleural drainage system. Which of the following is the most likely
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cause of this observation?
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-the patient has a pleural effusion
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-the suction/ vacuum pressure is too low
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-the drainage system is obstructed
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-the patient has a bronchopleural fistula. Ans- the patient has a bronchopleural fistula
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* Constant bubbling indicates a leak; either in the patient or in the tubing/chamber
system.
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Sp
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To measure the amount of auto-PEEP present in a patient receiving ventilatory support,
la
you would:
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Sp
-measure pressure during an end-expiratory pause
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-measure expiratory flow before and after bronchodilator
la
-measure pressure at volume increments using a super syringe
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-measure pressure during an end-inspiratory pause. Ans- measure pressure during an
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Sp
end-expiratory pause
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la
Which of the following indicate that a pleural drainage system is working properly?
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1. the water seal chamber level rises and falls with breathing
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2. there is continuous bubbling in the suction control chamber
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3. there is continuous bubbling in the water seal chamber
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Sp
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, ne
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1, 2, and 3
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1 only
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1 and 2
3 only. Ans- 1 and 2
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la
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* Suction control should bubble continuously and water seal chamber should rise and
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fall.
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* Continuous bubbling in the water seal chamber= leak.
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sh
A physician wants to calculate the static lung compliance for a 110-kg patient receiving
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volume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900
ml, Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10
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cmH2O, Mechanical dead space 100ml. The patient's static lung compliance is:
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22 mL/cmH2O
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26 mL/cmH2O
la
18 mL/cmH2O
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sh
36 mL/cmH2O. Ans- 36 mL/cmH2O
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*VT/(Plat-PEEP)
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A physician has attempted on several occasions to insert a central venous catheter into
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the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the
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ventilator's high-pressure alarm sounds, the patient's blood pressure drops, and the
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SPO2 value drips from 96% to 84%. Breath sounds are greatly diminished over the
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right-lung field. What action should you recommend?
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Sp
ne
la
-insert a chest tube into the right pleural space
-insert a pulmonary artery catheter
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-pull the ET back 2-3 cm into the trachea
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-insert a chest tube into the left pleural space. Ans- insert a chest tube into the right
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pleural space
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* Pneumothorax is a complication of central venous catheter.
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A 48-year-old 180-lb male is orally intubated receiving mechanical ventilation with a 6.0
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mm endotracheal tube secured in place, which requires a cuff pressure of 38 cm H2O to
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prevent significant volume loss. Which of the following actions would be appropriate in
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this case?
la
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-accept the large volume loss during inspiration
sh
Sp
-deflate and reinflate the cuff with 20 ml of air
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-replace the endotracheal tube with a larger size
la
sh
Sp
la
Sp
, ne
tz
sh
ne
-replace the endotracheal tube with a smaller size. Ans- replace the endotracheal tube
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with a larger size
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sh
Sp
*Most common cause of high ET tube cuff pressure is the tube is too small
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la
You are assisting with the oral intubation of an adult patient. After the ET tube has been
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placed, you note that breath sounds are decreased on the left compared with the right
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lung. The most likely cause of this observation is:
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-the tip of the tube is in the right mainstem bronchus
la
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-the endotracheal tube has been inserted into the esophagus
sh
-the cuff of the endotracheal tube has been overinflated
Sp
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-the tip Of the tube is in the left mainstem bronchus. Ans- the tip of the tube is in the
right mainstem bronchus
la
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sh
*Confirmed with CXR and corrected by withdrawing tube until it is 4-6cm above carina
Sp
ne
To minimize the risk of aspiration of glottic secretions or cord damage during removal of
la
an oral endotracheal tube, you should:
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sh
Sp
-have the patient cough while you quickly pull the tube
ne
-fully occlude the ET tube while you quickly it out
la
-provide 100% o»gen for 1-2 minute before extubation
tz
sh
-keep the tube cuff pressure below 25—30 cm H20. Ans- have the patient cough while
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you quickly pull the tube
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la
* Prevents damage to vocal cords and minimizes aspiration
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sh
Sp
If progressively higher and higher cuff pressures are needed to avoid leakage over time,
ne
the most likely problem is:
la
-tracheal dilation/tracheomalacia
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sh
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-tube is too small
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-tracheal stenosis
la
-right mainstem intubation. Ans- dilation/tracheomalacia
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* Or cuff/pilot balloon malfunction
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la
Immediately after endotracheal tube extubation, an adult patient exhibits a high pitched
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inspiratory noise, heard without a stethoscope. Which of the following actions would you
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Sp
recommend?
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la
-a STAT racemic epinephrine aerosol treatment
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-careful observation of the patient for 6 hours
sh
Sp
-a STAT heated aerosol treatment with saline
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la
sh
Sp
la
Sp
tz
sh
ne
TMC Mock Exam 100% Correct la
tz
Questions and Answers
sh
Sp
ne
la
tz
Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia
sh
Sp
begins to exhibit hypotension and decreased consciousness. Which of the following
ne
actions would you recommend at this time?
la
tz
immediately initiate CPR
sh
Sp
apply cardioversion
ne
administer epinephrine
la
defibrillate the patient. Ans- apply cardioversion
tz
sh
Sp
*If drug management fails, if the ventricular rate exceeds 150/min, or if the patient
ne
becomes hemodynamically unstable, synchronous cardioversion is indicated.
la
tz
A physician orders intubation and volume-controlled A/C ventilation for a 6-foot, 3-inch
sh
tall 190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator
Sp
ne
settings would you aim for to support this patient?
la
rate/min: 10; VT (mL): 800
tz
sh
rate/min: 15; VT (mL): 500
Sp
rate/min: 20; VT (mL): 900
ne
rate/min: 8; VT (mL): 1200. Ans- rate/min: 15; VT (mL): 500
la
tz
Tidal volume 6ml/kg IBW
sh
Sp
ne
6ft 3= 85kg IBW
la
Vt= 500
tz
sh
Rate= 10 to 20
Sp
ne
A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a
la
targeted tidal volume of 420 mL To maintain adequate ventilation with this tidal volume,
tz
the maximum respiratory rate you would allow is:
sh
Sp
ne
25/min
la
35/min
tz
20/min
sh
Sp
30/min. Ans- 35/min
ne
la
Which of the following PaCO2 levels would be considered a positive result for brain
tz
death determination at the end of an apnea test?
sh
Sp
ne
-at least 50 mm Hg
la
sh
Sp
la
Sp
, ne
tz
sh
ne
-at least 45 mm Hg la
-at least 60 mm Hg
tz
-at least 55 mm Hg. Ans- at least 60 mm Hg
sh
Sp
or 20+ from baseline CO2
ne
la
tz
A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of
sh
Sp
650 mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives
ne
would you recommend to help overcome this problem?
1. add an end-inspiratory pause
la
tz
2. switch to SIMV and decrease the rate
sh
3. increase the inspiratory flow
Sp
ne
2 and 3 only
la
1, 2, and 3
tz
sh
1 and 3 only
Sp
1 and 2 only. Ans- 2 and 3 only
ne
la
* Adding an end-inspiratory pause would cause more airtrapping
tz
sh
Sp
A patient who just underwent major thoracic surgery is placed on pressure-controlled
ne
A/C ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water
la
seal chamber of his pleural drainage system. Which of the following is the most likely
tz
sh
cause of this observation?
Sp
ne
-the patient has a pleural effusion
la
-the suction/ vacuum pressure is too low
tz
-the drainage system is obstructed
sh
Sp
-the patient has a bronchopleural fistula. Ans- the patient has a bronchopleural fistula
ne
la
* Constant bubbling indicates a leak; either in the patient or in the tubing/chamber
system.
tz
sh
Sp
ne
To measure the amount of auto-PEEP present in a patient receiving ventilatory support,
la
you would:
tz
sh
Sp
-measure pressure during an end-expiratory pause
ne
-measure expiratory flow before and after bronchodilator
la
-measure pressure at volume increments using a super syringe
tz
-measure pressure during an end-inspiratory pause. Ans- measure pressure during an
sh
Sp
end-expiratory pause
ne
la
Which of the following indicate that a pleural drainage system is working properly?
tz
1. the water seal chamber level rises and falls with breathing
sh
Sp
2. there is continuous bubbling in the suction control chamber
ne
3. there is continuous bubbling in the water seal chamber
la
sh
Sp
la
Sp
, ne
tz
sh
ne
1, 2, and 3
la
tz
1 only
sh
Sp
1 and 2
3 only. Ans- 1 and 2
ne
la
tz
* Suction control should bubble continuously and water seal chamber should rise and
sh
Sp
fall.
ne
* Continuous bubbling in the water seal chamber= leak.
la
tz
sh
A physician wants to calculate the static lung compliance for a 110-kg patient receiving
Sp
ne
volume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900
ml, Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10
la
cmH2O, Mechanical dead space 100ml. The patient's static lung compliance is:
tz
sh
Sp
22 mL/cmH2O
ne
26 mL/cmH2O
la
18 mL/cmH2O
tz
sh
36 mL/cmH2O. Ans- 36 mL/cmH2O
Sp
ne
*VT/(Plat-PEEP)
la
tz
sh
A physician has attempted on several occasions to insert a central venous catheter into
Sp
the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the
ne
ventilator's high-pressure alarm sounds, the patient's blood pressure drops, and the
la
SPO2 value drips from 96% to 84%. Breath sounds are greatly diminished over the
tz
right-lung field. What action should you recommend?
sh
Sp
ne
la
-insert a chest tube into the right pleural space
-insert a pulmonary artery catheter
tz
sh
Sp
-pull the ET back 2-3 cm into the trachea
ne
-insert a chest tube into the left pleural space. Ans- insert a chest tube into the right
la
pleural space
tz
sh
Sp
* Pneumothorax is a complication of central venous catheter.
ne
la
A 48-year-old 180-lb male is orally intubated receiving mechanical ventilation with a 6.0
tz
mm endotracheal tube secured in place, which requires a cuff pressure of 38 cm H2O to
sh
Sp
prevent significant volume loss. Which of the following actions would be appropriate in
ne
this case?
la
tz
-accept the large volume loss during inspiration
sh
Sp
-deflate and reinflate the cuff with 20 ml of air
ne
-replace the endotracheal tube with a larger size
la
sh
Sp
la
Sp
, ne
tz
sh
ne
-replace the endotracheal tube with a smaller size. Ans- replace the endotracheal tube
la
with a larger size
tz
sh
Sp
*Most common cause of high ET tube cuff pressure is the tube is too small
ne
la
You are assisting with the oral intubation of an adult patient. After the ET tube has been
tz
placed, you note that breath sounds are decreased on the left compared with the right
sh
Sp
lung. The most likely cause of this observation is:
ne
-the tip of the tube is in the right mainstem bronchus
la
tz
-the endotracheal tube has been inserted into the esophagus
sh
-the cuff of the endotracheal tube has been overinflated
Sp
ne
-the tip Of the tube is in the left mainstem bronchus. Ans- the tip of the tube is in the
right mainstem bronchus
la
tz
sh
*Confirmed with CXR and corrected by withdrawing tube until it is 4-6cm above carina
Sp
ne
To minimize the risk of aspiration of glottic secretions or cord damage during removal of
la
an oral endotracheal tube, you should:
tz
sh
Sp
-have the patient cough while you quickly pull the tube
ne
-fully occlude the ET tube while you quickly it out
la
-provide 100% o»gen for 1-2 minute before extubation
tz
sh
-keep the tube cuff pressure below 25—30 cm H20. Ans- have the patient cough while
Sp
you quickly pull the tube
ne
la
* Prevents damage to vocal cords and minimizes aspiration
tz
sh
Sp
If progressively higher and higher cuff pressures are needed to avoid leakage over time,
ne
the most likely problem is:
la
-tracheal dilation/tracheomalacia
tz
sh
Sp
-tube is too small
ne
-tracheal stenosis
la
-right mainstem intubation. Ans- dilation/tracheomalacia
tz
sh
Sp
* Or cuff/pilot balloon malfunction
ne
la
Immediately after endotracheal tube extubation, an adult patient exhibits a high pitched
tz
inspiratory noise, heard without a stethoscope. Which of the following actions would you
sh
Sp
recommend?
ne
la
-a STAT racemic epinephrine aerosol treatment
tz
-careful observation of the patient for 6 hours
sh
Sp
-a STAT heated aerosol treatment with saline
ne
la
sh
Sp
la
Sp
