NEW MODIFIED TMC EXAM A AND C
ACTUAL EXAM QUESTIONS WITH CORRECT
ANSWERS GRADED A+ WITH RATIONALES
An adult patient was admitted to the emergency department after involvement in a motor
vehicle accident. The patient is hyperventilating and appears to have a flail chest. Which of
the following ABG results would you expect for this patient?
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2
C. Decreased pH and decreased SaO2
D. Decreased pH and increased SaO2 -- ANSWER--The correct answer is: A. Increased
pH and decreased SaO2
First and foremost, the question tells us that the patient is hyperventilating which means that
they are blowing off too much CO2. With that said, you should automatically know that the
pH will be increased.
And for a patient with a flail chest, you would expect them to have hypoxemia as well.
So by breaking down the question, you should easily be able to determine that the correct
answer is A.
A 63-year-old female patient is intubated and receiving mechanical ventilation in the
pressure-controlled A/C mode. If the patient's compliance were to decrease, which of the
following would you expect to occur?
A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
Page 1 of 99
,D. Her PEEP level will decrease -- ANSWER--The correct answer is: A. Her delivered
volume will decrease
To get this one correct, you must have a basic understanding of lung compliance. You also
have to take into account that the ventilator is in the pressure control mode, which means that
the pressure is pre-set.
If there is a decrease in lung compliance when the ventilator is operating in the pressure
control mode, the machine will continue delivering a constant pressure. But, since the lungs
don't expand as much when there is decreased compliance, it reaches the set pressure limit
much faster. That means that there will be a decrease in the delivered tidal volume.
In this case, the inspiratory time will decrease and the PEEP levels should not be affected.
A 70-year-old male patient is intubated and receiving mechanical ventilation in the
volumecontrolled A/C mode. After performing endotracheal suctioning, which of the
following would indicate the effective clearance of retained secretions?
A. An increased tidal volume
B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure -- ANSWER--The correct answer is: D. A decreased peak
pressure
Generally, you should remember that retained secretions will increase the patient's airway
resistance and peak airway pressure during volume control ventilation.
So taking that into consideration, if you were to clear the secretions via suctioning, that
should decrease the patient's peak airway pressure.
On the other hand, if the patient had been receiving pressure-controlled ventilation, you
would expect an increase in delivered volume once secretions are cleared. That's the key to
Page 2 of 99
,getting this one correct — you needed to understand the difference between volume and
pressure-controlled ventilation.
None of the other answer choices make sense in this situation, so you know that the correct
answer has to be D.
An adult patient who is receiving mechanical ventilation suddenly started showing signs of
tachypnea. Upon assessment, you note tracheal deviation to the right and decreased breath
sounds and hyperresonance on the left. Which of the following would you recommend?
A. The patient needs suctioning
B. The patient needs a bronchoscopy
C. The insertion of a chest tube
D. The patient needs a thoracentesis -- ANSWER--The correct answer is: C. The
insertion of a chest tube
For this one, you needed to be able to interpret the signs and symptoms that were given in the
question. And by doing so, you could easily determine that all of the signs are consistent with
a pneumothorax.
Remember, patients with a pneumothorax will typically show tracheal deviation away from
the affected side. They will also show decreased breath sounds and hyperresonance on the
affected side as well.
So in order to treat a pneumothorax, the patient requires an immediate insertion of a chest
tube on the affected side. None of the other answer choices really make sense in this
situation, so you know that the correct answer has to be C.
A 57-year-old female patient with acute pulmonary edema is dyspneic and appears to be
wheezing. The resident physician has ordered an albuterol breathing treatment via SVN.
Which of the following would you recommend?
Page 3 of 99
, A. Recommend acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Recommend a diuretic and oxygen therapy -- ANSWER--The correct answer is: D.
Recommend a diuretic and oxygen therapy
Once you begin working as a Respiratory Therapist, this is something you will run into far
too often. A nurse or new physician will hear wheezing and automatically request for the RT
to provide a breathing treatment for the patient.
It's frustrating because wheezing in patients with CHF and pulmonary edema is usually due
to fluid overload, not due to bronchospasm.
So in general, acute pulmonary edema is best managed with a diuretic, such as Lasix. Oxygen
therapy may be indicated as well if hypoxemia is present. Also, NPPV is often indicated for
these patients as well.
A 39-year-old female patient who is intubated was admitted to the emergency department and
the nurse was unable to start an intravenous line during CPR. It is believed that the patient is
suffering from a narcotic overdose and the physician wants to administer Naloxone. Which of
the following is an alternative route that can be used to deliver this medication?
A. Through the feeding tube
B. Aerosolized via SVN
C. Through the nasogastric tube
D. Through the endotracheal tube -- ANSWER--The correct answer is: D. Through the
endotracheal tube
Page 4 of 99
ACTUAL EXAM QUESTIONS WITH CORRECT
ANSWERS GRADED A+ WITH RATIONALES
An adult patient was admitted to the emergency department after involvement in a motor
vehicle accident. The patient is hyperventilating and appears to have a flail chest. Which of
the following ABG results would you expect for this patient?
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2
C. Decreased pH and decreased SaO2
D. Decreased pH and increased SaO2 -- ANSWER--The correct answer is: A. Increased
pH and decreased SaO2
First and foremost, the question tells us that the patient is hyperventilating which means that
they are blowing off too much CO2. With that said, you should automatically know that the
pH will be increased.
And for a patient with a flail chest, you would expect them to have hypoxemia as well.
So by breaking down the question, you should easily be able to determine that the correct
answer is A.
A 63-year-old female patient is intubated and receiving mechanical ventilation in the
pressure-controlled A/C mode. If the patient's compliance were to decrease, which of the
following would you expect to occur?
A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
Page 1 of 99
,D. Her PEEP level will decrease -- ANSWER--The correct answer is: A. Her delivered
volume will decrease
To get this one correct, you must have a basic understanding of lung compliance. You also
have to take into account that the ventilator is in the pressure control mode, which means that
the pressure is pre-set.
If there is a decrease in lung compliance when the ventilator is operating in the pressure
control mode, the machine will continue delivering a constant pressure. But, since the lungs
don't expand as much when there is decreased compliance, it reaches the set pressure limit
much faster. That means that there will be a decrease in the delivered tidal volume.
In this case, the inspiratory time will decrease and the PEEP levels should not be affected.
A 70-year-old male patient is intubated and receiving mechanical ventilation in the
volumecontrolled A/C mode. After performing endotracheal suctioning, which of the
following would indicate the effective clearance of retained secretions?
A. An increased tidal volume
B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure -- ANSWER--The correct answer is: D. A decreased peak
pressure
Generally, you should remember that retained secretions will increase the patient's airway
resistance and peak airway pressure during volume control ventilation.
So taking that into consideration, if you were to clear the secretions via suctioning, that
should decrease the patient's peak airway pressure.
On the other hand, if the patient had been receiving pressure-controlled ventilation, you
would expect an increase in delivered volume once secretions are cleared. That's the key to
Page 2 of 99
,getting this one correct — you needed to understand the difference between volume and
pressure-controlled ventilation.
None of the other answer choices make sense in this situation, so you know that the correct
answer has to be D.
An adult patient who is receiving mechanical ventilation suddenly started showing signs of
tachypnea. Upon assessment, you note tracheal deviation to the right and decreased breath
sounds and hyperresonance on the left. Which of the following would you recommend?
A. The patient needs suctioning
B. The patient needs a bronchoscopy
C. The insertion of a chest tube
D. The patient needs a thoracentesis -- ANSWER--The correct answer is: C. The
insertion of a chest tube
For this one, you needed to be able to interpret the signs and symptoms that were given in the
question. And by doing so, you could easily determine that all of the signs are consistent with
a pneumothorax.
Remember, patients with a pneumothorax will typically show tracheal deviation away from
the affected side. They will also show decreased breath sounds and hyperresonance on the
affected side as well.
So in order to treat a pneumothorax, the patient requires an immediate insertion of a chest
tube on the affected side. None of the other answer choices really make sense in this
situation, so you know that the correct answer has to be C.
A 57-year-old female patient with acute pulmonary edema is dyspneic and appears to be
wheezing. The resident physician has ordered an albuterol breathing treatment via SVN.
Which of the following would you recommend?
Page 3 of 99
, A. Recommend acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Recommend a diuretic and oxygen therapy -- ANSWER--The correct answer is: D.
Recommend a diuretic and oxygen therapy
Once you begin working as a Respiratory Therapist, this is something you will run into far
too often. A nurse or new physician will hear wheezing and automatically request for the RT
to provide a breathing treatment for the patient.
It's frustrating because wheezing in patients with CHF and pulmonary edema is usually due
to fluid overload, not due to bronchospasm.
So in general, acute pulmonary edema is best managed with a diuretic, such as Lasix. Oxygen
therapy may be indicated as well if hypoxemia is present. Also, NPPV is often indicated for
these patients as well.
A 39-year-old female patient who is intubated was admitted to the emergency department and
the nurse was unable to start an intravenous line during CPR. It is believed that the patient is
suffering from a narcotic overdose and the physician wants to administer Naloxone. Which of
the following is an alternative route that can be used to deliver this medication?
A. Through the feeding tube
B. Aerosolized via SVN
C. Through the nasogastric tube
D. Through the endotracheal tube -- ANSWER--The correct answer is: D. Through the
endotracheal tube
Page 4 of 99
