TMC MOCK REAL EXAM 180+ ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH (VERIFIED ANSWERS) |ALREADY GRADED A+
1. During the assessment of a 64-year-old female patient, you note the following signs: dyspnea,
hypotension, and a tracheal shift to the right. The patient also has absent breath sounds, reduced
chest expansion, and a hyperresonant percussion note all on the left side. These findings suggest
which of the following?
A. A pleural effusion on the left side
B. A pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side - CORRECT ANSWER-B. A pneumothorax on the left side
2. A 39-year-old male patient was admitted to the emergency department with a fever and an SpO2
of 87% on room air. Upon auscultation, rhonchi is heard and the patient has a productive cough.
Which of the following would you recommend?
A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity - CORRECT
ANSWER-D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
3. A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-
controlled A/C ventilation. Upon assessment, you note that the patient's cuff pressure is measured
at 38 cm H2O. Which of the following would you recommend?
A. Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cm H2O
D. Recommend ventilation via a tracheostomy instead - CORRECT ANSWER-C. Lower the cuff
pressure to < 30 cm H2O
4. During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at
4 L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most
likely cause of this finding?
,A. There is an obstruction in the delivery tube
B. The patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high - CORRECT ANSWER-A. There is an obstruction in the
delivery tube
5. A pre and post bronchodilator test was ordered on a 48-year-old female patient. The forced
expiratory measurement that was obtained after the bronchodilator was given shows an increase in
the patient's FEV1 from 60% to 80% of the predicted value. This finding suggests which of the
following?
A. A fixed airway obstruction
B. A reversible airway obstruction
C. A normal diffusion capacity
D. A restrictive process - CORRECT ANSWER-B. A reversible airway obstruction
6. A 58-year-old female patient is intubated and appears to be breathing asynchronously with the
ventilator. Her breath sounds are absent on the left side and the trachea appears to be shifted to the
left. The patient has a dull percussion note on the left side as well. Which of the following is the most
likely explanation of these findings?
A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm - CORRECT ANSWER-C. The endotracheal
tube is in the right mainstem bronchus
7. 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
D. Her PEEP level will decrease - CORRECT ANSWER-A. Her delivered volume will decrease
,8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume
controlled 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 - CORRECT ANSWER-D. A decreased peak pressure
9. 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 - CORRECT ANSWER-C. The insertion of a chest tube
10. 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?
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 - CORRECT ANSWER-D. Recommend a diuretic
and oxygen therapy
11. 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 - CORRECT ANSWER-D. Through the endotracheal tube
, 12. A 176 lb male patient is intubated and receiving volume control A/C ventilation with the
following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An ABG was analyzed
and the following results were obtained:
pH 7.39
PaCO2 37
HCO3 23
PaO2 107
Which of the following would you recommend?
A. Place the patient on a 40% T-piece and monitor closely
B. Switch the patient to SIMV at a rate of 5/minute
C. Place the patient on CPAP and monitor closely
D. Maintain the current ventilator settings and re-evaluate later - CORRECT ANSWER-D.
Maintain the current ventilator settings and re-evaluate later
13. 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 - CORRECT ANSWER-A. Increased pH and decreased SaO2
14. A 51-year-old female patient with a history of asthma is receiving mechanical ventilation in the
assist-control mode. Upon assessment, you note that she is struggling to initiate inspiration. Which
of the following settings would you check first in order to resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP - CORRECT ANSWER-C. Sensitivity
15. The physician has requested the insertion of a nasopharyngeal airway on an adult patient. This
type of airway is useful in supporting which of the following?
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH (VERIFIED ANSWERS) |ALREADY GRADED A+
1. During the assessment of a 64-year-old female patient, you note the following signs: dyspnea,
hypotension, and a tracheal shift to the right. The patient also has absent breath sounds, reduced
chest expansion, and a hyperresonant percussion note all on the left side. These findings suggest
which of the following?
A. A pleural effusion on the left side
B. A pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side - CORRECT ANSWER-B. A pneumothorax on the left side
2. A 39-year-old male patient was admitted to the emergency department with a fever and an SpO2
of 87% on room air. Upon auscultation, rhonchi is heard and the patient has a productive cough.
Which of the following would you recommend?
A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity - CORRECT
ANSWER-D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
3. A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-
controlled A/C ventilation. Upon assessment, you note that the patient's cuff pressure is measured
at 38 cm H2O. Which of the following would you recommend?
A. Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cm H2O
D. Recommend ventilation via a tracheostomy instead - CORRECT ANSWER-C. Lower the cuff
pressure to < 30 cm H2O
4. During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at
4 L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most
likely cause of this finding?
,A. There is an obstruction in the delivery tube
B. The patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high - CORRECT ANSWER-A. There is an obstruction in the
delivery tube
5. A pre and post bronchodilator test was ordered on a 48-year-old female patient. The forced
expiratory measurement that was obtained after the bronchodilator was given shows an increase in
the patient's FEV1 from 60% to 80% of the predicted value. This finding suggests which of the
following?
A. A fixed airway obstruction
B. A reversible airway obstruction
C. A normal diffusion capacity
D. A restrictive process - CORRECT ANSWER-B. A reversible airway obstruction
6. A 58-year-old female patient is intubated and appears to be breathing asynchronously with the
ventilator. Her breath sounds are absent on the left side and the trachea appears to be shifted to the
left. The patient has a dull percussion note on the left side as well. Which of the following is the most
likely explanation of these findings?
A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm - CORRECT ANSWER-C. The endotracheal
tube is in the right mainstem bronchus
7. 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
D. Her PEEP level will decrease - CORRECT ANSWER-A. Her delivered volume will decrease
,8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume
controlled 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 - CORRECT ANSWER-D. A decreased peak pressure
9. 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 - CORRECT ANSWER-C. The insertion of a chest tube
10. 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?
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 - CORRECT ANSWER-D. Recommend a diuretic
and oxygen therapy
11. 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 - CORRECT ANSWER-D. Through the endotracheal tube
, 12. A 176 lb male patient is intubated and receiving volume control A/C ventilation with the
following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An ABG was analyzed
and the following results were obtained:
pH 7.39
PaCO2 37
HCO3 23
PaO2 107
Which of the following would you recommend?
A. Place the patient on a 40% T-piece and monitor closely
B. Switch the patient to SIMV at a rate of 5/minute
C. Place the patient on CPAP and monitor closely
D. Maintain the current ventilator settings and re-evaluate later - CORRECT ANSWER-D.
Maintain the current ventilator settings and re-evaluate later
13. 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 - CORRECT ANSWER-A. Increased pH and decreased SaO2
14. A 51-year-old female patient with a history of asthma is receiving mechanical ventilation in the
assist-control mode. Upon assessment, you note that she is struggling to initiate inspiration. Which
of the following settings would you check first in order to resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP - CORRECT ANSWER-C. Sensitivity
15. The physician has requested the insertion of a nasopharyngeal airway on an adult patient. This
type of airway is useful in supporting which of the following?
