C&S TMC EXAM ONE NEWEST ACTUAL EXAM PREPARATION WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
A respiratory therapist is assisting a physician during a transtracheal bronchoscopy. As the
bronchoscope is advanced into the airways, the ECG tracing on the cardiac monitor begins to
show frequent premature ventricular contractions (PVCs). The respiratory therapist should
recommend which of the following?
A) Administration of atropine sulfate
B) Administration of epinephrine
C) Administration of lidocaine
D) Administration of adenosine
E) Immediate synchronized cardioversion
Correct Answer: C) Administration of lidocaine
Rationale: During a bronchoscopy, mechanical irritation of the airway by the scope can
trigger cardiac arrhythmias, most commonly premature ventricular contractions (PVCs).
Lidocaine (Xylocaine) is a Class IB antiarrhythmic that acts by stabilizing the myocardial
membrane and inhibiting sodium channels, which decreases ventricular irritability. It can
be administered topically to the airway to provide local anesthesia and reduce the cough
reflex or intravenously if systemic suppression of ventricular ectopy is required. Options A
and B would increase heart rate and irritability, while Option D is for supraventricular
tachycardia.
Question 2
After extubating an adult patient, the respiratory therapist observes the onset of moderate
inspiratory stridor. The therapist administers nebulized racemic epinephrine. Following the
treatment, the patient still exhibits inspiratory stridor, though the severity has slightly decreased.
What should the therapist recommend next?
A) Immediate re-intubation
B) Administration of a cool mist aerosol
C) Continue with current therapy and monitor closely
, 2
D) Administer a dose of IV furosemide
E) Perform an emergency tracheostomy
Correct Answer: C) Continue with current therapy and monitor closely
Rationale: Inspiratory stridor following extubation is typically caused by glottic or
subglottic edema. Racemic epinephrine is a vasoconstrictor (alpha-1 agonist) that reduces
mucosal swelling. If the patient shows even a slight improvement and is not in marked
respiratory distress (significant retractions or dropping SpO2), the appropriate course is to
continue monitoring and potentially repeat the therapy. Re-intubation is only indicated if
the stridor is "marked" or if the patient’s condition deteriorates despite treatment.
Question 3
Prior to receiving bronchodilator therapy, a patient presents with tachycardia, tachypnea, and
bilateral inspiratory and expiratory wheezing. Thirty minutes after the administration of the
bronchodilator, the therapist notes that the patient has normal vital signs, clear breath sounds, and
is resting comfortably. Which of the following physiological parameters has most clearly
improved?
A) Lung compliance
B) Dead space ventilation
C) Resistance to airflow
D) Alveolar-capillary diffusion
E) Static lung volumes
Correct Answer: C) Resistance to airflow
Rationale: Wheezing is the classic clinical sign of bronchoconstriction, which increases
airway resistance (Raw). Bronchodilators work by relaxing the smooth muscle of the
bronchioles, thereby increasing the diameter of the airway and decreasing the resistance to
gas flow. The resolution of wheezing and the normalization of the work of breathing
(evidenced by normal vital signs) indicate that the primary obstruction to airflow has been
relieved. Compliance refers to elasticity, while diffusion refers to gas exchange at the
alveolar level, neither of which is the primary target of a bronchodilator.
, 3
Question 4
While monitoring a patient during a traditional T-tube weaning trial with an FiO2 of 0.40, the
respiratory therapist records the following data 15 minutes after the start of the trial: Heart Rate
increases from 88 to 112/min, Respiratory Rate increases from 12 to 24/min, PaCO2 increases
from 37 to 54 mmHg, and PaO2 decreases from 79 to 72 mmHg. Which of the following actions
is most appropriate?
A) Increase the FiO2 to 0.50 and continue the trial
B) Encourage the patient to take deeper breaths
C) Administer a sedative to reduce the heart rate
D) Reconnect the patient to the ventilator with prior settings
E) Switch the patient to a CPAP of 5 cm H2O
Correct Answer: D) Reconnect the patient to the ventilator with prior settings
Rationale: The patient is exhibiting clear signs of weaning failure and respiratory fatigue.
Standard criteria for terminating a weaning trial include a heart rate increase > 20 bpm, a
respiratory rate > 30-35/min, or significant hypercapnia (PaCO2 increasing > 10 mmHg or
pH dropping < 7.25). This patient’s PaCO2 has jumped significantly (from 37 to 54),
indicating an inability to maintain adequate alveolar ventilation spontaneously. Re-
establishing mechanical ventilation is necessary to rest the respiratory muscles and prevent
further respiratory acidosis.
Question 5
If the flowmeter is set too low on a high-flow oxygen delivery system, such as a large-volume
nebulizer with an air-entrainment device, the respiratory therapist should expect which of the
following?
A) An increase in the delivered FiO2
B) A decrease in inspired oxygen concentration
C) No change in the patient's oxygenation
D) A significant increase in total flow to the patient
E) The air-entrainment ports will become obstructed
, 4
Correct Answer: B) A decrease in inspired oxygen concentration
Rationale: High-flow oxygen systems are designed to meet or exceed the patient's peak
inspiratory flow demand. If the flow from the device is lower than the patient's inspiratory
demand, the patient will inhale ambient room air along with the gas from the device to
satisfy their flow needs. This room air (21% O2) dilutes the oxygen coming from the
system, resulting in a lower-than-intended inspired oxygen concentration (FiO2). To ensure
a stable FiO2, the total flow must always exceed the patient’s peak flow.
Question 6
A patient is placed in the Trendelenburg (head-down) position for postural drainage of the right
lower lobe. Shortly after the procedure begins, the patient starts to cough vigorously and reports
sudden shortness of breath. What is the most appropriate action for the respiratory therapist to
take?
A) Administer 100% oxygen and continue the drainage
B) Increase the angle of the head-down position
C) Sit the patient up and reassure him that coughing is normal
D) Perform immediate nasotracheal suctioning
E) Administer a rapid-acting bronchodilator
Correct Answer: C) Sit the patient up and reassure him that coughing is normal
Rationale: Vigorous coughing during postural drainage indicates that secretions are being
mobilized into the larger airways, which can temporarily cause dyspnea or "air hunger."
The immediate action is to stop the head-down position, which can be physiologically
stressful and increase intracranial pressure or decrease functional residual capacity. Sitting
the patient up allows for a more effective cough and better lung expansion. Reassuring the
patient reduces anxiety, which often contributes to the sensation of shortness of breath.
Question 7
Which of the following airway devices is most suitable for an adult patient who is expected to
require long-term continuous ventilatory support (exceeding 21 days)?
A) An oropharyngeal airway
B) A cuffed endotracheal tube
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
A respiratory therapist is assisting a physician during a transtracheal bronchoscopy. As the
bronchoscope is advanced into the airways, the ECG tracing on the cardiac monitor begins to
show frequent premature ventricular contractions (PVCs). The respiratory therapist should
recommend which of the following?
A) Administration of atropine sulfate
B) Administration of epinephrine
C) Administration of lidocaine
D) Administration of adenosine
E) Immediate synchronized cardioversion
Correct Answer: C) Administration of lidocaine
Rationale: During a bronchoscopy, mechanical irritation of the airway by the scope can
trigger cardiac arrhythmias, most commonly premature ventricular contractions (PVCs).
Lidocaine (Xylocaine) is a Class IB antiarrhythmic that acts by stabilizing the myocardial
membrane and inhibiting sodium channels, which decreases ventricular irritability. It can
be administered topically to the airway to provide local anesthesia and reduce the cough
reflex or intravenously if systemic suppression of ventricular ectopy is required. Options A
and B would increase heart rate and irritability, while Option D is for supraventricular
tachycardia.
Question 2
After extubating an adult patient, the respiratory therapist observes the onset of moderate
inspiratory stridor. The therapist administers nebulized racemic epinephrine. Following the
treatment, the patient still exhibits inspiratory stridor, though the severity has slightly decreased.
What should the therapist recommend next?
A) Immediate re-intubation
B) Administration of a cool mist aerosol
C) Continue with current therapy and monitor closely
, 2
D) Administer a dose of IV furosemide
E) Perform an emergency tracheostomy
Correct Answer: C) Continue with current therapy and monitor closely
Rationale: Inspiratory stridor following extubation is typically caused by glottic or
subglottic edema. Racemic epinephrine is a vasoconstrictor (alpha-1 agonist) that reduces
mucosal swelling. If the patient shows even a slight improvement and is not in marked
respiratory distress (significant retractions or dropping SpO2), the appropriate course is to
continue monitoring and potentially repeat the therapy. Re-intubation is only indicated if
the stridor is "marked" or if the patient’s condition deteriorates despite treatment.
Question 3
Prior to receiving bronchodilator therapy, a patient presents with tachycardia, tachypnea, and
bilateral inspiratory and expiratory wheezing. Thirty minutes after the administration of the
bronchodilator, the therapist notes that the patient has normal vital signs, clear breath sounds, and
is resting comfortably. Which of the following physiological parameters has most clearly
improved?
A) Lung compliance
B) Dead space ventilation
C) Resistance to airflow
D) Alveolar-capillary diffusion
E) Static lung volumes
Correct Answer: C) Resistance to airflow
Rationale: Wheezing is the classic clinical sign of bronchoconstriction, which increases
airway resistance (Raw). Bronchodilators work by relaxing the smooth muscle of the
bronchioles, thereby increasing the diameter of the airway and decreasing the resistance to
gas flow. The resolution of wheezing and the normalization of the work of breathing
(evidenced by normal vital signs) indicate that the primary obstruction to airflow has been
relieved. Compliance refers to elasticity, while diffusion refers to gas exchange at the
alveolar level, neither of which is the primary target of a bronchodilator.
, 3
Question 4
While monitoring a patient during a traditional T-tube weaning trial with an FiO2 of 0.40, the
respiratory therapist records the following data 15 minutes after the start of the trial: Heart Rate
increases from 88 to 112/min, Respiratory Rate increases from 12 to 24/min, PaCO2 increases
from 37 to 54 mmHg, and PaO2 decreases from 79 to 72 mmHg. Which of the following actions
is most appropriate?
A) Increase the FiO2 to 0.50 and continue the trial
B) Encourage the patient to take deeper breaths
C) Administer a sedative to reduce the heart rate
D) Reconnect the patient to the ventilator with prior settings
E) Switch the patient to a CPAP of 5 cm H2O
Correct Answer: D) Reconnect the patient to the ventilator with prior settings
Rationale: The patient is exhibiting clear signs of weaning failure and respiratory fatigue.
Standard criteria for terminating a weaning trial include a heart rate increase > 20 bpm, a
respiratory rate > 30-35/min, or significant hypercapnia (PaCO2 increasing > 10 mmHg or
pH dropping < 7.25). This patient’s PaCO2 has jumped significantly (from 37 to 54),
indicating an inability to maintain adequate alveolar ventilation spontaneously. Re-
establishing mechanical ventilation is necessary to rest the respiratory muscles and prevent
further respiratory acidosis.
Question 5
If the flowmeter is set too low on a high-flow oxygen delivery system, such as a large-volume
nebulizer with an air-entrainment device, the respiratory therapist should expect which of the
following?
A) An increase in the delivered FiO2
B) A decrease in inspired oxygen concentration
C) No change in the patient's oxygenation
D) A significant increase in total flow to the patient
E) The air-entrainment ports will become obstructed
, 4
Correct Answer: B) A decrease in inspired oxygen concentration
Rationale: High-flow oxygen systems are designed to meet or exceed the patient's peak
inspiratory flow demand. If the flow from the device is lower than the patient's inspiratory
demand, the patient will inhale ambient room air along with the gas from the device to
satisfy their flow needs. This room air (21% O2) dilutes the oxygen coming from the
system, resulting in a lower-than-intended inspired oxygen concentration (FiO2). To ensure
a stable FiO2, the total flow must always exceed the patient’s peak flow.
Question 6
A patient is placed in the Trendelenburg (head-down) position for postural drainage of the right
lower lobe. Shortly after the procedure begins, the patient starts to cough vigorously and reports
sudden shortness of breath. What is the most appropriate action for the respiratory therapist to
take?
A) Administer 100% oxygen and continue the drainage
B) Increase the angle of the head-down position
C) Sit the patient up and reassure him that coughing is normal
D) Perform immediate nasotracheal suctioning
E) Administer a rapid-acting bronchodilator
Correct Answer: C) Sit the patient up and reassure him that coughing is normal
Rationale: Vigorous coughing during postural drainage indicates that secretions are being
mobilized into the larger airways, which can temporarily cause dyspnea or "air hunger."
The immediate action is to stop the head-down position, which can be physiologically
stressful and increase intracranial pressure or decrease functional residual capacity. Sitting
the patient up allows for a more effective cough and better lung expansion. Reassuring the
patient reduces anxiety, which often contributes to the sensation of shortness of breath.
Question 7
Which of the following airway devices is most suitable for an adult patient who is expected to
require long-term continuous ventilatory support (exceeding 21 days)?
A) An oropharyngeal airway
B) A cuffed endotracheal tube
