TMC Exam Practice Questions and Correct Answers
The following ECG tracing is recorded for a 65-year-old male who is being monitored in the
cardiac intensive care unit. Based on this rhythm, the respiratory therapist will note which of
the following in the medical record?
A. patient has sinus tachycardia
B. cardiac ischemia is present
C. patient is currently experiencing myocardia injury
D. patient has sustained cardiac tissue damage from a previous myocardial infarction
Correct Answer
D. patient has sustained cardiac tissue damage from a previous myocardial infarction
Question 1
A trauma patient is admitted to intensive care unit with an expanding subdural
hematoma. Which of the following changes would you expect to see in the
monitored intracranial pressure?
A. decreased P2 waveform component
B. decreased ICP waveform amplitude
C. loss of clear P1 waveform component
D. decreased mean intracranial pressure
Correct Answer
A rapidly expanding mass lesion in the skull (such as a subdural hematoma) will cause
an increase in mean ICP and ICP waveform amplitude. Also typically, the P2 component
of the ICP wave (related to cerebral compliance) increases more than P1 (arterial pulse
component), with P1 no longer clearly discernible in some cases. And If there is no
,change in arterial perfusing pressure, an increase in ICP will cause a decrease in
cerebral perfusing pressure.
The correct answer is: loss of clear P1 waveform compon
Question 2
When observing the monitor of an adult patient in the CCU, you note a heart rate
of 135 beats/min with a regular rhythm. Which of the following is the most likely
cause of this observation?
A. beta-blocker adminstration
B. therapeutic hypothemia
C. arterial hypertension
D. anxiety or agitation
Correct Answer
A heart rate of 135 beats/min with a regular rhythm in an adult is more than likely sinus
tachycardia. Common causes of sinus tachycardia include fear, anxiety, hypotension,
hypoxemia, anemia, fever, exercise, and any drugs that exert positive chronotropic
effects (increased heart rate). These drugs are: adrenergic drugs with beta-1 action
12
(e.g., epinephrine, dopamine) and anticholinergics such as atropine. Administration of a
beta-blocker or therapeutic hypothermia wound tend to decrease, not increase heart
rate. In term of blood pressure, arterial hypotension is a common cause of tachycardia,
not arterial hypotension.
The correct answer is: anxiety or agitation
Question 3
The husband of a comatose patient asks you to cancel a previously approved DNR
order. How should you proceed?
A. record the request in the patient record
B. notify the attending physician of the request
C. explain that only her husband can cancel the order
D. notify the charge nurse of the request
Correct Answer
,Should a patient or their surrogate ask you to change or revoke an advance directive or
DNR order, you must immediately notify the attending physician, who either cancel
the DNR order or have the new request formalized to replace any prior written
documentation.
The correct answer is: notify the attending physician of the request
Question 4
In assessing a new admission to the Intensive Care Unit, you note a spontaneous
respiratory rate of 37/minute. The most likely cause of this observation is:
A. therapeutic hypothermia
B. CNS depression
C. metabolic acidosis
D. decreased CO2 production
Correct Answer
A respiratory rate of 37/minute in an adult represents tachypnea. The most common
causes of tachypnea in hospitalized patients are fever, increased metabolic rate/CO2
production, arterial hypoxemia, metabolic acidosis, anxiety, and pain. Typically CNS
depression decreases respiratory drive, while hypothermia decreases metabolic rate
(and CO2 production), thereby decreasing ventilatory demand.
The correct answer is: metabolic acidosis
Question 5
What is the normal range for vital capacity in a healthy male of average size?
A. 5000 to 6000 ml
B. 2000 to 3000 ml
C. 3000 to 4000 ml
D. 4000 to 5000 ml
Correct Answer
The normal range for vital capacity is 4000-5000 ml, representing about 80% of the
total lung capacity. Normal values can vary significantly depending on age, sex, and test
position. Weight is not a factor in predicting normal values. Various nomograms are
available for predicting normal values.
The correct answer is: 4000 to 5000 ml
, Question 6
On inspection of a patient's EKG strip, you note that there are no identifiable P
waves; rapid irregular undulations of the isoelectric line; and an irregular
ventricular rhythm. In addition, the precordial cardiac rate is greater than the
peripheral pulse rate. What is the most likely problem?
A. 2nd degree (Wenckebach) heart block
B. ventricular fibrillation
C. atrial fibrillation
D. ventricular tachycardia
Correct Answer
The most likely problem in this case is atrial fibrillation, in which ectopic foci in the atria
fire irregularly at rates greater than 350/min. P waves are replaced by irregular
undulations of the isoelectric line. Since AV node transmission varies, the ventricular
response is also irregular. With some contractions too weak to palpate peripherally, a
pulse deficit, which is the difference between the precordial and peripheral pulse rates,
is often observed.
The correct answer is: atrial fibrillation
Question 7
Simple spirometry can be used to measure any of the following except:
A. vital capacity
B. residual volume
C. tidal volume
D. inspiratory reserve volume
Correct Answer
Residual volume is defined as the amount of air left in the lungs after a maximal
exhalation. Because the RV cannot be exhaled, it is impossible to be measured by
simple spirometry. And because the RV is a component of the FRC and TLC, simple
spirometry also cannot measure these capacities.
The correct answer is: residual volume
The following ECG tracing is recorded for a 65-year-old male who is being monitored in the
cardiac intensive care unit. Based on this rhythm, the respiratory therapist will note which of
the following in the medical record?
A. patient has sinus tachycardia
B. cardiac ischemia is present
C. patient is currently experiencing myocardia injury
D. patient has sustained cardiac tissue damage from a previous myocardial infarction
Correct Answer
D. patient has sustained cardiac tissue damage from a previous myocardial infarction
Question 1
A trauma patient is admitted to intensive care unit with an expanding subdural
hematoma. Which of the following changes would you expect to see in the
monitored intracranial pressure?
A. decreased P2 waveform component
B. decreased ICP waveform amplitude
C. loss of clear P1 waveform component
D. decreased mean intracranial pressure
Correct Answer
A rapidly expanding mass lesion in the skull (such as a subdural hematoma) will cause
an increase in mean ICP and ICP waveform amplitude. Also typically, the P2 component
of the ICP wave (related to cerebral compliance) increases more than P1 (arterial pulse
component), with P1 no longer clearly discernible in some cases. And If there is no
,change in arterial perfusing pressure, an increase in ICP will cause a decrease in
cerebral perfusing pressure.
The correct answer is: loss of clear P1 waveform compon
Question 2
When observing the monitor of an adult patient in the CCU, you note a heart rate
of 135 beats/min with a regular rhythm. Which of the following is the most likely
cause of this observation?
A. beta-blocker adminstration
B. therapeutic hypothemia
C. arterial hypertension
D. anxiety or agitation
Correct Answer
A heart rate of 135 beats/min with a regular rhythm in an adult is more than likely sinus
tachycardia. Common causes of sinus tachycardia include fear, anxiety, hypotension,
hypoxemia, anemia, fever, exercise, and any drugs that exert positive chronotropic
effects (increased heart rate). These drugs are: adrenergic drugs with beta-1 action
12
(e.g., epinephrine, dopamine) and anticholinergics such as atropine. Administration of a
beta-blocker or therapeutic hypothermia wound tend to decrease, not increase heart
rate. In term of blood pressure, arterial hypotension is a common cause of tachycardia,
not arterial hypotension.
The correct answer is: anxiety or agitation
Question 3
The husband of a comatose patient asks you to cancel a previously approved DNR
order. How should you proceed?
A. record the request in the patient record
B. notify the attending physician of the request
C. explain that only her husband can cancel the order
D. notify the charge nurse of the request
Correct Answer
,Should a patient or their surrogate ask you to change or revoke an advance directive or
DNR order, you must immediately notify the attending physician, who either cancel
the DNR order or have the new request formalized to replace any prior written
documentation.
The correct answer is: notify the attending physician of the request
Question 4
In assessing a new admission to the Intensive Care Unit, you note a spontaneous
respiratory rate of 37/minute. The most likely cause of this observation is:
A. therapeutic hypothermia
B. CNS depression
C. metabolic acidosis
D. decreased CO2 production
Correct Answer
A respiratory rate of 37/minute in an adult represents tachypnea. The most common
causes of tachypnea in hospitalized patients are fever, increased metabolic rate/CO2
production, arterial hypoxemia, metabolic acidosis, anxiety, and pain. Typically CNS
depression decreases respiratory drive, while hypothermia decreases metabolic rate
(and CO2 production), thereby decreasing ventilatory demand.
The correct answer is: metabolic acidosis
Question 5
What is the normal range for vital capacity in a healthy male of average size?
A. 5000 to 6000 ml
B. 2000 to 3000 ml
C. 3000 to 4000 ml
D. 4000 to 5000 ml
Correct Answer
The normal range for vital capacity is 4000-5000 ml, representing about 80% of the
total lung capacity. Normal values can vary significantly depending on age, sex, and test
position. Weight is not a factor in predicting normal values. Various nomograms are
available for predicting normal values.
The correct answer is: 4000 to 5000 ml
, Question 6
On inspection of a patient's EKG strip, you note that there are no identifiable P
waves; rapid irregular undulations of the isoelectric line; and an irregular
ventricular rhythm. In addition, the precordial cardiac rate is greater than the
peripheral pulse rate. What is the most likely problem?
A. 2nd degree (Wenckebach) heart block
B. ventricular fibrillation
C. atrial fibrillation
D. ventricular tachycardia
Correct Answer
The most likely problem in this case is atrial fibrillation, in which ectopic foci in the atria
fire irregularly at rates greater than 350/min. P waves are replaced by irregular
undulations of the isoelectric line. Since AV node transmission varies, the ventricular
response is also irregular. With some contractions too weak to palpate peripherally, a
pulse deficit, which is the difference between the precordial and peripheral pulse rates,
is often observed.
The correct answer is: atrial fibrillation
Question 7
Simple spirometry can be used to measure any of the following except:
A. vital capacity
B. residual volume
C. tidal volume
D. inspiratory reserve volume
Correct Answer
Residual volume is defined as the amount of air left in the lungs after a maximal
exhalation. Because the RV cannot be exhaled, it is impossible to be measured by
simple spirometry. And because the RV is a component of the FRC and TLC, simple
spirometry also cannot measure these capacities.
The correct answer is: residual volume
