KETTERING TMC EXAM PRACTICE
(2026) – HIGH DIFFICULTY
PREPARATION REVIEW QUESTIONS
AND ANSWERS
1. A 65-year-old patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen via a 28% air-entrainment mask. The patient’s PaO2 is 55 mmHg and the PaCO2 is 68
mmHg. Which of the following is the most appropriate action?
A. Increase the oxygen concentration to 40%
B. Initiate non-invasive positive pressure ventilation (NIPPV)
C. Intubate and initiate mechanical ventilation
D. Maintain current therapy
Answer: B
Conceptual Explanation: The patient is experiencing acute-on-chronic respiratory failure
with hypercapnia. NIPPV is the first-line treatment for COPD exacerbations to reduce the
work of breathing and improve gas exchange before considering invasive ventilation.
,2. While monitoring a patient in the ICU, the respiratory therapist notes the following
hemodynamic values: CVP 12 mmHg, PAP 38/22 mmHg, PCWP 8 mmHg, and QT 3.8 L/min.
These findings are most consistent with:
A. Pulmonary embolism
B. Left heart failure
C. Hypervolemia
D. Right heart failure
Answer: A
Conceptual Explanation: High CVP and high PAP with a normal or low PCWP and low
cardiac output (QT) suggest an obstruction to blood flow in the lungs, such as a pulmonary
embolism or pulmonary hypertension.
3. A patient receiving volume-controlled ventilation has an increased peak inspiratory
pressure (PIP), while the plateau pressure remains unchanged. Which of the following has
likely occurred?
A. Decreased lung compliance
B. Development of a pneumothorax
C. Endotracheal tube cuff leak
D. Increased airway resistance
Answer: D
, Conceptual Explanation: An increase in PIP without an increase in plateau pressure
indicates an increase in transairway pressure, which is caused by increased airway
resistance (e.g., secretions, bronchospasm, or biting the tube).
4. Calculate the static compliance (Cs) for a patient with the following ventilator settings and
data: Vt 500 mL, PIP 35 cmH2O, Pplat 25 cmH2O, PEEP 5 cmH2O.
A. 14 mL/cmH2O
B. 20 mL/cmH2O
C. 25 mL/cmH2O
D. 50 mL/cmH2O
Answer: C
Conceptual Explanation: Static Compliance = Vt / (Pplat - PEEP). Here, 500 / (25 - 5) =
= 25 mL/cmH2O.
5. A 32-week gestational age neonate has a 1-minute Apgar score of 3. The infant is gasping
and has a heart rate of 80 bpm. What is the immediate next step?
A. Administer 100% oxygen via blow-by
B. Initiate positive pressure ventilation (PPV)
C. Perform chest compressions
D. Intubate and administer epinephrine
Answer: B
(2026) – HIGH DIFFICULTY
PREPARATION REVIEW QUESTIONS
AND ANSWERS
1. A 65-year-old patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen via a 28% air-entrainment mask. The patient’s PaO2 is 55 mmHg and the PaCO2 is 68
mmHg. Which of the following is the most appropriate action?
A. Increase the oxygen concentration to 40%
B. Initiate non-invasive positive pressure ventilation (NIPPV)
C. Intubate and initiate mechanical ventilation
D. Maintain current therapy
Answer: B
Conceptual Explanation: The patient is experiencing acute-on-chronic respiratory failure
with hypercapnia. NIPPV is the first-line treatment for COPD exacerbations to reduce the
work of breathing and improve gas exchange before considering invasive ventilation.
,2. While monitoring a patient in the ICU, the respiratory therapist notes the following
hemodynamic values: CVP 12 mmHg, PAP 38/22 mmHg, PCWP 8 mmHg, and QT 3.8 L/min.
These findings are most consistent with:
A. Pulmonary embolism
B. Left heart failure
C. Hypervolemia
D. Right heart failure
Answer: A
Conceptual Explanation: High CVP and high PAP with a normal or low PCWP and low
cardiac output (QT) suggest an obstruction to blood flow in the lungs, such as a pulmonary
embolism or pulmonary hypertension.
3. A patient receiving volume-controlled ventilation has an increased peak inspiratory
pressure (PIP), while the plateau pressure remains unchanged. Which of the following has
likely occurred?
A. Decreased lung compliance
B. Development of a pneumothorax
C. Endotracheal tube cuff leak
D. Increased airway resistance
Answer: D
, Conceptual Explanation: An increase in PIP without an increase in plateau pressure
indicates an increase in transairway pressure, which is caused by increased airway
resistance (e.g., secretions, bronchospasm, or biting the tube).
4. Calculate the static compliance (Cs) for a patient with the following ventilator settings and
data: Vt 500 mL, PIP 35 cmH2O, Pplat 25 cmH2O, PEEP 5 cmH2O.
A. 14 mL/cmH2O
B. 20 mL/cmH2O
C. 25 mL/cmH2O
D. 50 mL/cmH2O
Answer: C
Conceptual Explanation: Static Compliance = Vt / (Pplat - PEEP). Here, 500 / (25 - 5) =
= 25 mL/cmH2O.
5. A 32-week gestational age neonate has a 1-minute Apgar score of 3. The infant is gasping
and has a heart rate of 80 bpm. What is the immediate next step?
A. Administer 100% oxygen via blow-by
B. Initiate positive pressure ventilation (PPV)
C. Perform chest compressions
D. Intubate and administer epinephrine
Answer: B
