KETTERING TMC EXAM PRACTICE
(2026/2027) QUESTIONS AND ANSWERS
1. A 65-year-old patient with COPD is receiving mechanical ventilation in VC-CMV mode. The
patient’s PIP has increased from 35 cmH2O to 50 cmH2O over the last hour, while the Plateau
pressure has remained constant at 25 cmH2O. Which of the following is the most likely
cause?
A. Accumulation of secretions in the airway
B. Development of a pneumothorax
C. Decreased lung compliance
D. Pulmonary edema development
Answer: A
Conceptual Explanation: An increase in PIP with a constant Plateau pressure indicates an
increase in airway resistance (Raw). Secretions, bronchospasm, or a kinked ETT are
common causes. Decreased compliance would increase both PIP and Plateau pressure.
,2. A patient in the ICU has a Swan-Ganz catheter in place. The following measurements are
obtained: CVP 12 mmHg, PAP 35/15 mmHg, PCWP 8 mmHg, CO 3.5 L/min. Which of the
following conditions is most consistent with these findings?
A. Left heart failure
B. Pulmonary embolism
C. Hypovolemia
D. Hypervolemia
Answer: B
Conceptual Explanation: Increased CVP and PAP with a normal or low PCWP indicates a
problem in the pulmonary vasculature or right heart, such as a pulmonary embolism or
primary pulmonary hypertension.
3. Calculate the total flow delivered by a 40% Venturi mask running at an oxygen flow rate of
10 L/min.
A. 40 L/min
B. 30 L/min
C. 50 L/min
D. 60 L/min
Answer: A
, Conceptual Explanation: The air-to-oxygen ratio for 40% is 3:1. Total parts = 3 + 1 = 4.
Total flow = Oxygen flow x Total parts = 10 L/min x 4 = 40 L/min.
4. During a bedside PFT, a patient demonstrates a FEV1/FVC ratio of 60% of predicted. This
finding is most characteristic of:
A. Restrictive lung disease
B. Chest wall deformity
C. Normal lung function
D. Obstructive lung disease
Answer: D
Conceptual Explanation: A decreased FEV1/FVC ratio (typically less than 70%) is the
hallmark of obstructive lung disease.
5. A 28-week gestational age neonate is receiving nasal CPAP at 5 cmH2O with an FiO2 of
0.60. The infant is experiencing frequent apnea episodes and the PaCO2 is 62 mmHg with a
pH of 7.22. What is the most appropriate next step?
A. Increase CPAP to 8 cmH2O
B. Increase FiO2 to 0.70
C. Initiate mechanical ventilation
D. Administer caffeine citrate
Answer: C
(2026/2027) QUESTIONS AND ANSWERS
1. A 65-year-old patient with COPD is receiving mechanical ventilation in VC-CMV mode. The
patient’s PIP has increased from 35 cmH2O to 50 cmH2O over the last hour, while the Plateau
pressure has remained constant at 25 cmH2O. Which of the following is the most likely
cause?
A. Accumulation of secretions in the airway
B. Development of a pneumothorax
C. Decreased lung compliance
D. Pulmonary edema development
Answer: A
Conceptual Explanation: An increase in PIP with a constant Plateau pressure indicates an
increase in airway resistance (Raw). Secretions, bronchospasm, or a kinked ETT are
common causes. Decreased compliance would increase both PIP and Plateau pressure.
,2. A patient in the ICU has a Swan-Ganz catheter in place. The following measurements are
obtained: CVP 12 mmHg, PAP 35/15 mmHg, PCWP 8 mmHg, CO 3.5 L/min. Which of the
following conditions is most consistent with these findings?
A. Left heart failure
B. Pulmonary embolism
C. Hypovolemia
D. Hypervolemia
Answer: B
Conceptual Explanation: Increased CVP and PAP with a normal or low PCWP indicates a
problem in the pulmonary vasculature or right heart, such as a pulmonary embolism or
primary pulmonary hypertension.
3. Calculate the total flow delivered by a 40% Venturi mask running at an oxygen flow rate of
10 L/min.
A. 40 L/min
B. 30 L/min
C. 50 L/min
D. 60 L/min
Answer: A
, Conceptual Explanation: The air-to-oxygen ratio for 40% is 3:1. Total parts = 3 + 1 = 4.
Total flow = Oxygen flow x Total parts = 10 L/min x 4 = 40 L/min.
4. During a bedside PFT, a patient demonstrates a FEV1/FVC ratio of 60% of predicted. This
finding is most characteristic of:
A. Restrictive lung disease
B. Chest wall deformity
C. Normal lung function
D. Obstructive lung disease
Answer: D
Conceptual Explanation: A decreased FEV1/FVC ratio (typically less than 70%) is the
hallmark of obstructive lung disease.
5. A 28-week gestational age neonate is receiving nasal CPAP at 5 cmH2O with an FiO2 of
0.60. The infant is experiencing frequent apnea episodes and the PaCO2 is 62 mmHg with a
pH of 7.22. What is the most appropriate next step?
A. Increase CPAP to 8 cmH2O
B. Increase FiO2 to 0.70
C. Initiate mechanical ventilation
D. Administer caffeine citrate
Answer: C
