KETTERING TMC EXAM
COMPREHENSIVE PREP QUESTIONS
AND ANSWERS
1. A 58-year-old male patient with a history of COPD is receiving volume-controlled
ventilation. The respiratory therapist notices that the peak inspiratory pressure (PIP) has
increased from 35 cm H2O to 50 cm H2O, while the plateau pressure remains stable at 25 cm
H2O. Which of the following should the therapist perform first?
A. Suction the patient’s airway
B. Increase the PEEP setting
C. Check for a tension pneumothorax
D. Recommend a chest X-ray
Answer: A
Conceptual Explanation: An increase in PIP with a stable plateau pressure indicates an
increase in airway resistance (Raw). The most common causes are secretions,
bronchospasm, or a kinked ETT. Suctioning is the most appropriate first step.
,2. Which of the following hemodynamic parameters is most indicative of left heart failure?
A. Increased Central Venous Pressure (CVP)
B. Increased Pulmonary Capillary Wedge Pressure (PCWP)
C. Increased Mean Pulmonary Artery Pressure (PAP)
D. Decreased Systemic Vascular Resistance (SVR)
Answer: B
Conceptual Explanation: PCWP measures the pressure in the left atrium and reflects left
ventricular end-diastolic pressure. An increase indicates left-sided heart failure or mitral
valve stenosis.
3. A patient is being ventilated in Pressure Control mode. The physician wants to increase the
patient’s PaO2. Which of the following adjustments would most directly achieve this?
A. Increase the PEEP
B. Decrease the Inspiratory Time
C. Increase the Inspiratory Pressure
D. Decrease the Respiratory Rate
Answer: A
Conceptual Explanation: Oxygenation is primarily managed by FiO2 and Mean Airway
Pressure (MAP). Increasing PEEP is the most effective way to increase MAP and
recruitment, thereby improving PaO2.
, 4. During a bedside pulmonary function test, a patient achieves an FEV1/FVC ratio of 60%.
This finding is consistent with:
A. Restrictive lung disease
B. Normal lung function
C. Pulmonary fibrosis
D. Obstructive lung disease
Answer: D
Conceptual Explanation: An FEV1/FVC ratio less than 70% is the hallmark indicator of an
obstructive lung disease, such as asthma or COPD.
5. A 26-week gestational age neonate is receiving mechanical ventilation. The therapist
observes a decrease in SpO2 and muffled heart sounds. A transillumination test of the chest
shows a large glowing area on the left side. What is the immediate action?
A. Increase the FiO2 to 1.0
B. Obtain a stat ABG
C. Intubate the neonate
D. Perform a needle decompression
Answer: D
COMPREHENSIVE PREP QUESTIONS
AND ANSWERS
1. A 58-year-old male patient with a history of COPD is receiving volume-controlled
ventilation. The respiratory therapist notices that the peak inspiratory pressure (PIP) has
increased from 35 cm H2O to 50 cm H2O, while the plateau pressure remains stable at 25 cm
H2O. Which of the following should the therapist perform first?
A. Suction the patient’s airway
B. Increase the PEEP setting
C. Check for a tension pneumothorax
D. Recommend a chest X-ray
Answer: A
Conceptual Explanation: An increase in PIP with a stable plateau pressure indicates an
increase in airway resistance (Raw). The most common causes are secretions,
bronchospasm, or a kinked ETT. Suctioning is the most appropriate first step.
,2. Which of the following hemodynamic parameters is most indicative of left heart failure?
A. Increased Central Venous Pressure (CVP)
B. Increased Pulmonary Capillary Wedge Pressure (PCWP)
C. Increased Mean Pulmonary Artery Pressure (PAP)
D. Decreased Systemic Vascular Resistance (SVR)
Answer: B
Conceptual Explanation: PCWP measures the pressure in the left atrium and reflects left
ventricular end-diastolic pressure. An increase indicates left-sided heart failure or mitral
valve stenosis.
3. A patient is being ventilated in Pressure Control mode. The physician wants to increase the
patient’s PaO2. Which of the following adjustments would most directly achieve this?
A. Increase the PEEP
B. Decrease the Inspiratory Time
C. Increase the Inspiratory Pressure
D. Decrease the Respiratory Rate
Answer: A
Conceptual Explanation: Oxygenation is primarily managed by FiO2 and Mean Airway
Pressure (MAP). Increasing PEEP is the most effective way to increase MAP and
recruitment, thereby improving PaO2.
, 4. During a bedside pulmonary function test, a patient achieves an FEV1/FVC ratio of 60%.
This finding is consistent with:
A. Restrictive lung disease
B. Normal lung function
C. Pulmonary fibrosis
D. Obstructive lung disease
Answer: D
Conceptual Explanation: An FEV1/FVC ratio less than 70% is the hallmark indicator of an
obstructive lung disease, such as asthma or COPD.
5. A 26-week gestational age neonate is receiving mechanical ventilation. The therapist
observes a decrease in SpO2 and muffled heart sounds. A transillumination test of the chest
shows a large glowing area on the left side. What is the immediate action?
A. Increase the FiO2 to 1.0
B. Obtain a stat ABG
C. Intubate the neonate
D. Perform a needle decompression
Answer: D
