KETTERING TMC EXAM -
COMPREHENSIVE RESPIRATORY
THERAPY SIMULATION QUESTIONS
AND ANSWERS
1. A 68-year-old male with COPD is receiving oxygen via a 28% air-entrainment mask. The
patient’s SpO2 is 82% and he appears lethargic. An ABG shows: pH 7.24, PaCO2 68 mmHg,
PaO2 52 mmHg, HCO3 28 mEq/L. What is the most appropriate next step?
A. Increase the oxygen flow to the air-entrainment mask
B. Intubate and initiate mechanical ventilation
C. Switch to a non-rebreather mask at 15 L/min
D. Initiate Non-invasive Positive Pressure Ventilation (NiPPV)
Answer: D
Conceptual Explanation: The patient is experiencing acute-on-chronic respiratory failure
with respiratory acidosis and hypoxemia. In COPD patients, NiPPV is the first-line
treatment to avoid intubation while correcting pH and CO2.
,2. While performing a bedside PFT on a 45-year-old patient, you note the following results:
FVC 3.2L (75% pred), FEV1 1.8L (50% pred), and FEV1/FVC 56%. What is the interpretation?
A. Restrictive lung disease
B. Normal lung function
C. Obstructive lung disease
D. Combined obstructive and restrictive disease
Answer: C
Conceptual Explanation: An FEV1/FVC ratio less than 70% is the hallmark of an
obstructive defect. Although the FVC is slightly low, it is common in obstruction due to air
trapping.
3. A neonatal patient is receiving High-Frequency Oscillatory Ventilation (HFOV). The
physician wants to increase the PaO2. Which of the following adjustments would be most
effective?
A. Increase the Amplitude
B. Decrease the Frequency (Hz)
C. Decrease the Inspiratory Time
D. Increase the Mean Airway Pressure (mPaw)
Answer: D
, Conceptual Explanation: In HFOV, oxygenation is primarily controlled by the Mean
Airway Pressure (mPaw) and FiO2, while CO2 elimination is controlled by Amplitude and
Frequency.
4. During a spontaneous breathing trial (SBT) via a T-piece, a patient’s respiratory rate
increases from 18 to 32 breaths/min and heart rate increases from 90 to 115 beats/min. The
patient becomes diaphoretic. What should the respiratory therapist do?
A. Request an ABG immediately
B. Continue the trial for another 30 minutes
C. Return the patient to previous ventilator settings
D. Administer a sedative to calm the patient
Answer: C
Conceptual Explanation: The patient is showing signs of respiratory distress and
sympathetic overactivity (tachycardia, tachypnea, diaphoresis), indicating SBT failure. They
should be returned to stable ventilator support.
5. A patient with ARDS is being ventilated in Pressure Control mode. The plateau pressure is
35 cmH2O and the PaO2 is 55 mmHg on 80% FiO2 and 12 cmH2O PEEP. Which strategy is
most appropriate?
A. Switch to Volume Control ventilation
B. Increase the Inspiratory Pressure
C. Decrease the PEEP to 8 cmH2O
COMPREHENSIVE RESPIRATORY
THERAPY SIMULATION QUESTIONS
AND ANSWERS
1. A 68-year-old male with COPD is receiving oxygen via a 28% air-entrainment mask. The
patient’s SpO2 is 82% and he appears lethargic. An ABG shows: pH 7.24, PaCO2 68 mmHg,
PaO2 52 mmHg, HCO3 28 mEq/L. What is the most appropriate next step?
A. Increase the oxygen flow to the air-entrainment mask
B. Intubate and initiate mechanical ventilation
C. Switch to a non-rebreather mask at 15 L/min
D. Initiate Non-invasive Positive Pressure Ventilation (NiPPV)
Answer: D
Conceptual Explanation: The patient is experiencing acute-on-chronic respiratory failure
with respiratory acidosis and hypoxemia. In COPD patients, NiPPV is the first-line
treatment to avoid intubation while correcting pH and CO2.
,2. While performing a bedside PFT on a 45-year-old patient, you note the following results:
FVC 3.2L (75% pred), FEV1 1.8L (50% pred), and FEV1/FVC 56%. What is the interpretation?
A. Restrictive lung disease
B. Normal lung function
C. Obstructive lung disease
D. Combined obstructive and restrictive disease
Answer: C
Conceptual Explanation: An FEV1/FVC ratio less than 70% is the hallmark of an
obstructive defect. Although the FVC is slightly low, it is common in obstruction due to air
trapping.
3. A neonatal patient is receiving High-Frequency Oscillatory Ventilation (HFOV). The
physician wants to increase the PaO2. Which of the following adjustments would be most
effective?
A. Increase the Amplitude
B. Decrease the Frequency (Hz)
C. Decrease the Inspiratory Time
D. Increase the Mean Airway Pressure (mPaw)
Answer: D
, Conceptual Explanation: In HFOV, oxygenation is primarily controlled by the Mean
Airway Pressure (mPaw) and FiO2, while CO2 elimination is controlled by Amplitude and
Frequency.
4. During a spontaneous breathing trial (SBT) via a T-piece, a patient’s respiratory rate
increases from 18 to 32 breaths/min and heart rate increases from 90 to 115 beats/min. The
patient becomes diaphoretic. What should the respiratory therapist do?
A. Request an ABG immediately
B. Continue the trial for another 30 minutes
C. Return the patient to previous ventilator settings
D. Administer a sedative to calm the patient
Answer: C
Conceptual Explanation: The patient is showing signs of respiratory distress and
sympathetic overactivity (tachycardia, tachypnea, diaphoresis), indicating SBT failure. They
should be returned to stable ventilator support.
5. A patient with ARDS is being ventilated in Pressure Control mode. The plateau pressure is
35 cmH2O and the PaO2 is 55 mmHg on 80% FiO2 and 12 cmH2O PEEP. Which strategy is
most appropriate?
A. Switch to Volume Control ventilation
B. Increase the Inspiratory Pressure
C. Decrease the PEEP to 8 cmH2O
