TMC Exam questions and answers 2023
A 48-year-old female is admitted to the ED with diaphoresis, jugular venous distension, and
3+ pitting edema in the ankles. These findings are consistent with
A. liver failure.
B. pulmonary embolism.
C. heart failure.
D. electrolyte imbalances
Heart failure
A patient is admitted to the ED following a motor vehicle accident. On physical exam, the
respiratory therapist discovers that breath sounds are absent in the left chest with a
hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is
45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should
the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient.
Needle aspirate the 2nd left intercostal space.
All of the following strategies are likely to decrease the likelihood of damage to the tracheal
mucosa EXCEPT
A. maintaining cuff pressures between 20- and 25-mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
D. monitoring intracuff pressures.
monitoring intracuff pressures.
A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse
upon completion of postural drainage with percussion. The respiratory therapist should
recommend
A. continuing the therapy until breath sounds improve.
,B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions.
deep breathing and coughing to clear secretions.
A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30%
of his predicted value. What bronchial hygiene therapy would be most appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy
IPPB with normal saline
A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the
following controls, when adjusted independently, would increase expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity
1, 2, and 3 only
Which of the following would be the most appropriate therapy for a dyspneic patient who
has crepitus with tracheal deviation to the left and absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube
Insert a chest tube
A 55-year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30
torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results
are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.
A. 2.5 vol%
B. 4.0 vol%
,C. 5.0 vol%
D. 5.5 vol%
5.0 vol%
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and
PEEP of 5 cm H2O. What is the patient's static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O
50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes
increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on
40% oxygen is noted to be 86%. Which of the following would be most appropriate at this
time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation
reintubation
Which of the following patients would most likely benefit from pressure support ventilation?
A. An intubated patient with an absent respiratory drive.
B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.
C. A patient with acute lung injury.
D. A patient who requires short-term post-operative ventilatory support.
A patient on SIMV with a set rate of 12/min and total rate of 24/min.
A patient receiving mechanical ventilation has developed a temperature of 99.9° F with
purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady
increase in peak inspiratory pressure. What initial recommendation should be made to
address these changes?
A. Initiate bronchial hygiene therapy.
B. Obtain a sputum gram stain.
, C. Administer IPV.
D. Insert a CASS tube.
Obtain a sputum gram stain.
Which of the following information may be obtained from a FVC maneuver during bedside
pulmonary function testing?
1. FEV1
2. PEFR
3. FRC
4. RV
1 and 2 only
The respiratory therapist is providing patient education for a patient who is being discharged
home on aerosol therapy. The most important reason for the patient to follow the
recommended cleaning procedures using a vinegar/water solution is that this solution will
A. sterilize the equipment.
B. retard bacterial growth.
C. kill all micro-organisms and spores.
D. extend the equipment life.
Retard bacterial growth
A patient who complains of dyspnea is noted to have a dry, non-productive cough. On
physical examination, breath sounds are diminished on the right, tactile fremitus is decreased
and there is dullness to percussion over the right lower lobe. The respiratory therapist should
suspect that the patient is suffering from
A. pneumonia.
B. pulmonary embolism.
C. pleural effusion.
D. bronchiolitis.
pleural effusion
Which of the following suction catheters would be appropriate to use for a patient with a size
8.0 mm ID endotracheal tube?
A. 8 Fr
B. 10 Fr
C. 12 Fr
D. 14 Fr
A 48-year-old female is admitted to the ED with diaphoresis, jugular venous distension, and
3+ pitting edema in the ankles. These findings are consistent with
A. liver failure.
B. pulmonary embolism.
C. heart failure.
D. electrolyte imbalances
Heart failure
A patient is admitted to the ED following a motor vehicle accident. On physical exam, the
respiratory therapist discovers that breath sounds are absent in the left chest with a
hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is
45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should
the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient.
Needle aspirate the 2nd left intercostal space.
All of the following strategies are likely to decrease the likelihood of damage to the tracheal
mucosa EXCEPT
A. maintaining cuff pressures between 20- and 25-mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
D. monitoring intracuff pressures.
monitoring intracuff pressures.
A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse
upon completion of postural drainage with percussion. The respiratory therapist should
recommend
A. continuing the therapy until breath sounds improve.
,B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions.
deep breathing and coughing to clear secretions.
A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30%
of his predicted value. What bronchial hygiene therapy would be most appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy
IPPB with normal saline
A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the
following controls, when adjusted independently, would increase expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity
1, 2, and 3 only
Which of the following would be the most appropriate therapy for a dyspneic patient who
has crepitus with tracheal deviation to the left and absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube
Insert a chest tube
A 55-year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30
torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results
are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.
A. 2.5 vol%
B. 4.0 vol%
,C. 5.0 vol%
D. 5.5 vol%
5.0 vol%
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and
PEEP of 5 cm H2O. What is the patient's static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O
50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes
increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on
40% oxygen is noted to be 86%. Which of the following would be most appropriate at this
time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation
reintubation
Which of the following patients would most likely benefit from pressure support ventilation?
A. An intubated patient with an absent respiratory drive.
B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.
C. A patient with acute lung injury.
D. A patient who requires short-term post-operative ventilatory support.
A patient on SIMV with a set rate of 12/min and total rate of 24/min.
A patient receiving mechanical ventilation has developed a temperature of 99.9° F with
purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady
increase in peak inspiratory pressure. What initial recommendation should be made to
address these changes?
A. Initiate bronchial hygiene therapy.
B. Obtain a sputum gram stain.
, C. Administer IPV.
D. Insert a CASS tube.
Obtain a sputum gram stain.
Which of the following information may be obtained from a FVC maneuver during bedside
pulmonary function testing?
1. FEV1
2. PEFR
3. FRC
4. RV
1 and 2 only
The respiratory therapist is providing patient education for a patient who is being discharged
home on aerosol therapy. The most important reason for the patient to follow the
recommended cleaning procedures using a vinegar/water solution is that this solution will
A. sterilize the equipment.
B. retard bacterial growth.
C. kill all micro-organisms and spores.
D. extend the equipment life.
Retard bacterial growth
A patient who complains of dyspnea is noted to have a dry, non-productive cough. On
physical examination, breath sounds are diminished on the right, tactile fremitus is decreased
and there is dullness to percussion over the right lower lobe. The respiratory therapist should
suspect that the patient is suffering from
A. pneumonia.
B. pulmonary embolism.
C. pleural effusion.
D. bronchiolitis.
pleural effusion
Which of the following suction catheters would be appropriate to use for a patient with a size
8.0 mm ID endotracheal tube?
A. 8 Fr
B. 10 Fr
C. 12 Fr
D. 14 Fr
