TMC Practice Exam A + B 2023/24 updated&verified

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. D. deep breathing and coughing to clear secretions. See Patient Assessment A healthy adult female can exhale what portion of her forced vital capacity in the first second? 70% Following cardiac surgery, a 55 year-old 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. 5% volume What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? 5 to 15 The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, what should the RT do? Initiate an expiratory hold just prior to the next ventilator-delivered breath What do bronchial breath sounds heard over the lung periphery indicate? lung consolidation (pneumonia) Rationale: should be vesicular in periphery A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? A. Increase the frequency. B. Change to airway pressure release ventilation. C. Decrease the inspiratory time. D. Increase PEEP to 15 cm H2O. B. Change to airway pressure release ventilation. A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? A. Obtain a sputum specimen. B. Obtain an ABG. C. Measure peak expiratory flow. D. Determine the Glasgow Coma Score. B. Obtain an ABG. A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation D. Bronchial provocation Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 torr and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely. B. Increase the FIO2. The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is: A. adding liquid heparin to the sample. B. placing the syringe in an ice bath. C. shaking the sample continuously. D. applying a pressure bandage. B. placing the syringe in an ice bath. Rationale: it's been over 10 mins and the sample will continue to metabolize/eat up O2 otherwise A 72 year-old female post stem cell transplant patient in the ICU complains of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? A. Severe heart failure B. Respiratory distress syndrome C. Severe renal failure D. Moderate heart failure D. Moderate heart failure Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? 50 torr A patient has mild stridor immediately after extubation. This finding is most often associated with: A. lower airway obstruction. B. secretions in the large airways. C. upper airway obstruction. D. bronchial spasm. C. upper airway obstruction. A 60 kg (132 lb) female patient with congestive heart failure receives NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as: A. shunting. B. hypoventilation. C. hyperoxygenation. D. fluid overload. C. hyperoxygenation. A mechanically ventilated patient with a tracheostomy tube is on the following settings:PC, SIMV, PIP 30 cm H2O, f 20/min, FIO2 0.60, PEEP 5 cm H2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely? A. The patient has been disconnected. B. Complete obstruction of the tracheostomy tube. C. Development of a left-sided pneumothorax. D. Partial obstruction of the tracheostomy tube. D. Partial obstruction of the tracheostomy tube. A 75 year-old patient with end-stage COPD is admitted to the ED with an acute exacerbation. He has a DNI order in his chart. Physical exam reveals that the patient is febrile and has a weak, non-productive cough. Breath sounds reveal bilateral coarse crackles with scattered wheezes. The patient is started on bronchodilator therapy and antibiotics. Serial ABG results are: 7 PM: FiO2: 0.21 | pH: 7.30 | PCO2: 70 | PO2: 48 | HCO3: 34 | SpO2: 78% 8PM: FiO2: 0.40 | pH: 7.21 | PCO2: 83 | PO2: 58 | HCO3: 34 | SpO2: 89% What should the respiratory therapist recommend? A. Initiate comfort care procedures. B. Decrease FIO2 to 0.35. C. Administer IPV. D. Initiate NPPV. D. Initiate NPPV. While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the: A. peak flow meter is clogged. B. patient's asthma has worsened. C. patient is fatigued. D. peak flow meter is accurate. A. peak flow meter is clogged. An ICU patient's blood pressure is continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure? A. Trendelenburg position causes an elevation in blood pressure. B. The tip of the catheter was below the transducer. C. The catheter needed flushing. D. The catheter was kinked. B. The tip of the catheter was below the transducer. A 13 year-old patient in the ED complains of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate? A. Levalbuterol B. Oxygen C. Salmeterol D. PEP B. Oxygen