TMC Test Bank (Module 2) Questions and
Correct Answers
While inspecting an elderly female patient, you note that she has an abnormal
anteroposterior (AP) curvature of the spine. This best describes which of the
following?
A. kyphosis
B. scoliosis
C. kyphoscoliosis
D. pectus excavatum
✓ ~~~ A. kyphosis
Other common deformities are
1) pectus carinatum (abnormal anterior protrusion of the sternum);
2) pectus excavatum (depression of part or all of the sternum);
3) scoliosis (abnormal lateral curvature of the spinal); and
4) kyphoscoliosis (a combination of kyphosis and scoliosis which may produce a
severe restrictive lung defect).
While auscultating a patient's chest, you hear intermittent "bubbling" sounds at the
lung bases. Which of the following best describes this finding?
A. "bronchial sounds heard at lung bases"
B. "wheezes heard at lung bases"
C. "rhonchi heard at lung bases"
D. "crackles (rales) heard at lung bases"
✓ ~~~ D. "crackles (rales) heard at lung bases"
The preferred term for short, discontinuous adventitious lung sounds that are
crackling or bubbling in nature is crackles. Many clinicians still use the term rales for
these sounds. Crackles are caused either by movement of excessive secretions in
the airways (course crackles), or by collapsed airways opening during inspiration
(fine crackles).
While feeling a patient's radial pulse, you note that the pulse feels bounding and full.
Which of the following conditions would likely be the cause of this finding?
A. hypovolemia
B. hypertension
C. cardiovascular shock
D. low cardiac output
✓ ~~~ B. hypertension
A 'bounding' pulse is characterized by forceful pulsations that quickly disappear,
indicating a high systolic pressure without a rise in diastolic pressure (increased
pulse pressure). A bounding pulse is normal during exercise or as a result of a 'fight
or flight' release of epinephrine. A bounding pulse also can signal an abnormal
condition, most commonly hypertension due to atherosclerosis or disorders causing
increased stroke volume. Hypovolemia, shock, and low cardiac output usually result
in decreased systolic and pulse pressures.
,You notice the following vital signs during your assessment of a mechanically
ventilated patient in the ICU:
HR = 118/min
BP = 135/90
Set resp rate = 8/min
Total resp rate = 35/min
Temp = 99.3 F
The doctor has just inserted a right pleural chest tube to drain a significant pleural
effusion. At this point you should recommend that the doctor:
A. paralyze the patient
B. reposition the chest tube
C. ask the patient to relax
D. assess for pain
✓ ~~~ D. assess for pain
It is very common for a patient after any invasive procedure to develop surgical pain.
Since the patient is mechanically ventilated and cannot verbally communicate,
abnormal vital signs (usually on the high side of normal) are a common indication of
the presence of pain. Asking the patient to indicate if he or she is in pain and
providing for proper pain management is the right course of action. Paralytics are
indicated for patient-ventilator asynchrony. A chest tube should not be repositioned
without assessing a chest X-ray first; asking the patient to relax will not alleviate the
pain.
You have a patient who walks slower than people of the same age because of
breathlessness. How would you characterize their degree of dyspnea?
A. slight
B. moderate
C. severe
D. very severe
✓ ~~~ B. moderate
You can assess a patient's exercise tolerance via interview using the American
Thoracic Society Breathlessness Scale. By inquiring as to when breathlessness is
first noticed by the patient, you can assign a rating to the symptom, with a descriptive
term for each level. In this case, a patient who walks slower than people of the same
age on level ground because of breathlessness or has to stop for breath when
walking at own pace on level ground would be characterized as having moderate
dyspnea.
You've asked your patient to inhale as deeply as possible and blow out all of the air
as hard as they can until empty. Which test is being performed?
A. FVC
B. IC
C. TLC
D. MVV
✓ ~~~ A. FVC
, When a patient performs a maximal exhalation after a maximal inhalation, he is
performing the forced vital capacity (FVC) maneuver.
Which of the following patients most likely has some type of health literacy limitation?
A. a patient who asks a lot of care-related questions
B. a patient whose first language is not English
C. a patient who has difficulty correctly filling out a form
D. a patient who prefers watching television to reading
✓ ~~~ C. a patient who has difficulty correctly filling out a form
You should suspect health literacy problems when a patient offers excuses when
asked to read, e.g. left their eyeglasses at home; does not reorient materials
provided so as to be unreadable, e.g., upside down; identifies medications by their
appearance (e.g., color or shape) rather than by name; fails to correctly take
medications or cannot describe how to take them; or has difficulty correctly filling out
forms. Although patients with limited English skills may present a language barrier,
this does not necessarily indicate a health literacy problem. Many individuals with
limited English skills are well educated and knowledgeable of personal health-related
issues.
Which of the following during would you assess for during inspiration to indicate
normal diaphragm activity?
A. outward motion of the abdomen
B. supraclavicular retractions
C. intercostal retractions
D. inward motion of the abdomen
✓ ~~~ A. outward motion of the abdomen
Normally as the diaphragm contract during inspiration, it drops and displaces the
abdominal contents, forcing the abdominal wall to move outward (in men more than
women). If this does not occur, or if it occurs out-of-phase with inspiration, an
abnormality exists. Failure of the diaphragm to descend normally indicates either a
neuromuscular disorder or advanced emphysema, (in which 'flattening' of this
muscle impairs its function). Out-of-phase motion (aka thorcoabdominal asynchrony
or paradox) indicates increased work of breathing and/or muscle fatigue.
The most likely cause of stridor in an adult patient would be which of the following?
A. asthma
B. croup
C. epiglottitis
D. post-extubation edema
✓ ~~~ D. post-extubation edema
Stridor is a loud, high-pitched continuous sound heard primarily over the larynx or
trachea during inhalation in patients with upper airway obstruction. In adults, stridor
occurs mainly as a complication of endotracheal extubation (edema of the vocal
cords).
Which of the following physical signs would you likely see in a patient with an acute
upper airway obstruction?
Correct Answers
While inspecting an elderly female patient, you note that she has an abnormal
anteroposterior (AP) curvature of the spine. This best describes which of the
following?
A. kyphosis
B. scoliosis
C. kyphoscoliosis
D. pectus excavatum
✓ ~~~ A. kyphosis
Other common deformities are
1) pectus carinatum (abnormal anterior protrusion of the sternum);
2) pectus excavatum (depression of part or all of the sternum);
3) scoliosis (abnormal lateral curvature of the spinal); and
4) kyphoscoliosis (a combination of kyphosis and scoliosis which may produce a
severe restrictive lung defect).
While auscultating a patient's chest, you hear intermittent "bubbling" sounds at the
lung bases. Which of the following best describes this finding?
A. "bronchial sounds heard at lung bases"
B. "wheezes heard at lung bases"
C. "rhonchi heard at lung bases"
D. "crackles (rales) heard at lung bases"
✓ ~~~ D. "crackles (rales) heard at lung bases"
The preferred term for short, discontinuous adventitious lung sounds that are
crackling or bubbling in nature is crackles. Many clinicians still use the term rales for
these sounds. Crackles are caused either by movement of excessive secretions in
the airways (course crackles), or by collapsed airways opening during inspiration
(fine crackles).
While feeling a patient's radial pulse, you note that the pulse feels bounding and full.
Which of the following conditions would likely be the cause of this finding?
A. hypovolemia
B. hypertension
C. cardiovascular shock
D. low cardiac output
✓ ~~~ B. hypertension
A 'bounding' pulse is characterized by forceful pulsations that quickly disappear,
indicating a high systolic pressure without a rise in diastolic pressure (increased
pulse pressure). A bounding pulse is normal during exercise or as a result of a 'fight
or flight' release of epinephrine. A bounding pulse also can signal an abnormal
condition, most commonly hypertension due to atherosclerosis or disorders causing
increased stroke volume. Hypovolemia, shock, and low cardiac output usually result
in decreased systolic and pulse pressures.
,You notice the following vital signs during your assessment of a mechanically
ventilated patient in the ICU:
HR = 118/min
BP = 135/90
Set resp rate = 8/min
Total resp rate = 35/min
Temp = 99.3 F
The doctor has just inserted a right pleural chest tube to drain a significant pleural
effusion. At this point you should recommend that the doctor:
A. paralyze the patient
B. reposition the chest tube
C. ask the patient to relax
D. assess for pain
✓ ~~~ D. assess for pain
It is very common for a patient after any invasive procedure to develop surgical pain.
Since the patient is mechanically ventilated and cannot verbally communicate,
abnormal vital signs (usually on the high side of normal) are a common indication of
the presence of pain. Asking the patient to indicate if he or she is in pain and
providing for proper pain management is the right course of action. Paralytics are
indicated for patient-ventilator asynchrony. A chest tube should not be repositioned
without assessing a chest X-ray first; asking the patient to relax will not alleviate the
pain.
You have a patient who walks slower than people of the same age because of
breathlessness. How would you characterize their degree of dyspnea?
A. slight
B. moderate
C. severe
D. very severe
✓ ~~~ B. moderate
You can assess a patient's exercise tolerance via interview using the American
Thoracic Society Breathlessness Scale. By inquiring as to when breathlessness is
first noticed by the patient, you can assign a rating to the symptom, with a descriptive
term for each level. In this case, a patient who walks slower than people of the same
age on level ground because of breathlessness or has to stop for breath when
walking at own pace on level ground would be characterized as having moderate
dyspnea.
You've asked your patient to inhale as deeply as possible and blow out all of the air
as hard as they can until empty. Which test is being performed?
A. FVC
B. IC
C. TLC
D. MVV
✓ ~~~ A. FVC
, When a patient performs a maximal exhalation after a maximal inhalation, he is
performing the forced vital capacity (FVC) maneuver.
Which of the following patients most likely has some type of health literacy limitation?
A. a patient who asks a lot of care-related questions
B. a patient whose first language is not English
C. a patient who has difficulty correctly filling out a form
D. a patient who prefers watching television to reading
✓ ~~~ C. a patient who has difficulty correctly filling out a form
You should suspect health literacy problems when a patient offers excuses when
asked to read, e.g. left their eyeglasses at home; does not reorient materials
provided so as to be unreadable, e.g., upside down; identifies medications by their
appearance (e.g., color or shape) rather than by name; fails to correctly take
medications or cannot describe how to take them; or has difficulty correctly filling out
forms. Although patients with limited English skills may present a language barrier,
this does not necessarily indicate a health literacy problem. Many individuals with
limited English skills are well educated and knowledgeable of personal health-related
issues.
Which of the following during would you assess for during inspiration to indicate
normal diaphragm activity?
A. outward motion of the abdomen
B. supraclavicular retractions
C. intercostal retractions
D. inward motion of the abdomen
✓ ~~~ A. outward motion of the abdomen
Normally as the diaphragm contract during inspiration, it drops and displaces the
abdominal contents, forcing the abdominal wall to move outward (in men more than
women). If this does not occur, or if it occurs out-of-phase with inspiration, an
abnormality exists. Failure of the diaphragm to descend normally indicates either a
neuromuscular disorder or advanced emphysema, (in which 'flattening' of this
muscle impairs its function). Out-of-phase motion (aka thorcoabdominal asynchrony
or paradox) indicates increased work of breathing and/or muscle fatigue.
The most likely cause of stridor in an adult patient would be which of the following?
A. asthma
B. croup
C. epiglottitis
D. post-extubation edema
✓ ~~~ D. post-extubation edema
Stridor is a loud, high-pitched continuous sound heard primarily over the larynx or
trachea during inhalation in patients with upper airway obstruction. In adults, stridor
occurs mainly as a complication of endotracheal extubation (edema of the vocal
cords).
Which of the following physical signs would you likely see in a patient with an acute
upper airway obstruction?
