TMC EXAMINATION WITH QUESTIONS AND
ANSWERS GRADED A+
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. - ANSWER Deep breathing
and coughing to clear secretions.
A 13-year-old patient in the ED is complaining of dyspnea, chest tightness, and a loose
productive cough. The patient has a respiratory rate of 28 breaths/minute and bilateral
wheezing in the lungs. What treatment should the respiratory therapist initiate?
A. levalbuterol
B. oxygen
C. salmeterol
D. PEP – ANSWER oxygen
A 16-year-old patient with cystic fibrosis attends a public high school. Which of the
following bronchial hygiene therapies would be most appropriate for this patient?
A. intrapulmonary percussive ventilation
B. dornase alpha therapy
C. vibratory / oscillatory PEP
D. postural drainage and manual percussion – ANSWER vibratory / oscillatory PEP
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. – ANSWER Obtain an ABG.
A 28-year-old female has just been admitted through the ED with suspected CO
poisoning. She is receiving oxygen by non-rebreather mask at 10 L/min. Upon entering
the patient's room, the respiratory therapist notes that the reservoir bag of the mask
collapses during inspiration. This is most likely the result of
A. faulty one-way valves.
B. tight seal between the mask and the patient's face.
C. presence of a bubble humidifier.
,D. insufficient flow to the reservoir bag. – ANSWER insufficient flow to the reservoir bag.
A 30-year-old male with bronchitis has coarse bilateral rales with a SpO2 of 90%.
Despite a good cough effort, he has great difficulty in removing his thick secretions. The
respiratory therapist should initiate
,A. aerosol treatments with 3 cc normal saline every 4 hours.
B. sputum induction for gram stain.
C. a heated humidifier and oxygen therapy.
D. continuous ultrasonic via aerosol mask. – ANSWER a heated humidifier and
oxygen therapy.
A 36 year-old fireman was trapped and subsequently rescued from the collapse of a
burning building. Which of the following devices would be appropriate to accurately
assess his oxygenation status?
A. capnograph
B. pulse oximeter
C. blood gas analyzer
D. hemoximeter - ANSWERhemoximeter
A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected
pneumonia. The patient has no history of pulmonary disease. Auscultation reveal
medium crackles throughout both lungs. Which of the following should be
recommended for management of this patient?
A. Pre/post bronchodilator study
B. Ultrasonic nebulizer treatments
C. Manually assisted coughing
D. Regular coughing and deep breathing - ANSWERRegular coughing and deep
breathing
A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral
endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The
respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a
minimal occluding volume. This would indicate that the
A. tube is not of the appropriate size.
B. pilot balloon and line are obstructed.
C. pressure manometer is defective.
D. cuff has herniated over the tip of the tube. - ANSWERtube is not of the appropriate
size.
A 44 year-old patient who suffered a cerebral vascular accident has been moved from
Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly
drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min,
respiratory rate is 42/min and his breath sounds are very diminished. The respiratory
therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist
should
A. increase the suction pressure to 120 mm Hg.
, B. change to a 10 Fr suction catheter.
C. replace the tracheostomy tube.
D. orally intubate the patient. - ANSWERReplace the tracheostomy tube.
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 - ANSWERHeart failure
A 50 kg (110 lb) patient is being mechanically ventilated with the following settings: VC,
A/C, VT 400 mL, respiratory rate 14/min, FIO2 0.60 and 10 cm H2O PEEP. The chest
radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36, PaCO2
47 torr, PaO2 50 torr, and HCO3- 28 mEq/L. The respiratory therapist should increase
the
A. PEEP.
B. FIO2.
C. expiratory time.
D. respiratory rate. - ANSWERPEEP
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
E. continuing the therapy until breath sounds improve.
F. administering dornase alpha.
G. administering albuterol therapy.
H. deep breathing and coughing to clear secretions. - ANSWER Deep breathing
and coughing to clear secretions.
A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the
posterior basal segments of the lower lobes. Which of the following is the appropriate
postural drainage position?
A. Head down, patient supine with a pillow under knees
B. Patient prone with a pillow under head, bed flat
C. Patient supine with a pillow under knees, bed flat
D. Head down, patient prone with a pillow under hips - ANSWERHead down, patient
prone with a pillow under hips
ANSWERS GRADED A+
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. - ANSWER Deep breathing
and coughing to clear secretions.
A 13-year-old patient in the ED is complaining of dyspnea, chest tightness, and a loose
productive cough. The patient has a respiratory rate of 28 breaths/minute and bilateral
wheezing in the lungs. What treatment should the respiratory therapist initiate?
A. levalbuterol
B. oxygen
C. salmeterol
D. PEP – ANSWER oxygen
A 16-year-old patient with cystic fibrosis attends a public high school. Which of the
following bronchial hygiene therapies would be most appropriate for this patient?
A. intrapulmonary percussive ventilation
B. dornase alpha therapy
C. vibratory / oscillatory PEP
D. postural drainage and manual percussion – ANSWER vibratory / oscillatory PEP
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. – ANSWER Obtain an ABG.
A 28-year-old female has just been admitted through the ED with suspected CO
poisoning. She is receiving oxygen by non-rebreather mask at 10 L/min. Upon entering
the patient's room, the respiratory therapist notes that the reservoir bag of the mask
collapses during inspiration. This is most likely the result of
A. faulty one-way valves.
B. tight seal between the mask and the patient's face.
C. presence of a bubble humidifier.
,D. insufficient flow to the reservoir bag. – ANSWER insufficient flow to the reservoir bag.
A 30-year-old male with bronchitis has coarse bilateral rales with a SpO2 of 90%.
Despite a good cough effort, he has great difficulty in removing his thick secretions. The
respiratory therapist should initiate
,A. aerosol treatments with 3 cc normal saline every 4 hours.
B. sputum induction for gram stain.
C. a heated humidifier and oxygen therapy.
D. continuous ultrasonic via aerosol mask. – ANSWER a heated humidifier and
oxygen therapy.
A 36 year-old fireman was trapped and subsequently rescued from the collapse of a
burning building. Which of the following devices would be appropriate to accurately
assess his oxygenation status?
A. capnograph
B. pulse oximeter
C. blood gas analyzer
D. hemoximeter - ANSWERhemoximeter
A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected
pneumonia. The patient has no history of pulmonary disease. Auscultation reveal
medium crackles throughout both lungs. Which of the following should be
recommended for management of this patient?
A. Pre/post bronchodilator study
B. Ultrasonic nebulizer treatments
C. Manually assisted coughing
D. Regular coughing and deep breathing - ANSWERRegular coughing and deep
breathing
A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral
endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The
respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a
minimal occluding volume. This would indicate that the
A. tube is not of the appropriate size.
B. pilot balloon and line are obstructed.
C. pressure manometer is defective.
D. cuff has herniated over the tip of the tube. - ANSWERtube is not of the appropriate
size.
A 44 year-old patient who suffered a cerebral vascular accident has been moved from
Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly
drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min,
respiratory rate is 42/min and his breath sounds are very diminished. The respiratory
therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist
should
A. increase the suction pressure to 120 mm Hg.
, B. change to a 10 Fr suction catheter.
C. replace the tracheostomy tube.
D. orally intubate the patient. - ANSWERReplace the tracheostomy tube.
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 - ANSWERHeart failure
A 50 kg (110 lb) patient is being mechanically ventilated with the following settings: VC,
A/C, VT 400 mL, respiratory rate 14/min, FIO2 0.60 and 10 cm H2O PEEP. The chest
radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36, PaCO2
47 torr, PaO2 50 torr, and HCO3- 28 mEq/L. The respiratory therapist should increase
the
A. PEEP.
B. FIO2.
C. expiratory time.
D. respiratory rate. - ANSWERPEEP
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
E. continuing the therapy until breath sounds improve.
F. administering dornase alpha.
G. administering albuterol therapy.
H. deep breathing and coughing to clear secretions. - ANSWER Deep breathing
and coughing to clear secretions.
A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the
posterior basal segments of the lower lobes. Which of the following is the appropriate
postural drainage position?
A. Head down, patient supine with a pillow under knees
B. Patient prone with a pillow under head, bed flat
C. Patient supine with a pillow under knees, bed flat
D. Head down, patient prone with a pillow under hips - ANSWERHead down, patient
prone with a pillow under hips
