LINDSEY JONES TMC EXAM
QUESTIONS AND ANSWERS 100%
CORRECT
A respiratory therapist notices the waveform of a pulmonary artery catheter is
repeatedly rising and descending from 25 mmHg to 8 mmHg. However, a closer
observation reveals there is no dicrotic notch in the waveform. Which of the following
can the respiratory therapist do with the pulmonary artery catheter to correct the
situation?
A. withdraw the the catheter
B. advance the catheter
C. jiggle the catheter
D. aspirate the catheter - ANSWER-D. The absence of a dicrotic notch in a pulmonary
artery pressure waveform is called "pressure dampening". This does not harm the
patient. However, it is an indication of a poor signal and should be resolved. This may
be remedied by: First, aspirating from the catheter; second, flushing the catheter; and
third, rotating the catheter. Advancement or withdraw of the catheter is not an
appropriate remedy for pressure dampening.
The following arterial blood gas results are available for a patient receiving volume
controlled ventilation.
pH 7.21 PaCO2 53 torrPaO2 72 torrHCO3- 23 mEq/LBE -2 mEq/L
Current ventilator settings are:
Mode Assist/control VT 550 mL Mandatory rate 12Total rate 12FIO2 1.0PEEP 20 cm
H2O
The respiratory therapist should recommend:
A. increasing PEEP
B. decreasing tidal volume
C. decreasing FIO2
D. increasing mandatory rate - ANSWER-D. This patient's blood gas reveals
hypoventilation and hypoxemia. Of these two problems, ventilation should be addressed
first. Because PaCO2 is off target by more than 4 mmHg the best option would be to
increase mandatory rate.
A decreasing CvO2 while CaO2 remains constant is most closely associated with
A. increasing tissue oxygen consumption
B. decreasing SVR
C. increasing PVR
, D. decreasing oxygen consumption - ANSWER-A. If CvO2 is decreasing while CaO2
remains the same, there is a widening between the arterial and venous oxygen content
difference C(a-v)O2. A bigger gap between these numbers, or an increase in the C(a-
v)O2, is associated with decreasing tissue oxygen consumption which is also
associated with a decrease in cardiac output.
What is the static compliance in mL/cm H2O, given the following data on a patient
receiving VC AC ventilation?
Plateau pressure 15 cm H2O Peak pressure 25 cm H2OVT 500 mLPEEP 5 cm H2O
A. 25
B. 20
C. 50
D. 33 - ANSWER-C. To determine static compliance, tidal volume is divided by plateau
pressure after subtracting any PEEP. In this case, (500/(15-5) = 50 cm H2O.
A homeless patient reports to a clinic with hemoptysis and emaciation, as well as other
symptoms consistent with tuberculosis. Which of the following exams would be most
appropriate to further assess the patient?
A. Mantoux test
B. eosinophil count
C. FeNO exhaled gas analysis
D. serum creatinine blood level - ANSWER-A. A Mantoux test (also called a TB test) is
helpful in determining the patient's exposure to the tubercle bacilli. Although not
diagnostic for TB, it is a quick screening method that is appropriate.
A patient with confirmed Guillain-Barre' Syndrome is being monitored every 4 hours.
The following data is available:
10 am 2 pm 6 pm VC (L) 1.6 1.4 0.8VT (mL) 500 485 260MIP (cm H2O) -48 -35 -24
The respiratory therapist should recommend
A. intubate and initiate mechanical ventilatory support
B. administer systemic steroid medication
C. continue to monitor the patient closely
D. check the protein level in the spinal fluid - ANSWER-A. A patient with Guillain-Barre'
Syndrome experiences a slow onset of paralysis of the ventilatory muscles and will
ultimately require mechanical ventilatory support. The point at which ventilatory support
is needed is when vital capacity falls below 1 L. In this case, vital capacity is 0.8 L
indicating the patient should be intubated and receive mechanical ventilatory support.
,A patient with a history of hyper-reactive airway disease is having difficulty
expectorating because the sputum is thick and tenacious. Which of the following
medications should the respiratory therapist recommend?
A. Solu-Mederol
B. Acetylcysteine (mucomyst)
C. Spiriva (tiotropium bromide)
D. Beclamethasone (Beclovent) - ANSWER-B. Hyperactive airway disease is
associated with diseases such as asthma and consist of bronchoconstriction and
inflammation. This patient appears to have difficulty with bronchoconstriction and thick
secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are
appropriate.
A patient with a tracheostomy is receiving supplemental oxygen via tracheostomy collar
connected to a large volume nebulizer set at 40%. The respiratory therapist analyzes
the FIO2 at the tracheostomy collar with a galvanic fuel cell analyzer. The analysis
shows the FIO2 to be 55%. Which of the following could be the cause of the increase in
FIO2?
A. too much water in the circuit
B. calibration error in the galvanic fuel cell
C. the aerosol tubing is too short
D. clogged jet orifice in the nebulizer - ANSWER-A. When administering oxygen by any
device that has a venturi mechanism, back pressure on the venturi will slow the speed
of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options
offered, only excess water in the tubing would cause this type of back pressure.
What is the minute ventilation (L/min) of a 200-lb (91-kg) male who has a tidal volume
400 mL and a respiratory rate of 15?
A. 7.2
B. 4.6
C. 6.0
D. 3.0 - ANSWER-C. To determine the minute ventilation of the patient, one should
multiply the tidal volume by the rate. In this case, tidal volume is expressed in mL.
Because minute ventilation is expressed as L/min, tidal volume must be translated to
liters. Thus, .400 x 15 is equal to him 6.0 L.
Which of the following questions or directives would be most helpful in determining a
patient's ability to understand procedural instructions given in English?
A. "Please explain the procedure back to me."
B. "Do you speak English?"
C. "Nod your head if you understand me."
D. "Are you able to understand what I am saying?" - ANSWER-A. The key in
ascertaining a patient's ability to understand instruction is to ask open-ended questions.
An open-ended question is one that cannot be answered simply with 'Yes' or 'No'. In
, many cultures and languages, people are likely to respond with 'Yes' when they do not
understand what is being communicated.
A patient presents in the emergency department (ED) with fever, chills, general malaise,
and mild ventilatory distress. The patient has been in a long-term care center for the
past 6 months and is currently producing thick, yellow sputum. Which of the following
should the respiratory therapist do?
A. order a CBC
B. determine PAO2
C. request an echocardiogram
D. check electrolyte levels - ANSWER-A. Clinical evidence, including a febrile
condition, suggests the possibility of a bacterial infection. A CBC (complete blood count)
will help confirm the presence of an infection by examining the white blood cell count.
For the following pulmonary function graphic, the known volumes include
TLC 6.0 L VC 4.8 LVT 0.5 LERV 1.8 LIRV 2.5 L
How much is the estimated FRC?
A. 3.0 L
B. 2.3 L
C. 3.6 L
D. 4.3 L - ANSWER-A
Which of the follow data obtained from a pulmonary artery catheter would suggest
impeded blood flow through the pulmonary vasculature?
A. elevated CVP, normal mPAP and PCWP
B. elevated mPAP, normal or low PCWP
C. decreased C.O. with high PCWP
D. increased CVP, mPAP, PCWP, and C.O. - ANSWER-B. Problems related to blood
flowing through the pulmonary vasculature can be identified by examining the pressures
immediately before and after the lungs - mPAP and PCWP. In the case of poor or
impeded blood flow through the pulmonary vasculature, mPAP would likely be elevated
while PCWP would be normal or low.
High-frequency chest wall oscillation device is being used on a patient with pneumonia.
The oscillation setting is measured in which of the following units?
A. CPM
B. cm H2O
C. Hertz
D. RPM - ANSWER-C. Oscillations are set in Hertz.
QUESTIONS AND ANSWERS 100%
CORRECT
A respiratory therapist notices the waveform of a pulmonary artery catheter is
repeatedly rising and descending from 25 mmHg to 8 mmHg. However, a closer
observation reveals there is no dicrotic notch in the waveform. Which of the following
can the respiratory therapist do with the pulmonary artery catheter to correct the
situation?
A. withdraw the the catheter
B. advance the catheter
C. jiggle the catheter
D. aspirate the catheter - ANSWER-D. The absence of a dicrotic notch in a pulmonary
artery pressure waveform is called "pressure dampening". This does not harm the
patient. However, it is an indication of a poor signal and should be resolved. This may
be remedied by: First, aspirating from the catheter; second, flushing the catheter; and
third, rotating the catheter. Advancement or withdraw of the catheter is not an
appropriate remedy for pressure dampening.
The following arterial blood gas results are available for a patient receiving volume
controlled ventilation.
pH 7.21 PaCO2 53 torrPaO2 72 torrHCO3- 23 mEq/LBE -2 mEq/L
Current ventilator settings are:
Mode Assist/control VT 550 mL Mandatory rate 12Total rate 12FIO2 1.0PEEP 20 cm
H2O
The respiratory therapist should recommend:
A. increasing PEEP
B. decreasing tidal volume
C. decreasing FIO2
D. increasing mandatory rate - ANSWER-D. This patient's blood gas reveals
hypoventilation and hypoxemia. Of these two problems, ventilation should be addressed
first. Because PaCO2 is off target by more than 4 mmHg the best option would be to
increase mandatory rate.
A decreasing CvO2 while CaO2 remains constant is most closely associated with
A. increasing tissue oxygen consumption
B. decreasing SVR
C. increasing PVR
, D. decreasing oxygen consumption - ANSWER-A. If CvO2 is decreasing while CaO2
remains the same, there is a widening between the arterial and venous oxygen content
difference C(a-v)O2. A bigger gap between these numbers, or an increase in the C(a-
v)O2, is associated with decreasing tissue oxygen consumption which is also
associated with a decrease in cardiac output.
What is the static compliance in mL/cm H2O, given the following data on a patient
receiving VC AC ventilation?
Plateau pressure 15 cm H2O Peak pressure 25 cm H2OVT 500 mLPEEP 5 cm H2O
A. 25
B. 20
C. 50
D. 33 - ANSWER-C. To determine static compliance, tidal volume is divided by plateau
pressure after subtracting any PEEP. In this case, (500/(15-5) = 50 cm H2O.
A homeless patient reports to a clinic with hemoptysis and emaciation, as well as other
symptoms consistent with tuberculosis. Which of the following exams would be most
appropriate to further assess the patient?
A. Mantoux test
B. eosinophil count
C. FeNO exhaled gas analysis
D. serum creatinine blood level - ANSWER-A. A Mantoux test (also called a TB test) is
helpful in determining the patient's exposure to the tubercle bacilli. Although not
diagnostic for TB, it is a quick screening method that is appropriate.
A patient with confirmed Guillain-Barre' Syndrome is being monitored every 4 hours.
The following data is available:
10 am 2 pm 6 pm VC (L) 1.6 1.4 0.8VT (mL) 500 485 260MIP (cm H2O) -48 -35 -24
The respiratory therapist should recommend
A. intubate and initiate mechanical ventilatory support
B. administer systemic steroid medication
C. continue to monitor the patient closely
D. check the protein level in the spinal fluid - ANSWER-A. A patient with Guillain-Barre'
Syndrome experiences a slow onset of paralysis of the ventilatory muscles and will
ultimately require mechanical ventilatory support. The point at which ventilatory support
is needed is when vital capacity falls below 1 L. In this case, vital capacity is 0.8 L
indicating the patient should be intubated and receive mechanical ventilatory support.
,A patient with a history of hyper-reactive airway disease is having difficulty
expectorating because the sputum is thick and tenacious. Which of the following
medications should the respiratory therapist recommend?
A. Solu-Mederol
B. Acetylcysteine (mucomyst)
C. Spiriva (tiotropium bromide)
D. Beclamethasone (Beclovent) - ANSWER-B. Hyperactive airway disease is
associated with diseases such as asthma and consist of bronchoconstriction and
inflammation. This patient appears to have difficulty with bronchoconstriction and thick
secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are
appropriate.
A patient with a tracheostomy is receiving supplemental oxygen via tracheostomy collar
connected to a large volume nebulizer set at 40%. The respiratory therapist analyzes
the FIO2 at the tracheostomy collar with a galvanic fuel cell analyzer. The analysis
shows the FIO2 to be 55%. Which of the following could be the cause of the increase in
FIO2?
A. too much water in the circuit
B. calibration error in the galvanic fuel cell
C. the aerosol tubing is too short
D. clogged jet orifice in the nebulizer - ANSWER-A. When administering oxygen by any
device that has a venturi mechanism, back pressure on the venturi will slow the speed
of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options
offered, only excess water in the tubing would cause this type of back pressure.
What is the minute ventilation (L/min) of a 200-lb (91-kg) male who has a tidal volume
400 mL and a respiratory rate of 15?
A. 7.2
B. 4.6
C. 6.0
D. 3.0 - ANSWER-C. To determine the minute ventilation of the patient, one should
multiply the tidal volume by the rate. In this case, tidal volume is expressed in mL.
Because minute ventilation is expressed as L/min, tidal volume must be translated to
liters. Thus, .400 x 15 is equal to him 6.0 L.
Which of the following questions or directives would be most helpful in determining a
patient's ability to understand procedural instructions given in English?
A. "Please explain the procedure back to me."
B. "Do you speak English?"
C. "Nod your head if you understand me."
D. "Are you able to understand what I am saying?" - ANSWER-A. The key in
ascertaining a patient's ability to understand instruction is to ask open-ended questions.
An open-ended question is one that cannot be answered simply with 'Yes' or 'No'. In
, many cultures and languages, people are likely to respond with 'Yes' when they do not
understand what is being communicated.
A patient presents in the emergency department (ED) with fever, chills, general malaise,
and mild ventilatory distress. The patient has been in a long-term care center for the
past 6 months and is currently producing thick, yellow sputum. Which of the following
should the respiratory therapist do?
A. order a CBC
B. determine PAO2
C. request an echocardiogram
D. check electrolyte levels - ANSWER-A. Clinical evidence, including a febrile
condition, suggests the possibility of a bacterial infection. A CBC (complete blood count)
will help confirm the presence of an infection by examining the white blood cell count.
For the following pulmonary function graphic, the known volumes include
TLC 6.0 L VC 4.8 LVT 0.5 LERV 1.8 LIRV 2.5 L
How much is the estimated FRC?
A. 3.0 L
B. 2.3 L
C. 3.6 L
D. 4.3 L - ANSWER-A
Which of the follow data obtained from a pulmonary artery catheter would suggest
impeded blood flow through the pulmonary vasculature?
A. elevated CVP, normal mPAP and PCWP
B. elevated mPAP, normal or low PCWP
C. decreased C.O. with high PCWP
D. increased CVP, mPAP, PCWP, and C.O. - ANSWER-B. Problems related to blood
flowing through the pulmonary vasculature can be identified by examining the pressures
immediately before and after the lungs - mPAP and PCWP. In the case of poor or
impeded blood flow through the pulmonary vasculature, mPAP would likely be elevated
while PCWP would be normal or low.
High-frequency chest wall oscillation device is being used on a patient with pneumonia.
The oscillation setting is measured in which of the following units?
A. CPM
B. cm H2O
C. Hertz
D. RPM - ANSWER-C. Oscillations are set in Hertz.
