LINDSEY JONES TMC PRACTICE EXAM
QUESTIONS AND ANSWERS (GRADED
A+)
The medication prostacyclin is used for which of the following purposes?
A. decrease pulmonary hypertension
B. bronchodilate large airways
C. decrease systemic vascular resistance (SVR)
D. improve cardiac contractility - ANSWER-A. decrease pulmonary hypertension
The respiratory therapist obtains the following blood gas data on a patient breathing
spontaneously on room air:
pH 7.35 PaCO2 45 torr PaO2 50 torr HCO3- 27 mEq/L BE +2 mEq/L
The therapist could accurately estimate the patient's SaO2 to be which of the following?
A. 75%
B. 80%
C. 85%
D. 90% - ANSWER-B. 80%
A PaO2 of 50 mmHg most closely correlates with an oxygen saturation of about 80% on
the oxygen dissociation curve.
After instructing a patient and demonstrating the proper use of a metered dose inhaler
with a valved holding chamber, the patient performs the maneuver by placing the
chamber in his mouth, actuating the cannister, and then exhaling prior to performing
inhalation. The respiratory therapist should
A. document that the education was effective.
B. re-instruct the patient to inhale immediately after actuation of the cannister.
C. instruct the patient to inhale while depressing the cannister.
D. remove the cannister and have the patient reattempt the dose delivery. - ANSWER-
B. re-instruct the patient to inhale immediately after actuation of the cannister.
If the patient exhales through the chamber immediately after actuating the inhaler, the
medication may be ejected through the valve and out of the chamber. This would
discard the medication. After depressing the cannister, the first action should be to
inhale through the chamber.
In response to an Asthma action plan, the patient has attempted to contact their
physician after determining peak flow measurement is less than 50% of the patient's
,usual baseline value. The physician is not responding to the call. According to NAEP
guidelines, the patient should NEXT
A. take a short-term bronchodilator, check peak flow in 1 hour
B. take a corticosteroid inhaler and check again in 20 minutes
C. take a short-term bronchodilator and contact a different physician
D. report to the hospital or call an ambulance - ANSWER-D. report to the hospital or
call an ambulance
According the national asthma guidelines, a self monitored peak flow of 50% of baseline
is an indication to contact one's physician. However, if one's physician is not available,
the patient should report to the hospital or to the emergency room or call an ambulance.
A patient is orally intubated with a 7.0-mm ET tube. Immediately following the
procedure, the respiratory therapist will FIRST do which of the following to check for
proper positioning of the airway?
A. observe the color of the CO2 detector
B. obtain a chest radiograph
C. auscultate breath sounds
D. palpate the trachea - ANSWER-A. observe the color of the CO2 detector
When asked in a question what to do first in any given situation, the most likely answer
is that which is quickest. In this case a patient has just been inutbated and the therapist
is asked to determine if the tube is in the proper position. Palpating the trachea will not
be helpful but the other three options are all legitimate ways to ensure proper
positioning of the ET tube. But, the quickest way is to do something visual. In this case,
simply observing the color of the CO2 detector is quickest. The next best option is to
auscultate breath sounds. This is also very quick but takes a little longer than a simple
visual assessment. Finally, the next best answer is to obtain a chest radiograph. This
will provide conclusive evidence, but it is time-consuming and is not the best option
when trying to determine the position of the tube quickly.
Which of the following indicate a patient is ready to wean from mechanical ventilation?
A. A-aDO2 of 380 mmHg
B. RSBI 138
C. MIP of -12 cmH2O
D. VT of 6 mL/kg - ANSWER-D. VT of 6 mL/kg
In order to wean from the ventilator the MIP must be more than -28 cmH2O. Tidal
volume must be at least 5 mL per kilogram and RSBI must be less than 106. The
alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this
case only the tidal volume of 6 mL per kilogram and the RSBI of 90 indicate the patient
is ready to wean from mechanical ventilatory support.
, After placing a patient on helium-oxygen therapy (60%/40%) by nonrebreather mask,
the respiratory therapist notices a complete collapse of the attached reservoir with each
breath initially. After a few moments, the reservoir bag begins to collapse only partially
with each breath. The therapist should conclude
A. the presence of CO2 overdose.
B. a decrease in minute alveolar ventilation.
C. inadequate ventilatory drive.
D. a decrease in airway resistance. - ANSWER-D. a decrease in airway resistance.
A COPD patient is being assess in the hospital for readiness to be discharged home.
The respiratory therapist is in charge of establishing the appropriate oxygen flow rate by
nasal cannula to be used at home. The patient maintains an SpO2 of 90% on 2 L/min at
rest, and 86% during ambulation. Which of the following recommendation would be
most appropriate?
A. 2 L/min at rest, 3 L/min during exertion
B. 2 L/min at all times
C. 1 L/min at rest, 2 L/min during ambulation
D. 1 L/min during sleep, 2 L/min all other times - ANSWER-A. 2 L/min at rest, 3 L/min
during exertion
For COPD patients who need supplemental oxygen, 1-2 L/min or 24-28% is appropriate
while at rest. However, if the patient is participating in any kind of exercise or pulmonary
rehabilitation program that requires activity, additional flow may be provided during the
activity only. Increasing flow does not actually increase the FIO2 for the patient,
especially if they are on a nasal cannula. When the patient engages in exertion, they
typically increase their tidal volume and inspiratory flow rate. In doing so, they entrain
more air through their nose and lower their FIO2. Thus, an increase in flow rate during
the exercise helps to minimize air entrainment and changes in oxygen percentage.
Another way to approach this is to provide an air entrainment mask that delivers high
flow. In that case increasing FIO2 is not necessary.
A respiratory therapist is caring for a patient who has a sign posted outside their
hospital room door that indicates, "Respiratory Isolation". The therapist should observe
all of the following EXCEPT:
A. Do not allow visitors to enter the room
B. Use N95 respirator
C. Universal precautions
D. Patient should use a mask when visitors are present - ANSWER-A. Do not allow
visitors to enter the room
Respiratory isolation requires use of an N95 respirator, and universal precautions. The
patient's use of a mask when visitors are present is also required. Disallowing visitors in
the room is not required.
QUESTIONS AND ANSWERS (GRADED
A+)
The medication prostacyclin is used for which of the following purposes?
A. decrease pulmonary hypertension
B. bronchodilate large airways
C. decrease systemic vascular resistance (SVR)
D. improve cardiac contractility - ANSWER-A. decrease pulmonary hypertension
The respiratory therapist obtains the following blood gas data on a patient breathing
spontaneously on room air:
pH 7.35 PaCO2 45 torr PaO2 50 torr HCO3- 27 mEq/L BE +2 mEq/L
The therapist could accurately estimate the patient's SaO2 to be which of the following?
A. 75%
B. 80%
C. 85%
D. 90% - ANSWER-B. 80%
A PaO2 of 50 mmHg most closely correlates with an oxygen saturation of about 80% on
the oxygen dissociation curve.
After instructing a patient and demonstrating the proper use of a metered dose inhaler
with a valved holding chamber, the patient performs the maneuver by placing the
chamber in his mouth, actuating the cannister, and then exhaling prior to performing
inhalation. The respiratory therapist should
A. document that the education was effective.
B. re-instruct the patient to inhale immediately after actuation of the cannister.
C. instruct the patient to inhale while depressing the cannister.
D. remove the cannister and have the patient reattempt the dose delivery. - ANSWER-
B. re-instruct the patient to inhale immediately after actuation of the cannister.
If the patient exhales through the chamber immediately after actuating the inhaler, the
medication may be ejected through the valve and out of the chamber. This would
discard the medication. After depressing the cannister, the first action should be to
inhale through the chamber.
In response to an Asthma action plan, the patient has attempted to contact their
physician after determining peak flow measurement is less than 50% of the patient's
,usual baseline value. The physician is not responding to the call. According to NAEP
guidelines, the patient should NEXT
A. take a short-term bronchodilator, check peak flow in 1 hour
B. take a corticosteroid inhaler and check again in 20 minutes
C. take a short-term bronchodilator and contact a different physician
D. report to the hospital or call an ambulance - ANSWER-D. report to the hospital or
call an ambulance
According the national asthma guidelines, a self monitored peak flow of 50% of baseline
is an indication to contact one's physician. However, if one's physician is not available,
the patient should report to the hospital or to the emergency room or call an ambulance.
A patient is orally intubated with a 7.0-mm ET tube. Immediately following the
procedure, the respiratory therapist will FIRST do which of the following to check for
proper positioning of the airway?
A. observe the color of the CO2 detector
B. obtain a chest radiograph
C. auscultate breath sounds
D. palpate the trachea - ANSWER-A. observe the color of the CO2 detector
When asked in a question what to do first in any given situation, the most likely answer
is that which is quickest. In this case a patient has just been inutbated and the therapist
is asked to determine if the tube is in the proper position. Palpating the trachea will not
be helpful but the other three options are all legitimate ways to ensure proper
positioning of the ET tube. But, the quickest way is to do something visual. In this case,
simply observing the color of the CO2 detector is quickest. The next best option is to
auscultate breath sounds. This is also very quick but takes a little longer than a simple
visual assessment. Finally, the next best answer is to obtain a chest radiograph. This
will provide conclusive evidence, but it is time-consuming and is not the best option
when trying to determine the position of the tube quickly.
Which of the following indicate a patient is ready to wean from mechanical ventilation?
A. A-aDO2 of 380 mmHg
B. RSBI 138
C. MIP of -12 cmH2O
D. VT of 6 mL/kg - ANSWER-D. VT of 6 mL/kg
In order to wean from the ventilator the MIP must be more than -28 cmH2O. Tidal
volume must be at least 5 mL per kilogram and RSBI must be less than 106. The
alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this
case only the tidal volume of 6 mL per kilogram and the RSBI of 90 indicate the patient
is ready to wean from mechanical ventilatory support.
, After placing a patient on helium-oxygen therapy (60%/40%) by nonrebreather mask,
the respiratory therapist notices a complete collapse of the attached reservoir with each
breath initially. After a few moments, the reservoir bag begins to collapse only partially
with each breath. The therapist should conclude
A. the presence of CO2 overdose.
B. a decrease in minute alveolar ventilation.
C. inadequate ventilatory drive.
D. a decrease in airway resistance. - ANSWER-D. a decrease in airway resistance.
A COPD patient is being assess in the hospital for readiness to be discharged home.
The respiratory therapist is in charge of establishing the appropriate oxygen flow rate by
nasal cannula to be used at home. The patient maintains an SpO2 of 90% on 2 L/min at
rest, and 86% during ambulation. Which of the following recommendation would be
most appropriate?
A. 2 L/min at rest, 3 L/min during exertion
B. 2 L/min at all times
C. 1 L/min at rest, 2 L/min during ambulation
D. 1 L/min during sleep, 2 L/min all other times - ANSWER-A. 2 L/min at rest, 3 L/min
during exertion
For COPD patients who need supplemental oxygen, 1-2 L/min or 24-28% is appropriate
while at rest. However, if the patient is participating in any kind of exercise or pulmonary
rehabilitation program that requires activity, additional flow may be provided during the
activity only. Increasing flow does not actually increase the FIO2 for the patient,
especially if they are on a nasal cannula. When the patient engages in exertion, they
typically increase their tidal volume and inspiratory flow rate. In doing so, they entrain
more air through their nose and lower their FIO2. Thus, an increase in flow rate during
the exercise helps to minimize air entrainment and changes in oxygen percentage.
Another way to approach this is to provide an air entrainment mask that delivers high
flow. In that case increasing FIO2 is not necessary.
A respiratory therapist is caring for a patient who has a sign posted outside their
hospital room door that indicates, "Respiratory Isolation". The therapist should observe
all of the following EXCEPT:
A. Do not allow visitors to enter the room
B. Use N95 respirator
C. Universal precautions
D. Patient should use a mask when visitors are present - ANSWER-A. Do not allow
visitors to enter the room
Respiratory isolation requires use of an N95 respirator, and universal precautions. The
patient's use of a mask when visitors are present is also required. Disallowing visitors in
the room is not required.
