LINDSEY JONES TMC PRACTICE EXAM
WITH CORRECT SOLUTIONS
Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver.
During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should
A. record an MIP of -27 cmH2O
B. record and MIP of -20 cmH2O
C. record an MIP of -13 cmH2O
D. repeat the maneuver five more times - ANSWER-A. record an MIP of -27 cmH2O
Although -20 cmH2O is observed on the pressure manometer, the real pressure being
produced is -27 cmH2O. This is because the manometer is not properly calibrated to
zero. Therefore, an adjustment must be accounted for when taking a measurement.
You must add the number that the needle is pointing to prior to the maneuver to the
number achieved by the patient during the maneuver to get an accurate measurement.
Which of the following could be associated with asymmetrical chest rise?
A. significant atelectasis
B. COPD
C. pleural effusion
D. cystic fibrosis - ANSWER-A. significant atelectasis
Of the options given, only atelectasis is associated with asymmetrical chest rise.
A respiratory therapist examines the patient's record to see the results of an acid-fast
sputum stain. For which of the following conditions is the therapist investigating?
A. Penicillin allergies
B. Penicillin resistance
C. pulmonary tuberculosis
D. antibiotic sensitivity - ANSWER-C. pulmonary tuberculosis
The results of an acid-fast sputum stain will rule in or rule out pulmonary tuberculosis.
A patient is suspected for carbon monoxide poisoning after being found lethargic in an
enclosed space with a running motor vehicle. Which of the following would be helpful in
further assessing the patient for this suspicion?
A. multiple wave-length spectrophotometry
B. oxygen analysis with a Clark electrode
,C. Polargraphic oxygen analysis
D. PetCO2 monitoring - ANSWER-A. multiple wave-length spectrophotometry
Explanation : A pulse oximetry cannot be used to measure true oxygen saturation as it
can be erroneous in the presence of carbon monoxide poisoning. This is true because
pulse oximetry provides single wavelength spectrophotometry. However, there are
relatively new devices using multiple wavelength spectrophotometry that can detect
carbon monoxide in the blood much the same way a pulse oximeter can detect oxygen.
Because this method is quick and inexpensive it would be preferred over hemoximetry.
Due to slow emergence from sedation, a patient is receiving IPPB therapy by mask with
a pressure ventilator to help prevent post-operative complications. While administering
the therapy to the patient, the respiratory therapist notices that the pressure fails to rise
smoothly to the set pressure with intermittent downward deflections in the pressure
reading. The therapist should increase
A. flow.
B. inspiratory time.
C. set pressure.
D. sensitivity. - ANSWER-A. flow.
Failure of a pressure ventilator to smoothly rise to set pressure is typically related to
inadequate flow. At times, the patient's own inspiratory flow rate exceeds the machine's
flow rate, which can cause an intermittent, erratic rise to pressure - not desirable.
A respiratory therapist is called to stand by at the delivery of a newborn that has
experienced cardiac decelerations during labor. After the baby is delivered and
presented to the warmer, the respiratory therapist should assess
A. age of the mother
B. gestational age
C. radiograph
D. APGAR - ANSWER-D. APGAR
APGAR (appearance, pulse, grimace, activity, and respiratory effort) is done on every
newborn after 1-minute and after 5-minutes of life.
Pulmonary function testing shows the following lung volumes on a patient:
ERV (L) 1.0
FRC (L) 5.0
VC (L) 3.4
What is the patient's TLC?
A. 7.4 L
B. 9.4 L
, C. 2.6 L
D. 8.4 L - ANSWER-A. 7.4 L
The patient's total lung capacity can be calculated by adding the FRC to the vital
capacity and subtracting ERV. This amounts to a total lung capacity of 7400 mL.
The following laboratory data is observed in a patient who has been experiencing
massive vomiting for 12 hours:
BUN 18 mg/dL
K+ 2.8 mEq/L
Cl- 82 mEq/L
Na+ 101 mEq/L
RBC 6.0 g/dL
Hb 12 g/dL
Which of the following may also be observed?
A. elevated pulmonary artery pressure
B. loose bowel
C. flattened T waves on ECG
D. involuntary muscle contraction in the extremities - ANSWER-C. flattened T waves on
ECG
Close examination of this data reveals that the patient has hypokalemia, as shown by a
potassium level that is well below normal. Normal potassium is about 4.0 mEq/L. Low
potassium will cause the ECG tracing to demonstrate what is called flattened or dull T
waves.
A 70-kg (154-lb) male patient is receiving volume-controlled mechanical ventilation on
the following settings:
Mode SIMV
Mandatory rate 16
Tidal volume 600 mL
FIO2 0.4
PEEP 5 cm H2O
Insp flow rate 55 L/min
The following ventilator graphic is associated with the current state of ventilation. Which
of the following should the respiratory therapist recommend?
A. switch to assist/control mode
B. decrease tidal volume
C. increase inspiratory flow rate
D. decrease pressure limit - ANSWER-B. decrease tidal volume
The pressure-volume ventilator graphic shown demonstrates a pronounced beak. A
pronounced beak shows a significant increase in pressure to accomplish a very small
amount of volume. This is because the volume is too large for the lung and the lung is
WITH CORRECT SOLUTIONS
Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver.
During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should
A. record an MIP of -27 cmH2O
B. record and MIP of -20 cmH2O
C. record an MIP of -13 cmH2O
D. repeat the maneuver five more times - ANSWER-A. record an MIP of -27 cmH2O
Although -20 cmH2O is observed on the pressure manometer, the real pressure being
produced is -27 cmH2O. This is because the manometer is not properly calibrated to
zero. Therefore, an adjustment must be accounted for when taking a measurement.
You must add the number that the needle is pointing to prior to the maneuver to the
number achieved by the patient during the maneuver to get an accurate measurement.
Which of the following could be associated with asymmetrical chest rise?
A. significant atelectasis
B. COPD
C. pleural effusion
D. cystic fibrosis - ANSWER-A. significant atelectasis
Of the options given, only atelectasis is associated with asymmetrical chest rise.
A respiratory therapist examines the patient's record to see the results of an acid-fast
sputum stain. For which of the following conditions is the therapist investigating?
A. Penicillin allergies
B. Penicillin resistance
C. pulmonary tuberculosis
D. antibiotic sensitivity - ANSWER-C. pulmonary tuberculosis
The results of an acid-fast sputum stain will rule in or rule out pulmonary tuberculosis.
A patient is suspected for carbon monoxide poisoning after being found lethargic in an
enclosed space with a running motor vehicle. Which of the following would be helpful in
further assessing the patient for this suspicion?
A. multiple wave-length spectrophotometry
B. oxygen analysis with a Clark electrode
,C. Polargraphic oxygen analysis
D. PetCO2 monitoring - ANSWER-A. multiple wave-length spectrophotometry
Explanation : A pulse oximetry cannot be used to measure true oxygen saturation as it
can be erroneous in the presence of carbon monoxide poisoning. This is true because
pulse oximetry provides single wavelength spectrophotometry. However, there are
relatively new devices using multiple wavelength spectrophotometry that can detect
carbon monoxide in the blood much the same way a pulse oximeter can detect oxygen.
Because this method is quick and inexpensive it would be preferred over hemoximetry.
Due to slow emergence from sedation, a patient is receiving IPPB therapy by mask with
a pressure ventilator to help prevent post-operative complications. While administering
the therapy to the patient, the respiratory therapist notices that the pressure fails to rise
smoothly to the set pressure with intermittent downward deflections in the pressure
reading. The therapist should increase
A. flow.
B. inspiratory time.
C. set pressure.
D. sensitivity. - ANSWER-A. flow.
Failure of a pressure ventilator to smoothly rise to set pressure is typically related to
inadequate flow. At times, the patient's own inspiratory flow rate exceeds the machine's
flow rate, which can cause an intermittent, erratic rise to pressure - not desirable.
A respiratory therapist is called to stand by at the delivery of a newborn that has
experienced cardiac decelerations during labor. After the baby is delivered and
presented to the warmer, the respiratory therapist should assess
A. age of the mother
B. gestational age
C. radiograph
D. APGAR - ANSWER-D. APGAR
APGAR (appearance, pulse, grimace, activity, and respiratory effort) is done on every
newborn after 1-minute and after 5-minutes of life.
Pulmonary function testing shows the following lung volumes on a patient:
ERV (L) 1.0
FRC (L) 5.0
VC (L) 3.4
What is the patient's TLC?
A. 7.4 L
B. 9.4 L
, C. 2.6 L
D. 8.4 L - ANSWER-A. 7.4 L
The patient's total lung capacity can be calculated by adding the FRC to the vital
capacity and subtracting ERV. This amounts to a total lung capacity of 7400 mL.
The following laboratory data is observed in a patient who has been experiencing
massive vomiting for 12 hours:
BUN 18 mg/dL
K+ 2.8 mEq/L
Cl- 82 mEq/L
Na+ 101 mEq/L
RBC 6.0 g/dL
Hb 12 g/dL
Which of the following may also be observed?
A. elevated pulmonary artery pressure
B. loose bowel
C. flattened T waves on ECG
D. involuntary muscle contraction in the extremities - ANSWER-C. flattened T waves on
ECG
Close examination of this data reveals that the patient has hypokalemia, as shown by a
potassium level that is well below normal. Normal potassium is about 4.0 mEq/L. Low
potassium will cause the ECG tracing to demonstrate what is called flattened or dull T
waves.
A 70-kg (154-lb) male patient is receiving volume-controlled mechanical ventilation on
the following settings:
Mode SIMV
Mandatory rate 16
Tidal volume 600 mL
FIO2 0.4
PEEP 5 cm H2O
Insp flow rate 55 L/min
The following ventilator graphic is associated with the current state of ventilation. Which
of the following should the respiratory therapist recommend?
A. switch to assist/control mode
B. decrease tidal volume
C. increase inspiratory flow rate
D. decrease pressure limit - ANSWER-B. decrease tidal volume
The pressure-volume ventilator graphic shown demonstrates a pronounced beak. A
pronounced beak shows a significant increase in pressure to accomplish a very small
amount of volume. This is because the volume is too large for the lung and the lung is
