LINDSEY JONES TMC QUESTIONS WITH
VERIFIED ANSWERS
A 70-kg (154-lb) female patient is receiving mechanical ventilation on the following
settings:
Mode assist/control
Mandatory rate 14
Total rate 14
VT 500 mL
FIO2 0.55
PEEP 12 cmH2O
Arterial blood gases reveal
pH 7.49
PaCO2 32 mmHg
PaO2 109 mmHg
HCO3- 24 mEq/L
BE 0 mEq/L
The respiratory therapist should
A. increase mandatory rate
B. decrease PEEP
C. decrease FIO2
D. decrease mandatory rate - ANSWER-B. decrease PEEP
Prior to obtaining an MEP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of -4 cmH2O prior to the maneuver.
During the MEP maneuver, the needle reaches 32 cmH2O. The therapist should
A. record and MEP of -28 cmH2O
B. record an MEP of 36 cmH2O
C. record an MEP of 28 cmH2O
D. report the problem to the medical director - ANSWER-B. record an MEP of 36
cmH2O
Which of the following is the most significant complication of bronchoscopy?
A. coughing
B. vagal nerve stimulation
C. laryngospasms
D. hypotension - ANSWER-C. laryngospasms
,A patient has the following input/output history and other clinical information:
Yesterday Today
IN 1900 cc 1600 cc
OUT 2200 cc 1900 cc
C.O. 5.1 L/min 3.8 L/min
BP 110/80 mm Hg 110/80 mm Hg
CVP 5 mm Hg 5 mm Hg
These data would result in which of the following?
A. increase in PCWP
B. increase in PAP
C. decrease in PVR
D. increase in SVR - ANSWER-D. increase in SVR
This question is tricky. The first observation one must make is that the patient is putting
out more fluid than he is taking in. This will result in dehydration and a decrease in all
hemodynamic values including cardiac output. If cardiac output is decreased, systemic
vascular resistance will increase. One must know the formula for systemic vascular
resistance in order to understand this. Systemic vascular resistance is determined by
subtracting CVP from MAP and dividing it by cardiac output. If cardiac output is
decreased then the final SVR number will increase.
Which of the following would result in an increase in pulmonary capillary wedge
pressure?
A. decrease in pulmonary vascular resistance (PVR)
B. mitral valve stenosis
C. dehydration
D. cor pulmonale - ANSWER-B. mitral valve stenosis
During a difficult intubation, the emergency room physician requests an endotracheal
tube that is smaller than recommended for the patient's height and ideal body weight.
As a result, the respiratory therapist should anticipate
A. a decrease in static compliance
B. increase in PAW
C. an increase in RAW
D. increased I:E ratio - ANSWER-C. an increase in RAW
,A patient is receiving oxygen by nasal cannula at 4 L/min. After 24 hours of use with a
properly functioning bubble humidifier, the patient complains of nosebleeds. The
therapist would do which of the following to modify therapy?
A. decrease flow to 2 L/min
B. switch to an air-entrainment mask at FIO2 35%
C. provide a heated bubble humidifier
D. switch to a simple mask at 4 L/min - ANSWER-B. switch to an air-entrainment mask
at FIO2 35%
Which of the following airway clearance therapies should be administered first in the
order of therapy?
A. postural drainage and percussion
B. nasal tracheal suctioning
C. aerosolized Acetylcysteine (Mucomyst)
D. verbal coaching for coughing - ANSWER-C. aerosolized Acetylcysteine (Mucomyst)
Which of the following is most indicative of a pulmonary embolism?
A. increased PAP, decreased PCWP
B. increased PCWP, decreased cardiac output
C. decreased CVP, decreased cardiac output
D. increased CVP, decreased PAP - ANSWER-A. increased PAP, decreased PCWP
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest
radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most
likely has
A. a pulmonary embolism
B. ARDS
C. pneumonia
D. fluid overload - ANSWER-A. a pulmonary embolism
A pulse oximeter reading is significantly less than oxygen saturation by blood gas.
Which of the following could be the cause?
A. increased SVR
B. decreased QsQt
C. decreased CVP
D. marked hypotension - ANSWER-D. marked hypotension
An adult post-op patient is unable to get any of the balls to rise on an incentive
spirometer, in spite of reports of her best effort. The therapist should
A. switch to IPPB by mask
, B. discontinue therapy and report the problem to the physician
C. switch to postural drainage and percussion
D. switch to a volume-type incentive spirometer - ANSWER-D. switch to a volume-type
incentive spirometer
Which of the following would be a sufficient reason to discontinue an SBT (spontaneous
breathing trial)?
A. respiratory rate increases from 18 to 26 per minute
B. blood pressure increases from 110/70 to 132/90 mmHg
C. heart rate increases from 80 to 96 bpm
D. SPO2 decreases from 98% to 94% - ANSWER-B. blood pressure increases from
110/70 to 132/90 mmHg
A patient with decreasing pulmonary compliance is receiving volume-controlled
ventilation with an I:E ratio of 1:2. A chest radiograph shows increased atelectasis.
Blood gases show signs of refractory hypoxemia. Which of the following is an
appropriate change for this patient?
A. decrease PEEP
B. increase expiratory time
C. increase inspiratory pressure limit
D. decrease inspiratory flow rate - ANSWER-D. decrease inspiratory flow rate
A 74-kg (166-lb) 5-ft 8-in (173-cm) female is receiving mechanical ventilation by a
volume-controlled ventilator in the assist/control mode on the following settings:
Mandatory rate 12/min
VT 500 mL
FIO2 0.5
PEEP 5 cmH2O
Arterial blood gas results:
pH 7.47
PaCO2 34 mmHg
PO2 80 mmHg
HCO3- 23 mEq/L
BE -1 mEq/L
Which of the following represents the most appropriate action?
A. decrease tidal volume
B. increase FIO2 to 0.6
C. add 100 mL deadspace
D. increase rate to 16 - ANSWER-C. add 100 mL deadspace
VERIFIED ANSWERS
A 70-kg (154-lb) female patient is receiving mechanical ventilation on the following
settings:
Mode assist/control
Mandatory rate 14
Total rate 14
VT 500 mL
FIO2 0.55
PEEP 12 cmH2O
Arterial blood gases reveal
pH 7.49
PaCO2 32 mmHg
PaO2 109 mmHg
HCO3- 24 mEq/L
BE 0 mEq/L
The respiratory therapist should
A. increase mandatory rate
B. decrease PEEP
C. decrease FIO2
D. decrease mandatory rate - ANSWER-B. decrease PEEP
Prior to obtaining an MEP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of -4 cmH2O prior to the maneuver.
During the MEP maneuver, the needle reaches 32 cmH2O. The therapist should
A. record and MEP of -28 cmH2O
B. record an MEP of 36 cmH2O
C. record an MEP of 28 cmH2O
D. report the problem to the medical director - ANSWER-B. record an MEP of 36
cmH2O
Which of the following is the most significant complication of bronchoscopy?
A. coughing
B. vagal nerve stimulation
C. laryngospasms
D. hypotension - ANSWER-C. laryngospasms
,A patient has the following input/output history and other clinical information:
Yesterday Today
IN 1900 cc 1600 cc
OUT 2200 cc 1900 cc
C.O. 5.1 L/min 3.8 L/min
BP 110/80 mm Hg 110/80 mm Hg
CVP 5 mm Hg 5 mm Hg
These data would result in which of the following?
A. increase in PCWP
B. increase in PAP
C. decrease in PVR
D. increase in SVR - ANSWER-D. increase in SVR
This question is tricky. The first observation one must make is that the patient is putting
out more fluid than he is taking in. This will result in dehydration and a decrease in all
hemodynamic values including cardiac output. If cardiac output is decreased, systemic
vascular resistance will increase. One must know the formula for systemic vascular
resistance in order to understand this. Systemic vascular resistance is determined by
subtracting CVP from MAP and dividing it by cardiac output. If cardiac output is
decreased then the final SVR number will increase.
Which of the following would result in an increase in pulmonary capillary wedge
pressure?
A. decrease in pulmonary vascular resistance (PVR)
B. mitral valve stenosis
C. dehydration
D. cor pulmonale - ANSWER-B. mitral valve stenosis
During a difficult intubation, the emergency room physician requests an endotracheal
tube that is smaller than recommended for the patient's height and ideal body weight.
As a result, the respiratory therapist should anticipate
A. a decrease in static compliance
B. increase in PAW
C. an increase in RAW
D. increased I:E ratio - ANSWER-C. an increase in RAW
,A patient is receiving oxygen by nasal cannula at 4 L/min. After 24 hours of use with a
properly functioning bubble humidifier, the patient complains of nosebleeds. The
therapist would do which of the following to modify therapy?
A. decrease flow to 2 L/min
B. switch to an air-entrainment mask at FIO2 35%
C. provide a heated bubble humidifier
D. switch to a simple mask at 4 L/min - ANSWER-B. switch to an air-entrainment mask
at FIO2 35%
Which of the following airway clearance therapies should be administered first in the
order of therapy?
A. postural drainage and percussion
B. nasal tracheal suctioning
C. aerosolized Acetylcysteine (Mucomyst)
D. verbal coaching for coughing - ANSWER-C. aerosolized Acetylcysteine (Mucomyst)
Which of the following is most indicative of a pulmonary embolism?
A. increased PAP, decreased PCWP
B. increased PCWP, decreased cardiac output
C. decreased CVP, decreased cardiac output
D. increased CVP, decreased PAP - ANSWER-A. increased PAP, decreased PCWP
The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest
radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most
likely has
A. a pulmonary embolism
B. ARDS
C. pneumonia
D. fluid overload - ANSWER-A. a pulmonary embolism
A pulse oximeter reading is significantly less than oxygen saturation by blood gas.
Which of the following could be the cause?
A. increased SVR
B. decreased QsQt
C. decreased CVP
D. marked hypotension - ANSWER-D. marked hypotension
An adult post-op patient is unable to get any of the balls to rise on an incentive
spirometer, in spite of reports of her best effort. The therapist should
A. switch to IPPB by mask
, B. discontinue therapy and report the problem to the physician
C. switch to postural drainage and percussion
D. switch to a volume-type incentive spirometer - ANSWER-D. switch to a volume-type
incentive spirometer
Which of the following would be a sufficient reason to discontinue an SBT (spontaneous
breathing trial)?
A. respiratory rate increases from 18 to 26 per minute
B. blood pressure increases from 110/70 to 132/90 mmHg
C. heart rate increases from 80 to 96 bpm
D. SPO2 decreases from 98% to 94% - ANSWER-B. blood pressure increases from
110/70 to 132/90 mmHg
A patient with decreasing pulmonary compliance is receiving volume-controlled
ventilation with an I:E ratio of 1:2. A chest radiograph shows increased atelectasis.
Blood gases show signs of refractory hypoxemia. Which of the following is an
appropriate change for this patient?
A. decrease PEEP
B. increase expiratory time
C. increase inspiratory pressure limit
D. decrease inspiratory flow rate - ANSWER-D. decrease inspiratory flow rate
A 74-kg (166-lb) 5-ft 8-in (173-cm) female is receiving mechanical ventilation by a
volume-controlled ventilator in the assist/control mode on the following settings:
Mandatory rate 12/min
VT 500 mL
FIO2 0.5
PEEP 5 cmH2O
Arterial blood gas results:
pH 7.47
PaCO2 34 mmHg
PO2 80 mmHg
HCO3- 23 mEq/L
BE -1 mEq/L
Which of the following represents the most appropriate action?
A. decrease tidal volume
B. increase FIO2 to 0.6
C. add 100 mL deadspace
D. increase rate to 16 - ANSWER-C. add 100 mL deadspace
