MOCK TMC LEVEL TWO EXAM
QUESTIONS AND ANSWERS
A physician orders O2 therapy per protocol for an otherwise healthy postoperative
patient who has a PaO2 of 52 torr on room air. After initiating a nasal cannula at 2 L/min
and repeating an arterial blood gas, the patient's PaOs is now 50 torr. Which action
should the RRT take? - ANSWER-increase oxygen flow and reassess the patient
A toddler is receiving volume control A/C ventilation. To minimize volume loss due to
compression and tubing expansion, which of the following should a RRT select? -
ANSWER-low-compliance tubing
A physician is insistent in getting stat ABG results for a patient crashing in the ICU. The
RT draws the ABG and takes the specimen to the blood gas analyzer. There is a
calibration error message on the analyzer. The therapist sees that the last quality
control results were out of range for PaCO2 by -5 mm Hg. The best course of action is
to: - ANSWER-recalibrate and repeat quality control to within control limits
For which of the following patients should a RRT carefully monitor cardiovascular
function during application of intermittent positive pressure breathing (IPPB)?
I. a patient with low blood pressure
II. a patient with poor vasomotor tone
III. a patient with cardiac insufficiency - ANSWER-I. a patient with low blood pressure
II. a patient with poor vasomotor tone
III. a patient with cardiac insufficiency
During an interview with a patient, the RRT determines the patient is disoriented to time,
place, and person. The most likely cause of these findings is: - ANSWER-severe
hypoxemia
Normally the A-a gradient, PAO2 - PaO2, on room air is: - ANSWER-5-10 mm Hg
A patient with severe chronic bronchitis has developed P. aeruginosa the best
pharmacological intervention is: - ANSWER-tobramycin (TOBI)
A 45-yo woman is breathing 70% oxygen at sea level. She has the following ABG
results.
pH 7.35, PaO2 50 mm Hg, PaCO2 50 mm Hg
The RRT has calculated the A-a gradient (P[A-a]O2) as 399 mm Hg. These results are
most indicative of: - ANSWER-severe diminished alveolar-arterial oxygen transfer
Which of the following alarm conditions indicates a potential system leak when
delivering volume control mechanical ventilation? - ANSWER-low volume + low
pressure
,A respiratory therapist has assessed four patients for cardiovascular stability. The
results are as follows.
Patient
HR/min
B/P mm Hg
CI L/min/m2
ECG
Room 202
60
80/50
2.0
bradycardia
Room 204
90
100/70
2.5
occasional PVCs
Room 209
96
120/80
4.0
multiple runs of PVCs
Room 212
184
190/110
3.5
SVT
Which patient has the best cardiovascular status to consider weaning from mechanical
ventilation? - ANSWER-Room 204
A patient on mechanical ventilation has a respiratory rate of 12/min, VT 6 mL/Kg, PBW
72 Kg, and is on P/AC, PIP 26. What is the patient's TCT? - ANSWER-5
A patient's bedside spirometry results, as compared to normal, are as follows.
FVC decreased, FEV1 normal, FEV1% increased
What is the most likely diagnosis? - ANSWER-restrictive disorder
A RRT conducts a 6-minute walk test (6MWT) on four patients before and after
participation in a pulmonary rehabilitation program. Based on the 6-minute walking
distance (6MWD) provided below, for which patient has the program been effective in
improving their functional capacity?
Patient Pre-program 6MWD Post-program 6MWD
A 200 m 210 m
B 150 m 200 m
, C 250 m 270 m
D 400 m 430 m - ANSWER-patient B
A patient has the following ABG.
pH 7.37, PaO2 50 mm Hg, PaCO2 50 mm Hg, HCO3 25 mEq/L, PAO2 449 mm Hg
The P(A-a)O2 is: - ANSWER-399 torr
A respiratory therapist is asked to assess a 16-year-old girl with a severe head cold who
is receiving 4 L/min O2 via nasal cannula. The patient is alert and awake and is
complaining that she cannot breathe through her nose. Her SpO2 is 84%. Which action
should the respiratory therapist take? - ANSWER-Change to a simple O2 mask at 5-7
L/min
While suctioning a patient there is an abrupt change in the ECG waveform displayed on
the cardiac monitor. The SpO2 drops precipitously. Which of the following actions
should a RRT take next? - ANSWER-stop suctioning and immediately administer
oxygen
Lung recruitment maneuvers, RM, for patients with ARDS is most likely to be
successful: - ANSWER-early in the course of ARDS once the patient is stabilized
A mechanically ventilated patient has a VD/VT ratio of 0.62. The respiratory therapist
should recommend: - ANSWER-increasing VT
To evaluate and follow the course of a patient with interstitial lung disease, which of the
following procedures should the RRT recommend? - ANSWER-diffusing capacity
(DLCO)
A patient with acute bronchitis is receiving mechanical ventilation. Wheezing is heard
over all lung fields, and rhonchi are heard over the central airways. Secretions are thick.
The patient's peak pressure is 45 cm H2O, plateau pressure is 20 cm H2O. All of the
following would be useful to treat the patient except: - ANSWER-pancuronium bromide
(Pavulon)
An adult pressure release valve on a BVM device is most likely to vent pressures
exceeding: - ANSWER-45 cm H2O or greater
Methemoglobinemia exceeding 30% is best treated with: - ANSWER-methylene blue or
ascorbic acid
An apnea monitor on a premature infant indicates abnormal decrease in respiratory rate
and abnormal increase in heart rate. What is the most likely cause of these results? -
ANSWER-hypoxemia
While taking an aerosol treatment with 0.25 mg albuterol, a patient suddenly loses
consciousness. Which of the following is the first procedure the RRT should perform to
QUESTIONS AND ANSWERS
A physician orders O2 therapy per protocol for an otherwise healthy postoperative
patient who has a PaO2 of 52 torr on room air. After initiating a nasal cannula at 2 L/min
and repeating an arterial blood gas, the patient's PaOs is now 50 torr. Which action
should the RRT take? - ANSWER-increase oxygen flow and reassess the patient
A toddler is receiving volume control A/C ventilation. To minimize volume loss due to
compression and tubing expansion, which of the following should a RRT select? -
ANSWER-low-compliance tubing
A physician is insistent in getting stat ABG results for a patient crashing in the ICU. The
RT draws the ABG and takes the specimen to the blood gas analyzer. There is a
calibration error message on the analyzer. The therapist sees that the last quality
control results were out of range for PaCO2 by -5 mm Hg. The best course of action is
to: - ANSWER-recalibrate and repeat quality control to within control limits
For which of the following patients should a RRT carefully monitor cardiovascular
function during application of intermittent positive pressure breathing (IPPB)?
I. a patient with low blood pressure
II. a patient with poor vasomotor tone
III. a patient with cardiac insufficiency - ANSWER-I. a patient with low blood pressure
II. a patient with poor vasomotor tone
III. a patient with cardiac insufficiency
During an interview with a patient, the RRT determines the patient is disoriented to time,
place, and person. The most likely cause of these findings is: - ANSWER-severe
hypoxemia
Normally the A-a gradient, PAO2 - PaO2, on room air is: - ANSWER-5-10 mm Hg
A patient with severe chronic bronchitis has developed P. aeruginosa the best
pharmacological intervention is: - ANSWER-tobramycin (TOBI)
A 45-yo woman is breathing 70% oxygen at sea level. She has the following ABG
results.
pH 7.35, PaO2 50 mm Hg, PaCO2 50 mm Hg
The RRT has calculated the A-a gradient (P[A-a]O2) as 399 mm Hg. These results are
most indicative of: - ANSWER-severe diminished alveolar-arterial oxygen transfer
Which of the following alarm conditions indicates a potential system leak when
delivering volume control mechanical ventilation? - ANSWER-low volume + low
pressure
,A respiratory therapist has assessed four patients for cardiovascular stability. The
results are as follows.
Patient
HR/min
B/P mm Hg
CI L/min/m2
ECG
Room 202
60
80/50
2.0
bradycardia
Room 204
90
100/70
2.5
occasional PVCs
Room 209
96
120/80
4.0
multiple runs of PVCs
Room 212
184
190/110
3.5
SVT
Which patient has the best cardiovascular status to consider weaning from mechanical
ventilation? - ANSWER-Room 204
A patient on mechanical ventilation has a respiratory rate of 12/min, VT 6 mL/Kg, PBW
72 Kg, and is on P/AC, PIP 26. What is the patient's TCT? - ANSWER-5
A patient's bedside spirometry results, as compared to normal, are as follows.
FVC decreased, FEV1 normal, FEV1% increased
What is the most likely diagnosis? - ANSWER-restrictive disorder
A RRT conducts a 6-minute walk test (6MWT) on four patients before and after
participation in a pulmonary rehabilitation program. Based on the 6-minute walking
distance (6MWD) provided below, for which patient has the program been effective in
improving their functional capacity?
Patient Pre-program 6MWD Post-program 6MWD
A 200 m 210 m
B 150 m 200 m
, C 250 m 270 m
D 400 m 430 m - ANSWER-patient B
A patient has the following ABG.
pH 7.37, PaO2 50 mm Hg, PaCO2 50 mm Hg, HCO3 25 mEq/L, PAO2 449 mm Hg
The P(A-a)O2 is: - ANSWER-399 torr
A respiratory therapist is asked to assess a 16-year-old girl with a severe head cold who
is receiving 4 L/min O2 via nasal cannula. The patient is alert and awake and is
complaining that she cannot breathe through her nose. Her SpO2 is 84%. Which action
should the respiratory therapist take? - ANSWER-Change to a simple O2 mask at 5-7
L/min
While suctioning a patient there is an abrupt change in the ECG waveform displayed on
the cardiac monitor. The SpO2 drops precipitously. Which of the following actions
should a RRT take next? - ANSWER-stop suctioning and immediately administer
oxygen
Lung recruitment maneuvers, RM, for patients with ARDS is most likely to be
successful: - ANSWER-early in the course of ARDS once the patient is stabilized
A mechanically ventilated patient has a VD/VT ratio of 0.62. The respiratory therapist
should recommend: - ANSWER-increasing VT
To evaluate and follow the course of a patient with interstitial lung disease, which of the
following procedures should the RRT recommend? - ANSWER-diffusing capacity
(DLCO)
A patient with acute bronchitis is receiving mechanical ventilation. Wheezing is heard
over all lung fields, and rhonchi are heard over the central airways. Secretions are thick.
The patient's peak pressure is 45 cm H2O, plateau pressure is 20 cm H2O. All of the
following would be useful to treat the patient except: - ANSWER-pancuronium bromide
(Pavulon)
An adult pressure release valve on a BVM device is most likely to vent pressures
exceeding: - ANSWER-45 cm H2O or greater
Methemoglobinemia exceeding 30% is best treated with: - ANSWER-methylene blue or
ascorbic acid
An apnea monitor on a premature infant indicates abnormal decrease in respiratory rate
and abnormal increase in heart rate. What is the most likely cause of these results? -
ANSWER-hypoxemia
While taking an aerosol treatment with 0.25 mg albuterol, a patient suddenly loses
consciousness. Which of the following is the first procedure the RRT should perform to
