TMC EXAM C 140 QUESTIONS WITH 100%
CORRECT ANSWERS COMPLETE SOLUTION
You come upon a patient who is unresponsive and is not breathing. You had heard from
her nurse that she had discussed a do not resuscitate (DNR) order with her physician.
You should:
A) Check the patient's chart for a DNR order/advanced directive
B) Immediately call a code and begin resuscitation efforts
C) Contact the nurses' station and ask how best to proceed
D) Call a "slow code," i.e., apply basic CPR, but not ACLS ...ANSWER...The correct
answer is:
*Immediately call a code and begin resuscitation efforts*
If there is any doubt regarding a do not resuscitate (DNR) order or when written orders
are not present, resuscitation efforts should begin. Formal or informal directives such as
"slow code" or "code gray" bypass the patient's rights and are generally inappropriate.
Which of the following determine the amount of oxygen delivered to the tissues?
1. Venous O2 Content (CvO2)
2. Cardiac Output (CO)
3. Arterial O2 Content (CaO2)
A) 1 and 2
B) 1 and 3
C) 2 and 3
D) 1, 2, and 3 ...ANSWER...C) 2 and 3
Oxygen delivery to the tissues is a function of both the total arterial oxygen content and
the cardiac output: Oxygen Delivery (mL/min) = CO (dL/min) x CaO2 (mL/dL)
A polysomnography report indicates an average of 2-3 mainly obstructive
apnea/hypopnea events per hour. Which of the following statements is most consistent
with this observation?
,A) since there are less than 5 events per hour, the findings are inconclusive
B) the findings confirm a diagnosis of mild obstructive sleep apnea
C) the findings confirm a diagnosis of moderate obstructive sleep apnea
D) the findings confirm a diagnosis of severe obstructive sleep apnea ...ANSWER...A)
since there are less than 5 events per hour, the findings are inconclusive
In adults, a diagnosis of obstructive sleep apnea (OSA) is confirmed if the number of
abnormal respiratory events is > 5/hour. The severity of OSA is graded as follows Mild:
5-15 abnormal events/hour; Moderate: 15-30 abnormal events/hour; Severe: > 30
abnormal events/hour. In this case since there are less than 5 events per hour, the
findings are inconclusive.
The normal range of adult blood pressure (systolic/diastolic) is about:
A) 80-100/40-70 mm Hg
B) 100-140/60-90 mm Hg
C) 120-140/90-100 mm Hg
D) 130-150/100-110 mm Hg ...ANSWER...B) 100-140/60-90 mm Hg
Normal systolic pressure range from 100 to 140 mm Hg, with an average of 120 mm
Hg. Normal diastolic pressures range from 60 to 90 mm Hg, with an average of 80 mm
Hg. The blood pressure is recorded with systolic listed over diastolic; i.e., 120/80 mm
Hg.
A patient is admitted to the ICU from a post-operative surgical unit with a hospital-
acquired lobar pneumonia. A sputum Gram stain reveals Gram-positive organisms.
Which of the following is the most likely cause of the pneumonia?
A) Haemophilus influenzae
B) Klebsiella pneumoniae
C) Pseudomonas aeruginosa
D) Staphylococcus aureus ...ANSWER...D) Staphylococcus aureus
The most common bacteria causing nosocomial pneumonia are the Gram-negative
organisms Pseudomonas aeruginosa, Haemophilus influenzae, Escherichia coli,and
Klebsiella and Acinetobacter species and the Gram-positiveorganisms Staphylococcus
,aureus (especially methicillin-resistant S aureus or MRSA) and Streptococcus
pneumoniae.
Which of the following is the best index of oxygen transport for a patient who has been
resuscitated after carbon monoxide poisoning?
A) arterial oxygen tension
B) alveolar-arterial oxygen content
C) hemoglobin concentration
D) arterial oxygen content ...ANSWER...D) arterial oxygen content
The best index of oxygen transport is the total arterial oxygen content (CaO2) which is
the sum of the oxygen carried on hemoglobin (SaO2 x Hb) plus the oxygen dissolved in
the plasma (.003 x PaO2). By far the most important index of O2 transport is the
amount of oxygen carried on hemoglobin, as measured by CO-oximetry. Because it
represents such a small portion of the total CaO2, the PaO2 is almost irrelevant in these
patients.
To what section of a patient's chart should you refer to understand any important
cultural or religious influences on the provision of care?
A) social history
B) advance directives
C) family disease history
D) chief complaint ...ANSWER...A) social history
A patient's social history typically includes the following elements: education,
employment, finances; marital status; diet and exercise; cultural background and
religious influences; living situation and social support; social activities, hobbies and
recreation; tobacco, alcohol or drug use; satisfaction/stress with life situation, finances,
relationships; and recent travel or other event that might impact health.
In assessing a patient in the acute phase of ARDS, you would expect to find:
A) increased lung volumes
B) high pulmonary wedge pressure
C) decreased lung compliance
D) metabolic alkalosis ...ANSWER...C) decreased lung compliance
, In ARDS, pulmonary edema, atelectasis, and surfactant loss combine to reduce lung
volumes and compliance and cause severe hypoxemia that does not respond well to
increases in FIO2 (refractory hypoxemia). If the hypoxemia is severe enough to
compromise O2 delivery to the tissues, anerobic metabolism and a metabolic acidosis
(lactic acidosis) can develop. Although some findings are similar to those seen in CHF
(e.g., bilateral infiltrates, hypoxemia), patients with ARDS usually exhibit normal left
heart function, as evident by a normal pulmonary artery wedge pressure (6-12 mm Hg)
Auscultation of a patient's chest revealing wheezes would indicate the presence of
which of the following:
A) pleural effusion
B) pneumothorax
C) laryngospasm
D) bronchoconstriction ...ANSWER...D) bronchoconstriction
Wheezing generally indicates bronchoconstriction, mucosal edema, presence of
increased mucus or partial foreign body obstruction in the lower airways. Laryngospasm
(upper airway) typically causes stridor, not wheezing. Pleural effusion and
pneumothorax would tend to cause a decrease in breath sounds but not wheezing
Vesicular breath sounds indicate which of the following?
A) Pneumothorax
B) Normal lungs
C) Lung consolidation
D) Small airways obstruction ...ANSWER...B) Normal lungs
Normal breath sounds (head over the periphery) are described as vesicular sounds.
Vesicular breath sounds indicate normal air movement into and out of the lungs
Which of the following procedures require active patient cooperation to be effective?
A) ventilator weaning
B) tracheal suctioning
C) mask CPAP
D) incentive spirometry ...ANSWER...D) incentive spirometry
While it always is helpful to have a patient's cooperation, it is absolutely essential when
having a patient perform incentive spirometry. In regard to weaning and mask CPAP,
only spontaneous breathing effort is required. And tracheal suctioning requires no
patient cooperation
Which of the following would provide the most information about a patient's orientation
to time and place?
CORRECT ANSWERS COMPLETE SOLUTION
You come upon a patient who is unresponsive and is not breathing. You had heard from
her nurse that she had discussed a do not resuscitate (DNR) order with her physician.
You should:
A) Check the patient's chart for a DNR order/advanced directive
B) Immediately call a code and begin resuscitation efforts
C) Contact the nurses' station and ask how best to proceed
D) Call a "slow code," i.e., apply basic CPR, but not ACLS ...ANSWER...The correct
answer is:
*Immediately call a code and begin resuscitation efforts*
If there is any doubt regarding a do not resuscitate (DNR) order or when written orders
are not present, resuscitation efforts should begin. Formal or informal directives such as
"slow code" or "code gray" bypass the patient's rights and are generally inappropriate.
Which of the following determine the amount of oxygen delivered to the tissues?
1. Venous O2 Content (CvO2)
2. Cardiac Output (CO)
3. Arterial O2 Content (CaO2)
A) 1 and 2
B) 1 and 3
C) 2 and 3
D) 1, 2, and 3 ...ANSWER...C) 2 and 3
Oxygen delivery to the tissues is a function of both the total arterial oxygen content and
the cardiac output: Oxygen Delivery (mL/min) = CO (dL/min) x CaO2 (mL/dL)
A polysomnography report indicates an average of 2-3 mainly obstructive
apnea/hypopnea events per hour. Which of the following statements is most consistent
with this observation?
,A) since there are less than 5 events per hour, the findings are inconclusive
B) the findings confirm a diagnosis of mild obstructive sleep apnea
C) the findings confirm a diagnosis of moderate obstructive sleep apnea
D) the findings confirm a diagnosis of severe obstructive sleep apnea ...ANSWER...A)
since there are less than 5 events per hour, the findings are inconclusive
In adults, a diagnosis of obstructive sleep apnea (OSA) is confirmed if the number of
abnormal respiratory events is > 5/hour. The severity of OSA is graded as follows Mild:
5-15 abnormal events/hour; Moderate: 15-30 abnormal events/hour; Severe: > 30
abnormal events/hour. In this case since there are less than 5 events per hour, the
findings are inconclusive.
The normal range of adult blood pressure (systolic/diastolic) is about:
A) 80-100/40-70 mm Hg
B) 100-140/60-90 mm Hg
C) 120-140/90-100 mm Hg
D) 130-150/100-110 mm Hg ...ANSWER...B) 100-140/60-90 mm Hg
Normal systolic pressure range from 100 to 140 mm Hg, with an average of 120 mm
Hg. Normal diastolic pressures range from 60 to 90 mm Hg, with an average of 80 mm
Hg. The blood pressure is recorded with systolic listed over diastolic; i.e., 120/80 mm
Hg.
A patient is admitted to the ICU from a post-operative surgical unit with a hospital-
acquired lobar pneumonia. A sputum Gram stain reveals Gram-positive organisms.
Which of the following is the most likely cause of the pneumonia?
A) Haemophilus influenzae
B) Klebsiella pneumoniae
C) Pseudomonas aeruginosa
D) Staphylococcus aureus ...ANSWER...D) Staphylococcus aureus
The most common bacteria causing nosocomial pneumonia are the Gram-negative
organisms Pseudomonas aeruginosa, Haemophilus influenzae, Escherichia coli,and
Klebsiella and Acinetobacter species and the Gram-positiveorganisms Staphylococcus
,aureus (especially methicillin-resistant S aureus or MRSA) and Streptococcus
pneumoniae.
Which of the following is the best index of oxygen transport for a patient who has been
resuscitated after carbon monoxide poisoning?
A) arterial oxygen tension
B) alveolar-arterial oxygen content
C) hemoglobin concentration
D) arterial oxygen content ...ANSWER...D) arterial oxygen content
The best index of oxygen transport is the total arterial oxygen content (CaO2) which is
the sum of the oxygen carried on hemoglobin (SaO2 x Hb) plus the oxygen dissolved in
the plasma (.003 x PaO2). By far the most important index of O2 transport is the
amount of oxygen carried on hemoglobin, as measured by CO-oximetry. Because it
represents such a small portion of the total CaO2, the PaO2 is almost irrelevant in these
patients.
To what section of a patient's chart should you refer to understand any important
cultural or religious influences on the provision of care?
A) social history
B) advance directives
C) family disease history
D) chief complaint ...ANSWER...A) social history
A patient's social history typically includes the following elements: education,
employment, finances; marital status; diet and exercise; cultural background and
religious influences; living situation and social support; social activities, hobbies and
recreation; tobacco, alcohol or drug use; satisfaction/stress with life situation, finances,
relationships; and recent travel or other event that might impact health.
In assessing a patient in the acute phase of ARDS, you would expect to find:
A) increased lung volumes
B) high pulmonary wedge pressure
C) decreased lung compliance
D) metabolic alkalosis ...ANSWER...C) decreased lung compliance
, In ARDS, pulmonary edema, atelectasis, and surfactant loss combine to reduce lung
volumes and compliance and cause severe hypoxemia that does not respond well to
increases in FIO2 (refractory hypoxemia). If the hypoxemia is severe enough to
compromise O2 delivery to the tissues, anerobic metabolism and a metabolic acidosis
(lactic acidosis) can develop. Although some findings are similar to those seen in CHF
(e.g., bilateral infiltrates, hypoxemia), patients with ARDS usually exhibit normal left
heart function, as evident by a normal pulmonary artery wedge pressure (6-12 mm Hg)
Auscultation of a patient's chest revealing wheezes would indicate the presence of
which of the following:
A) pleural effusion
B) pneumothorax
C) laryngospasm
D) bronchoconstriction ...ANSWER...D) bronchoconstriction
Wheezing generally indicates bronchoconstriction, mucosal edema, presence of
increased mucus or partial foreign body obstruction in the lower airways. Laryngospasm
(upper airway) typically causes stridor, not wheezing. Pleural effusion and
pneumothorax would tend to cause a decrease in breath sounds but not wheezing
Vesicular breath sounds indicate which of the following?
A) Pneumothorax
B) Normal lungs
C) Lung consolidation
D) Small airways obstruction ...ANSWER...B) Normal lungs
Normal breath sounds (head over the periphery) are described as vesicular sounds.
Vesicular breath sounds indicate normal air movement into and out of the lungs
Which of the following procedures require active patient cooperation to be effective?
A) ventilator weaning
B) tracheal suctioning
C) mask CPAP
D) incentive spirometry ...ANSWER...D) incentive spirometry
While it always is helpful to have a patient's cooperation, it is absolutely essential when
having a patient perform incentive spirometry. In regard to weaning and mask CPAP,
only spontaneous breathing effort is required. And tracheal suctioning requires no
patient cooperation
Which of the following would provide the most information about a patient's orientation
to time and place?
