Tmc Exam
1.
A 56-year-old patient with COPD is receiving oxygen via nasal cannula at 3 L/min. The
following ABG results are reported:
pH: 7.36
PaCO₂: 58 mmHg
PaO₂: 48 mmHg
HCO₃⁻: 33 mEq/L
Which of the following is the most appropriate action?
A. Increase the flow to 6 L/min
B. Switch to a 28% air entrainment mask
C. Initiate non-invasive positive pressure ventilation (NPPV)
D. Maintain current therapy and monitor
Answer: B
Rationale:
This patient has chronic CO₂ retention and hypoxemia. Increasing the nasal cannula
flow could increase FiO₂ beyond safe limits, risking suppression of hypoxic drive. A
,28% air entrainment mask provides a fixed, controlled FiO₂, which is appropriate for
COPD patients.
2.
Which of the following would be the best way to confirm the placement of an
endotracheal tube immediately after intubation?
A. Listen for bilateral breath sounds
B. Observe chest rise and fall
C. Check color change on a CO₂ detector
D. Order a chest X-ray
Answer: C
Rationale:
The gold standard for immediate confirmation is detection of exhaled CO₂. A
colorimetric CO₂ detector or capnography provides the most reliable confirmation. A
chest X-ray is necessary later to verify position but is not immediate.
3.
A patient has the following pulmonary function test results:
FEV1: 45% predicted
FVC: 92% predicted
FEV1/FVC: 40%
What type of disorder does this indicate?
A. Restrictive
,B. Obstructive
C. Combined obstructive and restrictive
D. Normal
Answer: B
Rationale:
A decreased FEV1/FVC ratio (<70%) with a normal or high FVC indicates an
obstructive disorder, such as COPD or asthma.
4.
The most reliable method to determine the correct size of an endotracheal tube for
a full-term newborn is:
A. Body weight
B. Gestational age
C. Broselow tape
D. Internal diameter of 3.0–3.5 mm
Answer: D
Rationale:
For full-term neonates, a 3.0–3.5 mm internal diameter ETT is standard. Weight and
gestational age are considered, but exact sizing relies on these standard ranges.
5.
A ventilated patient has a sudden increase in peak inspiratory pressure (PIP) but the
plateau pressure remains the same. Which of the following is most likely the cause?
A. Decreased lung compliance
B. Increased airway resistance
C. Pneumothorax
, D. ARDS
Answer: B
Rationale:
An increase in PIP with unchanged plateau pressure indicates a problem with airway
resistance such as bronchospasm, secretions, or a kinked ETT.
6.
Which of the following humidifiers provides the highest level of humidification?
A. Simple bubble humidifier
B. Heated humidifier
C. Heat and moisture exchanger (HME)
D. Passover humidifier
Answer: B
Rationale:
Heated humidifiers deliver the most optimal humidification, essential for patients
with artificial airways to prevent mucosal drying and secretion plugging.
7.
The following data are obtained from a patient receiving mechanical ventilation:
Vt (set): 500 mL
f: 14/min
FiO₂: 0.40
PEEP: 5 cmH₂O
1.
A 56-year-old patient with COPD is receiving oxygen via nasal cannula at 3 L/min. The
following ABG results are reported:
pH: 7.36
PaCO₂: 58 mmHg
PaO₂: 48 mmHg
HCO₃⁻: 33 mEq/L
Which of the following is the most appropriate action?
A. Increase the flow to 6 L/min
B. Switch to a 28% air entrainment mask
C. Initiate non-invasive positive pressure ventilation (NPPV)
D. Maintain current therapy and monitor
Answer: B
Rationale:
This patient has chronic CO₂ retention and hypoxemia. Increasing the nasal cannula
flow could increase FiO₂ beyond safe limits, risking suppression of hypoxic drive. A
,28% air entrainment mask provides a fixed, controlled FiO₂, which is appropriate for
COPD patients.
2.
Which of the following would be the best way to confirm the placement of an
endotracheal tube immediately after intubation?
A. Listen for bilateral breath sounds
B. Observe chest rise and fall
C. Check color change on a CO₂ detector
D. Order a chest X-ray
Answer: C
Rationale:
The gold standard for immediate confirmation is detection of exhaled CO₂. A
colorimetric CO₂ detector or capnography provides the most reliable confirmation. A
chest X-ray is necessary later to verify position but is not immediate.
3.
A patient has the following pulmonary function test results:
FEV1: 45% predicted
FVC: 92% predicted
FEV1/FVC: 40%
What type of disorder does this indicate?
A. Restrictive
,B. Obstructive
C. Combined obstructive and restrictive
D. Normal
Answer: B
Rationale:
A decreased FEV1/FVC ratio (<70%) with a normal or high FVC indicates an
obstructive disorder, such as COPD or asthma.
4.
The most reliable method to determine the correct size of an endotracheal tube for
a full-term newborn is:
A. Body weight
B. Gestational age
C. Broselow tape
D. Internal diameter of 3.0–3.5 mm
Answer: D
Rationale:
For full-term neonates, a 3.0–3.5 mm internal diameter ETT is standard. Weight and
gestational age are considered, but exact sizing relies on these standard ranges.
5.
A ventilated patient has a sudden increase in peak inspiratory pressure (PIP) but the
plateau pressure remains the same. Which of the following is most likely the cause?
A. Decreased lung compliance
B. Increased airway resistance
C. Pneumothorax
, D. ARDS
Answer: B
Rationale:
An increase in PIP with unchanged plateau pressure indicates a problem with airway
resistance such as bronchospasm, secretions, or a kinked ETT.
6.
Which of the following humidifiers provides the highest level of humidification?
A. Simple bubble humidifier
B. Heated humidifier
C. Heat and moisture exchanger (HME)
D. Passover humidifier
Answer: B
Rationale:
Heated humidifiers deliver the most optimal humidification, essential for patients
with artificial airways to prevent mucosal drying and secretion plugging.
7.
The following data are obtained from a patient receiving mechanical ventilation:
Vt (set): 500 mL
f: 14/min
FiO₂: 0.40
PEEP: 5 cmH₂O
