C&S TMC Exam 1
- An infant is being mechanically ventilated via a time-cycled, pressure-limited ventilator.
Which of the following would occur if PEEP were increased without a corresponding
increase in peak pressure? - The tidal volume would decrease
- A physician requests the respiratory therapist to assess the upper airway function of a
patient with a fenestrated tracheostomy tube. The therapist should: - Remove the inner
cannula, deflate the cuff, plug the outer cannula
- A patient receiving sustained maximal inspiratory (SMI) treatments with a volume-
oriented incentive spirometer device begins to inhale through the device 18 times per
minute. Which of the following best explains this situation? - The patient needs re-
instruction regarding the SMI therapy
- After initiating mechanical ventilation in the A/C mode for an adult male patient, the
respiratory therapist observes that the patient is agitated and having difficulty in cycling
the ventilator. Which of the following should the therapist do? - Increase the sensitivity
setting
- Data recorded for a 52 kg (110 lb) mechanically ventilated patient who has a long
standing history of chronic hypercapnia are as follows:
Ventilator Settings Arterial Blood Gases
Mode: SIMV
pH: 7.36
VT: 400 mL
PaCO2: 62 mmHg
Rate: 8/min
HCO3: 34 mEq/L
FiO2: 0.35
PaO2: 61 mmHg
On the basis of this information, the respiratory therapist should: - Maintain current
settings
- A respiratory therapist is lmanually lventilating la lpatient lduring la
lcardiopulmonary lresuscitation lattempt. lAn larterial lblood lgas lis ldrawn land lthe
lresults lare las lfollows:
pH: l7.27
PaCO2: l38 lmmHg
HCO3: l17 lmEq/L
PaO2: l44 lmmHg
Based lon lthis linformation, lthe lrespiratory ltherapist lshould ldo lwhich lof lthe lfollowing? l-
lEnsure lthat lthe lmanual lresuscitator lis lconnected lto lan loxygen lsource
,C&S TMC Exam 1
- A lCOPD lpatient lis lbrought lto lthe lED lafter lseveral ldays lof lincreasing lrespiratory
ldistress. lBaseline lblood lgases lare ldrawn land lthe lpatient lis lplaced lon loxygen lat l2
lLPM lvia lnasal lcannula. lData lfrom lthe loriginal land la lsubsequent larterial lblood lsample
lare las lfollows:
Room lAir lSample
lpH: l7.23
PaCO2: l82 lmmHg
HCO3: l33 lmEq/L
PaO2: l49 lmmHg
2L lnasal lO2
pH: l7.33
PaCO2: l66 lmmHg
HCO3: l34 lmEq/L
PaO2: l54 lmmHg
Based lon lthe labove linformation, lthe lrespiratory ltherapist lshould: l- lIncrease lthe loxygen
lflow lto l3L/min land lcontinue lto lmonitor.
- A l16-year-old lfemale lhas ljust lbeen ladmitted lto lthe lED lfollowing la lbicycling
laccident. lShe lis lreceiving lsupplemental loxygen lvia lnonrebreathing lmask. lWhile
lstanding lat lthe lbedside, lthe lrespiratory ltherapist lnotes lthe lonset lof lataxic lbreathing.
lWhich lof lthe lfollowing lshould lthe ltherapist ldo? l- lBegin lmanual lventilation
- A lrespiratory ltherapist lis lperforming la lchest lexamination lon lan ladult lmale lpatient.
lThe ltherapist lnotes lthe ltrachea lis ldeviated lto lthe lright lwith lflatness lto lpercussion lon
lthe lright. lWhich lof lthe lfollowing lbest lexplains lthese lfindings? l- lRight lsided latelectasis
- A lpatient lin lthe lintensive lcare lunit lis lreceiving lsupplemental loxygen lvia l40%
lair- lentrainment lmask. lCurrent larterial lblood lgas lresults lare las lfollows:
pH: l7.43
PaCO2: l54 lmmHg
HCO3: l34 lmEq/L
PaO2: l88 lmmHg
Which lof lthe lfollowing lis lthe lcorrect linterpretation lfor lthese lresults? l- lCompensated
lmetabolic lalkalosis
- While la lrespiratory ltherapist lis lchecking lthe loxygen lsetup lof la lpatient lon l2L/min
lnasal lcannula, lthe lpatient lcomplains lof lnot lbeing lable lto ldetect lany loxygen lflow lfrom
lthe lcannula. lWhich lof lthe lfollowing lactions lis lappropriate lat lthis ltime? l- lTighten lall
lconnections
, C&S TMC Exam 1
- One lhour lafter lthe linitiation lof lvolume-controlled lventilation lin lthe lA/C lmode lfor la
l21- lyear-old, l178 lcm l( l5 lft l10 lin) ltall ladult lmale lpatient lwho lsustained lsevere llung
lcontusions lfollowing la lmotor lvehicle laccident, lan larterial lblood lgas lsample lwas
lobtained. lPertinent ldata lare las lfollows:
Ventilator lSettings:
FiO2: l0.60
Rate: l16/min
l VT: l500 lmL
lPEEP: l5 lcmH2O
Arterial lblood lgases:
lpH: l7.46
PaCO2: l30 lmmHg
HCO3: l21 lmEq/L
PaO2: l111 lmmHg
The lrespiratory ltherapist lshould lsuggest lwhich lof lthe lfollowing? l- lDecrease lthe
lmechanical lrate
- The ldata lbelow lwere lobtained lfrom l4 lseparate lpatients lwho lare lintubated land
lbeing lmechanically lventilated. lWhich lof lthe lfollowing lpatients lIS la lcandidate lfor
lweaning?
VD/VT lQs/Qt lMIP
Patient lA: l0.63 l0.12 l-60cmH2O
Patient lB: l0.25 l0.17 l-16cmH2O
Patient lC: l0.51 l0.27 l-30cmH2O
Patient lD: l0.32 l0.11 l-36cmH2O l- lPatient lD
- Following la ltraumatic lnasal lintubation, lthe lpatient lbegins lto lbleed lprofusely lfrom
lthe lnasopharynx. lThe lrespiratory ltherapist lshould: l- lKeep lthe lnasotracheal ltube's
lcuff linflated land lsuction lthe lpharynx las lneeded.
- A lpatient's lECG lrhythm lconsistently lreverts lto lthe lrhythm lshown labove.
lThe lrespiratory ltherapist lshould lrecommend: l- lCardioversion
- While lpreparing la lpatient lfor la lthoracentesis, lthe lpatient lasks lthe lrespiratory
ltherapist lwhy lhe lmust lbe lsitting lupright. lThe lrespiratory ltherapist lwould lexplain lto lthe
lpatient lthat lsitting lupright: l- lLowers lthe ldiaphragm land lreduced lthe lpossibility lof lits
lpuncture.
- During lthe ladministration lof la lfluid lchallenge lon la l74-year-old lpatient lwith lan
lindwelling lpulmonary lartery lcatheter, lthe lpulmonary lcapillary lwedge lpressure
labruptly lrises lfrom l7 lmmHg lto l14 lmmHg. lWhich lof lthe lfollowing lwould lbe lan
lappropriate laction lat lthis ltime? l- lStop lfluid ladministration
- An infant is being mechanically ventilated via a time-cycled, pressure-limited ventilator.
Which of the following would occur if PEEP were increased without a corresponding
increase in peak pressure? - The tidal volume would decrease
- A physician requests the respiratory therapist to assess the upper airway function of a
patient with a fenestrated tracheostomy tube. The therapist should: - Remove the inner
cannula, deflate the cuff, plug the outer cannula
- A patient receiving sustained maximal inspiratory (SMI) treatments with a volume-
oriented incentive spirometer device begins to inhale through the device 18 times per
minute. Which of the following best explains this situation? - The patient needs re-
instruction regarding the SMI therapy
- After initiating mechanical ventilation in the A/C mode for an adult male patient, the
respiratory therapist observes that the patient is agitated and having difficulty in cycling
the ventilator. Which of the following should the therapist do? - Increase the sensitivity
setting
- Data recorded for a 52 kg (110 lb) mechanically ventilated patient who has a long
standing history of chronic hypercapnia are as follows:
Ventilator Settings Arterial Blood Gases
Mode: SIMV
pH: 7.36
VT: 400 mL
PaCO2: 62 mmHg
Rate: 8/min
HCO3: 34 mEq/L
FiO2: 0.35
PaO2: 61 mmHg
On the basis of this information, the respiratory therapist should: - Maintain current
settings
- A respiratory therapist is lmanually lventilating la lpatient lduring la
lcardiopulmonary lresuscitation lattempt. lAn larterial lblood lgas lis ldrawn land lthe
lresults lare las lfollows:
pH: l7.27
PaCO2: l38 lmmHg
HCO3: l17 lmEq/L
PaO2: l44 lmmHg
Based lon lthis linformation, lthe lrespiratory ltherapist lshould ldo lwhich lof lthe lfollowing? l-
lEnsure lthat lthe lmanual lresuscitator lis lconnected lto lan loxygen lsource
,C&S TMC Exam 1
- A lCOPD lpatient lis lbrought lto lthe lED lafter lseveral ldays lof lincreasing lrespiratory
ldistress. lBaseline lblood lgases lare ldrawn land lthe lpatient lis lplaced lon loxygen lat l2
lLPM lvia lnasal lcannula. lData lfrom lthe loriginal land la lsubsequent larterial lblood lsample
lare las lfollows:
Room lAir lSample
lpH: l7.23
PaCO2: l82 lmmHg
HCO3: l33 lmEq/L
PaO2: l49 lmmHg
2L lnasal lO2
pH: l7.33
PaCO2: l66 lmmHg
HCO3: l34 lmEq/L
PaO2: l54 lmmHg
Based lon lthe labove linformation, lthe lrespiratory ltherapist lshould: l- lIncrease lthe loxygen
lflow lto l3L/min land lcontinue lto lmonitor.
- A l16-year-old lfemale lhas ljust lbeen ladmitted lto lthe lED lfollowing la lbicycling
laccident. lShe lis lreceiving lsupplemental loxygen lvia lnonrebreathing lmask. lWhile
lstanding lat lthe lbedside, lthe lrespiratory ltherapist lnotes lthe lonset lof lataxic lbreathing.
lWhich lof lthe lfollowing lshould lthe ltherapist ldo? l- lBegin lmanual lventilation
- A lrespiratory ltherapist lis lperforming la lchest lexamination lon lan ladult lmale lpatient.
lThe ltherapist lnotes lthe ltrachea lis ldeviated lto lthe lright lwith lflatness lto lpercussion lon
lthe lright. lWhich lof lthe lfollowing lbest lexplains lthese lfindings? l- lRight lsided latelectasis
- A lpatient lin lthe lintensive lcare lunit lis lreceiving lsupplemental loxygen lvia l40%
lair- lentrainment lmask. lCurrent larterial lblood lgas lresults lare las lfollows:
pH: l7.43
PaCO2: l54 lmmHg
HCO3: l34 lmEq/L
PaO2: l88 lmmHg
Which lof lthe lfollowing lis lthe lcorrect linterpretation lfor lthese lresults? l- lCompensated
lmetabolic lalkalosis
- While la lrespiratory ltherapist lis lchecking lthe loxygen lsetup lof la lpatient lon l2L/min
lnasal lcannula, lthe lpatient lcomplains lof lnot lbeing lable lto ldetect lany loxygen lflow lfrom
lthe lcannula. lWhich lof lthe lfollowing lactions lis lappropriate lat lthis ltime? l- lTighten lall
lconnections
, C&S TMC Exam 1
- One lhour lafter lthe linitiation lof lvolume-controlled lventilation lin lthe lA/C lmode lfor la
l21- lyear-old, l178 lcm l( l5 lft l10 lin) ltall ladult lmale lpatient lwho lsustained lsevere llung
lcontusions lfollowing la lmotor lvehicle laccident, lan larterial lblood lgas lsample lwas
lobtained. lPertinent ldata lare las lfollows:
Ventilator lSettings:
FiO2: l0.60
Rate: l16/min
l VT: l500 lmL
lPEEP: l5 lcmH2O
Arterial lblood lgases:
lpH: l7.46
PaCO2: l30 lmmHg
HCO3: l21 lmEq/L
PaO2: l111 lmmHg
The lrespiratory ltherapist lshould lsuggest lwhich lof lthe lfollowing? l- lDecrease lthe
lmechanical lrate
- The ldata lbelow lwere lobtained lfrom l4 lseparate lpatients lwho lare lintubated land
lbeing lmechanically lventilated. lWhich lof lthe lfollowing lpatients lIS la lcandidate lfor
lweaning?
VD/VT lQs/Qt lMIP
Patient lA: l0.63 l0.12 l-60cmH2O
Patient lB: l0.25 l0.17 l-16cmH2O
Patient lC: l0.51 l0.27 l-30cmH2O
Patient lD: l0.32 l0.11 l-36cmH2O l- lPatient lD
- Following la ltraumatic lnasal lintubation, lthe lpatient lbegins lto lbleed lprofusely lfrom
lthe lnasopharynx. lThe lrespiratory ltherapist lshould: l- lKeep lthe lnasotracheal ltube's
lcuff linflated land lsuction lthe lpharynx las lneeded.
- A lpatient's lECG lrhythm lconsistently lreverts lto lthe lrhythm lshown labove.
lThe lrespiratory ltherapist lshould lrecommend: l- lCardioversion
- While lpreparing la lpatient lfor la lthoracentesis, lthe lpatient lasks lthe lrespiratory
ltherapist lwhy lhe lmust lbe lsitting lupright. lThe lrespiratory ltherapist lwould lexplain lto lthe
lpatient lthat lsitting lupright: l- lLowers lthe ldiaphragm land lreduced lthe lpossibility lof lits
lpuncture.
- During lthe ladministration lof la lfluid lchallenge lon la l74-year-old lpatient lwith lan
lindwelling lpulmonary lartery lcatheter, lthe lpulmonary lcapillary lwedge lpressure
labruptly lrises lfrom l7 lmmHg lto l14 lmmHg. lWhich lof lthe lfollowing lwould lbe lan
lappropriate laction lat lthis ltime? l- lStop lfluid ladministration
