TMC QUESTIONS FROM LINDSEY
JONES (PART 1) WITH COMPLETE
SOLUTIONS
The respiratory therapist is making a home visit to evaluate an oxygen-dependent
patient. The patient has 3+ pitting peripheral edema and has not followed the
physician's orders to limit fluid intake. You would expect which of the following
hemodynamic values? - ANSWER-Elevated right sided preload with a normal to low
right ventricular after load
· Right-sided preload is another name for CVP (central venous pressure). Peripheral
edema is one of the signs associated with right heart failure, which results in an
elevated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right
ventricular afterload.
What is it called when the A-a gradient rises to 200, 300, 400 or more? - ANSWER-
Shunting
What is it called when the A-a gradient is less than 300? - ANSWER-Ventilation
perfusion (VQ) mismatch
What is it called when the A-a gradient is widened? - ANSWER-Pulmonary shunting
The best test determination for a forced vital capacity maneuver is done by which of the
following calculations? - ANSWER-FEV1+FVC
* To determine the best trial or best patient effort for a forced vital capacity maneuver,
the trial with the highest sum of the FEV1 and FVC is considered to be the patient's best
effort.
What is the relative humidity of the inspired gas of a patient who is intubated if the
humidity deficit is 33 mg/L? - ANSWER-25%
· There are 44 mg of water per liter of gas if the gas is at 100% relative humidity. If you
have only 11 mg/L of gas (deficit of 33 mg) then you have only 25% relative humidity
because 11 mg is 25% of 44.
,What should be done after giving albuterol, Alupent or Xopenex and the patient
experiences tingling in the extremities, nausea, & increased heart rate greater than 20
bpm? - ANSWER-Discontinue the treatment
Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver.
During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should -
ANSWER-Record an MIP of -27 cmH2O
· Although -20 cmH2O is observed on the pressure manometer, the real pressure being
produced is -27 cmH2O. This is because the manometer is not properly calibrated to
zero. Therefore, an adjustment must be accounted for when taking a measurement.
You must add the number that the needle is pointing to prior to the maneuver to the
number achieved by the patient during the maneuver to get an accurate measurement.
A patient with diabetes has significant respiratory distress. Arterial blood gases reveal a
pH of 7.10, PaCO2 of 29 torr, and a PaO2 of 81 torr. The patient has a spontaneous
tidal volume of 700 mL and a respiratory rate of 30/min. The patient is receiving 100%
oxygen by an air entrainment device with the flow at 15 L/min. Which of the following
will help the patient and is the most appropriate action? - ANSWER-Employ a tandem
air-entrainment device
· Although this patient is showing obvious signs of ventilatory failure the options given
do not allow us to address that problem. The options given relate to a correction of the
oxygenation status of the patient. If you look closely you will see that the total gas flow
to the patient at 100% at 15 L per minute is insufficient to keep up with the patient's
inspiratory demand. Some simple math, multiplying 600 mL times a rate of 30 per
minute is equal to a minute ventilation of 18 L/min. But, the patient is receiving only 15
L/min. To correct this problem and meet or exceed the patient's inspiratory demand, the
best option is to utilize a tandem device, or a side-by-side large volume nebulizer. This
will double the total flow to the patient to be 30 L/min, which will exceed the patient's
inspiratory demand.
What is C(a-v)O2? - ANSWER-Consumption of O2 by the tissues
What does a polarographic oxygen analyzer require to function? - ANSWER-Batteries,
computer, and an electrolyte solution
What is likely the cause if the analyzer fails to calibrate? - ANSWER-Depleted batteries
What is the association when a patient has pitting peripheral edema of +1, +2, +3? -
ANSWER-Congestive heart failure
What are the follow up examinations of suspected congestive heart failure? - ANSWER-
Creatinine or BUN
, Where should the high-pressure alarm on a volume-cycled mechanical ventilator be
set? - ANSWER-10-15cmH2O above the baseline peak pressures
A home care patient, who receives supplemental oxygen by concentrator at 2 L/min,
indicates that not enough oxygen is coming through the nasal cannula even though the
machine is on. The therapist should tell the patient to - ANSWER-Connect the cannula
to an E cylinder
· When a home care patient complains of difficulty getting enough oxygen from their
oxygen concentrator, the first step is to ensure they are receiving adequate oxygen by
another source. This should be done before troubleshooting or asking the patient to
help determine the source of the problem.
Which of the following provides the most significant evidence of improper placement of
a nasal endotracheal tube? - ANSWER-ET tube markings are 21cm at the right nare
· Proper placement of an endotracheal tube is manifest by bilateral breath sounds. Of
the options given the only one that indicates an improper placement of the nasal
endotracheal tube is the ET tube markings at the right nare. When the patient is nasally
intubated markings at the nose should be in the high 20s.
What should be seen on a normal chest x-ray? - ANSWER-The apices should be level
and the spinal process should be midline.
One should also be able to see the space between the vertebrae clearly
A 60 year-old male patient has the following pulmonary function values:
% of predicted
Actual Value
Fev1/FVC% 58%
FVC 81%
FEF25-75 79%
FEF200-1200 80%
DLCO 15
Which of the following could represent the patient's diagnosis? - ANSWER-Emphysema
· When looking at pulmonary function data the primary purpose is to differentiate
between an obstructive defect and a restrictive effect. To determine if the patient is
obstructive, we must look at flows. To determine if they are restrictive we must look at
volumes. In this case, flows are definitely diminished as seen in the Fev1/FVC% of 58%
of predicted. Volumes appear to be normal with an FVC of 81% of predicted. Thus, the
patient is obstructive but not restrictive. The answers show two obstructive diseases as
possibilities - emphysema and chronic bronchitis. To determine which is correct the
JONES (PART 1) WITH COMPLETE
SOLUTIONS
The respiratory therapist is making a home visit to evaluate an oxygen-dependent
patient. The patient has 3+ pitting peripheral edema and has not followed the
physician's orders to limit fluid intake. You would expect which of the following
hemodynamic values? - ANSWER-Elevated right sided preload with a normal to low
right ventricular after load
· Right-sided preload is another name for CVP (central venous pressure). Peripheral
edema is one of the signs associated with right heart failure, which results in an
elevated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right
ventricular afterload.
What is it called when the A-a gradient rises to 200, 300, 400 or more? - ANSWER-
Shunting
What is it called when the A-a gradient is less than 300? - ANSWER-Ventilation
perfusion (VQ) mismatch
What is it called when the A-a gradient is widened? - ANSWER-Pulmonary shunting
The best test determination for a forced vital capacity maneuver is done by which of the
following calculations? - ANSWER-FEV1+FVC
* To determine the best trial or best patient effort for a forced vital capacity maneuver,
the trial with the highest sum of the FEV1 and FVC is considered to be the patient's best
effort.
What is the relative humidity of the inspired gas of a patient who is intubated if the
humidity deficit is 33 mg/L? - ANSWER-25%
· There are 44 mg of water per liter of gas if the gas is at 100% relative humidity. If you
have only 11 mg/L of gas (deficit of 33 mg) then you have only 25% relative humidity
because 11 mg is 25% of 44.
,What should be done after giving albuterol, Alupent or Xopenex and the patient
experiences tingling in the extremities, nausea, & increased heart rate greater than 20
bpm? - ANSWER-Discontinue the treatment
Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist
notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver.
During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should -
ANSWER-Record an MIP of -27 cmH2O
· Although -20 cmH2O is observed on the pressure manometer, the real pressure being
produced is -27 cmH2O. This is because the manometer is not properly calibrated to
zero. Therefore, an adjustment must be accounted for when taking a measurement.
You must add the number that the needle is pointing to prior to the maneuver to the
number achieved by the patient during the maneuver to get an accurate measurement.
A patient with diabetes has significant respiratory distress. Arterial blood gases reveal a
pH of 7.10, PaCO2 of 29 torr, and a PaO2 of 81 torr. The patient has a spontaneous
tidal volume of 700 mL and a respiratory rate of 30/min. The patient is receiving 100%
oxygen by an air entrainment device with the flow at 15 L/min. Which of the following
will help the patient and is the most appropriate action? - ANSWER-Employ a tandem
air-entrainment device
· Although this patient is showing obvious signs of ventilatory failure the options given
do not allow us to address that problem. The options given relate to a correction of the
oxygenation status of the patient. If you look closely you will see that the total gas flow
to the patient at 100% at 15 L per minute is insufficient to keep up with the patient's
inspiratory demand. Some simple math, multiplying 600 mL times a rate of 30 per
minute is equal to a minute ventilation of 18 L/min. But, the patient is receiving only 15
L/min. To correct this problem and meet or exceed the patient's inspiratory demand, the
best option is to utilize a tandem device, or a side-by-side large volume nebulizer. This
will double the total flow to the patient to be 30 L/min, which will exceed the patient's
inspiratory demand.
What is C(a-v)O2? - ANSWER-Consumption of O2 by the tissues
What does a polarographic oxygen analyzer require to function? - ANSWER-Batteries,
computer, and an electrolyte solution
What is likely the cause if the analyzer fails to calibrate? - ANSWER-Depleted batteries
What is the association when a patient has pitting peripheral edema of +1, +2, +3? -
ANSWER-Congestive heart failure
What are the follow up examinations of suspected congestive heart failure? - ANSWER-
Creatinine or BUN
, Where should the high-pressure alarm on a volume-cycled mechanical ventilator be
set? - ANSWER-10-15cmH2O above the baseline peak pressures
A home care patient, who receives supplemental oxygen by concentrator at 2 L/min,
indicates that not enough oxygen is coming through the nasal cannula even though the
machine is on. The therapist should tell the patient to - ANSWER-Connect the cannula
to an E cylinder
· When a home care patient complains of difficulty getting enough oxygen from their
oxygen concentrator, the first step is to ensure they are receiving adequate oxygen by
another source. This should be done before troubleshooting or asking the patient to
help determine the source of the problem.
Which of the following provides the most significant evidence of improper placement of
a nasal endotracheal tube? - ANSWER-ET tube markings are 21cm at the right nare
· Proper placement of an endotracheal tube is manifest by bilateral breath sounds. Of
the options given the only one that indicates an improper placement of the nasal
endotracheal tube is the ET tube markings at the right nare. When the patient is nasally
intubated markings at the nose should be in the high 20s.
What should be seen on a normal chest x-ray? - ANSWER-The apices should be level
and the spinal process should be midline.
One should also be able to see the space between the vertebrae clearly
A 60 year-old male patient has the following pulmonary function values:
% of predicted
Actual Value
Fev1/FVC% 58%
FVC 81%
FEF25-75 79%
FEF200-1200 80%
DLCO 15
Which of the following could represent the patient's diagnosis? - ANSWER-Emphysema
· When looking at pulmonary function data the primary purpose is to differentiate
between an obstructive defect and a restrictive effect. To determine if the patient is
obstructive, we must look at flows. To determine if they are restrictive we must look at
volumes. In this case, flows are definitely diminished as seen in the Fev1/FVC% of 58%
of predicted. Volumes appear to be normal with an FVC of 81% of predicted. Thus, the
patient is obstructive but not restrictive. The answers show two obstructive diseases as
possibilities - emphysema and chronic bronchitis. To determine which is correct the
