C&S TMC EXAM TWO NEWEST ACTUAL EXAM PREPARATION WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED A+||
BRAND NEW VERSION!!
Question 1
A respiratory therapist is preparing to measure a pulmonary artery wedge pressure (PCWP) in a
critically ill patient with an indwelling Swan-Ganz catheter. Before obtaining the reading, what is
the most critical step the therapist must perform to ensure the accuracy of the hemodynamic
data?
A) Flush the distal port with heparinized saline.
B) Ensure the transducer is properly leveled at the phlebostatic axis and zeroed.
C) Inflate the balloon with 5 mL of air to ensure a solid "wedge."
D) Place the patient in a high-Fowler’s position for the reading.
E) Aspirate 10 mL of blood to clear the line before connecting the syringe.
Correct Answer: B) Ensure the transducer is properly leveled at the phlebostatic axis and
zeroed.
Rationale: Hemodynamic monitoring relies on hydrostatic pressure. For a PCWP reading to
be accurate, the transducer must be leveled at the phlebostatic axis (the fourth intercostal
space, mid-axillary line), which represents the level of the right atrium. If the transducer is
too low, the pressure will be falsely high; if it is too high, the pressure will be falsely low.
Zeroing the transducer to atmospheric pressure ensures that the monitor only displays the
internal pressures of the patient's vascular system. (bold)
Question 2
During a diagnostic procedure to evaluate a suspected endobronchial lesion, a physician chooses
to use a fiberoptic bronchoscope rather than a rigid bronchoscope. What is the primary clinical
advantage of the fiberoptic device in this scenario?
A) The ability to maintain a larger airway for ventilation during the procedure.
B) It allows for the removal of large foreign bodies more effectively.
C) Its flexibility allows for the visualization of smaller, more distal airways.
D) It provides better suctioning capability for massive hemoptysis.
E) It requires no topical anesthesia for the patient.
, 2
Correct Answer: C) Its flexibility allows for the visualization of smaller, more distal airways.
Rationale: The hallmark of the fiberoptic bronchoscope is its flexibility and small diameter.
This allows the operator to navigate past the mainstem bronchi into the segmental and sub-
segmental bronchi, which is impossible with a rigid scope. While rigid bronchoscopy is
superior for massive hemoptysis or large foreign body removal, fiberoptic bronchoscopy is
the preferred tool for routine diagnostics and inspecting distal segments due to its
maneuverability. (bold)
Question 3
A respiratory therapist is monitoring a capnograph tracing for a mechanically ventilated patient.
The therapist observes that the baseline (Phase IV) of the capnogram does not return to zero, and
the waveform appears to be "climbing" or drifting upward. What is the most appropriate action
for the therapist to take?
A) Increase the patient's tidal volume to improve CO2 clearance.
B) Check the exhalation valve of the ventilator for malfunction or moisture.
C) Perform an immediate arterial blood gas to verify the PaCO2.
D) Calibrate the infrared sensor using room air.
E) Shorten the inspiratory time to allow for a longer exhalation.
Correct Answer: B) Check the exhalation valve of the ventilator for malfunction or moisture.
Rationale: When a capnograph baseline fails to return to zero (rebreathing), it indicates
that the patient is inhaling gas that contains carbon dioxide. In a mechanical ventilation
circuit, this is frequently caused by a faulty exhalation valve that is not seating properly or
is "sticky" due to condensation. This allows expired gas to be drawn back into the
inspiratory limb. Other causes include insufficient fresh gas flow in certain circuits or a
saturated CO2 absorber in anesthesia setups. (bold)
Question 4
A respiratory therapist is performing nasotracheal suctioning on a patient with a weak cough.
Upon occluding the catheter's thumb port, the therapist notes that there is no vacuum pressure at
the tip of the catheter. The therapist should perform all of the following troubleshooting steps
EXCEPT:
, 3
A) Check if the suction canister is full.
B) Ensure the suction tubing is securely connected to the wall regulator.
C) Verify that the vacuum regulator is turned on and set to the correct pressure.
D) Use a longer suction catheter to reach the source of the blockage.
E) Check for kinks or obstructions within the suction tubing.
Correct Answer: D) Use a longer suction catheter.
Rationale: If there is no vacuum, the problem is mechanical or related to the integrity of the
suction system (leaks, clogs, or full canisters). Using a longer catheter (Option D) will not
resolve a lack of pressure and could potentially cause more trauma to the patient without
providing any clinical benefit. Troubleshooting should focus on the path from the wall
source to the catheter tip. (bold)
Question 5
What is the primary clinical hazard or contraindication associated with the use of an
oropharyngeal airway (OPA) in a semi-conscious patient?
A) It may cause the tongue to fall backward and obstruct the airway.
B) The device may cause the patient to gag, vomit, or fight the device, leading to aspiration.
C) It increases the anatomical dead space significantly.
D) It can only be used in patients with a suspected nasal fracture.
E) It interferes with the delivery of high-flow oxygen via a simple mask.
Correct Answer: B) The patient may gag or fight the device.
Rationale: An OPA should only be used in completely unconscious patients who lack a gag
reflex. In a semi-conscious or alert patient, the device stimulates the posterior pharynx,
which can trigger a strong gag reflex, potentially leading to vomiting and life-threatening
aspiration. If a semi-conscious patient requires an airway adjunct, a nasopharyngeal
airway (NPA) is better tolerated as it does not stimulate the base of the tongue as
aggressively. (bold)
Question 6
While performing manual ventilation with a bag-valve-mask (BVM) during a cardiac arrest, the
respiratory therapist notices that the oxygen reservoir bag is missing from the resuscitator. What
, 4
should the therapist conclude about the oxygen delivery to the patient?
A) The FiO2 will remain at 1.0 as long as the flow is 15 L/min.
B) The patient will receive 21% oxygen (room air) only.
C) The delivered FiO2 will most likely be significantly less than 1.0 (approximately 0.40–0.50).
D) The stroke volume of the bag will decrease by 50%.
E) The bag will refill much faster without the reservoir.
Correct Answer: C) The FiO2 will most likely be less than 1.0.
Rationale: The reservoir on a manual resuscitator is essential for delivering high
concentrations of oxygen. Without the reservoir, the bag draws in a significant amount of
room air (21% O2) during the refill phase to keep up with the speed of manual cycling.
This dilutes the 100% oxygen coming from the flowmeter, typically resulting in an FiO2 of
around 40% to 50% rather than the 90% to 100% required during resuscitation. (bold)
Question 7
A patient with a permanent tracheostomy is experiencing moderate amounts of thick, tenacious
secretions that are difficult to suction. Which of the following devices is most appropriate to
provide humidification and facilitate secretion clearance for this patient?
A) A standard heat moisture exchanger (HME).
/B) A room humidifier at the bedside.
C) A heated, large-reservoir air-entrainment jet nebulizer.
D) A simple bubble humidifier connected to a tracheostomy mask.
E) An ultrasonic nebulizer used for 10 minutes every 8 hours.
Correct Answer: C) A heated large reservoir air-entrainment jet nebulizer.
Rationale: Tenacious (thick) secretions indicate that the patient’s airway is dehydrated.
Because a tracheostomy bypasses the natural humidification of the upper airway, medical-
grade humidity is required. A heated jet nebulizer (Option C) provides 100% body
humidity and can deliver a large volume of aerosolized water particles to "thin" the mucus,
making it easier to expectorate or suction. HMEs (Option A) are for short-term use and
may become clogged with thick secretions. Bubble humidifiers (Option D) do not provide
enough humidity for a bypassed airway. (bold)
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED A+||
BRAND NEW VERSION!!
Question 1
A respiratory therapist is preparing to measure a pulmonary artery wedge pressure (PCWP) in a
critically ill patient with an indwelling Swan-Ganz catheter. Before obtaining the reading, what is
the most critical step the therapist must perform to ensure the accuracy of the hemodynamic
data?
A) Flush the distal port with heparinized saline.
B) Ensure the transducer is properly leveled at the phlebostatic axis and zeroed.
C) Inflate the balloon with 5 mL of air to ensure a solid "wedge."
D) Place the patient in a high-Fowler’s position for the reading.
E) Aspirate 10 mL of blood to clear the line before connecting the syringe.
Correct Answer: B) Ensure the transducer is properly leveled at the phlebostatic axis and
zeroed.
Rationale: Hemodynamic monitoring relies on hydrostatic pressure. For a PCWP reading to
be accurate, the transducer must be leveled at the phlebostatic axis (the fourth intercostal
space, mid-axillary line), which represents the level of the right atrium. If the transducer is
too low, the pressure will be falsely high; if it is too high, the pressure will be falsely low.
Zeroing the transducer to atmospheric pressure ensures that the monitor only displays the
internal pressures of the patient's vascular system. (bold)
Question 2
During a diagnostic procedure to evaluate a suspected endobronchial lesion, a physician chooses
to use a fiberoptic bronchoscope rather than a rigid bronchoscope. What is the primary clinical
advantage of the fiberoptic device in this scenario?
A) The ability to maintain a larger airway for ventilation during the procedure.
B) It allows for the removal of large foreign bodies more effectively.
C) Its flexibility allows for the visualization of smaller, more distal airways.
D) It provides better suctioning capability for massive hemoptysis.
E) It requires no topical anesthesia for the patient.
, 2
Correct Answer: C) Its flexibility allows for the visualization of smaller, more distal airways.
Rationale: The hallmark of the fiberoptic bronchoscope is its flexibility and small diameter.
This allows the operator to navigate past the mainstem bronchi into the segmental and sub-
segmental bronchi, which is impossible with a rigid scope. While rigid bronchoscopy is
superior for massive hemoptysis or large foreign body removal, fiberoptic bronchoscopy is
the preferred tool for routine diagnostics and inspecting distal segments due to its
maneuverability. (bold)
Question 3
A respiratory therapist is monitoring a capnograph tracing for a mechanically ventilated patient.
The therapist observes that the baseline (Phase IV) of the capnogram does not return to zero, and
the waveform appears to be "climbing" or drifting upward. What is the most appropriate action
for the therapist to take?
A) Increase the patient's tidal volume to improve CO2 clearance.
B) Check the exhalation valve of the ventilator for malfunction or moisture.
C) Perform an immediate arterial blood gas to verify the PaCO2.
D) Calibrate the infrared sensor using room air.
E) Shorten the inspiratory time to allow for a longer exhalation.
Correct Answer: B) Check the exhalation valve of the ventilator for malfunction or moisture.
Rationale: When a capnograph baseline fails to return to zero (rebreathing), it indicates
that the patient is inhaling gas that contains carbon dioxide. In a mechanical ventilation
circuit, this is frequently caused by a faulty exhalation valve that is not seating properly or
is "sticky" due to condensation. This allows expired gas to be drawn back into the
inspiratory limb. Other causes include insufficient fresh gas flow in certain circuits or a
saturated CO2 absorber in anesthesia setups. (bold)
Question 4
A respiratory therapist is performing nasotracheal suctioning on a patient with a weak cough.
Upon occluding the catheter's thumb port, the therapist notes that there is no vacuum pressure at
the tip of the catheter. The therapist should perform all of the following troubleshooting steps
EXCEPT:
, 3
A) Check if the suction canister is full.
B) Ensure the suction tubing is securely connected to the wall regulator.
C) Verify that the vacuum regulator is turned on and set to the correct pressure.
D) Use a longer suction catheter to reach the source of the blockage.
E) Check for kinks or obstructions within the suction tubing.
Correct Answer: D) Use a longer suction catheter.
Rationale: If there is no vacuum, the problem is mechanical or related to the integrity of the
suction system (leaks, clogs, or full canisters). Using a longer catheter (Option D) will not
resolve a lack of pressure and could potentially cause more trauma to the patient without
providing any clinical benefit. Troubleshooting should focus on the path from the wall
source to the catheter tip. (bold)
Question 5
What is the primary clinical hazard or contraindication associated with the use of an
oropharyngeal airway (OPA) in a semi-conscious patient?
A) It may cause the tongue to fall backward and obstruct the airway.
B) The device may cause the patient to gag, vomit, or fight the device, leading to aspiration.
C) It increases the anatomical dead space significantly.
D) It can only be used in patients with a suspected nasal fracture.
E) It interferes with the delivery of high-flow oxygen via a simple mask.
Correct Answer: B) The patient may gag or fight the device.
Rationale: An OPA should only be used in completely unconscious patients who lack a gag
reflex. In a semi-conscious or alert patient, the device stimulates the posterior pharynx,
which can trigger a strong gag reflex, potentially leading to vomiting and life-threatening
aspiration. If a semi-conscious patient requires an airway adjunct, a nasopharyngeal
airway (NPA) is better tolerated as it does not stimulate the base of the tongue as
aggressively. (bold)
Question 6
While performing manual ventilation with a bag-valve-mask (BVM) during a cardiac arrest, the
respiratory therapist notices that the oxygen reservoir bag is missing from the resuscitator. What
, 4
should the therapist conclude about the oxygen delivery to the patient?
A) The FiO2 will remain at 1.0 as long as the flow is 15 L/min.
B) The patient will receive 21% oxygen (room air) only.
C) The delivered FiO2 will most likely be significantly less than 1.0 (approximately 0.40–0.50).
D) The stroke volume of the bag will decrease by 50%.
E) The bag will refill much faster without the reservoir.
Correct Answer: C) The FiO2 will most likely be less than 1.0.
Rationale: The reservoir on a manual resuscitator is essential for delivering high
concentrations of oxygen. Without the reservoir, the bag draws in a significant amount of
room air (21% O2) during the refill phase to keep up with the speed of manual cycling.
This dilutes the 100% oxygen coming from the flowmeter, typically resulting in an FiO2 of
around 40% to 50% rather than the 90% to 100% required during resuscitation. (bold)
Question 7
A patient with a permanent tracheostomy is experiencing moderate amounts of thick, tenacious
secretions that are difficult to suction. Which of the following devices is most appropriate to
provide humidification and facilitate secretion clearance for this patient?
A) A standard heat moisture exchanger (HME).
/B) A room humidifier at the bedside.
C) A heated, large-reservoir air-entrainment jet nebulizer.
D) A simple bubble humidifier connected to a tracheostomy mask.
E) An ultrasonic nebulizer used for 10 minutes every 8 hours.
Correct Answer: C) A heated large reservoir air-entrainment jet nebulizer.
Rationale: Tenacious (thick) secretions indicate that the patient’s airway is dehydrated.
Because a tracheostomy bypasses the natural humidification of the upper airway, medical-
grade humidity is required. A heated jet nebulizer (Option C) provides 100% body
humidity and can deliver a large volume of aerosolized water particles to "thin" the mucus,
making it easier to expectorate or suction. HMEs (Option A) are for short-term use and
may become clogged with thick secretions. Bubble humidifiers (Option D) do not provide
enough humidity for a bypassed airway. (bold)
