C&S TMC EXAM THREE NEWEST ACTUAL EXAM PREPARATION WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
A 36-week gestation neonate is 4 hours post-delivery. The infant is currently in a 35% oxyhood.
Arterial Blood Gas (ABG) results are: pH 7.34, PaCO2 47 mmHg, PaO2 57 mmHg, and HCO3
25 mEq/L. Which of the following should the respiratory therapist recommend?
A) Increase the oxyhood concentration to 45%
B) Initiate nasal CPAP at 5 cmH2O
C) Perform endotracheal intubation
D) Maintain current therapy and continue to monitor
E) Transition the infant to a high-flow nasal cannula
Correct Answer: D) Maintain current therapy and continue to monitor
Rationale: In a newborn, especially one slightly premature at 36 weeks, these ABG values
are within acceptable physiological limits for the transition period. A PaO2 between 50-70
mmHg is often targeted in neonates to avoid retinopathy of prematurity (ROP) and
oxidative stress. A PaCO2 of 47 mmHg with a near-normal pH of 7.34 indicates adequate
alveolar ventilation for a 4-hour-old infant. Since the infant is stable on a relatively low
FiO2 (35%) and the acid-base balance is compensated, there is no immediate indication to
escalate care. Escalating to CPAP or intubation unnecessarily increases the risk of
barotrauma and infection.
Question 2
A patient with AIDS is scheduled to receive prophylactic treatment for Pneumocystis jirovecii
pneumonia (PCP). Which of the following represents the most appropriate pharmacological
intervention and delivery method?
A) Ribavirin via SPAG-2 nebulizer once daily
B) Pentamidine isethionate (NebuPent) via a standard small-volume nebulizer daily
C) Pentamidine isethionate (NebuPent) via a Respirgard II nebulizer once every 4 weeks
D) Tobramycin (TOBI) via PARI LC Plus nebulizer twice daily
E) Amphotericin B via ultrasonic nebulizer once weekly
, 2
Correct Answer: C) Pentamidine (NebuPent) via Respigard once every 4 weeks
Rationale: Pentamidine is a standard prophylactic treatment for PCP in
immunocompromised patients. It must be delivered using a specialized nebulizer system,
such as the Respirgard II, which utilizes one-way valves and an expiratory filter. This is
critical because pentamidine can be toxic to healthcare workers and can cause
bronchospasm in the patient; the filter captures exhaled particles to prevent environmental
contamination. The standard prophylactic dosing interval for this medication is 300 mg
once every four weeks. Ribavirin (Option A) is used for RSV, and Tobramycin (Option D) is
for Pseudomonas in cystic fibrosis.
Question 3
A patient is orally intubated and receiving mechanical ventilation in Assist/Control (A/C) mode.
The physician requests a transition to a weaning mode. Which of the following ventilator modes
or combinations would be appropriate for this objective?
A) Inverse Ratio Ventilation (IRV)
B) Synchronized Intermittent Mandatory Ventilation (SIMV) and Pressure Support Ventilation
(PSV)
C) Airway Pressure Release Ventilation (APRV) with high PEEP
D) Continuous Mandated Ventilation (CMV) with a high trigger sensitivity
E) A/C mode with a reduced tidal volume
Correct Answer: B) SIMV and PSV
Rationale: Weaning involves gradually shifting the work of breathing from the ventilator to
the patient. SIMV allows the patient to take spontaneous breaths between mandatory
mechanical breaths. PSV is added to these spontaneous breaths to overcome the resistance
of the endotracheal tube and the ventilator circuit, thereby reducing the work of breathing
and preventing respiratory muscle fatigue. Modes like IRV (Option A) and APRV (Option
C) are typically used for lung recruitment in severe ARDS, not for weaning. A/C (Option E)
provides full support and is generally not considered a weaning mode because the
ventilator delivers a full breath every time the patient triggers it.
, 3
Question 4
An adult patient in the Emergency Department is receiving oxygen via a nasal cannula at 5
L/min. Over the past hour, the patient’s respiratory pattern has become noticeably irregular and
shallow. ABG results show: pH 7.24, PaCO2 86 mmHg, PaO2 89 mmHg, and HCO3 36 mEq/L.
Which of the following should the respiratory therapist recommend?
A) Increase the oxygen flow to 10 L/min
B) Switch the patient to a non-rebreather mask at 15 L/min
C) Decrease the oxygen liter flow
D) Administer a dose of naloxone (Narcan)
E) Initiate immediate invasive mechanical ventilation
Correct Answer: C) decrease the O2 liter flow
Rationale: This patient is likely a chronic CO2 retainer (COPD) whose primary drive to
breathe is hypoxemia (the "hypoxic drive") rather than hypercapnia. By providing a
relatively high level of oxygen (5 L/min), the PaO2 has risen to 89 mmHg, which satisfies
the peripheral chemoreceptors and suppresses the drive to breathe. This results in
"oxygen-induced hypoventilation," leading to the severe respiratory acidosis (pH 7.24, CO2
86) seen here. The initial step should be to reduce the FiO2 to restore the patient's natural
respiratory drive. If the patient does not improve or remains obtunded, non-invasive
ventilation (BiPAP) would be the next logical step.
Question 5
A respiratory therapist is assessing a patient with a history of COPD and significant air trapping.
The patient is short of breath and reports difficulty mobilizing secretions. Auscultation reveals
scattered coarse crackles and occasional expiratory wheezing. Which of the following is the most
appropriate therapeutic recommendation?
A) Intravenous corticosteroids and postural drainage
B) Aerosolized bronchodilator followed by Positive Expiratory Pressure (PEP) therapy
C) High-frequency chest wall oscillation (The Vest)
D) Incentive spirometry every hour while awake
E) Oxygen therapy at 4 L/min via simple mask
, 4
Correct Answer: B) Aerosol bronchodilator with PEP therapy
Rationale: The patient has two primary issues: bronchospasm (evidenced by wheezing) and
retained secretions (coarse crackles). Administering a bronchodilator first will open the
airways, making secretion clearance more effective. PEP therapy is specifically indicated
for patients with air trapping and COPD. It creates back-pressure during exhalation,
which splints the airways open, allows air to get behind secretions, and facilitates their
movement to the larger airways for expectoration. Incentive spirometry (Option D) is
ineffective for COPD patients with air trapping as they already have hyperinflated lungs.
Question 6
A 28-week gestation neonate requires manual ventilation immediately following delivery.
Despite using high peak pressures with a self-inflating bag and mask, the infant exhibits poor
chest excursion and persistent cyanosis. What is the most appropriate immediate action?
A) Increase the bagging rate to 80 breaths per minute
B) Perform a needle decompression of the chest
C) Intubate the patient and initiate mechanical ventilation
D) Administer a dose of epinephrine intravenously
E) Switch to a T-piece resuscitator
Correct Answer: C) Intubate the patient
Rationale: In neonatal resuscitation, if mask ventilation is ineffective (evidenced by poor
chest rise) despite corrective measures (like checking the seal and increasing pressure),
endotracheal intubation is required. This secures the airway and ensures that the pressure
and oxygen are delivered directly to the lungs, bypassing potential upper airway
obstructions or poor mask seals. This is especially critical in a 28-week premature infant
who likely has low lung compliance due to surfactant deficiency. Option B is only indicated
if there are specific signs of a tension pneumothorax (e.g., shifted heart sounds or
asymmetric excursion).
Question 7
Following a traumatic nasotracheal intubation, a patient begins to experience profuse bleeding
from the nasopharynx. Which of the following actions should the respiratory therapist take to
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
A 36-week gestation neonate is 4 hours post-delivery. The infant is currently in a 35% oxyhood.
Arterial Blood Gas (ABG) results are: pH 7.34, PaCO2 47 mmHg, PaO2 57 mmHg, and HCO3
25 mEq/L. Which of the following should the respiratory therapist recommend?
A) Increase the oxyhood concentration to 45%
B) Initiate nasal CPAP at 5 cmH2O
C) Perform endotracheal intubation
D) Maintain current therapy and continue to monitor
E) Transition the infant to a high-flow nasal cannula
Correct Answer: D) Maintain current therapy and continue to monitor
Rationale: In a newborn, especially one slightly premature at 36 weeks, these ABG values
are within acceptable physiological limits for the transition period. A PaO2 between 50-70
mmHg is often targeted in neonates to avoid retinopathy of prematurity (ROP) and
oxidative stress. A PaCO2 of 47 mmHg with a near-normal pH of 7.34 indicates adequate
alveolar ventilation for a 4-hour-old infant. Since the infant is stable on a relatively low
FiO2 (35%) and the acid-base balance is compensated, there is no immediate indication to
escalate care. Escalating to CPAP or intubation unnecessarily increases the risk of
barotrauma and infection.
Question 2
A patient with AIDS is scheduled to receive prophylactic treatment for Pneumocystis jirovecii
pneumonia (PCP). Which of the following represents the most appropriate pharmacological
intervention and delivery method?
A) Ribavirin via SPAG-2 nebulizer once daily
B) Pentamidine isethionate (NebuPent) via a standard small-volume nebulizer daily
C) Pentamidine isethionate (NebuPent) via a Respirgard II nebulizer once every 4 weeks
D) Tobramycin (TOBI) via PARI LC Plus nebulizer twice daily
E) Amphotericin B via ultrasonic nebulizer once weekly
, 2
Correct Answer: C) Pentamidine (NebuPent) via Respigard once every 4 weeks
Rationale: Pentamidine is a standard prophylactic treatment for PCP in
immunocompromised patients. It must be delivered using a specialized nebulizer system,
such as the Respirgard II, which utilizes one-way valves and an expiratory filter. This is
critical because pentamidine can be toxic to healthcare workers and can cause
bronchospasm in the patient; the filter captures exhaled particles to prevent environmental
contamination. The standard prophylactic dosing interval for this medication is 300 mg
once every four weeks. Ribavirin (Option A) is used for RSV, and Tobramycin (Option D) is
for Pseudomonas in cystic fibrosis.
Question 3
A patient is orally intubated and receiving mechanical ventilation in Assist/Control (A/C) mode.
The physician requests a transition to a weaning mode. Which of the following ventilator modes
or combinations would be appropriate for this objective?
A) Inverse Ratio Ventilation (IRV)
B) Synchronized Intermittent Mandatory Ventilation (SIMV) and Pressure Support Ventilation
(PSV)
C) Airway Pressure Release Ventilation (APRV) with high PEEP
D) Continuous Mandated Ventilation (CMV) with a high trigger sensitivity
E) A/C mode with a reduced tidal volume
Correct Answer: B) SIMV and PSV
Rationale: Weaning involves gradually shifting the work of breathing from the ventilator to
the patient. SIMV allows the patient to take spontaneous breaths between mandatory
mechanical breaths. PSV is added to these spontaneous breaths to overcome the resistance
of the endotracheal tube and the ventilator circuit, thereby reducing the work of breathing
and preventing respiratory muscle fatigue. Modes like IRV (Option A) and APRV (Option
C) are typically used for lung recruitment in severe ARDS, not for weaning. A/C (Option E)
provides full support and is generally not considered a weaning mode because the
ventilator delivers a full breath every time the patient triggers it.
, 3
Question 4
An adult patient in the Emergency Department is receiving oxygen via a nasal cannula at 5
L/min. Over the past hour, the patient’s respiratory pattern has become noticeably irregular and
shallow. ABG results show: pH 7.24, PaCO2 86 mmHg, PaO2 89 mmHg, and HCO3 36 mEq/L.
Which of the following should the respiratory therapist recommend?
A) Increase the oxygen flow to 10 L/min
B) Switch the patient to a non-rebreather mask at 15 L/min
C) Decrease the oxygen liter flow
D) Administer a dose of naloxone (Narcan)
E) Initiate immediate invasive mechanical ventilation
Correct Answer: C) decrease the O2 liter flow
Rationale: This patient is likely a chronic CO2 retainer (COPD) whose primary drive to
breathe is hypoxemia (the "hypoxic drive") rather than hypercapnia. By providing a
relatively high level of oxygen (5 L/min), the PaO2 has risen to 89 mmHg, which satisfies
the peripheral chemoreceptors and suppresses the drive to breathe. This results in
"oxygen-induced hypoventilation," leading to the severe respiratory acidosis (pH 7.24, CO2
86) seen here. The initial step should be to reduce the FiO2 to restore the patient's natural
respiratory drive. If the patient does not improve or remains obtunded, non-invasive
ventilation (BiPAP) would be the next logical step.
Question 5
A respiratory therapist is assessing a patient with a history of COPD and significant air trapping.
The patient is short of breath and reports difficulty mobilizing secretions. Auscultation reveals
scattered coarse crackles and occasional expiratory wheezing. Which of the following is the most
appropriate therapeutic recommendation?
A) Intravenous corticosteroids and postural drainage
B) Aerosolized bronchodilator followed by Positive Expiratory Pressure (PEP) therapy
C) High-frequency chest wall oscillation (The Vest)
D) Incentive spirometry every hour while awake
E) Oxygen therapy at 4 L/min via simple mask
, 4
Correct Answer: B) Aerosol bronchodilator with PEP therapy
Rationale: The patient has two primary issues: bronchospasm (evidenced by wheezing) and
retained secretions (coarse crackles). Administering a bronchodilator first will open the
airways, making secretion clearance more effective. PEP therapy is specifically indicated
for patients with air trapping and COPD. It creates back-pressure during exhalation,
which splints the airways open, allows air to get behind secretions, and facilitates their
movement to the larger airways for expectoration. Incentive spirometry (Option D) is
ineffective for COPD patients with air trapping as they already have hyperinflated lungs.
Question 6
A 28-week gestation neonate requires manual ventilation immediately following delivery.
Despite using high peak pressures with a self-inflating bag and mask, the infant exhibits poor
chest excursion and persistent cyanosis. What is the most appropriate immediate action?
A) Increase the bagging rate to 80 breaths per minute
B) Perform a needle decompression of the chest
C) Intubate the patient and initiate mechanical ventilation
D) Administer a dose of epinephrine intravenously
E) Switch to a T-piece resuscitator
Correct Answer: C) Intubate the patient
Rationale: In neonatal resuscitation, if mask ventilation is ineffective (evidenced by poor
chest rise) despite corrective measures (like checking the seal and increasing pressure),
endotracheal intubation is required. This secures the airway and ensures that the pressure
and oxygen are delivered directly to the lungs, bypassing potential upper airway
obstructions or poor mask seals. This is especially critical in a 28-week premature infant
who likely has low lung compliance due to surfactant deficiency. Option B is only indicated
if there are specific signs of a tension pneumothorax (e.g., shifted heart sounds or
asymmetric excursion).
Question 7
Following a traumatic nasotracheal intubation, a patient begins to experience profuse bleeding
from the nasopharynx. Which of the following actions should the respiratory therapist take to
