RRT TMC EXAM THE ULTIMATE COMPREHENSIVE QUESTION
BANK WITH VERIFIED ANSWERS & RATIONALES (A+
GUARANTEED)
1. A patient with a history of COPD is receiving oxygen at 2 L/min via
nasal cannula. An arterial blood gas (ABG) analysis reveals a PaO2 of
58 mm Hg, PaCO2 of 55 mm Hg, and pH of 7.31. Which of the
following is the most appropriate initial action?
A. Increase oxygen to 4 L/min.
B. Prepare for immediate intubation.
C. Initiate non-invasive positive pressure ventilation (NPPV).
D. Administer sodium bicarbonate.
Correct Answer: C. Initiate non-invasive positive pressure ventilation
(NPPV).
Rationale: The patient is in acute hypercapnic respiratory failure (pH <
7.35, PaCO2 > 45). NPPV is the first-line intervention for hypercapnic
respiratory failure in a patient who is awake and able to protect their
airway, as it can improve ventilation and prevent the need for
intubation.
2. During a spontaneous breathing trial (SBT) on a 75-kg patient,
which of the following observations is the most sensitive indicator of
respiratory muscle fatigue and would necessitate stopping the trial?
A. Respiratory rate of 28 breaths/min.
B. Heart rate increase from 90 to 105 beats/min.
,C. SpO2 decrease from 94% to 90%.
D. Rapid shallow breathing index (RSBI) of 110 breaths/min/L.
Correct Answer: D. Rapid shallow breathing index (RSBI) of 110
breaths/min/L.
Rationale: An RSBI (f/Vt) > 105 breaths/min/L is a strong predictor of
weaning failure and indicates rapid, shallow breathing, which is a sign of
respiratory muscle fatigue. While other options are concerning, the
RSBI is a specific and sensitive indicator for this condition.
3. You are called to a patient's room to troubleshoot a high-pressure
alarm on a ventilator. The patient is on volume-controlled A/C
ventilation. After a quick assessment, you note the patient is coughing
and appears anxious. You measure the peak inspiratory pressure (PIP)
and plateau pressure (Pplat). The PIP is 45 cm H2O and the Pplat is 28
cm H2O. What is the most likely cause of the high-pressure alarm?
A. A kink in the patient's endotracheal tube.
B. A decrease in lung compliance.
C. An increase in airway resistance.
D. Patient-ventilator asynchrony.
Correct Answer: C. An increase in airway resistance.
Rationale: An increase in airway resistance (e.g., from bronchospasm,
secretions, or a kinked tube) will cause a disproportionate increase in
PIP compared to Pplat. The difference between PIP and Pplat (PIP -
Pplat) reflects airway resistance; a large difference suggests an airway
problem. A decrease in lung compliance would increase both PIP and
Pplat proportionally.
,4. Which of the following imaging procedures is most appropriate for
evaluating a suspected pulmonary embolism (PE) when a patient has a
contraindication to intravenous contrast?
A. Ventilation/perfusion (V/Q) scan.
B. CT pulmonary angiography (CTPA).
C. Chest X-ray.
D. Pulmonary angiography.
Correct Answer: A. Ventilation/perfusion (V/Q) scan.
Rationale: A V/Q scan is a nuclear medicine test that evaluates airflow
and blood flow in the lungs. It does not require IV contrast and is a
useful alternative to CTPA for PE diagnosis in patients with renal failure
or contrast allergy. A CTPA is the preferred test but requires contrast.
5. While setting up a 12-lead EKG, you are unable to obtain any
electrical signal on the monitor. The batteries are fully charged, and
the machine powers on. Which of the following is the most likely
cause of this problem?
A. A missing lead wire or a loose connection.
B. Patient is in asystole.
C. The gain is set too low.
D. The monitor is not in diagnostic mode.
Correct Answer: A. A missing lead wire or a loose connection.
Rationale: If the machine is powered on and the batteries are charged,
the absence of any signal is almost always due to a break in the
electrical circuit between the patient and the monitor. This is usually a
missing lead or a disconnected cable.
, 6. A 60-year-old male patient with a history of smoking is participating
in a pulmonary rehabilitation program. You obtain an expired carbon
monoxide (CO) reading of 18 ppm. Based on this finding, you can
conclude that the patient:
A. Has a severe respiratory infection.
B. Has recently smoked a cigarette.
C. Has carbon monoxide poisoning.
D. Is experiencing an asthma exacerbation.
Correct Answer: B. Has recently smoked a cigarette.
Rationale: Expired CO is a measure of recent smoking. Nonsmokers
generally have a CO level of < 3 ppm, while smokers can have levels
elevated to 10 ppm or more. A level of 18 ppm indicates that the
patient has smoked within the last 12-24 hours.
7. An unconscious apneic patient with a known difficult airway and a
full stomach cannot be orally intubated in the emergency room.
Which of the following would you recommend be used to secure the
airway?
A. Laryngeal mask airway (LMA).
B. Inserting an esophageal-tracheal combitube.
C. Needle cricothyroidotomy.
D. Nasotracheal intubation.
Correct Answer: B. Inserting an esophageal-tracheal combitube.
Rationale: The esophageal-tracheal combitube (or King LT) is a rescue
airway device that can be placed blindly without direct visualization. It
is specifically designed for difficult airway situations and in patients with
a full stomach, as it can ventilate the patient regardless of whether it is
BANK WITH VERIFIED ANSWERS & RATIONALES (A+
GUARANTEED)
1. A patient with a history of COPD is receiving oxygen at 2 L/min via
nasal cannula. An arterial blood gas (ABG) analysis reveals a PaO2 of
58 mm Hg, PaCO2 of 55 mm Hg, and pH of 7.31. Which of the
following is the most appropriate initial action?
A. Increase oxygen to 4 L/min.
B. Prepare for immediate intubation.
C. Initiate non-invasive positive pressure ventilation (NPPV).
D. Administer sodium bicarbonate.
Correct Answer: C. Initiate non-invasive positive pressure ventilation
(NPPV).
Rationale: The patient is in acute hypercapnic respiratory failure (pH <
7.35, PaCO2 > 45). NPPV is the first-line intervention for hypercapnic
respiratory failure in a patient who is awake and able to protect their
airway, as it can improve ventilation and prevent the need for
intubation.
2. During a spontaneous breathing trial (SBT) on a 75-kg patient,
which of the following observations is the most sensitive indicator of
respiratory muscle fatigue and would necessitate stopping the trial?
A. Respiratory rate of 28 breaths/min.
B. Heart rate increase from 90 to 105 beats/min.
,C. SpO2 decrease from 94% to 90%.
D. Rapid shallow breathing index (RSBI) of 110 breaths/min/L.
Correct Answer: D. Rapid shallow breathing index (RSBI) of 110
breaths/min/L.
Rationale: An RSBI (f/Vt) > 105 breaths/min/L is a strong predictor of
weaning failure and indicates rapid, shallow breathing, which is a sign of
respiratory muscle fatigue. While other options are concerning, the
RSBI is a specific and sensitive indicator for this condition.
3. You are called to a patient's room to troubleshoot a high-pressure
alarm on a ventilator. The patient is on volume-controlled A/C
ventilation. After a quick assessment, you note the patient is coughing
and appears anxious. You measure the peak inspiratory pressure (PIP)
and plateau pressure (Pplat). The PIP is 45 cm H2O and the Pplat is 28
cm H2O. What is the most likely cause of the high-pressure alarm?
A. A kink in the patient's endotracheal tube.
B. A decrease in lung compliance.
C. An increase in airway resistance.
D. Patient-ventilator asynchrony.
Correct Answer: C. An increase in airway resistance.
Rationale: An increase in airway resistance (e.g., from bronchospasm,
secretions, or a kinked tube) will cause a disproportionate increase in
PIP compared to Pplat. The difference between PIP and Pplat (PIP -
Pplat) reflects airway resistance; a large difference suggests an airway
problem. A decrease in lung compliance would increase both PIP and
Pplat proportionally.
,4. Which of the following imaging procedures is most appropriate for
evaluating a suspected pulmonary embolism (PE) when a patient has a
contraindication to intravenous contrast?
A. Ventilation/perfusion (V/Q) scan.
B. CT pulmonary angiography (CTPA).
C. Chest X-ray.
D. Pulmonary angiography.
Correct Answer: A. Ventilation/perfusion (V/Q) scan.
Rationale: A V/Q scan is a nuclear medicine test that evaluates airflow
and blood flow in the lungs. It does not require IV contrast and is a
useful alternative to CTPA for PE diagnosis in patients with renal failure
or contrast allergy. A CTPA is the preferred test but requires contrast.
5. While setting up a 12-lead EKG, you are unable to obtain any
electrical signal on the monitor. The batteries are fully charged, and
the machine powers on. Which of the following is the most likely
cause of this problem?
A. A missing lead wire or a loose connection.
B. Patient is in asystole.
C. The gain is set too low.
D. The monitor is not in diagnostic mode.
Correct Answer: A. A missing lead wire or a loose connection.
Rationale: If the machine is powered on and the batteries are charged,
the absence of any signal is almost always due to a break in the
electrical circuit between the patient and the monitor. This is usually a
missing lead or a disconnected cable.
, 6. A 60-year-old male patient with a history of smoking is participating
in a pulmonary rehabilitation program. You obtain an expired carbon
monoxide (CO) reading of 18 ppm. Based on this finding, you can
conclude that the patient:
A. Has a severe respiratory infection.
B. Has recently smoked a cigarette.
C. Has carbon monoxide poisoning.
D. Is experiencing an asthma exacerbation.
Correct Answer: B. Has recently smoked a cigarette.
Rationale: Expired CO is a measure of recent smoking. Nonsmokers
generally have a CO level of < 3 ppm, while smokers can have levels
elevated to 10 ppm or more. A level of 18 ppm indicates that the
patient has smoked within the last 12-24 hours.
7. An unconscious apneic patient with a known difficult airway and a
full stomach cannot be orally intubated in the emergency room.
Which of the following would you recommend be used to secure the
airway?
A. Laryngeal mask airway (LMA).
B. Inserting an esophageal-tracheal combitube.
C. Needle cricothyroidotomy.
D. Nasotracheal intubation.
Correct Answer: B. Inserting an esophageal-tracheal combitube.
Rationale: The esophageal-tracheal combitube (or King LT) is a rescue
airway device that can be placed blindly without direct visualization. It
is specifically designed for difficult airway situations and in patients with
a full stomach, as it can ventilate the patient regardless of whether it is
