lOMoARcPSD|64024314
TMC Review Sheet
Review Sheet for the TMC Exam 2021 – new items being added here
You must do Kettering Practice Exams A and B in order to succeed on the TMC Exam. Also,
take the free TMC Practice Exam at www.nbrc.org. Also take the two Self-Assessment Exams;
there is a small fee to do so, but the gain in TMC Exam Score is more than worth it! *
TABLE OF CONTENTS
Key Terminology page 1
I. Patient Data
A. Evaluate Data in the Patient Record page 2
B. Perform Clinical Assessment page 25
C. Perform Procedures to Gather Clinical Information page 69
D. Evaluate Procedure Results page 83
E. Recommend Diagnostic Procedures page 105
II. Troubleshooting and Quality Control of Devices, and Infection Control
A. Assemble / Troubleshoot Devices page 109
B. Ensure Infection Prevention page 112
C. Perform Quality Control Procedures page 116
III. Initiation and Modification of Interventions
A. Maintain a Patent Airway Including the Care of Artificial Airways page 120
B. Perform Airway Clearance and Lung Expansion Techniques page 125
C. Support Oxygenation and Ventilation page 131
D. Administer Medications and Specialty Gases
E. Ensure Modifications are Made to the Respiratory Care Plan page 149
F. Utilize Evidence Based Practice page 168
G. Provide Respiratory Care in High-Risk Situations page 170
H. Assist a Physician / Provider in Performing Procedures page 172
I. Conduct Patient and Family Education page 177
Resources, References, Learning Tools page 179
KEY TERMINOLOGY
Chocolate Brown Blood indicates Methemoglobinemia
So do hemoximetry to see how much of the various types of hemoglobin are present. One
common cause of methemoglobinemia is nitrite Also, Nitric Oxide Therapy. Treatment of
methemoglobinemia is Methylene Blue!
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
Hemoximetry is the same thing as CO-Oximetry
To measure carboxyhemoglobin and other types of hemoglobin. Crucial test in Carbon
Monoxide poisoning!
Empyema
Some students have confused this term with emphysema, so let’s explain.
Empyema is usually caused by an infection that spreads from the lung. It leads to a buildup of
pus in the pleural space. There can be a pint or more of infected fluid. This fluid puts pressure on
the lungs.
Risk factors include pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma, or injury to
the chest.
The health care provider may note decreased breath sounds or an abnormal sound (friction rub)
when listening to the chest with a stethoscope.
Tests that may be ordered include Chest x-ray, CT scan of the chest, Pleural fluid analysis,
Thoracentesis. The goal of treatment is to cure the infection. This involves the following placing
a chest tube to drain the pus and giving antibiotics to control the infection.
Phosphotidylglycerol (PG)
This is obtained by amniocentesis, when it is present, it indicates that the baby’s lungs are mature
“Thorpe Tube” – standard oxygen flowmeter, plugs into a wall outlet – not good for transport
“Bourdon Gauge” – regulator, good for transport
“Eupnea” – normal breathing, no distress “Eu”
BiPAP is called NPPV (Noninvasive Positive Pressure Ventilation) or NIV (Noninvasive
Ventilation) for testing purposes
“Marked”
Means very severe – so do something quickly
“Oscilloscope” – an older term for a cardiac monitor or other monitoring electronic monitoring
device.
“Adventitious” lung sounds are abnormal lung sounds. If your patient has abnormal lung
sounds, you are in for an “adventure.”
“Oxygenation Index”
= (FIO2 X Mean Airway Pressure) / PaO2
The oxygenation index (OI) is used to assess the intensity of ventilatory support required to
maintain oxygenation. It is used in neonates/pediatrics to assess the need for potential ECMO
therapy.
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
I. PATIENT DATA
A. EVALUATE DATA IN THE PATIENT RECORD
Case scenario
Your patient with smoking history has worsening dyspnea on exertion – think Pulmonary
Fibrosis.
What type of emphysema is typically seen in genetic Alpha-1 Antitrypsin deficiency?
- Panlobular emphysema.
Your asthma patient has episodes that are not linked to a specific antigen, they are not
seasonal, and IgE levels are normal. This is…..
Intrinsic Asthma, sometimes known as Atopic Asthma, often episodes are caused by exercise,
cold air, emotion, or other factors. This is not allergic (extrinsic) asthma.
Identifying diseases as either obstructive or restrictive:
∙ Lung Cancer: a large tumor would obviously be restrictive, but a tumor encroaching a bronchus
would produce obstruction
∙ Bronchiectasis: the distorted bronchi and excessive mucous would be obstructive, but
eventually, bronchiectasis becomes so pervasive that it becomes restrictive, and pulmonary
fibrosis sets in
∙ Cystic Fibrosis: for the same reasons as bronchiectasis
Your patient has a DNR order, but the patient’s spouse expresses to you that she wishes to
have that order changed. What should you do?
Notify the attending physician immediately. The ability of the spouse to alter the order will be
impacted by his/her status as a Healthcare Proxy (Durable Power of Attorney for Healthcare)
Your patient tells you that she does not want any “heroic” measures to lengthen her life.
What should this be documented in?
Advance Directives (you have heard of course of Living Will, but the term for testing is Advance
Directive)
Patent Ductus Arteriosus (PDA)
We see a difference between preductal SpO2 and post ductal SpO2.
For example, measuring SpO2 on the right hand (preductal) and comparing it with either foot
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
(post ductal) can demonstrate that a PDA exists.
CVP catheter, where should it be located?
- The tip in the superior vena cava, just superior to the right atrium.
Common Lab Values seen on the TMC
K+ Normal = 4.0 mEq/L Range: 3.5-4.5 mEq/L
Na +
Normal = 140 mEq/L Range: 135-145 mEq/L
Cl- Normal 90 mEq/L Range: 80-100 mEq/L
HCO3 -
Normal 24 mEq/L Range: 22-26 mEq/L
Creatinine Normal range 0.7-1.3 mg/dL
BUN Normal range 8-25 mg/dL
RBC Normal 4-6 mil/mm3
Hgb Normal 12-16 g/dL
Hct Normal 40-50%
Platelets 150,000-400,000 mm3
WBC Normal 5,000-10,000 per mm3
Critical Lab Values
revsd: October 2020
Downloaded by derrick maina ()
TMC Review Sheet
Review Sheet for the TMC Exam 2021 – new items being added here
You must do Kettering Practice Exams A and B in order to succeed on the TMC Exam. Also,
take the free TMC Practice Exam at www.nbrc.org. Also take the two Self-Assessment Exams;
there is a small fee to do so, but the gain in TMC Exam Score is more than worth it! *
TABLE OF CONTENTS
Key Terminology page 1
I. Patient Data
A. Evaluate Data in the Patient Record page 2
B. Perform Clinical Assessment page 25
C. Perform Procedures to Gather Clinical Information page 69
D. Evaluate Procedure Results page 83
E. Recommend Diagnostic Procedures page 105
II. Troubleshooting and Quality Control of Devices, and Infection Control
A. Assemble / Troubleshoot Devices page 109
B. Ensure Infection Prevention page 112
C. Perform Quality Control Procedures page 116
III. Initiation and Modification of Interventions
A. Maintain a Patent Airway Including the Care of Artificial Airways page 120
B. Perform Airway Clearance and Lung Expansion Techniques page 125
C. Support Oxygenation and Ventilation page 131
D. Administer Medications and Specialty Gases
E. Ensure Modifications are Made to the Respiratory Care Plan page 149
F. Utilize Evidence Based Practice page 168
G. Provide Respiratory Care in High-Risk Situations page 170
H. Assist a Physician / Provider in Performing Procedures page 172
I. Conduct Patient and Family Education page 177
Resources, References, Learning Tools page 179
KEY TERMINOLOGY
Chocolate Brown Blood indicates Methemoglobinemia
So do hemoximetry to see how much of the various types of hemoglobin are present. One
common cause of methemoglobinemia is nitrite Also, Nitric Oxide Therapy. Treatment of
methemoglobinemia is Methylene Blue!
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
Hemoximetry is the same thing as CO-Oximetry
To measure carboxyhemoglobin and other types of hemoglobin. Crucial test in Carbon
Monoxide poisoning!
Empyema
Some students have confused this term with emphysema, so let’s explain.
Empyema is usually caused by an infection that spreads from the lung. It leads to a buildup of
pus in the pleural space. There can be a pint or more of infected fluid. This fluid puts pressure on
the lungs.
Risk factors include pneumonia, Tuberculosis, Chest surgery, Lung abscess, Trauma, or injury to
the chest.
The health care provider may note decreased breath sounds or an abnormal sound (friction rub)
when listening to the chest with a stethoscope.
Tests that may be ordered include Chest x-ray, CT scan of the chest, Pleural fluid analysis,
Thoracentesis. The goal of treatment is to cure the infection. This involves the following placing
a chest tube to drain the pus and giving antibiotics to control the infection.
Phosphotidylglycerol (PG)
This is obtained by amniocentesis, when it is present, it indicates that the baby’s lungs are mature
“Thorpe Tube” – standard oxygen flowmeter, plugs into a wall outlet – not good for transport
“Bourdon Gauge” – regulator, good for transport
“Eupnea” – normal breathing, no distress “Eu”
BiPAP is called NPPV (Noninvasive Positive Pressure Ventilation) or NIV (Noninvasive
Ventilation) for testing purposes
“Marked”
Means very severe – so do something quickly
“Oscilloscope” – an older term for a cardiac monitor or other monitoring electronic monitoring
device.
“Adventitious” lung sounds are abnormal lung sounds. If your patient has abnormal lung
sounds, you are in for an “adventure.”
“Oxygenation Index”
= (FIO2 X Mean Airway Pressure) / PaO2
The oxygenation index (OI) is used to assess the intensity of ventilatory support required to
maintain oxygenation. It is used in neonates/pediatrics to assess the need for potential ECMO
therapy.
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
I. PATIENT DATA
A. EVALUATE DATA IN THE PATIENT RECORD
Case scenario
Your patient with smoking history has worsening dyspnea on exertion – think Pulmonary
Fibrosis.
What type of emphysema is typically seen in genetic Alpha-1 Antitrypsin deficiency?
- Panlobular emphysema.
Your asthma patient has episodes that are not linked to a specific antigen, they are not
seasonal, and IgE levels are normal. This is…..
Intrinsic Asthma, sometimes known as Atopic Asthma, often episodes are caused by exercise,
cold air, emotion, or other factors. This is not allergic (extrinsic) asthma.
Identifying diseases as either obstructive or restrictive:
∙ Lung Cancer: a large tumor would obviously be restrictive, but a tumor encroaching a bronchus
would produce obstruction
∙ Bronchiectasis: the distorted bronchi and excessive mucous would be obstructive, but
eventually, bronchiectasis becomes so pervasive that it becomes restrictive, and pulmonary
fibrosis sets in
∙ Cystic Fibrosis: for the same reasons as bronchiectasis
Your patient has a DNR order, but the patient’s spouse expresses to you that she wishes to
have that order changed. What should you do?
Notify the attending physician immediately. The ability of the spouse to alter the order will be
impacted by his/her status as a Healthcare Proxy (Durable Power of Attorney for Healthcare)
Your patient tells you that she does not want any “heroic” measures to lengthen her life.
What should this be documented in?
Advance Directives (you have heard of course of Living Will, but the term for testing is Advance
Directive)
Patent Ductus Arteriosus (PDA)
We see a difference between preductal SpO2 and post ductal SpO2.
For example, measuring SpO2 on the right hand (preductal) and comparing it with either foot
revsd: October 2020
Downloaded by derrick maina ()
, lOMoARcPSD|64024314
TMC Review Sheet
(post ductal) can demonstrate that a PDA exists.
CVP catheter, where should it be located?
- The tip in the superior vena cava, just superior to the right atrium.
Common Lab Values seen on the TMC
K+ Normal = 4.0 mEq/L Range: 3.5-4.5 mEq/L
Na +
Normal = 140 mEq/L Range: 135-145 mEq/L
Cl- Normal 90 mEq/L Range: 80-100 mEq/L
HCO3 -
Normal 24 mEq/L Range: 22-26 mEq/L
Creatinine Normal range 0.7-1.3 mg/dL
BUN Normal range 8-25 mg/dL
RBC Normal 4-6 mil/mm3
Hgb Normal 12-16 g/dL
Hct Normal 40-50%
Platelets 150,000-400,000 mm3
WBC Normal 5,000-10,000 per mm3
Critical Lab Values
revsd: October 2020
Downloaded by derrick maina ()
