TMC SECURE COMPREHENSIVE THERAPIST SAE EXAM
BANK QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES EACH | CURRENTLY TESTING AND FREQUENTLY
TESTED QUESTIONS | EXPERT VERIFIED FOR
GUARANTEED PASS
SECTION 1: PATIENT DATA - 50 QUESTIONS
1. A 65-year-old male with COPD is admitted with increased shortness of breath.
An ABG is drawn on room air: pH 7.36, PaCO2 55 mmHg, PaO2 50 mmHg, HCO3
30 mEq/L.
What is the primary acid-base disturbance?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is normal (7.36), but the PaCO2 is elevated (55), indicating
a respiratory acidosis. The elevated HCO3 (30) indicates renal compensation.
Because the pH is within the normal range, it is fully compensated.
2. A patient with a suspected pulmonary embolism is ordered an arterial blood
gas.
Which of the following findings is most consistent with this condition?
A. Increased PaO2 and decreased PaCO2
B. Decreased PaO2 and decreased PaCO2
C. Increased PaO2 and increased PaCO2
D. Decreased PaO2 and increased PaCO2
Correct Answer: B
Rationale: A pulmonary embolism creates a V/Q mismatch (dead space), leading
to hypoxemia (decreased PaO2). The patient typically hyperventilates due to
the hypoxemia and anxiety, which blows off CO2, leading to hypocapnia
(decreased PaCO2).
3. A 45-year-old female is admitted with an acute asthma exacerbation. She is
speaking in short sentences and has audible wheezing. Which of the following
bedside pulmonary function values would you expect?
1
, A. Increased FEV1, decreased FVC
B. Decreased FEV1, normal FVC
C. Decreased FEV1/FVC ratio
D. Increased FEF 25-75%
Correct Answer: C
Rationale: Asthma causes reversible airway obstruction. This results in a
decreased FEV1 and a decreased FEV1/FVC ratio (less than 70% predicted).
FVC may be normal or slightly decreased.
4. A patient on a mechanical ventilator has the following data: PIP 45 cmH2O,
Plateau pressure 35 cmH2O. What is the primary cause of the elevated
pressures?
A. Increased airway resistance (e.g., bronchospasm)
B. Decreased lung compliance (e.g., ARDS, pneumothorax)
C. Mucus plugging in the ET tube
D. Patient-ventilator dyssynchrony
Correct Answer: B
Rationale: The difference between PIP and Plateau (45 - 35 = 10 cmH2O) is
relatively normal (should be <10). The primary issue is the elevated Plateau
pressure (normal <30). Plateau pressure reflects alveolar pressure and is
elevated when lung compliance is decreased (e.g., ARDS, pneumonia,
pulmonary edema).
5. A 70-year-old male with a history of CHF is admitted with dyspnea. You note
bilateral crackles, jugular venous distension, and pink frothy sputum. Which
of the following is the most appropriate initial assessment?
A. Perform a forced vital capacity maneuver
B. Obtain a sputum culture
C. Auscultate breath sounds and obtain vital signs
D. Schedule a methacholine challenge
Correct Answer: C
Rationale: The patient is showing classic signs of acute pulmonary edema. The
immediate priority is to assess the patient's current status by auscultating
breath sounds, checking vital signs, and potentially obtaining an SpO2.
Invasive or lengthy procedures are not the first step in an acute emergency.
6. Which of the following ABG results indicates metabolic alkalosis?
A. pH 7.28, PaCO2 40, HCO3 18
2
, B. pH 7.50, PaCO2 40, HCO3 30
C. pH 7.30, PaCO2 50, HCO3 24
D. pH 7.48, PaCO2 30, HCO3 24
Correct Answer: B
Rationale: A pH > 7.45 indicates alkalosis. If the PaCO2 is normal (40), the
cause must be metabolic. An HCO3 > 26 confirms a metabolic alkalosis.
7. A patient has a chest X-ray that shows a flattened diaphragm and a
hyperlucent lung field. This is most consistent with:
A. Pneumonia
B. Pulmonary fibrosis
C. Emphysema
D. Atelectasis
Correct Answer: C
Rationale: Emphysema is characterized by air trapping and hyperinflation.
On a chest X-ray, this appears as hyperlucent (darker) lung fields and a
flattened diaphragm due to the increased lung volume.
8. A 55-year-old male presents with a dry, non-productive cough and
dyspnea on exertion. A chest X-ray reveals bilateral hilar adenopathy and
interstitial infiltrates. What is the most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Pneumonia
D. Lung cancer
Correct Answer: B
Rationale: Sarcoidosis is a granulomatous disease that classically presents
with bilateral hilar lymphadenopathy (adenopathy) and interstitial lung
disease. It is more common in African Americans and presents with non-specific
respiratory symptoms.
9. While monitoring a patient on a ventilator, you notice the peak inspiratory
pressure (PIP) has suddenly increased from 25 to 50 cmH2O. The patient is
agitated. What is the most appropriate immediate action?
A. Increase the sedation
B. Suction the patient's airway
C. Manually ventilate with a bag-valve-mask
D. Decrease the tidal volume
3
, Correct Answer: C
Rationale: A sudden, dramatic increase in PIP indicates a life-threatening
problem like a mucus plug, pneumothorax, or ET tube obstruction. The safest
immediate action is to disconnect the patient from the ventilator and
manually ventilate with a BVM while assessing for the cause.
10. Which of the following is a contraindication for performing a
modified Allen's test?
A. The patient has a history of Raynaud's syndrome
B. The patient is on anticoagulant therapy
C. The patient has an AV fistula in the arm
D. The patient has a history of smoking
Correct Answer: C
Rationale: The modified Allen's test assesses collateral circulation to the
hand before radial artery puncture. An AV fistula surgically creates a
shunt, altering blood flow and making the test unreliable and potentially
dangerous for the fistula.
11. A patient with a tracheostomy is being evaluated for decannulation. Which
of the following is the most important criterion to assess?
A. The patient's ability to speak
B. The patient's cough strength and ability to manage secretions
C. The patient's oxygen requirement
D. The size of the tracheostomy tube
Correct Answer: B
Rationale: Before decannulation, the patient must be able to protect their
airway. A strong cough and the ability to clear secretions are essential
to prevent aspiration and respiratory failure after the tube is removed.
12. A 60-year-old patient has a PaO2 of 55 mmHg on room air. Based on this
value, the patient is:
A. Normal
B. Mildly hypoxemic
C. Moderately hypoxemic
D. Severely hypoxemic
Correct Answer: C
Rationale: Normal PaO2 is 80-100 mmHg. Mild hypoxemia is 60-79 mmHg.
4
BANK QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES EACH | CURRENTLY TESTING AND FREQUENTLY
TESTED QUESTIONS | EXPERT VERIFIED FOR
GUARANTEED PASS
SECTION 1: PATIENT DATA - 50 QUESTIONS
1. A 65-year-old male with COPD is admitted with increased shortness of breath.
An ABG is drawn on room air: pH 7.36, PaCO2 55 mmHg, PaO2 50 mmHg, HCO3
30 mEq/L.
What is the primary acid-base disturbance?
A. Uncompensated respiratory acidosis
B. Compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is normal (7.36), but the PaCO2 is elevated (55), indicating
a respiratory acidosis. The elevated HCO3 (30) indicates renal compensation.
Because the pH is within the normal range, it is fully compensated.
2. A patient with a suspected pulmonary embolism is ordered an arterial blood
gas.
Which of the following findings is most consistent with this condition?
A. Increased PaO2 and decreased PaCO2
B. Decreased PaO2 and decreased PaCO2
C. Increased PaO2 and increased PaCO2
D. Decreased PaO2 and increased PaCO2
Correct Answer: B
Rationale: A pulmonary embolism creates a V/Q mismatch (dead space), leading
to hypoxemia (decreased PaO2). The patient typically hyperventilates due to
the hypoxemia and anxiety, which blows off CO2, leading to hypocapnia
(decreased PaCO2).
3. A 45-year-old female is admitted with an acute asthma exacerbation. She is
speaking in short sentences and has audible wheezing. Which of the following
bedside pulmonary function values would you expect?
1
, A. Increased FEV1, decreased FVC
B. Decreased FEV1, normal FVC
C. Decreased FEV1/FVC ratio
D. Increased FEF 25-75%
Correct Answer: C
Rationale: Asthma causes reversible airway obstruction. This results in a
decreased FEV1 and a decreased FEV1/FVC ratio (less than 70% predicted).
FVC may be normal or slightly decreased.
4. A patient on a mechanical ventilator has the following data: PIP 45 cmH2O,
Plateau pressure 35 cmH2O. What is the primary cause of the elevated
pressures?
A. Increased airway resistance (e.g., bronchospasm)
B. Decreased lung compliance (e.g., ARDS, pneumothorax)
C. Mucus plugging in the ET tube
D. Patient-ventilator dyssynchrony
Correct Answer: B
Rationale: The difference between PIP and Plateau (45 - 35 = 10 cmH2O) is
relatively normal (should be <10). The primary issue is the elevated Plateau
pressure (normal <30). Plateau pressure reflects alveolar pressure and is
elevated when lung compliance is decreased (e.g., ARDS, pneumonia,
pulmonary edema).
5. A 70-year-old male with a history of CHF is admitted with dyspnea. You note
bilateral crackles, jugular venous distension, and pink frothy sputum. Which
of the following is the most appropriate initial assessment?
A. Perform a forced vital capacity maneuver
B. Obtain a sputum culture
C. Auscultate breath sounds and obtain vital signs
D. Schedule a methacholine challenge
Correct Answer: C
Rationale: The patient is showing classic signs of acute pulmonary edema. The
immediate priority is to assess the patient's current status by auscultating
breath sounds, checking vital signs, and potentially obtaining an SpO2.
Invasive or lengthy procedures are not the first step in an acute emergency.
6. Which of the following ABG results indicates metabolic alkalosis?
A. pH 7.28, PaCO2 40, HCO3 18
2
, B. pH 7.50, PaCO2 40, HCO3 30
C. pH 7.30, PaCO2 50, HCO3 24
D. pH 7.48, PaCO2 30, HCO3 24
Correct Answer: B
Rationale: A pH > 7.45 indicates alkalosis. If the PaCO2 is normal (40), the
cause must be metabolic. An HCO3 > 26 confirms a metabolic alkalosis.
7. A patient has a chest X-ray that shows a flattened diaphragm and a
hyperlucent lung field. This is most consistent with:
A. Pneumonia
B. Pulmonary fibrosis
C. Emphysema
D. Atelectasis
Correct Answer: C
Rationale: Emphysema is characterized by air trapping and hyperinflation.
On a chest X-ray, this appears as hyperlucent (darker) lung fields and a
flattened diaphragm due to the increased lung volume.
8. A 55-year-old male presents with a dry, non-productive cough and
dyspnea on exertion. A chest X-ray reveals bilateral hilar adenopathy and
interstitial infiltrates. What is the most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Pneumonia
D. Lung cancer
Correct Answer: B
Rationale: Sarcoidosis is a granulomatous disease that classically presents
with bilateral hilar lymphadenopathy (adenopathy) and interstitial lung
disease. It is more common in African Americans and presents with non-specific
respiratory symptoms.
9. While monitoring a patient on a ventilator, you notice the peak inspiratory
pressure (PIP) has suddenly increased from 25 to 50 cmH2O. The patient is
agitated. What is the most appropriate immediate action?
A. Increase the sedation
B. Suction the patient's airway
C. Manually ventilate with a bag-valve-mask
D. Decrease the tidal volume
3
, Correct Answer: C
Rationale: A sudden, dramatic increase in PIP indicates a life-threatening
problem like a mucus plug, pneumothorax, or ET tube obstruction. The safest
immediate action is to disconnect the patient from the ventilator and
manually ventilate with a BVM while assessing for the cause.
10. Which of the following is a contraindication for performing a
modified Allen's test?
A. The patient has a history of Raynaud's syndrome
B. The patient is on anticoagulant therapy
C. The patient has an AV fistula in the arm
D. The patient has a history of smoking
Correct Answer: C
Rationale: The modified Allen's test assesses collateral circulation to the
hand before radial artery puncture. An AV fistula surgically creates a
shunt, altering blood flow and making the test unreliable and potentially
dangerous for the fistula.
11. A patient with a tracheostomy is being evaluated for decannulation. Which
of the following is the most important criterion to assess?
A. The patient's ability to speak
B. The patient's cough strength and ability to manage secretions
C. The patient's oxygen requirement
D. The size of the tracheostomy tube
Correct Answer: B
Rationale: Before decannulation, the patient must be able to protect their
airway. A strong cough and the ability to clear secretions are essential
to prevent aspiration and respiratory failure after the tube is removed.
12. A 60-year-old patient has a PaO2 of 55 mmHg on room air. Based on this
value, the patient is:
A. Normal
B. Mildly hypoxemic
C. Moderately hypoxemic
D. Severely hypoxemic
Correct Answer: C
Rationale: Normal PaO2 is 80-100 mmHg. Mild hypoxemia is 60-79 mmHg.
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