TMC Test Bank (Module 4) Questions and
Correct Answers
Before intubation in an emergency situation, injection of air into the pilot line fails to
inflate the cuff. Which of the following should you do?
A. check the cuff for leaks
B. check the valve on the pilot line
C. replace the endotracheal tube
D. inspect the pilot line for patency
✓ ~~~ C. replace the endotracheal tube
A cuff that fails to inflate when injected with air has a large leak. The faulty ET tube
should be replaced and the new tube tested in the same manner.
A 16-year-old patient with cystic fibrosis is receiving pressure control SIMV with
pressure support due to a severe bilateral pneumonia. The pulmonologist asks you
to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which
of these devices would you select to administer this therapy?
A. dry powder inhaler (DPI)
B. vibrating mesh nebulizer
C. metered dose inhaler (MPI)
D. small volume nebulizer
✓ ~~~ B. vibrating mesh nebulizer
Pulmozyme normally is administered by FDA-approved jet nebulizers. However, in-
line jet nebulization during mechanical ventilation can alter ventilator response
(especially with spontaneous breathing) and cause inaccurate flow/volume
measurement. For this reason many clinicians are using vibrating mesh nebulizers
for in-line ventilator drug aerosol therapy. These devices do not add any flow to the
circuit and thus do not affect ventilator function.
You note that a nebulizer is delivering large water droplets down the large bore
tubing. Which action should you take in order to correct this problem?
A. add a heating collar to the nebulizer
B. replace the nebulizer
C. add water to the nebulizer
D. dismantle and clean the nebulizer
✓ ~~~ B. replace the nebulizer
Nebulizers should deliver fine aerosol mists, not large water droplets. This situation
indicates malfunction of the device. Since disposable devices cannot be
disassembled and repaired, the unit should be replaced.
Shortly after replacing a jet nebulizer and tubing on a patient who has a
tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout
inspiration and expiration from the tracheostomy collar. Which of the following should
you do first to solve this problem?
A. decrease the input flow to the nebulizer
, B. ask the patient to breath slower and deeper
C. check the entrainment setting on the nebulizer
D. obtain an arterial blood gas sample for analysis
✓ ~~~ C. check the entrainment setting on the nebulizer
In general, when troubleshooting oxygenation issues the first step always should be
to check the O2 source and confirm that the proper FIO2 is being delivered. Because
aerosol is visible throughout inspiration and expiration, the flow is adequate to meet
patient needs and thus assure a stable FiO2. Given adequate flow, the only good
explanation is that the FIO2 setting on the new nebulizer was not checked and is
providing a lower O2 concentration than the prior setup. To correct the problem,
readjust the entrainment setting to match the prescribed value.
Which of the following choices would you expect to occur AFTER an unheated
bubble humidifier is set-up and operating properly?
A. the reservoir will be warmer than room temperature
B. the reservoir will be cooler than room temperature
C. the reservoir temperature will equal room temperature
D. water will condense on the inside of the delivery tubing
✓ ~~~ B. the reservoir will be cooler than room temperature
In all humidifiers, heat is lost due to evaporative cooling. This cooling lowers the
temperature of the gas and its ability to carry water vapor. In unheated humidifiers,
as water vaporizes into the gas, heat is lost and both the gas and the water are
cooled. Thus, gas leaving the device is warmed by room conditions, the relative
humidity drops, and no condensation occurs.
During computerized setup of a ventilator, you are prompted to enter a circuit
compliance factor. What is the purpose of this information?
A. To calibrate the flow sensors
B. To complete the automated leak test
C. To calibrate the pressure transducer
D. To compensate for compressed volume loss
✓ ~~~ D. To compensate for compressed volume loss
All disposable breathing circuits should come labeled with a compliance factor. This
factor is required during computerized ventilator setup to program the device to
compensate for compressed volume loss.
A bubble humidifier is connected to a flowmeter and is running at 4 L/min. When you
obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT
sound. Which of the following is the most likely cause of this observation?
A. excessive flow through the humidifier
B. a leak in the humidifier/delivery system
C. diameter of delivery tubing is too small
D. the flowmeter is not pressure compensated
✓ ~~~ B. a leak in the humidifier/delivery system
Correct Answers
Before intubation in an emergency situation, injection of air into the pilot line fails to
inflate the cuff. Which of the following should you do?
A. check the cuff for leaks
B. check the valve on the pilot line
C. replace the endotracheal tube
D. inspect the pilot line for patency
✓ ~~~ C. replace the endotracheal tube
A cuff that fails to inflate when injected with air has a large leak. The faulty ET tube
should be replaced and the new tube tested in the same manner.
A 16-year-old patient with cystic fibrosis is receiving pressure control SIMV with
pressure support due to a severe bilateral pneumonia. The pulmonologist asks you
to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which
of these devices would you select to administer this therapy?
A. dry powder inhaler (DPI)
B. vibrating mesh nebulizer
C. metered dose inhaler (MPI)
D. small volume nebulizer
✓ ~~~ B. vibrating mesh nebulizer
Pulmozyme normally is administered by FDA-approved jet nebulizers. However, in-
line jet nebulization during mechanical ventilation can alter ventilator response
(especially with spontaneous breathing) and cause inaccurate flow/volume
measurement. For this reason many clinicians are using vibrating mesh nebulizers
for in-line ventilator drug aerosol therapy. These devices do not add any flow to the
circuit and thus do not affect ventilator function.
You note that a nebulizer is delivering large water droplets down the large bore
tubing. Which action should you take in order to correct this problem?
A. add a heating collar to the nebulizer
B. replace the nebulizer
C. add water to the nebulizer
D. dismantle and clean the nebulizer
✓ ~~~ B. replace the nebulizer
Nebulizers should deliver fine aerosol mists, not large water droplets. This situation
indicates malfunction of the device. Since disposable devices cannot be
disassembled and repaired, the unit should be replaced.
Shortly after replacing a jet nebulizer and tubing on a patient who has a
tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout
inspiration and expiration from the tracheostomy collar. Which of the following should
you do first to solve this problem?
A. decrease the input flow to the nebulizer
, B. ask the patient to breath slower and deeper
C. check the entrainment setting on the nebulizer
D. obtain an arterial blood gas sample for analysis
✓ ~~~ C. check the entrainment setting on the nebulizer
In general, when troubleshooting oxygenation issues the first step always should be
to check the O2 source and confirm that the proper FIO2 is being delivered. Because
aerosol is visible throughout inspiration and expiration, the flow is adequate to meet
patient needs and thus assure a stable FiO2. Given adequate flow, the only good
explanation is that the FIO2 setting on the new nebulizer was not checked and is
providing a lower O2 concentration than the prior setup. To correct the problem,
readjust the entrainment setting to match the prescribed value.
Which of the following choices would you expect to occur AFTER an unheated
bubble humidifier is set-up and operating properly?
A. the reservoir will be warmer than room temperature
B. the reservoir will be cooler than room temperature
C. the reservoir temperature will equal room temperature
D. water will condense on the inside of the delivery tubing
✓ ~~~ B. the reservoir will be cooler than room temperature
In all humidifiers, heat is lost due to evaporative cooling. This cooling lowers the
temperature of the gas and its ability to carry water vapor. In unheated humidifiers,
as water vaporizes into the gas, heat is lost and both the gas and the water are
cooled. Thus, gas leaving the device is warmed by room conditions, the relative
humidity drops, and no condensation occurs.
During computerized setup of a ventilator, you are prompted to enter a circuit
compliance factor. What is the purpose of this information?
A. To calibrate the flow sensors
B. To complete the automated leak test
C. To calibrate the pressure transducer
D. To compensate for compressed volume loss
✓ ~~~ D. To compensate for compressed volume loss
All disposable breathing circuits should come labeled with a compliance factor. This
factor is required during computerized ventilator setup to program the device to
compensate for compressed volume loss.
A bubble humidifier is connected to a flowmeter and is running at 4 L/min. When you
obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT
sound. Which of the following is the most likely cause of this observation?
A. excessive flow through the humidifier
B. a leak in the humidifier/delivery system
C. diameter of delivery tubing is too small
D. the flowmeter is not pressure compensated
✓ ~~~ B. a leak in the humidifier/delivery system
