1|Page
TMC EXAM REVIEW|| LATEST AND COMPLETE
UPDATE WITH QUESTIONS AND 100%
CORRECT ANSWERS ALREADY GRADED A+||
NEWEST VERSION
During the assessment of a 64-year-old female patient, you note the following
signs: dyspnea, hypotension, and a tracheal shift to the right. The patient also has
absent breath sounds, reduced chest expansion, and a hyperresonant percussion
note all on the left side. These findings suggest which of the following?
A. A pleural effusion on the left side
B. A pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side - ANSWER: The correct answer is: B. A
pneumothorax on the left side
To get this one correct, you needed to be able to interpret the signs that were given
about the patient in the question. This is a common type of question for the TMC
Exam.
The question tells us that the patient has reduced chest expansion, a hyperresonant
percussion note, and absent breath sounds all on the left side. That to go along with
a tracheal shift to the right. This indicates that the patient has a pneumothorax on
the left side.
Remember that, when a pneumothorax is present, the trachea will shift away from
the affected side. That means you can rule out left-sided atelectasis because the
trachea would shift to that side.
A pleural effusion and consolidation would cause a dull percussion note, not a
hyperresonant note, so we can rule out those two as well.
A 39-year-old male patient was admitted to the emergency department with a fever
and SpO2 of 87% on room air. Upon auscultation, rhonchi is heard and the patient
has a productive cough. Which of the following would you recommend?
,2|Page
A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
- ANSWER: The correct answer is: D. Provide oxygen therapy and obtain a
sputum sample for culture and sensitivity
To get this one correct, you needed to be able to recognize that the patient has
some type of infection, such as pneumonia.
You know this because the question states that the patient is hypoxemic, has a
fever, and rhonchi breath sounds. So in this case, you would want to obtain a
sputum sample for culture and sensitivity in order to identify the type of organism.
Oxygen therapy is indicated for the hypoxemia.
Intubation and NPPV would not be indicated in this case. Postural drainage and
percussion are not recommended either. So by breaking down the question, the
best answer clearly is D.
A 50-year-old male patient is intubated with a size 8 endotracheal tube and is
receiving volume-controlled A/C ventilation. Upon assessment, you note that the
patient's cuff pressure is measured at 38 cm H2O. Which of the following would
you recommend?
A. Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cm H2O
D. Recommend ventilation via a tracheostomy instead - ANSWER: The correct
answer is: C. Lower the cuff pressure to < 30 cm H2O
, 3|Page
In order to get this one right, you needed to know the normal values for cuff
pressure. And in this case, you needed to recognize that 38 cm H2O is way too
high and could potentially be dangerous for the patient's trachea.
So your first action should be to lower the cuff pressure to < 30 cm H2O and then
check to make sure that there are not any leaks. For the TMC Exam, you need to
remember that the cuff pressure normal range is between 20-30 cm H2O.
There is no indication to withdraw the tube and using a smaller tube would only
cause the patient's peak pressure to increase which is something that we do not
want. Also, nothing in the question indicates that a tracheostomy is needed, so we
know that the correct answer has to be C.
During the assessment of a 52-year-old female patient that is receiving oxygen via
nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise.
Which of the following is the most likely cause of this finding?
A. There is an obstruction in the delivery tube
B. There patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high - ANSWER: The correct answer is: A.
There is an obstruction in the delivery tube
If you've ever accidentally stepped on the tubing when a bubble humidifier is being
used, then you will automatically know that the correct answer is A.
The relief valve of a bubble humidifier sounds when the pressure in the reservoir
container exceeds the valve's threshold pressure. And of course, the most common
reason for this to occur is when there is a downstream obstruction to outflow.
None of the other answer choices really make sense in this situation, so you know
that the correct answer has to be A.
TMC EXAM REVIEW|| LATEST AND COMPLETE
UPDATE WITH QUESTIONS AND 100%
CORRECT ANSWERS ALREADY GRADED A+||
NEWEST VERSION
During the assessment of a 64-year-old female patient, you note the following
signs: dyspnea, hypotension, and a tracheal shift to the right. The patient also has
absent breath sounds, reduced chest expansion, and a hyperresonant percussion
note all on the left side. These findings suggest which of the following?
A. A pleural effusion on the left side
B. A pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side - ANSWER: The correct answer is: B. A
pneumothorax on the left side
To get this one correct, you needed to be able to interpret the signs that were given
about the patient in the question. This is a common type of question for the TMC
Exam.
The question tells us that the patient has reduced chest expansion, a hyperresonant
percussion note, and absent breath sounds all on the left side. That to go along with
a tracheal shift to the right. This indicates that the patient has a pneumothorax on
the left side.
Remember that, when a pneumothorax is present, the trachea will shift away from
the affected side. That means you can rule out left-sided atelectasis because the
trachea would shift to that side.
A pleural effusion and consolidation would cause a dull percussion note, not a
hyperresonant note, so we can rule out those two as well.
A 39-year-old male patient was admitted to the emergency department with a fever
and SpO2 of 87% on room air. Upon auscultation, rhonchi is heard and the patient
has a productive cough. Which of the following would you recommend?
,2|Page
A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
- ANSWER: The correct answer is: D. Provide oxygen therapy and obtain a
sputum sample for culture and sensitivity
To get this one correct, you needed to be able to recognize that the patient has
some type of infection, such as pneumonia.
You know this because the question states that the patient is hypoxemic, has a
fever, and rhonchi breath sounds. So in this case, you would want to obtain a
sputum sample for culture and sensitivity in order to identify the type of organism.
Oxygen therapy is indicated for the hypoxemia.
Intubation and NPPV would not be indicated in this case. Postural drainage and
percussion are not recommended either. So by breaking down the question, the
best answer clearly is D.
A 50-year-old male patient is intubated with a size 8 endotracheal tube and is
receiving volume-controlled A/C ventilation. Upon assessment, you note that the
patient's cuff pressure is measured at 38 cm H2O. Which of the following would
you recommend?
A. Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cm H2O
D. Recommend ventilation via a tracheostomy instead - ANSWER: The correct
answer is: C. Lower the cuff pressure to < 30 cm H2O
, 3|Page
In order to get this one right, you needed to know the normal values for cuff
pressure. And in this case, you needed to recognize that 38 cm H2O is way too
high and could potentially be dangerous for the patient's trachea.
So your first action should be to lower the cuff pressure to < 30 cm H2O and then
check to make sure that there are not any leaks. For the TMC Exam, you need to
remember that the cuff pressure normal range is between 20-30 cm H2O.
There is no indication to withdraw the tube and using a smaller tube would only
cause the patient's peak pressure to increase which is something that we do not
want. Also, nothing in the question indicates that a tracheostomy is needed, so we
know that the correct answer has to be C.
During the assessment of a 52-year-old female patient that is receiving oxygen via
nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise.
Which of the following is the most likely cause of this finding?
A. There is an obstruction in the delivery tube
B. There patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high - ANSWER: The correct answer is: A.
There is an obstruction in the delivery tube
If you've ever accidentally stepped on the tubing when a bubble humidifier is being
used, then you will automatically know that the correct answer is A.
The relief valve of a bubble humidifier sounds when the pressure in the reservoir
container exceeds the valve's threshold pressure. And of course, the most common
reason for this to occur is when there is a downstream obstruction to outflow.
None of the other answer choices really make sense in this situation, so you know
that the correct answer has to be A.
