TMC Practice Exam Questions With
Complete Solutions.
1. 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...B. A pneumothorax on the left side
2. A 39-year-old male patient was admitted to the emergency department with a fever
and an 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?
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...D. Provide oxygen therapy and obtain a sputum sample for
culture and sensitivity
3. 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...C. Lower the cuff
pressure to < 30 cm H2O
,4. 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. The patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high ...ANSWER...A. There is an obstruction in the
delivery tube
5. A pre and post bronchodilator test was ordered on a 48-year-old female patient. The
forced expiratory measurement that was obtained after the bronchodilator was given
shows an increase in the patient's FEV1 from 60% to 80% of the predicted value. This
finding suggests which of the following?
A. A fixed airway obstruction
B. A reversible airway obstruction
C. A normal diffusion capacity
D. A restrictive process ...ANSWER...B. A reversible airway obstruction
6. A 58-year-old female patient is intubated and appears to be breathing
asynchronously with the ventilator. Her breath sounds are absent on the left side and
the trachea appears to be shifted to the left. The patient has a dull percussion note on
the left side as well. Which of the following is the most likely explanation of these
findings?
A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm ...ANSWER...C. The endotracheal
tube is in the right mainstem bronchus
7. A 63-year-old female patient is intubated and receiving mechanical ventilation in the
pressure controlled A/C mode. If the patient's compliance were to decrease, which of
the following would you expect to occur?
A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
D. Her PEEP level will decrease ...ANSWER...A. Her delivered volume will decrease
8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the
volume controlled A/C mode. After performing endotracheal suctioning, which of the
following would indicate the effective clearance of retained secretions?
A. An increased tidal volume
,B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure ...ANSWER...D. A decreased peak pressure
9. An adult patient who is receiving mechanical ventilation suddenly started showing
signs of tachypnea. Upon assessment, you note tracheal deviation to the right and
decreased breath sounds and hyperresonance on the left. Which of the following would
you recommend?
A. The patient needs suctioning
B. The patient needs a bronchoscopy
C. The insertion of a chest tube
D. The patient needs a thoracentesis ...ANSWER...C. The insertion of a chest tube
10. A 57-year-old female patient with acute pulmonary edema is dyspneic and appears
to be wheezing. The resident physician has ordered an albuterol breathing treatment via
SVN. Which of the following would you recommend?
A. Recommend acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Recommend a diuretic and oxygen therapy ...ANSWER...D. Recommend a diuretic
and oxygen therapy
11. A 39-year-old female patient who is intubated was admitted to the emergency
department and the nurse was unable to start an intravenous line during CPR. It is
believed that the patient is suffering from a narcotic overdose and the physician wants
to administer Naloxone. Which of the following is an alternative route that can be used
to deliver this medication?
A. Through the feeding tube
B. Aerosolized via SVN
C. Through the nasogastric tube
D. Through the endotracheal tube ...ANSWER...D. Through the endotracheal tube
12. A 176 lb male patient is intubated and receiving volume control A/C ventilation with
the following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An
ABG was analyzed and the following results were obtained:
pH 7.39
PaCO2 37
HCO3 23
PaO2 107
Which of the following would you recommend?
A. Place the patient on a 40% T-piece and monitor closely
, B. Switch the patient to SIMV at a rate of 5/minute
C. Place the patient on CPAP and monitor closely
D. Maintain the current ventilator settings and re-evaluate later ...ANSWER...D.
Maintain the current ventilator settings and re-evaluate later
13. An adult patient was admitted to the emergency department after involvement in a
motor vehicle accident. The patient is hyperventilating and appears to have a flail chest.
Which of the following ABG results would you expect for this patient?
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2
C. Decreased pH and decreased SaO2
D. Decreased pH and increased SaO2 ...ANSWER...A. Increased pH and decreased
SaO2
14. A 51-year-old female patient with a history of asthma is receiving mechanical
ventilation in the assist-control mode. Upon assessment, you note that she is struggling
to initiate inspiration. Which of the following settings would you check first in order to
resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP ...ANSWER...C. Sensitivity
15. The physician has requested the insertion of a nasopharyngeal airway on an adult
patient. This type of airway is useful in supporting which of the following?
A. Mechanical ventilation
B. Frequent suctioning
C. Incentive spirometry
D. Aerosol drug therapy ...ANSWER...B. Frequent suctioning
16. You would expect there to be difficultly establishing a patent airway for a patient with
which of the following conditions?
A. A patient with ARDS
B. A patient that is morbidly obese
C. A patient with a pleural effusion
D. A patient with ventilator-associated pneumonia ...ANSWER...B. A patient that is
morbidly obese
17. A premature infant who is receiving positive pressure ventilation appears to be in
acute respiratory distress with signs of hypotension and asymmetrical chest movement.
Which of the following would you recommend first?
Complete Solutions.
1. 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...B. A pneumothorax on the left side
2. A 39-year-old male patient was admitted to the emergency department with a fever
and an 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?
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...D. Provide oxygen therapy and obtain a sputum sample for
culture and sensitivity
3. 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...C. Lower the cuff
pressure to < 30 cm H2O
,4. 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. The patient's ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high ...ANSWER...A. There is an obstruction in the
delivery tube
5. A pre and post bronchodilator test was ordered on a 48-year-old female patient. The
forced expiratory measurement that was obtained after the bronchodilator was given
shows an increase in the patient's FEV1 from 60% to 80% of the predicted value. This
finding suggests which of the following?
A. A fixed airway obstruction
B. A reversible airway obstruction
C. A normal diffusion capacity
D. A restrictive process ...ANSWER...B. A reversible airway obstruction
6. A 58-year-old female patient is intubated and appears to be breathing
asynchronously with the ventilator. Her breath sounds are absent on the left side and
the trachea appears to be shifted to the left. The patient has a dull percussion note on
the left side as well. Which of the following is the most likely explanation of these
findings?
A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm ...ANSWER...C. The endotracheal
tube is in the right mainstem bronchus
7. A 63-year-old female patient is intubated and receiving mechanical ventilation in the
pressure controlled A/C mode. If the patient's compliance were to decrease, which of
the following would you expect to occur?
A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
D. Her PEEP level will decrease ...ANSWER...A. Her delivered volume will decrease
8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the
volume controlled A/C mode. After performing endotracheal suctioning, which of the
following would indicate the effective clearance of retained secretions?
A. An increased tidal volume
,B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure ...ANSWER...D. A decreased peak pressure
9. An adult patient who is receiving mechanical ventilation suddenly started showing
signs of tachypnea. Upon assessment, you note tracheal deviation to the right and
decreased breath sounds and hyperresonance on the left. Which of the following would
you recommend?
A. The patient needs suctioning
B. The patient needs a bronchoscopy
C. The insertion of a chest tube
D. The patient needs a thoracentesis ...ANSWER...C. The insertion of a chest tube
10. A 57-year-old female patient with acute pulmonary edema is dyspneic and appears
to be wheezing. The resident physician has ordered an albuterol breathing treatment via
SVN. Which of the following would you recommend?
A. Recommend acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Recommend a diuretic and oxygen therapy ...ANSWER...D. Recommend a diuretic
and oxygen therapy
11. A 39-year-old female patient who is intubated was admitted to the emergency
department and the nurse was unable to start an intravenous line during CPR. It is
believed that the patient is suffering from a narcotic overdose and the physician wants
to administer Naloxone. Which of the following is an alternative route that can be used
to deliver this medication?
A. Through the feeding tube
B. Aerosolized via SVN
C. Through the nasogastric tube
D. Through the endotracheal tube ...ANSWER...D. Through the endotracheal tube
12. A 176 lb male patient is intubated and receiving volume control A/C ventilation with
the following settings: FiO2 of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An
ABG was analyzed and the following results were obtained:
pH 7.39
PaCO2 37
HCO3 23
PaO2 107
Which of the following would you recommend?
A. Place the patient on a 40% T-piece and monitor closely
, B. Switch the patient to SIMV at a rate of 5/minute
C. Place the patient on CPAP and monitor closely
D. Maintain the current ventilator settings and re-evaluate later ...ANSWER...D.
Maintain the current ventilator settings and re-evaluate later
13. An adult patient was admitted to the emergency department after involvement in a
motor vehicle accident. The patient is hyperventilating and appears to have a flail chest.
Which of the following ABG results would you expect for this patient?
A. Increased pH and decreased SaO2
B. Increased pH and increased SaO2
C. Decreased pH and decreased SaO2
D. Decreased pH and increased SaO2 ...ANSWER...A. Increased pH and decreased
SaO2
14. A 51-year-old female patient with a history of asthma is receiving mechanical
ventilation in the assist-control mode. Upon assessment, you note that she is struggling
to initiate inspiration. Which of the following settings would you check first in order to
resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP ...ANSWER...C. Sensitivity
15. The physician has requested the insertion of a nasopharyngeal airway on an adult
patient. This type of airway is useful in supporting which of the following?
A. Mechanical ventilation
B. Frequent suctioning
C. Incentive spirometry
D. Aerosol drug therapy ...ANSWER...B. Frequent suctioning
16. You would expect there to be difficultly establishing a patent airway for a patient with
which of the following conditions?
A. A patient with ARDS
B. A patient that is morbidly obese
C. A patient with a pleural effusion
D. A patient with ventilator-associated pneumonia ...ANSWER...B. A patient that is
morbidly obese
17. A premature infant who is receiving positive pressure ventilation appears to be in
acute respiratory distress with signs of hypotension and asymmetrical chest movement.
Which of the following would you recommend first?
