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1
RTBoardReview
Standardized TMC-Like Exam
Version 1
1. A prescription for an aerosolized drug for a patient under your care is missing the actual prescribed
drug dosage. Which of the following would be the appropriate action for you to take?
A. use the standard dosage listed in the package insert
B. ask your medical director to rewrite the prescription
*C. contact the ordering physician to seek clarification
D. postpone the therapy until the following day
General Feedback: The minimum requirements for a proper drug prescription include the following: 1)
the patient's name, 2) the drug name, 3) the drug dosage, 4) the frequency of administration, 5) the
duration of administration (for some aerosol treatments), 6) the route of administration, and 7) the
signature of the physician. You should always seek clarification from the physician if the order does not
include all necessary information.
2. In a normal pulmonary angiogram, the arteries should
A. appear radiolucent (dark on X-ray image)
B. stop branching at the segmental level
*C. be clearly opacified with smooth walls
D. diminish in gravity-dependent zones
General Feedback: On a normal pulmonary angiogram, arteries should appear opacified (due to contrast
media), have smooth walls and gradually taper as they continue to branch. There should be no evidence of
vessel wall irregularity, aneurysm, narrowing, occlusion, extravasation, or arteriovenous shunting. When
performed on a patient in the supine position (normal position for CT angiography), the arteries will be
most prominent in the gravity-dependent posterior zones.
3. In assessing a patient in the acute phase of ARDS, you would expect to find:
A. increased lung volumes
*B. refractory hypoxemia
C. increased compliance
D. metabolic alkalosis
General Feedback: In ARDS, pulmonary edema, atelectasis, and surfactant loss combine to reduce lung
volumes and compliance. The decrease in lung volumes and compliance increases the patient's spontaneous work
of breathing, typically resulting in dyspnea and tachypnea, In addition, physiologic shunting causes severe
hypoxemia that does not respond well to increases in FIO2 (refractory hypoxemia). If the hypoxemia is
severe enough to compromise O2 delivery to the tissues, anerobic metabolism and a metabolic acidosis
(lactic acidosis) can develop.
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4. When reviewing the chart of a patient who presents with evidence of acute pulmonary infection, which
of the following laboratory studies would provide the most useful information?
*A. sputum culture and sensitivity
B. blood culture
C. sputum acid fast stain
D. sputum Gram stain
General Feedback: Sputum culture and sensitivity will provide not only what microbe is growing in the
lung, it will provide the drug(s) that are most effective in controlling the microbe.
5. On reviewing the results of the attending physician's physical examination of a patient's chest, you note
'a hyperresonant percussion note on the left.' Which of the following is the most likely problem?
A. infiltrates
*B. pneumothorax
C. atelectasis
D. consolidation
General Feedback: A patient with a hyperresonant percussion note on chest examination most likely has a
pneumothorax. Pulmonary infiltrates, atelectasis and consolidation would be evident by a dull percussion
note and bronchial breath sounds.
6. Which of the following would tend to decrease a patient's energy expenditure?
*A. hypothermia
B. inflammation
C. major trauma
D. agitation/pain
General Feedback: Common factors decreasing metabolic rate and thus energy expenditure include
sedation/analgesics, muscle paralysis, shock/hypovolemia, hypothermia/cooling, hypothyroidism,
antipyretics, starvation, and properly applied ventilatory support. Conversely, fever, Inflammation
(including SIRS), sepsis, major trauma (including burns), shivering, seizures, agitation/anxiety/pain,
hyperthyroidism, adrenergic drugs and ventilator weaning all tend to increase energy expenditure.
7. In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'A' in the
following figure. What type of abnormal respiratory event does this indicate?
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*A. central sleep apnea
B. mixed sleep apnea
C. obstructive sleep apnea
D. respiratory effort-related arousal
General Feedback: The abnormal respiratory event depicted in example 'A' is central sleep apnea. Central
sleep apnea is characterized by a lack of airflow lasting at least 10 seconds, but occurs without respiratory
effort (as indicated by the lack of esophageal pressure changes during the period of no airflow).
8. Which of the following PFT measurements usually increases with pulmonary emphysema?
A. flow rate
B. vital capacity
C. inspiratory capacity
*D. residual volume
General Feedback: In patients with pulmonary emphysema, air trapping due to loss of collagen and
resultant collapse of the small airways typically causes a progressive increased in residual volume.
Expiratory flow rates tend to decrease, as does the inspiratory capacity.
9. While interviewing a 55 year old male patient, you note substantial sternocleidomastoid and scalene
muscles activity during inspiration. This finding is most consistent with which of the following?
*A. COPD
B. pulmonary embolism
C. orthopnea
D. myasthenia gravis
General Feedback: Use of the “accessory muscles” of inspiration (sternocleidomastoids and anterior
scalenes) indicates an increased work of breathing and/or inefficient use of the diaphragm, both of which
are characteristic of patients with COPD.
10. When you make a return visit to a postoperative patient to assess her progress with incentive
spirometry, she indicates that compared to yesterday her pain is preventing her from carry out the
treatment. On a 10-point scale, she rates the effect of her pain on her activities as an '8.' You should
A. coach her to go ahead with the incentive spirometry anyway
B. tell the nurse to up the dosage of the patient's pain medication
C. switch the patient to intermittent positive pressure breathing therapy
*D. report this finding to the patient's attending physician
General Feedback: Good pain assessment includes determining how much it interferes with the patient's
activities. A 10-point scale can be used to make this assessment, with 0 signifying "no interference" and
10 signifies "unable to carry on usual activities." Whenever a patient reports an interference level above 4,
you report this finding to the patient's attending physician
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11. In a semi-comatose patient with pulmonary edema, which of the following would indicate a loss of
cough reflex?
*A. gurgling
B. cyanosis
C. dyspnea
D. diaphoresis
General Feedback: Normally, as secretions pool in the oropharynx, the cough reflex is stimulated to aid
clearance. Gurgling indicates that this reflex is not working correctly.
12. Which of the following of the following inspiratory/expiratory ratios would indicate an abnormally
long expiratory time?
A. 1:2
B. 1:3
*C. 1:4
D. 2:1
General Feedback: On inspection of an adult, inspiration (I) should normally be shorter than expiration
(E), with an I:E ratio of between 1:2 to 1:3. Expiratory time would be considered abnormally long when
this ratio exceeds 1:3.
13. A patient tells you that he has been coughing up thick, white sputum. The patient most likely has:
A. Pneumonia
*B. Asthma
C. Pulmonary edema
D. Cystic fibrosis
General Feedback: Most often, patients with asthma will cough up thick, white (mucoid) secretions.
Secretions from pulmonary edema are often thin and frothy. Patients with cystic fibrosis typically have
thick and yellow or green (mucopurulent) secretions, while those with pneumonia may have
mucopurulent and blood-tinged secretions.
14. When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly
expands during inspiration. Which of the following are potential causes of this problem?
A. flail chest
*B. phrenic nerve paralysis
C. acites
D. kyphoscoliosis
General Feedback: Inward motion of the abdomen as the rib cage expands during inspiration is termed
abdominal paradox. Abdominal paradox is a sign of generalized diaphragmatic dysfunction. The most
common cause of abdominal paradox is weakening of this muscle due to fatigue or atrophy. However,
abdominal paradox also can also occur in neurologic disorders that affect phrenic nerve transmission. In
either case, the accessory muscles of inspiration provide for most of the chest expansion, with the
weakened or flaccid diaphragm being "sucked up” into the thorax, causing inward motion of the
© Strategic Learning Associates – All Rights Reserved
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Downloaded by damaris mutuli ()
1
RTBoardReview
Standardized TMC-Like Exam
Version 1
1. A prescription for an aerosolized drug for a patient under your care is missing the actual prescribed
drug dosage. Which of the following would be the appropriate action for you to take?
A. use the standard dosage listed in the package insert
B. ask your medical director to rewrite the prescription
*C. contact the ordering physician to seek clarification
D. postpone the therapy until the following day
General Feedback: The minimum requirements for a proper drug prescription include the following: 1)
the patient's name, 2) the drug name, 3) the drug dosage, 4) the frequency of administration, 5) the
duration of administration (for some aerosol treatments), 6) the route of administration, and 7) the
signature of the physician. You should always seek clarification from the physician if the order does not
include all necessary information.
2. In a normal pulmonary angiogram, the arteries should
A. appear radiolucent (dark on X-ray image)
B. stop branching at the segmental level
*C. be clearly opacified with smooth walls
D. diminish in gravity-dependent zones
General Feedback: On a normal pulmonary angiogram, arteries should appear opacified (due to contrast
media), have smooth walls and gradually taper as they continue to branch. There should be no evidence of
vessel wall irregularity, aneurysm, narrowing, occlusion, extravasation, or arteriovenous shunting. When
performed on a patient in the supine position (normal position for CT angiography), the arteries will be
most prominent in the gravity-dependent posterior zones.
3. In assessing a patient in the acute phase of ARDS, you would expect to find:
A. increased lung volumes
*B. refractory hypoxemia
C. increased compliance
D. metabolic alkalosis
General Feedback: In ARDS, pulmonary edema, atelectasis, and surfactant loss combine to reduce lung
volumes and compliance. The decrease in lung volumes and compliance increases the patient's spontaneous work
of breathing, typically resulting in dyspnea and tachypnea, In addition, physiologic shunting causes severe
hypoxemia that does not respond well to increases in FIO2 (refractory hypoxemia). If the hypoxemia is
severe enough to compromise O2 delivery to the tissues, anerobic metabolism and a metabolic acidosis
(lactic acidosis) can develop.
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Not for Duplication or Distribution
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2
4. When reviewing the chart of a patient who presents with evidence of acute pulmonary infection, which
of the following laboratory studies would provide the most useful information?
*A. sputum culture and sensitivity
B. blood culture
C. sputum acid fast stain
D. sputum Gram stain
General Feedback: Sputum culture and sensitivity will provide not only what microbe is growing in the
lung, it will provide the drug(s) that are most effective in controlling the microbe.
5. On reviewing the results of the attending physician's physical examination of a patient's chest, you note
'a hyperresonant percussion note on the left.' Which of the following is the most likely problem?
A. infiltrates
*B. pneumothorax
C. atelectasis
D. consolidation
General Feedback: A patient with a hyperresonant percussion note on chest examination most likely has a
pneumothorax. Pulmonary infiltrates, atelectasis and consolidation would be evident by a dull percussion
note and bronchial breath sounds.
6. Which of the following would tend to decrease a patient's energy expenditure?
*A. hypothermia
B. inflammation
C. major trauma
D. agitation/pain
General Feedback: Common factors decreasing metabolic rate and thus energy expenditure include
sedation/analgesics, muscle paralysis, shock/hypovolemia, hypothermia/cooling, hypothyroidism,
antipyretics, starvation, and properly applied ventilatory support. Conversely, fever, Inflammation
(including SIRS), sepsis, major trauma (including burns), shivering, seizures, agitation/anxiety/pain,
hyperthyroidism, adrenergic drugs and ventilator weaning all tend to increase energy expenditure.
7. In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'A' in the
following figure. What type of abnormal respiratory event does this indicate?
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3
*A. central sleep apnea
B. mixed sleep apnea
C. obstructive sleep apnea
D. respiratory effort-related arousal
General Feedback: The abnormal respiratory event depicted in example 'A' is central sleep apnea. Central
sleep apnea is characterized by a lack of airflow lasting at least 10 seconds, but occurs without respiratory
effort (as indicated by the lack of esophageal pressure changes during the period of no airflow).
8. Which of the following PFT measurements usually increases with pulmonary emphysema?
A. flow rate
B. vital capacity
C. inspiratory capacity
*D. residual volume
General Feedback: In patients with pulmonary emphysema, air trapping due to loss of collagen and
resultant collapse of the small airways typically causes a progressive increased in residual volume.
Expiratory flow rates tend to decrease, as does the inspiratory capacity.
9. While interviewing a 55 year old male patient, you note substantial sternocleidomastoid and scalene
muscles activity during inspiration. This finding is most consistent with which of the following?
*A. COPD
B. pulmonary embolism
C. orthopnea
D. myasthenia gravis
General Feedback: Use of the “accessory muscles” of inspiration (sternocleidomastoids and anterior
scalenes) indicates an increased work of breathing and/or inefficient use of the diaphragm, both of which
are characteristic of patients with COPD.
10. When you make a return visit to a postoperative patient to assess her progress with incentive
spirometry, she indicates that compared to yesterday her pain is preventing her from carry out the
treatment. On a 10-point scale, she rates the effect of her pain on her activities as an '8.' You should
A. coach her to go ahead with the incentive spirometry anyway
B. tell the nurse to up the dosage of the patient's pain medication
C. switch the patient to intermittent positive pressure breathing therapy
*D. report this finding to the patient's attending physician
General Feedback: Good pain assessment includes determining how much it interferes with the patient's
activities. A 10-point scale can be used to make this assessment, with 0 signifying "no interference" and
10 signifies "unable to carry on usual activities." Whenever a patient reports an interference level above 4,
you report this finding to the patient's attending physician
© Strategic Learning Associates – All Rights Reserved
Not for Duplication or Distribution
Downloaded by damaris mutuli ()
, lOMoARcPSD|46240884
4
11. In a semi-comatose patient with pulmonary edema, which of the following would indicate a loss of
cough reflex?
*A. gurgling
B. cyanosis
C. dyspnea
D. diaphoresis
General Feedback: Normally, as secretions pool in the oropharynx, the cough reflex is stimulated to aid
clearance. Gurgling indicates that this reflex is not working correctly.
12. Which of the following of the following inspiratory/expiratory ratios would indicate an abnormally
long expiratory time?
A. 1:2
B. 1:3
*C. 1:4
D. 2:1
General Feedback: On inspection of an adult, inspiration (I) should normally be shorter than expiration
(E), with an I:E ratio of between 1:2 to 1:3. Expiratory time would be considered abnormally long when
this ratio exceeds 1:3.
13. A patient tells you that he has been coughing up thick, white sputum. The patient most likely has:
A. Pneumonia
*B. Asthma
C. Pulmonary edema
D. Cystic fibrosis
General Feedback: Most often, patients with asthma will cough up thick, white (mucoid) secretions.
Secretions from pulmonary edema are often thin and frothy. Patients with cystic fibrosis typically have
thick and yellow or green (mucopurulent) secretions, while those with pneumonia may have
mucopurulent and blood-tinged secretions.
14. When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly
expands during inspiration. Which of the following are potential causes of this problem?
A. flail chest
*B. phrenic nerve paralysis
C. acites
D. kyphoscoliosis
General Feedback: Inward motion of the abdomen as the rib cage expands during inspiration is termed
abdominal paradox. Abdominal paradox is a sign of generalized diaphragmatic dysfunction. The most
common cause of abdominal paradox is weakening of this muscle due to fatigue or atrophy. However,
abdominal paradox also can also occur in neurologic disorders that affect phrenic nerve transmission. In
either case, the accessory muscles of inspiration provide for most of the chest expansion, with the
weakened or flaccid diaphragm being "sucked up” into the thorax, causing inward motion of the
© Strategic Learning Associates – All Rights Reserved
Not for Duplication or Distribution
Downloaded by damaris mutuli ()
