LINDSEY JONES- TMC EXAM WITH
COMPLETE QUESTIONS AND
ANSWERS
Which is the preferred order to manipulate a mechanical ventilator in order to gradually
increase alveolar minute ventilation while limiting MAP? - ANSWER-Decrease
mechanical deadspace, increase VT, increase RR
An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the
oxygen coming from the end of the tubing and finds it is 60%. Which of the following
most likely explains this finding? - ANSWER-Excess water in the tubing
A respiratory therapist is participating on a Medical Emergency Response Team with a
patient who is exhibiting severe hypoxemia. The patient has a DNI advanced directive.
To maximize arterial oxygenation, the therapist should - ANSWER-Utilize a
nonrebreather mask with the flow on flush
A 75-kg (166-lb), 173-cm (5-ft, 8-in) patient is receiving PC, SIMV ventilation on the
following settings:
FIO2 0.50
Mandatory rate 16/min
Exhaled VT 780 mL
IP 32 cm H2O
PEEP 5 cm H2O
I:E ratio 1:1.9
ABGs are as follows:
pH 7.51
PaCO2 30 torr
PaO2 109 torr
HCO3- 25 mEq/L
BE 5 mEq/L
The respiratory therapist should - ANSWER-Decrease set inspiratory pressure.
,In spite of repeated attempts, the respiratory therapist has been unable to retrieve a
non-contaminated sputum sample through deep suctioning and normal expectoration.
Which of the following could be recommended to obtain a better sputum specimen for
laboratory analysis? - ANSWER-BAL
A morbidly obese female patient with a large neck circumference is trached with a 7.5
mm tracheostomy tube. The tube frequently becomes dislodged with her cough. What
should be done to resolve the problem? - ANSWER-Replace the tube with a longer
tube.
A patient with cystic fibrosis is receiving VC, SIMV ventilation. The respiratory therapist
notices secretions have become thick and tenacious over the last 24 hours. Which of
the following would be most helpful in addressing the thickness of secretions? -
ANSWER-Heated humidity
The respiratory therapist notices short, puffs of aerosol coming from an aerosol mask on
a patient receiving humidity therapy with an ultrasonic nebulizer. The therapist should
correct the problem by - ANSWER-Emptying water from the corrugated aerosol tubing
Which of following calculations will determine FRC? - ANSWER-TLC - VC + ERV
In preparation for pulmonary function testing, the respiratory therapist interviews the
patient to investigate use of tobacco products. The patient reports smoking 5 packs a
day for 10 years and 1.5 packs a day for 20 years. What is the pack-year history of
smoking for this patient? - ANSWER-80
A patient with COPD is receiving mechanical ventilation on the following settings:
Mode Assist/control
Mandatory rate 12
VT 450 mL
FIO2 0.40
PEEP 5 cm H2O
Total rate 14
I:E 1:1.8
The physician is concerned about air trapping and development of auto PEEP. The
therapist should recommend which of the following? - ANSWER-Increase inspiratory
flow
A normally health track runner is hospitalized with right side pneumonia. The patient has
chills and a temperature of 38.9 deg C (102 deg F). Which of the following will mostly
likely provide sufficient aid to the patient? - ANSWER-Coached coughing and deep
breathing exercises
,Which of the following can safely be combined with inhaled albuterol? - ANSWER-
Ipratropium Bromide
After running a blood gas, the respiratory therapist has concerns about the accuracy of
the reportable physiological range of the PO2 electrode in the blood gas machine. The
therapist should - ANSWER-Replace the PO2 electrode
A patient is expectorating pink frothy secretions as a result of exacerbation of
congestive heart failure. An ECG cannot be obtained due to marked diaphoresis. Non-
invasive ventilation is applied by full-face mask. What additional therapy would likely
provide relief from the patient's current condition? - ANSWER-Furosemide (Lasix)
The respiratory therapist measures the functional residual capacity with a body box and
determines the related value is 4.3 L. The FRC value is 3.4 L when determining via
helium dilution method. Which of the following can explain the difference? - ANSWER-
Significant amount of non-ventilated alveoli
A patient is experiencing reduced tidal volumes on a volume-cycled ventilator. There is
a gurgling sound coming from his mouth with each breath and the endotracheal tube
marking is 19 cm at the lips. The respiratory therapist should - ANSWER-Add air to the
pilot balloon while auscultating over the neck.
The addition of a heat moisture exchanger (artificial nose) to a ventilator circuit between
the wye and the patient would result in which of the following? - ANSWER-Increase in
arterial carbon dioxide tension
While transporting at patient from the emergency department (ED) to the intensive care
unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed
position. The quickest way to assess the ET tube position would be to - ANSWER-
Auscultate breath sounds
Which of the following laboratory examinations is most appropriate to further evaluate a
patient with kidney failure and CHF? - ANSWER-Creatinine
A patient in the emergency room has been vomiting profusely for over an hour. Which of
the following is mostly likely to develop? - ANSWER-Hypokalemia
A patient in the emergency room expectorates thick, yellow sputum. A CBC shows the
following:
RBC 6.0 mill/cu mm
Hb 17 g/dL
HCT 64 %
WBC 22,000 cu mm
The patient could benefit most from which of the following? - ANSWER-Sputum culture
and sensitivity
, Which of the following indicates an allergic response to albuterol sulfate by small
volume nebulizer? - ANSWER-Epistaxis
A 16-year-old child is admitted to the emergency room with a medical history of asthma.
The physician has ordered a rescue bronchodilator to address bronchoconstriction.
Which of the following medications should the respiratory therapist recommend to
address issues with airway inflammation? - ANSWER-Prednisone
One indication to change from administering a front door bronchodilator to a back door
bronchodilator is - ANSWER-Nausea and anxiousness induced by the front door
bronchodilator
A V/Q scan would be most helpful in evaluating which of the following? - ANSWER-
Pulmonary embolism
How is exhaled volume determined with IPPB? - ANSWER-Directly measured at the
exhalation valve outlet
How would the respiratory therapist conclude that bedside spirometry results are
reproducible? - ANSWER-Repeated efforts are within 5%
The balloon on a balloon-tipped, flow-directed pulmonary artery catheter may be found -
ANSWER-Proximal to the tip
A 33-year-old female has been rehabilitated from a motor vehicle accident where she
suffered a spinal injury. She has been admitted to the emergency department with flu-
like symptoms, is febrile, and is expectorating yellow sputum. Arterial blood gas results
are:
pH 7.27
PaCO2 52 torr
PaO2 67 torr
HCO3- 25 mEq/L
BE -1 mEq/L
The respiratory therapist should recommend - ANSWER-Non-invasive positive pressure
ventilation (NPPV)
A family is found sleeping in their vehicle on the side of the road during a long trip. The
officer who found them reports the family was difficult to arouse. Which of the following
would be the most appropriate examination? - ANSWER-COHb
A patient on the general floor becomes a primary mouth-breather while asleep, resulting
in a drop in SpO2 from 95% to 87% while on 3 L/min nasal cannula. The best remedy
while asleep is to - ANSWER-Change to a 30% air-entrainment mask.
COMPLETE QUESTIONS AND
ANSWERS
Which is the preferred order to manipulate a mechanical ventilator in order to gradually
increase alveolar minute ventilation while limiting MAP? - ANSWER-Decrease
mechanical deadspace, increase VT, increase RR
An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the
oxygen coming from the end of the tubing and finds it is 60%. Which of the following
most likely explains this finding? - ANSWER-Excess water in the tubing
A respiratory therapist is participating on a Medical Emergency Response Team with a
patient who is exhibiting severe hypoxemia. The patient has a DNI advanced directive.
To maximize arterial oxygenation, the therapist should - ANSWER-Utilize a
nonrebreather mask with the flow on flush
A 75-kg (166-lb), 173-cm (5-ft, 8-in) patient is receiving PC, SIMV ventilation on the
following settings:
FIO2 0.50
Mandatory rate 16/min
Exhaled VT 780 mL
IP 32 cm H2O
PEEP 5 cm H2O
I:E ratio 1:1.9
ABGs are as follows:
pH 7.51
PaCO2 30 torr
PaO2 109 torr
HCO3- 25 mEq/L
BE 5 mEq/L
The respiratory therapist should - ANSWER-Decrease set inspiratory pressure.
,In spite of repeated attempts, the respiratory therapist has been unable to retrieve a
non-contaminated sputum sample through deep suctioning and normal expectoration.
Which of the following could be recommended to obtain a better sputum specimen for
laboratory analysis? - ANSWER-BAL
A morbidly obese female patient with a large neck circumference is trached with a 7.5
mm tracheostomy tube. The tube frequently becomes dislodged with her cough. What
should be done to resolve the problem? - ANSWER-Replace the tube with a longer
tube.
A patient with cystic fibrosis is receiving VC, SIMV ventilation. The respiratory therapist
notices secretions have become thick and tenacious over the last 24 hours. Which of
the following would be most helpful in addressing the thickness of secretions? -
ANSWER-Heated humidity
The respiratory therapist notices short, puffs of aerosol coming from an aerosol mask on
a patient receiving humidity therapy with an ultrasonic nebulizer. The therapist should
correct the problem by - ANSWER-Emptying water from the corrugated aerosol tubing
Which of following calculations will determine FRC? - ANSWER-TLC - VC + ERV
In preparation for pulmonary function testing, the respiratory therapist interviews the
patient to investigate use of tobacco products. The patient reports smoking 5 packs a
day for 10 years and 1.5 packs a day for 20 years. What is the pack-year history of
smoking for this patient? - ANSWER-80
A patient with COPD is receiving mechanical ventilation on the following settings:
Mode Assist/control
Mandatory rate 12
VT 450 mL
FIO2 0.40
PEEP 5 cm H2O
Total rate 14
I:E 1:1.8
The physician is concerned about air trapping and development of auto PEEP. The
therapist should recommend which of the following? - ANSWER-Increase inspiratory
flow
A normally health track runner is hospitalized with right side pneumonia. The patient has
chills and a temperature of 38.9 deg C (102 deg F). Which of the following will mostly
likely provide sufficient aid to the patient? - ANSWER-Coached coughing and deep
breathing exercises
,Which of the following can safely be combined with inhaled albuterol? - ANSWER-
Ipratropium Bromide
After running a blood gas, the respiratory therapist has concerns about the accuracy of
the reportable physiological range of the PO2 electrode in the blood gas machine. The
therapist should - ANSWER-Replace the PO2 electrode
A patient is expectorating pink frothy secretions as a result of exacerbation of
congestive heart failure. An ECG cannot be obtained due to marked diaphoresis. Non-
invasive ventilation is applied by full-face mask. What additional therapy would likely
provide relief from the patient's current condition? - ANSWER-Furosemide (Lasix)
The respiratory therapist measures the functional residual capacity with a body box and
determines the related value is 4.3 L. The FRC value is 3.4 L when determining via
helium dilution method. Which of the following can explain the difference? - ANSWER-
Significant amount of non-ventilated alveoli
A patient is experiencing reduced tidal volumes on a volume-cycled ventilator. There is
a gurgling sound coming from his mouth with each breath and the endotracheal tube
marking is 19 cm at the lips. The respiratory therapist should - ANSWER-Add air to the
pilot balloon while auscultating over the neck.
The addition of a heat moisture exchanger (artificial nose) to a ventilator circuit between
the wye and the patient would result in which of the following? - ANSWER-Increase in
arterial carbon dioxide tension
While transporting at patient from the emergency department (ED) to the intensive care
unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed
position. The quickest way to assess the ET tube position would be to - ANSWER-
Auscultate breath sounds
Which of the following laboratory examinations is most appropriate to further evaluate a
patient with kidney failure and CHF? - ANSWER-Creatinine
A patient in the emergency room has been vomiting profusely for over an hour. Which of
the following is mostly likely to develop? - ANSWER-Hypokalemia
A patient in the emergency room expectorates thick, yellow sputum. A CBC shows the
following:
RBC 6.0 mill/cu mm
Hb 17 g/dL
HCT 64 %
WBC 22,000 cu mm
The patient could benefit most from which of the following? - ANSWER-Sputum culture
and sensitivity
, Which of the following indicates an allergic response to albuterol sulfate by small
volume nebulizer? - ANSWER-Epistaxis
A 16-year-old child is admitted to the emergency room with a medical history of asthma.
The physician has ordered a rescue bronchodilator to address bronchoconstriction.
Which of the following medications should the respiratory therapist recommend to
address issues with airway inflammation? - ANSWER-Prednisone
One indication to change from administering a front door bronchodilator to a back door
bronchodilator is - ANSWER-Nausea and anxiousness induced by the front door
bronchodilator
A V/Q scan would be most helpful in evaluating which of the following? - ANSWER-
Pulmonary embolism
How is exhaled volume determined with IPPB? - ANSWER-Directly measured at the
exhalation valve outlet
How would the respiratory therapist conclude that bedside spirometry results are
reproducible? - ANSWER-Repeated efforts are within 5%
The balloon on a balloon-tipped, flow-directed pulmonary artery catheter may be found -
ANSWER-Proximal to the tip
A 33-year-old female has been rehabilitated from a motor vehicle accident where she
suffered a spinal injury. She has been admitted to the emergency department with flu-
like symptoms, is febrile, and is expectorating yellow sputum. Arterial blood gas results
are:
pH 7.27
PaCO2 52 torr
PaO2 67 torr
HCO3- 25 mEq/L
BE -1 mEq/L
The respiratory therapist should recommend - ANSWER-Non-invasive positive pressure
ventilation (NPPV)
A family is found sleeping in their vehicle on the side of the road during a long trip. The
officer who found them reports the family was difficult to arouse. Which of the following
would be the most appropriate examination? - ANSWER-COHb
A patient on the general floor becomes a primary mouth-breather while asleep, resulting
in a drop in SpO2 from 95% to 87% while on 3 L/min nasal cannula. The best remedy
while asleep is to - ANSWER-Change to a 30% air-entrainment mask.
