Page 1 of 154
TMC EXAM – SECURE COMPREHENSIVE THERAPIST SAE
EXAM WITH COMPLETE QUESTIONS AND CORRECT
DETAILED SOLUTIONS ALL WITH RATIONALES LATEST
THIS YEAR
1. A patient with a history of COPD is receiving 2 L/min via nasal cannula. You note his breathing
pattern has become slower and his SpO2 has dropped to 88%. What is the most likely cause?
A) Excessive oxygen administration
B) Pneumothorax
C) Mucus plugging
D) Patient anxiety
Answer: A
The hypoxic drive theory suggests that some COPD patients rely on hypoxemia to stimulate
breathing. High FiO2 can depress this drive, leading to hypoventilation.
2. What is the most appropriate initial therapy for a patient with status asthmaticus who is not
responding to bronchodilators?
A) Heliox administration
B) IV corticosteroids
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C) Continuous bronchodilator therapy
D) Non-invasive positive pressure ventilation
Answer: C
Continuous nebulization of bronchodilators (e.g., albuterol) provides a more consistent and
effective delivery of medication to severely bronchoconstricted airways.
3. A patient is on a volume-controlled ventilator with a set tidal volume of 500 mL. The peak
inspiratory pressure (PIP) has increased from 25 to 40 cmH2O, but the plateau pressure (Pplat)
remains at 20 cmH2O. What is the most likely cause?
A) Decreased lung compliance
B) Bronchospasm
C) Pneumothorax
D) Pulmonary edema
Answer: B
An increase in PIP without an increase in Pplat indicates increased airway resistance, as the
resistance is overcome during the inspiratory flow phase. Bronchospasm is a classic cause of
elevated resistance.
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4. Which of the following patient parameters is the most sensitive indicator of a developing
pneumothorax in a mechanically ventilated patient?
A) Decreased blood pressure
B) Increased PIP and decreased Pplat
C) Sudden deterioration in SpO2
D) Decreased breath sounds on one side
Answer: C
While all are signs, a sudden drop in SpO2 is often the earliest and most sensitive indicator of a
life-threatening tension pneumothorax, prompting immediate action.
5. For a patient with a spinal cord injury at the C3 level, what is the primary goal of respiratory
care?
A) Promote airway clearance through cough assist devices
B) Provide long-term mechanical ventilation
C) Administer mucolytic therapy to thin secretions
D) Implement a weaning protocol
Answer: B
Injuries at C3 or above result in complete loss of phrenic nerve function and diaphragmatic
paralysis, rendering the patient ventilator-dependent.
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6. An adult patient has an endotracheal tube in place. You note that the cuff pressure is 35
cmH2O. What is the most appropriate action?
A) Document the finding as within normal limits
B) Deflate the cuff to 15 cmH2O
C) Deflate the cuff to 25 cmH2O
D) Increase the cuff pressure to prevent micro-aspiration
Answer: C
High cuff pressures (>30 cmH2O) can cause tracheal mucosal ischemia and injury. The
recommended cuff pressure is 20-30 cmH2O.
7. A patient’s arterial blood gas shows: pH 7.30, PaCO2 50 mmHg, HCO3- 24 mEq/L. What is the
primary acid-base disorder?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C
The low pH (acidemia) and elevated PaCO2 indicate a respiratory acidosis. The HCO3- is normal,
suggesting an acute process.
TMC EXAM – SECURE COMPREHENSIVE THERAPIST SAE
EXAM WITH COMPLETE QUESTIONS AND CORRECT
DETAILED SOLUTIONS ALL WITH RATIONALES LATEST
THIS YEAR
1. A patient with a history of COPD is receiving 2 L/min via nasal cannula. You note his breathing
pattern has become slower and his SpO2 has dropped to 88%. What is the most likely cause?
A) Excessive oxygen administration
B) Pneumothorax
C) Mucus plugging
D) Patient anxiety
Answer: A
The hypoxic drive theory suggests that some COPD patients rely on hypoxemia to stimulate
breathing. High FiO2 can depress this drive, leading to hypoventilation.
2. What is the most appropriate initial therapy for a patient with status asthmaticus who is not
responding to bronchodilators?
A) Heliox administration
B) IV corticosteroids
, Page 2 of 154
C) Continuous bronchodilator therapy
D) Non-invasive positive pressure ventilation
Answer: C
Continuous nebulization of bronchodilators (e.g., albuterol) provides a more consistent and
effective delivery of medication to severely bronchoconstricted airways.
3. A patient is on a volume-controlled ventilator with a set tidal volume of 500 mL. The peak
inspiratory pressure (PIP) has increased from 25 to 40 cmH2O, but the plateau pressure (Pplat)
remains at 20 cmH2O. What is the most likely cause?
A) Decreased lung compliance
B) Bronchospasm
C) Pneumothorax
D) Pulmonary edema
Answer: B
An increase in PIP without an increase in Pplat indicates increased airway resistance, as the
resistance is overcome during the inspiratory flow phase. Bronchospasm is a classic cause of
elevated resistance.
, Page 3 of 154
4. Which of the following patient parameters is the most sensitive indicator of a developing
pneumothorax in a mechanically ventilated patient?
A) Decreased blood pressure
B) Increased PIP and decreased Pplat
C) Sudden deterioration in SpO2
D) Decreased breath sounds on one side
Answer: C
While all are signs, a sudden drop in SpO2 is often the earliest and most sensitive indicator of a
life-threatening tension pneumothorax, prompting immediate action.
5. For a patient with a spinal cord injury at the C3 level, what is the primary goal of respiratory
care?
A) Promote airway clearance through cough assist devices
B) Provide long-term mechanical ventilation
C) Administer mucolytic therapy to thin secretions
D) Implement a weaning protocol
Answer: B
Injuries at C3 or above result in complete loss of phrenic nerve function and diaphragmatic
paralysis, rendering the patient ventilator-dependent.
, Page 4 of 154
6. An adult patient has an endotracheal tube in place. You note that the cuff pressure is 35
cmH2O. What is the most appropriate action?
A) Document the finding as within normal limits
B) Deflate the cuff to 15 cmH2O
C) Deflate the cuff to 25 cmH2O
D) Increase the cuff pressure to prevent micro-aspiration
Answer: C
High cuff pressures (>30 cmH2O) can cause tracheal mucosal ischemia and injury. The
recommended cuff pressure is 20-30 cmH2O.
7. A patient’s arterial blood gas shows: pH 7.30, PaCO2 50 mmHg, HCO3- 24 mEq/L. What is the
primary acid-base disorder?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C
The low pH (acidemia) and elevated PaCO2 indicate a respiratory acidosis. The HCO3- is normal,
suggesting an acute process.
