TMC PRACTICE EXAM 300 QUESTIONS AND CORRECT ANSWERS ALREADYGRADED A+

TMC PRACTICE EXAM 300 QUESTIONS AND CORRECT ANSWERS ALREADYGRADED A+ A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with A. liver failure. B. pulmonary embolism. C. heart failure. D. electrolyte imbalances - ANSWER-Heart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? A. Call for a STAT chest x-ray. B. Insert a chest tube into the left chest. C. Needle aspirate the 2nd left intercostal space. D. Activate the medical emergency team to intubate the patient. - ANSWER-Needle aspirate the 2nd left intercostal space. All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT A. maintaining cuff pressures between 20 and 25 mm Hg. B. using the minimal leak technique for inflation. C. using a low-residual-volume, low-compliance cuff. D. monitoring intracuff pressures. - ANSWER-monitoring intracuff pressures. A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend A. continuing the therapy until breath sounds improve. B. administering dornase alpha. C. administering albuterol therapy. D. deep breathing and coughing to clear secretions. - ANSWER-deep breathing and coughing to clear secretions. A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? A. IS / SMI B. IPPB with normal saline C. postural drainage and percussion D. PEP therapy - ANSWER-IPPB with normal saline A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity - ANSWER-1, 2, and 3 only Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? A. Perform chest physiotherapy B. Administer an IPPB treatment C. Insert an endotracheal tube D. Insert a chest tube - ANSWER-Insert a chest tube 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