TMC EXAM 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 ANS: 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? ANS: 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 ANS: using a low residual volume, low compliance cuff
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 ANS:
deep breathing & coughing to clear secretions
A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted
value. What bronchial hygiene therapy would be most appropriate initially? ANS: IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first second? ANS:
70%
A patient on VC ventilation demonstrates 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 ANS: 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? ANS: insert a chest tube
Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr,
PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39,
PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. ANS: 5.0 vol %
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm
H2O. What is the patient's static lung compliance? ANS: 50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing
respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to
be 76%. Which of the following would be most appropriate at this time? ANS: Reintubation
Which of the following patients would most likely benefit from pressure support ventilation? ANS: A
patient on SIMV with a mandatory rate of 12/min and total rate of 24/min.
A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent
secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak
inspiratory pressure. What initial recommendation should be made to address these changes? ANS:
obtain a sputum gram stain
Which of the following information may be obtained from a FVC maneuver during bedside pulmonary
function testing?
1. FEV1
2. PEFR
3. FRC
4. RV ANS: 1 & 2 only
, The respiratory therapist provides education for a patient who is being discharged home on aerosol
therapy. The most important reason for the patient to follow the recommended cleaning procedures
using a vinegar/water solution is that this solution will ANS: retard bacterial growth
A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical
examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is
dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the
patient is suffering from ANS: pleural effusion
Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID
endotracheal tube? ANS: 12 Fr
A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds
are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted
to the left. The most likely explanation for the problem is that ANS: the endotracheal tube has slipped
into the right main stem bronchus.
The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the
right radial artery. The immediate response is to ANS: apply pressure to the site
A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of
apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? ANS:
elevated intracranial pressure
What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? ANS: 5
to 15
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a
change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is
the most likely explanation for these changes? ANS: air leak around the sensor
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 ANS: 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? ANS: 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 ANS: using a low residual volume, low compliance cuff
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 ANS:
deep breathing & coughing to clear secretions
A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted
value. What bronchial hygiene therapy would be most appropriate initially? ANS: IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first second? ANS:
70%
A patient on VC ventilation demonstrates 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 ANS: 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? ANS: insert a chest tube
Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr,
PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39,
PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. ANS: 5.0 vol %
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm
H2O. What is the patient's static lung compliance? ANS: 50 mL/cm H2O
Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing
respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to
be 76%. Which of the following would be most appropriate at this time? ANS: Reintubation
Which of the following patients would most likely benefit from pressure support ventilation? ANS: A
patient on SIMV with a mandatory rate of 12/min and total rate of 24/min.
A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent
secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak
inspiratory pressure. What initial recommendation should be made to address these changes? ANS:
obtain a sputum gram stain
Which of the following information may be obtained from a FVC maneuver during bedside pulmonary
function testing?
1. FEV1
2. PEFR
3. FRC
4. RV ANS: 1 & 2 only
, The respiratory therapist provides education for a patient who is being discharged home on aerosol
therapy. The most important reason for the patient to follow the recommended cleaning procedures
using a vinegar/water solution is that this solution will ANS: retard bacterial growth
A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical
examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is
dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the
patient is suffering from ANS: pleural effusion
Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID
endotracheal tube? ANS: 12 Fr
A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds
are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted
to the left. The most likely explanation for the problem is that ANS: the endotracheal tube has slipped
into the right main stem bronchus.
The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the
right radial artery. The immediate response is to ANS: apply pressure to the site
A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of
apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? ANS:
elevated intracranial pressure
What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? ANS: 5
to 15
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a
change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is
the most likely explanation for these changes? ANS: air leak around the sensor
