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TMC EXAM 2 QUESTIONS WITH CORRECT
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PASS (2025/2026)
While performing routine oxygen rounds, the respiratory therapist notes a COPD patient who is receiving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min. The therapist should FIRST A. switch to FIO2 1. B. increase flow to 4 L/min by nasal cannula C. obtain an arterial blood gas D. go get help - ANS ✓The correct answer is : A Explanation : Even though a COPD patient should rarely receive more than 2 L/min oxygen, there are emergency circumstances that would dictate more supplemental oxygen. The use of the word "markedly" is an indication of an emergency. In this case the patient is markedly cyanotic and therefore has an oxygenation emergency. Switching to 100% oxygen is appropriate. A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive pressure ventilation. The therapist should recommend A. replacing the ET tube B. clamping the pilot tube C. monitoring the patient D. initiating high frequency jet ventilation - ANS ✓The correct answer is : A
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Explanation : The ET tube cuff that fails to increase in pressure after introducing additional air is most likely damaged. When a part of an ET tube is damaged, the only acceptable option is to replace it. Which of the following laboratory examinations would be helpful in further assessing a patient with diabetic ketoacidosis? A. creatinine B. PD C. glucose level D. P50 - ANS ✓The correct answer is : C Explanation : A patient with diabetic ketoacidosis primarily has a problem with the blood glucose level. Further assessment therefore can be done by examining the glucose level. What would most likely be indicated by an elevated CVP? A. pulmonary embolism B. fluid overload C. left heart failure D. increased pulmonary vascular resistance - ANS ✓The correct answer is : B Explanation : Hypervolemia (fluid overload) is shown hemodynamically by an increase in all hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP is the first and most significant indicator when fluid levels in the body are high or low. Remember, CVP may be known by other names such as, right atrial pressure, right side preload, right ventricular filling pressure, and right ventricular end-diastolic pressure. For which of the following conditions is PEP therapy most beneficial?
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The patient is cyanotic and anxious. The respiratory therapist will recommend which of the following? A. decrease mandatory rate B. increase tidal volume C. increase inspiratory flow rate D. increase FIO2 - ANS ✓The correct answer is : B Explanation : All of the answers offered indicate a change in the ventilator settings. However, the question shows no evidence of arterial blood gas analysis. This is because a close examination of the ventilator settings will show that there is something wrong. The patient weighs 81 kg which would suggest a minimum tidal volume of 500 mL. (6 x 81 kg = 486 mL). The patient's set tidal volume is only 450 mL. This should be corrected. The following graphic (shows fluttering expiratory flow) from an orally intubated patient receiving mechanical ventilation is most likely caused by A. vocal cord paralysis B. condensate in the tubing C. fixed upper airway obstruction D. PEP therapy - ANS ✓The correct answer is : B Explanation : Condensate in the tubing will show up as a fluttering expiratory flow. Which of the following patients would benefit most from an inverse I:E ratio ventilation? A. ARDS B. chronic bronchitis
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C. kyphoscoliosis D. COPD - ANS ✓The correct answer is : A Explanation : An inverse I:E ratio is a term that indicates a longer inspiratory time than expiratory time. The patient with adult respiratory distress syndrom is an example of a patient who can benefit from an inverse I:E ratio. Their lungs are noncompliant and therefore require more inspiratory time to allow for better gas distribution. The respiratory therapist is making a plan of care for a patient with mycoplasma pneumonia who needs assistance with airway clearance of secretions. In which order should therapy be performed? A. coach coughing, bronchodilator, percussion, postural drainage B. postural drainage, percussion, bronchodilator, coach coughing C. percussion, postural drainage, bronchodilator, coach coughing D. bronchodilator, percussion, postural drainage, coach coughing - ANS ✓The correct answer is : D Explanation : There is an oder at which procedures should be done to mobilize and remove secretions. The first steps are to open the airway, dislodge the sputum, move dispute into the upper airway, and then remove the sputum through coughing or suctioning. A pulmonary rehabilitation patient is having difficulty complying with a smoking cessation program. A physical and psychological screen reveals a heavy physiological dependence and a low psychological dependence on smoking. Which of the following is appropriate? A. Valium B. psychological counseling C. Versed
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patient is unknown. For example, if the cardiac output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8, cardiac output could be estimated to be 3.6 L/min. What is the primary purpose for a nitrogen washout test? A. determine closing volume B. determine FRC C. evaluate evenness of pulmonary gas distribution D. directly measure TLC - ANS ✓The correct answer is : B Explanation : A nitrogen washout test is used to determine three different lung volumes: TLC, RV, and FRC. For the NBCR exam the most important of those volumes is the FRC. Thus, when asked what a nitrogen washout test is for (or helium dilution test), the correct answer is FRC. While transporting a patient from a helicopter landing pad to the emergency department (ED), the respiratory therapist notices the ET tube has become unsecured. To best confirm to location of the ET tube, the therapist should recommend A. observe chest rise B. palpate the trachea C. chest radiograph D. auscultate breath sounds - ANS ✓The correct answer is : C Explanation : One may quickly determine the location of an endotracheal tube by observing chest rise and auscultating breath sounds. However, neither of these methods are conclusive. The only way to confirm proper placement is through a chest x-ray.
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A patient receives postural drainage and percussion. During the treatment, the patient develops rhonchi. The respiratory therapist should NEXT A. administer an IPPB treatment B. perform nasal tracheal suctioning C. discontinue treatment D. switch to PEP therapy - ANS ✓The correct answer is : B Explanation : The development of rhonchi during postural drainage and percussion is an indication that the therapy is working - is mobilizing secretions effectively and moving them upward where they can be expectorated or suctioned. A respiratory therapist is preparing for defibrillation on a patient with pulseless ventricular tachycardia. Which of the following should NOT be part of that preparation? A. set the defibrillator to deliver 360 joules B. prepare to administer supplemental oxygen C. set up for manual ventilation with a bag/valve D. set the defibrillator's synchronization to ON - ANS ✓The correct answer is : D Explanation : Pulseless ventricular tachycardia should be treated with defibrillation. When defibrillating a deadly cardiac rhythm, the synchronization setting on the defibrillator should be set to "off". A 62-year-old male has ventricular tachycardia. The patient is not alert and will not respond to verbal stimuli. A pulse is palpable. The respiratory therapist will respond by A. administering methyl prednisone, IV B. administering Isuprel (Isoproterenol)
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Explanation : The capnograph wave form shows a sudden fall to Zero end-tidal CO2. This is most likely caused from a disconnection of the ventilator circuit. Which of the following is considered subjective information? A. dyspnea B. breath sounds C. chest movement symmetry D. vital capacity - ANS ✓The correct answer is : A Explanation : Subjective information are those data that must be reported by the patient. This kind of data is also known as symptoms. Data that can be observed independent of the patient's input is known as objective information, otherwise called signs. Of the options here, dyspnea must be reported by the patient and therefore is the only subjective information offered. Which of the following transdermal nicotine preparations might the respiratory therapist recommend to help a patient stop smoking? A. gum B. patch C. MDI D. spray - ANS ✓The correct answer is : B Explanation : The question is asking for a transdermal nicotine preparation. "Transdermal" means "through-the-skin". A patch is the appropriate preparation were looking for. Which of the following most effectively makes up the humidity deficit for a patient who is orally intubated and receiving mechanical ventilation?
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A. bubble humidifier B. heated humidity C. HME D. centrifugal nebulizer - ANS ✓The correct answer is : B Explanation : A patient who is intubated cannot provide 100% humidity to their lungs because the ET tube bypasses the natural humidification processes of the body. In such case a humidification device is needed to make up the entire humidity deficit. Of the devices listed in the options, only a heated humidifier can accomplish this. A bubble humidifier is used with a nasal cannula and an HME device does not provide sufficient humidity. A centrifugal nebulizer is not used in conjunction with a mechanical ventilator. A pulmonary function study reveals a forced vital capacity (FVC) that is greater than a slow vital capacity (SVC). To which of the following can this be attributed? A. partial diaphragmatic paralysis B. poor patient effort on the SVC maneuver C. chronic air-trapping D. excessive effort on the FVC maneuver - ANS ✓The correct answer is : B Explanation : When the patient exhales slowly they are able to breathe out more air than if they were to exhale quickly. For this reason, and FVC should always be less than an SVC. If FVC is noted to be higher than the SVC, this is clear evidence that the patient's effort during the SVC maneuver was poor or insufficient. Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7. PaCO2 50 mmHg PaO2 81 mmHg
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A. PetCO2 and alveolar ventilation B. minute ventilation and alveolar ventilation C. minute ventilation and respiratory rate D. PECO2 and VD/VT - ANS ✓The correct answer is : C Explanation : If you take a minute ventilation and divide it by the respiratory rate you get tidal volume. While running quality control material through a blood gas analyzer, the therapist notes that 4 consecutive data points are beyond 2 SD from the mean. The therapist will A. monitor the machine closely for several days B. report the problem to the medical director C. remove the machine from service D. continue running quality control material until corrected - ANS ✓The correct answer is : C Explanation : When monitoring the quality control data for an arterial blood gas machine the points on the graph, which show the actual values of the quality control material, should be between the upper control limit and the lower control limit (two standard deviations above and below the mean for a total of a 4 standard deviation range). In this case there are several consecutive points that are beyond the two standard deviations and therefore the machine is considered out of control and should not be placed in service but removed. Blood gases should not be run on that machine until the problem has been resolved. More importantly, blood gas data should not be reported as part of the patient's medical record because they are likely inaccurate. A patient with a history of asthma reports to the emergency department after self-treating bronchoconstriction for the past 3 days. Periodic relief has been
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achieved but the patient is in current distress and is wheezing bilaterally. Which of the following treatment actions would be most appropriate? A. sildenafil, IV B. administer Sublimaze, PO C. full pulmonary function testing with DLCO measurement D. continuous aerosolized bronchodilator at 7 mg/hr - ANS ✓The correct answer is : D Explanation : The patient shown in this question obviously demonstrates lack of response to bronchodilator therapy. Of the options offer, IV methylprednisolone and continuous aerosolized bronchodilators are appropriate. Quality control data for an arterial blood gas analyzer is plotted on a graph that has a range of 4 standard deviations (2 SD up and 2 SD down). Points on the graph show a gradual rise from below the mean to above the mean. All points are within 2 SD of the mean. The respiratory supervisor should A. replace the electrodes B. remove this machine from service C. monitor this machine closely D. call the medical director for direction - ANS ✓The correct answer is : C Explanation : Because all points on the blood gas graphs are within two standard deviations of the mean, the blood gas machine is technically in control. But the use of the word gradual rise means that there is a trend upward. Whenever there's a trend you need to monitor that machine because the trend may ultimately rise above the two standard deviations. You do not need to remove the machine from service or perform any kind of maintenance when a trend is observed - only monitor. A 75-kg (165-lb) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings:
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FVC 72
FEV1.0 39
FEF25-75 52
FEF200-1200 76
DLCO 89
Which of the following most accurately represents the patient's condition? A. moderate obstructive defect B. normal spirometry C. severe restrictive defect only D. mild restriction with severe obstructive defect - ANS ✓The correct answer is : D Explanation : A slow vital capacity of 75% indicates a mild restriction. An FEV1 of 39% of predicted indicates a severe obstruction. A patient receiving volume-controlled ventilation has a balloon-tipped pulmonary artery catheter in place. The respiratory therapist notices the PA waveform is ascending and descending with inflection points at 25 and 2 mmHg. Based on this information, the therapist should recommend A. advancing the catheter B. monitoring the patient closely C. rotating the catheter D. deflating the catheter balloon - ANS ✓The correct answer is : A Explanation : The pulmonary artery catheter waveform that has a high inflection point of 25 and a low inflection point of 0-2 mmHg is an indication that the tip of the catheter is in the right ventricle of the heart. The proper placement of this catheter is in the pulmonary artery. Therefore, advancing the catheter is indicated. This is done by inflating the balloon and allowing the catheter to sail into a proper position in the pulmonary artery.
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A patient is receiving volume-controlled mechanical ventilation. Which of the following adjustments are appropriate to reduce autoPEEP? A. increase inspiratory flow rate B. decrease expiratory time C. increase tidal volume D. increase PEEP - ANS ✓The correct answer is : A Explanation : To reduce autoPEEP, expiratory time must be increased. This may be done by decreasing inspiratory time, which is accomplished by increasing inspiratory flow rate. A respiratory therapist is measuring the gas volume from a patient who exhales maximally after inhaling to inspiratory reserve volume. Which of the following volumes is the respiratory therapist attempting to observe? A. inspiratory reserve volume B. expiratory reserve volume C. total lung capacity D. vital capacity - ANS ✓The correct answer is : D Explanation : The volume exhaled maximally after a maximum inhalation is called vital capacity. Which of the following is needed to calculate minute alveolar ventilation? A. PAO2 and tidal volume B. VD/VT and PAO C. tidal volume, weight, respiratory rate
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A patient with a history of hyper-reactive airway disease is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recommend? A. Solu-Mederol B. Beclamethasone (Beclovent) C. Acetylcysteine (mucomyst) D. Spiriva (tiotropium bromide) - ANS ✓The correct answer is : C Explanation : Hyperactive airway disease is associated with diseases such as asthma and consist of bronchoconstriction and inflammation. This patient appears to have difficulty with bronchoconstriction and thick secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are appropriate. A physician has ordered administration of 80% / 20% heliox therapy to a spontaneously breathing patient. Which of the following gas delivery devices should the respiratory therapist plan on using? A. air-entrainment mask B. simple mask C. nasal cannula D. nonrebreathing mask - ANS ✓The correct answer is : D Explanation : The proper modality to administer Heliox therapy is a non- rebreathing mask. An infant is delivered and has a one-minute APGAR score of 5. The infant is placed on the radiant warmer. What other equipment would be most helpful at this time? A. non-rebreathing mask B. croup tent
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C. nasal cannula D. oxygen hood - ANS ✓The correct answer is : D Explanation : From examining Apgar scores one can determine the best therapy for the patient. An Apgar score of 1 to 3 requires CPR. An Apgar score of 4 to 6 necessitates supplemental oxygen and general stimulation. An Apgar score of 7 to 10 requires only routine care of the infant. No supplemental oxygen is required in this case, one must know that an oxygen hood is the most desirable method to deliver supplemental oxygen to the patient who has an Apgar score of five. A patient who is receiving volume-controlled ventilation has the following arterial blood gas and clinical data: Mode Assist/control Rate 14/min FIO2 0.50 (analyzed) VT 500 mL Arterial blood gas analysis was done at standard temperature and pressure (STP). Pressure (H2O) is 47 cm H2O pH 7. PaCO2 41 torr PaO2 358 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist can conclude which of the following? A. The patient has a significant shunt
