Download TMC PRACTICE EXAM 100 QUESTIONS WITH
ANSWERS 2023-2024
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ANSWERS 2023-
Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs should be able to exhale what percent of the FVC? A. 35-50% of the FVC B. 50-70% of the FVC C. 70-83% of the FVC D. 84-93% of the FVC Correct Answer: c. 70-83% of FVC Simple spirometry CANNOT be used to measure the A. vital capacity B. residual volume C. tidal volume D. inspiratory reserve volume Correct Answer: b. residual volume Which of the following approaches can be used to obtain a medication history from a patient with a depressed level of consciousness or who is severely agitated? A. obtain and review the patient's past medical history B. ask the patient's nurse about the patient's prescriptions C. request that the lab run a comprehensive blood drug screen D. obtain the patient's current prescription vials from the family Correct Answer: d. obtain the patient's current prescription vials from the family Which of the following thoracic ultrasound findings is consistent with the presence of a pneumothorax? A. presence of gliding sign B. absence of A-lines C. presence of barcode sign D. presence of seashore sign Correct Answer: c. presence of barcode lines Which of the following would tend to increase insensible water loss? A. hypothermia B. bypassed upper airway C. hypoventilation D. diuretic administration Correct Answer: b. bypassed upper airway Which of the following would tend to decrease a patient's energy expenditure? A. hypothermia B. inflammation C. major trauma D. agitation/pain Correct Answer: a. hypothermia
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A patient has acute respiratory acidosis. You would expect the base excess (BE) to range between: A. + 6 mEq/L B. - 6 mEq/L C. +/- 2 mEq/L D. +/- 8 mEq/L Correct Answer: c. +/- 2 mEq/L Which of the following arterial blood gas results would most likely be reported for a patient who is having a mild asthma attack? A. pH = 7.31 PCO2 = 50 torr PO2 = 60 torr B. pH = 7.40 PCO2 = 50 torr PO2 = 50 torr C. pH = 7.47 PCO2 = 32 torr PO2 = 60 torr D. pH = 7.47 PCO2 = 40 torr PO2 = 50 torr Correct Answer: c. pH= 7.47 PCO2= 32 torr PO2= 60 torr The Apgar score for a normal newborn infant ranges between A. 1- B. 4- C. 7- D. 10-13 Correct Answer: c. 7- On inspection of a patient's ECG strip, you note no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. The most likely problem is: A. 2nd degree (Wenckebach) heart block B. ventricular fibrillation C. atrial fibrillation D. ventricular tachycardia Correct Answer: c. atrial fibrillation In inspecting an elderly female patient, you note that her spine has an abnormal anterposterior (AP) curvature. Which of the following terms would you use in charting this observation? A. kyphosis B. scoliosis C. kyphoscoliosis D. pectus excavatum Correct Answer: a. kyphosis During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung bases. Which of the following chart entries best describe this finding? A. "bronchial sounds heard at lung bases" B. "wheezes heard at lung bases" C. "rhonchi heard at lung bases"
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A. left-sided pneumothorax B. left-sided consolidation C. left lobar obstruction/atelectasis D. left-sided pleural effusion Correct Answer: a. left-sided pneumothorax A patient's response to an interview question is initially vague or unclear. Which of the following responses on your part would be most appropriate? A. "Please go on" B. "You seem to be anxious" C. "I see why you are so upset" D. "Please explain that to me again" Correct Answer: d. "please explain that to me again" A patient is asked to inhale as deeply as possible and blow out all his air as hard as they can until empty. What test is being performed? A. FVC B. IC C. TLC D. MVV Correct Answer: a. fvc When a patient is receiving positive-pressure ventilation, you should strive to keep the alveolar (plateau) airway pressure below: A. 20 cm H2O B. 30 cm H2O C. 40 cm H2O D. 50 cm H2O Correct Answer: b. 30 cm H2O On inspection of an ECG rhythm strip from an adult patient, you note the following: rate of 150; regular rhythm; normal P waves, P-R intervals, and QRS complexes. The most likely problem is: A. atrial flutter B. sinus tachycardia C. ventricular tachycardia D. atrial fibrillation Correct Answer: b. sinus tachycardia On inspection of a 12-lead ECG, you note the absence of P waves and a variable R-R interval (> 0.12 sec). Which of the following is the most likely problem? A. atrial hypertrophy B. first-degree heart block C. atrial fibrillation D. sinus arrhythmia Correct Answer: c. atrial fibrillation
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What percent decrease in FEV1 needs to occur to conclude that a methacholine challenge is positive for airway hyperreactivity? A. 10% B. 15% C. 20% D. 25% Correct Answer: c. 20% A patient is receiving ventilatory support after thoracic surgery. You measure the patient's maximum inspiratory pressure (MIP/NIF) as -33 cm H2O. Based on this value, the patient has: A. a need for continued ventilatory support B. a large leak in their endotracheal tube cuff C. a normal maximum inspiratory pressure D. adequate muscle strength to consider weaning Correct Answer: d. adequate muscle strength to consider weaning During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicates: A. exhalation of mainly deadspace gas B. inspiration of fresh respiratory gas C. exhalation of mixed alveolar/deadspace gas D. exhalation of mainly alveolar gas Correct Answer: b. inspiration of fresh respiratory gas A patient is considered as having sufficient respiratory muscle strength to maintain adequate ventilation and prevent secretion retention when the maximum inspiratory pressure (MIP; NIF) is more negative than: A. -5 cm H2O B. -10 cm H2O C. -15 cm H2O D. -20 cm H2O Correct Answer: d. -20 cm H2O Over a 3 hour period, the plateau pressure of a patient receiving volume controlled ventilation has remained stable, but her peak pressure has been steadily increasing. Which of the following is the best explanation for this observation? A. the patient's airway resistance has increased B. the patient is developing atelectasis C. the patient's compliance has decreased D. the patient is developing pulmonary edema Correct Answer: a. the patient's airway resistance has increased On inspection of an adult patient's 12-lead ECG, you note a regular R-R interval of 0.40 sec, with no other apparent abnormalities. Which of the following is the most likely problem?
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Shortly after you replace a jet nebulizer and tubing on a patient who has a tracheostomy, the SpO2 drops from 98% to 90%. Aerosol is visible throughout inspiration and expiration in the tracheostomy collar. Which of the following should you do first to resolve the situation? A. Decrease the input flow to the nebulizer B. Ask the patient to breath slower and deeper C. Check the entrainment setting on the nebulizer D. Obtain an arterial blood gas sample for analysis Correct Answer: c. check the entrainment setting on the nebulizer Which of the following would you expect to occur AFTER an unheated bubble diffusion humidifier is set-up and operating? A. the reservoir will be warmer than room temperature B. the reservoir will be cooler than room temperature C. the reservoir temperature will equal room temperature D. water will condense on the inside of the delivery tubing Correct Answer: b. the reservoir will be cooler than room temperature During computerized setup of a ventilator, you are prompted to enter a circuit compliance factor. This information is needed to: A. calibrate the flow sensors B. complete the automated leak test C. calibrate the pressure transducer D. compensate for compressed volume loss Correct Answer: d. compensate for compressed volume loss A bubble humidifier is connected to a flowmeter set and running at 5 L/min. When you obstruct the outlet of the small-bore delivery tubing, the pressure pop-off does NOT sound. Which of the following is the most likely cause of this observation? A. excessive flow through the humidifier B. a leak in the humidifier/delivery system C. diameter of delivery tubing is too small D. the flowmeter is not pressure compensated Correct Answer: b. a leak in the humidifier/delivery system Which of the following analyzers would you select if your objective were to continuously measure changes in the FIO2 in a ventilator circuit with the fastest possible response time? A. physical (paramagnetic) analyzer B. thermal conductivity analyzer C. galvanic fuel cell analyzer D. polarographic (Clark) analyzer Correct Answer: d. polarographic (clark) analyzer
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To maximize the duration of flow/runtime outside the home, liquid portable O2 systems: A. hold about three liters of liquid oxygen B. can be refilled from a liquid O2 base unit C. incorporate a pulse-dose delivery system D. include a battery-powered contents indicator Correct Answer: c. incorporate a pulse-dose delivery system You run a control solution through a blood gas analyzer as part of daily quality control. The measured high PO2 value is 9 torr outside of the acceptable range. Prior runs were all in range. You should: A. report results after compensating for the deviation B. replace the PO2 electrode and recalibrate the analyzer C. analyze another control solution for comparison D. perform a two-point calibration and rerun the control Correct Answer: d. perform a two-point calibration and rerun the control Which of the following is true regarding calibration of exhaled nitric oxide (NO) gas analyzers? A. inlet flows should mimic breathing (variable flow/pressure) B. daily 2-point (zero/high %NO) calibration is required C. room air can be used as the 'zero' calibrating gas D. daily 1-point using a standardized NO% is sufficient Correct Answer: b. daily 2- point (zero/high %NO) calibration is required When reviewing statistical quality control data on a blood gas analyzer, you note a single pH measurement among 30 that falls below the ± 2 SD "in control" standard for your lab. Which of the following is the most likely cause of this error? A. statistical probability/chance B. contaminated buffer solutions C. incorrect analysis procedures D. failure of the pH electrode Correct Answer: a. statistical probability/ chance You are analyzing quality control samples on a blood gas analyzer as part of a routine quality control program. Multiple but not successive PCO2 values fall above and below the two standard deviation limit. You should: A. record the results as an acceptable B. record the results as an acceptable after correcting for the difference in measurements C. record the results as an acceptable if they are within +/- 2 SD of the mean D. perform a two-point calibration and reanalyze the control sample Correct Answer: d. perform a two-point calibration and reanalyze the control sample
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When suctioning an adult patient using a DISS wall-mounted regulator system with collection bottle, you would initially set the vacuum pressure at: A. -12 to -15 in Hg B. -80 to -100 mm Hg C. -5 to -7 in Hg D. -100 to -120 mm Hg Correct Answer: d. -100 to -120 mm Hg In which of the following clinical situations would a patient benefit most from deep breathing exercises? A. myasthenic crisis B. postop cholecystectomy C. exacerbation of COPD D. status asthmaticus Correct Answer: b. postop cholecystectomy What size suction catheter would you select to suction a patient with a 9.0 mm ID tracheostomy tube? A. 10 Fr B. 12 Fr C. 14 Fr D. 16 Fr Correct Answer: d. 16 Fr During postural drainage therapy, a patient's heart rate remains stable at 92/min and the SpO2 is 97%. However, after you pre-oxygenate the patient and begin nasotracheal suctioning, the patient's heart rate suddenly drops to 40/min. The most likely reason for this is: A. severe mucus plugging B. hypoxemia during suctioning C. a vago-vagal reflex D. postural hypotension Correct Answer: c. a vago-vagal reflex If tolerated, a specified postural drainage position should be maintained for at least: A. 3-5 minutes B. 5-10 minutes C. 10-20 minutes D. 20-30 minutes Correct Answer: b. 5-10 minutes You are about to suction an infant who has a 3.0 mm (ID) endotracheal tube in place. What is the MAXIMUM size catheter you would use in this case? A. 6 Fr B. 8 Fr C. 5 Fr
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D. 10 Fr Correct Answer: c. 5 Fr If a patient's chest X-ray shows infiltrates in the posterior segments of the lower lobes, postural drainage should be performed in which of the following positions? A. head down, patient prone with a pillow under her abdomen B. head down, patient supine with a pillow under her knees C. patient prone with a pillow under her head, bed flat D. patient supine with a pillow under her knees, bed flat Correct Answer: a. head down, patient prone with a pillow under her abdomen To increase a patient's maximum expiratory flow when using a cough assist or mechanical in- exsufflation (MI-E) device, you would: A. increase the inspiratory time B. decrease the expiratory pressure C. increase the expiratory time D. increase the inspiratory pressure Correct Answer: d. increase the inspiratory pressure Postural drainage would best be indicated for a patient with: A. pleural effusion B. asthma C. pneumonia D. cystic fibrosis Correct Answer: d. cystic fibrosis In discussing the goals of IPPB therapy with a postoperative patient, which of the following explanations would be most appropriate? A. "This will prevent pneumonitis." B. "This will help you take deep breaths." C. "This will prevent atelectasis." D. "This will increase your intrathoracic pressure." Correct Answer: b. "This will help you take deep breaths." A patient who is receiving an aerosol treatment with acetylcysteine (Mucomyst) and hypertonic saline via a SVN suddenly becomes dyspneic. The most likely cause of this problem is: A. hypercapnia B. bronchospasm C. pneumothorax D. fluid overload Correct Answer: b. bronchospasm A physician orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would be most appropriate to deliver this mixture?
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Which of the following describes the ventilatory pattern that is best suited for maximum aerosol deposition in the small airways? A. slow inhalation, pause, slow exhalation B. slow inhalation, pause, rapid exhalation C. rapid inhalation, pause, slow exhalation D. rapid inhalation, pause, rapid exhalation Correct Answer: a. slow inhalation, pause, slow exhalation A doctor orders a metered dose inhaler (MDI) bronchodilator for a patient receiving mechanical ventilation via a dual-limb breathing circuit. To maximize aerosol deposition, you would: A. place the MDI directly in-line on the inspiratory side of the circuit B. recommend that a small volume nebulizer be used instead of the MDI C. place the MDI plus a spacer in-line on the inspiratory side of the circuit D. place the MDI directly in-line on the expiratory side of the circuit Correct Answer: c. place the MDI plus a spacer in-line on the inspiratory side of the circuit Which of the following patient instructions for using a dry powder inhaler (DPI) is correct? A. hold the device vertically after loading B. perform slow (3-4 sec) deep inhalation C. exhale back into the device D. seal lips tightly around the mouthpiece Correct Answer: d. seal lips tightly around the mouthpiece An increase in a patient's heart rate during aerosolized bronchodilator therapy is primarily a result of which of the following effects of the drug? A. Alpha only B. Beta 1 only C. Beta 2 only D. Beta 1 and Beta 2 Correct Answer: b. beta 1 only A physician orders supplemental O2 for a patient via nasal cannula at a flow of 12 L/min. When you ask her what goal she has in mind, she states that she wants the patient to receive about 60% oxygen. Which of the following should you recommend? A. that the cannula flow be set to 15 L/min instead of 12 L/min B. that the O2 be given via a partial rebreathing mask at 10 L/min C. that a nasal catheter at 12 L/min be used instead of the cannula D. that the O2 be given via an air entrainment mask set at 60% Correct Answer: b. that the O be given via a partial rebreathing mask at 10 L/min A patient whose asthma was well-controlled using a short-acting beta-agonist inhaler PRN and low dose inhaled corticosteroid BID reports that she recently has been experiencing shortness of
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breath almost daily and is awakened at night with wheezing episodes. Her pea flow, which had been 83% of her predicted normal is now at 66% of the predicted value. Which of the following would you recommend to the patient's doctor as possible changes to the current drug regimen? A. discontinue the short-acting beta agonist inhaler B. add a leukotriene modifier to the regimen C. switch the short-acting beta agonist from PRN to Q4H D. switch from inhaled to oral corticosteroid therapy Correct Answer: b. add a leukotriene modifier to the regimen In assessing a patient receiving ventilatory support, you note that her white blood cell count is 18,000/mm3 and her temperature is 102 °F. In addition, her secretions have become more tenacious and yellow over the past 24 hours. Which of the following would you suggest to the attending physician? A. that her humidifier temperature be lowered to below 30 °C B. that a regimen of aerosolized carbenicillin be started ASAP C. that a sputum sample be obtained for culture and sensitivity D. that the frequency of suctioning be increased to every half hour Correct Answer: c. that a sputum sample be obtained for culture & sensitivity A clinical condition characterized by a history of a productive cough for at least three months a year for two consecutive years best describes: A. panlobular emphysema B. status asthmaticus C. centrilobular emphysema D. chronic bronchitis Correct Answer: d. chronic bronchitis After bronchodilator therapy, you record the following PFT data on a 67 year old male COPD patient with chronic cough and sputum production: FEV1/FVC = 65%; FEV1 = 82% predicted. You would characterize the stage of the patient's COPD as: A. mild B. moderate C. severe D. very severe Correct Answer: a. mild A doctor institutes volume control ventilation for a 70 kg ARDS patient with a targeted tidal volume of 420 mL. To maintain adequate ventilation with this tidal volume, you would allow a machine respiratory rate as high as: A. 20/min B. 25/min C. 30/min D. 35/min Correct Answer: d. 35/min
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The primary purpose of oxygen administration in the management of heart failure is to: A. increase the force of ventricular contractions B. decrease resistance to ventricular ejection C. increase ventricular stroke volume D. decrease the workload on the myocardium Correct Answer: d. decrease the workload of the myocardium A doctor institutes volume control ventilation for an 80 kg ARDS patient. Which of the following is the maximum pressure you would aim to achieve in this patient? A. 50 cm H2O peak pressure B. 30 cm H2O plateau pressure C. 40 cm H2O peak pressure D. 50 cm H2O plateau pressure Correct Answer: b. 30 cm H2O plateau pressure You would recommend against using noninvasive positive pressure ventilation (NPPV) for a patient with: A. secretions requiring suctioning B. the need for moderate sedation C. facial burns or trauma D. FIO2 needs greater than 40% Correct Answer: c. facial burns or trauma An alert patient with emphysema and an elevated CO2 level is given 50% O2 by an air entrainment mask. One hour later the nurse calls you to evaluate the patient. He is now very lethargic. Which of the following is the most likely cause of this? A. respiratory muscle fatigue B. cerebral hypoxia C. hypotension D. O2-induced hypoventilation Correct Answer: d. O2-induced hypoventilation Which of the following is a key therapeutic objective in the management of a patient who has closed head trauma and is receiving ventilatory support? A. increase the minute ventilation B. increase intrathoracic pressure C. assure patient-ventilator synchrony D. decrease cerebral perfusion pressure Correct Answer: c. assure patient-ventilator synchrony In individuals with disorders characterized by an increase in airway resistance, such as emphysema, which of the following breathing patterns results in the minimum work? A. deep breathing B. slow breathing
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C. shallow breathing D. rapid breathing Correct Answer: b. slow breathing Which of the following is true regarding patients in the early stages of an asthmatic attack? A. they all exhibit respiratory alkalosis B. they always have moderate hypoxemia C. they have decreased expiratory flows D. they never respond to beta adrenergics Correct Answer: c. they have decreased expiratory flows Maximum inspiratory pressure (MIP; NIF) measurement provides information about which of the following? A. airway resistance B. functional residual capacity C. inspiratory capacity D. respiratory muscle strength Correct Answer: d. respiratory muscle strength Which of the following laboratory values is most consistent with a diagnosis of fluid depletion (dehydration)? A. increased hematocrit B. decreased BUN C. decreased serum osmolality D. decreased urine specific gravity Correct Answer: a. increased hematocrit Which of the following would represent an abnormal V/Q scan suggesting pulmonary embolism? A. large segmental areas with normal ventilation and normal perfusion B. large segmental areas with no ventilation and no perfusion C. large segmental areas with normal ventilation but no perfusion D. large segmental areas with no ventilation but normal perfusion Correct Answer: c. large segmental areas with normal ventilation but no perfusion During the administration of an aerosol treatment, the patient's respiratory rate drops from 15 breaths/min to 6 breaths/min. Identify this breathing pattern. A. bradypnea B. Biot's breathing C. apnea D. hyperpnea Correct Answer: a. bradypnea You measure the blood pressure of an adult patient as 88/53 mm Hg. Which of the following chart entries would you use in describing this finding? A. patient is hypertensive
