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TMC Practice Exam 151 Questions and Answers Latest 2023 Graded A+.pdf, Exams of Nursing

Grambling State University (GSU)Nursing

TMC Practice Exam 151 Questions and Answers Latest 2023 Graded A+.pdf

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TMC Practice Exam 151 Questions and

Answers Latest 2023 Graded 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

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?

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.

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

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.

Ans

- 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.

Partial preview of the text

Download TMC Practice Exam 151 Questions and Answers Latest 2023 Graded A+.pdf and more Exams Nursing in PDF only on Docsity!

TMC Practice Exam 151 Questions and

Answers Latest 2023 Graded 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 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/ 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. 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 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. Ans
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. Ans

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 Ans
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?

Tidal volume
Respiratory Rate
Inspiratory flow
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? A. Perform chest physiotherapy B. Administer an IPPB treatment C. Insert an endotracheal tube D. Insert a chest tube Ans
Insert a chest tube A 55 year-old post cardiac surgery 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. A. 2.5 vol% B. 4.0 vol% C. 5.0 vol% D. 5.5 vol%

Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing?

FEV
PEFR
FRC
RV Ans

1 and 2 only The respiratory therapist is providing patient 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 A. sterilize the equipment. B. retard bacterial growth. C. kill all micro-organisms and spores. D. extend the equipment life. 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 A. pneumonia. B. pulmonary embolism. C. pleural effusion. D. bronchiolitis. 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? A. 8 Fr B. 10 Fr C. 12 Fr D. 14 Fr 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 A. the patient is disconnected from the ventilator.

B. the patient is experiencing diffuse bronchospasm. C. the endotracheal tube has slipped into the right main stem bronchus. D. the patient has developed a left tension pneumothorax. 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 A. notify the charge nurse. B. apply a pressure dressing. C. apply pressure to the site. D. perform a modified Allen's test. 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? A. Diabetes insipidus B. Renal failure C. Metabolic acidosis D. Elevated intracranial pressure Ans
Elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? A. Less than 5 B. 5 to 15 C. 16 to 30 D. Greater than 30 Ans
5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, you notice 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? A. Upper airway obstruction B. Poor peripheral perfusion C. Air leak around the sensor D. Device is out of range Ans
Air leak around the sensor A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient?

The respiratory therapist has been asked to measure Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should A. initiate an inspiratory hold just after the next ventilator-delivered breath. B. initiate an expiratory hold just prior to the next ventilator-delivered breath. C. subtract Pplat from Pdyn. D. subtract set PEEP from the measured Pplat. Ans

initiate an expiratory hold just prior to the next ventilator-delivered breath. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend

IV fluid challenge
positive inotropic agent
inhaled nitric oxide
diuretic therapy Ans

2 and 4 What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? A. VC limits and controls PIP. B. VC provides a constant minute ventilation. C. VC ensures better patient-ventilator synchrony. D. VC delivers a decelerating flow pattern. Ans
VC provides a constant minute ventilation. Bronchial breath sounds heard over the lung periphery indicate A. narrowed airways. B. obstructed bronchi. C. lung consolidation. D. pulmonary edema. Ans
lung consolidation. During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25- 75 81% of predicted. How should the respiratory therapist interpret these results?

A. a mild restrictive disorder B. a mild obstructive disorder C. normal lung function D. mixed obstructive/restrictive disorder Ans

normal lung function A 55 year-old male patient is being evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should A. reduce the speed of the bike. B. administer supplemental oxygen. C. gradually reduce the workload and monitor closely. D. terminate the procedure immediately. Ans
terminate the procedure immediately. At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? A. 4 & 8 B. 5 & 9 C. 5 & 10 D. 6 & 10 Ans
6 & 10 The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? A. 0.25 mL B. 0.50 mL C. 1.25 mL D. 2.5 mL Ans
0.50 mL After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist has documented in the Progress Notes a need to change the patient's treatment regimen. The respiratory therapist should A. continue the current treatment plan.

Obtain an ABG. A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from A. pulmonary embolism. B. gastroesophageal reflux. C. myocardial infarction. D. valvular stenosis. Ans
myocardial infarction. A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend? A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation Ans
Bronchial provocation Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend A. antiviral therapy. B. blood transfusion. C. SABA by small volume nebulizer. D. antibiotic therapy. Ans
antibiotic therapy. A tracheostomy tube has just been inserted percutaneously into a patient with a C fracture. How much air should the respiratory therapist initially inject into the cuff? A. Enough to achieve a pressure of 25-35 cmH2O. B. Enough to achieve a minimal occluding volume. C. A minimum of 20 mL. D. Until firm tension is felt in the pilot balloon. Ans
Enough to achieve a pressure of 25-35 cmH2O. All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A. carbon monoxide poisoning. B. decompression sickness.

C. anaerobic infections. D. pulmonary hypertension. Ans

pulmonary hypertension. Which of the following factors are determinants of cardiac output? A. ventricular filling and heart rate B. stroke volume and heart rate C. stroke volume and respiratory rate D. heart rate and tidal volume Ans
stroke volume and heart rate The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 8 mEq/L; SaO2 95%; BE - 15 mEq/L. The respiratory therapist should recommend A. initiating oxygen therapy via nasal cannula at 4 L/min. B. intubating and initiating mechanical ventilation. C. administering sodium bicarbonate intravenously. D. initiating non-invasive ventilation. Ans
administering sodium bicarbonate intravenously. The physician asks the respiratory therapist to set ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request? A. Decelerating B. Square wave C. Constant D. Accelerating Ans
Decelerating An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is A. hypoventilation. B. shunt. C. ventilation/perfusion mismatch. D. increased deadspace. Ans
ventilation/perfusion mismatch. A 16 year-old patient with cystic fibrosis attends public high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient?

Ans

pneumonia. A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely. Ans
Increase the FIO2. The primary source of infection in the health care setting is A. use of medical equipment for multiple patients. B. poor handwashing techniques of personnel. C. food and/or water intake by the patient. D. patient rooms not cleaned appropriately. Ans
poor handwashing techniques of personnel. A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? A. Pre/post bronchodilator study B. Ultrasonic nebulizer treatments C. Manually assisted coughing D. Regular coughing and deep breathing Ans
Regular coughing and deep breathing The respiratory therapist has obtained a blood gas sample from the patient's radial artery and applied pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is A. adding liquid heparin to the sample. B. placing the syringe in an ice bath. C. shaking the sample continuously. D. applying a pressure bandage. Ans
placing the syringe in an ice bath. Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray?

A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion Ans

Increased fremitus A spontaneous breathing trial was initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 30 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient's vital signs have remained stable throughout the trial. Which of the following is the most appropriate recommendation? A. Maintain current therapy. B. Initiate NPPV. C. Add 5 cm H2O CPAP. D. Extubate the patient. Ans
Extubate the patient. After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include

bronchospasm.
pneumothorax.
pulmonary hemorrhage. Ans

1, 2, and 3 A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? A. Head down, patient supine with a pillow under knees B. Patient prone with a pillow under head, bed flat C. Patient supine with a pillow under knees, bed flat D. Head down, patient prone with a pillow under hips Ans
Head down, patient prone with a pillow under hips A 72 year-old female post stem cell transplant patient in the ICU is complaining of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B- type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? A. severe heart failure

D. cuff has herniated over the tip of the tube. Ans

tube is not of the appropriate size. A patient is receiving oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80, HCO3 38 mEq/L. The most likely explanation for these results is that A. the sample was not iced properly. B. there was excess heparin in the syringe. C. the numbers were not reported correctly. D. The sample contains venous blood. Ans
the numbers were not reported correctly. The respiratory therapist is completing oxygen rounds on the ward and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? A. 70% ethyl alchohol B. Warm soapy water C. Bleach D. Acid glutaraldehyde Ans
70% ethyl alchohol Evaluation of a spontaneously breathing patient reveals tachypnea, tracheal deviation to the right and an absence of breath sounds on the left. The most likely etiology would be A. bronchiectasis. B. myasthenia gravis. C. acute asthmatic attack. D. left tension pneumothorax. Ans
left tension pneumothorax. The most serious complication associated with airway suctioning is A. hypoxemia. B. bradycardia. C. mucosal trauma. D. gag reflex stimulation. Ans
hypoxemia. What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and is complaining of difficulty breathing? A. Sims

B. Trendelenburg C. lateral Fowlers D. Fowlers Ans

lateral Fowlers Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? A. 20 torr B. 30 torr C. 40 torr D. 50 torr Ans
50 torr The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor

electrocardiogram.
electroencephalogram.
nasal air flow.
chest wall impedance. Ans

2, 3, and 4 All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT A. minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. B. minimal leak technique allows a small leak at the end of inspiration. C. at minimal occlusion volume, air leakage around the tube cuff should cease. D. cuff pressure should not exceed 35 cmH2O in order to allow circulation to tracheal mucosa. Ans
minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. The sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing is representative of A. tidal volume. B. pulmonary shunt. C. V/Q mismatch. D. alveolar gas that has participated in gas exchange. Ans
alveolar gas that has participated in gas exchange.

A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of Keflex® as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? A. thoracentesis B. polysomnography C. flexible bronchoscopy D. plethysmography Ans

flexible bronchoscopy A 60 kg (132 lb) female patient with congestive heart failure is receiving NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as A. shunting. B. hypoventilation. C. hyperoxygenation. D. fluid overload. Ans
hyperoxygenation Which of the following physiologic values would be present in a patient who has proper fluid balance? A. PCWP of 22 mm Hg B. CVP between 3 and 6 mm Hg C. urine output of 20 mL/hr D. increase in body weight Ans
CVP between 3 and 6 mm Hg The respiratory therapist prepares to assist with a bronchoscopy of a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT A. introduction of the bronchoscope will create increased resistance to flow. B. the tidal volume of the patient must be closely monitored during the procedure. C. the patient's extrinsic PEEP levels will increase. D. peak inspiratory pressure on the ventilator will rise. Ans
the patient's extrinsic PEEP levels will increase. Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions?

A. Post-traumatic chest trauma B. Community-acquired pneumonia C. Spinal cord injury D. Chronic bronchitis Ans

Chronic bronchitis A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist should recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: A. coordinating coughing with pain medication. B. performing serial coughs. C. applying pressure to patient's abdomen during exhalation. D. "splinting" the incision area. Ans
applying pressure to patient's abdomen during exhalation. Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation?

Select a ventilator that uses demand valves rather than a reservoir IMV system.
Calculate oxygen cylinder duration of flow.
Selecting a ventilator that incorporates an internal air compressor. Ans

1 and 2 only A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend? A. Leave the patient on the cannula and continue to monitor. B. Change to a 24% Venti-mask and repeat ABG. C. Change to a simple oxygen mask and repeat ABG. D. Prepare the patient for endotracheal intubation. Ans
Change to a 24% Venti-mask and repeat ABG. A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a A. high likelihood of excessive bleeding. B. normal clotting ability. C. propensity for increased clotting. D. decrease in bone marrow function. Ans
high likelihood of excessive bleeding.

TMC Practice Exam 151 Questions and Answers Latest 2023 Graded A+.pdf, Exams of Nursing

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Partial preview of the text

Download TMC Practice Exam 151 Questions and Answers Latest 2023 Graded A+.pdf and more Exams Nursing in PDF only on Docsity!

TMC Practice Exam 151 Questions and

Answers Latest 2023 Graded A+