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TMC Practice Exam A + B 47 Questions
and Correct Answers latest 2023
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. - ✔️ D. deep breathing and coughing to clear secretions.
See Patient Assessment
A healthy adult female can exhale what portion of her forced vital capacity in the first second? - ✔️ 70%
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 SvO 66%. Calculate the patient's C(a-v)O2. - ✔️ 5% volume
What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - ✔️ 5 to 15
The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, what should the RT do? - ✔️ Initiate an expiratory hold just prior to the next ventilator-delivered breath
What do bronchial breath sounds heard over the lung periphery indicate? - ✔️ lung consolidation (pneumonia)
Rationale: should be vesicular in periphery
A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure?
A. Increase the frequency. B. Change to airway pressure release ventilation. C. Decrease the inspiratory time.
D. Increase PEEP to 15 cm H2O. - ✔️ B. Change to airway pressure release ventilation.
A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient?
A. Obtain a sputum specimen. B. Obtain an ABG. C. Measure peak expiratory flow. D. Determine the Glasgow Coma Score. - ✔️ B. Obtain an ABG.
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 respiratory therapist recommend?
A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation - ✔️ D. Bronchial provocation
Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO is 35 torr 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. - ✔️ B. Increase the FIO2.
The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies 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. - ✔️ B. placing the syringe in an ice bath.
Rationale: it's been over 10 mins and the sample will continue to metabolize/eat up O2 otherwise
A 75 year-old patient with end-stage COPD is admitted to the ED with an acute exacerbation. He has a DNI order in his chart. Physical exam reveals that the patient is febrile and has a weak, non-productive cough. Breath sounds reveal bilateral coarse crackles with scattered wheezes. The patient is started on bronchodilator therapy and antibiotics.
Serial ABG results are: 7 PM: FiO2: 0.21 | pH: 7.30 | PCO2: 70 | PO2: 48 | HCO3: 34 | SpO2: 78% 8PM: FiO2: 0.40 | pH: 7.21 | PCO2: 83 | PO2: 58 | HCO3: 34 | SpO2: 89%
What should the respiratory therapist recommend?
A. Initiate comfort care procedures. B. Decrease FIO2 to 0.35. C. Administer IPV. D. Initiate NPPV. - ✔️ D. Initiate NPPV.
While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the:
A. peak flow meter is clogged. B. patient's asthma has worsened. C. patient is fatigued. D. peak flow meter is accurate. - ✔️ A. peak flow meter is clogged.
An ICU patient's blood pressure is continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure?
A. Trendelenburg position causes an elevation in blood pressure. B. The tip of the catheter was below the transducer. C. The catheter needed flushing. D. The catheter was kinked. - ✔️ B. The tip of the catheter was below the transducer.
A 13 year-old patient in the ED complains of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate?
A. Levalbuterol B. Oxygen C. Salmeterol D. PEP -
✔️ B. Oxygen
After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow- volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an:
A. normal tracing. B. obstructive pattern. C. restrictive pattern. D. large airway obstruction. - ✔️ D. large airway obstruction.
A 43-year-old female patient has just undergone a total abdominal hysterectomy. The patient arrives in the post anesthesia care unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient?
A. Initiate assisted ventilation B. Insert oropharyngeal airway C. Obtain positron emission tomography D. Initiate noninvasive capnography - ✔️ B. Insert oropharyngeal airway
Fine crepitant crackles are most commonly associated with which of the following conditions?
A. Bronchitis B. Pulmonary edema C. Pneumonia D. Foreign body aspiration - ✔️ B. Pulmonary edema
A patient with end-stage pulmonary fibrosis is receiving oxygen at 2 L/min via a transtracheal oxygen catheter. The patient experiences an increased work of breathing and shortness of breath. The respiratory therapist should:
A. manually ventilate the patient with a resuscitation bag. B. increase the flow to the transtracheal catheter to 6 L/min. C. evaluate the SpO2 with a pulse oximeter. D. flush the transtracheal device with isotonic saline. - ✔️ D. flush the transtracheal device with isotonic saline.
During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first:
A. verify the position of the transducer. B. check the transducer dome for air bubbles.
Which of the following is a FALSE statement about self-inflating resuscitation devices?
A. A reservoir is utilized to increase the delivered oxygen concentration. B. The therapist can sense changes in the patient's lung compliance and airway resistance. C. A compressed gas source is necessary for the device to operate. D. Excessive gas flow may cause the valve to malfunction. - ✔️ C. A compressed gas source is necessary for the device to operate.
The following pulmonary function data was reported for a 45 year old pre-op patient: TLC - 5. RV - 1. IRV - 2. VC - 4. ERV - 1. VT - 0. FRC - 2. IC - 3.2 L
Which of the above capacities is incorrect? - ✔️ TLC
Which of the following devices would produce the greatest humidity output for a patient?
A. Bubble humidifier B. Wick-type humidifier C. Large reservoir nebulizer D. Ultrasonic nebulizer - ✔️ D. Ultrasonic nebulizer
A patient has just been intubated with a naso-tracheal tube and is being manually ventilated. As the respiratory therapist ventilates the patient, he notices that there is no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed. A chest x-ray has determined that the endotracheal tube is in the correct position. What is the most likely cause of this situation?
A. The tube is in the esophagus. B. The patient has developed a tracheoesophageal fistula from the intubation process. C. The cuff ruptured during intubation. D. The cuff has herniated over the end of the tube. - ✔️ C. The cuff ruptured during intubation.
A patient is receiving 40% oxygen via a Venturi mask at 8 L/min. While performing oxygen rounds, the respiratory therapist notes that the flowmeter setting has been changed to 12 L/min. How would this change affect the accuracy of this device?
A. FIO2 will remain unchanged B. FIO2 will decrease to 0. C. air entrainment factor will decrease D. FIO2 will increase to 0.50 - ✔️ A. FIO2 will remain unchanged
The following measurements were obtained from a patient being monitored with a balloon tipped, flow directed catheter:
CVP- 2 cmH2O PAP - 12 torr (mean) PCWP - 3 torr CI - 1.2 L/min/m BP - 110/90 mm Hg
Based on the above information, all of the following parameters would be decreased EXCEPT:
A. right ventricular end diastolic pressure. B. left atrial filling pressure. C. systemic vascular resistance. D. cardiac output. - ✔️ C. systemic vascular resistance.
A patient recently underwent a thoracotomy and is now receiving IPPB QID. The patient's inspiratory capacity has diminished over the past several days and the patient is becoming increasingly short of breath. Chest radiograph shows left lower lobe radiodensity with a concave upper border. The respiratory therapist would conclude that the patient has developed:
A. a pleural effusion. B. atelectasis. C. a pneumothorax. D. pneumonia. - ✔️ A. a pleural effusion
Pressure-cycled ventilation would be LEAST appropriate for a patient with:
A. kyphosis. B. muscular dystrophy. C. chronic CO2 retention. D. a drug overdose. - ✔️ C. chronic CO2 retention.
A patient's cardiac output is increased and his QS/QT is calculated to be 20%. Based upon this information, the respiratory therapist would inform the physician this patient has:
A. an elevated shunt.
Which of the following will give the most accurate measurement of volume and flow for spirometry?
A. Collins water-sealed spirometer B. Vortex-shedding pneumotachometer C. Wright respirometer D. Dry-rolling spirometer - ✔️ A. Collins water-sealed spirometer
The following results are obtained from the pulmonary artery catheter of a patient who collapsed during a visit with a friend in the hospital:
CVP - 10 cmH2O PAP - 33/27 mm Hg PCWP - 20 mm Hg BP - 108/72 mm Hg
Which of the following conditions could be associated with these results?
A. Tricuspid valve stenosis B. Right ventricular failure C. Cardiogenic pulmonary edema D. Fluid overload - ✔️ C. Cardiogenic pulmonary edema
A patient is receiving oxygen at home via nasal cannula at 1 L/min. He has 50 feet of extension tubing attached to his oxygen concentrator. The patient complains that there does not seem to be enough oxygen flow reaching the cannula. The respiratory therapist should recommend:
A. decreasing the length of the extension tubing. B. increasing the concentrator flow. C. changing to a liquid system. D. analyzing the FIO2. - ✔️ A. decreasing the length of the extension tubing.
A post-operative thoracotomy patient is in the PACU and receiving 60% oxygen via a non-rebreather mask. A pulmonary diagnostic assessment reveals the following information:
pH - 7. PaCO2 - 34 torr PaO2 - 56 torr HCO3 - 22 mEq/L BE - 1 SaO2 - 90% f- 25/min. PAP - 49/28 mm Hg PWP - 5 mm Hg PVR - 400 dynes
SVR - 1150 dynes
To improve the patient's pulmonary status, the respiratory therapist should institute: A. mechanical ventilation with 100% O2. B. CPAP at 5 cmH2O at 60% O2. C. nitric oxide therapy at 10 ppm. D. heliox therapy at an 80:20 ratio. - ✔️ B. CPAP at 5 cmH2O at 60% O2.
Which of the following would modify the expiratory time and change the I:E ratio for a patient receiving IPPB therapy?
A. Expiratory resistance valve B. Inspiratory flow C. Rate control D. Volume control - ✔️ A. Expiratory resistance valve
