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Table of Contents
Section 1 ………………………………………………………………………………………………………………..4
Section 2 ………………………..……………………………………………………………………………….…..55
Practice Questions Pro ………………………..……..………………………………………….…..183
References ………………………..…………………………………..…………………………………….…..184

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Section 1

1. You are called to the emergency room to assist with a rapid

sequence intubation. Before the attempt, the injection of air
into the pilot line fails to inflate the cuff. What should you do
at this time?
A. Inspect the pilot line for patency
B. Replace the endotracheal tube
C. Check the cuff for leaks
D. Check the valve on the pilot line

2. You are called to assess a patient with pulmonary

hypertension. Which of the following would you recommend
for this patient?
A. Oxygen
B. Carbon dioxide
C. Heliox
D. Nitric oxide

3. You are called by the nurse because a patient with CHF keeps
taking off their nonrebreathing mask. Which of the following
would you recommend?
A. Change to a HFNC
B. Change to a partial rebreathing mask
C. Change to a 50% air entrainment mask
D. Use tape to keep the nonrebreathing mask in place

4. Which of the following EKG leads should be placed in the 4th

intercostal space at the patient’s right sternum?
A. V1

4
 B. V2
C. V3
D. V4

5. You would recommend ceasing a cardiopulmonary exercise

test in which of the following conditions?
A. A 10% decrease in SpO2 from the baseline value
B. A 10 mm Hg rise in systolic blood pressure
C. An increase in heart rate from 88/min to 165/min
D. An increase in the patient’s level of dyspnea

6. Which of the following would not be recommended for a

critically ill patient with signs and symptoms of fluid overload?
A. The initiation of diuretic therapy
B. The administration of corticosteroids
C. The administration of dialysis for renal failure
D. The restriction and close monitoring of fluid intake

7. The patient is instructed to take a deep breath in and then

exhale as quickly as possible. The fastest air movement is
recorded. Which of the following tests is being measured?
A. Vital capacity
B. FEV1
C. FEF25-75%
D. Peak flow

5
8. You are needed in the NICU to help with the intubation of an
infant. While gathering supplies, which of the following
laryngoscope blades would you select?
A. Miller
B. Macintosh
C. Guedel
D. Berman

9. You were called by the physician to obtain a capillary blood

sample. Which of the following is true regarding this sample
type?
A. The sample must be drawn from the first drop of surface
blood
B. The puncture normally is performed on the ball of the foot
C. The sample pH and PCO2 correlate well with standard ABG
results
D. To obtain the sample, you need to milk the puncture site

10. While listening to the breath sounds of a 55-year-old patient,

you hear a creaking or grating sound. The sound gets louder
with deep breathing but is not affected by coughing. Which
of the following conditions is most likely present?
A. Atelectasis
B. Pleurisy
C. Chronic bronchitis
D. Pulmonary edema

11. While assessing a female patient on her posterior side,

palpitation reveals minimal diaphragmatic movement on the
right side as she takes a deep breath. Her movement on the

6
 left side is normal. Which of the following conditions best
explains this finding?
A. Pulmonary emphysema
B. Atelectasis in the left lower lobe
C. Phrenic nerve paralysis on the left side
D. A pleural effusion on the right side

12. A 69-year-old male patient in the ICU displays the following

ABG results:
pH = 7.43
pCO2 = 21 torr
HCO3 = 13 mEq/L
His ABG results can be interpreted as which of the following?
A. Acute respiratory alkalosis
B. Partially compensated respiratory alkalosis
C. Fully compensated respiratory alkalosis
D. Combined respiratory and metabolic alkalosis

13. Which of the following must you do in order to allow a

patient with a tracheostomy button to talk or cough
effectively?
A. Attach a one-way inspiratory valve
B. Completely deflate the button cuff
C. Use spacers to position the button
D. Attach a standard 15-mm connector

14. Which of the following would be considered a

contraindication for the insertion of a Laryngeal Mask
Airway?
A. Conscious or semi-conscious patients
B. Patients with a risk of aspiration

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 C. Patients who are breathing spontaneously
D. Both A and B

15. The amount of gas that can be inhaled above the volume
that is normally inhaled during quiet breathing is called
what?
A. FRC
B. ERV
C. IRV
D. VC

16. You have been monitoring the vital capacity and maximum
inspiratory pressure readings over the last 4 hours of a 39-
year-old female patient that is receiving mechanical
ventilation. The values have steadily decreased over this time
period. How should this be interpreted?
A. Her condition is worsening
B. She has undiagnosed asthma
C. Her strength is improving
D. She is not giving her best effort

17. As a Respiratory Therapist, you should recommend an

annual influenza vaccination to which of the following?
A. A 4-month-old infant
B. A 63-year-old male with Guillain-Barr syndrome
C. A 28-year old pregnant female patient
D. A nurse that works on your floor

8
18. You are called to help measure a patient’s central venous
pressure with a strain-gauge pressure transducer. The
transducer appears to be positioned well above the middle of
the patient’s lateral chest wall. What effect, if any, would this
have on the measurement?
A. It would underestimate the CVP
B. It would overestimate the CVP
C. It would cause damping of the signal
D. It would not affect the measurement

19. While inspecting a 70-year-old male patient, you note that

he has an abnormal spine that appears to curve laterally and
from front to back. This best describes which of the
following?
A. Kyphosis
B. Scoliosis
C. Kyphoscoliosis
D. Pectus excavatum

20. A child is admitted to with the following symptoms:

Fever
Difficulty swallowing
Drooling
Stridor
A lateral neck x-ray was taken and shows supraglottic
swelling. Which of the following is the most likely diagnosis?
A. Croup
B. Asthma
C. Epiglottitis
D. Foreign body obstruction

9
21. A patient performs an FVC maneuver and displays the
following results:

How would you interpret this flow-volume loop tracing?

A. Normal lungs
B. Small airway obstruction
C. Large airway obstruction
D. Restrictive disease

22. The doctor requests the insertion of a nasopharyngeal airway

on a female patient. Which of the following would you do in
order to estimate the appropriate length of the airway?
A. Measure the distance from the earlobe to the tip of the
nose
B. Use the estimation formula of length (cm) = 12 + (age/2)
C. Subtract twice the diameter of the tube from its length
D. Measure the distance from the earlobe to the ‘Adam’s
Apple’

23. Which of the following patients is the best candidate for

high-frequency oscillation ventilation?
A. A child with severe hypercapnia

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 B. A neonate with refractory hypoxemia
C. An adult with refractory hypoxemia
D. An adult with status asthmaticus

24. A 61-year-old male patient who weighs 165 lbs is receiving

volume control A/C ventilation with a tidal volume of 500 mL.
He has the following data:
PEEP 5
PIP 35
Pplat 30
What is the patient’s static compliance?
A. 16.7 mL/cm H2O
B. 20.0 mL/cm H2O
C. 25.7 mL/cm H2O
D. 30.0 mL/cm H2O

25. Which of the following would most likely cause a misleading

or incorrect pulse oximetry reading?
A. High cardiac output
B. Low Hb concentration
C. Excessive probe movement
D. Elevated body temperature

26. While inspecting an EKG rhythm strip of a 57-year-old male

patient, you note the following:
Rate 164
Irregular rhythm
No clear P waves
Abnormal QRS complexes
Which of the following is the interpretation?

11
 A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. Ventricular fibrillation

27. An adult patient with pneumonia was intubated and placed

on pressure control ventilation with an FiO2 of 40% and a
PEEP of 10 cm H2O. Their chest x-ray shows bilateral
infiltrates. After being on the ventilator for 30 minutes, an
ABG is obtained with the following results:
pH 7.47
PaCO2 33 torr
PaO2 60 torr
SaO2 90%
HCO3 25 mEq/L
BE +2 MEq/L
You would describe the patient’s condition as being
consistent with which of the following:
A. Mild ARDS
B. Moderate ARDS
C. Severe ARDS
D. Moderate hypoxemia

28. A 56-year-old female patient with a pneumothorax has a

pleural drainage system in place. Upon assessment, you note
that there is sporadic bubbling in the water seal chamber.
Which of the following would you recommend?
A. This is a normal finding
B. Withdraw the chest tube about 3-4 cm
C. Check the connecting tubing for leaks
D. Add water to the water seal chamber

12
29. A 59-year-old male patient is receiving volume control
ventilation? Which of the following would cause his peak
airway pressure to increase?
A. Bronchospasm
B. Leak in the ET tube cuff
C. Leak in the ventilator circuit
D. Pulmonary edema that has improved

30. While assessing a 58-year-old female patient that is receiving

volume controlled A/C ventilation, you notice that her peak
pressure has increased by 10 cm H2O over the last hour while
her plateau pressure has not changed. The patient has
significant wheezing in both lungs that was not present
earlier. Which of the following would you recommend for this
patient?
A. Suction the patient’s airway
B. Nebulize a bronchodilator
C. Nebulize a corticosteroid
D. Increasing the tidal by 50 mL

31. Which of the following side effects can be expected after

that administration of aerosolized epinephrine?
A. Laryngospasm
B. Bronchospasm
C. Tachycardia
D. Bradycardia

13
32. The physician requests a humidifier device that can
condition the inspired gas to 100% body humidity. Which of
the following would you recommend?
A. Bubble humidifier
B. Pneumatic nebulizer
C. Heated wick humidifier
D. Heat and moister exchanger

33. You are needed to assist with the intubation of a premature

infant. Which laryngoscope blade would you recommend?
A. Miller blade number 0
B. Miller blade number 2
C. MacIntosh blade number 0
D. MacIntosh blade number 1

34. The physician ordered a V/Q scan on a 59-year-old patient.

Which of the following conditions would a ventilation scan
appear normal but a perfusion scan reveal areas of absent
blood flow?
A. Pneumonia
B. Lung cancer
C. Pulmonary embolism
D. Emphysema

35. A 55-year-old patient that is receiving aerosol therapy with

0.9% saline is unable to produce an acceptable volume of
sputum for a sample. Which of the following would you
recommend at this time?
A. Initiate chest physiotherapy
B. Administer the aerosol continuously
C. Change to hypertonic saline

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 D. Perform nasotracheal suctioning

36. A 40-year-old female patient was discharged with an order

for 2 L/min of home oxygen. Which of the following would
you recommend?
A. Oxygen concentrator with an oxygen-conserving nasal
cannula
B. Oxygen concentrator with a simple mask
C. Multiple H cylinder tanks with a nasal cannula
D. Liquid oxygen system with a nasal cannula

37. You are called to collect a sputum sample on a patient in the

ICU. Which of the characteristics of the sputum, when
assessed at the bedside, should be documented in the
patient’s chart?
A. The density
B. The viscosity
C. The DNA content
D. The surface tension

38. You are called to evaluate a patient who appears to be

asleep. His respiratory rate is 14 breaths/min and heart rate is
72 beats/min. In order to determine the patient’s level of
consciousness, you speak to the patient but he does not
respond. Which of the following should you do first?
A. Call for help
B. Administer a sternal rub
C. Wait 1 hour and then repeat the attempt
D. Gently shake the patient’s arm

15
39. While reviewing the lateral neck radiograph of a 3-year-old
boy, you note that there is a clear air column through the
upper airway and narrowing of the tracheal air column below
the larynx. Which of the following conditions is most likely
present?
A. Tonsillitis
B. Aspirated a coin
C. Epiglottitis
D. Laryngotracheobronchitis

40. A newborn infant needs immediate resuscitation. While

performing chest compressions, how far should the sternum
be compressed?
A. At least 2 inches
B. One-half the AP diameter of the chest
C. No more than 0.5 inches
D. One-third of the AP diameter of the chest

41. A 69-year-old female patient has been diagnosed with

pneumonia. The physician asks you to assess the patient.
Which of the following breath sounds would you expect to
hear upon auscultation?
A. Wheezing
B. Bronchial
C. Vesicular
D. Hyperresonance

42. You have just administered a routine breathing treatment

with albuterol via small volume nebulizer. Which of the

16
 following is the best documentation that must be added to
the patient’s chart?
A. Treatment given as ordered
B. Aerosol therapy given; pulse stable, no changes during
therapy; well tolerated
C. Aerosol therapy given with 0.5 mL albuterol and 3 mL
normal saline; vital signs stable; well tolerated
D. Aerosol therapy given with 0.5 mL albuterol and 3 mL
normal saline via SVN; heart rate of 74 beats/min during
therapy; B.P. stable at 120/80; respiratory rate 16/min;
therapy well tolerated; chest clear on auscultation

43. What is the primary cause of the S2 heart sound?

A. The opening of the semilunar valves
B. The opening of the atrioventricular valves
C. The closing of the semilunar valves
D. The closing of the atrioventricular valves

44. While auscultating the chest of an 62-year-old patient, you

hear diminished breath sounds. This may indicate the
presence of which of the following?
A. Laryngospasm
B. Pleural effusion
C. Bronchoconstriction
D. Aspirated foreign body

45. A 48-year-old female patient has been admitted to the

emergency department with the following arterial blood gas
results:
pH 7.54

17
 PaCO2 29 torr
PaO2 86 torr
HCO3- 24 mEq/L
Which of the following is the best interpretation of these
results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

46. Which of the following infection control procedures is to be

used when drawing an arterial blood gas?
A. Hand washing and gloves only
B. Gown and protective eyewear
C. Mask and protective eyewear
D. All CDC standard precautions

47. A 21-year-old male patient arrives to the ER with cervical

collar after a motor vehicle accident. In order to quickly
secure the airway and provide ventilation, which of the
following would you recommend?
A. Perform a blind nasotracheal intubation
B. Orally intubate with manual in-line stabilization
C. Insert a nasopharyngeal airway
D. Apply the head-tilt, chin-lift maneuver

48. After reviewing the chest radiograph of a 71-year-old male,

you noticed a large area of consolidation in the right lung.
Which of the following is the most likely cause of this
problem?
A. Pulmonary barotrauma

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 B. Tension pneumothorax
C. Interstitial emphysema
D. Lobar pneumonia

49. In general, which of the following radiographic imaging

procedures can be used to evaluate a patient’s arteries for
abnormalities?
A. PET scan
B. V/Q scanning
C. Angiography
D. Standard radiography

50. You are about to perform a pulmonary function test on a 65-

year-old male patient after providing a bronchodilator
breathing treatment. It is suspected that the patient has
COPD. His results are as follows:
FEV1/FVC ratio = 64%
FEV1 = 86% predicted
How would you would characterize this patient?
A. Normal
B. Mild COPD
C. Moderate COPD
D. Severe COPD

51. While palpating your patient’s radial artery for a 1-minute

pulse check, you noticed 95 unevenly spaced beats with a
decreased pulse strength during inspiration. Which of the
following best describes this patient’s pulse?
A. Bounding pulse
B. Thready pulse
C. Pulsus alternans

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 D. Pulsus paradoxus

52. In which of the following conditions would postural drainage

be most helpful?
A. Pleural effusion
B. Cystic fibrosis
C. Pneumonia
D. Asthma

53. You were called to help with the treatment of a newborn in

the neonatal ICU. The physician states that the infant needs
hyperventilation. This form of treatment would be
recommended in which of the following types of patients?
A. Meconium aspiration
B. Respiratory distress syndrome
C. Infant with normal lung compliance
D. Persistent newborn pulmonary hypertension

54. While administering a nebulizer breathing treatment to an

adult patient on the ventilator, you noticed that large water
droplets are coming from the device and are collecting in the
large bore tubing. Which of the following would you
recommend at this time?
A. Replace the faulty nebulizer
B. Add water to the nebulizer
C. Dismantle and clean the nebulizer
D. Add a heated humidifier to the nebulizer

20
55. A 71-year-old male patient is receiving pressure-control
mechanical ventilation with a set expiratory time. Upon
assessment, you noticed that the patient’s ET tube is partially
obstructed. Before checking the settings, you would expect
all of the following EXCEPT:
A. Decreased inspiratory time
B. Increased PEEP
C. Decreased delivered tidal volume
D. Increased respiratory rate

56. A 56-year-old male patient with pneumonia has a moderate

amount of oral secretions. Which of the following would you
recommend for suctioning at the patient’s bedside?
A. Lukens trap
B. Coude catheter
C. Yankauer
D. Bulb suction

57. A 55-year-old female patient is receiving oxygen via a

nonrebreathing mask that is set at 15 L/min. Upon
assessment, you note that the reservoir bag does not deflate
at all during inspiration. Which of the following is the most
likely cause of this problem?
A. The patient is a nose-breather
B. The patient is a mouth-breather
C. The oxygen flowmeter setting is too low
D. The mask is not tight enough on the face

58. An adult patient that is receiving volume control ventilation

has a circuit that is visibly soiled and needs to be changed.
After switching to a new circuit, the patient’s exhaled tidal

21
 volume is 200 mL less than before and the peak inspiratory
pressure is 10 cm H2O lower. Which of the following is the
most likely cause of these finding?
A. A circuit port is open to the atmosphere
B. An obstruction of the expiratory line
C. A mucous plug in the patient’s ET tube
D. The patient’s lung compliance has decreased

59. An adult patient in the emergency room needs to be

intubated STAT. Before starting the procedure, it’s required
to check all of the following devices EXCEPT:
A. Suction equipment
B. Laryngoscope light source
C. Rigidity of the stylet
D. Endotracheal tube cuff

60. A 73-year-old patient has been receiving aerosol

bronchodilator therapy via nebulizer with a mouthpiece
every 6 hours. The patient has become very lethargic since
the last treatment. How should you proceed?
A. Discontinuing the therapy
B. Give the treatment with an aerosol mask
C. Give the treatment as usual with a mouthpiece
D. Ask the physician for their opinion

61. A 67-year-old female patient diagnosed with pulmonary

edema has progressive worsened. In such case, you would
expect the fluid in her lungs to move in which of the
following sequences?
A. Alveoli, to bronchioles, to bronchi
B. Bronchioles, to bronchi, to the trachea

22
 C. Bronchi, to bronchioles, to alveoli
D. Pulmonary capillaries, to alveoli, to bronchi

62. While assessing a newborn infant girl, you note that the AP
and the lateral dimensions of her chest are about the same.
This would indicate that the infant has:
A. Pectus excavatum
B. Pectus carinatum
C. Signs of air trapping
D. Normal chest anatomy

63. In order to sterilize respiratory care equipment in an alkaline

glutaraldehyde (Cidex) solution, you would need to leave the
equipment submersed for how long?
A. 10-20 minutes
B. 2 hours
C. 10 hours
D. 24 hours

64. While assessing a 61-year-old male patient via chest

palpitation, you note that there is less movement on the
patient’s left side compared to the right side. This is an
indication for which of the following conditions?
A. Left-sided Emphysema
B. Right-sided Emphysema
C. Left-sided pneumonia
D. Right-sided pneumonia

23
65. A patient with which of the following conditions would
require airborne precautions?
A. Hepatitis
B. Tuberculosis
C. Lung cancer
D. An open wound

66. A blood gas was obtained on an adult patient but the results
appear to be erroneous. You suspect that the pH is falsely
high. Which of the following would cause this error?
A. Severe erythrocytosis
B. The use of a glass syringe
C. Ongoing blood metabolism
D. Air bubbles in the sample

67. An unconscious 47-year-old post-operative patient is

showing signs of atelectasis. Which of the following would
you recommend in order to improve the patient’s
ventilation?
A. Incentive spirometry
B. IPPB
C. Flutter
D. Nasotracheal suctioning

68. An EKG was taken on a dyspneic 50-year-old female patient

in the emergency department. In which of the following
results should defibrillation be performed?
A. Atrial flutter
B. Sinus tachycardia
C. Second-degree heart block
D. Pulseless ventricular tachycardia

24
69. During a bronchoscopy procedure, the physician notes that
the patient shows signs of endobronchial bleeding. Which of
the following would you recommend?
A. Providing 100% oxygen via nonrebreather
B. Direct instillation of Lidocaine
C. Direct instillation of a cold saline solution
D. Direct instillation of an epinephrine solution

70. A chest X-ray was taken on an intubated 44-year-old male

patient. Which of the following can be used to confirm
proper placement of the endotracheal tube?
A. The tip of the tube is even with the carina
B. The tip of the tube is 2-6 cm above the carina
C. The tip of the tube is at the sixth intercostal space
D. The tip of the tube is level with the 5th cervical vertebra

71. A 68-year-old female patient is receiving volume control A/C

mechanical ventilation. Which of the following would you
recommend in order to help prevent ventilator-associated
pneumonia?
A. Use heated humidification
B. Use disposable circuit components
C. Use a closed suction catheter
D. Change the ventilator circuit every 24 hours

72. A 41-year-old female patient was recently extubated. She is

current receiving cool mist therapy but begins to develop
stridor. Which of the following would you recommend?
A. Administer racemic epinephrine

25
 B. Reintubate the patient
C. Draw and analyze an arterial blood gas
D. Change from cool mist to heated aerosol

73. A 51-year-old male patient that is receiving mechanical

ventilation has passed a spontaneous breathing trial. The
physician wants to proceed with extubation. Before
considering extubation, you need to evaluate all of the
following criteria EXCEPT:
A. The presence of upper airway reflexes
B. The ability to cough
C. The risk of aspiration
D. The amount of secretions

74. A paralyzed 68-year-old female patient is receiving volume

control A/C mechanical ventilation. The high pressure alarm
keeps sounding and her breath sounds are noticeably
decreased. Which of the following actions would you
recommend first?
A. Recommend a chest X-ray
B. Reposition the endotracheal tube
C. Increase the alarm pressure limit
D. Attempt to insert a suction catheter

75. In which of the scenarios would it be appropriate to select a

heated humidifier during mechanical ventilation instead of
an HME?
A. A patient with a high fever
B. A patient with thick secretions
C. A patient intubated via the nasal route
D. A patient requiring intra hospital transport

26
76. A 60-year-old female patient is receiving volume control
ventilation and you note that the endotracheal tube has
become obstructed. Which of the following findings would
you expect?
A. High volume alarm
B. Low volume alarm
C. Decreased lung compliance
D. Decreased peak pressure

77. An intubated 59-year-old female patient is receiving

mechanical ventilation with a size 7.0 endotracheal tube.
Over the last hour, the patient has been clamping the tube
between her teeth. Which of the following would you
recommend?
A. The use of an oropharyngeal airway
B. The application of a Brigg’s adapter
C. The administration of a strong narcotic analgesic
D. The administration of a neuromuscular blocking agent

78. All of the following are indications for changing a

tracheostomy tube EXCEPT?
A. Need for a different size
B. Damaged tube cuff
C. Soiled stoma dressing
D. Need for a fenestrated tube

79. You are called to the emergency department to help

extubate an adult patient who is orally intubated. All of the

27
 following equipment should be available for extubation
EXCEPT:
A. Laryngoscope
B. Suction equipment
C. Bag-valve mask
D. Noninvasive ventilator

80. The physician asks for your opinion on whether or not to

initiate IPPB on a new post-operative adult patient. Which of
the following is an absolute contraindication for this
treatment modality?
A. Acute atelectasis
B. Tension pneumothorax
C. Congestive heart failure
D. Bacterial pneumonia

81. It is noted that a 64-year-old male patient has secretions in

the anterior segment of the right upper lobe. Which of the
following positions would you recommend for postural
drainage?
A. Right lateral decubitus position
B. Left lateral decubitus position
C. Supine position with a pillow under the hips
D. Trendelenburg position with a pillow under the hips

82. A 54-year-old female patient was admitted to the ER after

being in a motor vehicle accident. Which of the following
thoracic ultrasound findings will show with the presence of a
pneumothorax?
A. The absence of A-lines
B. The presence of seashore sign

28
 C. The presence of a barcode sign
D. The presence of gliding sign

83. Incentive spirometry was ordered for an adult post-operative

patient in the ICU. The ability to obtain successful results
from this type of therapy depends mostly on which of the
following?
A. The type of surgery that was performed
B. The difficulty of the set initial goal
C. The quality of the device
D. The effectiveness of instructing the patient

84. A 66-year-old female patient is receiving bland aerosol

therapy. Upon auscultation, you hear rhonchi sounds in the
middle and upper lung fields. Which of the following would
you recommend?
A. Encourage the patient to cough
B. Administer oxygen therapy
C. Discontinue bland aerosol therapy
D. Administer a bronchodilator

85. The nurse calls and requests for you to suction a 2-week-old
infant excess secretions. What is the normal range of
negative pressure that should be used?
A. -60 to -80 mm Hg
B. -80 to -100 mm Hg
C. -100 to -120 mm Hg
D. -150 to -200 mm Hg

29
86. A 65-year-old female patient is receiving therapy with a
pressure-cycled ventilator via mouthpiece. In order to extend
the inspiratory time, you can do which of the following?
A. Increase the flow
B. Decrease the flow
C. Increase the sensitivity
D. Decrease the sensitivity

87. You are called to perform a chest assessment of a new

patient. Upon assessment, you notice that the patient has a
paradoxical chest wall movement. Which of the following
best describes this finding?
A. Chronic bronchitis
B. Flail chest
C. Exacerbation of COPD
D. Tension pneumothorax

88. What size suction catheter is most appropriate for an adult

patient that is intubated with a size 8.0 mm endotracheal
tube?
A. 10 Fr
B. 12 Fr
C. 14 Fr
D. 16 Fr

89. An adult patient receiving oxygen via nasal cannula at 4

L/min is indicated for nasotracheal suctioning. Before
inserting the catheter, the patient’s heart rate is 89/min and
the SpO2 is 95%. After suctioning, the heart rate decreased to
45/min. What is the most likely cause of this problem?
A. A severe mucus plug

30
 B. Vagal stimulation
C. Hypoxemia during suctioning
D. A pneumothorax has developed

90. A 68-year-old male patient is receiving volume controlled

SIMV. Upon assessment, you note that the high exhaled
minute ventilation alarm is sounding. All of the following are
potential causes of this finding EXCEPT:
A. A change in the set rate
B. A change in the set tidal volume
C. An increase in spontaneous ventilation
D. A leak is present

91. A 75 kg postoperative male patient is intubated and the

physician orders pressure control A/C ventilation. Which of
the following settings would you choose for this patient?
A. Rate = 12/min; PIP = 30 cm H2O; inspiratory time = 2
seconds
B. Rate = 12/min; PIP = 25 cm H2O; inspiratory time = 1
second
C. Rate = 20/min; PIP = 40 cm H2O; inspiratory time = 1
second
D. Rate = 30/min; PIP = 30 cm H2O; inspiratory time = 1
second

92. An 80 kg male patient was admitted for an acute

exacerbation of COPD. Volume control ventilation was
initiated with a tidal volume of 600 mL and a mandatory rate
of 10/min. 30 minutes later, his ABG results show a PaCO2 of
30 mm Hg. The physician wants to increase the patient’s

31
 PaCO2 to 50 mm Hg. Which of the following settings would
you recommend?
A. Rate 10/min; Tidal volume 700 mL
B. Rate 10/min; Tidal volume 500 mL
C. Rate 15/min; Tidal volume 500 mL
D. Rate 15/min; Tidal volume 700 mL

93. A 63-year-old male patient is receiving mechanical

ventilation with a rate of 12/min and an l:E ratio of 1:3. What is
the length of the patient’s inspiration?
A. 1.0 second
B. 1.25 seconds
C. 1.5 seconds
D. 2.0 seconds

94. A 60-year-old female patient is receiving BiPAP in the ICU.

The physician wants to change the patient to CPAP while
remaining on the same machine. Which of the following
would you recommend?
A. Set the EPAP to 0 cm H2O
B. Set the IPAP less than the EPAP
C. Set the IPAP greater than the EPAP
D. Set the IPAP equal to the EPAP

95. A 57-year-old female patient is receiving positive-pressure

ventilation. You should strive to keep the plateau pressure
below which of the following?
A. 20 cm H2O
B. 30 cm H2O
C. 40 cm H2O
D. 50 cm H2O

32
96. An adult patient is receiving mechanical ventilation in the
assist-control mode. Which of the following is the most
common problem associated with this mode?
A. Hypoventilation
B. Hyperventilation
C. Increased work of breathing
D. The need for neuromuscular paralysis

97. An adult patient is receiving volume-controlled ventilation in

the ICU. Upon assessment, you note a sudden drop in the
peak inspiratory pressure. Which of the following is most
likely the cause of this problem?
A. Mucous plug
B. Tension pneumothorax
C. Busted ET tube cuff
D. Copious airway secretions

98. A 58-year-old female patient with a tracheostomy is

receiving aerosol via trach mask. Over a 1-week period, the
patient developed an infection in the stoma and airways.
Which of the following is the most likely cause?
A. Poor hand washing by caregivers
B. The patient’s own upper airway bacteria
C. A factory-contaminated tracheostomy mask
D. The use of nebulizer water past its expiration date

99. An adult patient diagnosed with chronic bronchitis needs to

be transported through an area of the hospital where there
are patients documented with a respiratory infection of

33
 unknown origin. Which of the following precautions would
you recommend for this patient?
A. Airborne
B. Droplet
C. Contact
D. All of the above

100. A 60-year-old female patient with tachypnea, dyspnea, and

expiratory wheezes was unresponsive to a bronchodilator
treatment. Which of the following is most likely the
patient’s condition?
A. Asthma
B. Chronic bronchitis
C. Pulmonary edema
D. Emphysema

101. What is the maximum volume of gas that can be exhaled

as forcefully and quickly as possible?
A. FVC
B. FRC
C. IRV
D. ERV

102. You are called to help obtain a central venous pressure

measurement using a Swan-Ganz catheter. Before the
measurement is taken, the physician asks, “what is the
normal range for CVP?” Which of the following would you
select?
A. 2 - 6 mmHg
B. 4 - 12 mmHg
C. 4 - 8 L/min

34
 D. 2 - 4 L/min/m2

103. It has been determined that a 62-year-old female patient

has pneumonia. This disorder can be classified as which of
the following?
A. A restrictive disorder
B. An obstructive disorder
C. Both a restrictive and obstructive disorder
D. Neither a restrictive or obstructive disorder

104. After obtaining a patient's PFT results, they have a vital

capacity of 4.1, functional residual capacity of 5.3, and a
expiratory reserve volume of 1.7. What is the patient's total
lung capacity?
A. 5.2
B. 7.7
C. 8.9
D. 9.7

105. You are called to review the electrolyte results of an adult

patient. Which of the following values is typical for serum
chloride?
A. 63 mEq/L
B. 77 mEq/L
C. 91 mEq/L
D. 109 mEq/L

35
106. Which of the following problems is most likely associated
with a patient whose ABG results show respiratory
alkalosis?
A. Hypoxemia
B. Hypothermia
C. CNS depression
D. Opiate overdose

107. While assessing a 49-year-old male patient, you notice

swelling in the lower limbs. This is most likely indicative of
which of the following?
A. Hypovolemia
B. Chronic hypertension
C. Right ventricular insufficiency
D. Left ventricular insufficiency

108. While performing a full code blue on a 5-year-old pediatric

patient that is in respiratory arrest, you should bag-mask
ventilation at a rate of what?
A. 6-12 breaths/min
B. 12-20 breaths/min
C. 20-25 breaths/min
D. 25-30 breaths/min

109. While auscultating a 42-year-old male patient, you hear a

grating sound on both inspiration and expiration. The
patient has been complaining of pain over his lungs. Which
of the following is the most likely cause of this problem?
A. Bronchoconstriction
B. Secretions in the airways

36
 C. Pleural friction rub
D. Exacerbation of COPD

110. You are scheduled to perform a methacholine challenge on

a female patient. What percent decrease in FEV1 needs to
occur in order to conclude that a methacholine challenge is
positive for airway hyperreactivity?
A. 10%
B. 15%
C. 20%
D. 25%

111. A 46-year-old female patient displays the following bedside

spirometry results:
FEV1 decreased
FVC normal
FEV1% decreased
Which of the following is most likely the problem?
A. An obstructive disorder
B. A restrictive disorder
C. Poor patient effort
D. Typical PFT results

112. A diagnostic bronchoscopy procedure would be

contraindicated in which of the following patients?
A. A patient with lung carcinoma
B. A patient with unexplained wheezing
C. A patient with active hemoptysis
D. A patient that is hemodynamically unstable

37
113. A 65-year-old male patient is receiving mechanical
ventilation in control mode. In this mode, a breath will be
triggered in response to which of the following?
A. The patient’s inspiratory efforts only
B. Either the patient’s inspiratory efforts or a timing
mechanism
C. The timing mechanism of the ventilator only
D. The timing mechanism and the pressure settings on
the ventilator

114. A patient in the ICU with a deep vein thrombosis suddenly

experienced an episode of dyspnea. Which of the following
would you recommend in order to further evaluate the
patient’s condition?
A. Chest radiograph
B. Lung compliance
C. VD/VT
D. Electrocardiogram

115. Hemodynamic data was collected on a 39-year-old male

patient. Which of the following indicates that there is a
problem with this patient?
A. Shunt of 3%
B. SVR of 1100 dyn/s/cm-5
C. Cardiac Index of 2.1 L/min/m2
D. CVP of 5 cmH2O

38
116. Which of the following would be your primary reasoning for
selecting a high flow nasal cannula system for an adult
patient?
A. To provide CPAP therapy
B. To increase the inspired humidity
C. To washout anatomic deadspace
D. To assure the delivery of a stable or fixed FiO2

117. A patient has been admitted to the emergency

department with the following arterial blood gas results:
pH 7.24
PaCO2 29 torr
PaO2 81 torr
HCO3- 13 mEq/L
Which of the following best describes the given results?
A. Partially compensated metabolic alkalosis
B. Partially compensated metabolic acidosis
C. Uncompensated respiratory acidosis
D. Uncompensated respiratory alkalosis

118. A 61-year-old male patient is intubated with a size 8

endotracheal tube and is receiving positive pressure
ventilation in volume control, assist-control. Upon
assessment, you notice a large air leak throughout
inspiration with a cuff pressure measurement of 14 cm H2O.
Which of the following actions should you take?
A. Reassess the cuff pressure during expiration
B. Inflate the ET tube cuff to between 20–30 cm H2O
C. Add an additional 10 mL of air to the ET tube cuff
D. Replace the endotracheal tube with a larger size

39
119. A 51-year-old patient on room air has the following ABG
results:
pH 7.43
PaCO2 47 torr
PaO2 169 torr
Which of the following is the best action to take?
A. Report the results to the attending physician
B. Report the results to the patient’s nurse
C. Discard the sample and obtain a new one
D. Give the patient a bronchodilator treatment

120. Using spirometry, you tested a 52-year-old female patient

before and after a bronchodilator was given. The results
show that her FEV1 increased from 62% to 83% of predicted.
What do these results indicate?
A. A fixed airway obstruction is present
B. The patient has normal diffusion capacity
C. The patient has a reversible airway obstruction
D. The patient has a restrictive process

121. A 64-year-old female patient with a neurological condition

is breathing at a very fast rate with periods of apnea. Which
of the following best describes this condition?
A. Biot’s
B. Hyperpnea
C. Orthopnea
D. Cheyne-stokes

122. The following ABG results were obtained on a 28-year-old

female patient:

40
 pH 7.28
PaCO2 22 torr
HCO3 12 mEq/L
BE -13
PaO2 111 torr
Her ABG results indicate which of the following?
A. Acute metabolic alkalosis
B. Partially compensated metabolic acidosis
C. Partially compensated respiratory alkalosis
D. Acute respiratory acidosis

123. What is the most common complication associated with

endotracheal tube extubation?
A. Tracheomalacia
B. Laryngospasm
C. Bradycardia
D. Aspiration

124. You were called to assess an infant in the NICU. While

observing the infant’s chest configuration, you note that it is
the same size in both the AP and the lateral dimensions.
This would indicate that the infant has which of the
following?
A. A normal chest
B. Lordosis
C. Pectus excavatum
D. Pulmonary emphysema with air trapping

125. While reviewing the ABG results of a newly admitted

patient, you note a PaCO2 of 23 torr, a base excess of -11

41
 mEq/L, and a pH of 7.36. This interpretation can be classified
as which of the following?
A. Acute (uncompensated) respiratory alkalosis
B. Acute (uncompensated) metabolic acidosis
C. Compensated metabolic acidosis
D. Compensated respiratory alkalosis

126. A patient has the following bedside spirometry results:

Respiratory rate = 12
Tidal volume = 450 mL
Dead space = 147 mL,
Vital capacity = 1.2 L
Based on this data, what is the patient’s minute ventilation?
A. 3.1 L/min
B. 4.7 L/min
C. 5.4 L/min
D. 8.2 L/min

127. Which of the following bedside measurements is

considered to be the best for assessing the function of the
respiratory muscles and mechanical properties of the
lungs?
A. Functional residual capacity
B. Vital capacity
C. Maximum inspiratory force
D. Minute ventilation

128. A 58-year-old male patient with thick oropharyngeal

secretions is in need of suctioning. Your first attempt with a
Yankauer was unsuccessful and you noticed that the

42
 pressure regulator is set to -80 mm Hg. Which of the
following would you recommend?
A. Perform nasotracheal suctioning
B. Replace the wall suction regulator
C. Change to a flexible catheter
D. Increase the suction pressure to -120 mm Hg

129. An adult patient is intubated and receiving volume control

ventilation with an HME. Over the past 6 hours, you noticed
that the patient’s peak pressure has been progressively
increasing. After in-line suctioning was performed, you
noted that the patient’s secretions were of normal volume
and viscosity. Which of the following would you
recommend?
A. Increase the HME temperature
B. Decrease the respiratory rate
C. Change the HME
D. Change to a heated wick humidifier

130. A 71-year-old female patient is receiving therapy via a

positive pressure-cycled ventilator via mouthpiece. Upon
assessment, you note that the machine fails to cycle off on
exhalation. Which of the following would you recommend?
A. Increase the sensitivity
B. Increase the flow
C. Use a flanged mouthpiece
D. Have the patient exhale more forcefully

131. Placing a patient in the Trendelenburg position would be

contraindicated for which of the following?

43
 A. Bronchiectasis
B. Congestive Heart Failure
C. Ciliary dyskinesia
D. Cystic fibrosis

132. In order to establish the initial ventilator settings for a new

patient, the most important consideration is which of the
following?
A. The amount of spontaneous ventilatory effort
B. The type of ventilatory support device used
C. The quality of the physician and staff
D. The patient’s size and clinical condition

133. A BiPAP machine that was used in the emergency

department was just returned for cleaning. Which of the
following agents would you use for surface disinfection?
A. Ethylene oxide
B. 70% ethyl alcohol
C. Alkaline glutaraldehyde
D. Acetic acid

134. An 58-year-old female patient is receiving positive pressure

mechanical ventilation. Which of the following is an
indication for the addition of positive-end expiratory
pressure?
A. To increase the efficiency of ventilation
B. To decrease hypoxemia due to shunting
C. To decrease the physiologic deadspace
D. To provide graded levels of ventilatory support

44
135. Oxygen via nasal cannula was ordered for a post-operative
patient with an SpO2 of 82% on room air. After 30 minutes
on 3 L/min, the patient’s SpO2 increased to 87%. Which of
the following actions is appropriate at this time?
A. Intubate and initiate mechanical ventilation
B. Initiate noninvasive ventilation via full face mask
C. Increase the oxygen flow and reassess the patient
D. Decrease the oxygen flow and reassess the patient

136. A 59-year-old male COPD patient who weighs 145 lbs. is

receiving ventilatory support in the volume-control SIMV
mode. The following data was obtained:
Ventilator settings:
Tidal volume 450 mL
Rate 10
FiO2 30%
PEEP 5 cm H2O
ABG results:
pH 7.38
PaCO2 59 torr
HCO3 34 mEq/L
PaO2 62 torr
SaO2 90%
Which of the following changes would you make?
A. Increase the FIO2
B. Increase the SIMV rate
C. Increase the tidal volume
D. Maintain the current settings

45
137. Intubation and mechanical ventilation was ordered for a
130 lb female patient that has a history of COPD. Which of
the following initial settings is best for this patient?
A. Rate 10; Tidal volume 450 mL
B. Rate 10; Tidal volume 650 mL
C. Rate 14; Tidal volume 500 mL
D. Rate 14; Tidal volume 750 mL

138. An adult patient is receiving pressure support ventilation.

All of the following factors determine the amount of tidal
volume that is delivered during this mode EXCEPT:
A. The set pressure level
B. The set rate
C. The patient’s lung compliance
D. The patient’s airway resistance

139. A 60-year-old adult patient is receiving mechanical

ventilation. Which of the following ventilator graphics
would you recommend in order to assess the work of
breathing associated with patient triggering?
A. Volume vs Time
B. Flow vs Volume
C. Flow vs Time
D. Pressure vs Volume

140. An adult patient is receiving mechanical ventilation in the

volume controlled A/C mode. The ventilator has an
inspiratory time limit control that is set. If the time needed

46
 to deliver the tidal volume increases to the preset limit,
which of the following will occur?
A. The delivered tidal volume will decrease
B. The ventilator will switch to pressure control
C. The ventilator will automatically cycle to end inspiration
D. More time will be provided to complete the inspiration

141. A 62-year-old male patient in the ICU is positioned in the

semi-fowler position. During auscultation, you hear crackles
and you also noticed that the patient has frothy secretions.
Which of the following is the most likely cause of this
finding?
A. Dehydrated
B. Emphysema
C. Fluid overload
D. Hypertension

142. A 21-year-old female patient was admitted to the

emergency department for having an asthma attack. The
patient is experiencing moderate to severe levels of
dyspnea. Which of the following drugs would you
recommend for administration via nebulization?
A. Levalbuterol
B. Beclomethasone
C. Montelukast
D. Magnesium sulfate

143. A 54-year-old female patient arrives to the ER intubated

and receiving CPR. The physician requests for atropine to
be given but the paramedics were unable to establish IV

47
 access. Which of the following routes of administration
would you recommend?
A. Aerosolized via SVN
B. Intramuscular injection
C. Endotracheal instillation
D. Nasogastric instillation

144. An infant in the NICU is receiving inhaled nitric oxide. The

physician put in a new order to stop the therapy but after
doing so, the infant becomes hemodynamically unstable.
Which of the following is the best action to take at this
time?
A. Increase the FiO2
B. Initiate chest compressions
C. Administer vasodilators
D. Return the infant to the prior NO dosage

145. A beta-adrenergic bronchodilator has been administered

to a 51-year-old female patient. All of the following are side
effects associated with this drug except:
A. Tachycardia
B. Palpitations
C. Tremors
D. Bradypnea

146. A 65-year-old female patient has been weaned from

mechanical ventilation and extubated. The patient was
placed on a cool aerosol mask with an FiO2 of 40%. Within
the hour, the patient starts to develop moderate hypoxemia

48
 and hypercapnia. Which of the following would you
recommend at this time?
A. Increase the FiO2 to 60%
B. Apply BiPAP via face mask
C. Administer albuterol via small volume nebulizer
D. Re-intubate and return to previous ventilator settings

147. A 55-year-old female patient with a neuromuscular disorder

is intubated and receiving vest oscillation to help mobilize
secretions into the larger airways. She is having difficulty
clearing the secretions. Which of the following techniques
would you recommend?
A. Mechanical insufflation-exsufflation
B. Positive expiratory pressure therapy
C. Acetylcysteine via small volume nebulizer
D. Postural drainage, percussion and vibration

148. A 58-year-old female patient is showing signs of shortness

of breath, lightheadedness, and cyanosis in the lips. The
patient has a history of COPD. Upon auscultation, you note
bilateral bronchial breath sounds with inspiratory crackles.
Her ABG results are as follows:
pH 7.35
PaCO2 65 torr
PaO2 49 torr
HCO3 31 mEq/L
BE +6
Which of the following would you recommend?
A. Nasal cannula at 4 L/min
B. Albuterol aerosol via SVN
C. Air-entrainment mask at 28%

49
 D. Nonrebreathing mask at 12 L/min

149. A 91-year-old female patient with a history of lung cancer

was admitted to the emergency room and arrived by
transport via family members. The patient is unable to
respond to questions. Which of the following should be
asked in order to ensure that the proper level of care is
delivered?
A. “When was the last time the patient ate?”
B. “When was the last time the patient had a bowel
movement?”
C. “Did you bring the patient’s current home care
medications?”
D. “Has an advance directive been documented?”

150. You were called by the nurse to check on a 59-year-old

postoperative male patient who is showing signs of
tachycardia and tachypnea. The patient has an SpO2 is 83%
on 4 L/min nasal cannula. Which of the following would you
recommend?
A. Increase the flow to 6 L/min via nasal cannula
B. Initiate CPAP with a pressure of 5 cm H2O
C. Change to a nonrebreathing mask at 12 L/min
D. Intubate and provide mechanical ventilation

151. A 63-year-old postoperative female patient has been

receiving oxygen via high-flow nasal cannula for 4 days. The
device is set with an FiO2 of 70% and the flow is set at 20
L/min. Her ABG results are as follows:
pH 7.39

50
 PaCO2 43 torr
PaO2 159 torr
SaO2 99%
HCO3 24 mEq/L
Which of the following would you recommend?
A. Decrease the FiO2
B. Decrease the flow
C. Decrease both the flow and FiO2
D. Switch to a standard nasal cannula

152. Suctioning was ordered PRN for a 57-year-old male patient

who is who is having difficulty clearing secretions. The
patient is awake and receiving oxygen via nasal cannula at 2
L/min. Which of the following would you recommend to
facilitate suctioning for this patient?
A. Yankauer catheter
B. Oropharyngeal airway
C. Laryngeal mask airway
D. Nasopharyngeal airway

153. A 69-year-old home care patient who is diagnosed with

chronic bronchitis is having trouble clearing secretions by
coughing. The patient lives alone but receives care in the
home. Which of the following would you recommend to aid
in the clearance of the secretions?
A. Incentive spirometry
B. Flutter valve therapy
C. Albuterol treatment via SVN
D. Postural drainage with percussion

51
154. A 61-year-old male patient who weighs 160 lbs is receiving
volume-control SIMV. The tidal volume is set at 500 mL, rate
of 12/min, FiO2 of 60% and a PEEP of 5. The patient’s ABG
results are as follows:
pH 7.45
PaCO2 37 torr
HCO3 24 mEq/L
PaO2 56 torr
SaO2 99%
Which of the following changes would you recommend?
A. Increase the rate
B. Increase the PEEP
C. Decrease the FiO2
D. Decrease the tidal volume

155. A adult female patient who weighs 134 lbs is receiving

volume-control SIMV. The tidal volume is set at 450 mL with
a mandatory rate of 12/min and pressure support of 5 cm
H2O. Upon assessment, note that that she is using her
accessory muscles during most spontaneous breaths and
her total rate is 39/min. Which of the following would you
recommend?
A. Increase the level of pressure support
B. Decrease the mandatory breath rate
C. Increase the set tidal volume
D. Increase the inspiratory flow

156. An adult male patient who weighs 85 kg is being initiated

on mechanical ventilation in the volume-control A/C mode.
The physician recommends the following settings:
Rate 12/min

52
 Tidal volume 900 mL
FiO2 40%
PEEP 5
Given this information, which of the following would you
recommend?
A. Suggest increasing the set rate
B. Suggest using pressure-control mode
C. Suggest increasing the level of PEEP
D. Suggest decreasing the tidal volume

157. A 57-year-old male patient with closed head trauma is

receiving volume control A/C ventilation. His intracranial
pressure has increased from 17 to 25 mm Hg despite proper
levels of sedation. Which of the following would you
recommend for this patient?
A. Decrease the set flow
B. Perform an inspiratory hold
C. Hyperventilation
D. Increase the level of PEEP

158. A 70-year-old female patient with ARDS is receiving volume

control ventilation in the assist-control mode. The physician
want to increase the level of PEEP to 30 cm H2O. Before
adjusting the setting, which of the following would you
recommend in order to minimize the effects on the
patient’s cardiovascular system?
A. Increase the inspiratory time
B. Decrease the expiratory time
C. Switch the patient to the SIMV mode
D. Switch the patient to pressure control

53
159. A 3-year-old patient presents to the emergency room with
unilateral wheezing. Which of the following would you
recommend?
A. Aerosolized albuterol
B. Aerosolized pulmicort
C. Furosemide (Lasix)
D. Bronchoscopy

160. A 66-year-old male patient who weighs 80 kg is receiving

volume controlled mechanical ventilation in the SIMV
mode. The tidal volume is set at 350 mL with a set rate of
10/min, FiO2 of 30% and a PEEP of 5. His ABG results are as
follows:
pH 7.28
PaCO2 52 torr
HCO3 25 mEq/L
PaO2 87 torr
SaO2 95%
Which of the following changes would you recommend?
A. Increase the set rate
B. Increase the tidal volume
C. Increase the level of PEEP
D. Add mechanical dead space

54
Section 2

1. You are called to the emergency room to assist with a rapid

sequence intubation. Before the attempt, the injection of air
into the pilot line fails to inflate the cuff. What should you do
at this time?
A. Inspect the pilot line for patency
B. Replace the endotracheal tube
C. Check the cuff for leaks
D. Check the valve on the pilot line

You should always test the cuff of an ET tube before using it

during intubation. If the cuff does not inflate when injected with
air, this means that it has a large leak.

Essentially, this means that it’s a faulty ET tube and should be

replaced with a new one. You should test the cuff of the new tube
as well before using it.

So by using what we know about ET tubes, as well as the process

of elimination, you know that the correct answer has to be B.

The correct answer is: B. Replace the endotracheal tube

2. You are called to assess a patient with pulmonary

hypertension. Which of the following would you recommend
for this patient?
A. Oxygen
B. Carbon dioxide
C. Heliox
D. Nitric oxide

To get this one correct, you simply just needed to know what to
recommend for patients with pulmonary hypertension.

55
For the TMC Exam, you should remember that inhaled nitric oxide
(iNO) is a pulmonary vasodilator that plays a major role in
regulating vascular muscle tone and can regulate pulmonary
blood flow without affecting the systemic blood pressure.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be D.

The correct answer is: D. Nitric oxide

3. You are called by the nurse because a patient with CHF keeps
taking off their nonrebreathing mask. Which of the following
would you recommend?
A. Change to a HFNC
B. Change to a partial rebreathing mask
C. Change to a 50% air entrainment mask
D. Use tape to keep the nonrebreathing mask in place

A patient on a nonrebreathing mask is obviously taking in a high

percentage of oxygen. If they are struggling to keep the mask on,
you would want to recommend a different modality that can still
provide a high FiO2.

By looking at the answer choices, only a high-flow nasal cannula

can provide an FiO2 as high as a nonrebreather, so you know that
it has to be the correct answer.

You can’t just tape the mask to the patient’s face — that is never
recommended. And also, it is unlikely that this patient will
tolerate any other type of mask either.

So by going through all the answer choices, you can easily

determine that the correct answer has to be A.

The correct answer is: A. Change to a HFNC

56
4. Which of the following EKG leads should be placed in the 4th
intercostal space at the patient’s right sternum?
A. V1
B. V2
C. V3
D. V4

You absolutely must know the proper placement for the chest
leads of an EKG for the TMC Exam. They are as follows:

• V1 – 4th intercostal space, patient’s right sternum

• V2 – 4th intercostal space, patient’s left sternum
• V3 – Between V2 and V4
• V4 – 5th intercostal space, Midclavicular line
• V5 – 5th intercostal space, between V4 and V6
• V6 – 5th intercostal space, Midaxillary line

So for this one, the correct answer has to be A.

The correct answer is: A. V1

5. You would recommend ceasing a cardiopulmonary exercise

test in which of the following conditions?
A. A 10% decrease in SpO2 from the baseline value
B. A 10 mm Hg rise in systolic blood pressure
C. An increase in heart rate from 88/min to 165/min
D. An increase in the patient’s level of dyspnea

To get this one right, you needed to know the indications for
ending a cardiopulmonary exercise test. They are as follows:

• Significant EKG abnormalities

57
 • Severe O2 desaturation
• A hypotensive response
• Development of angina
• Lightheadedness
• A request from the patient to stop the test.

It’s expected for there to be an increase in heart rate, blood

pressure, and level of dyspnea while exercising, so you can rule
out B, C, and D right away.

Concerning blood pressure, if it were to drop, then you would be

concerned. (e.g., a fall of > 20 mm Hg in systolic BP?.

But for the patient in the question, a 10% decrease in SpO2 from
the baseline values is too much and means you should stop the
test.

The correct answer is: A 10% decrease in SpO2 from the baseline
value

6. Which of the following would not be recommended for a

critically ill patient with signs and symptoms of fluid overload?
A. The initiation of diuretic therapy
B. The administration of corticosteroids
C. The administration of dialysis for renal failure
D. The restriction and close monitoring of fluid intake

If the patient has signs and symptoms of fluid overload, it means

that they have too much fluid in their body. In this case, the
patient need a diuretic medication such as Lasix. You would want
to restrict and closely monitor the patients fluid levels until they
returned to normal.

Also, if renal failure is present, you can recommend dialysis for this
patient.

58
You would not want to recommend corticosteroids for a patient
that is fluid overloaded because they can cause sodium and fluid
retention. You need to help the patient excrete fluid — not retain
it.

So by using what we know about fluid balance, as well as the

process of elimination, you know that the correct answer has to
be B.

The correct answer is: B. The administration of corticosteroids

7. The patient is instructed to take a deep breath in and then

exhale as quickly as possible. The fastest air movement is
recorded. Which of the following tests is being measured?
A. Vital capacity
B. FEV1
C. FEF25-75%
D. Peak flow

To get this one right, you simply have to know what a peak flow is.
Because if you do, then obviously, you would know right away
that it is the correct answer.

A peak flow, or peak expiratory flow rate, is defined as the fastest

air movement during a forced exhalation and is measured in
L/second.

None of the other answer choices fit the description of the test
that is being performed, so you know that the correct answer has
to be D.

The correct answer is: D. Peak flow

59
8. You are needed in the NICU to help with the intubation of an
infant. While gathering supplies, which of the following
laryngoscope blades would you select?
A. Miller
B. Macintosh
C. Guedel
D. Berman

In order to get this one correct, you simply just need to know
which type of blade is recommended for infants. That means that
you need to know that the Macintosh is the curved blade and the
Miller is the straight blade.

It is recommended to use the straight blade for infants. So the

correct answer is Miller.

The reason that the straight blade is best for intubating infants is
because most practitioners find it easier to use with an infant’s
smaller anatomy. The curved Macintosh blade makes the process
more difficult.

None of the other answers choices make sense in this situation,

so we know that the correct answer has to be A.

The correct answer is: A. Miller

9. You were called by the physician to obtain a capillary blood

sample. Which of the following is true regarding this sample
type?
A. The sample must be drawn from the first drop of surface
blood
B. The puncture normally is performed on the ball of the foot
C. The sample pH and PCO2 correlate well with standard
ABG results
D. To obtain the sample, you need to milk the puncture site

60
To get this one correct, you need to have a basic understanding of
capillary blood sampling and how the sample correlates with a
typical ABG sample.

A heel-stick is the most common site for capillary blood sampling

in infants — specifically the heel’s lateral aspect.

After you puncture the heel, you should wipe away first drop of
blood and observe for free flow before collection. You should not
squeeze or milk the puncture site.

Here’s another important thing to remember:

Capillary samples are useful only for assessing the infant’s acid-
base status — not the oxygenation status. The pH and PCO2
correlate well with arterial blood, however, the PaO2 does not.

So by using what we know about capillary blood samples, as well

as the process of elimination, you know that the correct answer
has to be C.

The correct answer is: C. The sample pH and PCO2 correlate well
with standard ABG results

10. While listening to the breath sounds of a 55-year-old patient,

you hear a creaking or grating sound. The sound gets louder
with deep breathing but is not affected by coughing. Which
of the following conditions is most likely present?
A. Atelectasis
B. Pleurisy
C. Chronic bronchitis
D. Pulmonary edema

Immediately after reading the question, you should know that a

pleural friction rub is present.

61
A Pleural friction rub occurs when the pleural surfaces of the
lungs become inflamed and rubs together during breathing,
which makes a loud creaking or grating sounds.

This most often occurs in pleurisy.

None of the other answer choices make sense in this situation, so

we know that the correct answer has to be B.

The correct answer is: B. Pleurisy

11. While assessing a female patient on her posterior side,

palpitation reveals minimal diaphragmatic movement on the
right side as she takes a deep breath. Her movement on the
left side is normal. Which of the following conditions best
explains this finding?
A. Pulmonary emphysema
B. Atelectasis in the left lower lobe
C. Phrenic nerve paralysis on the left side
D. A pleural effusion on the right side

To get this one right, you have to know the causes of unequal
chest expansion.

Some of the most common causes include consolidation,

atelectasis, pleural effusion, pneumothorax or phrenic nerve
paralysis.

For this patient, the reduced expansion occurs on the right side,
so we can automatically rule out atelectasis and phrenic nerve
paralysis because it states that they are on the left side.

We know that the issue is occurring on the right, which tells us

that the correct answer has to be D.

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The correct answer is: D. A pleural effusion on the right side

12. A 69-year-old male patient in the ICU displays the following

ABG results:
pH = 7.43
pCO2 = 21 torr
HCO3 = 13 mEq/L
His ABG results can be interpreted as which of the following?
A. Acute respiratory alkalosis
B. Partially compensated respiratory alkalosis
C. Fully compensated respiratory alkalosis
D. Combined respiratory and metabolic alkalosis

This is your typical ABG interpretation question. Let’s break this

one down.

The pH is in the normal range. The PaCO2 is decreased which tells

us that the patient is hyperventilating. The Bicarb is decreased.

The pH is on the high end of the normal range, meaning that it is

greater than 7.40. This tells us that the primary problem is
alkalosis. And since the PaCO2 is severely low, we know that there
is a respiratory issue because the patient is hyperventilating.

The Bicarb is also low because the body is compensating for the
hyperventilation in order to bring the pH back into the normal
range. So now we know that the correct answer has to be C.

The correct answer is: C. Fully compensated respiratory alkalosis

13. Which of the following must you do in order to allow a

patient with a tracheostomy button to talk or cough
effectively?

63
 A. Attach a one-way inspiratory valve
B. Completely deflate the button cuff
C. Use spacers to position the button
D. Attach a standard 15-mm connector

To get this one right, first, you have to know what a tracheostomy
button is. Basically, it is a small tube that is used to maintain an
open stoma after a tracheostomy tube has been removed.

When a tracheostomy button is being used, in order to allow

talking and coughing, the tube must be occluded. And to do that,
the patient can manually cover the opening, use a tube plug, or
attach a one-way inspiratory valve that allows inspiration but
closes on exhalation.

The one-way valve allows the patient to produce an effective

cough and speak without having to manually occlude the button.
None of the other answer choices make sense in this situation, so
we know that the correct answer has to be A.

The correct answer is: A. Attach a one-way inspiratory valve

14. Which of the following would be considered a

contraindication for the insertion of a Laryngeal Mask
Airway?
A. Conscious or semi-conscious patients
B. Patients with a risk of aspiration
C. Patients who are breathing spontaneously
D. Both A and B

To get this one right, you need to know the indications and
contraindication of using an Laryngeal Mask Airway. An LMA is an
airway that is indicated for short-term ventilation when normal ET
tube intubation attempts were unsuccessful.

64
You wouldn’t want to use an LMA in patients that are conscious
or semi-conscious because of the risk of gagging and vomiting.
Also, you shouldn’t use an LMA on patients that are at risk of
aspiration because this airway type does not protect the lungs
from aspirating gastric contents.

This tells us that the correct answer has to be D.

The correct answer: D. Both A and B

15. The amount of gas that can be inhaled above the volume
that is normally inhaled during quiet breathing is called
what?
A. FRC
B. ERV
C. IRV
D. VC

To get this one right, you have to know two things. First, you must
know what the abbreviations stand for. I hope that you do, at this
point, because you will need to know them for the TMC Exam.

And second, you have to know the definitions and differences

between the lung volumes and capacities. If you do, then this one
is super-easy and you know that the correct answer is C.

The IRV (inspiratory reserve volume) is the maximum volume of

air that can be inhaled above the tidal volume after a normal
quiet inspiration. So if you take a normal breath in, the air that you
can breathe in on top of that tidal volume is the IRV. The correct
answer has to be C.

The correct answer is: C. IRV

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16. You have been monitoring the vital capacity and maximum
inspiratory pressure readings over the last 4 hours of a 39-
year-old female patient that is receiving mechanical
ventilation. The values have steadily decreased over this time
period. How should this be interpreted?
A. Her condition is worsening
B. She has undiagnosed asthma
C. Her strength is improving
D. She is not giving her best effort

For the TMC Exam, remember that vital capacity and maximum
inspiratory pressure measurements are valuable readings for
determining if a patient is ready to wean from the ventilator.

The patient needs to have an MIP of at least -20 cm H2O and a VC

of at least 10 mL/kg in order to wean.

Since the patient’s VC and MIP values have been decreasing, this
means that she is getting weaker and her condition is getting
worse. Otherwise, the numbers would have been improving over
the last 4 hours.

None of the other answer choices really make sense in this

situation, so we know that the correct answer has to be A.

The correct answer is: A. Her conditioning is worsening

17. As a Respiratory Therapist, you should recommend an

annual influenza vaccination to which of the following?
A. A 4-month-old infant
B. A 63-year-old male with Guillain-Barr syndrome
C. A 28-year old pregnant female patient
D. A nurse that works on your floor

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To get this one correct, you basically just need to know the
indications and contraindication for recommending a flu shot.

Flu shots are not recommend for infants under 6 months of age.
Also, they are contraindicated in patients with Guillain-Barr
syndrome as well. Flu shots are contraindicated in pregnant
females in their first trimester, so we can rule that one out as well.

Flu shots are recommend for all healthcare workers due to the
high-risk of contact with infected patients.

Flu shots are also recommend for those with preexisting

cardiopulmonary diseases to help prevent exacerbations of their
condition. Flu shot are generally recommended for everyone over
the age of 50.

So by using what we know about the influenza vaccination, as

well as the process of elimination, you know that the correct
answer has to be D.

The correct answer is: D. A nurse that works on your floor

18. You are called to help measure a patient’s central venous

pressure with a strain-gauge pressure transducer. The
transducer appears to be positioned well above the middle of
the patient’s lateral chest wall. What effect, if any, would this
have on the measurement?
A. It would underestimate the CVP
B. It would overestimate the CVP
C. It would cause damping of the signal
D. It would not affect the measurement

When measuring vascular pressures, you must make sure that

the pressure transducer stopcock is positioned correctly in order

67
to obtain an accurate reading. In general, the stopcock should be
kept at the mid-chest or mid-heart level.

For the TMC Exam, remember this:

• If the stopcock is positioned too high, meaning that it is

placed above the patient’s mid-chest, you will get a reading
that’s falsely low.
• If the stopcock is positioned too low, meaning that it is
placed below the patient’s mid-chest, you will get a reading
that’s falsely high.

For this question, it tells us that the transducer is placed above

the chest, which means that the reading will be falsely low. So the
correct answer has to be A.

You will most likely see a question about this on the TMC Exam,
so please remember this information. We cover it more
thoroughly inside of our Hacking the TMC Exam course.

The correct answer is: A. It would underestimate the CVP

19. While inspecting a 70-year-old male patient, you note that

he has an abnormal spine that appears to curve laterally and
from front to back. This best describes which of the
following?
A. Kyphosis
B. Scoliosis
C. Kyphoscoliosis
D. Pectus excavatum

For the TMC Exam, you must be familiar with the spine
abnormalities. You will likely only see one question on the exam,

68
but you never know which one they’ll ask. That is why you must
know them all.

Here they are:

• Kyphosis – an abnormal AP curvature of the spine

• Scoliosis – an abnormal lateral curvature of the spine
• Kyphoscoliosis – a combination of kyphosis and scoliosis
which may produce a severe restrictive lung defect
• Pectus carinatum – abnormal anterior protrusion of the
sternum, i.e. the sternum pokes out.
• Pectus excavatum – depression of part or all of the sternum,
i.e. the sternum caves in.

Once you know this information, you can easily determine that
the correct answer is C.

The correct answer is: C. Kyphoscoliosis

20. A child is admitted to with the following symptoms:

Fever
Difficulty swallowing
Drooling
Stridor
A lateral neck x-ray was taken and shows supraglottic
swelling. Which of the following is the most likely diagnosis?
A. Croup
B. Asthma
C. Epiglottitis
D. Foreign body obstruction

For the TMC Exam, you absolutely MUST know how to tell the
difference between croup and epiglottitis.

69
Croup, also known as Laryngotracheobronchitis, is characterized
as subglottic edema, which means that the swelling occurs below
the glottis. It is associated with inspiratory stridor. The onset
occurs more slowly, usually over 24–48 hours. Look for the
“steeple” sign on a lateral neck x-ray.

Epiglottitis is characterized as inflammation of the epiglottis and

supraglottic structures, which means that the swelling occurs
above the glottis. The onset occurs rapidly and this condition can
be considered a medical emergency. Look for the “thumb” sign
on the lateral neck x-ray.

The key to getting this one right is the word ‘supraglottic,’ which
tells us that the swelling occurs above the glottis, so we know
that the correct answer has to be C.

The correct answer is: C. Epiglottitis

21. A patient performs an FVC maneuver and displays the

following results:

How would you interpret this flow-volume loop tracing?

A. Normal lungs
B. Small airway obstruction

70
 C. Large airway obstruction
D. Restrictive disease

You will most likely have one of these flow-volume loop tracings
on the exam, so you will need to know how to interpret them. Not
to worry, we break in down for you inside of our Hacking the TMC
Exam course, if you’re interested.

You should be able to recognize the tracing pattern for normal

lungs.

Also, in general, you can remember this rule of thumb:

• For restrictive diseases the loop will appear tall and skinny.
• For obstructive diseases, the loop will appear short and wide.

This one is neither tall and skinny, nor short and wide. However,
you can see that it has a scooped out appearance and is shifted to
the left. Whenever you see this pattern, you should automatically
know that the patient has a small airway obstruction.

This pattern is most likely due to an increased residual volume

caused by air trapping in diseases such as emphysema and
asthma.

The correct answer is: B. Small airway obstruction

22. The doctor requests the insertion of a nasopharyngeal airway

on a female patient. Which of the following would you do in
order to estimate the appropriate length of the airway?
A. Measure the distance from the earlobe to the tip of the
nose
B. Use the estimation formula of length (cm) = 12 + (age/2)
C. Subtract twice the diameter of the tube from its length

71
 D. Measure the distance from the earlobe to the ‘Adam’s
Apple’

When using a nasopharyngeal airway, it’s important to select the

correct length. Usually, the taller the patient, the longer
nasopharyngeal airway you will need.

In order to estimate the appropriate length, you can do so by

measuring the distance from the patient’s earlobe to the tip of
their nose. A quick and easy way to do this is to hold the actual
airway near the patient’s face measuring it up to the tip of their
nose and earlobe.

None of the other answer choices make sense in this situation, so

we know that the correct answer has to be A.

The correct answer is: A. Measure the distance from the earlobe to
the tip of the nose

23. Which of the following patients is the best candidate for

high-frequency oscillation ventilation?
A. A child with severe hypercapnia
B. A neonate with refractory hypoxemia
C. An adult with refractory hypoxemia
D. An adult with status asthmaticus

To get this one correct, you just needed to have a basic

understanding of HFOV.

Typically, HFOV is indicated in infants with hypoxemic respiratory

failure as seen in those with RDS.

In adults, HFOV has no advantage over conventional ventilation

with low tidal volumes and high PEEP. So that means we can rule
out C and D right away.

72
So by using what we know about HFOV, as well as the process of
elimination, you know that the correct answer has to be B.

The correct answer is: B. A neonate with refractory hypoxemia

24. A 61-year-old male patient who weighs 165 lbs is receiving

volume control A/C ventilation with a tidal volume of 500 mL.
He has the following data:
PEEP 5
PIP 35
Pplat 30
What is the patient’s static compliance?
A. 16.7 mL/cm H2O
B. 20.0 mL/cm H2O
C. 25.7 mL/cm H2O
D. 30.0 mL/cm H2O

For the TMC Exam, you need to know how to calculate both static
and dynamic compliance. That means you should know the
formulas for both.

• Static compliance = Exhaled VT / (Pplat – PEEP)

• Dynamic compliance = Exhaled VT / (PIP – PEEP)

So for this one, the question asks for the patients static
compliance. To get the answer, all you have to do is plug the
numbers in the formula.

Static compliance = 500 / (30 – 5)

Static compliance = 20

The correct answer is: B. 20.0 mL/cm H2O

73
25. Which of the following would most likely cause a misleading
or incorrect pulse oximetry reading?
A. High cardiac output
B. Low Hb concentration
C. Excessive probe movement
D. Elevated body temperature

For the TMC Exam, there are several factors that you must be
aware of that can cause a pulse oximeter to give incorrect results.
Some of them include:

• Motion artifact – make sure the probe is secure and limit

movement as much as possible.
• Low perfusion – if the patient lacks circulation in the finger,
you may have to try a different site, like the earlobe or
forehead.
• Presence of COHb – If the patient has been exposed to
carbon monoxide, as we discussed, their SpO2 will read
falsely high.
• Darkly pigmented skin – Patient’s with dark skin will yield
results that read falsely high.
• Painted fingernails – Patient’s with dark, painted nails will
yield results that read falsely high.

If the patient is moving around a lot during the reading, it’s more
than likely going to give inaccurate results.

SpO2 is a measurement of the relative concentration of HbO2.

This means that the total amount of hemoglobin that is present
does not affect the measurement.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be C.

The correct answer is: C. Excessive probe movement

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26. While inspecting an EKG rhythm strip of a 57-year-old male
patient, you note the following:
Rate 164
Irregular rhythm
No clear P waves
Abnormal QRS complexes
Which of the following is the interpretation?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. Ventricular fibrillation

You must be able to interpret and EKG rhythm for the TMC Exam.

This one is very simple. A fast rate with an irregular rhythm, no

clear P waves, and abnormal QRS complexes describes
ventricular fibrillation perfectly.

On the rhythm strip, you would see a totally irregular pattern that
looks like a zig zag. V-fib is fatal if not corrected immediately
which is why it’s one of the two shockable rhythms that you
should be familiar with.

The treatment of V-fib calls for rapid defibrillation, with CPR, 100%
oxygen, and antiarrhythmic medications.

The correct answer is: D. Ventricular fibrillation

27. An adult patient with pneumonia was intubated and placed

on pressure control ventilation with an FiO2 of 40% and a
PEEP of 10 cm H2O. Their chest x-ray shows bilateral

75
 infiltrates. After being on the ventilator for 30 minutes, an
ABG is obtained with the following results:
pH 7.47
PaCO2 33 torr
PaO2 60 torr
SaO2 90%
HCO3 25 mEq/L
BE +2 MEq/L
You would describe the patient’s condition as being
consistent with which of the following:
A. Mild ARDS
B. Moderate ARDS
C. Severe ARDS
D. Moderate hypoxemia

The first thing that should stand out is the fact that the PaO2 is
only 60 torr. That seems low considering the patient is getting an
FiO2 of 40% with a PEEP of 10 cm H2O.

The patient’s P/F ratio is 150 which you can calculate by dividing
the PaO2 by the FiO2. This indicates that the patient has ARDS in
the moderate form. For patients with moderate or severe ARDS,
you should recommend the initiation of the ARDSnet protocol.

So by breaking down the question, you can determine that the

correct answer has to be B.

The correct answer is: B. Moderate ARDS

28. A 56-year-old female patient with a pneumothorax has a

pleural drainage system in place. Upon assessment, you note
that there is sporadic bubbling in the water seal chamber.
Which of the following would you recommend?
A. This is a normal finding
B. Withdraw the chest tube about 3-4 cm

76
 C. Check the connecting tubing for leaks
D. Add water to the water seal chamber

For the TMC Exam, you need to be familiar with chest tubes and
pleural drainage systems. Here are a few tidbits that you should
remember:

• If there is no bubbling in the suction chamber, that means

that there could be a leak in the system, or you may just
need to increase the vacuum suction pressure.
• On the other hand, if there is bubbling in the water seal
chamber, this is normal when a pneumothorax is present.
This lets you know that the air is being drained properly.
• However, the bubbling in the water seal chamber should not
be continuous. It should be sporadic. If there is continuous
bubbling, that means that a new leak has developed. You
should check for a loose connection.
• If the collection chamber becomes full, you should clamp
the chest tube and exchange the system with an empty
chamber.
• If there has been no change in drainage, there may be a kink
in the tubing.

The correct answer is: A. This is a normal finding

29. A 59-year-old male patient is receiving volume control

ventilation? Which of the following would cause his peak
airway pressure to increase?
A. Bronchospasm
B. Leak in the ET tube cuff
C. Leak in the ventilator circuit
D. Pulmonary edema that has improved

To get this one correct, you simple needed to know the causes on
an increased peak airway pressure. There are two primary causes:

77
 • An increased airway resistance
• A decreased in lung compliance.

Now all you have to do is look at the answer choices to determine

which one meets this criteria.

Any type of leak would cause a decreased peak airway pressure,

so we can rule out B and C right away. When a patient with
pulmonary edema improves, their lung compliance increases —
so we can rule that one out as well.

Bronchospasm, on the other hand, would cause an increased

airway resistance, and thus, and increased peak airway pressure.
So you know that the correct answer has to be A.

The correct answer is: A. Bronchospasm

30. While assessing a 58-year-old female patient that is receiving

volume controlled A/C ventilation, you notice that her peak
pressure has increased by 10 cm H2O over the last hour while
her plateau pressure has not changed. The patient has
significant wheezing in both lungs that was not present
earlier. Which of the following would you recommend for this
patient?
A. Suction the patient’s airway
B. Nebulize a bronchodilator
C. Nebulize a corticosteroid
D. Increasing the tidal by 50 mL

This is a tricky one. Remember, for the TMC Exam, sometimes the
question may appear to have two correct answer — BUT — you
have to choose the BEST answer of the two. This is one of those
questions.

78
The question tells us that the patient is receiving volume
controlled ventilation. In this mode, when there is an increase in
peak pressure without an increase in plateau pressure, it’s usually
because the airway resistance has increased. The question states
that the patient is wheezing, which is what is causing the airway
resistance to increase.

So the FIRST thing you would want to do for this patient is to

administer a fast-acting, bronchodilator such as albuterol to
relieve bronchospasm. By doing so, the wheezing should stop
and the peak pressure should decrease back to the original level.

A lot of time, when there is an increase in peak pressure, thing

first thing we think to do is suction the patient’s airway. But in this
case, because of the wheezing, the best action to take is to
provide a bronchodilator, so we know that the correct answer is B.

The correct answer is: B. Nebulize a bronchodilator

31. Which of the following side effects can be expected after

that administration of aerosolized epinephrine?
A. Laryngospasm
B. Bronchospasm
C. Tachycardia
D. Bradycardia

To get this one right, you simply just have to have a basic
understanding of epinephrine.

Epinephrine is a drug that is given during CPR to increase the

patient’s heart rate and blood pressure. Therefore, it causes
tachycardia because of the strong beta-1 receptor stimulation.

That means that we can automatically rule out bradycardia

because that is the opposite effect. You should also know that

79
epinephrine is not directly associated with laryngospasm or
bronchospasm.

So by using what we know about epinephrine, as well as the

process of elimination, you know that the correct answer has to
be C.

The correct answer is: C. Tachycardia

32. The physician requests a humidifier device that can

condition the inspired gas to 100% body humidity. Which of
the following would you recommend?
A. Bubble humidifier
B. Pneumatic nebulizer
C. Heated wick humidifier
D. Heat and moister exchanger

To get this one correct, you needed to be familiar with the

different types of humidification devices.

A pneumatic nebulizer will provide the patient with water vapor

but it cannot deliver 100% body humidity. Nor can a bubble
humidifier or an HME, so we can rule those out as well.

A heated wick humidifier increases the surface area of the gas-

water interface and increases the humidifier’s efficiency. It is the
only humidification device that can condition gas to 100% body
humidity (44 mg/L).

The correct answer is: C. Heated wick humidifier

33. You are needed to assist with the intubation of a premature

infant. Which laryngoscope blade would you recommend?

80
 A. Miller blade number 0
B. Miller blade number 2
C. MacIntosh blade number 0
D. MacIntosh blade number 1

To get this one correct, you simply just need to know which type
of blade, and which size blade, to recommend for infants.

You must remember that you normally want to select a Miller

(straight) blade for infants. With their small anatomy, the straight
blade makes the intubation attempt easier than the curved
blade.
Also, you must remember that Miller size “0” is indicated for
premature infants. That means that we know the correct answer
has to be A.

The correct answer is: A. Miller blade number 0

34. The physician ordered a V/Q scan on a 59-year-old patient.

Which of the following conditions would a ventilation scan
appear normal but a perfusion scan reveal areas of absent
blood flow?
A. Pneumonia
B. Lung cancer
C. Pulmonary embolism
D. Emphysema

To get this one right, you need to have a basic understanding of a

pulmonary embolism, which is the correct answer.

A pulmonary embolism is blood clot in the arteries of the lungs. It

causes a deadspace condition in which there is ventilation
without perfusion.

81
For the TMC Exam, remember that you can diagnose a
pulmonary embolism with a V/Q scan, CT scan, and pulmonary
angiogram. You can treat it with the following: 100% oxygen,
analgesics for chest pain, and thrombolytic agents.

You can prevent a pulmonary embolism by using anticoagulants,

anti-embolism stockings, and early ambulation.

So by using what we know about a pulmonary embolism, we can

determine that the correct answer has to be C.

The correct answer is: C. Pulmonary embolism

35. A 55-year-old patient that is receiving aerosol therapy with

0.9% saline is unable to produce an acceptable volume of
sputum for a sample. Which of the following would you
recommend at this time?
A. Initiate chest physiotherapy
B. Administer the aerosol continuously
C. Change to hypertonic saline
D. Perform nasotracheal suctioning

To get this one correct, you needed to know what hypertonic

saline is used for.
A hypertonic saline solution via aerosolization can be used to
mobilize secretions and draw fluid out of the airway mucosa for a
sputum induction.

Chest physiotherapy and continuous aerosols would not be

helpful in this situation, and NT suctioning is not indicated.

So by using what we know about hypertonic saline, as well as the

process of elimination, you know that the correct answer has to
be C.

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The correct answer is: C. Change to hypertonic saline

36. A 40-year-old female patient was discharged with an order

for 2 L/min of home oxygen. Which of the following would
you recommend?
A. Oxygen concentrator with an oxygen-conserving nasal
cannula
B. Oxygen concentrator with a simple mask
C. Multiple H cylinder tanks with a nasal cannula
D. Liquid oxygen system with a nasal cannula

H cylinder tanks are massive tanks, and aren’t feasible for home
use. A simple mask generally wouldn’t be recommended either,
so we can rule that one out as well.

Liquid oxygen systems are very expensive and typically would not
be recommended over an oxygen concentrator.

Using an oxygen concentrator and oxygen-conserving nasal

cannula is the most economically feasible way to deliver oxygen
in the home setting, and is the best answer for this question.

The correct answer is: Oxygen concentrator with an oxygen-

conserving nasal cannula

37. You are called to collect a sputum sample on a patient in the

ICU. Which of the characteristics of the sputum, when
assessed at the bedside, should be documented in the
patient’s chart?
A. The density
B. The viscosity
C. The DNA content
D. The surface tension

83
When evaluating a patient’s sputum at bedside, you should note
and document the amount, color, and viscosity. If you didn’t
know, viscosity is just a fancy word for how sticky is the sputum.

It’s not possible to determine the sputum density, surface tension,

or DNA content at the bedside, so we know that the correct
answer has to be B.

The correct answer is: B. The viscosity

38. You are called to evaluate a patient who appears to be

asleep. His respiratory rate is 14 breaths/min and heart rate is
72 beats/min. In order to determine the patient’s level of
consciousness, you speak to the patient but he does not
respond. Which of the following should you do first?
A. Call for help
B. Administer a sternal rub
C. Wait 1 hour and then repeat the attempt
D. Gently shake the patient’s arm

Let’s go through the answer choices and break this one down.

The patient’s vital signs are normal, so at first glance, there is no

immediate need to call for help. A sternal rub is not indicated
either.

Since the patient did not respond to your verbal command, the
first thing you should do is see if you can arouse the patient by
gently shaking his shoulder. Most likely, he will awaken at this
point, so we know that the correct answer is D.

The correct answer is: D. Gently shake the patient’s arm

84
39. While reviewing the lateral neck radiograph of a 3-year-old
boy, you note that there is a clear air column through the
upper airway and narrowing of the tracheal air column below
the larynx. Which of the following conditions is most likely
present?
A. Tonsillitis
B. Aspirated a coin
C. Epiglottitis
D. Laryngotracheobronchitis

For the TMC Exam, you absolutely MUST know how to tell the
difference between croup and epiglottitis. And for this question,
you needed to know that Laryngotracheobronchitis is another
name for croup.

Croup is characterized as subglottic edema, which means that

the swelling occurs below the glottis or larynx. It is associated
with inspiratory stridor. The onset occurs more slowly, usually over
24–48 hours. Look for the “steeple” sign on a lateral neck x-ray.

Since the question tells you that there is narrowing below the
larynx, you should automatically know that croup is the condition
that is present in this case.

Epiglottitis, on the other hand, is characterized as inflammation of

the epiglottis and supraglottic structures, which means that the
swelling occurs above the glottis. The onset occurs rapidly and
this condition can be considered a medical emergency. Look for
the “thumb” sign on the lateral neck x-ray.

If the boy had swallowed a coin, you would be able to see it on the
x-ray. None of the other answer choices really make sense either,
so we know that the correct answer has to be D.

The correct answer is: D. Laryngotracheobronchitis

85
40. A newborn infant needs immediate resuscitation. While
performing chest compressions, how far should the sternum
be compressed?
A. At least 2 inches
B. One-half the AP diameter of the chest
C. No more than 0.5 inches
D. One-third of the AP diameter of the chest

To get this one correct, you simply needed to have a basic

understanding of how to perform chest compressions on a
neonate.

In infants, chest compressions should be delivered on the lower

third of the sternum to a depth of approximately one-third of the
AP diameter of the chest.

Compressions and ventilations should be coordinated to avoid

simultaneous delivery, with 90 compressions and 30 breaths per
minute. This provides a 3:1 compression-to-ventilation ratio and
comes out to 120 events per minute.

None of the other answer choices are correct in this situation, so

you know that the correct answer has to be D.

The correct answer is: D. One-third of the AP diameter of the

chest

41. A 69-year-old female patient has been diagnosed with

pneumonia. The physician asks you to assess the patient.
Which of the following breath sounds would you expect to
hear upon auscultation?
A. Wheezing
B. Bronchial
C. Vesicular
D. Hyperresonance

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Bronchial breath sounds are normal when heard over the trachea.
However, they are abnormal breath sounds when heard over the
lungs.

With that said, bronchial breath sounds are often heard in

patients with pneumonia due to consolidation.

Wheezing is heard in patients with bronchospasm, like asthma

and COPD. Hyperresonance is a percussion note that is heard
over an area with a pneumothorax. Vesicular breath sounds are
normal breath sounds that are heard over normal lung areas.

So by going through the answer choices, we know that the

correct answer has to be B.

The correct answer is: B. Bronchial

42. You have just administered a routine breathing treatment

with albuterol via small volume nebulizer. Which of the
following is the best documentation that must be added to
the patient’s chart?
A. Treatment given as ordered
B. Aerosol therapy given; pulse stable, no changes during
therapy; well tolerated
C. Aerosol therapy given with 0.5 mL albuterol and 3 mL
normal saline; vital signs stable; well tolerated
D. Aerosol therapy given with 0.5 mL albuterol and 3 mL
normal saline via SVN; heart rate of 74 beats/min during
therapy; B.P. stable at 120/80; respiratory rate 16/min;
therapy well tolerated; chest clear on auscultation

To get this one correct, you have to have a basic understanding of

what must be documented after a therapy has been performed.

87
Basically, after completing any type of therapy, you must
document it in the patient’s chart. For a breathing treatment, in
general, you should chart the drug given and dose, the patient’s
pulse, blood pressure, respiratory rate, breath sounds and the
extent to which the patient tolerated the therapy.

Clearly, you can tell that the correct answer has to be D.

The correct answer is: D. Aerosol therapy given with 0.5 mL

albuterol and 3 mL normal saline via SVN; heart rate of 74
beats/min during therapy; B.P. stable at 120/80; respiratory rate
16/min; therapy well tolerated; chest clear on auscultation

43. What is the primary cause of the S2 heart sound?

A. The opening of the semilunar valves
B. The opening of the atrioventricular valves
C. The closing of the semilunar valves
D. The closing of the atrioventricular valves

Remember, the normal heart sounds can be heard when the

heart valves close. That means we can rule out the first two
answer choices right away.

The first or S1 heart sound is produced by the closure of the mitral

and tricuspid valves during ventricular contraction. Remember,
the mitral and tricuspid valves are known as the atrioventricular
valves.

Also note that when systole ends, the semilunar valves close,
creating the second or S2 heart sound. Remember, the pulmonic
and aortic valves are known as the semilunar valves.

The correct answer is: C. The closing of the semilunar valves

88
44. While auscultating the chest of an 62-year-old patient, you
hear diminished breath sounds. This may indicate the
presence of which of the following?
A. Laryngospasm
B. Pleural effusion
C. Bronchoconstriction
D. Aspirated foreign body

To get this one correct, you simply needed to know the common
breath sounds for the conditions listed in the answer choices.

Laryngospasm typically causes stridor. Bronchoconstriction and

foreign body aspiration would cause wheezing, so we can rule
those out as well.

A pneumothorax and pleural effusion are conditions where you

would typically hear diminished breath sounds.

The correct answer is: B. Pleural effusion

45. A 48-year-old female patient has been admitted to the

emergency department with the following arterial blood gas
results:
pH 7.54
PaCO2 29 torr
PaO2 86 torr
HCO3- 24 mEq/L
Which of the following is the best interpretation of these
results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

89
This is just a classic ABG interpretation question. You likely won’t
see many of these on the TMC Exam because at this point, the
NBRC will assume that you already know how to interpret ABGs.
Otherwise, you wouldn’t have made it this far.

With that said, you still absolutely MUST know how to interpret
them because you will be required to do so for SEVERAL
questions on the exam.

So now let’s go ahead and interpret this one. The pH is increased,

which means alkalosis. The PaCO2 is decreased and the
bicarbonate level is normal. That means that the interpretation is
acute respiratory alkalosis with normal oxygenation. The correct
answer is D.

The correct answer is: D. Respiratory alkalosis.

46. Which of the following infection control procedures is to be

used when drawing an arterial blood gas?
A. Hand washing and gloves only
B. Gown and protective eyewear
C. Mask and protective eyewear
D. All CDC standard precautions

You should be able to select the correct answer for this one quick
and easily.

You should always use ALL CDC standard precautions for any
patient in every scenario– including, of course, drawing an ABG.

You must always wash your hands and wear gloves, as well as
wear the appropriate masks, gowns, and eyewear when
necessary. That means that the correct answer has to be D.

The correct answer is: D. All CDC standard precautions

90
47. A 21-year-old male patient arrives to the ER with cervical
collar after a motor vehicle accident. In order to quickly
secure the airway and provide ventilation, which of the
following would you recommend?
A. Perform a blind nasotracheal intubation
B. Orally intubate with manual in-line stabilization
C. Insert a nasopharyngeal airway
D. Apply the head-tilt, chin-lift maneuver

The question tells us that the patient is wearing a cervical collar,

which means that he has suffered a neck or spinal cord injury.

In this case, you should not use the sniffing position for intubation
because the could cause further injury. That means that you
should not apply the head-tilt, chin-lift maneuver, so it can’t be D.

A nasopharyngeal airway is not indicated, and you wouldn’t want

to perform a blind nasotracheal intubation either. So that means
that the correct answer has to be B.

Although it is more difficult to perform in cases like this, oral

intubation with manual in-line stabilization is what’s indicated at
this time. The key thing to remember about this question is that
the head-tilt, chin-lift maneuver is contraindicated when neck or
spinal injuries are suspected. The correct answer is B.

The correct answer is: B. Orally intubate with manual in-line

stabilization

48. After reviewing the chest radiograph of a 71-year-old male,

you noticed a large area of consolidation in the right lung.
Which of the following is the most likely cause of this
problem?

91
 A. Pulmonary barotrauma
B. Tension pneumothorax
C. Interstitial emphysema
D. Lobar pneumonia

To get this one right, you have to know what is consolidation and
what condition it is often seen in.

Consolidation in an x-ray basically means that as area is filled with

liquid instead of air. For the TMC Exam, I want you to remember
that consolidation is most often associated with pneumonia.

None of the other answer choices really make sense in this

situation, so we know that the correct answer has to be D.

The correct answer is: D. Lobar pneumonia

49. In general, which of the following radiographic imaging

procedures can be used to evaluate a patient’s arteries for
abnormalities?
A. PET scan
B. V/Q scanning
C. Angiography
D. Standard radiography

To get this one right, you had to be familiar with the different
imaging tests that are listed in the answer choices. If you were,
then you could easily select the correct answer.

A PET scan is often used to detect the presence of cancer, brain

disorder, and heart disease. V/Q scanning is used to examine the
ventilation and perfusion of the lungs. Standard radiography is
not a method that is used to evaluate the abnormalities of
arteries.

92
Angiography uses a contrast dye to access the blood or lymph
vessels in the lungs. For the TMC Exam, be sure to remember that
he main indication for angiography is to check for a pulmonary
embolism. So now you know that the correct answer has to be C.

The correct answer is: C. Angiography

50. You are about to perform a pulmonary function test on a 65-

year-old male patient after providing a bronchodilator
breathing treatment. It is suspected that the patient has
COPD. His results are as follows:
FEV1/FVC ratio = 64%
FEV1 = 86% predicted
How would you would characterize this patient?
A. Normal
B. Mild COPD
C. Moderate COPD
D. Severe COPD

Irreversible airflow obstruction is present when the FEV1/FVC ratio

is less than 70% of predicted after a bronchodilator is given.

However, the patient’s FEV1 is greater than 80% of the predicted

value. This tells us that he is in the mild stages of COPD.

If the FEV1 would have been less than 60% of predicted, it would
be classified as moderate. If the FEV1 would have be less than
40% of predicted, it would be classified as severe COPD. But, since
it was greater than 60%, we know that the correct answer has to
be B.

The correct answer is: B. Mild COPD

93
51. While palpating your patient’s radial artery for a 1-minute
pulse check, you noticed 95 unevenly spaced beats with a
decreased pulse strength during inspiration. Which of the
following best describes this patient’s pulse?
A. Bounding pulse
B. Thready pulse
C. Pulsus alternans
D. Pulsus paradoxus

To get this one right, you had to be familiar with the different
abnormal pulse types.

Pulsus paradoxus is defined as an abnormal decrease in pulse

strength and blood pressure during inspiration — which means
that it is the correct answer.

It is commonly seen in the following patients:

• COPD
• Asthma
• Croup
• Pericarditis
• Cardiac tamponade

The question does not describe either a thready or a weak pulse.

And pulsus alternans occurs when there are alternating strong
and weak pulses. It is an indication of left ventricular systolic
failure.

So with that said, we know that the correct answer is D.

The correct answer is: D. Pulsus paradoxus

52. In which of the following conditions would postural drainage

be most helpful?

94
 A. Pleural effusion
B. Cystic fibrosis
C. Pneumonia
D. Asthma

To get this one right, you have to have a basic understanding of

the listed conditions, as well as when postural drainage is
indicated.

The thing to remember about postural drainage is that it is used

to help patients with retained secretions that have difficulty
clearing them on their own.

Typically, it is most beneficial in patients with cystic fibrosis and

bronchiectasis. So now we know that B is the correct answer.

Postural drainage cannot remove fluid the pleural spaces, so we

can rule out a pleural effusion. Also, it has no benefit in treating
patients with asthma or pneumonia.

So by using what we know about cystic fibrosis and postural

drainage, as well as the process of elimination, you know that the
correct answer has to be B.

The correct answer is: B. Cystic fibrosis

53. You were called to help with the treatment of a newborn in

the neonatal ICU. The physician states that the infant needs
hyperventilation. This form of treatment would be
recommended in which of the following types of patients?
A. Meconium aspiration
B. Respiratory distress syndrome
C. Infant with normal lung compliance
D. Persistent newborn pulmonary hypertension

95
To get this one right, you need to know when it’s appropriate to
hyperventilate a newborn.

Remember that you can hyperventilate a patient with PPHN in

order to increase their pulmonary vasodilation. By doing so, this
will improve the infant’s condition by allowing more blood to pass
through the pulmonary circulation to be oxygenated.

Infant’s with any of the other conditions that are listed in the
answer choices would not benefit from hyperventilation, so we
know that the correct answer has to be D.

The correct answer is: D. Persistent newborn pulmonary

hypertension

54. While administering a nebulizer breathing treatment to an

adult patient on the ventilator, you noticed that large water
droplets are coming from the device and are collecting in the
large bore tubing. Which of the following would you
recommend at this time?
A. Replace the faulty nebulizer
B. Add water to the nebulizer
C. Dismantle and clean the nebulizer
D. Add a heated humidifier to the nebulizer

To get this one correct, you needed to have a basic

understanding of how nebulizers works.

Nebulizers were engineered to deliver very fine aerosol mists —

not large water droplets. No in this case, the nebulizer is not
functioning properly and should be replaced with a new, working
nebulizer.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be A.

96
The correct answer is: A. Replace the faulty nebulizer

55. A 71-year-old male patient is receiving pressure-control

mechanical ventilation with a set expiratory time. Upon
assessment, you noticed that the patient’s ET tube is partially
obstructed. Before checking the settings, you would expect
all of the following EXCEPT:
A. Decreased inspiratory time
B. Increased PEEP
C. Decreased delivered tidal volume
D. Increased respiratory rate

To get this one correct, you needed to have an understanding of

how pressure-control ventilation works.

In this mode, the pressure is preset. That means that a volume

will be delivered until a preset pressure limit is reached. The
pressure remains constant but the tidal volume varies depending
on the patient’s lung compliance and airway resistance.

In this case, the question tells us that the patient has an

obstruction. That means the delivered breath will cycle off early,
so the inspiratory time and delivered volume will decreased. This
will also cause the respiratory rate to increase.

PEEP, on the other hand, will not be affected, so you know that
the correct answer has to be B.

The correct answer is: B. Increased PEEP

97
56. A 56-year-old male patient with pneumonia has a moderate
amount of oral secretions. Which of the following would you
recommend for suctioning at the patient’s bedside?
A. Lukens trap
B. Coude catheter
C. Yankauer
D. Bulb suction

For the TMC Exam, you need to be familiar with the types of
suctioning devices.

• Yankauer – used for oral suctioning

• Coude tip catheter – is bent near the tip specifically to help
suction the left mainstem bronchus
• Bulb suction – used for an infant’s nose or mouth
• Ballard® – the brand name for in-line suctioning that we use
during mechanical ventilation
• Lukens trap – used to obtain a sputum sample

So for this patient, you can easily determine that the correct
answer has to be C.

The correct answer is: C. Yankauer

57. A 55-year-old female patient is receiving oxygen via a

nonrebreathing mask that is set at 15 L/min. Upon
assessment, you note that the reservoir bag does not deflate
at all during inspiration. Which of the following is the most
likely cause of this problem?
A. The patient is a nose-breather
B. The patient is a mouth-breather
C. The oxygen flowmeter setting is too low
D. The mask is not tight enough on the face

98
For the TMC Exam, you will likely see a question about the
reservoir bag of a nonrebreathing mask. There are two things to
keep in mind:

• If the reservoir bag collapses all the way during inspiration,

you can troubleshoot by increasing the flow.
• If the reservoir bag does not deflate at all during inspiration,
it means that the mask is too loose on the patient’s face. You
can troubleshoot by tightening the mask.

The flow for a nonrebreathing mask should be > 10 L/min in order

to keep the bag from collapsing. With a loose mask, that means
air is leaking in from the sides of the mask and explains why there
is no change in the volume of the reservoir bag. This would cause
a decrease in FiO2 as well.

Additionally, with this type of mask, it does not matter if the

patient breathes through the nose or mouth.

The correct answer is: D. The mask is not tight enough on the face

58. An adult patient that is receiving volume control ventilation

has a circuit that is visibly soiled and needs to be changed.
After switching to a new circuit, the patient’s exhaled tidal
volume is 200 mL less than before and the peak inspiratory
pressure is 10 cm H2O lower. Which of the following is the
most likely cause of these finding?
A. A circuit port is open to the atmosphere
B. An obstruction of the expiratory line
C. A mucous plug in the patient’s ET tube
D. The patient’s lung compliance has decreased

To get this one correct, you needed to have a basic

understanding of volume control mechanical ventilation.

99
When there is a drop in both the exhaled tidal volume and peak
inspiratory pressure, this tells us that a leak is present. Now you
just need to look through the answer choices and select the one
that indicates a leak.

Some common places for leaks include the ET tube cuff, the
humidifier connection, and when there is an open circuit/sensor
ports

A mucus plug and a decrease in lung compliance would cause

the PIP to increase, not decrease. So by breaking down the
question, you can determine that the correct answer has to be A.

The correct answer is: A. A circuit port is open to the atmosphere

59. An adult patient in the emergency room needs to be

intubated STAT. Before starting the procedure, it’s required
to check all of the following devices EXCEPT:
A. Suction equipment
B. Laryngoscope light source
C. Rigidity of the stylet
D. Endotracheal tube cuff

To get this one correct, you needed to have a basic

understanding of the intubation procedure. As a Respiratory
Therapist, before intubation, you are required to check the
following:

• The ET tube cuff should always be checked for leaks before

inserting.
• The laryngoscope blade should be checked to ensure that
the light source is functioning properly.
• The suction equipment should be assembled and checked
in case the patient vomitus or has secretions during
insertion.

100
A stylet is useful during the procedure. It helps to increase the
rigidity of the ET tube, but is not a required to check before the
procedure.

The correct answer is: C. Rigidity of the stylet

60. A 73-year-old patient has been receiving aerosol

bronchodilator therapy via nebulizer with a mouthpiece
every 6 hours. The patient has become very lethargic since
the last treatment. How should you proceed?
A. Discontinuing the therapy
B. Give the treatment with an aerosol mask
C. Give the treatment as usual with a mouthpiece
D. Ask the physician for their opinion

Patients that are lethargic generally will not be able to hold the
nebulizer up to their mouth in order to do the treatment properly
using mouthpiece.

So in these cases, an aerosol face mask would be indicated. The

patient still needs the treatment so you wouldn’t discontinue it.
And asking for the doctor’s opinion probably isn’t the best idea in
this case.

So by using what you know about aerosol therapy, you could

easily determine that the correct answer has to be B.

The correct answer is: B. Give the treatment with an aerosol mask

61. A 67-year-old female patient diagnosed with pulmonary

edema has progressive worsened. In such case, you would

101
 expect the fluid in her lungs to move in which of the
following sequences?
A. Alveoli, to bronchioles, to bronchi
B. Bronchioles, to bronchi, to the trachea
C. Bronchi, to bronchioles, to alveoli
D. Pulmonary capillaries, to alveoli, to bronchi

To get this one correct, you needed to have a basic understand of

lung anatomy as well as the underlying pathology of pulmonary
edema.

For patients with CHF/pulmonary edema, fluid overload is a major

finding. As the condition worsens, you would expect fluids to
move from the pulmonary capillaries to the interstitial spaces of
the lungs.

The means the fluids enters into the alveoli, then moves to the
bronchioles, then to the bronchi where is can be coughed out by
the patient.

The correct answer is: A. Alveoli, to bronchioles, to bronchi

62. While assessing a newborn infant girl, you note that the AP
and the lateral dimensions of her chest are about the same.
This would indicate that the infant has:
A. Pectus excavatum
B. Pectus carinatum
C. Signs of air trapping
D. Normal chest anatomy

To get this one correct, you simply just needed to have an

understanding of the basic anatomy of infants.

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An infant’s chest is typically round and should be same size in
both the AP and lateral dimensions. That means that this finding
is normal.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be D.

The correct answer is: D. Normal chest anatomy

63. In order to sterilize respiratory care equipment in an alkaline

glutaraldehyde (Cidex) solution, you would need to leave the
equipment submersed for how long?
A. 10-20 minutes
B. 2 hours
C. 10 hours
D. 24 hours

To get this one correct, you needed to have a basic

understanding of the disinfection and sterilization process.

Alkaline glutaraldehyde, aka Cidex, is a solution that can be used

for both high-level disinfection and sterilization. High-level
disinfection can be achieved with the equipment submersed for
about 10-20 minutes at room temperature

Sterilization, on the other hand, means that microorganisms are

destroyed, including spores. This process requires a full 10 hours.

The correct answer is: C. 10 hours

64. While assessing a 61-year-old male patient via chest

palpitation, you note that there is less movement on the

103
 patient’s left side compared to the right side. This is an
indication for which of the following conditions?
A. Left-sided Emphysema
B. Right-sided Emphysema
C. Left-sided pneumonia
D. Right-sided pneumonia

To get this one correct, you needed to have a basic

understanding of the pathology of the conditions that are listed
in the answer choices.

If you were to palpate the chest of a patient with emphysema,

you would not expect to find a one-sided change in movement.
That means we can rule out A and B right away.

With pneumonia, on the other hand, you would expect a

unilateral change of the affected side. The question tells us that
there is less movement on the left side, so we know that the
correct answer has to be C.

The correct answer is: C. Left-sided pneumonia

65. A patient with which of the following conditions would

require airborne precautions?
A. Hepatitis
B. Tuberculosis
C. Lung cancer
D. An open wound

Airborne precautions are used help to prevent the transmission of

infectious diseases that spread through the air. Tuberculosis is
one of those diseases which means that correct answer is B.

Other airborne-spread diseases that you should be familiar with

include:

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 • Varicella
• Measles
• Histoplasmosis
• SARS

For patients with these conditions, special masks and equipment

are required to prevent airborne transmission.

So for the TMC Exam (and in real life), when you see a TB patient,
always remember that it is an airborne disease.

The correct answer is: B. Tuberculosis

66. A blood gas was obtained on an adult patient but the results
appear to be erroneous. You suspect that the pH is falsely
high. Which of the following would cause this error?
A. Severe erythrocytosis
B. The use of a glass syringe
C. Ongoing blood metabolism
D. Air bubbles in the sample

To get this one correct, you needed to have an understanding of

ABGs and the normal values.

This one tends to confuse students, but let’s break it down. If

there is extra air in the sample, that going to dilute the PaCO2
reading and cause it to be lower than what it really is.

That’s because, there’s a very low percentage of CO2 in

atmospheric air, right? This is why the pH will be falsely high.

Ongoing blood metabolism would decrease, not increase the pH.

And the use of a glass syringe and the presence of erythrocytosis
should not affect the pH results. That means we now know that
the correct answer has to be D.

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The correct answer is: D. Air bubbles in the sample

67. An unconscious 47-year-old post-operative patient is

showing signs of atelectasis. Which of the following would
you recommend in order to improve the patient’s
ventilation?
A. Incentive spirometry
B. IPPB
C. Flutter
D. Nasotracheal suctioning

When a post-operative patient has atelectasis, there are two

treatment modalities to choose from:

• Incentive spirometry
• IPPB

The key to making the right choice is that the question tells us
that the patient is unconscious.

As a general rule, Incentive Spirometry is always preferred over

IPPB, as long as the patient can perform it with proper technique.
In cases like this where the patient is likely too sedated, then IPPB
would be indicated.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be B.

The correct answer is: B. IPPB

68. An EKG was taken on a dyspneic 50-year-old female patient

in the emergency department. In which of the following
results should defibrillation be performed?

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 A. Atrial flutter
B. Sinus tachycardia
C. Second-degree heart block
D. Pulseless ventricular tachycardia

For the TMC Exam, you have to know when it’s appropriate to
perform a shock on a patient with an irregular heart rhythm. First,
let’s discuss when unsynchronized defibrillation is required.

There are two shockable rhythms for defibrillation:

• Ventricular Fibrillation
• Pulseless Ventricular Tachycardia

Cardioversion, on the other hand, is a synchronized shockable

rhythm. Here’s when to recommend cardioversion:

• Supraventricular Tachycardia
• Ventricular Tachycardia with a Pulse

So for the patient mentioned in the question, with pulseless V-

tach, they should be defibrillated as soon as possible to restore
normal sinus rhythm.

The correct answer is: D. Pulseless ventricular tachycardia

69. During a bronchoscopy procedure, the physician notes that

the patient shows signs of endobronchial bleeding. Which of
the following would you recommend?
A. Providing 100% oxygen via nonrebreather
B. Direct instillation of Lidocaine
C. Direct instillation of a cold saline solution
D. Direct instillation of an epinephrine solution

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For the TMC Exam, you must be familiar the bronchoscopy
equipment and procedure, as well as the hazards that may arise.

When endobronchial bleeding occurs, you should recommend

direct instillation of an epinephrine solution and apply pressure to
the site where the bleeding is occurring.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be D.

The correct answer is: D. Direct instillation of an epinephrine

solution

70. A chest X-ray was taken on an intubated 44-year-old male

patient. Which of the following can be used to confirm
proper placement of the endotracheal tube?
A. The tip of the tube is even with the carina
B. The tip of the tube is 2-6 cm above the carina
C. The tip of the tube is at the sixth intercostal space
D. The tip of the tube is level with the 5th cervical vertebra

You must know and understand the proper placement of an

endotracheal tube for the TMC Exam.

In general, here’s how to determine if the tip of the ET tube is in

the right place:

• In adults, the ET tube should be inserted 3–4 cm through the

vocal cords.
• Another mark to look for is this: The tube should be inserted
21–24 cm at the patient’s lip, which you can verify by the
markings on the tube.
• The tip should be located between the 2nd and 4th thoracic
vertebrae.

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 • And finally, the tube is in the proper place when it’s 1.5
inches (or 2-6 cm) above the carina. This can be verified with
a chest x-ray.

The correct answer is: B. The tip of the tube is 2-6 cm above the
carina

71. A 68-year-old female patient is receiving volume control A/C

mechanical ventilation. Which of the following would you
recommend in order to help prevent ventilator-associated
pneumonia?
A. Use heated humidification
B. Use disposable circuit components
C. Use a closed suction catheter
D. Change the ventilator circuit every 24 hours

In order to get this one correct, you needed to be familiar with the
best practices that are used to prevent VAP and nosocomial
infections.

Remember, you should only break the circuit whenever it’s visibly
soiled. It should not be changed every 24 hours unless necessary.
Humidification is necessary for patients on the ventilator, but it’s
not a strategy to prevent VAP.

Using a closed suction catheter is a great infection control

strategy for mechanically ventilated patients because it keeps the
suctioning procedure sterile and prevents breaking the circuit.

The correct answer is: C. Use a closed suction catheter

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72. A 41-year-old female patient was recently extubated. She is
current receiving cool mist therapy but begins to develop
stridor. Which of the following would you recommend?
A. Administer racemic epinephrine
B. Reintubate the patient
C. Draw and analyze an arterial blood gas
D. Change from cool mist to heated aerosol

To get this one correct, you simply just needed to know how to
treat a patient with stridor.

Stridor is common post-extubation and indicates that there is

glottic edema. In this case, you should recommend a racemic
epinephrine treatment in order to decrease the swelling.

None of the other answer choices are correct in this case, so you
know the correct answer has to be A.

The correct answer is: A. Administer racemic epinephrine

73. A 51-year-old male patient that is receiving mechanical

ventilation has passed a spontaneous breathing trial. The
physician wants to proceed with extubation. Before
considering extubation, you need to evaluate all of the
following criteria EXCEPT:
A. The presence of upper airway reflexes
B. The ability to cough
C. The risk of aspiration
D. The amount of secretions

Since the patient has passed the SBT, this indicated that they are
able to maintain adequate oxygenation and ventilation. This is the
first step in determining if a patient is ready or not.

However, there are other criteria that must be evaluated as well:

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 • Make sure the patient is at minimal risk for an upper airway
obstruction
• Make sure the patient has intact upper airway reflexes
• Make sure the patient is at minimal risk for aspiration
• Make sure the patient can cough and clear secretions
adequately

The amount of secretions isn’t a determining factor for

extubation, so you know that the correct answer has to be D.

The correct answer is: D. The amount of secretions

74. A paralyzed 68-year-old female patient is receiving volume

control A/C mechanical ventilation. The high pressure alarm
keeps sounding and her breath sounds are noticeably
decreased. Which of the following actions would you
recommend first?
A. Recommend a chest X-ray
B. Reposition the endotracheal tube
C. Increase the alarm pressure limit
D. Attempt to insert a suction catheter

To get this one correct, you must be able to interpret ALL of the
details that are given in the question to determine the best action
to take.

The question tells us that the patient is paralyzed so that rules out
the possibility of patient-ventilator dyssynchrony or biting the ET
tube. Sometimes, small details such as this make a big difference
when it comes to choosing the correct answer, so always read the
question carefully.

The combination of a high pressure alarm with decreased breath

sounds indicates that there is an airway obstruction. So in this

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case, you should FIRST try to insert a suction catheter in order to
rule out a mucus plug or kinking of the airway.

You wouldn’t simply want to inadvertently increase the pressure

limit, so we can rule out C. The other answer choices are okay,
BUT before, the first thing you should try in to insert the suction
catheter.

The correct answer is: D. Attempt to insert a suction catheter

75. In which of the scenarios would it be appropriate to select a

heated humidifier during mechanical ventilation instead of
an HME?
A. A patient with a high fever
B. A patient with thick secretions
C. A patient intubated via the nasal route
D. A patient requiring intra hospital transport

To get this one correct, you needed to be familiar with the

different types of humidification devices.

An HME (Heat and Moisture Exchanger) is used to provide

humidification during mechanical ventilation. What I want you to
remember is that the HME may become obstructed if the patient
has really thick secretions and this will cause an increase in peak
pressure.

In this case, you should remove the HME and replace it with a
heated wick humidifier. These are the only humidification devices
that can condition gas to 100% body humidity (44 mg/L).

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be B.

The correct answer is: B. A patient with thick secretions

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76. A 60-year-old female patient is receiving volume control
ventilation and you note that the endotracheal tube has
become obstructed. Which of the following findings would
you expect?
A. High volume alarm
B. Low volume alarm
C. Decreased lung compliance
D. Decreased peak pressure

To get this one correct, you needed to have a basic

understanding of mechanical ventilation and the settings.

Whenever there is an obstruction of the ET tube during volume

control ventilation, you can expect the peak pressure to increase.

With an increased peak pressure, this will cause the patient to

reach the pressure limit early which results in a decrease in
delivered tidal volume. This would cause a low volume alarm.

Also, in cases such as this, you likely will not be able to pass a
suction catheter. This would confirm that an obstruction is
present.

The correct answer is: B. Low volume alarm

77. An intubated 59-year-old female patient is receiving

mechanical ventilation with a size 7.0 endotracheal tube.
Over the last hour, the patient has been clamping the tube
between her teeth. Which of the following would you
recommend?
A. The use of an oropharyngeal airway
B. The application of a Brigg’s adapter
C. The administration of a strong narcotic analgesic

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 D. The administration of a neuromuscular blocking agent

While orally intubated, it’s common for a patient to bite the

endotracheal tube, which is what’s going on in this question.

In order to fix the problem, you should recommend the use of a

bite block prevent the patient from biting the tube. An
oropharyngeal airway can be used for this as well.

None of the other answer choices are indicated in this situation,

so we know that the correct answer has to be A.

The correct answer is: A. The use of an oropharyngeal airway

78. All of the following are indications for changing a

tracheostomy tube EXCEPT?
A. Need for a different size
B. Damaged tube cuff
C. Soiled stoma dressing
D. Need for a fenestrated tube

To get this one correct, you needed to know in which situations

you should recommend changing a trach tube. Some examples
include:

• The cuff is damaged

• A different size is needed
• A different type of tube is needed (e.g. fenestrated)

A soiled stoma dressing is normal and should be changed out

regularly during trach care. It does not mean that the tube needs
to be changed, however, so you know the correct answer is C.

The correct answer is: C. Soiled stoma dressing

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79. You are called to the emergency department to help
extubate an adult patient who is orally intubated. All of the
following equipment should be available for extubation
EXCEPT:
A. Laryngoscope
B. Suction equipment
C. Bag-valve mask
D. Noninvasive ventilator

As a Respiratory Therapist, before extubating a patient, there is

certain equipment that is required for the procedure. You would
need the following:

• Suction equipment
• Oxygen and aerosol therapy setups
• Manual resuscitator with bag valve mask
• A new intubation kit

A laryngoscope, which would be included in a new intubation kit,

is needed in case rapid reintubation is required. Suction
equipment is always needed during extubation in case of excess
secretions. A manual resuscitator is always needed as well.

An NIV ventilator, for example a BiPAP, is not required for

extubation. If the patient were to deteriorate, NIV could be
considered but it’s not required.

The correct answer is: D. Noninvasive ventilator

80. The physician asks for your opinion on whether or not to

initiate IPPB on a new post-operative adult patient. Which of
the following is an absolute contraindication for this
treatment modality?

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 A. Acute atelectasis
B. Tension pneumothorax
C. Congestive heart failure
D. Bacterial pneumonia

To get this one correct, you simply just needed to know when
NOT to recommend IPPB therapy. The contraindications are:

• An untreated tension pneumothorax

• Hemoptysis
• Lack skilled personnel to operate the machine
• Availability of simpler therapies like incentive spirometry

IPPB or Intermittent Positive Pressure Ventilation is essentially a

positive pressure ventilator that uses a mouthpiece.

As a general rule, incentive spirometry is always preferred over

IPPB, as long as the patient can perform it with proper technique.

If they can’t, for example, if they’re too sedated after surgery, then
IPPB would be indicated.

The correct answer is: B. Tension pneumothorax

81. It is noted that a 64-year-old male patient has secretions in

the anterior segment of the right upper lobe. Which of the
following positions would you recommend for postural
drainage?
A. Right lateral decubitus position
B. Left lateral decubitus position
C. Supine position with a pillow under the hips
D. Trendelenburg position with a pillow under the hips

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You will see a question about the postural drainage positions on
the TMC Exam. The good news is, you will likely only see one of
these questions. Here are a few tidbits for you to remember:

• Supine – Drains the anterior segment of the upper lobes.

• Prone – Drains the superior segments and posterior basal
segments of the lower lobes.
• Trendelenburg – Drains the basal segments of the lower
lobes. Both the anterior and posterior.
• Lateral decubitus position – Used when there is
consolidation in one lung. Remember “good lung up.” For
example, to drain the right lung, you would recommend the
right lateral decubitus position.

So for this patient, we could determine that the correct answer

has to be C.

The correct answer is: C. Supine position with a pillow under the
hips

82. A 54-year-old female patient was admitted to the ER after

being in a motor vehicle accident. Which of the following
thoracic ultrasound findings will show with the presence of a
pneumothorax?
A. The absence of A-lines
B. The presence of seashore sign
C. The presence of a barcode sign
D. The presence of gliding sign

To get this one correct, you simply just needed to know which
“sign” is indicative of a pneumothorax.

In regards to a pneumothorax, for the TMC Exam, you should

remember the following:

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 • Absence of the gliding sign and B-lines
• Presence of A-lines
• Presence of a barcode sign

The presence of the seashore sign actually rules out a

pneumothorax, and none of the other answer choices really make
sense either. So you know that the answer has to be C.

The correct answer is: C. The presence of a barcode sign

83. Incentive spirometry was ordered for an adult post-operative

patient in the ICU. The ability to obtain successful results
from this type of therapy depends mostly on which of the
following?
A. The type of surgery that was performed
B. The difficulty of the set initial goal
C. The quality of the device
D. The effectiveness of instructing the patient

The key for a patient to achieve successful results with incentive

spirometry is highly dependent on the Respiratory Therapist’s
ability to teach the instructions properly.

The initial goal is also very important. It should be set at a level

that is attainable but requires moderate patient effort. If the initial
goal is too easy for the patient, their results will not be as
successful.

Neither the type of surgery nor the brand of the device are
relevant in this case, so you know that the correct answer has to
be D.

The correct answer is: D. The effectiveness of instructing the

patient

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84. A 66-year-old female patient is receiving bland aerosol
therapy. Upon auscultation, you hear rhonchi sounds in the
middle and upper lung fields. Which of the following would
you recommend?
A. Encourage the patient to cough
B. Administer oxygen therapy
C. Discontinue bland aerosol therapy
D. Administer a bronchodilator

To get this one correct, you needed to be familiar with the breath
sound rhonchi and what it indicates.

Rhonchi sounds occur when air moves through secretions in the

large airways. Rhonchi in the upper lung fields can usually be
cleared by coughing.

So for this patient, it seems that the bland aerosol therapy helped
loosen up some of the secretions. Now all you need to do is
encourage the patient to cough in order to clear secretions from
the large airways.

The correct answer is: A. Encourage the patient to cough

85. The nurse calls and requests for you to suction a 2-week-old
infant excess secretions. What is the normal range of
negative pressure that should be used?
A. -60 to -80 mm Hg
B. -80 to -100 mm Hg
C. -100 to -120 mm Hg
D. -150 to -200 mm Hg

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No matter if you’re suctioning an infant, child, or adult, it’s
important to use the proper pressure in order to help avoid
atelectasis and airway trauma.

Here’s what you need to remember:

• For adults, you should use a negative pressure of -100 to -120

cm H2O.
• For children, you should use a negative pressure of -80 to -
100 cm H2O.
• For infants, you should use a negative pressure of -60 to -80
cm H2O.

Do keep in mind, thicker secretions may require more negative

pressure, and thinner secretions may require less. So the pressure
can be adjusted as needed. In general, you should strive to set the
suction level at the lowest possible pressure that can still
effectively clear secretions.

Taking this into consideration, you know that the correct answer
has to be B.

The correct answer is: A. -60 to -80 mm Hg

86. A 65-year-old female patient is receiving therapy with a

pressure-cycled ventilator via mouthpiece. In order to extend
the inspiratory time, you can do which of the following?
A. Increase the flow
B. Decrease the flow
C. Increase the sensitivity
D. Decrease the sensitivity

You will definitely see a question about making adjustments to

IPPB settings in order to get the desired outcome. Since the new
version of the exam was released, you may not see the term IPPB

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any longer. It could be referred to as a pressure-cycled ventilator
instead.

But in general, this is what you should remember about making

adjustments to this type of machine:

• To give a larger tidal volume, increase the pressure setting.

• To give a smaller tidal volume, decrease the pressure setting.
• To give a faster breath, you must decrease the inspiratory
time. You can do that by increasing the flow.
• To give a slower breath, you must increase the inspiratory
time. You can do that by decreasing the flow.

The correct answer is: B. Decrease the flow

87. You are called to perform a chest assessment of a new

patient. Upon assessment, you notice that the patient has a
paradoxical chest wall movement. Which of the following
best describes this finding?
A. Chronic bronchitis
B. Flail chest
C. Exacerbation of COPD
D. Tension pneumothorax

For the exam, you should remember that a paradoxical chest wall
movement is a common sign of a flail chest.

A flail chest is when a section of the chest wall becomes unstable

and protrudes inward during inspiration and pushes out during
expiration.

It occurs when three or more adjacent ribs are fractured in two or

more places and is usually the result of trauma.

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None of the other answer choices make sense in this situation, so
we know that the correct answer has to be B.

The correct answer is: B. Flail chest

88. What size suction catheter is most appropriate for an adult

patient that is intubated with a size 8.0 mm endotracheal
tube?
A. 10 Fr
B. 12 Fr
C. 14 Fr
D. 16 Fr

For the TMC Exam, you must know the guidelines for what size
catheter to use, depending on the size of the patient’s ET tube.
Here is the general rule:

The outer diameter of the suction catheter should be no more

than one-half of the inner diameter of the ET tube. This ensures
that there is enough space for gas from the ventilator to flow
around the catheter.

Here’s an easy way for selecting the appropriate catheter size:

Take the size of the ET tube and double it. Then use the next
smallest catheter size.

So for this patient, they are intubated with a size 8 ET tube.

According to the rule we just learned, you should take the size of
the ET tube and double it.

So 8 x 2 = 16
Then, you should go one size down. The next smallest size is 14,
which means the correct answer has to be C.

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The correct answer is: C. 14 Fr

89. An adult patient receiving oxygen via nasal cannula at 4

L/min is indicated for nasotracheal suctioning. Before
inserting the catheter, the patient’s heart rate is 89/min and
the SpO2 is 95%. After suctioning, the heart rate decreased to
45/min. What is the most likely cause of this problem?
A. A severe mucus plug
B. Vagal stimulation
C. Hypoxemia during suctioning
D. A pneumothorax has developed

Whenever there is a sudden drop in heart rate during suctioning,

you can always associate that vagal stimulation.

As the suction catheter contacts the vagus nerve, it results in

bradycardia.

Hypoxemia causes tachycardia so we can rule that one out right

away. None of the other answer choices really make sense in this
situation, so you know that the correct answer has to be B.

The correct answer is: B. Vagal stimulation

90. A 68-year-old male patient is receiving volume controlled

SIMV. Upon assessment, you note that the high exhaled
minute ventilation alarm is sounding. All of the following are
potential causes of this finding EXCEPT:
A. A change in the set rate
B. A change in the set tidal volume
C. An increase in spontaneous ventilation
D. A leak is present

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To get this one correct, you needed to have a basic
understanding of ventilator alarms.

In general, a high exhaled minute ventilator alarm activates when

the patient’s minute ventilation exceeds the alarm setting. In
other words, it means that has been a change in either the
patient’s set rate, set tidal volume, or spontaneous ventilation.

If a leak were present, it would result in a low tidal volume or low

pressure alarm, which means that the correct answer has to be D.

The correct answer is: D. A leak is present

91. A 75 kg postoperative male patient is intubated and the

physician orders pressure control A/C ventilation. Which of
the following settings would you choose for this patient?
A. Rate = 12/min; PIP = 30 cm H2O; inspiratory time = 2
seconds
B. Rate = 12/min; PIP = 25 cm H2O; inspiratory time = 1
second
C. Rate = 20/min; PIP = 40 cm H2O; inspiratory time = 1
second
D. Rate = 30/min; PIP = 30 cm H2O; inspiratory time = 1
second

To get this one correct, you simply needed to know the normal
ranges for initial ventilator settings:

• Tidal volume 5 – 10 mL/kg of IBW

• PIP 20 – 30 cm H2O
• Respiratory rate 10 – 20 breaths/min
• FiO2 40 – 60% (or set to the level prior to ventilation)
• PEEP 2 – 6 cmH20
• I:E Ratio ≤ 1:2

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Now all you have to do is look through the answer choices to
select the one where all the values are within the normal
parameters.

The correct answer is: B. Rate = 15/min; PIP = 25 cm H2O;

inspiratory time = 1 second

92. An 80 kg male patient was admitted for an acute

exacerbation of COPD. Volume control ventilation was
initiated with a tidal volume of 600 mL and a mandatory rate
of 10/min. 30 minutes later, his ABG results show a PaCO2 of
30 mm Hg. The physician wants to increase the patient’s
PaCO2 to 50 mm Hg. Which of the following settings would
you recommend?
A. Rate 10/min; Tidal volume 700 mL
B. Rate 10/min; Tidal volume 500 mL
C. Rate 15/min; Tidal volume 500 mL
D. Rate 15/min; Tidal volume 700 mL

To get this one correct, you needed to have an understanding of

making adjustments to ventilator settings in order to achieve a
desired result.

There are two ways you can increase the PCO2. Either Decrease
the rate, or decrease the tidal volume.

Since the patient has COPD, a PaCO2 is too low which means he
is blowing off too much CO2. This is why the physician is
requesting for you in increase the PaCO2 value.

With a mandatory rate of 10, you wouldn’t want to decrease it

below that number, which means you much decrease the tidal
volume setting.

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So by looking through the answer choices, B is the only option
where the rate stays the same but the tidal volume is decreased.

The correct answer is: B. Rate 10/min; Tidal volume 500 mL

93. A 63-year-old male patient is receiving mechanical

ventilation with a rate of 12/min and an l:E ratio of 1:3. What is
the length of the patient’s inspiration?
A. 1.0 second
B. 1.25 seconds
C. 1.5 seconds
D. 2.0 seconds

In order to get this one correct, you needed to know how to

calculate inspiratory time.

The first step is to calculate the total cycle time by simply dividing
the 60 seconds by the rate.

60/12 = 5 seconds

Next, determine how much of the inspiratory time takes of the

total cycle time.

[1/(1+3) x 100] = 25%

Then, 25% of 5 seconds = 1.25 seconds.

The correct answer is: B. 1.25 seconds

94. A 60-year-old female patient is receiving BiPAP in the ICU.

The physician wants to change the patient to CPAP while

126
 remaining on the same machine. Which of the following
would you recommend?
A. Set the EPAP to 0 cm H2O
B. Set the IPAP less than the EPAP
C. Set the IPAP greater than the EPAP
D. Set the IPAP equal to the EPAP

To get this one correct, you needed to have a basic

understanding of bi-level ventilation.

In order to provide CPAP on a bi-level positive pressure device,

assuming there is no CPAP mode, you can make the IPAP setting
equal to the EPAP setting.

Doing so will effectively deliver continuous positive airway

pressure to the patient.

The correct answer is: D. Set the IPAP equal to the EPAP

95. A 57-year-old female patient is receiving positive-pressure

ventilation. You should strive to keep the plateau pressure
below which of the following?
A. 20 cm H2O
B. 30 cm H2O
C. 40 cm H2O
D. 50 cm H2O

Plateau Pressure is the pressure at the end of inspiration and can

be measured by having the patient hold their volume
momentarily.

To get this one correct, you simply needed to know the normal
value for Plateau Pressure.

127
In general, the risk of lung injury due to barotrauma can be
minimized by keeping the Plateau Pressure below 30 cm H2O.

If the plateau pressure is greater than 30 cmH2O, you can

consider changing the patient from a volume-cycled to a
pressure-cycled mode.

The correct answer is: B. 30 cm H2O

96. An adult patient is receiving mechanical ventilation in the

assist-control mode. Which of the following is the most
common problem associated with this mode?
A. Hypoventilation
B. Hyperventilation
C. Increased work of breathing
D. The need for neuromuscular paralysis

In order to get this one correct, you needed to have a basic

understanding of the assist-control (A/C) mode.

In this mode, the ventilator delivers a set minimum number of

mandatory breaths, however, patients can trigger assisted
breaths at a higher rate than the set rate.

While using this rate, some patients will develop tachypnea

which leads to hyperventilation, and thus, hypocapnia. None of
the other answer choices really make sense in this situation, so
you know that the correct answer has to be B.

The correct answer is: B. Hyperventilation

97. An adult patient is receiving volume-controlled ventilation in

the ICU. Upon assessment, you note a sudden drop in the

128
 peak inspiratory pressure. Which of the following is most
likely the cause of this problem?
A. Mucous plug
B. Tension pneumothorax
C. Busted ET tube cuff
D. Copious airway secretions

For the TMC Exam, you should be familiar with the basic reasons
that would cause the PIP to drop in volume-controlled ventilation.
Those reasons are:

• A leak is present
• There was a decrease in either the volume or flow setting
• Decreased airway resistance
• Increased lung/thorax compliance

A mucous plug and airway secretions would increase the PIP. A

tension pneumothorax would cause the lung compliance to
decrease, which would increase the PIP as well. A busted ET tube
cuff would definitely cause a sudden drop in peak pressure.

So by using what we know about PIP and volume-control

ventilation, as well as the process of elimination, you can
determine that the correct answer is C.

The correct answer is: C. Busted ET tube cuff

98. A 58-year-old female patient with a tracheostomy is

receiving aerosol via trach mask. Over a 1-week period, the
patient developed an infection in the stoma and airways.
Which of the following is the most likely cause?
A. Poor hand washing by caregivers
B. The patient’s own upper airway bacteria
C. A factory-contaminated tracheostomy mask
D. The use of nebulizer water past its expiration date

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In a case such as described in this question, it is likely the result of
transmission from a nurse or respiratory therapist who failed to
wash their hands properly.

While performing trach care, it’s important to use proper

technique in order to avoid transmitting an infection to the
patient. This, of course, includes proper hand-washing.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be A.

The correct answer is: A. Poor hand washing by caregivers

99. An adult patient diagnosed with chronic bronchitis needs to

be transported through an area of the hospital where there
are patients documented with a respiratory infection of
unknown origin. Which of the following precautions would
you recommend for this patient?
A. Airborne
B. Droplet
C. Contact
D. All of the above

In a unique case such as this, if you do not know the specific type
and cause of the infection, it’s best to take all precautions.

So during the patient transport, you should use a combination of

standard, contact, and airborne precautions until the organism or
infection is identified.

The correct answer is: D. All of the above

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100. A 60-year-old female patient with tachypnea, dyspnea, and
expiratory wheezes was unresponsive to a bronchodilator
treatment. Which of the following is most likely the
patient’s condition?
A. Asthma
B. Chronic bronchitis
C. Pulmonary edema
D. Emphysema

To get this one correct, you must have a basic understanding of

the cardiopulmonary diseases that are listed in the answer
choices.

Since the patient has expiratory wheezing but did not respond to
a bronchodilator treatment, this tells us that the wheezing is
being caused by something other than an obstructive disease.

So that means we can rule out asthma, chronic bronchitis, and

emphysema because they are obstructive diseases.

Pulmonary edema is a condition in which fluid accumulates in

the lungs and this is the cause of the wheezing. Also, this explains
why the bronchodilator didn’t work, and in this case, you would
want to recommend a diuretic instead.

The correct answer is: C. Pulmonary edema

101. What is the maximum volume of gas that can be exhaled

as forcefully and quickly as possible?
A. FVC
B. FRC
C. IRV
D. ERV

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To get this one correct, you simply just need to know the
definitions of the pulmonary volumes and capacities that are
listed in the answer choices.

It should go without saying that you absolutely need to know

these for the exam.

• VT – the volume of air that is inhaled or exhaled from the

lungs during effortless breathing.
• RV – the volume of gas remaining in the lungs after a
complete exhalation.
• IRV – the maximum volume of air that can be inhaled after a
normal inspiration.
• ERV – the total amount of gas that can be exhaled from the
lungs after a normal exhalation.
• VC – the total amount of air that can be exhaled after a
maximum inspiration. It is also the sum of the inspiratory
reserve volume, tidal volume, and expiratory reserve volume.
• IC – the maximum volume of air that can be inhaled after a
normal inspiration.
• FVC – the maximum volume of gas that can be exhaled as
forcefully and quickly as possible.
• FRC – the total amount of gas left in the lungs after a resting
expiration.
• TLC – the total amount of gas in the lungs after a maximum
inspiration.

For this one, you should automatically know that the correct
answer is A.

The correct answer is: A. FVC

102. You are called to help obtain a central venous pressure

measurement using a Swan-Ganz catheter. Before the
measurement is taken, the physician asks, “what is the

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 normal range for CVP?” Which of the following would you
select?
A. 2 - 6 mmHg
B. 4 - 12 mmHg
C. 4 - 8 L/min
D. 2 - 4 L/min/m2

For the TMC Exam, you must be familiar with the normal values
for hemodynamics.

Here are a few that you should remember:

• CVP 2 - 6 mmHg
• MAP 93 - 95 mmHg
• PCWP 4 - 12 mmHg
• CO 4 - 8 L/min
• CI 2 - 4 L/min/m2

So as long as you know the hemodynamic normal values, you

could easily determine that the correct answer is A.

The correct answer is: A. 2 - 6 mmHg

103. It has been determined that a 62-year-old female patient

has pneumonia. This disorder can be classified as which of
the following?
A. A restrictive disorder
B. An obstructive disorder
C. Both a restrictive and obstructive disorder
D. Neither a restrictive or obstructive disorder

For the TMC Exam, you MUST know the difference between the
obstructive and restrictive diseases! The best trick I know is this,
none other than: CBABE.

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You can remember this little mnemonic for all of the obstructive
diseases.

• C – Cystic Fibrosis
• B – Bronchiectasis
• A – Asthma
• B – Bronchitis (Chronic)
• E – Emphysema

Those are your obstructive diseases. ANY other disease that you
see on the TMC Exam can be considered a restrictive disease.

So just to recap: On the exam, whatever disorder is mentioned, if

it’s not in the CBABE mnemonic, you can go ahead and interpret
it as a restrictive disorder for treatment purposes.

For this question, pneumonia is restrictive disorder because

consolidation causes a decrease in lung compliance. So now you
know that the correct answer has to be A.

The correct answer is: A. A restrictive disorder

104. After obtaining a patient's PFT results, they have a vital

capacity of 4.1, functional residual capacity of 5.3, and a
expiratory reserve volume of 1.7. What is the patient's total
lung capacity?
A. 5.2
B. 7.7
C. 8.9
D. 9.7

To get this one correct, you simply need to know how to calculate
the patient’s TLC using the information that is given in the
question. This can easily be done using the “lung box.”

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We recommend that you draw the “lung box” on your scratch
paper before you begin the exam. That way you can use it on the
PFT questions (like this one) throughout the exam.

But for this one, basically all you have to do is subtract the ERV
from the FRC which will give you the patient’s residual volume.
Then, of course, the residual volume plus the vital capacity will
give you the patient’s TLC.

5.3 – 1.7 = 3.6

3.6 + 3.4 = 7.7

If you need more help with using the “lung box” for PFTs, we
cover it inside of our Hacking the TMC Exam video course.

The correct answer is: B. 7.7

105. You are called to review the electrolyte results of an adult

patient. Which of the following values is typical for serum
chloride?
A. 63 mEq/L
B. 77 mEq/L
C. 91 mEq/L
D. 109 mEq/L

You will need to know the normal values for serum electrolytes
for the TMC Exam. Here they are:

• Sodium: 135 – 145 mEq/L

• Potassium – 3.5 – 4.5 mEq/L
• Chloride – 80 – 100 mEq/L

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We cover a shortcut that makes memorizing these easy inside of
our Hacking the TMC Exam video course, so check that out if
you’re interested.

So once you know the normal ranges, you can easily determine
that the correct answer is C.

The correct answer is: C. 91 mEq/L

106. Which of the following problems is most likely associated

with a patient whose ABG results show respiratory
alkalosis?
A. Hypoxemia
B. Hypothermia
C. CNS depression
D. Opiate overdose

To get this one right, you had to know the cause of respiratory
alkalosis. Also, of course, you had to know that respiratory
alkalosis is often a side effect of hypoxemia.

When a patient has decreased oxygen levels, they will

hyperventilate which is what causes the respiratory alkalosis ABG
results. Remember, hyperventilation decreases the PaCO2 values.

None of the other answer choices make sense in this situation, so

we know that the correct answer has to be A.

The correct answer is: A. Hypoxemia

107. While assessing a 49-year-old male patient, you notice

swelling in the lower limbs. This is most likely indicative of
which of the following?

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 A. Hypovolemia
B. Chronic hypertension
C. Right ventricular insufficiency
D. Left ventricular insufficiency

Swelling in the lower limbs is a sure sign of peripheral or pitting

edema. This means that the patient is fluid overloaded and needs
a diuretic.

Peripheral edema is most commonly seen in the ankles and feet

and is caused by right ventricular insufficiency. If the right
ventricle is too weak, fluid will back up and leak out and start to
accumulate in the in the interstitial spaces— particularly the
lower limbs.

The answer obviously isn’t hypovolemia, and none of the other

answer choices are correct either. That means we know that the
correct answer has to be C.

The correct answer is: C. Right ventricular insufficiency.

108. While performing a full code blue on a 5-year-old pediatric

patient that is in respiratory arrest, you should bag-mask
ventilation at a rate of what?
A. 6-12 breaths/min
B. 12-20 breaths/min
C. 20-25 breaths/min
D. 25-30 breaths/min

When there is a child in respiratory arrest but they have a pulse,

you should provide breaths to a child at a rate of about 12-20
breaths per minute until spontaneous breathing resumes. This
equates to 1 breath every 3-5 seconds.

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In general, you should reassess the pulse about every 2 minutes
but spend no more than 10 seconds doing so.

None of the other answer choices are correct in this case, so you
know that the answer has to be B.

The correct answer is: B. 12-20 breaths/min

109. While auscultating a 42-year-old male patient, you hear a

grating sound on both inspiration and expiration. The
patient has been complaining of pain over his lungs. Which
of the following is the most likely cause of this problem?
A. Bronchoconstriction
B. Secretions in the airways
C. Pleural friction rub
D. Exacerbation of COPD

To get this one right, you simply had to know that a localized area
of pain in the lungs with grating breath sounds describes a
pleural friction rub.

It’s a low-pitch harsh grating noise that is heard in pleurisy as the

inflamed pleura rub together.

Bronchoconstriction nor secretions in the airways will cause such

a sound or pain. That means we know that the correct answer has
to be C.

The correct answer is: C. Pleural friction rub

110. You are scheduled to perform a methacholine challenge on

a female patient. What percent decrease in FEV1 needs to

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 occur in order to conclude that a methacholine challenge is
positive for airway hyperreactivity?
A. 10%
B. 15%
C. 20%
D. 25%

To get this one right, obviously, you have to know what a

methacholine challenge is and you need to know the percentage
decrease that must occur in the FEV1 in order to classify the
airway hyperreactivity as positive.

The methacholine challenge is a test that assesses how the

airway reacts or responds. It is normally used to diagnose patients
with asthma. A 20% decrease in FEV1 is considered a positive
result.

Be aware that another name for the methacholine challenge is

the bronchoprovocation challenge test. The correct answer is C.

The correct answer is: C. 20%

111. A 46-year-old female patient displays the following bedside

spirometry results:
FEV1 decreased
FVC normal
FEV1% decreased
Which of the following is most likely the problem?
A. An obstructive disorder
B. A restrictive disorder
C. Poor patient effort
D. Typical PFT results

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To get this one correct, you simply need to know how to interpret
the PFT results. This is definitely something you need to know
how to do for the TMC Exam.

A decreased FEV1 and FEV1% and a normal FVC — this tells us

that the patient has decreased flows.

That means that this is clearly the results of an obstructive

pulmonary disorder, so we know that the correct answer has to
be A.

The correct answer is: A. An obstructive disorder

112. A diagnostic bronchoscopy procedure would be

contraindicated in which of the following patients?
A. A patient with lung carcinoma
B. A patient with unexplained wheezing
C. A patient with active hemoptysis
D. A patient that is hemodynamically unstable

To get this one correct, you simply needed to be familiar with the
indications and contraindications for performing a bronchoscopy.

The most common contraindications include:

• Hemodynamic instability
• Refractory or severe hypoxemia
• Unstable arrhythmia
• Unstable bleeding disorder
• Severe obstructive airway disease

Unexplained wheezing may be a sign of a foreign body

obstruction, which is an indication for a bronchoscopy.

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Hemoptysis is also an indication, as is a lung carcinoma which
may require a biopsy for further inspection.

Hemodynamic instability is a direct contraindication and a

bronchoscopy should never be performed patients in this
condition.

One more note: It’s very important to monitor the patient’s

oxygenation status during the procedure. Hypoxemia is one of
the major hazards, especially as the bronchoscope is suctioning.

The correct answer is: D. A patient that is hemodynamically

unstable

113. A 65-year-old male patient is receiving mechanical

ventilation in control mode. In this mode, a breath will be
triggered in response to which of the following?
A. The patient’s inspiratory efforts only
B. Either the patient’s inspiratory efforts or a timing
mechanism
C. The timing mechanism of the ventilator only
D. The timing mechanism and the pressure settings on
the ventilator

To get this one correct, you needed to have a basic

understanding of control mode ventilation (CMV).

Control mode ventilation is a mode in which the machine delivers

the preset volume or pressure regardless of the patient's own
inspiratory efforts.

Common indications for CMV include severe neurological

conditions, deep sedation, shock, and severe respiratory failure.

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In this mode, a breath can only be triggered by the machine —
and that tells us that the correct answer has to be C.

The correct answer is: C. The timing mechanism of the ventilator

only

114. A patient in the ICU with a deep vein thrombosis suddenly

experienced an episode of dyspnea. Which of the following
would you recommend in order to further evaluate the
patient’s condition?
A. Chest radiograph
B. Lung compliance
C. VD/VT
D. Electrocardiogram

To get this one right, you first needed to recognized that this
patient is showing signs of a pulmonary embolism. Then you
must know what to recommend to further inspect that condition.

A pulmonary embolism should not affect the patient’s lung

compliance, nor their EKG results. Also, a pulmonary embolism is
unlikely to immediately show up on a chest x-ray as well.

For the TMC Exam, when a pulmonary embolism is suspected,

remember that you should recommend a VD/VT in order to see if
the patient’s deadspace has increased. If is has, this will confirm
that a pulmonary embolism is present.

So by go through all the answer choices, we can see that the

correct answer has to be C.

The correct answer is: C. VD/VT

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115. Hemodynamic data was collected on a 39-year-old male
patient. Which of the following indicates that there is a
problem with this patient?
A. Shunt of 3%
B. SVR of 1100 dyn/s/cm-5
C. Cardiac Index of 2.1 L/min/m2
D. CVP of 5 cmH2O

To get this one correct, you simply needed to know the normal
values of the hemodynamic data that is listed in the answer
choices. If you can interpret that, you can easily come up with the
correct answer.

• Normal shunt is 5% or less.

• Normal SVR is 900-1400 dyn/s/cm-5
• Normal CI is 2.5-4 L/min/m2
• Normal CVP for an adult is 2-8 cmH2O

By looking at the normal values, you can see that only one falls
outside of the normal range and it’s C.

The correct answer is: C. Cardiac Index of 2.1 L/min/m2

116. Which of the following would be your primary reasoning for

selecting a high flow nasal cannula system for an adult
patient?
A. To provide CPAP therapy
B. To increase the inspired humidity
C. To washout anatomic deadspace
D. To assure the delivery of a stable or fixed FiO2

To get this one right, you simply just needed to have a basic
understanding of a high flow nasal cannula.

143
The primary reason that you would want to select a HFNC is for
the delivery of a stable or fixed FiO2 to the patient.

The gas from a HFNC is humidified, but that is not the primary
reason for using this device. Also, they do help to washout CO2
from the anatomic deadspace but that is not the primary reason
either.

High flow nasal cannulas can provide CPAP to infants, but the
question specifically refers to an adult patient, so we can rule that
one out as well.

So by using what we know about high flow nasal cannulas, as well

as the process of elimination, you know that the correct answer
has to be D.

The correct answer is: D. To assure the delivery of a stable or fixed

FiO2

117. A patient has been admitted to the emergency

department with the following arterial blood gas results:
pH 7.24
PaCO2 29 torr
PaO2 81 torr
HCO3- 13 mEq/L
Which of the following best describes the given results?
A. Partially compensated metabolic alkalosis
B. Partially compensated metabolic acidosis
C. Uncompensated respiratory acidosis
D. Uncompensated respiratory alkalosis

This is just a classic ABG interpretation question. You likely won’t

see many of these on the TMC Exam because at this point, the
NBRC will assume that you already know how to interpret ABGs.
Otherwise, you wouldn’t have made it this far.

144
With that said, you still absolutely MUST know how to interpret
them because you will be required to do so for SEVERAL
questions on the exam.

So now let’s go ahead and interpret this one. The pH is decreased

which means acidosis. The Bicarb is severely low which tells us
that there is a metabolic issue. The PaCO2 is also low, because in
this case, the body is hyperventilating to try to blow off some CO2
in order to bring the pH back up into the normal range.

However, it has not compensated enough to fully bring the pH

into the normal range, so we know that it is only partially
compensated. That means that the correct answer is B.

The correct answer is: B. Partially compensated metabolic

acidosis

118. A 61-year-old male patient is intubated with a size 8

endotracheal tube and is receiving positive pressure
ventilation in volume control, assist-control. Upon
assessment, you notice a large air leak throughout
inspiration with a cuff pressure measurement of 14 cm H2O.
Which of the following actions should you take?
A. Reassess the cuff pressure during expiration
B. Inflate the ET tube cuff to between 20–30 cm H2O
C. Add an additional 10 mL of air to the ET tube cuff
D. Replace the endotracheal tube with a larger size

To get this one correct, you must know that the cuff pressure
should be maintained between 20–30 cm H2O. You must
remember this for the TMC Exam as well.

Typically a size 8 ET tube is normal for an adult male, so there is

no indication to use a larger size. Reassessing the cuff pressure

145
during expiration is not going to fix the leak. You could add 10 mL
of air to the cuff and this may or may not increase the cuff
pressure into the normal range. The uncertainty is what keeps
this one from being the correct answer.

So that means that we should immediately know that the best

action to take is to inflate the ET tube cuff to between 20–30 cm
H2O.

Also, in general, you should check the patient’s cuff pressure at

least once per shift and make the proper adjustments. This
should be documented in the patient’s chart.

So by using what we know about cuff pressure management, as

well as the process of elimination, you know that the correct
answer has to be B.

The correct answer is: B. Inflate the ET tube cuff to between 20–30
cm H2O

119. A 51-year-old patient on room air has the following ABG

results:
pH 7.43
PaCO2 47 torr
PaO2 169 torr
Which of the following is the best action to take?
A. Report the results to the attending physician
B. Report the results to the patient’s nurse
C. Discard the sample and obtain a new one
D. Give the patient a bronchodilator treatment

To get this one correct, there is a very important detail in the

question that you needed to notice, and it is: The patient is
breathing room air!

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Now, when you look at their results, you should know that a PaO2
above 120 torr is not possible for a patient that is only breathing
room air. This would require that the patient is receiving some
type of supplemental oxygen. So you know that there is an error
with the sample.

In the case, you wouldn’t want to report these erroneous results

and there is no indication for a bronchodilator at this time. So
now you know that the correct answer has to be C.

The correct answer is: C. Discard the sample and obtain a new
one

120. Using spirometry, you tested a 52-year-old female patient

before and after a bronchodilator was given. The results
show that her FEV1 increased from 62% to 83% of predicted.
What do these results indicate?
A. A fixed airway obstruction is present
B. The patient has normal diffusion capacity
C. The patient has a reversible airway obstruction
D. The patient has a restrictive process

The first thing you should notice is that the FEV1 increased by
greater than 15% post-bronchodilator. This tells us right away that
the patient has a reversible obstructive disease, like asthma, for
example.

For the TMC Exam, remember that the post-bronchodilator value

must increase greater than 15% for the obstructive disease to be
considered reversible.

None of the other answer choices make sense in this situation, so

we know that the correct answer has to be C.

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The correct answer is: C. The patient has a reversible airway
obstruction

121. A 64-year-old female patient with a neurological condition

is breathing at a very fast rate with periods of apnea. Which
of the following best describes this condition?
A. Biot’s
B. Hyperpnea
C. Orthopnea
D. Cheyne-stokes

For the TMC Exam, you must be familiar with the common
breathing patterns. Here’s what you need to know:

• Eupnea – Normal breathing.

• Hypopnea – Shallow breathing.
• Hyperpnea – Deep breathing.
• Bradypnea – Slow breathing.
• Tachypnea – Fast breathing.
• Kussmaul – Deep, fast breaths. Seen in diabetic ketoacidosis
which would show metabolic acidosis on the ABG.
• Cheyne-Stokes – Deep and/or shallow breaths with periods
of apnea. Seen in stroke and head trauma patients.
• Biot’s – Rapid breaths with periods of apnea. Seen in
neurological diseases.
• Agonal – Labored breathing or gasping.
• Apnea – No breathing.
• Orthopnea – Difficulty breathing while lying flat.

For this one, you needed to be able to distinguish the difference

between Biot’s and Cheyne-Stokes breathing.

In Biot’s breathing, the patient will have a rapid rate with periods
of apnea but all breaths have the same depth. In Cheyne-Stokes

148
breathing, on the other hand, the breaths alternate between
deep and shallow.

The correct answer is: A. Biot’s

122. The following ABG results were obtained on a 28-year-old

female patient:
pH 7.28
PaCO2 22 torr
HCO3 12 mEq/L
BE -13
PaO2 111 torr
Her ABG results indicate which of the following?
A. Acute metabolic alkalosis
B. Partially compensated metabolic acidosis
C. Partially compensated respiratory alkalosis
D. Acute respiratory acidosis

This is just a classic ABG interpretation question. You likely won’t

see many of these on the TMC Exam because at this point, the
NBRC will assume that you already know how to interpret ABGs.
Otherwise, you wouldn’t have made it this far.

With that said, you still absolutely MUST know how to interpret
them because you will be required to do so for SEVERAL
questions on the exam.

So now let’s go ahead and interpret this one. The pH is decreased

which means acidosis. The Bicarb and Base Excess levels are
severely decreased, which tells us that there is a metabolic issue.
The low PaCO2 tells us that the patient is trying to compensate by
hyperventilating, but since the pH is still outside of the normal
range, there is only partial compensation.

So we know that the correct answer has to be B.

149
The correct answer is: B. Partially compensated metabolic
acidosis

123. What is the most common complication associated with

endotracheal tube extubation?
A. Tracheomalacia
B. Laryngospasm
C. Bradycardia
D. Aspiration

This one is very simple and hopefully you were able to

immediately know the correct answer.

The most common complication associated with endotracheal

extubation is laryngospasm, or also known as post-extubation
laryngospasm.

In this case, the patient likely needs to be maintained with a high

FiO2.

Inspiratory Stridor is common with laryngospasm that occurs

after an extubation and is a sign of laryngeal edema. In this case,
you should administer oxygen and racemic epinephrine.

None of the other answer choices are common complications of

endotracheal extubation, so we know that the correct answer has
to be B.

The correct answer is: B. Laryngospasm

124. You were called to assess an infant in the NICU. While

observing the infant’s chest configuration, you note that it is
the same size in both the AP and the lateral dimensions.

150
 This would indicate that the infant has which of the
following?
A. A normal chest
B. Lordosis
C. Pectus excavatum
D. Pulmonary emphysema with air trapping

To get this one right, you just needed to have a basic

understanding of the normal chest anatomy in infants.

It’s normal for an infant’s chest to basically be round and the

same size in both the AP and lateral dimensions.

All of the other answer choices that are listed would be some type
of abnormal condition which isn’t the case here, so we know that
the correct answer has to be A.

The correct answer is: A. A normal chest

125. While reviewing the ABG results of a newly admitted

patient, you note a PaCO2 of 23 torr, a base excess of -11
mEq/L, and a pH of 7.36. This interpretation can be classified
as which of the following?
A. Acute (uncompensated) respiratory alkalosis
B. Acute (uncompensated) metabolic acidosis
C. Compensated metabolic acidosis
D. Compensated respiratory alkalosis

To get this one correct, you simply just needed to be able to

interpret the ABG results.

The PaCO2 is decreased and the pH is normal. This tells us right

away that there is compensation going on. The base excess is
decreased as well.

151
Since the pH is less than 7.40, you can conclude that the primary
problem that is causing acidosis is the decreased base excess.

So by breaking down the question, you can determine that the

correct answer has to be C.

The correct answer is: C. Compensated metabolic acidosis

126. A patient has the following bedside spirometry results:

Respiratory rate = 12
Tidal volume = 450 mL
Dead space = 147 mL,
Vital capacity = 1.2 L
Based on this data, what is the patient’s minute ventilation?
A. 3.1 L/min
B. 4.7 L/min
C. 5.4 L/min
D. 8.2 L/min

To get this one right, you need to know the simple calculation for
minute ventilation. You must know this formula:

Minute ventilation = rate x tidal volume

The question includes extra information that is not needed, just to

try to throw you off. But you’re a very smart student and I know
that you will be able to see straight through the games that the
NBRC will try to play. J

Now let’s plug the numbers in.

MV = 12 x 450
MV = 5,400 mL

152
Now you can convert that to liters by moving the decimal three
places to the left.

The correct answer is: C. 5.4 L/min

127. Which of the following bedside measurements is

considered to be the best for assessing the function of the
respiratory muscles and mechanical properties of the
lungs?
A. Functional residual capacity
B. Vital capacity
C. Maximum inspiratory force
D. Minute ventilation

To get this one right, you have to know and understand each of
the answer choices — particularly vital capacity since it is the
correct answer.

A vital capacity is the amount of gas a patient can exhale after a

complete inhalation. It’s a good way to test both the inspiratory
and expiratory muscle strength as well as lung compliance and
airway resistance. None of the other answer choices can provide
these measurements, so we know that the correct answer has to
be B.

The correct answer is: B. Vital capacity

128. A 58-year-old male patient with thick oropharyngeal

secretions is in need of suctioning. Your first attempt with a
Yankauer was unsuccessful and you noticed that the
pressure regulator is set to -80 mm Hg. Which of the
following would you recommend?

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 A. Perform nasotracheal suctioning
B. Replace the wall suction regulator
C. Change to a flexible catheter
D. Increase the suction pressure to -120 mm Hg

To get this one correct, you needed to have a basic

understanding of suctioning. Specifically, you need to know the
normal suction pressures.

• Adults: -100 to -120

• Child: -80 to -100
• Infants: -60 to -80

So by looking at these ranges, you can quickly see that, for this
58-year-old male, a suction pressure of -80 mm Hg is far to low.
That explains why the suction attempt was unsuccessful.

Keep in mind, you should strive to set the suction level at the
lowest possible pressure that can still effectively clear secretions.
So, for this patient, you could bump the pressure up to -100 mm
Hg and try that. If that’s still not enough, then you can go up to -
120 mm Hg for adults.

The correct answer is: D. Increase the suction pressure to -120 mm

Hg

129. An adult patient is intubated and receiving volume control

ventilation with an HME. Over the past 6 hours, you noticed
that the patient’s peak pressure has been progressively
increasing. After in-line suctioning was performed, you
noted that the patient’s secretions were of normal volume
and viscosity. Which of the following would you
recommend?
A. Increase the HME temperature

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 B. Decrease the respiratory rate
C. Change the HME
D. Change to a heated wick humidifier

To get this one correct, you first needed to know what an HME is.
Also, you needed to have a basic understanding of providing
humidification for patients on the ventilator.

An HME or Heat and Moisture Exchanger, is used to provide

humidification during mechanical ventilation. Over time, an HME
may become obstructed with water and secretions which will
cause an increase in peak pressure. In this case, you need to
replace the HME with a new one.

You should only remove the HME and replace it with a

heated wick humidifier if the patient has really thick secretions.

But for this patient, the question tells us that their secretions are
normal, so there isn’t an indication to provided heated humidity.
Instead, you simply need to change the HME.

The correct answer is: A. Change the HME

130. A 71-year-old female patient is receiving therapy via a

positive pressure-cycled ventilator via mouthpiece. Upon
assessment, you note that the machine fails to cycle off on
exhalation. Which of the following would you recommend?
A. Increase the sensitivity
B. Increase the flow
C. Use a flanged mouthpiece
D. Have the patient exhale more forcefully

The question tells us that the machine is failing to cycle off, so

that means that there’s a leak.

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In all likelihood, the patient probably doesn’t have a good lip seal
around the mouthpiece. This would explain why the machine
doesn’t cycle off because it never reaches the pressure limit.

In order to fix the problem, you can simply have the patient use a
flanged mouthpiece or mask in order to create a good seal and
prevent leaks.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be C.

The correct answer is: C. Use a flanged mouthpiece

131. Placing a patient in the Trendelenburg position would be

contraindicated for which of the following?
A. Bronchiectasis
B. Congestive Heart Failure
C. Ciliary dyskinesia
D. Cystic fibrosis

The Trendelenburg position in a head-down position that is used

during postural drainage to help mobilize secretions. This position
can significantly increase intracranial pressure which means that
it’s contraindicated in some patients. Here are some examples:

• Patient with elevated ICP

• Recently neurosurgery
• Traumatic brain injury
• CHF
• Cardiogenic pulmonary edema
• Right heart failure
• Those at high risk for aspiration

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So for this patient, you could easily determine that the correct
answer has to be B.

The correct answer is: B. Congestive Heart Failure

132. In order to establish the initial ventilator settings for a new

patient, the most important consideration is which of the
following?
A. The amount of spontaneous ventilatory effort
B. The type of ventilatory support device used
C. The quality of the physician and staff
D. The patient’s size and clinical condition

When establishing the initial ventilator settings, the first this you
have to take into account is the patient’s size and clinical
condition.

That is why I always say that Ideal Body Weight is the most
important calculation on the TMC Exam. Because you need to
know how to calculate IBW in order to determine the initial tidal
volume setting on the ventilator.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be D.

The correct answer is: D. The patient’s size and clinical condition

133. A BiPAP machine that was used in the emergency

department was just returned for cleaning. Which of the
following agents would you use for surface disinfection?
A. Ethylene oxide
B. 70% ethyl alcohol

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 C. Alkaline glutaraldehyde
D. Acetic acid

To get this one correct, you just need to know which substance
can be used as a disinfectant.

In general, alcohol substances are used to disinfect surfaces in the

hospital setting, so this is what would be recommended to clean
the surfaces of a BiPAP machine.

Glutaraldehyde solutions are used for high-level disinfection and

sterilization and required for the object to be submerged in the
solution for periods of time. Acetic acid is a disinfectant, but it is
recommended for use in the home setting — not the hospital.
Ethylene oxide is a gas that is used for sterilization.

So by using what we know about disinfectants, as well as the

process of elimination, you know that the correct answer has to
be B.

The correct answer is: B. 70% ethyl alcohol

134. An 58-year-old female patient is receiving positive pressure

mechanical ventilation. Which of the following is an
indication for the addition of positive-end expiratory
pressure?
A. To increase the efficiency of ventilation
B. To decrease hypoxemia due to shunting
C. To decrease the physiologic deadspace
D. To provide graded levels of ventilatory support

PEEP, or positive-end expiratory pressure, is indicated when the

patient is having oxygenation issues.

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To be more specific, the patient needs PEEP when they’re
hypoxemia is caused by shunting in conditions such as ARDS.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be B.

The correct answer is: B. To decrease hypoxemia due to shunting

135. Oxygen via nasal cannula was ordered for a post-operative

patient with an SpO2 of 82% on room air. After 30 minutes
on 3 L/min, the patient’s SpO2 increased to 87%. Which of
the following actions is appropriate at this time?
A. Intubate and initiate mechanical ventilation
B. Initiate noninvasive ventilation via full face mask
C. Increase the oxygen flow and reassess the patient
D. Decrease the oxygen flow and reassess the patient

Since the patient’s oxygen saturation level increased after O2

therapy was provided, this is a good sign. So intubation nor
noninvasive ventilation would be indicated.

Also, you wouldn’t want to decrease the oxygen liter flow because
an SpO2 of 87% is still hypoxemic.

So for this patient, it would be best to bump the liter flow up to 4

L/min and reassess.

The correct answer is: C. Increase the oxygen flow and reassess
the patient

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136. A 59-year-old male COPD patient who weighs 145 lbs. is
receiving ventilatory support in the volume-control SIMV
mode. The following data was obtained:
Ventilator settings:
Tidal volume 450 mL
Rate 10
FiO2 30%
PEEP 5 cm H2O
ABG results:
pH 7.38
PaCO2 59 torr
HCO3 34 mEq/L
PaO2 62 torr
SaO2 90%
Which of the following changes would you make?
A. Increase the FIO2
B. Increase the SIMV rate
C. Increase the tidal volume
D. Maintain the current settings

To get this one correct, you needed to have an understanding of

making the appropriate changes to ventilator settings when
given ABG results. You needed to be aware of how COPD patients
are a bit different from other patients.

In patients with COPD, they are considered to be chronic CO2

retainers. This means that they usually have high PaCO2s, with a
normal pH due to compensation. This is what you can see here
with this patient.

So since their pH is normal (fully compensated), we can accept

the high PaCO2 and we wouldn’t want to make any changes to
decrease it.

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Now let’s look at the oxygenation values. For patients with COPD,
we can live with an SaO2 of 90% and a PaO2 of 62 torr. A higher
FiO2 would raise the PaO2 and could potentially cause oxygen-
induced hypercapnia which is something that we do not want.

So for this patient, the best action to take is to maintain the

current settings and reassess at a later time.

The correct answer is: D. Maintain the current settings

137. Intubation and mechanical ventilation was ordered for a

130 lb female patient that has a history of COPD. Which of
the following initial settings is best for this patient?
A. Rate 10; Tidal volume 450 mL
B. Rate 10; Tidal volume 650 mL
C. Rate 14; Tidal volume 500 mL
D. Rate 14; Tidal volume 750 mL

In order to get this one correct, you need to know how to

determine the initial ventilator settings. You absolutely MUST
know how to do this for the TMC Exam.

The first step is to determine the patient’s ideal body weight by

converting lbs to kgs.

130/2.2 = IBW of 59 kg

That means that the initial tidal volume range should

approximately be set between 300-600 mL.

So by looking at the answer choices, you can rule out B and D

right away. For COPD patients, due to the high expiratory
resistance, lower rates are usually recommended. So that means

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that a rate of 10 would be preferred over a rate of 14, so you know
that the correct answer has to be A.

The correct answer is: A. Rate 10; Tidal volume 450 mL

138. An adult patient is receiving pressure support ventilation.

All of the following factors determine the amount of tidal
volume that is delivered during this mode EXCEPT:
A. The set pressure level
B. The set rate
C. The patient’s lung compliance
D. The patient’s airway resistance

To get this one correct, you needed to have a basic

understanding of pressure support ventilation.

The tidal volume that is delivered during this mode depends on

the following:

• The set pressure level

• The patient’s inspiratory effort
• The patient’s lung compliance
• The patient’s airway resistance

By knowing this information, you could easily determine that the

correct answer has to be B.

The correct answer is: B. The set rate

139. A 60-year-old adult patient is receiving mechanical

ventilation. Which of the following ventilator graphics

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 would you recommend in order to assess the work of
breathing associated with patient triggering?
A. Volume vs Time
B. Flow vs Volume
C. Flow vs Time
D. Pressure vs Volume

To get this one correct, you needed to have a basic

understanding of ventilator graphics — even though an actual
graphic is not shown in the question.

When it comes to assessing patient triggering, the Pressure-

Volume loop would be the best choice because you can see the
negative pressure when the patient triggers a breath.

Pressure-volume loops also can be used to assess the patient’s

lung compliance, airway resistance, and work of breathing.

The correct answer is: D. Pressure vs Volume

140. An adult patient is receiving mechanical ventilation in the

volume controlled A/C mode. The ventilator has an
inspiratory time limit control that is set. If the time needed
to deliver the tidal volume increases to the preset limit,
which of the following will occur?
A. The delivered tidal volume will decrease
B. The ventilator will switch to pressure control
C. The ventilator will automatically cycle to end inspiration
D. More time will be provided to complete the inspiration

To get this one correct, you needed to have a basic

understanding of ventilator settings and how the machine
operates.

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Being able to set a limit for the inspiratory time is used as a safety
mechanism and will override volume-cycling if the preset limit is
reached.

This will cause the ventilator to automatically cycle off when

inspiration becomes dangerously long. You might see this in
patients with high airway pressures.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be C.

The correct answer is: C. The ventilator will automatically cycle to

end inspiration

141. A 62-year-old male patient in the ICU is positioned in the

semi-fowler position. During auscultation, you hear crackles
and you also noticed that the patient has frothy secretions.
Which of the following is the most likely cause of this
finding?
A. Dehydrated
B. Emphysema
C. Fluid overload
D. Hypertension

To get this one correct, you simply needed to recognize the signs
that were given in the question. First and foremost, when a
patient has pink, frothy secretions, you should automatically
know that they have pulmonary edema/CHF.

And a common sign of that condition is excess fluid storage. You

must know all of the signs of fluid overload for the TMC Exam:

• Peripheral edema
• Jugular venous distention
• Crackles on auscultation

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 • Shortness of breath

In this case, the patient needs a diuretic, such as Lasix. None of

the other answer choices really make sense in this situation, so
we know that the correct answer has to be C.

The correct answer is: C. Fluid overload

142. A 21-year-old female patient was admitted to the

emergency department for having an asthma attack. The
patient is experiencing moderate to severe levels of
dyspnea. Which of the following drugs would you
recommend for administration via nebulization?
A. Levalbuterol
B. Beclomethasone
C. Montelukast
D. Magnesium sulfate

To get this one correct, you needed to have a basic

understanding of pharmacology and which drugs to give for an
acute asthma attack. Short acting bronchodilators are always
indicated for bronchospasm during an acute asthma attack.
These drugs include:

• Albuterol
• Levalbuterol
• Metaproterenol

Inhaled steroids are not typically used to treat acute

exacerbations. With that said, systemic steroids are often
administered during an acute attack, so keep that in mind.

Montelukast is a maintenance drug — not a rescue drug — so we

can rule that one out as well.

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The correct answer is: A. Levalbuterol

143. A 54-year-old female patient arrives to the ER intubated

and receiving CPR. The physician requests for atropine to
be given but the paramedics were unable to establish IV
access. Which of the following routes of administration
would you recommend?
A. Aerosolized via SVN
B. Intramuscular injection
C. Endotracheal instillation
D. Nasogastric instillation

To get this one correct, first and foremost, you needed to know
that what atropine is. It’s an ACLS drug that is often given for
bradycardia.

You also needed to know that some medications can be instilled

directly down endotracheal tube. To make it easy to remember,
you can learn the NAVEL mnemonic.

• N – Naloxone (Narcan)
• A – Atropine
• V – Vasopressin
• E – Epinephrine
• L – Lidocaine

Remember that when directly instilling medications down the ET

tube, you have to administer 2–2.5 times more of the medication
than the normal dose in order for it to be effective.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be C.

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The correct answer is: C. Endotracheal instillation

144. An infant in the NICU is receiving inhaled nitric oxide. The

physician put in a new order to stop the therapy but after
doing so, the infant becomes hemodynamically unstable.
Which of the following is the best action to take at this
time?
A. Increase the FiO2
B. Initiate chest compressions
C. Administer vasodilators
D. Return the infant to the prior NO dosage

Even though the question is about an infant that is receiving

nitric oxide, you really didn’t need to know anything about that in
order to come up with the correct answer.

Here’s a rule of thumb to remember:

As a Respiratory Therapist, in general, whenever you make a

change of any type and the patient has an adverse response —
your first move should be to return the patient back to what they
were previously on.

This applies to oxygen levels, vent settings, and almost everything

else. If you change something and things get worse — change it
back!

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be D.

The correct answer is: D. Return the infant to the prior NO dosage

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145. A beta-adrenergic bronchodilator has been administered
to a 51-year-old female patient. All of the following are side
effects associated with this drug except:
A. Tachycardia
B. Palpitations
C. Tremors
D. Bradypnea

Going back to first semester of RT school with this question. With

that said, you must know the side effects of beta-adrenergic
bronchodilators. They are:

• Tachycardia
• Increased cardiac arrhythmias
• Palpitations
• Skeletal muscle tremors
• Anxiety, nervousness, insomnia, and nausea.

So for this one, you should easily be able to determine that the
correct answer is D.

The correct answer is: D. Bradypnea

146. A 65-year-old female patient has been weaned from

mechanical ventilation and extubated. The patient was
placed on a cool aerosol mask with an FiO2 of 40%. Within
the hour, the patient starts to develop moderate hypoxemia
and hypercapnia. Which of the following would you
recommend at this time?
A. Increase the FiO2 to 60%
B. Apply BiPAP via face mask
C. Administer albuterol via small volume nebulizer
D. Re-intubate and return to previous ventilator settings

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Even though the patient in this question is getting worse, you
want to avoid re-intubation if at all possible. So first and foremost,
we can rule out D.

In general, BiPAP can be helpful in patients with mild to

moderate hypercapnia or hypoxemia. It’s the best option in this
case since it’s a form of noninvasive positive pressure ventilation.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be B.

The correct answer is: B. Apply BiPAP via face mask

147. A 55-year-old female patient with a neuromuscular disorder

is intubated and receiving vest oscillation to help mobilize
secretions into the larger airways. She is having difficulty
clearing the secretions. Which of the following techniques
would you recommend?
A. Mechanical insufflation-exsufflation
B. Positive expiratory pressure therapy
C. Acetylcysteine via small volume nebulizer
D. Postural drainage, percussion and vibration

To get this one correct, you needed to be familiar with the

techniques that are listed in the answer choices when it comes to
clearing secretions.

It’s common for patients with a neuromuscular disorder to have

difficultly mobilizing and clearing secretions. Secretions can be
mobilized with vest oscillation, postural drainage, percussion and
vibration, and IPV therapy.

BUT, after they’re mobilized into the larger airway, then they must
be cleared. And since this patient is unable to cough up the

169
secretions, Mechanical insufflation-exsufflation is indicated to
help with this.

PEP therapy would not be indicated because the patient has

inadequate respiratory muscle strength that is needed in order to
generate the expiratory pressure. Acetylcysteine, aka Mucomyst,
may help to thin the secretions, but it doesn’t actually help clear
them from the airways.

So by breaking down the question and answer choices, we can

determine that the correct answer has to be A.

The correct answer is: A. Mechanical insufflation-exsufflation

148. A 58-year-old female patient is showing signs of shortness

of breath, lightheadedness, and cyanosis in the lips. The
patient has a history of COPD. Upon auscultation, you note
bilateral bronchial breath sounds with inspiratory crackles.
Her ABG results are as follows:
pH 7.35
PaCO2 65 torr
PaO2 49 torr
HCO3 31 mEq/L
BE +6
Which of the following would you recommend?
A. Nasal cannula at 4 L/min
B. Albuterol aerosol via SVN
C. Air-entrainment mask at 28%
D. Nonrebreathing mask at 12 L/min

The first step in determining the correct answer is to interpret the

ABG results. The results show compensated respiratory acidosis
with severe hypoxemia.

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Judging by the signs that were given in the question, the
hypoxemia is likely due to an acute exacerbation of COPD. Or,
possibly even pneumonia since bronchial breath sounds were
heard. No wheezing was heard, so you can rule out albuterol as
the answer choice. But you know something has to be done for
the hypoxemia.

Remember, for COPD patients, you don’t want to give them too
much oxygen in order to avoid oxygen-induced hypercapnia. So
you can rule out a nonrebreather in this case.

Since the question tells us that the patient is dyspneic, we need

to provide oxygen with a little more flow than from a low-flow
nasal cannula. But also something with a controllable, low FiO2.
The clear best choice is an air-entrainment mask at 28% which
means that the correct answer has to be C.

The correct answer is: C. Air-entrainment mask at 28%

149. A 91-year-old female patient with a history of lung cancer

was admitted to the emergency room and arrived by
transport via family members. The patient is unable to
respond to questions. Which of the following should be
asked in order to ensure that the proper level of care is
delivered?
A. “When was the last time the patient ate?”
B. “When was the last time the patient had a bowel
movement?”
C. “Did you bring the patient’s current home care
medications?”
D. “Has an advance directive been documented?”

171
After reading the question, you can determine that, given the age
and condition, the patient is likely terminally ill with a condition
such as lung cancer.

So in this case, it would be appropriate to ask about advance

directives. You need to know if there is a DNR (do not resuscitate)
order in place in order to deliver the proper level or care.

None of the other answer choices are essential to know at this

time, so you know that the correct answer has to be D.

The correct answer is: D. “Has an advance directive been

documented?”

150. You were called by the nurse to check on a 59-year-old

postoperative male patient who is showing signs of
tachycardia and tachypnea. The patient has an SpO2 is 83%
on 4 L/min nasal cannula. Which of the following would you
recommend?
A. Increase the flow to 6 L/min via nasal cannula
B. Initiate CPAP with a pressure of 5 cm H2O
C. Change to a nonrebreathing mask at 12 L/min
D. Intubate and provide mechanical ventilation

The question tells us that the patient has an SpO2 of 83% on 4

L/min of oxygen. Clearly, this is not enough oxygen at this time.
The combination of tachycardia, tachypnea, and hypoxemia
indicates that a higher FiO2 is needed.

The best (and quickest) option is to change to a nonrebreathing

mask and then reassess the patient. Increasing the flow of the
nasal cannula likely isn’t going to be enough. Initiating CPAP at a
pressure level of 5 cm H2O likely won’t be enough either.

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Intubation is not indicated without first getting an ABG, and
meeting other criteria, so we can rule that one out as well.

A nonrebreathing mask can be used to deliver a consistent high

FiO2 which will help subside the tachycardia, tachypnea, and
hypoxemia. Therefore, best answer in this case has to be C.

The correct answer is: C. Change to a nonrebreathing mask at 12

L/min

151. A 63-year-old postoperative female patient has been

receiving oxygen via high-flow nasal cannula for 4 days. The
device is set with an FiO2 of 70% and the flow is set at 20
L/min. Her ABG results are as follows:
pH 7.39
PaCO2 43 torr
PaO2 159 torr
SaO2 99%
HCO3 24 mEq/L
Which of the following would you recommend?
A. Decrease the FiO2
B. Decrease the flow
C. Decrease both the flow and FiO2
D. Switch to a standard nasal cannula

To get this one correct, you needed to have a basic

understanding of high-flow nasal cannulas and how to interpret
ABG’s.

In general, HFNC’s need a flow setting of at least 20 L/min in order

to deliver the set FiO2. Since this patient’s flow is already set at
the lower limit of 20 L/min, you wouldn’t want to decrease it.

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By looking at the ABG results, you should note right away that the
PaO2 of 159 torr is too high and should be lowered. You can do so
by decreasing the FiO2.

The correct answer is: A. Decrease the FiO2

152. Suctioning was ordered PRN for a 57-year-old male patient

who is who is having difficulty clearing secretions. The
patient is awake and receiving oxygen via nasal cannula at 2
L/min. Which of the following would you recommend to
facilitate suctioning for this patient?
A. Yankauer catheter
B. Oropharyngeal airway
C. Laryngeal mask airway
D. Nasopharyngeal airway

To get this one correct, you needed to have a basic

understanding of suctioning. The key to getting this one correct is
the fact that the question tells us that the patient is away.

So in this case, a nasopharyngeal airway would facilitate

suctioning because it helps guide the catheter into the pharynx
and minimizes the likelihood of nasal trauma.

Remember that, to use an oropharyngeal airway, the patient

must be unconscious. None of the other answer choices really
make sense in this situation, so you know that the correct answer
has to be D.

The correct answer is: D. Nasopharyngeal airway

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153. A 69-year-old home care patient who is diagnosed with
chronic bronchitis is having trouble clearing secretions by
coughing. The patient lives alone but receives care in the
home. Which of the following would you recommend to aid
in the clearance of the secretions?
A. Incentive spirometry
B. Flutter valve therapy
C. Albuterol treatment via SVN
D. Postural drainage with percussion

To get this one correct, you needed to have a basic

understanding of airway clearance therapy.

As a home care patient, the easiest and most effective method to

aid in secretion clearance is via vibratory PEP therapy. Now all you
need to do is go through the answer choices and select this type
of treatment.

Albuterol is used to treat bronchospasm, not clear secretions.

Incentive spirometry is more focused on preventing atelectasis, so
we can rule that one out as well. Postural drainage with
percussion would be helpful, but since this is a home care patient,
that is not an option.

A flutter valve device can help mobilize secretions and aid in their
removal. And most importantly for this patient, it can be used in
the home without assistance.

The correct answer is: B. Flutter valve therapy

154. A 61-year-old male patient who weighs 160 lbs is receiving

volume-control SIMV. The tidal volume is set at 500 mL, rate
of 12/min, FiO2 of 60% and a PEEP of 5. The patient’s ABG
results are as follows:

175
 pH 7.45
PaCO2 37 torr
HCO3 24 mEq/L
PaO2 56 torr
SaO2 99%
Which of the following changes would you recommend?
A. Increase the rate
B. Increase the PEEP
C. Decrease the FiO2
D. Decrease the tidal volume

In order to get this one correct, you must be able to interpret the
ABG results and then make appropriate changes to the ventilator
settings. There will be several questions likes this on the TMC
Exam.

When looking at the ABG results, the first thing you should notice
is that the PaO2 is very low, especially since the patient is on an
FiO2 of 60% and a PEEP of 5. This lets you know that shunting is
present, and as a general rule of thumb — to treat shunting, you
should increase the level of PEEP.

There’s no indication to adjust the rate or tidal volume because

the PaO2 is normal. Since the patient is having oxygenation
issues, you wouldn’t want to decrease the FiO2. So after breaking
down the question, you can determine that the correct answer
has to be B.

The correct answer is: B. Increase the PEEP

155. A adult female patient who weighs 134 lbs is receiving

volume-control SIMV. The tidal volume is set at 450 mL with
a mandatory rate of 12/min and pressure support of 5 cm
H2O. Upon assessment, note that that she is using her

176
 accessory muscles during most spontaneous breaths and
her total rate is 39/min. Which of the following would you
recommend?
A. Increase the level of pressure support
B. Decrease the mandatory breath rate
C. Increase the set tidal volume
D. Increase the inspiratory flow

Since the question tells us that the patient is tachypneic and

using their accessory muscles, we know right away that there is
an increased work of breathing.

In order to decrease the work of breathing, all you have to do is

increase the set level of pressure support. Doing so will increase
the patient’s spontaneous tidal volume while decreasing the fast
breathing rate, and thus, decrease the work of breathing.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be A.

The correct answer is: A. Increase the level of pressure support

156. An adult male patient who weighs 85 kg is being initiated

on mechanical ventilation in the volume-control A/C mode.
The physician recommends the following settings:
Rate 12/min
Tidal volume 900 mL
FiO2 40%
PEEP 5
Given this information, which of the following would you
recommend?
A. Suggest increasing the set rate
B. Suggest using pressure-control mode
C. Suggest increasing the level of PEEP

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 D. Suggest decreasing the tidal volume

To get this one correct, you needed to have a basic understand of

initiating mechanical ventilation on a patient.

The question doesn’t give any details about the patient’s

oxygenation status, therefore, we are not concerned with the
FiO2 and PEEP right now. Also, a set rate of 12 is in the normal
range so we can now rule out A as well.

Now let’s look at the tidal volume.

The patient IBW is 85 kg which tells us that the tidal volume

range should be set between 425-850 mL. For the patient in this
question, the doctor wants to set the tidal volume at 900 mL
which is too high.

So in this case, you would need to suggest decreasing the tidal

volume which means that the correct answer has to be D.

The correct answer is: D. Suggest decreasing the tidal volume

157. A 57-year-old male patient with closed head trauma is

receiving volume control A/C ventilation. His intracranial
pressure has increased from 17 to 25 mm Hg despite proper
levels of sedation. Which of the following would you
recommend for this patient?
A. Decrease the set flow
B. Perform an inspiratory hold
C. Hyperventilation
D. Increase the level of PEEP

Intracranial pressure is basically just the pressure within the brain.

You want to keep the patient’s ICP less than 10 mm Hg. However,

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if the ICP increases above 10 mm Hg, then you must take some
things into consideration when providing mechanical ventilation.

Here’s what you need to know:

For patients on the ventilator with and increased ICP, you can
actually decrease the ICP by purposefully hyperventilating the
patient. By blowing off some PaCO2 pressure, this will help lower
the patient’s ICP.

Keep in mind, this technique is only to be used temporarily, and

you should aim to hyperventilate the patient until the PaCO2
drops into the 25–30 torr range, compared to the normal range of
35–45 torr.

The correct answer is: C. Hyperventilation

158. A 70-year-old female patient with ARDS is receiving volume

control ventilation in the assist-control mode. The physician
want to increase the level of PEEP to 30 cm H2O. Before
adjusting the setting, which of the following would you
recommend in order to minimize the effects on the
patient’s cardiovascular system?
A. Increase the inspiratory time
B. Decrease the expiratory time
C. Switch the patient to the SIMV mode
D. Switch the patient to pressure control

To get this one correct, you needed to have a different

understanding of the different ventilator modes and settings.

For ARDS patients, the IRV and APRV modes would be

appropriate. But they are not given in the answer choices, so you
must go through to find the next best option.

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In general, the SIMV mode would be the best for high levels of
PEEP because it allows the patient to breath spontaneously
during the expiratory phase which can help offset some of the
adverse effects of high PEEP levels.

None of the other answer choices really make sense in this

situation, so you know that the correct answer has to be C.

The correct answer is: C. Switch the patient to the SIMV mode

159. A 3-year-old patient presents to the emergency room with

unilateral wheezing. Which of the following would you
recommend?
A. Aerosolized albuterol
B. Aerosolized pulmicort
C. Furosemide (Lasix)
D. Bronchoscopy

To get this one correct, you needed to understand the different

types and causes of wheezing.

• Bilateral wheezing typically indicates bronchospasm and

can be treated with a short-acting bronchodilator.
• If the patient is wheezing due to fluid overload, giving a
bronchodilator is not going to do any good. You should
recommend a diuretic medication instead.
• Unilateral wheezing is an indication of a foreign body
obstruction. In this case, you should recommend a
bronchoscopy.

Inhaled steroids are not typically used to treat wheezing in any

case, so you can rule that one out right away.

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For a child with unilateral wheezing, it likely means that they
swallowed or aspirated a foreign object. So in this case, you
should recommend a bronchoscopy.

The correct answer is: D. Bronchoscopy

160. A 66-year-old male patient who weighs 80 kg is receiving

volume controlled mechanical ventilation in the SIMV
mode. The tidal volume is set at 350 mL with a set rate of
10/min, FiO2 of 30% and a PEEP of 5. His ABG results are as
follows:
pH 7.28
PaCO2 52 torr
HCO3 25 mEq/L
PaO2 87 torr
SaO2 95%
Which of the following changes would you recommend?
A. Increase the set rate
B. Increase the tidal volume
C. Increase the level of PEEP
D. Add mechanical dead space

In order to get this one correct, you must be able to interpret the
ABG results and then make appropriate changes to the ventilator
settings. There will be multiple questions likes this on the TMC
Exam.

The ABG results show acute respiratory acidosis and the patient
appears to be oxygenating properly. So there’s no need to adjust
the FiO2 or PEEP.

In order to correct the acidosis, you must decrease the PaCO2.

And you can do that by either increasing the tidal volume or the
set rate. While a rate is 10 is on the low end, that’s still within the

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normal range, therefore it is appropriate at this time. The tidal
volume, on the other hand, is too low.

The question tells us that the patient weighs 80 kg, which means
the tidal volume should be set between 400-800 mL. So now you
can easily see that a tidal volume of 350 mL is too low and need to
be increased.

The correct answer is: B. Increase the tidal volume

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One More Thing!
Before you move on to the next Module, I just wanted to remind
you about our Practice Questions Pro membership.

As you can most likely already tell, our practice questions are
loaded with helpful tidbits of information that can help you
prepare for (and) pass the TMC Exam.

Now, you can get these TMC Practice Questions sent to your
inbox on a daily basis.

Yes, it’s same practice questions that are inside of this book. And
you only get one question per day…

BUT, like I said before, repetitions are super important!

And the more practice questions you see, the better.

For many students, it’s very convenient to wake up each day and
have a new TMC practice question in your inbox waiting for you.

If this is something that sounds interesting to you, definitely

consider signing up.

Click Here to Get Daily Practice Questions via Email

I hope you enjoy and I’ll see you in the next module. J

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References

1. AARC Clinical Practice Guidelines, (2002-2019) Respirator Care.

www.aarc.org.

2. Egan’s Fundamentals of Respiratory Care. (2010) 11th Edition.

Kacmarek, RM, Stoller, JK, Heur, AH. Elsevier.

3. Mosby’s Respiratory Care Equipment. Cairo, JM. (2014) 9th

Edition. Elsevier.

4. Pilbeam’s Mechanical Ventilation. (2012) Cairo, JM. Physiological

and Clinical Applications. 5th Edition. Saunders, Elsevier.

5. Ruppel’s Manual of Pulmonary Function Testing. (2013)

Mottram, C. 10th Edition. Elsevier.

6. Rau’s Respiratory Care Pharmacology. (2012) Gardenhire, DS.

8th Edition. Elsevier.

7. Perinatal and Pediatric Respiratory Care. (2010) Walsh, BK,

Czervinske, MP, DiBlasi, RM. 3rd Edition. Saunders.

8. Wilkins’ Clinical Assessment in Respiratory Care (2013) Heuer, Al.

7th Edition. Saunders. Elsevier.

9. Clinical Manifestations and Assessment of Respiratory Disease.

(2010) Des Jardins, T, & Burton, GG. 6th edition. Elsevier.

10. Neonatal and Pediatric Respiratory Care. (2014) Walsh, Brian K.

4th edition. RRT. Elsevier.

11. Clinical Application of Mechanical Ventilation (2013) Chang,

David W. 4th edition. Cengage Learning.

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