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02 - Module 2

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Disclaimer:
Medicine and respiratory therapy are continuously changing
practices. The author and publisher have reviewed all information
in this report with resources believed to be reliable and accurate
and have made every effort to provide information that is up to
date with the best practices at the time of publication. Despite
our best efforts we cannot disregard the possibility of human
error and continual changes in best practices the author,
publisher, and any other party involved in the production of this
work can warrant that the information contained herein is
complete or fully accurate. The author, publisher, and all other
parties involved in this work disclaim all responsibility from any
errors contained within this work and from the results from the
use of this information. Readers are encouraged to check all
information in this publication with institutional guidelines, other
sources, and up to date information. Respiratory Therapy Zone is
not affiliated with the NBRC©, AARC©, or any other group at the
time of this publication.

Copyright ã Respiratory Therapy Zone

2
Table of Contents
Section 1 ………………………………………………………………………………………………………………..4
Section 2 ………………………..……………………………………………………………………………….…..55
Practice Questions Pro ………………………..……..………………………………………….…..179
References ………………………..…………………………………..…………………………………….…..180

3
Section 1

1. 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

2. Which of the following is the recommended adult dosage

when delivering albuterol via small volume nebulizer?
A. 0.3 mL of 1:20 aqueous solution in diluent
B. 0.3 mL of 1:200 aqueous solution in diluent
C. 0.5 mL of 1:200 aqueous solution in diluent
D. 1.0 mL of 1:200 aqueous solution in diluent

3. Immediately after intubation in the emergency room, the

doctor requests for you to auscultate the patient in order to
confirm proper tube placement. While listening, you hear
gurgling over the epigastrium and no breath sounds. Which of
the following is the most likely cause of this finding?
A. Right-sided tension pneumothorax
B. Intubation of the right mainstem bronchus
C. Intubation of the left mainstem bronchus
D. Intubation of the patient’s esophagus

4
4. A patient that is receiving mechanical ventilation in the SIMV
mode displays the following graph. Which type of breath does
it most likely represent?

A. Spontaneous breath
B. Pressure controlled breath
C. Pressure supported breath
D. Patient triggered mandatory breath

5. You are called to administer 70/30 heliox on an 11-year-old girl

in the emergency department. Which of the following would
you use to deliver the therapy?
A. Aerosol mask
B. Venturi mask
C. Nonrebreathing mask
D. Binasal cannula

6. If you were to take the total of the maximum volume of air

that can be exhaled from the maximum inspiratory level, this
can be defined as which of the following?
A. Residual volume
B. Expiratory reserve volume
C. Vital capacity

5
D. Total lung capacity

7. Upon the assessment of a patient receiving volume control AC

ventilation, you observe a flow-volume loop with a sawtooth
pattern on exhalation. Which of the following actions would
help this patient the most?
A. Switch to pressure control ventilation
B. Administer a bronchodilator
C. Increase the endotracheal tube cuff pressure
D. Assess the patient’s need for suctioning

8. Other than obtaining the results from a vital capacity

maneuver, what else should be obtained and noted from the
patient?
A. The patient’s resting minute ventilation
B. The patient’s height, gender, and age
C. The patient’s heart rate before/after testing
D. The patient’s actual and predicted body weight

9. A 61-year-old patient arrives to the emergency department in

a comatose state. The patient is unable to speak or answer
questions. Which of the following approaches can be used to
obtain the patient’s medication history?
A. Obtain and review the patient’s past medical history
B. Obtain the patient’s current prescription vials from the
family
C. Ask the patient’s nurse about the patient’s prescriptions
D. Request that the lab run a comprehensive blood drug
screen

6
10. A 64-year old female patient was admitted and the physician
suspects that a pneumothorax is present. Which of the
following percussion notes would you expect to find in this
patient?
A. Increased resonance
B. Flat percussion note
C. Dull percussion note
D. Hyperresonant percussion note

11. 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

12. A patient is the emergency room is suspected to have a

pulmonary embolism. In order to confirm this suspicion,
which of the following laboratory tests would you
recommend?
A. Hematocrit
B. Troponin I
C. D-dimer
D. Arterial blood gas

7
13. 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

14. 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

15. After obtaining an ABG sample, the results of a 49-year-old

female patient show acute respiratory acidosis. You would
expect for the base excess to be in the range of which of the
following?
A. +/- 2 mEq/L
B. +/- 6 mEq/L
C. +/- 8 mEq/L
D. +/- 10 mEq/L

16. A 60-year-old male patient has heart rate of 136 beats/min

with a regular rhythm. Which of the following is the most
likely cause of this observation?

8
A. Arterial hypertension
B. Anxiety or agitation
C. Beta-blocker administration
D. Therapeutic hypothermia

17. As a Respiratory Therapist, you should recommend an

annual influenza vaccination to which of the following?
A. A 3-month-old infant
B. A routine 53-year-old male patient
C. A 61-year-old male with Guillain-Barr syndrome
D. A 22-year old pregnant female patient

18. The results of a bedside spirometry test that was performed

on a patient reveals the following:
Respiratory rate = 19
Tidal volume = 380 mL
Dead space = 145 mL
Vital capacity = 1.1 L
Based on these results, what is the patient’s minute
ventilation?
A. 3.4 L/min
B. 4.7 L/min
C. 7.2 L/min
D. 21.3 L/min

19. You heard bronchial breath sounds over the patient’s right
middle lobe while performing a routine assessment. Due to
this finding, which of the following conditions would you
expect to be present?
A. Asthma

9
B. Pneumonia
C. Emphysema
D. Pleural effusion

20. A patient’s ABG results show that she has a pH of 7.56 and a
PaCO2 of 48 torr. Based on the results given, how would you
interpret the patient’s status?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis

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

10
22. In which of the following cases would you recommend
against the insertion of a supraglottic airway?
A. For a patient that needs emergency ventilation
B. For a patient with a suspected cervical spine injury
C. For a patient whom ET intubation is difficult
D. For a patient with a known esophageal disease

23. You are called for the assessment of a child in the

emergency department. It has been noted that the child has
stridor. Which of the following conditions would you expect?
A. Croup
B. Asthma
C. Pneumonia
D. Cystic fibrosis

24. A 50-year-old male patient was just admitted for asthma.

After obtaining the patient’s medication history, which of the
following would you consider least important?
A. Self-administration techniques
B. Frequency of rescue inhaler usage
C. Use of generic vs. brand name medications
D. Patient understanding of controllers vs. relievers

25. You are called to help treat a patient with a neuromuscular

condition. The patient is showing signs of paralysis that
started in the feet but has extended upwards throughout the
remainder of the body. Which of the following conditions is
most likely present?
A. Guillain-Barré syndrome
B. Myasthenia gravis
C. Stroke

11
D. Drug overdose

26. A female patient who was in a motor vehicle accident arrives

to the emergency department with broken ribs. While
palpitating the patient’s neck, crepitations were felt. What is
most likely the cause of this finding?
A. The patient has a laryngeal tumor
B. The patient has a pneumothorax
C. Blood is in the back of the patient’s throat
D. The patient has aspirated a tooth

27. A patient was admitted to the ICU with a severe case of

influenza. Before entering the patient’s rooms, in addition to
standard precautions, what else must be used?
A. Droplet precautions
B. Universal precautions
C. Contact precautions
D. Airborne precautions

28. A 69-year-old female patient in the ICU is positioned with her

head and body raised 45 degrees above her legs. Upon
assessment, you note that she has distended external jugular
veins. Which of the following is the most likely cause of this
finding?
A. The patient is fluid-overloaded
B. The patient is dehydrated
C. The patient has hypertension
D. The patient has emphysema

12
29. You are called to give a patient an SVN breathing treatment
with albuterol for wheezing. While obtaining the patient’s
pre-treatment vital signs, her heart rate is 84 beats/min with
a respiratory rate of 18 breaths/min. Three minutes into the
treatment, the patient’s heart rate climbs to 133 beats/min
and her respiratory rate increased to 23 breaths/min. Which
of the following actions should you take in this situation?
A. Continue the treatment as ordered to completion
B. Switch to arformoterol (Brovana) and continue the
treatment
C. Increase the patient’s FiO2
D. Stop the treatment, monitor the patient, and notify the
physician

30. You are called to provide a STAT bronchodilator treatment

for a male patient that is having a severe asthma attack.
While confirming the physician’s written order, you are not
sure if the note says “5 mL of Albuterol” or “0.5 mL of
Albuterol.” The prescribing doctor is busy overseeing a code
and is unable to respond. What action should you take?
A. Have the nurse review the note and clarify the order
B. Cross out the prohibited notations and initial and date
the changes
C. Wait until the physician is done with the code so that you
can clarify the improper notation and the correct order
D. Administer the treatment using the standard albuterol
dosage of 0.5 mL and clarify the order as soon as possible
thereafter

31. While administering an aerosolized albuterol breathing

treatment to a 61-year-old patient, you should be on guard
for which of the following adverse effects?
A. Tachycardia

13
B. Bradycardia
C. Vagovagal reflex
D. Laryngospasm

32. The ABG results of a 33-year-old male patient are as follows:

pH 7.30
PaCO2 22 torr
HCO3 12 mEq/L
BE -13
PaO2 110 torr
This data indicates which of the following?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis

33. A patient complains of difficulty in starting the treatment of

a mouthpiece positive pressure ventilator. Which control
should you adjust?
A. Flow
B. Pressure
C. Terminal flow
D. Sensitivity

34. On inspection of an EKG rhythm strip from a 63-year-old

male patient, you note the following: Rate of 81/min; regular
rhythm; normal P waves; P-R interval of 0.30 sec; normal QRS
complexes. What is the most likely problem is?
A. 1st degree heart block
B. 2nd degree heart block
C. 3rd degree heart block

14
D. Atrial fibrillation

35. A 69-year-old male patient has arrived in the ER with a

complaint of difficulty breathing. He has a history of both
COPD and CHF. In order to help with the differential
diagnosis, the doctor orders the patient’s blood to be tested
for bacteremia, CK-MB, cTnI, cTnT, and BNP. All results are
negative. What is the most likely cause of the patient’s
dyspnea?
A. CHF
B. Myocardial infarction
C. Exacerbation of COPD
D. Pneumonia

36. While performing a routine chest percussion, you noticed

that a 57-year-old male patient has a flat percussion note.
Which of the following does this finding indicate?
A. Pneumonia
B. Pneumothorax
C. COPD
D. Atelectasis

37. A 61-year-old female patient with a history of COPD was

admitted to the emergency department for an acute case
suspected pneumonia. Her ABG results are as follows:
pH = 7.19
PCO2 = 66 torr
HCO3 = 26 mEq/L
PaO2 = 41 torr
P(A-a)O2 = 43 torr

15
Which of the following best describes the patient’s
condition?
A. Acute hypercapnic respiratory failure
B. Chronic hypercapnic respiratory failure
C. Acute hypoxemic respiratory failure
D. Combined hypercapnic and hypoxemic respiratory
failure

38. A 3-day-old boy was brought into the emergency

department with his mother after being involved in a motor
vehicle accident. The infant is showing signs of respiratory
distress with cyanosis and tachycardia, and a pneumothorax
is suspected. Which of the following tests would you
recommend to confirm this suspicion?
A. Collect an ABG
B. Transillumination
C. Obtain an Apgar score
D. Perform a thoracentesis

39. A 59-year-old female patient has arrived to the emergency

department in respiratory distress due to severe hypoxemia.
She would most likely exhibit all of the following signs
except?
A. Diaphoresis
B. Cyanosis
C. Bradycardia
D. Tachypnea

40. A neonate has severe hypoxemia due to persistent

pulmonary hypertension. In order to treat the patient, the

16
doctor orders inhaled nitric oxide. What starting dose would
you recommend for this patient?
A. 2%
B. 2 ppm
C. 20 ppm
D. 200 ppm

41. A 60-year-old patient has been admitted and is showing

signs of fever, diaphoresis, use of accessory muscles, and a
respiratory rate or 22 breaths/min. Auscultation revealed
rhonchi in the lower lobes. Which of the following would you
suspect?
A. Heart attack
B. Pneumothorax
C. COPD exacerbation
D. Bacterial pneumonia

42. A 51-year-old male patient with asthma has been prescribed

an albuterol breathing treatment via small volume nebulizer.
Before initiating the therapy, you note from the chart that
the patient is severely hypertensive and has been
experiencing episodes of supraventricular tachycardia.
Which of the following actions should you take at this time?
A. Provide acetylcysteine instead of albuterol
B. Dilute the albuterol with extra normal saline
C. Postpone the treatment and consult the physician
D. Administer the treatment as ordered

43. While palpating a patient’s radial artery to take the pulse,

you note that it feels bounding and full. Which of the
following conditions is most likely the cause of this finding?

17
A. Cardiovascular shock
B. Low cardiac output
C. Hypovolemia
D. Hypertension

44. An unconscious patient with apnea has just arrived to the

ER. The physician states that the patient is at risk of
aspirating. Which of the following would you recommend for
securing this patient’s airway?
A. Performing a percutaneous tracheotomy
B. Inserting a laryngeal mask airway
C. Intubating via the nasal route instead
D. Inserting an esophageal-tracheal combitube

45. A female patient that is having an asthma attack was given

an adrenergic bronchodilator agent. Instead of
demonstrating improvement in airflow, her symptoms got
worse. Which of the following is the most likely explanation
for this reaction?
A. A paradoxical response to the agent
B. Tachyphylaxis or tolerance to the agent
C. Alterations in the V/Q ratio (a beta-2 effect)
D. The additive effect of other drug agents

46. You are needed to help assess a newborn infant that appears
to have an increased work of breathing. Which of the
following signs is an indication that the infant is in respiratory
distress?
A. Pallor
B. Cyanosis

18
C. Digital clubbing
D. Chest wall retractions

47. An adult patient with shortness of breath is admitted to the

emergency department. An ABG has been collected and
shows the following results:
pH 7.51
PaCO2 26 torr
PaO2 57 torr
HCO3- 24 mEq/L
Which of the following best describes the patient’s status?
A. The patient has a metabolic issue
B. The patient is hypoventilating
C. The primary concern is hypoxemia
D. The patient is in impending respiratory failure

48. Which of the following is the average depth of a proper oral

endotracheal tube insertion in an adult patient?
A. 26 cm from the patient’s teeth
B. 22 inches from the patient’s lip
C. 22 cm from the patient’s lip
D. 32 cm from the patient’s teeth

49. While evaluating a pediatric patient, upon entering the

room, you hear a harsh, high-pitched sound on the child’s
inspiration. Which of the following is most likely the cause of
this finding?
A. The sounds are bronchovesicular
B. The sounds are bronchial
C. The sounds are tracheal

19
D. The sounds are stridorous

50. The physician asks for you to evaluate a newborn infant’s

condition. The normal vital signs for a term newborn include
all of the following EXCEPT:
A. Heart rate of 132 beats/min
B. Respiratory rate of 20 breaths/min
C. Blood pressure of 62/40 mmHg
D. Rectal temperature of 35.9 degrees C

51. The doctor ordered a metered dose inhaler bronchodilator

for a 59-year-old female patient that is receiving mechanical
ventilation. You should do which of the following in order to
maximize aerosol deposition?
A. Place the MDI directly in-line on the expiratory side of the
circuit
B. Place the MDI directly in-line on the inspiratory side of
the circuit
C. Recommend that a small volume nebulizer be used
instead of an MDI
D. Place the MDI plus a spacer in-line on the inspiratory side
of the circuit

52. An infant that was born prematurely has a low Apgar score
and needs immediate resuscitation and chest compressions.
Which of the following statements about chest
compressions during neonatal resuscitation is correct?
A. Compressions should exceed 1/2 the AP chest diameter
B. Compressions should be delivered on the top third of the
sternum
C. The compression to ventilation ratio should be 3:1

20
D. Compressions and ventilations should be delivered
simultaneously

53. A conscious patient that requires frequent nasotracheal

suctioning needs a nasopharyngeal airway to be inserted. On
your first attempt, you are only able to pass the airway about
3 cm into the patient’s nostril. Which of the following actions
should you take at this time?
A. Recommend nasotracheal intubation
B. Use a laryngeal mask airway instead
C. Switch to an oropharyngeal airway
D. Insert the airway in the other nostril

54. A 54-year-old female patient’s spirometry results show an

FEV1 that is calculated to be 80% of her forced vital capacity.
This finding suggests that the patient probably has which of
the following?
A. Chronic bronchitis
B. Emphysema
C. An obstructive lung disease
D. Clinically normal values

55. You are called to assist with needle decompression for a

patient with a tension pneumothorax. Which of the following
is the correct placement for this procedure?
A. Second intercostal space in the anterior axillary line
B. Second intercostal space in the midclavicular line
C. Third intercostal space in the anterior axillary line
D. Third intercostal space in the midclavicular line

21
56. After auscultating a patient in the emergency department,
you noticed blood on the head of your stethoscope. How
should it be cleaned before use on another patient?
A. Sterilized with ethylene oxide
B. Wiped with a bleach solution
C. High-level disinfection with glutaraldehyde
D. Wiped with an alcohol solution

57. A 21-month-old girl with asthma is receiving volume control

SIMV mechanical ventilation with an inline small volume
nebulizer in place. After the treatment was started, the alarm
of the heated humidifier was activated. Which of the
following is the most likely cause of this alarm?
A. Low gas temperature
B. Empty water reservoir
C. Clogged expiratory filter
D. Decreased humidity output

58. A 51-year-old female patient arrived in the emergency room

with a spontaneous respiratory rate of 36/minute. Which of
the following is the most likely cause of this observation?
A. Decreased CO2 production
B. Metabolic acidosis
C. Therapeutic hypothermia
D. CNS depression

59. A patient with a history of COPD and an acute pneumonia

exhibits the following ABG results on room air:
pH = 7.20
PaCO2 = 65 torr

22
HCO3 = 26 mEq/L
PO2 = 40 torr
P(A-a)O2 = 42 torr
Which of the following best describes this patient’s
condition?
A. Acute hypercapnic respiratory failure
C. Acute hypoxemic respiratory failure
B. Chronic hypercapnic respiratory failure
D. Combined hypercapnic/hypoxemic respiratory failure

60. The husband of a comatose patient asks you to cancel a

previously approved DNR order. How should you proceed?
A. Record the request in the patient record
B. Explain that only her husband can cancel the order
C. Notify the charge nurse of the request
D. Notify the attending physician of the request

61. After reviewing the chart of a 55-year-old female patient, you

note that she had an admission diagnosis of dehydration.
Which of the following findings would you expect for this
patient?
A. Pitting edema
B. Venous distension
C. Inspissated secretions
D. Crackles on auscultation

62. While reviewing the chart of a 65-year-old patient diagnosed

with COPD and chronic hypoxemia, you would expect to find
which of the following?

23
A. Chronic respiratory alkalosis
B. Secondary polycythemia
C. A decreased A-P chest diameter
D. An FRC less than predicted

63. A 3-year-old boy has arrived in the emergency room with

noted stridor. Which of the following conditions would you
expect?
A. Asthma
B. Croup
C. Pneumonia
D. Cystic fibrosis

64. If noted on inspiration, which of the following respiratory

signs of an adult patient would be considered abnormal?
A. A respiratory rate of 18 breaths per minute
B. Ribs higher posteriorly than anteriorly at end-expiration
C. Costal angle of 90 degrees that increases with inspiration
D. The use of the sternocleidomastoid muscles at rest

65. A 52-year-old female patient has been smoking 1.5 packs of

cigarettes per day for 30 years. Her smoking history would be
recorded as:
A. 15 pack-years
B. 30 pack-years
C. 45 pack-years
D. 60 pack-years

24
66. You are called for the assessment of a chest radiograph for a
patient suffering from advanced stages of emphysema.
Upon observation, which of the following would you expect
to see?
A. An increased C/T ratio
B. Increased vascular markings
C. Decreased radiolucency
D. Flattening of the diaphragm

67. Which of the following procedures requires active patient

effort and cooperation in order to be completed?
A. Breathing exercises
B. Mask CPAP
C. Weaning from the ventilator
D. Mechanical insufflation-exsufflation

68. A 53-year-old male patient with supraventricular tachycardia

has a heart rate of 153 beats/min. Which of the following
effects would this have on his cardiac function?
A. Increased end-diastolic volume
B. Decreased end-diastolic volume
C. Increased stroke volume
D. Mitral valve regurgitation

69. While examining a patient with chronic bronchitis, which of

the following would you expect to find?
A. Decreased AP chest diameter
B. Course bilateral rhonchi
C. Nonproductive cough

25
D. Tracheal shift to the right

70. You were called by the attending physician to evaluate the

intensity of a patient’s pain. The most objective way to do so
would be to:
A. Measure the patient’s pulse and respiratory rate
B. Ask the patient “How much pain are you having”
C. Observe the patient for facial expressions indicative of
pain
D. Have the patient rate their level of pain on a numeric
rating scale

71. When inspecting a normal chest x-ray, where would you

expect the heart to be positioned?
A. Primarily to the left side of the patient’s midline/spine
B. Primarily to the right side of the patient’s midline/spine
C. Entirely to the right side of the patient’s midline/spine
D. Entirely to the left side of the patient’s midline/spine

72. After instructing a patient on how to perform diaphragmatic

breathing, which of the following can you observe to
recognize if they are performing it properly?
A. The use of pursed-lip breathing
B. The abdomen rising on exhalation
C. The abdomen rising on inspiration
D. The use of intercostal muscles during inspiration

26
73. While inspecting a 69-year-old female patient, you note that
she has an abnormal anteroposterior curvature of the spine.
This best describes which of the following?
A. Kyphosis
B. Scoliosis
C. Kyphoscoliosis
D. Pectus excavatum

74. While listening for a patient’s breath sounds, you hear what
appears to be a bubbling sound in both lung bases. Which of
the following best describes this finding?
A. Wheezes heard in the lung bases
B. Rhonchi heard in the lung bases
C. Crackles heard in the lung bases
D. Bronchial sounds heard in the lung bases

75. A 37-year-old female patient was admitted and treated for a

narcotic overdose but has improved of the past two days. She
appears to be cachexic and lacks energy. You also noted
signs of dry skin and edema. Which of the following is the
most likely problem in this scenario is?
A. Heart failure
B. Malnutrition
C. Addison’s disease
D. Renal failure

76. A 58-year-old male patient in the ICU just had a chest tube
inserted to drain the fluid from a pleural effusion. He is

27
receiving mechanical ventilation with basic settings and
displays the following vital signs:
Heart rate: 120/min
Blood pressure: 137/95
Set respiratory rate: 10/min
Total respiratory rate: 29/min
Body temperature: 99.2 F
Taking everything into consideration, you should
recommend which of the following?
A. Assess the patient for pain
B. Paralyze the patient
C. Ask the patient to relax
D. Reposition the chest tube

77. You are called to assess a 40-year-old female patient with an

acute upper airway obstruction. Which of the following
physical signs would you expect to see in this patient?
A. Inspiratory stridor
B. Inspiratory crackles
C. Unilateral lung expansion
D. Dullness to percussion

78. You are called to assess a 71-year-old male patient in the ICU.
Upon entering the room, which of the following is the best
way to assess his level of consciousness?
A. Check the patient’s vital signs
B. Check for reflex activity
C. Check pupil size and reactivity
D. Ask the patient to follow simple commands

28
79. While auscultating an 84-year-old patient’s chest, you hear
wheezing breath sounds. This may indicate the presence of
which of the following?
A. Laryngospasm
B. Pleural effusion
C. Pneumothorax
D. Aspirated foreign body

80. After obtaining results from a transcutaneous blood gas

monitor, you are asked to validate the readings. You should
do which of the following?
A. Perform a two-point calibration of the monitor
B. Change the placement of the sensor every 2–6 hours
C. Compare the monitor’s readings to an ABG
D. Re-membrane the sensor and adjust its temperature

81. A 5-foot, 6-inch-tall 130-lb. woman with normal lungs has a

tidal volume of 480 mL and is breathing at a rate of 12
breaths/min. What is her approximate alveolar ventilation?
A. 6.52 L/min
B. 3.62 L/min
C. 4.20 L/min
D. 5.40 L/min

82. You are needed to perform a set of measurement tests on an

unconscious patient. All of the following can be obtained
except?
A. Maximum inspiratory pressure
B. Maximum expiratory pressure

29
C. Spontaneous respiratory rate
D. Spontaneous tidal volume

83. After an intubation, you fear that too much air was inserted
into the endotracheal tube cuff. Which of the following
would result from significant overinflation if this were the
case?
A. Air leakage
B. Laryngospasm
C. Silent aspiration
D. Mucosal ischemia

84. Which of the following EKG leads should be placed in the 5th
intercostal space at the midclavicular line?
A. V1
B. V2
C. V3
D. V4

85. A 61-year-old male patient is scheduled to undergo

cardiopulmonary exercise testing. In which of the following
would you recommend extra precautions before the
performing the test?
A. A patient with a resting systolic BP > 200 mm Hg
B. A patient being evaluated for coronary artery disease
C. A patient recommended for cardiac rehabilitation
D. A patient being assessed for a cardiopulmonary disability

30
86. After obtaining an ABG on an adult patient that is receiving
volume control SIMV in the ICU, you must document all of
the following EXCEPT:
A. Oxygen concentration
B. Ventilator mode
C. Ventilator settings
D. Endotracheal tube size

87. You are called to perform a sputum induction on a trach

patient to gather a sample for microbiological identification.
The sample is collected using a Lukens trap. When applying
suction after entering the airway, the mucus should:
A. Pass through the wall tubing and then into the Lukens
trap
B. Pass into the trap and then move on into the collection
jar
C. Pass into the Lukens trap and then enter the suction
catheter
D. Pass through the suction catheter and then enter the
Lukens trap

88. You are needed to assess a 61-year-old male patient that is

conscious and appears to be in no apparent distress. You
note on the arterial pressure monitor that the pressure
waveform is absent and the alarm is sounding. What should
your first action be?
A. Call for the Rapid Response Team
B. Replace the broken monitor
C. Check the stopcock position
D. Confirm that the monitor is set to zero/cal

31
89. All spirometry values obtained under ambient conditions
should be converted to which of the following?
A. Standard temperature and pressure, dry (STPD)
B. Ambient temperature and pressure, dry (ATPD)
C. Ambient temperature and pressure, saturated (ATPS)
D. Body temperature, ambient pressure, saturated (BTPS)

90. Before adjusting a patient’s endotracheal tube cuff pressure,

you would select which of the following devices?
A. Volumeter
B. Manometer
C. Respirometer
D. Pneumotachometer

91. By looking at the data below, determine which of the

following patients has the most severe oxygenation issue:
FiO2 PaO2
Patient A 0.28 65 torr
Patient B 0.40 95 torr
Patient C 0.70 90 torr
Patient D 1.00 85 torr
A. Patient A
B. Patient B
C. Patient C
D. Patient D

32
92. Which of the following is a major disadvantage of using a
pulse oximeter to monitor a patient’s oxygenation status?
A. Skin burns due to using incompatible probes
B. Erroneous results leading to inappropriate treatment
C. Electrical shocks at the measuring site
D. Pressure sores at the measuring site

93. A 67-year-old female patient is receiving volume control

(A/C) ventilation with an FiO2 of 60%. A chest x-ray was
recently taken that reveals bilateral infiltrates. She has a a
PaO2 of 60 torr. Which of the following would you
recommend?
A. Initiating a spontaneous breathing trial
B. Switching to pressure control SIMV
C. Switching to high frequency oscillation
D. Implementing the ARDSNet protocol

94. A 56-year-old male patient is experiencing signs and

symptoms of tissue hypoxia but his cardiac output and PaO2
values are normal. Which of the following is the most likely
cause?
A. Hypoventilation
B. Low ambient PO2
C. Physiologic shunt
D. Hemoglobin deficiency

95. A 60-year-old female patient is receiving volume controlled

ventilation with a PEEP of 5 cm H2O. Over a 3-hour period,
both her peak and plateau pressure have been steadily

33
increasing and no ventilator setting changes have been
made. What is the most likely cause?
A. The patient is developing pneumonia
B. The patient is developing bronchospasm
C. The patient needs endotracheal suctioning
D. The patient’s lung compliance is increasing

96. While inspecting an EKG rhythm strip of a 50-year-old

female patient, you note the following:
Rate 145
Regular rhythm
Normal P waves
Normal P-R intervals
Normal QRS complexes
Which of the following is the interpretation?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. Ventricular tachycardia

97. An adult patient is receiving ventilatory support after

surgery. Their maximum inspiratory pressure was measured
with a result of -35 cm H2O. Based on this value, you would
conclude that the patient has:
A. A normal maximum inspiratory pressure
B. A need for continued ventilatory support
C. A large leak in their endotracheal tube cuff
D. Adequate muscle strength to consider weaning

34
98. Which of the following patients is most in need of ventilatory
support?
A. pH 7.35, PaCO2 61 torr, HCO3 33
B. pH 7.40, PaCO2 59 torr, HCO3 35
C. pH 7.37, PaCO2 52 torr, HCO3 29
D. pH 7.13, PaCO2 66 torr, HCO3 22

99. A patient has a systolic arterial pressure of 160 mm Hg and a

diastolic value of 85 mm Hg. What is his approximate mean
arterial pressure?
A. 115 mm Hg
B. 110 mm Hg
C. 105 mm Hg
D. 100 mm Hg

100. You are called to perform chest physiotherapy on a 62-year-

old female patient. Before you begin, she states that “When
I breathe l feel like I am getting enough air, but I seem to
breathe fast and lift my shoulders a lot. I sleep through the
night and use only one pillow.” You can conclude that the
patient likely has which of the following?
A. Orthopnea
B. Dyspnea
C. Obstructive sleep apnea
D. Increased work of breathing

101. A patient’s static compliance can be obtained by dividing

their tidal volume by which of the following:
A. (PIP – PEEP)

35
B. (Pplat – PEEP)
C. (PIP – Paw)
D. (Paw – Pplat)

102. A patient has excess fluid around the lungs and has been
diagnosed with a pleural effusion. Which of the following
would you recommend in order to determine the etiology
of the effusion?
A. CT scan of the chest
B. Fiberoptic bronchoscopy
C. Thoracentesis
D. Lung Biopsy

103. What is the total amount of gas that can be exhaled from
the lungs after a normal exhalation?
A. FVC
B. FRC
C. IRV
D. ERV

104. A patient is receiving mechanical ventilation in the SIMV

mode with an FiO2 of 35%. Their ABG results are as follows:
pH 7.53
PaCO2 27 torr
PaO2 84 torr
HCO3 24 mEq/L
The blood gas results indicate:
A. Respiratory acidosis with hypoxemia
B. Acute hypoxemic failure
C. Uncompensated respiratory alkalosis

36
D. Hyperchloremic metabolic alkalosis

105. Your patient has the following PFT results below:

Vital Capacity 54% of predicted
FEV1 76% of predicted
FEV1/FVC ratio 82% of predicted
Peak Flow 119% of predicted
Total Lung Capacity 65% of predicted
Which of the following would be the best interpretation of
the results?
A. Restrictive disease only
B. Obstructive disease only
C. Bronchitis
D. Mixed restrictive and obstructive disease

106. The physician requests for a patient to receive an FiO2 of

approximately 75%. Which of the following would you
recommend?
A. Simple mask
B. Air entrainment mask
C. Nonrebreathing mask
D. Nasal cannula at 6 L/min

107. You are called to check the VD/VT ratio on a 59-year-old

female patient with advanced COPD. Which of the
following would you expect to find?
A. Normal
B. Increased
C. Decreased
D. Not affected by the patient’s condition

37
108. 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 7%
B. SVR of 1100 dyn/s/cm-5
C. Cardiac Index of 3.7 L/min/m2
D. CVP of 5 cmH2O

109. A 54-year-old female patient on the general floor has the

following ABG results:
pH = 7.53
pCO2 = 44 torr
HCO3 = 34 mEq/L
Which of the following is the best interpretation of these
results?
A. Acute respiratory alkalosis
B. Acute metabolic alkalosis
C. Compensated respiratory alkalosis
D. Combined respiratory and metabolic alkalosis

110. While treating a 3-month-old infant, you note that she has
periods of apnea that result in bradycardia and cyanosis.
Which of the following medications would you
recommend?
A. Albuterol
B. Lidocaine
C. Neostigmine
D. Caffeine citrate

38
111. A 19-year-old male just arrived to the emergency room with
bilateral expiratory wheezing. Which of the following
treatments would you recommend?
A. Aerosolized cromolyn sodium
B. Aerosolized bronchodilator
C. Aerosolized normal saline solution
D. IV furosemide (Lasix)

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

patient. Which of the following values is typical for serum
sodium?
A. 127 mEq/L
B. 132 mEq/L
C. 141 mEq/L
D. 158 mEq/L

113. After collecting an ABG sample, you are about the analyze
the sample using a point-of-care analyzer. During the
process, the device flags the PaCO2 results. Which of the
following should you do at this time?
A. Send the sample to the central lab for analysis
B. Repeat the analysis using a fresh sample and the same
cartridge
C. Repeat analysis using a fresh sample and new cartridge
D. Repeat the analysis using the same sample and same
cartridge

114. After drawing an ABG sample, you notice that the blood
appears to be darker in color. You suspect that obtained

39
sample is actually venous blood. Which of the following
would be the best way to confirm this suspicion?
A. Get a second opinion from the attending physician
B. Compute the alveolar-arterial O2 gradient
C. Compute the patient’s P/F ratio
D. Cross-check the results against the patient’s SpO2

115. While performing an MIP test on a 19-year-old female

patient, she produces the following results after three
attempts:
Attempt #1: -23 cm H2O
Attempt #2: -42 cm H2O
Attempt #3: -14 cm H2O
Which of the following best explains this patients results?
A. There is a leak at the mouthpiece
B. The patient has an obstructive disease
C. The patient has a restrictive disease
D. The patient isn’t giving a good effort

116. A 29-year-old female patient with suspected asthma needs

to undergo pulmonary function testing to confirm the
diagnosis. Which of the following tests would be the least
helpful in this situation?
A. Lung diffusion study
B. Flow-volume loop
C. Bronchoprovocation testing
D. Pre- and post-bronchodilator testing

117. A diagnostic bronchoscopy procedure would be

contraindicated for which of the following patients?

40
A. A patient with unexplained wheezing
B. A patient with active hemoptysis
C. A patient with severe hypoxemia
D. A patient with lung carcinoma

118. A 57-year-old male patient is being ventilated with a bag-

valve resuscitator through an LMA. While providing manual
breaths, you notice a significant air leak. Which of the
following should be your first approach to eliminate the
leak?
A. Add more air to the LMA cuff
B. Decrease the cuff pressure
C. Pull the tube out 2–3 cm
D. Bag more slowly to reduce the peak pressure

119. If the Respiratory Therapist were to significantly overinflate

the endotracheal tube cuff, which of the following would
likely occur?
A. Air leakage
B. Laryngospasm
C. Silent aspiration
D. Mucosal ischemia

120. The following ABG results were obtained on a 54-year-old

female patient that is breathing room air:
pH 7.30
PaCO2 57 torr
PaO2 61 torr
HCO3- 24 mEq/L
Which of the following best describes the given results?

41
A. Normal blood gas with mild hypoxemia
B. Fully compensated metabolic acidosis with mild
hypoxemia
C. Acute respiratory alkalosis with mild hypoxemia
D. Acute uncompensated respiratory acidosis with mild
hypoxemia

121. The physician put in an order for an ABG that was not STAT.
You weren’t busy so you went ahead and collected the
sample. What is the best way to avoid analysis errors
associated with running the sample?
A. Analyze the sample immediately
B. Place the sample in an ice slush
C. Use dry instead or liquid heparin
D. Uncap the syringe to remove any air

122. A newborn infant in the NICU appears to have an increased

work of breathing. Which of the following signs is an
indication that the infant is in respiratory distress?
A. Chest wall retractions
B. Pallor
C. Diaphoresis
D. Digital clubbing

123. You are called to evaluate the sputum of a 66-year-old male

patient with chronic bronchitis. Which of the following
characteristics when assessed at the bedside should be
documented in the chart?
A. The color
B. The density

42
C. The DNA content
D. The surface tension

124. A patient 43-year-old male patient is receiving volume

controlled ventilation at a rate of 12/min. The expiratory time
is 3.30 seconds. What is the inspiratory time?
A. 1.45 seconds
B. 1.70 seconds
C. 1.85 seconds
D. 2.10 seconds

125. You recently set up a transcutaneous blood gas monitor to

track the PO2 of an infant. In order to avoid a thermal injury,
you would recommend which of the following?
A. Place the sensor over a boney area
B. Apply cortisone cream under the sensor
C. Maintain the sensor at body temperature
D. Relocate the sensor site on a regular basis

126. A 51-year-old male patient that is receiving volume control

ventilation had a sudden increase in peak airway pressure.
All of the following could be a possible cause EXCEPT:
A. A mucous plug
B. Patient-ventilator asynchrony
C. A leak in the circuit
D. Kinking of the endotracheal tube

43
127. A 63-year-old male patient who weighs 162 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 dynamic compliance?
A. 16.7 mL/cm H2O
B. 20.0 mL/cm H2O
C. 25.6 mL/cm H2O
D. 30.0 mL/cm H2O

128. A bedside peak flow was performed on a 39-year-old

female patient who is 5 feet 4 inches tall. Her results were
2.4 L/sec. Which of the following is the best interpretation of
this test?
A. Her peak flow is normal
B. She has poor gas distribution
C. She has low compliance
D. She has an expiratory flow obstruction

129. PFT tests were ordered on a 60-year-old male patient with

shortness of breath:
Actual % Predicted
FVC 3.21 L 85%
FEV1 1.96 L 65%
FEV1/FVC 62%
FEF25-75% 1.2 L/sec 35%
This data is consistent with which of the following?
A. Emphysema

44
B. Empyema
C. Kyphoscoliosis
D. Idiopathic fibrosis

130. A patient would most likely need ventilatory support once

their pulmonary shunt (Qs/Qt) value increases above what
level?
A. 3-5%
B. 5-10%
C. 10-15%
D. 20-25%

131. Which of the following conditions would have an adverse

effect on the accuracy of a pulse oximetry reading?
A. A patient with fever
B. A patient with tachycardia
C. A patient that is in shock
D. A patient that is in a coma

132. A 31-year-old patient arrives to the emergency department

with a mild flail chest. The physician orders an ABG STAT.
Which of the following blood gas results would you expect?
A. Increased pH, Increased SaO2
B. Increased pH, Decreased SaO2
C. Decreased pH, Increased SaO2
D. Decreased pH, Decreased SaO2

45
133. You are called to help obtain a pulmonary capillary wedge
pressure measurement using a Swan-Ganz catheter. Before
the measurement is taken, the physician asks, “what is the
normal range for PCWP?” Which of the following would be
your response?
A. 2 - 6 mmHg
B. 4 - 12 mmHg
C. 4 - 8 L/min
D. 2 - 4 L/min/m2

134. You are called to obtain an ABG of a 55-year-old female

patient. During your pre-stick assessment, it is noted that
the patinet’s oxygen saturation is 90%. Her ABG results are
as follows:
pH 7.40
PaCO2 40 torr
HCO3 24 mEq/L
What is the approximate PaO2 for this patient?
A. 55 torr
B. 60 torr
C. 65 torr
D. 70 torr

135. A patient who is receiving mechanical ventilation is being

monitored with a capnograph. Upon assessment, you
noticed that the end-tidal CO2 dropped to 0 mm Hg. This
finding could indicate all of the following EXCEPT:
A. A kinked ET tube
B. A system disconnection
C. Increased cardiac output
D. A complete airway obstruction

46
136. A carbon monoxide reading was taken on a COPD patient
with a result of 21 ppm. This finding indicates which of the
following:
A. The patient has abstained for more than 12 hours
B. The patient can be classified as a non-smoker
C. The patient has smoked within the past 24 hours
D. The patient has been exposed to secondhand smoke

137. The physician has requested for you to provide graphic

data that can be used to evaluate the ventilator-patient
interface. Which of the following would you recommend?
A. Hemoximetry
B. Capnography
C. Pulse oximetry
D. Electrocardiography

138. A 65-year-old male patient in the ICU is receiving

ventilatory support. While reviewing his chart, you noticed a
progressive increase in heart rate over the past two hours.
Which of the following would you recommend to help
identify the cause of this problem?
A. Obtain an arterial blood gas sample for analysis
B. Measure the patient’s vital capacity
C. Check the patient’s intake and output record
D. Obtain a sputum sample for culture and sensitivity

47
139. A patient that is suspected of having a sleep disorder was
scheduled for an overnight oximetry test. The results show
an oxygen desaturation index of 44/hour. Which of the
following would you recommend?
A. No action is needed at this time
B. Surgical correction of the airway obstruction
C. BiPAP with a full face mask
D. Full diagnostic polysomnography

140. Which of the following bedside measurements would you

recommend in order to assess a patient’s respiratory
muscle strength?
A. Physiologic deadspace
B. Minute ventilation
C. Maximum Inspiratory Pressure
D. Spontaneous tidal volume

141. A 61-year-old female patient is scheduled for a

bronchoscopy procedure with moderate sedation. You
would recommend which of the following in order to
monitor the patient’s cardiopulmonary status during the
procedure?
A. Frequent ABGs via arterial line
B. Transcutaneous PaO2 monitoring
C. Pulmonary function testing
D. Noninvasive pulse oximetry

48
142. Which of the following tests would be recommended for a
patient a history of alcohol and drug abuse and suspected
hepatitis?
A. Partial prothrombin time
B. Liver enzymes
C. Cardiac enzymes
D. Complete blood count

143. A 62-year-old female patient was admitted showing signs

of bronchiectasis. Which of the following would you
recommend in order to confirm this diagnosis?
A. A standard chest radiograph
B. A fiberoptic bronchoscopy
C. Computed tomography scanning
D. Pulmonary function testing

144. A 59-year-old male patient is being considered for

participation in a pulmonary rehabilitation program. All of
the following PFT measurements would you recommend
for preliminary evaluation EXCEPT:
A. Lung compliance
B. Lung Volumes
C. Pre/post bronchodilator
D. Diffusing capacity

145. It is suspected that a 51-year-old male patient has a

pulmonary embolism but his ordinary x-rays are negative.
Which of the following would you recommend in order to
confirm the diagnosis?

49
A. Arterial blood gas analysis
B. Ventilation/perfusion scan
C. Cardiovascular stress testing
D. Check the cardiac enzyme

146. Exhaled nitric oxide is most commonly indicated for which

of the following:
A. Treating refractory hypoxemia
B. Titrating asthma drugs and dosages
C. Treating pulmonary hypertension
D. Assessing the presence of air trapping

147. An adult patient arrives in the emergency department with

trauma to the chest and thoracic area. Which of the
following would you recommend first to determine the
extent of the trauma?
A. Pulmonary angiography
B. Ventilation/perfusion scan
C. Fiberoptic bronchoscopy
D. Thoracic ultrasound

148. A 64-year-old female patient is receiving mechanical

ventilation in the assist/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

50
D. The timing mechanism and the pressure settings on
the ventilator

149. A 50-year-old male patient was discharged with an order

for long-term oxygen therapy. The patient is active and fully
capable of performing activities of daily living on his own.
Which of the following modalities would you recommend?
A. A portable liquid oxygen system
B. A size E oxygen cylinder
C. A portable oxygen concentrator
D. A powered in-home concentrator

150. Upon assessment, you noticed thick secretions from an

adult patient that is being mechanically ventilated in the
assist/control mode. It appears that the wick humidifier is
not producing sufficient humidity. In this case, you would
recommend which of the following?
A. Remove the excess water in the humidifier
C. Increase the flow through the humidifier
B. Confirm an adequate temperature setting
D. Shorten the tubing between the gas source and
humidifier

151. The physician is considering initiating volume-controlled

ventilation on a 58-year-old male patient. How would you
describe this mode of ventilation?
A. “Inspiration begins after a specific volume is inhaled.”
B. “Inspiration ends after a pre-set volume is delivered.”
C. “Expiration ends after a pre-set volume is delivered.”

51
D. “Inspiration ends after the patient exhales a pre-set
volume.”

152. You were called by the nurse to assist with the transport of
a patient receiving oxygen via nasal cannula at 3 L/min. The
E cylinder for transport is full and has a regulator attached.
Upon opening, you hear a hissing noise and the flowmeter
is turned off. Which of the following actions should you
take?
A. Turn the flowmeter on
B. Replace the pressure regulator
C. Tighten the regulator connection
D. Replace the E cylinder with a new tank

153. A patient is receiving oxygen via nasal cannula at 6 L/min

with a bubble humidifier. During a routine assessment, you
note that there is no bubbling inside of the humidifier.
Which of the following is the most likely problem.
A. The humidifier outlet is obstructed
B. The oxygen flow is set too low
C. There is a leak in the tubing
D. The flowmeter connection has a leak

154. A 68-year-old female patient is receiving volume controlled

52
B. Seek further instruction from the attending physician
C. Disconnect patient and provide manual ventilation with
an FiO2 of 100%
D. Check the full patient-ventilator system for leaks and
malfunctions

155. A 70-year-old female patient is receiving volume control

ventilation. While reviewing her current settings, you note a
decrease in expired volume and a decreased airway
pressure from the previous measurement. There has been
no change in ventilator settings. Which of the following
best explains this finding?
A. There is a decrease patient-triggered breaths
B. There is a leak in the patient-ventilator system
C. The monitoring spirometer is malfunctioning
D. The patient has an increased airway resistance or
decreased lung compliance

156. An order was placed for insufflation-exsufflation therapy on

a 51-year-old female patient. While gathering the necessary
supplies, which of the following is required?
A. A bacterial filter
B. A heated wire humidifier
C. A heat and moisture exchanger
D. A balloon-type exhalation valve

157. It has been determined that a 67-year-old male patient has

a pneumothorax. This disorder can be classified as which of
the following?

53
A. A restrictive disorder
B. An obstructive disorder
C. Both a restrictive and obstructive disorder
D. Neither a restrictive or obstructive disorder

158. A 69-year-old male patient with congestive heart failure

states that he has trouble breathing while lying flat. Which
of the following best describes this condition?
A. Hyperpnea
B. Orthopnea
C. Apneustic
D. Cheyne-stokes

159. A 55-year-old male patient with a pneumothorax has a

pleural drainage system in place. Upon assessment, you
note that there is no bubbling in the suction control
chamber. After confirming that suctioning is turned on,
which of the following would you recommend?
A. Increase the power of the suction control
B. Withdraw the chest tube about 3-4 cm
C. Check the connecting tubing for leaks
D. Add more water to the suction control chamber

160. A patient is receiving 3 L/min of oxygen from an E-cylinder

at 1200 psi. What is the approximate duration of flow?
A. 72 minutes
B. 94 minutes
C. 102 minutes
D. 112 minutes

54
Section 2

1. 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

2. Which of the following is the recommended adult dosage

55
The recommended adult dosage for salbutamol (Albuterol;
Proventil) delivered by SVN is 0.5 ml of the 1:200 (0.5%) solution in
diluent. Usually, on the TMC Exam, they typically don’t ask specific
drug doses so you won’t need to worry about memorizing them
all. However, it’s still a good idea to remember the normal dosage
for Albuterol because I have seen cases where it was on the exam.

For the TMC Exam, you do now need to worry about memorizing
the specific doses for all the different types of drugs. The NBRC
typically doesn’t ask for the specific dose in the questions. I know,
right, hallelujah! However, there is one exception to this rule..

It may be a good idea to remember that a standard SVN dose for

albuterol because it has been seen on a few versions of the exam.
The recommended adult dose is:

Albuterol SVN: 0.5 mL (2.5 mg) of 1:200 aqueous solution in diluent

given 3–4 times per day.

So now we know that the correct answer is C.

The correct answer is: C. 0.5 mL of 1:200 aqueous solution in

diluent

3. Immediately after intubation in the emergency room, the

56
After reading the question, you should almost immediately know
the correct answer even before looking at the answer choices.

During auscultation after intubation, you should hear bilateral

breath sounds and no air movement over the epigastrium. If you
do hear gurgling over the epigastrium, this means that the tube
was inserted into the esophagus instead of the trachea. That fact
that you do not hear any breath sounds also confirms this
suspicion.

The tube must be removed and re-inserted through the vocal

cords and confirmed in the trachea. The correct answer is D.

The correct answer is: D. Intubation of the patient’s esophagus

4. A patient that is receiving mechanical ventilation in the SIMV

mode displays the following graph. Which type of breath does
it most likely represent?

A. Spontaneous breath
B. Pressure controlled breath
C. Pressure supported breath
D. Patient triggered mandatory breath

57
To get this one correct, you need to have a basic understanding
on the pressure-volume graphs for patients that are receiving
mechanical ventilation.

For this one, you can see that when the breath is initiated, the
pressure briefly goes into the negative zone. That means that the
breath was patient triggered, as can occur in the SIMV mode.

This is the only answer choice that can be correct for this graph,
so you know that the correct answer has to be D.

The correct answer is: D. Patient triggered mandatory breath

5. You are called to administer 70/30 heliox on an 11-year-old girl

in the emergency department. Which of the following would
you use to deliver the therapy?
A. Aerosol mask
B. Venturi mask
C. Nonrebreathing mask
D. Binasal cannula

To get this one correct, you simply just needed to know which
mask is most commonly used to administer heliox.

Of course, remember that heliox should be delivered via a

nonrebreathing mask.

None of the other answer choices are used to deliver heliox, so

you know that the correct answer has to be C.

The correct answer is: C. Nonrebreathing mask

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6. If you were to take the total of the maximum volume of air
that can be exhaled from the maximum inspiratory level, this
can be defined as which of the following?
A. Residual volume
B. Expiratory reserve volume
C. Vital capacity
D. Total lung capacity

To get this one correct, all you have to do is know the definitions
and differences between the lung volumes and capacities.

A lung capacity is a combination of different lung volumes. The

question tells us that it combines the inspiratory volume and the
expiratory volume, so we know that the answer has to be a
capacity. That means we can rule out residual volume and
expiratory reserve volume.

The maximum amount of air that can be exhaled after taking a

maximum breath in is defined as the vital capacity, which is the
correct answer.

In this case, the residual volume is the volume of air that remains
in the lungs after a maximum exhalation. The residual volume is
included in the total lung capacity, and since the residual volume
cannot be exhaled, we know that TLC cannot be the correct
answer.

The correct answer is: C. Vital capacity

7. Upon the assessment of a patient receiving volume control AC

59
C. Increase the endotracheal tube cuff pressure
D. Assess the patient’s need for suctioning

If you see a flow-volume loop that shows an irregular sawtooth-

pattern in the expiratory portion of the loop, this likely means that
there is some type of obstruction in the airway or ET tube.

So in this case, the best action to take is to assess for the need for
suctioning. Auscultation would reveal rhonchi and tactile fremitus
over the trachea would confirm excess secretions are present,
which means that the patient needs to be suctioned.

There is no indication to switch to pressure control, give a

bronchodilator, or increase the cuff pressure, so you know that
the correct answer has to be D.

The correct answer is: D. Assess the patient’s need for suctioning

8. Other than obtaining the results from a vital capacity

When performing a bedside vital capacity maneuver on a patient,

you must obtain the patient’s height, gender, and age as well
because these values are needed in order to compute the
patient’s predicted vital capacity value.

It’s also a good idea to know the patient’s smoking history and
current medications, even though they’re not mentioned in the
question or answer choices.

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The resting minute ventilation, heart rate, and predicted body
weight are not needed at this time, so we know that the correct
answer has to be B.

The correct answer is: B. The patient’s height, gender, and age

9. A 61-year-old patient arrives to the emergency department in

If there is a patient with a depressed level of consciousness,

obviously they are not in a state to respond and let you know their
current medications. So in a case such as this, the best course of
action is to obtain the medication history from the patient’s
family member.

None of the other answer choices really make sense in this

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

The correct answer is: B. Obtain the patient’s current prescription

vials from the family

10. A 64-year old female patient was admitted and the physician
suspects that a pneumothorax is present. Which of the
following percussion notes would you expect to find in this
patient?

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A. Increased resonance
B. Flat percussion note
C. Dull percussion note
D. Hyperresonant percussion note

You can actually tell a lot about a patient’s cardiopulmonary

status just by percussing the chest/lungs and listening for
particular sounds and loudness. You must know the different
notes and sounds for the exam.

• Normal Resonance – A low-pitch sound that is heard over

normal, air-filled lungs.
• Increased Resonance – Normally indicates hyperinflation, so
it’s heard in obstructive lung diseases.
• Dull Percussion Note – Heard in areas of consolidation, like
pneumonia.
• Flat Percussion Note – Heard in atelectasis.
• Hyperresonant Percussion Note – Makes a loud sound. This
one is heard over a pneumothorax.

Definitely remember this information for the exam. But for this
questions, you can easily determine that the correct answer has
to be D.

The correct answer is: D. Hyperresonant percussion note

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

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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.

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

12. A patient is the emergency room is suspected to have a

pulmonary embolism. In order to confirm this suspicion,
which of the following laboratory tests would you
recommend?
A. Hematocrit
B. Troponin I
C. D-dimer
D. Arterial blood gas

To get this one right, you simply just had to know which test is
used to diagnose a pulmonary embolism. Of course, it’s a d-dimer
test.

When this test is performed, if the d-dimer level is normal, the

presence of a thrombosis generally can be ruled out.

It’s also helpful to know about the other tests that are listed in the
answer choices as well. That way, you can easily rule them out.

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Troponin is used to assess for a myocardial infarction. An ABG, of
course, is used to access the patient’s acid-base status. And
hematocrit doesn’t have any diagnostic value in evaluating a
patient with a suspected pulmonary embolism.

So after going through all the answer choices, we can determine

that the correct answer has to be C.

The correct answer is: C. D-dimer

13. 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

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.

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The correct answer is: B. 70% ethyl alcohol

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

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:

• 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

15. After obtaining an ABG sample, the results of a 49-year-old

female patient show acute respiratory acidosis. You would
expect for the base excess to be in the range of which of the
following?

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A. +/- 2 mEq/L
B. +/- 6 mEq/L
C. +/- 8 mEq/L
D. +/- 10 mEq/L

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

understanding of ABG interpretation and what base excess
means.

When a patient has acute respiratory acidosis, this means that it’s
uncompensated. So in this case, the base excess should always
fall within the normal range.

On the other hand, when renal compensation is occurring in

response to a chronic (or compensated) respiratory acidosis, the
base excess should rise above the normal range due to the
increased levels of bicarb.

So after breaking it down, you can easily determine that the

correct answer has to be A.

The correct answer is: A. +/- 2 mEq/L

16. A 60-year-old male patient has heart rate of 136 beats/min

with a regular rhythm. Which of the following is the most
likely cause of this observation?
A. Arterial hypertension
B. Anxiety or agitation
C. Beta-blocker administration
D. Therapeutic hypothermia

To get this one correct, you simply needed to know the common
causes of tachycardia.

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An adult patient with a heart rate of 136 beats/min with a regular
indicates that sinus tachycardia is present. Some of the causes of
sinus tachycardia include fear, anxiety, hypotension, hypoxemia,
anemia, fever, and exercise.

Also, there are some drugs that can cause an increased heart rate
as well, and they are:

• Adrenergic drugs with beta-1 effects, such as epinephrine

and dopamine
• Anticholinergics such as atropine

The administration of a beta-blocker would decrease the heart

rate, not increase it. Hypothermia would tend to decrease the
heart rate as well.

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

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

The correct answer is: B. Anxiety or agitation

17. As a Respiratory Therapist, you should recommend an

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

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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 B.

The correct answer is: B. A routine 53-year-old male patient

18. The results of a bedside spirometry test that was performed

This is a very basic calculation and is something that every

Respiratory Therapy student should know how to compute and
you should never miss this one on the exam.

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They did include some extra numbers in the question, just to try
to throw you off.

But you should remember that:

Minute Ventilation = rate x tidal volume

So in this case MV = 19 x 380 = 7220 mL/min. Then you can convert

it to liters per minute, which rounds to 7.2 L/min. The correct
answer is C.

The correct answer is: C. 7.2 L/min

This one is very simple as long as you’re familiar with bronchial

breath sounds.

You should know that it’s normal to hear bronchial breath sounds
over the trachea. However, when they are heard over the lungs,
this tells us that consolidation is present. And for the TMC Exam,
whenever you have a patient with consolidation, I want you to
automatically think pneumonia.

In pneumonia, the consolidation in the lungs allows the turbulent

flow sounds of the larger airways to pass directly through the
lung, which explains why you hear bronchial sounds in this case.

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None of the other answer choices really make sense in this
situation, so we know that the correct answer has to be B.

The correct answer is: B. Pneumonia

For this ABG interpretation question, they only give you two of
the ABG values, so you have to use some critical thinking in order
to figure this one out.

The pH is high, which indicates alkalosis. So with that, we can

already rule out the answer choices containing acidosis.

Next, we can see that the PaCO2 is elevated. When there is a high
pH, we know that the only two possible causes could be either
respiratory alkalosis or metabolic alkalosis. And in this case, the
pH is increased which means that it can’t be respiratory alkalosis.

So by using our illustrious ABG interpretation skills, as well as the

process of elimination, we know that the correct answer has to be
D.

The correct answer is: D. Metabolic alkalosis

21. A patient performs an FVC maneuver and displays the

following results:

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How would you interpret this flow-volume loop tracing?
A. Normal lungs
B. Small airway obstruction
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. This is
clearly the pattern for normal lungs, which means that the
correct answer has to be A.

The correct answer is: A. Normal Lungs

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22. In which of the following cases would you recommend
against the insertion of a supraglottic airway?
A. For a patient that needs emergency ventilation
B. For a patient with a suspected cervical spine injury
C. For a patient whom ET intubation is difficult
D. For a patient with a known esophageal disease

Supraglottic airways are used to provide emergency ventilation,

or in cases when it’s difficult to insert an endotracheal tube. They
are also commonly used when there is a suspected neck or spine
injury.

With that said, they contraindicated for patient with an intact gag
reflex and for those with a known esophageal disease. That
means we know that the correct answer is D.

Some examples of supraglottic airways include LMA, Combitube,

and King LT.

The key to getting this one right is understanding that these

types of airway are indicated during difficult intubation scenarios.
Also note that they are only recommended for short-term
ventilation. The correct answer is D.

The correct answer is: D. For a patient with a known esophageal

disease

23. You are called for the assessment of a child in the

emergency department. It has been noted that the child has
stridor. Which of the following conditions would you expect?
A. Croup
B. Asthma
C. Pneumonia
D. Cystic fibrosis

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

Stridor is a loud, high-pitched sound that is heard primarily over

the larynx or trachea during inhalation in patients with an upper
airway obstruction.

The common causes of stridor in children include croup,

epiglottitis, and foreign body aspiration.

However, if you see stridor in an adult patient, it mainly occurs

with post-extubation edema. None of the other answers choices
will cause stridor in a child, so we know that the correct answer
has to be A.

The correct answer is: A. Croup

24. A 50-year-old male patient was just admitted for asthma.

For patients that have been admitted for asthma, generally, they
must know how to properly administer the medication with
correct technique. Also, the patient should understand the
difference between controller drugs and reliever drugs.

And it’s also important for you, the Respiratory Therapist, to know
how frequent the patient uses their rescue inhaler.

73
It does not matter if the patient uses generic medications or
brand name medications. That is because, generic medications
are 100% equivalent to their brand name counterparts.

So taking everything into consideration, you can determine that

the correct answer has to be C.

The correct answer is: C. Use of generic vs. brand name

medications

25. You are called to help treat a patient with a neuromuscular

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

the neuromuscular conditions that are listed in the answer
choices.

Guillain-Barré Syndrome is a rare autoimmune disorder of the

peripheral nervous system that causes inflammation and
deterioration of the patient’s peripheral nervous system.

For the exam, you should remember that Guillain-Barré

Syndrome is an ascending paralysis that moves from the Ground
to the Brain.

Myasthenia Gravis, on the other hand, is a descending paralysis

that moves from the Mind to the Ground.

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So by using what you know about neuromuscular disorders, we
can determine that the correct answer has to be A.

The correct answer is: A. Guillain-Barré syndrome

26. A female patient who was in a motor vehicle accident arrives

First and foremost, in order to get this one right, you have to
know what crepitations are.

Crepitations, or also known as subcutaneous emphysema, are air

bubbles under the skin that can be palpitated. This is a sign that a
pneumothorax is present due to the air leakage from the lungs.

None of the other answer choices really make sense in this

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

The correct answer is: B. The patient has a pneumothorax

27. A patient was admitted to the ICU with a severe case of

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To get this one right, you simply needed to know that influenza,
aka the flu, is an infection that is spread by droplets in the air.

Droplet precautions help to prevent spread and transmission by

placing the patient in a private room. Also, all medical personnel
must wear a surgical mask when within 3 feet of the patient. Eye
and face protection must be used if an aerosol-generating
procedure is to be performed. And if the patient is to be
transported, they are required to wear a mask.

So by using your knowledge about infection control, you know

that the correct answer has to be A.

The correct answer is: A. Droplet precautions

28. A 69-year-old female patient in the ICU is positioned with her

To get this one correct, you simply just had to know what it
means when a patient’s jugular veins are distended. In most
cases, JVD occurs due to fluid overload. In this case, the patient
needs a diuretic, such as Lasix.

Dehydration would result in the jugular veins being flat, not

distended. Hypertension and emphysema will not have an effect
on the jugular veins, so you can rule those out as well.

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So taking everything into consideration, we know that the correct
answer has to be A.

The correct answer is: A. The patient is fluid-overloaded

29. You are called to give a patient an SVN breathing treatment

with albuterol for wheezing. While obtaining the patient’s
pre-treatment vital signs, her heart rate is 84 beats/min with
a respiratory rate of 18 breaths/min. Three minutes into the
treatment, the patient’s heart rate climbs to 133 beats/min
and her respiratory rate increased to 23 breaths/min. Which
of the following actions should you take in this situation?
A. Continue the treatment as ordered to completion
B. Switch to arformoterol (Brovana) and continue the
treatment
C. Increase the patient’s FiO2
D. Stop the treatment, monitor the patient, and notify the
physician

This question tells us that there is a drastic increase in the

patient’s heart rate once she starts the breathing treatment with
albuterol. She is obviously having an adverse reaction to the
medication.

In this case, the best course of action would be to stop the

treatment, monitor the patient, and notify the physician.

There is almost always a question on the TMC Exam about

stopping a bronchodilator treatment. Just know that if the
patient’s heart rate increases more than 20% from the baseline
pre-treatment heart rate, then you should stop the treatment and
notify the physician.

77
Brovana is not indicated for acute bronchospasm and there is no
indication to increase the patient’s FiO2. You know that the
correct answer has to be D.

The correct answer is: D. Stop the treatment, monitor the patient,
and notify the physician

30. You are called to provide a STAT bronchodilator treatment

There is a lot going on in this question, so let’s break it down. To

get this one right, you, first, needed to know that 0.5 mL is the
standard dose of albuterol.

In general, the Respiratory Therapist should confirm the intent of

the physician’s order before proceeding. The only exception is
when order confirmation might delay essential or emergency
patient treatment, as is the case with the patient that is
mentioned in this question.

This patient is having a severe asthma attack, so delaying the

treatment would put the patient a greater risk. So in this case, you

78
should administer the standard dose and then obtain
confirmation as soon as possible afterwards.

Taking everything into consideration, we know that the correct

answer has to be D.

The correct answer is: D. Administer the treatment using the

standard albuterol dosage of 0.5 mL and clarify the order as soon
as possible thereafter

31. While administering an aerosolized albuterol breathing

treatment to a 61-year-old patient, you should be on guard
for which of the following adverse effects?
A. Tachycardia
B. Bradycardia
C. Vagovagal reflex
D. Laryngospasm

To get this one right, you simply just needed to have a basic
understanding of the side effects of beta-2 adrenergic
bronchodilators.

In general, albuterol will can cause a faster heart rate

(tachycardia) and palpitations in some patients. Some other side
effects include nervousness, tremors, and shakiness.

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. Tachycardia

32. The ABG results of a 33-year-old male patient are as follows:

pH 7.30

79
PaCO2 22 torr
HCO3 12 mEq/L
BE -13
PaO2 110 torr
This data indicates which of the following?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis

To get this one correct, you simply just needed to be able to

interpret the ABG results. Let’s break it down.

You can see that the pH is acidotic which indicates that the
primary problem is acidosis. The bicarb and base excess are
decreases, so this tells us that the acidosis is metabolic.

Also, the PaCO2 is decreased, so this indicates that the patient is

hyperventilating, or blowing off too much CO2. This tells us that
the metabolic acidosis is partially compensated.

The correct answer is: A. Metabolic acidosis

33. A patient complains of difficulty in starting the treatment of

a mouthpiece positive pressure ventilator. Which control
should you adjust?
A. Flow
B. Pressure
C. Terminal flow
D. Sensitivity

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

understanding of the settings for a mouthpiece ventilator.

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The sensitivity control is what determines how much effort
(negative pressure) the patient has to generate in order to trigger
on a breath.

Pressure, flow, and terminal flow will adjust the functioning

ventilator unit after the breath is started. So we can rule those out
right away. That means that the correct answer has to be D.

The correct answer is: D. Sensitivity

34. On inspection of an EKG rhythm strip from a 63-year-old

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

EKG interpretation and the heart block rhythms.

By reading the question, you can see that almost everything

appear to be normal. The only major abnormality is a prolonged
P-R interval, i.e., greater than 0.20 seconds. This tells us that the
most likely problem in this case is a 1st degree heart block.

A 1st degree heart block is a condition caused by inflammation,

infarction, or ischemia that impairs the ability of the A-V
node/bundle of His to transmit sinus impulses to the ventricles.
Also note that it is the least severe form.

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

you know that the correct answer has to be A.

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The correct answer is: A. 1st degree heart block

35. A 69-year-old male patient has arrived in the ER with a

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

understanding of the lab values that were provided in the
question.

Negative results for creatine kinase, troponin I, and troponin T

would rule out a myocardial infarction. Negative results for BNP
would rule out CHF. None of these tests is a marker for
pneumonia, so we can rule that one out as well.

That means that, by process of elimination, the patient’s dyspnea

has to be caused by an exacerbation of COPD.

The correct answer is: C. Exacerbation of COPD

36. While performing a routine chest percussion, you noticed

that a 57-year-old male patient has a flat percussion note.
Which of the following does this finding indicate?
A. Pneumonia
B. Pneumothorax

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C. COPD
D. Atelectasis

You can percuss a patient’s chest and it will reveal a lot about the
their status. Chest percussion is done by placing your middle
finger between two of the patient’s ribs and tapping it with your
other hand.

You must know the common percussion notes for the exam, as
there is usually at least one question about them.

For this question, the patient has a flat percussion note which
indicates that atelectasis is present. An easy way to remember
this one is Flat rhymes with At-electasis.

Atelectasis… Flat –electasis. The correct answer has to be D.

The correct answer is: D. Atelectasis

37. A 61-year-old female patient with a history of COPD was

admitted to the emergency department for an acute case
suspected pneumonia. Her ABG results are as follows:
pH = 7.19
PCO2 = 66 torr
HCO3 = 26 mEq/L
PaO2 = 41 torr
P(A-a)O2 = 43 torr
Which of the following best describes the patient’s
condition?
A. Acute hypercapnic respiratory failure
B. Chronic hypercapnic respiratory failure
C. Acute hypoxemic respiratory failure
D. Combined hypercapnic and hypoxemic respiratory
failure

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Let’s break this one down.

Right away, you should notice that the patient’s oxygenation

values are severely low. The pH is decreased and the PaCO2 is
increased, which means acidosis—and in this case— respiratory
failure.

In this patient’s case, the patient is in respiratory failure not only

due to ventilatory issues, but also for oxygenation issues as well. In
other words, her ABG results show hypercapnia (increased
PaCO2) and hypoxemia (decreased PaO2), so we know that the
correct answer has to be D.

The correct answer is: D. Combined hypercapnic and hypoxemic

respiratory failure

38. A 3-day-old boy was brought into the emergency

To get this one correct, you had to know that transillumination is

a test that is performed to see if an infant has a pneumothorax.

It’s a procedure where you shine a light through the infant’s chest
in order to inspect for a pneumothorax and is performed in high-
risk infants that are showing signs of respiratory distress.

84
When there is a “halo” sign through the neonate’s chest wall, this
confirms that a pneumothorax is present. In this case, immediate
chest tube insertion would be indicated.

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

The correct answer is: B. Transillumination

39. A 59-year-old female patient has arrived to the emergency

department in respiratory distress due to severe hypoxemia.
She would most likely exhibit all of the following signs
except?
A. Diaphoresis
B. Cyanosis
C. Bradycardia
D. Tachypnea

In order to get this one correct, you simply just needed to know
the general signs of respiratory distress due to hypoxemia. You
definitely must know this for the TMC Exam.

Tachycardia, diaphoresis, cyanosis, and tachypnea are all signs of

hypoxemia.

For the exam, I want you to remember that tachycardia is a major

sign of hypoxemia. If the patient’s oxygen levels are low, the heart
will beat faster to try to pump more oxygenated blood through
the body in order to compensate.

So you would expect the patient to have a fast— not a slow —

heart rate. So now we know that the correct answer has to be C.

The correct answer is: C. Bradycardia

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40. A neonate has severe hypoxemia due to persistent
pulmonary hypertension. In order to treat the patient, the
doctor orders inhaled nitric oxide. What starting dose would
you recommend for this patient?
A. 2%
B. 2 ppm
C. 20 ppm
D. 200 ppm

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

understanding of inhaled nitric oxide.

INO can be used to treat term and near-term neonates with

hypoxemic respiratory failure that is associated with persistent
pulmonary hypertension.

The recommended initial dose of inhaled nitric oxide is 20 parts

per million. Keep in mind that, oftentimes, the dose can be
quickly reduced to 5-6 ppm after the initial starting dose has been
given.

None of the other answer choices are correct, so you know that
the answer has to be C.

The correct answer is: C. 20 ppm

41. A 60-year-old patient has been admitted and is showing

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C. COPD exacerbation
D. Bacterial pneumonia

After looking through the answer choices, you should be able to

determine that the patient has bacterial pneumonia. That is
because, all of the signs and symptoms that are given in the
question support this conclusion.

The biggest takeaway is the fact that the patient has a fever,
which indicates that an infection is present.

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. Bacterial pneumonia

42. A 51-year-old male patient with asthma has been prescribed

To get this one right, you needed to know that albuterol is a beta-
adrenergic drug that has side effects such as an increased heart
rate and blood pressure.

So, since this patient is already hypertensive and is showing signs

of supraventricular tachycardia, the medication would be
contraindicated in this case.

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With that said, the best course of action is to postpone the
treatment and consult with the physician about the patient’s
current condition.

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. Postpone the treatment and consult the
physician

43. While palpating a patient’s radial artery to take the pulse,

you note that it feels bounding and full. Which of the
following conditions is most likely the cause of this finding?
A. Cardiovascular shock
B. Low cardiac output
C. Hypovolemia
D. Hypertension

To get this one right, you have to know what it means when a
pulse is bounding and full.

A bounding pulse is often seen in patients with high blood

pressure and it sometimes a sign that the patient is fluid
overloaded.

The other answer choices (hypovolemia, shock, and low cardiac

output) would result in decreased systolic and pulse pressures,
which would not produce a pulse that is bounding.

So now we know that the correct answer has to be D.

The correct answer is: D. Hypertension

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44. An unconscious patient with apnea has just arrived to the
ER. The physician states that the patient is at risk of
aspirating. Which of the following would you recommend for
securing this patient’s airway?
A. Performing a percutaneous tracheotomy
B. Inserting a laryngeal mask airway
C. Intubating via the nasal route instead
D. Inserting an esophageal-tracheal combitube

In general, an esophageal-tracheal combitube is used for

establishing an emergency airway. It has two tubes and two cuffs,
so when inserted, it can provide ventilation regardless if it enters
the trachea or esophagus.

One thing to note is that it should be used only for short-term

ventilation. You should switch to an ET tube as soon as possible.

A percutaneous tracheotomy is not indicated. And an LMA is

always contraindicated when there is a risk of aspiration. Also,
nasal intubation is not indicated either in this case.

So by using what we know about esophageal-tracheal

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

The correct answer is: D. Inserting an esophageal-tracheal

combitube

45. A female patient that is having an asthma attack was given

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C. Alterations in the V/Q ratio (a beta-2 effect)
D. The additive effect of other drug agents

This rarely occurs, however, some patients do have an opposite

response to adrenergic bronchodilators in which the symptoms
of acute airway obstruction actually are made worse by drug
agent.

When this happens, the adverse effect is usually a result of an

allergy to some of the metabolic products of the adrenergic
drugs.

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. A paradoxical response to the agent

To get this one correct, you simply needed to know the common
signs that occur when an infant is in respiratory distress.

The most common signs include:

• Tachypnea
• Nasal flaring
• Grunting

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• Chest wall retractions

Please remember these because you will (most likely) see them
again on the TMC Exam.

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. Chest wall retractions

47. An adult patient with shortness of breath is admitted to the

The first thing we must do with this question is interpret the ABG
results. By doing so, we see that the patient is in acute respiratory
alkalosis due to hyperventilation.

So we can immediately see that the patient is not

hypoventilating, nor are they in impending respiratory failure.
Also, we already determined that there is a respiratory issue, not a
metabolic issue, so we can rule that one out as well.

Since the PaO2 is below 60, this means that the patient is
hypoxemic, so their oxygenation status is our primary concern. It’s

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what’s causing the patient to hyperventilate and feel shortness of
breath.

So by using what we know about ABG interpretation, as well as

the process of elimination, we can determine that the correct
answer has to be C.

The correct answer is: C. The primary concern is hypoxemia

48. Which of the following is the average depth of a proper oral

endotracheal tube insertion in an adult patient?
A. 26 cm from the patient’s teeth
B. 22 inches from the patient’s lip
C. 22 cm from the patient’s lip
D. 32 cm from the patient’s teeth

You need to know how to identify to proper position of an ET tube

for the exam. In general, here’s what you should go by:

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

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

The correct answer is: C. 22 cm from the patient’s lip

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49. While evaluating a pediatric patient, upon entering the
room, you hear a harsh, high-pitched sound on the child’s
inspiration. Which of the following is most likely the cause of
this finding?
A. The sounds are bronchovesicular
B. The sounds are bronchial
C. The sounds are tracheal
D. The sounds are stridorous

To get this one correct, you simply just needed to have a basic
understanding of stridor.

Stridor is a loud, high-pitched sound that is heard primarily over

the larynx or trachea during inhalation in patients with an upper
airway obstruction.

The common causes of stridor in children include croup,

epiglottitis, and foreign body aspiration.

Inspiratory stridor is the only breath sound of the answer choices

that are listed that can be heard without a stethoscope. In most
cases, it should be considered a medical emergency.

You by using what we know about stridor, you can determine

that the correct answer has to be D.

The correct answer is: D. The sounds are stridorous

50. The physician asks for you to evaluate a newborn infant’s

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To get this one correct, you simply just needed to know that
normal vital sign values of a newborn.

A heart rate of 132 beats/min, blood pressure of 62/40, and a rectal

temperature of 35.9 are all normal for a term newborn.

With that said, a normal term newborn should have a respiratory

rate of 30–60 breaths/minute.

So by using what we know about newborn vital signs, as well as

the process of elimination, we can determine that the correct
answer has to be B.

The correct answer is: B. Respiratory rate of 20 breaths/min

51. The doctor ordered a metered dose inhaler bronchodilator

An MDI is an effective method for administering aerosol

medications to a patient that is receiving mechanical ventilation.
To get this one right, you just simply needed to know where in
the circuit the MDI should be inserted.

When using an SVN or an MDI adaptor, you should insert it into

the inspiratory limb. And for MDIs, you should place a spacer or

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holding chamber in-line in the ventilator circuit as well so that the
medication doesn’t deposit into the inner walls of the circuit.

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

we know that the correct answer has to be D.

The correct answer is: D. Place the MDI plus a spacer in-line on
the inspiratory side of the circuit

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

the basic guidelines for performing CPR on neonates.

Remember that compressions should be delivered on the bottom

third of the sternum with a compression to ventilation ratio of 3:1.

Compressions do not need to exceed half the AP chest diameter,

and compressions and ventilation do not need to be delivered
simultaneously.

So by using what we know about providing CPR to a neonate, 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. The compression to ventilation ratio
should be 3:1

53. A conscious patient that requires frequent nasotracheal

Since the nasopharyngeal airway cannot be inserted into one

nostril, it likely means that there is an obstruction. So the first
thing you should do is simply try to insert the nasotracheal airway
into the other nostril.

The question tells us that the patient is conscious, so an

oropharyngeal airway is contraindicated. There isn’t any
indications for nasotracheal intubation or for using an LMA.

So by using what we know about nasotracheal airways, as well as

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

The correct answer is: D. Insert the airway in the other nostril

54. A 54-year-old female patient’s spirometry results show an

FEV1 that is calculated to be 80% of her forced vital capacity.
This finding suggests that the patient probably has which of
the following?
A. Chronic bronchitis

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B. Emphysema
C. An obstructive lung disease
D. Clinically normal values

This one is simple to interpret.

This patient’s FEV1/FVC ratio is normal because she exhaled a

normal percentage of her vital capacity in the first second.

If the patient had an obstructive disease, the percentage would

be decreased. So that rules out the remaining answer choices and
tells us that the correct answer has to be D.

The correct answer is: D. Clinically normal values

55. You are called to assist with needle decompression for a

To get this one correct, you simply just need to know the correct
placement for the needle during decompression for treating a
tension pneumothorax.

According to ACLS guidelines, a large-bore needle may be

inserted into the second intercostal space at the midclavicular
line for decompression.

None of the other answer choices are correct in this case.

The correct answer is: B. Second intercostal space in the

midclavicular line

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56. After auscultating a patient in the emergency department,
you noticed blood on the head of your stethoscope. How
should it be cleaned before use on another patient?
A. Sterilized with ethylene oxide
B. Wiped with a bleach solution
C. High-level disinfection with glutaraldehyde
D. Wiped with an alcohol solution

To get this one correct, you must know how to disinfect

equipment that is contaminated with blood.

Alcohol can be used for low-level disinfection when no blood is

present, so we can rule that one out right away.

According to the CDC, bleach must be used to disinfect any

surface that is contaminated with blood. And this is something
you should remember for the TMC Exam because you may see a
question similar to this one.

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. Wipe with a bleach solution

57. A 21-month-old girl with asthma is receiving volume control

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Since the patient is receiving an in-line breathing treatment
through the ventilator circuit, that means that additional
unheated gas flow is being added to the circuit.

This will lower the temperature of the patient’s airway which can
cause the humidifier alarm to sound. To fix this problem, you can
readjust humidifier’s low temperature alarm during the
treatment.

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. Low gas temperature

58. A 51-year-old female patient arrived in the emergency room

A respiratory rate of 36/minute in an adult represents tachypnea,

so to get this one correct, you have to know the causes of
tachypnea.

The most common causes of tachypnea in hospitalized patients

are fever, increased metabolic rate/CO2 production, arterial
hypoxemia, metabolic acidosis, anxiety, and pain.

Typically CNS depression decreases the respiratory drive, while

hypothermia decreases metabolic rate (and CO2 production),
thereby decreasing ventilatory demand.

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So by going through the answer choices, you can determine that
the correct answer has to be B.

The correct answer is: B. Metabolic acidosis

59. A patient with a history of COPD and an acute pneumonia

exhibits the following ABG results on room air:
pH = 7.20
PaCO2 = 65 torr
HCO3 = 26 mEq/L
PO2 = 40 torr
P(A-a)O2 = 42 torr
Which of the following best describes this patient’s
condition?
A. Acute hypercapnic respiratory failure
C. Acute hypoxemic respiratory failure
B. Chronic hypercapnic respiratory failure
D. Combined hypercapnic/hypoxemic respiratory failure

To get this one correct, you just need to be able to interpret the
patient’s ABG results.

The pH is low and the PaCO2 is high, which indicates respiratory

acidosis. With that said, the low PO2 and elevated P(A-a)O2
indicates that the patient is suffering from oxygen-related
respiratory failure as well.

This means that there is a combined form of respiratory failure

and the correct answer has to be D.

The correct answer is: D. Combined hypercapnic/hypoxemic

respiratory failure

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60. The husband of a comatose patient asks you to cancel a
previously approved DNR order. How should you proceed?
A. Record the request in the patient record
B. Explain that only her husband can cancel the order
C. Notify the charge nurse of the request
D. Notify the attending physician of the request

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

understanding of how a DNR order works.

A DNR (do not resuscitate) order indicates a patient’s wishes not

to receive CPR or life-saving treatment.

Should a patient or their surrogate ask you to change or revoke

an advance directive or DNR order, you must immediately notify
the attending physician, who either cancels the DNR order or
have the new request formalized to replace any prior written
documentation.

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. Notify the attending physician of the

request

61. After reviewing the chart of a 55-year-old female patient, you

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To get this one correct, you needed to be able to recognize the
signs of dehydration.

Some common signs of include CNS disturbances, collapsed

veins, hypotension, inspissated secretions, decreased skin turgor,
sunken eyes and dry, coated tongue, and weight loss.

Even if you didn’t know the signs of dehydration, you could still
get this one correct by knowing the signs of fluid overload. They
are: venous distension, pitting edema, and crackles.

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

The correct answer is: C. Inspissated secretions

62. While reviewing the chart of a 65-year-old patient diagnosed

with COPD and chronic hypoxemia, you would expect to find
which of the following?
A. Chronic respiratory alkalosis
B. Secondary polycythemia
C. A decreased A-P chest diameter
D. An FRC less than predicted

To get this one correct, you needed to know the signs and
symptoms of patients with COPD and chronic hypoxemia. Then
you can use the process of elimination to come up with the
correct answer.

A patient with COPD and chronic hypoxemia would be expected

to exhibit CO2 retention. This means they would have respiratory
acidosis, not alkalosis so we can rule that one out. Also, for COPD
patients, the A-P chest diameter would be increased above
normal, as would the FRC due to air trapping.

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On the other hand, they would likely have secondary
polycythemia and possibly signs of cor pulmonale due to chronic
hypoxemia.

The correct answer is: B. Secondary polycythemia

63. A 3-year-old boy has arrived in the emergency room with

noted stridor. Which of the following conditions would you
expect?
A. Asthma
B. Croup
C. Pneumonia
D. Cystic fibrosis

To get this one correct, you simply just needed to know that
stridor in children is a finding that is associated with croup.

Stridor is a loud, high-pitched continuous sound heard primarily

over the larynx or trachea during inhalation in patients with
upper airway obstruction.

The common childhood causes of stridor include croup,

epiglottitis and foreign body aspiration. On the other hand, if
stridor were to occur in adults, it’s usually from a complication
after extubation due to edema of the vocal cords.

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. Croup

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64. If noted on inspiration, which of the following respiratory
signs of an adult patient would be considered abnormal?
A. A respiratory rate of 18 breaths per minute
B. Ribs higher posteriorly than anteriorly at end-expiration
C. Costal angle of 90 degrees that increases with inspiration
D. The use of the sternocleidomastoid muscles at rest

To get this one correct, you needed to know the signs of normal
breathing and be able to recognize when there is an increased
work of breathing.

For an adult, the respiratory rate should be between 10-20 breaths

per minute. Also, the ribs should be higher posteriorly than
anteriorly at end-expiration, and both side of thorax should
expand equally. Also, the costal angle should be about 90° but
increase with inspiration.

On the other hand, the accessory muscles of respiration, which

are the scalenes, sternocleidomastoids, and pectoralis major,
should not be used during quiet breathing.

If they are being used during normal breathing, that means that
there is an increased WOB, so we know that the correct answer
has to be D.

The correct answer is: D. The use of the sternocleidomastoid

muscles at rest

65. A 52-year-old female patient has been smoking 1.5 packs of

cigarettes per day for 30 years. Her smoking history would be
recorded as:
A. 15 pack-years
B. 30 pack-years
C. 45 pack-years

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D. 60 pack-years

To answer this one correctly, you just needed to know the simple
calculation for pack years.

Basically, all you have to do is multiple the number of packs of

cigarettes smoked per day x number of years that they’ve been
smoking.

So for this patient, you say 1.5 x 30 = 45 pack-years.

The correct answer is: C. 45 pack-years

66. You are called for the assessment of a chest radiograph for a
patient suffering from advanced stages of emphysema.
Upon observation, which of the following would you expect
to see?
A. An increased C/T ratio
B. Increased vascular markings
C. Decreased radiolucency
D. Flattening of the diaphragm

To get this one correct, you needed to know the signs of a patient
with emphysema in regards to their chest x-ray. The common
signs include:

• Flat diaphragms
• Increased radiolucency throughout the lung fields
• Decreased peripheral vascular markings

Also note, typically for a chest X-ray of a patient with emphysema,

they will have a smaller than normal heart and thus a decreased
C/T ratio — not an increased C/T ratio.

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So by using what we know about chest radiographs and
emphysema, as well as the process of elimination, you know that
the correct answer has to be D.

The correct answer is: D. Flattening of the diaphragm

67. Which of the following procedures requires active patient

effort and cooperation in order to be completed?
A. Breathing exercises
B. Mask CPAP
C. Weaning from the ventilator
D. Mechanical insufflation-exsufflation

You should be able to look at the answer choices and see that
there is only one that requires the patient’s active effort and
cooperation.

Ventilator weaning, mask CPAP, and mechanical cough assist

only require a spontaneous breathing effort — not active effort by
the patient.

Is it helpful to have a patient’s full cooperation? Yes, of course. But

that’s not always the case when working as a Respiratory
Therapist. With that said, it is absolutely essential when having a
patient perform breathing exercises in order for them to be
effective.

The correct answer is: A. Breathing exercises

68. A 53-year-old male patient with supraventricular tachycardia

has a heart rate of 153 beats/min. Which of the following
effects would this have on his cardiac function?

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A. Increased end-diastolic volume
B. Decreased end-diastolic volume
C. Increased stroke volume
D. Mitral valve regurgitation

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

understanding of how the heart contracts and how bloods flows
through the heart.

As the heart rate increases, the time available for ventricular filling
during diastole decreases. This leads to a reduction in both end-
diastolic volume and stroke volume.

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. Decreased end-diastolic volume

69. While examining a patient with chronic bronchitis, which of

the following would you expect to find?
A. Decreased AP chest diameter
B. Course bilateral rhonchi
C. Nonproductive cough
D. Tracheal shift to the right

To get this one correct, you simply just needed to know the signs
of a patient with chronic bronchitis upon physical examination.

A patient with COPD usually has air trapping which means that
they will have an overdistention of the thorax — in other words,
an increased AP diameter.

Patients with chronic bronchitis will have a productive cough and

usually there is no effect of the trachea.

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With increased mucous production, that means course bilateral
rhonchi is to be expected, which means that the correct answer
has to be B.

The correct answer is: B. Course bilateral rhonchi

70. You were called by the attending physician to evaluate the

As a Respiratory Therapist, sometimes you are required to

correlate the therapy that you provide with a patient’s regimen
on pain medications. Because if the patient is in too much pain,
they will not be able to perform certain therapies properly.

If an alert adult patient indicates that they have pain, the best was
to evaluate the severity is to use a numeric rating scale.

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. Have the patient rate their level of pain
on a numeric rating scale

71. When inspecting a normal chest x-ray, where would you

expect the heart to be positioned?

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A. Primarily to the left side of the patient’s midline/spine
B. Primarily to the right side of the patient’s midline/spine
C. Entirely to the right side of the patient’s midline/spine
D. Entirely to the left side of the patient’s midline/spine

To get this one correct, you simply needed to know the location of
the heart in regards to evaluating a chest x-ray.

Within the mediastinum, the heart is normally visualized

primarily to the left of the midline/spine, which would be on the
right side of the x-ray. The image consists mostly of the lateral
border of the left ventricle.

A smaller portion of the heart (the border of the right atrium)

normally lies to the right of the midline/spine, which would be on
the left side of the x-ray.

Also note that any lateral movement of the mediastinum away

from the midline will also shift the heart position in the same
direction.

The correct answer is: A. Primarily to the left side of the patient’s
midline/spine

72. After instructing a patient on how to perform diaphragmatic

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To answer this one correctly, you simply just needed to have a
basic understanding of how the lungs and diaphragm move as
you breathe.

During diaphragmatic breathing, as the diaphragm moves down,

it displaces the abdominal contents and the abdomen moves
outward or upward.

Therefore, the abdomen rising on inspiration is an indication of

diaphragmatic breathing. 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 abdomen rising on inspiration

73. While inspecting a 69-year-old female patient, you note that

she has an abnormal anteroposterior curvature of the spine.
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,
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

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• 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 A.

The correct answer is: A. Kyphosis

You must be familiar with breath sounds for the TMC Exam.
Generally, when you hear bubbling, this describes crackles, which
of course is an abnormal breath sound.

There are two types of crackles:

• Course crackles – caused by the movement of excessive

secretions in the airways.
• Fine crackles – caused by collapsed airways opening during
inspiration.

Another thing to remember, another name for crackles is rales,

and these two can be used interchangeably.

The correct answer is: C. Crackles heard in the lung bases

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75. A 37-year-old female patient was admitted and treated for a
narcotic overdose but has improved of the past two days. She
appears to be cachexic and lacks energy. You also noted
signs of dry skin and edema. Which of the following is the
most likely problem in this scenario is?
A. Heart failure
B. Malnutrition
C. Addison’s disease
D. Renal failure

To get this one correct, you needed to recognize the signs of

malnutrition that were provided in the question.

If you weren’t familiar, cachexia is a term that means the patient

has a weak appearance. Generalized edema, cracked lips, and dry
skin are also physical signs associated with malnutrition.

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. Malnutrition

76. A 58-year-old male patient in the ICU just had a chest tube
inserted to drain the fluid from a pleural effusion. He is
receiving mechanical ventilation with basic settings and
displays the following vital signs:
Heart rate: 120/min
Blood pressure: 137/95
Set respiratory rate: 10/min
Total respiratory rate: 29/min
Body temperature: 99.2 F

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Taking everything into consideration, you should
recommend which of the following?
A. Assess the patient for pain
B. Paralyze the patient
C. Ask the patient to relax
D. Reposition the chest tube

To get this once correct, you needed to be able to look at the vital
signs that were given, along with the circumstances, and
recognize that this patient is most likely experience pain.

Remember, postoperative patients that undergo an invasive

procedure will almost always experience pain. This patient is
mechanically ventilated, so he cannot verbally communicate this
to you.

The vital signs appear to be abnormally high, which is another

indication of the presence of pain. Paralytics are indicated for
patient-ventilator asynchrony, not for pain. And a chest tube
should not be repositioned without first obtaining a chest x-ray,
so we can rule that one out as well.

So by breaking down the question, we can easily determine that

the correct answer has to be A.

The correct answer is: A. Assess the patient for pain

77. You are called to assess a 40-year-old female patient with an

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To get this one correct, all you needed to know were the signs of
an acute upper airway obstruction. They are as follows:

• Marked respiratory distress

• Altered voice
• Dysphagia
• Inspiratory stridor
• Decreased breath sounds
• Tachycardia

Upper airway obstructions can be very serious in adults. If the

obstruction is not resolved by treatment, asphyxiation may
progress to cyanosis, bradycardia, hypotension, and
cardiovascular collapse.

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. Inspiratory stridor

This one is quite simple. The best and easiest way to assure that a
patient is fully aware and conscious is to test their ability to
understand instructions and follow simple commands.

You can first start with a verbal command. If the patient doesn’t
respond, gently shake their arm to see if you can get a response.

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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. Ask the patient to follow simple

commands

79. While auscultating an 84-year-old patient’s chest, you hear

wheezing breath sounds. This may indicate the presence of
which of the following?
A. Laryngospasm
B. Pleural effusion
C. Pneumothorax
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.

Wheezing generally indicates the following:

• Bronchoconstriction
• Mucosal edema
• Presence of increased mucus
• Partial foreign body obstruction in the lower airways

A pneumothorax and pleural effusion would cause diminished

breath sounds, not wheezing. Laryngospasm typically causes
stridor, not wheezing, so we can rule that one out as well.

The correct answer is: D. Aspirated foreign body

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80. After obtaining results from a transcutaneous blood gas
monitor, you are asked to validate the readings. You should
do which of the following?
A. Perform a two-point calibration of the monitor
B. Change the placement of the sensor every 2–6 hours
C. Compare the monitor’s readings to an ABG
D. Re-membrane the sensor and adjust its temperature

In order to validate the results of a transcutaneous blood gas

monitor, you need compare the PtcO2 and PtcCO2 to the values
that are concurrently obtained from a standard blood gas
analysis. This tells you right away that the correct answer has to
be C.

Also keep in mind that for an infant with an anatomic shunt, both
the transcutaneous and arterial values must be obtained from the
same side.

The correct answer is: C. Compare the monitor’s readings to an

ABG

81. A 5-foot, 6-inch-tall 130-lb. woman with normal lungs has a

tidal volume of 480 mL and is breathing at a rate of 12
breaths/min. What is her approximate alveolar ventilation?
A. 6.52 L/min
B. 3.62 L/min
C. 4.20 L/min
D. 5.40 L/min

In order to get this one correct, you obviously need to know the
steps for calculating alveolar ventilation. Let’s break it down.

We can assume that normal deadspace is equal to 1 mL/lb. So at a

body weight of 130 lbs, her deadspace is 130 mL.

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Then you need to know the formula:

VA = rate x (tidal volume – deadspace)

Now it’s simple. Just plug the numbers in.

VA = 12 x (480 – 130)
VA = 4,200 mL/min, or 4.20 L/min

The correct answer is: C. 4.20 L/min

82. You are needed to perform a set of measurement tests on an

unconscious patient. All of the following can be obtained
except?
A. Maximum inspiratory pressure
B. Maximum expiratory pressure
C. Spontaneous respiratory rate
D. Spontaneous tidal volume

In order to get this one correct, you needed to have a basic

understanding of the tests that are listed in the answer choices.

Respiratory rate, tidal volume, and minute ventilation can all be

measured if the patient is unconscious. Maximum inspiratory
pressure can be measured as well using a one-way valve system.

Vital capacity and maximum expiratory pressure measurements,

on the other hand, require that the patient be conscious and
cooperative in able to perform the tests. That means that the
correct answer has to be B.

The correct answer is: B. Maximum expiratory pressure

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83. After an intubation, you fear that too much air was inserted
into the endotracheal tube cuff. Which of the following
would result from significant overinflation if this were the
case?
A. Air leakage
B. Laryngospasm
C. Silent aspiration
D. Mucosal ischemia

If too much air is put in the endotracheal tube cuff — basically

anything above 30 cm H2O — this can decrease or occlude
capillary blood flow which will result in mucosal ischemia and
tissue damage to the tracheal wall.

Air leakage and silent aspiration are complications of low cuff

pressures — below 20 cm H2O. Overinflation wouldn’t cause
laryngospasm, so we can rule that one out as well.

So by breaking down the answer choices and using the process of

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

The correct answer is: D. Mucosal ischemia

84. Which of the following EKG leads should be placed in the 5th
intercostal space at the midclavicular line?
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

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• 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 D.

The correct answer is: D. V4

85. A 61-year-old male patient is scheduled to undergo

As with any therapy you will perform as a Respiratory Therapist,

there are contraindications for cardiopulmonary exercise tests as
well. Some of those include:

• Severe pulmonary hypertension

• Cor pulmonale
• Electrolyte disturbances
• Resting diastolic blood pressure > 110 mm Hg or resting
systolic blood pressure > 200 mm Hg
• Neuromuscular, musculoskeletal, or rheumatoid disorders
exacerbated by exercise
• SaO2 or SpO2 < 85% on room air
• Unstable asthma.

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All of the other answer choices that are listed are indications for
cardiopulmonary exercise testing, so that tells us that the correct
answer has to be A.

The correct answer is: A. A patient with a resting systolic BP > 200
mm Hg

86. After obtaining an ABG on an adult patient that is receiving

volume control SIMV in the ICU, you must document all of
the following EXCEPT:
A. Oxygen concentration
B. Ventilator mode
C. Ventilator settings
D. Endotracheal tube size

After getting an ABG on a patient on the ventilator, there are a

few things that are required for you to document. Those include
the ventilator mode, settings, FIO2, and any relevant aspects of
the patient’s status or condition.

The size of the endotracheal tube should have already been

documented when the patient what intubated. It is not relevant
to documenting the ABG results. That tells us that the correct
answer has to be D.

The correct answer is: D. Endotracheal tube size

87. You are called to perform a sputum induction on a trach

patient to gather a sample for microbiological identification.
The sample is collected using a Lukens trap. When applying
suction after entering the airway, the mucus should:

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A. Pass through the wall tubing and then into the Lukens
trap
B. Pass into the trap and then move on into the collection
jar
C. Pass into the Lukens trap and then enter the suction
catheter
D. Pass through the suction catheter and then enter the
Lukens trap

To get this one correct, you needed to know that basics of

collecting a sputum sample with a Lukens trap.

Here’s a simplified step-by-step process for using a Lukens trap:

You will place the trap between the suction catheter and the
suction system’s connecting tubing. Then, when suction is
applied, the secretions should then pass through the suction
catheter and enter the trap.

Then, after you collect the desired amount of secretions, you can
seal the trap with its own connecting tubing. That way, there is no
contamination. Then the sample can be placed in a biohazard
bag and be sent directly to the lab for processing.

The correct answer is: D. Pass through the suction catheter and
then enter the Lukens trap

88. You are needed to assess a 61-year-old male patient that is

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C. Check the stopcock position
D. Confirm that the monitor is set to zero/cal

Whenever you see an absent pressure waveform with low

pressure, this could be very serious — it could even indicate
cardiac arrest. With that said, the question tells us that the
patient is conscious in no apparent distress.

So in this case, it most likely means that the stopcock is out of

position. For the TMC Exam, remember this:

The stopcock should be kept at the mid-chest or mid-heart level.

• 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.

None of the other answer choices really make sense in this

situation.

You will most likely see a question about the A-line stopcock 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: C. Check the stopcock position

89. All spirometry values obtained under ambient conditions

should be converted to which of the following?
A. Standard temperature and pressure, dry (STPD)
B. Ambient temperature and pressure, dry (ATPD)
C. Ambient temperature and pressure, saturated (ATPS)

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D. Body temperature, ambient pressure, saturated (BTPS)

For the TMC Exam, you should remember that all flows and
volumes that can be measured on a PFT device under ambient
conditions must be corrected to those existing in the lungs.

This stands for BTPS, or body temperature, ambient pressure,

saturated.

If you’re not familiar with this, I realize that this question may
sound a little goofy. With that said, I’ve seen a questions similar to
this on several versions of the exam, so please remember this
information. You can thank me later. J

The correct answer is: D. Body temperature, ambient pressure,

saturated (BTPS)

90. Before adjusting a patient’s endotracheal tube cuff pressure,

you would select which of the following devices?
A. Volumeter
B. Manometer
C. Respirometer
D. Pneumotachometer

To get this one correct, you simply just needed to have a basic
understanding of the devices that are listed in the answer
choices.

In Respiratory Therapy, a pressure manometer is used to measure

endotracheal tube cuff pressures. So that means that B is the
correct answer.

A respirometer or volumeter is used to measure respired volumes.

A pneumotachometer is used to measure airflow.

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The correct answer is: B. Manometer

91. By looking at the data below, determine which of the

In order to determine which patient has the most serious

oxygenation issue, you can calculate their P/F ratio. To get this
number, all you have to do is divide the PaO2 by the FiO2.

If you do so, you can quickly determine that Patient D is the most
severe because they have P/F ratio of about 85. This is below the
100 threshold and indicates that a severe oxygenation
impairment is present.

Patient C has a P/F ratio of about 130. This is also unacceptable

but not quite so bad.

Patients A and B both have P/F ratios greater than 200 which
indicates that they have a mild oxygenation issue.

The correct answer is: D. Patient D

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92. Which of the following is a major disadvantage of using a
pulse oximeter to monitor a patient’s oxygenation status?
A. Skin burns due to using incompatible probes
B. Erroneous results leading to inappropriate treatment
C. Electrical shocks at the measuring site
D. Pressure sores at the measuring site

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

understanding of using an pulse oximeter.

The biggest issue with pulse oximeters inaccurate readings. False

readings may then lead to inappropriate treatment of the patient.
You will definitely see a question on this topic on the TMC Exam.

With that said, we cover everything you need to know about this
topic inside of our Hacking the TMC Exam video course, so
definitely check that out if you’re interested.

The answer choices A, C, and D really don’t make sense in this

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

The correct answer is: B. Erroneous results leading to

inappropriate treatment

93. A 67-year-old female patient is receiving volume control

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To get this one correct, you need to be able to determine the best
course of action for the patient by looking at the data that was
given in the question.

The first thing that stands out is that the patient has a P/F ratio of
100 which is very low. You can calculate this number by dividing
the PaO2 by the FiO2.

A low P/F ratio along with bilateral infiltrates on the chest x-ray —
this most likely indicates moderate to severe ARDS. And in this
case, you would want to recommend the initiation of the
ARDSNet protocol.

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. Implementing the ARDSNet protocol

94. A 56-year-old male patient is experiencing signs and

In general, a normal PaO2 does not always mean that there will
be adequate arterial O2 content or delivery. There needs to be
sufficient quantities of saturated hemoglobin in the blood as well.

Hemoglobin is what carries and transport oxygen in the blood. So

if hemoglobin levels are low, this is going to affect the patient’s
oxygenation which explains why he is showing signs of hypoxia.

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A shunt means that there is an issue with perfusion, and the
question doesn’t give us any reason to suspect this to be the case.
None of the other answer choices really make sense in this
situation either, so we know that the correct answer has to be D.

The correct answer is: D. Hemoglobin deficiency

95. A 60-year-old female patient is receiving volume controlled

ventilation with a PEEP of 5 cm H2O. Over a 3-hour period,
both her peak and plateau pressure have been steadily
increasing and no ventilator setting changes have been
made. What is the most likely cause?
A. The patient is developing pneumonia
B. The patient is developing bronchospasm
C. The patient needs endotracheal suctioning
D. The patient’s lung compliance is increasing

The question tells us that both the peak and plateau pressure are
increasing together at a steady rate. The means that the patient’s
lung compliance is decreasing.

Now you just need to look at the answer choices to determine

which one would cause a decrease in lung compliance.

Bronchospasm affects the airways, not the lung compliance.

Suctioning is indicated when there is a sudden increase in peak
pressure — not a gradual increase in both pressures.

Since the increase is occurring gradually, this tells us that

something more serious is going on, like pneumonia. Remember,
pneumonia causes consolidation which, of course, decreases lung
compliance. That is how we know that the correct has to be A.

The correct answer is: A. The patient is developing pneumonia

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96. While inspecting an EKG rhythm strip of a 50-year-old
female patient, you note the following:
Rate 145
Regular rhythm
Normal P waves
Normal P-R intervals
Normal QRS complexes
Which of the following is the interpretation?
A. Atrial flutter
B. Atrial fibrillation
C. Sinus tachycardia
D. Ventricular tachycardia

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

This one is very simple. Everything is normal except for the heart
rate, which is increased. A heart rate > 100 indicates tachycardia.
Thus, the patient is experiencing sinus tachycardia and the
correct answer is C.

One more note: As a Respiratory Therapist, when we see patients

with sinus tachycardia, it’s often related to hypoxemia. So we can
treat this patient by providing supplemental oxygen.

The correct answer is: C. Sinus tachycardia

97. An adult patient is receiving ventilatory support after

surgery. Their maximum inspiratory pressure was measured
with a result of -35 cm H2O. Based on this value, you would
conclude that the patient has:
A. A normal maximum inspiratory pressure

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B. A need for continued ventilatory support
C. A large leak in their endotracheal tube cuff
D. Adequate muscle strength to consider weaning

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

inspiratory pressure (MIP) and what the measurement is used for.

An MIP or NIF is often used to assess a patient’s readiness for

weaning. The threshold level that has been used to indicate
readiness to wean is a value > -20 cm H2O. Clearly this patient
surpassed this threshold which indicates that their inspiratory
muscle strength is good enough to consider weaning.

Of course, there are other criteria that must be met as well. We

cover all of the weaning parameters extensively inside of our TMC
Study Guide.

But for this question, only one answer choice makes sense which
is how you know that D has to be the correct answer.

The correct answer is: D. Adequate muscle strength to consider

weaning

98. Which of the following patients is most in need of ventilatory

support?
A. pH 7.35, PaCO2 61 torr, HCO3 33
B. pH 7.40, PaCO2 59 torr, HCO3 35
C. pH 7.37, PaCO2 52 torr, HCO3 29
D. pH 7.13, PaCO2 66 torr, HCO3 22

Each of the four patients have a PaCO2 above 50 torr. While not
ideal, three of the four patient’s pH falls within the normal range
due to compensation. This tells us that they have a chronic
condition.

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Patient D, on the other hand, has a pH of 7.13 which is
dangerously low. It can be interpreted as a life-threatening
respiratory acidosis. They are in most need of ventilatory support,
so now we know that the correct answer has to be D.

The correct answer is: D. pH 7.13, PaCO2 66 torr, HCO3 22

99. A patient has a systolic arterial pressure of 160 mm Hg and a

diastolic value of 85 mm Hg. What is his approximate mean
arterial pressure?
A. 115 mm Hg
B. 110 mm Hg
C. 105 mm Hg
D. 100 mm Hg

To get this one correct, you needed to know the simple

calculation for mean arterial pressure. The formula is as follows:

MAP = ((2 x diastolic) + systolic) / 3

MAP = ((2 x 85) + 160) / 3
MAP = ((2 x 85) + 160) / 3
MAP = (330) / 3

The mean arterial pressure for this patient is 110 mm Hg.

The correct answer is: B. 110 mm Hg

100. You are called to perform chest physiotherapy on a 62-year-

old female patient. Before you begin, she states that “When
I breathe l feel like I am getting enough air, but I seem to
breathe fast and lift my shoulders a lot. I sleep through the

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night and use only one pillow.” You can conclude that the
patient likely has which of the following?
A. Orthopnea
B. Dyspnea
C. Obstructive sleep apnea
D. Increased work of breathing

To get this one right, you really have to pay attention to the
patient’s statements that are in the question.

By saying that she sleeps through the night and gets enough air,
we can eliminate dyspnea and orthopnea. There is nothing that
indicates obstructive sleep apnea either, so we can rule that one
out as well.

The patient states that she breathes fast and lifts her shoulders —
this indicates tachypnea and use of accessory muscles while
breathing. Both of these are signs of increased work of breathing,
so we know that the correct answer has to be D.

The correct answer is: D. Increased work of breathing

101. A patient’s static compliance can be obtained by dividing

their tidal volume by which of the following:
A. (PIP – PEEP)
B. (Pplat – PEEP)
C. (PIP – Paw)
D. (Paw – Pplat)

To get this one right, you simply just need to know the formulas
for static and dynamic compliance. Here they are:

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

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

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Be sure to remember these formulas for the exam.

For this one, you know that the correct answer has to be B.

The correct answer is: B. (Pplat – PEEP)

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

of a pleural effusion and what to recommend as a Respiratory
Therapist.

A pleural effusion can be found when the patient has a dull

percussion note along with diminished breath sounds and a
tracheal shift away from the affected side.

An ultrasound can be used to find a pleural effusion. Also, the

patient’s x-ray findings with a lateral decubitus film will show
blunted costophrenic angles, so please remember this for the
exam.

For a pleural effusion, you should always recommend a

thoracentesis in order to remove fluid from the pleural space.

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. Thoracentesis

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103. What is the total amount of gas that can be exhaled from
the lungs after a normal exhalation?
A. FVC
B. FRC
C. IRV
D. ERV

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.

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For this one, you should automatically know that the correct
answer is D.

The correct answer is: D. ERV

104. A patient is receiving mechanical ventilation in the SIMV

To get this one correct, you simply need to be able to interpret

the ABG results.

The pH is increased and the PaCO2 is decreased. The HCO3 is

normal, so this indicates that the patient has an acute or
uncompensated respiratory alkalosis. In addition, the PaO2 tells
us that the patient’s oxygenation is normal.

The correct answer is: C. Uncompensated respiratory alkalosis

105. Your patient has the following PFT results below:

Vital Capacity 54% of predicted
FEV1 76% of predicted
FEV1/FVC ratio 82% of predicted
Peak Flow 119% of predicted

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Total Lung Capacity 65% of predicted
Which of the following would be the best interpretation of
the results?
A. Restrictive disease only
B. Obstructive disease only
C. Bronchitis
D. Mixed restrictive and obstructive disease

The first thing to look at is the FEV1/FVC ratio. If it is decreased,

then you know that an obstructive disorder is present. But in this
case, it is greater than normal. The total lung capacity, on the
other hand is decreased. This right away tells us that there is a
restrictive disease.

Obstructive diseases causes air trapping, which causes the TLC to

increase. In this case, since the TLC is decreased, we can conclude
that an obstructive disease is not present. So that rules out the
remaining answer choices and we know that this patient only has
a restrictive disorder.

The correct answer is: A. Restrictive disease only

106. The physician requests for a patient to receive an FiO2 of

approximately 75%. Which of the following would you
recommend?
A. Simple mask
B. Air entrainment mask
C. Nonrebreathing mask
D. Nasal cannula at 6 L/min

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

the different type of oxygen therapy that are listed in the answer
choices.

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A simple mask, air entrainment mask, and nasal cannula will not
be able to provide an FiO2 of 75%, so we can rule them out right
away.

A nonrebreathing mask with adequate flow can provide an FiO2

of up to 100%, so you know that this has to be the correct answer.

The correct answer is: C. Nonrebreathing mask

107. You are called to check the VD/VT ratio on a 59-year-old

female patient with advanced COPD. Which of the
following would you expect to find?
A. Normal
B. Increased
C. Decreased
D. Not affected by the patient’s condition

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

how COPD (air trapping) affects that patient’s dead space-to-
tidal-volume ratio.

You would expect a COPD patient to have a significant

ventilation-perfusion-mismatch, which would results in increased
dead space ventilation and shunt-like effects.

This tells us right away that the correct answer has to be B.

The correct answer is: B. Increased

108. 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 7%

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B. SVR of 1100 dyn/s/cm-5
C. Cardiac Index of 3.7 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 A.

The correct answer is: A. Shunt of 7%

109. A 54-year-old female patient on the general floor has the

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

one down.

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The pH is elevated which means alkalosis. The PaCO2 is in the
normal range. The Bicarb is elevated, which tells us that there is a
metabolic issue. And since we already determined that the pH is
elevated and the PaCO2 is normal, there is no compensation
going on here.

So that rules out all of the other answer choices and we know that
the correct answer has to be B.

The correct answer is: B. Acute metabolic alkalosis

To get this one correct, you had to know that caffeine citrate is a
drug that is given to
infants in order to help with breathing and periods of apnea.

None of the other answer choices really make sense in this case,
so you know that the correct answer has to be D.

The correct answer is: D. Caffeine citrate

111. A 19-year-old male just arrived to the emergency room with

bilateral expiratory wheezing. Which of the following
treatments would you recommend?
A. Aerosolized cromolyn sodium

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B. Aerosolized bronchodilator
C. Aerosolized normal saline solution
D. IV furosemide (Lasix)

No matter where you are on your journey of becoming a

Respiratory Therapist, you should know the answer to this one
right away.

A patient that has bilateral expiratory wheezes is showing signs of

bronchospasm. And of course, in order to treat bronchospasm,
you should recommend an aerosolized bronchodilator.

None of the other answer choices really make sense in this

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

The correct answer is: B. Aerosolized bronchodilator

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

patient. Which of the following values is typical for serum
sodium?
A. 127 mEq/L
B. 132 mEq/L
C. 141 mEq/L
D. 158 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

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.

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So once you know the normal ranges, you can easily determine
that the correct answer is C.

The correct answer is: C. 141 mEq/L

When using a point-of-care analyzer, sometimes it will flag the

sample. When this occurs, it usually means that one of the values
is outside the analyzer’s reportable range.

So in this case, you should send the sample to the central lab for
analysis. They will be able to analyze to sample properly and give
you accurate results so that you can proceed to treat the patient.

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. Send the sample to the central lab for
analysis

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114. After drawing an ABG sample, you notice that the blood
appears to be darker in color. You suspect that obtained
sample is actually venous blood. Which of the following
would be the best way to confirm this suspicion?
A. Get a second opinion from the attending physician
B. Compute the alveolar-arterial O2 gradient
C. Compute the patient’s P/F ratio
D. Cross-check the results against the patient’s SpO2

In general, sometimes an inexperienced practitioner can

accidentally stick a vein instead of the artery when trying to
obtain an ABG sample. When this occurs, the venous blood isn’t
oxygenated, so it has a darker appearance compared to the
bright red arterial blood.

In this case, the best way to confirm that the sample is venous
blood is to cross-check the results against the patient’s SpO2.
Because, when you run the results, the oxygenation values are
going to be falsely low, again, since venous blood is not
oxygenated.

You can check the patient’s oxygen saturation with a pulse

oximeter to see if it matches the results of the blood sample. Of
course, if it is in fact venous blood, there won’t be a match.

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. Cross-check the results against the

patient’s SpO2

115. While performing an MIP test on a 19-year-old female

patient, she produces the following results after three
attempts:
Attempt #1: -23 cm H2O

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Attempt #2: -42 cm H2O
Attempt #3: -14 cm H2O
Which of the following best explains this patients results?
A. There is a leak at the mouthpiece
B. The patient has an obstructive disease
C. The patient has a restrictive disease
D. The patient isn’t giving a good effort

In a case such as this, the patient’s results are way too

inconsistent. This tells us that she is giving a poor effort and not
trying equally as hard on each attempt. This invalidates the
results, so you can’t make a determination about there being an
obstructive or restrictive disease.

And if a leak were present, all of the results for each attempt
would be low. So we know that the correct answer has to be D.

The correct answer is: D. The patient isn’t giving a good effort

116. A 29-year-old female patient with suspected asthma needs

To get this one right, you have to understand the purpose of each
of the tests that are listed in the answer choices. If you know this,
you can easily select the correct answer.

A flow-volume loop, bronchoprovocation test, and pre- and post-

bronchodilator test are all very helpful in diagnosing asthma. That
means that the least helpful is a lung diffusion study.

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A lung diffusion study test measures the carbon monoxide
diffusion which can in turn evaluate oxygen diffusion. This is not
particularly helpful in diagnosing asthma.

So by using what we know about PFTs and asthma, as well as the

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

The correct answer is: A. Lung diffusion study

117. A diagnostic bronchoscopy procedure would be

contraindicated for which of the following patients?
A. A patient with unexplained wheezing
B. A patient with active hemoptysis
C. A patient with severe hypoxemia
D. A patient with lung carcinoma

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.
Hemoptysis is also an indication, as is a lung carcinoma which
may require a biopsy for further inspection.

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Severe hypoxemia is a direct contraindication and a
bronchoscopy should never be performed on a patient with
severe oxygenation issues.

The correct answer is: C. A patient with severe hypoxemia

118. A 57-year-old male patient is being ventilated with a bag-

An LMA, or Laryngeal Mask Airway, is an airway that is indicated

for short-term ventilation when normal ET tube intubation
attempts were unsuccessful.

In order to avoid leaks during ventilation through an LMA, you

can do so by bagging the patient more slowly to reduce the peak
pressure.

You don’t want to add more air to the cuff if it is already properly
inflated because this can push the cuff away from the larynx,
which will only worsen the leak. Also, you wouldn’t want to pull
the tube out. If anything, you would want to push it downward in
order to re-secure its position. And decreasing the cuff pressure
would worsen the leak as well.

So by using what we know about LMA’s, as well as the process of

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

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The correct answer is: D. Bag more slowly to reduce the peak
pressure

119. If the Respiratory Therapist were to significantly overinflate

the endotracheal tube cuff, which of the following would
likely occur?
A. Air leakage
B. Laryngospasm
C. Silent aspiration
D. Mucosal ischemia

For the exam, you must know that the cuff pressure should be
maintained between 20–30 cm H2O.

If the cuff were to be inflated over 30 cm H2O, this can occlude

and decrease capillary blood flow which will result in mucosal
ischemia and tissue damage to the tracheal wall.

So to get this one right, you had to know that ischemia means a
restriction of blood supply. So basically, if the cuff is overinflated, it
restricts blood supply to mucosal membrane of the trachea.

Also note, overinflating the cuff would not cause laryngospasm.

Air leakage and silent aspiration are complications of low cuff
pressures that are less than 20 cm H2O — not high cuff pressures.

So by using what we know about ET tube cuffs, as well as the

process of elimination, we can determine that the correct answer
has to be D.

The correct answer is: D. Mucosal ischemia

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120. The following ABG results were obtained on a 54-year-old
female patient that is breathing room air:
pH 7.30
PaCO2 57 torr
PaO2 61 torr
HCO3- 24 mEq/L
Which of the following best describes the given results?
A. Normal blood gas with mild hypoxemia
B. Fully compensated metabolic acidosis with mild
hypoxemia
C. Acute respiratory alkalosis with mild hypoxemia
D. Acute uncompensated respiratory acidosis with mild
hypoxemia

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 interpret this one.

The pH decreased which means acidosis. The PaCO2 is increased

and the Bicarb is in the normal range. This tells us that there
respiratory acidosis with no compensation because the Bicarb is
normal. The PaO2 is decreased as well, which tells us that there is
hypoxemia. So we know that the correct answer is D.

The correct answer is: D. Acute uncompensated respiratory

acidosis with mild hypoxemia

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121. The physician put in an order for an ABG that was not STAT.
You weren’t busy so you went ahead and collected the
sample. What is the best way to avoid analysis errors
associated with running the sample?
A. Analyze the sample immediately
B. Place the sample in an ice slush
C. Use dry instead or liquid heparin
D. Uncap the syringe to remove any air

The most common cause of errors when running an ABG sample

has to do with the time removed and temperature of the sample.

In a perfect world, all ABG samples should be analyzed

immediately. If the sample cannot be analyzed within 15 minutes,
it should be placed in an ice slush.

So by using what we know about ABG analysis, we can determine

that the correct answer has to be A.

The correct answer is: A. Analyze the sample immediately

122. A newborn infant in the NICU appears to have an increased

work of breathing. Which of the following signs is an
indication that the infant is in respiratory distress?
A. Chest wall retractions
B. Pallor
C. Diaphoresis
D. Digital clubbing

To get this one correct, you simply needed to know the common
signs that occur when an infant is in respiratory distress.

The most common signs include:

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• Tachypnea
• Nasal flaring
• Grunting
• Chest wall retractions

Please remember these because you will (most likely) see them
again on the TMC Exam.

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. Chest wall retractions

123. You are called to evaluate the sputum of a 66-year-old male

patient with chronic bronchitis. Which of the following
characteristics when assessed at the bedside should be
documented in the chart?
A. The color
B. The density
C. The DNA content
D. The surface tension

When evaluating a patient’s sputum, there are a few things that

you must note and document. They are:

• Volume
• Viscosity
• Color

Note, it is not possible determine the density of the sputum, the

surface tension, or the DNA content at the bedside. That
automatically tells us that the correct answer has to be A.

The correct answer is: A. The color

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124. A patient 43-year-old male patient is receiving volume
controlled ventilation at a rate of 12/min. The expiratory time
is 3.30 seconds. What is the inspiratory time?
A. 1.45 seconds
B. 1.70 seconds
C. 1.85 seconds
D. 2.10 seconds

To get this one correct, you obviously needed to know how to

calculate inspiratory time. Let’s break it down.

Since the rate and expiratory time were given, the inspiratory
time can be computed by using this formula:

I-time = (60/rate) – E-time

So now, all you have to do is plug the numbers in:

I-time = (60/12) – 3.3 seconds

I-time = 1.7 seconds

The correct answer is: B. 1.70 seconds

125. You recently set up a transcutaneous blood gas monitor to

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In general, the sensor of a transcutaneous blood gas monitor
must be heated above body temperature in order arterialize the
underlying capillary flow. That is why you must take precautions
in order to avoid a thermal injury to the infant’s skin.

This can be accomplished by carefully monitoring the sensor

temperature with an upper safe limit being around 42 °C. Also,
you should relocate the sensor site on a regular basis so that one
spot is not overexposed to the heat.

The ideal sensor sites are: the side of chest, the abdomen and
inner thigh. You should avoid areas that are directly over bone
because this placement can cause erroneous results.

The correct answer is: D. Relocate the sensor site on a regular

basis

126. A 51-year-old male patient that is receiving volume control

To get this one correct, you simply just needed to know the
causes of a sudden increase in peak inspiratory pressure (PIP).
The key word here is “sudden.”

Here are the causes that you should be familiar with:

• Coughing
• Increased secretions or mucous plugging
• Kinked circuit tubing

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• Kinked ET tube
• Tube displacement into the right mainstem bronchus
• Patient-ventilator asynchrony
• Bronchospasm
• Presence of a pneumothorax

A leak in the circuit would cause the PIP to decrease, not increase.
All of the other answer choices would cause a sudden increase in
the patient’s peak inspiratory pressure, so we know that the
correct answer has to be C.

The correct answer is: C. A leak in the circuit

127. A 63-year-old male patient who weighs 162 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 dynamic compliance?
A. 16.7 mL/cm H2O
B. 20.0 mL/cm H2O
C. 25.6 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 dynamic
compliance. To get the answer, all you have to do is plug the
numbers in the formula.

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Dynamic compliance = 500 / (35 – 5)
Dynamic compliance = 16.7

The correct answer is: A. 16.7 mL/cm H2O

128. A bedside peak flow was performed on a 39-year-old

To get this one correct, you simply just needed to know what the
normal ranges are for a peak flow measurement.

• For normal adult males, the peak flow range should be

between 8-12 L/sec
• For normal adult females, the peak flow range should be
between 6-9 L/sec

Since the result is clearly below the normal range, this indicates
that the patient has an obstructive condition.

With that said, remember that a peak flow test is highly effort-
dependent. So when performing the test, if the results are
below normal, always make sure that the patient is giving a
good effort.

But for this one, only one of the answer choices make sense
and it’s D.

The correct answer is: D. She has an expiratory flow obstruction

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129. PFT tests were ordered on a 60-year-old male patient with
shortness of breath:
Actual % Predicted
FVC 3.21 L 85%
FEV1 1.96 L 65%
FEV1/FVC 62%
FEF25-75% 1.2 L/sec 35%
This data is consistent with which of the following?
A. Emphysema
B. Empyema
C. Kyphoscoliosis
D. Idiopathic fibrosis

Before even looking at the data, when you look at the answer
choices, the first thing you should notice is that there is only
obstructive disease — Emphysema. Keep that is mind as you
proceed.

Now, the PFT results show that the patient’s FVC is normal which
rules out the restrictive disorders. That means you can rule out B,
C, and D.

The patient’s FEV1/FVC% and FEF25-75% are both decreased

which indicates that an obstructive disease is present. That’s how
you know that the correct answer has to be A.

The correct answer is: A. Emphysema

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130. A patient would most likely need ventilatory support once
their pulmonary shunt (Qs/Qt) value increases above what
level?
A. 3-5%
B. 5-10%
C. 10-15%
D. 20-25%

To get this one correct, you simply just needed to know that
normal values for shunting (Qs/Qt).

• Normal is less than or equal to 5

• Acceptable is < 20
• Severe is > 20

So when the patient’s shunting value is > 20, this means that they
are having severe oxygenation issues and are likely in need of
support like PEEP or CPAP. That means that the correct answer
has to be D.

The correct answer is: D. 20-25%

131. Which of the following conditions would have an adverse

effect on the accuracy of a pulse oximetry reading?
A. A patient with fever
B. A patient with tachycardia
C. A patient that is in shock
D. A patient that is in a coma

To get this one correct, you simply just needed to have a basic
understanding of how pulse oximetry works. You also needed to
know the conditions listed in the answer choices.

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The accuracy of a pulse oximeter depends heavily on the blood
circulation to that specific area. So if a patient has a condition that
affects circulation, it could majorly affect the pulse oximetry
reading as well.

Pulse oximetry should work as normal for patients with fever,

tachycardia, and those that are in a coma.

A patient that is in shock, on the other hand, will have issues with
circulation which will affect the pulse oximetry results. So now
you know that the correct answer has to be C.

The correct answer is: C. A patient that is in shock

132. A 31-year-old patient arrives to the emergency department

To get this one correct, you had to know what a flail chest is. Then,
you could use common sense to determine the correct answer.

Flail chest is a condition where a segment of the rib cage breaks

due to trauma and becomes detached from the rest of the chest
wall and there will be paradoxical chest movement.

It can be a very serious medical condition, but in this case, the

question tells us that it’s a mild flail chest. So taking that into
consideration, you probably wouldn’t expect that the patient
can’t take very deep breaths, right? You would expect short, fast

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breaths (hyperventilation) which means that the pH would be
increased.

It’s also safe to say that their oxygenation (SaO2) would be

decreased as well. This means that the correct answer has to be B.

The correct answer is: B. Increased pH, Decreased SaO2

133. You are called to help obtain a pulmonary capillary wedge

pressure measurement using a Swan-Ganz catheter. Before
the measurement is taken, the physician asks, “what is the
normal range for PCWP?” Which of the following would be
your response?
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 B.

The correct answer is: B. 4 - 12 mmHg

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134. You are called to obtain an ABG of a 55-year-old female
patient. During your pre-stick assessment, it is noted that
the patinet’s oxygen saturation is 90%. Her ABG results are
as follows:
pH 7.40
PaCO2 40 torr
HCO3 24 mEq/L
What is the approximate PaO2 for this patient?
A. 55 torr
B. 60 torr
C. 65 torr
D. 70 torr

At first glance, you can see that the patient’s ABG results are
normal — they are basically perfect. Since the values are normal,
that means we can use the 40-50-60/70-80-90 rule.

This rule basically helps you get an approximate idea of the

patient’s PaO2 and SaO2.

So here’s the 40-50-60/70-80-90 rule broken down:

• SaO2 of 70% = PaO2 of 40 torr

• SaO2 of 80% = PaO2 of 50 torr
• SaO2 of 90% = PaO2 of 60 torr

Remember, this rule just gives an estimate. It’s a fast way to get
an idea of what’s going on with the patient’s oxygenation.

So since this patient’s saturation is 90%, we can estimate that her

PaO2 is approximately 60 torr. That means that the correct
answer has to be B.

The correct answer is: B. 60 torr

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135. A patient who is receiving mechanical ventilation is being
monitored with a capnograph. Upon assessment, you
noticed that the end-tidal CO2 dropped to 0 mm Hg. This
finding could indicate all of the following EXCEPT:
A. A kinked ET tube
B. A system disconnection
C. Increased cardiac output
D. A complete airway obstruction

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

of capnography which is used to monitor the patient’s ventilatory
status via their end-tidal CO2.

There are a few things that could cause the reading to drop to
zero:

• A completely obstructed airway

• An obstructed of kinked ET tub
• A system leak or disconnection
• Esophageal intubation
• Cardiac arrest

An increased cardiac output would not cause the PETCO2 to drop

to zero, so we know that the correct answer has to be C.

The correct answer is: C. Increased cardiac output

136. A carbon monoxide reading was taken on a COPD patient

with a result of 21 ppm. This finding indicates which of the
following:
A. The patient has abstained for more than 12 hours
B. The patient can be classified as a non-smoker

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C. The patient has smoked within the past 24 hours
D. The patient has been exposed to secondhand smoke

Exhaled Carbon Monoxide Testing is used to monitor a patient’s

smoking status. In order to get this one correct, you needed to
know how to assess the results of an exhaled CO test.

The results can be interpreted as follows:

• Heavy smokers: > 20 ppm

• Moderate smokers: 11 – 20 ppm
• Light smokers: 7 – 10 ppm
• Non-smokers: < 7 ppm

With an expired CO analysis of 21 ppm, this patient definitely has

smoked within the past 24 hours, so you know that the correct
answer has to be C.

The correct answer is: C. The patient has smoked within the past
24 hours

137. The physician has requested for you to provide graphic

data that can be used to evaluate the ventilator-patient
interface. Which of the following would you recommend?
A. Hemoximetry
B. Capnography
C. Pulse oximetry
D. Electrocardiography

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

understanding of the tests that are listed in the answer choices.

Pulse oximetry and hemoximetry are used to evaluate the oxygen

and hemoglobin saturation in the blood. Electrocardiography is

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used to evaluate the heart. None of which provide data on the
patient-ventilator interface, so we can rule them out right away.

Capnography, on the other hand, monitors expired CO2. It can

provide a noninvasive method for assessing both the
effectiveness and efficiency of a patient’s ventilation. Not to
mention, the monitor provides a graphic display that can be
useful in evaluating the ventilator-patient interface.

So after going through the answer choices and using the process
of elimination, you could easily determine that the correct answer
has to the B.

The correct answer is: B. Capnography

138. A 65-year-old male patient in the ICU is receiving

To get this one correct, you needed to know the common causes
of tachycardia for patients that are receiving ventilatory support.

Anxiety is a common cause of tachycardia, but in this case, the

question tells us that it has progressively increased over a period
of time. This likely means that something more serious could be
going on here.

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Hypoxemia and hypercapnia are also cause of tachycardia. That is
why you would want to obtain an ABG in order to confirm or rule
out these possibilities.

The correct answer is: A. Obtain an arterial blood gas sample for
analysis

139. A patient that is suspected of having a sleep disorder was

scheduled for an overnight oximetry test. The results show
an oxygen desaturation index of 44/hour. Which of the
following would you recommend?
A. No action is needed at this time
B. Surgical correction of the airway obstruction
C. BiPAP with a full face mask
D. Full diagnostic polysomnography

Overnight pulse oximetry tests are used to look for desaturations

of less than 88% while the patient is asleep.

When that are > 15 desaturations per hour, in means that sleep
apnea is a possibility so more tests should be perform via full
diagnostic polysomnography.

For this patient, they had 44 desaturations per hour, which is well
above the limit of 15. This tells you right away that the correct
answer has to be D.

The correct answer is: D. Full diagnostic polysomnography

140. Which of the following bedside measurements would you

recommend in order to assess a patient’s respiratory
muscle strength?

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A. Physiologic deadspace
B. Minute ventilation
C. Maximum Inspiratory Pressure
D. Spontaneous tidal volume

In order to measure the patient’s respiratory muscle strength, you

need to obtain an MIP or MEP reading.

Remember, MIP is used to assess the possibility of weaning from

mechanical ventilation. MEP is helpful in assessing the patient’s
ability to cough and clear secretions, which is also helpful in
determining if it’s safe to extubate the patient.

None of the other answer choices can provide you with a

measurement of the patient’s respiratory muscle strength, so you
know that the correct answer has to be C.

The correct answer is: C. Maximum Inspiratory Pressure

141. A 61-year-old female patient is scheduled for a

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

bronchoscopy procedure.

Due to the nature of the procedure, it’s extremely important to

monitor the patients vital signs closely — especially oxygen

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saturation. Continuous pulse oximetry is the most effective way to
do that.

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. Noninvasive pulse oximetry

142. Which of the following tests would be recommended for a

patient a history of alcohol and drug abuse and suspected
hepatitis?
A. Partial prothrombin time
B. Liver enzymes
C. Cardiac enzymes
D. Complete blood count

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

understanding of the tests that are listed in the answer choices.

Testing the patient’s cardiac enzymes is indicated when there is a

suspected myocardial infarction or ischemia. A complete blood
count and partial prothrombin time are indicated to evaluate red
and white blood cell counts, as well as the coagulation status of
the blood.

Checking liver enzymes, on the other hand, would be indicated to

assess for liver damage that is often caused by alcohol and drug
abuse.

The correct answer is: B. Liver enzymes

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143. A 62-year-old female patient was admitted showing signs
of bronchiectasis. Which of the following would you
recommend in order to confirm this diagnosis?
A. A standard chest radiograph
B. A fiberoptic bronchoscopy
C. Computed tomography scanning
D. Pulmonary function testing

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

bronchiectasis as well as the tests that are listed in the answer
choices.

Bronchiectasis is an abnormal condition of the bronchial tree

characterized by irreversible dilation and destruction of the
bronchial walls. It is one of the six obstructive conditions.

Computed tomography scanning, aka a CT scan, is typically used

for evaluating and diagnosing bronchiectasis. This gives a view of
the surrounding lung tissue and also exclude other lesions such
as foreign bodies or tumors.

None of the other answer choices are used to diagnose

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

The correct answer is: C. Computed tomography scanning

144. A 59-year-old male patient is being considered for

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Before a patient begins a pulmonary rehabilitation program, they
should first undergo preliminary evaluation the test their
cardiopulmonary status.

Useful PFT measurements for this evaluation should include:

• Lung volumes (FRC, TLC)

• Diffusing capacity (DLCO)
• Pre and Post-bronchodilator spirometry

These measurements test the patients readiness as well as

established a baseline to see in there is improvement over time.

Measuring the patient’s lung compliance is not necessary for a

pulmonary rehabilitation program, which means that the correct
answer has to be A.

The correct answer is: A. Lung compliance

145. It is suspected that a 51-year-old male patient has a

pulmonary embolism but his ordinary x-rays are negative.
Which of the following would you recommend in order to
confirm the diagnosis?
A. Arterial blood gas analysis
B. Ventilation/perfusion scan
C. Cardiovascular stress testing
D. Check the cardiac enzyme

The most accurate method for detecting a pulmonary embolism

is via pulmonary angiography. With that said, it’s not listed in the
answer choices, so you have to select the next best option.

A V/Q Scan is a test that uses radioactive material to examine a

patient’s ventilation and perfusion in the lungs. During the scan, if

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the ventilation is normal but the perfusion is abnormal, this
confirms that a pulmonary embolism is present.

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. Ventilation/perfusion scan

146. Exhaled nitric oxide is most commonly indicated for which

of the following:
A. Treating refractory hypoxemia
B. Titrating asthma drugs and dosages
C. Treating pulmonary hypertension
D. Assessing the presence of air trapping

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

understanding of exhaled nitric oxide (FeNO) testing.

Exhaled nitric oxide testing is used to measure the amount of

nitric oxide in a patient’s exhaled breath. The results can be used
to monitor their response to a corticosteroid treatment.

The test is useful for patients with asthma in helping titrate

medications and dosages. A decrease in exhaled nitric oxide
indicates a decrease in airway inflammation.

None of the other answer choices really make sense in this

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

The correct answer is: B. Titrating asthma drugs and dosages

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147. An adult patient arrives in the emergency department with
trauma to the chest and thoracic area. Which of the
following would you recommend first to determine the
extent of the trauma?
A. Pulmonary angiography
B. Ventilation/perfusion scan
C. Fiberoptic bronchoscopy
D. Thoracic ultrasound

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

imaging tests that are listed in the answer choices.

Pulmonary angiography evaluates the blood vessels in the lungs

and is indicated for a pulmonary embolism. A V/Q scan is a way to
evaluate the ventilation and perfusion and is also useful in
detecting a pulmonary embolism.

If a patient has trauma to the chest of thoracic arear, a chest X-ray

or thoracic ultrasound exam should be performed as soon as
possible to determine the extent of the trauma.

A fiberoptic bronchoscopy would not be indicated in this case, so

you know the correct answer has to be D.

The correct answer is: D. Thoracic ultrasound

148. A 64-year-old female patient is receiving mechanical

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D. The timing mechanism and the pressure settings on
the ventilator

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

understanding of the assist/control mode of ventilation.

In the assist/control mode, the machine delivers a set minimum

number of mandatory breaths each minute. The patient can
trigger assisted breaths and exceed the set rate at any time on
demand.

That means that a breath can be triggered both by the machine

and the patient — and that tells us that the correct answer has to
be B.

The correct answer is: B. Either the patient’s inspiratory efforts or

a timing mechanism

149. A 50-year-old male patient was discharged with an order

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

different types of home-oxygen delivering devices.

A size E cylinder is limited to only a few hours of use and only

should be used as a backup. Liquid oxygen systems are highly
expensive and not typically recommended.

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A powered in-home concentrator would be fine for a home
patient that can’t move around a lot. But this patient is only 50-
years-old and the question tells us that he is active. This means
that he needs something more portable.

A portable oxygen concentrator is usually small and lightweight

which would allow the patient to go and do as he pleases.

The correct answer is: C. A portable oxygen concentrator

150. Upon assessment, you noticed thick secretions from an

A heated wick humidifier is generally the strongest type of

humidifier that we use in Respiratory Care. So the only reason for
it not to produce sufficient humidity is because the heat setting is
too low.

So for this patient, you can correct this problem by increasing the
temperature up to 34-41 °C,

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. Confirm an adequate temperature

setting

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151. The physician is considering initiating volume-controlled
ventilation on a 58-year-old male patient. How would you
describe this mode of ventilation?
A. “Inspiration begins after a specific volume is inhaled.”
B. “Inspiration ends after a pre-set volume is delivered.”
C. “Expiration ends after a pre-set volume is delivered.”
D. “Inspiration ends after the patient exhales a pre-set
volume.”

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

understanding of the common modes of mechanical ventilation.

• Volume Controlled Ventilation – the tidal volume is pre-set.

The machine will cycle off after a pre-set volume in delivered.
• Pressure Controlled Ventilation – the pressure is pre-set. The
machine will deliver volume until the pre-set pressure limit
is reached.

So, of course, during volume control, inspiration ends after a pre-

set volume is delivered. None of the other answer choices are
correct, so you know that the correct answer has to be B.

The correct answer is: B. “Inspiration ends after a pre-set volume

is delivered.”

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A. Turn the flowmeter on
B. Replace the pressure regulator
C. Tighten the regulator connection
D. Replace the E cylinder with a new tank

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

understanding of how oxygen cylinder tanks work.

The question tells us that the flowmeter on the regulator is

turned off. That means you should not hear any hissing noises.
But since there is hissing, that means that there must be a leak.

You can fix the leak simply by tightening the regular connection,
which means that the correct answer has to be C.

The correct answer is: C. Tighten the regulator connection

153. A patient is receiving oxygen via nasal cannula at 6 L/min

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

understanding of bubble humidifiers and oxygen therapy.

When you have a bubble humidifier with no bubbling, it either

means that there is a leak or an obstruction. But for this patient,
the question tells us that they are getting 6 L/min of oxygen. So
you know that there’s not an obstruction.

171
If the leak were in the tubing, the bubbling would still occur, so
we can rule that one out as well. That means that the leak must
be at the connection before the bubbling mechanism. The
correct answer has to be D.

The correct answer is: D. The flowmeter connection has a leak

154. A 68-year-old female patient is receiving volume controlled

A/C ventilation. Upon assessment, you note that both the
low tidal volume and high pressure limit alarms are
sounding on each inspiration. Which of the following
actions would you take FIRST?
A. Increase the preset tidal volume by 100 mL and reassess
B. Seek further instruction from the attending physician
C. Disconnect patient and provide manual ventilation with
an FiO2 of 100%
D. Check the full patient-ventilator system for leaks and
malfunctions

To get this one correct, you needed to understand the basic role
of a Respiratory Therapist. The order of concern goes 1)
Ventilation, 2) Oxygenation, 3) Circulation, and 4) Perfusion.

When a patient is receiving ventilatory support and a problem

arises, even if you don’t know how to fix the problem, your priority
should be to make sure that the patient is being adequately
ventilated and oxygenated.

So going back to the scenario is the question above, this patient

should be disconnected from the ventilator and be manually
ventilated with 100% oxygen via a manual resuscitator until the
problem is resolved.

172
That’s the first action you should take which is why the correct
answer has to be C.

The correct answer is: C. Disconnect patient and provide manual

ventilation with an FiO2 of 100%

155. A 70-year-old female patient is receiving volume control

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

understanding of volume-controlled ventilation.

During this mode of ventilation, when there is a decrease in

expired tidal volume that occurs along with a decreased airway
pressure — this usually means that there is a leak somewhere in
the system. 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. There is a leak in the patient-ventilator

system

173
156. An order was placed for insufflation-exsufflation therapy on
a 51-year-old female patient. While gathering the necessary
supplies, which of the following is required?
A. A bacterial filter
B. A heated wire humidifier
C. A heat and moisture exchanger
D. A balloon-type exhalation valve

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

understanding of the insufflation-exsufflation device.

The circuit of the device should include the delivery tubing and a
face mask or mouthpiece patient interface. You will also need a
HEPA bacteria filter to connect to the device outlet.

The filter serves two purposes: 1) It protects the patient from

inhaled microbes, and 2) It prevents a backflow of secretions into
the device. Therefore, a new filter must be used for each patient,
so you know that the correct answer has to be A.

The correct answer is: A. A bacterial filter

157. It has been determined that a 67-year-old male patient has

a pneumothorax. 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.

174
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, a pneumothorax is restrictive disorder because

air in the pleural space limits inspiration. So now you know that
the correct answer has to be A.

The correct answer is: A. A restrictive disorder

158. A 69-year-old male patient with congestive heart failure

states that he has trouble breathing while lying flat. Which
of the following best describes this condition?
A. Hyperpnea
B. Orthopnea
C. Apneustic
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.

175
• 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 – Rapid breaths with periods of apnea. Seen in
neurological diseases.
• Agonal – Labored breathing or gasping.
• Apnea – No breathing.
• Orthopnea – Difficulty breathing while lying flat.

Orthopnea means that the patient has an inability to breathe

while lying down comfortably. In such cases, they may need extra
pillows to raise the head and body.

One more note: For the TMC Exam, whenever you hear
orthopnea, always associate that with CHF.

The correct answer is: B. Orthopnea

159. A 55-year-old male patient with a pneumothorax has a

176
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: C. Check the connecting tubing for leaks

160. A patient is receiving 3 L/min of oxygen from an E-cylinder

at 1200 psi. What is the approximate duration of flow?
A. 72 minutes
B. 94 minutes
C. 102 minutes
D. 112 minutes

For the TMC Exam, you need to know how to calculate the
duration left in a cylinder tank. Here’s the formula:

Duration = (gauge pressure X tank factor) / liter flow

177
As you can see, all the numbers that we need to get the answer
were given to us in the question — everything except the tank
factor. This is a value that you’ll have to memorize!

There are several different sizes of tanks, and each one has a
different tank factor. However, we’re going to simplify it for you
and let you in on a little secret. You really only need to remember
(2) cylinder size tank factors:

• E cylinder – 0.28
• H cylinder – 3.14

That’s because, these are the only ones that the NBRC tends to
use on the exam. You can thank me later. Now back to the
calculation:

Duration = (1200 x 0.28) / 3

Duration = 112 minutes

The correct answer is: D. 112 minutes

178
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 Test Bank.
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

179
References

1. AARC Clinical Practice Guidelines, (2002-2019) Respirator Care.

[Link].

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.

180

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