TMC Practice Exam - edema in the ankles. These findings are consist...

TMC Practice Exam A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with

• liver failure.
• pulmonary embolism.
• heart failure.
• electrolyte imbalances - answerHeart failure

A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first?

• Call for a STAT chest x-ray.
• Insert a chest tube into the left chest.
• Needle aspirate the 2nd left intercostal space.
• Activate the medical emergency team to intubate the patient. - answerNeedle aspirate the 2nd left

intercostal space.All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa

EXCEPT 1 / 4

• maintaining cuff pressures between 20 and 25 mm Hg.
• using the minimal leak technique for inflation.
• using a low-residual-volume, low-compliance cuff.
• monitoring intracuff pressures. - answermonitoring intracuff pressures.

A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend

• continuing the therapy until breath sounds improve.
• administering dornase alpha.
• administering albuterol therapy.
• deep breathing and coughing to clear secretions. - answerdeep breathing and coughing to clear

secretions.A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially?

A. IS / SMI

• IPPB with normal saline
• postural drainage and percussion
• PEP therapy - answerIPPB with normal saline

A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 2 / 4

• Tidal volume
• Respiratory Rate
• Inspiratory flow
• Sensitivity - answer1, 2, and 3 only

Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right?

• Perform chest physiotherapy
• Administer an IPPB treatment
• Insert an endotracheal tube
• Insert a chest tube - answerInsert a chest tube

A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.

• 2.5 vol%
• 4.0 vol%
• 5.0 vol%
• 5.5 vol% - answer5.0 vol%

A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance 3 / 4

• 25 mL/cm H2O
• 35 mL/cm H2O
• 45 mL/cm H2O
• 50 mL/cm H2O - answer50 mL/cm H2O

Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time?

• cool mist aerosol treatment
• aerosolized racemic epinephrine
• manual ventilation with resuscitation bag and mask
• reintubation - answerreintubation

Which of the following patients would most likely benefit from pressure support ventilation?

• An intubated patient with an absent respiratory drive.
• A patient on SIMV with a set rate of 12/min and total rate of 24/min.
• A patient with acute lung injury.
• A patient who requires short-term post-operative ventilatory support. - answerA patient on SIMV

with a set rate of 12/min and total rate of 24/min.A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes?

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