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NBRC TMC Exam-V with answers
What |is |the |minute |alveolar |ventilation |for |a |200-lb |(91-kg) |patient |with |the |following |parameters? VT(spont) | 600 |mL | Respiratory |rate | 10 | PetCO2 | 30 |mm |Hg |A. |4.0 |L |B. |3.2 |L |C. |5.7 |L |D. |6.0 |L |- |The |correct |answer |is |: |A While |performing |chest |physiotherapy |on |a |patient |who |is |spontaneously |breathing, |you |notice |the | presence |of |PVCs |in |lead |II |on |the |monitor |when |the |head |of |the |bed |is |declined. |Based |on |this | observation, |the |respiratory |therapist |should |recommend |A. |restrict |CPT |to |semi-Fowler's |position. |B. |administer |Lidocaine, |IV |prior |to |future |treatments. |C. |employ |intrapulmonary |percussive |ventilation. |D. |switch |to |high-frequency |chest |wall |oscillation. |- |The |correct |answer |is |: |D A |'flat' |sound |is |heard |while |performing |diagnostic |chest |percussion. |This |sound |is |mostly |likely | observed |when |percussion |is |done |over |A. |a |fluid-filled |space. |B. |pulmonary |consolidation. |C. |fatty |tissue. |D. |bone. |- |The |correct |answer |is |: |D Which |of |the |following |medication |classifications |will |help |thin |secretions? |A. |anti-fungal |B. |proteolytic
|C. |decongestant |D. |antimicrobial |- |The |correct |answer |is |: |B The |medication |prostacyclin |is |used |for |which |of |the |following |purposes? |A. |bronchodilate |large |airways |B. |decrease |systemic |vascular |resistance |(SVR) |C. |improve |cardiac |contractility |D. |decrease |pulmonary |hypertension |- |The |correct |answer |is |: |D Breath |sounds |on |a |patient |with |CHF |are |described |as |wet |and |crepitant. |The |patient |also |has |+3 | pitting |edema |in |the |lower |extremities. |The |respiratory |therapist |should |recommend |A. |aerosolized |racemic |epinephrine. |B. |furosemide |(Lasix) |administration |IV. |C. |intravenous |atropine. |D. |diltiazem |(Cardizem) |by |mouth. |- |The |correct |answer |is |: |B A |homeless |patient |reports |to |a |clinic |with |hemoptysis |and |emaciation, |as |well |as |other |symptoms | consistent |with |tuberculosis. |Which |of |the |following |exams |would |be |most |appropriate |to |assess |the | patient |further? |A. |FeNO |exhaled |gas |analysis |B. |eosinophil |count |C. |serum |creatinine |blood |level |D. |Mantoux |test |- |The |correct |answer |is |: |D According |to |the |National |Asthma |Education |and |Prevention |program |(NAEPP), |a |patient |who |is |in | the |"yellow |zone" |of |their |personalized |asthma |action |plan |and |who |has |taken |bronchodilator | treatments |more |frequently |than |ordered |over |the |last | 24 |hours |should |consider |which |of |the | following? |A. |calling | 911 |B. |contacting |their |healthcare |provider |C. |switching |bronchodilator |medication
An |orally |intubated |patient |has |an |oral |pharyngeal |airway |(OPA) |in |place, |which |is |being |used |to | prevent |tube |occlusion |(as |a |bite |block). |While |helping |to |bathe |the |patient, |the |respiratory |therapist | observes |the |patient |ejecting |the |OPA |out |onto |the |bed |covers. |The |therapist |should |A. |re-insert |the |used |airway |and |secure |it |with |tape |to |the |patient's |mouth. |B. |sedate |the |patient |and |provide |a |new |airway. |C. |retrieve |the |airway |and |re-insert |into |the |patient's |mouth. |D. |insert |a |new, |sterile |airway |and |secure |it |to |the |ET |tube. |- |The |correct |answer |is |: |C Which |of |the |follow |data |obtained |from |a |pulmonary |artery |catheter |would |suggest |impeded |blood | flow |through |the |pulmonary |vasculature? |A. |increased |CVP, |mPAP, |PCWP, |and |C.O. |B. |elevated |CVP, |normal |mPAP |and |PCWP |C. |elevated |mPAP, |normal |or |low |PCWP |D. |decreased |C.O. |with |high |PCWP |- |The |correct |answer |is |: |C When |inspecting |the |X-ray |of |an |outpatient |with |nephrotic |syndrome, |you |note |a |homogeneous |area | of |increased |density |that |obscures |the |left |costophrenic |angle. |Which |of |the |following |is |the |most | likely |problem? A. |pleural |effusion B. |bacterial |pneumonia C. |pulmonary |edema D. |atelectasis |- |The |correct |answer |is: |A During |the |performance |of |cardioversion, |what |setting |on |the |defibrillator |is |required? |A. |bi-phasic |mode |selected |B. |joules |(power) |set |to | 300 |or |higher |C. |synchronization |set |to |active |D. |cardiac |pacing |turned |on |- |The |correct |answer |is |: |C
A |patient |with |suspected |spontaneous |pneumothorax |is |placed |on |a |non-rebreather |mask. |After | placing |the |mask, |the |respiratory |therapist |notices |the |reservoir |bag |consistently |collapses |completely |upon |each |breath. |The |therapist |should |A. |obtain |an |arterial |blood |gases. |B. |tighten |the |straps |on |the |mask. |C. |sedate |the |patient. |D. |increase |the |oxygen |flow |rate. |- |The |correct |answer |is |: |D A |patient |is |intubated |in |the |field |by |first |responders |with |a |Combitube. |After |connecting |the |patient | to |positive |pressure |ventilation, |the |respiratory |therapist |notices |the |sound |of |gas |escaping |around | the |tube |at |the |top |of |each |inspiration. |The |patient |is |receiving |a |Propofol |drip |IV. |The |following |data |is |available: Vent |settings | FIO2 |0.6 | PEEP | 5 |cm |H2O | VT |(set) | 500 |mL | VT |(return) | 220 |mL | Rate |(set) |14/min | Rate |(total) |14/min The |respiratory |therapist |should |A. |withdraw |the |tube |by | 2 |cm |B. |advance |the |tube |by | 2 |cm |C. |inject |air |into |the |tube's |white |port |D. |remove |air |from |the |blue |port |- |The |correct |answer |is |: |C A |42-year-old, |male |patient |is |brought |to |the |emergency |room |(ER) |unconscious |and |obtunded. | Spontaneous |tidal |volume |is |5.3 |mL/kg |and |RR |is |12/min. |Arterial |blood |gas |analysis |reveals: FIO2 |0.40 |
A |patient |is |receiving |PC |ventilatory |support |at |an |inspiratory |pressure |(IP) |of | 40 |cm |H2O |and |PEEP |of | 5 |cm |H2O. |Over |the |last | 2 |days, |plateau |pressures |have |decreased |from | 28 |cm |H2O |to | 22 |cm |H2O. | Assuming |no |changes |in |the |ventilator |settings, |what |value |would |the |respiratory |therapist |expect |to | have |risen? |A. |PAO |B. |delivered |tidal |volume |C. |RSBI |D. |MIP |- |The |correct |answer |is |: |B While |performing |routine |tracheostomy |tube |care |on |a |patient |who |breathes |spontaneously |during | the |day |but |requires |positive-pressure |ventilation |in |the |night, |the |respiratory |therapist |notices |that | the |cuff |will |not |maintain |pressure |when |air |is |injected |through |the |pilot |valve. |The |therapist |should | recommend |A. |clamping |the |pilot |line |immediately |after |injecting |air. |B. |exchanging |the |airway. |C. |cutting |the |pilot |line |and |inserting |a |blunt |needle. |D. |inserting |an |oral |airway. |- |The |correct |answer |is |: |B During |a |full |cardiopulmonary |arrest, |the |medical |team |is |unable |to |initiate |intravenous |access |for |the |purpose |of |epinephrine |delivery. |The |respiratory |therapist |should |recommend |A. |establishing |an |indwelling |arterial |catheter |for |medication |administration. |B. |doubling |the |dose |and |deliver |by |the |intramuscular |route |(IM). |C. |instillation |of |the |medication |through |the |endotracheal |tube. |D. |delivery |of |the |medication |through |the |oral |gastric |tube |(OG |tube). |- |The |correct |answer |is |: |C While |assisting |a |physician |in |inserting |a |pulmonary |artery |(PA) |catheter, |you |note |a |changeover |on | the |monitor |from |pulsatile |pressures |of |about |32/18 |mm |Hg |to |non |pulsatile |pressures |of | 15 |mm |Hg. | Which |of |the |following |has |occurred? A. |the |catheter |has |slipped |back |into |the |right |atrium |and |needs |to |be |and |reinserted B. |the |catheter |has |moved |from |the |right |ventricle |into |the |pulmonary |artery C. |the |catheter |has |advanced |into |the |pulmonary |wedge |or |occluded |position
D. |the |catheter |is |in |lung |Zone |I |and |needs |to |be |withdrawn |and |reinserted |- |The |correct |answer |is |: | C A |patient |has |been |receiving |VC |mechanical |ventilatory |support |for |several |days |following |an | industrial |accident |where |the |patient |inhaled |heated |gases. |The |following |data |is |recorded |on |the | ventilator |flow |sheet: Mon |- |Wed |- |Fri | Pressure |(plat) |(cm |H2O) | 28 |- | 33 |- | 36 | Pressure |(peak) |(cm |H2O) | 43 |- | 48 |- | 51 | VT |(L) |0.5 |- |0.5 |- |0.5 | PEEP |(cm |H2O) | 10 |- | 10 |- | 10 | Hb |(g/dL) | 14 |- | 13 |- | 14 | WBC |(cu |mm) |14,000 |- |12,500 |- |13,000 | HCT |(%) | 42 |- | 39 |- | 42 | OI | 24 |- | 26 |- | 32 Which |of |the |following |should |be |considered? |A. |ARDSnet |protocol |B. |ECMO |C. |more |frequent |suctioning |D. |NAEPP |guidelines |- |The |correct |answer |is |: |A A |patient |has |severe |congestive |heart |failure. |Which |of |the |following |hemodynamic |pressure | combinations |is |most |likely? |A. |low |PCWP |and |normal |cardiac |output |B. |elevated |PCWP, |low |cardiac |output |C. |low |CVP, |mPAP, |and |PCWP |D. |elevated |CVP |and |cardiac |output |- |The |correct |answer |is |: |B
The |respiratory |therapist |should |immediately |A. |switch |to |PC |ventilation. |B. |start |inhaled |NO |therapy. |C. |decrease |PEEP. |D. |increase |PEEP. |- |The |correct |answer |is |: |C A |patient's |PAO2 |is | 300 |mm |Hg |while |the |PaO2 |is | 180 |mm |Hg. |The |respiratory |therapist |can |assume | the |patient |has |A. |V/Q |mismatching. |B. |venous |admixture. |C. |a |pulmonary |embolism. |D. |pulmonary |hypertension. |- |The |correct |answer |is |: |A A |comatose |patient |intermittently |exhibits |airway |occlusion. |You |should |recommend: A. |immediately |intubate |and |ventilate B. |inserting |an |oropharyngeal |airway C. |performing |a |tracheostomy D. |ventilating |with |100% |oxygen |- |The |correct |answer |is |: |B A |respiratory |therapist |has |attempted |oral |intubation |unsuccessfully |on |a |patient |who |has |a | Mallampati |classification |of | 4 |and |who |is |experiencing |ventilatory |failure. |After |three |attempts, |the | patient |is |beginning |to |show |signs |of |significant |distress |and |has |an |SpO2 |of |82%. |Which |of |the | following |should |the |therapist |immediately |do? |A. |place |a |laryngeal |mask |and |provide |manual |ventilation |B. |re-attempt |using |the |direct |laryngoscopy |technique |C. |place |the |patient |on |non-invasive |ventilation |with |a |delta |P |of | 20 |cm |H2O |D. |schedule |the |patient |for |surgical |placement |of |a |tracheostomy |- |The |correct |answer |is |: |A
A |patient |has |an |autoPEEP |of | 18 |cm |H2O |while |the |PEEP |setting |on |the |ventilator |is | 5 |cm |H2O. |This | suggests |that |the |patient |has |A. |increasingly |compliant |lungs. |B. |a |bronchopulmonary |fistula. |C. |an |intrinsic |PEEP |level |of | 13 |cm |H2O. |D. |insufficient |expiratory |time. |- |The |correct |answer |is |: |D A |patient |has |elevated |pulmonary |vascular |pressure |(PVR) |while |receiving |PC |A/C |ventilation |on |the | following |settings |and |parameters: Rate |20/min | PIP | 50 |cm |H2O | PEEP | 15 |cm |H2O | VT |(return) | 396 |mL |(4.2 |mL/kg) | Pressure |(plat) | 35 |cm |H2O Which |of |the |following |would |benefit |the |patient? |A. |inhaled |nitric |oxide |B. |IV |bolus |of |epinephrine |C. |slow |IV |infusion |of |atropine |sulfate |D. |administration |of |KCL, |IV |- |The |correct |answer |is |: |A Helium-oxygen |is |used |primarily |to |A. |decrease |airway |resistance. |B. |increase |the |effectiveness |of |supplemental |oxygen. |C. |decrease |the |risk |for |nitrogen |narcosis. |D. |promote |bronchodilation. |- |The |correct |answer |is |: |A A |galvanic |type |oxygen |analyzer |is |indicating |an |oxygen |percentage |of |60% |with |a |known |gas |sample | that |is |40%. |The |respiratory |therapist |should |A. |replace |the |fuel |cell.
|B. | 20 |to | 25 |microns. |C. | 8 |to | 12 |microns. |D. |less |than | 1 |micron. |- |The |correct |answer |is |: |A A |spontaneously |breathing |patient |is |receiving |oxygen |by |a |high-flow |delivery |device |and |has |the | following |ABGs pH |7.35 | PaCO2 | 45 |mm |Hg | PaO2 | 75 |mm |Hg | HCO3- | 25 |mEq/L |BE |-1 |mEq/L | FIO2 |0. Which |of |the |following |should |be |suggested? |A. |Implement |oxygen |by |non-rebreather |mask. |B. |Coach |the |patient |in |deep-breathing |exercises. |C. |Monitor |the |patient's |ventilation |closely. |D. |Place |the |patient |on |mask |CPAP |of | 5 |cm |H2O. |- |The |correct |answer |is |: |D While |undergoing |tracheostomy |tube |hygiene, |the |patient |experiences |an |explosive |cough |and | partially |ejects |the |tracheostomy |tube. |After |reinsertion |of |the |tube, |the |patient |exhibits |a |moderate | amount |of |ventilatory |distress. |The |respiratory |therapist |should |immediately |A. |remove |the |tube. |B. |auscultate |breath |sounds. |C. |insert |an |obturator |into |the |tube. |D. |order |a |chest |radiograph. |- |The |correct |answer |is |: |B A |patient |has |orders |for |incentive |spirometry |following |surgery |to |help |prevent |post-operative | complications. |Within |one |hour |after |surgery, |the |patient |receives |incentive |spirometry |coaching |but | is |unable |to |follow |instructions |and |perform |the |maneuver |due |to |slow |emergence |from |sedation. | The |respiratory |therapist |should |consider
|A. |administering |Romazicon. |B. |performing |arterial |blood |gas |analysis. |C. |switching |to |IPPB |by |inflatable |mask. |D. |returning |later |when |sedation |has |dissipated. |- |The |correct |answer |is |: |C An |intubated |and |mechanically |ventilated |patient |with |COPD |is |failing |to |wean |from |the |ventilator, | despite |daily |spontaneous |breathing |trials. |The |patient |is |barely |failing |respiratory |parameters |of |MIP | and |RSBI. |The |physician |is |concerned |about |VAP. |What |could |the |respiratory |therapist |suggest? |A. |increasing |the |patent's |caloric |intake |B. |early |extubation |to |NIV |C. |increasing |in |corticosteroid |use |D. |periodic |sedation |to |control |anxiety |- |The |correct |answer |is |: |B Which |of |the |following |exercise |test |findings |(compared |to |normal) |is |MOST |consistent |with |exercise | intolerance |due |primarily |to |a |ventilatory |impairment? A. |normal |arterial |Pa B. |increased |max | 02 |consumption C. |increased |arterial |PaCO D. |normal |max |heart |rate |- |The |correct |answer |is |: |C What |is |the |advantage |of |point-of-care |bedside |testing? |A. |less |expensive |for |the |patient |B. |provides |standardized |care |C. |more |accurate |than |traditional |laboratory |testing |D. |allows |for |a |rapid |response |in |care |- |The |correct |answer |is |: |D A |respiratory |therapist |suspects |a |radiolucent |item |is |lodged |in |the |right |mainstem |bronchus |of |a |6- year-old |child. |Which |of |the |following |should |be |recommended |to |confirm |or |rule |out |the |suspicion? |A. |bronchography |B. |echocardiography
|D. |Vecuronium |- |The |correct |answer |is |: |A A |patient |is |orally |extubated |after |a |3-week |stent |of |mechanical |ventilatory |support. |Immediately | after |removing |the |endotracheal |tube, |the |patient |begins |to |exhibit |marked |expiratory |stridor. |Re- intubation |by |direct |laryngoscopy |is |attempted |but |is |unsuccessful. |The |respiratory |therapist |should |A. |perform |a |bedside |tracheotomy. |B. |utilize |a |laryngeal |mask |airway. |C. |re-attempt |intubation |with |a |video-assist |device. |D. |place |the |patient |on |non-invasive |ventilation. |- |The |correct |answer |is |: |C During |polysomnography, |a |patient |is |titrated |with |nasal |mask |CPAP |to |a |pressure |of | 9 |cm |H2O. |At | that |pressure, |stage |IV |sleep |is |achieved, |and |oxygen |saturation |consistently |remains |above |92%. |The | respiratory |therapist |notices |the |patient |continues |to |exhibit |audible |snoring. |The |therapist |should | recommend |A. |increasing |the |CPAP |pressure. |B. |continuing |the |therapy |as |presently |set. |C. |switching |to |Bi-level |therapy. |D. |switching |to |CPAP |by |nasal |pillows |- |The |correct |answer |is |: |A For |the |purpose |of |infection |control, |what |instruction |should |a |respiratory |therapist |provide |to |a | home |care |patient |who |has |COPD |and |self-administers |nebulized |bronchodilator |medication |by |small | volume |nebulizer? |A. |Clean |the |plastic |parts |in |the |dishwasher |placed |in |a |plastic |cage. |B. |Soak |the |nebulizer |in |Cidex |(alkaline |glutaraldehyde). |C. |Wipe |down |the |nebulizer |with |isopropyl |alcohol. |D. |Use |acetic |acid |to |help |clean |the |nebulizer. |- |The |correct |answer |is |: |D While |preparing |for |pulmonary |function |testing |on |a |patient, |the |respiratory |therapist |notices |that | the |disinfection |pouch |that |contains |the |reusable |mouthpiece |has |been |breached. |The |therapist | should |A. |discard |the |mouthpiece, |obtain |a |new |one. |B. |rinse |the |mouthpiece |with |tap |water |prior |to |use.
|C. |utilize |the |mouthpieces |for |patient |testing. |D. |send |the |mouthpiece |back |for |resterilization. |- |The |correct |answer |is |: |C A |patient |is |receiving |non-invasive |ventilation |by |mask |for |the |treatment |of |hypercarbia. |Current | settings |are: IPAP | 15 |cm |H2O | EPAP | 5 |cm |H2O Current |ABGs pH |7.32 | PaCO2 | 48 |torr | PaO2 | 80 |torr | HCO3- | 24 |mEq/L | BE |-2 |mEq/L Which |of |the |following |would |be |the |most |appropriate |action? |A. |increase |IPAP |B. |increase |EPAP |C. |increase |both |IPAP |and |EPAP |D. |decrease |EPAP |- |The |correct |answer |is |: |A A |patient |begins |to |gag |significantly |immediately |after |the |placement |of |an |oral |pharyngeal |airway. | The |respiratory |therapist |should |A. |replace |it |with |an |oral |endotracheal |tube. |B. |remove |the |airway |and |try |something |smaller. |C. |switch |to |a |nasal |pharyngeal |airway. |D. |provide |sedation |for |the |patient. |- |The |correct |answer |is |: |B
An |infant |is |delivered |early |due |to |decelerations |noted |on |the |tocometer. |The |exact |gestational |age |is |unknown |but |believed |to |be |less |than | 30 |weeks. |Which |of |following |assessment |techniques |should | be |used |to |estimate |gestational |age? |A. |Dubowitz |B. |PG |(phosphatidyglycerol) |level |determination |C. |New |Ballard |D. |L/S |ratio |determination |- |The |correct |answer |is |: |C A |55-kg |(121-lbs), |157-cm |(5 |ft, | 2 |in) |patient |with |ARDS |is |receiving |PC |A/C |ventilation |on |the | following |settings: PIP | 50 |cm |H2O | PEEP | 12 |cm |H2O | I-time |1.1 |seconds | Rate |16/min | FIO2 |0.55 | VT |(return) | 532 |mL On |these |settings, |ABGs |are pH |7.38 | PaCO2 | 42 |torr | PaO2 | 87 |torr The |respiratory |therapist |should |recommend |A. |decreasing |PEEP. |B. |decreasing |PIP. |C. |increasing |FIO2. |D. |decreasing |rate. |- |The |correct |answer |is |: |B
A |patient |in |the |intensive |care |unit, |receiving |VC, |A/C |ventilation, |has |the |following |clinical |and | laboratory |data: ABGs | pH |7.35 | PaCO2 | 46 |torr | PaO2 | 83 |torr | HCO3- | 25 |mEq/L | BE |-1 |mEq/L Ventilator |settings |and |other |data FIO2 |0.50 | VT | 500 |mL | PEEP | 5 |cm |H2O | Rate |14/min | Flow | 45 |L/min | PetCO2 | 10 |mm |Hg |RR |(total) |14/min The |respiratory |therapist |should |A. |obtain |a |chest |radiograph. |B. |employ |inverse |I:E |ratio |ventilation. |C. |schedule |the |patient |for |a |VQ |lung |scan. |D. |administer |Lasix |(furosemide). |- |The |correct |answer |is |: |A A |newborn |is |undergoing |a |1-minute |APGAR |assessment. |The |respiratory |therapist |observes |the | following: HR | 102 |Color |pink |body, |cyanotic |extremities |Grimace |grimace |Respiratory |effort |weak |cry |Activity | some |flexion |of |the |extremities |noted
