Standard TMC V1 EXAM1 RT250 PDF

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Practice questions for TMC Exam in preparation for boards....

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RTBoardReview Standardized TMC-Like Exam Version 1 1. A prescription for an aerosolized drug for a patient under your care is missing the actual prescribed drug dosage. Which of the following would be the appropriate action for you to take? A. use the standard dosage listed in the package insert B. ask your medical director to rewrite the prescription *C. contact the ordering physician to seek clarification D. postpone the therapy until the following day General Feedback: The minimum requirements for a proper drug prescription include the following: 1) the patient's name, 2) the drug name, 3) the drug dosage, 4) the frequency of administration, 5) the duration of administration (for some aerosol treatments), 6) the route of administration, and 7) the signature of the physician. You should always seek clarification from the physician if the order does not include all necessary information. 2. In a normal pulmonary angiogram, the arteries should A. appear radiolucent (dark on X-ray image) B. stop branching at the segmental level *C. be clearly opacified with smooth walls D. diminish in gravity-dependent zones General Feedback: On a normal pulmonary angiogram, arteries should appear opacified (due to contrast media), have smooth walls and gradually taper as they continue to branch. There should be no evidence of vessel wall irregularity, aneurysm, narrowing, occlusion, extravasation, or arteriovenous shunting. When performed on a patient in the supine position (normal position for CT angiography), the arteries will be most prominent in the gravity-dependent posterior zones. 3. In assessing a patient in the acute phase of ARDS, you would expect to find: A. increased lung volumes *B. refractory hypoxemia C. increased compliance D. metabolic alkalosis General Feedback: In ARDS, pulmonary edema, atelectasis, and surfactant loss combine to reduce lung volumes and compliance. The decrease in lung volumes and compliance increases the patient's spontaneous work of breathing, typically resulting in dyspnea and tachypnea, In addition, physiologic shunting causes severe hypoxemia that does not respond well to increases in FIO2 (refractory hypoxemia). If the hypoxemia is severe enough to compromise O2 delivery to the tissues, anerobic metabolism and a metabolic acidosis (lactic acidosis) can develop.

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4. When reviewing the chart of a patient who presents with evidence of acute pulmonary infection, which of the following laboratory studies would provide the most useful information? *A. sputum culture and sensitivity B. blood culture C. sputum acid fast stain D. sputum Gram stain General Feedback: Sputum culture and sensitivity will provide not only what microbe is growing in the lung, it will provide the drug(s) that are most effective in controlling the microbe. 5. On reviewing the results of the attending physician's physical examination of a patient's chest, you note 'a hyperresonant percussion note on the left.' Which of the following is the most likely problem? A. infiltrates *B. pneumothorax C. atelectasis D. consolidation General Feedback: A patient with a hyperresonant percussion note on chest examination most likely has a pneumothorax. Pulmonary infiltrates, atelectasis and consolidation would be evident by a dull percussion note and bronchial breath sounds. 6. Which of the following would tend to decrease a patient's energy expenditure? *A. hypothermia B. inflammation C. major trauma D. agitation/pain General Feedback: Common factors decreasing metabolic rate and thus energy expenditure include sedation/analgesics, muscle paralysis, shock/hypovolemia, hypothermia/cooling, hypothyroidism, antipyretics, starvation, and properly applied ventilatory support. Conversely, fever, Inflammation (including SIRS), sepsis, major trauma (including burns), shivering, seizures, agitation/anxiety/pain, hyperthyroidism, adrenergic drugs and ventilator weaning all tend to increase energy expenditure. 7. In reviewing a sleep study, you note 20 to 25 episodes per hour like that depicted in example 'A' in the following figure. What type of abnormal respiratory event does this indicate?

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*A. central sleep apnea B. mixed sleep apnea C. obstructive sleep apnea D. respiratory effort-related arousal General Feedback: The abnormal respiratory event depicted in example 'A' is central sleep apnea. Central sleep apnea is characterized by a lack of airflow lasting at least 10 seconds, but occurs without respiratory effort (as indicated by the lack of esophageal pressure changes during the period of no airflow). 8. Which of the following PFT measurements usually increases with pulmonary emphysema? A. flow rate B. vital capacity C. inspiratory capacity *D. residual volume General Feedback: In patients with pulmonary emphysema, air trapping due to loss of collagen and resultant collapse of the small airways typically causes a progressive increased in residual volume. Expiratory flow rates tend to decrease, as does the inspiratory capacity. 9. While interviewing a 55 year old male patient, you note substantial sternocleidomastoid and scalene muscles activity during inspiration. This finding is most consistent with which of the following? *A. COPD B. pulmonary embolism C. orthopnea D. myasthenia gravis General Feedback: Use of the “accessory muscles” of inspiration (sternocleidomastoids and anterior scalenes) indicates an increased work of breathing and/or inefficient use of the diaphragm, both of which are characteristic of patients with COPD. 10. When you make a return visit to a postoperative patient to assess her progress with incentive spirometry, she indicates that compared to yesterday her pain is preventing her from carry out the treatment. On a 10-point scale, she rates the effect of her pain on her activities as an '8.' You should A. coach her to go ahead with the incentive spirometry anyway B. tell the nurse to up the dosage of the patient's pain medication C. switch the patient to intermittent positive pressure breathing therapy *D. report this finding to the patient's attending physician General Feedback: Good pain assessment includes determining how much it interferes with the patient's activities. A 10-point scale can be used to make this assessment, with 0 signifying "no interference" and 10 signifies "unable to carry on usual activities." Whenever a patient reports an interference level above 4, you report this finding to the patient's attending physician

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11. In a semi-comatose patient with pulmonary edema, which of the following would indicate a loss of cough reflex? *A. gurgling B. cyanosis C. dyspnea D. diaphoresis General Feedback: Normally, as secretions pool in the oropharynx, the cough reflex is stimulated to aid clearance. Gurgling indicates that this reflex is not working correctly. 12. Which of the following of the following inspiratory/expiratory ratios would indicate an abnormally long expiratory time? A. 1:2 B. 1:3 *C. 1:4 D. 2:1 General Feedback: On inspection of an adult, inspiration (I) should normally be shorter than expiration (E), with an I:E ratio of between 1:2 to 1:3. Expiratory time would be considered abnormally long when this ratio exceeds 1:3. 13. A patient tells you that he has been coughing up thick, white sputum. The patient most likely has: A. Pneumonia *B. Asthma C. Pulmonary edema D. Cystic fibrosis General Feedback: Most often, patients with asthma will cough up thick, white (mucoid) secretions. Secretions from pulmonary edema are often thin and frothy. Patients with cystic fibrosis typically have thick and yellow or green (mucopurulent) secretions, while those with pneumonia may have mucopurulent and blood-tinged secretions. 14. When assessing a patient, you observe inward motion of the abdomen as the rib cage uniformly expands during inspiration. Which of the following are potential causes of this problem? A. flail chest *B. phrenic nerve paralysis C. acites D. kyphoscoliosis General Feedback: Inward motion of the abdomen as the rib cage expands during inspiration is termed abdominal paradox. Abdominal paradox is a sign of generalized diaphragmatic dysfunction. The most common cause of abdominal paradox is weakening of this muscle due to fatigue or atrophy. However, abdominal paradox also can also occur in neurologic disorders that affect phrenic nerve transmission. In either case, the accessory muscles of inspiration provide for most of the chest expansion, with the weakened or flaccid diaphragm being "sucked up” into the thorax, causing inward motion of the

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abdomen. Flail chest is a different form of paradoxical movement in which the multiple rib fractures result in portions of the rib cage being sucked inward during inspiration. 15. Which of the conditions is associated with jugular venous distension? *A. cor pulmonale B. pneumonia C. simple pneumothorax D. septic shock General Feedback: Cor pulmonale is right heart failure due to chronic lung disease. Right heart failure occurs when chronic hypoxemia elevates the pulmonary vascular resistance and puts a strain on the right ventricle to pump blood through the constricted pulmonary capillaries. Right heart failure causes venous blood to back up into the neck veins. 16. During auscultation of a patient's chest, you hear intermittent "bubbling" sounds occurring toward the end of inspiration, primarily at the lung bases. Which of the following conditions is most consistent with this finding? A. asthma B. laryngeal edema *C. atelectasis D. pleurisy General Feedback: Short, discontinuous lung sounds that are crackling or bubbling in nature are termed crackles (or rales). Late inspiratory crackles are thought to be caused by sudden opening of collapsed airways. Late inspiratory crackles are most common in patient with atelectasis, pneumonia, pulmonary edema, or pulmonary fibrosis. 17. Inspection of a PA chest radiograph reveals a CT ratio of 60%. Based on this finding, the most likely problem is: A. pneumothorax B. pleural effusion *C. cardiomegaly D. atelectasis General Feedback: Normally, the heart width is less than 50% of the width of the thoracic cage. Cardiomegaly exits when the cardiac-to-thoracic width ratio (CT ratio) exceeds 50% on a PA chest radiograph. Pneumothorax, pleural effusion, atelectasis all can affect the position of the heart, but not its size. 18. Which of the following patients most likely has a health literacy limitation? A. a patient who asks a lot of care-related questions B. a patient whose first language is not English *C. a patient who cannot describe how to take her medications D. a patient who prefers magazines to newspapers

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General Feedback: You should suspect health literacy problems when a patient offers excuses when asked to read, e.g. left their eyeglasses at home; does not reorient materials provided so as to be unreadable, e.g., upside down; identifies medications by their appearance (e.g., color or shape) rather than by name; fails to correctly take medications or cannot describe how to take them; or has difficulty correctly filling out forms. Although patients with limited English skills may present a language barrier, this does not necessarily indicate a health literacy problem. Many individuals with limited English skills are well educated and knowledgeable of personal health-related issues.

19. When questioning a patient regarding his environmental exposure history, you need to obtain information on: A. commuting distance from home to work *B. job tasks, location, materials, and agents used C. lines of authority/job reporting structure D. position title and hourly or annual salary General Feedback: When questioning patients regarding their environmental exposure history, you need to obtain information on (1) current and past exposure to metals, dust, fibers, fumes, chemicals, biologic hazards, radiation, noise; (2) typical workday activities (job tasks, location, materials, and agents used); (3) any changes in work routines or processes; and (4) whether other employees or household members have been similarly exposed or affected. 20. In examining the neck of a patient, you note that the trachea is not positioned in the midline. Which of the following conditions would be the mostly likely cause of this observation? A. pulmonary fibrosis B. chronic bronchitis *C. lobar collapse D. pulmonary edema General Feedback: Any voumetric change to either side of the movable mediastinum will cause a shift in the position of the trachea. In general, the mediastinum and trachea are pulled toward areas of decreased lung volume (e.g., lobar collapse, atelectasis, surgical resection) and pushed away from space occupying lesions (e.g., tension pneumothorax, large pleural effusions or mass lesions). Diseases or disorders that affect the lungs as a whole, such as chronic bronchitis or pulmonary fibrosis do not normally cause a shift in the mediastinum and trachea.

21. The chest X-ray of a patient admitted to ICU exhibits a large area of consolidation in the left lung. Which of the following is a potential cause of this finding? *A. lobar pneumonia B. pulmonary barotrauma C. tension pneumothorax D. interstitial emphysema General Feedback: On an X-ray consolidation appears as an increase in lung tissue density (increased radiopacity) that may be diffuse, patchy, or lobar in nature. Consolidation is most often associated with bacterial pneumonias, but is also seen in patients with traumatic injuries causing pulmonary contusions and when pulmonary embolization results in infarction. Consolidation may also occur in certain phases of acute respiratory distress syndrome (ARDS). © Strategic Learning Associates – All Rights Reserved Not for Duplication or Distribution

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22. The ER physician asks you to evaluate a trauma patient who was the victim of a house fire. In order to properly evaluate the cardiopulmonary status of this patient you should perform which of the following procedures? A. Glasgow coma scale *B. CO-oximetry C. pulse oximetry D. chest X-ray General Feedback: Due to the patient’s involvement in a house fire you should immediately suspect the presence of carbon monoxide poisoning. Carbon monoxide’s high affinity for hemoglobin will cause profound hypoxemia. Standard two-wavelength pulse oximetry is unable to measure carbon monoxide saturations and is contraindicated to assess patients with suspected smoke inhalation. In order to assess for the presence of carbon monoxide in the blood you must run a CO-oximetry blood gas test. 23. A 150-lb. patient has a tidal volume of 600 mL, an arterial PCO2 (PaCO2) of 50 torr, and a mixed expired PCO2 of 35 torr. What is the patient’s physiologic deadspace? A. 240 mL B. 300 mL *C. 180 mL D. 350 mL General Feedback: VD = 600 × [(50 – 35)/50] = 180 mL. 24. The most common way to determine the proper CPAP level for an individual patient is to: *A. assess the apnea-hypopnea index at different CPAP levels during a sleep study B. have the patient keep a log of sleep problems at different CPAP levels C. measure and record the patient's SpO2 continuously throughout sleep D. have the patient's spouse keep a log of sleep problems at different CPAP levels General Feedback: The proper CPAP level for a given patient is determined by one of several methods. The most common method is to repeat the sleep study, using different levels of CPAP, i.e., a titration study. Observed changes in the apnea-hypopnea index (AHI) are then correlated with the various CPAP pressures. The prescribed level of CPAP is the lowest pressure at which apneic episodes are reduced to a normal frequency and duration. 25. You are performing a spot check on a postoperative patient’s SpO2 using an oximeter that only displays numeric data. To verify that you are getting a good reading, you would: *A. compare the oximeter's pulse rate to a palpated or ECG-monitored rate B. obtain an arterial blood gas and measure the SaO2 using a CO-oximeter C. compare the readings obtained with the probe positioned at 3 different sites D. perform an Allen's test on the extremity used to check the SpO2

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General Feedback: To verify a good pulse oximeter signal, you can (a) observe the displayed waveform (if available); (b) assess the oximeter's indicator pulse lights, and/or (c) compare the oximeter's displayed rate against either a manually palpated pulse or that measured by an ECG monitor. 26. To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you would: A. measure pressure during an end-inspiratory pause B. measure pressure at volume increments using a super syringe *C. measure pressure during an end-expiratory pause D. measure expiratory flow before and after bronchodilator General Feedback: One can quantify the amount of auto-PEEP present by measuring the airway pressure during an end-expiratory pause. Accurate measurement requires that the patient be relaxed 27. The recommended range for tracheal tube cuff pressures is: A. 10 to 20 cm H2O *B. 20 to 30 cm H2O C. 30 to 40 cm H2O D. < 10 cm H2O General Feedback: Tracheal tube cuff pressures should be maintained in the 20 to 30 cm H2O range. Pressure above 30 cm H2O can cause tracheal injury and pressure below 20 cm H2O can increase the leakage of subglottic secretions past the cuff (increasing the incidence of VAP), contribute to air leak, and increase the risk of accidental extubation.

28. To assess gas exchange at the tissues you would sample blood from which of the following? A. systemic artery B. central vein *C. pulmonary artery D. peripheral vein General Feedback: To assess gas exchange at the tissues we need to assess blood after it leaves the capillaries. For the body as a whole, we need to wait until after all the blood from all the capillary beds mixes together, which is complete only in the pulmonary artery. 29. The proper starting point for FRC measurement via helium dilution or nitrogen washout is: A. end of a maximum exhalation B. end of a normal resting inspiration C. end of a maximum inhalation *D. end of a normal resting exhalation General Feedback: The validity of FRC measurement via either helium dilution or nitrogen depends on proper starting point, i.e., the end of a normal resting expiration. In addition, it is critical that the spirometer and breathing circuit be leak free and that the gas analyzers be properly calibrated.

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30. Upon inspection of a portable spirometer's FVC curve obtained on an adult outpatient, you observe that the breath last only 4 seconds and that the exhaled volume is still changing substantially during the last half second of the breath. Prior to repeating the maneuver, which of the following instructions would you provide to the patent? A. "Don’t hesitate" B. "Blast out faster" *C. "Blow out longer" D. "Deeper breath" General Feedback: In adults, if the forced expiratory time < 6.0 sec and if the change in exhaled volume during the last 0.5 sec of the maneuver exceeds 100 mL, then the patient is prematurely ending the breath, which will invalidate the results. In these cases, you need to make sure that the patient continues the effort to complete the breath, i.e., blow out longer." 31. To validate the readings provided by a transcutaneous blood gas monitor, you should: A. perform a two-point calibration of the monitor *B. compare the monitor’s readings to a concurrent ABG C. change the placement of the sensor every 2–6 hours D. re-membrane the sensor and adjust its temperature General Feedback: To validate tran...