(Test Bank) Rt 33 Tmc Test Bank (Ebook)

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2 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 disclai m 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 book with institutional guidelines, other sources, and up to date information. This study guide is intended to help prepare users to take credentialing exams. The information contained therein is not intended to instruct, recommend, or direct medical practitioners on how to provide care to actual patients. All materials published in this study guide are in compliance with the standards of ethics set forth by the governing testing authority. This study guide does not disclose any insider exam information. This content is based upon the content outlines, specifications, summaries, or matrices published by the testing authority. 3 Table of Contents Introduction ................................ ................................ ................................ .................. 4 Module 1 ................................ ................................ ................................ ....................... 5 Module 2 ................................ ................................ ................................ .................... 52 Module 3 ................................ ................................ ................................ .................... 97 Module 4 ................................ ................................ ................................ ................. 144 Module 5 ................................ ................................ ................................ ................. 191 Module 6 ................................ ................................ ................................ ................. 237 Module 7 ................................ ................................ ................................ ................. 285 Module 8 ................................ ................................ ................................ ................. 335 Module 9 ................................ ................................ ................................ ................. 381 Module 10 ................................ ................................ ................................ ............... 425 Conclusion ................................ ................................ ................................ ............... 470 4 Introduction Are you taking the TMC Exam soon? If so, and you’re like me, stress levels are probably going through the roof. I just want to tell you something really quick to calm your nerves: YOU GOT THIS!!! Seriously. You’re going to be fine! You’ve already spent months learning all the information that you need to know in the classroom. Now you just need to put it all together. And you do that by practicing! Congratulations, you have downloaded the best and largest Te st Bank out there to help prepare for the TMC Board Exam. The questions are laid out in the exact format as the ones you will see on the real thing. If you can go through these questions and know and understand them, you will absolutely have a great chance of doing well when you take the actual exam. This book is broken into 10 modules. There’s no order, really. The questions are mixed up so that you’re not spending too much time on one particular subject. Each one has the question, the answer choices, the correct answer, and a detailed rationale explaining why each answer is correct. Practice. Practice. Practice. Again, because it’s important (and I like to repeat myself), if you get good at answering these questions, you will do well on the actual exam. It’s really that simple. It’s definitely not easy, but it is very simple. So with that being said, I wish you well. Keep working and studying hard because you’re almost to the finish line! I wish you the best of luck and I look forward to hearing your success story about how well you scored on the TMC Exam! Good luck and as always, breathe easy my friend! 5 Module 1 1. A patient with normal lungs should be able exhale what percentage of the FVC within one second after initiating an Forced Vital Capacity maneuver? A. 35-50% of the FVC B. 50-70% of the FVC C. 70-83% of the FVC D. 84-93% of the FVC The normal range for the FEV1 as a percent of the FVC (FEV1%) is 70-83%. Patients with obstructive pulmonary disease will show a reduction in timed FEV% values, while patients with restrictive disorders will generally exhibit normal (or sometimes high) FEV% values. The correct answer is: 70-83% of the FVC 2. Simple spirometry can be used to measure any of the following except: A. vital capacity B. residual volume C. tidal volume D. inspiratory reserve volume Residual volume is defined as the amount of air left in the lungs after a maximal exhalation. Because the RV cannot be exhaled, it is impossible to be measured by simple spirometry. And because the RV is a component of the FRC and TLC, simple spirometry also cannot measure these capacities. The correct answer is: residual volume 3. A patient presents to the emergency room with a depressed level of consciousness and is severely agitated. Which of the following approaches can be used to obtain their medication history? A. obtain and review the patient’s past medical history B. ask the patient’s nurse about the patient’s prescriptions C. request that the lab run a comprehensive blood drug screen 6 D. obtain the patient’s current prescription vials from the family For patients with a depressed level of consciousness or severe agitation, you may have to obtain the medication history from the family members. In these cases, it also may be useful to either obtain information on the pharmacies where the patient has prescriptions filled, or request that a family member provide the hospital pharmacy with all the patient’s current prescription vials for review. The correct answer is: obtain the patient’s current prescription vials from the family 4. Which of the following thoracic ultrasound findings will show with the presence of a pneumothorax? A. presence of gliding sign B. absence of A-lines C. presence of barcode sign D. presence of seashore sign The following are ultrasound findings consistent with the presence of an underlying pneumothorax: absence of the gliding sign and B -lines, and the presence of A -lines and (on M -mode) the barcode sign. A lung point sign (or lead point) also may be pre sent in patients with a pneumothorax, representing the transition between an area where pleural gliding is visible and where it stops (demarcating the beginning of air in the pleural space). The presence of the seashore sign on M-mode rules out pneumothora x. The correct answer is: presence of barcode sign 5. Which of the following would increase insensible water loss in a patient? A. hypothermia B. bypassed upper airway C. hypoventilation D. diuretic administration The evaporative loss of water through the skin and respiratory tract is called insensible loss. Normally about two -thirds of this is lost through the skin, with only about one - third is lost via the respiratory tract. It is increased by fever, hypermetabolism and 7 hyperventilation. Insensible water also increases when the upper airway is bypassed and no supplemental humidification is provided. The correct answer is: bypassed upper airway 6. Which of the following would decrease a patient’s energy expenditure? A. hypothermia B. inflammation C. major trauma D. agitation/pain 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. The correct answer is: hypothermia 7. You would expect a patient with acute respiratory acidosis to have a base excess in the range of: A. + 6 mEq/L B. - 6 mEq/L D. +/- 2 mEq/L E. +/- 8 mEq/L In acute (uncompensated) respiratory acidosis, the base excess should always fall within the normal range. On the other hand, when renal compensation is occurring in response to a chronic respiratory acidosis, the base excess should rise above the normal range (due to the increased levels of HCO3). The correct answer is: +/- 2 mEq/L 8 8. Which of the following ABG results would you most likely see for a patient who is having a mild asthma attack? A. pH = 7.30 PCO2 = 49 torr PO2 = 61 torr B. pH = 7.41 PCO2 = 51 torr PO2 = 51 torr C. pH = 7.46 PCO2 = 31 torr PO2 = 61 torr D. pH = 7.45 PCO2 = 42 torr PO2 = 52 torr A mild asthma attack usually results in a respiratory alkalosis with hypoxemia. Therefore, there is only one answer choice that could be correct. The correct answer is: pH = 7.46 PCO2 = 31 torr PO2 = 61 torr 9. The normal Apgar score range for a newborn infant should be between: A. 1-4 B. 4-7 C. 7-10 D. 10-13 For an infant, an Apgar score of 7 -10 is considered normal. Scores of 4 -6 are intermediate & usually dictate the need for more intensive support. Infants with Apgar scores of 0 -3 usually undergo aggressive resuscitation. Needed interventions should never be delayed in order to obtain the Apgar score, nor should these scores dictate resuscitation procedures. The correct answer is: 7-10 10. On inspection of a patient’s EKG strip, you note that there are no identifiable P waves; rapid irregular undulations of the isoelectric line; and an irregular ventricular rhythm. In addition, the precordial cardiac rate is greater than the peripheral pulse rate. What is the most likely problem? A. 2nd degree (Wenckebach) heart block B. ventricular fibrillation C. atrial fibrillation D. ventricular tachycardia 9 The most likely problem in this case is atrial fibrillation, in which ectopic foci in the atria fire irregularly at rates greater than 350/min. P waves are replaced by irregular undulations of the isoelectric line. Since AV node transmission varies, the ventricular response is also irregular. With some contractions too weak to palpate peripherally, a pulse deficit, which is the difference between the precordial and peripheral pulse rates, is often observed. The correct answer is: atrial fibrillation 11. What is the normal range for vital capacity in a healthy male of average size? A. 5000 to 6000 ml B. 2000 to 3000 ml C. 3000 to 4000 ml D. 4000 to 5000 ml The normal range for vital capacity is 4000 -5000 ml, representing about 80% of the total lung capacity. Normal values can vary significantly depending on age, sex, and test position. Weight is not a factor in predicting normal values. Various nomograms are available for predicting normal values. The correct answer is: 4000 to 5000 ml 12. The pulmonary function parameters that signify an obstructive disease process include which of the following? A. A B. B C. C D. D 10 Obstructive lung disease is characterized by decreased flows, particularly on forced expiration. The primary factor in obstructive lung disease is an increase in airway resistance. Pulmonary function parameters that signal obstructive diseas e processes include: 1) increased airway resistance, 2) decreased forced expiratory flows, and 3) air trapping. The correct answer is: A 13. What is the amount of gas that can be inhaled over and above the volume that is normally inhaled during quiet breathing? A. IRV B. FRC C. ERV D. VC The inspiratory reserve volume (IRV) is the maximum volume of air that can be inhaled following a normal quiet inspiration. The correct answer is: IRV 14. Review the results of an arterial blood gas analysis: pH 7.29 PaCO2 23 torr HCO3 11 mEq/L BE -14 PaO2 111 torr This data indicates which of the following? A. primary metabolic acidosis B. primary metabolic alkalosis C. primary respiratory alkalosis D. primary respiratory acidosis The pH is acidotic indicating that the primary problem is causing acidosis. The low bicarbonate & base excess confirm that the acidosis is metabolic in origin. The low PaCO2 indicates that the patient is hyperventilating. In the presence of a primary 11 metabolic acidosis, a low PaCO2 (same direction change as the HCO3), represents a (partial) compensation for the metabolic acidosis. The correct answer is: primary metabolic acidosis 15. While examining a patient in the ICU, the nurse has indicated that the patient’s urine output is minimal. In what section of the medical record would you check to determine the patient’s fluid balance (intake vs. output)? A. physician orders B. consent C. lab results D. nurses’ notes and flowsheet A patient’s fluid balance is the relationship between fluid intake and outputs (pr imarily from urination). It is normally noted in the nurses notes and flowsheet section of the medical record. The normal fluid intake and output for adults is 1 to 2 liters per day, or 25 to 50 ml per hour. A positive fluid balance results from excessive intake and/or decreased output and may contribute to pulmonary or peripheral edema and hypertension. A negative fluid balance is generally due to insufficient hydration and/or excessive urination from medications such as diuretics or theophylline and may lead to hypotension and low cardiac output. The correct answer is: nurses’ notes and flowsheet 16. When observing the monitor of an adult patient in the CCU, you note a heart rate of 135 beats/min with a regular rhythm. Which of the following is the most likely cause of this observation? A. beta -blocker administration B. therapeutic hypothermia C. arterial hypertension D. anxiety or agitation A heart rate of 135 beats/min with a regular rhythm in an adult is more than likely sinus tachycardia. Common causes of sinus tachycardia include fear, anxiety, hypotension, hypoxemia, anemia, fever, exercise, and any drugs that exert positive chronotropic effects (increased heart rate). These drugs are: adrenergic drugs with beta -1 action 12 (e.g., epinephrine, dopami ne) and anticholinergics such as atropine. Administration of a beta -blocker or therapeutic hypothermia wound tend to decrease, not increase heart rate. In term of blood pressure, arterial hypotension is a common cause of tachycardia, not arterial hypotensi on. The correct answer is: anxiety or agitation 17. If the patient complains of difficulty in starting the IPPB treatment, which control should you adjust? A. Pressure B. Flow C. Sensitivity D. Terminal flow The sensitivity control is what determines how much effort (negative pressure) the patient has to generate to trigger on a breath. Pressure, flow, and terminal flow will adjust the functioning IPPB unit after the breath is started. The correct answer is: sensitivity 18. What is the gold standard for monitoring intracranial pressure (ICP)? A. intraparenchymal probe B. subarachnoid bolt C. intraventricular catheter D. epidural sensor The intraventricular catheter is the gold standard for ICP monitoring because it measures global ICP and also allows for CSF drainage (one therapy for lowering ICP). The intraparenchymal probe is a satisfactory alternative but measures local pressures only. Once common, subarachnoid bolts and epidural sensors are no longer in favor due to their limited accuracy. The correct answer is: intraventricular catheter 13 19. On inspection of an EKG rhythm strip from an adult patient, you note the following: rate of 79/min; regular rhythm; normal P waves; P-R interval of 0.25 sec; normal QRS complexes. What is the most likely problem is? A. 1st degree heart block B. atrial fibrillation C. 2nd degree heart block D. 3rd degree heart block The most likely problem in this case is a 1st degree heart block, 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. In 1st degree heart block (the least severe form), the only major abnormality is a prolonged P-R interval, i.e., greater than 0.20 seconds The correct answer is: 1st degree heart block 20. Which of the following laboratory values is most consistent with a diagnosis of dehydration? A. increased hematocrit B. decreased BUN C. decreased serum osmolality D. decreased urine specific gravity Fluid depletion is indicated by an increase in one of more of the following lab measures: hematocrit, BUN, serum osmolarlity and/or urine specific gravity. The correct answer is: increased hematocrit 21. Which of the following blood tests can indicate potential renal failure? 14 A. A B. B C. C D. D Blood urea nitrogen or BUN (normal range: 7 -20 mg/dL) and blood creatinine levels (normal range: 0.7 -1.3 mg/dL) are used to assess renal function. As by -products of protein metabolism, blood urea nitrogen and creatinine are elevated in certain forms of renal failure, such as chronic glomerulonephritis. Renal failure also typically causes metabolic acidosis, in which case the blood pH would be below normal. The correct answer is: A 22. Which of the following PFT findings are common in patients with chronic bronchitis and also found in those with emphysema? A. decreased forced expiratory flows B. increased lung compliance C. decreased diffusing capacity D. decreased total lung capacity As chronic obstructive lung diseases, both chronic bronchitis and emphysema result in decreased expiratory flows (by definition the FEV1% is less than 70% in COPD). Both also can cause air trapping and an INCREASE in total lung capacity. Increased lung compliance and decreased diffusing capacity tend to occur only in emphysema. High inspiratory airwa y resistance, on the other hand, is seen mainly in chronic bronchitis. The correct answer is: decreased forced expiratory flows 23. A sleep study report should include which of the following about blood oxygen levels? A. highest SpO2 during rapid eye movement sleep B. percent of sleep time with abnormally low SpO2 C. hourly arterial blood PO2 values D. before and after study HbCO saturation 15 A comprehensive sleep study report should include the lowest SpO2s recorded during abnormal respiratory events (apneas, hypopneas, respiratory effort -related arousals) and the sleep time spent within various SpO2 ranges. The most common index used to assess the latter is the cumulative percentage of overall sleep time during which the SpO2 is < 90% or CT90. A common threshold for the CT90 is 5%, meaning that lower value tends to rule out sleep apnea as a diagnosis. The correct answer is: percent of sleep time with abnormally low SpO2 24. In assessing a patient in the acute phase of ARDS, which of the following would you expect to find? A. increased lung volumes B. refractory hypoxemia C. increased compliance D. metabolic alkalosis Refractory hypoxemia and ARDs always go hand in hand. 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 WOB, typically resulting in dyspnea and tachypnea. In addition, physiologic shunting causes severe hypoxemia that does not respond well to increase s 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. The correct answer is: refractory hypoxemia 25. Which of the following should be included in the medication history of a patient? A. A