tmc practice tests

Question 1

Which of the following would decrease a patient’s energy expenditure?
A. hypothermia
B. inflammation
C. major trauma
D. agitation/pain

Answer 1

hypothermia

Question 2

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

Answer 2

4000 to 5000ml

Question 3

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

Answer 3

primary metabolic acidosis

Question 4

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

Answer 4

nurses notes and flowsheet

Question 5

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

Answer 5

increased hematocrit

Question 6

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

Answer 6

decreased forced expiratory flows

Question 7

In assessing a new admission to the Intensive Care Unit, you note a spontaneous
respiratory rate of 37/minute. The most likely cause of this observation is:
A. therapeutic hypothermia
B. CNS depression
C. metabolic acidosis
D. decreased CO2 production

Answer 7

metabolic acidosis

Question 8

A patient with a 9-year history of chronic bronchitis and an acute pneumonia
exhibits the following ABG results on room air:
pH = 7.21, PCO2 = 64 torr, HCO3 = 25 mEq/L, PO2 = 39 torr, P(A-a)O2 = 41 torr
Which of the following best describes this patient’s condition?
A. acute hypercapnic respiratory failure
B. chronic hypercapnic respiratory failure
C. acute hypoxemic respiratory failure
D. combined hypercapnic/hypoxemic respiratory failure

Answer 8

D

Question 9

A patient has an arterial pH of 7.28. What effect does this have on oxygen
transport?
A. hemoglobin’s affinity for O2 will be higher than normal
B. for a given PO2, the SaO2 will be less than normal
C. the oxyhemoglobin saturation curve will shift to the left
D. for a given PO2, the SaO2 will be greater than normal

Answer 9

B

Question 10

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. notify the attending physician of the request
C. explain that only her husband can cancel the order
D. notify the charge nurse of the request

Answer 10

B

Question 11

An ECG on a 48-year-old patient with exertional dyspnea reveals high velocity
tricuspid regurgitation, a dilated right ventricle, and an enlarged right atrium. Left
ventricular anatomy and systolic/diastolic function are normal. Which of the
following is the most likely problem?
A. pulmonary arterial hypertension
B. hypertrophic cardiomyopathy
C. acute respiratory distress syndrome
D. congestive heart failure

Answer 11

A

Question 12

A patient’s ABG shows respiratory alkalosis. Which of the following problems is
most likely?
A. hypoxemia
B. hypothermia
C. opiate overdose
D. CNS depression

Answer 12

A

Question 13

After review a patient’s chart, you note that an admission diagnosis of fluid
depletion/dehydration. Which of the following findings would be most likely on
bedside assessment of this patient?
A. inspissated secretions
B. pitting edema
C. venous distension
D. crackle on auscultation

Answer 13

A

Question 14

Which of the following VD/VT ratios is inconsistent with the ability of a patient to
maintain adequate carbon dioxide removal at a tolerable level of ventilation?
A. 0.10
B. 0.30
C. 0.50
D. 0.70

Answer 14

D

Question 15

What is the difference between the mean arterial pressure (MAP) and
intracranial pressure (ICP)?
A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure

Answer 15

B

Question 16

To meet quality assurance standards, the patient’s chart report of an ABG or
hemoximetry test results should include:
A. a statement by the technician performing the test regarding its validity
B. the date, time and results of the last machine calibration verification
C. the range of values used for statistical quality control data analysis
D. the date, time and results of the last external proficiency test

Answer 16

A

Question 17

In addition to obtaining information on a patient’s prescribed medications, a
good medication history should also include which of the following?
A. total costs of prescriptions
B. patient’s medication knowledge
C. family’s use of prescription drugs
D. generic vs. brand name drug use

Answer 17

B

Question 18

The maximum volume of air that can be exhaled from the maximum inspiratory
level is defined as which of the following?
A. vital capacity
B. residual volume
C. total lung capacity
D. expiratory reserve volume

Answer 18

A

Question 19

Your patient has a pH of 7.57 and a PaCO2 of 49 torr. Based on this data, what is
the primary acid-base disturbance?
18
A. respiratory alkalosis
B. metabolic acidosis
C. respiratory acidosis
D. metabolic alkalosis

Answer 19

D

Question 20

Which of the following choices best describes oxygen delivery to the tissues?
A. arterial oxygen content x stroke volume
B. arterial oxygen content x cardiac output
C. cardiac output x arterial PO2
D. cardiac output x vascular resistance

Answer 20

B

Question 21

Your patient is scheduled for a right lung pneumonectomy has a preoperative
FEV1 of 2.0 L. A split lung quantitative V/Q study indicates a 55%/45%
distribution of blood flow to the right and left lungs respectively. The patient’s
predicted postoperative FEV1 would be:
A. 1.10 L
B. 1.00 L
C. 0.90 L
D. 0.80 L

Answer 21

C

Question 22

Lung tumors are seen on a positron emission tomography scan as:
A. areas of decreased metabolism (‘dark spots’)
B. areas of increased radiolucency (‘dark spots’)
C. areas of increased metabolism (‘bright spots’)
D. areas of decreased radiolucency (‘bright spots’)

Answer 22

C

Question 23

While reviewing a cardiac catheterization report on a patient being assessed for
coronary artery disease, about what percent reduction in artery diameter would
indicate the need to proceed with balloon angioplasty and/or stenting?
A. 10%
B. 30%
C. 50%
D. 70%

Answer 23

D

Question 24

While reviewing the chart of a 63-year-old patient diagnosed with COPD and
chronic hypoxemia, you would expect to find which of the following?
A. decreased A-P chest diameter
B. chronic respiratory alkalosis
C. secondary polycythemia

Answer 24

C

Question 25

While reviewing the chart of a 63-year-old patient diagnosed with COPD and
chronic hypoxemia, you would expect to find which of the following?
A. decreased A-P chest diameter
B. chronic respiratory alkalosis
C. secondary polycythemia
D. FRC less than predicted

Answer 25

C

Question 26

A 62-year-old patient with COPD complains that she becomes breathless after
combing her hair and must sit down to catch her breath. Which of the following is
this complaint most closely related to?
A. increased work of breathing
B. cardiac tamponade
C. increased pulmonary reserve
D. orthopnea

Answer 26

A

Question 27

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

Answer 27

B

Question 28

When reviewing a chest x-ray, you note that the heart is shifted to the patient’s
right. Which of the following is the most likely cause of this finding?
A. right sided tension pneumothorax
B. right sided pleural effusion
C. left sided atelectasis/lung collapse
D. left sided tension pneumothorax

Answer 28

D

Question 29

You are called to evaluate a patient in the recovery room following an
exploratory laparotomy. The patient appears to be asleep. Her respiratory rate is
15/min and heart rate is 83/min. To determine the patient’s level of
consciousness, you speak to the patient, and she does not respond. Which of the
following should you do first?
A. wait 1 hour and then repeat the attempt
B. shake the patient’s arm gently
C. call for help
D. administer a sternal rub

Answer 29

B

Question 30

While observing a patient, you note that his breathing is extremely deep and fast.
Which of the following terms would you use to classify this type of breathing?
A. Kussmaul’s breathing
B. Biot’s breathing
C. Cheyne-Stokes breathing
D. apneustic breathing

Answer 30

B

Question 31

While observing the AP chest radiograph of a patient suffering from advanced
stages of pulmonary emphysema, which of the following finding would you
expect to see?
A. increased vascular markings
B. flattening of the diaphragms
C. decreased radiolucency
D. increased C/T ratio

Answer 31

B

Question 32

A patient in intensive care unit develops a supraventricular tachycardia at a rate
of 162/min. Which of the following effects would this have on cardiac function?
A. increased end-diastolic volume
B. mitral valve regurgitation
C. increased stroke volume
D. decreased end-diastolic volume

Answer 32

D

Question 33

What is the primary cause of the first heart sound (S1)?
A. closure of the semilunar valves
B. closure of the atrioventricular valves
C. opening of the semilunar valves
D. opening of the atrioventricular valves

Answer 33

B

Question 34

You note that a patient has a paradoxical chest wall movement. Which of the
following best describes this finding?
A. atopic asthma
B. chronic bronchitis
C. flail chest
D. tension pneumothorax

Answer 34

C

Question 35

If a patient develops a paradoxical pulse following trauma or cardiothoracic
surgery, especially in connection with increasing venous pressure and heart rate,
it would suggest which of the following?
A. severe COPD
B. pericarditis
C. myocardial infarction
D. cardiac tamponade

Answer 35

D

Question 36

After inspecting a spontaneously breathing adult patient’s thorax, you note
paradoxical movement of the right chest wall. Which of the following conditions
is this most consistent with?
A. pulmonary emphysema
B. phrenic nerve dysfunction
C. pulmonary embolism
D. pulmonary fibrosis

Answer 36

B

Question 37

After assessing your patient, they are acutely dyspneic and hypotensive, you note
the following (all limited to the left hemithorax): reduced chest expansion,
hyperresonance to percussion, absent of breath sounds and tactile fremitus, and
a tracheal shift to the right. Which of the following would these findings suggest?
A. left-sided pleural effusion
B. left-sided consolidation
C. left lobar obstruction/atelectasis
D. left-sided pneumothorax

Answer 37

D

Question 38

When you are about to administer incentive spirometry to a postoperative
patient, you ask him to about his pain level. On a 10-point scale, he rates the
effect of his pain on his activities as an ‘8.’ You should
A. coach him 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

Answer 38

D

Question 39

You note in the chart that a 47-year-old patient for whom you are planning an
instructional activity has a 5th-grade education. Based on this knowledge, you
should
A. emphasize oral (vs. written) instruction
B. recommend canceling the activity
C. use “fun and games” approach
D. keep the teaching activity short

Answer 39

A

Question 40

While assessing a patient, you note definitive use of the neck muscles during
regular inspiration, especially the scalenes. Which of the following is this finding
consistent with?
A. COPD
B. orthopnea
C. pulmonary embolism
D. myasthenia gravis

Answer 40

A

Question 41

Which of the following would you expect to find on the AP chest radiograph of a
patient suffering from advanced stages of pulmonary emphysema?
A. decreased vascular markings
B. elevated hemidiaphragms
C. decreased radiolucency
D. increased C/T ratio

Answer 41

A

Question 42

After determining that an alert patient is experiencing pain of a level 3 on a scale
of 1 to 10, you should:
A. immediately report your findings to the patient’s physician
B. record your findings in the chart, i.e., respiratory care progress notes
C. repeat the intensity assessment to see if the results are reproducible
D. assess how much the pain is interfering with the patient’s activities

Answer 42

D

Question 43

After interviewing a patient for information about sputum production, she states
that after coughing she typically produces about a tablespoon full of spit. Which
of the following would be your best estimate to put in the chart?
A. 2 mL
B. 5 mL
C. 15 mL
D. 30 mL

Answer 43

C

Question 44

Which of the following can you observe to recognize a patient properly utilizing
diaphragmatic breathing?
A. the abdomen rising on inspiration
B. the abdomen rising on exhalation
C. the use of pursed-lip breathing
D. the use of intercostal muscles during inspiration

Answer 44

A