tmc practice test Questions and Correct
Answers
When monitoring a patient during a spontaneous breathing trial (SBT), which of the
following observations would cause you to stop the trial and return the patient to
ventilatory support?
Select one:
A.decrease in O2 saturation from 93% to 88%
B.increase in respiratory rate from 15 to 25/min
C.increase in end-tidal PCO2 from 45 to 53 torr
D.development of thoracoabdominal paradox
✓ ~~~ Measures indicating failure of a SBT include inadequate gas exchange
(SpO2 ≤ 85-90% or PaO2 ≤ 50-60 torr; pH ≤ 7.30; increase in PaCO2 ≥ 10
torr); unstable hemodynamics (heart rate > 120-140/min; %change > 20%;
systolic BP > 180-200 mm Hg or < 90 mm Hg or %change > 20%); and an
unstable ventilatory pattern (respiratory rate ≥ 30-35/min or %change > 50%;
presence of accessory muscle use or thoracoabdominal paradox).
The correct answer is: development of thoracoabdominal paradox
The difference between the mean arterial pressure (MAP) and intracranial pressure
(ICP) is the:
Select one:
A.cerebral perfusion pressure
B.cerebral vascular resistance
C.blood-brain barrier pressure
D.jugular venous pressure
✓ ~~~ The difference between the mean arterial pressure (MAP) and
intracranial pressure (ICP) is the cerebral perfusion pressure (CPP); CPP =
MAP - ICP. As this equation makes clear, any factor that increases ICP and/or
lowers MAP will decrease CPP and thus potentially cause brain damage or
death. In general perfusion is adequate if the CPP can be maintained
between 60 to 100 mm Hg.
The correct answer is: cerebral perfusion pressure
A nutritionist arrives at the bedside of an ICU patient receiving pressure triggered
volume control A/C ventilation with an order to measure the patient's energy
expenditure. Just prior to her arrival you lowered the set tidal volume from 600 mL to
450 mL. Which of the following would you recommend?
Select one:
A.postponing metabolic measurements for at least 30 minutes
B.switching the ventilator trigger from pressure to flow
C.paralyzing the patient with cisatracurium (Nimbex)
D.suctioning the patient just prior to connecting the analyzer
, ✓ ~~~ Valid metabolic measures require that the patient be in a steady state,
i.e., have a stable minute ventilation and cardiac output. Typically this requires
waiting at least 30 minutes after any procedure that can alter metabolism/gas
exchange, e.g., CPT, suctioning, ventilator changes, etc. Paralysis is not
needed for metabolic measurements, and in fact would cause falsely low VO2
and VCO2 readings. And switching from pressure to flow-triggering will cause
measurement errors due to the continuous bias flow through the circuit.
The correct answer is: postponing metabolic measurements for at least 30 minutes
Based on the following blood-gas report, what is the most likely acid-base diagnosis?
pH = 7.52
pCO2 = 44 torr
HCO3 = 35.1 mEq/L
Select one:
A.acute (uncompensated) metabolic alkalosis
B.combined respiratory & metabolic alkalosis
C.acute (uncompensated) respiratory alkalosis
D.fully compensated respiratory alkalosis
✓ ~~~ The pH is above normal (alkaline). The PCO2 is in the normal range and
thus not a factor in the alkalosis. The HCO3 is high, which indicates a primary
metabolic alkalosis. Since the PCO2 is normal, no compensation is occurring,
and the problem is an acute or uncompensated metabolic alkalosis.
The correct answer is: acute (uncompensated) metabolic alkalosis
In reviewing the chart of a patient with a suspected pulmonary embolus, you would
expect to find an order for which of the following diagnostic procedures?
Select one:
A.chest radiography
B.CT angiography
C.pulmonary function test
D.bronchoscopy
✓ ~~~ CT pulmonary angiography (CTPA) has become the gold standard for
the diagnosis of pulmonary embolism, replacing both traditional X-ray
angiography and V/Q scanning. During CTPA the patient receives an
intravenous injection of an iodine-containing contrast agent. A normal CTPA
scan will show the contrast filling all the pulmonary vessels, appearing as
bright white. Any area of the pulmonary circulation where a blockage is
present will appear dark instead of white.
The correct answer is: CT angiography
The major goal of medication reconciliation is to:
Select one:
A.educate the patient
B.prevent medication errors
C.increase patient compliance
D.reduce prescription costs
, ✓ ~~~ Medication reconciliation is a process ideally implemented across the
continuum of care that compares what drugs the physician orders to those
that the patient is taking. The major goals of medication reconciliation are to:
(1) avoid/correct discrepancies between physician prescriptions and drugs the
patient is actually taking; and (2) prevent medication errors, adverse drug
reactions and potential patient harm.
The correct answer is: prevent medication errors
The normal range of adult blood pressure (systolic/diastolic) is about:
Select one:
A.80-100/40-70 mm Hg
B.100-140/60-90 mm Hg
C.120-140/90-100 mm Hg
D.130-150/100-110 mm Hg
✓ ~~~ Normal systolic pressure range from 100 to 140 mm Hg, with an average
of 120 mm Hg. Normal diastolic pressures range from 60 to 90 mm Hg, with
an average of 80 mm Hg. The blood pressure is recorded with systolic listed
over diastolic; i.e., 120/80 mm Hg.
The correct answer is: 100-140/60-90 mm Hg
In assessing a patient in the acute phase of ARDS, you would expect to find:
Select one:
A.increased lung volumes
B.refractory hypoxemia
C.increased compliance
D.metabolic alkalosis
✓ ~~~ 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.
The correct answer is: refractory hypoxemia
Lab tests on a patient with COPD reveal a hematocrit of 61% and a markedly
increased red call mass. Which of the following clinical findings is most likely in this
patient?
Select one:
A.cool, clammy skin
B.central cyanosis
C.dependent edema
D.skin pallor/paleness
, ✓ ~~~ A hematocrit of 61% with a markedly increased red call mass indicates
secondary polycythemia. In patients with COPD, secondary polycythemia is
most often due to chronic hypoxemia, which stimulates RBC production.
When hypoxemia is combined with an increased red call mass, the likelihood
of central cyanosis increases. Central cyanosis generally appears when the
amount of unoxygenated hemoglobin in the capillaries exceeds 5 g/dL. The
more hemoglobin in the blood, the more likely this threshold will be reached.
The correct answer is: central cyanosis
Which of the following aspects of a patient's social history is most important in the
diagnosis of lung disease?
Select one:
A.marital status
B.cultural background
C.education
D.occupational history
✓ ~~~ Of the items list, occupational history is most important in the diagnosis
of lung disease. Many lung diseases are associated with inhalation of dusts or
toxic chemicals in the work setting.
The correct answer is: occupational history
On physical examination of a patient with pulmonary emphysema, you would expect
to find which of the following? Course bilateralrhonchiWeight loss/cachexiaSigns of
corpulmonaleIncreased APchest
diameterA.YesYesYesYesB.NoYesYesNoC.YesNoNoYesD.NoYesNoYes
Select one:
A.A
B.B
C.C
D.D
✓ ~~~ A patient with COPD due primarily to emphysema typically will exhibit a
"quiet chest" with marked overdistention of the thorax (increased AP
diameter). Sputum is usually scanty and mucoid, while weight loss may be
severe and the patient appear malnourished (cachexia). Signs of cor
pulmonale, so common in chronic bronchitis, are usually absent.
The correct answer is: D
A patient coughs productively after receiving airway clearance therapy. You note that
the sputum sample is foul smelling and green. You would suspect that the patient
has:
Select one:
A.Pulmonary edema
B.Chronic bronchitis
C.Pneumococcal pneumonia
D.Lung abscess
✓ ~~~ Purulent sputum (yellow, green) usually indicates a pulmonary infection.
Foul-smelling or fetid purulent sputum is characteristic of lung abscess or
bronchiectasis.
The correct answer is: Lung abscess
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