A 51-year-old female patient with a history of asthma is receiving
mechanical ventilation in the assist-control mode. Upon assessment, you
note that she is struggling to initiate inspiration. Which of the following
settings would you check first in order to resolve this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP - ANS ✓The correct answer is: C. Sensitivity
To get this one correct, you simply needed to have a basic understanding of
ventilator settings.
If a patient is struggling to initiate inspiration while being mechanically
ventilated in the assist-control mode, you should automatically know that
the sensitivity setting is probably set incorrectly.
Sensitivity uses negative pressure in order to help trigger a breath and you
should strive to use the least amount of sensitivity possible to trigger the
ventilator into the inspiratory phase. However, sometimes the patient will
need a little more help, so you may need to increase the sensitivity setting.
None of the other answer choices will help the patient initiate a breath, so
you know that the correct answer has to be C.
The physician has requested the insertion of a nasopharyngeal airway on
an adult patient. This type of airway is useful in supporting which of the
following?
TMC EXAM
, 2
TMC
A. Mechanical ventilation
B. Frequent suctioning
C. Incentive spirometry
D. Aerosol drug therapy - ANS ✓The correct answer is: B. Frequent suctioning
For the TMC Exam, you need to know the difference between a
nasopharyngeal and oropharyngeal airway.
In general, an oropharyngeal airway must be used in patients who are
unconscious or sedated. They are often used during bag-mask ventilation to
facilitate effective ventilation.
A nasopharyngeal airway can be used in patients with an intact gag reflex
and they help facilitate ventilation and frequent nasal suctioning. They also
help to minimize mucosal trauma.
They are not used in invasive mechanical ventilation and have no role in
either incentive spirometry or aerosol drug therapy.
You would expect there to be difficultly establishing a patent airway for a
patient with which of the following conditions?
A. A patient with ARDS
B. A patient that is morbidly obese
C. A patient with a pleural effusion
D. A patient with ventilator-associated pneumonia - ANS ✓The correct
answer is: B. A patient that is morbidly obese
In general, you should know that it's often difficult to establish an airway in
a patient with morbid obesity.
Aside from obesity, the other conditions that are generally associated with
a difficult airway include:
Patients with a thick neck
Patients with a large tongue
Patients with a limited ability to move their head or neck
TMC EXAM
, 3
TMC
These anatomical differences simply just make it harder to insert the
endotracheal tube properly into the trachea. None of the other answer
choices really make sense in this situation, so you know that the correct
answer has to be B.
A premature infant who is receiving positive pressure ventilation appears
to be in acute respiratory distress with signs of hypotension and
asymmetrical chest movement. Which of the following would you
recommend first?
A. An arterial blood gas
B. A chest radiograph
C. A capillary heal stick
D. Chest transillumination - ANS ✓The correct answer is: D. Chest
transillumination
To get this one correct, you needed to be able to interpret the signs that
were given to you in the question and determine how to treat the infant.
In this case, you should know that these signs indicate that a pneumothorax
may be present.
Transillumination is a procedure where you shine a light through the
infant's chest in order to inspect for a pneumothorax. It is performed in
high-risk infants that are showing signs of respiratory distress.
You should recommend this test to see if the infant has a pneumothorax.
When there is a "halo" sign through the neonate's chest wall, this confirms
that a pneumothorax is present. In this case, immediate chest tube
insertion would be indicated.
On the other hand, if the transillumination test does not reveal a
pneumothorax but the infant still exhibits signs of respiratory distress, you
should recommend an immediate chest X-ray.
So while each of the tests that are listed in the answer choices may be
indicated, the best answer for this question is D.
TMC EXAM
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