TMC Exam 2024/2025 Q-Bank| 100% Correct Questions With Verified Answers| A+ Garde
Multiple Choice
At The Bedside Of A Patient Receiving Volume Control Ventilation, You Suddenly Observe The Simultaneous Sounding Of The High Pressure And Low Volume Alarms. Which Of Following Is The Most Likely...
At The Bedside Of A Patient Receiving Volume Control Ventilation, You Suddenly
Observe The Simultaneous Sounding Of The High Pressure And Low Volume
Alarms. Which Of Following Is The Most Likely Cause Of This Problem?
A. A Leak In The ET Tube Cuff
B. A Mucous Plug In The ET Tube
C. Ventilator Circuit Disconnection
D. Development Of Pulmonary Edema
Rationale: During Volume-Control Ventilation, A High Pressure/Low Volume
Condition Signals An Obstruction (Increased Impedance). Although Either The
Mucous Plug Or The Development Of Pulmonary Edema Increases Impedance, Only
A Plugged Et Tube Would Cause A Sudden Rise In Airway Pressure.
The Correct Answer Is: A Mucous Plug In The Et Tube
Which Of The Following Is True Regarding Synchronous Intermittent Mandatory
Ventilation (SIMV)?
A. Machine Breaths Cannot Be Pressure Controlled
B. Asynchrony Is Prevented During Machine Breaths
C. Only Partial Ventilatory Support Can Be Provided
D. Patient Normally Contributes To Minute Ventilation
Rationale: Simv Allows Spontaneous Breathing Between Machine Breaths, So That
The Patient Can Control Both The Overall Rate And Pattern And Contribute To The
Total Minute Ventilation. Simv Provides Full Ventilatory Support At Normal Rates
And Partial Support At Lower Rates. Machine Breaths May Target Either Volume
(Vc, Simv) Or Pressure (Pc, Simv) And Spontaneous Breaths May Be Pressure
Supported. Asynchronous Breathing Still Can Occur During Machine Breaths,
Usually Due To Improper Machine Sensitivity Or Flow Settings.
,The Correct Answer Is: Patient Normally Contributes To Minute Ventilation
To Initiate Weaning, A Patient Was Changed From Volume Control A/C Ventilation
To Pressure Support. After 30 Minutes On Pressure Support, The High Respiratory
Rate Alarm Sounds, With The Patient Breathing At A Rate Of 25 To 30 Per Minute.
What Change Should You Make To The Ventilator Settings?
A. Increase The Pressure Support Level
B. Increase The High Pressure Alarm To 50 Cm H2o
C. Increase The High Rate Alarm To 30-35
D. Switch The Patient Back To Volume Control A/C
Rationale: During Weaning Procedures, A Modest Increase In Respiratory Rate Is
Common And Generally Should Be Tolerated Up To A Maximum Of 30-35 Breaths
Per Minute. In This Instance, The High Respiratory Rate Alarm Should Be Increased
To 30-35 Breaths Per Minute.
The Correct Answer Is: Increase The High Rate Alarm To 30-35
Which Of The Following Ventilator Graphics Displays Would Be The Best Choice
To Assess The Work Of Breathing Associated With Patient Triggering?
A. Volume Vs. Time Display
B. Flow Vs. Volume Display
C. Flow Vs. Time Display
D. Pressure Vs. Volume Display
Rationale: The Best Choice To Assess The Work Of Breathing Associated With
Patient Triggering Using Ventilator Graphics Would Be A Pressure Vs. Volume
Loop.
The Correct Answer Is: Pressure Vs. Volume Display
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?
A. Decrease In O2 Saturation From 91% To 82%
B. Increase In Respiratory Rate From 18 To 28/Min
,C. Increase In Arterial Pco2 From 45 To 53 Torr
D. Increase In Heart Rate From 98/Min To 115/Min
Rationale: 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: Decrease In O2 Saturation From 91% To 82%
Which Of The Following Categories Of Patients Are Good Candidates For Negative
Pressure Ventilation?
A. Patients With Acute Obstructive Disorders Of The Upper Airway
B. Patients Suffering Acute Exacerbations Of Chronic Lung Disease
C. Patients With End-Stage Chronic Obstructive Pulmonary Disease
D. Patients With Chronic Neuromuscular Disorders And Normal Airways
Rationale: Although Its Use Has Declined In Recent Years, Negative Pressure
Ventilation Remains A Viable Alternative To The Positive Pressure Approach With
Certain Patient Categories. Specifically, Patients With Permanent Neuromuscular
Impairments Who Retain Adequate Upper Airway Protective And Clearance Reflexes
(Thereby Not Needing An Artificial Airway) But Cannot Tolerate
Masks/Mouthpieces Are Ideally Suited To Ventilatory Support Via Negative Pressure
Ventilation, Especially For Use In The Home.
The Correct Answer Is: Patients With Chronic Neuromuscular Disorders And
Normal Airways
Which Of The Following Is The Appropriate Load To Establish For Patients
Receiving Inspiratory Muscle Training?
A. At Least 33% Of The Predicted Inspiratory Capacity (Ic)
B. At Least 10-15 Ml/Kg Of Predicted Body Weight (Pbw)
C. At Least 30% Of The Maximum Inspiratory Pressure (Mip/Nif)
D. At Least -25 Cm H2o, As Measured By A Calibrated Manometer
, Rationale: For Inspiratory Training To Be Effective, The Load Against Which The
Patient Breathes Must Be Sufficient To Increase Muscle Strength. The Minimal
Resistance Load To Achieve This End Is An Inspiratory Pressure That Is At Least
30% Of The Mip/Nif.
The Correct Answer Is: At Least 30% Of The Maximum Inspiratory Pressure
(Mip/Nif)
Which Of The Following Is An Indication For Positive-End Expiratory Pressure?
A. To Provide Graded Levels Of Ventilatory Support
B. To Decrease Physiologic Deadspace
C. To Decrease Hypoxemia Due To Shunting
D. To Increase The Efficiency Of Ventilation
Rationale: The Primary Indication For Peep Is To Decrease Hypoxemia Due To
Shunting In Conditions Like Ards And Irds. Peep Can Also Lower Fio2 Needs In
Patients With Refractory Hypoxemia And Help Maintain Or Increase The Frc (E.G.,
In Thoracic Surgery). Last, Extrinsic Peep Can Be Applied To Decrease Auto-Peep In
Patients With Airway Obstruction Receiving Ventilatory Support.
The Correct Answer Is: To Decrease Hypoxemia Due To Shunting
Which Of The Following Are Acceptable Changes In Patient Status During A
Spontaneous Breathing Trial For Weaning From Mechanical Ventilation?
A. Heart Rate Rises From 103 To 118/Min
B. Spo2 Falls From 90% To 80%
C. Scalene Muscle Activity Increases
D. Systolic Bp Falls From 110 To 75 Mm Hg
Rationale: Measures Indicating A Successful Sbt Include Acceptable Gas Exchange
(Spo2 ≥ 85-90% Or Pao2 ≥ 50-60 Torr; Ph ≥ 7.30; Increase In Paco2 ≤ 10 Torr);
Stable Hemodynamics (Heart Rate <120-140/Min; %Change < 20%; Systolic Bp <
180-200 Mm Hg And > 90 Mm Hg With %Change < 20%); And A Stable Ventilatory
Pattern (Respiratory Rate ≤ 30- 35/Min, %Change < 50%; No Accessory Muscle Use
Or Thoracoabdominal Paradox).
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