TMC Respiratory Therapist practice questions with answers

Answer: B) Severe (GOLD 3)

• AIncorrect. That's 80% or more.
• BCorrect. The range is 30% to 49%.
• CIncorrect. That's 50% to 79%.
• DIncorrect. That's below 30%.

Answer: C) Preterm

• AIncorrect. That's 42 weeks or more.
• BIncorrect. Term is 37 weeks or more.
• CCorrect. Born before 37 weeks.
• DIncorrect. That's under 28 weeks.

Answer: D) An oxygen reservoir

• AIncorrect. It needs oxygen and a reservoir.
• BIncorrect. It needs a reservoir.
• CIncorrect. It needs a reservoir.
• DCorrect. With high oxygen flow.

Answer: A) Fit-tested N95 respirator

• ACorrect. Or a higher-level respirator.
• BIncorrect. That's for droplet precautions.
• CIncorrect. Use a fit-tested respirator.
• DIncorrect. Use a fit-tested respirator.

Answer: D) Improves distribution and lowers peak pressure

• AIncorrect. It doesn't affect PEEP.
• BIncorrect. It lowers it.
• CIncorrect. It improves distribution.
• DCorrect. It may increase mean airway pressure.

Answer: A) Measuring plateau pressure and improving gas distribution

• ACorrect. It holds the breath at end-inspiration.
• BIncorrect. That's an expiratory pause.
• CIncorrect. It holds the breath.
• DIncorrect. It's brief.

Answer: D) Basilar skull fracture

• AIncorrect. That isn't a contraindication.
• BIncorrect. NPAs are tolerated with a gag reflex.
• CIncorrect. NPAs help then.
• DCorrect. Risk of intracranial placement.

Answer: A) With a jaw-thrust maneuver

• ACorrect. It avoids moving the neck.
• BIncorrect. That moves the neck.
• CIncorrect. That moves the neck.
• DIncorrect. That moves the spine.

Answer: A) Shorter inspiratory time and longer expiratory time

In volume control, raising the inspiratory flow delivers the set tidal volume faster. This shortens inspiratory time and lengthens expiratory time, which is why higher flow is used to reduce auto-PEEP.

• ACorrect. The same set tidal volume is delivered faster, so inspiration is shorter. With the rate unchanged, more of each breath cycle is left for exhalation, and the I:E ratio widens. This helps reduce air trapping.
• BIncorrect. This is the reverse. Lowering the flow would lengthen inspiration and shorten exhalation.
• CIncorrect. In volume control the tidal volume is a set value, so changing the flow changes how fast it is delivered, not how much is delivered.
• DIncorrect. The mandatory rate is set separately and does not change with flow. The I:E ratio does change because inspiration gets shorter.

Answer: C) Check the patient and connections first when an alarm sounds, and use the bedside manual resuscitator if the problem persists

Home ventilator caregivers must respond to every alarm by assessing the patient and finding the cause, and must be able to ventilate right away with a bedside manual resuscitator. Alarms should not be silenced and settings should not be changed without a clinician's order.

• AIncorrect. A high-pressure alarm can mean a secretion plug, a kinked tube or an occluded airway. Alarms should not be silenced without finding and fixing the cause.
• BIncorrect. A low-pressure alarm usually means a disconnection or a leak, so the caregiver should check the connections. Caregivers should not change prescribed settings; only designated clinicians should.
• CCorrect. Caregivers must assess the patient, find the cause of the alarm, and give manual ventilation with a resuscitation bag kept at the bedside if the problem can't be fixed quickly.
• DIncorrect. The bag-valve resuscitator must be immediately available at the bedside so it can be used at once if the patient is disconnected, decannulated or the ventilator fails.

Answer: B) Increased alveolar dead space, such as from pulmonary embolism or low cardiac output

The normal PaCO2–PetCO2 difference is about 3–5 mm Hg. A 20 mm Hg gap means a lot of dead space or V/Q mismatch, for example from pulmonary embolism or reduced cardiac output, and the cause should be investigated.

• AIncorrect. Hypoventilation raises both PaCO2 and PetCO2 together, so the gap between them stays small. It does not explain a PetCO2 of 25 mm Hg with a PaCO2 of 45 mm Hg.
• BCorrect. Alveoli that are ventilated but poorly perfused add CO2-free gas to the exhaled breath. This lowers PetCO2 compared with PaCO2. Lung disease, pulmonary vascular disease (for example, embolism) and reduced cardiac output all widen the gradient.
• CIncorrect. Shunt mainly causes hypoxemia. Perfused but unventilated units add little to the arterial–end-tidal CO2 difference, so a 20 mm Hg gap points to dead space rather than shunt.
• DIncorrect. In healthy people the PaCO2–PetCO2 difference is only about 3–5 mm Hg. A 20 mm Hg difference is clearly abnormal.

Answer: B) Try nasal pillows and gradual desensitization

• AIncorrect. Find a better fit.
• BCorrect. Fit and comfort improve use.
• CIncorrect. That doesn't help claustrophobia.
• DIncorrect. That may worsen claustrophobia.

Answer: B) Honor the refusal and recommend symptom-directed care for dyspnea and anxiety

A competent patient may refuse intubation. The RT respects that decision and supports comfort-focused care, without stopping other appropriate treatments and without overriding the patient's wishes later.

• AIncorrect. A competent patient makes their own treatment decisions. Family members or a surrogate decide only when the patient cannot.
• BCorrect. A competent patient's informed refusal must be respected. Care then focuses on comfort, such as relieving shortness of breath and anxiety, rather than on intubation.
• CIncorrect. A clear, informed refusal does not stop applying when the patient loses the ability to repeat it. Intubating at that point would override the patient's stated wishes.
• DIncorrect. Declining one treatment is not declining all care. Orders that limit resuscitation do not cover other treatments, and comfort-focused care still treats symptoms such as shortness of breath.

Answer: B) Observe the patient's inhaler technique and review medication adherence

Frequent daily rescue bronchodilator use in COPD signals a poor response to the current regimen. Before therapy is escalated, inhaler technique and adherence should be reassessed, and any problems corrected.

• AIncorrect. The maintenance regimen may need to change, but the dose should not be raised before checking whether the patient uses the current device correctly and takes it as prescribed.
• BCorrect. Heavy daily rescue use suggests a poor response to the current regimen. Poor device technique and missed maintenance doses are common, correctable causes, so they should be checked before the provider escalates therapy.
• CIncorrect. With no fever and no change in sputum, nothing points to infection. Imaging does not deal with the likely cause, which is poor symptom control on the current regimen.
• DIncorrect. Changing the rescue delivery device does not address why symptoms are poorly controlled. Technique and adherence with the maintenance inhaler should be assessed first.

Answer: B) Immediate synchronized cardioversion plus supplemental oxygen

New AF with rapid ventricular response and signs of instability (hypotension, confusion, pulmonary congestion) needs immediate synchronized cardioversion and oxygen. Drug rate control is for stable patients.

• AIncorrect. Beta blockers or nondihydropyridine calcium channel blockers are used for rate control in hemodynamically stable AF. This patient is hypotensive and confused, and an oral drug acts too slowly.
• BCorrect. AF causing hemodynamic instability (hypotension, altered mental status, pulmonary congestion) calls for immediate synchronized cardioversion. Supplemental oxygen treats the hypoxemia from pulmonary edema.
• CIncorrect. Unsynchronized shocks are for pulseless VT or VF. A shock not timed to the QRS in an organized rhythm risks hitting the T wave and setting off ventricular fibrillation.
• DIncorrect. The crackles come from cardiogenic pulmonary congestion, not bronchospasm. Albuterol would also raise the heart rate further.