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The best part is, each question also comes with a detailed rationale explanation so that you can learn exactly why the answer is correct. This part is crucial when it comes to actually learning the information that is required in order to pass the TMC Exam.

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Sample TMC Practice Questions:

1. During the assessment of a 60-year-old female patient, you note the following signs: dyspnea, hypotension, reduced chest expansion on the left side, hyperresonant percussion note and tactile fremitus on the left side, absent breath sounds on the left side, and a tracheal shift to the right. These findings suggest which of the following?

A. A pleural effusion on the left side
B. A pneumothorax on the left side
C. Atelectasis on the left side
D. Consolidation on the left side

To get this one correct, you needed to be able to interpret the signs that were given about the patient in the question. This is a common type of question for the TMC Exam.

The question tells us that the patient has reduced chest expansion, a hyperresonant percussion note, absent breath sounds, and tactile fremitus all on the left side. That to go along with a tracheal shift to the right. This indicates that the patient has a pneumothorax on the left side.

Remember that, when a pneumothorax is present, the trachea will shift away from the affected side. That means you can rule out left-sided atelectasis because the trachea would shift to that side.

A pleural effusion and consolidation would cause a dull percussion note, not a hyperresonant note, so we can rule out those two as well.

The correct answer is: B. A pneumothorax on the left side

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2. A 39-year-old male patient was admitted to the emergency department with a fever and an SpO2 of 87% on room air. Upon auscultation, rhonchi is heard and the patient has a productive cough. Which of the following would you recommend?

A. Intubate and provide mechanical ventilation with 40% oxygen
B. Provide noninvasive positive pressure ventilation using a full face mask
C. Implement postural drainage and percussion with directed coughing
D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity

To get this one correct, you needed to be able to recognize that the patient has some type of infection, like pneumonia.

You know this because the question states that the patient is hypoxemic, has a fever, and rhonchi breath sounds. So in this case, you would want to obtain a sputum sample for culture and sensitivity in order to identify the type of organism. Oxygen therapy is indicated for the hypoxemia.

Intubation and NPPV would not be indicated in this case. Postural drainage and percussion are not recommended either. So by breaking down the question, the best answer clearly is D.

The correct answer is: D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity

3. A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-controlled A/C ventilation. Upon assessment, you note that the patient’s cuff pressure is measured at 38 cm H2O. Which of the following would you recommend?

A. Withdraw the tube 1-2 cm and reassess the patient’s breath sounds
B. Recommend reintubation with a smaller endotracheal tube
C. Lower the cuff pressure to < 30 cm H2O
D. Recommend ventilation via a tracheostomy instead

In order to get this one right, you needed to know the normal values for cuff pressure. And in this case, you needed to recognize that 38 cm H2O is way too high and could potentially be dangerous for the patient’s trachea.

So your first action should be to lower the cuff pressure to < 30 cm H2O and then check to make sure that there are not any leaks. For the TMC Exam, you need to remember that the cuff pressure normal range is between 20-30 cm H2O.

There is no indication to withdraw the tube and using a smaller tube would only cause the patient’s peak pressure to increase which is something that we do not want. Also, nothing in the question indicates that a tracheostomy is needed, so we know that the correct answer has to be C.

The correct answer is: C. Lower the cuff pressure to < 30 cm H2O

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4. During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most likely cause of this finding?

A. There is an obstruction in the delivery tube
B. The patient’s ventilation has increased
C. There is a clogged system diffuser
D. The flowmeter pressure is set too high

If you’ve ever accidentally stepped on the tubing when a bubble humidifier is being used, then you will automatically know that the correct answer is A.

The relief valve of a bubble humidifier sounds when the pressure in the reservoir container exceeds the valve’s threshold pressure. And of course, the most common reason for this to occur is when there is a downstream obstruction to outflow.

None of the other answer choices really make sense in this situation, so you know that the correct answer has to be A.

The correct answer is: A. There is an obstruction in the delivery tube

5. A pre and post-bronchodilator test was ordered on a 48-year-old female patient. The forced expiratory measurement that was obtained after the bronchodilator was given shows an increase in the patient’s FEV1 from 60% to 80% of the predicted value. This finding suggests which of the following?

A. A fixed airway obstruction
B. A reversible airway obstruction
C. A normal diffusion capacity
D. A restrictive process

The information that was given in the question suggest that the patient’s airway obstruction was somewhat relieved because the FEV1 increased from 60% to 80% of the predicted value. But was it enough to classify it as a reversible obstruction?

Remember that if pre-to-post values increase by at least 12-15%, you know that the treatment was effective. So in this case, there was a 20% increase, which means that —yes — the increase was enough and this indicates that there is a reversible airway obstruction.

We can rule out all of the other answer choices because we know that the correct answer has to be B.

The correct answer is: B. A reversible airway obstruction

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6. A 58-year-old female patient is intubated and appears to be breathing asynchronously with the ventilator. Her breath sounds are absent on the left side and the trachea appears to be shifted to the left. The patient has a dull percussion note on the left side as well. Which of the following is the most likely explanation of these findings?

A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm

To get this one correct, you need to be able to interpret the information that was provided about the patient in the question.

It states that she has a dull percussion note on the left side, tracheal shift toward the left side, and absent breath sounds on the left side. You needed to recognize that these are all signs of atelectasis.

So now you have to think, “What would cause atelectasis?” In this instance, it’s most likely that the endotracheal tube has slipped into the right mainstem bronchus which has caused left-sided atelectasis.

Diffuse bronchospasm would cause bilateral wheezing and a left-sided pneumothorax would cause a hyperresonant percussion note, not a dull percussion note. So by breaking down the question, you can easily determine that the correct answer has to be C.

The correct answer is: C. The endotracheal tube is in the right mainstem bronchus

7. A 63-year-old female patient is intubated and receiving mechanical ventilation in the pressure controlled A/C mode. If the patient’s compliance were to decrease, which of the following would you expect to occur?

A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
D. Her PEEP level will decrease

To get this one correct, you must have a basic understanding of lung compliance. You also have to take into account that the ventilator is in the pressure control mode, which means that the pressure is pre-set.

If there is a decrease in lung compliance when the ventilator is operating in the pressure control mode, the machine will continue delivering a constant pressure. But, since the lungs don’t expand as much when there is decreased compliance, it reaches the set pressure limit much faster. That means that there will be a decrease in the delivered tidal volume.

In this case, the inspiratory time will decrease and the PEEP levels should not be affected.

The correct answer is: A. Her delivered volume will decrease

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8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume controlled A/C mode. After performing endotracheal suctioning, which of the following would indicate the effective clearance of retained secretions?

A. An increased tidal volume
B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure

Generally, you should remember that retained secretions will increase the patient’s airway resistance and peak airway pressure during volume control ventilation.

So taking that into consideration, if you were to clear the secretions via suctioning, that should decrease the patient’s peak airway pressure.

On the other hand, if the patient had been receiving pressure controlled ventilation, you would expect an increase in delivered volume once secretions are cleared. That’s the key to getting this one correct — you needed to understand the difference between volume and pressure controlled ventilation.

None of the other answer choices make sense in this situation, so you know that the correct answer has to be D.

The correct answer is: D. A decreased peak pressure

9. An adult patient who is receiving mechanical ventilation suddenly started showing signs of tachypnea. Upon assessment, you note tracheal deviation to the right and decreased breath sounds and hyperresonance on the left. Which of the following would you recommend?

A. The patient needs suctioning
B. The patient needs a bronchoscopy
C. The insertion of a chest tube
D. The patient needs a thoracentesis

For this one, you needed to be able to interpret the signs and symptoms that were given in the question. And by doing so, you could easily determine that all of the signs are consistent with a pneumothorax.

Remember, patients with a pneumothorax will typically show tracheal deviation away from the affected side. They will also show decreased breath sounds and hyperresonance on the affected side as well.

So in order to treat a pneumothorax, the patient requires immediate insertion of a chest tube on the affected side. None of the other answer choices really make sense in this situation, so you know that the correct answer has to be C.

The correct answer is: C. The insertion of a chest tube

10. A 57-year-old female patient with acute pulmonary edema is dyspneic and appears to be wheezing. The resident physician has ordered an albuterol breathing treatment via SVN. Which of the following would you recommend?

A. Recommend acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Recommend a diuretic and oxygen therapy

Once you begin working as a Respiratory Therapist, this is something you will run into far too often. A nurse or new physician will hear wheezing and automatically request for the RT to provide a breathing treatment for the patient.

It’s frustrating because wheezing in patients with CHF and pulmonary edema is usually due to fluid overload, not due to bronchospasm.

So in general, acute pulmonary edema is best managed with a diuretic, such as Lasix. Oxygen therapy may be indicated as well if hypoxemia is present. Also, NPPV is often indicated for these patients as well.

So by breaking down the question, we can determine that the best answer in this case is D.

The correct answer is: D. Recommend a diuretic and oxygen therapy

Final Thoughts

So there you have it. Thank you so much for reading all the way to the end. I truly hope that these sample TMC Practice Questions were helpful for you. 

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