So here lately, I’ve had several students who were interested in our TMC Test Bank, but didn’t quite know what to expect. So in this study guide, we’ve included a small sample of some of the TMC Practice Questions that you will see inside.
For those of you who don’t know, our TMC Test Bank is our digital bank of practice questions for the TMC Exam. It contains over 1000 practice questions, answers, and detailed rationales that give in-depth explanations as to why the answer is correct.
And the best part is…
It’s already helped thousands of students pass the TMC Exam. How cool is that?
It’s my job and #1 goal to help Respiratory Therapy Students pass the board exams. And one of the best strategies that I always recommend is going through practice questions exactly like the ones you’ll see on the actual exam.
And that is exactly why we created this study guide that you’re reading now, to go along with our TMC Test Bank so that you can take an inside look.
So as you read though the practice questions below, this will give you an idea of what can be found inside of our TMC Test Bank.
But I’ll be honest with you.
This only scratches the surface of what’s inside! So if you’re ready, let’s go ahead and dive right in.
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TMC Test Bank Sample Practice Questions:
D. fluid overload
A common side effect of acetylcysteine is bronchospasm. For this reason, acetylcysteine normally should be administered with a bronchodilator such as albuterol.
The correct answer is: bronchospasm
2. The doctor orders a 70% He/30% O2 mixture to be delivered to a patient having an acute asthmatic attack. Which of the following systems would you select to deliver this mixture?
A. nebulizer set at 100% oxygen with aerosol mask
B. tight-fitting nonrebreathing mask with competent valving
C. simple oxygen mask set to deliver 15 L/min oxygen
D. tight-fitting partial rebreathing mask at 12 L/min
Because a tight-fitting nonrebreathing mask with competent valving and set at the appropriate flow rate can deliver close to 100% source gas, it approximates the characteristics of a fixed-performance delivery system. For this reason, the well-designed nonrebreather is the system of choice for short-term administration of high concentrations of O2, as well as other premixed therapeutic gases. Alternatively, a high flow nasal cannula can be used to deliver heliox.
The correct answer is: tight-fitting nonrebreathing mask with competent valving
3. A physician orders aerosol therapy for a patient receiving mechanical ventilation who is being provided humidification with a heat and moisture exchanger. To assure effective therapy, you must do which of the following?
A. place the aerosol device proximal to the HME in the stream of flow
B. remove the HME before aerosol therapy and replace it afterward
C. place the aerosol device distal to the HME in the stream of flow
D. switch from an HME to an active heated the humidification system
Because an HME traps aerosol, you must you must remove it before aerosol therapy and replace it afterward
The correct answer is: remove the HME before aerosol therapy and replace it afterward
4. Which of the following is associated with the administration of aerosolized epinephrine?
Epinephrine can cause tachycardia owing to its strong beta-1 receptor stimulation. Bradycardia is the opposite, so it can’t be that one. Epinephrine isn’t directly associated with laryngospasm or bronchospasm, so the BEST answer has to be tachycardia.
The correct answer is: tachycardia
5. After completing an aerosol treatment, which of the following is the most appropriate documentation for you to make?
A. Treatment given as ordered
B. Aerosol therapy given; pulse stable, no changes during therapy; well tolerated
C. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; vital signs stable; well tolerated
D. Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation
After completing therapy, you should chart the drug and dose/strength, the patient’s pulse, blood pressure, respiratory rate, breath sounds and the extent to which the patient tolerated the therapy.
The correct answer is: Aerosol therapy given with 0.5 mL albuterol and 3 mL normal saline; pulse stable at 72/min during therapy; B.P. stable at 120/80; respiratory rate 10/min; therapy well tolerated; chest clear on auscultation
6. A doctor orders 2.5 mL ipratropium bromide (Atrovent) 0.2% TID for a COPD patient with bronchospasm. Which of the following methods would you use to deliver this drug?
A. small volume nebulizer with mask
B. ultrasonic nebulizer with mask
C. small volume nebulizer with mouthpiece
Ipratropium bromide aerosol can cause temporary blurring of vision as well as narrow angle glaucoma or eye pain if the solution comes into direct contact with the eyes. Use of a nebulizer with a mouthpiece (rather than face mask) reduces the likelihood of the nebulizer solution reaching the eyes.
The correct answer is: small volume nebulizer with mouthpiece
7. Which of the following ventilatory patterns is best suited for maximum aerosol deposition in the small airways?
A. slow inhalation, pause, slow exhalation
B. slow inhalation, pause, rapid exhalation
C. rapid inhalation, pause, slow exhalation
D. rapid inhalation, pause, rapid exhalation
The ventilatory pattern that is best suited for maximum aerosol deposition in the small airways is a slow inhalation followed by a pause and then a slow exhalation.
The correct answer is: slow inhalation, pause, slow exhalation
8. A physician orders a metered dose inhaler (MDI) bronchodilator for a patient receiving mechanical ventilation via a dual-limb breathing circuit. In order to maximize aerosol deposition, you would do which of the following?
A. place the MDI directly in-line on the inspiratory side of the circuit
B. recommend that a small volume nebulizer be used instead of the MDI
C. place the MDI plus a spacer in-line on the inspiratory side of the circuit
D. place the MDI directly in-line on the expiratory side of the circuit
For patients receiving mechanical ventilation, who require aerosol drug therapy, proper positioning of the device in the circuit is critical to ensure good drug deposition in the lungs. With dual-limb circuits, place the SVN or MDI adaptor in the inspiratory limb. Position SVNs about 1 to 1-/1/2 feet from the patient. With MDIs you should place a spacer or holding chamber in-line in the ventilator circuit.
The correct answer is: place the MDI plus a spacer in-line on the inspiratory side of the circuit
9. Tactile fremitus would be reduced in all of the following conditions except:
C. pleural effusion
D. pulmonary edema
Tactile fremitus would be reduced in COPD and a pneumothorax because the lung is overinflated. A pleural effusion would block and decrease the sounds coming from the lungs.
The correct answer is: pulmonary edema
10. An increase in a patient’s heart rate during aerosolized breathing treatment is primarily a result of which of the following effects of the drug?
A. Alpha only
B. Beta 1 only
C. Beta 2 only
D. Beta 1 and beta 2 only
An increase in a patient’s heart rate after the administration of an adrenergic bronchodilator is primarily due to Beta 1 receptor stimulation.
The correct answer is: Beta 1 only
11. Which of the following represents the primary indication for inhaled nitric oxide?
A. hypoxemia associated with obstructive sleep apnea
B. hypoxemia in neonates with persistent pulmonary hypertension
C. ventilatory failure in premature neonates
D. hypoxemia associated with hyaline membrane disease
The primary indication and approved use of inhaled nitric oxide is for the treatment of term and near-term neonates with hypoxemic respiratory failure due to persistent pulmonary hypertension of the newborn (PPHN).
The correct answer is: hypoxemia in neonates with persistent pulmonary hypertension
12. A postoperative patient develops bilateral wheezing. Which of the following is the most appropriate therapy that you would recommend for this condition?
A. incentive spirometry
B. mucolytic agent
C. chest physiotherapy
The most common cause of wheezing is narrowing of the airways due to contraction of airway smooth muscle. The only therapy that will reverse this is the administration of a bronchodilator.
The correct answer is: bronchodilator
13. Which of the following drugs would you recommend for a patient with acute bronchospasm?
A. racemic epinephrine
B. acetylcysteine (Mucomyst)
C. albuterol (Proventil)
D. cromolyn sodium (lntal)
For patients with acute bronchospasm, you normally select an aerosolized bronchodilator (a beta-adrenergic like albuterol and/or a cholinergic blocker like ipratropium). Acetylcysteine is a mucolytic that would only worsen bronchospasm in sensitive patients. Cromolyn is a prophylactic anti-inflammatory useful in preventing bronchospasm in asthmatics. Racemic epinephrine (strong alpha-adrenergic) is selected to reverse the vasodilation and mucosal edema that can cause upper airway obstruction episodes such as croup.
The correct answer is: albuterol (Proventil)
14. You are administering beta-adrenergic bronchodilators to your patient. Which of the following are possible side effects associated with this modality?
Common side effects of beta-adrenergic bronchodilators include: increased heart rate and cardiac arrhythmias or palpitations (beta-1 effects); skeletal muscle tremors, anxiety, nervousness, insomnia, and nausea (beta-2 effects); and the potential for a decrease in arterial PO2 (beta-2 pulmonary vasodilation causing an increase in perfusion relative to ventilation, i.e. a low V/Q). Most current beta-agonists used for bronchodilation have minimal (but still some) Beta-1 effects. In addition, beta-agonists have been reported to produce ECG changes, such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression.
The correct answer is: D
15. You are about to start a patient on a new regimen of therapy. The patient is irritable, has difficulty focusing, and exhibits mild trembling of his hands. How should you proceed?
A. request that the physician discontinue the therapy
B. postpone therapy until the patient’s anxiety is resolved
C. request that the nurse be present during the therapy
D. proceed as quickly as possible with the therapy
Patients who appear depressed or overly anxious, as evident by irritability, difficulty focusing, breathlessness, dizziness, trembling, palpitations and/or chest pain are in an abnormal emotional state. In general, patients in an abnormal emotional state will be difficult to manage until their anxiety can be resolved.
The correct answer is: postpone therapy until the patient’s anxiety is resolved
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Spon VT 175 mL
PaCO2 35 mmHg
Spon VE 7.0 L/min
HCO3 21 mEq/L
VC 600 mL
PaO2 110 mm Hg
MIP/NIF -10 cmH2O
Which of the following actions would be appropriate at this time?
A. place the patient on a 40% T-tube and monitor closely
B. maintain current ventilator settings and re-evaluate later
C. switch the patient to SIMV at a rate of 4/minute
D. place the patient on 5 cm H2O CPAP and monitor closely
Although the patient’s on-ventilator blood gases are acceptable, the bedside measurements indicate that the patient is not yet ready for a spontaneous breathing trial. With a spontaneous VE of 7.0 L/min and VT of 175 mL, the patient’s spontaneous rate is 40/min, with the rapid shallow breathing index (RSBI) over 200 (40/.175 = 228). In general, a RSBI over 100-105 predicts weaning failure, so in this case, it would be best to maintain the current ventilator settings and re-evaluate the patient later.
The correct answer is: maintain current ventilator settings and re-evaluate later
17. After weaning and extubation, you place a patient on a cool aerosol mask at 40% O2 and they develop moderate hypoxemia and hypercapnia, with a falling pH. Which of the following actions would you recommend at this time?
A. increase the nebulizer oxygen concentration to 60%
B. apply bi-level positive airway pressure via mask
C. administer 50 mEq IV sodium bicarbonate
D. re-intubate and apply volume control ventilation
Bi-level positive airway pressure (BiPAP) is a good option to help avoid reintubation of patients who develop mild to moderate hypercapnia or hypoxemia after extubation. It also is used to (1) avoid intubation of COPD patients requiring ventilatory support for acute on chronic ventilatory failure, (2) treat CHF/pulmonary edema (short term application), and (3) manage obstructive and central sleep apnea (nocturnal application).
The correct answer is: apply bi-level positive airway pressure via mask
18. You are administering chest physical therapy in the Trendelenburg position to a 69-year-old female patient with chronic bronchitis. She starts to cough up a small amount of fresh blood. What action should you take in this situation?
A. continue the therapy and provide supplemental oxygen
B. continue the therapy but report the problem to the nurse
C. stop the therapy, stabilize the patient up and contact a physician
D. immediately call a code and begin resuscitation
Hemoptysis is always a serious problem. You should stop the treatment, stay with the patient until he is stable then and contact a physician.
The correct answer is: stop the therapy, stabilize the patient up and contact a physician
19. A female patient with a neuromuscular disorder who is breathing through an intact upper airway is receiving external (vest) oscillation to help mobilize secretions into the large airways. However, she is having difficulty clearing the secretions. Which of the following techniques would you recommend to facilitate the clearance of this patient secretions?
A. postural drainage, percussion and vibration
B. mechanical insufflation-exsufflation
C. positive expiratory pressure (PEP) therapy
D. acetylcysteine (Mucomyst) via aerosol
Patients with neuromuscular disorders can have trouble mobilizing and clearing secretions. To help mobilize secretion in patients with a neuromuscular disorder and an intact upper airway either postural drainage with percussion and vibration or external (vest) or internal (IPV) oscillation are indicated. Once mobilized, the secretions need to be cleared using one or more of the following methods: manually assisted cough, mechanical insufflation-exsufflation or nasotracheal suctioning. In these patients PEP therapy is not effective due to inadequate respiratory muscle strength (needed to generate the expiratory pressure). And acetylcysteine (Mucomyst) via aerosol may help thin/mobilize secretions, but does little to actually clear them from the large airways.
The correct answer is: mechanical insufflation-exsufflation
20. A COPD patient has the following ABG results on room air:
PaCO2 64 torr
PaO2 48 torr
HCO3 32 mEq/L
The patient complains of shortness of breath and lightheadedness, has bilateral bronchial breath sounds with inspiratory crackles and exhibits cyanosis around his lips. Which of the following would you recommend for this patient?
A. 10 L/min nonrebreathing mask
B. 28% air-entrainment mask
C. albuterol (Proventil) by SVN
D. 4 L/min nasal cannula
The ABG indicates partially compensated respiratory acidosis with severe hypoxemia, likely due to an acute exacerbation of the condition, possibly caused by pneumonia. Given the severity of the hypoxemia, immediate O2 therapy is indicated. However, especially during acute exacerbations of COPD, it is recommended that blood oxygen levels be carefully titrated in order to avoid oxygen-induced hypercapnia. Commonly cited target levels are PaO2s in the 55-70 torr range or SpO2s in the 88 to 93% range. Given the added issue of dyspnea, this patient should be placed on a high flow device capable of giving a precise low FIO2, i.e. a 28% air-entrainment device.
The correct answer is: 28% air-entrainment mask
21. A frail, thin patient known to have lung cancer is admitted to the emergency department and the patient’s family members are also present. What should be asked of them to make sure the proper level of care is delivered?
A. whether any advance directives have been documented
B. the last time the patient ate
C. the last time the patient had a bowel movement
D. whether the patient has brought home care medications
It’s appropriate to ask about advance directives, such as a DNR order, for a patient with a fatal illness. Eating and bowel habits are not essential to know at this time. He will be given new orders for medications during his stay in the hospital, so it does not matter if he brought his medications with him.
The correct answer is: whether any advance directives have been documented
22. A 57-year-old male patient in the open heart unit had cardiopulmonary bypass surgery with significant blood loss. On physical exam he presents with tachypnea and tachycardia and the SpO2 is 84% on 4 L/min nasal cannula. You should now recommend which of the following?
A. non-rebreathing mask at 12 L/min
B. CPAP with 5 cm H2O pressure
C. nasal cannula at 6 L/min
D. 60% air-entrainment mask
In combination, the tachypnea and tachycardia and the SpO2 all signal significant hypoxemia (an SpO2 of 85% equates to a PaO2 of 50 torr), compounded by diminished O2 carrying capacity due to the blood loss during surgery. To treat this hypoxemia, you should deliver the highest possible FIO2 to this patient. Among the available options, only the non-rebreathing mask is capable of consistently providing oxygen concentrations above 60%.
The correct answer is: non-rebreathing mask at 12 L/min
23. While monitoring a patient during a spontaneous breathing trial via T-tube, you note the following: an increase in heart rate from 86 to 104/min; an increase in respiratory rate from 18 to 25/min; an increase in PetO2 from 43 to 51 mm Hg; and a decrease in SpO2 from 95 to 89%. Which of the following actions would be appropriate at this time?
A. restore the patient to full ventilatory support
B. encourage the patient to relax and continue monitoring
C. request that the patient be given a mild sedative
D. measure the patient’s vital capacity and MIP/NIF
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).
The correct answer is: encourage the patient to relax and continue monitoring
24. A female patient has been on a high-flow nasal cannula for 2 days following abdominal surgery. The patient’s atelectasis has improved and the arterial blood gas results on a flow of 20 L/min and FIO2 of 0.70 (via blender) are as follows:
PaCO2 44 torr
PaO2 154 torr
HCO3 23 mEq/L
Which of the following would you recommend?
A. Decreasing the flow
B. Decreasing the flow and FIO2 together
C. Decreasing the FIO2
D. Changing to standard nasal cannula
Assuming normal Hb and Hct, a PaO2 of 154 torr is excessive and should be lowered. Moreover, after three days on a high FIO2, O2 toxicity should be a concern. So the best action is in this case would be to lower the FIO2, while maintaining the flow at 20 L/min. Only at flows of at least 20-30 L/min can you expect a high flow nasal cannula to deliver the set FIO2 to adult patients. Lowering the flow will have a variable effect on the FIO2 and whenever possible you should try to avoid changing two parameters at the same time.
The correct answer is: Decreasing the FIO2
25. Your patient receiving volume control SIMV shows clinical signs of a tension pneumothorax. A chest x-ray confirms this suspicion. Which of the following actions would you recommend to treat this problem?
A. lowering the peak inspiratory pressure
B. obtaining a stat arterial blood gas
C. performing a needle thoracostomy
D. switching to pressure control SIMV
A tension pneumothorax is a medical emergency. Treatment always involves decompression of the pleural space by either needle or tube thoracostomy chest tube insertion). Lowering the peak pressure will help prevent worsening of the problem, but does nothing to treat it. Likewise obtaining an ABG it is not a priority and will not help resolve the pneumothorax.
The correct answer is: performing a needle thoracostomy
So there you have it! Thank you so much for reading all the way to the end. I truly hope that this TMC Test Bank Sample was helpful for you.
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Thanks again for reading and as always, breathe easy my friend. 🙂
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