TMC Practice Exam 1, Predictor
Questions with answers. Verified.
You note in the chart of a patient's who is receiving volume control ventilation that the plateau pressure
has been increasing over the last 6 hours, w
...
TMC Practice Exam 1, Predictor
Questions with answers. Verified.
You note in the chart of a patient's who is receiving volume control ventilation that the plateau pressure
has been increasing over the last 6 hours, while the PEEP levels remains constant. Which of the
following would be the most likely cause of this change?
Select one:
A. development of pulmonary edema
B. water accumulation in the ventilator circuit
C. partial obstruction of the endotracheal tube
D. development of bronchospasm - ✔✔-An increase in the plateau pressure relative to baseline (PplatPEEP) indicates a decrease in the patient's lung and/or thoracic compliance. Common causes of a
decrease in lung compliance are pneumothorax, pulmonary edema, atelectasis and ARDS. Partial
obstruction of the ET tube and development of bronchospasm would increase airway resistance and
thus increase PIP and the PIP-Pplat pressure difference, but not affect Pplat.
The correct answer is: development of pulmonary edema
The difference between the mean arterial pressure (MAP) and intracranial pressure (ICP) is the:
Select one:
A. cerebral perfusion pressure
B. cerebral vascular resistance
C. blood-brain barrier pressure
D. jugular venous pressure - ✔✔-The difference between the mean arterial pressure (MAP) and
intracranial pressure (ICP) is the cerebral perfusion pressure (CPP); CPP = MAP - ICP. As this equation
makes clear, any factor that increases ICP and/or lowers MAP will decrease CPP and thus potentially
cause brain damage or death. In general perfusion is adequate if the CPP can be maintained between 60
to 100 mm Hg.
The correct answer is: cerebral perfusion pressure
Which of the following would provide the best bedside assessment of the need for mechanical
ventilation in a patient with Guillain-Barre syndrome?
Select one:
A. FRC
B. VC
C. airway resistance
D. TLC - ✔✔-Guillain-Barre syndrome is a restrictive neuromuscular disorder that results in
hypoventilation. Airway resistance measures are not useful in diagnosing restrictive ventilatory
impairments. Restrictive ventilatory impairments are characterized by low lung volumes. Of the volumes
listed, only the vital capacity (VC) can be measured at bedside
The correct answer is: VC
The normal range of adult blood pressure (systolic/diastolic) is about:
Select one:
A. 80-100/40-70 mm Hg
B. 100-140/60-90 mm Hg
C. 120-140/90-100 mm Hg
D. 130-150/100-110 mm Hg - ✔✔-Normal systolic pressure range from 100 to 140 mm Hg, with an
average of 120 mm Hg. Normal diastolic pressures range from 60 to 90 mm Hg, with an average of 80
mm Hg. The blood pressure is recorded with systolic listed over diastolic; i.e., 120/80 mm Hg.
The correct answer is: 100-140/60-90 mm Hg
A patient admitted to the ED exhibits wheezing and hypoxemia on room air. Lab tests indicate a normal
B-type natriuretic peptide (BNP) level. Which of the following conclusion can you draw from these
findings?
Select one:
A. renal function likely is normal
B. a myocardial infarction is likely
C. congestive heart failure is unlikely
D. liver function likely is normal - ✔✔-B-type natriuretic peptide (BNP) is a cardiac neurohormone
secreted from membrane granules in the cardiac ventricles as a response to ventricular volume
expansion and pressure overload. BNP levels that are less than 100 pg mL (normal is < 20 pg/mL) tend to
rule out diagnosis of CHF, while values exceeding 500 pg/mL help rule in this diagnosis. Intermediate
values are less helpful and may occur in conditions with similar symptoms, including renal insufficiency,
cor pulmonale, and acute pulmonary embolism.
The correct answer is: congestive heart failure is unlikely
Normal lung compliance is approximately:
Select one:
A. 0.1 - 0.4 L/cm H2O
B. 0.4 - 0.8 L/cm H2O
C. 10 - 15 L/cm H2O
D. 15 - 20 L/cm H2O - ✔✔-Normal compliance of the adult lung ranges from 0.1 to 0.4 L/cm H2O, with
an average value of about 0.2 L/cm H2O. The volume component of the compliance is measured as the
inhaled volume at any given pressure change. The pressure component represents the difference
between the alveolar and pleural pressures (the transpulmonary pressure gradient).
The correct answer is: 0.1 - 0.4 L/cm H2O
Within one second after initiating a forced vital capacity (FVC) maneuver, a patient with normal lungs
should be able exhale what percent of the FVC?
Select one:
A. 35-50% of the FVC
B. 50-70% of the FVC
C. 70-83% of the FVC
D. 84-93% of the FVC - ✔✔-The normal range for the FEV1 as a percent of the FVC (FEV1%) is 70-83%.
Patients with obstructive pulmonary disease will show a reduction in timed FEV% values, while patients
with restrictive disorders will generally exhibit normal (or sometimes high) FEV% values.
The correct answer is: 70-83% of the FVC
Which of the following clinical findings would increase the probability that a patient with some
perfusion defects on a V/Q scan has a pulmonary embolism?
Deep venousthrombosis
Recent history of cancer
Prolonged immobilization
A. Yes No Yes
B. Yes Yes Yes
C. No Yes Yes
D. Yes Yes No
Select one:
A. A
B. B
C. C
D. D - ✔✔-The accuracy of V/Q scans in diagnosing pulmonary embolism (PE) can be improved by
combining a set of clinical risk factors with the V/Q results. These factors (known as the Wells criteria)
include signs and symptoms of deep venous thrombosis (DVT), prior diagnosis of DVT or PE, tachycardia,
immobilization for three or more days or surgery during the prior month, hemoptysis and recent history
of cancer.
The correct answer is: B
During auscultation of a patient's chest, you hear intermittent "bubbling" sounds at the lung bases.
Which of the following chart entries best describe this finding?
Select one:
A. "bronchial sounds heard at lung bases"
B. "wheezes heard at lung bases"
C. "rhonchi heard at lung bases"
D. "crackles (rales) heard at lung bases" - ✔✔-The preferred term for short, discontinuous adventitious
lung sounds that are crackling or bubbling in nature is crackles. Many clinicians still use the term râles
for these sounds. Crackles are caused either by movement of excessive secretions in the airways (course
crackles), or by collapsed airways opening during inspiration (fine crackles).
The correct answer is: "crackles (rales) heard at lung bases"
A comprehensive environmental history needs to include information on:
Select one:
A. the jobs of all household members
B. home/apartment temperature settings
C. commuting distance to/from work
D. approximate hours per day spent on feet - ✔✔-In addition to work-related exposures, a
comprehensive environmental history should include information on present and previous home
locations, jobs of household members, home insulating and heating/cooling system, home cleaning
agents, pesticide exposure, water supply, recent renovation/remodeling, air pollution (indoor and
outdoor), hazardous wastes/spill exposure, and hobbies (e.g., painting, sculpting, ceramics, welding,
woodworking, automobiles, gardening, etc.)
The correct answer is: the jobs of all household members
Immediately following intubation of a patient's trachea, which of the following would yield the best
information regarding ET tube position in the trachea?
Select one:
A. arterial blood gas analysis
B. chest X-ray
C. exhaled volume
D. PETCO2 - ✔✔-While the PETCO2 can help determine lung vs esophageal placement of an ET tube,
only a chest X-ray can confirm its proper placement in the trachea. On an adult A-P chest X-ray, the ET
tube tip should be positioned about 4 to 6 cm above the carina or between T2 and T4. This position
minimizes the chance of the tube moving down into the mainstem bronchi (endobronchial intubation)
or up into the larynx (extubation).
The correct answer is: chest X-ray
In individuals with disorders causing an increased ELASTIC work of breathing, such as pulmonary fibrosis,
which of the following breathing patterns results in the minimum work?
Select one:
A. slow and deep breathing
B. slow and shallow breathing
C. rapid and deep breathing
D. rapid and shallow breathing - ✔✔-Individuals with disorders characterized by an increased elastic
work of breathing, such as pulmonary fibrosis, tend to assume a rapid and shallow breathing pattern.
For these patients, such a pattern results in the minimum mechanical work necessary to effectively
ventilate the lungs.
The correct answer is: rapid and shallow breathing
The most likely cause of bilateral fluffy infiltrates on a chest x-ray is:
Select one:
A. pulmonary edema
B. neoplasm
C. pleural effusion
D. hemothorax - ✔✔-Bilateral infiltrates indicate a global (lung-wide) as opposed to local pulmonary
problem. "Fluffy" infiltrates usually indicate an alveolar condition. Only pulmonary edema is a global
condition affecting the alveolar region (fluid transudation). Typically neoplasms, effusions and
hemothoraces are revealed as a localized areas of increased radiopacity.
The correct answer is: pulmonary edema
The normal apical impulse (PMI) usually is identified where?
Select one:
A. 3rd right intercostal space, left sternal border
B. 3rd left intercostal space, anterior axillary lin
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