Therapist Multiple-Choice (TMC) Examination Study Guide

Apply it

A patient's PaO2 rises from 60 to 80 mm Hg, but FIO2 was increased from 0.30 to 0.60 between samples. Describe the oxygenation response in relation to the increased support rather than reporting uncomplicated improvement.

Apply it

A patient with wheezing has an SpO2 of 96% while receiving oxygen but speaks in short phrases and has suprasternal retractions. Recognize significant respiratory distress and reassess airflow and ventilation promptly.

Apply it

After prolonged distress, an adult becomes less vocal, appears drowsy, and has very faint breath sounds. Although wheezing is quieter, the accompanying loss of air movement indicates deterioration requiring immediate clinical escalation.

Apply it

A COPD exacerbation with pH 7.28, PaCO2 65 mm Hg, and bicarbonate 30 mmol/L demonstrates respiratory acidosis with acidemia. By contrast, pH 7.40, PaCO2 60, and bicarbonate 36 in a patient taking diuretics suggests respiratory acidosis plus metabolic alkalosis: expected chronic bicarbonate is approximately 31, not 36.

Apply it

With bicarbonate 12 mmol/L, expected PaCO2 is 26 ±2 mm Hg, or 24–28. A gas with pH 7.25 and PaCO2 28 is compatible with respiratory compensation. At the same bicarbonate, PaCO2 40 would suggest additional respiratory acidosis and PaCO2 18 additional respiratory alkalosis.

Apply it

Two people develop headache and nausea after using a generator indoors. One has a displayed SpO2 of 99%. Recommend blood CO-oximetry and urgent exposure-directed care rather than using the saturation to exclude poisoning.

Apply it

A visibly air-contaminated specimen from a patient receiving substantial oxygen reports an unexpected PaO2 change. Question specimen integrity and obtain a properly handled replacement before making a nonurgent support adjustment based on that result.

Apply it

A venous blood gas reports an oxygen tension of 36 mm Hg in an alert patient with stable pulse oximetry. Do not diagnose severe arterial hypoxemia from that value; establish the sample source and assessment question.

Apply it

Acceptable measurements show FEV1 1.8 L and FVC 3.0 L, giving a ratio of 0.60. If the supplied ratio LLN is 0.67, the result supports obstruction. A ratio of 0.66 with a supplied LLN of 0.60 would not meet this LLN criterion.

Apply it

A patient coughs forcefully 0.4 seconds after beginning a maneuver, producing the largest displayed FEV1 of the session. Exclude that FEV1 from acceptable results and obtain additional coached attempts within an appropriate testing session.

Apply it

An adult's two largest acceptable FEV1 values are 2.42 and 2.31 L, a difference of 0.11 L. They meet the repeatability limit, but FVC repeatability and the quality of individual efforts still require separate review.

Apply it

FVC is 2.2 L with LLN 2.8 L, and FEV1/FVC is 0.82 with LLN 0.70. If TLC is 3.5 L with LLN 4.2 L, restriction is established. If TLC is 5.0 L with the same LLN, the low FVC does not establish restriction.

Apply it

During a neonatal resuscitation assessment, the ECG displays 90/min. Verify an audible heart rate or palpable pulse before concluding that mechanical cardiac activity has recovered.

Apply it

Peak pressure rises from 26 to 40 cm H2O while plateau remains 22 cm H2O at unchanged settings. Investigate airway or circuit resistance, including secretions and tube kinking, before assuming the lungs have become less compliant.

Apply it

A passive patient receives 420 mL with plateau pressure 24 cm H2O and total PEEP 10 cm H2O. Static compliance is 420 divided by 14, or 30 mL/cm H2O, using total rather than set PEEP.

Apply it

A passive patient's expiratory flow persists when the next breath starts. An expiratory hold shows total PEEP of 12 cm H2O with set PEEP of 5. Estimate intrinsic PEEP as 7 cm H2O.

Apply it

A ventilated patient has PaO2 84 mm Hg on FIO2 0.40. The ratio is 210 mm Hg. Document the support conditions and interpret the oxygenation impairment without claiming that this single calculation establishes a complete diagnosis.

Apply it

A newborn receiving positive-pressure ventilation has a clear ECG heart-rate tracing but no reliable oximeter signal yet. Use the ECG to assess heart-rate response while continuing efforts to obtain preductal saturation for oxygen guidance.

Apply it

During NIV for pulmonary edema, SpO2 rises from 88% to 96%, but blood pressure falls from 138/84 to 78/46 mm Hg and consciousness declines. Recognize hemodynamic deterioration rather than uncomplicated treatment success.

Apply it

A patient with asthma deteriorates abruptly and develops markedly reduced breath sounds on one side. A radiograph reports a new pneumothorax. Communicate the structural complication urgently and reassess the treatment plan rather than interpreting the episode solely as worsening airway narrowing.

Apply it

An overweight patient with unstable asthma reports loud snoring and witnessed breathing pauses despite treatment directed at nighttime wheezing. Recommend evaluation for coexisting sleep apnea rather than automatically attributing every awakening and saturation decline to bronchospasm.

Apply it

A ventilated patient has a low-pressure alarm and nearly absent exhaled tidal volume immediately after a bed transfer. Check the patient and the circuit connection at the airway while preparing backup ventilation if support is ineffective.

Apply it

A high-pressure alarm begins after a patient is turned. The patient is distressed and the inspiratory limb is compressed beneath a bed rail. Relieve the obstruction, reassess ventilation, and verify that pressures return toward baseline.

Apply it

A patient on bilevel NIV has eye irritation, audible mask leak, and nasal-bridge redness. Reassess mask fit and positioning and consider a better interface rather than progressively tightening straps or increasing pressure without checking delivery.

Apply it

Water repeatedly collects in dependent ventilator tubing after a room-temperature change. Keep the liquid from reaching the patient, manage it according to equipment procedures, and reassess circuit temperature control rather than simply stopping necessary humidification.

Apply it

Before testing, a spirometer measures a 3-L verification injection outside the permitted range. Repeat appropriate equipment checks and resolve the problem before patient testing, even if yesterday's verification and today's patient tracings appear satisfactory.

Apply it

An analyzer's control results remain outside limits after the initial check. A critically ill patient's specimen arrives. Use an approved functioning alternative while the fault is investigated rather than releasing an unverified result from the affected analyzer.

Apply it

A home-oxygen user becomes breathless after moving equipment between rooms. Check source operation, tubing continuity, and cannula position while assessing the patient and using the prescribed backup plan if the primary system has failed.

Apply it

A patient without a known infection requires suctioning that may splash respiratory secretions. Perform hand hygiene and select gloves and appropriate face and eye protection based on exposure risk rather than waiting for a positive culture.

Apply it

Use the required respirator before entering the patient's airborne-isolation room. For necessary transport of a masked patient with infectious skin lesions covered, apply CDC's transport exception unless facility policy requires additional protection.

Apply it

A ventilated patient suddenly has poor chest rise, falling exhaled volume, and distress. Assess the airway and circuit immediately and provide backup ventilation if needed while identifying obstruction, displacement, or a disconnected connection.

Apply it

For an intubated patient with increasingly tenacious secretions, inspect HME contamination, resistance, leaks, and secretion burden. Reconsider heated humidification when conditioning remains inadequate, plugging threatens patency, or added dead space compromises ventilation.

Apply it

An adult has an audible leak with measured cuff pressure of 38 cm H2O. Recognize excessive pressure, address it while maintaining ventilation, and reassess tube position and cuff integrity rather than adding more air.

Apply it

An intubated adult develops coarse airway sounds, visible secretions, and a sawtooth tracing. Perform indicated suctioning using the measured shallow approach, then reassess sounds, mechanics, and tolerance.

Apply it

For a child with a 5.0-mm-ID tube, an 8-Fr catheter has OD 2.67 mm and ratio 53.3%, exceeding the pediatric limit. A 6-Fr catheter has OD 2.0 mm and ratio 40%, below the limit. For a neonate with a 3.0-mm-ID tube, that 6-Fr catheter gives 66.7%, below the neonatal 70% limit.

Apply it

A distressed patient with acute asthma has diffuse wheezing, suprasternal retractions, and some sputum production but no established indication for an additional clearance procedure. Prioritize assessment and treatment of the exacerbation rather than adding routine percussion solely because mucus is present.

Apply it

An intubated adult requires suctioning and has previously desaturated during the procedure. Preoxygenate appropriately, use a brief controlled pass, monitor closely, and reassess between attempts rather than applying continuous suction until all visible secretions disappear.

Apply it

When reviewing a proposed heliox trial for severe obstruction, identify the intended benefit as reduced flow-related resistance and work of breathing. Evaluate respiratory effort, ventilation, oxygenation, and the patient's oxygen requirement rather than assuming that connection to a helium mixture proves effectiveness.

Apply it

An adult's predicted body weight is 60 kg, while actual weight is 105 kg. A tidal volume of 360 mL equals 6 mL/kg predicted body weight; calculate from 60 kg rather than using the larger actual weight.

Apply it

A passive adult has plateau pressure 33 cm H2O despite an acceptable oxygen saturation. Reassess tidal volume and respiratory mechanics and consider an appropriate protective adjustment rather than accepting the pressure because oxygenation currently appears satisfactory.

Apply it

A passive patient has plateau pressure 25 cm H2O and total PEEP 11 cm H2O. Calculate driving pressure as 14 cm H2O, then use it with the broader mechanics assessment rather than as an isolated treatment command.

Apply it

An obstructed patient has intrinsic PEEP and expiratory flow continuing into the next breath. Review obstruction and ventilator timing, considering a lower mandatory rate or shorter inspiratory time where appropriate while monitoring the resulting ventilation and pressures.

Apply it

A patient makes visible inspiratory efforts that do not consistently trigger ventilator breaths. Examine triggering, leaks, and intrinsic PEEP and correct the identified mismatch rather than assuming every unassisted effort requires a larger tidal volume.

Apply it

An alert adult with a COPD exacerbation remains tachypneic after initial treatment and has pH 7.29 with PaCO2 62 mm Hg. Consider closely monitored bilevel NIV if airway protection and other clinical circumstances permit.

Apply it

An awake, cooperative adult with cardiogenic pulmonary edema has marked respiratory distress but no shock. Consider CPAP or bilevel NIV alongside medical treatment, with close reassessment of respiratory effort, oxygenation, blood pressure, and tolerance.

Apply it

During bilevel NIV for acidotic COPD, a patient's pH falls further and the patient becomes drowsy with a weak cough. Escalate urgently for airway and invasive-ventilation assessment while maintaining appropriate immediate support.

Apply it

A newborn remains bradycardic with poor chest movement despite corrected mask seal and airway positioning. Prepare checked intubation equipment and backup ventilation while another team member monitors heart rate and saturation. After placement, promptly report absent chest movement or failure of heart rate to improve so the team reassesses the airway.

Apply it

An adult's acute illness is improving, oxygenation is acceptable on current modest support, and circulation is stable. Use the clinical readiness assessment to consider an SBT rather than postponing solely because an RSBI has not been calculated.

Apply it

An adult begins an SBT on FIO2 0.35. A colleague proposes increasing it to 0.60 in advance to avoid desaturation. Maintain the established concentration for assessment and monitor tolerance, intervening appropriately if the patient deteriorates.

Apply it

A patient completes an SBT without distress but has a weak cough and requires frequent suctioning for copious secretions. Reassess airway clearance and protection before recommending extubation rather than using the trial result as the only criterion.

Apply it

An adult rescued from an enclosed combustion exposure has headache and confusion despite a high displayed saturation. Initiate the recommended oxygen treatment and urgent clinical evaluation rather than waiting for the pulse oximeter to demonstrate hypoxemia.

Apply it

A patient uses extra fluticasone HFA for sudden wheezing and skips rinsing. Review the maintenance role and prescribed rapid-relief plan, then have the patient explain rinsing with water and spitting it out after treatment.

Apply it

A patient remains symptomatic despite a lower-airway treatment plan, and acceptable repeated loops show flattening of both limbs. Communicate concern for fixed airway obstruction and recommend specialist airway assessment.

Apply it

A patient demonstrates connecting a spacer to a new fluticasone DISKUS and breathing out through its mouthpiece before inhaling. Correct both steps and have the patient demonstrate exhaling away and inhaling through the device as labeled.

Apply it

A newborn receiving mask ventilation has little chest movement and no improvement in heart rate. Prioritize ventilation corrective steps and reassessment of effective breaths rather than assuming that increasing oxygen concentration alone will resolve the problem.

Apply it

A premature newborn is receiving respiratory support under a warmer. Continue measuring temperature and adjusting the thermal strategy toward the recommended range instead of considering warming complete merely because the heating device is switched on.

Apply it

After prescribed inhaled albuterol, an adult has better air entry, less effort, and improved peak flow but develops marked palpitations. Recognize bronchodilator benefit alongside possible toxicity; check heart rate and rhythm and communicate before additional treatment.

Apply it

A ventilated patient clears secretions effectively with indicated suctioning and remains stable. Do not recommend scheduled bronchoscopy simply to provide more thorough routine cleaning; reserve procedural discussion for a defined diagnostic or therapeutic indication.

Apply it

Before moving an intubated patient to imaging, verify the transport ventilator and connections, confirm gas availability for the planned trip, and assess the patient on that system before departure with appropriate monitoring and backup support.

Apply it

A home-oxygen user plans to remove the cannula briefly while a visitor smokes nearby. Explain that smoking and ignition sources must be kept away from oxygen use and equipment, and review a safe household plan.