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Are You Struggling To Pass The TMC Exam? Respiratory Teacher Can Help You Pass The Exam With Ease. You've Come To The Right Place.  Our Ebook Is Like None Other.  Additionally, The Ebook Is Better Than Lindsey Jones And Ketterings.   Very Few Test Takers Have Passed The TMC Using  Lindsey Jones And Ketterings.  The Exam Prep Is Over Priced And The Information Does Not Reflect The Recent TMC Exam.  Order the TMC exam ebook today.

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What makes this ebook study guide different from the rest?  The study points were compiled from recent exam test takers from 2015 thru 2017, and recent examinations. A few questions from the ACS exam are introduced and could potentially be fair game for the TMC exam. The feedback from our study guide for first attempt exam candidates were a mean score of 110.

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NBRC RRT exam

NBRC RRT Self-Assessment Examination

Question Answers

During the administration of an IPPB treatment, the respiratory therapist notices the system pressure drops after inspiration is initiated. Which of the following actions will best correct this problem? Increase the flow setting.Flow should be increased as tolerated until system pressure rises quickly and holds near the preset value.


An erratic pulse is palpated on a patient. Which of the following should the respiratory therapist recommend to further evaluate this clinical presentation? ECG. An ECG is indicated to assess cardiac rhythm based on clinical presentation.


A patient requiring continuous oxygen at 3 L/min wants to maintain a very active lifestyle. Which of the following would be the best oxygen delivery system for the respiratory therapist to recommend? a liquid system. A liquid system is used for long-term continuous oxygen therapy. The portable units are light-weight, which makes the liquid system the choice for active patients.


The respiratory therapist determines the tip of an endotracheal tube is in the trachea below the aortic knob but 2 cm above the carina on inspection of an AP chest radiograph. The therapist reports the tube should be left in place.The position is currently correct; therefore, it should be left in place.


A patient is receiving 35% oxygen through an air-entrainment mask. Cool mist is being provided at the air-entrainment port. The FIO2 measured at the mask is 42%. Which of the following should the respiratory therapist do? Verify the integrity of the air-entrainment port. The determinants of FIO2 in this device are the jet size and the size of the entrainment ports. Any obstruction to the air-entrainment port will increase the FIO2 by decreasing the volume of air entrained.


A patient is suspected of having an upper airway obstruction. Which of the following tests should the respiratory therapist recommend to best detect this abnormality? flow-volume loops. The ability to measure and display both inspiratory and expiratory flows is the best way to detect upper airway obstruction.


A patient using a transdermal nicotine patch complains of local skin irritation and insomnia. Which of the following should the respiratory therapist first recommend? Frequently rotate the site and discontinue at night.Frequent rotation of patch sites may decrease irritation and discontinuing the use during bedtime hours may lessen insomnia.


When a patient cannot increase minute ventilation, increasing mechanical dead space in the ventilator circuit will cause increased PaCO2.Increased mechanical dead space with a constant minute ventilation will increase PaCO2 by an increase in VD/VT.


Which of the following chest radiographs provide the best view of the lung apex, lingula, and right middle lobe? lordotic. The lordotic position provides the best view of the lung apex, lingula, and the right middle lobe.


While gathering equipment in the ICU to set up an arterial line ordered STAT, the respiratory therapist notes the noncompliant pressure tubing is in a sterile package, but the corner of the package is open. Which of the following should the therapist do? Obtain an unopened, sterile pressure tubing.Arterial line tubing must be sterile.


Which of the following would indicate a physical conditioning protocol has been effective for a patient with COPD? The patient has increased his level-walking distance by 15%. An important part of physical conditioning is an increase in exercise tolerance.


Occlusion of the expiratory circuit just prior to the next ventilator delivered breath facilitates the measurement of auto-PEEP. Auto-PEEP is measured by subtracting set PEEP from the measured pressure during expiratory hold just prior to the next ventilator delivered breath.


A patient with chronic hypercapnia is receiving home oxygen therapy by nasal cannula at 2 L/min. The SpO2 is 90%. The patient should be told not to increase the flow because a higher oxygen flow may be dangerous.Excessive oxygen may lead to increased CO2 retention in patients who are hypercapneic.


A patient with severe COPD is receiving oxygen by nasal cannula at 4 L/min. The patient is lethargic and his respirations are shallow at a rate of 20/min.The pulse oximeter is reading 94%. Which of the following should the respiratory therapist recommend? Change to a 28% air-entrainment mask.An air-entrainment system will deliver a controlled FIO2.


An unpackaged HME is found lying on top of a ventilator. No condensate is observed inside the HME. The patient has no other humidification device in place. Which of the following should the respiratory therapist do? Open a new HME and attach it to the endotracheal tube. A clean HME is required.


79-year-old patient with COPD shows signs of increasing anxiety & cyanosis while Receiving continuous heated aerosol therapy. patient complains of tightness in his Chest,frequent cough produces a small amount of pink,frothy sputum.patient most likely has pulmonary edema.These symptoms and signs are most consistent with pulmonary edema.


A shift supervisor wishes to determine the number of patients who are to receive bronchodilator treatments during the next 8 hours. To obtain this information quickly, the supervisor could review the assignment list from the last shift.


While reviewing a patient's chart, results of a chest radiograph indicate complete opacification of the left chest with a shift of the trachea and mediastinum to the left. These findings are consistent with atelectasis of the left lung









When explaining the purpose of incentive spirometry to a patient after abdominal surgery, the respiratory therapist should tell the patient the procedure is performed to prevent areas of the lung from collapsing.


Which of the following therapeutic gas mixtures should the respiratory therapist select to improve the distribution of ventilation for a patient with high airway resistance? helium/oxygen


A patient involved in motor vehicle crash presents with respiratory distress,chest radiograph confirms presence of multiple adjacent ribs fractured on the left side.Which of the following physical findings would be expected during palpation of the chest? paradoxical motion of the left chest.


When the respiratory therapist initiates an IPPB treatment, the patient's pulse is 78/min. Five minutes after the therapy is started, the patient's pulse increases to 90/min. The therapist should continue the treatment as ordered.The magnitude of the increase in pulse rate is not excessive for the treatment provided.


The respiratory therapist assesses a patient receiving supplemental oxygen by a transtracheal oxygen catheter. The patient is diaphoretic, has a higher than normal respiratory rate, and appears cyanotic. Which of the following is a possible explanation? The transtracheal catheter is obstructed by a mucous plug.


To assess an outcome indicator of the department's bronchodilator QA program, the respiratory therapist should monitor the average length-of-stay for patients receiving bronchodilators.


A 7-day-old neonate of 28-weeks gestational age is having frequent periods of apnea with desaturation. Which of the following should the respiratory therapist recommend? theophylline (Aminophylline)


While assisting with a therapeutic bronchoscopy for an adult patient, the physician is suddenly unable to view any anatomy because everything went black. Which of the following is a likely cause? The light source is disconnected.


A patient receiving mechanical ventilation using PEEP switched continuous-flow CPAP system for weaning. On initial evaluation,manometer shows negative pressure during inspiration & patient appears agitated & uncomfortable. Which is most appropriate Increase system flow. The reason for the negative pressure on the manometer is inadequate flow during inspiration. Increasing system flow would correct the problem.


During an interview, a patient with COPD who was recently admitted to the hospital tells the respiratory therapist that she does not want any heroic measures performed to lengthen her life. This information would best be documented in the advance directive. Documentation of a patient's desires regarding heroic measures should be specified in an advance directive. This can only be changed by the patient.

patient who is oxygen-dependent travels using oxygen from an E cylinder secured in back seat. He carries a spare cylinder in the trunk of his car when he plans to be out for longer periods of time. Respiratory therapist should inform the patient he should secure the spare cylinder in the back seat.


During nasotracheal suctioning, the patient does not cough, but watery secretions are aspirated through the catheter. Which of the following should the respiratory therapist do next? Hyperextend the patient's neck when passing the catheter.


Which of the following pharmacologic agents should be recommended for a patient who is intubated, receiving mechanical ventilation, and experiencing severe pain from a flail chest? morphine sulfate


A patient presents with sudden onset of dyspnea associated with cough, sputum production, and a chest radiograph demonstrating opacification of the right lower lobe. Which of the following is most consistent with these findings? asymmetrical chest movement


Which of the following is the best site for capnograph sampling during mechanical ventilation while using the SIMV mode? endotracheal tube connector

The respiratory therapist is treating a patient with pulmonary emphysema. During the course of therapy, the patient becomes very dyspneic. The therapist should instruct the patient to perform pursed-lip breathing. Pursed-lip breathing may allow improved exhalation by stabilization of the airways. This maneuver should decrease dyspnea.


The respiratory therapist is using a spring-loaded PEEP valve and notices the pressure reading on the manometer is 5 cm H2O higher than the set level. Which of the following is the probable cause? Secretions are in the valve. Secretions in the valve will cause the valve to stick, resulting in a higher pressure.


A 54.5-kg (120-lb) female has a respiratory rate of 30/min and a tidal volume of 200 mL. Her respirations dropped to 10/min and her tidal volume increased to 600 mL after a sedative was administered.Which of the following ventilatory parameters increased? alveolar ventilation.


An adult patient is receiving volume-controlled ventilation. The patient's peak airway pressure is 35 cm H2O and the plateau pressure is 25 cm H2O. The respiratory therapist would recommend the high pressure alarm be set at 45 cm H2O. The high airway pressure alarm must be set above the peak airway pressure to ensure set tidal volume delivery. The guideline is 10 to 15 cm H2O above the peak inspiratory pressure.


When performing quality control on an automated blood gas analyzer, the respiratory therapist notices the pH value is more than 2 standard deviations from the control group mean. The therapist should initially remeasure the reference sample.


Ventilator Induced Lung Injury

Ventilator-associated lung injury (VALI) is an acute lung injury that develops during mechanical ventilation and is termed ventilator-induced lung injury (VILI) if it can be proven that the mechanical ventilation caused the acute lung injury. In contrast, ventilator-associated lung injury (VALI) exists if the cause cannot be proven. VALI is the appropriate term in most situations because it is virtually impossible to prove what actually caused the lung injury in the hospital.





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Modes Of Ventilation

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Pressure Control Ventilation


Pressure-Controlled Ventilation (PCV)

Less risk of barotrauma as compared to ACV and SIMV. Does not allow for patient-initiated breaths. The inspiratory flow pattern decreases exponentially, reducing peak pressures and improving gas exchange [Chest 122: 2096, 2002]. The major disadvantage is that there are no guarantees for volume, especially when lung mechanics are changing. Thus, PCV has traditionally been preferred for patients with neuromuscular disease but otherwise normal lungs






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Assist Control


Assist-Control Ventilation (ACV)

Also known as continuous mandatory ventilation (CMV). Each breath is either an assist or control breath, but they are all of the same volume. The larger the volume, the more expiratory time required. If the I:E ratio is less than 1:2, progressive hyperinflation may result. ACV is particularly undesirable for patients who breathe rapidly – they may induce both hyperinflation and respiratory alkalosis. Note that mechanical ventilation does not eliminate the work of breathing, because the diaphragm may still be very active.

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Pressure Support Ventilation


Pressure Support Ventilation (PSV)

Allows the patient to determine inflation volume and respiratory frequency (but not pressure, as this is pressure-controlled), thus can only be used to augment spontaneous breathing. Pressure support can be used to overcome the resistance of ventilator tubing in another cycle (5 – 10 cm H20 are generally used, especially during weaning), or to augment spontaneous breathing. PSV can be delivered through specialized face masks.

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Pressure Controlled Inverse Ratio Ventilation


Pressure Controlled Inverse Ratio Ventilation (PCIRV)

Pressure controlled ventilatory mode in which the majority of time is spent at the higher (inspiratory) pressure. Early trials were promising, however the risks of auto PEEP and hemodynamic deterioration due to the decreased expiratory time and increased mean airway pressure generally outweight the small potential for improved oxygenation

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Airway Pressure Release Ventilation


Airway Pressure Release Ventilation (APRV)

Airway pressure release ventilation is similar to PCIRV – instead of being a variation of PCV in which the I:E ratio is reversed, APRV is a variation of CPAP that releases pressure temporarily on exhalation. This unique mode of ventilation results in higher average airway pressures. Patients are able to spontaneously ventilate at both low and high pressures, although typically most (or all) ventilation occurs at the high pressure. In the absence of attempted breaths, APRV and PCIRV are identical. As in PCIRV, hemodynamic compromise is a concern in APRV. Additionally, APRV typically requires increased sedation

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SIMV


Synchronized Intermittent-Mandatory Ventilation (SIMV)

Guarantees a certain number of breaths, but unlike ACV, patient breaths are partially their own, reducing the risk of hyperinflation or alkalosis. Mandatory breaths are synchronized to coincide with spontaneous respirations. Disadvantages of SIMV are increased work of breathing and a tendency to reduce cardiac output, which may prolong ventilator dependency. The addition of pressure support on top of spontaneous breaths can reduce some of the work of breathing. SIMV has been shown to decrease cardiac output in patients with left-ventricular dysfunction

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Customer Reviews



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