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TMC Mock Exam 100% Correct Questions and Answers.

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TMC Mock Exam 100% Correct Questions and Answers Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia begins to exhibit hypotension and decreased consciousness... . Which of the following actions would you recommend at this time? immediately initiate CPR apply cardioversion administer epinephrine defibrillate the patient. Ans- apply cardioversion *If drug management fails, if the ventricular rate exceeds 150/min, or if the patient becomes hemodynamically unstable, synchronous cardioversion is indicated. A physician orders intubation and volume-controlled A/C ventilation for a 6-foot, 3-inch tall 190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator settings would you aim for to support this patient? rate/min: 10; VT (mL): 800 rate/min: 15; VT (mL): 500 rate/min: 20; VT (mL): 900 rate/min: 8; VT (mL): 1200. Ans- rate/min: 15; VT (mL): 500 Tidal volume 6ml/kg IBW 6ft 3= 85kg IBW Vt= 500 Rate= 10 to 20 A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a targeted tidal volume of 420 mL To maintain adequate ventilation with this tidal volume, the maximum respiratory rate you would allow is: 25/min 35/min 20/min 30/min. Ans- 35/min Which of the following PaCO2 levels would be considered a positive result for brain death determination at the end of an apnea test? -at least 50 mm Hg-at least 45 mm Hg -at least 60 mm Hg -at least 55 mm Hg. Ans- at least 60 mm Hg or 20+ from baseline CO2 A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of 650 mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives would you recommend to help overcome this problem? 1. add an end-inspiratory pause 2. switch to SIMV and decrease the rate 3. increase the inspiratory flow 2 and 3 only 1, 2, and 3 1 and 3 only 1 and 2 only. Ans- 2 and 3 only * Adding an end-inspiratory pause would cause more airtrapping A patient who just underwent major thoracic surgery is placed on pressure-controlled A/C ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water seal chamber of his pleural drainage system. Which of the following is the most likely cause of this observation? -the patient has a pleural effusion -the suction/ vacuum pressure is too low -the drainage system is obstructed -the patient has a bronchopleural fistula. Ans- the patient has a bronchopleural fistula * Constant bubbling indicates a leak; either in the patient or in the tubing/chamber system. To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you would: -measure pressure during an end-expiratory pause -measure expiratory flow before and after bronchodilator -measure pressure at volume increments using a super syringe -measure pressure during an end-inspiratory pause. Ans- measure pressure during an end-expiratory pause Which of the following indicate that a pleural drainage system is working properly? 1. the water seal chamber level rises and falls with breathing 2. there is continuous bubbling in the suction control chamber 3. there is continuous bubbling in the water seal chamber1, 2, and 3 1 only 1 and 2 3 only. Ans- 1 and 2 * Suction control should bubble continuously and water seal chamber should rise and fall. * Continuous bubbling in the water seal chamber= leak. A physician wants to calculate the static lung compliance for a 110-kg patient receiving volume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900 ml, Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10 cmH2O, Mechanical dead space 100ml. The patient's static lung compliance is: 22 mL/cmH2O 26 mL/cmH2O 18 mL/cmH2O 36 mL/cmH2O. Ans- 36 mL/cmH2O *VT/(Plat-PEEP) A physician has attempted on several occasions to insert a central venous catheter into the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator's high-pressure alarm sounds, the patient's blood pressure drops, and the SPO2 value drips from 96% to 84%. Breath sounds are greatly diminished over the right-lung field. What action should you recommend? -insert a chest tube into the right pleural space -insert a pulmonary artery catheter -pull the ET back 2-3 cm into the trachea -insert a chest tube into the left pleural space. Ans- insert a chest tube into the right pleural space * Pneumothorax is a complication of central venous catheter. A 48-year-old 180-lb male is orally intubated receiving mechanical ventilation with a 6.0 mm endotracheal tube secured in place, which requires a cuff pressure of 38 cm H2O to prevent significant volume loss. Which of the following actions would be appropriate in this case? -accept the large volume loss during inspiration -deflate and reinflate the cuff with 20 ml of air -replace the endotracheal tube with a larger size-replace the endotracheal tube with a smaller size. Ans- replace the endotracheal tube with a larger size *Most common cause of high ET tube cuff pressure is the tube is too small You are assisting with the oral intubation of an adult patient. After the ET tube has been placed, you note that breath sounds are decreased on the left compared with the right lung. The most likely cause of this observation is: -the tip of the tube is in the right mainstem bronchus -the endotracheal tube has been inserted into the esophagus -the cuff of the endotracheal tube has been overinflated -the tip Of the tube is in the left mainstem bronchus. Ans- the tip of the tube is in the right mainstem bronchus *Confirmed with CXR and corrected by withdrawing tube until it is 4-6cm above carina To minimize the risk of aspiration of glottic secretions or cord damage during removal of an oral endotracheal tube, you should: -have the patient cough while you quickly pull the tube -fully occlude the ET tube while you quickly it out -provide 100% o»gen for 1-2 minute before extubation -keep the tube cuff pressure below 25—30 cm H20. Ans- have the patient cough while you quickly pull the tube * Prevents damage to vocal cords and minimizes aspiration If progressively higher and higher cuff pressures are needed to avoid leakage over time, the most likely problem is: -tracheal dilation/tracheomalacia -tube is too small -tracheal stenosis -right mainstem intubation. Ans- dilation/tracheomalacia * Or cuff/pilot balloon malfunction [Show More]

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