TMC Style Question and Explanation Example 1

Below is a sample question, similar to ones you might find on the tmc exam. This type of question is an analysis type of question , they are the hardest and the least common type of question on the exam . Analysis questions often give people the most trouble on the exam and is the area that causes most people to fail. Practicing analysis type questions will help you prepare for the exam because it requires you to know the normal values and equipment and how to apply each. This will help you on all the other exam questions.

Following surgery a 39 female, that is 5’6”,145 lbs is receiving mechanical ventilation at the following settings:

  • Mode AC
    • TV 500
    • F 13
    • Peep 5
    • Fio2 .45

The following patient values are available

  • pH 7.38
  • PCO2 46
  • PO2 63
  • HCO3- 23
  • CVP 8 cmHG
  • PAP 15mmHg

The respiratory therapist should recommend the following change

  1. Increase the peep to 8
  2. Increase Fio2 to 55%
  3. Increase  TV to 600
  4. Increase RR to 16

The first thing you do is analyze the information and ask:

  • Is the patient ventilating? Yes, her co2 and pH are normal
  • Is the patient oxygenating? No, her pO2 i s 63 so she hypoxic, this must be treated. Two answers here address hypoxia, peep and fio2 since the fio2 is below 60 we address that first. The correct answer is to increase the fio2 to 55%

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