TMC Exam – Secure Comprehensive Therapist SAE Exam-Style Practice
Bank 2026: 200 Original Multiple-Choice Questions with 100% Correct
Detailed Answers and Explanations
Questions 1–50
1. A patient receiving mechanical ventilation has a sudden increase in peak inspiratory pressure (PIP)
with no change in plateau pressure (Pplat). Which is the most likely cause?
• A) Decreased lung compliance
• B) Increased airway resistance
• C) Pneumothorax
• D) Mainstem bronchus intubation
Answer: B) Increased airway resistance
Rationale: Increased PIP with unchanged Pplat indicates increased airway resistance (bronchospasm,
secretions, kinked tube). Decreased compliance (A) would raise both PIP and Pplat. Pneumothorax (C)
and mainstem intubation (D) also raise both.
2. A patient on volume-controlled ventilation has a set tidal volume of 500 mL. The measured exhaled
tidal volume is 350 mL. What is the most appropriate initial action?
• A) Increase the set tidal volume
• B) Check for air leak in the circuit or ET tube cuff
• C) Change to pressure-controlled ventilation
• D) Increase the respiratory rate
Answer: B) Check for air leak in the circuit or ET tube cuff
Rationale: Large difference between set and exhaled tidal volume suggests an air leak (cuff leak, circuit
disconnect). Always check the system first before changing settings.
3. A patient with COPD has the following ABG on 2 L nasal cannula: pH 7.36, PaCO2 58, PaO2 68, HCO3
34. Which interpretation is correct?
• A) Acute respiratory acidosis
• B) Partially compensated metabolic alkalosis
• C) Fully compensated respiratory acidosis
, • D) Acute respiratory alkalosis
Answer: C) Fully compensated respiratory acidosis
Rationale: pH is normal (7.35–7.45) despite elevated PaCO2 (58). Elevated HCO3 (34) indicates
metabolic compensation. Normal pH = fully compensated respiratory acidosis.
4. A patient has a spontaneous breathing trial (SBT) with pressure support of 5 cm H2O and PEEP of 5
cm H2O. After 20 minutes, respiratory rate is 32, heart rate 130, SpO2 88%, and patient is anxious.
What should the therapist recommend?
• A) Extubate immediately
• B) Return to full ventilator support
• C) Increase pressure support to 10 cm H2O
• D) Perform a cuff leak test
Answer: B) Return to full ventilator support
Rationale: Signs of SBT failure (tachypnea, hypoxemia, tachycardia, anxiety). Abort SBT and return to full
support. Extubation (A) unsafe. Increasing PS (C) not appropriate for failed SBT.
5. Which of the following settings would most likely auto-PEEP (intrinsic PEEP) in a patient with
COPD?
• A) Tidal volume 8 mL/kg, respiratory rate 12, inspiratory flow 60 L/min
• B) Tidal volume 6 mL/kg, respiratory rate 20, inspiratory flow 40 L/min
• C) Tidal volume 10 mL/kg, respiratory rate 10, inspiratory flow 80 L/min
• D) Tidal volume 8 mL/kg, respiratory rate 15, inspiratory flow 70 L/min
Answer: B) Tidal volume 6 mL/kg, respiratory rate 20, inspiratory flow 40 L/min
Rationale: High respiratory rate (20) and low inspiratory flow (40) shorten expiratory time, leading to air
trapping and auto-PEEP in COPD patients. Lower RR and higher flow allow complete exhalation.
6. A patient with ARDS is on pressure control ventilation with a PEEP of 12 cm H2O. The plateau
pressure is 32 cm H2O. Which intervention is most appropriate to reduce ventilator-induced lung
injury (VILI)?
• A) Increase PEEP to 15
• B) Decrease tidal volume and allow permissive hypercapnia
• C) Increase respiratory rate to 30
• D) Switch to volume control
,Answer: B) Decrease tidal volume and allow permissive hypercapnia
Rationale: In ARDS, lung-protective ventilation targets plateau pressure <30 cm H2O. Decrease tidal
volume (even if PaCO2 rises) to reduce VILI. Increasing PEEP (A) may raise plateau further.
7. A patient on a ventilator has an endotracheal tube cuff pressure of 40 cm H2O. What is the priority
action?
• A) Document as normal
• B) Deflate the cuff immediately
• C) Decrease cuff pressure to 20–30 cm H2O
• D) Add more air to the cuff
Answer: C) Decrease cuff pressure to 20–30 cm H2O
Rationale: Normal cuff pressure is 20–30 cm H2O (or 25–35 cm H2O depending on reference). 40 cm
H2O risks tracheal ischemia. Deflate and reinflate to correct pressure. Do not leave deflated (B) – risk
aspiration.
8. A patient receiving heliox (80% helium, 20% oxygen) has a flowmeter set at 10 L/min. The actual
flow delivered to the patient is:
• A) 5 L/min
• B) 10 L/min
• C) 15 L/min
• D) 18 L/min
Answer: D) Approximately 18 L/min
Rationale: Helium is less dense, so flowmeter (calibrated for air/O2) under-reads. Correction factor for
80/20 heliox is ~1.8. 10 × 1.8 = 18 L/min.
9. Which of the following is the most reliable method to verify endotracheal tube placement
immediately after intubation?
• A) Auscultation of bilateral breath sounds
• B) Chest x-ray
• C) Capnography (end-tidal CO2)
• D) Pulse oximetry
Answer: C) Capnography (end-tidal CO2)
Rationale: Continuous waveform capnography confirms ET tube placement in trachea (exhaled CO2).
, Chest x-ray (B) confirms depth but takes time. Auscultation (A) can be misleading. Pulse ox (D) not
reliable for placement.
10. A patient with status asthmaticus is intubated and on volume-controlled ventilation. The peak
pressure is 55 cm H2O, plateau pressure 50 cm H2O. What is the priority intervention?
• A) Increase inspiratory flow
• B) Switch to pressure control with permissive hypercapnia
• C) Increase PEEP
• D) Administer a neuromuscular blocker
Answer: B) Switch to pressure control with permissive hypercapnia
Rationale: High plateau pressure (>30) risks barotrauma. Permissive hypercapnia allows lower tidal
volumes. Pressure control limits pressure. Increasing PEEP (C) may worsen hyperinflation.
11. A patient on a home ventilator has a high-pressure alarm. The therapist observes that the patient
is coughing and the circuit has condensation. What is the most appropriate action?
• A) Increase the high-pressure limit
• B) Suction the patient and drain the circuit
• C) Decrease tidal volume
• D) Change the ventilator
Answer: B) Suction the patient and drain the circuit
Rationale: Coughing and condensation increase airway resistance and circuit resistance, causing high
pressure. Suctioning and draining water will resolve. Do not increase alarm limit without fixing cause.
12. A patient has a PaO2 of 55 mm Hg on 40% Venturi mask. What is the PaO2/FiO2 (P/F) ratio?
• A) 137.5
• B) 110
• C) 220
• D) 275
Answer: A) 137.5
Rationale: FiO2 for 40% = 0.40. P/F = PaO2 / FiO2 = .40 = 137.5. Normal >400, ARDS <200.
13. Which of the following nebulizer medications requires refrigeration?
Bank 2026: 200 Original Multiple-Choice Questions with 100% Correct
Detailed Answers and Explanations
Questions 1–50
1. A patient receiving mechanical ventilation has a sudden increase in peak inspiratory pressure (PIP)
with no change in plateau pressure (Pplat). Which is the most likely cause?
• A) Decreased lung compliance
• B) Increased airway resistance
• C) Pneumothorax
• D) Mainstem bronchus intubation
Answer: B) Increased airway resistance
Rationale: Increased PIP with unchanged Pplat indicates increased airway resistance (bronchospasm,
secretions, kinked tube). Decreased compliance (A) would raise both PIP and Pplat. Pneumothorax (C)
and mainstem intubation (D) also raise both.
2. A patient on volume-controlled ventilation has a set tidal volume of 500 mL. The measured exhaled
tidal volume is 350 mL. What is the most appropriate initial action?
• A) Increase the set tidal volume
• B) Check for air leak in the circuit or ET tube cuff
• C) Change to pressure-controlled ventilation
• D) Increase the respiratory rate
Answer: B) Check for air leak in the circuit or ET tube cuff
Rationale: Large difference between set and exhaled tidal volume suggests an air leak (cuff leak, circuit
disconnect). Always check the system first before changing settings.
3. A patient with COPD has the following ABG on 2 L nasal cannula: pH 7.36, PaCO2 58, PaO2 68, HCO3
34. Which interpretation is correct?
• A) Acute respiratory acidosis
• B) Partially compensated metabolic alkalosis
• C) Fully compensated respiratory acidosis
, • D) Acute respiratory alkalosis
Answer: C) Fully compensated respiratory acidosis
Rationale: pH is normal (7.35–7.45) despite elevated PaCO2 (58). Elevated HCO3 (34) indicates
metabolic compensation. Normal pH = fully compensated respiratory acidosis.
4. A patient has a spontaneous breathing trial (SBT) with pressure support of 5 cm H2O and PEEP of 5
cm H2O. After 20 minutes, respiratory rate is 32, heart rate 130, SpO2 88%, and patient is anxious.
What should the therapist recommend?
• A) Extubate immediately
• B) Return to full ventilator support
• C) Increase pressure support to 10 cm H2O
• D) Perform a cuff leak test
Answer: B) Return to full ventilator support
Rationale: Signs of SBT failure (tachypnea, hypoxemia, tachycardia, anxiety). Abort SBT and return to full
support. Extubation (A) unsafe. Increasing PS (C) not appropriate for failed SBT.
5. Which of the following settings would most likely auto-PEEP (intrinsic PEEP) in a patient with
COPD?
• A) Tidal volume 8 mL/kg, respiratory rate 12, inspiratory flow 60 L/min
• B) Tidal volume 6 mL/kg, respiratory rate 20, inspiratory flow 40 L/min
• C) Tidal volume 10 mL/kg, respiratory rate 10, inspiratory flow 80 L/min
• D) Tidal volume 8 mL/kg, respiratory rate 15, inspiratory flow 70 L/min
Answer: B) Tidal volume 6 mL/kg, respiratory rate 20, inspiratory flow 40 L/min
Rationale: High respiratory rate (20) and low inspiratory flow (40) shorten expiratory time, leading to air
trapping and auto-PEEP in COPD patients. Lower RR and higher flow allow complete exhalation.
6. A patient with ARDS is on pressure control ventilation with a PEEP of 12 cm H2O. The plateau
pressure is 32 cm H2O. Which intervention is most appropriate to reduce ventilator-induced lung
injury (VILI)?
• A) Increase PEEP to 15
• B) Decrease tidal volume and allow permissive hypercapnia
• C) Increase respiratory rate to 30
• D) Switch to volume control
,Answer: B) Decrease tidal volume and allow permissive hypercapnia
Rationale: In ARDS, lung-protective ventilation targets plateau pressure <30 cm H2O. Decrease tidal
volume (even if PaCO2 rises) to reduce VILI. Increasing PEEP (A) may raise plateau further.
7. A patient on a ventilator has an endotracheal tube cuff pressure of 40 cm H2O. What is the priority
action?
• A) Document as normal
• B) Deflate the cuff immediately
• C) Decrease cuff pressure to 20–30 cm H2O
• D) Add more air to the cuff
Answer: C) Decrease cuff pressure to 20–30 cm H2O
Rationale: Normal cuff pressure is 20–30 cm H2O (or 25–35 cm H2O depending on reference). 40 cm
H2O risks tracheal ischemia. Deflate and reinflate to correct pressure. Do not leave deflated (B) – risk
aspiration.
8. A patient receiving heliox (80% helium, 20% oxygen) has a flowmeter set at 10 L/min. The actual
flow delivered to the patient is:
• A) 5 L/min
• B) 10 L/min
• C) 15 L/min
• D) 18 L/min
Answer: D) Approximately 18 L/min
Rationale: Helium is less dense, so flowmeter (calibrated for air/O2) under-reads. Correction factor for
80/20 heliox is ~1.8. 10 × 1.8 = 18 L/min.
9. Which of the following is the most reliable method to verify endotracheal tube placement
immediately after intubation?
• A) Auscultation of bilateral breath sounds
• B) Chest x-ray
• C) Capnography (end-tidal CO2)
• D) Pulse oximetry
Answer: C) Capnography (end-tidal CO2)
Rationale: Continuous waveform capnography confirms ET tube placement in trachea (exhaled CO2).
, Chest x-ray (B) confirms depth but takes time. Auscultation (A) can be misleading. Pulse ox (D) not
reliable for placement.
10. A patient with status asthmaticus is intubated and on volume-controlled ventilation. The peak
pressure is 55 cm H2O, plateau pressure 50 cm H2O. What is the priority intervention?
• A) Increase inspiratory flow
• B) Switch to pressure control with permissive hypercapnia
• C) Increase PEEP
• D) Administer a neuromuscular blocker
Answer: B) Switch to pressure control with permissive hypercapnia
Rationale: High plateau pressure (>30) risks barotrauma. Permissive hypercapnia allows lower tidal
volumes. Pressure control limits pressure. Increasing PEEP (C) may worsen hyperinflation.
11. A patient on a home ventilator has a high-pressure alarm. The therapist observes that the patient
is coughing and the circuit has condensation. What is the most appropriate action?
• A) Increase the high-pressure limit
• B) Suction the patient and drain the circuit
• C) Decrease tidal volume
• D) Change the ventilator
Answer: B) Suction the patient and drain the circuit
Rationale: Coughing and condensation increase airway resistance and circuit resistance, causing high
pressure. Suctioning and draining water will resolve. Do not increase alarm limit without fixing cause.
12. A patient has a PaO2 of 55 mm Hg on 40% Venturi mask. What is the PaO2/FiO2 (P/F) ratio?
• A) 137.5
• B) 110
• C) 220
• D) 275
Answer: A) 137.5
Rationale: FiO2 for 40% = 0.40. P/F = PaO2 / FiO2 = .40 = 137.5. Normal >400, ARDS <200.
13. Which of the following nebulizer medications requires refrigeration?
