TMC Practice Exam ACTUAL EXAM
2026/2027 | Therapist Multiple Choice
Practice | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain I: Patient Data Evaluation & Recommendations
Q1: A 58-year-old female with a history of myasthenia gravis presents to the ED with progressive
weakness, nasal regurgitation, and difficulty clearing secretions. Vital signs: HR 102, BP 134/78, RR 24
(shallow), SpO2 91% on room air. Bedside pulmonary function shows: VC = 18 mL/kg (baseline 45
mL/kg), MIP = –42 cmH2O (baseline –80). ABG on room air: pH 7.34, PaCO2 52, PaO2 68, HCO3 27. What
is the MOST appropriate immediate action?
A. Administer neostigmine for myasthenic crisis
B. Initiate BiPAP with IPAP 14, EPAP 6, backup rate 14
C. Intubate electively for impending respiratory failure [CORRECT]
D. Perform aggressive chest physiotherapy and suctioning
Correct Answer: C
Rationale: Myasthenic crisis with declining VC (18 mL/kg, significant drop from baseline), low MIP (< –30
indicates weakness), hypercapnia (PaCO2 52), and bulbar symptoms (nasal regurgitation) indicates high
risk of acute respiratory failure. Elective intubation is safer than emergent. Distractor A (neostigmine)
treats myasthenia but will not reverse weakness quickly enough and can worsen secretions. Distractor B
(BiPAP) is relatively contraindicated with bulbar dysfunction due to aspiration risk. Distractor D
(CPT/suctioning) does not address neuromuscular weakness.
TMC strategy: Bulbar symptoms + dropping VC + hypercapnia = intubate; do not wait for crisis.
,Q2: A 72-year-old male with COPD is receiving oxygen via nasal cannula at 4 L/min. An ABG is drawn
with the patient breathing room air for 20 minutes prior to the draw (clerical error in order). Results: pH
7.38, PaCO2 58, PaO2 55, HCO3 34. The RT receives the results and notes the error. What is the best
interpretation of these results?
A. Chronic respiratory acidosis with renal compensation. [CORRECT]
B. Acute respiratory acidosis with hypoxemia.
C. Chronic respiratory alkalosis with metabolic compensation.
D. Normal acid-base balance with mild hypoxemia.
Correct Answer: A
Rationale: The pH is normal (7.38), but on the acidic side. The PaCO2 is elevated (58). The HCO3 is
elevated (34). This pattern (Normal pH, High PaCO2, High HCO3) indicates fully compensated respiratory
acidosis, consistent with the patient's chronic COPD history (CO2 retainer). The fact that the sample was
drawn on room air explains the PaO2 of 55, but the acid-base status reflects his chronic baseline.
TMC strategy: In COPD, look for "chronic" compensation (elevated HCO3 and normal/near-normal pH)
before treating as acute distress.
Q3: Upon reviewing a chest radiograph of an intubated patient, the RT notes the tip of the endotracheal
tube is located at the level of the aortic knob. The patient is scheduled for a CT scan. What is the
appropriate recommendation?
A. Withdraw the tube 2 cm.
B. Advance the tube 2 cm.
C. Secure the tube; placement is optimal. [CORRECT]
D. Re-x-ray after the CT scan.
Correct Answer: C
Rationale: The aortic knob is the standard landmark for the carina. If the tip is at the aortic knob, it is
approximately 3–5 cm above the carina, which is the ideal position to prevent right mainstem intubation
or accidental extubation. No adjustment is needed.
TMC strategy: Ideal ET tube placement = 3–5 cm above the carina (landmark: aortic knob).
,Q4: A patient is being evaluated for home oxygen therapy. Which of the following criteria must be met
for Medicare reimbursement?
A. PaO2 of 60 mmHg on room air during sleep.
B. SaO2 of 89% on room air during exercise.
C. PaO2 of 55 mmHg or SaO2 of 88% on room air at rest. [CORRECT]
D. PaO2 of 65 mmHg with signs of cor pulmonale.
Correct Answer: C
Rationale: Medicare guidelines require a PaO2 ≤ 55 mmHg or SaO2 ≤ 88% on room air at rest (stable
state). Higher values (56–59 mmHg) require evidence of cor pulmonale, polycythemia, or heart failure.
Option A is too high. Option B describes exercise qualification but requires documentation that oxygen
improves exercise capacity. Option D is close but the PaO2 must be <60 with complicating factors; 65 is
too high.
TMC strategy: Reimbursement threshold = PaO2 < 55 or SaO2 < 88% at rest.
Q5: Pulmonary function testing reveals the following: FVC 65% of predicted, FEV1 60% of predicted,
FEV1/FVC ratio 85%, TLC 70% of predicted. These findings are consistent with:
A. Obstructive lung disease.
B. Restrictive lung disease. [CORRECT]
C. Combined obstructive-restrictive disease.
D. Normal lung function.
Correct Answer: B
Rationale: A reduced FEV1/FVC ratio defines obstruction. Here, the ratio is normal (85%). Both FVC and
FEV1 are reduced, and critically, Total Lung Capacity (TLC) is reduced (<80% predicted). A reduction in
TLC is the hallmark of restrictive lung disease (e.g., pulmonary fibrosis).
TMC strategy: Low TLC = Restriction. Low FEV1/FVC Ratio = Obstruction.
, Q6: A cardiac output measurement is obtained via thermodilution. The following three measurements
are recorded: 4.2 L/min, 5.8 L/min, and 4.4 L/min. What should the RT do?
A. Average the three values and record 4.8 L/min.
B. Discard the highest and lowest values, report the middle value.
C. Discard the highest value, average the remaining two. [CORRECT]
D. Repeat the measurements until three values are within 10%.
Correct Answer: C
Rationale: The standard procedure for thermodilution cardiac output is to obtain three measurements
within 10% of each other. If one is an outlier (5.8 is significantly different from 4.2 and 4.4), it is
discarded. The remaining two are averaged: (4.2 + 4.4) / 2 = 4.3 L/min.
TMC strategy: Outlier rule: Discard the "off" number, average the close ones.
Q7: Which of the following capnography waveforms would be expected in a patient with severe COPD?
A. Tall waveform with steep upslope and plateau.
B. Flat waveform with no expiratory slope.
C. Waveform with a slanted upslope ("shark fin" appearance). [CORRECT]
D. Sudden drop to baseline during inspiration.
Correct Answer: C
Rationale: In COPD, airway obstruction causes slow emptying of the alveoli. This results in a gradual rise
in CO2 during expiration, creating a slanted upslope that resembles a shark fin. Option A is normal.
Option B suggests a leak or apnea. Option D is normal inspiration.
TMC strategy: "Shark fin" waveform = Obstruction (COPD/Asthma).
Q8: A 30-year-old male is being weaned from mechanical ventilation. Spontaneous Breathing Trial (SBT)
data: RSBI 95, NIF -25 cmH2O, Spontaneous Vt 400 mL. The patient appears anxious but denies
shortness of breath. What is the next step?
2026/2027 | Therapist Multiple Choice
Practice | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain I: Patient Data Evaluation & Recommendations
Q1: A 58-year-old female with a history of myasthenia gravis presents to the ED with progressive
weakness, nasal regurgitation, and difficulty clearing secretions. Vital signs: HR 102, BP 134/78, RR 24
(shallow), SpO2 91% on room air. Bedside pulmonary function shows: VC = 18 mL/kg (baseline 45
mL/kg), MIP = –42 cmH2O (baseline –80). ABG on room air: pH 7.34, PaCO2 52, PaO2 68, HCO3 27. What
is the MOST appropriate immediate action?
A. Administer neostigmine for myasthenic crisis
B. Initiate BiPAP with IPAP 14, EPAP 6, backup rate 14
C. Intubate electively for impending respiratory failure [CORRECT]
D. Perform aggressive chest physiotherapy and suctioning
Correct Answer: C
Rationale: Myasthenic crisis with declining VC (18 mL/kg, significant drop from baseline), low MIP (< –30
indicates weakness), hypercapnia (PaCO2 52), and bulbar symptoms (nasal regurgitation) indicates high
risk of acute respiratory failure. Elective intubation is safer than emergent. Distractor A (neostigmine)
treats myasthenia but will not reverse weakness quickly enough and can worsen secretions. Distractor B
(BiPAP) is relatively contraindicated with bulbar dysfunction due to aspiration risk. Distractor D
(CPT/suctioning) does not address neuromuscular weakness.
TMC strategy: Bulbar symptoms + dropping VC + hypercapnia = intubate; do not wait for crisis.
,Q2: A 72-year-old male with COPD is receiving oxygen via nasal cannula at 4 L/min. An ABG is drawn
with the patient breathing room air for 20 minutes prior to the draw (clerical error in order). Results: pH
7.38, PaCO2 58, PaO2 55, HCO3 34. The RT receives the results and notes the error. What is the best
interpretation of these results?
A. Chronic respiratory acidosis with renal compensation. [CORRECT]
B. Acute respiratory acidosis with hypoxemia.
C. Chronic respiratory alkalosis with metabolic compensation.
D. Normal acid-base balance with mild hypoxemia.
Correct Answer: A
Rationale: The pH is normal (7.38), but on the acidic side. The PaCO2 is elevated (58). The HCO3 is
elevated (34). This pattern (Normal pH, High PaCO2, High HCO3) indicates fully compensated respiratory
acidosis, consistent with the patient's chronic COPD history (CO2 retainer). The fact that the sample was
drawn on room air explains the PaO2 of 55, but the acid-base status reflects his chronic baseline.
TMC strategy: In COPD, look for "chronic" compensation (elevated HCO3 and normal/near-normal pH)
before treating as acute distress.
Q3: Upon reviewing a chest radiograph of an intubated patient, the RT notes the tip of the endotracheal
tube is located at the level of the aortic knob. The patient is scheduled for a CT scan. What is the
appropriate recommendation?
A. Withdraw the tube 2 cm.
B. Advance the tube 2 cm.
C. Secure the tube; placement is optimal. [CORRECT]
D. Re-x-ray after the CT scan.
Correct Answer: C
Rationale: The aortic knob is the standard landmark for the carina. If the tip is at the aortic knob, it is
approximately 3–5 cm above the carina, which is the ideal position to prevent right mainstem intubation
or accidental extubation. No adjustment is needed.
TMC strategy: Ideal ET tube placement = 3–5 cm above the carina (landmark: aortic knob).
,Q4: A patient is being evaluated for home oxygen therapy. Which of the following criteria must be met
for Medicare reimbursement?
A. PaO2 of 60 mmHg on room air during sleep.
B. SaO2 of 89% on room air during exercise.
C. PaO2 of 55 mmHg or SaO2 of 88% on room air at rest. [CORRECT]
D. PaO2 of 65 mmHg with signs of cor pulmonale.
Correct Answer: C
Rationale: Medicare guidelines require a PaO2 ≤ 55 mmHg or SaO2 ≤ 88% on room air at rest (stable
state). Higher values (56–59 mmHg) require evidence of cor pulmonale, polycythemia, or heart failure.
Option A is too high. Option B describes exercise qualification but requires documentation that oxygen
improves exercise capacity. Option D is close but the PaO2 must be <60 with complicating factors; 65 is
too high.
TMC strategy: Reimbursement threshold = PaO2 < 55 or SaO2 < 88% at rest.
Q5: Pulmonary function testing reveals the following: FVC 65% of predicted, FEV1 60% of predicted,
FEV1/FVC ratio 85%, TLC 70% of predicted. These findings are consistent with:
A. Obstructive lung disease.
B. Restrictive lung disease. [CORRECT]
C. Combined obstructive-restrictive disease.
D. Normal lung function.
Correct Answer: B
Rationale: A reduced FEV1/FVC ratio defines obstruction. Here, the ratio is normal (85%). Both FVC and
FEV1 are reduced, and critically, Total Lung Capacity (TLC) is reduced (<80% predicted). A reduction in
TLC is the hallmark of restrictive lung disease (e.g., pulmonary fibrosis).
TMC strategy: Low TLC = Restriction. Low FEV1/FVC Ratio = Obstruction.
, Q6: A cardiac output measurement is obtained via thermodilution. The following three measurements
are recorded: 4.2 L/min, 5.8 L/min, and 4.4 L/min. What should the RT do?
A. Average the three values and record 4.8 L/min.
B. Discard the highest and lowest values, report the middle value.
C. Discard the highest value, average the remaining two. [CORRECT]
D. Repeat the measurements until three values are within 10%.
Correct Answer: C
Rationale: The standard procedure for thermodilution cardiac output is to obtain three measurements
within 10% of each other. If one is an outlier (5.8 is significantly different from 4.2 and 4.4), it is
discarded. The remaining two are averaged: (4.2 + 4.4) / 2 = 4.3 L/min.
TMC strategy: Outlier rule: Discard the "off" number, average the close ones.
Q7: Which of the following capnography waveforms would be expected in a patient with severe COPD?
A. Tall waveform with steep upslope and plateau.
B. Flat waveform with no expiratory slope.
C. Waveform with a slanted upslope ("shark fin" appearance). [CORRECT]
D. Sudden drop to baseline during inspiration.
Correct Answer: C
Rationale: In COPD, airway obstruction causes slow emptying of the alveoli. This results in a gradual rise
in CO2 during expiration, creating a slanted upslope that resembles a shark fin. Option A is normal.
Option B suggests a leak or apnea. Option D is normal inspiration.
TMC strategy: "Shark fin" waveform = Obstruction (COPD/Asthma).
Q8: A 30-year-old male is being weaned from mechanical ventilation. Spontaneous Breathing Trial (SBT)
data: RSBI 95, NIF -25 cmH2O, Spontaneous Vt 400 mL. The patient appears anxious but denies
shortness of breath. What is the next step?
