NBRC TMC Exam Prep 2026 | 300+ Q&A
with Rationales | Therapist Multiple
Choice Practice Test Bank
Domain 1: Patient Assessment & Diagnostics (Questions 1-25)
Q1. A patient's sputum is purulent, green in appearance, has separated into
layers, and has a foul odor. What is the most likely cause?
A. Aspiration
B. Tuberculosis
C. Emphysema
D. Bronchiectasis
,,,ANSWER,,,: D. Bronchiectasis
Rationale: The classic description of sputum that separates into three layers
(frothy, purulent, and sediment) with a foul odor is pathognomonic for
bronchiectasis. Chronic inflammation and infection in dilated airways lead to
pooling of secretions that develop these characteristic layers .
Q2. Which of the following is the primary function of the alveoli in the lungs?
A. Transport oxygen through the bloodstream
B. Facilitate gas exchange between air and blood
,C. Produce surfactant
D. Filter inhaled particles
,,,ANSWER,,,: B. Facilitate gas exchange between air and blood
Rationale: The alveoli are the primary sites for gas exchange, allowing oxygen to
diffuse into the blood and carbon dioxide to diffuse out. While type II alveolar
cells do produce surfactant, this is not their primary function in the context of gas
exchange .
Q3. A patient presents with a PaCO₂ of 55 mm Hg and pH of 7.28. What is the
most likely diagnosis?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
,,,ANSWER,,,: C. Respiratory acidosis
Rationale: Elevated PaCO₂ (normal 35-45 mm Hg) with decreased pH (normal
7.35-7.45) indicates respiratory acidosis due to hypoventilation. The primary
abnormality is CO₂ retention, which leads to acidemia .
Q4. A 23-year-old patient is in moderate respiratory distress while receiving
oxygen. ABG: pH 7.42, PaCO₂ 31 mm Hg, PaO₂ 38 mm Hg, HCO₃ 20 mEq/L,
BE -3, SaO₂ 71%. How should these results be interpreted?
A. Acute respiratory acidosis with hypoxemia
B. Chronic respiratory alkalosis with severe hypoxemia
,C. Metabolic acidosis with respiratory compensation
D. Normal ABG with mild hypoxemia
,,,ANSWER,,,: B. Chronic respiratory alkalosis with severe hypoxemia
Rationale: The pH is at the high end of normal (7.42) with low PaCO₂ (31 mm
Hg) and slightly low HCO₃ (20 mEq/L), indicating chronic respiratory alkalosis
with metabolic compensation. The PaO₂ of 38 mm Hg represents severe
hypoxemia (normal 80-100 mm Hg) .
Q5. A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), 41-
year-old female who was admitted 12 hours ago for an aspirin overdose. HR
89/min, RR 15/min, BP 110/70 mm Hg, SpO₂ 86%. What should the
respiratory therapist do first?
A. Initiate oxygen at 4 L/min by nasal cannula
B. Record the results in the medical record
C. Obtain an arterial blood gas sample
D. Validate the SpO₂ reading at a different site
,,,ANSWER,,,: D. Validate the SpO₂ reading at a different site
Rationale: The saturation may not be accurate (aspirin overdose can cause false
readings due to metabolic acidosis or poor perfusion). The reading should be
verified at a different site before initiating therapy .
Q6. Which of the following is a sign of right-sided heart failure secondary to
pulmonary disease (cor pulmonale)?
A. Pulmonary crackles
, B. Jugular venous distension
C. Peripheral edema
D. Orthopnea
,,,ANSWER,,,: B. Jugular venous distension
Rationale: Cor pulmonale causes systemic venous congestion. Jugular venous
distension (JVD) is a classic sign of elevated right atrial pressure from right-sided
heart failure. Peripheral edema is a later finding and less specific .
Q7. The polysomnography sleep laboratory is fully scheduled for several
weeks. The physician wants to know if there is another option to determine if
a patient has sleep apnea. What should be recommended?
A. Overnight pulse oximetry
B. Nasal air flow monitoring
C. Holter monitoring for 48 hours
D. Chest-wall and abdominal-wall impedance comparison
,,,ANSWER,,,: A. Overnight pulse oximetry
Rationale: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation characteristically
decreases during apneic episodes, providing indirect evidence of the condition
when formal polysomnography is unavailable .
Q8. A respiratory therapist is called to the ED for a 1-year-old with difficulty
breathing. Severe suprasternal, subcostal, and substernal retractions are
observed. The child has a harsh, barking cough. Stridor is present. The
with Rationales | Therapist Multiple
Choice Practice Test Bank
Domain 1: Patient Assessment & Diagnostics (Questions 1-25)
Q1. A patient's sputum is purulent, green in appearance, has separated into
layers, and has a foul odor. What is the most likely cause?
A. Aspiration
B. Tuberculosis
C. Emphysema
D. Bronchiectasis
,,,ANSWER,,,: D. Bronchiectasis
Rationale: The classic description of sputum that separates into three layers
(frothy, purulent, and sediment) with a foul odor is pathognomonic for
bronchiectasis. Chronic inflammation and infection in dilated airways lead to
pooling of secretions that develop these characteristic layers .
Q2. Which of the following is the primary function of the alveoli in the lungs?
A. Transport oxygen through the bloodstream
B. Facilitate gas exchange between air and blood
,C. Produce surfactant
D. Filter inhaled particles
,,,ANSWER,,,: B. Facilitate gas exchange between air and blood
Rationale: The alveoli are the primary sites for gas exchange, allowing oxygen to
diffuse into the blood and carbon dioxide to diffuse out. While type II alveolar
cells do produce surfactant, this is not their primary function in the context of gas
exchange .
Q3. A patient presents with a PaCO₂ of 55 mm Hg and pH of 7.28. What is the
most likely diagnosis?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
,,,ANSWER,,,: C. Respiratory acidosis
Rationale: Elevated PaCO₂ (normal 35-45 mm Hg) with decreased pH (normal
7.35-7.45) indicates respiratory acidosis due to hypoventilation. The primary
abnormality is CO₂ retention, which leads to acidemia .
Q4. A 23-year-old patient is in moderate respiratory distress while receiving
oxygen. ABG: pH 7.42, PaCO₂ 31 mm Hg, PaO₂ 38 mm Hg, HCO₃ 20 mEq/L,
BE -3, SaO₂ 71%. How should these results be interpreted?
A. Acute respiratory acidosis with hypoxemia
B. Chronic respiratory alkalosis with severe hypoxemia
,C. Metabolic acidosis with respiratory compensation
D. Normal ABG with mild hypoxemia
,,,ANSWER,,,: B. Chronic respiratory alkalosis with severe hypoxemia
Rationale: The pH is at the high end of normal (7.42) with low PaCO₂ (31 mm
Hg) and slightly low HCO₃ (20 mEq/L), indicating chronic respiratory alkalosis
with metabolic compensation. The PaO₂ of 38 mm Hg represents severe
hypoxemia (normal 80-100 mm Hg) .
Q5. A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), 41-
year-old female who was admitted 12 hours ago for an aspirin overdose. HR
89/min, RR 15/min, BP 110/70 mm Hg, SpO₂ 86%. What should the
respiratory therapist do first?
A. Initiate oxygen at 4 L/min by nasal cannula
B. Record the results in the medical record
C. Obtain an arterial blood gas sample
D. Validate the SpO₂ reading at a different site
,,,ANSWER,,,: D. Validate the SpO₂ reading at a different site
Rationale: The saturation may not be accurate (aspirin overdose can cause false
readings due to metabolic acidosis or poor perfusion). The reading should be
verified at a different site before initiating therapy .
Q6. Which of the following is a sign of right-sided heart failure secondary to
pulmonary disease (cor pulmonale)?
A. Pulmonary crackles
, B. Jugular venous distension
C. Peripheral edema
D. Orthopnea
,,,ANSWER,,,: B. Jugular venous distension
Rationale: Cor pulmonale causes systemic venous congestion. Jugular venous
distension (JVD) is a classic sign of elevated right atrial pressure from right-sided
heart failure. Peripheral edema is a later finding and less specific .
Q7. The polysomnography sleep laboratory is fully scheduled for several
weeks. The physician wants to know if there is another option to determine if
a patient has sleep apnea. What should be recommended?
A. Overnight pulse oximetry
B. Nasal air flow monitoring
C. Holter monitoring for 48 hours
D. Chest-wall and abdominal-wall impedance comparison
,,,ANSWER,,,: A. Overnight pulse oximetry
Rationale: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation characteristically
decreases during apneic episodes, providing indirect evidence of the condition
when formal polysomnography is unavailable .
Q8. A respiratory therapist is called to the ED for a 1-year-old with difficulty
breathing. Severe suprasternal, subcostal, and substernal retractions are
observed. The child has a harsh, barking cough. Stridor is present. The
