NBRC TMC PRACTICE EXAM PREP NEWEST 2026/2027
ACTUAL EXAM COMPLETE AND CORRECT DETAIL —
200 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area NBRC TMC Practice Exam Prep
Description This rigorous exam assesses mastery of advanced respiratory care concepts
including mechanical ventilation, pulmonary diagnostics, hemodynamic
monitoring, and critical care pharmacology. Designed to mirror the NBRC
Therapist Multiple-Choice (TMC) exam, it emphasizes clinical reasoning, data
synthesis, and application of current evidence-based guidelines.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Analyze complex clinical scenarios to determine appropriate ventilator settings
and modes.
2. Interpret advanced pulmonary function tests and arterial blood gases for
differential diagnosis.
3. Evaluate hemodynamic data and titrate vasoactive medications in critically ill
patients.
4. Apply infection control principles and newer diagnostic criteria for
ventilator-associated pneumonia.
5. Synthesize multiple data sources to optimize patient-ventilator synchrony and
weaning strategies.
Accreditation Meets or exceeds standards for Commission on Accreditation for Respiratory Care
(CoARC) accredited programs and NBRC TMC examination blueprint.
Page 1
,1. A patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation has a plateau pressure of 32 cm H2O and a PaCO2 of 48 mm Hg. The
respiratory therapist increases the respiratory rate from 20 to 28 breaths/min.
Which of the following changes is most likely to occur?
A. Decreased intrinsic PEEP
B. Increased alveolar dead space
C. Increased minute ventilation and decreased PaCO2
D. Decreased dynamic compliance
Answer: C. Increased minute ventilation and decreased PaCO2
Increasing respiratory rate directly increases minute ventilation (VE = VT x RR),
which typically reduces PaCO2 unless dead space increases. In ARDS, dead space is
often elevated, but the primary effect of increasing RR is increased VE and decreased
PaCO2. Intrinsic PEEP may increase with higher RR if expiratory time is insufficient.
Dynamic compliance is not directly affected by RR changes.
2. A patient on pressure support ventilation (PSV) exhibits double triggering and a
respiratory rate of 35 breaths/min. Which ventilator adjustment is most appropriate
to improve patient-ventilator synchrony?
A. Increase pressure support level
B. Switch to volume control mode
C. Increase the expiratory trigger sensitivity
D. Shorten the inspiratory time
Answer: C. Increase the expiratory trigger sensitivity
Double triggering often occurs when the patient's neural inspiratory time exceeds the
ventilator's set inspiratory time, or when the patient's effort is strong. Increasing
expiratory trigger sensitivity (cycling off) allows the ventilator to cycle to exhalation
earlier, matching the patient's shorter neural inspiratory time. Increasing pressure
support may worsen asynchrony by prolonging inspiration. Switching modes may not
address the root cause.
Page 2
,3. A patient with severe sepsis has the following hemodynamic parameters: CVP 2
mm Hg, PAWP 6 mm Hg, cardiac index 2.0 L/min/m2, SvO2 55%. Which
intervention should be prioritized?
A. Administer a vasopressor such as norepinephrine
B. Administer an inotrope such as dobutamine
C. Administer a fluid bolus of 500 mL crystalloid
D. Initiate continuous renal replacement therapy
Answer: C. Administer a fluid bolus of 500 mL crystalloid
Low CVP and PAWP indicate hypovolemia. In sepsis with low cardiac index and low
SvO2, the first step is fluid resuscitation to improve preload. Vasopressors are indicated
if hypotension persists after volume expansion. Inotropes are reserved for persistent
low cardiac output despite adequate preload. CRRT is not indicated based on these
data.
4. Which of the following ventilator waveforms is most consistent with the presence
of auto-PEEP?
A. Expiratory flow not returning to zero before the next inspiration
B. Inspiratory pressure curve showing a slow rise to plateau
C. Flow-volume loop showing a concave expiratory limb
D. Pressure-volume loop showing increased hysteresis
Answer: A. Expiratory flow not returning to zero before the next inspiration
Auto-PEEP (intrinsic PEEP) is identified on the flow-time waveform when expiratory
flow does not return to zero (baseline) before the next mandatory breath begins. This
indicates incomplete exhalation and air trapping. A slow rise to plateau suggests low
compliance or high resistance. A concave expiratory limb suggests flow limitation, but
not necessarily auto-PEEP.
Page 3
, 5. A patient with suspected ventilator-associated pneumonia (VAP) has a Clinical
Pulmonary Infection Score (CPIS) of 5. According to current guidelines, which
action is most appropriate?
A. Initiate empiric broad-spectrum antibiotics immediately
B. Obtain a bronchoalveolar lavage (BAL) with quantitative culture before starting
antibiotics
C. Monitor for 48 hours without antibiotics and reassess CPIS
D. Start antibiotics only if the patient develops new fever
Answer: B. Obtain a bronchoalveolar lavage (BAL) with quantitative culture
before starting antibiotics
Current guidelines recommend using clinical criteria (CPIS) to stratify risk, but a CPIS
<6 has low specificity for VAP. Obtaining a BAL with quantitative culture before
antibiotics is recommended to avoid unnecessary antibiotic exposure and to confirm the
diagnosis. Empiric antibiotics are reserved for higher suspicion (CPIS "e6) or severe
sepsis.
6. A patient receiving pressure-regulated volume control (PRVC) ventilation has a
set tidal volume of 450 mL. The measured exhaled tidal volume is consistently 420
mL. Which of the following is the most likely cause?
A. Low set inspiratory pressure limit
B. Circuit leak
C. Increased airway resistance
D. Decreased chest wall compliance
Answer: B. Circuit leak
In PRVC, the ventilator adjusts pressure to deliver the set tidal volume. A consistent
difference between set and exhaled VT (30 mL) suggests a leak in the circuit (e.g.,
around the endotracheal tube cuff or in the ventilator circuit). Low pressure limit
would cause the ventilator to alarm and not deliver the volume. Resistance and
compliance changes affect the pressure needed, but the ventilator compensates; a leak
prevents full delivery.
Page 4
ACTUAL EXAM COMPLETE AND CORRECT DETAIL —
200 Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area NBRC TMC Practice Exam Prep
Description This rigorous exam assesses mastery of advanced respiratory care concepts
including mechanical ventilation, pulmonary diagnostics, hemodynamic
monitoring, and critical care pharmacology. Designed to mirror the NBRC
Therapist Multiple-Choice (TMC) exam, it emphasizes clinical reasoning, data
synthesis, and application of current evidence-based guidelines.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Analyze complex clinical scenarios to determine appropriate ventilator settings
and modes.
2. Interpret advanced pulmonary function tests and arterial blood gases for
differential diagnosis.
3. Evaluate hemodynamic data and titrate vasoactive medications in critically ill
patients.
4. Apply infection control principles and newer diagnostic criteria for
ventilator-associated pneumonia.
5. Synthesize multiple data sources to optimize patient-ventilator synchrony and
weaning strategies.
Accreditation Meets or exceeds standards for Commission on Accreditation for Respiratory Care
(CoARC) accredited programs and NBRC TMC examination blueprint.
Page 1
,1. A patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation has a plateau pressure of 32 cm H2O and a PaCO2 of 48 mm Hg. The
respiratory therapist increases the respiratory rate from 20 to 28 breaths/min.
Which of the following changes is most likely to occur?
A. Decreased intrinsic PEEP
B. Increased alveolar dead space
C. Increased minute ventilation and decreased PaCO2
D. Decreased dynamic compliance
Answer: C. Increased minute ventilation and decreased PaCO2
Increasing respiratory rate directly increases minute ventilation (VE = VT x RR),
which typically reduces PaCO2 unless dead space increases. In ARDS, dead space is
often elevated, but the primary effect of increasing RR is increased VE and decreased
PaCO2. Intrinsic PEEP may increase with higher RR if expiratory time is insufficient.
Dynamic compliance is not directly affected by RR changes.
2. A patient on pressure support ventilation (PSV) exhibits double triggering and a
respiratory rate of 35 breaths/min. Which ventilator adjustment is most appropriate
to improve patient-ventilator synchrony?
A. Increase pressure support level
B. Switch to volume control mode
C. Increase the expiratory trigger sensitivity
D. Shorten the inspiratory time
Answer: C. Increase the expiratory trigger sensitivity
Double triggering often occurs when the patient's neural inspiratory time exceeds the
ventilator's set inspiratory time, or when the patient's effort is strong. Increasing
expiratory trigger sensitivity (cycling off) allows the ventilator to cycle to exhalation
earlier, matching the patient's shorter neural inspiratory time. Increasing pressure
support may worsen asynchrony by prolonging inspiration. Switching modes may not
address the root cause.
Page 2
,3. A patient with severe sepsis has the following hemodynamic parameters: CVP 2
mm Hg, PAWP 6 mm Hg, cardiac index 2.0 L/min/m2, SvO2 55%. Which
intervention should be prioritized?
A. Administer a vasopressor such as norepinephrine
B. Administer an inotrope such as dobutamine
C. Administer a fluid bolus of 500 mL crystalloid
D. Initiate continuous renal replacement therapy
Answer: C. Administer a fluid bolus of 500 mL crystalloid
Low CVP and PAWP indicate hypovolemia. In sepsis with low cardiac index and low
SvO2, the first step is fluid resuscitation to improve preload. Vasopressors are indicated
if hypotension persists after volume expansion. Inotropes are reserved for persistent
low cardiac output despite adequate preload. CRRT is not indicated based on these
data.
4. Which of the following ventilator waveforms is most consistent with the presence
of auto-PEEP?
A. Expiratory flow not returning to zero before the next inspiration
B. Inspiratory pressure curve showing a slow rise to plateau
C. Flow-volume loop showing a concave expiratory limb
D. Pressure-volume loop showing increased hysteresis
Answer: A. Expiratory flow not returning to zero before the next inspiration
Auto-PEEP (intrinsic PEEP) is identified on the flow-time waveform when expiratory
flow does not return to zero (baseline) before the next mandatory breath begins. This
indicates incomplete exhalation and air trapping. A slow rise to plateau suggests low
compliance or high resistance. A concave expiratory limb suggests flow limitation, but
not necessarily auto-PEEP.
Page 3
, 5. A patient with suspected ventilator-associated pneumonia (VAP) has a Clinical
Pulmonary Infection Score (CPIS) of 5. According to current guidelines, which
action is most appropriate?
A. Initiate empiric broad-spectrum antibiotics immediately
B. Obtain a bronchoalveolar lavage (BAL) with quantitative culture before starting
antibiotics
C. Monitor for 48 hours without antibiotics and reassess CPIS
D. Start antibiotics only if the patient develops new fever
Answer: B. Obtain a bronchoalveolar lavage (BAL) with quantitative culture
before starting antibiotics
Current guidelines recommend using clinical criteria (CPIS) to stratify risk, but a CPIS
<6 has low specificity for VAP. Obtaining a BAL with quantitative culture before
antibiotics is recommended to avoid unnecessary antibiotic exposure and to confirm the
diagnosis. Empiric antibiotics are reserved for higher suspicion (CPIS "e6) or severe
sepsis.
6. A patient receiving pressure-regulated volume control (PRVC) ventilation has a
set tidal volume of 450 mL. The measured exhaled tidal volume is consistently 420
mL. Which of the following is the most likely cause?
A. Low set inspiratory pressure limit
B. Circuit leak
C. Increased airway resistance
D. Decreased chest wall compliance
Answer: B. Circuit leak
In PRVC, the ventilator adjusts pressure to deliver the set tidal volume. A consistent
difference between set and exhaled VT (30 mL) suggests a leak in the circuit (e.g.,
around the endotracheal tube cuff or in the ventilator circuit). Low pressure limit
would cause the ventilator to alarm and not deliver the volume. Resistance and
compliance changes affect the pressure needed, but the ventilator compensates; a leak
prevents full delivery.
Page 4
