TMC Practice Exam | Real Exam Study
Guide | Latest 2025/2026 Update | Accurate
Expert-Verified Questions and Answers |
Guaranteed Pass
Section 1: Introduction
This document features a realistic TMC (Therapist Multiple-Choice) Practice Exam and
expertly verified study guide, updated for the 2025/2026 testing cycle. It includes 160
accurate and current questions reflecting NBRC standards, covering adult and pediatric
respiratory care, mechanical ventilation, ABG interpretation, pharmacology, diagnostics, and
critical thinking in clinical scenarios. Designed for students and professionals aiming to pass
the TMC exam with confidence, this guide is A+ graded and structured for high-yield review
and guaranteed exam success.
Section 2: Exam Questions and Answers
Question 1: A 65-year-old patient with COPD presents with an ABG showing pH 7.32,
PaCO2 60 torr, PaO2 55 torr, HCO3 30 mEq/L. What is the most appropriate initial
intervention?
A) Administer 100% oxygen via non-rebreather mask
B) Initiate mechanical ventilation
C) Administer albuterol via nebulizer
D) Increase oxygen to maintain SpO2 ≥ 90%
Correct Answer: D) Increase oxygen to maintain SpO2 ≥ 90%
Rationale: The ABG indicates chronic respiratory acidosis with hypoxemia. For COPD,
titrate oxygen to achieve SpO2 88–92% to avoid suppressing respiratory drive. 100% oxygen
(A) risks CO2 retention, mechanical ventilation (B) is premature, and albuterol (C) addresses
bronchospasm but not hypoxemia primarily.
Question 2: During a ventilator check, the high-pressure alarm sounds. The patient is
agitated, and breath sounds are diminished on the right. What is the most likely cause?
A) Pneumothorax
B) Ventilator circuit disconnection
C) Endotracheal tube obstruction
D) Bronchospasm
Correct Answer: A) Pneumothorax
Rationale: Diminished breath sounds on one side with a high-pressure alarm suggest
pneumothorax, which increases resistance and triggers the alarm. Disconnection (B) triggers
low-pressure alarms, obstruction (C) affects both lungs, and bronchospasm (D) is bilateral.
Question 3: A 32-year-old asthmatic patient has a peak expiratory flow rate (PEFR) of 50%
predicted. What should the respiratory therapist recommend?
A) Discharge with a rescue inhaler
,B) Administer a short-acting beta-agonist
C) Initiate oxygen at 2 L/min
D) Perform a pulmonary function test
Correct Answer: B) Administer a short-acting beta-agonist
Rationale: A PEFR of 50% indicates moderate asthma exacerbation, requiring immediate
bronchodilation with a short-acting beta-agonist (e.g., albuterol). Discharge (A) is
inappropriate, oxygen (C) is secondary, and PFT (D) is diagnostic, not therapeutic.
Question 4: A premature neonate on mechanical ventilation shows asymmetrical chest
movement and hypotension. What should the therapist recommend first?
A) Order an arterial blood gas
B) Obtain a chest radiograph
C) Perform chest transillumination
D) Increase PEEP
Correct Answer: C) Perform chest transillumination
Rationale: Asymmetrical chest movement and hypotension in a neonate suggest
pneumothorax, which can be quickly assessed with transillumination. A chest radiograph (B)
confirms but delays intervention, ABG (A) is non-specific, and increasing PEEP (D) worsens
pneumothorax.
Question 5: A patient with cystic fibrosis has thick secretions and a weak cough. The
physician orders acetylcysteine. What should the therapist recommend?
A) Administer as ordered
B) Perform nasotracheal suctioning post-treatment
C) Replace with dornase alfa
D) Postpone until cough improves
Correct Answer: B) Perform nasotracheal suctioning post-treatment
Rationale: Acetylcysteine thins secretions, but a weak cough necessitates suctioning to clear
airways. Dornase alfa (C) is specific for cystic fibrosis but not a direct substitute, postponing
(D) delays treatment, and administering without suctioning (A) risks obstruction.
Question 6: A patient’s ABG on room air shows pH 7.48, PaCO2 30 torr, PaO2 70 torr,
HCO3 22 mEq/L. What condition is indicated?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: B) Respiratory alkalosis
Rationale: Elevated pH with low PaCO2 indicates hyperventilation causing respiratory
alkalosis. Metabolic acidosis (A) lowers pH and HCO3, metabolic alkalosis (C) raises HCO3,
and respiratory acidosis (D) raises PaCO2.
Question 7: A patient on volume-control ventilation triggers simultaneous high-pressure and
low-volume alarms. What is the most likely cause?
A) Ventilator circuit disconnection
B) Mucous plug in the ET tube
C) Leak in the ET tube cuff
D) Patient agitation
Correct Answer: B) Mucous plug in the ET tube
Rationale: A mucous plug obstructs airflow, increasing pressure and reducing delivered
,volume, triggering both alarms. Disconnection (A) causes low-pressure alarms, cuff leak (C)
affects volume but not high pressure, and agitation (D) may increase pressure but not reduce
volume.
Question 8: A 56-year-old patient with jugular vein distention and right ventricular failure is
diagnosed. What is the most likely underlying condition?
A) Pulmonary embolism
B) Hypovolemia
C) Systolic hypertension
D) Left heart failure
Correct Answer: A) Pulmonary embolism
Rationale: Jugular vein distention and right ventricular failure suggest increased right heart
pressure, often due to pulmonary embolism obstructing pulmonary arteries. Hypovolemia (B)
reduces venous pressure, systolic hypertension (C) affects systemic arteries, and left heart
failure (D) causes pulmonary edema.
Question 9: A patient with chronic bronchitis has an FVC of 2,500 mL and SVC of 3,500
mL. What explains the difference?
A) Poor effort during testing
B) Increased lung compliance
C) Air trapping during forced exhalation
D) Muscle fatigue
Correct Answer: C) Air trapping during forced exhalation
Rationale: In chronic bronchitis, dynamic airway collapse during forced exhalation (FVC)
traps air, reducing FVC compared to SVC. Poor effort (A) affects both, compliance (B) is
unrelated, and fatigue (D) is less likely.
Question 10: A 16-year-old with digital clubbing, hyperresonance, and productive cough is
admitted. What condition is most likely?
A) Asthma
B) Cystic fibrosis
C) Pneumonia
D) Chronic bronchitis
Correct Answer: B) Cystic fibrosis
Rationale: Digital clubbing, hyperresonance, and productive cough in a young patient
suggest cystic fibrosis, a chronic obstructive disease. Asthma (A) lacks clubbing, pneumonia
(C) is acute, and chronic bronchitis (D) is typical in older smokers.
Question 11: A patient on CPAP with pressure support develops a respiratory rate of 29
breaths/min, triggering the high-rate alarm. What should the therapist do?
A) Switch to volume-control A/C mode
B) Increase pressure support
C) Adjust the high-rate alarm to 30–35 breaths/min
D) Discontinue CPAP
Correct Answer: B) Increase pressure support
Rationale: A high respiratory rate indicates inadequate support; increasing pressure support
reduces work of breathing. Switching modes (A) is premature, adjusting alarms (C) ignores
the issue, and discontinuing (D) is inappropriate.
, Question 12: A flow-volume loop is described as “tall and skinny.” What condition is
indicated?
A) Normal lungs
B) Small airway obstruction
C) Large airway obstruction
D) Restrictive disease
Correct Answer: D) Restrictive disease
Rationale: A “tall and skinny” flow-volume loop indicates high peak flow but reduced
volume, typical of restrictive disease (e.g., fibrosis). Normal lungs (A) have broader loops,
small airway obstruction (B) shows scooping, and large airway obstruction (C) flattens peaks.
Question 13: A patient with emphysema is dyspneic with inspiratory crackles and ABG: pH
7.34, PaCO2 65 torr, PaO2 47 torr, HCO3 31 mEq/L. What should be recommended?
A) Non-rebreather mask at 10 L/min
B) Nasal cannula at 2–4 L/min
C) BiPAP ventilation
D) Intubation and mechanical ventilation
Correct Answer: B) Nasal cannula at 2–4 L/min
Rationale: Chronic respiratory acidosis with hypoxemia in emphysema requires low-flow
oxygen (2–4 L/min) to improve PaO2 while monitoring CO2 retention. Non-rebreather (A)
risks hypercapnia, BiPAP (C) is for acute failure, and intubation (D) is excessive.
Question 14: A therapist is calibrating a spirometer. What is the minimum volume for
calibration?
A) 1 L
B) 2 L
C) 3 L
D) 5 L
Correct Answer: C) 3 L
Rationale: NBRC standards require a 3-L syringe for spirometer calibration to ensure
accuracy across typical lung volumes. Smaller (A, B) or larger (D) volumes are less standard.
Question 15: A patient with ARDS has a PaO2/FiO2 ratio of 150 on 60% FiO2. What is the
most appropriate ventilator adjustment?
A) Increase tidal volume
B) Increase PEEP
C) Decrease FiO2
D) Switch to pressure control
Correct Answer: B) Increase PEEP
Rationale: A PaO2/FiO2 ratio < 200 indicates severe ARDS; increasing PEEP improves
oxygenation by recruiting alveoli. Increasing tidal volume (A) risks barotrauma, decreasing
FiO2 (C) worsens hypoxemia, and switching modes (D) is unnecessary.
Question 16: A 45-year-old patient with pneumonia has a sputum culture positive for
Pseudomonas aeruginosa. What antibiotic is most appropriate?
A) Azithromycin
B) Ceftriaxone
C) Piperacillin-tazobactam
D) Vancomycin
Correct Answer: C) Piperacillin-tazobactam
Guide | Latest 2025/2026 Update | Accurate
Expert-Verified Questions and Answers |
Guaranteed Pass
Section 1: Introduction
This document features a realistic TMC (Therapist Multiple-Choice) Practice Exam and
expertly verified study guide, updated for the 2025/2026 testing cycle. It includes 160
accurate and current questions reflecting NBRC standards, covering adult and pediatric
respiratory care, mechanical ventilation, ABG interpretation, pharmacology, diagnostics, and
critical thinking in clinical scenarios. Designed for students and professionals aiming to pass
the TMC exam with confidence, this guide is A+ graded and structured for high-yield review
and guaranteed exam success.
Section 2: Exam Questions and Answers
Question 1: A 65-year-old patient with COPD presents with an ABG showing pH 7.32,
PaCO2 60 torr, PaO2 55 torr, HCO3 30 mEq/L. What is the most appropriate initial
intervention?
A) Administer 100% oxygen via non-rebreather mask
B) Initiate mechanical ventilation
C) Administer albuterol via nebulizer
D) Increase oxygen to maintain SpO2 ≥ 90%
Correct Answer: D) Increase oxygen to maintain SpO2 ≥ 90%
Rationale: The ABG indicates chronic respiratory acidosis with hypoxemia. For COPD,
titrate oxygen to achieve SpO2 88–92% to avoid suppressing respiratory drive. 100% oxygen
(A) risks CO2 retention, mechanical ventilation (B) is premature, and albuterol (C) addresses
bronchospasm but not hypoxemia primarily.
Question 2: During a ventilator check, the high-pressure alarm sounds. The patient is
agitated, and breath sounds are diminished on the right. What is the most likely cause?
A) Pneumothorax
B) Ventilator circuit disconnection
C) Endotracheal tube obstruction
D) Bronchospasm
Correct Answer: A) Pneumothorax
Rationale: Diminished breath sounds on one side with a high-pressure alarm suggest
pneumothorax, which increases resistance and triggers the alarm. Disconnection (B) triggers
low-pressure alarms, obstruction (C) affects both lungs, and bronchospasm (D) is bilateral.
Question 3: A 32-year-old asthmatic patient has a peak expiratory flow rate (PEFR) of 50%
predicted. What should the respiratory therapist recommend?
A) Discharge with a rescue inhaler
,B) Administer a short-acting beta-agonist
C) Initiate oxygen at 2 L/min
D) Perform a pulmonary function test
Correct Answer: B) Administer a short-acting beta-agonist
Rationale: A PEFR of 50% indicates moderate asthma exacerbation, requiring immediate
bronchodilation with a short-acting beta-agonist (e.g., albuterol). Discharge (A) is
inappropriate, oxygen (C) is secondary, and PFT (D) is diagnostic, not therapeutic.
Question 4: A premature neonate on mechanical ventilation shows asymmetrical chest
movement and hypotension. What should the therapist recommend first?
A) Order an arterial blood gas
B) Obtain a chest radiograph
C) Perform chest transillumination
D) Increase PEEP
Correct Answer: C) Perform chest transillumination
Rationale: Asymmetrical chest movement and hypotension in a neonate suggest
pneumothorax, which can be quickly assessed with transillumination. A chest radiograph (B)
confirms but delays intervention, ABG (A) is non-specific, and increasing PEEP (D) worsens
pneumothorax.
Question 5: A patient with cystic fibrosis has thick secretions and a weak cough. The
physician orders acetylcysteine. What should the therapist recommend?
A) Administer as ordered
B) Perform nasotracheal suctioning post-treatment
C) Replace with dornase alfa
D) Postpone until cough improves
Correct Answer: B) Perform nasotracheal suctioning post-treatment
Rationale: Acetylcysteine thins secretions, but a weak cough necessitates suctioning to clear
airways. Dornase alfa (C) is specific for cystic fibrosis but not a direct substitute, postponing
(D) delays treatment, and administering without suctioning (A) risks obstruction.
Question 6: A patient’s ABG on room air shows pH 7.48, PaCO2 30 torr, PaO2 70 torr,
HCO3 22 mEq/L. What condition is indicated?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: B) Respiratory alkalosis
Rationale: Elevated pH with low PaCO2 indicates hyperventilation causing respiratory
alkalosis. Metabolic acidosis (A) lowers pH and HCO3, metabolic alkalosis (C) raises HCO3,
and respiratory acidosis (D) raises PaCO2.
Question 7: A patient on volume-control ventilation triggers simultaneous high-pressure and
low-volume alarms. What is the most likely cause?
A) Ventilator circuit disconnection
B) Mucous plug in the ET tube
C) Leak in the ET tube cuff
D) Patient agitation
Correct Answer: B) Mucous plug in the ET tube
Rationale: A mucous plug obstructs airflow, increasing pressure and reducing delivered
,volume, triggering both alarms. Disconnection (A) causes low-pressure alarms, cuff leak (C)
affects volume but not high pressure, and agitation (D) may increase pressure but not reduce
volume.
Question 8: A 56-year-old patient with jugular vein distention and right ventricular failure is
diagnosed. What is the most likely underlying condition?
A) Pulmonary embolism
B) Hypovolemia
C) Systolic hypertension
D) Left heart failure
Correct Answer: A) Pulmonary embolism
Rationale: Jugular vein distention and right ventricular failure suggest increased right heart
pressure, often due to pulmonary embolism obstructing pulmonary arteries. Hypovolemia (B)
reduces venous pressure, systolic hypertension (C) affects systemic arteries, and left heart
failure (D) causes pulmonary edema.
Question 9: A patient with chronic bronchitis has an FVC of 2,500 mL and SVC of 3,500
mL. What explains the difference?
A) Poor effort during testing
B) Increased lung compliance
C) Air trapping during forced exhalation
D) Muscle fatigue
Correct Answer: C) Air trapping during forced exhalation
Rationale: In chronic bronchitis, dynamic airway collapse during forced exhalation (FVC)
traps air, reducing FVC compared to SVC. Poor effort (A) affects both, compliance (B) is
unrelated, and fatigue (D) is less likely.
Question 10: A 16-year-old with digital clubbing, hyperresonance, and productive cough is
admitted. What condition is most likely?
A) Asthma
B) Cystic fibrosis
C) Pneumonia
D) Chronic bronchitis
Correct Answer: B) Cystic fibrosis
Rationale: Digital clubbing, hyperresonance, and productive cough in a young patient
suggest cystic fibrosis, a chronic obstructive disease. Asthma (A) lacks clubbing, pneumonia
(C) is acute, and chronic bronchitis (D) is typical in older smokers.
Question 11: A patient on CPAP with pressure support develops a respiratory rate of 29
breaths/min, triggering the high-rate alarm. What should the therapist do?
A) Switch to volume-control A/C mode
B) Increase pressure support
C) Adjust the high-rate alarm to 30–35 breaths/min
D) Discontinue CPAP
Correct Answer: B) Increase pressure support
Rationale: A high respiratory rate indicates inadequate support; increasing pressure support
reduces work of breathing. Switching modes (A) is premature, adjusting alarms (C) ignores
the issue, and discontinuing (D) is inappropriate.
, Question 12: A flow-volume loop is described as “tall and skinny.” What condition is
indicated?
A) Normal lungs
B) Small airway obstruction
C) Large airway obstruction
D) Restrictive disease
Correct Answer: D) Restrictive disease
Rationale: A “tall and skinny” flow-volume loop indicates high peak flow but reduced
volume, typical of restrictive disease (e.g., fibrosis). Normal lungs (A) have broader loops,
small airway obstruction (B) shows scooping, and large airway obstruction (C) flattens peaks.
Question 13: A patient with emphysema is dyspneic with inspiratory crackles and ABG: pH
7.34, PaCO2 65 torr, PaO2 47 torr, HCO3 31 mEq/L. What should be recommended?
A) Non-rebreather mask at 10 L/min
B) Nasal cannula at 2–4 L/min
C) BiPAP ventilation
D) Intubation and mechanical ventilation
Correct Answer: B) Nasal cannula at 2–4 L/min
Rationale: Chronic respiratory acidosis with hypoxemia in emphysema requires low-flow
oxygen (2–4 L/min) to improve PaO2 while monitoring CO2 retention. Non-rebreather (A)
risks hypercapnia, BiPAP (C) is for acute failure, and intubation (D) is excessive.
Question 14: A therapist is calibrating a spirometer. What is the minimum volume for
calibration?
A) 1 L
B) 2 L
C) 3 L
D) 5 L
Correct Answer: C) 3 L
Rationale: NBRC standards require a 3-L syringe for spirometer calibration to ensure
accuracy across typical lung volumes. Smaller (A, B) or larger (D) volumes are less standard.
Question 15: A patient with ARDS has a PaO2/FiO2 ratio of 150 on 60% FiO2. What is the
most appropriate ventilator adjustment?
A) Increase tidal volume
B) Increase PEEP
C) Decrease FiO2
D) Switch to pressure control
Correct Answer: B) Increase PEEP
Rationale: A PaO2/FiO2 ratio < 200 indicates severe ARDS; increasing PEEP improves
oxygenation by recruiting alveoli. Increasing tidal volume (A) risks barotrauma, decreasing
FiO2 (C) worsens hypoxemia, and switching modes (D) is unnecessary.
Question 16: A 45-year-old patient with pneumonia has a sputum culture positive for
Pseudomonas aeruginosa. What antibiotic is most appropriate?
A) Azithromycin
B) Ceftriaxone
C) Piperacillin-tazobactam
D) Vancomycin
Correct Answer: C) Piperacillin-tazobactam
