TMC Exam B – Kettering Version | 60
Questions with 100% Correct Answers | A+
Graded | Verified 2025/2026 Edition
Section 1: Introduction
This document contains 60 expert-verified questions and 100% correct answers from the
TMC Exam B – Kettering Review Series, updated for the 2025/2026 academic year. It
focuses on high-yield respiratory therapy topics including airway management, mechanical
ventilation, ABG interpretation, oxygen therapy, disease-specific care, and patient assessment
strategies. Structured to reflect the Kettering format, this A+ graded resource is ideal for
learners preparing for NBRC success with guaranteed accuracy.
Section 2: Exam Questions and Answers
Question 1: A 70-year-old patient with COPD presents with an ABG: pH 7.30, PaCO2 65
torr, PaO2 50 torr, HCO3 30 mEq/L. What is the most appropriate initial intervention?
A) Administer 100% oxygen via non-rebreather mask
B) Initiate BiPAP
C) Administer albuterol nebulizer
D) Increase oxygen to maintain SpO2 88–92%
Correct Answer: B) Initiate BiPAP
Rationale: The ABG shows acute-on-chronic respiratory acidosis with hypoxemia. BiPAP is
indicated for hypercapnic respiratory failure in COPD to improve ventilation and reduce
PaCO2. High-flow oxygen (A) risks worsening hypercapnia, albuterol (C) addresses
bronchospasm but not ventilation, and low-flow oxygen (D) is insufficient for acute failure.
Question 2: A patient on volume-control ventilation triggers a high-pressure alarm. Breath
sounds are diminished on the left. What should be done first?
A) Suction the airway
B) Check for a pneumothorax
C) Administer a sedative
D) Increase tidal volume
Correct Answer: B) Check for a pneumothorax
Rationale: Unilateral diminished breath sounds with a high-pressure alarm suggest
pneumothorax, which requires urgent assessment (e.g., chest X-ray). Suctioning (A) is for
secretions, sedation (C) addresses agitation, and increasing tidal volume (D) worsens
pressure.
Question 3: A 25-year-old asthmatic patient has a PEFR of 40% predicted. What is the most
appropriate action?
A) Discharge with a rescue inhaler
B) Administer albuterol via nebulizer
C) Initiate oxygen at 4 L/min
D) Order a chest X-ray
, Correct Answer: B) Administer albuterol via nebulizer
Rationale: A PEFR of 40% indicates severe asthma exacerbation; albuterol provides rapid
bronchodilation. Discharge (A) is inappropriate, oxygen (C) is secondary, and X-ray (D) is
diagnostic, not therapeutic.
Question 4: A neonate on mechanical ventilation shows asymmetrical chest rise and
cyanosis. What should be done first?
A) Increase FiO2
B) Perform chest transillumination
C) Order an ABG
D) Adjust ventilator rate
Correct Answer: B) Perform chest transillumination
Rationale: Asymmetrical chest rise and cyanosis suggest pneumothorax; transillumination is
a rapid bedside test in neonates. Increasing FiO2 (A) or rate (D) doesn’t address the cause,
and ABG (C) delays intervention.
Question 5: A patient with cystic fibrosis has thick secretions. What medication should be
recommended?
A) Albuterol
B) Dornase alfa
C) Furosemide
D) Prednisone
Correct Answer: B) Dornase alfa
Rationale: Dornase alfa is a mucolytic that reduces mucus viscosity in cystic fibrosis.
Albuterol (A) is a bronchodilator, furosemide (C) is a diuretic, and prednisone (D) is an anti-
inflammatory.
Question 6: An ABG on room air shows pH 7.50, PaCO2 28 torr, PaO2 75 torr, HCO3 22
mEq/L. What is the acid-base disorder?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: B) Respiratory alkalosis
Rationale: High pH and low PaCO2 indicate hyperventilation causing respiratory alkalosis.
Metabolic acidosis (A) lowers HCO3, metabolic alkalosis (C) raises HCO3, and respiratory
acidosis (D) raises PaCO2.
Question 7: A patient on volume-control ventilation has simultaneous high-pressure and low-
volume alarms. What is the most likely cause?
A) Circuit disconnection
B) Mucous plug in the ET tube
C) Patient agitation
D) Pneumothorax
Correct Answer: B) Mucous plug in the ET tube
Rationale: A mucous plug obstructs airflow, increasing pressure and reducing volume,
triggering both alarms. Disconnection (A) causes low-pressure alarms, agitation (C) increases
pressure, and pneumothorax (D) is unilateral.
Questions with 100% Correct Answers | A+
Graded | Verified 2025/2026 Edition
Section 1: Introduction
This document contains 60 expert-verified questions and 100% correct answers from the
TMC Exam B – Kettering Review Series, updated for the 2025/2026 academic year. It
focuses on high-yield respiratory therapy topics including airway management, mechanical
ventilation, ABG interpretation, oxygen therapy, disease-specific care, and patient assessment
strategies. Structured to reflect the Kettering format, this A+ graded resource is ideal for
learners preparing for NBRC success with guaranteed accuracy.
Section 2: Exam Questions and Answers
Question 1: A 70-year-old patient with COPD presents with an ABG: pH 7.30, PaCO2 65
torr, PaO2 50 torr, HCO3 30 mEq/L. What is the most appropriate initial intervention?
A) Administer 100% oxygen via non-rebreather mask
B) Initiate BiPAP
C) Administer albuterol nebulizer
D) Increase oxygen to maintain SpO2 88–92%
Correct Answer: B) Initiate BiPAP
Rationale: The ABG shows acute-on-chronic respiratory acidosis with hypoxemia. BiPAP is
indicated for hypercapnic respiratory failure in COPD to improve ventilation and reduce
PaCO2. High-flow oxygen (A) risks worsening hypercapnia, albuterol (C) addresses
bronchospasm but not ventilation, and low-flow oxygen (D) is insufficient for acute failure.
Question 2: A patient on volume-control ventilation triggers a high-pressure alarm. Breath
sounds are diminished on the left. What should be done first?
A) Suction the airway
B) Check for a pneumothorax
C) Administer a sedative
D) Increase tidal volume
Correct Answer: B) Check for a pneumothorax
Rationale: Unilateral diminished breath sounds with a high-pressure alarm suggest
pneumothorax, which requires urgent assessment (e.g., chest X-ray). Suctioning (A) is for
secretions, sedation (C) addresses agitation, and increasing tidal volume (D) worsens
pressure.
Question 3: A 25-year-old asthmatic patient has a PEFR of 40% predicted. What is the most
appropriate action?
A) Discharge with a rescue inhaler
B) Administer albuterol via nebulizer
C) Initiate oxygen at 4 L/min
D) Order a chest X-ray
, Correct Answer: B) Administer albuterol via nebulizer
Rationale: A PEFR of 40% indicates severe asthma exacerbation; albuterol provides rapid
bronchodilation. Discharge (A) is inappropriate, oxygen (C) is secondary, and X-ray (D) is
diagnostic, not therapeutic.
Question 4: A neonate on mechanical ventilation shows asymmetrical chest rise and
cyanosis. What should be done first?
A) Increase FiO2
B) Perform chest transillumination
C) Order an ABG
D) Adjust ventilator rate
Correct Answer: B) Perform chest transillumination
Rationale: Asymmetrical chest rise and cyanosis suggest pneumothorax; transillumination is
a rapid bedside test in neonates. Increasing FiO2 (A) or rate (D) doesn’t address the cause,
and ABG (C) delays intervention.
Question 5: A patient with cystic fibrosis has thick secretions. What medication should be
recommended?
A) Albuterol
B) Dornase alfa
C) Furosemide
D) Prednisone
Correct Answer: B) Dornase alfa
Rationale: Dornase alfa is a mucolytic that reduces mucus viscosity in cystic fibrosis.
Albuterol (A) is a bronchodilator, furosemide (C) is a diuretic, and prednisone (D) is an anti-
inflammatory.
Question 6: An ABG on room air shows pH 7.50, PaCO2 28 torr, PaO2 75 torr, HCO3 22
mEq/L. What is the acid-base disorder?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: B) Respiratory alkalosis
Rationale: High pH and low PaCO2 indicate hyperventilation causing respiratory alkalosis.
Metabolic acidosis (A) lowers HCO3, metabolic alkalosis (C) raises HCO3, and respiratory
acidosis (D) raises PaCO2.
Question 7: A patient on volume-control ventilation has simultaneous high-pressure and low-
volume alarms. What is the most likely cause?
A) Circuit disconnection
B) Mucous plug in the ET tube
C) Patient agitation
D) Pneumothorax
Correct Answer: B) Mucous plug in the ET tube
Rationale: A mucous plug obstructs airflow, increasing pressure and reducing volume,
triggering both alarms. Disconnection (A) causes low-pressure alarms, agitation (C) increases
pressure, and pneumothorax (D) is unilateral.
