NBRC Mock TMC Exam Review ACTUAL
EXAM 2026/2027 | TMC Respiratory
Therapy Exam | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Patient Data Evaluation & Recommendations
Q1: A 68-year-old male with a 60-pack-year smoking history presents to the ED with progressive
dyspnea over 3 days. He has a chronic cough with purulent sputum. Vital signs: HR 112, BP 148/88, RR
28, SpO2 86% on room air. Chest auscultation reveals diffuse expiratory wheezing and diminished
breath sounds at bases. He has a known history of COPD GOLD Stage 3. Initial ABG on room air: pH 7.32,
PaCO2 65, PaO2 55, HCO3 32, BE +6. What is the MOST appropriate INITIAL respiratory care
intervention?
A. Initiate BiPAP (IPAP 12, EPAP 4, backup rate 12)
B. Administer albuterol/ipratropium via SVN with FiO2 0.28 via Venturi mask [CORRECT]
C. Intubate and initiate volume-controlled ventilation (VT 450 mL, rate 14, FiO2 1.0)
D. Place on high-flow nasal cannula at 40 L/min with FiO2 0.50
Correct Answer: B
Rationale: Patient has acute exacerbation of COPD with hypercapnic respiratory failure (pH 7.32, PaCO2
65) but is not in extremis. First-line therapy: bronchodilators with controlled oxygen (target SpO2 88–
92%) to avoid worsening hypercapnia while addressing bronchospasm. Distractor A (BiPAP) is
appropriate but not INITIAL — bronchodilators and oxygen come first unless patient has severe
respiratory distress or altered mental status. Distractor C (intubation) is premature — patient is awake,
protecting airway. Distractor D (HFNC) does not provide bronchodilation and may not unload respiratory
muscles as well as BiPAP if oxygen alone fails.
TMC exam strategy: Always start with the least invasive effective therapy — bronchodilators and
titrated oxygen before non-invasive ventilation, and NIV before intubation.
,Q2: A 55-year-old female is post-operative Day 2 following abdominal hysterectomy. She is febrile
(38.5°C) and complains of right-sided pleuritic chest pain. SpO2 is 91% on 2 L/min NC. The RT suspects a
pulmonary embolism. Which diagnostic test would be MOST appropriate to confirm this diagnosis?
A. Chest X-ray
B. D-dimer assay
C. CT Pulmonary Angiography (CTPA) [CORRECT]
D. Ventilation/Perfusion (V/Q) Scan
Correct Answer: C
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism (PE) in hemodynamically stable
patients, allowing visualization of filling defects in pulmonary arteries. Distractor A (CXR) is often normal
in PE or shows nonspecific findings (Hampton's hump, Westermark sign) but cannot diagnose PE.
Distractor B (D-dimer) has high negative predictive value but low specificity; it rules out PE but does not
confirm it. Distractor D (V/Q Scan) is used if CTPA is contraindicated (e.g., renal failure, contrast allergy).
TMC exam strategy: For suspected PE in stable patients, CT Angiography is the primary diagnostic tool.
Q3: A patient is receiving mechanical ventilation in Volume Control mode. The high-pressure alarm is
sounding continuously. The RT notes the patient is coughing vigorously and the peak inspiratory
pressure (PIP) is 45 cm H2O. What is the FIRST action the RT should take?
A. Suction the patient.
B. Disconnect the patient from the ventilator and bag.
C. Administer a bronchodilator.
D. Sedate the patient.
Correct Answer: A
Rationale: Coughing increases intrathoracic pressure, triggering high-pressure alarms and risking
barotrauma. Suctioning clears secretions that may be stimulating the cough reflex and checks for
endotracheal tube patency. Distractor B (disconnecting) is reserved for ventilator malfunction or circuit
obstruction, not simply coughing, as it disrupts support. Distractor C is indicated for bronchospasm
(wheezing), not simply coughing. Distractor D is premature before addressing the cause of coughing.
,TMC exam strategy: When high-pressure alarms ring due to active coughing/squealing, suction the
airway first to clear secretions and stimulate the cough.
Q4: A 22-year-old male with a history of asthma presents to the ED in severe respiratory distress. He is
unable to speak in full sentences, has diffuse wheezing, and is using accessory muscles. SpO2 is 92% on 6
L/min NC. HR 118, RR 32. Which medication should be administered FIRST?
A. IV Methylprednisolone (Solumedrol)
B. Albuterol via SVN [CORRECT]
C. Ipratropium bromide via SVN
D. Magnesium sulfate IV
Correct Answer: B
Rationale: Beta-agonists (Albuterol) are the first-line rescue medication for acute asthma exacerbation
to cause rapid bronchodilation. Distractor A (Steroids) reduces inflammation but takes hours to work;
they are given concurrently but are not the "first" rescue. Distractor C (Ipratropium) is an anticholinergic
and is often added (DuoNeb) but Albuterol acts faster. Distractor D (Mag Sulfate) is used for severe
refractory asthma, not first-line.
TMC exam strategy: Acute asthma = Bronchodilators first (Albuterol).
Q5: A patient has a pulmonary artery catheter in place. The waveform shows a damped tracing with loss
of the dicrotic notch and flattened peaks. The RT aspirates blood from the distal port, but the waveform
does not change. What is the most likely cause?
A. Air in the transducer system.
B. Clot in the catheter tip. [CORRECT]
C. Transducer zeroed too high.
D. Overwedging.
Correct Answer: B
, Rationale: A "damped" waveform (flattened) indicates resistance to pressure transmission. Aspiration
attempts to clear a clot. If the waveform does not improve, a clot is likely lodged in the tip. Distractor A
(Air) causes "whip" or damping, but usually, flushing removes air. Distractor C (Zero error) shifts the
baseline but doesn't change the waveform morphology. Distractor D (Overwedging) occurs when the
balloon is overinflated or the catheter migrates too far distally, showing a steady rise in pressure, not a
damped arterial-like trace.
TMC exam strategy: Damped waveform + unable to aspirate/flush = Clot or catheter tip occlusion.
Q6: Upon reviewing a chest radiograph of an intubated patient, the RT notes the endotracheal tube tip
is located 3 cm above the carina. The patient is scheduled for a MRI of the brain. What should the RT
recommend?
A. Advance the ET tube 2 cm.
B. Secure the tube and proceed with MRI.
C. Withdraw the ET tube 2 cm.
D. Verify tube placement with capnography.
Correct Answer: B
Rationale: Ideal ET tube placement is 3–5 cm above the carina. Since the tip is at 3 cm, it is in the correct
position. There is no need to manipulate the tube. Distractors A and C are incorrect as the position is
optimal. Distractor D is good practice but the question asks for a recommendation regarding the X-ray
finding/MRI context (tube safety).
TMC exam strategy: Know the landmarks: ET tube tip should be mid-trachea (3-5 cm above carina). NG
tube tip should be 10 cm past the GE junction.
Q7: A 70-year-old patient with CHF presents with acute dyspnea. ABG on 40% Venturi mask: pH 7.28,
PaCO2 58, PaO2 62, HCO3 26. The patient is alert but fatigued. What is the most appropriate
intervention?
A. Intubate and place on mechanical ventilation.
B. Initiate BiPAP. [CORRECT]
C. Increase FiO2 to 50% via Venturi mask.
D. Initiate CPAP at 10 cm H2O.
EXAM 2026/2027 | TMC Respiratory
Therapy Exam | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Patient Data Evaluation & Recommendations
Q1: A 68-year-old male with a 60-pack-year smoking history presents to the ED with progressive
dyspnea over 3 days. He has a chronic cough with purulent sputum. Vital signs: HR 112, BP 148/88, RR
28, SpO2 86% on room air. Chest auscultation reveals diffuse expiratory wheezing and diminished
breath sounds at bases. He has a known history of COPD GOLD Stage 3. Initial ABG on room air: pH 7.32,
PaCO2 65, PaO2 55, HCO3 32, BE +6. What is the MOST appropriate INITIAL respiratory care
intervention?
A. Initiate BiPAP (IPAP 12, EPAP 4, backup rate 12)
B. Administer albuterol/ipratropium via SVN with FiO2 0.28 via Venturi mask [CORRECT]
C. Intubate and initiate volume-controlled ventilation (VT 450 mL, rate 14, FiO2 1.0)
D. Place on high-flow nasal cannula at 40 L/min with FiO2 0.50
Correct Answer: B
Rationale: Patient has acute exacerbation of COPD with hypercapnic respiratory failure (pH 7.32, PaCO2
65) but is not in extremis. First-line therapy: bronchodilators with controlled oxygen (target SpO2 88–
92%) to avoid worsening hypercapnia while addressing bronchospasm. Distractor A (BiPAP) is
appropriate but not INITIAL — bronchodilators and oxygen come first unless patient has severe
respiratory distress or altered mental status. Distractor C (intubation) is premature — patient is awake,
protecting airway. Distractor D (HFNC) does not provide bronchodilation and may not unload respiratory
muscles as well as BiPAP if oxygen alone fails.
TMC exam strategy: Always start with the least invasive effective therapy — bronchodilators and
titrated oxygen before non-invasive ventilation, and NIV before intubation.
,Q2: A 55-year-old female is post-operative Day 2 following abdominal hysterectomy. She is febrile
(38.5°C) and complains of right-sided pleuritic chest pain. SpO2 is 91% on 2 L/min NC. The RT suspects a
pulmonary embolism. Which diagnostic test would be MOST appropriate to confirm this diagnosis?
A. Chest X-ray
B. D-dimer assay
C. CT Pulmonary Angiography (CTPA) [CORRECT]
D. Ventilation/Perfusion (V/Q) Scan
Correct Answer: C
Rationale: CTPA is the gold standard for diagnosing pulmonary embolism (PE) in hemodynamically stable
patients, allowing visualization of filling defects in pulmonary arteries. Distractor A (CXR) is often normal
in PE or shows nonspecific findings (Hampton's hump, Westermark sign) but cannot diagnose PE.
Distractor B (D-dimer) has high negative predictive value but low specificity; it rules out PE but does not
confirm it. Distractor D (V/Q Scan) is used if CTPA is contraindicated (e.g., renal failure, contrast allergy).
TMC exam strategy: For suspected PE in stable patients, CT Angiography is the primary diagnostic tool.
Q3: A patient is receiving mechanical ventilation in Volume Control mode. The high-pressure alarm is
sounding continuously. The RT notes the patient is coughing vigorously and the peak inspiratory
pressure (PIP) is 45 cm H2O. What is the FIRST action the RT should take?
A. Suction the patient.
B. Disconnect the patient from the ventilator and bag.
C. Administer a bronchodilator.
D. Sedate the patient.
Correct Answer: A
Rationale: Coughing increases intrathoracic pressure, triggering high-pressure alarms and risking
barotrauma. Suctioning clears secretions that may be stimulating the cough reflex and checks for
endotracheal tube patency. Distractor B (disconnecting) is reserved for ventilator malfunction or circuit
obstruction, not simply coughing, as it disrupts support. Distractor C is indicated for bronchospasm
(wheezing), not simply coughing. Distractor D is premature before addressing the cause of coughing.
,TMC exam strategy: When high-pressure alarms ring due to active coughing/squealing, suction the
airway first to clear secretions and stimulate the cough.
Q4: A 22-year-old male with a history of asthma presents to the ED in severe respiratory distress. He is
unable to speak in full sentences, has diffuse wheezing, and is using accessory muscles. SpO2 is 92% on 6
L/min NC. HR 118, RR 32. Which medication should be administered FIRST?
A. IV Methylprednisolone (Solumedrol)
B. Albuterol via SVN [CORRECT]
C. Ipratropium bromide via SVN
D. Magnesium sulfate IV
Correct Answer: B
Rationale: Beta-agonists (Albuterol) are the first-line rescue medication for acute asthma exacerbation
to cause rapid bronchodilation. Distractor A (Steroids) reduces inflammation but takes hours to work;
they are given concurrently but are not the "first" rescue. Distractor C (Ipratropium) is an anticholinergic
and is often added (DuoNeb) but Albuterol acts faster. Distractor D (Mag Sulfate) is used for severe
refractory asthma, not first-line.
TMC exam strategy: Acute asthma = Bronchodilators first (Albuterol).
Q5: A patient has a pulmonary artery catheter in place. The waveform shows a damped tracing with loss
of the dicrotic notch and flattened peaks. The RT aspirates blood from the distal port, but the waveform
does not change. What is the most likely cause?
A. Air in the transducer system.
B. Clot in the catheter tip. [CORRECT]
C. Transducer zeroed too high.
D. Overwedging.
Correct Answer: B
, Rationale: A "damped" waveform (flattened) indicates resistance to pressure transmission. Aspiration
attempts to clear a clot. If the waveform does not improve, a clot is likely lodged in the tip. Distractor A
(Air) causes "whip" or damping, but usually, flushing removes air. Distractor C (Zero error) shifts the
baseline but doesn't change the waveform morphology. Distractor D (Overwedging) occurs when the
balloon is overinflated or the catheter migrates too far distally, showing a steady rise in pressure, not a
damped arterial-like trace.
TMC exam strategy: Damped waveform + unable to aspirate/flush = Clot or catheter tip occlusion.
Q6: Upon reviewing a chest radiograph of an intubated patient, the RT notes the endotracheal tube tip
is located 3 cm above the carina. The patient is scheduled for a MRI of the brain. What should the RT
recommend?
A. Advance the ET tube 2 cm.
B. Secure the tube and proceed with MRI.
C. Withdraw the ET tube 2 cm.
D. Verify tube placement with capnography.
Correct Answer: B
Rationale: Ideal ET tube placement is 3–5 cm above the carina. Since the tip is at 3 cm, it is in the correct
position. There is no need to manipulate the tube. Distractors A and C are incorrect as the position is
optimal. Distractor D is good practice but the question asks for a recommendation regarding the X-ray
finding/MRI context (tube safety).
TMC exam strategy: Know the landmarks: ET tube tip should be mid-trachea (3-5 cm above carina). NG
tube tip should be 10 cm past the GE junction.
Q7: A 70-year-old patient with CHF presents with acute dyspnea. ABG on 40% Venturi mask: pH 7.28,
PaCO2 58, PaO2 62, HCO3 26. The patient is alert but fatigued. What is the most appropriate
intervention?
A. Intubate and place on mechanical ventilation.
B. Initiate BiPAP. [CORRECT]
C. Increase FiO2 to 50% via Venturi mask.
D. Initiate CPAP at 10 cm H2O.
