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NBRC TMC REAL EXAM PREP TEST BANK
Therapist Multiple-Choice (TMC) Examination
2026 Latest Update – 250 Questions with Correct
Answers and Rationales
SECTION 1: PATIENT DATA EVALUATION & ASSESSMENT (Questions 1–40)
1. 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
Rationale: Bronchiectasis produces thick, purulent, layered sputum (often called
"layered sputum") with a foul odor due to chronic infection and mucus stasis in
dilated airways.
2. What is tactile fremitus?
A) Secretions felt by touch
B) Vocal resonance heard through a stethoscope
C) Crackling sensation under the skin
D) Vibration of the chest wall during breathing
Answer: A
Rationale: Tactile fremitus refers to palpable vibrations transmitted through the
bronchopulmonary tree to the chest wall; increased fremitus suggests
consolidation, decreased suggests pleural effusion or pneumothorax.
3. Crepitus on physical examination indicates:
A) Pneumonia
B) Subcutaneous emphysema
C) Pleural effusion
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D) Pulmonary edema
Answer: B
Rationale: Crepitus (subcutaneous emphysema) feels like crackling or popping
under the skin, indicating air trapped in subcutaneous tissues—often from
pneumothorax, tracheostomy, or chest trauma.
4. While assessing breath sounds, the patient says "E" and it sounds like "A"
through the stethoscope. This finding is associated with:
A) Pleural effusion
B) Pneumonia (consolidation)
C) Bronchospasm
D) Atelectasis
Answer: B
Rationale: Egophony ("E-to-A" change) occurs when consolidated lung tissue
transmits sound differently, typically indicating pneumonia or lobar
consolidation.
5. A patient with pulmonary fibrosis presents with increased shortness of breath
and crackles in both lower lobes. Which diagnostic test is most beneficial?
A) Bronchial challenge test
B) Posteroanterior chest radiograph
C) Diffusion capacity (DLCO)
D) Arterial blood gas
Answer: B
Rationale: A PA chest radiograph provides valuable information about lung
condition, heart size, and interstitial changes. While DLCO is useful for fibrosis
diagnosis, the acute situation first requires imaging.
6. A patient in the ICU complains of lightheadedness, nausea, and chest pain. They
are diaphoretic with BP 90/60 mmHg. What should the RT recommend?
A) Lidocaine HCl
B) Cardioversion
C) Defibrillation
D) Epinephrine
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Answer: B
Rationale: These symptoms with hypotension suggest a tachyarrhythmia requiring
synchronized cardioversion. Defibrillation is for pulseless VT/VF.
7. Which of the following is needed to calculate alveolar oxygen tension (PAO2)?
A) VD/VT, PAO2
B) BP and FiO2
C) PetCO2 and PaO2
D) QS/QT, deadspace
Answer: B
Rationale: The alveolar gas equation requires barometric pressure (BP), FiO2,
PaCO2, and a constant (R). BP and FiO2 are key components.
8. A 45-year-old woman with a history of pulmonary fibrosis is admitted with
productive cough and increased SOB. She is tachypneic with crackles in both
lower lobes. The most beneficial diagnostic test is:
A) Bronchial challenge test
B) Posteroanterior chest radiograph
C) Anteroposterior chest radiograph
D) Arterial blood gas
Answer: B
Rationale: PA chest radiograph provides detailed lung imaging; AP view is less
valuable and typically for bedridden patients.
9. A patient has frothy secretions, moist crackles, and tachypnea with a history of
heart disease. Which should the RT recommend?
A) Suction immediately
B) Administer 100% oxygen
C) Place in Trendelenburg position
D) Administer furosemide
Answer: B
Rationale: These are signs of pulmonary edema. 100% oxygen and upright
positioning (Fowler's) are priorities.
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10. A patient with Guillain-Barré syndrome has a vital capacity of 625 mL. What
should be recommended FIRST?
A) MIP evaluation
B) Edrophonium chloride (Tensilon) test
C) MVV test
D) EMG and nerve conduction study
Answer: A
*Rationale: MIP (maximal inspiratory pressure) assesses respiratory muscle
strength; a VC < 10-15 mL/kg or MIP < -20 to -30 cmH2O indicates need for
ventilatory support. *
11. Which bedside pulmonary function test result most strongly indicates the
need for ventilatory assistance in a multiple sclerosis patient?
A) 5% decrease in peak expiratory flow
B) FEV1/FVC 85%
C) MIP of -23 cmH2O
D) Vital Capacity of 5 mL/kg
Answer: D
*Rationale: VC < 10-15 mL/kg suggests inadequate respiratory reserve and need
for ventilatory support. *
12. A chest X-ray shows increased retrosternal air, flat hemidiaphragm, decreased
movement, and no vascular markings on the right side. These signs are associated
with:
A) Pneumothorax
B) Pleural effusion
C) Pneumonia
D) Flail chest
Answer: A
Rationale: Flat hemidiaphragm and absent vascular markings indicate
pneumothorax; hyperlucency and loss of lung markings are key findings.
13. A 30-year-old automobile accident victim arrives with an esophageal-tracheal
Combitube inserted. What should be done to ensure proper functioning?
NBRC TMC REAL EXAM PREP TEST BANK
Therapist Multiple-Choice (TMC) Examination
2026 Latest Update – 250 Questions with Correct
Answers and Rationales
SECTION 1: PATIENT DATA EVALUATION & ASSESSMENT (Questions 1–40)
1. 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
Rationale: Bronchiectasis produces thick, purulent, layered sputum (often called
"layered sputum") with a foul odor due to chronic infection and mucus stasis in
dilated airways.
2. What is tactile fremitus?
A) Secretions felt by touch
B) Vocal resonance heard through a stethoscope
C) Crackling sensation under the skin
D) Vibration of the chest wall during breathing
Answer: A
Rationale: Tactile fremitus refers to palpable vibrations transmitted through the
bronchopulmonary tree to the chest wall; increased fremitus suggests
consolidation, decreased suggests pleural effusion or pneumothorax.
3. Crepitus on physical examination indicates:
A) Pneumonia
B) Subcutaneous emphysema
C) Pleural effusion
,2|Page
D) Pulmonary edema
Answer: B
Rationale: Crepitus (subcutaneous emphysema) feels like crackling or popping
under the skin, indicating air trapped in subcutaneous tissues—often from
pneumothorax, tracheostomy, or chest trauma.
4. While assessing breath sounds, the patient says "E" and it sounds like "A"
through the stethoscope. This finding is associated with:
A) Pleural effusion
B) Pneumonia (consolidation)
C) Bronchospasm
D) Atelectasis
Answer: B
Rationale: Egophony ("E-to-A" change) occurs when consolidated lung tissue
transmits sound differently, typically indicating pneumonia or lobar
consolidation.
5. A patient with pulmonary fibrosis presents with increased shortness of breath
and crackles in both lower lobes. Which diagnostic test is most beneficial?
A) Bronchial challenge test
B) Posteroanterior chest radiograph
C) Diffusion capacity (DLCO)
D) Arterial blood gas
Answer: B
Rationale: A PA chest radiograph provides valuable information about lung
condition, heart size, and interstitial changes. While DLCO is useful for fibrosis
diagnosis, the acute situation first requires imaging.
6. A patient in the ICU complains of lightheadedness, nausea, and chest pain. They
are diaphoretic with BP 90/60 mmHg. What should the RT recommend?
A) Lidocaine HCl
B) Cardioversion
C) Defibrillation
D) Epinephrine
,3|Page
Answer: B
Rationale: These symptoms with hypotension suggest a tachyarrhythmia requiring
synchronized cardioversion. Defibrillation is for pulseless VT/VF.
7. Which of the following is needed to calculate alveolar oxygen tension (PAO2)?
A) VD/VT, PAO2
B) BP and FiO2
C) PetCO2 and PaO2
D) QS/QT, deadspace
Answer: B
Rationale: The alveolar gas equation requires barometric pressure (BP), FiO2,
PaCO2, and a constant (R). BP and FiO2 are key components.
8. A 45-year-old woman with a history of pulmonary fibrosis is admitted with
productive cough and increased SOB. She is tachypneic with crackles in both
lower lobes. The most beneficial diagnostic test is:
A) Bronchial challenge test
B) Posteroanterior chest radiograph
C) Anteroposterior chest radiograph
D) Arterial blood gas
Answer: B
Rationale: PA chest radiograph provides detailed lung imaging; AP view is less
valuable and typically for bedridden patients.
9. A patient has frothy secretions, moist crackles, and tachypnea with a history of
heart disease. Which should the RT recommend?
A) Suction immediately
B) Administer 100% oxygen
C) Place in Trendelenburg position
D) Administer furosemide
Answer: B
Rationale: These are signs of pulmonary edema. 100% oxygen and upright
positioning (Fowler's) are priorities.
, 4|Page
10. A patient with Guillain-Barré syndrome has a vital capacity of 625 mL. What
should be recommended FIRST?
A) MIP evaluation
B) Edrophonium chloride (Tensilon) test
C) MVV test
D) EMG and nerve conduction study
Answer: A
*Rationale: MIP (maximal inspiratory pressure) assesses respiratory muscle
strength; a VC < 10-15 mL/kg or MIP < -20 to -30 cmH2O indicates need for
ventilatory support. *
11. Which bedside pulmonary function test result most strongly indicates the
need for ventilatory assistance in a multiple sclerosis patient?
A) 5% decrease in peak expiratory flow
B) FEV1/FVC 85%
C) MIP of -23 cmH2O
D) Vital Capacity of 5 mL/kg
Answer: D
*Rationale: VC < 10-15 mL/kg suggests inadequate respiratory reserve and need
for ventilatory support. *
12. A chest X-ray shows increased retrosternal air, flat hemidiaphragm, decreased
movement, and no vascular markings on the right side. These signs are associated
with:
A) Pneumothorax
B) Pleural effusion
C) Pneumonia
D) Flail chest
Answer: A
Rationale: Flat hemidiaphragm and absent vascular markings indicate
pneumothorax; hyperlucency and loss of lung markings are key findings.
13. A 30-year-old automobile accident victim arrives with an esophageal-tracheal
Combitube inserted. What should be done to ensure proper functioning?
