TMC PRACTICE EXAM 2026 EXAMPREP
STUDY SHEET WITH TARGETED TOPICS
AND SOLUTIONS
⫸ A patient is admitted to the ED following a motor vehicle accident.
On physical exam, the respiratory therapist discovers that breath sounds
are absent in the left chest with a hyperresonant percussion note. The
trachea is shifted to the right. The patient's heart rate is 45/min,
respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What
action should the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient. Answer:
Needle aspirate the 2nd left intercostal space.
⫸ All of the following strategies are likely to decrease the likelihood of
damage to the tracheal mucosa EXCEPT
A. maintaining cuff pressures between 20 and 25 mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
,D. monitoring intracuff pressures. Answer: monitoring intracuff
pressures.
⫸ A 52 year-old post-operative cholecystectomy patient's breath sounds
become more coarse upon completion of postural drainage with
percussion. The respiratory therapist should recommend
A. continuing the therapy until breath sounds improve.
B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions. Answer: deep
breathing and coughing to clear secretions.
⫸ A 65 kg spinal cord injured patient has developed atelectasis. His
inspiratory capacity is 30% of his predicted value. What bronchial
hygiene therapy would be most appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy Answer: IPPB with normal saline
,⫸ A patient on VC ventilation has demonstrated auto-PEEP on
ventilator graphics. Which of the following controls, when adjusted
independently, would increase expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity Answer: 1, 2, and 3 only
⫸ Which of the following would be the most appropriate therapy for a
dyspneic patient who has crepitus with tracheal deviation to the left and
absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube Answer: Insert a chest tube
⫸ A 55 year-old post cardiac surgery patient has the following ABG
results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2
92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2
43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.
, A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% Answer: 5.0 vol%
⫸ A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm
H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's
static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O Answer: 50 mL/cm H2O
⫸ Immediately after extubation of a patient in the ICU, the respiratory
therapist observes increasing respiratory distress with intercostal
retractions and marked stridor. The SpO2 on 40% oxygen is noted to be
86%. Which of the following would be most appropriate at this time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation Answer: reintubation
STUDY SHEET WITH TARGETED TOPICS
AND SOLUTIONS
⫸ A patient is admitted to the ED following a motor vehicle accident.
On physical exam, the respiratory therapist discovers that breath sounds
are absent in the left chest with a hyperresonant percussion note. The
trachea is shifted to the right. The patient's heart rate is 45/min,
respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What
action should the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient. Answer:
Needle aspirate the 2nd left intercostal space.
⫸ All of the following strategies are likely to decrease the likelihood of
damage to the tracheal mucosa EXCEPT
A. maintaining cuff pressures between 20 and 25 mm Hg.
B. using the minimal leak technique for inflation.
C. using a low-residual-volume, low-compliance cuff.
,D. monitoring intracuff pressures. Answer: monitoring intracuff
pressures.
⫸ A 52 year-old post-operative cholecystectomy patient's breath sounds
become more coarse upon completion of postural drainage with
percussion. The respiratory therapist should recommend
A. continuing the therapy until breath sounds improve.
B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions. Answer: deep
breathing and coughing to clear secretions.
⫸ A 65 kg spinal cord injured patient has developed atelectasis. His
inspiratory capacity is 30% of his predicted value. What bronchial
hygiene therapy would be most appropriate initially?
A. IS / SMI
B. IPPB with normal saline
C. postural drainage and percussion
D. PEP therapy Answer: IPPB with normal saline
,⫸ A patient on VC ventilation has demonstrated auto-PEEP on
ventilator graphics. Which of the following controls, when adjusted
independently, would increase expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity Answer: 1, 2, and 3 only
⫸ Which of the following would be the most appropriate therapy for a
dyspneic patient who has crepitus with tracheal deviation to the left and
absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube Answer: Insert a chest tube
⫸ A 55 year-old post cardiac surgery patient has the following ABG
results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2
92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2
43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.
, A. 2.5 vol%
B. 4.0 vol%
C. 5.0 vol%
D. 5.5 vol% Answer: 5.0 vol%
⫸ A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm
H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's
static lung compliance
A. 25 mL/cm H2O
B. 35 mL/cm H2O
C. 45 mL/cm H2O
D. 50 mL/cm H2O Answer: 50 mL/cm H2O
⫸ Immediately after extubation of a patient in the ICU, the respiratory
therapist observes increasing respiratory distress with intercostal
retractions and marked stridor. The SpO2 on 40% oxygen is noted to be
86%. Which of the following would be most appropriate at this time?
A. cool mist aerosol treatment
B. aerosolized racemic epinephrine
C. manual ventilation with resuscitation bag and mask
D. reintubation Answer: reintubation
