NBRC TMC Midterm Exam Questions and
Verified Answers with Rationale | Latest
Edition 2026/2027
Question 1
A 62 year old male with a history of severe emphysema is
admitted to the emergency department complaining of acute
worsening shortness of breath. Arterial blood gas analysis on
room air reveals pH 7.31, PaCO2 64 mm Hg, PaO2 54 mm Hg,
and HCO3 32 mEq/L. Which of the following oxygen delivery
devices is most appropriate to initiate controlled oxygen
therapy?
A. Non-rebreathing mask at 15 liters per minute
B. Simple face mask at 8 liters per minute
C. Venturi mask delivering 28 percent oxygen
D. Nasal cannula at 6 liters per minute
Correct Answer: C
Rationale: Patients with chronic hypercapnia and acute on
chronic respiratory failure require controlled, low-flow oxygen
therapy to prevent the elimination of their hypoxic ventilatory
drive. A Venturi mask delivers a fixed and precise fraction of
inspired oxygen, making it the safest choice for titration in
obstructive disease exacerbations.
Question 2
While performing a pre-use check of a mechanical ventilator in
the intensive care unit, the respiratory therapist performs a
,circuit leak test and notes a significant difference between the
set tidal volume and the exhaled tidal volume. Which of the
following components should be inspected first?
A. The humidifier water level chamber
B. The expiratory valve and circuit connections
C. The internal oxygen blender sensor module
D. The main power supply backup battery pack
Correct Answer: B
Rationale: A discrepancy between delivered and exhaled tidal
volumes during a circuit check most commonly indicates a leak
within the patient tubing circuit or around the expiratory valve
assembly. Inspecting connections and valve integrity is the most
direct troubleshooting step.
Question 3
A patient is receiving volume-controlled continuous mandatory
ventilation. The high pressure alarm sounds continuously during
inspiration. The respiratory therapist notes absent breath sounds
on the left side, tracheal deviation to the right, and subcutaneous
emphysema. Which of the following conditions is the most
likely cause?
A. Mucus plugging of the right mainstem bronchus
B. Left-sided tension pneumothorax
C. Right lower lobe pneumonia consolidation
D. Severe bronchospasm affecting both lungs
Correct Answer: B
,Rationale: The clinical triad of absent breath sounds on one side,
tracheal shift to the contralateral side, and subcutaneous
emphysema combined with high peak inspiratory pressures
points directly to a tension pneumothorax. This is an immediate,
life-threatening complication of mechanical ventilation requiring
urgent decompression.
Question 4
During an evaluation of a patient's pulmonary function test
results, the respiratory therapist notes a total lung capacity of 52
percent of predicted, a forced vital capacity of 58 percent of
predicted, and a forced expiratory volume in one second to
forced vital capacity ratio of 84 percent. These findings are
characteristic of which of the following disorders?
A. Chronic bronchitis
B. Asthma exacerbation
C. Pulmonary fibrosis
D. Pulmonary emphysema
Correct Answer: C
Rationale: A reduced total lung capacity below the lower limit
of normal combined with a normal or elevated forced expiratory
volume in one second to forced vital capacity ratio defines a
restrictive ventilatory defect. Pulmonary fibrosis is a primary
interstitial lung disease that causes restriction.
Question 5
A patient with smoke inhalation injury is admitted to the
emergency department. Pulse oximetry reads 98 percent on
, room air, but the patient remains cyanotic and confused. Arterial
blood gas analysis reveals a normal partial pressure of oxygen
and a calculated oxygen saturation of 84 percent. Which of the
following diagnostic tests should the respiratory therapist
recommend next?
A. Repeat arterial blood gas with direct electrolyte panel
B. Co-oximetry analysis of an arterial blood sample
C. Pulmonary function spirometry testing
D. Standard chest radiography with lateral view
Correct Answer: B
Rationale: Standard pulse oximeters cannot differentiate
between oxyhemoglobin and dysfunctional hemoglobins like
carboxyhemoglobin, often yielding falsely elevated readings in
smoke inhalation. A co-oximetry panel measures functional and
dysfunctional hemoglobins directly.
Question 6
While monitoring a mechanically ventilated patient in volume-
controlled ventilation, the respiratory therapist notes a peak
inspiratory pressure of 40 cm H2O and a plateau pressure of 30
cm H2O with an inspiratory flow of 60 liters per minute. What
is the calculated airway resistance?
A. 0.1 cm H2O per L per second
B. 5 cm H2O per L per second
C. 10 cm H2O per L per second
D. 20 cm H2O per L per second
Correct Answer: C
Verified Answers with Rationale | Latest
Edition 2026/2027
Question 1
A 62 year old male with a history of severe emphysema is
admitted to the emergency department complaining of acute
worsening shortness of breath. Arterial blood gas analysis on
room air reveals pH 7.31, PaCO2 64 mm Hg, PaO2 54 mm Hg,
and HCO3 32 mEq/L. Which of the following oxygen delivery
devices is most appropriate to initiate controlled oxygen
therapy?
A. Non-rebreathing mask at 15 liters per minute
B. Simple face mask at 8 liters per minute
C. Venturi mask delivering 28 percent oxygen
D. Nasal cannula at 6 liters per minute
Correct Answer: C
Rationale: Patients with chronic hypercapnia and acute on
chronic respiratory failure require controlled, low-flow oxygen
therapy to prevent the elimination of their hypoxic ventilatory
drive. A Venturi mask delivers a fixed and precise fraction of
inspired oxygen, making it the safest choice for titration in
obstructive disease exacerbations.
Question 2
While performing a pre-use check of a mechanical ventilator in
the intensive care unit, the respiratory therapist performs a
,circuit leak test and notes a significant difference between the
set tidal volume and the exhaled tidal volume. Which of the
following components should be inspected first?
A. The humidifier water level chamber
B. The expiratory valve and circuit connections
C. The internal oxygen blender sensor module
D. The main power supply backup battery pack
Correct Answer: B
Rationale: A discrepancy between delivered and exhaled tidal
volumes during a circuit check most commonly indicates a leak
within the patient tubing circuit or around the expiratory valve
assembly. Inspecting connections and valve integrity is the most
direct troubleshooting step.
Question 3
A patient is receiving volume-controlled continuous mandatory
ventilation. The high pressure alarm sounds continuously during
inspiration. The respiratory therapist notes absent breath sounds
on the left side, tracheal deviation to the right, and subcutaneous
emphysema. Which of the following conditions is the most
likely cause?
A. Mucus plugging of the right mainstem bronchus
B. Left-sided tension pneumothorax
C. Right lower lobe pneumonia consolidation
D. Severe bronchospasm affecting both lungs
Correct Answer: B
,Rationale: The clinical triad of absent breath sounds on one side,
tracheal shift to the contralateral side, and subcutaneous
emphysema combined with high peak inspiratory pressures
points directly to a tension pneumothorax. This is an immediate,
life-threatening complication of mechanical ventilation requiring
urgent decompression.
Question 4
During an evaluation of a patient's pulmonary function test
results, the respiratory therapist notes a total lung capacity of 52
percent of predicted, a forced vital capacity of 58 percent of
predicted, and a forced expiratory volume in one second to
forced vital capacity ratio of 84 percent. These findings are
characteristic of which of the following disorders?
A. Chronic bronchitis
B. Asthma exacerbation
C. Pulmonary fibrosis
D. Pulmonary emphysema
Correct Answer: C
Rationale: A reduced total lung capacity below the lower limit
of normal combined with a normal or elevated forced expiratory
volume in one second to forced vital capacity ratio defines a
restrictive ventilatory defect. Pulmonary fibrosis is a primary
interstitial lung disease that causes restriction.
Question 5
A patient with smoke inhalation injury is admitted to the
emergency department. Pulse oximetry reads 98 percent on
, room air, but the patient remains cyanotic and confused. Arterial
blood gas analysis reveals a normal partial pressure of oxygen
and a calculated oxygen saturation of 84 percent. Which of the
following diagnostic tests should the respiratory therapist
recommend next?
A. Repeat arterial blood gas with direct electrolyte panel
B. Co-oximetry analysis of an arterial blood sample
C. Pulmonary function spirometry testing
D. Standard chest radiography with lateral view
Correct Answer: B
Rationale: Standard pulse oximeters cannot differentiate
between oxyhemoglobin and dysfunctional hemoglobins like
carboxyhemoglobin, often yielding falsely elevated readings in
smoke inhalation. A co-oximetry panel measures functional and
dysfunctional hemoglobins directly.
Question 6
While monitoring a mechanically ventilated patient in volume-
controlled ventilation, the respiratory therapist notes a peak
inspiratory pressure of 40 cm H2O and a plateau pressure of 30
cm H2O with an inspiratory flow of 60 liters per minute. What
is the calculated airway resistance?
A. 0.1 cm H2O per L per second
B. 5 cm H2O per L per second
C. 10 cm H2O per L per second
D. 20 cm H2O per L per second
Correct Answer: C
