NBRC TMC EXAM PREP WITH 250
HIGH-YIELD PRACTICE (2025/2026
UPDATE) REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+| NBRC TMC EXAM REVIEW
(BRAND NEW!!)
1. A spontaneously breathing patient has ABG: pH 7.38, PaCO2 42, PaO2 76, HCO3-
24, BE 0. Which supplemental oxygen level is most appropriate?
A) 2 L/min nasal cannula
B) 5 L/min nasal cannula
C) Non-rebreathing mask
D) Venturi mask at 30%
Answer: B. PaO2 76 is mildly low; 5 L/min NC provides ~40% oxygen, appropriate for
mild hypoxemia without hypercapnia.
2. A patient receiving volume-controlled ventilation after bariatric surgery needs
comfort and ventilator management assistance. Which medication should the RT
recommend?
A) Pronestyl
B) Morphine sulfate
C) Vecuronium bromide (Norcuron)
D) Mestinon
Answer: B. Morphine provides sedation, pain relief, and reduces work of breathing.
Neuromuscular blockers should not be first-line for comfort.
3. A patient with idiopathic pneumonia and right lower lobe consolidation is
suspected of bacterial infection. Which provides conclusive data?
A) WBC count
B) Color of sputum
C) Sputum acid-fast stain
D) Oral temperature
,Answer: A. Elevated WBC with left shift confirms bacterial infection; sputum color
and temperature are suggestive but not conclusive.
4. A patient has a 45% pneumothorax with SpO2 92% on 35% oxygen. The best
recommendation is:
A) Increase FiO2
B) Insert pleural chest tube
C) Begin flutter valve therapy
D) Insert mediastinal chest tube
Answer: B. Large pneumothorax requires chest tube insertion. Increased FiO2 alone
will not correct the underlying problem.
5. A patient with pulmonary edema on 40% oxygen has ABG: pH 7.46, PaCO2 28,
PaO2 45, HCO3- 20, BE -4, SaO2 77%. What is the best treatment?
A) NPPV with 40% oxygen
B) Increase FiO2 to 100%
C) Intubate and mechanically ventilate
D) Administer furosemide
Answer: C. Severe hypoxemia with altered mental status despite maximum non-
invasive oxygen requires intubation.
6. While changing a patient's oxygen from 4 L/min NC to 50% Venturi mask, the RT
notes the patient has become agitated. What is the most likely cause?
A) Hyperoxia
B) Worsening hypoxemia
C) Carbon dioxide retention
D) Pneumothorax
Answer: C. COPD patients on controlled oxygen may develop hypercapnia when
FiO2 is increased, causing altered mental status/agitation.
7. A patient with a history of asthma presents with diffuse wheezing and SpO2 89%
on room air. What should the RT recommend?
A) Albuterol via MDI
B) Heliox therapy
C) Intubation
D) Chest physiotherapy
Answer: A. Acute asthma exacerbation requires bronchodilator therapy as first-line
treatment.
8. A patient receiving mechanical ventilation has an arterial line BP reading higher
than cuff sphygmomanometer pressure. The RT should conclude:
A) Non-compliant tubing is being used
B) Transducer is placed too low
C) Patient was lying flat
,D) Transducer dome contained air bubbles
Answer: B. Transducer placed below the heart level gives falsely high readings due
to hydrostatic pressure.
9. A 2-year-old child develops violent coughing and unilateral wheezing after playing
with friends. Inspiratory/expiratory chest films show air trapping with no foreign
body "noted." The RT should suspect:
A) Pneumothorax
B) Orthopnea
C) Aspirated foreign object
D) Tachyphylaxis
Answer: C. Unilateral wheezing with air trapping indicates foreign body aspiration;
radiolucent objects (plastic) may not appear on X-ray.
10. A V/Q scan shows poor perfusion but adequate ventilation. This is most closely
associated with:
A) COPD
B) Pulmonary embolism
C) Asthma
D) Pneumonia
Answer: B. Mismatch with normal ventilation but poor perfusion (V/Q > 1) is classic
for pulmonary embolism.
11. Which condition would benefit most from a thoracentesis?
A) Atelectasis
B) Complete opacification of the right lung
C) Small pneumothorax
D) Pericardial contusion
Answer: C. Thoracentesis removes air or fluid from pleural space; small
pneumothorax may be treated with aspiration. Large pneumothorax requires chest
tube.
12. The patient has a white blood cell count of 17,000/mm3 and a temperature of
102 °F. Which of the following would you suggest?
A) Decrease the humidifier temperature
B) Administer an aerosolized bronchodilator
C) Schedule suctioning twice per hour
D) Obtain a sputum sample for culture and sensitivity
Answer: D. Elevated WBC and fever suggest infection; sputum culture is needed to
identify the causative organism.
13. While reviewing the medical record of a 55-year-old female patient, you note
that her FEV1/FVC ratio was reported as being severely decreased. Which condition
would you expect?
, A) Pulmonary hypertension
B) Morbid obesity
C) Chronic asthma
D) Pneumonia
Answer: C. A decreased FEV1/FVC ratio is the hallmark of an obstructive ventilatory
defect, commonly seen in chronic asthma.
14. A 60-year-old female patient who is orally intubated is going through a
spontaneous breathing trial. Which finding would indicate the need to stop the trial?
A) Increase in heart rate from 96 to 114/min
B) Increase in respiratory rate from 17 to 27/min
C) Increase in arterial PCO2 from 44 to 52 torr
D) Decrease in SpO2 from 92% to 83%
Answer: D. A significant decrease in SpO2 indicates acute hypoxemia and
intolerance of the SBT, requiring immediate termination.
15. The physician requests dynamic compliance measurement for an adult patient on
mechanical ventilation. This value is obtained by dividing tidal volume by:
A) (Pplat - PEEP)
B) (PIP - PEEP)
C) (PIP - Paw)
Answer: B. Dynamic compliance is calculated by dividing tidal volume by the
difference between Peak Inspiratory Pressure (PIP) and PEEP.
16. A stable adult patient receiving mechanical ventilation displays: pH 7.49, PaCO2
29 mm Hg, HCO3 24 mEq/L, PaO2 87 mm Hg, SaO2 96%. What would you
recommend?
A) Add 10 cm H2O PEEP
B) Increase the minute ventilation
C) Decrease the tidal volume
D) Maintain the current settings
Answer: C. The ABG shows respiratory alkalosis (high pH, low PaCO2); decreasing
tidal volume will reduce minute ventilation and correct the alkalosis.
17. A 68-year-old female patient in the ICU is receiving mechanical ventilation but
appears to be breathing asynchronously with the ventilator. Which medication would
you recommend?
A) Fluoxetine (Prozac)
B) Lorazepam (Ativan)
C) Dextroamphetamine (Dexedrine)
D) Cisatracurium (Nimbex)
Answer: B. Lorazepam (Ativan) is a sedative that can help reduce patient-ventilator
dyssynchrony. Neuromuscular blockers like Cisatracurium are typically used only as a
last resort.
HIGH-YIELD PRACTICE (2025/2026
UPDATE) REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+| NBRC TMC EXAM REVIEW
(BRAND NEW!!)
1. A spontaneously breathing patient has ABG: pH 7.38, PaCO2 42, PaO2 76, HCO3-
24, BE 0. Which supplemental oxygen level is most appropriate?
A) 2 L/min nasal cannula
B) 5 L/min nasal cannula
C) Non-rebreathing mask
D) Venturi mask at 30%
Answer: B. PaO2 76 is mildly low; 5 L/min NC provides ~40% oxygen, appropriate for
mild hypoxemia without hypercapnia.
2. A patient receiving volume-controlled ventilation after bariatric surgery needs
comfort and ventilator management assistance. Which medication should the RT
recommend?
A) Pronestyl
B) Morphine sulfate
C) Vecuronium bromide (Norcuron)
D) Mestinon
Answer: B. Morphine provides sedation, pain relief, and reduces work of breathing.
Neuromuscular blockers should not be first-line for comfort.
3. A patient with idiopathic pneumonia and right lower lobe consolidation is
suspected of bacterial infection. Which provides conclusive data?
A) WBC count
B) Color of sputum
C) Sputum acid-fast stain
D) Oral temperature
,Answer: A. Elevated WBC with left shift confirms bacterial infection; sputum color
and temperature are suggestive but not conclusive.
4. A patient has a 45% pneumothorax with SpO2 92% on 35% oxygen. The best
recommendation is:
A) Increase FiO2
B) Insert pleural chest tube
C) Begin flutter valve therapy
D) Insert mediastinal chest tube
Answer: B. Large pneumothorax requires chest tube insertion. Increased FiO2 alone
will not correct the underlying problem.
5. A patient with pulmonary edema on 40% oxygen has ABG: pH 7.46, PaCO2 28,
PaO2 45, HCO3- 20, BE -4, SaO2 77%. What is the best treatment?
A) NPPV with 40% oxygen
B) Increase FiO2 to 100%
C) Intubate and mechanically ventilate
D) Administer furosemide
Answer: C. Severe hypoxemia with altered mental status despite maximum non-
invasive oxygen requires intubation.
6. While changing a patient's oxygen from 4 L/min NC to 50% Venturi mask, the RT
notes the patient has become agitated. What is the most likely cause?
A) Hyperoxia
B) Worsening hypoxemia
C) Carbon dioxide retention
D) Pneumothorax
Answer: C. COPD patients on controlled oxygen may develop hypercapnia when
FiO2 is increased, causing altered mental status/agitation.
7. A patient with a history of asthma presents with diffuse wheezing and SpO2 89%
on room air. What should the RT recommend?
A) Albuterol via MDI
B) Heliox therapy
C) Intubation
D) Chest physiotherapy
Answer: A. Acute asthma exacerbation requires bronchodilator therapy as first-line
treatment.
8. A patient receiving mechanical ventilation has an arterial line BP reading higher
than cuff sphygmomanometer pressure. The RT should conclude:
A) Non-compliant tubing is being used
B) Transducer is placed too low
C) Patient was lying flat
,D) Transducer dome contained air bubbles
Answer: B. Transducer placed below the heart level gives falsely high readings due
to hydrostatic pressure.
9. A 2-year-old child develops violent coughing and unilateral wheezing after playing
with friends. Inspiratory/expiratory chest films show air trapping with no foreign
body "noted." The RT should suspect:
A) Pneumothorax
B) Orthopnea
C) Aspirated foreign object
D) Tachyphylaxis
Answer: C. Unilateral wheezing with air trapping indicates foreign body aspiration;
radiolucent objects (plastic) may not appear on X-ray.
10. A V/Q scan shows poor perfusion but adequate ventilation. This is most closely
associated with:
A) COPD
B) Pulmonary embolism
C) Asthma
D) Pneumonia
Answer: B. Mismatch with normal ventilation but poor perfusion (V/Q > 1) is classic
for pulmonary embolism.
11. Which condition would benefit most from a thoracentesis?
A) Atelectasis
B) Complete opacification of the right lung
C) Small pneumothorax
D) Pericardial contusion
Answer: C. Thoracentesis removes air or fluid from pleural space; small
pneumothorax may be treated with aspiration. Large pneumothorax requires chest
tube.
12. The patient has a white blood cell count of 17,000/mm3 and a temperature of
102 °F. Which of the following would you suggest?
A) Decrease the humidifier temperature
B) Administer an aerosolized bronchodilator
C) Schedule suctioning twice per hour
D) Obtain a sputum sample for culture and sensitivity
Answer: D. Elevated WBC and fever suggest infection; sputum culture is needed to
identify the causative organism.
13. While reviewing the medical record of a 55-year-old female patient, you note
that her FEV1/FVC ratio was reported as being severely decreased. Which condition
would you expect?
, A) Pulmonary hypertension
B) Morbid obesity
C) Chronic asthma
D) Pneumonia
Answer: C. A decreased FEV1/FVC ratio is the hallmark of an obstructive ventilatory
defect, commonly seen in chronic asthma.
14. A 60-year-old female patient who is orally intubated is going through a
spontaneous breathing trial. Which finding would indicate the need to stop the trial?
A) Increase in heart rate from 96 to 114/min
B) Increase in respiratory rate from 17 to 27/min
C) Increase in arterial PCO2 from 44 to 52 torr
D) Decrease in SpO2 from 92% to 83%
Answer: D. A significant decrease in SpO2 indicates acute hypoxemia and
intolerance of the SBT, requiring immediate termination.
15. The physician requests dynamic compliance measurement for an adult patient on
mechanical ventilation. This value is obtained by dividing tidal volume by:
A) (Pplat - PEEP)
B) (PIP - PEEP)
C) (PIP - Paw)
Answer: B. Dynamic compliance is calculated by dividing tidal volume by the
difference between Peak Inspiratory Pressure (PIP) and PEEP.
16. A stable adult patient receiving mechanical ventilation displays: pH 7.49, PaCO2
29 mm Hg, HCO3 24 mEq/L, PaO2 87 mm Hg, SaO2 96%. What would you
recommend?
A) Add 10 cm H2O PEEP
B) Increase the minute ventilation
C) Decrease the tidal volume
D) Maintain the current settings
Answer: C. The ABG shows respiratory alkalosis (high pH, low PaCO2); decreasing
tidal volume will reduce minute ventilation and correct the alkalosis.
17. A 68-year-old female patient in the ICU is receiving mechanical ventilation but
appears to be breathing asynchronously with the ventilator. Which medication would
you recommend?
A) Fluoxetine (Prozac)
B) Lorazepam (Ativan)
C) Dextroamphetamine (Dexedrine)
D) Cisatracurium (Nimbex)
Answer: B. Lorazepam (Ativan) is a sedative that can help reduce patient-ventilator
dyssynchrony. Neuromuscular blockers like Cisatracurium are typically used only as a
last resort.
