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TMC FORM B EXAM | NBRC SAE TMC EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
TMC FORM B EXAM | NBRC SAE TMC | 250 QUESTIONS WITH RATIONALES
IMPORTANT NOTE ABOUT THE EXAM
The Therapist Multiple Choice (TMC) Exam
SECTION 1: PATIENT ASSESSMENT & ABG INTERPRETATION (Questions 1-50)
1. A 63-year-old patient with COPD is seen in the pulmonary clinic for a routine
appointment. Analysis of an ABG sample drawn while the patient is breathing room air
reveals: pH 7.35, PaCO₂ 57 mm Hg, PaO₂ 42 mm Hg, HCO₃⁻ 35 mEq/L, BE +8 mEq/L,
SaO₂ 77%. Which of the following is the most appropriate NEXT step?
A. Schedule polysomnography
B. Initiate supplemental oxygen
C. Perform a 6-minute walk test
D. Coach on deep breathing
Correct Answer: B
Rationale: The patient has severe hypoxemia (PaO₂ 42 mm Hg, SaO₂ 77%) with chronic
respiratory acidosis (compensated). Per GOLD guidelines, long-term oxygen therapy (LTOT)
is indicated when PaO₂ ≤ 55 mm Hg or SaO₂ ≤ 88%. This takes priority over other
interventions.
2. A patient's arterial blood gas results show: pH 7.28, PaCO₂ 60 mm Hg, HCO₃⁻ 26
mEq/L. The respiratory therapist should interpret this as:
A. Acute respiratory acidosis with no compensation
B. Acute respiratory acidosis with partial metabolic compensation
C. Chronic respiratory acidosis with full metabolic compensation
D. Metabolic acidosis with respiratory compensation
Correct Answer: A
Rationale: pH is below normal (7.35-7.45) indicating acidosis. PaCO₂ is elevated (>45 mm
Hg) indicating respiratory cause. HCO₃⁻ is normal (22-26 mEq/L), indicating the kidneys
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have not yet had time to compensate. This represents an acute respiratory acidosis without
renal compensation.
3. Following mechanical ventilation initiation, a patient's PaCO₂ decreased from 53 to
40 mm Hg. The respiratory therapist should expect which of the following will increase?
A. HCO₃⁻
B. pH
C. PETCO₂
D. Vd/Vt
Correct Answer: B
Rationale: As PaCO₂ decreases (hypocapnia), pH increases (respiratory alkalosis) per the
Henderson-Hasselbalch equation. HCO₃⁻ would decrease with chronic hypocapnia (renal
compensation). PETCO₂ would decrease with PaCO₂. Vd/Vt (dead space ratio) is unrelated to
this acute change.
4. A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin
saturation in which of the following clinical conditions?
• Congestive heart failure
• Polycythemia
• Pulmonary hypertension
• Carbon monoxide poisoning
A. 1, 2, and 3 only
B. 2, 3, and 4 only
C. 1, 2, and 4 only
D. 1, 3, and 4 only
Correct Answer: A
Rationale: Pulse oximetry is inaccurate in carbon monoxide poisoning because COHb is read
as oxyhemoglobin, falsely elevating SpO₂. CHF, polycythemia, and pulmonary hypertension
do not interfere with pulse oximeter accuracy, though poor perfusion in severe CHF may
affect signal quality.
5. A respiratory therapist is reviewing a chest radiograph and notes the presence of a
chest tube. The patient has a hemothorax. Which of the following locations is most
appropriate for this chest tube to be placed?
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A. Second intercostal space, mid-clavicular line
B. Fourth intercostal space, anterior axillary line
C. Fifth intercostal space, mid-axillary line
D. Sixth intercostal space, posterior axillary line
Correct Answer: C
Rationale: For drainage of fluid (hemothorax, pleural effusion), chest tubes are typically
placed in the lower chest, fifth or sixth intercostal space, mid-axillary line. This allows
gravity-assisted drainage. The second intercostal space is used for pneumothorax (air
removal).
6. Auscultation of the chest over a pneumothorax is most likely to reveal:
A. Diminished breath sounds
B. Bronchial breath sounds
C. Crackles
D. Wheezing
Correct Answer: A
Rationale: Pneumothorax (air in the pleural space) separates the lung from the chest wall,
decreasing transmission of breath sounds. This results in diminished or absent breath sounds
on the affected side. Bronchial breath sounds suggest consolidation; crackles suggest fluid;
wheezing suggests airway narrowing.
7. A patient on dialysis has a surgical shunt in the left ulnar artery and blood flow
absent in the right ulnar artery. Where should the ABG be obtained?
A. Left radial artery
B. Right radial artery
C. Dorsalis pedis artery
D. Femoral artery
Correct Answer: C
Rationale: The dorsalis pedis artery is the appropriate site when upper extremity sites are
compromised. The left ulnar site has a surgical shunt (contraindicated for puncture), and the
right ulnar artery lacks flow (indicating inadequate collateral circulation). The dorsalis pedis
provides an accessible alternative.
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8. A respiratory therapist auscultates a patient and instructs them to say "99," noting
the vocal fremitus is loud. This finding is most consistent with:
A. Emphysema
B. Pneumothorax
C. Pneumonia
D. Pleural effusion
Correct Answer: C
Rationale: Increased vocal fremitus (loud sounds) indicates consolidation, which is
characteristic of pneumonia. Decreased fremitus suggests hyperresonance, emphysema, or
pneumothorax.
9. What would explain a patient having right upper lobe atelectasis?
A. Right mainstem intubation
B. Left mainstem intubation
C. Right middle or upper lobe tumor
D. Both A and C
Correct Answer: D
Rationale: Right upper lobe atelectasis can be caused by right mainstem intubation (which
may result in mucus plugging or poor ventilation to the right lung) or by a tumor obstructing
the right upper or middle lobe bronchus. Both are plausible causes that should be
investigated.
10. The normal arterial-mixed venous oxygen content difference [C(a-v)O₂] is _______
or less:
A. 3 vol%
B. 5 vol%
C. 7 vol%
D. 10 vol%
Correct Answer: B
Rationale: The normal arterial-mixed venous oxygen content difference is 5 vol% or less. An
increased C(a-v)O₂ indicates decreased cardiac output or increased oxygen consumption,
while a decreased value suggests increased cardiac output or decreased oxygen consumption.
TMC FORM B EXAM | NBRC SAE TMC EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
TMC FORM B EXAM | NBRC SAE TMC | 250 QUESTIONS WITH RATIONALES
IMPORTANT NOTE ABOUT THE EXAM
The Therapist Multiple Choice (TMC) Exam
SECTION 1: PATIENT ASSESSMENT & ABG INTERPRETATION (Questions 1-50)
1. A 63-year-old patient with COPD is seen in the pulmonary clinic for a routine
appointment. Analysis of an ABG sample drawn while the patient is breathing room air
reveals: pH 7.35, PaCO₂ 57 mm Hg, PaO₂ 42 mm Hg, HCO₃⁻ 35 mEq/L, BE +8 mEq/L,
SaO₂ 77%. Which of the following is the most appropriate NEXT step?
A. Schedule polysomnography
B. Initiate supplemental oxygen
C. Perform a 6-minute walk test
D. Coach on deep breathing
Correct Answer: B
Rationale: The patient has severe hypoxemia (PaO₂ 42 mm Hg, SaO₂ 77%) with chronic
respiratory acidosis (compensated). Per GOLD guidelines, long-term oxygen therapy (LTOT)
is indicated when PaO₂ ≤ 55 mm Hg or SaO₂ ≤ 88%. This takes priority over other
interventions.
2. A patient's arterial blood gas results show: pH 7.28, PaCO₂ 60 mm Hg, HCO₃⁻ 26
mEq/L. The respiratory therapist should interpret this as:
A. Acute respiratory acidosis with no compensation
B. Acute respiratory acidosis with partial metabolic compensation
C. Chronic respiratory acidosis with full metabolic compensation
D. Metabolic acidosis with respiratory compensation
Correct Answer: A
Rationale: pH is below normal (7.35-7.45) indicating acidosis. PaCO₂ is elevated (>45 mm
Hg) indicating respiratory cause. HCO₃⁻ is normal (22-26 mEq/L), indicating the kidneys
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have not yet had time to compensate. This represents an acute respiratory acidosis without
renal compensation.
3. Following mechanical ventilation initiation, a patient's PaCO₂ decreased from 53 to
40 mm Hg. The respiratory therapist should expect which of the following will increase?
A. HCO₃⁻
B. pH
C. PETCO₂
D. Vd/Vt
Correct Answer: B
Rationale: As PaCO₂ decreases (hypocapnia), pH increases (respiratory alkalosis) per the
Henderson-Hasselbalch equation. HCO₃⁻ would decrease with chronic hypocapnia (renal
compensation). PETCO₂ would decrease with PaCO₂. Vd/Vt (dead space ratio) is unrelated to
this acute change.
4. A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin
saturation in which of the following clinical conditions?
• Congestive heart failure
• Polycythemia
• Pulmonary hypertension
• Carbon monoxide poisoning
A. 1, 2, and 3 only
B. 2, 3, and 4 only
C. 1, 2, and 4 only
D. 1, 3, and 4 only
Correct Answer: A
Rationale: Pulse oximetry is inaccurate in carbon monoxide poisoning because COHb is read
as oxyhemoglobin, falsely elevating SpO₂. CHF, polycythemia, and pulmonary hypertension
do not interfere with pulse oximeter accuracy, though poor perfusion in severe CHF may
affect signal quality.
5. A respiratory therapist is reviewing a chest radiograph and notes the presence of a
chest tube. The patient has a hemothorax. Which of the following locations is most
appropriate for this chest tube to be placed?
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A. Second intercostal space, mid-clavicular line
B. Fourth intercostal space, anterior axillary line
C. Fifth intercostal space, mid-axillary line
D. Sixth intercostal space, posterior axillary line
Correct Answer: C
Rationale: For drainage of fluid (hemothorax, pleural effusion), chest tubes are typically
placed in the lower chest, fifth or sixth intercostal space, mid-axillary line. This allows
gravity-assisted drainage. The second intercostal space is used for pneumothorax (air
removal).
6. Auscultation of the chest over a pneumothorax is most likely to reveal:
A. Diminished breath sounds
B. Bronchial breath sounds
C. Crackles
D. Wheezing
Correct Answer: A
Rationale: Pneumothorax (air in the pleural space) separates the lung from the chest wall,
decreasing transmission of breath sounds. This results in diminished or absent breath sounds
on the affected side. Bronchial breath sounds suggest consolidation; crackles suggest fluid;
wheezing suggests airway narrowing.
7. A patient on dialysis has a surgical shunt in the left ulnar artery and blood flow
absent in the right ulnar artery. Where should the ABG be obtained?
A. Left radial artery
B. Right radial artery
C. Dorsalis pedis artery
D. Femoral artery
Correct Answer: C
Rationale: The dorsalis pedis artery is the appropriate site when upper extremity sites are
compromised. The left ulnar site has a surgical shunt (contraindicated for puncture), and the
right ulnar artery lacks flow (indicating inadequate collateral circulation). The dorsalis pedis
provides an accessible alternative.
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8. A respiratory therapist auscultates a patient and instructs them to say "99," noting
the vocal fremitus is loud. This finding is most consistent with:
A. Emphysema
B. Pneumothorax
C. Pneumonia
D. Pleural effusion
Correct Answer: C
Rationale: Increased vocal fremitus (loud sounds) indicates consolidation, which is
characteristic of pneumonia. Decreased fremitus suggests hyperresonance, emphysema, or
pneumothorax.
9. What would explain a patient having right upper lobe atelectasis?
A. Right mainstem intubation
B. Left mainstem intubation
C. Right middle or upper lobe tumor
D. Both A and C
Correct Answer: D
Rationale: Right upper lobe atelectasis can be caused by right mainstem intubation (which
may result in mucus plugging or poor ventilation to the right lung) or by a tumor obstructing
the right upper or middle lobe bronchus. Both are plausible causes that should be
investigated.
10. The normal arterial-mixed venous oxygen content difference [C(a-v)O₂] is _______
or less:
A. 3 vol%
B. 5 vol%
C. 7 vol%
D. 10 vol%
Correct Answer: B
Rationale: The normal arterial-mixed venous oxygen content difference is 5 vol% or less. An
increased C(a-v)O₂ indicates decreased cardiac output or increased oxygen consumption,
while a decreased value suggests increased cardiac output or decreased oxygen consumption.
