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KETTERING TMC EXAM PRACTICE – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
TMC
Prepare effectively for the Kettering TMC Exam with this focused practice resource. It
supports review of respiratory therapy concepts, patient assessment, oxygenation
and ventilation, pulmonary disorders, mechanical ventilation, and clinical decision-
making. Use the material to reinforce your knowledge, practice applying key concepts,
and identify areas that may require additional study. This resource is suited for
respiratory therapy students, respiratory therapist trainees, and candidates preparing
for the TMC examination.
MULTIPLE CHOICE.
PATIENT ASSESSMENT (Questions 1–30)
Question #1
A patient is admitted to the ED following a motor vehicle accident. On
physical exam, the respiratory therapist notes absent breath sounds in the left
chest with a hyperresonant percussion note. What action should the therapist
recommend FIRST?
A. Obtain a stat chest X-ray
B. Needle decompression of the left chest
C. Administer high-flow oxygen
D. Prepare for intubation
Correct Answer: B
Rationale: Absent breath sounds with hyperresonance indicates a tension
pneumothorax, which is a life-threatening emergency requiring immediate
needle decompression. While chest X-ray confirms the diagnosis,
decompression should not be delayed. High-flow oxygen and intubation are
supportive but do not address the underlying tension.
, Page 2 of 65
Question #2
A healthy adult female can exhale what portion of her forced vital capacity
(FVC) in the first second (FEV₁/FVC ratio)?
A. 50%
B. 70%
C. 80%
D. 90%
Correct Answer: B
Rationale: A healthy adult typically exhales approximately 70-75% of FVC
in the first second (FEV₁/FVC ≥ 70-75% predicted). Values below 70% suggest
obstructive airway disease (e.g., asthma, COPD).
Question #3
A respiratory therapist is reviewing a patient's medical record. Which of the
following is the MOST important to review FIRST?
A. Social history
B. Allergies
C. Immunization status
D. Surgical history
Correct Answer: B
Rationale: Allergies are a critical safety priority—they must be identified
before any medication or treatment is administered. While history, advanced
directives, and HPI are important, allergies are the most urgent to prevent life-
threatening reactions.
Question #4
A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics.
Which of the following is the MOST appropriate initial intervention?
A. Increase inspiratory flow
B. Decrease respiratory rate
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C. Increase tidal volume
D. Decrease PEEP
Correct Answer: B
Rationale: Auto-PEEP (intrinsic PEEP) occurs when there is insufficient
expiratory time, leading to air trapping. Decreasing the respiratory rate
prolongs expiratory time and reduces auto-PEEP. Increasing inspiratory flow
may worsen trapping; increasing tidal volume increases pressure; decreasing
PEEP does not address the underlying cause.
Question #5
The four critical life functions identified by the Kettering approach are:
A. Ventilation, Oxygenation, Circulation, Perfusion
B. Ventilation, Oxygenation, Respiration, Perfusion
C. Airway, Breathing, Circulation, Disability
D. Oxygenation, Ventilation, Perfusion, Diffusion
Correct Answer: A
Rationale: Kettering emphasizes four critical life functions: Ventilation
(moving air in/out), Oxygenation (getting O₂ to the blood), Circulation (moving
blood through the body), and Perfusion (getting O₂ to the tissues). This
framework guides assessment and prioritization of interventions.
Question #6
A patient is receiving oxygen via nasal cannula at 4 L/min. The therapist notes
the patient's SpO₂ is 88%. What is the MOST appropriate action?
A. Increase to 6 L/min via nasal cannula
B. Switch to a non-rebreather mask at 15 L/min
C. Apply a simple mask at 6 L/min
D. Decrease to 2 L/min
Correct Answer: B
Rationale: An SpO₂ of 88% indicates significant hypoxemia. A nasal
cannula at 4 L/min delivers only ~36% FiO₂. A non-rebreather mask at 15
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L/min delivers up to 90-100% FiO₂ and is appropriate for severe hypoxemia.
Simply increasing to 6 L/min via nasal cannula is unlikely to achieve adequate
oxygenation.
Question #7
A patient with COPD has an SpO₂ of 89% on room air. The patient is alert and
oriented. What is the MOST appropriate oxygen delivery device?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 24-28% FiO₂
C. Nasal cannula at 6 L/min
D. Simple mask at 10 L/min
Correct Answer: B
Rationale: COPD patients require controlled, precise oxygen delivery to
avoid suppressing the hypoxic drive. A Venturi mask delivers a fixed FiO₂ (24-
28%), allowing careful titration. A non-rebreather or high-flow nasal cannula
may cause hypercapnia; a simple mask is less precise.
Question #8
A respiratory therapist is assessing a patient with suspected pulmonary
embolism. Which of the following findings is MOST consistent with this
diagnosis?
A. Hyperresonance to percussion
B. Sudden onset dyspnea with pleuritic chest pain
C. Crackles in bilateral lung bases
D. Wheezing on expiration
Correct Answer: B
Rationale: Sudden onset dyspnea with pleuritic chest pain is classic for
pulmonary embolism. Hyperresonance suggests pneumothorax; crackles
suggest pulmonary edema or pneumonia; wheezing suggests bronchospasm.
KETTERING TMC EXAM PRACTICE – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
TMC
Prepare effectively for the Kettering TMC Exam with this focused practice resource. It
supports review of respiratory therapy concepts, patient assessment, oxygenation
and ventilation, pulmonary disorders, mechanical ventilation, and clinical decision-
making. Use the material to reinforce your knowledge, practice applying key concepts,
and identify areas that may require additional study. This resource is suited for
respiratory therapy students, respiratory therapist trainees, and candidates preparing
for the TMC examination.
MULTIPLE CHOICE.
PATIENT ASSESSMENT (Questions 1–30)
Question #1
A patient is admitted to the ED following a motor vehicle accident. On
physical exam, the respiratory therapist notes absent breath sounds in the left
chest with a hyperresonant percussion note. What action should the therapist
recommend FIRST?
A. Obtain a stat chest X-ray
B. Needle decompression of the left chest
C. Administer high-flow oxygen
D. Prepare for intubation
Correct Answer: B
Rationale: Absent breath sounds with hyperresonance indicates a tension
pneumothorax, which is a life-threatening emergency requiring immediate
needle decompression. While chest X-ray confirms the diagnosis,
decompression should not be delayed. High-flow oxygen and intubation are
supportive but do not address the underlying tension.
, Page 2 of 65
Question #2
A healthy adult female can exhale what portion of her forced vital capacity
(FVC) in the first second (FEV₁/FVC ratio)?
A. 50%
B. 70%
C. 80%
D. 90%
Correct Answer: B
Rationale: A healthy adult typically exhales approximately 70-75% of FVC
in the first second (FEV₁/FVC ≥ 70-75% predicted). Values below 70% suggest
obstructive airway disease (e.g., asthma, COPD).
Question #3
A respiratory therapist is reviewing a patient's medical record. Which of the
following is the MOST important to review FIRST?
A. Social history
B. Allergies
C. Immunization status
D. Surgical history
Correct Answer: B
Rationale: Allergies are a critical safety priority—they must be identified
before any medication or treatment is administered. While history, advanced
directives, and HPI are important, allergies are the most urgent to prevent life-
threatening reactions.
Question #4
A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics.
Which of the following is the MOST appropriate initial intervention?
A. Increase inspiratory flow
B. Decrease respiratory rate
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C. Increase tidal volume
D. Decrease PEEP
Correct Answer: B
Rationale: Auto-PEEP (intrinsic PEEP) occurs when there is insufficient
expiratory time, leading to air trapping. Decreasing the respiratory rate
prolongs expiratory time and reduces auto-PEEP. Increasing inspiratory flow
may worsen trapping; increasing tidal volume increases pressure; decreasing
PEEP does not address the underlying cause.
Question #5
The four critical life functions identified by the Kettering approach are:
A. Ventilation, Oxygenation, Circulation, Perfusion
B. Ventilation, Oxygenation, Respiration, Perfusion
C. Airway, Breathing, Circulation, Disability
D. Oxygenation, Ventilation, Perfusion, Diffusion
Correct Answer: A
Rationale: Kettering emphasizes four critical life functions: Ventilation
(moving air in/out), Oxygenation (getting O₂ to the blood), Circulation (moving
blood through the body), and Perfusion (getting O₂ to the tissues). This
framework guides assessment and prioritization of interventions.
Question #6
A patient is receiving oxygen via nasal cannula at 4 L/min. The therapist notes
the patient's SpO₂ is 88%. What is the MOST appropriate action?
A. Increase to 6 L/min via nasal cannula
B. Switch to a non-rebreather mask at 15 L/min
C. Apply a simple mask at 6 L/min
D. Decrease to 2 L/min
Correct Answer: B
Rationale: An SpO₂ of 88% indicates significant hypoxemia. A nasal
cannula at 4 L/min delivers only ~36% FiO₂. A non-rebreather mask at 15
, Page 4 of 65
L/min delivers up to 90-100% FiO₂ and is appropriate for severe hypoxemia.
Simply increasing to 6 L/min via nasal cannula is unlikely to achieve adequate
oxygenation.
Question #7
A patient with COPD has an SpO₂ of 89% on room air. The patient is alert and
oriented. What is the MOST appropriate oxygen delivery device?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 24-28% FiO₂
C. Nasal cannula at 6 L/min
D. Simple mask at 10 L/min
Correct Answer: B
Rationale: COPD patients require controlled, precise oxygen delivery to
avoid suppressing the hypoxic drive. A Venturi mask delivers a fixed FiO₂ (24-
28%), allowing careful titration. A non-rebreather or high-flow nasal cannula
may cause hypercapnia; a simple mask is less precise.
Question #8
A respiratory therapist is assessing a patient with suspected pulmonary
embolism. Which of the following findings is MOST consistent with this
diagnosis?
A. Hyperresonance to percussion
B. Sudden onset dyspnea with pleuritic chest pain
C. Crackles in bilateral lung bases
D. Wheezing on expiration
Correct Answer: B
Rationale: Sudden onset dyspnea with pleuritic chest pain is classic for
pulmonary embolism. Hyperresonance suggests pneumothorax; crackles
suggest pulmonary edema or pneumonia; wheezing suggests bronchospasm.
