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SECURE COMPREHENSIVE THERAPIST MULTIPLE-CHOICE SAE
(FORM 2020) - TMC EXAM 2026- QUESTIONS LATEST 2026 –
2027 VERSION SOLVED QUESTIONS & ANSWERS
SECURE COMPREHENSIVE THERAPIST MULTIPLE-CHOICE SAE (FORM 2020) - TMC
EXAM
Questions with Detailed Rationales
SECTION 1: PATIENT DATA EVALUATION AND RECOMMENDATIONS
1. A 68-year-old male patient with a documented history of chronic obstructive
pulmonary disease is currently receiving mechanical ventilation in the intensive
care unit with the following settings: volume-controlled assist/control mode, rate
14 breaths per minute, tidal volume 450 mL, FiO2 0.50, and PEEP 5 cm H2O. The
most recent arterial blood gas analysis reveals a pH of 7.31, PaCO2 of 55 mmHg,
PaO2 of 68 mmHg, and HCO3- of 26 mEq/L. Which of the following interventions
should the respiratory therapist recommend as the priority action?
A. Increase the respiratory rate to 18 breaths per minute
B. Increase the tidal volume to 600 mL
C. Increase the PEEP to 10 cm H2O
D. Maintain current settings and reassess in 30 minutes
Correct Answer: A
Rationale: The ABG results demonstrate acute-on-chronic respiratory acidosis as
evidenced by the pH below 7.35 along with an elevated PaCO2 while the bicarbonate
remains within normal limits at 26 mEq/L. Increasing the respiratory rate will effectively
increase the minute ventilation and help reduce the PaCO2 to a more acceptable level.
Option B is incorrect because increasing tidal volume in a patient with COPD may
increase the risk of barotrauma and dynamic hyperinflation, while Option C addresses
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oxygenation rather than ventilation and Option D would delay necessary intervention for
the acidosis .
2. A 54-year-old female patient who is three days post-operative following a
thoracotomy procedure is using an incentive spirometer and achieves a sustained
maximal inspiration volume of 800 mL, though her predicted inspiratory capacity is
calculated to be 1800 mL. The respiratory therapist notes that the patient appears
drowsy and is breathing shallowly with a respiratory rate of 24 breaths per minute.
Which of the following actions should the therapist take as the most appropriate
response to these findings?
A. Encourage the patient to perform coughing exercises only
B. Coach the patient to achieve higher volumes with more aggressive encouragement
C. Initiate continuous positive airway pressure at 10 cm H2O
D. Document the results as within acceptable parameters
Correct Answer: B
Rationale: Post-operative patients should generally achieve at least 50% of their
predicted inspiratory capacity, or values typically above 10-15 mL/kg, to effectively
prevent atelectasis and other pulmonary complications. This patient is achieving less
than 50% of her predicted inspiratory capacity at 800 mL versus 1800 mL, which
indicates inadequate effort and places her at significant risk for developing post-
operative pulmonary complications. Aggressive coaching is needed to improve her
performance and prevent deterioration. Option A is insufficient as coughing alone does
not provide the alveolar expansion needed, while Option C would be premature without
first attempting to improve her incentive spirometry technique .
3. Upon reviewing a patient's bedside flow sheet, the respiratory therapist notes
that the patient has an SpO2 of 88% while receiving supplemental oxygen at 4
L/min via nasal cannula, with a respiratory rate of 28 breaths per minute and visible
use of accessory muscles of respiration. Auscultation of the chest reveals diffuse
expiratory wheezing that is audible throughout all lung fields. Based on this clinical
presentation, which of the following interventions should the respiratory therapist
recommend as the first and most appropriate action?
A. Increase the nasal cannula flow to 6 L/min
B. Initiate noninvasive positive pressure ventilation with BiPAP
C. Administer a bronchodilator via small volume nebulizer
D. Obtain a stat chest radiograph
Correct Answer: C
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Rationale: The clinical presentation of diffuse expiratory wheezing combined with
accessory muscle use, tachypnea, and hypoxemia strongly suggests acute
bronchospasm, which is most likely related to an asthma exacerbation or COPD flare-
up. The priority intervention must address the underlying airway obstruction, and
bronchodilator therapy via small volume nebulizer is the most appropriate first-line
treatment. While Option A would address the hypoxemia, it does not treat the
underlying airway obstruction. Option B may become necessary if the patient fails to
respond to pharmacological therapy, but it should not be the first intervention. Option D
would delay essential treatment without providing immediate benefit to the patient's
respiratory status .
4. A patient presents with the following arterial blood gas results while breathing
room air: pH 7.48, PaCO2 32 mmHg, PaO2 62 mmHg, and HCO3- 24 mEq/L. Which
of the following interpretations most accurately describes this patient's acid-base
and oxygenation status?
A. Uncompensated respiratory alkalosis with mild hypoxemia
B. Compensated respiratory alkalosis with moderate hypoxemia
C. Uncompensated metabolic alkalosis with severe hypoxemia
D. Compensated metabolic acidosis with mild hypoxemia
Correct Answer: A
Rationale: The arterial blood gas demonstrates a pH above 7.45 at 7.48, indicating
alkalemia, with a PaCO2 below 35 mmHg at 32 mmHg, which confirms a primary
respiratory alkalosis. The bicarbonate remains within normal limits at 24 mEq/L,
indicating that no renal compensation has yet occurred, making this an
uncompensated respiratory alkalosis. The PaO2 of 62 mmHg on room air is below the
normal range of 80-100 mmHg, indicating mild hypoxemia. The absence of
compensatory changes in the bicarbonate level is the key feature that distinguishes this
as uncompensated rather than compensated .
5. A 45-year-old female patient with a known history of asthma presents to the
emergency department with acute shortness of breath that began approximately
two hours ago after exposure to a known allergen. The patient's initial peak
expiratory flow rate measurement is 180 L/min, while her personal best recorded
peak flow is 450 L/min. The respiratory therapist auscultates the chest and notes
minimal air movement with only faint wheezing audible during expiration. Which of
the following interpretations and recommendations is most appropriate for this
clinical scenario?
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A. The patient is experiencing a mild asthma exacerbation and should be discharged
with a prescription for oral corticosteroids
B. The patient is in status asthmaticus and requires immediate intubation and
mechanical ventilation
C. The patient is experiencing a severe exacerbation with impending respiratory failure
and requires aggressive bronchodilator therapy and close monitoring
D. The patient is experiencing a moderate exacerbation and should receive one
bronchodilator treatment followed by reassessment
Correct Answer: C
Rationale: The peak expiratory flow rate of 180 L/min represents only 40% of the
patient's personal best of 450 L/min, which is consistent with a severe asthma
exacerbation. The finding of minimal air movement with only faint wheezing is
particularly concerning because it indicates severe airflow obstruction with markedly
reduced ventilation. This clinical picture with significantly reduced peak flow and
diminished breath sounds suggests impending respiratory failure, and the patient
requires aggressive bronchodilator therapy with continuous monitoring in an acute care
setting. Discharge would be inappropriate given the severity, while immediate
intubation would be premature without first attempting aggressive pharmacological
intervention .
6. A 72-year-old male patient with a history of congestive heart failure presents
with acute shortness of breath that awakened him from sleep approximately three
hours ago. The patient is sitting upright in bed, appears diaphoretic, and has a
respiratory rate of 32 breaths per minute with an SpO2 of 89% on room air.
Auscultation reveals fine inspiratory crackles that are audible bilaterally at the lung
bases extending to the mid-lung fields. Which of the following medications should
the respiratory therapist anticipate administering as the most appropriate
intervention for this patient's presenting condition?
A. Albuterol via small volume nebulizer
B. Furosemide (Lasix) intravenously
C. Prednisone orally
D. Guaifenesin (Mucinex) orally
Correct Answer: B
Rationale: The patient's clinical presentation of paroxysmal nocturnal dyspnea,
orthopnea, diaphoresis, tachypnea, and fine inspiratory crackles bilaterally is classic for
acute pulmonary edema secondary to congestive heart failure. Furosemide is a loop
diuretic that reduces preload by promoting diuresis and decreasing fluid volume, which
SECURE COMPREHENSIVE THERAPIST MULTIPLE-CHOICE SAE
(FORM 2020) - TMC EXAM 2026- QUESTIONS LATEST 2026 –
2027 VERSION SOLVED QUESTIONS & ANSWERS
SECURE COMPREHENSIVE THERAPIST MULTIPLE-CHOICE SAE (FORM 2020) - TMC
EXAM
Questions with Detailed Rationales
SECTION 1: PATIENT DATA EVALUATION AND RECOMMENDATIONS
1. A 68-year-old male patient with a documented history of chronic obstructive
pulmonary disease is currently receiving mechanical ventilation in the intensive
care unit with the following settings: volume-controlled assist/control mode, rate
14 breaths per minute, tidal volume 450 mL, FiO2 0.50, and PEEP 5 cm H2O. The
most recent arterial blood gas analysis reveals a pH of 7.31, PaCO2 of 55 mmHg,
PaO2 of 68 mmHg, and HCO3- of 26 mEq/L. Which of the following interventions
should the respiratory therapist recommend as the priority action?
A. Increase the respiratory rate to 18 breaths per minute
B. Increase the tidal volume to 600 mL
C. Increase the PEEP to 10 cm H2O
D. Maintain current settings and reassess in 30 minutes
Correct Answer: A
Rationale: The ABG results demonstrate acute-on-chronic respiratory acidosis as
evidenced by the pH below 7.35 along with an elevated PaCO2 while the bicarbonate
remains within normal limits at 26 mEq/L. Increasing the respiratory rate will effectively
increase the minute ventilation and help reduce the PaCO2 to a more acceptable level.
Option B is incorrect because increasing tidal volume in a patient with COPD may
increase the risk of barotrauma and dynamic hyperinflation, while Option C addresses
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oxygenation rather than ventilation and Option D would delay necessary intervention for
the acidosis .
2. A 54-year-old female patient who is three days post-operative following a
thoracotomy procedure is using an incentive spirometer and achieves a sustained
maximal inspiration volume of 800 mL, though her predicted inspiratory capacity is
calculated to be 1800 mL. The respiratory therapist notes that the patient appears
drowsy and is breathing shallowly with a respiratory rate of 24 breaths per minute.
Which of the following actions should the therapist take as the most appropriate
response to these findings?
A. Encourage the patient to perform coughing exercises only
B. Coach the patient to achieve higher volumes with more aggressive encouragement
C. Initiate continuous positive airway pressure at 10 cm H2O
D. Document the results as within acceptable parameters
Correct Answer: B
Rationale: Post-operative patients should generally achieve at least 50% of their
predicted inspiratory capacity, or values typically above 10-15 mL/kg, to effectively
prevent atelectasis and other pulmonary complications. This patient is achieving less
than 50% of her predicted inspiratory capacity at 800 mL versus 1800 mL, which
indicates inadequate effort and places her at significant risk for developing post-
operative pulmonary complications. Aggressive coaching is needed to improve her
performance and prevent deterioration. Option A is insufficient as coughing alone does
not provide the alveolar expansion needed, while Option C would be premature without
first attempting to improve her incentive spirometry technique .
3. Upon reviewing a patient's bedside flow sheet, the respiratory therapist notes
that the patient has an SpO2 of 88% while receiving supplemental oxygen at 4
L/min via nasal cannula, with a respiratory rate of 28 breaths per minute and visible
use of accessory muscles of respiration. Auscultation of the chest reveals diffuse
expiratory wheezing that is audible throughout all lung fields. Based on this clinical
presentation, which of the following interventions should the respiratory therapist
recommend as the first and most appropriate action?
A. Increase the nasal cannula flow to 6 L/min
B. Initiate noninvasive positive pressure ventilation with BiPAP
C. Administer a bronchodilator via small volume nebulizer
D. Obtain a stat chest radiograph
Correct Answer: C
, Page 3 of 126
Rationale: The clinical presentation of diffuse expiratory wheezing combined with
accessory muscle use, tachypnea, and hypoxemia strongly suggests acute
bronchospasm, which is most likely related to an asthma exacerbation or COPD flare-
up. The priority intervention must address the underlying airway obstruction, and
bronchodilator therapy via small volume nebulizer is the most appropriate first-line
treatment. While Option A would address the hypoxemia, it does not treat the
underlying airway obstruction. Option B may become necessary if the patient fails to
respond to pharmacological therapy, but it should not be the first intervention. Option D
would delay essential treatment without providing immediate benefit to the patient's
respiratory status .
4. A patient presents with the following arterial blood gas results while breathing
room air: pH 7.48, PaCO2 32 mmHg, PaO2 62 mmHg, and HCO3- 24 mEq/L. Which
of the following interpretations most accurately describes this patient's acid-base
and oxygenation status?
A. Uncompensated respiratory alkalosis with mild hypoxemia
B. Compensated respiratory alkalosis with moderate hypoxemia
C. Uncompensated metabolic alkalosis with severe hypoxemia
D. Compensated metabolic acidosis with mild hypoxemia
Correct Answer: A
Rationale: The arterial blood gas demonstrates a pH above 7.45 at 7.48, indicating
alkalemia, with a PaCO2 below 35 mmHg at 32 mmHg, which confirms a primary
respiratory alkalosis. The bicarbonate remains within normal limits at 24 mEq/L,
indicating that no renal compensation has yet occurred, making this an
uncompensated respiratory alkalosis. The PaO2 of 62 mmHg on room air is below the
normal range of 80-100 mmHg, indicating mild hypoxemia. The absence of
compensatory changes in the bicarbonate level is the key feature that distinguishes this
as uncompensated rather than compensated .
5. A 45-year-old female patient with a known history of asthma presents to the
emergency department with acute shortness of breath that began approximately
two hours ago after exposure to a known allergen. The patient's initial peak
expiratory flow rate measurement is 180 L/min, while her personal best recorded
peak flow is 450 L/min. The respiratory therapist auscultates the chest and notes
minimal air movement with only faint wheezing audible during expiration. Which of
the following interpretations and recommendations is most appropriate for this
clinical scenario?
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A. The patient is experiencing a mild asthma exacerbation and should be discharged
with a prescription for oral corticosteroids
B. The patient is in status asthmaticus and requires immediate intubation and
mechanical ventilation
C. The patient is experiencing a severe exacerbation with impending respiratory failure
and requires aggressive bronchodilator therapy and close monitoring
D. The patient is experiencing a moderate exacerbation and should receive one
bronchodilator treatment followed by reassessment
Correct Answer: C
Rationale: The peak expiratory flow rate of 180 L/min represents only 40% of the
patient's personal best of 450 L/min, which is consistent with a severe asthma
exacerbation. The finding of minimal air movement with only faint wheezing is
particularly concerning because it indicates severe airflow obstruction with markedly
reduced ventilation. This clinical picture with significantly reduced peak flow and
diminished breath sounds suggests impending respiratory failure, and the patient
requires aggressive bronchodilator therapy with continuous monitoring in an acute care
setting. Discharge would be inappropriate given the severity, while immediate
intubation would be premature without first attempting aggressive pharmacological
intervention .
6. A 72-year-old male patient with a history of congestive heart failure presents
with acute shortness of breath that awakened him from sleep approximately three
hours ago. The patient is sitting upright in bed, appears diaphoretic, and has a
respiratory rate of 32 breaths per minute with an SpO2 of 89% on room air.
Auscultation reveals fine inspiratory crackles that are audible bilaterally at the lung
bases extending to the mid-lung fields. Which of the following medications should
the respiratory therapist anticipate administering as the most appropriate
intervention for this patient's presenting condition?
A. Albuterol via small volume nebulizer
B. Furosemide (Lasix) intravenously
C. Prednisone orally
D. Guaifenesin (Mucinex) orally
Correct Answer: B
Rationale: The patient's clinical presentation of paroxysmal nocturnal dyspnea,
orthopnea, diaphoresis, tachypnea, and fine inspiratory crackles bilaterally is classic for
acute pulmonary edema secondary to congestive heart failure. Furosemide is a loop
diuretic that reduces preload by promoting diuresis and decreasing fluid volume, which
