NBRC TMC Exam verified with correct answers plus
rationales instant pdf 2026/2027
SECTION 1: PATIENT DATA EVALUATION & RECOMMENDATIONS
Unit 1A: Gather Clinical Information
1. Which of the following is needed to calculate alveolar oxygen tension (PAO₂)?
• A) VD/VT and PAO₂
• B) Barometric pressure and FiO₂
• C) PetCO₂ and PaO₂
• D) QS/QT and deadspace
Correct Answer: B
Rationale: The alveolar gas equation requires barometric pressure, FiO₂, PaCO₂, and the
respiratory quotient. Barometric pressure and FiO₂ are essential components to determine the
partial pressure of oxygen in inspired air (PiO₂) .
2. L/min/m² is the unit of measure for which of the following?
• A) Systemic vascular resistance
• B) Cardiac output
• C) Cardiac index
• D) Stroke volume
Correct Answer: C
Rationale: Cardiac index is cardiac output indexed to body surface area, expressed in L/min/m².
Cardiac output is simply L/min. Stroke volume is mL/beat. Systemic vascular resistance is
expressed in dyne·sec·cm⁻⁵ .
3. A spontaneously breathing patient has the following ABG results: pH 7.38, PaCO₂ 42
mmHg, PaO₂ 76 mmHg, HCO₃⁻ 24 mEq/L, BE 0 mEq/L. 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%
Correct Answer: B
Rationale: The patient shows mild hypoxemia (PaO₂ 76 mmHg) with normal acid-base status. A
5 L/min nasal cannula delivers approximately 40% FiO₂, which is therapeutic for this patient. 2
L/min is likely insufficient to correct the hypoxemia .
4. Left heart failure would be manifested in which of the following values?
• A) CVP and mPAP
• B) mPAP and wedge pressure
• C) MAP and SVR
• D) Cardiac output and wedge pressure
Correct Answer: D
Rationale: Left ventricular function is best assessed by pulmonary capillary wedge pressure
(PCWP) and cardiac output. PCWP reflects left atrial pressure (preload to the left heart), and
cardiac output reflects left ventricular pump function .
5. Which finding is most closely associated with increased airway resistance?
• A) Reduced SpO₂
• B) Accessory muscle use
• C) Altered P50
• D) Increased PetCO₂
Correct Answer: B
Rationale: Accessory muscle use (sternocleidomastoid, scalenes, intercostals) indicates
increased work of breathing due to airway resistance. This is especially significant in patients
with asthma, COPD, or upper airway obstruction .
,6. A 65-year-old male is receiving albuterol therapy. The therapist notes the patient is also
receiving a beta-blocker medication. The therapist should recommend:
• A) Administer dexamethasone instead of albuterol
• B) Add levalbuterol to the regimen
• C) Replace albuterol with beclomethasone
• D) Monitor for reduced bronchodilator response
Correct Answer: D
Rationale: Beta-blockers can antagonize the effects of beta-agonists like albuterol. The therapist
should recommend monitoring for reduced bronchodilator response and possibly adjusting
therapy .
7. Results of a V/Q scan show poor perfusion with adequate ventilation. A chest radiograph
shows a wedge-shaped infiltrate over the right lung field. The patient most likely has:
• A) Fluid overload
• B) ARDS
• C) Pulmonary embolism
• D) Pneumonia
Correct Answer: C
Rationale: A V/Q mismatch with poor perfusion but adequate ventilation (mismatch) is classic
for pulmonary embolism. Wedge-shaped infiltrates on CXR are also characteristic of PE .
8. For a patient receiving volume-controlled mechanical ventilation, the lower inflection
point on a pressure-volume loop represents:
• A) Amount of pressure required to keep alveoli open
• B) Optimal PEEP
• C) Minimal PEEP
• D) Upper limit of residual volume
Correct Answer: A
Rationale: The lower inflection point (LIP) on the PV loop indicates the pressure at which
collapsed alveoli begin to open, representing the minimum pressure needed to maintain alveolar
patency .
, 9. A patient with a 40-year history of smoking has a morning cough, purulent sputum, and
barrel chest. The most appropriate therapy is:
• A) Bronchodilators and postural drainage
• B) Antibiotics and mucolytics
• C) Oxygen therapy only
• D) Corticosteroids
Correct Answer: A
Rationale: This patient shows signs of chronic bronchitis with COPD. Bronchodilators help
reduce airway obstruction, and postural drainage with percussion helps mobilize secretions .
10. Which of the following chest radiograph findings is most consistent with a right-sided
tension pneumothorax?
• A) Blunted costophrenic angle
• B) Mediastinal shift to the left
• C) Hyperinflation of the left lung
• D) Bilateral infiltrates
Correct Answer: B
Rationale: In tension pneumothorax, the mediastinum shifts away from the affected side. A right-
sided tension pneumothorax causes mediastinal shift to the LEFT. Hyperinflation, blunted
costophrenic angles, and infiltrates are not characteristic .
11. A patient's ABG shows pH 7.20, PaCO₂ 58, HCO₃⁻ 24. This indicates:
• A) Metabolic acidosis with compensation
• B) Respiratory acidosis with no compensation
• C) Respiratory alkalosis
• D) Metabolic alkalosis
Correct Answer: B
Rationale: pH is low (acidemia), PaCO₂ is high (respiratory acidosis), and HCO₃⁻ is normal,
indicating acute respiratory acidosis with no renal compensation yet .
rationales instant pdf 2026/2027
SECTION 1: PATIENT DATA EVALUATION & RECOMMENDATIONS
Unit 1A: Gather Clinical Information
1. Which of the following is needed to calculate alveolar oxygen tension (PAO₂)?
• A) VD/VT and PAO₂
• B) Barometric pressure and FiO₂
• C) PetCO₂ and PaO₂
• D) QS/QT and deadspace
Correct Answer: B
Rationale: The alveolar gas equation requires barometric pressure, FiO₂, PaCO₂, and the
respiratory quotient. Barometric pressure and FiO₂ are essential components to determine the
partial pressure of oxygen in inspired air (PiO₂) .
2. L/min/m² is the unit of measure for which of the following?
• A) Systemic vascular resistance
• B) Cardiac output
• C) Cardiac index
• D) Stroke volume
Correct Answer: C
Rationale: Cardiac index is cardiac output indexed to body surface area, expressed in L/min/m².
Cardiac output is simply L/min. Stroke volume is mL/beat. Systemic vascular resistance is
expressed in dyne·sec·cm⁻⁵ .
3. A spontaneously breathing patient has the following ABG results: pH 7.38, PaCO₂ 42
mmHg, PaO₂ 76 mmHg, HCO₃⁻ 24 mEq/L, BE 0 mEq/L. 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%
Correct Answer: B
Rationale: The patient shows mild hypoxemia (PaO₂ 76 mmHg) with normal acid-base status. A
5 L/min nasal cannula delivers approximately 40% FiO₂, which is therapeutic for this patient. 2
L/min is likely insufficient to correct the hypoxemia .
4. Left heart failure would be manifested in which of the following values?
• A) CVP and mPAP
• B) mPAP and wedge pressure
• C) MAP and SVR
• D) Cardiac output and wedge pressure
Correct Answer: D
Rationale: Left ventricular function is best assessed by pulmonary capillary wedge pressure
(PCWP) and cardiac output. PCWP reflects left atrial pressure (preload to the left heart), and
cardiac output reflects left ventricular pump function .
5. Which finding is most closely associated with increased airway resistance?
• A) Reduced SpO₂
• B) Accessory muscle use
• C) Altered P50
• D) Increased PetCO₂
Correct Answer: B
Rationale: Accessory muscle use (sternocleidomastoid, scalenes, intercostals) indicates
increased work of breathing due to airway resistance. This is especially significant in patients
with asthma, COPD, or upper airway obstruction .
,6. A 65-year-old male is receiving albuterol therapy. The therapist notes the patient is also
receiving a beta-blocker medication. The therapist should recommend:
• A) Administer dexamethasone instead of albuterol
• B) Add levalbuterol to the regimen
• C) Replace albuterol with beclomethasone
• D) Monitor for reduced bronchodilator response
Correct Answer: D
Rationale: Beta-blockers can antagonize the effects of beta-agonists like albuterol. The therapist
should recommend monitoring for reduced bronchodilator response and possibly adjusting
therapy .
7. Results of a V/Q scan show poor perfusion with adequate ventilation. A chest radiograph
shows a wedge-shaped infiltrate over the right lung field. The patient most likely has:
• A) Fluid overload
• B) ARDS
• C) Pulmonary embolism
• D) Pneumonia
Correct Answer: C
Rationale: A V/Q mismatch with poor perfusion but adequate ventilation (mismatch) is classic
for pulmonary embolism. Wedge-shaped infiltrates on CXR are also characteristic of PE .
8. For a patient receiving volume-controlled mechanical ventilation, the lower inflection
point on a pressure-volume loop represents:
• A) Amount of pressure required to keep alveoli open
• B) Optimal PEEP
• C) Minimal PEEP
• D) Upper limit of residual volume
Correct Answer: A
Rationale: The lower inflection point (LIP) on the PV loop indicates the pressure at which
collapsed alveoli begin to open, representing the minimum pressure needed to maintain alveolar
patency .
, 9. A patient with a 40-year history of smoking has a morning cough, purulent sputum, and
barrel chest. The most appropriate therapy is:
• A) Bronchodilators and postural drainage
• B) Antibiotics and mucolytics
• C) Oxygen therapy only
• D) Corticosteroids
Correct Answer: A
Rationale: This patient shows signs of chronic bronchitis with COPD. Bronchodilators help
reduce airway obstruction, and postural drainage with percussion helps mobilize secretions .
10. Which of the following chest radiograph findings is most consistent with a right-sided
tension pneumothorax?
• A) Blunted costophrenic angle
• B) Mediastinal shift to the left
• C) Hyperinflation of the left lung
• D) Bilateral infiltrates
Correct Answer: B
Rationale: In tension pneumothorax, the mediastinum shifts away from the affected side. A right-
sided tension pneumothorax causes mediastinal shift to the LEFT. Hyperinflation, blunted
costophrenic angles, and infiltrates are not characteristic .
11. A patient's ABG shows pH 7.20, PaCO₂ 58, HCO₃⁻ 24. This indicates:
• A) Metabolic acidosis with compensation
• B) Respiratory acidosis with no compensation
• C) Respiratory alkalosis
• D) Metabolic alkalosis
Correct Answer: B
Rationale: pH is low (acidemia), PaCO₂ is high (respiratory acidosis), and HCO₃⁻ is normal,
indicating acute respiratory acidosis with no renal compensation yet .
