RESPIRATORY THERAPY · NBRC CREDENTIALING
TMC EXAM A+
2026/2027 Official Exam
Therapist Multiple-Choice Exit Exam · National Board for Respiratory Care Style
A+ QUESTIONS 6 SECTIONS 100%
VERIFIED COVERED RATIONALES
CATEGORIES
■ Section 1: Patient Data Evaluation & Assessment
■ Section 2: Equipment, Troubleshooting & Infection Control
■ Section 3: Oxygen, Aerosol Therapy & Airway Management
■ Section 4: Mechanical Ventilation
■ Section 5: Pulmonary Diagnostics & Special Procedures
■ Section 6: Neonatal, Pediatric & Emergency/Critical Care
Examination Specifications
Difficulty: Professional Certification · Bloom’s: Application / Analysis / Synthesis
Question Format: Multiple Choice (A–D) · Marks: 1 per question
Passing Score: 75% · Total Marks: 100
Content Alignment
This examination is aligned to the publicly available NBRC Therapist Multiple-Choice Detailed Content Outline domains, including patient
data evaluation, equipment troubleshooting and infection control, initiation and modification of therapeutic procedures, mechanical
ventilation, pulmonary diagnostics, and care across the lifespan including neonatal and pediatric populations.
STUVIAACTUALEXAM
, Section 1: Patient Data Evaluation & Assessment
Q1.
A 58-year-old patient with COPD is admitted with increased dyspnea. On examination the respiratory therapist notes a barrel chest,
prolonged expiratory phase, and diminished breath sounds bilaterally. The most recent ABG on room air shows pH 7.36, PaCO2
58 mm Hg, PaO2 62 mm Hg, HCO3 32 mEq/L. These findings are most consistent with:
A. Acute respiratory alkalosis with severe hypoxemia
B. Compensated respiratory acidosis with moderate hypoxemia
C. Uncompensated metabolic acidosis
D. Normal acid-base balance with mild hypoxemia
Correct Answer: B
Rationale: Chronic CO2 retention with elevated HCO3 indicates renal compensation for chronic respiratory acidosis. The near-normal pH
confirms compensation. PaO2 of 62 mm Hg represents moderate hypoxemia typical of advanced COPD.
Q2.
While reviewing a patient's chart before rounds, the therapist notes a sudden drop in SpO2 from 94% to 82% over 20 minutes with
no change in FiO2. The patient is on a simple mask at 6 L/min. The first action the therapist should take is to:
A. Immediately increase the oxygen flow to 15 L/min
B. Assess the patient, check the oxygen delivery system, and evaluate for acute clinical change
C. Document the reading and continue with other patients
D. Order an ABG without seeing the patient
Correct Answer: B
Rationale: A sudden desaturation requires prompt bedside assessment of the patient and equipment integrity before any intervention. Equipment
failure, disconnection, or acute pathology must be ruled out.
Q3.
A patient recovers from abdominal surgery and complains of difficulty taking deep breaths. Vital capacity is measured at 12 mL/kg.
The therapist should recognize that this value indicates:
A. Adequate lung expansion with no further action needed
B. Normal postoperative values for all surgical patients
C. Immediate need for intubation and mechanical ventilation
D. Significantly reduced vital capacity that may predispose the patient to atelectasis and may warrant lung expansion therapy
Correct Answer: D
Rationale: Vital capacity below approximately 15 mL/kg is associated with increased risk of postoperative atelectasis. Lung expansion therapies
such as incentive spirometry or CPAP may be indicated.
Q4.
On auscultation of a patient with suspected pneumonia, the therapist hears high-pitched, continuous musical sounds predominantly
during expiration over the right lower lobe. These adventitious sounds are best described as:
A. Wheezes
B. Fine crackles
C. Coarse crackles
D. Pleural friction rub
Correct Answer: A
Rationale: Wheezes are continuous, high-pitched, musical sounds caused by narrowed airways. Crackles are discontinuous; a pleural friction rub
is typically biphasic and grating.
TMC EXAM | Page 2
, Q5.
A patient's peak expiratory flow rate (PEFR) is measured at 45% of predicted personal best during an acute asthma exacerbation.
According to standard asthma action plans, this value places the patient in the:
A. Green zone, indicating good control
B. Yellow zone, indicating caution and need for increased bronchodilator therapy
C. Red zone, indicating medical alert and need for urgent intervention
D. Normal range requiring no change in therapy
Correct Answer: C
Rationale: PEFR <50% of personal best is the red zone, signaling a severe exacerbation that requires immediate medical attention and
aggressive treatment.
Q6.
An ABG obtained from a patient on mechanical ventilation shows pH 7.28, PaCO2 58 mm Hg, PaO2 78 mm Hg, HCO3 26 mEq/L.
The acid-base disturbance is best classified as:
A. Compensated metabolic alkalosis
B. Chronic respiratory acidosis with full compensation
C. Acute (uncompensated) respiratory acidosis
D. Mixed metabolic and respiratory alkalosis
Correct Answer: C
Rationale: Elevated PaCO2 with decreased pH and near-normal HCO3 indicates acute respiratory acidosis without significant renal
compensation.
Q7.
During a physical assessment the therapist observes use of accessory muscles, nasal flaring, and paradoxical abdominal
movement. These signs most strongly suggest:
A. Increased work of breathing and possible impending respiratory failure
B. Adequate spontaneous ventilation
C. Normal breathing pattern in an athletic patient
D. Primarily cardiac rather than respiratory distress
Correct Answer: A
Rationale: Accessory muscle use, nasal flaring, and paradoxical breathing indicate markedly increased work of breathing and are warning signs of
respiratory muscle fatigue and potential failure.
Q8.
A patient with suspected pulmonary embolism has an A-a gradient of 45 mm Hg on room air. The therapist correctly interprets this
finding as:
A. Normal A-a gradient for any age
B. Evidence of pure hypoventilation only
C. Elevated A-a gradient consistent with V/Q mismatch or shunt
D. Indication that oxygen therapy is contraindicated
Correct Answer: C
Rationale: Normal A-a gradient is roughly (age/4)+4. A value of 45 mm Hg is elevated and supports the presence of V/Q inequality or shunt, both
of which can occur with PE.
Q9.
A therapist reviews a chest radiograph that shows blunting of the costophrenic angle and a meniscus sign on the right side. The
most likely interpretation is:
A. Pleural effusion
B. Pneumothorax
C. Lobar consolidation only
D. Normal radiographic appearance
Correct Answer: A
Rationale: Blunting of the costophrenic angle with a meniscus is classic for pleural fluid accumulation. Pneumothorax typically shows a visceral
pleural line and absence of lung markings.
TMC EXAM | Page 3
TMC EXAM A+
2026/2027 Official Exam
Therapist Multiple-Choice Exit Exam · National Board for Respiratory Care Style
A+ QUESTIONS 6 SECTIONS 100%
VERIFIED COVERED RATIONALES
CATEGORIES
■ Section 1: Patient Data Evaluation & Assessment
■ Section 2: Equipment, Troubleshooting & Infection Control
■ Section 3: Oxygen, Aerosol Therapy & Airway Management
■ Section 4: Mechanical Ventilation
■ Section 5: Pulmonary Diagnostics & Special Procedures
■ Section 6: Neonatal, Pediatric & Emergency/Critical Care
Examination Specifications
Difficulty: Professional Certification · Bloom’s: Application / Analysis / Synthesis
Question Format: Multiple Choice (A–D) · Marks: 1 per question
Passing Score: 75% · Total Marks: 100
Content Alignment
This examination is aligned to the publicly available NBRC Therapist Multiple-Choice Detailed Content Outline domains, including patient
data evaluation, equipment troubleshooting and infection control, initiation and modification of therapeutic procedures, mechanical
ventilation, pulmonary diagnostics, and care across the lifespan including neonatal and pediatric populations.
STUVIAACTUALEXAM
, Section 1: Patient Data Evaluation & Assessment
Q1.
A 58-year-old patient with COPD is admitted with increased dyspnea. On examination the respiratory therapist notes a barrel chest,
prolonged expiratory phase, and diminished breath sounds bilaterally. The most recent ABG on room air shows pH 7.36, PaCO2
58 mm Hg, PaO2 62 mm Hg, HCO3 32 mEq/L. These findings are most consistent with:
A. Acute respiratory alkalosis with severe hypoxemia
B. Compensated respiratory acidosis with moderate hypoxemia
C. Uncompensated metabolic acidosis
D. Normal acid-base balance with mild hypoxemia
Correct Answer: B
Rationale: Chronic CO2 retention with elevated HCO3 indicates renal compensation for chronic respiratory acidosis. The near-normal pH
confirms compensation. PaO2 of 62 mm Hg represents moderate hypoxemia typical of advanced COPD.
Q2.
While reviewing a patient's chart before rounds, the therapist notes a sudden drop in SpO2 from 94% to 82% over 20 minutes with
no change in FiO2. The patient is on a simple mask at 6 L/min. The first action the therapist should take is to:
A. Immediately increase the oxygen flow to 15 L/min
B. Assess the patient, check the oxygen delivery system, and evaluate for acute clinical change
C. Document the reading and continue with other patients
D. Order an ABG without seeing the patient
Correct Answer: B
Rationale: A sudden desaturation requires prompt bedside assessment of the patient and equipment integrity before any intervention. Equipment
failure, disconnection, or acute pathology must be ruled out.
Q3.
A patient recovers from abdominal surgery and complains of difficulty taking deep breaths. Vital capacity is measured at 12 mL/kg.
The therapist should recognize that this value indicates:
A. Adequate lung expansion with no further action needed
B. Normal postoperative values for all surgical patients
C. Immediate need for intubation and mechanical ventilation
D. Significantly reduced vital capacity that may predispose the patient to atelectasis and may warrant lung expansion therapy
Correct Answer: D
Rationale: Vital capacity below approximately 15 mL/kg is associated with increased risk of postoperative atelectasis. Lung expansion therapies
such as incentive spirometry or CPAP may be indicated.
Q4.
On auscultation of a patient with suspected pneumonia, the therapist hears high-pitched, continuous musical sounds predominantly
during expiration over the right lower lobe. These adventitious sounds are best described as:
A. Wheezes
B. Fine crackles
C. Coarse crackles
D. Pleural friction rub
Correct Answer: A
Rationale: Wheezes are continuous, high-pitched, musical sounds caused by narrowed airways. Crackles are discontinuous; a pleural friction rub
is typically biphasic and grating.
TMC EXAM | Page 2
, Q5.
A patient's peak expiratory flow rate (PEFR) is measured at 45% of predicted personal best during an acute asthma exacerbation.
According to standard asthma action plans, this value places the patient in the:
A. Green zone, indicating good control
B. Yellow zone, indicating caution and need for increased bronchodilator therapy
C. Red zone, indicating medical alert and need for urgent intervention
D. Normal range requiring no change in therapy
Correct Answer: C
Rationale: PEFR <50% of personal best is the red zone, signaling a severe exacerbation that requires immediate medical attention and
aggressive treatment.
Q6.
An ABG obtained from a patient on mechanical ventilation shows pH 7.28, PaCO2 58 mm Hg, PaO2 78 mm Hg, HCO3 26 mEq/L.
The acid-base disturbance is best classified as:
A. Compensated metabolic alkalosis
B. Chronic respiratory acidosis with full compensation
C. Acute (uncompensated) respiratory acidosis
D. Mixed metabolic and respiratory alkalosis
Correct Answer: C
Rationale: Elevated PaCO2 with decreased pH and near-normal HCO3 indicates acute respiratory acidosis without significant renal
compensation.
Q7.
During a physical assessment the therapist observes use of accessory muscles, nasal flaring, and paradoxical abdominal
movement. These signs most strongly suggest:
A. Increased work of breathing and possible impending respiratory failure
B. Adequate spontaneous ventilation
C. Normal breathing pattern in an athletic patient
D. Primarily cardiac rather than respiratory distress
Correct Answer: A
Rationale: Accessory muscle use, nasal flaring, and paradoxical breathing indicate markedly increased work of breathing and are warning signs of
respiratory muscle fatigue and potential failure.
Q8.
A patient with suspected pulmonary embolism has an A-a gradient of 45 mm Hg on room air. The therapist correctly interprets this
finding as:
A. Normal A-a gradient for any age
B. Evidence of pure hypoventilation only
C. Elevated A-a gradient consistent with V/Q mismatch or shunt
D. Indication that oxygen therapy is contraindicated
Correct Answer: C
Rationale: Normal A-a gradient is roughly (age/4)+4. A value of 45 mm Hg is elevated and supports the presence of V/Q inequality or shunt, both
of which can occur with PE.
Q9.
A therapist reviews a chest radiograph that shows blunting of the costophrenic angle and a meniscus sign on the right side. The
most likely interpretation is:
A. Pleural effusion
B. Pneumothorax
C. Lobar consolidation only
D. Normal radiographic appearance
Correct Answer: A
Rationale: Blunting of the costophrenic angle with a meniscus is classic for pleural fluid accumulation. Pneumothorax typically shows a visceral
pleural line and absence of lung markings.
TMC EXAM | Page 3
