TMC PRACTICE EXAM 2026-2027
QUESTIONS AND CORRECT ANSWERS • Exams of Nursing • NBRC Therapist Multiple-Choice Examination
─────────────────────────────────────────────────────────────────────────────────────
NBRC TMC Content Outline Aligned • AARC Clinical Practice Guidelines • 110 Questions • Randomized Key • Evidence-Based Rationales
• For Study Purposes Only
IMPORTANT NOTICE: This document is an independent study aid and comprehensive practice examination designed to reflect the current NBRC
Therapist Multiple-Choice (TMC) Examination content outline and AARC Clinical Practice Guidelines for 2026–2027. It is NOT an actual, leaked, or
reproduced NBRC examination and does not guarantee credentialing. All content is for educational preparation only. "Questions and Correct Answers"
indicates each item includes a verified correct answer and evidence-based rationale for self-assessment.
Section 1: Brief Introduction
This TMC Practice Exam for 2026–2027 simulates actual NBRC Therapist Multiple-Choice examination
conditions and evaluates competency across the complete NBRC TMC content outline. Content spans patient
assessment, blood gas analysis and monitoring, oxygen and airway management, mechanical ventilation,
pharmacology, pulmonary function testing, resuscitation, neonatal/pediatric care, rehabilitation, home care,
and infection control, emphasizing data interpretation, clinical decision-making, and evidence-based
application of AARC Clinical Practice Guidelines.
EXAM BLUEPRINT (110 Items) — NBRC TMC Domain Alignment:
Content Domain Items Coverage
Patient Assessment & Diagnostic Data 12 Q1–Q12
Blood Gases, Acid-Base & Monitoring (ABG, SpO₂, EtCO₂) 14 Q13–Q26
Oxygen Therapy & Medical Gas Delivery 11 Q27–Q37
Airway Management & Tracheostomy Care 12 Q38–Q49
Mechanical Ventilation (Modes, Settings, Alarms, 20 Q50–Q69
Weaning)
Pharmacology & Aerosol Therapy 12 Q70–Q81
Pulmonary Function Testing & Interpretation 8 Q82–Q89
Emergency/CPR & Resuscitation 7 Q90–Q96
Neonatal & Pediatric Respiratory Care 8 Q97–Q104
Rehabilitation, Home Care & Infection Control 6 Q105–Q110
Instructions: Select the single best answer for each scenario. Correct answers are shown in bold cyan and are randomized across A–D.
Review rationales immediately after each item. Time allocation: ~75 seconds per item (≈ 2.25 hours total). NBRC TMC passing requires
application of guidelines to data interpretation and management prioritization — not recall alone.
Section 2: The Complete Exam — 110 Questions with Rationales
1. A 62-year-old male with COPD presents with increased dyspnea, fever, and productive cough. On
auscultation, you hear coarse crackles in the right lower lobe that clear partially with coughing,
with increased tactile fremitus and bronchophony in the same area. Chest X-ray shows a lobar
infiltrate. These findings most consistent with:
A. Consolidation (lobar pneumonia) with patent airway
B. Pleural effusion with diminished fremitus and dullness to percussion
C. Pneumothorax with absent breath sounds and hyperresonance
D. Atelectasis with diminished fremitus and tracheal shift toward lesion
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, Rationale: Coarse crackles that partially clear, increased fremitus/bronchophony, and lobar infiltrate
indicate consolidation with patent airway (pneumonia). Per AARC assessment guidelines, consolidation
transmits sound better. Pneumothorax/effusion diminish fremitus; effusion has dullness and absent sounds,
pneumothorax hyperresonance and absent sounds.
2. A patient with asthma exacerbation has audible wheezing, prolonged expiratory phase, and
accessory muscle use. After bronchodilator therapy, wheezing disappears but patient remains
dyspneic with diminished breath sounds. The therapist should interpret this as:
A. Silent chest - severe bronchospasm with markedly reduced airflow requiring
immediate escalation, not improvement
B. Pneumothorax confirmed without further assessment
C. Complete resolution, wheezing is always present if obstruction remains
D. Normal finding, wheezing always correlates with severity
Rationale: In severe asthma, wheezing requires airflow; disappearance with persistent dyspnea, diminished
breath sounds, and accessory muscle use indicates silent chest—critical airway obstruction and impending
respiratory failure per NBRC/AARC. Do not equate absent wheeze with improvement; immediate assessment
(ABG, PEF, ICU, continuous bronchodilators, magnesium, ventilatory support) is needed.
3. On palpation of the chest, you note absent tactile fremitus over the left base, dullness to
percussion, and absent breath sounds in the same area with tracheal deviation away from the
lesion. These findings suggest:
A. Asthma with wheezing
B. Large pleural effusion
C. Pneumothorax with hyperresonance
D. Consolidation with increased fremitus
Rationale: Large pleural effusion presents with absent/diminished fremitus (fluid blocks transmission),
dullness to percussion, absent breath sounds, and tracheal shift away from effusion due to mass effect.
Consolidation increases fremitus, pneumothorax has hyperresonance and diminished fremitus but with
tracheal shift away and absent sounds—percussion distinction (dull vs hyperresonant) differentiates effusion
from pneumothorax.
4. Clubbing, cyanosis, barrel chest, pursed-lip breathing, and prolonged expiration are most
characteristic of:
A. Acute pulmonary edema with crackles and tachypnea
B. Pneumothorax with sudden chest pain
C. Chronic obstructive pulmonary disease (chronic hypoxemia and hyperinflation)
D. Acute asthma attack in a child
Rationale: Barrel chest (increased AP diameter), pursed-lip breathing, clubbing/cyanosis from chronic
hypoxemia, and air-trapping indicate COPD/emphysema with chronic hyperinflation. Asthma is episodic with
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, wheezing; pulmonary edema has pink frothy sputum and acute crackles; pneumothorax has sudden
unilateral pain and absent sounds.
5. A 45-year-old with fever, night sweats, and weight loss has diminished breath sounds and
dullness at right base with Egophony (E→A change). Chest X-ray shows right lower lobe density
with air bronchograms. The most useful follow-up to assess oxygenation is:
A. Anion gap calculation
B. Peak flow measurement alone
C. Arterial blood gas and pulse oximetry to quantify hypoxemia and shunt
D. Urinalysis
Rationale: Egophony and air bronchograms confirm consolidation; ABG/SpO₂ quantify hypoxemia from V/Q
mismatch and shunt, guiding oxygen therapy (AARC CPG for oxygen). Egophony (E→A) indicates
consolidation. Pulse oximetry alone may miss hypercapnia; peak flow assesses airflow, not parenchymal
consolidation oxygenation.
6. Stridor heard on inspiration at rest in a 3-year-old with barking cough and fever suggests:
A. Upper airway obstruction (croup/laryngeal edema) requiring immediate airway
assessment
B. Bronchiolitis with wheezing
C. Asthma with expiratory wheeze
D. Pneumonia with crackles
Rationale: Stridor is high-pitched inspiratory sound from upper airway (laryngeal/tracheal) obstruction. In
a child with barking cough, inspiratory stridor at rest indicates moderate-severe croup
(laryngotracheobronchitis) with significant narrowing, requiring AARC/neonatal-pediatric CPG evaluation:
humidified O₂, racemic epinephrine, corticosteroids, and airway monitoring; wheezing is lower airway.
7. Pleural friction rub is best described as:
A. Leathery, grating sound heard in both inspiration and expiration, not clearing with
cough, due to inflamed pleural surfaces
B. Continuous rhonchi
C. Crackles that clear with cough
D. Musical wheeze on expiration
Rationale: Friction rub is leathery/grating from inflamed visceral-parietal pleura rubbing, heard
biphasically and not clearing with cough, often with pleuritic chest pain and decreased chest excursion.
Wheezes are musical from airway narrowing, crackles discontinuous from airway opening, rhonchi low-
pitched from secretions and often clear with cough.
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, 8. A COPD patient’s vital signs: RR 28, HR 110, BP 148/90, SpO₂ 88% on room air, temp 38.3°C, with
use of sternocleidomastoid muscles and paradoxical abdominal movement. This indicates:
A. Severe respiratory distress and increased work of breathing requiring immediate
assessment and oxygen/ventilatory support per AARC
B. Normal vital signs
C. Only fever needs treatment
D. Stable COPD, continue routine care
Rationale: Tachypnea, tachycardia, hypoxemia, accessory muscle use, and paradoxical (abdominal)
movement indicate diaphragmatic fatigue and severe distress, high risk for ventilatory failure. NBRC
prioritizes assessment of distress signs before labs; immediate actions include SpO₂/BGA, oxygen titration,
bronchodilators, and possible ventilatory support evaluation.
9. When performing chest inspection on a patient with severe emphysema, you expect:
A. Decreased anteroposterior (AP) diameter
B. Increased AP diameter (barrel chest), hyperresonance to percussion, and distant
breath sounds due to hyperinflation and air-trapping
C. Normal chest configuration
D. Tracheal tug toward lesion only
Rationale: Emphysema causes hyperinflation, flattened diaphragm, increased AP diameter (barrel chest),
hyperresonance, decreased diaphragmatic excursion, and distant breath sounds from excess air. Percussion
hyperresonance and distant sounds distinguish emphysema from consolidation (dullness, increased fremitus).
10. A patient with shortness of breath has orthopnea, paroxysmal nocturnal dyspnea (PND),
bibasilar fine crackles, S3 gallop, and pink frothy sputum. This pattern indicates:
A. Asthma with wheezing
B. Pulmonary embolism with pleuritic pain
C. COPD with barrel chest
D. Left-sided heart failure / cardiogenic pulmonary edema
Rationale: Orthopnea, PND, bibasilar fine crackles, S3, and pink frothy sputum are classic for left
HF/pulmonary edema (fluid transudation into alveoli). PE has acute pleuritic pain/tachycardia and often
clear lungs initially; asthma has wheezing and hyperinflation, not pink sputum.
11. Capillary refill time, skin turgor, and daily weights are most useful to assess:
A. Neurologic status
B. Airway patency directly
C. Lung compliance
D. Fluid status and perfusion, important before interpreting edema-related breath
sounds and electrolyte management
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
QUESTIONS AND CORRECT ANSWERS • Exams of Nursing • NBRC Therapist Multiple-Choice Examination
─────────────────────────────────────────────────────────────────────────────────────
NBRC TMC Content Outline Aligned • AARC Clinical Practice Guidelines • 110 Questions • Randomized Key • Evidence-Based Rationales
• For Study Purposes Only
IMPORTANT NOTICE: This document is an independent study aid and comprehensive practice examination designed to reflect the current NBRC
Therapist Multiple-Choice (TMC) Examination content outline and AARC Clinical Practice Guidelines for 2026–2027. It is NOT an actual, leaked, or
reproduced NBRC examination and does not guarantee credentialing. All content is for educational preparation only. "Questions and Correct Answers"
indicates each item includes a verified correct answer and evidence-based rationale for self-assessment.
Section 1: Brief Introduction
This TMC Practice Exam for 2026–2027 simulates actual NBRC Therapist Multiple-Choice examination
conditions and evaluates competency across the complete NBRC TMC content outline. Content spans patient
assessment, blood gas analysis and monitoring, oxygen and airway management, mechanical ventilation,
pharmacology, pulmonary function testing, resuscitation, neonatal/pediatric care, rehabilitation, home care,
and infection control, emphasizing data interpretation, clinical decision-making, and evidence-based
application of AARC Clinical Practice Guidelines.
EXAM BLUEPRINT (110 Items) — NBRC TMC Domain Alignment:
Content Domain Items Coverage
Patient Assessment & Diagnostic Data 12 Q1–Q12
Blood Gases, Acid-Base & Monitoring (ABG, SpO₂, EtCO₂) 14 Q13–Q26
Oxygen Therapy & Medical Gas Delivery 11 Q27–Q37
Airway Management & Tracheostomy Care 12 Q38–Q49
Mechanical Ventilation (Modes, Settings, Alarms, 20 Q50–Q69
Weaning)
Pharmacology & Aerosol Therapy 12 Q70–Q81
Pulmonary Function Testing & Interpretation 8 Q82–Q89
Emergency/CPR & Resuscitation 7 Q90–Q96
Neonatal & Pediatric Respiratory Care 8 Q97–Q104
Rehabilitation, Home Care & Infection Control 6 Q105–Q110
Instructions: Select the single best answer for each scenario. Correct answers are shown in bold cyan and are randomized across A–D.
Review rationales immediately after each item. Time allocation: ~75 seconds per item (≈ 2.25 hours total). NBRC TMC passing requires
application of guidelines to data interpretation and management prioritization — not recall alone.
Section 2: The Complete Exam — 110 Questions with Rationales
1. A 62-year-old male with COPD presents with increased dyspnea, fever, and productive cough. On
auscultation, you hear coarse crackles in the right lower lobe that clear partially with coughing,
with increased tactile fremitus and bronchophony in the same area. Chest X-ray shows a lobar
infiltrate. These findings most consistent with:
A. Consolidation (lobar pneumonia) with patent airway
B. Pleural effusion with diminished fremitus and dullness to percussion
C. Pneumothorax with absent breath sounds and hyperresonance
D. Atelectasis with diminished fremitus and tracheal shift toward lesion
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, Rationale: Coarse crackles that partially clear, increased fremitus/bronchophony, and lobar infiltrate
indicate consolidation with patent airway (pneumonia). Per AARC assessment guidelines, consolidation
transmits sound better. Pneumothorax/effusion diminish fremitus; effusion has dullness and absent sounds,
pneumothorax hyperresonance and absent sounds.
2. A patient with asthma exacerbation has audible wheezing, prolonged expiratory phase, and
accessory muscle use. After bronchodilator therapy, wheezing disappears but patient remains
dyspneic with diminished breath sounds. The therapist should interpret this as:
A. Silent chest - severe bronchospasm with markedly reduced airflow requiring
immediate escalation, not improvement
B. Pneumothorax confirmed without further assessment
C. Complete resolution, wheezing is always present if obstruction remains
D. Normal finding, wheezing always correlates with severity
Rationale: In severe asthma, wheezing requires airflow; disappearance with persistent dyspnea, diminished
breath sounds, and accessory muscle use indicates silent chest—critical airway obstruction and impending
respiratory failure per NBRC/AARC. Do not equate absent wheeze with improvement; immediate assessment
(ABG, PEF, ICU, continuous bronchodilators, magnesium, ventilatory support) is needed.
3. On palpation of the chest, you note absent tactile fremitus over the left base, dullness to
percussion, and absent breath sounds in the same area with tracheal deviation away from the
lesion. These findings suggest:
A. Asthma with wheezing
B. Large pleural effusion
C. Pneumothorax with hyperresonance
D. Consolidation with increased fremitus
Rationale: Large pleural effusion presents with absent/diminished fremitus (fluid blocks transmission),
dullness to percussion, absent breath sounds, and tracheal shift away from effusion due to mass effect.
Consolidation increases fremitus, pneumothorax has hyperresonance and diminished fremitus but with
tracheal shift away and absent sounds—percussion distinction (dull vs hyperresonant) differentiates effusion
from pneumothorax.
4. Clubbing, cyanosis, barrel chest, pursed-lip breathing, and prolonged expiration are most
characteristic of:
A. Acute pulmonary edema with crackles and tachypnea
B. Pneumothorax with sudden chest pain
C. Chronic obstructive pulmonary disease (chronic hypoxemia and hyperinflation)
D. Acute asthma attack in a child
Rationale: Barrel chest (increased AP diameter), pursed-lip breathing, clubbing/cyanosis from chronic
hypoxemia, and air-trapping indicate COPD/emphysema with chronic hyperinflation. Asthma is episodic with
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, wheezing; pulmonary edema has pink frothy sputum and acute crackles; pneumothorax has sudden
unilateral pain and absent sounds.
5. A 45-year-old with fever, night sweats, and weight loss has diminished breath sounds and
dullness at right base with Egophony (E→A change). Chest X-ray shows right lower lobe density
with air bronchograms. The most useful follow-up to assess oxygenation is:
A. Anion gap calculation
B. Peak flow measurement alone
C. Arterial blood gas and pulse oximetry to quantify hypoxemia and shunt
D. Urinalysis
Rationale: Egophony and air bronchograms confirm consolidation; ABG/SpO₂ quantify hypoxemia from V/Q
mismatch and shunt, guiding oxygen therapy (AARC CPG for oxygen). Egophony (E→A) indicates
consolidation. Pulse oximetry alone may miss hypercapnia; peak flow assesses airflow, not parenchymal
consolidation oxygenation.
6. Stridor heard on inspiration at rest in a 3-year-old with barking cough and fever suggests:
A. Upper airway obstruction (croup/laryngeal edema) requiring immediate airway
assessment
B. Bronchiolitis with wheezing
C. Asthma with expiratory wheeze
D. Pneumonia with crackles
Rationale: Stridor is high-pitched inspiratory sound from upper airway (laryngeal/tracheal) obstruction. In
a child with barking cough, inspiratory stridor at rest indicates moderate-severe croup
(laryngotracheobronchitis) with significant narrowing, requiring AARC/neonatal-pediatric CPG evaluation:
humidified O₂, racemic epinephrine, corticosteroids, and airway monitoring; wheezing is lower airway.
7. Pleural friction rub is best described as:
A. Leathery, grating sound heard in both inspiration and expiration, not clearing with
cough, due to inflamed pleural surfaces
B. Continuous rhonchi
C. Crackles that clear with cough
D. Musical wheeze on expiration
Rationale: Friction rub is leathery/grating from inflamed visceral-parietal pleura rubbing, heard
biphasically and not clearing with cough, often with pleuritic chest pain and decreased chest excursion.
Wheezes are musical from airway narrowing, crackles discontinuous from airway opening, rhonchi low-
pitched from secretions and often clear with cough.
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
, 8. A COPD patient’s vital signs: RR 28, HR 110, BP 148/90, SpO₂ 88% on room air, temp 38.3°C, with
use of sternocleidomastoid muscles and paradoxical abdominal movement. This indicates:
A. Severe respiratory distress and increased work of breathing requiring immediate
assessment and oxygen/ventilatory support per AARC
B. Normal vital signs
C. Only fever needs treatment
D. Stable COPD, continue routine care
Rationale: Tachypnea, tachycardia, hypoxemia, accessory muscle use, and paradoxical (abdominal)
movement indicate diaphragmatic fatigue and severe distress, high risk for ventilatory failure. NBRC
prioritizes assessment of distress signs before labs; immediate actions include SpO₂/BGA, oxygen titration,
bronchodilators, and possible ventilatory support evaluation.
9. When performing chest inspection on a patient with severe emphysema, you expect:
A. Decreased anteroposterior (AP) diameter
B. Increased AP diameter (barrel chest), hyperresonance to percussion, and distant
breath sounds due to hyperinflation and air-trapping
C. Normal chest configuration
D. Tracheal tug toward lesion only
Rationale: Emphysema causes hyperinflation, flattened diaphragm, increased AP diameter (barrel chest),
hyperresonance, decreased diaphragmatic excursion, and distant breath sounds from excess air. Percussion
hyperresonance and distant sounds distinguish emphysema from consolidation (dullness, increased fremitus).
10. A patient with shortness of breath has orthopnea, paroxysmal nocturnal dyspnea (PND),
bibasilar fine crackles, S3 gallop, and pink frothy sputum. This pattern indicates:
A. Asthma with wheezing
B. Pulmonary embolism with pleuritic pain
C. COPD with barrel chest
D. Left-sided heart failure / cardiogenic pulmonary edema
Rationale: Orthopnea, PND, bibasilar fine crackles, S3, and pink frothy sputum are classic for left
HF/pulmonary edema (fluid transudation into alveoli). PE has acute pleuritic pain/tachycardia and often
clear lungs initially; asthma has wheezing and hyperinflation, not pink sputum.
11. Capillary refill time, skin turgor, and daily weights are most useful to assess:
A. Neurologic status
B. Airway patency directly
C. Lung compliance
D. Fluid status and perfusion, important before interpreting edema-related breath
sounds and electrolyte management
TMC PRACTICE EXAM 2026-2027 • 110 Questions • NBRC TMC + AARC Guidelines • For Study Use Only — Not an Actual NBRC Examination
