Kettering TMC Exam Practice (2026) -
300 Practice Questions & Answers for
Respiratory Therapist TMC Board
Exam Prep Review (PDF) | Verified
Kettering TMC Exam Practice (2026) - 300 | Comprehensive
Examination
Kettering TMC Exam Practice (2026) - 300 Practice Questions
& Answers for Respiratory Therapist TMC Board Exam Prep
Review (PDF) actual exam preparation document with
INTRODUCTION
This document is an important and very helpful preparation
resource for Kettering TMC Exam Practice (2026) - 300
Practice Questions & Answers for Respiratory Therapist TMC
Board Exam Prep Review (PDF). Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
A patient with severe ARDS (P/F ratio 85) on volume-control ventilation (VT
6 mL/kg PBW, PEEP 18 cm H2O, FiO2 0.8) has plateau pressure 34 cm H2O
and driving pressure 16 cm H2O. Which intervention is most consistent with
current evidence-based ARDS management?
A. Increase PEEP to 22 cm H2O to further recruit collapsed alveoli.
B. Reduce tidal volume to 4 mL/kg PBW and accept permissive
hypercapnia.
C. Initiate prone positioning for at least 16 hours per day.
D. Administer a recruitment maneuver with sustained inflation of 40 cm
H2O for 40 seconds.
Correct Answer: C - Initiate prone positioning for at least 16
hours per day.
RATIONALE
Prone positioning is recommended for moderate-to-severe ARDS (P/F
<150) after optimization of ventilation, as it improves oxygenation
and mortality (PROSEVA trial). Plateau pressure is already near the
upper limit (30 cm H2O recommended), so increasing PEEP (A) or
recruitment maneuvers (D) risk barotrauma. Reducing VT to 4 mL/kg
(B) is not standard unless driving pressure remains elevated despite
other measures.
Question 2
Which set of arterial blood gas values is most consistent with a mixed
metabolic acidosis and respiratory alkalosis in a patient with salicylate
toxicity?
A. pH 7.52, PaCO2 28 mm Hg, HCO3- 22 mEq/L
B. pH 7.30, PaCO2 30 mm Hg, HCO3- 15 mEq/L
C. pH 7.40, PaCO2 40 mm Hg, HCO3- 24 mEq/L
D. pH 7.25, PaCO2 50 mm Hg, HCO3- 20 mEq/L
Page 2
,Correct Answer: B - pH 7.30, PaCO2 30 mm Hg, HCO3- 15
mEq/L
RATIONALE
Salicylate toxicity typically causes mixed metabolic acidosis (from
organic acids) and respiratory alkalosis (direct CNS stimulation). A
pH near normal with low HCO3- and low PaCO2 indicates a mixed
disorder; pH 7.30 is acidemic but PaCO2 is low, indicating concurrent
respiratory alkalosis. Options A and D show simple disorders; C is
normal.
Question 3
During volume-control ventilation, the pressure-time curve shows a sudden
increase in peak inspiratory pressure with no change in plateau pressure. Which
condition is most likely?
A. Decreased lung compliance (e.g., pneumothorax)
B. Increased airway resistance (e.g., bronchospasm)
C. Patient-ventilator asynchrony
D. Auto-PEEP
Correct Answer: B - Increased airway resistance (e.g.,
bronchospasm)
RATIONALE
An isolated rise in peak pressure with stable plateau pressure indicates
increased airway resistance (e.g., bronchospasm, secretions, kinked
tube). Decreased compliance would elevate both peak and plateau
pressures. Asynchrony and auto-PEEP typically show different
waveform patterns.
Question 4
A patient with a tracheostomy is being evaluated for decannulation. Which
combination of findings best predicts successful decannulation?
Page 3
, A. Cough peak expiratory flow > 160 L/min, PaCO2 < 45 mm Hg, and no
aspiration on swallow study
B. Spontaneous tidal volume > 5 mL/kg, RR < 25, and PaO2 > 60 mm
Hg on FiO2 0.4
C. Negative cuff leak test, Glasgow Coma Scale 15, and effective cough
D. Minimal secretions, SpO2 > 90% on 2 L NC, and ability to tolerate
oral diet
Correct Answer: A - Cough peak expiratory flow > 160 L/min,
PaCO2 < 45 mm Hg, and no aspiration on swallow study
RATIONALE
Decannulation criteria include adequate cough (peak expiratory flow
>160 L/min), stable gas exchange (PaCO2 <45 mm Hg), and no
aspiration risk. Option B focuses on oxygenation but not airway
protection; C includes negative cuff leak which may indicate upper
airway obstruction; D lacks objective cough and gas exchange
measures.
Question 5
Which of the following best explains why heliox improves laminar flow more
than turbulent flow in a patient with severe upper airway obstruction?
A. Heliox has a lower density, reducing Reynolds number and promoting
laminar flow.
B. Heliox has a higher viscosity, increasing laminar flow velocity.
C. Heliox increases nitrogen washout, improving alveolar ventilation.
D. Heliox reduces airway resistance primarily by decreasing gas
compressibility.
Correct Answer: A - Heliox has a lower density, reducing
Reynolds number and promoting laminar flow.
Page 4
300 Practice Questions & Answers for
Respiratory Therapist TMC Board
Exam Prep Review (PDF) | Verified
Kettering TMC Exam Practice (2026) - 300 | Comprehensive
Examination
Kettering TMC Exam Practice (2026) - 300 Practice Questions
& Answers for Respiratory Therapist TMC Board Exam Prep
Review (PDF) actual exam preparation document with
INTRODUCTION
This document is an important and very helpful preparation
resource for Kettering TMC Exam Practice (2026) - 300
Practice Questions & Answers for Respiratory Therapist TMC
Board Exam Prep Review (PDF). Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
A patient with severe ARDS (P/F ratio 85) on volume-control ventilation (VT
6 mL/kg PBW, PEEP 18 cm H2O, FiO2 0.8) has plateau pressure 34 cm H2O
and driving pressure 16 cm H2O. Which intervention is most consistent with
current evidence-based ARDS management?
A. Increase PEEP to 22 cm H2O to further recruit collapsed alveoli.
B. Reduce tidal volume to 4 mL/kg PBW and accept permissive
hypercapnia.
C. Initiate prone positioning for at least 16 hours per day.
D. Administer a recruitment maneuver with sustained inflation of 40 cm
H2O for 40 seconds.
Correct Answer: C - Initiate prone positioning for at least 16
hours per day.
RATIONALE
Prone positioning is recommended for moderate-to-severe ARDS (P/F
<150) after optimization of ventilation, as it improves oxygenation
and mortality (PROSEVA trial). Plateau pressure is already near the
upper limit (30 cm H2O recommended), so increasing PEEP (A) or
recruitment maneuvers (D) risk barotrauma. Reducing VT to 4 mL/kg
(B) is not standard unless driving pressure remains elevated despite
other measures.
Question 2
Which set of arterial blood gas values is most consistent with a mixed
metabolic acidosis and respiratory alkalosis in a patient with salicylate
toxicity?
A. pH 7.52, PaCO2 28 mm Hg, HCO3- 22 mEq/L
B. pH 7.30, PaCO2 30 mm Hg, HCO3- 15 mEq/L
C. pH 7.40, PaCO2 40 mm Hg, HCO3- 24 mEq/L
D. pH 7.25, PaCO2 50 mm Hg, HCO3- 20 mEq/L
Page 2
,Correct Answer: B - pH 7.30, PaCO2 30 mm Hg, HCO3- 15
mEq/L
RATIONALE
Salicylate toxicity typically causes mixed metabolic acidosis (from
organic acids) and respiratory alkalosis (direct CNS stimulation). A
pH near normal with low HCO3- and low PaCO2 indicates a mixed
disorder; pH 7.30 is acidemic but PaCO2 is low, indicating concurrent
respiratory alkalosis. Options A and D show simple disorders; C is
normal.
Question 3
During volume-control ventilation, the pressure-time curve shows a sudden
increase in peak inspiratory pressure with no change in plateau pressure. Which
condition is most likely?
A. Decreased lung compliance (e.g., pneumothorax)
B. Increased airway resistance (e.g., bronchospasm)
C. Patient-ventilator asynchrony
D. Auto-PEEP
Correct Answer: B - Increased airway resistance (e.g.,
bronchospasm)
RATIONALE
An isolated rise in peak pressure with stable plateau pressure indicates
increased airway resistance (e.g., bronchospasm, secretions, kinked
tube). Decreased compliance would elevate both peak and plateau
pressures. Asynchrony and auto-PEEP typically show different
waveform patterns.
Question 4
A patient with a tracheostomy is being evaluated for decannulation. Which
combination of findings best predicts successful decannulation?
Page 3
, A. Cough peak expiratory flow > 160 L/min, PaCO2 < 45 mm Hg, and no
aspiration on swallow study
B. Spontaneous tidal volume > 5 mL/kg, RR < 25, and PaO2 > 60 mm
Hg on FiO2 0.4
C. Negative cuff leak test, Glasgow Coma Scale 15, and effective cough
D. Minimal secretions, SpO2 > 90% on 2 L NC, and ability to tolerate
oral diet
Correct Answer: A - Cough peak expiratory flow > 160 L/min,
PaCO2 < 45 mm Hg, and no aspiration on swallow study
RATIONALE
Decannulation criteria include adequate cough (peak expiratory flow
>160 L/min), stable gas exchange (PaCO2 <45 mm Hg), and no
aspiration risk. Option B focuses on oxygenation but not airway
protection; C includes negative cuff leak which may indicate upper
airway obstruction; D lacks objective cough and gas exchange
measures.
Question 5
Which of the following best explains why heliox improves laminar flow more
than turbulent flow in a patient with severe upper airway obstruction?
A. Heliox has a lower density, reducing Reynolds number and promoting
laminar flow.
B. Heliox has a higher viscosity, increasing laminar flow velocity.
C. Heliox increases nitrogen washout, improving alveolar ventilation.
D. Heliox reduces airway resistance primarily by decreasing gas
compressibility.
Correct Answer: A - Heliox has a lower density, reducing
Reynolds number and promoting laminar flow.
Page 4
