Page 1 of 72
TMC SECURE COMPREHENSIVE THERAPIST SAE EXAM PREP 2026
QUESTIONS WITH VERIFIED ANSWERS DETAILED RATIONALES GRADED
A+
Part I: Patient Assessment and Pulmonary Diagnostics (Questions 1–40)
1. A respiratory therapist is assessing a patient with suspected COPD and notes
diminished breath sounds and a prolonged expiratory phase. These findings are
most consistent with which of the following?
A. Restrictive lung disease
B. Severe airway obstruction with air trapping
C. Normal lung function
D. Pulmonary edema
Rationale: Obstructive lung disease limits airflow, causing prolonged expiration
and diminished breath sounds due to hyperinflation and air trapping.
2. A patient's pulmonary function test shows a total lung capacity (TLC) of 65% of
predicted with a normal FEV1/FVC ratio. This pattern indicates which of the
following?
A. Obstructive defect
B. Restrictive defect
C. Mixed defect
D. Normal PFT
Rationale: A reduced TLC (<80% predicted) with a preserved or increased
FEV1/FVC ratio is the hallmark of restrictive lung disease.
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3. An ABG on room air shows pH 7.34, PaCO₂ 55 mm Hg, PaO₂ 70 mm Hg, and
HCO₃⁻ 30 mEq/L. What is the most appropriate interpretation?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with mild hypoxemia
C. Metabolic alkalosis
D. Mixed acidosis
Rationale: Elevated PaCO₂ with a near-normal pH and elevated bicarbonate
indicates chronic CO₂ retention with renal compensation; the low PaO₂ reflects
hypoxemia.
4. A patient with a 45% pneumothorax and SpO₂ of 92% on 35% oxygen requires
which of the following interventions?
A. Increase the inspired oxygen percentage
B. Insert a pleural chest tube
C. Begin flutter valve therapy
D. Insert a mediastinal chest tube
Rationale: A large pneumothorax requires pleural chest tube insertion to evacuate
air and re-expand the lung; supplemental oxygen alone does not resolve the
underlying collapse.
5. A patient presents with a right-sided pleural effusion of unknown etiology.
Which procedure should the respiratory therapist recommend to confirm the
cause?
A. Diagnostic bronchoscopy
B. Sputum culture
C. Thoracentesis
D. Pleurodesis
Rationale: Thoracentesis drains pleural fluid for diagnostic evaluation; pleurodesis
is used to prevent recurrence after the cause is known.
6. Which of the following best describes the primary function of the diaphragm
during normal inspiration?
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A. Elevates the rib cage
B. Contracts and moves downward to increase the vertical dimension of the
thoracic cavity
C. Relaxes to allow passive expansion
D. Compresses abdominal organs
Rationale: Diaphragmatic contraction flattens the muscle and increases thoracic
volume, decreasing intrapulmonary pressure and drawing air into the lungs.
7. At sea level (760 mm Hg), what is the partial pressure of oxygen in inspired air?
A. 100 mm Hg
B. 159 mm Hg
C. 200 mm Hg
D. 320 mm Hg
Rationale: Oxygen comprises approximately 21% of atmospheric air, so PO₂ = 760
× 0.21 ≈ 159 mm Hg.
8. Which of the following conditions would most likely decrease lung compliance?
A. Emphysema
B. Acute respiratory distress syndrome (ARDS)
C. Asthma in remission
D. Normal aging
Rationale: ARDS causes stiff, non-compliant lungs due to alveolar inflammation
and edema; emphysema increases compliance.
9. A drop in systolic blood pressure of more than 10 mm Hg during inspiration is
known as which of the following?
A. Pulsus alternans
B. Pulsus paradoxus
C. Kussmaul's sign
D. Beck's triad
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Rationale: Pulsus paradoxus is an exaggerated inspiratory fall in systolic pressure
seen in cardiac tamponade, severe asthma, and constrictive pericarditis.
10. A patient with suspected pulmonary embolism has a normal D-dimer. Which
interpretation is correct?
A. PE is ruled out regardless of pretest probability
B. A normal D-dimer excludes PE only in low-pretest-probability patients
C. The test is invalid
D. A V/Q scan is always required
Rationale: The negative predictive value of D-dimer is high in low-probability
patients but less reliable when clinical suspicion is high.
11. Which breath sound is characterized as high-pitched, discontinuous, and heard
primarily on inspiration, often indicating fluid in the alveoli?
A. Wheeze
B. Rhonchi
C. Fine crackles
D. Stridor
Rationale: Fine crackles result from the sudden opening of fluid-filled alveoli and
are classic for pulmonary edema and interstitial lung disease.
12. A patient's chest radiograph shows hyperlucency, flattened diaphragms, and a
narrow cardiac silhouette. These findings are most consistent with which
condition?
A. Pneumonia
B. Pleural effusion
C. COPD with hyperinflation
D. Pulmonary edema
Rationale: Hyperinflation, flattened diaphragms, and a narrow cardiac silhouette
are radiographic hallmarks of COPD.
4|Page
TMC SECURE COMPREHENSIVE THERAPIST SAE EXAM PREP 2026
QUESTIONS WITH VERIFIED ANSWERS DETAILED RATIONALES GRADED
A+
Part I: Patient Assessment and Pulmonary Diagnostics (Questions 1–40)
1. A respiratory therapist is assessing a patient with suspected COPD and notes
diminished breath sounds and a prolonged expiratory phase. These findings are
most consistent with which of the following?
A. Restrictive lung disease
B. Severe airway obstruction with air trapping
C. Normal lung function
D. Pulmonary edema
Rationale: Obstructive lung disease limits airflow, causing prolonged expiration
and diminished breath sounds due to hyperinflation and air trapping.
2. A patient's pulmonary function test shows a total lung capacity (TLC) of 65% of
predicted with a normal FEV1/FVC ratio. This pattern indicates which of the
following?
A. Obstructive defect
B. Restrictive defect
C. Mixed defect
D. Normal PFT
Rationale: A reduced TLC (<80% predicted) with a preserved or increased
FEV1/FVC ratio is the hallmark of restrictive lung disease.
1|Page
,Page 2 of 72
3. An ABG on room air shows pH 7.34, PaCO₂ 55 mm Hg, PaO₂ 70 mm Hg, and
HCO₃⁻ 30 mEq/L. What is the most appropriate interpretation?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with mild hypoxemia
C. Metabolic alkalosis
D. Mixed acidosis
Rationale: Elevated PaCO₂ with a near-normal pH and elevated bicarbonate
indicates chronic CO₂ retention with renal compensation; the low PaO₂ reflects
hypoxemia.
4. A patient with a 45% pneumothorax and SpO₂ of 92% on 35% oxygen requires
which of the following interventions?
A. Increase the inspired oxygen percentage
B. Insert a pleural chest tube
C. Begin flutter valve therapy
D. Insert a mediastinal chest tube
Rationale: A large pneumothorax requires pleural chest tube insertion to evacuate
air and re-expand the lung; supplemental oxygen alone does not resolve the
underlying collapse.
5. A patient presents with a right-sided pleural effusion of unknown etiology.
Which procedure should the respiratory therapist recommend to confirm the
cause?
A. Diagnostic bronchoscopy
B. Sputum culture
C. Thoracentesis
D. Pleurodesis
Rationale: Thoracentesis drains pleural fluid for diagnostic evaluation; pleurodesis
is used to prevent recurrence after the cause is known.
6. Which of the following best describes the primary function of the diaphragm
during normal inspiration?
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,Page 3 of 72
A. Elevates the rib cage
B. Contracts and moves downward to increase the vertical dimension of the
thoracic cavity
C. Relaxes to allow passive expansion
D. Compresses abdominal organs
Rationale: Diaphragmatic contraction flattens the muscle and increases thoracic
volume, decreasing intrapulmonary pressure and drawing air into the lungs.
7. At sea level (760 mm Hg), what is the partial pressure of oxygen in inspired air?
A. 100 mm Hg
B. 159 mm Hg
C. 200 mm Hg
D. 320 mm Hg
Rationale: Oxygen comprises approximately 21% of atmospheric air, so PO₂ = 760
× 0.21 ≈ 159 mm Hg.
8. Which of the following conditions would most likely decrease lung compliance?
A. Emphysema
B. Acute respiratory distress syndrome (ARDS)
C. Asthma in remission
D. Normal aging
Rationale: ARDS causes stiff, non-compliant lungs due to alveolar inflammation
and edema; emphysema increases compliance.
9. A drop in systolic blood pressure of more than 10 mm Hg during inspiration is
known as which of the following?
A. Pulsus alternans
B. Pulsus paradoxus
C. Kussmaul's sign
D. Beck's triad
3|Page
, Page 4 of 72
Rationale: Pulsus paradoxus is an exaggerated inspiratory fall in systolic pressure
seen in cardiac tamponade, severe asthma, and constrictive pericarditis.
10. A patient with suspected pulmonary embolism has a normal D-dimer. Which
interpretation is correct?
A. PE is ruled out regardless of pretest probability
B. A normal D-dimer excludes PE only in low-pretest-probability patients
C. The test is invalid
D. A V/Q scan is always required
Rationale: The negative predictive value of D-dimer is high in low-probability
patients but less reliable when clinical suspicion is high.
11. Which breath sound is characterized as high-pitched, discontinuous, and heard
primarily on inspiration, often indicating fluid in the alveoli?
A. Wheeze
B. Rhonchi
C. Fine crackles
D. Stridor
Rationale: Fine crackles result from the sudden opening of fluid-filled alveoli and
are classic for pulmonary edema and interstitial lung disease.
12. A patient's chest radiograph shows hyperlucency, flattened diaphragms, and a
narrow cardiac silhouette. These findings are most consistent with which
condition?
A. Pneumonia
B. Pleural effusion
C. COPD with hyperinflation
D. Pulmonary edema
Rationale: Hyperinflation, flattened diaphragms, and a narrow cardiac silhouette
are radiographic hallmarks of COPD.
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