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C&S TMC COMPREHENSIVE ACTUAL
EXAM | ALL QUESTIONS AND
CORRECT DETAILED ANSWERS |
LATEST 2026-2027 VERSION | RATED A +
| NEW AND REVISED
1. A patient with COPD presents with chronic hypercapnia.
Which renal compensation is expected?
A. Decreased bicarbonate reabsorption
B. Increased bicarbonate retention
C. Increased hydrogen ion excretion inhibition
D. Decreased ammonium production
Italicized rationale: Chronic respiratory acidosis leads the
kidneys to retain bicarbonate to buffer elevated PaCO₂.
2. Which lung volume cannot be measured by simple
spirometry?
A. Vital capacity
B. Tidal volume
C. Residual volume
D. Inspiratory reserve volume
Italicized rationale: Residual volume remains in the lungs
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after maximal exhalation and requires gas dilution or
plethysmography.
3. A normal PaO₂ on room air at sea level is:
A. 60–70 mmHg
B. 70–80 mmHg
C. 80–100 mmHg
D. 100–120 mmHg
Italicized rationale: Normal adult PaO₂ is approximately
80–100 mmHg.
4. Which medication is a short-acting beta-2 agonist?
A. Tiotropium
B. Salmeterol
C. Albuterol
D. Ipratropium
Italicized rationale: Albuterol provides rapid
bronchodilation and is used for acute bronchospasm.
5. The primary drive to breathe in a healthy adult is regulated
by:
A. Peripheral chemoreceptors
B. Central chemoreceptors
C. Stretch receptors
D. Baroreceptors
Italicized rationale: Central chemoreceptors respond to
changes in PaCO₂ via CSF pH.
6. A patient on mechanical ventilation develops sudden
hypotension and absent breath sounds on the right. The
most likely cause is:
A. Atelectasis
B. Pulmonary embolism
C. Tension pneumothorax
D. Bronchospasm
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Italicized rationale: Positive pressure ventilation
increases risk of tension pneumothorax causing
hemodynamic compromise.
7. Which ABG indicates uncompensated metabolic acidosis?
A. pH 7.48 / PaCO₂ 30 / HCO₃⁻ 22
B. pH 7.25 / PaCO₂ 40 / HCO₃⁻ 16
C. pH 7.36 / PaCO₂ 30 / HCO₃⁻ 18
D. pH 7.52 / PaCO₂ 48 / HCO₃⁻ 32
Italicized rationale: Low pH and low bicarbonate without
respiratory compensation indicates uncompensated
metabolic acidosis.
8. Which oxygen delivery device provides the most precise
FiO₂?
A. Nasal cannula
B. Simple mask
C. Venturi mask
D. Non-rebreather mask
Italicized rationale: Venturi masks entrain fixed air-
oxygen ratios for precise FiO₂ delivery.
9. Indication for endotracheal intubation includes:
A. Mild hypoxemia responsive to oxygen
B. Stable asthma
C. Inability to protect the airway
D. Productive cough
Italicized rationale: Loss of airway protection mandates
definitive airway management.
10. Surfactant primarily functions to:
A. Increase alveolar size
B. Increase airway resistance
C. Decrease alveolar surface tension
D. Increase lung compliance variability
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Italicized rationale: Surfactant prevents alveolar collapse
by reducing surface tension.
11. Which lab value best reflects oxygen-carrying
capacity?
A. PaO₂
B. SaO₂
C. Hemoglobin
D. pH
Italicized rationale: Hemoglobin concentration
determines blood oxygen content.
12. A patient with CHF presents with pink frothy sputum.
The priority therapy is:
A. Bronchodilator
B. Antibiotic
C. CPAP with supplemental oxygen
D. Incentive spirometry
Italicized rationale: Positive pressure reduces preload and
improves oxygenation in cardiogenic pulmonary edema.
13. Which waveform abnormality indicates airway
obstruction?
A. Scooped expiratory flow
B. Prolonged expiratory phase
C. Decreased inspiratory slope
D. Square waveform
Italicized rationale: Obstruction causes delayed
expiratory flow.
14. Which acid-base imbalance is common in severe
diarrhea?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
C&S TMC COMPREHENSIVE ACTUAL
EXAM | ALL QUESTIONS AND
CORRECT DETAILED ANSWERS |
LATEST 2026-2027 VERSION | RATED A +
| NEW AND REVISED
1. A patient with COPD presents with chronic hypercapnia.
Which renal compensation is expected?
A. Decreased bicarbonate reabsorption
B. Increased bicarbonate retention
C. Increased hydrogen ion excretion inhibition
D. Decreased ammonium production
Italicized rationale: Chronic respiratory acidosis leads the
kidneys to retain bicarbonate to buffer elevated PaCO₂.
2. Which lung volume cannot be measured by simple
spirometry?
A. Vital capacity
B. Tidal volume
C. Residual volume
D. Inspiratory reserve volume
Italicized rationale: Residual volume remains in the lungs
,2|Page
after maximal exhalation and requires gas dilution or
plethysmography.
3. A normal PaO₂ on room air at sea level is:
A. 60–70 mmHg
B. 70–80 mmHg
C. 80–100 mmHg
D. 100–120 mmHg
Italicized rationale: Normal adult PaO₂ is approximately
80–100 mmHg.
4. Which medication is a short-acting beta-2 agonist?
A. Tiotropium
B. Salmeterol
C. Albuterol
D. Ipratropium
Italicized rationale: Albuterol provides rapid
bronchodilation and is used for acute bronchospasm.
5. The primary drive to breathe in a healthy adult is regulated
by:
A. Peripheral chemoreceptors
B. Central chemoreceptors
C. Stretch receptors
D. Baroreceptors
Italicized rationale: Central chemoreceptors respond to
changes in PaCO₂ via CSF pH.
6. A patient on mechanical ventilation develops sudden
hypotension and absent breath sounds on the right. The
most likely cause is:
A. Atelectasis
B. Pulmonary embolism
C. Tension pneumothorax
D. Bronchospasm
,3|Page
Italicized rationale: Positive pressure ventilation
increases risk of tension pneumothorax causing
hemodynamic compromise.
7. Which ABG indicates uncompensated metabolic acidosis?
A. pH 7.48 / PaCO₂ 30 / HCO₃⁻ 22
B. pH 7.25 / PaCO₂ 40 / HCO₃⁻ 16
C. pH 7.36 / PaCO₂ 30 / HCO₃⁻ 18
D. pH 7.52 / PaCO₂ 48 / HCO₃⁻ 32
Italicized rationale: Low pH and low bicarbonate without
respiratory compensation indicates uncompensated
metabolic acidosis.
8. Which oxygen delivery device provides the most precise
FiO₂?
A. Nasal cannula
B. Simple mask
C. Venturi mask
D. Non-rebreather mask
Italicized rationale: Venturi masks entrain fixed air-
oxygen ratios for precise FiO₂ delivery.
9. Indication for endotracheal intubation includes:
A. Mild hypoxemia responsive to oxygen
B. Stable asthma
C. Inability to protect the airway
D. Productive cough
Italicized rationale: Loss of airway protection mandates
definitive airway management.
10. Surfactant primarily functions to:
A. Increase alveolar size
B. Increase airway resistance
C. Decrease alveolar surface tension
D. Increase lung compliance variability
, 4|Page
Italicized rationale: Surfactant prevents alveolar collapse
by reducing surface tension.
11. Which lab value best reflects oxygen-carrying
capacity?
A. PaO₂
B. SaO₂
C. Hemoglobin
D. pH
Italicized rationale: Hemoglobin concentration
determines blood oxygen content.
12. A patient with CHF presents with pink frothy sputum.
The priority therapy is:
A. Bronchodilator
B. Antibiotic
C. CPAP with supplemental oxygen
D. Incentive spirometry
Italicized rationale: Positive pressure reduces preload and
improves oxygenation in cardiogenic pulmonary edema.
13. Which waveform abnormality indicates airway
obstruction?
A. Scooped expiratory flow
B. Prolonged expiratory phase
C. Decreased inspiratory slope
D. Square waveform
Italicized rationale: Obstruction causes delayed
expiratory flow.
14. Which acid-base imbalance is common in severe
diarrhea?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
