THERAPIST MULTIPLE CHOICE (TMC) EXAM –
400 PRACTICE QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED CLINICAL RATIONALES (2026 EDITION)
UPDATED PER AARC 2026 RECOMMENDATIONS |
GRADED A+
SECTION 1: PATIENT ASSESSMENT AND MONITORING (Questions 1-80)
1. A 68-year-old male with a history of COPD presents with increased work of
breathing, use of accessory muscles, and a respiratory rate of 32 breaths/min.
Auscultation reveals diminished breath sounds with faint expiratory wheezes.
Pulse oximetry shows SpO2 of 86% on room air. Which of the following is the
MOST appropriate initial intervention?
A. Obtain a stat chest X-ray
B. Administer oxygen via nasal cannula at 2 L/min
C. Initiate non-invasive positive pressure ventilation (NIPPV)
D. Perform arterial blood gas analysis before any intervention
Correct Answer: B
Rationale: The patient is hypoxemic (SpO2 86%) with increased work of breathing.
Supplemental oxygen is the immediate priority to correct hypoxemia. While
NIPPV
(Option C) may ultimately be needed, oxygenation should be addressed first.
ABG (Option D) is important but should not delay oxygen administration. CXR
(Option A) is not the initial priority. Per AARC 2026 guidelines, oxygen therapy
should be initiated immediately in hypoxemic patients with signs of respiratory
distress. The target SpO2 for COPD patients is 88-92% to avoid CO2 retention.
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,2. A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mmHg, PaO2 58 mmHg,
HCO3 24 mEq/L. What is the MOST appropriate interpretation?
A. Acute respiratory acidosis with hypoxemia
B. Chronic respiratory acidosis with metabolic compensation
C. Acute respiratory alkalosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: A
Rationale: The pH is low (acidemia), PaCO2 is elevated (>45 mmHg) indicating
respiratory acidosis. The HCO3 is normal (22-26 mEq/L), indicating no metabolic
compensation has occurred yet, confirming an acute process. PaO2 <60 mmHg
indicates hypoxemic respiratory failure. This is an acute respiratory acidosis
with Type I respiratory failure.
3. A patient receiving mechanical ventilation has the following capnography
waveform: a gradual upslope, a plateau, and a sharp downslope. The end-tidal
CO2 (EtCO2) is 38 mmHg, and the arterial PaCO2 is 42 mmHg. What does this
waveform indicate?
A. Normal capnography waveform with normal gradient
B. Bronchospasm (shark fin appearance)
C. Rebreathing of CO2
D. Leak in the ventilator circuit
Correct Answer: A
Rationale: A normal capnography waveform has a gradual upslope (Phase II),
a plateau (Phase III), and a sharp downslope (Phase IV). The normal EtCO2-to-
PaCO2 gradient is 2-5 mmHg. A gradient of 4 mmHg (42-38) is within normal
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,limits. A "shark fin" appearance (Option B) indicates obstructive lung disease.
Rebreathing (Option C) would show an elevated baseline EtCO2.
4. Which of the following breath sounds is characterized by high-pitched,
musical, continuous sounds heard primarily during expiration?
A. Crackles (rales)
B. Rhonchi
C. Wheezes
D. Stridor
Correct Answer: C
Rationale: Wheezes are high-pitched, continuous, musical sounds caused by
airflow through narrowed airways, typically heard during expiration. Crackles
(Option A) are discontinuous popping sounds. Rhonchi (Option B) are low-pitched
snoring sounds. Stridor (Option D) is a high-pitched inspiratory sound
indicating upper airway obstruction.
5. A patient's pulse oximetry reading is 89% on 4 L/min nasal cannula. The
waveform is adequate. Which of the following is the MOST appropriate next step?
A. Increase oxygen to 6 L/min via nasal cannula
B. Switch to a non-rebreather mask at 15 L/min
C. Obtain an arterial blood gas
D. Document and continue current therapy
Correct Answer: C
Rationale: An SpO2 of 89% on 4 L/min indicates potential hypoxemia. However,
pulse oximetry does not provide information about PaCO2, pH, or hemoglobin
oxygen affinity. An ABG is needed to assess the patient's oxygenation status
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, (PaO2), ventilation (PaCO2), and acid-base balance before making changes to
oxygen therapy. Per AARC guidelines, ABG should be obtained when SpO2 is <90%
on supplemental oxygen.
6. A patient with a history of asthma is tachypneic and using accessory muscles.
Auscultation reveals absent breath sounds in the right lung field. What is the
MOST likely diagnosis?
A. Asthma exacerbation with severe bronchospasm
B. Spontaneous pneumothorax
C. Pleural effusion
D. Atelectasis
Correct Answer: B
Rationale: Unilateral absent breath sounds in a patient with respiratory
distress is highly concerning for a pneumothorax. In asthma, breath sounds are
typically diminished bilaterally, not unilaterally absent. A tension
pneumothorax is a life-threatening emergency requiring immediate needle
decompression or chest tube insertion.
7. A patient's ABG shows: pH 7.32, PaCO2 48 mmHg, PaO2 65 mmHg, HCO3 24
mEq/L,
and BE -2. What is the MOST appropriate interpretation?
A. Acute respiratory acidosis with hypoxemia
B. Compensated respiratory acidosis
C. Metabolic acidosis with respiratory compensation
D. Normal ABG
Correct Answer: A
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400 PRACTICE QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED CLINICAL RATIONALES (2026 EDITION)
UPDATED PER AARC 2026 RECOMMENDATIONS |
GRADED A+
SECTION 1: PATIENT ASSESSMENT AND MONITORING (Questions 1-80)
1. A 68-year-old male with a history of COPD presents with increased work of
breathing, use of accessory muscles, and a respiratory rate of 32 breaths/min.
Auscultation reveals diminished breath sounds with faint expiratory wheezes.
Pulse oximetry shows SpO2 of 86% on room air. Which of the following is the
MOST appropriate initial intervention?
A. Obtain a stat chest X-ray
B. Administer oxygen via nasal cannula at 2 L/min
C. Initiate non-invasive positive pressure ventilation (NIPPV)
D. Perform arterial blood gas analysis before any intervention
Correct Answer: B
Rationale: The patient is hypoxemic (SpO2 86%) with increased work of breathing.
Supplemental oxygen is the immediate priority to correct hypoxemia. While
NIPPV
(Option C) may ultimately be needed, oxygenation should be addressed first.
ABG (Option D) is important but should not delay oxygen administration. CXR
(Option A) is not the initial priority. Per AARC 2026 guidelines, oxygen therapy
should be initiated immediately in hypoxemic patients with signs of respiratory
distress. The target SpO2 for COPD patients is 88-92% to avoid CO2 retention.
1|Page
,2. A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mmHg, PaO2 58 mmHg,
HCO3 24 mEq/L. What is the MOST appropriate interpretation?
A. Acute respiratory acidosis with hypoxemia
B. Chronic respiratory acidosis with metabolic compensation
C. Acute respiratory alkalosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: A
Rationale: The pH is low (acidemia), PaCO2 is elevated (>45 mmHg) indicating
respiratory acidosis. The HCO3 is normal (22-26 mEq/L), indicating no metabolic
compensation has occurred yet, confirming an acute process. PaO2 <60 mmHg
indicates hypoxemic respiratory failure. This is an acute respiratory acidosis
with Type I respiratory failure.
3. A patient receiving mechanical ventilation has the following capnography
waveform: a gradual upslope, a plateau, and a sharp downslope. The end-tidal
CO2 (EtCO2) is 38 mmHg, and the arterial PaCO2 is 42 mmHg. What does this
waveform indicate?
A. Normal capnography waveform with normal gradient
B. Bronchospasm (shark fin appearance)
C. Rebreathing of CO2
D. Leak in the ventilator circuit
Correct Answer: A
Rationale: A normal capnography waveform has a gradual upslope (Phase II),
a plateau (Phase III), and a sharp downslope (Phase IV). The normal EtCO2-to-
PaCO2 gradient is 2-5 mmHg. A gradient of 4 mmHg (42-38) is within normal
2|Page
,limits. A "shark fin" appearance (Option B) indicates obstructive lung disease.
Rebreathing (Option C) would show an elevated baseline EtCO2.
4. Which of the following breath sounds is characterized by high-pitched,
musical, continuous sounds heard primarily during expiration?
A. Crackles (rales)
B. Rhonchi
C. Wheezes
D. Stridor
Correct Answer: C
Rationale: Wheezes are high-pitched, continuous, musical sounds caused by
airflow through narrowed airways, typically heard during expiration. Crackles
(Option A) are discontinuous popping sounds. Rhonchi (Option B) are low-pitched
snoring sounds. Stridor (Option D) is a high-pitched inspiratory sound
indicating upper airway obstruction.
5. A patient's pulse oximetry reading is 89% on 4 L/min nasal cannula. The
waveform is adequate. Which of the following is the MOST appropriate next step?
A. Increase oxygen to 6 L/min via nasal cannula
B. Switch to a non-rebreather mask at 15 L/min
C. Obtain an arterial blood gas
D. Document and continue current therapy
Correct Answer: C
Rationale: An SpO2 of 89% on 4 L/min indicates potential hypoxemia. However,
pulse oximetry does not provide information about PaCO2, pH, or hemoglobin
oxygen affinity. An ABG is needed to assess the patient's oxygenation status
3|Page
, (PaO2), ventilation (PaCO2), and acid-base balance before making changes to
oxygen therapy. Per AARC guidelines, ABG should be obtained when SpO2 is <90%
on supplemental oxygen.
6. A patient with a history of asthma is tachypneic and using accessory muscles.
Auscultation reveals absent breath sounds in the right lung field. What is the
MOST likely diagnosis?
A. Asthma exacerbation with severe bronchospasm
B. Spontaneous pneumothorax
C. Pleural effusion
D. Atelectasis
Correct Answer: B
Rationale: Unilateral absent breath sounds in a patient with respiratory
distress is highly concerning for a pneumothorax. In asthma, breath sounds are
typically diminished bilaterally, not unilaterally absent. A tension
pneumothorax is a life-threatening emergency requiring immediate needle
decompression or chest tube insertion.
7. A patient's ABG shows: pH 7.32, PaCO2 48 mmHg, PaO2 65 mmHg, HCO3 24
mEq/L,
and BE -2. What is the MOST appropriate interpretation?
A. Acute respiratory acidosis with hypoxemia
B. Compensated respiratory acidosis
C. Metabolic acidosis with respiratory compensation
D. Normal ABG
Correct Answer: A
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