1
NBRC Therapist Multiple Choice Self-
Assessment Exam B TMC Practice Actual
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Patient Data Evaluation — Gather Information & Evaluate
Procedure Results | Q1 – Q10
Section 2 | Patient Data Evaluation — Recommend Diagnostic
Procedures | Q11 – Q17
Section 3 | Troubleshooting and Quality Control | Q18 – Q29
Section 4 | Initiation and Modification of Interventions | Q30 – Q44
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q45 – Q50
Instructions: Choose the single best answer unless otherwise indicated as
Select-All-That-Apply (SATA). Pass: 38/50 (75%) in 60 minutes.
══════════════════════════════════════
SECTION 1: PATIENT DATA EVALUATION — GATHER
INFORMATION & EVALUATE PROCEDURE RESULTS Q1 – Q10
══════════════════════════════════════
,2
Question 1 of 50
A 68-year-old male with COPD exacerbation is receiving oxygen via
nasal cannula at 2 L/min. His current arterial blood gas results are: pH
7.32, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L, PaO₂ 62 mmHg. He is alert
but appears mildly dyspneic at rest. Based on these findings, which
interpretation most accurately characterizes his acid-base status?
A. Acute respiratory acidosis with mild hypoxemia
B. Compensated respiratory acidosis with adequate oxygenation
C. Uncompensated respiratory acidosis requiring increased FiO₂
D. Partially compensated respiratory acidosis with moderate hypoxemia
✓ CORRECT
Correct Answer: D
Rationale: The pH of 7.32 indicates acidosis, the elevated PaCO₂ of 58
mmHg identifies the primary disorder as respiratory acidosis, and the
HCO₃⁻ of 30 mEq/L shows partial renal compensation (expected HCO₃⁻
for acute would be approximately 25 mEq/L; for chronic it would
approach 33–35 mEq/L). A PaO₂ of 62 mmHg represents moderate
hypoxemia, which is common in COPD patients with baseline gas
exchange impairment. Choice A is incorrect because the elevated
bicarbonate demonstrates some compensatory mechanism is present;
choice B incorrectly states "compensated" when the pH remains below
normal; choice C misidentifies the compensation status and prematurely
recommends increasing FiO₂ without considering the risk of suppressing
hypoxic drive in this chronic CO₂ retainer.
,3
Question 2 of 50
A 54-year-old female post-operative day 2 from laparoscopic
cholecystectomy presents with sudden-onset shortness of breath and
tachypnea (rate 28/min). Her SpO₂ on room air is 88%. A chest X-ray is
obtained and read as normal. A D-dimer is ordered and returns markedly
elevated. Which additional diagnostic test result would most strongly
support the diagnosis of acute pulmonary embolism in this patient?
A. Decreased diffusing capacity for carbon monoxide (DLCO) on PFTs
B. Normal alveolar-arterial (A-a) oxygen gradient calculation
C. Elevated brain natriuretic peptide (BNP) level above 500 pg/mL
D. Large ventilation-perfusion (V/Q) mismatch on nuclear medicine
scan ✓ CORRECT
Correct Answer: D
Rationale: A V/Q scan demonstrating segmental or larger perfusion
defects with preserved ventilation (mismatch) is highly specific for
pulmonary embolism, particularly when pre-test probability is high and
chest radiograph is clear. This finding directly visualizes the
pathophysiology of PE—obstructed pulmonary arterial flow to
ventilated lung units. While DLCO may be reduced in chronic
thromboembolic disease, it is not diagnostic for acute PE; an elevated
BNP suggests right heart strain secondary to PE but is nonspecific; and a
normal A-a gradient would actually argue against significant PE-related
gas exchange abnormality.
, 4
Question 3 of 50
A premature infant born at 28 weeks gestation is now 3 days old and
receiving mechanical ventilation. The following data are obtained: FiO₂
0.40, PIP 22 cmH₂O, PEEP 5 cmH₂O, rate 35/min, MAP 12 cmH₂O.
Blood gas: pH 7.28, PaCO₂ 52 mmHg, PaO₂ 85 mmHg, HCO₃⁻ 24
mEq/L. The infant's current weight is 1100 g. What is the most
appropriate interpretation of this infant's ventilatory status?
A. Mild respiratory acidosis indicating need for increased minute
ventilation
B. Acceptable gas exchange for gestational age with optimal settings
C. Inadequate oxygenation requiring increased mean airway pressure
D. Metabolic acidosis superimposed on normal ventilation ✓
CORRECT
Correct Answer: A
Rationale: The pH of 7.28 combined with PaCO₂ of 52 mmHg indicates
acute respiratory acidosis (the HCO₃⁻ has not yet risen), meaning
alveolar ventilation is insufficient for this neonate's CO₂ production. In a
28-week premature infant, the target PaCO₂ is typically 45–50 mmHg;
values above this suggest hypoventilation requiring intervention such as
increasing rate or tidal volume. Choice B is incorrect because the pH and
PaCO₂ are outside acceptable neonatal targets; choice C misinterprets
the problem—the PaO₂ of 85 mmHg is actually adequate for a preterm
infant on 40% oxygen; choice D incorrectly attributes the acidosis to
metabolic causes when the low pH clearly correlates with elevated CO₂.
NBRC Therapist Multiple Choice Self-
Assessment Exam B TMC Practice Actual
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Patient Data Evaluation — Gather Information & Evaluate
Procedure Results | Q1 – Q10
Section 2 | Patient Data Evaluation — Recommend Diagnostic
Procedures | Q11 – Q17
Section 3 | Troubleshooting and Quality Control | Q18 – Q29
Section 4 | Initiation and Modification of Interventions | Q30 – Q44
Section 5 | NGN-Style Clinical Judgment & Integrated Case Analysis |
Q45 – Q50
Instructions: Choose the single best answer unless otherwise indicated as
Select-All-That-Apply (SATA). Pass: 38/50 (75%) in 60 minutes.
══════════════════════════════════════
SECTION 1: PATIENT DATA EVALUATION — GATHER
INFORMATION & EVALUATE PROCEDURE RESULTS Q1 – Q10
══════════════════════════════════════
,2
Question 1 of 50
A 68-year-old male with COPD exacerbation is receiving oxygen via
nasal cannula at 2 L/min. His current arterial blood gas results are: pH
7.32, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L, PaO₂ 62 mmHg. He is alert
but appears mildly dyspneic at rest. Based on these findings, which
interpretation most accurately characterizes his acid-base status?
A. Acute respiratory acidosis with mild hypoxemia
B. Compensated respiratory acidosis with adequate oxygenation
C. Uncompensated respiratory acidosis requiring increased FiO₂
D. Partially compensated respiratory acidosis with moderate hypoxemia
✓ CORRECT
Correct Answer: D
Rationale: The pH of 7.32 indicates acidosis, the elevated PaCO₂ of 58
mmHg identifies the primary disorder as respiratory acidosis, and the
HCO₃⁻ of 30 mEq/L shows partial renal compensation (expected HCO₃⁻
for acute would be approximately 25 mEq/L; for chronic it would
approach 33–35 mEq/L). A PaO₂ of 62 mmHg represents moderate
hypoxemia, which is common in COPD patients with baseline gas
exchange impairment. Choice A is incorrect because the elevated
bicarbonate demonstrates some compensatory mechanism is present;
choice B incorrectly states "compensated" when the pH remains below
normal; choice C misidentifies the compensation status and prematurely
recommends increasing FiO₂ without considering the risk of suppressing
hypoxic drive in this chronic CO₂ retainer.
,3
Question 2 of 50
A 54-year-old female post-operative day 2 from laparoscopic
cholecystectomy presents with sudden-onset shortness of breath and
tachypnea (rate 28/min). Her SpO₂ on room air is 88%. A chest X-ray is
obtained and read as normal. A D-dimer is ordered and returns markedly
elevated. Which additional diagnostic test result would most strongly
support the diagnosis of acute pulmonary embolism in this patient?
A. Decreased diffusing capacity for carbon monoxide (DLCO) on PFTs
B. Normal alveolar-arterial (A-a) oxygen gradient calculation
C. Elevated brain natriuretic peptide (BNP) level above 500 pg/mL
D. Large ventilation-perfusion (V/Q) mismatch on nuclear medicine
scan ✓ CORRECT
Correct Answer: D
Rationale: A V/Q scan demonstrating segmental or larger perfusion
defects with preserved ventilation (mismatch) is highly specific for
pulmonary embolism, particularly when pre-test probability is high and
chest radiograph is clear. This finding directly visualizes the
pathophysiology of PE—obstructed pulmonary arterial flow to
ventilated lung units. While DLCO may be reduced in chronic
thromboembolic disease, it is not diagnostic for acute PE; an elevated
BNP suggests right heart strain secondary to PE but is nonspecific; and a
normal A-a gradient would actually argue against significant PE-related
gas exchange abnormality.
, 4
Question 3 of 50
A premature infant born at 28 weeks gestation is now 3 days old and
receiving mechanical ventilation. The following data are obtained: FiO₂
0.40, PIP 22 cmH₂O, PEEP 5 cmH₂O, rate 35/min, MAP 12 cmH₂O.
Blood gas: pH 7.28, PaCO₂ 52 mmHg, PaO₂ 85 mmHg, HCO₃⁻ 24
mEq/L. The infant's current weight is 1100 g. What is the most
appropriate interpretation of this infant's ventilatory status?
A. Mild respiratory acidosis indicating need for increased minute
ventilation
B. Acceptable gas exchange for gestational age with optimal settings
C. Inadequate oxygenation requiring increased mean airway pressure
D. Metabolic acidosis superimposed on normal ventilation ✓
CORRECT
Correct Answer: A
Rationale: The pH of 7.28 combined with PaCO₂ of 52 mmHg indicates
acute respiratory acidosis (the HCO₃⁻ has not yet risen), meaning
alveolar ventilation is insufficient for this neonate's CO₂ production. In a
28-week premature infant, the target PaCO₂ is typically 45–50 mmHg;
values above this suggest hypoventilation requiring intervention such as
increasing rate or tidal volume. Choice B is incorrect because the pH and
PaCO₂ are outside acceptable neonatal targets; choice C misinterprets
the problem—the PaO₂ of 85 mmHg is actually adequate for a preterm
infant on 40% oxygen; choice D incorrectly attributes the acidosis to
metabolic causes when the low pH clearly correlates with elevated CO₂.
