Therapist Multiple Choice Form A&B (PDF) | 2026 TMC
Practice Q&A | Respiratory Therapy | 200 Verified Questions
- 187 Questions with Answers
Respiratory Therapy TMC Practice Exam 2026-187 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NBRC Guidelines | Graded A+
This comprehensive exam preparation document is meticulously crafted for respiratory therapy
students and practitioners preparing for the Therapist Multiple Choice (TMC) Examination. It contains
200 verified questions and answers, reflecting the latest NBRC guidelines for 2026-2027. The content
is organized to cover all major domains of respiratory care, ensuring a thorough review of essential
concepts and clinical applications. Each question is accompanied by detailed rationales to enhance
understanding and critical thinking.
Key Features:
Patient Assessment: Patient history, physical examination, vital signs, and diagnostic tests
Clinical Data Interpretation: Laboratory values, pulmonary function tests, and imaging
Gas Exchange and Acid-Base Balance: Oxygenation, ventilation, and acid-base disorders
Airway Management: Endotracheal intubation, tracheostomy, and airway clearance techniques
Mechanical Ventilation: Modes, settings, waveforms, and weaning strategies
Pharmacology: Bronchodilators, corticosteroids, mucolytics, and other respiratory medications
Pulmonary Diseases: COPD, asthma, pneumonia, ARDS, and other conditions
Cardiopulmonary Diagnostics: Hemodynamics, ECG, and exercise testing
Neonatal and Pediatric Respiratory Care: Special considerations and management
Patient Education and Communication: Teaching and interdisciplinary collaboration
Infection Control and Safety: Prevention and management of healthcare-associated infections
Ethical and Legal Issues: Professional conduct and patient rights
Quality Improvement and Evidence-Based Practice: Application of research and protocols
Emergency Procedures: Code management, ventilator emergencies, and crisis intervention
Pulmonary Rehabilitation and Home Care: Long-term management and support
Sleep Medicine: Sleep-disordered breathing and management
Pulmonary Function Testing: Spirometry, lung volumes, and diffusion capacity
Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) Integration
Updates for 2026:
- Revised to align with the 2026 NBRC TMC examination content outline
- Incorporated latest evidence-based guidelines for mechanical ventilation and ARDS management
- Updated pharmacological content to include new bronchodilator and anti-inflammatory agents
- Enhanced rationales with step-by-step clinical reasoning and common pitfalls
- Added new questions on telehealth and remote patient monitoring in respiratory care
Abstract:
This exam preparation document provides a rigorous review of respiratory therapy principles and practices,
specifically tailored for the Therapist Multiple Choice (TMC) Examination. The 200 questions are distributed
across all major content areas, including patient assessment, clinical data interpretation, gas exchange, airway
management, mechanical ventilation, pharmacology, and disease management. Each question is designed to test
critical thinking and application of knowledge in clinical scenarios. Detailed rationales explain the correct
Page 1
,answers and why distractors are incorrect, facilitating deep learning. The document is updated to reflect the
2026-2027 NBRC guidelines, ensuring relevance and accuracy. It serves as an invaluable resource for respiratory
therapy students, educators, and practitioners seeking to pass the TMC exam with confidence.
Keywords:
Respiratory Therapy, TMC Exam, Therapist Multiple Choice, NBRC, Mechanical Ventilation, Patient Assessment,
Pharmacology, 2026-2027
Answer Format:
Each question is presented in multiple-choice format with four options. The correct answer is indicated, followed
by a detailed rationale explaining the underlying physiological or clinical principles. Distractor explanations are
provided to clarify common misconceptions and reinforce learning.
Compliance Checklist:
Aligned with the latest NBRC TMC examination content outline
200 verified questions with accurate answers and rationales
Updated to reflect 2026-2027 clinical practice guidelines
Covers all major domains of respiratory care as per the exam blueprint
Includes rationales for both correct and incorrect options
Suitable for self-assessment and exam preparation
Content Area Overview:
Content Area Questions Key Topics Weight
Patient Assessment 1-25 Patient history, physical exam, vital signs, 12.5%
diagnostic tests
Clinical Data Interpretation 26-45 Lab values, PFTs, imaging, hemodynamics 10%
Gas Exchange and Acid-Base 46-65 Oxygenation, ventilation, acid-base 10%
Balance disorders
Airway Management 66-85 Intubation, tracheostomy, airway clearance 10%
Mechanical Ventilation 86-110 Modes, settings, waveforms, weaning 12.5%
Pharmacology 111-130 Bronchodilators, corticosteroids, mucolytics 10%
Pulmonary Diseases 131-155 COPD, asthma, pneumonia, ARDS 12.5%
Neonatal and Pediatric 156-170 Neonatal resuscitation, pediatric ventilation, 7.5%
Respiratory Care congenital disorders
Patient Education and 171-180 Teaching, interdisciplinary collaboration, 5%
Communication cultural competence
Infection Control and Safety 181-190 Standard precautions, sterilization, 5%
disinfection
Ethical and Legal Issues 191-195 Professional conduct, patient rights, legal 2.5%
responsibilities
Quality Improvement and 196-200 Protocols, research application, outcome 2.5%
Evidence-Based Practice measurement
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a tidal volume of 6 mL/kg ideal body weight.
Plateau pressure is 30 cm H2O, and driving pressure is 18 cm H2O. Which
intervention is most likely to reduce driving pressure without compromising alveolar
recruitment?
A. Increase PEEP to improve oxygenation
B. Decrease respiratory rate to reduce auto-PEEP
C. Switch to pressure-controlled ventilation with same tidal volume
D. Increase inspiratory time to improve gas distribution
Correct Answer: C. Switch to pressure-controlled ventilation with same tidal volume
Rationale: Driving pressure (plateau pressure minus PEEP) is a key determinant of
mortality in ARDS. Switching to pressure-controlled ventilation can help maintain tidal
volume while potentially reducing peak pressures and improving distribution, especially if
the patient has high airway resistance. Increasing PEEP may increase plateau pressure
and driving pressure if not carefully titrated. Decreasing respiratory rate or increasing
inspiratory time does not directly lower driving pressure.
Why Wrong:
A - Increasing PEEP may raise plateau pressure, potentially increasing driving
pressure.
B - Altering respiratory rate affects minute ventilation but not directly driving
pressure.
D - Increasing inspiratory time can increase mean airway pressure but does not
necessarily reduce driving pressure.
Reference: Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower
tidal volumes as compared with traditional tidal volumes for acute lung injury
and the acute respiratory distress syndrome. NEJM, 342(18), 1301-1308.
Q2. A patient with chronic obstructive pulmonary disease (COPD) has a blood gas
showing pH 7.36, PaCO2 65 mm Hg, PaO2 55 mm Hg, HCO3- 36 mEq/L. The patient
is alert but dyspneic. Which oxygen delivery system is most appropriate to maintain
adequate oxygenation without worsening hypercapnia?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 24% oxygen
C. Nasal cannula at 2 L/min
D. Simple face mask at 6 L/min
Correct Answer: B. Venturi mask at 24% oxygen
Rationale: In COPD patients with chronic hypercapnia, controlled oxygen therapy is
essential to avoid suppressing hypoxic drive. The Venturi mask at 24% provides precise
FiO2, minimizing the risk of worsening hypercapnia while achieving adequate
oxygenation (target PaO2 55-60 mm Hg). High-flow oxygen (non-rebreather, simple mask)
Page 3
, can lead to increased CO2 retention due to reduced hypoxic drive and worsening V/Q
mismatch.
Why Wrong:
A - Non-rebreather mask delivers high FiO2, which can suppress hypoxic drive and
worsen hypercapnia.
C - Nasal cannula at 2 L/min may not provide sufficient oxygen to achieve target
PaO2 in some patients.
D - Simple face mask at 6 L/min delivers variable FiO2 and may lead to CO2
retention.
Reference: Global Initiative for Chronic Obstructive Lung Disease. (2026). Global
Strategy for the Diagnosis, Management, and Prevention of COPD.
Q3. A patient with severe sepsis develops hypotension refractory to fluid
resuscitation. A pulmonary artery catheter is placed; cardiac index is 2.1 L/min/m2,
systemic vascular resistance is 1400 dyn-s-cm-5, and pulmonary capillary wedge
pressure is 12 mm Hg. Which vasoactive agent is most appropriate?
A. Norepinephrine
B. Phenylephrine
C. Dobutamine
D. Vasopressin
Correct Answer: A. Norepinephrine
Rationale: This patient has distributive shock with low cardiac index and high SVR.
Norepinephrine is the first-line vasopressor for septic shock; it provides both alpha- and
beta-adrenergic effects, increasing blood pressure and modestly improving cardiac output.
Phenylephrine is a pure alpha-agonist that may worsen cardiac output. Dobutamine is an
inotrope that would increase cardiac index but may cause hypotension. Vasopressin is a
second-line agent, not first-line.
Why Wrong:
B - Phenylephrine increases SVR but can decrease cardiac output due to reflex
bradycardia.
C - Dobutamine is an inotrope that would increase cardiac index but may worsen
hypotension in septic shock.
D - Vasopressin is reserved for refractory shock, not first-line therapy.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines
for Management of Sepsis and Septic Shock. Critical Care Medicine, 45(3),
486-552.
Q4. A patient on mechanical ventilation has a sudden increase in peak airway
pressure from 25 to 40 cm H2O, while plateau pressure remains unchanged at 20 cm
H2O. Which condition is most consistent with these findings?
Page 4
Practice Q&A | Respiratory Therapy | 200 Verified Questions
- 187 Questions with Answers
Respiratory Therapy TMC Practice Exam 2026-187 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NBRC Guidelines | Graded A+
This comprehensive exam preparation document is meticulously crafted for respiratory therapy
students and practitioners preparing for the Therapist Multiple Choice (TMC) Examination. It contains
200 verified questions and answers, reflecting the latest NBRC guidelines for 2026-2027. The content
is organized to cover all major domains of respiratory care, ensuring a thorough review of essential
concepts and clinical applications. Each question is accompanied by detailed rationales to enhance
understanding and critical thinking.
Key Features:
Patient Assessment: Patient history, physical examination, vital signs, and diagnostic tests
Clinical Data Interpretation: Laboratory values, pulmonary function tests, and imaging
Gas Exchange and Acid-Base Balance: Oxygenation, ventilation, and acid-base disorders
Airway Management: Endotracheal intubation, tracheostomy, and airway clearance techniques
Mechanical Ventilation: Modes, settings, waveforms, and weaning strategies
Pharmacology: Bronchodilators, corticosteroids, mucolytics, and other respiratory medications
Pulmonary Diseases: COPD, asthma, pneumonia, ARDS, and other conditions
Cardiopulmonary Diagnostics: Hemodynamics, ECG, and exercise testing
Neonatal and Pediatric Respiratory Care: Special considerations and management
Patient Education and Communication: Teaching and interdisciplinary collaboration
Infection Control and Safety: Prevention and management of healthcare-associated infections
Ethical and Legal Issues: Professional conduct and patient rights
Quality Improvement and Evidence-Based Practice: Application of research and protocols
Emergency Procedures: Code management, ventilator emergencies, and crisis intervention
Pulmonary Rehabilitation and Home Care: Long-term management and support
Sleep Medicine: Sleep-disordered breathing and management
Pulmonary Function Testing: Spirometry, lung volumes, and diffusion capacity
Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) Integration
Updates for 2026:
- Revised to align with the 2026 NBRC TMC examination content outline
- Incorporated latest evidence-based guidelines for mechanical ventilation and ARDS management
- Updated pharmacological content to include new bronchodilator and anti-inflammatory agents
- Enhanced rationales with step-by-step clinical reasoning and common pitfalls
- Added new questions on telehealth and remote patient monitoring in respiratory care
Abstract:
This exam preparation document provides a rigorous review of respiratory therapy principles and practices,
specifically tailored for the Therapist Multiple Choice (TMC) Examination. The 200 questions are distributed
across all major content areas, including patient assessment, clinical data interpretation, gas exchange, airway
management, mechanical ventilation, pharmacology, and disease management. Each question is designed to test
critical thinking and application of knowledge in clinical scenarios. Detailed rationales explain the correct
Page 1
,answers and why distractors are incorrect, facilitating deep learning. The document is updated to reflect the
2026-2027 NBRC guidelines, ensuring relevance and accuracy. It serves as an invaluable resource for respiratory
therapy students, educators, and practitioners seeking to pass the TMC exam with confidence.
Keywords:
Respiratory Therapy, TMC Exam, Therapist Multiple Choice, NBRC, Mechanical Ventilation, Patient Assessment,
Pharmacology, 2026-2027
Answer Format:
Each question is presented in multiple-choice format with four options. The correct answer is indicated, followed
by a detailed rationale explaining the underlying physiological or clinical principles. Distractor explanations are
provided to clarify common misconceptions and reinforce learning.
Compliance Checklist:
Aligned with the latest NBRC TMC examination content outline
200 verified questions with accurate answers and rationales
Updated to reflect 2026-2027 clinical practice guidelines
Covers all major domains of respiratory care as per the exam blueprint
Includes rationales for both correct and incorrect options
Suitable for self-assessment and exam preparation
Content Area Overview:
Content Area Questions Key Topics Weight
Patient Assessment 1-25 Patient history, physical exam, vital signs, 12.5%
diagnostic tests
Clinical Data Interpretation 26-45 Lab values, PFTs, imaging, hemodynamics 10%
Gas Exchange and Acid-Base 46-65 Oxygenation, ventilation, acid-base 10%
Balance disorders
Airway Management 66-85 Intubation, tracheostomy, airway clearance 10%
Mechanical Ventilation 86-110 Modes, settings, waveforms, weaning 12.5%
Pharmacology 111-130 Bronchodilators, corticosteroids, mucolytics 10%
Pulmonary Diseases 131-155 COPD, asthma, pneumonia, ARDS 12.5%
Neonatal and Pediatric 156-170 Neonatal resuscitation, pediatric ventilation, 7.5%
Respiratory Care congenital disorders
Patient Education and 171-180 Teaching, interdisciplinary collaboration, 5%
Communication cultural competence
Infection Control and Safety 181-190 Standard precautions, sterilization, 5%
disinfection
Ethical and Legal Issues 191-195 Professional conduct, patient rights, legal 2.5%
responsibilities
Quality Improvement and 196-200 Protocols, research application, outcome 2.5%
Evidence-Based Practice measurement
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a tidal volume of 6 mL/kg ideal body weight.
Plateau pressure is 30 cm H2O, and driving pressure is 18 cm H2O. Which
intervention is most likely to reduce driving pressure without compromising alveolar
recruitment?
A. Increase PEEP to improve oxygenation
B. Decrease respiratory rate to reduce auto-PEEP
C. Switch to pressure-controlled ventilation with same tidal volume
D. Increase inspiratory time to improve gas distribution
Correct Answer: C. Switch to pressure-controlled ventilation with same tidal volume
Rationale: Driving pressure (plateau pressure minus PEEP) is a key determinant of
mortality in ARDS. Switching to pressure-controlled ventilation can help maintain tidal
volume while potentially reducing peak pressures and improving distribution, especially if
the patient has high airway resistance. Increasing PEEP may increase plateau pressure
and driving pressure if not carefully titrated. Decreasing respiratory rate or increasing
inspiratory time does not directly lower driving pressure.
Why Wrong:
A - Increasing PEEP may raise plateau pressure, potentially increasing driving
pressure.
B - Altering respiratory rate affects minute ventilation but not directly driving
pressure.
D - Increasing inspiratory time can increase mean airway pressure but does not
necessarily reduce driving pressure.
Reference: Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower
tidal volumes as compared with traditional tidal volumes for acute lung injury
and the acute respiratory distress syndrome. NEJM, 342(18), 1301-1308.
Q2. A patient with chronic obstructive pulmonary disease (COPD) has a blood gas
showing pH 7.36, PaCO2 65 mm Hg, PaO2 55 mm Hg, HCO3- 36 mEq/L. The patient
is alert but dyspneic. Which oxygen delivery system is most appropriate to maintain
adequate oxygenation without worsening hypercapnia?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 24% oxygen
C. Nasal cannula at 2 L/min
D. Simple face mask at 6 L/min
Correct Answer: B. Venturi mask at 24% oxygen
Rationale: In COPD patients with chronic hypercapnia, controlled oxygen therapy is
essential to avoid suppressing hypoxic drive. The Venturi mask at 24% provides precise
FiO2, minimizing the risk of worsening hypercapnia while achieving adequate
oxygenation (target PaO2 55-60 mm Hg). High-flow oxygen (non-rebreather, simple mask)
Page 3
, can lead to increased CO2 retention due to reduced hypoxic drive and worsening V/Q
mismatch.
Why Wrong:
A - Non-rebreather mask delivers high FiO2, which can suppress hypoxic drive and
worsen hypercapnia.
C - Nasal cannula at 2 L/min may not provide sufficient oxygen to achieve target
PaO2 in some patients.
D - Simple face mask at 6 L/min delivers variable FiO2 and may lead to CO2
retention.
Reference: Global Initiative for Chronic Obstructive Lung Disease. (2026). Global
Strategy for the Diagnosis, Management, and Prevention of COPD.
Q3. A patient with severe sepsis develops hypotension refractory to fluid
resuscitation. A pulmonary artery catheter is placed; cardiac index is 2.1 L/min/m2,
systemic vascular resistance is 1400 dyn-s-cm-5, and pulmonary capillary wedge
pressure is 12 mm Hg. Which vasoactive agent is most appropriate?
A. Norepinephrine
B. Phenylephrine
C. Dobutamine
D. Vasopressin
Correct Answer: A. Norepinephrine
Rationale: This patient has distributive shock with low cardiac index and high SVR.
Norepinephrine is the first-line vasopressor for septic shock; it provides both alpha- and
beta-adrenergic effects, increasing blood pressure and modestly improving cardiac output.
Phenylephrine is a pure alpha-agonist that may worsen cardiac output. Dobutamine is an
inotrope that would increase cardiac index but may cause hypotension. Vasopressin is a
second-line agent, not first-line.
Why Wrong:
B - Phenylephrine increases SVR but can decrease cardiac output due to reflex
bradycardia.
C - Dobutamine is an inotrope that would increase cardiac index but may worsen
hypotension in septic shock.
D - Vasopressin is reserved for refractory shock, not first-line therapy.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines
for Management of Sepsis and Septic Shock. Critical Care Medicine, 45(3),
486-552.
Q4. A patient on mechanical ventilation has a sudden increase in peak airway
pressure from 25 to 40 cm H2O, while plateau pressure remains unchanged at 20 cm
H2O. Which condition is most consistent with these findings?
Page 4
