Page 1 of 65
KETTERING TMC EXAM PRACTICE – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
TMC
Prepare effectively for the Kettering TMC Exam with this focused practice resource. It
supports review of respiratory therapy concepts, patient assessment, oxygenation
and ventilation, pulmonary disorders, mechanical ventilation, and clinical decision-
making. Use the material to reinforce your knowledge, practice applying key concepts,
and identify areas that may require additional study. This resource is suited for
respiratory therapy students, respiratory therapist trainees, and candidates preparing
for the TMC examination.
MULTIPLE CHOICE.
SECTION 1: PATIENT ASSESSMENT (Questions 1–35)
1. A 48-year-old female is admitted to the ED with diaphoresis, jugular
venous distension, and 3+ pitting edema in the ankles. These findings are
MOST consistent with:
• A. Pulmonary embolism
• B. Right-sided heart failure
• C. Left-sided heart failure
• D. Cardiac tamponade
Correct Answer: B
Rationale: Jugular venous distension (JVD) and peripheral edema are
classic signs of right-sided heart failure, which results from fluid backup
into the systemic venous system. Left-sided heart failure typically
presents with pulmonary congestion (crackles, dyspnea). Pulmonary
embolism may cause JVD but not typically 3+ pitting edema.
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2. A healthy adult female can exhale what portion of her forced vital
capacity in the first second?
• A. 50%
• B. 60%
• C. 70%
• D. 80%
Correct Answer: C
Rationale: The normal FEV₁/FVC ratio is approximately 70–80% in healthy
adults. A healthy adult female should be able to exhale at least 70% of her
forced vital capacity in the first second. A ratio < 70% indicates
obstructive airway disease.
3. A patient on VC ventilation demonstrates auto-PEEP on ventilator
graphics. Which of the following is the MOST likely cause?
• A. Low tidal volume
• B. Insufficient expiratory time
• C. Decreased respiratory rate
• D. Low inspiratory flow
Correct Answer: B
Rationale: Auto-PEEP (intrinsic PEEP) occurs when air is trapped in the
lungs due to incomplete exhalation. Insufficient expiratory time—often
from a high respiratory rate or prolonged inspiratory time—is the most
common cause. Management includes decreasing the respiratory rate,
increasing inspiratory flow, or decreasing tidal volume.
4. A respiratory therapist enters a patient's room during oxygen rounds.
The patient has end-stage emphysema and appears to be sleeping. The
patient doesn't respond to questions and his pulse is 20 bpm. What
should the therapist do FIRST?
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• A. Confirm DNR status
• B. Go get help
• C. Begin rescue ventilation
• D. Check the patient's oxygen saturation
Correct Answer: C
Rationale: The patient is apneic (not responding) with a pulse of 20 bpm—
this is a life-threatening emergency. The priority is to begin rescue
ventilation immediately to restore oxygenation and ventilation. Checking
DNR status or getting help would delay critical intervention.
5. A patient following a thoracentesis has pleural fluid that is clear with a
slight straw color. This finding is MOST consistent with:
• A. Empyema
• B. Transudative effusion
• C. Chylothorax
• D. Hemothorax
Correct Answer: B
Rationale: Clear, straw-colored pleural fluid is characteristic of a
transudative effusion, often seen in conditions like heart failure or
cirrhosis. Empyema presents with purulent fluid; chylothorax presents
with milky fluid; hemothorax presents with bloody fluid.
6. Which of the following is a SIGN (objective finding) rather than a
symptom?
• A. Dyspnea
• B. Chest pain
• C. Wheezing
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• D. Dizziness
Correct Answer: C
Rationale: Per Kettering's teaching, signs are objective findings that can
be measured or observed by the clinician (wheezing, cyanosis, crackles).
Symptoms are subjective complaints reported by the patient (dyspnea,
chest pain, dizziness).
7. A patient with a 40 pack-year smoking history presents with a chronic
cough and progressive dyspnea. What is the calculated pack-year
history?
• A. 20 pack-years
• B. 30 pack-years
• C. 40 pack-years
• D. 50 pack-years
Correct Answer: C
Rationale: Pack-year history is calculated as: # packs per day × # years
smoked. A 40 pack-year history indicates significant tobacco exposure
and is a major risk factor for COPD and lung cancer.
8. A patient's arterial blood gas shows: pH 7.28, PaCO₂ 55 mmHg, PaO₂ 60
mmHg, HCO₃⁻ 24 mEq/L. This ABG is consistent with:
• A. Acute respiratory acidosis
• B. Chronic respiratory acidosis
• C. Metabolic acidosis
• D. Respiratory alkalosis
Correct Answer: A
Rationale: The pH is low (acidemia) with an elevated PaCO₂ (respiratory
KETTERING TMC EXAM PRACTICE – 2026/2027 COMPLETE
(150) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
TMC
Prepare effectively for the Kettering TMC Exam with this focused practice resource. It
supports review of respiratory therapy concepts, patient assessment, oxygenation
and ventilation, pulmonary disorders, mechanical ventilation, and clinical decision-
making. Use the material to reinforce your knowledge, practice applying key concepts,
and identify areas that may require additional study. This resource is suited for
respiratory therapy students, respiratory therapist trainees, and candidates preparing
for the TMC examination.
MULTIPLE CHOICE.
SECTION 1: PATIENT ASSESSMENT (Questions 1–35)
1. A 48-year-old female is admitted to the ED with diaphoresis, jugular
venous distension, and 3+ pitting edema in the ankles. These findings are
MOST consistent with:
• A. Pulmonary embolism
• B. Right-sided heart failure
• C. Left-sided heart failure
• D. Cardiac tamponade
Correct Answer: B
Rationale: Jugular venous distension (JVD) and peripheral edema are
classic signs of right-sided heart failure, which results from fluid backup
into the systemic venous system. Left-sided heart failure typically
presents with pulmonary congestion (crackles, dyspnea). Pulmonary
embolism may cause JVD but not typically 3+ pitting edema.
, Page 2 of 65
2. A healthy adult female can exhale what portion of her forced vital
capacity in the first second?
• A. 50%
• B. 60%
• C. 70%
• D. 80%
Correct Answer: C
Rationale: The normal FEV₁/FVC ratio is approximately 70–80% in healthy
adults. A healthy adult female should be able to exhale at least 70% of her
forced vital capacity in the first second. A ratio < 70% indicates
obstructive airway disease.
3. A patient on VC ventilation demonstrates auto-PEEP on ventilator
graphics. Which of the following is the MOST likely cause?
• A. Low tidal volume
• B. Insufficient expiratory time
• C. Decreased respiratory rate
• D. Low inspiratory flow
Correct Answer: B
Rationale: Auto-PEEP (intrinsic PEEP) occurs when air is trapped in the
lungs due to incomplete exhalation. Insufficient expiratory time—often
from a high respiratory rate or prolonged inspiratory time—is the most
common cause. Management includes decreasing the respiratory rate,
increasing inspiratory flow, or decreasing tidal volume.
4. A respiratory therapist enters a patient's room during oxygen rounds.
The patient has end-stage emphysema and appears to be sleeping. The
patient doesn't respond to questions and his pulse is 20 bpm. What
should the therapist do FIRST?
, Page 3 of 65
• A. Confirm DNR status
• B. Go get help
• C. Begin rescue ventilation
• D. Check the patient's oxygen saturation
Correct Answer: C
Rationale: The patient is apneic (not responding) with a pulse of 20 bpm—
this is a life-threatening emergency. The priority is to begin rescue
ventilation immediately to restore oxygenation and ventilation. Checking
DNR status or getting help would delay critical intervention.
5. A patient following a thoracentesis has pleural fluid that is clear with a
slight straw color. This finding is MOST consistent with:
• A. Empyema
• B. Transudative effusion
• C. Chylothorax
• D. Hemothorax
Correct Answer: B
Rationale: Clear, straw-colored pleural fluid is characteristic of a
transudative effusion, often seen in conditions like heart failure or
cirrhosis. Empyema presents with purulent fluid; chylothorax presents
with milky fluid; hemothorax presents with bloody fluid.
6. Which of the following is a SIGN (objective finding) rather than a
symptom?
• A. Dyspnea
• B. Chest pain
• C. Wheezing
, Page 4 of 65
• D. Dizziness
Correct Answer: C
Rationale: Per Kettering's teaching, signs are objective findings that can
be measured or observed by the clinician (wheezing, cyanosis, crackles).
Symptoms are subjective complaints reported by the patient (dyspnea,
chest pain, dizziness).
7. A patient with a 40 pack-year smoking history presents with a chronic
cough and progressive dyspnea. What is the calculated pack-year
history?
• A. 20 pack-years
• B. 30 pack-years
• C. 40 pack-years
• D. 50 pack-years
Correct Answer: C
Rationale: Pack-year history is calculated as: # packs per day × # years
smoked. A 40 pack-year history indicates significant tobacco exposure
and is a major risk factor for COPD and lung cancer.
8. A patient's arterial blood gas shows: pH 7.28, PaCO₂ 55 mmHg, PaO₂ 60
mmHg, HCO₃⁻ 24 mEq/L. This ABG is consistent with:
• A. Acute respiratory acidosis
• B. Chronic respiratory acidosis
• C. Metabolic acidosis
• D. Respiratory alkalosis
Correct Answer: A
Rationale: The pH is low (acidemia) with an elevated PaCO₂ (respiratory
