TMC Practice Exam Actual Exam 2026/2027
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EXAM QUESTIONS
Q1: A 68-year-old male with a 45-pack-year smoking history presents with progressive
shortness of breath over the past 2 years. On auscultation, you note decreased breath sounds
with prolonged expiration and faint expiratory wheezes. Which of the following is the most
likely underlying pathophysiology?
A. Destruction of alveolar walls with loss of elastic recoil
B. Chronic inflammation and narrowing of the small airways
C. Thickening of the alveolar-capillary membrane
D. Excessive mucus production obstructing large airways
Correct Answer: B
Rationale: Chronic bronchitis, characterized by chronic inflammation and narrowing of small
airways (bronchioles), presents with decreased breath sounds, prolonged expiration, and
wheezing. While emphysema involves alveolar destruction (A), the clinical presentation of
prolonged expiration with wheezing is more consistent with airway narrowing and obstruction
from chronic bronchitis.
Q2: A 72-year-old female with COPD is receiving oxygen via nasal cannula at 2 L/min. Her
SpO2 is 91%, respiratory rate is 22/min, and she appears comfortable. What is the most
appropriate next action?
A. Increase to 3 L/min immediately
B. Perform an ABG analysis
C. Switch to a Venturi mask at 28% FiO2
D. Maintain current settings and reassess in 30 minutes
Correct Answer: D
Rationale: For a COPD patient with SpO2 91% on 2 L/min who appears comfortable,
,maintaining current settings is appropriate. Target SpO2 for COPD is typically 88-92% to avoid
hyperoxia-induced hypoventilation. ABG is not urgently indicated, and increasing oxygen may
cause CO2 retention. NBRC guidelines recommend cautious oxygen titration in COPD.
Q3: A patient on mechanical ventilation in Assist-Control volume-cycled mode has a peak
inspiratory pressure (PIP) that has increased from 28 to 42 cmH2O over 4 hours. Plateau
pressure remains at 26 cmH2O. Which of the following is the most likely cause?
A. Bronchospasm
B. Decreased lung compliance
C. Kinked endotracheal tube
D. Pulmonary edema
Correct Answer: A
Rationale: Increased PIP with unchanged plateau pressure indicates increased airway
resistance, not decreased compliance. Bronchospasm increases airway resistance without
affecting compliance, causing elevated PIP while plateau pressure remains stable. Kinked ETT (C)
would affect both PIP and plateau. Decreased compliance (B) and pulmonary edema (D) would
elevate plateau pressure as well.
Q4: Which of the following ABG values is consistent with partially compensated metabolic
acidosis?
A. pH 7.31, PaCO2 48, HCO3 18
B. pH 7.33, PaCO2 30, HCO3 16
C. pH 7.26, PaCO2 40, HCO3 14
D. pH 7.38, PaCO2 55, HCO3 22
Correct Answer: B
Rationale: Partially compensated metabolic acidosis shows low pH (7.33), low HCO3 (16), and
low PaCO2 (30) as the respiratory system attempts compensation by blowing off CO2. The pH
remains abnormal (not fully compensated). Option A shows respiratory acidosis, C shows
uncompensated metabolic acidosis, and D shows respiratory acidosis with metabolic
compensation.
, Q5: A 45-year-old male is intubated and receiving mechanical ventilation. The high-pressure
alarm sounds. The ventilator is cycling off prematurely with each breath. Which of the
following is the most appropriate immediate action?
A. Disconnect the patient and manually ventilate with a bag-valve-mask
B. Increase the high-pressure alarm limit
C. Check for tube kinking, biting, or secretions
D. Change the ventilator circuit
Correct Answer: C
Rationale: The most common causes of high-pressure alarms are tube kinking, patient biting
the tube, or secretions obstructing the airway. The immediate action is to check these causes.
Increasing the alarm limit (B) is inappropriate without identifying the cause. Manual ventilation
(A) may be needed but only after assessment. Changing the circuit (D) is not indicated for high-
pressure alarms.
Q6: A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with the following settings: AC-VC, tidal volume 6 mL/kg, rate 16/min, FiO2 0.60, PEEP 12
cmH2O. Which of the following is the most important parameter to monitor to prevent
ventilator-induced lung injury?
A. Peak inspiratory pressure (PIP)
B. Plateau pressure (Pplat)
C. Mean airway pressure
D. Auto-PEEP
Correct Answer: B
Rationale: Plateau pressure reflects alveolar pressure and should be maintained below 30
cmH2O to prevent ventilator-induced lung injury (barotrauma). PIP (A) reflects airway resistance
as well as alveolar pressure and is less specific for lung injury risk. Monitoring Pplat is the
standard of care in ARDS management according to the ARDSNet protocol.
Q7: A 55-year-old female with asthma is receiving albuterol via small-volume nebulizer. Which
of the following parameters is the best indicator of treatment response?
A. Increased heart rate
B. Decreased respiratory rate
C. Increased peak expiratory flow rate
D. Decreased oxygen saturation
– Complete Exam-Style Questions | 100%
Verified – Pass Guaranteed – A+ Graded.
EXAM QUESTIONS
Q1: A 68-year-old male with a 45-pack-year smoking history presents with progressive
shortness of breath over the past 2 years. On auscultation, you note decreased breath sounds
with prolonged expiration and faint expiratory wheezes. Which of the following is the most
likely underlying pathophysiology?
A. Destruction of alveolar walls with loss of elastic recoil
B. Chronic inflammation and narrowing of the small airways
C. Thickening of the alveolar-capillary membrane
D. Excessive mucus production obstructing large airways
Correct Answer: B
Rationale: Chronic bronchitis, characterized by chronic inflammation and narrowing of small
airways (bronchioles), presents with decreased breath sounds, prolonged expiration, and
wheezing. While emphysema involves alveolar destruction (A), the clinical presentation of
prolonged expiration with wheezing is more consistent with airway narrowing and obstruction
from chronic bronchitis.
Q2: A 72-year-old female with COPD is receiving oxygen via nasal cannula at 2 L/min. Her
SpO2 is 91%, respiratory rate is 22/min, and she appears comfortable. What is the most
appropriate next action?
A. Increase to 3 L/min immediately
B. Perform an ABG analysis
C. Switch to a Venturi mask at 28% FiO2
D. Maintain current settings and reassess in 30 minutes
Correct Answer: D
Rationale: For a COPD patient with SpO2 91% on 2 L/min who appears comfortable,
,maintaining current settings is appropriate. Target SpO2 for COPD is typically 88-92% to avoid
hyperoxia-induced hypoventilation. ABG is not urgently indicated, and increasing oxygen may
cause CO2 retention. NBRC guidelines recommend cautious oxygen titration in COPD.
Q3: A patient on mechanical ventilation in Assist-Control volume-cycled mode has a peak
inspiratory pressure (PIP) that has increased from 28 to 42 cmH2O over 4 hours. Plateau
pressure remains at 26 cmH2O. Which of the following is the most likely cause?
A. Bronchospasm
B. Decreased lung compliance
C. Kinked endotracheal tube
D. Pulmonary edema
Correct Answer: A
Rationale: Increased PIP with unchanged plateau pressure indicates increased airway
resistance, not decreased compliance. Bronchospasm increases airway resistance without
affecting compliance, causing elevated PIP while plateau pressure remains stable. Kinked ETT (C)
would affect both PIP and plateau. Decreased compliance (B) and pulmonary edema (D) would
elevate plateau pressure as well.
Q4: Which of the following ABG values is consistent with partially compensated metabolic
acidosis?
A. pH 7.31, PaCO2 48, HCO3 18
B. pH 7.33, PaCO2 30, HCO3 16
C. pH 7.26, PaCO2 40, HCO3 14
D. pH 7.38, PaCO2 55, HCO3 22
Correct Answer: B
Rationale: Partially compensated metabolic acidosis shows low pH (7.33), low HCO3 (16), and
low PaCO2 (30) as the respiratory system attempts compensation by blowing off CO2. The pH
remains abnormal (not fully compensated). Option A shows respiratory acidosis, C shows
uncompensated metabolic acidosis, and D shows respiratory acidosis with metabolic
compensation.
, Q5: A 45-year-old male is intubated and receiving mechanical ventilation. The high-pressure
alarm sounds. The ventilator is cycling off prematurely with each breath. Which of the
following is the most appropriate immediate action?
A. Disconnect the patient and manually ventilate with a bag-valve-mask
B. Increase the high-pressure alarm limit
C. Check for tube kinking, biting, or secretions
D. Change the ventilator circuit
Correct Answer: C
Rationale: The most common causes of high-pressure alarms are tube kinking, patient biting
the tube, or secretions obstructing the airway. The immediate action is to check these causes.
Increasing the alarm limit (B) is inappropriate without identifying the cause. Manual ventilation
(A) may be needed but only after assessment. Changing the circuit (D) is not indicated for high-
pressure alarms.
Q6: A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation
with the following settings: AC-VC, tidal volume 6 mL/kg, rate 16/min, FiO2 0.60, PEEP 12
cmH2O. Which of the following is the most important parameter to monitor to prevent
ventilator-induced lung injury?
A. Peak inspiratory pressure (PIP)
B. Plateau pressure (Pplat)
C. Mean airway pressure
D. Auto-PEEP
Correct Answer: B
Rationale: Plateau pressure reflects alveolar pressure and should be maintained below 30
cmH2O to prevent ventilator-induced lung injury (barotrauma). PIP (A) reflects airway resistance
as well as alveolar pressure and is less specific for lung injury risk. Monitoring Pplat is the
standard of care in ARDS management according to the ARDSNet protocol.
Q7: A 55-year-old female with asthma is receiving albuterol via small-volume nebulizer. Which
of the following parameters is the best indicator of treatment response?
A. Increased heart rate
B. Decreased respiratory rate
C. Increased peak expiratory flow rate
D. Decreased oxygen saturation
