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NBRC TMC Exam and Practice Exam – Advanced
Therapist Multiple-Choice (TMC) | Comprehensive
Practice Questions with Detailed Rationales | 100%
Pass Guaranteed | Graded A+
Question 1
A 64-year-old patient with a history of COPD is receiving oxygen via a Venturi mask at 40%. The
device is set at a flow rate of 8 L/min. Which of the following adjustments should the therapist
make if the SpO₂ drops to 86% and the patient shows signs of increased work of breathing?
A. Increase the flow rate to 12 L/min while maintaining the 40% setting.
B. Change the entrainment port to deliver 50% oxygen.
C. Switch to a non-rebreather mask at 15 L/min.
D. Decrease the flow to 6 L/min to prevent drying of the airway.
☑ Correct Answer: B
☑ Explanation: A Venturi mask delivers a precise FiO₂ only when the total flow (oxygen
flow + entrained air) meets or exceeds the patient's peak inspiratory flow. If the SpO₂ drops, the
FiO₂ delivered is insufficient. Changing the entrainment port to 50% increases the delivered FiO₂
while still maintaining precise control. Increasing the flow rate without changing the port (A)
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does not increase FiO₂. Switching to a non-rebreather (C) delivers 60-80% FiO₂ but is not precise.
Decreasing flow (D) would worsen hypoxemia.
Question 2
Which of the following ABG values is most consistent with a patient experiencing acute
respiratory acidosis?
A. pH 7.25, PaCO2 60 mmHg, HCO3- 24 mEq/L
B. pH 7.48, PaCO2 30 mmHg, HCO3- 22 mEq/L
C. pH 7.35, PaCO2 50 mmHg, HCO3- 30 mEq/L
D. pH 7.30, PaCO2 55 mmHg, HCO3- 32 mEq/L
☑ Correct Answer: A
☑ Explanation: Acute respiratory acidosis is characterized by a low pH (<7.35) and
elevated PaCO2 (>45 mmHg) with a normal or minimally elevated HCO3- (<26 mEq/L). Option A
shows pH 7.25, PaCO2 60 (high), and normal HCO3- 24, consistent with acute respiratory
acidosis. Option B shows respiratory alkalosis. Option C shows partially compensated respiratory
acidosis (elevated HCO3-). Option D shows fully compensated respiratory acidosis (HCO3-
significantly elevated).
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Question 3
A patient is receiving mechanical ventilation with the following settings: Vt 500 mL, RR 14
breaths/min, PEEP 5 cm H₂O, FiO₂ 0.40. The peak inspiratory pressure (PIP) is 45 cm H₂O, and
the plateau pressure (Pplat) is 32 cm H₂O. Which of the following is the most appropriate
intervention?
A. Increase the inspiratory flow rate.
B. Administer a bronchodilator.
C. Change to pressure-controlled ventilation.
D. Reduce the tidal volume.
☑ Correct Answer: B
☑ Explanation: The patient has a high peak pressure (45 cm H₂O) and a high plateau
pressure (32 cm H₂O), with a difference between PIP and Pplat of 13 cm H₂O (normal is <10).
This indicates both high airway resistance (elevated PIP) and decreased lung compliance
(elevated Pplat). The most appropriate intervention is to administer a bronchodilator to reduce
airway resistance, which will lower the PIP. Increasing flow (A) would increase PIP further.
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Changing to pressure control (C) does not address the underlying compliance issue. Reducing
tidal volume (D) would lower Pplat but is a secondary intervention.
Question 4
Which of the following patients is at the highest risk for developing ventilator-associated
pneumonia (VAP)?
A. A patient on pressure support ventilation with an oropharyngeal airway.
B. A patient on volume-controlled ventilation with an endotracheal tube and frequent
ventilator circuit changes.
C. A patient on non-invasive positive pressure ventilation (NIPPV).
D. A patient on a tracheostomy mask with a speaking valve.
☑ Correct Answer: B
☑ Explanation: Ventilator-associated pneumonia is a common complication in
mechanically ventilated patients. Risk factors include invasive mechanical ventilation
(endotracheal tube), prolonged ventilation, and frequent ventilator circuit changes. Option B
includes the highest risk factors (invasive ventilation and frequent circuit changes). Option A
uses an oropharyngeal airway (which is not a definitive airway and is not used with invasive
NBRC TMC Exam and Practice Exam – Advanced
Therapist Multiple-Choice (TMC) | Comprehensive
Practice Questions with Detailed Rationales | 100%
Pass Guaranteed | Graded A+
Question 1
A 64-year-old patient with a history of COPD is receiving oxygen via a Venturi mask at 40%. The
device is set at a flow rate of 8 L/min. Which of the following adjustments should the therapist
make if the SpO₂ drops to 86% and the patient shows signs of increased work of breathing?
A. Increase the flow rate to 12 L/min while maintaining the 40% setting.
B. Change the entrainment port to deliver 50% oxygen.
C. Switch to a non-rebreather mask at 15 L/min.
D. Decrease the flow to 6 L/min to prevent drying of the airway.
☑ Correct Answer: B
☑ Explanation: A Venturi mask delivers a precise FiO₂ only when the total flow (oxygen
flow + entrained air) meets or exceeds the patient's peak inspiratory flow. If the SpO₂ drops, the
FiO₂ delivered is insufficient. Changing the entrainment port to 50% increases the delivered FiO₂
while still maintaining precise control. Increasing the flow rate without changing the port (A)
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does not increase FiO₂. Switching to a non-rebreather (C) delivers 60-80% FiO₂ but is not precise.
Decreasing flow (D) would worsen hypoxemia.
Question 2
Which of the following ABG values is most consistent with a patient experiencing acute
respiratory acidosis?
A. pH 7.25, PaCO2 60 mmHg, HCO3- 24 mEq/L
B. pH 7.48, PaCO2 30 mmHg, HCO3- 22 mEq/L
C. pH 7.35, PaCO2 50 mmHg, HCO3- 30 mEq/L
D. pH 7.30, PaCO2 55 mmHg, HCO3- 32 mEq/L
☑ Correct Answer: A
☑ Explanation: Acute respiratory acidosis is characterized by a low pH (<7.35) and
elevated PaCO2 (>45 mmHg) with a normal or minimally elevated HCO3- (<26 mEq/L). Option A
shows pH 7.25, PaCO2 60 (high), and normal HCO3- 24, consistent with acute respiratory
acidosis. Option B shows respiratory alkalosis. Option C shows partially compensated respiratory
acidosis (elevated HCO3-). Option D shows fully compensated respiratory acidosis (HCO3-
significantly elevated).
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Question 3
A patient is receiving mechanical ventilation with the following settings: Vt 500 mL, RR 14
breaths/min, PEEP 5 cm H₂O, FiO₂ 0.40. The peak inspiratory pressure (PIP) is 45 cm H₂O, and
the plateau pressure (Pplat) is 32 cm H₂O. Which of the following is the most appropriate
intervention?
A. Increase the inspiratory flow rate.
B. Administer a bronchodilator.
C. Change to pressure-controlled ventilation.
D. Reduce the tidal volume.
☑ Correct Answer: B
☑ Explanation: The patient has a high peak pressure (45 cm H₂O) and a high plateau
pressure (32 cm H₂O), with a difference between PIP and Pplat of 13 cm H₂O (normal is <10).
This indicates both high airway resistance (elevated PIP) and decreased lung compliance
(elevated Pplat). The most appropriate intervention is to administer a bronchodilator to reduce
airway resistance, which will lower the PIP. Increasing flow (A) would increase PIP further.
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Changing to pressure control (C) does not address the underlying compliance issue. Reducing
tidal volume (D) would lower Pplat but is a secondary intervention.
Question 4
Which of the following patients is at the highest risk for developing ventilator-associated
pneumonia (VAP)?
A. A patient on pressure support ventilation with an oropharyngeal airway.
B. A patient on volume-controlled ventilation with an endotracheal tube and frequent
ventilator circuit changes.
C. A patient on non-invasive positive pressure ventilation (NIPPV).
D. A patient on a tracheostomy mask with a speaking valve.
☑ Correct Answer: B
☑ Explanation: Ventilator-associated pneumonia is a common complication in
mechanically ventilated patients. Risk factors include invasive mechanical ventilation
(endotracheal tube), prolonged ventilation, and frequent ventilator circuit changes. Option B
includes the highest risk factors (invasive ventilation and frequent circuit changes). Option A
uses an oropharyngeal airway (which is not a definitive airway and is not used with invasive
