NBRC • THERAPIST MULTIPLE-CHOICE
NBRC TMC EXAM A+
AND PRACTICE EXAM
2026/2027
Therapist Multiple-Choice Examination — Entry-Level Respiratory Care Credentialing
A+ QUESTIONS 6 SECTIONS 100%
VERIFIED COMPLETE RATIONALES
CATEGORIES
■ 1. Patient Data Evaluation & Diagnostic Interpretation
■ 2. Airway Management & Oxygen Therapy
■ 3. Mechanical Ventilation Initiation & Modification
■ 4. Pharmacology, Aerosol Therapy & Humidity
■ 5. Troubleshooting, Equipment QC & Infection Control
■ 6. Neonatal/Pediatric Care, Specialty Interventions & Professional Practice
STUVIAACTUALEXAM
Passing Score: 75% • 1 Mark per Question • Application / Analysis / Synthesis Level
,SECTION 1: Patient Data Evaluation & Diagnostic Interpretation
Q1. A 68-year-old COPD patient arrives in the ED with increased dyspnea. ABG on room air: pH 7.32, PaCO■ 62 mm Hg, PaO■ 48
mm Hg, HCO■■ 31 mEq/L. The respiratory therapist’s interpretation of this blood gas is:
A. Acute respiratory alkalosis with severe hypoxemia
B. Partially compensated respiratory acidosis with severe hypoxemia
C. Fully compensated metabolic alkalosis
D. Uncompensated metabolic acidosis with mild hypoxemia
Correct Answer: B
Rationale: Elevated PaCO■ with low pH indicates respiratory acidosis; elevated HCO■■ shows partial renal compensation. PaO■ of 48 mm Hg
confirms severe hypoxemia common in acute COPD exacerbation.
Q2. A patient on mechanical ventilation has the following values: exhaled VT 450 mL, respiratory rate 14, FiO■ 0.40, PEEP 5 cm
H■O. Calculated minute ventilation is approximately:
A. 6.3 L/min
B. 4.5 L/min
C. 9.0 L/min
D. 12.6 L/min
Correct Answer: A
Rationale: Minute ventilation = tidal volume × respiratory rate = 0.45 L × 14 = 6.3 L/min. This is a fundamental calculation used in assessing
ventilation adequacy.
Q3. A chest radiograph of a newly intubated patient shows the endotracheal tube tip 2 cm above the carina. The therapist should:
A. Advance the tube 4 cm and re-secure
B. Withdraw the tube 3 cm immediately
C. Leave the tube in its current position because placement is appropriate
D. Recommend immediate tracheostomy
Correct Answer: C
Rationale: Ideal ET tube tip position is 3–5 cm above the carina in adults. Two centimeters is acceptable and does not require repositioning if
bilateral breath sounds and other signs confirm proper placement.
Q4. A patient has a peak inspiratory pressure of 38 cm H■O and a plateau pressure of 22 cm H■O on volume-controlled ventilation.
This difference most likely indicates:
A. Decreased lung compliance
B. Pneumothorax
C. Mainstem intubation
D. Increased airway resistance
Correct Answer: D
Rationale: A large gap between PIP and Pplat reflects elevated airway resistance (secretions, bronchospasm, kinked tube). Compliance problems
raise both pressures with a smaller difference.
Q5. While reviewing a patient’s chart, the therapist notes a recent PaO■ of 55 mm Hg on FiO■ 0.50. The calculated P/F ratio is:
A. 55
B. 110
C. 275
D. 500
Correct Answer: B
Rationale: P/F ratio = PaO■ / FiO■ = .50 = 110. A ratio <200 is consistent with moderate ARDS when other criteria are met.
Q6. A neonate’s capillary blood gas shows pH 7.25, PCO■ 55 mm Hg, PO■ 45 mm Hg. The therapist recognizes that capillary
samples:
A. Are useful for pH and PCO■ but underestimate arterial PO■
B. Accurately reflect arterial PO■ in all cases
C. Should never be used in neonates
D. Require no correlation with clinical status
Correct Answer: A
Rationale: Capillary blood gases approximate arterial pH and PCO■ when properly obtained but typically yield lower PO■ values than arterial
samples and must be interpreted with clinical correlation.
NBRC TMC EXAM | Page 2
, Q7. A patient with suspected pulmonary embolism has an A-a gradient of 45 mm Hg on room air. This finding suggests:
A. Normal gas exchange
B. Pure hypoventilation without lung pathology
C. Increased alveolar-arterial oxygen gradient consistent with V/Q mismatch or shunt
D. Hyperoxia
Correct Answer: C
Rationale: Normal A-a gradient on room air is roughly 5–15 mm Hg (increases with age). An elevated gradient indicates impaired oxygen transfer
due to V/Q inequality, shunt, or diffusion limitation.
Q8. Spirometry on a 55-year-old shows FEV1/FVC 58% and FEV1 65% predicted. Post-bronchodilator FEV1 increases by 8%. The
pattern is most consistent with:
A. Restrictive disease with significant reversibility
B. Normal spirometry
C. Mixed obstruction and restriction with full reversibility
D. Obstructive impairment without significant bronchodilator response
Correct Answer: D
Rationale: Reduced FEV1/FVC defines obstruction. An increase <12% (or <200 mL) indicates lack of significant reversibility, typical of COPD rather
than asthma.
Q9. A patient in the ICU has a central venous pressure of 18 mm Hg and a pulmonary artery occlusion pressure of 8 mm Hg. These
values most strongly suggest:
A. Left ventricular failure
B. Right ventricular dysfunction or increased pulmonary vascular resistance
C. Hypovolemia
D. Normal hemodynamics
Correct Answer: B
Rationale: Elevated CVP with low PAOP points to a problem proximal to the left atrium—commonly right-ventricular failure or pulmonary
hypertension—rather than left-sided heart failure.
Q10. A therapist reviews a sleep study report showing an AHI of 32 events per hour with predominant obstructive events. This
severity classification is:
A. Severe OSA
B. Mild OSA
C. Moderate OSA
D. Normal
Correct Answer: A
Rationale: AHI ≥30 events/hour defines severe obstructive sleep apnea. Moderate is 15–29 and mild is 5–14.
Q11. A patient receiving volume-controlled ventilation develops a sudden increase in peak pressure from 28 to 45 cm H■O. Plateau
pressure remains 24 cm H■O. The most likely cause is:
A. Pneumothorax
B. Pulmonary edema
C. Endotracheal tube obstruction or biting
D. Mainstem intubation with decreased compliance
Correct Answer: C
Rationale: Isolated rise in PIP with stable Pplat indicates an acute increase in airway resistance such as tube kinking, biting, or secretions, rather
than a compliance problem.
Q12. An ABG drawn from a patient on FiO■ 0.28 shows PaO■ 95 mm Hg. The approximate alveolar PO■ (assuming PB 760,
PH■O 47, PaCO■ 40, R 0.8) is closest to:
A. 100 mm Hg
B. 200 mm Hg
C. 250 mm Hg
D. 150 mm Hg
Correct Answer: D
Rationale: PAO■ ≈ FiO■(PB−47) − (PaCO■/0.8) ≈ 0.28×713 − 50 ≈ 150 mm Hg. This allows calculation of the A-a gradient.
NBRC TMC EXAM | Page 3
NBRC TMC EXAM A+
AND PRACTICE EXAM
2026/2027
Therapist Multiple-Choice Examination — Entry-Level Respiratory Care Credentialing
A+ QUESTIONS 6 SECTIONS 100%
VERIFIED COMPLETE RATIONALES
CATEGORIES
■ 1. Patient Data Evaluation & Diagnostic Interpretation
■ 2. Airway Management & Oxygen Therapy
■ 3. Mechanical Ventilation Initiation & Modification
■ 4. Pharmacology, Aerosol Therapy & Humidity
■ 5. Troubleshooting, Equipment QC & Infection Control
■ 6. Neonatal/Pediatric Care, Specialty Interventions & Professional Practice
STUVIAACTUALEXAM
Passing Score: 75% • 1 Mark per Question • Application / Analysis / Synthesis Level
,SECTION 1: Patient Data Evaluation & Diagnostic Interpretation
Q1. A 68-year-old COPD patient arrives in the ED with increased dyspnea. ABG on room air: pH 7.32, PaCO■ 62 mm Hg, PaO■ 48
mm Hg, HCO■■ 31 mEq/L. The respiratory therapist’s interpretation of this blood gas is:
A. Acute respiratory alkalosis with severe hypoxemia
B. Partially compensated respiratory acidosis with severe hypoxemia
C. Fully compensated metabolic alkalosis
D. Uncompensated metabolic acidosis with mild hypoxemia
Correct Answer: B
Rationale: Elevated PaCO■ with low pH indicates respiratory acidosis; elevated HCO■■ shows partial renal compensation. PaO■ of 48 mm Hg
confirms severe hypoxemia common in acute COPD exacerbation.
Q2. A patient on mechanical ventilation has the following values: exhaled VT 450 mL, respiratory rate 14, FiO■ 0.40, PEEP 5 cm
H■O. Calculated minute ventilation is approximately:
A. 6.3 L/min
B. 4.5 L/min
C. 9.0 L/min
D. 12.6 L/min
Correct Answer: A
Rationale: Minute ventilation = tidal volume × respiratory rate = 0.45 L × 14 = 6.3 L/min. This is a fundamental calculation used in assessing
ventilation adequacy.
Q3. A chest radiograph of a newly intubated patient shows the endotracheal tube tip 2 cm above the carina. The therapist should:
A. Advance the tube 4 cm and re-secure
B. Withdraw the tube 3 cm immediately
C. Leave the tube in its current position because placement is appropriate
D. Recommend immediate tracheostomy
Correct Answer: C
Rationale: Ideal ET tube tip position is 3–5 cm above the carina in adults. Two centimeters is acceptable and does not require repositioning if
bilateral breath sounds and other signs confirm proper placement.
Q4. A patient has a peak inspiratory pressure of 38 cm H■O and a plateau pressure of 22 cm H■O on volume-controlled ventilation.
This difference most likely indicates:
A. Decreased lung compliance
B. Pneumothorax
C. Mainstem intubation
D. Increased airway resistance
Correct Answer: D
Rationale: A large gap between PIP and Pplat reflects elevated airway resistance (secretions, bronchospasm, kinked tube). Compliance problems
raise both pressures with a smaller difference.
Q5. While reviewing a patient’s chart, the therapist notes a recent PaO■ of 55 mm Hg on FiO■ 0.50. The calculated P/F ratio is:
A. 55
B. 110
C. 275
D. 500
Correct Answer: B
Rationale: P/F ratio = PaO■ / FiO■ = .50 = 110. A ratio <200 is consistent with moderate ARDS when other criteria are met.
Q6. A neonate’s capillary blood gas shows pH 7.25, PCO■ 55 mm Hg, PO■ 45 mm Hg. The therapist recognizes that capillary
samples:
A. Are useful for pH and PCO■ but underestimate arterial PO■
B. Accurately reflect arterial PO■ in all cases
C. Should never be used in neonates
D. Require no correlation with clinical status
Correct Answer: A
Rationale: Capillary blood gases approximate arterial pH and PCO■ when properly obtained but typically yield lower PO■ values than arterial
samples and must be interpreted with clinical correlation.
NBRC TMC EXAM | Page 2
, Q7. A patient with suspected pulmonary embolism has an A-a gradient of 45 mm Hg on room air. This finding suggests:
A. Normal gas exchange
B. Pure hypoventilation without lung pathology
C. Increased alveolar-arterial oxygen gradient consistent with V/Q mismatch or shunt
D. Hyperoxia
Correct Answer: C
Rationale: Normal A-a gradient on room air is roughly 5–15 mm Hg (increases with age). An elevated gradient indicates impaired oxygen transfer
due to V/Q inequality, shunt, or diffusion limitation.
Q8. Spirometry on a 55-year-old shows FEV1/FVC 58% and FEV1 65% predicted. Post-bronchodilator FEV1 increases by 8%. The
pattern is most consistent with:
A. Restrictive disease with significant reversibility
B. Normal spirometry
C. Mixed obstruction and restriction with full reversibility
D. Obstructive impairment without significant bronchodilator response
Correct Answer: D
Rationale: Reduced FEV1/FVC defines obstruction. An increase <12% (or <200 mL) indicates lack of significant reversibility, typical of COPD rather
than asthma.
Q9. A patient in the ICU has a central venous pressure of 18 mm Hg and a pulmonary artery occlusion pressure of 8 mm Hg. These
values most strongly suggest:
A. Left ventricular failure
B. Right ventricular dysfunction or increased pulmonary vascular resistance
C. Hypovolemia
D. Normal hemodynamics
Correct Answer: B
Rationale: Elevated CVP with low PAOP points to a problem proximal to the left atrium—commonly right-ventricular failure or pulmonary
hypertension—rather than left-sided heart failure.
Q10. A therapist reviews a sleep study report showing an AHI of 32 events per hour with predominant obstructive events. This
severity classification is:
A. Severe OSA
B. Mild OSA
C. Moderate OSA
D. Normal
Correct Answer: A
Rationale: AHI ≥30 events/hour defines severe obstructive sleep apnea. Moderate is 15–29 and mild is 5–14.
Q11. A patient receiving volume-controlled ventilation develops a sudden increase in peak pressure from 28 to 45 cm H■O. Plateau
pressure remains 24 cm H■O. The most likely cause is:
A. Pneumothorax
B. Pulmonary edema
C. Endotracheal tube obstruction or biting
D. Mainstem intubation with decreased compliance
Correct Answer: C
Rationale: Isolated rise in PIP with stable Pplat indicates an acute increase in airway resistance such as tube kinking, biting, or secretions, rather
than a compliance problem.
Q12. An ABG drawn from a patient on FiO■ 0.28 shows PaO■ 95 mm Hg. The approximate alveolar PO■ (assuming PB 760,
PH■O 47, PaCO■ 40, R 0.8) is closest to:
A. 100 mm Hg
B. 200 mm Hg
C. 250 mm Hg
D. 150 mm Hg
Correct Answer: D
Rationale: PAO■ ≈ FiO■(PB−47) − (PaCO■/0.8) ≈ 0.28×713 − 50 ≈ 150 mm Hg. This allows calculation of the A-a gradient.
NBRC TMC EXAM | Page 3
