NBRC TMC EXAM NEWEST (2026/2027) NBRC
TMC ACTUAL EXAM STUDY GUIDE WITH
COMPLETE ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS WITH DETAILED
RATIONALES
1. A patient presenting with a right-sided pleural effusion requires
confirmation of the etiology of the fluid. Which of the following
procedures should the respiratory therapist recommend?
A. Diagnostic bronchoscopy
B. Sputum culture and Gram stain
C. Pleurodesis
D. Thoracentesis
Answer: D
Rationale: Thoracentesis involves inserting a needle or catheter
into the pleural space to drain fluid for diagnostic evaluation and
therapeutic relief. Bronchoscopy targets intrabronchial lesions,
while pleurodesis is performed to prevent recurrent effusions
rather than diagnose them.
2. A patient with an exacerbation of COPD is receiving NPPV in
spontaneous mode via nasal mask with FiO2 0.24, IPAP 12
cmH2O, and EPAP 6 cmH2O. One hour later, ABG shows: pH
7.27, PaCO2 76 mmHg, PaO2 62 mmHg, HCO3- 35 mEq/L. The
,patient exhibits prolonged inspiratory phase and dyssynchrony.
What should the respiratory therapist do FIRST?
A. Increase FiO2 to 0.28
B. Increase EPAP to 8 cmH2O
C. Change to a full-face mask
D. Change the ventilator circuit
Answer: C
Rationale: The prolonged inspiratory phase and dyssynchrony in
a patient using a nasal mask with persistent hypercapnia indicate
significant mouth leaks. Switching to a full-face mask eliminates
the leak, restores efficient ventilation delivery, and improves CO2
elimination.
3. A 6'2" male weighing 98 kg is receiving VC ventilation (Vt 600
mL). Low exhaled volume and low pressure alarms trigger
continuously. Data: Vte 340–390 mL, ETT size 8.5 mm, cuff
pressure 19 cmH2O, ETT position 18 cm at the incisors, HR 98,
RR 32, SpO2 83%. Which action should the therapist take?
A. Advance the ETT to 22 cm at the incisors
B. Adjust the cuff pressure to 30 cmH2O
C. Increase the set Vt to 700 mL
D. Reintubate with a larger ETT
,Answer: A
Rationale: At 18 cm at the incisors in an adult male who is 6'2",
the ETT cuff is positioned above or directly at the vocal cords,
causing a massive leak. The tube must be advanced to the proper
depth (21–23 cm) before adjusting cuff pressures or settings.
4. A respiratory therapist is assisting with a chest tube insertion for
a pleural effusion. After insertion and proper connection of the
three-chamber chest drainage system, what should be observed
in the water-seal chamber during normal breathing?
A. Continuous bubbling
B. Water level fluctuating with breathing
C. The water becoming cloudy
D. No visible liquid
Answer: B
Rationale: Tidaling (fluctuation of the water level with inspiration
and exhalation) reflects normal pressure changes in the pleural
space during spontaneous or mechanical breathing. Continuous
bubbling indicates a system or pleural air leak.
5. A mini-bronchoalveolar lavage (mini-BAL) procedure is
primarily indicated for the accurate diagnosis of which condition?
A. Ventilator-associated pneumonia (VAP)
B. Pleural effusion
, C. Pulmonary embolism
D. Idiopathic pulmonary fibrosis
Answer: A
Rationale: Mini-BAL is a non-bronchoscopic technique used at
the bedside to obtain quantitative distal airway cultures to confirm
or rule out ventilator-associated pneumonia (VAP).
6. A 44-year-old post-abdominal surgery patient has been
receiving vibratory PEP therapy q4h for 24 hours. The patient is
now ambulating independently on room air. What should the
therapist recommend?
A. Discontinuing therapy
B. Obtaining an ABG analysis
C. Performing a 6-minute walk test
D. Changing frequency of therapy to q8h
Answer: A
Rationale: Once a patient is fully ambulating independently,
natural deep breathing and coughing generated by mobility clear
secretions effectively, making formal hyperinflation/PEP therapy
unnecessary.
TMC ACTUAL EXAM STUDY GUIDE WITH
COMPLETE ACTUAL EXAM QUESTIONS AND
VERIFIED ANSWERS WITH DETAILED
RATIONALES
1. A patient presenting with a right-sided pleural effusion requires
confirmation of the etiology of the fluid. Which of the following
procedures should the respiratory therapist recommend?
A. Diagnostic bronchoscopy
B. Sputum culture and Gram stain
C. Pleurodesis
D. Thoracentesis
Answer: D
Rationale: Thoracentesis involves inserting a needle or catheter
into the pleural space to drain fluid for diagnostic evaluation and
therapeutic relief. Bronchoscopy targets intrabronchial lesions,
while pleurodesis is performed to prevent recurrent effusions
rather than diagnose them.
2. A patient with an exacerbation of COPD is receiving NPPV in
spontaneous mode via nasal mask with FiO2 0.24, IPAP 12
cmH2O, and EPAP 6 cmH2O. One hour later, ABG shows: pH
7.27, PaCO2 76 mmHg, PaO2 62 mmHg, HCO3- 35 mEq/L. The
,patient exhibits prolonged inspiratory phase and dyssynchrony.
What should the respiratory therapist do FIRST?
A. Increase FiO2 to 0.28
B. Increase EPAP to 8 cmH2O
C. Change to a full-face mask
D. Change the ventilator circuit
Answer: C
Rationale: The prolonged inspiratory phase and dyssynchrony in
a patient using a nasal mask with persistent hypercapnia indicate
significant mouth leaks. Switching to a full-face mask eliminates
the leak, restores efficient ventilation delivery, and improves CO2
elimination.
3. A 6'2" male weighing 98 kg is receiving VC ventilation (Vt 600
mL). Low exhaled volume and low pressure alarms trigger
continuously. Data: Vte 340–390 mL, ETT size 8.5 mm, cuff
pressure 19 cmH2O, ETT position 18 cm at the incisors, HR 98,
RR 32, SpO2 83%. Which action should the therapist take?
A. Advance the ETT to 22 cm at the incisors
B. Adjust the cuff pressure to 30 cmH2O
C. Increase the set Vt to 700 mL
D. Reintubate with a larger ETT
,Answer: A
Rationale: At 18 cm at the incisors in an adult male who is 6'2",
the ETT cuff is positioned above or directly at the vocal cords,
causing a massive leak. The tube must be advanced to the proper
depth (21–23 cm) before adjusting cuff pressures or settings.
4. A respiratory therapist is assisting with a chest tube insertion for
a pleural effusion. After insertion and proper connection of the
three-chamber chest drainage system, what should be observed
in the water-seal chamber during normal breathing?
A. Continuous bubbling
B. Water level fluctuating with breathing
C. The water becoming cloudy
D. No visible liquid
Answer: B
Rationale: Tidaling (fluctuation of the water level with inspiration
and exhalation) reflects normal pressure changes in the pleural
space during spontaneous or mechanical breathing. Continuous
bubbling indicates a system or pleural air leak.
5. A mini-bronchoalveolar lavage (mini-BAL) procedure is
primarily indicated for the accurate diagnosis of which condition?
A. Ventilator-associated pneumonia (VAP)
B. Pleural effusion
, C. Pulmonary embolism
D. Idiopathic pulmonary fibrosis
Answer: A
Rationale: Mini-BAL is a non-bronchoscopic technique used at
the bedside to obtain quantitative distal airway cultures to confirm
or rule out ventilator-associated pneumonia (VAP).
6. A 44-year-old post-abdominal surgery patient has been
receiving vibratory PEP therapy q4h for 24 hours. The patient is
now ambulating independently on room air. What should the
therapist recommend?
A. Discontinuing therapy
B. Obtaining an ABG analysis
C. Performing a 6-minute walk test
D. Changing frequency of therapy to q8h
Answer: A
Rationale: Once a patient is fully ambulating independently,
natural deep breathing and coughing generated by mobility clear
secretions effectively, making formal hyperinflation/PEP therapy
unnecessary.
