TMC Secure Comprehensive Therapist SAE
Exam Study Guide | Complete Actual Exam
Questions with Verified Correct Answers and
Detailed Rationales (100% Correct Solutions)
| Latest Edition – Updated 2026/2027 |
Already Graded A+
Exam Overview: This practice test covers the TMC Secure Comprehensive
Therapist SAE (Self-Assessment Examination) for respiratory therapy students and
practitioners. The content spans patient assessment, cardiopulmonary anatomy
and physiology, oxygen therapy, airway management, mechanical ventilation,
arterial blood gas analysis, pulmonary diagnostics, therapeutic procedures,
respiratory disease management, patient monitoring, pharmacology, and evidence-
based clinical decision-making. Answers and detailed rationales are provided for
each question.
Question 1
A patient is admitted to the ED following a motor vehicle accident. On physical
exam, the respiratory therapist discovers that breath sounds are absent in the left
chest with a hyperresonant percussion note. The trachea is shifted to the right. The
patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40
mm Hg. What action should the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient.
Answer: C
Rationale: The patient has signs of a tension pneumothorax (absent breath sounds,
hyperresonance, tracheal deviation away from the affected side, and hemodynamic
pg. 1
,instability). The immediate life-saving intervention is needle decompression, which
is performed by inserting a needle into the 2nd intercostal space at the
midclavicular line on the affected side. A chest tube is definitive treatment but
needle aspiration is the first step.
Question 2
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 consistent with:
A. Liver failure.
B. Pulmonary embolism.
C. Heart failure.
D. Electrolyte imbalances.
Answer: C
Rationale: Diaphoresis, JVD, and pitting edema are classic signs of heart failure.
JVD indicates increased central venous pressure (right-sided heart failure). Pitting
edema results from fluid retention. Liver failure causes ascites and jaundice.
Pulmonary embolism causes sudden dyspnea and chest pain. Electrolyte
imbalances do not cause these physical findings.
Question 3
All of the following strategies are likely to decrease the likelihood of damage to
the tracheal mucosa EXCEPT:
A. Maintaining cuff pressures between 20 and 25 mm Hg.
B. Using the minimal leak technique for inflation.
C. Using a low-residual-volume, low-compliance cuff.
D. Monitoring intracuff pressures.
Answer: C
Rationale: High-residual-volume, low-pressure cuffs are preferred to reduce
tracheal mucosal damage. Low-residual-volume, high-pressure cuffs concentrate
pressure over a smaller area, increasing the risk of mucosal ischemia. Maintaining
cuff pressures, using minimal leak technique, and monitoring pressures all help
reduce damage.
pg. 2
,Question 4
A 52-year-old post-operative cholecystectomy patient's breath sounds become
more coarse upon completion of postural drainage with percussion. The respiratory
therapist should recommend:
A. Continuing the therapy until breath sounds improve.
B. Administering dornase alpha.
C. Administering albuterol therapy.
D. Deep breathing and coughing to clear secretions.
Answer: D
Rationale: Coarse breath sounds after postural drainage indicate mobilized
secretions in the larger airways. The appropriate intervention is to have the patient
deep breathe and cough to clear these secretions. Continuing therapy may not be
necessary. Dornase alpha is for cystic fibrosis. Albuterol is a bronchodilator.
Question 5
A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory
capacity is 30% of his predicted value. What bronchial hygiene therapy would be
most appropriate initially?
A. IS/SMI
B. IPPB with normal saline
C. Postural drainage and percussion
D. PEP therapy
Answer: B
Rationale: IPPB (intermittent positive pressure breathing) is indicated for patients
with decreased inspiratory capacity who cannot generate adequate tidal volumes. A
spinal cord injured patient with an IC of 30% predicted would benefit from IPPB
to prevent and treat atelectasis. Incentive spirometry requires adequate inspiratory
effort.
pg. 3
, Question 6
A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics.
Which of the following controls, when adjusted independently, would increase
expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity
A. 1, 2, and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, 3, and 4
Answer: A
Rationale: Increasing tidal volume increases inspiratory time, decreasing
expiratory time. Increasing respiratory rate decreases total cycle time, decreasing
expiratory time. Decreasing inspiratory flow (increasing inspiratory time)
decreases expiratory time. Sensitivity does not affect expiratory time.
Question 7
Which of the following would be the most appropriate therapy for a dyspneic
patient who has crepitus with tracheal deviation to the left and absent breath
sounds on the right?
A. Perform chest physiotherapy.
B. Administer an IPPB treatment.
C. Insert an endotracheal tube.
D. Insert a chest tube.
Answer: D
Rationale: The patient has a right tension pneumothorax (tracheal deviation to the
left, absent breath sounds on the right, crepitus). The appropriate treatment is chest
tube insertion for definitive decompression. Needle aspiration may be done first in
an emergency, but chest tube is definitive.
pg. 4
Exam Study Guide | Complete Actual Exam
Questions with Verified Correct Answers and
Detailed Rationales (100% Correct Solutions)
| Latest Edition – Updated 2026/2027 |
Already Graded A+
Exam Overview: This practice test covers the TMC Secure Comprehensive
Therapist SAE (Self-Assessment Examination) for respiratory therapy students and
practitioners. The content spans patient assessment, cardiopulmonary anatomy
and physiology, oxygen therapy, airway management, mechanical ventilation,
arterial blood gas analysis, pulmonary diagnostics, therapeutic procedures,
respiratory disease management, patient monitoring, pharmacology, and evidence-
based clinical decision-making. Answers and detailed rationales are provided for
each question.
Question 1
A patient is admitted to the ED following a motor vehicle accident. On physical
exam, the respiratory therapist discovers that breath sounds are absent in the left
chest with a hyperresonant percussion note. The trachea is shifted to the right. The
patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40
mm Hg. What action should the therapist recommend first?
A. Call for a STAT chest x-ray.
B. Insert a chest tube into the left chest.
C. Needle aspirate the 2nd left intercostal space.
D. Activate the medical emergency team to intubate the patient.
Answer: C
Rationale: The patient has signs of a tension pneumothorax (absent breath sounds,
hyperresonance, tracheal deviation away from the affected side, and hemodynamic
pg. 1
,instability). The immediate life-saving intervention is needle decompression, which
is performed by inserting a needle into the 2nd intercostal space at the
midclavicular line on the affected side. A chest tube is definitive treatment but
needle aspiration is the first step.
Question 2
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 consistent with:
A. Liver failure.
B. Pulmonary embolism.
C. Heart failure.
D. Electrolyte imbalances.
Answer: C
Rationale: Diaphoresis, JVD, and pitting edema are classic signs of heart failure.
JVD indicates increased central venous pressure (right-sided heart failure). Pitting
edema results from fluid retention. Liver failure causes ascites and jaundice.
Pulmonary embolism causes sudden dyspnea and chest pain. Electrolyte
imbalances do not cause these physical findings.
Question 3
All of the following strategies are likely to decrease the likelihood of damage to
the tracheal mucosa EXCEPT:
A. Maintaining cuff pressures between 20 and 25 mm Hg.
B. Using the minimal leak technique for inflation.
C. Using a low-residual-volume, low-compliance cuff.
D. Monitoring intracuff pressures.
Answer: C
Rationale: High-residual-volume, low-pressure cuffs are preferred to reduce
tracheal mucosal damage. Low-residual-volume, high-pressure cuffs concentrate
pressure over a smaller area, increasing the risk of mucosal ischemia. Maintaining
cuff pressures, using minimal leak technique, and monitoring pressures all help
reduce damage.
pg. 2
,Question 4
A 52-year-old post-operative cholecystectomy patient's breath sounds become
more coarse upon completion of postural drainage with percussion. The respiratory
therapist should recommend:
A. Continuing the therapy until breath sounds improve.
B. Administering dornase alpha.
C. Administering albuterol therapy.
D. Deep breathing and coughing to clear secretions.
Answer: D
Rationale: Coarse breath sounds after postural drainage indicate mobilized
secretions in the larger airways. The appropriate intervention is to have the patient
deep breathe and cough to clear these secretions. Continuing therapy may not be
necessary. Dornase alpha is for cystic fibrosis. Albuterol is a bronchodilator.
Question 5
A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory
capacity is 30% of his predicted value. What bronchial hygiene therapy would be
most appropriate initially?
A. IS/SMI
B. IPPB with normal saline
C. Postural drainage and percussion
D. PEP therapy
Answer: B
Rationale: IPPB (intermittent positive pressure breathing) is indicated for patients
with decreased inspiratory capacity who cannot generate adequate tidal volumes. A
spinal cord injured patient with an IC of 30% predicted would benefit from IPPB
to prevent and treat atelectasis. Incentive spirometry requires adequate inspiratory
effort.
pg. 3
, Question 6
A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics.
Which of the following controls, when adjusted independently, would increase
expiratory time?
1. Tidal volume
2. Respiratory Rate
3. Inspiratory flow
4. Sensitivity
A. 1, 2, and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2, 3, and 4
Answer: A
Rationale: Increasing tidal volume increases inspiratory time, decreasing
expiratory time. Increasing respiratory rate decreases total cycle time, decreasing
expiratory time. Decreasing inspiratory flow (increasing inspiratory time)
decreases expiratory time. Sensitivity does not affect expiratory time.
Question 7
Which of the following would be the most appropriate therapy for a dyspneic
patient who has crepitus with tracheal deviation to the left and absent breath
sounds on the right?
A. Perform chest physiotherapy.
B. Administer an IPPB treatment.
C. Insert an endotracheal tube.
D. Insert a chest tube.
Answer: D
Rationale: The patient has a right tension pneumothorax (tracheal deviation to the
left, absent breath sounds on the right, crepitus). The appropriate treatment is chest
tube insertion for definitive decompression. Needle aspiration may be done first in
an emergency, but chest tube is definitive.
pg. 4
