TMC EXAM THERAPIST MULTIPLE
CHOICE ACTUAL EXAM BANK 2026 150
QUESTIONS WITH DETAILED
RATIONALES and BOLDED ANSWERS A+
GUARANTEED
TMC EXAM – SECURE COMPREHENSIVE
THERAPIST SAE EXAM BANK 2026 (Questions 1-150)
1. A respiratory therapist is evaluating a patient with COPD who
is receiving oxygen via a nasal cannula at 4 L/min. The patient’s
SpO2 is 88% and RR is 28 breaths/min. The therapist notes the
patient is using accessory muscles and has pursed-lip
breathing. Which of the following is the most appropriate initial
action?
A. Increase the oxygen flow to 6 L/min.
B. Initiate non-invasive positive pressure ventilation (NIPPV).
CORRECT ANSWER:
The patient is exhibiting signs of acute hypercapnic respiratory
failure (increased work of breathing, tachypnea, and hypoxemia
despite supplemental O2). NIPPV (BiPAP) is the gold standard
first-line intervention for COPD exacerbations to reduce work
of breathing and improve gas exchange.
C. Intubate and mechanically ventilate the patient immediately.
D. Administer a nebulized bronchodilator and reassess in 1
hour.
,2. A neonate born at 32 weeks gestation is placed on CPAP
shortly after birth. The infant’s SpO2 is consistently 96-98%
while on 40% FiO2. What is the most appropriate adjustment?
A. Increase CPAP pressure to 8 cm H2O.
B. Decrease FiO2 to maintain SpO2 between 90-95%.
CORRECT ANSWER:
For preterm infants, target SpO2 is typically 90-95% to prevent
retinopathy of prematurity (ROP) and oxidative stress. An
SpO2 of 96-98% indicates hyperoxia, so FiO2 should be
weaned.
C. Discontinue CPAP and place on a hood.
D. Administer surfactant immediately.
3. A patient on volume-controlled ventilation has a peak
inspiratory pressure (PIP) of 35 cm H2O and a plateau pressure
(Pplat) of 28 cm H2O. Two hours later, PIP is 45 cm H2O and
Pplat remains 28 cm H2O. What is the most likely cause?
A. Decreased lung compliance.
B. Pneumothorax.
C. Increased airway resistance. CORRECT ANSWER:
An increase in PIP with a stable Pplat indicates a problem with
airway resistance (e.g., secretions, biting tube, bronchospasm),
not compliance. If compliance were the issue, both PIP and
Pplat would rise.
D. Patient-ventilator asynchrony.
4. During a bedside assessment, a therapist hears coarse
crackles in the lower lobes bilaterally that do not clear with
coughing. The patient has a weak cough and thick secretions.
Which therapy is most indicated?
A. Incentive spirometry.
,B. Chest physiotherapy (CPT) and postural drainage.
CORRECT ANSWER:
CPT and postural drainage are indicated for mobilizing retained
secretions in patients with a weak cough and audible secretions
that do not clear voluntarily. IS is for prevention of atelectasis,
not secretion removal.
C. Aerosolized mucomyst (acetylcysteine).
D. IPPB treatment.
5. A patient is receiving mechanical ventilation with the
following settings: VC-CMV, VT 500 mL, Rate 12, FiO2 0.40,
PEEP 5. ABG results: pH 7.32, PaCO2 55 mmHg, PaO2 78
mmHg, HCO3 26 mEq/L. What is the best recommendation?
A. Increase FiO2 to 0.50.
B. Increase respiratory rate to 16 breaths/min. CORRECT
ANSWER:
The patient has respiratory acidosis (pH < 7.35, PaCO2 > 45).
To correct this, alveolar ventilation must be increased.
Increasing the rate is the most direct way to blow off CO2.
Oxygenation is acceptable (PaO2 78).
C. Increase tidal volume to 600 mL.
D. Add 5 cm H2O of PEEP.
6. A therapist is performing a capillary blood gas on a neonate.
The site chosen is the lateral aspect of the heel. Why is this site
preferred?
A. It has the highest arterial blood flow.
B. It avoids damage to the calcaneus bone and nerves.
CORRECT ANSWER:
, The lateral or medial plantar surface of the heel is the safe zone
for capillary sticks to avoid injury to the calcaneus bone, which
can cause osteomyelitis, and to avoid major nerves.
C. It provides a sample identical to an arterial stick.
D. It is the least painful area for the infant.
7. A patient with myasthenia gravis is being monitored in the
ICU. Serial measurements show: MIP -15 cm H2O, VC 800 mL,
RR 30. What is the most appropriate action?
A. Continue monitoring every 4 hours.
B. Administer pyridostigmine and reassess.
C. Prepare for endotracheal intubation. CORRECT ANSWER:
Critical values for impending respiratory failure in
neuromuscular disease include MIP less negative than -20 cm
H2O (i.e., -15 is worse), VC < 10-15 mL/kg (approx <1L for avg
adult), and RR > 30. This patient meets all criteria for
intubation.
D. Initiate NIPPV trial.
8. While rounding on a patient with a chest tube, the therapist
notices continuous bubbling in the water seal chamber. What
does this indicate?
A. Normal function of the chest tube.
B. An air leak in the system or patient. CORRECT ANSWER:
Continuous bubbling in the water seal chamber indicates an air
leak. Intermittent bubbling is normal during
expiration/coughing if there was a pneumothorax, but
continuous bubbling suggests a persistent leak.
C. The lung has fully re-expanded.
D. The suction control chamber is blocked.
CHOICE ACTUAL EXAM BANK 2026 150
QUESTIONS WITH DETAILED
RATIONALES and BOLDED ANSWERS A+
GUARANTEED
TMC EXAM – SECURE COMPREHENSIVE
THERAPIST SAE EXAM BANK 2026 (Questions 1-150)
1. A respiratory therapist is evaluating a patient with COPD who
is receiving oxygen via a nasal cannula at 4 L/min. The patient’s
SpO2 is 88% and RR is 28 breaths/min. The therapist notes the
patient is using accessory muscles and has pursed-lip
breathing. Which of the following is the most appropriate initial
action?
A. Increase the oxygen flow to 6 L/min.
B. Initiate non-invasive positive pressure ventilation (NIPPV).
CORRECT ANSWER:
The patient is exhibiting signs of acute hypercapnic respiratory
failure (increased work of breathing, tachypnea, and hypoxemia
despite supplemental O2). NIPPV (BiPAP) is the gold standard
first-line intervention for COPD exacerbations to reduce work
of breathing and improve gas exchange.
C. Intubate and mechanically ventilate the patient immediately.
D. Administer a nebulized bronchodilator and reassess in 1
hour.
,2. A neonate born at 32 weeks gestation is placed on CPAP
shortly after birth. The infant’s SpO2 is consistently 96-98%
while on 40% FiO2. What is the most appropriate adjustment?
A. Increase CPAP pressure to 8 cm H2O.
B. Decrease FiO2 to maintain SpO2 between 90-95%.
CORRECT ANSWER:
For preterm infants, target SpO2 is typically 90-95% to prevent
retinopathy of prematurity (ROP) and oxidative stress. An
SpO2 of 96-98% indicates hyperoxia, so FiO2 should be
weaned.
C. Discontinue CPAP and place on a hood.
D. Administer surfactant immediately.
3. A patient on volume-controlled ventilation has a peak
inspiratory pressure (PIP) of 35 cm H2O and a plateau pressure
(Pplat) of 28 cm H2O. Two hours later, PIP is 45 cm H2O and
Pplat remains 28 cm H2O. What is the most likely cause?
A. Decreased lung compliance.
B. Pneumothorax.
C. Increased airway resistance. CORRECT ANSWER:
An increase in PIP with a stable Pplat indicates a problem with
airway resistance (e.g., secretions, biting tube, bronchospasm),
not compliance. If compliance were the issue, both PIP and
Pplat would rise.
D. Patient-ventilator asynchrony.
4. During a bedside assessment, a therapist hears coarse
crackles in the lower lobes bilaterally that do not clear with
coughing. The patient has a weak cough and thick secretions.
Which therapy is most indicated?
A. Incentive spirometry.
,B. Chest physiotherapy (CPT) and postural drainage.
CORRECT ANSWER:
CPT and postural drainage are indicated for mobilizing retained
secretions in patients with a weak cough and audible secretions
that do not clear voluntarily. IS is for prevention of atelectasis,
not secretion removal.
C. Aerosolized mucomyst (acetylcysteine).
D. IPPB treatment.
5. A patient is receiving mechanical ventilation with the
following settings: VC-CMV, VT 500 mL, Rate 12, FiO2 0.40,
PEEP 5. ABG results: pH 7.32, PaCO2 55 mmHg, PaO2 78
mmHg, HCO3 26 mEq/L. What is the best recommendation?
A. Increase FiO2 to 0.50.
B. Increase respiratory rate to 16 breaths/min. CORRECT
ANSWER:
The patient has respiratory acidosis (pH < 7.35, PaCO2 > 45).
To correct this, alveolar ventilation must be increased.
Increasing the rate is the most direct way to blow off CO2.
Oxygenation is acceptable (PaO2 78).
C. Increase tidal volume to 600 mL.
D. Add 5 cm H2O of PEEP.
6. A therapist is performing a capillary blood gas on a neonate.
The site chosen is the lateral aspect of the heel. Why is this site
preferred?
A. It has the highest arterial blood flow.
B. It avoids damage to the calcaneus bone and nerves.
CORRECT ANSWER:
, The lateral or medial plantar surface of the heel is the safe zone
for capillary sticks to avoid injury to the calcaneus bone, which
can cause osteomyelitis, and to avoid major nerves.
C. It provides a sample identical to an arterial stick.
D. It is the least painful area for the infant.
7. A patient with myasthenia gravis is being monitored in the
ICU. Serial measurements show: MIP -15 cm H2O, VC 800 mL,
RR 30. What is the most appropriate action?
A. Continue monitoring every 4 hours.
B. Administer pyridostigmine and reassess.
C. Prepare for endotracheal intubation. CORRECT ANSWER:
Critical values for impending respiratory failure in
neuromuscular disease include MIP less negative than -20 cm
H2O (i.e., -15 is worse), VC < 10-15 mL/kg (approx <1L for avg
adult), and RR > 30. This patient meets all criteria for
intubation.
D. Initiate NIPPV trial.
8. While rounding on a patient with a chest tube, the therapist
notices continuous bubbling in the water seal chamber. What
does this indicate?
A. Normal function of the chest tube.
B. An air leak in the system or patient. CORRECT ANSWER:
Continuous bubbling in the water seal chamber indicates an air
leak. Intermittent bubbling is normal during
expiration/coughing if there was a pneumothorax, but
continuous bubbling suggests a persistent leak.
C. The lung has fully re-expanded.
D. The suction control chamber is blocked.
