Kettering TMC Exam Practice (2026) -
400+ Practice Questions & Answers for
Respiratory Therapist TMC Board
Exam Prep Review (PDF) | Verified
Kettering TMC Exam Practice (2026) - 400+ | Comprehensive
Examination
Kettering TMC Exam Practice (2026) - 400+ Practice
Questions & Answers for Respiratory Therapist TMC Board
Exam Prep Review (PDF) actual exam preparation document
INTRODUCTION
This document is an important and very helpful preparation
resource for Kettering TMC Exam Practice (2026) - 400+
Practice Questions & Answers for Respiratory Therapist TMC
Board Exam Prep Review (PDF). Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
A patient with ARDS is ventilated with volume-control, Vt 6 mL/kg PBW,
PEEP 14 cm H2O, FiO2 0.7. Plateau pressure is 34 cm H2O, and the driving
pressure is 20 cm H2O. Which intervention best aligns with current
lung-protective ventilation evidence?
A. Increase PEEP to 18 cm H2O to further recruit collapsed alveoli.
B. Reduce Vt to 4 mL/kg PBW to lower driving pressure.
C. Increase FiO2 to 1.0 to improve oxygenation.
D. Decrease inspiratory flow to prolong inspiratory time.
Correct Answer: B - Reduce Vt to 4 mL/kg PBW to lower driving
pressure.
RATIONALE
Driving pressure (Pplat PEEP) >15 cm H2O is independently
associated with mortality in ARDS; reducing Vt to lower driving
pressure is the primary evidence-based target. Increasing PEEP
without assessing recruitability may worsen overdistension, and
raising FiO2 does not address the mechanical injury. Prolonging
inspiratory time does not reduce driving pressure.
Question 2
A patient in the ICU has a pulmonary artery catheter showing: CVP 14 mm
Hg, PCWP 22 mm Hg, cardiac output 3.2 L/min, and mixed venous O2
saturation 52%. Which interpretation and action is most appropriate?
A. Cardiogenic pulmonary edema; initiate diuresis and consider inotropic
support.
B. Septic shock; begin fluid resuscitation and vasopressors.
C. Right heart failure; start inhaled nitric oxide.
D. ARDS; increase PEEP to 20 cm H2O.
Correct Answer: A - Cardiogenic pulmonary edema; initiate
diuresis and consider inotropic support.
Page 2
, RATIONALE
Elevated PCWP (>18 mm Hg) with low cardiac output and low SvO2
indicates cardiogenic pulmonary edema and low-output heart failure.
Diuresis and inotropic support target the underlying pathophysiology.
Septic shock typically presents with low PCWP and high cardiac
output; right heart failure would show elevated CVP with normal/low
PCWP; ARDS does not typically cause elevated PCWP.
Question 3
A patient with COPD exacerbation is placed on NIV with initial settings IPAP
12 cm H2O / EPAP 5 cm H2O. After 30 minutes, the patient remains
tachypneic with pH 7.28 and PaCO2 62 mm Hg. Which adjustment is most
appropriate?
A. Increase EPAP to 8 cm H2O to improve oxygenation.
B. Increase IPAP to 18 cm H2O to augment tidal volume and reduce
PaCO2.
C. Decrease IPAP to 10 cm H2O to reduce work of breathing.
D. Switch to high-flow nasal cannula at 60 L/min.
Correct Answer: B - Increase IPAP to 18 cm H2O to augment
tidal volume and reduce PaCO2.
RATIONALE
In hypercapnic COPD exacerbation, increasing IPAP (pressure
support) augments tidal volume and minute ventilation, thereby
reducing PaCO2 and improving pH. EPAP primarily addresses
oxygenation and auto-PEEP; decreasing IPAP would worsen
hypercapnia. High-flow nasal cannula is less effective for hypercapnic
respiratory failure than NIV.
Page 3
, Question 4
A patient with a tracheostomy is being evaluated for cuff deflation and
speaking valve placement. Which assessment finding would most strongly
contraindicate immediate placement of a one-way speaking valve?
A. Cuff pressure 22 cm H2O.
B. Patient is on 40% FiO2 via trach collar.
C. Positive expiratory pressure of 8 cm H2O with cuff deflated.
D. Patient tolerates cuff deflation with SpO2 94%.
Correct Answer: C - Positive expiratory pressure of 8 cm H2O
with cuff deflated.
RATIONALE
A positive expiratory pressure with cuff deflated suggests significant
upper airway obstruction or inability to exhale around the trach,
increasing risk of barotrauma or respiratory distress with a one-way
valve. Cuff pressure of 22 cm H2O is within acceptable range; 40%
FiO2 and stable SpO2 do not contraindicate valve placement. The key
is ensuring adequate exhalation path.
Question 5
An adult with status asthmaticus is receiving continuous albuterol nebulization.
Which finding most urgently indicates the need to add intravenous magnesium
sulfate?
A. Peak expiratory flow 55% of predicted.
B. Respiratory rate 28/min with accessory muscle use.
C. Persistent hypoxemia despite FiO2 0.5.
D. PaCO2 rising from 32 to 44 mm Hg with fatigue.
Correct Answer: D - PaCO2 rising from 32 to 44 mm Hg with
fatigue.
Page 4
400+ Practice Questions & Answers for
Respiratory Therapist TMC Board
Exam Prep Review (PDF) | Verified
Kettering TMC Exam Practice (2026) - 400+ | Comprehensive
Examination
Kettering TMC Exam Practice (2026) - 400+ Practice
Questions & Answers for Respiratory Therapist TMC Board
Exam Prep Review (PDF) actual exam preparation document
INTRODUCTION
This document is an important and very helpful preparation
resource for Kettering TMC Exam Practice (2026) - 400+
Practice Questions & Answers for Respiratory Therapist TMC
Board Exam Prep Review (PDF). Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
A patient with ARDS is ventilated with volume-control, Vt 6 mL/kg PBW,
PEEP 14 cm H2O, FiO2 0.7. Plateau pressure is 34 cm H2O, and the driving
pressure is 20 cm H2O. Which intervention best aligns with current
lung-protective ventilation evidence?
A. Increase PEEP to 18 cm H2O to further recruit collapsed alveoli.
B. Reduce Vt to 4 mL/kg PBW to lower driving pressure.
C. Increase FiO2 to 1.0 to improve oxygenation.
D. Decrease inspiratory flow to prolong inspiratory time.
Correct Answer: B - Reduce Vt to 4 mL/kg PBW to lower driving
pressure.
RATIONALE
Driving pressure (Pplat PEEP) >15 cm H2O is independently
associated with mortality in ARDS; reducing Vt to lower driving
pressure is the primary evidence-based target. Increasing PEEP
without assessing recruitability may worsen overdistension, and
raising FiO2 does not address the mechanical injury. Prolonging
inspiratory time does not reduce driving pressure.
Question 2
A patient in the ICU has a pulmonary artery catheter showing: CVP 14 mm
Hg, PCWP 22 mm Hg, cardiac output 3.2 L/min, and mixed venous O2
saturation 52%. Which interpretation and action is most appropriate?
A. Cardiogenic pulmonary edema; initiate diuresis and consider inotropic
support.
B. Septic shock; begin fluid resuscitation and vasopressors.
C. Right heart failure; start inhaled nitric oxide.
D. ARDS; increase PEEP to 20 cm H2O.
Correct Answer: A - Cardiogenic pulmonary edema; initiate
diuresis and consider inotropic support.
Page 2
, RATIONALE
Elevated PCWP (>18 mm Hg) with low cardiac output and low SvO2
indicates cardiogenic pulmonary edema and low-output heart failure.
Diuresis and inotropic support target the underlying pathophysiology.
Septic shock typically presents with low PCWP and high cardiac
output; right heart failure would show elevated CVP with normal/low
PCWP; ARDS does not typically cause elevated PCWP.
Question 3
A patient with COPD exacerbation is placed on NIV with initial settings IPAP
12 cm H2O / EPAP 5 cm H2O. After 30 minutes, the patient remains
tachypneic with pH 7.28 and PaCO2 62 mm Hg. Which adjustment is most
appropriate?
A. Increase EPAP to 8 cm H2O to improve oxygenation.
B. Increase IPAP to 18 cm H2O to augment tidal volume and reduce
PaCO2.
C. Decrease IPAP to 10 cm H2O to reduce work of breathing.
D. Switch to high-flow nasal cannula at 60 L/min.
Correct Answer: B - Increase IPAP to 18 cm H2O to augment
tidal volume and reduce PaCO2.
RATIONALE
In hypercapnic COPD exacerbation, increasing IPAP (pressure
support) augments tidal volume and minute ventilation, thereby
reducing PaCO2 and improving pH. EPAP primarily addresses
oxygenation and auto-PEEP; decreasing IPAP would worsen
hypercapnia. High-flow nasal cannula is less effective for hypercapnic
respiratory failure than NIV.
Page 3
, Question 4
A patient with a tracheostomy is being evaluated for cuff deflation and
speaking valve placement. Which assessment finding would most strongly
contraindicate immediate placement of a one-way speaking valve?
A. Cuff pressure 22 cm H2O.
B. Patient is on 40% FiO2 via trach collar.
C. Positive expiratory pressure of 8 cm H2O with cuff deflated.
D. Patient tolerates cuff deflation with SpO2 94%.
Correct Answer: C - Positive expiratory pressure of 8 cm H2O
with cuff deflated.
RATIONALE
A positive expiratory pressure with cuff deflated suggests significant
upper airway obstruction or inability to exhale around the trach,
increasing risk of barotrauma or respiratory distress with a one-way
valve. Cuff pressure of 22 cm H2O is within acceptable range; 40%
FiO2 and stable SpO2 do not contraindicate valve placement. The key
is ensuring adequate exhalation path.
Question 5
An adult with status asthmaticus is receiving continuous albuterol nebulization.
Which finding most urgently indicates the need to add intravenous magnesium
sulfate?
A. Peak expiratory flow 55% of predicted.
B. Respiratory rate 28/min with accessory muscle use.
C. Persistent hypoxemia despite FiO2 0.5.
D. PaCO2 rising from 32 to 44 mm Hg with fatigue.
Correct Answer: D - PaCO2 rising from 32 to 44 mm Hg with
fatigue.
Page 4
