NBRC TMC Exam Study Guide 2026/2027 – Questions &
Verified Answers with Rationales | Complete
Respiratory Therapy Review
Table of Contents
1. Patient Assessment and Clinical Data
2. Arterial Blood Gases and Acid–Base Balance
3. Oxygen Therapy and Aerosol Delivery
4. Pulmonary Function and Diagnostic Testing
5. Mechanical Ventilation
6. Ventilator Troubleshooting and Weaning
7. Pulmonary Diseases and Pathophysiology
8. Respiratory Pharmacology
9. Neonatal, Pediatric, and Emergency Care
10.Equipment, Infection Control, and Clinical Decision-Making
Section 1: Patient Assessment and Clinical Data
Question 1. A patient admitted with pneumonia has a respiratory rate of 32/min,
a temperature of 39°C (102.2°F), and an oxygen saturation of 88% on room air.
Which finding requires the most immediate respiratory intervention?
A. Temperature of 39°C
B. Respiratory rate of 32/min
C. Oxygen saturation of 88%
D. Productive cough
Correct Answer: C. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia in most
acutely ill adults. Promptly assess the patient, verify the reading, provide oxygen
,as indicated, and investigate the cause. The fever, tachypnea, and productive
cough are important findings but do not replace immediate assessment and
treatment of hypoxemia.
Question 2. Which assessment finding is most consistent with increased work of
breathing?
A. Respiratory rate of 14/min without distress
B. Use of accessory respiratory muscles
C. Warm hands and feet
D. Capillary refill of 2 seconds
Correct Answer: B. Use of accessory respiratory muscles
Rationale: Accessory muscle use indicates that the patient is recruiting additional
muscles to move air, often because of increased respiratory load or reduced
respiratory muscle efficiency. It should prompt assessment of oxygenation,
ventilation, fatigue, and the underlying cause.
Question 3. A patient with severe asthma initially has loud wheezing. The
wheezing becomes barely audible, but the patient appears increasingly
distressed. What is the best interpretation?
A. The asthma has resolved
B. Bronchospasm is no longer present
C. Airflow may be critically reduced
D. The patient is ready for discharge
Correct Answer: C. Airflow may be critically reduced
Rationale: A “silent chest” in a severely distressed patient can indicate critically
limited airflow. This is a life-threatening finding, not evidence of improvement.
Immediate escalation of care is necessary.
Question 4. Which finding most strongly suggests impending respiratory muscle
fatigue?
A. Mild cough after deep inspiration
,B. Increasing drowsiness with decreasing respiratory effort
C. Respiratory rate decreasing from 18 to 16/min in a comfortable patient
D. Stable oxygen saturation on prescribed oxygen
Correct Answer: B. Increasing drowsiness with decreasing respiratory effort
Rationale: Drowsiness and reduced respiratory effort in a patient who was
previously working hard to breathe may signal fatigue, worsening hypercapnia, or
declining consciousness. Immediate reassessment and preparation for ventilatory
support may be necessary.
Question 5. Which measurement provides the most direct routine assessment of
arterial oxygenation?
A. Arterial partial pressure of oxygen (PaO₂)
B. Arterial partial pressure of carbon dioxide (PaCO₂)
C. Serum bicarbonate
D. Respiratory rate alone
Correct Answer: A. Arterial partial pressure of oxygen (PaO₂)
Rationale: PaO₂ measures the partial pressure of dissolved oxygen in arterial
blood and is a direct indicator of arterial oxygenation. Pulse oximetry estimates
hemoglobin oxygen saturation, while PaCO₂ primarily reflects ventilation.
Question 6. A patient has a pulse oximeter reading of 82%, but the patient is alert,
speaking comfortably, and has cold fingers with a weak peripheral pulse. What
should the respiratory therapist do first?
A. Immediately diagnose severe respiratory failure
B. Check the probe position and signal quality and reassess the reading
C. Discontinue all oxygen therapy
D. Assume the reading is accurate because the device is digital
Correct Answer: B. Check the probe position and signal quality and reassess the
reading
, Rationale: Cold extremities and poor peripheral perfusion can impair pulse
oximeter accuracy. Check probe placement, waveform or signal quality, and
another suitable measurement site. Do not ignore the reading; if hypoxemia
remains plausible or the patient deteriorates, intervene and obtain further
assessment promptly.
Question 7. Which clinical finding is most consistent with chronic carbon dioxide
retention?
A. Persistently elevated PaCO₂ with renal bicarbonate compensation
B. Low PaCO₂ with low bicarbonate
C. High PaO₂ with respiratory alkalosis
D. Low PaCO₂ with elevated pH
Correct Answer: A. Persistently elevated PaCO₂ with renal bicarbonate
compensation
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate to
compensate for persistently elevated PaCO₂. The pH may be closer to normal than
in acute respiratory acidosis, although it may remain abnormal.
Question 8. A patient is receiving supplemental oxygen. Which measurement is
most useful for directly assessing whether carbon dioxide is accumulating?
A. Pulse oximetry alone
B. Skin temperature
C. PaCO₂ from an arterial blood gas
D. Heart rate alone
Correct Answer: C. PaCO₂ from an arterial blood gas
Rationale: Pulse oximetry assesses oxygen saturation but does not measure
carbon dioxide. An arterial blood gas directly measures PaCO₂. Capnography can
also provide useful information about exhaled carbon dioxide and ventilation
trends.
Verified Answers with Rationales | Complete
Respiratory Therapy Review
Table of Contents
1. Patient Assessment and Clinical Data
2. Arterial Blood Gases and Acid–Base Balance
3. Oxygen Therapy and Aerosol Delivery
4. Pulmonary Function and Diagnostic Testing
5. Mechanical Ventilation
6. Ventilator Troubleshooting and Weaning
7. Pulmonary Diseases and Pathophysiology
8. Respiratory Pharmacology
9. Neonatal, Pediatric, and Emergency Care
10.Equipment, Infection Control, and Clinical Decision-Making
Section 1: Patient Assessment and Clinical Data
Question 1. A patient admitted with pneumonia has a respiratory rate of 32/min,
a temperature of 39°C (102.2°F), and an oxygen saturation of 88% on room air.
Which finding requires the most immediate respiratory intervention?
A. Temperature of 39°C
B. Respiratory rate of 32/min
C. Oxygen saturation of 88%
D. Productive cough
Correct Answer: C. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia in most
acutely ill adults. Promptly assess the patient, verify the reading, provide oxygen
,as indicated, and investigate the cause. The fever, tachypnea, and productive
cough are important findings but do not replace immediate assessment and
treatment of hypoxemia.
Question 2. Which assessment finding is most consistent with increased work of
breathing?
A. Respiratory rate of 14/min without distress
B. Use of accessory respiratory muscles
C. Warm hands and feet
D. Capillary refill of 2 seconds
Correct Answer: B. Use of accessory respiratory muscles
Rationale: Accessory muscle use indicates that the patient is recruiting additional
muscles to move air, often because of increased respiratory load or reduced
respiratory muscle efficiency. It should prompt assessment of oxygenation,
ventilation, fatigue, and the underlying cause.
Question 3. A patient with severe asthma initially has loud wheezing. The
wheezing becomes barely audible, but the patient appears increasingly
distressed. What is the best interpretation?
A. The asthma has resolved
B. Bronchospasm is no longer present
C. Airflow may be critically reduced
D. The patient is ready for discharge
Correct Answer: C. Airflow may be critically reduced
Rationale: A “silent chest” in a severely distressed patient can indicate critically
limited airflow. This is a life-threatening finding, not evidence of improvement.
Immediate escalation of care is necessary.
Question 4. Which finding most strongly suggests impending respiratory muscle
fatigue?
A. Mild cough after deep inspiration
,B. Increasing drowsiness with decreasing respiratory effort
C. Respiratory rate decreasing from 18 to 16/min in a comfortable patient
D. Stable oxygen saturation on prescribed oxygen
Correct Answer: B. Increasing drowsiness with decreasing respiratory effort
Rationale: Drowsiness and reduced respiratory effort in a patient who was
previously working hard to breathe may signal fatigue, worsening hypercapnia, or
declining consciousness. Immediate reassessment and preparation for ventilatory
support may be necessary.
Question 5. Which measurement provides the most direct routine assessment of
arterial oxygenation?
A. Arterial partial pressure of oxygen (PaO₂)
B. Arterial partial pressure of carbon dioxide (PaCO₂)
C. Serum bicarbonate
D. Respiratory rate alone
Correct Answer: A. Arterial partial pressure of oxygen (PaO₂)
Rationale: PaO₂ measures the partial pressure of dissolved oxygen in arterial
blood and is a direct indicator of arterial oxygenation. Pulse oximetry estimates
hemoglobin oxygen saturation, while PaCO₂ primarily reflects ventilation.
Question 6. A patient has a pulse oximeter reading of 82%, but the patient is alert,
speaking comfortably, and has cold fingers with a weak peripheral pulse. What
should the respiratory therapist do first?
A. Immediately diagnose severe respiratory failure
B. Check the probe position and signal quality and reassess the reading
C. Discontinue all oxygen therapy
D. Assume the reading is accurate because the device is digital
Correct Answer: B. Check the probe position and signal quality and reassess the
reading
, Rationale: Cold extremities and poor peripheral perfusion can impair pulse
oximeter accuracy. Check probe placement, waveform or signal quality, and
another suitable measurement site. Do not ignore the reading; if hypoxemia
remains plausible or the patient deteriorates, intervene and obtain further
assessment promptly.
Question 7. Which clinical finding is most consistent with chronic carbon dioxide
retention?
A. Persistently elevated PaCO₂ with renal bicarbonate compensation
B. Low PaCO₂ with low bicarbonate
C. High PaO₂ with respiratory alkalosis
D. Low PaCO₂ with elevated pH
Correct Answer: A. Persistently elevated PaCO₂ with renal bicarbonate
compensation
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate to
compensate for persistently elevated PaCO₂. The pH may be closer to normal than
in acute respiratory acidosis, although it may remain abnormal.
Question 8. A patient is receiving supplemental oxygen. Which measurement is
most useful for directly assessing whether carbon dioxide is accumulating?
A. Pulse oximetry alone
B. Skin temperature
C. PaCO₂ from an arterial blood gas
D. Heart rate alone
Correct Answer: C. PaCO₂ from an arterial blood gas
Rationale: Pulse oximetry assesses oxygen saturation but does not measure
carbon dioxide. An arterial blood gas directly measures PaCO₂. Capnography can
also provide useful information about exhaled carbon dioxide and ventilation
trends.
