NBRC TMC Exam Practice Questions and
Answers with rationales
Question 1
An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After
the patient is placed on the system, the respiratory therapist notices that the pressure
falls to 2 cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system
Correct Answer
Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow.
Increasing the flow should meet the patient's inspiratory flow needs and stabilize
the CPAP pressure.
Page 1 of 216
,Question 2
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing.
Severe suprasternal, subcostal and substernal retraction are observed. The child has a
harsh, barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma
Correct Answer
Croup
Explain: The patient has some degree of upper airway obstruction caused by some
viral illness. The barky cough is a classic finding for patients experiencing croup.
Question 3
The polysomnography sleep laboratory is full scheduled for several weeks. The
physician wants to know if there is another option to determine if a patient has sleep
apnea. What should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison
Correct Answer
Overnight pulse oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation is found to decrease
during apnea episodes.
Page 2 of 216
,Question 4
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old
female who was admitted 12 hours ago for an aspirin overdose. The following
information is obtained as the patient breathes air:
HR 89/min
RR 15/min
BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site
Correct Answer
Validate the Sp02 reading at a different site
Explain: The saturation may not be accurate and should be measured at a different
site.
Question 5
A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration
of CPAP. The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A
respiratory therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP
Correct Answer
Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and
hypopnea episodes, standard protocol is to incrementally increase the CPAP level
until this occurs.
Page 3 of 216
, Question 6
An arterial puncture has been performed to obtain blood for analysis of 02, C02, and
pH. What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood
Correct Answer
Place it into a mix of ice and water
Explain: Placing the blood sample into ice water will prevent the blood from
consuming the O2 within the sample.
Question 7
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle
crash. The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving
volume-controlled ventilation. Twenty-four hours later, the patient has clear breath
sounds but cannot tolerate weaning the mandatory rate below 8 in the SIMV mode
with 15 cm H20 pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube
Correct Answer
Reintubating with a larger endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because
of increased airways resistance. This can be resolved only by a larger tube or
extubation.
Page 4 of 216
Answers with rationales
Question 1
An infant with pneumonia is placed on CPAP with the initial level is 6 cm H20. After
the patient is placed on the system, the respiratory therapist notices that the pressure
falls to 2 cm H20 with each inspiration. What should be done to correct the problem?
a. Tell the patient to relax and breath more slowly
b. Give the patient diazepam (Valium)
c. Increase the CPAP level to 8 cm H20
d. Increase the flow through the system
Correct Answer
Increase the flow through the system
Explain: Decreasing pressure with inspiration indicates inadequate gas flow.
Increasing the flow should meet the patient's inspiratory flow needs and stabilize
the CPAP pressure.
Page 1 of 216
,Question 2
A respiratory therapist is called to the ED for a 1-year-old with difficulty breathing.
Severe suprasternal, subcostal and substernal retraction are observed. The child has a
harsh, barking cough. Stridor is present. The therapist should anticipate treatment for
Choose only ONE best answer.
a. Cystic Fibrosis
b. Pneumonia
c. Croup
d. Asthma
Correct Answer
Croup
Explain: The patient has some degree of upper airway obstruction caused by some
viral illness. The barky cough is a classic finding for patients experiencing croup.
Question 3
The polysomnography sleep laboratory is full scheduled for several weeks. The
physician wants to know if there is another option to determine if a patient has sleep
apnea. What should be recommended?
a. Overnight pulse oximetry
b. Nasal air flow monitoring
c. Holter monitoring for 48 hours
d. Chest-wall and abdominal-wall impedance comparison
Correct Answer
Overnight pulse oximetry
Explain: Overnight pulse oximetry can be used to screen patients with suspected
obstructive sleep apnea. The patient's oxygen saturation is found to decrease
during apnea episodes.
Page 2 of 216
,Question 4
A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), a 41-year-old
female who was admitted 12 hours ago for an aspirin overdose. The following
information is obtained as the patient breathes air:
HR 89/min
RR 15/min
BP 110/70 mm Hg
Sp02 86%
A respiratory therapist should do first.
a. Initiate oxygen at 4L/min by cannula
b. Record the results in the medical record
c. Obtain an arterial blood gas sample
d. Validate the Sp02 reading at a different site
Correct Answer
Validate the Sp02 reading at a different site
Explain: The saturation may not be accurate and should be measured at a different
site.
Question 5
A 47-year-old male with a BMI of 50 kg/m is undergoing a sleep study with titration
of CPAP. The patient's baseline AHI is 59. At a CPAP level of 7 cm H20, the AHI is 9. A
respiratory therapist should recommend
a. Maintain the current level of CPAP
b. Decreasing the CPAP
c. Increasing the CPAP
d. Changing to bilevel PAP
Correct Answer
Increasing the CPAP
Explain: The goal of CPAP intervention is to completely eliminate apnea and
hypopnea episodes, standard protocol is to incrementally increase the CPAP level
until this occurs.
Page 3 of 216
, Question 6
An arterial puncture has been performed to obtain blood for analysis of 02, C02, and
pH. What is the best way to manage the blood sample?
a. Warm the sample to keep it at body temperature
b. Place it into a mix of ice and water
c. Let the blood naturally cool to room temperature
d. Shake the sample to hemolyze the blood
Correct Answer
Place it into a mix of ice and water
Explain: Placing the blood sample into ice water will prevent the blood from
consuming the O2 within the sample.
Question 7
A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle
crash. The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving
volume-controlled ventilation. Twenty-four hours later, the patient has clear breath
sounds but cannot tolerate weaning the mandatory rate below 8 in the SIMV mode
with 15 cm H20 pressure support. The respiratory therapist should recommend.
a. Increasing the peak inspiratory flow
b. Raising the VT
c. Setting the mandatory rate to 10
d. Reintubating with a larger endotracheal tube
Correct Answer
Reintubating with a larger endotracheal tube
Explain: The small endotracheal tube compromises spontaneous breathing because
of increased airways resistance. This can be resolved only by a larger tube or
extubation.
Page 4 of 216
