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NBRC TMC EXAM QUESTIONS AND CORRECT
ANSWERS| LATEST UPDATED VERSION WITH
VERIFIED SOLUTIONS - ASSURED PASS
Description:
This 50-question practice set is designed to simulate the TMC exam, covering all
major areas including patient assessment, cardiopulmonary physiology, diagnostic
testing, therapeutic procedures, pharmacology, and clinical decision-making. Each
question includes a correct answer and a detailed rationale to reinforce
understanding.
1. A 62-year-old patient with COPD presents with increased dyspnea and a
productive cough. ABG shows: pH 7.32, PaCO₂ 55 mmHg, PaO₂ 60 mmHg,
HCO₃⁻ 28 mEq/L. What is the most appropriate initial oxygen therapy?
A. 100% O₂ via non-rebreather
B. 2 L/min via nasal cannula
C. 40% via Venturi mask
D. 6 L/min via simple mask
Answer: B
Rationale: COPD patients are at risk of CO₂ retention. Low-flow O₂ (1–2
L/min) is preferred to maintain SaO₂ around 88–92%.
2. Which of the following best describes the physiological dead space?
A. Volume of alveoli participating in gas exchange
B. Volume of conducting airways plus alveoli not perfused
C. Residual volume in the lungs after maximal exhalation
D. Tidal volume minus inspiratory reserve volume
Answer: B
Rationale: Physiological dead space includes anatomical dead space
(airways) plus alveoli that are ventilated but not perfused.
3. A patient with acute respiratory distress has a PaO₂/FiO₂ ratio of 180. What
does this indicate?
A. Mild ARDS
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B. Moderate ARDS
C. Severe ARDS
D. Normal oxygenation
Answer: B
Rationale: ARDS severity is classified by PaO₂/FiO₂: mild (200–300),
moderate (100–200), severe (<100).
4. During mechanical ventilation, peak inspiratory pressure (PIP) suddenly
rises while plateau pressure remains unchanged. The most likely cause is:
A. Decreased lung compliance
B. Increased airway resistance
C. Auto-PEEP
D. Ventilator malfunction
Answer: B
Rationale: A rise in PIP without a change in plateau pressure indicates
increased airway resistance (e.g., bronchospasm, secretions).
5. A patient receiving mechanical ventilation develops hypotension and jugular
vein distention. Which of the following should be assessed first?
A. Pulmonary embolism
B. Tension pneumothorax
C. Right heart failure
D. Myocardial infarction
Answer: B
Rationale: Tension pneumothorax can cause hypotension and JVD during
positive-pressure ventilation; prompt needle decompression may be
lifesaving.
6. Which of the following ABG results is consistent with uncompensated
metabolic acidosis?
A. pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 18 mEq/L
B. pH 7.50, PaCO₂ 50 mmHg, HCO₃⁻ 38 mEq/L
C. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.20, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L
Answer: A
Rationale: Low pH (<7.35) with low HCO₃⁻ indicates metabolic acidosis.
PaCO₂ is not yet compensating, so it is uncompensated.
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7. A flow-volume loop shows scooping of the expiratory curve. Which
condition is most likely?
A. Restrictive lung disease
B. Obstructive lung disease
C. Normal lung function
D. Pulmonary embolism
Answer: B
Rationale: Scooping of the expiratory limb is characteristic of obstructive
diseases like COPD or asthma.
8. What is the recommended initial tidal volume for a 70 kg patient with ARDS
on volume-controlled ventilation?
A. 700 mL
B. 560 mL
C. 420 mL
D. 350 mL
Answer: C
Rationale: ARDSNet recommends low tidal volume ventilation of 6 mL/kg
predicted body weight: 70 × 6 = 420 mL.
9. A patient with asthma receives albuterol via nebulizer. Which of the
following vital sign changes is most likely?
A. Bradycardia
B. Hypotension
C. Tachycardia
D. Hypothermia
Answer: C
Rationale: Beta-2 agonists can cause tachycardia due to beta-1 receptor
stimulation.
10.In a patient with suspected pulmonary embolism, which diagnostic test is
most sensitive?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. ECG
Answer: C
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Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism with high sensitivity and specificity.
11.Which of the following ventilator modes provides full ventilatory support
with a set tidal volume?
A. CPAP
B. PSV
C. VC-CMV
D. BiPAP
Answer: C
Rationale: Volume-Controlled Continuous Mandatory Ventilation (VC-
CMV) delivers a preset tidal volume with each breath, fully supporting the
patient.
12.A patient has a PaO₂ of 55 mmHg on 2 L/min NC. Which of the following is
the best next step?
A. Increase O₂ to 5 L/min
B. Switch to 40% Venturi mask
C. Start CPAP therapy
D. Observe without change
Answer: B
Rationale: PaO₂ <60 mmHg indicates hypoxemia; precise FiO₂ with Venturi
mask ensures safer oxygen delivery.
13.What is the primary mechanism by which PEEP improves oxygenation?
A. Reduces airway resistance
B. Increases lung compliance
C. Recruits collapsed alveoli
D. Decreases cardiac output
Answer: C
Rationale: PEEP prevents alveolar collapse at end-expiration, improving
ventilation-perfusion matching and oxygenation.
14.Which pharmacologic agent is most appropriate for acute bronchospasm?
A. Ipratropium bromide
B. Salmeterol
C. Albuterol
D. Fluticasone
Answer: C
NBRC TMC EXAM QUESTIONS AND CORRECT
ANSWERS| LATEST UPDATED VERSION WITH
VERIFIED SOLUTIONS - ASSURED PASS
Description:
This 50-question practice set is designed to simulate the TMC exam, covering all
major areas including patient assessment, cardiopulmonary physiology, diagnostic
testing, therapeutic procedures, pharmacology, and clinical decision-making. Each
question includes a correct answer and a detailed rationale to reinforce
understanding.
1. A 62-year-old patient with COPD presents with increased dyspnea and a
productive cough. ABG shows: pH 7.32, PaCO₂ 55 mmHg, PaO₂ 60 mmHg,
HCO₃⁻ 28 mEq/L. What is the most appropriate initial oxygen therapy?
A. 100% O₂ via non-rebreather
B. 2 L/min via nasal cannula
C. 40% via Venturi mask
D. 6 L/min via simple mask
Answer: B
Rationale: COPD patients are at risk of CO₂ retention. Low-flow O₂ (1–2
L/min) is preferred to maintain SaO₂ around 88–92%.
2. Which of the following best describes the physiological dead space?
A. Volume of alveoli participating in gas exchange
B. Volume of conducting airways plus alveoli not perfused
C. Residual volume in the lungs after maximal exhalation
D. Tidal volume minus inspiratory reserve volume
Answer: B
Rationale: Physiological dead space includes anatomical dead space
(airways) plus alveoli that are ventilated but not perfused.
3. A patient with acute respiratory distress has a PaO₂/FiO₂ ratio of 180. What
does this indicate?
A. Mild ARDS
,2|Page
B. Moderate ARDS
C. Severe ARDS
D. Normal oxygenation
Answer: B
Rationale: ARDS severity is classified by PaO₂/FiO₂: mild (200–300),
moderate (100–200), severe (<100).
4. During mechanical ventilation, peak inspiratory pressure (PIP) suddenly
rises while plateau pressure remains unchanged. The most likely cause is:
A. Decreased lung compliance
B. Increased airway resistance
C. Auto-PEEP
D. Ventilator malfunction
Answer: B
Rationale: A rise in PIP without a change in plateau pressure indicates
increased airway resistance (e.g., bronchospasm, secretions).
5. A patient receiving mechanical ventilation develops hypotension and jugular
vein distention. Which of the following should be assessed first?
A. Pulmonary embolism
B. Tension pneumothorax
C. Right heart failure
D. Myocardial infarction
Answer: B
Rationale: Tension pneumothorax can cause hypotension and JVD during
positive-pressure ventilation; prompt needle decompression may be
lifesaving.
6. Which of the following ABG results is consistent with uncompensated
metabolic acidosis?
A. pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 18 mEq/L
B. pH 7.50, PaCO₂ 50 mmHg, HCO₃⁻ 38 mEq/L
C. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.20, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L
Answer: A
Rationale: Low pH (<7.35) with low HCO₃⁻ indicates metabolic acidosis.
PaCO₂ is not yet compensating, so it is uncompensated.
,3|Page
7. A flow-volume loop shows scooping of the expiratory curve. Which
condition is most likely?
A. Restrictive lung disease
B. Obstructive lung disease
C. Normal lung function
D. Pulmonary embolism
Answer: B
Rationale: Scooping of the expiratory limb is characteristic of obstructive
diseases like COPD or asthma.
8. What is the recommended initial tidal volume for a 70 kg patient with ARDS
on volume-controlled ventilation?
A. 700 mL
B. 560 mL
C. 420 mL
D. 350 mL
Answer: C
Rationale: ARDSNet recommends low tidal volume ventilation of 6 mL/kg
predicted body weight: 70 × 6 = 420 mL.
9. A patient with asthma receives albuterol via nebulizer. Which of the
following vital sign changes is most likely?
A. Bradycardia
B. Hypotension
C. Tachycardia
D. Hypothermia
Answer: C
Rationale: Beta-2 agonists can cause tachycardia due to beta-1 receptor
stimulation.
10.In a patient with suspected pulmonary embolism, which diagnostic test is
most sensitive?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. ECG
Answer: C
, 4|Page
Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism with high sensitivity and specificity.
11.Which of the following ventilator modes provides full ventilatory support
with a set tidal volume?
A. CPAP
B. PSV
C. VC-CMV
D. BiPAP
Answer: C
Rationale: Volume-Controlled Continuous Mandatory Ventilation (VC-
CMV) delivers a preset tidal volume with each breath, fully supporting the
patient.
12.A patient has a PaO₂ of 55 mmHg on 2 L/min NC. Which of the following is
the best next step?
A. Increase O₂ to 5 L/min
B. Switch to 40% Venturi mask
C. Start CPAP therapy
D. Observe without change
Answer: B
Rationale: PaO₂ <60 mmHg indicates hypoxemia; precise FiO₂ with Venturi
mask ensures safer oxygen delivery.
13.What is the primary mechanism by which PEEP improves oxygenation?
A. Reduces airway resistance
B. Increases lung compliance
C. Recruits collapsed alveoli
D. Decreases cardiac output
Answer: C
Rationale: PEEP prevents alveolar collapse at end-expiration, improving
ventilation-perfusion matching and oxygenation.
14.Which pharmacologic agent is most appropriate for acute bronchospasm?
A. Ipratropium bromide
B. Salmeterol
C. Albuterol
D. Fluticasone
Answer: C
