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TMC EXAM 8: COMPREHENSIVE PRACTICE
QUESTION BANK 2026-2027
RESPIRATORY THERAPY BOARD EXAM
PREPARATION
THERAPIST MULTIPLE-CHOICE (TMC)
EXAMINATION
PART I: PATIENT ASSESSMENT & DATA EVALUATION
## Section A: Physical Examination & Assessment Findings
**Questions 1-25**
**Q1:** During the assessment of a 64-year-old female patient, you note the
following signs: dyspnea, hypotension, and a tracheal shift to the right. The patient
has absent breath sounds, reduced chest expansion, and a hyperresonant percussion
note, all on the left side. These findings suggest which of the following?
A) Pleural effusion on the left side
B) Pneumothorax on the left side
C) Atelectasis on the left side
D) Consolidation on the left side
**Answer: B (Pneumothorax on the left side)**
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*Rationale:* The classic signs of a pneumothorax include tracheal deviation away
from the affected side (shift to the right indicates left-sided pneumothorax), absent
breath sounds, hyperresonance to percussion, and reduced chest expansion on the
affected side . Hypotension and dyspnea indicate possible tension pneumothorax,
which is life-threatening. Pleural effusion would present with dullness to
percussion, not hyperresonance. Atelectasis would cause tracheal deviation toward
the affected side with decreased breath sounds and dullness. Consolidation presents
with bronchial breath sounds, egophony, and dullness to percussion .
---
**Q2:** A 39-year-old male patient was admitted to the emergency department
with a fever and SpO2 of 87% on room air. Upon auscultation, rhonchi is heard,
and the patient has a productive cough. Which of the following would you
recommend first?
A) Intubate and provide mechanical ventilation with 40% oxygen
B) Provide noninvasive positive pressure ventilation using a full face mask
C) Implement postural drainage and percussion with directed coughing
D) Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
**Answer: D (Provide oxygen therapy and obtain a sputum sample for culture and
sensitivity)**
*Rationale:* The patient presents with fever, hypoxemia (SpO2 87%), rhonchi, and
productive cough—suggestive of pneumonia or a lower respiratory infection . The
priority is to provide supplemental oxygen to correct hypoxemia and obtain a
sputum sample to identify the causative organism. Since the patient is awake and
breathing spontaneously with a patent airway, intubation or NIPPV is not
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immediately indicated. Postural drainage may be beneficial but should not be the
first step .
---
**Q3:** A 50-year-old male patient is intubated with a size 8 endotracheal tube
and is receiving volume-controlled A/C ventilation. Upon assessment, you note
that the patient's cuff pressure is measured at 38 cmH2O. Which of the following
would you recommend?
A) Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B) Recommend reintubation with a smaller endotracheal tube
C) Lower the cuff pressure to < 30 cmH2O
D) Recommend ventilation via a tracheostomy instead
**Answer: C (Lower the cuff pressure to < 30 cmH2O)**
*Rationale:* Endotracheal tube cuff pressure should be maintained between 20-30
cmH2O to provide an effective seal while preventing tracheal mucosal ischemia . A
pressure of 38 cmH2O is too high and can cause tracheal damage, stenosis, or
necrosis. The appropriate action is to lower the cuff pressure to < 30 cmH2O. High
cuff pressure does not indicate tube malposition; therefore, withdrawing the tube or
reintubation is unnecessary .
---
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**Q4:** During the assessment of a 52-year-old female patient who is receiving
oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a
whistling noise. What is the most likely cause of this finding?
A) There is an obstruction in the delivery tube
B) The patient's ventilation has increased
C) There is a clogged system diffuser
D) The flowmeter pressure is set too high
**Answer: C (There is a clogged system diffuser)**
*Rationale:* A whistling sound from a bubble humidifier typically indicates that
the system diffuser is clogged or partially obstructed . This creates a high-pitched
sound as gas forces through the narrowed opening. An obstruction in the delivery
tube would cause the humidifier to back-pressure but would not typically produce
a whistling sound. Increased patient ventilation or high flowmeter pressure would
not cause this specific sound .
---
**Q5:** A pre and post-bronchodilator test was ordered on a 48-year-old female
patient. The forced expiratory measurement that was obtained after the
bronchodilator shows an increase in the patient's FEV1 from 60% to 80% of the
predicted value. This suggests which of the following?
A) Fixed airway obstruction
B) Reversible airway obstruction
TMC EXAM 8: COMPREHENSIVE PRACTICE
QUESTION BANK 2026-2027
RESPIRATORY THERAPY BOARD EXAM
PREPARATION
THERAPIST MULTIPLE-CHOICE (TMC)
EXAMINATION
PART I: PATIENT ASSESSMENT & DATA EVALUATION
## Section A: Physical Examination & Assessment Findings
**Questions 1-25**
**Q1:** During the assessment of a 64-year-old female patient, you note the
following signs: dyspnea, hypotension, and a tracheal shift to the right. The patient
has absent breath sounds, reduced chest expansion, and a hyperresonant percussion
note, all on the left side. These findings suggest which of the following?
A) Pleural effusion on the left side
B) Pneumothorax on the left side
C) Atelectasis on the left side
D) Consolidation on the left side
**Answer: B (Pneumothorax on the left side)**
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*Rationale:* The classic signs of a pneumothorax include tracheal deviation away
from the affected side (shift to the right indicates left-sided pneumothorax), absent
breath sounds, hyperresonance to percussion, and reduced chest expansion on the
affected side . Hypotension and dyspnea indicate possible tension pneumothorax,
which is life-threatening. Pleural effusion would present with dullness to
percussion, not hyperresonance. Atelectasis would cause tracheal deviation toward
the affected side with decreased breath sounds and dullness. Consolidation presents
with bronchial breath sounds, egophony, and dullness to percussion .
---
**Q2:** A 39-year-old male patient was admitted to the emergency department
with a fever and SpO2 of 87% on room air. Upon auscultation, rhonchi is heard,
and the patient has a productive cough. Which of the following would you
recommend first?
A) Intubate and provide mechanical ventilation with 40% oxygen
B) Provide noninvasive positive pressure ventilation using a full face mask
C) Implement postural drainage and percussion with directed coughing
D) Provide oxygen therapy and obtain a sputum sample for culture and sensitivity
**Answer: D (Provide oxygen therapy and obtain a sputum sample for culture and
sensitivity)**
*Rationale:* The patient presents with fever, hypoxemia (SpO2 87%), rhonchi, and
productive cough—suggestive of pneumonia or a lower respiratory infection . The
priority is to provide supplemental oxygen to correct hypoxemia and obtain a
sputum sample to identify the causative organism. Since the patient is awake and
breathing spontaneously with a patent airway, intubation or NIPPV is not
,3|Page
immediately indicated. Postural drainage may be beneficial but should not be the
first step .
---
**Q3:** A 50-year-old male patient is intubated with a size 8 endotracheal tube
and is receiving volume-controlled A/C ventilation. Upon assessment, you note
that the patient's cuff pressure is measured at 38 cmH2O. Which of the following
would you recommend?
A) Withdraw the tube 1-2 cm and reassess the patient's breath sounds
B) Recommend reintubation with a smaller endotracheal tube
C) Lower the cuff pressure to < 30 cmH2O
D) Recommend ventilation via a tracheostomy instead
**Answer: C (Lower the cuff pressure to < 30 cmH2O)**
*Rationale:* Endotracheal tube cuff pressure should be maintained between 20-30
cmH2O to provide an effective seal while preventing tracheal mucosal ischemia . A
pressure of 38 cmH2O is too high and can cause tracheal damage, stenosis, or
necrosis. The appropriate action is to lower the cuff pressure to < 30 cmH2O. High
cuff pressure does not indicate tube malposition; therefore, withdrawing the tube or
reintubation is unnecessary .
---
, 4|Page
**Q4:** During the assessment of a 52-year-old female patient who is receiving
oxygen via nasal cannula at 4 L/min, you hear the bubble humidifier making a
whistling noise. What is the most likely cause of this finding?
A) There is an obstruction in the delivery tube
B) The patient's ventilation has increased
C) There is a clogged system diffuser
D) The flowmeter pressure is set too high
**Answer: C (There is a clogged system diffuser)**
*Rationale:* A whistling sound from a bubble humidifier typically indicates that
the system diffuser is clogged or partially obstructed . This creates a high-pitched
sound as gas forces through the narrowed opening. An obstruction in the delivery
tube would cause the humidifier to back-pressure but would not typically produce
a whistling sound. Increased patient ventilation or high flowmeter pressure would
not cause this specific sound .
---
**Q5:** A pre and post-bronchodilator test was ordered on a 48-year-old female
patient. The forced expiratory measurement that was obtained after the
bronchodilator shows an increase in the patient's FEV1 from 60% to 80% of the
predicted value. This suggests which of the following?
A) Fixed airway obstruction
B) Reversible airway obstruction
