RESPIRATORY THERAPY LICENSURE
NBRC Mock TMC Exam Review(Q & A)Verified
100% 2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Patient Data Evaluation and Recommendations
Troubleshooting and Quality Control of Devices and Infection Control
Airway Management and Oxygen Therapy
Mechanical Ventilation and Critical Care Interventions
Pharmacology, Therapeutic Procedures, and Professional Practice
STUVIAACTUALEXAM
,SECTION 1: Patient Data Evaluation and Recommendations
Q1.
A 68-year-old male with a history of COPD is admitted with increasing dyspnea. His arterial blood gas on room air shows
pH 7.32, PaCO2 58 mm Hg, PaO2 52 mm Hg, and HCO3 29 mEq/L. The respiratory therapist is asked to recommend
the most appropriate initial oxygen delivery device.
A. Nasal cannula at 2 L/min
B. Simple mask at 6 L/min
C. Non-rebreather mask at 15 L/min
D. Venturi mask at 50% FiO2
Correct Answer: A
Rationale: For COPD patients with chronic hypercapnia, low-flow oxygen via nasal cannula is preferred to avoid suppressing hypoxic
drive while correcting hypoxemia. High FiO2 devices such as non-rebreather or high-concentration Venturi can worsen CO2 retention.
The ABG indicates chronic respiratory acidosis with hypoxemia that can be managed cautiously with low-flow O2.
Q2.
During a routine physical assessment of a 45-year-old postoperative patient, the respiratory therapist notes decreased
breath sounds over the left lower lobe and dullness to percussion. The patient is afebrile and oxygen saturation is 94%
on 2 L/min nasal cannula. Which diagnostic procedure should the therapist recommend first?
A. Chest radiograph
B. Sputum culture and sensitivity
C. Bronchoscopy
D. Pulmonary function testing
Correct Answer: A
Rationale: Decreased breath sounds and dullness suggest possible atelectasis or pleural effusion. A chest radiograph is the least
invasive and most appropriate initial diagnostic study to differentiate these conditions. Sputum culture is not indicated without signs of
infection; bronchoscopy and PFT are more invasive or less relevant acutely.
Q3.
A neonatal respiratory therapist reviews the chart of a 28-week gestational age infant. The most recent capillary blood
gas shows pH 7.28, PCO2 55 mm Hg, PO2 45 mm Hg. The infant is currently on nasal CPAP of 5 cm H2O with FiO2
0.35. What recommendation is most appropriate based on these data?
A. Increase CPAP to 7 cm H2O
B. Increase FiO2 to 0.45
C. Initiate mechanical ventilation
D. Continue current settings and reassess in 2 hours
Correct Answer: A
Rationale: The blood gas indicates mild respiratory acidosis and borderline oxygenation in a premature infant. Increasing CPAP
provides additional functional residual capacity support to improve ventilation and oxygenation without immediately escalating to
intubation. Raising FiO2 alone does not address the ventilation issue; mechanical ventilation is premature for these values.
,Q4.
A 55-year-old woman with suspected pulmonary embolism has a PaO2 of 58 mm Hg on a non-rebreather mask. The
respiratory therapist notes the A-a gradient is markedly elevated. Which additional laboratory or imaging study should be
recommended to further evaluate the cause of hypoxemia?
A. CT pulmonary angiogram
B. Sputum Gram stain
C. Complete blood count only
D. Serum electrolytes
Correct Answer: A
Rationale: An elevated A-a gradient with severe hypoxemia refractory to high FiO2 is classic for V/Q mismatch or shunt, most urgently
concerning for PE. CT pulmonary angiogram is the definitive imaging study. Sputum studies and routine labs do not address the acute
hypoxemia etiology suggested by the gradient.
Q5.
While reviewing morning laboratory results for a ventilated patient, the therapist notes a potassium of 2.9 mEq/L and a
recent increase in premature ventricular contractions on the cardiac monitor. The patient is receiving albuterol continuous
nebulization. What is the most likely contributing factor and recommended action?
A. Albuterol-induced hypokalemia; recommend electrolyte replacement and consider alternative bronchodilator strategy
B. Hypercapnia; increase minute ventilation
C. Metabolic alkalosis; administer acetazolamide
D. Volume overload; administer diuretic
Correct Answer: A
Rationale: Beta-agonists such as albuterol drive potassium intracellularly, causing hypokalemia that can precipitate arrhythmias.
Continuous nebulization increases the risk. Replacing potassium and reassessing the bronchodilator regimen is the appropriate
response. The other options do not address the electrolyte disturbance linked to the continuous beta-agonist.
Q6.
A 72-year-old patient with congestive heart failure has orthopnea and an SpO2 of 88% on room air. Physical exam
reveals bilateral crackles and an S3 gallop. The most appropriate initial recommendation for oxygen therapy is:
A. Nasal cannula at 4 L/min targeting SpO2 92-96%
B. Non-rebreather at 15 L/min
C. CPAP at 10 cm H2O with FiO2 0.5
D. High-flow nasal cannula at 40 L/min
Correct Answer: A
Rationale: Patients with CHF benefit from cautious oxygen titration to mild hypoxemia targets while avoiding high concentrations that
may reduce cardiac output. Nasal cannula is first-line; noninvasive ventilation is reserved for more severe respiratory distress or
hypercapnia.
NBRC Mock TMC Exam Review(Q & A)Verified 100% 2026/2027 Page 3
, Q7.
During chart review, a respiratory therapist notes that a patient scheduled for elective surgery has a predicted
postoperative FEV1 of 35% of predicted. The therapist should recommend:
A. Preoperative pulmonary rehabilitation and smoking cessation counseling
B. Immediate intubation and mechanical ventilation
C. Cancellation of surgery without further evaluation
D. High-dose systemic corticosteroids only
Correct Answer: A
Rationale: A predicted postoperative FEV1 below 40% indicates elevated risk of postoperative respiratory complications. Preoperative
optimization including rehab and smoking cessation is evidence-based and reduces morbidity. Immediate invasive measures are not
indicated for an elective case.
Q8.
A 3-year-old child presents with stridor, fever, and a barking cough. The lateral neck radiograph shows subglottic
narrowing. The respiratory therapist should recommend which initial management approach?
A. Racemic epinephrine nebulization and systemic corticosteroids
B. Immediate endotracheal intubation
C. Chest physiotherapy
D. High-flow nasal cannula alone
Correct Answer: A
Rationale: Croup (laryngotracheobronchitis) is managed primarily with nebulized epinephrine to reduce airway edema and
corticosteroids to decrease inflammation. Intubation is reserved for severe distress unresponsive to medical therapy.
Q9.
An adult patient with acute asthma exacerbation has a peak expiratory flow of 40% of personal best and is using
accessory muscles. After two doses of nebulized albuterol, the PEF improves to 55%. The therapist should recommend:
A. Continue frequent bronchodilator treatments and add systemic corticosteroids
B. Discontinue therapy and discharge
C. Initiate noninvasive ventilation immediately
D. Perform arterial blood gas sampling only
Correct Answer: A
Rationale: Incomplete response to initial bronchodilators requires continued intensive therapy and systemic steroids. Immediate NIV or
ABG alone does not address ongoing bronchospasm.
Q10.
A ventilated patient has a sudden drop in SpO2 from 96% to 82% and peak airway pressures rising from 22 to 38 cm
H2O. The most appropriate immediate data to evaluate is:
A. Endotracheal tube position and breath sounds bilaterally
B. Serum lactate level
C. Chest radiograph only
D. Capnography waveform for dead-space calculation
Correct Answer: A
Rationale: Acute desaturation with rising peak pressures suggests possible mainstem intubation, obstruction, or pneumothorax.
Immediate physical assessment of tube position and bilateral breath sounds is the first critical step.
NBRC Mock TMC Exam Review(Q & A)Verified 100% 2026/2027 Page 4
NBRC Mock TMC Exam Review(Q & A)Verified
100% 2026/2027
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED CORE DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Patient Data Evaluation and Recommendations
Troubleshooting and Quality Control of Devices and Infection Control
Airway Management and Oxygen Therapy
Mechanical Ventilation and Critical Care Interventions
Pharmacology, Therapeutic Procedures, and Professional Practice
STUVIAACTUALEXAM
,SECTION 1: Patient Data Evaluation and Recommendations
Q1.
A 68-year-old male with a history of COPD is admitted with increasing dyspnea. His arterial blood gas on room air shows
pH 7.32, PaCO2 58 mm Hg, PaO2 52 mm Hg, and HCO3 29 mEq/L. The respiratory therapist is asked to recommend
the most appropriate initial oxygen delivery device.
A. Nasal cannula at 2 L/min
B. Simple mask at 6 L/min
C. Non-rebreather mask at 15 L/min
D. Venturi mask at 50% FiO2
Correct Answer: A
Rationale: For COPD patients with chronic hypercapnia, low-flow oxygen via nasal cannula is preferred to avoid suppressing hypoxic
drive while correcting hypoxemia. High FiO2 devices such as non-rebreather or high-concentration Venturi can worsen CO2 retention.
The ABG indicates chronic respiratory acidosis with hypoxemia that can be managed cautiously with low-flow O2.
Q2.
During a routine physical assessment of a 45-year-old postoperative patient, the respiratory therapist notes decreased
breath sounds over the left lower lobe and dullness to percussion. The patient is afebrile and oxygen saturation is 94%
on 2 L/min nasal cannula. Which diagnostic procedure should the therapist recommend first?
A. Chest radiograph
B. Sputum culture and sensitivity
C. Bronchoscopy
D. Pulmonary function testing
Correct Answer: A
Rationale: Decreased breath sounds and dullness suggest possible atelectasis or pleural effusion. A chest radiograph is the least
invasive and most appropriate initial diagnostic study to differentiate these conditions. Sputum culture is not indicated without signs of
infection; bronchoscopy and PFT are more invasive or less relevant acutely.
Q3.
A neonatal respiratory therapist reviews the chart of a 28-week gestational age infant. The most recent capillary blood
gas shows pH 7.28, PCO2 55 mm Hg, PO2 45 mm Hg. The infant is currently on nasal CPAP of 5 cm H2O with FiO2
0.35. What recommendation is most appropriate based on these data?
A. Increase CPAP to 7 cm H2O
B. Increase FiO2 to 0.45
C. Initiate mechanical ventilation
D. Continue current settings and reassess in 2 hours
Correct Answer: A
Rationale: The blood gas indicates mild respiratory acidosis and borderline oxygenation in a premature infant. Increasing CPAP
provides additional functional residual capacity support to improve ventilation and oxygenation without immediately escalating to
intubation. Raising FiO2 alone does not address the ventilation issue; mechanical ventilation is premature for these values.
,Q4.
A 55-year-old woman with suspected pulmonary embolism has a PaO2 of 58 mm Hg on a non-rebreather mask. The
respiratory therapist notes the A-a gradient is markedly elevated. Which additional laboratory or imaging study should be
recommended to further evaluate the cause of hypoxemia?
A. CT pulmonary angiogram
B. Sputum Gram stain
C. Complete blood count only
D. Serum electrolytes
Correct Answer: A
Rationale: An elevated A-a gradient with severe hypoxemia refractory to high FiO2 is classic for V/Q mismatch or shunt, most urgently
concerning for PE. CT pulmonary angiogram is the definitive imaging study. Sputum studies and routine labs do not address the acute
hypoxemia etiology suggested by the gradient.
Q5.
While reviewing morning laboratory results for a ventilated patient, the therapist notes a potassium of 2.9 mEq/L and a
recent increase in premature ventricular contractions on the cardiac monitor. The patient is receiving albuterol continuous
nebulization. What is the most likely contributing factor and recommended action?
A. Albuterol-induced hypokalemia; recommend electrolyte replacement and consider alternative bronchodilator strategy
B. Hypercapnia; increase minute ventilation
C. Metabolic alkalosis; administer acetazolamide
D. Volume overload; administer diuretic
Correct Answer: A
Rationale: Beta-agonists such as albuterol drive potassium intracellularly, causing hypokalemia that can precipitate arrhythmias.
Continuous nebulization increases the risk. Replacing potassium and reassessing the bronchodilator regimen is the appropriate
response. The other options do not address the electrolyte disturbance linked to the continuous beta-agonist.
Q6.
A 72-year-old patient with congestive heart failure has orthopnea and an SpO2 of 88% on room air. Physical exam
reveals bilateral crackles and an S3 gallop. The most appropriate initial recommendation for oxygen therapy is:
A. Nasal cannula at 4 L/min targeting SpO2 92-96%
B. Non-rebreather at 15 L/min
C. CPAP at 10 cm H2O with FiO2 0.5
D. High-flow nasal cannula at 40 L/min
Correct Answer: A
Rationale: Patients with CHF benefit from cautious oxygen titration to mild hypoxemia targets while avoiding high concentrations that
may reduce cardiac output. Nasal cannula is first-line; noninvasive ventilation is reserved for more severe respiratory distress or
hypercapnia.
NBRC Mock TMC Exam Review(Q & A)Verified 100% 2026/2027 Page 3
, Q7.
During chart review, a respiratory therapist notes that a patient scheduled for elective surgery has a predicted
postoperative FEV1 of 35% of predicted. The therapist should recommend:
A. Preoperative pulmonary rehabilitation and smoking cessation counseling
B. Immediate intubation and mechanical ventilation
C. Cancellation of surgery without further evaluation
D. High-dose systemic corticosteroids only
Correct Answer: A
Rationale: A predicted postoperative FEV1 below 40% indicates elevated risk of postoperative respiratory complications. Preoperative
optimization including rehab and smoking cessation is evidence-based and reduces morbidity. Immediate invasive measures are not
indicated for an elective case.
Q8.
A 3-year-old child presents with stridor, fever, and a barking cough. The lateral neck radiograph shows subglottic
narrowing. The respiratory therapist should recommend which initial management approach?
A. Racemic epinephrine nebulization and systemic corticosteroids
B. Immediate endotracheal intubation
C. Chest physiotherapy
D. High-flow nasal cannula alone
Correct Answer: A
Rationale: Croup (laryngotracheobronchitis) is managed primarily with nebulized epinephrine to reduce airway edema and
corticosteroids to decrease inflammation. Intubation is reserved for severe distress unresponsive to medical therapy.
Q9.
An adult patient with acute asthma exacerbation has a peak expiratory flow of 40% of personal best and is using
accessory muscles. After two doses of nebulized albuterol, the PEF improves to 55%. The therapist should recommend:
A. Continue frequent bronchodilator treatments and add systemic corticosteroids
B. Discontinue therapy and discharge
C. Initiate noninvasive ventilation immediately
D. Perform arterial blood gas sampling only
Correct Answer: A
Rationale: Incomplete response to initial bronchodilators requires continued intensive therapy and systemic steroids. Immediate NIV or
ABG alone does not address ongoing bronchospasm.
Q10.
A ventilated patient has a sudden drop in SpO2 from 96% to 82% and peak airway pressures rising from 22 to 38 cm
H2O. The most appropriate immediate data to evaluate is:
A. Endotracheal tube position and breath sounds bilaterally
B. Serum lactate level
C. Chest radiograph only
D. Capnography waveform for dead-space calculation
Correct Answer: A
Rationale: Acute desaturation with rising peak pressures suggests possible mainstem intubation, obstruction, or pneumothorax.
Immediate physical assessment of tube position and bilateral breath sounds is the first critical step.
NBRC Mock TMC Exam Review(Q & A)Verified 100% 2026/2027 Page 4
