KETTERING TMC EXAM PRACTICE – QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
CORE DOMAINS
Patient Assessment
Airway Management and Mechanical Ventilation
Oxygen and Medical Gas Therapy
Pharmacology and Bronchodilator Therapy
Cardiopulmonary Pathophysiology
Monitoring and Diagnostic Procedures
Ethics, Legal Standards, and Professional Conduct
Emergency and Critical Care Management
Infection Control and Prevention
Patient Education and Care Coordination
INTRODUCTION
This comprehensive examination is designed to prepare respiratory therapist candidates for the
National Board for Respiratory Care (NBRC) Therapist Multiple-Choice (TMC) Examination. The
assessment evaluates foundational knowledge in patient assessment, therapeutic interventions,
mechanical ventilation, pharmacology, and critical decision-making skills required for clinical practice.
Questions are presented in multiple-choice and scenario-based formats to simulate real-world clinical
situations that respiratory therapists encounter daily. Each question includes a detailed rationale to
reinforce learning and enhance clinical reasoning. The examination emphasizes practical application,
critical thinking, and evidence-based practice across diverse patient populations and healthcare
settings. Candidates are expected to demonstrate proficiency in both theoretical knowledge and
clinical judgment necessary for safe and effective patient care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male patient with a history of COPD presents to the emergency department with
increased shortness of breath, productive cough with purulent sputum, and fever. Arterial blood
gas results reveal pH 7.29, PaCO2 68 mmHg, PaO2 55 mmHg, HCO3 32 mEq/L. What is the most
appropriate initial intervention?
A. Administer 100% oxygen via non-rebreather mask
B. Initiate bi-level positive airway pressure (BiPAP) therapy
,C. Administer intravenous corticosteroids
D. Initiate continuous positive airway pressure (CPAP) therapy
🟢 B. Initiate bi-level positive airway pressure (BiPAP) therapy
🔴 Explanation: This patient presents with acute exacerbation of COPD complicated by hypercapnic
respiratory failure (pH 7.29, PaCO2 68 mmHg). BiPAP provides inspiratory positive airway pressure
(IPAP) and expiratory positive airway pressure (EPAP), which improves alveolar ventilation, reduces
PaCO2, and corrects respiratory acidosis. Non-invasive ventilation is first-line therapy for acute
COPD exacerbations with respiratory acidosis. CPAP does not provide ventilatory support and is not
appropriate for hypercapnia. High-flow oxygen may worsen hypercapnia by reducing hypoxic drive.
While corticosteroids may be indicated, they are not the immediate intervention.
Question 2
Which of the following findings on a pulmonary function test is most consistent with a diagnosis of
restrictive lung disease?
A. Decreased FEV1/FVC ratio with increased TLC
B. Decreased FVC with normal FEV1/FVC ratio
C. Increased FRC with decreased DLCO
D. Normal FEV1 with decreased FEV1/FVC ratio
🟢 B. Decreased FVC with normal FEV1/FVC ratio
🔴 Explanation: Restrictive lung diseases are characterized by decreased lung volumes, primarily
reduced FVC, while the FEV1/FVC ratio remains normal or increased. This pattern reflects reduced
lung compliance or expansion limitation. Option A describes obstructive disease with airway flow
limitation. Option C describes hyperinflation with gas exchange impairment. Option D indicates
obstruction with preserved FVC.
Question 3
A patient receiving mechanical ventilation has the following settings: assist-control mode, tidal
volume 500 mL, respiratory rate 16 breaths/min, PEEP 5 cm H2O, FiO2 0.50. The patient's peak
inspiratory pressure is 42 cm H2O and plateau pressure is 28 cm H2O. Which of the following is the
most likely cause of the elevated peak inspiratory pressure?
A. Decreased lung compliance
B. Airway resistance obstruction
C. Auto-PEEP
D. Patient-ventilator asynchrony
🟢 B. Airway resistance obstruction
🔴 Explanation: The elevated peak inspiratory pressure (42 cm H2O) with a relatively normal
plateau pressure (28 cm H2O) indicates increased airway resistance rather than decreased lung
compliance. The difference between peak and plateau pressures (pressure gradient) reflects
,resistive pressure. Increased airway resistance is commonly caused by bronchospasm, secretions, or
airway obstruction. Decreased compliance would elevate both peak and plateau pressures. Auto-
PEEP would be detected by expiratory hold maneuvers. Patient-ventilator asynchrony could
contribute but is not the primary cause of elevated airway pressures.
Question 4
Which of the following agents is most appropriate for reversal of benzodiazepine-induced
respiratory depression?
A. Naloxone
B. Flumazenil
C. Atropine
D. Neostigmine
🟢 B. Flumazenil
🔴 Explanation: Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly
reverses sedation, respiratory depression, and other effects caused by benzodiazepines. It binds to
the GABA receptor complex and displaces benzodiazepines. Naloxone reverses opioid-induced
respiratory depression. Atropine blocks muscarinic receptors and is used for bradycardia.
Neostigmine is a cholinesterase inhibitor used for neuromuscular blockade reversal.
Question 5
A 72-year-old patient with pneumonia has a SpO2 of 86% on room air. The patient is tachypneic
with respiratory rate of 28 breaths/min and has crackles in the right lower lung. What is the most
appropriate initial oxygen delivery device?
A. Simple face mask at 6 L/min
B. Non-rebreather mask at 15 L/min
C. Nasal cannula at 2 L/min
D. Venturi mask at 40% FiO2
🟢 B. Non-rebreather mask at 15 L/min
🔴 Explanation: The patient has significant hypoxemia (SpO2 86%) and requires high concentration
oxygen. A non-rebreather mask delivers FiO2 between 60-80% at 15 L/min with a reservoir bag to
achieve high oxygen concentrations for severe hypoxemia. Nasal cannula at 2 L/min would provide
insufficient oxygen concentration. Simple face mask delivers inconsistent FiO2. Venturi mask
provides precise FiO2 but may not deliver sufficient oxygen concentration initially.
Question 6
, Which of the following is the correct initial step when performing bag-mask ventilation on an
unconscious patient?
A. Use the head-tilt chin-lift maneuver
B. Apply cricoid pressure
C. Insert an oropharyngeal airway
D. Position the patient in the recovery position
🟢 A. Use the head-tilt chin-lift maneuver
🔴 Explanation: The head-tilt chin-lift maneuver is the initial and fundamental step to open the
airway in unconscious patients without suspected cervical spine injury. This maneuver lifts the
tongue and epiglottis away from the posterior pharynx, establishing a patent airway. Cricoid
pressure (Sellick maneuver) is used during intubation to prevent aspiration, not as an initial step.
Oropharyngeal airway insertion may follow after unsuccessful mask ventilation. Recovery position is
for unconscious patients with a patent airway.
Question 7
A patient's arterial blood gas shows pH 7.32, PaCO2 52 mmHg, PaO2 78 mmHg, HCO3 24 mEq/L.
Which of the following describes this acid-base disturbance?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with no compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory and metabolic acidosis
🟢 B. Respiratory acidosis with no compensation
🔴 Explanation: The pH is below 7.35 (acidemia). The PaCO2 is elevated above 45 mmHg,
consistent with respiratory acidosis. The HCO3 is within normal range (22-26 mEq/L), indicating no
metabolic compensation has occurred. Compensation would be evidenced by an elevated HCO3.
Metabolic acidosis would present with low pH and low HCO3. Mixed acidosis would show both
respiratory and metabolic abnormalities.
Question 8
Which of the following medications is classified as a short-acting beta-2 agonist (SABA) used for
acute bronchospasm?
A. Salmeterol
B. Albuterol
C. Formoterol
D. Tiotropium
🟢 B. Albuterol
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
CORE DOMAINS
Patient Assessment
Airway Management and Mechanical Ventilation
Oxygen and Medical Gas Therapy
Pharmacology and Bronchodilator Therapy
Cardiopulmonary Pathophysiology
Monitoring and Diagnostic Procedures
Ethics, Legal Standards, and Professional Conduct
Emergency and Critical Care Management
Infection Control and Prevention
Patient Education and Care Coordination
INTRODUCTION
This comprehensive examination is designed to prepare respiratory therapist candidates for the
National Board for Respiratory Care (NBRC) Therapist Multiple-Choice (TMC) Examination. The
assessment evaluates foundational knowledge in patient assessment, therapeutic interventions,
mechanical ventilation, pharmacology, and critical decision-making skills required for clinical practice.
Questions are presented in multiple-choice and scenario-based formats to simulate real-world clinical
situations that respiratory therapists encounter daily. Each question includes a detailed rationale to
reinforce learning and enhance clinical reasoning. The examination emphasizes practical application,
critical thinking, and evidence-based practice across diverse patient populations and healthcare
settings. Candidates are expected to demonstrate proficiency in both theoretical knowledge and
clinical judgment necessary for safe and effective patient care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male patient with a history of COPD presents to the emergency department with
increased shortness of breath, productive cough with purulent sputum, and fever. Arterial blood
gas results reveal pH 7.29, PaCO2 68 mmHg, PaO2 55 mmHg, HCO3 32 mEq/L. What is the most
appropriate initial intervention?
A. Administer 100% oxygen via non-rebreather mask
B. Initiate bi-level positive airway pressure (BiPAP) therapy
,C. Administer intravenous corticosteroids
D. Initiate continuous positive airway pressure (CPAP) therapy
🟢 B. Initiate bi-level positive airway pressure (BiPAP) therapy
🔴 Explanation: This patient presents with acute exacerbation of COPD complicated by hypercapnic
respiratory failure (pH 7.29, PaCO2 68 mmHg). BiPAP provides inspiratory positive airway pressure
(IPAP) and expiratory positive airway pressure (EPAP), which improves alveolar ventilation, reduces
PaCO2, and corrects respiratory acidosis. Non-invasive ventilation is first-line therapy for acute
COPD exacerbations with respiratory acidosis. CPAP does not provide ventilatory support and is not
appropriate for hypercapnia. High-flow oxygen may worsen hypercapnia by reducing hypoxic drive.
While corticosteroids may be indicated, they are not the immediate intervention.
Question 2
Which of the following findings on a pulmonary function test is most consistent with a diagnosis of
restrictive lung disease?
A. Decreased FEV1/FVC ratio with increased TLC
B. Decreased FVC with normal FEV1/FVC ratio
C. Increased FRC with decreased DLCO
D. Normal FEV1 with decreased FEV1/FVC ratio
🟢 B. Decreased FVC with normal FEV1/FVC ratio
🔴 Explanation: Restrictive lung diseases are characterized by decreased lung volumes, primarily
reduced FVC, while the FEV1/FVC ratio remains normal or increased. This pattern reflects reduced
lung compliance or expansion limitation. Option A describes obstructive disease with airway flow
limitation. Option C describes hyperinflation with gas exchange impairment. Option D indicates
obstruction with preserved FVC.
Question 3
A patient receiving mechanical ventilation has the following settings: assist-control mode, tidal
volume 500 mL, respiratory rate 16 breaths/min, PEEP 5 cm H2O, FiO2 0.50. The patient's peak
inspiratory pressure is 42 cm H2O and plateau pressure is 28 cm H2O. Which of the following is the
most likely cause of the elevated peak inspiratory pressure?
A. Decreased lung compliance
B. Airway resistance obstruction
C. Auto-PEEP
D. Patient-ventilator asynchrony
🟢 B. Airway resistance obstruction
🔴 Explanation: The elevated peak inspiratory pressure (42 cm H2O) with a relatively normal
plateau pressure (28 cm H2O) indicates increased airway resistance rather than decreased lung
compliance. The difference between peak and plateau pressures (pressure gradient) reflects
,resistive pressure. Increased airway resistance is commonly caused by bronchospasm, secretions, or
airway obstruction. Decreased compliance would elevate both peak and plateau pressures. Auto-
PEEP would be detected by expiratory hold maneuvers. Patient-ventilator asynchrony could
contribute but is not the primary cause of elevated airway pressures.
Question 4
Which of the following agents is most appropriate for reversal of benzodiazepine-induced
respiratory depression?
A. Naloxone
B. Flumazenil
C. Atropine
D. Neostigmine
🟢 B. Flumazenil
🔴 Explanation: Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly
reverses sedation, respiratory depression, and other effects caused by benzodiazepines. It binds to
the GABA receptor complex and displaces benzodiazepines. Naloxone reverses opioid-induced
respiratory depression. Atropine blocks muscarinic receptors and is used for bradycardia.
Neostigmine is a cholinesterase inhibitor used for neuromuscular blockade reversal.
Question 5
A 72-year-old patient with pneumonia has a SpO2 of 86% on room air. The patient is tachypneic
with respiratory rate of 28 breaths/min and has crackles in the right lower lung. What is the most
appropriate initial oxygen delivery device?
A. Simple face mask at 6 L/min
B. Non-rebreather mask at 15 L/min
C. Nasal cannula at 2 L/min
D. Venturi mask at 40% FiO2
🟢 B. Non-rebreather mask at 15 L/min
🔴 Explanation: The patient has significant hypoxemia (SpO2 86%) and requires high concentration
oxygen. A non-rebreather mask delivers FiO2 between 60-80% at 15 L/min with a reservoir bag to
achieve high oxygen concentrations for severe hypoxemia. Nasal cannula at 2 L/min would provide
insufficient oxygen concentration. Simple face mask delivers inconsistent FiO2. Venturi mask
provides precise FiO2 but may not deliver sufficient oxygen concentration initially.
Question 6
, Which of the following is the correct initial step when performing bag-mask ventilation on an
unconscious patient?
A. Use the head-tilt chin-lift maneuver
B. Apply cricoid pressure
C. Insert an oropharyngeal airway
D. Position the patient in the recovery position
🟢 A. Use the head-tilt chin-lift maneuver
🔴 Explanation: The head-tilt chin-lift maneuver is the initial and fundamental step to open the
airway in unconscious patients without suspected cervical spine injury. This maneuver lifts the
tongue and epiglottis away from the posterior pharynx, establishing a patent airway. Cricoid
pressure (Sellick maneuver) is used during intubation to prevent aspiration, not as an initial step.
Oropharyngeal airway insertion may follow after unsuccessful mask ventilation. Recovery position is
for unconscious patients with a patent airway.
Question 7
A patient's arterial blood gas shows pH 7.32, PaCO2 52 mmHg, PaO2 78 mmHg, HCO3 24 mEq/L.
Which of the following describes this acid-base disturbance?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with no compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory and metabolic acidosis
🟢 B. Respiratory acidosis with no compensation
🔴 Explanation: The pH is below 7.35 (acidemia). The PaCO2 is elevated above 45 mmHg,
consistent with respiratory acidosis. The HCO3 is within normal range (22-26 mEq/L), indicating no
metabolic compensation has occurred. Compensation would be evidenced by an elevated HCO3.
Metabolic acidosis would present with low pH and low HCO3. Mixed acidosis would show both
respiratory and metabolic abnormalities.
Question 8
Which of the following medications is classified as a short-acting beta-2 agonist (SABA) used for
acute bronchospasm?
A. Salmeterol
B. Albuterol
C. Formoterol
D. Tiotropium
🟢 B. Albuterol
