Mechanical ventilation is a vital process in respiratory care that supports or replaces spontaneous breathing in patients with respiratory failure or compromised lung function.
This life-saving intervention requires a deep understanding of ventilation settings, modes, and patient management.
As a respiratory therapist, mastering mechanical ventilation is crucial for providing high-quality care. Understanding this topic is also essential for students preparing for their TMC exam.
In this guide, we’ve gathered sample TMC practice questions specifically focused on mechanical ventilation. These questions are designed to help you prepare for the NBRC licensure exam by simulating real exam scenarios, allowing you to sharpen your skills and boost your confidence.
Note: We haven’t included the correct answers on this page to give you the opportunity to test your knowledge. If you’d like to access the correct answers along with detailed explanations, simply download the digital study guide using the link below.
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What is Mechanical Ventilation?
Mechanical ventilation is a medical intervention that provides respiratory support to patients who are unable to breathe adequately on their own.
This process involves using a ventilator machine to assist or fully control the movement of air into and out of the lungs. Mechanical ventilation delivers oxygen to the patient and helps remove carbon dioxide, ensuring proper gas exchange.
It is commonly used in critical care settings for patients with severe respiratory failure, during surgery, or in cases of acute injury or illness affecting the lungs.
Mechanical Ventilation Sample TMC Practice Questions
1. While assessing a 64-year-old patient receiving volume-controlled ventilation, you note that the peak airway pressure has decreased from 52 cm H2O to 32 cm H2O. There have been no other changes to the ventilator settings. Which of the following actions would be appropriate at this time?
A. Increase the volume setting until the pressure equals 52 cm H2O
B. Increase the flow setting until the pressure equals 52 cm H2O
C. Check for increased secretions and suction if needed
D. Check the circuit for system leaks
2. The physician calls and asks you to select a mode of ventilation in which you can maintain a precise I:E ratio. Which of the following modes would you select?
A. Synchronous Intermittent Mandatory Ventilation
B. Control Mode Ventilation
C. Assist-Control Ventilation
D. Pressure Support Ventilation
3. A 63-year-old female patient is receiving pressure-controlled A/C mechanical ventilation. Which of the following changes would occur if her compliance were to decrease?
A. Her delivered volume will decrease
B. Her peak pressure will increase
C. Her inspiratory time will increase
D. Her PEEP level will decrease
4. Your patient is receiving volume control A/C ventilation. You notice that she has become agitated and her end-tidal CO2 has decreased from 38 to 27 torr over the last 3 hours. Which of the following is most likely the cause?
A. High body temperature
B. Increased ventilation
C. Increased cardiac output
D. Mainstem intubation
5. An intubated adult 69-year-old male patient with a severe obstructive airway disease requires support via mechanical ventilation. Which of the following capabilities would be most important in selecting a ventilator for this patient?
A. Approved for use during MRI procedures
B. The ability to compensate with tube flexibility
C. The ability to run on 12 volt DC (battery) power
D. A variable flow control and adjustable I:E ratio
6. A post-operative patient using an IPPB has an inspiratory time that is prolonged and the machine does not cycle off without an active patient effort. What should you do in order to correct this problem?
A. Increase the control pressure
B. Decrease the sensitivity setting
C. Check for a leak in the circuit or mouthpiece
D. Switch the unit to 100% source gas
7. You are called to increase the expiratory time of a patient receiving volume control ventilation without altering the minute ventilation. Which of the following settings would you adjust in order to fulfill this request?
A. Rate of breathing
B. Inspiratory flow
C. Tidal volume
D. Trigger sensitivity
8. You are called and asked to decrease the PaCO2 of a patient receiving high-frequency oscillation ventilation. Which of the following settings should you adjust?
A. Increase the frequency
B. Decrease the bias flow
C. Increase the power/amplitude
D. Increase the mechanical deadspace
9. A 53-year-old female patient with COPD is receiving volume controlled A/C ventilation. Rhonchal fremitus is felt over the central airways and wheezing is heard over all lung fields. She has ver thick secretions and her peak pressure is 45 cm H2O and plateau pressure is 20 cm H2O. Which of the following would be useful to treat this patient’s condition?
A. Cromolyn sodium (Intal)
B. Triamcinolone (Azmacort)
C. Levalbuterol (Xopenex)
D. Pancuronium bromide (Pavulon)
10. A 58-year-old postoperative male who weighs 172 lbs. is receiving volume control A/C ventilation at a rate of 14/min with a tidal volume of 650 mL and an FIO2 of 40%. You collected an ABG sample and obtained the following results:
pH 7.51
PaCO2 30 torr
HCO3 23 mEq/L
BE -1
PaO2 117 torr
SaO2 99%
Based on this information, you should recommend which of the following?
A. Discontinue mechanical ventilation
B. Administer IV bicarbonate
C. Increase the peak flow setting
D. Decrease the minute ventilation
11. A 51-year-old asthmatic patient is struggling to initiate inspiration on a mechanical ventilator that is operating in the assist-control mode. Which of the following settings would you first check in order to resolve of this problem?
A. Tidal volume
B. Pressure limit
C. Sensitivity
D. PEEP
12. You are called to assess a patient receiving mechanical ventilation and you suddenly notice the simultaneous sounding of the high-pressure and low-volume alarms. What is the most likely cause of this problem?
A. There is a disconnection in the ventilator circuit
B. There is a leak in the ET tube cuff
C. There is a mucous plug in the ET tube
D. The patient has developed pneumonia
13. Which of the following is true regarding the synchronous intermittent mandatory ventilation (SIMV) mode of ventilation?
A. Machine breaths cannot be pressure controlled
B. The patient contributes to minute ventilation
C. Asynchrony is prevented during machine breaths
D. Only partial ventilatory support can be provided
14. A 63-year-old male patient with a tracheostomy is being mechanically ventilated in the ICU. When the patient was coughing, blood and secretions were blown back into the circuit. What action should you take at this time?
A. Flush the blood out of the circuit with normal saline
B. Sedate the patient to prevent more coughing
C. Nebulize a local anesthetic to reduce surgical pain
D. Replace the circuit with a new one
15. In order to initiate weaning, you change the patient from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings?
A. Increase the pressure support level
B. Increase the high pressure alarm to 50 cm H2O
C. Increase the high rate alarm to 30–35
D. Switch the patient back to volume control A/C
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16. After intubating a patient, you are asked to confirm proper tube placement. Upon auscultation, you note that the breath sounds are absent on the patient’s left side. Which of the following is the most appropriate action to take at this time?
A. Obtain a stat chest radiograph
B. Withdraw the endotracheal tube by 1–2 cm
C. Reintubate the patient
D. Insert a large bore needle in the left upper chest
17. While monitoring a patient during a spontaneous breathing trial, which of the following observations would indicate that you need to stop the trial and return the patient back to full ventilatory support?
A. An increase in heart rate from 96/min to 114/min
B. An increase in respiratory rate from 17 to 27/min
C. An increase in arterial PCO2 from 44 to 52 torr
D. A decrease in O2 saturation from 92% to 83%
18. You are attempting to wean an alert intubated patient using CPAP with 40% oxygen. The patient’s respiratory rate increases from 23 to 30/min and you notice accessory muscle usage during the weaning attempt. What should you do at this time?
A. Return the patient to full ventilatory support
B. Increase the FiO2 to 50%
C. Apply 5-10 cm H2O of pressure support
D. Extubate the patient and reassess
19. You have a patient that is receiving ventilator support in the volume-control mode when suddenly the high pressure alarm begins to sound. Which of the following would you select in order to fix this problem?
A. Increase the flow
B. Increase the pressure limit
C. Suction the airway
D. Remove air from the endotracheal tube cuff
20. While attempting a spontaneous breathing trial for weaning, which of the following changes in the patient’s status would be acceptable?
A. The SpO2 falls from 91% to 81%
B. The scalene muscle activity increases
C. The heart rate increases from 97 to 115/min
D. The systolic blood pressure decreases from 115 to 76 mm Hg
21. You have a patient that is receiving mechanical ventilation in volume control mode that is being monitored with a continuous pulse oximeter. While temporarily removing the patient from the ventilator to perform suctioning, their SpO2 drops from 95% to 88%. Which of the following should be done in order to fix this problem?
A. Initiate PEEP at 10 cm H2O
B. Change to a closed-system suctioning device
C. Administer a short-acting bronchodilator
D. Perform bedside hemodynamic monitoring
22. Which of the following is the most common problem associated with the assist-control mode of ventilation?
A. Hypoventilation
B. Hyperventilation
C. The need for neuromuscular paralysis
D. Increased work of breathing
23. While performing a routine ventilator check, you note the following settings: Exhaled tidal volume 550 mL, PIP of 35 cm H2O, High pressure limit 64 cm H2O, Low pressure alarm 25 cm H2O, and Low tidal volume alarm 500 mL. Which of the following change should you make at this time?
A. Decrease the high pressure limit to 45–50 cm H2O
B. Decrease the low pressure alarm to 10 cm H2O
C. Increase the low tidal volume alarm to 600 mL
D. Increase the set tidal volume to 750 mL
24. Which of the following is an advantage of the SIMV mode of ventilation over assist/control?
A. SIMV maintains respiratory muscle strength
B. SIMV prevents hyperventilation
C. SIMV increases pleural pressures
D. SIMV increases the need for sedation
25. Your patient is intubated and is receiving positive-pressure ventilation. You should strive to keep the patient’s plateau pressure below which of the following in order to prevent barotrauma?
A. 20 cm H2O
B. 30 cm H2O
C. 40 cm H2O
D. 50 cm H2O
26. A male patient is being ventilated via a tracheostomy in volume control SIMV at a rate of 10/min. Upon assessment, you notice that the patient has started to use his accessory muscles during spontaneous breaths. What would you recommend to help this patient?
A. Switch the patient to an inspiratory flow pattern
B. Increase the pressure support
C. Decrease the SIMV rate to 6/minute
D. Switch to the patient to pressure control SIMV
27. What is the most important consideration to make when selecting the initial ventilatory settings for a new patient?
A. The type of device that is being used
B. The quality and amount of nursing supervision
C. The patient’s size and clinical condition
D. The amount of spontaneous ventilatory effort
28. After running an ABG sample, your patient that is on the ventilator in SIMV has a PaCO2 of 60 mm Hg. The physician asks for you to correct this problem. Which of the following actions would be most appropriate in this case?
A. Increase the frequency
B. Increase the FiO2
C. Increase the mechanical deadspace in the ventilator circuit
D. Decrease the tidal volume
29. The physician orders mechanical ventilation in the pressure control A/C mode for a 55 kg postoperative male patient. Which of the following initial settings would you choose?
A. PIP = 25 cm H2O; Rate = 30/min; Inspiratory time = 1 second
B. PIP = 32 cm H2O; Rate = 12/min; Inspiratory time = 2 seconds
C. PIP = 40 cm H2O; Rate = 20/min; Inspiratory time = 1 second
D. PIP = 25 cm H2O; Rate = 12/min; Inspiratory time = 1 second
30. A 54-year-old female patient is receiving ventilatory support in the volume control mode. After performing endotracheal suctioning, which of the following would indicate effective clearance of retained secretions?
A. A decreased inspiratory time
B. A smaller tidal volume
C. A lower plateau pressure
D. A lower peak pressure
31. While assessing a mechanically ventilated patient after brain surgery, the patient has an intracranial pressure of 20 mmHg but is otherwise stable. The latest ABG results are as follows:
pH 7.31
PaCO2 48 mm Hg
HCO3 24 mEq/L
PaO2 88 mm Hg
SpO2 95%
Based on this information, which of the following is should be done at this time?
A. Increase the minute ventilation
B. Add 10 cm H2O PEEP
C. Decrease the tidal volume
D. Maintain the current settings
32. You have a patient that is intubated and receiving ventilatory support via volume-controlled SIMV. The physician anticipates that the patient will be on the ventilator for another 3–5 days. Which of the following actions would you recommend?
A. Switch to the patient to NPPV
B. Switch from an ET tube to a tracheostomy
C. Maintain the endotracheal tube in place
D. Switch to pressure control ventilation
33. Your services are requested to interpret the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. The patient has a tidal volume of 400 mL, a set rate of 10/min, and the FiO2 is set at 35%. Her blood gas results are as follows:
pH 7.31
PaCO2 49 torr
HCO3 24 mEq/L
BE -2 mEq/L
PaO2 74 torr
SpO2 95%
Based on the given information, which of the following changes is appropriate at this time?
A. Increase the FiO2
B. Increase the tidal volume
C. Increase the set rate
D. Maintain the current settings
34. A patient is receiving mechanical ventilation with a PEEP setting of 10 cm H2O. The physician calls and orders you to increase the PEEP to 14 cm H2O. After making the adjustment, there is a rapid drop in the patient’s blood pressure and a significant rise in heart rate. Which of the following actions should you take?
A. Increase the FiO2 by 10%
B. Lower the PEEP back down to 10 cm H2O
C. Administer sodium bicarb
D. Obtain a stat EKG
35. A 43-year-old 57 kg patient is admitted with a suspected drug overdose. The man is unconscious and isn’t making respiratory efforts to breathe. The ABG results on a nonrebreathing mask are as follows:
pH 7.28
PCO2 74 torr
HCO3 20 mEq/L
PaO2 315 torr
What should you recommend at this time?
A. Apply BiPAP with: IPAP 20 cm H2O, EPAP 5 cm H2O, FIO2 30%
B. Intubate and apply: SIMV, tidal volume 600 mL, rate 6/min, FIO2 40 %
C. Intubate and apply: A/C ventilation, tidal volume 450 mL, rate 12/min, FIO2 50%
D. Apply CPAP at 10 cm H2O and an FIO2 of 100%
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Final Thoughts
Mastering mechanical ventilation is key to your success as a respiratory therapist, and practicing with sample TMC questions is an excellent way to reinforce your knowledge of this complex subject.
By working through these questions, you’ll become more familiar with the types of challenges you’ll face, improving your readiness and boosting your chances of passing the exam.
Stay diligent in your studies, keep practicing, and remember that your hard work will pave the way for a successful career in respiratory therapy. If you’re serious about passing the board exams, consider investing in our premium exam-prep resources to take your preparation to the next level.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Hickey SM, Sankari A, Giwa AO. Mechanical Ventilation. [Updated 2024 Mar 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
- Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013.
- Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 6th ed., Mosby, 2015.