10+ Free TMC Practice Questions and Explanations (2024)

The TMC Exam is a crucial milestone on the journey to becoming a respiratory therapist, testing your knowledge and clinical skills across a broad spectrum of topics.

Success on the exam requires more than just memorization—you need a thorough understanding of each subject and the ability to apply that knowledge in real-world scenarios. One of the most effective ways to prepare is by using practice questions to reinforce key concepts and sharpen your clinical thinking.

To help, we’ve compiled a comprehensive set of sample practice questions designed to evaluate your understanding and give you an idea of what to expect on exam day. Each question is paired with a detailed explanation to guide your learning and ensure you grasp the material.

By working through these questions and mastering the content, you’ll gain the confidence needed to approach the TMC Exam with certainty—putting you one step closer to achieving your goal of becoming a registered respiratory therapist (RRT).

Sample TMC Exam Practice Questions

These TMC practice questions are designed to test your knowledge and help you build the confidence needed to succeed.

Work through each one carefully, review the explanations provided, and use this as an opportunity to strengthen your understanding of key concepts:

Question #1

During the assessment of a 64-year-old female patient, you note the following clinical signs: dyspnea, hypotension, and a tracheal shift to the right. The patient also has absent breath sounds, reduced chest expansion, and a hyperresonant percussion note—all on the left side. Which of the following conditions do these findings indicate?

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

Explanation:

To answer this question correctly, it’s crucial to interpret all of the clinical details provided. This format is typical for questions you’ll encounter on the TMC Exam, requiring you to connect multiple pieces of information to reach the correct diagnosis.

Absent breath sounds, reduced chest expansion, and a hyperresonant percussion note on the left side are classic signs of a pneumothorax. The tracheal shift to the right confirms that there is significant pressure buildup on the left, pushing the trachea away from the affected side.

Pleural effusion and consolidation would produce a dull percussion note, not a hyperresonant one. Atelectasis on the left side would cause the trachea to shift toward the affected side, not away from it.

Correct Answer: B. Pneumothorax on the left side

Key Takeaway: Remember that when a pneumothorax is present, the trachea shifts away from the affected side due to increased intrapleural pressure. Understanding this concept will help you differentiate between conditions like pneumothorax, atelectasis, and pleural effusion during your exam.

Question #2

A 39-year-old male patient is admitted to the emergency department with a fever and an SpO2 of 87% on room air. During auscultation, rhonchi are heard, and the patient has a productive cough. Which of the following would you recommend?

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

Explanation:

To answer this question correctly, you need to identify that the patient is likely dealing with a respiratory infection, such as pneumonia. Here’s why:

• The fever, productive cough, and rhonchi on auscultation are strong indicators of an infectious process in the lungs.
• The SpO2 of 87% signifies hypoxemia, which requires immediate oxygen therapy.

In this scenario, the best course of action is to provide oxygen therapy to address the patient’s low oxygen levels. At the same time, you should obtain a sputum sample for culture and sensitivity to determine the specific organism causing the infection and guide appropriate antibiotic treatment.

Intubation and mechanical ventilation would be too invasive unless the patient shows signs of respiratory failure or severe distress. Noninvasive positive pressure ventilation (NPPV) is not indicated here, as the patient’s primary issues are infection and hypoxemia, not ventilatory failure.

Postural drainage and percussion are more appropriate for conditions like bronchiectasis or mucus plugging and won’t address the underlying infection.

Correct Answer: D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity

Key Takeaway: When dealing with a patient showing signs of a respiratory infection (e.g., fever, productive cough, and abnormal breath sounds), always prioritize oxygen therapy if hypoxemia is present and consider obtaining a sputum sample to identify the causative organism for targeted treatment.

Question #3

A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-controlled A/C ventilation. During 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

Explanation:

To answer this question, it’s important to know the acceptable range for endotracheal cuff pressures, which is 20–30 cmH2O. A cuff pressure of 38 cmH2O is dangerously high and could result in complications such as tracheal damage or impaired circulation to the surrounding tissues.

The correct response is to lower the cuff pressure to less than 30 cmH2O and then reassess for adequate sealing and airflow. Reducing the pressure will help prevent potential complications, including tracheal stenosis or tissue ischemia while maintaining a proper seal to prevent air leaks.

Withdrawing the tube is unnecessary and could disrupt proper tube placement, leading to complications such as accidental extubation or inadequate ventilation. Reintubating with a smaller tube would likely increase airway resistance and peak pressures, which could compromise ventilation.

There’s no indication that a tracheostomy is required in this situation. Tracheostomies are typically reserved for long-term ventilatory support or when intubation complications arise that cannot be resolved.

Correct Answer: C. Lower the cuff pressure to < 30 cmH2O

Key Takeaway: Always remember the safe range for cuff pressures (20–30 cmH2O) to prevent airway trauma. When pressures exceed this range, your first step should be to reduce it to an acceptable level while ensuring the seal is maintained for effective ventilation.

Question #4

A 45-year-old male, 183 cm (6 ft) tall and weighing 85 kg (187 lb), is receiving volume-controlled assist/control (VC, A/C) ventilation following emergency thoracic surgery. His initial ventilator settings are as follows:

• FiO2: 0.40
• Mandatory rate: 14/min
• Total rate: 14/min
• VT: 510 mL
• Inspiratory time: 1.2 sec
• PEEP: 8 cmH2O

Several hours later, the high-pressure alarm on the ventilator is triggered. The patient appears agitated with the following clinical signs:

• Heart rate: 125/min
• Respiratory rate: 30/min
• Blood pressure: 165/95 mmHg
• Oxygen saturation: 91%

Breath sounds are clear but diminished in the lower lung fields. Which of the following interventions should the respiratory therapist consider next?

A. Administer an antihypertensive medication
B. Increase the tidal volume to 700 mL
C. Change the ventilator mode to SIMV
D. Administer an IV sedative or analgesic

Explanation:

The patient’s elevated heart rate, respiratory rate, and blood pressure—along with agitation and a triggered high-pressure alarm—suggest that he is likely experiencing pain, anxiety, or discomfort. This is common in postoperative patients who are mechanically ventilated, particularly after major procedures like thoracic surgery.

Pain and agitation can increase muscle tension, resulting in high airway pressures and poor patient-ventilator synchrony.

The best approach in this scenario is to administer an IV sedative or analgesic. This will help alleviate the patient’s pain and anxiety, which should decrease the agitation, improve ventilator synchrony, and resolve the high-pressure alarms.

The patient’s elevated blood pressure is likely secondary to pain or agitation, not a primary hypertensive issue. Treating the underlying discomfort should resolve the high blood pressure.

Increasing the tidal volume would raise the peak inspiratory pressure, worsening the issue instead of alleviating it. Changing the ventilator mode won’t address the root cause of the patient’s agitation. In fact, it could increase the patient’s work of breathing and exacerbate his discomfort.

Correct Answer: D. Administer an IV sedative or analgesic

Key Takeaway: In mechanically ventilated patients, sudden agitation, tachycardia, and increased respiratory effort are often signs of pain, anxiety, or inadequate sedation—especially post-surgery. Addressing these symptoms with appropriate sedation or analgesia should always be considered before making changes to ventilator settings.

Question #5

A pre- and post-bronchodilator test was performed on a 48-year-old female patient. After administration of the bronchodilator, her FEV1 increased from 60% to 80% of the predicted value. This indicates which of the following?

A. Fixed airway obstruction
B. Reversible airway obstruction
C. Normal diffusion capacity
D. Restrictive process

Explanation:

To interpret this result, you need to evaluate the change in the patient’s FEV1 (Forced Expiratory Volume in 1 second) before and after bronchodilator administration. The test is used to determine whether airway obstruction is reversible, which is a hallmark of conditions like asthma.

For an airway obstruction to be classified as reversible, the FEV1 must show an increase of at least 12% and a minimum improvement of 200 mL after the bronchodilator. In this case, the patient’s FEV1 increased from 60% to 80%, which represents a 20% increase—well above the threshold.

A fixed obstruction would not show a significant change in FEV1 after bronchodilator use. Diffusion capacity measures gas exchange efficiency in the lungs, which is unrelated to FEV1 changes.

Restrictive lung diseases typically reduce lung volumes, but a bronchodilator would not lead to a marked FEV1 improvement in these conditions.

Correct Answer: B. Reversible airway obstruction

Key Takeaway: When you see a 12% or greater increase in FEV1 after bronchodilator administration, it confirms that the airway obstruction is reversible. This finding is most commonly associated with asthma and helps differentiate it from fixed obstructive conditions like COPD.

Question #6

A 58-year-old female patient is intubated and appears to be breathing asynchronously with the ventilator. Upon assessment, breath sounds are absent on the left side, and the trachea is shifted to the left. Additionally, the patient has a dull percussion note on the left side. What is the most likely explanation for these findings?

A. A tracheoesophageal fistula has developed
B. A tension pneumothorax has developed on the left side
C. The endotracheal tube is in the right mainstem bronchus
D. The patient is experiencing diffuse bronchospasm

Explanation:

To correctly answer this question, it’s essential to interpret the clinical signs provided:

• Absent breath sounds and a dull percussion note on the left side indicate that the left lung is not being adequately ventilated, likely due to collapse or compression.
• The tracheal shift toward the left suggests a volume loss on that side, which pulls the trachea in the same direction.

The most common reason for these findings in an intubated patient is malpositioning of the endotracheal tube. If the tube is inserted too far, it can slip into the right mainstem bronchus, resulting in left-sided atelectasis. This would cause all ventilation to be directed to the right lung, leading to absent breath sounds and reduced lung expansion on the left.

A tracheoesophageal fistula would cause air leakage and possibly gastric distension, but it wouldn’t result in a unilateral absence of breath sounds. A tension pneumothorax would cause hyperresonance on the affected side, not a dull note, and the trachea would shift away from the affected side. Diffuse bronchospasm would present with bilateral wheezing, not absent breath sounds on one side.

Correct Answer: C. The endotracheal tube is in the right mainstem bronchus

Key Takeaway: When an intubated patient has absent breath sounds and a tracheal shift to the same side, suspect atelectasis due to endotracheal tube malpositioning. The first step should be to confirm tube placement, usually by withdrawing the tube slightly and reassessing breath sounds. This will help restore ventilation to both lungs and resolve the issue.

Question #7

A 52-year-old postoperative female patient is receiving volume control SIMV with the following settings:

• Tidal Volume: 450 mL
• Rate: 10/min
• FiO2: 24%
• PEEP: 5 cmH2O

The patient is awake, alert, and ready to be assessed for a spontaneous breathing trial (SBT) but is unable to communicate verbally due to the presence of the endotracheal tube. Which of the following would you recommend for the patient’s SBT?

A. Increase the sedation dosage
B. CPAP with pressure support via ET tube
C. T-piece therapy at 24%
D. Extubate and provide BiPAP via full face mask

Explanation:

To answer this question, it’s essential to understand the purpose of a spontaneous breathing trial (SBT) and the appropriate methods for conducting one. The goal of an SBT is to evaluate the patient’s ability to breathe independently and assess their readiness for extubation.

There are several common methods for conducting a spontaneous breathing trial (SBT). One option is the T-piece trial, where the patient breathes spontaneously through a T-piece connected to a humidified oxygen source. This setup simulates a natural breathing environment without any ventilatory assistance, allowing the patient to work independently.

Another approach is to use CPAP mode without pressure support, which provides a constant baseline airway pressure to maintain alveolar stability but does not add any additional support during inspiration.

A third option is CPAP mode with pressure support, where a small amount of assistance is provided to help the patient overcome the resistance of the endotracheal tube. This is useful for patients who need a slight boost to maintain adequate tidal volumes while still primarily breathing on their own.

The patient mentioned in the question is awake, alert, and recovering from surgery. In most postoperative cases, the need for intubation is temporary and due to anesthesia rather than a primary respiratory issue.

Therefore, a simple T-piece trial with an FiO2 of 24% is the ideal option. It provides enough oxygen support while allowing the patient to breathe independently, making it a straightforward and effective way to assess readiness for extubation.

Sedation is never recommended during an SBT, as the patient must be awake and cooperative to accurately assess their breathing capability.

While CPAP with pressure support can provide assistance, it’s more suited for patients with increased work of breathing or marginal respiratory status. This level of support is unnecessary for a patient who is stable, alert, and likely intubated for surgical reasons.

Extubation should only be performed after a successful SBT, which the patient has not yet completed. Additionally, the question does not indicate that BiPAP is needed.

Correct Answer: C. T-piece therapy at 24%

Key Takeaway: For a stable, postoperative patient who is awake and alert, a T-piece trial is a simple and effective method to assess spontaneous breathing. It provides a minimal support environment, allowing for a proper evaluation of the patient’s readiness to breathe independently and progress toward safe extubation.

Question #8

A respiratory therapist is assisting a physician with the insertion of a chest tube for a patient with a large pleural effusion. During the procedure, the physician creates a 5 cm incision at the fifth intercostal space along the mid-axillary line. After connecting the chest tube to the suction system, the physician notices continuous bubbling in the water seal chamber. What should the respiratory therapist anticipate next?

A. Increase the water seal chamber level to 20 cm
B. Placement of additional sutures around the chest tube
C. Increase the suction regulator setting to greater than -100 cmH2O
D. Insert a new chest tube at the incision site

Explanation:

Continuous bubbling in the water seal chamber is an indication of an air leak. This typically occurs when there is an incomplete seal around the chest tube, often due to a loose connection or an insufficient closure of the insertion site. In this scenario, the large 5 cm incision may be the source of the leak.

The most appropriate next step is to anticipate the placement of additional sutures around the chest tube to secure the site and eliminate the air leak. This should be followed by applying an occlusive dressing to ensure a proper seal, which will stop the bubbling in the water seal chamber.

Adjusting the water level in the seal chamber won’t resolve an air leak and is not a standard intervention for this issue. Increasing suction pressure won’t fix the source of the air leak and could potentially cause lung injury.

There’s no indication that the existing chest tube is malfunctioning. Addressing the air leak at the current site is the appropriate step.

Correct Answer: B. Placement of additional sutures around the chest tube

Key Takeaway: When you notice continuous bubbling in the water seal chamber, it almost always points to an air leak. Check for loose connections, inadequate closure around the chest tube, or potential tube damage. The goal is to secure the insertion site with sutures and apply an occlusive dressing to create a proper seal and eliminate the leak.

Question #9

A female patient weighing 60 kg (132 lb) and standing 165 cm (5 ft 5 in) tall is receiving invasive mechanical ventilation in VC, A/C mode with the following settings:

• FiO2: 0.40
• Mandatory rate: 12
• Total rate: 12
• VT: 380 mL
• PIP: 28 cmH2O
• PEEP: 5 cmH2O

Arterial Blood Gas (ABG) results:

• pH: 7.30
• PaCO2: 50 mmHg
• PaO2: 80 mmHg
• HCO3: 24 mEq/L
• BE: -1 mEq/L
• SaO2: 97%

Which of the following would you recommended?

A. Increase the mandatory rate to 16
B. Increase the VT to 480 mL
C. Increase the PEEP to 8 cmH2O
D. Increase the FiO2 to 0.50

Explanation:

The ABG results indicate respiratory acidosis, as evidenced by a low pH (7.30) and an elevated PaCO2 (50 mmHg). This suggests the patient is hypoventilating, meaning they are not expelling enough CO2.

To correct this, you need to increase minute ventilation, which can be achieved by either increasing the mandatory rate or tidal volume (VT).

The most effective and safest option is to increase the mandatory rate from 12 to 16 breaths per minute. This will increase the total minute ventilation, allowing the patient to expel more CO2 and thereby reducing the PaCO2 levels, which will correct the respiratory acidosis.

While increasing the tidal volume could also help with ventilation, the patient’s current peak inspiratory pressure (PIP) is already 28 cmH2O. Raising the VT could push the PIP higher, increasing the risk of barotrauma or volutrauma. Therefore, it’s better to optimize the rate first.

The patient’s oxygenation (PaO2 of 80 mmHg and SaO2 of 97%) is adequate, so adjusting PEEP is not necessary. Futhermore, there’s no need to increase the FiO2 since the oxygenation is sufficient. The main issue here is ventilation, not oxygenation.

Correct Answer: A. Increase the mandatory rate to 16

Key Takeaway: For patients with respiratory acidosis due to hypoventilation on mechanical ventilation, the priority is to increase minute ventilation. This can be achieved by raising the respiratory rate, which is often safer than increasing the tidal volume in terms of preventing lung injury.

Question #10

A 57-year-old female patient with acute pulmonary edema is dyspneic and shows signs of wheezing. The resident physician has ordered an albuterol breathing treatment via a small-volume nebulizer (SVN). Which of the following would you recommend?

A. Administer acetylcysteine instead of albuterol
B. Perform the therapy with supplemental oxygen
C. Perform the treatment as ordered
D. Administer a diuretic and oxygen therapy

Explanation:

When evaluating this scenario, it’s important to recognize that wheezing in a patient with acute pulmonary edema is typically caused by fluid overload in the lungs, not bronchospasm. This type of wheezing is sometimes referred to as “cardiac wheezing” and is due to fluid accumulating in the airways, not airway constriction.

For patients with acute pulmonary edema, the goal is to reduce the fluid buildup in the lungs. The preferred treatment is a diuretic, such as Lasix (furosemide), which helps eliminate excess fluid from the body.

Additionally, oxygen therapy is indicated to manage hypoxemia, and noninvasive positive pressure ventilation (NPPV), such as BiPAP, is often recommended to support breathing and reduce the work of breathing.

Acetylcysteine is a mucolytic agent that is not appropriate for fluid overload and could worsen airway irritation in this scenario.

While supplemental oxygen is beneficial, albuterol is not indicated in this case, as it treats bronchospasm rather than fluid-related wheezing. Administering albuterol won’t address the underlying issue of pulmonary edema and may not improve the patient’s symptoms.

Correct Answer: D. Administer a diuretic and oxygen therapy

Key Takeaway: When treating acute pulmonary edema with associated wheezing, always consider the underlying cause. In these cases, the priority is to reduce the fluid overload with a diuretic and support oxygenation. Administering albuterol may seem intuitive due to the wheezing, but it does not address the primary issue, which is why a diuretic is the appropriate treatment.

Final Thoughts

The TMC Exam is known for being challenging, but with the right approach, you can go into exam day feeling confident and prepared. The key to success is not just memorizing facts—it’s about truly understanding the material and knowing how to apply it in clinical settings.

To get there, you need a solid study plan that includes regular review, asking questions whenever you’re unsure, and practicing with high-quality practice questions—like the ones in this article.

For even more in-depth preparation, consider getting access to our TMC Test Bank, where you’ll gain access to hundreds of premium practice questions, quizzes, and full-length practice exams that have helped thousands of students succeed on the TMC Exam.

The more you practice, the stronger your grasp of the material will become. Going through sample questions and mock exams will help you build familiarity with the types of questions you’ll see on the real test, boosting your confidence and sharpening your critical thinking skills.

Remember, the TMC Exam is just one step on your path to becoming a respiratory therapist. With consistent effort and a focused mindset, you’ll be well on your way to achieving your goal.