Sample TMC Practice Questions (with Rationale Explanations)

Top 10 Sample TMC Practice Questions and Explanations (2024)

by | Updated: May 29, 2024

The TMC Exam is an obstacle that students must overcome to become a respiratory therapist. The exam covers a wide range of topics, including:

To be fully prepared, you must develop a deep understanding of these subjects and be able to apply them in a clinical setting. One effective strategy to do so is to use practice questions to help your brain master the essential topics.

We created this article to help!

Below you will find a comprehensive set of sample questions to test your knowledge and help you get a sense of what to expect on exam day.

By working through these questions and studying the accompanying explanations, you’ll be able to confidently approach the TMC Exam and increase your chances of earning a passing score.

So let’s dive in and take a step closer to achieving your goal of becoming a registered respiratory therapist (RRT).

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1. 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

To get this one correct, you needed to interpret ALL information provided in the question. This is a common question format that you’ll see on the TMC Exam.

The question states that the patient has reduced chest expansion, a hyperresonant percussion note, and absent breath sounds on the left side. It also points out a tracheal shift to the right.

All of these suggest that the patient has a pneumothorax on the left side.

Remember: The trachea will shift away from the affected side when a pneumothorax is present. Therefore, you can rule out left-sided atelectasis because, if that were the case, the trachea would shift to that side.

Pleural effusion and consolidation would cause a dull percussion note, not a hyperresonant note. So, we can also rule those two out as well.

The correct answer is: B. Pneumothorax on the left side

2. 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?
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

To get this one correct, you needed to recognize that the patient has some type of infection (e.g., pneumonia).

You know this because the question states that the patient is hypoxemic, has a fever, and has rhonchi on auscultation.

So, in this case, you should obtain a sputum sample for culture and sensitivity to identify the type of organism that is present. Additionally, oxygen therapy would be indicated to treat the patient’s hypoxemia.

Intubation and NPPV would not be indicated in this case, and postural drainage and percussion would also not be recommended.

The correct answer is: D. Provide oxygen therapy and obtain a sputum sample for culture and sensitivity

3. 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

To get this one correct, you needed to know the normal values for cuff pressure. And in this case, you needed to recognize that 38 cmH2O is way too high and could potentially be dangerous for the patient.

Therefore, your first action should be to lower the cuff pressure to < 30 cmH2O and then check to ensure there are no leaks.

For the TMC Exam, you must remember that the normal range for cuff pressure is between 20–30 cmH2O.

In this case, there is no indication to withdraw the tube, and using a smaller tube would only cause the patient’s peak pressure to increase, which is something that we do not want.

Furthermore, there is nothing in the question that suggests a tracheostomy is indicated, so we can rule that one out as well.

The correct answer is: C. Lower the cuff pressure to < 30 cmH2O

4. 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

If you’ve ever accidentally stepped on the tubing of a bubble humidifier while being used, you will automatically recognize that the correct answer is A.

The relief valve of a bubble humidifier was designed to sound whenever the pressure in the reservoir container exceeds the valve’s threshold pressure, resulting in a loud, whistling noise.

And, of course, the most common reason for this to occur is when there is a downstream obstruction to outflow.

The correct answer is: A. There is an obstruction in the delivery tube

5. 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
C. Normal diffusion capacity
D. Restrictive process

The information given in the question suggests that the patient’s airway obstruction was somewhat relieved after the bronchodilator was given. We know this because their FEV1 increased from 60% to 80% of the predicted value.

Was the increase enough to classify it as a reversible obstruction?

Remember: If the patient’s pre-to-post values increase by at least 12%, you know that the treatment was effective.

So, in this case, there was a 20% increase, which means that; yes, the improvement was enough to interpret the patient’s condition as a reversible airway obstruction.

The correct answer is: B. Reversible airway obstruction

6. A 58-year-old female patient is intubated and appears to be breathing asynchronously with the ventilator. Her breath sounds are absent on the left side, and the trachea is shifted to the left. The patient has a dull percussion note on the left side as well. Which of the following 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

To get this one correct, you needed to be able to interpret the information that was provided in the question.

It states that the patient has a dull percussion note on the left side, a tracheal shift toward the left side, and absent breath sounds on the left side. Therefore, you needed to recognize that these are all signs of atelectasis.

So, now you have to think, “what could possibly be the cause of this atelectasis?”

And in this case, the endotracheal tube has likely slipped into the right mainstem bronchus, which has resulted in left-sided atelectasis.

Diffuse bronchospasm would cause bilateral wheezing, and a left-sided pneumothorax would cause a hyperresonant percussion note, not a dull percussion note.

The correct answer is: C. The endotracheal tube is in the right mainstem bronchus

7. A 63-year-old female patient is intubated and receiving mechanical ventilation in the pressure-controlled A/C mode. If the patient’s compliance were to decrease, which of the following would you expect to occur?
A. The delivered volume will decrease
B. The peak pressure will increase
C. The inspiratory time will increase
D. The PEEP level will decrease

To get this one correct, you needed to have a basic understanding of lung compliance. You also needed to recognize that the pressure level is preset because the ventilator is in a pressure-controlled mode.

If there is a decrease in lung compliance when the ventilator is operating in pressure control, the machine will continue delivering a constant pressure.

But, since the lungs don’t expand as much when there is decreased compliance, it reaches the preset pressure limit much faster.

This means that there will be a decrease in the delivered tidal volume.

Also, in this case, the inspiratory time would decrease, and the PEEP levels would not be affected.

The correct answer is: A. The delivered volume will decrease

8. A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume-controlled A/C mode. After performing endotracheal suctioning, which of the following would indicate the effective clearance of retained secretions?
A. An increased tidal volume
B. A decreased inspiratory time
C. A decreased plateau pressure
D. A decreased peak pressure

In general, you should remember that retained secretions will increase the patient’s airway resistance and peak airway pressure during volume-controlled ventilation.

So, taking that into consideration, if you were to clear the secretions via suctioning, that should decrease the patient’s peak airway pressure.

On the other hand, if the patient had been receiving pressure-controlled ventilation, you would expect an increase in delivered volume once the secretions were cleared.

That is the key tidbit that you needed to recognize in order to answer this question correctly.

In other words, you needed to understand the difference between volume and pressure-controlled ventilation.

The correct answer is: D. A decreased peak pressure

9. An adult patient who is receiving mechanical ventilation suddenly started showing signs of tachypnea. Upon assessment, you noticed tracheal deviation to the right and decreased breath sounds and hyperresonance on the left side. Which of the following would you recommend?
A. Endotracheal suctioning
B. Flexible bronchoscopy
C. The insertion of a chest tube
D. Thoracentesis

For this question, you needed to be able to interpret the signs and symptoms that were given in the question. And by doing so, you could easily determine that all of the signs are consistent with a pneumothorax.

Remember: Patients with a pneumothorax will typically show signs of tracheal deviation away from the affected side.

They will also have decreased breath sounds and hyperresonance on the affected side.

Therefore, to treat a pneumothorax, you should recommend the immediate insertion of a chest tube on the affected side.

The correct answer is: C. The insertion of a chest tube

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 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

Once you start your career and begin working as a respiratory therapist, this is something you will run into far too often.

A nurse or new physician will hear wheezing while listening to breath sounds and automatically request you to administer an albuterol breathing treatment.

This can be frustrating because wheezing in patients with CHF and pulmonary edema is usually due to fluid overload, not bronchospasm.

Therefore, in general, acute pulmonary edema is best managed with a diuretic agent, such as Lasix.

Oxygen therapy is also usually indicated due to the presence of hypoxemia. And in general, NPPV (e.g., BiPAP) is typically indicated for these patients.

The correct answer is: D. Administer a diuretic and oxygen therapy

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Final Thoughts

There’s no denying that the TMC Exam is a challenging test, but with the right preparation, you can feel confident and ready on exam day. The key to success on the TMC Exam is to understand the material thoroughly and be able to apply it in real-world scenarios.

To achieve this, it is important to study often, ask questions when you are unsure, and practice with sample questions like the ones provided here in this article.

Check out our TMC Test Bank to access hundreds of premium practice questions, quizzes, and practice exams that thousands of students have used to pass the TMC Exam.

The more you practice, the better you will become at understanding the material and applying it in real-world scenarios. Practicing with sample questions and mock exams will give you a feel for the types of questions you may encounter on the real thing.

Remember, the TMC Exam is just one step in your journey towards becoming a respiratory therapist, and with hard work and dedication, you can reach your goal. Best of luck!

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

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

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Chang, David. Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013.
  • Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019.
  • Faarc, Cairo J. PhD Rrt. Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017.
  • Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
  • Faarc, Heuer Al PhD Mba Rrt Rpft. Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017.
  • Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019.
  • Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
  • Faarc, Mottram Carl Ba Rrt Rpft. Ruppel’s Manual of Pulmonary Function Testing. 11th ed., Mosby, 2017.
  • Faarc, Walsh Brian Rrt-Nps Accs. Neonatal and Pediatric Respiratory Care. 5th ed., Saunders, 2018.

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