Respiratory Therapist Multiple Choice Exam Questions (2023)

Each respiratory therapy student must pass the Therapist Multiple-Choice (TMC) Examination to become a licensed respiratory therapist. It’s the national certification exam administered by the National Board for Respiratory Care (NBRC).

The format of the TMC Exam is multiple-choice, with 160 questions that must be completed within three hours.

Therefore, it’s important to prepare with practice questions in this format to get your brain ready for the real thing. This guide has sample review questions that can help. Be sure to access the free guide if you want to check the correct answers. 

Respiratory Therapist Review Practice Questions for the TMC Exam:

1. An adult male patient on ventilatory support has just been intubated with a 7.0 mm oral endotracheal tube equipped with a high residual volume low-pressure cuff. When sealing the cuff to achieve a minimal occluding volume, you note a cuff pressure of 45 cm H20 What is the most likely problem?
A. The cuff pilot balloon and line is obstructed
B. The pressure manometer is out of calibration
C. The tube chosen is too small for the patient
D. The tube is in the right mainstem bronchus

2. To achieve the highest O2 concentration, you would select which of the following devices?
A. Venturi mask
B. Face tent
C. Nonrebreathing mask
D. Simple oxygen mask

3. You are asked to position a patient for orotracheal intubation You should place the patient’s head:
A. In the sniffing position
B. Straight with the torso, with the neck hyperextended
C. Tilted forward toward the chest
D. Turned to the right, with the neck hyperextended

4. What maximum flow would you apply to an 8 year-old child receiving O2 therapy via a high flow nasal cannula?
A. 5 L/min
B. 10 L/min
C. 15 L/min
D. 20 L/min

5. A patient is intubated with an appropriate size endotracheal tube and is being ventilated with a positive pressure ventilator. During inspiration, air is heard at the mouth. Which of the following should be done?
A. Check the cuff inflation
B. Suction the patient
C. Order a chest X-ray
D. Replace the tube

6. A galvanic oxygen analyzer is being used to monitor a mechanically ventilated patient The patient is receiving 100% oxygen, and the analyzer registers 104%. Which of the following is the most likely cause for this?
A. The analyzer requires calibration
B. The analyzer probe has water condensation on its surface
C. The ventilator’s blending unit requires adjustment
D. The batteries in the analyzer need to be changed

7. A patient has a pH of 7.58 and a PaCO2 of 25 torr. Based on these data, what is the primary acid-base disturbance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis

8. To change the level of negative pressure delivered by a pleural drainage system, you would
A. Adjust the vacuum level on the suction regulator
B. Adjust the water level in the suction control chamber
C. Adjust the water level in the water seal chamber
D. Adjust the size of the atmospheric vent

9. During a single-breath capnogram, the sharp downstroke and return to baseline that normally occurs after the end-tidal point indicate:
A. Exhalation of mainly deadspace gas
B. Inspiration of fresh respiratory gas
C. Exhalation of mixed alveolar/deadspace gas
D. Exhalation of mainly alveolar gas

10. Bedside spirometry performed on a patient reveals the following: Respiratory rate = 22 Tidal volume = 360 mL Dead space = 150 mL Inspiratory capacity = 1.0 L Based on these data, what is the patient’s minute ventilation?
A. 3.3 L/min
B. 4.6 L/min
C. 7.9 L/min
D. 22.0 L/min

11. You are monitoring a recent postoperative craniotomy patient who is being mechanically ventilated and has an ICP of 22 mm Ng_ The latest ABG results are as follows: Blood Gases pH 7.35 PaCO2 47 mm Hg HCO3 25 mEq/L BE 0 Pa02 89 mm Hg Sa02 96% Based on this information, which of the following is the most acceptable action?
A. Maintain the current settings
B. Decrease the tidal volume
C. Increase the minute ventilation
D. Add 10 cm H20 PEEP

12. Oropharyngeal and nasopharyngeal airways helps restore airway patency by:
A. Providing a secure route into the larynx and trachea
B. Separating the tongue from the posterior pharyngeal wall
C. Isolating/protecting the lower airway from aspiration
D. Displacing the soft palate and uvula posteriorly

13. In patients with chronic respiratory disease, pedal edema is a sign of:
A. Impaired pulmonary diffusion
B. Hypercapnia (impaired CO2 removal)
C. Right ventricular hypertrophy
D. Systemic hypertension

14. You observe the following on the bedside capnograph display of a patient receiving ventilatory support. What is your interpretation of this display data?
A. The capnograrn indicates hyperventilation
B. The capnogram indicates rebreathing
C. The capnograrn indicates a leak around the E I tube
D. The capnograrri indicates hypoventilation

15. Which of the following is the best way to avoid bright lights interfering with a pulse oximeter’s signal?
A. Recheck and clean the site
B. Shield or cover the probe
C. Apply the probe more tightly
D. Replace the probe

16. You hear a high-pitched sound coming from the pressure relief valve on a patient’s bubble-type humidifier. Gas can be felt coming from the valve. Which of the following could cause this problem? 1. the O2 delivery tubing is obstructed 2. the O2 flow is too high 3. the water reservoir jar lid is screwed on too tightly 4. the water reservoir jar lid is missing an O-ring
A. 1 and 3 only
B. 2 and 4 only
C. 1 and 4 only
D. 1 and 2 only

17. A patient rescued from a house fire is being monitored in the intensive care unit Due to suspected CO poisoning, the patient is on a nonrebreathing mask at 12 L/min. A pulse oximeter reveals an Sp02 of 99%. An arterial blood sample is obtained and sent to the laboratory for gas analysis and hemoximetry (CO-oximetry). The lab results are as follows: Blood Gas Analysis pH 7.26, PaCO2 34 mm Hg, Pa02 350 mm Hg, HCO3 10 mEq/L, Sa02 100%, BE13 mEq/L, Hemoximetry Hb02% 79% COH1D% 19%, MetH1D% 2%. Which result(s) give the best indication of the patient’s oxygenation?
A. Sa02
B. Hb02%
C. Sp02
D. Pa02

18. Normally, an individual can maintain about what percent of their maximum voluntary ventilation (MVV) on maximum exercise?
A. 60-70%
B. 70-80%
C. 80-90%
D. 90-100%

19. Which one of the following is NOT required on a patient’s drug prescription?
A. Patient’s name
B. Drug name and dose
C. Frequency of administration
D. Contraindications

20. To minimize the risk of aspiration of glottic secretions or cord damage during removal of an oral endotracheal tube, you should
A. Have the patient cough while you quickly pull the tube
B. Provide 100% oxygen for 1-2 minute before extubation
C. Keep the tube cuff pressure below 25-30 cm H20
D. Fully occlude the ET tube while you quickly it out

21. Which of the following would provide the best bedside assessment of the need for mechanical ventilation in a patient with Guillain-Barre syndrome?
A. FRC
B. VC
C. Airway resistance
D. TLC

22. Which of the following is false regarding switching from an esophageal-tracheal Combitube® (ETC) to an oral endotracheal tube?
A. The equipment needed is the same as for endotracheal intubation
B. The patient’s stomach contents should be aspirate through the 42 tube
C. The body of the tube normally must be positioned in the trachea
D. The large 41 pharyngeal cuff must be deflated before laryngoscopy

23. The radial site is preferred for arterial puncture or cannulation because:
A. The radial artery is the most superficial artery available
B. Other available arteries are too small to easily puncture
C. The radial artery has the highest systolic pressure available
D. Collateral circulation is provided through the ulnar artery

24. Directed coughing is useful in helping maintain bronchial hygiene in all of the following patients categories EXCEPT:
A. Bronchiectasis
B. Acute asthma
C. Cystic fibrosis
D. Spinal cord injury

25. While using an ICU ventilator with its optional air compressor running, you note that the low air pressure alarm suddenly sounds. Which of the following would the best initial action in this situation? 1. adjust and analyze FIO2 2. connect to a 50 psig air source 3. replace the air compressor filters 4. replace the air compressor
A. 1 only
B. 2 only
C. 2 and 4 only
D. 3 and 4 only

26. The normal apical impulse (PMI) usually is identified where?
A. 3rd right intercostal space, left sternal border
B. 3rd left intercostal space, anterior axillary line
C. 5th right intercostal space, midclavicular line
D. 5th left intercostal space, midclavicular line

27. Proper technique in the auscultatory method of measuring blood pressure includes which of the following? 1. inflate the cuff to 30 mm Hg above brachial pulse stoppage 2. place the lower cuff edge 3 inches above the antecubital fossa 3. deflate the cuff at a rate of 2 to 3 mm Hg per second 4. place bell of stethoscope over the brachial artery
A. 1 and 3 only
B. 1, 2 and 3 only
C. 1, 3 and 4 only
D. 1, 2, 3 and 4

28. In reviewing the chart of a 55 year old male patient, you note the following symptoms: obesity, loud snoring and insomnia. These findings are most consistent with which of the following diagnoses?
A. Pulmonary emphysema
B. Acute asthma
C. Gullian-Barre syndrome
D. Obstructive sleep apnea

29. During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far?
A. Until the proximal (mouth) end of the tube is at the teeth
B. Just far enough so that the tube cuff is no longer visible
C. Until its cuff has passed the cords by two to three inches
D. Until its cuff has passed the cords by two to three centimeters

30. Which of the following endotracheal tube malfunctions could require extubation and reintubation with a new tube to allow effective positive pressure ventilation of the patient? 1. a large leak in the cuff of the tube 2. obstruction of the tube that is unrelieved by suctioning 3. separation of the pilot tube from the endotracheal tube cuff
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1 2 and 3

31. When inspecting the X-ray of an out-patient with nephrotic syndrome, you note a homogeneous area of increased density that obscures the left costophrenic angle. Which of the following is the most likely problem?
A. Pleural effusion
B. Bacterial pneumonia
C. Pulmonary edema
D. Atelectasis

32. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

33. The following figure is a statistical quality control plot for PCO2 measurements made by a blood gas analyzer using a control value of 40 mmHg. The horizontal (x) axis depicts 8-hour shifts. The vertical (y) axis is PCO2 level, with 38-42 representing + 2 standard deviations. What type of error is represented by the series of points labeled ‘B on the plot?
A. Instrument bias
B. Computation error
C. Instrument imprecision
D. Random error

34. A patient’s response to an interview question is initially vague or unclear. Which of the following responses on your part would be most appropriate?
A. “Please go on”
B. “You seem to be anxious”
C. “I see why you are so upset”
D. “Please explain that to me again”

35. Which of the following humidification devices would be appropriate for a patient receiving nasal oxygen therapy at 6 Limn?
A. Unheated bubble humidifier
B. Heated wick-type humidifier
C. Heat and moisture exchanger (HME)
D. Large volume jet nebulizer

36. A 68 year-old female patient with severe COPD has been provided with educational materials describing essential self-management activities to help her control her disease. Which of the following additional support measures would you consider recommending? 1. counseling/behavior modification interventions 2. telephonic follow-up and/or home health visits 3. social services to address self-management barriers
A. 1 only
B. 1 and 2
C. 2 and 3
D. 1, 2 and 3

37. Which of the following best describe the key rationale for intubating nasally rather than orally’?
A. Nasal tubes are less likely to cause trauma
B. Nasal tubes offer less resistance to gas flow
C. Nasal tubes are less likely to cause infection
D. Nasal tubes are better tolerated by the patients

38. A patient’s respirations are characterized by a gradual increase and then a gradual decrease in the depth of breathing, followed by a period of apnea. This pattern is known as which of the following?
A. Blot’s breathing Ai
B. Cheyne-Stokes breathing
C. Kussmaul’s breathing
D. Apneustic breathing

39. All of the following would be essential medication history information to obtain for a patient admitted for an acute exacerbation of asthma EXCEPT:
A. Frequency of rescue inhaler usage
B. Use of generic vs brand name medications
C. Patient understanding of controllers vs_ relievers
D. Self-administration techniques

40. The use of pursed-lip breathing during exhalation would be most common among which of the following patient groups?
A. Diffuse interstitial fibrosis
B. Consolidation of lung tissue
C. Chronic airways obstruction
D. Acute upper airway obstruction

41. Which of the following are acceptable changes in patient status during a traditional T-tube weaning trial? I. an increase in respiratory rates of 20/min II. an increase in cardiac rate of 15/min III. a 5 mm Hg rise in the arterial PCO2 IV. the development of paradoxical breathing
A. II and IV only
B. I, ll and Ill only
C. II and III only
D. I, II, Ill and IV

42. If the rate of breathing increases without any change in total minute ventilation (VE constant):
A. The alveolar ventilation per minute will increase
B. The alveolar ventilation per minute will decrease
C. The deadspace ventilation per minute will decrease
D. The alveolar ventilation per minute will remain constant

43. All of the following cause false HIGH Sp02 readings when using a pulse oximeter EXCEPT
A. Dark nail polish
B. Intravenous dyes
C. Carboxyhemoglobin
D. Bright ambient light

44. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

45. A COPD patient is receiving sustained-release theophylline Adverse effects of this therapy that you should be on guard for include all of the following EXCEPT:
A. Cardiac arrhythmias
B. Nausea/vomiting
C. Hyperkalemia
D. Restlessness and tremors

46. Incentive spirometry is ordered for a female patient after abdominal surgery_ Which of the following statements would be the most appropriate initial explanation of the therapy?
A. “Your doctor has ordered this therapy to prevent atelectasis.”
B. “We are trying to improve your lung volume”
C. “This therapy will help you take deep breaths and expand your lungs”
D. “You may experience pain and lightheadedness from this therapy”

47. Following a myocardial infarction, a 60-year-old patient with congestive heart failure is being mechanically ventilated. The patient’s blood pressure is 95/60 mm Hg. Ventilator settings are as follows: FIO2 0.45 Rate 12 Tidal volume 600 mL PEEP 12 cm H20 While awaiting blood gas results, you obtain an Sp02 of 78%. Which of the following actions would you take at this time?
A. Increase the F102 to 1.0
B. Decrease the rate to 6
C. Increase the PEEP to 16 cm H20
D. Initiate inverse ratio ventilation

48. Which of the following statements regarding CENTRAL cyanosis is FALSE?
A. It is an unreliable indicator of hypoxemia and hypoxia
B. It is best observed in the capillaries of the lips and gums
C. It results from excessive reduced Hb in the venous blood
D. It may occur even in the presence of adequate O2 delivery

49. Which of the following are FALSE regarding oropharyngeal airways?
A. Incorrect placement can worsen airway obstruction
B. They are contraindicated for use with infants and children
C. They all consist of a flange, body and channel(s)
D. They should only be used by trained personnel

50. Which of the following is the most common problem associated with the removal of an esophageal obturator airway?
A. Tracheomalacia
B. Gastric insufflation
C. Aspiration
D. Esophageal bleeding

51. A patient has a minute volume of 7.50 L/min and is breathing at a rate of 16 breaths/min. What is his average tidal volume?
A. 120 mL
B. 215 mL
C. 350 mL
D. 470 mL

52. To minimize the risk of aspiration of glottic secretions or cord damage during the removal of an oral endotracheal tube, you should:
A. Have the patient cough while you quickly pull the tube
B. Provide 100% oxygen for 1-2 minute before extubation
C. Keep the tube cuff pressure below 25-30 cm H20
D. Fully occlude the ET tube while you quickly pull it out

53. Which of the following is false regarding switching from an esophageal-tracheal Combitube® (ETC) to an oral endotracheal tube?
A. The equipment needed is the same as for endotracheal intubation
B. The patient’s stomach contents should be aspirate through the #2 tube
C. The body of the tube normally must be positioned in the trachea
D. The large #1 pharyngeal cuff must be deflated before laryngoscopy

54. All of the following are common causes of fluid overload (overhydration) in patients EXCEPT:
A. Congestive heart failure
B. Hemorrhage
C. Renal failure
D. Overinfusion of fluids

55. At rest, the normal tidal movement of the diaphragm is approximately:
A. 6-10 cm
B. 1-2 cm
C. 30-40 cm
D. 6-10 in

56. A physician has requested your assistance in extubating an orally intubated patient. Which of the following should be done BEFORE the tube itself is removed? 1. suction the pharynx 2. preoxygenate the patient 3. confirm cuff inflation 4. suction the ET tube
A. 2 and 4 only
B. 1, 2 and 4 only
C. 3 and 4 only
D. 1, 2, 3 and 4

57. A patient suddenly loses consciousness. Which of the following is the first procedure you should perform to maintain an open airway in this patient?
A. Inserting a laryngeal mask airway
B. Applying the “jaw thrust” maneuver
C. Inserting an oropharyngeal airway
D. Applying the “head-tilt/chin-lift” maneuver

58. When open to the atmosphere, a manometer calibrated in cm H2O units should read:
A. 0 cm H2O
B. 1 atmosphere
C. 760 cm H2O
D. 1034 cm H2O

59. A patient has a pH of 7.58 and a PaCO2 of 25 torr. Based on these data, what is the primary acid-base disturbance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Metabolic alkalosis

60. The methylene blue test is used to confirm:
A. Tracheal granuloma
B. “leakage” type aspiration
C. Infection with pneumococcus
D. Artificial airway obstruction

61. Bronchial breath sounds heard over the periphery indicate
A. Normal lungs
B. Lung consolidation
C. Small airways obstruction
D. Acute bronchospasm

62. Which of the following endotracheal tube malfunctions could require extubation and reintubation with a new tube to allow effective positive pressure ventilation of the patient? 1. a large leak in the cuff of the tube 2, obstruction of the tube that is unrelieved by suctioning 3. separation of the pilot tube from the endotracheal tube cuff
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2 and 3

63. While assessing the endotracheal tube cuff pressure in an intubated patient, you confirm a leak at 18 cm H20 throughout most of inspiration. You should:
A. Add air to the cuff until a minimal leak is heard
B. Reassess the cuff pressure during expiration
C. Replace the endotracheal tube with a larger size
D. Inflate cuff until the leak ceases at < 25-30 cm H20

64. A patient has a minute volume of 7.50 L/min and is breathing at a rate of 16 breaths/min. What is his average tidal volume?
A. 120 mL
B. 215 mL
C. 350 mL
D. 470 mL

65. In most blood gas analyzers, what media is used to calibrate the pH electrode?
A. Tonometered whole blood samples
B. Commercial calibration control media
C. Precision gas mixtures (02/002)
D. Standardized buffer solutions

66. Which of the following is the approximate total output flow delivered from a 40% air-entrainment mask operating at 12 L/min?
A. 12 L/min
B. 48 L/min
C. 52 L/min
D. 72 L/min

67. Which of the following parameters is affected when the air-mix control is changed to 100% oxygen on a pneumatically-powered IPPB device?
A. Pressure
B. Sensitivity
C. Peak flow
D. Nebulization

68. The proper positioning of an endotracheal tube in an adult is confirmed by which of the following?
A. 21-23 cm marks at teeth
B. Adequate airway seal
C. Chest X-ray
D. Neutral head position

69. When inspecting the x-ray of a patient in ICU, you note a large area of radiolucency between the left lung border and chest wall and increased density of left lung. Which of the following is the most likely problem?
A. Pleural effusion
B. Pneumomediastinum
C. Pneumothorax
D. Interstitial infiltration

70. Which of the following would deliver the most particulate water to a patient’s airway?
A. A bubble humidifier
B. A wick humidifier
C. An ultrasonic nebulizer
D. A jet nebulizer

71. On a pneumatically-powered IPPB device, switching the air-mix control to 100% oxygen will have which of the following effects on flow?
A. Make the flow dependent on patient effort
B. Decrease the flow to a lower level
C. Increase the flow to a higher level
D. The change will have no effect on flow

72. Rule-based procedures designed to help detect, respond to and correct blood gas analyzer or hemoximeter errors over time best describe:
A. Statistical quality control
B. Machine calibration
C. Preventive maintenance
D. Control media verification

73. To avoid preanalytic errors associated with air contamination of a blood gas sample, all of the following are appropriate EXCEPT:
A. Fully expel any bubbles
B. Mix only after bubbles expelled
C. Cap the syringe quickly
D. Place sample in ice slush

Final Thoughts

One thing is certain: The TMC Exam is definitely not easy! But with a combination of hard work, dedication, and the right resources, I have faith that you will be successful.

Hopefully, the practice questions in this guide can help.

If you want more, definitely consider getting access to our TMC Test Bank, which students are using to increase their TMC Exam scores.

Thanks for reading, and I wish you the best of luck!