NBRC Therapist Multiple-Choice (TMC) Examination — Questions and Answers

Question 1: Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?

Fluid volume excess
Risk for infection
Alteration in tissue perfusion
Risk for injury (Correct answer)

Correct answer: Risk for injury

Sedative-hypnotics cause CNS depression. putting the patient at risk for injury.

Question 2: An older female patient visits the doctor due to sleep issues. What could be the reason behind her sleep?

None of the above.
Older age decreases the amount of REM sleep naturally (Correct answer)
Regularly drinking alcohol increases the chances of good sleep.
Exercising increases the amount REM sleep

Correct answer: Older age decreases the amount of REM sleep naturally

As people age, there is a natural decrease in the amount of REM (Rapid Eye Movement) sleep they experience. REM sleep is a stage of sleep associated with dreaming and is important for cognitive function and memory consolidation. This decrease in REM sleep can lead to sleep issues, such as difficulty falling asleep or staying asleep throughout the night. Therefore, the reason behind the older female patient's sleep issues could be the natural decrease in REM sleep that occurs with age.

Question 3: Oxygen is primarily transported in the blood by:

As bicarbonate ions
Bound to hemoglobin (Correct answer)
Bound to albumin
Dissolved in plasma

Correct answer: Bound to hemoglobin

Approximately 97–98% of oxygen is transported bound to hemoglobin as oxyhemoglobin; only a small fraction dissolves in plasma.

Question 4: Septic shock is defined as sepsis PLUS:

WBC count above 20,000
Temperature above 39°C
MAP <65 mmHg despite adequate fluid resuscitation requiring vasopressors, with lactate >2 mmol/L (Correct answer)
PaO2/FiO2 ratio below 300

Correct answer: MAP <65 mmHg despite adequate fluid resuscitation requiring vasopressors, with lactate >2 mmol/L

Septic shock (Sepsis-3 definition) requires vasopressor use to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.

Question 5: Meconium aspiration syndrome (MAS) occurs when:

Group B streptococcus causes neonatal pneumonia
Persistent pulmonary hypertension develops without meconium
Premature birth causes surfactant deficiency
Meconium-stained amniotic fluid is inhaled, causing airway obstruction and inflammation (Correct answer)

Correct answer: Meconium-stained amniotic fluid is inhaled, causing airway obstruction and inflammation

MAS results from aspiration of meconium-stained amniotic fluid, causing chemical pneumonitis, mechanical obstruction, and surfactant inactivation, often in term or post-term infants.

Question 6: Which of the following is the best nursing advice to promote better sleep in kids?

Encourage that kids participate in some leisure activities
Increase screen time before going to sleep
Ensure that the meal is healthy & the room is quite for good sleep (Correct answer)
All of the above

Correct answer: Ensure that the meal is healthy & the room is quite for good sleep

The best nursing advice to promote better sleep in kids is to ensure that the meal is healthy and the room is quiet. A healthy meal can help regulate blood sugar levels and provide essential nutrients for better sleep. A quiet room creates a calm and peaceful environment, reducing distractions and promoting relaxation. Increasing screen time before sleep can have a negative impact on sleep quality, as the blue light emitted from screens can disrupt the production of melatonin, a hormone that regulates sleep. Encouraging kids to participate in leisure activities can be beneficial, but it is not specifically related to promoting better sleep.

Question 7: In examining your patient, you notice that she has greatly diminished breath sounds in her right lower lobe, and her trachea has shifted to the right. These signs indicate which condition?

Right-sided pneumothorax
Left-sided pneumonia
Left-sided pneumothorax
Right-sided atelectasis (Correct answer)

Correct answer: Right-sided atelectasis

Diminished breath sounds and a shift in the trachea to the affected side are indicative of atelectasis, which is the collapse or closure of a lung or part of a lung. In this case, the patient's symptoms suggest right-sided atelectasis, as the breath sounds are diminished in the right lower lobe and the trachea is shifted to the right. Atelectasis can be caused by various factors, such as blockage of the airway, compression of the lung, or surfactant deficiency.

Question 8: The normal arterial pH range is:

7.30–7.35
7.35–7.45 (Correct answer)
7.20–7.30
7.45–7.55

Correct answer: 7.35–7.45

Arterial blood pH is normally maintained between 7.35 and 7.45 by respiratory and renal buffering mechanisms.

Question 9: An RT reviews a patient's chart and notes a P/F ratio of 180 mmHg on FiO2 of 0.60. According to the Berlin Definition, this represents:

Mild ARDS
Severe ARDS
Moderate ARDS (Correct answer)
Acute lung injury (ALI), not ARDS

Correct answer: Moderate ARDS

The Berlin Definition classifies ARDS as mild (P/F 200–300), moderate (P/F 100–200), or severe (P/F < 100), all requiring PEEP ≥ 5 cmH2O.

Question 10: Apnea of prematurity is defined as cessation of breathing for more than:

10 seconds or 20 seconds with associated bradycardia or desaturation (Correct answer)
30 seconds regardless of other signs
5 seconds with bradycardia
60 seconds only

Correct answer: 10 seconds or 20 seconds with associated bradycardia or desaturation

Apnea of prematurity is defined as breathing cessation ≥20 seconds, or a shorter pause accompanied by bradycardia (<100 bpm) or oxygen desaturation.

Question 11: Synchronized intermittent mandatory ventilation (SIMV) delivers mandatory breaths that are:

Asynchronous with patient effort
Only pressure-controlled
Independent of set respiratory rate
Synchronized to patient inspiratory effort when present (Correct answer)

Correct answer: Synchronized to patient inspiratory effort when present

SIMV attempts to time mandatory breaths to coincide with the patient's own inspiratory effort to reduce patient-ventilator asynchrony.

Question 12: The functional residual capacity (FRC) is the sum of which two lung volumes?

Tidal volume and inspiratory reserve volume
Vital capacity and residual volume
Expiratory reserve volume and residual volume (Correct answer)
Inspiratory capacity and residual volume

Correct answer: Expiratory reserve volume and residual volume

FRC equals expiratory reserve volume (ERV) plus residual volume (RV), representing the lung volume remaining after a passive exhalation.

Question 13: A candidate who fails the RRT-ACCS examination on the first attempt may retest after:

6 months
90 days (Correct answer)
30 days
1 year

Correct answer: 90 days

NBRC policy requires a 90-day waiting period before retesting after a failed specialty examination attempt.

Question 14: Which lung zone, according to the West zones model, has the greatest blood flow?

Zone 3 (base) (Correct answer)
Zone 4 (extreme base)
Zone 2 (mid-lung)
Zone 1 (apex)

Correct answer: Zone 3 (base)

Zone 3 (base) has the greatest blood flow because both arterial and venous pressures exceed alveolar pressure, keeping pulmonary capillaries continuously open.

Question 15: Inhaled nitric oxide (iNO) is used therapeutically to produce which primary effect?

Decreased pulmonary secretions
Selective pulmonary vasodilation (Correct answer)
Systemic vasodilation
Bronchodilation

Correct answer: Selective pulmonary vasodilation

Inhaled nitric oxide selectively dilates pulmonary vasculature in ventilated lung regions by activating guanylate cyclase; it is rapidly inactivated by hemoglobin, preventing systemic effects.

Question 16: Which NBRC credential is most appropriate for an RT specializing in diagnosing and managing sleep-disordered breathing?

ACCS (Adult Critical Care Specialist)
SDS (Sleep Disorders Specialist) (Correct answer)
NPS (Neonatal/Pediatric Specialist)
RPFT (Registered Pulmonary Function Technologist)

Correct answer: SDS (Sleep Disorders Specialist)

The RRT-SDS credential is awarded to respiratory therapists who demonstrate advanced competency in sleep disorders testing and management.

Question 17: A patient with suspected obstructive sleep apnea undergoes a polysomnogram. Which finding is diagnostic of severe OSA?

Snoring index > 50%
Oxygen desaturation to 88% once
AHI of 10–14 events/hour
AHI ≥ 30 events/hour (Correct answer)

Correct answer: AHI ≥ 30 events/hour

Severe OSA is defined by an apnea-hypopnea index (AHI) of 30 or more events per hour of sleep.

Question 18: Acute cor pulmonale on the 12-lead ECG may show all of the following EXCEPT:

Peaked P waves in leads II, III, aVF (P pulmonale) (Correct answer)
Right axis deviation
Right bundle branch block
S1Q3T3 pattern

Correct answer: Peaked P waves in leads II, III, aVF (P pulmonale)

P pulmonale (peaked P waves) reflects chronic right atrial enlargement from pulmonary hypertension, not the acute ECG changes of sudden right heart strain.

Question 19: Which chemoreceptors respond most rapidly to changes in PaCO2?

J-receptors in lung parenchyma
Pulmonary stretch receptors
Central chemoreceptors in the medulla (Correct answer)
Peripheral chemoreceptors in the carotid bodies

Correct answer: Central chemoreceptors in the medulla

Central chemoreceptors in the medulla oblongata are highly sensitive to changes in cerebrospinal fluid pH caused by CO2 diffusion, driving the primary ventilatory response.

Question 20: Acute hypoxemic respiratory failure is defined by a PaO2/FiO2 (P/F) ratio below:

100
300 (Correct answer)
400
200

Correct answer: 300

A P/F ratio below 300 mmHg defines acute hypoxemic respiratory failure; values below 200 define ARDS and below 100 define severe ARDS (Berlin criteria).

Question 21: Which drug is the first-line treatment for anaphylaxis causing severe bronchospasm?

Albuterol
Epinephrine (Correct answer)
Diphenhydramine
Methylprednisolone

Correct answer: Epinephrine

Epinephrine is the first-line treatment for anaphylaxis because it rapidly reverses bronchospasm, hypotension, and angioedema through alpha and beta adrenergic receptor stimulation.

Question 22: A patient with COPD presents with pH 7.30, PaCO2 58 mmHg, PaO2 52 mmHg, and HCO3 28 mEq/L. What is the correct interpretation?

Chronic respiratory acidosis fully compensated
Acute-on-chronic respiratory acidosis (Correct answer)
Metabolic acidosis with compensation
Acute respiratory alkalosis

Correct answer: Acute-on-chronic respiratory acidosis

Elevated HCO3 indicates chronic CO2 retention, but pH below 7.35 suggests an acute exacerbation superimposed on the chronic state.

Question 23: Which of the following best describes anatomical dead space?

Conducting airways that do not participate in gas exchange (Correct answer)
Alveoli that are ventilated but not perfused
The volume of gas remaining after maximal exhalation
Lung tissue destroyed by emphysema

Correct answer: Conducting airways that do not participate in gas exchange

Anatomical dead space comprises the conducting airways (nose, trachea, bronchi) where no gas exchange occurs, roughly 150 mL in adults.

Question 24: The normal mixed venous oxygen saturation (SvO2) is approximately:

60–75% (Correct answer)
80–90%
40–50%
95–100%

Correct answer: 60–75%

Normal SvO2 is 60–75%, reflecting the balance between oxygen delivery and consumption in systemic tissues.

Question 25: Compliance of the lung is defined as:

Work of breathing divided by tidal volume
Change in pressure per unit change in volume
Airway resistance multiplied by flow rate
Change in volume per unit change in pressure (Correct answer)

Correct answer: Change in volume per unit change in pressure

Compliance (C = ΔV/ΔP) measures the ease with which the lung distends in response to an applied pressure change.

Question 26: Cricothyrotomy provides emergency surgical airway access through the:

Cricothyroid membrane (Correct answer)
Thyrohyoid membrane
Tracheal rings 2–4
Pyriform sinus

Correct answer: Cricothyroid membrane

Cricothyrotomy is performed through the cricothyroid membrane, the preferred emergency access site because of its surface anatomy and vascularity.

Question 27: Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?

Melatonin (Correct answer)
Amphetamine
Methylphenidate
Pemoline

Correct answer: Melatonin

Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.

Question 28: A tracheostomy tube is indicated for all of the following EXCEPT:

Facilitation of secretion removal
Short-term airway management during a brief surgery (Correct answer)
Prolonged mechanical ventilation (>2 weeks)
Upper airway obstruction

Correct answer: Short-term airway management during a brief surgery

Tracheostomy is reserved for situations requiring a prolonged or secure airway; an endotracheal tube is preferred for short-term surgical airway needs.

Question 29: Inverse ratio ventilation (IRV) is characterized by:

Fixed 1:2 I:E ratio at all respiratory rates
Inspiratory time equal to or longer than expiratory time (I:E ≥ 1:1) (Correct answer)
Inspiratory time shorter than expiratory time (I:E < 1:2)
Patient-triggered breaths only

Correct answer: Inspiratory time equal to or longer than expiratory time (I:E ≥ 1:1)

IRV reverses the normal I:E ratio so inspiration is as long as or longer than expiration, recruiting alveoli and improving oxygenation in severe ARDS.

Question 30: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 of 0.8 and PEEP of 12 cmH2O. The P/F ratio is:

97
44
440
69 (Correct answer)

Correct answer: 69

P/F ratio = PaO2 / FiO2 = 55 / 0.8 = 68.75 ≈ 69, which falls below 100 mmHg, meeting criteria for severe ARDS.

NBRC Therapist Multiple-Choice (TMC) Examination

The TMC Examination is the entry-level credentialing exam for respiratory therapists, administered by the National Board for Respiratory Care (NBRC). It assesses clinical knowledge across patient data evaluation, equipment troubleshooting, and respiratory care interventions, with dual cut scores awarding CRT or RRT credentials.

Questions

35 min

Time Limit

70%

To Pass

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