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

Question 1: Compliance of the lung is defined as:

Airway resistance multiplied by flow rate
Change in pressure per unit change in volume
Work of breathing divided by tidal volume
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 2: PEEP (positive end-expiratory pressure) is used primarily to:

Decrease functional residual capacity
Prevent alveolar collapse and improve oxygenation (Correct answer)
Decrease mean airway pressure
Reduce the work of breathing by eliminating auto-PEEP

Correct answer: Prevent alveolar collapse and improve oxygenation

PEEP maintains alveolar patency at end-expiration, recruits collapsed lung units, and improves V/Q matching and oxygenation.

Question 3: Which airway device is considered a supraglottic (extraglottic) airway?

Endotracheal tube
Endobronchial blocker
Laryngeal mask airway (LMA) (Correct answer)
Tracheostomy tube

Correct answer: Laryngeal mask airway (LMA)

The LMA sits above the glottis in the hypopharynx and forms a seal around the laryngeal inlet, classifying it as a supraglottic airway device.

Question 4: What is the primary goal of prone positioning in patients with severe ARDS?

Decrease PaCO2 levels
Lower peak airway pressures
Improve V/Q matching and oxygenation (Correct answer)
Reduce ventilator-associated pneumonia risk

Correct answer: Improve V/Q matching and oxygenation

Prone positioning redistributes lung perfusion to better-ventilated dorsal regions, improving ventilation-perfusion matching and oxygenation.

Question 5: Sildenafil (Revatio) is used in respiratory care to treat which condition?

Acute respiratory distress syndrome
Severe persistent asthma
Cystic fibrosis
Pulmonary arterial hypertension (Correct answer)

Correct answer: Pulmonary arterial hypertension

Sildenafil inhibits phosphodiesterase-5, increasing cyclic GMP and causing pulmonary vascular smooth muscle relaxation, reducing pulmonary vascular resistance in pulmonary arterial hypertension.

Question 6: The anion gap is calculated as:

Na+ + K+ – (Cl– + HCO3–)
Na+ – K+
Cl– – HCO3–
Na+ – (Cl– + HCO3–) (Correct answer)

Correct answer: Na+ – (Cl– + HCO3–)

The anion gap = Na+ – (Cl– + HCO3–); a normal anion gap is 8–12 mEq/L, and an elevated gap indicates unmeasured anions from conditions like lactic acidosis or DKA.

Question 7: Bronchopulmonary dysplasia (BPD) is defined as oxygen dependency at:

28 days of life (Correct answer)
6 months of corrected age
3 months of corrected age
7 days of life

Correct answer: 28 days of life

BPD is defined as oxygen requirement at 28 days of life and reflects chronic lung injury from mechanical ventilation, oxygen toxicity, and inflammation in premature infants.

Question 8: Normal cardiac output at rest is approximately:

8–10 L/min
1–2 L/min
5–6 L/min (Correct answer)
3–4 L/min

Correct answer: 5–6 L/min

Resting cardiac output is typically 5–6 L/min, calculated as heart rate multiplied by stroke volume.

Question 9: In diabetic ketoacidosis (DKA), the respiratory compensation (Kussmaul respirations) produces:

Metabolic alkalosis
Respiratory acidosis
No change in PaCO2
Respiratory alkalosis to compensate for metabolic acidosis (Correct answer)

Correct answer: Respiratory alkalosis to compensate for metabolic acidosis

Kussmaul respirations are deep, rapid breaths that blow off CO2, lowering PaCO2 to partially compensate for the metabolic acidosis of DKA.

Question 10: Which of the following best describes the primary function of the alveoli?

Warming and humidifying inspired air
Producing surfactant only
Gas exchange between air and blood (Correct answer)
Filtering particulates from inhaled air

Correct answer: Gas exchange between air and blood

Alveoli are the primary sites of gas exchange where oxygen diffuses into the blood and carbon dioxide diffuses out.

Question 11: In restrictive lung disease, spirometry typically shows:

Elevated residual volume
Proportionally reduced FEV1 and FVC with a normal or elevated FEV1/FVC ratio (Correct answer)
Reduced FEV1/FVC ratio with preserved FVC
Increased total lung capacity

Correct answer: Proportionally reduced FEV1 and FVC with a normal or elevated FEV1/FVC ratio

Restriction reduces overall lung volumes including FVC, but because both FEV1 and FVC decrease proportionally, the FEV1/FVC ratio is preserved or elevated.

Question 12: An RT is setting up a transport ventilator for an ICU patient being moved to CT. Which consideration is MOST critical?

Switch the patient to manual ventilation during elevator travel
Ensure adequate oxygen cylinder volume for the entire transport duration (Correct answer)
Use the same ventilator brand as in the ICU
Increase PEEP by 2 cmH2O to compensate for position changes

Correct answer: Ensure adequate oxygen cylinder volume for the entire transport duration

Running out of oxygen supply during transport is a life-threatening risk; calculate required cylinder volume based on FiO2, flow, and estimated transport time.

Question 13: Which route of delivery provides the highest systemic absorption for a bronchodilator but also carries the greatest risk of systemic side effects?

Metered-dose inhaler
Dry powder inhaler
Nebulization
Intravenous infusion (Correct answer)

Correct answer: Intravenous infusion

Intravenous administration delivers 100% of the drug directly into the systemic circulation, providing maximal bioavailability but also the greatest risk of cardiovascular and metabolic side effects.

Question 14: To help determine your patient's level of consciousness, you should ask which of the following questions? 1. Do you you know what day this is? 2. Can I see your identification wristband? 3. Do you know where you are? 4. How are you feeling today? 5. Do you know who the president is?

3
2, 4 (Correct answer)
5
1, 3

Correct answer: 2, 4

To help determine a patient's level of consciousness, it is important to ask questions that assess their orientation to person, place, and time. Question 2, "Can I see your identification wristband?" helps determine if the patient is aware of their own identity and location. Question 4, "How are you feeling today?" helps assess the patient's awareness of their current state and overall well-being. These questions provide valuable information about the patient's cognitive function and level of consciousness.

Question 15: Nitrogen washout and helium dilution are techniques used to measure:

Oxygen consumption
Functional residual capacity (FRC) (Correct answer)
Airway resistance
Peak expiratory flow rate

Correct answer: Functional residual capacity (FRC)

Both nitrogen washout and helium dilution techniques measure FRC by using inert tracer gases to calculate the volume of gas in communication with the open airways.

Question 16: A term neonate is born with poor respiratory effort, heart rate 90 bpm, and central cyanosis. After initial warming and stimulation, no improvement occurs. What is the next step?

Administer epinephrine via umbilical catheter
Intubate and administer surfactant
Begin positive pressure ventilation with 21% oxygen (Correct answer)
Perform chest compressions immediately

Correct answer: Begin positive pressure ventilation with 21% oxygen

NRP guidelines direct positive pressure ventilation as the primary intervention when a neonate fails to respond to initial stabilization steps.

Question 17: The target PaCO2 during CPR for an adult patient is:

35–45 mmHg (Correct answer)
20–25 mmHg
50–60 mmHg
30–35 mmHg

Correct answer: 35–45 mmHg

During CPR, ventilation should target a normal PaCO2 of 35–45 mmHg to avoid hypocapnia-induced cerebral vasoconstriction or hypercapnia-induced acidosis.

Question 18: Surfactant is produced by which cell type?

Clara cells
Type I pneumocytes
Type II pneumocytes (Correct answer)
Goblet cells

Correct answer: Type II pneumocytes

Type II pneumocytes synthesize and secrete pulmonary surfactant, which reduces alveolar surface tension and prevents alveolar collapse.

Question 19: Systemic inflammatory response syndrome (SIRS) criteria include all of the following EXCEPT:

Heart rate >90 bpm
SpO2 <88% on room air (Correct answer)
Temperature >38°C or <36°C
Respiratory rate >20 breaths/min or PaCO2 <32 mmHg

Correct answer: SpO2 <88% on room air

SIRS criteria include temperature, heart rate, respiratory rate/PaCO2, and WBC count abnormalities; SpO2 below 88% is not a SIRS criterion.

Question 20: 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?

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

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 21: Extracorporeal membrane oxygenation (ECMO) provides gas exchange support by:

Withdrawing blood, oxygenating it externally, and returning it to the patient (Correct answer)
Using high-frequency oscillation to recruit alveoli
Administering inhaled nitric oxide continuously
Delivering 100% oxygen directly to the alveoli

Correct answer: Withdrawing blood, oxygenating it externally, and returning it to the patient

ECMO removes blood via cannula, passes it through an oxygenator membrane to add O2 and remove CO2, then returns oxygenated blood to the patient's circulation.

Question 22: Which laryngoscope blade is inserted into the vallecula (space between the epiglottis and base of tongue)?

Wis-Hipple blade
Macintosh (curved) blade (Correct answer)
Miller (straight) blade
Wisconsin blade

Correct answer: Macintosh (curved) blade

The Macintosh (curved) blade is placed in the vallecula, and lifting indirectly elevates the epiglottis to expose the glottis.

Question 23: An RT who earned only the CRT credential wants to obtain the RRT-NPS. What must they do first?

Apply directly for the NPS examination regardless of CRT status
Petition the NBRC for a credential equivalency review
Complete 2 years of NICU experience to waive the RRT requirement
Earn the RRT credential before applying for any specialty credential (Correct answer)

Correct answer: Earn the RRT credential before applying for any specialty credential

All NBRC specialty credentials (NPS, ACCS, SDS) require an active RRT as a prerequisite; the CRT alone is insufficient.

Question 24: Which NBRC credential is specifically designed for respiratory therapists who demonstrate advanced competency in neonatal and pediatric care?

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

Correct answer: NPS (Neonatal/Pediatric Specialist)

The NPS credential is awarded by the NBRC to RTs who pass a specialty examination focused on neonatal and pediatric respiratory care.

Question 25: Continuous renal replacement therapy (CRRT) is preferred over intermittent hemodialysis in critically ill patients primarily because it:

Does not require anticoagulation
Can be managed without ICU nursing
Causes less hemodynamic instability in hypotensive patients (Correct answer)
Provides faster toxin clearance

Correct answer: Causes less hemodynamic instability in hypotensive patients

CRRT removes solutes and fluid slowly and continuously, making it better tolerated hemodynamically in critically ill patients who cannot tolerate the rapid fluid shifts of intermittent hemodialysis.

Question 26: Which waveform is characteristic of volume-controlled, constant-flow ventilation?

Ascending ramp flow waveform
Sinusoidal flow waveform
Decelerating flow waveform
Square (constant) flow waveform (Correct answer)

Correct answer: Square (constant) flow waveform

Volume control with constant flow produces a square (rectangular) flow waveform, resulting in a linearly increasing pressure waveform.

Question 27: 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:

Severe ARDS
Moderate ARDS (Correct answer)
Acute lung injury (ALI), not ARDS
Mild 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 28: Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?

Risk for infection
Fluid volume excess
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 29: A candidate for the NBRC specialty examination discovers their application was denied due to an invalid credential. The most appropriate next step is to:

Apply to the state licensing board instead of NBRC
Wait one year before reapplying without contacting NBRC
Take the examination anyway and appeal the result
Contact the NBRC directly to resolve the credential status issue before reapplying (Correct answer)

Correct answer: Contact the NBRC directly to resolve the credential status issue before reapplying

Applicants who receive a denial due to credential issues should contact the NBRC directly, as resolving the underlying credential problem is required before reapplication.

Question 30: The primary treatment for neonatal RDS is:

Inhaled nitric oxide
Systemic corticosteroids after birth
High-frequency oscillatory ventilation immediately
Exogenous surfactant replacement therapy (Correct answer)

Correct answer: Exogenous surfactant replacement therapy

Exogenous surfactant administered intratracheally stabilizes alveoli and dramatically improves oxygenation and survival in neonates with RDS.

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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