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CRT (CREST) practice questions

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Question 1TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Under the CRT Detailed Content Outline effective January 2020 through December 31, 2026, which item is classified as a therapeutic device rather than a monitoring or diagnostic device?

  1. Electrocardiograph monitor
  2. Mechanical ventilator Correct answer.
  3. Pulse oximeter
  4. Spirometer

Explanation

Therapeutic devices act on the patient to treat or support physiology, and a mechanical ventilator delivers breaths that sustain ventilation, making it therapeutic. Monitoring devices such as pulse oximeters and ECG monitors only observe physiologic parameters, and spirometers measure lung volumes for diagnosis.

Question 2TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is asked to verify the identity of a specimen label before analysis in the blood gas laboratory. Which action best reflects the preanalytical quality-control requirement?

  1. Confirm that the label matches the requisition and the patient's identification before running the sample Correct answer.
  2. Recalibrate the analyzer only if the result looks unusual
  3. Run the sample immediately and compare results with the previous value afterward
  4. Store the specimen at room temperature until the next shift

Explanation

Preanalytical quality control requires confirming that the specimen is correctly identified and labeled before analysis, because mislabeling is a leading cause of erroneous blood gas results. Verification must occur before testing, not after results are generated, and analyzer calibration addresses a different phase of quality control.

Question 3TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which organization publishes the Safe Medical Devices Act reporting requirements that a respiratory care department must follow when a device causes or contributes to serious injury?

  1. Food and Drug Administration Correct answer.
  2. Occupational Safety and Health Administration
  3. The Joint Commission
  4. National Institute for Occupational Safety and Health

Explanation

The Safe Medical Devices Act is federal legislation administered by the Food and Drug Administration, which requires user facilities to report device-related serious injuries and deaths. The Joint Commission accredits organizations, OSHA regulates workplace safety, and NIOSH conducts research rather than device reporting.

Question 4TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

During a cardiopulmonary exercise test, which measured variable is used to determine whether the patient achieved a maximal effort?

  1. Respiratory exchange ratio Correct answer.
  2. Oxygen pulse
  3. Tidal volume
  4. Peak heart rate response

Explanation

The respiratory exchange ratio rises with increasing exercise intensity, and a value above roughly 1.10 to 1.15 is a standard indicator of maximal effort. Peak heart rate is a predicted value that varies widely among patients and is less reliable, while tidal volume and oxygen pulse do not define maximality.

Question 5TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with an arterial line has a blood gas sample drawn. Which practice most directly reduces the risk of a falsely low PaO2 result?

  1. Expelling all air bubbles immediately and capping the syringe Correct answer.
  2. Delaying analysis by 30 minutes at room temperature
  3. Drawing the sample slowly with a large syringe
  4. Adding heparin to a final concentration of 10 percent

Explanation

Air bubbles equilibrate with the blood and can falsely raise or lower PaO2 depending on the gradient, so immediate bubble removal and capping protect accuracy. Excessive heparin dilutes the sample and lowers measured values, and prolonged room-temperature storage allows ongoing cellular metabolism to alter results.

Question 6TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which instruction is appropriate when teaching a patient to use a metered-dose inhaler with a valved holding chamber?

  1. Exhale fully, actuate once, and inhale slowly over several seconds Correct answer.
  2. Hold the breath for one second after inhalation
  3. Actuate the canister several times in rapid succession before inhaling
  4. Inhale forcefully and quickly to maximize particle impaction

Explanation

Proper technique with a valved holding chamber is to exhale away from the device, actuate a single puff, and inhale slowly and deeply so the aerosol reaches the lower airways. Rapid forceful inhalation increases oropharyngeal impaction, and a breath hold of about 10 seconds is recommended rather than one second.

Question 7TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A spontaneously breathing patient has a documented do-not-resuscitate order and develops respiratory distress. Which action is consistent with ethical and legal practice?

  1. Withhold all comfort measures because the order limits intervention
  2. Transfer the patient to another unit without discussion
  3. Provide comfort-focused measures such as oxygen and positioning while honoring the order Correct answer.
  4. Initiate full resuscitative efforts because distress is present

Explanation

A do-not-resuscitate order addresses resuscitation in the event of cardiac or respiratory arrest and does not prohibit comfort care such as oxygen, positioning, or suctioning. Withholding all supportive measures misinterprets the order, and initiating full resuscitation violates the documented directive.

Question 8TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

When performing endotracheal suctioning on an adult patient, which practice reduces the risk of hypoxemia and mucosal trauma?

  1. Applying continuous suction while inserting the catheter
  2. Using the largest catheter that fits the airway
  3. Instilling 10 mL of normal saline before each pass
  4. Limiting suction to 10 to 15 seconds and hyperoxygenating before the pass Correct answer.

Explanation

Suction should be applied only during withdrawal, limited to about 10 to 15 seconds, and preceded by hyperoxygenation to prevent hypoxemia. Suction during insertion and routine saline instillation increase mucosal injury and hypoxemia risk, and a catheter larger than half the airway diameter causes atelectasis.

Question 9TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A chest radiograph shows a tracheostomy tube whose tip lies above the carina with the cuff in the mid-trachea. Which conclusion is most appropriate?

  1. The tube has entered the right mainstem bronchus
  2. The tube is inserted too shallow and should be advanced
  3. The tube must be replaced with a longer device
  4. The tube is positioned acceptably Correct answer.

Explanation

An appropriate tracheostomy position places the tip above the carina with the cuff in the mid-trachea, allowing ventilation of both lungs. Mainstem intubation would show tip displacement into a bronchus with unilateral aeration, and a tip above the carina is not too shallow.

Question 10TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which value represents the normal range for adult arterial blood pH at sea level?

  1. 7.00 to 7.20
  2. 7.50 to 7.60
  3. 7.35 to 7.45 Correct answer.
  4. 7.20 to 7.30

Explanation

Normal arterial pH in adults is approximately 7.35 to 7.45, reflecting tight regulation of hydrogen ion concentration. Values below 7.35 indicate acidemia and values above 7.45 indicate alkalemia, so the other ranges fall outside normal physiology.

Question 11TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

An arterial blood gas shows pH 7.28, PaCO2 58 mm Hg, and HCO3- 26 mEq/L. Which interpretation is correct?

  1. Metabolic acidosis
  2. Metabolic alkalosis
  3. Respiratory alkalosis
  4. Acute respiratory acidosis Correct answer.

Explanation

A low pH with an elevated PaCO2 indicates respiratory acidosis, and a near-normal bicarbonate shows that renal compensation has not yet occurred, making the disturbance acute. Metabolic disorders would show a primary change in bicarbonate rather than in carbon dioxide.

Question 12TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient receiving volume-controlled ventilation has a peak airway pressure of 45 cm H2O while the plateau pressure is 22 cm H2O. Which cause best explains this gradient?

  1. Chest wall rigidity
  2. Decreased lung compliance
  3. Pleural effusion
  4. Increased airway resistance Correct answer.

Explanation

A widened difference between peak and plateau pressure indicates resistance to airflow rather than a compliance problem, because plateau pressure reflects alveolar pressure. Bronchospasm, secretions, or a kinked tube raise peak pressure while leaving plateau pressure relatively unchanged.

Question 13TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which finding is most consistent with a tension pneumothorax in a patient receiving positive-pressure ventilation?

  1. Bilateral crackles with frothy secretions
  2. Bradycardia with diffuse wheezing
  3. Gradual oxygen desaturation with fever and purulent sputum
  4. Sudden hypotension with tracheal deviation and absent breath sounds on one side Correct answer.

Explanation

Tension pneumothorax produces sudden hemodynamic compromise with mediastinal shift, tracheal deviation, and unilateral absent breath sounds, and positive-pressure ventilation accelerates its development. The other findings describe pulmonary edema, pneumonia, and bronchospasm rather than a tension pneumothorax.

Question 14TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is preparing to wean a patient from mechanical ventilation. Which parameter best predicts weaning success when assessed alone?

  1. Peak inspiratory pressure of 40 cm H2O
  2. Rapid shallow breathing index below 105 Correct answer.
  3. Minute ventilation of 15 L/min
  4. Static compliance of 20 mL/cm H2O

Explanation

A rapid shallow breathing index below about 105 breaths per minute per liter is a validated predictor of weaning success. High peak inspiratory pressure, elevated minute ventilation, and very low compliance indicate increased work of breathing and predict difficulty rather than success.

Question 15TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which statement about the physiological effects of positive end-expiratory pressure is correct?

  1. It consistently increases venous return to the right heart
  2. It decreases functional residual capacity
  3. It recruits collapsed alveoli and may reduce cardiac output Correct answer.
  4. It lowers mean airway pressure

Explanation

Positive end-expiratory pressure recruits and stabilizes alveoli, increasing functional residual capacity and improving oxygenation, but elevated intrathoracic pressure can reduce venous return and cardiac output. It raises rather than lowers mean airway pressure and does not consistently increase venous return.

Question 16TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with COPD has a chronic baseline PaCO2 of 55 mm Hg and a bicarbonate of 32 mEq/L. Which statement best describes this finding?

  1. It represents a primary metabolic alkalosis
  2. It represents an uncompensated acute respiratory acidosis
  3. It represents chronic compensated respiratory acidosis Correct answer.
  4. It represents a mixed respiratory and metabolic acidosis

Explanation

A chronically elevated PaCO2 with a proportionally elevated bicarbonate reflects renal compensation, producing chronic compensated respiratory acidosis. An acute disturbance would show a normal bicarbonate, and a primary metabolic alkalosis would present with an elevated pH.

Question 17TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which measure is most effective for preventing ventilator-associated pneumonia?

  1. Routine prophylactic antibiotic administration
  2. Elevating the head of the bed to 30 to 45 degrees Correct answer.
  3. Changing the ventilator circuit every 24 hours
  4. Routine instillation of saline into the airway

Explanation

Head-of-bed elevation of 30 to 45 degrees reduces aspiration of gastric contents and is a core element of ventilator-associated pneumonia prevention bundles. Routine circuit changes, saline instillation, and prophylactic antibiotics do not prevent this complication and may introduce harm.

Question 18TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

When performing closed-chest compressions on an adult during cardiopulmonary resuscitation, which technique is correct?

  1. Compress at 140 per minute with a depth of 8 cm
  2. Compress at a rate of 60 per minute with a depth of 2 cm
  3. Compress at 100 to 120 per minute with a depth of 5 to 6 cm Correct answer.
  4. Compress at 80 per minute with a depth of 3 cm

Explanation

High-quality adult compressions are delivered at 100 to 120 per minute with a depth of at least 5 cm but no more than 6 cm, allowing full chest recoil. Slower or shallower compressions reduce perfusion, and deeper compressions increase injury risk.

Question 19TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with a new tracheostomy has been decannulated accidentally and is breathing spontaneously with mild stridor. Which initial action is most appropriate?

  1. Cover the stoma with an occlusive dressing
  2. Assess the airway and provide oxygen while preparing for reinsertion Correct answer.
  3. Immediately reinsert the tracheostomy tube using the same size
  4. Place the patient supine and wait for the surgeon

Explanation

The priority after accidental decannulation is to assess airway patency and oxygenation while preparing for controlled reinsertion, because the stoma may have narrowed. Blind forceful reinsertion of the same size tube can create a false passage, and an occlusive dressing over the stoma impairs ventilation.

Question 20TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which parameter is the most reliable indicator of adequate oxygenation during mechanical ventilation?

  1. Tidal volume
  2. PaCO2 alone
  3. Peak airway pressure
  4. PaO2 and oxygen saturation Correct answer.

Explanation

Oxygenation is assessed by arterial oxygen tension and hemoglobin saturation, which directly reflect oxygen delivery to the blood. PaCO2 reflects ventilation rather than oxygenation, and airway pressure and tidal volume are ventilator variables rather than oxygenation measures.

Question 21TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient receiving oxygen by nasal cannula at 4 L/min reports nasal dryness and irritation. Which intervention is most appropriate?

  1. Increase the flow to 8 L/min to improve humidification
  2. Discontinue oxygen therapy entirely
  3. Add a bubble humidifier to the low-flow oxygen system Correct answer.
  4. Switch to a nonrebreather mask at 15 L/min

Explanation

Low-flow nasal cannula oxygen at higher flow rates can dry the nasal mucosa, and adding a bubble humidifier improves comfort without changing the prescribed oxygen concentration. Increasing flow or escalating to a high-concentration mask does not address the dryness and may be unnecessary.

Question 22TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which finding on a flow-volume loop suggests a fixed upper airway obstruction?

  1. Flattening of the expiratory limb only
  2. Flattening of both inspiratory and expiratory limbs Correct answer.
  3. A reduced peak flow with a normal loop shape
  4. A scooped-out expiratory limb with a normal inspiratory limb

Explanation

A fixed upper airway obstruction limits flow during both inspiration and expiration, producing plateau-like flattening of both limbs of the flow-volume loop. Variable extrathoracic obstruction flattens the inspiratory limb, and variable intrathoracic obstruction flattens the expiratory limb.

Question 23TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with an artificial airway requires manual ventilation before transport. Which device delivers the most reliable tidal volume?

  1. A flow-inflating bag with a tight mask seal Correct answer.
  2. A nasal cannula at 6 L/min
  3. A simple face mask at 10 L/min
  4. A self-inflating resuscitation bag squeezed at a fixed rate

Explanation

A flow-inflating bag with a tight seal allows the clinician to observe chest rise and titrate ventilation, providing more reliable volume delivery than a self-inflating bag squeezed at a fixed rate. Nasal cannula and simple masks cannot deliver positive-pressure breaths.

Question 24TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient in the intensive care unit has a pulmonary artery catheter with a pulmonary artery occlusion pressure of 18 mm Hg and diffuse bilateral infiltrates. Which interpretation is most consistent with these findings?

  1. Simple pneumothorax
  2. Cardiogenic pulmonary edema Correct answer.
  3. Pulmonary embolism without infarction
  4. Noncardiogenic acute respiratory distress syndrome

Explanation

An elevated pulmonary artery occlusion pressure suggests elevated left atrial pressure, and with bilateral infiltrates this points to cardiogenic pulmonary edema. Acute respiratory distress syndrome typically produces infiltrates with a normal or low occlusion pressure, and pneumothorax or embolism would not produce these pressures.

Question 25TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

Which statement about the physiological effects of hyperoxia during oxygen therapy is accurate?

  1. High oxygen concentrations improve mucociliary clearance
  2. Oxygen toxicity develops only after several weeks of exposure
  3. Supplemental oxygen has no effect on ventilation-perfusion matching
  4. High inspired oxygen concentrations can cause absorption atelectasis and airway irritation Correct answer.

Explanation

Prolonged high inspired oxygen concentrations can wash out alveolar nitrogen, promote absorption atelectasis, and irritate the airways. Oxygen therapy also alters ventilation-perfusion matching, and toxicity can develop with sustained exposure well before several weeks.

Question 26TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is reviewing the detailed content outline for the CRT examination. Which set of areas does the examination content primarily organize around?

  1. Only hospital-based critical care and mechanical ventilation topics
  2. Only neonatal and pediatric respiratory care topics
  3. Only outpatient pulmonary function testing and rehabilitation topics
  4. Clinical data, equipment, and therapeutic procedures with patient assessment woven throughout Correct answer.

Explanation

The CRT detailed content outline is organized around broad domains such as patient assessment, clinical data interpretation, equipment application, and therapeutic procedures. It is not limited to a single care setting or patient population. Candidates should expect integrated questions that combine assessment findings with equipment and therapy decisions.

Question 27TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient's medical record lists a hemoglobin of 9 g/dL. When selecting a method to assess this patient's oxygenation status, which limitation applies to pulse oximetry?

  1. SpO2 is unaffected by abnormal hemoglobin species
  2. SpO2 directly measures dissolved oxygen in plasma
  3. SpO2 reflects oxygen saturation of hemoglobin but not the total oxygen content carried Correct answer.
  4. SpO2 provides a direct measurement of tissue oxygen delivery

Explanation

Pulse oximetry estimates the percentage of hemoglobin binding sites saturated with oxygen. It does not measure hemoglobin concentration or dissolved oxygen, so a patient with anemia can have a normal SpO2 while total oxygen content and delivery are reduced. This distinction is central to interpreting oxygenation data correctly.

Question 28TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is asked to evaluate a patient's ability to clear secretions before extubation. Which bedside measure provides the most direct information about cough strength?

  1. Rapid shallow breathing index measured with a ventilator
  2. Vital capacity measured with a spirometer
  3. Peak cough flow measured with a peak flow meter Correct answer.
  4. Maximum inspiratory pressure measured with a pressure gauge

Explanation

Peak cough flow quantifies the expiratory force generated during a cough, which relates directly to airway clearance capability. Values are compared against thresholds associated with successful secretion clearance. Vital capacity and maximum inspiratory pressure reflect inspiratory muscle strength rather than cough effectiveness.

Question 29TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient receiving mechanical ventilation has a sudden drop in SpO2 and absent breath sounds over the right chest. Which initial action is most appropriate?

  1. Reduce the positive end-expiratory pressure to improve venous return
  2. Assess for and relieve a possible right mainstem obstruction or pneumothorax according to protocol Correct answer.
  3. Increase the fraction of inspired oxygen and reassess in 30 minutes
  4. Obtain a routine chest radiograph before any intervention

Explanation

Sudden desaturation with unilateral absent breath sounds in a ventilated patient suggests a life-threatening problem such as pneumothorax, mucus plug, or tube malposition. Immediate assessment and intervention take priority over delayed diagnostic studies. Waiting or reducing PEEP can worsen the patient's condition.

Question 30TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is preparing to obtain an arterial blood gas sample. Which practice is most important to ensure accurate results?

  1. Draw the sample into a syringe and store it at room temperature for one hour
  2. Use a heparin volume large enough to fill the syringe dead space
  3. Apply prolonged pressure after puncture only for patients on anticoagulants
  4. Expel air bubbles promptly and analyze the sample without delay Correct answer.

Explanation

Air bubbles in an arterial sample equilibrate with the blood and can alter PaO2 and PaCO2 values. Samples should be deaired, capped, mixed, and analyzed promptly or placed on ice per policy. Proper technique preserves the accuracy of the results.

Question 31TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

An arterial blood gas shows pH 7.50, PaCO2 30 mm Hg, and HCO3- 24 mEq/L. Which acid-base interpretation is correct?

  1. Metabolic acidosis with respiratory compensation
  2. Acute respiratory acidosis with metabolic compensation
  3. Metabolic alkalosis with respiratory compensation
  4. Acute respiratory alkalosis without metabolic compensation Correct answer.

Explanation

An elevated pH with a low PaCO2 and a normal bicarbonate indicates a primary respiratory alkalosis. Because the bicarbonate is still within the normal range, metabolic compensation has not yet developed. This pattern is consistent with acute hyperventilation.

Question 32TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is teaching a patient to perform incentive spirometry after abdominal surgery. Which instruction best supports effective use?

  1. Take a slow maximal inhalation and hold the breath for several seconds Correct answer.
  2. Complete the maneuver only once each hour while awake
  3. Breathe through the nose while using the mouthpiece
  4. Perform rapid forceful exhalations through the device

Explanation

Incentive spirometry is designed to promote sustained maximal inspiration, which helps prevent atelectasis. A slow deep breath held for a few seconds achieves the desired lung expansion. Frequency should follow the prescribed schedule, typically more often than once hourly.

Question 33TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with a tracheostomy tube is receiving heated aerosol therapy. Which complication is most directly associated with inadequate humidification of inspired gas?

  1. Barotrauma from elevated airway pressure
  2. Hypercapnia from increased dead space
  3. Retention of thick secretions and mucous plugging Correct answer.
  4. Hypoxemia from diffusion impairment

Explanation

When the upper airway is bypassed by an artificial airway, inspired gas must be conditioned to prevent drying of secretions. Inadequate humidification causes thickened secretions and mucus plugging. The other listed problems are not direct consequences of insufficient humidification.

Question 34TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist observes a patient using a small-volume nebulizer with a mouthpiece. Which technique indicates the patient needs further teaching?

  1. Breathing rapidly through the nose during nebulization Correct answer.
  2. Tapping the nebulizer cup to dislodge medication
  3. Rinsing the mouthpiece after completing the treatment
  4. Sitting upright and breathing slowly through the mouth

Explanation

A small-volume nebulizer with a mouthpiece requires slow oral breathing to promote aerosol deposition in the lower airways. Nasal breathing filters and reduces drug delivery. The other described actions support effective treatment.

Question 35TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient's oxygen prescription is 2 L/min by nasal cannula. Which device would deliver a more precise and stable fraction of inspired oxygen at a higher flow?

  1. Simple mask at 2 L/min
  2. Air-entrainment mask Correct answer.
  3. Nasal cannula at 6 L/min
  4. Nonrebreather mask without a reservoir

Explanation

An air-entrainment mask uses a Venturi mechanism to blend oxygen with room air and deliver a specific FiO2. It provides a more predictable oxygen concentration than low-flow devices such as cannulas and simple masks. A nonrebreather without a reservoir does not function as intended.

Question 36TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist notes that a patient's chest radiograph shows a widened mediastinum and a deviated trachea after central line placement. Which interpretation is most appropriate?

  1. Evidence of chronic obstructive pulmonary disease
  2. Possible vascular injury with mediastinal hemorrhage requiring urgent evaluation Correct answer.
  3. Expected finding after uncomplicated central line placement
  4. Sign of resolving atelectasis

Explanation

A widened mediastinum with tracheal deviation after central venous catheter insertion raises concern for vascular injury and bleeding. This finding requires urgent clinical and imaging evaluation. It is not an expected or benign post-procedure finding.

Question 37TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient reports chest discomfort and the respiratory therapist notes a sudden decrease in SpO2 after a thoracentesis. Which assessment finding would most suggest a pneumothorax?

  1. Inspiratory stridor localized to the upper airway
  2. Unilateral decreased breath sounds with hyperresonance on the affected side Correct answer.
  3. Dullness to percussion with absent tactile fremitus
  4. Bilateral crackles with increased sputum production

Explanation

A pneumothorax produces air in the pleural space, leading to decreased breath sounds and hyperresonance on the affected side. These findings after thoracentesis warrant prompt evaluation. The other options describe different conditions.

Question 38TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is assessing a patient's level of consciousness as part of a respiratory evaluation. Which finding is most concerning for hypoxemia or hypercapnia?

  1. Report of mild fatigue after activity
  2. New onset of confusion and restlessness Correct answer.
  3. Stable orientation to person, place, and time
  4. Bilateral pupil constriction to light

Explanation

Acute changes in mental status such as confusion and restlessness can be early signs of hypoxemia or hypercapnia. Neurologic status is a key component of respiratory assessment. Stable orientation and reactive pupils are reassuring findings.

Question 39TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is reviewing a patient's pulmonary function test results. Which finding is most consistent with a restrictive pattern?

  1. Normal total lung capacity with a reduced diffusing capacity
  2. Reduced total lung capacity with a normal or increased FEV1/FVC ratio Correct answer.
  3. Increased residual volume with air trapping
  4. Increased total lung capacity with a reduced FEV1/FVC ratio

Explanation

A restrictive pattern is defined by reduced total lung capacity. The FEV1/FVC ratio is typically normal or elevated because both volumes are reduced proportionally or the airway obstruction is absent. Increased lung volumes and air trapping suggest obstruction.

Question 40TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with a new tracheostomy is being assessed for cuff pressure. Which pressure range is generally recommended to minimize tracheal injury while maintaining a seal?

  1. 20 to 30 cm H2O Correct answer.
  2. 40 to 50 cm H2O
  3. 5 to 10 cm H2O
  4. 60 to 70 cm H2O

Explanation

Cuff pressure is typically maintained between 20 and 30 cm H2O to prevent aspiration while limiting tracheal mucosal ischemia. Pressures above this range increase the risk of injury, and very low pressures fail to seal the airway. Regular monitoring helps prevent complications.

Question 41TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient is receiving noninvasive positive pressure ventilation for an acute exacerbation of COPD. Which finding suggests the therapy is failing and intubation should be considered?

  1. Worsening acidosis with increasing respiratory rate and declining mental status Correct answer.
  2. Reduced use of accessory muscles
  3. A decrease in respiratory rate from 30 to 22 breaths per minute
  4. Improvement in pH from 7.28 to 7.34

Explanation

Failure of noninvasive ventilation is signaled by worsening gas exchange, persistent or rising respiratory rate, and deteriorating mental status. These findings indicate the patient cannot be supported noninvasively and may need intubation. Improvements in rate, pH, and work of breathing indicate success.

Question 42TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is preparing to suction a patient with a closed suction system. Which practice is correct?

  1. Instill normal saline routinely before each suction pass
  2. Apply continuous suction while inserting the catheter
  3. Limit preoxygenation to patients with documented hypoxemia
  4. Advance the catheter without applying suction, then apply suction while withdrawing Correct answer.

Explanation

Suction should be applied only during withdrawal to limit mucosal trauma and hypoxemia. Advancing the catheter without suction allows it to reach secretions safely. Routine saline instillation is not recommended, and preoxygenation should be considered for all at-risk patients.

Question 43TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with asthma is prescribed a short-acting beta-2 agonist. Which effect is the primary therapeutic goal of this medication?

  1. Relaxation of bronchial smooth muscle to relieve bronchospasm Correct answer.
  2. Suppression of the cough reflex centrally
  3. Thinning of secretions to improve clearance
  4. Reduction of airway inflammation through corticosteroid activity

Explanation

Short-acting beta-2 agonists stimulate beta-2 receptors on bronchial smooth muscle, producing bronchodilation. They provide rapid relief of bronchospasm but do not treat underlying inflammation. Anti-inflammatory effects belong to corticosteroids, not beta agonists.

Question 44TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist notes that a patient receiving mechanical ventilation has a peak airway pressure of 40 cm H2O and a plateau pressure of 15 cm H2O. Which cause best explains this difference?

  1. Decreased lung compliance from pulmonary edema
  2. Increased alveolar pressure from auto-PEEP
  3. Decreased chest wall compliance from obesity
  4. Increased airway resistance from bronchospasm or secretions Correct answer.

Explanation

A large difference between peak and plateau pressure indicates a resistance problem because the gradient reflects pressure needed to overcome airflow resistance. Bronchospasm and secretions are common causes. Compliance problems raise both peak and plateau pressures together.

Question 45TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient in respiratory distress has an SpO2 of 88% on room air and is unable to speak in full sentences. Which initial action is most appropriate?

  1. Apply supplemental oxygen and assess the response with continuous oximetry Correct answer.
  2. Encourage the patient to breathe more slowly without oxygen
  3. Schedule an outpatient pulmonary function test
  4. Obtain a sputum culture before intervening

Explanation

A patient with hypoxemia and increased work of breathing needs immediate supplemental oxygen and reassessment. Diagnostic testing should not delay oxygen therapy in an acute situation. Outpatient testing is inappropriate for an acute presentation.

Question 46TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is evaluating a patient's readiness to use a peak flow meter at home. Which instruction is most accurate?

  1. Lie down and exhale slowly through the meter
  2. Inhale forcefully through the meter and record the value
  3. Stand upright, take a maximal breath, and blow out as hard and fast as possible Correct answer.
  4. Use the meter only during severe symptoms

Explanation

A peak flow meter measures the maximum expiratory flow achieved after a full inspiration. The patient should stand, inhale maximally, and exhale as forcefully and rapidly as possible. Measurements are typically recorded daily to detect worsening obstruction early.

Question 47TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is reviewing a patient's chest tube drainage system. Which finding requires immediate notification of the provider?

  1. Fluid level fluctuating with respiration in the water-seal chamber
  2. Continuous bubbling in the water-seal chamber Correct answer.
  3. Drainage of 20 mL over the first hour after insertion
  4. Intermittent bubbling in the suction control chamber

Explanation

Continuous bubbling in the water-seal chamber suggests an air leak in the system or a persistent pleural air leak. This finding requires prompt evaluation. Fluctuation with respiration is expected and reflects pressure changes.

Question 48TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A patient with a permanent tracheostomy speaks with a tracheoesophageal voice prosthesis. Which factor is most important when the therapist assesses the prosthesis?

  1. Checking for leakage around the prosthesis during swallowing Correct answer.
  2. Measuring the patient's vital capacity
  3. Reviewing the patient's oxygen prescription
  4. Assessing the patient's peak cough flow only

Explanation

A tracheoesophageal voice prosthesis creates a one-way communication between the trachea and esophagus, so leakage around or through the device during swallowing can indicate enlargement or failure. Assessment focuses on voice quality, leakage, and fit. Other measures do not directly evaluate the prosthesis.

Question 49TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is asked to select a humidification method for a patient receiving mechanical ventilation with a heated humidifier. Which statement about heated humidifiers is accurate?

  1. They provide no benefit compared with a heat-moisture exchanger
  2. They remove moisture from inspired gas to prevent condensation
  3. They add water vapor to inspired gas and require a temperature-monitoring strategy Correct answer.
  4. They are contraindicated in patients with artificial airways

Explanation

Heated humidifiers actively add water vapor to inspired gas and require temperature monitoring to prevent thermal injury and condensation. They are commonly used when the upper airway is bypassed. Heat-moisture exchangers are an alternative, not a superior replacement in all cases.

Question 50TMC Examination content areas (Detailed Content Outline, effective January 2020–December 31, 2026)

A respiratory therapist is reviewing the use of a metered-dose inhaler with a spacer in a patient with poor coordination. Which statement best describes the advantage of the spacer?

  1. It reduces oropharyngeal deposition and improves lung delivery Correct answer.
  2. It eliminates the need to coordinate actuation with inhalation
  3. It replaces the need for a bronchodilator medication
  4. It increases the dose delivered to the mouth and throat

Explanation

A spacer reduces the velocity of the aerosol, decreasing impaction in the oropharynx and improving delivery to the lower airways. It does not eliminate the need for some coordination, although it makes timing less critical. It does not change the prescribed medication.