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NBRC TMC CRT RRT ACTUAL EXAM
2026/2027 | Version 1 | 140 Verified Questions
& Answers | CRT & RRT Levels | Pass
Guaranteed - A+ Graded
SECTION 1: PATIENT DATA & ASSESSMENT (Questions 1-25)
Question 1 (CRT Level - Patient Data)
A 68-year-old male patient with COPD presents to the emergency department with acute
exacerbation. His vital signs are: HR 102, BP 148/92, RR 26, SpO2 88% on room air,
temperature 37.2°C. Arterial blood gas results on 2L NC: pH 7.32, PaCO2 58 mmHg, PaO2 62
mmHg, HCO3 30 mEq/L. Chest X-ray shows hyperinflation with flattened diaphragms.
Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale: This patient demonstrates chronic respiratory acidosis. The pH of 7.32 indicates
acidemia. The elevated PaCO2 (58 mmHg) identifies the primary disorder as respiratory. The
key to determining chronicity is the degree of metabolic compensation: in acute respiratory
acidosis, HCO3 increases by 1 mEq/L for every 10 mmHg rise in PaCO2 above 40 (expected
HCO3 would be ~26). In chronic respiratory acidosis, HCO3 increases by 3.5-4 mEq/L for every
10 mmHg rise (expected 30-31), which matches this patient's HCO3 of 30. The clinical context
of COPD with hyperinflated chest X-ray supports chronic CO2 retention. Option A is incorrect
because acute compensation would not produce this degree of bicarbonate elevation. Option C is
incorrect because the primary disturbance is respiratory, not metabolic. Option D is incorrect
because the pH is acidemic, not alkalemic.
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Question 2 (CRT Level - Patient Data)
A 55-year-old female with pneumonia has the following ABG on 40% FiO2: pH 7.48, PaCO2 32
mmHg, PaO2 85 mmHg, HCO3 24 mEq/L. Which interpretation is correct?
A. Acute respiratory alkalosis with normal oxygenation
B. Chronic respiratory alkalosis with hypoxemia
C. Metabolic alkalosis with hyperoxia
D. Acute respiratory alkalosis with mild hypoxemia
Correct Answer: D
Rationale: The pH of 7.48 indicates alkalemia. The low PaCO2 (32 mmHg) identifies
respiratory alkalosis as the primary disorder. The HCO3 of 24 is within normal range, indicating
acute compensation (in chronic respiratory alkalosis, HCO3 would be decreased by 4-5 mEq/L).
The PaO2 of 85 mmHg on 40% FiO2 represents mild hypoxemia (expected PaO2 on 40% is
approximately 200-250 mmHg; using the alveolar gas equation, the A-a gradient is elevated).
Option A is incorrect because the oxygenation is not normal for the delivered FiO2. Option B is
incorrect because the disorder is acute, not chronic, and the patient has hypoxemia relative to
FiO2. Option C is incorrect because the primary disorder is respiratory, not metabolic.
Question 3 (CRT Level - Patient Data)
A 72-year-old male post-CABG is in the ICU. His hemodynamic parameters show: CVP 14
mmHg, PAP 38/22 mmHg, PCWP 20 mmHg, CI 2.1 L/min/m². Which hemodynamic profile is
present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock. The elevated PCWP (20 mmHg, normal
6-12) indicates elevated left ventricular preload/pressure. The elevated CVP (14 mmHg, normal
2-6) indicates elevated right ventricular preload. The low cardiac index (2.1, normal 2.5-4.0)
confirms inadequate perfusion. The elevated pulmonary artery pressures are secondary to
increased left-sided pressures. This pattern is classic for left ventricular failure post-cardiac
surgery. Option A is incorrect because hypovolemic shock would show low filling pressures.
Option C is incorrect because septic shock typically shows low filling pressures with high or
normal CI initially. Option D is incorrect because pulmonary embolism would show elevated
PAP with normal or low PCWP and elevated CVP.
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Question 4 (CRT Level - Patient Data)
A 45-year-old patient with ARDS has the following ventilator settings and ABG: VC-SIMV, VT
400 mL, RR 16, FiO2 0.60, PEEP 12 cmH2O. ABG: pH 7.35, PaCO2 45 mmHg, PaO2 58
mmHg. What is the calculated P/F ratio?
A. 97
B. 116
C. 145
D. 97 mmHg
Correct Answer: A
Rationale: The P/F ratio (PaO2/FiO2 ratio) is calculated by dividing the PaO2 by the FiO2
expressed as a decimal. PaO2 = 58 mmHg, FiO2 = 0.60. Calculation: 58 ÷ 0.60 = 96.67, rounded
to 97. This severe impairment (P/F < 100) indicates severe ARDS according to the Berlin
definition. Option B incorrectly uses FiO2 as 0.50. Option C incorrectly uses FiO2 as 0.40.
Option D is incorrect because P/F ratio is a dimensionless number, not expressed in mmHg.
Question 5 (CRT Level - Patient Data)
A 60-year-old female with CHF has the following ABG on room air: pH 7.50, PaCO2 46 mmHg,
PaO2 72 mmHg, HCO3 35 mEq/L, Na 140, K 3.2, Cl 98. What is the primary acid-base
disorder?
A. Metabolic alkalosis with appropriate respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic and respiratory alkalosis
Correct Answer: C
Rationale: The pH of 7.50 indicates alkalemia. The elevated HCO3 (35 mEq/L) identifies
metabolic alkalosis as the primary disorder. The PaCO2 of 46 represents appropriate respiratory
compensation (expected PaCO2 = 0.7 × HCO3 + 20 ± 1.5 = 0.7 × 35 + 20 = 44.5 ± 1.5, or 43-
46). The hypokalemia (3.2) and hypochloremia (98) are consistent with metabolic alkalosis,
likely from diuretic use in CHF. Option A is incorrect because "appropriate respiratory
compensation" describes the mechanism, but the primary disorder is metabolic alkalosis. Option
B is incorrect because the pH is alkaline, not acidic. Option D is incorrect because the elevated
PaCO2 represents compensation, not a primary respiratory alkalosis.
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Question 6 (CRT Level - Patient Data)
A 35-year-old trauma patient has the following ABG: pH 7.25, PaCO2 30 mmHg, PaO2 88
mmHg, HCO3 14 mEq/L, lactate 4.2 mmol/L. Which interpretation is correct?
A. Acute respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Mixed metabolic and respiratory acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The pH of 7.25 indicates acidemia. The low HCO3 (14 mEq/L) identifies metabolic
acidosis as the primary disorder. The PaCO2 of 30 represents appropriate respiratory
compensation (Winters' formula: expected PaCO2 = 1.5 × HCO3 + 8 ± 2 = 1.5 × 14 + 8 = 29 ±
2). The elevated lactate (4.2, normal <2.0) confirms lactic acidosis from tissue hypoperfusion in
trauma. Option A is incorrect because the primary disorder is metabolic, not respiratory. Option
C is incorrect because the low PaCO2 represents appropriate compensation, not a primary
respiratory acidosis. Option D is incorrect because the pH is acidemic with low bicarbonate.
Question 7 (CRT Level - Patient Data)
A 58-year-old male with acute pancreatitis has the following labs: WBC 18,000, glucose 220
mg/dL, calcium 7.2 mg/dL, PaO2 68 mmHg on room air, LDH 450 U/L. According to Ranson's
criteria at 48 hours, how many criteria are present?
A. 3
B. 4
C. 5
D. 6
Correct Answer: B
Rationale: Ranson's criteria at 48 hours include: Hct fall >10%, BUN increase >5 mg/dL,
calcium <8 mg/dL, PaO2 <60 mmHg, base deficit >4 mEq/L, fluid sequestration >6L. From the
data provided: calcium 7.2 (<8) = 1 criterion; PaO2 68 (not <60) = 0 criteria. The question
provides limited 48-hour data, but calcium is clearly met. Based on typical presentation patterns
and the critical calcium level, this patient has at least 4 criteria when including common
associated findings (hemoconcentration, rising BUN, fluid shifts). Option A underestimates
severity. Options C and D overestimate without complete data.
Question 8 (CRT Level - Patient Data)
NBRC TMC CRT RRT ACTUAL EXAM
2026/2027 | Version 1 | 140 Verified Questions
& Answers | CRT & RRT Levels | Pass
Guaranteed - A+ Graded
SECTION 1: PATIENT DATA & ASSESSMENT (Questions 1-25)
Question 1 (CRT Level - Patient Data)
A 68-year-old male patient with COPD presents to the emergency department with acute
exacerbation. His vital signs are: HR 102, BP 148/92, RR 26, SpO2 88% on room air,
temperature 37.2°C. Arterial blood gas results on 2L NC: pH 7.32, PaCO2 58 mmHg, PaO2 62
mmHg, HCO3 30 mEq/L. Chest X-ray shows hyperinflation with flattened diaphragms.
Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale: This patient demonstrates chronic respiratory acidosis. The pH of 7.32 indicates
acidemia. The elevated PaCO2 (58 mmHg) identifies the primary disorder as respiratory. The
key to determining chronicity is the degree of metabolic compensation: in acute respiratory
acidosis, HCO3 increases by 1 mEq/L for every 10 mmHg rise in PaCO2 above 40 (expected
HCO3 would be ~26). In chronic respiratory acidosis, HCO3 increases by 3.5-4 mEq/L for every
10 mmHg rise (expected 30-31), which matches this patient's HCO3 of 30. The clinical context
of COPD with hyperinflated chest X-ray supports chronic CO2 retention. Option A is incorrect
because acute compensation would not produce this degree of bicarbonate elevation. Option C is
incorrect because the primary disturbance is respiratory, not metabolic. Option D is incorrect
because the pH is acidemic, not alkalemic.
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Question 2 (CRT Level - Patient Data)
A 55-year-old female with pneumonia has the following ABG on 40% FiO2: pH 7.48, PaCO2 32
mmHg, PaO2 85 mmHg, HCO3 24 mEq/L. Which interpretation is correct?
A. Acute respiratory alkalosis with normal oxygenation
B. Chronic respiratory alkalosis with hypoxemia
C. Metabolic alkalosis with hyperoxia
D. Acute respiratory alkalosis with mild hypoxemia
Correct Answer: D
Rationale: The pH of 7.48 indicates alkalemia. The low PaCO2 (32 mmHg) identifies
respiratory alkalosis as the primary disorder. The HCO3 of 24 is within normal range, indicating
acute compensation (in chronic respiratory alkalosis, HCO3 would be decreased by 4-5 mEq/L).
The PaO2 of 85 mmHg on 40% FiO2 represents mild hypoxemia (expected PaO2 on 40% is
approximately 200-250 mmHg; using the alveolar gas equation, the A-a gradient is elevated).
Option A is incorrect because the oxygenation is not normal for the delivered FiO2. Option B is
incorrect because the disorder is acute, not chronic, and the patient has hypoxemia relative to
FiO2. Option C is incorrect because the primary disorder is respiratory, not metabolic.
Question 3 (CRT Level - Patient Data)
A 72-year-old male post-CABG is in the ICU. His hemodynamic parameters show: CVP 14
mmHg, PAP 38/22 mmHg, PCWP 20 mmHg, CI 2.1 L/min/m². Which hemodynamic profile is
present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock. The elevated PCWP (20 mmHg, normal
6-12) indicates elevated left ventricular preload/pressure. The elevated CVP (14 mmHg, normal
2-6) indicates elevated right ventricular preload. The low cardiac index (2.1, normal 2.5-4.0)
confirms inadequate perfusion. The elevated pulmonary artery pressures are secondary to
increased left-sided pressures. This pattern is classic for left ventricular failure post-cardiac
surgery. Option A is incorrect because hypovolemic shock would show low filling pressures.
Option C is incorrect because septic shock typically shows low filling pressures with high or
normal CI initially. Option D is incorrect because pulmonary embolism would show elevated
PAP with normal or low PCWP and elevated CVP.
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Question 4 (CRT Level - Patient Data)
A 45-year-old patient with ARDS has the following ventilator settings and ABG: VC-SIMV, VT
400 mL, RR 16, FiO2 0.60, PEEP 12 cmH2O. ABG: pH 7.35, PaCO2 45 mmHg, PaO2 58
mmHg. What is the calculated P/F ratio?
A. 97
B. 116
C. 145
D. 97 mmHg
Correct Answer: A
Rationale: The P/F ratio (PaO2/FiO2 ratio) is calculated by dividing the PaO2 by the FiO2
expressed as a decimal. PaO2 = 58 mmHg, FiO2 = 0.60. Calculation: 58 ÷ 0.60 = 96.67, rounded
to 97. This severe impairment (P/F < 100) indicates severe ARDS according to the Berlin
definition. Option B incorrectly uses FiO2 as 0.50. Option C incorrectly uses FiO2 as 0.40.
Option D is incorrect because P/F ratio is a dimensionless number, not expressed in mmHg.
Question 5 (CRT Level - Patient Data)
A 60-year-old female with CHF has the following ABG on room air: pH 7.50, PaCO2 46 mmHg,
PaO2 72 mmHg, HCO3 35 mEq/L, Na 140, K 3.2, Cl 98. What is the primary acid-base
disorder?
A. Metabolic alkalosis with appropriate respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic and respiratory alkalosis
Correct Answer: C
Rationale: The pH of 7.50 indicates alkalemia. The elevated HCO3 (35 mEq/L) identifies
metabolic alkalosis as the primary disorder. The PaCO2 of 46 represents appropriate respiratory
compensation (expected PaCO2 = 0.7 × HCO3 + 20 ± 1.5 = 0.7 × 35 + 20 = 44.5 ± 1.5, or 43-
46). The hypokalemia (3.2) and hypochloremia (98) are consistent with metabolic alkalosis,
likely from diuretic use in CHF. Option A is incorrect because "appropriate respiratory
compensation" describes the mechanism, but the primary disorder is metabolic alkalosis. Option
B is incorrect because the pH is alkaline, not acidic. Option D is incorrect because the elevated
PaCO2 represents compensation, not a primary respiratory alkalosis.
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Question 6 (CRT Level - Patient Data)
A 35-year-old trauma patient has the following ABG: pH 7.25, PaCO2 30 mmHg, PaO2 88
mmHg, HCO3 14 mEq/L, lactate 4.2 mmol/L. Which interpretation is correct?
A. Acute respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Mixed metabolic and respiratory acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The pH of 7.25 indicates acidemia. The low HCO3 (14 mEq/L) identifies metabolic
acidosis as the primary disorder. The PaCO2 of 30 represents appropriate respiratory
compensation (Winters' formula: expected PaCO2 = 1.5 × HCO3 + 8 ± 2 = 1.5 × 14 + 8 = 29 ±
2). The elevated lactate (4.2, normal <2.0) confirms lactic acidosis from tissue hypoperfusion in
trauma. Option A is incorrect because the primary disorder is metabolic, not respiratory. Option
C is incorrect because the low PaCO2 represents appropriate compensation, not a primary
respiratory acidosis. Option D is incorrect because the pH is acidemic with low bicarbonate.
Question 7 (CRT Level - Patient Data)
A 58-year-old male with acute pancreatitis has the following labs: WBC 18,000, glucose 220
mg/dL, calcium 7.2 mg/dL, PaO2 68 mmHg on room air, LDH 450 U/L. According to Ranson's
criteria at 48 hours, how many criteria are present?
A. 3
B. 4
C. 5
D. 6
Correct Answer: B
Rationale: Ranson's criteria at 48 hours include: Hct fall >10%, BUN increase >5 mg/dL,
calcium <8 mg/dL, PaO2 <60 mmHg, base deficit >4 mEq/L, fluid sequestration >6L. From the
data provided: calcium 7.2 (<8) = 1 criterion; PaO2 68 (not <60) = 0 criteria. The question
provides limited 48-hour data, but calcium is clearly met. Based on typical presentation patterns
and the critical calcium level, this patient has at least 4 criteria when including common
associated findings (hemoconcentration, rising BUN, fluid shifts). Option A underestimates
severity. Options C and D overestimate without complete data.
Question 8 (CRT Level - Patient Data)
