NBRC TMC CRT RRT Practice Exam 2026–2028 | Version 1 |
Practice Questions & Answers | Complete Study Guide
Prepare for the NBRC Therapist Multiple-Choice (TMC) examination with this comprehensive
practice study guide featuring original practice questions, detailed answer explanations, and
review material aligned with the published exam content areas. Topics include patient
assessment, airway management, oxygen therapy, mechanical ventilation, arterial blood gas
interpretation, pulmonary function testing, neonatal and pediatric care, and respiratory
pharmacology. This resource is designed to strengthen clinical reasoning and help respiratory
therapy students prepare for the CRT and RRT credentialing pathway.
Question 1
A 62-year-old male with an acute exacerbation of COPD is receiving mechanical
ventilation in the ICU. The current ventilator settings are: Volume Control A/C, Rate
12/min, Tidal Volume (\(V_{T}\)) 450 mL, PEEP 5 cmH₂O, FiO₂ 0.40. The patient is
trigger-ventilating at a total respiratory rate of 28/min. An arterial blood gas (ABG)
reveals: pH 7.51, PaCO₂ 30 mmHg, PaO₂ 68 mmHg, HCO₃⁻ 24 mEq/L. Which of the
following is the most appropriate action?
A) Increase the FiO₂ to 0.50
B) Decrease the set tidal volume to 350 mL
C) Change to Pressure Support Ventilation (PSV)
D) Decrease the ventilator rate to 8/min
Answer: C) Change to Pressure Support Ventilation (PSV)
Rationale: The patient is exhibiting acute respiratory alkalosis (pH 7.51, PaCO₂ 30) due
to severe tachypnea (total rate 28/min) on Assist/Control ventilation. In A/C mode, every
breath triggered by the patient delivers the full set tidal volume, leading to
hyperventilation. Switching to Pressure Support Ventilation allows the patient to control
their own rate and inspiratory flow, which helps normalize the PaCO₂ and respiratory
rate. Decreasing the set ventilator rate will have no effect because the patient is
breathing well above the set rate.
Question 2
A 28-year-old female patient is admitted to the emergency department following an
accidental house fire. She presents with dynamic facial burns, soot around her nares,
and a hoarse voice. She is conscious, alert, and breathing comfortably on a non-
rebreather mask at 15 L/min. Pulse oximetry reads 99%. What should the respiratory
therapist recommend immediately?
,A) Obtain an arterial blood gas and monitor closely
B) Perform an immediate endotracheal intubation
C) Initiate continuous bronchodilator therapy
D) Discontinue the oxygen mask and initiate a high-flow nasal cannula
Answer: B) Perform an immediate endotracheal intubation
Rationale: Signs of upper airway thermal injury, such as facial burns, soot around the
nares, mucosal edema, and hoarseness, carry a high risk of sudden, catastrophic upper
airway obstruction. Proactive, early endotracheal intubation is critical before swelling
seals the upper airway completely. Waiting for an ABG or pulse oximetry trend is
dangerous because oxygenation metrics may remain completely normal until total
obstruction occurs.
Question 3
While conducting a routine ventilator check on a patient in the coronary care unit, the
respiratory therapist notices that the low-pressure alarm is actively sounding. The
therapist notes that the patient's exhaled tidal volume is dropping drastically down to 50
mL. Which of the following clinical situations would explain these findings?
A) Secretions packing the mainstem bronchus
B) External kinking of the endotracheal tube
C) Disconnection of the ventilator circuit at the heat-moisture exchanger (HME)
D) Dynamic auto-PEEP development
Answer: C) Disconnection of the ventilator circuit at the heat-moisture exchanger
(HME)
Rationale: A low-pressure alarm combined with a sudden drop in exhaled tidal volume
indicates a severe system leak or structural disconnection in the circuit pathway.
Secretions, kinking, and airway obstructions lead to high-pressure alarms due to
increased resistance.
Question 4
A 55-year-old patient diagnosed with acute respiratory distress syndrome (ARDS) is
undergoing lung-protective volume ventilation. The ventilator settings are: \(V_{T}\) 360
mL, Rate 24/min, PEEP 12 cmH₂O. During a routine assessment, the respiratory
therapist calculates a plateau pressure (\(P_{plat}\)) of 34 cmH₂O. Which structural
modification should the therapist suggest?
A) Increase the PEEP to 15 cmH₂O to recruit alveoli
B) Decrease the tidal volume to bring the plateau pressure below 30 cmH₂O
,C) Increase the inspiratory flow rate to decrease inspiratory time
D) Switch the patient to a standard heat-moisture exchanger
Answer: B) Decrease the tidal volume to bring the plateau pressure below 30
cmH₂O
Rationale: ARDS lung-protective ventilation strategy mandates keeping the plateau
pressure (\(P_{plat}\)) strictly under 30 cmH₂O to avoid barotrauma and volutrauma. If
the plateau pressure rises above 30 cmH₂O, the tidal volume should be down-titrated
(down to a minimum of 4 mL/kg ideal body weight) to reduce alveolar inflation
pressures.
Question 5
A respiratory therapist is analyzing an arterial blood gas drawn from a patient in the
neurological step-down unit. The results read: pH 7.22, PaCO₂ 65 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 26 mEq/L. How should this acid-base balance be interpreted?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
C) Partially compensated metabolic alkalosis
D) Fully compensated respiratory acidosis
Answer: B) Uncompensated respiratory acidosis
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is elevated (>45
mmHg), which accounts for the drop in pH, confirming a respiratory origin. Because the
HCO₃⁻ is still within normal limits (22–26 mEq/L), no renal compensation has occurred
yet.
Question 6
A neonate born at 28 weeks of gestation is experiencing severe grunting, nasal flaring,
and intercostal retractions on an FiO₂ of 0.50 via an oxygen hood. An arterial blood gas
shows a PaO₂ of 46 mmHg. What clinical intervention is indicated next?
A) Initiate mechanical ventilation via a neonatal volume ventilator
B) Implement Nasal Continuous Positive Airway Pressure (nCPAP) at 5 cmH₂O
C) Increase the oxygen hood concentration to 0.70
D) Administer intravenous building boluses of sodium bicarbonate
Answer: B) Implement Nasal Continuous Positive Airway Pressure (nCPAP) at 5
cmH₂O
, Rationale: A premature neonate presenting with signs of respiratory distress syndrome
(grunting, flaring, retractions) along with refractory hypoxemia should be placed on
nasal CPAP. This recruits collapsed alveoli, increases functional residual capacity
(FRC), and improves ventilation-perfusion matching without the immediate risks of
invasive mechanical ventilation.
Question 7
A patient in the intensive care unit is receiving Volume Control ventilation. The peak
inspiratory pressure (PIP) has progressively risen from 25 to 42 cmH₂O over the last
four hours. Meanwhile, the calculated plateau pressure (\(P_{plat}\)) has remained
completely constant at 18 cmH₂O. What does this trend indicate?
A) Decreasing static lung compliance
B) Increasing dynamic airway resistance
C) Alveolar collapse or atelectasis
D) Development of a tension pneumothorax
Answer: B) Increasing dynamic airway resistance
Rationale: Airway resistance (\(R_{aw}\)) is reflected by the difference between the peak
inspiratory pressure and the plateau pressure (\(PIP - P_{plat}\)). Because the PIP
increased while the plateau pressure remained constant, the transairway pressure
gradient widened, indicating an increase in airway resistance (e.g., from bronchospasm,
secretions, or a kinked tube). If compliance were dropping, both PIP and plateau
pressures would rise together.
Question 8
A 42-year-old postoperative male patient who underwent abdominal surgery is
cooperative but unable to achieve his target incentive spirometry volumes. Crackles are
auscultated in both lung bases. The respiratory therapist wants to implement an
alternative hyperinflation therapy modality. What should be selected?
A) Intermittent Positive Pressure Breathing (IPPB)
B) Intrapulmonary Percussive Ventilation (IPV)
C) Continuous bronchodilator therapy via a vibrating mesh nebulizer
D) Mechanical insufflation-exsufflation therapy
Answer: A) Intermittent Positive Pressure Breathing (IPPB)
Rationale: IPPB is indicated for patients who require hyperinflation therapy to treat or
prevent atelectasis but are uncooperative or unable to perform incentive spirometry
effectively (e.g., due to pain or weakness following major abdominal surgeries).
Practice Questions & Answers | Complete Study Guide
Prepare for the NBRC Therapist Multiple-Choice (TMC) examination with this comprehensive
practice study guide featuring original practice questions, detailed answer explanations, and
review material aligned with the published exam content areas. Topics include patient
assessment, airway management, oxygen therapy, mechanical ventilation, arterial blood gas
interpretation, pulmonary function testing, neonatal and pediatric care, and respiratory
pharmacology. This resource is designed to strengthen clinical reasoning and help respiratory
therapy students prepare for the CRT and RRT credentialing pathway.
Question 1
A 62-year-old male with an acute exacerbation of COPD is receiving mechanical
ventilation in the ICU. The current ventilator settings are: Volume Control A/C, Rate
12/min, Tidal Volume (\(V_{T}\)) 450 mL, PEEP 5 cmH₂O, FiO₂ 0.40. The patient is
trigger-ventilating at a total respiratory rate of 28/min. An arterial blood gas (ABG)
reveals: pH 7.51, PaCO₂ 30 mmHg, PaO₂ 68 mmHg, HCO₃⁻ 24 mEq/L. Which of the
following is the most appropriate action?
A) Increase the FiO₂ to 0.50
B) Decrease the set tidal volume to 350 mL
C) Change to Pressure Support Ventilation (PSV)
D) Decrease the ventilator rate to 8/min
Answer: C) Change to Pressure Support Ventilation (PSV)
Rationale: The patient is exhibiting acute respiratory alkalosis (pH 7.51, PaCO₂ 30) due
to severe tachypnea (total rate 28/min) on Assist/Control ventilation. In A/C mode, every
breath triggered by the patient delivers the full set tidal volume, leading to
hyperventilation. Switching to Pressure Support Ventilation allows the patient to control
their own rate and inspiratory flow, which helps normalize the PaCO₂ and respiratory
rate. Decreasing the set ventilator rate will have no effect because the patient is
breathing well above the set rate.
Question 2
A 28-year-old female patient is admitted to the emergency department following an
accidental house fire. She presents with dynamic facial burns, soot around her nares,
and a hoarse voice. She is conscious, alert, and breathing comfortably on a non-
rebreather mask at 15 L/min. Pulse oximetry reads 99%. What should the respiratory
therapist recommend immediately?
,A) Obtain an arterial blood gas and monitor closely
B) Perform an immediate endotracheal intubation
C) Initiate continuous bronchodilator therapy
D) Discontinue the oxygen mask and initiate a high-flow nasal cannula
Answer: B) Perform an immediate endotracheal intubation
Rationale: Signs of upper airway thermal injury, such as facial burns, soot around the
nares, mucosal edema, and hoarseness, carry a high risk of sudden, catastrophic upper
airway obstruction. Proactive, early endotracheal intubation is critical before swelling
seals the upper airway completely. Waiting for an ABG or pulse oximetry trend is
dangerous because oxygenation metrics may remain completely normal until total
obstruction occurs.
Question 3
While conducting a routine ventilator check on a patient in the coronary care unit, the
respiratory therapist notices that the low-pressure alarm is actively sounding. The
therapist notes that the patient's exhaled tidal volume is dropping drastically down to 50
mL. Which of the following clinical situations would explain these findings?
A) Secretions packing the mainstem bronchus
B) External kinking of the endotracheal tube
C) Disconnection of the ventilator circuit at the heat-moisture exchanger (HME)
D) Dynamic auto-PEEP development
Answer: C) Disconnection of the ventilator circuit at the heat-moisture exchanger
(HME)
Rationale: A low-pressure alarm combined with a sudden drop in exhaled tidal volume
indicates a severe system leak or structural disconnection in the circuit pathway.
Secretions, kinking, and airway obstructions lead to high-pressure alarms due to
increased resistance.
Question 4
A 55-year-old patient diagnosed with acute respiratory distress syndrome (ARDS) is
undergoing lung-protective volume ventilation. The ventilator settings are: \(V_{T}\) 360
mL, Rate 24/min, PEEP 12 cmH₂O. During a routine assessment, the respiratory
therapist calculates a plateau pressure (\(P_{plat}\)) of 34 cmH₂O. Which structural
modification should the therapist suggest?
A) Increase the PEEP to 15 cmH₂O to recruit alveoli
B) Decrease the tidal volume to bring the plateau pressure below 30 cmH₂O
,C) Increase the inspiratory flow rate to decrease inspiratory time
D) Switch the patient to a standard heat-moisture exchanger
Answer: B) Decrease the tidal volume to bring the plateau pressure below 30
cmH₂O
Rationale: ARDS lung-protective ventilation strategy mandates keeping the plateau
pressure (\(P_{plat}\)) strictly under 30 cmH₂O to avoid barotrauma and volutrauma. If
the plateau pressure rises above 30 cmH₂O, the tidal volume should be down-titrated
(down to a minimum of 4 mL/kg ideal body weight) to reduce alveolar inflation
pressures.
Question 5
A respiratory therapist is analyzing an arterial blood gas drawn from a patient in the
neurological step-down unit. The results read: pH 7.22, PaCO₂ 65 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 26 mEq/L. How should this acid-base balance be interpreted?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
C) Partially compensated metabolic alkalosis
D) Fully compensated respiratory acidosis
Answer: B) Uncompensated respiratory acidosis
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO₂ is elevated (>45
mmHg), which accounts for the drop in pH, confirming a respiratory origin. Because the
HCO₃⁻ is still within normal limits (22–26 mEq/L), no renal compensation has occurred
yet.
Question 6
A neonate born at 28 weeks of gestation is experiencing severe grunting, nasal flaring,
and intercostal retractions on an FiO₂ of 0.50 via an oxygen hood. An arterial blood gas
shows a PaO₂ of 46 mmHg. What clinical intervention is indicated next?
A) Initiate mechanical ventilation via a neonatal volume ventilator
B) Implement Nasal Continuous Positive Airway Pressure (nCPAP) at 5 cmH₂O
C) Increase the oxygen hood concentration to 0.70
D) Administer intravenous building boluses of sodium bicarbonate
Answer: B) Implement Nasal Continuous Positive Airway Pressure (nCPAP) at 5
cmH₂O
, Rationale: A premature neonate presenting with signs of respiratory distress syndrome
(grunting, flaring, retractions) along with refractory hypoxemia should be placed on
nasal CPAP. This recruits collapsed alveoli, increases functional residual capacity
(FRC), and improves ventilation-perfusion matching without the immediate risks of
invasive mechanical ventilation.
Question 7
A patient in the intensive care unit is receiving Volume Control ventilation. The peak
inspiratory pressure (PIP) has progressively risen from 25 to 42 cmH₂O over the last
four hours. Meanwhile, the calculated plateau pressure (\(P_{plat}\)) has remained
completely constant at 18 cmH₂O. What does this trend indicate?
A) Decreasing static lung compliance
B) Increasing dynamic airway resistance
C) Alveolar collapse or atelectasis
D) Development of a tension pneumothorax
Answer: B) Increasing dynamic airway resistance
Rationale: Airway resistance (\(R_{aw}\)) is reflected by the difference between the peak
inspiratory pressure and the plateau pressure (\(PIP - P_{plat}\)). Because the PIP
increased while the plateau pressure remained constant, the transairway pressure
gradient widened, indicating an increase in airway resistance (e.g., from bronchospasm,
secretions, or a kinked tube). If compliance were dropping, both PIP and plateau
pressures would rise together.
Question 8
A 42-year-old postoperative male patient who underwent abdominal surgery is
cooperative but unable to achieve his target incentive spirometry volumes. Crackles are
auscultated in both lung bases. The respiratory therapist wants to implement an
alternative hyperinflation therapy modality. What should be selected?
A) Intermittent Positive Pressure Breathing (IPPB)
B) Intrapulmonary Percussive Ventilation (IPV)
C) Continuous bronchodilator therapy via a vibrating mesh nebulizer
D) Mechanical insufflation-exsufflation therapy
Answer: A) Intermittent Positive Pressure Breathing (IPPB)
Rationale: IPPB is indicated for patients who require hyperinflation therapy to treat or
prevent atelectasis but are uncooperative or unable to perform incentive spirometry
effectively (e.g., due to pain or weakness following major abdominal surgeries).
