NBRC TMC/CRT/RRT Version 1 Exam:
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SECTION 1: PATIENT ASSESSMENT & ABG INTERPRETATION (Questions 1–60)
1. A 68-year-old patient with COPD is receiving oxygen via nasal cannula at 2
L/min. ABG results show pH 7.32, PaCO₂ 68 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 34
mEq/L. What is the most appropriate intervention?
a. Increase oxygen to 4 L/min via nasal cannula
b. Initiate noninvasive positive pressure ventilation (NIPPV)
c. Administer sodium bicarbonate
d. Decrease oxygen to 1 L/min
Answer: b. Initiate noninvasive positive pressure ventilation (NIPPV)
Rationale: This ABG shows chronic respiratory acidosis with hypoxemia. The pH is low
(7.32), PaCO₂ is severely elevated (68 mmHg), and HCO₃⁻ is elevated (34 mEq/L),
indicating renal compensation. NIPPV is the most appropriate intervention to support
ventilation, reduce PaCO₂, and correct the pH without the risks of intubation .
2. An RT returns to the room of a 63-year-old patient and finds her less responsive.
Her HR is 154/min, RR 8/min, and she has a weak pulse. She is receiving 2 L/min
nasal cannula. What should the RT do FIRST?
a. Contact the physician for patient evaluation
b. Activate the medical emergency team
c. Recommend a CXR to evaluate pulmonary status
d. Increase nasal cannula to 4 L/min and monitor with pulse oximetry
Answer: b. Activate the medical emergency team
,Rationale: This patient shows signs of impending respiratory failure and cardiovascular
compromise. The first action is to activate the emergency response team to provide
immediate intervention .
3. A patient's ABG shows pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L. This is
consistent with:
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
Answer: b. Respiratory alkalosis
Rationale: Respiratory alkalosis is characterized by elevated pH (>7.45) and decreased
PaCO₂ (<35 mmHg) with normal HCO₃⁻. This ABG shows pH 7.48, PaCO₂ 30, and normal
HCO₃⁻ 22, indicating hyperventilation .
4. A patient's ABG shows pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 25 mEq/L. This is
consistent with:
a. Acute respiratory acidosis
b. Chronic respiratory acidosis
c. Metabolic acidosis with respiratory compensation
d. Mixed acidosis
Answer: a. Acute respiratory acidosis
Rationale: Acute respiratory acidosis is characterized by decreased pH (<7.35), elevated
PaCO₂ (>45 mmHg), and normal or minimally elevated HCO₃⁻. Here, pH 7.28, PaCO₂ 55,
and normal HCO₃⁻ 25 indicate acute respiratory acidosis .
5. A patient's ABG shows pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 36 mEq/L. This is
consistent with:
,a. Acute respiratory acidosis
b. Metabolic alkalosis with respiratory compensation
c. Respiratory alkalosis with metabolic compensation
d. Mixed alkalosis
Answer: b. Metabolic alkalosis with respiratory compensation
Rationale: Metabolic alkalosis is characterized by elevated pH (>7.45) and elevated HCO₃⁻
(>26 mEq/L) with compensatory respiratory acidosis (elevated PaCO₂). Here, pH 7.50,
HCO₃⁻ 36, and PaCO₂ 48 indicate metabolic alkalosis with respiratory compensation .
6. A patient's ABG shows pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 12 mEq/L. This is
consistent with:
a. Respiratory acidosis with metabolic compensation
b. Metabolic acidosis with respiratory compensation
c. Mixed acidosis
d. Respiratory alkalosis with metabolic compensation
Answer: b. Metabolic acidosis with respiratory compensation
Rationale: Metabolic acidosis is characterized by decreased pH (<7.35) and decreased
HCO₃⁻ (<22 mEq/L) with compensatory respiratory alkalosis (decreased PaCO₂). Here, pH
7.25, HCO₃⁻ 12, and PaCO₂ 30 indicate metabolic acidosis with respiratory compensation .
7. A patient's ABG shows pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L. This is
consistent with:
a. Acute respiratory acidosis
b. Chronic respiratory acidosis with compensation
c. Metabolic acidosis with respiratory compensation
d. Normal
Answer: b. Chronic respiratory acidosis with compensation
Rationale: Chronic respiratory acidosis is characterized by decreased pH (near normal),
elevated PaCO₂ (>45 mmHg), and elevated HCO₃⁻ (>26 mEq/L) indicating renal
, compensation. Here, pH 7.35, PaCO₂ 50, and HCO₃⁻ 28 indicate chronic respiratory
acidosis with compensation .
8. A patient's ABG shows pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L. This is:
a. Normal
b. Respiratory acidosis
c. Metabolic acidosis
d. Respiratory alkalosis
Answer: a. Normal
Rationale: Normal ABG values are pH 7.35–7.45, PaCO₂ 35–45 mmHg, and HCO₃⁻ 22–26
mEq/L. This ABG is within normal limits .
9. Which of the following is the most reliable indicator of adequate oxygenation in
a patient receiving mechanical ventilation?
a. SpO₂ of 92%
b. PaO₂/FiO₂ ratio
c. PaO₂ of 80 mmHg
d. SaO₂ of 95%
Answer: b. PaO₂/FiO₂ ratio
Rationale: The PaO₂/FiO₂ (P/F) ratio is the most reliable indicator of oxygenation status
because it accounts for both the partial pressure of oxygen and the fraction of inspired
oxygen. A P/F ratio <300 indicates acute lung injury, and <200 indicates ARDS .
10. A patient has a PaO₂ of 50 mmHg on FiO₂ 0.40. The P/F ratio is:
a. 100
b. 125
c. 150
d. 200
Answer: b. 125
Questions & Answers | Complete A+ Guide |
100% Guaranteed Success
SECTION 1: PATIENT ASSESSMENT & ABG INTERPRETATION (Questions 1–60)
1. A 68-year-old patient with COPD is receiving oxygen via nasal cannula at 2
L/min. ABG results show pH 7.32, PaCO₂ 68 mmHg, PaO₂ 55 mmHg, HCO₃⁻ 34
mEq/L. What is the most appropriate intervention?
a. Increase oxygen to 4 L/min via nasal cannula
b. Initiate noninvasive positive pressure ventilation (NIPPV)
c. Administer sodium bicarbonate
d. Decrease oxygen to 1 L/min
Answer: b. Initiate noninvasive positive pressure ventilation (NIPPV)
Rationale: This ABG shows chronic respiratory acidosis with hypoxemia. The pH is low
(7.32), PaCO₂ is severely elevated (68 mmHg), and HCO₃⁻ is elevated (34 mEq/L),
indicating renal compensation. NIPPV is the most appropriate intervention to support
ventilation, reduce PaCO₂, and correct the pH without the risks of intubation .
2. An RT returns to the room of a 63-year-old patient and finds her less responsive.
Her HR is 154/min, RR 8/min, and she has a weak pulse. She is receiving 2 L/min
nasal cannula. What should the RT do FIRST?
a. Contact the physician for patient evaluation
b. Activate the medical emergency team
c. Recommend a CXR to evaluate pulmonary status
d. Increase nasal cannula to 4 L/min and monitor with pulse oximetry
Answer: b. Activate the medical emergency team
,Rationale: This patient shows signs of impending respiratory failure and cardiovascular
compromise. The first action is to activate the emergency response team to provide
immediate intervention .
3. A patient's ABG shows pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L. This is
consistent with:
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
Answer: b. Respiratory alkalosis
Rationale: Respiratory alkalosis is characterized by elevated pH (>7.45) and decreased
PaCO₂ (<35 mmHg) with normal HCO₃⁻. This ABG shows pH 7.48, PaCO₂ 30, and normal
HCO₃⁻ 22, indicating hyperventilation .
4. A patient's ABG shows pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 25 mEq/L. This is
consistent with:
a. Acute respiratory acidosis
b. Chronic respiratory acidosis
c. Metabolic acidosis with respiratory compensation
d. Mixed acidosis
Answer: a. Acute respiratory acidosis
Rationale: Acute respiratory acidosis is characterized by decreased pH (<7.35), elevated
PaCO₂ (>45 mmHg), and normal or minimally elevated HCO₃⁻. Here, pH 7.28, PaCO₂ 55,
and normal HCO₃⁻ 25 indicate acute respiratory acidosis .
5. A patient's ABG shows pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 36 mEq/L. This is
consistent with:
,a. Acute respiratory acidosis
b. Metabolic alkalosis with respiratory compensation
c. Respiratory alkalosis with metabolic compensation
d. Mixed alkalosis
Answer: b. Metabolic alkalosis with respiratory compensation
Rationale: Metabolic alkalosis is characterized by elevated pH (>7.45) and elevated HCO₃⁻
(>26 mEq/L) with compensatory respiratory acidosis (elevated PaCO₂). Here, pH 7.50,
HCO₃⁻ 36, and PaCO₂ 48 indicate metabolic alkalosis with respiratory compensation .
6. A patient's ABG shows pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 12 mEq/L. This is
consistent with:
a. Respiratory acidosis with metabolic compensation
b. Metabolic acidosis with respiratory compensation
c. Mixed acidosis
d. Respiratory alkalosis with metabolic compensation
Answer: b. Metabolic acidosis with respiratory compensation
Rationale: Metabolic acidosis is characterized by decreased pH (<7.35) and decreased
HCO₃⁻ (<22 mEq/L) with compensatory respiratory alkalosis (decreased PaCO₂). Here, pH
7.25, HCO₃⁻ 12, and PaCO₂ 30 indicate metabolic acidosis with respiratory compensation .
7. A patient's ABG shows pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L. This is
consistent with:
a. Acute respiratory acidosis
b. Chronic respiratory acidosis with compensation
c. Metabolic acidosis with respiratory compensation
d. Normal
Answer: b. Chronic respiratory acidosis with compensation
Rationale: Chronic respiratory acidosis is characterized by decreased pH (near normal),
elevated PaCO₂ (>45 mmHg), and elevated HCO₃⁻ (>26 mEq/L) indicating renal
, compensation. Here, pH 7.35, PaCO₂ 50, and HCO₃⁻ 28 indicate chronic respiratory
acidosis with compensation .
8. A patient's ABG shows pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L. This is:
a. Normal
b. Respiratory acidosis
c. Metabolic acidosis
d. Respiratory alkalosis
Answer: a. Normal
Rationale: Normal ABG values are pH 7.35–7.45, PaCO₂ 35–45 mmHg, and HCO₃⁻ 22–26
mEq/L. This ABG is within normal limits .
9. Which of the following is the most reliable indicator of adequate oxygenation in
a patient receiving mechanical ventilation?
a. SpO₂ of 92%
b. PaO₂/FiO₂ ratio
c. PaO₂ of 80 mmHg
d. SaO₂ of 95%
Answer: b. PaO₂/FiO₂ ratio
Rationale: The PaO₂/FiO₂ (P/F) ratio is the most reliable indicator of oxygenation status
because it accounts for both the partial pressure of oxygen and the fraction of inspired
oxygen. A P/F ratio <300 indicates acute lung injury, and <200 indicates ARDS .
10. A patient has a PaO₂ of 50 mmHg on FiO₂ 0.40. The P/F ratio is:
a. 100
b. 125
c. 150
d. 200
Answer: b. 125
