NBRC TMC/CRT/RRT Version 2 Exam:
Questions & Answers 2026/2027 | Complete
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SECTION 1: PATIENT ASSESSMENT & DIAGNOSTICS (Questions 1-80)
Question 1
A 67-year-old male with COPD is on 2 L/min nasal cannula. ABG: pH 7.36, PaCO₂ 55 mm
Hg, PaO₂ 65 mm Hg, HCO₃⁻ 32 mEq/L. What is the correct interpretation?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Normal ABG
Correct Answer: B) Chronic respiratory acidosis with metabolic compensation
Rationale: pH is normal (7.36) but PaCO₂ is elevated (55) and HCO₃⁻ is elevated (32). This
indicates chronic respiratory acidosis with renal compensation. In chronic states, the
kidneys retain bicarbonate to compensate for the elevated CO₂, normalizing pH.
Question 2
A patient on volume-controlled ventilation has peak pressure 48 cm H₂O and plateau
pressure 32 cm H₂O. The most likely problem is:
A) Decreased lung compliance
B) Increased airway resistance
C) Auto-PEEP
D) Circuit leak
Correct Answer: B) Increased airway resistance
Rationale: Normal peak-pressure difference is 5-10 cm H₂O. A difference of 16 indicates
increased airway resistance (bronchospasm, secretions, or kinked endotracheal tube).
Decreased lung compliance would elevate both peak and plateau pressures equally.
,Question 3
A capnography waveform shows a prolonged expiratory plateau with a rounded "shark
fin" shape. EtCO₂ is 42 mm Hg. This indicates:
A) Normal lung function
B) Bronchospasm
C) Esophageal intubation
D) Cardiac arrest
Correct Answer: B) Bronchospasm
Rationale: The rounded, sloping upslope indicates obstructive lung disease (asthma/COPD)
with uneven alveolar emptying. In normal physiology, the waveform shows a rapid
upstroke with a rectangular plateau.
Question 4
Which of the following would cause a falsely low SpO₂ reading?
A) Carboxyhemoglobin
B) Methemoglobin
C) Dark skin pigmentation
D) Nail polish
Correct Answer: A) Carboxyhemoglobin
Rationale: Carboxyhemoglobin causes falsely elevated SpO₂ readings, not falsely low.
Methemoglobinemia causes readings to trend toward 85%. Dark skin pigmentation and
nail polish can interfere but the primary concern is carboxyhemoglobin causing
overestimation of oxygen saturation.
Question 5
A patient on 50% Venturi mask has PaO₂ 55 mm Hg. What is the P/F ratio?
A) 110
B) 140
,C) 200
D) 275
Correct Answer: A) 110
Rationale: P/F ratio = PaO₂ / FiO₂. .5 = 110. This indicates severe hypoxemia. P/F
ratio < 300 indicates acute lung injury; < 200 indicates ARDS; < 100 indicates severe
ARDS.
Question 6
A patient's ABG shows pH 7.48, PaCO₂ 30 mm Hg, HCO₃⁻ 22 mEq/L. Correct
interpretation:
A) Acute respiratory alkalosis
B) Chronic respiratory alkalosis
C) Metabolic alkalosis
D) Normal
Correct Answer: A) Acute respiratory alkalosis
Rationale: pH is alkalotic (>7.45), PaCO₂ is low (<35), and HCO₃⁻ is normal (22). This
indicates acute respiratory alkalosis (hyperventilation). If it were chronic, HCO₃⁻ would be
decreased.
Question 7
Which of the following is the best method to confirm ET tube placement immediately
after intubation?
A) Chest X-ray
B) Auscultation
C) End-tidal CO₂ detection
D) Pulse oximetry
Correct Answer: C) End-tidal CO₂ detection
, Rationale: Colorimetric or waveform capnography is the gold standard for confirming
tracheal tube placement (provided cardiac output is present). Auscultation and chest X-ray
are secondary confirmation methods. Pulse oximetry is not confirmatory.
Question 8
A patient's SpO₂ is 88% on 4 L/min nasal cannula. You switch to a non-rebreather mask.
What is the minimum flow rate?
A) 5 L/min
B) 8 L/min
C) 10 L/min
D) 15 L/min
Correct Answer: C) 10 L/min
Rationale: A non-rebreather mask requires 10-15 L/min to keep the reservoir bag inflated
and prevent rebreathing of exhaled CO₂. If the bag deflates during inspiration, flow is
inadequate.
Question 9
Normal transcutaneous oxygen (PtcO₂) in a neonate is:
A) 20–40 mm Hg
B) 40–60 mm Hg
C) 60–80 mm Hg
D) 80–100 mm Hg
Correct Answer: C) 60–80 mm Hg
Rationale: PtcO₂ approximates PaO₂; normal values in neonates are 60–80 mm Hg.
Values below 50 indicate hypoxemia requiring intervention.
Question 10
A patient has PaCO₂ 60 mm Hg, minute ventilation 8 L/min, RR 16. What is the tidal
volume?
Questions & Answers 2026/2027 | Complete
A+ Guide | 100% Guaranteed Success
SECTION 1: PATIENT ASSESSMENT & DIAGNOSTICS (Questions 1-80)
Question 1
A 67-year-old male with COPD is on 2 L/min nasal cannula. ABG: pH 7.36, PaCO₂ 55 mm
Hg, PaO₂ 65 mm Hg, HCO₃⁻ 32 mEq/L. What is the correct interpretation?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis with metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Normal ABG
Correct Answer: B) Chronic respiratory acidosis with metabolic compensation
Rationale: pH is normal (7.36) but PaCO₂ is elevated (55) and HCO₃⁻ is elevated (32). This
indicates chronic respiratory acidosis with renal compensation. In chronic states, the
kidneys retain bicarbonate to compensate for the elevated CO₂, normalizing pH.
Question 2
A patient on volume-controlled ventilation has peak pressure 48 cm H₂O and plateau
pressure 32 cm H₂O. The most likely problem is:
A) Decreased lung compliance
B) Increased airway resistance
C) Auto-PEEP
D) Circuit leak
Correct Answer: B) Increased airway resistance
Rationale: Normal peak-pressure difference is 5-10 cm H₂O. A difference of 16 indicates
increased airway resistance (bronchospasm, secretions, or kinked endotracheal tube).
Decreased lung compliance would elevate both peak and plateau pressures equally.
,Question 3
A capnography waveform shows a prolonged expiratory plateau with a rounded "shark
fin" shape. EtCO₂ is 42 mm Hg. This indicates:
A) Normal lung function
B) Bronchospasm
C) Esophageal intubation
D) Cardiac arrest
Correct Answer: B) Bronchospasm
Rationale: The rounded, sloping upslope indicates obstructive lung disease (asthma/COPD)
with uneven alveolar emptying. In normal physiology, the waveform shows a rapid
upstroke with a rectangular plateau.
Question 4
Which of the following would cause a falsely low SpO₂ reading?
A) Carboxyhemoglobin
B) Methemoglobin
C) Dark skin pigmentation
D) Nail polish
Correct Answer: A) Carboxyhemoglobin
Rationale: Carboxyhemoglobin causes falsely elevated SpO₂ readings, not falsely low.
Methemoglobinemia causes readings to trend toward 85%. Dark skin pigmentation and
nail polish can interfere but the primary concern is carboxyhemoglobin causing
overestimation of oxygen saturation.
Question 5
A patient on 50% Venturi mask has PaO₂ 55 mm Hg. What is the P/F ratio?
A) 110
B) 140
,C) 200
D) 275
Correct Answer: A) 110
Rationale: P/F ratio = PaO₂ / FiO₂. .5 = 110. This indicates severe hypoxemia. P/F
ratio < 300 indicates acute lung injury; < 200 indicates ARDS; < 100 indicates severe
ARDS.
Question 6
A patient's ABG shows pH 7.48, PaCO₂ 30 mm Hg, HCO₃⁻ 22 mEq/L. Correct
interpretation:
A) Acute respiratory alkalosis
B) Chronic respiratory alkalosis
C) Metabolic alkalosis
D) Normal
Correct Answer: A) Acute respiratory alkalosis
Rationale: pH is alkalotic (>7.45), PaCO₂ is low (<35), and HCO₃⁻ is normal (22). This
indicates acute respiratory alkalosis (hyperventilation). If it were chronic, HCO₃⁻ would be
decreased.
Question 7
Which of the following is the best method to confirm ET tube placement immediately
after intubation?
A) Chest X-ray
B) Auscultation
C) End-tidal CO₂ detection
D) Pulse oximetry
Correct Answer: C) End-tidal CO₂ detection
, Rationale: Colorimetric or waveform capnography is the gold standard for confirming
tracheal tube placement (provided cardiac output is present). Auscultation and chest X-ray
are secondary confirmation methods. Pulse oximetry is not confirmatory.
Question 8
A patient's SpO₂ is 88% on 4 L/min nasal cannula. You switch to a non-rebreather mask.
What is the minimum flow rate?
A) 5 L/min
B) 8 L/min
C) 10 L/min
D) 15 L/min
Correct Answer: C) 10 L/min
Rationale: A non-rebreather mask requires 10-15 L/min to keep the reservoir bag inflated
and prevent rebreathing of exhaled CO₂. If the bag deflates during inspiration, flow is
inadequate.
Question 9
Normal transcutaneous oxygen (PtcO₂) in a neonate is:
A) 20–40 mm Hg
B) 40–60 mm Hg
C) 60–80 mm Hg
D) 80–100 mm Hg
Correct Answer: C) 60–80 mm Hg
Rationale: PtcO₂ approximates PaO₂; normal values in neonates are 60–80 mm Hg.
Values below 50 indicate hypoxemia requiring intervention.
Question 10
A patient has PaCO₂ 60 mm Hg, minute ventilation 8 L/min, RR 16. What is the tidal
volume?
