NBRC TMC/CRT/RRT Version 3 Exam 2026 | 200 Exam-
Style Questions with Bold Italic Answers and Italic
Rationales | Comprehensive Study Guide for
Respiratory Therapy Certification
Domain I: Patient Data Evaluation and Recommendations (Questions 1–72)
1. A 68-year-old male with a history of COPD presents with increased dyspnea,
cough, and purulent sputum. His vital signs are: HR 110, RR 28, BP 138/86, SpO₂
88% on room air. Which of the following should the respiratory therapist
recommend FIRST?
A) Administer a bronchodilator via small-volume nebulizer
B) Initiate oxygen therapy to maintain SpO₂ between 88-92%
C) Obtain an arterial blood gas
D) Begin incentive spirometry
Answer: B) Initiate oxygen therapy to maintain SpO₂ between 88-92%
Explanation: For a COPD patient with hypoxemia (SpO₂ 88%), the immediate
priority is oxygen therapy titrated to the target range of 88-92% to prevent further
desaturation while avoiding oxygen-induced hypercapnia.
2. A respiratory therapist is reviewing a patient's medical record and notes a
history of smoking 1.5 packs per day for 20 years. What is the patient's smoking
history in pack-years?
A) 20 pack-years
B) 30 pack-years
C) 15 pack-years
D) 40 pack-years
,Answer: B) 30 pack-years
Explanation: Pack-years are calculated by multiplying the number of packs
smoked per day by the number of years smoked (1.5 × 20 = 30 pack-years).
3. A patient's sputum specimen is purulent, green in appearance, has separated
into layers, and has a foul odor. Which of the following is the MOST likely
cause?
A) Viral pneumonia
B) Pulmonary embolism
C) Anaerobic bacterial infection
D) Congestive heart failure
Answer: C) Anaerobic bacterial infection
Explanation: Purulent, green, foul-smelling sputum that separates into layers is
characteristic of an anaerobic bacterial infection, often seen in aspiration
pneumonia or lung abscess.
4. A respiratory therapist interviews a 14-year-old patient with cystic fibrosis
who reports difficulty clearing sputum despite using albuterol, hypertonic
saline, and a high-frequency chest wall oscillation vest. Which of the following
should the therapist recommend?
A) Montelukast
B) Budesonide
C) N-acetylcysteine
D) Dornase alfa (Pulmozyme)
Answer: D) Dornase alfa (Pulmozyme)
Explanation: Dornase alfa is a mucolytic specifically indicated for cystic fibrosis
that cleaves extracellular DNA in mucus, reducing viscosity and improving
clearance when standard therapies are insufficient.
5. A patient's chest radiograph shows asymmetrically spaced clavicles around
the sternum. The therapist should conclude that:
A) The patient was rotated
B) The patient has pectus excavatum
C) A pneumomediastinum occurred
D) The radiograph is overexposed
,Answer: A) The patient was rotated
Explanation: Asymmetric spacing of the clavicles around the sternum on a chest
radiograph indicates patient rotation, which can distort the image and lead to
misinterpretation.
6. A 52-year-old post-operative cholecystectomy patient's breath sounds
become more coarse upon completion of postural drainage with percussion.
The respiratory therapist should recommend:
A) Continuing the therapy until breath sounds improve
B) Administering dornase alpha
C) Administering albuterol therapy
D) Deep breathing and coughing to clear secretions
Answer: D) Deep breathing and coughing to clear secretions
Explanation: Coarse breath sounds after postural drainage indicate mobilized
secretions in the larger airways; deep breathing and coughing are the appropriate
next step to clear them.
7. A 65-kg spinal cord injured patient has developed atelectasis with an
inspiratory capacity of 30% of predicted. What bronchial hygiene therapy would
be MOST appropriate initially?
A) Incentive spirometry
B) IPPB with normal saline
C) Postural drainage and percussion
D) PEP therapy
Answer: B) IPPB with normal saline
Explanation: IPPB is indicated when a patient's inspiratory capacity is less than
30% of predicted and they cannot perform effective deep breathing exercises,
providing positive pressure to expand the lungs.
8. A respiratory therapist is assessing a patient's level of dyspnea. Which
statement by the patient indicates the presence of dyspnea?
A) "I can only sleep when sitting upright."
B) "I have trouble remembering to take my medication."
C) "My chest is congested, particularly in the morning."
D) "I feel short of breath while walking and have to stop and rest."
, Answer: D) "I feel short of breath while walking and have to stop and rest."
Explanation: Dyspnea is the subjective sensation of difficult or labored breathing.
The statement describing shortness of breath during exertion directly describes
dyspnea.
9. A 48-year-old female is admitted to the ED with diaphoresis, jugular venous
distension, and 3+ pitting edema in the ankles. These findings are MOST
consistent with:
A) Liver failure
B) Pulmonary embolism
C) Heart failure
D) Electrolyte imbalances
Answer: C) Heart failure
Explanation: Diaphoresis, jugular venous distension, and peripheral edema are
classic signs of heart failure due to fluid overload and impaired cardiac output.
10. A patient is admitted to the ED following a motor vehicle accident. Breath
sounds are absent in the left chest with a hyperresonant percussion note, and
the trachea is shifted to the right. HR is 45, RR is 30, and BP is 60/40. What
action should the therapist recommend FIRST?
A) Call for a STAT chest x-ray
B) Insert a chest tube into the left chest
C) Needle aspirate the 2nd left intercostal space
D) Activate the medical emergency team to intubate
Answer: C) Needle aspirate the 2nd left intercostal space
Explanation: The presentation is consistent with tension pneumothorax.
Immediate needle decompression is required before chest tube placement or
imaging.
11. A respiratory therapist is reviewing a patient's arterial blood gas results: pH
7.28, PaCO₂ 58 mm Hg, HCO₃⁻ 26 mEq/L. What is the correct interpretation?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Style Questions with Bold Italic Answers and Italic
Rationales | Comprehensive Study Guide for
Respiratory Therapy Certification
Domain I: Patient Data Evaluation and Recommendations (Questions 1–72)
1. A 68-year-old male with a history of COPD presents with increased dyspnea,
cough, and purulent sputum. His vital signs are: HR 110, RR 28, BP 138/86, SpO₂
88% on room air. Which of the following should the respiratory therapist
recommend FIRST?
A) Administer a bronchodilator via small-volume nebulizer
B) Initiate oxygen therapy to maintain SpO₂ between 88-92%
C) Obtain an arterial blood gas
D) Begin incentive spirometry
Answer: B) Initiate oxygen therapy to maintain SpO₂ between 88-92%
Explanation: For a COPD patient with hypoxemia (SpO₂ 88%), the immediate
priority is oxygen therapy titrated to the target range of 88-92% to prevent further
desaturation while avoiding oxygen-induced hypercapnia.
2. A respiratory therapist is reviewing a patient's medical record and notes a
history of smoking 1.5 packs per day for 20 years. What is the patient's smoking
history in pack-years?
A) 20 pack-years
B) 30 pack-years
C) 15 pack-years
D) 40 pack-years
,Answer: B) 30 pack-years
Explanation: Pack-years are calculated by multiplying the number of packs
smoked per day by the number of years smoked (1.5 × 20 = 30 pack-years).
3. A patient's sputum specimen is purulent, green in appearance, has separated
into layers, and has a foul odor. Which of the following is the MOST likely
cause?
A) Viral pneumonia
B) Pulmonary embolism
C) Anaerobic bacterial infection
D) Congestive heart failure
Answer: C) Anaerobic bacterial infection
Explanation: Purulent, green, foul-smelling sputum that separates into layers is
characteristic of an anaerobic bacterial infection, often seen in aspiration
pneumonia or lung abscess.
4. A respiratory therapist interviews a 14-year-old patient with cystic fibrosis
who reports difficulty clearing sputum despite using albuterol, hypertonic
saline, and a high-frequency chest wall oscillation vest. Which of the following
should the therapist recommend?
A) Montelukast
B) Budesonide
C) N-acetylcysteine
D) Dornase alfa (Pulmozyme)
Answer: D) Dornase alfa (Pulmozyme)
Explanation: Dornase alfa is a mucolytic specifically indicated for cystic fibrosis
that cleaves extracellular DNA in mucus, reducing viscosity and improving
clearance when standard therapies are insufficient.
5. A patient's chest radiograph shows asymmetrically spaced clavicles around
the sternum. The therapist should conclude that:
A) The patient was rotated
B) The patient has pectus excavatum
C) A pneumomediastinum occurred
D) The radiograph is overexposed
,Answer: A) The patient was rotated
Explanation: Asymmetric spacing of the clavicles around the sternum on a chest
radiograph indicates patient rotation, which can distort the image and lead to
misinterpretation.
6. A 52-year-old post-operative cholecystectomy patient's breath sounds
become more coarse upon completion of postural drainage with percussion.
The respiratory therapist should recommend:
A) Continuing the therapy until breath sounds improve
B) Administering dornase alpha
C) Administering albuterol therapy
D) Deep breathing and coughing to clear secretions
Answer: D) Deep breathing and coughing to clear secretions
Explanation: Coarse breath sounds after postural drainage indicate mobilized
secretions in the larger airways; deep breathing and coughing are the appropriate
next step to clear them.
7. A 65-kg spinal cord injured patient has developed atelectasis with an
inspiratory capacity of 30% of predicted. What bronchial hygiene therapy would
be MOST appropriate initially?
A) Incentive spirometry
B) IPPB with normal saline
C) Postural drainage and percussion
D) PEP therapy
Answer: B) IPPB with normal saline
Explanation: IPPB is indicated when a patient's inspiratory capacity is less than
30% of predicted and they cannot perform effective deep breathing exercises,
providing positive pressure to expand the lungs.
8. A respiratory therapist is assessing a patient's level of dyspnea. Which
statement by the patient indicates the presence of dyspnea?
A) "I can only sleep when sitting upright."
B) "I have trouble remembering to take my medication."
C) "My chest is congested, particularly in the morning."
D) "I feel short of breath while walking and have to stop and rest."
, Answer: D) "I feel short of breath while walking and have to stop and rest."
Explanation: Dyspnea is the subjective sensation of difficult or labored breathing.
The statement describing shortness of breath during exertion directly describes
dyspnea.
9. A 48-year-old female is admitted to the ED with diaphoresis, jugular venous
distension, and 3+ pitting edema in the ankles. These findings are MOST
consistent with:
A) Liver failure
B) Pulmonary embolism
C) Heart failure
D) Electrolyte imbalances
Answer: C) Heart failure
Explanation: Diaphoresis, jugular venous distension, and peripheral edema are
classic signs of heart failure due to fluid overload and impaired cardiac output.
10. A patient is admitted to the ED following a motor vehicle accident. Breath
sounds are absent in the left chest with a hyperresonant percussion note, and
the trachea is shifted to the right. HR is 45, RR is 30, and BP is 60/40. What
action should the therapist recommend FIRST?
A) Call for a STAT chest x-ray
B) Insert a chest tube into the left chest
C) Needle aspirate the 2nd left intercostal space
D) Activate the medical emergency team to intubate
Answer: C) Needle aspirate the 2nd left intercostal space
Explanation: The presentation is consistent with tension pneumothorax.
Immediate needle decompression is required before chest tube placement or
imaging.
11. A respiratory therapist is reviewing a patient's arterial blood gas results: pH
7.28, PaCO₂ 58 mm Hg, HCO₃⁻ 26 mEq/L. What is the correct interpretation?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
