NBRC TMC CRT RRT ACTUAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
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1. A 56-year-old male patient with a history of COPD is admitted to the emergency department with acute
respiratory distress. His initial arterial blood gas (ABG) on room air reveals a pH of 7.28, PaCO2 of 68 mmHg,
and PaO2 of 48 mmHg. Which of the following initial interventions is most appropriate?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Initiate non-invasive positive pressure ventilation (NIPPV)
C. Perform endotracheal intubation and mechanical ventilation
D. Administer nebulized albuterol and ipratropium
Correct Answer: B. Initiate non-invasive positive pressure ventilation (NIPPV)
*Rationale: The ABG shows acute respiratory acidosis (low pH, elevated PaCO2) with significant hypoxemia in a
patient with known COPD. NIPPV is the first-line intervention for acute hypercapnic respiratory failure in COPD
patients, as it can improve gas exchange, reduce the work of breathing, and often prevent the need for intubation.
Option A is incorrect because high-flow oxygen can suppress the hypoxic drive in some COPD patients and may
worsen hypercapnia. Option C, intubation, is reserved for patients who fail NIPPV or are unable to protect their
airway. Option D, bronchodilators, are an adjunctive therapy but do not address the primary issue of ventilatory
failure.
,2. A therapist is calibrating a disposable oxygen saturation probe. The device displays a reading of 94% on a
healthy volunteer known to have a saturation of 98% on a calibrated co-oximeter. What is the most appropriate
action?
A. Replace the probe immediately as it is faulty.
B. Adjust the sensitivity setting on the pulse oximeter.
C. Document the reading and proceed as the difference is clinically acceptable.
D. Use the probe only on patients with darker skin pigmentation.
Correct Answer: C. Document the reading and proceed as the difference is clinically acceptable.
*Rationale: Pulse oximeters are generally accurate within +/- 2% to 3% of the true arterial saturation. A 4% difference
(98% vs. 94%) is borderline but may be acceptable depending on the device's specifications and the clinical context.
However, for a healthy volunteer, this discrepancy should be noted. A difference of 4% is not typically a cause for
immediate replacement unless it is outside the manufacturer's stated tolerance. Option A is incorrect without further
confirmation. Option B is inappropriate as sensitivity settings are not usually user-adjustable for standard SpO2
monitoring. Option D is incorrect and could lead to inaccuracies; the probe's accuracy should be verified
independently, not biased toward a specific population.
,3. Which of the following ventilator settings is most likely to directly increase a patient's mean airway pressure,
thereby improving oxygenation?
A. Decreasing the inspiratory flow rate
B. Increasing the peak inspiratory pressure (PIP)
C. Adding positive end-expiratory pressure (PEEP)
D. Decreasing the inspiratory-to-expiratory (I:E) ratio
Correct Answer: C. Adding positive end-expiratory pressure (PEEP)
*Rationale: PEEP directly increases the pressure in the alveoli at the end of expiration, which increases mean airway
pressure and helps recruit collapsed alveoli, improving oxygenation. Option A, decreasing the flow rate, would increase
inspiratory time but might not significantly affect mean airway pressure and could cause air trapping. Option B,
increasing PIP, is a more general measure for ventilation and may increase mean pressure but is not as targeted for
oxygenation as PEEP. Option D, decreasing the I:E ratio (e.g., moving from 1:2 to 1:3), would shorten inspiratory time
and decrease mean airway pressure, potentially worsening oxygenation.
4. A patient is on a volume-controlled ventilator with the following settings: tidal volume 600 mL, respiratory
rate 14 breaths/min, and FiO2 0.40. An arterial blood gas reveals a PaCO2 of 32 mmHg and a pH of 7.48. Which
of the following ventilator adjustments would best address this condition?
, A. Increase the tidal volume to 700 mL.
B. Decrease the respiratory rate to 10 breaths/min.
C. Decrease the FiO2 to 0.30.
D. Increase the inspiratory flow rate.
Correct Answer: B. Decrease the respiratory rate to 10 breaths/min.
*Rationale: The patient is experiencing respiratory alkalosis, indicated by an elevated pH and low PaCO2. This is
typically caused by excessive alveolar ventilation. Decreasing the respiratory rate will reduce the minute ventilation,
allowing the PaCO2 to rise toward normal and correct the alkalosis. Option A, increasing tidal volume, would further
exacerbate the problem. Option C, decreasing FiO2, addresses oxygenation, not ventilation. Option D, increasing flow,
would not have a direct effect on the PaCO2 or pH.
5. During a routine check, a therapist notices that the water level in the heated humidifier has dropped
significantly and is nearly empty. The low water alarm has not sounded. What is the most immediate priority?
A. Pour sterile water into the humidifier until it is full.
B. Manually refill the humidifier and check the alarm function.
C. Turn off the humidifier and allow it to cool before refilling.
D. Ignore it and wait for the alarm to activate to confirm the sensor is working.
PLUS RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
1. A 56-year-old male patient with a history of COPD is admitted to the emergency department with acute
respiratory distress. His initial arterial blood gas (ABG) on room air reveals a pH of 7.28, PaCO2 of 68 mmHg,
and PaO2 of 48 mmHg. Which of the following initial interventions is most appropriate?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Initiate non-invasive positive pressure ventilation (NIPPV)
C. Perform endotracheal intubation and mechanical ventilation
D. Administer nebulized albuterol and ipratropium
Correct Answer: B. Initiate non-invasive positive pressure ventilation (NIPPV)
*Rationale: The ABG shows acute respiratory acidosis (low pH, elevated PaCO2) with significant hypoxemia in a
patient with known COPD. NIPPV is the first-line intervention for acute hypercapnic respiratory failure in COPD
patients, as it can improve gas exchange, reduce the work of breathing, and often prevent the need for intubation.
Option A is incorrect because high-flow oxygen can suppress the hypoxic drive in some COPD patients and may
worsen hypercapnia. Option C, intubation, is reserved for patients who fail NIPPV or are unable to protect their
airway. Option D, bronchodilators, are an adjunctive therapy but do not address the primary issue of ventilatory
failure.
,2. A therapist is calibrating a disposable oxygen saturation probe. The device displays a reading of 94% on a
healthy volunteer known to have a saturation of 98% on a calibrated co-oximeter. What is the most appropriate
action?
A. Replace the probe immediately as it is faulty.
B. Adjust the sensitivity setting on the pulse oximeter.
C. Document the reading and proceed as the difference is clinically acceptable.
D. Use the probe only on patients with darker skin pigmentation.
Correct Answer: C. Document the reading and proceed as the difference is clinically acceptable.
*Rationale: Pulse oximeters are generally accurate within +/- 2% to 3% of the true arterial saturation. A 4% difference
(98% vs. 94%) is borderline but may be acceptable depending on the device's specifications and the clinical context.
However, for a healthy volunteer, this discrepancy should be noted. A difference of 4% is not typically a cause for
immediate replacement unless it is outside the manufacturer's stated tolerance. Option A is incorrect without further
confirmation. Option B is inappropriate as sensitivity settings are not usually user-adjustable for standard SpO2
monitoring. Option D is incorrect and could lead to inaccuracies; the probe's accuracy should be verified
independently, not biased toward a specific population.
,3. Which of the following ventilator settings is most likely to directly increase a patient's mean airway pressure,
thereby improving oxygenation?
A. Decreasing the inspiratory flow rate
B. Increasing the peak inspiratory pressure (PIP)
C. Adding positive end-expiratory pressure (PEEP)
D. Decreasing the inspiratory-to-expiratory (I:E) ratio
Correct Answer: C. Adding positive end-expiratory pressure (PEEP)
*Rationale: PEEP directly increases the pressure in the alveoli at the end of expiration, which increases mean airway
pressure and helps recruit collapsed alveoli, improving oxygenation. Option A, decreasing the flow rate, would increase
inspiratory time but might not significantly affect mean airway pressure and could cause air trapping. Option B,
increasing PIP, is a more general measure for ventilation and may increase mean pressure but is not as targeted for
oxygenation as PEEP. Option D, decreasing the I:E ratio (e.g., moving from 1:2 to 1:3), would shorten inspiratory time
and decrease mean airway pressure, potentially worsening oxygenation.
4. A patient is on a volume-controlled ventilator with the following settings: tidal volume 600 mL, respiratory
rate 14 breaths/min, and FiO2 0.40. An arterial blood gas reveals a PaCO2 of 32 mmHg and a pH of 7.48. Which
of the following ventilator adjustments would best address this condition?
, A. Increase the tidal volume to 700 mL.
B. Decrease the respiratory rate to 10 breaths/min.
C. Decrease the FiO2 to 0.30.
D. Increase the inspiratory flow rate.
Correct Answer: B. Decrease the respiratory rate to 10 breaths/min.
*Rationale: The patient is experiencing respiratory alkalosis, indicated by an elevated pH and low PaCO2. This is
typically caused by excessive alveolar ventilation. Decreasing the respiratory rate will reduce the minute ventilation,
allowing the PaCO2 to rise toward normal and correct the alkalosis. Option A, increasing tidal volume, would further
exacerbate the problem. Option C, decreasing FiO2, addresses oxygenation, not ventilation. Option D, increasing flow,
would not have a direct effect on the PaCO2 or pH.
5. During a routine check, a therapist notices that the water level in the heated humidifier has dropped
significantly and is nearly empty. The low water alarm has not sounded. What is the most immediate priority?
A. Pour sterile water into the humidifier until it is full.
B. Manually refill the humidifier and check the alarm function.
C. Turn off the humidifier and allow it to cool before refilling.
D. Ignore it and wait for the alarm to activate to confirm the sensor is working.
