NBRC TMC CRT RRT Actual Exam
2026/2027 Official Practice Exam with
Detailed Rationales | Complete Exam-Style
Questions – Pass Guaranteed A+ Graded
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SECTION 1: PATIENT ASSESSMENT & DIAGNOSTICS Q1 – Q20
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Question 1 of 140
A 68-year-old male with a 45 pack-year smoking history presents to the emergency
department with progressive dyspnea over the past 3 days. His vital signs are: BP 148/92
mmHg, HR 112 bpm, RR 28 breaths/min, SpO₂ 86% on room air, temperature 37.2°C.
Auscultation reveals distant breath sounds and hyperresonance to percussion bilaterally. He
is using accessory muscles and is unable to speak in full sentences. Which therapeutic
intervention should the respiratory therapist initiate first?
A. Administer a bronchodilator via small-volume nebulizer
B. Initiate noninvasive positive pressure ventilation
C. Apply a 2 L/min nasal cannula and titrate to maintain SpO₂ above 88% ✓ CORRECT
D. Perform chest physiotherapy with postural drainage
Correct Answer: C
Rationale: This patient presents with severe COPD exacerbation with hypoxemia; the
immediate priority per GOLD guidelines is controlled oxygen therapy via nasal cannula
starting at 1–2 L/min to achieve a target SpO₂ of 88–92%, avoiding CO₂ retention from
excessive oxygen. Initiating NIPPV before correcting hypoxemia is premature, and
bronchodilators, while important, do not address the life-threatening hypoxemia first. In COPD
with chronic hypercapnia, uncontrolled high-flow oxygen can worsen respiratory acidosis and
depress the respiratory drive.
Question 2 of 140
A 52-year-old female post-abdominal surgery develops sudden-onset tachypnea, pleuritic
chest pain, and mild hemoptysis on postoperative day 3. Vital signs: BP 102/68 mmHg, HR
118 bpm, RR 32 breaths/min, SpO₂ 89% on 4 L/min nasal cannula. Her ABG on 4 L/min shows
pH 7.48, PaCO₂ 30 mmHg, PaO₂ 58 mmHg, HCO₃⁻ 22 mEq/L. Which ABG interpretation best
describes her acid-base and oxygenation status?
,A. Acute respiratory alkalosis with moderate hypoxemia ✓ CORRECT
B. Acute respiratory acidosis with severe hypoxemia
C. Metabolic alkalosis with compensated respiratory acidosis
D. Chronic respiratory alkalosis with mild hypoxemia
Correct Answer: A
Rationale: The pH is elevated with a low PaCO₂, indicating acute respiratory alkalosis from
hyperventilation due to pain and anxiety; the PaO₂ of 58 mmHg on supplemental oxygen
represents moderate hypoxemia consistent with a significant V/Q mismatch from pulmonary
embolism. The normal HCO₃⁻ rules out metabolic compensation or primary metabolic
disorders. A tempting error is selecting respiratory acidosis, but the pH is alkalotic, not
acidotic, and the low PaCO₂ confirms hyperventilation rather than hypoventilation.
Question 3 of 140
A 4-year-old boy with a history of asthma is brought to the pediatric clinic by his mother. He
has been wheezing and coughing for 2 days, and his albuterol rescue inhaler has provided
only temporary relief. On examination, he is alert but anxious, with suprasternal and
intercostal retractions. HR 142 bpm, RR 44 breaths/min, SpO₂ 91% on room air. Breath sounds
are diminished bilaterally with prolonged expiration. Which clinical finding most strongly
indicates that this child is approaching respiratory failure?
A. The presence of bilateral wheezing on auscultation
B. A heart rate of 142 bpm
C. Diminished breath sounds with a silent chest ✓ CORRECT
D. An SpO₂ of 91% on room air
Correct Answer: C
Rationale: A silent chest with diminished breath sounds in a severe asthmatic indicates
critical airway obstruction and impending respiratory failure due to insufficient airflow to
generate wheezing; this is a pediatric emergency requiring immediate intervention. While
tachycardia and mild hypoxemia are concerning, they are expected in moderate
exacerbations, whereas a silent chest signals exhaustion and severe bronchospasm.
Wheezing actually indicates some air movement, so its absence is far more ominous than its
presence.
Question 4 of 140
A 74-year-old male with congestive heart failure is receiving 40% oxygen via Venturi mask.
His arterial blood gas results show pH 7.36, PaCO₂ 44 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 24
mEq/L, SaO₂ 90%. The physician asks the respiratory therapist to assess oxygenation. What
is the calculated P/F ratio, and what does it indicate?
A. 155, indicating mild ARDS
,B. 155, indicating moderate ARDS ✓ CORRECT
C. 198, indicating mild ARDS
D. 198, indicating severe ARDS
Correct Answer: B
Rationale: The P/F ratio is calculated as PaO₂ divided by FiO₂ (decimal), so 62 ÷ 0.40 = 155;
per the Berlin definition, a P/F ratio of 100–200 on PEEP ≥5 cmH₂O defines moderate ARDS,
though this patient is not yet intubated. A common trap is forgetting to convert 40% to 0.40,
which would yield an incorrect ratio of 155 if mistakenly divided by 40. This calculation is
essential for triaging patients and determining the need for escalating oxygenation strategies.
Question 5 of 140
A 29-year-old male was involved in a high-speed motor vehicle collision and sustained a flail
chest injury to the left lateral chest wall. He is alert and oriented but reports severe pain with
breathing. Vital signs: BP 94/60 mmHg, HR 128 bpm, RR 34 breaths/min, SpO₂ 88% on a
non-rebreather mask. Breath sounds are present but diminished on the left. Which
assessment finding requires the most immediate attention?
A. The flail chest segment causing paradoxical motion
B. The tachycardia and hypotension suggesting hemorrhagic shock ✓ CORRECT
C. The diminished breath sounds suggesting pneumothorax
D. The severe pain limiting inspiratory effort
Correct Answer: B
Rationale: In trauma, tachycardia with hypotension indicates hemorrhagic shock, which takes
precedence over all other injuries because circulatory collapse will rapidly lead to death if not
addressed immediately with fluid resuscitation and hemorrhage control. While flail chest,
possible pneumothorax, and pain are serious, they do not represent the same immediate
threat to life as ongoing internal bleeding and hypovolemia. The ABCs of trauma always
prioritize circulation when hemorrhage is present, and shock can develop rapidly from rib
fractures lacerating intercostal vessels.
Question 6 of 140
A 61-year-old female with a BMI of 42 kg/m² is admitted for elective bariatric surgery. During
preoperative assessment, the respiratory therapist notes she snores loudly, has morning
headaches, and reports daytime somnolence. Her neck circumference is 18 inches. Which
sleep study parameter is most critical to obtain before surgery to guide perioperative
respiratory management?
A. Total sleep time
B. Apnea-hypopnea index (AHI) ✓ CORRECT
C. Sleep latency
, D. REM sleep percentage
Correct Answer: B
Rationale: The AHI quantifies the severity of obstructive sleep apnea by measuring the
number of apneic and hypopneic events per hour, which directly guides perioperative
monitoring needs, CPAP requirements, and extubation risk stratification. Total sleep time and
REM percentage are relevant for sleep quality but do not determine clinical severity or
intervention thresholds. An AHI ≥30 is classified as severe OSA and significantly increases
the risk of postoperative respiratory complications, including airway obstruction and
hypoventilation.
Question 7 of 140
A 55-year-old male with acute pancreatitis develops fever, tachypnea, and confusion 48 hours
after admission. His ABG on room air shows pH 7.32, PaCO₂ 32 mmHg, PaO₂ 48 mmHg,
HCO₃⁻ 16 mEq/L, lactate 4.2 mmol/L. Chest X-ray shows bilateral diffuse infiltrates. Which
clinical syndrome best explains these findings?
A. Acute hypoxemic respiratory failure from ARDS ✓ CORRECT
B. Acute hypercapnic respiratory failure from opioid overdose
C. Metabolic acidosis with appropriate respiratory compensation
D. Cardiogenic pulmonary edema from left ventricular failure
Correct Answer: A
Rationale: The combination of severe hypoxemia (PaO₂/FiO₂ ratio of 48), bilateral infiltrates,
and non-cardiogenic pulmonary edema in a patient with a known risk factor (pancreatitis)
meets the Berlin criteria for ARDS. The low PaCO₂ with acidosis indicates concomitant
metabolic acidosis from sepsis with appropriate respiratory compensation, not primary
hypercapnic failure. A common trap is focusing only on the metabolic acidosis and missing
the profound hypoxemia and radiographic findings that define ARDS.
Question 8 of 140
A 38-year-old female with Guillain-Barré syndrome is in the ICU. Over the past 6 hours, her
vital capacity has dropped from 2.8 L to 1.1 L, and her maximal inspiratory pressure (MIP) is
now −18 cmH₂O. She is alert but reports increasing difficulty taking deep breaths. Her SpO₂
remains 94% on 2 L/min nasal cannula. Which parameter change most strongly indicates the
need for immediate intubation and mechanical ventilation?
A. The drop in SpO₂ to 94%
B. The vital capacity falling below 1.5 L ✓ CORRECT
C. The MIP of −18 cmH₂O alone
D. The patient’s subjective report of dyspnea
2026/2027 Official Practice Exam with
Detailed Rationales | Complete Exam-Style
Questions – Pass Guaranteed A+ Graded
══════════════════════════════════════
SECTION 1: PATIENT ASSESSMENT & DIAGNOSTICS Q1 – Q20
══════════════════════════════════════
Question 1 of 140
A 68-year-old male with a 45 pack-year smoking history presents to the emergency
department with progressive dyspnea over the past 3 days. His vital signs are: BP 148/92
mmHg, HR 112 bpm, RR 28 breaths/min, SpO₂ 86% on room air, temperature 37.2°C.
Auscultation reveals distant breath sounds and hyperresonance to percussion bilaterally. He
is using accessory muscles and is unable to speak in full sentences. Which therapeutic
intervention should the respiratory therapist initiate first?
A. Administer a bronchodilator via small-volume nebulizer
B. Initiate noninvasive positive pressure ventilation
C. Apply a 2 L/min nasal cannula and titrate to maintain SpO₂ above 88% ✓ CORRECT
D. Perform chest physiotherapy with postural drainage
Correct Answer: C
Rationale: This patient presents with severe COPD exacerbation with hypoxemia; the
immediate priority per GOLD guidelines is controlled oxygen therapy via nasal cannula
starting at 1–2 L/min to achieve a target SpO₂ of 88–92%, avoiding CO₂ retention from
excessive oxygen. Initiating NIPPV before correcting hypoxemia is premature, and
bronchodilators, while important, do not address the life-threatening hypoxemia first. In COPD
with chronic hypercapnia, uncontrolled high-flow oxygen can worsen respiratory acidosis and
depress the respiratory drive.
Question 2 of 140
A 52-year-old female post-abdominal surgery develops sudden-onset tachypnea, pleuritic
chest pain, and mild hemoptysis on postoperative day 3. Vital signs: BP 102/68 mmHg, HR
118 bpm, RR 32 breaths/min, SpO₂ 89% on 4 L/min nasal cannula. Her ABG on 4 L/min shows
pH 7.48, PaCO₂ 30 mmHg, PaO₂ 58 mmHg, HCO₃⁻ 22 mEq/L. Which ABG interpretation best
describes her acid-base and oxygenation status?
,A. Acute respiratory alkalosis with moderate hypoxemia ✓ CORRECT
B. Acute respiratory acidosis with severe hypoxemia
C. Metabolic alkalosis with compensated respiratory acidosis
D. Chronic respiratory alkalosis with mild hypoxemia
Correct Answer: A
Rationale: The pH is elevated with a low PaCO₂, indicating acute respiratory alkalosis from
hyperventilation due to pain and anxiety; the PaO₂ of 58 mmHg on supplemental oxygen
represents moderate hypoxemia consistent with a significant V/Q mismatch from pulmonary
embolism. The normal HCO₃⁻ rules out metabolic compensation or primary metabolic
disorders. A tempting error is selecting respiratory acidosis, but the pH is alkalotic, not
acidotic, and the low PaCO₂ confirms hyperventilation rather than hypoventilation.
Question 3 of 140
A 4-year-old boy with a history of asthma is brought to the pediatric clinic by his mother. He
has been wheezing and coughing for 2 days, and his albuterol rescue inhaler has provided
only temporary relief. On examination, he is alert but anxious, with suprasternal and
intercostal retractions. HR 142 bpm, RR 44 breaths/min, SpO₂ 91% on room air. Breath sounds
are diminished bilaterally with prolonged expiration. Which clinical finding most strongly
indicates that this child is approaching respiratory failure?
A. The presence of bilateral wheezing on auscultation
B. A heart rate of 142 bpm
C. Diminished breath sounds with a silent chest ✓ CORRECT
D. An SpO₂ of 91% on room air
Correct Answer: C
Rationale: A silent chest with diminished breath sounds in a severe asthmatic indicates
critical airway obstruction and impending respiratory failure due to insufficient airflow to
generate wheezing; this is a pediatric emergency requiring immediate intervention. While
tachycardia and mild hypoxemia are concerning, they are expected in moderate
exacerbations, whereas a silent chest signals exhaustion and severe bronchospasm.
Wheezing actually indicates some air movement, so its absence is far more ominous than its
presence.
Question 4 of 140
A 74-year-old male with congestive heart failure is receiving 40% oxygen via Venturi mask.
His arterial blood gas results show pH 7.36, PaCO₂ 44 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 24
mEq/L, SaO₂ 90%. The physician asks the respiratory therapist to assess oxygenation. What
is the calculated P/F ratio, and what does it indicate?
A. 155, indicating mild ARDS
,B. 155, indicating moderate ARDS ✓ CORRECT
C. 198, indicating mild ARDS
D. 198, indicating severe ARDS
Correct Answer: B
Rationale: The P/F ratio is calculated as PaO₂ divided by FiO₂ (decimal), so 62 ÷ 0.40 = 155;
per the Berlin definition, a P/F ratio of 100–200 on PEEP ≥5 cmH₂O defines moderate ARDS,
though this patient is not yet intubated. A common trap is forgetting to convert 40% to 0.40,
which would yield an incorrect ratio of 155 if mistakenly divided by 40. This calculation is
essential for triaging patients and determining the need for escalating oxygenation strategies.
Question 5 of 140
A 29-year-old male was involved in a high-speed motor vehicle collision and sustained a flail
chest injury to the left lateral chest wall. He is alert and oriented but reports severe pain with
breathing. Vital signs: BP 94/60 mmHg, HR 128 bpm, RR 34 breaths/min, SpO₂ 88% on a
non-rebreather mask. Breath sounds are present but diminished on the left. Which
assessment finding requires the most immediate attention?
A. The flail chest segment causing paradoxical motion
B. The tachycardia and hypotension suggesting hemorrhagic shock ✓ CORRECT
C. The diminished breath sounds suggesting pneumothorax
D. The severe pain limiting inspiratory effort
Correct Answer: B
Rationale: In trauma, tachycardia with hypotension indicates hemorrhagic shock, which takes
precedence over all other injuries because circulatory collapse will rapidly lead to death if not
addressed immediately with fluid resuscitation and hemorrhage control. While flail chest,
possible pneumothorax, and pain are serious, they do not represent the same immediate
threat to life as ongoing internal bleeding and hypovolemia. The ABCs of trauma always
prioritize circulation when hemorrhage is present, and shock can develop rapidly from rib
fractures lacerating intercostal vessels.
Question 6 of 140
A 61-year-old female with a BMI of 42 kg/m² is admitted for elective bariatric surgery. During
preoperative assessment, the respiratory therapist notes she snores loudly, has morning
headaches, and reports daytime somnolence. Her neck circumference is 18 inches. Which
sleep study parameter is most critical to obtain before surgery to guide perioperative
respiratory management?
A. Total sleep time
B. Apnea-hypopnea index (AHI) ✓ CORRECT
C. Sleep latency
, D. REM sleep percentage
Correct Answer: B
Rationale: The AHI quantifies the severity of obstructive sleep apnea by measuring the
number of apneic and hypopneic events per hour, which directly guides perioperative
monitoring needs, CPAP requirements, and extubation risk stratification. Total sleep time and
REM percentage are relevant for sleep quality but do not determine clinical severity or
intervention thresholds. An AHI ≥30 is classified as severe OSA and significantly increases
the risk of postoperative respiratory complications, including airway obstruction and
hypoventilation.
Question 7 of 140
A 55-year-old male with acute pancreatitis develops fever, tachypnea, and confusion 48 hours
after admission. His ABG on room air shows pH 7.32, PaCO₂ 32 mmHg, PaO₂ 48 mmHg,
HCO₃⁻ 16 mEq/L, lactate 4.2 mmol/L. Chest X-ray shows bilateral diffuse infiltrates. Which
clinical syndrome best explains these findings?
A. Acute hypoxemic respiratory failure from ARDS ✓ CORRECT
B. Acute hypercapnic respiratory failure from opioid overdose
C. Metabolic acidosis with appropriate respiratory compensation
D. Cardiogenic pulmonary edema from left ventricular failure
Correct Answer: A
Rationale: The combination of severe hypoxemia (PaO₂/FiO₂ ratio of 48), bilateral infiltrates,
and non-cardiogenic pulmonary edema in a patient with a known risk factor (pancreatitis)
meets the Berlin criteria for ARDS. The low PaCO₂ with acidosis indicates concomitant
metabolic acidosis from sepsis with appropriate respiratory compensation, not primary
hypercapnic failure. A common trap is focusing only on the metabolic acidosis and missing
the profound hypoxemia and radiographic findings that define ARDS.
Question 8 of 140
A 38-year-old female with Guillain-Barré syndrome is in the ICU. Over the past 6 hours, her
vital capacity has dropped from 2.8 L to 1.1 L, and her maximal inspiratory pressure (MIP) is
now −18 cmH₂O. She is alert but reports increasing difficulty taking deep breaths. Her SpO₂
remains 94% on 2 L/min nasal cannula. Which parameter change most strongly indicates the
need for immediate intubation and mechanical ventilation?
A. The drop in SpO₂ to 94%
B. The vital capacity falling below 1.5 L ✓ CORRECT
C. The MIP of −18 cmH₂O alone
D. The patient’s subjective report of dyspnea
