NBRC TMC CRT RRT ACTUAL EXAM
2026/2027 | Version 1 | 140 Verified Questions &
Answers | CRT & RRT Levels | Pass Guaranteed
- A+ Graded
SECTION 1: PATIENT DATA & ASSESSMENT (Questions 1–25)
Question 1 (CRT Level – Patient Data)
A 68-year-old male patient with COPD presents to the emergency
department with acute exacerbation. His vital signs are:
• HR 102
• BP 148/92
• RR 26
• SpO₂ 88% on room air
• Temperature 37.2°C
Arterial blood gas results on 2 L NC:
• pH 7.32
• PaCO₂ 58 mmHg
• PaO₂ 62 mmHg
• HCO₃ 30 mEq/L
Chest X-ray shows hyperinflation with flattened diaphragms.
Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis with metabolic compensation
,Correct Answer: B
Rationale: This patient demonstrates chronic respiratory acidosis. The
pH of 7.32 indicates acidemia. The elevated PaCO₂ (58 mmHg)
identifies the primary disorder as respiratory. The key to determining
chronicity is the degree of metabolic compensation: in acute respiratory
acidosis, HCO₃ increases by 1 mEq/L for every 10 mmHg rise in PaCO₂
above 40 (expected HCO₃ ≈26). In chronic respiratory acidosis, HCO₃
increases by 3.5–4 mEq/L for every 10 mmHg rise (expected 30–31),
which matches this patient's HCO₃ of 30. The clinical context of COPD
with hyperinflated chest X-ray supports chronic CO₂ retention. Option A
is incorrect because acute compensation would not produce this degree
of bicarbonate elevation. Option C is incorrect because the primary
disturbance is respiratory, not metabolic. Option D is incorrect because
the pH is acidemic, not alkalemic.
Question 2 (CRT Level – Patient Data)
A 55-year-old female with pneumonia has the following ABG on 40%
FiO₂:
• pH 7.48
• PaCO₂ 32 mmHg
• PaO₂ 85 mmHg
• HCO₃ 24 mEq/L
Which interpretation is correct?
A. Acute respiratory alkalosis with normal oxygenation
B. Chronic respiratory alkalosis with hypoxemia
C. Metabolic alkalosis with hyperoxia
D. Acute respiratory alkalosis with mild hypoxemia
Correct Answer: D
,Rationale: The pH of 7.48 indicates alkalemia. The low PaCO₂ (32
mmHg) identifies respiratory alkalosis as the primary disorder. The
HCO₃ of 24 is within the normal range, indicating acute compensation
(in chronic respiratory alkalosis, HCO₃ would be decreased by 4–5
mEq/L). The PaO₂ of 85 mmHg on 40% FiO₂ represents mild
hypoxemia (expected PaO₂ on 40% FiO₂ is approximately 200–250
mmHg; using the alveolar gas equation, the A–a gradient is elevated).
Option A is incorrect because the oxygenation is not normal for the
delivered FiO₂. Option B is incorrect because the disorder is acute, not
chronic, and the patient has hypoxemia relative to FiO₂. Option C is
incorrect because the primary disorder is respiratory, not metabolic.
__________________________________________________________
Question 3 (CRT Level – Patient Data)
A 72-year-old male post-CABG is in the ICU. His hemodynamic
parameters show:
• CVP 14 mmHg
• PAP 38/22 mmHg
• PCWP 20 mmHg
• CI 2.1 L/min/m²
Which hemodynamic profile is present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock. The elevated
PCWP (20 mmHg, normal 6–12) indicates elevated left ventricular
, preload/pressure. The elevated CVP (14 mmHg, normal 2–6) indicates
elevated right ventricular preload. The low cardiac index (2.1, normal
2.5–4.0) confirms inadequate perfusion. The elevated pulmonary artery
pressures are secondary to increased left-sided pressures. This pattern is
classic for left ventricular failure post-cardiac surgery. Option A is
incorrect because hypovolemic shock would show low filling pressures.
Option C is incorrect because septic shock typically shows low filling
pressures with high or normal cardiac output. Option D is incorrect
because pulmonary embolism would show elevated PAP with normal or
low PCWP and elevated CVP.
Question 4 (CRT Level – Patient Data)
A 45-year-old patient with ARDS has the following ventilator settings
and ABG:
• VC-SIMV
• VT 400 mL
• RR 16
• FiO₂ 0.60
• PEEP 12 cmH₂O
ABG:
• pH 7.35
• PaCO₂ 45 mmHg
• PaO₂ 58 mmHg
What is the calculated P/F ratio?
A. 97
B. 116
C. 145
D. 97 mmHg
2026/2027 | Version 1 | 140 Verified Questions &
Answers | CRT & RRT Levels | Pass Guaranteed
- A+ Graded
SECTION 1: PATIENT DATA & ASSESSMENT (Questions 1–25)
Question 1 (CRT Level – Patient Data)
A 68-year-old male patient with COPD presents to the emergency
department with acute exacerbation. His vital signs are:
• HR 102
• BP 148/92
• RR 26
• SpO₂ 88% on room air
• Temperature 37.2°C
Arterial blood gas results on 2 L NC:
• pH 7.32
• PaCO₂ 58 mmHg
• PaO₂ 62 mmHg
• HCO₃ 30 mEq/L
Chest X-ray shows hyperinflation with flattened diaphragms.
Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis with metabolic compensation
,Correct Answer: B
Rationale: This patient demonstrates chronic respiratory acidosis. The
pH of 7.32 indicates acidemia. The elevated PaCO₂ (58 mmHg)
identifies the primary disorder as respiratory. The key to determining
chronicity is the degree of metabolic compensation: in acute respiratory
acidosis, HCO₃ increases by 1 mEq/L for every 10 mmHg rise in PaCO₂
above 40 (expected HCO₃ ≈26). In chronic respiratory acidosis, HCO₃
increases by 3.5–4 mEq/L for every 10 mmHg rise (expected 30–31),
which matches this patient's HCO₃ of 30. The clinical context of COPD
with hyperinflated chest X-ray supports chronic CO₂ retention. Option A
is incorrect because acute compensation would not produce this degree
of bicarbonate elevation. Option C is incorrect because the primary
disturbance is respiratory, not metabolic. Option D is incorrect because
the pH is acidemic, not alkalemic.
Question 2 (CRT Level – Patient Data)
A 55-year-old female with pneumonia has the following ABG on 40%
FiO₂:
• pH 7.48
• PaCO₂ 32 mmHg
• PaO₂ 85 mmHg
• HCO₃ 24 mEq/L
Which interpretation is correct?
A. Acute respiratory alkalosis with normal oxygenation
B. Chronic respiratory alkalosis with hypoxemia
C. Metabolic alkalosis with hyperoxia
D. Acute respiratory alkalosis with mild hypoxemia
Correct Answer: D
,Rationale: The pH of 7.48 indicates alkalemia. The low PaCO₂ (32
mmHg) identifies respiratory alkalosis as the primary disorder. The
HCO₃ of 24 is within the normal range, indicating acute compensation
(in chronic respiratory alkalosis, HCO₃ would be decreased by 4–5
mEq/L). The PaO₂ of 85 mmHg on 40% FiO₂ represents mild
hypoxemia (expected PaO₂ on 40% FiO₂ is approximately 200–250
mmHg; using the alveolar gas equation, the A–a gradient is elevated).
Option A is incorrect because the oxygenation is not normal for the
delivered FiO₂. Option B is incorrect because the disorder is acute, not
chronic, and the patient has hypoxemia relative to FiO₂. Option C is
incorrect because the primary disorder is respiratory, not metabolic.
__________________________________________________________
Question 3 (CRT Level – Patient Data)
A 72-year-old male post-CABG is in the ICU. His hemodynamic
parameters show:
• CVP 14 mmHg
• PAP 38/22 mmHg
• PCWP 20 mmHg
• CI 2.1 L/min/m²
Which hemodynamic profile is present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock. The elevated
PCWP (20 mmHg, normal 6–12) indicates elevated left ventricular
, preload/pressure. The elevated CVP (14 mmHg, normal 2–6) indicates
elevated right ventricular preload. The low cardiac index (2.1, normal
2.5–4.0) confirms inadequate perfusion. The elevated pulmonary artery
pressures are secondary to increased left-sided pressures. This pattern is
classic for left ventricular failure post-cardiac surgery. Option A is
incorrect because hypovolemic shock would show low filling pressures.
Option C is incorrect because septic shock typically shows low filling
pressures with high or normal cardiac output. Option D is incorrect
because pulmonary embolism would show elevated PAP with normal or
low PCWP and elevated CVP.
Question 4 (CRT Level – Patient Data)
A 45-year-old patient with ARDS has the following ventilator settings
and ABG:
• VC-SIMV
• VT 400 mL
• RR 16
• FiO₂ 0.60
• PEEP 12 cmH₂O
ABG:
• pH 7.35
• PaCO₂ 45 mmHg
• PaO₂ 58 mmHg
What is the calculated P/F ratio?
A. 97
B. 116
C. 145
D. 97 mmHg
