Certified Respiratory Therapist (CRT) Exam 2026 Latest
Comprehensive Study Guide with Practice Questions,
Respiratory Care Review, Detailed Rationales, Verified
Answers, Success Workbook
SECTION 1: PATIENT DATA EVALUATION AND
RECOMMENDATIONS (Questions 1-35)
Question 1: A patient is admitted to the emergency department following a motor
vehicle accident. On physical examination, the respiratory therapist notes absent
breath sounds on the left side, tracheal deviation to the right, and hypotension.
What is the MOST likely diagnosis?
A) Left-sided pneumothorax
B) Right-sided pneumothorax
C) Left-sided hemothorax
D) Tension pneumothorax
Answer: D) Tension pneumothorax
Rationale: Tension pneumothorax is characterized by absent breath sounds on the
affected side, tracheal deviation away from the affected side (to the right in this
case), and hemodynamic compromise (hypotension). The air trapped in the pleural
space causes mediastinal shift, which compresses the heart and great vessels,
leading to decreased cardiac output and hypotension. A simple pneumothorax
would not cause tracheal deviation or hypotension. Hemothorax would present
with dullness to percussion, not absent breath sounds, and would not typically
cause tracheal deviation.
Question 2: A 65-kg spinal cord injured patient has developed atelectasis. Which
of the following therapeutic interventions would be MOST appropriate
INITIALLY?
A) Incentive spirometry
B) Intubation and mechanical ventilation
C) Chest physiotherapy
D) Bronchoscopy
,Answer: A) Incentive spirometry
Rationale: Incentive spirometry is the initial intervention of choice for preventing
and treating atelectasis in patients with spinal cord injury who have adequate
respiratory muscle function. It encourages deep breathing and sustained maximal
inspiration, which helps re-expand collapsed alveoli. Intubation is not initially
indicated unless the patient shows signs of respiratory failure. Chest physiotherapy
may be beneficial but is not the first-line intervention. Bronchoscopy is invasive
and reserved for cases where other interventions fail.
Question 3: A healthy adult female can exhale what portion of her forced vital
capacity (FVC) in the first second of a forced expiration?
A) 50%
B) 60%
C) 70%
D) 80%
Answer: D) 80%
Rationale: In a healthy adult, the FEV₁ (forced expiratory volume in one second)
should be approximately 80% of the FVC. This is a key measure of airway
obstruction; a lower FEV₁/FVC ratio indicates obstructive lung disease such as
asthma or COPD. The normal range is typically 70-80%, with 80% being the
expected value in healthy individuals.
Question 4: Which of the following ABG values would indicate partially
compensated respiratory acidosis?
A) pH 7.32, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
B) pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
C) pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
D) pH 7.25, PaCO₂ 60 mmHg, HCO₃⁻ 24 mEq/L
Answer: A) pH 7.32, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
Rationale: Partially compensated respiratory acidosis is characterized by a low pH
(acidemia), elevated PaCO₂ (the primary respiratory disturbance), and an elevated
HCO₃⁻ (renal compensation that is attempting to correct the acidosis but has not
,fully normalized the pH). Option A shows all three: pH < 7.35, PaCO₂ > 45
mmHg, and HCO₃⁻ > 26 mEq/L. Option B is normal. Option C shows respiratory
alkalosis. Option D shows uncompensated respiratory acidosis (HCO₃⁻ is normal).
Question 5: A patient with COPD has a chest X-ray showing hyperlucency,
flattened diaphragms, and increased AP diameter. These findings are MOST
consistent with:
A) Pneumonia
B) Pulmonary edema
C) Emphysema
D) Pleural effusion
Answer: C) Emphysema
Rationale: The classic chest X-ray findings in emphysema include hyperlucency
(due to air trapping), flattened diaphragms (from hyperinflation), and increased
anteroposterior (AP) diameter (barrel chest). These findings reflect the destructive
changes in the alveolar walls and the resulting air trapping. Pneumonia would
show infiltrates or consolidation. Pulmonary edema would show Kerley B lines
and perihilar opacities. Pleural effusion would show a meniscus sign and blunting
of the costophrenic angle.
Question 6: What is the primary indication for measuring peak expiratory flow
rate (PEFR) in a patient with asthma?
A) To diagnose asthma
B) To monitor response to bronchodilator therapy
C) To assess for airway obstruction
D) To evaluate for restrictive lung disease
Answer: B) To monitor response to bronchodilator therapy
Rationale: Peak expiratory flow rate (PEFR) is primarily used to monitor the
response to bronchodilator therapy in patients with asthma. It provides a simple,
objective measure of airway obstruction that can be performed at the bedside.
While PEFR can help assess airway obstruction, it is not diagnostic for asthma and
is less useful for restrictive lung diseases where FVC is more affected.
, Question 7: A patient's chest X-ray shows air bronchograms. This finding is
MOST consistent with:
A) Pneumothorax
B) Pneumonia
C) Atelectasis
D) Pulmonary embolism
Answer: B) Pneumonia
Rationale: Air bronchograms are visible air-filled bronchi against a background of
opacified (consolidated) lung tissue. This is a classic finding in pneumonia, where
the alveoli are filled with inflammatory exudate, making the air-filled bronchi
visible. In pneumothorax, the lung would be collapsed and air bronchograms
would not be seen. Atelectasis may show volume loss but not typically air
bronchograms. Pulmonary embolism typically shows a wedge-shaped opacity
(Hampton's hump) or oligemia (Westernark's sign).
Question 8: Which of the following is the correct formula for calculating alveolar
oxygen tension (PAO₂)?
A) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ / RQ)
B) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ × 1.25)
C) PAO₂ = FiO₂ × (PB + PH₂O) - (PaCO₂ / 0.8)
D) PAO₂ = (FiO₂ × PB) - (PaCO₂ × RQ)
Answer: A) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ / RQ)
Rationale: The alveolar gas equation is used to calculate PAO₂: PAO₂ = FiO₂ ×
(PB - PH₂O) - (PaCO₂ / RQ) , where PB is barometric pressure, PH₂O is water
vapor pressure (47 mmHg at body temperature), and RQ is the respiratory quotient
(typically 0.8). The term (PB - PH₂O) accounts for the partial pressure of dry gas in
the airways, and PaCO₂ is divided by RQ to account for the exchange ratio. Option
B uses an incorrect multiplier. Option C has incorrect signs. Option D omits water
vapor correction.
Comprehensive Study Guide with Practice Questions,
Respiratory Care Review, Detailed Rationales, Verified
Answers, Success Workbook
SECTION 1: PATIENT DATA EVALUATION AND
RECOMMENDATIONS (Questions 1-35)
Question 1: A patient is admitted to the emergency department following a motor
vehicle accident. On physical examination, the respiratory therapist notes absent
breath sounds on the left side, tracheal deviation to the right, and hypotension.
What is the MOST likely diagnosis?
A) Left-sided pneumothorax
B) Right-sided pneumothorax
C) Left-sided hemothorax
D) Tension pneumothorax
Answer: D) Tension pneumothorax
Rationale: Tension pneumothorax is characterized by absent breath sounds on the
affected side, tracheal deviation away from the affected side (to the right in this
case), and hemodynamic compromise (hypotension). The air trapped in the pleural
space causes mediastinal shift, which compresses the heart and great vessels,
leading to decreased cardiac output and hypotension. A simple pneumothorax
would not cause tracheal deviation or hypotension. Hemothorax would present
with dullness to percussion, not absent breath sounds, and would not typically
cause tracheal deviation.
Question 2: A 65-kg spinal cord injured patient has developed atelectasis. Which
of the following therapeutic interventions would be MOST appropriate
INITIALLY?
A) Incentive spirometry
B) Intubation and mechanical ventilation
C) Chest physiotherapy
D) Bronchoscopy
,Answer: A) Incentive spirometry
Rationale: Incentive spirometry is the initial intervention of choice for preventing
and treating atelectasis in patients with spinal cord injury who have adequate
respiratory muscle function. It encourages deep breathing and sustained maximal
inspiration, which helps re-expand collapsed alveoli. Intubation is not initially
indicated unless the patient shows signs of respiratory failure. Chest physiotherapy
may be beneficial but is not the first-line intervention. Bronchoscopy is invasive
and reserved for cases where other interventions fail.
Question 3: A healthy adult female can exhale what portion of her forced vital
capacity (FVC) in the first second of a forced expiration?
A) 50%
B) 60%
C) 70%
D) 80%
Answer: D) 80%
Rationale: In a healthy adult, the FEV₁ (forced expiratory volume in one second)
should be approximately 80% of the FVC. This is a key measure of airway
obstruction; a lower FEV₁/FVC ratio indicates obstructive lung disease such as
asthma or COPD. The normal range is typically 70-80%, with 80% being the
expected value in healthy individuals.
Question 4: Which of the following ABG values would indicate partially
compensated respiratory acidosis?
A) pH 7.32, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
B) pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
C) pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
D) pH 7.25, PaCO₂ 60 mmHg, HCO₃⁻ 24 mEq/L
Answer: A) pH 7.32, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
Rationale: Partially compensated respiratory acidosis is characterized by a low pH
(acidemia), elevated PaCO₂ (the primary respiratory disturbance), and an elevated
HCO₃⁻ (renal compensation that is attempting to correct the acidosis but has not
,fully normalized the pH). Option A shows all three: pH < 7.35, PaCO₂ > 45
mmHg, and HCO₃⁻ > 26 mEq/L. Option B is normal. Option C shows respiratory
alkalosis. Option D shows uncompensated respiratory acidosis (HCO₃⁻ is normal).
Question 5: A patient with COPD has a chest X-ray showing hyperlucency,
flattened diaphragms, and increased AP diameter. These findings are MOST
consistent with:
A) Pneumonia
B) Pulmonary edema
C) Emphysema
D) Pleural effusion
Answer: C) Emphysema
Rationale: The classic chest X-ray findings in emphysema include hyperlucency
(due to air trapping), flattened diaphragms (from hyperinflation), and increased
anteroposterior (AP) diameter (barrel chest). These findings reflect the destructive
changes in the alveolar walls and the resulting air trapping. Pneumonia would
show infiltrates or consolidation. Pulmonary edema would show Kerley B lines
and perihilar opacities. Pleural effusion would show a meniscus sign and blunting
of the costophrenic angle.
Question 6: What is the primary indication for measuring peak expiratory flow
rate (PEFR) in a patient with asthma?
A) To diagnose asthma
B) To monitor response to bronchodilator therapy
C) To assess for airway obstruction
D) To evaluate for restrictive lung disease
Answer: B) To monitor response to bronchodilator therapy
Rationale: Peak expiratory flow rate (PEFR) is primarily used to monitor the
response to bronchodilator therapy in patients with asthma. It provides a simple,
objective measure of airway obstruction that can be performed at the bedside.
While PEFR can help assess airway obstruction, it is not diagnostic for asthma and
is less useful for restrictive lung diseases where FVC is more affected.
, Question 7: A patient's chest X-ray shows air bronchograms. This finding is
MOST consistent with:
A) Pneumothorax
B) Pneumonia
C) Atelectasis
D) Pulmonary embolism
Answer: B) Pneumonia
Rationale: Air bronchograms are visible air-filled bronchi against a background of
opacified (consolidated) lung tissue. This is a classic finding in pneumonia, where
the alveoli are filled with inflammatory exudate, making the air-filled bronchi
visible. In pneumothorax, the lung would be collapsed and air bronchograms
would not be seen. Atelectasis may show volume loss but not typically air
bronchograms. Pulmonary embolism typically shows a wedge-shaped opacity
(Hampton's hump) or oligemia (Westernark's sign).
Question 8: Which of the following is the correct formula for calculating alveolar
oxygen tension (PAO₂)?
A) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ / RQ)
B) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ × 1.25)
C) PAO₂ = FiO₂ × (PB + PH₂O) - (PaCO₂ / 0.8)
D) PAO₂ = (FiO₂ × PB) - (PaCO₂ × RQ)
Answer: A) PAO₂ = FiO₂ × (PB - PH₂O) - (PaCO₂ / RQ)
Rationale: The alveolar gas equation is used to calculate PAO₂: PAO₂ = FiO₂ ×
(PB - PH₂O) - (PaCO₂ / RQ) , where PB is barometric pressure, PH₂O is water
vapor pressure (47 mmHg at body temperature), and RQ is the respiratory quotient
(typically 0.8). The term (PB - PH₂O) accounts for the partial pressure of dry gas in
the airways, and PaCO₂ is divided by RQ to account for the exchange ratio. Option
B uses an incorrect multiplier. Option C has incorrect signs. Option D omits water
vapor correction.
