NBRC TMC/CRT/RRT EXAM LATEST QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Patient Assessment, Data Evaluation, and Recommendations
Blood Gas Analysis, Acid-Base Balance, and Monitoring
Oxygen Therapy and Medical Gas Delivery
Airway Management and Emergency Resuscitation
Mechanical Ventilation: Modes, Settings, and Weaning
Pharmacology and Aerosol Therapy
Pulmonary Function Testing and Diagnostic Interpretation
Neonatal, Pediatric, and Specialty Respiratory Care
Introduction
The NBRC TMC/CRT/RRT Examination assesses the competency of respiratory therapists seeking
entry-level and advanced practitioner credentials. It evaluates knowledge across patient
assessment, blood gas interpretation, oxygen therapy, airway management, mechanical
ventilation, pharmacology, and diagnostic testing. The assessment employs multiple-choice and
scenario-based questions to test clinical decision-making and evidence-based application of
AARC Clinical Practice Guidelines. Emphasis is placed on data interpretation, patient safety, and
real-world prioritization. This exam ensures candidates are prepared to deliver safe, effective, and
ethical respiratory care.
Section One: Questions 1–100
1. A patient with severe acute respiratory distress syndrome is being mechanically ventilated
with a tidal volume of 4 mL/kg of predicted body weight and a respiratory rate of 28
breaths/min. Arterial blood gas results show pH 7.31, PaCO2 52 mm Hg, PaO2 62 mm Hg,
and HCO3 26 mEq/L. Which of the following ventilator adjustments should the respiratory
therapist recommend first?
A. Increase the tidal volume to 8 mL/kg
B. Increase the respiratory rate to 34 breaths/min
,C. Add or increase positive end-expiratory pressure
D. Switch to pressure control ventilation immediately
🟢 C. Add or increase positive end-expiratory pressure
🔴 RATIONALE: The patient is exhibiting refractory hypoxemia and is managed with a lung-
protective ventilation strategy using low tidal volumes. In ARDS, increasing PEEP helps recruit
collapsed alveoli, improve functional residual capacity, and enhance oxygenation without
exposing the lungs to excessive stretch. Increasing tidal volume can cause volutrauma, and a
higher respiratory rate alone will not resolve the underlying oxygenation deficit.
2. During a pre-assessment check of a mechanical ventilator in the intensive care unit, the
respiratory therapist performs a circuit leak test and notes a significant difference between
the set tidal volume and the exhaled tidal volume. Which of the following components
should be inspected first?
A. The humidifier water level chamber
B. The expiratory valve and circuit connections
C. The internal oxygen blender sensor module
D. The main power supply backup battery pack
🟢 B. The expiratory valve and circuit connections
🔴 RATIONALE: A discrepancy between delivered and exhaled tidal volumes during a circuit
check most commonly indicates a leak within the patient circuit or around the expiratory valve
assembly. Inspecting the tubing connections, water traps, and the integrity of the expiratory
valve membrane is the most direct troubleshooting step.
3. A 68-year-old male with a history of chronic obstructive pulmonary disease presents to the
emergency department with acute shortness of breath and lethargy. Arterial blood gas
analysis on room air reveals pH 7.26, PaCO2 68 mm Hg, PaO2 54 mm Hg, and HCO3 30
mEq/L. Which of the following oxygen delivery devices is most appropriate to initiate
controlled oxygen therapy?
A. Non-rebreather mask at 15 L/min
B. Simple mask at 8 L/min
C. Nasal cannula at 6 L/min
D. Venturi mask delivering 28 percent oxygen
,🟢 D. Venturi mask delivering 28 percent oxygen
🔴 RATIONALE: Patients with chronic hypercapnia and acute on chronic respiratory failure
require controlled, low-flow oxygen therapy to prevent the removal of their hypoxic drive and
worsening hypercapnia. A Venturi mask provides a fixed and predictable fraction of inspired
oxygen, making it the safest and most accurate choice.
4. A patient is receiving volume-controlled continuous mandatory ventilation. The high
pressure alarm is sounding continuously during inspiration. The respiratory therapist notes
absent breath sounds on the left side, tracheal deviation to the right, and subcutaneous
emphysema. Which of the following conditions is the most likely cause?
A. Mucus plugging of the right mainstem bronchus
B. Left-sided tension pneumothorax
C. Right lower lobe pneumonia consolidation
D. Severe bronchospasm affecting both lungs
🟢 B. Left-sided tension pneumothorax
🔴 RATIONALE: The clinical triad of absent breath sounds on one side, tracheal shift to the
contralateral side, and subcutaneous emphysema indicates a tension pneumothorax, a life-
threatening emergency requiring immediate needle decompression.
5. 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 consistent with:
A. liver failure
B. pulmonary embolism
C. heart failure
D. electrolyte imbalances
🟢 C. heart failure
🔴 RATIONALE: Diaphoresis, jugular venous distension, and pitting edema are classic signs of
heart failure due to fluid overload and impaired cardiac output.
6. A patient is admitted to the ED following a motor vehicle accident. On physical exam, the
respiratory therapist discovers that breath sounds are absent in the left chest with a
hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is
, 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mmHg. 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 the patient
🟢 C. Needle aspirate the 2nd left intercostal space
🔴 RATIONALE: This presentation is consistent with a tension pneumothorax causing
obstructive shock. Immediate needle decompression is required before chest tube placement
or imaging.
7. All of the following strategies are likely to decrease the likelihood of damage to the tracheal
mucosa EXCEPT:
A. maintaining cuff pressures between 20 and 25 mmHg
B. using the minimal leak technique for inflation
C. using a low-residual-volume, low-compliance cuff
D. monitoring intracuff pressures
🟢 C. using a low-residual-volume, low-compliance cuff
🔴 RATIONALE: High-volume, low-pressure cuffs are preferred to distribute pressure over a
larger area. Low-residual-volume, low-compliance cuffs create higher pressures against the
tracheal wall and increase the risk of mucosal damage.
8. 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
🟢 D. deep breathing and coughing to clear secretions
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Patient Assessment, Data Evaluation, and Recommendations
Blood Gas Analysis, Acid-Base Balance, and Monitoring
Oxygen Therapy and Medical Gas Delivery
Airway Management and Emergency Resuscitation
Mechanical Ventilation: Modes, Settings, and Weaning
Pharmacology and Aerosol Therapy
Pulmonary Function Testing and Diagnostic Interpretation
Neonatal, Pediatric, and Specialty Respiratory Care
Introduction
The NBRC TMC/CRT/RRT Examination assesses the competency of respiratory therapists seeking
entry-level and advanced practitioner credentials. It evaluates knowledge across patient
assessment, blood gas interpretation, oxygen therapy, airway management, mechanical
ventilation, pharmacology, and diagnostic testing. The assessment employs multiple-choice and
scenario-based questions to test clinical decision-making and evidence-based application of
AARC Clinical Practice Guidelines. Emphasis is placed on data interpretation, patient safety, and
real-world prioritization. This exam ensures candidates are prepared to deliver safe, effective, and
ethical respiratory care.
Section One: Questions 1–100
1. A patient with severe acute respiratory distress syndrome is being mechanically ventilated
with a tidal volume of 4 mL/kg of predicted body weight and a respiratory rate of 28
breaths/min. Arterial blood gas results show pH 7.31, PaCO2 52 mm Hg, PaO2 62 mm Hg,
and HCO3 26 mEq/L. Which of the following ventilator adjustments should the respiratory
therapist recommend first?
A. Increase the tidal volume to 8 mL/kg
B. Increase the respiratory rate to 34 breaths/min
,C. Add or increase positive end-expiratory pressure
D. Switch to pressure control ventilation immediately
🟢 C. Add or increase positive end-expiratory pressure
🔴 RATIONALE: The patient is exhibiting refractory hypoxemia and is managed with a lung-
protective ventilation strategy using low tidal volumes. In ARDS, increasing PEEP helps recruit
collapsed alveoli, improve functional residual capacity, and enhance oxygenation without
exposing the lungs to excessive stretch. Increasing tidal volume can cause volutrauma, and a
higher respiratory rate alone will not resolve the underlying oxygenation deficit.
2. During a pre-assessment check of a mechanical ventilator in the intensive care unit, the
respiratory therapist performs a circuit leak test and notes a significant difference between
the set tidal volume and the exhaled tidal volume. Which of the following components
should be inspected first?
A. The humidifier water level chamber
B. The expiratory valve and circuit connections
C. The internal oxygen blender sensor module
D. The main power supply backup battery pack
🟢 B. The expiratory valve and circuit connections
🔴 RATIONALE: A discrepancy between delivered and exhaled tidal volumes during a circuit
check most commonly indicates a leak within the patient circuit or around the expiratory valve
assembly. Inspecting the tubing connections, water traps, and the integrity of the expiratory
valve membrane is the most direct troubleshooting step.
3. A 68-year-old male with a history of chronic obstructive pulmonary disease presents to the
emergency department with acute shortness of breath and lethargy. Arterial blood gas
analysis on room air reveals pH 7.26, PaCO2 68 mm Hg, PaO2 54 mm Hg, and HCO3 30
mEq/L. Which of the following oxygen delivery devices is most appropriate to initiate
controlled oxygen therapy?
A. Non-rebreather mask at 15 L/min
B. Simple mask at 8 L/min
C. Nasal cannula at 6 L/min
D. Venturi mask delivering 28 percent oxygen
,🟢 D. Venturi mask delivering 28 percent oxygen
🔴 RATIONALE: Patients with chronic hypercapnia and acute on chronic respiratory failure
require controlled, low-flow oxygen therapy to prevent the removal of their hypoxic drive and
worsening hypercapnia. A Venturi mask provides a fixed and predictable fraction of inspired
oxygen, making it the safest and most accurate choice.
4. A patient is receiving volume-controlled continuous mandatory ventilation. The high
pressure alarm is sounding continuously during inspiration. The respiratory therapist notes
absent breath sounds on the left side, tracheal deviation to the right, and subcutaneous
emphysema. Which of the following conditions is the most likely cause?
A. Mucus plugging of the right mainstem bronchus
B. Left-sided tension pneumothorax
C. Right lower lobe pneumonia consolidation
D. Severe bronchospasm affecting both lungs
🟢 B. Left-sided tension pneumothorax
🔴 RATIONALE: The clinical triad of absent breath sounds on one side, tracheal shift to the
contralateral side, and subcutaneous emphysema indicates a tension pneumothorax, a life-
threatening emergency requiring immediate needle decompression.
5. 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 consistent with:
A. liver failure
B. pulmonary embolism
C. heart failure
D. electrolyte imbalances
🟢 C. heart failure
🔴 RATIONALE: Diaphoresis, jugular venous distension, and pitting edema are classic signs of
heart failure due to fluid overload and impaired cardiac output.
6. A patient is admitted to the ED following a motor vehicle accident. On physical exam, the
respiratory therapist discovers that breath sounds are absent in the left chest with a
hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is
, 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mmHg. 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 the patient
🟢 C. Needle aspirate the 2nd left intercostal space
🔴 RATIONALE: This presentation is consistent with a tension pneumothorax causing
obstructive shock. Immediate needle decompression is required before chest tube placement
or imaging.
7. All of the following strategies are likely to decrease the likelihood of damage to the tracheal
mucosa EXCEPT:
A. maintaining cuff pressures between 20 and 25 mmHg
B. using the minimal leak technique for inflation
C. using a low-residual-volume, low-compliance cuff
D. monitoring intracuff pressures
🟢 C. using a low-residual-volume, low-compliance cuff
🔴 RATIONALE: High-volume, low-pressure cuffs are preferred to distribute pressure over a
larger area. Low-residual-volume, low-compliance cuffs create higher pressures against the
tracheal wall and increase the risk of mucosal damage.
8. 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
🟢 D. deep breathing and coughing to clear secretions
