1
NBRC TMC CRT RRT ACTUAL EXAM
TESTBANK 2026/2027 | Version 1 & Study
Guide | Verified Questions and Answers | Pass
Guaranteed - A+ Graded
TESTBANK - VERSION 1 (100 Questions)
DOMAIN 1: PATIENT DATA EVALUATION & RECOMMENDATIONS (Questions 1-20)
Question 1 (CRT Level - CXR Interpretation)
A 68-year-old male with a history of COPD presents to the emergency department with increased
dyspnea. The chest X-ray report describes: "Hyperinflation with flattened diaphragms, increased
retrosternal airspace, bullous changes in the upper lobes, and diminished peripheral vascular
markings." Which clinical condition do these findings most likely represent?
A. Acute respiratory distress syndrome (ARDS)
B. Chronic obstructive pulmonary disease (COPD) with emphysematous changes
C. Congestive heart failure
D. Pneumothorax
Correct Answer: B
Rationale: The described findings—hyperinflation, flattened diaphragms, increased retrosternal
airspace, bullous changes, and diminished vascular markings—are classic radiographic
hallmarks of emphysema-type COPD. The bullous changes indicate parenchymal destruction.
ARDS typically shows bilateral diffuse infiltrates; CHF shows cardiomegaly and pulmonary
edema; pneumothorax shows absent lung markings with a visible pleural line.
Question 2 (CRT Level - ABG Analysis)
An ABG is drawn from a 55-year-old patient with pneumonia: pH 7.32, PaCO₂ 52 mmHg, PaO₂
68 mmHg, HCO₃⁻ 26 mEq/L, BE +2. What is the primary acid-base disorder?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
,2
C. Respiratory acidosis, uncompensated
D. Metabolic alkalosis
Correct Answer: A
Rationale: The pH of 7.32 indicates acidemia. PaCO₂ is elevated (52 mmHg), identifying
respiratory acidosis as the primary disorder. The HCO₃⁻ of 26 mEq/L (slightly elevated) and
positive base excess indicate metabolic compensation has occurred. Acute respiratory acidosis
would show HCO₃⁻ increase of 1 mEq/L per 10 mmHg PaCO₂ rise; chronic shows 3.5-4 mEq/L
increase. This represents chronic or compensated respiratory acidosis.
Question 3 (CRT Level - Hemodynamics)
A patient in the ICU has the following hemodynamic values: MAP 65 mmHg, CVP 4 mmHg,
PAP 28/14 mmHg, PCWP 8 mmHg, CI 2.1 L/min/m². Which condition is suggested?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Pulmonary hypertension
Correct Answer: B
Rationale: The low CVP (4 mmHg), low-normal PCWP (8 mmHg), low cardiac index (2.1
L/min/m²), and borderline MAP indicate inadequate preload/volume status consistent with
hypovolemic shock. Cardiogenic shock would show elevated CVP and PCWP; septic shock
typically shows low SVR with high or normal CI initially; pulmonary hypertension would show
elevated PAP with normal PCWP.
Question 4 (CRT Level - Patient Assessment)
A spontaneously breathing patient has the following: respiratory rate 28, use of accessory
muscles, paradoxical breathing, SpO₂ 88% on room air, unable to speak in complete sentences.
Which recommendation is most appropriate?
A. Initiate CPAP at 10 cm H₂O immediately
B. Prepare for intubation and mechanical ventilation
C. Administer bronchodilator therapy and reassess
D. Apply nasal cannula at 6 L/min
Correct Answer: B
,3
Rationale: This patient exhibits signs of impending respiratory failure: tachypnea, accessory
muscle use, paradoxical breathing (indicates diaphragmatic fatigue), hypoxemia, and inability to
maintain verbal communication. These are classic criteria for initiating mechanical ventilation.
While bronchodilators may help underlying COPD/asthma, the severity indicates ventilatory
support is needed. CPAP alone may be insufficient for this degree of distress.
Question 5 (CRT Level - Lab Values)
Which laboratory finding in a mechanically ventilated patient warrants immediate clinical
attention?
A. Serum potassium 3.8 mEq/L
B. Hemoglobin 12.5 g/dL
C. Serum calcium 7.0 mg/dL
D. Platelet count 180,000/μL
Correct Answer: C
Rationale: A serum calcium of 7.0 mg/dL represents significant hypocalcemia (normal 8.5-10.5
mg/dL). In ventilated patients, hypocalcemia can cause respiratory muscle weakness,
hypotension, and cardiac dysfunction. Severe hypocalcemia may prolong weaning and cause
hemodynamic instability requiring immediate correction. The other values are within acceptable
ranges.
Question 6 (CRT Level - Patient Data)
A post-operative patient has the following trend over 4 hours: temperature 38.2°C → 39.1°C,
WBC 12,000 → 18,000/μL, PaO₂/FiO₂ ratio 280 → 180, respiratory rate 22 → 32. What should
the RT recommend?
A. Increase FiO₂ to maintain SpO₂ > 92%
B. Evaluate for ventilator-associated pneumonia and potential antibiotic therapy
C. Initiate prone positioning
D. Extubate and transition to high-flow nasal cannula
Correct Answer: B
Rationale: This represents Systemic Inflammatory Response Syndrome (SIRS) criteria with
deterioration in oxygenation (PaO₂/FiO₂ declining from 280 to 180 indicates worsening lung
injury). The combination of fever, leukocytosis, and worsening oxygenation in a post-op
ventilated patient strongly suggests ventilator-associated pneumonia (VAP). While increasing
FiO₂ addresses the symptom, identifying and treating the underlying infection is critical.
, 4
Question 7 (CRT Level - CXR Interpretation)
A chest X-ray report states: "Bilateral diffuse interstitial and alveolar infiltrates, air
bronchograms present, normal cardiac silhouette, no pleural effusions." These findings are most
consistent with:
A. Cardiogenic pulmonary edema
B. Acute respiratory distress syndrome (ARDS)
C. Bilateral pneumonia
D. Atelectasis
Correct Answer: B
Rationale: ARDS is characterized by bilateral diffuse infiltrates, air bronchograms (indicating
alveolar filling with patent airways), normal heart size (non-cardiogenic), and absent effusions.
Cardiogenic edema typically shows cardiomegaly and effusions; bilateral pneumonia may show
patchy consolidation; atelectasis shows volume loss with mediastinal shift.
Question 8 (CRT Level - ABG Interpretation)
ABG on a COPD patient: pH 7.38, PaCO₂ 58 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 33 mEq/L. The
patient is on 2L NC with SpO₂ 88%. Which is the best interpretation?
A. Acute respiratory acidosis; increase oxygen to 4L
B. Chronic respiratory acidosis with adequate metabolic compensation; maintain current therapy
C. Metabolic alkalosis; decrease bicarbonate supplementation
D. Mixed disorder requiring emergency intubation
Correct Answer: B
Rationale: The near-normal pH (7.38) with elevated PaCO₂ (58) and significantly elevated
HCO₃⁻ (33) indicates fully compensated chronic respiratory acidosis, typical of stable COPD
with CO₂ retention. The HCO₃⁻ has increased appropriately (3.5-4 mEq/L per 10 mmHg PaCO₂
rise above 40). The PaO₂ of 62 mmHg is acceptable for a COPD patient (permissive hypoxemia).
Maintaining current therapy and avoiding excessive oxygen (which could worsen CO₂ retention)
is appropriate.
Question 9 (Select All That Apply - CRT Level)
Which of the following are appropriate indications for arterial blood gas analysis? (Select all that
apply)
NBRC TMC CRT RRT ACTUAL EXAM
TESTBANK 2026/2027 | Version 1 & Study
Guide | Verified Questions and Answers | Pass
Guaranteed - A+ Graded
TESTBANK - VERSION 1 (100 Questions)
DOMAIN 1: PATIENT DATA EVALUATION & RECOMMENDATIONS (Questions 1-20)
Question 1 (CRT Level - CXR Interpretation)
A 68-year-old male with a history of COPD presents to the emergency department with increased
dyspnea. The chest X-ray report describes: "Hyperinflation with flattened diaphragms, increased
retrosternal airspace, bullous changes in the upper lobes, and diminished peripheral vascular
markings." Which clinical condition do these findings most likely represent?
A. Acute respiratory distress syndrome (ARDS)
B. Chronic obstructive pulmonary disease (COPD) with emphysematous changes
C. Congestive heart failure
D. Pneumothorax
Correct Answer: B
Rationale: The described findings—hyperinflation, flattened diaphragms, increased retrosternal
airspace, bullous changes, and diminished vascular markings—are classic radiographic
hallmarks of emphysema-type COPD. The bullous changes indicate parenchymal destruction.
ARDS typically shows bilateral diffuse infiltrates; CHF shows cardiomegaly and pulmonary
edema; pneumothorax shows absent lung markings with a visible pleural line.
Question 2 (CRT Level - ABG Analysis)
An ABG is drawn from a 55-year-old patient with pneumonia: pH 7.32, PaCO₂ 52 mmHg, PaO₂
68 mmHg, HCO₃⁻ 26 mEq/L, BE +2. What is the primary acid-base disorder?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
,2
C. Respiratory acidosis, uncompensated
D. Metabolic alkalosis
Correct Answer: A
Rationale: The pH of 7.32 indicates acidemia. PaCO₂ is elevated (52 mmHg), identifying
respiratory acidosis as the primary disorder. The HCO₃⁻ of 26 mEq/L (slightly elevated) and
positive base excess indicate metabolic compensation has occurred. Acute respiratory acidosis
would show HCO₃⁻ increase of 1 mEq/L per 10 mmHg PaCO₂ rise; chronic shows 3.5-4 mEq/L
increase. This represents chronic or compensated respiratory acidosis.
Question 3 (CRT Level - Hemodynamics)
A patient in the ICU has the following hemodynamic values: MAP 65 mmHg, CVP 4 mmHg,
PAP 28/14 mmHg, PCWP 8 mmHg, CI 2.1 L/min/m². Which condition is suggested?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Pulmonary hypertension
Correct Answer: B
Rationale: The low CVP (4 mmHg), low-normal PCWP (8 mmHg), low cardiac index (2.1
L/min/m²), and borderline MAP indicate inadequate preload/volume status consistent with
hypovolemic shock. Cardiogenic shock would show elevated CVP and PCWP; septic shock
typically shows low SVR with high or normal CI initially; pulmonary hypertension would show
elevated PAP with normal PCWP.
Question 4 (CRT Level - Patient Assessment)
A spontaneously breathing patient has the following: respiratory rate 28, use of accessory
muscles, paradoxical breathing, SpO₂ 88% on room air, unable to speak in complete sentences.
Which recommendation is most appropriate?
A. Initiate CPAP at 10 cm H₂O immediately
B. Prepare for intubation and mechanical ventilation
C. Administer bronchodilator therapy and reassess
D. Apply nasal cannula at 6 L/min
Correct Answer: B
,3
Rationale: This patient exhibits signs of impending respiratory failure: tachypnea, accessory
muscle use, paradoxical breathing (indicates diaphragmatic fatigue), hypoxemia, and inability to
maintain verbal communication. These are classic criteria for initiating mechanical ventilation.
While bronchodilators may help underlying COPD/asthma, the severity indicates ventilatory
support is needed. CPAP alone may be insufficient for this degree of distress.
Question 5 (CRT Level - Lab Values)
Which laboratory finding in a mechanically ventilated patient warrants immediate clinical
attention?
A. Serum potassium 3.8 mEq/L
B. Hemoglobin 12.5 g/dL
C. Serum calcium 7.0 mg/dL
D. Platelet count 180,000/μL
Correct Answer: C
Rationale: A serum calcium of 7.0 mg/dL represents significant hypocalcemia (normal 8.5-10.5
mg/dL). In ventilated patients, hypocalcemia can cause respiratory muscle weakness,
hypotension, and cardiac dysfunction. Severe hypocalcemia may prolong weaning and cause
hemodynamic instability requiring immediate correction. The other values are within acceptable
ranges.
Question 6 (CRT Level - Patient Data)
A post-operative patient has the following trend over 4 hours: temperature 38.2°C → 39.1°C,
WBC 12,000 → 18,000/μL, PaO₂/FiO₂ ratio 280 → 180, respiratory rate 22 → 32. What should
the RT recommend?
A. Increase FiO₂ to maintain SpO₂ > 92%
B. Evaluate for ventilator-associated pneumonia and potential antibiotic therapy
C. Initiate prone positioning
D. Extubate and transition to high-flow nasal cannula
Correct Answer: B
Rationale: This represents Systemic Inflammatory Response Syndrome (SIRS) criteria with
deterioration in oxygenation (PaO₂/FiO₂ declining from 280 to 180 indicates worsening lung
injury). The combination of fever, leukocytosis, and worsening oxygenation in a post-op
ventilated patient strongly suggests ventilator-associated pneumonia (VAP). While increasing
FiO₂ addresses the symptom, identifying and treating the underlying infection is critical.
, 4
Question 7 (CRT Level - CXR Interpretation)
A chest X-ray report states: "Bilateral diffuse interstitial and alveolar infiltrates, air
bronchograms present, normal cardiac silhouette, no pleural effusions." These findings are most
consistent with:
A. Cardiogenic pulmonary edema
B. Acute respiratory distress syndrome (ARDS)
C. Bilateral pneumonia
D. Atelectasis
Correct Answer: B
Rationale: ARDS is characterized by bilateral diffuse infiltrates, air bronchograms (indicating
alveolar filling with patent airways), normal heart size (non-cardiogenic), and absent effusions.
Cardiogenic edema typically shows cardiomegaly and effusions; bilateral pneumonia may show
patchy consolidation; atelectasis shows volume loss with mediastinal shift.
Question 8 (CRT Level - ABG Interpretation)
ABG on a COPD patient: pH 7.38, PaCO₂ 58 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 33 mEq/L. The
patient is on 2L NC with SpO₂ 88%. Which is the best interpretation?
A. Acute respiratory acidosis; increase oxygen to 4L
B. Chronic respiratory acidosis with adequate metabolic compensation; maintain current therapy
C. Metabolic alkalosis; decrease bicarbonate supplementation
D. Mixed disorder requiring emergency intubation
Correct Answer: B
Rationale: The near-normal pH (7.38) with elevated PaCO₂ (58) and significantly elevated
HCO₃⁻ (33) indicates fully compensated chronic respiratory acidosis, typical of stable COPD
with CO₂ retention. The HCO₃⁻ has increased appropriately (3.5-4 mEq/L per 10 mmHg PaCO₂
rise above 40). The PaO₂ of 62 mmHg is acceptable for a COPD patient (permissive hypoxemia).
Maintaining current therapy and avoiding excessive oxygen (which could worsen CO₂ retention)
is appropriate.
Question 9 (Select All That Apply - CRT Level)
Which of the following are appropriate indications for arterial blood gas analysis? (Select all that
apply)
