1
NBRC TMC CRT RRT BOARD CERTIFICATION EXAM
2026/2027 | Latest Version | Complete Questions & Correct
Answers | A Grade | Pass Guaranteed
Section 1: Patient Data Evaluation & Assessment (Questions 1-35)
1.1: Patient History & Physical Findings (Questions 1-12)
Q1. A patient presents with progressive dyspnea on exertion, a chronic productive
cough with purulent sputum, and a history of smoking 2 packs per day for 30 years. On
physical examination, the patient has a barrel chest, distant heart sounds, and
decreased breath sounds bilaterally. These findings are MOST consistent with:
A. Asthma
B. Chronic obstructive pulmonary disease (COPD) [CORRECT]
C. Pulmonary fibrosis
D. Pneumothorax
Rationale: Barrel chest, distant heart sounds, decreased breath sounds, chronic
productive cough, and heavy smoking history are classic for COPD. Asthma (A) typically
presents with wheezing and reversible obstruction; pulmonary fibrosis (C) has fine
crackles and restrictive pattern; pneumothorax (D) presents acutely with unilateral
findings.
Correct Answer: B
Q2. A patient with a history of asthma reports increased shortness of breath and
wheezing. On auscultation, the RT notes prolonged expiratory phase and diffuse
wheezing. Which finding on physical examination would indicate a SEVERE
exacerbation?
A. Loud, widespread wheezing
B. Silent chest with minimal air movement [CORRECT]
C. Normal breath sounds
D. Crackles at the bases
Rationale: A silent chest indicates severe airway obstruction with minimal air
movement—an ominous sign of life-threatening asthma. Loud wheezing (A) indicates
some air movement; normal sounds (C) and crackles (D) are not signs of severe
,2
obstruction.
Correct Answer: B
Q3. A patient with cystic fibrosis presents with increased sputum production,
hemoptysis, and digital clubbing. Digital clubbing is caused by:
A. Chronic hypoxemia and tissue proliferation at the nail bed [CORRECT]
B. Acute bacterial infection
C. Vitamin deficiency
D. Medication side effect
Rationale: Digital clubbing results from chronic hypoxemia and proliferation of
vascular connective tissue at the distal phalanges. It is seen in CF, bronchiectasis, lung
cancer, and congenital heart disease. It is not caused by acute infection (B), vitamin
deficiency (C), or medications (D).
Correct Answer: A
Q4. A patient post-thoracic surgery has absent breath sounds on the right side, tracheal
deviation to the left, and subcutaneous emphysema. These findings suggest:
A. Right-sided pneumothorax or tension pneumothorax [CORRECT]
B. Right-sided pleural effusion
C. Left-sided pneumonia
D. Bilateral atelectasis
Rationale: Absent breath sounds with tracheal deviation AWAY from the affected side
indicates pneumothorax or tension pneumothorax. Pleural effusion (B) causes dullness
to percussion; pneumonia (C) would have crackles; bilateral atelectasis (D) causes
tracheal deviation toward the affected side.
Correct Answer: A
Q5. A patient with COPD presents with peripheral edema, jugular venous distension,
and a prominent pulmonic component of the second heart sound (P2). These findings
are consistent with:
A. Left ventricular failure
B. Cor pulmonale (right heart failure secondary to pulmonary hypertension)
[CORRECT]
C. Mitral valve stenosis
D. Aortic regurgitation
,3
Rationale: Cor pulmonale presents with signs of right heart failure (JVD, peripheral
edema, P2 loudness) secondary to chronic pulmonary hypertension from COPD. Left
heart failure (A) causes pulmonary edema; valvular diseases (C, D) have different
presentations.
Correct Answer: B
Q6. A patient with ARDS is noted to have coarse crackles throughout all lung fields,
tachypnea, and use of accessory muscles. The presence of accessory muscle use
indicates:
A. Normal breathing pattern
B. Increased work of breathing and respiratory muscle fatigue [CORRECT]
C. Improved lung compliance
D. Decreased metabolic demand
Rationale: Accessory muscle use (sternocleidomastoid, scalenes, intercostals) indicates
increased work of breathing and impending respiratory failure. It is never normal (A)
and indicates worsening, not improvement (C, D).
Correct Answer: B
Q7. A patient with neuromuscular disease presents with weak cough, decreased breath
sounds at the bases, and paradoxical abdominal movement during inspiration.
Paradoxical abdominal movement indicates:
A. Strong diaphragmatic function
B. Diaphragmatic weakness or paralysis [CORRECT]
C. Normal respiratory mechanics
D. Increased lung compliance
Rationale: Paradoxical abdominal movement (inward movement during inspiration)
indicates diaphragmatic weakness/paralysis, as the weakened diaphragm is drawn
upward by negative intrathoracic pressure. It is a sign of neuromuscular respiratory
failure.
Correct Answer: B
Q8. A patient with pneumonia has dullness to percussion, increased tactile fremitus,
and bronchial breath sounds over the right lower lobe. These findings indicate:
A. Pneumothorax
B. Consolidation (lobar pneumonia) [CORRECT]
, 4
C. Pleural effusion
D. Atelectasis
Rationale: Consolidation causes dullness, increased fremitus, and bronchial breath
sounds due to solidified lung tissue conducting sound. Pneumothorax (A) has
hyperresonance and decreased fremitus; effusion (C) has dullness but decreased
fremitus; atelectasis (D) has variable findings.
Correct Answer: B
Q9. A patient with acute asthma exacerbation has a respiratory rate of 32, heart rate of
118, and is unable to speak in complete sentences. The RT should recognize that:
A. The patient is stable and can be discharged
B. The patient has severe asthma requiring immediate intervention [CORRECT]
C. The patient has mild asthma
D. The patient is improving
Rationale: RR >30, HR >120, and inability to speak in sentences indicate severe asthma
requiring immediate bronchodilator therapy and possible mechanical ventilation. These
are not signs of stability (A), mild disease (C), or improvement (D).
Correct Answer: B
Q10. A patient post-cardiac surgery has a mediastinal chest tube with 200 mL of bright
red blood in the first hour. This finding indicates:
A. Normal postoperative drainage
B. Excessive bleeding requiring surgical evaluation [CORRECT]
C. Infection
D. Chylothorax
Rationale: >200 mL/hr of bright red blood post-cardiac surgery indicates active
hemorrhage requiring surgical re-evaluation. Normal drainage is serosanguineous and
<100 mL/hr; infection (C) causes purulent drainage; chylothorax (D) is milky white.
Correct Answer: B
Q11. A patient with obstructive sleep apnea presents with morning headaches, daytime
somnolence, and obesity. Which physical finding is MOST commonly associated with
OSA?
A. Scoliosis
B. Large neck circumference (>17 inches in men, >16 inches in women) [CORRECT]
NBRC TMC CRT RRT BOARD CERTIFICATION EXAM
2026/2027 | Latest Version | Complete Questions & Correct
Answers | A Grade | Pass Guaranteed
Section 1: Patient Data Evaluation & Assessment (Questions 1-35)
1.1: Patient History & Physical Findings (Questions 1-12)
Q1. A patient presents with progressive dyspnea on exertion, a chronic productive
cough with purulent sputum, and a history of smoking 2 packs per day for 30 years. On
physical examination, the patient has a barrel chest, distant heart sounds, and
decreased breath sounds bilaterally. These findings are MOST consistent with:
A. Asthma
B. Chronic obstructive pulmonary disease (COPD) [CORRECT]
C. Pulmonary fibrosis
D. Pneumothorax
Rationale: Barrel chest, distant heart sounds, decreased breath sounds, chronic
productive cough, and heavy smoking history are classic for COPD. Asthma (A) typically
presents with wheezing and reversible obstruction; pulmonary fibrosis (C) has fine
crackles and restrictive pattern; pneumothorax (D) presents acutely with unilateral
findings.
Correct Answer: B
Q2. A patient with a history of asthma reports increased shortness of breath and
wheezing. On auscultation, the RT notes prolonged expiratory phase and diffuse
wheezing. Which finding on physical examination would indicate a SEVERE
exacerbation?
A. Loud, widespread wheezing
B. Silent chest with minimal air movement [CORRECT]
C. Normal breath sounds
D. Crackles at the bases
Rationale: A silent chest indicates severe airway obstruction with minimal air
movement—an ominous sign of life-threatening asthma. Loud wheezing (A) indicates
some air movement; normal sounds (C) and crackles (D) are not signs of severe
,2
obstruction.
Correct Answer: B
Q3. A patient with cystic fibrosis presents with increased sputum production,
hemoptysis, and digital clubbing. Digital clubbing is caused by:
A. Chronic hypoxemia and tissue proliferation at the nail bed [CORRECT]
B. Acute bacterial infection
C. Vitamin deficiency
D. Medication side effect
Rationale: Digital clubbing results from chronic hypoxemia and proliferation of
vascular connective tissue at the distal phalanges. It is seen in CF, bronchiectasis, lung
cancer, and congenital heart disease. It is not caused by acute infection (B), vitamin
deficiency (C), or medications (D).
Correct Answer: A
Q4. A patient post-thoracic surgery has absent breath sounds on the right side, tracheal
deviation to the left, and subcutaneous emphysema. These findings suggest:
A. Right-sided pneumothorax or tension pneumothorax [CORRECT]
B. Right-sided pleural effusion
C. Left-sided pneumonia
D. Bilateral atelectasis
Rationale: Absent breath sounds with tracheal deviation AWAY from the affected side
indicates pneumothorax or tension pneumothorax. Pleural effusion (B) causes dullness
to percussion; pneumonia (C) would have crackles; bilateral atelectasis (D) causes
tracheal deviation toward the affected side.
Correct Answer: A
Q5. A patient with COPD presents with peripheral edema, jugular venous distension,
and a prominent pulmonic component of the second heart sound (P2). These findings
are consistent with:
A. Left ventricular failure
B. Cor pulmonale (right heart failure secondary to pulmonary hypertension)
[CORRECT]
C. Mitral valve stenosis
D. Aortic regurgitation
,3
Rationale: Cor pulmonale presents with signs of right heart failure (JVD, peripheral
edema, P2 loudness) secondary to chronic pulmonary hypertension from COPD. Left
heart failure (A) causes pulmonary edema; valvular diseases (C, D) have different
presentations.
Correct Answer: B
Q6. A patient with ARDS is noted to have coarse crackles throughout all lung fields,
tachypnea, and use of accessory muscles. The presence of accessory muscle use
indicates:
A. Normal breathing pattern
B. Increased work of breathing and respiratory muscle fatigue [CORRECT]
C. Improved lung compliance
D. Decreased metabolic demand
Rationale: Accessory muscle use (sternocleidomastoid, scalenes, intercostals) indicates
increased work of breathing and impending respiratory failure. It is never normal (A)
and indicates worsening, not improvement (C, D).
Correct Answer: B
Q7. A patient with neuromuscular disease presents with weak cough, decreased breath
sounds at the bases, and paradoxical abdominal movement during inspiration.
Paradoxical abdominal movement indicates:
A. Strong diaphragmatic function
B. Diaphragmatic weakness or paralysis [CORRECT]
C. Normal respiratory mechanics
D. Increased lung compliance
Rationale: Paradoxical abdominal movement (inward movement during inspiration)
indicates diaphragmatic weakness/paralysis, as the weakened diaphragm is drawn
upward by negative intrathoracic pressure. It is a sign of neuromuscular respiratory
failure.
Correct Answer: B
Q8. A patient with pneumonia has dullness to percussion, increased tactile fremitus,
and bronchial breath sounds over the right lower lobe. These findings indicate:
A. Pneumothorax
B. Consolidation (lobar pneumonia) [CORRECT]
, 4
C. Pleural effusion
D. Atelectasis
Rationale: Consolidation causes dullness, increased fremitus, and bronchial breath
sounds due to solidified lung tissue conducting sound. Pneumothorax (A) has
hyperresonance and decreased fremitus; effusion (C) has dullness but decreased
fremitus; atelectasis (D) has variable findings.
Correct Answer: B
Q9. A patient with acute asthma exacerbation has a respiratory rate of 32, heart rate of
118, and is unable to speak in complete sentences. The RT should recognize that:
A. The patient is stable and can be discharged
B. The patient has severe asthma requiring immediate intervention [CORRECT]
C. The patient has mild asthma
D. The patient is improving
Rationale: RR >30, HR >120, and inability to speak in sentences indicate severe asthma
requiring immediate bronchodilator therapy and possible mechanical ventilation. These
are not signs of stability (A), mild disease (C), or improvement (D).
Correct Answer: B
Q10. A patient post-cardiac surgery has a mediastinal chest tube with 200 mL of bright
red blood in the first hour. This finding indicates:
A. Normal postoperative drainage
B. Excessive bleeding requiring surgical evaluation [CORRECT]
C. Infection
D. Chylothorax
Rationale: >200 mL/hr of bright red blood post-cardiac surgery indicates active
hemorrhage requiring surgical re-evaluation. Normal drainage is serosanguineous and
<100 mL/hr; infection (C) causes purulent drainage; chylothorax (D) is milky white.
Correct Answer: B
Q11. A patient with obstructive sleep apnea presents with morning headaches, daytime
somnolence, and obesity. Which physical finding is MOST commonly associated with
OSA?
A. Scoliosis
B. Large neck circumference (>17 inches in men, >16 inches in women) [CORRECT]
