Page 1 of 171
NBRC TMC CRT RRT ACTUAL EXAM WITH 300
QUESTIONS AND CORRECT DETAILED SOLUTIONS WITH
RATIONALES LATEST UPDATED VERSION THIS YEAR
2026-2027
Question 1
A 68-year-old patient with a history of COPD presents with increased shortness of breath,
productive cough with green sputum, and fever. Arterial blood gas on room air shows: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃ 30 mEq/L. What is the most appropriate interpretation
of this ABG?
A) Acute respiratory acidosis with hypoxemia
B) Chronic respiratory acidosis with acute exacerbation
C) Metabolic alkalosis with respiratory compensation
D) Mixed metabolic and respiratory acidosis
Correct Answer: B
Rationale: The pH is acidemic (7.28), PaCO₂ is elevated (68) indicating respiratory acidosis. The
HCO₃ is elevated (30) suggesting chronic compensation. The acute drop in pH with elevated
PaCO₂ indicates an acute exacerbation on top of chronic respiratory acidosis.
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Question 2
A 55-year-old patient is receiving mechanical ventilation with the following settings: Mode
SIMV, Rate 12, Vt 500 mL, FiO₂ 0.40, PEEP 5 cm H₂O. Arterial blood gas shows: pH 7.31, PaCO₂
55 mmHg, PaO₂ 78 mmHg, HCO₃ 26 mEq/L. What is the most appropriate ventilator
adjustment?
A) Increase the respiratory rate
B) Decrease the tidal volume
C) Increase FiO₂
D) Decrease PEEP
Correct Answer: A
Rationale: The ABG shows respiratory acidosis (pH 7.31, PaCO₂ 55). Increasing the respiratory
rate will increase minute ventilation and help lower PaCO₂. The PaO₂ is acceptable at 78 mmHg.
Question 3
A patient with asthma is receiving continuous albuterol nebulization. The patient's heart rate is
140 bpm and they are complaining of palpitations and tremors. What is the most appropriate
action?
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A) Continue albuterol and add a beta-blocker
B) Decrease the albuterol rate or switch to intermittent therapy
C) Increase the albuterol rate to improve bronchodilation
D) Discontinue all bronchodilators immediately
Correct Answer: B
Rationale: The patient is showing signs of beta-agonist toxicity (tachycardia, palpitations,
tremors). Decreasing the albuterol rate or switching to intermittent therapy will reduce systemic
side effects while maintaining bronchodilation.
Question 4
A 72-year-old patient with pneumonia has the following ABG on 2 L/min nasal cannula: pH 7.32,
PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. The patient is awake and alert. What is the
most appropriate next step?
A) Increase FiO₂ to 4 L/min and reassess
B) Initiate noninvasive positive pressure ventilation (NPPV)
C) Intubate and initiate mechanical ventilation
D) Administer sodium bicarbonate
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Correct Answer: B
Rationale: The patient has acute respiratory acidosis (pH 7.32, PaCO₂ 52) with hypoxemia. NPPV
can support ventilation and improve oxygenation while avoiding intubation in an awake, alert
patient.
Question 5
A patient with ARDS is on mechanical ventilation with the following settings: PC-CMV, Pressure
Control 18 cm H₂O, Rate 16, FiO₂ 0.60, PEEP 12 cm H₂O. The patient's SpO₂ drops from 94% to
86%. What is the MOST appropriate initial action?
A) Increase FiO₂ to 1.0
B) Increase PEEP
C) Increase the pressure control level
D) Suction the patient
Correct Answer: D
Rationale: A sudden drop in SpO₂ should prompt an immediate assessment for an acute
problem. The most common cause is mucus plugging or secretion accumulation. Suctioning
should be performed first before making ventilator changes.
NBRC TMC CRT RRT ACTUAL EXAM WITH 300
QUESTIONS AND CORRECT DETAILED SOLUTIONS WITH
RATIONALES LATEST UPDATED VERSION THIS YEAR
2026-2027
Question 1
A 68-year-old patient with a history of COPD presents with increased shortness of breath,
productive cough with green sputum, and fever. Arterial blood gas on room air shows: pH 7.28,
PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃ 30 mEq/L. What is the most appropriate interpretation
of this ABG?
A) Acute respiratory acidosis with hypoxemia
B) Chronic respiratory acidosis with acute exacerbation
C) Metabolic alkalosis with respiratory compensation
D) Mixed metabolic and respiratory acidosis
Correct Answer: B
Rationale: The pH is acidemic (7.28), PaCO₂ is elevated (68) indicating respiratory acidosis. The
HCO₃ is elevated (30) suggesting chronic compensation. The acute drop in pH with elevated
PaCO₂ indicates an acute exacerbation on top of chronic respiratory acidosis.
, Page 2 of 171
Question 2
A 55-year-old patient is receiving mechanical ventilation with the following settings: Mode
SIMV, Rate 12, Vt 500 mL, FiO₂ 0.40, PEEP 5 cm H₂O. Arterial blood gas shows: pH 7.31, PaCO₂
55 mmHg, PaO₂ 78 mmHg, HCO₃ 26 mEq/L. What is the most appropriate ventilator
adjustment?
A) Increase the respiratory rate
B) Decrease the tidal volume
C) Increase FiO₂
D) Decrease PEEP
Correct Answer: A
Rationale: The ABG shows respiratory acidosis (pH 7.31, PaCO₂ 55). Increasing the respiratory
rate will increase minute ventilation and help lower PaCO₂. The PaO₂ is acceptable at 78 mmHg.
Question 3
A patient with asthma is receiving continuous albuterol nebulization. The patient's heart rate is
140 bpm and they are complaining of palpitations and tremors. What is the most appropriate
action?
, Page 3 of 171
A) Continue albuterol and add a beta-blocker
B) Decrease the albuterol rate or switch to intermittent therapy
C) Increase the albuterol rate to improve bronchodilation
D) Discontinue all bronchodilators immediately
Correct Answer: B
Rationale: The patient is showing signs of beta-agonist toxicity (tachycardia, palpitations,
tremors). Decreasing the albuterol rate or switching to intermittent therapy will reduce systemic
side effects while maintaining bronchodilation.
Question 4
A 72-year-old patient with pneumonia has the following ABG on 2 L/min nasal cannula: pH 7.32,
PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. The patient is awake and alert. What is the
most appropriate next step?
A) Increase FiO₂ to 4 L/min and reassess
B) Initiate noninvasive positive pressure ventilation (NPPV)
C) Intubate and initiate mechanical ventilation
D) Administer sodium bicarbonate
, Page 4 of 171
Correct Answer: B
Rationale: The patient has acute respiratory acidosis (pH 7.32, PaCO₂ 52) with hypoxemia. NPPV
can support ventilation and improve oxygenation while avoiding intubation in an awake, alert
patient.
Question 5
A patient with ARDS is on mechanical ventilation with the following settings: PC-CMV, Pressure
Control 18 cm H₂O, Rate 16, FiO₂ 0.60, PEEP 12 cm H₂O. The patient's SpO₂ drops from 94% to
86%. What is the MOST appropriate initial action?
A) Increase FiO₂ to 1.0
B) Increase PEEP
C) Increase the pressure control level
D) Suction the patient
Correct Answer: D
Rationale: A sudden drop in SpO₂ should prompt an immediate assessment for an acute
problem. The most common cause is mucus plugging or secretion accumulation. Suctioning
should be performed first before making ventilator changes.
