NBRC Therapist Multiple-Choice (TMC) Examination — Questions and Answers

Question 1: You are called ot help in the evaluation of a 55-year old male patient. You notice the following signs and symptoms: oral temperature of 40 degrees C (104.5 F), diaphoresis, respiratory rate of 22, the use of accessory muscles of respiration, and palpable rhonchi in the right lower love. You would suspect which of the following diagnoses:

Pneumothorax
Viral pneumonia
Bacterial pneumonia (Correct answer)
Heart attack

Correct answer: Bacterial pneumonia

Based on the signs and symptoms observed in the patient, such as high fever, diaphoresis (excessive sweating), increased respiratory rate, use of accessory muscles for breathing, and palpable rhonchi (abnormal sounds) in the right lower lobe, the most likely diagnosis would be bacterial pneumonia. Bacterial pneumonia is an infection of the lungs caused by bacteria, which can lead to symptoms such as high fever, difficulty breathing, and abnormal lung sounds. Heart attack and pneumothorax may present with different symptoms, while viral pneumonia may have similar symptoms but is less likely given the severity of the patient's presentation.

Question 2: An RT holds the RRT credential and wants to sit for the ACCS examination. What is a primary eligibility requirement?

Must have 5 years of ICU experience
Must hold an active RRT credential (Correct answer)
Must complete an ACCS-approved fellowship
Must hold only a CRT credential

Correct answer: Must hold an active RRT credential

The NBRC requires candidates to hold an active RRT credential as a prerequisite for the ACCS examination.

Question 3: A sleep study scorer preparing for the RRT-SDS examination should know that hypopnea is scored when airflow decreases by at least:

30% from baseline with associated 3% oxygen desaturation or arousal (Correct answer)
50% from baseline with 5% desaturation
10% from baseline with any desaturation
20% from baseline with an arousal only

Correct answer: 30% from baseline with associated 3% oxygen desaturation or arousal

Per AASM scoring rules, a hypopnea requires ≥30% airflow reduction from baseline plus either ≥3% oxygen desaturation or an arousal.

Question 4: Croup (laryngotracheobronchitis) is most commonly caused by:

Streptococcus pneumoniae
Respiratory syncytial virus (RSV)
Parainfluenza virus (Correct answer)
Haemophilus influenzae type b

Correct answer: Parainfluenza virus

Parainfluenza virus (most commonly type 1) is the most frequent causative agent of croup, producing subglottic edema and the characteristic barking cough and stridor.

Question 5: Which muscle is the primary muscle of inspiration?

Sternocleidomastoid
Diaphragm (Correct answer)
Scalenes
Internal intercostals

Correct answer: Diaphragm

The diaphragm contracts and flattens during inspiration, generating the pressure gradient that draws air into the lungs.

Question 6: A pulmonary artery catheter (Swan-Ganz) wedge pressure (PAWP) of 25 mmHg suggests:

Normal hemodynamics
Left ventricular failure and pulmonary venous hypertension (Correct answer)
Right heart failure
Pulmonary arterial hypertension

Correct answer: Left ventricular failure and pulmonary venous hypertension

Elevated PAWP (>18 mmHg) reflects high left atrial filling pressure from left ventricular failure, indicating cardiogenic pulmonary edema.

Question 7: In observing an infant's chest configuration, you notice that it is the same size in both the AP and lateral dimensions. This would indicate that the patient has:

A normal chest (Correct answer)
Lordosis
Pulmonary emphysema with air trapping
Funnel chest/pectus excavatum

Correct answer: A normal chest

If an infant's chest configuration is the same size in both the AP (anterior-posterior) and lateral dimensions, it indicates a normal chest. This means that there are no abnormalities or deformities present in the chest structure.

Question 8: On the CPFT examination, which of the following measurement techniques would a candidate most need to understand?

Polysomnography electrode placement
Body plethysmography for measuring functional residual capacity (Correct answer)
Arterial line insertion technique
Transcutaneous CO2 monitoring in neonates

Correct answer: Body plethysmography for measuring functional residual capacity

Body plethysmography is a key pulmonary function testing method for accurately measuring lung volumes including FRC, making it central to the CPFT examination.

Question 9: A patient requires aerosol therapy via small-volume nebulizer during mechanical ventilation. Where should the nebulizer be placed in the circuit?

15 cm from the patient Y-piece on the inspiratory limb (Correct answer)
Directly at the endotracheal tube adapter
In the expiratory limb
In the humidifier chamber

Correct answer: 15 cm from the patient Y-piece on the inspiratory limb

Placing the SVN 15 cm from the Y-piece on the inspiratory limb allows aerosol to accumulate in the circuit between breaths, increasing delivery.

Question 10: Which sign indicates that a tracheostomy tube cuff is overinflated?

Patient able to speak with tube in place
Tracheal mucosal ischemia and pressure necrosis over time (Correct answer)
Decreased peak airway pressures
Audible air leak around the tube

Correct answer: Tracheal mucosal ischemia and pressure necrosis over time

Overinflated cuffs exert excessive pressure on tracheal mucosa, reducing capillary perfusion and causing ischemic necrosis if sustained.

Question 11: Body plethysmography is used to measure which lung volume that spirometry cannot directly assess?

Expiratory reserve volume
Inspiratory reserve volume
Residual volume (Correct answer)
Tidal volume

Correct answer: Residual volume

Residual volume (RV) cannot be measured by spirometry because it remains in the lungs after maximal exhalation; body plethysmography or gas dilution techniques are required.

Question 12: Which neuromuscular blocking agent is most commonly used to facilitate endotracheal intubation due to its rapid onset and short duration?

Vecuronium
Pancuronium
Succinylcholine (Correct answer)
Rocuronium

Correct answer: Succinylcholine

Succinylcholine is a depolarizing neuromuscular blocking agent with the fastest onset (60 seconds) and shortest duration (~10 minutes), making it ideal for rapid sequence intubation.

Question 13: A patient on mechanical ventilation has a sudden decrease in SpO2 and a shift of the trachea to the unaffected side. The most likely diagnosis is:

Right mainstem intubation
Mucus plug causing atelectasis
Tension pneumothorax (Correct answer)
Pulmonary embolism

Correct answer: Tension pneumothorax

Tension pneumothorax causes tracheal deviation away from the affected side, hypotension, absent breath sounds, and severe hypoxia — a life-threatening emergency.

Question 14: What is the best way to keep the newborn baby to prevent sudden infant death syndrome (SIDS)?

All of the above
By placing the baby on his/her back (Correct answer)
By placing the baby on his/her stomach
Keeping the room of the baby super cool

Correct answer: By placing the baby on his/her back

Placing the baby on his/her back is the best way to prevent sudden infant death syndrome (SIDS). This sleeping position reduces the risk of suffocation and allows for better airflow. Placing the baby on his/her stomach increases the risk of SIDS as it can restrict breathing. Keeping the room cool does not directly prevent SIDS, but maintaining a comfortable temperature can create a safe sleep environment. Therefore, the best option to prevent SIDS is by placing the baby on his/her back.

Question 15: Endotracheal tube cuff pressure should be maintained at:

40–50 cmH2O
5–10 cmH2O
20–30 cmH2O (Correct answer)
10–15 cmH2O

Correct answer: 20–30 cmH2O

ETT cuff pressure of 20–30 cmH2O (or 15–22 mmHg) provides an adequate seal to prevent aspiration while avoiding mucosal ischemia.

Question 16: Right mainstem bronchus intubation is most commonly detected by:

Decreased ETCO2 readings
Lower peak airway pressures
Absent left-sided breath sounds (Correct answer)
Decreased heart rate

Correct answer: Absent left-sided breath sounds

Intubation of the right mainstem bronchus results in absent or decreased breath sounds over the left lung because only the right lung is being ventilated.

Question 17: An RT reviews a patient's chart and notes a P/F ratio of 180 mmHg on FiO2 of 0.60. According to the Berlin Definition, this represents:

Moderate ARDS (Correct answer)
Acute lung injury (ALI), not ARDS
Mild ARDS
Severe ARDS

Correct answer: Moderate ARDS

The Berlin Definition classifies ARDS as mild (P/F 200–300), moderate (P/F 100–200), or severe (P/F < 100), all requiring PEEP ≥ 5 cmH2O.

Question 18: Which of the following are the symptoms of Narcolepsy?

Unwanted weight gain
Cataplexy (Sudden loss of muscle tone) (Correct answer)
Increased daytime energy
All of the above

Correct answer: Cataplexy (Sudden loss of muscle tone)

The correct answer is "Cataplexy (Sudden loss of muscle tone)". Narcolepsy is a neurological disorder that affects the brain's ability to regulate sleep-wake cycles. One of the main symptoms of narcolepsy is cataplexy, which is characterized by sudden and temporary loss of muscle tone, leading to weakness or paralysis. This can be triggered by strong emotions such as laughter, anger, or surprise. Increased daytime energy and unwanted weight gain are not specific symptoms of narcolepsy.

Question 19: Which of the following causes a high anion gap metabolic acidosis?

Renal tubular acidosis
Excessive chloride infusion
Diarrhea
Lactic acidosis (Correct answer)

Correct answer: Lactic acidosis

Lactic acidosis increases unmeasured anions (lactate), elevating the anion gap, unlike hyperchloremic (normal anion gap) acidoses such as diarrhea or RTA.

Question 20: The functional residual capacity (FRC) is the sum of which two lung volumes?

Expiratory reserve volume and residual volume (Correct answer)
Tidal volume and inspiratory reserve volume
Inspiratory capacity and residual volume
Vital capacity and residual volume

Correct answer: Expiratory reserve volume and residual volume

FRC equals expiratory reserve volume (ERV) plus residual volume (RV), representing the lung volume remaining after a passive exhalation.

Question 21: The Silverman-Andersen scoring system in neonates evaluates:

Cardiac function and arrhythmias
Degree of respiratory distress based on clinical signs (retractions, grunting, etc.) (Correct answer)
Level of pain during procedures
Gestational age at birth

Correct answer: Degree of respiratory distress based on clinical signs (retractions, grunting, etc.)

The Silverman-Andersen score assesses five clinical signs of respiratory distress (upper chest lag, lower chest retraction, xiphoid retractions, nasal flaring, expiratory grunt) to grade severity.

Question 22: Oxygen is primarily transported in the blood by:

As bicarbonate ions
Bound to albumin
Bound to hemoglobin (Correct answer)
Dissolved in plasma

Correct answer: Bound to hemoglobin

Approximately 97–98% of oxygen is transported bound to hemoglobin as oxyhemoglobin; only a small fraction dissolves in plasma.

Question 23: Which congenital lung malformation involves sequestration of nonfunctional lung tissue with its own systemic arterial supply?

Tracheoesophageal fistula
Congenital pulmonary airway malformation (CPAM)
Pulmonary sequestration (Correct answer)
Congenital lobar emphysema

Correct answer: Pulmonary sequestration

Pulmonary sequestration is nonfunctional lung tissue supplied by an anomalous systemic artery with no communication to the tracheobronchial tree.

Question 24: Which finding on a flow-volume loop is most consistent with a fixed upper airway obstruction?

Scooped-out expiratory limb
Flattening of both the inspiratory and expiratory limbs (Correct answer)
Flattening of the inspiratory limb only
Normal loop with reduced peak flow

Correct answer: Flattening of both the inspiratory and expiratory limbs

Fixed upper airway obstruction (e.g., tracheal stenosis) limits flow equally in both directions, producing a flattened plateau on both limbs.

Question 25: When interpreting a DLCO result, an RPFT-credentialed technologist knows that a significantly reduced DLCO with normal spirometry most commonly suggests:

Obstructive lung disease with air trapping
Upper airway obstruction
Pulmonary vascular disease or early interstitial lung disease (Correct answer)
A purely restrictive ventilatory defect

Correct answer: Pulmonary vascular disease or early interstitial lung disease

Isolated DLCO reduction with normal spirometry indicates impaired gas exchange at the alveolar-capillary membrane, characteristic of pulmonary vascular or early interstitial disease.

Question 26: Septic shock is defined as sepsis PLUS:

PaO2/FiO2 ratio below 300
MAP <65 mmHg despite adequate fluid resuscitation requiring vasopressors, with lactate >2 mmol/L (Correct answer)
Temperature above 39°C
WBC count above 20,000

Correct answer: MAP <65 mmHg despite adequate fluid resuscitation requiring vasopressors, with lactate >2 mmol/L

Septic shock (Sepsis-3 definition) requires vasopressor use to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.

Question 27: The Mallampati classification is used to predict:

Degree of COPD severity
Difficulty of endotracheal intubation (Correct answer)
Likelihood of aspiration pneumonia
Severity of upper airway obstruction

Correct answer: Difficulty of endotracheal intubation

The Mallampati scale assesses oropharyngeal anatomy by viewing visible structures with the mouth open, helping predict difficult intubation.

Question 28: An RT preparing for the RRT-ACCS examination reviews ventilator-induced lung injury (VILI). Which protective ventilation strategy is most strongly supported by evidence for ARDS patients?

High respiratory rates with tidal volumes of 4 mL/kg IBW
Tidal volumes of 10-12 mL/kg IBW to ensure adequate minute ventilation
Tidal volumes of 6 mL/kg IBW with plateau pressure <30 cmH2O (Correct answer)
Volume control ventilation with PEEP set to 20 cmH2O in all ARDS patients

Correct answer: Tidal volumes of 6 mL/kg IBW with plateau pressure <30 cmH2O

The ARDSNet protocol of 6 mL/kg IBW with plateau pressure limitation to <30 cmH2O is the cornerstone evidence-based lung-protective strategy for ARDS.

Question 29: Acute cor pulmonale on the 12-lead ECG may show all of the following EXCEPT:

Right bundle branch block
S1Q3T3 pattern
Peaked P waves in leads II, III, aVF (P pulmonale) (Correct answer)
Right axis deviation

Correct answer: Peaked P waves in leads II, III, aVF (P pulmonale)

P pulmonale (peaked P waves) reflects chronic right atrial enlargement from pulmonary hypertension, not the acute ECG changes of sudden right heart strain.

Question 30: Which NBRC credential is specifically designed for respiratory therapists who demonstrate advanced competency in neonatal and pediatric care?

NPS (Neonatal/Pediatric Specialist) (Correct answer)
CPFT (Certified Pulmonary Function Technologist)
ACCS (Adult Critical Care Specialist)
SDS (Sleep Disorders Specialist)

Correct answer: NPS (Neonatal/Pediatric Specialist)

The NPS credential is awarded by the NBRC to RTs who pass a specialty examination focused on neonatal and pediatric respiratory care.

Question 31: An RRT-NPS candidate is reviewing high-frequency oscillatory ventilation (HFOV). Why is this topic particularly relevant to the NPS examination?

HFOV is covered only on the ACCS examination
HFOV is a neonatal and pediatric rescue ventilation mode covered extensively on the NPS exam (Correct answer)
HFOV appears only on the RPFT examination
HFOV is exclusively an adult ICU ventilation strategy

Correct answer: HFOV is a neonatal and pediatric rescue ventilation mode covered extensively on the NPS exam

HFOV is a specialty ventilation mode most commonly used in neonatal and pediatric patients, making it a core NPS examination topic.

Question 32: Which condition in premature infants results from surfactant deficiency?

Transient tachypnea of the newborn (TTN)
Meconium aspiration syndrome
Bronchopulmonary dysplasia (BPD)
Respiratory distress syndrome (RDS) (Correct answer)

Correct answer: Respiratory distress syndrome (RDS)

Neonatal RDS (hyaline membrane disease) results from surfactant deficiency in premature infants, leading to diffuse alveolar collapse and respiratory failure.

Question 33: In pressure support ventilation (PSV), the ventilator:

Controls both rate and tidal volume
Provides a fixed pressure boost to patient-initiated breaths (Correct answer)
Cycles based on a set inspiratory time
Delivers mandatory breaths independent of patient effort

Correct answer: Provides a fixed pressure boost to patient-initiated breaths

PSV augments each spontaneous patient-initiated breath with a clinician-set pressure boost, reducing work of breathing while maintaining patient control of rate and timing.

Question 34: Nitrogen washout and helium dilution are techniques used to measure:

Airway resistance
Oxygen consumption
Functional residual capacity (FRC) (Correct answer)
Peak expiratory flow rate

Correct answer: Functional residual capacity (FRC)

Both nitrogen washout and helium dilution techniques measure FRC by using inert tracer gases to calculate the volume of gas in communication with the open airways.

Question 35: Which of the following is the best nursing advice to promote better sleep in kids?

Encourage that kids participate in some leisure activities
Increase screen time before going to sleep
All of the above
Ensure that the meal is healthy & the room is quite for good sleep (Correct answer)

Correct answer: Ensure that the meal is healthy & the room is quite for good sleep

The best nursing advice to promote better sleep in kids is to ensure that the meal is healthy and the room is quiet. A healthy meal can help regulate blood sugar levels and provide essential nutrients for better sleep. A quiet room creates a calm and peaceful environment, reducing distractions and promoting relaxation. Increasing screen time before sleep can have a negative impact on sleep quality, as the blue light emitted from screens can disrupt the production of melatonin, a hormone that regulates sleep. Encouraging kids to participate in leisure activities can be beneficial, but it is not specifically related to promoting better sleep.

Question 36: You have finished charting on your patient when you notice that an error was made. You should do which of the following?

Tell the nurse so that she will chart the correct information
Have your supervisor chart the correct information
Place a line through the error, initial it, and write in the correct information (Correct answer)
Tell the nurse so that she will tell the physician

Correct answer: Place a line through the error, initial it, and write in the correct information

When an error is made while charting on a patient, the appropriate action is to place a line through the error, initial it, and then write in the correct information. This ensures that the error is clearly marked and the correct information is recorded. Informing the nurse or supervisor is not necessary in this case as the error can be rectified immediately by the person who made it.

Question 37: A tracheostomy tube is indicated for all of the following EXCEPT:

Facilitation of secretion removal
Prolonged mechanical ventilation (>2 weeks)
Upper airway obstruction
Short-term airway management during a brief surgery (Correct answer)

Correct answer: Short-term airway management during a brief surgery

Tracheostomy is reserved for situations requiring a prolonged or secure airway; an endotracheal tube is preferred for short-term surgical airway needs.

Question 38: A variable extrathoracic obstruction (e.g., vocal cord dysfunction during inspiration) flattens which portion of the flow-volume loop?

Inspiratory limb (Correct answer)
Expiratory limb
Peak expiratory flow
Both limbs equally

Correct answer: Inspiratory limb

Variable extrathoracic obstructions worsen during inspiration because negative pressure draws the obstruction into the airway, flattening the inspiratory limb.

Question 39: A 70 kg adult patient receives volume-controlled ventilation at VT 500 mL, rate 14, PEEP 5. Peak pressure is 45 cmH2O and plateau pressure is 42 cmH2O. What is the primary problem?

High airway resistance
Auto-PEEP
Decreased lung compliance (Correct answer)
ETT obstruction

Correct answer: Decreased lung compliance

When plateau pressure is high and the peak-to-plateau gradient is small, the problem is low lung compliance, not airway resistance.

Question 40: How often must NBRC specialty credential holders complete the Continuing Competency requirements to maintain their credential?

Every 10 years
Every 5 years (Correct answer)
Every year
Every 2 years

Correct answer: Every 5 years

NBRC specialty credentials follow a 5-year Continuing Competency cycle requiring recertification activities.

Question 41: Which pulmonary function test finding is characteristic of a restrictive lung disease pattern?

FEV1/FVC < 70% with normal TLC
Reduced TLC with normal or elevated FEV1/FVC ratio (Correct answer)
Decreased DLCO with obstructive pattern
Increased RV with air trapping

Correct answer: Reduced TLC with normal or elevated FEV1/FVC ratio

Restrictive disease reduces lung volumes (TLC, VC, FRC) while the FEV1/FVC ratio remains normal or elevated due to proportional reductions.

Question 42: Which medication is a depolarizing neuromuscular blocking agent used in RSI?

Atracurium
Succinylcholine (Correct answer)
Rocuronium
Vecuronium

Correct answer: Succinylcholine

Succinylcholine is the only depolarizing neuromuscular blocker in clinical use; it causes rapid-onset fasciculations followed by paralysis.

Question 43: Which ventilator setting directly affects the rate of CO2 elimination?

FiO2
PEEP
Inspiratory flow rate
Minute ventilation (respiratory rate × tidal volume) (Correct answer)

Correct answer: Minute ventilation (respiratory rate × tidal volume)

CO2 elimination is directly proportional to alveolar minute ventilation; increasing respiratory rate or tidal volume increases CO2 clearance.

Question 44: The anion gap is calculated as:

Na+ – (Cl– + HCO3–) (Correct answer)
Na+ + K+ – (Cl– + HCO3–)
Na+ – K+
Cl– – HCO3–

Correct answer: Na+ – (Cl– + HCO3–)

The anion gap = Na+ – (Cl– + HCO3–); a normal anion gap is 8–12 mEq/L, and an elevated gap indicates unmeasured anions from conditions like lactic acidosis or DKA.

Question 45: Rapid sequence intubation (RSI) uses a sedative agent followed immediately by a neuromuscular blocking agent to:

Minimize time to intubation and reduce aspiration risk (Correct answer)
Prolong preoxygenation time
Avoid need for a laryngoscope
Increase airway reflexes

Correct answer: Minimize time to intubation and reduce aspiration risk

RSI rapidly achieves sedation and paralysis to minimize apnea time and intubation attempts, thereby reducing the risk of pulmonary aspiration.

Question 46: The rapid shallow breathing index (RSBI) predicts weaning success. A favorable RSBI is:

Less than 105 breaths/min/L (Correct answer)
Greater than 200
Equal to zero
Greater than 105

Correct answer: Less than 105 breaths/min/L

An RSBI below 105 (f/VT ratio) is associated with successful weaning; values above 105 suggest the patient is unlikely to tolerate extubation.

Question 47: Synchronized intermittent mandatory ventilation (SIMV) delivers mandatory breaths that are:

Synchronized to patient inspiratory effort when present (Correct answer)
Independent of set respiratory rate
Only pressure-controlled
Asynchronous with patient effort

Correct answer: Synchronized to patient inspiratory effort when present

SIMV attempts to time mandatory breaths to coincide with the patient's own inspiratory effort to reduce patient-ventilator asynchrony.

Question 48: In examining your patient, you notice that she has greatly diminished breath sounds in her right lower lobe, and her trachea has shifted to the right. These signs indicate which condition?

Left-sided pneumothorax
Right-sided pneumothorax
Right-sided atelectasis (Correct answer)
Left-sided pneumonia

Correct answer: Right-sided atelectasis

Diminished breath sounds and a shift in the trachea to the affected side are indicative of atelectasis, which is the collapse or closure of a lung or part of a lung. In this case, the patient's symptoms suggest right-sided atelectasis, as the breath sounds are diminished in the right lower lobe and the trachea is shifted to the right. Atelectasis can be caused by various factors, such as blockage of the airway, compression of the lung, or surfactant deficiency.

Question 49: The normal mixed venous oxygen saturation (SvO2) is approximately:

95–100%
80–90%
60–75% (Correct answer)
40–50%

Correct answer: 60–75%

Normal SvO2 is 60–75%, reflecting the balance between oxygen delivery and consumption in systemic tissues.

Question 50: What is the Bohr effect?

Increased CO2 shifts the oxyhemoglobin curve left
Increased CO2 shifts the oxyhemoglobin curve right (Correct answer)
Decreased temperature shifts the curve right
Increased pH shifts the curve right

Correct answer: Increased CO2 shifts the oxyhemoglobin curve right

The Bohr effect describes how elevated CO2 (and decreased pH) reduces hemoglobin's affinity for oxygen, shifting the oxyhemoglobin dissociation curve to the right.

Question 51: An older female patient visits the doctor due to sleep issues. What could be the reason behind her sleep?

Exercising increases the amount REM sleep
None of the above.
Regularly drinking alcohol increases the chances of good sleep.
Older age decreases the amount of REM sleep naturally (Correct answer)

Correct answer: Older age decreases the amount of REM sleep naturally

As people age, there is a natural decrease in the amount of REM (Rapid Eye Movement) sleep they experience. REM sleep is a stage of sleep associated with dreaming and is important for cognitive function and memory consolidation. This decrease in REM sleep can lead to sleep issues, such as difficulty falling asleep or staying asleep throughout the night. Therefore, the reason behind the older female patient's sleep issues could be the natural decrease in REM sleep that occurs with age.

Question 52: A patient with status asthmaticus is receiving continuous albuterol nebulization. Which adverse effect must be monitored most closely?

Hyperglycemia
Metabolic acidosis
Hypernatremia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Beta-2 agonists like albuterol stimulate Na+/K+-ATPase, shifting potassium intracellularly and potentially causing hypokalemia, which can lead to cardiac dysrhythmias.

Question 53: During a 6-minute walk test, a patient's SpO2 drops from 96% to 84%. The appropriate clinical response is to:

Continue the test and document the desaturation
Stop the test and administer supplemental oxygen (Correct answer)
Increase walking pace to complete the test faster
Repeat the test the following day with supplemental oxygen

Correct answer: Stop the test and administer supplemental oxygen

Exercise-induced desaturation to ≤88% (or ≤84% by some protocols) is a safety endpoint requiring test termination and supplemental oxygen.

Question 54: Which condition is characterized by a normal PAWP with elevated pulmonary artery pressure and high pulmonary vascular resistance?

Left ventricular failure
Fluid overload
Cardiogenic pulmonary edema
Pulmonary arterial hypertension (Correct answer)

Correct answer: Pulmonary arterial hypertension

Pulmonary arterial hypertension involves elevated pulmonary artery pressure due to increased pulmonary vascular resistance with a normal PAWP, distinguishing it from cardiac causes.

Question 55: Acute hypoxemic respiratory failure is defined by a PaO2/FiO2 (P/F) ratio below:

300 (Correct answer)
200
100
400

Correct answer: 300

A P/F ratio below 300 mmHg defines acute hypoxemic respiratory failure; values below 200 define ARDS and below 100 define severe ARDS (Berlin criteria).

Question 56: A patient on BiPAP for acute hypercapnic respiratory failure has the following settings: IPAP 14, EPAP 6. What is the pressure support being delivered?

20 cmH2O
6 cmH2O
8 cmH2O (Correct answer)
14 cmH2O

Correct answer: 8 cmH2O

Pressure support on BiPAP equals IPAP minus EPAP (14 - 6 = 8 cmH2O), which drives tidal volume during spontaneous breaths.

Question 57: A patient has a V/Q ratio of zero. This indicates:

Dead space ventilation
Normal gas exchange
Diffusion impairment
Intrapulmonary shunt (Correct answer)

Correct answer: Intrapulmonary shunt

A V/Q ratio of zero means there is perfusion but no ventilation, which constitutes a true intrapulmonary shunt.

Question 58: Inverse ratio ventilation (IRV) is characterized by:

Inspiratory time equal to or longer than expiratory time (I:E ≥ 1:1) (Correct answer)
Fixed 1:2 I:E ratio at all respiratory rates
Inspiratory time shorter than expiratory time (I:E < 1:2)
Patient-triggered breaths only

Correct answer: Inspiratory time equal to or longer than expiratory time (I:E ≥ 1:1)

IRV reverses the normal I:E ratio so inspiration is as long as or longer than expiration, recruiting alveoli and improving oxygenation in severe ARDS.

Question 59: In listening to a patient's lungs, you notice bronchial breath sounds in her right lower lobe. These would indicate which of the following?

Consolidation in her right lower lobe (Correct answer)
Normal lungs
Pneumothorax
Pleural effusion in her right lower lobe

Correct answer: Consolidation in her right lower lobe

Bronchial breath sounds are harsh and high-pitched sounds heard over the trachea or bronchi, and they are not normally heard in healthy lung tissue. The presence of bronchial breath sounds in the right lower lobe suggests consolidation, which refers to the filling of the alveoli with fluid or solid material. This can be caused by conditions such as pneumonia or lung abscess. Therefore, the correct answer is consolidation in her right lower lobe.

Question 60: Plateau pressure should ideally be kept below which threshold to reduce ventilator-induced lung injury (VILI)?

25 cmH2O
40 cmH2O
30 cmH2O (Correct answer)
20 cmH2O

Correct answer: 30 cmH2O

Current lung-protective ventilation guidelines recommend keeping plateau pressure below 30 cmH2O to minimize barotrauma and VILI.

Question 61: To help determine your patient's level of consciousness, you should ask which of the following questions? 1. Do you you know what day this is? 2. Can I see your identification wristband? 3. Do you know where you are? 4. How are you feeling today? 5. Do you know who the president is?

2, 4 (Correct answer)
3
1, 3
5

Correct answer: 2, 4

To help determine a patient's level of consciousness, it is important to ask questions that assess their orientation to person, place, and time. Question 2, "Can I see your identification wristband?" helps determine if the patient is aware of their own identity and location. Question 4, "How are you feeling today?" helps assess the patient's awareness of their current state and overall well-being. These questions provide valuable information about the patient's cognitive function and level of consciousness.

Question 62: An FEV1/FVC ratio below 70% (or below the lower limit of normal) indicates:

Restrictive lung disease
Obstructive lung disease (Correct answer)
Normal lung function
Diffusion impairment

Correct answer: Obstructive lung disease

A reduced FEV1/FVC ratio is the hallmark of obstructive lung disease, indicating impaired expiratory airflow relative to total lung capacity.

Question 63: Normal cardiac output at rest is approximately:

1–2 L/min
5–6 L/min (Correct answer)
8–10 L/min
3–4 L/min

Correct answer: 5–6 L/min

Resting cardiac output is typically 5–6 L/min, calculated as heart rate multiplied by stroke volume.

Question 64: A term neonate is born with poor respiratory effort, heart rate 90 bpm, and central cyanosis. After initial warming and stimulation, no improvement occurs. What is the next step?

Begin positive pressure ventilation with 21% oxygen (Correct answer)
Perform chest compressions immediately
Administer epinephrine via umbilical catheter
Intubate and administer surfactant

Correct answer: Begin positive pressure ventilation with 21% oxygen

NRP guidelines direct positive pressure ventilation as the primary intervention when a neonate fails to respond to initial stabilization steps.

Question 65: Which waveform is characteristic of volume-controlled, constant-flow ventilation?

Ascending ramp flow waveform
Square (constant) flow waveform (Correct answer)
Sinusoidal flow waveform
Decelerating flow waveform

Correct answer: Square (constant) flow waveform

Volume control with constant flow produces a square (rectangular) flow waveform, resulting in a linearly increasing pressure waveform.

Question 66: Which laryngoscope blade is inserted into the vallecula (space between the epiglottis and base of tongue)?

Wisconsin blade
Miller (straight) blade
Wis-Hipple blade
Macintosh (curved) blade (Correct answer)

Correct answer: Macintosh (curved) blade

The Macintosh (curved) blade is placed in the vallecula, and lifting indirectly elevates the epiglottis to expose the glottis.

Question 67: In diabetic ketoacidosis (DKA), the respiratory compensation (Kussmaul respirations) produces:

Respiratory alkalosis to compensate for metabolic acidosis (Correct answer)
Metabolic alkalosis
No change in PaCO2
Respiratory acidosis

Correct answer: Respiratory alkalosis to compensate for metabolic acidosis

Kussmaul respirations are deep, rapid breaths that blow off CO2, lowering PaCO2 to partially compensate for the metabolic acidosis of DKA.

Question 68: N-acetylcysteine (Mucomyst) works as a mucolytic by which mechanism?

Inhibiting phosphodiesterase
Cleaving disulfide bonds in mucus glycoproteins (Correct answer)
Increasing mucociliary clearance
Blocking leukotriene receptors

Correct answer: Cleaving disulfide bonds in mucus glycoproteins

N-acetylcysteine reduces mucus viscosity by breaking disulfide bonds within mucus glycoproteins, making secretions easier to expectorate.

Question 69: The maximum voluntary ventilation (MVV) test measures:

The maximum volume breathed in and out over 12–15 seconds, extrapolated to one minute (Correct answer)
Forced vital capacity repeated three times
Resting tidal volume over one minute
Inspiratory capacity during maximal effort

Correct answer: The maximum volume breathed in and out over 12–15 seconds, extrapolated to one minute

MVV assesses the maximum minute ventilation achievable with maximal effort, reflecting overall ventilatory capacity including respiratory muscle strength and airway patency.

Question 70: An NPS-credentialed RT is assessing a 28-week premature infant with increasing FiO2 requirements on nasal CPAP. The next most appropriate escalation step is:

Initiate high-flow nasal cannula at 1 L/kg/min
Intubation and administration of exogenous surfactant (Correct answer)
Increase CPAP pressure to 15 cmH2O
Begin inhaled nitric oxide therapy immediately

Correct answer: Intubation and administration of exogenous surfactant

Premature infants with respiratory distress syndrome who fail CPAP require intubation and surfactant replacement therapy as the next escalation step.

Question 71: The normal arterial pH range is:

7.35–7.45 (Correct answer)
7.30–7.35
7.45–7.55
7.20–7.30

Correct answer: 7.35–7.45

Arterial blood pH is normally maintained between 7.35 and 7.45 by respiratory and renal buffering mechanisms.

Question 72: An RT is setting up a transport ventilator for an ICU patient being moved to CT. Which consideration is MOST critical?

Ensure adequate oxygen cylinder volume for the entire transport duration (Correct answer)
Switch the patient to manual ventilation during elevator travel
Use the same ventilator brand as in the ICU
Increase PEEP by 2 cmH2O to compensate for position changes

Correct answer: Ensure adequate oxygen cylinder volume for the entire transport duration

Running out of oxygen supply during transport is a life-threatening risk; calculate required cylinder volume based on FiO2, flow, and estimated transport time.

Question 73: The appropriate depth of insertion for an oral endotracheal tube in an average adult male is approximately:

20 cm at the lips
23 cm at the lips (Correct answer)
28 cm at the lips
15 cm at the lips

Correct answer: 23 cm at the lips

Oral ETT depth of approximately 23 cm at the teeth/lips places the tube tip about 3–5 cm above the carina in most adult males.

Question 74: The lung-protective ventilation strategy for ARDS recommends tidal volumes of:

15 mL/kg ideal body weight
3–4 mL/kg ideal body weight
10–12 mL/kg ideal body weight
6 mL/kg ideal body weight (Correct answer)

Correct answer: 6 mL/kg ideal body weight

The ARDSNet protocol demonstrated improved survival with tidal volumes of 6 mL/kg IBW compared to conventional 12 mL/kg volumes.

Question 75: The target PaCO2 during CPR for an adult patient is:

35–45 mmHg (Correct answer)
20–25 mmHg
30–35 mmHg
50–60 mmHg

Correct answer: 35–45 mmHg

During CPR, ventilation should target a normal PaCO2 of 35–45 mmHg to avoid hypocapnia-induced cerebral vasoconstriction or hypercapnia-induced acidosis.

Question 76: When performing nasotracheal suctioning, the maximum suction pressure for an adult should not exceed:

-80 mmHg
-120 mmHg (Correct answer)
-150 mmHg
-200 mmHg

Correct answer: -120 mmHg

Adult nasotracheal suctioning should not exceed -120 mmHg to avoid mucosal trauma and hypoxia.

Question 77: In palpating your patient for symmetrical chest movements, you notice that his left side does not move as much as his right side. This indicates that he has which condition or conditions? 1. Emphysema 2. Congestive heart failure 3. Left-sided pneumonia 4. Left-sided pneumothorax 5. Right sided pneumonia

1, 2
2
4, 5
3, 4 (Correct answer)

Correct answer: 3, 4

When palpating the patient for symmetrical chest movements, if the left side does not move as much as the right side, it indicates that the patient may have left-sided pneumonia or left-sided pneumothorax. Left-sided pneumonia refers to an infection in the left lung, which can cause decreased movement on that side. Left-sided pneumothorax refers to the presence of air in the left pleural space, which can also cause decreased chest movement on the left side. Therefore, the correct answer is 3, 4.

Question 78: A premature infant at 28 weeks gestation is intubated for respiratory distress syndrome. After surfactant administration, the RT should reassess ventilator settings because:

Lung compliance improves rapidly, risking volutrauma if pressures are not reduced (Correct answer)
FiO2 requirements typically increase after surfactant
Surfactant increases airway resistance significantly
The ETT may become dislodged during administration

Correct answer: Lung compliance improves rapidly, risking volutrauma if pressures are not reduced

Surfactant rapidly improves lung compliance, so if inspiratory pressures are not promptly reduced, the delivered tidal volume rises and can cause volutrauma.

Question 79: What is the primary mechanism of action of ipratropium bromide?

Muscarinic receptor blockade (Correct answer)
Phosphodiesterase inhibition
Beta-2 receptor stimulation
Mast cell stabilization

Correct answer: Muscarinic receptor blockade

Ipratropium bromide is an anticholinergic agent that blocks muscarinic receptors, reducing bronchoconstriction and secretions by inhibiting acetylcholine binding.

Question 80: Dornase alfa (Pulmozyme) is primarily indicated for which condition?

Pulmonary hypertension
Cystic fibrosis (Correct answer)
Asthma exacerbations
COPD with chronic bronchitis

Correct answer: Cystic fibrosis

Dornase alfa is a recombinant human DNase that cleaves extracellular DNA in mucus, reducing viscosity and improving airway clearance in patients with cystic fibrosis.

Question 81: Which spirometric pattern is typically seen in a patient with severe scoliosis?

Restrictive pattern (Correct answer)
Obstructive pattern
Mixed obstructive-restrictive pattern
Normal spirometry

Correct answer: Restrictive pattern

Severe scoliosis restricts chest wall expansion, reducing lung volumes and producing a restrictive spirometric pattern with reduced FVC and TLC.

Question 82: Inhaled nitric oxide (iNO) in neonates is used to treat:

Apnea of prematurity
Persistent pulmonary hypertension of the newborn (PPHN) (Correct answer)
Respiratory distress syndrome from surfactant deficiency
Meconium aspiration syndrome without pulmonary hypertension

Correct answer: Persistent pulmonary hypertension of the newborn (PPHN)

iNO selectively dilates pulmonary vasculature, reducing pulmonary vascular resistance and right-to-left shunting in PPHN.

Question 83: Which drug used in respiratory care inhibits phosphodiesterase, resulting in increased cyclic AMP and bronchodilation?

Cromolyn sodium
Montelukast
Aminophylline (Correct answer)
Tiotropium

Correct answer: Aminophylline

Aminophylline (a prodrug of theophylline) inhibits phosphodiesterase, preventing breakdown of cyclic AMP, which leads to smooth muscle relaxation and bronchodilation.

Question 84: Which oxygen delivery system is BEST suited for a patient who requires precise FiO2 control regardless of respiratory pattern?

Non-rebreather mask
Simple face mask
Venturi mask (Correct answer)
Nasal cannula at 4 L/min

Correct answer: Venturi mask

The Venturi mask uses fixed air-entrainment orifices to deliver accurate, predetermined FiO2 independent of patient flow.

Question 85: What is the primary purpose of the NBRC Examination Candidate Handbook?

To provide answer keys for practice examinations
To outline eligibility requirements, testing policies, and examination content specifications (Correct answer)
To describe clinical rotation requirements for RRT candidates
To list approved continuing education providers

Correct answer: To outline eligibility requirements, testing policies, and examination content specifications

The Candidate Handbook is the official NBRC document detailing how to apply, eligibility rules, examination format, and content outlines.

Question 86: Respiratory muscle strength is assessed by measuring:

FEV1 and FVC only
Oxygen saturation at peak exercise
Maximum inspiratory pressure (MIP/PImax) and maximum expiratory pressure (MEP/PEmax) (Correct answer)
FEF25-75% and PEFR

Correct answer: Maximum inspiratory pressure (MIP/PImax) and maximum expiratory pressure (MEP/PEmax)

MIP and MEP directly measure the force-generating capacity of inspiratory and expiratory muscles, respectively, to evaluate neuromuscular respiratory disease.

Question 87: Which of the following best distinguishes the NPS from the ACCS credential in terms of scope?

NPS covers only neonates while ACCS covers pediatric and adult patients
ACCS and NPS cover the same patient populations with different examination formats
NPS requires more continuing education hours than ACCS each cycle
NPS covers patients from birth through adolescence while ACCS focuses exclusively on adult critical care patients (Correct answer)

Correct answer: NPS covers patients from birth through adolescence while ACCS focuses exclusively on adult critical care patients

The NPS credential spans neonatal through pediatric patients, whereas the ACCS credential is scoped to the adult intensive care environment.

Question 88: Systemic inflammatory response syndrome (SIRS) criteria include all of the following EXCEPT:

Respiratory rate >20 breaths/min or PaCO2 <32 mmHg
Temperature >38°C or <36°C
Heart rate >90 bpm
SpO2 <88% on room air (Correct answer)

Correct answer: SpO2 <88% on room air

SIRS criteria include temperature, heart rate, respiratory rate/PaCO2, and WBC count abnormalities; SpO2 below 88% is not a SIRS criterion.

Question 89: What is the primary advantage of the NBRC credential verification system for employers?

It automatically notifies employers when an employee's credential lapses
It provides full examination score reports to employers
It allows employers to confirm an RT's current credential status and expiration date online (Correct answer)
It lists disciplinary actions taken against all credential holders

Correct answer: It allows employers to confirm an RT's current credential status and expiration date online

The NBRC online registry lets employers verify whether a respiratory therapist currently holds an active credential and when it expires.

Question 90: Video laryngoscopy compared to direct laryngoscopy typically provides:

Worse glottic visualization in most patients
Faster time to intubation in all situations
No advantage in obese patients
Improved glottic view, especially in difficult airways (Correct answer)

Correct answer: Improved glottic view, especially in difficult airways

Video laryngoscopy offers an improved view of the glottis by providing an indirect, magnified image, particularly benefiting patients with difficult airway anatomy.

Question 91: Which ventilator mode delivers a set tidal volume regardless of airway resistance or compliance changes?

Pressure support ventilation (PSV)
CPAP
Volume control ventilation (VCV) (Correct answer)
Pressure control ventilation (PCV)

Correct answer: Volume control ventilation (VCV)

Volume control ventilation guarantees delivery of a preset tidal volume by adjusting peak inspiratory pressure as lung mechanics change.

Question 92: Which airway device is considered a supraglottic (extraglottic) airway?

Tracheostomy tube
Endobronchial blocker
Endotracheal tube
Laryngeal mask airway (LMA) (Correct answer)

Correct answer: Laryngeal mask airway (LMA)

The LMA sits above the glottis in the hypopharynx and forms a seal around the laryngeal inlet, classifying it as a supraglottic airway device.

Question 93: Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?

Risk for injury (Correct answer)
Alteration in tissue perfusion
Fluid volume excess
Risk for infection

Correct answer: Risk for injury

Sedative-hypnotics cause CNS depression. putting the patient at risk for injury.

Question 94: Which of the following best describes the primary function of the alveoli?

Warming and humidifying inspired air
Producing surfactant only
Filtering particulates from inhaled air
Gas exchange between air and blood (Correct answer)

Correct answer: Gas exchange between air and blood

Alveoli are the primary sites of gas exchange where oxygen diffuses into the blood and carbon dioxide diffuses out.

Question 95: Which lung zone, according to the West zones model, has the greatest blood flow?

Zone 4 (extreme base)
Zone 3 (base) (Correct answer)
Zone 2 (mid-lung)
Zone 1 (apex)

Correct answer: Zone 3 (base)

Zone 3 (base) has the greatest blood flow because both arterial and venous pressures exceed alveolar pressure, keeping pulmonary capillaries continuously open.

Question 96: An increase in 2,3-DPG causes which shift of the oxyhemoglobin dissociation curve?

Left shift, increasing oxygen affinity
Right shift, decreasing oxygen affinity (Correct answer)
No change in the curve
Left shift, decreasing oxygen affinity

Correct answer: Right shift, decreasing oxygen affinity

Elevated 2,3-DPG reduces hemoglobin's affinity for oxygen, shifting the curve rightward and facilitating oxygen release to tissues.

Question 97: Respiratory syncytial virus (RSV) most commonly causes which lower respiratory illness in infants?

Lung abscess
Empyema
Lobar pneumonia
Bronchiolitis (Correct answer)

Correct answer: Bronchiolitis

RSV is the leading cause of bronchiolitis in infants, causing small airway inflammation, mucus plugging, air trapping, and wheezing.

Question 98: Hypoxic pulmonary vasoconstriction (HPV) serves to:

Divert blood away from poorly ventilated alveoli (Correct answer)
Raise alveolar PO2 in well-ventilated regions
Decrease pulmonary vascular resistance globally
Increase blood flow to poorly ventilated areas

Correct answer: Divert blood away from poorly ventilated alveoli

HPV redirects pulmonary blood flow away from hypoxic lung segments to better-ventilated areas, optimizing V/Q matching.

Question 99: Meconium aspiration syndrome (MAS) occurs when:

Group B streptococcus causes neonatal pneumonia
Premature birth causes surfactant deficiency
Meconium-stained amniotic fluid is inhaled, causing airway obstruction and inflammation (Correct answer)
Persistent pulmonary hypertension develops without meconium

Correct answer: Meconium-stained amniotic fluid is inhaled, causing airway obstruction and inflammation

MAS results from aspiration of meconium-stained amniotic fluid, causing chemical pneumonitis, mechanical obstruction, and surfactant inactivation, often in term or post-term infants.

Question 100: Closed-suction catheter systems are preferred in mechanically ventilated patients primarily to:

Reduce cost compared to open suctioning
Deliver medications during suctioning
Allow suctioning without nursing assistance
Maintain PEEP and prevent circuit contamination during suctioning (Correct answer)

Correct answer: Maintain PEEP and prevent circuit contamination during suctioning

Closed-suction systems allow tracheal suctioning without disconnecting the ventilator circuit, preserving PEEP, oxygenation, and reducing infection risk.

Question 101: Which calculation correctly determines alveolar oxygen tension (PAO2) using the alveolar air equation?

PAO2 = PaO2 + PaCO2
PAO2 = (PB - 47) × FiO2 - PaCO2 × 1.2
PAO2 = (FiO2 × 713) - (PaCO2 / 0.8) (Correct answer)
PAO2 = FiO2 × PB - PaCO2

Correct answer: PAO2 = (FiO2 × 713) - (PaCO2 / 0.8)

The alveolar air equation is PAO2 = (FiO2 × [PB - PH2O]) - (PaCO2/RQ), which at sea level simplifies to (FiO2 × 713) - (PaCO2/0.8).

Question 102: A candidate who fails the RRT-ACCS examination on the first attempt may retest after:

30 days
1 year
90 days (Correct answer)
6 months

Correct answer: 90 days

NBRC policy requires a 90-day waiting period before retesting after a failed specialty examination attempt.

Question 103: During patient teaching. The nurse explains the difference between a sedative and hypnotic by stating:

“Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time.”
“Sedative drugs induce sleep. whereas hypnotic drugs induce a state of hypnosis.”
“Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.” (Correct answer)
“There really is no difference; the terms are used interchangeably.”

Correct answer: “Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses.”

Many drugs have both sedative and hypnotic properties. with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.

Question 104: Cricothyrotomy provides emergency surgical airway access through the:

Tracheal rings 2–4
Pyriform sinus
Thyrohyoid membrane
Cricothyroid membrane (Correct answer)

Correct answer: Cricothyroid membrane

Cricothyrotomy is performed through the cricothyroid membrane, the preferred emergency access site because of its surface anatomy and vascularity.

Question 105: Which of the following substances is a natural hormone produced by the pineal gland that induces sleep?

Amphetamine
Methylphenidate
Melatonin (Correct answer)
Pemoline

Correct answer: Melatonin

Melatonin is a natural hormone that induces sleep. All the others are medications classified as stimulants.

Question 106: An RRT-ACCS credentialed therapist is managing a patient on ECMO. Recognizing this as an advanced critical care modality, this topic would most likely appear on which NBRC examination?

CRT entry-level examination
NPS examination only
RRT-ACCS examination (Correct answer)
CPFT examination

Correct answer: RRT-ACCS examination

ECMO in adult critically ill patients falls within the advanced adult critical care scope that the ACCS credential and examination address.

Question 107: Extracorporeal membrane oxygenation (ECMO) provides gas exchange support by:

Delivering 100% oxygen directly to the alveoli
Withdrawing blood, oxygenating it externally, and returning it to the patient (Correct answer)
Using high-frequency oscillation to recruit alveoli
Administering inhaled nitric oxide continuously

Correct answer: Withdrawing blood, oxygenating it externally, and returning it to the patient

ECMO removes blood via cannula, passes it through an oxygenator membrane to add O2 and remove CO2, then returns oxygenated blood to the patient's circulation.

Question 108: Which medication is a phosphodiesterase-5 inhibitor used to treat pulmonary arterial hypertension?

Ambrisentan
Epoprostenol
Sildenafil (Correct answer)
Bosentan

Correct answer: Sildenafil

Sildenafil inhibits PDE-5, increasing cGMP levels and producing pulmonary vasodilation without significant systemic effects.

Question 109: Which NBRC credential is most appropriate for an RT specializing in diagnosing and managing sleep-disordered breathing?

NPS (Neonatal/Pediatric Specialist)
SDS (Sleep Disorders Specialist) (Correct answer)
RPFT (Registered Pulmonary Function Technologist)
ACCS (Adult Critical Care Specialist)

Correct answer: SDS (Sleep Disorders Specialist)

The RRT-SDS credential is awarded to respiratory therapists who demonstrate advanced competency in sleep disorders testing and management.

Question 110: Which pulmonary function test result pattern would an RPFT-credentialed technologist most associate with a restrictive lung defect?

Normal spirometry with reduced DLCO only
Elevated RV with air trapping on the flow-volume loop
Reduced TLC with normal or elevated FEV1/FVC ratio (Correct answer)
Reduced FEV1/FVC ratio with normal TLC

Correct answer: Reduced TLC with normal or elevated FEV1/FVC ratio

Restriction is characterized by a reduced total lung capacity (TLC) while the FEV1/FVC ratio is preserved or elevated due to proportional reductions in both values.

Question 111: Which complication is specific to tracheostomy and not typically seen with endotracheal intubation?

Cuff overinflation injury
Tracheoinnominate artery fistula (Correct answer)
Subglottic stenosis
Inadvertent extubation

Correct answer: Tracheoinnominate artery fistula

Tracheoinnominate artery fistula is a rare but life-threatening complication unique to tracheostomy due to the proximity of the innominate artery to the lower trachea.

Question 112: Which equation is used to estimate alveolar oxygen partial pressure (PAO2)?

Alveolar gas equation (Correct answer)
Henderson-Hasselbalch equation
Laplace equation
Fick equation

Correct answer: Alveolar gas equation

The alveolar gas equation (PAO2 = FiO2 × [Pb – PH2O] – PaCO2/R) estimates the partial pressure of oxygen in the alveoli.

Question 113: Sildenafil (Revatio) is used in respiratory care to treat which condition?

Pulmonary arterial hypertension (Correct answer)
Cystic fibrosis
Acute respiratory distress syndrome
Severe persistent asthma

Correct answer: Pulmonary arterial hypertension

Sildenafil inhibits phosphodiesterase-5, increasing cyclic GMP and causing pulmonary vascular smooth muscle relaxation, reducing pulmonary vascular resistance in pulmonary arterial hypertension.

Question 114: A normal respiratory rate for a 6-month-old infant is approximately:

20–30 breaths/min
12–20 breaths/min
60–80 breaths/min
30–60 breaths/min (Correct answer)

Correct answer: 30–60 breaths/min

Infants normally breathe 30–60 times per minute; respiratory rates above 60 in an infant at rest suggest respiratory distress.

Question 115: During an RRT-SDS examination scenario, a patient's polysomnography shows an AHI of 35 with predominantly obstructive events. The most appropriate initial treatment recommendation is:

Supplemental oxygen only
CPAP therapy titration (Correct answer)
Bilevel PAP in spontaneous mode
Surgical referral for uvulopalatopharyngoplasty

Correct answer: CPAP therapy titration

CPAP is the first-line evidence-based treatment for moderate-to-severe obstructive sleep apnea, and titration is the initial management step.

Question 116: Prone positioning in ARDS improves oxygenation primarily by:

Reducing lung compliance
Decreasing cardiac output
Increasing FiO2 delivery
Redistributing blood flow to better-ventilated dorsal lung regions and recruiting dependent lung (Correct answer)

Correct answer: Redistributing blood flow to better-ventilated dorsal lung regions and recruiting dependent lung

Prone positioning recruits previously collapsed dorsal (posterior) alveoli and redistributes perfusion to better-ventilated regions, improving V/Q matching and oxygenation.

Question 117: Which PFT finding is most consistent with pulmonary fibrosis?

Increased TLC, increased RV, reduced FEV1/FVC
Normal TLC, reduced FEV1/FVC, increased RV
Increased DLCO, normal TLC, reduced FVC
Reduced TLC, reduced FVC, normal or elevated FEV1/FVC, reduced DLCO (Correct answer)

Correct answer: Reduced TLC, reduced FVC, normal or elevated FEV1/FVC, reduced DLCO

Pulmonary fibrosis causes restrictive physiology with reduced TLC and FVC, elevated FEV1/FVC ratio, and reduced DLCO due to loss of alveolar-capillary surface.

Question 118: Which of the following conditions characterizes rapid eye movement (REM) sleep?

Highly active brain and physiological activity levels. (Correct answer)
Pulse rate slowed by 5 to 10 beats/minute.
Disorientation and disorganized thinking.
Jerky limb movements and position changes.

Correct answer: Highly active brain and physiological activity levels.

Highly active brain and physiological activity levels characterize REM stage. Stages 3 and 4 of NREM sleep are characterized by disorientation and disorganization. During REM sleep. the body movement ceases except for the eyes. The pulse rate slows by 5-10 beats/minute during NREM sleep. not REM sleep.

Question 119: Which inhaled agent is used to assess airway hyperresponsiveness during a bronchoprovocation challenge test?

Methacholine (Correct answer)
Tiotropium
Albuterol
Fluticasone

Correct answer: Methacholine

Methacholine is a cholinergic agonist that causes bronchoconstriction in a dose-dependent manner; a positive test (≥20% fall in FEV1) confirms airway hyperresponsiveness consistent with asthma.

Question 120: A respiratory therapist holds both the RRT and RRT-NPS credentials. The RRT credential lapses due to non-renewal. What happens to the NPS credential?

The NPS credential remains valid independently
The NPS automatically renews the RRT
The NPS credential becomes invalid because it requires an active RRT (Correct answer)
Only the CRT credential is required to maintain NPS

Correct answer: The NPS credential becomes invalid because it requires an active RRT

NBRC specialty credentials are dependent on maintaining the prerequisite RRT credential; if the RRT lapses, the specialty credential is also invalidated.

Question 121: Which medication is classified as a long-acting beta-2 agonist (LABA)?

Levalbuterol
Albuterol
Salmeterol (Correct answer)
Metaproterenol

Correct answer: Salmeterol

Salmeterol is a LABA with a duration of action of approximately 12 hours, making it suitable for twice-daily maintenance dosing rather than acute rescue.

Question 122: Oral suctioning with a Yankauer catheter should be limited to:

10–15 second intervals (Correct answer)
15-second intervals
5-minute intervals
30-second intervals

Correct answer: 10–15 second intervals

Suctioning should be limited to 10–15 seconds per pass to minimize hypoxia and mucosal trauma.

Question 123: Compliance of the lung is defined as:

Change in pressure per unit change in volume
Airway resistance multiplied by flow rate
Work of breathing divided by tidal volume
Change in volume per unit change in pressure (Correct answer)

Correct answer: Change in volume per unit change in pressure

Compliance (C = ΔV/ΔP) measures the ease with which the lung distends in response to an applied pressure change.

Question 124: The RRT-ACCS credential examination blueprint places the heaviest emphasis on which area?

Pulmonary function test interpretation
Outpatient COPD management
Patient assessment and diagnosis in the adult ICU (Correct answer)
Neonatal resuscitation algorithms

Correct answer: Patient assessment and diagnosis in the adult ICU

The ACCS exam is weighted toward complex adult critical care assessment, diagnosis, and management competencies.

Question 125: Inhaled nitric oxide (iNO) is used therapeutically to produce which primary effect?

Systemic vasodilation
Bronchodilation
Decreased pulmonary secretions
Selective pulmonary vasodilation (Correct answer)

Correct answer: Selective pulmonary vasodilation

Inhaled nitric oxide selectively dilates pulmonary vasculature in ventilated lung regions by activating guanylate cyclase; it is rapidly inactivated by hemoglobin, preventing systemic effects.

Question 126: A patient has ABG: pH 7.52, PaCO2 28 mmHg, HCO3 22 mEq/L. This is consistent with:

Respiratory alkalosis (uncompensated) (Correct answer)
Compensated respiratory acidosis
Metabolic alkalosis
Normal values

Correct answer: Respiratory alkalosis (uncompensated)

pH above 7.45 (alkalosis) with low PaCO2 and near-normal HCO3 indicates uncompensated acute respiratory alkalosis from hyperventilation.

Question 127: A patient has ABG values: pH 7.28, PaCO2 55 mmHg, HCO3 24 mEq/L. This represents:

Respiratory alkalosis
Metabolic acidosis
Respiratory acidosis (uncompensated) (Correct answer)
Metabolic alkalosis

Correct answer: Respiratory acidosis (uncompensated)

pH below 7.35 (acidosis) with elevated PaCO2 and normal HCO3 indicates uncompensated acute respiratory acidosis.

Question 128: Nasopharyngeal airways are contraindicated in patients with:

Intact gag reflex
Basilar skull fracture (Correct answer)
Trismus (lockjaw)
Nasal congestion

Correct answer: Basilar skull fracture

Basilar skull fractures are a contraindication for nasopharyngeal airways because the tube may inadvertently enter the cranial vault through the fracture.

Question 129: When using high-frequency oscillatory ventilation (HFOV), oxygenation is primarily controlled by adjusting:

Amplitude (ΔP)
Frequency (Hz)
Mean airway pressure (mPaw) (Correct answer)
Inspiratory time percentage

Correct answer: Mean airway pressure (mPaw)

On HFOV, mean airway pressure determines lung recruitment and FRC, which is the primary determinant of oxygenation.

Question 130: The normal partial pressure of oxygen (PaO2) in arterial blood at sea level is approximately:

60 mmHg
80–100 mmHg (Correct answer)
40 mmHg
120 mmHg

Correct answer: 80–100 mmHg

Normal PaO2 ranges from 80 to 100 mmHg in a healthy adult breathing room air at sea level.

Question 131: A patient on mechanical ventilation develops sudden hypotension, tachycardia, and decreased breath sounds on the left. What is the most likely cause?

Tension pneumothorax (Correct answer)
Mucus plug
Pulmonary embolism
Atelectasis

Correct answer: Tension pneumothorax

Tension pneumothorax causes mediastinal shift, compressing the heart and great vessels, leading to hemodynamic instability.

Question 132: Surfactant is produced by which cell type?

Type I pneumocytes
Goblet cells
Type II pneumocytes (Correct answer)
Clara cells

Correct answer: Type II pneumocytes

Type II pneumocytes synthesize and secrete pulmonary surfactant, which reduces alveolar surface tension and prevents alveolar collapse.

Question 133: Heliox therapy is most appropriate for which clinical situation?

Hypoxemia due to diffusion impairment
Pulmonary edema
Upper airway obstruction causing increased work of breathing (Correct answer)
Hypercapnic respiratory failure

Correct answer: Upper airway obstruction causing increased work of breathing

Heliox (helium-oxygen mixture) reduces gas density, decreasing turbulent flow and work of breathing in conditions with upper airway obstruction such as croup or post-extubation stridor.

Question 134: An RT is calibrating a blood gas analyzer. The two-point calibration uses:

Room air and 100% oxygen
Distilled water and isotonic saline
Low and high standard gas concentrations (Correct answer)
Patient blood and known reference values

Correct answer: Low and high standard gas concentrations

Two-point calibration establishes the analyzer's linearity using certified low-concentration and high-concentration reference gas mixtures.

Question 135: Which mode is most appropriate for weaning a patient from mechanical ventilation?

High-frequency oscillatory ventilation
Pressure support ventilation (PSV) with gradually reduced support (Correct answer)
Controlled mandatory ventilation at a fixed rate
Assist-control with high PEEP

Correct answer: Pressure support ventilation (PSV) with gradually reduced support

PSV weaning allows clinicians to progressively reduce inspiratory support as the patient's spontaneous breathing strength improves, facilitating a smooth transition to extubation.

Question 136: Which of the following clinical competencies is unique to the RRT-SDS examination blueprint and would NOT appear on the ACCS examination?

Interpreting arterial blood gases
Managing a patient on mechanical ventilation
Scoring polysomnography respiratory events using AASM criteria (Correct answer)
Administering inhaled bronchodilators

Correct answer: Scoring polysomnography respiratory events using AASM criteria

Polysomnography scoring using AASM criteria is a sleep-specific skill that belongs exclusively to the SDS examination scope.

Question 137: Which of the following sleep disorders is the most prevalent?

Insomnia. (Correct answer)
Sleep-awake schedule disturbance.
Parasomnia.
Hypersomnia.

Correct answer: Insomnia.

Approximately 1/3 of American adults have some type of sleep disorder. and insomnia is the most common.

Question 138: A candidate for the NBRC specialty examination discovers their application was denied due to an invalid credential. The most appropriate next step is to:

Apply to the state licensing board instead of NBRC
Wait one year before reapplying without contacting NBRC
Contact the NBRC directly to resolve the credential status issue before reapplying (Correct answer)
Take the examination anyway and appeal the result

Correct answer: Contact the NBRC directly to resolve the credential status issue before reapplying

Applicants who receive a denial due to credential issues should contact the NBRC directly, as resolving the underlying credential problem is required before reapplication.

Question 139: Which statement best describes the Registered Pulmonary Function Technologist (RPFT) compared to the CPFT?

The RPFT is the advanced-level credential requiring a higher passing score on a more comprehensive PFT examination (Correct answer)
The RPFT does not require an active RRT credential
The RPFT and CPFT are identical credentials with different names
The RPFT is an entry-level credential and the CPFT is advanced

Correct answer: The RPFT is the advanced-level credential requiring a higher passing score on a more comprehensive PFT examination

The RPFT represents advanced mastery in pulmonary function testing and is distinguished from the entry-level CPFT by a more rigorous examination.

Question 140: PEEP (positive end-expiratory pressure) is used primarily to:

Reduce the work of breathing by eliminating auto-PEEP
Decrease functional residual capacity
Decrease mean airway pressure
Prevent alveolar collapse and improve oxygenation (Correct answer)

Correct answer: Prevent alveolar collapse and improve oxygenation

PEEP maintains alveolar patency at end-expiration, recruits collapsed lung units, and improves V/Q matching and oxygenation.

Question 141: During orotracheal suctioning, the catheter should be inserted to what depth before applying suction?

Until resistance is met (carina level), then withdrawn 1 cm (Correct answer)
Only to the level of the vocal cords
5 cm past the lips
Past the carina into the right mainstem bronchus

Correct answer: Until resistance is met (carina level), then withdrawn 1 cm

The catheter is advanced until carina resistance is felt, then withdrawn 1 cm before applying suction to avoid direct mucosal injury at the carina.

Question 142: Which of the following best describes anatomical dead space?

Lung tissue destroyed by emphysema
The volume of gas remaining after maximal exhalation
Alveoli that are ventilated but not perfused
Conducting airways that do not participate in gas exchange (Correct answer)

Correct answer: Conducting airways that do not participate in gas exchange

Anatomical dead space comprises the conducting airways (nose, trachea, bronchi) where no gas exchange occurs, roughly 150 mL in adults.

Question 143: High-frequency oscillatory ventilation (HFOV) uses:

Normal tidal volumes with oscillating PEEP
Very small tidal volumes at very high rates (3–15 Hz) (Correct answer)
Intermittent jet insufflation
Large tidal volumes at low rates

Correct answer: Very small tidal volumes at very high rates (3–15 Hz)

HFOV delivers very small tidal volumes (often less than anatomical dead space) at very high frequencies, maintaining lung recruitment while minimizing pressure swings.

Question 144: The DLCO (diffusing capacity for carbon monoxide) is reduced in which condition?

Asthma
Emphysema (Correct answer)
Obesity
Neuromuscular weakness

Correct answer: Emphysema

Emphysema destroys alveolar walls and pulmonary capillaries, reducing the surface area available for gas diffusion and lowering DLCO.

Question 145: Which route of delivery provides the highest systemic absorption for a bronchodilator but also carries the greatest risk of systemic side effects?

Intravenous infusion (Correct answer)
Dry powder inhaler
Nebulization
Metered-dose inhaler

Correct answer: Intravenous infusion

Intravenous administration delivers 100% of the drug directly into the systemic circulation, providing maximal bioavailability but also the greatest risk of cardiovascular and metabolic side effects.

Question 146: The NBRC Therapist Multiple-Choice (TMC) examination is a prerequisite for which credential pathway?

Both the CRT and RRT credentials require passing the TMC (Correct answer)
Only the RRT-ACCS requires the TMC
The NPS examination replaces the TMC for neonatal specialists
The TMC is optional for candidates holding a bachelor's degree

Correct answer: Both the CRT and RRT credentials require passing the TMC

All entry and advanced credential candidates must pass the TMC; CRT is awarded at a lower cut score and RRT requires both a higher TMC score and passing the CSE.

Question 147: Post-bronchodilator testing showing ≥12% and ≥200 mL improvement in FEV1 indicates:

Fixed airflow obstruction
Restrictive physiology
Normal baseline spirometry
Significant bronchodilator reversibility (consistent with asthma) (Correct answer)

Correct answer: Significant bronchodilator reversibility (consistent with asthma)

A 12% and 200 mL improvement in FEV1 after bronchodilator is the ATS/ERS criterion for significant reversibility, supporting an asthma diagnosis.

Question 148: The correct endotracheal tube position is confirmed by all of the following EXCEPT:

End-tidal CO2 capnography waveform
Chest rise with ventilation
Bilateral breath sounds on auscultation
Presence of a cuff pilot balloon (Correct answer)

Correct answer: Presence of a cuff pilot balloon

A cuff pilot balloon confirms cuff inflation but does NOT confirm correct tracheal positioning; only assessment of ventilation and capnography confirm proper tube placement.

Question 149: The peak expiratory flow (PEF) is most effort-dependent and primarily reflects:

Respiratory muscle endurance
Large central airway caliber and effort (Correct answer)
Alveolar gas mixing
Small airway function

Correct answer: Large central airway caliber and effort

PEF is highly effort-dependent and reflects large central airway function; it is commonly used for asthma monitoring but is not a sensitive marker of small airway disease.

Question 150: Which inhaled medication is classified as a long-acting muscarinic antagonist (LAMA)?

Albuterol sulfate
Ipratropium bromide
Salmeterol xinafoate
Tiotropium bromide (Correct answer)

Correct answer: Tiotropium bromide

Tiotropium is a LAMA with a 24-hour duration of action, used for maintenance therapy in COPD.

Question 151: Which chemoreceptors respond most rapidly to changes in PaCO2?

Pulmonary stretch receptors
Central chemoreceptors in the medulla (Correct answer)
J-receptors in lung parenchyma
Peripheral chemoreceptors in the carotid bodies

Correct answer: Central chemoreceptors in the medulla

Central chemoreceptors in the medulla oblongata are highly sensitive to changes in cerebrospinal fluid pH caused by CO2 diffusion, driving the primary ventilatory response.

Question 152: The primary treatment for mild-to-moderate RSV bronchiolitis in infants is:

Supportive care: hydration, nasal suctioning, supplemental O2 as needed (Correct answer)
Nebulized albuterol scheduled every 4 hours
Systemic corticosteroids
Routine antibiotics

Correct answer: Supportive care: hydration, nasal suctioning, supplemental O2 as needed

Evidence supports supportive care for bronchiolitis; corticosteroids, routine bronchodilators, and antibiotics are not recommended for typical RSV bronchiolitis.

Question 153: A patient receiving aerosolized pentamidine therapy most likely has which underlying condition?

Bacterial pneumonia
Pulmonary tuberculosis
Aspergillosis
Pneumocystis jirovecii pneumonia prophylaxis in HIV (Correct answer)

Correct answer: Pneumocystis jirovecii pneumonia prophylaxis in HIV

Inhaled pentamidine is used for prophylaxis against Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients who cannot tolerate trimethoprim-sulfamethoxazole.

Question 154: Bronchopulmonary dysplasia (BPD) is defined as oxygen dependency at:

7 days of life
3 months of corrected age
6 months of corrected age
28 days of life (Correct answer)

Correct answer: 28 days of life

BPD is defined as oxygen requirement at 28 days of life and reflects chronic lung injury from mechanical ventilation, oxygen toxicity, and inflammation in premature infants.

Question 155: Which of the following is the most appropriate initial tidal volume setting for lung-protective ventilation in a 70 kg IBW patient with ARDS?

560 mL (8 mL/kg IBW)
700 mL (10 mL/kg IBW)
280 mL (4 mL/kg IBW)
420 mL (6 mL/kg IBW) (Correct answer)

Correct answer: 420 mL (6 mL/kg IBW)

The ARDSNet protocol recommends initiating mechanical ventilation at 6 mL/kg IBW to limit volutrauma and improve mortality.

Question 156: What is the primary goal of prone positioning in patients with severe ARDS?

Reduce ventilator-associated pneumonia risk
Improve V/Q matching and oxygenation (Correct answer)
Decrease PaCO2 levels
Lower peak airway pressures

Correct answer: Improve V/Q matching and oxygenation

Prone positioning redistributes lung perfusion to better-ventilated dorsal regions, improving ventilation-perfusion matching and oxygenation.

Question 157: Continuous renal replacement therapy (CRRT) is preferred over intermittent hemodialysis in critically ill patients primarily because it:

Causes less hemodynamic instability in hypotensive patients (Correct answer)
Does not require anticoagulation
Can be managed without ICU nursing
Provides faster toxin clearance

Correct answer: Causes less hemodynamic instability in hypotensive patients

CRRT removes solutes and fluid slowly and continuously, making it better tolerated hemodynamically in critically ill patients who cannot tolerate the rapid fluid shifts of intermittent hemodialysis.

Question 158: To help you determine whether your patient has orthopnea, you would ask which of the following?

How many flights of stairs can you climb before you become short of breath?
Do you know who the governor is?
Do any particular foods seem to make it harder for you to cough up your secretions?
Do you need to use extra pillows behind your head and back to keep from getting short of breath when you sleep? (Correct answer)

Correct answer: Do you need to use extra pillows behind your head and back to keep from getting short of breath when you sleep?

The question is asking about a symptom called orthopnea, which is shortness of breath that occurs when lying flat. The correct answer is "Do you need to use extra pillows behind your head and back to keep from getting short of breath when you sleep?" This question specifically addresses the symptom of orthopnea by asking if the patient needs to elevate their head and back with extra pillows to prevent shortness of breath while sleeping. This can help determine if the patient experiences orthopnea.

Question 159: A patient with ARDS has a PaO2 of 55 mmHg on FiO2 of 0.8 and PEEP of 12 cmH2O. The P/F ratio is:

69 (Correct answer)
97
440
44

Correct answer: 69

P/F ratio = PaO2 / FiO2 = 55 / 0.8 = 68.75 ≈ 69, which falls below 100 mmHg, meeting criteria for severe ARDS.

Question 160: What is the therapeutic serum level range for theophylline in adults?

1–5 mcg/mL
20–30 mcg/mL
10–20 mcg/mL (Correct answer)
5–10 mcg/mL

Correct answer: 10–20 mcg/mL

The therapeutic range for theophylline is 10–20 mcg/mL; levels above 20 mcg/mL are associated with toxicity including seizures, tachycardia, and nausea.

NBRC Therapist Multiple-Choice (TMC) Examination

The TMC Examination is the entry-level credentialing exam for respiratory therapists, administered by the National Board for Respiratory Care (NBRC). It assesses clinical knowledge across patient data evaluation, equipment troubleshooting, and respiratory care interventions, with dual cut scores awarding CRT or RRT credentials.

160

Questions

180 min

Time Limit

70%

To Pass

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