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

Question 1: 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 2: During patient teaching. The nurse explains the difference between a sedative and hypnotic by stating:

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

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

200
300 (Correct answer)
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 4: Plateau pressure should ideally be kept below which threshold to reduce ventilator-induced lung injury (VILI)?

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

Correct answer: 30 cmH2O

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

Question 5: Which congenital lung malformation involves sequestration of nonfunctional lung tissue with its own systemic arterial supply?

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

Correct answer: Pulmonary sequestration

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

Question 6: Which amongst the following are the most prevalent sleep disorders?

Anemia
Sleep Apnea
Insomnia (Correct answer)
Narcolepsy

Correct answer: Insomnia

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both. It is one of the most prevalent sleep disorders, affecting a significant number of individuals worldwide. People with insomnia often experience daytime sleepiness, fatigue, irritability, and decreased concentration. The causes of insomnia can vary, including stress, anxiety, depression, certain medications, and underlying medical conditions. Treatment options for insomnia may include behavioral changes, medication, and addressing any underlying causes.

Question 7: How often must NBRC specialty credential holders complete the Continuing Competency requirements to maintain their credential?

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

Correct answer: Every 5 years

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

Question 8: Acute cor pulmonale on the 12-lead ECG may show all of the following EXCEPT:

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

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 9: Neonatal nasal CPAP is most commonly used to treat which condition?

Neonatal RDS and apnea of prematurity (Correct answer)
Pierre Robin sequence
Congenital diaphragmatic hernia
Tracheoesophageal fistula

Correct answer: Neonatal RDS and apnea of prematurity

Nasal CPAP reduces the need for invasive mechanical ventilation in preterm infants with RDS by maintaining alveolar patency, and also reduces apnea of prematurity episodes.

Question 10: A patient has ABG: pH 7.52, PaCO2 28 mmHg, HCO3 22 mEq/L. This is consistent with:

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

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

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)
ACCS and NPS cover the same patient populations with different examination formats
NPS covers only neonates while ACCS covers pediatric and adult patients

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 12: Which of the following are the symptoms of Narcolepsy?

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

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

Hypokalemia (Correct answer)
Metabolic acidosis
Hypernatremia
Hyperglycemia

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

Allow suctioning without nursing assistance
Reduce cost compared to open suctioning
Deliver medications during suctioning
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 15: Which pulmonary function test result pattern would an RPFT-credentialed technologist most associate with a restrictive lung defect?

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

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 16: Compliance of the lung is defined as:

Airway resistance multiplied by flow rate
Change in pressure per unit change in volume
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 17: The normal partial pressure of oxygen (PaO2) in arterial blood at sea level is approximately:

80–100 mmHg (Correct answer)
60 mmHg
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 18: 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?

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

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 19: Septic shock is defined as sepsis PLUS:

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

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 20: Nitrogen washout and helium dilution are techniques used to measure:

Airway resistance
Functional residual capacity (FRC) (Correct answer)
Oxygen consumption
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 21: Inhaled nitric oxide (iNO) is used therapeutically to produce which primary effect?

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

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

28 cm at the lips
23 cm at the lips (Correct answer)
15 cm at the lips
20 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 23: Normal cardiac output at rest is approximately:

3–4 L/min
8–10 L/min
5–6 L/min (Correct answer)
1–2 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 24: An adult patient has a TLC of 120% predicted, an FRC of 140% predicted, and a reduced FEV1/FVC ratio. These findings are consistent with:

Asthma without chronic hyperinflation
Severe emphysema with air trapping (Correct answer)
Pulmonary fibrosis
Normal lung function

Correct answer: Severe emphysema with air trapping

Elevated TLC, markedly elevated FRC (hyperinflation), and reduced FEV1/FVC ratio are classic features of severe emphysema with gas trapping.

Question 25: The NBRC's CPFT examination primarily assesses competency in which clinical area?

Sleep study scoring and analysis
Neonatal resuscitation procedures
Mechanical ventilator management
Pulmonary function testing and spirometry interpretation (Correct answer)

Correct answer: Pulmonary function testing and spirometry interpretation

The CPFT credential validates knowledge and skill in performing and interpreting pulmonary function studies.

Question 26: The functional residual capacity (FRC) is the sum of which two lung volumes?

Vital capacity and residual volume
Expiratory reserve volume and residual volume (Correct answer)
Tidal volume and inspiratory reserve volume
Inspiratory 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 27: What is the primary advantage of the NBRC credential verification system for employers?

It automatically notifies employers when an employee's credential lapses
It allows employers to confirm an RT's current credential status and expiration date online (Correct answer)
It provides full examination score reports to employers
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 28: Which mode is most appropriate for weaning a patient from mechanical ventilation?

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

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 29: 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:

Increase CPAP pressure to 15 cmH2O
Initiate high-flow nasal cannula at 1 L/kg/min
Intubation and administration of exogenous surfactant (Correct answer)
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 30: PEEP (positive end-expiratory pressure) is used primarily to:

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

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

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

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

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

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 33: The primary treatment for neonatal RDS is:

Inhaled nitric oxide
Exogenous surfactant replacement therapy (Correct answer)
High-frequency oscillatory ventilation immediately
Systemic corticosteroids after birth

Correct answer: Exogenous surfactant replacement therapy

Exogenous surfactant administered intratracheally stabilizes alveoli and dramatically improves oxygenation and survival in neonates with RDS.

Question 34: Which sign indicates that a tracheostomy tube cuff is overinflated?

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

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 35: Which parameter is used to calculate static compliance on a mechanically ventilated patient?

Tidal volume divided by peak inspiratory flow
Mean airway pressure divided by respiratory rate
Plateau pressure minus PEEP divided by tidal volume (Correct answer)
Peak pressure minus PEEP divided by tidal volume

Correct answer: Plateau pressure minus PEEP divided by tidal volume

Static compliance = Tidal Volume / (Plateau Pressure – PEEP), reflecting the compliance of the respiratory system without the influence of airway resistance.

Question 36: Which sedative agent used in mechanically ventilated patients also provides bronchodilation and is considered a good choice for patients with bronchospasm?

Propofol
Midazolam
Fentanyl
Ketamine (Correct answer)

Correct answer: Ketamine

Ketamine is a dissociative anesthetic with sympathomimetic properties that causes bronchodilation, making it particularly useful for sedation or induction in patients with severe bronchospasm.

Question 37: The NBRC defines 'credential lapse' as occurring when:

A credential holder voluntarily surrenders the credential
A credential holder is found to have cheated on an examination
A credential holder moves to a state that does not require licensure
A credential holder fails to complete Continuing Competency requirements by the expiration date (Correct answer)

Correct answer: A credential holder fails to complete Continuing Competency requirements by the expiration date

Credential lapse is the automatic loss of credential status that occurs when the 5-year Continuing Competency deadline passes without fulfillment.

Question 38: Acceptable spirometry requires that the technician ensure the patient performs a maneuver that is:

Performed seated or standing only
Of any duration as long as effort is present
Repeatable within 150 mL for the two best FVC and FEV1 values (Correct answer)
Completed in under 3 seconds

Correct answer: Repeatable within 150 mL for the two best FVC and FEV1 values

ATS/ERS acceptability criteria require reproducibility of the best two FVC and FEV1 values within 150 mL to ensure test reliability.

Question 39: Right mainstem bronchus intubation is most commonly detected by:

Lower peak airway pressures
Decreased ETCO2 readings
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 40: 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
Place a line through the error, initial it, and write in the correct information (Correct answer)
Have your supervisor chart the correct information
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 41: Oral suctioning with a Yankauer catheter should be limited to:

10–15 second intervals (Correct answer)
30-second intervals
5-minute intervals
15-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 42: An FEV1/FVC ratio below 70% (or below the lower limit of normal) indicates:

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

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

3–4 mL/kg ideal body weight
15 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 44: Respiratory muscle strength is assessed by measuring:

FEV1 and FVC only
Maximum inspiratory pressure (MIP/PImax) and maximum expiratory pressure (MEP/PEmax) (Correct answer)
Oxygen saturation at peak exercise
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 45: Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic agent?

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

Correct answer: Risk for injury

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

Question 46: 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
Contact the NBRC directly to resolve the credential status issue before reapplying (Correct answer)
Wait one year before reapplying without contacting NBRC
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 47: 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 48: The normal arterial pH range is:

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

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 49: 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
Administering inhaled bronchodilators
Scoring polysomnography respiratory events using AASM criteria (Correct answer)
Managing a patient on mechanical ventilation

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

Succinylcholine (Correct answer)
Rocuronium
Pancuronium
Vecuronium

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 51: Which of the following sleep disorders is the most prevalent?

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

Correct answer: Insomnia.

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

Question 52: 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
Ensure that the meal is healthy & the room is quite for good sleep (Correct answer)
All of the above

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 53: 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 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)
Do you know who the governor is?

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

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

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

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
To provide answer keys for practice examinations

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 56: Which condition in premature infants results from surfactant deficiency?

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

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

Melatonin (Correct answer)
Methylphenidate
Amphetamine
Pemoline

Correct answer: Melatonin

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

Question 58: The NBRC Therapist Multiple-Choice (TMC) examination is a prerequisite for which credential pathway?

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

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

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

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 60: The target PaCO2 during CPR for an adult patient is:

20–25 mmHg
30–35 mmHg
35–45 mmHg (Correct answer)
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 61: Apnea of prematurity is defined as cessation of breathing for more than:

60 seconds only
30 seconds regardless of other signs
5 seconds with bradycardia
10 seconds or 20 seconds with associated bradycardia or desaturation (Correct answer)

Correct answer: 10 seconds or 20 seconds with associated bradycardia or desaturation

Apnea of prematurity is defined as breathing cessation ≥20 seconds, or a shorter pause accompanied by bradycardia (<100 bpm) or oxygen desaturation.

Question 62: A patient has a V/Q ratio of zero. This indicates:

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

Correct answer: Intrapulmonary shunt

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

Question 63: 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:

Heart attack
Bacterial pneumonia (Correct answer)
Pneumothorax
Viral pneumonia

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 64: Heat and moisture exchangers (HMEs) used in ventilator circuits function by:

Filtering only bacterial contaminants
Actively heating inspired air with an electric heating element
Capturing heat and moisture from exhaled air and returning it to the next breath (Correct answer)
Infusing sterile water directly into the circuit

Correct answer: Capturing heat and moisture from exhaled air and returning it to the next breath

HMEs are passive 'artificial noses' that trap heat and moisture from exhaled gas and release it to warm and humidify the next inhaled breath.

Question 65: Epiglottitis in children presents with the classic triad of:

Drooling, dysphagia, and high fever with muffled voice (Correct answer)
Wheezing, retractions, and tachypnea
Cyanosis, apnea, and bradycardia
Barky cough, hoarseness, stridor

Correct answer: Drooling, dysphagia, and high fever with muffled voice

Epiglottitis classically presents with drooling, dysphagia, and a toxic-appearing child with a high fever and muffled (hot potato) voice due to supraglottic inflammation.

Question 66: What is the therapeutic serum level range for theophylline in adults?

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

Question 67: Inverse ratio ventilation (IRV) is characterized by:

Patient-triggered breaths only
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)

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 68: Which bronchodilator class acts primarily on beta-2 adrenergic receptors to cause bronchodilation?

Short-acting beta-2 agonists (Correct answer)
Leukotriene modifiers
Methylxanthines
Short-acting muscarinic antagonists

Correct answer: Short-acting beta-2 agonists

Short-acting beta-2 agonists (SABAs) such as albuterol selectively stimulate beta-2 adrenergic receptors in airway smooth muscle, causing relaxation and bronchodilation.

Question 69: Which chemoreceptors respond most rapidly to changes in PaCO2?

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

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 70: 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 71: A candidate who fails the RRT-ACCS examination on the first attempt may retest after:

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

Correct answer: 90 days

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

Question 72: Which PFT finding is most consistent with pulmonary fibrosis?

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

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

HFOV is a neonatal and pediatric rescue ventilation mode covered extensively on the NPS exam (Correct answer)
HFOV is covered only on the ACCS examination
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 74: 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?

Tidal volumes of 10-12 mL/kg IBW to ensure adequate minute ventilation
High respiratory rates with tidal volumes of 4 mL/kg IBW
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 75: Pediatric tidal volumes for mechanical ventilation are typically set at:

10–12 mL/kg IBW
3–4 mL/kg IBW
5–7 mL/kg IBW (Correct answer)
15 mL/kg IBW

Correct answer: 5–7 mL/kg IBW

Lung-protective pediatric ventilation targets tidal volumes of 5–7 mL/kg IBW, similar to adult ARDSNet principles but accounting for smaller lung units.

Question 76: 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?

Only the CRT credential is required to maintain NPS
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)

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

Wis-Hipple blade
Miller (straight) blade
Wisconsin 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 78: Surfactant is produced by which cell type?

Type II pneumocytes (Correct answer)
Type I pneumocytes
Goblet cells
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 79: Normal SpO2 targets for premature neonates receiving supplemental oxygen to reduce retinopathy of prematurity (ROP) risk are:

96–99%
100%
85–89%
91–95% (Correct answer)

Correct answer: 91–95%

Current guidelines recommend targeting SpO2 of 91–95% in premature neonates to balance ROP risk (excess oxygen) against necrotizing enterocolitis and mortality risk (insufficient oxygen).

Question 80: A respiratory therapist administers a metered-dose inhaler with a spacer device. What is the primary advantage of using a spacer?

Decreases the dose required per actuation
Increases medication concentration
Eliminates the need for patient coordination
Reduces oropharyngeal deposition and improves lung delivery (Correct answer)

Correct answer: Reduces oropharyngeal deposition and improves lung delivery

A spacer (valved holding chamber) slows aerosol velocity and allows large particles to settle out before inhalation, significantly reducing oropharyngeal deposition and improving lower airway drug delivery.

Question 81: 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)
Keeping the room of the baby super cool
By placing the baby on his/her stomach

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 82: A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?

Flumazenil (Romazicon)
Ipecac syrup
Activated charcoal (Correct answer)
Naloxone HCl (Narcan

Correct answer: Activated charcoal

There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the GI tract. preventing absorption.

Question 83: 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:

440
44
97
69 (Correct answer)

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 84: An RT is applying for the RRT-NPS credential. Which patient care setting is most directly relevant to this specialty?

Adult medical ICU
Neonatal intensive care unit (NICU) (Correct answer)
Cardiac catheterization lab
Outpatient pulmonary rehabilitation

Correct answer: Neonatal intensive care unit (NICU)

The NPS credential focuses on neonatal and pediatric care, with the NICU being the most directly relevant practice setting.

Question 85: On the CPFT examination, which of the following measurement techniques would a candidate most need to understand?

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

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 86: An RT who earned only the CRT credential wants to obtain the RRT-NPS. What must they do first?

Complete 2 years of NICU experience to waive the RRT requirement
Petition the NBRC for a credential equivalency review
Earn the RRT credential before applying for any specialty credential (Correct answer)
Apply directly for the NPS examination regardless of CRT status

Correct answer: Earn the RRT credential before applying for any specialty credential

All NBRC specialty credentials (NPS, ACCS, SDS) require an active RRT as a prerequisite; the CRT alone is insufficient.

Question 87: The Mallampati classification is used to predict:

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

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 88: Cricothyrotomy provides emergency surgical airway access through the:

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

Correct answer: Cricothyroid membrane

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

Question 89: Endotracheal tube cuff pressure should be maintained at:

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

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 90: Oxygen is primarily transported in the blood by:

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

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

Respiratory rate >20 breaths/min or PaCO2 <32 mmHg
Heart rate >90 bpm
Temperature >38°C or <36°C
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 92: Video laryngoscopy compared to direct laryngoscopy typically provides:

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

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 93: Which inhaled corticosteroid is most commonly used as maintenance therapy for persistent asthma?

Methylprednisolone
Hydrocortisone
Fluticasone (Correct answer)
Prednisone

Correct answer: Fluticasone

Fluticasone (and other inhaled corticosteroids like budesonide and beclomethasone) is used as daily maintenance therapy for persistent asthma to reduce airway inflammation.

Question 94: Respiratory syncytial virus (RSV) most commonly causes which lower respiratory illness in infants?

Bronchiolitis (Correct answer)
Lobar pneumonia
Empyema
Lung abscess

Correct answer: Bronchiolitis

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

Question 95: Which ventilator mode delivers a set tidal volume regardless of airway resistance or compliance changes?

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

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

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

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

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

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

Right shift, decreasing oxygen affinity (Correct answer)
No change in the curve
Left shift, increasing oxygen affinity
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 99: The primary treatment for mild-to-moderate RSV bronchiolitis in infants is:

Systemic corticosteroids
Nebulized albuterol scheduled every 4 hours
Supportive care: hydration, nasal suctioning, supplemental O2 as needed (Correct answer)
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 100: Which of the following causes a high anion gap metabolic acidosis?

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

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

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

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 102: During methacholine challenge testing, a positive result (PC20) is defined as a ≥20% fall in FEV1 at a concentration of methacholine at or below:

16 mg/mL
4 mg/mL
8 mg/mL (Correct answer)
0.5 mg/mL

Correct answer: 8 mg/mL

A PC20 ≤8 mg/mL is the traditional threshold for a positive methacholine challenge, indicating airway hyperresponsiveness consistent with asthma.

Question 103: Nasopharyngeal airways are contraindicated in patients with:

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

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 104: Hypoxic pulmonary vasoconstriction (HPV) serves to:

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

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

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

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

Residual volume (Correct answer)
Expiratory reserve volume
Inspiratory reserve volume
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 107: What is the primary mechanism of action of ipratropium bromide?

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

Correct answer: Muscarinic receptor blockade

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

Question 108: In listening to a patient's lungs, you notice bronchial breath sounds in her right lower lobe. These would indicate which of the following?

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

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

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

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 110: What is the Bohr effect?

Increased CO2 shifts the oxyhemoglobin curve right (Correct answer)
Increased CO2 shifts the oxyhemoglobin curve left
Increased pH shifts the curve right
Decreased temperature 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 111: Which of the following best describes the Continuing Competency pathway for NBRC credential holders?

Credential holders must complete 100 clinical hours each year
Continuing competency is only required for specialty credentials, not the RRT
Credential holders must accumulate CEUs or pass a recertification examination within each 5-year cycle (Correct answer)
Credential holders must retake the full original examination every 5 years

Correct answer: Credential holders must accumulate CEUs or pass a recertification examination within each 5-year cycle

The NBRC Continuing Competency program allows RTs to maintain credentials through CEU accumulation or by passing a recertification exam within a 5-year window.

Question 112: 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?

Right-sided atelectasis (Correct answer)
Right-sided pneumothorax
Left-sided pneumothorax
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 113: Which alarm condition most urgently requires immediate assessment and intervention?

High pressure alarm that self-resolves
Apnea alarm with absent patient effort (Correct answer)
Low PEEP alarm during a cough
Low exhaled minute volume alarm

Correct answer: Apnea alarm with absent patient effort

An apnea alarm with absent patient effort indicates the patient is not breathing, requiring immediate assessment and intervention to prevent hypoxia.

Question 114: Spirometry is primarily used to detect and quantify:

Pulmonary vascular resistance
Gas transfer abnormalities
Lung perfusion abnormalities
Obstructive and restrictive ventilatory defects (Correct answer)

Correct answer: Obstructive and restrictive ventilatory defects

Spirometry measures airflow and lung volumes, allowing classification of ventilatory defects as obstructive, restrictive, or mixed.

Question 115: Which of the following best describes the primary function of the alveoli?

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

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

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

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

Decelerating flow waveform
Square (constant) flow waveform (Correct answer)
Sinusoidal flow waveform
Ascending ramp 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 118: 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:

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

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 119: Racemic epinephrine nebulization is used in croup primarily to:

Cause mucosal vasoconstriction and reduce subglottic edema (Correct answer)
Treat the underlying viral infection
Increase respiratory rate
Improve alveolar ventilation

Correct answer: Cause mucosal vasoconstriction and reduce subglottic edema

Racemic epinephrine stimulates alpha-adrenergic receptors in the subglottic mucosa, causing vasoconstriction and reducing edema to relieve upper airway obstruction in croup.

Question 120: Inhaled nitric oxide (iNO) in neonates is used to treat:

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

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

Alveolar gas equation (Correct answer)
Fick equation
Laplace equation
Henderson-Hasselbalch 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 122: Which NBRC credential is specifically designed for respiratory therapists who demonstrate advanced competency in neonatal and pediatric care?

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

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 123: The Silverman-Andersen scoring system in neonates evaluates:

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

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 124: Montelukast (Singulair) belongs to which drug class used in asthma management?

Mast cell stabilizer
Leukotriene receptor antagonist (Correct answer)
Inhaled corticosteroid
Long-acting beta-2 agonist

Correct answer: Leukotriene receptor antagonist

Montelukast is a leukotriene receptor antagonist that blocks the action of cysteinyl leukotrienes, reducing airway inflammation, bronchoconstriction, and mucus secretion in asthma.

Question 125: Which medication is a depolarizing neuromuscular blocking agent used in RSI?

Vecuronium
Succinylcholine (Correct answer)
Atracurium
Rocuronium

Correct answer: Succinylcholine

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

Question 126: Which muscle is the primary muscle of inspiration?

Diaphragm (Correct answer)
Scalenes
Sternocleidomastoid
Internal intercostals

Correct answer: Diaphragm

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

Question 127: The maximum voluntary ventilation (MVV) test measures:

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

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 128: The flow-volume loop in a patient with a fixed upper airway obstruction shows:

Flattening of the inspiratory limb only
Flattening of both the inspiratory and expiratory limbs (Correct answer)
Flattening of the expiratory limb only
Normal inspiratory and expiratory curves

Correct answer: Flattening of both the inspiratory and expiratory limbs

Fixed upper airway obstructions (such as tracheal stenosis) truncate both inspiratory and expiratory flows equally, producing a flattened box-like loop.

Question 129: The peak expiratory flow (PEF) is most effort-dependent and primarily reflects:

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

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 130: A patient's peak airway pressure suddenly increases with no change in plateau pressure. This suggests:

Pulmonary edema
Worsening lung compliance
Increased airway resistance (e.g., bronchospasm, secretions) (Correct answer)
Pneumothorax

Correct answer: Increased airway resistance (e.g., bronchospasm, secretions)

A rise in peak pressure with unchanged plateau pressure indicates increased airway resistance because resistance affects dynamic (peak) but not static (plateau) pressure.

Question 131: 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
RRT-ACCS examination (Correct answer)
CPFT examination
NPS examination only

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 132: In restrictive lung disease, spirometry typically shows:

Proportionally reduced FEV1 and FVC with a normal or elevated FEV1/FVC ratio (Correct answer)
Increased total lung capacity
Elevated residual volume
Reduced FEV1/FVC ratio with preserved FVC

Correct answer: Proportionally reduced FEV1 and FVC with a normal or elevated FEV1/FVC ratio

Restriction reduces overall lung volumes including FVC, but because both FEV1 and FVC decrease proportionally, the FEV1/FVC ratio is preserved or elevated.

Question 133: The normal mixed venous oxygen saturation (SvO2) is approximately:

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

Correct answer: 60–75%

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

Question 134: Dornase alfa (Pulmozyme) is primarily indicated for which condition?

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

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

Neuromuscular weakness
Obesity
Asthma
Emphysema (Correct answer)

Correct answer: Emphysema

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

Question 136: 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 137: Which lung zone, according to the West zones model, has the greatest blood flow?

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

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

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

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 139: 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)
Funnel chest/pectus excavatum
Lordosis
Pulmonary emphysema with air trapping

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

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

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

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

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

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

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 143: Which of the following best describes anatomical dead space?

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

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

Pulse rate slowed by 5 to 10 beats/minute.
Highly active brain and physiological activity levels. (Correct answer)
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 145: Which complication is specific to tracheostomy and not typically seen with endotracheal intubation?

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

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

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

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

Albuterol
Metaproterenol
Salmeterol (Correct answer)
Levalbuterol

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 148: 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:

Tension pneumothorax (Correct answer)
Mucus plug causing atelectasis
Right mainstem intubation
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 149: You are called to start a new aerosolized medication treatment. After reading the physician's order, you notice that the drug dosage is outside the normal department guidelines. You should do which of the following?

Give the treatment as ordered
Give the treatment as ordered, and leave a note in the chart asking for clarification for the next treatment
Contact the physician to confirm that the order is indeed correct (Correct answer)
Have the nurse rewrite the order

Correct answer: Contact the physician to confirm that the order is indeed correct

Given the scenario where the drug dosage is outside the normal department guidelines, it is important to ensure patient safety. Contacting the physician to confirm the order is the appropriate course of action as it allows for clarification and verification of the dosage. This step helps to prevent any potential harm to the patient and ensures that the medication is administered correctly.

Question 150: 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

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

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 151: Prone positioning in ARDS improves oxygenation primarily by:

Reducing lung compliance
Increasing FiO2 delivery
Decreasing cardiac output
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 152: A patient has ABG values: pH 7.28, PaCO2 55 mmHg, HCO3 24 mEq/L. This represents:

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

Correct answer: Respiratory acidosis (uncompensated)

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

Question 153: Bronchopulmonary dysplasia (BPD) is defined as oxygen dependency at:

7 days of life
6 months of corrected age
3 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 154: The spontaneous breathing trial (SBT) is used to assess:

Patient readiness for extubation (Correct answer)
Cardiac output during ventilation
Response to bronchodilator therapy
Optimal PEEP settings

Correct answer: Patient readiness for extubation

An SBT evaluates whether a patient can sustain adequate ventilation and oxygenation without mechanical ventilator support before extubation is attempted.

Question 155: Auto-PEEP (intrinsic PEEP) occurs when:

Set PEEP exceeds 10 cmH2O
Insufficient expiratory time prevents full exhalation before the next breath (Correct answer)
Tidal volume is set below 6 mL/kg IBW
Inspiratory time is too short

Correct answer: Insufficient expiratory time prevents full exhalation before the next breath

Auto-PEEP develops when air trapping occurs because the next breath is delivered before the previous breath is fully exhaled, leading to gas stacking.

Question 156: Rapid sequence intubation (RSI) uses a sedative agent followed immediately by a neuromuscular blocking agent to:

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

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 157: Croup (laryngotracheobronchitis) is most commonly caused by:

Respiratory syncytial virus (RSV)
Streptococcus pneumoniae
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 158: High-frequency oscillatory ventilation (HFOV) uses:

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

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 159: Permissive hypercapnia in ARDS management allows PaCO2 to rise to reduce:

FiO2 requirements
Barotrauma and volutrauma from aggressive ventilation (Correct answer)
Sedation requirements
Cardiac afterload

Correct answer: Barotrauma and volutrauma from aggressive ventilation

Permissive hypercapnia accepts elevated PaCO2 to enable lower tidal volumes and pressures, minimizing ventilator-induced lung injury.

Question 160: 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)
Can be managed without ICU nursing
Provides faster toxin clearance
Does not require anticoagulation

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.

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.

Questions

35 min

Time Limit

70%

To Pass

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