NBRC Specialty Credentials 5 — Questions and Answers
Question 1: 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:
- Intubation and administration of exogenous surfactant (Correct answer)
- Increase CPAP pressure to 15 cmH2O
- Initiate high-flow nasal cannula at 1 L/kg/min
- 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 2: 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 3: Which of the following clinical competencies is unique to the RRT-SDS examination blueprint and would NOT appear on the ACCS examination?
- Scoring polysomnography respiratory events using AASM criteria (Correct answer)
- Managing a patient on mechanical ventilation
- Interpreting arterial blood gases
- 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 4: 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)
- Obstructive lung disease with air trapping
- Upper airway obstruction
- 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 5: 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 6 mL/kg IBW with plateau pressure <30 cmH2O (Correct answer)
- Tidal volumes of 10-12 mL/kg IBW to ensure adequate minute ventilation
- High respiratory rates with tidal volumes of 4 mL/kg IBW
- 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 6: A candidate for the NBRC specialty examination discovers their application was denied due to an invalid credential. The most appropriate next step is to:
- Contact the NBRC directly to resolve the credential status issue before reapplying (Correct answer)
- Take the examination anyway and appeal the result
- Apply to the state licensing board instead of NBRC
- Wait one year before reapplying without contacting NBRC
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 7: Which of the following best distinguishes the NPS from the ACCS credential in terms of scope?
- NPS covers patients from birth through adolescence while ACCS focuses exclusively on adult critical care patients (Correct answer)
- 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
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.
NBRC Specialty Credentials 5
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: