RRT (REGISTERED RESPIRATORY
THERAPIST) ADVANCED-LEVEL CONTENT
OF THE NBRC RRT EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
LATEST EXAM
1. A patient on mechanical ventilation has sudden onset of hypotension, tachycardia,
elevated peak pressures, and absent breath sounds on the left. What is the most appropriate
immediate action?
A. Stat chest x-ray
B. Needle decompression of the left chest
C. Increase IV fluids
D. Administer bronchodilators
Answer: B
*Rationale: Sudden hypotension, tachycardia, elevated airway pressures, and unilateral absent
breath sounds in a ventilated patient suggest tension pneumothorax until proven otherwise.
Positive pressure ventilation can rapidly convert a simple pneumothorax to tension physiology
with hemodynamic compromise. Needle decompression at the 2nd intercostal space,
midclavicular line is the life-saving intervention before chest x-ray .*
,2. A patient with COPD has an SpO₂ of 91% on 2 L/min nasal cannula. ABG shows pH
7.38, PaCO₂ 58 mmHg, PaO₂ 62 mmHg, HCO₃ 34 mEq/L. What is the most appropriate
recommendation?
A. Increase O₂ to 3 L/min
B. Maintain current O₂ therapy
C. Decrease O₂ to 1 L/min
D. Initiate noninvasive ventilation
Answer: B
*Rationale: This patient has chronic compensated respiratory acidosis (elevated PaCO₂ with
normal pH and elevated HCO₃). PaO₂ of 62 mmHg (SpO₂ ~91%) is within the acceptable target
range for COPD patients (88-92%). Increasing oxygen could suppress hypoxic drive and worsen
hypercapnia. Decreasing oxygen could cause dangerous hypoxemia. NIV is not indicated with
stable pH and acceptable oxygenation .*
3. A patient with massive hemoptysis is coughing up approximately 400 mL of blood in 24
hours. What is the most appropriate intervention?
A. Continue monitoring
B. Protect the airway with intubation
C. Administer nebulized racemic epinephrine
D. Schedule bronchoscopy for next day
Answer: B
,*Rationale: Massive hemoptysis (>200-600 mL/24 hours) is life-threatening due to risk of
asphyxiation and hemodynamic compromise. Airway protection via intubation is the priority.
The affected lung should be positioned down if possible to prevent spillage into the unaffected
lung. Bronchoscopy may be needed but only after airway secured .*
4. A patient receiving pressure control ventilation has an exhaled tidal volume of 350 mL.
Set parameters: IPAP 18 cm H₂O, PEEP 8 cm H₂O, rate 16/min. What is the driving
pressure?
A. 8 cm H₂O
B. 10 cm H₂O
C. 18 cm H₂O
D. 26 cm H₂O
Answer: B
*Rationale: Driving pressure (ΔP) = Plateau pressure - PEEP. In pressure control ventilation,
plateau pressure equals set IPAP (assuming adequate inspiratory time). ΔP = 18 - 8 = 10 cm H₂O.
Driving pressure is a key ventilator parameter associated with lung injury; values >15 cm H₂O
are associated with increased mortality in ARDS .*
5. A patient has a PaO₂ of 55 mmHg on FiO₂ 0.90. What is the PaO₂/FiO₂ (P/F) ratio?
A. 50
B. *61*
C. 72
D. 85
, Answer: B
*Rationale: P/F ratio = PaO₂ ÷ FiO₂ (expressed as decimal). 55 ÷ 0.90 = 61.1. A P/F ratio <100
indicates severe ARDS. This patient meets criteria for severe ARDS per Berlin definition (P/F
≤100 with PEEP ≥5 cm H₂O) .*
6. During an apnea test for brain death determination, the patient's PaCO₂ rises from 40 to
65 mmHg after 10 minutes without ventilatory support. What does this indicate?
A. Absence of respiratory drive, consistent with brain death
B. Inadequate test duration
C. Preserved brainstem function
D. Technical error
Answer: A
Rationale: The apnea test for brain death requires that PaCO₂ rises to ≥60 mmHg (or 20 mmHg
above baseline) without any spontaneous respiratory effort. A rise from 40 to 65 mmHg without
ventilatory support and with no respiratory effort indicates absence of brainstem respiratory
center function, supporting the diagnosis of brain death .
7. A patient with asthma has a peak flow of 120 L/min (predicted normal 400 L/min) 20
minutes after bronchodilator therapy. What classification of severity does this represent?
A. Mild
B. Moderate
C. Severe
THERAPIST) ADVANCED-LEVEL CONTENT
OF THE NBRC RRT EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
LATEST EXAM
1. A patient on mechanical ventilation has sudden onset of hypotension, tachycardia,
elevated peak pressures, and absent breath sounds on the left. What is the most appropriate
immediate action?
A. Stat chest x-ray
B. Needle decompression of the left chest
C. Increase IV fluids
D. Administer bronchodilators
Answer: B
*Rationale: Sudden hypotension, tachycardia, elevated airway pressures, and unilateral absent
breath sounds in a ventilated patient suggest tension pneumothorax until proven otherwise.
Positive pressure ventilation can rapidly convert a simple pneumothorax to tension physiology
with hemodynamic compromise. Needle decompression at the 2nd intercostal space,
midclavicular line is the life-saving intervention before chest x-ray .*
,2. A patient with COPD has an SpO₂ of 91% on 2 L/min nasal cannula. ABG shows pH
7.38, PaCO₂ 58 mmHg, PaO₂ 62 mmHg, HCO₃ 34 mEq/L. What is the most appropriate
recommendation?
A. Increase O₂ to 3 L/min
B. Maintain current O₂ therapy
C. Decrease O₂ to 1 L/min
D. Initiate noninvasive ventilation
Answer: B
*Rationale: This patient has chronic compensated respiratory acidosis (elevated PaCO₂ with
normal pH and elevated HCO₃). PaO₂ of 62 mmHg (SpO₂ ~91%) is within the acceptable target
range for COPD patients (88-92%). Increasing oxygen could suppress hypoxic drive and worsen
hypercapnia. Decreasing oxygen could cause dangerous hypoxemia. NIV is not indicated with
stable pH and acceptable oxygenation .*
3. A patient with massive hemoptysis is coughing up approximately 400 mL of blood in 24
hours. What is the most appropriate intervention?
A. Continue monitoring
B. Protect the airway with intubation
C. Administer nebulized racemic epinephrine
D. Schedule bronchoscopy for next day
Answer: B
,*Rationale: Massive hemoptysis (>200-600 mL/24 hours) is life-threatening due to risk of
asphyxiation and hemodynamic compromise. Airway protection via intubation is the priority.
The affected lung should be positioned down if possible to prevent spillage into the unaffected
lung. Bronchoscopy may be needed but only after airway secured .*
4. A patient receiving pressure control ventilation has an exhaled tidal volume of 350 mL.
Set parameters: IPAP 18 cm H₂O, PEEP 8 cm H₂O, rate 16/min. What is the driving
pressure?
A. 8 cm H₂O
B. 10 cm H₂O
C. 18 cm H₂O
D. 26 cm H₂O
Answer: B
*Rationale: Driving pressure (ΔP) = Plateau pressure - PEEP. In pressure control ventilation,
plateau pressure equals set IPAP (assuming adequate inspiratory time). ΔP = 18 - 8 = 10 cm H₂O.
Driving pressure is a key ventilator parameter associated with lung injury; values >15 cm H₂O
are associated with increased mortality in ARDS .*
5. A patient has a PaO₂ of 55 mmHg on FiO₂ 0.90. What is the PaO₂/FiO₂ (P/F) ratio?
A. 50
B. *61*
C. 72
D. 85
, Answer: B
*Rationale: P/F ratio = PaO₂ ÷ FiO₂ (expressed as decimal). 55 ÷ 0.90 = 61.1. A P/F ratio <100
indicates severe ARDS. This patient meets criteria for severe ARDS per Berlin definition (P/F
≤100 with PEEP ≥5 cm H₂O) .*
6. During an apnea test for brain death determination, the patient's PaCO₂ rises from 40 to
65 mmHg after 10 minutes without ventilatory support. What does this indicate?
A. Absence of respiratory drive, consistent with brain death
B. Inadequate test duration
C. Preserved brainstem function
D. Technical error
Answer: A
Rationale: The apnea test for brain death requires that PaCO₂ rises to ≥60 mmHg (or 20 mmHg
above baseline) without any spontaneous respiratory effort. A rise from 40 to 65 mmHg without
ventilatory support and with no respiratory effort indicates absence of brainstem respiratory
center function, supporting the diagnosis of brain death .
7. A patient with asthma has a peak flow of 120 L/min (predicted normal 400 L/min) 20
minutes after bronchodilator therapy. What classification of severity does this represent?
A. Mild
B. Moderate
C. Severe
