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NBRC RRT EXAM TEST BANK 2026/2027 – REGISTERED
RESPIRATORY THERAPIST ADVANCED-LEVEL QUESTIONS AND
REVIEW GUIDE,100% CORRECT ALREADY GRADED A+
Question 1
A 58-year-old patient with COPD is receiving oxygen via nasal cannula at 2 L/min.
ABG: pH 7.32, PaCO₂ 60 mmHg, PaO₂ 54 mmHg, HCO₃⁻ 29 mEq/L. Which
adjustment is most appropriate?
A. Increase FiO₂ to 60%
B. Discontinue oxygen immediately
C. Increase flow to 3–4 L/min and monitor closely
D. Begin CPAP at 12 cmH₂O
Rationale: Hypoxemia must be corrected, but cautiously in COPD patients. A
modest oxygen increase is safest.
Question 2
A mechanically ventilated patient suddenly shows high-pressure alarms. Breath
sounds are absent on the left, SpO₂ drops to 80%, and BP decreases. Which is the
priority?
A. Check cuff pressure
B. Insert needle into left chest
C. Call respiratory therapy supervisor
D. Perform suctioning
Rationale: This is a tension pneumothorax; immediate decompression is required.
Question 3
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Which parameter best assesses oxygenation in mechanically ventilated patients?
A. Tidal volume
B. Respiratory rate
C. PaO₂/FiO₂ ratio
D. Peak inspiratory pressure
Rationale: PaO₂/FiO₂ ratio determines severity of oxygenation impairment,
critical in ARDS evaluation.
Question 4
A patient with ARDS is placed on mechanical ventilation. Which strategy improves
oxygenation while limiting lung injury?
A. High tidal volume, low PEEP
B. Low respiratory rate, high FiO₂
C. Low tidal volume, high PEEP
D. High tidal volume, high respiratory rate
Rationale: Lung-protective strategy = low tidal volumes (6 mL/kg IBW) and
higher PEEP to prevent alveolar collapse.
Question 5
What is the primary indication for initiating ECMO in a patient with severe
respiratory failure?
A. Severe asthma exacerbation
B. Refractory hypoxemia despite maximal conventional therapy
C. Mild ARDS responsive to FiO₂ 40%
D. Obstructive sleep apnea
Rationale: ECMO is reserved for severe, refractory hypoxemia unresponsive to
optimal ventilator management.
Question 6
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Which diagnostic finding confirms ventilator-associated pneumonia (VAP)?
A. Fever and leukocytosis
B. Purulent secretions
C. Positive culture from bronchoalveolar lavage
D. Chest X-ray with infiltrates
Rationale: BAL culture provides definitive diagnosis of VAP.
Question 7
During bronchoscopy, the patient develops hypoxemia. What should the
respiratory therapist do first?
A. Suction secretions
B. Remove bronchoscope immediately
C. Increase FiO₂ and pause procedure
D. Administer epinephrine
Rationale: Increasing FiO₂ and pausing prevents worsening hypoxemia while
maintaining safety.
Question 8
Which pulmonary function test result is consistent with restrictive lung disease?
A. FEV₁/FVC < 70%
B. Decreased TLC with normal/high FEV₁/FVC ratio
C. Increased RV, decreased FEV₁
D. Normal TLC, low DLCO
Rationale: Restriction = low TLC but preserved FEV₁/FVC.
Question 9
Which condition requires the use of a cuffed tracheostomy tube?
A. Patient with vocal cord paralysis requiring speech therapy
B. Patient requiring positive pressure ventilation
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C. Patient with stable airway, breathing spontaneously
D. Pediatric patient under age 8
Rationale: Cuffed tubes are used when PPV is needed to prevent leaks.
Question 10
Which drug is the best choice for acute severe bronchospasm?
A. Montelukast
B. Albuterol
C. Theophylline
D. Cromolyn sodium
Rationale: Short-acting β₂-agonist (SABA) is first-line rescue therapy.
Question 11
A patient on volume-control ventilation develops auto-PEEP. Which intervention is
most appropriate?
A. Increase tidal volume
B. Decrease inspiratory flow
C. Increase expiratory time
D. Add PEEP equal to auto-PEEP
Rationale: Auto-PEEP is reduced by prolonging expiratory time (e.g., lowering
RR, shortening I-time).
Question 12
Which condition shows “honeycomb” pattern on HRCT?
A. COPD
B. Asthma
C. Pulmonary fibrosis
D. Pneumonia
Rationale: Honeycombing = interstitial lung disease/fibrosis.
NBRC RRT EXAM TEST BANK 2026/2027 – REGISTERED
RESPIRATORY THERAPIST ADVANCED-LEVEL QUESTIONS AND
REVIEW GUIDE,100% CORRECT ALREADY GRADED A+
Question 1
A 58-year-old patient with COPD is receiving oxygen via nasal cannula at 2 L/min.
ABG: pH 7.32, PaCO₂ 60 mmHg, PaO₂ 54 mmHg, HCO₃⁻ 29 mEq/L. Which
adjustment is most appropriate?
A. Increase FiO₂ to 60%
B. Discontinue oxygen immediately
C. Increase flow to 3–4 L/min and monitor closely
D. Begin CPAP at 12 cmH₂O
Rationale: Hypoxemia must be corrected, but cautiously in COPD patients. A
modest oxygen increase is safest.
Question 2
A mechanically ventilated patient suddenly shows high-pressure alarms. Breath
sounds are absent on the left, SpO₂ drops to 80%, and BP decreases. Which is the
priority?
A. Check cuff pressure
B. Insert needle into left chest
C. Call respiratory therapy supervisor
D. Perform suctioning
Rationale: This is a tension pneumothorax; immediate decompression is required.
Question 3
,2 | Page
Which parameter best assesses oxygenation in mechanically ventilated patients?
A. Tidal volume
B. Respiratory rate
C. PaO₂/FiO₂ ratio
D. Peak inspiratory pressure
Rationale: PaO₂/FiO₂ ratio determines severity of oxygenation impairment,
critical in ARDS evaluation.
Question 4
A patient with ARDS is placed on mechanical ventilation. Which strategy improves
oxygenation while limiting lung injury?
A. High tidal volume, low PEEP
B. Low respiratory rate, high FiO₂
C. Low tidal volume, high PEEP
D. High tidal volume, high respiratory rate
Rationale: Lung-protective strategy = low tidal volumes (6 mL/kg IBW) and
higher PEEP to prevent alveolar collapse.
Question 5
What is the primary indication for initiating ECMO in a patient with severe
respiratory failure?
A. Severe asthma exacerbation
B. Refractory hypoxemia despite maximal conventional therapy
C. Mild ARDS responsive to FiO₂ 40%
D. Obstructive sleep apnea
Rationale: ECMO is reserved for severe, refractory hypoxemia unresponsive to
optimal ventilator management.
Question 6
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Which diagnostic finding confirms ventilator-associated pneumonia (VAP)?
A. Fever and leukocytosis
B. Purulent secretions
C. Positive culture from bronchoalveolar lavage
D. Chest X-ray with infiltrates
Rationale: BAL culture provides definitive diagnosis of VAP.
Question 7
During bronchoscopy, the patient develops hypoxemia. What should the
respiratory therapist do first?
A. Suction secretions
B. Remove bronchoscope immediately
C. Increase FiO₂ and pause procedure
D. Administer epinephrine
Rationale: Increasing FiO₂ and pausing prevents worsening hypoxemia while
maintaining safety.
Question 8
Which pulmonary function test result is consistent with restrictive lung disease?
A. FEV₁/FVC < 70%
B. Decreased TLC with normal/high FEV₁/FVC ratio
C. Increased RV, decreased FEV₁
D. Normal TLC, low DLCO
Rationale: Restriction = low TLC but preserved FEV₁/FVC.
Question 9
Which condition requires the use of a cuffed tracheostomy tube?
A. Patient with vocal cord paralysis requiring speech therapy
B. Patient requiring positive pressure ventilation
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C. Patient with stable airway, breathing spontaneously
D. Pediatric patient under age 8
Rationale: Cuffed tubes are used when PPV is needed to prevent leaks.
Question 10
Which drug is the best choice for acute severe bronchospasm?
A. Montelukast
B. Albuterol
C. Theophylline
D. Cromolyn sodium
Rationale: Short-acting β₂-agonist (SABA) is first-line rescue therapy.
Question 11
A patient on volume-control ventilation develops auto-PEEP. Which intervention is
most appropriate?
A. Increase tidal volume
B. Decrease inspiratory flow
C. Increase expiratory time
D. Add PEEP equal to auto-PEEP
Rationale: Auto-PEEP is reduced by prolonging expiratory time (e.g., lowering
RR, shortening I-time).
Question 12
Which condition shows “honeycomb” pattern on HRCT?
A. COPD
B. Asthma
C. Pulmonary fibrosis
D. Pneumonia
Rationale: Honeycombing = interstitial lung disease/fibrosis.
