NBRC RRT Final Exam Study Guide 2026
Complete Questions with Correct
Detailed Answers || 100% Guaranteed
Pass <Recent Version>
Domain 1: Patient Data Evaluation and Recommendations
1. A 55-year-old patient with COPD is admitted with an acute exacerbation. ABG on 2 L/min
via nasal cannula shows: pH 7.28, PaCO2 65 mmHg, PaO2 50 mmHg, HCO3- 32 mEq/L. What is
the correct interpretation?
a) Acute respiratory acidosis without hypoxemia
b) Partially compensated metabolic alkalosis
c) Fully compensated respiratory acidosis
d) Acute respiratory acidosis with hypoxemia
Answer: D
Explanation: The pH is acidotic (<7.35), and the primary disturbance is the elevated PaCO2 (>45
mmHg), indicating respiratory acidosis. The HCO3- is elevated, but the pH has not returned to
normal, indicating a partial compensation, not full. The PaO2 of 50 mmHg indicates significant
hypoxemia. Therefore, this is an acute-on-chronic respiratory acidosis with hypoxemia.
2. A post-operative patient has a sudden onset of dyspnea, tachycardia, and pleuritic chest
pain. SpO2 drops from 98% to 85%. The most likely diagnosis is:
a) Atelectasis
b) Pulmonary embolism
c) Pneumothorax
d) Hospital-acquired pneumonia
Answer: B
Explanation: The classic triad for pulmonary embolism (PE) is dyspnea, pleuritic chest pain, and
hemoptysis (though hemoptysis is not always present). Tachycardia and sudden hypoxemia are
also hallmark signs. While pneumothorax can cause dyspnea and pain, it is less commonly
associated with such profound, sudden hypoxemia without a change in breath sounds.
3. While reviewing a patient's chart, you note a P/F ratio of 180. This is consistent with:
a) Mild ARDS
b) Moderate ARDS
, c) Severe ARDS
d) Normal lung function
Answer: B
Explanation: The P/F ratio is the PaO2 / FiO2. The Berlin Definition for ARDS classifies it as: Mild
(200 < P/F ≤ 300), Moderate (100 < P/F ≤ 200), and Severe (P/F ≤ 100). A P/F ratio of 180 falls
within the moderate ARDS range.
4. A patient with Guillain-Barré syndrome is undergoing serial vital capacity (VC)
measurements. Which VC value is the generally accepted threshold for considering
endotracheal intubation and mechanical ventilation?
a) VC < 20 mL/kg
b) VC < 15 mL/kg
c) VC < 10 mL/kg
d) VC < 5 mL/kg
Answer: B
Explanation: A vital capacity of less than 15 mL/kg (or an absolute value of < 1 L in an adult) is a
key indicator of impending respiratory failure in neuromuscular diseases like Guillain-Barré, as it
reflects a significant reduction in the ability to take a deep breath and cough.
5. The waveform below shows a drop in peak pressure with no change in plateau pressure.
This indicates a problem with:
a) Patient-ventilator asynchrony
b) A leak in the circuit
c) An increase in airway resistance
d) A decrease in lung compliance
Answer: B
Explanation: Peak pressure (Ppeak) is affected by both resistance and compliance. Plateau
pressure (Pplat) is mainly affected by compliance. A drop in Ppeak with a stable Pplat suggests a
problem that occurs only during flow, such as a circuit leak, and not a change in the lung's
properties.
6. What is the primary mechanism of hypoxemia in a patient with a large pulmonary shunt?
a) Hypoventilation
b) Diffusion impairment
c) V/Q mismatch
d) Blood bypassing the alveoli entirely
Answer: D
Explanation: A shunt refers to blood that reaches the arterial system without participating in
gas exchange. This is different from V/Q mismatch, where there is some gas exchange, albeit
Complete Questions with Correct
Detailed Answers || 100% Guaranteed
Pass <Recent Version>
Domain 1: Patient Data Evaluation and Recommendations
1. A 55-year-old patient with COPD is admitted with an acute exacerbation. ABG on 2 L/min
via nasal cannula shows: pH 7.28, PaCO2 65 mmHg, PaO2 50 mmHg, HCO3- 32 mEq/L. What is
the correct interpretation?
a) Acute respiratory acidosis without hypoxemia
b) Partially compensated metabolic alkalosis
c) Fully compensated respiratory acidosis
d) Acute respiratory acidosis with hypoxemia
Answer: D
Explanation: The pH is acidotic (<7.35), and the primary disturbance is the elevated PaCO2 (>45
mmHg), indicating respiratory acidosis. The HCO3- is elevated, but the pH has not returned to
normal, indicating a partial compensation, not full. The PaO2 of 50 mmHg indicates significant
hypoxemia. Therefore, this is an acute-on-chronic respiratory acidosis with hypoxemia.
2. A post-operative patient has a sudden onset of dyspnea, tachycardia, and pleuritic chest
pain. SpO2 drops from 98% to 85%. The most likely diagnosis is:
a) Atelectasis
b) Pulmonary embolism
c) Pneumothorax
d) Hospital-acquired pneumonia
Answer: B
Explanation: The classic triad for pulmonary embolism (PE) is dyspnea, pleuritic chest pain, and
hemoptysis (though hemoptysis is not always present). Tachycardia and sudden hypoxemia are
also hallmark signs. While pneumothorax can cause dyspnea and pain, it is less commonly
associated with such profound, sudden hypoxemia without a change in breath sounds.
3. While reviewing a patient's chart, you note a P/F ratio of 180. This is consistent with:
a) Mild ARDS
b) Moderate ARDS
, c) Severe ARDS
d) Normal lung function
Answer: B
Explanation: The P/F ratio is the PaO2 / FiO2. The Berlin Definition for ARDS classifies it as: Mild
(200 < P/F ≤ 300), Moderate (100 < P/F ≤ 200), and Severe (P/F ≤ 100). A P/F ratio of 180 falls
within the moderate ARDS range.
4. A patient with Guillain-Barré syndrome is undergoing serial vital capacity (VC)
measurements. Which VC value is the generally accepted threshold for considering
endotracheal intubation and mechanical ventilation?
a) VC < 20 mL/kg
b) VC < 15 mL/kg
c) VC < 10 mL/kg
d) VC < 5 mL/kg
Answer: B
Explanation: A vital capacity of less than 15 mL/kg (or an absolute value of < 1 L in an adult) is a
key indicator of impending respiratory failure in neuromuscular diseases like Guillain-Barré, as it
reflects a significant reduction in the ability to take a deep breath and cough.
5. The waveform below shows a drop in peak pressure with no change in plateau pressure.
This indicates a problem with:
a) Patient-ventilator asynchrony
b) A leak in the circuit
c) An increase in airway resistance
d) A decrease in lung compliance
Answer: B
Explanation: Peak pressure (Ppeak) is affected by both resistance and compliance. Plateau
pressure (Pplat) is mainly affected by compliance. A drop in Ppeak with a stable Pplat suggests a
problem that occurs only during flow, such as a circuit leak, and not a change in the lung's
properties.
6. What is the primary mechanism of hypoxemia in a patient with a large pulmonary shunt?
a) Hypoventilation
b) Diffusion impairment
c) V/Q mismatch
d) Blood bypassing the alveoli entirely
Answer: D
Explanation: A shunt refers to blood that reaches the arterial system without participating in
gas exchange. This is different from V/Q mismatch, where there is some gas exchange, albeit
