NBRC TMC / CRT / RRT Exam – Latest
Updated Questions and Correct Verified Answers
| A+ Grade
Question 1
A 54-year-old male (75 kg) with acute asthma is receiving 0.83 mg/kg of methylprednisolone IV q6h.
After 24 h his peak flow has improved only 10 %. Which of the following is the most appropriate
modification to the respiratory care plan?
A. Switch to oral prednisone 40 mg daily
B. Add 20 mg nebulized budesonide BID
C. Increase methylprednisolone to 1.5 mg/kg q6h
D. Discontinue steroid and begin omalizumab
Correct Answer: C
Rationale: Current systemic dose is sub-therapeutic for severe acute asthma (≤1 mg/kg). Guideline-
based ceiling is 1–2 mg/kg q6h; increasing dose is therefore appropriate (C). A is wrong because oral bio-
equivalence is lower and tapering is premature. B is wrong because inhaled steroids add little in the first
48 h of severe exacerbation. D is wrong because omalizumab is for allergic asthma and takes weeks to
work.
Question 2
While performing a pre-round check you note the pressure-time scalar on a VC-CMV ventilator shows a
positive deflection above baseline at end-exhalation. Which of the following best explains this finding?
A. Inadequate inspiratory flow
B. Auto-PEEP
C. Circuit leak
D. Over-distension
Correct Answer: B
Rationale: A positive pressure spike above PEEP at end-expiration indicates air-trapping/auto-PEEP (B). A
would affect the inspiratory limb, not end-expiration. C would cause negative drift. D would be
evidenced by plateau >30 cm H₂O and not by scalar morphology alone.
Question 3
A neonate born at 29 weeks is on nasal CPAP 6 cm H₂O with FiO₂ 0.35. SpO₂ is 88 %, RR 68, and work of
breathing is moderate. Which is the most appropriate next step?
,A. Increase CPAP to 8 cm H₂O
B. Intubate and give surfactant
C. Increase FiO₂ to 0.45
D. Start high-flow nasal cannula at 4 L/min
Correct Answer: A
Rationale: Target SpO₂ for preterm is 90–95 %. First optimize distending pressure (A) before increasing
FiO₂ to limit oxygen toxicity. B is premature—intubation threshold is CPAP failure. C would increase FiO₂
unnecessarily. D delivers unpredictable pressure and would not recruit lung.
Question 4
A post-op CABG patient on 5 cm H₂O PEEP has a PaO₂ of 58 mm Hg on 60 % O₂. The respiratory therapist
should recommend which of the following?
A. Increase PEEP to 10 cm H₂O
B. Increase FiO₂ to 0.80
C. Initiate inhaled nitric oxide at 20 ppm
D. Add 10 cm H₂O pressure support
Correct Answer: A
Rationale: PaO₂ 58 mm Hg on 60 % indicates V/Q mismatch; first-line is PEEP recruitment (A). B risks
oxygen toxicity. C is for documented pulmonary hypertension/refractory hypoxemia. D unloads work,
not oxygenation.
Question 5
An ABG on a 70 kg patient shows pH 7.18, PaCO₂ 85 mm Hg, HCO₃⁻ 31 mEq/L, PaO₂ 55 mm Hg on 28 %
venturi mask. Which ventilator setting should the therapist select for initial volume-controlled
ventilation?
A. Vt 350 mL, RR 24, PEEP 5, FiO₂ 0.40
B. Vt 700 mL, RR 10, PEEP 5, FiO₂ 0.40
C. Vt 500 mL, RR 20, PEEP 5, FiO₂ 1.0
D. Vt 600 mL, RR 12, PEEP 5, FiO₂ 0.28
Correct Answer: A
Rationale: Acute hypercapnic failure needs ↑VE; 350×24≈8.4 L (A) doubles current VE. B lowers VE. C
over-distends and uses 100 % unnecessarily. D maintains near-current VE and inadequate PaO₂.
Question 6
, During a spontaneous breathing trial the rapid-shallow-breathing index is 125 (bpm/L). Which of the
following best explains why extubation would be inappropriate?
A. High risk of post-extubation stridor
B. Work of breathing exceeds reserves
C. Respiratory alkalosis likely
D. Secretion burden is excessive
Correct Answer: B
Rationale: RSBI >105 predicts extubation failure due to imbalance between load and neuromuscular
capacity (B). A requires cuff-leak test. C is opposite—patients usually develop mild acidosis. D is not
reflected by RSBI.
Question 7
A 6-year-old with pneumonia has a chest radiograph showing right lower-lobe opacification and
mediastinal shift to the right. Which of the following is the most likely cause?
A. Atelectasis with volume loss
B. Large pleural effusion
C. Tension pneumothorax
D. Pulmonary embolus
Correct Answer: A
Rationale: Mediastinal shift toward opacification implies volume loss, i.e., atelectasis (A). Effusion or
pneumothorax would shift away. PE rarely causes shift.
Question 8
A patient receiving 10 mcg/kg/min of dobutamine suddenly shows a drop in SvO₂ from 70 % to 55 %
with unchanged SpO₂. Which should be assessed first?
A. Arterial blood pressure
B. Cardiac output
C. Hemoglobin level
D. Temperature
Correct Answer: B
Rationale: SvO₂ reflects O₂ER; acute fall with stable SpO₂ indicates ↓Qt or ↑VO₂; first confirm cardiac
output (B). A is surrogate, not direct. C and D are slower variables.
Question 9
Updated Questions and Correct Verified Answers
| A+ Grade
Question 1
A 54-year-old male (75 kg) with acute asthma is receiving 0.83 mg/kg of methylprednisolone IV q6h.
After 24 h his peak flow has improved only 10 %. Which of the following is the most appropriate
modification to the respiratory care plan?
A. Switch to oral prednisone 40 mg daily
B. Add 20 mg nebulized budesonide BID
C. Increase methylprednisolone to 1.5 mg/kg q6h
D. Discontinue steroid and begin omalizumab
Correct Answer: C
Rationale: Current systemic dose is sub-therapeutic for severe acute asthma (≤1 mg/kg). Guideline-
based ceiling is 1–2 mg/kg q6h; increasing dose is therefore appropriate (C). A is wrong because oral bio-
equivalence is lower and tapering is premature. B is wrong because inhaled steroids add little in the first
48 h of severe exacerbation. D is wrong because omalizumab is for allergic asthma and takes weeks to
work.
Question 2
While performing a pre-round check you note the pressure-time scalar on a VC-CMV ventilator shows a
positive deflection above baseline at end-exhalation. Which of the following best explains this finding?
A. Inadequate inspiratory flow
B. Auto-PEEP
C. Circuit leak
D. Over-distension
Correct Answer: B
Rationale: A positive pressure spike above PEEP at end-expiration indicates air-trapping/auto-PEEP (B). A
would affect the inspiratory limb, not end-expiration. C would cause negative drift. D would be
evidenced by plateau >30 cm H₂O and not by scalar morphology alone.
Question 3
A neonate born at 29 weeks is on nasal CPAP 6 cm H₂O with FiO₂ 0.35. SpO₂ is 88 %, RR 68, and work of
breathing is moderate. Which is the most appropriate next step?
,A. Increase CPAP to 8 cm H₂O
B. Intubate and give surfactant
C. Increase FiO₂ to 0.45
D. Start high-flow nasal cannula at 4 L/min
Correct Answer: A
Rationale: Target SpO₂ for preterm is 90–95 %. First optimize distending pressure (A) before increasing
FiO₂ to limit oxygen toxicity. B is premature—intubation threshold is CPAP failure. C would increase FiO₂
unnecessarily. D delivers unpredictable pressure and would not recruit lung.
Question 4
A post-op CABG patient on 5 cm H₂O PEEP has a PaO₂ of 58 mm Hg on 60 % O₂. The respiratory therapist
should recommend which of the following?
A. Increase PEEP to 10 cm H₂O
B. Increase FiO₂ to 0.80
C. Initiate inhaled nitric oxide at 20 ppm
D. Add 10 cm H₂O pressure support
Correct Answer: A
Rationale: PaO₂ 58 mm Hg on 60 % indicates V/Q mismatch; first-line is PEEP recruitment (A). B risks
oxygen toxicity. C is for documented pulmonary hypertension/refractory hypoxemia. D unloads work,
not oxygenation.
Question 5
An ABG on a 70 kg patient shows pH 7.18, PaCO₂ 85 mm Hg, HCO₃⁻ 31 mEq/L, PaO₂ 55 mm Hg on 28 %
venturi mask. Which ventilator setting should the therapist select for initial volume-controlled
ventilation?
A. Vt 350 mL, RR 24, PEEP 5, FiO₂ 0.40
B. Vt 700 mL, RR 10, PEEP 5, FiO₂ 0.40
C. Vt 500 mL, RR 20, PEEP 5, FiO₂ 1.0
D. Vt 600 mL, RR 12, PEEP 5, FiO₂ 0.28
Correct Answer: A
Rationale: Acute hypercapnic failure needs ↑VE; 350×24≈8.4 L (A) doubles current VE. B lowers VE. C
over-distends and uses 100 % unnecessarily. D maintains near-current VE and inadequate PaO₂.
Question 6
, During a spontaneous breathing trial the rapid-shallow-breathing index is 125 (bpm/L). Which of the
following best explains why extubation would be inappropriate?
A. High risk of post-extubation stridor
B. Work of breathing exceeds reserves
C. Respiratory alkalosis likely
D. Secretion burden is excessive
Correct Answer: B
Rationale: RSBI >105 predicts extubation failure due to imbalance between load and neuromuscular
capacity (B). A requires cuff-leak test. C is opposite—patients usually develop mild acidosis. D is not
reflected by RSBI.
Question 7
A 6-year-old with pneumonia has a chest radiograph showing right lower-lobe opacification and
mediastinal shift to the right. Which of the following is the most likely cause?
A. Atelectasis with volume loss
B. Large pleural effusion
C. Tension pneumothorax
D. Pulmonary embolus
Correct Answer: A
Rationale: Mediastinal shift toward opacification implies volume loss, i.e., atelectasis (A). Effusion or
pneumothorax would shift away. PE rarely causes shift.
Question 8
A patient receiving 10 mcg/kg/min of dobutamine suddenly shows a drop in SvO₂ from 70 % to 55 %
with unchanged SpO₂. Which should be assessed first?
A. Arterial blood pressure
B. Cardiac output
C. Hemoglobin level
D. Temperature
Correct Answer: B
Rationale: SvO₂ reflects O₂ER; acute fall with stable SpO₂ indicates ↓Qt or ↑VO₂; first confirm cardiac
output (B). A is surrogate, not direct. C and D are slower variables.
Question 9
