NBRC RT Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Report the test as consistent with brain death: Absence of breathing counts only once the PaCO2 targets are reached; 57 mm Hg is below both.

Continue the apnea period and repeat the ABG in a few minutes: Correct. A positive test needs PaCO2 of at least 60 mm Hg and at least 20 mm Hg above baseline (here 61 mm Hg). At 57 mm Hg (+16) neither target is met, and because she is stable and well oxygenated, the apnea period can continue with another ABG.

Reconnect the ventilator and report the test as inconclusive: Stopping early is right if she becomes unstable or desaturates, but she is stable, so ending now wastes a valid test.

Raise the catheter oxygen flow to 15 L/min to speed the CO2 rise: Higher insufflation flow does not raise CO2 faster; it can wash out CO2 and risks barotrauma.

Apnea test (adult): positive when there is no respiratory effort at PaCO2 ≥ 60 mm Hg and ≥ 20 mm Hg above baseline; continue while stable until the targets are met.

Answer: A

Start NIV with an oronasal mask and recheck the ABG in 1 to 2 hours: Correct. Acute hypercapnic acidosis in COPD is a strong indication for NIV, and the POLST explicitly allows it while refusing intubation. Starting NIV now honors the documented wishes and treats the acidosis; an early ABG shows whether the trial is working.

Intubate now, because a POLST does not apply in the emergency department: A POLST is a portable medical order meant for exactly this setting; overriding a valid do-not-intubate order is not acceptable.

Give oxygen by nasal cannula only, because DNI status excludes ventilation: This confuses do-not-intubate with refusing all ventilatory support; the form specifically accepts NIV.

Hold ventilatory support until the ethics committee reviews the form: The order is valid and clear, so there is no conflict to resolve; delaying treatment of a pH of 7.24 is harmful.

Read the advance directive or POLST for exactly what is accepted and refused: DNI is not "do not treat", and NIV may be offered when the form allows it.

Answer: C

1. 1. Day 9 (yesterday) is about 104.6 mm Hg: (104.6 − 100.0) ÷ 2.0 = +2.3 SD.
2. 2. Day 10 (today) is about 105.0 mm Hg: (105.0 − 100.0) ÷ 2.0 = +2.5 SD.
3. 3. Both lie between the +2 SD (104) and +3 SD (106) lines, so no 1-3s violation.
4. 4. Two consecutive results beyond +2 SD on the same side = 2-2s violation, so the run is rejected.

Accept the run, because each value is within 3 SD: Both points are below the +3 SD line, but this applies only the 1-3s rule and misses the 2-2s rule for consecutive results.

Accept the run with a warning, as this is a 1-2s event: A single 1-2s result is a warning, but two consecutive ones on the same side are a rejection.

Reject the run under the 2-2s rule and hold patient PO2 results: Correct. Days 9 and 10 both lie above the +2 SD line (about +2.3 and +2.5 SD): two consecutive results beyond 2 SD on the same side violate the 2-2s rule, which signals systematic error. Patient PO2 results should not be reported until the cause is corrected and the control is back in range.

Rerun the control and report patient results if it falls within 2 SD: Repeating the control until it passes hides the systematic error that the rule has already found.

Westgard rules: 1-2s is a warning; 1-3s and 2-2s are rejections, and patient testing stops until QC is back in control.

Answer: C

Increase the set VT to 650 mL to make up for the volume lost to the leak: This compensates for the leak instead of fixing it, and the leak may change unpredictably.

Arrange to exchange the endotracheal tube: An exchange is needed only if the cuff cannot hold pressure; reinflating it comes first.

Reinflate the cuff to 20 to 30 cm H2O and recheck exhaled VT: Correct. Lower PIP, lost exhaled volume and audible gurgling during inspiration point to gas escaping around an underinflated cuff. Restoring cuff pressure to 20 to 30 cm H2O is the first step; if the cuff will not hold, the tube is then evaluated for replacement.

Suction the oropharynx and above the cuff: Pooled secretions can gurgle, but the low cuff pressure and lost volume show the main problem is the cuff seal.

Low exhaled VT with a falling PIP and gurgling means a leak; check and restore cuff pressure (20 to 30 cm H2O) before larger interventions.

Answer: C

Instill saline and try suctioning again: This delays relief of a complete obstruction, and routine saline instillation is not recommended.

Give breaths with the resuscitation bag through the tube: Bagging cannot ventilate through a blocked tube and wastes critical seconds.

Change the tracheostomy tube immediately: Correct. A suction catheter that will not pass means the tube is blocked, most often by a mucus plug. Replacing the tube right away, with the spare tube kept at the bedside, is the lifesaving step. They then call for help if he does not recover.

Call emergency services and wait for their arrival: Calling for help is right, but it comes after the tube change. A child with a blocked tube cannot wait for responders.

If a child with a tracheostomy is in distress and a suction catheter will not pass, change the tube immediately; caregivers must keep a spare (and a smaller) tube at hand.

Answer: B

Increase FiO2 to 0.80: The table pairs FiO2 0.80 with PEEP 14. Raising FiO2 now skips the PEEP steps still available at 0.70.

Increase PEEP to 12 cm H2O: Correct. His PaO2 is below the 55–80 mm Hg goal. In the lower-PEEP table, FiO2 0.70 pairs with PEEP 10, 12 or 14, so the next step is to raise PEEP at the same FiO2. The Pplat of 25 leaves room under 30.

Increase VT to 8 mL/kg PBW: Changing VT is not part of the oxygenation steps. It raises Pplat and stretch without targeting oxygenation.

Perform a 40-cm H2O, 40-second recruitment maneuver: A sustained high-pressure recruitment maneuver is not a protocol step and risks hypotension and barotrauma.

In the ARDS Network protocol, adjust oxygenation in PEEP/FiO2 pairs from the table (FiO2 0.70 allows PEEP 10–14) while keeping VT at 6 mL/kg PBW and Pplat ≤ 30 cm H2O.

Answer: D

Albuterol 2.5 mg by nebulizer: Right drug, but at the usual bronchodilator dose it has little effect on serum potassium.

Ipratropium 0.5 mg by nebulizer: This is a near-sibling bronchodilator. Anticholinergics do not move potassium into cells.

Racemic epinephrine 2.25%, 0.5 mL, by nebulizer: Racemic epinephrine is used for upper-airway edema. It is not an established therapy for hyperkalemia, and its alpha effects are unwanted.

Albuterol 10 to 20 mg by nebulizer: Correct. The strip shows tall, narrow, peaked T waves with flattened P waves and a widened QRS, the pattern of hyperkalemia, which fits potassium release from damaged muscle with failing kidneys. Beta-2 agonists shift potassium into cells; the effective nebulized albuterol dose is 10–20 mg, about 4–8 times the bronchodilator dose, lowering serum K+ by roughly 0.5–1 mEq/L within about 30 minutes as a temporary measure alongside insulin and dextrose.

Peaked T waves with a widened QRS signal hyperkalemia; after membrane stabilization with calcium, recommend nebulized albuterol 10–20 mg as a temporary shift therapy, because the bronchodilator dose is too small.

Answer: D

Make the trigger more sensitive: The small dip before each breath shows triggering is working, and each dip is followed promptly by a breath; the problem occurs after the breath starts.

Increase the set tidal volume: A larger VT at the same flow lengthens a breath that is already too slow for him and may cause overdistension.

Increase sedation to reduce his drive: Sedation may be needed later, but the first step is to fix the ventilator setting that is causing the dyssynchrony.

Increase the inspiratory flow: Correct. The concave, "scooped" inspiratory pressure limb shows the patient is pulling harder than the set 40 L/min can supply: flow starvation. Raising the flow (or switching to a pressure-targeted or variable-flow mode) matches delivery to his demand.

A scooped inspiratory pressure curve in volume control means flow starvation: increase flow or use a mode that lets flow vary with demand.

Answer: C

1. 1. Leak volume = inspired VT − average exhaled VT with the cuff deflated = 450 − 410 = 40 mL.
2. 2. 40 mL is below the commonly used 110-mL threshold, so the leak test is failed.

Extubate now and give racemic epinephrine afterward: Racemic epinephrine treats stridor once it appears; it does not replace pre-extubation steroids in a high-risk patient.

Recommend tracheostomy, since she failed the leak test: A failed leak test is not an indication for tracheostomy; most such patients extubate successfully after steroids.

Give systemic corticosteroids at least 4 hours before extubation: Correct. A leak of 40 mL (below about 110 mL) in a patient with risk factors (prolonged intubation, traumatic intubation) predicts post-extubation stridor. Guidelines suggest systemic steroids at least 4 hours before extubation, without needing to repeat the leak test.

Repeat the cuff leak test every day until the leak is above 110 mL: Waiting for the leak to improve prolongs ventilation; steroid pretreatment is the recommended approach.

High-risk patient + failed cuff leak test: recommend systemic steroids at least 4 hours before extubation.

Answer: D

Increase the FiO2 to 1.0: The problem is no ventilation, not low FiO2. Raising O2 without chest movement does not help.

Increase the PIP to 40 cm H2O: Raising pressure comes later, after mask seal, position, suction and mouth opening have been addressed.

Intubate before further mask ventilation: An alternative airway is the last corrective step, used if the simpler steps fail.

Reapply the mask and reposition the head: Correct. No chest movement with a heart rate that is not rising means ventilation is ineffective. The corrective sequence starts with the simplest fixes: improve the mask seal and reposition the airway (sniffing position), then suction, open the mouth, raise pressure, and finally use an alternative airway.

When the chest does not move during neonatal PPV, follow the corrective steps in order: mask, reposition, suction, open mouth, increase pressure, alternative airway.

Answer: C

Keep 3 L/min, since SpO2 is now normal: A "normal" SpO2 here means pulmonary overcirculation at the cost of systemic perfusion.

Add inhaled nitric oxide to lower pulmonary resistance: Wrong direction: further pulmonary vasodilation worsens the overcirculation.

Return to the prior flow and target SpO2 75%–85%: Correct. In parallel (single-ventricle) circulation, SpO2 reflects how flow is balanced between the lungs and the body. Extra O2 lowers pulmonary vascular resistance and steals flow from the systemic circulation, which explains his falling BP and urine output. His baseline 75%–85% target should be restored.

Increase the flow until SpO2 exceeds 95%: This pushes the imbalance further and worsens systemic hypoperfusion.

In shunt-dependent single-ventricle physiology, target SpO2 about 75%–85%; high FiO2 causes pulmonary overcirculation and systemic hypoperfusion.

Answer: D

Decrease PEEP to 10 cm H2O: At FiO2 0.80 the PEEP/FiO2 table calls for PEEP 14. Dropping PEEP to lower Pplat causes derecruitment and hypoxemia.

Increase the inspiratory flow to lower Pplat: Inspiratory flow changes PIP (the resistive part) but not the plateau, which reflects alveolar stretch.

Accept it, since pH remains above 7.30: The pH goal does not override the Pplat limit. A Pplat of 33 means ongoing overdistension.

Reduce VT to 350 mL and raise the rate to 30/min: Correct. Pplat is above 30 cm H2O even at 6 mL/kg PBW. The protocol lowers VT in 1-mL/kg steps (to 5 mL/kg = 350 mL, as low as 4 mL/kg) and raises the rate (up to 35/min) to protect minute ventilation, accepting permissive hypercapnia as long as pH stays at or above 7.30.

In ARDS, if Pplat > 30 cm H2O at 6 mL/kg PBW, reduce VT stepwise toward 4 mL/kg and raise the rate (≤ 35/min) to hold minute ventilation.

Answer: A

Endotracheal intubation for airway protection: Correct. A depressed level of consciousness (GCS 8), absent protective reflexes and pooled secretions mean she cannot protect her airway from aspiration. Intubation is indicated for airway protection even though her gas exchange is currently normal.

Bilevel NIV through an oronasal mask: NIV needs an intact airway and the ability to clear secretions. It raises the aspiration risk here.

An oropharyngeal airway with hourly suctioning: An OPA keeps the airway open but gives no protection against aspiration.

No change, since her gas exchange is normal: A normal ABG shows adequate ventilation, not a protected airway.

Indications for intubation include failure to protect the airway (depressed consciousness, absent gag or cough, pooled secretions), not just failure of oxygenation or ventilation.

Answer: A

Honor his request and support a move to comfort care: Correct. A capable patient may refuse any treatment, including life-sustaining NIV. The team removes NIV as part of a planned transition to comfort care, with opioids for dyspnea and family support, as an ethically accepted withdrawal of treatment.

Continue NIV, since stopping it would cause his death: This overrides an informed refusal by a patient with capacity. Withdrawing treatment at the patient's request is not the same as causing death.

Request a psychiatric evaluation before removing the mask: His capacity is already documented. A routine psychiatric hold delays honoring a valid decision.

Intubate, since NIV has failed: This is contrary to his expressed wishes. Escalation is not consented to.

A patient with decision-making capacity may refuse or withdraw any treatment, including NIV; the team honors it and provides comfort-focused care.

Answer: D

1. TI = 0.45 L ÷ (54 L/min ÷ 60) = 0.45 L ÷ 0.9 L/s = 0.5 s; cycle at 24/min = 2.5 s, so TE = 2.0 s
2. Auto-PEEP = total PEEP 12 − set PEEP 5 = 7 cm H2O
3. At 16/min: cycle = 3.75 s, so TE = 3.25 s
4. At 80 L/min and 24/min: TI = 0.45 L ÷ 1.33 L/s ≈ 0.34 s, so TE ≈ 2.16 s
5. Expected PaCO2 at 16/min ≈ 41 × 24/16 ≈ 62 mm Hg, near her compensated baseline

Increase the inspiratory flow to 80 L/min: This works in the right direction but is less effective. TI falls from 0.5 to about 0.34 s, so expiratory time grows by only about 0.16 s.

Increase PEEP to 12 cm H2O: Applied PEEP helps a patient who is triggering against auto-PEEP. In a passive patient it does not reduce hyperinflation and can raise end-expiratory volume.

Add a 0.3-second end-inspiratory pause: Wrong direction: an inspiratory pause lengthens TI and shortens expiratory time, which worsens air trapping.

Decrease the rate to 16/min: Correct. Expiratory flow never returns to zero (7 cm H2O of auto-PEEP), and the ABG shows alkalemia because she is ventilated below her chronic PaCO2 (HCO3− 31 suggests a baseline near 60). Dropping the rate lengthens expiratory time from 2.0 s to 3.25 s, the largest single gain, and lets PaCO2 return toward her baseline.

Auto-PEEP in a passive COPD patient is best relieved by lowering minute ventilation, mainly the rate, to lengthen expiratory time; aim for the patient's baseline PaCO2, not a normal one.