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Free NBRC Respiratory Therapy Exam practice questions

15 free NBRC Respiratory Therapy Exam practice questions from the ICU Basics bank of 587, each with the answer and a rationale for every choice. Try them here, then practice the rest free in your browser. No account, no ads.

The 2027 Respiratory Therapy Examination has 185 questions (160 scored and 25 unscored pretest questions) in a single 4-hour sitting, with a lower cut score for the CRT credential and a higher one for the RRT. Topic proportions follow the NBRC detailed content outline effective January 2027.

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Practice all 587 NBRC Respiratory Therapy Exam questions free in your browserMock exams, rationales for every choice and a study plan. No account or download needed.

Question 1 · Patient Data

A patient with a history of heart failure has orthopnea and fine, late-inspiratory crackles at both bases that do not clear with coughing. What do these findings suggest?

  1. Retained secretions in the large airways
  2. Pulmonary edema or interstitial fluid
  3. Upper airway obstruction
  4. Bronchospasm
Show the answer and rationale

Answer: B

  • A. Secretions produce coarse crackles or rhonchi that change with coughing.
  • B. Correct. Fine late-inspiratory crackles that persist after coughing come from fluid or fibrosis in the alveoli and small airways; with orthopnea and heart failure, pulmonary edema is likely.
  • C. Obstruction above the thorax produces stridor.
  • D. Bronchospasm produces wheezing.

Breath sound interpretation: fine crackles (fluid, fibrosis, atelectasis), coarse crackles (secretions), wheezes (narrowed lower airways), rhonchi (secretions in large airways), stridor (upper-airway narrowing), pleural friction rub, and diminished or absent sounds (effusion, pneumothorax, consolidation, hyperinflation). Palpation adds tactile fremitus, crepitus and tracheal position; percussion adds dullness and hyperresonance.

Sources: Wilkins' Clinical Assessment in RC, 10th ed.; Egan's Fundamentals of Resp Care, 13th ed.

Question 2 · Patient Data

A man pulled from a house fire has soot in his nares and an SpO₂ of 83% on a nonrebreathing mask. A multiwavelength pulse CO-oximeter displays a carboxyhemoglobin (SpCO) of 3%. What is the best interpretation of the SpCO?

  1. It is reliable if the plethysmographic waveform is clean
  2. It is accurate, because the device uses more than two wavelengths
  3. It rules out CO poisoning, so the oxygen can be titrated down
  4. It is unreliable at this saturation and cannot exclude poisoning
Show the answer and rationale

Answer: D

  • A. A clean waveform shows that the sensor is detecting a pulse, which helps separate motion or perfusion artifact from a true SpO₂. It does not make the carboxyhemoglobin estimate accurate: agreement with blood values in suspected poisoning is wide, and the device can fail outright when the saturation is below about 85%.
  • B. Extra wavelengths let the device estimate dyshemoglobins, but its accuracy falls during hypoxemia, which is exactly when this patient needs a reliable number.
  • C. A low SpCO cannot be trusted at this level of hypoxemia, and stopping high-concentration oxygen on its strength could leave poisoning untreated.
  • D. Correct. Noninvasive SpCO agrees poorly with blood carboxyhemoglobin in suspected poisoning, and in one study the device could not measure carboxyhemoglobin once the SaO₂ fell below 85%. Only a blood sample on a laboratory CO-oximeter (venous is acceptable) can confirm or exclude poisoning, while 100% oxygen continues.

Standard two-wavelength oximeters cannot tell carboxyhemoglobin from oxyhemoglobin, so they overestimate oxygenation in carbon monoxide poisoning. Pulse CO-oximeters add wavelengths to estimate carboxyhemoglobin and methemoglobin; they track blood values closely in healthy volunteers but show wide error in suspected poisoning (limits of agreement roughly −12% to +14%) and can fail when the SaO₂ is below 85%. Treat the SpCO as a screen at most, and confirm suspected poisoning with laboratory CO-oximetry; levels fall quickly once oxygen is given, so draw the sample early.

Sources: Merck Manual, Professional Version

Question 3 · Devices and Patient Safety

During reprocessing, a flexible bronchoscope releases a steady stream of bubbles from the insertion tube during the leak test. What should be done?

  1. Stop reprocessing and send the scope for repair
  2. Seal the area with tape and return the scope to service
  3. Continue with manual cleaning and high-level disinfection as usual
  4. Soak the scope longer in disinfectant to compensate
Show the answer and rationale

Answer: A

  • A. Correct. A failed leak test means the sheath or a channel is breached. Immersion lets fluid into the scope, damaging it and creating a place for organisms to survive.
  • B. A breached scope cannot be disinfected reliably.
  • C. Immersing a leaking scope causes fluid invasion.
  • D. A longer soak increases the damage.

Bronchoscope reprocessing steps: wipe and flush at the bedside, leak test, manual cleaning with brushing of every channel, high-level disinfection or sterilization, rinsing, drying with forced air, and hanging storage. Each use and each reprocessing cycle is logged to the patient and the scope.

Sources: Mosby's Respiratory Care Equipment, 12th ed.; Egan's Fundamentals of Resp Care, 13th ed.

Question 4 · Devices and Patient Safety

A therapist with acrylic nail extensions has been assigned to the medical intensive care unit. Which practice follows CDC hand hygiene guidance?

  1. Remove the extensions before caring for ICU patients
  2. Keep them and wear gloves for patient contact
  3. Trim the acrylic tips to less than one-quarter inch
  4. Keep them and use soap and water instead of alcohol rub
Show the answer and rationale

Answer: A

  • A. Correct. The CDC recommends not wearing artificial nails or extenders when giving direct care to high-risk patients, such as those in intensive care units and operating rooms.
  • B. Gloves reduce contamination, but they can tear or leak, hands are contaminated as gloves come off, and artificial nails stay colonized with gram-negative organisms.
  • C. The quarter-inch limit applies to natural nail tips; shortening an artificial nail does not remove the reservoir of organisms around it.
  • D. Soap and water is needed when hands are visibly soiled, but it does not clean beneath artificial nails better, and alcohol rub remains the routine method.

The 2002 CDC hand hygiene guideline makes not wearing artificial fingernails or extenders during direct contact with high-risk patients a Category IA recommendation, because artificial and long nails carry more gram-negative bacteria and yeasts and have been linked to outbreaks, including a Pseudomonas outbreak in a neonatal unit. Natural nail tips are kept under one-quarter inch. Alcohol-based rub is the routine method when hands are not visibly soiled, soap and water is used when they are, and hands are cleaned after gloves are removed.

Sources: CDC Hand Hygiene Guideline (2002)

Question 5 · Initiation and Modification of Interventions

A ventilated patient on PEEP 12 cm H₂O and FiO₂ 0.70 must go to CT. Which preparation is most important?

  1. Lowering the PEEP to 5 cm H₂O an hour beforehand to test tolerance
  2. Removing the monitors to speed the transfer
  3. A transport ventilator that matches the PEEP
  4. A manual resuscitator without a PEEP valve attached
Show the answer and rationale

Answer: C

  • A. Reducing support for convenience risks hypoxemia.
  • B. Monitoring continues during transport.
  • C. Correct. A patient who depends on PEEP derecruits quickly when it is lost. A capable transport ventilator and an oxygen supply calculated with a reserve maintain support throughout.
  • D. Hand ventilation without PEEP causes derecruitment and variable volumes.

Transport within the hospital: weigh the benefit against the risk, bring a transport ventilator, a manual resuscitator with mask and PEEP valve, airway equipment, suction, medications and monitors including capnography, and confirm that the destination has oxygen and power. Clamp the tube briefly when changing circuits at high PEEP.

Sources: Egan's Fundamentals of Resp Care, 13th ed.

Question 6 · Initiation and Modification of Interventions

Twenty minutes after extubation a patient develops a high-pitched inspiratory sound, mild retractions and an SpO₂ of 93% on a cool aerosol mask. What should the therapist recommend first?

  1. Immediate reintubation with a larger tube
  2. Nebulized racemic epinephrine
  3. A sedative to reduce the work of breathing
  4. Nebulized albuterol and ipratropium
Show the answer and rationale

Answer: B

  • A. Reintubation is for failure of treatment, and a smaller tube would be used.
  • B. Correct. Post-extubation stridor is from laryngeal edema. Inhaled epinephrine constricts the mucosal vessels and reduces swelling within minutes.
  • C. Sedation can remove the drive that is keeping the airway open.
  • D. Bronchodilators act on the lower airways and do not shrink laryngeal edema.

Post-extubation stridor is treated with racemic epinephrine, an intravenous corticosteroid and close observation, because edema can return as the drug wears off. Heliox can reduce the work of breathing in the meantime. Worsening stridor, fatigue or hypoxemia calls for reintubation.

Sources: Egan's Fundamentals of Resp Care, 13th ed.; Pilbeam's Mechanical Ventilation, 8th ed.

Question 7 · Initiation and Modification of Interventions

A ventilated patient with resolving pneumonia has a PaO₂ of 142 mm Hg on FiO₂ 0.80 and PEEP 10 cm H₂O. Which change should be made first?

  1. Increase the tidal volume to open more alveoli
  2. Reduce the FiO₂ in steps toward 0.50 or less
  3. Reduce the PEEP to 5 cm H₂O and leave the FiO₂ at 0.80
  4. Leave the settings until the radiograph is clear
Show the answer and rationale

Answer: B

  • A. Oxygenation is already excessive.
  • B. Correct. The patient is over-oxygenated on a potentially toxic FiO₂. The FiO₂ is lowered first, and PEEP is reduced once the FiO₂ is at a safer level.
  • C. Removing PEEP first risks derecruitment while the toxic FiO₂ remains.
  • D. Radiographic change lags, and hyperoxia is harmful in the meantime.

Weaning oxygenation support: reduce the FiO₂ to about 0.50 to 0.60 or below, then reduce PEEP in steps of 2 cm H₂O, checking the saturation after each change. High FiO₂ causes absorption atelectasis and oxidant injury, so the target is the lowest FiO₂ that maintains an SpO₂ in the low to mid 90s.

Sources: Pilbeam's Mechanical Ventilation, 8th ed.; AARC CPG: Adult Oxygen in Acute Care (2022); Egan's Fundamentals of Resp Care, 13th ed.

Question 8 · Initiation and Modification of Interventions

An alert, competent patient with COPD declines a scheduled bronchodilator treatment, saying it makes her shaky. What should the therapist do?

  1. Tell her that refusing will lead to discharge
  2. Explore her concern, explain the options and respect her decision
  3. Record the treatment as given and move on
  4. Give the treatment anyway, since the physician ordered it on a schedule
Show the answer and rationale

Answer: B

  • A. Coercion is unethical.
  • B. Correct. A competent patient may refuse treatment. Understanding the reason often leads to a solution, such as a different dose or drug.
  • C. This is falsification of the record.
  • D. Treating against her wishes violates her autonomy.

Patient-centered care respects autonomy and informed refusal. The therapist explains the benefits and risks in plain language, records the refusal and the reason, notifies the prescriber and suggests alternatives. Cultural background and past experiences shape how patients respond to care.

Sources: Egan's Fundamentals of Resp Care, 13th ed.; Joint Commission Performance Goals (2026)

Question 9 · Initiation and Modification of Interventions

Under an oxygen titration protocol, a postoperative patient without lung disease has an SpO₂ of 99% on a nasal cannula at 4 L/min. What should the therapist do?

  1. Continue 4 L/min until the physician rewrites the order
  2. Remove the cannula and recheck the saturation tomorrow
  3. Change to a simple mask to keep the SpO₂ at 100%
  4. Reduce the flow in steps, keeping the SpO₂ on target
Show the answer and rationale

Answer: D

  • A. The protocol already gives the therapist authority to adjust.
  • B. Oxygen is weaned stepwise with a check after each change.
  • C. A saturation of 100% is not a goal.
  • D. Correct. The protocol authorizes titration to the target range, usually 94% to 98% (92% to 96% in some protocols). A saturation of 99% means the patient is receiving more oxygen than needed.

Therapist-driven oxygen protocols define a target range, the steps for raising and lowering the flow or FiO₂, the reassessment interval and the criteria for stopping oxygen or calling the provider. They reduce both unrecognized hypoxemia and unnecessary oxygen.

Sources: AARC CPG: Adult Oxygen in Acute Care (2022); BTS Emergency Oxygen Guideline (2017)

Question 10 · Clinical Judgment: Adult Patients

A patient with smear-positive pulmonary tuberculosis has been in airborne isolation for 2 weeks on four-drug therapy. Which finding allows isolation to be discontinued?

  1. A clear chest radiograph
  2. Three negative smears with improvement
  3. A normal temperature for at least 24 hours
  4. Completion of the first 3 days of four-drug therapy
Show the answer and rationale

Answer: B

  • A. Radiographic changes resolve slowly and do not define infectiousness.
  • B. Correct. Isolation ends when the patient is on effective therapy, improving, and no longer has acid-fast bacilli on three sputum smears collected at least 8 hours apart.
  • C. Resolution of fever alone does not show that the patient is no longer infectious.
  • D. Three days is too short to make the patient non-infectious.

Tuberculosis control: airborne isolation for suspected or confirmed disease, fit-tested respirators for staff, a surgical mask on the patient during transport, sputum induction in a booth, and public health notification. The standard regimen lasts at least 6 months; a 4-month rifapentine-moxifloxacin regimen is an option for patients aged 12 or older (weighing at least 40 kg) with drug-susceptible pulmonary TB.

Sources: CDC Isolation Precautions Guideline (2007); Egan's Fundamentals of Resp Care, 13th ed.

Question 11 · Clinical Judgment: Adult Patients

A 30-year-old driver in a side-impact crash has bruising over the left chest wall and fractures of the left 5th to 7th ribs without a flail segment. His admission chest radiograph was clear. Eighteen hours later he is alert and afebrile, with RR 28/min and SpO₂ 89% on 4 L/min. A repeat radiograph shows patchy, nonsegmental opacities in the left mid and lower lung beneath the fractures, and the right lung is clear. What is the MOST likely cause of his worsening oxygenation?

  1. Pulmonary contusion from the impact
  2. Acute respiratory distress syndrome
  3. Fat embolism syndrome from the rib fractures
  4. Aspiration pneumonitis in the left lower lobe
Show the answer and rationale

Answer: A

  • A. Correct. Contusion is bleeding and edema in the lung without laceration; its opacities may not be visible for 24 to 48 hours after injury and enlarge over time, and hypoxemia worsens as they do.
  • B. ARDS needs bilateral opacities not explained by effusion, collapse or nodules. His opacities are confined to the injured side, although an extensive contusion can later progress to ARDS.
  • C. Fat embolism follows long-bone or pelvic fractures, usually 24 to 72 hours later, with diffuse bilateral infiltrates, confusion and petechiae. Rib fractures alone rarely cause it, and his findings are one-sided.
  • D. Aspiration usually follows a depressed level of consciousness or vomiting and favors dependent segments, often on the right. He has been alert, and the opacities sit under the injured chest wall.

Pulmonary contusion is trauma-induced hemorrhage and edema of the lung without laceration, and it often accompanies rib fractures. Radiographic opacification may not be visible for 24 to 48 hours and grows over time, so a clear admission film does not exclude it, and CT is far more sensitive. Hypoxemia worsens over the first day or two, so oxygenation is monitored serially. Treatment is supportive: analgesia so the patient can breathe deeply, oxygen, careful fluid management, and mechanical ventilation for moderate to severe hypoxemia. Pneumonia and ARDS are later complications.

Sources: Merck Manual, Professional Version; StatPearls (NCBI Bookshelf)

Question 12 · Clinical Judgment: Adult Patients

A 70-year-old with COPD arrives in the emergency department with increased dyspnea, wheezing and an SpO₂ of 86% on room air, and he is drowsy but arousable. Which information should the therapist obtain first to guide the level of support?

  1. A blood gas with the mental status assessment
  2. A chest CT scan
  3. A full pulmonary function test
  4. A sputum culture result from the previous admission
Show the answer and rationale

Answer: A

  • A. Correct. Drowsiness in a COPD exacerbation suggests hypercapnic encephalopathy; the blood gas and mental status decide between controlled oxygen with bronchodilators, noninvasive ventilation, and intubation.
  • B. Imaging follows stabilization and does not determine the ventilatory support level.
  • C. Spirometry is not feasible or useful during an acute exacerbation.
  • D. Cultures take days and do not affect immediate support decisions.

Information gathering in acute chronic lung disease: mental status, work of breathing, blood gases, saturation, peak flow when possible, chest radiograph to exclude pneumonia or pneumothorax, medication history and adherence, home oxygen and ventilation use, prior intubations, and advance directives. These findings determine escalation.

Sources: GOLD COPD Report (2026); Egan's Fundamentals of Resp Care, 13th ed.

Question 13 · Clinical Judgment: Adult Patients

A 66-year-old with COPD has been ventilated for 4 days and is now on pressure support 14 cm H₂O with PEEP 5 cm H₂O. The respiratory rate is 28/min, VT 540 mL and inspiratory time 1.5 s. On the graphics, inspiratory flow tapers slowly, and airway pressure spikes above the set level at the end of each breath while the patient's abdominal muscles tighten. Which adjustment should the respiratory therapist make?

  1. Raise the pressure support to 18 cm H₂O
  2. Make the flow trigger more sensitive (1 L/min)
  3. Raise the flow-cycle threshold to 45% of peak flow
  4. Raise the PEEP to 8 cm H₂O to offset auto-PEEP
Show the answer and rationale

Answer: C

  • A. Higher pressure support enlarges each breath and, in COPD, carries mechanical inspiration even further past the end of the patient's effort. Delayed cycling, active exhalation against the breath and air trapping all get worse.
  • B. Trigger sensitivity controls how breaths begin, not how they end. A 1 L/min trigger does not shorten inspiration and invites auto-triggering from leaks or cardiac oscillations.
  • C. Correct. Ending the breath when flow has fallen to 45% of its peak, instead of the usual 25%, shortens inspiration so the ventilator stops when the patient stops. Expiratory time lengthens and auto-PEEP falls.
  • D. Applied PEEP helps when auto-PEEP makes efforts fail to trigger, which is a problem at the start of the breath. Here every effort triggers; the problem is the breath running past the end of the patient's own inspiration.

In pressure support the breath ends when inspiratory flow decays to a set fraction of its peak, often 25% by default. In COPD the long time constant makes flow decay slowly, so the ventilator keeps delivering gas after the patient's neural inspiration has ended. The patient then exhales actively against the breath, seen as a pressure spike at end-inspiration with expiratory muscle use, and the shortened expiratory time worsens hyperinflation. Raising the expiratory cycle setting, commonly to 40% to 50% in COPD, corrects this delayed cycling.

Sources: Pilbeam's Mechanical Ventilation, 8th ed.; AARC CPG: Patient-Vent Assessment (2024)

Question 14 · Clinical Judgment: Adult Patients

A 78-year-old with four rib fractures has an incentive spirometry volume that has fallen from 1,200 to 600 mL in 12 hours. She is splinting and cannot cough because of pain. What should the therapist recommend?

  1. A binder wrapped tightly around the chest wall
  2. Chest percussion over the fractures
  3. Sedation so that she can sleep through the night
  4. Better analgesia, such as a regional block
Show the answer and rationale

Answer: D

  • A. Binders restrict ventilation and promote atelectasis.
  • B. Percussion is contraindicated over fractures.
  • C. Sedation reduces ventilation and cough further.
  • D. Correct. A falling inspiratory volume in an older patient with rib fractures predicts pneumonia and respiratory failure. Relieving the pain, for example with a regional block, restores the ability to breathe deeply and cough, and lung expansion therapy continues.

Older patients with several rib fractures are monitored with serial inspiratory volumes or vital capacity, pain scores and saturation. A volume under about 15 mL/kg, or a decline, prompts escalation of analgesia, a higher level of care and consideration of noninvasive support.

Sources: ACS ATLS, 11th ed.; Egan's Fundamentals of Resp Care, 13th ed.

Question 15 · Clinical Judgment: Pediatric and Neonatal

A 2-year-old had a sudden choking episode while eating peanuts yesterday. Today he has a persistent cough, wheezing heard only on the right and a hyperlucent right lung on an expiratory radiograph. What should be recommended?

  1. Chest physiotherapy with the head down
  2. A course of oral antibiotics
  3. Rigid bronchoscopy
  4. Albuterol every 4 hours and review in a week
Show the answer and rationale

Answer: C

  • A. Percussion and drainage can shift the object and obstruct a larger airway.
  • B. Antibiotics do not treat the obstruction.
  • C. Correct. A choking episode followed by unilateral wheeze and air trapping indicates an aspirated foreign body acting as a one-way valve. Rigid bronchoscopy removes it.
  • D. Bronchodilators do not move a foreign body, and delay risks pneumonia.

Foreign body aspiration peaks between 1 and 3 years. Nuts and seeds are the most common objects, and most lodge in the right main bronchus. An expiratory or decubitus film shows air trapping on the affected side. A normal radiograph does not exclude it when the history is convincing.

Sources: Walsh, Neonatal/Pediatric Resp Care, 6th ed.; Egan's Fundamentals of Resp Care, 13th ed.

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