The CRT (Certified Respiratory Therapist) is an allied-health certification awarded by NBRC.
NBRC publishes the official exam outline, eligibility rules and fees — see NBRC's official page before you book.
Twenty CRT (Certified Respiratory Therapist) questions, with the answers hidden until you want them — covering Procedures, Diagnostics, Management, Assessment and more. They are real cards from our 1040-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. NBRC publishes the official exam outline — check it for the real blueprint.
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An RT notices a large air bubble in an ABG sample from a patient on room air. The sample sat for 5 minutes before analysis. How will the PCO2 and PO2 values be affected?
Show answer →Air bubbles cause equilibration between the sample and room air (PO2 ~150 mmHg, PCO2 ~0 mmHg). Results: PCO2 decreases; PO2 increases (if the patient's actual PO2 is <150) or decreases (if actual PO2 is >150, such as on supplemental O2). pH increases slightly due to the PCO2 drop. NBRC Tip: Always check if the patient is on room air vs. 100% O2. On 100% O2, an air bubble will LOWER the PO2.
During a modified Allen's test, the patient's hand remains blanched for 20 seconds after releasing the ulnar artery. What is the most appropriate next step for the RT?
Show answer →A delay >10-15 seconds indicates a negative Allen's test (inadequate collateral circulation). Action: Do NOT use the radial artery on that hand. Proceed to the other hand's radial artery. If both are negative, consider the brachial artery or an ultrasound-guided draw. NBRC Focus: Safety first. Never puncture a site without confirmed collateral flow to prevent ischemic injury.
An ABG is drawn using a syringe with excessive liquid sodium heparin. Which of the following changes to the pH, PCO2, and HCO3- are expected?
Show answer →Excessive liquid heparin (dilution effect) causes: 1. PCO2 decreases (diluted by the low CO2 of the liquid), 2. HCO3- decreases, 3. pH remains stable or slightly decreases (heparin is acidic). NBRC Distractor: Do not confuse liquid heparin dilution with the metabolic effect of delayed analysis. Modern dry heparin kits minimize this, but the exam still tests the liquid dilution theory.
A plastic ABG syringe is left at room temperature for 45 minutes before being run in the lab. What specific changes to the pH, PCO2, and PO2 should the RT expect?
Show answer →Ongoing cellular metabolism (leukocytes/reticulocytes) consumes O2 and produces CO2. Results: pH decreases (acidosis), PCO2 increases, and PO2 decreases. Clinical Pearl: Samples in plastic syringes should be analyzed within 30 minutes. If delay is expected, use glass syringes and ice, or recognize that plastic syringes are gas-permeable at low temperatures (O2 can enter).
A chest X-ray is performed to confirm endotracheal tube (ETT) placement after a difficult intubation. Where should the tip of the ETT be positioned relative to the carina for an adult patient?
Show answer →The ETT tip should be 3-5 cm (roughly 1.5-2 inches) above the carina. This ensures the tube remains in the trachea during neck flexion/extension. NBRC Tip: The carina is located at the level of the 4th or 5th thoracic vertebrae (T4-T5). If the tube is too high, it risks accidental extubation; too low, it risks right mainstem bronchus intubation.
When comparing a Posterior-Anterior (PA) view to an Anterior-Posterior (AP) view, how does the cardiac silhouette typically appear on the AP film, and why?
Show answer →On an AP film, the heart appears larger (magnified) because it sits further from the image receptor/film and closer to the X-ray source. Clinical Pearl: PA films are the gold standard for assessing heart size; a Cardiothoracic Ratio (CTR) > 50% on a PA film suggests cardiomegaly. On AP films (portable), heart size is often overestimated.
An RT reviews a CXR and notices the medial ends of the clavicles are not equidistant from the vertebral spinous processes. What does this finding indicate regarding film quality?
Show answer →This indicates patient rotation. If the clavicles are not symmetrical relative to the spine, the patient was turned during the exposure. Rotation can distort the appearance of the mediastinum, heart size, and lung fields, potentially leading to a false diagnosis of tracheal deviation or cardiomegaly.
To evaluate if a chest radiograph has adequate inspiratory effort, how many posterior ribs should be visible above the level of the diaphragm?
Show answer →An adequate inspiratory film should show 9 to 11 posterior ribs. If fewer than 9 ribs are visible, the film is considered an expiratory or poor-effort film, which can cause the heart to appear enlarged and the lung bases to appear congested (mimicking pneumonia or edema).
A patient on mechanical ventilation is in the supine position for a dressing change. To minimize VAP risk, what is the minimum recommended elevation for the head of the bed (HOB), and what is the primary rationale?
Show answer →The HOB should be maintained at 30-45 degrees. Rationale: This position uses gravity to prevent the aspiration of gastric contents and oropharyngeal secretions into the lower airway. NBRC Tip: If a patient must be flat for a procedure, return them to the semi-Fowler's position immediately after. Supine positioning is a major independent risk factor for VAP.
When selecting an endotracheal tube for a patient expected to require mechanical ventilation for more than 48-72 hours, which feature is specifically recommended by current VAP prevention guidelines?
Show answer →Use an ET tube with a subglottic secretion drainage (CASS) port. Rationale: Secretions pool above the cuff; CASS allows continuous or intermittent suctioning of these secretions before they leak into the lungs. NBRC Tip: Standard suctioning only clears the distal airway; CASS targets the space between the vocal cords and the cuff.
During a routine ventilator check, the RT measures the ETT cuff pressure. What is the target range to prevent both tracheal wall ischemia and the micro-aspiration of subglottic secretions?
Show answer →20-30 cmH2O (or 15-22 mmHg). Rationale: Pressures <20 cmH2O allow secretions to leak past the cuff (micro-aspiration), while pressures >30 cmH2O can cause mucosal ischemia and tracheal malacia. NBRC Tip: Use a calibrated manometer; do not rely on pilot balloon feel. If the pressure is too low, VAP risk increases significantly.
A patient with CHF presents with a sudden onset of tachypnea and is coughing up thin, pink, frothy secretions. What is the most likely cause and the immediate recommended intervention?
Show answer →Pink frothy secretions are pathognomonic for Pulmonary Edema. NBRC Expectation: Recognize this as a fluid shift into the alveoli caused by high pulmonary capillary wedge pressure. Immediate actions include 100% Oxygen, CPAP or BiPAP to increase intrathoracic pressure (which helps push fluid back into the vasculature), and pharmacological management (diuretics like Lasix, inotropes, or vasodilators). Key Exam Tip: If the patient is hemodynamically unstable, CPAP provides rapid recruitment and oxygenation improvement.
A patient with bronchiectasis produces large volumes of foul-smelling (fetid), purulent, green sputum that separates into three layers. What is the most likely cause and the best diagnostic test to order?
Show answer →Fetid, layered sputum is classic for Bronchiectasis or a Lung Abscess. The green color indicates stagnant secretions and infection (often Pseudomonas aeruginosa). NBRC Strategy: If you see three layers in the description, think Bronchiectasis. The Gold Standard diagnostic test to confirm bronchiectasis is a High-Resolution CT (HRCT) scan, which shows bronchial wall thickening and dilation (signet ring sign). Sputum culture and sensitivity (C&S) is also required to guide antibiotic therapy.
A patient with COPD is receiving mechanical ventilation. The capnogram displays a shark-fin appearance with a prolonged Phase II and a steep Phase III. What is the most likely cause and immediate intervention?
Show answer →This waveform indicates increased airway resistance or airflow obstruction (bronchospasm). Immediate intervention includes bronchodilator therapy or checking for ETT obstruction. NBRC Strategy: Differentiate this from a Curare Cleft (dip in Phase III). Shark-fin = Obstruction; Cleft = Patient effort. If the patient is wheezing or has high peak pressures, think bronchospasm.\
Small, rhythmic ripples are noted at the end of the alveolar plateau and during the descending limb of a capnogram in a pediatric patient. What is this phenomenon?
Show answer →Cardiac Oscillations. Rationale: The heart beating against the lungs causes small amounts of gas to move in and out of the airway. This is common in pediatric patients or adults with slow respiratory rates and large hearts. NBRC Note: This is a normal physiological variant and does not require intervention. Do not mistake these for Curare Clefts which are larger and occur in the plateau.\
During an SVN treatment with 2.5mg Albuterol, the patient's heart rate increases from 90 bpm to 118 bpm. What is the most appropriate immediate action for the Respiratory Therapist according to NBRC standards?
Show answer →Stop the treatment immediately and notify the physician. NBRC guidelines state that if the heart rate increases by 20% or more from the baseline, the treatment must be terminated. In this case, 118 bpm is a 31% increase from 90 bpm. You must document the adverse reaction, the peak heart rate, and the duration of the treatment given. Strategy: Always prioritize patient safety over completing the dose when tachycardia is significant.
A patient with a history of cardiac arrhythmias requires a rescue bronchodilator for acute wheezing. Which SABA is most appropriate to minimize potential beta-1 stimulation and cardiac side effects?
Show answer →Levalbuterol (Xopenex). Levalbuterol is the R-isomer of albuterol. The S-isomer found in racemic albuterol is thought to be physiologically inert regarding bronchodilation but may contribute to side effects like tachycardia and tremors. Standard SVN doses are 0.63 mg or 1.25 mg. NBRC Tip: Levalbuterol is the go-to answer for patients who are tremor-prone or have pre-existing tachycardia where a SABA is still indicated.
A 28-year-old patient presents with sudden palpitations, HR 190 bpm, regular rhythm, and narrow QRS complexes. P waves are not visible. What is the most likely rhythm and the initial recommended non-pharmacological treatment?
Show answer →Supraventricular Tachycardia (SVT). SVT is characterized by a regular, narrow-complex tachycardia (rate >150 bpm) where P waves are buried in the preceding T waves. Initial treatment for a stable patient involves Vagal Maneuvers (e.g., Valsalva maneuver or carotid sinus massage). NBRC Exam Tip: If the patient is hemodynamically unstable (hypotension, chest pain, altered mental status), the primary treatment is Synchronized Cardioversion, not maneuvers or meds. Distinguish SVT from Sinus Tachycardia by looking for a clear cause; SVT often has a sudden onset and lacks P-wave clarity.
A 72-year-old patient's ECG shows an irregularly irregular rhythm with no discernible P waves, replaced by fine fibrillatory waves. What is the primary hemodynamic consequence of this rhythm?
Show answer →Atrial Fibrillation (Afib). The primary hemodynamic consequence is the loss of the Atrial Kick, which normally accounts for 20-30% of ventricular filling (Cardiac Output). In patients with reduced ventricular compliance (like those with HF), this loss can lead to significant hypotension and pulmonary edema. Clinical Pearl: The NBRC emphasizes the risk of thrombus formation in the atria due to blood stasis. If Afib has persisted for >48 hours, anticoagulation is required before attempting cardioversion to prevent embolic stroke.
A respiratory therapist is preparing to process a reusable laryngoscope blade used during an emergency intubation. According to the Spalding Classification system, how should this device be categorized and what is the minimum level of processing required?
Show answer →Laryngoscope blades are categorized as **Semicritical** items because they come into contact with mucous membranes but do not penetrate sterile tissues. Semicritical items require **High-Level Disinfection (HLD)** at a minimum. Sterilization is preferred if the device is heat-stable. NBRC Tip: Remember that Critical items (e.g., surgical instruments) require sterilization, while Noncritical items (e.g., BP cuffs) require low-level disinfection.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Procedures questions
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