The RRT (Registered 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 RRT (Registered Respiratory Therapist) questions, with the answers hidden until you want them — covering Diagnostics, Procedures, 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.
20
Questions here
1040
Total RRT cards
$7
Full access
Answer each one before opening it. Keep score as you go.
A 68-year-old patient with a history of chronic bronchitis presents with a Hematocrit (Hct) of 58% and Hemoglobin (Hb) of 19 g/dL. What is the most likely physiological cause for these findings?
Show answer →These findings indicate secondary polycythemia. In patients with chronic hypoxemia (common in COPD/bronchitis), the kidneys stimulate erythropoietin production to increase RBC count and oxygen-carrying capacity. NBRC Exam Tip: While this increases CaO2, it also increases blood viscosity, which can lead to increased pulmonary vascular resistance and right heart strain (Cor Pulmonale). Normal Hb: 12-16 g/dL (female), 14-18 g/dL (male). Normal Hct: 37-47% (female), 42-52% (male).
A patient presenting with an acute asthma exacerbation has a normal total WBC count, but the differential shows 9% eosinophils. What is the clinical significance of this finding?
Show answer →Eosinophilia (normal is 1-4%) is frequently associated with allergic responses, extrinsic asthma, or parasitic infections. NBRC Exam Tip: When you see increased eosinophils in an asthma scenario, the NBRC is often testing your knowledge of the need for corticosteroid therapy to treat the underlying airway inflammation. Yellow sputum in these patients may not indicate infection but rather the presence of eosinophils (extrinsic asthma).
A patient in the ICU has a platelet count of 45,000/mcL. The physician orders an arterial blood gas (ABG) to assess ventilation. What is the most appropriate action by the Respiratory Therapist?
Show answer →The RT should alert the physician to the thrombocytopenia (normal: 150,000-400,000/mcL). A count <50,000 indicates a high risk for bleeding. NBRC Exam Tip: If the ABG is essential, the RT must maintain pressure on the puncture site for significantly longer than the standard 5 minutes (often 15+ minutes) or recommend non-invasive monitoring like SpO2 or EtCO2 if appropriate. Avoid ABGs in severe thrombocytopenia unless absolutely necessary.
An intubated patient with suspected VAP has a WBC of 15,000/mm3 with 12% bands and 65% segments. How should the RT interpret the bands value?
Show answer →The presence of increased bands (immature neutrophils) is known as a shift to the left. This indicates that the bone marrow is releasing immature cells to fight a severe, acute bacterial infection or sepsis. NBRC Exam Tip: Normal bands are 0-5%. A shift to the left is a classic indicator of bacterial pneumonia or sepsis. Expect to recommend sputum culture, sensitivity testing, and broad-spectrum antibiotics.
A patient with a SpO2 of 96% on room air has a Hemoglobin of 7 g/dL. Despite the normal saturation, why might the patient exhibit tachycardia and tachypnea?
Show answer →The patient has severe anemia. While the hemoglobin that is present is well-saturated (96%), the total oxygen content (CaO2) is significantly reduced because there is insufficient Hb to carry oxygen to the tissues. NBRC Exam Tip: CaO2 = (Hb x 1.34 x SaO2) + (PaO2 x 0.003). In anemia, the SaO2 looks good, but the patient is tissue hypoxic. The primary treatment is blood transfusion, not just increasing FiO2.
How often is a 1-point calibration typically performed on a blood gas analyzer, and what specific electronic adjustment does it make?
Show answer →Every 30 minutes or before each sample (depending on manufacturer/CLIA). It adjusts the offset or intercept of the electrode's response curve. NBRC Exam Tip: If the analyzer has been idle, a 1-point calibration is the first step before running a patient sample.
A Levey-Jennings chart shows six consecutive PCO2 control values gradually increasing from the mean toward the +2 SD limit. Identify this pattern and its most likely cause.
Show answer →This is a **Trend**. It indicates a gradual loss of reliability in the electrode. Common causes: Electrode aging, protein buildup on the membrane, or deteriorating reagent/buffer. Action: Clean the electrode or replace the membrane. NBRC emphasizes differentiating trends from sudden shifts.
A pH control suddenly jumps from the mean to +1.8 SD and remains there for four consecutive runs. Identify this pattern and name two common causes.
Show answer →This is a **Shift**. It represents a sudden, consistent change in the mean. Causes: New reagent lot, use of an incorrect calibrator gas concentration, or a sudden change in analyzer temperature (heating block failure). Action: Recalibrate the device and re-run controls.
Applying Westgard Rules: Two consecutive Level 2 control runs for PO2 exceed +2 SD, while Level 1 remains at the mean. What is this violation called, and can you report patient results?
Show answer →This is a **2-2s Rule violation** (Systematic Error). The analyzer is out of control. Action: You MUST NOT report patient results. Troubleshoot by checking reagents/membranes, perform a 2-point calibration, and re-run controls until they fall within limits.
Differentiate between a Random Error and a Systematic Error in blood gas QC. Provide one example of each that might appear on the NBRC exam.
Show answer →**Random Error:** Statistical flukes or one-time events (e.g., 1-3s rule). Example: A tiny bubble in the control material. **Systematic Error:** Consistent bias in one direction (e.g., 2-2s, 4-1s, or 10-x). Example: Contaminated buffers or aging electrodes. NBRC Tip: Systematic errors require troubleshooting.
A 62-year-old patient has been intubated for 48 hours. To adhere to the VAP prevention bundle, what is the minimum recommended elevation for the head of the bed (HOB)?
Show answer →The NBRC and CDC guidelines specify a Head of Bed (HOB) elevation of 30-45 degrees. Rational: This position uses gravity to prevent the aspiration of gastric contents and oropharyngeal secretions into the lower airway. Exam Strategy: NBRC often tests this as the first-line, lowest-cost intervention for VAP prevention. If a patient must be flat for a procedure, the RT must ensure it is returned to 30-45 degrees immediately afterward.
A patient is expected to require mechanical ventilation for more than 72 hours. Which specific endotracheal tube feature is recommended by the VAP prevention bundle to reduce the risk of microaspiration?
Show answer →Endotracheal tubes with a dorsal lumen above the cuff for Continuous Aspiration of Subglottic Secretions (CASS) are recommended. Rationale: Secretions pool above the cuff; CASS tubes allow for the removal of these contaminated fluids before they leak into the lungs. Clinical Pearl: Even with CASS, cuff pressure must be maintained at 20-30 cmH2O to ensure an effective seal.
During a routine ventilator check, the RT notes the cuff pressure is 15 cmH2O. What is the appropriate action and the target pressure range to prevent VAP?
Show answer →The RT must increase the cuff pressure to the 20-30 cmH2O range (or 15-22 mmHg). Rationale: Pressures <20 cmH2O significantly increase the risk of silent aspiration of subglottic secretions. Pressures >30 cmH2O risk tracheal mucosal ischemia and necrosis. NBRC Tip: Always prioritize cuff pressure checks after position changes or changes in airway pressures.
According to evidence-based VAE prevention bundles, how frequently should the ventilator circuit be changed for a patient with no visible soilage?
Show answer →Ventilator circuits should NOT be changed routinely; they should only be changed when visibly soiled or malfunctioning. Rationale: Frequent circuit breaks increase the risk of introducing pathogens into the lower respiratory tract and cause transient loss of PEEP/lung recruitment. NBRC emphasizes if it isn't broken, don't fix it to minimize VAP/VAE risks.
A patient with COPD states they take two puffs of Spiriva every 4 hours. Their home bottle confirms Tiotropium 18 mcg once daily. What is the priority action for the RT during medication reconciliation?
Show answer →Identify this as a medication discrepancy and notify the provider/pharmacist. Tiotropium (Spiriva) is a Long-Acting Muscarinic Antagonist (LAMA) with a 24-hour duration. Dosing it Q4H is a significant safety risk and indicates the patient likely confuses it with their rescue SABA. NBRC Tip: Always distinguish between maintenance (LAMA/LABA) and rescue medications; patients frequently confuse frequency, leading to toxicity or poor control.
A home care patient uses a 5 L/min oxygen concentrator. During a power failure, the patient switches to an E-cylinder (factor 0.28) with 1500 psi. How long will this backup supply last?
Show answer →The backup will last 84 minutes. Calculation: (1500 psi x 0.28) / 5 L/min = 84 minutes. Clinical Pearl: RTs must ensure home patients have a redundant supply and know the duration. NBRC emphasizes safety planning. If the duration is insufficient for the expected outage, the patient needs emergency transport or a larger backup (H-cylinder).
A 28-week GA neonate presents with grunting, nasal flaring, and retractions shortly after birth. CXR shows diffuse ground-glass opacities and air bronchograms. What is the primary pathophysiological defect?
Show answer →Respiratory Distress Syndrome (RDS) is primarily caused by surfactant deficiency (Type II pneumocytes). This leads to high surface tension, decreased lung compliance, and widespread atelectasis. Key NBRC Focus: RDS typically presents within minutes to hours of birth. The ground-glass appearance is pathognomonic. Strategy: Distinguish from Transient Tachypnea of the Newborn (TTN), which presents with streaky hilum and fluid in fissures and usually resolves in 24-72 hours.
A post-term neonate born through meconium-stained fluid develops severe respiratory distress. The RT notes increased AP diameter and hyperresonance. What mechanical phenomenon explains the air trapping seen in this pathology?
Show answer →The Ball-Valve effect. Meconium particles allow air entry during inspiration (airways dilate) but obstruct air exit during expiration (airways constrict), leading to hyperinflation and increased risk of pneumothorax. Pathophysiology also includes chemical pneumonitis and surfactant inactivation. NBRC Tip: MAS is often associated with Persistent Pulmonary Hypertension of the Newborn (PPHN) due to hypoxic pulmonary vasoconstriction and right-to-left shunting.
A 65-year-old COPD patient presents with acute dyspnea and wheezing. HR is 105 bpm. What is the NBRC-recommended first-line pharmacological intervention for immediate relief?
Show answer →The gold standard for acute COPD exacerbation is the combination of a SABA (Albuterol) and a SAMA (Ipratropium Bromide), often delivered via SVN as DuoNeb or MDI as Combivent. Rationale: SABAs provide rapid bronchodilation via B2 stimulation, while SAMAs block cholinergic-induced bronchoconstriction. Synergy is proven to improve FEV1 more than either agent alone in COPD. Exam Tip: NBRC often asks for the most effective combo; for COPD, think Albuterol + Atrovent. For asthma, SABA is the primary rescue, with SAMA added for severe cases.
A patient with acute asthma has a HR of 142 bpm. The physician orders 2.5mg Albuterol. What is the most appropriate recommendation by the RT to minimize further tachycardia while treating bronchospasm?
Show answer →Recommend Levalbuterol (Xopenex) 0.63mg or 1.25mg. Rationale: Albuterol is a racemic mixture of R-albuterol (bronchodilator) and S-albuterol (associated with side effects like tachycardia and inflammation). Levalbuterol is the pure R-isomer, offering similar bronchodilation with potentially fewer B1-mediated cardiac side effects. Exam Tip: If HR increases >20 bpm from baseline during treatment, NBRC expects you to stop the treatment and notify the physician. Switching to Levalbuterol is a standard clinical recommendation for patients with pre-existing cardiac irritability.
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.
Diagnostics questions
Free RRT practice on this topic →
Procedures questions
Free RRT practice on this topic →
Management questions
Free RRT practice on this topic →
Assessment questions
Free RRT practice on this topic →
Pathology questions
Free RRT practice on this topic →
Liked the free cards?
Try free first. Pay once only if it helps you study.
One-time payment · less than 1¢ per card · 30-day money-back guarantee
Try 30 free RRT cards firstIt is 20 real question-and-answer cards from our 1040-card RRT deck, mixed across topics so it feels like the breadth of the exam. It is not the official NBRC exam and is not endorsed by NBRC — for the official outline and any official practice material, go to NBRC directly.
Use the bands on this page as study guidance, not as a pass mark: we do not publish a passing score for the RRT because NBRC sets it, and it can change. Confirm the current standard in the official handbook.
No — deliberately. The 30 cards on the free RRT preview page and these 20 questions do not overlap, so you get 50 free questions across the two pages.
A one-time $7 for all 1040 cards — no subscription, lifetime access, and a 30-day money-back guarantee if it does not help.
Eligibility rules, fees, question counts and passing standards are set by the certifying body and change over time. Always confirm them at the source before you apply or schedule your exam — our flashcards are practice material, not the official handbook.