NBRC CRT Exam Flashcards

Q: How many questions are on the NBRC CRT (TMC) exam?

The Therapist Multiple-Choice (TMC) examination has 160 multiple-choice items: 140 scored and 20 unscored pretest items, delivered over 3 hours (about 67.5 seconds per item). Pretest items are not labeled, so every question should be treated as scored. This format applies to candidates testing through December 31, 2026.

Q: What is the difference between the low cut and high cut score?

The TMC uses two cut scores. The low cut score earns the Certified Respiratory Therapist (CRT) credential. The high cut score earns CRT and grants eligibility for the Clinical Simulation Examination (CSE), which must still be passed to complete the RRT pathway under the current 2026 system. The high cut alone does not award RRT before 2027.

Q: What content does the CRT exam cover?

The 2026 TMC detailed content outline has three scored domains: Patient Data Evaluation (50 items, 36%), Troubleshooting and Quality Control of Devices / Infection Control (20 items, 14%), and Initiation and Modification of Interventions (70 items, 50%). The Interventions domain is the largest and highest-yield for study time.

Q: What are the eligibility requirements for the CRT exam?

Candidates must be at least 18 years old and graduate from a CoARC-supported or accredited entry-level respiratory care education program with a minimum associate degree. There is no post-graduate work-experience requirement because the CRT is an entry credential. The TMC fee is $190 for a first attempt and $150 for a repeat attempt.

Q: Is the CRT exam changing in 2027?

Yes. The current 160-item, 3-hour TMC applies through December 31, 2026. Starting in 2027, the NBRC introduces the Respiratory Therapy Examination with 185 items over 4 hours, where the low cut earns CRT and the high cut earns RRT directly. Candidates testing in 2026 should prepare for the TMC format, not the 2027 structure.

Question 1

ABC + Trend Scan Order

Accepted Answer

Read patient data as Airway, Breathing, Circulation, Trend, then Context. The best answer follows the finding that can harm the patient soonest; a worsening trend outranks one isolated abnormal value.

Question 2

High Work of Breathing Signs

Accepted Answer

Accessory muscle use, tripod positioning, and nasal flaring indicate increased work of breathing. Assess severity and support gas exchange rather than treating it as a minor or stable finding.

Question 3

Unilateral Absent Breath Sounds

Accepted Answer

Suggests a tube position problem (right mainstem), pneumothorax, or a mucus plug. Check tube position, pressures, and symmetry clues rather than assuming the lung exam is simply abnormal.

Question 4

Conflicting Findings Rule

Accepted Answer

When two findings conflict, trust the trend that links physiology and appearance. A patient who looks worse, speaks less, or needs more support is worsening even if one displayed value looks stable.

Question 5

Normal Arterial Blood Gas Values

Accepted Answer

pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3- 22-26 mEq/L, PaO2 80-100 mmHg on room air, SaO2 95-100%, base excess -2 to +2 mEq/L. Interpret acid-base, ventilation, and oxygenation as separate questions.

Question 6

Five-Step ABG Method

Accepted Answer

1) Classify pH (acidemic/alkalemic/normal). 2) Check PaCO2 (respiratory component). 3) Check HCO3- (metabolic component). 4) Decide if compensation is present. 5) Interpret oxygenation. Name the primary disturbance first.

Question 7

Respiratory Acidosis

Accepted Answer

Low pH with high PaCO2 (>45 mmHg) from hypoventilation (COPD, sedation, neuromuscular weakness). Acute uncompensated example: pH 7.25, PaCO2 62, HCO3- 26. CO2 retention lowers pH—support ventilation.

Question 8

Compensation Check

Accepted Answer

Compensation moves pH back toward normal but not past it. If pH is still acidemic, the primary problem is an acidosis even after the compensating value shifts. If PaCO2 and HCO3- move so pH worsens, suspect a mixed disorder.

Question 9

P/F Ratio

Accepted Answer

PaO2 divided by FiO2 expressed as a decimal (e.g., FiO2 0.50). It exposes oxygenation impairment hidden by high oxygen settings—a normal PaO2 on high FiO2 can still represent severe gas-exchange failure.

Question 10

SpO2 Does Not Equal Oxygen Content

Accepted Answer

An acceptable SpO2 does not guarantee adequate oxygen delivery when hemoglobin is low or abnormal hemoglobins are present. Low hemoglobin reduces oxygen content and can explain dyspnea despite a reassuring saturation.

Question 11

PFT Interpretation Sequence

Accepted Answer

Start with FEV1/FVC for obstruction, TLC for restriction, bronchodilator response for reversibility, and DLCO for diffusion. A reduced FEV1/FVC ratio points to an obstructive pattern.

Question 12

Lab Clues That Change the Respiratory Picture

Accepted Answer

Low hemoglobin lowers oxygen content; elevated WBC with neutrophils supports a bacterial pattern; elevated BNP supports heart-failure edema; elevated lactate raises shock/sepsis concern. Use labs as support, not isolated answers.

Question 13

Hyperkalemia vs Hypokalemia on ECG

Accepted Answer

Hyperkalemia: tall peaked T waves and widening QRS (urgent conduction/arrest risk). Hypokalemia: flattened T waves and ST depression with weakness and dysrhythmia risk that can worsen ventilation.

Question 14

Right-Heart Strain ECG Clues

Accepted Answer

Right axis deviation, a tall R wave in V1, or peaked P waves support chronic lung disease, pulmonary hypertension, or cor pulmonale. ST changes with dyspnea may point to cardiac ischemia instead of a primary lung problem.

Question 15

Recommendation Ladder

Accepted Answer

Verify (sample/probe/device), Stabilize (treat ABC threats), Classify (the dominant problem), Match (the targeted action), Reassess (response data). The recommendation should solve the verified problem, not decorate it.

Question 16

Oxygen Does Not Fix Hypoventilation

Accepted Answer

More oxygen corrects hypoxemia but not CO2 retention. Drowsiness, acidemia, and rising PaCO2 call for ventilatory support, not just a higher FiO2—matching the action to the cause is the tested skill.

Question 17

Verify Data Before Acting

Accepted Answer

When a measurement conflicts with the patient, device setup, or sampling method, check sample quality, probe placement, oxygen source, and patient identity before changing therapy on a possibly artifactual value.

Question 18

Low-Flow vs Fixed-Performance Oxygen

Accepted Answer

Low-flow systems (nasal cannula, simple mask, non-rebreather) deliver variable FiO2 that changes with breathing pattern. Fixed-performance systems (Venturi mask, blender, HFNC) deliver a more controlled FiO2.

Question 19

Simple Mask Minimum Flow

Accepted Answer

A simple mask must run at least 5 L/min to flush exhaled CO2 from the mask and prevent rebreathing. Too little flow allows CO2 accumulation—an exam trap when flow is set too low.

Question 20

Venturi Mask Use

Accepted Answer

The exam choice when a precise, fixed FiO2 matters—especially in COPD with CO2-retention risk needing controlled titration. Blocked entrainment ports change the delivered FiO2.

Question 21

Non-Rebreather Mask Troubleshooting

Accepted Answer

Delivers high FiO2 for severe hypoxemia while definitive care is prepared. A collapsed reservoir bag means troubleshoot flow and valves first—keep the bag inflated with high flow.

Question 22

CPAP vs BiPAP Selection

Accepted Answer

CPAP recruits alveoli in an alert patient with cardiogenic pulmonary edema. BiPAP (bilevel) adds inspiratory support for hypercapnia with spontaneous breathing—both require an intact, protectable airway and cooperation.

Question 23

Bland Aerosol / Large-Volume Nebulizer

Accepted Answer

Used for aerosolized humidity, often via trach collar. Watch FiO2 accuracy and adequate total flow; a weak mist or heavy rainout signals a device or flow problem to troubleshoot.

Question 24

Heat-Moisture Exchanger (HME) Limits

Accepted Answer

Appropriate for short-term ventilation with stable secretions. It adds dead space and resistance and can become wet or plugged—rising pressure or thick secretions means switch to active heated humidification.

Question 25

Why Bypassed Airways Need Humidification

Accepted Answer

An endotracheal or tracheostomy tube bypasses the upper airway's warming and humidifying function. Dry gas thickens secretions, increases airway resistance, injures mucosa, and risks tube obstruction.

Question 26

MDI Spacer Benefit

Accepted Answer

A spacer reduces the timing/coordination demand of a metered-dose inhaler and decreases oropharyngeal deposition. It is the device fix for poor hand-breath coordination—one actuation at a time.

Question 27

Albuterol Response vs Side Effects

Accepted Answer

A short-acting beta agonist works if peak flow improves, wheeze and accessory use decrease, and the patient speaks more easily. Tachycardia and tremor are adverse effects, NOT proof of therapeutic success.

Question 28

Ipratropium Eye Precaution

Accepted Answer

Ipratropium is an anticholinergic bronchodilator often paired with a beta agonist in COPD exacerbations. Avoid spraying it in the eyes—it can cause irritation and worsen narrow-angle glaucoma symptoms.

Question 29

Racemic Epinephrine Indication

Accepted Answer

Used for upper-airway edema with stridor (e.g., post-extubation, croup). Monitor for rebound symptoms after the effect wears off and watch heart rate during and after delivery.

Question 30

Heliox Limitation

Accepted Answer

A helium-oxygen mix can reduce work of breathing in upper-airway obstruction or severe airflow limitation, but only when the patient's oxygen requirement is low enough to allow a helium-rich mixture.

Question 31

Oropharyngeal vs Nasopharyngeal Airway

Accepted Answer

An oral airway is for an unconscious patient WITHOUT a gag reflex. A nasal airway is better tolerated when a gag reflex is present—avoid the nasal route with suspected basilar skull fracture or severe midface trauma.

Question 32

ET Tube Position Confirmation

Accepted Answer

Confirm with symmetric chest rise, bilateral breath sounds, absent gastric sounds, exhaled CO2 detection, improving oxygenation, and chest radiograph. Exhaled CO2 is especially important immediately after placement.

Question 33

ET Tube Tip Position

Accepted Answer

A common adult ET tube tip target is about 2-6 cm above the carina on chest radiograph. Absent left-sided breath sounds with louder right-sided sounds suggests right mainstem placement—withdraw slightly per protocol.

Question 34

Adult Cuff Pressure Target

Accepted Answer

Adult endotracheal or tracheostomy cuff pressure is commonly maintained around 20-30 cmH2O to limit air leak while reducing tracheal mucosal injury from excessive pressure.

Question 35

Suctioning Safety

Accepted Answer

Suction based on clinical need (not a fixed schedule), use an appropriate catheter size, and stop if severe hypoxemia, bradycardia, or distress develops. Reoxygenate and reassess before resuming.

Question 36

Ventilator Alarm First Response

Accepted Answer

Never silence an alarm as the primary action. Assess the patient first; if deteriorating, disconnect and manually ventilate with 100% oxygen while the airway, circuit, gas source, and ventilator are checked.

Question 37

High-Pressure Alarm Causes

Accepted Answer

Increased resistance or decreased compliance: secretions, bronchospasm, biting, coughing, water in tubing, kinks, or pneumothorax. First move: assess patient, airway, and tubing and evaluate the need for suctioning.

Question 38

Low-Pressure / Low-Volume Alarm Causes

Accepted Answer

Gas is escaping or not delivered: circuit disconnection, loose connection, circuit or cuff leak, low supply pressure, or exhalation-valve issue. First move: reconnect and inspect from airway to machine.

Question 39

Peak vs Plateau Pressure

Accepted Answer

High peak pressure with a normal plateau suggests an airway-resistance problem (secretions, bronchospasm, kink). High peak AND high plateau suggests decreased compliance or overdistention.

Question 40

Volume Control vs Pressure Control

Accepted Answer

Volume control sets tidal volume and minute ventilation directly (pressure varies). Pressure control sets inspiratory pressure (tidal volume varies). Choose the mode by the problem you must guarantee.

Question 41

Oxygenation vs Ventilation Knobs

Accepted Answer

Oxygenation is managed mainly with FiO2 and PEEP (mean airway pressure). Ventilation (CO2) is managed mainly with minute ventilation—rate and tidal volume changes. Match the setting to the problem.

Question 42

Lung-Protective Ventilation in ARDS

Accepted Answer

Favor low tidal volume around 6 mL/kg ideal body weight and plateau pressure at or below 30 cmH2O. Permissive hypercapnia may be acceptable when pH is tolerable and oxygenation is managed safely.

Question 43

Initial Tidal Volume and PEEP

Accepted Answer

Tidal volume is based on ideal body weight, not actual weight—commonly 6-8 mL/kg, with ~6 mL/kg when ARDS or poor compliance is present. PEEP often starts near 5 cmH2O unless oxygenation requires more.

Question 44

Weaning Readiness Criteria

Accepted Answer

The original problem improving, stable oxygenation on modest FiO2/PEEP, hemodynamic stability, adequate mental status and airway protection, manageable secretions, and enough strength to breathe spontaneously.

Question 45

Rapid Shallow Breathing Index (RSBI)

Accepted Answer

Respiratory rate divided by tidal volume in liters. A value below approximately 105 is a favorable weaning sign, but it must be interpreted with the full clinical picture, not used alone.

Question 46

Spontaneous Breathing Trial Failure Signs

Accepted Answer

Rising respiratory rate (e.g., above ~35/min with distress), falling SpO2, rising PaCO2, tachycardia, hypertension, diaphoresis, anxiety, or accessory use. Return the patient to support and evaluate the cause.

Question 47

DOPE Mnemonic

Accepted Answer

For acute deterioration on a ventilator: Displacement of the tube, Obstruction (secretions/kink/biting), Pneumothorax, Equipment failure. Run DOPE with ABC before fine-tuning routine settings.

Question 48

E-Cylinder Full Pressure & Duration

Accepted Answer

A full oxygen E cylinder is about 2200 psig. Duration problems use usable cylinder pressure times the cylinder factor divided by the flow rate—replace before pressure is unsafe for transport.

Question 49

Compressed Gas Cylinder Safety

Accepted Answer

Secure storage upright and chained, no oil or grease near oxygen fittings, correct regulator assembly, leak checks, and timely replacement before pressure becomes unsafe for transport.

Question 50

C. difficile Hand Hygiene

Accepted Answer

C. difficile requires soap-and-water hand hygiene after care because alcohol-based hand rub does not reliably remove spores. Use gown and gloves and treat as an enteric contact precaution.

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