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100+ Free RRT-ACCS Practice Questions

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A patient is undergoing a 30-minute SBT on PSV 5/PEEP 5. Which finding indicates SBT failure?

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2026 Statistics

Key Facts: RRT-ACCS Exam

170

Total Questions

NBRC

150

Scored Items

NBRC

4 hours

Time Limit

NBRC

$300

New Applicant Fee

NBRC 2026

61.0%

2024 New-Candidate Pass Rate

NBRC 2024 Exams in Review

PSI

Testing Centers

NBRC

RRT 1+ yr

Prerequisite

NBRC

1,093

ACCS Exams Given in 2024

NBRC 2024 Exams in Review

The NBRC ACCS exam contains 170 multiple-choice items (150 scored + 20 pretest) administered via linear-on-the-fly testing at PSI over 4 hours. The August 2026 outline weights Respiratory Critical Care at 80 of 150 items (airways, vent/oxygenation/synchrony, specialty inhalants, pharmacologic agents) and General Critical Care at 70 of 150 items (non-pulmonary systems, contributors to respiratory failure, labs, imaging, sedation, sepsis, end-of-life, procedures, troubleshoot systems, continuous improvement). At least 5 items per minipool engage medical ethics. Candidates must hold the RRT credential at least one year before applying.

Sample RRT-ACCS Practice Questions

Try these sample questions to test your RRT-ACCS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old intubated ICU patient with retained secretions cannot tolerate routine endotracheal suctioning because of severe oxygen desaturation. Which intervention best maintains oxygenation while clearing secretions?
A.Switch to open-circuit suctioning at 200 mm Hg
B.Use a closed in-line (closed-circuit) suction catheter
C.Increase suction duration to 30 seconds per pass
D.Stop PEEP just before each suction pass
Explanation: Closed in-line suction catheters allow secretion removal without disconnecting the patient from the ventilator, preserving PEEP, FiO2, and lung volume. AARC airway clearance guidelines recommend them for patients who desaturate or are hemodynamically unstable with routine open suctioning. Each pass should remain less than 15 seconds.
2An adult with anticipated difficult intubation has a Mallampati IV, restricted mouth opening, and limited neck extension. Which device is most appropriate to load on the endotracheal tube to aid first-pass success?
A.Stylet bent to a 35 degree hockey-stick
B.Gum elastic bougie
C.Magill forceps
D.Laryngeal mask airway as a primary tube
Explanation: A gum elastic bougie (Eschmann introducer) is advanced into the trachea first when only the epiglottis is visible (Cormack-Lehane III) and the tube is railroaded over it. It is one of the most commonly cited rescue tools in difficult-airway algorithms because it improves first-pass success without surgical access.
3During rapid sequence intubation of a 90 kg adult, the operator asks for cricoid pressure. The most appropriate teaching point about cricoid (Sellick) maneuver is that it:
A.Should be applied with 30 to 40 N of force at the cricoid cartilage
B.Should be applied at the thyroid cartilage
C.Eliminates the need to confirm tube placement with capnography
D.Should be released only after intubation if vomiting occurs
Explanation: Sellick maneuver is performed with approximately 10 N of force pre-induction increasing to roughly 30 to 40 N once the patient is unconscious, applied to the cricoid cartilage to compress the esophagus. It is intended to reduce passive regurgitation, but recent evidence is mixed and it should be released if it impairs the laryngeal view.
4A patient who is mechanically ventilated requires ongoing sedation but is having frequent ventilator dyssynchrony with biting on the endotracheal tube. The team plans to exchange the standard oral ETT for a wire-reinforced (armored) tube. The primary advantage of a wire-reinforced tube is that it:
A.Resists kinking and external compression
B.Has integrated subglottic suction
C.Allows lung isolation
D.Eliminates the need for cuff pressure monitoring
Explanation: Wire-reinforced (armored) endotracheal tubes contain a metal coil within the wall that resists kinking from biting, neck flexion, or surgical positioning. They are common in prone ARDS, neurosurgery, and other settings where tube compression is a risk.
5A patient is undergoing one-lung ventilation for a left thoracotomy with a left-sided double-lumen endobronchial tube. SpO2 falls to 85% on FiO2 1.0 with the right (nondependent) lung deflated. The most appropriate first respiratory therapist intervention is to:
A.Apply CPAP 5 to 10 cm H2O to the nondependent lung
B.Increase tidal volume on the dependent lung to 12 mL/kg
C.Re-inflate the nondependent lung and abandon one-lung ventilation
D.Switch to volume-controlled ventilation with zero PEEP
Explanation: During one-lung ventilation, the first hypoxemia rescue is to apply 5 to 10 cm H2O CPAP to the nondependent (collapsed) lung while continuing two-lung physiology in the dependent lung. This recruits the operative lung without committing to two-lung ventilation. Other steps include increasing dependent-lung PEEP and confirming tube position with bronchoscopy.
6A patient with subglottic stenosis is scheduled for bronchoscopy. Which tracheostomy tube is most appropriate to allow the patient to phonate when the cuff is deflated?
A.A standard cuffed nonfenestrated tube
B.A speaking valve placed on a cuffed inflated tube
C.A fenestrated tracheostomy tube
D.A T-tube spanning the entire trachea
Explanation: A fenestrated tracheostomy tube has an opening in the outer cannula above the cuff. With the cuff deflated and the inner cannula removed (or replaced with a fenestrated inner cannula), exhaled gas passes through the fenestration and the upper airway, enabling phonation.
7An ICU patient with a 7.5 mm orotracheal tube has developed a leak around the cuff that does not resolve at the maximum recommended cuff pressure. After confirming the cuff is intact, which procedure is most appropriate?
A.Increase cuff pressure to 50 cm H2O
B.Use an airway exchange catheter to swap to a larger ETT
C.Cut and shorten the existing tube to reposition the cuff
D.Convert immediately to a surgical tracheostomy
Explanation: Persistent cuff leak after ruling out a defective cuff often reflects a tube that is too small for the trachea or a malpositioned cuff. The safest exchange uses a hollow airway exchange catheter (AEC) so the patient can be oxygenated through the catheter if reintubation fails.
8Routine measurement of endotracheal tube cuff pressure on rounds shows a value of 35 cm H2O. The most appropriate action is to:
A.Document and recheck in 8 hours
B.Add air until the leak disappears
C.Remove air to bring pressure into the 20 to 30 cm H2O range
D.Replace the tube immediately
Explanation: Recommended cuff pressures are 20 to 30 cm H2O (about 15 to 22 mm Hg) to seal the airway while preserving tracheal mucosal capillary perfusion (~30 mm Hg). Pressures above 30 cm H2O risk ischemia, tracheal stenosis, and tracheoesophageal fistula.
9A 72-year-old with COPD exacerbation needs noninvasive ventilation. After 90 minutes of bilevel pressure support, pH is 7.18, PaCO2 92 mm Hg, and the patient is increasingly somnolent. The most appropriate next step is to:
A.Increase IPAP/EPAP and reassess in 60 minutes
B.Switch to a heated high-flow nasal cannula at 60 L/min
C.Intubate and initiate invasive mechanical ventilation
D.Add helium-oxygen 80:20 by mask
Explanation: NIV failure markers include worsening pH, persistent hypercapnia, and declining mental status. With pH below 7.20, somnolence, and progressive hypercapnia despite optimal NIV, intubation is indicated to protect the airway and provide controlled ventilation.
10A respiratory therapist is preparing an awake fiberoptic intubation in a patient with rheumatoid cervical instability. To facilitate the procedure, which topical agent provides effective laryngotracheal anesthesia?
A.Nebulized 4% lidocaine
B.Nebulized racemic epinephrine
C.Aerosolized albuterol
D.Topical bupivacaine 0.5%
Explanation: Nebulized 4% lidocaine produces topical anesthesia of the upper airway and trachea before awake intubation, supplemented by superior laryngeal nerve blocks or transtracheal lidocaine. The maximum total dose for adults is approximately 4 to 5 mg/kg.

About the RRT-ACCS Exam

The RRT-ACCS is an NBRC specialty credential for Registered Respiratory Therapists working in adult intensive care. It validates advanced competency in airway management, advanced mechanical ventilation, ECMO, hemodynamics, sepsis, end-of-life care, and ICU procedures.

Questions

170 scored questions

Time Limit

4 hours

Passing Score

NBRC standard-setting cut score (not publicly listed)

Exam Fee

$300 ($250 reapplicant) (NBRC)

RRT-ACCS Exam Content Outline

80 items (53%)

Respiratory Critical Care

Manage airways (24), apply techniques to enhance ventilation/oxygenation/synchrony (48), administer specialty inhalants (4), and deliver pharmacologic agents (4) in adult ICU patients.

70 items (47%)

General Critical Care

Evaluate non-pulmonary systems (6), manage contributors to respiratory failure (15), anticipate care from labs (9) and imaging (4), anticipate effects of pharmacologic agents (8), nutritional status (2), infections/sepsis (4), end-of-life (3), disaster (2), interdisciplinary teams (3), procedures (4), troubleshoot systems (6), and support continuous improvement (4).

How to Pass the RRT-ACCS Exam

What You Need to Know

  • Passing score: NBRC standard-setting cut score (not publicly listed)
  • Exam length: 170 questions
  • Time limit: 4 hours
  • Exam fee: $300 ($250 reapplicant)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

RRT-ACCS Study Tips from Top Performers

1Master the ARDSNet protocol: 6 mL/kg PBW tidal volume, plateau pressure 30 cm H2O or less, both PEEP/FiO2 tables, and permissive hypercapnia targets.
2Memorize PROSEVA prone positioning criteria (PaO2/FiO2 less than 150 with FiO2 0.6 or higher and PEEP 5 or higher) and 16-hour daily session duration.
3Know ELSO V-V ECMO indications (PaO2/FiO2 less than 80, Murray score greater than 3, pH less than 7.25 with PaCO2 60 or more) and V-A indications for refractory cardiogenic shock.
4Drill the Surviving Sepsis 1-hour bundle: lactate, blood cultures before antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid, and norepinephrine to MAP 65 mm Hg.
5Practice sedation/analgesia/delirium bundles: RASS targets, CAM-ICU, daily SAT/SBT pairing, and the ABCDEF approach.
6Allocate ~20 medical-ethics questions per pass — at least 5 ethics items appear on each form.

Frequently Asked Questions

What is the NBRC RRT-ACCS exam format?

The ACCS exam consists of 170 multiple-choice questions (150 scored and 20 pretest) administered over 4 hours by linear-on-the-fly testing at PSI testing centers. At least 5 items on each minipool are tied to medical ethics.

What are the RRT-ACCS exam content domains?

Per the August 2026 outline, Respiratory Critical Care contributes 80 of 150 scored items (Manage Airways 24, Apply Techniques to Enhance Ventilation/Oxygenation/Synchrony 48, Specialty Inhalants 4, Pharmacologic Agents 4) and General Critical Care contributes 70 items (Non-Pulmonary Systems 6, Contributors to Respiratory Failure 15, Labs 9, Imaging 4, Pharmacologic Agents 8, Nutrition 2, Sepsis 4, End-of-Life 3, Disaster 2, Interdisciplinary Team 3, Procedures 4, Troubleshoot Systems 6, Continuous Improvement 4).

How much does the RRT-ACCS exam cost?

The ACCS exam fee is $300 for new applicants and $250 for reapplicants. AARC members may receive a discount on first-time applications. Fees are paid to NBRC when submitting your application before scheduling at PSI.

What are the eligibility requirements for RRT-ACCS?

Candidates must hold the NBRC Registered Respiratory Therapist (RRT) credential and must have held it for at least one year prior to applying for the ACCS examination.

What is the RRT-ACCS pass rate?

Per the 2024 NBRC Examinations in Review, the ACCS new-candidate pass rate was 61.0% and the repeat-candidate pass rate was 36.9%. Pass rates were 65.1% (2022) and 65.4% (2023) for new candidates.

How many ACCS exams were given in 2024?

NBRC administered 1,093 Adult Critical Care Specialist examinations in 2024 and awarded 610 new RRT-ACCS credentials, bringing total RRT-ACCS credentials awarded to 6,801.