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Free RRT practice questions

Five free practice questions for the RRT and the 2027 NBRC Respiratory Therapy Examination, each with an explanation. They are original items written to the 2027 content outline, not real or recalled exam questions. There are 50 more free in the app, no account needed.

1. ABGs

A patient with diabetic ketoacidosis has: pH 7.28, PaCO2 30 mm Hg, HCO3- 14 mEq/L. Using Winter's formula, how should the respiratory response be described?

  1. A concurrent respiratory acidosis (inadequate compensation)
  2. A concurrent respiratory alkalosis (excessive compensation)
  3. Fully compensated metabolic acidosis
  4. Appropriate respiratory compensation for the metabolic acidosis
Show answer and explanation

Answer: D. Winter's formula estimates the expected PaCO2 in metabolic acidosis: expected PaCO2 = (1.5 x HCO3-) + 8 +/- 2 = (1.5 x 14) + 8 = 29 +/- 2, i.e., 27-31 mm Hg. The measured PaCO2 of 30 is inside that range, so the respiratory response is appropriate. The pH is still acidemic, so it is partially (not fully) compensated.

Outline: I. Patient Data - D. Evaluate Procedure Results (5. blood gas analysis). Source: Merck Manual: Winter's Formula for Expected PCO2

2. Ventilator Management

Over one hour, a ventilated patient's peak inspiratory pressure rises from 28 to 40 cm H2O while the plateau pressure stays at 20-21 cm H2O. Coarse rhonchi are heard bilaterally. What is the most appropriate action?

  1. Prepare for needle decompression of a pneumothorax
  2. Suction the artificial airway
  3. Increase PEEP by 5 cm H2O
  4. Withdraw the endotracheal tube 2 cm for suspected right mainstem intubation
Show answer and explanation

Answer: B. A rising PIP with a stable plateau pressure means the PIP-Pplat difference (resistive pressure) went up: a problem with airway resistance (secretions, bronchospasm, kinked or bitten tube), not lung compliance. With rhonchi, secretions are the most likely cause, so suctioning is the best first step.

Outline: II. Management of Devices and Patient Safety Procedures - A. Troubleshoot Devices During and After Assembling (9. mechanical ventilators). Source: StatPearls: Physiology, Airflow Resistance

3. Oxygen Therapy

A patient with COPD and known chronic hypercapnia is on a 6 L/min nasal cannula. SpO2 is 99%, and the nurse reports he is harder to wake than an hour ago. What is the most appropriate first action?

  1. Discontinue oxygen and recheck the SpO2 in 15 minutes
  2. Change to a nonrebreather mask to protect oxygenation
  3. Titrate oxygen to an SpO2 of 88-92% and obtain an ABG
  4. Increase the cannula to 8 L/min and recheck the SpO2
Show answer and explanation

Answer: C. In patients at risk for hypercapnic respiratory failure, excessive oxygen can worsen CO2 retention (mainly through V/Q changes and the Haldane effect). Drowsiness raises concern for rising PaCO2. GOLD recommends a target SpO2 of 88-92% in this group; titrate (don't stop) oxygen and check an ABG to look for hypercapnia and acidosis.

Outline: III. Initiation and Modification of Interventions - E. Make or Recommend Changes to the Respiratory Care Plan (2k. oxygen therapy). Source: GOLD 2026 Report

4. Neonatal & Pediatrics

At 1 minute, a newborn has a heart rate of 90/min, slow irregular respirations, some flexion of the extremities, a grimace with suctioning, and a pink body with blue extremities. What is the 1-minute Apgar score?

  1. 6
  2. 7
  3. 5
  4. 3
Show answer and explanation

Answer: C. Score each sign 0-2: heart rate <100 = 1; slow/irregular respirations = 1; some flexion = 1; grimace = 1; pink body with blue extremities (acrocyanosis) = 1. Total = 5. Note: resuscitation decisions are based on breathing, heart rate, and tone, not the Apgar score.

Outline: I. Patient Data - A. Evaluate Data in the Patient Record (5. maternal and perinatal/neonatal history: APGAR). Source: ACOG/AAP Committee Opinion 644: The Apgar Score

5. Ethics & Professional Practice

An alert, oriented adult with asthma refuses a scheduled albuterol treatment after you explain why it was ordered. What should the respiratory therapist do?

  1. Respect the refusal, chart it, and notify the provider
  2. Ask a family member to give consent for the treatment
  3. Skip the treatment without telling anyone or charting it
  4. Give the treatment anyway because it was ordered
Show answer and explanation

Answer: A. A competent adult has the right to refuse treatment. The therapist explains the purpose and risks of refusing, then respects the decision, documents the refusal and the education given, and informs the ordering provider.

Outline: III. Initiation and Modification of Interventions - I. Interact with Team Members, Patients, and Families (1.e patient-centered interactions; ethics: refusal of treatment). Source: AARC Statement of Ethics and Professional Conduct

Practice it now. Get 50 free questions with a rationale for every choice, 3 full clinical-judgment cases, a 50-item mock in the 2027 format, and a heat map of every outline section.
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Also use the official free practice exam

The NBRC offers a free RT practice examination, built with the same software as the real exam, so you can get used to the content and question types.[2][1] It is copyrighted, so we never copy or paraphrase its items. Take it, then use TidalPrep to drill the outline sections where you were weakest.[3]

Sources

  1. NBRC: Free practice exams
  2. NBRC: CRT and RRT, RT Examination page and FAQs
  3. NBRC: The Respiratory Therapy Examination Detailed Content Outline, effective January 2027 (PDF)

Exam facts on this page come from nbrc.org and were last checked on October 30, 2026. The NBRC can change its policies at any time, so confirm details on nbrc.org before you apply or test. Written by Noel Navarro, a practicing respiratory therapist who built TidalPrep.