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NBRC CRT practice questions

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Question 1Patient Data

Which resting respiratory rate for a healthy adult is within the normal range?

  1. 4 breaths/min
  2. 36 breaths/min
  3. 28 breaths/min
  4. 12 breaths/min Correct answer.

Explanation

The accepted normal adult resting respiratory rate is roughly 12 to 20 breaths per minute. Values below 12 define bradypnea and values above 20 define tachypnea, and either finding requires further evaluation of the patient.

Question 2Patient Data

Which resting heart rate is within normal limits for a healthy adult?

  1. 112 beats/min
  2. 140 beats/min
  3. 38 beats/min
  4. 72 beats/min Correct answer.

Explanation

The normal adult resting heart rate is approximately 60 to 100 beats per minute. Rates outside this window are described as bradycardia or tachycardia and should be correlated with the patient's clinical status.

Question 3Patient Data

Which breath sound is most consistent with secretions in the larger airways?

  1. Vesicular sounds over the periphery
  2. A pleural friction rub
  3. Fine crackles at both bases
  4. Coarse rhonchi clearing with cough Correct answer.

Explanation

Coarse, low-pitched rhonchi arise from turbulent flow through secretions in the larger airways and typically change or clear after coughing. Vesicular sounds are normal, fine crackles suggest distal airway or alveolar fluid, and a friction rub arises from inflamed pleura.

Question 4Patient Data

Which SpO2 range is generally considered normal for a healthy adult breathing room air at sea level?

  1. 95% to 100% Correct answer.
  2. 80% to 84%
  3. 85% to 89%
  4. 70% to 79%

Explanation

A healthy adult breathing room air at sea level typically has an SpO2 of about 95% to 100%. Values below roughly 90% represent significant hypoxemia and warrant further assessment and possible oxygen therapy.

Question 5Patient Data

A patient reports shortness of breath that begins when lying flat and resolves on sitting upright. Which term describes this finding?

  1. Platypnea
  2. Orthopnea Correct answer.
  3. Paroxysmal nocturnal dyspnea
  4. Trepopnea

Explanation

Orthopnea is dyspnea produced by the supine position and relieved by sitting or standing upright, and it is commonly graded by the number of pillows required. Platypnea is the opposite pattern, and paroxysmal nocturnal dyspnea refers to episodes that wake the patient from sleep.

Question 6Patient Data

Pulse oximetry directly estimates which of the following?

  1. Arterial carbon dioxide tension
  2. Arterial hemoglobin oxygen saturation Correct answer.
  3. Plasma bicarbonate concentration
  4. Cardiac output

Explanation

A pulse oximeter uses differential light absorption to estimate the percentage of hemoglobin binding sites saturated with oxygen. It provides no information about carbon dioxide, acid-base status, or cardiac output.

Question 7Patient Data

A patient with a long-standing history of COPD typically presents with which chest configuration?

  1. Kyphoscoliosis
  2. Increased anterior-posterior diameter Correct answer.
  3. Flail chest
  4. Pectus excavatum

Explanation

Chronic air trapping in COPD leads to hyperinflation and a barrel chest, in which the anterior-posterior diameter approaches the lateral diameter. Pectus excavatum and kyphoscoliosis are structural deformities, and flail chest follows acute trauma.

Question 8Patient Data

Which oral temperature is within the normal adult range?

  1. 34.4 C (94.0 F)
  2. 35.0 C (95.0 F)
  3. 37.0 C (98.6 F) Correct answer.
  4. 40.0 C (104.0 F)

Explanation

Normal oral temperature is approximately 36.5 to 37.5 C (97.7 to 99.5 F), making 37.0 C (98.6 F) the normal value listed. Lower readings indicate hypothermia and higher readings indicate fever.

Question 9Patient Data

A patient's right chest wall segment moves inward during inspiration while the rest of the chest expands. This finding is most consistent with which condition?

  1. Flail chest Correct answer.
  2. Tension pneumothorax
  3. Atelectasis of the left lung
  4. Pulmonary embolism

Explanation

Paradoxical inward movement of a chest wall segment during inspiration occurs when multiple adjacent ribs are fractured in two places, creating a free-floating segment known as flail chest. The remainder of the chest expands normally while the unstable segment is drawn inward by negative intrathoracic pressure.

Question 10Patient Data

During auscultation the patient says "E" and the clinician hears "A" over the right lower lobe. This finding indicates which of the following?

  1. A normal finding over the trachea
  2. A pneumothorax on that side
  3. Consolidation of the underlying lung Correct answer.
  4. Retained secretions in the airways

Explanation

Egophony is the transformation of a spoken "E" into an "A" sound, produced when sound travels more efficiently through consolidated lung tissue. It is a sign of increased transmission through solid rather than air-filled parenchyma.

Question 11Patient Data

What diaphragmatic excursion is expected during deep breathing in a healthy adult?

  1. 3 to 5 cm Correct answer.
  2. 10 to 12 cm
  3. 1 to 2 cm
  4. 7 to 9 cm

Explanation

Percussion of the diaphragm during deep breathing normally shows about 3 to 5 cm of excursion in a healthy adult. Reduced excursion suggests hyperinflation, phrenic nerve dysfunction, or restrictive disease.

Question 12Patient Data

Digital clubbing is most commonly associated with which of the following?

  1. Simple pneumothorax
  2. Acute asthma exacerbation
  3. Pulmonary embolism
  4. Chronic hypoxemic lung disease Correct answer.

Explanation

Clubbing develops over months to years in association with chronic hypoxemia, most often from cystic fibrosis, bronchiectasis, lung cancer, or congenital heart disease. Acute processes such as asthma, pneumothorax, or embolism do not produce clubbing.

Question 13Patient Data

At what bed position should a patient be placed to assess jugular venous distention?

  1. Trendelenburg with the head low
  2. Prone with the head turned
  3. Supine and flat with legs elevated
  4. Semi-Fowler's at 30 to 45 degrees Correct answer.

Explanation

Jugular venous pressure is assessed with the patient reclined at roughly 30 to 45 degrees so the sternal angle serves as a reproducible reference point. The height of the venous column above the sternal angle estimates right atrial pressure.

Question 14Patient Data

A blood pressure cuff shows a 12 mm Hg fall in systolic pressure during inspiration. This finding is best described as which of the following?

  1. Pulsus alternans
  2. Pulsus paradoxus Correct answer.
  3. A narrowed pulse pressure
  4. A normal inspiratory variation

Explanation

A systolic decline greater than 10 mm Hg during inspiration is termed pulsus paradoxus and reflects impaired right ventricular filling or exaggerated ventricular interdependence. It is classically seen in severe asthma, pericardial tamponade, and constrictive pericarditis.

Question 15Patient Data

Which instruction is most appropriate when collecting a sputum specimen for culture?

  1. Collect the sample immediately after a nebulizer treatment
  2. Collect the sample after the patient has eaten breakfast
  3. Collect saliva in the container and label it as sputum
  4. Rinse the mouth and collect the sample on arising Correct answer.

Explanation

A reliable sputum specimen is obtained on arising, before eating, after rinsing the mouth with water to reduce oral contamination. The patient should be instructed to cough deeply and expectorate material from the lower airway rather than saliva.

Question 16Patient Data

Which end-tidal CO2 value is expected in a healthy, spontaneously breathing adult?

  1. 50 to 55 mm Hg
  2. 35 to 45 mm Hg Correct answer.
  3. 20 to 25 mm Hg
  4. 10 to 15 mm Hg

Explanation

End-tidal CO2 in a healthy adult approximates the arterial CO2 tension at about 35 to 45 mm Hg. Values well below this range suggest hyperventilation, poor perfusion, or a sampling problem, while higher values suggest hypoventilation.

Question 17Patient Data

Which maximum inspiratory pressure (MIP) value is within normal limits for an adult?

  1. +10 cm H2O
  2. -80 cm H2O Correct answer.
  3. -5 cm H2O
  4. -15 cm H2O

Explanation

Normal adult MIP is roughly -60 to -100 cm H2O, and more negative values indicate greater inspiratory muscle strength. A value near -20 to -25 cm H2O or less negative suggests inspiratory muscle weakness.

Question 18Patient Data

Which tool is used to quantify a patient's perceived breathlessness at the bedside?

  1. Modified Borg scale Correct answer.
  2. APACHE II score
  3. Murray lung injury score
  4. Glasgow Coma Scale

Explanation

The modified Borg scale asks the patient to rate the intensity of dyspnea on a numbered categorical scale, allowing change over time or with intervention to be tracked. The other instruments grade consciousness, critical illness severity, and lung injury rather than perceived breathlessness.

Question 19Patient Data

Percussion over the posterior chest produces a dull note over the left base. This finding is most consistent with which of the following?

  1. A left-sided pneumothorax
  2. Fluid or solid tissue in the left pleural space Correct answer.
  3. Normal lung tissue
  4. Hyperinflation of the left lung

Explanation

Percussion over air-filled lung is resonant; dullness indicates that air has been replaced by fluid or solid tissue, as with a pleural effusion, consolidation, or atelectasis. Hyperinflation and pneumothorax instead produce hyperresonance.

Question 20Patient Data

Which assessment finding indicates increased work of breathing in an adult?

  1. Supraclavicular retractions with each breath Correct answer.
  2. Abdominal motion during quiet rest
  3. Symmetric chest expansion
  4. A respiratory rate of 14 breaths/min

Explanation

Retractions occur when accessory muscles pull the compliant chest wall inward to overcome increased resistance or reduced compliance, signaling elevated work of breathing. Normal resting breathing is unlabored, symmetric, and does not draw in the suprasternal or supraclavicular tissues.

Question 21Patient Data

A patient has smoked 1.5 packs per day for 24 years. What is the pack-year history?

  1. 24 pack-years
  2. 16 pack-years
  3. 36 pack-years Correct answer.
  4. 60 pack-years

Explanation

Pack-years are calculated by multiplying packs smoked per day by the number of years smoked, so 1.5 times 24 equals 36 pack-years. This value quantifies cumulative tobacco exposure and is used in risk assessment.

Question 22Patient Data

Deep, rapid respirations with a prolonged inspiratory phase and no pause in a patient with metabolic acidosis describes which pattern?

  1. Kussmaul breathing Correct answer.
  2. Apneustic breathing
  3. Biot's respiration
  4. Cheyne-Stokes respiration

Explanation

Kussmaul breathing is deep and rapid, driven by the respiratory center's attempt to blow off carbon dioxide in metabolic acidosis. It is most often associated with diabetic ketoacidosis and renal failure.

Question 23Patient Data

Which finding meets the criteria for orthostatic hypotension?

  1. Systolic rise of 15 mm Hg with standing
  2. Heart rate rise of 8 beats/min with standing
  3. Systolic drop of 25 mm Hg with standing Correct answer.
  4. Diastolic rise of 10 mm Hg with standing

Explanation

Orthostatic hypotension is defined as a fall in systolic pressure of at least 20 mm Hg or in diastolic pressure of at least 10 mm Hg within three minutes of standing. A compensatory heart rate increase often accompanies the change but is not part of the diagnostic criteria.

Question 24Patient Data

Central cyanosis generally becomes visible when which amount of deoxygenated hemoglobin is present?

  1. 1 g/dL
  2. 10 g/dL
  3. 5 g/dL Correct answer.
  4. 3 g/dL

Explanation

Cyanosis is detected when roughly 5 g/dL or more of hemoglobin is unsaturated, so it depends on the absolute amount of deoxygenated hemoglobin rather than saturation alone. This is why anemic patients may be profoundly hypoxemic without appearing cyanotic.

Question 25Patient Data

A patient with suspected carbon monoxide poisoning has an SpO2 of 99%. How should this reading be interpreted?

  1. Suggestive of device failure that needs repeat testing
  2. Falsely high; carboxyhemoglobin reads as oxyhemoglobin Correct answer.
  3. Reliable evidence of adequate tissue oxygen delivery
  4. Accurate, and it rules out significant hypoxemia

Explanation

Standard pulse oximeters cannot distinguish carboxyhemoglobin from oxyhemoglobin, so a normal reading does not exclude significant impairment of oxygen delivery in carbon monoxide poisoning. A co-oximeter measuring carboxyhemoglobin is required for accurate assessment.

Question 26Patient Data

What is the normal resting respiratory rate for a healthy adult?

  1. 30 to 36 breaths/min
  2. 22 to 28 breaths/min
  3. 12 to 20 breaths/min Correct answer.
  4. 8 to 10 breaths/min

Explanation

The normal adult resting respiratory rate is approximately 12 to 20 breaths/min. Rates below or above this range can reflect sedation, fatigue, pain, fever, or respiratory distress.

Question 27Patient Data

Which resting heart rate range is normal for an adult?

  1. 100 to 140 beats/min
  2. 60 to 100 beats/min Correct answer.
  3. 40 to 60 beats/min
  4. 80 to 120 beats/min

Explanation

Normal resting heart rate for an adult is about 60 to 100 beats/min. Bradycardia is generally below 60, and tachycardia is above 100.

Question 28Patient Data

Which SpO2 range is generally expected in a healthy adult breathing room air at sea level?

  1. 88% to 92%
  2. 80% to 85%
  3. 90% to 94%
  4. 95% to 100% Correct answer.

Explanation

A healthy adult breathing room air at sea level typically has an SpO2 of 95% to 100%. Values persistently below 90% indicate hypoxemia and warrant evaluation.

Question 29Patient Data

What is the total score range of the Glasgow Coma Scale?

  1. 5 to 20
  2. 0 to 10
  3. 3 to 15 Correct answer.
  4. 1 to 12

Explanation

The Glasgow Coma Scale sums eye (1-4), verbal (1-5), and motor (1-6) scores, giving a total range of 3 to 15. Lower scores indicate a lower level of consciousness.

Question 30Patient Data

Which arterial blood pH range is normal for an adult?

  1. 7.20 to 7.30
  2. 7.30 to 7.35
  3. 7.35 to 7.45 Correct answer.
  4. 7.45 to 7.55

Explanation

Normal arterial pH is 7.35 to 7.45. A pH below 7.35 indicates acidemia, and a pH above 7.45 indicates alkalemia.

Question 31Patient Data

Which PaO2 range is considered normal for a healthy adult breathing room air?

  1. 40 to 60 mm Hg
  2. 20 to 40 mm Hg
  3. 80 to 100 mm Hg Correct answer.
  4. 100 to 120 mm Hg

Explanation

A normal PaO2 for a healthy adult breathing room air is roughly 80 to 100 mm Hg. Values below 60 mm Hg indicate severe hypoxemia.

Question 32Patient Data

Which breath sound is normally heard over the trachea?

  1. Bronchial Correct answer.
  2. Vesicular
  3. Crackles
  4. Pleural friction rub

Explanation

Bronchial breath sounds are normally heard over the trachea because airflow is turbulent in the large central airway. Vesicular sounds are heard over the lung periphery, and crackles or rubs are abnormal.

Question 33Patient Data

Vesicular breath sounds are best heard over which area?

  1. Over the mainstem bronchi
  2. Over the sternum
  3. Over the lung periphery Correct answer.
  4. Over the trachea

Explanation

Vesicular breath sounds are soft, low-pitched, and heard over the lung periphery where airflow reaches small airways and alveoli. They are not the normal sound over the trachea or mainstem bronchi.

Question 34Patient Data

Fine crackles heard at the lung bases during inspiration most often result from which mechanism?

  1. Inflamed pleural surfaces
  2. Opening of collapsed alveoli Correct answer.
  3. Narrowed large airways
  4. Decreased pulmonary compliance

Explanation

Fine crackles occur when collapsed small airways and alveoli pop open during inspiration, often with fluid in the airspaces. They are not caused by pleural inflammation or large-airway narrowing.

Question 35Patient Data

Diffuse expiratory wheezing during auscultation most directly suggests which finding?

  1. Alveolar consolidation
  2. Reduced diaphragmatic excursion
  3. Lower airway narrowing Correct answer.
  4. Pleural fluid

Explanation

Diffuse expiratory wheezing reflects narrowing of lower airways, as in asthma or bronchospasm. Pleural fluid and consolidation produce different auscultatory findings.

Question 36Patient Data

A harsh, high-pitched inspiratory sound heard without a stethoscope most suggests which condition?

  1. Upper airway obstruction Correct answer.
  2. Pulmonary edema
  3. Pleural inflammation
  4. Peripheral airway collapse

Explanation

Stridor is a harsh, high-pitched inspiratory sound caused by obstruction of the upper airway, such as laryngeal edema or a foreign body. It is a sign of a potentially emergent airway problem.

Question 37Patient Data

A grating sound heard during both inspiration and expiration over the lateral chest wall most suggests which finding?

  1. Alveolar fluid
  2. Bronchial obstruction
  3. Pleural inflammation Correct answer.
  4. Air trapping

Explanation

A pleural friction rub is a grating sound heard during both inspiration and expiration when inflamed pleural surfaces rub together. It is not caused by airflow obstruction or alveolar fluid.

Question 38Patient Data

Tactile fremitus is typically increased over an area of lung affected by which process?

  1. Consolidation Correct answer.
  2. Pleural effusion
  3. Pneumothorax
  4. Hyperinflation

Explanation

Consolidated lung tissue transmits vocal and tactile vibrations more readily, increasing tactile fremitus. Air or fluid in the pleural space tends to reduce transmission.

Question 39Patient Data

Tracheal deviation toward the affected side is most consistent with which finding?

  1. Flail chest
  2. Large pleural effusion
  3. Atelectasis Correct answer.
  4. Tension pneumothorax

Explanation

Atelectasis causes volume loss in the affected lung, which pulls the mediastinum and trachea toward that side. Space-occupying processes such as tension pneumothorax or large effusion push the trachea away.

Question 40Patient Data

What bladder width is recommended for an appropriately sized blood pressure cuff?

  1. About 60% of the arm circumference
  2. About 40% of the arm circumference Correct answer.
  3. About 80% of the arm circumference
  4. About 20% of the arm circumference

Explanation

A blood pressure cuff bladder should be about 40% of the arm circumference in width and about 80% in length. A cuff that is too narrow or short can falsely elevate the reading.

Question 41Patient Data

A sputum specimen that is thick, yellow-green, and purulent most likely indicates which finding?

  1. Pulmonary thromboembolism
  2. Viral bronchospasm
  3. Bacterial infection Correct answer.
  4. Pleural effusion

Explanation

Thick, yellow-green sputum suggests the presence of neutrophils and bacteria, consistent with a bacterial respiratory infection. The specimen should still be sent for culture to identify the organism.

Question 42Patient Data

Which pain assessment tool is designed for nonverbal critically ill adults who cannot self-report?

  1. Numeric rating scale for adult self-report
  2. Wong-Baker FACES scale for pediatric self-report
  3. Critical-Care Pain Observation Tool Correct answer.
  4. Visual analog scale for adult self-report

Explanation

The Critical-Care Pain Observation Tool uses behavioral and physiologic indicators for patients who cannot self-report pain, such as intubated adults. Numeric and visual analog scales require self-report.

Question 43Patient Data

Bilateral pinpoint pupils in an unresponsive patient most suggest exposure to which substance?

  1. Amphetamines
  2. Salicylates
  3. Opioids Correct answer.
  4. Atropine

Explanation

Opioid toxicity classically produces pinpoint pupils along with depressed consciousness and respiratory depression. Anticholinergic and stimulant exposures tend to dilate the pupils.

Question 44Patient Data

When measuring peak expiratory flow, how many efforts should generally be obtained and what value is recorded?

  1. Three efforts; record the best value Correct answer.
  2. One effort; record the first value
  3. Five efforts; record the lowest value
  4. Two efforts; average them

Explanation

Peak expiratory flow is measured with up to three acceptable efforts, and the best value is recorded because it best reflects the patient's maximal effort. The patient should stand and seal the lips around the mouthpiece.

Question 45Patient Data

On a chest radiograph, how does air within the pleural space appear?

  1. Radiopaque and white
  2. Calcified and bright
  3. Radiolucent and dark Correct answer.
  4. Isodense with bone

Explanation

Air attenuates x-rays poorly, so it appears radiolucent and dark on a chest radiograph. Fluid, soft tissue, and bone appear progressively more radiopaque and white.

Question 46Patient Data

An arterial blood gas shows pH 7.28, PaCO2 60 mm Hg, and HCO3 26 mEq/L. How should this be interpreted?

  1. Metabolic alkalosis
  2. Compensated metabolic acidosis
  3. Respiratory alkalosis with compensation
  4. Uncompensated respiratory acidosis Correct answer.

Explanation

The pH is acidemic, and the elevated PaCO2 identifies a respiratory cause. The near-normal HCO3 indicates that metabolic compensation has not yet occurred.

Question 47Patient Data

An arterial blood gas shows pH 7.25, PaCO2 30 mm Hg, and HCO3 15 mEq/L. Which interpretation is most accurate?

  1. Metabolic alkalosis with respiratory compensation
  2. Metabolic acidosis with respiratory compensation Correct answer.
  3. Uncompensated respiratory alkalosis
  4. Respiratory acidosis with full metabolic compensation

Explanation

The low pH and low HCO3 identify a primary metabolic acidosis. The low PaCO2 reflects compensatory hyperventilation, which lowers carbon dioxide to help restore pH.

Question 48Patient Data

Spirometry shows an FEV1/FVC ratio of 58% with a reduced FEV1. This pattern is most consistent with which defect?

  1. Fixed upper airway obstruction
  2. Obstructive defect Correct answer.
  3. Restrictive defect
  4. Normal spirometry

Explanation

An FEV1/FVC ratio below 70% after bronchodilator testing is the hallmark of an obstructive defect. Restrictive disease reduces FVC but usually preserves or increases the ratio.

Question 49Patient Data

Which set of findings most suggests tension pneumothorax?

  1. Tracheal deviation toward the affected side with dull percussion and egophony
  2. Unilateral wheezing with prolonged expiration
  3. Bilateral crackles with frothy sputum
  4. Tracheal deviation away from the affected side with absent breath sounds Correct answer.

Explanation

Tension pneumothorax raises intrathoracic pressure, collapsing the affected lung and pushing the mediastinum and trachea to the opposite side. Breath sounds are absent on the affected side and hypotension may develop.

Question 50Patient Data

A patient has a respiratory rate of 20 breaths/min and a tidal volume of 400 mL. What is the minute ventilation?

  1. 4 L/min
  2. 8 L/min Correct answer.
  3. 2 L/min
  4. 20 L/min

Explanation

Minute ventilation equals respiratory rate multiplied by tidal volume. With 20 breaths/min and 0.4 L per breath, minute ventilation is 8 L/min.