Module teasers
The opening concept from every module.
RT-01Arterial Blood Gas Interpretation
Analysis & Monitoring · 6 concept sections · 8 questions · ~24 min
A repeatable four-step read of any ABG — acid-base status, compensation, oxygenation, and the clinical story that produced it.
01
Step 1 — Read the pH first, never the CO2
The pH tells you which direction the body has actually landed, and it is the only value that defines the primary disorder when two abnormalities coexist.
- Normal pH 7.35–7.45. Below 7.35 is acidemia; above 7.45 is alkalemia.
- If the pH is abnormal, look at ROME (Respiratory Opposite, Metabolic Equal).
RT-02Mechanical Ventilation Fundamentals
Initiation & Modification of Therapy · 7 concept sections · 8 questions · ~28 min
Modes, initial settings, and the pressure readings that tell you whether the problem is the circuit, the airway, or the lung.
01
Modes are just two questions
Every conventional mode answers who triggers the breath and what the ventilator guarantees once it starts.
- Volume control guarantees tidal volume; pressure varies with compliance and resistance, so pressure is the alarm you watch.
- Pressure control guarantees inspiratory pressure; volume varies, so delivered tidal volume is the number you watch.
RT-03Oxygen Delivery Devices
Initiation & Modification of Therapy · 5 concept sections · 6 questions · ~20 min
Low-flow versus high-flow logic, deliverable FiO2 ranges, and how to choose the device that matches the patient's inspiratory demand.
01
The organizing question: does the device meet inspiratory flow demand?
An adult in distress can pull 30–60 L/min. Any device delivering less than that is diluted by entrained room air, so its FiO2 varies with the patient's breathing pattern.
- Low-flow systems (nasal cannula, simple mask) deliver variable FiO2 — a deeper, faster breath dilutes it further.
- Reservoir systems (partial rebreather, non-rebreather) store oxygen between breaths, raising but not stabilizing FiO2.
RT-04Pulmonary Function Test Interpretation
Analysis & Monitoring · 5 concept sections · 8 questions · ~22 min
How to sort obstructive from restrictive patterns, grade severity, and read the bronchodilator and diffusion results that follow.
01
The ratio comes first
FEV1/FVC separates the two major patterns. Everything after that is severity and cause.
- FEV1/FVC below 70% (or below the lower limit of normal) defines obstruction.
- A normal or elevated ratio with a reduced FVC suggests restriction — but FVC alone cannot confirm it.
RT-05Airway Management: Intubation, Tracheostomy & Suctioning
Initiation & Modification · 3 concept sections · 4 questions · ~26 min
Tube selection, placement confirmation, cuff management, suctioning technique, and the emergency airway decisions the exam asks about most.
01
Setup and tube selection
Every intubation question starts with equipment. If the setup is wrong, no later answer choice saves the patient.
- Adult ETT: 7.0–8.0 mm for women, 8.0–9.0 mm for men. Larger tubes lower resistance and allow bronchoscopy.
- Pediatric uncuffed tube size = (age/4) + 4; cuffed = (age/4) + 3.5. Depth ≈ tube size × 3.
RT-06Mechanical Ventilation: Monitoring, Graphics & Waveforms
Analysis & Monitoring · 3 concept sections · 4 questions · ~25 min
Reading scalars and loops to localize a problem — resistance versus compliance, auto-PEEP, asynchrony, and leaks — before touching a setting.
01
Peak, plateau, and the two mechanics
Almost every graphics question resolves into one question: is this resistance or compliance?
- Plateau pressure is measured with an inspiratory hold and reflects alveolar pressure; keep it under 30 cm H2O.
- Peak minus plateau is the resistive component. A widening gap means secretions, bronchospasm, a kinked tube, or biting.
RT-07Ventilator Weaning, Liberation & Extubation
Initiation & Modification · 3 concept sections · 4 questions · ~22 min
Readiness criteria, the spontaneous breathing trial, the numbers that predict success, and how to recognize post-extubation failure early.
01
Readiness before the trial
Liberation begins with the disease, not the ventilator. The cause of the failure must be improving.
- Reversal of the underlying cause, hemodynamic stability on minimal vasopressors, and adequate mental status.
- Oxygenation: PaO2/FiO2 >150–200 on FiO2 ≤0.40–0.50 and PEEP ≤5–8 cm H2O.
RT-08Noninvasive Ventilation, CPAP & BiPAP
Initiation & Modification · 3 concept sections · 4 questions · ~21 min
Who benefits, who must be intubated instead, how to set IPAP and EPAP, and how to tell in two hours whether NIV is working.
01
CPAP versus bilevel — the physiology decides
CPAP fixes oxygenation and preload. Bilevel adds ventilation. Pick by whether the CO2 is the problem.
- CPAP: obstructive sleep apnea, cardiogenic pulmonary edema, and atelectasis — one continuous pressure that splints airways and reduces preload and afterload.
- Bilevel (IPAP/EPAP): hypercapnic failure — COPD exacerbation, neuromuscular weakness, obesity hypoventilation. The pressure difference is the tidal volume.
RT-09Patient History, Chart Review & Physical Assessment
Data Evaluation · 3 concept sections · 4 questions · ~20 min
Building the clinical picture before you touch a device — history, vitals, inspection, auscultation, and the lab values that change respiratory decisions.
01
Chart review with a purpose
The exam rewards therapists who look for the specific data that changes the next action.
- Advance directives and code status precede any escalation decision.
- Home oxygen liter flow, baseline gases, and prior intubations define what 'normal' means for this patient.
RT-10Pharmacology: Bronchodilators, Steroids & Adjunct Agents
Initiation & Modification · 3 concept sections · 4 questions · ~22 min
Drug classes by mechanism, dosing, side effects, and the exam's favorite question: which agent for this patient, right now.
01
Bronchodilators
Two mechanisms: stimulate beta-2 to relax smooth muscle, or block muscarinic receptors to prevent constriction.
- Short-acting beta agonists (albuterol, levalbuterol): onset 5–15 minutes, duration 4–6 hours. Rescue therapy. Side effects: tachycardia, tremor, hypokalemia, hyperglycemia.
- Long-acting beta agonists (salmeterol, formoterol): maintenance only, never rescue, and never as monotherapy in asthma.
RT-11Chest Radiograph & Imaging Interpretation
Data Evaluation · 3 concept sections · 4 questions · ~20 min
A systematic read of the portable film — line and tube position, the classic pathology patterns, and what imaging can and cannot answer.
01
A repeatable read
Read the film the same way every time so nothing is skipped under pressure.
- Confirm patient, date, and projection. Portable films are AP, which magnifies the heart — never call cardiomegaly on a portable.
- Assess quality: adequate inspiration is 8–10 posterior ribs; rotation is judged by clavicle symmetry around the spinous processes.
RT-12Humidity, Aerosol Therapy & Bland Aerosol
Equipment · 3 concept sections · 4 questions · ~18 min
Choosing humidifiers and nebulizers, particle size and deposition, delivery technique, and the troubleshooting the exam expects.
01
Humidification
Bypassing the upper airway removes the body's humidifier; the circuit must replace it.
- An artificial airway requires at minimum 30 mg/L of water vapor at 30–34°C; the natural airway delivers 44 mg/L at 37°C at the carina.
- Heat and moisture exchangers are passive, cheap, and add dead space — contraindicated with thick or bloody secretions, hypothermia, large leaks, low tidal volumes, or minute ventilation above ~10 L/min.
RT-13Bronchial Hygiene, Lung Expansion & Hyperinflation Therapy
Initiation & Modification · 3 concept sections · 4 questions · ~18 min
Secretion clearance and lung expansion therapies — who needs which, how to judge effectiveness, and when to stop.
01
Two different problems
Atelectasis needs volume. Retained secretions need clearance. Choosing the wrong family is the classic exam error.
- Lung expansion therapy: incentive spirometry, IPPB, CPAP/EPAP, and deep breathing — for atelectasis and postoperative prevention.
- Secretion clearance: directed cough, postural drainage and percussion, PEP and oscillating PEP, high-frequency chest wall oscillation, and airway clearance devices — for retained secretions.
RT-14Emergency Care, ACLS, Resuscitation & Transport
Initiation & Modification · 3 concept sections · 4 questions · ~20 min
The therapist's role in codes: high-quality CPR metrics, airway and ventilation during arrest, capnography feedback, and safe transport.
01
High-quality CPR
The exam tests numbers and priorities, and the priority is almost always compressions.
- Adults: rate 100–120/min, depth at least 2 inches (5 cm) and no more than 2.4 inches, full recoil, interruptions under 10 seconds.
- Compression-to-ventilation 30:2 without an advanced airway; with an advanced airway, continuous compressions with one breath every 6 seconds (10/min).
RT-15Neonatal & Pediatric Respiratory Care
Initiation & Modification · 3 concept sections · 4 questions · ~20 min
Delivery room resuscitation, surfactant, neonatal ventilation targets, and the pediatric airway differences that change every decision.
01
The delivery room
Ventilation, not oxygen, is the cornerstone of neonatal resuscitation.
- Initial steps: warm, dry, stimulate, position, and clear the airway only if needed. Assess breathing and heart rate.
- Heart rate under 100 with apnea or gasping → positive pressure ventilation at 40–60/min. Heart rate under 60 after 30 seconds of effective PPV → compressions at 3:1 with ventilation (90 compressions and 30 breaths per minute).
RT-16Hemodynamic Monitoring & Cardiac Assessment / ECG
Data Evaluation · 3 concept sections · 4 questions · ~20 min
Reading pressures and rhythms the way a therapist must: what the number means, what it changes, and which rhythm needs action now.
01
Pressures and what they mean
Each pressure reports on a different part of the circuit.
- CVP 2–6 mm Hg reflects right heart preload; it rises with fluid overload, right heart failure, tension pneumothorax, high PEEP, and cardiac tamponade.
- Pulmonary artery pressure 25/8 mm Hg (mean 10–20) reflects the pulmonary circuit; it rises with hypoxic vasoconstriction, embolism, ARDS, and left heart failure.
RT-17Infection Control, Sterilization & Equipment Quality Control
Equipment · 3 concept sections · 4 questions · ~16 min
Isolation precautions, disinfection levels, equipment processing, and the quality control checks the exam expects you to perform and interpret.
01
Precautions
Match the barrier to the transmission route, and standard precautions apply to everyone.
- Contact: gown and gloves — C. difficile (soap and water, not alcohol gel), MRSA, VRE, RSV.
- Droplet: surgical mask within about 6 feet — influenza, pertussis, meningococcus, mumps.
RT-18Chronic Disease Management, Home Care & Pulmonary Rehab
Initiation & Modification · 3 concept sections · 4 questions · ~18 min
Long-term oxygen criteria, home equipment selection, sleep-disordered breathing, patient education, and rehabilitation outcomes.
01
Long-term oxygen therapy
Qualification is defined by measurement, not by symptoms.
- Qualifying criteria: PaO2 of 55 mm Hg or less, or SpO2 of 88% or less, on room air at rest; or PaO2 of 56–59 mm Hg with cor pulmonale, right heart failure, or a hematocrit above 55%.
- Documented desaturation with exertion or sleep can qualify a patient for oxygen in those settings.
RT-19Equipment Assembly & Troubleshooting
Equipment · 3 concept sections · 2 questions · ~20 min
The NBRC tests equipment failure constantly: what breaks, what the patient looks like when it breaks, and the fix you perform before you call anyone.
01
Verify before you connect
Every assembly is checked the same way: power, gas source, circuit integrity, then a functional test against a test lung.
- Ventilator pre-use check: leak test at 30 cm H2O, verify delivered volume against set volume on a test lung, confirm oxygen analyzer accuracy at 21% and 100%, confirm alarms annunciate.
- Humidifier: water level between the min and max lines, temperature probe at the patient wye, heated-wire circuit set 2–3 degrees above chamber temperature to limit rainout.
RT-20Medical Gas Supply & Cylinder Systems
Equipment · 3 concept sections · 2 questions · ~16 min
Cylinder duration math, safety index systems, regulators, and bulk supply — the calculation questions you can guarantee will appear.
01
Cylinder duration is a guaranteed calculation
Duration in minutes equals gauge pressure times the cylinder factor, divided by flow in L/min.
- Cylinder factors: E = 0.28, H/K = 3.14, D = 0.16, G = 2.41.
- A full E cylinder holds about 660 L at 2200 psi; a full H cylinder about 6900 L.
RT-21Sleep-Disordered Breathing & Titration
Initiation & Modification · 3 concept sections · 2 questions · ~18 min
Obstructive versus central events, AHI severity, and how a CPAP or bilevel titration is actually driven overnight.
01
Naming the event
Effort is the discriminator: obstructive events have effort against a closed airway, central events have none.
- Apnea: airflow drops at least 90% for 10 seconds or more. Hypopnea: airflow drops at least 30% for 10 seconds with a desaturation or arousal.
- Obstructive apnea shows continued or paradoxical chest and abdominal effort; central apnea shows a flat effort channel.
RT-22Bronchoscopy & Special Procedures
Initiation & Modification · 3 concept sections · 2 questions · ~16 min
Assisting with bronchoscopy, thoracentesis, chest tubes, and arterial lines — the setup, the monitoring, and the complication you must catch.
01
Bronchoscopy
Your job is airway, oxygenation, and monitoring while someone else drives the scope.
- Indications: retained secretions and lobar atelectasis unresolved by therapy, hemoptysis, foreign body, difficult intubation, tissue sampling, and lavage.
- Through an endotracheal tube, the tube must be at least 2 mm larger than the scope; the scope can occupy half the lumen and cause auto-PEEP and hypoxemia.
RT-23Protocols, Documentation & Professional Ethics
Analysis & Monitoring · 3 concept sections · 2 questions · ~14 min
Therapist-driven protocols, charting that holds up, scope of practice, and the ethics questions the NBRC scores as clinical judgment.
01
Therapist-driven protocols
A protocol delegates titration to you within defined boundaries, and it always contains an exit point.
- Protocols require an assessment, a defined severity score or trigger, an intervention, and a scheduled reassessment.
- Escalate out of the protocol when the patient deteriorates, falls outside the inclusion criteria, or the protocol's endpoint is reached without improvement.
RT-24Capnography & Bedside Monitoring
Analysis & Monitoring · 3 concept sections · 2 questions · ~18 min
Waveform capnography, the PaCO2–EtCO2 gradient, pulse oximetry limits, and the monitors that tell you the truth before the gas does.
01
The capnogram, phase by phase
Shape names the problem; height names the ventilation. Read both on every waveform question.
- Phase I: anatomic dead space, no CO2. Phase II: rapid upstroke as alveolar gas arrives. Phase III: alveolar plateau, nearly flat. Phase IV: inspiratory downstroke to zero.
- Normal EtCO2 is 35–43 mm Hg with a plateau that returns to a zero baseline.
RT-25Specialty Gas Therapy: Heliox, Nitric Oxide & Hyperbarics
Initiation & Modification · 3 concept sections · 2 questions · ~16 min
When density, selective vasodilation, or dissolved oxygen is the therapy — indications, delivery, monitoring, and the toxic endpoints.
01
Heliox
Helium's low density converts turbulent flow to laminar flow, lowering the work of breathing through a narrowed large airway.
- Indications: severe asthma exacerbation, upper airway obstruction, post-extubation stridor, and large-airway tumors. It does not treat inflammation — it buys time.
- Common mixtures are 80/20, 70/30, and 60/40 helium to oxygen. The higher the oxygen fraction, the less benefit, and above 40% oxygen the density advantage is largely lost.
RT-26Tracheostomy & Long-Term Airway Care
Initiation & Modification · 3 concept sections · 2 questions · ~16 min
Tube anatomy, cuff management, speaking valves, decannulation, and the emergency that kills — a dislodged fresh trach.
01
The tube and the cuff
Tube choice is about airway protection, secretion clearance, and speech — usually in that order early and reversed later.
- Components: outer cannula, inner cannula (removable and cleaned), obturator (used only for insertion), flange, and cuff pilot balloon.
- Fenestrated tubes allow speech with the inner cannula removed and the cuff deflated; never suction through a fenestration or use one with a cuff inflated and the fenestration open.
RT-27Laboratory Data & Microbiology Interpretation
Analysis & Monitoring · 3 concept sections · 2 questions · ~16 min
Electrolytes, CBC, coagulation, cardiac and sputum data read the way a respiratory therapist has to read them.
01
Electrolytes drive the ventilator
Weaning failures are frequently metabolic, not pulmonary.
- Potassium 3.5–5.0 mEq/L. Hypokalemia weakens respiratory muscles and causes arrhythmias; beta agonists and diuretics drive it down.
- Phosphate and magnesium deficiency directly weaken the diaphragm — correct both before blaming the lung for a failed spontaneous breathing trial.
RT-28Patient Transport & Disaster Response
Initiation & Modification · 3 concept sections · 2 questions · ~14 min
Intrahospital and flight transport planning, gas supply math under pressure, and triage when resources run out.
01
Planning the move
Every transport is stabilized first, equipped second, and moved third.
- Bring: transport ventilator or resuscitator with mask and PEEP valve, oxygen with a calculated reserve, suction, monitoring for SpO2 and EtCO2, airway rescue equipment, and medications.
- Calculate cylinder duration and double it. An E cylinder at 1800 psi on 10 L/min lasts about 50 minutes — a delayed elevator or a held CT scanner ends transports.
RT-29Pulmonary Rehabilitation, Education & Smoking Cessation
Analysis & Monitoring · 3 concept sections · 2 questions · ~14 min
Exercise prescription, breathing retraining, adherence teaching, and the cessation counseling the exam expects you to deliver.
01
Building the program
Rehabilitation improves dyspnea, exercise tolerance, and quality of life even when spirometry does not change.
- Candidates: symptomatic COPD, interstitial disease, bronchiectasis, pre- and post-transplant, and post-COVID deconditioning. Unstable angina and uncontrolled arrhythmia are exclusions until treated.
- Baseline testing: 6-minute walk distance, spirometry, symptom scores, and oxygen assessment during exertion.