Free RTE Exam Practice Questions (2027 NBRC Format)

Reviewed by Damon Wiseley, RRT-CPFT, B.H.S.c.

These free RTE exam practice questions are written in the new 2027 format — scenario-based multiple-choice items that test clinical judgment, not just recall. Each question gives you a realistic patient situation, asks for the best next action, and includes a full rationale so you understand why the right answer is right and the others are wrong.

Beginning January 2027, the NBRC’s Respiratory Therapy Examination (RTE) replaces the TMC and CSE with a single exam built around exactly this kind of reasoning. New to the changes? Start with our complete 2027 RTE exam guide, then come back and test yourself below.

How to use these practice questions

For each question, read the scenario, decide on the best next action before looking at the answer, then check your reasoning against the rationale. On the real exam, the wrong options are usually plausible — so train yourself to justify why you’re ruling each one out, not just why your pick is right.

Want more than 10? Respiratory Cram’s RTE Prep Platform has a full bank of scenario-based questions with rationales, built for the 2027 format. Start practicing → respiratorycram.com

10 Free RTE Practice Questions

Question 1

A 51-year-old female patient with suspected neuromuscular weakness remains on 2L/min nasal cannula and undergoes respiratory muscle testing with the following results: MIP: –18 cm H2O, MVV: 84 L/min. The patient is observed with rising respiratory rate and reports increasing difficulty clearing secretions, demonstrating a loose, weak, non-productive cough. Which of the following is indicated at this time?

A. Maintain current therapy, continue to monitor
B. Apply a therapeutic expiratory resistive device
C. Intubate and begin mechanical ventilation
D. Begin IPPB therapy with normal saline

Correct answer: C — Intubate and begin mechanical ventilation

A. A normal maximal inspiratory pressure (MIP, aka. NIF) value is typically -60 to -100 cmH2O with any value at -30 cmH2O or less (i.e., -25, -20, etc.) indicating significant inspiratory muscle weakness. A normal maximum voluntary ventilation (MVV) is approximately 80-180 L/min (highest in adult males), usually about 30-40 times a patient’s FEV1 value. This patient is currently demonstrating significant deterioration and exemplifying a relative inability to protect their airway or effectively cough.

B. Both maximal inspiratory pressure (MIP, aka. NIF) and maximum voluntary ventilation (MVV) assess specific inspiratory muscle strength, although a decreased MVV can also indicate overall respiratory muscle weakness. This patient is currently demonstrating significant deterioration and exemplifying a relative inability to protect their airway or effective cough, neither of which can be enhanced by implementation of an expiratory resistive device. An expiratory resistive device (i.e., PEP therapy) will likely worsen the patient’s condition by accelerating muscle weakness.

C. A maximum inspiratory pressure (MIP) value at -30 cmH2O or less (i.e., -25, -20, etc.) indicates significant inspiratory muscle weakness. A maximum voluntary ventilation (MVV) less than about 100 L/min usually indicates significant respiratory muscle weakness. This patient is currently demonstrating significant deterioration and exemplifying a relative inability to protect their airway or effectively cough. Given the indications of impending respiratory failure, intubation and mechanical ventilation should be accomplished to prevent eventual respiratory arrest.

D. Both maximal inspiratory pressure (MIP, aka. NIF) and maximum voluntary ventilation (MVV) assess specific inspiratory muscle strength, although a decreased MVV can also indicate overall respiratory muscle weakness. This patient is currently demonstrating significant deterioration and exemplifying a relative inability to protect their airway or effective cough, neither of which can be enhanced by implementation of intermittent positive pressure breathing (IPPB) and aerosol therapy with normal saline.

Question 2

A mechanically ventilated patient with COPD becomes increasingly dyspneic. Ventilator waveforms show expiratory flow not returning to baseline before the next breath. The respiratory therapist performs an end-expiratory hold maneuver and measures a pressure of 12 cm H2O, while the set PEEP is 5 cm H2O. What is the patient’s auto-PEEP level?

A. 5 cm H2O
B. 7 cm H2O
C. 12 cm H2O
D. 17 cm H2O

Correct answer: B — 7 cm H₂O

A. Set PEEP is 5 cmH2O.

B. The difference in set PEEP (5 cmH2O) and total PEEP (12 cmH2O) is known as auto-PEEP: 12 cmH2O – 5 cmH2O = 7 cmH2O

C. The total PEEP is calculated after an expiratory breath hold reveals total, measured end expiratory pressure, also known as total PEEP (12 cmH2O)

D. There is current set PEEP of 5 cmH2O and total PEEP of 12 cmH2O. No metric indicates a 17 cmH2O level.

Question 3

A mechanically ventilated patient is being transported from the ICU to CT scan. During transport, the patient develops sudden desaturation and a low-pressure alarm on the transport ventilator begins to sound. Which of the following is the most appropriate immediate action?

A. Increase FiO2 administer a paralytic
B. Increase tidal volume setting and pause the transport
C. Assess for circuit disconnection and manually ventilate if needed
D. Continue transport and reassess upon arrival to the CT lab

Correct answer: C — Assess for circuit disconnection and manually ventilate if needed

A. Although increasing FiO2 and temporary administration of paralytic may be indicated in certain cases but does not address the underlying issue of loss of circuit integrity which likely caused a leak (low pressure alarm).

B. A low-pressure alarm with sudden desaturation indicates a circuit leak (low pressure alarm). Ventilator adjustments are ineffective if there is a circuit disconnection or leak.

C. A low-pressure alarm with sudden desaturation indicates a likely circuit leak or disconnection. Immediate assessment and manual ventilation restore oxygenation.

D. Delaying intervention in the setting of acute desaturation increases the risk of more severe deterioration.

Question 4

A patient develops a large pneumothorax requiring chest tube placement. While assisting with the procedure, you note continuous bubbling in the water seal chamber immediately after insertion. What does this finding most likely indicate?

A. Normal pleural fluid drainage
B. Presence of an air leak from the pleural space
C. Obstruction in the chest tube system
D. Inadequate suction pressure

Correct answer: B — Presence of an air leak from the pleural space

A. Fluid drainage does not produce continuous bubbling; bubbling specifically indicates air movement through the chest tube system.

B. Continuous bubbling in the water seal chamber indicates air escaping from the pleural space, consistent with an ongoing pneumothorax or air leak.

C. An obstruction would result in reduced or absent bubbling through the water seal chamber, not continuous bubbling.

D. Suction level affects the suction control chamber, not continuous bubbling in the water seal chamber.

Question 5

A patient’s respiratory status is deteriorating despite current therapy, and the ordering provider has not yet responded to prior clinical staff (i.e., RT, RN) recommendations. What should you do next?

A. Continue current therapy and reassess, as needed
B. Wait for the provider to respond, continue to monitor
C. Escalate concerns through the appropriate chain of command
D. Discontinue therapy and document in the patient’s chart

Correct answer: C — Escalate concerns through the appropriate chain of command

A. Continuing ineffective therapy delays necessary intervention and may worsen the patient’s condition.

B. Waiting in the setting of deterioration increases the risk of clinical decline and adverse outcomes.

C. When a patient is deteriorating and prior communication has failed; escalation ensures timely intervention and patient safety through established protocols.

D. Stopping therapy without a plan may further compromise patient stability.

Halfway there. If you’re finding these useful, the RTE Prep Platform has hundreds more like them, organized by domain and difficulty. See the full question bank →

Question 6

A patient with cystic fibrosis was placed on BiPAP (IPAP 12 / EPAP 5) continues to have worsening dyspnea and increasing PaCO2. The patient is becoming fatigued and appears sleepy. What is the most appropriate next step?

A. Increase IPAP to 18 cmH2O
B. Increase EPAP to 8 cmH2O
C. Switch to heated, high flow nasal cannula 15 L/min
D. Prepare for endotracheal intubation

Correct answer: D — Prepare for endotracheal intubation

A. While increasing IPAP may improve ventilation, continued deterioration and mental status changes indicate NIV failure, making further escalation inappropriate.

B. Increasing EPAP primarily affects oxygenation and airway splinting, not ventilation, and does not address worsening hypercapnia.

C. HFNC provides less ventilatory support than BiPAP and is not appropriate in a patient with worsening hypercapnic respiratory failure.

D. The patient demonstrates failure of noninvasive ventilation, evidenced by worsening dyspnea, rising PaCO2, fatigue, and declining mental status. These findings indicate impending respiratory failure and the need for invasive mechanical ventilation.

Question 7

A patient with multiple right-sided rib fractures has asymmetrical chest wall movement and develops increasing respiratory distress, fatigue, and worsening oxygenation despite supplemental oxygen and adequate pain control. What is the most appropriate recommendation?

A. Begin hyperinflation therapy with IPPB via mask
B. Administer chest physiotherapy to unaffected side
C. Proceed with endotracheal intubation and mechanical ventilation
D. Initiate bronchodilator therapy via continuous nebulizer

Correct answer: C — Proceed with endotracheal intubation and mechanical ventilation

A. IPPB may aid lung expansion but does not provide adequate support in established or impending respiratory failure.

B. Chest physiotherapy does not address acute ventilatory failure and may be poorly tolerated in rib fracture patients.

C. The patient shows progressive respiratory distress, fatigue, and worsening oxygenation consistent with respiratory failure in the setting of chest trauma (likely flail segment). When oxygen and pain control are insufficient, invasive ventilation is required to stabilize gas exchange and reduce work of breathing.

D. Bronchodilators treat airway obstruction, not the primary issue of mechanical chest wall instability and ventilatory failure.

Question 8

A patient with acute decompensated heart failure presents with severe dyspnea, bilateral crackles, and pink frothy sputum. SpO2 is 84% on 4 L/min nasal cannula. Blood pressure is 151/89. What is the most appropriate initial intervention?

A. Initiate bronchodilator therapy
B. Initiate CPAP or BiPAP
C. Proceed with immediate intubation
D. Administer mucolytic therapy

Correct answer: B — Initiate CPAP or BiPAP

A. Bronchodilators treat airway obstruction, not fluid overload in the alveoli, and do not address the underlying pathology of heart failure.

B. The patient presents with acute cardiogenic pulmonary edema (dyspnea, crackles, pink frothy sputum, hypoxemia). Noninvasive ventilation provides positive pressure, improving oxygenation, reducing preload/afterload, and decreasing work of breathing, making it the preferred initial intervention.

C. Intubation is indicated with NIV failure, severe hypoxemia, or inability to protect the airway. This patient is still appropriate for a trial of NIV.

D. Mucolytics target thick secretions, not fluid accumulation from pulmonary edema.

Question 9

A 5’9”, 205lb. male patient with Guillain-Barré syndrome develops progressive muscle weakness. Vital capacity has declined from 1.93L to 0.87 L. The patient demonstrates a weak cough on command and has a current resting, respiratory rate of 24 bpm. What is the most appropriate next step?

A. Initiate hyperinflation therapy (i.e., IPPB)
B. Place on BiPAP non-invasive ventilation
C. Intubation and mechanical ventilation
D. Place on oxygen therapy

Correct answer: C — Intubation and mechanical ventilation

A. IPPB may assist with lung expansion but does not address progressive ventilatory failure or provide sufficient ventilatory support.

B. NIV may be considered early; however, the presence of significantly reduced vital capacity and weak cough suggests high risk for NIV failure and secretion retention, making intubation more appropriate.

C. The patient demonstrates impending respiratory failure due to neuromuscular weakness. A diminishing vital capacity down to 0.87 L (~12 mL/kg PBW), weak cough, and tachypnea indicate inability to maintain adequate ventilation and airway clearance. These findings warrant early intubation and invasive mechanical ventilation.

D. Oxygen therapy does not address ventilatory failure and CO2 retention associated with neuromuscular weakness.

Question 10

A patient presents to the ED with 2 days history of fever, productive cough, worsening dyspnea, and is found with diffuse bilateral infiltrates on chest x-ray. SpO2 is 88% on room air, and breath sounds reveal crackles. What should you suggest to best assess this patient’s status?

A. acquire an arterial blood gas
B. obtain sputum and blood cultures
C. perform bronchoscopy for intrapulmonary biopsy
D. cytogenetic chromosomal testing

Correct answer: B — obtain sputum and blood cultures

A. An ABG provides information about oxygenation and ventilation status but does not identify the underlying infectious etiology. While useful, it is not the best step to guide definitive management.

B. The patient presents with findings consistent with acute infectious pneumonia (fever, productive cough, bilateral infiltrates, hypoxemia). Obtaining sputum and blood cultures is essential to identify the causative organism and guide targeted antimicrobial therapy.

C. Bronchoscopy is invasive and typically reserved for atypical, severe, or non-resolving cases, not initial evaluation of suspected pneumonia which can be accomplish with simple sputum sample.

D. Cytogenetic testing analyzes specific chromosomes of a patient’s DNA, is unrelated to acute infectious processes and has no role in this clinical scenario.

What these questions are training

What these questions are training
Notice the pattern across all ten: each one hands you real patient data — vitals, waveforms, lab values, clinical findings — and asks you to interpret it and make the right call, whether that’s calculating a value, recognizing what a finding means, or choosing the safest next action.

That’s the core skill the 2027 RTE tests — the clinical judgment that used to live in the CSE, now delivered as scenario-based MCQs woven throughout the exam.

Memorizing facts isn’t enough; you have to apply it under realistic conditions.

For the full breakdown of the exam’s format, scoring, and what’s changing, see the complete 2027 RTE exam guide. And if you’re deciding whether to finish under the old system or switch to the new exam, read CSE or RTE in 2027?

Ready to really prepare? These 10 questions are a taste. Respiratory Cram’s RTE Prep Platform gives you a full bank of scenario-based questions with rationales, plus a clinical-judgment engine built specifically for the 2027 exam. Start preparing for the RTE → respiratorycram.com

Frequently asked questions

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These practice questions are for study purposes and are not affiliated with or endorsed by the NBRC. For official exam information, visit nbrc.org.