A ventilator's high-pressure alarm is sounding repeatedly on a volume-controlled, assist-control breath. Peak inspiratory pressure has risen, but plateau pressure is unchanged from baseline. What is the most likely cause?
NBRC exam prep · New: the 2027 RT Exam, explained
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PawcmH₂O
FlowL/min
- Pplat
- 28cmH₂O
- Driving P
- 16cmH₂O
- SpO₂
- 93%
- pH
- 7.40
Driving pressure is above 15 on this stiff lung. Lower the tidal volume — then see what it costs in CO₂.
Plateau 28target ≤ 30 cmH₂ODriving P 16target ≤ 15 cmH₂OSpO₂ 93%target 88–95%pH 7.40target ≥ 7.25
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A rationale for every option, mapped to the NBRC content outline.
What's inside
Why the right answer is right, and why each distractor is wrong. When you miss, the explanation of your own choice comes right after the correct one — that's the misconception to unlearn.
Written to the NBRC TMC content outline, in effect through December 31, 2026, with weak-area tracking by content area. Questions written to the 2027 RT Exam outline are in clinical review. What changes in 2027.
Respiratory Encounters
Real physiology. Not an animation loop.
Assess, decide, treat. The lungs on this card are running the same physiology engine.
68-year-old, breathless on a 50% venturi mask
Sitting hyperinflated, 1.6 cmH₂O trapped · rapid and shallow · visibly increased effort
RR 25Vt 322 mLauto-PEEP 1.6hyperinflated
Educational representation of modelled physiology — not a diagnostic image or literal anatomy.
- PaCO₂
- 70mmHg
- pH
- 7.27
- Auto-PEEP
- 1.6cmH₂O
- SpO₂
- 96%
- RR
- 25/min
- HR
- 117bpm
Breathless on a 50% mask. Watch the chest: expiration never finishes before the next breath starts.
What's inside
Full patient encounters from the moment Respiratory is called. You decide what to assess — the diagnosis is never handed to you. Escalate through oxygen, high-flow and non-invasive to the ventilator, on the same patient, then get a clinical debrief that names what you missed and feeds your study plan.
The AI clinical shift simulator runs a hospital workflow — pages, physician orders, rapid responses and codes — and scores every clinical decision.
AI tutor · Premium
An experienced RT, on call at 2am.
Ask it the way you'd ask a preceptor — then have it quiz you on the answer.
AI TutorExample conversation
What's auto-PEEP, and how do I fix it?
Air still trapped when the next breath starts — exhalation never finished. It makes triggering harder and can drop venous return and blood pressure. Watch for it in COPD and asthma.
How to spot it and fix it
Spot it: the expiratory flow trace doesn't return to zero before the next breath. An end-expiratory hold measures it.
Fix it: give exhalation more time — lower the rate, shorten inspiratory time by raising the flow, consider a smaller VT — and treat the bronchospasm behind it.
Quiz me.
Flow doesn't return to zero before the next breath. Which change helps most?
What's inside
Streaming answers framed around NBRC exam logic, adapting to your weakest topics. Available any time.
Clinical tools · free
Read a gas the way you would at the bedside.
The interpreter's real output: the values, the verdict, then the reasoning if you want it.
- pH
- 7.31↓
- PaCO₂
- 61↑
- HCO₃⁻
- 30↑
- PaO₂
- 58↓
- FiO₂
- 0.36
Respiratory acidosis, partially compensated
Oxygenation: moderate impairment (P/F ≤ 200)
Show the reasoning, step by step
- 1
pH
pH 7.31 → acidemia.
- 2
Ventilation
PaCO₂ 61 mmHg (high), HCO₃⁻ 30 mEq/L (high) → primary disorder: Respiratory acidosis.
- 3
Metabolic
Compensating system is metabolic (HCO₃⁻) → partially compensated.
- 4
Oxygenation
Oxygenation: P/F ratio 161, A–a gradient ~122 (expected ~21) → moderate impairment (P/F ≤ 200).
Board readiness
Know where you stand before exam day.
A readiness score weighted the way the TMC blueprint weights the exam.
Getting there
Estimated range 69–77% against our 75% readiness target (not an NBRC passing score), from 268 answers across 17 areas.
- III.E Ensure Modifications Are Made to the Respiratory Care Plan
- II.A Assemble / Troubleshoot Devices
- III.C Support Oxygenation and Ventilation
- I.C Perform Procedures to Gather Clinical Information
- I.A Evaluate Data in the Patient Record
What's inside
The ABG card is the interpreter's real output for a COPD patient on a 4 L/min cannula. Free alongside it: A-a gradient, P/F ratio, RSBI, ideal body weight, an FiO₂ estimator and a ventilator modes reference. All clinical tools.
Readiness updates after every session and shows a range, not false precision. It's a practice estimate from your answers here — not an NBRC score or a prediction of your result. Smart study notes sit alongside it: clinical blocks for ABGs, ventilator settings and medications, and AI that turns your notes into quiz questions.
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Questions
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Is the NBRC exam changing?
From January 2027, the NBRC's new RT Examination replaces the TMC and CSE. Our question bank follows the TMC outline (in effect through December 31, 2026), questions written to the RT Exam outline are in clinical review, and the simulators and clinical-judgment practice train skills both exams test. Readiness scores here use our own 75% target — the NBRC sets its own cut scores. Dates, the new format and a "which exam should I take?" helper are at rrtacademy.com/rt-exam-2027.
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