10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The RRT-NPS exam has 170 questions and runs 4 hours.
These 10 free RRT-NPS questions are organized by exam domain, so you can see how each part of the Neonatal/Pediatric Respiratory Care Specialist (RRT-NPS) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: COMPETENCIES SHARED BETWEEN CRITICAL AND GENERAL CARE OF NEONATAL OR PEDIATRIC PATIENTS
Question 1
An 11-year-old has received continuous nebulized albuterol for two hours. Air entry and retractions have improved, but respiratory rate remains 38/min. The child is alert, afebrile, and well perfused, with normal blood pressure. Arterial results are pH 7.32, PaCO2 28 mmHg, and bicarbonate 14 mmol/L; lactate has increased from 1.6 to 6.2 mmol/L and potassium has fallen to 2.9 mmol/L. What best explains the persistent tachypnea?
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Correct answer: A - Beta2-agonist-associated lactic acidosis with compensatory hyperventilation.
Question 2
A 20-month-old developed abrupt coughing while eating peanuts yesterday. Today the child is comfortable with SpO2 98% in room air, but a localized monophonic wheeze and reduced air entry persist on the right. An albuterol treatment does not change these findings. Chest radiographs show neither a radiopaque object nor a focal infiltrate. The respiratory therapist should recommend:
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Correct answer: D - Prompt specialist assessment for bronchoscopy despite the normal radiographs.
Question 3
During delivery-room resuscitation of a term newborn, the first 30 seconds of effective ventilation through an endotracheal tube produce bilateral chest movement and raise the ECG heart rate from 45 to 85/min. Exhaled carbon dioxide is detected, but the infant remains apneic. The immediate priority is to:
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Correct answer: C - Continue positive-pressure ventilation and reassess the heart rate.
Question 4
Newborn screening identifies one CF-causing CFTR variant in a 5-week-old infant. An adequate quantitative sweat test at an accredited center yields a chloride concentration of 44 mmol/L. The infant is growing normally and has no respiratory symptoms. Which interpretation should guide follow-up?
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Correct answer: D - The result is intermediate; repeat sweat testing and further CFTR evaluation are indicated.
Question 5
An RSV-positive 7-month-old, born at term and previously healthy, is observed for a first episode of bronchiolitis. After gentle nasal suctioning, the infant takes a feed without difficulty and has only mild subcostal retractions. Respiratory rate is 42/min, room-air SpO2 remains 93-95% with a reliable signal, and there has been no apnea. What respiratory care is warranted at this point?
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Correct answer: B - Provide supportive care with feeding assessment and clinical observation.
Question 6
Despite a daytime SpO2 of 98% and PaCO2 of 42 mmHg, a 14-year-old with Duchenne muscular dystrophy reports morning headaches and unrefreshing sleep. Polysomnography shows transcutaneous CO2 of 54-60 mmHg for 38% of total sleep time, with an obstructive apnea-hypopnea index of 0.6 events/hour. Bulbar function is adequate and there is no acute infection. Which treatment targets the principal sleep-related abnormality?
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Correct answer: D - Nocturnal bilevel noninvasive ventilation with a backup rate.
Domain 2: COMPETENCIES SPECIFIC TO CRITICAL CARE OF NEONATAL OR PEDIATRIC PATIENTS
Question 7
Fifteen minutes after poractant alfa administration, a 28-week neonate's exhaled tidal volume rises from 4.5 to 8.5 mL/kg on unchanged pressure-control ventilation. Inspiratory pressure is 18 cm H2O above PEEP, and PEEP is 6 cm H2O. The arterial pH is 7.50 with PaCO2 28 mmHg. FiO2 has already been reduced to 0.25, with SpO2 93%. The endotracheal tube has minimal leak. Which adjustment most directly addresses both the excessive tidal volume and the hypocapnia?
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Correct answer: C - Reduce the inspiratory pressure above PEEP while monitoring exhaled volume.
Question 8
At the six-hour reassessment of a previously healthy 6-year-old with pneumonia-associated pediatric ARDS, invasive ventilation delivers a mean airway pressure of 18 cm H2O, peak inspiratory pressure of 36 cm H2O, and FiO2 0.70. SpO2 is 92%, and a simultaneous arterial sample shows PaO2 60 mmHg. Using PALICC-2, which oxygenation-index and severity pairing is correct?
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Correct answer: B - OI 21; severe PARDS.
Question 9
The expiratory flow tracing of a passively ventilated 9-year-old with status asthmaticus has not returned to zero when each new breath begins. At a set rate of 28/min, an end-expiratory hold measures total PEEP of 13 cm H2O despite set PEEP of 5 cm H2O. PaCO2 is 64 mmHg and pH is 7.25; blood pressure is stable. The tube is patent, and bronchodilator treatment is continuing. Which ventilator change addresses the immediate mechanical problem?
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Correct answer: A - Decrease the set rate to provide more time for expiration.
Question 10
A term newborn with echocardiographically confirmed persistent pulmonary hypertension has been stable on inhaled nitric oxide at 5 ppm and FiO2 0.35. Nitric oxide is discontinued in a single step. Within one minute, SpO2 falls from 95% to 76% and systemic blood pressure decreases. Chest movement, tube position, and ventilator function are unchanged. Supplemental oxygen is increased while the team checks the delivery system. Which intervention specifically reverses the likely cause?
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Correct answer: B - Reinstate inhaled nitric oxide at the previously effective dose.
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