RRT Clinical Simulations (CSE) – NBRC
Practice Scenarios with Verified Answers
2024–2025
Emphysema - Answer--Weakening and permanent enlargement of the air spaces distal
to the terminal bronchioles
Etiology of Emphysema - Answer--Cigarette smoking >80% of all cases
Genetic predisposition
Occupational exposure
Atmospheric pollutants
Primary Assessment of Emphysema - Answer--Past medical history
Shortness of breath
Cough
Appearance of the chest
Respiratory Pattern
Color
Appearance of the nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Emphysema - Answer--CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum
Appearance of CXR in patient with Emphysema - Answer--Hyperlucent lung fields
,Depressed or flattened diaphragm
Narrow heart
Increased retro sternal air space (lateral film)
Arterial Blood Gas findings in patient with Emphysema - Answer--Mild to moderate
Emphysema
Acute alveolar hyperventilation with hypoxemia
Severe Emphysema
Chronic ventilatory failure with hypoxemia
Pulmonary Function Findings in patient with Emphysema - Answer--Decreased flow
rates and Decreased DLco
CBC findings in a patient with Emphysema - Answer--Increased RBC, Hb, HCT
Sputum findings in a patient with Emphysema - Answer--May indicate bacterial infection
Treatment/Management of Emphysema - Answer--Low Flow (FiO2) oxygen therapy 1-2
L/min (.24-.28)
Antibiotics as indicated by sputum culture
Pulmonary Rehab and Home Care
Aerosolized medications
Consider NPPV for acute exacerbation of ventilatory failure
Annual Flu injection
Smoking cessation
Pulmonary Hygiene
Chronic Bronchitis - Answer--Daily productive cough for at least 3 consecutive month
each year for 2 years in a row
Etiology of Chronic Bronchitis - Answer--Cigarette smoking
Pollution
Infection
GERD
Primary Assessment of Chronic Bronchitis - Answer--Past medical history
Shortness of Breath
Cough
Appearance of the Chest
,Respiratory Pattern
Color
Appearance of Nail beds
Diagnostic Chest Percussion
Breath Sounds
Secondary Assessment of Chronic Bronchitis - Answer--CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum Electrolytes
CXR findings in a patient with Chronic Bronchitis - Answer--Hyper lucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
Arterial Blood gas in a patient with mild to moderate Chronic Bronchitis - Answer--Acute
alveolar hyperventilation with hypoxemia
ABG in a patient with severe Chronic Bronchitis - Answer--Chronic ventilatory failure
with hypoxemia
Pulmonary Function test in a patient with Chronic Bronchitis - Answer--Decreased flow
rates
CBC in a patient with Chronic Bronchitis - Answer--Increased Hb and HCT
Sputum findings in a patient with Chronic Bronchitis - Answer--May indicate infection
Electrolyte findings in a patient with Chronic Bronchitis - Answer--Increased HCO3
(chronic ventilatory failure)
Treatment and Management of a patient with Chronic Bronchitis - Answer--Pulmonary
Hygiene therapy
Antibiotics for infection
Oxygen for hypoxemia
Aerosolized mediations
Consider NPPV for acute exacerbations
Smoking cessation
Reduce risk factors
, What aerosolized medications should be considered for Chronic Bronchitis -
Answer--Short acting Beta 2 agonists
Anticholinergics
Long acting Beta 2 agonists
Inhaled corticosteroids
Bronchiectasis - Answer--Chronic dilation and distortion of one or more bronchi as a
result of excessive inflammation and destruction of bronchial walls, blood vessels,
elastic tissue and smooth muscle. Can create an obstructive or restrictive pattern
Etiology of Bronchiectasis - Answer--Not always clear
Can be either acquired or congenital
Primary assessment of Bronchiectasis - Answer--Past medical history
Shortness of breath
Cough- productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum
Appearance of chest
Respiratory pattern
Color
Appearance of nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Bronchiectasis - Answer--CXR
ABG
Pulmonary Function
CBC
Sputum
Special Diagnostic tests
CXR findings in Bronchiectasis - Answer--Hyperlucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
ABG of mild to moderate Bronchiectasis - Answer--Acute alveolar hyperventilation with
hypoxemia
ABG of severe Bronchiectasis - Answer--Chronic ventilatory failure with hypoxemia
Practice Scenarios with Verified Answers
2024–2025
Emphysema - Answer--Weakening and permanent enlargement of the air spaces distal
to the terminal bronchioles
Etiology of Emphysema - Answer--Cigarette smoking >80% of all cases
Genetic predisposition
Occupational exposure
Atmospheric pollutants
Primary Assessment of Emphysema - Answer--Past medical history
Shortness of breath
Cough
Appearance of the chest
Respiratory Pattern
Color
Appearance of the nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Emphysema - Answer--CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum
Appearance of CXR in patient with Emphysema - Answer--Hyperlucent lung fields
,Depressed or flattened diaphragm
Narrow heart
Increased retro sternal air space (lateral film)
Arterial Blood Gas findings in patient with Emphysema - Answer--Mild to moderate
Emphysema
Acute alveolar hyperventilation with hypoxemia
Severe Emphysema
Chronic ventilatory failure with hypoxemia
Pulmonary Function Findings in patient with Emphysema - Answer--Decreased flow
rates and Decreased DLco
CBC findings in a patient with Emphysema - Answer--Increased RBC, Hb, HCT
Sputum findings in a patient with Emphysema - Answer--May indicate bacterial infection
Treatment/Management of Emphysema - Answer--Low Flow (FiO2) oxygen therapy 1-2
L/min (.24-.28)
Antibiotics as indicated by sputum culture
Pulmonary Rehab and Home Care
Aerosolized medications
Consider NPPV for acute exacerbation of ventilatory failure
Annual Flu injection
Smoking cessation
Pulmonary Hygiene
Chronic Bronchitis - Answer--Daily productive cough for at least 3 consecutive month
each year for 2 years in a row
Etiology of Chronic Bronchitis - Answer--Cigarette smoking
Pollution
Infection
GERD
Primary Assessment of Chronic Bronchitis - Answer--Past medical history
Shortness of Breath
Cough
Appearance of the Chest
,Respiratory Pattern
Color
Appearance of Nail beds
Diagnostic Chest Percussion
Breath Sounds
Secondary Assessment of Chronic Bronchitis - Answer--CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum Electrolytes
CXR findings in a patient with Chronic Bronchitis - Answer--Hyper lucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
Arterial Blood gas in a patient with mild to moderate Chronic Bronchitis - Answer--Acute
alveolar hyperventilation with hypoxemia
ABG in a patient with severe Chronic Bronchitis - Answer--Chronic ventilatory failure
with hypoxemia
Pulmonary Function test in a patient with Chronic Bronchitis - Answer--Decreased flow
rates
CBC in a patient with Chronic Bronchitis - Answer--Increased Hb and HCT
Sputum findings in a patient with Chronic Bronchitis - Answer--May indicate infection
Electrolyte findings in a patient with Chronic Bronchitis - Answer--Increased HCO3
(chronic ventilatory failure)
Treatment and Management of a patient with Chronic Bronchitis - Answer--Pulmonary
Hygiene therapy
Antibiotics for infection
Oxygen for hypoxemia
Aerosolized mediations
Consider NPPV for acute exacerbations
Smoking cessation
Reduce risk factors
, What aerosolized medications should be considered for Chronic Bronchitis -
Answer--Short acting Beta 2 agonists
Anticholinergics
Long acting Beta 2 agonists
Inhaled corticosteroids
Bronchiectasis - Answer--Chronic dilation and distortion of one or more bronchi as a
result of excessive inflammation and destruction of bronchial walls, blood vessels,
elastic tissue and smooth muscle. Can create an obstructive or restrictive pattern
Etiology of Bronchiectasis - Answer--Not always clear
Can be either acquired or congenital
Primary assessment of Bronchiectasis - Answer--Past medical history
Shortness of breath
Cough- productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum
Appearance of chest
Respiratory pattern
Color
Appearance of nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Bronchiectasis - Answer--CXR
ABG
Pulmonary Function
CBC
Sputum
Special Diagnostic tests
CXR findings in Bronchiectasis - Answer--Hyperlucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
ABG of mild to moderate Bronchiectasis - Answer--Acute alveolar hyperventilation with
hypoxemia
ABG of severe Bronchiectasis - Answer--Chronic ventilatory failure with hypoxemia
