CLINICAL SIMULATION PRACTICE Exam 2025/2026

CLINICAL SIMULATION PRACTICE
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1. A respiratory therapist is called to the pulmonary clinic in a hospital to eval-
uate a 63-year-old male with COPD and an uncuffed, 7.0-mm tracheostomy
tube. The patient complains of increased shortness of breath and sputum
production over the past 2 to 3 days. The patient is 180 cm (5 ft 11 in) tall
and weighs 59 kg (130 lb). The patient is alert and oriented, but anxious.
Physiologic data obtained while the patient is receiving an FIO2 of 0.24 are:

Temperature 39.2º C (102.5º F) HR 135/min RR 28/min BP 162/94 mm Hg SpO2
86% pH 7.30 PaCO2 65 mm Hg PaO2 50 mm Hg HCO3- 32 mEq/L BE +3 mEq/L
SaO2 (calc) 85%

Which of the following should be evaluated initially? (SELECT MANY)
-Breath Sounds
-Home O2 use
-Deep tendon relexes
-MVV
-Sputum Culture
-FEV1/FVC
-PEF
-Sedate the pt


Which of the following should be recommended? (choose ONE)
-sedate the pt
-place inner cannula
-initiate CPAP 5cmH2O
-Perform postural drainage
-place pt on 30% via trach mask

Which of the following should be evaluated postadmission?

(SELECT AS MANY)
-Flexible Bronch


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-12 LEAD ECG
-PETSCAN
-CBC
-sputum quality and characteristics
-CT Angiogram of chest
-PFT
-CHEST XRAY
-VD/VT
Antibiotics have been administered. Which of the following additional thera-
peutic interventions should be recommended?

(SELECT AS MANY)
-Titrate FIO2 89-90%
-Administer duoneb
-initial systemic corticosteroid
-administer spiriva
-mucomyst
-fio2 40%

Twelve hours later, the patient is diaphoretic and using accessory muscles of
respiration. The tracheostomy tube is patent. ABG analysis while receiving an
FIO2 of 0.50 reveals:

pH 7.15 PCO2 85 mm Hg PO2 66 mm Hg HCO3- 30 mEq/L BE -2 mEq/L SO2
(calc) 93%

Which of the following should be recommended?

(CHOOSE ONLY ONE)

- place trach button
-initiate ventilation & cuffed trach
-place cuffed trach and maintain: section 1:


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BREATH SOUNDS
HOME O2 USE
SPUTUM CULTURE

SECTION 2:
PLACE PT ON FIO2 30% VIA TRACH
or
PLACE INNER CANNULA

SECTION 3:
12 LEAD ECG
SPUTUM QUALITY AND CHARACTERISTICS
CBC
CHEST RADIOGRAPH

SECTION 4:
TITRATE FIO2 89%-90%
ADMINISTER DUONEB
ADMINISTER CORTICOSTEROIDS

SECTION 5:
INITIATE VENTILATION AND CUFFED TRACH
2. A respiratory therapist is assessing a 56-year-old female who is in respiratory
distress in an ED. The patient is anxious, alert, and oriented. Moderate stridor
is noted. She was hospitalized 6 months ago with a diagnosis of influenza
A during which she received invasive ventilation for 6 days through an oral
endotracheal tube. While the patient is breathing air, vital signs are:

Temperature 38.3º C (100.9º F) HR 100/min RR 30/min BP 140/98 mm Hg SpO2
87%

Which of the following should be recommended FIRST?



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-CHEST CT
-INITIATE O2 AT 4L VIA NASAL CANNULA
-INITIATE 100% NRB
-INITIATE MANUAL VENTILATION

(CHOOSE ONLY ONE)
-sputum gram atain
-cardiac enzymes
-resting energy expenditure
-serum creatine
-CBC
-measured percent shunt
-12 Lead EKG
-VD/VT
-PTT

During the next 30 minutes, the patient's respiratory distress worsens. SpO2
is 88% while the patient is receiving O2 by nasal cannula at 4 L/min and stridor
has increased. Which of the following should be recommended?

(SELECT AS MANY)
-NPPV
-Administer NRB
-Obtain ABG
-Initiate Heliox
-administer racemic epi


The patient has been transferred to an ICU and is receiving 70/30 heliox
following a single dose of racemic epinephrine. The patient is difficult to
arouse, and the stridor is slightly diminished. ABG analysis reveals:

pH 7.23 PCO2 57 mm Hg PO2 70 mm Hg HCO3- 24 mEq/L BE -5 mEq/L SO2