Respiratory Therapy Board Exam 2026 | Clinical
Scenarios with Rationales
Question 1: COPD Exacerbation
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents
with worsening dyspnea, productive cough, and wheezing. His SpO2 is 84% on room air. ABG
results show:
pH: 7.31
PaCO2: 58 mmHg
HCO3: 30 mEq/L
PaO2: 55 mmHg
What is the most appropriate initial oxygen therapy?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 1–2 L/min
C. Room air observation
D. Hyperbaric oxygen therapy
Correct Answer:
B. Nasal cannula at 1–2 L/min
,Rationale:
Patients with COPD and chronic CO2 retention require controlled oxygen therapy to prevent
suppression of hypoxic drive. Low-flow oxygen via nasal cannula is the safest initial option
while carefully monitoring oxygen saturation and ABGs.
Question 2: Ventilator Alarm
A mechanically ventilated patient suddenly triggers a high-pressure alarm. Breath sounds are
diminished on the right side, and tracheal deviation is noted.
What is the most likely cause?
A. Pulmonary edema
B. Pneumothorax
C. Low tidal volume setting
D. Humidifier malfunction
Correct Answer:
B. Pneumothorax
Rationale:
,A sudden increase in airway pressure with unilateral breath sounds and tracheal deviation
strongly suggests tension pneumothorax. This is a medical emergency requiring immediate
decompression.
Question 3: Asthma Management
A 22-year-old patient arrives in severe respiratory distress due to an asthma attack.
Wheezing is minimal, respiratory rate is 34/min, and accessory muscles are being used.
Which medication should be administered first?
A. Inhaled corticosteroid
B. Broad-spectrum antibiotic
C. Short-acting beta agonist
D. Oral antihistamine
Correct Answer:
C. Short-acting beta agonist
Rationale:
Short-acting beta agonists such as albuterol are first-line medications during acute asthma
exacerbations because they rapidly dilate bronchial smooth muscle.
, Question 4: Neonatal Respiratory Distress
A premature infant at 30 weeks gestation demonstrates nasal flaring, grunting, and
retractions shortly after birth.
Which condition is most likely?
A. Epiglottitis
B. Respiratory Distress Syndrome
C. Pulmonary fibrosis
D. Bronchiectasis
Correct Answer:
B. Respiratory Distress Syndrome
Rationale:
Premature infants often lack sufficient surfactant, leading to alveolar collapse and
respiratory distress syndrome (RDS). Symptoms include grunting, nasal flaring, and
retractions.
Question 5: ABG Interpretation
ABG results:
pH: 7.25
Scenarios with Rationales
Question 1: COPD Exacerbation
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents
with worsening dyspnea, productive cough, and wheezing. His SpO2 is 84% on room air. ABG
results show:
pH: 7.31
PaCO2: 58 mmHg
HCO3: 30 mEq/L
PaO2: 55 mmHg
What is the most appropriate initial oxygen therapy?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 1–2 L/min
C. Room air observation
D. Hyperbaric oxygen therapy
Correct Answer:
B. Nasal cannula at 1–2 L/min
,Rationale:
Patients with COPD and chronic CO2 retention require controlled oxygen therapy to prevent
suppression of hypoxic drive. Low-flow oxygen via nasal cannula is the safest initial option
while carefully monitoring oxygen saturation and ABGs.
Question 2: Ventilator Alarm
A mechanically ventilated patient suddenly triggers a high-pressure alarm. Breath sounds are
diminished on the right side, and tracheal deviation is noted.
What is the most likely cause?
A. Pulmonary edema
B. Pneumothorax
C. Low tidal volume setting
D. Humidifier malfunction
Correct Answer:
B. Pneumothorax
Rationale:
,A sudden increase in airway pressure with unilateral breath sounds and tracheal deviation
strongly suggests tension pneumothorax. This is a medical emergency requiring immediate
decompression.
Question 3: Asthma Management
A 22-year-old patient arrives in severe respiratory distress due to an asthma attack.
Wheezing is minimal, respiratory rate is 34/min, and accessory muscles are being used.
Which medication should be administered first?
A. Inhaled corticosteroid
B. Broad-spectrum antibiotic
C. Short-acting beta agonist
D. Oral antihistamine
Correct Answer:
C. Short-acting beta agonist
Rationale:
Short-acting beta agonists such as albuterol are first-line medications during acute asthma
exacerbations because they rapidly dilate bronchial smooth muscle.
, Question 4: Neonatal Respiratory Distress
A premature infant at 30 weeks gestation demonstrates nasal flaring, grunting, and
retractions shortly after birth.
Which condition is most likely?
A. Epiglottitis
B. Respiratory Distress Syndrome
C. Pulmonary fibrosis
D. Bronchiectasis
Correct Answer:
B. Respiratory Distress Syndrome
Rationale:
Premature infants often lack sufficient surfactant, leading to alveolar collapse and
respiratory distress syndrome (RDS). Symptoms include grunting, nasal flaring, and
retractions.
Question 5: ABG Interpretation
ABG results:
pH: 7.25
