RRT Clinical Simulations (CSE) – NBRC
2026/2027 200 Multiple Choice Questions
with Bold Italic (100% verified answers and
Italic Explanations Upgraded
DOMAIN 1: PATIENT ASSESSMENT & DATA EVALUATION (Questions 1-30)
1. A 55-year-old male with a history of deep vein thrombosis presents with
acute shortness of breath. ABG on room air: pH 7.48, PaCO₂ 30 mmHg, PaO₂ 55
mmHg, HCO₃⁻ 24 mEq/L. What is the most likely diagnosis?
A) Acute asthma exacerbation
B) Pulmonary Embolism
C) COPD exacerbation
D) Cardiogenic pulmonary edema
The ABG shows acute respiratory alkalosis (high pH, low PaCO₂) with significant
hypoxemia . In a patient with DVT risk factors, this pattern—acute tachypnea
driving off CO₂ while O₂ remains low due to V/Q mismatch—is classic for a
Pulmonary Embolism . The normal HCO₃⁻ indicates this is an acute process .
2. A 68-year-old male with COPD presents with increased dyspnea, cough, and
purulent sputum. Vital signs: HR 110 bpm, RR 28/min, BP 145/90 mmHg, SpO₂
88% on room air. What is the MOST appropriate initial action?
A) Obtain a chest X-ray
B) Administer a bronchodilator via nebulizer
C) Apply supplemental oxygen
D) Draw arterial blood gases
,The patient is hypoxemic (SpO₂ 88%) and in respiratory distress . The priority is to
correct hypoxemia with supplemental oxygen . Assessment and treatment of
oxygenation precede diagnostic testing .
3. A patient with asthma has a silent chest on auscultation, uses accessory
muscles, and is diaphoretic. The therapist should recognize this as:
A) Mild asthma exacerbation
B) Moderate asthma exacerbation
C) Severe asthma exacerbation with impending respiratory failure
D) Normal presentation of asthma
A silent chest in asthma indicates severe airflow obstruction with minimal air
movement, a sign of impending respiratory failure . Accessory muscle use and
diaphoresis indicate significant work of breathing . This is a life-threatening
emergency requiring immediate intervention .
4. A unilateral wheeze is auscultated in a 3-year-old child. This finding most
likely indicates:
A) Asthma
B) Heart failure
C) Foreign body aspiration
D) Atelectasis
Asthma typically causes bilateral, diffuse wheezing . A foreign body usually lodges
in one mainstem bronchus (usually the right), causing air trapping and localized
wheezing on the affected side . Atelectasis usually presents with diminished or
absent breath sounds .
5. A patient's chest X-ray reveals a "Batwing" or "Butterfly" pattern of opacities
in the central lungs. This is classic for:
A) Tuberculosis
B) Pulmonary edema (CHF)
,C) Pneumonia
D) Atelectasis
A "Batwing" or "Butterfly" pattern of opacities in the central lungs is classic for
pulmonary edema . This pattern represents interstitial and alveolar edema
accumulating in the perihilar region .
6. The presence of a "Steeple Sign" on a neck or chest x-ray is diagnostic for:
A) Epiglottitis
B) Bacterial Pneumonia
C) Croup (Laryngotracheobronchitis)
D) Pleural Effusion
The steeple sign (or hourglass sign) refers to subglottic narrowing of the trachea
seen on an AP radiograph . It is classic for croup, which is a viral infection causing
inflammation in the upper airway . Epiglottitis shows a "Thumb sign" .
7. A patient's peak flow reading is 180 L/min. The patient's predicted peak flow
is 450 L/min. This indicates:
A) Normal lung function
B) Mild obstruction
C) Moderate obstruction
D) Severe obstruction
Peak flow values: 80-100% predicted = normal; 50-80% = mild-moderate
obstruction; <50% = severe obstruction . 180/450 = 40% of predicted, indicating
severe obstruction requiring immediate intervention .
8. During a physical assessment, the therapist notes a patient has a barrel chest,
pursed-lip breathing, and prolonged expiration. These findings are MOST
consistent with:
A) Asthma
B) Pulmonary fibrosis
, C) Chronic Obstructive Pulmonary Disease (COPD)
D) Pneumonia
Barrel chest, pursed-lip breathing, and prolonged expiration are classic physical
findings in COPD/emphysema . These result from air trapping, hyperinflation, and
airway obstruction .
9. A patient's chest X-ray shows bilateral fluffy infiltrates, Kerley B lines, and
cardiomegaly. The therapist should suspect:
A) Pneumonia
B) Atelectasis
C) Pulmonary edema (CHF)
D) Pulmonary fibrosis
Bilateral fluffy infiltrates, Kerley B lines (interstitial edema), and cardiomegaly are
classic radiographic findings in congestive heart failure with pulmonary edema .
10. A patient with a tracheostomy tube has copious, thick, yellow secretions.
The therapist should recommend:
A) Increasing the frequency of suctioning
B) Administering a mucolytic agent
C) Instilling normal saline before suctioning
D) Changing the tracheostomy tube
Thick, tenacious secretions are difficult to clear and can obstruct the airway . A
mucolytic agent such as acetylcysteine (Mucomyst) helps break down mucus,
making it easier to suction . Normal saline instillation is no longer routinely
recommended .
11. A patient is 2 days post-operative from abdominal surgery. Decreased
breath sounds in the right lower lobe, crackles, and pleuritic chest pain. SpO₂ is
91% on 2 L/min nasal cannula. The MOST appropriate action is:
2026/2027 200 Multiple Choice Questions
with Bold Italic (100% verified answers and
Italic Explanations Upgraded
DOMAIN 1: PATIENT ASSESSMENT & DATA EVALUATION (Questions 1-30)
1. A 55-year-old male with a history of deep vein thrombosis presents with
acute shortness of breath. ABG on room air: pH 7.48, PaCO₂ 30 mmHg, PaO₂ 55
mmHg, HCO₃⁻ 24 mEq/L. What is the most likely diagnosis?
A) Acute asthma exacerbation
B) Pulmonary Embolism
C) COPD exacerbation
D) Cardiogenic pulmonary edema
The ABG shows acute respiratory alkalosis (high pH, low PaCO₂) with significant
hypoxemia . In a patient with DVT risk factors, this pattern—acute tachypnea
driving off CO₂ while O₂ remains low due to V/Q mismatch—is classic for a
Pulmonary Embolism . The normal HCO₃⁻ indicates this is an acute process .
2. A 68-year-old male with COPD presents with increased dyspnea, cough, and
purulent sputum. Vital signs: HR 110 bpm, RR 28/min, BP 145/90 mmHg, SpO₂
88% on room air. What is the MOST appropriate initial action?
A) Obtain a chest X-ray
B) Administer a bronchodilator via nebulizer
C) Apply supplemental oxygen
D) Draw arterial blood gases
,The patient is hypoxemic (SpO₂ 88%) and in respiratory distress . The priority is to
correct hypoxemia with supplemental oxygen . Assessment and treatment of
oxygenation precede diagnostic testing .
3. A patient with asthma has a silent chest on auscultation, uses accessory
muscles, and is diaphoretic. The therapist should recognize this as:
A) Mild asthma exacerbation
B) Moderate asthma exacerbation
C) Severe asthma exacerbation with impending respiratory failure
D) Normal presentation of asthma
A silent chest in asthma indicates severe airflow obstruction with minimal air
movement, a sign of impending respiratory failure . Accessory muscle use and
diaphoresis indicate significant work of breathing . This is a life-threatening
emergency requiring immediate intervention .
4. A unilateral wheeze is auscultated in a 3-year-old child. This finding most
likely indicates:
A) Asthma
B) Heart failure
C) Foreign body aspiration
D) Atelectasis
Asthma typically causes bilateral, diffuse wheezing . A foreign body usually lodges
in one mainstem bronchus (usually the right), causing air trapping and localized
wheezing on the affected side . Atelectasis usually presents with diminished or
absent breath sounds .
5. A patient's chest X-ray reveals a "Batwing" or "Butterfly" pattern of opacities
in the central lungs. This is classic for:
A) Tuberculosis
B) Pulmonary edema (CHF)
,C) Pneumonia
D) Atelectasis
A "Batwing" or "Butterfly" pattern of opacities in the central lungs is classic for
pulmonary edema . This pattern represents interstitial and alveolar edema
accumulating in the perihilar region .
6. The presence of a "Steeple Sign" on a neck or chest x-ray is diagnostic for:
A) Epiglottitis
B) Bacterial Pneumonia
C) Croup (Laryngotracheobronchitis)
D) Pleural Effusion
The steeple sign (or hourglass sign) refers to subglottic narrowing of the trachea
seen on an AP radiograph . It is classic for croup, which is a viral infection causing
inflammation in the upper airway . Epiglottitis shows a "Thumb sign" .
7. A patient's peak flow reading is 180 L/min. The patient's predicted peak flow
is 450 L/min. This indicates:
A) Normal lung function
B) Mild obstruction
C) Moderate obstruction
D) Severe obstruction
Peak flow values: 80-100% predicted = normal; 50-80% = mild-moderate
obstruction; <50% = severe obstruction . 180/450 = 40% of predicted, indicating
severe obstruction requiring immediate intervention .
8. During a physical assessment, the therapist notes a patient has a barrel chest,
pursed-lip breathing, and prolonged expiration. These findings are MOST
consistent with:
A) Asthma
B) Pulmonary fibrosis
, C) Chronic Obstructive Pulmonary Disease (COPD)
D) Pneumonia
Barrel chest, pursed-lip breathing, and prolonged expiration are classic physical
findings in COPD/emphysema . These result from air trapping, hyperinflation, and
airway obstruction .
9. A patient's chest X-ray shows bilateral fluffy infiltrates, Kerley B lines, and
cardiomegaly. The therapist should suspect:
A) Pneumonia
B) Atelectasis
C) Pulmonary edema (CHF)
D) Pulmonary fibrosis
Bilateral fluffy infiltrates, Kerley B lines (interstitial edema), and cardiomegaly are
classic radiographic findings in congestive heart failure with pulmonary edema .
10. A patient with a tracheostomy tube has copious, thick, yellow secretions.
The therapist should recommend:
A) Increasing the frequency of suctioning
B) Administering a mucolytic agent
C) Instilling normal saline before suctioning
D) Changing the tracheostomy tube
Thick, tenacious secretions are difficult to clear and can obstruct the airway . A
mucolytic agent such as acetylcysteine (Mucomyst) helps break down mucus,
making it easier to suction . Normal saline instillation is no longer routinely
recommended .
11. A patient is 2 days post-operative from abdominal surgery. Decreased
breath sounds in the right lower lobe, crackles, and pleuritic chest pain. SpO₂ is
91% on 2 L/min nasal cannula. The MOST appropriate action is:
