RESPIRATORY THERAPY RCP190 FW: CLINICAL SIMULATION SELF-
ASSESSMENT EXAMINATION (FORM 2026 A) ACTUAL CASE STUDIES &
EXPLANATIONS
The National Board for Respiratory Care, Inc. - SIMULATION RESPONSE REPORT
Simulation 1: A2. Adult Chronic Airways Disease - Noninvasive
management
USE THE SCROLL BAR ON THE RIGHT SIDE OF ANY WINDOW AS NEEDED TO SEE ALL
INFORMATION.
A respiratory therapist is called to the pulmonary clinic in a hospital to evaluate 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
HCO - 32 mEq/L
3
BE +3 mEq/L
SaO2 (calc) 85%
Which of the following should be evaluated initially?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section
button to proceed.)
2 Breath sounds
Diminished and coarse crackles bilaterally
Explanation: Assessment of breath sounds may suggest underlying pathology.
1 Sputum culture
Specimen sent to the laboratory for analysis
Explanation: This test may identify the specific pathogen responsible for suspected
pulmonary infection.
,2 Home O2 use
24% O2 by tracheostomy collar
Explanation: Knowledge of the patient's use of home O2 is important to establish baseline
information to guide further management.
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2 Increase to an FIO2 of 0.30 by tracheostomy mask.
The physician agrees and the patient is also admitted to an ICU.
Explanation: This patient with COPD is having an acute exacerbation and requires O2
supplementation and acute care in the hospital.
Which of the following should be evaluated postadmission?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 CBC
Hb 18 g/dL, Hct 54%, WBC 18,000/µL, platelets 210,000/µL
Explanation: It is important to evaluate the WBC count for possible infection and Hb and
Hct for polycythemia or anemia.
2 Chest radiograph
Hyperinflation with scattered infiltrates in the right lower lobe, tracheostomy tube in
place
Explanation: A chest radiograph is important for evaluating the lungs and pleural space for
the presence of pathologic processes.
1 Sputum quantity and characteristics
Large quantity of thick, foul-smelling, greenish-yellow sputum
Explanation: This evaluation is necessary to assess for potential infection and difficulties
with secretion mobilization.
1 12-lead ECG
Sinus tachycardia at 130/min, otherwise normal
Explanation: An ECG is necessary for the evaluation of any cardiac rate or rhythm
abnormality.
,Antibiotics have been administered. Which of the following additional therapeutic
interventions should be recommended?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 Titrate FIO2 to maintain an SpO2 of 88-90%.
Noted.
Explanation: This SpO2 level is consistent with a desirable PaO2 for a patient with COPD
and chronic CO2 retention.
1
Administer aerosolized albuterol/ipratropium (DuoNeb).
Noted.
Explanation: A combination of bronchodilators with different mechanisms of action will
improve the patient's ventilation and assist in clearing secretions.
1
Initiate systemic corticosteroid
therapy. Noted.
Explanation: The patient's infection will cause airway inflammation and an anti-
inflammatory agent is needed to treat this component of the disease.
THIS IS THE FINAL SECTION OF THIS PROBLEM.
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
HCO - 30 mEq/L
3
BE -2 mEq/L
SO2 (calc) 93%
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2
Insert a cuffed tracheostomy tube, and initiate mechanical
ventilation. End of the problem.
Explanation: The patient requires mechanical ventilation for acute-on-chronic ventilatory
failure with a decompensated pH. A cuffed tracheostomy tube is required to
initiate mechanical ventilation.
, Simulation 2: E4. Adult Medical or Surgical - Other
USE THE SCROLL BAR ON THE RIGHT SIDE OF ANY WINDOW AS NEEDED TO SEE ALL
INFORMATION.
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?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2 Initiate O2 by nasal cannula at 4 L/min.
O2 is initiated, and SpO2 increases to 95%.
Explanation: This level of O2 therapy should increase the FIO2 enough to correct the
hypoxemia, which will allow further studies to be done to identify the cause of
respiratory distress.
The patient has been admitted to an acute care ward. A chest radiograph reveals an
infiltrate in the left lower lobe and a significant narrowing of the distal tracheal air column.
While receiving O2 by nasal cannula at 4 L/min, ABG analysis reveals:
pH 7.44
PCO2 36 mm Hg
PO2 87 mm Hg
- 24 mEq/L
HCO3
BE 0 mEq/L
SO2 (calc) 97%
Which of the following should be evaluated?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 12-lead ECG
Normal sinus rhythm, rate 100/min
ASSESSMENT EXAMINATION (FORM 2026 A) ACTUAL CASE STUDIES &
EXPLANATIONS
The National Board for Respiratory Care, Inc. - SIMULATION RESPONSE REPORT
Simulation 1: A2. Adult Chronic Airways Disease - Noninvasive
management
USE THE SCROLL BAR ON THE RIGHT SIDE OF ANY WINDOW AS NEEDED TO SEE ALL
INFORMATION.
A respiratory therapist is called to the pulmonary clinic in a hospital to evaluate 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
HCO - 32 mEq/L
3
BE +3 mEq/L
SaO2 (calc) 85%
Which of the following should be evaluated initially?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section
button to proceed.)
2 Breath sounds
Diminished and coarse crackles bilaterally
Explanation: Assessment of breath sounds may suggest underlying pathology.
1 Sputum culture
Specimen sent to the laboratory for analysis
Explanation: This test may identify the specific pathogen responsible for suspected
pulmonary infection.
,2 Home O2 use
24% O2 by tracheostomy collar
Explanation: Knowledge of the patient's use of home O2 is important to establish baseline
information to guide further management.
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2 Increase to an FIO2 of 0.30 by tracheostomy mask.
The physician agrees and the patient is also admitted to an ICU.
Explanation: This patient with COPD is having an acute exacerbation and requires O2
supplementation and acute care in the hospital.
Which of the following should be evaluated postadmission?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 CBC
Hb 18 g/dL, Hct 54%, WBC 18,000/µL, platelets 210,000/µL
Explanation: It is important to evaluate the WBC count for possible infection and Hb and
Hct for polycythemia or anemia.
2 Chest radiograph
Hyperinflation with scattered infiltrates in the right lower lobe, tracheostomy tube in
place
Explanation: A chest radiograph is important for evaluating the lungs and pleural space for
the presence of pathologic processes.
1 Sputum quantity and characteristics
Large quantity of thick, foul-smelling, greenish-yellow sputum
Explanation: This evaluation is necessary to assess for potential infection and difficulties
with secretion mobilization.
1 12-lead ECG
Sinus tachycardia at 130/min, otherwise normal
Explanation: An ECG is necessary for the evaluation of any cardiac rate or rhythm
abnormality.
,Antibiotics have been administered. Which of the following additional therapeutic
interventions should be recommended?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 Titrate FIO2 to maintain an SpO2 of 88-90%.
Noted.
Explanation: This SpO2 level is consistent with a desirable PaO2 for a patient with COPD
and chronic CO2 retention.
1
Administer aerosolized albuterol/ipratropium (DuoNeb).
Noted.
Explanation: A combination of bronchodilators with different mechanisms of action will
improve the patient's ventilation and assist in clearing secretions.
1
Initiate systemic corticosteroid
therapy. Noted.
Explanation: The patient's infection will cause airway inflammation and an anti-
inflammatory agent is needed to treat this component of the disease.
THIS IS THE FINAL SECTION OF THIS PROBLEM.
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
HCO - 30 mEq/L
3
BE -2 mEq/L
SO2 (calc) 93%
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2
Insert a cuffed tracheostomy tube, and initiate mechanical
ventilation. End of the problem.
Explanation: The patient requires mechanical ventilation for acute-on-chronic ventilatory
failure with a decompensated pH. A cuffed tracheostomy tube is required to
initiate mechanical ventilation.
, Simulation 2: E4. Adult Medical or Surgical - Other
USE THE SCROLL BAR ON THE RIGHT SIDE OF ANY WINDOW AS NEEDED TO SEE ALL
INFORMATION.
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?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
2 Initiate O2 by nasal cannula at 4 L/min.
O2 is initiated, and SpO2 increases to 95%.
Explanation: This level of O2 therapy should increase the FIO2 enough to correct the
hypoxemia, which will allow further studies to be done to identify the cause of
respiratory distress.
The patient has been admitted to an acute care ward. A chest radiograph reveals an
infiltrate in the left lower lobe and a significant narrowing of the distal tracheal air column.
While receiving O2 by nasal cannula at 4 L/min, ABG analysis reveals:
pH 7.44
PCO2 36 mm Hg
PO2 87 mm Hg
- 24 mEq/L
HCO3
BE 0 mEq/L
SO2 (calc) 97%
Which of the following should be evaluated?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button
to proceed.)
1 12-lead ECG
Normal sinus rhythm, rate 100/min
