CLINICAL SIMULATION PRACTICE EXAM QUESTIONS AND ANSWERS

CLINICAL SIMULATION PRACTICE
EXAM QUESTIONS AND ANSWERS



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 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
-pl - Correct Answers -section 1:
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

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?

-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 inc -
Correct Answers -SECTION 1
INITIATE O2 AT 4L/MIN NASAL CANNULA

, SECTION 2
CBC
SPUTUM GRAM STAIN
12 LEAD EKG

SECTION 3
ADMINISTER RACEMIC EPI
INITIATE HELIOX

SECTION 4
INITIATE MECHANICAL VENTILATION

A 64-year-old male, who is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb), has COPD
with three exacerbations in the last 18 months and a laryngectomy with a permanent
stoma. He is admitted to the medical ICU with acute respiratory decompensation.
Physiologic data established while the patient is receiving an FIO2 of 0.30 by
tracheostomy mask are:

Temperature 38º C (99.8º F) HR 105/min RR 25/min BP 130/80 mm Hg SpO2 93% pH
7.14 PaCO2 87 mm Hg PaO2 63 mm Hg HCO3- 30 mEq/L BE -2 mEq/L SaO2 (calc)
92%

After inserting a cuffed tracheostomy tube, a respiratory therapist is asked to initiate
mechanical ventilation. Which of the following should be recommended?

(CHOOSE ONLY ONE)
AC/VC FIO2 60% RR 16 VT 500 PEEP 7
AC/VC FIO2 40% RR 10 VT 500 PEEP 5
VC/ AC FIO2 40 % RR 18 VT 600 PEEP 5
PSV FIO2 50% PIP 8 PEEP 3
VC SIMV FIO2 50% RR 12 VT 500 PS 5 PEEP 5

For 5 minutes, the patient has been receiving VC, A/C ventilation, - Correct Answers -
SECTION 1
ACVC FIO2 40% RR 10 VT 500 PEEP 5

SECTION 2
DECREASE I TIME

SECTION 3
MAINTAIN SETTINGS
TITRATE FIO2 TO ACHIEVE 89-91

SECTION 4
EVALUATE CUFF PRESSURE AND SEAL INTEGRITY