NBRC CSE | Clinical Simulation Examination Study Guide & Exam Prep 2026/2027
Croup IG: Viral infection of the upper airway with a barking cough and often stridor, low
grade fever developed over 2-5 days, rhinorrhea, marked intercostal retractions.
X-ray shows pencil point of the upper airway.
DM: give racemic epi (if you have to give more than 1 be worried) and
corticosteroids Decadron (dexamethasone), along w/ cool aerosol mist. If no
improvement with epi suction and intubate. make sure to listen for a leak around
the cuff before you extubate.
neonatal resuscitation wipe baby off, put under radiant warmer, if grunting & HR 80 Initiate CPAP or
neopuff if HR decreases to 60 or less initiate compressions and 100% FiO2
-NRP: 1 rescuer 30:2
2 rescuer 15:2
pulmonary edema IG: sudden onset with orthopnea, pink frothy secretions, enlarged heart, ST
depress, bilateral fluffy infiltrates on x ray.
DM: give hyperinflation therapy, put in fowler's position. Thoracentesis for
infiltrate and fluid. Medication: Lasix, morphine, and digitalis.
Myocardial Ischemia/infarction IG: chest pain and nausea, substernal squeezing pain in left shoulder, shows
elevated ST segment, ST depression T wave inversion on EKG.
IG: Troponin 0.78 (elevated) (> 0.1), CK shows recent MI, pedal edema,
character of chest pain, peripheral pulses, CBC, electrolytes, ECG, if intubated
evaluate CXR for tube placement, elevation in cardiac enzymes
DM: give oxygen for hypoxemia 2L/M BP 80/40 give dopamine, digoxin,
Levophed (inotropic drug) to increase BP. Use Verapamil if BP is high .
Sublingual nitroglycerin, O2, aspirin, and morphine. (OMAN)
ultrasound to determine if mitral valve is blocked
PVC's ---> lidocaine or amiodarone
Guillian-Barre IG: pt. comes in with acute weakness in legs, onset of difficulty walking, reduced
lower extremity strength, recent infection
Test: Lumbar puncture if not diagnosed. positive if increase in protein within
cerebral spinal fluid
(Tx: plasmapheresis)
IG: ability to swallow, cough effort, sensory and motor function, level of
consciousness, and deep tendon reflexes.
--> closely monitor respiratory muscle strength
(VC,VT, MIP) VC < 1.0 intubate, MIP < -60- -70
DM: continue to monitor MIP and VC if not intubated, refer to physical therapy for
evaluation, pressure stockings
Cystic Fibrosis IG: has elevated hemoglobin and hematocrit sweat chloride to diagnose must be
above 60(usually already diagnosed so wont need to do), tenacious yellow-green
sputum (infection), decreased BS, coarse crackles,
IG: Spirometry, sputum culture & sensitivity for infection, 6MWT, CXR
(bronchiectasis give antibiotics- ciprofloxacin)
DM: oral ciprofloxacin (antibiotic), increase frequency of airway clearance
therapy.
hemoptysis present give epinephrine
ivacafort, cayston is medication for CF first being diagnosed
DM: Home care management: bronchodilator, pulmozyme, HFCWO, tobramycin,
pancreatic enzymes, For C.F. adult at college give DPI TOBI instead of
Nebulizer.
neonate being delivered pick intubation supplies if needed: size 2.5-3.5 ETT, laryngoscope blades, bag to
ventilate suction material, warmer, drying materials (if suction material and tubes
already gathered don't pick again) wipe off and warm under radiant warmer first
-baby ends up having a pneumothorax on left, insert chest tube
otherwise suction, give surfactant, right after birth & 12 hours later if needed. If
still showing distress put on ventilator, PC/SIMV
, NBRC CSE | Clinical Simulation Examination Study Guide & Exam Prep 2026/2027
Asthma IG: Personal best PEF establish different zones, adherence to medication
regimen, nocturnal awakenings. Complete education on medications and yellow
zone. Add inhaled steroid (Flovent) for persistent yellow zone.
DM: Asthma exacerbation: albuterol multiple treatments and IV methylprednisone
if no improvement with albuterol
DM: if exercise induced use albuterol 2 puffs prior to exercise. seasonal allergies
Singulair and budesonide/formoterol (Symbicort) complete allergen testing,
vacuum, wash sheets, change filters
COPD IG: Diffuse crackles & wheezing, bronchospasm, progressive dyspnea, SOB,
ABG: 50-50 club PaCO2 & PaO2- normal pH, hyperinflation
DM: first give: 24-28% (1-2L) O2
IG: FEV1 Pre and post 12-15% difference, Lung volumes, DLCO, O2 titration
during exercise, 6MWT, CXR, PFT (not acute) , for infection do sputum C&S,
chemistry panel, ECG if pedal edema present
DM: Acute infection/exacerbation/bronchospasm: give Albuterol or DuoNeb, then
IV methylprednisone or oral prednisone, oral ciprofloxacin (antibiotic) for
infection, maintain FiO2 at 0.28
1) LAMA (Spiriva, Spiriva Respimat, Incruse Ellipta)
2) LABA (Salmeterol, Formoterol, Arformoterol(Brovana))
3) LAMA/LABA (Spiolto Respimat, Anoro Ellipta)
-long term O2 therapy if needed
-yearly flu and pneumonia vaccinations
-pulmonary rehab referral
-have patient demonstrate proper use of meds
-smoking cessation if patient still smokes
Epiglottitis Comes in drooling, emergency needs to go to the OR for intubation. Order a
lateral neck X ray (thumb sign), administer racemic epi.
initial neonate vent settings PC/SIMV
Vt 4-5 mL/kg
RR 30-35
FIO2 40-60% (always use previous FiO2 or 0.10 above)
I-time .3-.6 (.4-.5-ideal)
PEEP 5
PIP 20-25
* always write down settings if Rate is decreased also decrease PIP
how to treat low ventilator alarms Low Volume
1) manually ventilate
--> check ventilator circuit connections
check tubing connections
assess chest rise
verify alarm settings
check the delivered tidal volume
check the integrity of the ET cuff
check the humidifier
check the exhalation valve
if intubated confirm ETT position
occlude the Y and cycle the ventilator
HIV/drug use/homeless IG: pt. is homeless IV meth user, give HIV (ELISA) test, pneumocystis jiroveci
pneumonia underlying condition
DM: pentamidine (NebuPent) aerosolized administered w// respiguard (a one
way valve neb to prevent the therapist from exposure to the drug)
pregnant women with blisters chicken pox (varicella zoster virus)
-use airborne precautions (wear N95 mask, private room, negative pressure
room) HFNC on 40%,
-clean stethoscope with 70% alcohol wipes leave inside room.
LAMA medications 1st line of treatment for COPD
(Tiotropium bromide) Spiriva
(Tiotropium) Spiriva Respimat
(Umeclidinium) Incruse Ellipta
(Ipatropium bromide) Atrovent
Croup IG: Viral infection of the upper airway with a barking cough and often stridor, low
grade fever developed over 2-5 days, rhinorrhea, marked intercostal retractions.
X-ray shows pencil point of the upper airway.
DM: give racemic epi (if you have to give more than 1 be worried) and
corticosteroids Decadron (dexamethasone), along w/ cool aerosol mist. If no
improvement with epi suction and intubate. make sure to listen for a leak around
the cuff before you extubate.
neonatal resuscitation wipe baby off, put under radiant warmer, if grunting & HR 80 Initiate CPAP or
neopuff if HR decreases to 60 or less initiate compressions and 100% FiO2
-NRP: 1 rescuer 30:2
2 rescuer 15:2
pulmonary edema IG: sudden onset with orthopnea, pink frothy secretions, enlarged heart, ST
depress, bilateral fluffy infiltrates on x ray.
DM: give hyperinflation therapy, put in fowler's position. Thoracentesis for
infiltrate and fluid. Medication: Lasix, morphine, and digitalis.
Myocardial Ischemia/infarction IG: chest pain and nausea, substernal squeezing pain in left shoulder, shows
elevated ST segment, ST depression T wave inversion on EKG.
IG: Troponin 0.78 (elevated) (> 0.1), CK shows recent MI, pedal edema,
character of chest pain, peripheral pulses, CBC, electrolytes, ECG, if intubated
evaluate CXR for tube placement, elevation in cardiac enzymes
DM: give oxygen for hypoxemia 2L/M BP 80/40 give dopamine, digoxin,
Levophed (inotropic drug) to increase BP. Use Verapamil if BP is high .
Sublingual nitroglycerin, O2, aspirin, and morphine. (OMAN)
ultrasound to determine if mitral valve is blocked
PVC's ---> lidocaine or amiodarone
Guillian-Barre IG: pt. comes in with acute weakness in legs, onset of difficulty walking, reduced
lower extremity strength, recent infection
Test: Lumbar puncture if not diagnosed. positive if increase in protein within
cerebral spinal fluid
(Tx: plasmapheresis)
IG: ability to swallow, cough effort, sensory and motor function, level of
consciousness, and deep tendon reflexes.
--> closely monitor respiratory muscle strength
(VC,VT, MIP) VC < 1.0 intubate, MIP < -60- -70
DM: continue to monitor MIP and VC if not intubated, refer to physical therapy for
evaluation, pressure stockings
Cystic Fibrosis IG: has elevated hemoglobin and hematocrit sweat chloride to diagnose must be
above 60(usually already diagnosed so wont need to do), tenacious yellow-green
sputum (infection), decreased BS, coarse crackles,
IG: Spirometry, sputum culture & sensitivity for infection, 6MWT, CXR
(bronchiectasis give antibiotics- ciprofloxacin)
DM: oral ciprofloxacin (antibiotic), increase frequency of airway clearance
therapy.
hemoptysis present give epinephrine
ivacafort, cayston is medication for CF first being diagnosed
DM: Home care management: bronchodilator, pulmozyme, HFCWO, tobramycin,
pancreatic enzymes, For C.F. adult at college give DPI TOBI instead of
Nebulizer.
neonate being delivered pick intubation supplies if needed: size 2.5-3.5 ETT, laryngoscope blades, bag to
ventilate suction material, warmer, drying materials (if suction material and tubes
already gathered don't pick again) wipe off and warm under radiant warmer first
-baby ends up having a pneumothorax on left, insert chest tube
otherwise suction, give surfactant, right after birth & 12 hours later if needed. If
still showing distress put on ventilator, PC/SIMV
, NBRC CSE | Clinical Simulation Examination Study Guide & Exam Prep 2026/2027
Asthma IG: Personal best PEF establish different zones, adherence to medication
regimen, nocturnal awakenings. Complete education on medications and yellow
zone. Add inhaled steroid (Flovent) for persistent yellow zone.
DM: Asthma exacerbation: albuterol multiple treatments and IV methylprednisone
if no improvement with albuterol
DM: if exercise induced use albuterol 2 puffs prior to exercise. seasonal allergies
Singulair and budesonide/formoterol (Symbicort) complete allergen testing,
vacuum, wash sheets, change filters
COPD IG: Diffuse crackles & wheezing, bronchospasm, progressive dyspnea, SOB,
ABG: 50-50 club PaCO2 & PaO2- normal pH, hyperinflation
DM: first give: 24-28% (1-2L) O2
IG: FEV1 Pre and post 12-15% difference, Lung volumes, DLCO, O2 titration
during exercise, 6MWT, CXR, PFT (not acute) , for infection do sputum C&S,
chemistry panel, ECG if pedal edema present
DM: Acute infection/exacerbation/bronchospasm: give Albuterol or DuoNeb, then
IV methylprednisone or oral prednisone, oral ciprofloxacin (antibiotic) for
infection, maintain FiO2 at 0.28
1) LAMA (Spiriva, Spiriva Respimat, Incruse Ellipta)
2) LABA (Salmeterol, Formoterol, Arformoterol(Brovana))
3) LAMA/LABA (Spiolto Respimat, Anoro Ellipta)
-long term O2 therapy if needed
-yearly flu and pneumonia vaccinations
-pulmonary rehab referral
-have patient demonstrate proper use of meds
-smoking cessation if patient still smokes
Epiglottitis Comes in drooling, emergency needs to go to the OR for intubation. Order a
lateral neck X ray (thumb sign), administer racemic epi.
initial neonate vent settings PC/SIMV
Vt 4-5 mL/kg
RR 30-35
FIO2 40-60% (always use previous FiO2 or 0.10 above)
I-time .3-.6 (.4-.5-ideal)
PEEP 5
PIP 20-25
* always write down settings if Rate is decreased also decrease PIP
how to treat low ventilator alarms Low Volume
1) manually ventilate
--> check ventilator circuit connections
check tubing connections
assess chest rise
verify alarm settings
check the delivered tidal volume
check the integrity of the ET cuff
check the humidifier
check the exhalation valve
if intubated confirm ETT position
occlude the Y and cycle the ventilator
HIV/drug use/homeless IG: pt. is homeless IV meth user, give HIV (ELISA) test, pneumocystis jiroveci
pneumonia underlying condition
DM: pentamidine (NebuPent) aerosolized administered w// respiguard (a one
way valve neb to prevent the therapist from exposure to the drug)
pregnant women with blisters chicken pox (varicella zoster virus)
-use airborne precautions (wear N95 mask, private room, negative pressure
room) HFNC on 40%,
-clean stethoscope with 70% alcohol wipes leave inside room.
LAMA medications 1st line of treatment for COPD
(Tiotropium bromide) Spiriva
(Tiotropium) Spiriva Respimat
(Umeclidinium) Incruse Ellipta
(Ipatropium bromide) Atrovent
