RESPIRATORY THERAPY RCP190 FW: CLINICAL SIMULATION SELF-ASSESSMENT EXAMINATION (FORM 2026 B) ACTUAL CASE STUDIES &
EXPLANATIONS
Simulation 1: B. Adult Trauma
The night-shift respiratory therapy supervisor is evaluating a 25-year-old male unrestrained
driver who was involved in a head-on collision. The patient is agitated and has a cervical spine
collar in place. He is 183 cm (6 ft) tall and weighs 80 kg (176 lb). While receiving O2 by nasal
cannula at 3 L/min, vital signs are:
Tempera 36.2º C
ture (97.2º F)
HR 120/min
RR 30/min
BP 90/60 mm
Hg
SpO2 87%
O2 flow is increased to 6 L/min. Which of the following information should be evaluated?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button to proceed.)
Thermodilution cardiac output
LOC
PAP
eFAST
Physical examination of the Chest
Cervical Spine Range of Motion
Physical examination of the
abdomen Presence of Craniofacial
Trauma CVP
Elicitation of the Gag Reflex
Allen’s Test
Presence of the Vestibulo-Ocular (dolls eyes) reflex
The patient is agitated, with a GCS score of 12, and has scattered facial ecchymosis and
lacerations. A left apical pneumothorax is observed along with paradoxical movement of the
left chest. Breath sounds are reduced on the left side. SpO2 is 86% while receiving O2 by nasal
cannula at 6 L/min. Which of the following should the therapist recommend?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Intubate and initiate mechanical ventilation
Administer O2 by NRB
Five minutes later, SpO2 is 93% while the patient is receiving HHFNC at 50 L/min with an
FIO2 of 1.0. A strong odor of alcohol is noted on the patient. A chest radiograph reveals ribs 2
through 7 are fractured in several places on the left and there is an infiltrate consistent with
pulmonary contusion on the left side of the chest. 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.)
Sputum Culture
Urine culture
Chest CT
Toxicology screen
Lumbar puncture
12-lead ECG
Ventilation/Perfusion Scan
Cardiac enzymes
Urine sodium
P50
CBC
,Blood Culture
Cervical spine Radiograph
Which of the following should be recommended?
,(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Insert a left chest tube
Insert a thoracic epidural catheter
Initiate antibiotics for pneumonia
Transfer for cardiac catheterization
After 2 hours of receiving HHFNC at 50 L/min with an F IO2 of 1.0, and receiving volume
resuscitation, physiologic data are:
Tempera 36.1º C PCO2 33 mm
ture (97º F) Hg
HR 111/min PO2 48 mm
RR 32/min Hg
BP 108/72 HCO3- 25
mm Hg mEq/L
SpO2 85% BE +2
mEq/L
pH 7.48 SO2 (calc 83%
)
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Initiate NPPV
Intubate and initiate mechanical ventilation
Maintain the current therapy
Initiate inhaled NO therapy
Simulation 2: E2. Adult Medical or Surgical - Infectious disease
A 75-year-old man, who is 178 cm (5 ft 10 in) tall and weighs 82 kg (180 lb), is admitted though
the ED after developing an uncontrollable, productive cough and hypoxia. A chest radiograph
from the ED reveals:
The patient is transferred to an acute care unit. Oxygen by nasal cannula at 2 L/min is initiated
after observing the patient has an SpO2 of 89% while breathing air. Vital signs are:
Tempera 38.9º C
ture (102º F)
HR 102/min
RR 18/min
BP 116/72 mm
Hg
SpO2 95%
Which of the following should be assessed?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button to proceed.)
Echocardiogram
Blood culture
Basic Metabolic Panel chemistries
Transbronchial biopsy
, Urinalysis
CT scan of the Abdomen
Cardiovascular stress test
Sputum culture and Gram stain
CBC
Coronary Angiography
Endobronchial ultrasound
Chest auscultation
Spirometry
There is evidence of an infection in the left lung. Which of the following should a respiratory
therapist anticipate?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Restriction of IV fluids
Nebulization of 7% NaCl q4h
Titration of O2 to maintain SpO2 of 90-94%
Initiation of vibratory PEP therapy
Sputum culture identifies Streptococcal pneumonia that requires initiation of droplet
precautions. The patient is receiving antibiotic treatment for pneumonia, as well as
O2 therapy. According to CDC Guidelines for Isolation Precautions, which of the following
personal protective equipment is the therapist required to don before entering this patient's
room?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Gown
Face mask
Gloves
Show covers
Eye shield
While the patient is receiving O2 by nasal cannula at 2 L/min, the therapist observes the
following information:
Tempera 38.1º C
ture (100.6º F)
HR 118/min
RR 24/min
BP 114/75 mm
Hg
SpO2 88%
Breath sounds are diminished over both bases, but crackles are audible over the left
lung. Which of the following should the therapist do FIRST?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Switch to 5 cm H2O mask CPAP with an FIO2 of 0.50.
Switch to HHFNC at 50 L/min with an FIO2 of 0.70.
Set O2 flow to 4 L/min.
The patient's respiratory distress increases over the next 24 hours. The patient care team
decides to transition to noninvasive mechanical ventilation using a dual-limb,
humidified, heated-wire circuit. Which of the following should the therapist do with the circuit
relative to droplet precautions?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Add a water trap at the low point of the expiratory limb
EXPLANATIONS
Simulation 1: B. Adult Trauma
The night-shift respiratory therapy supervisor is evaluating a 25-year-old male unrestrained
driver who was involved in a head-on collision. The patient is agitated and has a cervical spine
collar in place. He is 183 cm (6 ft) tall and weighs 80 kg (176 lb). While receiving O2 by nasal
cannula at 3 L/min, vital signs are:
Tempera 36.2º C
ture (97.2º F)
HR 120/min
RR 30/min
BP 90/60 mm
Hg
SpO2 87%
O2 flow is increased to 6 L/min. Which of the following information should be evaluated?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button to proceed.)
Thermodilution cardiac output
LOC
PAP
eFAST
Physical examination of the Chest
Cervical Spine Range of Motion
Physical examination of the
abdomen Presence of Craniofacial
Trauma CVP
Elicitation of the Gag Reflex
Allen’s Test
Presence of the Vestibulo-Ocular (dolls eyes) reflex
The patient is agitated, with a GCS score of 12, and has scattered facial ecchymosis and
lacerations. A left apical pneumothorax is observed along with paradoxical movement of the
left chest. Breath sounds are reduced on the left side. SpO2 is 86% while receiving O2 by nasal
cannula at 6 L/min. Which of the following should the therapist recommend?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Intubate and initiate mechanical ventilation
Administer O2 by NRB
Five minutes later, SpO2 is 93% while the patient is receiving HHFNC at 50 L/min with an
FIO2 of 1.0. A strong odor of alcohol is noted on the patient. A chest radiograph reveals ribs 2
through 7 are fractured in several places on the left and there is an infiltrate consistent with
pulmonary contusion on the left side of the chest. 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.)
Sputum Culture
Urine culture
Chest CT
Toxicology screen
Lumbar puncture
12-lead ECG
Ventilation/Perfusion Scan
Cardiac enzymes
Urine sodium
P50
CBC
,Blood Culture
Cervical spine Radiograph
Which of the following should be recommended?
,(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Insert a left chest tube
Insert a thoracic epidural catheter
Initiate antibiotics for pneumonia
Transfer for cardiac catheterization
After 2 hours of receiving HHFNC at 50 L/min with an F IO2 of 1.0, and receiving volume
resuscitation, physiologic data are:
Tempera 36.1º C PCO2 33 mm
ture (97º F) Hg
HR 111/min PO2 48 mm
RR 32/min Hg
BP 108/72 HCO3- 25
mm Hg mEq/L
SpO2 85% BE +2
mEq/L
pH 7.48 SO2 (calc 83%
)
Which of the following should be recommended?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Initiate NPPV
Intubate and initiate mechanical ventilation
Maintain the current therapy
Initiate inhaled NO therapy
Simulation 2: E2. Adult Medical or Surgical - Infectious disease
A 75-year-old man, who is 178 cm (5 ft 10 in) tall and weighs 82 kg (180 lb), is admitted though
the ED after developing an uncontrollable, productive cough and hypoxia. A chest radiograph
from the ED reveals:
The patient is transferred to an acute care unit. Oxygen by nasal cannula at 2 L/min is initiated
after observing the patient has an SpO2 of 89% while breathing air. Vital signs are:
Tempera 38.9º C
ture (102º F)
HR 102/min
RR 18/min
BP 116/72 mm
Hg
SpO2 95%
Which of the following should be assessed?
(SELECT AS MANY as you consider indicated, then click on the Go To Next Section button to proceed.)
Echocardiogram
Blood culture
Basic Metabolic Panel chemistries
Transbronchial biopsy
, Urinalysis
CT scan of the Abdomen
Cardiovascular stress test
Sputum culture and Gram stain
CBC
Coronary Angiography
Endobronchial ultrasound
Chest auscultation
Spirometry
There is evidence of an infection in the left lung. Which of the following should a respiratory
therapist anticipate?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Restriction of IV fluids
Nebulization of 7% NaCl q4h
Titration of O2 to maintain SpO2 of 90-94%
Initiation of vibratory PEP therapy
Sputum culture identifies Streptococcal pneumonia that requires initiation of droplet
precautions. The patient is receiving antibiotic treatment for pneumonia, as well as
O2 therapy. According to CDC Guidelines for Isolation Precautions, which of the following
personal protective equipment is the therapist required to don before entering this patient's
room?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Gown
Face mask
Gloves
Show covers
Eye shield
While the patient is receiving O2 by nasal cannula at 2 L/min, the therapist observes the
following information:
Tempera 38.1º C
ture (100.6º F)
HR 118/min
RR 24/min
BP 114/75 mm
Hg
SpO2 88%
Breath sounds are diminished over both bases, but crackles are audible over the left
lung. Which of the following should the therapist do FIRST?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Switch to 5 cm H2O mask CPAP with an FIO2 of 0.50.
Switch to HHFNC at 50 L/min with an FIO2 of 0.70.
Set O2 flow to 4 L/min.
The patient's respiratory distress increases over the next 24 hours. The patient care team
decides to transition to noninvasive mechanical ventilation using a dual-limb,
humidified, heated-wire circuit. Which of the following should the therapist do with the circuit
relative to droplet precautions?
(CHOOSE ONLY ONE unless you are directed to "Make another selection.")
Add a water trap at the low point of the expiratory limb
