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Sample Practice Questions

Try these 10 sample questions from the Clinical Simulation Examination practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1A 62-year-old former smoker is admitted with progressive dyspnea, a chronic productive cough, and three lower respiratory tract infections in the past year. The therapist reviews the chart and finds no spirometry on record. Under the GOLD strategy document, what does this history establish?

    1. A. It supports considering a diagnosis of COPD, but spirometry is still required to establish it
    2. B. It establishes a diagnosis of COPD, so spirometry adds nothing to the diagnostic evaluation
    3. C. It excludes COPD unless the patient also reports at least ten years of occupational dust exposure
    4. D. It establishes COPD only if the patient reports more than twenty pack-years of cigarette smoking

    Answer: A

    Explanation: GOLD states that "A diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum" production and a history of exposure to risk factors, and separately that "spirometry with post-bronchodilator FEV1/FVC < 0.7 is mandatory to establish the diagnosis of" COPD. History raises the suspicion; the post-bronchodilator ratio confirms it.

    Reference: Creator: Adobe Acrobat (32-bit) 25.1.20937 — GOLD 2026 Report, Chapter 2, Diagnosis and Assessment, key points

  2. 2A point-of-care blood gas analyzer in a critical care unit has not had its functional status validated since the unit opened. Under the AARC blood gas analysis and hemoximetry guideline, which two activities validate the functional status of a blood gas analyzer?

    1. A. Analysis of commercially prepared quality control products or tonometered whole blood, and participation in proficiency testing
    2. B. Analysis of a patient sample in duplicate on two analyzers, and review of the manufacturer's service log
    3. C. Comparison of results with a pulse oximeter reading, and documentation of the operator's competency file
    4. D. Analysis of a saline blank at each shift change, and monthly replacement of the electrode membranes

    Answer: A

    Explanation: The guideline names as a contraindication "a blood gas analyzer that has not had functional status validated through" either "analysis of commercially prepared quality control products or tonometered whole blood" or "participation in a proficiency testing pro-" gram. Duplicate patient analysis, oximeter comparison, saline blanks, and membrane replacement are not the validation activities the guideline names.

    Reference: AARC Clinical Practice Guideline: Blood Gas Analysis and Hemoximetry: 2013 — AARC CPG Blood Gas Analysis and Hemoximetry 2013, sections BGA 4.0, item 4.1 and 4.2

  3. 3A patient with end-stage COPD is admitted with severe dyspnea and a documented resting SpO2 of 96% on room air. The chart shows a valid advance directive declining intubation. What does the AARC home oxygen guideline identify as the appropriate role of oxygen for dyspnea in this patient?

    1. A. Oxygen may be tried at 1-3 L/min to obtain subjective relief of dyspnea in patients near the end of life
    2. B. Oxygen is contraindicated whenever a patient has declined intubation in an advance directive
    3. C. Oxygen must be titrated to a resting SaO2 of at least 92% before any other dyspnea treatment is added
    4. D. Oxygen must be withheld until arterial blood gas analysis documents a PaO2 at or below 55 mm Hg

    Answer: A

    Explanation: The guideline notes that patients approaching end of life often have dyspnea with or without hypoxemia, and that oxygen may be tried in "these patients at 1-3 liters per minute, to obtain subjective relief of dyspnea". The laboratory threshold of a documented "PaO2 ≤ 55 mm" Hg applies to long-term oxygen therapy for hypoxemia, not to this palliative indication.

    Reference: oxygen therapy CPG :Continuous Pressure CPG — AARC CPG Oxygen Therapy in the Home or Alternate Site Health Care Facility 2007, section OT-CC 4.0, item 4.5

  4. 4The record of an intubated adult documents a new skin breakdown at the corner of the mouth where the endotracheal tube is secured. According to the AARC patient-ventilator assessment guideline, how is the skin surrounding artificial airways and noninvasive ventilation interfaces to be handled during patient-ventilator assessment?

    1. A. It carries a strong recommendation that the surrounding skin be assessed
    2. B. It carries a strong recommendation against routine assessment of the surrounding skin
    3. C. It is assessed only when the patient has been ventilated for more than seven consecutive days
    4. D. It is assessed only when a continuous cuff pressure regulating device is already in place

    Answer: A

    Explanation: The guideline states: "We recommend that the skin surrounding artificial airways and NIV interfaces be assessed (strong" recommendation, high certainty). The recommendation is unconditional; it is not limited by ventilator days or by the presence of a cuff pressure device.

    Reference: DE-RESC240114 1042..1054 — AARC CPG Patient-Ventilator Assessment 2024, abstract, recommendation (11)

  5. 5A pulmonary function laboratory is writing its spirometer quality control procedure. Under the ATS/ERS standardization of spirometry, how often must calibration verification be performed and with what device?

    1. A. At least daily, using a 3-L syringe cycled at least three times
    2. B. At least weekly, using a 3-L syringe cycled at least three times
    3. C. At least monthly, using a 1-L syringe cycled at least five times
    4. D. At least quarterly, using a 3-L syringe cycled at least ten times

    Answer: A

    Explanation: The standard states that calibration verifications "must be undertaken at least daily using a 3-L syringe cycled at least three times to give a range" of flows. The monthly interval in the same standard applies to the leak test of the calibration syringe itself, not to calibration verification of the spirometer.

    Reference: Standardization of Spirometry 2019 Update — ATS/ERS Standardization of Spirometry 2019 Update, equipment quality control

  6. 6A therapist is preparing to teach a newly diagnosed patient with COPD to use a home nebulizer. What role does the AARC guideline on providing patient and caregiver training assign to the respiratory therapist in this encounter?

    1. A. To take an active role in educating the patient, family, and caregivers about their cardiopulmonary disease state
    2. B. To defer education to the case manager, who coordinates all discharge teaching for pulmonary patients
    3. C. To limit teaching to the written manufacturer instructions supplied with the nebulizer compressor
    4. D. To postpone teaching until the patient has been transferred out of the acute care environment

    Answer: A

    Explanation: The guideline's recommendation is: "It is suggested that RTs take an active role in educating patient, family, and caregivers in the management of their cardiopulmonary disease state." It also states that "The training process should occur with every en-" counter between the healthcare providers and the patient, family, and caregiver, which rules out deferring or postponing the teaching.

    Reference: AARC CPG Patient Caregiver Training (2010) — AARC CPG Providing Patient and Caregiver Training 2010, abstract and section PCGT 14.1

  7. 7A therapist reviewing the record of an intubated adult finds that the tube taping was changed overnight but no re-confirmation of tube depth was charted. What does the AARC patient-ventilator assessment guideline say about placement and securement of artificial airways?

    1. A. It suggests assessing the proper placement and securement of artificial airways
    2. B. It suggests that placement be verified only by the clinician who performed the intubation
    3. C. It recommends against assessing securement because repositioning increases extubation risk
    4. D. It suggests that securement be assessed only when the ventilator alarms for a low exhaled volume

    Answer: A

    Explanation: The guideline's final recommendation is: "We suggest assessing the proper placement and securement of artificial airways" (conditional recommendation, very low certainty). Nothing in the recommendation restricts who performs the assessment or ties it to a ventilator alarm condition.

    Reference: DE-RESC240114 1042..1054 — AARC CPG Patient-Ventilator Assessment 2024, abstract, recommendation (15)

  8. 8A technologist drops a 3-L calibration syringe on the laboratory floor. Under the ATS/ERS standardization of spirometry, how should that syringe be treated?

    1. A. It should be considered out of calibration until it is checked
    2. B. It may continue in service until the next scheduled monthly leak test
    3. C. It may continue in service if the daily verification that day was within tolerance
    4. D. It should be discarded, because a dropped syringe cannot be recertified

    Answer: A

    Explanation: The standard states: "A dropped or damaged syringe should be considered out of calibration until it is checked." Deferring to the next scheduled leak test or relying on an earlier verification would leave every subsequent spirometry result anchored to an unverified reference volume.

    Reference: Standardization of Spirometry 2019 Update — ATS/ERS Standardization of Spirometry 2019 Update, calibration syringe section

  9. 9A therapist auscultates an intubated adult and hears coarse crackles that clear after a suctioning pass. Under the AARC artificial airway suctioning guideline, how should suctioning be scheduled for this patient going forward?

    1. A. Only as needed on the basis of assessment findings, rather than on a fixed schedule
    2. B. Every two hours around the clock, because scheduled suctioning prevents tube occlusion
    3. C. Only during the day shift, because nocturnal suctioning disrupts sleep architecture
    4. D. Every four hours, but only after instillation of normal saline solution into the tube

    Answer: A

    Explanation: The AARC guidelines state that "as-needed only, rather than scheduled, suctioning is sufficient" and that "the use of normal saline solution should generally be avoided during suctioning". Assessment findings such as breath sounds drive the decision, so neither a fixed interval nor a saline-primed routine is supported.

    Reference: AARC Clinical Practice Guidelines: Artificial Airway Suctioning — AARC CPG Artificial Airway Suctioning 2022, abstract, recommendations (2) and (5)

  10. 10A stable patient with COPD is on LABA plus LAMA and has had two moderate exacerbations in the past year. The therapist reviews the complete blood count before the pharmacy rounds. Under the GOLD strategy document, what treatment decision does the blood eosinophil count from that CBC inform?

    1. A. Whether to add an inhaled corticosteroid to the maintenance bronchodilator regimen
    2. B. Whether to prescribe long-term oxygen therapy for the patient at home
    3. C. Whether to change the patient from a dry-powder inhaler to a nebulized bronchodilator
    4. D. Whether to refer the patient for surgical lung volume reduction of the upper lobes

    Answer: A

    Explanation: GOLD states that "blood eosinophil counts predict the magnitude of the effect of ICS (added on" top of regular maintenance bronchodilator treatment) in preventing future exacerbations, and that "blood eosinophil counts are recommended by GOLD to guide the use of ICS as part of pharmacological management". The count is an inhaled-corticosteroid decision variable, not an oxygen, device, or surgical criterion.

    Reference: Creator: Adobe Acrobat (32-bit) 25.1.20937 — GOLD 2026 Report, Chapter 2, blood eosinophil count section

Topics in this practice bank

These topics describe the available practice for Clinical Simulation Examination. Review the examination outline and its sources for scope and allocation details.

  • I. PATIENT DATA
    • I.A. Evaluate Data in the Patient Record — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, Apgar scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, Apgar score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary exercise testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary exercise testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF EQUIPMENT, AND INFECTION CONTROL
    • II.A. Assemble /Troubleshoot Devices — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation device; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care Techniques in High-Risk Situations — 1. Emergency a. cardiopulmonary emergencies excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, EBUS, navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent

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