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Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.BI. PATIENT DATAA. Evaluate Data in the Patient Record1. Patient history, for example, history of present illness (HPI) orders medication reconciliation progress notes DNR status / advance directives social, family, and medical history2. Physical examination relative to the cardiopulmonary system3. Lines, drains, and airways, for example, chest tube vascular lines artificial airway4. Laboratory results, for example, CBC electrolytes coagulation studies sputum culture and sensitivities cardiac biomarkers5. Blood gas analysis and / or hemoximetry (CO-oximetry) results6. Pulmonary function testing results, for example spirometry lung volumes DLCO7. 6 minute walk test results8. Imaging study results, for example, chest radiograph CT scan ultrasonography and / or echocardiography PET scan ventilation / perfusion scan9. Maternal and perinatal / neonatal history, for example, Apgar scores gestational age L / S ratio10. Sleep study results, for example, apnea-hypopnea index (AHI)

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B11. Trends in monitoring resultsa. fluid balanceb. vital signsc. intracranial pressured. ventilator liberation parameterse. pulmonary mechanicsf. noninvasive, for example, pulse oximetry capnography transcutaneousg. cardiac evaluation / monitoring results, for example, ECG hemodynamic parameters12. Determination of a patient's pathophysiological stateB. Perform Clinical Assessment1. Interviewing a patient to assessa. level of consciousness and orientation, emotional state, and ability tocooperateb. level of painc. shortness of breath, sputum production, and exercise toleranced. smoking historye. environmental exposuresf. activities of daily livingg. learning needs, for example, literacy preferred learning style social / cultural2. Performing inspection to assessa. general appearanceb. characteristics of the airway, for example, patency Mallampati classification tracheal shiftc. cough, sputum amount and characterd. status of a neonate, for example, Apgar score gestational agee. skin integrity, for example, pressure ulcers stoma site

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B3. Palpating to assessa. pulse, rhythm, intensityb. accessory muscle activityc. asymmetrical chest movements, tactile fremitus, crepitus, tenderness,tactile rhonchi, and / or tracheal deviation4. Performing diagnostic chest percussion5. Auscultating to assessa. breath soundsb. heart sounds and rhythmc. blood pressure6. Reviewing a chest radiograph to assessa. quality of imaging, for example, patient positioning penetration lung inflationb. presence and position of airways, lines, and drainsc. presence of foreign bodiesd. heart size and positione. presence of, or change in,(i) cardiopulmonary abnormalities, for example, pneumothorax consolidation pleural effusion pulmonary edema pulmonary artery size(ii) diaphragm, mediastinum, and / or tracheaC. Perform Procedures to Gather Clinical Information1. 12 lead ECG2. Noninvasive monitoring, for example, pulse oximetry capnography transcutaneous3. Peak flow4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume,maximal inspiratory pressure, and vital capacity5. Blood gas sample collection6. Blood gas analysis and / or hemoximetry (CO-oximetry)7. Oxygen titration with exercise

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B8. Cardiopulmonary calculations, for example, P(A a)O2 VD / V T P/F OI9. Hemodynamic monitoring10. Pulmonary compliance and airways resistance11. Plateau pressure12. Auto PEEP determination13. Spontaneous breathing trial (SBT)14. Apnea monitoring15. Apnea test (brain death determination)16. Overnight pulse oximetry17. CPAP / NPPV titration during sleep18. Cuff management, for example, tracheal laryngeal19. Sputum induction20. Cardiopulmonary exercise testing21. 6-minute walk test22. Spirometry outside or inside a pulmonary function laboratory23. DLCO inside a pulmonary function laboratory24. Lung volumes inside a pulmonary function laboratory25. Tests of respiratory muscle strength - MIP and MEP26. Therapeutic bronchoscopyD. Evaluate Procedure Results1. 12 lead ECG2. Noninvasive monitoring, for example, pulse oximetry capnography transcutaneous3. Peak flow4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume,maximal inspiratory pressure, and vital capacity5. Blood gas analysis and / or hemoximetry (CO-oximetry)6. Oxygen titration with exercise

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B7. Cardiopulmonary calculations, for example, P(A a)O2 VD / V T P/F OI8. Hemodynamic monitoring9. Pulmonary compliance and airways resistance10. Plateau pressure11. Auto PEEP12. Spontaneous breathing trial (SBT)13. Apnea monitoring14. Apnea test (brain death determination)15. Overnight pulse oximetry16. CPAP / NPPV titration during sleep17. Cuff status, for example, laryngeal tracheal18. Cardiopulmonary exercise testing19. 6-minute walk test20. Spirometry outside or inside a pulmonary function laboratory21. DLCO inside a pulmonary function laboratory22. Lung volumes inside a pulmonary function laboratory23. Tests of respiratory muscle strength - MIP and MEPE. Recommend Diagnostic Procedures1. Testing for tuberculosis2. Laboratory tests, for example, CBC electrolytes coagulation studies sputum culture and sensitivities cardiac biomarkers3. Imaging studies4. Bronchoscopya. diagnosticb. therapeutic5. Bronchoalveolar lavage (BAL)6. Pulmonary function testing

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B7. Noninvasive monitoring, for example, pulse oximetry capnography transcutaneous8. Blood gas and/or hemoximetry (CO-oximetry)9. ECG10. Exhaled gas analysis, for example, CO2 CO FENO11. Hemodynamic monitoring12. Sleep studies13. ThoracentesisII. TROUBLESHOOTING AND QUALITY CONTROL OF EQUIPMENT, AND INFECTIONCONTROLA. Assemble /Troubleshoot Devices1. Medical gas delivery interfaces, for example, mask cannula heated high-flow nasal cannula2. Long-term oxygen therapy3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator liquid system flowmeter regulator gas cylinder blender air compressor gas analyzers4. CPAP / NPPV with patient interfaces5. Humidifiers6. Nebulizers7. Metered-dose inhalers, spacers, and valved holding chambers8. Dry-powder inhalers (DPI)9. Resuscitation equipment, for example, self-inflating resuscitator flow-inflating resuscitator AED10. Mechanical ventilators

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B11. Intubation equipment12. Artificial airways13. Suctioning equipment, for example, regulator canister tubing catheter14. Blood analyzers, for example, hemoximetry (CO-oximetry) point of care blood gas15. Patient breathing circuits16. Hyperinflation devices17. Secretion clearance devices18. Heliox delivery device19. Portable spirometer20. Testing equipment in a pulmonary function laboratory21. Pleural drainage22. Noninvasive monitoring, for example, pulse oximeter capnometer transcutaneous23. Bronchoscopes and light sources24. Hemodynamic monitoringa. pressure transducersb. catheters, for example, arterial pulmonary arteryB. Ensure Infection Prevention1. Adhering to infection prevention policies and procedures, for example, Standard Precautions donning/doffing isolation2. Adhering to disinfection policies and procedures3. Proper handling of biohazardous materialsC. Perform Quality Control Procedures1. Blood analyzers2. Gas analyzers3. Pulmonary function equipment for testinga. spirometry results

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.Bb. lung volumesc. diffusing capacity (DLCO)4. Mechanical ventilators5. Noninvasive monitorsIII. INITIATION AND MODIFICATION OF INTERVENTIONSA. Maintain a Patent Airway Including the Care of Artificial Airways1. Proper positioning of a patient2. Recognition of a difficult airway3. Establishing and managing a patient’s airwaya. nasopharyngeal airwayb. oropharyngeal airwayc. esophagealtracheal tubes / supraglottic airwaysd. endotracheal tubee. tracheostomy tubef. laryngectomy tubeg. speaking valvesh. devices that assist with intubation, for example, endotracheal tube exchanger video laryngoscopy4. Performing tracheostomy care5. Exchanging artificial airways6. Maintaining adequate humidification7. Initiating protocols to prevent ventilator-associated infections8. Performing extubationB. Perform Airway Clearance and Lung Expansion Techniques1. Postural drainage, percussion, or vibration2. Suctioning, for example, nasotracheal oropharyngeal3. Mechanical devices, for example, high frequency chest wall oscillation vibratory PEP intrapulmonary percussive ventilation insufflation / exsufflation device4. Assisted cough, for example, huff abdominal thrust5. Hyperinflation therapy6. Inspiratory muscle training

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.BC. Support Oxygenation and Ventilation1. Initiating and adjusting oxygen therapy2. Minimizing hypoxemia, for example, patient positioning secretion removal3. Initiating and adjusting mask or nasal CPAP4. Initiating and adjusting mechanical ventilation settingsa. continuous mechanical ventilationb. noninvasive ventilationc. high frequency ventilationd. alarms5. Recognizing and correcting patient-ventilator dyssynchrony6. Utilizing ventilator graphics7. Performing lung recruitment maneuvers8. Liberating a patient from mechanical ventilationD. Administer Medications and Specialty Gases1. Aerosolized preparationsa. antimicrobialsb. pulmonary vasodilatorsc. bronchodilatorsd. mucolytics / proteolyticse. steroids2. Endotracheal instillation3. Specialty gases, for example, heliox inhaled NOE. Ensure Modifications are Made to the Respiratory Care Plan1. Treatment termination, for example, life-threatening adverse event2. Recommendationsa. starting treatment based on patient responseb. treatment of pneumothoraxc. adjustment of fluid balanced. adjustment of electrolyte therapye. insertion or change of artificial airwayf. liberating from mechanical ventilationg. extubationh. discontinuing treatment based on patient responsei. consultation from a physician specialist

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.B3. Recommendations for changesa. patient positionb. oxygen therapyc. humidificationd. airway clearancee. hyperinflationf. mechanical ventilation4. Recommendations for pharmacologic interventionsa. bronchodilatorsb. anti-inflammatory drugsc. mucolytics and proteolyticsd. aerosolized antibioticse. inhaled pulmonary vasodilatorsf. cardiovascularg. antimicrobialsh. sedatives and hypnoticsi. analgesicsj. narcotic antagonistsk. benzodiazepine antagonistsl. neuromuscular blocking agentsm. diureticsn. surfactantso. changes to drug, dosage, administration frequency, mode, or concentrationF. Utilize Evidence Based Practice1. Classification of disease severity2. Recommendations for changes in a therapeutic plan when indicated3. Application of guidelines, for example, ARDSNet NAEPP GOLDG. Provide Respiratory Care Techniques in High-Risk Situations1. Emergencya. cardiopulmonary emergencies excluding CPRb. disaster managementc. medical emergency team (MET) / rapid response team2. Interprofessional communication3. Patient transporta. land / air between hospitalsb. within a hospital

Effective: January 2020Clinical Simulation ExaminationDetailed Content OutlineEach section of each problem is classified to a minor content heading,for example, I.A, II.BH. Assist a Physician / Provider in Performing Procedures1. Intubation2. Bronchoscopy3. Specialized bronchoscopy, for example, EBUS navigational bronchoscopy (ENB)4. Thoracentesis5. Tracheotomy6. Chest tube insertion7. Insertion of arterial or venous catheters8. Moderate (conscious) sedation9. Cardioversion10. Withdrawal of life supportI. Conduct Patient and Family Education1. Safety and infection control2. Home care and related equipment3. Lifestyle changes, for example, smoking cessation exercise4. Pulmonary rehabilitation5. Disease / condition management, for example, asthma COPD CF tracheostomy care ventilator dependent

Effective: January 2020Test Form Assembly SpecificationsA. Adult Chronic Airways Disease1. Intubation and mechanical ventilation2. Noninvasive management-for example, medical treatment, noninvasive positive pressureventilation3. Outpatient management of COPD-for example, medical treatment, discharge planning, rehabilitation4. Outpatient management of asthma-for example, medical treatment, discharge planning, rehabilitation5. Diagnosis-for example emphysema, chronic bronchitis, bronchiectasis, asthmaB. Adult TraumaC. Adult Cardiovascular1. H