Before and during treatment with ethambutol, the nurse ensures regular monitoring of the patient's:

Visual acuity and red-green colour vision

Urine colour for orange staining

Hearing and vestibular balance on audiometry

In week 3 of first-line ATT (HRZE), a patient develops nausea, vomiting, yellow sclera and an ALT five times the upper limit of normal. What is the most appropriate nursing action?

Withhold ATT and report to the doctor urgently

Continue ATT and give an antiemetic before doses

Stop only ethambutol and continue the others

Double the pyridoxine dose and continue ATT

A patient with sputum-positive pulmonary tuberculosis is admitted to the ward. When giving direct care, the nurse should wear:

A gown, gloves and a face shield

Respiratory: COPD, asthma, ARDS and oxygen therapy

26 AIIMS NORCET (Nursing Officer) practice questions on Respiratory: COPD, asthma, ARDS and oxygen therapy, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Before and during treatment with ethambutol, the nurse ensures regular monitoring of the patient's:
1. AUrine colour for orange staining
2. BSerum uric acid level
3. CVisual acuity and red-green colour vision
4. DHearing and vestibular balance on audiometry
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Answer: C · Visual acuity and red-green colour vision
Ethambutol can cause optic neuritis, seen first as reduced visual acuity and loss of red-green colour discrimination. The risk rises with dose and with renal impairment. A baseline eye test is recorded and the patient is asked to report blurred vision at once, as early withdrawal usually allows recovery. Young children who cannot report visual changes need careful dosing.
- A: Orange-red urine is a harmless effect of rifampicin.
- B: Raised uric acid and joint pain are linked mainly to pyrazinamide.
- D: Hearing and balance are monitored with streptomycin and other aminoglycosides.
Question 2 · Easy
The normal range of arterial carbon dioxide tension (PaCO2) in an adult is:
1. A22-26 mmHg
2. B35-45 mmHg
3. C80-100 mmHg
4. D45-55 mmHg
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Answer: B · 35-45 mmHg
PaCO2 shows how well the lungs are ventilating; its normal range is 35-45 mmHg. A PaCO2 above 45 mmHg means hypoventilation and respiratory acidosis, and below 35 mmHg means hyperventilation and respiratory alkalosis. It is the respiratory component of the ABG, while bicarbonate (22-26 mEq/L) is the metabolic component.
- A: 22-26 is the normal bicarbonate range, measured in mEq/L.
- C: 80-100 mmHg is the normal PaO2 on room air.
- D: A PaCO2 of 45-55 mmHg is raised and indicates hypoventilation.
Question 3 · Easy
Which oxygen delivery device gives the most precise, fixed FiO2 to a patient with COPD who retains carbon dioxide?
1. ASimple face mask
2. BNon-rebreather mask
3. CVenturi mask
4. DNasal cannula
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Answer: C · Venturi mask
A Venturi mask uses a jet of oxygen to draw in a fixed proportion of room air through a sized port, so it delivers a set FiO2 (for example 24%, 28% or 35%) whatever the patient's breathing pattern. This allows controlled oxygen therapy in COPD, where too much oxygen can worsen carbon dioxide retention. Each colour-coded adaptor needs its own oxygen flow rate. The nurse checks that the ports are not covered by bedclothes.
- A: A simple mask gives a variable FiO2 of about 40-60% and is not precise.
- B: A non-rebreather gives a high FiO2 and is not suited to controlled therapy in CO2 retainers.
- D: A nasal cannula gives a variable FiO2 that changes with the breathing rate and depth.
Question 4 · Hard
In week 3 of first-line ATT (HRZE), a patient develops nausea, vomiting, yellow sclera and an ALT five times the upper limit of normal. What is the most appropriate nursing action?
1. AContinue ATT and give an antiemetic before doses
2. BWithhold ATT and report to the doctor urgently
3. CStop only ethambutol and continue the others
4. DDouble the pyridoxine dose and continue ATT
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Answer: B · Withhold ATT and report to the doctor urgently
Isoniazid, rifampicin and pyrazinamide can all damage the liver. Jaundice with a marked rise in transaminases means drug-induced hepatitis, and NTEP guidance is to stop the hepatotoxic drugs until the liver recovers. The nurse withholds the drugs and reports at once so that liver tests can be followed and the drugs reintroduced one by one under supervision. Patients are taught to report loss of appetite, vomiting or yellow eyes early.
- A: Continuing the drugs in hepatitis can cause liver failure.
- C: Ethambutol is the drug least likely to injure the liver.
- D: Pyridoxine prevents isoniazid neuropathy, not hepatitis.
Question 5 · Medium
A patient with sputum-positive pulmonary tuberculosis is admitted to the ward. When giving direct care, the nurse should wear:
1. AA gown, gloves and a face shield
2. BA surgical mask
3. CGloves only
4. DA fitted N95 respirator
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Answer: D · A fitted N95 respirator
Mycobacterium tuberculosis spreads by droplet nuclei small enough to stay suspended in the air and reach the alveoli, so airborne precautions are needed. A fit-tested N95 respirator filters these particles, while the patient is placed in a single, well-ventilated or negative-pressure room. The patient wears a surgical mask when leaving the room. Precautions continue until the patient is no longer infectious.
- A: A gown and face shield protect from splashes but not from inhaled droplet nuclei.
- B: A surgical mask does not seal or filter droplet nuclei for the wearer.
- C: Gloves protect against contact spread, not airborne particles.
Question 6 · Easy
Which position most relieves breathlessness in a patient with an acute exacerbation of COPD?
1. ALying flat on the back with one pillow
2. BLeft lateral Sims' position
3. CHead-down (Trendelenburg) position
4. DSitting up, leaning forward on a bedside table
Answer and explanation in LearnFree account
Question 7 · Medium
Postural drainage for a patient with bronchiectasis is best scheduled:
1. AOnly at bedtime, after the evening meal
2. BWithin 30 minutes after a main meal
3. CImmediately after a large fluid intake
4. DBefore meals, or 1-2 hours after a meal
Answer and explanation in LearnFree account
Question 8 · Hard
A patient with a chest drain for a pneumothorax suddenly becomes very breathless and restless. The trachea is shifted away from the affected side, BP is 82/50 mmHg and the tube was found clamped after a bottle change. What is the nurse's priority action?
1. AIncrease the oxygen to 15 L/min
2. BSend the patient for a chest X-ray
3. CPosition the patient flat and raise legs
4. DUnclamp the chest tube at once
Answer and explanation in LearnFree account
Question 9 · Medium
While a patient is being turned, the chest tube separates from the underwater seal tubing. What is the nurse's immediate action?
1. APut the tube end 2-3 cm under sterile water
2. BLeave the tube open and call the doctor
3. CClamp the tube and leave it clamped
4. DRemove the chest tube and apply a dressing
Answer and explanation in LearnFree account
Question 10 · Hard
A patient with long-standing COPD has an ABG on room air: pH 7.36, PaCO2 62 mmHg, HCO3 34 mEq/L, PaO2 58 mmHg (reference pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L). The acid-base interpretation is:
1. AUncompensated respiratory acidosis
2. BFully compensated respiratory acidosis
3. CCompensated metabolic alkalosis
4. DPartially compensated respiratory acidosis
Answer and explanation in LearnFree account
Question 11 · Easy
Pursed-lip breathing helps a patient with COPD mainly by:
1. AIncreasing the rate of breathing
2. BRaising the arterial carbon dioxide level
3. CShortening each exhalation to reduce effort
4. DKeeping small airways open during exhalation
Answer and explanation in LearnFree account
Question 12 · Hard
A 72-year-old with pneumonia is alert and oriented, with respiratory rate 32/min, BP 100/58 mmHg and blood urea 30 mg/dL. Using CURB-65 (1 point each: confusion; urea over 42 mg/dL; RR 30 or more; systolic BP under 90 or diastolic 60 or less; age 65 or more), what is his score?
1. A1 point
2. B3 points
3. C2 points
4. D4 points
Answer and explanation in LearnFree account
Question 13 · Easy
In an asthma action plan based on peak expiratory flow (PEF), the green zone, in which the patient continues usual treatment, is a reading of:
1. A60-100% of the predicted value
2. B80-100% of personal best
3. C50-79% of personal best
4. DBelow 50% of personal best
Answer and explanation in LearnFree account
Question 14 · Medium
To obtain the most useful sputum culture in a patient admitted with suspected pneumonia, the nurse collects:
1. AA sample of saliva taken soon after the first antibiotic dose is given
2. BAn early-morning deep-cough sample before the first antibiotic
3. CA sample at any time of day once antibiotics have started
4. DA pooled 24-hour sputum collection in one container
Answer and explanation in LearnFree account
Question 15 · Medium
A patient with COPD who is known to retain carbon dioxide is on 2 L/min of oxygen by nasal cannula, and his SpO2 is 90%. What is the most appropriate action by the nurse?
1. AChange to a non-rebreather mask at 15 L/min
2. BStop the oxygen, because SpO2 above 88% is adequate
3. CIncrease the flow until the SpO2 reaches 98-100%
4. DContinue the present flow, as SpO2 is in the target range
Answer and explanation in LearnFree account
Question 16 · Medium
For lung-protective ventilation of a patient with ARDS, the tidal volume is usually set at:
1. A10-12 mL/kg of actual body weight
2. B6 mL/kg of predicted body weight
3. C3 mL/kg of actual body weight
4. D15 mL/kg of predicted body weight
Answer and explanation in LearnFree account
Question 17 · Hard
A 24-year-old in a severe asthma attack had loud wheeze and a PaCO2 of 30 mmHg on arrival. An hour later she is drowsy, the wheeze is now barely audible, her respiratory rate has fallen from 34 to 14/min and PaCO2 is 46 mmHg. These findings most likely indicate:
1. ARespiratory muscle fatigue with impending failure
2. BHyperventilation from anxiety settling down
3. CResolution of bronchospasm after treatment
4. DRenal compensation for respiratory alkalosis
Answer and explanation in LearnFree account
Question 18 · Medium
An ABG shows pH 7.30, PaCO2 58 mmHg and HCO3 26 mEq/L (reference pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L). The interpretation is:
1. AUncompensated metabolic acidosis
2. BCompensated metabolic alkalosis
3. CPartially compensated respiratory acidosis
4. DUncompensated respiratory acidosis
Answer and explanation in LearnFree account
Question 19 · Easy
In an underwater seal chest drainage bottle, the end of the long tube connected to the patient is kept below the water level by about:
1. A20 cm
2. B10 cm
3. C0 cm (at the surface)
4. D2 cm
Answer and explanation in LearnFree account
Question 20 · Hard
A ventilated patient with bilateral infiltrates not explained by heart failure has a PaO2 of 72 mmHg on FiO2 0.6 with PEEP 8 cmH2O. By the Berlin definition (PaO2/FiO2: mild 201-300, moderate 101-200, severe 100 or less), the ARDS is:
1. ANot ARDS by this ratio
2. BSevere
3. CModerate
4. DMild
Answer and explanation in LearnFree account
Question 21 · Medium
A patient has an underwater seal drain for a haemothorax. The nurse notices continuous bubbling in the water-seal chamber during both inspiration and expiration. What should the nurse do first?
1. ARaise the drainage bottle to chest level
2. BCheck the dressing, tubing and joints for an air leak
3. CClamp the chest tube until the doctor arrives
4. DAdd more water to the suction control chamber
Answer and explanation in LearnFree account
Question 22 · Hard
A patient with COPD brought in by ambulance on a non-rebreather mask at 15 L/min becomes increasingly drowsy. SpO2 is 99%; ABG shows pH 7.24 and PaCO2 78 mmHg. Which action should the nurse anticipate?
1. AChange to a Venturi mask at 28% for SpO2 88-92%
2. BContinue the mask to keep SpO2 near 100%
3. CRemove all oxygen until the drowsiness clears
4. DGive a sedative to calm the restless patient
Answer and explanation in LearnFree account
Question 23 · Easy
A patient using a beclomethasone inhaler for asthma is told to rinse the mouth and gargle after each dose, mainly to prevent:
1. AOral candidiasis
2. BParadoxical bronchospasm
3. CStaining of the teeth
4. DPalpitations
Answer and explanation in LearnFree account
Question 24 · Medium
Which feature best distinguishes acute respiratory distress syndrome from simple hypoxaemia?
1. AUnilateral lobar consolidation on chest X-ray
2. BHypoxaemia that persists despite increasing FiO2
3. CA rapid rise in SpO2 on low-flow oxygen
4. DRaised left atrial pressure as the main cause
Answer and explanation in LearnFree account
Question 25 · Easy
Under the National TB Elimination Programme (NTEP), the intensive phase of treatment for drug-sensitive TB lasts:
1. A4 months
2. B6 months
3. C1 month
4. D2 months
Answer and explanation in LearnFree account

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Respiratory: COPD, asthma, ARDS and oxygen therapy

Before and during treatment with ethambutol, the nurse ensures regular monitoring of the patient's:

The normal range of arterial carbon dioxide tension (PaCO2) in an adult is:

Which oxygen delivery device gives the most precise, fixed FiO2 to a patient with COPD who retains carbon dioxide?

In week 3 of first-line ATT (HRZE), a patient develops nausea, vomiting, yellow sclera and an ALT five times the upper limit of normal. What is the most appropriate nursing action?

A patient with sputum-positive pulmonary tuberculosis is admitted to the ward. When giving direct care, the nurse should wear:

Which position most relieves breathlessness in a patient with an acute exacerbation of COPD?

Postural drainage for a patient with bronchiectasis is best scheduled:

A patient with a chest drain for a pneumothorax suddenly becomes very breathless and restless. The trachea is shifted away from the affected side, BP is 82/50 mmHg and the tube was found clamped after a bottle change. What is the nurse's priority action?

While a patient is being turned, the chest tube separates from the underwater seal tubing. What is the nurse's immediate action?

A patient with long-standing COPD has an ABG on room air: pH 7.36, PaCO2 62 mmHg, HCO3 34 mEq/L, PaO2 58 mmHg (reference pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L). The acid-base interpretation is:

Pursed-lip breathing helps a patient with COPD mainly by:

A 72-year-old with pneumonia is alert and oriented, with respiratory rate 32/min, BP 100/58 mmHg and blood urea 30 mg/dL. Using CURB-65 (1 point each: confusion; urea over 42 mg/dL; RR 30 or more; systolic BP under 90 or diastolic 60 or less; age 65 or more), what is his score?

In an asthma action plan based on peak expiratory flow (PEF), the green zone, in which the patient continues usual treatment, is a reading of:

To obtain the most useful sputum culture in a patient admitted with suspected pneumonia, the nurse collects:

A patient with COPD who is known to retain carbon dioxide is on 2 L/min of oxygen by nasal cannula, and his SpO2 is 90%. What is the most appropriate action by the nurse?

For lung-protective ventilation of a patient with ARDS, the tidal volume is usually set at:

A 24-year-old in a severe asthma attack had loud wheeze and a PaCO2 of 30 mmHg on arrival. An hour later she is drowsy, the wheeze is now barely audible, her respiratory rate has fallen from 34 to 14/min and PaCO2 is 46 mmHg. These findings most likely indicate:

An ABG shows pH 7.30, PaCO2 58 mmHg and HCO3 26 mEq/L (reference pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L). The interpretation is:

In an underwater seal chest drainage bottle, the end of the long tube connected to the patient is kept below the water level by about:

A ventilated patient with bilateral infiltrates not explained by heart failure has a PaO2 of 72 mmHg on FiO2 0.6 with PEEP 8 cmH2O. By the Berlin definition (PaO2/FiO2: mild 201-300, moderate 101-200, severe 100 or less), the ARDS is:

A patient has an underwater seal drain for a haemothorax. The nurse notices continuous bubbling in the water-seal chamber during both inspiration and expiration. What should the nurse do first?

A patient with COPD brought in by ambulance on a non-rebreather mask at 15 L/min becomes increasingly drowsy. SpO2 is 99%; ABG shows pH 7.24 and PaCO2 78 mmHg. Which action should the nurse anticipate?

A patient using a beclomethasone inhaler for asthma is told to rinse the mouth and gargle after each dose, mainly to prevent:

Which feature best distinguishes acute respiratory distress syndrome from simple hypoxaemia?

Under the National TB Elimination Programme (NTEP), the intensive phase of treatment for drug-sensitive TB lasts: