Three days after hip replacement, a patient is anxious and breathless. RR 30/min, HR 118/min, BP 128/76 mm Hg. ABG on room air: pH 7.51, PaCO2 4.0 kPa (30 mmHg), HCO3- 23 mmol/L, PaO2 8.0 kPa (60 mmHg). Which interpretation is most accurate?

Respiratory alkalosis with hypoxaemia; suspect pulmonary embolism

Metabolic alkalosis with hypoxaemia; suspect vomiting

Respiratory alkalosis with normal oxygen; suspect anxiety

Respiratory acidosis, compensated; suspect opioid excess

A 70-year-old admitted with a left-sided stroke 6 hours ago is asking for a cup of tea. To reduce his risk of aspiration pneumonia, the nurse should first:

Complete a bedside swallowing screen

Thicken the tea before giving it

Which equipment must be kept at the bedside of every patient with a tracheostomy?

Spare tubes of the same size and one size smaller

A spare nasogastric tube and a feeding syringe

A sealed chest drainage unit and two clamps

A peak flow meter and a spacer device

A patient had a chest drain inserted yesterday for a large pneumothorax. Today the water level no longer fluctuates, he is newly breathless and his SpO2 has fallen from 96% to 89%. What should the nurse do first?

Trace the tubing for kinks, clots or a dependent loop

Record that the lung has re-expanded fully

Clamp the chest tube close to the dressing

Raise the drainage unit to the bed's height

As part of a ventilator-associated pneumonia prevention bundle, which daily measure helps to shorten the time a patient spends on the ventilator?

A sedation break and an assessment of readiness to extubate

A routine change of the ventilator circuit every morning

A daily dose of prophylactic broad-spectrum antibiotic

Keeping the patient flat in bed between nursing procedures

Respiratory care, oxygen therapy and ventilation

42 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Respiratory care, oxygen therapy and ventilation, part of Adult Health 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 · Hard
Three days after hip replacement, a patient is anxious and breathless. RR 30/min, HR 118/min, BP 128/76 mm Hg. ABG on room air: pH 7.51, PaCO2 4.0 kPa (30 mmHg), HCO3- 23 mmol/L, PaO2 8.0 kPa (60 mmHg). Which interpretation is most accurate?
1. AMetabolic alkalosis with hypoxaemia; suspect vomiting
2. BRespiratory alkalosis with normal oxygen; suspect anxiety
3. CRespiratory acidosis, compensated; suspect opioid excess
4. DRespiratory alkalosis with hypoxaemia; suspect pulmonary embolism
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Answer: D · Respiratory alkalosis with hypoxaemia; suspect pulmonary embolism
The pH is high and the PaCO2 is low with a normal bicarbonate, so this is an acute respiratory alkalosis from hyperventilation. The PaO2 of 8.0 kPa (60 mmHg) is clearly low, so the patient is not just anxious. Hypoxaemia, tachypnoea and tachycardia after joint surgery strongly suggest pulmonary embolism. The nurse gives oxygen, sits the patient up and reports urgently, without labelling the breathlessness as anxiety.
- A: The bicarbonate is normal, so the alkalosis is not metabolic.
- B: The PaO2 is low, so this is not a benign anxiety-driven picture.
- C: The pH is alkalotic and the PaCO2 low, the opposite of opioid-induced acidosis.
Question 2 · Medium
A 70-year-old admitted with a left-sided stroke 6 hours ago is asking for a cup of tea. To reduce his risk of aspiration pneumonia, the nurse should first:
1. ALay him flat while he drinks
2. BGive the tea through a straw
3. CThicken the tea before giving it
4. DComplete a bedside swallowing screen
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Answer: D · Complete a bedside swallowing screen
Dysphagia is common after stroke and leads to silent aspiration and pneumonia. Every stroke patient should have a swallowing screen by a trained person before any food, fluid or oral medicine is given. If the screen fails, the patient stays nil by mouth and is referred to a speech and language therapist. Patients who are allowed to eat are positioned upright.
- A: Lying flat during drinking greatly increases the risk of aspiration.
- B: Straws give less control of the bolus and can increase aspiration.
- C: Thickened fluids are chosen only after the swallow has been assessed.
Question 3 · Easy
Which equipment must be kept at the bedside of every patient with a tracheostomy?
1. AA spare nasogastric tube and a feeding syringe
2. BA sealed chest drainage unit and two clamps
3. CA peak flow meter and a spacer device
4. DSpare tubes of the same size and one size smaller
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Answer: D · Spare tubes of the same size and one size smaller
If the tube becomes dislodged or blocked, it may need to be replaced at once, so a spare tube of the same size and one a size smaller (in case the stoma narrows) are kept at the bedside. The obturator, tracheal dilator, suction, oxygen and a bag-valve device are kept with them. These are checked at the start of every shift. Without them, a displaced tube can quickly become a fatal airway emergency.
- A: A nasogastric tube is not emergency airway equipment.
- B: Chest drainage equipment is unrelated to tracheostomy emergencies.
- C: A peak flow meter and spacer are asthma tools, not tracheostomy safety equipment.
Question 4 · Hard
A patient had a chest drain inserted yesterday for a large pneumothorax. Today the water level no longer fluctuates, he is newly breathless and his SpO2 has fallen from 96% to 89%. What should the nurse do first?
1. ATrace the tubing for kinks, clots or a dependent loop
2. BRecord that the lung has re-expanded fully
3. CClamp the chest tube close to the dressing
4. DRaise the drainage unit to the bed's height
Show answerHide answer
Answer: A · Trace the tubing for kinks, clots or a dependent loop
Loss of tidaling can mean either re-expansion or a blocked system, and the new breathlessness and falling SpO2 point to blockage. The nurse checks the whole system from the dressing to the unit for kinks, clots, a patient lying on the tube, or a dependent loop full of fluid, and corrects any found. If nothing is found, the doctor is called urgently, as the pneumothorax may be re-accumulating. Oxygen is given meanwhile.
- B: Re-expansion would not cause new breathlessness and hypoxaemia.
- C: Clamping traps air in the pleural space and can cause a tension pneumothorax.
- D: Raising the unit lets fluid flow back towards the chest and solves nothing.
Question 5 · Medium
As part of a ventilator-associated pneumonia prevention bundle, which daily measure helps to shorten the time a patient spends on the ventilator?
1. AA sedation break and an assessment of readiness to extubate
2. BA routine change of the ventilator circuit every morning
3. CA daily dose of prophylactic broad-spectrum antibiotic
4. DKeeping the patient flat in bed between nursing procedures
Show answerHide answer
Answer: A · A sedation break and an assessment of readiness to extubate
A daily interruption of sedation, paired with a spontaneous breathing trial, shows whether the patient can breathe without the ventilator. Fewer days on the ventilator means less exposure to the endotracheal tube and fewer cases of VAP. Other bundle measures include head-of-bed elevation, oral care and subglottic secretion drainage where available. Circuits are changed only when visibly soiled or faulty.
- B: Routine circuit changes do not reduce VAP and may increase it.
- C: Prophylactic antibiotics promote resistance and are not part of the bundle.
- D: A flat position increases aspiration and VAP risk.
Question 6 · Medium
A patient with smear-positive pulmonary TB has been on effective treatment for 3 weeks, and his cough is improving. Airborne isolation can be stopped once he has:
1. ACompleted the full 6 months of therapy
2. BA normal chest X-ray on repeat imaging
3. CBeen afebrile for at least 24 hours
4. DThree consecutive negative sputum smears
Answer and explanation in LearnFree account
Question 7 · Easy
Most pulmonary emboli originate from a thrombus in the:
1. ALeft atrium of the heart
2. BDeep veins of the legs and pelvis
3. CSuperficial veins of the arms
4. DCarotid arteries of the neck
Answer and explanation in LearnFree account
Question 8 · Easy
A patient with asthma feels tight-chested and wheezy while walking to the ward toilet. Which inhaler should he use first?
1. ABudesonide
2. BSalmeterol
3. CSalbutamol
4. DTiotropium
Answer and explanation in LearnFree account
Question 9 · Medium
A chest drainage system with wet suction is set to -20 cmH2O. The nurse sees gentle, continuous bubbling in the suction-control chamber. This means:
1. ASuction is working as expected
2. BThe water seal has been lost
3. CThere is a leak from the pleural space
4. DThe tube is blocked by a clot
Answer and explanation in LearnFree account
Question 10 · Hard
A 70-kg patient with pneumonia has BP 84/50 mm Hg, HR 122/min and a lactate of 4.6 mmol/L. Under Surviving Sepsis guidance, how much IV crystalloid should be given in the first 3 hours?
1. A1,400 mL
2. B3,500 mL
3. C2,100 mL
4. D700 mL
Answer and explanation in LearnFree account
Question 11 · Hard
On a busy respiratory ward, four patients have just been handed over. Whose bedside needs the nurse before any of the others?
1. AA TB patient in isolation asking when he can be discharged home
2. BA tracheostomy patient who is restless, with gurgling breaths and SpO2 86%
3. CA pneumonia patient on 2 L/min, talking in full sentences, SpO2 93%
4. DA patient with a drain for pneumothorax, with bubbling in the water seal on coughing
Answer and explanation in LearnFree account
Question 12 · Hard
After a ventilated patient is moved from the trolley to the ICU bed, the SpO2 falls from 97% to 88%. The tube mark at the teeth, 22 cm at intubation, now reads 26 cm. Breath sounds are absent on the left. What is the most likely cause?
1. AThe tube has moved into the right main bronchus
2. BA large left pleural effusion has formed suddenly
3. CThe cuff has deflated and the tube is leaking
4. DThe tube has slipped back out into the pharynx
Answer and explanation in LearnFree account
Question 13 · Hard
A patient with acute severe asthma has had salbutamol and ipratropium nebulisers and IV hydrocortisone. IV magnesium sulfate 2 g in 50 mL normal saline over 20 minutes is ordered. The pump rate should be:
1. A100 mL/h
2. B2.5 mL/h
3. C300 mL/h
4. D150 mL/h
Answer and explanation in LearnFree account
Question 14 · Medium
A young adult with sickle cell disease is admitted with a painful crisis affecting the chest and back and is receiving IV morphine. Which nursing measure most reduces his risk of acute chest syndrome?
1. AKeeping him flat in bed to rest the chest
2. BRestricting oral fluids to 1 litre each day
3. CIncentive spirometry every 2 hours while awake
4. DHolding all opioids until the pain eases
Answer and explanation in LearnFree account
Question 15 · Medium
A patient with moderate asthma uses a budesonide-formoterol inhaler twice daily. He plans to fast during Ramadan and asks how to manage his inhaler. The nurse's best advice is:
1. AAsk for oral prednisolone instead of the inhaler
2. BUse only the salbutamol reliever while fasting
3. CStop the inhaler until Ramadan has ended
4. DTake the twice-daily doses at suhoor and iftar
Answer and explanation in LearnFree account
Question 16 · Hard
A patient with massive pulmonary embolism and hypotension is to receive IV alteplase. Which item in the history is an absolute contraindication that the nurse must report before the drug is given?
1. AType 2 diabetes on oral metformin
2. BBlood pressure of 150/90 mm Hg last year
3. CIntracerebral haemorrhage 3 years ago
4. DIschaemic stroke 2 years ago
Answer and explanation in LearnFree account
Question 17 · Easy
A patient with suspected pulmonary tuberculosis is admitted to an airborne infection isolation room. The room should be kept at:
1. ANegative pressure to the corridor, with the door open
2. BPositive pressure to the corridor, with the door closed
3. CEqual pressure to the corridor, with a window open
4. DNegative pressure to the corridor, with the door closed
Answer and explanation in LearnFree account
Question 18 · Hard
A man 175 cm tall and weighing 90 kg is ventilated for ARDS. Lung-protective ventilation at 6 mL/kg of predicted body weight is ordered, where PBW (kg) = 50 + 0.91 x (height in cm - 152.4). Which tidal volume is closest?
1. AAbout 705 mL
2. BAbout 540 mL
3. CAbout 565 mL
4. DAbout 425 mL
Answer and explanation in LearnFree account
Question 19 · Medium
A patient with intestinal obstruction has had nasogastric suction for 3 days. ABG: pH 7.51, PaCO2 6.3 kPa (47 mmHg), HCO3- 34 mmol/L (reference pH 7.35-7.45, PaCO2 4.7-6.0 kPa, HCO3- 22-26 mmol/L). This shows:
1. ARespiratory alkalosis, uncompensated
2. BMetabolic acidosis, partly compensated
3. CRespiratory acidosis, fully compensated
4. DMetabolic alkalosis, partly compensated
Answer and explanation in LearnFree account
Question 20 · Medium
A farm worker who handles camels comes to the ER triage desk with fever, cough and shortness of breath. What should the triage nurse do first?
1. ASend him to the general waiting area until a bed is free
2. BPut a mask on him and isolate him in a single room
3. CCollect a sputum sample at the triage desk
4. DGive paracetamol and ask him to return if worse
Answer and explanation in LearnFree account
Question 21 · Medium
A simple face mask is ordered for a patient. The flow rate should be at least 5 L/min, mainly to:
1. AFlush exhaled carbon dioxide out of the mask
2. BKeep the reservoir bag inflated during inspiration
3. CDry out the secretions in the upper airway
4. DGive an exact FiO2 of 28% with every breath
Answer and explanation in LearnFree account
Question 22 · Medium
As the doctor pulls out a chest drain, the nurse coaches the patient to take a deep breath and hold it (or bear down). What is the purpose of this?
1. ATo stop air being drawn into the pleural space
2. BTo lessen the pain of the stitches being cut
3. CTo push residual pleural fluid out of the tube
4. DTo check that the lung has re-expanded fully
Answer and explanation in LearnFree account
Question 23 · Easy
A patient with asthma records his peak expiratory flow each morning. He should blow three times and record:
1. AThe average of the three readings
2. BThe highest of the three readings
3. CThe lowest of the three readings
4. DOnly the first of the three readings
Answer and explanation in LearnFree account
Question 24 · Medium
A patient started on enoxaparin for pulmonary embolism 7 days ago has a platelet count that has fallen from 260 to 110 x10^9/L. The nurse suspects:
1. AVitamin K deficiency from the drug
2. BA normal response to the anticoagulant
3. CExpected dilution from IV fluids
4. DHeparin-induced thrombocytopenia
Answer and explanation in LearnFree account
Question 25 · Easy
For most acutely ill adults who are not at risk of carbon dioxide retention, the recommended target oxygen saturation is:
1. A99% to 100%
2. B94% to 98%
3. C88% to 92%
4. D85% to 89%
Answer and explanation in LearnFree account

17 more Respiratory care, oxygen therapy and ventilation questions

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Respiratory care, oxygen therapy and ventilation

Three days after hip replacement, a patient is anxious and breathless. RR 30/min, HR 118/min, BP 128/76 mm Hg. ABG on room air: pH 7.51, PaCO2 4.0 kPa (30 mmHg), HCO3- 23 mmol/L, PaO2 8.0 kPa (60 mmHg). Which interpretation is most accurate?

A 70-year-old admitted with a left-sided stroke 6 hours ago is asking for a cup of tea. To reduce his risk of aspiration pneumonia, the nurse should first:

Which equipment must be kept at the bedside of every patient with a tracheostomy?

A patient had a chest drain inserted yesterday for a large pneumothorax. Today the water level no longer fluctuates, he is newly breathless and his SpO2 has fallen from 96% to 89%. What should the nurse do first?

As part of a ventilator-associated pneumonia prevention bundle, which daily measure helps to shorten the time a patient spends on the ventilator?

A patient with smear-positive pulmonary TB has been on effective treatment for 3 weeks, and his cough is improving. Airborne isolation can be stopped once he has:

Most pulmonary emboli originate from a thrombus in the:

A patient with asthma feels tight-chested and wheezy while walking to the ward toilet. Which inhaler should he use first?

A chest drainage system with wet suction is set to -20 cmH2O. The nurse sees gentle, continuous bubbling in the suction-control chamber. This means:

A 70-kg patient with pneumonia has BP 84/50 mm Hg, HR 122/min and a lactate of 4.6 mmol/L. Under Surviving Sepsis guidance, how much IV crystalloid should be given in the first 3 hours?

On a busy respiratory ward, four patients have just been handed over. Whose bedside needs the nurse before any of the others?

After a ventilated patient is moved from the trolley to the ICU bed, the SpO2 falls from 97% to 88%. The tube mark at the teeth, 22 cm at intubation, now reads 26 cm. Breath sounds are absent on the left. What is the most likely cause?

A patient with acute severe asthma has had salbutamol and ipratropium nebulisers and IV hydrocortisone. IV magnesium sulfate 2 g in 50 mL normal saline over 20 minutes is ordered. The pump rate should be:

A young adult with sickle cell disease is admitted with a painful crisis affecting the chest and back and is receiving IV morphine. Which nursing measure most reduces his risk of acute chest syndrome?

A patient with moderate asthma uses a budesonide-formoterol inhaler twice daily. He plans to fast during Ramadan and asks how to manage his inhaler. The nurse's best advice is:

A patient with massive pulmonary embolism and hypotension is to receive IV alteplase. Which item in the history is an absolute contraindication that the nurse must report before the drug is given?

A patient with suspected pulmonary tuberculosis is admitted to an airborne infection isolation room. The room should be kept at:

A man 175 cm tall and weighing 90 kg is ventilated for ARDS. Lung-protective ventilation at 6 mL/kg of predicted body weight is ordered, where PBW (kg) = 50 + 0.91 x (height in cm - 152.4). Which tidal volume is closest?

A patient with intestinal obstruction has had nasogastric suction for 3 days. ABG: pH 7.51, PaCO2 6.3 kPa (47 mmHg), HCO3- 34 mmol/L (reference pH 7.35-7.45, PaCO2 4.7-6.0 kPa, HCO3- 22-26 mmol/L). This shows:

A farm worker who handles camels comes to the ER triage desk with fever, cough and shortness of breath. What should the triage nurse do first?

A simple face mask is ordered for a patient. The flow rate should be at least 5 L/min, mainly to:

As the doctor pulls out a chest drain, the nurse coaches the patient to take a deep breath and hold it (or bear down). What is the purpose of this?

A patient with asthma records his peak expiratory flow each morning. He should blow three times and record:

A patient started on enoxaparin for pulmonary embolism 7 days ago has a platelet count that has fallen from 260 to 110 x10^9/L. The nurse suspects:

For most acutely ill adults who are not at risk of carbon dioxide retention, the recommended target oxygen saturation is: