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Respiratory CCRN Practice Questions

10 free CCRN-style respiratory practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: A patient with ARDS has a PaO2 of 58 mmHg on FiO2 of 100%. The P/F ratio is:
  2. Q2: The recommended tidal volume for a patient with ARDS using lung-protective venti…
  3. Q3: A patient has an ABG showing: pH 7.28, PaCO2 55, HCO3 24, PaO2 68. This indicate…
  4. Q4: Which clinical finding is associated with a tension pneumothorax?
  5. Q5: The gold standard for diagnosing pulmonary embolism is:
  6. Q6: What is the appropriate oxygen saturation target for a patient with COPD?
  7. Q7: High peak airway pressure with NORMAL plateau pressure on a ventilator indicates…
  8. Q8: A COPD patient in respiratory distress has the following ABG: pH 7.25, PaCO2 70,…
  9. Q9: The Rapid Shallow Breathing Index (RSBI) that predicts successful weaning is:
  10. Q10: Prone positioning in ARDS should be maintained for at least:
Question 1

A patient with ARDS has a PaO2 of 58 mmHg on FiO2 of 100%. The P/F ratio is:

  1. 580
  2. 58
  3. 5.8
  4. Cannot be calculated

Correct Answer: B. 58

Rationale: P/F ratio = PaO2 ÷ FiO2. With PaO2 of 58 and FiO2 of 1.0 (100%), P/F = 58/1.0 = 58. This indicates SEVERE ARDS (P/F <100). Berlin criteria: Mild ARDS = 200-300, Moderate = 100-200, Severe = <100. A normal P/F ratio is approximately 400-500.
Question 2

The recommended tidal volume for a patient with ARDS using lung-protective ventilation is:

  1. 10-12 mL/kg ideal body weight
  2. 8-10 mL/kg ideal body weight
  3. 6-8 mL/kg ideal body weight
  4. 4-6 mL/kg ideal body weight

Correct Answer: C. 6-8 mL/kg ideal body weight

Rationale: Low tidal volume ventilation (LTVV) uses 6-8 mL/kg of IDEAL body weight (not actual weight). This strategy reduces ventilator-induced lung injury and has been shown to decrease mortality in ARDS (ARDSNet trial). The goal is to maintain plateau pressure <30 cmH2O. Higher volumes can cause volutrauma.
Question 3

A patient has an ABG showing: pH 7.28, PaCO2 55, HCO3 24, PaO2 68. This indicates:

  1. Respiratory acidosis, uncompensated
  2. Respiratory alkalosis, compensated
  3. Metabolic acidosis, compensated
  4. Mixed acid-base disorder

Correct Answer: A. Respiratory acidosis, uncompensated

Rationale: pH <7.35 indicates acidosis. PaCO2 is elevated (>45) indicating respiratory cause. HCO3 is normal (22-26), showing no metabolic compensation yet (uncompensated). This is acute respiratory acidosis, commonly seen in hypoventilation states like COPD exacerbation, sedation, or neuromuscular weakness.
Question 4

Which clinical finding is associated with a tension pneumothorax?

  1. Bilateral wheezing
  2. Tracheal deviation toward the affected side
  3. Absent breath sounds on affected side with JVD
  4. Inspiratory stridor

Correct Answer: C. Absent breath sounds on affected side with JVD

Rationale: Tension pneumothorax presents with absent breath sounds on the affected side, tracheal deviation AWAY from the affected side (mediastinal shift), hypotension, and JVD (impaired venous return). This is a life-threatening emergency requiring immediate needle decompression followed by chest tube placement.
Question 5

The gold standard for diagnosing pulmonary embolism is:

  1. D-dimer
  2. V/Q scan
  3. CT pulmonary angiography
  4. Chest X-ray

Correct Answer: C. CT pulmonary angiography

Rationale: CT Pulmonary Angiography (CTPA) is the gold standard for PE diagnosis. It visualizes clots directly and can assess clot burden. D-dimer is sensitive but not specific (good for ruling out, not diagnosing). V/Q scan is an alternative when contrast is contraindicated. Chest X-ray is often normal or shows nonspecific findings.
Question 6

What is the appropriate oxygen saturation target for a patient with COPD?

  1. 98-100%
  2. 94-98%
  3. 88-92%
  4. 85-88%

Correct Answer: C. 88-92%

Rationale: Target SpO2 for COPD patients is 88-92%. These patients may have chronic CO2 retention and rely on hypoxic respiratory drive. Excessive oxygen can suppress this drive, leading to hypoventilation and CO2 narcosis. Higher targets are appropriate for patients without chronic hypercapnia.
Question 7

High peak airway pressure with NORMAL plateau pressure on a ventilator indicates:

  1. Decreased lung compliance
  2. Increased airway resistance
  3. Pneumothorax
  4. ARDS worsening

Correct Answer: B. Increased airway resistance

Rationale: High peak pressure with normal plateau suggests airway RESISTANCE problem (the airway, not the lungs). Causes include: bronchospasm, secretions, kinked ET tube, biting on tube. If BOTH peak and plateau are elevated, it suggests compliance issue (stiff lungs: ARDS, pulmonary edema, pneumothorax).
Question 8

A COPD patient in respiratory distress has the following ABG: pH 7.25, PaCO2 70, HCO3 28. The MOST appropriate initial intervention is:

  1. Intubation and mechanical ventilation
  2. Initiate BiPAP
  3. Increase supplemental oxygen to 100%
  4. Administer IV sodium bicarbonate

Correct Answer: B. Initiate BiPAP

Rationale: BiPAP (non-invasive ventilation) is first-line treatment for COPD exacerbation with respiratory acidosis. It reduces work of breathing, improves ventilation, and decreases intubation rates. The elevated HCO3 suggests chronic compensation. Intubation is reserved for BiPAP failure or altered mental status. High-flow oxygen risks worsening hypercapnia.
Question 9

The Rapid Shallow Breathing Index (RSBI) that predicts successful weaning is:

  1. >150
  2. <105
  3. >200
  4. <50

Correct Answer: B. <105

Rationale: RSBI = Respiratory Rate ÷ Tidal Volume (in liters). An RSBI <105 predicts successful weaning and extubation. Higher values indicate rapid, shallow breathing which suggests the patient cannot sustain spontaneous breathing. RSBI is measured during a spontaneous breathing trial with minimal support.
Question 10

Prone positioning in ARDS should be maintained for at least:

  1. 2-4 hours
  2. 6-8 hours
  3. 12-14 hours
  4. 16 hours or more

Correct Answer: D. 16 hours or more

Rationale: The PROSEVA trial demonstrated mortality benefit with prone positioning for 16+ hours per day in moderate-severe ARDS (P/F <150). Prone positioning improves V/Q matching by recruiting dorsal lung regions and reducing compression. Shorter durations have not shown the same benefit.

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