Respiratory Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Oxygen Therapy, Asthma and COPD Care, Pneumonia, Tuberculosis Isolation, Chest Drains, Tracheostomy Care, Pulmonary Embolism, Inhaler Technique and Non-invasive Ventilation

Respiratory nursing is tested across the medical-surgical and critical care domains of the registered nurse paper, typically 10 to 14 questions, and respiratory wards in the Gulf are busy with asthma and COPD in a dusty, hot climate, pneumonia and tuberculosis in a largely expatriate workforce, and post-operative chest complications. The exam tests oxygen safety, airway devices, isolation rules and the assessments that catch deterioration early. This set covers what recurs; mechanical ventilation is in the critical care set.

Oxygen therapy

Question 1

A patient with COPD has saturations of 85% on air and is drowsy. The nurse should:

1. Apply a non-rebreather mask at 15 L/min and leave it until the doctor arrives
2. Give controlled oxygen, for example a 24 to 28% Venturi mask or nasal cannula at 1 to 2 L/min, titrated to a target saturation of 88 to 92%, obtain an arterial blood gas, monitor respiratory rate and consciousness closely, and call for help, because uncontrolled high-flow oxygen can worsen hypercapnia in patients who rely on hypoxic drive and have ventilation-perfusion changes
3. Withhold oxygen entirely because of the COPD
4. Sit the patient upright and wait

Answer: B. Hypoxia still kills faster than hypercapnia, so oxygen is never withheld; the target is lower, and the gas guides escalation to non-invasive ventilation.

Question 2

Which oxygen device delivers the highest concentration for a spontaneously breathing patient in an emergency?

1. Nasal cannula at 6 L/min
2. A non-rebreather (reservoir) mask at 10 to 15 L/min, delivering about 60 to 90% oxygen provided the reservoir bag is inflated before application and stays at least one third full during inspiration; a simple face mask gives 35 to 60% at 5 to 10 L/min and must run at 5 L/min or more to clear exhaled carbon dioxide; nasal cannulae give 24 to 40% at 1 to 6 L/min; Venturi masks give fixed concentrations of 24 to 60%
3. A simple face mask at 2 L/min
4. A Venturi mask at 24%

Answer: B. Humidification is added for high flows and prolonged use; oxygen is a prescribed drug with a documented target range for every patient, and smoking or open flames near oxygen are prohibited.

Question 3

Which situation makes the pulse oximeter reading unreliable?

1. A warm, well-perfused finger with a steady waveform
2. Poor peripheral perfusion or hypotension, cold extremities, movement or shivering, dark nail polish or artificial nails, carbon monoxide poisoning (falsely normal), methaemoglobinaemia, severe anaemia, bright ambient light, and venous congestion; the nurse treats the patient rather than the number and confirms with another site, a good waveform or a blood gas
3. A patient breathing room air
4. A patient sitting upright

Answer: B. Oximetry measures saturation, not ventilation; a patient on high-flow oxygen can have normal saturations while carbon dioxide rises.

Asthma and COPD

Question 4

A 25-year-old with asthma arrives breathless, speaking in single words, respiratory rate 32, heart rate 125, peak flow 35% of best, saturations 90%. After high-flow oxygen targeting 94 to 98%, the nurse's actions are:

1. Oral salbutamol tablets and discharge when calmer
2. Nebulised salbutamol (oxygen-driven) repeated or continuous with nebulised ipratropium added, systemic corticosteroid (oral prednisolone or intravenous hydrocortisone) within the first hour, continuous monitoring of saturations, respiratory rate, heart rate and peak flow, urgent medical review, and preparation for intravenous magnesium sulfate; a silent chest, cyanosis, exhaustion, confusion, bradycardia or a normal or rising carbon dioxide on blood gas indicates life-threatening asthma and ICU involvement
3. Sedation for anxiety
4. Antibiotics as first treatment

Answer: B. Sedatives are contraindicated outside intubation; after recovery the nurse checks inhaler technique, provides a written action plan and arranges follow-up within two days of discharge.

Question 5

The nurse observes a patient use a pressurised metered-dose inhaler by puffing it into the mouth while breathing normally, then immediately taking a second puff. Correct technique teaching includes:

1. The technique is adequate
2. Shake the inhaler, breathe out fully away from the inhaler, seal the lips around the mouthpiece (or use a spacer, which improves lung deposition and is recommended for all pMDI users, especially children and during attacks), press the canister once while starting a slow deep breath in over 3 to 5 seconds, hold the breath for about 10 seconds, wait 30 to 60 seconds before a second puff, and rinse the mouth after inhaled corticosteroids to prevent oral candidiasis and hoarseness; dry powder inhalers need a fast, deep inhalation instead
3. Take all puffs in quick succession
4. Breathe out through the inhaler

Answer: B. Up to 90% of patients make at least one critical inhaler error; technique is rechecked at every visit, and spacers are washed weekly in detergent and left to air dry to reduce static.

Question 6

A patient with COPD is being discharged after an exacerbation. Which education reduces readmission?

1. Avoid all physical activity to save breath
2. Smoking cessation support (the only intervention that slows decline), correct inhaler technique, a written self-management plan with rescue medication for exacerbations, pulmonary rehabilitation referral, annual influenza and pneumococcal vaccination, pursed-lip and diaphragmatic breathing, energy conservation, nutrition, recognising worsening symptoms early, and the correct use of home oxygen where prescribed (15 hours or more daily, never with smoking)
3. Stopping inhalers when feeling well
4. Oxygen at the highest flow available

Answer: B. Shisha (waterpipe) smoking is common in the Gulf and carries risks comparable to cigarettes; it is included in cessation counselling.

Infection

Question 7

An 80-year-old with pneumonia has a respiratory rate of 30, new confusion, blood pressure 95/60 and urea of 9 mmol/L. The nurse's priorities are:

1. Oral antibiotics and review tomorrow
2. Recognise severe pneumonia (CURB-65 of 4) and probable sepsis, escalate immediately, start the sepsis pathway (cultures before antibiotics, intravenous antibiotics within an hour, fluids, lactate, oxygen to target, urine output monitoring), position upright, encourage deep breathing and coughing with analgesia, and assess swallowing before oral intake because confusion and pneumonia raise aspiration risk
3. Give paracetamol only and recheck in four hours
4. Lie the patient flat for comfort

Answer: B. Sputum is collected before antibiotics where possible, ideally an early-morning deep-cough sample after mouth rinsing with water (not mouthwash), and sent within one to two hours.

Question 8

A newly admitted construction worker has three weeks of cough, night sweats and haemoptysis, and a chest radiograph with an upper lobe cavity. The nurse should:

1. Nurse in an open bay with standard precautions
2. Place the patient in airborne isolation immediately (a negative-pressure single room with the door closed, N95 or FFP2 respirators fit-tested for staff, a surgical mask on the patient when moving), collect three sputum samples for acid-fast bacilli smear, culture and rapid molecular testing, limit visitors, notify infection control and public health, and continue isolation until the patient has had at least two weeks of effective treatment with clinical improvement and three negative smears per policy
3. Place the patient in droplet precautions only
4. Delay isolation until culture confirms tuberculosis

Answer: B. Tuberculosis is notifiable and has residency implications across the Gulf; healthcare workers receive annual TB screening.

Question 9

A patient starting tuberculosis treatment asks about the medications. Which teaching is correct?

1. Stop the tablets once the cough improves
2. Take all drugs together daily on an empty stomach as prescribed for the full course (usually six months: four drugs for two months, then two drugs for four months), ideally under directly observed or supported treatment; rifampicin colours urine, tears and contact lenses orange and reduces the effect of oral contraceptives and many other drugs; report jaundice, nausea, abdominal pain, visual changes (ethambutol) or tingling in the feet (isoniazid, prevented with pyridoxine) immediately; incomplete treatment causes drug-resistant disease
3. Take the tablets only when symptomatic
4. Alcohol is safe during treatment

Answer: B. Baseline and periodic liver function tests and visual acuity checks are part of monitoring; household contacts are screened.

Chest drains and tracheostomy

Question 10

A patient has an underwater-seal chest drain for a pneumothorax. The nurse notes the fluid level in the tubing is no longer swinging with respiration and there is no bubbling. The most likely explanations and actions are:

1. The lung has definitely re-expanded; remove the drain
2. Either the lung has re-expanded or the tube is blocked, kinked or clamped, or the patient is lying on it; the nurse checks the tubing from patient to bottle, ensures the bottle is below chest level and the tube is not kinked, assesses the patient's respiratory status and air entry, and informs the medical team for a chest radiograph before any decision to remove; the drain is never routinely clamped, and tubing is not milked or stripped
3. Clamp the drain and wait
4. Raise the bottle above the chest to check

Answer: B. Continuous bubbling indicates an air leak (expected early in pneumothorax, or a system leak); if the drain disconnects, the tube end is placed in sterile water or re-connected immediately, and if it is pulled out, an occlusive dressing taped on three sides is applied and help called.

Question 11

Which assessment findings in a patient with a chest drain require immediate escalation?

1. Small swings of the fluid level with breathing
2. Sudden breathlessness, chest pain, tracheal deviation, subcutaneous emphysema spreading over the chest or neck, drainage of more than about 100 to 200 mL/h of fresh blood, new continuous bubbling in a drain that had stopped, or signs of infection at the site
3. Serous drainage of 50 mL over a shift
4. Mild discomfort at the insertion site

Answer: B. The nurse records drainage volume and character hourly initially, marks the level on the bottle, and encourages deep breathing, coughing and arm movement on the affected side.

Question 12

A patient with a new tracheostomy (day 2) becomes acutely distressed with noisy breathing and falling saturations; suctioning meets resistance and the suction catheter will not pass. The nurse should:

1. Increase the oxygen and recheck in ten minutes
2. Call for help immediately, apply high-flow oxygen to the tracheostomy and face, remove the inner cannula (and any speaking valve or cap), attempt to pass a suction catheter again, and if the tube is still blocked or displaced, deflate the cuff and, following the emergency tracheostomy algorithm, remove the tube and oxygenate via the stoma or the upper airway with the stoma covered, with the anaesthetist or ENT team re-establishing the airway; a spare tube one size smaller, obturator, suction, dilators and oxygen are kept at the bedside at all times
3. Reinsert the inner cannula and wait
4. Push the tube further in

Answer: B. A fresh tracheostomy track (under 7 days) can close or create a false passage on reinsertion; the bedside sign states the tube type, size, date and whether the upper airway is patent.

Question 13

Which tracheostomy suctioning practice is correct?

1. Suction routinely every hour for one minute each time
2. Suction only when indicated (visible or audible secretions, desaturation, increased work of breathing, patient request), pre-oxygenate if required, use a sterile catheter no more than half the internal diameter of the tube, insert without suction to the pre-measured length (about the tube length, or until resistance then withdraw 1 cm), apply suction for no more than 10 to 15 seconds while withdrawing, limit to two or three passes, allow recovery between passes, and monitor saturations and heart rate; humidify inspired gas to prevent crusting
3. Instil saline before every suction
4. Use the largest catheter available

Answer: B. Routine saline instillation is not recommended; inner cannulae are cleaned or changed per policy, and the stoma is cleaned and the dressing and ties changed with two staff to prevent tube displacement.

Vascular, pleural and procedures

Question 14

Three days after a hip replacement, a patient develops sudden breathlessness, pleuritic chest pain, tachycardia of 118 and saturations of 90% with a clear chest. The nurse should:

1. Give an antacid for indigestion
2. Suspect pulmonary embolism, sit the patient upright, give oxygen to target, obtain observations and ECG, call for urgent medical review, prepare for CT pulmonary angiography and anticoagulation (low-molecular-weight heparin or a DOAC, or thrombolysis if haemodynamically unstable), check the calves for DVT, and avoid leg massage; the nurse also reviews whether VTE prophylaxis was given
3. Encourage ambulation to ease the pain
4. Give oral paracetamol and reassess in an hour

Answer: B. Immobility, surgery, cancer, oral contraceptives, pregnancy and long flights are the tested risk factors; prophylaxis compliance is audited.

Question 15

A patient is scheduled for a diagnostic thoracentesis for a large pleural effusion. The nurse's pre- and post-procedure care includes:

1. Lying the patient flat on the affected side during the procedure
2. Explaining the procedure and obtaining consent, checking coagulation and platelets as ordered, positioning the patient sitting upright leaning forward over a table, instructing the patient not to cough or move during needle insertion, monitoring vital signs and oxygen saturation, labelling and sending the fluid for protein, LDH, glucose, pH, cell count, cytology and microbiology, and afterwards observing for pneumothorax (sudden breathlessness, chest pain), re-expansion pulmonary oedema if a large volume was removed (usually limited to 1 to 1.5 litres), bleeding and infection, with a chest radiograph as ordered
3. Giving a large meal before the procedure
4. No monitoring is needed afterwards

Answer: B. Light's criteria classify the fluid as transudate or exudate; a purulent or low-pH infected effusion needs a chest drain.

Question 16

A patient with a COPD exacerbation is started on bilevel non-invasive ventilation on the ward. Nursing priorities include:

1. Leaving the patient alone to rest once the mask is on
2. Explaining and reassuring, fitting the mask to minimise leak without excessive tightness, protecting the nasal bridge with a dressing, continuous saturation monitoring with a repeat blood gas within one to two hours, observing respiratory rate, synchrony, consciousness and comfort, providing short breaks for drinks and mouth care, keeping the patient semi-upright, ensuring the plan for escalation or intubation is documented, and recognising failure (worsening pH, rising carbon dioxide, declining consciousness, intolerance) early
3. Applying the tightest possible mask strap
4. Giving sedatives to improve tolerance

Answer: B. Contraindications include inability to protect the airway, vomiting, facial trauma, undrained pneumothorax and severe confusion; NIV reduces intubation and mortality in acidotic COPD exacerbations.

Prevention and occupational lung disease

Question 17

A post-operative patient after upper abdominal surgery has shallow breathing, a low-grade fever on day 1 and reduced air entry at the bases. The nurse's actions include:

1. Bed rest and a cough suppressant
2. Recognise probable atelectasis, give adequate analgesia so the patient can breathe deeply, teach and supervise incentive spirometry or deep breathing and coughing exercises every hour while awake with the incision splinted, mobilise early, position upright, encourage fluids, and monitor temperature, saturations and sputum for progression to pneumonia
3. Start antibiotics immediately without assessment
4. Restrict fluids

Answer: B. Fever in the first 48 hours after surgery is most often atelectasis; pneumonia and wound infection follow later.

Question 18

Which chest physiotherapy and positioning principle is correct for a patient with copious secretions in the right lower lobe?

1. Postural drainage immediately after meals
2. Positioning so that the affected segment is uppermost (for the right lower lobe, lying on the left side with the foot of the bed raised, as tolerated) for 10 to 15 minutes, combined with percussion and vibration where not contraindicated, performed before meals or at least one hour after and before bedtime, with the airway clearance technique (active cycle of breathing, huffing) taught, and stopped if the patient becomes breathless, hypoxic or dizzy; contraindications include raised intracranial pressure, recent spinal or chest surgery, rib fractures, haemoptysis and unstable cardiac status
3. Percussion directly over the spine and kidneys
4. Trendelenburg positioning for all patients regardless of condition

Answer: B. Oscillating positive expiratory pressure devices are an alternative for patients who cannot tolerate positioning.

Question 19

A 40-year-old labourer who has worked for years cutting stone and in cement production has progressive breathlessness and upper-zone nodular shadowing. The nurse's understanding and health promotion role include:

1. This is asthma; inhalers will cure it
2. Recognising probable silicosis, an irreversible occupational lung disease common among construction and quarry workers in the Gulf, which increases tuberculosis risk; supporting referral for occupational health assessment and TB screening, teaching the use of respiratory protection and dust control at work, smoking cessation, vaccination, and energy conservation, and documenting the occupational history, because occupational disease is reportable and compensable under Gulf labour laws
3. Advising the patient to continue working without protection
4. No action; this is normal ageing

Answer: B. Dust storms and extreme heat also drive asthma and COPD exacerbations in the region, and nurses advise patients to limit outdoor exposure during dust events.

Question 20

Which smoking cessation approach has the best evidence for a hospitalised smoker?

1. Telling the patient to stop and leaving a leaflet
2. Brief advice at every contact using an ask-advise-act approach, assessing readiness and nicotine dependence, offering nicotine replacement therapy (patch plus a short-acting form) during admission to manage withdrawal, referral to a cessation service with behavioural support and pharmacotherapy (varenicline or bupropion where available and appropriate), setting a quit date, addressing shisha and smokeless tobacco as well as cigarettes, and arranging follow-up after discharge
3. Prescribing a lower-tar cigarette
4. Waiting until the patient asks for help

Answer: B. Combination nicotine replacement with behavioural support roughly doubles quit rates; Gulf hospitals audit the offer of cessation support as a quality measure.

How to practise

• Memorise the oxygen devices and targets: 94 to 98% for most, 88 to 92% in hypercapnic risk, flow rates and concentrations per device.
• Learn the emergencies as sequences: life-threatening asthma, severe pneumonia and sepsis, blocked tracheostomy, chest drain disconnection, pulmonary embolism, NIV failure.
• Know the isolation and public health rules for tuberculosis and the treatment teaching points.
• Practise technique questions: inhalers, suctioning, postural drainage, sputum collection.

Respiratory chapters with explanations are in the Registered Nurse bank; related sets are the critical care questions, infection control questions, medical-surgical questions and fluid and electrolyte questions. Respiratory therapists have their own set (respiratory therapist questions).

Frequently asked questions

How many respiratory questions are in the Prometric nursing exam?

About 10 to 14 of 150, within the medical-surgical and critical care domains.

Which respiratory nursing topics come up most?

Oxygen therapy and targets, acute asthma care, COPD education, tuberculosis isolation, chest drain management, tracheostomy emergencies and pulmonary embolism recognition.

Do I need to know blood gas interpretation?

At the level of recognising respiratory acidosis and alkalosis and the nursing response; the full method is in the fluid and electrolyte set.

Which guidelines does the exam follow?

Current GINA, GOLD, BTS oxygen and pleural guidance, and national tracheostomy safety project algorithms, as reflected in standard nursing textbooks.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.