CCRN Respiratory Practice Questions
Updated October 30, 2026
Respiratory questions on the CCRN (Adult) exam are mostly about the ventilated patient: what the alarms and waveforms are telling you, which setting to change, and when a patient is failing. The rest cover the problems that put patients on the ventilator in the first place, from ARDS and pulmonary embolism to COPD, asthma and chest trauma.
The 12 questions below are original, written for this page in the style of the real exam. They are independent practice and are not official AACN material.
Respiratory on the CCRN at a glance
| Item | Details |
|---|---|
| Share of the exam | 12% of the scored questions, about 15 of 125 |
| Test plan | Adult CCRN test plan for exams on or after November 12, 2025 |
| Question style | Ventilator data, ABGs and bedside findings, four choices, one best answer |
| Previous share | 15% under the 2020 plan |
What the respiratory questions cover
The test plan lists acute pulmonary edema, pulmonary embolism, ARDS, acute respiratory failure, pneumonia and other acute infections, chronic conditions such as COPD and asthma, mechanical ventilation complications, pleural space problems such as pneumothorax and effusion, pulmonary hemorrhage, pulmonary hypertension, status asthmaticus, thoracic and airway trauma, and thoracic surgery.
The nursing actions include airway management and rapid sequence intubation, chest tubes, mechanical ventilation and noninvasive ventilation including high-flow nasal cannula, prone positioning, capnography and other monitoring, therapeutic gases, thoracentesis, bronchoscopy and tracheostomy care.
Tips for respiratory questions
- Read the alarm. A high-pressure alarm points toward the airway or lungs (secretions, bronchospasm, pneumothorax). A low-volume or low-pressure alarm points toward a leak or disconnection.
- Protect the lung. For ARDS, expect low tidal volumes based on predicted body weight and limits on plateau pressure.
- A normal number can be bad news. A PaCO2 climbing toward normal in a patient who was blowing it off during an asthma attack means fatigue, not recovery.
- Treat the patient, not the film. A patient in obvious tension physiology needs decompression before any imaging.
CCRN respiratory practice questions
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A patient with ARDS is on volume control ventilation with a tidal volume of 8 mL/kg of predicted body weight, PEEP 12 cm H2O and FiO2 0.80. The plateau pressure is 34 cm H2O and the PaO2/FiO2 ratio is 90. Which change should the nurse anticipate?Answer: CLung-protective ventilation in ARDS uses low tidal volumes, about 6 mL/kg of predicted body weight, with the plateau pressure kept at or under 30 cm H2O. Lowering the PEEP in severe hypoxemia would worsen oxygenation, and a larger tidal volume raises the risk of lung injury.
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Moments after a ventilated patient with ARDS is turned to the prone position, the capnography waveform disappears, the ventilator alarms for low exhaled volume and breath sounds are absent on both sides. The patient still has a pulse. What is the MOST LIKELY cause?Answer: ALoss of exhaled CO2, low exhaled volumes and absent breath sounds on both sides right after a turn point to a displaced tube. A mucus plug or pneumothorax would cause a high-pressure alarm, and worsening shunt lowers oxygenation without removing the CO2 waveform.
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A ventilated patient after blunt chest trauma suddenly has peak airway pressures rise from 28 to 52 cm H2O, BP 72/40 mm Hg, HR 138, absent breath sounds on the right and tracheal deviation to the left. Which action is the PRIORITY?Answer: DRising airway pressures, hypotension, absent breath sounds and a shifted trachea are a tension pneumothorax, a clinical diagnosis that needs immediate decompression. Waiting for an x-ray or trying suction delays treatment while the patient is in obstructive shock.
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During a thoracentesis, 1.8 L of fluid is removed from a large right pleural effusion. Shortly after, the patient develops a persistent cough, dyspnea, crackles on the right and an SpO2 drop from 95% to 86%. What is the MOST LIKELY cause?Answer: ARapid removal of a large effusion can cause re-expansion pulmonary edema, with cough, dyspnea, crackles and hypoxemia on the drained side. A pneumothorax would reduce breath sounds rather than add crackles, and a vasovagal reaction causes bradycardia and hypotension without crackles.
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A 44-year-old patient taking oral contraceptives, with no recent surgery or bleeding, develops sudden dyspnea. HR is 124, BP 84/52 mm Hg and SpO2 86%. CT shows a saddle pulmonary embolism with right ventricular dilation. Which therapy should the nurse anticipate?Answer: BA pulmonary embolism with sustained hypotension is high risk, and without a contraindication it calls for reperfusion, with systemic thrombolysis as the usual first option. Heparin alone does not clear the clot fast enough, a filter does not treat the existing clot, and large fluid volumes can overdistend a failing right ventricle.
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A patient with COPD has an ABG of pH 7.26, PaCO2 72 mm Hg and HCO3 31 mEq/L on 2 L/min nasal cannula. The patient is alert, follows commands and is using accessory muscles. Which intervention is MOST appropriate?Answer: CAcute hypercapnic respiratory acidosis in an alert, cooperative COPD patient is the classic indication for noninvasive positive pressure ventilation, which lowers the need for intubation. High-flow oxygen through a mask can worsen CO2 retention, and sedation would further depress breathing.
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A patient with status asthmaticus had a PaCO2 of 30 mm Hg an hour ago. Despite continuous bronchodilators, the PaCO2 is now 46 mm Hg with a pH of 7.33. The patient is drowsy, and wheezes are harder to hear. What does this change MOST LIKELY indicate?Answer: DIn a severe asthma attack the PaCO2 is expected to be low from rapid breathing. A rise toward or above normal with drowsiness and quieter wheezes means the patient is tiring and moving less air, a sign that intubation may be needed soon.
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The nurse is reviewing a unit bundle to prevent ventilator-associated events. Which intervention is supported by the evidence?Answer: BRaising the head of the bed reduces aspiration and is part of standard prevention bundles, along with daily sedation interruption and breathing trials. Routine circuit changes, saline instillation and cuff deflation do not lower the risk and can increase it.
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Twenty minutes into a spontaneous breathing trial on low pressure support, a patient has RR 36, HR up from 92 to 124, SpO2 86%, diaphoresis and visible accessory muscle use. What should the nurse do?Answer: ATachypnea, a large rise in heart rate, desaturation and accessory muscle use are signs of a failed breathing trial. The patient should be returned to full support to rest, and the cause of failure reviewed before the next attempt.
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A patient with pulmonary arterial hypertension receives a continuous IV epoprostenol infusion through a central line. The central line is found occluded and cannot be cleared. What is the PRIORITY?Answer: DEpoprostenol has a half-life of only minutes, and an interruption can cause rebound pulmonary hypertension and rapid collapse. The infusion should be resumed through any available IV access without delay while a new central line is arranged.
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A ventilated patient with COPD has rising peak pressures, a BP that falls with each breath, and an expiratory flow waveform that does not return to baseline before the next breath. Which ventilator change would be MOST helpful?Answer: BExpiratory flow that does not reach zero means air trapping and auto-PEEP, which raises intrathoracic pressure and lowers venous return. Giving more time to exhale by lowering the rate is the key fix; a higher rate, larger volumes or longer inspiration all shorten expiration or add volume.
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After a motor vehicle crash, a patient has several adjacent ribs broken in two places, with a segment of the right chest wall moving inward on inspiration. SpO2 is 91% on 4 L/min, and the patient splints and takes shallow breaths because of pain. Which intervention is the PRIORITY?Answer: CThe main danger in flail chest is the underlying lung contusion and hypoventilation from pain. Good analgesia lets the patient breathe deeply and cough; strapping and sandbags restrict ventilation, and liberal fluids can worsen a contused lung.
Keep practicing
Our Respiratory practice exam has 15 questions, the same share as the real exam, and the full practice exams mix all six areas into 125 scored questions with 83 to pass. Start from the home page.
Next, try the cardiovascular questions or the multisystem questions, or see the CCRN exam guide.
Pass the CCRN exam on your first try
- All 338 questions across every area of the 2025 Adult CCRN test plan
- A rationale for every answer, including why the tempting choice is wrong
- Unlimited full 125-question practice exams, scored like the real one (83 to pass)