Respiratory Therapy Comprehensive Review 2026–2027
Respiratory Therapy Comprehensive Review 2026–2027
Clinical Concepts & Practice Questions
(200 Questions)
Scope: Respiratory assessment, oxygen therapy, airway management, ABG interpretation, mechanical
ventilation, COPD/asthma, and clinical decision-making. The source notes alignment with respiratory-care
educational priorities and AARC clinical-practice resources.
Question 1
A patient with COPD is receiving supplemental oxygen
during an acute exacerbation. Which SpO₂ target is generally appropriate for a
patient known to have chronic CO₂ retention?
A. 70–75%
B. 80–85%
C. 88–92%
D. 96–100%
Correct Answer: C. 88–92%
Detailed Rationale:
For critically ill adults with COPD or known CO₂ retention, an SpO₂ target of approximately 88–92% is
commonly recommended to provide adequate oxygenation while reducing the risk of excessive oxygen
administration. Oxygen should be titrated to the patient's clinical condition and monitored closely. AARC
guidance specifically identifies 88–92% as the target range for critically ill adults with CO₂ retention and/or
COPD.
Why the Other Options Are Incorrect:
A) 70–75%: This represents significant hypoxemia and would generally provide inadequate oxygenation.
B) 80–85%: This is below the commonly recommended target for COPD patients with CO₂ retention.
D) 96–100%: This may provide unnecessarily high oxygen exposure in a patient susceptible to hypercapnia and
is not the usual target for chronic CO₂ retainers.
Question 2
Which assessment finding is most consistent with
increased work of breathing?
A. Respiratory rate of 12/min with relaxed posture
B. Use of accessory muscles with intercostal retractions
C. Regular breathing with normal chest expansion
D. Symmetric chest movement without distress
Correct Answer: B. Use of accessory muscles with
Detailed Rationale:
Accessory-muscle use and intercostal retractions indicate that the patient is generating increased respiratory
effort. These findings can occur with airway obstruction, decreased lung compliance, respiratory muscle
fatigue, or significant respiratory distress.
Why the Other Options Are Incorrect:
A) A normal respiratory rate and relaxed posture do not indicate increased respiratory effort.
C) Regular breathing with normal expansion is generally consistent with adequate respiratory mechanics.
D) Symmetric chest movement without distress is not characteristic of increased work of breathing.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 1
, Respiratory Therapy Comprehensive Review 2026–2027
Question 3
A patient has the following ABG results: pH 7.28,
PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L, PaO₂ 68 mmHg. How should these results be
interpreted?
A. Uncompensated respiratory acidosis with hypoxemia
B. Uncompensated metabolic acidosis
C. Fully compensated respiratory acidosis
D. Respiratory alkalosis with hypoxemia
Correct Answer: A. Uncompensated respiratory acidosis
Detailed Rationale:
The pH is low, indicating acidemia. The PaCO₂ is elevated, identifying the respiratory component as the
primary cause. The bicarbonate is within the normal range, indicating little or no metabolic compensation. The
PaO₂ is also reduced, indicating hypoxemia.
Why the Other Options Are Incorrect:
B) Metabolic acidosis would primarily involve a decreased HCO₃⁻.
C) Fully compensated respiratory acidosis would have a pH within the normal range with an elevated HCO₃⁻.
D) Respiratory alkalosis is associated with a decreased PaCO₂, not an elevated PaCO₂.
Question 4
Which ABG value primarily reflects the patient's
ventilatory status?
A. PaO₂
B. SaO₂
C. PaCO₂
D. HCO₃⁻
Correct Answer: C. PaCO₂
Detailed Rationale:
PaCO₂ is closely related to alveolar ventilation. When alveolar ventilation decreases, CO₂ generally
accumulates, causing PaCO₂ to rise. Conversely, increased alveolar ventilation generally lowers PaCO₂.
Why the Other Options Are Incorrect:
A) PaO₂ primarily reflects oxygenation rather than ventilation.
B) SaO₂ represents hemoglobin oxygen saturation.
D) HCO₃⁻ primarily reflects the metabolic component of acid-base balance.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 2
, Respiratory Therapy Comprehensive Review 2026–2027
Question 5
A patient with acute asthma develops severe dyspnea,
wheezing, and difficulty speaking. Which medication is commonly used for rapid
bronchodilation?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Tiotropium
Correct Answer: A. Albuterol
Detailed Rationale:
Albuterol is a short-acting β₂-adrenergic agonist that produces rapid bronchodilation and is commonly used
for acute bronchospasm. Respiratory-care education continues to emphasize appropriate aerosolized
medication selection for acute asthma management.
Why the Other Options Are Incorrect:
B) Fluticasone is an inhaled corticosteroid used primarily for anti-inflammatory maintenance therapy.
C) Montelukast is a leukotriene receptor antagonist used mainly as controller therapy.
D) Tiotropium is a long-acting anticholinergic bronchodilator and is not the typical first rescue medication for
acute bronchospasm.
Question 6
Which oxygen-delivery device provides the most
precise fixed FiO₂ among commonly used low-flow devices?
A. Nasal cannula
B. Simple face mask
C. Venturi mask
D. Nonrebreather mask
Correct Answer: C. Venturi mask
Detailed Rationale:
A Venturi mask uses the Venturi principle to entrain room air in controlled proportions, allowing delivery of a
relatively precise oxygen concentration. This is particularly useful when controlled oxygen therapy is
important.
Why the Other Options Are Incorrect:
A) A nasal cannula delivers variable FiO₂ depending on flow, breathing pattern, and patient factors.
B) A simple mask provides variable FiO₂.
D) A nonrebreather can deliver high concentrations of oxygen but does not provide the same controlled fixed
FiO₂ as a Venturi system.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 3
, Respiratory Therapy Comprehensive Review 2026–2027
Question 7
A mechanically ventilated patient's high-pressure
alarm suddenly activates. Which condition should the respiratory therapist
consider first?
A. Circuit disconnection
B. Airway obstruction
C. Low oxygen supply
D. Cuff leak
Correct Answer: B. Airway obstruction
Detailed Rationale:
A sudden increase in airway resistance can produce a high-pressure alarm. Causes include secretions,
bronchospasm, biting the tube, kinked tubing, or obstruction of the artificial airway. Immediate patient
assessment is essential.
Why the Other Options Are Incorrect:
A) Circuit disconnection typically causes a low-pressure or low-volume alarm.
C) Low oxygen supply affects delivered oxygen but does not typically cause an isolated sudden high-pressure
alarm.
D) A cuff leak generally produces low delivered volume and may trigger low-pressure or low-volume alarms.
Question 8
Which ventilator variable is most directly
responsible for improving alveolar ventilation when tidal volume is increased?
A. PaCO₂
B. PaO₂ only
C. Hemoglobin concentration
D. Inspiratory oxygen concentration only
Correct Answer: A. PaCO₂
Detailed Rationale:
Alveolar ventilation strongly influences CO₂ elimination. Increasing effective alveolar ventilation generally
decreases PaCO₂, assuming other variables remain relatively stable.
Why the Other Options Are Incorrect:
B) PaO₂ is primarily influenced by FiO₂, V/Q relationships, diffusion, and mean airway pressure.
C) Hemoglobin concentration affects oxygen-carrying capacity rather than directly controlling CO₂
elimination.
D) FiO₂ primarily affects oxygenation rather than ventilation.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 4
Respiratory Therapy Comprehensive Review 2026–2027
Clinical Concepts & Practice Questions
(200 Questions)
Scope: Respiratory assessment, oxygen therapy, airway management, ABG interpretation, mechanical
ventilation, COPD/asthma, and clinical decision-making. The source notes alignment with respiratory-care
educational priorities and AARC clinical-practice resources.
Question 1
A patient with COPD is receiving supplemental oxygen
during an acute exacerbation. Which SpO₂ target is generally appropriate for a
patient known to have chronic CO₂ retention?
A. 70–75%
B. 80–85%
C. 88–92%
D. 96–100%
Correct Answer: C. 88–92%
Detailed Rationale:
For critically ill adults with COPD or known CO₂ retention, an SpO₂ target of approximately 88–92% is
commonly recommended to provide adequate oxygenation while reducing the risk of excessive oxygen
administration. Oxygen should be titrated to the patient's clinical condition and monitored closely. AARC
guidance specifically identifies 88–92% as the target range for critically ill adults with CO₂ retention and/or
COPD.
Why the Other Options Are Incorrect:
A) 70–75%: This represents significant hypoxemia and would generally provide inadequate oxygenation.
B) 80–85%: This is below the commonly recommended target for COPD patients with CO₂ retention.
D) 96–100%: This may provide unnecessarily high oxygen exposure in a patient susceptible to hypercapnia and
is not the usual target for chronic CO₂ retainers.
Question 2
Which assessment finding is most consistent with
increased work of breathing?
A. Respiratory rate of 12/min with relaxed posture
B. Use of accessory muscles with intercostal retractions
C. Regular breathing with normal chest expansion
D. Symmetric chest movement without distress
Correct Answer: B. Use of accessory muscles with
Detailed Rationale:
Accessory-muscle use and intercostal retractions indicate that the patient is generating increased respiratory
effort. These findings can occur with airway obstruction, decreased lung compliance, respiratory muscle
fatigue, or significant respiratory distress.
Why the Other Options Are Incorrect:
A) A normal respiratory rate and relaxed posture do not indicate increased respiratory effort.
C) Regular breathing with normal expansion is generally consistent with adequate respiratory mechanics.
D) Symmetric chest movement without distress is not characteristic of increased work of breathing.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 1
, Respiratory Therapy Comprehensive Review 2026–2027
Question 3
A patient has the following ABG results: pH 7.28,
PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L, PaO₂ 68 mmHg. How should these results be
interpreted?
A. Uncompensated respiratory acidosis with hypoxemia
B. Uncompensated metabolic acidosis
C. Fully compensated respiratory acidosis
D. Respiratory alkalosis with hypoxemia
Correct Answer: A. Uncompensated respiratory acidosis
Detailed Rationale:
The pH is low, indicating acidemia. The PaCO₂ is elevated, identifying the respiratory component as the
primary cause. The bicarbonate is within the normal range, indicating little or no metabolic compensation. The
PaO₂ is also reduced, indicating hypoxemia.
Why the Other Options Are Incorrect:
B) Metabolic acidosis would primarily involve a decreased HCO₃⁻.
C) Fully compensated respiratory acidosis would have a pH within the normal range with an elevated HCO₃⁻.
D) Respiratory alkalosis is associated with a decreased PaCO₂, not an elevated PaCO₂.
Question 4
Which ABG value primarily reflects the patient's
ventilatory status?
A. PaO₂
B. SaO₂
C. PaCO₂
D. HCO₃⁻
Correct Answer: C. PaCO₂
Detailed Rationale:
PaCO₂ is closely related to alveolar ventilation. When alveolar ventilation decreases, CO₂ generally
accumulates, causing PaCO₂ to rise. Conversely, increased alveolar ventilation generally lowers PaCO₂.
Why the Other Options Are Incorrect:
A) PaO₂ primarily reflects oxygenation rather than ventilation.
B) SaO₂ represents hemoglobin oxygen saturation.
D) HCO₃⁻ primarily reflects the metabolic component of acid-base balance.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 2
, Respiratory Therapy Comprehensive Review 2026–2027
Question 5
A patient with acute asthma develops severe dyspnea,
wheezing, and difficulty speaking. Which medication is commonly used for rapid
bronchodilation?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Tiotropium
Correct Answer: A. Albuterol
Detailed Rationale:
Albuterol is a short-acting β₂-adrenergic agonist that produces rapid bronchodilation and is commonly used
for acute bronchospasm. Respiratory-care education continues to emphasize appropriate aerosolized
medication selection for acute asthma management.
Why the Other Options Are Incorrect:
B) Fluticasone is an inhaled corticosteroid used primarily for anti-inflammatory maintenance therapy.
C) Montelukast is a leukotriene receptor antagonist used mainly as controller therapy.
D) Tiotropium is a long-acting anticholinergic bronchodilator and is not the typical first rescue medication for
acute bronchospasm.
Question 6
Which oxygen-delivery device provides the most
precise fixed FiO₂ among commonly used low-flow devices?
A. Nasal cannula
B. Simple face mask
C. Venturi mask
D. Nonrebreather mask
Correct Answer: C. Venturi mask
Detailed Rationale:
A Venturi mask uses the Venturi principle to entrain room air in controlled proportions, allowing delivery of a
relatively precise oxygen concentration. This is particularly useful when controlled oxygen therapy is
important.
Why the Other Options Are Incorrect:
A) A nasal cannula delivers variable FiO₂ depending on flow, breathing pattern, and patient factors.
B) A simple mask provides variable FiO₂.
D) A nonrebreather can deliver high concentrations of oxygen but does not provide the same controlled fixed
FiO₂ as a Venturi system.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 3
, Respiratory Therapy Comprehensive Review 2026–2027
Question 7
A mechanically ventilated patient's high-pressure
alarm suddenly activates. Which condition should the respiratory therapist
consider first?
A. Circuit disconnection
B. Airway obstruction
C. Low oxygen supply
D. Cuff leak
Correct Answer: B. Airway obstruction
Detailed Rationale:
A sudden increase in airway resistance can produce a high-pressure alarm. Causes include secretions,
bronchospasm, biting the tube, kinked tubing, or obstruction of the artificial airway. Immediate patient
assessment is essential.
Why the Other Options Are Incorrect:
A) Circuit disconnection typically causes a low-pressure or low-volume alarm.
C) Low oxygen supply affects delivered oxygen but does not typically cause an isolated sudden high-pressure
alarm.
D) A cuff leak generally produces low delivered volume and may trigger low-pressure or low-volume alarms.
Question 8
Which ventilator variable is most directly
responsible for improving alveolar ventilation when tidal volume is increased?
A. PaCO₂
B. PaO₂ only
C. Hemoglobin concentration
D. Inspiratory oxygen concentration only
Correct Answer: A. PaCO₂
Detailed Rationale:
Alveolar ventilation strongly influences CO₂ elimination. Increasing effective alveolar ventilation generally
decreases PaCO₂, assuming other variables remain relatively stable.
Why the Other Options Are Incorrect:
B) PaO₂ is primarily influenced by FiO₂, V/Q relationships, diffusion, and mean airway pressure.
C) Hemoglobin concentration affects oxygen-carrying capacity rather than directly controlling CO₂
elimination.
D) FiO₂ primarily affects oxygenation rather than ventilation.
Respiratory Therapy Comprehensive Review 2026–2027 | Practice Resource • Page 4
