Respiratory Therapist Prometric exam questions

The Respiratory Therapist exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Respiratory Therapist practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Mechanical Ventilation: Initiation, Management & Liberation

   A woman with ARDS (PBW 60 kg) is on volume A/C, tidal volume 480 mL, rate 24/min, PEEP 10 cmH2O. Plateau pressure is 32 cmH2O; ABG shows pH 7.32, PaCO2 50 mmHg, PaO2 74 mmHg on FIO2 0.6. What is the most appropriate next step?

   1. AIncrease PEEP to 16 cmH2O to recruit more lung
   2. BIncrease the rate to 30/min to normalize the PaCO2
   3. CSwitch to pressure control with an inspiratory pressure of 32 cmH2O
   4. DReduce tidal volume to 360 mL (6 mL/kg PBW) and reassess plateau and driving pressure
   Show answer and explanation

   Correct answer: D. Reduce tidal volume to 360 mL (6 mL/kg PBW) and reassess plateau and driving pressure

   The current tidal volume is 8 mL/kg PBW, the plateau exceeds 30 cmH2O, and the driving pressure (plateau minus PEEP) is 22 cmH2O, well above the 14-15 cmH2O associated with better survival. Lowering tidal volume to 6 mL/kg directly reduces both plateau and driving pressure. Raising PEEP without lowering tidal volume would push plateau higher, the mild acidemia is acceptable under permissive hypercapnia, and simply changing modes at the same distending pressure does not reduce stress.

   Reference: ARDS Network, NEJM (2000); Amato MBP et al., Driving pressure and survival in ARDS, NEJM 372:747 (2015)

2. Question 2 · Patient Safety, Infection Prevention, Professionalism, Ethics & Scope of Practice

   A patient develops tracheal stenosis after a prolonged intubation during which documented departmental policy required cuff pressure measurement every shift, and no measurements were recorded. For a claim of professional negligence against the therapist to succeed, which combination must be established?

   1. AA bad outcome and the patient's dissatisfaction with the care received
   2. BDuty of care owed to the patient, breach of the accepted standard of that duty, causation linking the breach to the injury, and resulting damages
   3. CIntent to cause harm plus a documented deviation from policy
   4. DA departmental policy violation alone, regardless of any resulting harm
   Show answer and explanation

   Correct answer: B. Duty of care owed to the patient, breach of the accepted standard of that duty, causation linking the breach to the injury, and resulting damages

   Negligence requires all four elements: a duty owed, a breach of the applicable standard of care, causation connecting that breach to the harm, and actual damages; failing any single element defeats the claim. A poor outcome without breach and causation is not negligence, and dissatisfaction is not a legal element. Intent is the hallmark of an intentional tort, not negligence, and a policy breach that causes no harm creates no damages even though it may attract internal disciplinary or quality review.

   Reference: Egan's Fundamentals of Respiratory Care, 12th ed. (2021), legal and ethical implications chapter

3. Question 3 · Cardiopulmonary Anatomy, Physiology & Pathophysiology

   Which clinical situation is most likely to produce an INCREASED measured DLCO?

   1. ASevere anemia with a hemoglobin of 7 g/dL
   2. BAcute alveolar hemorrhage
   3. CRecent cigarette smoking with elevated carboxyhemoglobin
   4. DAcute pulmonary embolism
   Show answer and explanation

   Correct answer: B. Acute alveolar hemorrhage

   Blood within the alveolar spaces provides extra hemoglobin that avidly binds the test carbon monoxide, so alveolar hemorrhage (as in Goodpasture syndrome) raises measured DLCO; polycythemia, asthma and left-to-right shunts do the same. Anemia lowers DLCO because there is less hemoglobin to bind CO, elevated COHb from smoking back-pressures the test gas and lowers the measurement, and pulmonary embolism reduces perfused capillary volume.

   Reference: ERS/ATS Standardisation of the Single-Breath Determination of Carbon Monoxide Uptake in the Lung (Eur Respir J, 2017)

4. Question 4 · Oxygen Therapy, Medical Gas Delivery, Humidity & Aerosol Therapy

   A 55-year-old with viral pneumonia has been on heated high-flow nasal cannula at 60 L/min and FIO2 1.0 for two hours. Respiratory rate is 38 per minute, SpO2 is 87 percent, accessory muscle use is marked, and the ROX index is 3.2. What is the most appropriate action?

   1. AIncrease the flow to 70 L/min and reassess in four hours
   2. BChange to a non-rebreathing mask at 15 L/min
   3. CProceed to endotracheal intubation and invasive mechanical ventilation
   4. DAdd a nasal cannula at 15 L/min underneath the high-flow prongs
   Show answer and explanation

   Correct answer: C. Proceed to endotracheal intubation and invasive mechanical ventilation

   A ROX index below about 3.85 after two hours of high-flow therapy, together with persistent tachypnea, accessory muscle use and hypoxemia on FIO2 1.0, predicts high-flow failure and should prompt intubation rather than continued escalation. Waiting a further four hours risks delayed intubation, which is associated with worse outcomes. A non-rebreathing mask delivers less flow and no humidification and would worsen matters, and layering a second cannula adds no meaningful support.

   Reference: Roca et al., An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy, American Journal of Respiratory and Critical Care Medicine 2019

5. Question 5 · Respiratory Pharmacology & Medication Administration

   A patient has taken high-dose oral prednisolone continuously for 4 months for severe asthma and now wishes to stop. Why must the dose be tapered rather than stopped abruptly?

   1. AAbrupt cessation causes rebound bronchoconstriction through beta receptor upregulation
   2. BProlonged exogenous steroid suppresses the hypothalamic-pituitary-adrenal axis, so abrupt withdrawal can precipitate adrenal insufficiency
   3. CTapering is required to allow renal clearance of accumulated drug metabolites
   4. DAbrupt cessation causes an immediate rise in blood glucose and ketoacidosis
   Show answer and explanation

   Correct answer: B. Prolonged exogenous steroid suppresses the hypothalamic-pituitary-adrenal axis, so abrupt withdrawal can precipitate adrenal insufficiency

   Courses longer than about 2-3 weeks suppress endogenous cortisol production through negative feedback on the HPA axis, and abrupt withdrawal can cause adrenal crisis with hypotension, hypoglycaemia and shock; tapering allows adrenal recovery. Steroid withdrawal does not act through beta receptor upregulation or accumulated metabolites, and stopping steroids lowers rather than raises blood glucose.

   Reference: Global Initiative for Asthma (GINA) Report, 2023; Goodman & Gilman's The Pharmacological Basis of Therapeutics, 13th ed. (2018), adrenocorticosteroids

6. Question 6 · Neonatal & Pediatric Respiratory Care

   A post-term infant with meconium aspiration syndrome is being ventilated with PIP 30 cmH2O, PEEP 6 cmH2O and FIO2 0.90. The chest film shows hyperinflation with patchy coarse infiltrates. The infant suddenly deteriorates with a fall in SpO2 to 62%, bradycardia, decreased breath sounds on the right and a shift of the cardiac impulse to the left. Which complication is most likely?

   1. ARight mainstem intubation
   2. BTension pneumothorax on the right
   3. CAcute pulmonary hemorrhage
   4. DComplete right lower lobe atelectasis
   Show answer and explanation

   Correct answer: B. Tension pneumothorax on the right

   Meconium creates a ball-valve obstruction with gas trapping, and when combined with high inflating pressures it makes air leak the most common acute complication; sudden desaturation with bradycardia, unilaterally decreased breath sounds and contralateral mediastinal shift is the classic picture of a tension pneumothorax requiring immediate needle decompression. Right mainstem intubation reduces breath sounds on the left, not the right, and does not usually shift the mediastinum away from the affected side. Pulmonary hemorrhage produces bloody secretions from the airway, and lobar atelectasis pulls the mediastinum toward the affected side rather than away from it.

   Reference: Walsh BK. Neonatal and Pediatric Respiratory Care, 5th ed., Elsevier (2019); Egan's Fundamentals of Respiratory Care, 12th ed. (2021)

7. Question 7 · Equipment Assembly, Troubleshooting & Quality Control

   An 80/20 helium-oxygen mixture is being delivered through a standard oxygen Thorpe tube flowmeter, which is set at an indicated 10 L/min. What is the approximate actual flow of heliox delivered?

   1. A6 L/min
   2. B10 L/min
   3. C14 L/min
   4. D18 L/min
   Show answer and explanation

   Correct answer: D. 18 L/min

   Because helium is far less dense than oxygen, it flows more readily through the flowmeter than the gas the device was calibrated for, and the indicated value must be multiplied by a correction factor of 1.8 for 80/20 heliox: 10 x 1.8 = 18 L/min (the factor for 70/30 heliox is 1.6). Reading the dial directly underestimates the delivered flow, and dividing rather than multiplying gives the incorrect low value. Failure to apply the factor leads to serious errors in estimating delivered flow and FIO2.

   Reference: Cairo JM, Mosby's Respiratory Care Equipment, 10th ed. (2018), heliox delivery and flowmeter correction factors

8. Question 8 · Patient Assessment & Clinical Data Evaluation

   Over four hours in a volume-controlled ventilated patient, the peak inspiratory pressure has risen from 28 to 42 cmH2O while the plateau pressure has remained at 22 cmH2O with unchanged settings. What does this trend indicate?

   1. AIncreased airway resistance, such as secretions, bronchospasm or a partially obstructed tube
   2. BDecreased lung compliance, such as developing pulmonary edema
   3. CDevelopment of a large pneumothorax
   4. DA leak in the ventilator circuit
   Show answer and explanation

   Correct answer: A. Increased airway resistance, such as secretions, bronchospasm or a partially obstructed tube

   Peak pressure reflects both resistive and elastic loads whereas plateau pressure reflects elastic load alone, so a rising peak with a stable plateau widens the peak-to-plateau difference and localizes the problem to airway resistance. A falling compliance problem such as edema or pneumothorax would raise the plateau pressure as well, and a circuit leak lowers rather than raises measured pressures.

   Reference: Egan's Fundamentals of Respiratory Care, 12th edition (Elsevier, 2021)

9. Question 9 · Arterial Blood Gases, Acid-Base Balance & Oxygenation Assessment

   A ventilated patient at sea level on FIO2 1.0 has Hb 15 g/dL, PaO2 100 mmHg with SaO2 97%, and mixed venous PO2 40 mmHg with SvO2 70%. Assuming end-capillary blood is fully saturated at a PAO2 of about 663 mmHg, what is the approximate shunt fraction?

   1. A10%
   2. B18%
   3. C29%
   4. D41%
   Show answer and explanation

   Correct answer: C. 29%

   CcO2 = (1.34 x 15 x 1.00) + (0.003 x 663) = 22.1 vol%, CaO2 = (1.34 x 15 x 0.97) + (0.003 x 100) = 19.8 vol%, and CvO2 = (1.34 x 15 x 0.70) + (0.003 x 40) = 14.2 vol%. Qs/Qt = (22.1 - 19.8) / (22.1 - 14.2) = 2.3 / 7.9 = about 0.29, a large shunt (normal is under 5%) that indicates the need for recruitment and PEEP rather than further FIO2 escalation.

   Reference: Egan's Fundamentals of Respiratory Care, 12th ed., 2021; Marino's The ICU Book, 4th ed., 2014

10. Question 10 · Pulmonary Function Testing, Diagnostic Procedures & Chest Imaging

    A patient with chronic iron-deficiency anemia (hemoglobin 8.5 g/dL) has an uncorrected DLCO of 62% predicted. After adjustment for hemoglobin the DLCO is 79% predicted. Which statement is most accurate?

    1. AAnemia lowers the measured DLCO, and the hemoglobin-adjusted value should be used for interpretation
    2. BAnemia raises the measured DLCO, so the true diffusing capacity is even lower than 62%
    3. CHemoglobin adjustment applies only to patients with an elevated carboxyhemoglobin level
    4. DThe adjusted value should be ignored, because only the raw measured DLCO is clinically valid
    Show answer and explanation

    Correct answer: A. Anemia lowers the measured DLCO, and the hemoglobin-adjusted value should be used for interpretation

    Carbon monoxide uptake depends on the amount of hemoglobin available to bind it, so anemia reduces the measured DLCO independently of any lung disease and polycythemia raises it. Standards therefore require reporting a hemoglobin-adjusted DLCO, which here shows a far less severe defect than the raw value implied. Carboxyhemoglobin and altitude are separate additional corrections, and the adjusted value is the one that should guide clinical interpretation.

    Reference: Graham BL et al., ERS/ATS Standards for Single-Breath Carbon Monoxide Uptake in the Lung, Eur Respir J 2017

11. Question 11 · Airway Management & Artificial Airways

    A patient is intubated with an 8.0 mm internal diameter endotracheal tube. Using the standard rule that the catheter should occlude no more than about half the tube's internal diameter, which suction catheter size is most appropriate?

    1. A8 Fr
    2. B10 Fr
    3. C12 Fr
    4. D18 Fr
    Show answer and explanation

    Correct answer: C. 12 Fr

    The common sizing rule multiplies the tube's internal diameter in millimetres by 3 and divides by 2, giving (8 x 3) / 2 = 12 Fr, which keeps catheter cross-section at roughly half the tube lumen and preserves gas flow around it. An 8 or 10 Fr catheter would function but is less efficient at removing thick secretions from a large tube. An 18 Fr catheter would occlude most of the lumen, generating excessive negative airway pressure, hypoxemia and atelectasis.

    Reference: AARC Clinical Practice Guideline: Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways, 2010

12. Question 12 · Respiratory Pharmacology & Medication Administration

    A patient with severe ARDS is receiving a continuous cisatracurium infusion. Train-of-four monitoring at the ulnar nerve shows 0 of 4 twitches. What is the most appropriate action?

    1. AReduce the infusion rate, aiming for 1-2 twitches of 4, and confirm that deep sedation and analgesia are maintained
    2. BStop all sedation because paralysis alone provides comfort
    3. CDiscontinue train-of-four monitoring since paralysis is confirmed
    4. DIncrease the infusion rate to guarantee complete paralysis
    Show answer and explanation

    Correct answer: A. Reduce the infusion rate, aiming for 1-2 twitches of 4, and confirm that deep sedation and analgesia are maintained

    A train-of-four of 0 of 4 indicates excessive blockade, which prolongs recovery and increases the risk of ICU-acquired weakness; titration to 1-2 twitches provides adequate paralysis with less drug. Neuromuscular blockers provide no sedation, amnesia or analgesia, so deep sedation must always accompany them, and monitoring must continue to guide titration.

    Reference: Society of Critical Care Medicine Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient (Murray et al., Crit Care Med, 2016)

Respiratory Therapist reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Respiratory Therapist questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.