NORCET 11 • NURSING OFFICER • CLINICAL SCENARIOS
Respiratory System – 30 Clinical Scenario-Based MCQs
AIIMS-style Nursing Priority & Emergency Care questions covering airway management, oxygen therapy, ABG, mechanical ventilation, chest tube care, COPD, asthma, pneumonia and respiratory emergencies.
🫁 30 MCQs
🚨 Emergency Nursing
🩺 Clinical Scenarios
💨 Oxygen Therapy
🫁 Ventilator Care
🧪 ABG
🩹 Chest Tube
🎯 NORCET Mains
How to attempt this post:
Read each clinical situation carefully and decide what the nurse should do first, what intervention has the highest priority, or which finding requires immediate action.
Important: These are original AIIMS-style clinical practice questions designed around the case-scenario orientation of NORCET Mains. They are not claimed to be actual recalled AIIMS questions.
Read each clinical situation carefully and decide what the nurse should do first, what intervention has the highest priority, or which finding requires immediate action.
Important: These are original AIIMS-style clinical practice questions designed around the case-scenario orientation of NORCET Mains. They are not claimed to be actual recalled AIIMS questions.
🫁 RESPIRATORY SYSTEM — 30 CLINICAL SCENARIO MCQs
Q1
A patient with acute severe asthma suddenly becomes drowsy. His SpO₂ is 84%, respiratory effort is decreasing and air entry is markedly reduced bilaterally. What should the nurse recognize as the priority?
A) Improvement because wheezing has decreased
B) Impending respiratory failure
C) Anxiety attack
D) Mild bronchospasm
✅ Show Answer & Nursing Rationale
Correct Answer: B) Impending respiratory failure
A suddenly quiet chest in a patient with severe asthma, especially with
drowsiness, hypoxemia and reduced respiratory effort, is a dangerous sign.
It may indicate severe airflow obstruction with impending respiratory failure.
👩⚕️ Nursing Priority: Activate emergency response, maintain airway,
administer prescribed oxygen/bronchodilator therapy and prepare for
advanced airway management.
Q2
A COPD patient receiving oxygen has SpO₂ 99%, becomes increasingly drowsy and develops shallow breathing. What is the nurse's priority?
A) Increase oxygen flow further
B) Assess ventilation and obtain ABG as prescribed
C) Give oral fluids
D) Encourage the patient to sleep
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess ventilation and obtain ABG as prescribed
The combination of excessive oxygenation, drowsiness and hypoventilation
raises concern for carbon-dioxide retention in a susceptible COPD patient.
ABG helps assess PaCO₂, PaO₂ and acid-base status.
👩⚕️ Nursing Priority: Assess airway and breathing, monitor SpO₂ and
clinical status, and promptly communicate deterioration.
Q3
A patient suddenly develops severe dyspnea, hypotension, distended neck veins and absent breath sounds on the right side after central venous catheter insertion. What should the nurse suspect?
A) Pulmonary edema
B) Tension pneumothorax
C) Pneumonia
D) Pleural effusion
✅ Show Answer & Nursing Rationale
Correct Answer: B) Tension pneumothorax
Sudden respiratory distress, unilateral absent breath sounds and
hemodynamic compromise after an invasive procedure are highly concerning
for tension pneumothorax.
🚨 Emergency: This is a life-threatening condition requiring immediate
medical intervention; do not delay emergency management while waiting
for routine investigations.
Q4
A patient with a chest tube suddenly has severe dyspnea and the water-seal chamber shows no fluctuation. What should the nurse do first?
A) Clamp the tube immediately
B) Assess the tubing for kinks or obstruction
C) Remove the chest tube
D) Increase suction to maximum
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess the tubing for kinks or obstruction
Sudden absence of expected water-seal fluctuation with clinical deterioration
requires assessment of the drainage system and tubing for kinking,
compression or obstruction.
👩⚕️ Nursing Priority: Maintain a patent drainage system and immediately
assess the patient for respiratory deterioration.
Q5
A patient with a chest tube is accidentally disconnected from the drainage system. What should the nurse do immediately?
A) Leave the tube open to air
B) Reconnect the system using aseptic technique
C) Permanently clamp the tube
D) Remove the tube
✅ Show Answer & Nursing Rationale
Correct Answer: B) Reconnect the system using aseptic technique
A chest drainage system should remain a closed system. Accidental
disconnection can compromise the water seal and allow air entry.
👩⚕️ Nursing Priority: Restore the closed drainage system promptly and
assess the patient for respiratory compromise.
Q6
A patient with acute pulmonary edema is extremely breathless, has crackles and pink frothy sputum. Which position should the nurse use initially?
A) Flat supine
B) High Fowler's position
C) Trendelenburg
D) Prone position
✅ Show Answer & Nursing Rationale
Correct Answer: B) High Fowler's position
Upright positioning improves lung expansion and can reduce venous return,
helping relieve pulmonary congestion and work of breathing.
👩⚕️ Nursing Priority: Position upright, provide prescribed oxygen/positive
pressure support and continuously reassess respiratory status.
Q7
A patient on a non-rebreather mask has SpO₂ 78% despite oxygen therapy and is becoming exhausted. What should the nurse do?
A) Reassure and continue observation
B) Escalate immediately for advanced respiratory support
C) Remove oxygen
D) Give oral fluids
✅ Show Answer & Nursing Rationale
Correct Answer: B) Escalate immediately for advanced respiratory support
Persistent severe hypoxemia despite high-concentration oxygen with
respiratory exhaustion suggests impending respiratory failure.
🚨 Nursing Priority: Activate emergency response and prepare for
advanced airway/ventilatory support.
Q8
ABG shows pH 7.25, PaCO₂ 60 mmHg and HCO₃⁻ 25 mEq/L. How should the nurse interpret this?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
✅ Show Answer & Nursing Rationale
Correct Answer: A) Respiratory acidosis
Low pH indicates acidemia. Elevated PaCO₂ indicates respiratory retention
of carbon dioxide. HCO₃⁻ is not significantly elevated, suggesting an
acute respiratory acidosis pattern.
Q9
ABG of a patient with severe hyperventilation shows pH 7.52, PaCO₂ 28 mmHg and HCO₃⁻ 23 mEq/L. What is the interpretation?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
✅ Show Answer & Nursing Rationale
Correct Answer: B) Respiratory alkalosis
The pH is high and PaCO₂ is low, indicating excessive elimination of CO₂
due to hyperventilation.
Q10
A ventilated patient suddenly has a high-pressure alarm. The nurse finds the patient biting the endotracheal tube. What is the most likely cause?
A) Increased airway resistance
B) Low oxygen concentration
C) Circuit disconnection
D) Low tidal volume setting
✅ Show Answer & Nursing Rationale
Correct Answer: A) Increased airway resistance
Biting the endotracheal tube can obstruct airflow and increase airway
resistance, producing a high-pressure alarm.
👩⚕️ Nursing Approach: Assess the patient first, check tube patency,
secretions, biting, bronchospasm and circuit problems.
Q11
A mechanically ventilated patient develops a low-pressure alarm. Which problem should the nurse suspect first?
A) Circuit disconnection or leak
B) Thick secretions
C) Bronchospasm
D) Patient biting the tube
✅ Show Answer & Nursing Rationale
Correct Answer: A) Circuit disconnection or leak
A low-pressure alarm commonly indicates loss of pressure from circuit
disconnection, cuff leak or another system leak.
👩⚕️ Nursing Priority: Immediately assess the patient and ventilator
connections rather than silencing the alarm without finding the cause.
Q12
A patient with a tracheostomy has noisy breathing, falling SpO₂ and visible thick secretions. What should the nurse do first?
A) Offer oral food
B) Assess airway patency and suction as indicated
C) Place the patient flat
D) Remove the tracheostomy tube
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess airway patency and suction as indicated
Noisy breathing, hypoxemia and visible secretions suggest airway
obstruction. Suctioning may be required when clinically indicated.
🚨 Always assess oxygenation and airway patency immediately in a deteriorating
tracheostomy patient.
Q13
A patient develops sudden dyspnea, pleuritic chest pain and tachycardia after prolonged immobilization. Which condition should the nurse suspect?
A) Pulmonary embolism
B) Chronic bronchitis
C) Pleural effusion
D) Stable asthma
✅ Show Answer & Nursing Rationale
Correct Answer: A) Pulmonary embolism
Sudden unexplained dyspnea, pleuritic chest pain and tachycardia in a
patient with a risk factor such as prolonged immobilization should raise
concern for pulmonary embolism.
👩⚕️ Nursing Priority: Assess ABCs, provide prescribed oxygen and urgently
notify the clinical team.
Q14
A patient with suspected pulmonary embolism suddenly becomes hypotensive and confused. What is the nurse's immediate priority?
A) Ask about dietary history
B) Assess airway, breathing and circulation
C) Encourage ambulation
D) Give oral fluids
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess airway, breathing and circulation
Hypotension and altered mental status indicate possible hemodynamic
instability. ABC assessment and emergency escalation take priority.
Q15
A patient with pneumonia has SpO₂ 86%, RR 32/min and increasing work of breathing. Which nursing action should be prioritized?
A) Delay oxygen until chest X-ray
B) Initiate prescribed oxygen and reassess response
C) Encourage sleep
D) Give a large meal
✅ Show Answer & Nursing Rationale
Correct Answer: B) Initiate prescribed oxygen and reassess response
The patient has significant hypoxemia and respiratory distress.
Oxygenation and breathing are immediate priorities while definitive
diagnosis and treatment continue.
Q16
A patient with suspected pulmonary tuberculosis is admitted. Which infection-control precaution is most appropriate?
A) Contact precautions only
B) Droplet precautions only
C) Airborne precautions
D) No precautions
✅ Show Answer & Nursing Rationale
Correct Answer: C) Airborne precautions
Suspected infectious pulmonary tuberculosis requires airborne infection
control measures, including appropriate respiratory protection and
appropriate patient placement according to institutional policy.
Q17
A patient with COPD is prescribed pursed-lip breathing. What is the main purpose?
A) Increase airway collapse
B) Prolong expiration and reduce air trapping
C) Stop oxygen absorption
D) Increase respiratory rate
✅ Show Answer & Nursing Rationale
Correct Answer: B) Prolong expiration and reduce air trapping
Pursed-lip breathing creates mild positive pressure during expiration,
helping keep small airways open and improve emptying of trapped air.
Q18
A postoperative patient has shallow breathing because of pain and is at risk of atelectasis. Which nursing intervention is most appropriate?
A) Encourage deep breathing and incentive spirometry
B) Keep the patient continuously supine
C) Restrict all movement
D) Avoid coughing
✅ Show Answer & Nursing Rationale
Correct Answer: A) Encourage deep breathing and incentive spirometry
Deep breathing, coughing and incentive spirometry help improve lung
expansion and reduce postoperative atelectasis risk.
Q19
A patient has just undergone bronchoscopy. Which finding requires immediate nursing attention?
A) Mild throat discomfort
B) Temporary hoarseness
C) Increasing respiratory distress and falling SpO₂
D) Mild cough
✅ Show Answer & Nursing Rationale
Correct Answer: C) Increasing respiratory distress and falling SpO₂
Respiratory distress and hypoxemia after bronchoscopy can indicate a serious
complication and require immediate assessment.
🚨 Airway and oxygenation take priority over expected minor throat symptoms.
Q20
A patient with acute respiratory distress is unable to speak full sentences and has accessory muscle use. Which assessment is most important?
A) Hair condition
B) Airway patency and work of breathing
C) Appetite
D) Sleep pattern
✅ Show Answer & Nursing Rationale
Correct Answer: B) Airway patency and work of breathing
In acute respiratory distress, airway and breathing assessment is the
immediate priority. Accessory muscle use and inability to speak full
sentences suggest significant respiratory compromise.
Q21
A patient on a Venturi mask requires a precise oxygen concentration. Why is this device useful?
A) It delivers an accurately controlled FiO₂
B) It always delivers 100% oxygen
C) It is used only for unconscious patients
D) It eliminates the need for monitoring
✅ Show Answer & Nursing Rationale
Correct Answer: A) It delivers an accurately controlled FiO₂
Venturi systems use air-entrainment principles to provide a controlled
oxygen concentration, making them useful when precise FiO₂ delivery is
important.
Q22
A patient receiving oxygen by nasal cannula complains of dryness and nasal irritation. Which nursing intervention is appropriate?
A) Remove oxygen permanently
B) Assess the prescribed flow and provide appropriate humidification when indicated
C) Increase oxygen flow without order
D) Apply oil-based petroleum products inside the nose
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess the prescribed flow and provide appropriate humidification when indicated
Nasal mucosal dryness can occur with oxygen therapy. Humidification may
be appropriate depending on the flow, device and institutional protocol.
Oil-based products should generally be avoided around oxygen equipment
because of fire risk.
Q23
A mechanically ventilated patient has copious secretions and coarse breath sounds. What should the nurse do?
A) Ignore because secretions are expected
B) Assess the patient and suction when clinically indicated
C) Disconnect the ventilator permanently
D) Stop all humidification
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess the patient and suction when clinically indicated
Accumulated secretions can increase airway resistance and impair
ventilation. Suctioning should be based on clinical indications and
performed using appropriate technique.
Q24
A patient with ARDS continues to have severe hypoxemia despite high oxygen concentrations. Which ventilatory strategy is commonly used to improve oxygenation while limiting ventilator-induced lung injury?
A) High tidal volumes for every patient
B) Lung-protective ventilation with low tidal volumes
C) Avoid PEEP completely
D) Stop mechanical ventilation
✅ Show Answer & Nursing Rationale
Correct Answer: B) Lung-protective ventilation with low tidal volumes
ARDS management commonly uses lung-protective mechanical ventilation with
lower tidal volumes based on predicted body weight and appropriate PEEP,
along with other strategies according to severity.
Q25
A patient being weaned from mechanical ventilation develops RR 38/min, diaphoresis, agitation and falling SpO₂. What should the nurse do?
A) Continue weaning regardless of symptoms
B) Recognize possible weaning intolerance and notify the clinical team
C) Remove the airway immediately
D) Give oral food
✅ Show Answer & Nursing Rationale
Correct Answer: B) Recognize possible weaning intolerance and notify the clinical team
Tachypnea, diaphoresis, agitation and worsening oxygenation suggest poor
tolerance of spontaneous breathing and require reassessment.
👩⚕️ Nursing Priority: Stop or modify the trial according to protocol,
support oxygenation and promptly communicate deterioration.
Q26
A patient with suspected bacterial pneumonia has fever, productive cough and increasing confusion. Which finding is most concerning for deterioration?
A) Mild cough
B) New confusion with hypotension
C) Appetite improvement
D) Mild fatigue
✅ Show Answer & Nursing Rationale
Correct Answer: B) New confusion with hypotension
New altered mental status and hypotension may indicate systemic
deterioration and possible sepsis or shock. Immediate assessment and
escalation are required.
Q27
A patient with severe asthma receives a nebulized bronchodilator. Which finding indicates that the treatment is having the desired effect?
A) Increased work of breathing
B) Improved air entry and reduced respiratory distress
C) Falling SpO₂
D) Increasing drowsiness
✅ Show Answer & Nursing Rationale
Correct Answer: B) Improved air entry and reduced respiratory distress
Improved airflow, reduced wheezing/respiratory effort and improved
oxygenation indicate clinical response to bronchodilator treatment.
Q28
A patient with a chest tube has continuous bubbling in the water-seal chamber. What should the nurse suspect?
A) Possible air leak
B) Normal finding in every patient
C) Immediate tube removal
D) Fluid overload
✅ Show Answer & Nursing Rationale
Correct Answer: A) Possible air leak
Continuous bubbling in the water-seal chamber can indicate an air leak
from the patient or drainage system. The system should be assessed
systematically to identify the source.
👩⚕️ Never routinely clamp a chest tube just to stop bubbling; assess the
system and follow institutional protocol.
Q29
A patient suddenly develops stridor after extubation. What should the nurse recognize?
A) Possible upper-airway obstruction
B) Normal recovery finding
C) Improved airway patency
D) Simple gastric discomfort
✅ Show Answer & Nursing Rationale
Correct Answer: A) Possible upper-airway obstruction
Stridor is a high-pitched sound associated with upper-airway narrowing.
After extubation it may indicate significant airway edema or obstruction.
🚨 Airway emergency: Immediately assess airway and oxygenation and
escalate for urgent airway support.
Q30
A patient arrives in the emergency department with severe respiratory distress, cyanosis, RR 36/min and SpO₂ 72%. Which nursing action takes priority?
A) Complete the detailed past history first
B) Assess and support airway and breathing immediately
C) Wait for the chest X-ray
D) Give oral medication first
✅ Show Answer & Nursing Rationale
Correct Answer: B) Assess and support airway and breathing immediately
The patient has severe hypoxemia and respiratory distress. In an emergency,
the nurse follows the ABC approach: airway and breathing must be assessed
and supported immediately while further diagnosis proceeds.
🚨 NORCET Clinical Priority:
Do not delay life-saving airway and breathing interventions for routine
history, documentation or investigations.
🔥 Respiratory System — NORCET Quick Revision
- Severe asthma: Silent/quiet chest + exhaustion + altered consciousness = possible impending respiratory failure.
- COPD: Always assess the complete respiratory picture; SpO₂ alone does not assess ventilation.
- ABG: PaCO₂ reflects the respiratory component; HCO₃⁻ reflects the metabolic component.
- High-pressure ventilator alarm: Think obstruction, secretions, bronchospasm, biting or reduced lung compliance.
- Low-pressure alarm: Think disconnection or leak.
- Chest tube: Keep the drainage system closed and patent; assess sudden changes in bubbling, drainage and respiratory status.
- Pulmonary embolism: Sudden dyspnea + pleuritic chest pain + tachycardia should raise suspicion.
- TB: Airborne precautions are required for suspected infectious pulmonary TB.
- Stridor: Think upper-airway obstruction and assess urgently.
- ARDS: Lung-protective ventilation is a key component of mechanical ventilation management.
- Emergency rule: In severe respiratory distress, prioritize Airway → Breathing → Circulation.
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❓ Frequently Asked Questions
Are these actual NORCET 11 recalled questions?
No. These are original clinical scenario-based practice questions created for NORCET preparation. They are designed around the case-scenario and nursing-skills orientation described for NORCET Mains and are not presented as leaked or recalled AIIMS questions.
Why are respiratory emergency scenarios important for Nursing Officer exams?
Respiratory emergencies require rapid assessment, prioritization, oxygenation, airway management, monitoring and escalation. Therefore, clinical-scenario questions can test both knowledge and nursing decision-making.
Which respiratory topics should I revise for NORCET?
Important areas include asthma, COPD, pneumonia, pulmonary embolism, pneumothorax, chest tube care, tracheostomy, oxygen therapy, ABG, mechanical ventilation, ventilator alarms, ARDS, suctioning and postoperative respiratory complications.
What is the most important approach in a respiratory emergency?
Start with rapid assessment of airway and breathing, evaluate oxygenation and ventilation, provide appropriate immediate support within nursing scope, and escalate promptly when the patient is deteriorating.
Are these questions suitable for AIIMS Nursing Officer preparation?
They are designed as AIIMS-style clinical practice questions emphasizing clinical prioritization, patient safety and nursing interventions. They should be used along with standard nursing textbooks, current institutional protocols and official examination information.
What is the difference between a high-pressure and low-pressure ventilator alarm?
A high-pressure alarm commonly suggests increased resistance or reduced compliance, whereas a low-pressure alarm commonly suggests a leak or disconnection. The nurse should always assess the patient first and then check the ventilator system.
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NORCET • AIIMS • Nursing Officer • Clinical Scenario Practice
Learn • Practice • Succeed
NORCET • AIIMS • Nursing Officer • Clinical Scenario Practice
Learn • Practice • Succeed