Respiratory Assessment and Airwa… PNLE Questions
Introduction
The live inventory contains 39 original PNLE-style practice questions, last updated August 12, 2026. Its questions stay within respiratory assessment, oxygen delivery, suctioning, airway adjuncts, tracheostomy, and ventilation fundamentals. They are practice material for applying nursing decisions, not actual or recalled board items.
This topic trains you to identify airway and breathing priorities, select an appropriate oxygen or airway device, perform suctioning safely, maintain a tracheostomy, respond to cuff or circuit concerns, and evaluate the patient after an intervention. The scope also includes technique for lung-expansion and nebulizer therapies when the question is about delivery rather than disease treatment.
The 2025 Enhanced TOS places respiratory care within competencies mapped across the official five-subject PNLE TOS. Respiratory Assessment and Airway Care is a Tangerine pedagogical lens, not a separate official test subject. The TOS does not assign a guaranteed weight to this microtopic, so use the inventory to build decisions and retrieval skills rather than to predict an exam form.
Key concepts
- Airway-first assessment
Recognize: Check patency, work of breathing, respiratory pattern, ability to speak, breath sounds, skin or mucosal color, and mental status together.
Decide: Address an immediately threatened airway, position for ventilation, provide oxygen according to the order or protocol, and seek assistance when the assessment shows deterioration.
Avoid: Treating one isolated finding as the whole assessment or delaying action while collecting nonessential data. - Oxygen delivery and reassessment
Recognize: Device choice depends on the prescribed oxygen need, the patient’s breathing pattern, fit, secretions, and ability to use the device correctly.
Decide: Verify the source, connections, prescribed setting, patient response, and skin protection; reassess work of breathing and mental status after changes.
Avoid: Increasing flow casually, assuming oxygen alone corrects airway obstruction, or ignoring a poorly fitting mask or displaced cannula. - Airway adjunct selection
Recognize: An oropharyngeal airway is intended for an unresponsive patient without a gag reflex. A nasopharyngeal airway may be considered when consciousness and gag reflex are present, provided there is no relevant nasal, facial, or skull-base contraindication.
Decide: Match the adjunct to consciousness, protective reflexes, anatomy, and the immediate airway problem.
Avoid: Forcing an adjunct, using an oral airway in a patient who gags, or overlooking the need for direct help when the airway remains unstable. - Indication-based suctioning
Recognize: Consider suction when secretions obstruct airflow, the patient cannot clear them effectively, or assessment shows audible or visible secretions with impaired ventilation.
Decide: Position to support breathing and secretion drainage, use the correct route and technique, apply suction during withdrawal as taught, and allow recovery between passes according to policy.
Avoid: Suctioning on a routine schedule without assessment, inserting while suction is applied, or continuing despite distress, bleeding, or worsening oxygenation. - Tracheostomy security and inner-cannula care
Recognize: The outer cannula maintains the tracheal opening, while the inner cannula may be removable depending on the device. A fresh tracheostomy requires especially careful stabilization and observation.
Decide: Follow the device-specific procedure, stabilize the tracheostomy during care, maintain a clear inner cannula when applicable, and keep emergency equipment available according to policy.
Avoid: Removing an outer cannula as if it were a routine cleaning step, pulling on the tube, or performing care without checking the patient’s airway response. - Cuff, tube, and ventilator-leak assessment
Recognize: A leak may reflect a loose connection, tube displacement, an issue with the cuff, or a change in the patient-device relationship.
Decide: Assess the patient first, then inspect tube position, connections, cuff management, and ventilator findings; report persistent problems and follow prescribed measurement or adjustment procedures.
Avoid: Repeatedly adding air to the cuff without finding the cause or treating a machine alarm before checking the patient and airway. - Ventilation fundamentals
Recognize: Ventilation means movement of air that supports carbon dioxide removal, whereas oxygenation concerns oxygen transfer. Tube position, circuit integrity, patient synchrony, and observed respiratory effort affect both assessment and support.
Decide: Link the observed finding to airway patency, tubing, positioning, or prescribed support, then verify the response after an intervention.
Avoid: Equating a normal-looking oxygen reading with adequate ventilation or changing ventilator settings outside the authorized plan. - Lung-expansion and nebulizer technique
Recognize: Incentive spirometry depends on upright positioning, a good seal, a slow deep inhalation, and coaching that matches the device instructions. Nebulizer delivery depends on correct assembly, a secure interface, and breathing that allows medication to reach the intended airway.
Decide: Correct positioning, seal, breathing pattern, and equipment setup before judging treatment effectiveness; consider aspiration risk when positioning for airway care or drainage.
Avoid: Calling a therapy ineffective before correcting technique, placing a patient in an unsafe position, or confusing delivery technique with disease-specific treatment.
What to expect on the PNLE
The supplied 39-question inventory supports several forms of respiratory-care practice: identifying the priority assessment, selecting an oxygen or airway device, arranging a procedure in the correct sequence, recognizing an unsafe finding, and evaluating the patient or equipment after an intervention. Representative scope includes tracheostomy cleaning and stabilization, suction positioning, nebulizer technique, cuff or ventilator-leak assessment, tube selection, and lung-expansion technique.
Its live difficulty distribution is easy=10, medium=11, and hard=18. The live Bloom distribution is evaluating=14, applying=11, remembering=11, and analyzing=3, so practice should include recall of equipment principles but should emphasize choosing and judging actions from clinical cues.
- Remembering: retrieve the purpose of airway components, oxygen devices, and tracheostomy parts.
- Applying: select positioning, technique, or the next nursing action for a described patient.
- Evaluating: judge whether an intervention, device setup, response, or troubleshooting step is safe.
- Analyzing: connect several findings, such as patient effort, tube position, secretions, and a leak, to the most defensible priority.
Exact topic distribution varies by exam form. Use this inventory to rehearse the reasoning demanded by respiratory care, not to infer a guaranteed number of questions for any microtopic.
Study tips
- Begin with diagnostic practice. Work through the 39 live questions before reviewing explanations. Mark each response as confident, guessed, or missed, and record the cue that changed the priority: airway patency, work of breathing, secretions, device position, or patient response.
- Use focused retrieval by decision. Study one narrow cluster at a time, such as suctioning or tracheostomy care, then answer from memory before looking at notes. Make a comparison grid you can redraw: Finding or task | First check | Safe decision | Recheck
Audible secretions | Airway and breathing effort | Position and suction if indicated | Breath sounds and response
Ventilator leak | Patient, tube, and connections | Follow the prescribed troubleshooting path | Airway stability - Review the rationale and the error. For every missed or guessed item, write why the correct action protects airway patency, oxygenation, ventilation, or safety. Label the error as a recognition problem, sequencing problem, device-selection problem, or failure to reassess.
- Retry with spacing. Return to the same decision cluster after a delay, without copying the original answer. Re-explain why a different option is less safe, especially when the choices differ by timing, positioning, suction technique, or escalation.
- Finish with mixed timed practice. Combine respiratory assessment, oxygen devices, adjuncts, suctioning, tracheostomy, and ventilation fundamentals. After timing ends, review decisions and rationales rather than relying only on the score, then schedule another spaced retry for unresolved errors.
Common mistakes to avoid
- Anchoring on a single oxygen reading. A learner may stop assessing after seeing an acceptable value. The correcting cue is the whole respiratory picture: effort, pattern, ability to speak, breath sounds, color, mental status, and trend; a patient can still have an airway or ventilation problem.
- Choosing an airway adjunct from age or convenience alone. The safety principle is to match the device to consciousness, gag reflex, anatomy, and contraindications. An oral airway can stimulate gagging, while a nasal route may be unsafe with relevant facial or skull-base injury.
- Suctioning automatically or with the wrong sequence. Suction is indicated by assessment, not simply by the presence of a tracheostomy. Position safely, use the appropriate technique, apply suction during withdrawal, monitor tolerance, and stop or escalate when the patient worsens.
- Removing or destabilizing the wrong tracheostomy component. The inner cannula and outer cannula do not have the same role. Confirm the device, stabilize the tube, and follow the specific care procedure; fresh tracheostomies require particular caution.
- Inflating a cuff repeatedly to silence a leak. A leak can come from a loose circuit, tube displacement, or a cuff problem. Assess the patient and system first, then follow prescribed cuff-management procedures rather than using added air as a blind fix.
- Using the mouth or nose as the airway after total laryngectomy. The decisive anatomy cue is that the respiratory tract is separated from the upper airway. Oxygenation and ventilation must be directed through the stoma, while assistance is obtained promptly if breathing is compromised.
Try a question
A real Respiratory Assessment and Airway Care question from our bank. Give it a shot.
A nurse is caring for a patient with a double-lumen tracheostomy tube. Which part should be removed for routine cleaning?
A double-lumen tracheostomy tube consists of two main components: the outer cannula and the inner cannula. The inner cannula is designed to be removable and cleaned regularly to maintain airway patency and reduce the risk of infection, such as tracheitis or pneumonia.
<!-- rationale-image:1052 -->
Why the Inner Cannula Should Be Removed for Cleaning:
The inner cannula is prone to accumulating secretions, mucous plugs, and crusts, which can cause airway obstruction if not regularly cleared. Routine removal and cleaning of the inner cannula help maintain airway patency and prevent respiratory complications.
Why the Other Options Are Incorrect:
| Option | Rationale |
|---|---|
| A. The outer cannula | The outer cannula stays in place to maintain the tracheostomy stoma and secure the airway. Removing it, except during a tube change, risks airway loss. Only experienced personnel, typically physicians or respiratory therapists, change the outer cannula. |
| B. The tracheostomy dressing | The dressing is changed according to protocol (at least once per shift or if wet/soiled) to keep the site clean and dry, but it is not the component specifically designed for routine removal and cleaning of the airway lumen. |
| C. The tracheostomy ties | Ties are replaced or adjusted only when necessary to secure the tube and prevent accidental dislodgement. Routine removal for cleaning may compromise airway security. |
Key Clinical Concepts:
- The double-lumen tracheostomy tube is designed for safety and maintenance. The inner cannula can be swiftly removed, cleaned, and reinserted, allowing continuous airway access.
- Regular cleaning minimizes risks of infection and obstruction.
- Nursing guidelines stress sterile or clean technique when handling the cannula to avoid introducing pathogens into the lower airway.
Clinical Pearl: Remember: "The inner cannula is IN for breathing, OUT for cleaning." This simple phrase reinforces that only the inner cannula is routinely removed for cleaning, keeping the patient’s airway safe.
- Silvestri, L. A. (2017). Saunders Comprehensive Review for the NCLEX-RN Examination (7th ed.). Elsevier.
More Respiratory Assessment and Airway Care questions
39 questions available. Sign up to practice all of them.
The nurse has completed tracheostomy care for a patient whose tracheostomy tube has a non-disposable inner cannula. The nurse reinserts the inner cannula into the tracheostomy immediately after:
The therapeutic effect of incentive spirometry depends on the:
A conscious patient requires oral suctioning but becomes more dyspneic whenever the head of the bed is lowered. The patient can maintain head control and has no suspected spinal injury. Which position best supports both ventilation and access for the procedure?
References and further reading
- PRC Enhanced Table of Specifications for the Nurses Licensure Examination official
The current public competency and cognitive-level blueprint, effective from the November 2025 NLE onward. - Tangerine Prep PNLE Reviewer question bank
The live source for the published question count, question previews, rationales, and inventory distributions on this page.
How this page is built
The counts and distributions on this page come from Tangerine Prep's live published question bank. The source inventory was last updated on August 12, 2026.
The questions are original PNLE-style practice items, not recalled or leaked board questions. Topic scope follows Tangerine's pedagogical taxonomy and is mapped to the PRC 2025 Enhanced Table of Specifications, effective from the November 2025 NLE onward. Exact topic distribution varies by exam form.