PCCN respiratory review: the 14% you can win back fastest
Respiratory is 14% of the PCCN, about 17 or 18 of the 125 scored questions, the biggest single organ system after the heart. Four patterns carry most of it: blood gases with oxygen support, COPD and asthma, pulmonary embolism, and chest tubes. The whole exam is Clinical Judgment 80% and Professional Caring and Ethical Practice 20%, and the pass line is 82 of the 125 scored questions.
The American Association of Critical-Care Nurses test plan for exams taken on or after February 6, 2024 puts respiratory inside Clinical Judgment at 14% of the exam, third of the 12 test-plan areas behind cardiovascular (20%) and multisystem (15%). AACN lists the conditions under it but gives no count per condition, so the yield column below is our ranking: how often a topic drives a priority question in published sample items and in our own bank.
Topic
What gets asked
Yield
Acute and chronic respiratory failure, respiratory depression, failure to wean
Reading the blood gas, when oxygen or NIV is failing, opioid-related hypoventilation
High
COPD exacerbation and severe asthma
Oxygen targets, NIV, bronchodilators and steroids, the signs of a patient tiring
High
Pulmonary embolism
Recognition, the first anticoagulant, when to escalate past heparin
Reading a chest drainage system; tension pneumothorax
High
Pneumonia, including aspiration
Prevention, pneumonitis versus pneumonia, the sepsis overlap
Medium
Thoracic surgery, including VATS
Air leaks, drainage, pain control that lets the patient cough
Medium
ARDS
Who meets the newer definition, oxygenation, positioning
Medium
Sleep apnea, obstructive and central
CPAP after surgery, opioid and sedative risk
Medium
Pulmonary hypertension
The infusion that must never stop; what strains the right ventricle
Lower
Pulmonary fibrosis, sarcoidosis
Restrictive disease and exertional desaturation
Lower
Topic names are paraphrased from AACN's test plan. AACN publishes area weights only; the yield column is our judgment, not an item count.
The equipment is progressive care equipment: nasal cannula, Venturi and non-rebreather masks, high-flow nasal oxygen, CPAP and BiPAP, end-tidal CO2, tracheostomies, chest tubes, prone positioning, and stable or home ventilators. Expect a question to be set at the bedside of any of them.
Triage
Rank the topics before you study them
1First
Blood gases with oxygen and NIV, COPD and asthma, and pulmonary embolism. They come up on every step-down shift and they leak into other areas: sepsis gases into multisystem (15%), PE and right heart strain into cardiovascular (20%). Work them until the first action comes without looking.
2Next
Chest tubes and the pleural space, thoracic surgery, pneumonia and aspiration, sleep apnea and opioid respiratory depression. Each is a short pattern: three findings that give it away and one action that comes first.
3Last
ARDS ventilator numbers, pulmonary hypertension drug classes, fibrosis and sarcoidosis. One defining fact each is enough. Read the last table on this page in your final week, then let them go.
Gas, airway, clot, tube: four patterns carry most of the respiratory points.
ABG
Blood gases in five steps
Nearly every respiratory vignette hands you a gas, and the same five steps read all of them. Go in order; most wrong answers come from jumping to compensation before naming the primary problem.
1Read the pH
Below 7.35 is acidemia, above 7.45 is alkalemia. A pH inside the range is either normal or fully compensated, and the next two values tell you which.
2Match the PaCO2
Normal is 35 to 45 mm Hg. If it moves opposite to the pH (high CO2, low pH), the primary problem is respiratory.
3Match the bicarbonate
Normal HCO3 is 22 to 26 mEq/L. If it moves the same way as the pH (low bicarbonate, low pH), the primary problem is metabolic.
4Look for compensation
The other value moves to pull the pH back. pH still abnormal: partial. pH normal: full, and it sits on the side of the primary problem. Lungs compensate within minutes to hours, kidneys over days.
5Then the oxygen
PaO2 is normally 80 to 100 mm Hg on room air. Below 60 mm Hg is hypoxemic respiratory failure, and an SpO2 of 90% sits at roughly that PaO2, at the edge of the steep part of the curve.
Gas pattern
The vignette it usually comes with
Acute respiratory acidosis: low pH, high PaCO2, normal HCO3
Opioid oversedation, an asthmatic who is tiring, a COPD exacerbation on top of baseline retention
Compensated respiratory acidosis: pH low-normal, high PaCO2, high HCO3
Stable chronic CO2 retention in COPD; this is the patient's normal, not an emergency
Respiratory alkalosis: high pH, low PaCO2
Anxiety, pain, early PE, the first hours of an asthma attack
Metabolic acidosis: low pH, low HCO3, PaCO2 falling to compensate
DKA, lactic acidosis in sepsis or shock, kidney failure
Metabolic alkalosis: high pH, high HCO3
Vomiting, NG suction, loop diuretics, low potassium
O2
Oxygen, high-flow and NIV
Oxygen questions ask two things: which device fits the patient, and when support is failing. The device answer follows the problem. Low oxygen needs FiO2 or flow; high CO2 needs ventilation, which only pressure support adds.
Device
What it delivers
When it is the answer, and the catch
Nasal cannula
1 to 6 L/min, a variable FiO2
Mild hypoxemia; the FiO2 shifts with the patient's breathing pattern
Venturi mask
A fixed FiO2 set by the adapter
When an exact FiO2 matters, such as a COPD patient being titrated to 88% to 92%
Non-rebreather mask
10 to 15 L/min, the reservoir bag kept inflated
A short bridge for severe hypoxemia; if the bag collapses on inspiration, the flow is too low
High-flow nasal oxygen
Heated, humidified flow up to 60 L/min, FiO2 up to 100%
Hypoxemic failure: flushes dead space and adds a little PEEP; the patient can still talk and eat
CPAP
One continuous pressure
Obstructive sleep apnea and cardiogenic pulmonary edema; it splints airways and alveoli open
BiPAP
A higher inspiratory and a lower expiratory pressure
Hypercapnic failure, above all COPD: the pressure difference moves air and clears CO2
Airways
COPD exacerbation or severe asthma
Both are obstructive and both wheeze, but the exam separates them on three points: the oxygen target, what the CO2 means, and what comes after the bronchodilator.
COPD exacerbation
Severe asthma attack
Oxygen target
SpO2 88% to 92% (GOLD)
SpO2 93% to 95% in adults (GINA)
What the CO2 tells you
pH 7.35 or lower with PaCO2 45 mm Hg or higher: NIV is first-line
Early on the PaCO2 is low. A normal or rising PaCO2 in a breathless patient means they are tiring
First drugs
Short-acting bronchodilators (albuterol, with or without ipratropium); prednisone 40 mg daily for 5 days
Repeated albuterol, ipratropium, early systemic corticosteroids; IV magnesium when the attack does not respond
Antibiotics
When sputum turns purulent along with more breathlessness or more sputum, or when ventilatory support is needed
Not routine
The danger sign
New drowsiness or confusion: CO2 narcosis
A silent chest, single words instead of sentences, drowsiness
Severe asthma wheezes on expiration. When the wheeze fades without improvement, air is not moving: that is the silent chest, and it needs escalation, not reassurance.
PE
Pulmonary embolism: spot it, then climb the ladder
A PE vignette is a sudden change: dyspnea, tachycardia, pleuritic pain and a falling SpO2 with clear lungs, often after surgery, immobility, cancer or a known DVT. The early gas usually shows a low PaCO2. JVD, hypotension and a dilated right ventricle mean the clot is straining the right heart.
Situation
What the exam expects
Suspected PE, low clinical probability
A D-dimer to rule it out. A negative result makes PE unlikely; a positive one proves nothing
Suspected PE, high probability
CT pulmonary angiography, or a V/Q scan when contrast is a problem; anticoagulation starts while you wait if bleeding risk allows
Confirmed PE, stable
Anticoagulation: LMWH over unfractionated heparin, which is kept for patients who may need thrombolysis or a procedure or have severe kidney failure; then a DOAC over warfarin
An IVC filter, with anticoagulation restarted once the bleeding is controlled
Newer AHA/ACC guidance replaces the words massive and submassive with lettered risk categories, and questions may use either. The management is what gets tested, and it has not moved: anticoagulate, and add reperfusion when the right ventricle is failing.
Tubes
Chest tubes and the pleural space
What you see
What it means
What you do
Tidaling in the water seal
Normal: the level rises on inspiration and falls on expiration (reversed on a ventilator)
Document it
Bubbling in the water seal on coughing or exhaling only
A small air leak from the lung, expected after a pneumothorax or lung resection
Monitor it and record whether it is shrinking
Continuous bubbling in the water seal
An air leak in the patient or the system
Check the insertion site and every connection from the chest down; report a leak you cannot find
No tidaling
The lung has re-expanded, or the tube is blocked
Tell them apart: equal breath sounds and a good SpO2 mean re-expansion; new dyspnea means look for kinks, clots and dependent loops
Tubing disconnected
An open system
Put the tube end about 2 cm under sterile water, or connect a new unit; do not clamp
Tube pulled out of the chest
An open chest wound
Cover the site with a sterile dressing, call the provider, watch for tension
The pleural space in one line each
Problem
What gives it away
What comes first
Tension pneumothorax
Hypotension, distended neck veins, absent breath sounds on one side, rising airway pressures; tracheal shift is a late sign
Needle decompression without waiting for an X-ray (4th or 5th intercostal space at the anterior to midaxillary line, or 2nd at the midclavicular line), then a chest tube
Simple pneumothorax
Sudden pleuritic pain, dyspnea, reduced breath sounds on one side
Oxygen; observation or a chest tube depending on size and symptoms
Pleural effusion
Dullness and reduced breath sounds at the base
Thoracentesis; afterwards watch for pneumothorax and for re-expansion edema after a large drain
Hemothorax
Dullness with signs of blood loss after trauma or surgery
Chest tube; a large or steady hourly output goes to the surgeon
Empyema
Infected pleural fluid; fever that persists despite antibiotics
Drainage plus antibiotics
Test
12 PCCN respiratory questions
12 items from area 2A, written to the current test plan: pulmonary embolism, chest drainage after thoracic surgery, asthma versus COPD, sleep apnea, pulmonary fibrosis, the oxyhemoglobin curve, aspiration on the unit, BiPAP in a COPD exacerbation and a home ventilator on a tracheostomy. They are practice items, not exam questions. When you finish, the 60-question practice test mixes respiratory with the other 11 areas at exam weight.
Item 1 of 12
0 answered · 0 right
Item 01 Respiratory (2A)
A patient with a confirmed PE develops BP 72/44, JVD, and right ventricular dilation on echo despite a 500 mL fluid bolus and norepinephrine. No contraindications to bleeding exist. The nurse should prepare for
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, A: systemic thrombolysis
Persistent hypotension from PE is obstructive shock, and reperfusion with systemic thrombolysis (or catheter or surgical embolectomy) is needed to unload the right ventricle. An IVC filter prevents new emboli but does not remove the clot already causing shock. Heparin alone prevents propagation but acts too slowly, and more fluid overdistends the failing right ventricle.
Your pick, B: More fluid overdistends a right ventricle that is already failing.
Your pick, C: A filter prevents new emboli but does not remove the clot causing the shock.
Your pick, D: Heparin stops propagation but acts too slowly to unload the failing right ventricle.
Item 02 Respiratory (2A)
A patient with a new proximal DVT and a small PE develops a major upper GI bleed requiring transfusion. Anticoagulation has been stopped. Which intervention should the nurse anticipate to prevent further emboli?
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, D: an inferior vena cava filter
An inferior vena cava filter is indicated when a patient with acute proximal DVT or PE cannot receive anticoagulation because of active bleeding; anticoagulation is resumed once the bleeding is controlled. Reduced-dose enoxaparin and aspirin still add bleeding risk and do not adequately prevent PE. Thrombolysis is contraindicated with active bleeding.
Your pick, A: Thrombolysis is contraindicated during active bleeding.
Your pick, B: Any dose of enoxaparin adds bleeding risk during an active major bleed.
Your pick, C: Aspirin does not adequately prevent PE and still adds bleeding risk.
Item 03 Respiratory (2A)
On postoperative day 1 after a lobectomy, a patient's chest drainage system shows intermittent bubbling in the water seal chamber only during coughing. Breath sounds are present on the operative side and SpO2 is 95%. The nurse recognizes
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, C: an expected small air leak from the resection
Intermittent bubbling with coughing after lung resection reflects a small leak from the staple line that usually seals within days; the nurse monitors and documents it. A disconnection causes continuous bubbling and an open system. Tension pneumothorax causes hemodynamic compromise and absent breath sounds. Bubbling shows the tube is patent, and stripping is not routine.
Your pick, A: A disconnection causes continuous bubbling, not bubbling only on coughing.
Your pick, B: Bubbling shows the tube is patent, and stripping is not routine.
Your pick, D: A tension pneumothorax would cause hemodynamic compromise and absent breath sounds.
Item 04 Respiratory (2A)
After a thoracotomy, a patient's chest tube drainage abruptly stops and the water seal no longer tidals. SpO2 has fallen from 95% to 90%, and breath sounds are diminished on the operative side. The nurse's FIRST action should be to
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, D: check the tubing for kinks and clots
Sudden loss of drainage and tidaling with worsening oxygenation suggests the tube or tubing is obstructed, so the tubing should be checked for kinks, clots, or dependent loops first. Routine stripping produces very high negative pressure and is not recommended. Clamping can turn a pneumothorax into a tension pneumothorax. Increasing suction beyond the ordered level does not fix a kinked tube and can injure tissue.
Your pick, A: Raising suction does not clear a kink and can injure tissue.
Your pick, B: Stripping creates very high negative pressure and is not recommended.
Your pick, C: Clamping can turn a pneumothorax into a tension pneumothorax.
Item 05 Respiratory (2A)
Three days after chest tube insertion for a pneumothorax, tidaling in the water seal chamber has stopped. Breath sounds are equal bilaterally and SpO2 is 97% on room air. The MOST likely explanation is that
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, D: the lung has re-expanded
Tidaling stops when the lung fully re-expands and pleural pressure changes no longer transmit to the water seal; equal breath sounds and normal SpO2 confirm this. An obstructed tube also stops tidaling but would be accompanied by recurring dyspnea or decreased breath sounds. A new air leak causes bubbling in the water seal, not loss of tidaling. The suction setting does not create or abolish tidaling.
Your pick, A: An obstructed tube would come with dyspnea or diminished breath sounds.
Your pick, B: A new air leak causes bubbling in the water seal, not loss of tidaling.
Your pick, C: The suction setting does not create or abolish tidaling.
Item 06 Respiratory (2A)
Which finding MOST supports a diagnosis of asthma rather than COPD?
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, A: FEV1 improves 25% after a bronchodilator
Marked reversibility of airflow obstruction after a bronchodilator (at least 12% and 200 mL, here 25%) is characteristic of asthma. Onset later in life with a smoking history favors COPD. A persistent post-bronchodilator FEV1/FVC below 0.70 defines COPD. A chronic productive cough is typical of chronic bronchitis.
Your pick, B: Onset after 60 in a smoker favors COPD.
Your pick, C: A post-bronchodilator FEV1/FVC below 0.70 is the defining finding of COPD.
Your pick, D: A chronic daily productive cough is typical of chronic bronchitis.
Item 07 Respiratory (2A)
A patient with obstructive sleep apnea newly started on nasal CPAP reports waking with a very dry mouth, and the device reports a large leak from the mouth. The nurse's BEST action is to suggest
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, C: a full-face mask with heated humidification
Mouth breathing with nasal CPAP causes a leak and dry mouth, so a full-face mask (or chin strap) with heated humidification restores effective pressure and comfort. Overtightening causes skin breakdown and does not stop a mouth leak. Lowering pressure below the prescribed level leaves the airway obstructed. Partial-night use leaves apneas untreated.
Your pick, A: Overtightening causes skin breakdown and does not stop air escaping through the mouth.
Your pick, B: Using CPAP for half the night leaves the rest of the apneas untreated.
Your pick, D: 3 cm H2O is below the prescribed pressure and leaves the airway obstructed.
Item 08 Respiratory (2A)
A patient with idiopathic pulmonary fibrosis has SpO2 94% on 2 L nasal cannula at rest, which falls to 84% while walking to the bathroom. The nurse should anticipate
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, B: increasing oxygen flow during activity
In pulmonary fibrosis the thickened interstitium limits diffusion, and desaturation worsens with exertion as capillary transit time shortens, so oxygen is titrated upward during activity. Bed rest causes deconditioning and is not the answer to exertional hypoxemia. Bronchodilators do not treat a restrictive diffusion defect. CO2 retention is uncommon in pulmonary fibrosis, and lowering oxygen would worsen hypoxemia.
Your pick, A: Bronchodilators do not treat a restrictive diffusion defect.
Your pick, C: Bed rest causes deconditioning and does not fix exertional hypoxemia.
Your pick, D: CO2 retention is uncommon in pulmonary fibrosis, and less oxygen would worsen hypoxemia.
Item 09 Respiratory (2A)
A patient with septic shock has a temperature of 39.5 °C and an arterial pH of 7.25. How do these conditions affect the oxyhemoglobin dissociation curve?
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, C: shift it right, releasing more O2 to tissues
Fever and acidosis (along with increased CO2 and 2,3-DPG) shift the curve to the right, reducing hemoglobin's affinity for oxygen and unloading more oxygen at the tissues. A left shift, caused by alkalosis and hypothermia, increases affinity and reduces unloading. A right shift decreases, not increases, oxygen binding. The curve's position depends on these factors regardless of PaO2.
Your pick, A: A left shift increases affinity and reduces oxygen unloading.
Your pick, B: Temperature and pH move the curve whatever the PaO2 is.
Your pick, D: A right shift loosens oxygen binding; it does not tighten it.
Item 10 Respiratory (2A)
A patient vomits and is witnessed aspirating gastric contents. After oral suctioning, SpO2 is 92% on 2 L/min, RR 24, temperature 37.0 °C, and lung sounds reveal right basilar crackles. The nurse should anticipate
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, A: supportive care and monitoring
Aspiration of sterile gastric contents causes a chemical pneumonitis, which is treated with airway clearance, oxygen and monitoring; antibiotics are started only if signs of infection persist or develop, or in specific high-risk situations such as bowel obstruction. Corticosteroids have not shown benefit. Keeping the patient flat increases the risk of repeat aspiration.
Your pick, B: Antibiotics are added only if signs of infection persist or develop, not straight after the event.
Your pick, C: Corticosteroids have not shown benefit in aspiration pneumonitis.
Your pick, D: Lying flat raises the risk of a repeat aspiration.
Item 11 Respiratory (2A)
Two hours after BiPAP is started for a COPD exacerbation, the patient is more alert. ABG has changed from pH 7.28, PaCO2 72 to pH 7.33, PaCO2 63 mm Hg. SpO2 is 90%. The nurse should anticipate
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, B: continuing BiPAP with a repeat ABG
A rising pH, falling PaCO2 and improving mental status within 1–2 hours show that noninvasive ventilation is working, so it is continued with repeat gas monitoring. Intubation is for NIV failure, which these results do not show. Removing BiPAP this early risks relapse, and raising SpO2 above 92% in hypercapnic COPD can worsen CO2 retention.
Your pick, A: Raising SpO2 above 92% in hypercapnic COPD can worsen CO2 retention.
Your pick, C: Taking BiPAP off this early risks a relapse into hypercapnic failure.
Your pick, D: Intubation is for NIV failure, and these results show improvement.
Item 12 Respiratory (2A)
A patient with COPD on a home ventilator via tracheostomy becomes hypotensive with rising peak pressures. The flow graphic shows expiratory flow does not return to zero before the next breath. The MOST likely cause is
Tick one box. The rationale is written here once you answer.
Right.Not the keyed answer.
Keyed answer, B: auto-PEEP from incomplete exhalation
Expiratory flow that fails to reach zero before the next breath indicates air trapping (auto-PEEP), which raises intrathoracic pressure, impairs venous return, and causes hypotension in obstructive lung disease. A mucus plug raises peak pressure but does not by itself produce incomplete exhalation with hypotension. A cuff leak lowers delivered volumes and pressures. A disconnection triggers low-pressure alarms, not rising peak pressures.
Your pick, A: A disconnection sets off low-pressure alarms, not rising peak pressures.
Your pick, C: A cuff leak lowers delivered volumes and pressures.
Your pick, D: A mucus plug raises peak pressure but does not by itself cause incomplete exhalation with hypotension.
Score sheet
You answered 0 and got 0 right.
Answer a few items and the sheet ranks your weakest system by points lost.
For scale: the real exam pass line is 82 of the 125 scored questions. This set is practice, not a calibrated score.
Keys: 1 to 4 tick an answer, the arrow keys move between items.
Traps
The traps behind those questions
The tempting answer
Why it loses
What wins
More IV fluid for a hypotensive PE
A failing right ventricle overdistends; heparin alone is too slow for shock
Reperfusion, if nothing forbids it
Reduced-dose anticoagulation in a PE patient who is bleeding
Any anticoagulant still adds bleeding risk without protecting enough
An IVC filter until anticoagulation is safe
Calling bubbling on a cough a disconnection
A disconnection bubbles continuously
An expected small leak after resection: monitor
Stripping or clamping a tube that stopped draining
Neither fixes a kink; clamping risks tension
Check the tubing for kinks, clots and loops first
Lowering oxygen in pulmonary fibrosis
CO2 retention is uncommon; desaturation on exertion is the problem
Turn oxygen up for activity
Antibiotics right after a witnessed aspiration
Crackles and a dip in SpO2 within hours are chemical pneumonitis
Oxygen, airway clearance, monitoring; antibiotics only if infection signs persist or develop
Intubating a COPD patient whose gas is improving on BiPAP
Rising pH, falling PaCO2 and a more alert patient mean NIV is working
Continue BiPAP and repeat the gas
A mucus plug behind rising pressures and hypotension in COPD
Expiratory flow that never returns to zero means trapped air
Name it auto-PEEP: give more time to exhale
Tightening the CPAP mask for a mouth leak
Skin breaks down and the mouth still leaks
A full-face mask or chin strap with heated humidification
Paraphrased from the rationales of the 12 items above.
One-liners
The rest of the area, one fact each
Condition
The one fact that earns the point
ARDS
Bilateral infiltrates and hypoxemia (a P/F ratio of 300 or lower) within a week of a trigger such as sepsis or pneumonia, not explained by heart failure. The 2023 global definition also counts patients on high-flow oxygen at 30 L/min or more. Care is oxygenation, prone positioning and careful fluids; on a ventilator, tidal volume 4 to 8 mL/kg of predicted body weight and a plateau pressure under 30 cm H2O
Aspiration
Pneumonitis is chemical and appears within hours; pneumonia is infection and develops over days. Head of bed at 30 degrees or more and a dysphagia screen before anything by mouth
Pneumonia with sepsis signs
Cultures, then antibiotics without delay; treat the gas and the pressure, not just the infiltrate
Obstructive sleep apnea
Home CPAP goes back on after surgery; minimize opioids and sedatives; continuous monitoring and a side-lying or upright position
Central sleep apnea
Pauses without breathing effort, linked to heart failure and opioids
Opioid respiratory depression
Sedation comes before the breathing slows, so check sedation before each dose. Naloxone is titrated to breathing, not to full alertness
Pulmonary hypertension
Never interrupt an IV epoprostenol infusion: dedicated line, backup ready. Hypoxemia, hypercapnia and acidosis all tighten the pulmonary vessels
Pulmonary fibrosis
Restrictive, with desaturation on exertion; oxygen goes up for activity
Sarcoidosis
Granulomas with enlarged lymph nodes at both lung hila; corticosteroids are the usual treatment
Thoracic surgery and VATS
Pain control good enough to cough and use the incentive spirometer, early walking, and the chest drain readings above
Tracheostomy or home ventilator
High-pressure alarm: secretions, biting, bronchospasm, trapped air. Low-pressure alarm: disconnection or a cuff leak. If you cannot fix it fast, bag the patient off the ventilator
Low yield
What not to over-study
Also low yield: pulmonary function testing beyond two facts (a post-bronchodilator FEV1/FVC below 0.70 defines COPD; a big bronchodilator response points to asthma), every antifibrotic and pulmonary hypertension drug name, and the physics of V/Q scanning. You can miss those and still pass respiratory comfortably on gases, airways, clots and tubes.
Where the CCRN picks up
CCRN patients are critically ill and unstable; typically 1 nurse to 1 or 2 patients: that is where acute ventilator management and unstable ARDS belong. If those are most of your shifts, read PCCN vs CCRN, side by side before you book.
Summary
Before you move on
End-of-shift summary
Respiratory is 14% of the PCCN, about 17 or 18 scored items: third by weight.
Read every gas in the same order: pH, PaCO2, bicarbonate, compensation, oxygen.
COPD: titrate to 88% to 92%; the hypoxic drive is a myth; NIV for a pH of 7.35 or lower with a PaCO2 of 45 or higher.
Asthma: a normal or rising PaCO2 in a breathless patient means the patient is tiring.
PE: D-dimer rules out; LMWH over heparin; hypotension means reperfusion; a filter only when you cannot anticoagulate.
Chest tubes: continuous bubbling is a leak, lost tidaling is re-expansion or a block; no routine clamping or stripping.
Skip ventilator mode menus, ECMO and pediatrics.
If you have not done the heart yet, it comes first: the cardiovascular guide covers the heaviest 20%. Multisystem (15%) outweighs this area, and its guide is still being written, so drill its chip in the practice test. The PCCN study guide ranks all seven domains.
Keep the respiratory questions coming
The app carries our full PCCN practice bank with a rationale on every item, so the heaviest systems keep getting worked after you close this page.
About 17 or 18. Respiratory is weighted at 14% and the exam has 125 scored questions, so 14% of 125 lands between those two. It is an approximation: AACN publishes area weights, not item counts per topic.
What respiratory topics are on the PCCN exam?
Respiratory failure and blood gases, COPD and asthma, pulmonary embolism and the pleural space carry the most weight. The test plan also lists pneumonia, thoracic surgery, ARDS, sleep apnea, pulmonary hypertension, pulmonary fibrosis and sarcoidosis.
Is mechanical ventilation on the PCCN?
In its progressive care form: stable and home ventilators, tracheostomy care, CPAP, BiPAP, high-flow oxygen and prone positioning. Managing an unstable ventilated patient or weaning someone fresh from surgery belongs to critical care.
What oxygen saturation does the PCCN expect in COPD?
88% to 92%, the GOLD target. Answers that withhold oxygen to protect a hypoxic drive are outdated.
Are these real PCCN respiratory questions?
No. They are original practice items written to the current test plan and checked against current guidance. Exam questions are confidential.
Next
Lungs done, now find your next leak
Run the full practice test next: it mixes respiratory with the other areas at exam weight, and its score sheet names the system costing you the most points.