NCLEX NGN EAQ RESPIRATORY
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A nurse assesses a client with an acute exacerbation of COPD. Which finding should the
nurse report to the healthcare provider immediately?
A. Increased anteroposterior diameter of the chest
B. New onset of confusion and lethargy
C. Oxygen saturation of 89% on room air
D. Productive cough with thick, white sputum
Answer: B
Conceptual Explanation: New-onset confusion and lethargy are signs of CO2 narcosis and
impending respiratory failure in COPD patients. An AP diameter increase is a chronic
change, 89% SpO2 is common in COPD, and white sputum is expected.
2. A client is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the ‘gold standard’ for confirming this diagnosis?
A. Chest X-ray
B. D-dimer assay
,C. Arterial Blood Gas (ABG)
D. Computed Tomography Angiography (CTA)
Answer: D
Conceptual Explanation: Spiral CT or CTA is the preferred gold standard for diagnosing
PE. D-dimer is a screening tool but not confirmatory. X-rays and ABGs are non-specific.
3. Which arterial blood gas (ABG) result most likely indicates a client is in the early stages of
respiratory failure?
A. pH 7.35, PaCO2 45, HCO3 24
B. pH 7.30, PaCO2 52, PaO2 58
C. pH 7.48, PaCO2 30, PaO2 85
D. pH 7.25, PaCO2 60, HCO3 28
Answer: B
Conceptual Explanation: Respiratory failure is defined by PaO2 < 60 mmHg or PaCO2 >
50 mmHg with pH < 7.35. Option B meets these criteria for acute respiratory failure.
4. The nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding.
B. Clamp the chest tube immediately.
C. Increase the suction to -25 cm H2O.
, D. Check the system for an air leak.
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or from the client. Normal bubbling is intermittent (with coughing or
expiration).
5. A client with tuberculosis (TB) is starting a multidrug regimen. The nurse should instruct
the client to report which side effect specific to Ethambutol?
A. Orange discoloration of urine
B. Peripheral neuropathy
C. Changes in visual acuity or color perception
D. Tinnitus and hearing loss
Answer: C
Conceptual Explanation: Ethambutol can cause optic neuritis; vision changes are the
priority side effect. Orange urine is caused by Rifampin, and neuropathy by Isoniazid.
6. A nurse is suctioning a client with an endotracheal tube. Which action by the nurse
represents correct technique?
A. Applying suction while inserting the catheter.
B. Suctioning for a maximum of 20 seconds at a time.
C. Hyperoxygenating the client with 100% O2 before the procedure.
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A nurse assesses a client with an acute exacerbation of COPD. Which finding should the
nurse report to the healthcare provider immediately?
A. Increased anteroposterior diameter of the chest
B. New onset of confusion and lethargy
C. Oxygen saturation of 89% on room air
D. Productive cough with thick, white sputum
Answer: B
Conceptual Explanation: New-onset confusion and lethargy are signs of CO2 narcosis and
impending respiratory failure in COPD patients. An AP diameter increase is a chronic
change, 89% SpO2 is common in COPD, and white sputum is expected.
2. A client is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the ‘gold standard’ for confirming this diagnosis?
A. Chest X-ray
B. D-dimer assay
,C. Arterial Blood Gas (ABG)
D. Computed Tomography Angiography (CTA)
Answer: D
Conceptual Explanation: Spiral CT or CTA is the preferred gold standard for diagnosing
PE. D-dimer is a screening tool but not confirmatory. X-rays and ABGs are non-specific.
3. Which arterial blood gas (ABG) result most likely indicates a client is in the early stages of
respiratory failure?
A. pH 7.35, PaCO2 45, HCO3 24
B. pH 7.30, PaCO2 52, PaO2 58
C. pH 7.48, PaCO2 30, PaO2 85
D. pH 7.25, PaCO2 60, HCO3 28
Answer: B
Conceptual Explanation: Respiratory failure is defined by PaO2 < 60 mmHg or PaCO2 >
50 mmHg with pH < 7.35. Option B meets these criteria for acute respiratory failure.
4. The nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding.
B. Clamp the chest tube immediately.
C. Increase the suction to -25 cm H2O.
, D. Check the system for an air leak.
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or from the client. Normal bubbling is intermittent (with coughing or
expiration).
5. A client with tuberculosis (TB) is starting a multidrug regimen. The nurse should instruct
the client to report which side effect specific to Ethambutol?
A. Orange discoloration of urine
B. Peripheral neuropathy
C. Changes in visual acuity or color perception
D. Tinnitus and hearing loss
Answer: C
Conceptual Explanation: Ethambutol can cause optic neuritis; vision changes are the
priority side effect. Orange urine is caused by Rifampin, and neuropathy by Isoniazid.
6. A nurse is suctioning a client with an endotracheal tube. Which action by the nurse
represents correct technique?
A. Applying suction while inserting the catheter.
B. Suctioning for a maximum of 20 seconds at a time.
C. Hyperoxygenating the client with 100% O2 before the procedure.
