NCLEX NGN RESPIRATORY SYSTEM
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the high-pressure alarm is sounding. Which action should the
nurse take first?
A. Perform endotracheal suctioning immediately.
B. Increase the oxygen concentration (FiO2).
C. Check the tubing for kinks or obstruction.
D. Administer a sedative to the patient.
Answer: C
Conceptual Explanation: The first action for a high-pressure alarm is to assess for simple
mechanical obstructions like kinks in the tubing or the patient biting the tube before
moving to invasive procedures like suctioning.
2. A client is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the ‘gold standard’ for confirming this diagnosis?
A. Computed Tomographic Pulmonary Angiography (CTPA)
,B. D-dimer assay
C. Chest X-ray
D. Arterial Blood Gas (ABG) analysis
Answer: A
Conceptual Explanation: While D-dimer is a screening tool, CTPA is the preferred
definitive diagnostic test for pulmonary embolism due to its high sensitivity and specificity.
3. The nurse is caring for a patient with a chest tube following a lobectomy. The nurse notices
continuous bubbling in the water-seal chamber. What does this finding suggest?
A. The system is functioning normally.
B. The suction pressure is too high.
C. The patient has a resolving pneumothorax.
D. There is a leak in the drainage system.
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or the pleural space. Intermittent bubbling is expected in a patient with a
pneumothorax during expiration.
4. A patient with COPD is being discharged. Which statement by the patient indicates a need
for further teaching regarding pursed-lip breathing?
A. I should puff out my cheeks when I exhale.
, B. I should inhale slowly through my nose.
C. My exhalation should be twice as long as my inhalation.
D. I should keep my lips like I am going to whistle.
Answer: A
Conceptual Explanation: In pursed-lip breathing, the patient should not puff out the
cheeks. They should exhale slowly through pursed lips to maintain airway pressure and
keep the airways open longer.
5. Which arterial blood gas (ABG) result is most indicative of late-stage respiratory failure?
A. pH 7.35, PaCO2 40, PaO2 90
B. pH 7.25, PaCO2 60, PaO2 55
C. pH 7.48, PaCO2 30, PaO2 80
D. pH 7.32, PaCO2 48, PaO2 75
Answer: B
Conceptual Explanation: Option C represents respiratory acidosis with severe hypoxemia,
which is characteristic of acute respiratory failure.
6. A client is prescribed Rifampin for the treatment of Tuberculosis. What side effect should
the nurse specifically warn the patient about?
A. Blurred vision and color blindness
B. Orange discoloration of urine and tears
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the high-pressure alarm is sounding. Which action should the
nurse take first?
A. Perform endotracheal suctioning immediately.
B. Increase the oxygen concentration (FiO2).
C. Check the tubing for kinks or obstruction.
D. Administer a sedative to the patient.
Answer: C
Conceptual Explanation: The first action for a high-pressure alarm is to assess for simple
mechanical obstructions like kinks in the tubing or the patient biting the tube before
moving to invasive procedures like suctioning.
2. A client is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the ‘gold standard’ for confirming this diagnosis?
A. Computed Tomographic Pulmonary Angiography (CTPA)
,B. D-dimer assay
C. Chest X-ray
D. Arterial Blood Gas (ABG) analysis
Answer: A
Conceptual Explanation: While D-dimer is a screening tool, CTPA is the preferred
definitive diagnostic test for pulmonary embolism due to its high sensitivity and specificity.
3. The nurse is caring for a patient with a chest tube following a lobectomy. The nurse notices
continuous bubbling in the water-seal chamber. What does this finding suggest?
A. The system is functioning normally.
B. The suction pressure is too high.
C. The patient has a resolving pneumothorax.
D. There is a leak in the drainage system.
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the system or the pleural space. Intermittent bubbling is expected in a patient with a
pneumothorax during expiration.
4. A patient with COPD is being discharged. Which statement by the patient indicates a need
for further teaching regarding pursed-lip breathing?
A. I should puff out my cheeks when I exhale.
, B. I should inhale slowly through my nose.
C. My exhalation should be twice as long as my inhalation.
D. I should keep my lips like I am going to whistle.
Answer: A
Conceptual Explanation: In pursed-lip breathing, the patient should not puff out the
cheeks. They should exhale slowly through pursed lips to maintain airway pressure and
keep the airways open longer.
5. Which arterial blood gas (ABG) result is most indicative of late-stage respiratory failure?
A. pH 7.35, PaCO2 40, PaO2 90
B. pH 7.25, PaCO2 60, PaO2 55
C. pH 7.48, PaCO2 30, PaO2 80
D. pH 7.32, PaCO2 48, PaO2 75
Answer: B
Conceptual Explanation: Option C represents respiratory acidosis with severe hypoxemia,
which is characteristic of acute respiratory failure.
6. A client is prescribed Rifampin for the treatment of Tuberculosis. What side effect should
the nurse specifically warn the patient about?
A. Blurred vision and color blindness
B. Orange discoloration of urine and tears
