NCLEX NGN EAQ RESPIRATORY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the peak inspiratory pressure is rising. Which action should the
nurse take first?
A. Increase the fraction of inspired oxygen (FiO2).
B. Suction the client’s airway for secretions.
C. Perform a manual bag-valve-mask ventilation.
D. Auscultate the client’s breath sounds.
Answer: D
Conceptual Explanation: Assessment is the first step in the nursing process. The nurse
must determine the cause of the high pressure (e.g., pneumothorax, secretions, or
bronchospasm) by auscultating breath sounds before intervening.
,2. Which arterial blood gas (ABG) result would the nurse expect to find in a client with a
history of COPD and chronic carbon dioxide retention?
A. pH 7.50, PaCO2 30 mmHg, HCO3 20 mEq/L
B. pH 7.30, PaCO2 60 mmHg, HCO3 24 mEq/L
C. pH 7.45, PaCO2 35 mmHg, HCO3 22 mEq/L
D. pH 7.35, PaCO2 50 mmHg, HCO3 30 mEq/L
Answer: D
Conceptual Explanation: Clients with chronic COPD often live in a state of fully
compensated respiratory acidosis. The pH is at the low end of normal, the PaCO2 is high,
and the HCO3 is high (renal compensation).
3. A client is 4 hours postoperative following a right lower lobectomy. Which assessment
finding requires immediate notification of the healthcare provider?
A. Pain level of 6 on a scale of 0 to 10.
B. Diminished breath sounds in the right lower base.
C. Chest tube drainage of 150 mL in the last hour.
D. Subcutaneous emphysema near the insertion site.
Answer: C
Conceptual Explanation: Chest tube drainage greater than 100 mL/hr is excessive and
may indicate hemorrhage, requiring immediate surgical intervention.
, 4. The nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Constant bubbling is noted in the water-seal chamber. What is the nurse’s priority
action?
A. Check the system for an air leak.
B. Document this as a normal finding for a pneumothorax.
C. Increase the suction level on the regulator.
D. Clamp the chest tube near the insertion site.
Answer: A
Conceptual Explanation: Constant bubbling in the water-seal chamber indicates an air
leak in the system. The nurse should check the tubing and connections to locate the leak.
5. A client with a pulmonary embolism is receiving a heparin infusion. Which laboratory value
indicates the treatment is therapeutic?
A. INR of 2.5.
B. aPTT of 1.5 to 2.5 times the control.
C. Prothrombin time (PT) of 20 seconds.
D. Platelet count of 150,000/mm³.
Answer: B
Conceptual Explanation: Therapeutic heparin levels are monitored via activated partial
thromboplastin time (aPTT), with a goal of 1.5 to 2.5 times the normal baseline.
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the peak inspiratory pressure is rising. Which action should the
nurse take first?
A. Increase the fraction of inspired oxygen (FiO2).
B. Suction the client’s airway for secretions.
C. Perform a manual bag-valve-mask ventilation.
D. Auscultate the client’s breath sounds.
Answer: D
Conceptual Explanation: Assessment is the first step in the nursing process. The nurse
must determine the cause of the high pressure (e.g., pneumothorax, secretions, or
bronchospasm) by auscultating breath sounds before intervening.
,2. Which arterial blood gas (ABG) result would the nurse expect to find in a client with a
history of COPD and chronic carbon dioxide retention?
A. pH 7.50, PaCO2 30 mmHg, HCO3 20 mEq/L
B. pH 7.30, PaCO2 60 mmHg, HCO3 24 mEq/L
C. pH 7.45, PaCO2 35 mmHg, HCO3 22 mEq/L
D. pH 7.35, PaCO2 50 mmHg, HCO3 30 mEq/L
Answer: D
Conceptual Explanation: Clients with chronic COPD often live in a state of fully
compensated respiratory acidosis. The pH is at the low end of normal, the PaCO2 is high,
and the HCO3 is high (renal compensation).
3. A client is 4 hours postoperative following a right lower lobectomy. Which assessment
finding requires immediate notification of the healthcare provider?
A. Pain level of 6 on a scale of 0 to 10.
B. Diminished breath sounds in the right lower base.
C. Chest tube drainage of 150 mL in the last hour.
D. Subcutaneous emphysema near the insertion site.
Answer: C
Conceptual Explanation: Chest tube drainage greater than 100 mL/hr is excessive and
may indicate hemorrhage, requiring immediate surgical intervention.
, 4. The nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Constant bubbling is noted in the water-seal chamber. What is the nurse’s priority
action?
A. Check the system for an air leak.
B. Document this as a normal finding for a pneumothorax.
C. Increase the suction level on the regulator.
D. Clamp the chest tube near the insertion site.
Answer: A
Conceptual Explanation: Constant bubbling in the water-seal chamber indicates an air
leak in the system. The nurse should check the tubing and connections to locate the leak.
5. A client with a pulmonary embolism is receiving a heparin infusion. Which laboratory value
indicates the treatment is therapeutic?
A. INR of 2.5.
B. aPTT of 1.5 to 2.5 times the control.
C. Prothrombin time (PT) of 20 seconds.
D. Platelet count of 150,000/mm³.
Answer: B
Conceptual Explanation: Therapeutic heparin levels are monitored via activated partial
thromboplastin time (aPTT), with a goal of 1.5 to 2.5 times the normal baseline.
