NCLEX NGN EAQ Respiratory Questions
and Answers with Rationales | 2026
Update | 100% Correct.
SECTION 1: NGN CASE STUDIES – PULMONARY EMBOLISM
Question 1: A 52-year-old client presents to the ED with acute sharp chest pain and
shortness of breath. Vital signs: BP 88/62 mmHg, HR 108 bpm, RR 32, O2 sat 86% on
room air, temperature 101.2°F. Crackles bilateral mid and lower lobes. Accentuated S2
heart sound noted. The client recently returned from a business trip to Japan. Which
condition is the client most likely experiencing?
A) Pneumonia
B) Pulmonary embolism
C) Spontaneous pneumothorax
D) Acute respiratory distress syndrome
Answer: B
Rationale: The combination of acute pleuritic chest pain, dyspnea, hypoxemia,
tachycardia, tachypnea, and an accentuated S2 is classic for pulmonary embolism (PE).
Recent travel (prolonged immobility) is a major risk factor. Hypotension with PE
indicates a massive PE with right ventricular failure .
, Question 2: For the client with acute pulmonary embolism and hypotension (systolic BP
< 90 mmHg), which action should the nurse anticipate?
A) Antibiotics
B) Chest tube insertion
C) Thrombolytic therapy
D) Needle decompression
Answer: C
Rationale: Thrombolytic therapy is indicated for clients with acute PE accompanied by
hypotension (systolic BP < 90 mmHg) in the absence of high bleeding risk.
Anticoagulation with low-molecular-weight heparin is first-line for stable PE .
Question 3: A postoperative client (24 hours post-total hip replacement) suddenly
reports sharp chest pain and difficulty breathing. Vital signs: BP 100/60, HR 125, RR 32,
SpO2 86% on 2 L/min nasal cannula. Which condition is the client most likely
experiencing?
A) Atelectasis
B) Pulmonary embolism (PE)
C) Pneumonia
D) Myocardial infarction
Answer: B
Rationale: Sudden dyspnea, chest pain, tachycardia, and hypoxemia in a postoperative
client are classic for PE, often from a deep vein thrombosis (DVT). Postoperative
immobility is a major risk factor .
Question 4: Which diagnostic test should the nurse anticipate first for a suspected PE?
A) Chest x-ray
B) D-dimer
C) CT pulmonary angiography
D) Ventilation-perfusion (V/Q) scan
and Answers with Rationales | 2026
Update | 100% Correct.
SECTION 1: NGN CASE STUDIES – PULMONARY EMBOLISM
Question 1: A 52-year-old client presents to the ED with acute sharp chest pain and
shortness of breath. Vital signs: BP 88/62 mmHg, HR 108 bpm, RR 32, O2 sat 86% on
room air, temperature 101.2°F. Crackles bilateral mid and lower lobes. Accentuated S2
heart sound noted. The client recently returned from a business trip to Japan. Which
condition is the client most likely experiencing?
A) Pneumonia
B) Pulmonary embolism
C) Spontaneous pneumothorax
D) Acute respiratory distress syndrome
Answer: B
Rationale: The combination of acute pleuritic chest pain, dyspnea, hypoxemia,
tachycardia, tachypnea, and an accentuated S2 is classic for pulmonary embolism (PE).
Recent travel (prolonged immobility) is a major risk factor. Hypotension with PE
indicates a massive PE with right ventricular failure .
, Question 2: For the client with acute pulmonary embolism and hypotension (systolic BP
< 90 mmHg), which action should the nurse anticipate?
A) Antibiotics
B) Chest tube insertion
C) Thrombolytic therapy
D) Needle decompression
Answer: C
Rationale: Thrombolytic therapy is indicated for clients with acute PE accompanied by
hypotension (systolic BP < 90 mmHg) in the absence of high bleeding risk.
Anticoagulation with low-molecular-weight heparin is first-line for stable PE .
Question 3: A postoperative client (24 hours post-total hip replacement) suddenly
reports sharp chest pain and difficulty breathing. Vital signs: BP 100/60, HR 125, RR 32,
SpO2 86% on 2 L/min nasal cannula. Which condition is the client most likely
experiencing?
A) Atelectasis
B) Pulmonary embolism (PE)
C) Pneumonia
D) Myocardial infarction
Answer: B
Rationale: Sudden dyspnea, chest pain, tachycardia, and hypoxemia in a postoperative
client are classic for PE, often from a deep vein thrombosis (DVT). Postoperative
immobility is a major risk factor .
Question 4: Which diagnostic test should the nurse anticipate first for a suspected PE?
A) Chest x-ray
B) D-dimer
C) CT pulmonary angiography
D) Ventilation-perfusion (V/Q) scan
