NCLEX-Style Questions on Respiratory Management
Question 1:
A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The nurse notices that the
client's respiratory rate has decreased from 20 to 10 breaths per minute. What is the most
appropriate nursing intervention?
A. Increase the oxygen flow to 8 L/min
B. Lower the oxygen flow rate
C. Continue monitoring the client
D. Place the client in high Fowler's position
Answer: B
Rationale: Clients with COPD retain CO2 and are often dependent on low oxygen levels to
stimulate breathing. High-flow oxygen can suppress their drive to breathe, leading to
hypoventilation. Lowering the oxygen flow rate is necessary to avoid oxygen toxicity and
hypercapnia.
Question 2:
The nurse is assessing a client who has pneumonia. Which assessment finding requires
immediate intervention?
A. Crackles in both lung bases
B. A productive cough with green sputum
C. A respiratory rate of 32 breaths/min
D. Fever of 100.6°F (38.1°C)
Answer: C
Rationale: A respiratory rate of 32 breaths/min indicates tachypnea and possible respiratory
distress, which requires immediate intervention. Crackles and productive cough are expected
findings in pneumonia, and a mild fever is not critical.
Question 3:
A client receiving mechanical ventilation is experiencing respiratory acidosis. Which ventilator
change should the nurse anticipate to correct this imbalance?
A. Increase the tidal volume
B. Increase the respiratory rate
C. Decrease the PEEP
D. Decrease the FiO2
Answer: B
Rationale: Increasing the respiratory rate will help blow off more CO2, reducing hypercapnia
,and correcting respiratory acidosis. Increasing the tidal volume could also help but is not the best
first intervention. PEEP and FiO2 adjustments are primarily related to oxygenation, not CO2
removal.
Question 4:
The nurse is educating a client on the proper use of an incentive spirometer. Which statement by
the client indicates a need for further teaching?
A. "I should breathe in slowly and deeply through the mouthpiece."
B. "I need to exhale quickly into the mouthpiece."
C. "I will try to hold my breath after inhaling."
D. "I should use the spirometer every hour while awake."
Answer: B
Rationale: Exhaling into the incentive spirometer is incorrect; the device is designed to
encourage deep inhalation. Clients should slowly inhale and hold their breath after inhalation to
fully expand the lungs.
Question 5:
Which oxygen delivery system provides the highest concentration of oxygen?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Venturi mask
Answer: C
Rationale: A non-rebreather mask provides the highest concentration of oxygen (up to 100%) as
it allows the client to inhale pure oxygen without mixing with room air. The Venturi mask
provides precise oxygen concentrations but not the highest.
Question 6:
A client is being treated for a pulmonary embolism. Which clinical finding would suggest a
worsening condition?
A. Increased oxygen saturation
B. Tachycardia
C. Decreased respiratory rate
D. Bradycardia
Answer: B
Rationale: Tachycardia is a compensatory response to hypoxia and is often a sign of worsening
, pulmonary embolism. Bradycardia and decreased respiratory rate are late signs of deterioration,
while increased oxygen saturation is a sign of improvement.
Question 7:
Which of the following interventions should be included in the care of a client with a chest tube?
A. Clamping the chest tube during transportation
B. Keeping the chest tube drainage system below the level of the chest
C. Emptying the drainage system at the end of every shift
D. Milk the chest tube regularly to prevent blockages
Answer: B
Rationale: The chest tube drainage system must be kept below the chest level to allow proper
drainage by gravity. Clamping the chest tube can lead to tension pneumothorax, and the system
should not be emptied but replaced when full.
Question 8:
A client with asthma is prescribed albuterol. Which assessment finding indicates that the
medication is effective?
A. Increased respiratory rate
B. Decreased wheezing
C. Pulse oximetry of 85%
D. Bradycardia
Answer: B
Rationale: Albuterol is a bronchodilator, and its effectiveness is indicated by decreased
wheezing, which shows improved airflow. An increased respiratory rate or low pulse oximetry
would indicate worsening respiratory function.
Question 9:
A client presents with a new onset of confusion, restlessness, and agitation. Which condition
should the nurse suspect first?
A. Cerebrovascular accident (CVA)
B. Hyperglycemia
C. Hypoxia
D. Dehydration
Answer: C
Rationale: Hypoxia is a common cause of new-onset confusion, restlessness, and agitation, as
the brain is sensitive to low oxygen levels. Other conditions could cause these symptoms, but
hypoxia should be ruled out first.
Question 1:
A client with COPD is receiving oxygen at 6 L/min via nasal cannula. The nurse notices that the
client's respiratory rate has decreased from 20 to 10 breaths per minute. What is the most
appropriate nursing intervention?
A. Increase the oxygen flow to 8 L/min
B. Lower the oxygen flow rate
C. Continue monitoring the client
D. Place the client in high Fowler's position
Answer: B
Rationale: Clients with COPD retain CO2 and are often dependent on low oxygen levels to
stimulate breathing. High-flow oxygen can suppress their drive to breathe, leading to
hypoventilation. Lowering the oxygen flow rate is necessary to avoid oxygen toxicity and
hypercapnia.
Question 2:
The nurse is assessing a client who has pneumonia. Which assessment finding requires
immediate intervention?
A. Crackles in both lung bases
B. A productive cough with green sputum
C. A respiratory rate of 32 breaths/min
D. Fever of 100.6°F (38.1°C)
Answer: C
Rationale: A respiratory rate of 32 breaths/min indicates tachypnea and possible respiratory
distress, which requires immediate intervention. Crackles and productive cough are expected
findings in pneumonia, and a mild fever is not critical.
Question 3:
A client receiving mechanical ventilation is experiencing respiratory acidosis. Which ventilator
change should the nurse anticipate to correct this imbalance?
A. Increase the tidal volume
B. Increase the respiratory rate
C. Decrease the PEEP
D. Decrease the FiO2
Answer: B
Rationale: Increasing the respiratory rate will help blow off more CO2, reducing hypercapnia
,and correcting respiratory acidosis. Increasing the tidal volume could also help but is not the best
first intervention. PEEP and FiO2 adjustments are primarily related to oxygenation, not CO2
removal.
Question 4:
The nurse is educating a client on the proper use of an incentive spirometer. Which statement by
the client indicates a need for further teaching?
A. "I should breathe in slowly and deeply through the mouthpiece."
B. "I need to exhale quickly into the mouthpiece."
C. "I will try to hold my breath after inhaling."
D. "I should use the spirometer every hour while awake."
Answer: B
Rationale: Exhaling into the incentive spirometer is incorrect; the device is designed to
encourage deep inhalation. Clients should slowly inhale and hold their breath after inhalation to
fully expand the lungs.
Question 5:
Which oxygen delivery system provides the highest concentration of oxygen?
A. Nasal cannula
B. Simple face mask
C. Non-rebreather mask
D. Venturi mask
Answer: C
Rationale: A non-rebreather mask provides the highest concentration of oxygen (up to 100%) as
it allows the client to inhale pure oxygen without mixing with room air. The Venturi mask
provides precise oxygen concentrations but not the highest.
Question 6:
A client is being treated for a pulmonary embolism. Which clinical finding would suggest a
worsening condition?
A. Increased oxygen saturation
B. Tachycardia
C. Decreased respiratory rate
D. Bradycardia
Answer: B
Rationale: Tachycardia is a compensatory response to hypoxia and is often a sign of worsening
, pulmonary embolism. Bradycardia and decreased respiratory rate are late signs of deterioration,
while increased oxygen saturation is a sign of improvement.
Question 7:
Which of the following interventions should be included in the care of a client with a chest tube?
A. Clamping the chest tube during transportation
B. Keeping the chest tube drainage system below the level of the chest
C. Emptying the drainage system at the end of every shift
D. Milk the chest tube regularly to prevent blockages
Answer: B
Rationale: The chest tube drainage system must be kept below the chest level to allow proper
drainage by gravity. Clamping the chest tube can lead to tension pneumothorax, and the system
should not be emptied but replaced when full.
Question 8:
A client with asthma is prescribed albuterol. Which assessment finding indicates that the
medication is effective?
A. Increased respiratory rate
B. Decreased wheezing
C. Pulse oximetry of 85%
D. Bradycardia
Answer: B
Rationale: Albuterol is a bronchodilator, and its effectiveness is indicated by decreased
wheezing, which shows improved airflow. An increased respiratory rate or low pulse oximetry
would indicate worsening respiratory function.
Question 9:
A client presents with a new onset of confusion, restlessness, and agitation. Which condition
should the nurse suspect first?
A. Cerebrovascular accident (CVA)
B. Hyperglycemia
C. Hypoxia
D. Dehydration
Answer: C
Rationale: Hypoxia is a common cause of new-onset confusion, restlessness, and agitation, as
the brain is sensitive to low oxygen levels. Other conditions could cause these symptoms, but
hypoxia should be ruled out first.
