1
HESI Specialty Exam Prep:
Respiratory Disorders & Oxygen
Therapy in Nursing
Table of Contents
Subtopic 1: Assessment and Early Recognition of Respiratory Compromise
(Questions 1–20)..............................................................................................2
Subtopic 2: Oxygen Delivery Systems and Monitoring (Questions 21–40)....10
Subtopic 3: Acute Respiratory Disorders and Emergency Management
(Questions 41–60)..........................................................................................18
Subtopic 4: Mechanical Ventilation and Weaning (Questions 61–80).............26
Subtopic 5: Chronic Respiratory Disorders and Long-Term Management
(Questions 81–100)........................................................................................34
Subtopic 6: Acute Respiratory Failure and Emergency Airway Management
(Questions 101–120)......................................................................................42
Subtopic 7: Chest Tubes, Pleural Drainage, and Lung Collapse Management
(Questions 121–140)......................................................................................50
Subtopic 8: Mechanical Ventilation Principles and Complications (Questions
141–160)........................................................................................................58
Subtopic 9: Emergency Respiratory Interventions and Code Management
(Questions 161–180)......................................................................................66
Subtopic 10: Patient Safety, Quality Improvement & Interprofessional
Collaboration in Respiratory Care (Questions 181–200)................................74
, 2
Subtopic 1: Assessment and Early
Recognition of Respiratory Compromise
(Questions 1–20)
1. A nurse is assessing a client admitted with suspected pneumonia. Which
clinical finding would most strongly indicate impaired gas exchange?
A. Temperature of 101.6°F (38.7°C)
B. Productive cough with green sputum
C. Oxygen saturation of 86% on room air
D. Respiratory rate of 22 breaths/min
Correct Answer: C. Oxygen saturation of 86% on room air
Rationale: Oxygen saturation below 90% indicates hypoxemia and impaired
gas exchange. While other signs support infection, the saturation directly
reflects compromised respiratory function.
2. The nurse is caring for a client with chronic obstructive pulmonary disease
(COPD). Which of the following assessment findings requires immediate
intervention?
A. Clubbing of fingers
B. Use of accessory muscles to breathe
C. Barrel chest appearance
D. PaO₂ of 70 mmHg
Correct Answer: B. Use of accessory muscles to breathe
Rationale: Accessory muscle use suggests respiratory distress and potential
failure. It is an urgent sign indicating the client is struggling to ventilate
effectively.
, 3
3. A client presents with dyspnea and wheezing. What is the nurse’s priority
assessment?
A. Color of sputum
B. History of smoking
C. Presence of stridor or silent chest
D. Oxygen flow rate at triage
Correct Answer: C. Presence of stridor or silent chest
Rationale: Stridor or silent chest can indicate complete airway obstruction
and imminent respiratory arrest, requiring immediate action.
4. During auscultation of a client’s lungs, the nurse hears high-pitched,
musical sounds during expiration. How should the nurse interpret this
finding?
A. Wheezes indicating narrowed airways
B. Crackles indicating fluid accumulation
C. Rhonchi suggesting mucus obstruction
D. Pleural friction rub from inflamed membranes
Correct Answer: A. Wheezes indicating narrowed airways
Rationale: Wheezes are characteristic of bronchospasm or airway narrowing,
commonly found in asthma or COPD exacerbations.
5. A nurse is monitoring arterial blood gases (ABGs) for a client with acute
respiratory distress. Which value is most critical to report?
A. pH 7.34
B. HCO₃ 22 mEq/L
C. PaCO₂ 48 mmHg
D. PaO₂ 58 mmHg
, 4
Correct Answer: D. PaO₂ 58 mmHg
Rationale: A PaO₂ below 60 mmHg indicates significant hypoxemia, which
can be life-threatening and requires immediate oxygen therapy or ventilation
support.
6. A client with asthma reports increasing shortness of breath. The nurse
notes decreased breath sounds in all lobes. What should the nurse do next?
A. Encourage slow breathing
B. Notify the provider immediately
C. Reposition the client to high Fowler’s
D. Offer a bronchodilator orally
Correct Answer: B. Notify the provider immediately
Rationale: Decreased or absent breath sounds in an asthmatic client may
indicate impending respiratory failure or severe bronchoconstriction,
necessitating immediate intervention.
7. A client reports shortness of breath and has jugular vein distension. Which
additional assessment supports the presence of respiratory compromise?
A. Crackles heard at the lung bases
B. Clear lung sounds
C. Flat neck veins
D. Low blood pressure
Correct Answer: A. Crackles heard at the lung bases
Rationale: Crackles and JVD suggest fluid overload and possible pulmonary
edema, both of which impair gas exchange.
HESI Specialty Exam Prep:
Respiratory Disorders & Oxygen
Therapy in Nursing
Table of Contents
Subtopic 1: Assessment and Early Recognition of Respiratory Compromise
(Questions 1–20)..............................................................................................2
Subtopic 2: Oxygen Delivery Systems and Monitoring (Questions 21–40)....10
Subtopic 3: Acute Respiratory Disorders and Emergency Management
(Questions 41–60)..........................................................................................18
Subtopic 4: Mechanical Ventilation and Weaning (Questions 61–80).............26
Subtopic 5: Chronic Respiratory Disorders and Long-Term Management
(Questions 81–100)........................................................................................34
Subtopic 6: Acute Respiratory Failure and Emergency Airway Management
(Questions 101–120)......................................................................................42
Subtopic 7: Chest Tubes, Pleural Drainage, and Lung Collapse Management
(Questions 121–140)......................................................................................50
Subtopic 8: Mechanical Ventilation Principles and Complications (Questions
141–160)........................................................................................................58
Subtopic 9: Emergency Respiratory Interventions and Code Management
(Questions 161–180)......................................................................................66
Subtopic 10: Patient Safety, Quality Improvement & Interprofessional
Collaboration in Respiratory Care (Questions 181–200)................................74
, 2
Subtopic 1: Assessment and Early
Recognition of Respiratory Compromise
(Questions 1–20)
1. A nurse is assessing a client admitted with suspected pneumonia. Which
clinical finding would most strongly indicate impaired gas exchange?
A. Temperature of 101.6°F (38.7°C)
B. Productive cough with green sputum
C. Oxygen saturation of 86% on room air
D. Respiratory rate of 22 breaths/min
Correct Answer: C. Oxygen saturation of 86% on room air
Rationale: Oxygen saturation below 90% indicates hypoxemia and impaired
gas exchange. While other signs support infection, the saturation directly
reflects compromised respiratory function.
2. The nurse is caring for a client with chronic obstructive pulmonary disease
(COPD). Which of the following assessment findings requires immediate
intervention?
A. Clubbing of fingers
B. Use of accessory muscles to breathe
C. Barrel chest appearance
D. PaO₂ of 70 mmHg
Correct Answer: B. Use of accessory muscles to breathe
Rationale: Accessory muscle use suggests respiratory distress and potential
failure. It is an urgent sign indicating the client is struggling to ventilate
effectively.
, 3
3. A client presents with dyspnea and wheezing. What is the nurse’s priority
assessment?
A. Color of sputum
B. History of smoking
C. Presence of stridor or silent chest
D. Oxygen flow rate at triage
Correct Answer: C. Presence of stridor or silent chest
Rationale: Stridor or silent chest can indicate complete airway obstruction
and imminent respiratory arrest, requiring immediate action.
4. During auscultation of a client’s lungs, the nurse hears high-pitched,
musical sounds during expiration. How should the nurse interpret this
finding?
A. Wheezes indicating narrowed airways
B. Crackles indicating fluid accumulation
C. Rhonchi suggesting mucus obstruction
D. Pleural friction rub from inflamed membranes
Correct Answer: A. Wheezes indicating narrowed airways
Rationale: Wheezes are characteristic of bronchospasm or airway narrowing,
commonly found in asthma or COPD exacerbations.
5. A nurse is monitoring arterial blood gases (ABGs) for a client with acute
respiratory distress. Which value is most critical to report?
A. pH 7.34
B. HCO₃ 22 mEq/L
C. PaCO₂ 48 mmHg
D. PaO₂ 58 mmHg
, 4
Correct Answer: D. PaO₂ 58 mmHg
Rationale: A PaO₂ below 60 mmHg indicates significant hypoxemia, which
can be life-threatening and requires immediate oxygen therapy or ventilation
support.
6. A client with asthma reports increasing shortness of breath. The nurse
notes decreased breath sounds in all lobes. What should the nurse do next?
A. Encourage slow breathing
B. Notify the provider immediately
C. Reposition the client to high Fowler’s
D. Offer a bronchodilator orally
Correct Answer: B. Notify the provider immediately
Rationale: Decreased or absent breath sounds in an asthmatic client may
indicate impending respiratory failure or severe bronchoconstriction,
necessitating immediate intervention.
7. A client reports shortness of breath and has jugular vein distension. Which
additional assessment supports the presence of respiratory compromise?
A. Crackles heard at the lung bases
B. Clear lung sounds
C. Flat neck veins
D. Low blood pressure
Correct Answer: A. Crackles heard at the lung bases
Rationale: Crackles and JVD suggest fluid overload and possible pulmonary
edema, both of which impair gas exchange.
