Nursing PNP: Respiratory System Nclex-styled questions with Rationales and Note
2025
Answer: c) Oxygen saturation of 89%
A nurse is caring for a client with pneumonia. Which of the follow-
Rationale: An oxygen saturation below 90% indicates hypoxia and
ing assessment findings would require immediate intervention?
requires immediate intervention, such as oxygen therapy. Other
a) Crackles in the lungs
symptoms like crackles, a productive cough, and a mild fever are
b) Productive cough with green sputum
expected findings in pneumonia.
c) Oxygen saturation of 89%
Helpful Note: Always assess airway and oxygenation first in res-
d) Fever of 100.4°F
piratory conditions (ABCs - Airway, Breathing, Circulation).
A patient is receiving a bronchodilator for an acute asthma attack. Answer: c) Tachycardia
Which side effect should the nurse monitor for? Rationale: Bronchodilators, such as albuterol, stimulate the sym-
a) Bradycardia pathetic nervous system, which can cause an increased heart
b) Hypoglycemia rate.
c) Tachycardia Helpful Note: Teach patients to report chest pain or palpitations
d) Respiratory depression after using a bronchodilator.
Answer: d) A positive sputum culture after 3 months of treatment
A nurse is assessing a client with tuberculosis (TB). Which of the
Rationale: TB treatment typically lasts 6-9 months, but sputum
following findings is most concerning?
cultures should start turning negative within the first few months. A
a) Night sweats
persistent positive culture suggests treatment failure or noncom-
b) Weight loss
pliance.
c) Blood-tinged sputum
Helpful Note: Directly observed therapy (DOT) is recommended
d) A positive sputum culture after 3 months of treatment
for clients who have difficulty adhering to TB treatment.
A patient with COPD is receiving oxygen therapy at 4 L/min
via nasal cannula. The nurse notes increasing drowsiness. What Answer: b) Lower the oxygen flow rate
should the nurse do first? Rationale: COPD patients have a hypoxic drive to breathe, and too
a) Increase the oxygen flow much oxygen can suppress their respiratory effort.
b) Lower the oxygen flow rate Helpful Note: Oxygen should be kept between 1-3 L/min for most
c) Encourage the patient to deep breathe COPD patients unless otherwise directed by a provider.
d) Check the oxygen saturation level
A nurse is caring for a client who just had a thoracentesis. What Answer: b) Oxygen saturation
is the priority assessment? Rationale: A thoracentesis involves removing fluid from the pleural
a) Pain level space, which can sometimes lead to lung collapse (pneumotho-
b) Oxygen saturation rax). Monitoring oxygen levels helps detect complications early.
c) Blood pressure Helpful Note: Educate patients to report sudden shortness of
d) Urine output breath after the procedure.
A patient is experiencing an acute asthma attack. Which medica- Answer: c) Albuterol
tion should the nurse administer first? Rationale: Albuterol is a short-acting beta-agonist (SABA) that
a) Montelukast provides rapid bronchodilation during acute asthma attacks. The
b) Fluticasone other medications are for long-term asthma management.
c) Albuterol Helpful Note: Teach patients to always carry a rescue inhaler
d) Tiotropium (albuterol) for sudden symptoms.
A nurse is teaching a patient with pneumonia about preventing
Answer: a) "I will take deep breaths and cough every hour while
complications. Which statement by the patient indicates under-
awake."
standing? Rationale: Deep breathing and coughing help prevent atelectasis
a) "I will take deep breaths and cough every hour while awake."
(lung collapse) and improve oxygenation.
"I should avoid drinking too many fluids to prevent more mucus."
b)
c) "I should stay in bed to conserve energy." Helpful Note: Pneumonia patients should complete their full
course of antibiotics, even if they feel better.
d) "I can stop my antibiotics once my fever goes away."
The nurse is reviewing arterial blood gas (ABG) results: pH 7.31,
Answer: a) Respiratory acidosis
PaCO2 50 mmHg, HCO3 24 mEq/L. How should the nurse inter-
Rationale: The pH is low (acidosis), and the PaCO2 is high, indi-
pret these results?
cating that the problem is respiratory.
a) Respiratory acidosis
Helpful Note: ROME mnemonic: Respiratory Opposite, Metabolic
b) Respiratory alkalosis
Equal. In respiratory disorders, pH and CO2 move in opposite
c) Metabolic acidosis
directions.
d) Metabolic alkalosis
A nurse is assessing a patient with pleurisy. What is the most
common symptom? Answer: b) Sharp chest pain that worsens with inspiration
a) Productive cough Rationale: Pleurisy is inflammation of the pleura, causing sharp
b) Sharp chest pain that worsens with inspiration
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,Nursing PNP: Respiratory System Nclex-styled questions with Rationales and Note
2025
c) Decreased breath sounds pain with breathing.
d) Cyanosis Helpful Note: A pleural friction rub may be heard on auscultation.
A patient with a pulmonary embolism (PE) suddenly becomes
Answer: c) Elevate the head of the bed and apply oxygen
anxious and short of breath. What is the nurse's first action?
Rationale: The priority intervention for a suspected PE is ensuring
a) Obtain an electrocardiogram (ECG)
adequate oxygenation.
b) Prepare the patient for a CT scan
Helpful Note: "Sudden dyspnea + chest pain + anxiety = suspect
c) Elevate the head of the bed and apply oxygen
PE."
d) Administer heparin
A patient is using a metered-dose inhaler (MDI) with a corticos- Answer: b) "Rinse your mouth after using this inhaler."
teroid. What should the nurse include in the teaching? Rationale: Corticosteroids can cause oral thrush, so rinsing the
"Use this inhaler when experiencing acute shortness of breath."
a)
b) "Rinse your mouth after using this inhaler." mouth helps prevent this.
Helpful Note: SABA (albuterol) is used first, then corticosteroids if
c) "Shake the inhaler and take slow, shallow breaths."
both are prescribed.
d) "Use a spacer only when using a bronchodilator."
A nurse is caring for a patient with tuberculosis (TB) in an airborne
Answer: c) Have visitors wear N95 masks.
isolation room. Which intervention is appropriate?
Rationale: TB is airborne, so an N95 respirator is required for
a) Wear a surgical mask when entering the room.
protection.
b) Keep the door open to monitor the patient.
Helpful Note: TB patients need 3 negative sputum cultures before
c) Have visitors wear N95 masks.
precautions are lifted.
d) Discontinue precautions after 24 hours of antibiotics.
Which patient is at highest risk for developing a pneumothorax? Answer: c) A patient with a rib fracture
a) A patient with asthma using a nebulizer Rationale: Rib fractures can puncture the lung, leading to air
b) A patient with COPD on home oxygen entering the pleural space (pneumothorax).
c) A patient with a rib fracture Helpful Note: Absent breath sounds on one side = suspect pneu-
d) A patient with viral pneumonia mothorax.
A patient with chronic bronchitis reports increased sputum pro-
duction and worsening dyspnea. What is the nurse's priority in- Answer: a) Administer bronchodilators
tervention? Rationale: Bronchodilators help open airways, making it easier to
a) Administer bronchodilators clear mucus and breathe.
b) Encourage deep breathing and coughing Helpful Note: COPD patients should not receive high-flow oxygen
c) Increase oxygen to 6 L/min (>3 L/min) unless necessary.
d) Prepare for intubation
A patient with a chest tube has continuous bubbling in the wa-
Answer: c) An air leak is present
ter-seal chamber. What does this indicate?
Rationale: Continuous bubbling suggests air is leaking into the
a) Normal function
system and should be reported.
b) A pneumothorax has resolved
Helpful Note: Intermittent bubbling is normal in a pneumothorax as
c) An air leak is present
air escapes from the pleural space.
d) The tube is blocked
A nurse is evaluating a patient's understanding of pursed-lip
breathing for COPD. Which statement indicates correct tech-
nique?
Answer: b) "I will inhale slowly through my nose and exhale
a) "I will inhale quickly through my nose and exhale forcefully
through pursed lips twice as long."
through my mouth."
Rationale: Pursed-lip breathing helps prevent air trapping and
b) "I will inhale slowly through my nose and exhale through pursed
promotes better oxygenation by prolonging exhalation.
lips twice as long."
Helpful Note: "Inhale through the nose for 2 seconds, exhale
c) "I will breathe in and out through my mouth quickly to expel
through pursed lips for 4 seconds."
carbon dioxide."
d) "I will hold my breath for 10 seconds before exhaling through
my nose."
A patient with influenza is prescribed oseltamivir (Tamiflu). Which
statement by the patient requires further teaching?
Answer: b) "This medication will cure my flu completely."
a) "I should start this medication within 48 hours of symptom
Rationale: Antiviral medications like oseltamivir do not cure the flu
onset."
but reduce the severity and duration of symptoms if started early.
b) "This medication will cure my flu completely."
Helpful Note: Patients should continue infection control measures
c) "I might still be contagious even while taking the medication."
even while taking antivirals.
d) "This medication may help reduce the severity of my symp-
toms."
2/5
2025
Answer: c) Oxygen saturation of 89%
A nurse is caring for a client with pneumonia. Which of the follow-
Rationale: An oxygen saturation below 90% indicates hypoxia and
ing assessment findings would require immediate intervention?
requires immediate intervention, such as oxygen therapy. Other
a) Crackles in the lungs
symptoms like crackles, a productive cough, and a mild fever are
b) Productive cough with green sputum
expected findings in pneumonia.
c) Oxygen saturation of 89%
Helpful Note: Always assess airway and oxygenation first in res-
d) Fever of 100.4°F
piratory conditions (ABCs - Airway, Breathing, Circulation).
A patient is receiving a bronchodilator for an acute asthma attack. Answer: c) Tachycardia
Which side effect should the nurse monitor for? Rationale: Bronchodilators, such as albuterol, stimulate the sym-
a) Bradycardia pathetic nervous system, which can cause an increased heart
b) Hypoglycemia rate.
c) Tachycardia Helpful Note: Teach patients to report chest pain or palpitations
d) Respiratory depression after using a bronchodilator.
Answer: d) A positive sputum culture after 3 months of treatment
A nurse is assessing a client with tuberculosis (TB). Which of the
Rationale: TB treatment typically lasts 6-9 months, but sputum
following findings is most concerning?
cultures should start turning negative within the first few months. A
a) Night sweats
persistent positive culture suggests treatment failure or noncom-
b) Weight loss
pliance.
c) Blood-tinged sputum
Helpful Note: Directly observed therapy (DOT) is recommended
d) A positive sputum culture after 3 months of treatment
for clients who have difficulty adhering to TB treatment.
A patient with COPD is receiving oxygen therapy at 4 L/min
via nasal cannula. The nurse notes increasing drowsiness. What Answer: b) Lower the oxygen flow rate
should the nurse do first? Rationale: COPD patients have a hypoxic drive to breathe, and too
a) Increase the oxygen flow much oxygen can suppress their respiratory effort.
b) Lower the oxygen flow rate Helpful Note: Oxygen should be kept between 1-3 L/min for most
c) Encourage the patient to deep breathe COPD patients unless otherwise directed by a provider.
d) Check the oxygen saturation level
A nurse is caring for a client who just had a thoracentesis. What Answer: b) Oxygen saturation
is the priority assessment? Rationale: A thoracentesis involves removing fluid from the pleural
a) Pain level space, which can sometimes lead to lung collapse (pneumotho-
b) Oxygen saturation rax). Monitoring oxygen levels helps detect complications early.
c) Blood pressure Helpful Note: Educate patients to report sudden shortness of
d) Urine output breath after the procedure.
A patient is experiencing an acute asthma attack. Which medica- Answer: c) Albuterol
tion should the nurse administer first? Rationale: Albuterol is a short-acting beta-agonist (SABA) that
a) Montelukast provides rapid bronchodilation during acute asthma attacks. The
b) Fluticasone other medications are for long-term asthma management.
c) Albuterol Helpful Note: Teach patients to always carry a rescue inhaler
d) Tiotropium (albuterol) for sudden symptoms.
A nurse is teaching a patient with pneumonia about preventing
Answer: a) "I will take deep breaths and cough every hour while
complications. Which statement by the patient indicates under-
awake."
standing? Rationale: Deep breathing and coughing help prevent atelectasis
a) "I will take deep breaths and cough every hour while awake."
(lung collapse) and improve oxygenation.
"I should avoid drinking too many fluids to prevent more mucus."
b)
c) "I should stay in bed to conserve energy." Helpful Note: Pneumonia patients should complete their full
course of antibiotics, even if they feel better.
d) "I can stop my antibiotics once my fever goes away."
The nurse is reviewing arterial blood gas (ABG) results: pH 7.31,
Answer: a) Respiratory acidosis
PaCO2 50 mmHg, HCO3 24 mEq/L. How should the nurse inter-
Rationale: The pH is low (acidosis), and the PaCO2 is high, indi-
pret these results?
cating that the problem is respiratory.
a) Respiratory acidosis
Helpful Note: ROME mnemonic: Respiratory Opposite, Metabolic
b) Respiratory alkalosis
Equal. In respiratory disorders, pH and CO2 move in opposite
c) Metabolic acidosis
directions.
d) Metabolic alkalosis
A nurse is assessing a patient with pleurisy. What is the most
common symptom? Answer: b) Sharp chest pain that worsens with inspiration
a) Productive cough Rationale: Pleurisy is inflammation of the pleura, causing sharp
b) Sharp chest pain that worsens with inspiration
1/5
,Nursing PNP: Respiratory System Nclex-styled questions with Rationales and Note
2025
c) Decreased breath sounds pain with breathing.
d) Cyanosis Helpful Note: A pleural friction rub may be heard on auscultation.
A patient with a pulmonary embolism (PE) suddenly becomes
Answer: c) Elevate the head of the bed and apply oxygen
anxious and short of breath. What is the nurse's first action?
Rationale: The priority intervention for a suspected PE is ensuring
a) Obtain an electrocardiogram (ECG)
adequate oxygenation.
b) Prepare the patient for a CT scan
Helpful Note: "Sudden dyspnea + chest pain + anxiety = suspect
c) Elevate the head of the bed and apply oxygen
PE."
d) Administer heparin
A patient is using a metered-dose inhaler (MDI) with a corticos- Answer: b) "Rinse your mouth after using this inhaler."
teroid. What should the nurse include in the teaching? Rationale: Corticosteroids can cause oral thrush, so rinsing the
"Use this inhaler when experiencing acute shortness of breath."
a)
b) "Rinse your mouth after using this inhaler." mouth helps prevent this.
Helpful Note: SABA (albuterol) is used first, then corticosteroids if
c) "Shake the inhaler and take slow, shallow breaths."
both are prescribed.
d) "Use a spacer only when using a bronchodilator."
A nurse is caring for a patient with tuberculosis (TB) in an airborne
Answer: c) Have visitors wear N95 masks.
isolation room. Which intervention is appropriate?
Rationale: TB is airborne, so an N95 respirator is required for
a) Wear a surgical mask when entering the room.
protection.
b) Keep the door open to monitor the patient.
Helpful Note: TB patients need 3 negative sputum cultures before
c) Have visitors wear N95 masks.
precautions are lifted.
d) Discontinue precautions after 24 hours of antibiotics.
Which patient is at highest risk for developing a pneumothorax? Answer: c) A patient with a rib fracture
a) A patient with asthma using a nebulizer Rationale: Rib fractures can puncture the lung, leading to air
b) A patient with COPD on home oxygen entering the pleural space (pneumothorax).
c) A patient with a rib fracture Helpful Note: Absent breath sounds on one side = suspect pneu-
d) A patient with viral pneumonia mothorax.
A patient with chronic bronchitis reports increased sputum pro-
duction and worsening dyspnea. What is the nurse's priority in- Answer: a) Administer bronchodilators
tervention? Rationale: Bronchodilators help open airways, making it easier to
a) Administer bronchodilators clear mucus and breathe.
b) Encourage deep breathing and coughing Helpful Note: COPD patients should not receive high-flow oxygen
c) Increase oxygen to 6 L/min (>3 L/min) unless necessary.
d) Prepare for intubation
A patient with a chest tube has continuous bubbling in the wa-
Answer: c) An air leak is present
ter-seal chamber. What does this indicate?
Rationale: Continuous bubbling suggests air is leaking into the
a) Normal function
system and should be reported.
b) A pneumothorax has resolved
Helpful Note: Intermittent bubbling is normal in a pneumothorax as
c) An air leak is present
air escapes from the pleural space.
d) The tube is blocked
A nurse is evaluating a patient's understanding of pursed-lip
breathing for COPD. Which statement indicates correct tech-
nique?
Answer: b) "I will inhale slowly through my nose and exhale
a) "I will inhale quickly through my nose and exhale forcefully
through pursed lips twice as long."
through my mouth."
Rationale: Pursed-lip breathing helps prevent air trapping and
b) "I will inhale slowly through my nose and exhale through pursed
promotes better oxygenation by prolonging exhalation.
lips twice as long."
Helpful Note: "Inhale through the nose for 2 seconds, exhale
c) "I will breathe in and out through my mouth quickly to expel
through pursed lips for 4 seconds."
carbon dioxide."
d) "I will hold my breath for 10 seconds before exhaling through
my nose."
A patient with influenza is prescribed oseltamivir (Tamiflu). Which
statement by the patient requires further teaching?
Answer: b) "This medication will cure my flu completely."
a) "I should start this medication within 48 hours of symptom
Rationale: Antiviral medications like oseltamivir do not cure the flu
onset."
but reduce the severity and duration of symptoms if started early.
b) "This medication will cure my flu completely."
Helpful Note: Patients should continue infection control measures
c) "I might still be contagious even while taking the medication."
even while taking antivirals.
d) "This medication may help reduce the severity of my symp-
toms."
2/5
