NCLEX RN Respiratory Disorders
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A client with a history of asthma presents to the emergency department
with severe dyspnea, wheezing, and a prolonged expiratory phase. The
client’s arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 55
mmHg, and PaO2 of 60 mmHg. Which finding indicates that the client is
experiencing a respiratory acidosis and requires immediate intervention?
Answer: The client’s breath sounds are silent with no audible wheezing.
Rationale: A silent chest in a client with asthma is a life-threatening sign
indicating severe airway obstruction and impending respiratory failure.
The absence of wheezing does not mean improvement; rather, it means
that there is insufficient airflow to produce sound. This, combined with
elevated PaCO2 and low pH, confirms respiratory acidosis from
hypercapnia, requiring immediate intervention such as intubation or
aggressive bronchodilator therapy. The nurse must recognize this as a
medical emergency and prepare for advanced airway management.
2. The nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who is receiving continuous oxygen at 2 liters per minute via nasal
cannula. The client’s oxygen saturation is 90% and the respiratory rate is 22
breaths per minute. Which action should the nurse take first when the
client’s oxygen saturation drops to 85% and the respiratory rate increases to
30?
Answer: Reassess the client’s airway and breathing, then increase the
oxygen flow rate to 4 L/min.
, Rationale: In COPD clients, the hypoxic drive is a compensatory
mechanism; however, when the client is acutely deteriorating with a drop
in SpO2 and tachypnea, the priority is to restore adequate oxygenation.
Increasing the oxygen flow rate temporarily is indicated, but the nurse
must first ensure the airway is patent and breath sounds are audible. The
classic teaching to avoid high oxygen in COPD applies to stable chronic
states, not acute decompensation where severe hypoxia poses a greater
risk than oxygen-induced hypercapnia. The nurse should adjust oxygen to
achieve SpO2 of 88-92% while closely monitoring for changes in mental
status.
3. A client diagnosed with community-acquired pneumonia is prescribed
levofloxacin. The client asks the nurse about the purpose of this medication.
Which explanation by the nurse is most accurate?
Answer: Levofloxacin kills the bacteria causing your pneumonia by
interfering with the bacteria’s ability to replicate.
Rationale: Levofloxacin is a fluoroquinolone antibiotic that works by
inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential
for DNA replication and transcription. This bactericidal action effectively
eradicates the bacterial pathogens commonly responsible for community-
acquired pneumonia, such as Streptococcus pneumoniae and atypical
organisms. The nurse should also educate the client about potential side
effects, including tendon rupture and photosensitivity, and the importance
of completing the full course of therapy to prevent resistance.
4. A client with a pneumothorax has a chest tube inserted and is connected to
a water-seal drainage system. The nurse observes continuous bubbling in
the water-seal chamber. Which action should the nurse take?
Answer: Check the entire drainage system for leaks and ensure all
connections are tight.
Rationale: Continuous bubbling in the water-seal chamber indicates that
air is leaking into the system, which can occur from a leak in the tubing
connections, a dislodged chest tube, or a leak in the drainage unit itself.
This is not the normal intermittent bubbling that should occur with
, expiration. The nurse must systematically inspect the system, auscultate
for subcutaneous emphysema, and assess the insertion site. If a leak is
found, the nurse should tighten connections or apply a sterile occlusive
dressing if the tube is dislodged. Continuous bubbling could also indicate
an air leak from the lung parenchyma, which requires notification of the
healthcare provider.
5. A client is receiving mechanical ventilation with a tidal volume of 500 mL
and a respiratory rate of 14 breaths per minute. The peak inspiratory
pressure alarm sounds. Which assessment finding is most likely the cause of
this high-pressure alarm?
Answer: The client is biting on the endotracheal tube, causing increased
resistance to airflow.
Rationale: The peak inspiratory pressure alarm indicates that the pressure
required to deliver the set tidal volume has increased. Common causes
include airway obstruction from secretions, bronchospasm, biting the
tube, or a pneumothorax. Biting the tube is a frequently overlooked cause
that increases resistance and triggers the high-pressure alarm. The nurse
should assess the client’s oral airway, check for biting, and if present,
insert a bite block or oral airway. Other actions include suctioning for
secretions, assessing breath sounds for wheezing, and checking for
tension pneumothorax. The nurse must not ignore the alarm and should
prioritize identifying and correcting the underlying cause.
6. A nurse is teaching a client with asthma about how to use a metered-dose
inhaler (MDI) with a spacer device. Which statement by the client indicates
a need for further teaching?
Answer: I will breathe out completely, place the inhaler in my mouth, and
spray while taking a quick, shallow breath.
Rationale: The correct technique for using an MDI with a spacer involves
placing the mouthpiece between the lips, exhaling gently (not completely)
to functional residual capacity, then activating the inhaler and taking a
slow, deep breath over 3 to 5 seconds. A quick, shallow breath does not
allow the medication to reach the lower airways effectively. The client
, should then hold the breath for 5 to 10 seconds to allow deposition of the
drug. The nurse should demonstrate the proper technique and have the
client return demonstrate to ensure correct use, which is crucial for
effective asthma management.
7. A client with severe pneumonia has an arterial blood gas analysis showing a
pH of 7.32, PaCO2 of 48 mmHg, and HCO3 of 22 mEq/L. The nurse
interprets these results as indicating which acid-base imbalance?
Answer: Respiratory acidosis with no metabolic compensation.
Rationale: The pH is low (acidemic) at 7.32, and the PaCO2 is elevated at
48 mmHg, which indicates respiratory acidosis. The HCO3 is within the
normal range (22-26 mEq/L), suggesting that the kidneys have not had
time to retain bicarbonate to compensate for the respiratory acidosis. This
is an acute respiratory acidosis because the PaCO2 is high and the
bicarbonate is normal. The client’s pneumonia impairs gas exchange,
leading to carbon dioxide retention. The nurse should assess the client’s
respiratory status, consider the need for noninvasive ventilation or
intubation, and address the underlying cause of hypoventilation.
8. The nurse is preparing to administer a prescribed dose of albuterol via
nebulizer to a client with an acute asthma exacerbation. The client’s heart
rate is 120 beats per minute. Which action should the nurse take?
Answer: Administer the albuterol as prescribed, because the tachycardia
is likely related to the asthma exacerbation and the drug will improve
oxygenation.
Rationale: Tachycardia in a client with asthma exacerbation is often due to
hypoxia, sympathetic stimulation, and the systemic effects of endogenous
catecholamines. Albuterol is a beta-2 selective agonist that
bronchodilates, but it can also cause mild tachycardia; however,
withholding the medication would be inappropriate because the primary
goal is to relieve bronchospasm and improve oxygenation. The nurse
should administer the albuterol and monitor the heart rate before and
after administration. If the tachycardia worsens significantly or the client
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A client with a history of asthma presents to the emergency department
with severe dyspnea, wheezing, and a prolonged expiratory phase. The
client’s arterial blood gas (ABG) results show a pH of 7.30, PaCO2 of 55
mmHg, and PaO2 of 60 mmHg. Which finding indicates that the client is
experiencing a respiratory acidosis and requires immediate intervention?
Answer: The client’s breath sounds are silent with no audible wheezing.
Rationale: A silent chest in a client with asthma is a life-threatening sign
indicating severe airway obstruction and impending respiratory failure.
The absence of wheezing does not mean improvement; rather, it means
that there is insufficient airflow to produce sound. This, combined with
elevated PaCO2 and low pH, confirms respiratory acidosis from
hypercapnia, requiring immediate intervention such as intubation or
aggressive bronchodilator therapy. The nurse must recognize this as a
medical emergency and prepare for advanced airway management.
2. The nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who is receiving continuous oxygen at 2 liters per minute via nasal
cannula. The client’s oxygen saturation is 90% and the respiratory rate is 22
breaths per minute. Which action should the nurse take first when the
client’s oxygen saturation drops to 85% and the respiratory rate increases to
30?
Answer: Reassess the client’s airway and breathing, then increase the
oxygen flow rate to 4 L/min.
, Rationale: In COPD clients, the hypoxic drive is a compensatory
mechanism; however, when the client is acutely deteriorating with a drop
in SpO2 and tachypnea, the priority is to restore adequate oxygenation.
Increasing the oxygen flow rate temporarily is indicated, but the nurse
must first ensure the airway is patent and breath sounds are audible. The
classic teaching to avoid high oxygen in COPD applies to stable chronic
states, not acute decompensation where severe hypoxia poses a greater
risk than oxygen-induced hypercapnia. The nurse should adjust oxygen to
achieve SpO2 of 88-92% while closely monitoring for changes in mental
status.
3. A client diagnosed with community-acquired pneumonia is prescribed
levofloxacin. The client asks the nurse about the purpose of this medication.
Which explanation by the nurse is most accurate?
Answer: Levofloxacin kills the bacteria causing your pneumonia by
interfering with the bacteria’s ability to replicate.
Rationale: Levofloxacin is a fluoroquinolone antibiotic that works by
inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes essential
for DNA replication and transcription. This bactericidal action effectively
eradicates the bacterial pathogens commonly responsible for community-
acquired pneumonia, such as Streptococcus pneumoniae and atypical
organisms. The nurse should also educate the client about potential side
effects, including tendon rupture and photosensitivity, and the importance
of completing the full course of therapy to prevent resistance.
4. A client with a pneumothorax has a chest tube inserted and is connected to
a water-seal drainage system. The nurse observes continuous bubbling in
the water-seal chamber. Which action should the nurse take?
Answer: Check the entire drainage system for leaks and ensure all
connections are tight.
Rationale: Continuous bubbling in the water-seal chamber indicates that
air is leaking into the system, which can occur from a leak in the tubing
connections, a dislodged chest tube, or a leak in the drainage unit itself.
This is not the normal intermittent bubbling that should occur with
, expiration. The nurse must systematically inspect the system, auscultate
for subcutaneous emphysema, and assess the insertion site. If a leak is
found, the nurse should tighten connections or apply a sterile occlusive
dressing if the tube is dislodged. Continuous bubbling could also indicate
an air leak from the lung parenchyma, which requires notification of the
healthcare provider.
5. A client is receiving mechanical ventilation with a tidal volume of 500 mL
and a respiratory rate of 14 breaths per minute. The peak inspiratory
pressure alarm sounds. Which assessment finding is most likely the cause of
this high-pressure alarm?
Answer: The client is biting on the endotracheal tube, causing increased
resistance to airflow.
Rationale: The peak inspiratory pressure alarm indicates that the pressure
required to deliver the set tidal volume has increased. Common causes
include airway obstruction from secretions, bronchospasm, biting the
tube, or a pneumothorax. Biting the tube is a frequently overlooked cause
that increases resistance and triggers the high-pressure alarm. The nurse
should assess the client’s oral airway, check for biting, and if present,
insert a bite block or oral airway. Other actions include suctioning for
secretions, assessing breath sounds for wheezing, and checking for
tension pneumothorax. The nurse must not ignore the alarm and should
prioritize identifying and correcting the underlying cause.
6. A nurse is teaching a client with asthma about how to use a metered-dose
inhaler (MDI) with a spacer device. Which statement by the client indicates
a need for further teaching?
Answer: I will breathe out completely, place the inhaler in my mouth, and
spray while taking a quick, shallow breath.
Rationale: The correct technique for using an MDI with a spacer involves
placing the mouthpiece between the lips, exhaling gently (not completely)
to functional residual capacity, then activating the inhaler and taking a
slow, deep breath over 3 to 5 seconds. A quick, shallow breath does not
allow the medication to reach the lower airways effectively. The client
, should then hold the breath for 5 to 10 seconds to allow deposition of the
drug. The nurse should demonstrate the proper technique and have the
client return demonstrate to ensure correct use, which is crucial for
effective asthma management.
7. A client with severe pneumonia has an arterial blood gas analysis showing a
pH of 7.32, PaCO2 of 48 mmHg, and HCO3 of 22 mEq/L. The nurse
interprets these results as indicating which acid-base imbalance?
Answer: Respiratory acidosis with no metabolic compensation.
Rationale: The pH is low (acidemic) at 7.32, and the PaCO2 is elevated at
48 mmHg, which indicates respiratory acidosis. The HCO3 is within the
normal range (22-26 mEq/L), suggesting that the kidneys have not had
time to retain bicarbonate to compensate for the respiratory acidosis. This
is an acute respiratory acidosis because the PaCO2 is high and the
bicarbonate is normal. The client’s pneumonia impairs gas exchange,
leading to carbon dioxide retention. The nurse should assess the client’s
respiratory status, consider the need for noninvasive ventilation or
intubation, and address the underlying cause of hypoventilation.
8. The nurse is preparing to administer a prescribed dose of albuterol via
nebulizer to a client with an acute asthma exacerbation. The client’s heart
rate is 120 beats per minute. Which action should the nurse take?
Answer: Administer the albuterol as prescribed, because the tachycardia
is likely related to the asthma exacerbation and the drug will improve
oxygenation.
Rationale: Tachycardia in a client with asthma exacerbation is often due to
hypoxia, sympathetic stimulation, and the systemic effects of endogenous
catecholamines. Albuterol is a beta-2 selective agonist that
bronchodilates, but it can also cause mild tachycardia; however,
withholding the medication would be inappropriate because the primary
goal is to relieve bronchospasm and improve oxygenation. The nurse
should administer the albuterol and monitor the heart rate before and
after administration. If the tachycardia worsens significantly or the client
