NCLEX RN Next Generation NGN Case
Study Exam 7 Questions And Correct
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CASE STUDY 1 — ACUTE RESPIRATORY DISTRESS
A 68-year-old client with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increasing
shortness of breath, productive cough, and fatigue. The client reports
that symptoms worsened over the past 3 days.
Assessment findings:
Temperature: 38.4°C (101.1°F)
Heart rate: 108/min
Respiratory rate: 30/min
Blood pressure: 146/84 mm Hg
Oxygen saturation: 84% on room air
Audible wheezing
Thick yellow-green sputum
Use of accessory muscles
1. Which finding requires the nurse's immediate attention?
,A. Temperature of 38.4°C
B. Productive cough
C. Oxygen saturation of 84%
D. Heart rate of 108/min
Answer: C. Oxygen saturation of 84%
Rationale: Severe hypoxemia is the priority because impaired
oxygenation can rapidly become life-threatening. Airway and breathing
take priority over fever, cough, and mild tachycardia.
2. Which nursing action should the nurse take first?
A. Obtain a sputum specimen
B. Place the client in high-Fowler's position
C. Administer an oral antibiotic
D. Encourage oral fluids
Answer: B. Place the client in high-Fowler's position
Rationale: Positioning upright promotes lung expansion and decreases
the work of breathing. Immediate support of oxygenation and
ventilation takes priority.
3. Which prescription should the nurse implement first?
A. Obtain a chest x-ray
B. Administer prescribed supplemental oxygen
C. Collect a sputum culture
D. Administer an antipyretic
Answer: B. Administer prescribed supplemental oxygen
Rationale: The client has significant hypoxemia. Oxygen therapy should
be initiated promptly while the nurse continues assessment and
treatment.
,4. Which findings are consistent with an acute COPD exacerbation?
Select all that apply.
A. Increased sputum production
B. Purulent sputum
C. Respiratory distress
D. Oxygen saturation of 84%
E. Bradycardia
F. Clear lung sounds without distress
Answer: A. Increased sputum production; B. Purulent sputum; C.
Respiratory distress; D. Oxygen saturation of 84%
Rationale: COPD exacerbations commonly produce increased dyspnea,
sputum production, sputum purulence, wheezing, and hypoxemia.
5. The nurse administers oxygen by nasal cannula. Which finding
indicates improvement?
A. Respiratory rate decreases from 30/min to 22/min
B. Client becomes increasingly drowsy
C. Oxygen saturation decreases to 80%
D. Accessory muscle use increases
Answer: A. Respiratory rate decreases from 30/min to 22/min
Rationale: A reduction in respiratory rate and work of breathing
indicates improved ventilation and respiratory effort.
6. Which medication would the nurse expect to administer to relieve
bronchospasm?
A. Albuterol
B. Furosemide
C. Warfarin
D. Metoprolol
, Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that
produces bronchodilation and helps relieve acute bronchospasm.
7. Which assessment findings should the nurse monitor after
administering albuterol? Select all that apply.
A. Heart rate
B. Tremors
C. Respiratory status
D. Potassium level
E. Bowel sounds only
Answer: A. Heart rate; B. Tremors; C. Respiratory status; D. Potassium
level
Rationale: Albuterol can cause tachycardia, tremors, and hypokalemia.
Respiratory status must be monitored to determine therapeutic
response.
8. The client's arterial blood gas results are: pH 7.31, PaCO₂ 58 mm Hg,
HCO₃⁻ 28 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis with compensation
D. Metabolic alkalosis
Answer: C. Respiratory acidosis with compensation
Rationale: The low pH and elevated PaCO₂ indicate respiratory acidosis.
The elevated bicarbonate suggests renal compensation, which is
common in chronic CO₂ retention.
9. Which client statement indicates a need for additional teaching?
Study Exam 7 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
CASE STUDY 1 — ACUTE RESPIRATORY DISTRESS
A 68-year-old client with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increasing
shortness of breath, productive cough, and fatigue. The client reports
that symptoms worsened over the past 3 days.
Assessment findings:
Temperature: 38.4°C (101.1°F)
Heart rate: 108/min
Respiratory rate: 30/min
Blood pressure: 146/84 mm Hg
Oxygen saturation: 84% on room air
Audible wheezing
Thick yellow-green sputum
Use of accessory muscles
1. Which finding requires the nurse's immediate attention?
,A. Temperature of 38.4°C
B. Productive cough
C. Oxygen saturation of 84%
D. Heart rate of 108/min
Answer: C. Oxygen saturation of 84%
Rationale: Severe hypoxemia is the priority because impaired
oxygenation can rapidly become life-threatening. Airway and breathing
take priority over fever, cough, and mild tachycardia.
2. Which nursing action should the nurse take first?
A. Obtain a sputum specimen
B. Place the client in high-Fowler's position
C. Administer an oral antibiotic
D. Encourage oral fluids
Answer: B. Place the client in high-Fowler's position
Rationale: Positioning upright promotes lung expansion and decreases
the work of breathing. Immediate support of oxygenation and
ventilation takes priority.
3. Which prescription should the nurse implement first?
A. Obtain a chest x-ray
B. Administer prescribed supplemental oxygen
C. Collect a sputum culture
D. Administer an antipyretic
Answer: B. Administer prescribed supplemental oxygen
Rationale: The client has significant hypoxemia. Oxygen therapy should
be initiated promptly while the nurse continues assessment and
treatment.
,4. Which findings are consistent with an acute COPD exacerbation?
Select all that apply.
A. Increased sputum production
B. Purulent sputum
C. Respiratory distress
D. Oxygen saturation of 84%
E. Bradycardia
F. Clear lung sounds without distress
Answer: A. Increased sputum production; B. Purulent sputum; C.
Respiratory distress; D. Oxygen saturation of 84%
Rationale: COPD exacerbations commonly produce increased dyspnea,
sputum production, sputum purulence, wheezing, and hypoxemia.
5. The nurse administers oxygen by nasal cannula. Which finding
indicates improvement?
A. Respiratory rate decreases from 30/min to 22/min
B. Client becomes increasingly drowsy
C. Oxygen saturation decreases to 80%
D. Accessory muscle use increases
Answer: A. Respiratory rate decreases from 30/min to 22/min
Rationale: A reduction in respiratory rate and work of breathing
indicates improved ventilation and respiratory effort.
6. Which medication would the nurse expect to administer to relieve
bronchospasm?
A. Albuterol
B. Furosemide
C. Warfarin
D. Metoprolol
, Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that
produces bronchodilation and helps relieve acute bronchospasm.
7. Which assessment findings should the nurse monitor after
administering albuterol? Select all that apply.
A. Heart rate
B. Tremors
C. Respiratory status
D. Potassium level
E. Bowel sounds only
Answer: A. Heart rate; B. Tremors; C. Respiratory status; D. Potassium
level
Rationale: Albuterol can cause tachycardia, tremors, and hypokalemia.
Respiratory status must be monitored to determine therapeutic
response.
8. The client's arterial blood gas results are: pH 7.31, PaCO₂ 58 mm Hg,
HCO₃⁻ 28 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis with compensation
D. Metabolic alkalosis
Answer: C. Respiratory acidosis with compensation
Rationale: The low pH and elevated PaCO₂ indicate respiratory acidosis.
The elevated bicarbonate suggests renal compensation, which is
common in chronic CO₂ retention.
9. Which client statement indicates a need for additional teaching?
