Respiratory conditions NCLEX-RN Practice Questions

Respiratory conditions NCLEX-RN Practice Questions

Mastering respiratory conditions is essential for safe practice and success on the NCLEX-RN, especially within the Physiological Adaptation domain. This topic-wise question set helps you apply core concepts such as gas exchange, airway management, ventilator alarms, acid–base balance, oxygen delivery systems, and priority decision-making. You’ll encounter scenarios on asthma, COPD, pneumonia, ARDS, pulmonary embolism, chest tubes, tracheostomy care, tuberculosis pharmacotherapy, and more. Each question mirrors NCLEX-style complexity and emphasizes clinical judgment, safety, and evidence-based interventions. Whether you’re refining pharmacologic insights or honing assessment and prioritization skills, these practice questions will help you confidently navigate high-stakes respiratory situations commonly seen in acute and chronic care settings.

Q1. A client with COPD presents with worsening dyspnea and an SpO2 of 88% on room air. Which nursing action is the priority?

• Apply a Venturi mask at prescribed FiO2 and reassess oxygenation
• Encourage incentive spirometry for 10 breaths hourly
• Start a nonrebreather mask at 15 L/min immediately
• Position the client supine to improve perfusion

Correct Answer: Apply a Venturi mask at prescribed FiO2 and reassess oxygenation

Q2. A client with asthma uses a short-acting beta2-agonist (albuterol) and an inhaled corticosteroid (fluticasone). Which teaching is correct?

• Use the corticosteroid first, then the bronchodilator to enhance steroid deposition
• Rinse the mouth after the corticosteroid to reduce risk of oral thrush
• Use albuterol on a fixed schedule twice daily to prevent attacks
• Use both inhalers only when symptoms occur to minimize adverse effects

Correct Answer: Rinse the mouth after the corticosteroid to reduce risk of oral thrush

Q3. The nurse reviews ABGs for a client with COPD exacerbation: pH 7.30, PaCO2 58 mm Hg, HCO3− 24 mEq/L, PaO2 60 mm Hg. Which interpretation is most accurate?

• Uncompensated metabolic acidosis with hypoxemia
• Uncompensated respiratory acidosis with hypoxemia
• Partially compensated respiratory alkalosis with mild hypoxemia
• Fully compensated respiratory acidosis with adequate oxygenation

Correct Answer: Uncompensated respiratory acidosis with hypoxemia

Q4. A postoperative client is at high risk for atelectasis. Which instruction regarding incentive spirometry is correct?

• Exhale forcefully into the device for 10 repetitions every hour
• Inhale slowly to raise the marker, hold for 3–5 seconds, repeat 10 times hourly
• Perform 3–4 deep breaths once per shift to minimize fatigue
• Use after meals only to synchronize with diaphragmatic movement

Correct Answer: Inhale slowly to raise the marker, hold for 3–5 seconds, repeat 10 times hourly

Q5. A client with pneumonia is to receive IV antibiotics. Which action should the nurse perform first?

• Administer the first dose of broad-spectrum antibiotic
• Obtain sputum culture and sensitivity
• Encourage oral fluids and ambulation
• Administer acetaminophen for fever

Correct Answer: Obtain sputum culture and sensitivity

Q6. A client with suspected pulmonary embolism develops sudden dyspnea and pleuritic chest pain. Which is the priority nursing action?

• Prepare for immediate chest physiotherapy
• Place the client in high Fowler’s position and administer oxygen
• Encourage coughing and deep breathing exercises
• Initiate IV fluids at a rapid rate

Correct Answer: Place the client in high Fowler’s position and administer oxygen

Q7. The chest tube of a client with a pneumothorax shows continuous bubbling in the water-seal chamber. What is the best interpretation?

• This is expected and indicates effective lung re-expansion
• An air leak is present; assess connections and the insertion site
• The suction is set too low; increase the suction regulator
• The system needs to be clamped to stop the bubbling

Correct Answer: An air leak is present; assess connections and the insertion site

Q8. A ventilated client triggers a high-pressure alarm. Which assessment should the nurse perform first?

• Check for tubing disconnection at the Y-connector
• Auscultate breath sounds for possible secretions or bronchospasm
• Decrease the tidal volume to reduce airway pressure
• Silence the alarm and reassess in 10 minutes

Correct Answer: Auscultate breath sounds for possible secretions or bronchospasm

Q9. A client with active tuberculosis is prescribed isoniazid, rifampin, pyrazinamide, and ethambutol. Which teaching is most important to include?

• Report yellowing of the skin or eyes immediately
• Expect blue discoloration of urine, which is harmless
• Take pyridoxine (vitamin B6) only if neuropathy develops
• Wear contact lenses to prevent rifampin eye staining

Correct Answer: Report yellowing of the skin or eyes immediately

Q10. A client with asthma is prescribed theophylline. Which statement indicates understanding of medication teaching?

• “I will take this with high-fat meals to increase absorption.”
• “I will avoid caffeinated beverages while on this drug.”
• “I can double the dose if my wheezing worsens.”
• “Routine blood tests are unnecessary after the dose is stable.”

Correct Answer: I will avoid caffeinated beverages while on this drug.

Q11. A client has an SpO2 of 85% with good pleth waveform. The nurse applies a nonrebreather mask at 15 L/min. What finding indicates correct use?

• Reservoir bag remains partially inflated during inspiration
• Reservoir bag fully collapses with each inspiration
• Exhalation valves are removed to allow room air entrainment
• FiO2 delivered is 100% consistently

Correct Answer: Reservoir bag remains partially inflated during inspiration

Q12. Which assessment finding in a client with suspected tension pneumothorax requires immediate intervention?

• Decreased breath sounds on the right and dullness to percussion
• Tracheal deviation away from the affected side and hypotension
• Pleuritic chest pain relieved by leaning forward
• Crackles in both bases and orthopnea

Correct Answer: Tracheal deviation away from the affected side and hypotension

Q13. A client with ARDS is on mechanical ventilation with high PEEP. Which complication should the nurse monitor for most closely?

• Hypertension due to increased intrathoracic pressure
• Airway edema requiring racemic epinephrine
• Barotrauma and decreased venous return causing hypotension
• Metabolic alkalosis from carbon dioxide retention

Correct Answer: Barotrauma and decreased venous return causing hypotension

Q14. The nurse prepares to suction a client with a tracheostomy. Which step is correct?

• Apply continuous suction while advancing the catheter
• Limit each suction pass to 10 seconds and oxygenate between passes
• Instill normal saline to loosen secretions routinely
• Use clean technique to reduce complexity

Correct Answer: Limit each suction pass to 10 seconds and oxygenate between passes

Q15. Which client should the nurse see first after shift report?

• Asthma client with expiratory wheezing and relief after albuterol
• Pneumonia client with fever 38.3°C reporting productive cough
• PE client with hemoptysis and new-onset confusion
• COPD client requesting assistance to ambulate to the bathroom

Correct Answer: PE client with hemoptysis and new-onset confusion

Q16. A client with cystic fibrosis requires chest physiotherapy (CPT) and pancreatic enzymes. Which plan is best?

• Administer pancreatic enzymes at bedtime; perform CPT after large meals
• Perform CPT before meals; administer pancreatic enzymes with meals and snacks
• Perform CPT immediately after meals; administer enzymes on an empty stomach
• Hold CPT if secretions are thick; rely on increased fluids only

Correct Answer: Perform CPT before meals; administer pancreatic enzymes with meals and snacks

Q17. A client with COPD is maintained on 28% FiO2 by Venturi mask. The nurse notes drowsiness and a rising PaCO2. Which action is most appropriate?

• Increase FiO2 to 60% to improve oxygenation rapidly
• Notify the provider; assess for CO2 narcosis and anticipate adjusting oxygen and ventilation
• Remove oxygen to stimulate respiratory drive
• Switch to a nonrebreather mask for higher FiO2

Correct Answer: Notify the provider; assess for CO2 narcosis and anticipate adjusting oxygen and ventilation

Q18. The nurse teaches a client with asthma to use a peak flow meter. Which statement indicates correct understanding?

• “I will use it after my controller inhaler to check improvement.”
• “In the red zone, I will use my rescue inhaler and seek emergency care if not improving.”
• “A reading in the yellow zone means I should rest and repeat in 24 hours.”
• “I exhale slowly into the device for my best reading.”

Correct Answer: In the red zone, I will use my rescue inhaler and seek emergency care if not improving.

Q19. A client with suspected aspiration pneumonia after a stroke has dysphagia. Which intervention takes priority?

• Provide thin liquids with a straw for easy intake
• Keep NPO until a swallow evaluation is completed
• Offer large bites with alternating sips of water
• Place in supine position to prevent fatigue during feeding

Correct Answer: Keep NPO until a swallow evaluation is completed

Q20. The nurse recognizes early signs of hypoxemia in a postoperative client. Which findings are most consistent?

• Bradycardia and somnolence
• Restlessness and tachycardia
• Hypotension and cyanosis
• Clubbing and barrel chest

Correct Answer: Restlessness and tachycardia

Q21. A client with community-acquired pneumonia is prescribed levofloxacin. Which teaching is essential?

• Avoid dairy products due to risk of severe hypokalemia
• Report tendon pain or swelling promptly
• Expect dark orange urine as a harmless side effect
• Take with antacids to reduce GI upset

Correct Answer: Report tendon pain or swelling promptly

Q22. A client with a new tracheostomy becomes acutely dyspneic and the SpO2 drops. The nurse notes decreased airflow through the trach. What is the priority action?

• Deflate the cuff and remove the inner cannula
• Remove and clean the obturator
• Assess for mucus plug and suction the tracheostomy
• Apply a speaking valve to improve airflow

Correct Answer: Assess for mucus plug and suction the tracheostomy

Q23. A client presents with fever, night sweats, weight loss, and hemoptysis. Airborne precautions are initiated. Which room assignment is appropriate?

• Private room with droplet precautions
• Negative pressure airborne isolation room
• Cohort with another client with pneumonia
• Positive pressure room to prevent contamination

Correct Answer: Negative pressure airborne isolation room

Q24. The nurse evaluates teaching for a client using an inhaled corticosteroid and a long-acting beta2-agonist (LABA) combination. Which indicates correct use?

• “I will use this inhaler for acute wheezing episodes.”
• “I should use this every day, even if I feel well.”
• “If I skip a dose, I will double the next dose.”
• “I will stop it if I develop a cough.”

Correct Answer: I should use this every day, even if I feel well.

Q25. The nurse assesses an elderly client with pneumonia for fluid status. Which finding best indicates effective hydration therapy?

• Crackles persist but heart rate increases
• Urine output ≥0.5 mL/kg/hr and thinning secretions
• Dry mucous membranes and concentrated urine
• Increased BUN/creatinine ratio with thick sputum

Correct Answer: Urine output ≥0.5 mL/kg/hr and thinning secretions

Q26. During care of a client with an open chest wound, which immediate action is appropriate?

• Apply a sterile occlusive dressing taped on three sides
• Insert a chest tube at the bedside without provider order
• Seal the wound on all four sides to prevent any airflow
• Cover with dry gauze and no tape to allow bleeding to escape

Correct Answer: Apply a sterile occlusive dressing taped on three sides

Q27. A client on mechanical ventilation triggers a low-pressure alarm. What is the most likely cause?

• Secretions causing airway obstruction
• Disconnection or leak in the ventilator circuit
• Biting on the endotracheal tube
• Bronchospasm with increased airway resistance

Correct Answer: Disconnection or leak in the ventilator circuit

Q28. The nurse prepares to administer montelukast to a client with asthma. Which statement is accurate?

• It is used as a rescue medication during acute bronchospasm
• It is a leukotriene receptor antagonist for long-term control
• It causes bronchodilation within minutes of dosing
• It should be taken only when symptoms worsen

Correct Answer: It is a leukotriene receptor antagonist for long-term control

Q29. A client with ARDS has refractory hypoxemia despite high FiO2. Which intervention can improve oxygenation?

• Prone positioning to improve ventilation–perfusion matching
• Lowering PEEP to reduce alveolar overdistension
• Restricting all fluids to prevent pulmonary edema
• Increasing tidal volume to 10–12 mL/kg to recruit alveoli

Correct Answer: Prone positioning to improve ventilation–perfusion matching

Q30. The nurse evaluates a client with COPD on home oxygen. Which outcome indicates appropriate oxygen therapy?

• SpO2 maintained at 88–92% at rest and with activity as prescribed
• SpO2 consistently 100% to maximize oxygen delivery
• Elimination of dyspnea with exertion
• Decreased respiratory rate to less than 10/min at rest

Correct Answer: SpO2 maintained at 88–92% at rest and with activity as prescribed

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