NCLEX Question of the Day – Monday, March 30, 2026

Today’s question targets priority action in a changing clinical situation, a skill that matters on every shift. The NCLEX often tests whether you can spot the most urgent risk, connect it to the patient’s history, and act before the problem gets worse. In real nursing, that is the difference between routine care and timely intervention.

Clinical Scenario

A 68-year-old man is admitted to a medical-surgical unit with community-acquired pneumonia. He has a history of chronic obstructive pulmonary disease, type 2 diabetes, and hypertension. He has been receiving oxygen at 2 L/min by nasal cannula, IV fluids, and prescribed antibiotics.

At 1000, the nurse finds him sitting upright and looking restless. He says, “I feel more short of breath than earlier.” His respiratory rate is 30/min, heart rate is 112/min, blood pressure is 148/86 mm Hg, temperature is 37.9 C (100.2 F), and oxygen saturation is 88% on 2 L/min by nasal cannula. Lung sounds reveal coarse crackles in the right lower lobe. He is alert but using accessory muscles to breathe.

The Question

Which action should the nurse take first?

Answer Choices

1. Increase the oxygen flow rate and place the patient in high-Fowler position.
2. Administer the next scheduled dose of IV antibiotic early.
3. Encourage the patient to use the incentive spirometer 10 times.
4. Obtain a sputum specimen for culture and sensitivity.

Correct Answer

A. Increase the oxygen flow rate and place the patient in high-Fowler position.

Detailed Rationale

This is a priority question about airway and breathing. The patient has several signs of worsening respiratory status: increased work of breathing, tachypnea, low oxygen saturation, restlessness, and accessory muscle use. Restlessness matters because it can be an early sign of hypoxia before a patient becomes confused or lethargic.

The nurse should act on the most immediate problem first, which is impaired oxygenation. Raising the head of the bed to high-Fowler position improves lung expansion and reduces the work of breathing. Increasing oxygen, based on the patient’s current order, addresses the low saturation right away. If oxygen needs exceed the current order or unit protocol, the nurse should still apply immediate supportive measures and notify the provider or respiratory therapy promptly.

After that first action, the nurse should continue a focused respiratory assessment. This includes checking respiratory effort, skin color, mental status, breath sounds, pulse oximetry trend, and response to the oxygen increase. The nurse should also reassess whether the patient can speak in full sentences, whether accessory muscle use improves, and whether the oxygen saturation rises to a safer range.

Next steps would include notifying the provider of the change in status, preparing for possible escalation of oxygen delivery, and reviewing recent labs and imaging if available. Depending on facility protocol and the patient’s response, the nurse may need respiratory therapy, arterial blood gases, or a chest x-ray. Because he has pneumonia and COPD, careful monitoring is important. The goal is not just to raise the number on the pulse oximeter, but to improve actual breathing effort and gas exchange.

One practical point: patients with COPD can retain carbon dioxide, so oxygen should be titrated thoughtfully. But that does not mean withholding oxygen from a hypoxic patient. Hypoxia is the immediate threat. The nurse treats the breathing problem first, then monitors closely for effectiveness and for signs of carbon dioxide retention if that is a concern.

Why the Other Options Are Wrong

B. Administer the next scheduled dose of IV antibiotic early.

Antibiotics are important for treating pneumonia, but they do not fix acute hypoxia in the moment. Infection treatment helps over hours to days. This patient is showing signs of respiratory distress now, so breathing support comes first.

C. Encourage the patient to use the incentive spirometer 10 times.

Incentive spirometry can help improve ventilation and prevent atelectasis, but it is not the first action for a patient who is already struggling to breathe and has an oxygen saturation of 88%. Asking him to do repeated deep breaths before stabilizing him may increase fatigue.

D. Obtain a sputum specimen for culture and sensitivity.

A sputum culture may be useful if the provider needs more information about the infection, especially if the patient is not improving. However, this is not the priority when the patient has signs of worsening oxygenation. Assessment and intervention for airway and breathing come before diagnostic tasks.

Key Takeaways

• Use ABCs first. Low oxygen saturation plus increased work of breathing means breathing is the priority.
• Restlessness can be an early sign of hypoxia. Do not wait for severe confusion or cyanosis.
• Positioning matters. High-Fowler can improve chest expansion quickly.
• Oxygen is a treatment, not just a number adjustment. Reassess the patient, not only the pulse oximeter.
• In COPD, titrate oxygen carefully, but do not delay treating hypoxia.

• On-shift mini-checklist:
• Raise the head of the bed.
• Increase oxygen per order or protocol.
• Reassess respiratory rate, effort, lung sounds, mental status, and oxygen saturation.
• Notify the provider or respiratory therapy if the patient does not improve quickly.
• Prepare for further interventions if breathing worsens.

Quick Practice Extension

1. If this patient becomes drowsy and his oxygen saturation remains 88% despite a higher oxygen flow rate, what finding would make you suspect carbon dioxide retention or respiratory fatigue?

2. A patient with pneumonia reports chest pain when coughing and has thick secretions. Which nursing interventions would best support airway clearance while avoiding unnecessary fatigue?

Category: Med-Surg

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