NCLEX Question of the Day – Friday, May 22, 2026

Today’s question focuses on Med-Surg priority setting in a patient with worsening respiratory status. This skill matters because nurses often see subtle changes before a full emergency happens. Knowing which finding signals immediate danger helps you act fast, protect oxygenation, and prevent rapid decline.

Clinical Scenario

A 68-year-old client is admitted to a medical-surgical unit with community-acquired pneumonia affecting the right lower lobe. The client has a history of chronic obstructive pulmonary disease, type 2 diabetes, and hypertension. It is the start of your shift. The client is receiving oxygen at 2 L/min by nasal cannula and IV antibiotics.

During your assessment, the client says, “I feel more tired than I did earlier.” You note a temperature of 38.3 C (100.9 F), heart rate 108/min, blood pressure 146/84 mm Hg, respiratory rate 30/min, and oxygen saturation 89% on 2 L/min. Lung sounds reveal coarse crackles in the right base. The client is restless, using accessory muscles to breathe, and answers questions with short phrases.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Ask respiratory therapy to administer a scheduled nebulizer treatment
2. B. Increase the client’s oxygen and place the client in high-Fowler’s position
3. C. Obtain a sputum sample before the next antibiotic dose
4. D. Administer acetaminophen for the elevated temperature

Correct Answer

B. Increase the client’s oxygen and place the client in high-Fowler’s position

Detailed Rationale

This client is showing signs of acute worsening oxygenation. The key clues are not just the low oxygen saturation. The bigger warning signs are restlessness, accessory muscle use, tachypnea, and inability to speak in full sentences. Those findings suggest increased work of breathing and possible impending respiratory failure.

In NCLEX priority questions, start with airway, breathing, and circulation. Breathing is the most urgent issue here. The nurse should first improve oxygen delivery and reduce the work of breathing. Raising the head of the bed to high-Fowler’s position improves lung expansion. Increasing oxygen, based on facility protocol or provider orders, supports gas exchange right away.

After doing that first action, the nurse should continue with a focused respiratory assessment. That includes:

• Reassessing oxygen saturation after the intervention
• Watching respiratory rate, depth, and effort
• Listening for changes in breath sounds
• Assessing mental status, because confusion or increasing agitation can signal hypoxia
• Monitoring skin color and checking for cyanosis

The nurse should also be ready for the next steps. If the client does not improve quickly, the nurse should notify the provider or activate the rapid response team, depending on the severity and unit policy. The client may need a higher level of oxygen support, arterial blood gases, a chest x-ray, or escalation of treatment.

This question is really testing whether you notice that the client is becoming less stable. Fever and infection matter, but they are not the first threat. A sputum sample may help guide treatment, but it does not fix the immediate problem. The priority is to support breathing before the client tires out further.

Why the Other Options Are Wrong

A. Ask respiratory therapy to administer a scheduled nebulizer treatment

This may be helpful later, especially if bronchospasm is part of the problem, but it is not the first action. The stem does not give strong evidence of wheezing or acute bronchoconstriction. The client’s immediate issue is hypoxia and increased work of breathing. The nurse should not delay basic airway and breathing support while waiting for another department.

C. Obtain a sputum sample before the next antibiotic dose

A sputum culture can be useful in pneumonia, especially early in treatment. But this action is not urgent enough for a client who is struggling to breathe. It also may be hard for this client to produce a sample safely while in respiratory distress. Stabilization comes before diagnostic collection.

D. Administer acetaminophen for the elevated temperature

The fever is mild and expected with infection. Treating fever may improve comfort, but it will not address the most urgent problem. A client can tolerate a temperature of 38.3 C far better than ongoing hypoxia. NCLEX often includes comfort measures as distractors when a more serious physiologic issue is present.

Key Takeaways

• Restlessness, short phrases, accessory muscle use, and tachypnea are early signs that breathing is worsening.
• Low oxygen saturation matters, but pair it with the full clinical picture. The trend and the work of breathing tell you how urgent the situation is.
• In priority questions, treat airway and breathing problems before fever, labs, or routine treatments.
• Positioning is not a minor step. High-Fowler’s can improve ventilation quickly and with no delay.
• If oxygenation does not improve after immediate nursing actions, escalate care fast.

What you’d do on shift:

• Raise the head of the bed
• Increase oxygen as appropriate
• Stay with the client and reassess breathing
• Check pulse oximetry response and mental status
• Call for provider or rapid response support if distress continues

Quick Practice Extension

1. A client with pneumonia becomes suddenly confused and drowsy while receiving oxygen. Which assessment finding would make you suspect carbon dioxide retention rather than only worsening hypoxia?

2. After you raise the head of the bed and increase oxygen, the client’s saturation improves to 93%, but the respiratory rate remains 32/min with labored breathing. What should the nurse do next?

NCLEX Question of the Day – Friday, May 22, 2026

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