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Respiratory NCLEX practice questions

Five NCLEX-style questions on asthma, COPD, pneumonia, tuberculosis, chest tubes and oxygen therapy. Pick your answer, then open it to see the right choice and why. New questions every week.

1. Question 1

   Which blood gas result will the nurse expect to observe in a patient with respiratory alkalosis?

   • A.pH 7.53, PaCO2 30 mm Hg, HCO3-24 mEq/L
   • B.pH 7.35, PaCO2 35 mm Hg. HCO3-26 mEq/L
   • C.pH 7.25, PaCO2 48 mm Hg. HCO3-23 mEq/L
   • D.pH 7.60, PaCO2 40 mm Hg, HCO3-30 mEq/L
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. pH 7.53, PaCO2 30 mm Hg, HCO3-24 mEq/L

   pH: Elevated (above 7.45), indicating alkalosis. PaCO₂: Decreased (below 35 mm Hg), reflecting hyperventilation and CO₂ loss. HCO₃⁻: Usually normal (around 24 mEq/L) or slightly decreased, as metabolic compensation might not be immediate. The results here show an elevated pH, decreased PaCO₂, and normal HCO₃⁻, which are consistent with respiratory alkalosis. pH: Decreased (acidic), indicating acidosis. PaCO₂: Slightly elevated (near normal), not indicative of respiratory alkalosis. HCO₃⁻: Normal (around 26 mEq/L), suggesting no significant metabolic component or compensation. This profile does not match respiratory alkalosis; it is more consistent with a mixed or different type of acid-base imbalance. pH: Decreased (acidic), indicating acidosis. PaCO₂: Elevated (above 45 mm Hg), indicating CO₂ retention, which is characteristic of respiratory acidosis, not alkalosis. HCO₃⁻: Normal (around 23 mEq/L), showing no significant metabolic compensation or disturbance. This profile indicates respiratory acidosis rather than respiratory alkalosis. pH: Elevated (alkaline), which is consistent with alkalosis. PaCO₂: Normal (around 40 mm Hg), indicating that CO₂ levels are not the primary cause of the alkalosis. HCO₃⁻: Elevated (above 28 mEq/L), suggesting a metabolic alkalosis or compensation for a respiratory acidosis, but not respiratory alkalosis alone.

2. Question 2

   A nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. Which of the following actions should the nurse take?

   • A.Lubricate the suction catheter tip with sterile saline.
   • B.Hyperoxygenate the patient with 100% oxygen for at least 30 to 60 seconds before suctioning.
   • C.Perform chest physiotherapy prior to suctioning.
   • D.Instill-normal saline instillation into the airway before endotracheal suctioning.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Hyperoxygenate the patient with 100% oxygen for at least 30 to 60 seconds before suctioning.

   Lubricating the suction catheter tip with sterile saline is generally not recommended. The catheter tip is usually not lubricated before suctioning. Instead, suctioning should be performed using a dry, sterile catheter to prevent introducing any substances into the airway that could cause irritation or infection. Hyperoxygenating the patient with 100% oxygen before suctioning is a crucial step. This helps to prevent hypoxia during the suctioning procedure, as suctioning can temporarily reduce the oxygen levels in the blood. By providing 100% oxygen for 30 to 60 seconds, the nurse ensures that the patient has an adequate oxygen reserve and reduces the risk of oxygen desaturation during suctioning. Performing chest physiotherapy is not a routine pre-suctioning action and is generally done as part of a separate management strategy for clearing secretions. Chest physiotherapy involves techniques such as percussion, vibration, and postural drainage to help mobilize secretions from the lungs. Instilling normal saline into the airway before suctioning (known as “normal saline lavage”) is not recommended. This practice can actually cause harm, such as increasing the risk of infection, causing bronchospasm, and diluting secretions which may then become more difficult to suction.

3. Question 3

   A nurse is caring for a patient with a chest tube connected to wall suction due to a right-sided pneumothorax. The patient reports a sensation of chest burning.What should the nurse do next?

   • A.Clamp the patient’s chest tube.
   • B.Increase the patient’s wall suction.
   • C.Strip the patient’s chest tube.
   • D.Reposition the patient.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: D. Reposition the patient.

   Clamping the patient’s chest tube is not the appropriate action. Clamping the tube can lead to tension pneumothorax, which is a life-threatening condition. Increasing the patient’s wall suction is not the correct action. The sensation of chest burning is not related to the level of suction. Increasing the suction could potentially cause more harm. Stripping the patient’s chest tube is not recommended. This action can cause negative pressure in the chest and can lead to injury of the lung tissue. Repositioning the patient is the correct action. The sensation of chest burning could be due to the position of the chest tube. Repositioning the patient may alleviate the discomfort.

4. Question 4

   A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings would indicate that the treatment has been effective?

   • A.Decreased stridor
   • B.Decreased temperature
   • C.Barking cough
   • D.Improved hydration
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. Decreased stridor

   Acute laryngotracheobronchitis, also known as croup, is a common childhood condition that is usually caused by a viral infection. The main symptom is a distinctive barking cough. A cool mist tent can help to soothe the inflamed airways and reduce stridor, which is a high-pitched, wheezing sound caused by disrupted airflow. Therefore, decreased stridor would indicate that the treatment has been effective. While a decreased temperature might indicate a resolution of any underlying infection, it is not directly related to the effectiveness of a cool mist tent in treating acute laryngotracheobronchitis. A barking cough is a symptom of acute laryngotracheobronchitis and does not indicate treatment effectiveness. Improved hydration is important but is not a direct indicator of the effectiveness of the cool mist tent.

5. Question 5

   A nurse on a medical unit is caring for a client who suddenly becomes confused and drowsy. Additional data includes pulse 100/min, respiratory rate 24/min, BP 132/76 mm Hg, and temperature 36.8° C (98.2° F). Which of the following actions should the nurse perform?

   • A.Hold the client's evening dose of digoxin.
   • B.Increase the client's fluid intake.
   • C.Complete a neurological check.
   • D.Administer the prescribed PRN antihypertensive medication.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: C. Complete a neurological check.

   Holding the client's evening dose of digoxin is not the priority at this time. The client's symptoms of confusion and drowsiness require immediate attention to determine the cause. Increasing the client's fluid intake may be important for various reasons, but it is not the most urgent action in this situation. The client's altered mental status and vital signs need to be assessed first. Completing a neurological check is the most appropriate action in this situation. The sudden onset of confusion and drowsiness may indicate a neurological issue that needs to be assessed promptly. This includes assessing the client's level of consciousness, pupillary response, motor function, and other neurological signs. Administering the prescribed PRN antihypertensive medication is not indicated based on the client's current presentation. The client's symptoms are more suggestive of a neurological issue rather than hypertension. It's important to address the altered mental status first.