Medical-Surgical Nursing: Respiratory (NCLEX-RN Medical-Surgical Nursing) Practice Questions
Test yourself on Respiratory (NCLEX-RN Medical-Surgical Nursing) with 12 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
advertisement
Answer the questions below — you get instant feedback and a full explanation for each.
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula. The nurse should be MOST concerned if which finding develops?
Explanation. In some clients with chronic CO2 retention, high oxygen levels can blunt the hypoxic respiratory drive, leading to hypoventilation, rising CO2, somnolence, and a falling respiratory rate—signs of CO2 narcosis. An SpO2 of 90% is acceptable in COPD; productive cough and mild dyspnea are expected baseline findings.
2. The nurse is teaching a client how to use a metered-dose inhaler (MDI) with a spacer. Which instruction is correct?
Explanation. A slow, deep inhalation followed by a 10-second breath hold allows the medication to deposit deep in the airways. The client should exhale away from the device first, wait about 1 minute between puffs, and avoid rapid inhalation, which causes drug to deposit in the mouth/throat.
3. A client with a chest tube connected to a water-seal drainage system suddenly has the tubing become disconnected from the chest tube. What is the nurse's PRIORITY action?
Explanation. If the drainage system disconnects, immediately place the open end of the chest tube into sterile water to re-establish a water seal and prevent air from entering the pleural space. Clamping risks a tension pneumothorax. An occlusive dressing is used if the tube comes OUT of the chest, not when the system disconnects.
4. A client is admitted with suspected active pulmonary tuberculosis. Which type of isolation precautions should the nurse implement?
Explanation. Mycobacterium tuberculosis is transmitted via airborne droplet nuclei, requiring airborne precautions: a negative-pressure room and an N95 respirator for staff. Droplet precautions and a surgical mask are insufficient; contact precautions address direct/indirect contact transmission.
5. A client with asthma is using a peak flow meter at home. The client's personal best is 400 L/min and today's reading is 220 L/min. The nurse explains this falls in which zone?
Explanation. Peak flow zones are based on percentage of personal best: Green = 80–100% (≥320), Yellow = 50–79% (200–319), Red = below 50% (<200). 220 L/min is 55% of 400, placing the client in the yellow zone, indicating caution and use of a quick-relief (rescue) bronchodilator.
6. A nurse is caring for a client with a pulmonary embolism receiving a continuous heparin infusion. Which laboratory value should the nurse monitor to evaluate therapeutic effect?
Explanation. Heparin's anticoagulant effect is monitored with aPTT, with a therapeutic goal typically 1.5–2.5 times the control. PT/INR monitors warfarin. Platelet counts are watched for heparin-induced thrombocytopenia but do not measure therapeutic dosing, and D-dimer aids diagnosis, not titration.
7. A client recovering from a thoracentesis suddenly reports sharp chest pain, dyspnea, and a sensation of not being able to breathe. The nurse notes absent breath sounds on the affected side. Which complication should the nurse suspect?
Explanation. Sudden dyspnea, sharp chest pain, and absent breath sounds after thoracentesis strongly suggest pneumothorax from inadvertent lung puncture. Pulmonary edema produces crackles and frothy sputum, atelectasis develops more gradually, and anesthetic reactions do not cause unilateral absent breath sounds.
8. The nurse is assessing arterial blood gases on a client: pH 7.30, PaCO2 55 mmHg, HCO3 24 mEq/L. How should the nurse interpret these values?
Explanation. pH is low (acidosis). PaCO2 is elevated (55), indicating a respiratory cause that moves the same direction as the acidosis. HCO3 is normal (24), so there is no metabolic compensation—this is uncompensated respiratory acidosis, often seen with hypoventilation/CO2 retention.
9. A client with pneumonia has thick, tenacious secretions. Which nursing intervention is the BEST initial action to help mobilize secretions?
Explanation. Adequate hydration thins secretions and helps the client expectorate them. Cough suppressants would retain secretions, immobility promotes pooling and atelectasis, and deep breathing/coughing should be encouraged, not limited, to clear the airways.
10. A client returns from surgery and the nurse is performing an incentive spirometry teaching session. What is the primary purpose of this device?
Explanation. Incentive spirometry encourages sustained maximal inspiration, expanding the alveoli to prevent atelectasis and postoperative pneumonia. It does not deliver medication (that's a nebulizer/MDI), measure oxygen (pulse oximeter), or suction secretions.
11. A nurse is caring for a client with acute respiratory distress syndrome (ARDS) on mechanical ventilation. Which ventilator strategy is recommended to reduce ventilator-induced lung injury?
Explanation. Lung-protective ventilation uses low tidal volumes (around 6 mL/kg ideal body weight) with appropriate PEEP to keep alveoli open while minimizing barotrauma/volutrauma. High tidal volumes and zero PEEP worsen lung injury, and suctioning is done as needed, not routinely hourly.
12. A client with emphysema demonstrates pursed-lip breathing. The nurse recognizes that this technique primarily helps the client by:
Explanation. Pursed-lip breathing creates back-pressure (positive pressure) in the airways during a slow, prolonged exhalation, which keeps small airways open and improves CO2 elimination and air trapping in emphysema. It slows—not increases—respiratory rate and does not directly strengthen the diaphragm or lower cardiac oxygen demand.
📘 Want a full structured course and official-style practice tests? Browse top-rated NCLEX-RN prep books and courses. Some links are affiliate links; we may earn a commission at no cost to you.
advertisement
FAQ
How do I quickly interpret ABGs for the NCLEX?
Use the ROME/tic-tac-toe approach: First check pH (low = acidosis, high = alkalosis). Then look at PaCO2 (respiratory) and HCO3 (metabolic). Whichever moves in the OPPOSITE direction of pH for alkalosis or SAME pattern is the primary problem—remember Respiratory Opposite, Metabolic Equal (ROME). If the other value has shifted to normalize pH, compensation is occurring; if pH is back in range, it's fully compensated.
What respiratory content shows up most on NCLEX-RN?
High-yield areas include chest tube management, oxygen therapy (especially the COPD/CO2 retainer concern), TB airborne precautions, asthma/COPD medications and inhaler teaching, ABG interpretation, postoperative atelectasis prevention (incentive spirometry, coughing/deep breathing), pneumonia care, and recognizing complications like pneumothorax and pulmonary embolism.
How should I study respiratory prioritization questions?
Apply the ABCs (Airway, Breathing, Circulation) and Maslow first—respiratory problems often take priority. For 'what should the nurse do first' items, choose the action that directly protects the airway or gas exchange and is within nursing scope, such as repositioning, applying oxygen, or re-establishing a water seal before calling the provider. Practice distinguishing expected findings from true emergencies.