NCLEX Medical-Surgical: Respiratory Conditions

Question 1

A patient with COPD is admitted for exacerbation. Which oxygen delivery goal is most appropriate for this patient?

Accepted Answer

Maintain SpO2 at 88–92% to avoid suppressing hypoxic respiratory drive

Answer

Maintain SpO2 at 99–100% to maximize oxygenation

Answer

Apply 100% non-rebreather mask immediately regardless of baseline

Answer

Withhold oxygen entirely to preserve the hypoxic drive

Question 2

A nurse is caring for a patient with a right-sided pneumothorax. On assessment, the nurse notes tracheal deviation to the left, absent breath sounds on the right, and severe respiratory distress. What condition does this represent?

Accepted Answer

Tension pneumothorax requiring immediate needle decompression

Answer

Simple pneumothorax requiring observation

Answer

Pleural effusion requiring thoracentesis

Answer

Hemothorax requiring chest tube placement

Question 3

A patient is receiving mechanical ventilation and the nurse notes high-pressure alarms. Which assessment should the nurse perform first?

Accepted Answer

Assess the patient and ventilator circuit for obstruction — suctioning, kinking, patient biting tube, bronchospasm

Answer

Increase the set tidal volume to overcome the obstruction

Answer

Immediately disconnect the patient from the ventilator

Answer

Increase FiO2 to compensate for potential hypoxia

Question 4

A patient is admitted with community-acquired pneumonia (CAP). Which findings support this diagnosis?

Accepted Answer

Productive cough, fever, pleuritic chest pain, focal infiltrate on CXR, and elevated WBC

Answer

Clear lung fields on chest X-ray, low-grade fever, and dry cough

Answer

Bilateral wheezing, expiratory prolongation, and low-grade fever

Answer

Sudden onset chest pain, dyspnea, and normal chest X-ray

Question 5

A patient is on continuous pulse oximetry. The SpO2 reads 97%, but the patient appears cyanotic, confused, and the waveform is poor. What action should the nurse take?

Accepted Answer

Assess the patient clinically, obtain an ABG, and consider pulse ox inaccuracy

Answer

Trust the pulse oximetry reading and reassure the patient

Answer

Increase supplemental oxygen based on the 97% reading

Answer

Remove the pulse oximeter as it is clearly malfunctioning and not needed

Question 6

A patient with pulmonary embolism (PE) is being anticoagulated with IV heparin. Which goal best describes anticoagulation in acute PE?

Accepted Answer

Preventing clot propagation and recurrence while allowing natural fibrinolysis

Answer

Dissolving the existing clot to restore pulmonary blood flow immediately

Answer

Preventing DVT only — the PE itself resolves without treatment

Answer

Eliminating all risk factors for future emboli with a single medication

Question 7

A nurse is caring for a patient following a bronchoscopy with biopsy. Which postprocedure complication requires immediate intervention?

Accepted Answer

Frank hemoptysis with large amounts of blood, worsening dyspnea, and hypoxia

Answer

Mild sore throat and hoarseness for 24 hours

Answer

NPO status for 2 hours after the procedure

Answer

Mild productive cough for 12 hours after procedure

Question 8

A patient with asthma presents with severe dyspnea. On assessment, the nurse notes absent breath sounds bilaterally. What is the interpretation of this finding?

Accepted Answer

The patient is in severe bronchospasm ('silent chest') — a medical emergency indicating respiratory failure

Answer

The patient has resolved the bronchospasm and is breathing normally

Answer

Bilateral absence of breath sounds is normal in asthma exacerbations

Answer

The patient is hyperventilating; repositioning will restore breath sounds

Question 9

A nurse is preparing to administer the influenza vaccine to a patient. Which patient statement requires clarification?

Accepted Answer

I am allergic to eggs and have had anaphylaxis after eating eggs

Answer

I have a history of Guillain-Barré syndrome 6 years ago

Answer

I received the flu vaccine last year and still got sick

Answer

I am 8 months pregnant

Question 10

A patient is placed on a 60% Venturi mask. The nurse notes the patient is still hypoxic with SpO2 of 85%. What is the appropriate action?

Accepted Answer

Switch to a non-rebreather mask to deliver higher FiO2

Answer

Increase the flowmeter setting on the current Venturi mask to deliver higher FiO2

Answer

Continue current therapy and recheck in 1 hour

Answer

Obtain an ABG and wait for results before changing oxygen delivery