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

COPD patients who are chronic CO2 retainers may rely on hypoxic drive (low O2) to breathe. Targeting SpO2 88–92% provides adequate oxygenation without suppressing respiratory drive or worsening hypercapnia.

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

Tracheal deviation away from the affected side, absent breath sounds, and severe respiratory distress indicate tension pneumothorax — a life-threatening emergency requiring immediate needle decompression (2nd intercostal space, midclavicular line).

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

High-pressure alarms indicate increased resistance or obstruction in the circuit or patient airway. Assessment should identify and correct the cause — secretions, tube kinking, bronchospasm, or pneumothorax.

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

Community-acquired pneumonia presents with productive cough, fever, pleuritic chest pain, lobar or focal infiltrate on chest X-ray, and leukocytosis. Auscultation reveals bronchial breath sounds, crackles, and dullness to percussion over the affected area.

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

Pulse oximetry has limitations: poor perfusion, nail polish, carbon monoxide poisoning (falsely normal), methemoglobinemia, and motion artifact cause inaccurate readings. Clinical assessment and ABG are more reliable when clinical findings don't match.

NCLEX Practice Test

NCLEX Practice Test

NCLEX Medical-Surgical: Respiratory Conditions