🌬️ Introduction
The respiratory system is a key focus area on the NCLEX exam because it involves life-sustaining functions such as oxygenation, ventilation, and airway management. Nurses play a critical role in assessing respiratory conditions, administering oxygen, and preventing complications like hypoxia or pneumonia.
This set of 100 NCLEX Respiratory System Questions with rationales helps you master essential topics such as asthma, COPD, pneumonia, mechanical ventilation, and chest tube management. Each question reflects real NCLEX difficulty — helping you build critical-thinking and patient safety skills for clinical excellence.
You can also practice related topics like NCLEX Pharmacology MCQs and NCLEX Prioritization and Delegation Questions for a complete preparation.
🧠 Part 1: NCLEX Respiratory System Questions (1–25)
1. The nurse is caring for a patient with asthma. Which medication should be administered first during an acute attack?
A. Fluticasone
B. Salmeterol
C. Albuterol
D. Montelukast
✅ Correct Answer: C
Rationale: Albuterol is a short-acting bronchodilator that provides rapid relief by relaxing bronchial smooth muscles.
2. Which of the following findings indicates hypoxia in a patient?
A. Pale, dry skin
B. Restlessness and confusion
C. Bradycardia
D. Decreased respiratory rate
✅ Correct Answer: B
Rationale: Early signs of hypoxia include restlessness, anxiety, and confusion due to low oxygen levels in the brain.
3. The nurse is teaching a patient with chronic bronchitis. Which statement indicates a need for further teaching?
A. “I will increase fluid intake.”
B. “I will avoid people with infections.”
C. “I will use my inhaler only when I feel breathless.”
D. “I will perform breathing exercises daily.”
✅ Correct Answer: C
Rationale: Bronchodilators should be used as prescribed, not just during breathlessness. This ensures consistent airway patency.
4. Which assessment finding is most concerning in a patient with pneumonia?
A. Productive cough
B. Temperature of 101°F (38.3°C)
C. Respiratory rate of 32/min
D. Fatigue
✅ Correct Answer: C
Rationale: Tachypnea indicates increased work of breathing and respiratory distress — it requires immediate nursing attention.
5. A nurse is providing oxygen via nasal cannula at 2 L/min. What is the expected oxygen concentration delivered?
A. 21%
B. 24%
C. 28%
D. 35%
✅ Correct Answer: B
Rationale: A flow rate of 1–2 L/min delivers approximately 24–28% FiO₂. Nasal cannulas are for low-flow oxygen therapy.
6. The nurse should place a patient with right lower lobe pneumonia in which position to improve oxygenation?
A. Right side-lying
B. Left side-lying
C. Supine
D. Prone
✅ Correct Answer: B
Rationale: Positioning the unaffected lung down (good lung down) improves oxygenation and ventilation-perfusion matching.
7. Which nursing action prevents ventilator-associated pneumonia (VAP)?
A. Maintain HOB at 30–45 degrees
B. Provide oral care once daily
C. Keep patient NPO
D. Reduce suctioning
✅ Correct Answer: A
Rationale: Keeping the head of the bed elevated reduces aspiration risk, the most common cause of VAP.
8. A patient with COPD should be instructed to:
A. Use high-flow oxygen at 10 L/min
B. Perform pursed-lip breathing
C. Restrict fluids
D. Avoid all physical activity
✅ Correct Answer: B
Rationale: Pursed-lip breathing helps control exhalation and prevent airway collapse, improving gas exchange in COPD patients.
9. Which ABG result suggests respiratory acidosis?
A. pH 7.50, PaCO₂ 30 mmHg
B. pH 7.30, PaCO₂ 55 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.48, PaCO₂ 33 mmHg
✅ Correct Answer: B
Rationale: Low pH and high CO₂ indicate respiratory acidosis — caused by hypoventilation or CO₂ retention.
10. The nurse recognizes which sign as late hypoxia?
A. Tachycardia
B. Cyanosis
C. Restlessness
D. Hypertension
✅ Correct Answer: B
Rationale: Cyanosis is a late sign of hypoxia due to prolonged oxygen deprivation and poor tissue perfusion.
11. Which nursing action is most important for a patient after a bronchoscopy?
A. Encourage deep breathing immediately
B. Provide oral fluids right away
C. Assess gag reflex before feeding
D. Keep the patient flat
✅ Correct Answer: C
Rationale: Anesthesia during bronchoscopy suppresses the gag reflex; feeding too early risks aspiration.
12. A patient on oxygen therapy complains of nasal dryness. What should the nurse do?
A. Increase the flow rate
B. Add humidification
C. Stop oxygen therapy
D. Administer antihistamine
✅ Correct Answer: B
Rationale: Humidification prevents mucosal drying during oxygen therapy, especially at higher flow rates.
13. Which of the following is a priority intervention for a patient with acute pulmonary edema?
A. Increase oral fluids
B. Position in high Fowler’s
C. Encourage ambulation
D. Restrict oxygen
✅ Correct Answer: B
Rationale: High Fowler’s position promotes lung expansion and decreases venous return to the heart, easing breathing.
14. A nurse suspects tension pneumothorax in a trauma patient. Which finding confirms this condition?
A. Equal chest movement
B. Tracheal deviation to the unaffected side
C. Decreased heart rate
D. Dull percussion sounds
✅ Correct Answer: B
Rationale: Tracheal deviation away from the affected side is a hallmark sign of tension pneumothorax.
15. The nurse caring for a patient with tuberculosis (TB) should implement:
A. Contact precautions
B. Airborne precautions
C. Droplet precautions
D. Neutropenic precautions
✅ Correct Answer: B
Rationale: TB is transmitted via airborne particles; N95 mask and negative-pressure room are required.
16. Which lab result indicates respiratory alkalosis?
A. pH 7.52, PaCO₂ 28 mmHg
B. pH 7.28, PaCO₂ 60 mmHg
C. pH 7.35, PaCO₂ 45 mmHg
D. pH 7.40, PaCO₂ 40 mmHg
✅ Correct Answer: A
Rationale: Elevated pH and decreased CO₂ show hyperventilation, a hallmark of respiratory alkalosis.
17. A nurse teaches incentive spirometer use. Which action shows correct technique?
A. Exhale forcefully into the device
B. Inhale slowly and deeply
C. Blow quickly and short
D. Take shallow breaths
✅ Correct Answer: B
Rationale: Slow, deep inhalation promotes lung expansion and prevents atelectasis.
18. Which symptom is most characteristic of COPD exacerbation?
A. Sudden weight gain
B. Productive cough with thick sputum
C. Clear lungs
D. Decreased respiratory effort
✅ Correct Answer: B
Rationale: COPD exacerbations cause mucus overproduction and airway obstruction leading to a productive cough.
19. A patient post-thoracentesis should be monitored for:
A. Hypertension
B. Pneumothorax
C. Hyperglycemia
D. Constipation
✅ Correct Answer: B
Rationale: Air entry during thoracentesis can cause lung collapse — pneumothorax is a serious complication.
20. In chest tube drainage, bubbling in the water seal chamber indicates:
A. Normal air removal
B. Blocked tubing
C. Leak in the system
D. Suction off
✅ Correct Answer: C
Rationale: Continuous bubbling means air leakage; the nurse must check the system connections.
21. Which patient finding needs immediate intervention?
A. O₂ saturation 92%
B. Clubbing of fingers
C. Respiratory rate 8/min
D. Use of accessory muscles
✅ Correct Answer: C
Rationale: Bradypnea indicates respiratory depression and risk of hypoventilation — a medical emergency.
22. Which instruction is correct for a patient with asthma using inhalers?
A. Use corticosteroid before bronchodilator
B. Use bronchodilator first
C. Skip doses when asymptomatic
D. Store inhaler in the refrigerator
✅ Correct Answer: B
Rationale: The bronchodilator opens airways first, allowing corticosteroids to reach deeper parts of the lungs.
23. The nurse identifies which sign as an early indication of respiratory distress in children?
A. Cyanosis
B. Nasal flaring
C. Decreased breath sounds
D. Loss of consciousness
✅ Correct Answer: B
Rationale: Nasal flaring and intercostal retractions are early signs of respiratory distress in children.
24. A COPD patient’s O₂ saturation drops to 85%. What is the first nursing action?
A. Increase O₂ to 6 L/min
B. Encourage pursed-lip breathing
C. Give bronchodilator
D. Notify physician immediately
✅ Correct Answer: B
Rationale: Pursed-lip breathing helps slow exhalation, improving oxygenation before increasing O₂ flow.
25. Which statement shows understanding by a patient using home oxygen therapy?
A. “I can smoke as long as I stay 5 feet away.”
B. “I’ll use water-based lubricants around my nose.”
C. “I’ll increase flow rate when breathless.”
D. “I can store my oxygen tank near the stove.”
✅ Correct Answer: B
Rationale: Only water-based lubricants should be used with oxygen to prevent fire hazards.
💡 Want to strengthen your basics before moving to advanced fluid therapy questions? Check out our NCLEX Fundamentals of Nursing Practice Questions — perfect for beginners.
🫁 NCLEX Respiratory System Practice Questions (26–50)
26. The nurse is caring for a client post–thoracotomy. Which assessment finding requires immediate intervention?
A. Shallow respirations at 16/min
B. Oxygen saturation of 89%
C. Small amount of serosanguinous drainage
D. Pain at incision site
✅ Correct Answer: B
💡 Rationale: O₂ saturation below 90% indicates hypoxemia. The nurse should administer oxygen and notify the provider immediately.
27. A client with a tracheostomy has thick secretions and difficulty breathing. The nurse should first:
A. Increase oxygen flow
B. Suction the airway
C. Notify the provider
D. Give a bronchodilator
✅ Correct Answer: B
💡 Rationale: Suctioning clears the airway obstruction and restores ventilation before any other intervention.
28. A patient has a chest tube connected to a water-seal drainage system. Bubbling is observed in the water seal chamber. What does this indicate?
A. Normal operation
B. Air leak in the system
C. Blocked tube
D. Tube displacement
✅ Correct Answer: B
💡 Rationale: Continuous bubbling in the water-seal chamber usually means an air leak, which requires checking the tubing and connections.
29. The nurse is teaching a client with emphysema about breathing techniques. Which instruction is most appropriate?
A. “Take rapid deep breaths.”
B. “Use pursed-lip breathing.”
C. “Avoid using accessory muscles.”
D. “Lie flat while breathing.”
✅ Correct Answer: B
💡 Rationale: Pursed-lip breathing promotes slow exhalation, prevents alveolar collapse, and improves gas exchange.
30. The best position for a patient with acute respiratory distress is:
A. Supine
B. High Fowler’s
C. Prone
D. Trendelenburg
✅ Correct Answer: B
💡 Rationale: High Fowler’s position promotes maximum lung expansion and eases breathing.
31. The nurse notes crackles in both lung bases. This finding is consistent with:
A. Asthma
B. Pulmonary edema
C. Pneumothorax
D. COPD
✅ Correct Answer: B
💡 Rationale: Crackles (rales) are caused by fluid in the alveoli, a hallmark of pulmonary edema or heart failure.
32. Which symptom is most specific to tuberculosis (TB)?
A. Night sweats and weight loss
B. Productive cough
C. Shortness of breath
D. Fatigue
✅ Correct Answer: A
💡 Rationale: TB typically presents with night sweats, weight loss, low-grade fever, and hemoptysis.
33. A patient’s ABG shows: pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 25 mEq/L. What condition does this indicate?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
✅ Correct Answer: B
💡 Rationale: High pH and low PaCO₂ indicate respiratory alkalosis, often due to hyperventilation.
34. The nurse should instruct a client with chronic bronchitis to:
A. Limit fluid intake
B. Increase fluid intake
C. Avoid all physical activity
D. Take shallow breaths
✅ Correct Answer: B
💡 Rationale: Fluids thin mucus, making it easier to expectorate and improve airway clearance.
35. A patient with pneumonia reports pleuritic chest pain. What nursing intervention is most effective?
A. Apply ice packs
B. Encourage splinting the chest during coughing
C. Encourage bed rest
D. Reduce fluid intake
✅ Correct Answer: B
💡 Rationale: Splinting reduces pain during coughing and promotes productive cough without worsening discomfort.
36. In COPD patients, oxygen should be administered cautiously because:
A. It may cause oxygen toxicity
B. It can suppress hypoxic respiratory drive
C. It leads to fluid overload
D. It increases CO₂ elimination
✅ Correct Answer: B
💡 Rationale: COPD patients depend on low oxygen levels to stimulate breathing; high oxygen flow may stop respirations.
37. What is the priority assessment for a patient receiving IV morphine for postoperative pain after lung surgery?
A. Pain score
B. Respiratory rate
C. Heart rate
D. Temperature
✅ Correct Answer: B
💡 Rationale: Opioids depress the respiratory center; monitoring respiration prevents hypoventilation and arrest.
38. Which diagnostic test confirms pulmonary embolism?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. ABG
✅ Correct Answer: C
💡 Rationale: CT pulmonary angiography is the gold standard for detecting pulmonary emboli.
39. A nurse observes a patient with COPD using accessory muscles to breathe. This indicates:
A. Normal breathing pattern
B. Increased work of breathing
C. Decreased airway resistance
D. Ineffective medication use
✅ Correct Answer: B
💡 Rationale: Use of accessory muscles (neck, shoulders) shows respiratory distress and fatigue.
40. The best time to collect a sputum sample for culture is:
A. Before breakfast
B. After meals
C. Anytime during the day
D. Before bedtime
✅ Correct Answer: A
💡 Rationale: Early morning sputum is most concentrated, yielding accurate culture results.
41. Which clinical finding is most consistent with pneumothorax?
A. Bilateral crackles
B. Dull percussion note
C. Absent breath sounds on one side
D. Productive cough
✅ Correct Answer: C
💡 Rationale: Air in the pleural cavity collapses the lung, causing absent breath sounds on the affected side.
42. The nurse teaching incentive spirometer use should instruct the patient to:
A. Exhale forcefully into the mouthpiece
B. Inhale slowly and deeply
C. Blow out quickly
D. Take shallow breaths
✅ Correct Answer: B
💡 Rationale: Slow, deep inhalation expands alveoli, prevents atelectasis, and promotes lung recovery.
43. Which intervention helps prevent ventilator-associated pneumonia (VAP)?
A. Deep suctioning every 2 hours
B. Keeping head of bed elevated 30–45°
C. Limiting oral hygiene
D. Frequent position changes only
✅ Correct Answer: B
💡 Rationale: Elevating the head reduces aspiration risk — a key preventive measure for VAP.
44. A client with cystic fibrosis requires which diet?
A. Low-protein, low-fat
B. High-protein, high-calorie
C. Low-calorie, low-fiber
D. High-fat, low-protein
✅ Correct Answer: B
💡 Rationale: Cystic fibrosis increases energy needs; high-protein, high-calorie diets meet metabolic demands.
45. During suctioning, the nurse should apply suction:
A. During insertion
B. During withdrawal
C. Continuously
D. For at least 30 seconds
✅ Correct Answer: B
💡 Rationale: Suctioning during withdrawal prevents mucosal injury and hypoxia. Duration should not exceed 10–15 seconds.
46. Which sign indicates improvement in a patient with pneumonia?
A. Persistent fever
B. Decreased sputum production
C. Worsening dyspnea
D. Coarse crackles
✅ Correct Answer: B
💡 Rationale: Reduced sputum and improved oxygen saturation indicate effective treatment.
47. The nurse should monitor which electrolyte in a client receiving loop diuretics for pulmonary edema?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
✅ Correct Answer: B
💡 Rationale: Loop diuretics (e.g., furosemide) cause potassium loss, leading to hypokalemia.
48. A patient is having a bronchoscopy. The nurse should ensure:
A. The patient eats before the procedure
B. Informed consent is signed
C. Sedation is avoided
D. Oral care is withheld
✅ Correct Answer: B
💡 Rationale: Invasive procedures require informed consent to ensure patient understanding and safety.
49. Post-bronchoscopy, the nurse should report which finding immediately?
A. Sore throat
B. Small blood-streaked sputum
C. Stridor and difficulty breathing
D. Hoarseness
✅ Correct Answer: C
💡 Rationale: Stridor indicates airway obstruction — a medical emergency.
50. Which nursing action promotes secretion clearance in a COPD patient?
A. Encourage coughing after nebulization
B. Administer diuretics
C. Encourage bed rest
D. Restrict fluids
✅ Correct Answer: A
💡 Rationale: Nebulization loosens mucus, and coughing helps clear airways for better oxygenation.
🔹 Related Topic: Review NCLEX Pathology MCQs to better understand how kidney function affects electrolytes and acid-base balance.*
🫁 NCLEX Respiratory System Practice Questions (51–75)
51. A patient with asthma experiences wheezing and shortness of breath after exercise. What type of asthma is this?
A. Occupational asthma
B. Exercise-induced asthma
C. Nocturnal asthma
D. Status asthmaticus
✅ Correct Answer: B
💡 Rationale: Exercise-induced asthma is triggered by physical activity, resulting in airway narrowing and wheezing shortly after exercise.
52. The nurse administers albuterol to a patient with asthma. Which effect indicates the drug is working?
A. Increased wheezing
B. Decreased heart rate
C. Relief of shortness of breath
D. Increased sputum production
✅ Correct Answer: C
💡 Rationale: Albuterol is a bronchodilator that relaxes airway muscles, improving airflow and relieving dyspnea.
53. The nurse must stop a nebulizer treatment immediately if the patient develops:
A. Tremors
B. Tachycardia
C. Palpitations
D. Severe anxiety and chest tightness
✅ Correct Answer: D
💡 Rationale: Severe anxiety or chest tightness may indicate paradoxical bronchospasm — treatment should be stopped and provider notified.
54. Which finding is most consistent with respiratory acidosis?
A. pH 7.50, CO₂ 30
B. pH 7.30, CO₂ 55
C. pH 7.45, CO₂ 40
D. pH 7.35, CO₂ 25
✅ Correct Answer: B
💡 Rationale: Low pH and high CO₂ indicate respiratory acidosis, commonly caused by hypoventilation or COPD.
55. A patient with COPD is prescribed pursed-lip breathing. The purpose is to:
A. Improve oxygen intake
B. Prevent airway collapse
C. Increase respiratory rate
D. Reduce carbon dioxide retention
✅ Correct Answer: B
💡 Rationale: Pursed-lip breathing prolongs exhalation, prevents airway collapse, and promotes gas exchange.
56. The nurse is teaching incentive spirometer use. Which statement shows correct understanding?
A. “I should exhale forcefully.”
B. “I should inhale slowly and deeply.”
C. “I will blow out quickly.”
D. “I will breathe shallowly.”
✅ Correct Answer: B
💡 Rationale: Inhaling slowly and deeply expands the lungs and prevents atelectasis.
57. A client with cystic fibrosis should be taught to:
A. Limit fluid intake
B. Avoid postural drainage
C. Perform chest physiotherapy daily
D. Avoid high-calorie foods
✅ Correct Answer: C
💡 Rationale: Chest physiotherapy helps mobilize secretions and prevent infection in cystic fibrosis patients.
58. Which blood gas pattern is typical for a patient with severe COPD?
A. Low PaCO₂, high pH
B. High PaCO₂, low pH
C. Normal PaCO₂ and pH
D. High HCO₃⁻, high pH
✅ Correct Answer: B
💡 Rationale: Chronic CO₂ retention leads to respiratory acidosis (high CO₂, low pH).
59. The nurse suspects a pulmonary embolism in a postoperative patient. The first action should be:
A. Start CPR
B. Administer oxygen
C. Give anticoagulants
D. Notify the provider
✅ Correct Answer: B
💡 Rationale: Immediate oxygen administration prevents hypoxia while awaiting further medical intervention.
60. Which finding indicates tension pneumothorax?
A. Decreased breath sounds bilaterally
B. Tracheal deviation to the opposite side
C. Bilateral crackles
D. Increased breath sounds
✅ Correct Answer: B
💡 Rationale: Tracheal deviation is a hallmark of tension pneumothorax and requires emergency decompression.
61. A client using home oxygen should be taught to:
A. Keep oxygen near an open flame
B. Use cotton blankets
C. Use wool clothing
D. Store oxygen cylinders near heat sources
✅ Correct Answer: B
💡 Rationale: Cotton fabric reduces static electricity and fire risk when using oxygen.
62. The nurse monitors for which sign of early hypoxia?
A. Cyanosis
B. Restlessness
C. Bradycardia
D. Hypotension
✅ Correct Answer: B
💡 Rationale: Restlessness and confusion are early indicators of inadequate oxygenation.
63. Which nursing intervention helps prevent postoperative atelectasis?
A. Encourage deep breathing and coughing
B. Encourage immobility
C. Restrict fluids
D. Apply abdominal binder tightly
✅ Correct Answer: A
💡 Rationale: Deep breathing and coughing promote lung expansion and secretion clearance.
64. A patient with pneumonia is receiving antibiotics. The most important indicator of treatment effectiveness is:
A. Clearer breath sounds
B. Increased cough
C. Elevated temperature
D. Decreased appetite
✅ Correct Answer: A
💡 Rationale: Improved breath sounds and decreased sputum production signal recovery.
65. Which client is at highest risk for aspiration pneumonia?
A. Client with COPD
B. Client with dysphagia after stroke
C. Client with asthma
D. Client on bronchodilators
✅ Correct Answer: B
💡 Rationale: Impaired swallowing reflex increases aspiration risk, leading to pneumonia.
66. The nurse should place a patient with a left lower lobe pneumonia in which position to promote drainage?
A. Right side-lying
B. Left side-lying
C. Supine
D. Prone
✅ Correct Answer: A
💡 Rationale: Positioning on the unaffected side promotes drainage from the infected lung.
67. Which sign indicates oxygen toxicity?
A. Bradycardia
B. Productive cough
C. Substernal chest pain and restlessness
D. Cyanosis
✅ Correct Answer: C
💡 Rationale: Prolonged high-concentration oxygen causes chest pain and restlessness due to lung tissue damage.
68. What is the primary reason for humidifying oxygen?
A. To cool oxygen
B. To prevent mucosal dryness
C. To increase oxygen concentration
D. To prevent infection
✅ Correct Answer: B
💡 Rationale: Humidification prevents drying and irritation of the respiratory mucosa.
69. A nurse is caring for a patient with ARDS. Which finding is expected?
A. Normal chest X-ray
B. Severe hypoxemia despite oxygen therapy
C. Elevated pH
D. Bradycardia
✅ Correct Answer: B
💡 Rationale: ARDS is characterized by refractory hypoxemia — oxygen levels remain low even with high oxygen administration.
70. In COPD patients, the stimulus to breathe is:
A. Low CO₂ levels
B. High oxygen levels
C. Low oxygen levels
D. High bicarbonate levels
✅ Correct Answer: C
💡 Rationale: COPD patients rely on hypoxic drive; excessive oxygen may suppress breathing.
71. The nurse observes a patient coughing after swallowing. This finding suggests:
A. Dysphagia
B. Asthma
C. Normal reflex
D. Esophagitis
✅ Correct Answer: A
💡 Rationale: Coughing after swallowing indicates aspiration risk due to impaired swallowing mechanisms.
72. A patient with chronic bronchitis has clubbing of fingers. What does this indicate?
A. Iron deficiency
B. Chronic hypoxemia
C. Acute infection
D. Hyperventilation
✅ Correct Answer: B
💡 Rationale: Clubbing results from prolonged oxygen deprivation and tissue hypoxia.
73. A patient with tuberculosis is prescribed isoniazid (INH). Which instruction is essential?
A. Avoid vitamin supplements
B. Take on an empty stomach
C. Avoid alcohol
D. Limit fluids
✅ Correct Answer: C
💡 Rationale: Alcohol with INH increases the risk of liver toxicity.
74. The nurse should encourage a COPD client to use which breathing technique during exertion?
A. Deep, rapid breathing
B. Pursed-lip breathing
C. Shallow chest breathing
D. Holding breath for long periods
✅ Correct Answer: B
💡 Rationale: Pursed-lip breathing promotes slow exhalation and prevents air trapping.
75. Which lab result is most concerning for a client with respiratory distress?
A. PaO₂ 95 mmHg
B. SaO₂ 98%
C. PaCO₂ 60 mmHg
D. HCO₃⁻ 22 mEq/L
✅ Correct Answer: C
💡 Rationale: Elevated PaCO₂ indicates hypercapnia — a sign of respiratory failure needing immediate attention.
🩺 Part 4: NCLEX Respiratory System Practice Questions (76–100)
76. Which nursing intervention is a priority for a patient with COPD receiving oxygen therapy?
A. Encourage deep breathing exercises every hour
B. Administer oxygen at 6 L/min via nasal cannula
C. Maintain oxygen saturation between 88–92%
D. Keep the patient in a supine position
✅ Correct Answer: C
💡 Rationale: COPD patients rely on hypoxic drive; maintaining SpO₂ between 88–92% prevents respiratory depression from excessive oxygen.
77. A patient with pneumonia is complaining of pleuritic chest pain. What is the best nursing intervention?
A. Encourage shallow breathing
B. Administer pain medication as prescribed
C. Encourage fluid restriction
D. Place the patient in Trendelenburg position
✅ Correct Answer: B
💡 Rationale: Pain control promotes deep breathing and coughing, preventing atelectasis and worsening infection.
78. Which finding in a patient with asthma indicates worsening condition?
A. Increased wheezing after bronchodilator therapy
B. Productive cough
C. Heart rate 90 bpm
D. Respiratory rate 18 breaths/min
✅ Correct Answer: A
💡 Rationale: Wheezing after bronchodilator use indicates ineffective therapy and possible airway obstruction.
79. A nurse is caring for a patient post-thoracentesis. What is the most important nursing action?
A. Encourage ambulation immediately
B. Assess for signs of pneumothorax
C. Increase fluid intake
D. Apply warm compresses
✅ Correct Answer: B
💡 Rationale: Pneumothorax is a major complication after thoracentesis; monitor for dyspnea, chest pain, or decreased breath sounds.
80. In a patient with tuberculosis (TB), which symptom is expected?
A. Sudden onset of chest pain
B. Productive cough with night sweats
C. Watery nasal discharge
D. Pain on inspiration only
✅ Correct Answer: B
💡 Rationale: Chronic cough, night sweats, weight loss, and hemoptysis are classic TB manifestations.
81. The purpose of pursed-lip breathing in COPD is to:
A. Strengthen respiratory muscles
B. Promote airway collapse
C. Improve CO₂ elimination
D. Increase inspiratory volume
✅ Correct Answer: C
💡 Rationale: Pursed-lip breathing slows exhalation and reduces CO₂ retention by maintaining airway pressure.
82. A patient is receiving chest physiotherapy. Which nursing action is correct?
A. Perform after meals
B. Administer bronchodilator before therapy
C. Limit sessions to once daily
D. Perform while patient lies flat
✅ Correct Answer: B
💡 Rationale: Administering a bronchodilator before physiotherapy helps open airways and improve secretion clearance.
83. Which lab test confirms respiratory acidosis?
A. pH 7.50, PaCO₂ 30 mmHg
B. pH 7.30, PaCO₂ 50 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.48, PaCO₂ 35 mmHg
✅ Correct Answer: B
💡 Rationale: Low pH with elevated PaCO₂ indicates respiratory acidosis due to hypoventilation.
84. What is the priority nursing diagnosis for a patient with severe asthma attack?
A. Ineffective airway clearance
B. Activity intolerance
C. Risk for infection
D. Anxiety
✅ Correct Answer: A
💡 Rationale: Maintaining airway patency is the top priority during an acute asthma episode.
85. Which condition is most likely to cause clubbing of fingers?
A. Acute bronchitis
B. Chronic hypoxia
C. Sinus infection
D. Pneumothorax
✅ Correct Answer: B
💡 Rationale: Chronic hypoxia stimulates tissue growth in fingertips, causing clubbing.
86. A nurse observes pink frothy sputum in a patient with dyspnea. What should the nurse suspect?
A. Pulmonary edema
B. Tuberculosis
C. Asthma
D. Pleural effusion
✅ Correct Answer: A
💡 Rationale: Pink frothy sputum is a hallmark sign of pulmonary edema caused by left heart failure.
87. What is a major risk factor for developing lung cancer?
A. Alcohol consumption
B. Smoking
C. Dust exposure
D. Viral infection
✅ Correct Answer: B
💡 Rationale: Cigarette smoking is the leading preventable cause of lung cancer globally.
88. What should a nurse teach a patient using an incentive spirometer?
A. Inhale slowly to raise the ball
B. Exhale quickly into the device
C. Use it only when short of breath
D. Hold breath for 10 seconds after exhalation
✅ Correct Answer: A
💡 Rationale: Slow, deep inhalation expands alveoli, preventing atelectasis post-surgery.
89. Which position helps a patient with respiratory distress breathe easier?
A. Supine
B. Semi-Fowler’s
C. High-Fowler’s
D. Trendelenburg
✅ Correct Answer: C
💡 Rationale: High-Fowler’s position promotes maximal chest expansion and improves ventilation.
90. A nurse notes crackles in both lung bases. What is the likely cause?
A. Airway inflammation
B. Fluid in alveoli
C. Mucus in bronchi
D. Air trapping
✅ Correct Answer: B
💡 Rationale: Crackles (rales) are caused by fluid accumulation, commonly seen in heart failure or pneumonia.
91. A patient is prescribed albuterol. Which side effect should be monitored?
A. Bradycardia
B. Tremors and tachycardia
C. Hypotension
D. Sedation
✅ Correct Answer: B
💡 Rationale: Albuterol, a beta-agonist, may cause tremors, palpitations, and tachycardia due to adrenergic stimulation.
92. What finding requires immediate nursing intervention?
A. Oxygen saturation 93%
B. Use of accessory muscles for breathing
C. Cough with sputum
D. Slight tachypnea
✅ Correct Answer: B
💡 Rationale: Use of accessory muscles signals severe respiratory distress and impending failure.
93. A nurse caring for a patient with emphysema should expect which ABG result?
A. pH 7.48, PaCO₂ 32
B. pH 7.35, PaCO₂ 50
C. pH 7.60, PaCO₂ 20
D. pH 7.25, PaCO₂ 25
✅ Correct Answer: B
💡 Rationale: Chronic CO₂ retention leads to compensated respiratory acidosis in emphysema.
94. Which dietary instruction is best for a COPD patient?
A. Low-protein, high-carbohydrate diet
B. High-calorie, high-protein meals
C. Low-fat, high-carbohydrate meals
D. Fluid restriction
✅ Correct Answer: B
💡 Rationale: COPD patients require high-calorie, protein-rich diets to prevent muscle wasting.
95. The nurse is teaching about preventing atelectasis. Which statement shows understanding?
A. “I should take deep breaths and cough often.”
B. “I will avoid moving after surgery.”
C. “I’ll breathe shallowly to reduce pain.”
D. “I don’t need the incentive spirometer.”
✅ Correct Answer: A
💡 Rationale: Deep breathing and coughing exercises help re-expand alveoli and prevent atelectasis.
96. A nurse should suspect a tension pneumothorax when:
A. Trachea deviates to the unaffected side
B. Breath sounds are equal bilaterally
C. Patient has productive cough
D. Pulse rate decreases
✅ Correct Answer: A
💡 Rationale: Tracheal deviation is a late sign of tension pneumothorax requiring immediate intervention.
97. Which sign differentiates chronic bronchitis from emphysema?
A. Barrel chest
B. Productive cough for at least 3 months
C. Use of accessory muscles
D. Weight loss
✅ Correct Answer: B
💡 Rationale: Chronic productive cough defines chronic bronchitis, whereas emphysema causes barrel chest and weight loss.
98. A patient with cystic fibrosis is at high risk for:
A. Bacterial lung infections
B. Viral pneumonia
C. Pneumothorax only
D. Asthma
✅ Correct Answer: A
💡 Rationale: Thick mucus in cystic fibrosis traps bacteria, predisposing to recurrent lung infections.
99. Which intervention helps prevent ventilator-associated pneumonia (VAP)?
A. Routine suctioning every hour
B. Keeping head of bed at 30–45 degrees
C. Administering antibiotics daily
D. Changing tubing every 8 hours
✅ Correct Answer: B
💡 Rationale: Elevating the head of the bed prevents aspiration and reduces the risk of VAP.
100. The first nursing action for a patient with acute dyspnea is:
A. Call the physician immediately
B. Apply oxygen and assess vital signs
C. Start IV fluids
D. Administer antibiotics
✅ Correct Answer: B
💡 Rationale: Oxygen administration and rapid assessment are priority steps to prevent hypoxia.
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