Question A 65-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with increased shortness of breath, wheezing, and a productive cough with green sputum. Vital signs are BP 150/90 mmHg, HR 102 bpm, RR 28 breaths/min, and SpO2 88% on room air. The patient is using accessory muscles to breathe and appears anxious. Which of the following actions should the nurse take first?
A. Administer a short-acting bronchodilator via nebulizer.
B. Educate the patient on the importance of quitting smoking.
C. Initiate oxygen therapy to maintain SpO2 above 92%.
D. Obtain a sputum sample for culture and sensitivity.
E. Encourage the patient to perform pursed-lip breathing.

Show the answer: The correct answer is C Rationale: The patient’s SpO2 of 88% indicates hypoxemia, which is a critical issue requiring immediate intervention to prevent further complications. Oxygen therapy is essential to increase the oxygen saturation to a safe level, aiming for above 92% in a COPD patient to avoid oxygen-induced hypercapnia. This intervention takes priority over others like administering medications or patient education because addressing the immediate oxygenation needs can prevent life-threatening complications. Once oxygenation is stabilized, other treatments such as bronchodilators and patient education can be addressed.

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Question A 72-year-old female patient with a history of asthma is admitted to the hospital with symptoms of an asthma exacerbation. She reports increasing difficulty breathing, chest tightness, and a wheezing sound with expiration. Her current medications include an inhaled corticosteroid and a short-acting beta-agonist as needed. She is currently using her short-acting beta-agonist every 4 hours. What is the most appropriate nursing intervention at this time?

A. Prescribe a course of oral corticosteroids.

B. Increase the frequency of the short-acting beta-agonist.

C. Add a long-acting beta-agonist to her treatment regimen.

D. Advise the patient to stop using the inhaled corticosteroid.

E. Perform peak flow monitoring to assess asthma control.

Show the answer: The correct answer is E Rationale: Peak flow monitoring is an essential tool for assessing the severity of an asthma exacerbation and the effectiveness of the current treatment regimen. It provides objective data that can guide further treatment decisions, such as adjusting medications. This intervention is crucial before making changes to the patient’s medication regimen, as it helps to ensure that treatments are tailored to the patient’s current level of asthma control. It’s a non-invasive, quick, and effective way to monitor asthma and prevent exacerbations from worsening.

Question A 55-year-old patient is admitted with pneumonia. The patient has a fever of 38.6°C (101.5°F), productive cough with yellow sputum, and is experiencing shortness of breath. The patient’s oxygen saturation is 93% on 2 liters of nasal cannula oxygen. Auscultation reveals crackles in the lower lobes of both lungs. Which of the following medications should the nurse anticipate administering?
A. A beta-blocker.
B. A broad-spectrum antibiotic.
C. An antiviral medication.
D. An anti-inflammatory steroid.
E. A calcium channel blocker.

Show the answer: The correct answer is B Rationale: Pneumonia is typically caused by bacterial infection, making antibiotics the cornerstone of treatment. The patient’s symptoms of fever, productive cough with colored sputum, and auscultation findings of crackles are indicative of a bacterial infection, warranting the use of a broad-spectrum antibiotic to cover a wide range of potential pathogens. Administering antibiotics promptly can help reduce the infection’s severity and prevent complications. Antivirals, steroids, and cardiovascular medications like beta-blockers and calcium channel blockers are not first-line treatments for bacterial pneumonia. 

Question A patient with a history of pulmonary fibrosis is experiencing increased dyspnea, fatigue, and a dry cough. The patient’s respiratory rate is elevated, and pulse oximetry shows an oxygen saturation of 89% on room air. What is the most appropriate initial intervention by the nurse?
A. Start the patient on high-flow oxygen therapy.
B. Administer a short-acting bronchodilator.
C. Encourage the patient to use a spirometer.
D. Initiate pulmonary rehabilitation exercises.
E. Prescribe an antifibrotic medication.

Show the answer: The correct answer is A Rationale: Pulmonary fibrosis leads to a progressive decline in lung function, resulting in reduced oxygenation as evidenced by the patient’s oxygen saturation of 89%. The primary goal is to improve oxygenation and relieve symptoms of dyspnea, making high-flow oxygen therapy the most appropriate initial intervention. This will help increase the patient’s oxygen saturation to acceptable levels, reduce the work of breathing, and alleviate symptoms. Other options like bronchodilators, spirometry, rehabilitation exercises, and antifibrotic medications may be part of the long-term management but do not address the immediate need for improved oxygenation. 

Question A 60-year-old patient with chronic bronchitis is admitted to the hospital with increased dyspnea, fever, and a productive cough. The patient is hypoxic with an oxygen saturation of 90% on room air and has a respiratory rate of 24 breaths per minute. Auscultation reveals wheezing and rhonchi throughout both lung fields. Which of the following interventions should the nurse prioritize?
A. Administer nebulized albuterol.
B.  Start IV antibiotics after obtaining blood culture.
C. Provide supplemental oxygen to maintain SpO2 > 92%.
D. Increase fluid intake to thin secretions.
E. Prescribe a systemic corticosteroid.

Show the answer: The correct answer is C Rationale: The immediate priority in managing a patient with chronic bronchitis, especially when presenting with hypoxia (SpO2 of 90%), is to improve oxygenation. Supplemental oxygen should be administered to increase the oxygen saturation to a target of greater than 92%, which is essential to ensure adequate tissue perfusion and prevent complications associated with hypoxia. While other interventions such as administering nebulized bronchodilators, starting antibiotics, and increasing fluid intake are important in the treatment plan, the initial focus should be on stabilizing the patient’s oxygen levels. Corticosteroids may be considered later in the treatment process to reduce inflammation. 

Question A 28-year-old female patient with no significant medical history presents to the clinic complaining of a two-week history of dry cough, shortness of breath, and a feeling of tightness in the chest. She mentions that these symptoms often worsen at night. Physical examination reveals expiratory wheezes on auscultation. The patient denies any recent travel or sick contacts. Which of the following is the most appropriate next step in managing this patient?
A. Prescribe a course of antibiotics.
B. Initiate inhaled corticosteroids.
C. Order a chest x-ray.
D.Start an antitussive medication.
E. Perform a spirometry test.

Show the answer: The correct answer is E Rationale: The patient’s symptoms of dry cough, shortness of breath, chest tightness, and nocturnal worsening are suggestive of asthma. A spirometry test is essential for diagnosing asthma by assessing the reversibility of airflow obstruction, which is a hallmark of the condition. This test can help confirm the diagnosis and guide the appropriate management plan, such as initiating inhaled corticosteroids or other asthma-specific treatments. Antibiotics, antitussives, and chest x-rays would not be the first step in this scenario without evidence of infection or other specific indications. 

Question A 70-year-old male patient with a history of heart failure is admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD). He is currently on 3 liters per minute of oxygen via nasal cannula and has a respiratory rate of 22 breaths/min. The patient complains of increasing shortness of breath over the last two days. His current medications include a long-acting muscarinic antagonist (LAMA), a long-acting beta-agonist (LABA), and an inhaled corticosteroid. Which of the following actions should the nurse take first?
A. Increase the oxygen flow rate to 5 liters per minute.
B. Administer a short-acting bronchodilator via nebulizer.
C. Perform a chest physiotherapy session.
D. Advise the patient to perform diaphragmatic breathing.
E. Assess the patient’s current inhaler technique.

Show the answer: The correct answer is B Rationale: In a patient with COPD exacerbation presenting with increased shortness of breath, administering a short-acting bronchodilator (SABA or SAMA) via nebulizer is often the first step to provide quick relief from bronchospasm. This intervention can improve airflow, reduce work of breathing, and alleviate symptoms more rapidly than other measures. While optimizing oxygen therapy, assessing inhaler technique, and teaching breathing exercises are important components of comprehensive COPD management, they are secondary to the immediate need to relieve bronchoconstriction and improve respiratory function. 

Question A 45-year-old female patient with a history of rheumatoid arthritis presents with a three-day history of fever, cough, and dyspnea. She is currently taking methotrexate. On examination, her temperature is 38.3°C (100.9°F), respiratory rate is 26 breaths/min, and her oxygen saturation is 92% on room air. Chest auscultation reveals diffuse crackles. Which of the following is the most appropriate initial management?
A. Start high-dose corticosteroids.
B. Order a computed tomography (CT) scan of the chest.
C. Initiate broad-spectrum antibiotics.
D. Prescribe an antitussive medication.
E. Discontinue methotrexate.

Show the answer: The correct answer is C Rationale: The patient’s symptoms of fever, cough, dyspnea, and the presence of diffuse crackles on auscultation suggest a respiratory infection, possibly pneumonia. Given the patient’s immunocompromised state due to methotrexate therapy, it is crucial to start broad-spectrum antibiotics promptly to cover a range of potential pathogens, including opportunistic infections. While further diagnostic imaging, like a CT scan, may be helpful for detailed assessment, the initiation of antibiotics should not be delayed. Adjustments in medications such as methotrexate and the use of corticosteroids can be considered after stabilizing the patient and in consultation with rheumatology. 

Question A 33-year-old male patient is brought to the emergency department after a house fire with suspected inhalation injury. He is coughing, wheezing, and complaining of difficulty breathing. His face and neck have sooty deposits, and his voice is hoarse. Oxygen saturation is 89% on room air. What is the most immediate nursing intervention?
A. Administer a nebulized bronchodilator.
B. Initiate 100% oxygen via a non-rebreather mask.
C. Perform oropharyngeal suctioning.
D. Administer intravenous corticosteroids.
E. Insert a nasogastric tube.

Show the answer: The correct answer is B Rationale: In the case of suspected inhalation injury with evidence of airway compromise and hypoxemia (as indicated by an oxygen saturation of 89%), the immediate priority is to ensure adequate oxygenation. Administering 100% oxygen via a non-rebreather mask can help improve oxygen saturation levels and mitigate the effects of carbon monoxide poisoning, a common complication of smoke inhalation. This intervention addresses the most life-threatening aspect of the patient’s condition and should precede other treatments such as bronchodilators, corticosteroids, or airway clearance techniques, which can be considered once oxygenation is stabilized. 

Question A 58-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is admitted to the ICU with worsening respiratory failure. He is currently on high-flow nasal cannula (HFNC) oxygen therapy but remains dyspneic with an oxygen saturation of 88%. The patient is alert and oriented but increasingly anxious due to difficulty breathing. Which of the following actions should the nurse prioritize?
A. Transition the patient to mechanical ventilation.
B. Administer an anxiolytic medication.
C. Increase the flow rate on the HFNC.
D. Position the patient in a prone position.
E. Initiate extracorporeal membrane oxygenation (ECMO).

Show the answer: The correct answer is D Rationale: For patients with COVID-19 experiencing acute respiratory distress syndrome (ARDS), prone positioning has been shown to improve oxygenation by redistributing lung perfusion and improving ventilation-perfusion matching. This intervention should be considered before escalating to more invasive measures such as mechanical ventilation or ECMO, especially in a patient who is alert and oriented but experiencing significant dyspnea. Prone positioning can be a simple, non-invasive strategy to enhance respiratory function and oxygenation. Increasing HFNC flow rates and administering anxiolytics may provide symptomatic relief but do not directly address the underlying issue of impaired gas exchange as effectively as prone positioning.

Nursing care for pneumonia

Pneumonia is an infection of the respiratory tract. It can involve an infection of the airways, including the alveoli and the bronchioles. With infection, we see inflammation, edema, low oxygen levels, or hypoxia. Patients can acquire pneumonia outside of the hospital or in the community, as well as in the hospital.

When we assess a patient who has pneumonia, we see fever, chills, chest pain, and increased respiratory rate. When we listen with a stethoscope, we may hear bronchi or wheezes. We may also see evidence of respiratory distress; it appears as if the patient is struggling to breathe. If pneumonia is severe, we may see mental status changes and confusion as a result of low oxygen levels.

Often patients will cough up secretions or what is referred to as sputum. It is important to take note of the color of the sputum, the amount of sputum, and the general appearance of the sputum. Pneumonia is associated with yellow apurum, but it may also be brown, rusty in appearance, or blood-tinged.

Nursing intervention for patients with pneumonia includes administering oxygen, monitoring breathing, assessing for labored respirations and use of accessory muscles. If tolerated, we should encourage patients to deep breathe, cough, and use spirometry if provided. It is generally more comfortable for the patient to be in that semi-Fowler’s position because this allows for lung expansion. Ambulation is also important and that can be done with assistance because that helps to mobilize the sputum.

Patients need not be NPO, however, they should be encouraged to eat small meals and meals that are high in calories and proteins. Drinking fluids is important, encouraging an increase in water from two and a half to three liters per day. An increase in activity should be balanced. Patients will be treated with antibiotics, antipyretics for fever, cough suppressants, mucolytics, and bronchodilators.

Viral Pneumonia vs Bacterial Pneumonia

The second type of infection is a viral infection of the lungs. This can be acute and includes influenza, COVID, and many others. To reduce the number of viral infections each year, vaccination is recommended especially for individuals over 50 years of age.This includes individuals who have underlying lung infections and patients who are immunocompromised or are at higher risk for exposure.

The signs and symptoms of acute viral infection of the pulmonary system include fever, muscle aches, or myalgias, headache, sore throat, runny nose, nausea, cough, and weakness.Treatment for most individuals is supportive. This includes encouraging fluid, monitoring the patient closely, cough suppressants, encouraging rest, and antipyretics.

Nursing care for asthma

The third pulmonary condition is asthma. Asthma is a chronic inflammatory condition of the airways. There is some degree of obstruction in patients with asthma, and that results in difficulty breathing. The symptoms of asthma may occur as a result of triggers in the environment. When exposed to these triggers, patients may experience shortness of breath, chest tightness, wheezing, coughing, and breathlessness.

Triggers include pollen, dust, animal hair, fumes, molds, and sudden weather changes. Even occupational exposure, such as chemicals and plastics. Even medications may act as triggers for asthma. We classify asthma severity as mild intermittent, mild persistent, moderate persistent, and severe persistent.

Signs and symptoms of asthma include shortness of breath, wheezes, and crackles, decreased breath sounds, the use of accessory muscles to breathe, increased heart rate or tachycardia, decreased oxygen saturation, and restlessness or irritability.

Nursing interventions include providing oxygen, bronchodilators, reassurance, monitoring vital signs, and pulse oximetry. An additional assessment of respiratory status, such as obtaining a peak flow reading. Positioning the patient in a high-fowler’s position helps with breathing. Oxygen is often prescribed for these patients.

In addition to bronchodilators, corticosteroids may be prescribed and will be administered. Staying with the patient during acute asthma reassures the patient and decreases the level of anxiety.

More: Respiratory NCLEX Questions

Nursing care plan for cOPD

The fourth condition that we will talk about is chronic obstructive pulmonary disease or COPD. This is a condition where air movement is limited due to airflow obstruction. COPD includes emphysema and chronic bronchitis. Emphysema is a condition where the lungs and the air sacs in the lungs are damaged.

The alveoli or air sacs are weakened, and over time, larger airspace is created in the lungs. This affects the movement of oxygen. This is a progressive condition of the lungs. Bronchitis is a condition that affects the airway or bronchial tubes of the lungs. The airways become inflamed, which results in coughing and excessive mucus production that affects the patient’s ability to breathe.

Like emphysema, Chronic Bronchitis is a progressive condition of the disease of the lungs. Over time, if COPD is not treated, it can result in pulmonary hypertension and right heart failure.

The physical exam in patients with COPD reveals shortness of breath, sputum production, and cough. Physical characteristics may be noted such as the use of accessory muscles for breathing, weight loss due to the work of breathing, difficulty breathing when the patient lays flat, and changes in pulmonary function tests and ABG baseline levels.

Nursing interventions for patients with acute exacerbation of COPD include continuous monitoring of the patient’s vital signs and respiratory status. It is important to provide respiratory treatments that are prescribed including oxygen support, Bronco, dilators, steroids, mucolytics, and antibiotics.

In some cases, the patient may be allowed to participate in activities as tolerated. Position the patient for the most comfortable breathing, this is generally a high Fowler’s position or leaning forward to help with breathing. These patients do not have to be NPO. The patient should be encouraged to eat small frequent meals which should be high in calories and protein.

Respiratory Nursing

More: Respiratory NCLEX NextGen Questions

Infection may be the cause of the acute exacerbation of COPD, and these patients’ secretions should be monitored for change – noting if sputum is yellow, brown, rusty, or, blood-tinged. This may indicate infection, as well as fever, chills, and elevated white blood cell count.

The test that we use to evaluate patients with cardiovascular disease respiratory infection is the complete blood count or CBC. Importantly, we look at the hemoglobin,hematocrit levels and the white blood cell count. The white blood cell count is routinely used to indicate infection. For example, in patients with pneumonia, the patient’s white blood cell count is elevated. In other conditions, such as bone marrow suppression, the white blood cell count may decrease.

Patients should be encouraged to avoid smoking and smoke exposure. Breathing techniques, such as pursed lip breathing, and diaphragmatic breathing should be taught.

Chest Imaging

The primary imaging study is the chest x-ray. Chest X-ray is very important and it may show pneumonia, tumors, pulmonary edema or other pathology.The computerized tomography (CT) scan or “cat scan” is a a more advanced study that provides more detail.

NCLEX Style Questions

Respiratory NCLEX Questions

NCLEX Question 1. The nurse assesses a patient with shortness of breath that is suspected of having a pulmonary embolism (PE), what are the nursing priorities?
(select all that apply)
A. Reassure and position the patient in prone position
B. Administer oxygen
C. Notify the health care provider
D. Obtain a sputum for culture

Pneumonia

NCLEX Question 2. The nurse assesses a patient with cough and dark yellow sputum. Which of the following is true about the evaluation of lung infection? (select all that apply)
A. a chest x-ray will not be needed
B. if sputum collection is done, 15 milliliters (ml) of sputum should be obtained
C. a clean, dry, nonsterile cup may be used for sputum collection
D. remove all jewelry in the chest area if a chest x-ray is ordered

COPD risk modification

NCLEX Question 3. The nurse is instructing a patient with COPD that is being discharged home. What are the instructions for this patient? (select all that apply)
A. Smoking should be limited to less than one pack per day
B. Dietary restrictions of 1800 calories per day
C. Use pursed-lip and diaphragmatic breathing
D. Alternate periods of activity and rest

COPD chest x-ray

NCLEX Question 4. The nurse assesses a patient with cough that is suspected of having COPD. The patient’s chest x-ray shows a barrel chest. This is a characteristic of what condition? (select all that apply)
A. Asthma
B. Sarcoidosis
C. Chronic pneumonia
D. Emphysema

Tuberculin skin test

NCLEX Question 5. The nurse assesses a patient with cough and weight loss suspected of having TB. Induration of 10 mm on a tuberculin skin test reaction indicates, (select all that apply)
A. Positive in healthy low risk individuals
B. Positive in residents of prisons and jails
C. Positive in children 2 years of age
D. Positive in patients with renal failure on dialysis

how to collect sputum specimen

NCLEX Question 6. The nurse needs to obtain a sputum sample on a patient suspected of pneumonia. How does the nurse proceed?
A. have the patient rinse the mouth with water prior to the sputum collection
B. rinse the mouth and spit the rinse into the specimen cup
C. obtain approximately 10 milliliters (ml) of expectorant
D. suction the mouth and include the tip of the cannula in the specimen cup

Bronchoscopy procedure

NCLEX Question 7. Which of the following statements are FALSE regarding preparation for and aftercare of bronchoscopy?
A. the patient should be NPO prior to the procedure
B. dentures may be left in place
C. intravenous access is maintained for medication administration and fluids as needed
D. the patient should be monitored for bloody sputum after the procedure

Bronchoscopy Aftercare

NCLEX Question 8. The nurse receives a patient from the recovery room who has undergone bronchoscopy, which of the following are important steps? (select all that apply)
A. NPO prior to bronchoscopy
B. Obtain informed consent prior to the bronchoscopy
C. Administer contrast dye 20 minutes prior to bronchoscopy
D.Emergency supplies for resuscitation should be obtained and readily available prior to starting bronchoscopy.

Pneumothorax treatment

NCLEX Question 9. Which of the following is true about the nursing care of a patient with a pneumothorax?
A. Supplemental oxygen by nasal canula or facemask should be removed prior to starting any procedure.
B. To assess for an air leak, the nurse should clamp the chest tube and observe the chest tube drainage system.
C. When the chest tube is in place, no holes should be visible outside of the skin.
D. When transporting the patient, the chest tube drainage system may be placed on top of the bed mattress, near the patient’s feet.Emergency supplies for resuscitation should be obtained and readily available prior to starting bronchoscopy.

Endobronchial Ultrasound

NCLEX Question 10. The UAP ask the nurse about a patient who has just undergone endobronchial ultrasound (EBUS), the nurse correctly answers, (select all that apply)
A. The exam is done to evaluate lung tumors and collect specimens.
B. Informed consent will not need to be obtained for this procedure
C. The patient will be monitored for respiratory distress after the procedure
D. Bleeding is not a complication of this procedure

Answers to NCLEX-style Questions

NCLEX Respiratory Questions

1. B and C
PE may occur when a clot forms in a deep vein that travels to the heart and then goes to the lung. Symptoms include shortness of breath, syncope, severe hypotension, and respiratory distress.
2. B and D
Evaluating patients for lung infection or pneumonia includes chest x-ray and sputum collection. A clean, dry, sterile cup will be used. Presenting symptoms may include fever, productive cough, chest pain and mild to severe shortness of breath.
3. C and D
Patients with COPD should receive education and ensure that they understand activity limitations, dietary recommendations, avoiding allergens, prescribed medications, breathing techniques and stop smoking.
4. D
Emphysema is a chronic obstructive pulmonary disease strongly associated with a history of smoking. The air sacs become damaged, and the lungs are hyperinflated. This alters lung mechanics and barrel chest is a characteristic.
5. B, C and D
Induration of greater than or equal to 10 mm is considered positive for children < 4 years of age and some high-risk groups. This includes residents of prisons and jails and patients receiving renal dialysis.
6. A
Sputum assessment in pneumonia helps identify the organisms causing the lung infection. The patient will take deep breaths and then cough deeply. Obtain 15 ml of sputum for the sample. This should be sent to the lab for culture and sensitivity..
7. B Bronchoscopy allows direct visualization of the airways. In addition, samples and biopsies can be obtained. The patient is sedated and a long scope with a light at the tip will be inserted into the airway for this procedure.
8. A, C and D
Bronchoscopy is an invasive procedure that requires informed consent. NPO is necessary to prevent aspiration during the procedure. In the event of distress, emergency resuscitative supplies should be at the bedside.
9. C
Patients with pneumothorax are typically short of breath and require supplemental oxygen around the clock. Do not clamp chest tubes unless you have a written order. The chest tube drainage system should be maintained below the level of the heart.
10. A and C
Endobronchial ultrasound (EBUS) is a useful test to assess lymph nodes and some lung masses. EBUS is an invasive procedure that requires informed consent. NPO is necessary to prevent aspiration during the procedure. In the event of distress, emergency resuscitative supplies should be at the bedside.