Respiratory
NCLEX® practice.

Free practice set · 6 questions

6 more free respiratory NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 6 · Emergency Response, Triage & Disaster

   A 79-year-old woman on a medical-surgical unit began a newly prescribed daily antibiotic and developed urticaria, facial edema, wheezing, and hypotension. Her respirations became labored with stridor; oxygen saturation fell to 78%, and the airway appeared partially occluded by edema. She is now unresponsive, not breathing normally, and has no pulse detected within 10 seconds. The monitor shows PEA. The chart documents full code; the code team and defibrillator are at the bedside, although her daughter says she would not want resuscitation. Which action should the nurse take first?

   1. ALeave the bedside to obtain the AED and perform abdominal thrusts if the airway remains obstructed.
   2. BWithhold CPR pending clarification of the daughter’s statement and give IV diphenhydramine before epinephrine.
   3. CDeliver an unsynchronized shock for PEA, then resume compressions after confirming the rhythm.
   4. DStart high-quality chest compressions immediately and direct another nurse to prepare ACLS epinephrine for the PEA arrest.
   Show the answer and rationale

   Correct answer: D. Start high-quality chest compressions immediately and direct another nurse to prepare ACLS epinephrine for the PEA arrest.

   Start high-quality CPR immediately and direct preparation of epinephrine. The AHA BLS adult chain of survival requires recognition of cardiac arrest, activation of the code response, and immediate compressions; do not delay for an AED in another location. Because this client’s monitor shows PEA, the ACLS PEA/asystole algorithm requires CPR and epinephrine 1 mg every 3–5 minutes, not defibrillation or atropine. Her preceding urticaria, airway edema, stridor, wheezing, and hypotension indicate anaphylaxis; the anaphylaxis guideline requires IM epinephrine first before antihistamines, but once pulseless, CPR is the immediate lifesaving priority. A daughter’s report cannot replace the documented full-code status. An unresponsive choking client receives CPR, not continued abdominal thrusts.

   A. Leave the bedside to obtain the AED and perform abdominal thrusts if the airway remains obstructed.

   The AHA BLS sequence requires compressions immediately; another responder should retrieve the AED while CPR continues. Leaving the client delays circulation. Abdominal thrusts are not continued after a choking client becomes unresponsive; the client receives CPR with airway checks before breaths.

   B. Withhold CPR pending clarification of the daughter’s statement and give IV diphenhydramine before epinephrine.

   A family member’s statement does not override the documented full-code status, so withholding CPR violates emergency protocol. In suspected anaphylaxis, IM epinephrine is first because diphenhydramine does not rapidly reverse airway edema or hypotension. In this now-pulseless client, compressions take priority over antihistamine administration.

   C. Deliver an unsynchronized shock for PEA, then resume compressions after confirming the rhythm.

   PEA is a nonshockable rhythm in the ACLS PEA/asystole algorithm. Defibrillation is reserved for ventricular fibrillation or pulseless ventricular tachycardia; shocking PEA delays effective compressions and does not correct the underlying absence of mechanical cardiac activity.

   D. Start high-quality chest compressions immediately and direct another nurse to prepare ACLS epinephrine for the PEA arrest.

   This action follows the AHA BLS adult arrest sequence: begin compressions without interruption and assign others to obtain medications and equipment. PEA is nonshockable, so the ACLS PEA/asystole algorithm adds epinephrine while CPR continues. The documented full-code order requires resuscitation despite the daughter’s statement.

2. Question 2 of 6 · Thoracic Drainage & Airway Devices

   A 22-year-old female client in a long-term care facility is 2 hours after a thoracentesis for a pleural effusion and recently started a daily combined oral contraceptive. Compared with 1 hour ago, BP is 104/68 from 118/76, HR 118 from 88, RR 30 from 20, temperature 37.1°C, and SpO2 89% from 97% on room air. She reports sudden right-sided pleuritic pain and dyspnea; breath sounds are absent on the right. Which action should the RN take first?

   1. AReassure the client that the symptoms are anxiety related and coach slow breathing.
   2. BAdminister the prescribed opioid and reassess the pleuritic pain in 30 minutes.
   3. CPage the health care provider about the oxygen saturation and wait for further instructions.
   4. DPlace the client in high-Fowler position, apply oxygen, and activate urgent clinical assistance.
   Show the answer and rationale

   Correct answer: D. Place the client in high-Fowler position, apply oxygen, and activate urgent clinical assistance.

   Place the client upright, provide oxygen, and activate urgent assistance first. The sudden pleuritic pain, dyspnea, marked tachycardia, falling blood pressure, new hypoxemia, and absent unilateral breath sounds 2 hours after thoracentesis identify a likely iatrogenic pneumothorax with respiratory compromise; the recently started estrogen-containing contraceptive also makes pulmonary embolism a plausible competing concern, not anxiety. The RN must act on the early trend before overt collapse, address breathing before circulation, and communicate the situation, baseline, assessment, and requested evaluation using SBAR while documenting the response. Reassurance delays treatment, analgesia masks a time-critical complication, and waiting for a callback delays ABC care.

   A. Reassure the client that the symptoms are anxiety related and coach slow breathing.

   Anxiety does not adequately explain the combination of sudden pleuritic pain, unilateral absent breath sounds, worsening tachycardia, and a rapid oxygen-saturation decline after thoracentesis. A pulmonary embolism is possible because of the recent estrogen-containing medication, but the postprocedure unilateral finding also strongly suggests pneumothorax. Reassurance and breathing coaching delay oxygen support and urgent evaluation.

   B. Administer the prescribed opioid and reassess the pleuritic pain in 30 minutes.

   Pain medication may eventually be prescribed, but treating pain alone is unsafe when the pain accompanies acute dyspnea, hypoxemia, tachycardia, and absent unilateral breath sounds. Analgesia could obscure worsening respiratory compromise and does not correct the likely pneumothorax or possible embolic process. Airway and breathing interventions must precede symptom-only treatment.

   C. Page the health care provider about the oxygen saturation and wait for further instructions.

   The RN should notify the health care provider, but paging and waiting without immediate intervention fails to address the client’s compromised breathing. Oxygen and positioning should begin while urgent assistance is activated. The communication should include the post-thoracentesis timing, baseline-to-current vital-sign trend, unilateral absent breath sounds, and response to interventions rather than merely reporting an isolated saturation.

   D. Place the client in high-Fowler position, apply oxygen, and activate urgent clinical assistance.

   This is the priority because the client has an early but worsening respiratory complication: new tachycardia, tachypnea, hypoxemia, pleuritic pain, and absent right-sided breath sounds after thoracentesis. Upright positioning and oxygen support breathing immediately, while urgent assistance allows rapid evaluation and escalation. The RN should then communicate the trend and assessment using SBAR and continue monitoring for deterioration.

3. Question 3 of 6 · Respiratory Failure & Oxygenation

   During a home-health visit, the nurse assesses a 68-year-old man on postoperative day 3 after video-assisted thoracic decortication. His chest tube is prescribed to −20 cm H₂O suction; the collection chamber is below chest level, but tubing has disconnected from the chamber. The client has 200 mL of sudden bright-red drainage this hour, SpO₂ 94% on 2 L/min, diminished left breath sounds, intact dressing, no subcutaneous emphysema, and continuous prior water-seal bubbling. Which action should the nurse take first?

   1. AVigorously milk the chest tube toward the chamber every 1 to 2 hours to prevent clot formation.
   2. BClamp the chest tube before moving the client to a chair or transporting him for evaluation.
   3. CReinsert the disconnected chest tube into the client’s thorax at the bedside before restoring suction.
   4. DPlace the disconnected tube end 2 cm into sterile water, maintain the chamber below the chest, and notify the health care provider.
   Show the answer and rationale

   Correct answer: D. Place the disconnected tube end 2 cm into sterile water, maintain the chamber below the chest, and notify the health care provider.

   Immediately placing the disconnected tube end in 2 cm of sterile water, keeping the chamber below the chest, and notifying the health care provider is correct. The water temporarily restores a seal, while the dependent chamber preserves gravity and the prescribed pressure gradient. This postoperative client’s sudden 200-mL bright-red output exceeds the concerning chest-tube threshold, and prior continuous bubbling suggests an air leak, so prompt notification is required. Routine stripping can injure lung tissue; clamping can cause tension pneumothorax. Reinsertion is outside RN scope and breaches sterility. A full chamber is replaced, not emptied; a broken NPWT seal is re-sealed, not merely silenced.

   A. Vigorously milk the chest tube toward the chamber every 1 to 2 hours to prevent clot formation.

   Routine vigorous milking or stripping is not indicated and can create dangerously high negative intrathoracic pressure, potentially injuring healing lung tissue. It does not appropriately address the disconnected system or the client’s hemorrhage and possible air leak.

   B. Clamp the chest tube before moving the client to a chair or transporting him for evaluation.

   The chest tube should remain unclamped during routine movement. Clamping can trap air when an air leak is present and precipitate tension pneumothorax. The system should remain below chest level; transport does not justify interrupting drainage.

   C. Reinsert the disconnected chest tube into the client’s thorax at the bedside before restoring suction.

   An RN should not reinsert a dislodged or disconnected chest tube. Reinsertion requires provider-level procedural management, may introduce infection, and can damage tissue. The nurse instead protects the drainage pathway, stabilizes any dislodgement with the appropriate sterile dressing, and promptly notifies the health care provider.

   D. Place the disconnected tube end 2 cm into sterile water, maintain the chamber below the chest, and notify the health care provider.

   This action temporarily reestablishes a closed water barrier after disconnection, while the chamber remains below the insertion site to support gravity drainage and the prescribed negative-pressure gradient. The sudden bright-red 200-mL output and prior continuous bubbling require immediate provider notification in this postoperative thoracic client.

4. Question 4 of 6 · Respiratory Failure & Oxygenation

   A 68-year-old man with stage IIIA right-upper-lobe non-small-cell lung cancer completed chemoradiation 6 weeks ago and resides in a long-term care facility. Two hours ago, his vital signs were T 37.6°C, HR 96, BP 118/72, RR 20, and SpO2 94% on 2 L/min oxygen. He now reports worsening breathlessness and chest heaviness when supine; HR 112, BP 106/68, RR 30, T 37.9°C, and SpO2 89% on 4 L/min. Breath sounds are diminished at the right base, and he is restless with new mild confusion. Which action should the nurse take first?

   1. ADocument the new confusion as an expected age-related finding and continue routine respiratory assessments.
   2. BPage the health care provider about the oxygen desaturation and wait for instructions before repositioning or providing further oxygen.
   3. CReassure the client that anxiety commonly causes breathlessness after cancer treatment and encourage slow breathing.
   4. DPlace the client in high-Fowler position, apply oxygen per protocol, and notify the health care provider using SBAR.
   Show the answer and rationale

   Correct answer: D. Place the client in high-Fowler position, apply oxygen per protocol, and notify the health care provider using SBAR.

   The nurse should immediately position the client upright, support oxygenation according to protocol, and communicate the deterioration with SBAR. The new oxygen requirement, persistent SpO2 of 89%, tachycardia, tachypnea, chest heaviness, restlessness, and confusion after a recent baseline change indicate worsening respiratory failure and possible pulmonary embolism or another acute pulmonary complication. These early changes require action before overt collapse. Reassurance does not explain the concerning cluster, and new confusion is not an expected consequence of age. Waiting for a callback delays airway and breathing support; the nurse should begin appropriate supportive care while escalating with the specific findings, trend, baseline, and recommendation.

   A. Document the new confusion as an expected age-related finding and continue routine respiratory assessments.

   New confusion and restlessness in a client with worsening hypoxemia are warning signs that may reflect inadequate oxygenation or another acute complication. Age does not make mental-status change expected, so documenting it as normal would miss an early decline requiring assessment and escalation.

   B. Page the health care provider about the oxygen desaturation and wait for instructions before repositioning or providing further oxygen.

   The provider should be notified, but waiting for instructions before positioning and supporting oxygenation neglects the immediate airway-and-breathing priority. The nurse can initiate appropriate oxygen and positioning while communicating the trend and preparing for further evaluation.

   C. Reassure the client that anxiety commonly causes breathlessness after cancer treatment and encourage slow breathing.

   Anxiety may accompany dyspnea, but it does not adequately explain the abrupt tachycardia, tachypnea, falling oxygen saturation despite increased oxygen, chest heaviness, and new confusion. Reassurance alone could delay treatment of pulmonary embolism or another serious respiratory complication.

   D. Place the client in high-Fowler position, apply oxygen per protocol, and notify the health care provider using SBAR.

   This action addresses breathing first by improving positioning and oxygen delivery, then escalates the early deterioration with a structured report. The nurse communicates the current findings, change from baseline, relevant cancer history, and recommended evaluation rather than waiting for severe decompensation.

5. Question 5 of 6 · Respiratory Failure & Oxygenation

   A home health RN visits a 78-year-old woman with advanced COPD who lives alone. Her daughter reports increased breathlessness since yesterday with productive cough. On assessment: RR 32/min, shallow, with accessory muscle use and nasal flaring; she speaks only 2-3 words at a time and appears drowsy but arousable. SpO2 is 84% on her baseline home oxygen order of 2 L/min nasal cannula. Lung sounds reveal scattered wheezes and rhonchi. The RN obtains a stat ABG: pH 7.29, PaCO2 62 mmHg, PaO2 52 mmHg, HCO3 28 mEq/L. What is the appropriate initial oxygen management for this client? Which action should the RN take first regarding this client's oxygen therapy?

   1. AAdminister a low dose of IV lorazepam to reduce her drowsiness and restlessness first.
   2. BIncrease supplemental oxygen in small increments, targeting an SpO2 of 88-92%.
   3. CSwitch to a 100% non-rebreather mask to raise SpO2 to 98-100% quickly.
   4. DKeep oxygen at 2 L/min without increasing it, since raising it could suppress her drive to breathe.
   Show the answer and rationale

   Correct answer: B. Increase supplemental oxygen in small increments, targeting an SpO2 of 88-92%.

   This client has advanced COPD with acute hypoxemia (SpO2 84%) and an ABG confirming acute-on-chronic respiratory acidosis (pH 7.29, PaCO2 62, HCO3 28 showing renal compensation for chronic CO2 retention). For chronic CO2 retainers, the oxygen titration target is 88-92%, not the 92-96% used in most adults, because chemoreceptors in advanced COPD rely partly on hypoxic drive; over-oxygenating can blunt that drive and worsen V/Q mismatch and CO2 narcosis. However, an SpO2 of 84% is below even this lower target and represents dangerous acute hypoxemia that must be corrected, so the correct action is to titrate oxygen upward carefully toward 88-92%, not withhold it. Applying a non-rebreather mask to push SpO2 to 98-100% ignores the population-specific target and risks worsening hypercapnia in a CO2 retainer. Withholding additional oxygen out of fear of suppressing respiratory drive ignores the priority of correcting severe hypoxemia; acute hypoxia is treated with controlled, titrated oxygen while monitoring for rising CO2. Sedating her with lorazepam treats a symptom (restlessness/drowsiness) that is actually caused by hypoxia and hypercapnia; sedation would further depress respiratory drive and worsen her acidosis without addressing the underlying oxygenation problem. This client's COPD exacerbation etiology requires controlled oxygen titration alongside bronchodilator therapy, not aggressive oxygenation or sedation.

   A. Administer a low dose of IV lorazepam to reduce her drowsiness and restlessness first.

   This is a likely error: her restlessness and drowsiness are signs of hypoxia and rising CO2, not primary agitation needing sedation. Giving a benzodiazepine would further depress ventilation and worsen her respiratory failure.

   B. Increase supplemental oxygen in small increments, targeting an SpO2 of 88-92%.

   Titrating oxygen upward toward 88-92% corrects dangerous hypoxemia (SpO2 84%) while respecting the lower target appropriate for a chronic CO2 retainer, avoiding suppression of hypoxic drive and further hypercapnia.

   C. Switch to a 100% non-rebreather mask to raise SpO2 to 98-100% quickly.

   This reflects the misconception that more oxygen is always better. In a CO2 retainer, pushing SpO2 to near 100% can blunt hypoxic respiratory drive and worsen hypercapnia and acidosis, which is the opposite of the goal here.

   D. Keep oxygen at 2 L/min without increasing it, since raising it could suppress her drive to breathe.

   This reflects a wrong-priority fear response. An SpO2 of 84% is acutely dangerous hypoxemia that must be corrected; withholding oxygen entirely to protect respiratory drive ignores the immediate life threat of severe hypoxia.

6. Question 6 of 6 · Respiratory Failure & Oxygenation

   An 78-year-old woman in the intensive care unit has a size 6 cuffed, non-fenestrated tracheostomy placed 3 days ago after emergency surgery for prolonged ventilator dependence following aspiration pneumonia. The stoma tract is not yet mature. The client's daughter is at the bedside, has not yet received teaching about tracheostomy care, and appears anxious. Before beginning the shift, the nurse checks the bedside table and finds suction equipment and a self-inflating bag. The obturator and a spare tracheostomy tube are stored in the central supply room down the hall. Based on this finding, what action should the nurse take first?

   1. AAsk the daughter to begin learning trach care before addressing the missing supplies
   2. BLeave the supplies in the supply room since suction and a bag-mask are already present
   3. CWait to gather the spare tube and obturator until the tube actually becomes dislodged
   4. DBring the obturator and a same-size plus one-size-smaller spare tube to the bedside now
   Show the answer and rationale

   Correct answer: D. Bring the obturator and a same-size plus one-size-smaller spare tube to the bedside now

   For any client with a tracheostomy, the obturator and a same-size plus one-size-smaller spare tube must remain at the bedside at all times, not in a central supply area. This is an airway-safety principle: if the tube becomes dislodged, especially in a fresh tracheostomy where the tract has not matured, seconds matter, and the equipment needed for safe reinsertion must be immediately accessible. Suction and a self-inflating bag alone are not sufficient substitutes because they support oxygenation temporarily but do not allow the provider to re-establish the airway with a new tube. Leaving the supplies in the supply room ignores this timing rule and delays emergency response. Asking the daughter to begin trach-care teaching is not the priority when a basic safety requirement is unmet, and teaching readiness must be assessed separately from immediate equipment needs. Waiting until the tube is actually dislodged to retrieve the spare equipment reverses the correct sequence entirely; the equipment must be in place before any emergency occurs, not obtained afterward, since retrieval during an actual dislodgement wastes critical time and increases hypoxia risk. Correcting the missing bedside supplies now, before any complication occurs, satisfies the fundamental rule of tracheostomy airway preparedness for this fresh, non-fenestrated tube.

   A. Ask the daughter to begin learning trach care before addressing the missing supplies

   Wrong. While assessing the daughter's readiness for teaching matters eventually, it does not address the immediate, basic safety gap of missing emergency airway equipment at this fresh tracheostomy's bedside.

   B. Leave the supplies in the supply room since suction and a bag-mask are already present

   Wrong. Suction and a bag-mask support oxygenation but cannot replace a dislodged tube; without the obturator and spare tube at the bedside, reinsertion is delayed during an airway emergency.

   C. Wait to gather the spare tube and obturator until the tube actually becomes dislodged

   Wrong. Waiting until dislodgement occurs to retrieve the spare tube and obturator reverses proper timing; equipment must be in place proactively so it is available the instant it is needed, not fetched afterward.

   D. Bring the obturator and a same-size plus one-size-smaller spare tube to the bedside now

   Correct. The obturator and a same-size plus one-size-smaller spare trach tube must be at the bedside at all times for any client with a tracheostomy, especially one that is fresh and non-fenestrated, so the provider can act instantly if the tube is dislodged.