NCLEX-RN Med-Surg: Respiratory Practice Questions

480 Med-Surg: Respiratory questions written for the NCLEX-RN, each with a rationale explaining why the correct answer is correct and why the others are not. Free, no account required. 10 examples are shown below.

Topics covered

• Interstitial Lung Disease (78)
• Asthma (58)
• Pneumothorax & Hemothorax (50)
• Sleep Apnea & Respiratory Disorders (50)
• Tracheostomy Care (40)
• COPD (40)
• Pulmonary Embolism (38)
• Mechanical Ventilation (38)
• Tuberculosis (38)
• Acute Respiratory Distress (20)
• Pneumonia & Respiratory Infections (20)
• Respiratory: COPD, Pneumonia, PE (4)
• Chest Tube (1)
• COPD Exacerbation (1)
• Community-Acquired Pneumonia (1)
• ARDS (1)
• Asthma Exacerbation (1)
• Pneumothorax (1)

Example questions with rationales

Answers are shown so you can read these as worked examples. To answer them yourself and track what you get wrong, start a practice set.

1. 1COPD Exacerbation

   Based on the patient's presentation, history, and diagnostic findings, what is the most likely primary problem that needs to be addressed immediately?

   • Acute COPD exacerbation due to respiratory infection — correct
   • Congestive heart failure secondary to fluid overload
   • Pulmonary embolism
   • Anxiety disorder with hyperventilation
   Rationale

   The answer: A — Acute COPD exacerbation due to respiratory infection Think of it this way: A COPD patient who has been stable for months suddenly deteriorates over 3 days with yellow-green (purulent) sputum, elevated white blood cells, and labored breathing. That's the textbook picture of an infection triggering a COPD exacerbation. The bacterial or viral invader inflames already-damaged airways, causing them to swell and produce more mucus than the patient can clear. Why A is right: Multiple findings converge on this diagnosis: known severe COPD, acute worsening of dyspnea over 3 days, purulent sputum (yellow-green = infection), elevated WBC (leukocytosis from infection), use of accessory muscles and tripod positioning (increased work of breathing), and ABG showing acute respiratory acidosis with hypoxemia — all consistent with an infectious COPD exacerbation. Why the others are wrong: - B: Heart failure is less likely — no peripheral edema, no JVD, and the presentation is dominated by infection signs (purulent sputum, elevated WBC). - C: Pulmonary embolism is possible but less likely without chest pain, disproportionate tachycardia, or current PE risk factors. The infection markers point away from PE. - D: Anxiety is secondary to the respiratory distress, not the primary diagnosis. The objective physiological findings (ABG, WBC, sputum) confirm organic respiratory compromise. Remember: COPD + sudden worsening + purulent sputum + elevated WBC = infectious COPD exacerbation. Treatment: short-acting bronchodilators, systemic corticosteroids, antibiotics, controlled oxygen. Technical note: COPD exacerbations are classified as mild (managed with bronchodilators alone), moderate (add steroids), or severe (hospitalization required). The most common triggers are respiratory infections (bacterial: H. influenzae, S. pneumoniae, M. catarrhalis; viral: rhinovirus, influenza).

2. 2COPD

   Select all that are complications of advanced COPD:

   • Cor pulmonale — correct
   • Respiratory failure — correct
   • Spontaneous pneumothorax — correct
   • Pulmonary embolism
   Rationale

   Complications of advanced COPD include cor pulmonale (right heart failure from pulmonary hypertension), respiratory failure (due to progressive hypoxemia and hypercapnia), and spontaneous pneumothorax (due to rupture of blebs on hyperinflated lungs). While COPD patients are at increased risk for pulmonary embolism due to immobility, it is not a direct complication of the COPD disease process itself but rather a comorbidity.

3. 3Asthma

   A patient with asthma asks the nurse about exercise-induced asthma. Which statement by the nurse is most appropriate?

   • You should avoid all physical activity to prevent asthma attacks
   • Using a SABA 15-30 minutes before exercise can prevent symptoms — correct
   • Exercise-induced asthma only occurs in elite athletes
   • Warm-up exercises are not recommended for patients with exercise-induced asthma
   Rationale

   Pre-exercise use of a SABA (such as albuterol) 15-30 minutes before activity is the standard treatment for exercise-induced bronchoconstriction. Patients should not be advised to avoid exercise; rather, they should be taught to prevent symptoms with appropriate medication and warm-up activities.

4. 4Tuberculosis

   A nurse is performing a health assessment on a client who recently immigrated from a country with high TB prevalence. Which question is most appropriate to identify TB risk?

   • Have you ever been vaccinated against tuberculosis?
   • Do you have a family history of lung disease?
   • Have you had any night sweats, weight loss, or persistent cough? — correct
   • Do you smoke cigarettes or use illicit drugs?
   Rationale

   When assessing for TB risk, the nurse should ask about classic symptoms of active TB: persistent cough (often productive), night sweats, fever, and unexplained weight loss (cachexia). These symptoms indicate possible active disease requiring evaluation. While country of origin, smoking, and drug use are risk factors, specific symptom inquiry is most direct for identifying active TB.

5. 5Pulmonary Embolism

   A patient with pulmonary embolism is receiving intravenous unfractionated heparin. The nurse notes that the aPTT is 90 seconds. Based on this result, which nursing action is appropriate?

   • Stop the heparin infusion immediately
   • Increase the heparin infusion rate
   • Maintain the current heparin infusion rate — correct
   • Decrease the heparin infusion rate
   Rationale

   The therapeutic aPTT range for unfractionated heparin therapy in PE is typically 1.5 to 2.5 times the control value (usually 60-80 seconds, depending on the lab reference range). An aPTT of 90 seconds falls within the therapeutic range. Therefore, the current infusion rate should be maintained. Stopping or adjusting the rate would be inappropriate unless the aPTT was above the therapeutic range.

6. 6Interstitial Lung Disease

   The nurse is caring for a patient with interstitial lung disease related to rheumatoid arthritis. Which assessment finding would indicate the patient is developing pulmonary hypertension as a complication?

   • Bilateral wheezes on auscultation
   • Increased oxygen requirement with activity
   • Prominent P2 heart sound — correct
   • Dry, hacking cough
   Rationale

   Pulmonary hypertension in ILD often manifests as a prominent or loud second heart sound (P2) on auscultation due to increased pulmonary artery pressure. Other signs include right-sided heart failure signs (edema, jugular venous distension), but P2 is a specific auscultatory finding. Wheezes suggest airway involvement, increased oxygen need is non-specific, and cough is a symptom of ILD itself.

7. 7Interstitial Lung Disease

   The nurse is developing a palliative care plan for a patient with end-stage interstitial lung disease. Which intervention would be most appropriate?

   • Discontinue all respiratory medications
   • Focus on symptom management and quality of life — correct
   • Recommend aggressive pulmonary rehabilitation
   • Encourage the patient to increase activity level
   Rationale

   Palliative care in end-stage ILD focuses on symptom management (dyspnea, pain, anxiety), psychological support, and quality of life rather than disease modification. This includes opioid therapy for dyspnea, oxygen for comfort, anxiolytics, and advance care planning. Aggressive interventions that increase suffering are not appropriate.

8. 8Acute Respiratory Distress

   The nurse is caring for a client with ARDS who is on continuous sedation. Which intervention is most important to prevent complications?

   • Perform oral care every 2 hours and maintain head of bed elevated 30-45 degrees — correct
   • Limit suctioning to every 8 hours to prevent airway trauma
   • Turn the client only every 8 hours to prevent dislodging the ET tube
   • Restrict intravenous fluids to prevent pulmonary edema
   Rationale

   VAP prevention is critical in intubated ARDS patients. Oral care every 2 hours and maintaining HOB elevation 30-45 degrees are evidence-based interventions to reduce ventilator-associated pneumonia risk.

9. 9Mechanical Ventilation

   The high-pressure alarm on the ventilator keeps sounding. The nurse assesses the client and finds the client is restless, tachycardic, and has decreased breath sounds on the right side. What should the nurse do FIRST?

   • Increase the sedative medication
   • Suction the endotracheal tube — correct
   • Check the ventilator circuit for kinks
   • Call the respiratory therapist
   Rationale

   The client's restlessness, tachycardia, and decreased breath sounds on the right side, along with a high-pressure alarm, suggest a possible pneumothorax, a life-threatening complication of mechanical ventilation. The nurse should first assess for tracheal deviation and notify the provider immediately; suctioning is not indicated for this finding. Kinks in the circuit are possible but less likely given the unilateral breath sounds. Sedating the client would mask symptoms, and calling the RT delays intervention.

10. 10Pulmonary Embolism

    Which ECG finding is most commonly associated with massive pulmonary embolism?

    • ST-segment elevation in leads V1-V4
    • S1Q3T3 pattern — correct
    • Atrial fibrillation with rapid ventricular response
    • Left bundle branch block
    Rationale

    The S1Q3T3 pattern (prominent S wave in lead I, Q wave in lead III, and inverted T wave in lead III) is a classic ECG finding associated with acute cor pulmonale from massive pulmonary embolism, though it is not always present.

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