NCLEX-PN respiratory practice questions

Question 1

On a medical unit, the nurse is caring for a 67-year-old client on day 3 of treatment for an exacerbation of chronic obstructive pulmonary disease (COPD). The client is stable, receives oxygen at 2 L/min by nasal cannula and has a prescribed SpO2 target of 88% to 92%. For each task, click to specify if the nurse should assign the task to the unlicensed assistive personnel (UAP) or perform the task.

Accepted Answer

Reinforce the pursed-lip breathing that the respiratory therapist taught: Nurse performs; Help the client wash and change into a clean gown: Assign to the UAP; Give the scheduled ipratropium and albuterol nebulizer treatment: Nurse performs; Walk with the client in the hallway using the portable oxygen tank: Assign to the UAP; Adjust the oxygen flow to keep the SpO2 within the prescribed target: Nurse performs; Measure the vital signs and SpO2 at 1200 and report an SpO2 under 88%: Assign to the UAP. A stable client with COPD needs a mix of routine care and nursing care, and the split follows the line between measuring and deciding. The UAP can measure vital signs and SpO2 on a stable client and report a value the nurse has named, walk with the client using the portable oxygen and help with hygiene.

The nurse keeps the medication, the teaching and the oxygen. A nebulizer treatment is a medication. Reinforcing breathing techniques is teaching, which needs the nurse's knowledge to correct the client's technique. Adjusting the oxygen flow within a prescribed target means deciding what a reading means and acting on it, and in COPD too much oxygen can blunt the drive to breathe and raise the carbon dioxide level.

Question 2

The nurse prepares to give a client oxycodone 10 mg by mouth for pain rated 7 on a scale of 0 to 10. The nurse finds the client difficult to wake, with a respiratory rate of 9/min. Which of the following actions should the nurse take?

Accepted Answer

C: Hold the dose, stay with the client, and report the findings to the registered nurse (RN). Opioids depress the central nervous system and breathing. A client who is hard to wake with a respiratory rate under 12/min shows signs of opioid-induced sedation and respiratory depression, so no more opioid is given. The nurse stays with the client, encourages deep breathing, and reports at once, because naloxone may be needed.

Question 3

The adult daughter of a 66-year-old client admitted with active pulmonary tuberculosis tells the nurse, "I'm so ashamed. People will think our family is dirty. I don't want my children near Dad ever again." Which statement by the nurse is appropriate?

Accepted Answer

A: "This is a lot to take in. Tuberculosis spreads through the air, and it can be cured.". Tuberculosis still carries a stigma, and families often believe it comes from being poor or unclean. Shame can lead a family to hide the diagnosis, avoid screening, or pull away from the client, all of which harm the client and the people around them.

The nurse first acknowledges how hard this news is, then corrects the misunderstanding with facts. Tuberculosis is spread through the air by coughing, not by dirt, and it is curable with a full course of treatment. After a few weeks of effective treatment and negative sputum smears, the client stops being contagious. The family, including the children, will be offered screening, which the nurse can reinforce next.

Question 4

The nurse is caring for a 58-year-old client with pneumonia who receives oxygen at 5 L/min by nasal cannula. After 2 days of oxygen therapy, the client reports a dry, burning nose, and there is a small amount of dried blood in the left naris. Which action should the nurse take?

Accepted Answer

C: Add a sterile water humidifier to the flowmeter. Oxygen from a wall outlet or tank is a dry gas. At higher flow rates it dries the nasal mucosa and can cause burning, crusting and small nosebleeds. Most facilities add a humidifier filled with sterile water when the flow through a nasal cannula is above 4 L/min. The nurse checks the water level in the humidifier at least every shift, along with the flow rate.

Question 5

At a college health clinic, a 19-year-old client with exercise-triggered asthma is starting montelukast 10 mg orally once daily, and the nurse reinforces the provider's teaching about the medication. Which of the following statements by the client indicates a need for further teaching?

Accepted Answer

D: "I will take a montelukast tablet as soon as I start wheezing during a game.". Montelukast is a leukotriene receptor antagonist. Leukotrienes are chemicals released in the airways that cause swelling, mucus, and bronchospasm, and montelukast blocks them to prevent asthma symptoms over time. It is a daily controller medication, usually taken in the evening, and it does not act fast enough to relieve wheezing that has already started.

Wheezing during a game calls for the quick-relief inhaler, albuterol, which opens the airways within minutes. Taking a montelukast tablet then would delay real treatment.

Question 6

On a medical unit, an 87-year-old client admitted with pneumonia was oriented on admission but has been drowsy and disoriented to time and place since last night. Her son, who is not her power of attorney, brings a document and says, "This puts her house in my name so I can pay her bills. She agreed to it last month. Can you witness her signature?" Which action should the nurse take?

Accepted Answer

D: Decline to witness her signature, and report the request and her confusion to the registered nurse (RN). Signing over a house is a major legal and financial decision, and the person signing must be able to understand what the document does and what it means for her. A client who has become drowsy and disoriented with pneumonia may have delirium, which clouds thinking and comes and goes. She cannot reliably make that decision now, and whether she can is not something the nurse decides at the bedside.

A request to transfer property from a confused older adult is also a recognized warning sign of financial exploitation, whatever the son's intentions. By witnessing, the nurse would be confirming that the client signed willingly and with understanding, which the nurse cannot confirm. Declining and reporting both the request and the new confusion to the RN protects the client. The RN can involve the provider and the social worker, and the new disorientation itself needs reporting because it may mean the pneumonia is getting worse.

Question 7

At 2130 the nurse in a long-term care facility walks into the room of a client with chronic obstructive pulmonary disease who receives oxygen at 2 L/min by nasal cannula. The client is holding a cigarette and reaching for a lighter. Which action should the nurse take first?

Accepted Answer

C: Move the lighter well out of the client's reach. Oxygen does not burn, but it makes anything nearby burn much faster and hotter. A spark or flame near a cannula can ignite the tubing, hair or bedding and cause severe facial and airway burns. Removing the source of ignition is the action that prevents the fire. Afterward the nurse explains the danger, checks that no-smoking signs are posted and stays alert for other smoking materials.

Question 8

A 5-year-old child with suspected epiglottitis is sitting upright on a parent's lap while the team prepares the operating room for intubation. Thirty minutes after arrival, the nurse checks the child again. Which of the following findings indicate that the airway obstruction is worsening?

Accepted Answer

B: Increasing restlessness with attempts to climb off the parent's lap; D: Heart rate rising from 128/min to 154/min; E: New suprasternal and intercostal retractions. Epiglottitis is a serious infection that causes swelling of the epiglottis, the flap of tissue at the base of the tongue.

Restlessness is an early sign of hypoxia in a child, and a rising heart rate shows that the body is working harder to deliver oxygen. New retractions mean the child is pulling harder against a narrowing airway. Together these findings signal that the obstruction is progressing and that complete obstruction may follow. The nurse reports the changes right away to the registered nurse (RN) and the airway team, keeps the child upright and calm and has the intubation and tracheostomy equipment ready. A child who becomes quiet, with softer stridor and less air movement, is tiring and is close to respiratory arrest.

Question 9

On a medical unit, the nurse is reinforcing discharge teaching about a new inhaler with a 59-year-old client whose first language is Spanish. The client speaks some conversational English and declined an interpreter on admission. He smiles, nods and says "yes" after each instruction, but when the nurse asks him to show how he will use the inhaler, he holds it upside down. Which action should the nurse take?

Accepted Answer

C: Offer a qualified Spanish medical interpreter again, and continue the teaching session with the interpreter. Nodding and saying "yes" often signal politeness, respect or a wish not to look foolish, not understanding. The client's return demonstration tells the real story: a metered-dose inhaler held upside down delivers almost none of the medication to the lungs. Conversational English is enough for small talk but often not for medication instructions, which use unfamiliar words and depend on exact steps.

A client may decline an interpreter, but when teaching is not landing, the nurse offers a qualified interpreter again and explains that it is to make sure the instructions are clear. A qualified interpreter lets the client hear the teaching in the language he thinks in and ask his own questions. The nurse then checks understanding with another return demonstration.

Question 10

The home health nurse is visiting a 77-year-old client who takes warfarin for atrial fibrillation and has had a stable INR of 2.4 for 6 months. After a hospital stay for pneumonia, the client has a poor appetite, and the dietitian recommends an oral nutrition supplement 3 times a day. Each 240-mL bottle provides 20% of the daily value of vitamin K. Which action should the nurse take?

Accepted Answer

B: Report the new supplement to the health care provider so the INR can be checked more often. Warfarin is an anticoagulant that works by blocking the liver's use of vitamin K to make clotting factors. A steady intake of vitamin K keeps the INR steady, and a sudden increase lowers the INR and the protection against stroke.

Three bottles a day at 20% of the daily value each is a new 60% of the daily value of vitamin K that the client was not taking when the warfarin dose was set. The client needs the extra calories and protein, so the supplement is not stopped. Instead the provider is told so the INR can be checked more often over the next few weeks and the warfarin dose adjusted if needed. After that, the client drinks the supplement every day in the same amount, so the vitamin K intake stays consistent again.

NCLEX-PN respiratory practice questions.