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NCLEX respiratory practice questions

20 free NCLEX-style respiratory questions: COPD, chest tubes, oxygen devices, ABG interpretation and pediatric airway emergencies, each with the answer and a full rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A nurse is making rounds on four clients who are receiving oxygen. Which finding requires the nurse to take action?

  1. Oxygen at 4 L/min by nasal cannula, mouth breathing while asleep, SpO2 95%
  2. A simple face mask running at 8 L/min on a client whose SpO2 is now 96%
  3. A venturi mask set at 28% with the adapter tucked under the bed sheet
  4. Oxygen at 2 L/min by nasal cannula with no humidifier on the flowmeter
Show the answer and rationale

Answer: C

The air-entrainment ports on a venturi adapter mix a set amount of room air with the oxygen jet, so bedding over the adapter changes the concentration the client receives and defeats the purpose of a precise device; the nurse uncovers it and checks the saturation. Oxygen at 2 L/min does not need routine humidification, which is added at flows above about 4 L/min or when the client reports dryness. A client who mouth-breathes on a cannula with a saturation of 95% is still being oxygenated, and a simple face mask at 8 L/min is within its range, which starts at 5 L/min to flush exhaled carbon dioxide from the mask.

๐Ÿ“š Learn it: Oxygen Devices in One Table

Question 2 of 20

A client with pneumonia has a blood pressure of 84/48 mm Hg, a heart rate of 122 beats/min, a respiratory rate of 30 breaths/min, an SpO2 of 95% on 2 L/min, and a lactate of 4.6 mmol/L. Arterial blood gas: pH 7.27, PaCO2 29 mm Hg, HCO3 13 mEq/L. Which action should the nurse take first?

  1. Repeat the blood gas in 1 hour to confirm the trend
  2. Coach the client to breathe more slowly to raise the PaCO2
  3. Start the prescribed IV crystalloid bolus to restore perfusion
  4. Ask the provider about sodium bicarbonate to correct the pH
Show the answer and rationale

Answer: C

The pH and bicarbonate are low, and the fast breathing has lowered the PaCO2 to offset them, so this is a partially compensated metabolic acidosis. With hypotension and a lactate of 4.6 mmol/L, the acid comes from tissues starved of oxygen, and restoring perfusion with the prescribed fluid bolus treats the cause. Bicarbonate is the tempting runner-up because it raises the number, but it does not restore perfusion or clear the lactate. Slowing the breathing would remove the compensation and drop the pH further, and waiting an hour delays care for a client in shock.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 3 of 20

The parent of a 10-year-old who takes montelukast for asthma calls the clinic. Which report from the parent requires the nurse's immediate follow-up?

  1. 'She has nightmares now and said she wishes she were dead.'
  2. 'She started sleepwalking last week and wakes up frightened and confused.'
  3. 'She seems more irritable and moody since she started the tablet, and she has quit soccer.'
  4. 'Her peak flow was in the yellow zone this morning before school.'
Show the answer and rationale

Answer: A

Montelukast carries a boxed warning for serious neuropsychiatric events, so a statement that the child wishes she were dead requires immediate follow-up: her safety is assessed right away and the provider is notified so the drug can be stopped. The runner-up is the new sleepwalking with frightened, confused waking, another neuropsychiatric effect that needs prompt reporting, but it carries no stated wish to die. Growing irritability, low mood and loss of interest since starting the drug also fit the warning and are reported and monitored. A yellow-zone peak flow is managed with the quick-relief steps in her asthma action plan.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 4 of 20

A client who had a total laryngectomy yesterday has an SpO2 of 88%. The nurse finds that oxygen is being delivered by a face mask placed over the client's nose and mouth. Which action should the nurse take?

  1. Raise the head of the bed and increase the flow to the face mask
  2. Suction the stoma, then recheck the oxygen saturation
  3. Move the oxygen to a tracheostomy collar over the stoma
  4. Reposition the pulse oximeter probe and repeat the reading
Show the answer and rationale

Answer: C

A total laryngectomy permanently separates the trachea from the mouth and nose, so the client breathes only through the neck stoma, and oxygen, humidity, suctioning and rescue breaths must all go through the stoma. Suctioning the stoma is a reasonable step if the saturation stays low once oxygen reaches it, but right now the client is getting no supplemental oxygen at all. Rechecking the probe delays a fix for a cause already found, and oxygen over the nose and mouth never reaches the lungs, no matter how high the flow or how the bed is positioned.

๐Ÿ“š Learn it: Oxygen Devices in One Table

Question 5 of 20

A client with DKA on an intermediate care unit had deep, rapid respirations at 34 breaths/min on arrival 3 hours ago. The client is now hard to arouse, and respirations are shallow at 14 breaths/min. Arterial blood gas: pH 7.02, PaCO2 40 mm Hg, HCO3 10 mEq/L. Which action should the nurse take first?

  1. Ask the provider for a sodium bicarbonate infusion to raise the pH
  2. Call the rapid response team and prepare to support ventilation
  3. Increase the insulin infusion to clear the ketones faster
  4. Document that the slower breathing shows the acidosis is resolving
Show the answer and rationale

Answer: B

Kussmaul breathing blows off carbon dioxide to offset a metabolic acidosis, so with a bicarbonate of 10 mEq/L the PaCO2 should be far below 40 mm Hg. A normal PaCO2 with slow, shallow breaths and a falling level of consciousness means the client is tiring and the compensation has failed, which lets the pH fall further, so help and ventilatory support are needed now. Reading the slower breathing as improvement is the trap: breathing eases as DKA resolves only when the pH and bicarbonate are rising. Bicarbonate is considered only below a pH of 7.0 and does not fix hypoventilation, and the insulin rate follows the protocol.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 6 of 20

A client with asthma uses an albuterol inhaler as needed and a fluticasone inhaler twice daily, both metered-dose inhalers. On a morning when both are needed, which statement by the client indicates correct use?

  1. 'I'll use the fluticasone first to open my airways, then the albuterol, and rinse.'
  2. 'I'll breathe in fast and hard as I press the canister, then hold my breath briefly.'
  3. 'I'll use the albuterol first, then the fluticasone, and rinse my mouth.'
  4. 'I'll take extra puffs of fluticasone whenever I start to wheeze, then rinse my mouth.'
Show the answer and rationale

Answer: C

Albuterol is used first so the airways open and the inhaled corticosteroid can reach deeper into the lungs, and rinsing and spitting after fluticasone lowers the risk of oral thrush and hoarseness. The runner-up reverses that order: fluticasone does not open airways, so taking it first delivers less steroid to narrowed airways. A metered-dose inhaler is inhaled slowly and deeply as the canister is pressed, ideally with a spacer; a fast, forceful breath suits a dry-powder inhaler. Extra fluticasone puffs cannot relieve acute wheezing because it controls inflammation over time, not bronchospasm.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 7 of 20

A client with pneumonia who is receiving oxygen at 6 L/min by nasal cannula has an SpO2 of 85% and a respiratory rate of 30 breaths/min. The provider prescribes a non-rebreather mask. Which action should the nurse take?

  1. Connect the mask to the same flowmeter, still set at 6 L/min
  2. Add a bubble humidifier to the flowmeter before connecting the mask
  3. Set the flow at 15 L/min and let the reservoir bag fill before applying the mask
  4. Place the mask on the client first, then turn the flow up to 15 L/min
Show the answer and rationale

Answer: C

A non-rebreather delivers its high concentration from the reservoir bag, so the nurse sets the flow at 10 to 15 L/min and fills the bag, by covering the valve between the mask and the bag, before putting the mask on; the flow then stays high enough to keep the bag inflated. Putting the mask on first seems faster, but the client's first breaths come from an empty bag behind one-way valves, which gives little oxygen to a client who is already hypoxemic. A flow of 6 L/min cannot keep the bag filled, and stopping to add a humidifier delays oxygen the client needs now.

๐Ÿ“š Learn it: Oxygen Devices in One Table

Question 8 of 20

A 2-year-old began coughing and gagging while eating peanuts yesterday. Today the child has a persistent cough, wheezing heard only over the right lung, and diminished breath sounds on the right. The child has no fever and no history of asthma. Which condition should the nurse suspect?

  1. Croup from a viral infection of the upper airway
  2. Bronchiolitis from respiratory syncytial virus
  3. A first asthma attack triggered by a peanut allergy
  4. An aspirated foreign body in the right bronchus
Show the answer and rationale

Answer: D

A sudden choking or coughing episode while eating, followed by a persistent cough with wheezing and decreased breath sounds on one side, is the classic picture of an aspirated foreign body, which most often lodges on the right because the right mainstem bronchus is straighter and wider; the child needs imaging and bronchoscopy to remove it. Asthma and bronchiolitis cause wheezing over both lungs, and croup causes a barking cough and inspiratory stridor from the upper airway. Nuts are a common culprit, which is why they are kept away from children younger than about 4.

๐Ÿ“š Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 9 of 20

A client receiving mechanical ventilation after an overdose is sedated and is not breathing above the set rate of 22 breaths/min. Arterial blood gas results: pH 7.53, PaCO2 27 mm Hg, HCO3 23 mEq/L, PaO2 98 mm Hg. Which change in the ventilator settings should the nurse anticipate?

  1. An increase in the set tidal volume
  2. An increase in the set respiratory rate
  3. An increase in the fraction of inspired oxygen
  4. A decrease in the set respiratory rate
Show the answer and rationale

Answer: D

A pH above 7.45 with a PaCO2 below 35 mm Hg and a normal bicarbonate is uncompensated respiratory alkalosis, and in a sedated client who breathes only at the set rate, the ventilator is removing too much carbon dioxide, so the provider or respiratory therapist is likely to lower the rate. Raising the rate or the tidal volume would blow off even more carbon dioxide, and a PaO2 of 98 mm Hg shows oxygenation is adequate, so more oxygen is not needed.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 10 of 20

While the nurse suctions a client's tracheostomy, the heart rate drops from 92 to 48 beats/min and the SpO2 falls from 95% to 86%. Which action should the nurse take first?

  1. Instill sterile saline to loosen the secretions
  2. Give the prescribed atropine by IV push
  3. Finish the pass quickly so the airway is cleared
  4. Stop suctioning and give 100% oxygen
Show the answer and rationale

Answer: D

The suction catheter can stimulate the vagus nerve and removes oxygen along with secretions, causing bradycardia and desaturation, so the nurse stops suctioning at once, withdraws the catheter, and gives 100% oxygen, then lets the client recover before trying again with shorter passes of no more than 10 to 15 seconds. Finishing the pass deepens the hypoxemia, saline instillation is not recommended, and atropine is reserved for bradycardia that persists after the stimulus is removed.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Practice 10 more Respiratory questions free โ†’

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Question 11 of 20

A 4-year-old is brought to the emergency department with a fever of 104ยฐF (40ยฐC) that began 6 hours ago. The child is sitting upright on the parent's lap, leaning forward with the chin thrust out, drooling, and has a muffled voice and inspiratory stridor. Which action should the nurse take?

  1. Lay the child flat and look at the throat with a tongue blade to find the cause
  2. Obtain a throat culture before the first dose of antibiotic is given
  3. Keep the child upright on the parent's lap and call the airway team
  4. Start an IV line and draw blood cultures right away
Show the answer and rationale

Answer: C

Sudden high fever, drooling, a muffled voice, stridor and the tripod position are the picture of epiglottitis, in which the swollen epiglottis can close the airway at any moment, so the nurse keeps the child calm and upright where the child chooses to sit, gives oxygen as tolerated, and calls for the team that can secure the airway in a controlled setting such as the operating room. Nothing goes into the mouth and the child is not laid down, because a tongue blade, a throat swab or crying and struggling during an IV start can trigger complete obstruction. Cultures, IV access and antibiotics follow once the airway is secured.

๐Ÿ“š Learn it: Croup, Epiglottitis and the Tongue Blade You Never Use

Question 12 of 20

A client with long-standing COPD is at a routine clinic visit, talking comfortably on 2 L/min of oxygen. The arterial blood gas shows pH 7.36, PaCO2 58 mm Hg, HCO3 32 mEq/L, and PaO2 62 mm Hg. How should the nurse interpret these results?

  1. Uncompensated respiratory acidosis that needs urgent intubation
  2. Fully compensated respiratory acidosis, likely the client's baseline
  3. Partially compensated metabolic alkalosis from diuretic use
  4. Normal values that show no acid-base problem
Show the answer and rationale

Answer: B

The pH is normal but on the acidic side of 7.40, the PaCO2 is high, and the bicarbonate has risen to offset it, which is a chronic respiratory acidosis that the kidneys have fully compensated, typical of stable COPD with carbon dioxide retention. Because the pH is normal and the client is comfortable, no emergency treatment is needed, and oxygen stays titrated to the usual COPD target of 88 to 92%. A metabolic alkalosis would push the pH above 7.40, and with the PaCO2 and bicarbonate this far outside their ranges, the gas is not normal.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 13 of 20

While assessing tactile fremitus, a nurse places the ulnar side of each hand on the client's posterior chest and asks the client to say 'ninety-nine.' The vibrations are much stronger over the right lower lobe than over the left. Which condition is most consistent with this finding?

  1. Hyperinflated lungs from long-standing emphysema
  2. A pneumothorax that has partly collapsed the right lung
  3. Consolidation of the right lower lobe from pneumonia
  4. A large pleural effusion filling the right lower chest
Show the answer and rationale

Answer: C

Vibrations from the voice travel better through solid or fluid-filled lung tissue than through air, so fremitus increases over consolidation, as in lobar pneumonia. Anything that separates the lung from the chest wall, such as air in a pneumothorax or fluid in a pleural effusion, and the trapped air of emphysema dampen the vibrations and decrease fremitus. The nurse compares matching areas side to side, moving from the top of the chest down.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 14 of 20

A client receiving oxygen at 3 L/min by nasal cannula is having a cardiac catheterization with moderate sedation. Over 10 minutes the end-tidal carbon dioxide rises from 38 to 58 mm Hg and the respiratory rate falls from 16 to 9 breaths/min, while the SpO2 stays at 98%. How should the nurse interpret these findings?

  1. The rising carbon dioxide reflects anxious hyperventilation
  2. Ventilation and oxygenation are both adequate
  3. The capnography sensor has probably slipped out of place
  4. The client is hypoventilating despite a normal saturation
Show the answer and rationale

Answer: D

A rising end-tidal carbon dioxide with a slowing respiratory rate means the client is retaining carbon dioxide from sedation-induced hypoventilation, and supplemental oxygen can keep the saturation normal for minutes after breathing has become inadequate, which is why capnography detects the problem before pulse oximetry does. The nurse stimulates the client, encourages deep breaths, and alerts the provider before the saturation falls. A displaced sensor or hyperventilation would lower the end-tidal reading, not raise it.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 15 of 20

A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation and is receiving oxygen at 2 L/min by nasal cannula. Which finding requires the nurse's immediate follow-up?

  1. Oxygen saturation of 90% on the prescribed flow
  2. Pursed-lip breathing while walking to the bathroom
  3. New headache with increasing drowsiness
  4. Increased anteroposterior diameter of the chest
Show the answer and rationale

Answer: C

A new headache with increasing drowsiness suggests rising carbon dioxide (hypercapnia), which can progress to carbon dioxide narcosis and respiratory failure, so the nurse assesses the client and notifies the provider promptly, anticipating an arterial blood gas. A saturation of 90% sits inside the usual COPD target of 88 to 92%, and pursed-lip breathing is a helpful technique that keeps the airways open longer. A barrel chest reflects long-standing air trapping and is an expected chronic finding.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 16 of 20

A client has had a severe asthma attack for 6 hours despite repeated bronchodilator treatments. On arrival the PaCO2 was 30 mm Hg. Now the client is drowsy and speaks in single words, and the arterial blood gas shows pH 7.36 and PaCO2 44 mm Hg. How should the nurse interpret these findings?

  1. The client's breathing has improved, and the gas is now normal
  2. The kidneys have fully compensated for the asthma attack
  3. The client is tiring and nearing respiratory failure
  4. The bronchodilators have caused a metabolic alkalosis
Show the answer and rationale

Answer: C

Early in an asthma attack the client breathes fast and blows off carbon dioxide, so the PaCO2 is low; a PaCO2 that climbs back into the normal range while the client is still in distress, drowsy, and unable to speak in sentences means the breathing muscles are tiring and ventilation is failing, so the nurse alerts the provider and prepares for possible intubation. The values look normal only in isolation. Renal compensation begins within hours but takes days to become complete, and a normal pH with a normal PaCO2 shows no compensation pattern. Nothing in these results points to a metabolic alkalosis.

๐Ÿ“š Learn it: ABGs in Three Steps: ROME

Question 17 of 20

A client's chest tube is scheduled to be removed in 30 minutes. Which action by the nurse is most appropriate to prepare the client?

  1. Strip the tubing to clear any clots first
  2. Clamp the chest tube until it is removed
  3. Give the prescribed pain medication now
  4. Teach rapid breathing for when the tube is pulled
Show the answer and rationale

Answer: C

Chest tube removal is painful, so the prescribed analgesic is given about 30 minutes beforehand to take effect by the time of removal, and the client is taught to take a deep breath and hold it, or bear down, as the tube is pulled so air is not drawn into the pleural space. Clamping a chest tube can cause a tension pneumothorax, stripping the tubing generates dangerous negative pressure, and breathing in quickly during removal could pull air in through the tract. An occlusive dressing is applied immediately afterward while the nurse watches for respiratory distress.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 18 of 20

A client with a COPD exacerbation was started on bilevel positive airway pressure (BiPAP) 1 hour ago for hypercapnic respiratory failure. The client is now difficult to arouse, and the repeat arterial blood gas shows pH 7.21 and PaCO2 84 mm Hg, compared with pH 7.28 and PaCO2 70 mm Hg before BiPAP. Which action should the nurse anticipate?

  1. Increasing the oxygen delivered through the mask
  2. Removing the mask so the client can rest more easily
  3. Continuing BiPAP and repeating the gas in 4 hours
  4. Preparing for endotracheal intubation
Show the answer and rationale

Answer: D

Noninvasive ventilation should improve the pH and PaCO2 within 1 to 2 hours; a falling pH, a rising carbon dioxide level, and a decreasing level of consciousness mean it has failed, and a client who can no longer protect the airway needs intubation and mechanical ventilation. Extra oxygen does not remove carbon dioxide and can worsen hypercapnia in COPD. Removing the mask or waiting another 4 hours leaves the client sliding toward respiratory arrest.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 19 of 20

A client with extensive pneumonia of the left lung is short of breath, with an SpO2 of 90% on 4 L/min of oxygen. When turning the client, which position should the nurse favor to improve oxygenation?

  1. Lying on the right side, with the unaffected lung down
  2. Prone, as is done for acute respiratory distress syndrome
  3. Lying on the left side, with the affected lung down
  4. Lying flat on the back with the head of the bed at 0 degrees
Show the answer and rationale

Answer: A

Gravity sends more blood flow to the lowest part of the lungs, so placing the healthy lung down matches blood flow to the lung that is still ventilating well and improves oxygenation in one-sided lung disease. Lying on the affected side sends blood to consolidated tissue that cannot exchange gas, and lying flat lets the abdominal contents push up on the diaphragm. Prone positioning is a protocol-driven treatment for severe acute respiratory distress syndrome affecting both lungs, not routine care for pneumonia in one lung.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Question 20 of 20

A chest tube is inserted for a right hemothorax after a motor vehicle crash. Within minutes, 1,600 mL of blood drains into the collection chamber, and the client's heart rate rises from 108 to 128 beats/min. Which action should the nurse take?

  1. Clamp the chest tube to stop further blood loss
  2. Strip the tubing to keep clots from blocking it
  3. Document the output and recheck it in 1 hour
  4. Notify the surgeon now and prepare for surgery
Show the answer and rationale

Answer: D

An immediate output of about 1,500 mL of blood, or continued drainage of about 200 mL/hr for 2 to 4 hours, signals a massive hemothorax from bleeding that will not stop on its own, and the client needs an urgent thoracotomy and blood products. Clamping the tube does not stop the bleeding; blood keeps collecting in the chest, where it compresses the lung and can impair the heart. Stripping the tubing creates dangerously high negative pressure, and waiting an hour wastes time the client does not have.

๐Ÿ“š Learn it: Chest Tubes, COPD and the Silent Chest

Practice 10 more Respiratory questions free โ†’

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