Free NCLEX respiratory questions with full rationales
Four free NCLEX-RN respiratory questions covering CO2 narcosis in COPD, chest tube air leaks, status asthmaticus warning signs, and anaphylaxis with airway compromise. Respiratory items are airway-priority items — they often answer the "see this client first" question.
Top respiratory topics on NCLEX-RN
- COPD with CO2 retention. Target SpO2 88–92% only. Higher O2 saturations can blunt hypoxic drive and worsen hypercapnia.
- Asthma exacerbation. Silent chest = impending respiratory failure. Albuterol, ipratropium, steroids, magnesium escalation.
- Pulmonary embolism. Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxia. D-dimer + CT angiography. Anticoagulation.
- ARDS. Bilateral infiltrates, PaO2/FiO2 ratio < 300, refractory hypoxia. Low tidal volume ventilation, prone positioning.
- Chest tube management. Continuous bubbling = air leak. Tidaling = patent system. Cessation of drainage with respiratory distress = possible occlusion.
- Tracheostomy emergencies. Decannulation, mucus plug, bleeding. Always have a spare trach at bedside.
Master the ABG in 4 steps
- pH. Above 7.45 alkalosis. Below 7.35 acidosis.
- PaCO2. Respiratory cause if pH and PaCO2 move opposite directions.
- HCO3. Metabolic cause if pH and HCO3 move same direction.
- Compensation. If both PaCO2 and HCO3 are abnormal, the body is compensating. Fully normal pH = full compensation.
Oxygen delivery decision tree
- Nasal cannula 1–6 L → ~24–44% FiO2.
- Simple mask 6–10 L → ~35–55% FiO2.
- Venturi mask → precise FiO2 control, ideal for COPD.
- Non-rebreather 10–15 L → ~80–95% FiO2.
- High-flow nasal cannula or BiPAP → escalation when FiO2 above 50% needed.
- Intubation → for refractory hypoxia, hypercapnia with acidosis, or airway protection.
Try these 4 questions now
No signup required. Tap an answer to reveal the rationale.
- Question 1 · Respiratory · MCQ
A client with COPD on 4 L oxygen via nasal cannula becomes progressively more drowsy. ABG: pH 7.28, PaCO2 68, PaO2 78. What should the nurse do first?
- a.Increase oxygen to 6 L
- b.Decrease oxygen to 2 L and notify the provider
- c.Encourage the client to take deep breaths
- d.Position client supine for comfort
Show answer + rationale
Correct: B. This is CO2 narcosis: chronic CO2 retainers can lose hypoxic drive when given too much oxygen. Drowsiness with acute respiratory acidosis (pH 7.28, PaCO2 68) means PaCO2 is climbing. Decreasing oxygen to the lowest level maintaining SpO2 88–92% is the priority, then provider notification for possible BiPAP. Increasing O2 worsens the problem. Supine position worsens dyspnea.
- Question 2 · Respiratory · MCQ
Which assessment finding indicates a potentially life-threatening complication of a chest tube?
- a.Continuous bubbling in the water seal chamber
- b.Tidaling in the water seal chamber
- c.150 mL serosanguineous drainage in 24 hours
- d.Crepitus in the chest wall around insertion site
Show answer + rationale
Correct: A. Continuous bubbling in the water seal indicates an air leak from the lung, tubing, or insertion site — could signal worsening pneumothorax or tube disconnection. Tidaling is expected (it shows the system is patent). 150 mL/day drainage is acceptable. Crepitus warrants documentation and monitoring but is not immediately life-threatening unless rapidly progressing.
- Question 3 · Respiratory · MCQ
A client with status asthmaticus is becoming quiet with shallow breathing after 30 minutes of nebulized albuterol. What does this finding suggest?
- a.Improvement — the client is responding to treatment
- b.Impending respiratory failure
- c.Medication side effect
- d.Adequate hydration
Show answer + rationale
Correct: B. A 'silent chest' in status asthmaticus is ominous — airways are so narrowed that air movement is minimal. The client is exhausted and approaching respiratory failure. Requires immediate escalation: IV steroids, magnesium, possible intubation. Quiet breath sounds in an asthmatic in crisis are NEVER a good sign.
- Question 4 · Respiratory · NGN case study
A 4-year-old with a known peanut allergy is brought to the clinic after accidentally eating a granola bar. The child has stridor, lip swelling, and audible wheezing. Vital signs: HR 148, RR 38, BP 78/40, SpO2 88% on room air. Which intervention is the priority?
- a.Administer oral diphenhydramine
- b.Administer IM epinephrine 0.15 mg
- c.Start an IV of 0.9% NaCl bolus
- d.Apply 6 L oxygen via simple mask
Show answer + rationale
Correct: B. Anaphylaxis with airway compromise (stridor), respiratory distress, and hypotension requires immediate IM epinephrine to the mid-anterolateral thigh. Epinephrine reverses bronchoconstriction, restores vascular tone, and stabilizes mast cells. Antihistamines are adjuncts only and do not treat airway swelling. IV fluids and oxygen follow epinephrine, not before it.
These are 5 of 5,000+ NCLEX questions in the Clarity bank. The full bank includes real NGN case studies, bow-tie items, AI tutor follow-up, and 5 readiness exams.
Get 5,000+ more questions free for 10/day →Frequently asked questions
What SpO2 should I target in a COPD patient?
88–92% for chronic CO2 retainers. Higher saturations risk blunting hypoxic drive and worsening hypercapnia. Use the Venturi mask for precise FiO2 control.
What is a silent chest in asthma?
Absence of audible wheezing in an asthmatic in crisis. It is NOT improvement — it means airways are so narrowed that air movement is minimal. Sign of impending respiratory failure requiring immediate escalation.
When do I worry about chest tube bubbling?
Continuous bubbling in the water seal indicates an air leak from the lung, tubing, or insertion site. Intermittent bubbling with cough or exhalation is normal. Cessation of bubbling can mean lung re-expansion (good) or tube occlusion (bad).
How do I interpret a quick ABG?
pH first (acidosis vs alkalosis), then PaCO2 (respiratory cause if moves opposite to pH), then HCO3 (metabolic cause if moves with pH). Mixed disorders if both abnormal. Compensated if pH near normal.