NCLEX Respiratory & Oxygenation questions
The PrepScore bank has 90 Respiratory & Oxygenation questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Learn how to recognize acute breathing cues, avoid chronic-history traps, and choose the safest first action.
Three worked questions
Q1. A 72-year-old male with severe COPD has a baseline SpO2 of 92% on home oxygen. He presents to the clinic with mild dyspnea and SpO2 88% on room air. What is the nurse's BEST initial action for oxygen titration?
- A. Apply oxygen at 6 L/min via nasal cannula to rapidly normalize the SpO2 to above 95% range
- B. Apply oxygen at 1-2 L/min via nasal cannula titrated to SpO2 88-92% (COPD target)
- C. Apply 100% non-rebreather mask immediately regardless of baseline COPD status or current symptoms
- D. Withhold all oxygen and observe the patient closely until SpO2 drops below 80% on room air
Show answer and rationale
Answer: Apply oxygen at 1-2 L/min via nasal cannula titrated to SpO2 88-92% (COPD target)
COPD oxygen target is 88-92% — higher targets risk suppressing hypoxic drive and worsening hypercarbia. Withholding oxygen risks hypoxemia.
Q2. A 58-year-old male with COPD is admitted with worsening dyspnea. The nurse reviews ABG results to identify the acid-base disturbance. Which ABG result indicates UNCOMPENSATED RESPIRATORY ACIDOSIS?
- A. pH 7.30, PaCO2 55 mmHg, HCO3 24 mEq/L (acidemia + hypercarbia + normal HCO3)
- B. pH 7.30, PaCO2 30 mmHg, HCO3 14 mEq/L (acidemia + hypocarbia + low HCO3)
- C. pH 7.50, PaCO2 28 mmHg, HCO3 24 mEq/L (alkalemia + hypocarbia + normal HCO3)
- D. pH 7.40, PaCO2 40 mmHg, HCO3 24 mEq/L (normal pH + normal PaCO2 + normal HCO3)
Show answer and rationale
Answer: pH 7.30, PaCO2 55 mmHg, HCO3 24 mEq/L (acidemia + hypercarbia + normal HCO3)
Uncompensated respiratory acidosis = low pH + high PaCO2 + normal HCO3. Other patterns are metabolic acidosis, respiratory alkalosis, and normal.
Q3. A 28-year-old male with severe asthma is in the ED with worsening dyspnea over 30 minutes despite nebulized albuterol. The triage nurse evaluates for impending respiratory failure. Which findings indicate IMPENDING RESPIRATORY FAILURE in this asthmatic? Select all that apply.
- A. Respiratory rate 35 + accessory muscle use (sustained tripod, retractions)
- B. Silent chest with decreased breath sounds (inadequate air movement)
- C. SpO2 86% on room air despite albuterol nebulizer treatment
- D. Drowsiness, confusion, or decreased level of consciousness (hypercarbia)
- E. Strong productive cough with loud audible wheezing throughout lung fields
Show answer and rationale
Answer: Respiratory rate 35 + accessory muscle use (sustained tripod, retractions)Silent chest with decreased breath sounds (inadequate air movement)SpO2 86% on room air despite albuterol nebulizer treatmentDrowsiness, confusion, or decreased level of consciousness (hypercarbia)
Impending respiratory failure: tachypnea + accessory use + silent chest + hypoxemia despite treatment + AMS from hypercarbia. Strong cough with loud wheeze is paradoxically reassuring — air is moving.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
When a client with chronic disease shows sudden new abnormal findings, treat the change as current instability — not as their baseline. Chronic disease does not produce sudden, clustered changes. The presence of a chronic diagnosis is information, not an explanation for an acute event.
Clients with chronic CO2 retention can rely partially on their hypoxic respiratory drive. Excessive oxygen can suppress that drive and lead to CO2 narcosis. Target SpO2 88–92% in COPD, starting at the lowest effective flow and increasing only as needed. Watch the mental status — new drowsiness is the cue to titrate down, not up.
On opioids, increasing sedation (alert → drowsy → difficult to arouse) is the warning sign that comes BEFORE the respiratory rate falls. RR ≤10 + sedation = opioid-induced respiratory depression. Stop the opioid first; reversal agents come second.
Wheezing requires air movement to produce. In severe asthma, a 'silent chest' after bronchodilator means too little air is moving to make a sound. Silent chest + worsening work of breathing + falling SpO2 = airway emergency. Don't call this 'improvement.'
Older adults often present acute physiological problems through changes in cognition rather than through complaints of pain or shortness of breath. New confusion in an elderly client with infection should trigger a workup for hypoxia and sepsis, not a 'hospital delirium' label.
Sudden chest pain or shortness of breath in a post-op client, especially after orthopedic surgery, raises immediate concern for pulmonary embolism. Unilateral calf swelling, tachycardia, tachypnea, and a 'sense of impending doom' should not be dismissed as anxiety. DVT prophylaxis reduces but does not eliminate VTE risk.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Respiratory & Oxygenation questions does the bank have?
90 multiple-choice items, plus 10 unfolding cases in the Respiratory & Oxygenation pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Take action, though every step appears.
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