🎯 High-Yield Points for This Topic
- COPD: low-flow oxygen (1-2 L/min); hypoxic drive — avoid high O2 concentrations
- Asthma: peak flow meter assessment; bronchodilators before corticosteroids (order matters)
- Pneumonia: position on affected side (not healthy side) to maximise ventilation
- PE: sudden onset pleuritic chest pain + dyspnoea + tachycardia; Virchow's triad
- Tuberculosis: airborne precautions (N95 mask, negative pressure room)
[Infographic: Respiratory NCLEX Questions Key Concepts — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A nurse is caring for a client with COPD experiencing respiratory distress. Which oxygen delivery is MOST appropriate?
✓ Correct: Nasal cannula at 1-2 L/min
COPD patients retain CO2 and their respiratory drive shifts to hypoxic drive (low O2 stimulates breathing). High-flow oxygen can suppress this drive and cause respiratory depression. Low-flow oxygen via nasal cannula at 1-2 L/min maintains SpO2 at 88-92% target without eliminating hypoxic drive. Venturi masks are also used but the nasal cannula at low flow is the safest first approach.
COPD patients retain CO2 and their respiratory drive shifts to hypoxic drive (low O2 stimulates breathing). High-flow oxygen can suppress this drive and cause respiratory depression. Low-flow oxygen via nasal cannula at 1-2 L/min maintains SpO2 at 88-92% target without eliminating hypoxic drive. Venturi masks are also used but the nasal cannula at low flow is the safest first approach.
Question 2
A client with asthma is prescribed both a short-acting bronchodilator (albuterol) and an inhaled corticosteroid (fluticasone). In which order should these be administered?
✓ Correct: Bronchodilator first, then corticosteroid 5 minutes later
The bronchodilator (albuterol) should always be administered FIRST. Albuterol opens the airways by relaxing bronchial smooth muscle, allowing the inhaled corticosteroid to penetrate deeper into the lung tissue for maximum effectiveness. Administering the corticosteroid first to closed airways reduces its therapeutic benefit significantly.
The bronchodilator (albuterol) should always be administered FIRST. Albuterol opens the airways by relaxing bronchial smooth muscle, allowing the inhaled corticosteroid to penetrate deeper into the lung tissue for maximum effectiveness. Administering the corticosteroid first to closed airways reduces its therapeutic benefit significantly.
Question 3
A client with pneumonia is positioned on bed rest. Which position does the nurse recommend to best optimise ventilation?
✓ Correct: Semi-Fowler position on the affected side
For pneumonia, positioning on the affected side is recommended. This position allows the unaffected lung to expand maximally and receive better ventilation/perfusion matching. Trendelenburg is contraindicated as it increases work of breathing. While semi-Fowler on the affected side may seem counterintuitive, it prevents the good lung from being compressed and optimises overall gas exchange.
For pneumonia, positioning on the affected side is recommended. This position allows the unaffected lung to expand maximally and receive better ventilation/perfusion matching. Trendelenburg is contraindicated as it increases work of breathing. While semi-Fowler on the affected side may seem counterintuitive, it prevents the good lung from being compressed and optimises overall gas exchange.
Question 4
A nurse suspects a client has developed a pulmonary embolism. Which assessment finding is MOST consistent with this diagnosis?
✓ Correct: Sudden onset pleuritic chest pain with dyspnoea and tachycardia
Pulmonary embolism classically presents with SUDDEN onset pleuritic chest pain (sharp, worse with inspiration), dyspnoea, and tachycardia. This triad represents acute obstruction of pulmonary vasculature. Gradual onset and bilateral pain suggest musculoskeletal or pneumonia. Productive cough suggests infection. Bilateral wheezing suggests bronchospasm.
Pulmonary embolism classically presents with SUDDEN onset pleuritic chest pain (sharp, worse with inspiration), dyspnoea, and tachycardia. This triad represents acute obstruction of pulmonary vasculature. Gradual onset and bilateral pain suggest musculoskeletal or pneumonia. Productive cough suggests infection. Bilateral wheezing suggests bronchospasm.
Question 5
A client with tuberculosis is being admitted. Which isolation precautions does the nurse implement?
✓ Correct: Airborne precautions with negative pressure room and N95 respirator
Tuberculosis requires AIRBORNE precautions because TB bacteria are transmitted via small airborne droplet nuclei that remain suspended in air for prolonged periods. Requirements: private room with negative air pressure, door kept closed, N95 respirator (not surgical mask) for all entering the room. Standard, droplet, and contact precautions are insufficient to prevent TB transmission.
Tuberculosis requires AIRBORNE precautions because TB bacteria are transmitted via small airborne droplet nuclei that remain suspended in air for prolonged periods. Requirements: private room with negative air pressure, door kept closed, N95 respirator (not surgical mask) for all entering the room. Standard, droplet, and contact precautions are insufficient to prevent TB transmission.
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