NCLEX-RN Med-Surg — Respiratory flashcards
10 of 66 cards free to study here · 11 topics · the whole deck is built into Willys
COPD, asthma, pneumonia, TB, pulmonary embolism, chest tubes, ARDS, tracheostomy care, oxygen devices, ventilator alarms and hypoxia: the respiratory nursing priorities the NCLEX-RN tests.
Learn deck · part of NCLEX-RN · written against: NCSBN 2026 NCLEX-RN Test Plan, in effect from 1 April 2026 (Next Generation NCLEX; client-needs categories and percentages unchanged from 2023, fact-checked 2026-10-11). Updated 2026-10-10.
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A client with COPD has an SpO2 of 84% on room air. Why does the nurse give oxygen but titrate it to a lower target instead of running it high?Controlled oxygen: oxygen is never withheld from a hypoxemic client, but in chronic CO2 retainers it is titrated to the ordered target (often around 88–92%), because high concentrations can worsen hypercapnia and cause CO2 narcosis.COPD
Watch out: New drowsiness, headache, or confusion after the oxygen is turned up suggests CO2 retention, not improvement. -
A client in an asthma attack that has not responded to repeated rescue inhaler use now has a quiet chest on auscultation. What does this mean?Near-complete airway obstruction in status asthmaticus: a 'silent chest' means too little air is moving to produce a wheeze. Call the rapid response team, give oxygen and the ordered bronchodilators, and prepare for possible intubation.Asthma
Watch out: Fading wheezes mean improvement only if the work of breathing also eases. -
An 84-year-old client with pneumonia has no fever but is newly confused. Why should the nurse not be reassured by the normal temperature?Older adults often present atypically: new confusion, falls, or poor appetite may be the first or only sign of pneumonia, and fever may be absent because the immune response is blunted.Pneumonia
Watch out: any sudden change in an older client's mental status calls for an SpO2, respiratory rate, and lung sounds. -
A client with a cough lasting several weeks reports night sweats, low-grade afternoon fevers, and weight loss. What does the nurse suspect, and what is the first action?Active pulmonary tuberculosis. Place a surgical mask on the client and move them to an airborne infection isolation room (negative pressure) before further workup; staff wear fit-tested N95 respirators.Tuberculosis
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A post-operative client suddenly becomes anxious and short of breath, with a racing pulse and an SpO2 that drops to 86%. What are the nurse's first actions?Suspect a pulmonary embolism: stay with the client, raise the head of the bed, apply oxygen, and call the rapid response team or provider. Then prepare for diagnostic imaging and anticoagulation as ordered.Pulmonary Embolism
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What is the hallmark finding that sets acute respiratory distress syndrome (ARDS) apart from other causes of hypoxemia?Refractory hypoxemia: the PaO2 stays low even as the oxygen concentration is raised, because fluid-filled, collapsed alveoli cannot exchange gas. The chest x-ray shows bilateral infiltrates ('white-out') not explained by heart failure.ARDS
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What are the key steps of safe tracheal suctioning?Hyperoxygenate before and after, use sterile technique, insert the catheter without suction, then apply intermittent suction only while withdrawing with a rotating motion. Limit each pass to about 10 seconds and let the client recover between passes.Tracheostomy & Suctioning
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Which oxygen delivery device gives the most precise oxygen concentration, and who benefits most?The Venturi mask: its adapters mix in a fixed amount of room air, so the oxygen percentage stays close to the set value.Oxygen Delivery
It suits clients with COPD who need controlled oxygen.
Watch out: If the client breathes more than 30 times a minute, run the flow above the minimum listed on the packaging so fast breaths do not dilute it; extra flow does not raise the percentage. -
A ventilator's high-pressure alarm sounds. What are the common causes?Anything that increases resistance to airflow: secretions needing suction, coughing, biting the tube or fighting the ventilator, kinked tubing or water in the circuit, bronchospasm, or a pneumothorax.Ventilators
Mnemonic: High pressure = something is blocking the airway. -
What are the early signs of hypoxia the nurse should catch before the client deteriorates?Restlessness, anxiety, irritability, tachycardia, tachypnea, and a rise in blood pressure.Hypoxia & Respiratory Assessment
Watch out: A newly restless or agitated client needs the SpO2 checked before receiving any sedative.
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About these cards
Review status: Second-reader reviewed, with corrections applied.
Checked against:
- Checked against Open RN Health Alterations and Open RN Nursing Skills (Chippewa Valley Technical College, CC BY 4.0) and MedlinePlus (U.S. National Library of Medicine); reference only, no text copied.
- Tuberculosis testing and treatment principles cross-checked against CDC tuberculosis guidance (public domain); peak flow zones against the NHLBI asthma guidelines (public domain); reference only.
- Pulse oximetry limits checked against the FDA safety communication on pulse oximeter accuracy (2021); COPD spirometry against the GOLD 2026 report; latent versus active TB and IGRA testing against CDC (public domain); reference only, no text copied.
- Perioperative sleep apnea care checked against the Society of Anesthesia and Sleep Medicine guidelines (2016 and 2018); reference only, no text copied.
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