Airway & Respiratory NCLEX Practice Questions

Airway is always the first priority in clinical nursing — and on the NCLEX. When a question involves multiple clients or competing priorities, the patient with a compromised respiratory status nearly always requires immediate assessment. Mastering ABG interpretation and recognizing respiratory failure is critical for passing the NCLEX.

Use the Rome or TICLOS method. Check pH first (normal 7.35–7.45), then PaCO2 (respiratory indicator, normal 35–45 mmHg), then HCO3 (metabolic indicator, normal 22–26 mEq/L). Determine if findings are acidic or alkalotic, identify the primary cause (respiratory vs metabolic), then assess whether compensation is occurring.

Nasal cannula: 1–6 L/min (24–44% FiO2). Simple face mask: 6–10 L/min (40–60%). Non-rebreather mask: 10–15 L/min (80–95%). Venturi mask: precise FiO2 delivery, preferred for COPD clients. Key rule: COPD patients retain CO2 and rely on hypoxic drive — use low-flow O2 (1–2 L/min) to avoid suppressing respiratory drive.

Key points: keep the drainage system below the chest level at all times, monitor for tidaling (normal — fluctuation in the water seal chamber with respirations), continuous bubbling in the water seal indicates an air leak (abnormal after initial placement), never clamp a chest tube unless specifically ordered, and keep petroleum gauze at the bedside in case of accidental dislodgement. Report drainage >100 mL/hr (indicates hemorrhage).

Immediate actions: position upright (high Fowler's), assess airway patency, apply supplemental oxygen, obtain pulse oximetry, assess lung sounds bilaterally, and prepare for potential intubation. Assess work of breathing — accessory muscle use, retractions, nasal flaring, and paradoxical chest movement signal impending respiratory failure. Notify the rapid response team for acute deterioration.

Asthma: reversible airway obstruction, triggered by allergens or exercise, treat with short-acting bronchodilators (albuterol) for acute episodes and inhaled corticosteroids for maintenance. COPD: irreversible, progressive obstruction (emphysema + chronic bronchitis), use low-flow O2, bronchodilators, smoking cessation is the single most effective intervention, and pursed-lip breathing to prevent air trapping. Both use SABAs for rescue but management goals differ significantly.