Respiratory Disorders (NCLEX) Nursing Quiz

1. Which finding on chest X-ray is most specific for acute pneumonia?

Consolidation with air bronchograms

Hyperinflation with flattened diaphragm

Pleural effusion without parenchymal involvement

Mediastinal widening

2. A patient with chronic hypercapnia from COPD develops metabolic alkalosis. What is the nursing priority?

Monitor respiratory status carefully; avoid aggressive hyperventilation

Administer sodium bicarbonate to correct alkalosis

Increase supplemental oxygen to maximize PaO2

Initiate mechanical ventilation immediately

3. Which medication is the first-line agent for acute asthma exacerbation in the emergency department?

Short-acting beta-2 agonist (albuterol)

Long-acting beta-2 agonist (salmeterol)

Leukotriene antagonist (montelukast)

Long-acting muscarinic antagonist (tiotropium)

4. A patient with acute asthma exacerbation shows silent chest on examination. What does this indicate?

Severe airway obstruction with minimal air movement

Improvement in respiratory status

Resolution of bronchospasm

Development of pneumothorax

5. In acute pulmonary embolism, which clinical finding would suggest hemodynamic compromise?

Tachycardia, hypotension, and elevated central venous pressure

Bradycardia and hypertension

Decreased respiratory rate and fever

Crackles on lung auscultation

6. A patient with pneumothorax has a small spontaneous leak. What is the expected natural resolution mechanism?

Pleural fluid absorption and visceral pleural healing

Continued air leak requiring chest tube drainage

Spontaneous rupture of the parietal pleura

Fibrosis sealing the pleural tear

7. Which clinical presentation is most consistent with acute respiratory distress syndrome (ARDS)?

Sudden onset dyspnea, hypoxemia refractory to supplemental O2, bilateral infiltrates

Gradual onset dyspnea with unilateral infiltrate

Pleuritic chest pain with pleural effusion

Hemoptysis with cavitary lung lesion

8. A patient with acute exacerbation of COPD is started on corticosteroids. What is the primary anti-inflammatory mechanism?

Suppression of inflammatory cytokines and recruitment of immune cells

Direct bronchial smooth muscle relaxation

Increased mucus clearance

Prevention of bacterial colonization

9. In obstructive sleep apnea (OSA), what is the primary mechanism of oxygen desaturation during apneic episodes?

Complete cessation of airflow despite respiratory effort

Reduced tidal volume from shallow breathing

Hypoventilation from sedative medication

Aspiration of gastric contents

10. A patient with acute bronchitis presents with a persistent cough. What is the primary airway pathology?

Inflammation of the tracheobronchial mucosa

Alveolar consolidation

Bronchial smooth muscle constriction

Pleural inflammation

11. A patient with COPD presents with pursed-lip breathing. What is the primary physiological benefit of this breathing technique?

Increases intrathoracic pressure to keep airways open during expiration

Reduces oxygen consumption by the respiratory muscles

Decreases carbon dioxide production

Improves gas exchange in the alveoli

12. A patient with idiopathic pulmonary fibrosis (IPF) shows bilateral lower lobe interstitial opacities on chest X-ray. What is the expected pulmonary function test pattern?

Restrictive pattern with reduced FVC and normal FEV1/FVC ratio

Obstructive pattern with reduced FEV1/FVC ratio

Mixed pattern with both reduced FVC and FEV1/FVC

Normal spirometry with reduced DLCO only

13. In pulmonary embolism (PE), what is the most common cause of hypoxemia?

Ventilation-perfusion (V/Q) mismatch in non-perfused lung areas

Hypoventilation from decreased respiratory drive

Diffusion impairment from pulmonary edema

Right-to-left cardiac shunt

14. A patient with cystic fibrosis develops recurrent pulmonary infections. This is primarily due to:

Impaired mucociliary clearance from thick, viscous secretions

Reduced production of immunoglobulins

Decreased alveolar surface area

Chronic pulmonary edema

15. Which clinical sign indicates pneumothorax on physical examination?

Decreased breath sounds and hyperresonance to percussion

Crackles on auscultation and dullness to percussion

Wheezes and increased tactile fremitus

Stridor and subcutaneous emphysema

16. A patient with emphysema has a low diffusing capacity (DLCO). What structural change accounts for this finding?

Loss of alveolar surface area from destruction of alveolar walls

Increased mucus production in the airways

Inflammation of the pleural lining

Fibrosis of the lung parenchyma

17. In asthma, what is the primary pathophysiological change that occurs during an acute exacerbation?

Bronchial smooth muscle constriction and airway inflammation

Permanent destruction of alveolar walls

Pulmonary edema from left heart failure

Pleural effusion from infection

18. A patient is diagnosed with acute respiratory distress syndrome (ARDS). Which mechanism best explains the severe hypoxemia?

Increased intrapulmonary shunting due to alveolar collapse

Hypoventilation from respiratory muscle weakness

Diffusion impairment from thickened alveolar membranes

Ventilation-perfusion mismatch from bronchial obstruction

19. Which arterial blood gas (ABG) pattern is characteristic of acute respiratory acidosis?

PH < 7.35, PaCO2 > 45 mmHg

PH < 7.35, PaCO2 < 35 mmHg

PH > 7.45, PaCO2 > 45 mmHg

PH > 7.45, PaCO2 < 35 mmHg

Respiratory Quiz: Can You Keep Them Breathing?