Positioning and oxygenation
A patient with dyspnea is lying flat in bed and reports difficulty breathing. What is the nurse’s priority action?
A. Apply restraints
B. Place in high Fowler’s position
C. Administer sedatives
D. Obtain labs
Answer: B
Rationale: High Fowler’s maximizes lung expansion and improves oxygenation immediately.
A patient becomes restless and tachypneic. What is the FIRST nursing action?
A. Call provider
B. Apply oxygen
C. Document findings
D. Administer sedatives
Answer: B
Rationale: ABCs → oxygen first.
A patient with sleep apnea is admitted and requires nighttime respiratory support. Which intervention should the nurse anticipate?
A. BiPAP
B. Intubation
C. CPAP
D. Non-rebreather mask
Answer: C
Rationale: CPAP provides continuous pressure and is commonly used for sleep apnea.
A patient with asthma presents with wheezing and shortness of breath. What should the nurse administer FIRST?
A. Corticosteroids
B. Bronchodilator
C. Antibiotics
D. Oxygen only
Answer: B
Rationale: bronchodilators come first before corticosteroids because they quickly relieve bronchospasm and reopen constricted bronchioles allowing the corticosteroids to come in and decrease inflammation.
A patient on 4L nasal cannula is sitting upright but keeps saying “I can’t catch my breath” and is visibly anxious. Their SpO2 is 95%. What should the nurse do FIRST?
A. Reassure the patient and leave the room
B. Increase oxygen to 6L
C. Assess work of breathing and respiratory effort
D. Document stable oxygen saturation
Answer: C
Rationale: dyspnea and air hunger matter even if SpO2 looks okay. The patient may be compensating and worsening. You must assess the full respiratory picture, not just the number.
Which positions improve oxygenation in a patient with respiratory distress? (Select all that apply)
A. High Fowler’s
B. Tripod position
C. Supine
D. Upright sitting
E. Flat with legs elevated
Answer: A, B, D
Rationale: Upright positioning reduces work of breathing and improves lung expansion.
Which findings require immediate escalation of care? (Select all that apply)
A. Cyanosis
B. Confusion
C. Restlessness
D. Lethargy
E. Mild tachycardia
Answer: A, B, D
Rationale: Late signs = emergency.
A patient with COPD is placed on BiPAP. Which assessments indicate the therapy is working? (Select all that apply)
A. Decreased respiratory rate
B. Decreased restlessness
C. Improved mental status
D. Rising CO2 levels
E. Increased fatigue
Answer: A, B, C
Rationale: Improvement in RR, mental status, and restlessness indicates better ventilation and oxygenation.
A patient with asthma continues to wheeze after using a rescue inhaler. Which findings indicate the condition is worsening? (Select all that apply)
A. Increased work of breathing
B. Persistent dyspnea
C. Relief of symptoms
D. No response to treatment
E. Fatigue
Answer: A, B, D, E
Rationale: worsening asthma is ongoing dyspnea, increased work of breathing, fatigue, and failure to respond to usual treatments. Relief of symptoms would suggest improvement, not decline.
A patient with respiratory failure is receiving oxygen and is placed in high Fowler’s position. Which findings indicate the intervention is effective? (Select all that apply)
A. Decreased work of breathing
B. Reduced anxiety/restlessness
C. Improved ability to speak in full sentences
D. Increasing fatigue
E. Slower respiratory rate
Answer: A, B, C, E
Rationale: improved oxygenation to reduced work of breathing and improved comfort. Fatigue would indicate worsening, not improvement.
A patient is experiencing air hunger and is anxious. What actions should the nurse take? (Select all that apply)
A. Elevate head of bed
B. Stay with the patient
C. Lay patient flat
D. Administer oxygen
E. Encourage slow breathing
Answer: A, B, D, E
Rationale: Air hunger signals worsening respiratory status → support, positioning, oxygen.
A patient on BiPAP becomes increasingly fatigued and confused. What is the nurse’s priority?
A. Decrease oxygen
B. Prepare for intubation
C. Encourage rest
D. Remove mask
Answer: B
Rationale: Failure of BiPAP + late signs → intubation needed.
A patient on BiPAP becomes increasingly restless and is pulling at their mask. What should the nurse do FIRST?
A. Apply restraints
B. Administer Ativan
C. Assess oxygenation and ABGs
D. Remove the mask
Answer: C
Rationale: Restlessness = early hypoxia. Sedation/restraints worsen respiratory status.
A patient in status asthmaticus is not improving after continuous treatments. What is the nurse’s priority action?
A. Provide reassurance
B. Reduce oxygen
C. Prepare for intubation
D. Encourage fluids
Answer: C
Rationale: status asthmaticus is a life-threatening asthma attack that may require intubation when the patient does not respond to rescue inhalers and continuous treatments.
A patient with respiratory failure is on BiPAP and initially alert. Two hours later, the patient becomes increasingly sleepy and difficult to arouse. What is the nurse’s PRIORITY interpretation?
A. The patient is finally resting comfortably
B. The patient is experiencing medication side effects
C. The patient is retaining carbon dioxide and deteriorating
D. The patient no longer requires respiratory support
Answer: C
Rationale:
lethargy and decreased level of consciousness are late signs of respiratory failure, especially with CO2 retention (hypercapnia). A patient becoming sleepy on BiPAP is a red flag for ventilatory failure and worsening gas exchange, not improvement. This requires immediate reassessment and likely escalation
A patient with respiratory failure is positioned supine and begins to show increased work of breathing. What is the nurse’s best response?
A. Continue monitoring
B. Reposition to high Fowler’s
C. Administer sedatives
D. Apply restraints
Answer: B
Rationale: Supine worsens lung expansion → reposition immediately.
Which actions are appropriate for a deteriorating respiratory patient? (Select all that apply)
A. Notify provider
B. Stay with patient
C. Increase monitoring
D. Give sedatives
E. Prepare airway equipment
Answer: A, B, C, E
Rationale: Escalation + airway prep; avoid sedation.
A patient on BiPAP is now lethargic with increasing CO2 levels. Which actions should the nurse take? (Select all that apply)
A. Notify provider immediately
B. Prepare for intubation
C. Decrease oxygen
D. Continue current therapy
E. Call respiratory therapy
Answer: A, B, E
Rationale: Lethargy + rising CO2 = failure → escalate care.
A patient with severe asthma becomes increasingly fatigued and quiet with minimal wheezing. Which actions should the nurse take? (Select all that apply)
A. Recognize impending respiratory failure
B. Notify provider immediately
C. Prepare for intubation
D. Continue routine monitoring
E. Increase vigilance and reassessment
Answer: A, B, C, E
Rationale: severe asthma can rapidly deteriorate and lead to respiratory arrest. A patient who is tiring out and not improving needs escalation, close reassessment, and likely preparation for advanced airway support. Routine monitoring alone is not enough.
A patient with respiratory failure is receiving oxygen therapy and begins to develop tachycardia, diaphoresis, and increasing fatigue. Which actions should the nurse take? (Select all that apply)
A. Reassess respiratory status and oxygenation
B. Notify provider
C. Prepare for possible escalation (BiPAP/intubation)
D. Decrease oxygen therapy
E. Increase monitoring frequency
Answer: A, B, C, E
Rationale: These are signs the body is working harder and beginning to fail compensation. Your notes emphasize frequent reassessment and early escalation to prevent deterioration.
Which patients would benefit MOST from tripod positioning? (Select all that apply)
A. COPD exacerbation
B. Asthma attack
C. Pulmonary embolism
D. Severe dyspnea
E. Sleep apnea
Answer: A, B, D
Rationale: Tripod reduces work of breathing and improves ventilation.
A patient suddenly becomes unresponsive with no respiratory effort. What should the nurse do FIRST?
A. Document
B. Reposition patient
C. Check labs
D. Call for help
Answer: D
Rationale: Respiratory arrest → immediate emergency response.
A patient on BiPAP is requiring 90% FiO2 and continues to show signs of fatigue and confusion. What is the nurse’s priority?
A. Encourage rest
B. Prepare for mechanical ventilation
C. Reduce oxygen
D. Document findings
Answer: B
Rationale: High FiO2 + decline = BiPAP failure → intubation.
A patient with status asthmaticus suddenly becomes unresponsive and is experiencing respiratory arrest. What should the nurse do FIRST?
A. Call for help
B. Document
C. Administer steroids
D. Check labs
Answer: A
Rationale: respiratory arrest as a life-threatening emergency requiring immediate action. An unresponsive asthma patient must be treated as an emergency first, not a documentation or lab situation.
A patient initially presents with tachypnea and restlessness. Over the next hour, the patient becomes quiet, lethargic, and has a decreasing respiratory rate. What is the nurse’s priority interpretation?
A. The patient is improving
B. The patient is stabilizing
C. The patient is tiring out and approaching respiratory failure
D. The patient is experiencing anxiety
Answer: C
Rationale: fatigue, lethargy, and decreased effort are dangerous late signs. This indicates the patient is no longer compensating and may require immediate airway support.