Respiratory Nursing
Respiratory nursing encompasses the assessment and management of patients with acute and chronic respiratory conditions including asthma, COPD, pneumonia, tuberculosis, and acute respiratory failure. NCLEX questions test your ability to interpret respiratory assessments, manage oxygen therapy, maintain airways, and prioritize interventions for patients with breathing difficulties. Airway management is a top NCLEX priority.
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Study Tips
- ✓Remember that airway is always the top priority in the ABCs framework, making respiratory questions critical on the NCLEX.
- ✓Know the oxygen flow rates for each delivery device: nasal cannula (1-6 L/min), simple mask (5-8 L/min), non-rebreather (10-15 L/min).
- ✓Understand why COPD patients require low-flow oxygen (1-2 L/min) to avoid suppressing their hypoxic drive.
- ✓Study chest tube management including expected drainage, water seal assessment, and what to do if the tube is accidentally dislodged.
- ✓Learn tuberculosis isolation requirements: airborne precautions, negative-pressure room, N95 respirator for staff.
Common Mistakes to Avoid
The most critical mistake is administering high-flow oxygen to a COPD patient, which can suppress their hypoxic drive and cause respiratory arrest. Students also confuse the sequence of inhaler use in asthma: bronchodilators (rescue inhalers) should be used before corticosteroid inhalers. Another common error is not recognizing the difference between a tension pneumothorax (tracheal deviation, absent breath sounds, JVD) and a simple pneumothorax, as tension pneumothorax is a life-threatening emergency requiring immediate needle decompression. When a chest tube is accidentally dislodged, cover the site with petroleum gauze, not dry sterile gauze.
Respiratory Nursing FAQs
Common questions about respiratory nursing
Know the delivery devices in order of increasing FiO2: nasal cannula (24-44%, 1-6 L/min), simple face mask (40-60%, 5-8 L/min), Venturi mask (precise FiO2 24-50%), partial rebreather (60-75%, 6-10 L/min), and non-rebreather (80-95%, 10-15 L/min). For COPD patients, use low-flow oxygen (1-2 L/min via nasal cannula or Venturi mask) because these patients rely on hypoxic drive for respiratory stimulation. Always monitor oxygen saturation and respiratory status when titrating oxygen.
Key chest tube principles: continuous bubbling in the water seal chamber indicates an air leak (not normal after the first 24 hours), tidaling (fluctuation with respiration) in the water seal chamber is normal, the drainage collection chamber should be monitored for amount and character, never clamp a chest tube without a provider order, never raise the drainage system above chest level, and if the tube is accidentally dislodged, cover the insertion site immediately with sterile petroleum gauze taped on three sides. Report drainage greater than 70-100 mL/hour as this may indicate hemorrhage.
Escalate immediately when a patient shows SpO2 below 90% despite supplemental oxygen, respiratory rate above 30 or below 8, use of accessory muscles (intercostal retractions, nasal flaring, tripod positioning), new-onset stridor or wheezing, inability to speak in full sentences, cyanosis of the lips or nail beds, altered level of consciousness, or sudden asymmetric chest movement. These findings suggest respiratory failure and require rapid response team activation. On the NCLEX, the nurse should intervene first (raise the head of bed, apply oxygen, suction if needed) and then notify the provider rather than waiting for an order before acting in an emergency.