NLE Respiratory Nursing Reviewer 2026

Answer: B. 12–20 breaths per minute

Step 1 – Recall the normal value: The normal adult respiratory rate is 12–20 breaths per minute. Step 2 – Eliminate the wrong options: A rate of 8–11 is bradypnea (too slow), 22–28 is tachypnea (too fast), and 30–35 is severely elevated, often seen in respiratory distress. Step 3 – Apply the concept: Any rate outside 12–20 triggers further assessment. On the NLE, this is a basic recall item — memorize 12–20 as the anchor normal value for adult respiratory rate.

Answer: C. Wheezes

Step 1 – Identify the key descriptors in the question: continuous, high-pitched, musical, and expiratory. Step 2 – Match to the correct sound: Wheezes are continuous, musical, high-pitched sounds produced by air moving through narrowed airways — exactly what happens in asthma due to bronchoconstriction. Step 3 – Eliminate wrong answers: Crackles are discontinuous and popping (not musical); rhonchi are low-pitched and snoring-like (large airway secretions); pleural friction rub has a grating quality. Step 4 – Clinical connection: Wheezes are the hallmark of asthma and COPD — classic NLE question pairing.

Answer: B. Stridor; indicating upper airway obstruction

Step 1 – Key clue: heard WITHOUT a stethoscope. This means the sound is loud enough to be audible at the bedside. Step 2 – Identify the sound: Stridor is a high-pitched, crowing, or barking sound produced when airflow is obstructed at the level of the trachea or larynx (upper airway). Step 3 – Clinical urgency: Stridor is always an emergency — it signals a potentially life-threatening upper airway obstruction (foreign body, laryngospasm, croup, or epiglottitis). Step 4 – Maslow prioritization: Airway is the first physiologic need. Stridor = act immediately. Step 5 – Eliminate others: Wheezes come from lower airways; crackles and rhonchi require a stethoscope.

Answer: C. Respiratory acidosis, uncompensated

Step 1 – Check pH: 7.30 is below 7.35 → ACIDOSIS. Step 2 – Check PaCO2: 50 mmHg is above the normal range of 35–45 mmHg → elevated CO2. Step 3 – Apply ROME (Respiratory Opposite): pH is LOW and CO2 is HIGH — they move in opposite directions → RESPIRATORY problem. Elevated CO2 causes respiratory acidosis. Step 4 – Check HCO3: 24 mEq/L is within normal (22–26) → the kidneys have NOT compensated yet. Step 5 – Conclusion: Respiratory acidosis, uncompensated. Common causes include COPD, hypoventilation, and sedative overdose.

Answer: B. pH 7.38, PaCO2 40 mmHg, HCO3 24 mEq/L

Step 1 – Memorize normal ABG ranges: pH 7.35–7.45; PaCO2 35–45 mmHg; HCO3 22–26 mEq/L. Step 2 – Evaluate each option: Option A has pH 7.50 (alkalosis) and CO2 28 (low) → respiratory alkalosis. Option B: pH 7.38 is between 7.35 and 7.45 ✓; PaCO2 40 is between 35 and 45 ✓; HCO3 24 is between 22 and 26 ✓ — all normal. Option C: pH 7.30 is too low (acidosis). Option D: pH 7.50 and HCO3 30 suggest metabolic alkalosis. Step 3 – Answer: Option B is the only set where all three values fall within normal range.

Answer: B. Approximately 36%

Step 1 – Recall nasal cannula FiO2 range: A nasal cannula delivers 24–44% O2 at flow rates of 1–6 L/min. Step 2 – Use the general estimate: Each 1 L/min adds approximately 4% above room air (21%). At 4 L/min: 21% + (4 × 4%) = 21% + 16% = 37% — approximately 36–37%. Step 3 – Eliminate wrong options: 21% is room air (no supplemental O2 added); 60% requires a simple face mask; 90% requires a non-rebreather mask. Step 4 – Safety note: Flow rates above 6 L/min do not significantly increase FiO2 via nasal cannula and will dry the mucosa — add humidification at flows above 4 L/min.

Answer: C. Venturi mask

Step 1 – Understand the COPD oxygen concern: Some COPD patients are chronic CO2 retainers who may rely on a hypoxic drive to breathe. Giving too much uncontrolled oxygen can suppress this drive and cause CO2 retention (CO2 narcosis). Step 2 – The Venturi mask is a high-flow, fixed-performance device that delivers a precise, preset FiO2 (commonly 24%, 28%, 31%, 35%, 40%) regardless of the patient's breathing pattern. Step 3 – This precision makes it the device of choice for COPD patients. Target SpO2 for COPD is 88–92%, not the usual 94–98%. Step 4 – Eliminate others: The non-rebreather, simple mask, and partial rebreather are all variable-FiO2 (low-flow) devices that can deliver unpredictable amounts of oxygen.

Answer: B. This is tidaling and is a NORMAL expected finding

Step 1 – Define tidaling: Tidaling (also called fluctuation) refers to the gentle rise and fall of fluid in the water-seal chamber that moves with the patient's breathing. It reflects changes in intrapleural pressure with respiration. Step 2 – Why it is normal: During spontaneous inspiration, the diaphragm descends, making intrathoracic pressure more negative → water rises. During expiration, pressure increases → water falls. Step 3 – What to watch for instead: CONTINUOUS bubbling = air leak (abnormal); ABSENT tidaling = tube kinked, clogged, or lung has re-expanded. Step 4 – Action: No action is needed; document as a normal finding and continue monitoring.

Answer: B. Cover the site with a sterile occlusive dressing taped on three sides

Step 1 – Priority: Airway and breathing (Maslow's physiologic needs). A dislodged chest tube creates an open wound in the chest — air can rush in and collapse the lung (open pneumothorax). Step 2 – Correct action: Immediately cover the site with a sterile occlusive dressing (e.g., petroleum gauze or plastic wrap) taped on THREE sides only. The fourth side left open acts as a flutter valve — it allows air to escape during expiration but prevents air from entering during inspiration. Step 3 – Why NOT four sides: Taping all four sides traps air inside the pleural space, potentially causing a tension pneumothorax — a life-threatening emergency. Step 4 – Follow-up: Notify the physician immediately and prepare for chest tube reinsertion.

Answer: B. Obstructive lung disease (e.g., asthma or COPD)

Step 1 – Understand the FEV1/FVC ratio: FEV1 is the amount of air forcefully exhaled in 1 second; FVC is the total air exhaled with maximum effort. The ratio reflects how quickly air can exit the lungs. Step 2 – Obstructive disease: In conditions like asthma and COPD, airways are narrowed → airflow is limited → FEV1 falls more than FVC → FEV1/FVC ratio is LOW (below 70%). Step 3 – Restrictive disease: In fibrosis or chest-wall deformity, the lungs are stiff/small → FVC is reduced, but air still exits quickly → FEV1/FVC ratio is NORMAL or even HIGH. Step 4 – Memory aid: Obstruct = blocked = low ratio. Restrict = small = low FVC but normal ratio.

Answer: C. Airborne precautions

Step 1 – Identify the route of transmission: Mycobacterium tuberculosis spreads via airborne droplet nuclei – tiny particles that remain suspended in the air for long periods and travel more than 1 meter. Step 2 – Match transmission route to precaution type: Airborne precautions are required for pathogens spread by airborne nuclei (TB, measles, varicella). These require a negative-pressure isolation room and an N95 respirator for healthcare workers. Step 3 – Eliminate wrong options: Contact precautions are for direct skin or surface contact (e.g., MRSA, wound infections). Droplet precautions are for larger droplets that fall within 1 meter (e.g., influenza, strep pharyngitis) – a very common NLE distractor with TB. Reverse isolation protects an immunocompromised patient FROM others, not the reverse. Step 4 – Key NLE point: TB = AIRBORNE, not droplet. Staff wear N95 respirator; a surgical mask is placed on the PATIENT during transport.

Answer: C. Rifampicin; reassure the patient that this is a harmless, expected side effect.

Step 1 – Recognize the drug-specific side effect: Orange-red discoloration of urine, sweat, saliva, and tears is the signature side effect of Rifampicin. It occurs because rifampicin is an orange-red pigmented drug that is excreted in body fluids. Step 2 – Determine clinical significance: This discoloration is harmless and expected. It is NOT a sign of bleeding. Patients often panic, so therapeutic communication and reassurance are key nursing actions. Step 3 – Eliminate wrong options: Isoniazid causes peripheral neuropathy, not orange urine; stopping it without medical advice is dangerous. Ethambutol causes optic neuritis (visual changes). Pyrazinamide raises uric acid causing gout, not orange urine. Step 4 – Additional teaching point: Rifampicin can permanently stain soft contact lenses orange – advise the patient to wear glasses during therapy.