Adult Health Respiratory Exam: Silvestri-Style NCLEX Review (150 Qs & Rationales) – COPD, Asthma, ARDS, PE, TB, Chest Tubes

1|Page


ADULT HEALTH RESPIRATORY EXAM
SILVESTRI-STYLE NCLEX REVIEW | 150
QUESTIONS & RATIONALES | GRADED A+


TABLE OF CONTENTS
| Section | Topic | Questions |
| 1 | Upper Respiratory Disorders | 15 |
| 2 | Lower Respiratory Disorders (Pneumonia, TB, Lung Abscess) | 20 |
| 3 | Obstructive Lung Diseases (COPD, Asthma, Bronchiectasis) | 25 |
| 4 | Restrictive Lung Diseases (ARDS, Pulmonary Fibrosis, Sarcoidosis)
| 15 |
| 5 | Pulmonary Vascular Disorders (PE, Pulmonary HTN, Cor
Pulmonale) | 15 |
| 6 | Respiratory Diagnostics & Procedures | 15 |
| 7 | Respiratory Medications & Inhalers | 15 |
| 8 | Oxygen Therapy & Mechanical Ventilation | 15 |
| 9 | Chest Tubes & Thoracic Surgery | 10 |
| 10 | NGN Case Studies (Respiratory) | 10 |
| **TOTAL** | | **150** |




## SECTION 1 – UPPER RESPIRATORY DISORDERS (15 Questions)

,2|Page


**1. A nurse is assessing a client with acute tonsillitis. Which finding
requires immediate intervention?**
- A) Sore throat
- B) Fever 38.5°C (101.3°F)
- C) Stridor (indicates airway obstruction)
- D) Enlarged tonsils with exudate


** Correct Answer: C – Stridor**
**Rationale (Silvestri):** Stridor indicates upper airway obstruction
(potential emergency). Assess for drooling, dysphagia, respiratory
distress. Notify provider, prepare for airway management.
**2. A client is scheduled for a tonsillectomy. Which postoperative
finding requires immediate notification of the provider?**
- A) Frequent swallowing (may indicate bleeding)
- B) Nausea
- C) Throat pain
- D) Hoarse voice


** Correct Answer: A – Frequent swallowing**
**Rationale (Silvestri):** Frequent swallowing after tonsillectomy
suggests bleeding (blood dripping down throat). Assess for vomiting
bright red blood, tachycardia, hypotension. Notify provider immediately.

,3|Page


**3. A nurse is providing discharge teaching to a client following a
tonsillectomy. Which statement indicates a need for further teaching?**
- A) “I will drink cold fluids to soothe my throat.”
- B) “I will avoid red or brown liquids.”
- C) “I will use a straw to drink fluids.”
- D) “I will rest my voice for several days.”


** Correct Answer: C – “I will use a straw”**
**Rationale (Silvestri):** Straw use creates suction, which can dislodge
the clot and cause bleeding. Avoid straws, coughing, vigorous gargling,
and red/brown liquids (may be mistaken for blood).
**4. A client with acute sinusitis reports facial pain and pressure. Which
intervention provides the most relief?**
- A) Cold compresses
- B) Warm compresses and humidification
- C) Lying supine
- D) Avoiding fluids


** Correct Answer: B – Warm compresses and humidification**
**Rationale (Silvestri):** Warm compresses promote sinus drainage.
Humidification thins secretions. Encourage fluids. Decongestants
(oxymetazoline) for short-term use.

, 4|Page


**5. A client has a new tracheostomy. Which action is most important to
maintain airway patency?**
- A) Clean the inner cannula every 8 hours
- B) Change tracheostomy ties daily
- C) Apply a dry gauze dressing around the stoma
- D) Deflate the cuff for 5 minutes every 8 hours


** Correct Answer: A – Clean inner cannula q8h**
**Rationale (Silvestri):** Inner cannula cleaning prevents mucus
plugging (airway obstruction). Cuff deflation (if cuffed) prevents
tracheal necrosis but not highest priority for patency.
**6. A nurse is suctioning a client with a tracheostomy. Which action is
correct?**
- A) Apply suction while inserting the catheter
- B) Suction for 30 seconds
- C) Apply suction while withdrawing the catheter
- D) Hyperoxygenate only after suctioning


** Correct Answer: C – Apply suction while withdrawing**
**Rationale (Silvestri):** Apply intermittent suction (10–15 seconds)
while withdrawing catheter, rotating gently. Hyperoxygenate before and
after. Limit to 2–3 passes.