NCLEX-RN Respiratory System Comprehensive Review
2025/2026 Ace Your Nursing Exam on the First
Attempt
aspirated contents more likely to enter right
middle/lower lobes. Mucociliary Apparatus -
ANSWER//Goblet cells secrete mucus → traps dust,
pollen, pathogens. Cilia - ANSWER//Push mucus upward
→ swallowed or expelled. Smoking -
ANSWER//Paralyzes cilia → smoker's cough
compensates. Oxyhemoglobin - ANSWER//Hb binds O₂
in lungs, releases it in tissues. Pulse ox - ANSWER//% of
Hb saturated with O₂ (Normal 90-100%). Hypoxemia -
ANSWER//<90% O₂ saturation. Erythropoietin -
ANSWER//Produced by kidneys when hypoxia occurs →
stimulates bone marrow → ↑ RBC production.
Ventilation - ANSWER//Air movement. Perfusion -
ANSWER//Blood flow. Breathing Control -
ANSWER//Stimulated by ↑ CO₂ (hypercapnia). PCO₂
normal - ANSWER//35-45 mmHg. Chronic CO₂ retainers -
ANSWER//COPD patients become insensitive to CO₂ →
rely on low O₂ (hypoxia) to drive breathing. Atelectasis -
ANSWER//Collapse of alveoli → ↓ gas exchange. Causes
of Atelectasis - ANSWER//Post-op sedation, obstruction
(mucus plug, tumor, foreign body), pleural effusion. S/S
of Atelectasis - ANSWER//Dyspnea, hypoxemia, crackles,
diminished breath sounds. Prevention/Treatment of
Atelectasis - ANSWER//Incentive spirometer, flutter
valve, deep breathing/coughing, ambulation, turning,
,suctioning, postural drainage. Hypoxic - ANSWER//Low
O₂ in blood (low SpO₂, cyanosis, confusion).
Hypoventilation - ANSWER//Insufficient air movement
→ ↑ CO₂. Dyspnea - ANSWER//Shortness of breath.
Bradypnea - ANSWER//<12 breaths/min. Tachypnea -
ANSWER//>20 breaths/min. Crackles (Rales) -
ANSWER//Fluid in alveoli (pneumonia, HF). Wheezes -
ANSWER//High-pitched whistling, narrowed airway
(asthma). Rhonchi - ANSWER//Low-pitched snorelike,
mucus in inflamed bronchial airways (bronchitis). Pleural
friction rub - ANSWER//Loud rough, grating scratchy
sound, pleural inflammation. Tactile Fremitus -
ANSWER//Vibration with speech; ↑ Fremitus = density
lung consolidation. Crepitus - ANSWER//Air under skin
(subcutaneous emphysema) → feels like crackling.
Hemoptysis - ANSWER//Coughing up blood. Pulmonary
edema - ANSWER//An emergency condition
characterized by excess fluid in the lungs. Frequent
assessment - ANSWER//Monitoring respiratory rate (RR),
SpO₂, lung sounds, and chest expansion. Oxygen therapy
- ANSWER//A treatment that requires careful
monitoring in patients with COPD. Red flags to report -
ANSWER//Sudden shortness of breath (SOB), absent
breath sounds, pink frothy sputum, severe hemoptysis.
Right lung aspiration risk - ANSWER//The anatomical
position of the right lung makes it more susceptible to
aspiration. Chronic hypercapnia - ANSWER//A condition
in COPD where elevated carbon dioxide levels change
the drive to breathe. Incentive spirometer - ANSWER//A
device used to encourage deep breathing and prevent
post-operative atelectasis. Crackles -
,ANSWER//Abnormal lung sounds indicative of
pneumonia or heart failure. Fremitus -
ANSWER//Increased fremitus indicates consolidation,
while decreased fremitus indicates fluid or air.
Pulmonary Function Tests (PFTs) - ANSWER//Tests that
assess lung function, volumes, gas exchange, and
differentiate obstructive vs restrictive disease.
Bronchoscopy - ANSWER//A procedure for direct
visualization of the larynx, trachea, and bronchi, used
for diagnosis and therapy. Pre-Procedure Nursing for
Bronchoscopy - ANSWER//Includes checking allergies,
lab tests, NPO status, and obtaining consent. Intra-
Procedure Nursing for Bronchoscopy -
ANSWER//Involves monitoring vital signs, oxygen
saturation, and administering sedation. Post-Procedure
Nursing for Bronchoscopy - ANSWER//Includes
monitoring for complications like fever, bleeding, and
pneumothorax. Thoracentesis - ANSWER//A procedure
for needle aspiration of pleural fluid or air to relieve
pressure. Pre-Procedure Nursing for Thoracentesis -
ANSWER//Involves locating the effusion and positioning
the patient correctly. Intra-Procedure Nursing for
Thoracentesis - ANSWER//Requires strict aseptic
technique and monitoring vital signs throughout. Post-
Procedure Nursing for Thoracentesis -
ANSWER//Includes chest x-ray to check for
pneumothorax and monitoring for complications.
Complications of Thoracentesis -
ANSWER//Pneumothorax, indicated by absent breath
sounds, shortness of breath, and tracheal shift. Tension
pneumothorax - ANSWER//Air trapped in the pleural
, space creating a one-way valve effect, leading to shock
risk. Subcutaneous emphysema - ANSWER//Air trapped
under the skin, characterized by crackling on palpation.
Re-expansion pulmonary edema - ANSWER//Condition
marked by pink frothy sputum and dyspnea occurring
after rapid re-expansion of the lung. Patient Teaching
Report - ANSWER//Patients should report new cough,
sharp chest pain, dyspnea, cyanosis, trachea shift, and
air hunger. Massive Pleural Effusion -
ANSWER//Condition where the mediastinum shifts to
the opposite side on X-ray. Nursing Role in Imaging -
ANSWER//Recognize findings and correlate with patient
symptoms such as shortness of breath and absent
breath sounds. PFT prep - ANSWER//No smoking, no
inhalers, monitor after the test. Bronchoscopy prep -
ANSWER//NPO, no dentures, consent, and labs are
required. Post-bronchoscopy care - ANSWER//NPO until
the gag reflex returns; monitor for pneumothorax.
Mediastinal shift - ANSWER//In the case of effusion, the
shift is away from the affected side; in atelectasis, the
shift is toward the affected side. Tracheotomy -
ANSWER//Surgical incision into the trachea to create an
airway. Tracheostomy - ANSWER//A stoma (opening)
created by a tracheotomy. Indications for Tracheostomy
- ANSWER//Long-term ventilation (usually >7-10 days
after intubation), airway obstruction, and failure to
wean from ventilator. Cuff pressure for tracheostomy -
ANSWER//Should be maintained at 20-25 mmHg to
prevent aspiration and tracheal necrosis. Stoma care -
ANSWER//Clean with ½ hydrogen peroxide and rinse
with sterile saline; clean trach plate and ties. Suctioning
2025/2026 Ace Your Nursing Exam on the First
Attempt
aspirated contents more likely to enter right
middle/lower lobes. Mucociliary Apparatus -
ANSWER//Goblet cells secrete mucus → traps dust,
pollen, pathogens. Cilia - ANSWER//Push mucus upward
→ swallowed or expelled. Smoking -
ANSWER//Paralyzes cilia → smoker's cough
compensates. Oxyhemoglobin - ANSWER//Hb binds O₂
in lungs, releases it in tissues. Pulse ox - ANSWER//% of
Hb saturated with O₂ (Normal 90-100%). Hypoxemia -
ANSWER//<90% O₂ saturation. Erythropoietin -
ANSWER//Produced by kidneys when hypoxia occurs →
stimulates bone marrow → ↑ RBC production.
Ventilation - ANSWER//Air movement. Perfusion -
ANSWER//Blood flow. Breathing Control -
ANSWER//Stimulated by ↑ CO₂ (hypercapnia). PCO₂
normal - ANSWER//35-45 mmHg. Chronic CO₂ retainers -
ANSWER//COPD patients become insensitive to CO₂ →
rely on low O₂ (hypoxia) to drive breathing. Atelectasis -
ANSWER//Collapse of alveoli → ↓ gas exchange. Causes
of Atelectasis - ANSWER//Post-op sedation, obstruction
(mucus plug, tumor, foreign body), pleural effusion. S/S
of Atelectasis - ANSWER//Dyspnea, hypoxemia, crackles,
diminished breath sounds. Prevention/Treatment of
Atelectasis - ANSWER//Incentive spirometer, flutter
valve, deep breathing/coughing, ambulation, turning,
,suctioning, postural drainage. Hypoxic - ANSWER//Low
O₂ in blood (low SpO₂, cyanosis, confusion).
Hypoventilation - ANSWER//Insufficient air movement
→ ↑ CO₂. Dyspnea - ANSWER//Shortness of breath.
Bradypnea - ANSWER//<12 breaths/min. Tachypnea -
ANSWER//>20 breaths/min. Crackles (Rales) -
ANSWER//Fluid in alveoli (pneumonia, HF). Wheezes -
ANSWER//High-pitched whistling, narrowed airway
(asthma). Rhonchi - ANSWER//Low-pitched snorelike,
mucus in inflamed bronchial airways (bronchitis). Pleural
friction rub - ANSWER//Loud rough, grating scratchy
sound, pleural inflammation. Tactile Fremitus -
ANSWER//Vibration with speech; ↑ Fremitus = density
lung consolidation. Crepitus - ANSWER//Air under skin
(subcutaneous emphysema) → feels like crackling.
Hemoptysis - ANSWER//Coughing up blood. Pulmonary
edema - ANSWER//An emergency condition
characterized by excess fluid in the lungs. Frequent
assessment - ANSWER//Monitoring respiratory rate (RR),
SpO₂, lung sounds, and chest expansion. Oxygen therapy
- ANSWER//A treatment that requires careful
monitoring in patients with COPD. Red flags to report -
ANSWER//Sudden shortness of breath (SOB), absent
breath sounds, pink frothy sputum, severe hemoptysis.
Right lung aspiration risk - ANSWER//The anatomical
position of the right lung makes it more susceptible to
aspiration. Chronic hypercapnia - ANSWER//A condition
in COPD where elevated carbon dioxide levels change
the drive to breathe. Incentive spirometer - ANSWER//A
device used to encourage deep breathing and prevent
post-operative atelectasis. Crackles -
,ANSWER//Abnormal lung sounds indicative of
pneumonia or heart failure. Fremitus -
ANSWER//Increased fremitus indicates consolidation,
while decreased fremitus indicates fluid or air.
Pulmonary Function Tests (PFTs) - ANSWER//Tests that
assess lung function, volumes, gas exchange, and
differentiate obstructive vs restrictive disease.
Bronchoscopy - ANSWER//A procedure for direct
visualization of the larynx, trachea, and bronchi, used
for diagnosis and therapy. Pre-Procedure Nursing for
Bronchoscopy - ANSWER//Includes checking allergies,
lab tests, NPO status, and obtaining consent. Intra-
Procedure Nursing for Bronchoscopy -
ANSWER//Involves monitoring vital signs, oxygen
saturation, and administering sedation. Post-Procedure
Nursing for Bronchoscopy - ANSWER//Includes
monitoring for complications like fever, bleeding, and
pneumothorax. Thoracentesis - ANSWER//A procedure
for needle aspiration of pleural fluid or air to relieve
pressure. Pre-Procedure Nursing for Thoracentesis -
ANSWER//Involves locating the effusion and positioning
the patient correctly. Intra-Procedure Nursing for
Thoracentesis - ANSWER//Requires strict aseptic
technique and monitoring vital signs throughout. Post-
Procedure Nursing for Thoracentesis -
ANSWER//Includes chest x-ray to check for
pneumothorax and monitoring for complications.
Complications of Thoracentesis -
ANSWER//Pneumothorax, indicated by absent breath
sounds, shortness of breath, and tracheal shift. Tension
pneumothorax - ANSWER//Air trapped in the pleural
, space creating a one-way valve effect, leading to shock
risk. Subcutaneous emphysema - ANSWER//Air trapped
under the skin, characterized by crackling on palpation.
Re-expansion pulmonary edema - ANSWER//Condition
marked by pink frothy sputum and dyspnea occurring
after rapid re-expansion of the lung. Patient Teaching
Report - ANSWER//Patients should report new cough,
sharp chest pain, dyspnea, cyanosis, trachea shift, and
air hunger. Massive Pleural Effusion -
ANSWER//Condition where the mediastinum shifts to
the opposite side on X-ray. Nursing Role in Imaging -
ANSWER//Recognize findings and correlate with patient
symptoms such as shortness of breath and absent
breath sounds. PFT prep - ANSWER//No smoking, no
inhalers, monitor after the test. Bronchoscopy prep -
ANSWER//NPO, no dentures, consent, and labs are
required. Post-bronchoscopy care - ANSWER//NPO until
the gag reflex returns; monitor for pneumothorax.
Mediastinal shift - ANSWER//In the case of effusion, the
shift is away from the affected side; in atelectasis, the
shift is toward the affected side. Tracheotomy -
ANSWER//Surgical incision into the trachea to create an
airway. Tracheostomy - ANSWER//A stoma (opening)
created by a tracheotomy. Indications for Tracheostomy
- ANSWER//Long-term ventilation (usually >7-10 days
after intubation), airway obstruction, and failure to
wean from ventilator. Cuff pressure for tracheostomy -
ANSWER//Should be maintained at 20-25 mmHg to
prevent aspiration and tracheal necrosis. Stoma care -
ANSWER//Clean with ½ hydrogen peroxide and rinse
with sterile saline; clean trach plate and ties. Suctioning
