NCLEX Respiratory Nursing: Oxygen Therapy & Ventilation

Respiratory nursing is one of the most critical sections on the NCLEX, focusing on oxygen therapy, airway management, ventilation, and ABG interpretation. Because respiratory issues can quickly become life‑threatening, the exam frequently tests your ability to assess, intervene, and apply clinical judgment. This guide covers the essential **NCLEX respiratory** concepts every nursing student must know.

Why Respiratory Nursing Is Important on NCLEX

The respiratory system affects oxygenation, perfusion, acid‑base balance, and overall patient stability. The NCLEX evaluates your ability to:

• Recognize distress: Rapidly identify signs of respiratory distress such as increased work of breathing, accessory muscle use, cyanosis, or altered mental status.
• Interpret ABGs: Accurately analyze arterial blood gases (ABGs) to assess oxygenation, ventilation, and acid-base status. Know how to spot hypoxemia, hypercapnia, acidosis, and alkalosis.
• Use oxygen therapy safely: Select the correct delivery device (nasal cannula, mask, non-rebreather, etc.), set appropriate flow rates, and monitor for complications like oxygen toxicity or CO₂ retention (especially in COPD patients).
• Manage ventilated patients: Monitor mechanical ventilator settings, alarms, and patient response. Prevent complications such as ventilator-associated pneumonia (VAP).
• Prioritize based on ABCs: Always address Airway, Breathing, and Circulation (ABCs) in correct order when responding to respiratory problems.

Mastering these concepts ensures safe and effective patient care.

Understanding Oxygen Therapy

Common Oxygen Delivery Devices

• Nasal Cannula (1–6 L/min)
  
  • Used for mild hypoxia
  • Increases FiO₂ by 24–44%
  • Skin breakdown risk around ears and nose
• Simple Face Mask (6–10 L/min)
  
  • Moderate oxygen needs
  • Not recommended for COPD patients due to CO₂ retention
• Non‑Rebreather Mask (10–15 L/min)
  
  • Delivers up to 95% FiO₂
  • Used for severe hypoxia, trauma, or shock
  • Bag must remain inflated
• Venturi Mask
  
  • Precise oxygen concentration
  • Ideal for COPD and CO₂-retaining patients

NCLEX Tip:
Never reduce oxygen for a patient in distress, even with COPD.

ABG Interpretation (High Yield)

Remember the **ROME** method:

• Respiratory Opposite
• Metabolic Equal

Normal ABG values:

• pH: 7.35–7.45
• PaCO₂: 35–45
• HCO₃: 22–26
• PaO₂: 80–100

Examples:

• pH ↓, CO₂ ↑ → Respiratory acidosis
• pH ↑, CO₂ ↓ → Respiratory alkalosis
• pH ↓, HCO₃ ↓ → Metabolic acidosis
• pH ↑, HCO₃ ↑ → Metabolic alkalosis

NCLEX prioritizes recognizing **respiratory failure**:

• PaCO₂ > 50
• PaO₂ < 60
• pH < 7.25

Mechanical Ventilation Essentials

• 1. Low Pressure Alarm
  Caused by:
  • Tube disconnection
  • Cuff leak
  • Extubation
  Priority: Check the patient first, then reconnect.
• 2. High Pressure Alarm
  Caused by:
  • Secretions
  • Biting the tube
  • Kinks
  • ARDS or bronchospasm
  Priority: Suction, reposition, assess breathing.
• 3. Ventilator-Associated Pneumonia (VAP) Prevention
  • Elevate HOB 30–45°
  • Oral care q2h
  • Suction as needed
  • Monitor for infection

Respiratory Red Flags on NCLEX

Always treat these as emergencies:

• Stridor
• Accessory muscle use
• Cyanosis
• O₂ sat < 90% on oxygen
• Silent chest in asthma
• Sudden confusion (early hypoxia sign)

Example NCLEX Respiratory Question

Final Thoughts

Respiratory nursing requires quick thinking, strong assessment skills, and safe interventions. Mastering oxygen therapy, ABG interpretation, and ventilation principles will help you excel in **NCLEX respiratory** questions and provide life‑saving care in real practice.