How COPD and asthma are tested on the NCLEX-RN
Items fall under Physiological Adaptation, Pharmacological Therapies, and Health Promotion.
Recognize cues of respiratory distress
A tiring client is more dangerous than a noisy one.
| Cue | Meaning | Action |
|---|---|---|
| Restlessness, confusion | Hypoxia or rising CO₂ | Assess SpO₂, ABG as ordered; notify |
| Silent chest | Severe obstruction | Emergency: rapid response |
| Drowsiness in COPD on oxygen | Possible CO₂ retention | Check ABG; adjust oxygen to target as ordered; notify |
| Fever, change in sputum color | Infection triggering exacerbation | Culture as ordered, notify |
Early signs of hypoxia are subtle; cyanosis is a late sign.
Inhalers and pharmacological therapies
Know rescue vs controller and how to use devices.
| Drug (example) | Role | Nursing / teaching point |
|---|---|---|
| Albuterol (SABA) | Rescue | Tremor, tachycardia; overuse signals poor control |
| Ipratropium (short-acting) and tiotropium (long-acting) anticholinergics | Acute relief (ipratropium); COPD maintenance (tiotropium) | Dry mouth; avoid spraying into eyes |
| Inhaled corticosteroid (fluticasone) | Controller | Rinse and spit after use; not for acute attacks |
| Salmeterol (LABA) | Controller | Not a rescue drug; used with an inhaled steroid in asthma |
| Montelukast (leukotriene modifier) | Controller | Report mood or behavior changes |
| Systemic steroids (prednisone) | Exacerbations | Glucose monitoring; taper if prolonged |
A spacer improves delivery from a metered-dose inhaler.
Oxygen and breathing techniques in COPD
The nurse balances oxygenation with the risk of CO₂ retention in some clients.
- Titrate oxygen to the ordered target (commonly SpO₂ 88–92% for clients at risk of CO₂ retention).
- Pursed-lip breathing: inhale through the nose, exhale slowly through pursed lips, about twice as long as inhaling.
- Tripod or upright positioning helps the diaphragm and accessory muscles.
- Small, frequent, high-calorie meals reduce fatigue and dyspnea.
- Smoking cessation is the most effective way to slow COPD progression; vaccines (influenza, pneumococcal, others as recommended) reduce exacerbations.
NGN-style case
A classic priority question.
functions Clinical judgment case — getting quieter
A child in an asthma attack had loud wheezing 20 minutes ago. Now wheezing is barely audible, the child is drowsy, and SpO₂ is 85%. What does the nurse conclude?
- Recognize cues: decreasing wheeze, drowsiness, low SpO₂.
- Analyze: little air is moving; the child is tiring. This is not improvement.
- Act: call the rapid response team, give oxygen, prepare emergency bronchodilators and airway support as ordered.
- Stay with the child and monitor continuously.
Answer. The child is deteriorating (silent chest). Call for emergency help and support oxygenation immediately.