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MEDICAL-SURGICAL RESPIRATORY EXAM
QUESTIONS AND CORRECT ANSWERS| LATEST
UPDATED VERSION WITH VERIFIED
SOLUTIONS - ASSURED PASS
Course: Advanced Medical-Surgical Nursing
Subject: Respiratory System
Description: This exam assesses knowledge of respiratory pathophysiology,
diagnostics, pharmacology, interventions, and patient care in adult medical-
surgical settings. It covers common respiratory conditions such as COPD, asthma,
pneumonia, pulmonary embolism, ARDS, and respiratory failure, emphasizing
clinical reasoning, nursing interventions, and evidence-based management.
1. A 65-year-old patient with a history of chronic bronchitis presents with
increased shortness of breath and productive cough. Which nursing intervention is
most appropriate initially?
A. Administer high-flow oxygen via non-rebreather mask
B. Encourage fluid intake and assess sputum characteristics
C. Prepare for immediate intubation
D. Restrict all activity until symptoms subside
Answer: B
Rationale: Encouraging fluids helps thin secretions, making them easier to
expectorate. Assessment of sputum color and consistency helps determine infection
or exacerbation of chronic bronchitis. Oxygen therapy may be necessary, but
assessing airway clearance is the first step.
2. A patient with COPD is prescribed a short-acting beta-agonist inhaler. What is
the primary mechanism of action?
A. Anti-inflammatory effect on bronchial mucosa
B. Dilates bronchioles by stimulating beta-2 receptors
,2|Page
C. Reduces mucus production
D. Suppresses cough reflex
Answer: B
Rationale: Short-acting beta-agonists (e.g., albuterol) act on beta-2 receptors in
the lungs to relax bronchial smooth muscle, causing bronchodilation and relief of
acute bronchospasm.
3. A nurse is assessing a patient with asthma experiencing an acute exacerbation.
Which finding indicates impending respiratory failure?
A. Wheezing on auscultation
B. Use of accessory muscles
C. PaCO₂ of 55 mmHg
D. Cough productive of clear sputum
Answer: C
Rationale: Elevated PaCO₂ indicates hypoventilation and CO₂ retention, which is
a sign of respiratory failure. Wheezing and accessory muscle use indicate distress
but not necessarily imminent failure.
4. Which statement by a patient with obstructive sleep apnea (OSA) indicates
correct understanding of lifestyle modifications?
A. "I should avoid sleeping on my back."
B. "I need to drink a glass of wine before bed to relax my airway."
C. "Exercise in the evening will improve my oxygenation during sleep."
D. "I should increase my caffeine intake at night to stay awake."
Answer: A
Rationale: Sleeping on the back worsens OSA by allowing the tongue and soft
tissues to obstruct the airway. Lifestyle modifications include weight loss,
positional therapy, and avoidance of sedatives or alcohol before sleep.
,3|Page
5. A 50-year-old patient is admitted with community-acquired pneumonia. Which
laboratory finding supports the diagnosis?
A. Decreased WBC count
B. Hypokalemia
C. Elevated WBC count with left shift
D. Increased hemoglobin
Answer: C
Rationale: Pneumonia commonly causes leukocytosis with a left shift (increase in
immature neutrophils) due to bacterial infection. WBCs are typically elevated, not
decreased.
6. Which nursing action is most important before performing incentive spirometry?
A. Administering bronchodilator
B. Assessing oxygen saturation and lung sounds
C. Positioning the patient upright
D. Encouraging fluid restriction
Answer: C
Rationale: Proper positioning (upright) ensures maximum lung expansion,
improving the effectiveness of incentive spirometry in preventing atelectasis.
7. A patient with COPD has an SpO₂ of 88%. Which action is most appropriate?
A. Administer high-flow oxygen at 10 L/min
B. Encourage pursed-lip breathing and start low-flow oxygen
C. Call rapid response immediately
D. Perform chest physiotherapy
Answer: B
Rationale: COPD patients rely on hypoxic drive for breathing. Administering high-
flow oxygen may suppress their respiratory drive. Pursed-lip breathing helps
control ventilation, and low-flow oxygen improves oxygenation safely.
, 4|Page
8. Which finding is characteristic of emphysema?
A. Productive cough with green sputum
B. Barrel-shaped chest and decreased breath sounds
C. Crackles at lung bases
D. Cyanosis of lips and nail beds
Answer: B
Rationale: Emphysema leads to hyperinflation of alveoli, causing a barrel chest.
Breath sounds are often decreased due to air trapping.
9. Which complication is most concerning for a patient with acute respiratory
distress syndrome (ARDS)?
A. Mild hypoxemia
B. Pulmonary fibrosis
C. Hypercapnia
D. Tachycardia
Answer: B
Rationale: ARDS can progress to pulmonary fibrosis due to chronic inflammation
and scarring, leading to long-term respiratory compromise.
10. A patient with pulmonary embolism presents with sudden dyspnea and
pleuritic chest pain. Which diagnostic test is preferred to confirm the diagnosis?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. Arterial blood gas
Answer: C
Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism. Chest X-ray may appear normal, and D-dimer is more useful
for ruling out PE rather than confirming it.
MEDICAL-SURGICAL RESPIRATORY EXAM
QUESTIONS AND CORRECT ANSWERS| LATEST
UPDATED VERSION WITH VERIFIED
SOLUTIONS - ASSURED PASS
Course: Advanced Medical-Surgical Nursing
Subject: Respiratory System
Description: This exam assesses knowledge of respiratory pathophysiology,
diagnostics, pharmacology, interventions, and patient care in adult medical-
surgical settings. It covers common respiratory conditions such as COPD, asthma,
pneumonia, pulmonary embolism, ARDS, and respiratory failure, emphasizing
clinical reasoning, nursing interventions, and evidence-based management.
1. A 65-year-old patient with a history of chronic bronchitis presents with
increased shortness of breath and productive cough. Which nursing intervention is
most appropriate initially?
A. Administer high-flow oxygen via non-rebreather mask
B. Encourage fluid intake and assess sputum characteristics
C. Prepare for immediate intubation
D. Restrict all activity until symptoms subside
Answer: B
Rationale: Encouraging fluids helps thin secretions, making them easier to
expectorate. Assessment of sputum color and consistency helps determine infection
or exacerbation of chronic bronchitis. Oxygen therapy may be necessary, but
assessing airway clearance is the first step.
2. A patient with COPD is prescribed a short-acting beta-agonist inhaler. What is
the primary mechanism of action?
A. Anti-inflammatory effect on bronchial mucosa
B. Dilates bronchioles by stimulating beta-2 receptors
,2|Page
C. Reduces mucus production
D. Suppresses cough reflex
Answer: B
Rationale: Short-acting beta-agonists (e.g., albuterol) act on beta-2 receptors in
the lungs to relax bronchial smooth muscle, causing bronchodilation and relief of
acute bronchospasm.
3. A nurse is assessing a patient with asthma experiencing an acute exacerbation.
Which finding indicates impending respiratory failure?
A. Wheezing on auscultation
B. Use of accessory muscles
C. PaCO₂ of 55 mmHg
D. Cough productive of clear sputum
Answer: C
Rationale: Elevated PaCO₂ indicates hypoventilation and CO₂ retention, which is
a sign of respiratory failure. Wheezing and accessory muscle use indicate distress
but not necessarily imminent failure.
4. Which statement by a patient with obstructive sleep apnea (OSA) indicates
correct understanding of lifestyle modifications?
A. "I should avoid sleeping on my back."
B. "I need to drink a glass of wine before bed to relax my airway."
C. "Exercise in the evening will improve my oxygenation during sleep."
D. "I should increase my caffeine intake at night to stay awake."
Answer: A
Rationale: Sleeping on the back worsens OSA by allowing the tongue and soft
tissues to obstruct the airway. Lifestyle modifications include weight loss,
positional therapy, and avoidance of sedatives or alcohol before sleep.
,3|Page
5. A 50-year-old patient is admitted with community-acquired pneumonia. Which
laboratory finding supports the diagnosis?
A. Decreased WBC count
B. Hypokalemia
C. Elevated WBC count with left shift
D. Increased hemoglobin
Answer: C
Rationale: Pneumonia commonly causes leukocytosis with a left shift (increase in
immature neutrophils) due to bacterial infection. WBCs are typically elevated, not
decreased.
6. Which nursing action is most important before performing incentive spirometry?
A. Administering bronchodilator
B. Assessing oxygen saturation and lung sounds
C. Positioning the patient upright
D. Encouraging fluid restriction
Answer: C
Rationale: Proper positioning (upright) ensures maximum lung expansion,
improving the effectiveness of incentive spirometry in preventing atelectasis.
7. A patient with COPD has an SpO₂ of 88%. Which action is most appropriate?
A. Administer high-flow oxygen at 10 L/min
B. Encourage pursed-lip breathing and start low-flow oxygen
C. Call rapid response immediately
D. Perform chest physiotherapy
Answer: B
Rationale: COPD patients rely on hypoxic drive for breathing. Administering high-
flow oxygen may suppress their respiratory drive. Pursed-lip breathing helps
control ventilation, and low-flow oxygen improves oxygenation safely.
, 4|Page
8. Which finding is characteristic of emphysema?
A. Productive cough with green sputum
B. Barrel-shaped chest and decreased breath sounds
C. Crackles at lung bases
D. Cyanosis of lips and nail beds
Answer: B
Rationale: Emphysema leads to hyperinflation of alveoli, causing a barrel chest.
Breath sounds are often decreased due to air trapping.
9. Which complication is most concerning for a patient with acute respiratory
distress syndrome (ARDS)?
A. Mild hypoxemia
B. Pulmonary fibrosis
C. Hypercapnia
D. Tachycardia
Answer: B
Rationale: ARDS can progress to pulmonary fibrosis due to chronic inflammation
and scarring, leading to long-term respiratory compromise.
10. A patient with pulmonary embolism presents with sudden dyspnea and
pleuritic chest pain. Which diagnostic test is preferred to confirm the diagnosis?
A. Chest X-ray
B. D-dimer assay
C. CT pulmonary angiography
D. Arterial blood gas
Answer: C
Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism. Chest X-ray may appear normal, and D-dimer is more useful
for ruling out PE rather than confirming it.
