ATI MEDICAL SURGICAL RESPIRATORY DETAILED ANSWER KEY
2026/2027 | 75 Questions | Comprehensive Rationales | Latest
Version | Pass Guaranteed - A+ Graded
Question 1: A 68-year-old client with a 40-pack-year smoking history presents with
progressive dyspnea, barrel chest, and pursed-lip breathing. Which arterial blood gas
(ABG) result would the nurse expect to find?
A. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.32, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L
C. pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 35 mEq/L
Correct Answer: B
Rationale:
Option A: This represents respiratory alkalosis with normal bicarbonate. The low PaCO₂
indicates hyperventilation, which contradicts the client's presentation of COPD with
chronic CO₂ retention. Clients with emphysema typically retain CO₂ due to loss of
alveolar surface area and impaired gas exchange. This ABG pattern would be seen in
anxiety-induced hyperventilation or early septic shock, not chronic obstructive
pulmonary disease.
Option B: [CORRECT] This demonstrates uncompensated respiratory acidosis with
metabolic compensation beginning. The low pH (acidemia), elevated PaCO₂
(hypercapnia), and elevated bicarbonate (renal compensation) are classic for chronic
bronchitis-type COPD. The elevated bicarbonate indicates the kidneys have increased
,acid excretion over days to weeks to buffer the retained CO₂. This matches the client's
barrel chest (indicating chronic air trapping), pursed-lip breathing (prolonged expiration
to prevent airway collapse), and smoking history.
Option C: This is a normal ABG, which would be inappropriate for a client with advanced
COPD and progressive dyspnea. Normal values would not explain the clinical
manifestations presented.
Option D: This represents metabolic alkalosis with respiratory compensation. The
elevated bicarbonate is primary here, with CO₂ rising to compensate. This pattern
occurs with vomiting, NG suction, or diuretic use—not COPD. The pH is alkalotic, which
contradicts the acid-base disturbance expected in CO₂-retaining COPD clients.
Question 2: A nurse is caring for a client with asthma who is prescribed albuterol
(Proventil) and fluticasone (Flovent). Which statement by the client indicates
understanding of the medication regimen?
A. "I should use my fluticasone inhaler first when I have an asthma attack."
B. "I need to rinse my mouth after using my fluticasone inhaler."
C. "Albuterol will reduce the inflammation in my airways over time."
D. "I can stop taking fluticasone when my breathing feels better."
Correct Answer: B
Rationale:
Option A: This is incorrect because fluticasone is a corticosteroid (controller
medication) that works slowly to reduce inflammation, not to provide immediate
bronchodilation during an acute attack. Albuterol, a short-acting beta-agonist (SABA),
,should always be used first during an acute exacerbation to open airways quickly. Using
the corticosteroid first delays relief and could worsen the attack.
Option B: [CORRECT] Rinsing the mouth after inhaled corticosteroid use is essential to
prevent oral candidiasis (thrush) and minimize systemic absorption. Fluticasone
deposits in the oropharynx can cause localized immunosuppression, allowing fungal
overgrowth. This teaching point demonstrates proper self-administration technique and
adverse effect prevention, which is a priority nursing intervention for inhaled
corticosteroid therapy.
Option C: This confuses the mechanisms of the two medications. Albuterol is a
bronchodilator that relaxes smooth muscle; it has minimal anti-inflammatory properties.
Fluticasone is the anti-inflammatory agent that reduces airway inflammation over time.
Misunderstanding this distinction could lead to inappropriate medication use during
exacerbations.
Option D: This indicates dangerous nonadherence. Corticosteroids must be taken daily
regardless of symptoms to maintain airway inflammation control. Stopping abruptly can
cause adrenal suppression (if systemic steroids were used previously) and rebound
airway inflammation. "Feeling better" indicates controlled symptoms from the
medication, not cure of the underlying disease.
Question 3: A client is admitted with community-acquired pneumonia (CAP). Which
assessment finding requires immediate nursing intervention?
A. Oxygen saturation 92% on 2L nasal cannula
B. Productive cough with rust-colored sputum
C. Respiratory rate 28 breaths/minute with use of accessory muscles
, D. Temperature 38.6°C (101.5°F)
Correct Answer: C
Rationale:
Option A: While 92% saturation is lower than normal, it is acceptable for a client with
pneumonia on low-flow oxygen and does not constitute an emergency. The nurse
should continue monitoring and consider increasing oxygen if the client becomes
symptomatic, but this does not require immediate intervention compared to more
critical findings.
Option B: Rust-colored sputum is characteristic of Streptococcus pneumoniae
pneumonia and, while notable, is an expected finding that confirms the diagnosis rather
than indicating acute deterioration. This finding should be documented and reported but
does not require immediate action.
Option C: [CORRECT] A respiratory rate of 28 (tachypnea) with accessory muscle use
indicates respiratory distress and impending respiratory failure. Accessory muscle
recruitment (sternocleidomastoid, scalenes, intercostals) signifies the client is working
excessively hard to breathe and is approaching ventilatory exhaustion. This requires
immediate nursing assessment, potential escalation to high-flow oxygen or non-invasive
ventilation, and urgent provider notification. According to the ABC priority framework,
airway and breathing take precedence over all other interventions.
Option D: Fever is an expected immune response to infection and, while uncomfortable,
is not immediately life-threatening. Antipyretics can be administered, but this finding
does not take priority over respiratory compromise.
2026/2027 | 75 Questions | Comprehensive Rationales | Latest
Version | Pass Guaranteed - A+ Graded
Question 1: A 68-year-old client with a 40-pack-year smoking history presents with
progressive dyspnea, barrel chest, and pursed-lip breathing. Which arterial blood gas
(ABG) result would the nurse expect to find?
A. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.32, PaCO₂ 58 mmHg, HCO₃⁻ 30 mEq/L
C. pH 7.40, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 35 mEq/L
Correct Answer: B
Rationale:
Option A: This represents respiratory alkalosis with normal bicarbonate. The low PaCO₂
indicates hyperventilation, which contradicts the client's presentation of COPD with
chronic CO₂ retention. Clients with emphysema typically retain CO₂ due to loss of
alveolar surface area and impaired gas exchange. This ABG pattern would be seen in
anxiety-induced hyperventilation or early septic shock, not chronic obstructive
pulmonary disease.
Option B: [CORRECT] This demonstrates uncompensated respiratory acidosis with
metabolic compensation beginning. The low pH (acidemia), elevated PaCO₂
(hypercapnia), and elevated bicarbonate (renal compensation) are classic for chronic
bronchitis-type COPD. The elevated bicarbonate indicates the kidneys have increased
,acid excretion over days to weeks to buffer the retained CO₂. This matches the client's
barrel chest (indicating chronic air trapping), pursed-lip breathing (prolonged expiration
to prevent airway collapse), and smoking history.
Option C: This is a normal ABG, which would be inappropriate for a client with advanced
COPD and progressive dyspnea. Normal values would not explain the clinical
manifestations presented.
Option D: This represents metabolic alkalosis with respiratory compensation. The
elevated bicarbonate is primary here, with CO₂ rising to compensate. This pattern
occurs with vomiting, NG suction, or diuretic use—not COPD. The pH is alkalotic, which
contradicts the acid-base disturbance expected in CO₂-retaining COPD clients.
Question 2: A nurse is caring for a client with asthma who is prescribed albuterol
(Proventil) and fluticasone (Flovent). Which statement by the client indicates
understanding of the medication regimen?
A. "I should use my fluticasone inhaler first when I have an asthma attack."
B. "I need to rinse my mouth after using my fluticasone inhaler."
C. "Albuterol will reduce the inflammation in my airways over time."
D. "I can stop taking fluticasone when my breathing feels better."
Correct Answer: B
Rationale:
Option A: This is incorrect because fluticasone is a corticosteroid (controller
medication) that works slowly to reduce inflammation, not to provide immediate
bronchodilation during an acute attack. Albuterol, a short-acting beta-agonist (SABA),
,should always be used first during an acute exacerbation to open airways quickly. Using
the corticosteroid first delays relief and could worsen the attack.
Option B: [CORRECT] Rinsing the mouth after inhaled corticosteroid use is essential to
prevent oral candidiasis (thrush) and minimize systemic absorption. Fluticasone
deposits in the oropharynx can cause localized immunosuppression, allowing fungal
overgrowth. This teaching point demonstrates proper self-administration technique and
adverse effect prevention, which is a priority nursing intervention for inhaled
corticosteroid therapy.
Option C: This confuses the mechanisms of the two medications. Albuterol is a
bronchodilator that relaxes smooth muscle; it has minimal anti-inflammatory properties.
Fluticasone is the anti-inflammatory agent that reduces airway inflammation over time.
Misunderstanding this distinction could lead to inappropriate medication use during
exacerbations.
Option D: This indicates dangerous nonadherence. Corticosteroids must be taken daily
regardless of symptoms to maintain airway inflammation control. Stopping abruptly can
cause adrenal suppression (if systemic steroids were used previously) and rebound
airway inflammation. "Feeling better" indicates controlled symptoms from the
medication, not cure of the underlying disease.
Question 3: A client is admitted with community-acquired pneumonia (CAP). Which
assessment finding requires immediate nursing intervention?
A. Oxygen saturation 92% on 2L nasal cannula
B. Productive cough with rust-colored sputum
C. Respiratory rate 28 breaths/minute with use of accessory muscles
, D. Temperature 38.6°C (101.5°F)
Correct Answer: C
Rationale:
Option A: While 92% saturation is lower than normal, it is acceptable for a client with
pneumonia on low-flow oxygen and does not constitute an emergency. The nurse
should continue monitoring and consider increasing oxygen if the client becomes
symptomatic, but this does not require immediate intervention compared to more
critical findings.
Option B: Rust-colored sputum is characteristic of Streptococcus pneumoniae
pneumonia and, while notable, is an expected finding that confirms the diagnosis rather
than indicating acute deterioration. This finding should be documented and reported but
does not require immediate action.
Option C: [CORRECT] A respiratory rate of 28 (tachypnea) with accessory muscle use
indicates respiratory distress and impending respiratory failure. Accessory muscle
recruitment (sternocleidomastoid, scalenes, intercostals) signifies the client is working
excessively hard to breathe and is approaching ventilatory exhaustion. This requires
immediate nursing assessment, potential escalation to high-flow oxygen or non-invasive
ventilation, and urgent provider notification. According to the ABC priority framework,
airway and breathing take precedence over all other interventions.
Option D: Fever is an expected immune response to infection and, while uncomfortable,
is not immediately life-threatening. Antipyretics can be administered, but this finding
does not take priority over respiratory compromise.
