ATI Med Surg Respiratory 2025/2026
Complete Study Guide | Medical Surgical
Nursing Respiratory System Exam Prep |
Comprehensive Review of Respiratory
Disorders, Oxygenation and
Ventilation, ABG Interpretation,
Mechanical Ventilation,
Pharmacology for Respiratory Care,
COPD, Asthma, Pneumonia, ARDS,
Tuberculosis, Patient Assessment,
Nursing Interventions, Clinical Case
Studies, Critical Thinking Strategies,
and Verified ATI Practice Questions for
Nursing Students and Professionals
Question 1: A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
experiencing increased dyspnea. Which assessment finding should the nurse recognize as the priority
to report to the provider?
A. Oxygen saturation of 91% on room air
B. Productive cough with yellow-green sputum
C. Use of accessory muscles during inspiration
D. Respiratory rate of 24 breaths per minute
CORRECT ANSWER: B. Productive cough with yellow-green sputum
RATIONALE: A productive cough with yellow-green sputum indicates a possible respiratory infection,
which can exacerbate COPD and lead to respiratory failure. This finding requires prompt provider
notification for potential antibiotic therapy. While the other findings warrant monitoring, they are more
consistent with baseline COPD status or less urgent changes.
Question 2: A nurse is preparing to administer albuterol via metered-dose inhaler to a client with
asthma. Which instruction should the nurse include to ensure optimal medication delivery?
A. Inhale rapidly and deeply while activating the inhaler
B. Hold breath for 10 seconds after inhaling the medication
C. Rinse mouth with water immediately before using the inhaler
D. Use the inhaler only when experiencing severe shortness of breath
CORRECT ANSWER: B. Hold breath for 10 seconds after inhaling the medication
RATIONALE: Holding the breath for 5-10 seconds after inhaling a bronchodilator allows the medication
to deposit in the airways and improves absorption. Rapid inhalation can cause the medication to impact
,the oropharynx rather than reaching the lungs. Rinsing is recommended after corticosteroid inhalers,
not before bronchodilators. Albuterol is used for acute symptom relief, not exclusively for severe
episodes.
Question 3: A nurse is assessing a client who is 2 hours postoperative following a thoracentesis. Which
finding should the nurse identify as indicative of a pneumothorax?
A. Decreased breath sounds on the affected side
B. Mild pain at the insertion site rated 3/10
C. Small amount of serosanguineous drainage on dressing
D. Temperature of 37.8° C (100° F)
CORRECT ANSWER: A. Decreased breath sounds on the affected side
RATIONALE: Decreased or absent breath sounds on the affected side following thoracentesis is a classic
sign of pneumothorax, a potential complication of the procedure. Mild pain, minimal drainage, and low-
grade fever are expected post-procedure findings. Pneumothorax requires immediate intervention, such
as chest tube insertion.
Question 4: A nurse is developing a teaching plan for a client newly diagnosed with tuberculosis.
Which statement by the client indicates understanding of infection control measures?
A. "I will wear a surgical mask when visitors come to my room."
B. "I can return to work once I have taken medications for 2 weeks."
C. "I should cover my mouth with my hand when I cough or sneeze."
D. "I need to stay in a room with negative air pressure while hospitalized."
CORRECT ANSWER: D. "I need to stay in a room with negative air pressure while hospitalized."
RATIONALE: Clients with active tuberculosis require airborne precautions, including placement in a
negative-pressure room to prevent transmission. Surgical masks are worn by staff entering the room,
not by the client. Clients are typically non-infectious after 2-3 weeks of effective therapy, but clearance
requires sputum testing. Covering the mouth with a tissue (not hand) is recommended, but airborne
precautions are the priority.
Question 5: A nurse is caring for a client with a chest tube connected to a water-seal drainage system
following lobectomy. Which action should the nurse take when continuous bubbling is observed in the
water-seal chamber?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for an air leak
D. Increase the suction pressure
CORRECT ANSWER: C. Assess the system for an air leak
RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which
requires assessment to locate and correct the source. Clamping a chest tube without a provider order
,can cause tension pneumothorax. Intermittent bubbling with exhalation is expected; continuous
bubbling is not. Increasing suction does not address the leak and may worsen the situation.
Question 6: A nurse is reviewing arterial blood gas results for a client with acute respiratory distress
syndrome (ARDS). Which result indicates respiratory acidosis?
A. pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L
B. pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L
C. pH 7.35, PaCO2 40 mm Hg, HCO3 22 mEq/L
D. pH 7.48, PaCO2 32 mm Hg, HCO3 26 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L
RATIONALE: Respiratory acidosis is characterized by a pH below 7.35 and an elevated PaCO2 above 45
mm Hg, with normal bicarbonate indicating an acute process. Option A represents respiratory alkalosis.
Option C is within normal limits. Option D indicates respiratory alkalosis with partial metabolic
compensation.
Question 7: A nurse is preparing to suction a client with an endotracheal tube. Which action should
the nurse take to minimize hypoxia during the procedure?
A. Hyperoxygenate the client with 100% oxygen before suctioning
B. Apply suction continuously while inserting the catheter
C. Limit suctioning to 30 seconds per pass
D. Use a catheter that occludes the entire airway
CORRECT ANSWER: A. Hyperoxygenate the client with 100% oxygen before suctioning
RATIONALE: Pre-oxygenation with 100% oxygen helps prevent hypoxia during suctioning, which
removes oxygen along with secretions. Suction should be applied only during catheter withdrawal, not
insertion, to minimize mucosal trauma. Suction passes should be limited to 10-15 seconds. The catheter
should be no more than half the diameter of the airway to allow airflow during suctioning.
Question 8: A nurse is caring for a client receiving mechanical ventilation. The low-pressure alarm
sounds. Which situation should the nurse assess for first?
A. Kinked ventilator tubing
B. Client biting on the endotracheal tube
C. Disconnection in the ventilator circuit
D. Excessive secretions in the airway
CORRECT ANSWER: C. Disconnection in the ventilator circuit
RATIONALE: A low-pressure alarm indicates a loss of pressure in the circuit, most commonly due to
disconnection or a leak. Kinks, biting, and secretions typically cause high-pressure alarms by obstructing
airflow. The nurse should immediately check connections and assess the client's respiratory status.
Question 9: A nurse is teaching a client with asthma about using a peak flow meter. Which statement
by the client indicates correct understanding?
, A. "I will record the average of three attempts in my asthma diary."
B. "I should stand up straight and take a deep breath before blowing."
C. "I will use the meter only when I feel short of breath."
D. "I should blow into the meter as slowly and steadily as possible."
CORRECT ANSWER: B. "I should stand up straight and take a deep breath before blowing."
RATIONALE: Proper peak flow technique includes standing, taking a deep breath, sealing lips around
the mouthpiece, and blowing out as hard and fast as possible. The highest of three readings is recorded,
not the average. Peak flow should be measured daily at the same time, not just during symptoms, to
establish a personal best and monitor trends.
Question 10: A nurse is caring for a client with pulmonary embolism. Which intervention should the
nurse prioritize?
A. Apply sequential compression devices to lower extremities
B. Administer prescribed heparin via continuous IV infusion
C. Encourage deep breathing and coughing every 2 hours
D. Obtain a baseline 12-lead electrocardiogram
CORRECT ANSWER: B. Administer prescribed heparin via continuous IV infusion
RATIONALE: Anticoagulation with heparin is the priority intervention for pulmonary embolism to
prevent further clot formation and extension. While SCDs prevent DVT, they are not therapeutic for an
existing embolism. Deep breathing promotes oxygenation but does not address the clot. ECG may show
changes but is diagnostic, not therapeutic.
Question 11: A nurse is assessing a client with suspected tension pneumothorax. Which finding should
the nurse expect?
A. Tracheal deviation toward the affected side
B. Hyperresonance to percussion on the affected side
C. Distended neck veins on the unaffected side
D. Increased breath sounds on the affected side
CORRECT ANSWER: B. Hyperresonance to percussion on the affected side
RATIONALE: Tension pneumothorax causes air accumulation in the pleural space, leading to
hyperresonance on percussion, absent breath sounds, tracheal deviation away from the affected side,
and distended neck veins due to impaired venous return. Increased breath sounds would not occur with
lung collapse.
Question 12: A nurse is administering rifampin to a client with tuberculosis. Which client statement
indicates understanding of medication teaching?
A. "I will report any yellowing of my skin or eyes immediately."
B. "I should take this medication with a full glass of milk."
C. "I can stop taking this once my cough improves."
D. "This medication may cause my urine to appear green."
Complete Study Guide | Medical Surgical
Nursing Respiratory System Exam Prep |
Comprehensive Review of Respiratory
Disorders, Oxygenation and
Ventilation, ABG Interpretation,
Mechanical Ventilation,
Pharmacology for Respiratory Care,
COPD, Asthma, Pneumonia, ARDS,
Tuberculosis, Patient Assessment,
Nursing Interventions, Clinical Case
Studies, Critical Thinking Strategies,
and Verified ATI Practice Questions for
Nursing Students and Professionals
Question 1: A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is
experiencing increased dyspnea. Which assessment finding should the nurse recognize as the priority
to report to the provider?
A. Oxygen saturation of 91% on room air
B. Productive cough with yellow-green sputum
C. Use of accessory muscles during inspiration
D. Respiratory rate of 24 breaths per minute
CORRECT ANSWER: B. Productive cough with yellow-green sputum
RATIONALE: A productive cough with yellow-green sputum indicates a possible respiratory infection,
which can exacerbate COPD and lead to respiratory failure. This finding requires prompt provider
notification for potential antibiotic therapy. While the other findings warrant monitoring, they are more
consistent with baseline COPD status or less urgent changes.
Question 2: A nurse is preparing to administer albuterol via metered-dose inhaler to a client with
asthma. Which instruction should the nurse include to ensure optimal medication delivery?
A. Inhale rapidly and deeply while activating the inhaler
B. Hold breath for 10 seconds after inhaling the medication
C. Rinse mouth with water immediately before using the inhaler
D. Use the inhaler only when experiencing severe shortness of breath
CORRECT ANSWER: B. Hold breath for 10 seconds after inhaling the medication
RATIONALE: Holding the breath for 5-10 seconds after inhaling a bronchodilator allows the medication
to deposit in the airways and improves absorption. Rapid inhalation can cause the medication to impact
,the oropharynx rather than reaching the lungs. Rinsing is recommended after corticosteroid inhalers,
not before bronchodilators. Albuterol is used for acute symptom relief, not exclusively for severe
episodes.
Question 3: A nurse is assessing a client who is 2 hours postoperative following a thoracentesis. Which
finding should the nurse identify as indicative of a pneumothorax?
A. Decreased breath sounds on the affected side
B. Mild pain at the insertion site rated 3/10
C. Small amount of serosanguineous drainage on dressing
D. Temperature of 37.8° C (100° F)
CORRECT ANSWER: A. Decreased breath sounds on the affected side
RATIONALE: Decreased or absent breath sounds on the affected side following thoracentesis is a classic
sign of pneumothorax, a potential complication of the procedure. Mild pain, minimal drainage, and low-
grade fever are expected post-procedure findings. Pneumothorax requires immediate intervention, such
as chest tube insertion.
Question 4: A nurse is developing a teaching plan for a client newly diagnosed with tuberculosis.
Which statement by the client indicates understanding of infection control measures?
A. "I will wear a surgical mask when visitors come to my room."
B. "I can return to work once I have taken medications for 2 weeks."
C. "I should cover my mouth with my hand when I cough or sneeze."
D. "I need to stay in a room with negative air pressure while hospitalized."
CORRECT ANSWER: D. "I need to stay in a room with negative air pressure while hospitalized."
RATIONALE: Clients with active tuberculosis require airborne precautions, including placement in a
negative-pressure room to prevent transmission. Surgical masks are worn by staff entering the room,
not by the client. Clients are typically non-infectious after 2-3 weeks of effective therapy, but clearance
requires sputum testing. Covering the mouth with a tissue (not hand) is recommended, but airborne
precautions are the priority.
Question 5: A nurse is caring for a client with a chest tube connected to a water-seal drainage system
following lobectomy. Which action should the nurse take when continuous bubbling is observed in the
water-seal chamber?
A. Clamp the chest tube immediately
B. Document the finding as expected
C. Assess the system for an air leak
D. Increase the suction pressure
CORRECT ANSWER: C. Assess the system for an air leak
RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which
requires assessment to locate and correct the source. Clamping a chest tube without a provider order
,can cause tension pneumothorax. Intermittent bubbling with exhalation is expected; continuous
bubbling is not. Increasing suction does not address the leak and may worsen the situation.
Question 6: A nurse is reviewing arterial blood gas results for a client with acute respiratory distress
syndrome (ARDS). Which result indicates respiratory acidosis?
A. pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L
B. pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L
C. pH 7.35, PaCO2 40 mm Hg, HCO3 22 mEq/L
D. pH 7.48, PaCO2 32 mm Hg, HCO3 26 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO2 55 mm Hg, HCO3 24 mEq/L
RATIONALE: Respiratory acidosis is characterized by a pH below 7.35 and an elevated PaCO2 above 45
mm Hg, with normal bicarbonate indicating an acute process. Option A represents respiratory alkalosis.
Option C is within normal limits. Option D indicates respiratory alkalosis with partial metabolic
compensation.
Question 7: A nurse is preparing to suction a client with an endotracheal tube. Which action should
the nurse take to minimize hypoxia during the procedure?
A. Hyperoxygenate the client with 100% oxygen before suctioning
B. Apply suction continuously while inserting the catheter
C. Limit suctioning to 30 seconds per pass
D. Use a catheter that occludes the entire airway
CORRECT ANSWER: A. Hyperoxygenate the client with 100% oxygen before suctioning
RATIONALE: Pre-oxygenation with 100% oxygen helps prevent hypoxia during suctioning, which
removes oxygen along with secretions. Suction should be applied only during catheter withdrawal, not
insertion, to minimize mucosal trauma. Suction passes should be limited to 10-15 seconds. The catheter
should be no more than half the diameter of the airway to allow airflow during suctioning.
Question 8: A nurse is caring for a client receiving mechanical ventilation. The low-pressure alarm
sounds. Which situation should the nurse assess for first?
A. Kinked ventilator tubing
B. Client biting on the endotracheal tube
C. Disconnection in the ventilator circuit
D. Excessive secretions in the airway
CORRECT ANSWER: C. Disconnection in the ventilator circuit
RATIONALE: A low-pressure alarm indicates a loss of pressure in the circuit, most commonly due to
disconnection or a leak. Kinks, biting, and secretions typically cause high-pressure alarms by obstructing
airflow. The nurse should immediately check connections and assess the client's respiratory status.
Question 9: A nurse is teaching a client with asthma about using a peak flow meter. Which statement
by the client indicates correct understanding?
, A. "I will record the average of three attempts in my asthma diary."
B. "I should stand up straight and take a deep breath before blowing."
C. "I will use the meter only when I feel short of breath."
D. "I should blow into the meter as slowly and steadily as possible."
CORRECT ANSWER: B. "I should stand up straight and take a deep breath before blowing."
RATIONALE: Proper peak flow technique includes standing, taking a deep breath, sealing lips around
the mouthpiece, and blowing out as hard and fast as possible. The highest of three readings is recorded,
not the average. Peak flow should be measured daily at the same time, not just during symptoms, to
establish a personal best and monitor trends.
Question 10: A nurse is caring for a client with pulmonary embolism. Which intervention should the
nurse prioritize?
A. Apply sequential compression devices to lower extremities
B. Administer prescribed heparin via continuous IV infusion
C. Encourage deep breathing and coughing every 2 hours
D. Obtain a baseline 12-lead electrocardiogram
CORRECT ANSWER: B. Administer prescribed heparin via continuous IV infusion
RATIONALE: Anticoagulation with heparin is the priority intervention for pulmonary embolism to
prevent further clot formation and extension. While SCDs prevent DVT, they are not therapeutic for an
existing embolism. Deep breathing promotes oxygenation but does not address the clot. ECG may show
changes but is diagnostic, not therapeutic.
Question 11: A nurse is assessing a client with suspected tension pneumothorax. Which finding should
the nurse expect?
A. Tracheal deviation toward the affected side
B. Hyperresonance to percussion on the affected side
C. Distended neck veins on the unaffected side
D. Increased breath sounds on the affected side
CORRECT ANSWER: B. Hyperresonance to percussion on the affected side
RATIONALE: Tension pneumothorax causes air accumulation in the pleural space, leading to
hyperresonance on percussion, absent breath sounds, tracheal deviation away from the affected side,
and distended neck veins due to impaired venous return. Increased breath sounds would not occur with
lung collapse.
Question 12: A nurse is administering rifampin to a client with tuberculosis. Which client statement
indicates understanding of medication teaching?
A. "I will report any yellowing of my skin or eyes immediately."
B. "I should take this medication with a full glass of milk."
C. "I can stop taking this once my cough improves."
D. "This medication may cause my urine to appear green."
