NUR 257 Chronic Exam 4 ACTUAL EXAM
2026/2027 | Galen College | Complete Exam-
Style Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Chronic Respiratory Disorders — COPD, Asthma, Pulmonary Fibrosis (13 Questions)
Q1: A 68-year-old patient with end-stage COPD (GOLD Stage 4) is on continuous home O₂ at 2 L/min via
nasal cannula. During a routine clinic visit, the patient's spouse reports increased confusion and morning
headaches over the past week. SpO₂ is 91% on current O₂ flow. What is the nurse's priority action?
A. Increase O₂ to 4 L/min to improve oxygenation to the brain.
B. Obtain an ABG to assess for CO₂ retention. *CORRECT+
C. Schedule a CT chest to rule out lung cancer.
D. Reassure the spouse that confusion is normal in advanced COPD.
Correct Answer: B
Rationale: Morning headaches and confusion in advanced COPD are classic manifestations of chronic
hypercapnia (CO₂ retention) resulting from hypoventilation and blunted respiratory drive. The priority is
obtaining an arterial blood gas (ABG) to confirm elevated PaCO₂ and assess acid-base status, which
guides interventions such as non-invasive ventilation or ventilatory support. Distractor A is dangerous—
increasing O₂ flow in the setting of CO₂ retention can suppress the hypoxic respiratory drive (the primary
stimulus in chronic hypercapnia), worsening respiratory acidosis; C is not urgent for these neurological
symptoms and delays critical assessment of gas exchange; D is negligent—confusion and headaches
represent acute decompensation requiring immediate evaluation, not reassurance.
Source: Galen NUR 257, Unit 3: Chronic Respiratory Disorders, pp. 89–94; GOLD 2026 Guidelines; NCLEX-
RN 2026 Test Plan — Physiological Integrity: Physiological Adaptation.
Q2: A 54-year-old patient with asthma uses an albuterol MDI daily and reports using it more than 12
times per week for symptom relief. The patient's peak flow is 65% of personal best. What is the nurse's
priority teaching?
A. Continue current albuterol use and increase fluid intake.
B. Contact the provider to discuss adding a daily inhaled corticosteroid. [CORRECT]
,C. Switch to a nebulizer for all albuterol treatments.
D. Use albuterol only before exercise to prevent overuse.
Correct Answer: B
Rationale: Albuterol use more than twice weekly indicates poor asthma control per GINA guidelines. A
peak flow of 65% of personal best places the patient in the yellow zone (caution), indicating worsening
control requiring controller medication escalation. Inhaled corticosteroids (ICS) are first-line
maintenance therapy for persistent asthma and reduce airway inflammation and exacerbation
frequency. Distractor A ignores the warning signs of uncontrolled asthma; C does not address the
underlying inflammation and may increase systemic side effects; D is inappropriate—albuterol should be
used for symptomatic relief, not withheld, while controller therapy is optimized.
Source: Galen NUR 257, Unit 3: Asthma Management, pp. 102–108; GINA 2026 Guidelines; NCLEX-RN
2026 — Physiological Integrity: Reduction of Risk Potential.
Q3: A patient with idiopathic pulmonary fibrosis (IPF) is started on pirfenidone. Which laboratory
monitoring is most important?
A. Complete blood count monthly.
B. Liver function tests every 4–6 weeks. [CORRECT]
C. Serum creatinine weekly.
D. Thyroid-stimulating hormone quarterly.
Correct Answer: B
Rationale: Pirfenidone is an antifibrotic agent used in IPF that carries a significant risk of hepatotoxicity.
Baseline and periodic monitoring of liver function tests (ALT, AST, bilirubin) every 4–6 weeks is required
to detect drug-induced liver injury. Distractor A is not specifically indicated for pirfenidone; C is
unnecessary—pirfenidone does not primarily affect renal function; D is unrelated to pirfenidone
pharmacology.
Source: Galen NUR 257, Unit 3: Interstitial Lung Disease, pp. 115–118; FDA Prescribing Information:
Pirfenidone; NCLEX-RN 2026 — Pharmacological and Parenteral Therapies.
Q4: A patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. The patient reports dry mouth
and difficulty swallowing. What is the nurse's most appropriate response?
A. Discontinue the medication and contact the provider.
B. Teach the patient to rinse the mouth after each use and maintain oral hydration. [CORRECT]
C. Switch to a short-acting anticholinergic instead.
,D. Recommend sucking on hard candy throughout the day.
Correct Answer: B
Rationale: Anticholinergic medications such as tiotropium commonly cause dry mouth (xerostomia) due
to muscarinic receptor blockade. Rinsing the mouth after inhalation and maintaining adequate
hydration are first-line management strategies that allow continued use of this effective maintenance
medication. Distractor A is premature—dry mouth is an expected, manageable side effect, not a
contraindication; C sacrifices the benefits of long-acting maintenance therapy for a manageable side
effect; D is insufficient—while hard candy may provide temporary relief, it does not address the
underlying cause or prevent oral complications.
Source: Galen NUR 257, Unit 3: COPD Pharmacology, pp. 95–97; NCLEX-RN 2026 — Pharmacological and
Parenteral Therapies.
Q5: A home health nurse visits a patient with COPD who reports increased dyspnea and ankle edema
over the past 3 days. The patient has gained 4 pounds. Current medications include
fluticasone/salmeterol and albuterol PRN. What is the nurse's priority action?
A. Increase the fluticasone/salmeterol to twice daily.
B. Assess for signs of right-sided heart failure (cor pulmonale) and notify the provider. [CORRECT]
C. Recommend increasing home O₂ flow by 1 L/min.
D. Teach the patient to elevate legs and restrict sodium.
Correct Answer: B
Rationale: In COPD, chronic hypoxia leads to pulmonary vasoconstriction and increased pulmonary
artery pressure, resulting in right ventricular hypertrophy and eventual failure (cor pulmonale). New-
onset ankle edema with weight gain and increased dyspnea indicates right-sided heart failure
decompensation, requiring prompt provider notification for diuretic therapy and cardiac evaluation.
Distractor A addresses airway inflammation but not cardiac decompensation; C may provide temporary
relief but does not address the underlying cardiac issue; D is appropriate chronic management but
secondary to medical evaluation for acute decompensation.
Source: Galen NUR 257, Unit 3: COPD Complications, pp. 98–101; NCLEX-RN 2026 — Physiological
Integrity: Physiological Adaptation.
Q6: A patient with severe persistent asthma is prescribed omalizumab (Xolair) subcutaneously every 4
weeks. Which pre-administration assessment is essential?
A. Blood glucose monitoring.
B. Assessment for IgE level and history of anaphylaxis. [CORRECT]
, C. Pulmonary function testing.
D. Sputum cytology.
Correct Answer: B
Rationale: Omalizumab is a monoclonal antibody that binds IgE and is indicated for severe allergic
asthma. Baseline IgE levels determine dosing, and the medication carries a black box warning for
anaphylaxis. Pre-administration assessment must include verification of IgE levels and screening for
history of severe allergic reactions. Distractor A is unrelated to omalizumab; C is useful for asthma
monitoring but not specifically required before each dose; D is unnecessary—sputum cytology is not
part of omalizumab monitoring.
Source: Galen NUR 257, Unit 3: Biologic Therapy in Asthma, pp. 110–112; FDA Black Box Warning:
Omalizumab; NCLEX-RN 2026 — Pharmacological and Parenteral Therapies.
Q7: A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. The patient's SpO₂ is 95%.
What is the nurse's most appropriate action?
A. Maintain current O₂ flow—SpO₂ is within target range for COPD.
B. Reduce O₂ to 1 L/min to prevent CO₂ retention. *CORRECT+
C. Increase O₂ to 3 L/min to achieve 98% SpO₂.
D. Switch to a Venturi mask for precise FiO₂ delivery.
Correct Answer: B
Rationale: The target SpO₂ for patients with COPD is 88–92% to maintain adequate oxygenation while
preserving hypoxic respiratory drive. An SpO₂ of 95% exceeds the target and risks suppressing
respiratory drive, leading to CO₂ retention and respiratory acidosis. Distractor A is incorrect—95% is
above the recommended target; C is dangerous—higher O₂ increases the risk of hypercapnic respiratory
failure; D is unnecessary when simple flow reduction achieves the goal.
Source: Galen NUR 257, Unit 3: Oxygen Therapy in COPD, pp. 92–94; British Thoracic Society COPD
Guidelines 2026; NCLEX-RN 2026 — Physiological Integrity: Reduction of Risk Potential.
Q8: A patient with pulmonary fibrosis reports a nonproductive cough and progressive dyspnea on
exertion. The patient asks about lung transplantation. Which response is most accurate?
A. Lung transplantation is contraindicated in all patients over 60.
B. Transplantation may be an option when pulmonary function severely declines and the patient meets
selection criteria. [CORRECT]
C. Transplantation is only available for patients with a smoking history.
2026/2027 | Galen College | Complete Exam-
Style Questions | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Chronic Respiratory Disorders — COPD, Asthma, Pulmonary Fibrosis (13 Questions)
Q1: A 68-year-old patient with end-stage COPD (GOLD Stage 4) is on continuous home O₂ at 2 L/min via
nasal cannula. During a routine clinic visit, the patient's spouse reports increased confusion and morning
headaches over the past week. SpO₂ is 91% on current O₂ flow. What is the nurse's priority action?
A. Increase O₂ to 4 L/min to improve oxygenation to the brain.
B. Obtain an ABG to assess for CO₂ retention. *CORRECT+
C. Schedule a CT chest to rule out lung cancer.
D. Reassure the spouse that confusion is normal in advanced COPD.
Correct Answer: B
Rationale: Morning headaches and confusion in advanced COPD are classic manifestations of chronic
hypercapnia (CO₂ retention) resulting from hypoventilation and blunted respiratory drive. The priority is
obtaining an arterial blood gas (ABG) to confirm elevated PaCO₂ and assess acid-base status, which
guides interventions such as non-invasive ventilation or ventilatory support. Distractor A is dangerous—
increasing O₂ flow in the setting of CO₂ retention can suppress the hypoxic respiratory drive (the primary
stimulus in chronic hypercapnia), worsening respiratory acidosis; C is not urgent for these neurological
symptoms and delays critical assessment of gas exchange; D is negligent—confusion and headaches
represent acute decompensation requiring immediate evaluation, not reassurance.
Source: Galen NUR 257, Unit 3: Chronic Respiratory Disorders, pp. 89–94; GOLD 2026 Guidelines; NCLEX-
RN 2026 Test Plan — Physiological Integrity: Physiological Adaptation.
Q2: A 54-year-old patient with asthma uses an albuterol MDI daily and reports using it more than 12
times per week for symptom relief. The patient's peak flow is 65% of personal best. What is the nurse's
priority teaching?
A. Continue current albuterol use and increase fluid intake.
B. Contact the provider to discuss adding a daily inhaled corticosteroid. [CORRECT]
,C. Switch to a nebulizer for all albuterol treatments.
D. Use albuterol only before exercise to prevent overuse.
Correct Answer: B
Rationale: Albuterol use more than twice weekly indicates poor asthma control per GINA guidelines. A
peak flow of 65% of personal best places the patient in the yellow zone (caution), indicating worsening
control requiring controller medication escalation. Inhaled corticosteroids (ICS) are first-line
maintenance therapy for persistent asthma and reduce airway inflammation and exacerbation
frequency. Distractor A ignores the warning signs of uncontrolled asthma; C does not address the
underlying inflammation and may increase systemic side effects; D is inappropriate—albuterol should be
used for symptomatic relief, not withheld, while controller therapy is optimized.
Source: Galen NUR 257, Unit 3: Asthma Management, pp. 102–108; GINA 2026 Guidelines; NCLEX-RN
2026 — Physiological Integrity: Reduction of Risk Potential.
Q3: A patient with idiopathic pulmonary fibrosis (IPF) is started on pirfenidone. Which laboratory
monitoring is most important?
A. Complete blood count monthly.
B. Liver function tests every 4–6 weeks. [CORRECT]
C. Serum creatinine weekly.
D. Thyroid-stimulating hormone quarterly.
Correct Answer: B
Rationale: Pirfenidone is an antifibrotic agent used in IPF that carries a significant risk of hepatotoxicity.
Baseline and periodic monitoring of liver function tests (ALT, AST, bilirubin) every 4–6 weeks is required
to detect drug-induced liver injury. Distractor A is not specifically indicated for pirfenidone; C is
unnecessary—pirfenidone does not primarily affect renal function; D is unrelated to pirfenidone
pharmacology.
Source: Galen NUR 257, Unit 3: Interstitial Lung Disease, pp. 115–118; FDA Prescribing Information:
Pirfenidone; NCLEX-RN 2026 — Pharmacological and Parenteral Therapies.
Q4: A patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. The patient reports dry mouth
and difficulty swallowing. What is the nurse's most appropriate response?
A. Discontinue the medication and contact the provider.
B. Teach the patient to rinse the mouth after each use and maintain oral hydration. [CORRECT]
C. Switch to a short-acting anticholinergic instead.
,D. Recommend sucking on hard candy throughout the day.
Correct Answer: B
Rationale: Anticholinergic medications such as tiotropium commonly cause dry mouth (xerostomia) due
to muscarinic receptor blockade. Rinsing the mouth after inhalation and maintaining adequate
hydration are first-line management strategies that allow continued use of this effective maintenance
medication. Distractor A is premature—dry mouth is an expected, manageable side effect, not a
contraindication; C sacrifices the benefits of long-acting maintenance therapy for a manageable side
effect; D is insufficient—while hard candy may provide temporary relief, it does not address the
underlying cause or prevent oral complications.
Source: Galen NUR 257, Unit 3: COPD Pharmacology, pp. 95–97; NCLEX-RN 2026 — Pharmacological and
Parenteral Therapies.
Q5: A home health nurse visits a patient with COPD who reports increased dyspnea and ankle edema
over the past 3 days. The patient has gained 4 pounds. Current medications include
fluticasone/salmeterol and albuterol PRN. What is the nurse's priority action?
A. Increase the fluticasone/salmeterol to twice daily.
B. Assess for signs of right-sided heart failure (cor pulmonale) and notify the provider. [CORRECT]
C. Recommend increasing home O₂ flow by 1 L/min.
D. Teach the patient to elevate legs and restrict sodium.
Correct Answer: B
Rationale: In COPD, chronic hypoxia leads to pulmonary vasoconstriction and increased pulmonary
artery pressure, resulting in right ventricular hypertrophy and eventual failure (cor pulmonale). New-
onset ankle edema with weight gain and increased dyspnea indicates right-sided heart failure
decompensation, requiring prompt provider notification for diuretic therapy and cardiac evaluation.
Distractor A addresses airway inflammation but not cardiac decompensation; C may provide temporary
relief but does not address the underlying cardiac issue; D is appropriate chronic management but
secondary to medical evaluation for acute decompensation.
Source: Galen NUR 257, Unit 3: COPD Complications, pp. 98–101; NCLEX-RN 2026 — Physiological
Integrity: Physiological Adaptation.
Q6: A patient with severe persistent asthma is prescribed omalizumab (Xolair) subcutaneously every 4
weeks. Which pre-administration assessment is essential?
A. Blood glucose monitoring.
B. Assessment for IgE level and history of anaphylaxis. [CORRECT]
, C. Pulmonary function testing.
D. Sputum cytology.
Correct Answer: B
Rationale: Omalizumab is a monoclonal antibody that binds IgE and is indicated for severe allergic
asthma. Baseline IgE levels determine dosing, and the medication carries a black box warning for
anaphylaxis. Pre-administration assessment must include verification of IgE levels and screening for
history of severe allergic reactions. Distractor A is unrelated to omalizumab; C is useful for asthma
monitoring but not specifically required before each dose; D is unnecessary—sputum cytology is not
part of omalizumab monitoring.
Source: Galen NUR 257, Unit 3: Biologic Therapy in Asthma, pp. 110–112; FDA Black Box Warning:
Omalizumab; NCLEX-RN 2026 — Pharmacological and Parenteral Therapies.
Q7: A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. The patient's SpO₂ is 95%.
What is the nurse's most appropriate action?
A. Maintain current O₂ flow—SpO₂ is within target range for COPD.
B. Reduce O₂ to 1 L/min to prevent CO₂ retention. *CORRECT+
C. Increase O₂ to 3 L/min to achieve 98% SpO₂.
D. Switch to a Venturi mask for precise FiO₂ delivery.
Correct Answer: B
Rationale: The target SpO₂ for patients with COPD is 88–92% to maintain adequate oxygenation while
preserving hypoxic respiratory drive. An SpO₂ of 95% exceeds the target and risks suppressing
respiratory drive, leading to CO₂ retention and respiratory acidosis. Distractor A is incorrect—95% is
above the recommended target; C is dangerous—higher O₂ increases the risk of hypercapnic respiratory
failure; D is unnecessary when simple flow reduction achieves the goal.
Source: Galen NUR 257, Unit 3: Oxygen Therapy in COPD, pp. 92–94; British Thoracic Society COPD
Guidelines 2026; NCLEX-RN 2026 — Physiological Integrity: Reduction of Risk Potential.
Q8: A patient with pulmonary fibrosis reports a nonproductive cough and progressive dyspnea on
exertion. The patient asks about lung transplantation. Which response is most accurate?
A. Lung transplantation is contraindicated in all patients over 60.
B. Transplantation may be an option when pulmonary function severely declines and the patient meets
selection criteria. [CORRECT]
C. Transplantation is only available for patients with a smoking history.
