NSG 223 MED-SURG EXAM 3 (2026) – QUESTIONS WITH ANSWERS &
RATIONALES
Section 1: Respiratory Disorders (Questions 1–20)
1. A patient with COPD has a pulse oximetry reading of 88% on room air. Which
action should the nurse take first?
A) Administer high-flow oxygen at 10 L/min via mask
B) Apply supplemental oxygen at 2 L/min via nasal cannula
C) Encourage deep breathing and coughing
D) Notify the provider immediately
Answer: B – Apply supplemental oxygen at 2 L/min via nasal cannula
Rationale: COPD patients require low-flow oxygen (1-3 L/min) to avoid
suppressing hypoxic drive. Target SpO2 88-92%. High flow can cause hypercapnia.
2. A patient with pneumonia has a fever, productive cough with green sputum,
and crackles in the right lower lobe. Which intervention is most important?
A) Administer antipyretics
B) Start prescribed antibiotics
C) Encourage oral fluids
D) Position in high Fowler’s
,Answer: B – Start prescribed antibiotics
Rationale: Antibiotics treat bacterial infection. All other interventions are
supportive but antibiotics address the cause.
3. Which finding in a patient with a pulmonary embolism requires immediate
intervention?
A) Heart rate 102 bpm
B) Respiratory rate 24 breaths/min
C) Sudden hypotension and confusion
D) Oxygen saturation 91% on 2 L NC
Answer: C – Sudden hypotension and confusion
Rationale: Hypotension and confusion indicate massive PE with hemodynamic
instability (possible obstructive shock). Requires emergency reperfusion.
4. A patient with status asthmaticus is not responding to nebulized albuterol. The
nurse expects the next medication to be:
A) Oral prednisone
B) IV magnesium sulfate
,C) Inhaled ipratropium
D) IV diphenhydramine
Answer: B – IV magnesium sulfate
Rationale: IV magnesium is a bronchodilator used in severe asthma exacerbations
not responding to beta-agonists and steroids.
5. The nurse is caring for a patient with a chest tube after a thoracotomy. Which
finding requires immediate action?
A) Continuous bubbling in the suction control chamber
B) Tidaling in the water seal chamber
C) Sudden cessation of tidaling with respiratory distress
D) 100 mL of bloody drainage in 4 hours
Answer: C – Sudden cessation of tidaling with respiratory distress
Rationale: Cessation of tidaling with distress suggests tube obstruction or clot.
Continuous bubbling in suction chamber is expected.
6. A patient with tuberculosis is started on rifampin. The nurse should teach that
this medication causes:
, A) Red-orange discoloration of urine and tears
B) Hearing loss
C) Constipation
D) Photosensitivity
Answer: A – Red-orange discoloration of urine and tears
Rationale: Rifampin causes harmless orange-red body fluids. Patients should be
warned to prevent unnecessary concern.
7. Which assessment finding is most concerning in a patient with a tracheostomy?
A) Small amount of blood-tinged secretions
B) Crackles in bilateral lung bases
C) Sudden difficulty passing a suction catheter
D) Dry, crusted secretions around stoma
Answer: C – Sudden difficulty passing a suction catheter
Rationale: Difficulty passing catheter may indicate mucus plug or tracheostomy
tube obstruction. Immediate intervention needed.
RATIONALES
Section 1: Respiratory Disorders (Questions 1–20)
1. A patient with COPD has a pulse oximetry reading of 88% on room air. Which
action should the nurse take first?
A) Administer high-flow oxygen at 10 L/min via mask
B) Apply supplemental oxygen at 2 L/min via nasal cannula
C) Encourage deep breathing and coughing
D) Notify the provider immediately
Answer: B – Apply supplemental oxygen at 2 L/min via nasal cannula
Rationale: COPD patients require low-flow oxygen (1-3 L/min) to avoid
suppressing hypoxic drive. Target SpO2 88-92%. High flow can cause hypercapnia.
2. A patient with pneumonia has a fever, productive cough with green sputum,
and crackles in the right lower lobe. Which intervention is most important?
A) Administer antipyretics
B) Start prescribed antibiotics
C) Encourage oral fluids
D) Position in high Fowler’s
,Answer: B – Start prescribed antibiotics
Rationale: Antibiotics treat bacterial infection. All other interventions are
supportive but antibiotics address the cause.
3. Which finding in a patient with a pulmonary embolism requires immediate
intervention?
A) Heart rate 102 bpm
B) Respiratory rate 24 breaths/min
C) Sudden hypotension and confusion
D) Oxygen saturation 91% on 2 L NC
Answer: C – Sudden hypotension and confusion
Rationale: Hypotension and confusion indicate massive PE with hemodynamic
instability (possible obstructive shock). Requires emergency reperfusion.
4. A patient with status asthmaticus is not responding to nebulized albuterol. The
nurse expects the next medication to be:
A) Oral prednisone
B) IV magnesium sulfate
,C) Inhaled ipratropium
D) IV diphenhydramine
Answer: B – IV magnesium sulfate
Rationale: IV magnesium is a bronchodilator used in severe asthma exacerbations
not responding to beta-agonists and steroids.
5. The nurse is caring for a patient with a chest tube after a thoracotomy. Which
finding requires immediate action?
A) Continuous bubbling in the suction control chamber
B) Tidaling in the water seal chamber
C) Sudden cessation of tidaling with respiratory distress
D) 100 mL of bloody drainage in 4 hours
Answer: C – Sudden cessation of tidaling with respiratory distress
Rationale: Cessation of tidaling with distress suggests tube obstruction or clot.
Continuous bubbling in suction chamber is expected.
6. A patient with tuberculosis is started on rifampin. The nurse should teach that
this medication causes:
, A) Red-orange discoloration of urine and tears
B) Hearing loss
C) Constipation
D) Photosensitivity
Answer: A – Red-orange discoloration of urine and tears
Rationale: Rifampin causes harmless orange-red body fluids. Patients should be
warned to prevent unnecessary concern.
7. Which assessment finding is most concerning in a patient with a tracheostomy?
A) Small amount of blood-tinged secretions
B) Crackles in bilateral lung bases
C) Sudden difficulty passing a suction catheter
D) Dry, crusted secretions around stoma
Answer: C – Sudden difficulty passing a suction catheter
Rationale: Difficulty passing catheter may indicate mucus plug or tracheostomy
tube obstruction. Immediate intervention needed.
