ATI Respiratory Med-Surg Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A client with chronic obstructive pulmonary disease (COPD) presents with a barrel
chest, tripod positioning, and pursed-lip breathing. Which pathophysiological change is
primarily responsible for the barrel chest appearance?
A. Destruction of alveolar walls and loss of lung elasticity leading to air trapping
B. Excessive production of surfactant causing alveolar collapse
C. Hypertrophy of bronchial smooth muscle resulting in airway narrowing
D. Accumulation of pleural fluid causing mediastinal shift
Correct Answer: A
Rationale: Barrel chest in COPD results from chronic air trapping due to alveolar wall
destruction and loss of elastic recoil, causing the chest to remain in a hyperinflated
position. The primary distractor is C; bronchial smooth muscle hypertrophy causes
airflow limitation but does not produce the fixed hyperinflation characteristic of a barrel
chest.
Question 2
A client with asthma reports increased shortness of breath at night and decreased peak
expiratory flow rates in the early morning. Which physiological mechanism explains
these early morning symptoms?
A. Circadian variation in cortisol and epinephrine levels causing increased airway
inflammation and bronchoconstriction
B. Accumulation of carbon dioxide during sleep leading to respiratory acidosis
C. Increased cardiac output during sleep overwhelming pulmonary circulation
,D. Supine positioning causing compression of the left mainstem bronchus
Correct Answer: A
Rationale: Nocturnal asthma is linked to circadian decreases in cortisol and epinephrine,
which normally suppress inflammation and bronchoconstriction; their nadir in early
morning worsens airway hyperresponsiveness. The primary distractor is B; CO2
accumulation during sleep is normally compensated and does not explain early morning
bronchoconstriction.
Question 3
A nurse is caring for a client hospitalized with an acute exacerbation of COPD. The
client is receiving oxygen at 2 L/min via nasal cannula and has an SpO2 of 88%. Which
is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min to achieve an SpO2 of 95%
B. Maintain the current oxygen delivery and notify the provider of the persistent
hypoxemia
C. Switch to a non-rebreather mask at 15 L/min
D. Discontinue oxygen and encourage deep breathing exercises
Correct Answer: B
Rationale: COPD clients rely on hypoxic drive; excessive oxygen suppresses respiratory
drive and causes CO2 retention. The priority is to maintain low-flow oxygen and
communicate with the provider for further orders. The primary distractor is A; increasing
oxygen to 6 L/min risks precipitating hypercapnic respiratory failure in a chronic CO2
retainer.
Question 4
A client is admitted with community-acquired pneumonia (CAP). Which assessment
finding indicates the client is developing sepsis and requires immediate intervention?
A. Temperature 38.2°C and productive cough
,B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory rate 28
breaths/min
C. Crackles in the right lower lobe and pleuritic chest pain
D. SpO2 92% on room air and use of accessory muscles
Correct Answer: B
Rationale: Tachycardia, hypotension, and tachypnea are components of the qSOFA
criteria indicating sepsis and septic shock, requiring immediate fluid resuscitation and
provider notification. The primary distractor is A; fever and cough are expected findings
in pneumonia, not indicators of sepsis.
Question 5
The following arterial blood gas (ABG) results are obtained from a client with COPD: pH
7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L, PaO2 62 mmHg. Which interpretation is
correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
Correct Answer: B
Rationale: The low pH and elevated PaCO2 indicate respiratory acidosis; the elevated
HCO3- shows renal compensation is occurring but has not normalized the pH, making it
partially compensated. The primary distractor is A; uncompensated respiratory acidosis
would present with a normal HCO3- level.
Question 6
A client with asthma is prescribed fluticasone/salmeterol (Advair Diskus) twice daily
and albuterol PRN. Which statement by the client indicates correct understanding of the
medication regimen?
A. "I will use the Advair Diskus only when I feel wheezing."
B. "I will rinse my mouth after using the Advair to prevent oral candidiasis."
, C. "I will use the albuterol daily to prevent asthma attacks."
D. "I can stop the Advair once my breathing improves."
Correct Answer: B
Rationale: Inhaled corticosteroids such as fluticasone suppress local immunity and
increase risk of oral candidiasis; rinsing the mouth after each use is essential preventive
teaching. The primary distractor is A; Advair is a daily controller, not a rescue
medication.
Question 7
A nurse is caring for a client with a new diagnosis of pulmonary tuberculosis (TB).
Which action by the nurse demonstrates appropriate infection control?
A. Place the client in a negative-pressure airborne infection isolation room and wear an
N95 respirator
B. Place the client in droplet precautions and wear a surgical mask
C. Place the client in contact precautions and wear a gown and gloves only
D. No isolation is needed because the client is receiving anti-TB medications
Correct Answer: A
Rationale: Pulmonary TB requires airborne precautions, including a negative-pressure
room and N95 respirator, because Mycobacterium tuberculosis is transmitted via
airborne droplet nuclei. The primary distractor is B; surgical masks are insufficient for
airborne pathogens and are used for droplet precautions.
Question 8
A client with acute asthma exacerbation presents with audible wheezing, use of
accessory muscles, and an inability to speak in full sentences. The respiratory rate is 32,
heart rate 124, and SpO2 89%. Which is the nurse's priority intervention?
A. Administer oxygen via nasal cannula at 2 L/min and obtain a chest X-ray
B. Administer a short-acting beta-agonist (albuterol) via nebulizer immediately and
prepare for possible intubation
C. Administer oral corticosteroids and reassess in 30 minutes
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A client with chronic obstructive pulmonary disease (COPD) presents with a barrel
chest, tripod positioning, and pursed-lip breathing. Which pathophysiological change is
primarily responsible for the barrel chest appearance?
A. Destruction of alveolar walls and loss of lung elasticity leading to air trapping
B. Excessive production of surfactant causing alveolar collapse
C. Hypertrophy of bronchial smooth muscle resulting in airway narrowing
D. Accumulation of pleural fluid causing mediastinal shift
Correct Answer: A
Rationale: Barrel chest in COPD results from chronic air trapping due to alveolar wall
destruction and loss of elastic recoil, causing the chest to remain in a hyperinflated
position. The primary distractor is C; bronchial smooth muscle hypertrophy causes
airflow limitation but does not produce the fixed hyperinflation characteristic of a barrel
chest.
Question 2
A client with asthma reports increased shortness of breath at night and decreased peak
expiratory flow rates in the early morning. Which physiological mechanism explains
these early morning symptoms?
A. Circadian variation in cortisol and epinephrine levels causing increased airway
inflammation and bronchoconstriction
B. Accumulation of carbon dioxide during sleep leading to respiratory acidosis
C. Increased cardiac output during sleep overwhelming pulmonary circulation
,D. Supine positioning causing compression of the left mainstem bronchus
Correct Answer: A
Rationale: Nocturnal asthma is linked to circadian decreases in cortisol and epinephrine,
which normally suppress inflammation and bronchoconstriction; their nadir in early
morning worsens airway hyperresponsiveness. The primary distractor is B; CO2
accumulation during sleep is normally compensated and does not explain early morning
bronchoconstriction.
Question 3
A nurse is caring for a client hospitalized with an acute exacerbation of COPD. The
client is receiving oxygen at 2 L/min via nasal cannula and has an SpO2 of 88%. Which
is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min to achieve an SpO2 of 95%
B. Maintain the current oxygen delivery and notify the provider of the persistent
hypoxemia
C. Switch to a non-rebreather mask at 15 L/min
D. Discontinue oxygen and encourage deep breathing exercises
Correct Answer: B
Rationale: COPD clients rely on hypoxic drive; excessive oxygen suppresses respiratory
drive and causes CO2 retention. The priority is to maintain low-flow oxygen and
communicate with the provider for further orders. The primary distractor is A; increasing
oxygen to 6 L/min risks precipitating hypercapnic respiratory failure in a chronic CO2
retainer.
Question 4
A client is admitted with community-acquired pneumonia (CAP). Which assessment
finding indicates the client is developing sepsis and requires immediate intervention?
A. Temperature 38.2°C and productive cough
,B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory rate 28
breaths/min
C. Crackles in the right lower lobe and pleuritic chest pain
D. SpO2 92% on room air and use of accessory muscles
Correct Answer: B
Rationale: Tachycardia, hypotension, and tachypnea are components of the qSOFA
criteria indicating sepsis and septic shock, requiring immediate fluid resuscitation and
provider notification. The primary distractor is A; fever and cough are expected findings
in pneumonia, not indicators of sepsis.
Question 5
The following arterial blood gas (ABG) results are obtained from a client with COPD: pH
7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L, PaO2 62 mmHg. Which interpretation is
correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
Correct Answer: B
Rationale: The low pH and elevated PaCO2 indicate respiratory acidosis; the elevated
HCO3- shows renal compensation is occurring but has not normalized the pH, making it
partially compensated. The primary distractor is A; uncompensated respiratory acidosis
would present with a normal HCO3- level.
Question 6
A client with asthma is prescribed fluticasone/salmeterol (Advair Diskus) twice daily
and albuterol PRN. Which statement by the client indicates correct understanding of the
medication regimen?
A. "I will use the Advair Diskus only when I feel wheezing."
B. "I will rinse my mouth after using the Advair to prevent oral candidiasis."
, C. "I will use the albuterol daily to prevent asthma attacks."
D. "I can stop the Advair once my breathing improves."
Correct Answer: B
Rationale: Inhaled corticosteroids such as fluticasone suppress local immunity and
increase risk of oral candidiasis; rinsing the mouth after each use is essential preventive
teaching. The primary distractor is A; Advair is a daily controller, not a rescue
medication.
Question 7
A nurse is caring for a client with a new diagnosis of pulmonary tuberculosis (TB).
Which action by the nurse demonstrates appropriate infection control?
A. Place the client in a negative-pressure airborne infection isolation room and wear an
N95 respirator
B. Place the client in droplet precautions and wear a surgical mask
C. Place the client in contact precautions and wear a gown and gloves only
D. No isolation is needed because the client is receiving anti-TB medications
Correct Answer: A
Rationale: Pulmonary TB requires airborne precautions, including a negative-pressure
room and N95 respirator, because Mycobacterium tuberculosis is transmitted via
airborne droplet nuclei. The primary distractor is B; surgical masks are insufficient for
airborne pathogens and are used for droplet precautions.
Question 8
A client with acute asthma exacerbation presents with audible wheezing, use of
accessory muscles, and an inability to speak in full sentences. The respiratory rate is 32,
heart rate 124, and SpO2 89%. Which is the nurse's priority intervention?
A. Administer oxygen via nasal cannula at 2 L/min and obtain a chest X-ray
B. Administer a short-acting beta-agonist (albuterol) via nebulizer immediately and
prepare for possible intubation
C. Administer oral corticosteroids and reassess in 30 minutes
