1
NSG 300 Exam 3 – Foundations of Nursing (GCU) 2026/2027 | 200
Practice Questions with Answers and Rationales
Section 1: Oxygenation, Perfusion, and Respiratory Function (Questions 1-40)
1. A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD). Which finding is the priority to report to the healthcare provider?
A. Barrel-shaped chest
B. Productive cough with green sputum
C. Oxygen saturation of 88%
D. Use of pursed-lip breathing
ANSWER : C. Oxygen saturation of 88%
Rationale: While a barrel-shaped chest, productive cough, and pursed-lip
breathing are expected findings in a client with COPD, an oxygen saturation of
88% indicates hypoxemia. The priority is to report a low SpO2, as it suggests the
client's oxygenation status is compromised and requires immediate intervention.
An SpO2 below 92% generally warrants further assessment and possible oxygen
therapy.
2. A nurse is preparing to administer oxygen to a client via nasal cannula. What
is the maximum flow rate that can be delivered through a standard nasal
cannula?
A. 2 L/min
B. 4 L/min
C. 6 L/min
D. 8 L/min
ANSWER : C. 6 L/min
Rationale: A standard nasal cannula can deliver oxygen at flow rates of 1-6 L/min.
Flow rates greater than 6 L/min can cause drying of the nasal mucosa and are not
effective as the client cannot comfortably inhale the higher flow. A non-
rebreather mask or other high-flow delivery system would be used for higher
oxygen requirements.
pg. 1
,2
3. When auscultating the lungs of a client with pneumonia, the nurse would
expect to hear which of the following breath sounds?
A. Wheezes
B. Rhonchi
C. Crackles (rales)
D. Stridor
ANSWER : C. Crackles (rales)
Rationale: Crackles (also called rales) are discontinuous, bubbling sounds heard
during inspiration. They are caused by the popping open of airways that have
been collapsed by fluid, mucus, or pus, which is characteristic of pneumonia.
Wheezes are musical sounds associated with asthma or COPD. Rhonchi are
coarse, rattling sounds from secretions in larger airways. Stridor is a high-pitched
sound heard on inspiration indicating upper airway obstruction.
4. The nurse is caring for a client who is 2 days post-operative and is at risk for
developing atelectasis. Which nursing intervention is most effective in
preventing this complication?
A. Encouraging the client to cough and deep breathe every 2 hours
B. Maintaining the client on strict bed rest
C. Administering prescribed narcotics for pain
D. Placing the client in a supine position
ANSWER : A. Encouraging the client to cough and deep breathe every 2 hours
Rationale: Atelectasis is the collapse of alveoli, often due to shallow breathing,
which is common after surgery. Deep breathing and coughing exercises help to
expand the lungs and clear secretions, preventing alveolar collapse. Incentive
spirometry is another key intervention to prevent atelectasis. Bed rest, narcotics
(which can depress respirations), and the supine position can all contribute to the
risk of atelectasis.
5. A client with a new tracheostomy has thick, tenacious secretions. What is the
best intervention to help liquefy these secretions?
A. Suction the tracheostomy every 15 minutes
B. Increase the client's oral fluid intake
pg. 2
,3
C. Instill normal saline into the tracheostomy tube before suctioning
D. Apply a tracheostomy collar with humidified oxygen
ANSWER : D. Apply a tracheostomy collar with humidified oxygen
Rationale: Thick, tenacious secretions are best managed by providing humidified
oxygen or air. Dry air causes secretions to become thick and difficult to clear. A
tracheostomy collar with humidification moistens the inspired air, helping to thin
secretions. While adequate hydration is important, humidification directly targets
the airway. Routine instillation of normal saline is no longer recommended as it
can dislodge bacteria into the lower airway. Frequent suctioning can cause
trauma to the mucosa.
6. A nurse is monitoring a client's pulse oximetry. Which of the following factors
can cause a false reading?
A. Poor peripheral perfusion
B. Hypothermia
C. Nail polish
D. All of the above
ANSWER : D. All of the above
Rationale: Pulse oximetry readings can be affected by several factors, including
poor peripheral perfusion (e.g., from shock or vasoconstriction), hypothermia
(which causes vasoconstriction), and nail polish or acrylic nails (which can
interfere with light transmission). Other factors include carbon monoxide
poisoning, edema, and excessive movement. Always assess the client’s clinical
condition in conjunction with the pulse oximetry reading.
7. The nurse is providing discharge teaching for a client with asthma. Which
statement by the client indicates a need for further teaching?
A. "I will use my rescue inhaler before exercising if I feel short of breath."
B. "I will monitor my peak flow meter daily and record the results."
C. "I will avoid triggers like dust and smoke."
D. "I should take my maintenance inhaler (corticosteroid) daily to prevent
attacks."
ANSWER : A. "I will use my rescue inhaler before exercising if I feel short of
breath."
pg. 3
, 4
Rationale: The teaching is incorrect in the wording. Clients with exercise-induced
asthma should use their rescue inhaler (short-acting beta-
agonist) before exercising to prevent bronchospasm, not just if they feel short of
breath. Daily use of a rescue inhaler indicates poorly controlled asthma and
requires a reassessment of the treatment plan. The client should use the rescue
inhaler prophylactically before activities known to trigger symptoms.
8. A client is on a mechanical ventilator and the high-pressure alarm sounds.
Which of the following is the most likely cause?
A. A disconnection in the ventilator circuit
B. The client is biting the endotracheal tube
C. A low oxygen saturation
D. The client is apneic
ANSWER : B. The client is biting the endotracheal tube
Rationale: A high-pressure alarm on a ventilator indicates increased airway
resistance or decreased lung compliance. Common causes include the client biting
the endotracheal tube, kinking of the tubing, secretions obstructing the airway, or
the client coughing or fighting the ventilator. A disconnection or low oxygen
saturation would trigger a low-pressure or low-volume alarm, and apnea would
trigger an apnea alarm.
9. Which of the following is a critical step in the application of a non-rebreather
mask?
A. Ensure a good seal over the client's mouth and nose
B. Set the flow rate to 2-4 L/min
C. Inflate the reservoir bag before applying the mask
D. Use for clients with chronic COPD
ANSWER : C. Inflate the reservoir bag before applying the mask
Rationale: Before placing a non-rebreather mask on a client, the reservoir bag
must be inflated with oxygen. This ensures the client receives 100% oxygen (or
close to it) immediately. A non-rebreather mask is a high-flow device delivering
60-90% oxygen at rates of 10-15 L/min and is used for clients in respiratory
distress. A good seal is important, but not as critical as inflating the bag. It is not
pg. 4
NSG 300 Exam 3 – Foundations of Nursing (GCU) 2026/2027 | 200
Practice Questions with Answers and Rationales
Section 1: Oxygenation, Perfusion, and Respiratory Function (Questions 1-40)
1. A nurse is assessing a client with chronic obstructive pulmonary disease
(COPD). Which finding is the priority to report to the healthcare provider?
A. Barrel-shaped chest
B. Productive cough with green sputum
C. Oxygen saturation of 88%
D. Use of pursed-lip breathing
ANSWER : C. Oxygen saturation of 88%
Rationale: While a barrel-shaped chest, productive cough, and pursed-lip
breathing are expected findings in a client with COPD, an oxygen saturation of
88% indicates hypoxemia. The priority is to report a low SpO2, as it suggests the
client's oxygenation status is compromised and requires immediate intervention.
An SpO2 below 92% generally warrants further assessment and possible oxygen
therapy.
2. A nurse is preparing to administer oxygen to a client via nasal cannula. What
is the maximum flow rate that can be delivered through a standard nasal
cannula?
A. 2 L/min
B. 4 L/min
C. 6 L/min
D. 8 L/min
ANSWER : C. 6 L/min
Rationale: A standard nasal cannula can deliver oxygen at flow rates of 1-6 L/min.
Flow rates greater than 6 L/min can cause drying of the nasal mucosa and are not
effective as the client cannot comfortably inhale the higher flow. A non-
rebreather mask or other high-flow delivery system would be used for higher
oxygen requirements.
pg. 1
,2
3. When auscultating the lungs of a client with pneumonia, the nurse would
expect to hear which of the following breath sounds?
A. Wheezes
B. Rhonchi
C. Crackles (rales)
D. Stridor
ANSWER : C. Crackles (rales)
Rationale: Crackles (also called rales) are discontinuous, bubbling sounds heard
during inspiration. They are caused by the popping open of airways that have
been collapsed by fluid, mucus, or pus, which is characteristic of pneumonia.
Wheezes are musical sounds associated with asthma or COPD. Rhonchi are
coarse, rattling sounds from secretions in larger airways. Stridor is a high-pitched
sound heard on inspiration indicating upper airway obstruction.
4. The nurse is caring for a client who is 2 days post-operative and is at risk for
developing atelectasis. Which nursing intervention is most effective in
preventing this complication?
A. Encouraging the client to cough and deep breathe every 2 hours
B. Maintaining the client on strict bed rest
C. Administering prescribed narcotics for pain
D. Placing the client in a supine position
ANSWER : A. Encouraging the client to cough and deep breathe every 2 hours
Rationale: Atelectasis is the collapse of alveoli, often due to shallow breathing,
which is common after surgery. Deep breathing and coughing exercises help to
expand the lungs and clear secretions, preventing alveolar collapse. Incentive
spirometry is another key intervention to prevent atelectasis. Bed rest, narcotics
(which can depress respirations), and the supine position can all contribute to the
risk of atelectasis.
5. A client with a new tracheostomy has thick, tenacious secretions. What is the
best intervention to help liquefy these secretions?
A. Suction the tracheostomy every 15 minutes
B. Increase the client's oral fluid intake
pg. 2
,3
C. Instill normal saline into the tracheostomy tube before suctioning
D. Apply a tracheostomy collar with humidified oxygen
ANSWER : D. Apply a tracheostomy collar with humidified oxygen
Rationale: Thick, tenacious secretions are best managed by providing humidified
oxygen or air. Dry air causes secretions to become thick and difficult to clear. A
tracheostomy collar with humidification moistens the inspired air, helping to thin
secretions. While adequate hydration is important, humidification directly targets
the airway. Routine instillation of normal saline is no longer recommended as it
can dislodge bacteria into the lower airway. Frequent suctioning can cause
trauma to the mucosa.
6. A nurse is monitoring a client's pulse oximetry. Which of the following factors
can cause a false reading?
A. Poor peripheral perfusion
B. Hypothermia
C. Nail polish
D. All of the above
ANSWER : D. All of the above
Rationale: Pulse oximetry readings can be affected by several factors, including
poor peripheral perfusion (e.g., from shock or vasoconstriction), hypothermia
(which causes vasoconstriction), and nail polish or acrylic nails (which can
interfere with light transmission). Other factors include carbon monoxide
poisoning, edema, and excessive movement. Always assess the client’s clinical
condition in conjunction with the pulse oximetry reading.
7. The nurse is providing discharge teaching for a client with asthma. Which
statement by the client indicates a need for further teaching?
A. "I will use my rescue inhaler before exercising if I feel short of breath."
B. "I will monitor my peak flow meter daily and record the results."
C. "I will avoid triggers like dust and smoke."
D. "I should take my maintenance inhaler (corticosteroid) daily to prevent
attacks."
ANSWER : A. "I will use my rescue inhaler before exercising if I feel short of
breath."
pg. 3
, 4
Rationale: The teaching is incorrect in the wording. Clients with exercise-induced
asthma should use their rescue inhaler (short-acting beta-
agonist) before exercising to prevent bronchospasm, not just if they feel short of
breath. Daily use of a rescue inhaler indicates poorly controlled asthma and
requires a reassessment of the treatment plan. The client should use the rescue
inhaler prophylactically before activities known to trigger symptoms.
8. A client is on a mechanical ventilator and the high-pressure alarm sounds.
Which of the following is the most likely cause?
A. A disconnection in the ventilator circuit
B. The client is biting the endotracheal tube
C. A low oxygen saturation
D. The client is apneic
ANSWER : B. The client is biting the endotracheal tube
Rationale: A high-pressure alarm on a ventilator indicates increased airway
resistance or decreased lung compliance. Common causes include the client biting
the endotracheal tube, kinking of the tubing, secretions obstructing the airway, or
the client coughing or fighting the ventilator. A disconnection or low oxygen
saturation would trigger a low-pressure or low-volume alarm, and apnea would
trigger an apnea alarm.
9. Which of the following is a critical step in the application of a non-rebreather
mask?
A. Ensure a good seal over the client's mouth and nose
B. Set the flow rate to 2-4 L/min
C. Inflate the reservoir bag before applying the mask
D. Use for clients with chronic COPD
ANSWER : C. Inflate the reservoir bag before applying the mask
Rationale: Before placing a non-rebreather mask on a client, the reservoir bag
must be inflated with oxygen. This ensures the client receives 100% oxygen (or
close to it) immediately. A non-rebreather mask is a high-flow device delivering
60-90% oxygen at rates of 10-15 L/min and is used for clients in respiratory
distress. A good seal is important, but not as critical as inflating the bag. It is not
pg. 4
