NSG 223 Exam 3: Medical-Surgical Nursing II 50 Questions | Herzing University 2026/2027
NSG223 / NSG 223 Exam 3 (Latest Update)
Medical-Surgical Nursing II | Questions and Verified Answers | 100% Correct | Grade A
Herzing University
Section 1: Respiratory Disorders (COPD, Asthma, Pneumonia, TB)
1. A 62-year-old patient with a 40 pack-year smoking history presents with chronic cough, sputum production,
and progressive dyspnea on exertion. Spirometry shows post-bronchodilator FEV1/FVC ratio of 0.62. Which
diagnosis do these findings support?
A. Asthma
B. Chronic Obstructive Pulmonary Disease (COPD) [CORRECT]
C. Pneumonia
D. Pulmonary embolism
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow limitation diagnostic of COPD.
Asthma (A) shows reversible obstruction with bronchodilator improvement. Pneumonia (C) presents with fever and infiltrates.
Pulmonary embolism (D) presents with acute dyspnea and pleuritic pain. Per Herzing NSG 223 (2026/2027), smoking is the
primary risk factor and spirometry is the gold standard diagnostic.
2. A patient with COPD is admitted with an acute exacerbation. The nurse observes the patient sitting upright
leaning forward with arms supported on the bedside table. What is the significance of this positioning?
A. It indicates the patient is comfortable and ready for discharge
B. It is the tripod position, which improves breathing by accessory muscle use [CORRECT]
C. It suggests the patient has developed cor pulmonale
D. It indicates the patient needs immediate intubation
Correct Answer: B
Rationale: The tripod position (leaning forward with arms supported) is a classic sign of respiratory distress in COPD that uses
accessory muscles to improve breathing mechanics. It does not indicate comfort (A) or discharge readiness. Cor pulmonale (C)
presents with right-sided heart failure signs. Tripod alone does not mandate intubation (D). Herzing NSG 223 emphasizes
recognizing this position as a sign of respiratory difficulty.
3. The nurse is educating a patient newly diagnosed with COPD about the most effective intervention to slow
disease progression. Which instruction is most important?
A. Begin pulmonary rehabilitation exercises immediately
B. Quit smoking immediately [CORRECT]
C. Use inhaled corticosteroids as prescribed
D. Receive annual influenza and pneumococcal vaccines
Correct Answer: B
Rationale: Smoking cessation is the single most effective intervention to slow COPD progression. While pulmonary rehab (A),
medications (C), and vaccines (D) are important, quitting smoking addresses the primary causative factor. Herzing NSG 223
(2026/2027) identifies smoking cessation as the priority teaching for COPD patients.
4. A patient with COPD has an oxygen saturation of 85% on room air. What oxygen saturation range should
the nurse target?
A. 94-100%
B. 88-92% [CORRECT]
C. 80-85%
D. 75-80%
Correct Answer: B
Rationale: For COPD patients, target O2 sat is 88-92%. Higher levels can suppress the hypoxic drive, causing CO2 retention
and respiratory acidosis. Levels below 88% (C, D) cause tissue hypoxia. This careful titration is a core Herzing NSG 223
concept.
Page 1
, NSG 223 Exam 3: Medical-Surgical Nursing II 50 Questions | Herzing University 2026/2027
5. A patient with emphysema asks the nurse why they have developed a barrel chest. What is the best
explanation?
A. Increased mucus production causes chest wall thickening
B. Loss of lung elasticity causes air trapping and hyperinflation [CORRECT]
C. Chronic inflammation causes rib cage calcification
D. Repeated infections cause scarring of the chest wall
Correct Answer: B
Rationale: In emphysema, alveolar wall destruction and loss of elasticity cause air trapping and hyperinflation, leading to
barrel chest. Increased mucus (A) is chronic bronchitis. Rib calcification (C) and scarring (D) are not mechanisms. Herzing
NSG 223 distinguishes emphysema (barrel chest) from chronic bronchitis (mucus hypersecretion).
6. A patient with COPD reports morning headaches and confusion. Which complication should the nurse
suspect?
A. Pulmonary embolism
B. Cor pulmonale
C. Carbon dioxide retention leading to increased ICP [CORRECT]
D. Pneumothorax
Correct Answer: C
Rationale: Morning headaches and confusion in COPD are classic signs of CO2 retention (hypercapnia), causing cerebral
vasodilation and increased ICP during sleep. PE (A) presents with acute dyspnea and pleuritic pain. Cor pulmonale (B) presents
with edema and JVD. Herzing NSG 223 emphasizes recognizing CO2 retention signs.
7. A patient with COPD takes a SABA, ICS, and LAMA. Which statement about LAMAs is correct?
A. LAMAs provide rapid relief during exacerbations
B. LAMAs are used as rescue inhalers
C. LAMAs provide sustained bronchodilation via anticholinergic action [CORRECT]
D. LAMAs reduce airway inflammation
Correct Answer: C
Rationale: LAMAs (e.g., tiotropium) provide sustained bronchodilation via anticholinergic action. SABAs (A, B) provide rapid
relief. ICS (D) reduce inflammation. LAMA side effects include dry mouth and urinary retention. Herzing NSG 223 (2026/2027)
distinguishes LAMA maintenance from SABA rescue therapy.
8. A nurse provides discharge teaching about energy conservation for COPD. Which instruction is most
appropriate?
A. Perform all ADLs in the morning when energy is highest
B. Plan activities with frequent rest periods and pace throughout the day [CORRECT]
C. Avoid all physical activity to conserve energy
D. Exercise only when using supplemental oxygen
Correct Answer: B
Rationale: Energy conservation includes pacing activities with rest periods and avoiding extreme fatigue. All ADLs in the
morning (A) causes fatigue. Avoiding activity (C) leads to deconditioning. Exercise should be encouraged (D). Herzing NSG 223
emphasizes energy conservation as a key COPD intervention.
9. A 28-year-old patient presents with wheezing and dyspnea shortly after exposure to cat dander. Peak
expiratory flow rate is 55% of predicted. What is the priority nursing action?
A. Administer SABA albuterol via nebulizer [CORRECT]
B. Order a chest x-ray
C. Obtain arterial blood gases
D. Administer inhaled corticosteroid
Correct Answer: A
Rationale: SABA (albuterol) is the first-line treatment for acute asthma exacerbation. ABCs priority: airway and breathing must
be addressed first. CXR (B) and ABGs (C) are diagnostic but not priority actions. ICS (D) is a controller medication, not for
acute relief. Per Herzing NSG 223, SABA is the priority intervention for acute asthma.
Page 2
NSG223 / NSG 223 Exam 3 (Latest Update)
Medical-Surgical Nursing II | Questions and Verified Answers | 100% Correct | Grade A
Herzing University
Section 1: Respiratory Disorders (COPD, Asthma, Pneumonia, TB)
1. A 62-year-old patient with a 40 pack-year smoking history presents with chronic cough, sputum production,
and progressive dyspnea on exertion. Spirometry shows post-bronchodilator FEV1/FVC ratio of 0.62. Which
diagnosis do these findings support?
A. Asthma
B. Chronic Obstructive Pulmonary Disease (COPD) [CORRECT]
C. Pneumonia
D. Pulmonary embolism
Correct Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow limitation diagnostic of COPD.
Asthma (A) shows reversible obstruction with bronchodilator improvement. Pneumonia (C) presents with fever and infiltrates.
Pulmonary embolism (D) presents with acute dyspnea and pleuritic pain. Per Herzing NSG 223 (2026/2027), smoking is the
primary risk factor and spirometry is the gold standard diagnostic.
2. A patient with COPD is admitted with an acute exacerbation. The nurse observes the patient sitting upright
leaning forward with arms supported on the bedside table. What is the significance of this positioning?
A. It indicates the patient is comfortable and ready for discharge
B. It is the tripod position, which improves breathing by accessory muscle use [CORRECT]
C. It suggests the patient has developed cor pulmonale
D. It indicates the patient needs immediate intubation
Correct Answer: B
Rationale: The tripod position (leaning forward with arms supported) is a classic sign of respiratory distress in COPD that uses
accessory muscles to improve breathing mechanics. It does not indicate comfort (A) or discharge readiness. Cor pulmonale (C)
presents with right-sided heart failure signs. Tripod alone does not mandate intubation (D). Herzing NSG 223 emphasizes
recognizing this position as a sign of respiratory difficulty.
3. The nurse is educating a patient newly diagnosed with COPD about the most effective intervention to slow
disease progression. Which instruction is most important?
A. Begin pulmonary rehabilitation exercises immediately
B. Quit smoking immediately [CORRECT]
C. Use inhaled corticosteroids as prescribed
D. Receive annual influenza and pneumococcal vaccines
Correct Answer: B
Rationale: Smoking cessation is the single most effective intervention to slow COPD progression. While pulmonary rehab (A),
medications (C), and vaccines (D) are important, quitting smoking addresses the primary causative factor. Herzing NSG 223
(2026/2027) identifies smoking cessation as the priority teaching for COPD patients.
4. A patient with COPD has an oxygen saturation of 85% on room air. What oxygen saturation range should
the nurse target?
A. 94-100%
B. 88-92% [CORRECT]
C. 80-85%
D. 75-80%
Correct Answer: B
Rationale: For COPD patients, target O2 sat is 88-92%. Higher levels can suppress the hypoxic drive, causing CO2 retention
and respiratory acidosis. Levels below 88% (C, D) cause tissue hypoxia. This careful titration is a core Herzing NSG 223
concept.
Page 1
, NSG 223 Exam 3: Medical-Surgical Nursing II 50 Questions | Herzing University 2026/2027
5. A patient with emphysema asks the nurse why they have developed a barrel chest. What is the best
explanation?
A. Increased mucus production causes chest wall thickening
B. Loss of lung elasticity causes air trapping and hyperinflation [CORRECT]
C. Chronic inflammation causes rib cage calcification
D. Repeated infections cause scarring of the chest wall
Correct Answer: B
Rationale: In emphysema, alveolar wall destruction and loss of elasticity cause air trapping and hyperinflation, leading to
barrel chest. Increased mucus (A) is chronic bronchitis. Rib calcification (C) and scarring (D) are not mechanisms. Herzing
NSG 223 distinguishes emphysema (barrel chest) from chronic bronchitis (mucus hypersecretion).
6. A patient with COPD reports morning headaches and confusion. Which complication should the nurse
suspect?
A. Pulmonary embolism
B. Cor pulmonale
C. Carbon dioxide retention leading to increased ICP [CORRECT]
D. Pneumothorax
Correct Answer: C
Rationale: Morning headaches and confusion in COPD are classic signs of CO2 retention (hypercapnia), causing cerebral
vasodilation and increased ICP during sleep. PE (A) presents with acute dyspnea and pleuritic pain. Cor pulmonale (B) presents
with edema and JVD. Herzing NSG 223 emphasizes recognizing CO2 retention signs.
7. A patient with COPD takes a SABA, ICS, and LAMA. Which statement about LAMAs is correct?
A. LAMAs provide rapid relief during exacerbations
B. LAMAs are used as rescue inhalers
C. LAMAs provide sustained bronchodilation via anticholinergic action [CORRECT]
D. LAMAs reduce airway inflammation
Correct Answer: C
Rationale: LAMAs (e.g., tiotropium) provide sustained bronchodilation via anticholinergic action. SABAs (A, B) provide rapid
relief. ICS (D) reduce inflammation. LAMA side effects include dry mouth and urinary retention. Herzing NSG 223 (2026/2027)
distinguishes LAMA maintenance from SABA rescue therapy.
8. A nurse provides discharge teaching about energy conservation for COPD. Which instruction is most
appropriate?
A. Perform all ADLs in the morning when energy is highest
B. Plan activities with frequent rest periods and pace throughout the day [CORRECT]
C. Avoid all physical activity to conserve energy
D. Exercise only when using supplemental oxygen
Correct Answer: B
Rationale: Energy conservation includes pacing activities with rest periods and avoiding extreme fatigue. All ADLs in the
morning (A) causes fatigue. Avoiding activity (C) leads to deconditioning. Exercise should be encouraged (D). Herzing NSG 223
emphasizes energy conservation as a key COPD intervention.
9. A 28-year-old patient presents with wheezing and dyspnea shortly after exposure to cat dander. Peak
expiratory flow rate is 55% of predicted. What is the priority nursing action?
A. Administer SABA albuterol via nebulizer [CORRECT]
B. Order a chest x-ray
C. Obtain arterial blood gases
D. Administer inhaled corticosteroid
Correct Answer: A
Rationale: SABA (albuterol) is the first-line treatment for acute asthma exacerbation. ABCs priority: airway and breathing must
be addressed first. CXR (B) and ABGs (C) are diagnostic but not priority actions. ICS (D) is a controller medication, not for
acute relief. Per Herzing NSG 223, SABA is the priority intervention for acute asthma.
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