Respiratory and Pulmonary Nursing Examination
Questions and Verified Solutions 2026-2027
Comprehensive Board Review & Practice Test Bank for Advanced Pulmonary Nursing
1. A patient with severe COPD is receiving oxygen therapy via a Venturi mask at an FiO2
of 28%. What is the primary advantage of using a Venturi mask for this patient?
A. It delivers humidified low-flow oxygen without an external water source.
B. It prevents oxygen toxicity by maintaining FiO2 below 21%.
C. It delivers a precise, predictable concentration of oxygen regardless of the patient's
breathing pattern.
D. It provides positive end-expiratory pressure during expiration.
Rationale: The Venturi mask is the most accurate device for delivering precise oxygen
concentrations. In hypercapnic COPD patients dependent on hypoxic drive, delivering exact
FiO2 levels avoids suppressing respiratory effort while correcting hypoxemia.
2. A patient with acute respiratory distress syndrome (ARDS) is placed on mechanical
ventilation. Which ventilator setting strategy reduces the risk of ventilator-induced lung
injury (volutrauma)?
A. Low tidal volume ventilation (4 to 8 mL/kg of predicted body weight) with PEEP
B. High tidal volume ventilation (10 to 12 mL/kg) with zero PEEP
C. Pressure support ventilation with a low inspiratory time
D. High-frequency ventilation with high FiO2 and zero PEEP
Rationale: Low tidal volume ventilation based on predicted body weight prevents alveolar
overdistention (volutrauma and barotrauma) in ARDS. Combining low tidal volumes with
PEEP recruits collapsed alveoli while protecting fragile lung parenchyma.
3. An adult patient who underwent a left lower lobectomy has a closed chest tube
drainage system in place. The nurse notes continuous, brisk bubbling in the water-seal
chamber during inspiration and expiration. How should the nurse interpret this finding?
A. Normal expected drainage during the immediate postoperative period
B. Adequate suction application from the wall regulator
C. An active air leak in the system or pleural cavity
D. Occlusion of the chest tube by blood clots
Rationale: Intermittent bubbling in the water-seal chamber occurs during exhalation when air
escapes the pleural space. Continuous bubbling during both inspiration and expiration
indicates an active air leak either within the drainage system tubing connections or from a
large bronchopleural air leak.
4. Arterial blood gas results for a mechanically ventilated patient are: pH 7.26, PaCO2 58
,mmHg, PaO2 70 mmHg, and HCO3- 26 mEq/L. How should the nurse classify this acid-
base imbalance?
A. Uncompensated respiratory acidosis with moderate hypoxemia
B. Compensated metabolic acidosis
C. Fully compensated respiratory alkalosis
D. Combined respiratory and metabolic alkalosis
Rationale: The pH is below 7.35 (acidemia), PaCO2 is elevated above 45 mmHg (respiratory
origin), and the bicarbonate level is within normal limits (22–26 mEq/L), indicating no renal
compensation has occurred yet. PaO2 below 80 mmHg shows hypoxemia.
5. A patient presenting with an acute asthma exacerbation has auscultated wheezing that
suddenly disappears, and breath sounds become significantly diminished throughout all
lung fields. What is the immediate priority action?
A. Document the resolution of bronchospasm and recheck in 2 hours.
B. Administer an oral corticosteroid dose.
C. Prepare for emergency airway management and intubation, notifying the provider
immediately.
D. Encourage the patient to perform pursed-lip breathing exercises.
Rationale: The sudden disappearance of wheezing alongside silent chest indicates critical
airway constriction with minimal to no air movement. This is a life-threatening sign of
impending respiratory arrest requiring immediate emergency intubation and resuscitation.
6. A patient 2 days post-op from orthopedic surgery develops sudden chest pain,
tachypnea, dyspnea, and an SpO2 of 86% on room air. Computed Tomography
Pulmonary Angiography (CTPA) confirms a massive pulmonary embolism. What is the
primary mechanism causing hypoxemia in pulmonary embolism?
A. Increased alveolar dead space creating a ventilation-perfusion (V/Q) mismatch
B. Diffuse alveolar capillary membrane thickening
C. Widespread atelectasis due to surfactant destruction
D. Bronchial smooth muscle hypertrophy
Rationale: Pulmonary embolism obstructs blood flow to ventilated alveoli, resulting in dead
space ventilation (V/Q mismatch where areas of the lung are ventilated but unperfused),
leading to acute hypoxemia and elevated pulmonary vascular resistance.
7. A client with active pulmonary tuberculosis is admitted to the medical unit. Which
transmission-based isolation precautions must be implemented?
A. Droplet precautions in a standard private room
B. Airborne precautions in a negative-pressure isolation room with N95 respirator
masks worn by healthcare staff
C. Contact precautions with surgical masks
D. Standard precautions with protective eyewear only
Rationale: Mycobacterium tuberculosis is transmitted via droplet nuclei that remain
suspended in air. Airborne precautions require a negative-pressure isolation room (at least 6–
, 12 air exchanges/hr) and N95 or higher respirators for healthcare personnel entering the
room.
8. A 58-year-old male with chronic bronchitis undergoes pulmonary function testing.
Which spirometric finding is the diagnostic hallmark of chronic obstructive pulmonary
disease (COPD)?
A. Post-bronchodilator FEV1/FVC ratio less than 0.70 (70%)
B. Increased forced vital capacity (FVC) above 120% predicted
C. Reversible airflow obstruction with a 25% increase in FEV1 post-albuterol
D. Total lung capacity (TLC) less than 50% predicted
Rationale: The GOLD guidelines define COPD by persistent, non-fully reversible airflow
limitation demonstrated by a post-bronchodilator Forced Expiratory Volume in 1 second to
Forced Vital Capacity (FEV1/FVC) ratio < 0.70.
9. A patient with idiopathic pulmonary fibrosis asks the nurse why Pirfenidone has been
prescribed. What is the mechanism and goal of antifibrotic therapy in pulmonary
fibrosis?
A. It cures the disease by regenerating damaged alveolar walls.
B. It inhibits fibroblast proliferation and collagen synthesis, slowing the decline in lung
function.
C. It acts as a rapid-acting bronchodilator to relieve dyspnea during exertion.
D. It suppresses bacterial growth in fibrotic cyst cavities.
Rationale: Antifibrotic agents like Pirfenidone and Nintedanib do not reverse established lung
scar tissue, but they inhibit pathways involved in fibroblast proliferation and extracellular
matrix deposition, significantly slowing disease progression and preserving forced vital
capacity.
10. A nurse assesses a patient receiving mechanical ventilation and notes high-pressure
alarm sounding continuously. Which potential cause should the nurse investigate first?
A. Endotracheal tube bite, secretions in the airway, or a kinked ventilator circuit
B. Disconnection of the ventilator tubing from the endotracheal tube
C. Cuff leak in the endotracheal tube
D. Patient self-extubation
Rationale: High-pressure alarms are triggered by increased resistance to airflow, such as
airway secretions requiring suctioning, patient biting on the ET tube, tube kinking,
bronchospasm, or pneumothorax. Circuit disconnections trigger low-pressure alarms.
11. What anatomical landmark is used for perform thoracentesis to drain a pleural
effusion when the patient is sitting upright?
A. 2nd intercostal space at the midclavicular line
B. 7th to 9th intercostal space along the midaxillary or posterior scapular line,
interspace below the fluid level
Questions and Verified Solutions 2026-2027
Comprehensive Board Review & Practice Test Bank for Advanced Pulmonary Nursing
1. A patient with severe COPD is receiving oxygen therapy via a Venturi mask at an FiO2
of 28%. What is the primary advantage of using a Venturi mask for this patient?
A. It delivers humidified low-flow oxygen without an external water source.
B. It prevents oxygen toxicity by maintaining FiO2 below 21%.
C. It delivers a precise, predictable concentration of oxygen regardless of the patient's
breathing pattern.
D. It provides positive end-expiratory pressure during expiration.
Rationale: The Venturi mask is the most accurate device for delivering precise oxygen
concentrations. In hypercapnic COPD patients dependent on hypoxic drive, delivering exact
FiO2 levels avoids suppressing respiratory effort while correcting hypoxemia.
2. A patient with acute respiratory distress syndrome (ARDS) is placed on mechanical
ventilation. Which ventilator setting strategy reduces the risk of ventilator-induced lung
injury (volutrauma)?
A. Low tidal volume ventilation (4 to 8 mL/kg of predicted body weight) with PEEP
B. High tidal volume ventilation (10 to 12 mL/kg) with zero PEEP
C. Pressure support ventilation with a low inspiratory time
D. High-frequency ventilation with high FiO2 and zero PEEP
Rationale: Low tidal volume ventilation based on predicted body weight prevents alveolar
overdistention (volutrauma and barotrauma) in ARDS. Combining low tidal volumes with
PEEP recruits collapsed alveoli while protecting fragile lung parenchyma.
3. An adult patient who underwent a left lower lobectomy has a closed chest tube
drainage system in place. The nurse notes continuous, brisk bubbling in the water-seal
chamber during inspiration and expiration. How should the nurse interpret this finding?
A. Normal expected drainage during the immediate postoperative period
B. Adequate suction application from the wall regulator
C. An active air leak in the system or pleural cavity
D. Occlusion of the chest tube by blood clots
Rationale: Intermittent bubbling in the water-seal chamber occurs during exhalation when air
escapes the pleural space. Continuous bubbling during both inspiration and expiration
indicates an active air leak either within the drainage system tubing connections or from a
large bronchopleural air leak.
4. Arterial blood gas results for a mechanically ventilated patient are: pH 7.26, PaCO2 58
,mmHg, PaO2 70 mmHg, and HCO3- 26 mEq/L. How should the nurse classify this acid-
base imbalance?
A. Uncompensated respiratory acidosis with moderate hypoxemia
B. Compensated metabolic acidosis
C. Fully compensated respiratory alkalosis
D. Combined respiratory and metabolic alkalosis
Rationale: The pH is below 7.35 (acidemia), PaCO2 is elevated above 45 mmHg (respiratory
origin), and the bicarbonate level is within normal limits (22–26 mEq/L), indicating no renal
compensation has occurred yet. PaO2 below 80 mmHg shows hypoxemia.
5. A patient presenting with an acute asthma exacerbation has auscultated wheezing that
suddenly disappears, and breath sounds become significantly diminished throughout all
lung fields. What is the immediate priority action?
A. Document the resolution of bronchospasm and recheck in 2 hours.
B. Administer an oral corticosteroid dose.
C. Prepare for emergency airway management and intubation, notifying the provider
immediately.
D. Encourage the patient to perform pursed-lip breathing exercises.
Rationale: The sudden disappearance of wheezing alongside silent chest indicates critical
airway constriction with minimal to no air movement. This is a life-threatening sign of
impending respiratory arrest requiring immediate emergency intubation and resuscitation.
6. A patient 2 days post-op from orthopedic surgery develops sudden chest pain,
tachypnea, dyspnea, and an SpO2 of 86% on room air. Computed Tomography
Pulmonary Angiography (CTPA) confirms a massive pulmonary embolism. What is the
primary mechanism causing hypoxemia in pulmonary embolism?
A. Increased alveolar dead space creating a ventilation-perfusion (V/Q) mismatch
B. Diffuse alveolar capillary membrane thickening
C. Widespread atelectasis due to surfactant destruction
D. Bronchial smooth muscle hypertrophy
Rationale: Pulmonary embolism obstructs blood flow to ventilated alveoli, resulting in dead
space ventilation (V/Q mismatch where areas of the lung are ventilated but unperfused),
leading to acute hypoxemia and elevated pulmonary vascular resistance.
7. A client with active pulmonary tuberculosis is admitted to the medical unit. Which
transmission-based isolation precautions must be implemented?
A. Droplet precautions in a standard private room
B. Airborne precautions in a negative-pressure isolation room with N95 respirator
masks worn by healthcare staff
C. Contact precautions with surgical masks
D. Standard precautions with protective eyewear only
Rationale: Mycobacterium tuberculosis is transmitted via droplet nuclei that remain
suspended in air. Airborne precautions require a negative-pressure isolation room (at least 6–
, 12 air exchanges/hr) and N95 or higher respirators for healthcare personnel entering the
room.
8. A 58-year-old male with chronic bronchitis undergoes pulmonary function testing.
Which spirometric finding is the diagnostic hallmark of chronic obstructive pulmonary
disease (COPD)?
A. Post-bronchodilator FEV1/FVC ratio less than 0.70 (70%)
B. Increased forced vital capacity (FVC) above 120% predicted
C. Reversible airflow obstruction with a 25% increase in FEV1 post-albuterol
D. Total lung capacity (TLC) less than 50% predicted
Rationale: The GOLD guidelines define COPD by persistent, non-fully reversible airflow
limitation demonstrated by a post-bronchodilator Forced Expiratory Volume in 1 second to
Forced Vital Capacity (FEV1/FVC) ratio < 0.70.
9. A patient with idiopathic pulmonary fibrosis asks the nurse why Pirfenidone has been
prescribed. What is the mechanism and goal of antifibrotic therapy in pulmonary
fibrosis?
A. It cures the disease by regenerating damaged alveolar walls.
B. It inhibits fibroblast proliferation and collagen synthesis, slowing the decline in lung
function.
C. It acts as a rapid-acting bronchodilator to relieve dyspnea during exertion.
D. It suppresses bacterial growth in fibrotic cyst cavities.
Rationale: Antifibrotic agents like Pirfenidone and Nintedanib do not reverse established lung
scar tissue, but they inhibit pathways involved in fibroblast proliferation and extracellular
matrix deposition, significantly slowing disease progression and preserving forced vital
capacity.
10. A nurse assesses a patient receiving mechanical ventilation and notes high-pressure
alarm sounding continuously. Which potential cause should the nurse investigate first?
A. Endotracheal tube bite, secretions in the airway, or a kinked ventilator circuit
B. Disconnection of the ventilator tubing from the endotracheal tube
C. Cuff leak in the endotracheal tube
D. Patient self-extubation
Rationale: High-pressure alarms are triggered by increased resistance to airflow, such as
airway secretions requiring suctioning, patient biting on the ET tube, tube kinking,
bronchospasm, or pneumothorax. Circuit disconnections trigger low-pressure alarms.
11. What anatomical landmark is used for perform thoracentesis to drain a pleural
effusion when the patient is sitting upright?
A. 2nd intercostal space at the midclavicular line
B. 7th to 9th intercostal space along the midaxillary or posterior scapular line,
interspace below the fluid level
