ATI Med Surg Respiratory | ATI Medical-Surgical
Respiratory Exam Study Guide & Exam Prep
2026/2027 | ATI RN Respiratory Nursing Review,
COPD, Asthma, Pneumonia, Pulmonary Embolism,
ARDS, Respiratory Failure, Oxygen Therapy,
Airway Management, Mechanical Ventilation,
Chest Tubes, ABG Interpretation, Respiratory
Assessment, Pharmacology, Clinical Judgment,
Practice Questions, Answers & Detailed Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment finding
indicates a potential complication of this therapy that the nurse should
monitor for?
A. Increased respiratory rate from 18 to 24 breaths per minute
B. A decrease in the patient's oxygen saturation from 92% to 88%
C. The patient's respiratory drive becoming dependent on hypoxic stimulation
D. An increase in the patient's carbon dioxide (CO2) level from 58 to 68 mmHg
CORRECT ANSWER: C. The patient's respiratory drive becoming dependent on
hypoxic stimulation
Rationale: Patients with severe, long-standing COPD may have a blunted response to
carbon dioxide (CO2) as a respiratory drive and rely on hypoxic stimulation to breathe.
Administering high-flow oxygen can eliminate this hypoxic drive, leading to respiratory
depression, apnea, and CO2 narcosis. While monitoring for increased CO2 is important,
the underlying mechanism is the loss of the hypoxic drive. Options A, B, and D describe
effects but do not name the underlying complication.
Question 2: The nurse is caring for a patient with status asthmaticus who is
not responding to standard bronchodilator therapy. Which assessment finding
is the most concerning indicator of impending respiratory failure?
A. Heart rate of 110 beats per minute
B. Absence of wheezing on auscultation
C. Respiratory rate of 28 breaths per minute
D. Use of accessory muscles to breathe
CORRECT ANSWER: B. Absence of wheezing on auscultation
Rationale: A "silent chest" in a patient with severe asthma is a critical sign. It indicates
that airflow is so severely diminished that wheezing, which requires air movement, is no
longer audible. This is a sign of impending respiratory failure and requires immediate,
aggressive intervention. Tachycardia, tachypnea, and accessory muscle use are also
signs of respiratory distress but do not indicate the imminent failure of ventilation to the
same degree as a silent chest.
,Question 3: A patient is diagnosed with a pulmonary embolism (PE). Which of
the following physiological changes is the primary cause of the sudden onset
of dyspnea and hypoxemia in this patient?
A. Pulmonary vasodilation leading to increased perfusion
B. Ventilation-perfusion (V/Q) mismatch due to a perfusion defect
C. A direct blockage of the trachea by the embolus
D. Increased surfactant production causing alveolar collapse
CORRECT ANSWER: B. Ventilation-perfusion (V/Q) mismatch due to a
perfusion defect
Rationale: A pulmonary embolism obstructs blood flow to a segment of the lung,
creating a region that is ventilated but not perfused. This creates a V/Q mismatch where
blood is shunted away from the alveoli, leading to hypoxemia. The response is not
typically pulmonary vasodilation, but rather vasoconstriction in the affected area. A PE
does not block the trachea, and surfactant production is not the primary issue.
Question 4: The nurse is teaching a patient with a new diagnosis of
tuberculosis (TB) about the prescribed medication regimen. Which statement
by the patient indicates a need for further education regarding the treatment
plan?
A. "I will need to take these medications for at least 6 to 12 months."
B. "It is important that I take these medications on an empty stomach."
C. "I should expect my sputum and tears to turn a reddish-orange color."
D. "I can stop taking the medications once my cough and fever have resolved."
CORRECT ANSWER: D. "I can stop taking the medications once my cough and
fever have resolved."
Rationale: Treatment for tuberculosis is lengthy (6-12 months) and requires strict
adherence to prevent the development of drug-resistant strains. Patients must complete
the entire course of therapy, not just until symptoms resolve. Option A is correct (at least
6 months). Option B is correct (many TB drugs are better absorbed on an empty
stomach). Option C is correct for rifampin.
Question 5: A patient with pneumonia is receiving supplemental oxygen and
has a prescription for an albuterol nebulizer treatment. Which of the following
nursing assessments is the priority immediately after the nebulizer treatment?
A. Assess the patient's heart rate for tachycardia.
B. Assess the patient's sputum production and color.
C. Assess the patient for bronchospasm.
D. Assess the patient's blood pressure for hypotension.
CORRECT ANSWER: A. Assess the patient's heart rate for tachycardia.
Rationale: Albuterol is a beta2-adrenergic agonist. While it has a strong affinity for beta2
receptors in the lungs, it can also stimulate beta1 receptors in the heart, leading to
,tachycardia and palpitations. While assessing for a therapeutic effect is important, the
immediate priority is monitoring for this potentially adverse cardiovascular effect.
Sputum assessment is important but not the immediate priority post-treatment.
Bronchospasm is the condition being treated, not a side effect to assess for in this
context.
Question 6: The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. The nurse notices continuous
bubbling in the water-seal chamber. What is the most appropriate action for
the nurse to take?
A. Clamp the chest tube immediately.
B. Continue to monitor because this is a normal finding.
C. Assess the system for an air leak.
D. Instruct the patient to perform deep breathing and coughing exercises.
CORRECT ANSWER: C. Assess the system for an air leak.
Rationale: In a water-seal drainage system, intermittent bubbling in the water-seal
chamber is normal and indicates air is being evacuated from the pleural space.
Continuous bubbling, however, indicates a leak in the system, either from the patient's
chest (a bronchopleural fistula) or from a disconnection or loose connection in the
drainage system. The nurse should first assess the system for the source of the leak.
Question 7: A patient is admitted with acute exacerbation of chronic
bronchitis. The nurse notes that the patient's pulse oximetry is 88% on room
air. Which of the following actions should the nurse take first?
A. Apply oxygen at 2 L/min via nasal cannula.
B. Administer a prescribed bronchodilator.
C. Place the patient in a high-Fowler's position.
D. Notify the healthcare provider of the oxygen saturation.
CORRECT ANSWER: A. Apply oxygen at 2 L/min via nasal cannula.
Rationale: The priority action in a patient with a low oxygen saturation is to provide
supplemental oxygen to correct the hypoxemia. While other interventions like
bronchodilators and positioning are important, they are not the first action. The nurse
should initiate oxygen therapy and then notify the provider if it's not already prescribed.
Question 8: The nurse is administering a tuberculin skin test (TST) to a
patient. Which site is most appropriate for the nurse to administer this
intradermal injection?
A. The dorsal aspect of the upper arm
B. The anterior aspect of the forearm
C. The ventrogluteal muscle
D. The deltoid muscle
CORRECT ANSWER: B. The anterior aspect of the forearm
, Rationale: The tuberculin skin test (PPD) is administered intradermally, usually on the
volar (inner) surface of the forearm, about 2-4 inches below the elbow. This area is
chosen because it is relatively hairless and easy to assess for a reaction.
Question 9: A patient is diagnosed with pleural effusion. The healthcare
provider is preparing to perform a thoracentesis. What position should the
nurse place the patient in for this procedure?
A. Prone
B. Supine with the head of the bed flat
C. Sitting on the edge of the bed, leaning forward over a bedside table
D. Reverse Trendelenburg
CORRECT ANSWER: C. Sitting on the edge of the bed, leaning forward over a
bedside table
Rationale: For a thoracentesis, the patient is typically positioned sitting upright and
leaning forward. This position widens the intercostal spaces, allowing for safer needle
insertion and helps to pool the pleural fluid at the base of the lung for easier aspiration.
Question 10: The nurse is caring for a patient with a tracheostomy who is
being mechanically ventilated. The patient suddenly develops respiratory
distress, has absent breath sounds on the right side, and the trachea is
deviated to the left. Which complication should the nurse suspect?
A. A pulmonary embolism
B. A mucous plug in the tracheostomy tube
C. A tension pneumothorax
D. A right-sided atelectasis
CORRECT ANSWER: C. A tension pneumothorax
Rationale: A tension pneumothorax is a life-threatening condition where air accumulates
in the pleural space and causes a shift of the mediastinum to the opposite side. Signs
include sudden respiratory distress, tracheal deviation away from the affected side
(deviation to the left indicates the tension is on the right), and absent breath sounds on
the affected side.
Question 11: A patient with chronic obstructive pulmonary disease (COPD) is
being discharged with home oxygen therapy. Which of the following
instructions is most important for the nurse to include in the discharge
teaching?
A. "Increase your oxygen flow rate to 4 L/min during exercise to prevent shortness of
breath."
B. "Check your oxygen saturation regularly and adjust flow as needed, but avoid using
petroleum-based products on your face or near the oxygen source."
C. "You may smoke as long as you do so outside the house, away from the oxygen tank."
Respiratory Exam Study Guide & Exam Prep
2026/2027 | ATI RN Respiratory Nursing Review,
COPD, Asthma, Pneumonia, Pulmonary Embolism,
ARDS, Respiratory Failure, Oxygen Therapy,
Airway Management, Mechanical Ventilation,
Chest Tubes, ABG Interpretation, Respiratory
Assessment, Pharmacology, Clinical Judgment,
Practice Questions, Answers & Detailed Rationales
Question 1: A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which assessment finding
indicates a potential complication of this therapy that the nurse should
monitor for?
A. Increased respiratory rate from 18 to 24 breaths per minute
B. A decrease in the patient's oxygen saturation from 92% to 88%
C. The patient's respiratory drive becoming dependent on hypoxic stimulation
D. An increase in the patient's carbon dioxide (CO2) level from 58 to 68 mmHg
CORRECT ANSWER: C. The patient's respiratory drive becoming dependent on
hypoxic stimulation
Rationale: Patients with severe, long-standing COPD may have a blunted response to
carbon dioxide (CO2) as a respiratory drive and rely on hypoxic stimulation to breathe.
Administering high-flow oxygen can eliminate this hypoxic drive, leading to respiratory
depression, apnea, and CO2 narcosis. While monitoring for increased CO2 is important,
the underlying mechanism is the loss of the hypoxic drive. Options A, B, and D describe
effects but do not name the underlying complication.
Question 2: The nurse is caring for a patient with status asthmaticus who is
not responding to standard bronchodilator therapy. Which assessment finding
is the most concerning indicator of impending respiratory failure?
A. Heart rate of 110 beats per minute
B. Absence of wheezing on auscultation
C. Respiratory rate of 28 breaths per minute
D. Use of accessory muscles to breathe
CORRECT ANSWER: B. Absence of wheezing on auscultation
Rationale: A "silent chest" in a patient with severe asthma is a critical sign. It indicates
that airflow is so severely diminished that wheezing, which requires air movement, is no
longer audible. This is a sign of impending respiratory failure and requires immediate,
aggressive intervention. Tachycardia, tachypnea, and accessory muscle use are also
signs of respiratory distress but do not indicate the imminent failure of ventilation to the
same degree as a silent chest.
,Question 3: A patient is diagnosed with a pulmonary embolism (PE). Which of
the following physiological changes is the primary cause of the sudden onset
of dyspnea and hypoxemia in this patient?
A. Pulmonary vasodilation leading to increased perfusion
B. Ventilation-perfusion (V/Q) mismatch due to a perfusion defect
C. A direct blockage of the trachea by the embolus
D. Increased surfactant production causing alveolar collapse
CORRECT ANSWER: B. Ventilation-perfusion (V/Q) mismatch due to a
perfusion defect
Rationale: A pulmonary embolism obstructs blood flow to a segment of the lung,
creating a region that is ventilated but not perfused. This creates a V/Q mismatch where
blood is shunted away from the alveoli, leading to hypoxemia. The response is not
typically pulmonary vasodilation, but rather vasoconstriction in the affected area. A PE
does not block the trachea, and surfactant production is not the primary issue.
Question 4: The nurse is teaching a patient with a new diagnosis of
tuberculosis (TB) about the prescribed medication regimen. Which statement
by the patient indicates a need for further education regarding the treatment
plan?
A. "I will need to take these medications for at least 6 to 12 months."
B. "It is important that I take these medications on an empty stomach."
C. "I should expect my sputum and tears to turn a reddish-orange color."
D. "I can stop taking the medications once my cough and fever have resolved."
CORRECT ANSWER: D. "I can stop taking the medications once my cough and
fever have resolved."
Rationale: Treatment for tuberculosis is lengthy (6-12 months) and requires strict
adherence to prevent the development of drug-resistant strains. Patients must complete
the entire course of therapy, not just until symptoms resolve. Option A is correct (at least
6 months). Option B is correct (many TB drugs are better absorbed on an empty
stomach). Option C is correct for rifampin.
Question 5: A patient with pneumonia is receiving supplemental oxygen and
has a prescription for an albuterol nebulizer treatment. Which of the following
nursing assessments is the priority immediately after the nebulizer treatment?
A. Assess the patient's heart rate for tachycardia.
B. Assess the patient's sputum production and color.
C. Assess the patient for bronchospasm.
D. Assess the patient's blood pressure for hypotension.
CORRECT ANSWER: A. Assess the patient's heart rate for tachycardia.
Rationale: Albuterol is a beta2-adrenergic agonist. While it has a strong affinity for beta2
receptors in the lungs, it can also stimulate beta1 receptors in the heart, leading to
,tachycardia and palpitations. While assessing for a therapeutic effect is important, the
immediate priority is monitoring for this potentially adverse cardiovascular effect.
Sputum assessment is important but not the immediate priority post-treatment.
Bronchospasm is the condition being treated, not a side effect to assess for in this
context.
Question 6: The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. The nurse notices continuous
bubbling in the water-seal chamber. What is the most appropriate action for
the nurse to take?
A. Clamp the chest tube immediately.
B. Continue to monitor because this is a normal finding.
C. Assess the system for an air leak.
D. Instruct the patient to perform deep breathing and coughing exercises.
CORRECT ANSWER: C. Assess the system for an air leak.
Rationale: In a water-seal drainage system, intermittent bubbling in the water-seal
chamber is normal and indicates air is being evacuated from the pleural space.
Continuous bubbling, however, indicates a leak in the system, either from the patient's
chest (a bronchopleural fistula) or from a disconnection or loose connection in the
drainage system. The nurse should first assess the system for the source of the leak.
Question 7: A patient is admitted with acute exacerbation of chronic
bronchitis. The nurse notes that the patient's pulse oximetry is 88% on room
air. Which of the following actions should the nurse take first?
A. Apply oxygen at 2 L/min via nasal cannula.
B. Administer a prescribed bronchodilator.
C. Place the patient in a high-Fowler's position.
D. Notify the healthcare provider of the oxygen saturation.
CORRECT ANSWER: A. Apply oxygen at 2 L/min via nasal cannula.
Rationale: The priority action in a patient with a low oxygen saturation is to provide
supplemental oxygen to correct the hypoxemia. While other interventions like
bronchodilators and positioning are important, they are not the first action. The nurse
should initiate oxygen therapy and then notify the provider if it's not already prescribed.
Question 8: The nurse is administering a tuberculin skin test (TST) to a
patient. Which site is most appropriate for the nurse to administer this
intradermal injection?
A. The dorsal aspect of the upper arm
B. The anterior aspect of the forearm
C. The ventrogluteal muscle
D. The deltoid muscle
CORRECT ANSWER: B. The anterior aspect of the forearm
, Rationale: The tuberculin skin test (PPD) is administered intradermally, usually on the
volar (inner) surface of the forearm, about 2-4 inches below the elbow. This area is
chosen because it is relatively hairless and easy to assess for a reaction.
Question 9: A patient is diagnosed with pleural effusion. The healthcare
provider is preparing to perform a thoracentesis. What position should the
nurse place the patient in for this procedure?
A. Prone
B. Supine with the head of the bed flat
C. Sitting on the edge of the bed, leaning forward over a bedside table
D. Reverse Trendelenburg
CORRECT ANSWER: C. Sitting on the edge of the bed, leaning forward over a
bedside table
Rationale: For a thoracentesis, the patient is typically positioned sitting upright and
leaning forward. This position widens the intercostal spaces, allowing for safer needle
insertion and helps to pool the pleural fluid at the base of the lung for easier aspiration.
Question 10: The nurse is caring for a patient with a tracheostomy who is
being mechanically ventilated. The patient suddenly develops respiratory
distress, has absent breath sounds on the right side, and the trachea is
deviated to the left. Which complication should the nurse suspect?
A. A pulmonary embolism
B. A mucous plug in the tracheostomy tube
C. A tension pneumothorax
D. A right-sided atelectasis
CORRECT ANSWER: C. A tension pneumothorax
Rationale: A tension pneumothorax is a life-threatening condition where air accumulates
in the pleural space and causes a shift of the mediastinum to the opposite side. Signs
include sudden respiratory distress, tracheal deviation away from the affected side
(deviation to the left indicates the tension is on the right), and absent breath sounds on
the affected side.
Question 11: A patient with chronic obstructive pulmonary disease (COPD) is
being discharged with home oxygen therapy. Which of the following
instructions is most important for the nurse to include in the discharge
teaching?
A. "Increase your oxygen flow rate to 4 L/min during exercise to prevent shortness of
breath."
B. "Check your oxygen saturation regularly and adjust flow as needed, but avoid using
petroleum-based products on your face or near the oxygen source."
C. "You may smoke as long as you do so outside the house, away from the oxygen tank."
