,Hondros NUR 245 Exam 3 | Concepts of Nursing Care of the
Adult II (2026) Q&A
1. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
who is mechanically ventilated. Which finding indicates that the current ventilator
setting of positive end-expiratory pressure (PEEP) is having the desired therapeutic
effect?
A) Decreased heart rate from 110 to 90 beats per minute
B) Increased urine output to 40 mL/hr
C) Improved oxygen saturation and decreased work of breathing
D) Decreased mean arterial pressure from 85 to 70 mmHg
Correct Answer: Improved oxygen saturation and decreased work of breathing
Rationale: PEEP is used in ARDS to prevent alveolar collapse at end-expiration,
thereby improving oxygenation. The desired effect is improved gas exchange,
reflected by increased oxygen saturation and reduced respiratory effort. Hypotension
and decreased urine output are potential adverse effects of high PEEP, not
therapeutic goals.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which assessment finding is most important for the
nurse to monitor to prevent oxygen-induced hypoventilation?
A) Heart rate and rhythm
B) Respiratory rate and depth
C) Skin color and temperature
D) Level of consciousness and orientation
Correct Answer: Respiratory rate and depth
,Rationale: In patients with COPD who have chronic hypercapnia, the respiratory
drive may be dependent on hypoxemia rather than hypercapnia. Administering high-
flow oxygen can eliminate this hypoxic drive, leading to respiratory depression.
Monitoring respiratory rate and depth is essential to detect early signs of
hypoventilation.
3. A patient is admitted with an exacerbation of chronic obstructive pulmonary
disease (COPD). The nurse notes that the patient is using accessory muscles to
breathe, has a barrel chest, and is sitting in a tripod position. Which of the following
is the priority nursing intervention?
A) Administer a prescribed bronchodilator
B) Place the patient in a supine position to rest
C) Encourage the patient to drink at least 3 liters of fluid per day
D) Instruct the patient to use pursed-lip breathing during exertion
Correct Answer: Administer a prescribed bronchodilator
Rationale: In an acute COPD exacerbation, the priority is to relieve bronchospasm
and improve airflow. Bronchodilators, such as albuterol or ipratropium, are the first-
line treatment to open airways and reduce work of breathing. Pursed-lip breathing is
a helpful technique but does not address the immediate underlying pathophysiology
of bronchoconstriction.
4. Which assessment finding is a classic late sign of chronic obstructive pulmonary
disease (COPD)?
A) Chronic intermittent cough
B) Increased sputum production
C) Barrel chest and use of accessory muscles
D) Dyspnea on exertion
, Correct Answer: Barrel chest and use of accessory muscles
Rationale: Barrel chest and use of accessory muscles are late signs of COPD,
indicating significant hyperinflation and respiratory muscle fatigue. Early signs
include chronic cough, increased sputum production, and dyspnea on exertion.
Recognizing late signs is critical for identifying disease progression and the need for
advanced interventions.
5. A patient with COPD has an arterial blood gas (ABG) result showing pH 7.32,
PaCO₂ 58 mmHg, and HCO₃ 30 mEq/L. The nurse interprets this as:
A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Mixed respiratory and metabolic acidosis
Correct Answer: Partially compensated respiratory acidosis
Rationale: The ABG shows a low pH (acidosis), elevated PaCO₂ (respiratory acidosis),
and elevated HCO₃ (metabolic compensation). The HCO₃ is elevated but not enough
to return the pH to normal, indicating partial compensation. In fully compensated
respiratory acidosis, the pH would be within normal range despite elevated PaCO₂
and HCO₃.
6. The nurse is caring for a patient with a chest tube connected to a closed-chest
drainage system. Which finding indicates that the chest tube is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Tidaling (fluctuation) in the water seal chamber with respirations
C) Constant bubbling in the suction control chamber
Adult II (2026) Q&A
1. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
who is mechanically ventilated. Which finding indicates that the current ventilator
setting of positive end-expiratory pressure (PEEP) is having the desired therapeutic
effect?
A) Decreased heart rate from 110 to 90 beats per minute
B) Increased urine output to 40 mL/hr
C) Improved oxygen saturation and decreased work of breathing
D) Decreased mean arterial pressure from 85 to 70 mmHg
Correct Answer: Improved oxygen saturation and decreased work of breathing
Rationale: PEEP is used in ARDS to prevent alveolar collapse at end-expiration,
thereby improving oxygenation. The desired effect is improved gas exchange,
reflected by increased oxygen saturation and reduced respiratory effort. Hypotension
and decreased urine output are potential adverse effects of high PEEP, not
therapeutic goals.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. Which assessment finding is most important for the
nurse to monitor to prevent oxygen-induced hypoventilation?
A) Heart rate and rhythm
B) Respiratory rate and depth
C) Skin color and temperature
D) Level of consciousness and orientation
Correct Answer: Respiratory rate and depth
,Rationale: In patients with COPD who have chronic hypercapnia, the respiratory
drive may be dependent on hypoxemia rather than hypercapnia. Administering high-
flow oxygen can eliminate this hypoxic drive, leading to respiratory depression.
Monitoring respiratory rate and depth is essential to detect early signs of
hypoventilation.
3. A patient is admitted with an exacerbation of chronic obstructive pulmonary
disease (COPD). The nurse notes that the patient is using accessory muscles to
breathe, has a barrel chest, and is sitting in a tripod position. Which of the following
is the priority nursing intervention?
A) Administer a prescribed bronchodilator
B) Place the patient in a supine position to rest
C) Encourage the patient to drink at least 3 liters of fluid per day
D) Instruct the patient to use pursed-lip breathing during exertion
Correct Answer: Administer a prescribed bronchodilator
Rationale: In an acute COPD exacerbation, the priority is to relieve bronchospasm
and improve airflow. Bronchodilators, such as albuterol or ipratropium, are the first-
line treatment to open airways and reduce work of breathing. Pursed-lip breathing is
a helpful technique but does not address the immediate underlying pathophysiology
of bronchoconstriction.
4. Which assessment finding is a classic late sign of chronic obstructive pulmonary
disease (COPD)?
A) Chronic intermittent cough
B) Increased sputum production
C) Barrel chest and use of accessory muscles
D) Dyspnea on exertion
, Correct Answer: Barrel chest and use of accessory muscles
Rationale: Barrel chest and use of accessory muscles are late signs of COPD,
indicating significant hyperinflation and respiratory muscle fatigue. Early signs
include chronic cough, increased sputum production, and dyspnea on exertion.
Recognizing late signs is critical for identifying disease progression and the need for
advanced interventions.
5. A patient with COPD has an arterial blood gas (ABG) result showing pH 7.32,
PaCO₂ 58 mmHg, and HCO₃ 30 mEq/L. The nurse interprets this as:
A) Uncompensated respiratory acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Mixed respiratory and metabolic acidosis
Correct Answer: Partially compensated respiratory acidosis
Rationale: The ABG shows a low pH (acidosis), elevated PaCO₂ (respiratory acidosis),
and elevated HCO₃ (metabolic compensation). The HCO₃ is elevated but not enough
to return the pH to normal, indicating partial compensation. In fully compensated
respiratory acidosis, the pH would be within normal range despite elevated PaCO₂
and HCO₃.
6. The nurse is caring for a patient with a chest tube connected to a closed-chest
drainage system. Which finding indicates that the chest tube is functioning properly?
A) Continuous bubbling in the water seal chamber
B) Tidaling (fluctuation) in the water seal chamber with respirations
C) Constant bubbling in the suction control chamber
