Herzing University NSG 233 Medical-Surgical Nursing
III Exam 3: Comprehensive 2026/2027 Review
(Questions with Answers & Rationales) – Respiratory,
Cardiovascular, Neurological, Endocrine, Renal &
Gastrointestinal Disorders
1. A client with COPD has an O2 saturation of 86% on room air. Which action
should the nurse take first?
A. Place the client in a high-Fowler's position
B. Administer oxygen at 2 L/min via nasal cannula
C. Notify the provider immediately
D. Obtain an ABG sample
Answer: B
Rationale: For COPD clients, target SpO2 is 88–92%; low-flow O2 (1–2 L/min) is
appropriate. Positioning helps but doesn't correct hypoxemia. Notifying the
provider can wait until the immediate need is met. ABGs are useful but not the
first action.
2. A client with an acute asthma attack is prescribed albuterol. Which finding
indicates the medication is effective?
A. Decreased wheezing with improved air movement
B. Increased respiratory rate
C. Decreased heart rate
D. Productive cough with green sputum
Answer: A
Rationale: Albuterol is a short-acting beta-2 agonist that relieves bronchospasm.
Decreased wheezing with better air entry = improved airflow. A silent chest (no
wheezing) is actually worse. Increased HR is a side effect, not a sign of
effectiveness.
3. A client is admitted with a suspected pulmonary embolism. Which
manifestation is most consistent?
,A. Bradypnea and bradycardia
B. Sudden dyspnea, pleuritic chest pain, tachycardia
C. Productive cough with hemoptysis only
D. Gradual onset of peripheral edema
Answer: B
Rationale: PE classically presents with sudden dyspnea, pleuritic chest pain,
tachycardia, and hypoxemia. Gradual peripheral edema suggests heart failure.
4. Which client is at highest risk for tuberculosis reactivation?
A. A 25-year-old with a recent cold
B. A 60-year-old with HIV and a positive PPD
C. A 40-year-old with well-controlled asthma
D. A 30-year-old with seasonal allergies
Answer: B
Rationale: Immunocompromise (HIV) plus latent TB infection greatly increases
reactivation risk. Asthma and allergies are not risk factors.
5. A client with a chest tube has continuous bubbling in the water-seal chamber.
What should the nurse do first?
A. Clamp the tube
B. Assess for an air leak
C. Increase suction
D. Document as normal
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
The nurse should assess the insertion site, tubing connections, and system.
Clamping is contraindicated unless ordered.
6. Which ABG result indicates respiratory acidosis?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 25
,C. pH 7.50, PaCO2 40, HCO3 30
D. pH 7.32, PaCO2 40, HCO3 18
Answer: B
Rationale: pH < 7.35 with elevated PaCO2 = respiratory acidosis. Option D is
metabolic acidosis (low HCO3).
7. A client with ARDS is being mechanically ventilated. Which position improves
oxygenation?
A. Supine
B. Prone
C. Trendelenburg
D. Reverse Trendelenburg
Answer: B
Rationale: Prone positioning improves ventilation-perfusion matching in ARDS
and reduces mortality in severe cases.
8. A client post-thoracentesis reports sudden shortness of breath. The nurse
notes tracheal deviation away from the affected side and absent breath sounds.
What is the priority action?
A. Administer a bronchodilator
B. Prepare for chest tube insertion
C. Obtain a chest X-ray
D. Reposition the client
Answer: B
Rationale: Signs indicate tension pneumothorax — a medical emergency requiring
immediate chest tube/needle decompression. X-ray delays treatment.
9. Which instruction is most important for a client using a metered-dose inhaler?
A. "Use it whenever you feel like it."
B. "Rinse your mouth after using a steroid inhaler."
, C. "Hold your breath for 2 seconds."
D. "Use the bronchodilator after the steroid."
Answer: B
Rationale: Rinsing prevents oral candidiasis. Bronchodilator should be used before
steroid. Breath should be held ~10 seconds.
10. A client has a new tracheostomy. Which finding requires immediate
intervention?
A. Pink, moist stoma
B. Copious secretions
C. Bleeding around the site with hypotension
D. Mild coughing during suctioning
Answer: C
Rationale: Hemorrhage with hypotension may indicate erosion into a major vessel
(tracheoinnominate fistula) — emergency.
11. Which client is at greatest risk for atelectasis postoperatively?
A. Client who ambulates frequently
B. Client using an incentive spirometer every hour
C. Client with incisional pain refusing to deep breathe
D. Client using PCA
Answer: C
Rationale: Shallow breathing from pain leads to alveolar collapse. Incentive
spirometry and ambulation prevent atelectasis.
12. For a client with a new diagnosis of TB, which isolation precaution is required?
A. Standard
B. Contact
C. Airborne with N95
D. Droplet
III Exam 3: Comprehensive 2026/2027 Review
(Questions with Answers & Rationales) – Respiratory,
Cardiovascular, Neurological, Endocrine, Renal &
Gastrointestinal Disorders
1. A client with COPD has an O2 saturation of 86% on room air. Which action
should the nurse take first?
A. Place the client in a high-Fowler's position
B. Administer oxygen at 2 L/min via nasal cannula
C. Notify the provider immediately
D. Obtain an ABG sample
Answer: B
Rationale: For COPD clients, target SpO2 is 88–92%; low-flow O2 (1–2 L/min) is
appropriate. Positioning helps but doesn't correct hypoxemia. Notifying the
provider can wait until the immediate need is met. ABGs are useful but not the
first action.
2. A client with an acute asthma attack is prescribed albuterol. Which finding
indicates the medication is effective?
A. Decreased wheezing with improved air movement
B. Increased respiratory rate
C. Decreased heart rate
D. Productive cough with green sputum
Answer: A
Rationale: Albuterol is a short-acting beta-2 agonist that relieves bronchospasm.
Decreased wheezing with better air entry = improved airflow. A silent chest (no
wheezing) is actually worse. Increased HR is a side effect, not a sign of
effectiveness.
3. A client is admitted with a suspected pulmonary embolism. Which
manifestation is most consistent?
,A. Bradypnea and bradycardia
B. Sudden dyspnea, pleuritic chest pain, tachycardia
C. Productive cough with hemoptysis only
D. Gradual onset of peripheral edema
Answer: B
Rationale: PE classically presents with sudden dyspnea, pleuritic chest pain,
tachycardia, and hypoxemia. Gradual peripheral edema suggests heart failure.
4. Which client is at highest risk for tuberculosis reactivation?
A. A 25-year-old with a recent cold
B. A 60-year-old with HIV and a positive PPD
C. A 40-year-old with well-controlled asthma
D. A 30-year-old with seasonal allergies
Answer: B
Rationale: Immunocompromise (HIV) plus latent TB infection greatly increases
reactivation risk. Asthma and allergies are not risk factors.
5. A client with a chest tube has continuous bubbling in the water-seal chamber.
What should the nurse do first?
A. Clamp the tube
B. Assess for an air leak
C. Increase suction
D. Document as normal
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak.
The nurse should assess the insertion site, tubing connections, and system.
Clamping is contraindicated unless ordered.
6. Which ABG result indicates respiratory acidosis?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 25
,C. pH 7.50, PaCO2 40, HCO3 30
D. pH 7.32, PaCO2 40, HCO3 18
Answer: B
Rationale: pH < 7.35 with elevated PaCO2 = respiratory acidosis. Option D is
metabolic acidosis (low HCO3).
7. A client with ARDS is being mechanically ventilated. Which position improves
oxygenation?
A. Supine
B. Prone
C. Trendelenburg
D. Reverse Trendelenburg
Answer: B
Rationale: Prone positioning improves ventilation-perfusion matching in ARDS
and reduces mortality in severe cases.
8. A client post-thoracentesis reports sudden shortness of breath. The nurse
notes tracheal deviation away from the affected side and absent breath sounds.
What is the priority action?
A. Administer a bronchodilator
B. Prepare for chest tube insertion
C. Obtain a chest X-ray
D. Reposition the client
Answer: B
Rationale: Signs indicate tension pneumothorax — a medical emergency requiring
immediate chest tube/needle decompression. X-ray delays treatment.
9. Which instruction is most important for a client using a metered-dose inhaler?
A. "Use it whenever you feel like it."
B. "Rinse your mouth after using a steroid inhaler."
, C. "Hold your breath for 2 seconds."
D. "Use the bronchodilator after the steroid."
Answer: B
Rationale: Rinsing prevents oral candidiasis. Bronchodilator should be used before
steroid. Breath should be held ~10 seconds.
10. A client has a new tracheostomy. Which finding requires immediate
intervention?
A. Pink, moist stoma
B. Copious secretions
C. Bleeding around the site with hypotension
D. Mild coughing during suctioning
Answer: C
Rationale: Hemorrhage with hypotension may indicate erosion into a major vessel
(tracheoinnominate fistula) — emergency.
11. Which client is at greatest risk for atelectasis postoperatively?
A. Client who ambulates frequently
B. Client using an incentive spirometer every hour
C. Client with incisional pain refusing to deep breathe
D. Client using PCA
Answer: C
Rationale: Shallow breathing from pain leads to alveolar collapse. Incentive
spirometry and ambulation prevent atelectasis.
12. For a client with a new diagnosis of TB, which isolation precaution is required?
A. Standard
B. Contact
C. Airborne with N95
D. Droplet
