ATI MED SURG II RESPIRATORY
ALTERATIONS STUDY GUIDE PRACTICE
QUESTIONS ANSWERS 2026/2027 | INSTANT
DOWNLOAD PDF. The examination employs
multiple-choice and scenario-based
questions testing application and analysis
consistent with ATI and NCLEX-RN standards
Core Domains
Assessment and Diagnostic Findings
Oxygenation and Ventilation
Acid-Base Interpretation
Medication Management
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Pneumonia and Tuberculosis
Pulmonary Embolism and Chest Trauma
Mechanical Ventilation and Airway Management
Introduction
The ATI Medical-Surgical Respiratory Alterations examination assesses
nursing students' knowledge and clinical judgment regarding respiratory
system disorders. Candidates must demonstrate competence in respiratory
assessment, oxygenation and ventilation, acid-base interpretation, respiratory
pharmacology, and nursing interventions for COPD, asthma, pneumonia,
tuberculosis, and pulmonary embolism. The examination employs multiple-
choice and scenario-based questions testing application and analysis
consistent with ATI and NCLEX-RN standards. Successful candidates must
,demonstrate critical thinking and prioritization skills necessary for safe
nursing care of clients with respiratory alterations.
SECTION ONE: QUESTIONS 1–100
Question 1
A client with chronic obstructive pulmonary disease (COPD) presents with a
barrel chest, tripod positioning, and pursed-lip breathing. Which
pathophysiological change is primarily responsible for the barrel chest
appearance?
A. Destruction of alveolar walls and loss of lung elasticity leading to air
trapping
B. Excessive production of surfactant causing alveolar collapse
C. Hypertrophy of bronchial smooth muscle resulting in airway narrowing
D. Accumulation of pleural fluid causing mediastinal shift
A. Destruction of alveolar walls and loss of lung elasticity leading to air
trapping
RATIONALE: Barrel chest in COPD results from chronic air trapping due
to alveolar wall destruction and loss of elastic recoil, causing the chest to
remain in a hyperinflated position .
Question 2
A client with asthma reports increased shortness of breath at night and
decreased peak expiratory flow rates in the early morning. Which
physiological mechanism explains these early morning symptoms?
A. Circadian variation in cortisol and epinephrine levels causing increased
airway inflammation and bronchoconstriction
B. Accumulation of carbon dioxide during sleep leading to respiratory
acidosis
C. Increased cardiac output during sleep overwhelming pulmonary
,circulation
D. Supine positioning causing compression of the left mainstem bronchus
A. Circadian variation in cortisol and epinephrine levels causing increased
airway inflammation and bronchoconstriction
RATIONALE: Nocturnal asthma is linked to circadian decreases in
cortisol and epinephrine, which normally suppress inflammation and
bronchoconstriction; their nadir in early morning worsens airway
hyperresponsiveness .
Question 3
A nurse is caring for a client hospitalized with an acute exacerbation of COPD.
The client is receiving oxygen at 2 L/min via nasal cannula and has an SpO2 of
88%. Which is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min to achieve an SpO2 of 95%
B. Maintain the current oxygen delivery and notify the provider of the
persistent hypoxemia
C. Switch to a non-rebreather mask at 15 L/min
D. Discontinue oxygen and encourage deep breathing exercises
B. Maintain the current oxygen delivery and notify the provider of the
persistent hypoxemia
RATIONALE: COPD clients rely on hypoxic drive; excessive oxygen
suppresses respiratory drive and causes CO2 retention. The priority is to
maintain low-flow oxygen and communicate with the provider for further
orders .
Question 4
A client is admitted with community-acquired pneumonia (CAP). Which
assessment finding indicates the client is developing sepsis and requires
immediate intervention?
, A. Temperature 38.2°C and productive cough
B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory rate
28 breaths/min
C. Crackles in the right lower lobe and pleuritic chest pain
D. SpO2 92% on room air and use of accessory muscles
B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory
rate 28 breaths/min
RATIONALE: Tachycardia, hypotension, and tachypnea are components
of the qSOFA criteria indicating sepsis and septic shock, requiring immediate
fluid resuscitation and provider notification .
Question 5
The following arterial blood gas (ABG) results are obtained from a client with
COPD: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L, PaO2 62 mmHg. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
B. Partially compensated respiratory acidosis
RATIONALE: The low pH and elevated PaCO2 indicate respiratory
acidosis; the elevated HCO3- shows renal compensation is occurring but has
not normalized the pH, making it partially compensated .
Question 6
A client with asthma is prescribed fluticasone/salmeterol (Advair Diskus)
twice daily and albuterol PRN. Which statement by the client indicates
understanding of the medication regimen?
A. "I should use my fluticasone inhaler first when I have an asthma attack."
B. "I need to rinse my mouth after using my fluticasone inhaler."
ALTERATIONS STUDY GUIDE PRACTICE
QUESTIONS ANSWERS 2026/2027 | INSTANT
DOWNLOAD PDF. The examination employs
multiple-choice and scenario-based
questions testing application and analysis
consistent with ATI and NCLEX-RN standards
Core Domains
Assessment and Diagnostic Findings
Oxygenation and Ventilation
Acid-Base Interpretation
Medication Management
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Pneumonia and Tuberculosis
Pulmonary Embolism and Chest Trauma
Mechanical Ventilation and Airway Management
Introduction
The ATI Medical-Surgical Respiratory Alterations examination assesses
nursing students' knowledge and clinical judgment regarding respiratory
system disorders. Candidates must demonstrate competence in respiratory
assessment, oxygenation and ventilation, acid-base interpretation, respiratory
pharmacology, and nursing interventions for COPD, asthma, pneumonia,
tuberculosis, and pulmonary embolism. The examination employs multiple-
choice and scenario-based questions testing application and analysis
consistent with ATI and NCLEX-RN standards. Successful candidates must
,demonstrate critical thinking and prioritization skills necessary for safe
nursing care of clients with respiratory alterations.
SECTION ONE: QUESTIONS 1–100
Question 1
A client with chronic obstructive pulmonary disease (COPD) presents with a
barrel chest, tripod positioning, and pursed-lip breathing. Which
pathophysiological change is primarily responsible for the barrel chest
appearance?
A. Destruction of alveolar walls and loss of lung elasticity leading to air
trapping
B. Excessive production of surfactant causing alveolar collapse
C. Hypertrophy of bronchial smooth muscle resulting in airway narrowing
D. Accumulation of pleural fluid causing mediastinal shift
A. Destruction of alveolar walls and loss of lung elasticity leading to air
trapping
RATIONALE: Barrel chest in COPD results from chronic air trapping due
to alveolar wall destruction and loss of elastic recoil, causing the chest to
remain in a hyperinflated position .
Question 2
A client with asthma reports increased shortness of breath at night and
decreased peak expiratory flow rates in the early morning. Which
physiological mechanism explains these early morning symptoms?
A. Circadian variation in cortisol and epinephrine levels causing increased
airway inflammation and bronchoconstriction
B. Accumulation of carbon dioxide during sleep leading to respiratory
acidosis
C. Increased cardiac output during sleep overwhelming pulmonary
,circulation
D. Supine positioning causing compression of the left mainstem bronchus
A. Circadian variation in cortisol and epinephrine levels causing increased
airway inflammation and bronchoconstriction
RATIONALE: Nocturnal asthma is linked to circadian decreases in
cortisol and epinephrine, which normally suppress inflammation and
bronchoconstriction; their nadir in early morning worsens airway
hyperresponsiveness .
Question 3
A nurse is caring for a client hospitalized with an acute exacerbation of COPD.
The client is receiving oxygen at 2 L/min via nasal cannula and has an SpO2 of
88%. Which is the nurse's priority action?
A. Increase the oxygen flow rate to 6 L/min to achieve an SpO2 of 95%
B. Maintain the current oxygen delivery and notify the provider of the
persistent hypoxemia
C. Switch to a non-rebreather mask at 15 L/min
D. Discontinue oxygen and encourage deep breathing exercises
B. Maintain the current oxygen delivery and notify the provider of the
persistent hypoxemia
RATIONALE: COPD clients rely on hypoxic drive; excessive oxygen
suppresses respiratory drive and causes CO2 retention. The priority is to
maintain low-flow oxygen and communicate with the provider for further
orders .
Question 4
A client is admitted with community-acquired pneumonia (CAP). Which
assessment finding indicates the client is developing sepsis and requires
immediate intervention?
, A. Temperature 38.2°C and productive cough
B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory rate
28 breaths/min
C. Crackles in the right lower lobe and pleuritic chest pain
D. SpO2 92% on room air and use of accessory muscles
B. Heart rate 118 beats/min, blood pressure 88/56 mmHg, and respiratory
rate 28 breaths/min
RATIONALE: Tachycardia, hypotension, and tachypnea are components
of the qSOFA criteria indicating sepsis and septic shock, requiring immediate
fluid resuscitation and provider notification .
Question 5
The following arterial blood gas (ABG) results are obtained from a client with
COPD: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L, PaO2 62 mmHg. Which
interpretation is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis with respiratory compensation
D. Fully compensated respiratory acidosis
B. Partially compensated respiratory acidosis
RATIONALE: The low pH and elevated PaCO2 indicate respiratory
acidosis; the elevated HCO3- shows renal compensation is occurring but has
not normalized the pH, making it partially compensated .
Question 6
A client with asthma is prescribed fluticasone/salmeterol (Advair Diskus)
twice daily and albuterol PRN. Which statement by the client indicates
understanding of the medication regimen?
A. "I should use my fluticasone inhaler first when I have an asthma attack."
B. "I need to rinse my mouth after using my fluticasone inhaler."
