,D454 Adult Health III Exam Prep —
Comprehensive Review + Practice MCQs —
Western Governors University 2025/2026
1. A client with a history of heart failure is admitted with acute shortness of breath, crackles in both lung
bases, and an SpO₂ of 88% on room air. What is the priority nursing action?
A. Administer prescribed IV furosemide
B. Apply supplemental oxygen
C. Place the client in high Fowler's position
D. Obtain a stat chest X-ray
Correct Answer: B. Apply supplemental oxygen
Rationale: The priority is to address airway, breathing, and circulation (ABCs). Hypoxemia (SpO₂ 88%) is an
immediate threat to tissue perfusion, so applying oxygen to improve oxygenation is the first action before
other interventions like diuresis or positioning.
---
2. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The client's SpO₂ is 88%. What action
should the nurse take?
A. Increase oxygen to 6 L/min immediately
B. Switch to a non-rebreather mask
C. Increase oxygen to 3 L/min and monitor response
D. Encourage deep breathing and coughing
Correct Answer: C. Increase oxygen to 3 L/min and monitor response
,Rationale: COPD clients require careful oxygen titration to avoid suppressing the hypoxic drive. High-flow
oxygen can cause CO₂ retention. The nurse should increase oxygen gradually and monitor the client's response.
---
3. A client with COPD becomes somnolent after receiving high-flow oxygen. What is the most likely cause?
A. The client is experiencing an opioid overdose
B. Oxygen-induced hypercarbia has occurred
C. The client is having a stroke
D. The client is experiencing hypoglycemia
Correct Answer: B. Oxygen-induced hypercarbia has occurred
Rationale: In some clients with severe COPD who retain CO₂, high oxygen levels can suppress their hypoxic
respiratory drive, leading to hypoventilation, CO₂ narcosis, and somnolence.
---
4. A patient admitted with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation. Which
intervention is the nurse's highest priority?
A. Increase fluid intake
B. Maintain adequate oxygenation and monitor ABGs
C. Encourage ambulation
D. Administer sedatives
Correct Answer: B. Maintain adequate oxygenation and monitor ABGs
, Rationale: The highest priority for a patient with ARDS on mechanical ventilation is to maintain adequate
oxygenation and monitor arterial blood gases (ABGs) to ensure proper ventilation and prevent further
respiratory compromise.
---
5. A nurse is caring for a client with acute respiratory distress syndrome (ARDS). Which ventilator setting
should the nurse anticipate?
A. High tidal volumes to improve oxygenation
B. Low tidal volumes to prevent lung injury
C. High positive end-expiratory pressure (PEEP) only
D. Pressure support ventilation alone
Correct Answer: B. Low tidal volumes to prevent lung injury
Rationale: Lung-protective ventilation with low tidal volumes (4–8 mL/kg of predicted body weight) is the
standard of care for ARDS. High tidal volumes can cause ventilator-induced lung injury and worsen outcomes.
---
6. Which assessment finding by the nurse caring for a patient receiving mechanical ventilation indicates the
need for suctioning?
A. The patient's respiratory rate is 32 breaths/min
B. The patient has occasional audible expiratory wheezes
C. The patient's oxygen saturation drops to 93%
D. The patient was last suctioned 6 hours ago
Correct Answer: A. The patient's respiratory rate is 32 breaths/min
Comprehensive Review + Practice MCQs —
Western Governors University 2025/2026
1. A client with a history of heart failure is admitted with acute shortness of breath, crackles in both lung
bases, and an SpO₂ of 88% on room air. What is the priority nursing action?
A. Administer prescribed IV furosemide
B. Apply supplemental oxygen
C. Place the client in high Fowler's position
D. Obtain a stat chest X-ray
Correct Answer: B. Apply supplemental oxygen
Rationale: The priority is to address airway, breathing, and circulation (ABCs). Hypoxemia (SpO₂ 88%) is an
immediate threat to tissue perfusion, so applying oxygen to improve oxygenation is the first action before
other interventions like diuresis or positioning.
---
2. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The client's SpO₂ is 88%. What action
should the nurse take?
A. Increase oxygen to 6 L/min immediately
B. Switch to a non-rebreather mask
C. Increase oxygen to 3 L/min and monitor response
D. Encourage deep breathing and coughing
Correct Answer: C. Increase oxygen to 3 L/min and monitor response
,Rationale: COPD clients require careful oxygen titration to avoid suppressing the hypoxic drive. High-flow
oxygen can cause CO₂ retention. The nurse should increase oxygen gradually and monitor the client's response.
---
3. A client with COPD becomes somnolent after receiving high-flow oxygen. What is the most likely cause?
A. The client is experiencing an opioid overdose
B. Oxygen-induced hypercarbia has occurred
C. The client is having a stroke
D. The client is experiencing hypoglycemia
Correct Answer: B. Oxygen-induced hypercarbia has occurred
Rationale: In some clients with severe COPD who retain CO₂, high oxygen levels can suppress their hypoxic
respiratory drive, leading to hypoventilation, CO₂ narcosis, and somnolence.
---
4. A patient admitted with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation. Which
intervention is the nurse's highest priority?
A. Increase fluid intake
B. Maintain adequate oxygenation and monitor ABGs
C. Encourage ambulation
D. Administer sedatives
Correct Answer: B. Maintain adequate oxygenation and monitor ABGs
, Rationale: The highest priority for a patient with ARDS on mechanical ventilation is to maintain adequate
oxygenation and monitor arterial blood gases (ABGs) to ensure proper ventilation and prevent further
respiratory compromise.
---
5. A nurse is caring for a client with acute respiratory distress syndrome (ARDS). Which ventilator setting
should the nurse anticipate?
A. High tidal volumes to improve oxygenation
B. Low tidal volumes to prevent lung injury
C. High positive end-expiratory pressure (PEEP) only
D. Pressure support ventilation alone
Correct Answer: B. Low tidal volumes to prevent lung injury
Rationale: Lung-protective ventilation with low tidal volumes (4–8 mL/kg of predicted body weight) is the
standard of care for ARDS. High tidal volumes can cause ventilator-induced lung injury and worsen outcomes.
---
6. Which assessment finding by the nurse caring for a patient receiving mechanical ventilation indicates the
need for suctioning?
A. The patient's respiratory rate is 32 breaths/min
B. The patient has occasional audible expiratory wheezes
C. The patient's oxygen saturation drops to 93%
D. The patient was last suctioned 6 hours ago
Correct Answer: A. The patient's respiratory rate is 32 breaths/min
