NUR 245 Exam 3|Comprehensive Review | Questions and Answers with Rationales | 2026/2027
Updated | 100% Correct.
Section 1 — COPD and Hypercapnic Respiratory Failure
Questions 1–12
Question 1. A 68-year-old client with COPD arrives at the emergency department with increased
dyspnea, wheezing, and use of accessory muscles. Which prescribed medication should the nurse
anticipate administering first to relieve acute bronchospasm?
A. Salmeterol inhaler B. Albuterol nebulizer C. Fluticasone inhaler D. Montelukast tablet
Correct Answer: B. Albuterol nebulizer
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly relaxes bronchial
smooth muscle and is used for immediate relief of bronchospasm. Salmeterol is a long-acting
bronchodilator for maintenance treatment. Fluticasone is an inhaled corticosteroid that reduces
inflammation but does not provide immediate relief. Montelukast is not an acute rescue treatment
for COPD.
Question 2. A client with COPD who is at risk of hypercapnic respiratory failure is receiving
supplemental oxygen while awaiting arterial blood gas results. Which oxygen saturation target is
generally appropriate initially?
A. 70–75% B. 80–85% C. 88–92% D. 98–100%
Correct Answer: C. 88–92%
Rationale: For patients at risk of hypercapnic respiratory failure, controlled oxygen is commonly
titrated to an initial SpO₂ target of 88–92%, pending blood gas results and individualized orders.
Oxygen should never be withheld from a severely hypoxemic patient; the nurse must administer
oxygen, monitor closely, and escalate care when necessary.
Question 3. A nurse reviews the following arterial blood gas results for a client experiencing an
acute COPD exacerbation:
pH: 7.29
PaCO₂: 62 mmHg
HCO₃⁻: 28 mEq/L
PaO₂: 58 mmHg
How should the nurse interpret these findings?
A. Metabolic alkalosis B. Respiratory alkalosis C. Respiratory acidosis with partial metabolic
compensation D. Fully compensated metabolic acidosis
,Correct Answer: C. Respiratory acidosis with partial metabolic compensation
Rationale: The low pH indicates acidemia. The elevated PaCO₂ identifies a respiratory cause,
while the mildly elevated bicarbonate suggests renal compensation. Because the pH remains
below normal, compensation is incomplete. The low PaO₂ also indicates hypoxemia.
Question 4. A client with COPD sits leaning forward with hands supported on the bedside table.
The nurse recognizes that this position primarily helps the client by:
A. Increasing abdominal pressure B. Improving accessory respiratory muscle effectiveness C.
Preventing pulmonary embolism D. Reducing the need for all supplemental oxygen
Correct Answer: B. Improving accessory respiratory muscle effectiveness
Rationale: The tripod position stabilizes the shoulder girdle and may improve the mechanical
advantage of accessory muscles used during breathing. It can reduce perceived respiratory effort,
although it does not treat the underlying disease.
Question 5. A client with advanced COPD has experienced unintended weight loss and fatigue
during meals. Which nutritional intervention is most appropriate?
A. Provide one large meal daily B. Encourage low-protein meals C. Offer small, frequent,
nutrient-dense meals D. Restrict all dietary fats
Correct Answer: C. Offer small, frequent, nutrient-dense meals
Rationale: Advanced COPD can increase the energy required for breathing. Small, frequent
meals with adequate calories and protein can help meet nutritional needs without causing
excessive fatigue. Nutritional plans should be individualized, particularly when the client has
other conditions requiring dietary modifications.
Question 6. A client uses an inhaled corticosteroid as part of COPD maintenance therapy. Which
instruction should the nurse emphasize?
A. Use it as the only treatment during sudden severe dyspnea B. Rinse the mouth and spit after
each dose C. Discontinue it when symptoms improve without consulting the prescriber D.
Double the dose when coughing increases
Correct Answer: B. Rinse the mouth and spit after each dose
Rationale: Inhaled corticosteroids increase the risk of oral candidiasis. Rinsing and spitting after
use helps reduce medication residue in the mouth. This precaution is specifically associated with
inhaled corticosteroids, rather than LABA medications alone.
, Question 7. A client with COPD has a respiratory rate of 30/min, pH of 7.26, and PaCO₂ of 70
mmHg. The client is awake, cooperative, and able to protect the airway. Which intervention is
most likely to improve ventilation?
A. Encourage the client to hold their breath repeatedly B. Initiate prescribed noninvasive
positive-pressure ventilation C. Administer a sedative to decrease respiratory effort D. Restrict
oral fluids without further assessment
Correct Answer: B. Initiate prescribed noninvasive positive-pressure ventilation
Rationale: Noninvasive ventilation, such as bilevel positive airway pressure, can improve
alveolar ventilation, reduce respiratory muscle workload, and decrease CO₂ retention in selected
patients experiencing acute hypercapnic respiratory failure. The nurse must assess airway
protection, mental status, hemodynamic stability, and tolerance.
Question 8. Which finding in a client with an acute COPD exacerbation requires the most
immediate intervention?
A. Barrel-shaped chest B. Chronic productive cough C. Increasing somnolence with shallow
respirations D. History of tobacco exposure
Correct Answer: C. Increasing somnolence with shallow respirations
Rationale: Worsening somnolence and shallow respirations may indicate severe CO₂ retention,
respiratory muscle fatigue, or impending ventilatory failure. This is an acute airway and
breathing concern requiring immediate assessment and escalation.
Question 9. A client with COPD asks why pursed-lip breathing is recommended. Which
response is most accurate?
A. “It increases the amount of mucus produced.” B. “It helps keep small airways open longer
during exhalation.” C. “It eliminates the need for prescribed inhalers.” D. “It prevents all
respiratory infections.”
Correct Answer: B. “It helps keep small airways open longer during exhalation.”
Rationale: Pursed-lip breathing creates mild positive pressure during expiration, which can
reduce premature airway collapse and improve emptying of trapped air. It is a supportive
breathing technique, not a replacement for prescribed therapy.
Question 10. A nurse is assessing four clients. Which client should be evaluated first?
A. A stable COPD client requesting assistance with meals B. A COPD client with chronic
exertional dyspnea C. A COPD client with new confusion, cyanosis, and SpO₂ of 78% D. A
COPD client asking about pulmonary rehabilitation
Updated | 100% Correct.
Section 1 — COPD and Hypercapnic Respiratory Failure
Questions 1–12
Question 1. A 68-year-old client with COPD arrives at the emergency department with increased
dyspnea, wheezing, and use of accessory muscles. Which prescribed medication should the nurse
anticipate administering first to relieve acute bronchospasm?
A. Salmeterol inhaler B. Albuterol nebulizer C. Fluticasone inhaler D. Montelukast tablet
Correct Answer: B. Albuterol nebulizer
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly relaxes bronchial
smooth muscle and is used for immediate relief of bronchospasm. Salmeterol is a long-acting
bronchodilator for maintenance treatment. Fluticasone is an inhaled corticosteroid that reduces
inflammation but does not provide immediate relief. Montelukast is not an acute rescue treatment
for COPD.
Question 2. A client with COPD who is at risk of hypercapnic respiratory failure is receiving
supplemental oxygen while awaiting arterial blood gas results. Which oxygen saturation target is
generally appropriate initially?
A. 70–75% B. 80–85% C. 88–92% D. 98–100%
Correct Answer: C. 88–92%
Rationale: For patients at risk of hypercapnic respiratory failure, controlled oxygen is commonly
titrated to an initial SpO₂ target of 88–92%, pending blood gas results and individualized orders.
Oxygen should never be withheld from a severely hypoxemic patient; the nurse must administer
oxygen, monitor closely, and escalate care when necessary.
Question 3. A nurse reviews the following arterial blood gas results for a client experiencing an
acute COPD exacerbation:
pH: 7.29
PaCO₂: 62 mmHg
HCO₃⁻: 28 mEq/L
PaO₂: 58 mmHg
How should the nurse interpret these findings?
A. Metabolic alkalosis B. Respiratory alkalosis C. Respiratory acidosis with partial metabolic
compensation D. Fully compensated metabolic acidosis
,Correct Answer: C. Respiratory acidosis with partial metabolic compensation
Rationale: The low pH indicates acidemia. The elevated PaCO₂ identifies a respiratory cause,
while the mildly elevated bicarbonate suggests renal compensation. Because the pH remains
below normal, compensation is incomplete. The low PaO₂ also indicates hypoxemia.
Question 4. A client with COPD sits leaning forward with hands supported on the bedside table.
The nurse recognizes that this position primarily helps the client by:
A. Increasing abdominal pressure B. Improving accessory respiratory muscle effectiveness C.
Preventing pulmonary embolism D. Reducing the need for all supplemental oxygen
Correct Answer: B. Improving accessory respiratory muscle effectiveness
Rationale: The tripod position stabilizes the shoulder girdle and may improve the mechanical
advantage of accessory muscles used during breathing. It can reduce perceived respiratory effort,
although it does not treat the underlying disease.
Question 5. A client with advanced COPD has experienced unintended weight loss and fatigue
during meals. Which nutritional intervention is most appropriate?
A. Provide one large meal daily B. Encourage low-protein meals C. Offer small, frequent,
nutrient-dense meals D. Restrict all dietary fats
Correct Answer: C. Offer small, frequent, nutrient-dense meals
Rationale: Advanced COPD can increase the energy required for breathing. Small, frequent
meals with adequate calories and protein can help meet nutritional needs without causing
excessive fatigue. Nutritional plans should be individualized, particularly when the client has
other conditions requiring dietary modifications.
Question 6. A client uses an inhaled corticosteroid as part of COPD maintenance therapy. Which
instruction should the nurse emphasize?
A. Use it as the only treatment during sudden severe dyspnea B. Rinse the mouth and spit after
each dose C. Discontinue it when symptoms improve without consulting the prescriber D.
Double the dose when coughing increases
Correct Answer: B. Rinse the mouth and spit after each dose
Rationale: Inhaled corticosteroids increase the risk of oral candidiasis. Rinsing and spitting after
use helps reduce medication residue in the mouth. This precaution is specifically associated with
inhaled corticosteroids, rather than LABA medications alone.
, Question 7. A client with COPD has a respiratory rate of 30/min, pH of 7.26, and PaCO₂ of 70
mmHg. The client is awake, cooperative, and able to protect the airway. Which intervention is
most likely to improve ventilation?
A. Encourage the client to hold their breath repeatedly B. Initiate prescribed noninvasive
positive-pressure ventilation C. Administer a sedative to decrease respiratory effort D. Restrict
oral fluids without further assessment
Correct Answer: B. Initiate prescribed noninvasive positive-pressure ventilation
Rationale: Noninvasive ventilation, such as bilevel positive airway pressure, can improve
alveolar ventilation, reduce respiratory muscle workload, and decrease CO₂ retention in selected
patients experiencing acute hypercapnic respiratory failure. The nurse must assess airway
protection, mental status, hemodynamic stability, and tolerance.
Question 8. Which finding in a client with an acute COPD exacerbation requires the most
immediate intervention?
A. Barrel-shaped chest B. Chronic productive cough C. Increasing somnolence with shallow
respirations D. History of tobacco exposure
Correct Answer: C. Increasing somnolence with shallow respirations
Rationale: Worsening somnolence and shallow respirations may indicate severe CO₂ retention,
respiratory muscle fatigue, or impending ventilatory failure. This is an acute airway and
breathing concern requiring immediate assessment and escalation.
Question 9. A client with COPD asks why pursed-lip breathing is recommended. Which
response is most accurate?
A. “It increases the amount of mucus produced.” B. “It helps keep small airways open longer
during exhalation.” C. “It eliminates the need for prescribed inhalers.” D. “It prevents all
respiratory infections.”
Correct Answer: B. “It helps keep small airways open longer during exhalation.”
Rationale: Pursed-lip breathing creates mild positive pressure during expiration, which can
reduce premature airway collapse and improve emptying of trapped air. It is a supportive
breathing technique, not a replacement for prescribed therapy.
Question 10. A nurse is assessing four clients. Which client should be evaluated first?
A. A stable COPD client requesting assistance with meals B. A COPD client with chronic
exertional dyspnea C. A COPD client with new confusion, cyanosis, and SpO₂ of 78% D. A
COPD client asking about pulmonary rehabilitation
