NR-224 | Exam 3 Practice Examination Page 1
, NR-224 EXAM 3
Fundamentals - Skills
Chamberlain University
100-Question Original Practice Examination 2026/2027 Edition
1. A patient with new dyspnea is lying flat and has an oxygen saturation of 89%. What immediate nursing action is most
appropriate?
A) Lower the head of the bed
B) Raise the head of the bed and assess breathing effort
C) Delay assessment until rounds
D) Offer a large meal
Correct Answer: Raise the head of the bed and assess breathing effort
Rationale: Upright positioning can improve lung expansion and reduce work of breathing. The nurse should promptly assess
respiratory rate, effort, and oxygenation, and follow oxygen orders or emergency protocols. Food and delayed assessment do not
address the immediate breathing problem.
2. During assessment, a client has gurgling respirations and cannot clear oral secretions. What should the nurse prioritize?
A) Provide oral fluids despite impaired swallowing
B) Begin routine discharge education
C) Ask the client to ambulate alone
D) Reposition and suction the airway as indicated
Correct Answer: Reposition and suction the airway as indicated
Rationale: Gurgling suggests pooled secretions obstructing the airway. Appropriate positioning and suction can restore patency
while the nurse assesses oxygenation. Giving fluids to someone unable to clear secretions increases aspiration risk and does not
resolve the obstruction.
3. An older adult becomes restless and confused while respiratory rate increases to 30/min. Which explanation requires prompt
assessment?
A) Early hypoxemia may present as altered behavior
B) Rapid breathing guarantees sufficient oxygen delivery
C) Restlessness is never associated with respiratory compromise
D) Confusion always proves dementia
Correct Answer: Early hypoxemia may present as altered behavior
Rationale: Restlessness, agitation, and confusion can be early manifestations of hypoxemia. A nurse should assess airway,
respiratory status, vital signs, and oxygen saturation. Assuming dementia may delay identification of a reversible acute respiratory
change.
4. A postoperative client takes shallow breaths because of incision pain. Which intervention best reduces atelectasis risk?
A) Avoid pain assessment until discharge
B) Support the incision during coached deep breathing and incentive spirometry
C) Keep the patient supine without movement
D) Encourage breath holding for several minutes
Correct Answer: Support the incision during coached deep breathing and incentive spirometry
NR-224 | Exam 3 Practice Examination Page 2
, Rationale: Pain control, splinting, deep breathing, and incentive spirometry promote alveolar expansion after surgery. Shallow
breathing can cause dependent alveoli to collapse. Activity and breathing exercises should be individualized to the patient's
condition and surgical instructions.
5. A patient using an incentive spirometer repeatedly exhales into the device. Which teaching is correct?
A) Skip upright positioning during practice
B) Blow hard into the device like a balloon
C) Use the device only while sleeping
D) Inhale slowly and deeply through the mouthpiece
Correct Answer: Inhale slowly and deeply through the mouthpiece
Rationale: Most incentive spirometers are designed to encourage sustained maximal inspiration rather than forceful expiration.
Slow inhalation recruits alveoli and helps reduce postoperative atelectasis. Proper upright positioning and repeated practice
improve technique.
6. A pulse oximeter reads 82% on a cold finger, but the patient is comfortable and the waveform is poor. What should the nurse
do first?
A) Check sensor placement and perfusion while assessing the patient
B) Disconnect monitoring permanently
C) Assume the reading is exact without examination
D) Document normal oxygenation
Correct Answer: Check sensor placement and perfusion while assessing the patient
Rationale: Cold extremities and motion can degrade pulse oximetry signals. The nurse should examine respiratory status, improve
probe placement or choose another site, and obtain a reliable reading. Clinical assessment remains essential because an artifact
and true hypoxemia can coexist.
7. A client on supplemental oxygen asks why smoking is prohibited. Which explanation is most accurate?
A) Petroleum jelly prevents ignition around oxygen
B) Smoking is safe if the flow is reduced briefly
C) Oxygen supports combustion and creates severe fire risk
D) Oxygen cannot affect the burning of cigarettes
Correct Answer: Oxygen supports combustion and creates severe fire risk
Rationale: Oxygen is not itself a fuel but greatly accelerates combustion. Flames and smoking materials near oxygen can cause
devastating burns or fires. Smoking and open flames must remain away from oxygen equipment, and oil-based products should
be avoided.
8. A nurse observes a low oxygen saturation after starting a nasal cannula. What should be checked before increasing flow
beyond the order?
A) Whether the room lights are dimmed
B) Cannula placement, tubing patency, and prescribed settings
C) The patient's preferred television channel
D) The brand of bedside tissues
Correct Answer: Cannula placement, tubing patency, and prescribed settings
Rationale: Disconnected or kinked tubing and displaced prongs can prevent prescribed oxygen from reaching the patient.
Equipment assessment belongs alongside immediate respiratory reassessment. Flow adjustments require an appropriate order or
standing protocol, particularly for patients needing controlled oxygen delivery.
NR-224 | Exam 3 Practice Examination Page 3
, NR-224 EXAM 3
Fundamentals - Skills
Chamberlain University
100-Question Original Practice Examination 2026/2027 Edition
1. A patient with new dyspnea is lying flat and has an oxygen saturation of 89%. What immediate nursing action is most
appropriate?
A) Lower the head of the bed
B) Raise the head of the bed and assess breathing effort
C) Delay assessment until rounds
D) Offer a large meal
Correct Answer: Raise the head of the bed and assess breathing effort
Rationale: Upright positioning can improve lung expansion and reduce work of breathing. The nurse should promptly assess
respiratory rate, effort, and oxygenation, and follow oxygen orders or emergency protocols. Food and delayed assessment do not
address the immediate breathing problem.
2. During assessment, a client has gurgling respirations and cannot clear oral secretions. What should the nurse prioritize?
A) Provide oral fluids despite impaired swallowing
B) Begin routine discharge education
C) Ask the client to ambulate alone
D) Reposition and suction the airway as indicated
Correct Answer: Reposition and suction the airway as indicated
Rationale: Gurgling suggests pooled secretions obstructing the airway. Appropriate positioning and suction can restore patency
while the nurse assesses oxygenation. Giving fluids to someone unable to clear secretions increases aspiration risk and does not
resolve the obstruction.
3. An older adult becomes restless and confused while respiratory rate increases to 30/min. Which explanation requires prompt
assessment?
A) Early hypoxemia may present as altered behavior
B) Rapid breathing guarantees sufficient oxygen delivery
C) Restlessness is never associated with respiratory compromise
D) Confusion always proves dementia
Correct Answer: Early hypoxemia may present as altered behavior
Rationale: Restlessness, agitation, and confusion can be early manifestations of hypoxemia. A nurse should assess airway,
respiratory status, vital signs, and oxygen saturation. Assuming dementia may delay identification of a reversible acute respiratory
change.
4. A postoperative client takes shallow breaths because of incision pain. Which intervention best reduces atelectasis risk?
A) Avoid pain assessment until discharge
B) Support the incision during coached deep breathing and incentive spirometry
C) Keep the patient supine without movement
D) Encourage breath holding for several minutes
Correct Answer: Support the incision during coached deep breathing and incentive spirometry
NR-224 | Exam 3 Practice Examination Page 2
, Rationale: Pain control, splinting, deep breathing, and incentive spirometry promote alveolar expansion after surgery. Shallow
breathing can cause dependent alveoli to collapse. Activity and breathing exercises should be individualized to the patient's
condition and surgical instructions.
5. A patient using an incentive spirometer repeatedly exhales into the device. Which teaching is correct?
A) Skip upright positioning during practice
B) Blow hard into the device like a balloon
C) Use the device only while sleeping
D) Inhale slowly and deeply through the mouthpiece
Correct Answer: Inhale slowly and deeply through the mouthpiece
Rationale: Most incentive spirometers are designed to encourage sustained maximal inspiration rather than forceful expiration.
Slow inhalation recruits alveoli and helps reduce postoperative atelectasis. Proper upright positioning and repeated practice
improve technique.
6. A pulse oximeter reads 82% on a cold finger, but the patient is comfortable and the waveform is poor. What should the nurse
do first?
A) Check sensor placement and perfusion while assessing the patient
B) Disconnect monitoring permanently
C) Assume the reading is exact without examination
D) Document normal oxygenation
Correct Answer: Check sensor placement and perfusion while assessing the patient
Rationale: Cold extremities and motion can degrade pulse oximetry signals. The nurse should examine respiratory status, improve
probe placement or choose another site, and obtain a reliable reading. Clinical assessment remains essential because an artifact
and true hypoxemia can coexist.
7. A client on supplemental oxygen asks why smoking is prohibited. Which explanation is most accurate?
A) Petroleum jelly prevents ignition around oxygen
B) Smoking is safe if the flow is reduced briefly
C) Oxygen supports combustion and creates severe fire risk
D) Oxygen cannot affect the burning of cigarettes
Correct Answer: Oxygen supports combustion and creates severe fire risk
Rationale: Oxygen is not itself a fuel but greatly accelerates combustion. Flames and smoking materials near oxygen can cause
devastating burns or fires. Smoking and open flames must remain away from oxygen equipment, and oil-based products should
be avoided.
8. A nurse observes a low oxygen saturation after starting a nasal cannula. What should be checked before increasing flow
beyond the order?
A) Whether the room lights are dimmed
B) Cannula placement, tubing patency, and prescribed settings
C) The patient's preferred television channel
D) The brand of bedside tissues
Correct Answer: Cannula placement, tubing patency, and prescribed settings
Rationale: Disconnected or kinked tubing and displaced prongs can prevent prescribed oxygen from reaching the patient.
Equipment assessment belongs alongside immediate respiratory reassessment. Flow adjustments require an appropriate order or
standing protocol, particularly for patients needing controlled oxygen delivery.
NR-224 | Exam 3 Practice Examination Page 3
