ATI Med Surg Respiratory Exam 2025 –
Complete verified questions and
rationales, A+ graded.
Section 1: Asthma & COPD (Questions 1-25)
1. Q: A client with asthma is prescribed a fluticasone (Flovent) inhaler. The nurse
should teach the client that this medication primarily serves which purpose?
A: Reduces airway inflammation.
Rationale: Fluticasone is an inhaled corticosteroid. Its main action is anti-
inflammatory, reducing swelling and mucus production in the airways, which is a
cornerstone of long-term asthma control.
2. Q: When assessing a client with chronic obstructive pulmonary disease (COPD),
the nurse expects to find which classic finding on inspection of the chest?
A: Barrel chest.
Rationale: Due to chronic air trapping and hyperinflation of the lungs, the
anteroposterior diameter of the chest increases, giving it a rounded, barrel-like
appearance.
3. Q: A client is using a albuterol (ProAir HFA) inhaler for acute asthma symptoms.
The nurse should instruct the client to report which adverse effect immediately?
A: Tachycardia and palpitations.
Rationale: Albuterol is a beta-2 agonist that can cause systemic effects like cardiac
stimulation (tachycardia, palpitations) and tremors, indicating possible overuse or
sensitivity.
4. Q: The nurse is teaching a client with COPD about energy conservation. Which
statement by the client indicates understanding?
A: "I will exhale slowly through pursed lips when doing activities like
bending or lifting."
,Rationale: Pursed-lip breathing prolongs exhalation, prevents collapse of small
airways, and improves gas exchange, making exertion less taxing.
5. Q: Which arterial blood gas (ABG) result would the nurse anticipate during a
mild to moderate acute asthma attack?
A: Respiratory alkalosis (pH >7.45, PaCO2 <35).
Rationale: Initially, hyperventilation from anxiety and hypoxia leads to "blowing
off" CO2, resulting in respiratory alkalosis. In a severe, life-threatening attack,
PaCO2 rises (normalizes then increases) indicating respiratory muscle fatigue and
impending failure.
6. Q: A client with COPD has a PaO2 of 55 mm Hg on room air. The nurse
anticipates an order for which intervention?
A: Initiating low-flow oxygen therapy via nasal cannula.
Rationale: Oxygen saturation <88% or PaO2 <55 mm Hg indicates the need for
supplemental oxygen in COPD. It must be given at low flow rates (1-3 L/min) to
avoid suppressing the hypoxic drive to breathe.
7. Q: Before administering the first dose of IV methylprednisolone to a client with
status asthmaticus, it is most important for the nurse to assess what?
A: The client's allergy history, especially to sulfites or steroids.
Rationale: While checking blood glucose and infection signs are important,
assessing for life-threatening allergic reactions is the highest priority before
initiating any new medication.
8. Q: Which finding in a client with asthma indicates the treatment is effective and
the attack is resolving?
A: A louder, more productive cough.
Rationale: As bronchospasm eases, airways open, allowing mobilization and
expulsion of mucus plugs, leading to a more productive cough. Silent chest is a
dire sign.
9. Q: The nurse is preparing to administer ipratropium bromide (Atrovent) via
nebulizer to a client with COPD. The client has a history of glaucoma. What is the
nurse's priority action?
, A: Ensure the client uses a mouthpiece rather than a mask for the
treatment.
Rationale: Ipratropium is an anticholinergic. If a mask is used, medication can get
into the eyes and increase intraocular pressure, exacerbating glaucoma. A
mouthpiece prevents this.
10. Q: A client with COPD asks why they need a pneumococcal vaccine. The
nurse's best response is based on what understanding?
A: "Patients with COPD are at higher risk for severe complications from
pneumonia, and this vaccine helps prevent the most common bacterial cause."
Rationale: Respiratory infections are a major cause of acute exacerbations in
COPD. Prevention through vaccination is a key component of disease
management.
11. Q: What is the primary teaching point for a client using a corticosteroid inhaler
(like beclomethasone)?
A: "Rinse your mouth thoroughly after each use to prevent oral thrush."
Rationale: Inhaled corticosteroids can cause localized immunosuppression in the
oropharynx, leading to candidiasis (thrush). Rinsing removes residual medication.
12. Q: Which instruction is essential for a client prescribed both a bronchodilator
(albuterol) and a corticosteroid (fluticasone) inhaler?
A: "Use the bronchodilator inhaler first, wait 5 minutes, then use the
corticosteroid inhaler."
Rationale: The bronchodilator opens the airways first, allowing the corticosteroid
to be inhaled more deeply into the lungs for maximum anti-inflammatory effect.
13. Q: A client with COPD exhibits confusion, irritability, and a decreased
respiratory rate. The nurse suspects oxygen-induced hypoventilation. Which ABG
finding confirms this?
A: Respiratory acidosis (pH <7.35, PaCO2 >45) with an elevated PaO2.
Rationale: In some clients with severe COPD, high oxygen levels can suppress the
hypoxic drive, leading to hypoventilation, CO2 retention (hypercapnia), and
respiratory acidosis. This is a medical emergency.
Complete verified questions and
rationales, A+ graded.
Section 1: Asthma & COPD (Questions 1-25)
1. Q: A client with asthma is prescribed a fluticasone (Flovent) inhaler. The nurse
should teach the client that this medication primarily serves which purpose?
A: Reduces airway inflammation.
Rationale: Fluticasone is an inhaled corticosteroid. Its main action is anti-
inflammatory, reducing swelling and mucus production in the airways, which is a
cornerstone of long-term asthma control.
2. Q: When assessing a client with chronic obstructive pulmonary disease (COPD),
the nurse expects to find which classic finding on inspection of the chest?
A: Barrel chest.
Rationale: Due to chronic air trapping and hyperinflation of the lungs, the
anteroposterior diameter of the chest increases, giving it a rounded, barrel-like
appearance.
3. Q: A client is using a albuterol (ProAir HFA) inhaler for acute asthma symptoms.
The nurse should instruct the client to report which adverse effect immediately?
A: Tachycardia and palpitations.
Rationale: Albuterol is a beta-2 agonist that can cause systemic effects like cardiac
stimulation (tachycardia, palpitations) and tremors, indicating possible overuse or
sensitivity.
4. Q: The nurse is teaching a client with COPD about energy conservation. Which
statement by the client indicates understanding?
A: "I will exhale slowly through pursed lips when doing activities like
bending or lifting."
,Rationale: Pursed-lip breathing prolongs exhalation, prevents collapse of small
airways, and improves gas exchange, making exertion less taxing.
5. Q: Which arterial blood gas (ABG) result would the nurse anticipate during a
mild to moderate acute asthma attack?
A: Respiratory alkalosis (pH >7.45, PaCO2 <35).
Rationale: Initially, hyperventilation from anxiety and hypoxia leads to "blowing
off" CO2, resulting in respiratory alkalosis. In a severe, life-threatening attack,
PaCO2 rises (normalizes then increases) indicating respiratory muscle fatigue and
impending failure.
6. Q: A client with COPD has a PaO2 of 55 mm Hg on room air. The nurse
anticipates an order for which intervention?
A: Initiating low-flow oxygen therapy via nasal cannula.
Rationale: Oxygen saturation <88% or PaO2 <55 mm Hg indicates the need for
supplemental oxygen in COPD. It must be given at low flow rates (1-3 L/min) to
avoid suppressing the hypoxic drive to breathe.
7. Q: Before administering the first dose of IV methylprednisolone to a client with
status asthmaticus, it is most important for the nurse to assess what?
A: The client's allergy history, especially to sulfites or steroids.
Rationale: While checking blood glucose and infection signs are important,
assessing for life-threatening allergic reactions is the highest priority before
initiating any new medication.
8. Q: Which finding in a client with asthma indicates the treatment is effective and
the attack is resolving?
A: A louder, more productive cough.
Rationale: As bronchospasm eases, airways open, allowing mobilization and
expulsion of mucus plugs, leading to a more productive cough. Silent chest is a
dire sign.
9. Q: The nurse is preparing to administer ipratropium bromide (Atrovent) via
nebulizer to a client with COPD. The client has a history of glaucoma. What is the
nurse's priority action?
, A: Ensure the client uses a mouthpiece rather than a mask for the
treatment.
Rationale: Ipratropium is an anticholinergic. If a mask is used, medication can get
into the eyes and increase intraocular pressure, exacerbating glaucoma. A
mouthpiece prevents this.
10. Q: A client with COPD asks why they need a pneumococcal vaccine. The
nurse's best response is based on what understanding?
A: "Patients with COPD are at higher risk for severe complications from
pneumonia, and this vaccine helps prevent the most common bacterial cause."
Rationale: Respiratory infections are a major cause of acute exacerbations in
COPD. Prevention through vaccination is a key component of disease
management.
11. Q: What is the primary teaching point for a client using a corticosteroid inhaler
(like beclomethasone)?
A: "Rinse your mouth thoroughly after each use to prevent oral thrush."
Rationale: Inhaled corticosteroids can cause localized immunosuppression in the
oropharynx, leading to candidiasis (thrush). Rinsing removes residual medication.
12. Q: Which instruction is essential for a client prescribed both a bronchodilator
(albuterol) and a corticosteroid (fluticasone) inhaler?
A: "Use the bronchodilator inhaler first, wait 5 minutes, then use the
corticosteroid inhaler."
Rationale: The bronchodilator opens the airways first, allowing the corticosteroid
to be inhaled more deeply into the lungs for maximum anti-inflammatory effect.
13. Q: A client with COPD exhibits confusion, irritability, and a decreased
respiratory rate. The nurse suspects oxygen-induced hypoventilation. Which ABG
finding confirms this?
A: Respiratory acidosis (pH <7.35, PaCO2 >45) with an elevated PaO2.
Rationale: In some clients with severe COPD, high oxygen levels can suppress the
hypoxic drive, leading to hypoventilation, CO2 retention (hypercapnia), and
respiratory acidosis. This is a medical emergency.
