2026 Respiratory Medical Surgical Nursing
Study Guide Practice Questions COPD Asthma
Pneumonia Respiratory Failure Oxygen Therapy
Nursing Interventions
1. A nurse is caring for a patient with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The patient is receiving oxygen at 2
L/min via nasal cannula. The nurse notes the patient's oxygen saturation is
92%. Which of the following actions should the nurse take?
A. Increase the oxygen flow rate to 6 L/min.
B. Continue to monitor the patient and maintain the current oxygen flow rate.
C. Discontinue the oxygen and reassess in 15 minutes.
D. Place the patient in a supine position.
Answer: B. Continue to monitor the patient and maintain the current oxygen
flow rate.
Rationale: For a patient with COPD, the target oxygen saturation is typically 88-
92%. A saturation of 92% is within the acceptable range. Increasing the oxygen
flow rate could suppress the patient's hypoxic drive and lead to respiratory failure.
Therefore, the nurse should maintain the current flow rate and continue to monitor
the patient.
2. A patient with asthma is experiencing an acute attack. Which of the
following clinical manifestations indicates a severe, life-threatening
exacerbation?
A. Wheezing
B. A productive cough
C. A silent chest
D. Use of accessory muscles
Answer: C. A silent chest
Rationale: A silent chest is an ominous sign in an asthma attack. It indicates that
the airways are so severely constricted that there is not enough airflow to produce a
wheeze. This is a sign of impending respiratory failure and requires immediate
intervention.
,3. A nurse is assessing a patient with community-acquired pneumonia. Which
of the following clinical manifestations is most commonly expected?
A. Bradycardia
B. A dry, non-productive cough
C. Fever and chills
D. Hypertension
Answer: C. Fever and chills
Rationale: Community-acquired pneumonia typically presents with fever, chills, a
productive cough with purulent sputum, pleuritic chest pain, and dyspnea.
Bradycardia and hypertension are not typical findings.
4. A patient is admitted with acute respiratory failure. Which of the following
arterial blood gas (ABG) values is consistent with this diagnosis?
A. pH 7.35, PaO2 90 mmHg, PaCO2 40 mmHg
B. pH 7.25, PaO2 50 mmHg, PaCO2 60 mmHg
C. pH 7.45, PaO2 95 mmHg, PaCO2 35 mmHg
D. pH 7.30, PaO2 85 mmHg, PaCO2 45 mmHg
Answer: B. pH 7.25, PaO2 50 mmHg, PaCO2 60 mmHg
Rationale: Acute respiratory failure is defined as a PaO2 of less than 60 mmHg
and/or a PaCO2 of greater than 50 mmHg with an accompanying pH of less than
7.35 (respiratory acidosis). Option B represents both hypoxemia and hypercapnia
with acidosis.
5. A nurse is caring for a patient with a chest tube. Which of the following
findings requires immediate intervention?
A. Continuous bubbling in the water seal chamber.
B. Fluctuation (tidaling) in the water seal chamber.
C. Serosanguineous drainage in the collection chamber.
D. The chest tube is clamped during transport.
Answer: A. Continuous bubbling in the water seal chamber.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system. This requires immediate assessment and intervention to prevent a
pneumothorax from worsening. Tidaling is a normal finding. Clamping the chest
tube during transport is appropriate.
6. A patient with COPD is prescribed a short-acting beta-agonist (SABA)
inhaler. The nurse should teach the patient that this medication:
A. Is a maintenance medication taken daily.
,B. Provides rapid relief of bronchospasm.
C. Should be taken only at bedtime.
D. Has no side effects.
Answer: B. Provides rapid relief of bronchospasm.
Rationale: Short-acting beta-agonists (SABAs) such as albuterol are rescue
medications used for the rapid relief of acute bronchospasm. They should be taken
as needed for symptoms. They are not maintenance medications.
7. A nurse is assessing a patient with a suspected pulmonary embolism. Which
of the following clinical manifestations is most common?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Bradycardia
C. Hypertension
D. A dry, non-productive cough
Answer: A. Sudden onset of pleuritic chest pain and dyspnea
Rationale: The most common presenting symptoms of a pulmonary embolism are
the sudden onset of dyspnea and pleuritic chest pain (pain that worsens with
breathing). Tachycardia and tachypnea are also common.
8. A patient with pneumonia is prescribed intravenous antibiotics. Which of
the following nursing interventions is the priority before administering the
first dose?
A. Administer the antibiotic as ordered.
B. Obtain a sputum culture.
C. Administer an antipyretic.
D. Encourage fluid intake.
Answer: B. Obtain a sputum culture.
Rationale: Before administering the first dose of antibiotics, a sputum culture
should be obtained to identify the causative organism and its sensitivity to
antibiotics. This ensures that the patient receives the most appropriate antibiotic
therapy. If there is a delay, antibiotics should be administered, but cultures should
ideally be obtained first.
9. A nurse is caring for a patient with a tracheostomy. Which of the following
actions is the priority for maintaining a patent airway?
A. Suctioning the tracheostomy as needed.
B. Changing the tracheostomy ties daily.
, C. Providing humidified oxygen.
D. Cleaning the stoma site.
Answer: A. Suctioning the tracheostomy as needed.
Rationale: The priority for a patient with a tracheostomy is to maintain a patent
airway by suctioning secretions as needed. While humidification, cleaning, and tie
changes are important, suctioning is the most critical intervention to prevent
airway obstruction.
10. A patient is admitted with an acute exacerbation of asthma. Which of the
following medications is a long-term control medication?
A. Albuterol
B. Inhaled corticosteroids
C. Ipratropium
D. Levalbuterol
Answer: B. Inhaled corticosteroids
Rationale: Inhaled corticosteroids (e.g., fluticasone, budesonide) are long-term
control medications used to reduce airway inflammation and prevent asthma
attacks. They are taken daily. Albuterol, levalbuterol, and ipratropium are rescue
medications.
11. A nurse is assessing a patient with respiratory failure. Which of the
following findings indicates the patient is developing hypoxemia?
A. Restlessness and confusion
B. Bradycardia
C. Hypertension
D. Decreased respiratory rate
Answer: A. Restlessness and confusion
Rationale: Restlessness, confusion, and altered mental status are early signs of
hypoxemia (decreased oxygen in the blood). The brain is very sensitive to low
oxygen levels. Tachycardia and tachypnea are also common early signs.
12. A patient with COPD is prescribed home oxygen therapy. Which of the
following oxygen delivery devices is most appropriate for this patient?
A. A non-rebreather mask
B. A venturi mask
C. A simple face mask
D. A partial rebreather mask
Study Guide Practice Questions COPD Asthma
Pneumonia Respiratory Failure Oxygen Therapy
Nursing Interventions
1. A nurse is caring for a patient with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The patient is receiving oxygen at 2
L/min via nasal cannula. The nurse notes the patient's oxygen saturation is
92%. Which of the following actions should the nurse take?
A. Increase the oxygen flow rate to 6 L/min.
B. Continue to monitor the patient and maintain the current oxygen flow rate.
C. Discontinue the oxygen and reassess in 15 minutes.
D. Place the patient in a supine position.
Answer: B. Continue to monitor the patient and maintain the current oxygen
flow rate.
Rationale: For a patient with COPD, the target oxygen saturation is typically 88-
92%. A saturation of 92% is within the acceptable range. Increasing the oxygen
flow rate could suppress the patient's hypoxic drive and lead to respiratory failure.
Therefore, the nurse should maintain the current flow rate and continue to monitor
the patient.
2. A patient with asthma is experiencing an acute attack. Which of the
following clinical manifestations indicates a severe, life-threatening
exacerbation?
A. Wheezing
B. A productive cough
C. A silent chest
D. Use of accessory muscles
Answer: C. A silent chest
Rationale: A silent chest is an ominous sign in an asthma attack. It indicates that
the airways are so severely constricted that there is not enough airflow to produce a
wheeze. This is a sign of impending respiratory failure and requires immediate
intervention.
,3. A nurse is assessing a patient with community-acquired pneumonia. Which
of the following clinical manifestations is most commonly expected?
A. Bradycardia
B. A dry, non-productive cough
C. Fever and chills
D. Hypertension
Answer: C. Fever and chills
Rationale: Community-acquired pneumonia typically presents with fever, chills, a
productive cough with purulent sputum, pleuritic chest pain, and dyspnea.
Bradycardia and hypertension are not typical findings.
4. A patient is admitted with acute respiratory failure. Which of the following
arterial blood gas (ABG) values is consistent with this diagnosis?
A. pH 7.35, PaO2 90 mmHg, PaCO2 40 mmHg
B. pH 7.25, PaO2 50 mmHg, PaCO2 60 mmHg
C. pH 7.45, PaO2 95 mmHg, PaCO2 35 mmHg
D. pH 7.30, PaO2 85 mmHg, PaCO2 45 mmHg
Answer: B. pH 7.25, PaO2 50 mmHg, PaCO2 60 mmHg
Rationale: Acute respiratory failure is defined as a PaO2 of less than 60 mmHg
and/or a PaCO2 of greater than 50 mmHg with an accompanying pH of less than
7.35 (respiratory acidosis). Option B represents both hypoxemia and hypercapnia
with acidosis.
5. A nurse is caring for a patient with a chest tube. Which of the following
findings requires immediate intervention?
A. Continuous bubbling in the water seal chamber.
B. Fluctuation (tidaling) in the water seal chamber.
C. Serosanguineous drainage in the collection chamber.
D. The chest tube is clamped during transport.
Answer: A. Continuous bubbling in the water seal chamber.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system. This requires immediate assessment and intervention to prevent a
pneumothorax from worsening. Tidaling is a normal finding. Clamping the chest
tube during transport is appropriate.
6. A patient with COPD is prescribed a short-acting beta-agonist (SABA)
inhaler. The nurse should teach the patient that this medication:
A. Is a maintenance medication taken daily.
,B. Provides rapid relief of bronchospasm.
C. Should be taken only at bedtime.
D. Has no side effects.
Answer: B. Provides rapid relief of bronchospasm.
Rationale: Short-acting beta-agonists (SABAs) such as albuterol are rescue
medications used for the rapid relief of acute bronchospasm. They should be taken
as needed for symptoms. They are not maintenance medications.
7. A nurse is assessing a patient with a suspected pulmonary embolism. Which
of the following clinical manifestations is most common?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Bradycardia
C. Hypertension
D. A dry, non-productive cough
Answer: A. Sudden onset of pleuritic chest pain and dyspnea
Rationale: The most common presenting symptoms of a pulmonary embolism are
the sudden onset of dyspnea and pleuritic chest pain (pain that worsens with
breathing). Tachycardia and tachypnea are also common.
8. A patient with pneumonia is prescribed intravenous antibiotics. Which of
the following nursing interventions is the priority before administering the
first dose?
A. Administer the antibiotic as ordered.
B. Obtain a sputum culture.
C. Administer an antipyretic.
D. Encourage fluid intake.
Answer: B. Obtain a sputum culture.
Rationale: Before administering the first dose of antibiotics, a sputum culture
should be obtained to identify the causative organism and its sensitivity to
antibiotics. This ensures that the patient receives the most appropriate antibiotic
therapy. If there is a delay, antibiotics should be administered, but cultures should
ideally be obtained first.
9. A nurse is caring for a patient with a tracheostomy. Which of the following
actions is the priority for maintaining a patent airway?
A. Suctioning the tracheostomy as needed.
B. Changing the tracheostomy ties daily.
, C. Providing humidified oxygen.
D. Cleaning the stoma site.
Answer: A. Suctioning the tracheostomy as needed.
Rationale: The priority for a patient with a tracheostomy is to maintain a patent
airway by suctioning secretions as needed. While humidification, cleaning, and tie
changes are important, suctioning is the most critical intervention to prevent
airway obstruction.
10. A patient is admitted with an acute exacerbation of asthma. Which of the
following medications is a long-term control medication?
A. Albuterol
B. Inhaled corticosteroids
C. Ipratropium
D. Levalbuterol
Answer: B. Inhaled corticosteroids
Rationale: Inhaled corticosteroids (e.g., fluticasone, budesonide) are long-term
control medications used to reduce airway inflammation and prevent asthma
attacks. They are taken daily. Albuterol, levalbuterol, and ipratropium are rescue
medications.
11. A nurse is assessing a patient with respiratory failure. Which of the
following findings indicates the patient is developing hypoxemia?
A. Restlessness and confusion
B. Bradycardia
C. Hypertension
D. Decreased respiratory rate
Answer: A. Restlessness and confusion
Rationale: Restlessness, confusion, and altered mental status are early signs of
hypoxemia (decreased oxygen in the blood). The brain is very sensitive to low
oxygen levels. Tachycardia and tachypnea are also common early signs.
12. A patient with COPD is prescribed home oxygen therapy. Which of the
following oxygen delivery devices is most appropriate for this patient?
A. A non-rebreather mask
B. A venturi mask
C. A simple face mask
D. A partial rebreather mask
