NURS 120 | Medical-Surgical Nursing | Respiratory Disorders &
Oxygenation | 2026 Update WCU
1. A nurse is caring for a patient with a chest tube following a lobectomy. The
nurse notes continuous bubbling in the water-seal chamber. Which action
should the nurse take first?
A. Document the finding as a normal occurrence post-surgery.
B. Check all connections between the patient and the drainage system for leaks.
C. Increase the suction pressure on the wall regulator.
D. Clamp the chest tube close to the patient’s chest wall.
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system. The nurse should first check connections. Clamping is only done briefly to locate a
leak or per specific orders.
2. A patient with COPD is receiving oxygen via a nasal cannula at 2 L/min. The
patient’s SpO2 is 89%. Which physiological principle explains why oxygen flow
should not be aggressively increased in this patient?
A. High oxygen levels can cause surfactant inactivation.
B. High PaO2 levels can suppress the hypoxic drive to breathe.
C. Excessive oxygen can lead to absorption atelectasis.
D. Oxygen toxicity can lead to pulmonary fibrosis.
Answer: B
Rationale: In chronic CO2 retainers (COPD), the stimulus to breathe changes from high
CO2 to low O2 (hypoxic drive). Increasing oxygen too much can suppress this stimulus,
leading to respiratory arrest.
,3. An arterial blood gas (ABG) result shows: pH 7.31, PaCO2 52 mmHg, HCO3 26
mEq/L. How should the nurse interpret these results?
A. Respiratory Acidosis, uncompensated
B. Respiratory Alkalosis, partially compensated
C. Metabolic Acidosis, uncompensated
D. Metabolic Alkalosis, fully compensated
Answer: A
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is normal, meaning no compensation has occurred yet.
4. Which assessment finding is considered an early sign of hypoxia in an adult
patient?
A. Cyanosis of the lips and nail beds
B. Restlessness and apprehension
C. Bradypnea and hypotension
D. Clubbing of the fingers
Answer: B
Rationale: Restlessness, anxiety, and tachycardia are early signs of hypoxia as the brain
and heart react to decreasing oxygen. Cyanosis is a late sign.
5. A patient is scheduled for a bronchoscopy. Which nursing intervention is a
priority following the procedure?
A. Encouraging immediate oral fluid intake to prevent dehydration.
B. Administering a bolus of IV fluids.
C. Checking the gag reflex before allowing the patient to eat or drink.
D. Positioning the patient in a prone position.
Answer: C
, Rationale: The throat is typically numbed with a local anesthetic during a bronchoscopy.
To prevent aspiration, the nurse must ensure the gag reflex has returned before giving
anything by mouth.
6. A nurse is teaching a patient about using an Incentive Spirometer (IS). Which
instruction is correct?
A. Exhale forcefully into the mouthpiece.
B. Inhale slowly and deeply through the mouthpiece.
C. Use the device once every 4 hours while awake.
D. Hold your breath for 30 seconds after inhalation.
Answer: B
Rationale: The IS is used to promote alveolar expansion through slow, deep inhalation. It
should be used 10 times per hour while awake.
7. Which oxygen delivery device provides the most precise concentration of
oxygen?
A. Venturi Mask
B. Simple Face Mask
C. Non-rebreather Mask
D. Nasal Cannula
Answer: A
Rationale: The Venturi mask uses specific adapters or a dial to deliver a precise FiO2,
making it ideal for patients with COPD who require controlled oxygen levels.
Oxygenation | 2026 Update WCU
1. A nurse is caring for a patient with a chest tube following a lobectomy. The
nurse notes continuous bubbling in the water-seal chamber. Which action
should the nurse take first?
A. Document the finding as a normal occurrence post-surgery.
B. Check all connections between the patient and the drainage system for leaks.
C. Increase the suction pressure on the wall regulator.
D. Clamp the chest tube close to the patient’s chest wall.
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system. The nurse should first check connections. Clamping is only done briefly to locate a
leak or per specific orders.
2. A patient with COPD is receiving oxygen via a nasal cannula at 2 L/min. The
patient’s SpO2 is 89%. Which physiological principle explains why oxygen flow
should not be aggressively increased in this patient?
A. High oxygen levels can cause surfactant inactivation.
B. High PaO2 levels can suppress the hypoxic drive to breathe.
C. Excessive oxygen can lead to absorption atelectasis.
D. Oxygen toxicity can lead to pulmonary fibrosis.
Answer: B
Rationale: In chronic CO2 retainers (COPD), the stimulus to breathe changes from high
CO2 to low O2 (hypoxic drive). Increasing oxygen too much can suppress this stimulus,
leading to respiratory arrest.
,3. An arterial blood gas (ABG) result shows: pH 7.31, PaCO2 52 mmHg, HCO3 26
mEq/L. How should the nurse interpret these results?
A. Respiratory Acidosis, uncompensated
B. Respiratory Alkalosis, partially compensated
C. Metabolic Acidosis, uncompensated
D. Metabolic Alkalosis, fully compensated
Answer: A
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is normal, meaning no compensation has occurred yet.
4. Which assessment finding is considered an early sign of hypoxia in an adult
patient?
A. Cyanosis of the lips and nail beds
B. Restlessness and apprehension
C. Bradypnea and hypotension
D. Clubbing of the fingers
Answer: B
Rationale: Restlessness, anxiety, and tachycardia are early signs of hypoxia as the brain
and heart react to decreasing oxygen. Cyanosis is a late sign.
5. A patient is scheduled for a bronchoscopy. Which nursing intervention is a
priority following the procedure?
A. Encouraging immediate oral fluid intake to prevent dehydration.
B. Administering a bolus of IV fluids.
C. Checking the gag reflex before allowing the patient to eat or drink.
D. Positioning the patient in a prone position.
Answer: C
, Rationale: The throat is typically numbed with a local anesthetic during a bronchoscopy.
To prevent aspiration, the nurse must ensure the gag reflex has returned before giving
anything by mouth.
6. A nurse is teaching a patient about using an Incentive Spirometer (IS). Which
instruction is correct?
A. Exhale forcefully into the mouthpiece.
B. Inhale slowly and deeply through the mouthpiece.
C. Use the device once every 4 hours while awake.
D. Hold your breath for 30 seconds after inhalation.
Answer: B
Rationale: The IS is used to promote alveolar expansion through slow, deep inhalation. It
should be used 10 times per hour while awake.
7. Which oxygen delivery device provides the most precise concentration of
oxygen?
A. Venturi Mask
B. Simple Face Mask
C. Non-rebreather Mask
D. Nasal Cannula
Answer: A
Rationale: The Venturi mask uses specific adapters or a dial to deliver a precise FiO2,
making it ideal for patients with COPD who require controlled oxygen levels.
