CHAMBERLAIN UNIVERSITY | COLLEGE OF NURSING
NR 603 Week 2 Case Discussion:
Pulmonary (Part One)
Official Practice Exam - 2026/2027 Edition
75 Questions | 90 Minutes | Passing Score: 80% | Recertification Exam
TABLE OF CONTENTS
Section 1: Respiratory Assessment & Diagnostic Reasoning (15 Questions)
Section 2: Obstructive Airway Diseases (18 Questions)
Section 3: Restrictive & Interstitial Lung Diseases (15 Questions)
Section 4: Pulmonary Infections & Acute Conditions (15 Questions)
Section 5: Pulmonary Pharmacology & Collaborative Management (12 Questions)
EXAM INSTRUCTIONS
1. This exam contains 75 multiple-choice questions. Select the ONE best answer for each question.
2. You have 90 minutes to complete the exam. Pace yourself at approximately 1.2 minutes per question.
3. A passing score of 80% (60 correct out of 75) is required. Each question is worth equal points.
4. Read each scenario carefully before selecting your answer. All options are plausible but only one is best.
5. The correct answer and rationale are provided immediately after each question for study purposes.
6. No penalties for incorrect answers. Answer every question even if uncertain.
7. Review the rationale for each question, including why the top distractor is incorrect.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Respiratory Assessment & Diagnostic Reasoning - 2026/2027
2026/2027 Edition
Q1 Question 1 of 75
A 62-year-old male presents to the primary care clinic with a persistent cough lasting eight weeks and
progressive dyspnea on exertion. He reports a 40-pack-year smoking history and occupational exposure to
asbestos during his 30-year career in shipbuilding. On auscultation, bilateral fine crackles are heard at the
lung bases. Which diagnostic finding would most strongly support a diagnosis of asbestosis rather than
COPD?
A. Forced expiratory volume in 1 second (FEV1) less than 70% of predicted
B. Residual volume increased to 180% of predicted
C. Diffusing capacity for carbon monoxide (DLCO) significantly reduced with restrictive pattern on
PFTs
D. FEV1/FVC ratio of 0.55 on spirometry
Correct Answer: C
Rationale:
Asbestosis produces a restrictive pattern with reduced DLCO, distinguishing it from COPD which shows an
obstructive pattern with reduced FEV1/FVC ratio and increased residual volume. The reduced DLCO reflects
interstitial fibrosis impairing gas exchange, while an FEV1/FVC ratio below 0.70 is characteristic of obstructive
disease.
Q2 Question 2 of 75
A 45-year-old female with a body mass index of 34 kg/m2 presents complaining of excessive daytime
sleepiness, morning headaches, and witnessed apneic episodes during sleep. Her neck circumference
measures 17 inches. Which diagnostic study is the gold standard for confirming the suspected diagnosis?
A. Overnight pulse oximetry monitoring at home
B. Multiple sleep latency test performed during daytime hours
C. Polysomnography in an accredited sleep laboratory
D. Arterial blood gas analysis obtained during waking hours
Correct Answer: C
Rationale:
Polysomnography is the gold standard for diagnosing obstructive sleep apnea because it simultaneously records
brain activity, eye movements, muscle activity, heart rhythm, airflow, and oxygen saturation during sleep. Home
pulse oximetry can miss events and lacks electroencephalographic data, while daytime ABG cannot capture
sleep-related events.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 2
,Q3 Question 3 of 75
A 58-year-old male with known COPD presents to the emergency department with acute worsening of
dyspnea, increased sputum production, and a change in sputum color from white to yellow-green over the
past three days. Arterial blood gas reveals pH 7.33, PaCO2 55 mmHg, PaO2 58 mmHg, and HCO3 28
mEq/L. What is the most accurate interpretation of these results?
A. Acute respiratory alkalosis with metabolic compensation
B. Uncompensated metabolic acidosis with respiratory compensation
C. Acute-on-chronic respiratory acidosis with partial renal compensation
D. Acute respiratory failure with normal compensatory mechanisms
Correct Answer: C
Rationale:
The elevated PaCO2 with acidic pH indicates acute respiratory acidosis, while the elevated bicarbonate suggests
chronic renal compensation typical of COPD patients who retain CO2 at baseline. The acute worsening with
still-acidic pH indicates an acute exacerbation superimposed on chronic respiratory acidosis, not a fully
compensated state.
Q4 Question 4 of 75
A 34-year-old female presents with acute onset pleuritic chest pain, dyspnea, and hemoptysis 10 days after
an uncomplicated cesarean section. Her heart rate is 118 bpm and respiratory rate is 26 breaths per minute.
Which diagnostic finding would most definitively confirm the suspected diagnosis of pulmonary embolism?
A. Elevated D-dimer level exceeding 500 ng/mL
B. S1Q3T3 pattern on 12-lead electrocardiogram
C. Positive computed tomography pulmonary angiogram showing a filling defect
D. Ventilation-perfusion scan showing a single matched defect
Correct Answer: C
Rationale:
CT pulmonary angiogram demonstrating a filling defect is the most definitive diagnostic finding for pulmonary
embolism, directly visualizing the thrombus within the pulmonary vasculature. D-dimer is sensitive but not
specific, the S1Q3T3 pattern is neither sensitive nor specific, and a single matched defect on V/Q scan is less
definitive.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 3
, Q5 Question 5 of 75
A 71-year-old male is admitted with community-acquired pneumonia. On day two, his oxygen saturation
drops to 85% on room air, respiratory rate increases to 34, and he becomes confused. Arterial blood gas
shows PaO2 54 mmHg on a non-rebreather mask at 15 liters per minute. According to the Berlin criteria,
which finding is required to diagnose acute respiratory distress syndrome?
A. PaO2/FiO2 ratio greater than 300 mmHg
B. Pulmonary capillary wedge pressure greater than 18 mmHg
C. Bilateral infiltrates on chest radiograph not fully explained by cardiac failure
D. Onset of symptoms within 72 hours of hospital admission
Correct Answer: C
Rationale:
The Berlin criteria require bilateral infiltrates not fully explained by cardiac failure, acute onset within one week,
and PaO2/FiO2 ratio of 300 mmHg or less with PEEP of 5 cmH2O or more. A wedge pressure greater than 18
mmHg would suggest cardiogenic pulmonary edema rather than ARDS, and a PaO2/FiO2 above 300 excludes
ARDS.
Q6 Question 6 of 75
A 55-year-old male with a 30-pack-year smoking history undergoes spirometry as part of a preoperative
evaluation for abdominal surgery. The results show FEV1 65% of predicted, FVC 80% of predicted, and
FEV1/FVC ratio 0.68. How should these results be classified?
A. Mild obstructive defect with normal lung volumes
B. Mild restrictive defect with preserved flow rates
C. Moderate obstructive defect with reduced FEV1
D. Moderate restrictive defect with air trapping
Correct Answer: C
Rationale:
An FEV1/FVC ratio below 0.70 confirms obstruction, and an FEV1 of 65% of predicted classifies this as
moderate obstruction per GOLD guidelines. The FVC is relatively preserved, which is characteristic of obstructive
rather than restrictive disease, where FVC would be reduced with a normal or elevated FEV1/FVC ratio.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 4
NR 603 Week 2 Case Discussion:
Pulmonary (Part One)
Official Practice Exam - 2026/2027 Edition
75 Questions | 90 Minutes | Passing Score: 80% | Recertification Exam
TABLE OF CONTENTS
Section 1: Respiratory Assessment & Diagnostic Reasoning (15 Questions)
Section 2: Obstructive Airway Diseases (18 Questions)
Section 3: Restrictive & Interstitial Lung Diseases (15 Questions)
Section 4: Pulmonary Infections & Acute Conditions (15 Questions)
Section 5: Pulmonary Pharmacology & Collaborative Management (12 Questions)
EXAM INSTRUCTIONS
1. This exam contains 75 multiple-choice questions. Select the ONE best answer for each question.
2. You have 90 minutes to complete the exam. Pace yourself at approximately 1.2 minutes per question.
3. A passing score of 80% (60 correct out of 75) is required. Each question is worth equal points.
4. Read each scenario carefully before selecting your answer. All options are plausible but only one is best.
5. The correct answer and rationale are provided immediately after each question for study purposes.
6. No penalties for incorrect answers. Answer every question even if uncertain.
7. Review the rationale for each question, including why the top distractor is incorrect.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Respiratory Assessment & Diagnostic Reasoning - 2026/2027
2026/2027 Edition
Q1 Question 1 of 75
A 62-year-old male presents to the primary care clinic with a persistent cough lasting eight weeks and
progressive dyspnea on exertion. He reports a 40-pack-year smoking history and occupational exposure to
asbestos during his 30-year career in shipbuilding. On auscultation, bilateral fine crackles are heard at the
lung bases. Which diagnostic finding would most strongly support a diagnosis of asbestosis rather than
COPD?
A. Forced expiratory volume in 1 second (FEV1) less than 70% of predicted
B. Residual volume increased to 180% of predicted
C. Diffusing capacity for carbon monoxide (DLCO) significantly reduced with restrictive pattern on
PFTs
D. FEV1/FVC ratio of 0.55 on spirometry
Correct Answer: C
Rationale:
Asbestosis produces a restrictive pattern with reduced DLCO, distinguishing it from COPD which shows an
obstructive pattern with reduced FEV1/FVC ratio and increased residual volume. The reduced DLCO reflects
interstitial fibrosis impairing gas exchange, while an FEV1/FVC ratio below 0.70 is characteristic of obstructive
disease.
Q2 Question 2 of 75
A 45-year-old female with a body mass index of 34 kg/m2 presents complaining of excessive daytime
sleepiness, morning headaches, and witnessed apneic episodes during sleep. Her neck circumference
measures 17 inches. Which diagnostic study is the gold standard for confirming the suspected diagnosis?
A. Overnight pulse oximetry monitoring at home
B. Multiple sleep latency test performed during daytime hours
C. Polysomnography in an accredited sleep laboratory
D. Arterial blood gas analysis obtained during waking hours
Correct Answer: C
Rationale:
Polysomnography is the gold standard for diagnosing obstructive sleep apnea because it simultaneously records
brain activity, eye movements, muscle activity, heart rhythm, airflow, and oxygen saturation during sleep. Home
pulse oximetry can miss events and lacks electroencephalographic data, while daytime ABG cannot capture
sleep-related events.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 2
,Q3 Question 3 of 75
A 58-year-old male with known COPD presents to the emergency department with acute worsening of
dyspnea, increased sputum production, and a change in sputum color from white to yellow-green over the
past three days. Arterial blood gas reveals pH 7.33, PaCO2 55 mmHg, PaO2 58 mmHg, and HCO3 28
mEq/L. What is the most accurate interpretation of these results?
A. Acute respiratory alkalosis with metabolic compensation
B. Uncompensated metabolic acidosis with respiratory compensation
C. Acute-on-chronic respiratory acidosis with partial renal compensation
D. Acute respiratory failure with normal compensatory mechanisms
Correct Answer: C
Rationale:
The elevated PaCO2 with acidic pH indicates acute respiratory acidosis, while the elevated bicarbonate suggests
chronic renal compensation typical of COPD patients who retain CO2 at baseline. The acute worsening with
still-acidic pH indicates an acute exacerbation superimposed on chronic respiratory acidosis, not a fully
compensated state.
Q4 Question 4 of 75
A 34-year-old female presents with acute onset pleuritic chest pain, dyspnea, and hemoptysis 10 days after
an uncomplicated cesarean section. Her heart rate is 118 bpm and respiratory rate is 26 breaths per minute.
Which diagnostic finding would most definitively confirm the suspected diagnosis of pulmonary embolism?
A. Elevated D-dimer level exceeding 500 ng/mL
B. S1Q3T3 pattern on 12-lead electrocardiogram
C. Positive computed tomography pulmonary angiogram showing a filling defect
D. Ventilation-perfusion scan showing a single matched defect
Correct Answer: C
Rationale:
CT pulmonary angiogram demonstrating a filling defect is the most definitive diagnostic finding for pulmonary
embolism, directly visualizing the thrombus within the pulmonary vasculature. D-dimer is sensitive but not
specific, the S1Q3T3 pattern is neither sensitive nor specific, and a single matched defect on V/Q scan is less
definitive.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 3
, Q5 Question 5 of 75
A 71-year-old male is admitted with community-acquired pneumonia. On day two, his oxygen saturation
drops to 85% on room air, respiratory rate increases to 34, and he becomes confused. Arterial blood gas
shows PaO2 54 mmHg on a non-rebreather mask at 15 liters per minute. According to the Berlin criteria,
which finding is required to diagnose acute respiratory distress syndrome?
A. PaO2/FiO2 ratio greater than 300 mmHg
B. Pulmonary capillary wedge pressure greater than 18 mmHg
C. Bilateral infiltrates on chest radiograph not fully explained by cardiac failure
D. Onset of symptoms within 72 hours of hospital admission
Correct Answer: C
Rationale:
The Berlin criteria require bilateral infiltrates not fully explained by cardiac failure, acute onset within one week,
and PaO2/FiO2 ratio of 300 mmHg or less with PEEP of 5 cmH2O or more. A wedge pressure greater than 18
mmHg would suggest cardiogenic pulmonary edema rather than ARDS, and a PaO2/FiO2 above 300 excludes
ARDS.
Q6 Question 6 of 75
A 55-year-old male with a 30-pack-year smoking history undergoes spirometry as part of a preoperative
evaluation for abdominal surgery. The results show FEV1 65% of predicted, FVC 80% of predicted, and
FEV1/FVC ratio 0.68. How should these results be classified?
A. Mild obstructive defect with normal lung volumes
B. Mild restrictive defect with preserved flow rates
C. Moderate obstructive defect with reduced FEV1
D. Moderate restrictive defect with air trapping
Correct Answer: C
Rationale:
An FEV1/FVC ratio below 0.70 confirms obstruction, and an FEV1 of 65% of predicted classifies this as
moderate obstruction per GOLD guidelines. The FVC is relatively preserved, which is characteristic of obstructive
rather than restrictive disease, where FVC would be reduced with a normal or elevated FEV1/FVC ratio.
NR 603 Pulmonary Case Discussion - 2026/2027 | Passing Score: 80% | Page 4
