NUR257 Chronic Exam 4 Galen College of
Nursing Fall 2025/2026 Actual Exam 2026/2027
| Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
Section 1: Chronic Respiratory Disorders (COPD, Asthma, Oxygen
Therapy, ABGs) — 9 Questions
Q1: A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes a respiratory rate of 10 breaths per minute and a drowsy patient. What is the
priority nursing action?
A. Increase the oxygen flow to 6 L/min to improve oxygenation
B. Reassess the oxygen flow rate and reduce to 1-2 L/min as tolerated
C. Administer a bronchodilator immediately
D. Place the patient in supine position to promote rest
Correct Answer: B
Rationale: Correct because COPD patients rely on a hypoxic drive to breathe; excessive
oxygen administration suppresses the respiratory drive, leading to hypoventilation and
,CO₂ retention. The priority is to reassess and titrate oxygen to maintain SpO₂ 88-92% at
1-2 L/min. This matches NUR 257 Exam 4 content on COPD oxygen management.
Q2: A nurse is teaching a patient with COPD about self-management techniques. Which
statement by the patient indicates understanding of pursed-lip breathing?
A. "I should breathe in quickly through pursed lips and out through my nose."
B. "I should breathe in through my nose for two counts and out through pursed lips for
four counts."
C. "I should take rapid, shallow breaths through pursed lips."
D. "I should hold my breath for 10 seconds after each inhalation."
Correct Answer: B
Rationale: Correct because pursed-lip breathing involves slow inhalation through the
nose and prolonged exhalation through pursed lips, which creates positive
end-expiratory pressure to prevent airway collapse, improve gas exchange, and reduce
dyspnea. The pathophysiologic mechanism is maintaining airway patency during
exhalation in COPD.
Q3: A patient with COPD is experiencing acute dyspnea. Which position should the
nurse assist the patient into to maximize lung expansion?
A. Supine with the head of the bed flat
B. Orthopneic position with arms supported on an overbed table
C. Trendelenburg position
,D. Prone position
Correct Answer: B
Rationale: Correct because the orthopneic position (leaning forward with arms
supported) allows the diaphragm to descend more fully, maximizes thoracic expansion,
and decreases the work of breathing in patients with COPD. This matches NUR 257
Exam 4 content on positioning for respiratory distress.
Q4: A patient with COPD presents with the following ABG results: pH 7.30, PaCO₂ 55
mmHg, PaO₂ 68 mmHg, HCO₃⁻ 28 mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: Correct because a pH below 7.35 indicates acidosis, an elevated PaCO₂
above 45 mmHg indicates a respiratory cause, and an elevated HCO₃⁻ indicates
metabolic compensation. This pattern reflects CO₂ retention, which is characteristic of
COPD with chronic respiratory acidosis. The priority action is to address ventilation and
oxygenation.
Q5: A patient with asthma is experiencing an acute exacerbation. Which medication
should the nurse administer first?
A. Inhaled fluticasone (corticosteroid)
, B. Inhaled albuterol (short-acting beta-agonist)
C. Oral montelukast (leukotriene receptor antagonist)
D. Intravenous theophylline
Correct Answer: B
Rationale: Correct because albuterol is a short-acting beta-agonist (SABA) that provides
rapid bronchodilation by relaxing smooth muscle spasm, making it the first-line
treatment for acute bronchospasm in asthma. The pathophysiologic mechanism
involves beta-2 receptor agonism to reverse acute airway obstruction.
Q6: A patient with severe asthma is receiving treatment in the emergency department.
The nurse notes that the patient's wheezing has suddenly stopped, but the patient
appears increasingly anxious and cyanotic. What is the nurse's priority action?
A. Document that the asthma attack is resolving
B. Prepare for emergency intubation and notify the provider immediately
C. Administer a sedative to reduce anxiety
D. Discontinue bronchodilator therapy
Correct Answer: B
Rationale: Correct because the sudden cessation of wheezing in severe asthma
indicates worsening airway obstruction to the point of minimal air movement (silent
chest), which is a life-threatening sign of impending respiratory failure. The priority
action is to prepare for emergency intubation and notify the provider immediately.
Nursing Fall 2025/2026 Actual Exam 2026/2027
| Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
Section 1: Chronic Respiratory Disorders (COPD, Asthma, Oxygen
Therapy, ABGs) — 9 Questions
Q1: A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse
notes a respiratory rate of 10 breaths per minute and a drowsy patient. What is the
priority nursing action?
A. Increase the oxygen flow to 6 L/min to improve oxygenation
B. Reassess the oxygen flow rate and reduce to 1-2 L/min as tolerated
C. Administer a bronchodilator immediately
D. Place the patient in supine position to promote rest
Correct Answer: B
Rationale: Correct because COPD patients rely on a hypoxic drive to breathe; excessive
oxygen administration suppresses the respiratory drive, leading to hypoventilation and
,CO₂ retention. The priority is to reassess and titrate oxygen to maintain SpO₂ 88-92% at
1-2 L/min. This matches NUR 257 Exam 4 content on COPD oxygen management.
Q2: A nurse is teaching a patient with COPD about self-management techniques. Which
statement by the patient indicates understanding of pursed-lip breathing?
A. "I should breathe in quickly through pursed lips and out through my nose."
B. "I should breathe in through my nose for two counts and out through pursed lips for
four counts."
C. "I should take rapid, shallow breaths through pursed lips."
D. "I should hold my breath for 10 seconds after each inhalation."
Correct Answer: B
Rationale: Correct because pursed-lip breathing involves slow inhalation through the
nose and prolonged exhalation through pursed lips, which creates positive
end-expiratory pressure to prevent airway collapse, improve gas exchange, and reduce
dyspnea. The pathophysiologic mechanism is maintaining airway patency during
exhalation in COPD.
Q3: A patient with COPD is experiencing acute dyspnea. Which position should the
nurse assist the patient into to maximize lung expansion?
A. Supine with the head of the bed flat
B. Orthopneic position with arms supported on an overbed table
C. Trendelenburg position
,D. Prone position
Correct Answer: B
Rationale: Correct because the orthopneic position (leaning forward with arms
supported) allows the diaphragm to descend more fully, maximizes thoracic expansion,
and decreases the work of breathing in patients with COPD. This matches NUR 257
Exam 4 content on positioning for respiratory distress.
Q4: A patient with COPD presents with the following ABG results: pH 7.30, PaCO₂ 55
mmHg, PaO₂ 68 mmHg, HCO₃⁻ 28 mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Rationale: Correct because a pH below 7.35 indicates acidosis, an elevated PaCO₂
above 45 mmHg indicates a respiratory cause, and an elevated HCO₃⁻ indicates
metabolic compensation. This pattern reflects CO₂ retention, which is characteristic of
COPD with chronic respiratory acidosis. The priority action is to address ventilation and
oxygenation.
Q5: A patient with asthma is experiencing an acute exacerbation. Which medication
should the nurse administer first?
A. Inhaled fluticasone (corticosteroid)
, B. Inhaled albuterol (short-acting beta-agonist)
C. Oral montelukast (leukotriene receptor antagonist)
D. Intravenous theophylline
Correct Answer: B
Rationale: Correct because albuterol is a short-acting beta-agonist (SABA) that provides
rapid bronchodilation by relaxing smooth muscle spasm, making it the first-line
treatment for acute bronchospasm in asthma. The pathophysiologic mechanism
involves beta-2 receptor agonism to reverse acute airway obstruction.
Q6: A patient with severe asthma is receiving treatment in the emergency department.
The nurse notes that the patient's wheezing has suddenly stopped, but the patient
appears increasingly anxious and cyanotic. What is the nurse's priority action?
A. Document that the asthma attack is resolving
B. Prepare for emergency intubation and notify the provider immediately
C. Administer a sedative to reduce anxiety
D. Discontinue bronchodilator therapy
Correct Answer: B
Rationale: Correct because the sudden cessation of wheezing in severe asthma
indicates worsening airway obstruction to the point of minimal air movement (silent
chest), which is a life-threatening sign of impending respiratory failure. The priority
action is to prepare for emergency intubation and notify the provider immediately.
