NSG3130 Exam 2 - Fundamental Concepts and Skills for Nursing
Practice II
Galen College of Nursing | 2026/2027 Curriculum Aligned
75 Questions | Verified Answers with Comprehensive Rationales
Section 1: Oxygenation and Respiratory Nursing Care
Q1. A patient is receiving oxygen via a non-rebreather mask at 12 L/min. The nurse understands that this device
delivers approximately which FiO2 range?
A. 35-50%
B. 40-60%
C. 60-90% [CORRECT]
D. 24-40%
Correct Answer: C
Rationale: A non-rebreather mask delivers 60-90% FiO2 at flow rates of 10-15 L/min. It has a one-way valve and reservoir bag that
prevents exhaled air from mixing with the oxygen supply, maximizing the concentration of oxygen delivered. A simple face mask delivers
35-50% at 5-10 L/min, a partial rebreather delivers 40-60% at 6-10 L/min, and a Venturi mask delivers precise FiO2 of 24-50%.
Q2. The nurse is assessing a patient and auscultates crackles (rales) bilaterally in the lung bases. The nurse understands
that crackles are most commonly associated with which condition?
A. Asthma
B. Chronic bronchitis
C. Heart failure or fluid overload [CORRECT]
D. Pulmonary fibrosis
Correct Answer: C
Rationale: Crackles (formerly called rales) are discontinuous popping sounds heard primarily on inspiration and are caused by fluid or
secretions in the small airways and alveoli. They are most commonly associated with heart failure, pulmonary edema, pneumonia, and
fluid overload. Wheezes are associated with asthma and bronchitis. Rhonchi are heard with chronic bronchitis and secretions in larger
airways. Pulmonary fibrosis produces dry, fine crackles but the most common and classic association is fluid in the alveoli from heart
failure.
Q3. A postoperative patient has a SpO2 reading of 88% on room air. Which of the following is the correct nursing
action?
A. Encourage the patient to increase fluid intake
B. Apply supplemental oxygen and reassess [CORRECT]
C. Document the finding and continue to monitor
D. Have the patient cough and deep breathe without supplemental oxygen
Correct Answer: B
Rationale: A SpO2 below 90% indicates hypoxemia requiring immediate intervention. The nurse should first apply supplemental oxygen to
correct the hypoxemia and then reassess. While coughing, deep breathing, and hydration are important respiratory interventions, the
priority is to address the hypoxemia with oxygen. Simply documenting without intervening would be unsafe as hypoxemia can lead to
tissue hypoxia and end-organ damage.
Q4. The nurse is preparing to suction a patient with an endotracheal tube. Which of the following is the correct
technique?
, A. Suction continuously for 30 seconds while rotating the catheter
B. Pre-oxygenate with 100% FiO2, suction for no more than 10-15 seconds, and monitor SpO2 and heart rate
[CORRECT]
C. Apply suction only during insertion of the catheter into the airway
D. Suction without pre-oxygenation if the patient has adequate SpO2 levels
Correct Answer: B
Rationale: The correct suctioning technique involves pre-oxygenating the patient with 100% FiO2 before suctioning to prevent hypoxemia,
inserting the catheter without suction, applying suction intermittently while withdrawing and rotating the catheter, limiting suctioning to
10-15 seconds maximum for adults, and monitoring SpO2 and heart rate throughout. Suctioning for 30 seconds is excessive and
dangerous. Suction is applied during withdrawal, not insertion. Pre-oxygenation is always required regardless of baseline SpO2 to create
an oxygen reserve.
Q5. A patient with COPD is prescribed oxygen at 2 L/min via nasal cannula. The patient asks the nurse why the flow
rate is kept low. What is the best response by the nurse?
A. High oxygen flow rates can cause oxygen toxicity and damage your lungs permanently
B. Your lungs have adapted to lower oxygen levels, and too much oxygen can suppress your drive to breathe
[CORRECT]
C. High flow rates will dry out your nasal passages and cause nosebleeds
D. The medication you are taking interacts with high oxygen levels
Correct Answer: B
Rationale: Patients with COPD often have chronic hypercapnia (elevated CO2) and rely on a hypoxic drive to stimulate respiration. Their
primary respiratory stimulus becomes low PO2 rather than elevated PCO2. Administering high-flow oxygen can eliminate this hypoxic
stimulus, leading to decreased ventilatory drive, further CO2 retention, and potentially respiratory failure. This is why COPD patients
typically receive low-flow oxygen (1-3 L/min). Oxygen toxicity occurs with prolonged FiO2 greater than 50%, not the low flow rates used
here.
Q6. The nurse is teaching a patient how to use an incentive spirometer postoperatively. Which of the following
instructions is correct?
A. Exhale fully into the spirometer to achieve the goal volume
B. Inhale slowly and deeply to raise the piston to the goal marker, hold for 2-3 seconds, and exhale normally
[CORRECT]
C. Use the incentive spirometer once per shift to prevent fatigue
D. Rapidly inhale to move the piston as quickly as possible
Correct Answer: B
Rationale: The correct technique for incentive spirometry is to place the mouthpiece in the mouth, exhale normally, then inhale slowly and
deeply to raise the flow-oriented piston or volume-oriented indicator to the preset goal. The patient should hold the breath for 2-3 seconds
and then exhale normally. The goal is 10-15 breaths per hour while awake. Slow, sustained maximal inspiration prevents atelectasis by
fully expanding the alveoli. Rapid inhalation or exhaling into the device are incorrect techniques.
Q7. A patient presents with sudden onset of dyspnea, pleuritic chest pain, and hemoptysis. The patient was recently
discharged after knee replacement surgery. The nurse should suspect which condition?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism [CORRECT]
D. Tension pneumothorax
Correct Answer: C
Rationale: Sudden onset of dyspnea, pleuritic chest pain (sharp, worsens with inspiration), and hemoptysis in a patient with recent surgery
(knee replacement) and immobility are the classic triad of pulmonary embolism (PE). Post-surgical patients are at increased risk for deep
, vein thrombosis (DVT) and PE due to venous stasis, endothelial injury, and hypercoagulability (Virchow triad). Atelectasis causes
dyspnea but not typically hemoptysis or pleuritic pain. Pneumonia has a more subacute onset with fever and productive cough. Tension
pneumothorax causes sudden dyspnea and tracheal deviation.
Q8. The nurse is caring for a patient on mechanical ventilation in the assist-control (AC) mode. The nurse understands
that in AC mode, the ventilator:
A. Delivers a set pressure during inspiration regardless of patient effort
B. Delivers a set tidal volume with each breath, whether triggered by the patient or the backup rate [CORRECT]
C. Provides pressure support only when the patient initiates a breath
D. Delivers a set number of breaths but the patient cannot trigger additional breaths
Correct Answer: B
Rationale: In assist-control (AC) mode, the ventilator delivers a preset tidal volume at a minimum set rate. The patient can trigger
additional breaths above the set rate, and each triggered breath will deliver the full set tidal volume. This ensures a minimum minute
ventilation. CPAP provides continuous positive pressure without a set tidal volume. Pressure support provides assistance only with
patient-initiated breaths. SIMV delivers a set number of mandatory breaths with the patient able to take spontaneous breaths between them
at their own tidal volume.
Q9. A patient has a tracheostomy tube in place. Which of the following is an essential component of emergency
equipment that must be kept at the bedside?
A. A spare bag-valve-mask device only
B. An obturator and a replacement tracheostomy tube of the same size and one size smaller [CORRECT]
C. A suction machine with sterile catheters only
D. A portable ventilator
Correct Answer: B
Rationale: Emergency equipment at the bedside of a patient with a tracheostomy must include an obturator (used to guide insertion of the
tracheostomy tube), a replacement tracheostomy tube of the same size (for accidental decannulation), and a replacement tube one size
smaller (in case the same size cannot be inserted due to stoma narrowing). Suction equipment is also essential but alone is insufficient. A
bag-valve-mask is needed but cannot ventilate through a tracheostomy stoma without the tube in place.
Q10. The nurse assesses a patient and finds the trachea deviated toward the right side of the neck. The nurse
understands that tracheal deviation toward the affected side suggests which condition?
A. Right-sided tension pneumothorax
B. Left-sided pleural effusion
C. Right-sided atelectasis or fibrosis [CORRECT]
D. Left-sided tension pneumothorax
Correct Answer: C
Rationale: Tracheal deviation occurs when pressure in the thoracic cavity shifts the mediastinum. Tracheal deviation toward the affected
side is caused by conditions that collapse or reduce lung volume on that side, such as atelectasis, fibrosis, or pleural effusion. The lung
pulls the trachea toward it. In contrast, tracheal deviation away from the affected side occurs with tension pneumothorax or large pleural
effusion, where pressure pushes the mediastinum to the opposite side.
Q11. The nurse is caring for a patient with a Venturi mask set at 40% FiO2. The nurse understands that the primary
advantage of a Venturi mask over other oxygen delivery devices is:
A. It can deliver the highest possible FiO2 of any device
B. It delivers a precise and consistent FiO2 regardless of the patient breathing pattern [CORRECT]
C. It is the most comfortable device for long-term use
D. It does not require a physician order to adjust
Correct Answer: B
Practice II
Galen College of Nursing | 2026/2027 Curriculum Aligned
75 Questions | Verified Answers with Comprehensive Rationales
Section 1: Oxygenation and Respiratory Nursing Care
Q1. A patient is receiving oxygen via a non-rebreather mask at 12 L/min. The nurse understands that this device
delivers approximately which FiO2 range?
A. 35-50%
B. 40-60%
C. 60-90% [CORRECT]
D. 24-40%
Correct Answer: C
Rationale: A non-rebreather mask delivers 60-90% FiO2 at flow rates of 10-15 L/min. It has a one-way valve and reservoir bag that
prevents exhaled air from mixing with the oxygen supply, maximizing the concentration of oxygen delivered. A simple face mask delivers
35-50% at 5-10 L/min, a partial rebreather delivers 40-60% at 6-10 L/min, and a Venturi mask delivers precise FiO2 of 24-50%.
Q2. The nurse is assessing a patient and auscultates crackles (rales) bilaterally in the lung bases. The nurse understands
that crackles are most commonly associated with which condition?
A. Asthma
B. Chronic bronchitis
C. Heart failure or fluid overload [CORRECT]
D. Pulmonary fibrosis
Correct Answer: C
Rationale: Crackles (formerly called rales) are discontinuous popping sounds heard primarily on inspiration and are caused by fluid or
secretions in the small airways and alveoli. They are most commonly associated with heart failure, pulmonary edema, pneumonia, and
fluid overload. Wheezes are associated with asthma and bronchitis. Rhonchi are heard with chronic bronchitis and secretions in larger
airways. Pulmonary fibrosis produces dry, fine crackles but the most common and classic association is fluid in the alveoli from heart
failure.
Q3. A postoperative patient has a SpO2 reading of 88% on room air. Which of the following is the correct nursing
action?
A. Encourage the patient to increase fluid intake
B. Apply supplemental oxygen and reassess [CORRECT]
C. Document the finding and continue to monitor
D. Have the patient cough and deep breathe without supplemental oxygen
Correct Answer: B
Rationale: A SpO2 below 90% indicates hypoxemia requiring immediate intervention. The nurse should first apply supplemental oxygen to
correct the hypoxemia and then reassess. While coughing, deep breathing, and hydration are important respiratory interventions, the
priority is to address the hypoxemia with oxygen. Simply documenting without intervening would be unsafe as hypoxemia can lead to
tissue hypoxia and end-organ damage.
Q4. The nurse is preparing to suction a patient with an endotracheal tube. Which of the following is the correct
technique?
, A. Suction continuously for 30 seconds while rotating the catheter
B. Pre-oxygenate with 100% FiO2, suction for no more than 10-15 seconds, and monitor SpO2 and heart rate
[CORRECT]
C. Apply suction only during insertion of the catheter into the airway
D. Suction without pre-oxygenation if the patient has adequate SpO2 levels
Correct Answer: B
Rationale: The correct suctioning technique involves pre-oxygenating the patient with 100% FiO2 before suctioning to prevent hypoxemia,
inserting the catheter without suction, applying suction intermittently while withdrawing and rotating the catheter, limiting suctioning to
10-15 seconds maximum for adults, and monitoring SpO2 and heart rate throughout. Suctioning for 30 seconds is excessive and
dangerous. Suction is applied during withdrawal, not insertion. Pre-oxygenation is always required regardless of baseline SpO2 to create
an oxygen reserve.
Q5. A patient with COPD is prescribed oxygen at 2 L/min via nasal cannula. The patient asks the nurse why the flow
rate is kept low. What is the best response by the nurse?
A. High oxygen flow rates can cause oxygen toxicity and damage your lungs permanently
B. Your lungs have adapted to lower oxygen levels, and too much oxygen can suppress your drive to breathe
[CORRECT]
C. High flow rates will dry out your nasal passages and cause nosebleeds
D. The medication you are taking interacts with high oxygen levels
Correct Answer: B
Rationale: Patients with COPD often have chronic hypercapnia (elevated CO2) and rely on a hypoxic drive to stimulate respiration. Their
primary respiratory stimulus becomes low PO2 rather than elevated PCO2. Administering high-flow oxygen can eliminate this hypoxic
stimulus, leading to decreased ventilatory drive, further CO2 retention, and potentially respiratory failure. This is why COPD patients
typically receive low-flow oxygen (1-3 L/min). Oxygen toxicity occurs with prolonged FiO2 greater than 50%, not the low flow rates used
here.
Q6. The nurse is teaching a patient how to use an incentive spirometer postoperatively. Which of the following
instructions is correct?
A. Exhale fully into the spirometer to achieve the goal volume
B. Inhale slowly and deeply to raise the piston to the goal marker, hold for 2-3 seconds, and exhale normally
[CORRECT]
C. Use the incentive spirometer once per shift to prevent fatigue
D. Rapidly inhale to move the piston as quickly as possible
Correct Answer: B
Rationale: The correct technique for incentive spirometry is to place the mouthpiece in the mouth, exhale normally, then inhale slowly and
deeply to raise the flow-oriented piston or volume-oriented indicator to the preset goal. The patient should hold the breath for 2-3 seconds
and then exhale normally. The goal is 10-15 breaths per hour while awake. Slow, sustained maximal inspiration prevents atelectasis by
fully expanding the alveoli. Rapid inhalation or exhaling into the device are incorrect techniques.
Q7. A patient presents with sudden onset of dyspnea, pleuritic chest pain, and hemoptysis. The patient was recently
discharged after knee replacement surgery. The nurse should suspect which condition?
A. Atelectasis
B. Pneumonia
C. Pulmonary embolism [CORRECT]
D. Tension pneumothorax
Correct Answer: C
Rationale: Sudden onset of dyspnea, pleuritic chest pain (sharp, worsens with inspiration), and hemoptysis in a patient with recent surgery
(knee replacement) and immobility are the classic triad of pulmonary embolism (PE). Post-surgical patients are at increased risk for deep
, vein thrombosis (DVT) and PE due to venous stasis, endothelial injury, and hypercoagulability (Virchow triad). Atelectasis causes
dyspnea but not typically hemoptysis or pleuritic pain. Pneumonia has a more subacute onset with fever and productive cough. Tension
pneumothorax causes sudden dyspnea and tracheal deviation.
Q8. The nurse is caring for a patient on mechanical ventilation in the assist-control (AC) mode. The nurse understands
that in AC mode, the ventilator:
A. Delivers a set pressure during inspiration regardless of patient effort
B. Delivers a set tidal volume with each breath, whether triggered by the patient or the backup rate [CORRECT]
C. Provides pressure support only when the patient initiates a breath
D. Delivers a set number of breaths but the patient cannot trigger additional breaths
Correct Answer: B
Rationale: In assist-control (AC) mode, the ventilator delivers a preset tidal volume at a minimum set rate. The patient can trigger
additional breaths above the set rate, and each triggered breath will deliver the full set tidal volume. This ensures a minimum minute
ventilation. CPAP provides continuous positive pressure without a set tidal volume. Pressure support provides assistance only with
patient-initiated breaths. SIMV delivers a set number of mandatory breaths with the patient able to take spontaneous breaths between them
at their own tidal volume.
Q9. A patient has a tracheostomy tube in place. Which of the following is an essential component of emergency
equipment that must be kept at the bedside?
A. A spare bag-valve-mask device only
B. An obturator and a replacement tracheostomy tube of the same size and one size smaller [CORRECT]
C. A suction machine with sterile catheters only
D. A portable ventilator
Correct Answer: B
Rationale: Emergency equipment at the bedside of a patient with a tracheostomy must include an obturator (used to guide insertion of the
tracheostomy tube), a replacement tracheostomy tube of the same size (for accidental decannulation), and a replacement tube one size
smaller (in case the same size cannot be inserted due to stoma narrowing). Suction equipment is also essential but alone is insufficient. A
bag-valve-mask is needed but cannot ventilate through a tracheostomy stoma without the tube in place.
Q10. The nurse assesses a patient and finds the trachea deviated toward the right side of the neck. The nurse
understands that tracheal deviation toward the affected side suggests which condition?
A. Right-sided tension pneumothorax
B. Left-sided pleural effusion
C. Right-sided atelectasis or fibrosis [CORRECT]
D. Left-sided tension pneumothorax
Correct Answer: C
Rationale: Tracheal deviation occurs when pressure in the thoracic cavity shifts the mediastinum. Tracheal deviation toward the affected
side is caused by conditions that collapse or reduce lung volume on that side, such as atelectasis, fibrosis, or pleural effusion. The lung
pulls the trachea toward it. In contrast, tracheal deviation away from the affected side occurs with tension pneumothorax or large pleural
effusion, where pressure pushes the mediastinum to the opposite side.
Q11. The nurse is caring for a patient with a Venturi mask set at 40% FiO2. The nurse understands that the primary
advantage of a Venturi mask over other oxygen delivery devices is:
A. It can deliver the highest possible FiO2 of any device
B. It delivers a precise and consistent FiO2 regardless of the patient breathing pattern [CORRECT]
C. It is the most comfortable device for long-term use
D. It does not require a physician order to adjust
Correct Answer: B
