2026 ATI RESPIRATORY ACTUAL EXAM ASSESSMENT 80
QUESTION AND CORRECT DETAILED ANSWERS WITH
RATIONALES RATED A GRADE.
A nurse is assessing a patient who has a chest tube in place following a thoracic
surgery. Which of the following findings indicates a need for intervention?
1. Fluctuation of drainage in the tubing with inspiration.
2. Continuous bubbling in the water seal chamber.
3. Drainage of 75 mL in the first hour after surgery.
4. Several small, dark-red blood clots in the tubing.
CORRECT ANS: 2. Continuous bubbling in the water seal chamber.
Expert Rationale: A chest tube drainage system is a closed system that functions
to remove air and fluid from the pleural space and to restore negative pressure,
allowing for lung re-expansion. Continuous bubbling in the water seal chamber is
an abnormal finding that indicates an air leak in the system. This air leak can
originate from the patient's lung (bronchopleural fistula), a disconnection in the
tubing, or a loose connection at the insertion site. An air leak prevents the re-
establishment of negative intrapleural pressure, compromising lung re-expansion
and potentially leading to a pneumothorax. The nurse must assess the source of
the air leak and notify the provider immediately. In contrast, fluctuation (tidaling)
is an expected finding, as is 75 mL of drainage in the first hour post-operatively.
Small, dark-red blood clots are also an expected finding in the immediate post-
operative period, provided they do not obstruct the tubing.
A nurse is caring for an elderly patient who suffers from COPD with pneumonia.
The nurse should monitor the patient for which of the following acid-base
imbalances?
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
, 4. Metabolic acidosis
CORRECT ANS: 2. Respiratory acidosis.
Expert Rationale: Chronic Obstructive Pulmonary Disease (COPD) is characterized
by airflow limitation and loss of elastic recoil in the lungs, leading to air trapping
and impaired gas exchange. Patients with COPD have difficulty exhaling carbon
dioxide (CO2) effectively, resulting in chronic hypercapnia (elevated PaCO2). When
a patient with COPD develops a superimposed condition like pneumonia, the
increased respiratory demand and further compromise of gas exchange
exacerbate CO2 retention. This leads to a primary respiratory acidosis,
characterized by a decreased pH (below 7.35) and an elevated PaCO2 (above 45
mm Hg). The kidneys may attempt to compensate by retaining bicarbonate
(HCO3-), but this is a secondary response. Respiratory alkalosis, metabolic
alkalosis, and metabolic acidosis are not the primary acid-base disturbances
associated with this clinical presentation.
A nurse is preparing to administer cisplatin IV to a patient with lung cancer. The
nurse should identify that which of the following findings is an adverse effect of
this medication?
1. Hallucinations
2. Pruritis
3. Hand and foot syndrome
4. Tinnitus
CORRECT ANS: 4. Tinnitus.
Expert Rationale: Cisplatin is a platinum-based chemotherapeutic agent that is
highly effective against various malignancies, including lung cancer. However, it
carries a significant adverse effect profile. A well-documented and serious adverse
effect is ototoxicity, which is dose-related and can be irreversible. Ototoxicity
manifests as tinnitus (ringing in the ears), high-frequency hearing loss, and vertigo.
This occurs due to damage to the hair cells in the cochlea. The nurse must assess
for tinnitus before and during therapy, and the patient should be instructed to
,report any hearing changes immediately. While pruritis can occur, it is not a
hallmark of cisplatin. Hallucinations are not a typical adverse effect. Hand and foot
syndrome (palmar-plantar erythrodysesthesia) is associated with other
chemotherapeutic agents like capecitabine, not cisplatin.
A nurse is preparing to assist a provider to withdraw arterial blood from a patient's
radial artery for measurement of ABG. Which of the following actions should the
nurse plan to take?
1. Hyperventilate the patient with 100% oxygen prior to obtaining the
specimen.
2. Apply ice to the site after obtaining the specimen.
3. Perform an Allen's test prior to obtaining the specimen.
4. Release pressure applied to the puncture site 1 minute after the needle is
withdrawn.
CORRECT ANS: 3. Perform an Allen's test prior to obtaining the specimen.
Expert Rationale: An Allen's test is an essential and critical safety step before
performing a radial artery puncture for arterial blood gas (ABG) analysis. The
radial artery is a common site for arterial puncture, but it is a collateral artery; the
ulnar artery also supplies blood to the hand. The Allen's test assesses the patency
of the ulnar artery. The procedure involves occluding both the radial and ulnar
arteries, having the patient clench and release their fist to exsanguinate the hand,
and then releasing pressure on the ulnar artery. If the hand does not flush (return
to a pink color) within 5-15 seconds, the ulnar artery is compromised. If the ulnar
artery is not patent and the radial artery is injured or occluded during the
puncture, the patient is at risk for ischemia and necrosis of the hand.
Hyperventilation with oxygen is not a standard prerequisite. Applying ice to the
site after obtaining the specimen is not a recommended practice; pressure should
be applied for a minimum of 5 minutes (or longer if the patient is on
anticoagulants). The provider or nurse should apply firm pressure for at least 5
minutes to achieve hemostasis.
, A nurse is providing instructions about pursed-lip breathing for a patient who has
COPD with emphysema. The nurse should explain that this breathing technique
accomplishes which of the following:
1. Increases oxygen intake
2. Promotes carbon dioxide elimination
3. Uses the intercostal muscles
4. Strengthens the diaphragm
CORRECT ANS: 2. Promotes carbon dioxide elimination.
Expert Rationale: Pursed-lip breathing is a fundamental and effective breathing
technique taught to patients with COPD. It is a self-management strategy used to
control dyspnea and improve ventilation. The primary mechanism of action is to
prolong exhalation and keep the airways open by maintaining positive pressure in
the airways during expiration. This prevents premature airway collapse, which is a
common problem in emphysema due to the loss of elastic recoil. By keeping the
airways open, pursed-lip breathing facilitates the removal of trapped air and
promotes the elimination of carbon dioxide. The technique involves inhaling
slowly through the nose and exhaling slowly and gently through pursed lips, taking
at least twice as long to exhale as to inhale. It does not primarily increase oxygen
intake, nor does it specifically target the intercostal muscles or strengthen the
diaphragm; its main benefit is in improving gas exchange by prolonging expiration
and reducing air trapping.
A nurse is preparing a patient for a thoracentesis. In which of the following
positions should the nurse place the patient:
1. Lying flat on the affected site
2. Prone with arms raised over the head
3. Supine with the head of the bed elevated
4. Sitting while leaning forward over the bedside table
CORRECT ANS: 4. Sitting while leaning forward over the bedside table.
QUESTION AND CORRECT DETAILED ANSWERS WITH
RATIONALES RATED A GRADE.
A nurse is assessing a patient who has a chest tube in place following a thoracic
surgery. Which of the following findings indicates a need for intervention?
1. Fluctuation of drainage in the tubing with inspiration.
2. Continuous bubbling in the water seal chamber.
3. Drainage of 75 mL in the first hour after surgery.
4. Several small, dark-red blood clots in the tubing.
CORRECT ANS: 2. Continuous bubbling in the water seal chamber.
Expert Rationale: A chest tube drainage system is a closed system that functions
to remove air and fluid from the pleural space and to restore negative pressure,
allowing for lung re-expansion. Continuous bubbling in the water seal chamber is
an abnormal finding that indicates an air leak in the system. This air leak can
originate from the patient's lung (bronchopleural fistula), a disconnection in the
tubing, or a loose connection at the insertion site. An air leak prevents the re-
establishment of negative intrapleural pressure, compromising lung re-expansion
and potentially leading to a pneumothorax. The nurse must assess the source of
the air leak and notify the provider immediately. In contrast, fluctuation (tidaling)
is an expected finding, as is 75 mL of drainage in the first hour post-operatively.
Small, dark-red blood clots are also an expected finding in the immediate post-
operative period, provided they do not obstruct the tubing.
A nurse is caring for an elderly patient who suffers from COPD with pneumonia.
The nurse should monitor the patient for which of the following acid-base
imbalances?
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
, 4. Metabolic acidosis
CORRECT ANS: 2. Respiratory acidosis.
Expert Rationale: Chronic Obstructive Pulmonary Disease (COPD) is characterized
by airflow limitation and loss of elastic recoil in the lungs, leading to air trapping
and impaired gas exchange. Patients with COPD have difficulty exhaling carbon
dioxide (CO2) effectively, resulting in chronic hypercapnia (elevated PaCO2). When
a patient with COPD develops a superimposed condition like pneumonia, the
increased respiratory demand and further compromise of gas exchange
exacerbate CO2 retention. This leads to a primary respiratory acidosis,
characterized by a decreased pH (below 7.35) and an elevated PaCO2 (above 45
mm Hg). The kidneys may attempt to compensate by retaining bicarbonate
(HCO3-), but this is a secondary response. Respiratory alkalosis, metabolic
alkalosis, and metabolic acidosis are not the primary acid-base disturbances
associated with this clinical presentation.
A nurse is preparing to administer cisplatin IV to a patient with lung cancer. The
nurse should identify that which of the following findings is an adverse effect of
this medication?
1. Hallucinations
2. Pruritis
3. Hand and foot syndrome
4. Tinnitus
CORRECT ANS: 4. Tinnitus.
Expert Rationale: Cisplatin is a platinum-based chemotherapeutic agent that is
highly effective against various malignancies, including lung cancer. However, it
carries a significant adverse effect profile. A well-documented and serious adverse
effect is ototoxicity, which is dose-related and can be irreversible. Ototoxicity
manifests as tinnitus (ringing in the ears), high-frequency hearing loss, and vertigo.
This occurs due to damage to the hair cells in the cochlea. The nurse must assess
for tinnitus before and during therapy, and the patient should be instructed to
,report any hearing changes immediately. While pruritis can occur, it is not a
hallmark of cisplatin. Hallucinations are not a typical adverse effect. Hand and foot
syndrome (palmar-plantar erythrodysesthesia) is associated with other
chemotherapeutic agents like capecitabine, not cisplatin.
A nurse is preparing to assist a provider to withdraw arterial blood from a patient's
radial artery for measurement of ABG. Which of the following actions should the
nurse plan to take?
1. Hyperventilate the patient with 100% oxygen prior to obtaining the
specimen.
2. Apply ice to the site after obtaining the specimen.
3. Perform an Allen's test prior to obtaining the specimen.
4. Release pressure applied to the puncture site 1 minute after the needle is
withdrawn.
CORRECT ANS: 3. Perform an Allen's test prior to obtaining the specimen.
Expert Rationale: An Allen's test is an essential and critical safety step before
performing a radial artery puncture for arterial blood gas (ABG) analysis. The
radial artery is a common site for arterial puncture, but it is a collateral artery; the
ulnar artery also supplies blood to the hand. The Allen's test assesses the patency
of the ulnar artery. The procedure involves occluding both the radial and ulnar
arteries, having the patient clench and release their fist to exsanguinate the hand,
and then releasing pressure on the ulnar artery. If the hand does not flush (return
to a pink color) within 5-15 seconds, the ulnar artery is compromised. If the ulnar
artery is not patent and the radial artery is injured or occluded during the
puncture, the patient is at risk for ischemia and necrosis of the hand.
Hyperventilation with oxygen is not a standard prerequisite. Applying ice to the
site after obtaining the specimen is not a recommended practice; pressure should
be applied for a minimum of 5 minutes (or longer if the patient is on
anticoagulants). The provider or nurse should apply firm pressure for at least 5
minutes to achieve hemostasis.
, A nurse is providing instructions about pursed-lip breathing for a patient who has
COPD with emphysema. The nurse should explain that this breathing technique
accomplishes which of the following:
1. Increases oxygen intake
2. Promotes carbon dioxide elimination
3. Uses the intercostal muscles
4. Strengthens the diaphragm
CORRECT ANS: 2. Promotes carbon dioxide elimination.
Expert Rationale: Pursed-lip breathing is a fundamental and effective breathing
technique taught to patients with COPD. It is a self-management strategy used to
control dyspnea and improve ventilation. The primary mechanism of action is to
prolong exhalation and keep the airways open by maintaining positive pressure in
the airways during expiration. This prevents premature airway collapse, which is a
common problem in emphysema due to the loss of elastic recoil. By keeping the
airways open, pursed-lip breathing facilitates the removal of trapped air and
promotes the elimination of carbon dioxide. The technique involves inhaling
slowly through the nose and exhaling slowly and gently through pursed lips, taking
at least twice as long to exhale as to inhale. It does not primarily increase oxygen
intake, nor does it specifically target the intercostal muscles or strengthen the
diaphragm; its main benefit is in improving gas exchange by prolonging expiration
and reducing air trapping.
A nurse is preparing a patient for a thoracentesis. In which of the following
positions should the nurse place the patient:
1. Lying flat on the affected site
2. Prone with arms raised over the head
3. Supine with the head of the bed elevated
4. Sitting while leaning forward over the bedside table
CORRECT ANS: 4. Sitting while leaning forward over the bedside table.
