NUR 242 Exam 3 2026 | Practice Questions with
Answers & Detailed Explanations | Medical-
Surgical Nursing – Respiratory, GI, Hepatic, Renal
& Pain Management | Galen College | Latest
Update
📚 Section 1: Respiratory Disorders – COPD, Asthma, Pneumonia & TB (Questions 1–
50)
1. A patient with COPD has an oxygen saturation of 88% on room air. Which oxygen
delivery device should the nurse use initially?
A) Non-rebreather mask
B) Simple face mask
C) Nasal cannula at 2 L/min
D) Venturi mask
Answer: C
Explanation: For a COPD patient, the target SpO₂ is 88–92%. A nasal cannula at 2 L/min is
appropriate to maintain this target range. Higher oxygen levels can suppress the hypoxic
, drive to breathe in patients with chronic hypercapnia. A non-rebreather mask delivers too
high a concentration of oxygen, which can lead to carbon dioxide narcosis .
2. A patient with COPD on 2 L/min oxygen becomes lethargic and confused after the
nurse increases oxygen to 3 L/min. What is the probable cause?
A) Carbon dioxide narcosis
B) Increased intracranial pressure
C) Acute asthma exacerbation
D) Pulmonary embolism
Answer: A
Explanation: Some COPD patients with chronic hypercapnia rely on a hypoxic respiratory
drive. Increasing oxygen can decrease their respiratory drive, leading to CO₂ retention and
narcosis (lethargy, confusion). The target SpO₂ for COPD patients is 88–92%. Carbon
dioxide narcosis is a serious complication of oxygen therapy in COPD patients with CO₂
retention .
3. The nurse is assessing a patient with a chest tube following a pneumonectomy.
Which assessment finding requires intervention?
A) Bandage around the posterior tube is loose
B) 2 cm of water is in the second chest tube chamber
C) The water in the water seal chamber rises and falls with inhalation/exhalation
, D) Bubbling present in the water seal chamber when the patient coughs
Answer: A
Explanation: After lung surgery, two tubes, anterior and posterior, are used. Dressings
around the wound should not be loose. The wounds should be covered with airtight
dressings. A loose dressing can allow air to enter the pleural space, causing a
pneumothorax. Tidaling (rising and falling with respirations) is a normal finding in the water
seal chamber. Intermittent bubbling with coughing is also expected .
4. A home health patient with a history of asthma has a peak expiratory flow (PEF)
reading in the red zone. What is the priority nursing action?
A) Call 911 immediately
B) Take the patient's vital signs
C) Notify the patient's prescriber
D) Repeat the PEF reading to verify the results
Answer: A
Explanation: A PEF reading in the red zone indicates a range that is 50% below the
patient's personal best PEF reading and indicates serious respiratory obstruction requiring
911 or rapid response. Offer medications and stay with the patient. Repeating the PEF
reading and taking vital signs are also important, but doing so first delays the administration
of rescue drugs and physician notification .
, 5. A patient with pneumonia is admitted with the following vital signs: BP 138/88, HR
128, RR 36, O₂ saturation 88% on room air, temperature 101.6°F. Which finding
requires the nurse's immediate attention?
A) Blood pressure
B) Respiratory rate
C) Temperature
D) Blood glucose
Answer: B
Explanation: All of the patient's vital signs are abnormal. However, the most important one
to report immediately is increased respirations (and decreased oxygen saturation). The
patient is experiencing tachypnea and hypoxia. Even though a diagnosis has not been
confirmed, it is very important to address these problems. Oxygen therapy should be
initiated first .
6. The following orders are received for a patient with pneumonia: IV fluids, oxygen at
2 L per nasal cannula, blood cultures × 3 and urinalysis, Tylenol PRN for fever,
Cefazolin IVP every 8 hours. Which order should the nurse implement FIRST?
A) IV fluids 1000 mL 0.9 NS at 60 mL/hr
B) Oxygen at 2 L per nasal cannula
C) Blood cultures and urinalysis
D) Cefazolin 1 g IVP every 8 hours
Answer: B
Explanation: All of the provider's orders are very important. However, the most important
Answers & Detailed Explanations | Medical-
Surgical Nursing – Respiratory, GI, Hepatic, Renal
& Pain Management | Galen College | Latest
Update
📚 Section 1: Respiratory Disorders – COPD, Asthma, Pneumonia & TB (Questions 1–
50)
1. A patient with COPD has an oxygen saturation of 88% on room air. Which oxygen
delivery device should the nurse use initially?
A) Non-rebreather mask
B) Simple face mask
C) Nasal cannula at 2 L/min
D) Venturi mask
Answer: C
Explanation: For a COPD patient, the target SpO₂ is 88–92%. A nasal cannula at 2 L/min is
appropriate to maintain this target range. Higher oxygen levels can suppress the hypoxic
, drive to breathe in patients with chronic hypercapnia. A non-rebreather mask delivers too
high a concentration of oxygen, which can lead to carbon dioxide narcosis .
2. A patient with COPD on 2 L/min oxygen becomes lethargic and confused after the
nurse increases oxygen to 3 L/min. What is the probable cause?
A) Carbon dioxide narcosis
B) Increased intracranial pressure
C) Acute asthma exacerbation
D) Pulmonary embolism
Answer: A
Explanation: Some COPD patients with chronic hypercapnia rely on a hypoxic respiratory
drive. Increasing oxygen can decrease their respiratory drive, leading to CO₂ retention and
narcosis (lethargy, confusion). The target SpO₂ for COPD patients is 88–92%. Carbon
dioxide narcosis is a serious complication of oxygen therapy in COPD patients with CO₂
retention .
3. The nurse is assessing a patient with a chest tube following a pneumonectomy.
Which assessment finding requires intervention?
A) Bandage around the posterior tube is loose
B) 2 cm of water is in the second chest tube chamber
C) The water in the water seal chamber rises and falls with inhalation/exhalation
, D) Bubbling present in the water seal chamber when the patient coughs
Answer: A
Explanation: After lung surgery, two tubes, anterior and posterior, are used. Dressings
around the wound should not be loose. The wounds should be covered with airtight
dressings. A loose dressing can allow air to enter the pleural space, causing a
pneumothorax. Tidaling (rising and falling with respirations) is a normal finding in the water
seal chamber. Intermittent bubbling with coughing is also expected .
4. A home health patient with a history of asthma has a peak expiratory flow (PEF)
reading in the red zone. What is the priority nursing action?
A) Call 911 immediately
B) Take the patient's vital signs
C) Notify the patient's prescriber
D) Repeat the PEF reading to verify the results
Answer: A
Explanation: A PEF reading in the red zone indicates a range that is 50% below the
patient's personal best PEF reading and indicates serious respiratory obstruction requiring
911 or rapid response. Offer medications and stay with the patient. Repeating the PEF
reading and taking vital signs are also important, but doing so first delays the administration
of rescue drugs and physician notification .
, 5. A patient with pneumonia is admitted with the following vital signs: BP 138/88, HR
128, RR 36, O₂ saturation 88% on room air, temperature 101.6°F. Which finding
requires the nurse's immediate attention?
A) Blood pressure
B) Respiratory rate
C) Temperature
D) Blood glucose
Answer: B
Explanation: All of the patient's vital signs are abnormal. However, the most important one
to report immediately is increased respirations (and decreased oxygen saturation). The
patient is experiencing tachypnea and hypoxia. Even though a diagnosis has not been
confirmed, it is very important to address these problems. Oxygen therapy should be
initiated first .
6. The following orders are received for a patient with pneumonia: IV fluids, oxygen at
2 L per nasal cannula, blood cultures × 3 and urinalysis, Tylenol PRN for fever,
Cefazolin IVP every 8 hours. Which order should the nurse implement FIRST?
A) IV fluids 1000 mL 0.9 NS at 60 mL/hr
B) Oxygen at 2 L per nasal cannula
C) Blood cultures and urinalysis
D) Cefazolin 1 g IVP every 8 hours
Answer: B
Explanation: All of the provider's orders are very important. However, the most important
