NURS 274 Exam 2 – Respiratory II | Practice
Questions & Detailed Answers | Nursing
Exam Study Guide | 2026/2027
SECTION 1: Respiratory Assessment & Diagnostic Testing (Questions 1–20)
1. A nurse is assessing a client with suspected respiratory disease. Which finding
indicates clubbing of the fingers?
• A) Yellow discoloration of the nail bed
• B) Increased angle of the nail base to greater than 180 degrees
• C) White spots on the nails
• D) Brittle nails that break easily
Clubbing is characterized by an increase in the angle between the nail base
and the nail fold to greater than 180 degrees, often associated with chronic
hypoxemia from conditions like COPD, lung cancer, or bronchiectasis. Yellow
discoloration suggests nicotine staining, white spots suggest trauma or zinc
deficiency, and brittle nails suggest nutritional deficiencies.
2. A nurse is preparing a client for a pulmonary function test (PFT). Which
instruction should the nurse include?
• A) "You should eat a heavy meal before the test."
• B) "You should avoid smoking for at least 4–6 hours before the test."
• C) "You should exercise vigorously before the test."
• D) "You should take your bronchodilator immediately before the test."
Smoking within 4–6 hours of a PFT can alter results by causing bronchospasm
and increased airway resistance. A heavy meal can interfere with effort and
,comfort. Vigorous exercise can alter respiratory rate and effort. Bronchodilators
should be withheld per provider order (usually 4–24 hours) to obtain baseline
values unless the test is specifically to assess bronchodilator response.
3. Which arterial blood gas (ABG) value indicates respiratory acidosis?
• A) pH 7.48, PaCO₂ 30 mm Hg
• B) pH 7.50, PaCO₂ 40 mm Hg
• C) pH 7.30, PaCO₂ 50 mm Hg
• D) pH 7.32, HCO₃⁻ 20 mEq/L
Respiratory acidosis is characterized by a pH below 7.35 and a PaCO₂ above 45
mm Hg. Option C shows an acidic pH with elevated CO₂, indicating
hypoventilation. Option A shows respiratory alkalosis (high pH, low CO₂). Option B
shows alkalosis with normal CO₂. Option D shows metabolic acidosis (low pH, low
bicarbonate).
4. A nurse is interpreting ABG results: pH 7.48, PaCO₂ 32 mm Hg, HCO₃⁻ 24
mEq/L. Which condition does this indicate?
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic acidosis
• D) Metabolic alkalosis
This ABG shows an elevated pH (>7.45) and decreased PaCO₂ (<35 mm Hg)
with normal bicarbonate, indicating respiratory alkalosis caused by
hyperventilation. The kidneys have not yet compensated, so bicarbonate remains
normal.
,5. A client is scheduled for a bronchoscopy. Which nursing action is most
important post-procedure?
• A) Encourage immediate oral intake
• B) Monitor for return of gag reflex before allowing oral intake
• C) Place the client in a supine position
• D) Encourage coughing and deep breathing immediately
After bronchoscopy, the throat is anesthetized, suppressing the gag reflex.
Oral intake must be withheld until the gag reflex returns to prevent aspiration. The
client should be positioned with the head elevated, and coughing should be
encouraged once the gag reflex returns, not immediately.
6. Which test is considered the gold standard for diagnosing pulmonary
embolism (PE)?
• A) Chest X-ray
• B) D-dimer
• C) CT pulmonary angiography (CTPA)
• D) Ventilation-perfusion (V/Q) scan
CT pulmonary angiography is the gold standard for diagnosing PE, providing
direct visualization of emboli in pulmonary arteries. Chest X-ray is often normal in
PE. D-dimer is a screening tool with low specificity. V/Q scan is used when CTPA is
contraindicated (e.g., renal failure, contrast allergy).
7. A nurse is caring for a client with a chest tube. Which finding requires
immediate intervention?
• A) Serosanguineous drainage of 50 mL in the first hour
, • B) Continuous bubbling in the water-seal chamber
• C) Tidaling in the water-seal chamber
• D) Blood-tinged drainage at the insertion site
Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which can lead to ineffective lung re-expansion and pneumothorax.
Tidaling is normal with respiration. Serosanguineous drainage up to 100 mL/hr in
the first hour can be normal post-operatively. Blood-tinged drainage at the site is
expected.
8. A client's peak expiratory flow rate (PEFR) is 60% of their personal best. What
does this indicate?
• A) Normal lung function
• B) Moderate asthma exacerbation requiring intervention
• C) Mild asthma exacerbation
• D) Severe asthma exacerbation requiring emergency care
A PEFR of 50–79% of personal best indicates a moderate asthma exacerbation.
Green zone (80–100%) is normal. Yellow zone (50–79%) indicates caution and
need for increased medication. Red zone (below 50%) indicates severe
exacerbation requiring emergency care.
9. Which nursing intervention is appropriate for a client after a lung biopsy?
• A) Encourage ambulation immediately
• B) Monitor for hemoptysis and signs of pneumothorax
• C) Place the client in a prone position
• D) Withhold analgesia to assess pain accurately
Questions & Detailed Answers | Nursing
Exam Study Guide | 2026/2027
SECTION 1: Respiratory Assessment & Diagnostic Testing (Questions 1–20)
1. A nurse is assessing a client with suspected respiratory disease. Which finding
indicates clubbing of the fingers?
• A) Yellow discoloration of the nail bed
• B) Increased angle of the nail base to greater than 180 degrees
• C) White spots on the nails
• D) Brittle nails that break easily
Clubbing is characterized by an increase in the angle between the nail base
and the nail fold to greater than 180 degrees, often associated with chronic
hypoxemia from conditions like COPD, lung cancer, or bronchiectasis. Yellow
discoloration suggests nicotine staining, white spots suggest trauma or zinc
deficiency, and brittle nails suggest nutritional deficiencies.
2. A nurse is preparing a client for a pulmonary function test (PFT). Which
instruction should the nurse include?
• A) "You should eat a heavy meal before the test."
• B) "You should avoid smoking for at least 4–6 hours before the test."
• C) "You should exercise vigorously before the test."
• D) "You should take your bronchodilator immediately before the test."
Smoking within 4–6 hours of a PFT can alter results by causing bronchospasm
and increased airway resistance. A heavy meal can interfere with effort and
,comfort. Vigorous exercise can alter respiratory rate and effort. Bronchodilators
should be withheld per provider order (usually 4–24 hours) to obtain baseline
values unless the test is specifically to assess bronchodilator response.
3. Which arterial blood gas (ABG) value indicates respiratory acidosis?
• A) pH 7.48, PaCO₂ 30 mm Hg
• B) pH 7.50, PaCO₂ 40 mm Hg
• C) pH 7.30, PaCO₂ 50 mm Hg
• D) pH 7.32, HCO₃⁻ 20 mEq/L
Respiratory acidosis is characterized by a pH below 7.35 and a PaCO₂ above 45
mm Hg. Option C shows an acidic pH with elevated CO₂, indicating
hypoventilation. Option A shows respiratory alkalosis (high pH, low CO₂). Option B
shows alkalosis with normal CO₂. Option D shows metabolic acidosis (low pH, low
bicarbonate).
4. A nurse is interpreting ABG results: pH 7.48, PaCO₂ 32 mm Hg, HCO₃⁻ 24
mEq/L. Which condition does this indicate?
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic acidosis
• D) Metabolic alkalosis
This ABG shows an elevated pH (>7.45) and decreased PaCO₂ (<35 mm Hg)
with normal bicarbonate, indicating respiratory alkalosis caused by
hyperventilation. The kidneys have not yet compensated, so bicarbonate remains
normal.
,5. A client is scheduled for a bronchoscopy. Which nursing action is most
important post-procedure?
• A) Encourage immediate oral intake
• B) Monitor for return of gag reflex before allowing oral intake
• C) Place the client in a supine position
• D) Encourage coughing and deep breathing immediately
After bronchoscopy, the throat is anesthetized, suppressing the gag reflex.
Oral intake must be withheld until the gag reflex returns to prevent aspiration. The
client should be positioned with the head elevated, and coughing should be
encouraged once the gag reflex returns, not immediately.
6. Which test is considered the gold standard for diagnosing pulmonary
embolism (PE)?
• A) Chest X-ray
• B) D-dimer
• C) CT pulmonary angiography (CTPA)
• D) Ventilation-perfusion (V/Q) scan
CT pulmonary angiography is the gold standard for diagnosing PE, providing
direct visualization of emboli in pulmonary arteries. Chest X-ray is often normal in
PE. D-dimer is a screening tool with low specificity. V/Q scan is used when CTPA is
contraindicated (e.g., renal failure, contrast allergy).
7. A nurse is caring for a client with a chest tube. Which finding requires
immediate intervention?
• A) Serosanguineous drainage of 50 mL in the first hour
, • B) Continuous bubbling in the water-seal chamber
• C) Tidaling in the water-seal chamber
• D) Blood-tinged drainage at the insertion site
Continuous bubbling in the water-seal chamber indicates an air leak in the
system, which can lead to ineffective lung re-expansion and pneumothorax.
Tidaling is normal with respiration. Serosanguineous drainage up to 100 mL/hr in
the first hour can be normal post-operatively. Blood-tinged drainage at the site is
expected.
8. A client's peak expiratory flow rate (PEFR) is 60% of their personal best. What
does this indicate?
• A) Normal lung function
• B) Moderate asthma exacerbation requiring intervention
• C) Mild asthma exacerbation
• D) Severe asthma exacerbation requiring emergency care
A PEFR of 50–79% of personal best indicates a moderate asthma exacerbation.
Green zone (80–100%) is normal. Yellow zone (50–79%) indicates caution and
need for increased medication. Red zone (below 50%) indicates severe
exacerbation requiring emergency care.
9. Which nursing intervention is appropriate for a client after a lung biopsy?
• A) Encourage ambulation immediately
• B) Monitor for hemoptysis and signs of pneumothorax
• C) Place the client in a prone position
• D) Withhold analgesia to assess pain accurately
