COMPREHENSIVE MEDICAL-SURGICAL
NURSING EXAM
Respiratory and Endocrine Disorders — 200 Examination Questions
with Rationales
SECTION 1: RESPIRATORY DISORDERS (Questions 1 - 100)
Question 1: A client is admitted with acute shortness of breath,
productive cough with rust-colored sputum, and a temperature of 39.2°C
(102.5°F). Which diagnostic finding is most consistent with
pneumococcal pneumonia?
A. Infiltrates on chest X-ray
B. Hyperresonance on percussion
C. Decreased fremitus
D. Flattened diaphragm
Rationale: Correct Answer: Infiltrates on chest X-ray. Pneumococcal
pneumonia typically presents with lobar consolidation visible as
infiltrates on chest X-ray, fever, and rust-colored sputum.
Hyperresonance and flattened diaphragms are typical of obstructive
diseases like COPD.
Question 2: A nurse is caring for a client with severe COPD who is
receiving supplemental oxygen via nasal cannula at 3 L/min. The client
becomes increasingly lethargic and confused. What is the priority
nursing action?
A. Increase the oxygen flow rate to improve oxygenation
B. Decrease the oxygen flow rate and notify the primary
healthcare provider
C. Prepare for immediate endotracheal intubation
, D. Administer prescribed intravenous sedatives
Rationale: Correct Answer: Decrease the oxygen flow rate and notify
the primary healthcare provider. Clients with chronic hypercapnia
(COPD) rely on hypoxic drive for respiration. Excess oxygen can
depress ventilation, leading to CO2 narcosis. The flow rate should be
reduced, and the provider notified.
Question 3: A client experiencing an acute asthma attack presents with
inspiratory and expiratory wheezing, tachypnea, and use of accessory
muscles. Auscultation suddenly reveals absent breath sounds over all
lung fields. What is the nurse's immediate interpretation?
A. The client's asthma attack is fully resolving
B. The client is experiencing severe bronchospasm with
impending respiratory arrest (silent chest)
C. The client has developed a left-sided pneumothorax
D. The client has normal baseline lung sounds for severe asthma
Rationale: Correct Answer: The client is experiencing severe
bronchospasm with impending respiratory arrest (silent chest). A
'silent chest' during an asthma exacerbation indicates an extreme
emergency where airflow is virtually nonexistent due to severe
bronchospasm and muscle fatigue, signaling impending respiratory
arrest.
Question 4: A client with acute respiratory distress syndrome (ARDS)
is mechanically ventilated with PEEP set at 10 cm H2O. Which clinical
finding indicates a potential complication of high PEEP therapy?
A. Increased arterial oxygen saturation (SaO2)
B. Sudden drop in blood pressure and absent breath sounds on
the right side
C. Increased urine output
D. Normalized serum bicarbonate levels
, Rationale: Correct Answer: Sudden drop in blood pressure and
absent breath sounds on the right side. High levels of Positive End-
Expiratory Pressure (PEEP) increase intrathoracic pressure, reducing
venous return and cardiac output (hypotension) and risking
barotrauma such as a tension pneumothorax.
Question 5: A client diagnosed with a massive pulmonary embolism
exhibits sudden pleuritic chest pain, tachycardia, and hypotension.
Which anticoagulant medication is indicated for immediate acute
management?
A. Oral Warfarin
B. Intravenous Unfractionated Heparin
C. Subcutaneous Low-Molecular-Weight Heparin
D. Oral Apixaban
Rationale: Correct Answer: Intravenous Unfractionated Heparin. In
massive pulmonary embolism with hemodynamic instability, IV
unfractionated heparin is preferred due to its rapid onset and short
half-life, allowing quick reversal if emergency procedures are
required.
Question 6: A client with a chest tube following a lobectomy has
continuous bubbling in the water-seal chamber. What does this finding
indicate?
A. Normal lung re-expansion
B. An air leak in the chest tube system
C. Normal tidaling during respiration
D. Obstruction of the chest drainage tubing
Rationale: Correct Answer: An air leak in the chest tube system.
Continuous bubbling in the water-seal chamber indicates an air leak
in the system or patient chest. Tidaling (fluctuation with respiration)
is normal, while bubbling in the suction control chamber is normal.
, Question 7: A nurse is caring for a client with a pleural effusion
undergoing thoracentesis. During the procedure, the client develops
sudden coughing, tightness in the chest, and shortness of breath. What is
the priority nursing action?
A. Encourage the client to take deep breaths
B. Stop the procedure immediately and notify the physician
C. Increase the rate of IV fluids
D. Prepare for immediate chest tube insertion
Rationale: Correct Answer: Stop the procedure immediately and
notify the physician. Sudden coughing and chest tightness during
thoracentesis can indicate re-expansion pulmonary edema or
pneumothorax. The procedure must be stopped immediately.
Question 8: A client with active pulmonary tuberculosis (TB) is
prescribed isoniazid (INH), rifampin, pyrazinamide, and ethambutol.
Which client statement indicates a need for further teaching regarding
rifampin?
A. I will take this medication on an empty stomach.
B. My urine, tears, and sweat may turn a harmless orange-red
color.
C. I will stop taking rifampin as soon as my cough disappears.
D. I should report any signs of jaundice or abdominal pain
immediately.
Rationale: Correct Answer: I will stop taking rifampin as soon as my
cough disappears.. TB therapy requires a strict multi-month regimen.
Stopping early leads to drug resistance. Clients must complete the full
course regardless of symptom resolution.
Question 9: A mechanically ventilated client is restless and attempting
to pull out the endotracheal tube. Arterial blood gases show pH 7.48,
NURSING EXAM
Respiratory and Endocrine Disorders — 200 Examination Questions
with Rationales
SECTION 1: RESPIRATORY DISORDERS (Questions 1 - 100)
Question 1: A client is admitted with acute shortness of breath,
productive cough with rust-colored sputum, and a temperature of 39.2°C
(102.5°F). Which diagnostic finding is most consistent with
pneumococcal pneumonia?
A. Infiltrates on chest X-ray
B. Hyperresonance on percussion
C. Decreased fremitus
D. Flattened diaphragm
Rationale: Correct Answer: Infiltrates on chest X-ray. Pneumococcal
pneumonia typically presents with lobar consolidation visible as
infiltrates on chest X-ray, fever, and rust-colored sputum.
Hyperresonance and flattened diaphragms are typical of obstructive
diseases like COPD.
Question 2: A nurse is caring for a client with severe COPD who is
receiving supplemental oxygen via nasal cannula at 3 L/min. The client
becomes increasingly lethargic and confused. What is the priority
nursing action?
A. Increase the oxygen flow rate to improve oxygenation
B. Decrease the oxygen flow rate and notify the primary
healthcare provider
C. Prepare for immediate endotracheal intubation
, D. Administer prescribed intravenous sedatives
Rationale: Correct Answer: Decrease the oxygen flow rate and notify
the primary healthcare provider. Clients with chronic hypercapnia
(COPD) rely on hypoxic drive for respiration. Excess oxygen can
depress ventilation, leading to CO2 narcosis. The flow rate should be
reduced, and the provider notified.
Question 3: A client experiencing an acute asthma attack presents with
inspiratory and expiratory wheezing, tachypnea, and use of accessory
muscles. Auscultation suddenly reveals absent breath sounds over all
lung fields. What is the nurse's immediate interpretation?
A. The client's asthma attack is fully resolving
B. The client is experiencing severe bronchospasm with
impending respiratory arrest (silent chest)
C. The client has developed a left-sided pneumothorax
D. The client has normal baseline lung sounds for severe asthma
Rationale: Correct Answer: The client is experiencing severe
bronchospasm with impending respiratory arrest (silent chest). A
'silent chest' during an asthma exacerbation indicates an extreme
emergency where airflow is virtually nonexistent due to severe
bronchospasm and muscle fatigue, signaling impending respiratory
arrest.
Question 4: A client with acute respiratory distress syndrome (ARDS)
is mechanically ventilated with PEEP set at 10 cm H2O. Which clinical
finding indicates a potential complication of high PEEP therapy?
A. Increased arterial oxygen saturation (SaO2)
B. Sudden drop in blood pressure and absent breath sounds on
the right side
C. Increased urine output
D. Normalized serum bicarbonate levels
, Rationale: Correct Answer: Sudden drop in blood pressure and
absent breath sounds on the right side. High levels of Positive End-
Expiratory Pressure (PEEP) increase intrathoracic pressure, reducing
venous return and cardiac output (hypotension) and risking
barotrauma such as a tension pneumothorax.
Question 5: A client diagnosed with a massive pulmonary embolism
exhibits sudden pleuritic chest pain, tachycardia, and hypotension.
Which anticoagulant medication is indicated for immediate acute
management?
A. Oral Warfarin
B. Intravenous Unfractionated Heparin
C. Subcutaneous Low-Molecular-Weight Heparin
D. Oral Apixaban
Rationale: Correct Answer: Intravenous Unfractionated Heparin. In
massive pulmonary embolism with hemodynamic instability, IV
unfractionated heparin is preferred due to its rapid onset and short
half-life, allowing quick reversal if emergency procedures are
required.
Question 6: A client with a chest tube following a lobectomy has
continuous bubbling in the water-seal chamber. What does this finding
indicate?
A. Normal lung re-expansion
B. An air leak in the chest tube system
C. Normal tidaling during respiration
D. Obstruction of the chest drainage tubing
Rationale: Correct Answer: An air leak in the chest tube system.
Continuous bubbling in the water-seal chamber indicates an air leak
in the system or patient chest. Tidaling (fluctuation with respiration)
is normal, while bubbling in the suction control chamber is normal.
, Question 7: A nurse is caring for a client with a pleural effusion
undergoing thoracentesis. During the procedure, the client develops
sudden coughing, tightness in the chest, and shortness of breath. What is
the priority nursing action?
A. Encourage the client to take deep breaths
B. Stop the procedure immediately and notify the physician
C. Increase the rate of IV fluids
D. Prepare for immediate chest tube insertion
Rationale: Correct Answer: Stop the procedure immediately and
notify the physician. Sudden coughing and chest tightness during
thoracentesis can indicate re-expansion pulmonary edema or
pneumothorax. The procedure must be stopped immediately.
Question 8: A client with active pulmonary tuberculosis (TB) is
prescribed isoniazid (INH), rifampin, pyrazinamide, and ethambutol.
Which client statement indicates a need for further teaching regarding
rifampin?
A. I will take this medication on an empty stomach.
B. My urine, tears, and sweat may turn a harmless orange-red
color.
C. I will stop taking rifampin as soon as my cough disappears.
D. I should report any signs of jaundice or abdominal pain
immediately.
Rationale: Correct Answer: I will stop taking rifampin as soon as my
cough disappears.. TB therapy requires a strict multi-month regimen.
Stopping early leads to drug resistance. Clients must complete the full
course regardless of symptom resolution.
Question 9: A mechanically ventilated client is restless and attempting
to pull out the endotracheal tube. Arterial blood gases show pH 7.48,
