NUR 242 Exam 3: Medical-Surgical Nursing
Concepts | Comprehensive Review Questions
and Correct Answers & Rationales | New
2026-2027 | Galen
An older adult client is being prepared for flu prevention teaching. When
instructing on the differences between live and killed virus vaccines, which
guideline is correct for immunocompromised individuals?
A. They should receive a half-dose of the live virus vaccine with prophylactic
antivirals.
B. They should receive the live virus vaccine to ensure active immunity.
C. They should only receive the killed virus vaccine.
D. They are contraindicated from receiving any form of the flu vaccine.
Correct Answer: C.
Rationale: Live attenuated vaccines are contraindicated in immunocompromised
clients; only killed/inactivated vaccine should be given.
A client is diagnosed with empyema. The nurse understands that this condition
is most commonly caused by which underlying respiratory disorder?
A. Asthma
B. Pneumonia
C. Chronic Obstructive Pulmonary Disease (COPD)
D. Obstructive Sleep Apnea (OSA)
Correct Answer: B.
Rationale: Empyema is pus in the pleural space, most often a complication of
pneumonia.
The nurse is providing dietary teaching to a client with Chronic Obstructive
Pulmonary Disease (COPD). Which nutritional instruction should be included?
,A. Consume three large meals daily to minimize preparation energy.
B. Restrict fluid intake to prevent fluid volume excess.
C. Maintain a high-carbohydrate diet to sustain quick energy levels.
D. Increase high-protein food intake and consume frequent meals.
Correct Answer: D.
Rationale: High-protein, frequent small meals help maintain respiratory muscle
strength without overloading the stomach.
During physical assessment of a client with COPD, the nurse expects to observe
which classic sign and symptom?
A. Pectus excavatum and rapid, shallow inspirations with rapid expirations.
B. Asymmetrical chest expansion with a long inspiration phase.
C. Barrel chest and a short inspiration with a long expiration phase.
D. Sunken chest and equal inspiration and expiration times.
Correct Answer: C.
Rationale: COPD causes hyperinflation (barrel chest) and prolonged expiration
due to air trapping.
A client experiencing a COPD exacerbation has arterial blood gas (ABG) results
drawn. Which typical ABG alteration does the nurse anticipate?
A. Decreased PaO2 and decreased PaCO2.
B. Increased PaO2 and decreased PaCO2.
C. Increased pH and decreased PaCO2.
D. Decreased PaO2 and increased PaCO2.
Correct Answer: D.
Rationale: COPD exacerbation leads to hypoxemia and CO2 retention.
An asthma client is discussing triggers with the nurse. Which of the following
substances should the nurse instruct the client to avoid?
A. Organic cotton bedding and low-sodium salts.
B. Monosodium glutamate (MSG) and dust mites.
C. High-protein dairy items and tap water.
,D. Purified bottled water and citrus fruits.
Correct Answer: B.
Rationale: MSG and dust mites are common asthma triggers.
The nurse is caring for an asthmatic client who has been wheezing continuously.
Suddenly, the wheezing stops. What is the nurse's priority action?
A. Encourage the client to use a spacer for their maintenance corticosteroid.
B. Document the finding as a sign of bronchospasm resolution.
C. Place the client in a supine position and re-assess in 15 minutes.
D. Intervene immediately as this indicates a complete airway occlusion.
Correct Answer: D.
Rationale: Sudden cessation of wheezing may indicate complete airway
obstruction and impending respiratory failure.
A client is prescribed Ipratropium (Atrovent) for bronchodilation. Which
common side effect should the nurse include in the teaching plan?
A. Dry mouth; instruct the client to increase fluid intake.
B. Bradycardia; instruct the client to monitor their pulse daily.
C. Excessive salivation; instruct the client to spit out excess saliva.
D. Diarrhea; instruct the client to follow a low-fiber diet.
Correct Answer: A.
Rationale: Ipratropium is an anticholinergic that commonly causes dry mouth.
When assessing an older adult client for acute respiratory illness, which clinical
finding requires immediate intervention by the nurse?
A. An elevated temperature of 100.4°F.
B. Mild fatigue after physical activity.
C. A sudden change in level of consciousness (LOC).
D. A productive cough with clear mucus.
Correct Answer: C.
Rationale: Sudden change in LOC in an older adult may indicate hypoxia or severe
infection and requires immediate action.
, The nurse is teaching a client with obstructive sleep apnea about continuous
positive airway pressure (CPAP) therapy. Which statement should be included?
A. The CPAP machine directly treats the underlying metabolic cause of sleep
apnea.
B. The CPAP mask should be fitted loosely to allow air to escape easily.
C. Ensure a proper mask fit and use the CPAP machine every night.
D. Use the CPAP machine only during periods of severe daytime sleepiness.
Correct Answer: C.
Rationale: CPAP must be used nightly with a properly fitted mask to be effective.
What is considered a classic behavioral symptom or sign of obstructive sleep
apnea (OSA)?
A. Increased concentration
B. Auditory hallucinations
C. Irritability
D. Euphoria
Correct Answer: C.
Rationale: Irritability and mood changes are common behavioral signs of OSA.
A client with active pulmonary tuberculosis (TB) is admitted to the hospital.
Which transmission-based precaution is mandatory for this client?
A. Airborne precautions, utilizing an N95 respirator for health care workers.
B. Contact precautions, requiring gown and gloves only.
C. Protective isolation, requiring a positive-pressure room.
D. Droplet precautions, requiring a standard surgical mask.
Correct Answer: A.
Rationale: TB requires airborne precautions and N95 respirators for staff.
A hospital client on airborne precautions for TB needs to be transported to the
radiology department. Which action is correct?
A. No mask is needed for the client; the transport staff must wear N95 masks.
Concepts | Comprehensive Review Questions
and Correct Answers & Rationales | New
2026-2027 | Galen
An older adult client is being prepared for flu prevention teaching. When
instructing on the differences between live and killed virus vaccines, which
guideline is correct for immunocompromised individuals?
A. They should receive a half-dose of the live virus vaccine with prophylactic
antivirals.
B. They should receive the live virus vaccine to ensure active immunity.
C. They should only receive the killed virus vaccine.
D. They are contraindicated from receiving any form of the flu vaccine.
Correct Answer: C.
Rationale: Live attenuated vaccines are contraindicated in immunocompromised
clients; only killed/inactivated vaccine should be given.
A client is diagnosed with empyema. The nurse understands that this condition
is most commonly caused by which underlying respiratory disorder?
A. Asthma
B. Pneumonia
C. Chronic Obstructive Pulmonary Disease (COPD)
D. Obstructive Sleep Apnea (OSA)
Correct Answer: B.
Rationale: Empyema is pus in the pleural space, most often a complication of
pneumonia.
The nurse is providing dietary teaching to a client with Chronic Obstructive
Pulmonary Disease (COPD). Which nutritional instruction should be included?
,A. Consume three large meals daily to minimize preparation energy.
B. Restrict fluid intake to prevent fluid volume excess.
C. Maintain a high-carbohydrate diet to sustain quick energy levels.
D. Increase high-protein food intake and consume frequent meals.
Correct Answer: D.
Rationale: High-protein, frequent small meals help maintain respiratory muscle
strength without overloading the stomach.
During physical assessment of a client with COPD, the nurse expects to observe
which classic sign and symptom?
A. Pectus excavatum and rapid, shallow inspirations with rapid expirations.
B. Asymmetrical chest expansion with a long inspiration phase.
C. Barrel chest and a short inspiration with a long expiration phase.
D. Sunken chest and equal inspiration and expiration times.
Correct Answer: C.
Rationale: COPD causes hyperinflation (barrel chest) and prolonged expiration
due to air trapping.
A client experiencing a COPD exacerbation has arterial blood gas (ABG) results
drawn. Which typical ABG alteration does the nurse anticipate?
A. Decreased PaO2 and decreased PaCO2.
B. Increased PaO2 and decreased PaCO2.
C. Increased pH and decreased PaCO2.
D. Decreased PaO2 and increased PaCO2.
Correct Answer: D.
Rationale: COPD exacerbation leads to hypoxemia and CO2 retention.
An asthma client is discussing triggers with the nurse. Which of the following
substances should the nurse instruct the client to avoid?
A. Organic cotton bedding and low-sodium salts.
B. Monosodium glutamate (MSG) and dust mites.
C. High-protein dairy items and tap water.
,D. Purified bottled water and citrus fruits.
Correct Answer: B.
Rationale: MSG and dust mites are common asthma triggers.
The nurse is caring for an asthmatic client who has been wheezing continuously.
Suddenly, the wheezing stops. What is the nurse's priority action?
A. Encourage the client to use a spacer for their maintenance corticosteroid.
B. Document the finding as a sign of bronchospasm resolution.
C. Place the client in a supine position and re-assess in 15 minutes.
D. Intervene immediately as this indicates a complete airway occlusion.
Correct Answer: D.
Rationale: Sudden cessation of wheezing may indicate complete airway
obstruction and impending respiratory failure.
A client is prescribed Ipratropium (Atrovent) for bronchodilation. Which
common side effect should the nurse include in the teaching plan?
A. Dry mouth; instruct the client to increase fluid intake.
B. Bradycardia; instruct the client to monitor their pulse daily.
C. Excessive salivation; instruct the client to spit out excess saliva.
D. Diarrhea; instruct the client to follow a low-fiber diet.
Correct Answer: A.
Rationale: Ipratropium is an anticholinergic that commonly causes dry mouth.
When assessing an older adult client for acute respiratory illness, which clinical
finding requires immediate intervention by the nurse?
A. An elevated temperature of 100.4°F.
B. Mild fatigue after physical activity.
C. A sudden change in level of consciousness (LOC).
D. A productive cough with clear mucus.
Correct Answer: C.
Rationale: Sudden change in LOC in an older adult may indicate hypoxia or severe
infection and requires immediate action.
, The nurse is teaching a client with obstructive sleep apnea about continuous
positive airway pressure (CPAP) therapy. Which statement should be included?
A. The CPAP machine directly treats the underlying metabolic cause of sleep
apnea.
B. The CPAP mask should be fitted loosely to allow air to escape easily.
C. Ensure a proper mask fit and use the CPAP machine every night.
D. Use the CPAP machine only during periods of severe daytime sleepiness.
Correct Answer: C.
Rationale: CPAP must be used nightly with a properly fitted mask to be effective.
What is considered a classic behavioral symptom or sign of obstructive sleep
apnea (OSA)?
A. Increased concentration
B. Auditory hallucinations
C. Irritability
D. Euphoria
Correct Answer: C.
Rationale: Irritability and mood changes are common behavioral signs of OSA.
A client with active pulmonary tuberculosis (TB) is admitted to the hospital.
Which transmission-based precaution is mandatory for this client?
A. Airborne precautions, utilizing an N95 respirator for health care workers.
B. Contact precautions, requiring gown and gloves only.
C. Protective isolation, requiring a positive-pressure room.
D. Droplet precautions, requiring a standard surgical mask.
Correct Answer: A.
Rationale: TB requires airborne precautions and N95 respirators for staff.
A hospital client on airborne precautions for TB needs to be transported to the
radiology department. Which action is correct?
A. No mask is needed for the client; the transport staff must wear N95 masks.
