RESPIRATORY NURSING: CASE-BASED PATIENT MANAGEMENT
CHALLENGE — COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION
WITH QUESTIONS, ANSWERS AND RATIONALES FOR ADVANCED
NURSING AND RESPIRATORY THERAPY STUDENTS 2026-2027
1. A 68-year-old male with a 45-pack-year smoking history presents with dyspnea, productive cough,
and wheezing. His ABG shows pH 7.32, PaCO2 58 mm Hg, PaO2 58 mm Hg, and HCO3 28 mEq/L. What is
the priority nursing intervention?
A. Administer oxygen at 6 L/min via nasal cannula
B. Initiate low-flow oxygen at 1–2 L/min and monitor respiratory status
C. Administer a high-dose bronchodilator via nebulizer
D. Place the patient in a supine position
Correct Answer:B
Rationale: This patient has COPD with chronic respiratory acidosis (elevated HCO3 indicating metabolic
compensation). Low-flow oxygen (1–2 L/min) is appropriate to maintain SpO2 88–92% and avoid
suppressing the hypoxic drive.
2. A 55-year-old female with asthma presents with severe dyspnea, silent chest, and SpO2 86%. She is
unable to speak full sentences. What is the priority nursing action?
A. Administer a rescue inhaler and reassess in 15 minutes
B. Prepare for emergency intubation and administer continuous nebulized albuterol
C. Place the patient in a supine position
D. Administer oral corticosteroids
Correct Answer:B
Rationale: A silent chest with severe hypoxemia indicates a life-threatening asthma exacerbation
(status asthmaticus). Immediate intervention with continuous bronchodilator therapy and preparation
for intubation are priorities.
,3. A 72-year-old male is admitted with community-acquired pneumonia. He has a temperature of
39.2°C, respiratory rate of 30 breaths/min, and SpO2 of 88% on room air. Which nursing intervention is
the priority?
A. Administer antipyretics
B. Apply supplemental oxygen and obtain blood cultures
C. Encourage oral fluids
D. Administer antibiotics after cultures are obtained
Correct Answer:B
Rationale: Hypoxemia (SpO2 88%) requires immediate supplemental oxygen. Blood cultures should be
obtained before antibiotics to identify the causative organism.
4. A 60-year-old female with a history of DVT develops sudden pleuritic chest pain, dyspnea, and
tachycardia. Her SpO2 is 89%. What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Pneumothorax
D. Asthma exacerbation
Correct Answer:B
Rationale: Sudden pleuritic chest pain, dyspnea, tachycardia, and hypoxemia in a patient with DVT
strongly suggest pulmonary embolism.
5. A 45-year-old male is involved in a motor vehicle accident and sustains multiple rib fractures. He
develops respiratory distress with absent breath sounds on the right and tracheal deviation to the left.
What is the priority nursing action?
A. Apply a chest tube
,B. Prepare for needle decompression
C. Administer oxygen
D. Obtain a chest X-ray
Correct Answer:B
Rationale: Tension pneumothorax is a life-threatening emergency. Needle decompression is the
immediate priority to relieve pressure and restore hemodynamics.
6. A 70-year-old female with heart failure develops pink frothy sputum, bilateral crackles, and SpO2 of
85%. What is the priority nursing intervention?
A. Administer IV furosemide and position in high Fowler's
B. Administer IV fluids
C. Place in supine position
D. Restrict oxygen
Correct Answer:A
Rationale: Pulmonary edema requires immediate diuresis with furosemide and positioning in high
Fowler's to improve oxygenation and reduce venous return.
7. A 30-year-old male with a history of asthma is intubated for status asthmaticus. The high-pressure
alarm sounds. What is the priority nursing action?
A. Silence the alarm
B. Assess for breath sounds and possible mucus plugging
C. Increase the tidal volume
D. Decrease the PEEP
Correct Answer:B
, Rationale: High-pressure alarms indicate increased airway resistance. Assessment for mucus plugging,
bronchospasm, or tube obstruction is the priority.
8. A 65-year-old male with COPD has a barrel chest, pursed-lip breathing, and clubbing of the fingers.
Which finding indicates chronic hypoxemia?
A. Barrel chest
B. Clubbing of the fingers
C. Pursed-lip breathing
D. Wheezing
Correct Answer:B
Rationale: Clubbing of the fingers is a sign of chronic hypoxemia, commonly seen in COPD and other
chronic respiratory conditions.
9. A 50-year-old female is admitted with ARDS. She is receiving mechanical ventilation with PEEP of 15
cm H2O. Her blood pressure is 85/50 mm Hg. What is the priority nursing action?
A. Increase the PEEP
B. Decrease the PEEP and notify the provider
C. Administer a fluid bolus
D. Increase the FiO2
Correct Answer:B
Rationale: High PEEP can decrease venous return and cardiac output, causing hypotension. Decreasing
PEEP and notifying the provider are appropriate.
10. A 40-year-old male with a chest tube has continuous bubbling in the water-seal chamber. What is
the priority nursing action?
A. Clamp the tube
CHALLENGE — COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION
WITH QUESTIONS, ANSWERS AND RATIONALES FOR ADVANCED
NURSING AND RESPIRATORY THERAPY STUDENTS 2026-2027
1. A 68-year-old male with a 45-pack-year smoking history presents with dyspnea, productive cough,
and wheezing. His ABG shows pH 7.32, PaCO2 58 mm Hg, PaO2 58 mm Hg, and HCO3 28 mEq/L. What is
the priority nursing intervention?
A. Administer oxygen at 6 L/min via nasal cannula
B. Initiate low-flow oxygen at 1–2 L/min and monitor respiratory status
C. Administer a high-dose bronchodilator via nebulizer
D. Place the patient in a supine position
Correct Answer:B
Rationale: This patient has COPD with chronic respiratory acidosis (elevated HCO3 indicating metabolic
compensation). Low-flow oxygen (1–2 L/min) is appropriate to maintain SpO2 88–92% and avoid
suppressing the hypoxic drive.
2. A 55-year-old female with asthma presents with severe dyspnea, silent chest, and SpO2 86%. She is
unable to speak full sentences. What is the priority nursing action?
A. Administer a rescue inhaler and reassess in 15 minutes
B. Prepare for emergency intubation and administer continuous nebulized albuterol
C. Place the patient in a supine position
D. Administer oral corticosteroids
Correct Answer:B
Rationale: A silent chest with severe hypoxemia indicates a life-threatening asthma exacerbation
(status asthmaticus). Immediate intervention with continuous bronchodilator therapy and preparation
for intubation are priorities.
,3. A 72-year-old male is admitted with community-acquired pneumonia. He has a temperature of
39.2°C, respiratory rate of 30 breaths/min, and SpO2 of 88% on room air. Which nursing intervention is
the priority?
A. Administer antipyretics
B. Apply supplemental oxygen and obtain blood cultures
C. Encourage oral fluids
D. Administer antibiotics after cultures are obtained
Correct Answer:B
Rationale: Hypoxemia (SpO2 88%) requires immediate supplemental oxygen. Blood cultures should be
obtained before antibiotics to identify the causative organism.
4. A 60-year-old female with a history of DVT develops sudden pleuritic chest pain, dyspnea, and
tachycardia. Her SpO2 is 89%. What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Pneumothorax
D. Asthma exacerbation
Correct Answer:B
Rationale: Sudden pleuritic chest pain, dyspnea, tachycardia, and hypoxemia in a patient with DVT
strongly suggest pulmonary embolism.
5. A 45-year-old male is involved in a motor vehicle accident and sustains multiple rib fractures. He
develops respiratory distress with absent breath sounds on the right and tracheal deviation to the left.
What is the priority nursing action?
A. Apply a chest tube
,B. Prepare for needle decompression
C. Administer oxygen
D. Obtain a chest X-ray
Correct Answer:B
Rationale: Tension pneumothorax is a life-threatening emergency. Needle decompression is the
immediate priority to relieve pressure and restore hemodynamics.
6. A 70-year-old female with heart failure develops pink frothy sputum, bilateral crackles, and SpO2 of
85%. What is the priority nursing intervention?
A. Administer IV furosemide and position in high Fowler's
B. Administer IV fluids
C. Place in supine position
D. Restrict oxygen
Correct Answer:A
Rationale: Pulmonary edema requires immediate diuresis with furosemide and positioning in high
Fowler's to improve oxygenation and reduce venous return.
7. A 30-year-old male with a history of asthma is intubated for status asthmaticus. The high-pressure
alarm sounds. What is the priority nursing action?
A. Silence the alarm
B. Assess for breath sounds and possible mucus plugging
C. Increase the tidal volume
D. Decrease the PEEP
Correct Answer:B
, Rationale: High-pressure alarms indicate increased airway resistance. Assessment for mucus plugging,
bronchospasm, or tube obstruction is the priority.
8. A 65-year-old male with COPD has a barrel chest, pursed-lip breathing, and clubbing of the fingers.
Which finding indicates chronic hypoxemia?
A. Barrel chest
B. Clubbing of the fingers
C. Pursed-lip breathing
D. Wheezing
Correct Answer:B
Rationale: Clubbing of the fingers is a sign of chronic hypoxemia, commonly seen in COPD and other
chronic respiratory conditions.
9. A 50-year-old female is admitted with ARDS. She is receiving mechanical ventilation with PEEP of 15
cm H2O. Her blood pressure is 85/50 mm Hg. What is the priority nursing action?
A. Increase the PEEP
B. Decrease the PEEP and notify the provider
C. Administer a fluid bolus
D. Increase the FiO2
Correct Answer:B
Rationale: High PEEP can decrease venous return and cardiac output, causing hypotension. Decreasing
PEEP and notifying the provider are appropriate.
10. A 40-year-old male with a chest tube has continuous bubbling in the water-seal chamber. What is
the priority nursing action?
A. Clamp the tube
