RESPIRATORY NURSING: COMPREHENSIVE CLINICAL PRACTICE
ASSESSMENT — QUESTIONS, ANSWERS AND RATIONALES FOR 2026-
2027
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which clinical
finding is most characteristic of advanced disease?
A. Increased tactile fremitus
B. Barrel-shaped chest
C. Dull percussion note
D. Tracheal deviation
Correct Answer:B
Rationale: A barrel-shaped chest results from hyperinflation and air trapping in advanced COPD.
Increased tactile fremitus and dullness suggest consolidation, while tracheal deviation indicates a
mediastinal shift.
2. A patient with asthma has a peak expiratory flow rate (PEFR) at 45% of personal best. How should the
nurse classify this exacerbation?
A. Mild
B. Moderate
C. Severe
D. Life-threatening
Correct Answer:C
Rationale: A PEFR of 33–50% of personal best indicates a severe asthma exacerbation requiring urgent
medical intervention, including systemic corticosteroids and frequent bronchodilator therapy.
3. Which breath sound is best described as continuous, musical, and predominantly heard on expiration
in a patient with asthma?
,A. Crackles
B. Wheeze
C. Pleural friction rub
D. Stridor
Correct Answer:B
Rationale: Wheezing is a continuous, musical adventitious sound caused by narrowed airways, typically
heard on expiration in asthma and COPD. Stridor is inspiratory and indicates upper ai rway obstruction.
4. A patient with a chest tube has continuous bubbling in the water-seal chamber. What is the priority
nursing action?
A. Clamp the chest tube immediately
B. Assess for an air leak in the system
C. Increase the suction pressure
D. Document the finding as normal
Correct Answer:B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. The nurse should
systematically assess the system from the patient to the drainage unit to identify the source.
5. A nurse is caring for a patient receiving mechanical ventilation. Which alarm requires the most
immediate intervention?
A. High-pressure alarm sounding
B. Low-pressure alarm sounding
C. Low tidal volume alarm
D. Apnea alarm sounding
,Correct Answer:D
Rationale: The apnea alarm indicates the patient has stopped breathing spontaneously and is not
receiving set breaths—a life-threatening emergency requiring immediate manual ventilation and
assessment.
6. Which position is most appropriate for a patient with unilate ral pneumonia to improve oxygenation?
A. Supine
B. Prone
C. Lateral position with the unaffected lung down
D. Trendelenburg
Correct Answer:C
Rationale: Positioning the patient with the unaffected (good) lung in the dependent position improves
ventilation-perfusion matching and oxygenation in unilateral lung disease.
7. A patient with a pulmonary embolism is started on heparin infusion. Which laboratory value should
the nurse monitor?
A. INR
B. aPTT
C. Platelet count only
D. Hemoglobin
Correct Answer:B
Rationale: Unfractionated heparin therapy is monitored using the activated partial thromboplastin
time (aPTT), which should be maintained at 1.5–2.5 times the control value. INR monitors warfarin
therapy.
, 8. A nurse auscultates fine crackles at the lung bases in a patient with heart failure. What do these
sounds indicate?
A. Air trapping
B. Fluid in the alveoli
C. Bronchial obstruction
D. Pleural inflammation
Correct Answer:B
Rationale: Fine crackles result from fluid in the alveoli or interstitial space s, commonly heard in heart
failure, pneumonia, and pulmonary fibrosis.
9. Which finding in a patient with a tracheostomy indicates the need for immediate suctioning?
A. Respiratory rate of 18 breaths/min
B. Audible gurgling sounds with respiration
C. Oxygen saturation of 97%
D. Clear tracheal secretions
Correct Answer:B
Rationale: Audible gurgling indicates secretions in the airway requiring suctioning. Suctioning should be
performed based on clinical assessment, not on a routine schedule.
10. A patient with tuberculosis is placed in airborne precautions. Which personal protective equipment
is essential?
A. Surgical mask
B. N95 respirator
C. Face shield only
D. Gown and gloves only
ASSESSMENT — QUESTIONS, ANSWERS AND RATIONALES FOR 2026-
2027
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which clinical
finding is most characteristic of advanced disease?
A. Increased tactile fremitus
B. Barrel-shaped chest
C. Dull percussion note
D. Tracheal deviation
Correct Answer:B
Rationale: A barrel-shaped chest results from hyperinflation and air trapping in advanced COPD.
Increased tactile fremitus and dullness suggest consolidation, while tracheal deviation indicates a
mediastinal shift.
2. A patient with asthma has a peak expiratory flow rate (PEFR) at 45% of personal best. How should the
nurse classify this exacerbation?
A. Mild
B. Moderate
C. Severe
D. Life-threatening
Correct Answer:C
Rationale: A PEFR of 33–50% of personal best indicates a severe asthma exacerbation requiring urgent
medical intervention, including systemic corticosteroids and frequent bronchodilator therapy.
3. Which breath sound is best described as continuous, musical, and predominantly heard on expiration
in a patient with asthma?
,A. Crackles
B. Wheeze
C. Pleural friction rub
D. Stridor
Correct Answer:B
Rationale: Wheezing is a continuous, musical adventitious sound caused by narrowed airways, typically
heard on expiration in asthma and COPD. Stridor is inspiratory and indicates upper ai rway obstruction.
4. A patient with a chest tube has continuous bubbling in the water-seal chamber. What is the priority
nursing action?
A. Clamp the chest tube immediately
B. Assess for an air leak in the system
C. Increase the suction pressure
D. Document the finding as normal
Correct Answer:B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. The nurse should
systematically assess the system from the patient to the drainage unit to identify the source.
5. A nurse is caring for a patient receiving mechanical ventilation. Which alarm requires the most
immediate intervention?
A. High-pressure alarm sounding
B. Low-pressure alarm sounding
C. Low tidal volume alarm
D. Apnea alarm sounding
,Correct Answer:D
Rationale: The apnea alarm indicates the patient has stopped breathing spontaneously and is not
receiving set breaths—a life-threatening emergency requiring immediate manual ventilation and
assessment.
6. Which position is most appropriate for a patient with unilate ral pneumonia to improve oxygenation?
A. Supine
B. Prone
C. Lateral position with the unaffected lung down
D. Trendelenburg
Correct Answer:C
Rationale: Positioning the patient with the unaffected (good) lung in the dependent position improves
ventilation-perfusion matching and oxygenation in unilateral lung disease.
7. A patient with a pulmonary embolism is started on heparin infusion. Which laboratory value should
the nurse monitor?
A. INR
B. aPTT
C. Platelet count only
D. Hemoglobin
Correct Answer:B
Rationale: Unfractionated heparin therapy is monitored using the activated partial thromboplastin
time (aPTT), which should be maintained at 1.5–2.5 times the control value. INR monitors warfarin
therapy.
, 8. A nurse auscultates fine crackles at the lung bases in a patient with heart failure. What do these
sounds indicate?
A. Air trapping
B. Fluid in the alveoli
C. Bronchial obstruction
D. Pleural inflammation
Correct Answer:B
Rationale: Fine crackles result from fluid in the alveoli or interstitial space s, commonly heard in heart
failure, pneumonia, and pulmonary fibrosis.
9. Which finding in a patient with a tracheostomy indicates the need for immediate suctioning?
A. Respiratory rate of 18 breaths/min
B. Audible gurgling sounds with respiration
C. Oxygen saturation of 97%
D. Clear tracheal secretions
Correct Answer:B
Rationale: Audible gurgling indicates secretions in the airway requiring suctioning. Suctioning should be
performed based on clinical assessment, not on a routine schedule.
10. A patient with tuberculosis is placed in airborne precautions. Which personal protective equipment
is essential?
A. Surgical mask
B. N95 respirator
C. Face shield only
D. Gown and gloves only
