RESPIRATORY NURSING: CASE-BASED PATIENT MANAGEMENT
CHALLENGE — COMPREHENSIVE EXAMINATION QUESTIONS,
ANSWERS AND RATIONALES FOR 2026-2027
1. A 68-year-old male with a 40-pack-year smoking history presents with a productive cough, dyspnea
on exertion, and barrel-shaped chest. His SpO₂ is 89% on room air. Which pathophysiological change is
most responsible for his oxygen saturation?
A. Excessive mucus production
B. Destruction of alveolar walls with loss of elastic recoil
C. Bronchial hyperresponsiveness
D. Pleural inflammation
Correct Answer:B
Rationale: The patient has emphysema, a component of COPD. Destruction of alveolar walls reduces
surface area for gas exchange and causes air trapping, leading to hypoxemia.
2. The same patient is prescribed home oxygen. Which target SpO₂ range should the nurse recommend?
A. 94–98%
B. 88–92%
C. 85–88%
D. 90–95%
Correct Answer:B
Rationale: COPD patients at risk of hypercapnia should have a target SpO₂ of 88–92% to avoid
suppressing respiratory drive.
3. A 24-year-old female presents with acute onset of wheezing, chest tightness, and dyspnea after
exposure to cat dander. Her peak flow is 55% of personal best. What is the priority nursing intervention?
,A. Administer inhaled corticosteroid
B. Administer short-acting beta-2 agonist
C. Obtain a chest X-ray
D. Administer oral antihistamine
Correct Answer:B
Rationale: Acute asthma exacerbation requires immediate bronchodilation with a short-acting beta-2
agonist. Inhaled corticosteroids are for maintenance, not rescue.
4. The patient's wheezing decreases but she becomes drowsy with a respiratory rate of 10 breaths/min.
What does this indicate?
A. Improvement in condition
B. Impending respiratory failure
C. Normal response to treatment
D. Need for a second bronchodilator dose
Correct Answer:B
Rationale: Decreasing wheezing with drowsiness and bradypnea indicates a silent chest and impending
respiratory failure—a life-threatening emergency requiring immediate ventilatory support.
5. A 55-year-old male is admitted with fever, productive cough, and right-sided pleuritic chest pain.
Auscultation reveals crackles and bronchial breath sounds over the right lower lobe. What is the most
likely diagnosis?
A. Pneumothorax
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
,Correct Answer:C
Rationale: Fever, productive cough, pleuritic pain, and focal crackles with bronchial breath sounds
indicate consolidation from pneumonia.
6. Which percussion finding would the nurse expect over the right lower lobe in this patient?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Correct Answer:C
Rationale: Consolidation from pneumonia produces dullness on percussion due to increased density of
lung tissue.
7. A 45-year-old female develops sudden pleuritic chest pain and dyspnea 5 days after knee surgery. Her
heart rate is 118 beats/min, and SpO₂ is 90% on room air. What is the priority nursing action?
A. Administer a bronchodilator
B. Apply supplemental oxygen and escalate care
C. Encourage ambulation
D. Obtain a sputum culture
Correct Answer:B
Rationale: The presentation is suspicious for pulmonary embolism. Oxygen should be applied
immediately, and the provider notified for urgent diagnostic testing and anticoagulation.
8. Which diagnostic test is the gold standard for confirming pulmonary embolism in this patient?
, A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. ECG
Correct Answer:C
Rationale: CT pulmonary angiography is the definitive diagnostic test for pulmonary embolism.
9. A 62-year-old male with heart failure presents with severe dyspnea, orthopnea, and pink frothy
sputum. Auscultation reveals bilateral crackles. What is the priority nursing intervention?
A. Administer IV furosemide
B. Position upright and administer oxygen
C. Obtain a chest X-ray
D. Restrict fluids
Correct Answer:B
Rationale: The patient has acute pulmonary edema. Positioning upright improves ventilation, and
oxygen treats hypoxemia—immediate ABC priorities before pharmacological intervention.
10. Which medication is most appropriate for acute pulmonary edema with hypertension?
A. Nitroglycerin infusion
B. Normal saline bolus
C. Dopamine infusion
D. Beta-blocker
Correct Answer:A
CHALLENGE — COMPREHENSIVE EXAMINATION QUESTIONS,
ANSWERS AND RATIONALES FOR 2026-2027
1. A 68-year-old male with a 40-pack-year smoking history presents with a productive cough, dyspnea
on exertion, and barrel-shaped chest. His SpO₂ is 89% on room air. Which pathophysiological change is
most responsible for his oxygen saturation?
A. Excessive mucus production
B. Destruction of alveolar walls with loss of elastic recoil
C. Bronchial hyperresponsiveness
D. Pleural inflammation
Correct Answer:B
Rationale: The patient has emphysema, a component of COPD. Destruction of alveolar walls reduces
surface area for gas exchange and causes air trapping, leading to hypoxemia.
2. The same patient is prescribed home oxygen. Which target SpO₂ range should the nurse recommend?
A. 94–98%
B. 88–92%
C. 85–88%
D. 90–95%
Correct Answer:B
Rationale: COPD patients at risk of hypercapnia should have a target SpO₂ of 88–92% to avoid
suppressing respiratory drive.
3. A 24-year-old female presents with acute onset of wheezing, chest tightness, and dyspnea after
exposure to cat dander. Her peak flow is 55% of personal best. What is the priority nursing intervention?
,A. Administer inhaled corticosteroid
B. Administer short-acting beta-2 agonist
C. Obtain a chest X-ray
D. Administer oral antihistamine
Correct Answer:B
Rationale: Acute asthma exacerbation requires immediate bronchodilation with a short-acting beta-2
agonist. Inhaled corticosteroids are for maintenance, not rescue.
4. The patient's wheezing decreases but she becomes drowsy with a respiratory rate of 10 breaths/min.
What does this indicate?
A. Improvement in condition
B. Impending respiratory failure
C. Normal response to treatment
D. Need for a second bronchodilator dose
Correct Answer:B
Rationale: Decreasing wheezing with drowsiness and bradypnea indicates a silent chest and impending
respiratory failure—a life-threatening emergency requiring immediate ventilatory support.
5. A 55-year-old male is admitted with fever, productive cough, and right-sided pleuritic chest pain.
Auscultation reveals crackles and bronchial breath sounds over the right lower lobe. What is the most
likely diagnosis?
A. Pneumothorax
B. Pulmonary embolism
C. Pneumonia
D. Pleural effusion
,Correct Answer:C
Rationale: Fever, productive cough, pleuritic pain, and focal crackles with bronchial breath sounds
indicate consolidation from pneumonia.
6. Which percussion finding would the nurse expect over the right lower lobe in this patient?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Correct Answer:C
Rationale: Consolidation from pneumonia produces dullness on percussion due to increased density of
lung tissue.
7. A 45-year-old female develops sudden pleuritic chest pain and dyspnea 5 days after knee surgery. Her
heart rate is 118 beats/min, and SpO₂ is 90% on room air. What is the priority nursing action?
A. Administer a bronchodilator
B. Apply supplemental oxygen and escalate care
C. Encourage ambulation
D. Obtain a sputum culture
Correct Answer:B
Rationale: The presentation is suspicious for pulmonary embolism. Oxygen should be applied
immediately, and the provider notified for urgent diagnostic testing and anticoagulation.
8. Which diagnostic test is the gold standard for confirming pulmonary embolism in this patient?
, A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. ECG
Correct Answer:C
Rationale: CT pulmonary angiography is the definitive diagnostic test for pulmonary embolism.
9. A 62-year-old male with heart failure presents with severe dyspnea, orthopnea, and pink frothy
sputum. Auscultation reveals bilateral crackles. What is the priority nursing intervention?
A. Administer IV furosemide
B. Position upright and administer oxygen
C. Obtain a chest X-ray
D. Restrict fluids
Correct Answer:B
Rationale: The patient has acute pulmonary edema. Positioning upright improves ventilation, and
oxygen treats hypoxemia—immediate ABC priorities before pharmacological intervention.
10. Which medication is most appropriate for acute pulmonary edema with hypertension?
A. Nitroglycerin infusion
B. Normal saline bolus
C. Dopamine infusion
D. Beta-blocker
Correct Answer:A
