Test Bank: Davis Advantage –
Understanding Medical-Surgical Nursing
(Original Practice Questions)
1–20: Respiratory
1. A patient with COPD has increased PaCO₂ and chronic respiratory acidosis with
metabolic compensation. Which lab value indicates appropriate compensation?
A. pH 7.32, HCO₃⁻ 38 mEq/L
B. pH 7.48, HCO₃⁻ 25 mEq/L
C. pH 7.10, HCO₃⁻ 20 mEq/L
D. pH 7.40, HCO₃⁻ 22 mEq/L
Answer: A. Rationale: Chronic respiratory acidosis (elevated PaCO₂) shows low pH with
elevated HCO₃⁻ from renal compensation; pH ~7.32 with HCO₃⁻ 38 fits.
2. A patient with suspected pulmonary embolism suddenly becomes dyspneic and hypoxic.
The nurse's immediate priority is:
A. Administer subcutaneous heparin
B. Apply oxygen and notify provider
C. Draw arterial blood gas
D. Obtain a CT pulmonary angiogram
Answer: B. Rationale: Immediate oxygenation is priority for hypoxia; definitive diagnostics and
anticoagulation follow after stabilization.
3. Which finding suggests impending respiratory failure in a patient with pneumonia?
A. RR 20, SpO₂ 96%
,B. Use of accessory muscles and PaO₂ 55 mm Hg
C. Productive cough with yellow sputum
D. Temperature 38.1°C
Answer: B. Rationale: Accessory muscle use and PaO₂ <60 mm Hg indicate inadequate
oxygenation and possible respiratory failure.
4. For a patient using a metered-dose inhaler (MDI), the correct teaching includes:
A. Inhale rapidly and deeply while depressing canister
B. Hold breath for 5 seconds after inhalation
C. Shake the inhaler and use a spacer if available
D. Rinse mouth before each use
Answer: C. Rationale: Shaking and spacer use improve drug delivery; hold breath for ~10
seconds after inhalation.
5. A patient with acute asthma exacerbation has wheezing that suddenly disappears. The
nurse should:
A. Document improvement
B. Assess for decreased air movement and impending respiratory arrest
C. Encourage pursed-lip breathing
D. Give a bronchodilator and reassess in 1 hour
Answer: B. Rationale: Loss of wheeze can indicate severe obstruction with little airflow; this is
an emergency.
6. Postoperative patient developing atelectasis — best nursing intervention:
A. Restrict fluids
B. Encourage deep breathing and incentive spirometry
C. Apply humidified oxygen only
D. Give prophylactic antibiotics
Answer: B. Rationale: Deep breathing and IS help re-expand alveoli and prevent atelectasis.
, 7. Which is the earliest sign of hypoxemia in many patients?
A. Cyanosis
B. Confusion or restlessness
C. Bradycardia
D. Hypotension
Answer: B. Rationale: Neurologic changes (anxiety, restlessness) often precede visible signs
like cyanosis.
8. Indication for chest tube placement after thoracotomy is:
A. Pulmonary embolism
B. Pneumothorax with respiratory compromise
C. Lobar pneumonia
D. Stable pleural effusion not causing dyspnea
Answer: B. Rationale: Chest tube removes air causing pneumothorax and re-expands lung.
9. In ARDS, the hallmark pathophysiology is:
A. Airway obstruction from mucus
B. Noncardiogenic pulmonary edema with refractory hypoxemia
C. Bronchospasm and airway hyperresponsiveness
D. Embolic occlusion of pulmonary arteries
Answer: B. Rationale: ARDS causes diffuse alveolar damage, increased permeability, and
hypoxemia not responsive to usual oxygen.
10.When suctioning an endotracheal tube, the nurse should:
A. Instill normal saline routinely before suctioning
B. Apply suction while inserting catheter
C. Limit each suction pass to 10–15 seconds
D. Suction on the way in and out
, Answer: C. Rationale: Limit suction time to reduce hypoxia; do not suction during insertion;
saline is not routine.
11.A patient with obstructive sleep apnea (OSA) most likely reports:
A. Difficulty falling asleep only
B. Loud snoring with daytime sleepiness
C. Night sweats and fever
D. Early-morning headaches only when standing
Answer: B. Rationale: OSA features loud snoring, apneic episodes, and daytime somnolence.
12.Best measure to prevent ventilator-associated pneumonia (VAP):
A. Routine closed suctioning
B. Elevate head of bed 30–45° and oral care
C. Increase sedation to prevent coughing
D. Change ventilator circuit daily
Answer: B. Rationale: HOB elevation and oral care reduce aspiration risk and VAP incidence.
13.Sputum culture result returns with Pseudomonas aeruginosa. Nurse recognizes this
organism is associated with:
A. Community-acquired atypical pneumonia only
B. Hospital-acquired infections and resistant organisms
C. Viral respiratory infection
D. Fungal infections only
Answer: B. Rationale: Pseudomonas is commonly a nosocomial pathogen and often
drug-resistant.
14.A patient on long-term corticosteroids is at increased risk for:
A. Hypoglycemia
B. Osteoporosis and increased infection risk
C. Increased bone density
Understanding Medical-Surgical Nursing
(Original Practice Questions)
1–20: Respiratory
1. A patient with COPD has increased PaCO₂ and chronic respiratory acidosis with
metabolic compensation. Which lab value indicates appropriate compensation?
A. pH 7.32, HCO₃⁻ 38 mEq/L
B. pH 7.48, HCO₃⁻ 25 mEq/L
C. pH 7.10, HCO₃⁻ 20 mEq/L
D. pH 7.40, HCO₃⁻ 22 mEq/L
Answer: A. Rationale: Chronic respiratory acidosis (elevated PaCO₂) shows low pH with
elevated HCO₃⁻ from renal compensation; pH ~7.32 with HCO₃⁻ 38 fits.
2. A patient with suspected pulmonary embolism suddenly becomes dyspneic and hypoxic.
The nurse's immediate priority is:
A. Administer subcutaneous heparin
B. Apply oxygen and notify provider
C. Draw arterial blood gas
D. Obtain a CT pulmonary angiogram
Answer: B. Rationale: Immediate oxygenation is priority for hypoxia; definitive diagnostics and
anticoagulation follow after stabilization.
3. Which finding suggests impending respiratory failure in a patient with pneumonia?
A. RR 20, SpO₂ 96%
,B. Use of accessory muscles and PaO₂ 55 mm Hg
C. Productive cough with yellow sputum
D. Temperature 38.1°C
Answer: B. Rationale: Accessory muscle use and PaO₂ <60 mm Hg indicate inadequate
oxygenation and possible respiratory failure.
4. For a patient using a metered-dose inhaler (MDI), the correct teaching includes:
A. Inhale rapidly and deeply while depressing canister
B. Hold breath for 5 seconds after inhalation
C. Shake the inhaler and use a spacer if available
D. Rinse mouth before each use
Answer: C. Rationale: Shaking and spacer use improve drug delivery; hold breath for ~10
seconds after inhalation.
5. A patient with acute asthma exacerbation has wheezing that suddenly disappears. The
nurse should:
A. Document improvement
B. Assess for decreased air movement and impending respiratory arrest
C. Encourage pursed-lip breathing
D. Give a bronchodilator and reassess in 1 hour
Answer: B. Rationale: Loss of wheeze can indicate severe obstruction with little airflow; this is
an emergency.
6. Postoperative patient developing atelectasis — best nursing intervention:
A. Restrict fluids
B. Encourage deep breathing and incentive spirometry
C. Apply humidified oxygen only
D. Give prophylactic antibiotics
Answer: B. Rationale: Deep breathing and IS help re-expand alveoli and prevent atelectasis.
, 7. Which is the earliest sign of hypoxemia in many patients?
A. Cyanosis
B. Confusion or restlessness
C. Bradycardia
D. Hypotension
Answer: B. Rationale: Neurologic changes (anxiety, restlessness) often precede visible signs
like cyanosis.
8. Indication for chest tube placement after thoracotomy is:
A. Pulmonary embolism
B. Pneumothorax with respiratory compromise
C. Lobar pneumonia
D. Stable pleural effusion not causing dyspnea
Answer: B. Rationale: Chest tube removes air causing pneumothorax and re-expands lung.
9. In ARDS, the hallmark pathophysiology is:
A. Airway obstruction from mucus
B. Noncardiogenic pulmonary edema with refractory hypoxemia
C. Bronchospasm and airway hyperresponsiveness
D. Embolic occlusion of pulmonary arteries
Answer: B. Rationale: ARDS causes diffuse alveolar damage, increased permeability, and
hypoxemia not responsive to usual oxygen.
10.When suctioning an endotracheal tube, the nurse should:
A. Instill normal saline routinely before suctioning
B. Apply suction while inserting catheter
C. Limit each suction pass to 10–15 seconds
D. Suction on the way in and out
, Answer: C. Rationale: Limit suction time to reduce hypoxia; do not suction during insertion;
saline is not routine.
11.A patient with obstructive sleep apnea (OSA) most likely reports:
A. Difficulty falling asleep only
B. Loud snoring with daytime sleepiness
C. Night sweats and fever
D. Early-morning headaches only when standing
Answer: B. Rationale: OSA features loud snoring, apneic episodes, and daytime somnolence.
12.Best measure to prevent ventilator-associated pneumonia (VAP):
A. Routine closed suctioning
B. Elevate head of bed 30–45° and oral care
C. Increase sedation to prevent coughing
D. Change ventilator circuit daily
Answer: B. Rationale: HOB elevation and oral care reduce aspiration risk and VAP incidence.
13.Sputum culture result returns with Pseudomonas aeruginosa. Nurse recognizes this
organism is associated with:
A. Community-acquired atypical pneumonia only
B. Hospital-acquired infections and resistant organisms
C. Viral respiratory infection
D. Fungal infections only
Answer: B. Rationale: Pseudomonas is commonly a nosocomial pathogen and often
drug-resistant.
14.A patient on long-term corticosteroids is at increased risk for:
A. Hypoglycemia
B. Osteoporosis and increased infection risk
C. Increased bone density
