ATI Medical Surgical Nursing – Respiratory System
Comprehensive Study Guide, ATI Med-Surg Respiratory
Review Notes, Pathophysiology, Nursing Interventions,
Oxygen Therapy, Ventilation Management & NCLEX Exam
Prep for Nursing Students
Question 1: A nurse is caring for a client with chronic obstructive pulmonary disease (COPD)
who is experiencing increased shortness of breath. Which assessment finding should the
nurse prioritize?
A. Oxygen saturation of 92% on room air
B. Use of accessory muscles during respiration
C. Productive cough with clear sputum
D. Respiratory rate of 22 breaths per minute
CORRECT ANSWER: B. Use of accessory muscles during respiration
Rationale: Use of accessory muscles indicates increased work of breathing and respiratory
distress, which requires immediate intervention in a client with COPD. While the other findings
warrant monitoring, accessory muscle use signals decompensation and potential respiratory
failure, making it the priority assessment finding.
Question 2: A nurse is preparing to administer albuterol via nebulizer to a client with asthma.
Which action should the nurse take first?
A. Assess the client's lung sounds
B. Explain the procedure to the client
C. Check the client's heart rate
D. Ensure the nebulizer is connected to oxygen
CORRECT ANSWER: A. Assess the client's lung sounds
Rationale: Assessment of baseline lung sounds is essential before administering bronchodilator
therapy to evaluate the effectiveness of the intervention and identify any changes post-
administration. While all options are appropriate nursing actions, baseline assessment takes
priority in the nursing process.
Question 3: A client with pneumonia has an arterial blood gas (ABG) result showing pH 7.30,
PaCO2 50 mm Hg, PaO2 65 mm Hg, and HCO3 24 mEq/L. Which acid-base imbalance should
the nurse identify?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Respiratory acidosis
Rationale: The ABG values indicate respiratory acidosis: pH is low (<7.35), PaCO2 is elevated
(>45 mm Hg), and HCO3 is within normal range, indicating an acute uncompensated respiratory
process. Pneumonia impairs gas exchange, leading to CO2 retention.
Question 4: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber with respiration
B. Continuous bubbling in the water-seal chamber
,C. 50 mL of serosanguineous drainage in the collection chamber
D. Fluctuation of fluid level in the water-seal chamber
CORRECT ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system,
which can compromise lung re-expansion and requires immediate assessment and
intervention. Tidaling and fluctuation are expected findings; drainage volume should be
monitored but is not emergent at 50 mL.
Question 5: A nurse is teaching a client with tuberculosis about medication adherence. Which
statement by the client indicates understanding?
A. "I can stop taking my medications once I feel better."
B. "I will take my medications only when I have symptoms."
C. "I must take all my medications exactly as prescribed for the full duration."
D. "I can skip doses if I experience side effects."
CORRECT ANSWER: C. "I must take all my medications exactly as prescribed for the full
duration."
Rationale: Tuberculosis treatment requires strict adherence to the full medication regimen to
prevent drug resistance and ensure eradication of the organism. Stopping early, skipping doses,
or taking medications only when symptomatic increases the risk of treatment failure and
transmission.
Question 6: A client with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation with positive end-expiratory pressure (PEEP). Which complication should the
nurse monitor for?
A. Hypertension
B. Barotrauma
C. Hypothermia
D. Hyperglycemia
CORRECT ANSWER: B. Barotrauma
Rationale: PEEP increases intrathoracic pressure, which can cause alveolar overdistention and
barotrauma, including pneumothorax. Nurses must monitor for sudden changes in respiratory
status, subcutaneous emphysema, or asymmetrical chest movement. Hypertension,
hypothermia, and hyperglycemia are not direct complications of PEEP.
Question 7: A nurse is assessing a client suspected of having a pulmonary embolism. Which
finding is most indicative of this condition?
A. Bradycardia and hypotension
B. Sudden onset of pleuritic chest pain and dyspnea
C. Productive cough with yellow sputum
D. Gradual onset of wheezing
CORRECT ANSWER: B. Sudden onset of pleuritic chest pain and dyspnea
Rationale: Pulmonary embolism typically presents with acute onset of pleuritic chest pain,
dyspnea, tachycardia, and possibly hemoptysis. These symptoms result from vascular
obstruction and lung ischemia. Bradycardia is uncommon; productive cough suggests infection;
wheezing is more characteristic of asthma or COPD.
,Question 8: A nurse is caring for a client receiving oxygen therapy via nasal cannula at 4
L/min. Which action should the nurse take to prevent complications?
A. Apply water-soluble lubricant to the nares
B. Increase the flow rate to 6 L/min if saturation drops
C. Remove the cannula every 2 hours for skin assessment
D. Use petroleum jelly on the nares to prevent dryness
CORRECT ANSWER: A. Apply water-soluble lubricant to the nares
Rationale: Oxygen therapy can dry nasal mucosa, causing irritation and bleeding. Water-soluble
lubricants prevent dryness without the fire hazard associated with petroleum-based products.
Flow rates should not be adjusted without an order; petroleum jelly is contraindicated with
oxygen due to flammability.
Question 9: A client with asthma is prescribed fluticasone inhaler. Which instruction should
the nurse include in the teaching plan?
A. "Rinse your mouth with water after each use."
B. "Use this inhaler during an acute asthma attack."
C. "Take this medication only when you feel wheezing."
D. "Shake the inhaler vigorously after use."
CORRECT ANSWER: A. "Rinse your mouth with water after each use."
Rationale: Fluticasone is an inhaled corticosteroid; rinsing the mouth after use reduces the risk
of oral candidiasis and dysphonia. It is a maintenance medication, not for acute attacks. The
inhaler should be shaken before use, not after.
Question 10: A nurse is caring for a client post-thoracentesis. Which assessment finding
should be reported to the provider immediately?
A. Mild discomfort at the puncture site
B. Small amount of serous drainage on dressing
C. Tracheal deviation to the unaffected side
D. Decreased breath sounds on the affected side
CORRECT ANSWER: C. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation away from the affected side suggests tension pneumothorax, a
life-threatening complication of thoracentesis requiring immediate intervention. Mild
discomfort and minimal drainage are expected; decreased breath sounds may indicate
reaccumulation but are less urgent than tracheal deviation.
Question 11: A client with COPD is prescribed theophylline. Which serum level should the
nurse recognize as therapeutic?
A. 5 mcg/mL
B. 12 mcg/mL
C. 25 mcg/mL
D. 30 mcg/mL
CORRECT ANSWER: B. 12 mcg/mL
Rationale: The therapeutic range for theophylline is 10-20 mcg/mL. A level of 12 mcg/mL is
within this range. Levels below 10 mcg/mL may be subtherapeutic; levels above 20 mcg/mL
increase the risk of toxicity, including arrhythmias and seizures.
, Question 12: A nurse is preparing to suction a client with a tracheostomy. Which action
should the nurse take first?
A. Hyperoxygenate the client with 100% oxygen
B. Insert the catheter without applying suction
C. Apply intermittent suction while withdrawing the catheter
D. Assess the client's oxygen saturation
CORRECT ANSWER: A. Hyperoxygenate the client with 100% oxygen
Rationale: Hyperoxygenation before suctioning prevents hypoxemia during the procedure,
which can cause bradycardia and arrhythmias. While assessing oxygen saturation is important,
pre-oxygenation is the priority intervention to ensure client safety during suctioning.
Question 13: A client with community-acquired pneumonia is prescribed azithromycin. Which
instruction should the nurse provide?
A. "Take this medication with dairy products to reduce stomach upset."
B. "Complete the entire course of antibiotics even if you feel better."
C. "Stop the medication if you develop a rash."
D. "Take this medication on an empty stomach only."
CORRECT ANSWER: B. "Complete the entire course of antibiotics even if you feel better."
Rationale: Completing the full antibiotic course prevents bacterial resistance and ensures
eradication of the infection. Azithromycin can be taken with or without food; dairy does not
significantly affect absorption. Rash should be reported but does not automatically require
discontinuation without provider guidance.
Question 14: A nurse is assessing a client with suspected tension pneumothorax. Which
finding is most critical?
A. Decreased breath sounds on the affected side
B. Tracheal deviation to the unaffected side
C. Subcutaneous emphysema
D. Pleuritic chest pain
CORRECT ANSWER: B. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation is a late and critical sign of tension pneumothorax, indicating
mediastinal shift and compromised cardiac output. This requires immediate needle
decompression. While decreased breath sounds and pleuritic pain are common, they are not as
immediately life-threatening as tracheal deviation.
Question 15: A client with asthma is experiencing an acute exacerbation. Which medication
should the nurse administer first?
A. Ipratropium bromide
B. Fluticasone
C. Albuterol
D. Montelukast
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-agonist (SABA) that provides rapid bronchodilation
during acute asthma exacerbations. Ipratropium may be added but is not first-line; fluticasone
and montelukast are maintenance medications and do not provide immediate relief.
Comprehensive Study Guide, ATI Med-Surg Respiratory
Review Notes, Pathophysiology, Nursing Interventions,
Oxygen Therapy, Ventilation Management & NCLEX Exam
Prep for Nursing Students
Question 1: A nurse is caring for a client with chronic obstructive pulmonary disease (COPD)
who is experiencing increased shortness of breath. Which assessment finding should the
nurse prioritize?
A. Oxygen saturation of 92% on room air
B. Use of accessory muscles during respiration
C. Productive cough with clear sputum
D. Respiratory rate of 22 breaths per minute
CORRECT ANSWER: B. Use of accessory muscles during respiration
Rationale: Use of accessory muscles indicates increased work of breathing and respiratory
distress, which requires immediate intervention in a client with COPD. While the other findings
warrant monitoring, accessory muscle use signals decompensation and potential respiratory
failure, making it the priority assessment finding.
Question 2: A nurse is preparing to administer albuterol via nebulizer to a client with asthma.
Which action should the nurse take first?
A. Assess the client's lung sounds
B. Explain the procedure to the client
C. Check the client's heart rate
D. Ensure the nebulizer is connected to oxygen
CORRECT ANSWER: A. Assess the client's lung sounds
Rationale: Assessment of baseline lung sounds is essential before administering bronchodilator
therapy to evaluate the effectiveness of the intervention and identify any changes post-
administration. While all options are appropriate nursing actions, baseline assessment takes
priority in the nursing process.
Question 3: A client with pneumonia has an arterial blood gas (ABG) result showing pH 7.30,
PaCO2 50 mm Hg, PaO2 65 mm Hg, and HCO3 24 mEq/L. Which acid-base imbalance should
the nurse identify?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: C. Respiratory acidosis
Rationale: The ABG values indicate respiratory acidosis: pH is low (<7.35), PaCO2 is elevated
(>45 mm Hg), and HCO3 is within normal range, indicating an acute uncompensated respiratory
process. Pneumonia impairs gas exchange, leading to CO2 retention.
Question 4: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Tidaling in the water-seal chamber with respiration
B. Continuous bubbling in the water-seal chamber
,C. 50 mL of serosanguineous drainage in the collection chamber
D. Fluctuation of fluid level in the water-seal chamber
CORRECT ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system,
which can compromise lung re-expansion and requires immediate assessment and
intervention. Tidaling and fluctuation are expected findings; drainage volume should be
monitored but is not emergent at 50 mL.
Question 5: A nurse is teaching a client with tuberculosis about medication adherence. Which
statement by the client indicates understanding?
A. "I can stop taking my medications once I feel better."
B. "I will take my medications only when I have symptoms."
C. "I must take all my medications exactly as prescribed for the full duration."
D. "I can skip doses if I experience side effects."
CORRECT ANSWER: C. "I must take all my medications exactly as prescribed for the full
duration."
Rationale: Tuberculosis treatment requires strict adherence to the full medication regimen to
prevent drug resistance and ensure eradication of the organism. Stopping early, skipping doses,
or taking medications only when symptomatic increases the risk of treatment failure and
transmission.
Question 6: A client with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation with positive end-expiratory pressure (PEEP). Which complication should the
nurse monitor for?
A. Hypertension
B. Barotrauma
C. Hypothermia
D. Hyperglycemia
CORRECT ANSWER: B. Barotrauma
Rationale: PEEP increases intrathoracic pressure, which can cause alveolar overdistention and
barotrauma, including pneumothorax. Nurses must monitor for sudden changes in respiratory
status, subcutaneous emphysema, or asymmetrical chest movement. Hypertension,
hypothermia, and hyperglycemia are not direct complications of PEEP.
Question 7: A nurse is assessing a client suspected of having a pulmonary embolism. Which
finding is most indicative of this condition?
A. Bradycardia and hypotension
B. Sudden onset of pleuritic chest pain and dyspnea
C. Productive cough with yellow sputum
D. Gradual onset of wheezing
CORRECT ANSWER: B. Sudden onset of pleuritic chest pain and dyspnea
Rationale: Pulmonary embolism typically presents with acute onset of pleuritic chest pain,
dyspnea, tachycardia, and possibly hemoptysis. These symptoms result from vascular
obstruction and lung ischemia. Bradycardia is uncommon; productive cough suggests infection;
wheezing is more characteristic of asthma or COPD.
,Question 8: A nurse is caring for a client receiving oxygen therapy via nasal cannula at 4
L/min. Which action should the nurse take to prevent complications?
A. Apply water-soluble lubricant to the nares
B. Increase the flow rate to 6 L/min if saturation drops
C. Remove the cannula every 2 hours for skin assessment
D. Use petroleum jelly on the nares to prevent dryness
CORRECT ANSWER: A. Apply water-soluble lubricant to the nares
Rationale: Oxygen therapy can dry nasal mucosa, causing irritation and bleeding. Water-soluble
lubricants prevent dryness without the fire hazard associated with petroleum-based products.
Flow rates should not be adjusted without an order; petroleum jelly is contraindicated with
oxygen due to flammability.
Question 9: A client with asthma is prescribed fluticasone inhaler. Which instruction should
the nurse include in the teaching plan?
A. "Rinse your mouth with water after each use."
B. "Use this inhaler during an acute asthma attack."
C. "Take this medication only when you feel wheezing."
D. "Shake the inhaler vigorously after use."
CORRECT ANSWER: A. "Rinse your mouth with water after each use."
Rationale: Fluticasone is an inhaled corticosteroid; rinsing the mouth after use reduces the risk
of oral candidiasis and dysphonia. It is a maintenance medication, not for acute attacks. The
inhaler should be shaken before use, not after.
Question 10: A nurse is caring for a client post-thoracentesis. Which assessment finding
should be reported to the provider immediately?
A. Mild discomfort at the puncture site
B. Small amount of serous drainage on dressing
C. Tracheal deviation to the unaffected side
D. Decreased breath sounds on the affected side
CORRECT ANSWER: C. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation away from the affected side suggests tension pneumothorax, a
life-threatening complication of thoracentesis requiring immediate intervention. Mild
discomfort and minimal drainage are expected; decreased breath sounds may indicate
reaccumulation but are less urgent than tracheal deviation.
Question 11: A client with COPD is prescribed theophylline. Which serum level should the
nurse recognize as therapeutic?
A. 5 mcg/mL
B. 12 mcg/mL
C. 25 mcg/mL
D. 30 mcg/mL
CORRECT ANSWER: B. 12 mcg/mL
Rationale: The therapeutic range for theophylline is 10-20 mcg/mL. A level of 12 mcg/mL is
within this range. Levels below 10 mcg/mL may be subtherapeutic; levels above 20 mcg/mL
increase the risk of toxicity, including arrhythmias and seizures.
, Question 12: A nurse is preparing to suction a client with a tracheostomy. Which action
should the nurse take first?
A. Hyperoxygenate the client with 100% oxygen
B. Insert the catheter without applying suction
C. Apply intermittent suction while withdrawing the catheter
D. Assess the client's oxygen saturation
CORRECT ANSWER: A. Hyperoxygenate the client with 100% oxygen
Rationale: Hyperoxygenation before suctioning prevents hypoxemia during the procedure,
which can cause bradycardia and arrhythmias. While assessing oxygen saturation is important,
pre-oxygenation is the priority intervention to ensure client safety during suctioning.
Question 13: A client with community-acquired pneumonia is prescribed azithromycin. Which
instruction should the nurse provide?
A. "Take this medication with dairy products to reduce stomach upset."
B. "Complete the entire course of antibiotics even if you feel better."
C. "Stop the medication if you develop a rash."
D. "Take this medication on an empty stomach only."
CORRECT ANSWER: B. "Complete the entire course of antibiotics even if you feel better."
Rationale: Completing the full antibiotic course prevents bacterial resistance and ensures
eradication of the infection. Azithromycin can be taken with or without food; dairy does not
significantly affect absorption. Rash should be reported but does not automatically require
discontinuation without provider guidance.
Question 14: A nurse is assessing a client with suspected tension pneumothorax. Which
finding is most critical?
A. Decreased breath sounds on the affected side
B. Tracheal deviation to the unaffected side
C. Subcutaneous emphysema
D. Pleuritic chest pain
CORRECT ANSWER: B. Tracheal deviation to the unaffected side
Rationale: Tracheal deviation is a late and critical sign of tension pneumothorax, indicating
mediastinal shift and compromised cardiac output. This requires immediate needle
decompression. While decreased breath sounds and pleuritic pain are common, they are not as
immediately life-threatening as tracheal deviation.
Question 15: A client with asthma is experiencing an acute exacerbation. Which medication
should the nurse administer first?
A. Ipratropium bromide
B. Fluticasone
C. Albuterol
D. Montelukast
CORRECT ANSWER: C. Albuterol
Rationale: Albuterol is a short-acting beta-agonist (SABA) that provides rapid bronchodilation
during acute asthma exacerbations. Ipratropium may be added but is not first-line; fluticasone
and montelukast are maintenance medications and do not provide immediate relief.
