NUR 425 Exam 1: Acute & Chronic Health Disruptions In
Adults II V1 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a barrel chest. How should
the nurse explain this finding?
A. It signifies a temporary collapse of the lower airway.
B. It results from an acute infection of the pleural space.
C. It is due to the overdevelopment of the pectoral muscles.
D. It is caused by a loss of lung elasticity and air trapping.
Ans: D
Explanation: Hyperinflation of the lungs leads to the characteristic barrel chest seen in COPD patients.
This structural change occurs because air becomes trapped in the alveoli during expiration. The
increased anterior-posterior diameter of the chest is a permanent adaptation to chronic airway
obstruction. Nurses should recognize this as a sign of long-standing respiratory disease during
assessment. Understanding the pathophysiology of air trapping helps in planning appropriate respiratory
care for these individuals.
2. Which arterial blood gas (ABG) result would the nurse expect in a patient experiencing an acute asthma
attack with hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 23
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 35, HCO3 18
,Ans: B
Explanation: Hyperventilation during an asthma attack causes the patient to blow off excessive carbon
dioxide. This process leads to a decrease in PaCO2 and an increase in blood pH. The resulting state is
known as respiratory alkalosis in the early stages of an attack. Nurses must monitor these levels closely
to detect if the patient begins to tire. If the PaCO2 starts to rise, it may indicate impending respiratory
failure.
3. A nurse is caring for a patient with a suspected pulmonary embolism. What is the priority nursing action?
A. Obtain a permit for a chest X-ray.
B. Start an intravenous line for fluids.
C. Administer supplemental oxygen.
D. Teach the patient deep breathing exercises.
Ans: C
Explanation: Oxygen therapy is the immediate priority to manage hypoxemia associated with a
pulmonary embolism. Restoring oxygen saturation helps protect vital organs from ischemic damage
during the acute phase. The nurse should also elevate the head of the bed to facilitate breathing.
Following oxygenation, the nurse will prepare for anticoagulation therapy as ordered by the physician.
Timely intervention is critical because a pulmonary embolism can be a life-threatening emergency.
4. A patient has a chest tube connected to a water-seal drainage system. Which finding requires immediate
intervention by the nurse?
A. The presence of occasional tidaling in the tubing.
B. Fluctuation of the water level with inspiration.
C. Drainage of 50 mL of serosanguinous fluid in two hours.
, D. Continuous bubbling in the water-seal chamber.
Ans: D
Explanation: Continuous bubbling in the water-seal chamber usually indicates an air leak in the system.
This is an abnormal finding that requires the nurse to check all connections and the insertion site.
Expected tidaling is the normal rise and fall of water with the patient’s breathing cycle. Occasional
bubbling may occur if the patient has a known pneumothorax, but continuous bubbling is a concern. The
nurse must notify the provider if the leak cannot be located or resolved quickly.
5. In the emergency department, a patient presents with crushing chest pain and diaphoresis. Which
diagnostic test is most specific for myocardial infarction?
A. Creatine kinase (CK-MB)
B. Electrocardiogram (ECG)
C. Myoglobin
D. Troponin I and T
Ans: D
Explanation: Troponins are highly specific markers for myocardial injury and are the preferred
diagnostic test for MI. These proteins are released into the bloodstream when the heart muscle is
damaged. They remain elevated for several days, allowing for a wider diagnostic window than other
markers. While an ECG can show changes, troponin levels provide biochemical evidence of necrosis. The
nurse should anticipate serial troponin draws to track the progression of the injury.
6. A patient with right-sided heart failure is likely to exhibit which of the following assessment findings?
A. Pulmonary edema and crackles
B. Dry, hacking cough and wheezing
Adults II V1 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a barrel chest. How should
the nurse explain this finding?
A. It signifies a temporary collapse of the lower airway.
B. It results from an acute infection of the pleural space.
C. It is due to the overdevelopment of the pectoral muscles.
D. It is caused by a loss of lung elasticity and air trapping.
Ans: D
Explanation: Hyperinflation of the lungs leads to the characteristic barrel chest seen in COPD patients.
This structural change occurs because air becomes trapped in the alveoli during expiration. The
increased anterior-posterior diameter of the chest is a permanent adaptation to chronic airway
obstruction. Nurses should recognize this as a sign of long-standing respiratory disease during
assessment. Understanding the pathophysiology of air trapping helps in planning appropriate respiratory
care for these individuals.
2. Which arterial blood gas (ABG) result would the nurse expect in a patient experiencing an acute asthma
attack with hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 23
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 35, HCO3 18
,Ans: B
Explanation: Hyperventilation during an asthma attack causes the patient to blow off excessive carbon
dioxide. This process leads to a decrease in PaCO2 and an increase in blood pH. The resulting state is
known as respiratory alkalosis in the early stages of an attack. Nurses must monitor these levels closely
to detect if the patient begins to tire. If the PaCO2 starts to rise, it may indicate impending respiratory
failure.
3. A nurse is caring for a patient with a suspected pulmonary embolism. What is the priority nursing action?
A. Obtain a permit for a chest X-ray.
B. Start an intravenous line for fluids.
C. Administer supplemental oxygen.
D. Teach the patient deep breathing exercises.
Ans: C
Explanation: Oxygen therapy is the immediate priority to manage hypoxemia associated with a
pulmonary embolism. Restoring oxygen saturation helps protect vital organs from ischemic damage
during the acute phase. The nurse should also elevate the head of the bed to facilitate breathing.
Following oxygenation, the nurse will prepare for anticoagulation therapy as ordered by the physician.
Timely intervention is critical because a pulmonary embolism can be a life-threatening emergency.
4. A patient has a chest tube connected to a water-seal drainage system. Which finding requires immediate
intervention by the nurse?
A. The presence of occasional tidaling in the tubing.
B. Fluctuation of the water level with inspiration.
C. Drainage of 50 mL of serosanguinous fluid in two hours.
, D. Continuous bubbling in the water-seal chamber.
Ans: D
Explanation: Continuous bubbling in the water-seal chamber usually indicates an air leak in the system.
This is an abnormal finding that requires the nurse to check all connections and the insertion site.
Expected tidaling is the normal rise and fall of water with the patient’s breathing cycle. Occasional
bubbling may occur if the patient has a known pneumothorax, but continuous bubbling is a concern. The
nurse must notify the provider if the leak cannot be located or resolved quickly.
5. In the emergency department, a patient presents with crushing chest pain and diaphoresis. Which
diagnostic test is most specific for myocardial infarction?
A. Creatine kinase (CK-MB)
B. Electrocardiogram (ECG)
C. Myoglobin
D. Troponin I and T
Ans: D
Explanation: Troponins are highly specific markers for myocardial injury and are the preferred
diagnostic test for MI. These proteins are released into the bloodstream when the heart muscle is
damaged. They remain elevated for several days, allowing for a wider diagnostic window than other
markers. While an ECG can show changes, troponin levels provide biochemical evidence of necrosis. The
nurse should anticipate serial troponin draws to track the progression of the injury.
6. A patient with right-sided heart failure is likely to exhibit which of the following assessment findings?
A. Pulmonary edema and crackles
B. Dry, hacking cough and wheezing
