NUR 254 Exam 2 Actual Exam 2026/2027 – 50 Q&A with
Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section A: Respiratory Disorders — Assessment, Diagnostics, &
Management (Questions 1–15)
Q1: A patient presents with sudden onset of dyspnea, pleuritic chest pain, tachycardia,
and hemoptysis. The patient has a history of recent long-haul flight and oral
contraceptive use. Which diagnostic test is the gold standard for confirming the
suspected diagnosis?
A. D-dimer assay
B. Chest X-ray
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
Correct Answer: C
Rationale: CTPA is the gold standard diagnostic test for pulmonary embolism, providing
direct visualization of pulmonary artery filling defects. Option A (D-dimer) is a screening
test with high sensitivity but low specificity. Option B (chest X-ray) is often normal or
shows nonspecific findings. Option D (V/Q scan) is used when CTPA is contraindicated
(e.g., renal impairment, contrast allergy).
Q2: A patient with a pulmonary embolism is hemodynamically unstable with
hypotension (BP 82/56 mmHg), tachycardia (128 bpm), and signs of right ventricular
strain on ECG. Which management is the priority?
,A. Initiate heparin infusion and observe
B. Systemic thrombolytic therapy (e.g., alteplase) or embolectomy
C. Warfarin 5 mg PO daily
D. Inferior vena cava (IVC) filter placement only
Correct Answer: B
Rationale: Massive PE with hemodynamic instability (hypotension, shock) requires
emergent systemic thrombolytics or surgical/catheter embolectomy. Anticoagulation
alone (Options A and C) is insufficient for massive PE. Option D (IVC filter) is adjunctive,
not primary treatment for massive PE.
Q3: A patient with COPD has the following ABG: pH 7.32, PaCO2 58 mmHg, PaO2 62
mmHg, HCO3 30 mEq/L. Which acid-base disorder is present, and what is the target
oxygen saturation for this patient?
A. Respiratory alkalosis; target SpO2 94–98%
B. Respiratory acidosis with metabolic compensation; target SpO2 88–92%
C. Metabolic acidosis; target SpO2 94–98%
D. Respiratory acidosis without compensation; target SpO2 100%
Correct Answer: B
Rationale: The ABG shows respiratory acidosis (pH 7.32, PaCO2 58) with metabolic
compensation (HCO3 30 elevated). COPD patients with chronic hypercapnia depend on
hypoxic drive; target SpO2 is 88–92% to avoid CO2 retention and respiratory acidosis
worsening. Options A, C, and D misidentify the disorder or target.
Q4: A patient with asthma presents with severe wheezing, dyspnea, use of accessory
muscles, and an inability to speak in full sentences. Peak expiratory flow is 35% of
predicted. Which classification and priority intervention apply?
, A. Mild exacerbation; administer albuterol 2 puffs PRN
B. Moderate exacerbation; administer albuterol and oral corticosteroids
C. Severe exacerbation; administer high-dose albuterol/ipratropium nebulizer, systemic
corticosteroids, and consider magnesium sulfate
D. Near-fatal asthma; immediate intubation and mechanical ventilation
Correct Answer: C
Rationale: Severe asthma exacerbation is characterized by PEF <50% predicted, inability
to speak in full sentences, use of accessory muscles, and severe dyspnea. Priority
interventions include high-dose bronchodilators (albuterol + ipratropium), systemic
corticosteroids, and magnesium sulfate. Option A describes mild exacerbation. Option
B describes moderate. Option D (near-fatal) requires intubation for altered
consciousness or respiratory arrest.
Q5: A patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. Which
mechanism of action and therapeutic effect should the nurse explain to the patient?
A. Beta-2 agonist; bronchodilation via smooth muscle relaxation
B. Anticholinergic; bronchodilation via inhibition of acetylcholine at muscarinic
receptors
C. Inhaled corticosteroid; reduction of airway inflammation
D. Leukotriene modifier; reduction of bronchoconstriction and inflammation
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA/anticholinergic)
that causes bronchodilation by blocking acetylcholine at muscarinic receptors. Option A
describes beta-2 agonists (albuterol, salmeterol). Option C describes inhaled
corticosteroids (fluticasone). Option D describes leukotriene modifiers (montelukast).
Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section A: Respiratory Disorders — Assessment, Diagnostics, &
Management (Questions 1–15)
Q1: A patient presents with sudden onset of dyspnea, pleuritic chest pain, tachycardia,
and hemoptysis. The patient has a history of recent long-haul flight and oral
contraceptive use. Which diagnostic test is the gold standard for confirming the
suspected diagnosis?
A. D-dimer assay
B. Chest X-ray
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
Correct Answer: C
Rationale: CTPA is the gold standard diagnostic test for pulmonary embolism, providing
direct visualization of pulmonary artery filling defects. Option A (D-dimer) is a screening
test with high sensitivity but low specificity. Option B (chest X-ray) is often normal or
shows nonspecific findings. Option D (V/Q scan) is used when CTPA is contraindicated
(e.g., renal impairment, contrast allergy).
Q2: A patient with a pulmonary embolism is hemodynamically unstable with
hypotension (BP 82/56 mmHg), tachycardia (128 bpm), and signs of right ventricular
strain on ECG. Which management is the priority?
,A. Initiate heparin infusion and observe
B. Systemic thrombolytic therapy (e.g., alteplase) or embolectomy
C. Warfarin 5 mg PO daily
D. Inferior vena cava (IVC) filter placement only
Correct Answer: B
Rationale: Massive PE with hemodynamic instability (hypotension, shock) requires
emergent systemic thrombolytics or surgical/catheter embolectomy. Anticoagulation
alone (Options A and C) is insufficient for massive PE. Option D (IVC filter) is adjunctive,
not primary treatment for massive PE.
Q3: A patient with COPD has the following ABG: pH 7.32, PaCO2 58 mmHg, PaO2 62
mmHg, HCO3 30 mEq/L. Which acid-base disorder is present, and what is the target
oxygen saturation for this patient?
A. Respiratory alkalosis; target SpO2 94–98%
B. Respiratory acidosis with metabolic compensation; target SpO2 88–92%
C. Metabolic acidosis; target SpO2 94–98%
D. Respiratory acidosis without compensation; target SpO2 100%
Correct Answer: B
Rationale: The ABG shows respiratory acidosis (pH 7.32, PaCO2 58) with metabolic
compensation (HCO3 30 elevated). COPD patients with chronic hypercapnia depend on
hypoxic drive; target SpO2 is 88–92% to avoid CO2 retention and respiratory acidosis
worsening. Options A, C, and D misidentify the disorder or target.
Q4: A patient with asthma presents with severe wheezing, dyspnea, use of accessory
muscles, and an inability to speak in full sentences. Peak expiratory flow is 35% of
predicted. Which classification and priority intervention apply?
, A. Mild exacerbation; administer albuterol 2 puffs PRN
B. Moderate exacerbation; administer albuterol and oral corticosteroids
C. Severe exacerbation; administer high-dose albuterol/ipratropium nebulizer, systemic
corticosteroids, and consider magnesium sulfate
D. Near-fatal asthma; immediate intubation and mechanical ventilation
Correct Answer: C
Rationale: Severe asthma exacerbation is characterized by PEF <50% predicted, inability
to speak in full sentences, use of accessory muscles, and severe dyspnea. Priority
interventions include high-dose bronchodilators (albuterol + ipratropium), systemic
corticosteroids, and magnesium sulfate. Option A describes mild exacerbation. Option
B describes moderate. Option D (near-fatal) requires intubation for altered
consciousness or respiratory arrest.
Q5: A patient with COPD is prescribed tiotropium (Spiriva) via HandiHaler. Which
mechanism of action and therapeutic effect should the nurse explain to the patient?
A. Beta-2 agonist; bronchodilation via smooth muscle relaxation
B. Anticholinergic; bronchodilation via inhibition of acetylcholine at muscarinic
receptors
C. Inhaled corticosteroid; reduction of airway inflammation
D. Leukotriene modifier; reduction of bronchoconstriction and inflammation
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA/anticholinergic)
that causes bronchodilation by blocking acetylcholine at muscarinic receptors. Option A
describes beta-2 agonists (albuterol, salmeterol). Option C describes inhaled
corticosteroids (fluticasone). Option D describes leukotriene modifiers (montelukast).
