NR324 / NR-324: Adult Health I Exam 1
Chamberlain College of Nursing | Latest 2026/2027 Curriculum
Subject Adult Health I (NR 324) Questions 75 (Multiple Choice)
25% Recall / 55% Application / 20%
Sections 6 Sections Cognitive Levels
Analysis
Section 1: Respiratory Disorders
Upper & Lower Respiratory, COPD, Asthma, Pneumonia, Tuberculosis
Q1: A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which of the following
findings is most consistent with emphysema rather than chronic bronchitis?
A. Prodigious sputum production with a chronic productive cough
B. Barrel chest, dyspnea on exertion, and weight loss with minimal cough [CORRECT]
C. Cyanosis and polycythemia secondary to chronic hypoxemia
D. Frequent pulmonary infections with thick, tenacious secretions
Correct Answer: B
Rationale: Emphysema is characterized by alveolar destruction and loss of elastic recoil, leading to air trapping, barrel chest, and dyspnea.
Weight loss occurs due to increased work of breathing. Chronic bronchitis is defined by a productive cough for at least 3 months in 2
consecutive years, with significant sputum production. Cyanosis and polycythemia are more associated with chronic bronchitis (the 'blue
bloater' phenotype), while emphysema patients are often referred to as 'pink puffers.'
[Analysis | SCENARIO]
Q2: A patient with COPD has an arterial blood gas (ABG) result of pH 7.32, PaCO2 58 mmHg, HCO3 32
mEq/L, PaO2 52 mmHg. The nurse interprets this as which acid-base imbalance?
A. Respiratory acidosis with partial renal compensation [CORRECT]
B. Respiratory alkalosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Uncompensated respiratory acidosis
Correct Answer: A
Rationale: The pH of 7.32 is below normal (7.35-7.45), indicating acidosis. The PaCO2 of 58 mmHg is elevated (normal 35-45), indicating a
respiratory cause. The HCO3 of 32 mEq/L is elevated (normal 22-26), reflecting renal compensation (retention of bicarbonate to buffer the
acidosis). This is a chronic finding in COPD patients due to persistent hypercapnia from impaired gas exchange and air trapping. The partial
compensation means the pH has not fully returned to normal.
[Analysis | SCENARIO]
Q3: The nurse is providing discharge teaching to a patient with COPD. Which instruction is the most important
to include for long-term disease management?
A. Use a humidifier in the home to thin secretions
B. Engage in high-intensity aerobic exercise to build endurance
C. Participate in a smoking cessation program immediately [CORRECT]
D. Limit fluid intake to prevent fluid overload
,Correct Answer: C
Rationale: Smoking cessation is the single most effective intervention for slowing COPD progression and reducing further airway
inflammation. Smoking is the primary risk factor for COPD, and continued exposure accelerates alveolar destruction and airway remodeling.
While humidifiers may help with secretions and exercise is beneficial when prescribed within tolerance, neither addresses the underlying
disease progression like smoking cessation does. Fluid intake should generally be encouraged (not limited) to help thin secretions.
[Application | SCENARIO]
Q4: A patient with severe COPD is admitted with acute exacerbation. The nurse notes the patient is receiving
oxygen at 4 L/min via nasal cannula. Which assessment finding would indicate a potential complication of this
oxygen therapy?
A. Decreased respiratory rate from 24 to 18 breaths/min
B. Increased alertness and improved color
C. PaCO2 rising from 50 to 68 mmHg on repeat ABG [CORRECT]
D. SpO2 improving from 88% to 95%
Correct Answer: C
Rationale: COPD patients often rely on hypoxic drive to stimulate respirations. Administering excessive oxygen (typically above 1-2 L/min) can
suppress this drive, causing hypoventilation and further CO2 retention (hypercapnia). A rising PaCO2 from 50 to 68 mmHg indicates
worsening carbon dioxide retention, which can lead to carbon dioxide narcosis and respiratory failure. The appropriate oxygen target for most
COPD patients is an SpO2 of 88-92%, not 95% or higher.
[Analysis | SCENARIO]
Q5: A nurse is teaching pursed-lip breathing to a patient with COPD. What is the primary purpose of this
breathing technique?
A. Increase oxygen delivery to the alveoli
B. Prolong the expiratory phase and maintain airway patency [CORRECT]
C. Strengthen the diaphragm for more effective inspiration
D. Reduce the work of breathing during inspiration
Correct Answer: B
Rationale: Pursed-lip breathing prolongs the expiratory phase by creating back-pressure in the airways, which helps keep small bronchioles
open during exhalation. This reduces air trapping, improves gas exchange, and helps the patient exhale more fully. In COPD, the loss of elastic
recoil and premature airway collapse during expiration causes air trapping. Pursed-lip breathing directly counteracts this pathophysiologic
mechanism. Diaphragmatic (belly) breathing, not pursed-lip, primarily strengthens the diaphragm.
[Application | RECALL]
Q6: A patient with asthma presents to the emergency department with severe dyspnea, wheezing, and inability
to speak in full sentences. The nurse identifies this as which condition?
A. Mild intermittent asthma exacerbation
B. Status asthmaticus [CORRECT]
C. Chronic obstructive asthma
D. Exercise-induced bronchospasm
Correct Answer: B
Rationale: Status asthmaticus is a severe, life-threatening asthma exacerbation that does not respond to standard bronchodilator therapy.
Clinical features include severe dyspnea, marked wheezing (or absent breath sounds indicating no air movement), inability to speak in full
sentences, use of accessory muscles, and altered mental status. It is a medical emergency requiring continuous nebulized bronchodilators,
systemic corticosteroids, oxygen, and possibly intubation and mechanical ventilation.
[Application | SCENARIO]
, Q7: A nurse is providing medication education to a patient newly prescribed an inhaled corticosteroid (ICS) for
asthma long-term control. Which instruction is most important?
A. Take the ICS as a quick-relief medication during acute episodes
B. Rinse the mouth thoroughly after each use to prevent oral candidiasis [CORRECT]
C. Use the ICS immediately before exercise to prevent bronchospasm
D. Expect immediate relief of symptoms within 5 minutes of use
Correct Answer: B
Rationale: Inhaled corticosteroids reduce airway inflammation but carry a risk of oral candidiasis (thrush) due to local immunosuppression in
the oropharynx. Rinsing the mouth after each use removes residual medication from the oral mucosa and significantly reduces this risk. ICS
are long-term control medications, not quick-relief drugs; albuterol (SABA) provides quick relief. ICS do not provide immediate
bronchodilation and take days to weeks for full therapeutic effect.
[Application | SCENARIO]
Q8: A patient with asthma asks the nurse about the correct order of using a short-acting beta-agonist (SABA)
and an inhaled corticosteroid (ICS). What is the correct teaching?
A. Use the ICS first, then wait 5 minutes before the SABA
B. Use the SABA first to open airways, then use the ICS 15 minutes later [CORRECT]
C. Use both medications simultaneously for maximum effect
D. Alternate between the SABA and ICS every other day
Correct Answer: B
Rationale: The correct sequence is to use the SABA (e.g., albuterol) first to bronchodilate and open the airways, then wait approximately 15
minutes before using the ICS. This allows the bronchodilated airways to receive better distribution and penetration of the inhaled corticosteroid
into the distal airways, improving its anti-inflammatory effectiveness. Using ICS first would not provide optimal drug delivery since inflamed
and constricted airways limit medication penetration.
[Application | SCENARIO]
Q9: A nurse is reviewing trigger avoidance with a patient who has asthma. Which of the following medications
should the nurse identify as potentially triggering bronchospasm in an asthmatic patient?
A. Acetaminophen
B. Aspirin and NSAIDs [CORRECT]
C. Loratadine
D. Omeprazole
Correct Answer: B
Rationale: Aspirin and NSAIDs can trigger bronchospasm in patients with aspirin-exacerbated respiratory disease (AERD), also known as
Samter's triad (asthma, nasal polyps, and aspirin sensitivity). This occurs due to the shunting of arachidonic acid metabolism toward the
leukotriene pathway when COX-1 is inhibited, producing excessive leukotrienes that cause bronchoconstriction. Beta-blockers are another
important medication class that can trigger asthma by blocking beta-2 receptors in bronchial smooth muscle.
[Application | SCENARIO]
Q10: A patient with an acute asthma exacerbation has the following ABG results: pH 7.48, PaCO2 30 mmHg,
HCO3 24 mEq/L. The nurse interprets this as which condition?
A. Respiratory acidosis
B. Respiratory alkalosis [CORRECT]
C. Metabolic alkalosis
D. Metabolic acidosis
Correct Answer: B
Chamberlain College of Nursing | Latest 2026/2027 Curriculum
Subject Adult Health I (NR 324) Questions 75 (Multiple Choice)
25% Recall / 55% Application / 20%
Sections 6 Sections Cognitive Levels
Analysis
Section 1: Respiratory Disorders
Upper & Lower Respiratory, COPD, Asthma, Pneumonia, Tuberculosis
Q1: A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which of the following
findings is most consistent with emphysema rather than chronic bronchitis?
A. Prodigious sputum production with a chronic productive cough
B. Barrel chest, dyspnea on exertion, and weight loss with minimal cough [CORRECT]
C. Cyanosis and polycythemia secondary to chronic hypoxemia
D. Frequent pulmonary infections with thick, tenacious secretions
Correct Answer: B
Rationale: Emphysema is characterized by alveolar destruction and loss of elastic recoil, leading to air trapping, barrel chest, and dyspnea.
Weight loss occurs due to increased work of breathing. Chronic bronchitis is defined by a productive cough for at least 3 months in 2
consecutive years, with significant sputum production. Cyanosis and polycythemia are more associated with chronic bronchitis (the 'blue
bloater' phenotype), while emphysema patients are often referred to as 'pink puffers.'
[Analysis | SCENARIO]
Q2: A patient with COPD has an arterial blood gas (ABG) result of pH 7.32, PaCO2 58 mmHg, HCO3 32
mEq/L, PaO2 52 mmHg. The nurse interprets this as which acid-base imbalance?
A. Respiratory acidosis with partial renal compensation [CORRECT]
B. Respiratory alkalosis with metabolic compensation
C. Metabolic acidosis with respiratory compensation
D. Uncompensated respiratory acidosis
Correct Answer: A
Rationale: The pH of 7.32 is below normal (7.35-7.45), indicating acidosis. The PaCO2 of 58 mmHg is elevated (normal 35-45), indicating a
respiratory cause. The HCO3 of 32 mEq/L is elevated (normal 22-26), reflecting renal compensation (retention of bicarbonate to buffer the
acidosis). This is a chronic finding in COPD patients due to persistent hypercapnia from impaired gas exchange and air trapping. The partial
compensation means the pH has not fully returned to normal.
[Analysis | SCENARIO]
Q3: The nurse is providing discharge teaching to a patient with COPD. Which instruction is the most important
to include for long-term disease management?
A. Use a humidifier in the home to thin secretions
B. Engage in high-intensity aerobic exercise to build endurance
C. Participate in a smoking cessation program immediately [CORRECT]
D. Limit fluid intake to prevent fluid overload
,Correct Answer: C
Rationale: Smoking cessation is the single most effective intervention for slowing COPD progression and reducing further airway
inflammation. Smoking is the primary risk factor for COPD, and continued exposure accelerates alveolar destruction and airway remodeling.
While humidifiers may help with secretions and exercise is beneficial when prescribed within tolerance, neither addresses the underlying
disease progression like smoking cessation does. Fluid intake should generally be encouraged (not limited) to help thin secretions.
[Application | SCENARIO]
Q4: A patient with severe COPD is admitted with acute exacerbation. The nurse notes the patient is receiving
oxygen at 4 L/min via nasal cannula. Which assessment finding would indicate a potential complication of this
oxygen therapy?
A. Decreased respiratory rate from 24 to 18 breaths/min
B. Increased alertness and improved color
C. PaCO2 rising from 50 to 68 mmHg on repeat ABG [CORRECT]
D. SpO2 improving from 88% to 95%
Correct Answer: C
Rationale: COPD patients often rely on hypoxic drive to stimulate respirations. Administering excessive oxygen (typically above 1-2 L/min) can
suppress this drive, causing hypoventilation and further CO2 retention (hypercapnia). A rising PaCO2 from 50 to 68 mmHg indicates
worsening carbon dioxide retention, which can lead to carbon dioxide narcosis and respiratory failure. The appropriate oxygen target for most
COPD patients is an SpO2 of 88-92%, not 95% or higher.
[Analysis | SCENARIO]
Q5: A nurse is teaching pursed-lip breathing to a patient with COPD. What is the primary purpose of this
breathing technique?
A. Increase oxygen delivery to the alveoli
B. Prolong the expiratory phase and maintain airway patency [CORRECT]
C. Strengthen the diaphragm for more effective inspiration
D. Reduce the work of breathing during inspiration
Correct Answer: B
Rationale: Pursed-lip breathing prolongs the expiratory phase by creating back-pressure in the airways, which helps keep small bronchioles
open during exhalation. This reduces air trapping, improves gas exchange, and helps the patient exhale more fully. In COPD, the loss of elastic
recoil and premature airway collapse during expiration causes air trapping. Pursed-lip breathing directly counteracts this pathophysiologic
mechanism. Diaphragmatic (belly) breathing, not pursed-lip, primarily strengthens the diaphragm.
[Application | RECALL]
Q6: A patient with asthma presents to the emergency department with severe dyspnea, wheezing, and inability
to speak in full sentences. The nurse identifies this as which condition?
A. Mild intermittent asthma exacerbation
B. Status asthmaticus [CORRECT]
C. Chronic obstructive asthma
D. Exercise-induced bronchospasm
Correct Answer: B
Rationale: Status asthmaticus is a severe, life-threatening asthma exacerbation that does not respond to standard bronchodilator therapy.
Clinical features include severe dyspnea, marked wheezing (or absent breath sounds indicating no air movement), inability to speak in full
sentences, use of accessory muscles, and altered mental status. It is a medical emergency requiring continuous nebulized bronchodilators,
systemic corticosteroids, oxygen, and possibly intubation and mechanical ventilation.
[Application | SCENARIO]
, Q7: A nurse is providing medication education to a patient newly prescribed an inhaled corticosteroid (ICS) for
asthma long-term control. Which instruction is most important?
A. Take the ICS as a quick-relief medication during acute episodes
B. Rinse the mouth thoroughly after each use to prevent oral candidiasis [CORRECT]
C. Use the ICS immediately before exercise to prevent bronchospasm
D. Expect immediate relief of symptoms within 5 minutes of use
Correct Answer: B
Rationale: Inhaled corticosteroids reduce airway inflammation but carry a risk of oral candidiasis (thrush) due to local immunosuppression in
the oropharynx. Rinsing the mouth after each use removes residual medication from the oral mucosa and significantly reduces this risk. ICS
are long-term control medications, not quick-relief drugs; albuterol (SABA) provides quick relief. ICS do not provide immediate
bronchodilation and take days to weeks for full therapeutic effect.
[Application | SCENARIO]
Q8: A patient with asthma asks the nurse about the correct order of using a short-acting beta-agonist (SABA)
and an inhaled corticosteroid (ICS). What is the correct teaching?
A. Use the ICS first, then wait 5 minutes before the SABA
B. Use the SABA first to open airways, then use the ICS 15 minutes later [CORRECT]
C. Use both medications simultaneously for maximum effect
D. Alternate between the SABA and ICS every other day
Correct Answer: B
Rationale: The correct sequence is to use the SABA (e.g., albuterol) first to bronchodilate and open the airways, then wait approximately 15
minutes before using the ICS. This allows the bronchodilated airways to receive better distribution and penetration of the inhaled corticosteroid
into the distal airways, improving its anti-inflammatory effectiveness. Using ICS first would not provide optimal drug delivery since inflamed
and constricted airways limit medication penetration.
[Application | SCENARIO]
Q9: A nurse is reviewing trigger avoidance with a patient who has asthma. Which of the following medications
should the nurse identify as potentially triggering bronchospasm in an asthmatic patient?
A. Acetaminophen
B. Aspirin and NSAIDs [CORRECT]
C. Loratadine
D. Omeprazole
Correct Answer: B
Rationale: Aspirin and NSAIDs can trigger bronchospasm in patients with aspirin-exacerbated respiratory disease (AERD), also known as
Samter's triad (asthma, nasal polyps, and aspirin sensitivity). This occurs due to the shunting of arachidonic acid metabolism toward the
leukotriene pathway when COX-1 is inhibited, producing excessive leukotrienes that cause bronchoconstriction. Beta-blockers are another
important medication class that can trigger asthma by blocking beta-2 receptors in bronchial smooth muscle.
[Application | SCENARIO]
Q10: A patient with an acute asthma exacerbation has the following ABG results: pH 7.48, PaCO2 30 mmHg,
HCO3 24 mEq/L. The nurse interprets this as which condition?
A. Respiratory acidosis
B. Respiratory alkalosis [CORRECT]
C. Metabolic alkalosis
D. Metabolic acidosis
Correct Answer: B
