Exam 3: NUR201 / NUR 201 (Latest 2026
/ 2027 Update) Medical-Surgical Nursing
I | Questions and Verified Answers 100%
Correct | Grade A – Fortis
Question 1
A patient with a tracheostomy has a new order for a fenestrated tracheostomy
tube. Which action should the nurse include in the plan of care in collaboration
with the speech therapist?
A. Leave the tracheostomy inner cannula inserted at all times
B. Place the decannulation cap in the tube before cuff deflation
C. Deflate the cuff before capping the tube for speech
D. Keep the cuff inflated at all times to prevent aspiration
Correct Answer: C. Deflate the cuff before capping the tube for speech
Rationale: A fenestrated tracheostomy tube allows air to pass through the vocal cords
for speech when the cuff is deflated and the inner cannula is removed or capped. The
decannulation cap is used for weaning, not speech. Collaboration with speech therapy is
essential for safe use of the fenestrated tube .
Question 2
The nurse notes that a patient has incisional pain, a poor cough effort, and
scattered coarse crackles after a thoracotomy. Which action should the nurse take
first?
A. Assist the patient to sit upright in a chair
B. Splint the patient's chest during coughing
C. Medicate the patient with prescribed morphine
D. Observe the patient use the incentive spirometer
Correct Answer: C. Medicate the patient with prescribed morphine
,Rationale: A major reason for atelectasis and poor airway clearance in patients after
chest surgery is incisional pain (which increases with deep breathing and coughing). The
nurse should first medicate the patient to minimize incisional pain. The other actions are
all appropriate ways to improve airway clearance but should be done after the morphine
is given .
Question 3
A patient is admitted to the emergency department with an open stab wound to
the left chest. What action should the nurse take?
A. Keep the head of the patient's bed positioned flat
B. Cover the wound tightly with an occlusive dressing
C. Position the patient so that the left chest is dependent
D. Tape a nonporous dressing on three sides over the wound
Correct Answer: D. Tape a nonporous dressing on three sides over the wound
Rationale: The dressing taped on three sides will allow air to escape when intrapleural
pressure increases during expiration, but it will prevent air from moving into the pleural
space during inspiration (creating a one-way valve effect). Placing the patient on the left
side or covering the chest wound with an occlusive dressing will allow trapped air in the
pleural space and cause tension pneumothorax. The head of the bed should be elevated
to 30 to 45 degrees to facilitate breathing .
Question 4
A patient who was admitted the previous day with pneumonia reports a sharp pain
of 7 (on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse
take next?
A. Auscultate for breath sounds
B. Administer as-needed morphine
C. Have the patient cough forcefully
D. Notify the patient's health care provider
Correct Answer: A. Auscultate for breath sounds
,Rationale: The patient's statement indicates that pleurisy or a pleural effusion may have
developed, and the nurse will need to listen for a pleural friction rub and decreased
breath sounds. Assessment should occur before administration of pain medications. The
patient is unlikely to be able to cough forcefully until pain medication has been
administered .
Question 5
The nurse is caring for a patient with idiopathic pulmonary arterial hypertension
(IPAH). Which assessment information requires the most immediate action by the
nurse?
A. The O2 saturation is 90%
B. The blood pressure is 98/56 mm Hg
C. The epoprostenol (Flolan) infusion is disconnected
D. The international normalized ratio (INR) is prolonged
Correct Answer: C. The epoprostenol (Flolan) infusion is disconnected
Rationale: The half-life of this drug is 6 minutes, so the nurse will need to restart the
infusion as soon as possible to prevent rapid clinical deterioration. The other data also
indicate a need for ongoing monitoring or intervention, but the priority action is to
reconnect the infusion .
Question 6
A client with COPD has a PaCO₂ of 58 mmHg. What is the priority nursing
intervention?
A. Increase oxygen to 6 L/min
B. Encourage pursed-lip breathing
C. Position in supine
D. Restrict fluids
Correct Answer: B. Encourage pursed-lip breathing
, Rationale: Pursed-lip breathing improves CO₂ elimination by creating positive pressure
in the airways during exhalation, preventing airway collapse. High oxygen flow may
worsen CO₂ retention in COPD patients by suppressing the hypoxic drive. The head of
the bed should be elevated, not supine .
Question 7
A patient has acute bronchitis with a nonproductive cough and wheezes. Which
topic should the nurse plan to include in the teaching plan?
A. Purpose of antibiotic therapy
B. Ways to limit oral fluid intake
C. Appropriate use of cough suppressants
D. Safety concerns with home O2 therapy
Correct Answer: C. Appropriate use of cough suppressants
Rationale: Cough suppressants are frequently prescribed for acute bronchitis. Because
most acute bronchitis is viral in origin, antibiotics are not prescribed unless there are
systemic symptoms. Fluid intake is encouraged. Home O2 is not prescribed for acute
bronchitis, although it may be used for chronic bronchitis .
Question 8
The nurse hears crackles in the lower lobes. What is the most likely cause?
A. Bronchospasm
B. Air in pleural space
C. Fluid in alveoli
D. Upper airway obstruction
Correct Answer: C. Fluid in alveoli
Rationale: Crackles (rales) are caused by air passing through fluid-filled or collapsed
alveoli. Common causes include heart failure (pulmonary edema) and pneumonia.
Bronchospasm causes wheezing; air in the pleural space causes decreased breath
sounds; upper airway obstruction causes stridor .
/ 2027 Update) Medical-Surgical Nursing
I | Questions and Verified Answers 100%
Correct | Grade A – Fortis
Question 1
A patient with a tracheostomy has a new order for a fenestrated tracheostomy
tube. Which action should the nurse include in the plan of care in collaboration
with the speech therapist?
A. Leave the tracheostomy inner cannula inserted at all times
B. Place the decannulation cap in the tube before cuff deflation
C. Deflate the cuff before capping the tube for speech
D. Keep the cuff inflated at all times to prevent aspiration
Correct Answer: C. Deflate the cuff before capping the tube for speech
Rationale: A fenestrated tracheostomy tube allows air to pass through the vocal cords
for speech when the cuff is deflated and the inner cannula is removed or capped. The
decannulation cap is used for weaning, not speech. Collaboration with speech therapy is
essential for safe use of the fenestrated tube .
Question 2
The nurse notes that a patient has incisional pain, a poor cough effort, and
scattered coarse crackles after a thoracotomy. Which action should the nurse take
first?
A. Assist the patient to sit upright in a chair
B. Splint the patient's chest during coughing
C. Medicate the patient with prescribed morphine
D. Observe the patient use the incentive spirometer
Correct Answer: C. Medicate the patient with prescribed morphine
,Rationale: A major reason for atelectasis and poor airway clearance in patients after
chest surgery is incisional pain (which increases with deep breathing and coughing). The
nurse should first medicate the patient to minimize incisional pain. The other actions are
all appropriate ways to improve airway clearance but should be done after the morphine
is given .
Question 3
A patient is admitted to the emergency department with an open stab wound to
the left chest. What action should the nurse take?
A. Keep the head of the patient's bed positioned flat
B. Cover the wound tightly with an occlusive dressing
C. Position the patient so that the left chest is dependent
D. Tape a nonporous dressing on three sides over the wound
Correct Answer: D. Tape a nonporous dressing on three sides over the wound
Rationale: The dressing taped on three sides will allow air to escape when intrapleural
pressure increases during expiration, but it will prevent air from moving into the pleural
space during inspiration (creating a one-way valve effect). Placing the patient on the left
side or covering the chest wound with an occlusive dressing will allow trapped air in the
pleural space and cause tension pneumothorax. The head of the bed should be elevated
to 30 to 45 degrees to facilitate breathing .
Question 4
A patient who was admitted the previous day with pneumonia reports a sharp pain
of 7 (on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse
take next?
A. Auscultate for breath sounds
B. Administer as-needed morphine
C. Have the patient cough forcefully
D. Notify the patient's health care provider
Correct Answer: A. Auscultate for breath sounds
,Rationale: The patient's statement indicates that pleurisy or a pleural effusion may have
developed, and the nurse will need to listen for a pleural friction rub and decreased
breath sounds. Assessment should occur before administration of pain medications. The
patient is unlikely to be able to cough forcefully until pain medication has been
administered .
Question 5
The nurse is caring for a patient with idiopathic pulmonary arterial hypertension
(IPAH). Which assessment information requires the most immediate action by the
nurse?
A. The O2 saturation is 90%
B. The blood pressure is 98/56 mm Hg
C. The epoprostenol (Flolan) infusion is disconnected
D. The international normalized ratio (INR) is prolonged
Correct Answer: C. The epoprostenol (Flolan) infusion is disconnected
Rationale: The half-life of this drug is 6 minutes, so the nurse will need to restart the
infusion as soon as possible to prevent rapid clinical deterioration. The other data also
indicate a need for ongoing monitoring or intervention, but the priority action is to
reconnect the infusion .
Question 6
A client with COPD has a PaCO₂ of 58 mmHg. What is the priority nursing
intervention?
A. Increase oxygen to 6 L/min
B. Encourage pursed-lip breathing
C. Position in supine
D. Restrict fluids
Correct Answer: B. Encourage pursed-lip breathing
, Rationale: Pursed-lip breathing improves CO₂ elimination by creating positive pressure
in the airways during exhalation, preventing airway collapse. High oxygen flow may
worsen CO₂ retention in COPD patients by suppressing the hypoxic drive. The head of
the bed should be elevated, not supine .
Question 7
A patient has acute bronchitis with a nonproductive cough and wheezes. Which
topic should the nurse plan to include in the teaching plan?
A. Purpose of antibiotic therapy
B. Ways to limit oral fluid intake
C. Appropriate use of cough suppressants
D. Safety concerns with home O2 therapy
Correct Answer: C. Appropriate use of cough suppressants
Rationale: Cough suppressants are frequently prescribed for acute bronchitis. Because
most acute bronchitis is viral in origin, antibiotics are not prescribed unless there are
systemic symptoms. Fluid intake is encouraged. Home O2 is not prescribed for acute
bronchitis, although it may be used for chronic bronchitis .
Question 8
The nurse hears crackles in the lower lobes. What is the most likely cause?
A. Bronchospasm
B. Air in pleural space
C. Fluid in alveoli
D. Upper airway obstruction
Correct Answer: C. Fluid in alveoli
Rationale: Crackles (rales) are caused by air passing through fluid-filled or collapsed
alveoli. Common causes include heart failure (pulmonary edema) and pneumonia.
Bronchospasm causes wheezing; air in the pleural space causes decreased breath
sounds; upper airway obstruction causes stridor .
