NSG 223 Exam 3: Medical-Surgical Nursing II - Herzing University (2026/2027) Guide Questions & Verified Answers | Grade A
NSG 223 Exam 3: Medical-Surgical Nursing II
Herzing University | Latest Update
Guide Questions and Verified Answers - 100% Correct - Grade A
Total Questions: 50 | Sections: 5 | Cognitive Distribution: 25% Recall, 55% Application, 20% Analysis | Question Style: 70%
Scenario-Based, 20% Direct Recall, 10% Clinical Judgment
Section 1: Respiratory Disorders (COPD, Asthma, Pneumonia, TB) -
Questions Q1-Q15
Q1. A 68-year-old male with a 40-pack-year smoking history presents with chronic productive cough and
dyspnea on exertion. Prolonged expiratory phase, barrel chest, and clubbing are noted on assessment. Which
pathophysiologic process is the PRIMARY cause of his condition?
A. Reversible bronchospasm triggered by allergens
B. Acute bacterial infection of the lung parenchyma
C. Progressive alveolar destruction and chronic bronchial inflammation from cigarette smoking
[CORRECT]
D. Pulmonary embolism causing sudden ventilation-perfusion mismatch
Correct Answer: C
Rationale: COPD is a progressive chronic condition most commonly caused by cigarette smoking, producing emphysema (alveolar
destruction and loss of elasticity) and chronic bronchitis (inflammation with excessive mucus). Unlike asthma, the airflow
limitation is not fully reversible. Acute infection and PE do not explain the chronic progressive presentation.
Q2. The nurse is teaching a newly diagnosed COPD patient about the most effective way to slow disease
progression. Which statement by the patient indicates teaching has been effective?
A. "I will use my inhaler only when I feel short of breath."
B. "I will limit my fluids to prevent fluid overload."
C. "I will stop smoking and avoid second-hand smoke." [CORRECT]
D. "I will take antibiotics daily to prevent infections."
Correct Answer: C
Rationale: Smoking cessation is the single most effective intervention to slow COPD progression and reduce exacerbations.
Inhalers should be used as prescribed, not just when symptomatic. Fluids help thin secretions and should not be limited unless
clinically indicated. Daily prophylactic antibiotics are not part of COPD management.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 1
,NSG 223 Exam 3: Medical-Surgical Nursing II - Herzing University (2026/2027) Guide Questions & Verified Answers | Grade A
Q3. A COPD patient receiving oxygen therapy at 4 L/min via nasal cannula becomes lethargic and the family
reports increasing drowsiness. The nurse recognizes that the most likely cause is:
A. Hypoxia from insufficient oxygen delivery
B. An allergic reaction to the nasal cannula
C. Carbon dioxide retention due to excessive oxygen administration [CORRECT]
D. Hypoglycemia from missed meals
Correct Answer: C
Rationale: In COPD patients with chronic CO2 retention, the respiratory drive becomes hypoxic rather than hypercapnic.
Excessive oxygen can blunt this drive, leading to worsening hypercapnia and CO2 narcosis (lethargy, drowsiness). The target
SpO2 for COPD patients is 88-92% to avoid CO2 retention. Hypoxia is unlikely with 4 L/min, and allergic/hypoglycemic causes
do not fit the context.
Q4. Which oxygen saturation target is most appropriate for a patient with severe COPD and chronic
hypercapnia?
A. 92-100%
B. 80-85%
C. 88-92% [CORRECT]
D. 94-98%
Correct Answer: C
Rationale: For COPD patients with chronic CO2 retention, the target SpO2 is 88-92%. Higher saturations risk suppressing the
hypoxic respiratory drive and worsening hypercapnia. Lower saturations (80-85%) cause tissue hypoxia. Targets of 94-100% are
appropriate for patients without chronic CO2 retention.
Q5. A patient with COPD demonstrates a tripod position and pursed-lip breathing during exertion. The
nurse understands that pursed-lip breathing works by:
A. Prolonging exhalation and preventing airway collapse, promoting CO2 elimination [CORRECT]
B. Increasing respiratory rate to improve oxygen intake
C. Strengthening intercostal muscles
D. Reducing the work of breathing by decreasing oxygen demand
Correct Answer: A
Rationale: Pursed-lip breathing prolongs exhalation, maintains positive pressure in the airways, and prevents small airway
collapse. This promotes more complete CO2 elimination and reduces air trapping. It does not increase respiratory rate or
strengthen muscles directly. The tripod position, not pursed-lip breathing, reduces the work of breathing by stabilizing accessory
muscles.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 2
, NSG 223 Exam 3: Medical-Surgical Nursing II - Herzing University (2026/2027) Guide Questions & Verified Answers | Grade A
Q6. A 70-year-old COPD patient develops right-sided heart failure with jugular venous distension and
peripheral edema. The nurse recognizes this complication as:
A. Left-sided heart failure
B. Pericarditis
C. Cardiogenic shock
D. Cor pulmonale [CORRECT]
Correct Answer: D
Rationale: Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension from chronic lung disease.
Pulmonary vasoconstriction from hypoxia increases pulmonary vascular resistance, causing right ventricular hypertrophy and
eventual failure. Left-sided failure would present with pulmonary edema. Cardiogenic shock and pericarditis do not match this
presentation.
Q7. Spirometry results for a patient with suspected COPD show a post-bronchodilator FEV1/FVC ratio of
0.65. The nurse correctly interprets this finding as:
A. Normal lung function
B. Reversible airflow obstruction consistent with asthma
C. Restrictive lung disease
D. Persistent airflow limitation consistent with COPD [CORRECT]
Correct Answer: D
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow limitation, the diagnostic criterion
for COPD. Normal ratio is approximately 0.75-0.80. Asthma shows reversible obstruction (improved FEV1 after bronchodilator).
Restrictive disease shows increased ratio with reduced total lung capacity.
Q8. A 24-year-old patient with asthma presents with wheezing, dyspnea, chest tightness, and nocturnal cough.
Which underlying pathophysiologic process is primarily responsible for these symptoms?
A. Chronic eosinophilic and mast cell-mediated airway inflammation with bronchospasm
[CORRECT]
B. Bacterial infection of the bronchi
C. Permanent destruction of alveolar walls
D. Pulmonary vascular obstruction
Correct Answer: A
Rationale: Asthma is a chronic inflammatory airway disease characterized by eosinophilic and mast cell-mediated inflammation,
bronchospasm, and airway hyperresponsiveness. Unlike COPD, asthma is generally reversible. Bacterial infection suggests
pneumonia. Alveolar destruction is emphysema. Pulmonary vascular obstruction is PE.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 3
NSG 223 Exam 3: Medical-Surgical Nursing II
Herzing University | Latest Update
Guide Questions and Verified Answers - 100% Correct - Grade A
Total Questions: 50 | Sections: 5 | Cognitive Distribution: 25% Recall, 55% Application, 20% Analysis | Question Style: 70%
Scenario-Based, 20% Direct Recall, 10% Clinical Judgment
Section 1: Respiratory Disorders (COPD, Asthma, Pneumonia, TB) -
Questions Q1-Q15
Q1. A 68-year-old male with a 40-pack-year smoking history presents with chronic productive cough and
dyspnea on exertion. Prolonged expiratory phase, barrel chest, and clubbing are noted on assessment. Which
pathophysiologic process is the PRIMARY cause of his condition?
A. Reversible bronchospasm triggered by allergens
B. Acute bacterial infection of the lung parenchyma
C. Progressive alveolar destruction and chronic bronchial inflammation from cigarette smoking
[CORRECT]
D. Pulmonary embolism causing sudden ventilation-perfusion mismatch
Correct Answer: C
Rationale: COPD is a progressive chronic condition most commonly caused by cigarette smoking, producing emphysema (alveolar
destruction and loss of elasticity) and chronic bronchitis (inflammation with excessive mucus). Unlike asthma, the airflow
limitation is not fully reversible. Acute infection and PE do not explain the chronic progressive presentation.
Q2. The nurse is teaching a newly diagnosed COPD patient about the most effective way to slow disease
progression. Which statement by the patient indicates teaching has been effective?
A. "I will use my inhaler only when I feel short of breath."
B. "I will limit my fluids to prevent fluid overload."
C. "I will stop smoking and avoid second-hand smoke." [CORRECT]
D. "I will take antibiotics daily to prevent infections."
Correct Answer: C
Rationale: Smoking cessation is the single most effective intervention to slow COPD progression and reduce exacerbations.
Inhalers should be used as prescribed, not just when symptomatic. Fluids help thin secretions and should not be limited unless
clinically indicated. Daily prophylactic antibiotics are not part of COPD management.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 1
,NSG 223 Exam 3: Medical-Surgical Nursing II - Herzing University (2026/2027) Guide Questions & Verified Answers | Grade A
Q3. A COPD patient receiving oxygen therapy at 4 L/min via nasal cannula becomes lethargic and the family
reports increasing drowsiness. The nurse recognizes that the most likely cause is:
A. Hypoxia from insufficient oxygen delivery
B. An allergic reaction to the nasal cannula
C. Carbon dioxide retention due to excessive oxygen administration [CORRECT]
D. Hypoglycemia from missed meals
Correct Answer: C
Rationale: In COPD patients with chronic CO2 retention, the respiratory drive becomes hypoxic rather than hypercapnic.
Excessive oxygen can blunt this drive, leading to worsening hypercapnia and CO2 narcosis (lethargy, drowsiness). The target
SpO2 for COPD patients is 88-92% to avoid CO2 retention. Hypoxia is unlikely with 4 L/min, and allergic/hypoglycemic causes
do not fit the context.
Q4. Which oxygen saturation target is most appropriate for a patient with severe COPD and chronic
hypercapnia?
A. 92-100%
B. 80-85%
C. 88-92% [CORRECT]
D. 94-98%
Correct Answer: C
Rationale: For COPD patients with chronic CO2 retention, the target SpO2 is 88-92%. Higher saturations risk suppressing the
hypoxic respiratory drive and worsening hypercapnia. Lower saturations (80-85%) cause tissue hypoxia. Targets of 94-100% are
appropriate for patients without chronic CO2 retention.
Q5. A patient with COPD demonstrates a tripod position and pursed-lip breathing during exertion. The
nurse understands that pursed-lip breathing works by:
A. Prolonging exhalation and preventing airway collapse, promoting CO2 elimination [CORRECT]
B. Increasing respiratory rate to improve oxygen intake
C. Strengthening intercostal muscles
D. Reducing the work of breathing by decreasing oxygen demand
Correct Answer: A
Rationale: Pursed-lip breathing prolongs exhalation, maintains positive pressure in the airways, and prevents small airway
collapse. This promotes more complete CO2 elimination and reduces air trapping. It does not increase respiratory rate or
strengthen muscles directly. The tripod position, not pursed-lip breathing, reduces the work of breathing by stabilizing accessory
muscles.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 2
, NSG 223 Exam 3: Medical-Surgical Nursing II - Herzing University (2026/2027) Guide Questions & Verified Answers | Grade A
Q6. A 70-year-old COPD patient develops right-sided heart failure with jugular venous distension and
peripheral edema. The nurse recognizes this complication as:
A. Left-sided heart failure
B. Pericarditis
C. Cardiogenic shock
D. Cor pulmonale [CORRECT]
Correct Answer: D
Rationale: Cor pulmonale is right-sided heart failure secondary to pulmonary hypertension from chronic lung disease.
Pulmonary vasoconstriction from hypoxia increases pulmonary vascular resistance, causing right ventricular hypertrophy and
eventual failure. Left-sided failure would present with pulmonary edema. Cardiogenic shock and pericarditis do not match this
presentation.
Q7. Spirometry results for a patient with suspected COPD show a post-bronchodilator FEV1/FVC ratio of
0.65. The nurse correctly interprets this finding as:
A. Normal lung function
B. Reversible airflow obstruction consistent with asthma
C. Restrictive lung disease
D. Persistent airflow limitation consistent with COPD [CORRECT]
Correct Answer: D
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 confirms persistent airflow limitation, the diagnostic criterion
for COPD. Normal ratio is approximately 0.75-0.80. Asthma shows reversible obstruction (improved FEV1 after bronchodilator).
Restrictive disease shows increased ratio with reduced total lung capacity.
Q8. A 24-year-old patient with asthma presents with wheezing, dyspnea, chest tightness, and nocturnal cough.
Which underlying pathophysiologic process is primarily responsible for these symptoms?
A. Chronic eosinophilic and mast cell-mediated airway inflammation with bronchospasm
[CORRECT]
B. Bacterial infection of the bronchi
C. Permanent destruction of alveolar walls
D. Pulmonary vascular obstruction
Correct Answer: A
Rationale: Asthma is a chronic inflammatory airway disease characterized by eosinophilic and mast cell-mediated inflammation,
bronchospasm, and airway hyperresponsiveness. Unlike COPD, asthma is generally reversible. Bacterial infection suggests
pneumonia. Alveolar destruction is emphysema. Pulmonary vascular obstruction is PE.
NSG 223 Exam 3 - 50-Question Comprehensive Examination Page 3
