NR 507 EDAPT WEEK 3 OBSTRUCTIVE AND RESTRICTIVE LUNG DISEASES EXAM
PRACTICE | COMPREHENSIVE STUDY GUIDE | ADVANCED TESTBANK WITH
PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Obstructive vs. Restrictive Pulmonary Physiology
ii. Chronic Obstructive Pulmonary Disease
iii. Chronic Bronchitis and Emphysema
iv. Asthma Pathophysiology and Clinical Management
v. Interstitial Lung Disease and Pulmonary Fibrosis
vi. Pulmonary Function Testing and Gas Exchange
vii. Clinical Assessment, Complications, and Advanced Decision-Making
INTRODUCTION
This comprehensive practice examination reviews obstructive and restrictive
pulmonary disorders at an advanced NR 507 level, emphasizing pathophysiology,
pulmonary function interpretation, clinical manifestations, complications, and
evidence-based management. Questions focus on COPD, chronic bronchitis,
emphysema, asthma, interstitial lung disease, and pulmonary fibrosis while
requiring students to distinguish impaired airflow from impaired lung expansion.
Expect complex clinical scenarios involving spirometry, gas exchange, oxygenation,
airway inflammation, medication response, and disease progression. The questions
are designed to test application, interpretation, clinical reasoning, and prioritization
rather than simple memorization. Students should be prepared to integrate
physiologic findings with patient history and clinical presentation to determine the
most appropriate diagnosis, intervention, or interpretation.
QUESTION 1
A 67-year-old patient with a 45-pack-year smoking history reports progressive
dyspnea and difficulty exhaling. Pulmonary function testing demonstrates a
markedly reduced FEV₁, reduced FEV₁/FVC ratio, and increased residual volume.
Which pathophysiologic process best explains these findings?
A. Reduced pulmonary compliance caused by interstitial fibrosis
B. Increased airway resistance with expiratory airflow limitation and air trapping
,C. Decreased functional residual capacity caused by alveolar collapse
D. Impaired diffusion caused exclusively by pulmonary vascular disease
🔴 Correct Answer: B. Increased airway resistance with expiratory airflow
limitation and air trapping.
🔵 Explanation: Obstructive disease is characterized by difficulty moving air out of
the lungs, producing a reduced FEV₁/FVC ratio. Increased airway resistance and
premature airway closure promote air trapping, often increasing residual volume.
COPD is a classic example.
QUESTION 2
A patient with severe COPD has chronic hypercapnia and an arterial blood gas
showing pH 7.37, PaCO₂ 58 mmHg, and HCO₃⁻ 32 mEq/L. Which interpretation is
most appropriate?
A. Acute respiratory alkalosis with metabolic compensation
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis with respiratory compensation
D. Uncompensated respiratory acidosis
🔴 Correct Answer: B. Chronic respiratory acidosis with renal compensation.
🔵 Explanation: The elevated PaCO₂ indicates respiratory acidosis, while the elevated
bicarbonate reflects renal retention of bicarbonate to compensate for chronic carbon
dioxide retention. The near-normal pH supports a compensated chronic process.
QUESTION 3
A 59-year-old patient with COPD presents with worsening dyspnea and increased
sputum production. The patient is using accessory muscles and has an oxygen
saturation of 84% on room air. Which intervention should the nurse prioritize?
A. Administer controlled supplemental oxygen and reassess respiratory status
B. Place the patient supine to maximize diaphragmatic excursion
C. Encourage rapid deep breathing to eliminate carbon dioxide
D. Administer a sedative to decrease respiratory muscle activity
🔴 Correct Answer: A. Administer controlled supplemental oxygen and reassess
respiratory status.
,🔵 Explanation: Significant hypoxemia requires prompt oxygen therapy. In patients
with severe COPD, oxygen should be carefully titrated to the prescribed target
because excessive oxygen administration can worsen hypercapnia in susceptible
patients. Respiratory status must be continuously reassessed.
QUESTION 4
A patient with emphysema has severe destruction of alveolar walls. Which
physiologic consequence most directly results from this structural change?
A. Increased elastic recoil and improved expiratory flow
B. Increased pulmonary capillary pressure
C. Reduced surface area for gas exchange and loss of elastic recoil
D. Increased airway cartilage strength
🔴 Correct Answer: C. Reduced surface area for gas exchange and loss of elastic
recoil.
🔵 Explanation: Emphysema causes destruction of alveolar septa and loss of elastic
tissue. This decreases the surface area available for gas exchange and reduces elastic
recoil, promoting airway collapse during expiration and air trapping.
QUESTION 5
A patient with chronic bronchitis has a persistent productive cough for several
months over multiple consecutive years. Which mechanism most directly
contributes to the patient's airflow limitation?
A. Alveolar wall destruction from protease excess alone
B. Mucous gland enlargement, mucus hypersecretion, and airway inflammation
C. Loss of surfactant causing diffuse alveolar collapse
D. Pulmonary vascular obstruction causing isolated airway narrowing
🔴 Correct Answer: B. Mucous gland enlargement, mucus hypersecretion, and
airway inflammation.
🔵 Explanation: Chronic bronchitis involves chronic airway inflammation and mucus
hypersecretion associated with enlargement of mucus-producing glands and
increased goblet cells. Excess mucus and airway inflammation narrow the airways
and impair airflow.
, QUESTION 6
A patient with asthma develops wheezing and chest tightness after exposure to an
environmental allergen. Which combination of mechanisms most directly produces
the acute airflow obstruction?
A. Bronchial smooth-muscle contraction, mucosal edema, and increased mucus
production
B. Alveolar septal destruction, pulmonary fibrosis, and reduced compliance
C. Pleural fluid accumulation, alveolar compression, and vascular congestion
D. Pulmonary vascular dilation, decreased airway resistance, and hyperinflation
🔴 Correct Answer: A. Bronchial smooth-muscle contraction, mucosal edema,
and increased mucus production.
🔵 Explanation: Acute asthma exacerbations involve bronchoconstriction, airway
mucosal edema, and increased mucus secretion. These changes markedly increase
airway resistance and produce wheezing, dyspnea, and expiratory airflow limitation.
QUESTION 7
A patient with asthma has frequent symptoms despite appropriate use of a short-
acting bronchodilator. The patient reports nighttime awakenings and increasing
reliance on the rescue inhaler. Which interpretation is most appropriate?
A. The disease is adequately controlled because the bronchodilator provides
temporary relief
B. The patient likely has inadequate long-term control and requires reassessment of
controller therapy
C. Increased rescue-inhaler use confirms restrictive lung disease
D. The symptoms indicate irreversible destruction of alveolar walls
🔴 Correct Answer: B. The patient likely has inadequate long-term control and
requires reassessment of controller therapy.
🔵 Explanation: Frequent symptoms and increased rescue-medication use indicate
inadequate asthma control. Long-term management generally requires anti-
inflammatory controller therapy and assessment of adherence, triggers, inhaler
technique, and disease severity.
QUESTION 8
PRACTICE | COMPREHENSIVE STUDY GUIDE | ADVANCED TESTBANK WITH
PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE 2026/2027
TABLE OF CONTENTS
i. Obstructive vs. Restrictive Pulmonary Physiology
ii. Chronic Obstructive Pulmonary Disease
iii. Chronic Bronchitis and Emphysema
iv. Asthma Pathophysiology and Clinical Management
v. Interstitial Lung Disease and Pulmonary Fibrosis
vi. Pulmonary Function Testing and Gas Exchange
vii. Clinical Assessment, Complications, and Advanced Decision-Making
INTRODUCTION
This comprehensive practice examination reviews obstructive and restrictive
pulmonary disorders at an advanced NR 507 level, emphasizing pathophysiology,
pulmonary function interpretation, clinical manifestations, complications, and
evidence-based management. Questions focus on COPD, chronic bronchitis,
emphysema, asthma, interstitial lung disease, and pulmonary fibrosis while
requiring students to distinguish impaired airflow from impaired lung expansion.
Expect complex clinical scenarios involving spirometry, gas exchange, oxygenation,
airway inflammation, medication response, and disease progression. The questions
are designed to test application, interpretation, clinical reasoning, and prioritization
rather than simple memorization. Students should be prepared to integrate
physiologic findings with patient history and clinical presentation to determine the
most appropriate diagnosis, intervention, or interpretation.
QUESTION 1
A 67-year-old patient with a 45-pack-year smoking history reports progressive
dyspnea and difficulty exhaling. Pulmonary function testing demonstrates a
markedly reduced FEV₁, reduced FEV₁/FVC ratio, and increased residual volume.
Which pathophysiologic process best explains these findings?
A. Reduced pulmonary compliance caused by interstitial fibrosis
B. Increased airway resistance with expiratory airflow limitation and air trapping
,C. Decreased functional residual capacity caused by alveolar collapse
D. Impaired diffusion caused exclusively by pulmonary vascular disease
🔴 Correct Answer: B. Increased airway resistance with expiratory airflow
limitation and air trapping.
🔵 Explanation: Obstructive disease is characterized by difficulty moving air out of
the lungs, producing a reduced FEV₁/FVC ratio. Increased airway resistance and
premature airway closure promote air trapping, often increasing residual volume.
COPD is a classic example.
QUESTION 2
A patient with severe COPD has chronic hypercapnia and an arterial blood gas
showing pH 7.37, PaCO₂ 58 mmHg, and HCO₃⁻ 32 mEq/L. Which interpretation is
most appropriate?
A. Acute respiratory alkalosis with metabolic compensation
B. Chronic respiratory acidosis with renal compensation
C. Metabolic alkalosis with respiratory compensation
D. Uncompensated respiratory acidosis
🔴 Correct Answer: B. Chronic respiratory acidosis with renal compensation.
🔵 Explanation: The elevated PaCO₂ indicates respiratory acidosis, while the elevated
bicarbonate reflects renal retention of bicarbonate to compensate for chronic carbon
dioxide retention. The near-normal pH supports a compensated chronic process.
QUESTION 3
A 59-year-old patient with COPD presents with worsening dyspnea and increased
sputum production. The patient is using accessory muscles and has an oxygen
saturation of 84% on room air. Which intervention should the nurse prioritize?
A. Administer controlled supplemental oxygen and reassess respiratory status
B. Place the patient supine to maximize diaphragmatic excursion
C. Encourage rapid deep breathing to eliminate carbon dioxide
D. Administer a sedative to decrease respiratory muscle activity
🔴 Correct Answer: A. Administer controlled supplemental oxygen and reassess
respiratory status.
,🔵 Explanation: Significant hypoxemia requires prompt oxygen therapy. In patients
with severe COPD, oxygen should be carefully titrated to the prescribed target
because excessive oxygen administration can worsen hypercapnia in susceptible
patients. Respiratory status must be continuously reassessed.
QUESTION 4
A patient with emphysema has severe destruction of alveolar walls. Which
physiologic consequence most directly results from this structural change?
A. Increased elastic recoil and improved expiratory flow
B. Increased pulmonary capillary pressure
C. Reduced surface area for gas exchange and loss of elastic recoil
D. Increased airway cartilage strength
🔴 Correct Answer: C. Reduced surface area for gas exchange and loss of elastic
recoil.
🔵 Explanation: Emphysema causes destruction of alveolar septa and loss of elastic
tissue. This decreases the surface area available for gas exchange and reduces elastic
recoil, promoting airway collapse during expiration and air trapping.
QUESTION 5
A patient with chronic bronchitis has a persistent productive cough for several
months over multiple consecutive years. Which mechanism most directly
contributes to the patient's airflow limitation?
A. Alveolar wall destruction from protease excess alone
B. Mucous gland enlargement, mucus hypersecretion, and airway inflammation
C. Loss of surfactant causing diffuse alveolar collapse
D. Pulmonary vascular obstruction causing isolated airway narrowing
🔴 Correct Answer: B. Mucous gland enlargement, mucus hypersecretion, and
airway inflammation.
🔵 Explanation: Chronic bronchitis involves chronic airway inflammation and mucus
hypersecretion associated with enlargement of mucus-producing glands and
increased goblet cells. Excess mucus and airway inflammation narrow the airways
and impair airflow.
, QUESTION 6
A patient with asthma develops wheezing and chest tightness after exposure to an
environmental allergen. Which combination of mechanisms most directly produces
the acute airflow obstruction?
A. Bronchial smooth-muscle contraction, mucosal edema, and increased mucus
production
B. Alveolar septal destruction, pulmonary fibrosis, and reduced compliance
C. Pleural fluid accumulation, alveolar compression, and vascular congestion
D. Pulmonary vascular dilation, decreased airway resistance, and hyperinflation
🔴 Correct Answer: A. Bronchial smooth-muscle contraction, mucosal edema,
and increased mucus production.
🔵 Explanation: Acute asthma exacerbations involve bronchoconstriction, airway
mucosal edema, and increased mucus secretion. These changes markedly increase
airway resistance and produce wheezing, dyspnea, and expiratory airflow limitation.
QUESTION 7
A patient with asthma has frequent symptoms despite appropriate use of a short-
acting bronchodilator. The patient reports nighttime awakenings and increasing
reliance on the rescue inhaler. Which interpretation is most appropriate?
A. The disease is adequately controlled because the bronchodilator provides
temporary relief
B. The patient likely has inadequate long-term control and requires reassessment of
controller therapy
C. Increased rescue-inhaler use confirms restrictive lung disease
D. The symptoms indicate irreversible destruction of alveolar walls
🔴 Correct Answer: B. The patient likely has inadequate long-term control and
requires reassessment of controller therapy.
🔵 Explanation: Frequent symptoms and increased rescue-medication use indicate
inadequate asthma control. Long-term management generally requires anti-
inflammatory controller therapy and assessment of adherence, triggers, inhaler
technique, and disease severity.
QUESTION 8
