NUR201 | NUR201 Medical Surgical Exam 2
Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD).
Which clinical finding should the nurse anticipate as a result of chronic air trapping?
A. A decrease in the anteroposterior diameter of the chest
B. An increased anteroposterior diameter of the chest (barrel chest)
C. Hyperventilation with respiratory alkalosis
D. Bilateral pleural effusions
Correct Answer: B
Expert Explanation: COPD leads to chronic air trapping which causes the lungs to
remain overinflated. This physiological change results in a barrel-shaped chest as
the rib cage stays partially expanded. Option A is incorrect because the diameter
increases rather than decreases. Option C is unlikely because these patients often
retain CO2, leading to respiratory acidosis. This assessment finding is a classic
hallmark of long-term emphysema and requires careful monitoring of respiratory
effort.
,2. A patient is admitted with an acute asthma attack. Which medication should the
nurse prepare to administer first to provide rapid relief of bronchospasms?
A. Salmeterol (Serevent)
B. Albuterol (Proventil)
C. Fluticasone (Flovent)
D. Montelukast (Singulair)
Correct Answer: B
Expert Explanation: Albuterol is a short-acting beta-agonist (SABA) that acts
quickly to relax bronchial smooth muscle during an acute attack. Salmeterol is a
long-acting bronchodilator and is not intended for rescue use. Fluticasone is a
corticosteroid used for long-term control of inflammation rather than immediate
symptom relief. Montelukast is a leukotriene modifier used for maintenance therapy
and does not work fast enough for emergencies. Prioritizing rapid-acting
bronchodilators is essential for maintaining airway patency in acute asthma.
3. The nurse is caring for a patient with pneumonia who is experiencing increased
secretions. Which intervention should the nurse prioritize to help liquefy the
secretions?
A. Increasing fluid intake to 2 to 3 liters per day
B. Administering oral antitussives
,C. Performing postural drainage every 12 hours
D. Providing frequent high-protein snacks
Correct Answer: A
Expert Explanation: Adequate hydration is the most effective way to thin and
liquefy thick respiratory secretions. Antitussives may actually be contraindicated as
they suppress the cough reflex needed to clear the airway. Postural drainage helps
move secretions but does not change their consistency directly. High-protein snacks
are important for healing but do not affect the viscosity of mucus. Ensuring the
patient is well-hydrated facilitates easier expectoration and improves gas exchange
outcomes.
4. A nurse is monitoring a patient on a mechanical ventilator. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check the patient’s oxygen saturation level
B. Assess the patient for a need to suction or for tubing kinks
C. Call the respiratory therapist immediately
D. Increase the oxygen concentration on the ventilator
Correct Answer: B
, Expert Explanation: High-pressure alarms usually indicate an obstruction such as
secretions, biting on the tube, or kinked tubing. Assessing the patient and the circuit
should be the immediate priority to resolve the cause of the resistance. Checking
oxygen saturation is important but does not address the cause of the alarm. Calling
for help is appropriate but should follow the initial rapid assessment of the
equipment and patient. Ensuring the airway is clear is a fundamental safety
intervention for ventilated patients.
5. A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. Why must the
nurse exercise caution when increasing the oxygen flow rate for this patient?
A. Excessive oxygen may eliminate the patient’s stimulus to breathe
B. Higher flow rates can cause oxygen toxicity in the lungs
C. It could lead to a rapid increase in blood pressure
D. High flow oxygen increases the risk of pulmonary embolism
Correct Answer: A
Expert Explanation: In some patients with chronic CO2 retention, the primary
drive to breathe shifts from high CO2 levels to low oxygen levels (hypoxic drive).
Providing too much supplemental oxygen can raise the PaO2 and suppress this
drive, leading to respiratory arrest. Oxygen toxicity is a concern with very high
concentrations over time but is not the immediate risk here. Blood pressure and
Version 2 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD).
Which clinical finding should the nurse anticipate as a result of chronic air trapping?
A. A decrease in the anteroposterior diameter of the chest
B. An increased anteroposterior diameter of the chest (barrel chest)
C. Hyperventilation with respiratory alkalosis
D. Bilateral pleural effusions
Correct Answer: B
Expert Explanation: COPD leads to chronic air trapping which causes the lungs to
remain overinflated. This physiological change results in a barrel-shaped chest as
the rib cage stays partially expanded. Option A is incorrect because the diameter
increases rather than decreases. Option C is unlikely because these patients often
retain CO2, leading to respiratory acidosis. This assessment finding is a classic
hallmark of long-term emphysema and requires careful monitoring of respiratory
effort.
,2. A patient is admitted with an acute asthma attack. Which medication should the
nurse prepare to administer first to provide rapid relief of bronchospasms?
A. Salmeterol (Serevent)
B. Albuterol (Proventil)
C. Fluticasone (Flovent)
D. Montelukast (Singulair)
Correct Answer: B
Expert Explanation: Albuterol is a short-acting beta-agonist (SABA) that acts
quickly to relax bronchial smooth muscle during an acute attack. Salmeterol is a
long-acting bronchodilator and is not intended for rescue use. Fluticasone is a
corticosteroid used for long-term control of inflammation rather than immediate
symptom relief. Montelukast is a leukotriene modifier used for maintenance therapy
and does not work fast enough for emergencies. Prioritizing rapid-acting
bronchodilators is essential for maintaining airway patency in acute asthma.
3. The nurse is caring for a patient with pneumonia who is experiencing increased
secretions. Which intervention should the nurse prioritize to help liquefy the
secretions?
A. Increasing fluid intake to 2 to 3 liters per day
B. Administering oral antitussives
,C. Performing postural drainage every 12 hours
D. Providing frequent high-protein snacks
Correct Answer: A
Expert Explanation: Adequate hydration is the most effective way to thin and
liquefy thick respiratory secretions. Antitussives may actually be contraindicated as
they suppress the cough reflex needed to clear the airway. Postural drainage helps
move secretions but does not change their consistency directly. High-protein snacks
are important for healing but do not affect the viscosity of mucus. Ensuring the
patient is well-hydrated facilitates easier expectoration and improves gas exchange
outcomes.
4. A nurse is monitoring a patient on a mechanical ventilator. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check the patient’s oxygen saturation level
B. Assess the patient for a need to suction or for tubing kinks
C. Call the respiratory therapist immediately
D. Increase the oxygen concentration on the ventilator
Correct Answer: B
, Expert Explanation: High-pressure alarms usually indicate an obstruction such as
secretions, biting on the tube, or kinked tubing. Assessing the patient and the circuit
should be the immediate priority to resolve the cause of the resistance. Checking
oxygen saturation is important but does not address the cause of the alarm. Calling
for help is appropriate but should follow the initial rapid assessment of the
equipment and patient. Ensuring the airway is clear is a fundamental safety
intervention for ventilated patients.
5. A patient with COPD is receiving oxygen via nasal cannula at 2 L/min. Why must the
nurse exercise caution when increasing the oxygen flow rate for this patient?
A. Excessive oxygen may eliminate the patient’s stimulus to breathe
B. Higher flow rates can cause oxygen toxicity in the lungs
C. It could lead to a rapid increase in blood pressure
D. High flow oxygen increases the risk of pulmonary embolism
Correct Answer: A
Expert Explanation: In some patients with chronic CO2 retention, the primary
drive to breathe shifts from high CO2 levels to low oxygen levels (hypoxic drive).
Providing too much supplemental oxygen can raise the PaO2 and suppress this
drive, leading to respiratory arrest. Oxygen toxicity is a concern with very high
concentrations over time but is not the immediate risk here. Blood pressure and
