NSG 3850 Exam 2 Galen College Of Nursing Actual Exam Questions And Answers Practice
Questions with Solutions Newest | Already Graded A+
Question 1
A patient presents with sudden respiratory distress. Which of the following physical assessment
findings is most indicative of a left-sided tension pneumothorax?
A) Coarse crackles throughout the left lung fields
B) Tracheal deviation toward the left side
C) Absent breath sounds on the left side with tracheal deviation to the right
D) Respiratory acidosis with increased tactile fremitus
E) Dullness to percussion over the left base
Correct Answer: C) Absent breath sounds on the left side with tracheal deviation to the right
Rationale: In a tension pneumothorax, air enters the pleural space but cannot escape,
causing a rapid increase in intrapleural pressure. This leads to the collapse of the lung on
the affected side (causing absent breath sounds) and a "mediastinal shift," which pushes
the trachea toward the opposite (unaffected) side. Tracheal deviation to the left (Option B)
would indicate a right-sided tension pneumothorax.
Question 2
A patient presents with a productive cough and a chest X-ray revealing parenchymal infiltrates.
These clinical findings are most consistent with which diagnosis?
A) Viral pneumonia
B) Bacterial pneumonia
C) Tuberculosis
D) Acute Respiratory Distress Syndrome (ARDS)
E) Pulmonary Embolism
Correct Answer: B) Bacterial pneumonia
Rationale: Bacterial pneumonia is characterized by an acute inflammatory response that
leads to the accumulation of exudate within the alveoli (parenchymal infiltrates). This
typically manifests as a productive cough with purulent sputum and distinct shadows on an
X-ray. Viral pneumonia (Option A) more commonly presents with a non-productive, dry
cough and interstitial rather than parenchymal patterns.
Question 3
Which of the following respiratory diseases is specifically caused by the repeated inhalation of
organic substances, such as bird droppings or moldy hay?
A) Diffuse interstitial lung disease
B) Hypersensitivity pneumonitis
C) Sarcoidosis
D) Acute Respiratory Distress Syndrome (ARDS)
E) Anthracosis
Correct Answer: B) Hypersensitivity pneumonitis
Rationale: Hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) is an
immune-mediated inflammatory disease of the distal airways caused by an inhaled organic
, 2
antigen. Examples include "Farmer’s Lung" (moldy hay) or "Bird Fancier’s Lung" (avian
proteins). The other options involve inorganic dusts, idiopathic causes, or acute injury.
Question 4
In a clinical setting, how is "Empyema" specifically defined?
A) A form of exudative bronchitis
B) The presence of an infection/pus within the pleural space
C) A localized pocket of infection within the lung parenchyma
D) A systemic infection circulating in the bloodstream
E) The accumulation of clear serous fluid in the pleural cavity
Correct Answer: B) Infection in the pleural space
Rationale: Empyema is the accumulation of purulent exudate (pus) in the pleural cavity,
usually resulting from the spread of infection from the lungs (pneumonia) or a penetrating
chest wound. It is a specific type of complicated pleural effusion that requires drainage.
Question 5
A patient has suffered multiple rib fractures in two or more places, resulting in a "flail chest."
What paradoxical movement will the nurse observe during respiration?
A) The entire chest wall remains immobile during breaths.
B) No inspiratory breath sounds are heard on the affected side.
C) The chest wall moves inward on inspiration and outward on expiration.
D) The chest wall flutters uncontrollably only during forced expiration.
E) The chest wall moves outward on inspiration and inward on expiration.
Correct Answer: C) The chest wall moves inward on inspiration and outward on expiration.
Rationale: Flail chest occurs when a segment of the rib cage breaks under extreme stress
and becomes detached from the rest of the chest wall. During inspiration, the negative
pressure pulls the "flail" segment inward while the rest of the chest expands. During
expiration, the flail segment is pushed outward. This is the definition of paradoxical
breathing.
Question 6
Obstructive sleep apnea (OSA) is frequently associated with which of the following conditions
characterized by severe obesity and chronic hypoventilation?
A) Myasthenia gravis
B) Poliomyelitis
C) Pickwickian syndrome
D) Pneumonia
E) Cystic Fibrosis
Correct Answer: C) Pickwickian syndrome
Rationale: Pickwickian syndrome, also known as Obesity Hypoventilation Syndrome
(OHS), involves a combination of severe obesity, sleep apnea, and high CO2 levels during
, 3
the day. The excess weight on the chest and neck obstructs the airway during sleep and
impairs the drive to breathe, leading to chronic respiratory failure.
Question 7
The term "Pneumocystis jirovecii" refers to a specific type of pneumonia that is most commonly
found in which patient population?
A) Patients with fungal pneumonia secondary to HIV/AIDS
B) Transplant recipients suffering from viral pneumonia
C) Healthy individuals following a cold
D) Patients with a primary bladder infection that migrated
E) Coal miners with restrictive lung disease
Correct Answer: A) Fungal pneumonia secondary to HIV
Rationale: Pneumocystis jirovecii is an opportunistic fungal infection. While it rarely causes
disease in healthy individuals, it is a leading cause of severe pneumonia and death in
immunocompromised patients, particularly those with HIV/AIDS.
Question 8
Which of the following is considered the most definitive diagnostic method for confirming a
diagnosis of active Pulmonary Tuberculosis?
A) Sputum culture for acid-fast bacilli
B) Mantoux (PPD) skin test
C) Chest X-ray showing apical infiltrates
D) Blood culture for systemic bacteria
E) Physical assessment of breath sounds
Correct Answer: A) Sputum culture
Rationale: While a skin test (PPD) indicates exposure and an X-ray can suggest disease, the
sputum culture is the "gold standard." It identifies the growth of Mycobacterium
tuberculosis, confirming that the disease is active and infectious. Cultures can take several
weeks due to the slow growth of the organism.
Question 9
In the management of Tuberculosis (TB), what is recognized as the primary cause of treatment
failure and the development of drug-resistant strains?
A) Naturally resistant organisms
B) Widespread patient allergy to Rifampin
C) Patient noncompliance with the long-term medication regimen
D) Excessive immunosuppression from steroid use
E) Inadequate hospital ventilation systems
Correct Answer: C) Noncompliance
Rationale: TB treatment requires a multi-drug regimen (usually 6–9 months). Because
symptoms often improve quickly, many patients stop taking their medications before the
, 4
bacteria are completely eradicated. This noncompliance allows the remaining bacteria to
mutate and develop resistance, leading to treatment failure.
Question 10
Legionnaires' disease is a unique form of pneumonia characterized by which of the following?
A) The presence of a severe systemic illness
B) An airborne mechanism of communicability between humans
C) Mild, self-limiting cold-like symptoms
D) Resolution without the need for antimicrobial therapy
E) Being caused by a viral pathogen found in cooling towers
Correct Answer: A) Presence of systemic illness
Rationale: Legionnaires' disease is caused by Legionella pneumophila (a bacteria). It
typically presents as a severe pneumonia accompanied by systemic symptoms such as high
fever, diarrhea, and confusion. It is spread through contaminated water sources (like AC
cooling towers) but is NOT spread person-to-person.
Question 11
Bacterial pneumonia leads to significant hypoxemia. What is the primary underlying mechanism
for this drop in blood oxygen?
A) Cardiogenic pulmonary edema
B) Obstruction of the upper airway by the tongue
C) Accumulation of alveolar exudates interfering with gas exchange
D) Thickening of the interstitial basement membrane
E) Destruction of the pulmonary artery
Correct Answer: C) Accumulation of alveolar exudates
Rationale: In bacterial pneumonia, the inflammatory response causes the alveoli to fill with
fluid, bacteria, and white blood cells (exudate). This creates a "diffusion barrier" or
"shunt" where blood passes through the lungs without being oxygenated because the
alveoli are consolidated and unavailable for gas exchange.
Question 12
Which clinical feature is a common characteristic of viral pneumonia that distinguishes it from
typical bacterial pneumonia?
A) Extremely high fever (>104°F)
B) Dense lobar infiltrates on a chest X-ray
C) Significantly elevated White Blood Cell (WBC) count
D) A dry, non-productive cough
E) Sudden onset of purulent (green) sputum
Correct Answer: D) Dry cough
Rationale: Viral pneumonia typically involves the interstitial spaces of the lungs rather than
Questions with Solutions Newest | Already Graded A+
Question 1
A patient presents with sudden respiratory distress. Which of the following physical assessment
findings is most indicative of a left-sided tension pneumothorax?
A) Coarse crackles throughout the left lung fields
B) Tracheal deviation toward the left side
C) Absent breath sounds on the left side with tracheal deviation to the right
D) Respiratory acidosis with increased tactile fremitus
E) Dullness to percussion over the left base
Correct Answer: C) Absent breath sounds on the left side with tracheal deviation to the right
Rationale: In a tension pneumothorax, air enters the pleural space but cannot escape,
causing a rapid increase in intrapleural pressure. This leads to the collapse of the lung on
the affected side (causing absent breath sounds) and a "mediastinal shift," which pushes
the trachea toward the opposite (unaffected) side. Tracheal deviation to the left (Option B)
would indicate a right-sided tension pneumothorax.
Question 2
A patient presents with a productive cough and a chest X-ray revealing parenchymal infiltrates.
These clinical findings are most consistent with which diagnosis?
A) Viral pneumonia
B) Bacterial pneumonia
C) Tuberculosis
D) Acute Respiratory Distress Syndrome (ARDS)
E) Pulmonary Embolism
Correct Answer: B) Bacterial pneumonia
Rationale: Bacterial pneumonia is characterized by an acute inflammatory response that
leads to the accumulation of exudate within the alveoli (parenchymal infiltrates). This
typically manifests as a productive cough with purulent sputum and distinct shadows on an
X-ray. Viral pneumonia (Option A) more commonly presents with a non-productive, dry
cough and interstitial rather than parenchymal patterns.
Question 3
Which of the following respiratory diseases is specifically caused by the repeated inhalation of
organic substances, such as bird droppings or moldy hay?
A) Diffuse interstitial lung disease
B) Hypersensitivity pneumonitis
C) Sarcoidosis
D) Acute Respiratory Distress Syndrome (ARDS)
E) Anthracosis
Correct Answer: B) Hypersensitivity pneumonitis
Rationale: Hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) is an
immune-mediated inflammatory disease of the distal airways caused by an inhaled organic
, 2
antigen. Examples include "Farmer’s Lung" (moldy hay) or "Bird Fancier’s Lung" (avian
proteins). The other options involve inorganic dusts, idiopathic causes, or acute injury.
Question 4
In a clinical setting, how is "Empyema" specifically defined?
A) A form of exudative bronchitis
B) The presence of an infection/pus within the pleural space
C) A localized pocket of infection within the lung parenchyma
D) A systemic infection circulating in the bloodstream
E) The accumulation of clear serous fluid in the pleural cavity
Correct Answer: B) Infection in the pleural space
Rationale: Empyema is the accumulation of purulent exudate (pus) in the pleural cavity,
usually resulting from the spread of infection from the lungs (pneumonia) or a penetrating
chest wound. It is a specific type of complicated pleural effusion that requires drainage.
Question 5
A patient has suffered multiple rib fractures in two or more places, resulting in a "flail chest."
What paradoxical movement will the nurse observe during respiration?
A) The entire chest wall remains immobile during breaths.
B) No inspiratory breath sounds are heard on the affected side.
C) The chest wall moves inward on inspiration and outward on expiration.
D) The chest wall flutters uncontrollably only during forced expiration.
E) The chest wall moves outward on inspiration and inward on expiration.
Correct Answer: C) The chest wall moves inward on inspiration and outward on expiration.
Rationale: Flail chest occurs when a segment of the rib cage breaks under extreme stress
and becomes detached from the rest of the chest wall. During inspiration, the negative
pressure pulls the "flail" segment inward while the rest of the chest expands. During
expiration, the flail segment is pushed outward. This is the definition of paradoxical
breathing.
Question 6
Obstructive sleep apnea (OSA) is frequently associated with which of the following conditions
characterized by severe obesity and chronic hypoventilation?
A) Myasthenia gravis
B) Poliomyelitis
C) Pickwickian syndrome
D) Pneumonia
E) Cystic Fibrosis
Correct Answer: C) Pickwickian syndrome
Rationale: Pickwickian syndrome, also known as Obesity Hypoventilation Syndrome
(OHS), involves a combination of severe obesity, sleep apnea, and high CO2 levels during
, 3
the day. The excess weight on the chest and neck obstructs the airway during sleep and
impairs the drive to breathe, leading to chronic respiratory failure.
Question 7
The term "Pneumocystis jirovecii" refers to a specific type of pneumonia that is most commonly
found in which patient population?
A) Patients with fungal pneumonia secondary to HIV/AIDS
B) Transplant recipients suffering from viral pneumonia
C) Healthy individuals following a cold
D) Patients with a primary bladder infection that migrated
E) Coal miners with restrictive lung disease
Correct Answer: A) Fungal pneumonia secondary to HIV
Rationale: Pneumocystis jirovecii is an opportunistic fungal infection. While it rarely causes
disease in healthy individuals, it is a leading cause of severe pneumonia and death in
immunocompromised patients, particularly those with HIV/AIDS.
Question 8
Which of the following is considered the most definitive diagnostic method for confirming a
diagnosis of active Pulmonary Tuberculosis?
A) Sputum culture for acid-fast bacilli
B) Mantoux (PPD) skin test
C) Chest X-ray showing apical infiltrates
D) Blood culture for systemic bacteria
E) Physical assessment of breath sounds
Correct Answer: A) Sputum culture
Rationale: While a skin test (PPD) indicates exposure and an X-ray can suggest disease, the
sputum culture is the "gold standard." It identifies the growth of Mycobacterium
tuberculosis, confirming that the disease is active and infectious. Cultures can take several
weeks due to the slow growth of the organism.
Question 9
In the management of Tuberculosis (TB), what is recognized as the primary cause of treatment
failure and the development of drug-resistant strains?
A) Naturally resistant organisms
B) Widespread patient allergy to Rifampin
C) Patient noncompliance with the long-term medication regimen
D) Excessive immunosuppression from steroid use
E) Inadequate hospital ventilation systems
Correct Answer: C) Noncompliance
Rationale: TB treatment requires a multi-drug regimen (usually 6–9 months). Because
symptoms often improve quickly, many patients stop taking their medications before the
, 4
bacteria are completely eradicated. This noncompliance allows the remaining bacteria to
mutate and develop resistance, leading to treatment failure.
Question 10
Legionnaires' disease is a unique form of pneumonia characterized by which of the following?
A) The presence of a severe systemic illness
B) An airborne mechanism of communicability between humans
C) Mild, self-limiting cold-like symptoms
D) Resolution without the need for antimicrobial therapy
E) Being caused by a viral pathogen found in cooling towers
Correct Answer: A) Presence of systemic illness
Rationale: Legionnaires' disease is caused by Legionella pneumophila (a bacteria). It
typically presents as a severe pneumonia accompanied by systemic symptoms such as high
fever, diarrhea, and confusion. It is spread through contaminated water sources (like AC
cooling towers) but is NOT spread person-to-person.
Question 11
Bacterial pneumonia leads to significant hypoxemia. What is the primary underlying mechanism
for this drop in blood oxygen?
A) Cardiogenic pulmonary edema
B) Obstruction of the upper airway by the tongue
C) Accumulation of alveolar exudates interfering with gas exchange
D) Thickening of the interstitial basement membrane
E) Destruction of the pulmonary artery
Correct Answer: C) Accumulation of alveolar exudates
Rationale: In bacterial pneumonia, the inflammatory response causes the alveoli to fill with
fluid, bacteria, and white blood cells (exudate). This creates a "diffusion barrier" or
"shunt" where blood passes through the lungs without being oxygenated because the
alveoli are consolidated and unavailable for gas exchange.
Question 12
Which clinical feature is a common characteristic of viral pneumonia that distinguishes it from
typical bacterial pneumonia?
A) Extremely high fever (>104°F)
B) Dense lobar infiltrates on a chest X-ray
C) Significantly elevated White Blood Cell (WBC) count
D) A dry, non-productive cough
E) Sudden onset of purulent (green) sputum
Correct Answer: D) Dry cough
Rationale: Viral pneumonia typically involves the interstitial spaces of the lungs rather than
