ECITCARP • 3 MAXE
★ ★
Nursing Fundamentals Assessment
N Exam 3 — Practice Questions
EST. 2026
E XC E L L E N C E I N N U RS I N G E D U C AT I O N
Exam 3 Practice Questions — Nursing Fundamentals
R E S P I R ATO R Y, PA I N , E T H I CS , D E L E G AT I O N , C R I T I C A L T H I N K I N G & V I TA L S I G N S
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Nursing Fundamentals — Exam 3 Practice
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Exam 3 Practice Questions — TOTAL QUESTIONS 90 Questions
Fundamentals
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice / True-False / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Select all that apply questions are indicated — choose every correct option.
▸ Questions cover respiratory care, pain management, ethics, delegation, critical thinking, and vital signs.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice.
SECTION I — FUNDAMENTALS PRACTICE EXAMINATION Questions 1 – 90
1. Postural drainage is the drainage by gravity of secretions from various lung segments.
A. True.
B. False.
CORRECT ANSWER A — True.
RATIONALE Postural drainage uses gravity to drain secretions from specific lung segments into larger airways where they
can be expectorated or suctioned. The patient is positioned so that the affected lung segment is uppermost,
allowing gravity to move secretions toward the main bronchi and trachea. It is often combined with
percussion and vibration as part of chest physiotherapy (CPT). Positions vary based on the lung segment
being drained (e.g., Trendelenburg for lower lobes, side-lying for lateral segments). Postural drainage is
commonly used in patients with cystic fibrosis, bronchiectasis, and excessive pulmonary secretions.
,2. Suctioning is aspirating secretions through a catheter connected to a suction machine or wall suction outlet.
A. True.
B. False.
CORRECT ANSWER A — True.
RATIONALE Suctioning is the mechanical aspiration of pulmonary secretions through a catheter connected to a suction
source. It is performed when the patient cannot clear secretions independently. Types:
oropharyngeal/nasopharyngeal (removes secretions from the upper airway), endotracheal/tracheostomy
(sterile technique — enters the lower airway). Suctioning should be performed only when clinically indicated
(audible secretions, decreased SpO₂, ineffective cough) — not on a fixed schedule. Hyperoxygenation (100%
O₂ for 30–60 seconds) is performed before and between suction passes to prevent hypoxemia. Each suction
pass should be limited to 10–15 seconds. Suction pressure: wall unit 100–120 mmHg for adults; portable unit
10–15 mmHg.
3. Hyperoxygenation involves giving the client breaths that are 1 to 1.5 times the tidal volume set on the ventilator
through the ventilator circuit or via a manual resuscitation bag.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE The statement describes HYPERINFLATION, not hyperoxygenation. Hyperinflation involves delivering breaths
1–1.5 times the tidal volume (using a manual resuscitation bag or ventilator) to expand alveoli and prevent
atelectasis during suctioning. HYPEROXYGENATION is the administration of 100% oxygen before and between
suction attempts to prevent suction-induced hypoxemia. Both are performed together as part of the
suctioning procedure: hyperoxygenate first, then hyperinflate (if ordered), suction, then hyperoxygenate
again. The statement incorrectly defines hyperoxygenation — it is about increasing oxygen concentration, not
tidal volume. These are critical distinctions for safe respiratory care.
4. When air collects in the pleural space, it is known as a hemothorax.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE Air in the pleural space is a PNEUMOTHORAX — the lung collapses as air accumulates in the normally
negative-pressure pleural cavity. A HEMOTHORAX is blood in the pleural space. Both cause lung collapse but
have different etiologies and treatments. Pneumothorax types: spontaneous (rupture of a bleb), traumatic
(penetrating injury, rib fracture), and tension (one-way valve effect — air enters but cannot exit — medical
emergency). Hemothorax results from trauma, surgery, or malignancy. Both may require chest tube insertion
for drainage. The terms are NOT interchangeable — the distinction is critical for diagnosis and management.
Hemothorax = blood; Pneumothorax = air.
,5. Hyperinflation can be done with a manual resuscitation bag or through the ventilator and is performed by
increasing the oxygen flow (usually to 100%) before suctioning and between suction attempts.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE The statement confuses hyperinflation with hyperoxygenation. HYPERINFLATION is increasing the TIDAL
VOLUME (delivering breaths 1–1.5 times normal tidal volume) using a manual resuscitation bag or ventilator
— it mechanically expands alveoli. HYPEROXYGENATION is increasing the OXYGEN CONCENTRATION (usually
to 100% FiO₂) before and between suction passes. The statement says hyperinflation is performed "by
increasing the oxygen flow" — this is incorrect. Hyperinflation is about VOLUME (bigger breaths);
hyperoxygenation is about OXYGEN CONCENTRATION (higher FiO₂). Both are used together: hyperoxygenate
→ hyperinflate (if ordered) → suction → hyperoxygenate. Precise terminology is essential for safe respiratory
care.
6. What is the lipoprotein produced by specialized alveolar cells that acts like a detergent, reducing the surface
tension of alveolar fluid?
A. Hemoglobin.
B. Surfactant.
C. Erythrocytes.
D. Sputum.
CORRECT ANSWER B — Surfactant.
RATIONALE Surfactant is a phospholipid produced by type II alveolar cells. It reduces surface tension within the alveoli,
preventing alveolar collapse (atelectasis) during exhalation and reducing the work of breathing. Surfactant
deficiency is the primary problem in neonatal respiratory distress syndrome (RDS) in premature infants — the
lungs are stiff and alveoli collapse. Synthetic surfactant is administered to premature infants to improve lung
compliance. Hemoglobin is the oxygen-carrying protein in RBCs. Erythrocytes are red blood cells. Sputum is
expectorated material from the respiratory tract. Lung recoil is the continual tendency of the lungs to
collapse; lung compliance is the ease with which lungs expand.
7. What is the condition of insufficient oxygen anywhere in the body, from the inspired gas to the tissues?
A. Hypoxemia.
B. Hypoxia.
C. Hypercapnia.
D. Cyanosis.
CORRECT ANSWER B — Hypoxia.
RATIONALE Hypoxia is insufficient oxygen at the TISSUE level — anywhere from inspired gas to cellular utilization. It is a
broader term than hypoxemia. HYPOXEMIA specifically refers to reduced oxygen in the BLOOD (low PaO₂ or
low hemoglobin saturation). Hypoxia can occur with normal PaO₂ if tissue perfusion is impaired (e.g., shock,
anemia, carbon monoxide poisoning). Hypercapnia/hypercarbia is elevated CO₂ in the blood. Cyanosis is the
bluish discoloration of skin/mucous membranes from reduced hemoglobin-oxygen saturation — a late sign of
hypoxia. Eupnea is normal, quiet respiration. Bradypnea is abnormally slow respiratory rate. Orthopnea is
inability to breathe except in an upright position. Tachypnea is rapid respiratory rate.
, 8. Which of the following refers to reduced oxygen in the blood and is characterized by a low partial pressure of
oxygen in arterial blood or a low hemoglobin saturation?
A. Cyanosis.
B. Tachypnea.
C. Hypoxemia.
D. Bradypnea.
CORRECT ANSWER C — Hypoxemia.
RATIONALE Hypoxemia is specifically low oxygen in the BLOOD — measured as decreased PaO₂ (partial pressure of oxygen
in arterial blood, normal 80–100 mmHg) or decreased SaO₂/SpO₂ (hemoglobin saturation, normal ≥95%). It is
an objective measurement. Hypoxia is low oxygen at the TISSUE level — the consequence if hypoxemia is not
corrected. Cyanosis is a late, unreliable sign of hypoxemia (appears when reduced hemoglobin exceeds 5
g/dL). Tachypnea is rapid respiratory rate (>20/min) — a compensatory response to hypoxemia. Bradypnea is
slow respiratory rate (<12/min). The nurse should assess SpO₂ regularly and recognize that SpO₂ <90%
indicates significant hypoxemia requiring intervention (oxygen therapy, provider notification).
9. Normal respiration is quiet, rhythmic, and effortless. What is this called?
A. Orthopnea.
B. Apnea.
C. Dyspnea.
D. Eupnea.
CORRECT ANSWER D — Eupnea.
RATIONALE Eupnea is normal, quiet, rhythmic, effortless respiration at a rate of 12–20 breaths per minute in adults.
Orthopnea is the inability to breathe except in an upright position (common in heart failure and COPD). Apnea
is the absence of breathing. Dyspnea is the subjective sensation of difficulty breathing or shortness of breath.
Tachypnea is rapid breathing (>20/min). Bradypnea is slow breathing (<12/min). Respiratory patterns:
Cheyne-Stokes — rhythmic waxing and waning from deep to shallow with periods of apnea (seen in heart
failure, brain injury, end of life). Biot's (cluster) — irregular clusters of breaths with periods of apnea (seen in
neurological injury). Kussmaul — deep, rapid, labored (metabolic acidosis, DKA).
10. Which of the following does adequate ventilation NOT depend on?
A. Clear airways.
B. Adequate pulmonary compliance and recoil.
C. An intact sympathetic nervous system and respiratory center.
D. An intact thoracic cavity capable of expanding and contracting.
CORRECT ANSWER C — An intact sympathetic nervous system and respiratory center.
RATIONALE Adequate ventilation requires: (1) clear airways (patent from mouth/nose to alveoli — no obstruction), (2)
adequate pulmonary compliance (lungs must be able to expand easily) and recoil (lungs must be able to
return to resting state after expansion), (3) an intact CENTRAL nervous system (respiratory center in the
medulla oblongata and pons — not the sympathetic nervous system), and (4) an intact thoracic cavity capable
of expanding and contracting (diaphragm, intercostal muscles, intact pleura). The sympathetic nervous
system influences airway diameter (bronchodilation) but is not required for basic ventilation. The respiratory
center in the brainstem (central nervous system) drives the automatic rhythm of breathing. The phrenic nerve
(C3–C5) innervates the diaphragm.
★ ★
Nursing Fundamentals Assessment
N Exam 3 — Practice Questions
EST. 2026
E XC E L L E N C E I N N U RS I N G E D U C AT I O N
Exam 3 Practice Questions — Nursing Fundamentals
R E S P I R ATO R Y, PA I N , E T H I CS , D E L E G AT I O N , C R I T I C A L T H I N K I N G & V I TA L S I G N S
INSTITUTION Nursing Fundamentals Assessment COURSE CODE Nursing Fundamentals — Exam 3 Practice
PROGRAM Practical Nursing (PN) / Associate Degree ACADEMIC YEAR
in Nursing (ADN)
EXAM TITLE Exam 3 Practice Questions — TOTAL QUESTIONS 90 Questions
Fundamentals
COURSE TITLE Fundamentals of Nursing FORMAT Multiple Choice / True-False / Select All
That Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Select all that apply questions are indicated — choose every correct option.
▸ Questions cover respiratory care, pain management, ethics, delegation, critical thinking, and vital signs.
▸ Correct answers and clinical rationales appear below each question for review purposes.
▸ All content reflects current evidence-based nursing practice.
SECTION I — FUNDAMENTALS PRACTICE EXAMINATION Questions 1 – 90
1. Postural drainage is the drainage by gravity of secretions from various lung segments.
A. True.
B. False.
CORRECT ANSWER A — True.
RATIONALE Postural drainage uses gravity to drain secretions from specific lung segments into larger airways where they
can be expectorated or suctioned. The patient is positioned so that the affected lung segment is uppermost,
allowing gravity to move secretions toward the main bronchi and trachea. It is often combined with
percussion and vibration as part of chest physiotherapy (CPT). Positions vary based on the lung segment
being drained (e.g., Trendelenburg for lower lobes, side-lying for lateral segments). Postural drainage is
commonly used in patients with cystic fibrosis, bronchiectasis, and excessive pulmonary secretions.
,2. Suctioning is aspirating secretions through a catheter connected to a suction machine or wall suction outlet.
A. True.
B. False.
CORRECT ANSWER A — True.
RATIONALE Suctioning is the mechanical aspiration of pulmonary secretions through a catheter connected to a suction
source. It is performed when the patient cannot clear secretions independently. Types:
oropharyngeal/nasopharyngeal (removes secretions from the upper airway), endotracheal/tracheostomy
(sterile technique — enters the lower airway). Suctioning should be performed only when clinically indicated
(audible secretions, decreased SpO₂, ineffective cough) — not on a fixed schedule. Hyperoxygenation (100%
O₂ for 30–60 seconds) is performed before and between suction passes to prevent hypoxemia. Each suction
pass should be limited to 10–15 seconds. Suction pressure: wall unit 100–120 mmHg for adults; portable unit
10–15 mmHg.
3. Hyperoxygenation involves giving the client breaths that are 1 to 1.5 times the tidal volume set on the ventilator
through the ventilator circuit or via a manual resuscitation bag.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE The statement describes HYPERINFLATION, not hyperoxygenation. Hyperinflation involves delivering breaths
1–1.5 times the tidal volume (using a manual resuscitation bag or ventilator) to expand alveoli and prevent
atelectasis during suctioning. HYPEROXYGENATION is the administration of 100% oxygen before and between
suction attempts to prevent suction-induced hypoxemia. Both are performed together as part of the
suctioning procedure: hyperoxygenate first, then hyperinflate (if ordered), suction, then hyperoxygenate
again. The statement incorrectly defines hyperoxygenation — it is about increasing oxygen concentration, not
tidal volume. These are critical distinctions for safe respiratory care.
4. When air collects in the pleural space, it is known as a hemothorax.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE Air in the pleural space is a PNEUMOTHORAX — the lung collapses as air accumulates in the normally
negative-pressure pleural cavity. A HEMOTHORAX is blood in the pleural space. Both cause lung collapse but
have different etiologies and treatments. Pneumothorax types: spontaneous (rupture of a bleb), traumatic
(penetrating injury, rib fracture), and tension (one-way valve effect — air enters but cannot exit — medical
emergency). Hemothorax results from trauma, surgery, or malignancy. Both may require chest tube insertion
for drainage. The terms are NOT interchangeable — the distinction is critical for diagnosis and management.
Hemothorax = blood; Pneumothorax = air.
,5. Hyperinflation can be done with a manual resuscitation bag or through the ventilator and is performed by
increasing the oxygen flow (usually to 100%) before suctioning and between suction attempts.
A. True.
B. False.
CORRECT ANSWER B — False.
RATIONALE The statement confuses hyperinflation with hyperoxygenation. HYPERINFLATION is increasing the TIDAL
VOLUME (delivering breaths 1–1.5 times normal tidal volume) using a manual resuscitation bag or ventilator
— it mechanically expands alveoli. HYPEROXYGENATION is increasing the OXYGEN CONCENTRATION (usually
to 100% FiO₂) before and between suction passes. The statement says hyperinflation is performed "by
increasing the oxygen flow" — this is incorrect. Hyperinflation is about VOLUME (bigger breaths);
hyperoxygenation is about OXYGEN CONCENTRATION (higher FiO₂). Both are used together: hyperoxygenate
→ hyperinflate (if ordered) → suction → hyperoxygenate. Precise terminology is essential for safe respiratory
care.
6. What is the lipoprotein produced by specialized alveolar cells that acts like a detergent, reducing the surface
tension of alveolar fluid?
A. Hemoglobin.
B. Surfactant.
C. Erythrocytes.
D. Sputum.
CORRECT ANSWER B — Surfactant.
RATIONALE Surfactant is a phospholipid produced by type II alveolar cells. It reduces surface tension within the alveoli,
preventing alveolar collapse (atelectasis) during exhalation and reducing the work of breathing. Surfactant
deficiency is the primary problem in neonatal respiratory distress syndrome (RDS) in premature infants — the
lungs are stiff and alveoli collapse. Synthetic surfactant is administered to premature infants to improve lung
compliance. Hemoglobin is the oxygen-carrying protein in RBCs. Erythrocytes are red blood cells. Sputum is
expectorated material from the respiratory tract. Lung recoil is the continual tendency of the lungs to
collapse; lung compliance is the ease with which lungs expand.
7. What is the condition of insufficient oxygen anywhere in the body, from the inspired gas to the tissues?
A. Hypoxemia.
B. Hypoxia.
C. Hypercapnia.
D. Cyanosis.
CORRECT ANSWER B — Hypoxia.
RATIONALE Hypoxia is insufficient oxygen at the TISSUE level — anywhere from inspired gas to cellular utilization. It is a
broader term than hypoxemia. HYPOXEMIA specifically refers to reduced oxygen in the BLOOD (low PaO₂ or
low hemoglobin saturation). Hypoxia can occur with normal PaO₂ if tissue perfusion is impaired (e.g., shock,
anemia, carbon monoxide poisoning). Hypercapnia/hypercarbia is elevated CO₂ in the blood. Cyanosis is the
bluish discoloration of skin/mucous membranes from reduced hemoglobin-oxygen saturation — a late sign of
hypoxia. Eupnea is normal, quiet respiration. Bradypnea is abnormally slow respiratory rate. Orthopnea is
inability to breathe except in an upright position. Tachypnea is rapid respiratory rate.
, 8. Which of the following refers to reduced oxygen in the blood and is characterized by a low partial pressure of
oxygen in arterial blood or a low hemoglobin saturation?
A. Cyanosis.
B. Tachypnea.
C. Hypoxemia.
D. Bradypnea.
CORRECT ANSWER C — Hypoxemia.
RATIONALE Hypoxemia is specifically low oxygen in the BLOOD — measured as decreased PaO₂ (partial pressure of oxygen
in arterial blood, normal 80–100 mmHg) or decreased SaO₂/SpO₂ (hemoglobin saturation, normal ≥95%). It is
an objective measurement. Hypoxia is low oxygen at the TISSUE level — the consequence if hypoxemia is not
corrected. Cyanosis is a late, unreliable sign of hypoxemia (appears when reduced hemoglobin exceeds 5
g/dL). Tachypnea is rapid respiratory rate (>20/min) — a compensatory response to hypoxemia. Bradypnea is
slow respiratory rate (<12/min). The nurse should assess SpO₂ regularly and recognize that SpO₂ <90%
indicates significant hypoxemia requiring intervention (oxygen therapy, provider notification).
9. Normal respiration is quiet, rhythmic, and effortless. What is this called?
A. Orthopnea.
B. Apnea.
C. Dyspnea.
D. Eupnea.
CORRECT ANSWER D — Eupnea.
RATIONALE Eupnea is normal, quiet, rhythmic, effortless respiration at a rate of 12–20 breaths per minute in adults.
Orthopnea is the inability to breathe except in an upright position (common in heart failure and COPD). Apnea
is the absence of breathing. Dyspnea is the subjective sensation of difficulty breathing or shortness of breath.
Tachypnea is rapid breathing (>20/min). Bradypnea is slow breathing (<12/min). Respiratory patterns:
Cheyne-Stokes — rhythmic waxing and waning from deep to shallow with periods of apnea (seen in heart
failure, brain injury, end of life). Biot's (cluster) — irregular clusters of breaths with periods of apnea (seen in
neurological injury). Kussmaul — deep, rapid, labored (metabolic acidosis, DKA).
10. Which of the following does adequate ventilation NOT depend on?
A. Clear airways.
B. Adequate pulmonary compliance and recoil.
C. An intact sympathetic nervous system and respiratory center.
D. An intact thoracic cavity capable of expanding and contracting.
CORRECT ANSWER C — An intact sympathetic nervous system and respiratory center.
RATIONALE Adequate ventilation requires: (1) clear airways (patent from mouth/nose to alveoli — no obstruction), (2)
adequate pulmonary compliance (lungs must be able to expand easily) and recoil (lungs must be able to
return to resting state after expansion), (3) an intact CENTRAL nervous system (respiratory center in the
medulla oblongata and pons — not the sympathetic nervous system), and (4) an intact thoracic cavity capable
of expanding and contracting (diaphragm, intercostal muscles, intact pleura). The sympathetic nervous
system influences airway diameter (bronchodilation) but is not required for basic ventilation. The respiratory
center in the brainstem (central nervous system) drives the automatic rhythm of breathing. The phrenic nerve
(C3–C5) innervates the diaphragm.
