UR 201/ NUR201 Exam 2 –
N
Medical-Surgical Nursing I Review |
Fortis (Latest 2026/ 2027 Update)
100% Verified Questions & Answers |
Grade A
* *Q1 (Respiratory – COPD oxygen therapy):** A 68-year-old male with COPD presents to the
ED with acute exacerbation. His ABG shows pH 7.32, PaCO₂ 58 mmHg, PaO₂ 52 mmHg. What
is the appropriate oxygen target for this patient?
) SpO₂ 94-98% via nasal cannula at 4 L/min
A
B) SpO₂ 88-92% via nasal cannula at 1-2 L/min
C) SpO₂ 100% via non-rebreather mask at 15 L/min
D) SpO₂ 85-88% via Venturi mask at 24% FiO₂
* *[CORRECT]** B
*Rationale: GOLD 2026 guidelines recommend maintaining SpO₂ 88-92% in COPD patients
with chronic hypercapnia to avoid suppressing the hypoxic respiratory drive and worsening CO₂
retention. Option A is incorrect because high oxygen targets can cause CO₂ narcosis in COPD
patients. Option C is dangerous as 100% oxygen would completely abolish the hypoxic drive.
Option D is too low and would cause tissue hypoxia. Clinical pearl: Always titrate oxygen slowly
in COPD and monitor ABGs; the "2 L/min rule" is a starting point, not a ceiling.*
---
* *Q2 (Respiratory – Asthma stepwise therapy):** A 22-year-old with moderate persistent asthma
is currently on low-dose ICS. She reports nighttime symptoms 2-3 times weekly and uses her
albuterol rescue inhaler 4 times weekly. According to GINA 2026 guidelines, what is the next
step in therapy?
) Increase to medium-dose ICS monotherapy
A
B) Add a long-acting muscarinic antagonist (LAMA)
C) Add a long-acting β₂-agonist (LABA) to low-dose ICS
D) Start oral corticosteroids daily
,* *[CORRECT]** C
*Rationale: GINA 2026 recommends adding a LABA to ICS (Step 3) for moderate persistent
asthma when symptoms persist despite low-dose ICS. Option A is less effective than ICS+LABA
combination. Option B (LAMA) is typically reserved for severe asthma or when LABA is
insufficient. Option D (oral steroids) is inappropriate for maintenance and reserved for severe
exacerbations. Clinical pearl: The SMART approach (single inhaler maintenance and reliever
therapy) with ICS-formoterol is now preferred in GINA 2026 for Steps 3-5.*
---
* *Q3 (Respiratory – Pneumonia assessment):** A 74-year-old is admitted with
community-acquired pneumonia. Which assessment finding would most strongly indicate the
need for ICU admission according to IDSA/ATS 2026 criteria?
) Respiratory rate 28 breaths/min and PaO₂/FiO₂ ratio 220
A
B) Temperature 38.8°C and white blood cell count 14,000/μL
C) Confusion and blood urea nitrogen 22 mg/dL
D) Systolic blood pressure 100 mmHg and heart rate 110 bpm
* *[CORRECT]** A
*Rationale: IDSA/ATS 2026 severe pneumonia criteria include respiratory rate ≥30, PaO₂/FiO₂
≤250, multilobar infiltrates, septic shock, or need for mechanical ventilation. Option A meets two
major criteria (RR >30 equivalent, PaO₂/FiO₂ <250). Option B and C represent CURB-65 criteria
(moderate severity, not ICU). Option D shows mild hypotension but not septic shock. Clinical
pearl: The PaO₂/FiO₂ ratio is critical—<<250 indicates acute hypoxemic respiratory failure
requiring ICU-level care.*
---
* *Q4 (Respiratory – Pulmonary embolism diagnosis):** A 48-year-old postoperative patient
develops sudden dyspnea and pleuritic chest pain. Wells score is 6.5 (intermediate probability).
What is the next best diagnostic step?
) Immediately start heparin and obtain CT pulmonary angiography (CTPA)
A
B) Obtain D-dimer testing first
C) Perform ventilation-perfusion (V/Q) scan as first-line
D) Order transthoracic echocardiography to assess RV strain
* *[CORRECT]** A
*Rationale: For intermediate-to-high probability PE (Wells ≥4), the 2026 CHEST guidelines
recommend proceeding directly to CTPA without D-dimer testing, as D-dimer is often elevated
postoperatively and has low specificity. Empiric anticoagulation should be started if PE is
strongly suspected and testing is delayed. Option B is appropriate for low probability only.
Option C is reserved for patients with renal failure or contrast allergy. Option D supports the
, iagnosis but is not definitive. Clinical pearl: In postoperative patients, D-dimer is notoriously
d
unreliable—always use clinical probability scoring first.*
---
* *Q5 (Respiratory – ARDS management):** A 55-year-old with ARDS is on mechanical
ventilation. The physician orders lung-protective ventilation. Which parameter combination best
aligns with current evidence?
) Tidal volume 10 mL/kg predicted body weight, PEEP 5 cmH₂O
A
B) Tidal volume 6 mL/kg predicted body weight, PEEP 10-15 cmH₂O
C) Tidal volume 4 mL/kg actual body weight, PEEP 20 cmH₂O
D) Tidal volume 8 mL/kg predicted body weight, zero PEEP
* *[CORRECT]** B
*Rationale: The ARDSNet protocol (updated 2026) recommends tidal volume 6 mL/kg predicted
body weight (not actual weight) with plateau pressure <30 cmH₂O and appropriate PEEP
(typically 10-15 cmH₂O) to prevent alveolar collapse. Option A uses excessive tidal volume.
Option C uses actual body weight and excessive PEEP, risking barotrauma. Option D omits
PEEP, which is essential for preventing atelectasis. Clinical pearl: Predicted body weight is
calculated using gender and height—using actual weight in obese patients causes volutrauma
and worsens outcomes.*
---
* *Q6 (Respiratory – COPD pharmacology):** A patient with COPD is prescribed tiotropium
(Spiriva). The nurse should teach the patient which critical information about this medication?
) "Use this inhaler only when you feel short of breath"
A
B) "Rinse your mouth after each use to prevent oral thrush"
C) "This medication is a rescue inhaler for acute bronchospasm"
D) "This is a long-acting anticholinergic; use it once daily for maintenance"
* *[CORRECT]** D
*Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) used once daily for COPD
maintenance, not as a rescue medication. Option A and C confuse LAMA with short-acting
bronchodilators (SABA). Option B describes inhaled corticosteroid teaching (preventing thrush),
not anticholinergics. Clinical pearl: LAMAs are cornerstone maintenance therapy in COPD;
ensure patients understand the difference between daily controllers and rescue
inhalers—confusion leads to poor outcomes and exacerbations.*
---
, * *Q7 (Respiratory – Asthma peak flow monitoring):** A patient with asthma has a personal best
peak flow of 500 L/min. Today, her peak flow is 350 L/min. According to the asthma action plan,
what zone is she in and what action is required?
) Green zone (80-100%); continue current medications
A
B) Yellow zone (50-80%); increase medications and contact provider
C) Red zone (<50%); seek emergency care immediately
D) Orange zone (60-75%); use rescue inhaler and monitor
* *[CORRECT]** B
*Rationale: 350/500 = 70%, which falls in the yellow zone (50-80% of personal best). The
asthma action plan requires increasing medications (typically doubling ICS or adding LABA) and
contacting the provider. Option A is for 80-100%. Option C is for <50% (250 L/min). Option D is
not a standard zone classification. Clinical pearl: Teach patients to calculate percentages, not
just memorize numbers—personal best varies by individual, and action plans must be
personalized.*
---
* *Q8 (Respiratory – Pneumonia antibiotics):** A 35-year-old otherwise healthy adult is
diagnosed with community-acquired pneumonia (CAP). Which empiric antibiotic regimen is
most appropriate per IDSA/ATS 2026 guidelines?
) Vancomycin and piperacillin-tazobactam
A
B) Amoxicillin 1 g three times daily
C) Azithromycin monotherapy
D) Levofloxacin 750 mg daily
* *[CORRECT]** B
*Rationale: For healthy outpatients with CAP and no comorbidities, IDSA/ATS 2026
recommends amoxicillin as first-line empiric therapy. Option A is for hospital-acquired or severe
CAP with risk factors for MRSA/Pseudomonas. Option C (macrolide monotherapy) is reserved
for patients with comorbidities or when amoxicillin is contraindicated, due to increasing
resistance. Option D (fluoroquinolone) is an alternative but carries tendon and QT risks. Clinical
pearl: Overuse of broad-spectrum antibiotics in simple CAP drives resistance—always match
antibiotic spectrum to patient risk factors.*
---
* *Q9 (Respiratory – Oxygen delivery devices):** A patient with COPD requires precise oxygen
titration. Which device provides the most accurate FiO₂ delivery regardless of breathing pattern?
) Simple face mask
A
B) Nasal cannula
N
Medical-Surgical Nursing I Review |
Fortis (Latest 2026/ 2027 Update)
100% Verified Questions & Answers |
Grade A
* *Q1 (Respiratory – COPD oxygen therapy):** A 68-year-old male with COPD presents to the
ED with acute exacerbation. His ABG shows pH 7.32, PaCO₂ 58 mmHg, PaO₂ 52 mmHg. What
is the appropriate oxygen target for this patient?
) SpO₂ 94-98% via nasal cannula at 4 L/min
A
B) SpO₂ 88-92% via nasal cannula at 1-2 L/min
C) SpO₂ 100% via non-rebreather mask at 15 L/min
D) SpO₂ 85-88% via Venturi mask at 24% FiO₂
* *[CORRECT]** B
*Rationale: GOLD 2026 guidelines recommend maintaining SpO₂ 88-92% in COPD patients
with chronic hypercapnia to avoid suppressing the hypoxic respiratory drive and worsening CO₂
retention. Option A is incorrect because high oxygen targets can cause CO₂ narcosis in COPD
patients. Option C is dangerous as 100% oxygen would completely abolish the hypoxic drive.
Option D is too low and would cause tissue hypoxia. Clinical pearl: Always titrate oxygen slowly
in COPD and monitor ABGs; the "2 L/min rule" is a starting point, not a ceiling.*
---
* *Q2 (Respiratory – Asthma stepwise therapy):** A 22-year-old with moderate persistent asthma
is currently on low-dose ICS. She reports nighttime symptoms 2-3 times weekly and uses her
albuterol rescue inhaler 4 times weekly. According to GINA 2026 guidelines, what is the next
step in therapy?
) Increase to medium-dose ICS monotherapy
A
B) Add a long-acting muscarinic antagonist (LAMA)
C) Add a long-acting β₂-agonist (LABA) to low-dose ICS
D) Start oral corticosteroids daily
,* *[CORRECT]** C
*Rationale: GINA 2026 recommends adding a LABA to ICS (Step 3) for moderate persistent
asthma when symptoms persist despite low-dose ICS. Option A is less effective than ICS+LABA
combination. Option B (LAMA) is typically reserved for severe asthma or when LABA is
insufficient. Option D (oral steroids) is inappropriate for maintenance and reserved for severe
exacerbations. Clinical pearl: The SMART approach (single inhaler maintenance and reliever
therapy) with ICS-formoterol is now preferred in GINA 2026 for Steps 3-5.*
---
* *Q3 (Respiratory – Pneumonia assessment):** A 74-year-old is admitted with
community-acquired pneumonia. Which assessment finding would most strongly indicate the
need for ICU admission according to IDSA/ATS 2026 criteria?
) Respiratory rate 28 breaths/min and PaO₂/FiO₂ ratio 220
A
B) Temperature 38.8°C and white blood cell count 14,000/μL
C) Confusion and blood urea nitrogen 22 mg/dL
D) Systolic blood pressure 100 mmHg and heart rate 110 bpm
* *[CORRECT]** A
*Rationale: IDSA/ATS 2026 severe pneumonia criteria include respiratory rate ≥30, PaO₂/FiO₂
≤250, multilobar infiltrates, septic shock, or need for mechanical ventilation. Option A meets two
major criteria (RR >30 equivalent, PaO₂/FiO₂ <250). Option B and C represent CURB-65 criteria
(moderate severity, not ICU). Option D shows mild hypotension but not septic shock. Clinical
pearl: The PaO₂/FiO₂ ratio is critical—<<250 indicates acute hypoxemic respiratory failure
requiring ICU-level care.*
---
* *Q4 (Respiratory – Pulmonary embolism diagnosis):** A 48-year-old postoperative patient
develops sudden dyspnea and pleuritic chest pain. Wells score is 6.5 (intermediate probability).
What is the next best diagnostic step?
) Immediately start heparin and obtain CT pulmonary angiography (CTPA)
A
B) Obtain D-dimer testing first
C) Perform ventilation-perfusion (V/Q) scan as first-line
D) Order transthoracic echocardiography to assess RV strain
* *[CORRECT]** A
*Rationale: For intermediate-to-high probability PE (Wells ≥4), the 2026 CHEST guidelines
recommend proceeding directly to CTPA without D-dimer testing, as D-dimer is often elevated
postoperatively and has low specificity. Empiric anticoagulation should be started if PE is
strongly suspected and testing is delayed. Option B is appropriate for low probability only.
Option C is reserved for patients with renal failure or contrast allergy. Option D supports the
, iagnosis but is not definitive. Clinical pearl: In postoperative patients, D-dimer is notoriously
d
unreliable—always use clinical probability scoring first.*
---
* *Q5 (Respiratory – ARDS management):** A 55-year-old with ARDS is on mechanical
ventilation. The physician orders lung-protective ventilation. Which parameter combination best
aligns with current evidence?
) Tidal volume 10 mL/kg predicted body weight, PEEP 5 cmH₂O
A
B) Tidal volume 6 mL/kg predicted body weight, PEEP 10-15 cmH₂O
C) Tidal volume 4 mL/kg actual body weight, PEEP 20 cmH₂O
D) Tidal volume 8 mL/kg predicted body weight, zero PEEP
* *[CORRECT]** B
*Rationale: The ARDSNet protocol (updated 2026) recommends tidal volume 6 mL/kg predicted
body weight (not actual weight) with plateau pressure <30 cmH₂O and appropriate PEEP
(typically 10-15 cmH₂O) to prevent alveolar collapse. Option A uses excessive tidal volume.
Option C uses actual body weight and excessive PEEP, risking barotrauma. Option D omits
PEEP, which is essential for preventing atelectasis. Clinical pearl: Predicted body weight is
calculated using gender and height—using actual weight in obese patients causes volutrauma
and worsens outcomes.*
---
* *Q6 (Respiratory – COPD pharmacology):** A patient with COPD is prescribed tiotropium
(Spiriva). The nurse should teach the patient which critical information about this medication?
) "Use this inhaler only when you feel short of breath"
A
B) "Rinse your mouth after each use to prevent oral thrush"
C) "This medication is a rescue inhaler for acute bronchospasm"
D) "This is a long-acting anticholinergic; use it once daily for maintenance"
* *[CORRECT]** D
*Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA) used once daily for COPD
maintenance, not as a rescue medication. Option A and C confuse LAMA with short-acting
bronchodilators (SABA). Option B describes inhaled corticosteroid teaching (preventing thrush),
not anticholinergics. Clinical pearl: LAMAs are cornerstone maintenance therapy in COPD;
ensure patients understand the difference between daily controllers and rescue
inhalers—confusion leads to poor outcomes and exacerbations.*
---
, * *Q7 (Respiratory – Asthma peak flow monitoring):** A patient with asthma has a personal best
peak flow of 500 L/min. Today, her peak flow is 350 L/min. According to the asthma action plan,
what zone is she in and what action is required?
) Green zone (80-100%); continue current medications
A
B) Yellow zone (50-80%); increase medications and contact provider
C) Red zone (<50%); seek emergency care immediately
D) Orange zone (60-75%); use rescue inhaler and monitor
* *[CORRECT]** B
*Rationale: 350/500 = 70%, which falls in the yellow zone (50-80% of personal best). The
asthma action plan requires increasing medications (typically doubling ICS or adding LABA) and
contacting the provider. Option A is for 80-100%. Option C is for <50% (250 L/min). Option D is
not a standard zone classification. Clinical pearl: Teach patients to calculate percentages, not
just memorize numbers—personal best varies by individual, and action plans must be
personalized.*
---
* *Q8 (Respiratory – Pneumonia antibiotics):** A 35-year-old otherwise healthy adult is
diagnosed with community-acquired pneumonia (CAP). Which empiric antibiotic regimen is
most appropriate per IDSA/ATS 2026 guidelines?
) Vancomycin and piperacillin-tazobactam
A
B) Amoxicillin 1 g three times daily
C) Azithromycin monotherapy
D) Levofloxacin 750 mg daily
* *[CORRECT]** B
*Rationale: For healthy outpatients with CAP and no comorbidities, IDSA/ATS 2026
recommends amoxicillin as first-line empiric therapy. Option A is for hospital-acquired or severe
CAP with risk factors for MRSA/Pseudomonas. Option C (macrolide monotherapy) is reserved
for patients with comorbidities or when amoxicillin is contraindicated, due to increasing
resistance. Option D (fluoroquinolone) is an alternative but carries tendon and QT risks. Clinical
pearl: Overuse of broad-spectrum antibiotics in simple CAP drives resistance—always match
antibiotic spectrum to patient risk factors.*
---
* *Q9 (Respiratory – Oxygen delivery devices):** A patient with COPD requires precise oxygen
titration. Which device provides the most accurate FiO₂ delivery regardless of breathing pattern?
) Simple face mask
A
B) Nasal cannula
