ATI MED SURG RESPIRATORY
PROCTORED EXAM TEST BANK 2025–
2026 200 VERIFIED QUESTIONS,
ANSWERS, AND DETAILED
RATIONALES GRADED A+
This premium study resource features 200 highly technical, NCLEX-
style multiple-choice questions mapping directly to the advanced
medical-surgical respiratory curriculum. Every question includes the
correct answer in bold italics along with a deep, pathophysiological
rationale evaluating complex ventilation, chest tube, and arterial
blood gas scenarios. It is the ultimate tool for nursing students
seeking top-tier scores on high-stakes proctored exit exams and
course midterms.
Q1. A nurse is interpreting the arterial blood gas (ABG) results of a
client with severe acute respiratory distress syndrome (ARDS) on
mechanical ventilation. The results are: pH 7.21, PaCO₂ 68 mmHg,
HCO₃⁻ 28 mEq/L, PaO₂ 52 mmHg. Which of the following acid-base
imbalances is present?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO₂ is
elevated above 45 mmHg, indicating a respiratory origin. The HCO₃⁻ is
,elevated above 26 mEq/L, which demonstrates that the kidneys have
begun to retain bicarbonate to buffer the acid, indicating partial
compensation because the pH has not yet returned to the normal
range.
Q2. A nurse is caring for a client with a newly inserted chest tube for a
pneumothorax. Which of the following findings in the water-seal
chamber requires immediate intervention?
A. Gentle tidaling during inspiration and expiration
B. Intermittent bubbling during forced expiration
C. Continuous, rapid bubbling throughout the respiratory cycle
D. Fluid level fluctuating with the client's breathing
Rationale: Continuous bubbling in the water-seal chamber indicates a
persistent air leak within the system or a large tear in the visceral
pleura. Tidaling and intermittent bubbling during expiration or
coughing are expected, normal findings as air leaves the pleural
space.
Q3. A nurse is monitoring a client on mechanical ventilation in the
intensive care unit. The high-pressure limit alarm begins to sound.
Which of the following conditions should the nurse suspect?
A. The client is biting the endotracheal tube.
B. There is a leak in the endotracheal tube cuff.
C. The ventilator tubing has become disconnected.
D. The client is experiencing a total sedation block.
Rationale: High-pressure alarms are triggered by increased resistance
to airflow, such as a client biting the tube, thick secretions
obstructing the airway, kinks in the tubing, or a pneumothorax. Cuff
leaks and disconnections decrease resistance, triggering low-
pressure alarms.
Q4. A client with a massive pulmonary embolism is prescribed a
continuous intravenous heparin infusion. The nurse should titrate the
heparin dosage based on which of the following laboratory values?
,A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Bleeding time
D. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT is the specific laboratory value used to monitor
and adjust unfractionated heparin therapy. PT and INR are utilized to
track oral warfarin therapy.
Q5. A nurse is evaluating a client with advanced chronic obstructive
pulmonary disease (COPD). Which of the following arterial blood gas
profiles represents chronic, fully compensated respiratory acidosis
typical for this population?
A. pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.36, PaCO₂ 58 mmHg, HCO₃⁻ 32 mEq/L
C. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 20 mEq/L
D. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
Rationale: Clients with severe chronic COPD are chronic carbon
dioxide retainers. Full compensation is marked by a pH within the
normal range but on the acidotic side (7.35–7.39), a high PaCO₂, and a
significantly elevated HCO₃⁻ level, showing renal compensation over
time.
Q6. A nurse is providing discharge teaching to a client with
emphysema regarding pursed-lip breathing. Which of the following
statements by the client indicates a correct understanding?
A. "I should inhale through my mouth and exhale quickly through my nose."
B. "I need to breathe out twice as long as I breathe in to help empty
my lungs."
C. "This exercise will help strengthen my upper chest and neck muscles."
D. "I should use this technique only when my oxygen tank runs completely
out."
Rationale: Pursed-lip breathing keeps the airways open longer by
creating positive expiratory pressure. The client should inhale for 2
seconds and exhale smoothly for 4 seconds, effectively doubling
expiration to prevent air trapping.
, Q7. A nurse is monitoring a client following a bronchoscopy with
biopsy. Which of the following assessments is the priority before
allowing the client to consume fluids?
A. Presence of blood-tinged sputum
B. Return of the gag reflex
C. Client's report of a mild sore throat
D. Recovery of baseline heart rate
Rationale: Topical anesthetics used during a bronchoscopy paralyze
the pharyngeal muscles. The nurse must verify the return of the gag
and swallow reflexes before administering anything by mouth to
prevent aspiration.
Q8. A client is admitted to the emergency department with acute
respiratory distress secondary to a status asthmaticus flare-up.
Which of the following medications should the nurse prepare to
administer first?
A. Salmeterol via dry powder inhaler
B. Albuterol via nebulizer
C. Fluticasone via metered-dose inhaler
D. Methylprednisolone intravenously
Rationale: Albuterol is a short-acting beta₂ agonist (SABA) that acts
rapidly as a rescue bronchodilator. Salmeterol is long-acting;
corticosteroids like fluticasone and methylprednisolone reduce
inflammation but do not provide immediate bronchodilation.
Q9. A nurse is caring for a client with acute respiratory failure who is
receiving mechanical ventilation with a high level of Positive End-
Expiratory Pressure (PEEP). The nurse should monitor the client for
which of the following systemic complications?
A. Increased cardiac output
B. Hypotension
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: High levels of PEEP increase intrathoracic pressure, which
PROCTORED EXAM TEST BANK 2025–
2026 200 VERIFIED QUESTIONS,
ANSWERS, AND DETAILED
RATIONALES GRADED A+
This premium study resource features 200 highly technical, NCLEX-
style multiple-choice questions mapping directly to the advanced
medical-surgical respiratory curriculum. Every question includes the
correct answer in bold italics along with a deep, pathophysiological
rationale evaluating complex ventilation, chest tube, and arterial
blood gas scenarios. It is the ultimate tool for nursing students
seeking top-tier scores on high-stakes proctored exit exams and
course midterms.
Q1. A nurse is interpreting the arterial blood gas (ABG) results of a
client with severe acute respiratory distress syndrome (ARDS) on
mechanical ventilation. The results are: pH 7.21, PaCO₂ 68 mmHg,
HCO₃⁻ 28 mEq/L, PaO₂ 52 mmHg. Which of the following acid-base
imbalances is present?
A. Uncompensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated respiratory acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO₂ is
elevated above 45 mmHg, indicating a respiratory origin. The HCO₃⁻ is
,elevated above 26 mEq/L, which demonstrates that the kidneys have
begun to retain bicarbonate to buffer the acid, indicating partial
compensation because the pH has not yet returned to the normal
range.
Q2. A nurse is caring for a client with a newly inserted chest tube for a
pneumothorax. Which of the following findings in the water-seal
chamber requires immediate intervention?
A. Gentle tidaling during inspiration and expiration
B. Intermittent bubbling during forced expiration
C. Continuous, rapid bubbling throughout the respiratory cycle
D. Fluid level fluctuating with the client's breathing
Rationale: Continuous bubbling in the water-seal chamber indicates a
persistent air leak within the system or a large tear in the visceral
pleura. Tidaling and intermittent bubbling during expiration or
coughing are expected, normal findings as air leaves the pleural
space.
Q3. A nurse is monitoring a client on mechanical ventilation in the
intensive care unit. The high-pressure limit alarm begins to sound.
Which of the following conditions should the nurse suspect?
A. The client is biting the endotracheal tube.
B. There is a leak in the endotracheal tube cuff.
C. The ventilator tubing has become disconnected.
D. The client is experiencing a total sedation block.
Rationale: High-pressure alarms are triggered by increased resistance
to airflow, such as a client biting the tube, thick secretions
obstructing the airway, kinks in the tubing, or a pneumothorax. Cuff
leaks and disconnections decrease resistance, triggering low-
pressure alarms.
Q4. A client with a massive pulmonary embolism is prescribed a
continuous intravenous heparin infusion. The nurse should titrate the
heparin dosage based on which of the following laboratory values?
,A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Bleeding time
D. Activated partial thromboplastin time (aPTT)
Rationale: The aPTT is the specific laboratory value used to monitor
and adjust unfractionated heparin therapy. PT and INR are utilized to
track oral warfarin therapy.
Q5. A nurse is evaluating a client with advanced chronic obstructive
pulmonary disease (COPD). Which of the following arterial blood gas
profiles represents chronic, fully compensated respiratory acidosis
typical for this population?
A. pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.36, PaCO₂ 58 mmHg, HCO₃⁻ 32 mEq/L
C. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 20 mEq/L
D. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
Rationale: Clients with severe chronic COPD are chronic carbon
dioxide retainers. Full compensation is marked by a pH within the
normal range but on the acidotic side (7.35–7.39), a high PaCO₂, and a
significantly elevated HCO₃⁻ level, showing renal compensation over
time.
Q6. A nurse is providing discharge teaching to a client with
emphysema regarding pursed-lip breathing. Which of the following
statements by the client indicates a correct understanding?
A. "I should inhale through my mouth and exhale quickly through my nose."
B. "I need to breathe out twice as long as I breathe in to help empty
my lungs."
C. "This exercise will help strengthen my upper chest and neck muscles."
D. "I should use this technique only when my oxygen tank runs completely
out."
Rationale: Pursed-lip breathing keeps the airways open longer by
creating positive expiratory pressure. The client should inhale for 2
seconds and exhale smoothly for 4 seconds, effectively doubling
expiration to prevent air trapping.
, Q7. A nurse is monitoring a client following a bronchoscopy with
biopsy. Which of the following assessments is the priority before
allowing the client to consume fluids?
A. Presence of blood-tinged sputum
B. Return of the gag reflex
C. Client's report of a mild sore throat
D. Recovery of baseline heart rate
Rationale: Topical anesthetics used during a bronchoscopy paralyze
the pharyngeal muscles. The nurse must verify the return of the gag
and swallow reflexes before administering anything by mouth to
prevent aspiration.
Q8. A client is admitted to the emergency department with acute
respiratory distress secondary to a status asthmaticus flare-up.
Which of the following medications should the nurse prepare to
administer first?
A. Salmeterol via dry powder inhaler
B. Albuterol via nebulizer
C. Fluticasone via metered-dose inhaler
D. Methylprednisolone intravenously
Rationale: Albuterol is a short-acting beta₂ agonist (SABA) that acts
rapidly as a rescue bronchodilator. Salmeterol is long-acting;
corticosteroids like fluticasone and methylprednisolone reduce
inflammation but do not provide immediate bronchodilation.
Q9. A nurse is caring for a client with acute respiratory failure who is
receiving mechanical ventilation with a high level of Positive End-
Expiratory Pressure (PEEP). The nurse should monitor the client for
which of the following systemic complications?
A. Increased cardiac output
B. Hypotension
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: High levels of PEEP increase intrathoracic pressure, which
