Detailed Answer Key Medsurge
Respiratory Latest 2023
EXAM
SECTION 1: CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
1. A nurse is caring for a client with COPD. Which of the
following findings should the nurse expect?
A) Increased anteroposterior (AP) chest diameter
B) Decreased residual volume
C) Increased PaO2
D) Normal breath sounds
Answer: A – Increased anteroposterior (AP) chest diameter
Rationale: COPD causes air trapping, leading to a barrel chest
(increased AP diameter). Residual volume increases, PaO2
decreases, and breath sounds are diminished.
2. A client with COPD has a prescription for oxygen at 2 L/min
via nasal cannula. Which of the following is the most
important rationale for this low flow rate?
A) High oxygen flow can suppress the hypoxic drive.
B) Low flow prevents oxygen toxicity.
C) The client cannot tolerate higher flows.
D) The client requires humidified oxygen.
,Answer: A – High oxygen flow can suppress the hypoxic drive
Rationale: Clients with chronic hypercapnia rely on hypoxic drive;
excessive oxygen can cause hypoventilation and respiratory
acidosis.
3. A nurse is reinforcing teaching about pursed-lip breathing
for a client with COPD. Which of the following statements
indicates understanding?
A) "I will inhale slowly through my mouth and exhale through
pursed lips."
B) "I will inhale through my nose and exhale through pursed lips."
C) "I will hold my breath for 10 seconds after inhaling."
D) "I will exhale as quickly as possible."
Answer: B – "I will inhale through my nose and exhale
through pursed lips."
Rationale: Pursed-lip breathing involves inhaling through the
nose and exhaling slowly through pursed lips to prolong
exhalation and prevent airway collapse.
4. A nurse is assessing a client with COPD who has a
productive cough. Which of the following sputum
characteristics should the nurse report to the provider?
A) White, frothy sputum
B) Yellow, thick sputum
C) Clear, thin sputum
D) Scant, mucoid sputum
,Answer: B – Yellow, thick sputum
Rationale: Yellow or green sputum indicates infection; the
provider should be notified.
5. A client with COPD is prescribed ipratropium bromide
(Atrovent). Which of the following is a potential adverse
effect?
A) Dry mouth
B) Tachycardia
C) Bronchospasm
D) Hyperglycemia
Answer: A – Dry mouth
Rationale: Ipratropium is an anticholinergic; dry mouth is a
common side effect. Tachycardia is more common with beta-
agonists.
6. A client with COPD has an ABG: pH 7.32, PaCO₂ 58, HCO₃
25. Which interpretation is correct?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C – Respiratory acidosis
Rationale: Low pH (7.32 < 7.35) = acidosis. High PaCO₂ (58 > 45)
indicates a respiratory cause.
7. A client with COPD and an SpO₂ of 88% on 2 L/min is alert
and breathing comfortably. What should the nurse do?
A) Increase to 4 L/min to achieve SpO₂ >95%
, B) Leave O₂ at 2 L/min because 88-92% is target for COPD
C) Switch to a non-rebreather mask
D) Prepare for intubation
Answer: B – Leave O₂ at 2 L/min because 88-92% is target for
COPD
Rationale: In COPD, the hypoxic drive may be present. Target
SpO₂ is 88-92%. Higher O₂ can lead to CO₂ retention and
respiratory failure.
8. Which assessment finding indicates worsening respiratory
status in a COPD patient?
A) Barrel chest
B) Use of accessory muscles
C) Chronic cough
D) Clubbing
Answer: B – Use of accessory muscles
Rationale: Accessory muscle use (sternocleidomastoid, scalene)
indicates increased work of breathing and worsening respiratory
status.
9. A nurse is caring for a client with emphysema. Which of the
following findings should the nurse expect to assess? (Select
all that apply)
A) Dyspnea
B) Bradycardia
C) Barrel chest
D) Clubbing of fingers
Respiratory Latest 2023
EXAM
SECTION 1: CHRONIC OBSTRUCTIVE PULMONARY DISEASE
(COPD)
1. A nurse is caring for a client with COPD. Which of the
following findings should the nurse expect?
A) Increased anteroposterior (AP) chest diameter
B) Decreased residual volume
C) Increased PaO2
D) Normal breath sounds
Answer: A – Increased anteroposterior (AP) chest diameter
Rationale: COPD causes air trapping, leading to a barrel chest
(increased AP diameter). Residual volume increases, PaO2
decreases, and breath sounds are diminished.
2. A client with COPD has a prescription for oxygen at 2 L/min
via nasal cannula. Which of the following is the most
important rationale for this low flow rate?
A) High oxygen flow can suppress the hypoxic drive.
B) Low flow prevents oxygen toxicity.
C) The client cannot tolerate higher flows.
D) The client requires humidified oxygen.
,Answer: A – High oxygen flow can suppress the hypoxic drive
Rationale: Clients with chronic hypercapnia rely on hypoxic drive;
excessive oxygen can cause hypoventilation and respiratory
acidosis.
3. A nurse is reinforcing teaching about pursed-lip breathing
for a client with COPD. Which of the following statements
indicates understanding?
A) "I will inhale slowly through my mouth and exhale through
pursed lips."
B) "I will inhale through my nose and exhale through pursed lips."
C) "I will hold my breath for 10 seconds after inhaling."
D) "I will exhale as quickly as possible."
Answer: B – "I will inhale through my nose and exhale
through pursed lips."
Rationale: Pursed-lip breathing involves inhaling through the
nose and exhaling slowly through pursed lips to prolong
exhalation and prevent airway collapse.
4. A nurse is assessing a client with COPD who has a
productive cough. Which of the following sputum
characteristics should the nurse report to the provider?
A) White, frothy sputum
B) Yellow, thick sputum
C) Clear, thin sputum
D) Scant, mucoid sputum
,Answer: B – Yellow, thick sputum
Rationale: Yellow or green sputum indicates infection; the
provider should be notified.
5. A client with COPD is prescribed ipratropium bromide
(Atrovent). Which of the following is a potential adverse
effect?
A) Dry mouth
B) Tachycardia
C) Bronchospasm
D) Hyperglycemia
Answer: A – Dry mouth
Rationale: Ipratropium is an anticholinergic; dry mouth is a
common side effect. Tachycardia is more common with beta-
agonists.
6. A client with COPD has an ABG: pH 7.32, PaCO₂ 58, HCO₃
25. Which interpretation is correct?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C – Respiratory acidosis
Rationale: Low pH (7.32 < 7.35) = acidosis. High PaCO₂ (58 > 45)
indicates a respiratory cause.
7. A client with COPD and an SpO₂ of 88% on 2 L/min is alert
and breathing comfortably. What should the nurse do?
A) Increase to 4 L/min to achieve SpO₂ >95%
, B) Leave O₂ at 2 L/min because 88-92% is target for COPD
C) Switch to a non-rebreather mask
D) Prepare for intubation
Answer: B – Leave O₂ at 2 L/min because 88-92% is target for
COPD
Rationale: In COPD, the hypoxic drive may be present. Target
SpO₂ is 88-92%. Higher O₂ can lead to CO₂ retention and
respiratory failure.
8. Which assessment finding indicates worsening respiratory
status in a COPD patient?
A) Barrel chest
B) Use of accessory muscles
C) Chronic cough
D) Clubbing
Answer: B – Use of accessory muscles
Rationale: Accessory muscle use (sternocleidomastoid, scalene)
indicates increased work of breathing and worsening respiratory
status.
9. A nurse is caring for a client with emphysema. Which of the
following findings should the nurse expect to assess? (Select
all that apply)
A) Dyspnea
B) Bradycardia
C) Barrel chest
D) Clubbing of fingers
