Medical-Surgical Respiratory Disorders Exam Prep –
Real Practice Questions, Answers & Detailed
Rationales (Updated 2026) | COPD & Asthma
Management, Pneumonia & Tuberculosis Care,
Respiratory Failure & ARDS, Oxygen Therapy &
Ventilator Support, ABG Interpretation, Pulmonary
Pharmacology, Airway Management, Nursing
Interventions & NCLEX-Style Clinical Scenarios
Question 1: Which anatomical structure is primarily responsible for warming,
humidifying, and filtering inspired air before it reaches the lower respiratory tract?
A. Alveoli
B. Bronchioles
C. Nasal mucosa and turbinates
D. Pleural membranes
CORRECT ANSWER: C. Nasal mucosa and turbinates
Rationale: The nasal cavity, lined with vascular mucosa and turbinates, functions to
warm, humidify, and filter inspired air through ciliary action and mucus production. This
protects delicate lower airway structures from irritants, pathogens, and temperature
extremes. Alveoli facilitate gas exchange, bronchioles conduct air, and pleural
membranes reduce friction during lung movement.
Question 2: A patient with chronic obstructive pulmonary disease (COPD) presents
with a barrel chest configuration. This finding is primarily associated with which
pathophysiological change?
A. Increased anteroposterior chest diameter due to chronic air trapping
B. Decreased lung compliance from pulmonary fibrosis
C. Pleural thickening from recurrent infections
D. Diaphragmatic hypertrophy from chronic hypoxemia
CORRECT ANSWER: A. Increased anteroposterior chest diameter due to chronic air
trapping
Rationale: Barrel chest in COPD results from chronic hyperinflation and air trapping,
which increases the anteroposterior diameter of the thorax. This is a classic physical
assessment finding in emphysema-predominant COPD. Pulmonary fibrosis decreases
lung volumes, pleural thickening alters chest wall movement, and diaphragmatic
changes in COPD typically involve flattening, not hypertrophy.
,Question 3: During auscultation of a patient with suspected pneumonia, the nurse
hears low-pitched, rumbling sounds that persist after coughing. These sounds are
BEST described as:
A. Wheezes
B. Crackles
C. Rhonchi
D. Pleural friction rub
CORRECT ANSWER: C. Rhonchi
Rationale: Rhonchi are low-pitched, continuous, rumbling or snoring-like adventitious
lung sounds caused by secretions or mucus in the larger airways; they may partially
clear with coughing. Wheezes are high-pitched and musical, crackles are discontinuous
popping sounds, and pleural friction rubs are grating sounds heard during both
inspiration and expiration due to inflamed pleural surfaces.
Question 4: Which arterial blood gas (ABG) result is MOST consistent with acute
respiratory acidosis in a patient with severe asthma exacerbation?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
C. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 20 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
Rationale: Acute respiratory acidosis is characterized by low pH (<7.35), elevated
PaCO₂ (>45 mmHg), and normal or slightly elevated bicarbonate due to minimal renal
compensation in acute settings. Option B reflects this pattern. Option A and D show
respiratory alkalosis; Option C represents normal ABG values.
Question 5: A patient with pulmonary embolism is MOST likely to exhibit which
classic triad of symptoms?
A. Fever, productive cough, and chest pain
B. Dyspnea, pleuritic chest pain, and hemoptysis
C. Wheezing, orthopnea, and peripheral edema
D. Stridor, hoarseness, and dysphagia
CORRECT ANSWER: B. Dyspnea, pleuritic chest pain, and hemoptysis
Rationale: The classic triad of pulmonary embolism includes sudden dyspnea, pleuritic
chest pain (worsened by inspiration), and hemoptysis, though not all three are present
in every case. Fever and productive cough suggest pneumonia; wheezing and orthopnea
indicate heart failure or asthma; stridor and hoarseness suggest upper airway
obstruction.
Question 6: Which nursing intervention is PRIORITY for a patient with a newly
inserted chest tube connected to a water-seal drainage system?
,A. Clamp the tube during ambulation to prevent air leaks
B. Ensure the drainage system remains below the level of the chest
C. Milk the tube every hour to maintain patency
D. Empty the collection chamber when it is completely full
CORRECT ANSWER: B. Ensure the drainage system remains below the level of the
chest
Rationale: Maintaining the drainage system below chest level prevents backflow of fluid
or air into the pleural space, reducing risk of infection or tension pneumothorax.
Clamping a chest tube without specific orders can cause tension pneumothorax;
milking is controversial and not routine; the collection chamber should be emptied
before it is full to maintain accurate measurement and system function.
Question 7: A patient with asthma is prescribed a metered-dose inhaler containing
both fluticasone and salmeterol. The nurse teaches the patient that this
combination medication is used for:
A. Immediate relief of acute bronchospasm
B. Long-term control and prevention of asthma symptoms
C. Treatment of respiratory infections triggering asthma
D. Reduction of mucus viscosity during exacerbations
CORRECT ANSWER: B. Long-term control and prevention of asthma symptoms
Rationale: Fluticasone (an inhaled corticosteroid) and salmeterol (a long-acting beta-
agonist) form a maintenance medication for persistent asthma, reducing inflammation
and providing prolonged bronchodilation. It is NOT for acute rescue; albuterol is used
for immediate relief. This combination does not treat infections or directly affect mucus
viscosity.
Question 8: Which finding during pulmonary function testing is MOST indicative of
obstructive lung disease such as COPD?
A. Decreased total lung capacity with normal FEV₁/FVC ratio
B. Increased residual volume with FEV₁/FVC ratio <70%
C. Normal diffusing capacity with reduced vital capacity
D. Elevated forced expiratory flow with decreased functional residual capacity
CORRECT ANSWER: B. Increased residual volume with FEV₁/FVC ratio <70%
Rationale: Obstructive lung diseases like COPD are characterized by airflow limitation,
reflected by a reduced FEV₁/FVC ratio (<70% post-bronchodilator) and air trapping
leading to increased residual volume. Restrictive diseases show reduced lung volumes
with preserved or increased FEV₁/FVC ratio.
Question 9: A patient with tuberculosis is placed on airborne precautions. Which
personal protective equipment is REQUIRED for healthcare personnel entering the
room?
, A. Surgical mask and gloves
B. N95 respirator or higher-level respiratory protection
C. Face shield and gown only
D. Standard precautions with hand hygiene
CORRECT ANSWER: B. N95 respirator or higher-level respiratory protection
Rationale: Tuberculosis is transmitted via airborne droplet nuclei; therefore, NIOSH-
approved N95 respirators or powered air-purifying respirators (PAPRs) are required for
entry into the room. Surgical masks do not provide adequate filtration for airborne
particles. Gowns and gloves are used for contact precautions, not airborne.
Question 10: Which assessment finding in a post-thoracotomy patient requires
IMMEDIATE nursing intervention?
A. Pain rating of 6/10 at the incision site
B. Absent breath sounds on the operative side with tracheal deviation
C. Serous drainage on the chest dressing
D. Oxygen saturation of 92% on 2 L/min nasal cannula
CORRECT ANSWER: B. Absent breath sounds on the operative side with tracheal
deviation
Rationale: Absent breath sounds with tracheal deviation suggest tension
pneumothorax, a life-threatening emergency requiring immediate decompression. Pain,
serous drainage, and mild hypoxemia are expected postoperatively but warrant
monitoring; however, they do not indicate imminent crisis like tension pneumothorax.
Question 11: A patient with community-acquired pneumonia is prescribed
azithromycin. The nurse recognizes that this antibiotic is selected primarily for its
activity against:
A. Gram-negative bacilli such as Pseudomonas aeruginosa
B. Atypical pathogens including Mycoplasma pneumoniae and Legionella
C. Fungal organisms like Histoplasma capsulatum
D. Mycobacterium tuberculosis
CORRECT ANSWER: B. Atypical pathogens including Mycoplasma pneumoniae and
Legionella
Rationale: Azithromycin, a macrolide antibiotic, is first-line for community-acquired
pneumonia due to excellent coverage of atypical pathogens (Mycoplasma, Legionella,
Chlamydophila). Pseudomonas requires antipseudomonal agents; fungal infections
need antifungals; TB requires multi-drug regimens including isoniazid and rifampin.
Question 12: Which statement by a patient with COPD indicates understanding of
energy conservation techniques?
A. "I will perform all my activities in the morning when I have the most energy."
B. "I will sit while brushing my teeth and preparing meals to reduce oxygen demand."
Real Practice Questions, Answers & Detailed
Rationales (Updated 2026) | COPD & Asthma
Management, Pneumonia & Tuberculosis Care,
Respiratory Failure & ARDS, Oxygen Therapy &
Ventilator Support, ABG Interpretation, Pulmonary
Pharmacology, Airway Management, Nursing
Interventions & NCLEX-Style Clinical Scenarios
Question 1: Which anatomical structure is primarily responsible for warming,
humidifying, and filtering inspired air before it reaches the lower respiratory tract?
A. Alveoli
B. Bronchioles
C. Nasal mucosa and turbinates
D. Pleural membranes
CORRECT ANSWER: C. Nasal mucosa and turbinates
Rationale: The nasal cavity, lined with vascular mucosa and turbinates, functions to
warm, humidify, and filter inspired air through ciliary action and mucus production. This
protects delicate lower airway structures from irritants, pathogens, and temperature
extremes. Alveoli facilitate gas exchange, bronchioles conduct air, and pleural
membranes reduce friction during lung movement.
Question 2: A patient with chronic obstructive pulmonary disease (COPD) presents
with a barrel chest configuration. This finding is primarily associated with which
pathophysiological change?
A. Increased anteroposterior chest diameter due to chronic air trapping
B. Decreased lung compliance from pulmonary fibrosis
C. Pleural thickening from recurrent infections
D. Diaphragmatic hypertrophy from chronic hypoxemia
CORRECT ANSWER: A. Increased anteroposterior chest diameter due to chronic air
trapping
Rationale: Barrel chest in COPD results from chronic hyperinflation and air trapping,
which increases the anteroposterior diameter of the thorax. This is a classic physical
assessment finding in emphysema-predominant COPD. Pulmonary fibrosis decreases
lung volumes, pleural thickening alters chest wall movement, and diaphragmatic
changes in COPD typically involve flattening, not hypertrophy.
,Question 3: During auscultation of a patient with suspected pneumonia, the nurse
hears low-pitched, rumbling sounds that persist after coughing. These sounds are
BEST described as:
A. Wheezes
B. Crackles
C. Rhonchi
D. Pleural friction rub
CORRECT ANSWER: C. Rhonchi
Rationale: Rhonchi are low-pitched, continuous, rumbling or snoring-like adventitious
lung sounds caused by secretions or mucus in the larger airways; they may partially
clear with coughing. Wheezes are high-pitched and musical, crackles are discontinuous
popping sounds, and pleural friction rubs are grating sounds heard during both
inspiration and expiration due to inflamed pleural surfaces.
Question 4: Which arterial blood gas (ABG) result is MOST consistent with acute
respiratory acidosis in a patient with severe asthma exacerbation?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
C. pH 7.35, PaCO₂ 40 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.48, PaCO₂ 32 mmHg, HCO₃⁻ 20 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
Rationale: Acute respiratory acidosis is characterized by low pH (<7.35), elevated
PaCO₂ (>45 mmHg), and normal or slightly elevated bicarbonate due to minimal renal
compensation in acute settings. Option B reflects this pattern. Option A and D show
respiratory alkalosis; Option C represents normal ABG values.
Question 5: A patient with pulmonary embolism is MOST likely to exhibit which
classic triad of symptoms?
A. Fever, productive cough, and chest pain
B. Dyspnea, pleuritic chest pain, and hemoptysis
C. Wheezing, orthopnea, and peripheral edema
D. Stridor, hoarseness, and dysphagia
CORRECT ANSWER: B. Dyspnea, pleuritic chest pain, and hemoptysis
Rationale: The classic triad of pulmonary embolism includes sudden dyspnea, pleuritic
chest pain (worsened by inspiration), and hemoptysis, though not all three are present
in every case. Fever and productive cough suggest pneumonia; wheezing and orthopnea
indicate heart failure or asthma; stridor and hoarseness suggest upper airway
obstruction.
Question 6: Which nursing intervention is PRIORITY for a patient with a newly
inserted chest tube connected to a water-seal drainage system?
,A. Clamp the tube during ambulation to prevent air leaks
B. Ensure the drainage system remains below the level of the chest
C. Milk the tube every hour to maintain patency
D. Empty the collection chamber when it is completely full
CORRECT ANSWER: B. Ensure the drainage system remains below the level of the
chest
Rationale: Maintaining the drainage system below chest level prevents backflow of fluid
or air into the pleural space, reducing risk of infection or tension pneumothorax.
Clamping a chest tube without specific orders can cause tension pneumothorax;
milking is controversial and not routine; the collection chamber should be emptied
before it is full to maintain accurate measurement and system function.
Question 7: A patient with asthma is prescribed a metered-dose inhaler containing
both fluticasone and salmeterol. The nurse teaches the patient that this
combination medication is used for:
A. Immediate relief of acute bronchospasm
B. Long-term control and prevention of asthma symptoms
C. Treatment of respiratory infections triggering asthma
D. Reduction of mucus viscosity during exacerbations
CORRECT ANSWER: B. Long-term control and prevention of asthma symptoms
Rationale: Fluticasone (an inhaled corticosteroid) and salmeterol (a long-acting beta-
agonist) form a maintenance medication for persistent asthma, reducing inflammation
and providing prolonged bronchodilation. It is NOT for acute rescue; albuterol is used
for immediate relief. This combination does not treat infections or directly affect mucus
viscosity.
Question 8: Which finding during pulmonary function testing is MOST indicative of
obstructive lung disease such as COPD?
A. Decreased total lung capacity with normal FEV₁/FVC ratio
B. Increased residual volume with FEV₁/FVC ratio <70%
C. Normal diffusing capacity with reduced vital capacity
D. Elevated forced expiratory flow with decreased functional residual capacity
CORRECT ANSWER: B. Increased residual volume with FEV₁/FVC ratio <70%
Rationale: Obstructive lung diseases like COPD are characterized by airflow limitation,
reflected by a reduced FEV₁/FVC ratio (<70% post-bronchodilator) and air trapping
leading to increased residual volume. Restrictive diseases show reduced lung volumes
with preserved or increased FEV₁/FVC ratio.
Question 9: A patient with tuberculosis is placed on airborne precautions. Which
personal protective equipment is REQUIRED for healthcare personnel entering the
room?
, A. Surgical mask and gloves
B. N95 respirator or higher-level respiratory protection
C. Face shield and gown only
D. Standard precautions with hand hygiene
CORRECT ANSWER: B. N95 respirator or higher-level respiratory protection
Rationale: Tuberculosis is transmitted via airborne droplet nuclei; therefore, NIOSH-
approved N95 respirators or powered air-purifying respirators (PAPRs) are required for
entry into the room. Surgical masks do not provide adequate filtration for airborne
particles. Gowns and gloves are used for contact precautions, not airborne.
Question 10: Which assessment finding in a post-thoracotomy patient requires
IMMEDIATE nursing intervention?
A. Pain rating of 6/10 at the incision site
B. Absent breath sounds on the operative side with tracheal deviation
C. Serous drainage on the chest dressing
D. Oxygen saturation of 92% on 2 L/min nasal cannula
CORRECT ANSWER: B. Absent breath sounds on the operative side with tracheal
deviation
Rationale: Absent breath sounds with tracheal deviation suggest tension
pneumothorax, a life-threatening emergency requiring immediate decompression. Pain,
serous drainage, and mild hypoxemia are expected postoperatively but warrant
monitoring; however, they do not indicate imminent crisis like tension pneumothorax.
Question 11: A patient with community-acquired pneumonia is prescribed
azithromycin. The nurse recognizes that this antibiotic is selected primarily for its
activity against:
A. Gram-negative bacilli such as Pseudomonas aeruginosa
B. Atypical pathogens including Mycoplasma pneumoniae and Legionella
C. Fungal organisms like Histoplasma capsulatum
D. Mycobacterium tuberculosis
CORRECT ANSWER: B. Atypical pathogens including Mycoplasma pneumoniae and
Legionella
Rationale: Azithromycin, a macrolide antibiotic, is first-line for community-acquired
pneumonia due to excellent coverage of atypical pathogens (Mycoplasma, Legionella,
Chlamydophila). Pseudomonas requires antipseudomonal agents; fungal infections
need antifungals; TB requires multi-drug regimens including isoniazid and rifampin.
Question 12: Which statement by a patient with COPD indicates understanding of
energy conservation techniques?
A. "I will perform all my activities in the morning when I have the most energy."
B. "I will sit while brushing my teeth and preparing meals to reduce oxygen demand."
