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The primary purpose of the respiratory system is which of the following?
A. Regulation of blood pressure
B. Gas exchange of O₂ and CO₂
C. Production of red blood cells
D. Regulation of body temperature

B — Gas exchange of O₂ and CO₂
Rationale: The respiratory system’s main purpose is gas exchange—O₂ into blood and CO₂ out at the alveoli.

Gas exchange in the lungs occurs primarily at which structure?
A. Trachea
B. Bronchi
C. Alveoli
D. Bronchioles

C — Alveoli
Rationale: Gas exchange occurs at the alveolar‑capillary membrane in the alveoli.

Which structure is part of the upper respiratory tract?
A. Bronchi
B. Alveoli
C. Trachea
D. Pharynx

D — Pharynx
Rationale: The upper respiratory tract includes the nose, mouth, pharynx, epiglottis, larynx, and trachea.

Which structure marks the bifurcation of the trachea into the right and left mainstem bronchi?
A. Epiglottis
B. Carina
C. Larynx
D. Septum

B — Carina
Rationale: The carina is the point where the trachea divides into the mainstem bronchi.

How many lobes does the right lung have?
A. 1
B. 2
C. 3
D. 4

C — 3
Rationale: The right lung has three lobes; the left has two.

Surfactant is best described as:
A. A hormone that increases respiratory rate
B. A lipoprotein that reduces surface tension in alveoli
C. A protein that increases blood viscosity
D. A neurotransmitter in the medulla

B — A lipoprotein that reduces surface tension in alveoli
Rationale: Surfactant reduces surface tension and prevents alveolar collapse.

Atelectasis is defined as:
A. Fluid in the pleural space
B. Collapsed alveoli
C. Air in the pleural space
D. Infection of the bronchioles

B — Collapsed alveoli
Rationale: Atelectasis is collapse of alveoli, often with diminished breath sounds.

In pulmonary circulation, which vessel carries deoxygenated blood from the heart to the lungs?
A. Pulmonary vein
B. Aorta
C. Pulmonary artery
D. Superior vena cava

C — Pulmonary artery
Rationale: The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs.

A normal PaO₂ value is:
A. 40–60 mmHg
B. 60–80 mmHg
C. 80–100 mmHg
D. 100–120 mmHg

C — 80–100 mmHg
Rationale: Normal PaO₂ is 80–100 mmHg.

A normal SaO₂ (arterial oxygen saturation) is:
A. 80–85%
B. 85–90%
C. >90%
D. >95%

D — >95%
Rationale: Normal SaO₂ is greater than 95%.

Diffusion of O₂ and CO₂ at the alveolar‑capillary membrane occurs because:
A. Blood flow is turbulent
B. Gases move from low to high concentration
C. Gases move from high to low concentration
D. The diaphragm contracts

C — Gases move from high to low concentration
Rationale: Gases diffuse from areas of higher to lower concentration until equal.

Ventilation is defined as:
A. Movement of blood through the lungs
B. Movement of air in and out of the lungs
C. Exchange of gases at the cellular level
D. Oxygen binding to hemoglobin

B — Movement of air in and out of the lungs
Rationale: Ventilation is inspiration and expiration due to pressure changes and muscle action.

Decreased lung compliance means:
A. Lungs are easy to inflate
B. Lungs are hard to inflate
C. Lungs recoil too quickly
D. Lungs are overdistended

B — Lungs are hard to inflate
Rationale: Decreased compliance means the lungs are stiff and difficult to expand.

Airway resistance is increased when:
A. Airways are dilated
B. Airways are narrowed by constriction or secretions
C. Respiratory rate is decreased
D. Surfactant is increased

B — Airways are narrowed by constriction or secretions
Rationale: Narrowed airways increase resistance to airflow.

The primary respiratory center is located in the:
A. Pons
B. Cerebellum
C. Medulla
D. Hypothalamus

C — Medulla
Rationale: The medulla is the main respiratory control center.

Which of the following is a respiratory defense mechanism?
A. Decreased cough reflex
B. Mucociliary clearance
C. Reduced surfactant
D. Increased airway resistance

B — Mucociliary clearance
Rationale: Respiratory defenses include filtration, mucociliary clearance, cough reflex, bronchoconstriction, and alveolar macrophages.

An expected age‑related change in the respiratory system is:
A. Increased chest expansion
B. Increased number of functional alveoli
C. Reduced compliance and chest expansion
D. Stronger cough reflex

C — Reduced compliance and chest expansion
Rationale: Older adults have reduced chest expansion, fewer functional alveoli, and weaker defenses.

A normal anteroposterior (AP) to transverse chest diameter is:
A. 1:1
B. 1:2
C. 2:1
D. 3:1

B — 1:2
Rationale: The normal AP:transverse ratio is 1:2.

Normal respiratory rate for an adult is:
A. 6–10 breaths/min
B. 10–16 breaths/min
C. 12–20 breaths/min
D. 20–28 breaths/min

C — 12–20 breaths/min
Rationale: Normal adult respirations are 12–20 breaths per minute.

A client with an asthma exacerbation is most likely to exhibit which finding?
A. Dullness to percussion
B. Hyperresonance and wheezes
C. Absent breath sounds and egophony
D. Crackles that clear with coughing

B — Hyperresonance and wheezes
Rationale: Asthma causes airway narrowing, producing wheezes and hyperresonance from air trapping.

Which assessment finding is most consistent with atelectasis involving a large area?
A. Hyperresonance
B. Fine crackles that disappear with deep breaths
C. Increased movement and fremitus
D. Loud bronchial breath sounds

B — Fine crackles that disappear with deep breaths
Rationale: Atelectasis often produces fine crackles that may clear as alveoli reopen.

A client with COPD is most likely to have which chest assessment finding?
A. Barrel chest and distant breath sounds
B. Egophony over affected area
C. Normal AP diameter
D. Increased fremitus

A — Barrel chest and distant breath sounds
Rationale: COPD causes hyperinflation, leading to barrel chest and decreased breath sound intensity.

Pleural effusion typically presents with:
A. Hyperresonance over effusion
B. Increased fremitus over effusion
C. Dullness to percussion and decreased/absent breath sounds
D. Normal percussion and vesicular sounds

C — Dullness to percussion and decreased/absent breath sounds
Rationale: Fluid in the pleural space blocks sound transmission, causing dullness and reduced breath sounds.

Pneumonia is most likely to cause which finding?
A. Hyperresonance
B. Dullness and increased fremitus
C. Decreased fremitus and hyperresonance
D. Absent breath sounds only

B — Dullness and increased fremitus
Rationale: Consolidation increases sound transmission, producing increased fremitus and dullness.

Stridor is best described as:
A. Low‑pitched snoring sound
B. High‑pitched crowing sound from upper airway obstruction
C. Popping sound from fluid in alveoli
D. Grating sound from pleural inflammation

B — High‑pitched crowing sound from upper airway obstruction
Rationale: Stridor indicates critical upper airway narrowing and requires immediate intervention.

Wheezes are commonly associated with:
A. Pleural effusion
B. Asthma and COPD
C. Pulmonary fibrosis
D. Atelectasis

B — Asthma and COPD
Rationale: Wheezes result from narrowed airways during airflow.

Crackles (rales) are usually caused by:
A. Air moving through narrowed bronchi
B. Fluid in the alveoli
C. Secretions in large airways
D. Pleural inflammation

B — Fluid in the alveoli
Rationale: Crackles occur when collapsed or fluid‑filled alveoli pop open.

Rhonchi are best described as:
A. High‑pitched musical sounds
B. Popping sounds at end‑inspiration
C. Low‑pitched snoring or gurgling sounds
D. Grating sounds with respiration

C — Low‑pitched snoring or gurgling sounds
Rationale: Rhonchi indicate secretions in large airways and may clear with coughing.

A pleural friction rub is characterized by:
A. Clearing with coughing
B. Harsh, grating sound that does not clear with coughing
C. High‑pitched musical sound
D. Low‑pitched snoring sound

B — Harsh, grating sound that does not clear with coughing
Rationale: A pleural rub occurs when inflamed pleural surfaces rub together.

Increased tactile fremitus is most consistent with:
A. Pneumothorax
B. Pleural effusion
C. COPD
D. Pneumonia

D — Pneumonia
Rationale: Consolidated lung tissue transmits vibrations more effectively.

Hyperresonance on percussion is most likely in:
A. Pneumonia
B. Pleural effusion
C. COPD or pneumothorax
D. Pulmonary fibrosis

C — COPD or pneumothorax
Rationale: Excess air in the lungs or pleural space produces hyperresonance.

Normal SpO₂ by pulse oximetry is:
A. 80–90%
B. 90–93%
C. 94–99%
D. 100–105%

C — 94–99%
Rationale: Normal oxygen saturation is typically 94–99% on room air.

Which factor can interfere with accurate pulse oximetry readings?
A. Low blood pressure only
B. Gel nail polish and vasoconstrictors
C. High respiratory rate
D. Use of nasal cannula

B — Gel nail polish and vasoconstrictors
Rationale: Poor perfusion and nail coatings can distort light absorption.

Mixed venous oxygen saturation (SvO₂) is normally:
A. 20–40%
B. 40–60%
C. 60–80%
D. 80–100%

C — 60–80%
Rationale: SvO₂ reflects oxygen remaining after tissue extraction and normally ranges 60–80%.

An increased SvO₂ may indicate:
A. Increased oxygen consumption
B. Decreased oxygen consumption or impaired tissue uptake
C. Normal tissue oxygen use
D. Hypovolemia

B — Decreased oxygen consumption or impaired tissue uptake
Rationale: High SvO₂ suggests tissues are extracting less oxygen, as in sepsis or sedation.

Before a CT scan with contrast, the nurse should:
A. Hold all fluids
B. Check for iodine allergy and renal function, and metformin use
C. Give high‑dose steroids
D. Administer diuretics

B — Check for iodine allergy and renal function, and metformin use
Rationale: Contrast can worsen renal function; metformin increases lactic acidosis risk.

A chest X‑ray alone can:
A. Confirm pneumonia
B. Rule out pneumonia
C. Suggest pneumonia but requires sputum test for confirmation
D. Replace sputum culture

C — Suggest pneumonia but requires sputum test for confirmation
Rationale: Imaging shows consolidation, but microbiology confirms the organism.

After bronchoscopy, which is the priority before resuming oral intake?
A. Check blood pressure
B. Confirm gag reflex has returned
C. Obtain chest X‑ray
D. Give antiemetic

B — Confirm gag reflex has returned
Rationale: An absent gag reflex increases aspiration risk.

During thoracentesis, the client is best positioned:
A. Supine with head flat
B. Side‑lying with knees flexed
C. Sitting upright, leaning forward over bedside table
D. Prone

C — Sitting upright, leaning forward over bedside table
Rationale: This position opens the intercostal spaces and allows the provider to safely access pleural fluid.

Post‑thoracentesis, which finding requires immediate intervention?
A. Mild discomfort at site
B. Sudden dyspnea and asymmetric chest expansion
C. Slight tachycardia
D. Fatigue

B — Sudden dyspnea and asymmetric chest expansion
Rationale: These findings suggest pneumothorax, a serious complication requiring urgent evaluation.

Tidal volume (VT) is:
A. Air left after maximal exhalation
B. Air inspired and expired in a normal breath
C. Maximum air exhaled after normal exhalation
D. Total lung capacity

B — Air inspired and expired in a normal breath
Rationale: VT represents the amount of air moved during quiet breathing.

Residual volume (RV) is:
A. Air that can be exhaled after normal exhalation
B. Air left in lungs after maximal exhalation
C. Air inspired in a normal breath
D. Air inspired after normal inspiration

B — Air left in lungs after maximal exhalation
Rationale: RV prevents lung collapse and cannot be voluntarily exhaled.

Total lung capacity (TLC) is:
A. VT + ERV
B. RV + VT + ERV + IRV
C. VT + IRV
D. RV + ERV

B — RV + VT + ERV + IRV
Rationale: TLC is the sum of all lung volumes.

Vital capacity (VC) is:
A. RV + VT
B. VT + ERV + IRV
C. RV + ERV + IRV
D. VT + RV

B — VT + ERV + IRV
Rationale: VC is the maximum amount of air exhaled after a maximal inhalation.

Functional residual capacity (FRC) is:
A. Air in lungs after normal exhalation
B. Air after maximal exhalation
C. Air inspired in a normal breath
D. Air inspired after normal inspiration

A — Air in lungs after normal exhalation
Rationale: FRC represents the balance point between lung recoil and chest wall expansion.

In emphysema, which change is expected?
A. Decreased RV and TLC
B. Very high RV and increased TLC with air trapping
C. Normal RV and TLC
D. Decreased TLC and increased VC

B — Very high RV and increased TLC with air trapping
Rationale: Emphysema causes destruction of alveoli and air trapping, increasing RV and TLC.

Respiratory failure is indicated by:
A. PaO₂ > 80, CO₂ < 35 B. PaO₂ < 50, CO₂ > 50, pH < 7.35 C. PaO₂ 60–80, CO₂ 35–45 D. PaO₂ > 100, CO₂ < 30

B — PaO₂ < 50, CO₂ > 50, pH < 7.35
Rationale: Severe hypoxemia and hypercapnia with acidosis define respiratory failure.

A patient with elevated CO₂ is at risk for:
A. Hypertension
B. Altered level of consciousness
C. Polycythemia
D. Hypothermia

B — Altered level of consciousness
Rationale: Hypercapnia depresses the central nervous system, leading to confusion or somnolence.

COPD is best described as:
A. Acute airway inflammation
B. Chronic airflow limitation with air trapping
C. Reversible bronchospasm only
D. Restrictive lung disease

B — Chronic airflow limitation with air trapping
Rationale: COPD involves persistent airflow obstruction and hyperinflation.

The “blue bloater” phenotype refers to:
A. Emphysema
B. Chronic bronchitis
C. Asthma
D. Pulmonary fibrosis

B — Chronic bronchitis
Rationale: Chronic bronchitis often presents with cyanosis, edema, and chronic productive cough.

The “pink puffer” phenotype refers to:
A. Chronic bronchitis
B. Emphysema
C. Pulmonary edema
D. Pneumonia

B — Emphysema
Rationale: Emphysema patients typically appear thin, dyspneic, and use pursed‑lip breathing.

A late sign of COPD includes:
A. Mild cough
B. Hyperventilation
C. Hypercapnia and hypoxemia
D. Bradycardia

C — Hypercapnia and hypoxemia
Rationale: Advanced COPD leads to impaired gas exchange and CO₂ retention.

Nail clubbing in COPD is primarily associated with:
A. Hypercapnia
B. Hypoxemia
C. Hyperventilation
D. Metabolic alkalosis

B — Hypoxemia
Rationale: Chronic low oxygen levels stimulate changes in nail bed vasculature.

A COPD patient is usually in which acid‑base state?
A. Uncompensated respiratory alkalosis
B. Compensated respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis

B — Compensated respiratory acidosis
Rationale: Chronic CO₂ retention leads to respiratory acidosis with renal compensation.

Which medication is a short‑acting beta₂ agonist bronchodilator?
A. Ipratropium
B. Montelukast
C. Albuterol
D. Prednisone

C — Albuterol
Rationale: Albuterol provides rapid bronchodilation for acute symptoms.

Ipratropium bromide is classified as:
A. Beta₂ agonist
B. Anticholinergic
C. Corticosteroid
D. Leukotriene modifier

B — Anticholinergic
Rationale: Ipratropium reduces bronchoconstriction by blocking muscarinic receptors.

Theophylline is:
A. A strong diuretic
B. A mild bronchodilator with possible anti‑inflammatory effects
C. A mucolytic
D. An antibiotic

B — A mild bronchodilator with possible anti‑inflammatory effects
Rationale: Theophylline relaxes airway smooth muscle but requires monitoring due to narrow therapeutic range.

Long‑term corticosteroid use can cause which side effect?
A. Weight loss and muscle wasting
B. Cushingoid features and weak bones
C. Hypoglycemia
D. Decreased infection risk

B — Cushingoid features and weak bones
Rationale: Chronic steroid therapy can cause osteoporosis, hyperglycemia, and characteristic physical changes.

A nasal cannula at 1–6 L/min delivers approximately what FiO₂ range:
A. 21–28%
B. 24–44%
C. 40–60%
D. 60–90%

B — 24–44%
Rationale: A nasal cannula at 1–6 L/min typically provides 24–44% FiO₂.

At flows greater than 4 L/min via nasal cannula, the nurse should:
A. Decrease flow
B. Add humidification
C. Switch to room air
D. Use nonrebreather

B — Add humidification
Rationale: Higher flows dry the mucosa and require humidification.

A simple face mask typically delivers:
A. 24–44% FiO₂
B. 35–50% FiO₂ at 6–10 L/min
C. 60–90% FiO₂
D. 100% FiO₂

B — 35–50% FiO₂ at 6–10 L/min
Rationale: Simple masks require at least 6 L/min to prevent CO₂ rebreathing.

The Venturi mask is especially useful for clients with:
A. Epistaxis
B. COPD at risk for respiratory failure
C. Acute pulmonary edema only
D. Pneumothorax

B — COPD at risk for respiratory failure
Rationale: Venturi masks deliver precise FiO₂, ideal for CO₂ retainers.

A nonrebreather mask is most appropriate for:
A. Stable COPD patient on home oxygen
B. Client with mild dyspnea
C. Client with deteriorating respiratory status who may need intubation
D. Long‑term oxygen therapy

C — Client with deteriorating respiratory status who may need intubation
Rationale: Nonrebreathers deliver high FiO₂ for severe hypoxia.

Nasal high‑flow therapy can deliver up to:
A. 6 L/min
B. 10 L/min
C. 20 L/min
D. 40–60 L/min

D — 40–60 L/min
Rationale: High‑flow nasal cannula systems deliver heated, humidified oxygen at high flow rates.

CPAP provides:
A. Different pressures for inspiration and expiration
B. A set positive pressure during both inspiration and expiration
C. Only expiratory pressure
D. Only inspiratory pressure

B — A set positive pressure during both inspiration and expiration
Rationale: CPAP keeps alveoli open throughout the respiratory cycle.

BiPAP provides:
A. Only expiratory pressure
B. Only inspiratory pressure
C. Different inspiratory and expiratory pressures
D. No positive pressure

C — Different inspiratory and expiratory pressures
Rationale: BiPAP delivers IPAP and EPAP to support ventilation and oxygenation.

Which client is NOT appropriate for BiPAP:
A. Awake COPD patient
B. CHF patient with hypercapnia
C. Patient who is lethargic and cannot remove mask
D. Patient with obstructive sleep apnea

C — Patient who is lethargic and cannot remove mask
Rationale: BiPAP requires the ability to protect the airway and remove the mask if needed.

On a mechanical ventilator, an increasing FiO₂ requirement usually indicates:
A. Improving condition
B. Worsening respiratory status
C. Stable condition
D. Hyperventilation

B — Worsening respiratory status
Rationale: Needing more oxygen suggests declining gas exchange.

Gas exchange occurs primarily in which structure:
A. Bronchi
B. Alveoli
C. Trachea
D. Bronchioles

B — Alveoli
Rationale: The alveoli are the site of oxygen and carbon dioxide exchange across the capillary membrane.

The main purpose of surfactant is to:
A. Increase airway resistance
B. Reduce surface tension in alveoli
C. Increase mucus production
D. Stimulate cough reflex

B — Reduce surface tension in alveoli
Rationale: Surfactant prevents alveolar collapse and improves lung compliance.

Atelectasis is best defined as:
A. Fluid in pleural space
B. Collapsed alveoli
C. Air in pleural space
D. Infection of bronchioles

B — Collapsed alveoli
Rationale: Atelectasis refers to alveolar collapse, often causing decreased breath sounds.

The right lung contains how many lobes:
A. 1
B. 2
C. 3
D. 4

C — 3
Rationale: The right lung has three lobes; the left has two.

The pulmonary artery carries:
A. Oxygenated blood to the lungs
B. Deoxygenated blood to the lungs
C. Oxygenated blood to the left atrium
D. Deoxygenated blood to the left atrium

B — Deoxygenated blood to the lungs
Rationale: The pulmonary artery transports deoxygenated blood from the right ventricle to the lungs for oxygenation.

Normal PaO₂ is:
A. 40–60 mmHg
B. 60–80 mmHg
C. 80–100 mmHg
D. 100–120 mmHg

C — 80–100 mmHg
Rationale: This is the expected arterial oxygen tension in healthy adults.

Gas diffusion occurs because gases move:
A. From low to high concentration
B. From high to low concentration
C. Only during inspiration
D. Only during expiration

B — From high to low concentration
Rationale: Diffusion follows concentration gradients across the alveolar membrane.

Which of the following is a normal respiratory assessment finding?
A. Barrel chest
B. Vesicular breath sounds without crackles or wheezes
C. Use of accessory muscles
D. Increased tactile fremitus

B — Vesicular breath sounds without crackles or wheezes
Rationale: Normal findings include vesicular breath sounds, nonlabored breathing, and equal expansion.

Which assessment finding is most consistent with pneumonia?
A. Hyperresonance
B. Dullness and increased fremitus
C. Decreased fremitus and hyperresonance
D. Absent breath sounds only

B — Dullness and increased fremitus
Rationale: Consolidation increases sound transmission, producing increased fremitus and dullness.

Which oxygen delivery device provides the most precise FiO₂?
A. Nasal cannula
B. Simple mask
C. Venturi mask
D. Nonrebreather mask

C — Venturi mask
Rationale: Venturi masks deliver controlled, precise oxygen concentrations.

Which breath sound is most associated with fluid in the alveoli?
A. Wheezes
B. Crackles
C. Rhonchi
D. Stridor

B — Crackles
Rationale: Crackles occur when collapsed or fluid‑filled alveoli pop open.

Which condition is most associated with hyperresonance on percussion?
A. Pleural effusion
B. Pneumonia
C. Pneumothorax
D. Atelectasis

C — Pneumothorax
Rationale: Excess air in the pleural space produces hyperresonance.

Which oxygen device delivers the highest FiO₂ short of intubation?
A. Nasal cannula
B. Simple mask
C. Venturi mask
D. Nonrebreather mask

D — Nonrebreather mask
Rationale: A nonrebreather can deliver up to 90–100% FiO₂ in emergencies.

Which finding after bronchoscopy is most concerning?
A. Mild sore throat
B. Low‑grade fever
C. Stridor
D. Small amount of blood‑tinged sputum

C — Stridor
Rationale: Stridor indicates airway obstruction and requires immediate intervention.

Which lung volume is increased in COPD due to air trapping?
A. Tidal volume
B. Residual volume
C. Vital capacity
D. Inspiratory reserve volume

B — Residual volume
Rationale: COPD causes air trapping, increasing RV.

Which ABG pattern indicates chronic CO₂ retention with compensation?
A. pH 7.50, PaCO₂ 30
B. pH 7.25, PaCO₂ 60
C. pH 7.37, PaCO₂ 55
D. pH 7.10, PaCO₂ 80

C — pH 7.37, PaCO₂ 55
Rationale: Normal pH with elevated CO₂ indicates compensated respiratory acidosis.