College Exams & Notes

Master your nursing exams with comprehensive practice questions and detailed explanations

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QUESTION #1
Fundamentals of Nursing Exam 3 Fundamentals
A patient with chronic obstructive pulmonary disease (COPD) uses which drive to breathe?
A Increased PaCO₂
B Decreased hemoglobin
C Decreased PaO₂ levels
D Increased PaO₂ levels

Explanations

A
In healthy individuals, rising carbon dioxide is the primary respiratory drive, but in chronic COPD this drive becomes blunted. These patients rely less on CO₂ levels to stimulate breathing.
B
Hemoglobin levels affect oxygen-carrying capacity but do not directly control the respiratory drive. This option does not regulate ventilation.
C
Patients with chronic COPD rely on hypoxic drive, meaning low oxygen levels stimulate breathing via peripheral chemoreceptors. This is the dominant respiratory drive in long-standing COPD.
D
Increased oxygen would reduce the stimulus to breathe rather than trigger it. This option is opposite of what drives respiration.
In chronic COPD, persistent CO₂ retention blunts the normal hypercapnic respiratory drive. On exams, remember that these patients depend on low oxygen levels (hypoxic drive) to stimulate breathing.
QUESTION #2
Fundamentals of Nursing Exam 3 Fundamentals
During handoff to the oncoming shift, the nurse includes in the SBAR report that the patient needs to be evaluated by speech therapy for which of the following reasons?
A Persistent aspiration of liquids
B Hypoventilation due to smoking
C Hyperventilation due to anxiety
D Decreased respiratory effort due to scoliosis

Explanations

A
Speech-language pathologists assess swallowing function and manage dysphagia to prevent aspiration. Ongoing aspiration is a clear indication for speech therapy evaluation.
B
Hypoventilation related to smoking is managed by respiratory therapy and medical treatment, not speech therapy. Speech therapy does not address ventilation issues.
C
Anxiety-related hyperventilation is managed through calming techniques, counseling, or medical intervention. Speech therapy is not indicated for this condition.
D
Respiratory compromise from musculoskeletal deformities is addressed by respiratory therapy or physical therapy. Speech therapy focuses on communication and swallowing.
Speech therapy referrals are appropriate for patients with swallowing difficulties or aspiration risk. On exams, associate speech-language pathology with dysphagia, aspiration prevention, and safe oral intake.
QUESTION #3
Fundamentals of Nursing Exam 3 Fundamentals
The nurse understands that which of the following is most likely occurring when caring for a pulmonary patient who has bluish discoloration around the lips?
A Increased PaCO₂ levels
B Hemoglobin that is not saturated with oxygen
C Elevated white blood cell count
D Decreased PaCO₂ levels

Explanations

A
Elevated carbon dioxide may occur in respiratory failure, but it does not directly cause bluish discoloration. Cyanosis is related to oxygenation, not CO₂ levels alone.
B
Bluish discoloration (cyanosis) occurs when there is an increased amount of deoxygenated hemoglobin in the blood. This indicates inadequate oxygen delivery to tissues.
C
An increased WBC count indicates infection or inflammation, not impaired oxygenation. It does not cause cyanosis.
D
Low carbon dioxide levels are associated with hyperventilation and respiratory alkalosis, not cyanosis. This finding would not explain bluish lips.
Cyanosis is a late sign of hypoxemia and reflects increased levels of deoxygenated hemoglobin. On exams, always associate bluish skin or lips with poor oxygen saturation rather than carbon dioxide or infection markers.
QUESTION #4
Fundamentals of Nursing Exam 3 Fundamentals
When administering oxygen to a patient, the nurse recognizes that using which oxygen delivery system places a patient in danger of receiving inadequate oxygen?
A Nasal cannula at a flow rate of 2 L/min
B Nasal cannula at a flow rate of 5 L/min
C Simple mask at a flow rate of 6 L/min
D Nonrebreather mask at a flow rate of 5 L/min

Explanations

A
This is an appropriate low-flow setting that delivers approximately 24–28% oxygen. It does not place the patient at risk of inadequate oxygen delivery.
B
A nasal cannula can safely deliver oxygen up to 6 L/min. This flow rate provides adequate supplemental oxygen for many patients.
C
Simple masks require at least 5–6 L/min to prevent carbon dioxide rebreathing. At 6 L/min, oxygen delivery is appropriate.
D
A nonrebreather mask requires high flow rates (10–15 L/min) to keep the reservoir bag inflated. At 5 L/min, the patient is at risk for inadequate oxygen delivery and carbon dioxide rebreathing.
Always match the oxygen device with its required flow rate to ensure safe and effective oxygen delivery. On exams, remember that nonrebreather masks need high flow rates to work properly.
QUESTION #5
Fundamentals of Nursing Exam 3 Fundamentals
What is the desired outcome related to the nursing diagnosis of Impaired Airway Clearance?
A Patient’s respiratory secretions will become thicker so they are not moved when coughing.
B Patient’s respiratory secretions will have a thinner consistency after being given a mucolytic agent.
C Patient will have improved range of motion while in bed.
D Patient’s respiratory rate will increase from 16 to 28 breaths/min during hospitalization.

Explanations

A
Thick secretions are harder to mobilize and worsen airway clearance. This outcome contradicts the goal of improving secretion removal.
B
Thinner secretions are easier to cough up and remove from the airway. This directly supports improved airway clearance.
C
Range of motion is unrelated to airway patency or secretion management. This outcome does not address the diagnosed problem.
D
An increased respiratory rate suggests respiratory distress, not improvement. Desired outcomes focus on easier breathing, not tachypnea.
Impaired airway clearance goals focus on mobilizing and removing secretions to improve ventilation. On exams, choose outcomes that make secretions easier to expectorate, such as thinning mucus or improving cough effectiveness.
QUESTION #6
Fundamentals of Nursing Exam 3 Fundamentals
The nurse assesses a patient with chronic obstructive pulmonary disease (COPD). Which significant finding does the nurse anticipate when inspecting the chest?
A A ratio of 1 : 2 when comparing the side and front views of the chest
B A barrel chest
C A concave shape to the sternum
D A severe lateral curvature of the spine

Explanations

A
A normal chest has an anteroposterior to transverse diameter ratio of about 1:2. COPD alters this ratio, so this finding would be unexpected.
B
COPD causes chronic air trapping and hyperinflation of the lungs, increasing the anteroposterior diameter of the chest. This results in the characteristic barrel-shaped chest.
C
A concave sternum (pectus excavatum) is a congenital chest wall deformity and is not associated with COPD.
D
Severe lateral curvature describes scoliosis, which affects posture and lung expansion but is not a typical inspection finding specific to COPD.
COPD leads to air trapping and lung hyperinflation, which increases the chest’s anteroposterior diameter. On exams, associate COPD with a barrel chest rather than normal chest ratios or structural deformities.
QUESTION #7
Fundamentals of Nursing Exam 3 Fundamentals
Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates?
A Time management
B Decreased grain intake
C Relaxation therapy
D Regimented exercise

Explanations

A
Time management may reduce stress long term, but it does not directly address the physiologic stress response currently affecting bowel function and vital signs. It is not an immediate nursing intervention.
B
Decreasing grains reduces fiber intake and may worsen constipation rather than improve it. This option is inappropriate for bowel regulation.
C
Stress and anxiety can increase heart and respiratory rates and inhibit normal gastrointestinal motility, leading to constipation. Relaxation techniques help reduce sympathetic stimulation and promote bowel activity.
D
Exercise can support bowel function over time, but a strict or regimented plan may increase stress initially. This does not directly address the acute stress response reflected in vital signs.
Stress activates the sympathetic nervous system, which can slow gastrointestinal motility and increase heart and respiratory rates. On exams, choose relaxation-based interventions when constipation is paired with signs of physiologic stress.
QUESTION #8
Fundamentals of Nursing Exam 3 Fundamentals
Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety with supporting data, including upcoming diagnostic tests, expressions of concern, and pacing around the room?
A Patient will discuss specific aspects of concern.
B Nurse will administer prescribed antianxiety medication.
C Patient will understand diagnostic test procedures.
D Nurse will describe test procedures in detail to allay concerns.

Explanations

A
This goal is patient-centered, measurable, and achievable in the short term. Verbalizing concerns is an appropriate first outcome when anxiety is present.
B
This is a nursing intervention, not a patient goal. Goals should describe what the patient will do or demonstrate.
C
Understanding procedures is appropriate but represents a longer-term cognitive outcome rather than an immediate anxiety-related goal. It does not directly address emotional expression.
D
This option describes a nursing action rather than a desired patient outcome. Goals should not be nurse-focused.
Goals for anxiety should be patient-centered and focus on expression, coping, or reduction of anxious behaviors. On exams, choose goals that describe what the patient will verbalize or demonstrate, not what the nurse will do.
QUESTION #9
Fundamentals of Nursing Exam 3 Fundamentals
In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response would the nurse recognize as being directly responsible for the patient’s increased blood sugar?
A Release of epinephrine
B Circulation of endorphins
C Increase in corticosteroids
D Secretion of corticotropin-releasing hormone (CRH)

Explanations

A
Epinephrine can raise blood glucose temporarily by stimulating glycogen breakdown, but it is not the primary cause of sustained postoperative hyperglycemia. Its effects are short-lived compared with corticosteroids.
B
Endorphins primarily modulate pain and stress perception and do not significantly affect blood glucose levels. They are not responsible for hyperglycemia.
C
Corticosteroids such as cortisol increase blood glucose by promoting gluconeogenesis and decreasing cellular glucose uptake. This stress response commonly causes hyperglycemia in postoperative patients, even without diabetes.
D
CRH stimulates the release of ACTH, which then leads to cortisol release, but CRH itself does not directly raise blood glucose. The downstream corticosteroids are responsible.
Physiologic stress triggers cortisol release, which increases blood glucose to provide energy during illness or surgery. On exams, associate postoperative or stress-induced hyperglycemia with elevated corticosteroid (cortisol) levels.
QUESTION #10
Fundamentals of Nursing Exam 3 Fundamentals
A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient?
A Sublimation
B Repression
C Projection
D Regression

Explanations

A
Sublimation involves channeling unacceptable impulses into socially acceptable behaviors, such as exercising to relieve anger. This behavior does not reflect a mature coping redirection.
B
Repression is the unconscious blocking of unpleasant thoughts or memories from awareness. The patient is actively expressing fear and dependency, not suppressing it.
C
Projection involves attributing one’s own feelings or thoughts to another person. There is no evidence the patient is blaming others for her anxiety.
D
Regression occurs when an individual reverts to behaviors typical of an earlier developmental stage when stressed. Seeking parental presence for reassurance reflects childlike dependency in response to anxiety.
Regression is a common defense mechanism during illness or stress and often appears as dependency or childlike behavior. On exams, look for adults seeking comfort or security typical of childhood as a key sign of regression.