COPD is a staple of med-surg practice and of the exam, and the questions usually turn on judgement rather than recall: how much oxygen is too much, which change in a patient signals an exacerbation, and what to teach before discharge. These questions cover oxygen targets, exacerbation recognition and management, inhaler technique and patient education.
Question 1
43 of 125. A hospital's strategic plan prioritizes reducing preventable 30-day readmissions. A medical-surgical unit manager analyzes data showing high COPD readmissions due to inhaler technique errors. Which interdisciplinary strategy optimally supports this organizational goal?
- A) A) Pharmacists conducting bedside inhaler education with teach-back before discharge✓
- B) B) Nurses distributing written instructions with QR codes to online demonstration videos
- C) C) Respiratory therapists performing daily breathing treatment assessments
- D) D) Physicians ordering follow-up pulmonary clinic appointments within 7 days
Show rationale
Pharmacist-led teach-back (A) directly addresses the identified technique errors through hands-on validation of comprehension—key for COPD management. Written/video instructions (B) lack personalized validation. Daily assessments (C) occur too early to impact discharge readiness. Early appointments (D) facilitate follow-up but don't correct technique gaps. AHRQ guidelines emphasize teach-back as the gold standard for health literacy, reducing readmissions by confirming skill transfer.
Question 2
69 of 125. A 70-year-old with COPD, mild dementia, and macular degeneration is overwhelmed by inhaler instructions. The spouse reports missed doses due to confusion. Which intervention optimizes adherence?
- A) A) Teach spacer technique using high-contrast visual aids and establish a daily medication checklist.✓
- B) B) Schedule thrice-daily nurse visits for medication administration over the next week.
- C) C) Provide simplified written instructions with large-font bullet points for self-management.
- D) D) Recommend adult daycare services for supervision of all medical routines.
Show rationale
Option A adapts to visual/cognitive barriers via sensory aids and compensates for memory deficits with checklists. Nurse visits (B) are unsustainable and reduce autonomy. Written instructions (C) fail to address dementia-related memory loss. Daycare referral (D) overlooks immediate training needs and patient dignity. Medical-surgical nursing best practices support adaptive tools for sensory/cognitive limitations. Distractors each miss one cue: B ignores long-term self-management, C misses dementia, D misses immediate skill-building.
Question 3
118 of 125. A 68-year-old patient with COPD is recovering from laparoscopic cholecystectomy in PACU. Their Aldrete score is 8: 2 for activity (moves all extremities), 2 for circulation (BP ±15% baseline), 1 for respiration (dyspneic with shallow breathing), 1 for consciousness (arousable on calling), and 2 for SpO₂ (96% on 2L O₂). Which discharge readiness determination aligns with institutional standards?
- A) A) Discharge to surgical unit now; respiration score suffices for stable COPD
- B) B) Keep in PACU for 30-minute re-evaluation; one parameter requires improvement✓
- C) C) Transfer to step-down unit; oxygen dependency mandates higher care level
- D) D) Discharge to home with home oxygen; all parameters meet baseline function
Show rationale
Aldrete score ≥9 is required for safe PACU discharge. The respiration score of 1 (dyspnea/shallow breathing) and consciousness score of 1 (arousable only) indicate unresolved sedation/respiratory effects, particularly risky with COPD. Option A ignores the suboptimal respiration/consciousness scores. Option C overreacts—oxygen use doesn't automatically require step-down if other criteria improve. Option D is unsafe due to unresolved respiratory effort and alertness. Re-evaluation in 30 minutes allows assessment of improvement post-intervention (e.g., bronchodilators, opioid reversal).
Question 4
91 of 125. A COPD patient (FEV1 45%) with severe anxiety refuses nebulized albuterol, stating, "It makes my heart race." Respiratory rate is 28/min. Which response adheres to therapeutic communication principles?
- A) A) This is ordered to prevent respiratory failure. I’ll give it IV instead.
- B) B) Let’s try one puff of your inhaler with a spacer now to ease symptoms.✓
- C) C) I’ll document your refusal. Would you prefer oxygen via nasal cannula?
- D) D) Your anxiety is worsening your breathing. I’ll add an alprazolam dose.
Show rationale
Offering inhaler with spacer (B) respects autonomy while addressing dyspnea with a lower-dose alternative that may reduce tachycardia. IV administration (A) escalates care unnecessarily. Documenting refusal (C) delays treatment during respiratory distress. Blaming anxiety (D) dismisses valid concerns and benzodiazepines suppress respiratory drive in COPD. GOLD guidelines recommend shared decision-making for inhaler technique adjustments to improve adherence during anxiety-triggered exacerbations.
Question 5
10 of 125. A patient with severe COPD and depression tells a clinic nurse, "I skip inhalers because I can't get to the pharmacy." They live in a rural area with no public transit and report fatigue. Which action best promotes adherence?
- A) A) Contacting a nonprofit that delivers chronic disease medications free of charge✓
- B) B) Teaching the patient to order medications via a hospital's telehealth portal
- C) C) Referring to a pulmonary rehab program at a regional medical center
- D) D) Arranging volunteer transportation to monthly mental health counseling
Show rationale
Medication delivery resolves the transportation barrier (rural setting) and fatigue-related access issue, directly targeting inhaler adherence. Telehealth portals (B) require tech access/skills not mentioned. Pulmonary rehab (C) addresses COPD but not medication access. Counseling (D) supports depression but ignores the immediate inhaler crisis. The American Lung Association emphasizes removing access barriers for COPD medications to prevent exacerbations.
Question 6
12 of 125. A nurse in a wildfire-affected clinic sees an asthma patient using albuterol every hour with peak flow 40% of baseline. The patient has audible wheezing and accessory muscle use. Which intervention aligns with disaster resource constraints?
- A) A) Administer IV methylprednisolone and continuous albuterol nebulization
- B) B) Provide spacer training and initiate oral prednisone immediately✓
- C) C) Escort to an air-cleaned area and repeat assessment in 30 minutes
- D) D) Start oxygen via nasal cannula and obtain stat chest X-ray
Show rationale
Severe asthma exacerbation requires systemic steroids and bronchodilator optimization. Option B uses scarce resources efficiently: spacers improve medication delivery without nebulizers. Option A overuses limited IV/nebulizer resources for non-life-threatening status. Option C delays treatment for acute distress. Option D wastes imaging resources during disasters. GINA guidelines prioritize oral steroids and inhaler techniques during resource limitations.
Question 7
30 of 125. A volunteer nurse deployed to a flood zone assesses an elderly patient with COPD using home BiPAP who reports worsening dyspnea. The shelter lacks electrical outlets but has portable oxygen. Which intervention aligns with disaster adaptation standards?
- A) A) Administer high-flow oxygen via non-rebreather mask at 15 L/min
- B) B) Position upright and use a manual resuscitation bag hourly
- C) C) Provide pursed-lip breathing coaching and conserve portable oxygen✓
- D) D) Transfer to advanced care despite blocked evacuation routes
Show rationale
Pursed-lip breathing improves oxygenation without resources and avoids oxygen-induced hypercapnia risk in COPD. Option A may suppress respiratory drive without BiPAP support. Option B is impractical for sustained use and may cause barotrauma. Option D is impossible per cue, requiring resourceful adaptation. Disaster nursing emphasizes conserving limited supplies while managing symptoms. Coaching leverages patient self-management, aligning with PAICE ethics for resource-limited settings.
Question 8
96 of 125. During laparoscopic cholecystectomy, a patient develops ETCO₂ 65mmHg, tachycardia, and generalized rigidity. As PACU nurse receiving report, which action takes priority per MHAUS protocols?
- A) A) Prepare dantrolene 2.5mg/kg and activate malignant hyperthermia protocol✓
- B) B) Administer 100% oxygen and initiate rapid surface cooling with ice packs
- C) C) Draw blood for CK and myoglobin levels while awaiting ABG results
- D) D) Give calcium gluconate 1g IV and monitor for dysrhythmias
Show rationale
Rigidity with hypercapnia and tachycardia indicates acute MH crisis; dantrolene administration within 10 minutes is MHAUS priority. Option B delays definitive treatment. Option C addresses complications but not the emergency. Option D treats hyperkalemia not yet confirmed. Intraoperative rigidity and ETCO₂ elevation are diagnostic cues requiring immediate protocol activation per MHAUS standards.
Question 9
104 of 125. A patient with asthma (recent ED visit for exacerbation) and allergic rhinitis uses albuterol daily but forgets their corticosteroid inhaler. They have a cat despite documented dander allergy. Which action best promotes self-management?
- A) A) Co-develop an asthma action plan with environmental control strategies✓
- B) B) Demonstrate correct inhaler spacer use and peak flow monitoring
- C) C) Provide allergen avoidance education and nasal corticosteroid instructions
- D) D) Schedule follow-up to assess albuterol overuse and technique
Show rationale
Frequent rescue use and ongoing allergen exposure (discriminating cues) indicate poor control. Option A integrates medication adherence with trigger modification in a personalized plan, aligning with NIH asthma guidelines. Option B addresses technique but ignores environmental triggers. Option C focuses only on rhinitis, not asthma control. Option D delays intervention despite recent ED visit. Collaborative action plans improve outcomes in high-risk asthma.
Question 10
106 of 125. A 62-year-old patient with COPD and obesity is admitted to a medical-surgical unit during an influenza pandemic surge. The unit is operating at 150% capacity with limited high-flow oxygen devices. The patient's SpO₂ drops to 88% on 4L NC, respiratory rate is 28/min, and they're using accessory muscles. Which intervention aligns with pandemic surge capacity protocols?
- A) A) Escalate to non-rebreather mask immediately and prepare for ICU transfer
- B) B) Initiate high-flow nasal cannula per respiratory therapist recommendation
- C) C) Administer bronchodilators and position in high Fowler's before escalating oxygen✓
- D) D) Provide bilevel positive airway pressure therapy with airborne precautions
Show rationale
Correct answer prioritizes conservative oxygen escalation per pandemic surge guidelines to preserve limited resources. Bronchodilators address reversible airflow obstruction in COPD, and positioning optimizes ventilation. Option A ignores resource constraints and risks depleting devices for higher-acuity patients. Option B violates surge protocols by using scarce high-flow devices before conservative measures. Option D uses non-invasive ventilation prematurely despite airborne transmission risk and device scarcity. Discriminating cues: COPD comorbidity requires bronchodilator-first approach; surge capacity limits dictate resource conservation.
