Respiratory Nursing Quiz: From COPD To ARDS

1. Which pathophysiological change is primary in COPD?

Irreversible airflow obstruction and loss of elastic recoil

Acute alveolar collapse and surfactant deficiency

Sudden pulmonary vascular occlusion

Allergic inflammatory response in airways

2. In ARDS, the primary mechanism of hypoxemia is:

Ventilation-perfusion mismatch and intrapulmonary shunting

Hypoventilation from respiratory muscle fatigue

Diffusion impairment only

Low cardiac output reducing pulmonary blood flow

3. A patient with COPD presents with pursed-lip breathing. This adaptive mechanism works by:

Increasing positive airway pressure to prevent small airway collapse

Decreasing respiratory rate and tidal volume

Enhancing oxygen diffusion across alveolar membranes

Reducing carbon dioxide production

4. Which ABG finding is consistent with acute exacerbation of COPD?

PH 7.30, PaCO₂ 65, HCO₃⁻ 28 (partially compensated respiratory acidosis)

PH 7.45, PaCO₂ 30, HCO₃⁻ 24 (respiratory alkalosis)

PH 7.35, PaCO₂ 40, HCO₃⁻ 20 (metabolic acidosis)

PH 7.50, PaCO₂ 50, HCO₃⁻ 36 (metabolic alkalosis)

5. ARDS is defined by a PaO₂/FiO₂ ratio of ≤300 and bilateral infiltrates. Which condition is NOT a common etiology?

Chronic idiopathic pulmonary fibrosis

Sepsis

Aspiration pneumonia

Acute pancreatitis

6. Lung protective ventilation strategy in ARDS includes low tidal volumes of:

6–8 mL/kg ideal body weight

10–12 mL/kg ideal body weight

15–20 mL/kg actual body weight

8–10 mL/kg actual body weight

7. Which medication class is first-line for acute bronchospasm in COPD exacerbation?

Short-acting beta-2 agonists (albuterol)

Long-acting muscarinic antagonists

Inhaled corticosteroids

Phosphodiesterase-4 inhibitors

8. Positive end-expiratory pressure (PEEP) in ARDS mechanically:

Recruits collapsed alveoli and improves oxygenation

Decreases intrathoracic pressure and increases venous return

Reduces work of breathing by lowering respiratory rate

Eliminates the need for mechanical ventilation

9. A COPD patient on home oxygen therapy should maintain SpO₂ at:

88–92% to avoid suppressing hypoxic drive

94–98% for optimal tissue oxygenation

85–87% to prevent oxygen toxicity

>99% for maximum safety margin

10. Which finding suggests cor pulmonale (right heart failure) secondary to COPD?

Peripheral edema, elevated JVP, and right ventricular hypertrophy

Decreased hemoglobin and left ventricular dilation

Pulmonary edema and frothy sputum

Tachycardia with clear lung sounds

11. In prone positioning for ARDS, the primary benefit is:

Redistribution of perfusion to ventilated dorsal lung regions

Reduction of intracranial pressure

Elimination of ventilator-associated pneumonia

Decreased sedative requirements

12. Acute exacerbation of COPD is often triggered by:

Respiratory tract infection or poor medication adherence

High altitude exposure

Excessive salt intake

Increased physical activity

13. The hallmark histological finding in ARDS is:

Hyaline membrane formation and diffuse alveolar damage

Centrilobular emphysema

Bronchial wall thickening

Pleural fibrosis

14. Which nursing intervention reduces risk of ventilator-associated pneumonia?

Semi-recumbent positioning and frequent oral care

Supine positioning to promote drainage

Continuous sedation without interruption

Daily suctioning without clinical indication

15. A patient with COPD has a FEV₁/FVC ratio of 0.58. This indicates:

Fixed airflow obstruction characteristic of COPD

Reversible obstruction consistent with asthma

Normal pulmonary function

Restrictive lung disease

Respiratory Nursing Quiz: From COPD to ARDS