unit 1 practice questions

A patient with ARDS is receiving mechanical ventilation with high PEEP. Which complication should the nurse monitor for most closely?

1. Hypotension

1. Pulmonary embolism

2. Hypoglycemia

3. Metabolic alkalosis

• 1. Hypotension

  High PEEP → ↑ intrathoracic pressure → ↓ venous return → hypotension; also ↑ risk barotrauma.

The nurse reviews the ABG results: pH 7.30, PaCO₂ 58, HCO₃⁻ 26. Which interpretation is correct?

1. Respiratory alkalosis, uncompensated

2. Respiratory acidosis, uncompensated

3. Metabolic acidosis, partially compensated

4. Metabolic alkalosis, fully compensated

2. Respiratory acidosis, uncompensated
Low pH, high PaCO₂, normal HCO₃⁻.

SATA: Which findings are clinical manifestations of acute respiratory failure?

• PaO₂ 48 mmHg

• PaCO₂ 60 mmHg

• pH 7.52

• Dyspnea and restlessness

• Metabolic alkalosis

PaO₂ 48; PaCO₂ 60; Dyspnea/restlessness
ARF criteria include PaO₂ < ~60, PaCO₂ > ~50 + clinical signs.

A nurse suspects a pulmonary embolism. Which diagnostic test is most definitive for confirming the diagnosis?

D-dimer assay

Chest x-ray

Multidetector-row CT angiography (MDCTA)

ECG

3. MDCTA (CT pulmonary angiography)
Most definitive/first-line confirmatory test.

A patient with a pleural effusion is scheduled for a thoracentesis. Which finding requires the nurse to contact the provider before the procedure?

1. SpO₂ 92%

2. INR 3.2

3. Breath sounds diminished over the affected area

4. Patient reports mild dyspnea

2. INR 3.2
Thoracentesis risk of bleeding → hold for coagulopathy. Pleural effusion managed with thoracentesis/chest tube.

• traditional guidelines recommend an INR of less than 1.5 or 2.0 before the procedure.

• An INR of 3.2 is outside the typical therapeutic range of 2.0 to 3.0 for most patients on anticoagulants.

During a chest tube assessment, the nurse notes continuous bubbling in the water seal chamber. What is the priority action?

1. Document the finding as expected

2. Check for an air leak in the system

3. Increase the suction

4. Clamp the chest tube immediately

2. Check for an air leak in the system
Continuous bubbling in water seal = air leak.

Fill in the blank:

The nurse recognizes acute respiratory failure when PaO₂ is less than ______ mmHg, PaCO₂ is greater than ______ mmHg, and pH is less than ______.

PaO₂ < 60 mmHg; PaCO₂ > 50 mmHg; pH < 7.35
Common ARF thresholds reflected in slide blanks (ARF criteria + ABG focus).

SATA: Which are priority nursing actions when a patient’s chest tube becomes disconnected from the drainage system?

• Apply a sterile gauze to the chest tube insertion site

• Place the end of the chest tube in sterile water

• Notify the provider immediately

• Reconnect the tubing to the drainage system if possible

• Increase the suction level

Place end in sterile water; Reconnect if possible; Notify provider
If disconnection occurs, place distal end in sterile water to re‑establish water seal, then fix and notify.

A patient with a large pneumothorax suddenly becomes hypotensive, tachycardic, and cyanotic. Which action should the nurse perform first?

1. Prepare for needle decompression

2. Increase oxygen flow rate

3. Position the patient in high Fowler’s

4. Notify the rapid response team

1. Prepare for needle decompression
Sudden hypotension + severe distress in pneumothorax → suspect tension pneumo → immediate decompression.

1. Which physical assessment finding is most consistent with a pleural effusion?

   1. Hyperresonance to percussion

   2. Dullness to percussion over the affected area

   3. Loud, coarse crackles in upper lobes

   4. Stridor

2. Dullness to percussion
Pleural effusion = fluid → dullness; diminished breath sounds.

The nurse is preparing for rapid sequence intubation. Which medication is given first?

1. Sedative

2. Paralytic

3. Vasopressor

4. Analgesic

1. Sedative
RSI sequence: sedation then paralytic (per slide “medications for rapid sequence intubation”).

After intubation, the nurse hears breath sounds on the right side only. What is the priority action?

1. Notify the provider immediately

2. Pull the ET tube back slightly per protocol

3. Increase the ventilator rate

4. Administer 100% oxygen

2. Pull the ET tube back slightly per protocol
Right‑mainstem intubation (right breath sounds only) → withdraw slightly.

SATA: Which are advantages of noninvasive positive pressure ventilation (NIPPV) over invasive ventilation?

• Reduced risk of ventilator-associated pneumonia

• Ability to eat while receiving therapy

• Decreased work of breathing

• Pressure-controlled mode capability

• Elimination of the need for sedation

Reduced VAP risk; Decreased WOB; Pressure‑controlled capability
NIPPV ↓ nosocomial infections, ↓ work of breathing; provided via pressure modes. (You still remove mask to eat; sedation not “eliminated” but usually avoided.)

A patient on mechanical ventilation has a high-pressure alarm sounding. Which cause is most likely?

1. Tubing disconnect

2. Patient coughing

3. Extubation

4. Leak in the ventilator circuit

2. Patient coughing
High‑pressure alarms: coughing, kink, occlusion, ↓ compliance, pneumo.

Which ventilator mode is most appropriate for a patient undergoing a spontaneous breathing trial?

1. SIMV

2. Pressure Support Ventilation (PSV)

3. Volume Control Continuous Mandatory Ventilation (VC-CMV)

4. Pressure Control Continuous Mandatory Ventilation (PC-CMV)

2. Pressure Support Ventilation (PSV)
Weaning/SBT mode with low PEEP and patient‑initiated breaths.

Fill in the blank:

When setting volume control ventilation, the tidal volume is generally calculated at ______ to ______ mL/kg of ideal body weight.

6–10 mL/kg (ideal body weight)
Volume control TV range on slide.

The nurse is caring for a patient post-extubation. Which intervention is priority?

1. Encourage early ambulation

2. Apply humidified oxygen

3. Start incentive spirometry

4. Suction oral secretions

2. Apply humidified oxygen
Post‑extubation priority: humidified O₂ + close monitoring.

A patient on BiPAP is about to eat breakfast. What should the nurse do?

1. Leave the BiPAP on during eating

2. Remove the BiPAP temporarily for eating

3. Switch the patient to 100% FiO₂ via mask while eating

4. Delay breakfast until BiPAP is no longer needed

2. Remove the BiPAP temporarily for eating
Mask off to eat; coordinate breaks.

SATA: Which complications are associated with mechanical ventilation?

• Barotrauma

• Pneumothorax

• Infection

• Increased cardiac output

• Delirium

Barotrauma; Pneumothorax; Infection; Delirium
Classic vent complications; decreased (not increased) cardiac output also occurs

The nurse notes a patient on mechanical ventilation with FiO₂ of 100% has SpO₂ in the low 80s. What is the first action?

1. Increase the FiO₂

2. Assess tube placement and patency

3. Call respiratory therapy

4. Notify the provider

2. Assess tube placement and patency
On 100% FiO₂ with low SpO₂ → assess first (dislodgement, kink, secretions) before changing settings.

pH 7.38, PaCO₂ 28, HCO₃⁻ 15. Which interpretation is correct?

1. Respiratory alkalosis, fully compensated

2. Metabolic acidosis, fully compensated

3. Respiratory alkalosis, uncompensated

4. Metabolic acidosis, uncompensated

2. Metabolic acidosis, fully compensated
Normal-ish pH (acid side), low HCO₃⁻ with low PaCO₂ (resp compensation). Matches example.

Fill in the blank:

A pH of 7.44 with PaCO₂ 30 and HCO₃⁻ 20 is classified as __________________.

Respiratory alkalosis with full compensation
Exactly as in slide example: pH 7.44, PaCO₂ 30, HCO₃⁻ 20.

Which ABG result indicates the patient is partially compensated?

1. pH 7.25, PaCO₂ 56, HCO₃⁻ 35

2. pH 7.40, PaCO₂ 40, HCO₃⁻ 24

3. pH 7.38, PaCO₂ 28, HCO₃⁻ 15

4. pH 7.44, PaCO₂ 30, HCO₃⁻ 20

1. pH 7.25, PaCO₂ 56, HCO₃⁻ 35
Acidic pH with elevated CO₂ and elevated HCO₃⁻ = partial compensation (slide example).

A patient’s ABG shows pH 7.25, PaCO₂ 56, HCO₃⁻ 25. Which is the correct interpretation?

1. Respiratory alkalosis, uncompensated

2. Respiratory acidosis, uncompensated

3. Metabolic alkalosis, partially compensated

4. Metabolic acidosis, fully compensated

2. Respiratory acidosis, uncompensated
Matches slide example with normal HCO₃⁻.

Which acid-base imbalance is most likely in a patient with acute respiratory failure?

1. Respiratory acidosis

2. Respiratory alkalosis

3. Metabolic acidosis

4. Metabolic alkalosis

1. Respiratory acidosis
Hypoventilation/hypercapnia typical in ARF.

• Which finding indicates the patient is not tolerating the ventilator weaning process?

  1. HR 84, BP 120/78, SpO₂ 95%

  2. Use of accessory muscles, RR 32, agitation

  3. Tidal volumes of 450 mL consistently

  4. Calm and alert

2. Use of accessory muscles, RR 32, agitation
Signs of failed SBT/intolerance.

• SATA: Which conditions must be met before initiating ventilator weaning?

  • Hemodynamically stable

  • FiO₂ requirement > 80%

  • Able to breathe spontaneously

  • Reversal of acute medical problem

  • Receiving high-dose sedation

Hemodynamically stable; Able to breathe spontaneously; Reversal of acute problem
Weaning readiness criteria; FiO₂ >80% and high‑dose sedation are NOT ready.

• During extubation, which is the nurse’s primary role?

  1. Remove the tube quickly

  2. Provide humidified oxygen and monitor respiratory status

  3. Increase FiO₂ to 100% post-extubation

  4. Suction only after signs of distress appear

2. Provide humidified oxygen and monitor respiratory status
Post‑extubation care per slide.

• Which statement best explains why tidal volume is monitored during weaning?

  1. To assess for risk of barotrauma

  2. To ensure adequate ventilation without fatigue

  3. To prevent high-pressure alarms

  4. To maintain FiO₂ levels

2. To ensure adequate ventilation without fatigue
During weaning, watch spontaneous TVs to gauge effort/adequacy.

26. The patient self-extubates. What should the nurse do first?

    1. Restrain the patient

    2. Apply humidified oxygen and assess airway

    3. Reinsert the tube immediately

    4. Notify the provider

2. Apply humidified oxygen and assess airway
First actions after self‑extubation.

Which artificial airway is most appropriate for long-term ventilation?

1. Nasopharyngeal airway

2. Endotracheal tube

3. Tracheostomy tube

4. Oropharyngeal airway

• 3. Tracheostomy tube
  Preferred for long‑term mechanical ventilation.

SATA: Which equipment must be at the bedside for a patient with a tracheostomy?

• Obturator

• Suction equipment

• Spare tracheostomy tube

• Defibrillator pads

• Ambu bag with mask

• Obturator; Suction equipment; Spare trach tube; Ambu bag with mask
  Essential bedside items for airway security.

Which ventilator setting maintains alveoli open at the end of exhalation?

1. SIMV

2. PEEP

3. PSV

4. FiO₂

2. PEEP
Positive pressure at end‑expiration keeps alveoli open.

The nurse hears a low-pressure alarm on a ventilator. Which cause is most likely?

1. Patient biting the tube

2. Secretions blocking the airway

3. Disconnected ventilator tubing

4. Kinked tubing

3. Disconnected ventilator tubing
Low‑pressure alarms = disconnection/leak. High‑pressure is kinks/occlusion/coughing.

Which intervention best prevents ventilator-associated pneumonia (VAP)?

1. Routine chest physiotherapy

2. Elevating HOB to 30–45 degrees

3. Changing ventilator tubing daily

4. Providing deep suction every hour

2. Elevating HOB to 30–45°
Core VAP prevention. (Oral care, suctioning PRN also; tubing not changed daily.)

A patient with a history of COPD is on NIPPV. Which finding requires immediate intervention?

1. Mild skin redness from the mask

2. PaCO₂ rising from 55 to 70 mmHg

3. SpO₂ 90% on current settings

4. Slight leak around the mask

2. PaCO₂ rising from 55 to 70 mmHg
Hypercapnia worsening = immediate intervention. NIPPV aims to ↓ WOB and improve ventilation.

Which statement by a new nurse about caring for a patient on an endotracheal tube requires correction?

1. “I’ll perform oral care every 2 hours.”

2. “I’ll suction the patient before and after repositioning.”

3. “I’ll deflate the cuff when the patient is on mechanical ventilation to prevent tracheal damage.”

4. “I’ll keep the head of bed elevated to reduce aspiration risk.”

3. “I’ll deflate the cuff…to prevent tracheal damage.”
Cuff stays inflated for ventilation/aspiration prevention; protect trachea with minimal occlusive volume, not routine deflation.

A patient post-PE diagnosis is started on thrombolytic therapy. Which finding requires immediate intervention?

1. Oozing from IV site

2. Hematuria

3. Mild headache

4. BP 110/70

2. Hematuria
On thrombolytics, frank bleeding = emergency. (PE mgmt includes thrombolytics in unstable PE.)

Which patient should the nurse see first?

1. ARDS patient with SpO₂ 88% on high-flow oxygen

2. Chest tube patient with 50 mL drainage in the past hour

3. Pleural effusion patient scheduled for thoracentesis in 2 hours

4. Ventilator patient with occasional coughing

1. ARDS patient with SpO₂ 88% on high‑flow O₂
Airway/oxygenation trumps others (unstable hypoxemia). ARDS hallmark: refractory hypoxemia.

31. The nurse is caring for a patient on volume-control ventilation. The patient’s peak inspiratory pressures have increased over the past hour. What is the priority action?

    1. Increase tidal volume

    2. Check for causes of decreased lung compliance

    3. Increase PEEP

    4. Suction every 30 minutes

1. 2. Check for causes of decreased lung compliance
   Rising PIP in volume‑control suggests ↓ compliance (bronchospasm, edema, pneumo, secretions). Assess before changing settings.