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A 60-year-old patient reports smoking 1.5 packs of cigarettes daily for 30 years. What is this patient’s pack-year history?
A. 20 pack-years
B. 30 pack-years
C. 45 pack-years
D. 60 pack-years
Answer: C. 45 pack-years
Rationale: Pack years = packs/day × years smoked. 1.5 × 30 = 45.
Which interventions are appropriate for a patient with COPD? (Select all that apply)
A. Encourage pursed-lip breathing
B. Provide high-flow oxygen at 10 L/min
C. Teach tripod positioning
D. Monitor for signs of cor pulmonale
E. Schedule activities early in the morning only
Answers: A, C, D
Rationale: COPD patients need controlled O₂ (usually ≤2 L/min). Pursed-lip breathing, tripod positioning, and monitoring for right heart failure are key interventions.
Which are key nursing interventions to prevent VAP? (Select all that apply)
A. Elevate HOB 30–45°
B. Perform oral care with chlorhexidine
C. Administer prophylactic antibiotics daily
D. Implement daily sedation vacations
E. Suction secretions frequently
Answers: A, B, D, E
Rationale: Elevation, oral care, suctioning, and sedation vacations reduce VAP. Prophylactic antibiotics are not recommended.
Which are true regarding PSV? (Select all that apply)
A. It provides a preset tidal volume
B. Patient initiates all breaths
C. Pressure is applied during inspiration to decrease work of breathing
D. Used as a weaning mode from mechanical ventilation
E. Prevents apnea by delivering backup breaths
Answers: B, C, D
Rationale: PSV only assists spontaneous breaths, decreases workload, and is used for weaning. It does not guarantee tidal volume or backup breaths.
The low-pressure alarm sounds on a patient receiving mechanical ventilation. Which situation is MOST likely the cause?
A. Secretions in the endotracheal tube
B. Patient coughing against the ventilator
C. Ventilator tubing disconnected
D. Water condensation in the tubing
Answer: C. Ventilator tubing disconnected
Rationale: Low-pressure alarms = disconnection or leak in the system.
A patient on Assist-Control (AC) ventilation is anxious and "fighting the ventilator." Which action should the nurse take FIRST?
A. Increase FiO₂
B. Notify the respiratory therapist to adjust rate
C. Assess the patient for hypoxemia and anxiety
D. Administer an opioid for pain
Answer: C. Assess the patient for hypoxemia and anxiety
Rationale: Always assess before intervening. The patient may need sedation or ventilator adjustment, but assessment is priority.
A patient with acute asthma exacerbation is receiving albuterol nebulization. Which finding indicates the treatment is effective?
A. Increased inspiratory wheezing
B. Decreased respiratory rate and improved SpO₂
C. Use of accessory muscles
D. Silent chest with absent breath sounds
Answer: B. Decreased respiratory rate and improved SpO₂
Rationale: Effective treatment improves oxygenation and reduces work of breathing. Silent chest = impending respiratory failure.
Which lab finding would the nurse expect in a patient with chronic COPD exacerbation?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: C. Respiratory acidosis
Rationale: COPD patients retain CO₂ → respiratory acidosis with hypoxemia.
A patient is placed on CPAP via face mask. The nurse explains that CPAP:
A. Provides positive pressure throughout inspiration and expiration
B. Assists only during expiration
C. Provides mandatory breaths if the patient stops breathing
D. Delivers preset tidal volumes
Answer: A. Provides positive pressure throughout inspiration and expiration
Rationale: CPAP continuously maintains positive pressure to keep alveoli open.
Which organism is the most common cause of pneumonia in hospitalized patients?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Legionella pneumophila
Answer: B
Rationale: Streptococcus pneumoniae is the predominant pathogen and most common cause of pneumonia requiring hospitalization
Which statements are true about Continuous Positive Airway Pressure (CPAP)? (Select all that apply)
A. Provides a set tidal volume with each breath
B. Used primarily in patients with sleep apnea
C. Delivers a constant pressure to keep alveoli open
D. Can be delivered invasively or non-invasively
E. Provides mandatory breaths if the patient becomes apneic
Answers: B, C, D
Rationale: CPAP keeps alveoli open with constant pressure; used for sleep apnea and can be invasive or noninvasive. It does not provide set tidal volumes or mandatory breaths.
The nurse is teaching a patient newly diagnosed with TB. Which statement indicates further teaching is needed?
A. “I need to wear a mask when around others until my provider says I’m not contagious.”
B. “I should continue taking my medications for at least 6 to 9 months.”
C. “I can stop taking my medication once I start feeling better.”
D. “My family members should get tested for TB as well.”
Answer: C. “I can stop taking my medication once I start feeling better.”
Rationale: TB requires long-term therapy; stopping early risks resistance and relapse.
A patient receiving warfarin has an INR of 5.2. What is the nurse’s best action?
A. Administer vitamin K
B. Continue current dose
C. Increase dose
D. Document finding as normal
Answer: A. Administer vitamin K
Rationale: INR 5.2 is critically high; reversal needed to prevent bleeding.
The ventilator is set to deliver 100% FiO₂ for a patient with severe hypoxemia. What is the nurse’s priority intervention?
A. Maintain FiO₂ at 100% until oxygen saturation is >95%
B. Reduce FiO₂ as soon as possible to <60%
C. Increase PEEP to reduce oxygen toxicity risk
D. Switch to BiPAP immediately
Answer: B. Reduce FiO₂ as soon as possible to <60%
Rationale: Prolonged high FiO₂ (>60%) causes oxygen toxicity and lung injury. PEEP is usually added to reduce FiO₂ needs.
Which type of pleural effusion results from local factors such as pleural inflammation, increased permeability, or lymphatic obstruction?
A. Transudate
B. Exudate
C. Chylothorax
D. Hemothorax
Answer: B
Rationale: Exudative effusions result from local factors such as inflammation or infection. Transudates, in contrast, are due to systemic factors like heart failure
Which assessment finding indicates a tension pneumothorax in a patient receiving mechanical ventilation?
A. Dullness to percussion
B. Tracheal deviation away from affected side
C. Crackles throughout lung fields
D. Symmetrical chest expansion
Answer: B. Tracheal deviation away from affected side
Rationale: Hallmark sign of tension pneumothorax is tracheal shift due to pressure buildup.
Which assessment finding is MOST concerning for a patient with a suspected deep vein thrombosis (DVT)?
A. Warmth, redness, and swelling in one leg
B. Pain in calf when dorsiflexing the foot
C. Positive Homan’s sign
D. Sudden shortness of breath and chest pain
Answer: D. Sudden shortness of breath and chest pain
Rationale: This suggests pulmonary embolism, a life-threatening complication.
A patient on AC mode is set with a rate of 14, tidal volume of 500 mL, FiO₂ 40%. The patient begins breathing at a rate of 28/min. What will the ventilator do?
A. Deliver a preset tidal volume with each breath, including spontaneous ones
B. Allow spontaneous breaths without support
C. Adjust FiO₂ automatically to meet oxygen demand
D. Switch to SIMV mode to prevent hyperventilation
Answer: A. Deliver a preset tidal volume with each breath, including spontaneous ones
Rationale: In AC mode, all breaths (spontaneous or ventilator-triggered) deliver the preset tidal volume, which can cause hyperventilation and respiratory alkalosis.
A patient on AC mode has a high-pressure ventilator alarm sounding. What is the nurse’s FIRST action?
A. Silence the alarm and notify respiratory therapy
B. Assess for kinks, secretions, or biting on tube
C. Increase FiO₂ to 100%
D. Disconnect the patient from the ventilator
Answer: B. Assess for kinks, secretions, or biting on tube
Rationale: High-pressure alarms indicate obstruction—always assess the cause first.
What are the most common causes of traumatic pneumothorax in critically ill patients?
A. Pneumonia
B. Barotrauma
C. Invasive procedures
D. Both B and C
Answer: D
Rationale: Both invasive procedures (iatrogenic pneumothorax) and barotrauma from mechanical ventilation are leading causes in critically ill patients
The nurse is monitoring a patient with continuous end-tidal CO₂ (capnography). A sudden drop to near zero is noted. What is the priority action?
A. Recheck calibration of the monitor
B. Call the provider for medication adjustment
C. Assess for dislodged or disconnected endotracheal tube
D. Increase FiO₂ immediately
Answer: C. Assess for dislodged or disconnected endotracheal tube
Rationale: A sudden drop in ETCO₂ often means disconnection, dislodgment, or apnea.
Which finding best differentiates hospital-acquired (nosocomial) pneumonia from community-acquired pneumonia?
A. Onset within 24 hours of hospital admission
B. Occurs ≥48 hours after hospital admission
C. Associated with droplet exposure
D. Caused only by viral pathogens
Answer: B. Occurs ≥48 hours after hospital admission
Rationale: Nosocomial pneumonia is defined as pneumonia acquired ≥48 hrs after admission.
A patient is on SIMV mode with a set rate of 10 breaths/min. The patient begins taking spontaneous breaths between ventilator breaths. What happens during those breaths?
A. Patient receives full ventilator support with set tidal volume
B. Patient receives pressure support only if enabled
C. Ventilator prevents spontaneous breathing
D. FiO₂ is reduced to room air
Answer: B. Patient receives pressure support only if enabled
Rationale: SIMV provides mandatory breaths but allows spontaneous breaths, which may be assisted by PSV if set.
The low-pressure alarm sounds on a patient receiving mechanical ventilation. Which situation is MOST likely the cause?
A. Secretions in the endotracheal tube
B. Patient coughing against the ventilator
C. Ventilator tubing disconnected
D. Water condensation in the tubing
Answer: C. Ventilator tubing disconnected
Rationale: Low-pressure alarms = disconnection or leak in the system.
Which of the following is included in Virchow’s triad for pulmonary embolism risk?
A. Pulmonary hypertension
B. Airway obstruction
C. Venous stasis
D. Pneumonia
Answer: C
Rationale: Virchow’s triad includes venous stasis, hypercoagulability, and endothelial injury as primary risk factors for thromboembolism