CEN Respiratory Emergencies 2

Question 1

A patient is intubated and the ventilator alarms for high peak airway pressure. Breath sounds are absent on the left. What is the most likely cause?

Accepted Answer

Right mainstem intubation

Answer

Right mainstem intubation is common because the right bronchus is less angled; it causes absent breath sounds on the left and increased peak airway pressures.

Question 2

Which clinical criterion is NOT part of the Berlin Definition of ARDS?

Accepted Answer

A high BNP level confirming cardiac cause

Answer

The Berlin Definition requires bilateral opacities, P/F ratio < 300, respiratory failure within 1 week of insult, and exclusion of cardiac cause—it does not require a high BNP.

Question 3

A 65-year-old patient post-knee replacement develops sudden dyspnea, tachycardia, and hypoxia. ECG shows sinus tachycardia with an S1Q3T3 pattern. What is the most appropriate initial diagnostic test?

Accepted Answer

CT pulmonary angiography (CTPA)

Answer

CTPA is the gold-standard imaging test for diagnosing pulmonary embolism in a high-probability patient with the clinical and ECG findings described.

Question 4

What is the appropriate size (French) for a chest tube inserted for a hemothorax?

Accepted Answer

28–32 Fr or larger tube

Answer

A large-bore chest tube (28–32 Fr or larger) is required for hemothorax to allow adequate drainage of blood and prevent clotting of the tube.

Question 5

Which ventilator strategy is recommended to reduce lung injury in ARDS patients?

Accepted Answer

Tidal volume of 6 mL/kg ideal body weight with permissive hypercapnia

Answer

Lung-protective ventilation in ARDS uses low tidal volumes of 6 mL/kg IBW to reduce volutrauma, allowing permissive hypercapnia as tolerated.

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Respiratory Emergencies 2