CMSRN Respiratory and Pulmonary Care 2 — Questions and Answers
Question 1: A patient on mechanical ventilation develops high peak airway pressures. What is the priority nursing assessment?
- Check the IV site for infiltration
- Assess for kinking of the ventilator tubing or ET tube (Correct answer)
- Increase the tidal volume
- Decrease the FiO2
Correct answer: Assess for kinking of the ventilator tubing or ET tube
High peak airway pressures often result from obstruction such as kinked tubing, secretions, or biting of the ET tube, which must be assessed immediately.
Question 2: Which position is best for a spontaneously breathing patient with unilateral pneumonia to improve oxygenation?
- Supine with head of bed flat
- Affected side down (dependent)
- Good lung down (unaffected side dependent) (Correct answer)
- Prone position
Correct answer: Good lung down (unaffected side dependent)
Positioning the good (unaffected) lung down uses gravity to improve perfusion to the better-ventilated lung, optimizing V/Q matching.
Question 3: A patient with asthma is experiencing an acute exacerbation. What is the first-line medication the nurse should administer?
- Inhaled corticosteroid
- Short-acting beta-2 agonist (SABA) (Correct answer)
- Leukotriene receptor antagonist
- Intravenous aminophylline
Correct answer: Short-acting beta-2 agonist (SABA)
Short-acting beta-2 agonists (e.g., albuterol) are the first-line treatment for acute asthma exacerbations due to their rapid bronchodilating effect.
Question 4: The nurse is caring for a patient with a pleural effusion. Which intervention would the nurse anticipate assisting with to relieve symptoms?
- Chest tube insertion for pneumothorax
- Thoracentesis to drain fluid (Correct answer)
- Bronchoscopy for direct visualization
- Pericardiocentesis
Correct answer: Thoracentesis to drain fluid
Thoracentesis is performed to drain fluid from the pleural space, relieving dyspnea and allowing lung re-expansion.
Question 5: A patient with pulmonary embolism (PE) is being treated with heparin infusion. Which lab value requires immediate dose adjustment?
- Platelet count of 200,000/mm³
- aPTT of 120 seconds (therapeutic range 60–100 seconds) (Correct answer)
- Hemoglobin of 10 g/dL
- BUN of 18 mg/dL
Correct answer: aPTT of 120 seconds (therapeutic range 60–100 seconds)
An aPTT above the therapeutic range indicates excessive anticoagulation with heparin, requiring dose reduction to prevent hemorrhagic complications.
Question 6: A patient with a tracheostomy has thick, tenacious secretions. Which independent nursing intervention is most appropriate?
- Increase IV fluid rate without a physician order
- Administer mucolytic medication
- Increase humidification of inspired air (Correct answer)
- Perform postural drainage every 4 hours
Correct answer: Increase humidification of inspired air
Increasing humidification of inspired air is an independent nursing intervention that helps thin secretions for easier clearance.
CMSRN Respiratory and Pulmonary Care 2
A patient on mechanical ventilation develops high peak airway pressures.
What is the priority nursing assessment?