MSNCB Respiratory Care 2 — Questions and Answers
Question 1: A patient with COPD exacerbation has ABGs: pH 7.28, PaCO2 62 mmHg, PaO2 54 mmHg, HCO3 28 mEq/L. Which intervention is priority?
- Administer 100% O2 via non-rebreather mask
- Initiate non-invasive positive pressure ventilation (NIPPV) (Correct answer)
- Prepare for immediate intubation
- Increase IV fluid rate to 150 mL/hr
Correct answer: Initiate non-invasive positive pressure ventilation (NIPPV)
NIPPV (BiPAP) is first-line for COPD exacerbation with hypercapnic respiratory failure, improving ventilation while avoiding intubation.
Question 2: Which finding in a patient receiving mechanical ventilation indicates ventilator-associated pneumonia (VAP)?
- PEEP requirement of 5 cmH2O
- New infiltrate on chest X-ray with purulent secretions and fever >38.3°C (Correct answer)
- SpO2 of 94% on FiO2 0.40
- Respiratory rate of 18 breaths per minute
Correct answer: New infiltrate on chest X-ray with purulent secretions and fever >38.3°C
VAP is diagnosed by new or worsening radiographic infiltrate plus at least two of: fever, leukocytosis, and purulent secretions.
Question 3: A nurse is caring for a patient after thoracentesis. Which assessment finding requires immediate intervention?
- Mild soreness at the puncture site
- SpO2 dropping from 96% to 88% with tracheal deviation (Correct answer)
- Blood pressure 128/76 mmHg
- Respiratory rate of 20 breaths per minute
Correct answer: SpO2 dropping from 96% to 88% with tracheal deviation
Tracheal deviation with decreasing SpO2 after thoracentesis suggests tension pneumothorax, a life-threatening complication requiring emergency needle decompression.
Question 4: A patient using an incentive spirometer should be instructed to perform the technique in which way?
- Exhale forcefully into the device 10 times per hour
- Inhale slowly and deeply to raise the piston, hold 3–5 seconds, then exhale (Correct answer)
- Breathe rapidly in and out to exercise respiratory muscles
- Use the device only at night to prevent respiratory fatigue
Correct answer: Inhale slowly and deeply to raise the piston, hold 3–5 seconds, then exhale
Slow, sustained maximal inhalation with a 3–5 second breath hold maximizes alveolar recruitment and prevents atelectasis.
Question 5: Which oxygen delivery system provides the most precise FiO2 for a patient with chronic hypercapnia?
- Simple face mask at 8 L/min
- Venturi mask (Correct answer)
- Non-rebreather mask at 15 L/min
- Nasal cannula at 4 L/min
Correct answer: Venturi mask
The Venturi mask delivers a precise, controlled FiO2 regardless of patient breathing pattern, essential for patients with chronic CO2 retention.
Question 6: A post-operative patient refuses to perform deep breathing exercises. Which is the nurse's best initial response?
- Document the refusal and notify the physician
- Explain that atelectasis and pneumonia are serious risks of not breathing deeply
- Administer prescribed pain medication and then reteach the technique (Correct answer)
- Apply a nasal cannula at 2 L/min as an alternative measure
Correct answer: Administer prescribed pain medication and then reteach the technique
Adequate pain control is the most common barrier to deep breathing post-operatively; managing pain first enables effective patient participation.
Question 7: When performing endotracheal suctioning, the nurse should limit each suction pass to a maximum of how many seconds?
- 5 seconds
- 10–15 seconds (Correct answer)
- 20–25 seconds
- 30 seconds
Correct answer: 10–15 seconds
Suctioning beyond 10–15 seconds risks hypoxemia, dysrhythmias, and mucosal trauma; pre- and post-oxygenation with 100% O2 is also required.
MSNCB Respiratory Care 2
A patient with COPD exacerbation has ABGs: pH 7.28, PaCO2 62 mmHg, PaO2 54 mmHg, HCO3 28 mEq/L.
Which intervention is priority?