MSNCB Respiratory Care 2

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?

Accepted Answer

Initiate non-invasive positive pressure ventilation (NIPPV)

Answer

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)?

Accepted Answer

New infiltrate on chest X-ray with purulent secretions and fever >38.3°C

Answer

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?

Accepted Answer

SpO2 dropping from 96% to 88% with tracheal deviation

Answer

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?

Accepted Answer

Inhale slowly and deeply to raise the piston, hold 3–5 seconds, then exhale

Answer

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?

Accepted Answer

Venturi mask

Answer

The Venturi mask delivers a precise, controlled FiO2 regardless of patient breathing pattern, essential for patients with chronic CO2 retention.

(MSNCB) Medical-Surgical Nursing Certification Board Practice Test

(MSNCB) Medical-Surgical Nursing Certification Board Practice Test

MSNCB Respiratory Care 2