MSNCB Respiratory Care 3 — Questions and Answers
Question 1: A patient with asthma is admitted with severe bronchospasm. Which medication class is the first priority treatment?
- Inhaled corticosteroids (e.g., fluticasone)
- Short-acting beta-2 agonists (e.g., albuterol) (Correct answer)
- Leukotriene modifiers (e.g., montelukast)
- Long-acting beta-2 agonists (e.g., salmeterol)
Correct answer: Short-acting beta-2 agonists (e.g., albuterol)
Short-acting beta-2 agonists provide rapid bronchodilation and are the cornerstone of acute asthma exacerbation management.
Question 2: A nurse assesses paradoxical breathing in a trauma patient. This pattern is MOST consistent with which condition?
- Pleural effusion
- Flail chest (Correct answer)
- Spontaneous pneumothorax
- Pulmonary embolism
Correct answer: Flail chest
Flail chest occurs when multiple rib fractures create a free-floating segment that moves inward during inhalation and outward during exhalation (paradoxical movement).
Question 3: Which arterial blood gas result is consistent with metabolic alkalosis with respiratory compensation?
- pH 7.30, PaCO2 28, HCO3 13
- pH 7.50, PaCO2 50, HCO3 38 (Correct answer)
- pH 7.35, PaCO2 40, HCO3 24
- pH 7.48, PaCO2 30, HCO3 22
Correct answer: pH 7.50, PaCO2 50, HCO3 38
Metabolic alkalosis shows elevated pH and HCO3; the body compensates by hypoventilating (retaining CO2), raising PaCO2.
Question 4: A patient with a tracheostomy tube has cuff pressure measured at 32 cmH2O. The nurse's priority action is to:
- Document the reading as within normal range
- Deflate the cuff slightly to achieve 20–25 cmH2O (Correct answer)
- Increase the cuff pressure to 40 cmH2O to prevent aspiration
- Notify respiratory therapy to change the tracheostomy tube
Correct answer: Deflate the cuff slightly to achieve 20–25 cmH2O
Cuff pressure should be maintained at 20–25 cmH2O; pressures above 25 cmH2O impair tracheal mucosal perfusion and risk tracheal necrosis.
Question 5: The nurse suspects a patient has developed a pulmonary embolism. Which combination of findings best supports this suspicion?
- Bradycardia, hypertension, and productive cough
- Sudden dyspnea, pleuritic chest pain, and tachycardia (Correct answer)
- Gradual onset crackles, fever, and purulent sputum
- Barrel chest, pursed-lip breathing, and prolonged expiration
Correct answer: Sudden dyspnea, pleuritic chest pain, and tachycardia
The classic PE triad includes sudden-onset dyspnea, pleuritic chest pain, and tachycardia, reflecting acute obstruction of pulmonary vasculature.
Question 6: A patient is receiving a continuous albuterol nebulization treatment. Which side effect requires the nurse to notify the physician?
- Mild tremor in the hands
- Serum potassium of 2.8 mEq/L with cardiac dysrhythmia (Correct answer)
- Heart rate of 102 beats per minute
- Dry mouth and throat irritation
Correct answer: Serum potassium of 2.8 mEq/L with cardiac dysrhythmia
Beta-2 agonists drive potassium into cells, causing hypokalemia; severe hypokalemia with dysrhythmias is a life-threatening complication requiring immediate physician notification.
Question 7: A patient on a ventilator has a sudden high-pressure alarm with decreased breath sounds on the left. The nurse's immediate action is to:
- Increase the tidal volume setting
- Assess for right mainstem bronchus intubation or pneumothorax (Correct answer)
- Silence the alarm and continue monitoring
- Increase the FiO2 to 1.0
Correct answer: Assess for right mainstem bronchus intubation or pneumothorax
High-pressure alarm with unilateral absent breath sounds indicates either ET tube migration into the right mainstem bronchus or left-sided pneumothorax, both requiring urgent assessment.
MSNCB Respiratory Care 3
A patient with asthma is admitted with severe bronchospasm.
Which medication class is the first priority treatment?