MSNCB Respiratory Care 4 — Questions and Answers
Question 1: A patient with a chest tube for hemothorax drains 250 mL of bright red blood in the first 30 minutes post-insertion. The nurse should:
- Clamp the chest tube and await physician orders
- Notify the physician immediately and prepare for possible surgical intervention (Correct answer)
- Document the output as expected and reassess in one hour
- Increase IV fluid rate to compensate for blood loss
Correct answer: Notify the physician immediately and prepare for possible surgical intervention
Drainage of >200 mL/hr of bright red blood from a chest tube indicates active hemorrhage requiring immediate physician notification and potential surgical exploration.
Question 2: Which position is optimal for a patient with unilateral pneumonia affecting the right lung to improve oxygenation?
- Supine with head elevated 30 degrees
- Right lateral decubitus (right side down)
- Left lateral decubitus (left side down) (Correct answer)
- Prone position
Correct answer: Left lateral decubitus (left side down)
Placing the healthy lung (left) in the dependent position increases perfusion to the better-ventilated lung, optimizing the V/Q ratio and improving oxygenation.
Question 3: A patient is prescribed theophylline for COPD management. Which serum level indicates toxicity risk?
- 4 mcg/mL
- 8 mcg/mL
- 12 mcg/mL
- 22 mcg/mL (Correct answer)
Correct answer: 22 mcg/mL
The therapeutic range for theophylline is 5–15 mcg/mL; levels above 20 mcg/mL are associated with toxicity including seizures, dysrhythmias, and nausea.
Question 4: A nurse notes that a patient's pulse oximetry reads 98% but the patient appears cyanotic and confused. Which condition best explains this discrepancy?
- Peripheral arterial disease causing poor perfusion
- Carbon monoxide poisoning falsely elevating SpO2 (Correct answer)
- Sensor malfunction due to nail polish
- Methemoglobinemia causing actual hypoxia
Correct answer: Carbon monoxide poisoning falsely elevating SpO2
Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, so CO poisoning reads falsely normal while the patient is actually hypoxic.
Question 5: Which finding in a patient with a new pleural effusion most strongly suggests an exudate rather than a transudate?
- Bilateral effusions with peripheral edema and low protein
- Unilateral effusion with elevated LDH and pleural fluid protein >0.5 serum ratio (Correct answer)
- History of congestive heart failure and low BNP
- Clear, straw-colored fluid with specific gravity <1.015
Correct answer: Unilateral effusion with elevated LDH and pleural fluid protein >0.5 serum ratio
Exudates meet Light's criteria: pleural fluid protein >0.5 of serum protein and/or pleural LDH >0.6 of serum LDH, indicating inflammation or malignancy.
Question 6: A patient with acute respiratory distress syndrome (ARDS) is on lung-protective ventilation. Which ventilator settings reflect this strategy?
- Tidal volume 10 mL/kg IBW, FiO2 1.0, PEEP 3 cmH2O
- Tidal volume 6 mL/kg IBW, plateau pressure <30 cmH2O, PEEP 8–12 cmH2O (Correct answer)
- Tidal volume 8 mL/kg IBW, respiratory rate 8, PEEP 5 cmH2O
- Tidal volume 12 mL/kg IBW, pressure support mode, FiO2 0.30
Correct answer: Tidal volume 6 mL/kg IBW, plateau pressure <30 cmH2O, PEEP 8–12 cmH2O
ARDSNet lung-protective ventilation uses low tidal volumes (6 mL/kg IBW) with plateau pressure ≤30 cmH2O and higher PEEP to prevent ventilator-induced lung injury.
Question 7: A nurse is caring for a patient with obstructive sleep apnea (OSA) who was just extubated. Which is the most important nursing intervention in the first two hours post-extubation?
- Administer supplemental oxygen at 4 L/min via nasal cannula indefinitely
- Apply continuous pulse oximetry and keep CPAP device at bedside (Correct answer)
- Position the patient supine to prevent aspiration
- Restrict oral intake for 4 hours to prevent nausea
Correct answer: Apply continuous pulse oximetry and keep CPAP device at bedside
Patients with OSA are at high risk for upper airway obstruction after extubation; continuous SpO2 monitoring and bedside CPAP allow rapid intervention if obstruction occurs.
MSNCB Respiratory Care 4
A patient with a chest tube for hemothorax drains 250 mL of bright red blood in the first 30 minutes post-insertion.
The nurse should: