MSNCB Respiratory Care 4

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:

Accepted Answer

Notify the physician immediately and prepare for possible surgical intervention

Answer

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?

Accepted Answer

Left lateral decubitus (left side down)

Answer

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?

Accepted Answer

22 mcg/mL

Answer

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?

Accepted Answer

Carbon monoxide poisoning falsely elevating SpO2

Answer

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?

Accepted Answer

Unilateral effusion with elevated LDH and pleural fluid protein >0.5 serum ratio

Answer

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.

(MSNCB) Medical-Surgical Nursing Certification Board Practice Test

(MSNCB) Medical-Surgical Nursing Certification Board Practice Test

MSNCB Respiratory Care 4