MSNCB Respiratory Care 5 — Questions and Answers
Question 1: A nurse is preparing to administer ipratropium bromide to a patient with COPD. Which assessment finding is a contraindication for this medication?
- Heart rate of 88 beats per minute
- History of narrow-angle glaucoma (Correct answer)
- Serum potassium of 3.8 mEq/L
- Blood pressure of 142/88 mmHg
Correct answer: History of narrow-angle glaucoma
Ipratropium, an anticholinergic, can increase intraocular pressure and is contraindicated in narrow-angle glaucoma; closed-angle glaucoma crisis can result from systemic or inhaled anticholinergics.
Question 2: Which clinical indicator most reliably signals that weaning from mechanical ventilation should proceed?
- Patient has been on the ventilator for at least 48 hours
- Rapid shallow breathing index (RSBI) of 80 or less with hemodynamic stability (Correct answer)
- SpO2 of 88% on FiO2 0.60
- Patient can open eyes to voice commands
Correct answer: Rapid shallow breathing index (RSBI) of 80 or less with hemodynamic stability
An RSBI (respiratory rate / tidal volume in liters) ≤105, especially ≤80, combined with hemodynamic stability and adequate oxygenation, predicts successful extubation.
Question 3: A patient with community-acquired pneumonia has a CURB-65 score of 3. This score indicates the patient should receive care in which setting?
- Outpatient with oral antibiotics
- Observation unit for 23 hours only
- General medical-surgical unit
- ICU-level or inpatient with close monitoring (Correct answer)
Correct answer: ICU-level or inpatient with close monitoring
A CURB-65 score of 3–5 indicates severe pneumonia with high 30-day mortality risk, requiring hospitalization and consideration of ICU-level care.
Question 4: A patient receiving high-flow nasal cannula (HFNC) therapy develops increasing work of breathing and SpO2 of 86% despite FiO2 of 0.80 at 50 L/min. The nurse's priority action is:
- Increase the HFNC flow rate to 60 L/min
- Reposition to high Fowler's position and reassess
- Notify the physician immediately for escalation of respiratory support (Correct answer)
- Obtain an ABG and await results before acting
Correct answer: Notify the physician immediately for escalation of respiratory support
Failure to maintain oxygenation on maximum HFNC settings indicates the need for immediate physician notification and escalation to non-invasive or invasive ventilation.
Question 5: A nurse is educating a patient newly diagnosed with tuberculosis (TB) about respiratory precautions at home. Which statement by the patient indicates understanding?
- I can remove my mask when family visits if they stand 3 feet away.
- I should wear a surgical mask in common areas and sleep in a well-ventilated separate room until non-infectious. (Correct answer)
- I only need to cover my mouth when coughing for the first week of treatment.
- I can return to work after 48 hours of antibiotics.
Correct answer: I should wear a surgical mask in common areas and sleep in a well-ventilated separate room until non-infectious.
Active TB requires airborne precautions including wearing a mask in shared spaces and sleeping separately in a well-ventilated room until sputum cultures are negative on three consecutive tests.
Question 6: A patient with cystic fibrosis is admitted for a pulmonary exacerbation. Which intervention is most important for airway clearance?
- Encourage the patient to limit fluid intake to avoid pulmonary edema
- Perform chest physiotherapy with postural drainage and administer DNase (dornase alfa) (Correct answer)
- Administer high-dose IV diuretics to reduce airway secretions
- Apply a non-rebreather mask to improve secretion mobilization
Correct answer: Perform chest physiotherapy with postural drainage and administer DNase (dornase alfa)
Chest physiotherapy, postural drainage, and DNase (which breaks down the DNA in thick secretions) are cornerstone airway clearance therapies in cystic fibrosis exacerbations.
Question 7: A patient is receiving supplemental oxygen via nasal cannula. The nurse knows that each 1 L/min increase in flow rate raises the FiO2 by approximately:
- 1%
- 2%
- 4% (Correct answer)
- 8%
Correct answer: 4%
Each 1 L/min of oxygen via nasal cannula increases FiO2 by approximately 4% (room air ~21%; 1 L/min ≈ 25%, 2 L/min ≈ 29%, etc.).
MSNCB Respiratory Care 5
A nurse is preparing to administer ipratropium bromide to a patient with COPD.
Which assessment finding is a contraindication for this medication?