Question set A: ten items, respiratory failure and shock

Twelve minutes. Do not turn back to earlier pages. Mark every answer in the box, including the ones you guessed.

1. A patient on the second post-operative day is receiving oxygen at 4 liters per minute by nasal cannula. Over 30 minutes the oxygen saturation remains 96%, the respiratory rate falls from 16 to 8 breaths per minute, and the patient becomes difficult to rouse. Which action should the nurse take first?

1. Increase the oxygen flow rate to 6 liters per minute and continue to monitor the saturation.
2. Stimulate the patient, support ventilation with a bag-valve-mask, and call for help.
3. Reposition the pulse oximeter probe and obtain a second reading.
4. Lower the head of the bed and obtain orthostatic vital signs.

2. Select all findings that indicate a tension pneumothorax rather than a simple pneumothorax.

1. Distended neck veins
2. Hypotension with a narrow pulse pressure
3. Sudden pleuritic chest pain
4. Tracheal deviation toward the unaffected side
5. Hyperresonance to percussion over the affected side
6. Rapidly worsening hypoxemia with rising airway pressures in a ventilated patient

3. Which patient's presentation identifies shunt rather than ventilation-perfusion mismatch as the mechanism of hypoxemia?

1. A patient with an opioid overdose whose saturation rises from 88% to 97% on a nasal cannula at 2 liters per minute.
2. A patient with bilateral opacities whose saturation remains 86% on a non-rebreather mask at 15 liters per minute.
3. A patient with an asthma exacerbation whose saturation rises to 96% after a bronchodilator and 4 liters per minute.
4. A patient with atelectasis whose saturation corrects after coughing, deep breathing, and incentive spirometry.

4. A ventilated patient triggers a high-pressure alarm and coarse secretions are audible in the endotracheal tube. Place the nurse's actions in the correct order.

• A. Silence the alarm.
• B. Assess chest rise, breath sounds, and oxygen saturation.
• C. Hyperoxygenate the patient.
• D. Suction the airway.
• E. Reassess breath sounds, saturation, and peak airway pressure.
• F. Document the event and the patient's response.

5. A patient with a cervical spine injury has a blood pressure of 82/48, a heart rate of 54, and skin that is warm and dry below the level of injury. Which type of shock is present?

1. Hypovolemic shock
2. Cardiogenic shock
3. Neurogenic shock
4. Septic shock

6. A chest drainage unit is knocked over and the tubing separates from the unit. Select all correct nursing actions.

1. Submerge the distal end of the chest tube in a container of sterile water.
2. Clamp the chest tube until a new drainage unit is available.
3. Obtain a replacement drainage unit and reconnect using sterile technique.
4. Assess respiratory rate, breath sounds, oxygen saturation, and work of breathing.
5. Strip the tubing to clear any clot before reconnecting.
6. Notify the provider and document the event and the patient's response.

7. A patient with a chronic obstructive pulmonary disease exacerbation is drowsy but rousable, protects the airway, and has a rising carbon dioxide level with acidemia. Which oxygen support should the nurse anticipate?

1. Nasal cannula at 6 liters per minute
2. Non-rebreather mask at 15 liters per minute
3. Bilevel positive airway pressure with titrated oxygen
4. Immediate intubation and invasive mechanical ventilation

8. Classify each finding as consistent with hypovolemic, cardiogenic, or distributive shock.

9. A tracheostomy placed four days ago is found dislodged and lying on the patient's gown. Which action should the nurse take first?

1. Reinsert the tracheostomy tube using the obturator.
2. Pass a suction catheter through the stoma to confirm the tract.
3. Occlude the stoma and ventilate with a bag-valve-mask over the mouth and nose while calling for help.
4. Place the patient in high Fowler position and wait for the provider.

10. An 80-year-old admitted with a urinary tract infection is being reassessed. Select all cues that together indicate sepsis rather than an uncomplicated infection.

1. New confusion and inability to state the location
2. A respiratory rate of 26 breaths per minute
3. Urine output that has fallen across two shifts
4. Dysuria and urinary frequency
5. A serum lactate that has risen on repeat measurement
6. A serum creatinine that has risen above the patient's documented baseline

Margin notecircle the ones you guessed. those are the real score.

TakeawayA guessed correct answer is a wrong answer with better luck.