MS3 final study guide, 2026 with complete
solutions.
Nasal Cannula (when & what they deliver)
1-6 L/min; ~24-44% FiO2; for mild hypoxia and stable patients.
Simple face mask (when & what they deliver)
6-12 L/min; ~35-50% FiO2; short-term use, need at least 6 L to flush CO2.
Nonrebreather mask (when & what they deliver)
10-15 L/min; up to ~60-90% FiO2; for severe hypoxia,
keep bag 2/3 inflated.
Venturi mask (when & what they deliver)
Precise FiO2 control (24-50%); best for COPD patients who need controlled O2.
High-flow devices (HFNC, Venturi, etc.) (when & what they deliver)
Used in more acute respiratory failure to deliver predictable FiO2 and some PEEP.
What key assessments are required for a patient with a chest tube?
Assess respiratory status (RR, SpO₂, breath sounds), insertion site (drainage, crepitus), and
drainage amount/color.
What should the water-seal chamber do during normal breathing?
It should tidale with breathing; continuous bubbling indicates an air leak.
What is expected in the suction control chamber when suction is ordered?
,gentle bubbling (normal)
What positioning and tubing care should be maintained for a chest tube system?
Keep the system below the chest and ensure tubing has no dependent loops or kinks; maintain an
intact occlusive dressing.
What actions should NEVER be done with a chest tube?
Never clamp the tube routinely or strip it due to risk of tension pneumothorax.
What are the manifestations of a tension pneumothorax and the required emergency
response?
- Sudden severe dyspnea
- tachypnea
- hypoxia
- tracheal deviation to the opposite side (late sign)
- absent breath sounds on the affected side
- distended neck veins
- hypotension
- tachycardia from obstructive shock
*this is an emergency → call the provider and prepare for needle decompression/chest tube
insertion.
What are classic early signs of hypoxia?
Restlessness, anxiety, confusion, tachypnea, and tachycardia.
How might hypoxia present differently in elderly patients?
,Confusion, agitation, or changes in level of consciousness before obvious shortness of breath.
What is the late sign for hypoxia?
cyanosis
What is a SABA (short acting beta agonist) used for and what is its onset?
SABA (ex: albuterol) is a rescue inhaler for acute SOB or wheezing, with onset in minutes.
Using a SABA more than 2 days per week indicates what?
Asthma is not well controlled.
What is a LABA (long acting beta agonists) used for?
LABA (ex: salmeterol, formoterol) is for long-term maintenance, not for acute attacks.
Why are LABAs (long acting beta agonists) usually given with inhaled corticosteroids in
asthma?
LABAs alone increase the risk of asthma-related complications; ICS + LABA provides safe
long-term control.
What is the correct order of inhaler use when using a bronchodilator and a steroid?
Use bronchodilator (SABA or LABA) first, wait ~5 minutes, then use the steroid.
What PFT finding confirms COPD?
FEV1/FVC ratio < 70%.
What ABG pattern is typical in COPD patients?
Chronic respiratory acidosis with metabolic compensation.
, What might a chest X-ray show in COPD?
Hyperinflated lungs and flattened diaphragms.
What additional tests may be used in COPD evaluation?
Six-minute walk test, pulse oximetry, and alpha-1 antitrypsin levels (especially in younger
patients).
What are the hallmark symptoms of COPD?
Chronic cough, sputum production, and progressive dyspnea.
What physical findings might be seen in COPD?
Barrel chest, prolonged expiratory phase, and use of accessory muscles.
What systemic effects can COPD cause?
Weight loss, fatigue, and frequent respiratory infections.
What are the classic "blue bloater" vs. "pink puffer" characteristics?
- Chronic bronchitis = cyanosis and edema ("blue bloater")
- Emphysema = pursed-lip breathing and thin body habitus ("pink puffer").
What is the hallmark oxygenation problem in ARDS (acute respiratory distress
syndrome)?
Severe refractory hypoxemia (PaO₂ remains low despite high FiO₂).
What chest X-ray finding is expected in ARDS (acute respiratory distress syndrome)?
Diffuse bilateral infiltrates, also called "white-out lung."
solutions.
Nasal Cannula (when & what they deliver)
1-6 L/min; ~24-44% FiO2; for mild hypoxia and stable patients.
Simple face mask (when & what they deliver)
6-12 L/min; ~35-50% FiO2; short-term use, need at least 6 L to flush CO2.
Nonrebreather mask (when & what they deliver)
10-15 L/min; up to ~60-90% FiO2; for severe hypoxia,
keep bag 2/3 inflated.
Venturi mask (when & what they deliver)
Precise FiO2 control (24-50%); best for COPD patients who need controlled O2.
High-flow devices (HFNC, Venturi, etc.) (when & what they deliver)
Used in more acute respiratory failure to deliver predictable FiO2 and some PEEP.
What key assessments are required for a patient with a chest tube?
Assess respiratory status (RR, SpO₂, breath sounds), insertion site (drainage, crepitus), and
drainage amount/color.
What should the water-seal chamber do during normal breathing?
It should tidale with breathing; continuous bubbling indicates an air leak.
What is expected in the suction control chamber when suction is ordered?
,gentle bubbling (normal)
What positioning and tubing care should be maintained for a chest tube system?
Keep the system below the chest and ensure tubing has no dependent loops or kinks; maintain an
intact occlusive dressing.
What actions should NEVER be done with a chest tube?
Never clamp the tube routinely or strip it due to risk of tension pneumothorax.
What are the manifestations of a tension pneumothorax and the required emergency
response?
- Sudden severe dyspnea
- tachypnea
- hypoxia
- tracheal deviation to the opposite side (late sign)
- absent breath sounds on the affected side
- distended neck veins
- hypotension
- tachycardia from obstructive shock
*this is an emergency → call the provider and prepare for needle decompression/chest tube
insertion.
What are classic early signs of hypoxia?
Restlessness, anxiety, confusion, tachypnea, and tachycardia.
How might hypoxia present differently in elderly patients?
,Confusion, agitation, or changes in level of consciousness before obvious shortness of breath.
What is the late sign for hypoxia?
cyanosis
What is a SABA (short acting beta agonist) used for and what is its onset?
SABA (ex: albuterol) is a rescue inhaler for acute SOB or wheezing, with onset in minutes.
Using a SABA more than 2 days per week indicates what?
Asthma is not well controlled.
What is a LABA (long acting beta agonists) used for?
LABA (ex: salmeterol, formoterol) is for long-term maintenance, not for acute attacks.
Why are LABAs (long acting beta agonists) usually given with inhaled corticosteroids in
asthma?
LABAs alone increase the risk of asthma-related complications; ICS + LABA provides safe
long-term control.
What is the correct order of inhaler use when using a bronchodilator and a steroid?
Use bronchodilator (SABA or LABA) first, wait ~5 minutes, then use the steroid.
What PFT finding confirms COPD?
FEV1/FVC ratio < 70%.
What ABG pattern is typical in COPD patients?
Chronic respiratory acidosis with metabolic compensation.
, What might a chest X-ray show in COPD?
Hyperinflated lungs and flattened diaphragms.
What additional tests may be used in COPD evaluation?
Six-minute walk test, pulse oximetry, and alpha-1 antitrypsin levels (especially in younger
patients).
What are the hallmark symptoms of COPD?
Chronic cough, sputum production, and progressive dyspnea.
What physical findings might be seen in COPD?
Barrel chest, prolonged expiratory phase, and use of accessory muscles.
What systemic effects can COPD cause?
Weight loss, fatigue, and frequent respiratory infections.
What are the classic "blue bloater" vs. "pink puffer" characteristics?
- Chronic bronchitis = cyanosis and edema ("blue bloater")
- Emphysema = pursed-lip breathing and thin body habitus ("pink puffer").
What is the hallmark oxygenation problem in ARDS (acute respiratory distress
syndrome)?
Severe refractory hypoxemia (PaO₂ remains low despite high FiO₂).
What chest X-ray finding is expected in ARDS (acute respiratory distress syndrome)?
Diffuse bilateral infiltrates, also called "white-out lung."
