Galen College of Nursing NU 136 Exam 5
Actual Practice Questions: Oxygenation,
Cardiac & Complex Care with Complete
Solutions
SECTION 1: OXYGENATION & RESPIRATORY CARE (Questions 1-19)
Q1: A patient with severe COPD is receiving oxygen at 2 L/min via nasal cannula. The
patient's SpO₂ is 88%, respiratory rate is 28, and they appear anxious. The family asks if
the oxygen can be increased to help with breathing. What is the nurse's BEST response?
A. "Yes, I'll increase the oxygen to 4 L/min immediately."
B. "No, increasing oxygen could actually make breathing more difficult."
C. "Let me reposition you first, then we can discuss options with the doctor."
D. "The current oxygen level is fine; anxiety is causing the problem."
Correct Answer: B
Rationale: Patients with severe COPD may develop chronic hypercapnia (elevated CO₂),
and their ventilatory drive becomes dependent on hypoxemia rather than CO₂ levels
(hypoxic drive). Excessive oxygen can reduce this drive, causing respiratory depression
and CO₂ narcosis. While repositioning (C) may help, the priority is explaining the safety
concern. The SpO₂ of 88%, while low, may be acceptable for this patient (target often
,88-92% in COPD). Option A is dangerous without provider assessment. Option D
dismisses legitimate concerns.
Clinical Judgment Model: Recognize cues (COPD, SpO₂ 88%, RR 28) → Analyze cues
(hypoxic drive risk) → Prioritize hypotheses (oxygen-induced hypoventilation) →
Generate solutions (explain safety, maintain current O₂, notify provider).
Galen Curriculum Alignment: Oxygenation module - Understanding COPD-specific
oxygen therapy protocols.
Q2: Calculate the approximate FiO₂ for a patient receiving oxygen at 6 L/min via simple
face mask.
A. 35%
B. 45%
C. 55%
D. 65%
Correct Answer: B
Rationale: Simple face mask delivers approximately 40-60% FiO₂ at flow rates of 5-10
L/min. Estimation formula: Room air (21%) + (liter flow × 4%). At 6 L/min: 21% + (6 × 4%)
= 21% + 24% = 45%. Actual delivered FiO₂ varies with mask fit, respiratory rate, and tidal
volume.
Oxygen Delivery Reference:
TableCopy
, Device Flow Rate (L/min) FiO₂ Range
Nasal cannula 1-6 24-44%
Simple mask 5-10 40-60%
Non-rebreather 10-15 60-90%
Venturi mask 4-15 24-50% (precise)
Q3: A patient has a new tracheostomy. Which action is PRIORITY during the first 24
hours?
A. Deflate the cuff to assess for air leak
B. Change the tracheostomy ties
C. Keep obturator at bedside for emergency reinsertion
D. Begin cuff deflation exercises
Correct Answer: C
Rationale: The obturator is essential for emergency tracheostomy reinsertion if
accidental decannulation occurs. During the first 24-72 hours (before a stable tract
forms), reinsertion can be difficult and may require surgical intervention. The obturator
guides the tube during insertion and must be immediately available. Cuff deflation (A, D)
is contraindicated initially. Changing ties (B) is unnecessary and risky during the
immediate postoperative period.
, Safety Alert: New tracheostomy (<7 days) = surgical emergency if dislodged.
Established tracheostomy (>7 days) = can usually be replaced at bedside.
Q4: Select-All-That-Apply: Which findings indicate a patient with an artificial airway may
need suctioning? (Select all that apply)
A. Gurgling sounds during inspiration and expiration
B. SpO₂ 94% on 40% FiO₂
C. Restlessness and increased respiratory rate
D. Respiratory rate of 16 breaths/minute
E. Visible secretions in the airway
F. Decreased breath sounds bilaterally
Correct Answers: A, C, E, F
Rationale:
● A (CORRECT): Gurgling indicates secretions in large airways
● C (CORRECT): Restlessness and tachypnea are signs of respiratory
distress/hypoxia from airway obstruction
● E (CORRECT): Visible secretions require removal
● F (CORRECT): Decreased breath sounds may indicate mucus plugging
● B (INCORRECT): SpO₂ 94% on 40% FiO₂ indicates adequate oxygenation (though
borderline, not suctioning indication)
● D (INCORRECT): RR 16 is normal; not an indication for suctioning
Suctioning Indicators: Visible secretions, auscultated crackles/gurgling, decreased
SpO₂, restlessness, increased RR, decreased breath sounds, coughing without clearing
secretions.
Actual Practice Questions: Oxygenation,
Cardiac & Complex Care with Complete
Solutions
SECTION 1: OXYGENATION & RESPIRATORY CARE (Questions 1-19)
Q1: A patient with severe COPD is receiving oxygen at 2 L/min via nasal cannula. The
patient's SpO₂ is 88%, respiratory rate is 28, and they appear anxious. The family asks if
the oxygen can be increased to help with breathing. What is the nurse's BEST response?
A. "Yes, I'll increase the oxygen to 4 L/min immediately."
B. "No, increasing oxygen could actually make breathing more difficult."
C. "Let me reposition you first, then we can discuss options with the doctor."
D. "The current oxygen level is fine; anxiety is causing the problem."
Correct Answer: B
Rationale: Patients with severe COPD may develop chronic hypercapnia (elevated CO₂),
and their ventilatory drive becomes dependent on hypoxemia rather than CO₂ levels
(hypoxic drive). Excessive oxygen can reduce this drive, causing respiratory depression
and CO₂ narcosis. While repositioning (C) may help, the priority is explaining the safety
concern. The SpO₂ of 88%, while low, may be acceptable for this patient (target often
,88-92% in COPD). Option A is dangerous without provider assessment. Option D
dismisses legitimate concerns.
Clinical Judgment Model: Recognize cues (COPD, SpO₂ 88%, RR 28) → Analyze cues
(hypoxic drive risk) → Prioritize hypotheses (oxygen-induced hypoventilation) →
Generate solutions (explain safety, maintain current O₂, notify provider).
Galen Curriculum Alignment: Oxygenation module - Understanding COPD-specific
oxygen therapy protocols.
Q2: Calculate the approximate FiO₂ for a patient receiving oxygen at 6 L/min via simple
face mask.
A. 35%
B. 45%
C. 55%
D. 65%
Correct Answer: B
Rationale: Simple face mask delivers approximately 40-60% FiO₂ at flow rates of 5-10
L/min. Estimation formula: Room air (21%) + (liter flow × 4%). At 6 L/min: 21% + (6 × 4%)
= 21% + 24% = 45%. Actual delivered FiO₂ varies with mask fit, respiratory rate, and tidal
volume.
Oxygen Delivery Reference:
TableCopy
, Device Flow Rate (L/min) FiO₂ Range
Nasal cannula 1-6 24-44%
Simple mask 5-10 40-60%
Non-rebreather 10-15 60-90%
Venturi mask 4-15 24-50% (precise)
Q3: A patient has a new tracheostomy. Which action is PRIORITY during the first 24
hours?
A. Deflate the cuff to assess for air leak
B. Change the tracheostomy ties
C. Keep obturator at bedside for emergency reinsertion
D. Begin cuff deflation exercises
Correct Answer: C
Rationale: The obturator is essential for emergency tracheostomy reinsertion if
accidental decannulation occurs. During the first 24-72 hours (before a stable tract
forms), reinsertion can be difficult and may require surgical intervention. The obturator
guides the tube during insertion and must be immediately available. Cuff deflation (A, D)
is contraindicated initially. Changing ties (B) is unnecessary and risky during the
immediate postoperative period.
, Safety Alert: New tracheostomy (<7 days) = surgical emergency if dislodged.
Established tracheostomy (>7 days) = can usually be replaced at bedside.
Q4: Select-All-That-Apply: Which findings indicate a patient with an artificial airway may
need suctioning? (Select all that apply)
A. Gurgling sounds during inspiration and expiration
B. SpO₂ 94% on 40% FiO₂
C. Restlessness and increased respiratory rate
D. Respiratory rate of 16 breaths/minute
E. Visible secretions in the airway
F. Decreased breath sounds bilaterally
Correct Answers: A, C, E, F
Rationale:
● A (CORRECT): Gurgling indicates secretions in large airways
● C (CORRECT): Restlessness and tachypnea are signs of respiratory
distress/hypoxia from airway obstruction
● E (CORRECT): Visible secretions require removal
● F (CORRECT): Decreased breath sounds may indicate mucus plugging
● B (INCORRECT): SpO₂ 94% on 40% FiO₂ indicates adequate oxygenation (though
borderline, not suctioning indication)
● D (INCORRECT): RR 16 is normal; not an indication for suctioning
Suctioning Indicators: Visible secretions, auscultated crackles/gurgling, decreased
SpO₂, restlessness, increased RR, decreased breath sounds, coughing without clearing
secretions.
