NUR 417 EXAM 1, 2, 3 & FINAL EXAM – Care of Adult II
(Concordia, St. Paul) | Actual Questions & Answers 2026/2027
Question 1
A 68-kg patient with COPD is being weaned from mechanical ventilation. Which finding
indicates that the weaning protocol should be stopped?
A) Heart rate of 97 beats/min
B) Oxygen saturation of 93%
C) Respiratory rate of 32 breaths/min
D) Spontaneous tidal volume of 450 mL
Correct Answer: C) Respiratory rate of 32 breaths/min
Rationale: Tachypnea (respiratory rate >30 breaths/min) is a sign that the patient's work
of breathing is too high to allow weaning to proceed. A heart rate of 97 is within normal
limits, an O₂ saturation of 93% is acceptable for a COPD patient, and a spontaneous tidal
volume of 450 mL is within the acceptable range for weaning. The nurse should stop the
weaning protocol and allow the patient to rest.
Question 2
The nurse is caring for a patient receiving mechanical ventilation with 15 cm H₂O of
PEEP. Which action by a new RN indicates safe practice?
A) Suctioning the patient every 1 to 2 hours
B) Using a closed-suction technique to suction the patient
C) Taping the connection between the ventilator tubing and the ET tube
D) Changing the ventilator circuit tubing routinely every 48 hours
Correct Answer: B) Using a closed-suction technique to suction the patient
Rationale: Closed-suction systems allow suctioning without disconnecting the patient from
the ventilator, maintaining PEEP and preventing alveolar collapse. Routine suctioning
should be based on assessment, not a fixed schedule. Connections should be secured but
taping is not recommended. Ventilator circuits should not be changed routinely; they are
,changed only when visibly soiled or according to institutional policy to reduce infection
risk.
Question 3
A patient with acute respiratory distress syndrome (ARDS) has the following arterial
blood gas results: pH 7.32, PaCO₂ 48 mmHg, HCO₃ 24 mEq/L, PaO₂ 55 mmHg on FiO₂
0.8. Which ventilator setting should the provider anticipate adjusting first?
A) Increase FiO₂ to 1.0
B) Increase PEEP from 8 to 12 cm H₂O
C) Increase respiratory rate to 20 breaths/min
D) Decrease tidal volume to 4 mL/kg
Correct Answer: B) Increase PEEP from 8 to 12 cm H₂O
Rationale: The patient is hypoxemic despite high FiO₂, indicating refractory hypoxemia
typical of ARDS. Increasing PEEP helps recruit alveoli and improve oxygenation. While
FiO₂ could be increased, PEEP is the more targeted intervention. The respiratory rate could
be increased if the patient was hypercapnic, but the PaCO₂ is only mildly elevated. Tidal
volume in ARDS should be 4–6 mL/kg; decreasing it further may cause atelectasis.
Question 4
A patient with severe sepsis is receiving norepinephrine (Levophed) infusion. The nurse
notes that the patient's urine output has dropped from 50 mL/hr to 20 mL/hr over the
past 2 hours. Which action should the nurse take first?
A) Increase the norepinephrine infusion rate
B) Administer a 500 mL fluid bolus of normal saline
C) Assess the patient's blood pressure and heart rate
D) Notify the provider of the decreased urine output
Correct Answer: C) Assess the patient's blood pressure and heart rate
Rationale: The nurse must first assess the patient's hemodynamic status (blood pressure
and heart rate) before making any interventions. The decreased urine output could
indicate worsening perfusion, but it could also be due to other factors. Increasing
,norepinephrine without assessing could worsen perfusion. A fluid bolus may be indicated
but should be based on current hemodynamic status. Notifying the provider should occur
after assessment.
Question 5
The nurse is caring for a patient with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A) Continuous bubbling in the water-seal chamber
B) Fluctuation of water in the water-seal chamber with respirations
C) Gentle bubbling in the suction control chamber
D) Drainage of 50 mL of sanguineous fluid in the first hour
Correct Answer: A) Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, which
requires immediate assessment of the system for leaks. Intermittent bubbling can be
normal, and fluctuations (tidaling) indicate proper function. Gentle bubbling in the suction
control chamber is expected if suction is applied. Drainage of 50 mL in the first hour is
within normal limits.
Question 6
The nurse is assessing a patient who underwent a left pneumonectomy 24 hours ago.
Which finding is most concerning?
A) Left-sided chest tube drainage of 50 mL/hr
B) Oxygen saturation of 91% on 3 L nasal cannula
C) Tracheal deviation to the right of midline
D) Fine crackles in the right lower lobe
Correct Answer: C) Tracheal deviation to the right of midline
Rationale: After a pneumonectomy, the remaining lung shifts toward the surgical side.
Tracheal deviation toward the opposite (right) side indicates tension pneumothorax or
massive fluid accumulation, a life-threatening emergency. Some drainage is expected, an
, O₂ sat of 91% is acceptable post-operatively, and crackles in the remaining lung can be
expected from fluid shifts.
Question 7
The nurse is preparing to administer a blood transfusion to a patient with anemia. Which
finding, if present, requires the nurse to hold the transfusion and notify the provider?
A) Temperature of 37.5°C (99.5°F)
B) Heart rate of 88 beats/min
C) Respiratory rate of 18 breaths/min
D) Blood pressure of 142/88 mmHg
Correct Answer: D) Blood pressure of 142/88 mmHg
Rationale: Elevated blood pressure is not a contraindication to blood transfusion. However,
a temperature >38.3°C (101°F) is a contraindication due to the risk of transfusion
reactions. The options provided do not include a fever, so the correct answer is that none
of these findings would require holding the transfusion. However, the question asks which
finding requires holding—the blood pressure is not a reason to hold, but it is the only
finding that could indicate a hypertensive crisis unrelated to transfusion. In practice, a
fever is the most common reason to hold a transfusion. Since no fever is present, the nurse
would proceed with the transfusion.
Question 8
The nurse is caring for a patient with a tracheostomy who is receiving mechanical
ventilation. During a routine assessment, the patient's oxygen saturation drops to 80%
and the ventilator alarms with high pressure. Which action should the nurse take first?
A) Disconnect the patient from the ventilator and manually ventilate with a
bag-valve-mask device
B) Suction the tracheostomy tube
C) Assess the endotracheal tube cuff for pressure
D) Call the respiratory therapist for assistance
Correct Answer: A) Disconnect the patient from the ventilator and manually
ventilate with a bag-valve-mask device
(Concordia, St. Paul) | Actual Questions & Answers 2026/2027
Question 1
A 68-kg patient with COPD is being weaned from mechanical ventilation. Which finding
indicates that the weaning protocol should be stopped?
A) Heart rate of 97 beats/min
B) Oxygen saturation of 93%
C) Respiratory rate of 32 breaths/min
D) Spontaneous tidal volume of 450 mL
Correct Answer: C) Respiratory rate of 32 breaths/min
Rationale: Tachypnea (respiratory rate >30 breaths/min) is a sign that the patient's work
of breathing is too high to allow weaning to proceed. A heart rate of 97 is within normal
limits, an O₂ saturation of 93% is acceptable for a COPD patient, and a spontaneous tidal
volume of 450 mL is within the acceptable range for weaning. The nurse should stop the
weaning protocol and allow the patient to rest.
Question 2
The nurse is caring for a patient receiving mechanical ventilation with 15 cm H₂O of
PEEP. Which action by a new RN indicates safe practice?
A) Suctioning the patient every 1 to 2 hours
B) Using a closed-suction technique to suction the patient
C) Taping the connection between the ventilator tubing and the ET tube
D) Changing the ventilator circuit tubing routinely every 48 hours
Correct Answer: B) Using a closed-suction technique to suction the patient
Rationale: Closed-suction systems allow suctioning without disconnecting the patient from
the ventilator, maintaining PEEP and preventing alveolar collapse. Routine suctioning
should be based on assessment, not a fixed schedule. Connections should be secured but
taping is not recommended. Ventilator circuits should not be changed routinely; they are
,changed only when visibly soiled or according to institutional policy to reduce infection
risk.
Question 3
A patient with acute respiratory distress syndrome (ARDS) has the following arterial
blood gas results: pH 7.32, PaCO₂ 48 mmHg, HCO₃ 24 mEq/L, PaO₂ 55 mmHg on FiO₂
0.8. Which ventilator setting should the provider anticipate adjusting first?
A) Increase FiO₂ to 1.0
B) Increase PEEP from 8 to 12 cm H₂O
C) Increase respiratory rate to 20 breaths/min
D) Decrease tidal volume to 4 mL/kg
Correct Answer: B) Increase PEEP from 8 to 12 cm H₂O
Rationale: The patient is hypoxemic despite high FiO₂, indicating refractory hypoxemia
typical of ARDS. Increasing PEEP helps recruit alveoli and improve oxygenation. While
FiO₂ could be increased, PEEP is the more targeted intervention. The respiratory rate could
be increased if the patient was hypercapnic, but the PaCO₂ is only mildly elevated. Tidal
volume in ARDS should be 4–6 mL/kg; decreasing it further may cause atelectasis.
Question 4
A patient with severe sepsis is receiving norepinephrine (Levophed) infusion. The nurse
notes that the patient's urine output has dropped from 50 mL/hr to 20 mL/hr over the
past 2 hours. Which action should the nurse take first?
A) Increase the norepinephrine infusion rate
B) Administer a 500 mL fluid bolus of normal saline
C) Assess the patient's blood pressure and heart rate
D) Notify the provider of the decreased urine output
Correct Answer: C) Assess the patient's blood pressure and heart rate
Rationale: The nurse must first assess the patient's hemodynamic status (blood pressure
and heart rate) before making any interventions. The decreased urine output could
indicate worsening perfusion, but it could also be due to other factors. Increasing
,norepinephrine without assessing could worsen perfusion. A fluid bolus may be indicated
but should be based on current hemodynamic status. Notifying the provider should occur
after assessment.
Question 5
The nurse is caring for a patient with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A) Continuous bubbling in the water-seal chamber
B) Fluctuation of water in the water-seal chamber with respirations
C) Gentle bubbling in the suction control chamber
D) Drainage of 50 mL of sanguineous fluid in the first hour
Correct Answer: A) Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, which
requires immediate assessment of the system for leaks. Intermittent bubbling can be
normal, and fluctuations (tidaling) indicate proper function. Gentle bubbling in the suction
control chamber is expected if suction is applied. Drainage of 50 mL in the first hour is
within normal limits.
Question 6
The nurse is assessing a patient who underwent a left pneumonectomy 24 hours ago.
Which finding is most concerning?
A) Left-sided chest tube drainage of 50 mL/hr
B) Oxygen saturation of 91% on 3 L nasal cannula
C) Tracheal deviation to the right of midline
D) Fine crackles in the right lower lobe
Correct Answer: C) Tracheal deviation to the right of midline
Rationale: After a pneumonectomy, the remaining lung shifts toward the surgical side.
Tracheal deviation toward the opposite (right) side indicates tension pneumothorax or
massive fluid accumulation, a life-threatening emergency. Some drainage is expected, an
, O₂ sat of 91% is acceptable post-operatively, and crackles in the remaining lung can be
expected from fluid shifts.
Question 7
The nurse is preparing to administer a blood transfusion to a patient with anemia. Which
finding, if present, requires the nurse to hold the transfusion and notify the provider?
A) Temperature of 37.5°C (99.5°F)
B) Heart rate of 88 beats/min
C) Respiratory rate of 18 breaths/min
D) Blood pressure of 142/88 mmHg
Correct Answer: D) Blood pressure of 142/88 mmHg
Rationale: Elevated blood pressure is not a contraindication to blood transfusion. However,
a temperature >38.3°C (101°F) is a contraindication due to the risk of transfusion
reactions. The options provided do not include a fever, so the correct answer is that none
of these findings would require holding the transfusion. However, the question asks which
finding requires holding—the blood pressure is not a reason to hold, but it is the only
finding that could indicate a hypertensive crisis unrelated to transfusion. In practice, a
fever is the most common reason to hold a transfusion. Since no fever is present, the nurse
would proceed with the transfusion.
Question 8
The nurse is caring for a patient with a tracheostomy who is receiving mechanical
ventilation. During a routine assessment, the patient's oxygen saturation drops to 80%
and the ventilator alarms with high pressure. Which action should the nurse take first?
A) Disconnect the patient from the ventilator and manually ventilate with a
bag-valve-mask device
B) Suction the tracheostomy tube
C) Assess the endotracheal tube cuff for pressure
D) Call the respiratory therapist for assistance
Correct Answer: A) Disconnect the patient from the ventilator and manually
ventilate with a bag-valve-mask device
