NR341/NR 341 Exam 1 V3 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes that the patient’s PaO2 remains low despite increasing the
fraction of inspired oxygen (FiO2) to 80%. Which pathophysiological mechanism explains this
finding?
A. Increased pulmonary compliance
B. Alveolar hypoventilation
C. Refractory hypoxemia due to intrapulmonary shunting
D. Increased dead space ventilation
Correct Answer: C
Explanation: Refractory hypoxemia is a hallmark sign of ARDS where oxygenation does
not improve with supplemental oxygen. This occurs because fluid-filled or collapsed alveoli
are unable to participate in gas exchange, leading to intrapulmonary shunting. The nurse
must recognize that increasing PEEP is often necessary to recruit alveoli and improve
oxygenation in these patients.
2. The nurse is caring for a patient on a ventilator and hears the high-pressure alarm
sounding. Which action should the nurse take first?
A. Check for a leak in the ventilator circuit
,B. Assess the patient’s breath sounds and need for suctioning
C. Call the respiratory therapist to adjust settings
D. Turn off the alarm to prevent patient anxiety
Correct Answer: B
Explanation: High-pressure alarms are triggered by increased resistance in the airway,
often caused by secretions, biting the tube, or kinked tubing. The nurse should immediately
assess the patient’s status and clear the airway if needed. This priority action ensures the
patient is safely ventilated before troubleshooting the machine further.
3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Uncompensated metabolic acidosis
C. Compensated respiratory acidosis
D. Partially compensated respiratory alkalosis
Correct Answer: A
Explanation: The pH is below the normal range (7.35-7.45), indicating acidosis. The PaCO2
is elevated above the normal range (35-45 mmHg), which corresponds with the acidic pH.
Because the bicarbonate level is normal, no compensation has occurred yet, making it
uncompensated respiratory acidosis.
, 4. A patient is admitted with a suspected pulmonary embolism (PE). Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. D-dimer assay
B. Chest X-ray
C. Electrocardiogram (ECG)
D. Spiral (CT) pulmonary angiography
Correct Answer: D
Explanation: Spiral CT pulmonary angiography is the preferred and most common
diagnostic tool to visualize clots in the pulmonary vasculature. While a D-dimer is sensitive
for clotting activity, it is not specific to PE. The CT scan provides definitive evidence of the
location and extent of the embolism.
5. A nurse is monitoring a patient with a chest tube following a lobectomy. Which finding
requires immediate notification of the healthcare provider?
A. Tidaling in the water-seal chamber with respiration
B. Drainage of 250 mL of bright red blood in the last hour
C. Intermittent bubbling in the water-seal chamber during coughing
D. Small amount of subcutaneous emphysema around the insertion site
Correct Answer: B
Q&A with Rationale | Chamberlain University
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes that the patient’s PaO2 remains low despite increasing the
fraction of inspired oxygen (FiO2) to 80%. Which pathophysiological mechanism explains this
finding?
A. Increased pulmonary compliance
B. Alveolar hypoventilation
C. Refractory hypoxemia due to intrapulmonary shunting
D. Increased dead space ventilation
Correct Answer: C
Explanation: Refractory hypoxemia is a hallmark sign of ARDS where oxygenation does
not improve with supplemental oxygen. This occurs because fluid-filled or collapsed alveoli
are unable to participate in gas exchange, leading to intrapulmonary shunting. The nurse
must recognize that increasing PEEP is often necessary to recruit alveoli and improve
oxygenation in these patients.
2. The nurse is caring for a patient on a ventilator and hears the high-pressure alarm
sounding. Which action should the nurse take first?
A. Check for a leak in the ventilator circuit
,B. Assess the patient’s breath sounds and need for suctioning
C. Call the respiratory therapist to adjust settings
D. Turn off the alarm to prevent patient anxiety
Correct Answer: B
Explanation: High-pressure alarms are triggered by increased resistance in the airway,
often caused by secretions, biting the tube, or kinked tubing. The nurse should immediately
assess the patient’s status and clear the airway if needed. This priority action ensures the
patient is safely ventilated before troubleshooting the machine further.
3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these results?
A. Uncompensated respiratory acidosis
B. Uncompensated metabolic acidosis
C. Compensated respiratory acidosis
D. Partially compensated respiratory alkalosis
Correct Answer: A
Explanation: The pH is below the normal range (7.35-7.45), indicating acidosis. The PaCO2
is elevated above the normal range (35-45 mmHg), which corresponds with the acidic pH.
Because the bicarbonate level is normal, no compensation has occurred yet, making it
uncompensated respiratory acidosis.
, 4. A patient is admitted with a suspected pulmonary embolism (PE). Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. D-dimer assay
B. Chest X-ray
C. Electrocardiogram (ECG)
D. Spiral (CT) pulmonary angiography
Correct Answer: D
Explanation: Spiral CT pulmonary angiography is the preferred and most common
diagnostic tool to visualize clots in the pulmonary vasculature. While a D-dimer is sensitive
for clotting activity, it is not specific to PE. The CT scan provides definitive evidence of the
location and extent of the embolism.
5. A nurse is monitoring a patient with a chest tube following a lobectomy. Which finding
requires immediate notification of the healthcare provider?
A. Tidaling in the water-seal chamber with respiration
B. Drainage of 250 mL of bright red blood in the last hour
C. Intermittent bubbling in the water-seal chamber during coughing
D. Small amount of subcutaneous emphysema around the insertion site
Correct Answer: B
