,NSG 233 Medical-Surgical Nursing III Final
Exam| Herzing | Latest 2026/2027 Update
(PDF)
1. A patient with respiratory failure is placed on mechanical ventilation. Which assessment finding
best indicates the primary indication for this intervention?
A) Respiratory rate of 28 breaths per minute
B) PaCO2 of 48 mmHg with metabolic alkalosis
C) PaO2 of 55 mmHg despite receiving supplemental oxygen
D) pH of 7.38 with normal bicarbonate
Correct Answer: PaO2 of 55 mmHg despite receiving supplemental oxygen
Rationale: The primary indication for mechanical ventilation is respiratory failure characterized by
hypoxemia (PaO2 < 60 mmHg) despite supplemental oxygen, or hypercapnia (PaCO2 > 50 mmHg) with
acidosis. A PaO2 of 55 mmHg with supplemental oxygen indicates refractory hypoxemia requiring
ventilatory support. Tachypnea alone does not mandate intubation, and a pH of 7.38 is within normal
limits.
2. A patient is prescribed BiPAP for obstructive sleep apnea. Which statement correctly describes how
BiPAP differs from CPAP?
A) BiPAP delivers a single continuous pressure throughout the respiratory cycle
B) BiPAP uses two pressures: higher during inhalation and lower during exhalation
C) BiPAP is only used for patients who are already intubated
D) BiPAP does not require a mask for delivery
Correct Answer: BiPAP uses two pressures: higher during inhalation and lower during exhalation
Rationale: Bi-level Positive Airway Pressure (BiPAP) delivers two distinct pressure levels: a higher
inspiratory positive airway pressure (IPAP) to assist inhalation and a lower expiratory positive airway
pressure (EPAP) to maintain airway patency during exhalation. CPAP delivers a single continuous
,pressure. BiPAP is a non-invasive ventilation modality used for conscious patients with sleep apnea or
respiratory distress.
3. A patient on mechanical ventilation has a peak inspiratory pressure (PIP) that has increased from 22
cm H₂O to 38 cm H₂O. Which complication should the nurse suspect?
A) Decreased airway resistance
B) Increased lung compliance
C) Increased airway resistance or decreased lung compliance
D) Rupture of the endotracheal tube cuff
Correct Answer: Increased airway resistance or decreased lung compliance
Rationale: An increase in peak inspiratory pressure (PIP) indicates increased airway resistance (e.g.,
bronchospasm, mucus plugging, kinked tube) or decreased lung compliance (e.g., ARDS, pulmonary
edema, pneumothorax). Normal PIP is 15-20 cm H₂O. The nurse should assess the patient and
ventilator system to identify the cause. Decreased airway resistance and increased lung compliance
would lower PIP.
4. A patient with ARDS is receiving mechanical ventilation with PEEP. Which adverse effect should the
nurse monitor for?
A) Increased cardiac output and hypertension
B) Decreased venous return and hypotension
C) Bronchodilation and improved oxygenation
D) Increased intracranial pressure
Correct Answer: Decreased venous return and hypotension
Rationale: PEEP increases intrathoracic pressure, which can decrease venous return to the heart,
leading to decreased cardiac output and hypotension. The nurse should monitor blood pressure and
assess for signs of decreased perfusion. PEEP does not increase cardiac output, and while it improves
oxygenation, hypotension is a significant adverse effect that requires monitoring.
, 5. A nurse is caring for a patient with a chest tube for a pneumothorax. The nurse observes
intermittent bubbling in the water seal chamber with inspiration and expiration. Which action should
the nurse take?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Document the finding as expected
D) Increase the suction pressure
Correct Answer: Document the finding as expected
Rationale: Intermittent bubbling in the water seal chamber with respiration is an expected finding,
indicating that air is being evacuated from the pleural space. Continuous bubbling indicates an air
leak. Clamping the chest tube could cause a tension pneumothorax, and increasing suction is not
indicated for intermittent bubbling.
6. A patient with a chest tube has 250 mL of sanguineous drainage in the first hour after insertion.
Which action should the nurse take?
A) Document the finding and continue monitoring
B) Notify the healthcare provider immediately
C) Empty the drainage collection chamber
D) Clamp the chest tube to prevent further drainage
Correct Answer: Notify the healthcare provider immediately
Rationale: Drainage of more than 100 mL/hour of sanguineous fluid from a chest tube indicates active
bleeding and should be reported to the provider immediately. This may indicate a complication such
as a lacerated vessel. Clamping the chest tube could cause a tension pneumothorax. Documenting
without notification is inappropriate.
7. A patient in hypovolemic shock requires fluid resuscitation. Which fluid should the nurse anticipate
administering first?
A) 5% Dextrose in Water (D5W)
Exam| Herzing | Latest 2026/2027 Update
(PDF)
1. A patient with respiratory failure is placed on mechanical ventilation. Which assessment finding
best indicates the primary indication for this intervention?
A) Respiratory rate of 28 breaths per minute
B) PaCO2 of 48 mmHg with metabolic alkalosis
C) PaO2 of 55 mmHg despite receiving supplemental oxygen
D) pH of 7.38 with normal bicarbonate
Correct Answer: PaO2 of 55 mmHg despite receiving supplemental oxygen
Rationale: The primary indication for mechanical ventilation is respiratory failure characterized by
hypoxemia (PaO2 < 60 mmHg) despite supplemental oxygen, or hypercapnia (PaCO2 > 50 mmHg) with
acidosis. A PaO2 of 55 mmHg with supplemental oxygen indicates refractory hypoxemia requiring
ventilatory support. Tachypnea alone does not mandate intubation, and a pH of 7.38 is within normal
limits.
2. A patient is prescribed BiPAP for obstructive sleep apnea. Which statement correctly describes how
BiPAP differs from CPAP?
A) BiPAP delivers a single continuous pressure throughout the respiratory cycle
B) BiPAP uses two pressures: higher during inhalation and lower during exhalation
C) BiPAP is only used for patients who are already intubated
D) BiPAP does not require a mask for delivery
Correct Answer: BiPAP uses two pressures: higher during inhalation and lower during exhalation
Rationale: Bi-level Positive Airway Pressure (BiPAP) delivers two distinct pressure levels: a higher
inspiratory positive airway pressure (IPAP) to assist inhalation and a lower expiratory positive airway
pressure (EPAP) to maintain airway patency during exhalation. CPAP delivers a single continuous
,pressure. BiPAP is a non-invasive ventilation modality used for conscious patients with sleep apnea or
respiratory distress.
3. A patient on mechanical ventilation has a peak inspiratory pressure (PIP) that has increased from 22
cm H₂O to 38 cm H₂O. Which complication should the nurse suspect?
A) Decreased airway resistance
B) Increased lung compliance
C) Increased airway resistance or decreased lung compliance
D) Rupture of the endotracheal tube cuff
Correct Answer: Increased airway resistance or decreased lung compliance
Rationale: An increase in peak inspiratory pressure (PIP) indicates increased airway resistance (e.g.,
bronchospasm, mucus plugging, kinked tube) or decreased lung compliance (e.g., ARDS, pulmonary
edema, pneumothorax). Normal PIP is 15-20 cm H₂O. The nurse should assess the patient and
ventilator system to identify the cause. Decreased airway resistance and increased lung compliance
would lower PIP.
4. A patient with ARDS is receiving mechanical ventilation with PEEP. Which adverse effect should the
nurse monitor for?
A) Increased cardiac output and hypertension
B) Decreased venous return and hypotension
C) Bronchodilation and improved oxygenation
D) Increased intracranial pressure
Correct Answer: Decreased venous return and hypotension
Rationale: PEEP increases intrathoracic pressure, which can decrease venous return to the heart,
leading to decreased cardiac output and hypotension. The nurse should monitor blood pressure and
assess for signs of decreased perfusion. PEEP does not increase cardiac output, and while it improves
oxygenation, hypotension is a significant adverse effect that requires monitoring.
, 5. A nurse is caring for a patient with a chest tube for a pneumothorax. The nurse observes
intermittent bubbling in the water seal chamber with inspiration and expiration. Which action should
the nurse take?
A) Clamp the chest tube immediately
B) Notify the healthcare provider
C) Document the finding as expected
D) Increase the suction pressure
Correct Answer: Document the finding as expected
Rationale: Intermittent bubbling in the water seal chamber with respiration is an expected finding,
indicating that air is being evacuated from the pleural space. Continuous bubbling indicates an air
leak. Clamping the chest tube could cause a tension pneumothorax, and increasing suction is not
indicated for intermittent bubbling.
6. A patient with a chest tube has 250 mL of sanguineous drainage in the first hour after insertion.
Which action should the nurse take?
A) Document the finding and continue monitoring
B) Notify the healthcare provider immediately
C) Empty the drainage collection chamber
D) Clamp the chest tube to prevent further drainage
Correct Answer: Notify the healthcare provider immediately
Rationale: Drainage of more than 100 mL/hour of sanguineous fluid from a chest tube indicates active
bleeding and should be reported to the provider immediately. This may indicate a complication such
as a lacerated vessel. Clamping the chest tube could cause a tension pneumothorax. Documenting
without notification is inappropriate.
7. A patient in hypovolemic shock requires fluid resuscitation. Which fluid should the nurse anticipate
administering first?
A) 5% Dextrose in Water (D5W)
