NUR 265 EXAM 1 COMPREHENSIVE
REVIEW QUESTIONS AND ANSWERS |
2026 UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING.
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with High-Frequency Oscillatory Ventilation. The nurse notes a sudden drop in SpO2 and
absent breath sounds on the right side. What is the priority nursing action?
A. Prepare for needle thoracostomy or chest tube insertion
B. Obtain an arterial blood gas
C. Increase the FiO2 to 100%
D. Suction the endotracheal tube
Answer: A
Conceptual Explanation: A sudden drop in oxygenation and absent breath sounds in a
patient on high-pressure ventilation suggests a tension pneumothorax, which is a medical
emergency requiring immediate decompression.
2. An elderly patient is admitted with a pH of 7.28, PaCO2 of 55 mmHg, and HCO3 of 25
mEq/L. The patient is lethargic and has weak respiratory effort. Which intervention should
the nurse anticipate first?
A. Administration of sodium bicarbonate
,B. Initiation of BiPAP or mechanical ventilation
C. Encouraging the patient to cough and deep breathe
D. Increasing IV fluid rate
Answer: B
Conceptual Explanation: The patient is in uncompensated respiratory acidosis with signs
of respiratory failure (lethargy, weak effort). BiPAP or intubation is needed to improve
ventilation and clear CO2.
3. A patient in the exudative phase of ARDS has a PaO2/FiO2 ratio of 120. Which positioning
strategy is most effective for improving oxygenation?
A. High-Fowler’s position
B. Supine position with head of bed at 30 degrees
C. Prone positioning
D. Trendelenburg position
Answer: C
Conceptual Explanation: Prone positioning helps recruit collapsed alveoli in the posterior
chest wall and improves ventilation-perfusion matching in patients with severe ARDS.
4. When assessing a patient with a chest tube following a lobectomy, the nurse notes
continuous bubbling in the water-seal chamber. What does this finding indicate?
A. There is an air leak in the system or the pleural space
, B. The system is functioning normally
C. The suction is set too high
D. The lung has fully re-expanded
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak. Intermittent bubbling is normal during expiration or coughing, but continuous
bubbling requires investigation.
5. A patient is admitted with 40% Total Body Surface Area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), calculate the fluid requirement for the first 8 hours for a patient
weighing 70kg.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 1,400 mL
Answer: B
Conceptual Explanation: Total = 4 x 70 x 40 = 11,200 mL. Half of the total (5,600 mL)
must be given in the first 8 hours.
REVIEW QUESTIONS AND ANSWERS |
2026 UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING.
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with High-Frequency Oscillatory Ventilation. The nurse notes a sudden drop in SpO2 and
absent breath sounds on the right side. What is the priority nursing action?
A. Prepare for needle thoracostomy or chest tube insertion
B. Obtain an arterial blood gas
C. Increase the FiO2 to 100%
D. Suction the endotracheal tube
Answer: A
Conceptual Explanation: A sudden drop in oxygenation and absent breath sounds in a
patient on high-pressure ventilation suggests a tension pneumothorax, which is a medical
emergency requiring immediate decompression.
2. An elderly patient is admitted with a pH of 7.28, PaCO2 of 55 mmHg, and HCO3 of 25
mEq/L. The patient is lethargic and has weak respiratory effort. Which intervention should
the nurse anticipate first?
A. Administration of sodium bicarbonate
,B. Initiation of BiPAP or mechanical ventilation
C. Encouraging the patient to cough and deep breathe
D. Increasing IV fluid rate
Answer: B
Conceptual Explanation: The patient is in uncompensated respiratory acidosis with signs
of respiratory failure (lethargy, weak effort). BiPAP or intubation is needed to improve
ventilation and clear CO2.
3. A patient in the exudative phase of ARDS has a PaO2/FiO2 ratio of 120. Which positioning
strategy is most effective for improving oxygenation?
A. High-Fowler’s position
B. Supine position with head of bed at 30 degrees
C. Prone positioning
D. Trendelenburg position
Answer: C
Conceptual Explanation: Prone positioning helps recruit collapsed alveoli in the posterior
chest wall and improves ventilation-perfusion matching in patients with severe ARDS.
4. When assessing a patient with a chest tube following a lobectomy, the nurse notes
continuous bubbling in the water-seal chamber. What does this finding indicate?
A. There is an air leak in the system or the pleural space
, B. The system is functioning normally
C. The suction is set too high
D. The lung has fully re-expanded
Answer: A
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak. Intermittent bubbling is normal during expiration or coughing, but continuous
bubbling requires investigation.
5. A patient is admitted with 40% Total Body Surface Area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), calculate the fluid requirement for the first 8 hours for a patient
weighing 70kg.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 1,400 mL
Answer: B
Conceptual Explanation: Total = 4 x 70 x 40 = 11,200 mL. Half of the total (5,600 mL)
must be given in the first 8 hours.
