1
NRNP 6550 Final Exam 200 Multiple
Choice Questions with Verified
Correct Answers and Detailed Clinical
Rationales for Advanced Practice
Adult Acute Care Success||100% pass
graded A+
SECTION 1: MECHANICAL VENTILATION AND RESPIRATORY FAILURE (Questions 1–40)
Question 1
A 72-year-old with COPD exacerbation is on BiPAP (IPAP 14, EPAP 6, FiO₂ 40%). ABG: pH 7.31,
PaCO₂ 62, PaO₂ 68, HCO₃ 30. What is the priority adjustment?
A) Increase FiO₂ to 60%
B) Increase IPAP to 18
C) Increase EPAP to 10
D) Intubate immediately
Correct Answer: B
Rationale: Increasing IPAP improves alveolar ventilation (lowers PaCO₂). EPAP helps oxygenation
(PaO₂ is acceptable). Intubation not yet indicated .
Question 2
Which ventilator setting directly affects minute ventilation?
A) PEEP
B) FiO₂
, 2
C) Tidal volume
D) I:E ratio
Correct Answer: C
Rationale: Minute ventilation = tidal volume × respiratory rate. Tidal volume directly impacts
CO₂ clearance .
Question 3
A patient on pressure control ventilation has sudden hypotension. The most likely cause is:
A) Auto-PEEP
B) Decreased FiO₂
C) Increased respiratory rate
D) Low peak pressure alarm
Correct Answer: A
Rationale: Auto-PEEP (air trapping) increases intrathoracic pressure → decreased venous return
→ hypotension .
Question 4
In ARDS, a lung-protective ventilation strategy includes:
A) Tidal volume 10–12 mL/kg IBW
B) Plateau pressure < 30 cm H₂O
C) PEEP of 0 cm H₂O
D) Respiratory rate 8 breaths/min
Correct Answer: B
Rationale: Lung-protective ventilation in ARDS targets plateau pressure < 30 cm H₂O and tidal
volume 4–6 mL/kg IBW .
Question 5
A patient on volume-controlled ventilation has a peak pressure of 45 and plateau pressure of
28. The problem is likely:
, 3
A) Decreased lung compliance
B) Increased airway resistance
C) Auto-PEEP
D) Patient-ventilator asynchrony
Correct Answer: B
Rationale: High peak with normal plateau → increased airway resistance (bronchospasm,
secretions) .
Question 6
Which mode allows spontaneous breathing with pressure support but guarantees minimum
minute ventilation?
A) SIMV
B) APRV
C) PRVC
D) NAVA
Correct Answer: A
Rationale: SIMV (synchronized intermittent mandatory ventilation) delivers set breaths + allows
spontaneous breaths .
Question 7
High PEEP is most helpful in:
A) COPD exacerbation
B) Severe ARDS with poor oxygenation
C) Asthma
D) Myasthenia gravis
Correct Answer: B
Rationale: High PEEP recruits collapsed alveoli and improves oxygenation in severe ARDS .
Question 8
, 4
Mr. Lincoln is a 55-year-old male admitted for sepsis secondary to pneumonia. Chest
radiography demonstrates a diffuse, bilateral "white-out" appearance. His PaO₂ is 55 mm Hg. To
increase oxygenation, which intervention is indicated?
A) Increased FiO₂
B) Increased respiratory rate
C) Increased tidal volume
D) Increased PEEP
Correct Answer: D
Rationale: The patient has ARDS with refractory hypoxemia. Increased PEEP recruits collapsed
alveoli and improves oxygenation .
Question 9
A patient with COPD exacerbation has ABG: pH 7.28, PaCO₂ 68, PaO₂ 58. Which intervention is
most appropriate?
A) High-flow nasal cannula at 15 L/min
B) Non-invasive positive pressure ventilation (BiPAP)
C) Immediate intubation
D) 100% FiO₂ via non-rebreather
Correct Answer: B
Rationale: BiPAP provides ventilatory support and reduces intubation rates in COPD
exacerbation with hypercapnic respiratory failure .
Question 10
A patient on mechanical ventilation has sudden desaturation to 85%. Which action should the
nurse take first?
A) Increase FiO₂ to 100%
B) Assess for tube displacement or obstruction
C) Order a stat chest X-ray
D) Suction the patient
Correct Answer: B
NRNP 6550 Final Exam 200 Multiple
Choice Questions with Verified
Correct Answers and Detailed Clinical
Rationales for Advanced Practice
Adult Acute Care Success||100% pass
graded A+
SECTION 1: MECHANICAL VENTILATION AND RESPIRATORY FAILURE (Questions 1–40)
Question 1
A 72-year-old with COPD exacerbation is on BiPAP (IPAP 14, EPAP 6, FiO₂ 40%). ABG: pH 7.31,
PaCO₂ 62, PaO₂ 68, HCO₃ 30. What is the priority adjustment?
A) Increase FiO₂ to 60%
B) Increase IPAP to 18
C) Increase EPAP to 10
D) Intubate immediately
Correct Answer: B
Rationale: Increasing IPAP improves alveolar ventilation (lowers PaCO₂). EPAP helps oxygenation
(PaO₂ is acceptable). Intubation not yet indicated .
Question 2
Which ventilator setting directly affects minute ventilation?
A) PEEP
B) FiO₂
, 2
C) Tidal volume
D) I:E ratio
Correct Answer: C
Rationale: Minute ventilation = tidal volume × respiratory rate. Tidal volume directly impacts
CO₂ clearance .
Question 3
A patient on pressure control ventilation has sudden hypotension. The most likely cause is:
A) Auto-PEEP
B) Decreased FiO₂
C) Increased respiratory rate
D) Low peak pressure alarm
Correct Answer: A
Rationale: Auto-PEEP (air trapping) increases intrathoracic pressure → decreased venous return
→ hypotension .
Question 4
In ARDS, a lung-protective ventilation strategy includes:
A) Tidal volume 10–12 mL/kg IBW
B) Plateau pressure < 30 cm H₂O
C) PEEP of 0 cm H₂O
D) Respiratory rate 8 breaths/min
Correct Answer: B
Rationale: Lung-protective ventilation in ARDS targets plateau pressure < 30 cm H₂O and tidal
volume 4–6 mL/kg IBW .
Question 5
A patient on volume-controlled ventilation has a peak pressure of 45 and plateau pressure of
28. The problem is likely:
, 3
A) Decreased lung compliance
B) Increased airway resistance
C) Auto-PEEP
D) Patient-ventilator asynchrony
Correct Answer: B
Rationale: High peak with normal plateau → increased airway resistance (bronchospasm,
secretions) .
Question 6
Which mode allows spontaneous breathing with pressure support but guarantees minimum
minute ventilation?
A) SIMV
B) APRV
C) PRVC
D) NAVA
Correct Answer: A
Rationale: SIMV (synchronized intermittent mandatory ventilation) delivers set breaths + allows
spontaneous breaths .
Question 7
High PEEP is most helpful in:
A) COPD exacerbation
B) Severe ARDS with poor oxygenation
C) Asthma
D) Myasthenia gravis
Correct Answer: B
Rationale: High PEEP recruits collapsed alveoli and improves oxygenation in severe ARDS .
Question 8
, 4
Mr. Lincoln is a 55-year-old male admitted for sepsis secondary to pneumonia. Chest
radiography demonstrates a diffuse, bilateral "white-out" appearance. His PaO₂ is 55 mm Hg. To
increase oxygenation, which intervention is indicated?
A) Increased FiO₂
B) Increased respiratory rate
C) Increased tidal volume
D) Increased PEEP
Correct Answer: D
Rationale: The patient has ARDS with refractory hypoxemia. Increased PEEP recruits collapsed
alveoli and improves oxygenation .
Question 9
A patient with COPD exacerbation has ABG: pH 7.28, PaCO₂ 68, PaO₂ 58. Which intervention is
most appropriate?
A) High-flow nasal cannula at 15 L/min
B) Non-invasive positive pressure ventilation (BiPAP)
C) Immediate intubation
D) 100% FiO₂ via non-rebreather
Correct Answer: B
Rationale: BiPAP provides ventilatory support and reduces intubation rates in COPD
exacerbation with hypercapnic respiratory failure .
Question 10
A patient on mechanical ventilation has sudden desaturation to 85%. Which action should the
nurse take first?
A) Increase FiO₂ to 100%
B) Assess for tube displacement or obstruction
C) Order a stat chest X-ray
D) Suction the patient
Correct Answer: B
