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NCLEX RN Exam Bank: Respiratory Dysfunction, ARDS, COPD
Management & Ventilator Care
Table of Contents
Subtopic 1: Acute Respiratory Distress Syndrome (ARDS), Recognition, Pathophysiology,
and Early Interventions .................................................................................................. 2
Subtopic 2: COPD Management—Exacerbations, Long-Term Care, and Patient Teaching . 10
Subtopic 3: Mechanical Ventilation—Settings, Weaning, and Complications .................. 19
Subtopic 4: COPD & ARDS Pharmacologic Interventions—Inhalers, Steroids, and Sedatives
.................................................................................................................................. 28
Subtopic 5: Mechanical Ventilation—Modes, Monitoring & Troubleshooting (Questions 81–
100) ........................................................................................................................... 36
Subtopic 6: Mechanical Ventilation Complications and Alarms (Q101–Q120) .................. 44
Subtopic 7: Pulmonary Embolism Recognition, Oxygenation Crisis, and Emergency
Interventions .............................................................................................................. 52
Subtopic 8: Ventilator-Associated Pneumonia (VAP) Prevention and Early Detection........ 60
Subtopic 9: Oxygenation Devices, Airway Clearance & Humidification Therapies ............. 67
Subtopic 10: Patient & Family Education, Discharge Planning, and Community Resources
.................................................................................................................................. 76
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Subtopic 1: Acute Respiratory Distress Syndrome (ARDS),
Recognition, Pathophysiology, and Early Interventions
Question 1
A patient with severe pneumonia suddenly develops increasing oxygen requirements and
bilateral infiltrates on chest X-ray. The nurse suspects ARDS. Which pathophysiological
change primarily underlies ARDS?
A. Increased pulmonary capillary oncotic pressure
B. Increased alveolar-capillary membrane permeability
C. Decreased intrapleural pressure
D. Bronchial smooth muscle constriction
Correct Answer: B
Rationale: ARDS is characterized by damage to the alveolar-capillary membrane, leading to
increased permeability and fluid leakage into the alveoli, impairing gas exchange.
Question 2
Which is an early clinical manifestation of ARDS in a patient admitted with sepsis?
A. Bradycardia
B. Hemoptysis
C. Refractory hypoxemia
D. Hyperresonance on percussion
Correct Answer: C
Rationale: Refractory hypoxemia—low oxygen levels unresponsive to oxygen therapy—is a
hallmark of ARDS and appears early in the course of illness.
Question 3
, 3
The nurse is caring for a patient with early ARDS. Which position helps improve oxygenation
by promoting ventilation-perfusion matching?
A. High Fowler's
B. Prone
C. Sims' position
D. Supine with head flat
Correct Answer: B
Rationale: Prone positioning in ARDS improves oxygenation by enhancing alveolar
recruitment in the dorsal lung regions and reducing shunting.
Question 4
Which diagnostic test confirms the presence of ARDS in a patient with acute respiratory
failure?
A. Sputum culture
B. Pulmonary angiogram
C. Chest X-ray showing bilateral infiltrates
D. Arterial line waveform
Correct Answer: C
Rationale: A chest X-ray in ARDS typically shows diffuse bilateral infiltrates, consistent with
pulmonary edema not due to cardiac causes.
Question 5
A patient with ARDS is intubated and on mechanical ventilation. Which ventilator setting is
critical to prevent further lung injury?
A. Increased tidal volume
, 4
B. Low tidal volume ventilation (lung protective strategy)
C. High FiO₂
D. Increased PEEP to 20 cm H₂O
Correct Answer: B
Rationale: Low tidal volume (e.g., 6 mL/kg) ventilation helps prevent barotrauma and
volutrauma in ARDS patients, preserving lung integrity.
Question 6
Which lab value indicates worsening oxygenation in an ARDS patient?
A. Decreased WBC count
B. PaO₂/FiO₂ ratio < 200
C. Elevated hemoglobin
D. Increased serum sodium
Correct Answer: B
Rationale: A PaO₂/FiO₂ ratio < 200 is a diagnostic criterion for ARDS and signals significant
hypoxemia.
Question 7
Which inflammatory mediator is involved in the pathogenesis of ARDS?
A. Erythropoietin
B. Interleukin-6 (IL-6)
C. Thyroxine
D. Insulin
Correct Answer: B
NCLEX RN Exam Bank: Respiratory Dysfunction, ARDS, COPD
Management & Ventilator Care
Table of Contents
Subtopic 1: Acute Respiratory Distress Syndrome (ARDS), Recognition, Pathophysiology,
and Early Interventions .................................................................................................. 2
Subtopic 2: COPD Management—Exacerbations, Long-Term Care, and Patient Teaching . 10
Subtopic 3: Mechanical Ventilation—Settings, Weaning, and Complications .................. 19
Subtopic 4: COPD & ARDS Pharmacologic Interventions—Inhalers, Steroids, and Sedatives
.................................................................................................................................. 28
Subtopic 5: Mechanical Ventilation—Modes, Monitoring & Troubleshooting (Questions 81–
100) ........................................................................................................................... 36
Subtopic 6: Mechanical Ventilation Complications and Alarms (Q101–Q120) .................. 44
Subtopic 7: Pulmonary Embolism Recognition, Oxygenation Crisis, and Emergency
Interventions .............................................................................................................. 52
Subtopic 8: Ventilator-Associated Pneumonia (VAP) Prevention and Early Detection........ 60
Subtopic 9: Oxygenation Devices, Airway Clearance & Humidification Therapies ............. 67
Subtopic 10: Patient & Family Education, Discharge Planning, and Community Resources
.................................................................................................................................. 76
, 2
Subtopic 1: Acute Respiratory Distress Syndrome (ARDS),
Recognition, Pathophysiology, and Early Interventions
Question 1
A patient with severe pneumonia suddenly develops increasing oxygen requirements and
bilateral infiltrates on chest X-ray. The nurse suspects ARDS. Which pathophysiological
change primarily underlies ARDS?
A. Increased pulmonary capillary oncotic pressure
B. Increased alveolar-capillary membrane permeability
C. Decreased intrapleural pressure
D. Bronchial smooth muscle constriction
Correct Answer: B
Rationale: ARDS is characterized by damage to the alveolar-capillary membrane, leading to
increased permeability and fluid leakage into the alveoli, impairing gas exchange.
Question 2
Which is an early clinical manifestation of ARDS in a patient admitted with sepsis?
A. Bradycardia
B. Hemoptysis
C. Refractory hypoxemia
D. Hyperresonance on percussion
Correct Answer: C
Rationale: Refractory hypoxemia—low oxygen levels unresponsive to oxygen therapy—is a
hallmark of ARDS and appears early in the course of illness.
Question 3
, 3
The nurse is caring for a patient with early ARDS. Which position helps improve oxygenation
by promoting ventilation-perfusion matching?
A. High Fowler's
B. Prone
C. Sims' position
D. Supine with head flat
Correct Answer: B
Rationale: Prone positioning in ARDS improves oxygenation by enhancing alveolar
recruitment in the dorsal lung regions and reducing shunting.
Question 4
Which diagnostic test confirms the presence of ARDS in a patient with acute respiratory
failure?
A. Sputum culture
B. Pulmonary angiogram
C. Chest X-ray showing bilateral infiltrates
D. Arterial line waveform
Correct Answer: C
Rationale: A chest X-ray in ARDS typically shows diffuse bilateral infiltrates, consistent with
pulmonary edema not due to cardiac causes.
Question 5
A patient with ARDS is intubated and on mechanical ventilation. Which ventilator setting is
critical to prevent further lung injury?
A. Increased tidal volume
, 4
B. Low tidal volume ventilation (lung protective strategy)
C. High FiO₂
D. Increased PEEP to 20 cm H₂O
Correct Answer: B
Rationale: Low tidal volume (e.g., 6 mL/kg) ventilation helps prevent barotrauma and
volutrauma in ARDS patients, preserving lung integrity.
Question 6
Which lab value indicates worsening oxygenation in an ARDS patient?
A. Decreased WBC count
B. PaO₂/FiO₂ ratio < 200
C. Elevated hemoglobin
D. Increased serum sodium
Correct Answer: B
Rationale: A PaO₂/FiO₂ ratio < 200 is a diagnostic criterion for ARDS and signals significant
hypoxemia.
Question 7
Which inflammatory mediator is involved in the pathogenesis of ARDS?
A. Erythropoietin
B. Interleukin-6 (IL-6)
C. Thyroxine
D. Insulin
Correct Answer: B
