NRNP 6566 Week 4 Quiz V1 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 4 Quiz) | Walden University
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 26 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH level is below 7.35, indicating a state of acidosis. Since the PaCO2 is
elevated above the normal range of 45 mmHg and the bicarbonate is relatively normal, the
primary cause is respiratory. This condition is often seen in clinical practice during acute
respiratory failure where CO2 retention occurs.
2. When managing a patient with an acute exacerbation of COPD, what is the initial
recommended goal for oxygen saturation (SpO2)?
A. 94% to 98%
B. 92% to 100%
,C. 90% to 95%
D. 88% to 92%
Answer: D
Rationale: Patients with chronic obstructive pulmonary disease are often chronic CO2
retainers who rely on a hypoxic drive to breathe. Providing excessive oxygen can suppress
this drive and lead to worsening hypercapnia. Maintaining a target range of 88% to 92%
balances oxygenation while minimizing the risk of respiratory depression.
3. A patient on a mechanical ventilator has a sudden high-pressure alarm. Which of the
following is a possible cause?
A. Circuit disconnection
B. Cuff leak
C. Secretions in the airway
D. Extubation
Answer: C
Rationale: High-pressure alarms are triggered when the ventilator meets resistance that
exceeds the set pressure limit. Common causes include secretions, bronchospasm, or the
patient biting the endotracheal tube. In contrast, circuit disconnections and leaks typically
trigger low-pressure alarms.
, 4. What is considered the gold standard for diagnosing a pulmonary embolism (PE)?
A. Computed Tomographic Pulmonary Angiography (CTPA)
B. D-dimer assay
C. Ventilation-Perfusion (V/Q) scan
D. Chest X-ray
Answer: A
Rationale: CTPA is currently the preferred imaging modality because of its high sensitivity
and specificity in detecting thrombi within the pulmonary vasculature. While a V/Q scan
can be used if CT is contraindicated, it is often less definitive. A D-dimer is useful for ruling
out PE in low-risk patients but is not diagnostic on its own.
5. Which clinical finding is most suggestive of a tension pneumothorax?
A. Decreased tactile fremitus
B. Crackles on auscultation
C. Dullness to percussion
D. Tracheal deviation to the contralateral side
Answer: D
Rationale: A tension pneumothorax occurs when air enters the pleural space but cannot
escape, leading to increased intrathoracic pressure. This pressure causes a mediastinal
shift, which manifests clinically as tracheal deviation away from the affected side. This is a
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 4 Quiz) | Walden University
1. A patient presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 26 mEq/L. Which
acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH level is below 7.35, indicating a state of acidosis. Since the PaCO2 is
elevated above the normal range of 45 mmHg and the bicarbonate is relatively normal, the
primary cause is respiratory. This condition is often seen in clinical practice during acute
respiratory failure where CO2 retention occurs.
2. When managing a patient with an acute exacerbation of COPD, what is the initial
recommended goal for oxygen saturation (SpO2)?
A. 94% to 98%
B. 92% to 100%
,C. 90% to 95%
D. 88% to 92%
Answer: D
Rationale: Patients with chronic obstructive pulmonary disease are often chronic CO2
retainers who rely on a hypoxic drive to breathe. Providing excessive oxygen can suppress
this drive and lead to worsening hypercapnia. Maintaining a target range of 88% to 92%
balances oxygenation while minimizing the risk of respiratory depression.
3. A patient on a mechanical ventilator has a sudden high-pressure alarm. Which of the
following is a possible cause?
A. Circuit disconnection
B. Cuff leak
C. Secretions in the airway
D. Extubation
Answer: C
Rationale: High-pressure alarms are triggered when the ventilator meets resistance that
exceeds the set pressure limit. Common causes include secretions, bronchospasm, or the
patient biting the endotracheal tube. In contrast, circuit disconnections and leaks typically
trigger low-pressure alarms.
, 4. What is considered the gold standard for diagnosing a pulmonary embolism (PE)?
A. Computed Tomographic Pulmonary Angiography (CTPA)
B. D-dimer assay
C. Ventilation-Perfusion (V/Q) scan
D. Chest X-ray
Answer: A
Rationale: CTPA is currently the preferred imaging modality because of its high sensitivity
and specificity in detecting thrombi within the pulmonary vasculature. While a V/Q scan
can be used if CT is contraindicated, it is often less definitive. A D-dimer is useful for ruling
out PE in low-risk patients but is not diagnostic on its own.
5. Which clinical finding is most suggestive of a tension pneumothorax?
A. Decreased tactile fremitus
B. Crackles on auscultation
C. Dullness to percussion
D. Tracheal deviation to the contralateral side
Answer: D
Rationale: A tension pneumothorax occurs when air enters the pleural space but cannot
escape, leading to increased intrathoracic pressure. This pressure causes a mediastinal
shift, which manifests clinically as tracheal deviation away from the affected side. This is a
