NUR 2755 – Multidimensional Care IV (MDC 4) Exam 2
Questions with Answers| Rasmussen University|
Updated| Pass Guaranteed
1. Which finding defines acute hypoxemic respiratory failure?
A. pH above 7.45
B. PaO2 above 80 mm Hg
C. PaO2 below 60 mm Hg on room air
D. PaCO2 below 35 mm Hg
Answer: C
Rationale: Hypoxemic (Type I) failure is a failure of oxygenation, with
PaO2 below 60 mm Hg or SpO2 below about 90%. Hypercapnic (Type II)
failure is a failure of ventilation, with PaCO2 above 50 mm Hg and pH
below 7.35.
2. ABG results: pH 7.28, PaCO2 62 mm Hg, HCO3 26 mEq/L. Which
interpretation is correct?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Uncompensated respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: A low pH with a high PaCO2 indicates respiratory acidosis. The
bicarbonate is normal, so the kidneys have not yet compensated. Use the
"ROME" approach: Respiratory Opposite, Metabolic Equal.
NUR 2755 Exam 2– Page 1
,3. ABG results: pH 7.32, PaCO2 60 mm Hg, HCO3 32 mEq/L. Which
interpretation is correct?
A. Partially compensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Uncompensated metabolic acidosis
D. Fully compensated respiratory acidosis
Answer: A
Rationale: The pH is acidotic and matches the elevated PaCO2
(respiratory cause). The elevated bicarbonate shows renal compensation,
but the pH is still outside the normal range of 7.35–7.45, so compensation
is partial. This pattern is typical of chronic COPD.
4. ABG results: pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L. What is
the MOST likely cause?
A. Diabetic ketoacidosis
B. Prolonged vomiting
C. Hyperventilation from anxiety or pain
D. Opioid overdose
Answer: C
Rationale: This is uncompensated respiratory alkalosis, from blowing off
too much CO2. Other causes include fever, early hypoxemia, and
pulmonary embolism. DKA causes metabolic acidosis, vomiting causes
metabolic alkalosis, and opioids cause respiratory acidosis.
5. ABG results: pH 7.30, PaCO2 30 mm Hg, HCO3 14 mEq/L. Which
interpretation is correct?
A. Partially compensated respiratory alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic acidosis
D. Fully compensated metabolic alkalosis
NUR 2755 Exam 2– Page 2
,Answer: C
Rationale: The low pH matches the low bicarbonate (metabolic cause).
The low PaCO2 shows the lungs are compensating by blowing off CO2, as
in Kussmaul respirations, but the pH remains abnormal.
6. Which finding is an EARLY sign of hypoxemia?
A. Cyanosis
B. Somnolence
C. Bradycardia
D. Restlessness, anxiety, and tachycardia
Answer: D
Rationale: Early hypoxemia triggers sympathetic stimulation: restlessness,
anxiety, tachycardia, and tachypnea. Cyanosis, bradycardia, and
decreased LOC are late and ominous signs.
7. A client with COPD has an SpO2 of 84% and is prescribed oxygen.
Which target SpO2 does the nurse expect?
A. Above 98%
B. 88% to 92%
C. 80% to 85%
D. 95% to 100%
Answer: B
Rationale: Clients with chronic hypercapnia are given the lowest oxygen
concentration that achieves a target of 88–92%. High-flow oxygen can
worsen V/Q mismatch and raise PaCO2, leading to somnolence and
respiratory acidosis.
NUR 2755 Exam 2– Page 3
, 8. A client with COPD on 6 L/min oxygen is increasingly drowsy. The
ABG shows pH 7.24 and PaCO2 78 mm Hg. What does the nurse
anticipate?
A. Noninvasive positive-pressure ventilation (BiPAP) with a lowered
oxygen concentration
B. Encourage the client to sleep
C. Increase the oxygen flow rate
D. Give a sedative to help the client rest
Answer: A
Rationale: Drowsiness with acute hypercapnia (CO2 narcosis) signals
ventilatory failure. BiPAP improves ventilation and eliminates CO2.
Sedatives and increased oxygen can worsen hypoventilation.
9. Which client is NOT a candidate for noninvasive positive-pressure
ventilation (BiPAP)?
A. A client who is unresponsive and actively vomiting
B. A client with COPD exacerbation who is alert
C. A client with sleep apnea who is awake
D. A client with acute cardiogenic pulmonary edema who is cooperative
Answer: A
Rationale: NIV requires a cooperative client who can protect the airway.
Decreased LOC, vomiting, facial trauma, and hemodynamic instability are
contraindications because of the risk of aspiration and treatment failure.
10. Which finding is characteristic of acute respiratory distress
syndrome (ARDS)?
A. Elevated BNP with left heart failure as the cause
B. Refractory hypoxemia that does not improve with increased oxygen,
with bilateral infiltrates
C. Hypoxemia that corrects with 2 L nasal cannula
D. Unilateral lung consolidation only
NUR 2755 Exam 2– Page 4
Questions with Answers| Rasmussen University|
Updated| Pass Guaranteed
1. Which finding defines acute hypoxemic respiratory failure?
A. pH above 7.45
B. PaO2 above 80 mm Hg
C. PaO2 below 60 mm Hg on room air
D. PaCO2 below 35 mm Hg
Answer: C
Rationale: Hypoxemic (Type I) failure is a failure of oxygenation, with
PaO2 below 60 mm Hg or SpO2 below about 90%. Hypercapnic (Type II)
failure is a failure of ventilation, with PaCO2 above 50 mm Hg and pH
below 7.35.
2. ABG results: pH 7.28, PaCO2 62 mm Hg, HCO3 26 mEq/L. Which
interpretation is correct?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Uncompensated respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: A low pH with a high PaCO2 indicates respiratory acidosis. The
bicarbonate is normal, so the kidneys have not yet compensated. Use the
"ROME" approach: Respiratory Opposite, Metabolic Equal.
NUR 2755 Exam 2– Page 1
,3. ABG results: pH 7.32, PaCO2 60 mm Hg, HCO3 32 mEq/L. Which
interpretation is correct?
A. Partially compensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Uncompensated metabolic acidosis
D. Fully compensated respiratory acidosis
Answer: A
Rationale: The pH is acidotic and matches the elevated PaCO2
(respiratory cause). The elevated bicarbonate shows renal compensation,
but the pH is still outside the normal range of 7.35–7.45, so compensation
is partial. This pattern is typical of chronic COPD.
4. ABG results: pH 7.50, PaCO2 30 mm Hg, HCO3 24 mEq/L. What is
the MOST likely cause?
A. Diabetic ketoacidosis
B. Prolonged vomiting
C. Hyperventilation from anxiety or pain
D. Opioid overdose
Answer: C
Rationale: This is uncompensated respiratory alkalosis, from blowing off
too much CO2. Other causes include fever, early hypoxemia, and
pulmonary embolism. DKA causes metabolic acidosis, vomiting causes
metabolic alkalosis, and opioids cause respiratory acidosis.
5. ABG results: pH 7.30, PaCO2 30 mm Hg, HCO3 14 mEq/L. Which
interpretation is correct?
A. Partially compensated respiratory alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic acidosis
D. Fully compensated metabolic alkalosis
NUR 2755 Exam 2– Page 2
,Answer: C
Rationale: The low pH matches the low bicarbonate (metabolic cause).
The low PaCO2 shows the lungs are compensating by blowing off CO2, as
in Kussmaul respirations, but the pH remains abnormal.
6. Which finding is an EARLY sign of hypoxemia?
A. Cyanosis
B. Somnolence
C. Bradycardia
D. Restlessness, anxiety, and tachycardia
Answer: D
Rationale: Early hypoxemia triggers sympathetic stimulation: restlessness,
anxiety, tachycardia, and tachypnea. Cyanosis, bradycardia, and
decreased LOC are late and ominous signs.
7. A client with COPD has an SpO2 of 84% and is prescribed oxygen.
Which target SpO2 does the nurse expect?
A. Above 98%
B. 88% to 92%
C. 80% to 85%
D. 95% to 100%
Answer: B
Rationale: Clients with chronic hypercapnia are given the lowest oxygen
concentration that achieves a target of 88–92%. High-flow oxygen can
worsen V/Q mismatch and raise PaCO2, leading to somnolence and
respiratory acidosis.
NUR 2755 Exam 2– Page 3
, 8. A client with COPD on 6 L/min oxygen is increasingly drowsy. The
ABG shows pH 7.24 and PaCO2 78 mm Hg. What does the nurse
anticipate?
A. Noninvasive positive-pressure ventilation (BiPAP) with a lowered
oxygen concentration
B. Encourage the client to sleep
C. Increase the oxygen flow rate
D. Give a sedative to help the client rest
Answer: A
Rationale: Drowsiness with acute hypercapnia (CO2 narcosis) signals
ventilatory failure. BiPAP improves ventilation and eliminates CO2.
Sedatives and increased oxygen can worsen hypoventilation.
9. Which client is NOT a candidate for noninvasive positive-pressure
ventilation (BiPAP)?
A. A client who is unresponsive and actively vomiting
B. A client with COPD exacerbation who is alert
C. A client with sleep apnea who is awake
D. A client with acute cardiogenic pulmonary edema who is cooperative
Answer: A
Rationale: NIV requires a cooperative client who can protect the airway.
Decreased LOC, vomiting, facial trauma, and hemodynamic instability are
contraindications because of the risk of aspiration and treatment failure.
10. Which finding is characteristic of acute respiratory distress
syndrome (ARDS)?
A. Elevated BNP with left heart failure as the cause
B. Refractory hypoxemia that does not improve with increased oxygen,
with bilateral infiltrates
C. Hypoxemia that corrects with 2 L nasal cannula
D. Unilateral lung consolidation only
NUR 2755 Exam 2– Page 4
