,Arizona College NUR 445 Exam 2 | Acute & Chronic
Health Disruptions Adults III (2026) Q&A
1. A nurse is caring for a client with a new onset of confusion and an oxygen saturation of
82% on room air. Which action should the nurse take first?
A) Administer a prescribed sedative
B) Apply supplemental oxygen and assess airway patency
C) Obtain a blood glucose level
D) Document the finding and reassess in one hour
Correct Answer: Apply supplemental oxygen and assess airway patency
Rationale: New-onset confusion with severe hypoxemia indicates inadequate oxygen
delivery to the brain. Airway and breathing are the priority. Administering a sedative would
worsen the condition, and delaying intervention could lead to further deterioration.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
85% on 2 L/min via nasal cannula. Which assessment finding requires immediate
intervention?
A) Respiratory rate of 24 breaths/min
B) Use of accessory muscles
C) Increasing lethargy and confusion
D) PaCO2 of 50 mm Hg
Correct Answer: Increasing lethargy and confusion
Rationale: Lethargy and confusion in a client with COPD may indicate worsening
hypercapnia and impending respiratory failure. While an elevated PaCO2 is expected in
,chronic CO2 retainers, a change in mental status signals decompensation requiring
immediate intervention.
3. Which of the following is the primary purpose of positive end-expiratory pressure
(PEEP) in mechanical ventilation?
A) To increase tidal volume
B) To prevent alveolar collapse and improve oxygenation
C) To decrease the respiratory rate
D) To reduce the work of breathing
Correct Answer: To prevent alveolar collapse and improve oxygenation
Rationale: PEEP maintains positive pressure in the airways at the end of expiration,
preventing alveolar collapse and improving oxygenation by keeping the alveoli open. It does
not directly increase tidal volume or decrease respiratory rate.
4. A client with acute respiratory distress syndrome (ARDS) is being mechanically
ventilated. Which ventilator strategy is recommended to reduce mortality?
A) High tidal volumes
B) Low tidal volumes (6 mL/kg of predicted body weight)
C) High respiratory rates
D) Zero PEEP
Correct Answer: Low tidal volumes (6 mL/kg of predicted body weight)
Rationale: Low tidal volume ventilation (6 mL/kg of predicted body weight) is
recommended for clients with ARDS to reduce ventilator-induced lung injury and mortality.
High tidal volumes can cause barotrauma, and zero PEEP can lead to alveolar collapse.
, 5. Which finding is the earliest indicator of ARDS?
A) Presence of inspiratory crackles
B) Increased respiratory rate and dyspnea
C) Decreased PaO2 despite supplemental oxygen
D) Bilateral infiltrates on chest x-ray
Correct Answer: Increased respiratory rate and dyspnea
Rationale: The earliest indicator of ARDS is increased respiratory rate and dyspnea, often
occurring before changes in oxygenation or chest x-ray findings. As the condition
progresses, refractory hypoxemia and bilateral infiltrates develop.
6. A nurse is caring for a client with a chest tube. Which finding indicates that the chest tube
is functioning properly?
A) Continuous bubbling in the water-seal chamber
B) Fluctuation of the fluid level in the water-seal chamber with respirations
C) Absence of drainage in the collection chamber
D) Continuous bubbling in the suction control chamber
Correct Answer: Fluctuation of the fluid level in the water-seal chamber with
respirations
Rationale: Fluctuation (tidaling) in the water-seal chamber with respirations indicates
that the chest tube is patent and communicating with the pleural space. Continuous
bubbling in the water-seal chamber indicates an air leak.
Health Disruptions Adults III (2026) Q&A
1. A nurse is caring for a client with a new onset of confusion and an oxygen saturation of
82% on room air. Which action should the nurse take first?
A) Administer a prescribed sedative
B) Apply supplemental oxygen and assess airway patency
C) Obtain a blood glucose level
D) Document the finding and reassess in one hour
Correct Answer: Apply supplemental oxygen and assess airway patency
Rationale: New-onset confusion with severe hypoxemia indicates inadequate oxygen
delivery to the brain. Airway and breathing are the priority. Administering a sedative would
worsen the condition, and delaying intervention could lead to further deterioration.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
85% on 2 L/min via nasal cannula. Which assessment finding requires immediate
intervention?
A) Respiratory rate of 24 breaths/min
B) Use of accessory muscles
C) Increasing lethargy and confusion
D) PaCO2 of 50 mm Hg
Correct Answer: Increasing lethargy and confusion
Rationale: Lethargy and confusion in a client with COPD may indicate worsening
hypercapnia and impending respiratory failure. While an elevated PaCO2 is expected in
,chronic CO2 retainers, a change in mental status signals decompensation requiring
immediate intervention.
3. Which of the following is the primary purpose of positive end-expiratory pressure
(PEEP) in mechanical ventilation?
A) To increase tidal volume
B) To prevent alveolar collapse and improve oxygenation
C) To decrease the respiratory rate
D) To reduce the work of breathing
Correct Answer: To prevent alveolar collapse and improve oxygenation
Rationale: PEEP maintains positive pressure in the airways at the end of expiration,
preventing alveolar collapse and improving oxygenation by keeping the alveoli open. It does
not directly increase tidal volume or decrease respiratory rate.
4. A client with acute respiratory distress syndrome (ARDS) is being mechanically
ventilated. Which ventilator strategy is recommended to reduce mortality?
A) High tidal volumes
B) Low tidal volumes (6 mL/kg of predicted body weight)
C) High respiratory rates
D) Zero PEEP
Correct Answer: Low tidal volumes (6 mL/kg of predicted body weight)
Rationale: Low tidal volume ventilation (6 mL/kg of predicted body weight) is
recommended for clients with ARDS to reduce ventilator-induced lung injury and mortality.
High tidal volumes can cause barotrauma, and zero PEEP can lead to alveolar collapse.
, 5. Which finding is the earliest indicator of ARDS?
A) Presence of inspiratory crackles
B) Increased respiratory rate and dyspnea
C) Decreased PaO2 despite supplemental oxygen
D) Bilateral infiltrates on chest x-ray
Correct Answer: Increased respiratory rate and dyspnea
Rationale: The earliest indicator of ARDS is increased respiratory rate and dyspnea, often
occurring before changes in oxygenation or chest x-ray findings. As the condition
progresses, refractory hypoxemia and bilateral infiltrates develop.
6. A nurse is caring for a client with a chest tube. Which finding indicates that the chest tube
is functioning properly?
A) Continuous bubbling in the water-seal chamber
B) Fluctuation of the fluid level in the water-seal chamber with respirations
C) Absence of drainage in the collection chamber
D) Continuous bubbling in the suction control chamber
Correct Answer: Fluctuation of the fluid level in the water-seal chamber with
respirations
Rationale: Fluctuation (tidaling) in the water-seal chamber with respirations indicates
that the chest tube is patent and communicating with the pleural space. Continuous
bubbling in the water-seal chamber indicates an air leak.
