PCCN|VERIFIED QUESTIONS AND CORRECT DETAILED ANSWERS|RATED AND
GRADED A+ NEW UPDATE| 2026/2027
Your patient had an exacerbation of COPD. The rapid response team was called and is currently
intubating the patient and preparing him for transfer to ICU. When the family visits, they are shocked to
see the people working with the patient. No one had told them the patient had deteriorated and
required intubation. After the patient is intubated and is being wheeled past them, family members try
to communicate verbally with the patient, but he does not respond except to gesture. The nurse should
tell the family members:
-They must leave the area because they are exciting the patient.
-The tube used for breathing prevents the patient from speaking
-They must speak with the doctor, who will explain why the patient cannot speak
-The patient is very ill and may die. - ANSWER✔ The tube used for breathing prevents the patient
from speaking
This is a case where communication is clearly the problem. The family should have been informed by
someone that the patient needed assistance with breathing and that they should expect a transfer. It
should also have been mentioned how the patient might look in the ICU. In addition, it could have been
communicated about the patient's inability to speak.
The other answers are all non-theraputic responses. The family is clearly distressed, so a simple
explaination in best.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. Ben states, "I
can't be here now. What if something like this happens to me again?" The nurse's best response would
be:
-The nurses in our unit can take care of you
-We are not very far away at the nurses' station
-Your insurance will not cover another day there
-You sound concerned about leaving the ICU - ANSWER✔ You sound concerned about leaving the ICU
,Theraputic communication occurs when the patient's feelings are validated. This response allows for the
patient to express the concerns he has about the transfer. The other answers are closed and judgmental
and do not allow for any expression of feeling from the patient.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. A set of blood
gases drawn just prior to his transfer show:
pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
These results would indicate:
-Respiratory acidosis
-Respiratory alkalosis
-Metabloic acidosis
-Metabolic alkalosis - ANSWER✔ Respiratory alkalosis
Ben was quite anxious and tachycardic. His RR probably was increased because of both anxiety and his
condition.
He would blow off CO2.
His pH is below normal, so it is uncompensated.
The HCO3 is low, indicating alkalosis
The interpretation would be:
Uncompensated Respiratory Alkolosis
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. Ben is finally
released from the hospital. He plans to visit his family in Denver. Part of the patient teaching for Ben
should include information on the effects of high altitude on his ability to oxygenate effectively. Which
of the following changes would be expected on his blood gas results?
,-The pH would decrease
-No effect
-The O2 saturation would decrease
-The PaO2 would increase - ANSWER✔ The O2 saturation would decrease
At higher altitudes, there is decreased atmospheric pressure to force oxygen into the lungs. To
compensate for the lower pressure, the person must breathe faster. The percentage of oxygen remains
the same, but the partial pressure of the oxygen decreases. Aterial PaO2 decreases, as does O2
saturation. The rapid breathing will result in hyperventillation, raising the pH and lowering the PaCO2
level.
SaO2 values account for what % of O2 carreid within the bloodstream?
-2-3%
-10-24%
-97-98%
-100% - ANSWER✔ 97-98%
The % of total oxygen carried within the bloodstream attributed to the SaO2 is 97-98%.
SaO2 is the arterial saturation of hemoglobin. The % corresponds to the % of hemoglobin on the red
blood cells that carries O2. Typically this % is documented as normal when within 93-99%.
PaO2 is the % of O2 within the bloodstream that is free or dissolved in the plasma. This value is
documented in mmHg and is considered normal when within the range of 80-100 mmHg.
Hypoxemia is best defined as:
-A decrease in O2 at the cellular level
-A decrease in O2 levels in arterial blood
-A decrease in O2 levels in venous blood
-A decrease in O2 levels from the brain - ANSWER✔ A decrease in O2 levels in arterial blood
, Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg.
Hypoxia is defined as a decreased oxygen level at the cellular level.
Decreased O2 levels within veins refer to PaO2 < 50mmHg
Decreased O2 levels within the brain refer to ScVO2 < 20
Your patient has been diagnosed with pulmonary HTN. Which of the following compensatory
mechanisms would be expected if the patient suffered from chronic hypoxia?
-Polycythemia
-Hypoplasia of the pulmonary vasculature
-Thinning of blood vessels in the lungs
-Cor pulmonale - ANSWER✔ Polycythemia
Effects of acute hypoxia are reversible.
Chronic hypoxia causes permanent changes in the lungs and pulmonary vasculature (hyperplasia and
hypertrophy). This will cause thickening of the blood vessels and will narrow the lumen.
Polycythemia develops and the blood viscosity increases. The increased number of cells will be available
to carry O2 but the increased viscosity will increase pressure in the pulmonary vasculature and force the
right ventricle to pump harder to maintain the CO level. The right venticle will hypertrophy and
eventually weaken, and the patient will develop right heart failure (cor pulmonale).
Type II alveolar cells produce:
-Macrocytes
-Phagocytes
-Surfactant
-CO2 - ANSWER✔ Surfactant
Surfactant is a lipoprotein that functions by increasing surface tension of alveoli and allow alveoli to
expand and contract. Some residual pressure should be present in the alveoli at the end of respiration to
GRADED A+ NEW UPDATE| 2026/2027
Your patient had an exacerbation of COPD. The rapid response team was called and is currently
intubating the patient and preparing him for transfer to ICU. When the family visits, they are shocked to
see the people working with the patient. No one had told them the patient had deteriorated and
required intubation. After the patient is intubated and is being wheeled past them, family members try
to communicate verbally with the patient, but he does not respond except to gesture. The nurse should
tell the family members:
-They must leave the area because they are exciting the patient.
-The tube used for breathing prevents the patient from speaking
-They must speak with the doctor, who will explain why the patient cannot speak
-The patient is very ill and may die. - ANSWER✔ The tube used for breathing prevents the patient
from speaking
This is a case where communication is clearly the problem. The family should have been informed by
someone that the patient needed assistance with breathing and that they should expect a transfer. It
should also have been mentioned how the patient might look in the ICU. In addition, it could have been
communicated about the patient's inability to speak.
The other answers are all non-theraputic responses. The family is clearly distressed, so a simple
explaination in best.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. Ben states, "I
can't be here now. What if something like this happens to me again?" The nurse's best response would
be:
-The nurses in our unit can take care of you
-We are not very far away at the nurses' station
-Your insurance will not cover another day there
-You sound concerned about leaving the ICU - ANSWER✔ You sound concerned about leaving the ICU
,Theraputic communication occurs when the patient's feelings are validated. This response allows for the
patient to express the concerns he has about the transfer. The other answers are closed and judgmental
and do not allow for any expression of feeling from the patient.
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. A set of blood
gases drawn just prior to his transfer show:
pH 7.52, PaCO2 31, HCO3 22, PaO2 87.
These results would indicate:
-Respiratory acidosis
-Respiratory alkalosis
-Metabloic acidosis
-Metabolic alkalosis - ANSWER✔ Respiratory alkalosis
Ben was quite anxious and tachycardic. His RR probably was increased because of both anxiety and his
condition.
He would blow off CO2.
His pH is below normal, so it is uncompensated.
The HCO3 is low, indicating alkalosis
The interpretation would be:
Uncompensated Respiratory Alkolosis
Ben was just transferred to the PCU. He had been in ICU for 2 weeks. Ben was intubated for a time
because of his ARDs. On arrival to your unit, you note that he is tachycardic and restless. Ben is finally
released from the hospital. He plans to visit his family in Denver. Part of the patient teaching for Ben
should include information on the effects of high altitude on his ability to oxygenate effectively. Which
of the following changes would be expected on his blood gas results?
,-The pH would decrease
-No effect
-The O2 saturation would decrease
-The PaO2 would increase - ANSWER✔ The O2 saturation would decrease
At higher altitudes, there is decreased atmospheric pressure to force oxygen into the lungs. To
compensate for the lower pressure, the person must breathe faster. The percentage of oxygen remains
the same, but the partial pressure of the oxygen decreases. Aterial PaO2 decreases, as does O2
saturation. The rapid breathing will result in hyperventillation, raising the pH and lowering the PaCO2
level.
SaO2 values account for what % of O2 carreid within the bloodstream?
-2-3%
-10-24%
-97-98%
-100% - ANSWER✔ 97-98%
The % of total oxygen carried within the bloodstream attributed to the SaO2 is 97-98%.
SaO2 is the arterial saturation of hemoglobin. The % corresponds to the % of hemoglobin on the red
blood cells that carries O2. Typically this % is documented as normal when within 93-99%.
PaO2 is the % of O2 within the bloodstream that is free or dissolved in the plasma. This value is
documented in mmHg and is considered normal when within the range of 80-100 mmHg.
Hypoxemia is best defined as:
-A decrease in O2 at the cellular level
-A decrease in O2 levels in arterial blood
-A decrease in O2 levels in venous blood
-A decrease in O2 levels from the brain - ANSWER✔ A decrease in O2 levels in arterial blood
, Hypoxemia is a decrease in O2 levels in arterial blood or PaO2 < 80 mmHg.
Hypoxia is defined as a decreased oxygen level at the cellular level.
Decreased O2 levels within veins refer to PaO2 < 50mmHg
Decreased O2 levels within the brain refer to ScVO2 < 20
Your patient has been diagnosed with pulmonary HTN. Which of the following compensatory
mechanisms would be expected if the patient suffered from chronic hypoxia?
-Polycythemia
-Hypoplasia of the pulmonary vasculature
-Thinning of blood vessels in the lungs
-Cor pulmonale - ANSWER✔ Polycythemia
Effects of acute hypoxia are reversible.
Chronic hypoxia causes permanent changes in the lungs and pulmonary vasculature (hyperplasia and
hypertrophy). This will cause thickening of the blood vessels and will narrow the lumen.
Polycythemia develops and the blood viscosity increases. The increased number of cells will be available
to carry O2 but the increased viscosity will increase pressure in the pulmonary vasculature and force the
right ventricle to pump harder to maintain the CO level. The right venticle will hypertrophy and
eventually weaken, and the patient will develop right heart failure (cor pulmonale).
Type II alveolar cells produce:
-Macrocytes
-Phagocytes
-Surfactant
-CO2 - ANSWER✔ Surfactant
Surfactant is a lipoprotein that functions by increasing surface tension of alveoli and allow alveoli to
expand and contract. Some residual pressure should be present in the alveoli at the end of respiration to
