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RNSG 1128 EXAM 2 GAS EXCHANGE Final Exam
Newest Exam Preparation With Complete Questions
And Correct Answers With Rationales | Already
Graded A+||Brand New Version!!
1. A client with chronic obstructive pulmonary disease (COPD) is
exhibiting signs of respiratory acidosis. Which of the following
pathophysiological mechanisms is the primary contributor to this acid-
base imbalance?
A) Increased excretion of bicarbonate by the kidneys
B) Hyperventilation leading to a rapid loss of carbon dioxide
C) Hypoventilation resulting in an accumulation of carbon dioxide
D) Overproduction of metabolic acids due to tissue hypoxia
Answer: C
Explanation: Respiratory acidosis is primarily caused by alveolar
hypoventilation, which leads to an accumulation of carbon dioxide
(CO2) in the blood. CO2 combines with water to form carbonic acid,
thus lowering the pH. In COPD, airway obstruction and decreased lung
elasticity impair the ability to effectively exhale CO2. Option A would
lead to metabolic acidosis. Option B describes respiratory alkalosis.
Option D describes metabolic acidosis.
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2. A nurse is assessing a patient who has just been extubated after a
period of mechanical ventilation. Which of the following assessment
findings would be of greatest concern indicating a potential for
immediate respiratory compromise?
A) Hoarseness and a sore throat
B) Stridor and intercostal retractions
C) Mild anxiety and restlessness
D) Frequent swallowing and coughing
Answer: B
Explanation: Stridor (a high-pitched inspiratory sound) and intercostal
retractions are classic signs of upper airway obstruction and increased
work of breathing, which can indicate laryngeal edema or spasm post-
extubation. This represents an immediate threat to gas exchange and
requires prompt intervention. Hoarseness and a sore throat are
expected findings after extubation. Mild anxiety and restlessness can be
signs of hypoxia, but stridor and retractions are more specific and
immediate indicators of mechanical obstruction.
3. A patient with a history of heart failure is receiving supplemental
oxygen via nasal cannula at 2 L/min. The nurse notes that the patient's
oxygen saturation has dropped from 94% to 88% over the last hour.
The patient is now confused and lethargic. What is the nurse's priority
action?
A) Increase the oxygen flow rate to 4 L/min.
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B) Notify the healthcare provider immediately.
C) Place the patient in a high-Fowler's position.
D) Assess the patient's respiratory rate and lung sounds.
Answer: D
Explanation: While all options involve important interventions, the
priority action is to reassess the patient to gather more data before
making a clinical decision. The nurse must first assess respiratory rate,
depth, lung sounds, and work of breathing. This assessment will help
determine the underlying cause of the desaturation and guide further
interventions. Increasing oxygen without a thorough assessment could
mask a deteriorating condition or be contraindicated in some patients
with COPD. Notifying the provider is important but should follow a rapid
assessment.
4. A patient with pneumonia is prescribed a high-flow oxygen delivery
system. The nurse understands that the primary advantage of a high-
flow system is that it:
A) Provides a consistent and precise fraction of inspired oxygen (FiO2).
B) Is the most comfortable and least intrusive method for the patient.
C) Is the most cost-effective oxygen delivery method.
D) Does not require humidification, thus reducing infection risk.
Answer: A
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Explanation: High-flow oxygen delivery systems, such as Venturi masks,
are designed to deliver a precise and consistent FiO2 regardless of the
patient's respiratory pattern. This is critical for patients who require
specific oxygen concentrations to maintain adequate oxygenation
without the risk of hypercapnia, especially in conditions like COPD.
Option B describes low-flow devices like nasal cannula. Option C is
incorrect as high-flow systems can be more expensive. Option D is
incorrect because high-flow oxygen often requires humidification to
prevent mucosal drying.
5. During the assessment of a patient's respiratory status, the nurse
identifies that the patient is using accessory muscles to breathe. Which
of the following muscle groups would the nurse expect to observe?
A) Diaphragm and intercostal muscles
B) Sternocleidomastoid and scalene muscles
C) Rectus abdominis and internal obliques
D) Latissimus dorsi and pectoralis major
Answer: B
Explanation: Accessory muscles of breathing are used when the primary
muscles (diaphragm and intercostals) are insufficient to maintain
adequate ventilation. The sternocleidomastoid and scalene muscles are
located in the neck and assist with elevating the rib cage during
inspiration. Use of these muscles indicates increased work of breathing
and respiratory distress. The rectus abdominis and internal obliques are
used for forced expiration. The latissimus dorsi and pectoralis major are
not primary muscles of respiration.
RNSG 1128 EXAM 2 GAS EXCHANGE Final Exam
Newest Exam Preparation With Complete Questions
And Correct Answers With Rationales | Already
Graded A+||Brand New Version!!
1. A client with chronic obstructive pulmonary disease (COPD) is
exhibiting signs of respiratory acidosis. Which of the following
pathophysiological mechanisms is the primary contributor to this acid-
base imbalance?
A) Increased excretion of bicarbonate by the kidneys
B) Hyperventilation leading to a rapid loss of carbon dioxide
C) Hypoventilation resulting in an accumulation of carbon dioxide
D) Overproduction of metabolic acids due to tissue hypoxia
Answer: C
Explanation: Respiratory acidosis is primarily caused by alveolar
hypoventilation, which leads to an accumulation of carbon dioxide
(CO2) in the blood. CO2 combines with water to form carbonic acid,
thus lowering the pH. In COPD, airway obstruction and decreased lung
elasticity impair the ability to effectively exhale CO2. Option A would
lead to metabolic acidosis. Option B describes respiratory alkalosis.
Option D describes metabolic acidosis.
,2|Page
2. A nurse is assessing a patient who has just been extubated after a
period of mechanical ventilation. Which of the following assessment
findings would be of greatest concern indicating a potential for
immediate respiratory compromise?
A) Hoarseness and a sore throat
B) Stridor and intercostal retractions
C) Mild anxiety and restlessness
D) Frequent swallowing and coughing
Answer: B
Explanation: Stridor (a high-pitched inspiratory sound) and intercostal
retractions are classic signs of upper airway obstruction and increased
work of breathing, which can indicate laryngeal edema or spasm post-
extubation. This represents an immediate threat to gas exchange and
requires prompt intervention. Hoarseness and a sore throat are
expected findings after extubation. Mild anxiety and restlessness can be
signs of hypoxia, but stridor and retractions are more specific and
immediate indicators of mechanical obstruction.
3. A patient with a history of heart failure is receiving supplemental
oxygen via nasal cannula at 2 L/min. The nurse notes that the patient's
oxygen saturation has dropped from 94% to 88% over the last hour.
The patient is now confused and lethargic. What is the nurse's priority
action?
A) Increase the oxygen flow rate to 4 L/min.
,3|Page
B) Notify the healthcare provider immediately.
C) Place the patient in a high-Fowler's position.
D) Assess the patient's respiratory rate and lung sounds.
Answer: D
Explanation: While all options involve important interventions, the
priority action is to reassess the patient to gather more data before
making a clinical decision. The nurse must first assess respiratory rate,
depth, lung sounds, and work of breathing. This assessment will help
determine the underlying cause of the desaturation and guide further
interventions. Increasing oxygen without a thorough assessment could
mask a deteriorating condition or be contraindicated in some patients
with COPD. Notifying the provider is important but should follow a rapid
assessment.
4. A patient with pneumonia is prescribed a high-flow oxygen delivery
system. The nurse understands that the primary advantage of a high-
flow system is that it:
A) Provides a consistent and precise fraction of inspired oxygen (FiO2).
B) Is the most comfortable and least intrusive method for the patient.
C) Is the most cost-effective oxygen delivery method.
D) Does not require humidification, thus reducing infection risk.
Answer: A
, 4|Page
Explanation: High-flow oxygen delivery systems, such as Venturi masks,
are designed to deliver a precise and consistent FiO2 regardless of the
patient's respiratory pattern. This is critical for patients who require
specific oxygen concentrations to maintain adequate oxygenation
without the risk of hypercapnia, especially in conditions like COPD.
Option B describes low-flow devices like nasal cannula. Option C is
incorrect as high-flow systems can be more expensive. Option D is
incorrect because high-flow oxygen often requires humidification to
prevent mucosal drying.
5. During the assessment of a patient's respiratory status, the nurse
identifies that the patient is using accessory muscles to breathe. Which
of the following muscle groups would the nurse expect to observe?
A) Diaphragm and intercostal muscles
B) Sternocleidomastoid and scalene muscles
C) Rectus abdominis and internal obliques
D) Latissimus dorsi and pectoralis major
Answer: B
Explanation: Accessory muscles of breathing are used when the primary
muscles (diaphragm and intercostals) are insufficient to maintain
adequate ventilation. The sternocleidomastoid and scalene muscles are
located in the neck and assist with elevating the rib cage during
inspiration. Use of these muscles indicates increased work of breathing
and respiratory distress. The rectus abdominis and internal obliques are
used for forced expiration. The latissimus dorsi and pectoralis major are
not primary muscles of respiration.
