CCN EXAM 1 | QUESTIONS AND ANSWERS | 2026
UPDATE | WITH COMPLETE SOLUTION
To evaluate the effectiveness of prescribed therapies for a patient with
ventilatory failure, which diagnostic test will be most useful to the nurse?
a. Chest x-rays
b. Pulse oximetry
c. Arterial blood gas (ABG) analysis
d. Pulmonary artery pressure monitoring Answer - ANS: C
ABG analysis is most useful in this setting because ventilatory failure causes
problems with CO2 retention, and ABGs provide information about the PaCO2
and pH. The other tests also may be done to help in assessing oxygenation or
determining the cause of the patient's ventilatory failure.
While caring for a patient who has been admitted with a pulmonary embolism,
the nurse notes a change in the patient's oxygen saturation (SpO2) from 94% to
88%. The nurse will
a. increase the oxygen flow rate.
b. suction the patient's oropharynx.
c. assist the patient to cough and deep breathe.
d. help the patient to sit in a more upright position. Answer - ANS: A
Increasing oxygen flow rate usually will improve oxygen saturation in patients
with ventilation-perfusion mismatch, as occurs with pulmonary embolism.
Because the problem is with perfusion, actions that improve ventilation, such
as deep-breathing and coughing, sitting upright, and suctioning, are not likely
to improve oxygenation.
,A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of
89%. The patient is increasingly lethargic. The nurse will anticipate assisting
with
a. administration of 100% oxygen by non-rebreather mask.
b. endotracheal intubation and positive pressure ventilation.
c. insertion of a mini-tracheostomy with frequent suctioning.
d. initiation of bilevel positive pressure ventilation (BiPAP). Answer - ANS: B
The patient's lethargy, low respiratory rate, and SpO2 indicate the need for
mechanical ventilation with ventilator-controlled respiratory rate.
Administration of high flow oxygen will not be helpful because the patient's
respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate
removal of secretions, but it will not improve the patient's respiratory rate or
oxygenation. BiPAP requires that the patient initiate an adequate respiratory
rate to allow adequate gas exchange.
The pulse oximetry for a patient with right lower lobe pneumonia indicates an
oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and
complains of fatigue. Which action is best for the nurse to take?
a. Position the patient on the right side.
b. Place a humidifier in the patient's room.
c. Assist the patient with staged coughing.
d. Schedule a 2-hour rest period for the patient. Answer - ANS: C
The patient's assessment indicates that assisted coughing is needed to help
remove secretions, which will improve oxygenation. A 2-hour rest period at this
time may allow the oxygen saturation to drop further. Humidification will not
be helpful unless the secretions can be mobilized. Positioning on the right side
may cause a further decrease in oxygen saturation because perfusion will be
directed more toward the more poorly ventilated lung.
,When the nurse is caring for an obese patient with left lower lobe pneumonia,
gas exchange will be best when the patient is positioned
a. on the left side.
b. on the right side.
c. in the tripod position.
d. in the high-Fowler's position. Answer - ANS: B
The patient should be positioned with the "good" lung in the dependent
position to improve the match between ventilation and perfusion. The obese
patient's abdomen will limit respiratory excursion when sitting in the high-
Fowler's or tripod positions.
When admitting a patient in possible respiratory failure with a high PaCO2,
which assessment information will be of most concern to the nurse?
a. The patient is somnolent.
b. The patient's SpO2 is 90%.
c. The patient complains of weakness.
d. The patient's blood pressure is 162/94. Answer - ANS: A
Increasing somnolence will decrease the patient's respiratory rate and further
increase the PaCO2 and respiratory failure. Rapid action is needed to prevent
respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all
require ongoing monitoring but are not indicators of possible impending
respiratory arrest.
A patient with acute respiratory distress syndrome (ARDS) and acute renal
failure has the following medications prescribed. Which medication should the
nurse discuss with the health care provider before administration?
a. ranitidine (Zantac) 50 mg IV
b. gentamicin (Garamycin) 60 mg IV
c. sucralfate (Carafate) 1 g per nasogastric tube
d. methylprednisolone (Solu-Medrol) 40 mg IV Answer - ANS: B
, Gentamicin, which is one of the aminoglycoside antibiotics, is potentially
nephrotoxic, and the nurse should clarify the drug and dosage with the health
care provider before administration. The other medications are appropriate for
the patient with ARDS.
A patient develops increasing dyspnea and hypoxemia 2 days after having
cardiac surgery. To determine whether the patient has acute respiratory
distress syndrome (ARDS) or pulmonary edema caused by left ventricular
failure, the nurse will anticipate assisting with
a. inserting a pulmonary artery catheter.
b. obtaining a ventilation-perfusion scan.
c. drawing blood for arterial blood gases.
d. positioning the patient for a chest radiograph. Answer - ANS: A
Pulmonary artery wedge pressures are normal in the patient with ARDS
because the fluid in the alveoli is caused by increased permeability of the
alveolar-capillary membrane rather than by the backup of fluid from the lungs
(as occurs in cardiogenic pulmonary edema). The other tests will not help in
differentiating cardiogenic from noncardiogenic pulmonary edema.
Which assessment finding by the nurse when caring for a patient with ARDS
who is being treated with mechanical ventilation and high levels of positive
end-expiratory pressure (PEEP) indicates that the PEEP may need to be
decreased?
a. The patient has subcutaneous emphysema.
b. The patient has a sinus bradycardia with a rate of 52.
c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%.
d. The patient has bronchial breath sounds in both the lung fields. Answer -
ANS: A
The subcutaneous emphysema indicates barotrauma caused by positive
pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath
UPDATE | WITH COMPLETE SOLUTION
To evaluate the effectiveness of prescribed therapies for a patient with
ventilatory failure, which diagnostic test will be most useful to the nurse?
a. Chest x-rays
b. Pulse oximetry
c. Arterial blood gas (ABG) analysis
d. Pulmonary artery pressure monitoring Answer - ANS: C
ABG analysis is most useful in this setting because ventilatory failure causes
problems with CO2 retention, and ABGs provide information about the PaCO2
and pH. The other tests also may be done to help in assessing oxygenation or
determining the cause of the patient's ventilatory failure.
While caring for a patient who has been admitted with a pulmonary embolism,
the nurse notes a change in the patient's oxygen saturation (SpO2) from 94% to
88%. The nurse will
a. increase the oxygen flow rate.
b. suction the patient's oropharynx.
c. assist the patient to cough and deep breathe.
d. help the patient to sit in a more upright position. Answer - ANS: A
Increasing oxygen flow rate usually will improve oxygen saturation in patients
with ventilation-perfusion mismatch, as occurs with pulmonary embolism.
Because the problem is with perfusion, actions that improve ventilation, such
as deep-breathing and coughing, sitting upright, and suctioning, are not likely
to improve oxygenation.
,A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of
89%. The patient is increasingly lethargic. The nurse will anticipate assisting
with
a. administration of 100% oxygen by non-rebreather mask.
b. endotracheal intubation and positive pressure ventilation.
c. insertion of a mini-tracheostomy with frequent suctioning.
d. initiation of bilevel positive pressure ventilation (BiPAP). Answer - ANS: B
The patient's lethargy, low respiratory rate, and SpO2 indicate the need for
mechanical ventilation with ventilator-controlled respiratory rate.
Administration of high flow oxygen will not be helpful because the patient's
respiratory rate is so low. Insertion of a mini-tracheostomy will facilitate
removal of secretions, but it will not improve the patient's respiratory rate or
oxygenation. BiPAP requires that the patient initiate an adequate respiratory
rate to allow adequate gas exchange.
The pulse oximetry for a patient with right lower lobe pneumonia indicates an
oxygen saturation of 90%. The patient has rhonchi, a weak cough effort, and
complains of fatigue. Which action is best for the nurse to take?
a. Position the patient on the right side.
b. Place a humidifier in the patient's room.
c. Assist the patient with staged coughing.
d. Schedule a 2-hour rest period for the patient. Answer - ANS: C
The patient's assessment indicates that assisted coughing is needed to help
remove secretions, which will improve oxygenation. A 2-hour rest period at this
time may allow the oxygen saturation to drop further. Humidification will not
be helpful unless the secretions can be mobilized. Positioning on the right side
may cause a further decrease in oxygen saturation because perfusion will be
directed more toward the more poorly ventilated lung.
,When the nurse is caring for an obese patient with left lower lobe pneumonia,
gas exchange will be best when the patient is positioned
a. on the left side.
b. on the right side.
c. in the tripod position.
d. in the high-Fowler's position. Answer - ANS: B
The patient should be positioned with the "good" lung in the dependent
position to improve the match between ventilation and perfusion. The obese
patient's abdomen will limit respiratory excursion when sitting in the high-
Fowler's or tripod positions.
When admitting a patient in possible respiratory failure with a high PaCO2,
which assessment information will be of most concern to the nurse?
a. The patient is somnolent.
b. The patient's SpO2 is 90%.
c. The patient complains of weakness.
d. The patient's blood pressure is 162/94. Answer - ANS: A
Increasing somnolence will decrease the patient's respiratory rate and further
increase the PaCO2 and respiratory failure. Rapid action is needed to prevent
respiratory arrest. An SpO2 of 90%, weakness, and elevated blood pressure all
require ongoing monitoring but are not indicators of possible impending
respiratory arrest.
A patient with acute respiratory distress syndrome (ARDS) and acute renal
failure has the following medications prescribed. Which medication should the
nurse discuss with the health care provider before administration?
a. ranitidine (Zantac) 50 mg IV
b. gentamicin (Garamycin) 60 mg IV
c. sucralfate (Carafate) 1 g per nasogastric tube
d. methylprednisolone (Solu-Medrol) 40 mg IV Answer - ANS: B
, Gentamicin, which is one of the aminoglycoside antibiotics, is potentially
nephrotoxic, and the nurse should clarify the drug and dosage with the health
care provider before administration. The other medications are appropriate for
the patient with ARDS.
A patient develops increasing dyspnea and hypoxemia 2 days after having
cardiac surgery. To determine whether the patient has acute respiratory
distress syndrome (ARDS) or pulmonary edema caused by left ventricular
failure, the nurse will anticipate assisting with
a. inserting a pulmonary artery catheter.
b. obtaining a ventilation-perfusion scan.
c. drawing blood for arterial blood gases.
d. positioning the patient for a chest radiograph. Answer - ANS: A
Pulmonary artery wedge pressures are normal in the patient with ARDS
because the fluid in the alveoli is caused by increased permeability of the
alveolar-capillary membrane rather than by the backup of fluid from the lungs
(as occurs in cardiogenic pulmonary edema). The other tests will not help in
differentiating cardiogenic from noncardiogenic pulmonary edema.
Which assessment finding by the nurse when caring for a patient with ARDS
who is being treated with mechanical ventilation and high levels of positive
end-expiratory pressure (PEEP) indicates that the PEEP may need to be
decreased?
a. The patient has subcutaneous emphysema.
b. The patient has a sinus bradycardia with a rate of 52.
c. The patient's PaO2 is 50 mm Hg and the SaO2 is 88%.
d. The patient has bronchial breath sounds in both the lung fields. Answer -
ANS: A
The subcutaneous emphysema indicates barotrauma caused by positive
pressure ventilation and PEEP. Bradycardia, hypoxemia, and bronchial breath
