NRNP 6566 ADVANCED CARE OF ADULTS IN ACUTE
SETTINGS I WEEK 9 KNOWLEDGE CHECK 2026/2027 |
Questions and Verified Answers | Pass Guaranteed - A+
Graded
Total Questions: 50
Alignment: AGACNP Certification Exam Blueprint, SCCM Guidelines, AHA/ACC
Guidelines, Evidence-Based Acute Care Practice 2026/2027
Respiratory Failure & Mechanical Ventilation Basics
Q1: A 68-year-old with COPD presents with increased work of breathing, using
accessory muscles, and somnolent. ABG shows pH 7.25, PaCO2 68, PaO2 52. This
represents:
A. Type I respiratory failure only
B. Type II respiratory failure [CORRECT]
C. Normal ABG
D. Compensated respiratory alkalosis
Correct Answer: B
Rationale: Type II respiratory failure is defined by PaCO2 >45 mmHg with acidemia (pH
<7.35), indicating alveolar hypoventilation. This patient's hypercapnia with respiratory
acidosis is classic Type II failure. Type I failure (A) is hypoxemia without hypercapnia
,(PaCO2 normal or low). The ABG is clearly abnormal (C), and this is acidosis not
alkalosis (D).
Q2: A patient with ARDS is being ventilated. The lung-protective ventilation strategy
includes:
A. Tidal volume 12 mL/kg actual body weight
B. Tidal volume 6 mL/kg predicted body weight with plateau pressure <30 cm H2O
[CORRECT]
C. High tidal volumes to prevent atelectasis
D. No PEEP to avoid barotrauma
Correct Answer: B
Rationale: ARDSNet protocol established lung-protective ventilation: tidal volume 6
mL/kg predicted body weight (not actual weight), plateau pressure <30 cm H2O, and
appropriate PEEP. This reduces volutrauma and barotrauma. High tidal volumes (A, C)
cause lung injury, and no PEEP (D) causes atelectasis and hypoxemia.
Q3: A patient on assist-control (AC) ventilation is triggering breaths but not receiving
them. The likely cause is:
A. Sensitivity set too high
B. Sensitivity set too low or patient has weak inspiratory effort [CORRECT]
C. PEEP set too high
D. FiO2 set too low
,Correct Answer: B
Rationale: Trigger sensitivity determines how much patient effort (flow or pressure
change) is needed to initiate a breath. If set too low (insensitive) or if patient is too
weak, breaths won't trigger. High sensitivity (A) would cause auto-triggering. PEEP (C)
and FiO2 (D) don't affect triggering mechanism.
Q4: Auto-PEEP (intrinsic PEEP) is most likely to occur in:
A. ARDS with low compliance
B. COPD/asthma with airway obstruction and insufficient expiratory time [CORRECT]
C. Neuromuscular disease with weak diaphragm
D. Pulmonary edema with high compliance
Correct Answer: B
Rationale: Auto-PEEP occurs when expiratory time is insufficient for complete
exhalation, trapping gas and creating positive end-expiratory pressure. This is common
in obstructive diseases (COPD, asthma) with expiratory flow limitation. ARDS (A) has
low compliance but not necessarily obstruction, neuromuscular disease (C) has weak
inspiratory not expiratory muscles, and pulmonary edema (D) doesn't cause obstruction.
Q5: A patient with severe asthma is intubated. The ventilator strategy should include:
A. High respiratory rate (24-28 breaths/min)
B. Prolonged expiratory time (I:E ratio 1:3 or 1:4) to prevent air trapping [CORRECT]
C. High tidal volumes (10-12 mL/kg)
, D. Zero PEEP
Correct Answer: B
Rationale: Status asthmaticus requires ventilatory strategy to minimize air trapping: low
respiratory rate (8-12, not A), prolonged expiratory time (inverse I:E ratio), low tidal
volumes (6-8, not C), and careful PEEP (not zero, D—may help overcome auto-PEEP).
Permissive hypercapnia may be necessary.
Q6: Pressure support ventilation (PSV) is best described as:
A. Full mechanical control of all breaths
B. Patient-triggered, pressure-targeted, flow-cycled spontaneous breathing mode that
reduces work of breathing [CORRECT]
C. Time-cycled mandatory breaths only
D. Volume-guaranteed mode regardless of pressure
Correct Answer: B
Rationale: PSV is a spontaneous mode where patient triggers breath, ventilator delivers
set pressure support above PEEP, and breath cycles off when flow decays to percentage
of peak (flow-cycled). It reduces inspiratory work and is used for weaning. AC (A) is
controlled, SIMV (C) has mandatory breaths, and volume-guaranteed (D) describes
different modes.
Q7: A patient on mechanical ventilation has plateau pressure 32 cm H2O and PEEP 10
cm H2O. The driving pressure is:
A. 42 cm H2O
SETTINGS I WEEK 9 KNOWLEDGE CHECK 2026/2027 |
Questions and Verified Answers | Pass Guaranteed - A+
Graded
Total Questions: 50
Alignment: AGACNP Certification Exam Blueprint, SCCM Guidelines, AHA/ACC
Guidelines, Evidence-Based Acute Care Practice 2026/2027
Respiratory Failure & Mechanical Ventilation Basics
Q1: A 68-year-old with COPD presents with increased work of breathing, using
accessory muscles, and somnolent. ABG shows pH 7.25, PaCO2 68, PaO2 52. This
represents:
A. Type I respiratory failure only
B. Type II respiratory failure [CORRECT]
C. Normal ABG
D. Compensated respiratory alkalosis
Correct Answer: B
Rationale: Type II respiratory failure is defined by PaCO2 >45 mmHg with acidemia (pH
<7.35), indicating alveolar hypoventilation. This patient's hypercapnia with respiratory
acidosis is classic Type II failure. Type I failure (A) is hypoxemia without hypercapnia
,(PaCO2 normal or low). The ABG is clearly abnormal (C), and this is acidosis not
alkalosis (D).
Q2: A patient with ARDS is being ventilated. The lung-protective ventilation strategy
includes:
A. Tidal volume 12 mL/kg actual body weight
B. Tidal volume 6 mL/kg predicted body weight with plateau pressure <30 cm H2O
[CORRECT]
C. High tidal volumes to prevent atelectasis
D. No PEEP to avoid barotrauma
Correct Answer: B
Rationale: ARDSNet protocol established lung-protective ventilation: tidal volume 6
mL/kg predicted body weight (not actual weight), plateau pressure <30 cm H2O, and
appropriate PEEP. This reduces volutrauma and barotrauma. High tidal volumes (A, C)
cause lung injury, and no PEEP (D) causes atelectasis and hypoxemia.
Q3: A patient on assist-control (AC) ventilation is triggering breaths but not receiving
them. The likely cause is:
A. Sensitivity set too high
B. Sensitivity set too low or patient has weak inspiratory effort [CORRECT]
C. PEEP set too high
D. FiO2 set too low
,Correct Answer: B
Rationale: Trigger sensitivity determines how much patient effort (flow or pressure
change) is needed to initiate a breath. If set too low (insensitive) or if patient is too
weak, breaths won't trigger. High sensitivity (A) would cause auto-triggering. PEEP (C)
and FiO2 (D) don't affect triggering mechanism.
Q4: Auto-PEEP (intrinsic PEEP) is most likely to occur in:
A. ARDS with low compliance
B. COPD/asthma with airway obstruction and insufficient expiratory time [CORRECT]
C. Neuromuscular disease with weak diaphragm
D. Pulmonary edema with high compliance
Correct Answer: B
Rationale: Auto-PEEP occurs when expiratory time is insufficient for complete
exhalation, trapping gas and creating positive end-expiratory pressure. This is common
in obstructive diseases (COPD, asthma) with expiratory flow limitation. ARDS (A) has
low compliance but not necessarily obstruction, neuromuscular disease (C) has weak
inspiratory not expiratory muscles, and pulmonary edema (D) doesn't cause obstruction.
Q5: A patient with severe asthma is intubated. The ventilator strategy should include:
A. High respiratory rate (24-28 breaths/min)
B. Prolonged expiratory time (I:E ratio 1:3 or 1:4) to prevent air trapping [CORRECT]
C. High tidal volumes (10-12 mL/kg)
, D. Zero PEEP
Correct Answer: B
Rationale: Status asthmaticus requires ventilatory strategy to minimize air trapping: low
respiratory rate (8-12, not A), prolonged expiratory time (inverse I:E ratio), low tidal
volumes (6-8, not C), and careful PEEP (not zero, D—may help overcome auto-PEEP).
Permissive hypercapnia may be necessary.
Q6: Pressure support ventilation (PSV) is best described as:
A. Full mechanical control of all breaths
B. Patient-triggered, pressure-targeted, flow-cycled spontaneous breathing mode that
reduces work of breathing [CORRECT]
C. Time-cycled mandatory breaths only
D. Volume-guaranteed mode regardless of pressure
Correct Answer: B
Rationale: PSV is a spontaneous mode where patient triggers breath, ventilator delivers
set pressure support above PEEP, and breath cycles off when flow decays to percentage
of peak (flow-cycled). It reduces inspiratory work and is used for weaning. AC (A) is
controlled, SIMV (C) has mandatory breaths, and volume-guaranteed (D) describes
different modes.
Q7: A patient on mechanical ventilation has plateau pressure 32 cm H2O and PEEP 10
cm H2O. The driving pressure is:
A. 42 cm H2O
