NRNP 6550 FINAL EXAM (WALDEN) NEWEST 2025 TEST
BANK| NRNP 6550 FINAL EXAM REVIEW WITH
COMPLETE 500 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(BRAND NEW!!)
1. A 72-year-old with COPD exacerbation is on BiPAP (IPAP 14,
EPAP 6, FiO₂ 40%). ABG: pH 7.31, PaCO₂ 62, PaO₂ 68, HCO₃
30. What is the priority adjustment?
A. Increase FiO₂ to 60%
B. Increase IPAP to 18
C. Increase EPAP to 10
D. Intubate immediately
Answer: B – Increasing IPAP improves alveolar ventilation
(lowers PaCO₂). EPAP helps oxygenation (PaO₂ is acceptable).
Intubation not yet indicated.
2. Which ventilator setting directly affects minute ventilation?
A. PEEP
B. FiO₂
1
,C. Tidal volume
D. I:E ratio
Answer: C – Minute ventilation = tidal volume × respiratory
rate. Tidal volume directly impacts CO₂ clearance.
3. A patient on pressure control ventilation has sudden
hypotension. The most likely cause is:
A. Auto-PEEP
B. Decreased FiO₂
C. Increased respiratory rate
D. Low peak pressure alarm
Answer: A – Auto-PEEP (air trapping) increases intrathoracic
pressure → decreased venous return → hypotension.
4. In ARDS, a lung-protective ventilation strategy includes:
A. Tidal volume 10–12 mL/kg IBW
B. Plateau pressure < 30 cm H₂O
C. PEEP of 0 cm H₂O
D. Respiratory rate 8 breaths/min
2
,Answer: B – Plateau pressure < 30 reduces barotrauma. Tidal
volume should be 4–6 mL/kg IBW in ARDS.
5. A post-op patient develops acute hypoxemic respiratory
failure. CXR shows bilateral infiltrates, PAOP is 12 mmHg. Likely
diagnosis?
A. Cardiogenic pulmonary edema
B. ARDS
C. Pneumonia
D. PE
Answer: B – PAOP < 18 rules out cardiogenic edema. ARDS =
acute onset, bilateral infiltrates, PaO₂/FiO₂ ≤ 300, no heart
failure.
6. Which sedation strategy is preferred in a mechanically
ventilated patient to reduce delirium and VAP?
A. Continuous infusion midazolam
B. Daily sedation vacation + spontaneous breathing trial
C. Propofol infusion without interruption
D. PRN only fentanyl
3
, Answer: B – Daily sedation vacation + SBT reduces ICU
delirium, VAP, and ventilation days.
7. A patient on volume-controlled ventilation has a peak pressure
of 45 and plateau pressure of 28. The problem is likely:
A. Decreased lung compliance
B. Increased airway resistance
C. Auto-PEEP
D. Patient-ventilator asynchrony
Answer: B – High peak with normal plateau → increased
airway resistance (bronchospasm, mucus, kinked tube).
8. Which ABG finding indicates adequate BiPAP response in
hypercapnic respiratory failure?
A. pH rising toward 7.35
B. PaCO₂ rising
C. PaO₂ falling
D. HCO₃ falling
Answer: A – Rising pH indicates improving ventilation. PaCO₂
should fall.
4
BANK| NRNP 6550 FINAL EXAM REVIEW WITH
COMPLETE 500 REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(BRAND NEW!!)
1. A 72-year-old with COPD exacerbation is on BiPAP (IPAP 14,
EPAP 6, FiO₂ 40%). ABG: pH 7.31, PaCO₂ 62, PaO₂ 68, HCO₃
30. What is the priority adjustment?
A. Increase FiO₂ to 60%
B. Increase IPAP to 18
C. Increase EPAP to 10
D. Intubate immediately
Answer: B – Increasing IPAP improves alveolar ventilation
(lowers PaCO₂). EPAP helps oxygenation (PaO₂ is acceptable).
Intubation not yet indicated.
2. Which ventilator setting directly affects minute ventilation?
A. PEEP
B. FiO₂
1
,C. Tidal volume
D. I:E ratio
Answer: C – Minute ventilation = tidal volume × respiratory
rate. Tidal volume directly impacts CO₂ clearance.
3. A patient on pressure control ventilation has sudden
hypotension. The most likely cause is:
A. Auto-PEEP
B. Decreased FiO₂
C. Increased respiratory rate
D. Low peak pressure alarm
Answer: A – Auto-PEEP (air trapping) increases intrathoracic
pressure → decreased venous return → hypotension.
4. In ARDS, a lung-protective ventilation strategy includes:
A. Tidal volume 10–12 mL/kg IBW
B. Plateau pressure < 30 cm H₂O
C. PEEP of 0 cm H₂O
D. Respiratory rate 8 breaths/min
2
,Answer: B – Plateau pressure < 30 reduces barotrauma. Tidal
volume should be 4–6 mL/kg IBW in ARDS.
5. A post-op patient develops acute hypoxemic respiratory
failure. CXR shows bilateral infiltrates, PAOP is 12 mmHg. Likely
diagnosis?
A. Cardiogenic pulmonary edema
B. ARDS
C. Pneumonia
D. PE
Answer: B – PAOP < 18 rules out cardiogenic edema. ARDS =
acute onset, bilateral infiltrates, PaO₂/FiO₂ ≤ 300, no heart
failure.
6. Which sedation strategy is preferred in a mechanically
ventilated patient to reduce delirium and VAP?
A. Continuous infusion midazolam
B. Daily sedation vacation + spontaneous breathing trial
C. Propofol infusion without interruption
D. PRN only fentanyl
3
, Answer: B – Daily sedation vacation + SBT reduces ICU
delirium, VAP, and ventilation days.
7. A patient on volume-controlled ventilation has a peak pressure
of 45 and plateau pressure of 28. The problem is likely:
A. Decreased lung compliance
B. Increased airway resistance
C. Auto-PEEP
D. Patient-ventilator asynchrony
Answer: B – High peak with normal plateau → increased
airway resistance (bronchospasm, mucus, kinked tube).
8. Which ABG finding indicates adequate BiPAP response in
hypercapnic respiratory failure?
A. pH rising toward 7.35
B. PaCO₂ rising
C. PaO₂ falling
D. HCO₃ falling
Answer: A – Rising pH indicates improving ventilation. PaCO₂
should fall.
4
