1
NR 570 FINAL EXAM 2026/2027 | Common Diagnosis &
Management in Acute Care Practicum | Comprehensive
Review | Verified Answers | Pass Guaranteed - A+ Graded
Section 1: Advanced Respiratory Failure & Mechanical Ventilation (Questions 1-
12)
Q1. A 68-year-old male with ARDS is recovering on AC/VC ventilation. Settings: VT
400 mL, RR 14, PEEP 8, FiO2 40%. ABG: pH 7.38, PaCO2 42, PaO2 88, HCO3 24. A
spontaneous breathing trial is initiated; spontaneous VT is 250 mL with RR 30. What
is the RSBI and correct weaning recommendation?
A. RSBI 80; proceed with extubation
B. RSBI 95; continue SBT for 2 hours
C. RSBI 120; weaning not recommended at this time [CORRECT]
D. RSBI 60; immediate extubation indicated
C. RSBI 120; weaning not recommended at this time [CORRECT]
Rationale: RSBI = RR/VT(L) = 30/0.25 = 120. An RSBI >105 predicts weaning failure.
The patient requires continued ventilatory support and rehabilitation before another
SBT.
Correct Answer: C
Q2. A patient with acute hypoxemic respiratory failure due to ARDS requires initial
mechanical ventilation. Which ventilator mode and tidal volume strategy aligns with
lung-protective ventilation principles?
A. AC/VC with VT 10 mL/kg actual body weight
B. PC with inspiratory pressure 40 cm H2O above PEEP
C. AC/VC with VT 6 mL/kg predicted body weight [CORRECT]
D. SIMV with VT 8 mL/kg actual body weight
C. AC/VC with VT 6 mL/kg predicted body weight [CORRECT]
Rationale: Lung-protective ventilation for ARDS uses AC/VC with VT 6 mL/kg
,2
predicted body weight to prevent volutrauma and barotrauma. Actual body weight is
incorrect; SIMV is not the preferred initial mode for ARDS.
Correct Answer: C
Q3. A patient on AC/VC ventilation has the following ABG: pH 7.28, PaCO2 58, PaO2
62, HCO3 26, on FiO2 60%, PEEP 10. Which ventilator adjustment is most
appropriate?
A. Increase respiratory rate to 24 to blow off CO2
B. Increase tidal volume to 8 mL/kg predicted body weight
C. Increase PEEP and FiO2 to improve oxygenation; address respiratory acidosis due
to insufficient alveolar ventilation [CORRECT]
D. Decrease PEEP to 5 to improve venous return
C. Increase PEEP and FiO2 to improve oxygenation; address respiratory acidosis due
to insufficient alveolar ventilation [CORRECT]
Rationale: pH 7.28 with PaCO2 58 indicates respiratory acidosis with inadequate
ventilation; HCO3 26 shows minimal metabolic compensation. PaO2 62 on 60% FiO2
indicates hypoxemia requiring increased PEEP/FiO2. Increasing VT violates lung
protection.
Correct Answer: C
Q4. During rounds, the nurse reports a patient on mechanical ventilation day 6 has
had temperature 38.4°C for 48 hours, WBC 15,200, and new left lower lobe infiltrate.
Which VAE prevention bundle element was most likely omitted, contributing to this
complication?
A. Daily chest physiotherapy every 4 hours
B. Head of bed elevation 30-45°, oral care with chlorhexidine, and daily sedation
vacation with spontaneous awakening trial [CORRECT]
C. Prophylactic broad-spectrum antibiotics
D. Prone positioning for 16 hours daily
,3
B. Head of bed elevation 30-45°, oral care with chlorhexidine, and daily sedation
vacation with spontaneous awakening trial [CORRECT]
Rationale: The VAE prevention bundle includes HOB 30-45°, oral care, DVT
prophylaxis, stress ulcer prophylaxis, and daily SAT/SBT. Prophylactic antibiotics and
routine prone positioning are not bundle components.
Correct Answer: B
Q5. A 55-year-old female post-craniotomy is being assessed for extubation
readiness. Her negative inspiratory force (NIF) is -15 cm H2O. Which conclusion and
action are correct?
A. Adequate respiratory muscle strength; proceed with SBT
B. Inadequate strength; NIF should be more negative than -20 to -30 cm H2O for
extubation readiness [CORRECT]
C. NIF is normal; check RSBI next and extubate
D. NIF is falsely elevated due to patient facial muscle weakness
B. Inadequate strength; NIF should be more negative than -20 to -30 cm H2O for
extubation readiness [CORRECT]
Rationale: NIF (MIP) should be <-20 to -30 cm H2O to indicate adequate respiratory
muscle strength for liberation. -15 cm H2O predicts weaning failure and requires
continued support.
Correct Answer: B
Q6. A patient has passed a spontaneous awakening trial and spontaneous breathing
trial with RSBI 85 and NIF -35 cm H2O. Which ventilator strategy best supports
liberation from mechanical ventilation?
A. Transition to APRV with progressive release time reduction
B. Transition to PSV with gradual pressure reduction and extubation [CORRECT]
C. Maintain AC/VC and increase VT to 10 mL/kg
D. Switch to PC with high inspiratory pressure and no spontaneous breathing
, 4
B. Transition to PSV with gradual pressure reduction and extubation [CORRECT]
Rationale: PSV with gradual weaning and successful SBT is the standard approach for
ventilator liberation after passing readiness criteria. APRV is for refractory hypoxemia,
not weaning. Increasing VT violates lung protection.
Correct Answer: B
Q7. A patient with severe ARDS (PaO2/FiO2 75) remains hypoxemic despite AC/VC
with FiO2 100% and PEEP 18 cm H2O. Which mode change is most appropriate?
A. Switch to SIMV with volume guarantee
B. Initiate APRV with appropriate high CPAP and short release time [CORRECT]
C. Increase VT to 8 mL/kg predicted body weight
D. Switch to PSV only with PEEP 5
B. Initiate APRV with appropriate high CPAP and short release time [CORRECT]
Rationale: APRV is indicated for severe ARDS with refractory hypoxemia when
conventional lung-protective ventilation fails. Increasing VT causes volutrauma; PSV
provides no mandatory breaths for severe hypoxemia.
Correct Answer: B
Q8. Which statement best describes Pressure Regulated Volume Control (PRVC)?
A. A pressure control mode with a set tidal volume target that automatically adjusts
inspiratory pressure within limits [CORRECT]
B. A volume control mode with decelerating flow pattern only
C. A spontaneous mode with no backup rate and no pressure support
D. A dual-control mode requiring patient effort for every breath
A. A pressure control mode with a set tidal volume target that automatically adjusts
inspiratory pressure within limits [CORRECT]
Rationale: PRVC is a pressure control mode that delivers a target VT by automatically
adjusting inspiratory pressure, combining benefits of PC and VC ventilation.
Correct Answer: A
NR 570 FINAL EXAM 2026/2027 | Common Diagnosis &
Management in Acute Care Practicum | Comprehensive
Review | Verified Answers | Pass Guaranteed - A+ Graded
Section 1: Advanced Respiratory Failure & Mechanical Ventilation (Questions 1-
12)
Q1. A 68-year-old male with ARDS is recovering on AC/VC ventilation. Settings: VT
400 mL, RR 14, PEEP 8, FiO2 40%. ABG: pH 7.38, PaCO2 42, PaO2 88, HCO3 24. A
spontaneous breathing trial is initiated; spontaneous VT is 250 mL with RR 30. What
is the RSBI and correct weaning recommendation?
A. RSBI 80; proceed with extubation
B. RSBI 95; continue SBT for 2 hours
C. RSBI 120; weaning not recommended at this time [CORRECT]
D. RSBI 60; immediate extubation indicated
C. RSBI 120; weaning not recommended at this time [CORRECT]
Rationale: RSBI = RR/VT(L) = 30/0.25 = 120. An RSBI >105 predicts weaning failure.
The patient requires continued ventilatory support and rehabilitation before another
SBT.
Correct Answer: C
Q2. A patient with acute hypoxemic respiratory failure due to ARDS requires initial
mechanical ventilation. Which ventilator mode and tidal volume strategy aligns with
lung-protective ventilation principles?
A. AC/VC with VT 10 mL/kg actual body weight
B. PC with inspiratory pressure 40 cm H2O above PEEP
C. AC/VC with VT 6 mL/kg predicted body weight [CORRECT]
D. SIMV with VT 8 mL/kg actual body weight
C. AC/VC with VT 6 mL/kg predicted body weight [CORRECT]
Rationale: Lung-protective ventilation for ARDS uses AC/VC with VT 6 mL/kg
,2
predicted body weight to prevent volutrauma and barotrauma. Actual body weight is
incorrect; SIMV is not the preferred initial mode for ARDS.
Correct Answer: C
Q3. A patient on AC/VC ventilation has the following ABG: pH 7.28, PaCO2 58, PaO2
62, HCO3 26, on FiO2 60%, PEEP 10. Which ventilator adjustment is most
appropriate?
A. Increase respiratory rate to 24 to blow off CO2
B. Increase tidal volume to 8 mL/kg predicted body weight
C. Increase PEEP and FiO2 to improve oxygenation; address respiratory acidosis due
to insufficient alveolar ventilation [CORRECT]
D. Decrease PEEP to 5 to improve venous return
C. Increase PEEP and FiO2 to improve oxygenation; address respiratory acidosis due
to insufficient alveolar ventilation [CORRECT]
Rationale: pH 7.28 with PaCO2 58 indicates respiratory acidosis with inadequate
ventilation; HCO3 26 shows minimal metabolic compensation. PaO2 62 on 60% FiO2
indicates hypoxemia requiring increased PEEP/FiO2. Increasing VT violates lung
protection.
Correct Answer: C
Q4. During rounds, the nurse reports a patient on mechanical ventilation day 6 has
had temperature 38.4°C for 48 hours, WBC 15,200, and new left lower lobe infiltrate.
Which VAE prevention bundle element was most likely omitted, contributing to this
complication?
A. Daily chest physiotherapy every 4 hours
B. Head of bed elevation 30-45°, oral care with chlorhexidine, and daily sedation
vacation with spontaneous awakening trial [CORRECT]
C. Prophylactic broad-spectrum antibiotics
D. Prone positioning for 16 hours daily
,3
B. Head of bed elevation 30-45°, oral care with chlorhexidine, and daily sedation
vacation with spontaneous awakening trial [CORRECT]
Rationale: The VAE prevention bundle includes HOB 30-45°, oral care, DVT
prophylaxis, stress ulcer prophylaxis, and daily SAT/SBT. Prophylactic antibiotics and
routine prone positioning are not bundle components.
Correct Answer: B
Q5. A 55-year-old female post-craniotomy is being assessed for extubation
readiness. Her negative inspiratory force (NIF) is -15 cm H2O. Which conclusion and
action are correct?
A. Adequate respiratory muscle strength; proceed with SBT
B. Inadequate strength; NIF should be more negative than -20 to -30 cm H2O for
extubation readiness [CORRECT]
C. NIF is normal; check RSBI next and extubate
D. NIF is falsely elevated due to patient facial muscle weakness
B. Inadequate strength; NIF should be more negative than -20 to -30 cm H2O for
extubation readiness [CORRECT]
Rationale: NIF (MIP) should be <-20 to -30 cm H2O to indicate adequate respiratory
muscle strength for liberation. -15 cm H2O predicts weaning failure and requires
continued support.
Correct Answer: B
Q6. A patient has passed a spontaneous awakening trial and spontaneous breathing
trial with RSBI 85 and NIF -35 cm H2O. Which ventilator strategy best supports
liberation from mechanical ventilation?
A. Transition to APRV with progressive release time reduction
B. Transition to PSV with gradual pressure reduction and extubation [CORRECT]
C. Maintain AC/VC and increase VT to 10 mL/kg
D. Switch to PC with high inspiratory pressure and no spontaneous breathing
, 4
B. Transition to PSV with gradual pressure reduction and extubation [CORRECT]
Rationale: PSV with gradual weaning and successful SBT is the standard approach for
ventilator liberation after passing readiness criteria. APRV is for refractory hypoxemia,
not weaning. Increasing VT violates lung protection.
Correct Answer: B
Q7. A patient with severe ARDS (PaO2/FiO2 75) remains hypoxemic despite AC/VC
with FiO2 100% and PEEP 18 cm H2O. Which mode change is most appropriate?
A. Switch to SIMV with volume guarantee
B. Initiate APRV with appropriate high CPAP and short release time [CORRECT]
C. Increase VT to 8 mL/kg predicted body weight
D. Switch to PSV only with PEEP 5
B. Initiate APRV with appropriate high CPAP and short release time [CORRECT]
Rationale: APRV is indicated for severe ARDS with refractory hypoxemia when
conventional lung-protective ventilation fails. Increasing VT causes volutrauma; PSV
provides no mandatory breaths for severe hypoxemia.
Correct Answer: B
Q8. Which statement best describes Pressure Regulated Volume Control (PRVC)?
A. A pressure control mode with a set tidal volume target that automatically adjusts
inspiratory pressure within limits [CORRECT]
B. A volume control mode with decelerating flow pattern only
C. A spontaneous mode with no backup rate and no pressure support
D. A dual-control mode requiring patient effort for every breath
A. A pressure control mode with a set tidal volume target that automatically adjusts
inspiratory pressure within limits [CORRECT]
Rationale: PRVC is a pressure control mode that delivers a target VT by automatically
adjusting inspiratory pressure, combining benefits of PC and VC ventilation.
Correct Answer: A
