MECHANICAL VENTILATION (NCLEX)
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ The nurse is caring for a patient with a chest tube. The nurse knows that the
drainage system is working correctly if she Observes? 1. Continuous
bubbling in the waterseal chamber. 2. Intermittent bubbling in the waterseal
chamber. 3. No bubbling appears in the suction chamber. 4. Titling is absent
in the waterseal chamber..
Answer: Answer: 2. Intermittent or occasional bubbling in the water seal
chamber is to be expected. If the bubbling increases or becomes continuous
this would be indicative of an airleak. There should be continuous, gentle
bubbling in the suction seal chamber. Tilting would not be expected.
◍ Primary nursing concerns with Vents.
Answer: Regularly auscultate breath sounds and monitor RR for
irregularities. Maintain appropriate tube placement and cuff inflation.
Prevent skin breakdown. Develop plan for communication (before insertion
if possible). Administer sedatives, analgesics, and/or paralytics prn to
maintain comfort and promote cooperation with vent. ET tube suctioning.
Monitor ABGs.
◍ Which of the following ABG values would the nurse expect to see on the
patient with Acute Respiratory Failure?A) pH 7.35B) O2 72C) HCO3 26D)
PCO2 55.
Answer: Answer: D. A PCO2 level of over 50 is one of the criteria for
classifying/diagnosing ARF. Others include a pH below 7.35 and an O2
below 50. The HCO3 can be elevated (for compensation) or normal
depending on the person and the state of the respiratory failure
◍ Which of the following nursing diagnoses would be the most important yet
, relevant nursing diagnosis for the patient diagnosed with having a
pulmonary contusion?A) Fluid Volume OverloadB) Imbalanced Nutrition:
Less than body requirementsC) Acute PainD) Risk for Infection.
Answer: Answer: A. Fluid volume overload would be appropriate for this
client because of the fluid build-up occurring in the lungs (AEB: Crackles,
decreased breath sounds, etc.). This build-up is caused by the bruising and
edema pulling fluid from the vascular spaces.
◍ A client has a chest tube in place following a left lower lobectomy done
after a stab wound to the chest. When repositioning the client, the nurse
notices 200 cc of dark, red fluid flows into the collection chamber of the
chest drain. What is the MOST appropriate nursing action?a. Clamp the
chest tubeb. Call the surgeon immediatelyc. Prepare for blood transfusiond.
Continue to monitor the rate of drainage.
Answer: Answer: D. This amount of drainage would be expected, and most
likely increase r/t repositioning of the client.
◍ What should be on hand during an extubation procedure?.
Answer: Intubation Kit. In-case the patient doesn't tolerate the procedure
well, we need to be ready to put another tube back down.
◍ SIMV.
Answer: Synchronized Intermittent Mandatory VentilationA preset rate and
tidal volume are set, but the machine allows the patient to initiate AND
perform their own breaths as well. Positive pressure is applied to ASSIST
with the breath, but it is the patient doing the WOB. The ventilator
synchronizes the automated breaths with the patient's own breaths.
◍ Adverse effects of propofol.
Answer: HypotensionBradycardiaElevated triglyceride levels
◍ Primary nursing concerns for patient with ET tube.
Answer: Unplanned (inadvertent) extubationAspiration
◍ What test is performed before paralyzing a patient for Ventilation therapy?.
Answer: Train-of-Four (TOF) of the ulnar nerve
, ◍ Signs of VAP.
Answer: Elevated temp and WBCs. Purulent sputum. Odorous sputum.
Crackles or rhonchi on auscultation. Pulmonary infiltrates on X-ray.
◍ A thoracentesis is performed on a chest-injured client, and no fluid or air is
found. Blood and fluids is administered intravenously (IV), but the client's
vital signs do not improve. A central venous pressure line is inserted, and
the initial reading is 20 cm H^
O. The most likely cause of these findings is which of the following?
A. Spontaneous pneumothorax B. Ruptured diaphragm C. Hemothorax D.
Pericardial tamponade.
Answer: Answer: D. The reading of CVP of 20 means that there increased
venous pressure backing up because the heart is not pumping effective. This
would indicate the presence of cardiac tamponade.
◍ The nurse knows that which of the following conditions would most likely
contribute to the development of ARDS?A) Simple PneumothoraxB) Right
Lobular Pulmonary ContusionC) Cardiac TamponadeD) Subcutaneous
Emphysema.
Answer: Answer: B. Pulmonary contusion causes fluid build-up to occur in
the lungs which can in-turn impair gas exchange and and prevent oxygen
and CO2 exchange. This fluid build-up can contribute to the development of
ARDS (Acute Respiratory Distress Syndrome). This is the MOST likely to
contribute this disorder.
◍ Complications with positive pressure ventilation.
Answer: Increased intra-thoracic pressure can cause compression of thoracic
vessels. Decreased CVPDecreased COHypotension (We need to compensate
to avoid shock)
◍ PSV.
Answer: Pressure Support VentilationPositive pressure that is applied to the
airway ONLY DURING INSPIRATION. The patient initiates and performs
that actual breaths, but the machine makes them easier with positive
pressure. Think of really smart CPAP. Decreases the work of breathing.
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ The nurse is caring for a patient with a chest tube. The nurse knows that the
drainage system is working correctly if she Observes? 1. Continuous
bubbling in the waterseal chamber. 2. Intermittent bubbling in the waterseal
chamber. 3. No bubbling appears in the suction chamber. 4. Titling is absent
in the waterseal chamber..
Answer: Answer: 2. Intermittent or occasional bubbling in the water seal
chamber is to be expected. If the bubbling increases or becomes continuous
this would be indicative of an airleak. There should be continuous, gentle
bubbling in the suction seal chamber. Tilting would not be expected.
◍ Primary nursing concerns with Vents.
Answer: Regularly auscultate breath sounds and monitor RR for
irregularities. Maintain appropriate tube placement and cuff inflation.
Prevent skin breakdown. Develop plan for communication (before insertion
if possible). Administer sedatives, analgesics, and/or paralytics prn to
maintain comfort and promote cooperation with vent. ET tube suctioning.
Monitor ABGs.
◍ Which of the following ABG values would the nurse expect to see on the
patient with Acute Respiratory Failure?A) pH 7.35B) O2 72C) HCO3 26D)
PCO2 55.
Answer: Answer: D. A PCO2 level of over 50 is one of the criteria for
classifying/diagnosing ARF. Others include a pH below 7.35 and an O2
below 50. The HCO3 can be elevated (for compensation) or normal
depending on the person and the state of the respiratory failure
◍ Which of the following nursing diagnoses would be the most important yet
, relevant nursing diagnosis for the patient diagnosed with having a
pulmonary contusion?A) Fluid Volume OverloadB) Imbalanced Nutrition:
Less than body requirementsC) Acute PainD) Risk for Infection.
Answer: Answer: A. Fluid volume overload would be appropriate for this
client because of the fluid build-up occurring in the lungs (AEB: Crackles,
decreased breath sounds, etc.). This build-up is caused by the bruising and
edema pulling fluid from the vascular spaces.
◍ A client has a chest tube in place following a left lower lobectomy done
after a stab wound to the chest. When repositioning the client, the nurse
notices 200 cc of dark, red fluid flows into the collection chamber of the
chest drain. What is the MOST appropriate nursing action?a. Clamp the
chest tubeb. Call the surgeon immediatelyc. Prepare for blood transfusiond.
Continue to monitor the rate of drainage.
Answer: Answer: D. This amount of drainage would be expected, and most
likely increase r/t repositioning of the client.
◍ What should be on hand during an extubation procedure?.
Answer: Intubation Kit. In-case the patient doesn't tolerate the procedure
well, we need to be ready to put another tube back down.
◍ SIMV.
Answer: Synchronized Intermittent Mandatory VentilationA preset rate and
tidal volume are set, but the machine allows the patient to initiate AND
perform their own breaths as well. Positive pressure is applied to ASSIST
with the breath, but it is the patient doing the WOB. The ventilator
synchronizes the automated breaths with the patient's own breaths.
◍ Adverse effects of propofol.
Answer: HypotensionBradycardiaElevated triglyceride levels
◍ Primary nursing concerns for patient with ET tube.
Answer: Unplanned (inadvertent) extubationAspiration
◍ What test is performed before paralyzing a patient for Ventilation therapy?.
Answer: Train-of-Four (TOF) of the ulnar nerve
, ◍ Signs of VAP.
Answer: Elevated temp and WBCs. Purulent sputum. Odorous sputum.
Crackles or rhonchi on auscultation. Pulmonary infiltrates on X-ray.
◍ A thoracentesis is performed on a chest-injured client, and no fluid or air is
found. Blood and fluids is administered intravenously (IV), but the client's
vital signs do not improve. A central venous pressure line is inserted, and
the initial reading is 20 cm H^
O. The most likely cause of these findings is which of the following?
A. Spontaneous pneumothorax B. Ruptured diaphragm C. Hemothorax D.
Pericardial tamponade.
Answer: Answer: D. The reading of CVP of 20 means that there increased
venous pressure backing up because the heart is not pumping effective. This
would indicate the presence of cardiac tamponade.
◍ The nurse knows that which of the following conditions would most likely
contribute to the development of ARDS?A) Simple PneumothoraxB) Right
Lobular Pulmonary ContusionC) Cardiac TamponadeD) Subcutaneous
Emphysema.
Answer: Answer: B. Pulmonary contusion causes fluid build-up to occur in
the lungs which can in-turn impair gas exchange and and prevent oxygen
and CO2 exchange. This fluid build-up can contribute to the development of
ARDS (Acute Respiratory Distress Syndrome). This is the MOST likely to
contribute this disorder.
◍ Complications with positive pressure ventilation.
Answer: Increased intra-thoracic pressure can cause compression of thoracic
vessels. Decreased CVPDecreased COHypotension (We need to compensate
to avoid shock)
◍ PSV.
Answer: Pressure Support VentilationPositive pressure that is applied to the
airway ONLY DURING INSPIRATION. The patient initiates and performs
that actual breaths, but the machine makes them easier with positive
pressure. Think of really smart CPAP. Decreases the work of breathing.
