NR 341 Complex Oxygenation Alterations 2026 Chamberlain
1. Which assessment finding is most characteristic of the early stage of Acute
Respiratory Distress Syndrome (ARDS)?
A. Hypercapnia and respiratory acidosis
B. Refractory hypoxemia despite increasing FiO2
C. Decreased respiratory rate and depth
D. Copious thick, purulent secretions
Answer: B
Rationale: Refractory hypoxemia, where blood oxygen levels do not improve significantly
even with supplemental oxygen, is a hallmark of ARDS due to significant shunting and
alveolar collapse.
2. In a patient with a suspected Pulmonary Embolism (PE), which diagnostic test
is considered the ‘gold standard’ for visualization?
A. Computed Tomography Pulmonary Angiography (CTPA)
B. Electrocardiogram (ECG)
C. Chest X-ray
D. D-dimer assay
Answer: A
Rationale: CTPA is currently the preferred gold standard for diagnosing PE because it
provides clear visualization of the pulmonary vasculature.
,3. A nurse is caring for a patient on mechanical ventilation. The high-pressure
alarm sounds. What is a likely cause?
A. A leak in the ventilator circuit
B. The patient is biting the endotracheal tube
C. Spontaneous disconnection from the ventilator
D. The endotracheal tube cuff has deflated
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
coughing, or the patient biting the tube. Leaks and disconnections cause low-pressure
alarms.
4. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in
ARDS management?
A. To increase the patient’s respiratory rate
B. To prevent the patient from fighting the ventilator
C. To keep alveoli open at the end of expiration to improve gas exchange
D. To decrease the risk of barotrauma
Answer: C
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
(atelectasis) and improve functional residual capacity, which enhances oxygenation.
5. A patient with a flail chest is observed to have paradoxical chest wall
movement. This means:
A. The patient is using abdominal muscles only to breathe
B. The entire chest wall expands symmetrically with effort
C. The chest wall remains stationary during respiration
D. The chest wall moves out during expiration and in during inspiration
Answer: D
, Rationale: Paradoxical movement occurs when the injured segment of the chest wall sinks
in during inspiration (as the rest of the chest expands) and bulges out during expiration.
6. Which ABG result is consistent with a patient in early respiratory failure
caused by hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 35, HCO3 18
Answer: C
Rationale: Hyperventilation leads to the excessive blowing off of CO2, resulting in
Respiratory Alkalosis (high pH, low PaCO2).
7. A patient with a tension pneumothorax will most likely exhibit which of the
following?
A. Tracheal deviation toward the affected side
B. Increased breath sounds on the affected side
C. Flattened neck veins
D. Tracheal deviation toward the unaffected side
Answer: D
Rationale: In a tension pneumothorax, air builds up in the pleural space and pushes the
mediastinum and trachea toward the opposite (unaffected) side.
8. What is the most common initial symptom of a Pulmonary Embolism?
A. Hemoptysis
B. Bradypnea
C. Sudden onset of unexplained dyspnea
D. Sharp localized back pain
Answer: C
1. Which assessment finding is most characteristic of the early stage of Acute
Respiratory Distress Syndrome (ARDS)?
A. Hypercapnia and respiratory acidosis
B. Refractory hypoxemia despite increasing FiO2
C. Decreased respiratory rate and depth
D. Copious thick, purulent secretions
Answer: B
Rationale: Refractory hypoxemia, where blood oxygen levels do not improve significantly
even with supplemental oxygen, is a hallmark of ARDS due to significant shunting and
alveolar collapse.
2. In a patient with a suspected Pulmonary Embolism (PE), which diagnostic test
is considered the ‘gold standard’ for visualization?
A. Computed Tomography Pulmonary Angiography (CTPA)
B. Electrocardiogram (ECG)
C. Chest X-ray
D. D-dimer assay
Answer: A
Rationale: CTPA is currently the preferred gold standard for diagnosing PE because it
provides clear visualization of the pulmonary vasculature.
,3. A nurse is caring for a patient on mechanical ventilation. The high-pressure
alarm sounds. What is a likely cause?
A. A leak in the ventilator circuit
B. The patient is biting the endotracheal tube
C. Spontaneous disconnection from the ventilator
D. The endotracheal tube cuff has deflated
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
coughing, or the patient biting the tube. Leaks and disconnections cause low-pressure
alarms.
4. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in
ARDS management?
A. To increase the patient’s respiratory rate
B. To prevent the patient from fighting the ventilator
C. To keep alveoli open at the end of expiration to improve gas exchange
D. To decrease the risk of barotrauma
Answer: C
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
(atelectasis) and improve functional residual capacity, which enhances oxygenation.
5. A patient with a flail chest is observed to have paradoxical chest wall
movement. This means:
A. The patient is using abdominal muscles only to breathe
B. The entire chest wall expands symmetrically with effort
C. The chest wall remains stationary during respiration
D. The chest wall moves out during expiration and in during inspiration
Answer: D
, Rationale: Paradoxical movement occurs when the injured segment of the chest wall sinks
in during inspiration (as the rest of the chest expands) and bulges out during expiration.
6. Which ABG result is consistent with a patient in early respiratory failure
caused by hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 35, HCO3 18
Answer: C
Rationale: Hyperventilation leads to the excessive blowing off of CO2, resulting in
Respiratory Alkalosis (high pH, low PaCO2).
7. A patient with a tension pneumothorax will most likely exhibit which of the
following?
A. Tracheal deviation toward the affected side
B. Increased breath sounds on the affected side
C. Flattened neck veins
D. Tracheal deviation toward the unaffected side
Answer: D
Rationale: In a tension pneumothorax, air builds up in the pleural space and pushes the
mediastinum and trachea toward the opposite (unaffected) side.
8. What is the most common initial symptom of a Pulmonary Embolism?
A. Hemoptysis
B. Bradypnea
C. Sudden onset of unexplained dyspnea
D. Sharp localized back pain
Answer: C
