NSG 3130 Exam 4
Fundamental Concepts and Skills for Nursing Practice
II
Galen College of Nursing
2026/2027 |Newly Released
50 Verified questions & Answers with Detailed Rationales
Graded A+
Oxygenation, Cardiopulmonary & Trach Care
Q1: The nurse is preparing to perform nasopharyngeal suctioning on an adult patient. Which
action is most important to prevent hypoxia during this procedure?
A. Limiting suctioning to 5 seconds.
B. Hyper-oxygenating the patient before and after the procedure. [CORRECT]
C. Applying sterile suction technique.
D. Lubricating the catheter with water-soluble gel.
Correct Answer: B
Rationale: Hyperoxygenating the patient with 100% oxygen for 1 to 2 minutes before
suctioning helps prevent hypoxia, a common complication of airway suctioning. While sterile
technique and time limits are crucial, oxygenation is the priority intervention to maintain safety.
Board Pearl: Pre-oxygenate to prevent the "dip" in saturation that happens when you suck air out
of the lungs.
Q2: The nurse is caring for a patient with a new tracheostomy. When securing the tracheostomy
ties, what is the safest practice to prevent accidental decannulation?
A. Tying the knot in a square knot behind the patient's neck.
B. Leaving enough slack to fit two fingers under the ties.
C. Having another nurse hold the tracheostomy tube in place while securing the ties.
[CORRECT]
D. Using twill tape to secure the device.
Correct Answer: C
,Rationale: Tracheostomy displacement is a life-threatening emergency. Having a second nurse
hold the tube securely while the primary nurse changes the ties ensures the tube does not become
dislodged during the process. A square knot is preferred, but holding the tube is the safety
priority.
Board Pearl: Two hands, two nurses—never let go of the trach when changing ties.
Q3: A patient with a chest tube drainage system is complaining of increased pain at the insertion
site. Upon assessment, the nurse observes subcutaneous emphysema (crepitus) around the chest
tube. What is the nurse's priority action?
A. Administer the ordered analgesic medication.
B. Reposition the patient on their unaffected side.
C. Notify the provider immediately. [CORRECT]
D. Clamp the chest tube near the insertion site.
Correct Answer: C
Rationale: Subcutaneous emphysema indicates air is leaking into the tissues, suggesting the
chest tube may not be draining properly or there is a new leak. This is a potential complication
requiring immediate provider notification. Clamping can cause tension pneumothorax and is
contraindicated unless specifically ordered.
Board Pearl: Crepitus around a chest tube means air is leaking where it shouldn't—get the doctor
involved fast.
Q4: The nurse is reviewing the arterial blood gas (ABG) results of a patient in respiratory
distress. The pH is 7.28, PaCO2 is 55 mm Hg, and HCO3 is 24 mEq/L. The nurse interprets
these results as:
A. Metabolic acidosis.
B. Respiratory alkalosis.
C. Fully compensated respiratory acidosis.
D. Uncompensated respiratory acidosis. [CORRECT]
Correct Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory source). The HCO3 is
normal, indicating no metabolic compensation has occurred yet. This is acute uncompensated
respiratory acidosis.
Board Pearl: pH down, CO2 up = Respiratory Acidosis (Lungs failing to blow off acid).
Q5: The nurse is caring for a patient with a pleural effusion. The provider inserts a chest tube.
The nurse observes that the water in the water-seal chamber is tidaling (fluctuating with the
patient's breathing) but there is no bubbling. What does this finding indicate?
A. The chest tube is occluded.
B. The system is functioning correctly to remove fluid. [CORRECT]
C. There is an air leak in the pleural space.
D. The suction control chamber is malfunctioning.
Correct Answer: B
, Rationale: Tidaling (rising and falling) in the water-seal chamber with respiration indicates
negative pressure is being transmitted from the pleural space, meaning the system is patent and
draining. Bubbling in this chamber indicates an air leak.
Board Pearl: Tidaling is good; bubbling in the water seal means there is an air leak.
Q6: Which patient is at highest risk for developing respiratory acidosis?
A. A patient with hyperventilation due to anxiety.
B. A patient with severe COPD experiencing an acute exacerbation. [CORRECT]
C. A patient with a history of vomiting.
D. A patient who is post-operative day 1 after a laparotomy.
Correct Answer: B
Rationale: COPD is a restrictive/obstructive disease where patients retain CO2. During an
exacerbation, alveolar ventilation decreases further, causing CO2 retention (hypercapnia), which
drives the pH down.
Board Pearl: Retainers (COPD) = High risk for Respiratory Acidosis.
Q7: The nurse is preparing to administer supplemental oxygen to a patient with COPD. The
provider has ordered a precise FiO2 of 28%. Which oxygen delivery device is most appropriate?
A. Nasal cannula at 2 L/min.
B. Simple face mask at 4 L/min.
C. Venturi mask. [CORRECT]
D. Non-rebreather mask.
Correct Answer: C
Rationale: Venturi masks are the only devices capable of delivering a precise, fixed FiO2
(percentage of oxygen). This is essential for patients with chronic CO2 retention to prevent
blunting their hypoxic drive while still adequately oxygenating them.
Board Pearl: Exact FiO2 required? Use a Venturi mask.
Q8: A patient is 2 days post-operative from abdominal surgery. The nurse notes the patient has
not coughed since surgery and is now febrile and experiencing tachypnea and tachycardia. What
is the nurse's priority action?
A. Apply abdominal binders.
B. Medicate for pain.
C. Coach the patient to deep breathe and use the incentive spirometer. [CORRECT]
D. Check the abdominal incision.
Correct Answer: C
Fundamental Concepts and Skills for Nursing Practice
II
Galen College of Nursing
2026/2027 |Newly Released
50 Verified questions & Answers with Detailed Rationales
Graded A+
Oxygenation, Cardiopulmonary & Trach Care
Q1: The nurse is preparing to perform nasopharyngeal suctioning on an adult patient. Which
action is most important to prevent hypoxia during this procedure?
A. Limiting suctioning to 5 seconds.
B. Hyper-oxygenating the patient before and after the procedure. [CORRECT]
C. Applying sterile suction technique.
D. Lubricating the catheter with water-soluble gel.
Correct Answer: B
Rationale: Hyperoxygenating the patient with 100% oxygen for 1 to 2 minutes before
suctioning helps prevent hypoxia, a common complication of airway suctioning. While sterile
technique and time limits are crucial, oxygenation is the priority intervention to maintain safety.
Board Pearl: Pre-oxygenate to prevent the "dip" in saturation that happens when you suck air out
of the lungs.
Q2: The nurse is caring for a patient with a new tracheostomy. When securing the tracheostomy
ties, what is the safest practice to prevent accidental decannulation?
A. Tying the knot in a square knot behind the patient's neck.
B. Leaving enough slack to fit two fingers under the ties.
C. Having another nurse hold the tracheostomy tube in place while securing the ties.
[CORRECT]
D. Using twill tape to secure the device.
Correct Answer: C
,Rationale: Tracheostomy displacement is a life-threatening emergency. Having a second nurse
hold the tube securely while the primary nurse changes the ties ensures the tube does not become
dislodged during the process. A square knot is preferred, but holding the tube is the safety
priority.
Board Pearl: Two hands, two nurses—never let go of the trach when changing ties.
Q3: A patient with a chest tube drainage system is complaining of increased pain at the insertion
site. Upon assessment, the nurse observes subcutaneous emphysema (crepitus) around the chest
tube. What is the nurse's priority action?
A. Administer the ordered analgesic medication.
B. Reposition the patient on their unaffected side.
C. Notify the provider immediately. [CORRECT]
D. Clamp the chest tube near the insertion site.
Correct Answer: C
Rationale: Subcutaneous emphysema indicates air is leaking into the tissues, suggesting the
chest tube may not be draining properly or there is a new leak. This is a potential complication
requiring immediate provider notification. Clamping can cause tension pneumothorax and is
contraindicated unless specifically ordered.
Board Pearl: Crepitus around a chest tube means air is leaking where it shouldn't—get the doctor
involved fast.
Q4: The nurse is reviewing the arterial blood gas (ABG) results of a patient in respiratory
distress. The pH is 7.28, PaCO2 is 55 mm Hg, and HCO3 is 24 mEq/L. The nurse interprets
these results as:
A. Metabolic acidosis.
B. Respiratory alkalosis.
C. Fully compensated respiratory acidosis.
D. Uncompensated respiratory acidosis. [CORRECT]
Correct Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory source). The HCO3 is
normal, indicating no metabolic compensation has occurred yet. This is acute uncompensated
respiratory acidosis.
Board Pearl: pH down, CO2 up = Respiratory Acidosis (Lungs failing to blow off acid).
Q5: The nurse is caring for a patient with a pleural effusion. The provider inserts a chest tube.
The nurse observes that the water in the water-seal chamber is tidaling (fluctuating with the
patient's breathing) but there is no bubbling. What does this finding indicate?
A. The chest tube is occluded.
B. The system is functioning correctly to remove fluid. [CORRECT]
C. There is an air leak in the pleural space.
D. The suction control chamber is malfunctioning.
Correct Answer: B
, Rationale: Tidaling (rising and falling) in the water-seal chamber with respiration indicates
negative pressure is being transmitted from the pleural space, meaning the system is patent and
draining. Bubbling in this chamber indicates an air leak.
Board Pearl: Tidaling is good; bubbling in the water seal means there is an air leak.
Q6: Which patient is at highest risk for developing respiratory acidosis?
A. A patient with hyperventilation due to anxiety.
B. A patient with severe COPD experiencing an acute exacerbation. [CORRECT]
C. A patient with a history of vomiting.
D. A patient who is post-operative day 1 after a laparotomy.
Correct Answer: B
Rationale: COPD is a restrictive/obstructive disease where patients retain CO2. During an
exacerbation, alveolar ventilation decreases further, causing CO2 retention (hypercapnia), which
drives the pH down.
Board Pearl: Retainers (COPD) = High risk for Respiratory Acidosis.
Q7: The nurse is preparing to administer supplemental oxygen to a patient with COPD. The
provider has ordered a precise FiO2 of 28%. Which oxygen delivery device is most appropriate?
A. Nasal cannula at 2 L/min.
B. Simple face mask at 4 L/min.
C. Venturi mask. [CORRECT]
D. Non-rebreather mask.
Correct Answer: C
Rationale: Venturi masks are the only devices capable of delivering a precise, fixed FiO2
(percentage of oxygen). This is essential for patients with chronic CO2 retention to prevent
blunting their hypoxic drive while still adequately oxygenating them.
Board Pearl: Exact FiO2 required? Use a Venturi mask.
Q8: A patient is 2 days post-operative from abdominal surgery. The nurse notes the patient has
not coughed since surgery and is now febrile and experiencing tachypnea and tachycardia. What
is the nurse's priority action?
A. Apply abdominal binders.
B. Medicate for pain.
C. Coach the patient to deep breathe and use the incentive spirometer. [CORRECT]
D. Check the abdominal incision.
Correct Answer: C
