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Jean A. O’Connor
TEST BLUEPRINT
Course Unit: Alterations in Respiratory Status and Functioning
________________________________________
CONTENT OBJ. COGNITIVE PHASE OF AREA OF
# LEVEL NSG. PROCESS CLIENT
NEEDS
Environment
Application
Comprehend
Physiological
Psychosocial
Understand
Assessment
Implement
Evaluation
Promotion
Safe Care
Analysis
Planning
Analysis
Health
Traumatic 1 X X X
Pneumothorax
Pulmonary 1 X X X
Embolus
Respiratory Failure 1 X X X
Pulmonary Edema 2 X X X
Respiratory Arrest 2 X X X
ABG 2 X X X
Totals 6 0 0 1 5 1 1 1 2 1 0 6 0 0
Percentages 0 0 17 83 17 17 17 33 17 0 100 0 0
TOTAL: 6
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COVER SHEET
Exam 1
Examination 1
November 2017
This is a 6 question, closed book test. Each question is worth 5 points. You have 30
minutes to complete the exam. You will need a #2 pencil only. No electronic devices are
permitted in the testing area. All books, and personal belongings must be put away.
This is a multiple-choice exam. Select the one option that best answers the question. If
you are unsure of an answer, skip it and return when you have completed the rest of the
exam. There are no penalties for guessing, but try not to guess. Your knowledge of the
Good luck!
ASSEMBLING & ADMINISTERING A TEST 4
Directions:
Check that you have 7 pages total: 1 cover page, 1 direction page , and 5 exam
pages.
Ensure your test number on your exam pages matches the exam number on the
cover page.
If the question requires more than one answer, then circle all the correct choices
to the question
If the question wants you to place your answers in order of importance, then place
If you have any questions during the exam please raise your hand.
Mark any questions that you skip in order to easily return to the question.
When the exam is finished, wait for the proctor to collect the exam.
Signature: ________________________________________
Date: ____________________________________________
ASSEMBLING & ADMINISTERING A TEST 5
Exam 1
Name: _____________________
Date: ______________________
Test Questions
Question 1: A nurse in the Post Anesthesia Care Unit (PACU) has received a patient
from Endoscopy status post bronchoscopy with biopsy. 15 minutes into the recovery the
patient becomes tachypneic with respirations 36, and O2 saturation drops to 86%. The
patient is anxious and using accessory muscles. What intervention must the nurse prepare
for immediately?
A. Immediate intubation
Question 2: A nurse is caring for a client in the emergency room who came in
complaining of chest pain, and shortness of breath. Chest X-Ray is within normal limits.
ABG shows a PaO2 of 88, SaO2 of 96%, and PaCO2 38. The client is ordered for a
pulmonary angiogram. The nurse understands that this test is being performed because
the patient’s diagnosis is highly suspicious for which of the following conditions?
A. Lung Cancer
B. ARDS
C. Pulmonary Embolism
D. Pneumothorax
ASSEMBLING & ADMINISTERING A TEST 6
Question 3: The nurse has just received a patient in myasthenia gravis crisis to the
Intensive Care Unit for monitoring. The patient was diagnosed with pneumonia and has
been taking antibiotics at home for the past three days. The nurse is developing a plan of
care to maintain a patent airway. Which of these outcomes should receive priority in the
B. Absence of drooling
D. Cough suppression
G. Absence of snoring
Question 4: A nurse in the cardiac step down unit is caring for a client being managed
for heart failure after an acute myocardial infarction (MI). During the nurses morning
assessment the client is observed to be anxious, restless, coughing, and short of breath. In
order of importance select from the choices below what assessments the nurse should
perform.
Question 5: The nurse is caring for an elderly client in the Post Anesthesia Care Unit
and the patient is medicated with 50mcg of fentanyl. Shortly after the fentanyl
administration the cardiac monitor SpO2 alarms indicating a rapidly decreasing oxygen
saturation, and apneic respirations. The patient is not responsive. What is the nurse’s first
intervention?
B. Provide positive pressure ventilation with Bag Mask Ventilation with oxygen at
Question 6: The nurse is caring for a 63kg client with a diagnosis of pneumonia. Vital
signs are B.P. 80/50, HR 110 sinus tachycardia, RR 26; Temperature 102.2 F/39 C. Initial
pH 7.27
PaCO2 53 mm Hg
PaO2 50 mm Hg
SaO2 79%
HCO3- 20 mEq/L
The patient is now intubated and placed on mechanical ventilation with the following
settings: assist control with a respiratory rate of 16, Tidal volume 650, FIO2 100%, and
PEEP 5. Repeat ABG is obtained. Which one of these ABG values indicate the ventilator
A.
pH 7.38
PaCO2 48 mm Hg
PaO2 88 mm Hg
SaO2 95%
HCO3- 22mEq/L
B.
pH 7.55
PaCO2 30 mmHg
PaO2 75 mmHg
SaO2 84%
HCO3- 28mEq/L
C.
pH 7.20
PaCO2 65 mmHg
PaO2 68 mmHg
SaO2 80%
HCO3- 18mEq/L
D.
pH 7.50
PaCO2 40 mmHg
ASSEMBLING & ADMINISTERING A TEST 9
PaO2 80 mmHg
SaO2 94%
HCO3- 31mEq/L
ASSEMBLING & ADMINISTERING A TEST 10
Question 1: A nurse in the Post Anesthesia Care Unit (PACU) has received a patient
from Endoscopy status post bronchoscopy with biopsy. 15 minutes into the recovery the
patient becomes tachypneic with respirations 36, and O2 saturation drops to 86%. The
patient is anxious and using accessory muscles. What intervention must the nurse prepare
for immediately?
A. Immediate intubation
signs and symptoms of respiratory distress in patients with altered states of respiratory
health.
Test Answer and Rationale: Answer is B Chest tube insertion. Patients undergoing
invasive procedures such as Bronchoscopy with biopsy are at risk for traumatic
pneumothorax due to accidental puncture of the pleura. Although it is normal for patients
to cough profusely after a bronchoscopy with biopsy, symptoms usually resolve with 15-
pneumothorax through the deterioration of respiratory function, and understand that chest
ASSEMBLING & ADMINISTERING A TEST 11
tube insertion is the medical management for this condition (Hinkle & Cheever, 2014, p.
614).
Question 2: A nurse is caring for a client in the emergency room who came in
complaining of chest pain, and shortness of breath. Chest X-Ray is within normal limits.
ABG shows a PaO2 of 88, SaO2 of 96%, and PaCO2 38. The client is ordered for a
pulmonary angiogram. The nurse understands that this test is being performed because
the patient’s diagnosis is highly suspicious for which of the following conditions?
A. Lung Cancer
B. ARDS
C. Pulmonary Embolism
D. Pneumothorax
(PE) is a life-threatening respiratory emergency. Nurses need to recognize the signs and
symptoms of PE, which may present differently for different patients. In this scenario the
client’s complaint of chest pain, and shortness of breath are signs and symptoms of PE,
but could be mistaken for myocardial infarction, or other respiratory illness. Typically on
a 12 lead ECG tachycardia and T-wave inversion in leads I-IV are seen. ABG values,
ASSEMBLING & ADMINISTERING A TEST 12
and chest x-ray can be normal in patients with a PE, however hypoxemia and hypocapnia
can be seen on ABG as well due to obstruction and tachypnea (Hinkle & Cheever, 2014,
Question 3: The nurse has just received a patient in myasthenia gravis crisis to the
Intensive Care Unit for monitoring. The patient was diagnosed with pneumonia and has
been taking antibiotics at home for the past three days. The nurse is developing a plan of
care to maintain a patent airway. Which of these outcomes should receive priority in the
B. Absence of drooling
D. Cough suppression
G. Absence of snoring
respiratory status.
upper airway management emergency. Patients in crisis are at risk for respiratory failure.
ASSEMBLING & ADMINISTERING A TEST 13
Nurses caring for these patients must be aware of the signs of impending failure on these
patients that will ultimately lead to intubation, and have a plan set in place. MG is an
muscle strength is seen with this disorder. It is critical to monitor the muscle strength of
the head and neck and accessory muscles as well as the gag reflex. Drooling indicates
inability to control secretions. A negative inspiratory force (NIF) and low forced vital
capacity (FVC) are the two most important indications for intubation, and should be
checked regularly by the nursing staff to determine trends. A normal NIF is >30cmH2O
and a normal FVC is >20ml/kg. A patient who can cough demonstrates good muscle
control, and patients should have a positive gag reflex that indicates airway protection.
Snoring while sleeping does not indicate respiratory failure (Hinkle & Cheever, 2014, p.
2040-2043).
Question 4: A nurse in the cardiac step down unit is caring for a client being managed
for heart failure after an acute myocardial infarction (MI). During the nurses morning
assessment the client is observed to be anxious, restless, coughing, and short of breath. In
order of importance select from the choices below what assessments the nurse should
perform.
status/functioning.
with know history of heart failure, or acute MI are at risk for pulmonary edema due to left
ventricular (LV) failure. As the LV fails, blood backs up into the pulmonary circulation
causing pulmonary interstitial edema. Blood volume and pressure develop in the left
atrium as a result of the left ventricular failure. The increased left atrial pressure causes
pressure, that forces fluid out of the pulmonary capillaries and into the interstitial spaces
and alveoli (Hinkle & Cheever, 2014, p. 811). It is important for the nurse to understand
that patients with known heart failure (chronic), or acute MI (acute) can develop
pulmonary edema. Prevention is achieved through early recognition of the signs and
symptoms. The nurse must first recognize the level of dyspnea the client is experiencing.
sounds. Clients are often tachycardic so vital signs should be checked, and client placed
on cardiac monitor, if not on one already. The nurse should observe for JVD and
peripheral edema as a sign of right heart failure from severe pulmonary congestion.
Blood work and Chest x-ray will confirm the extent of pulmonary edema (Hinkle &
Question 5: The nurse is caring for an elderly client in the Post Anesthesia Care Unit
and the patient is medicated with 50mcg of fentanyl. Shortly after the fentanyl
administration the cardiac monitor SpO2 alarms indicating a rapidly decreasing oxygen
saturation, and apneic respirations. The patient is not responsive. What is the nurse’s first
intervention?
B. Provide positive pressure ventilation with Bag Mask Ventilation with oxygen at
Test Answer and Rationale: Answer is B. Fentanyl is an opioid analgesic often used on
patients in the PACU for pain management. Side effects from opioids include respiratory
depression, and elderly clients are at a higher risk for this. Immediate management of a
patient in respiratory arrest for the nurse at the bedside would be to begin positive
pressure ventilation with BMV, and oxygenation until an advanced airway could be
placed or an opioid antagonist such as naloxone can be given (Hinkle & Cheever, 2014,
ASSEMBLING & ADMINISTERING A TEST 16
p. 227-231). The proper dose for naloxone initially is 0.1-0.2mg IV at 2-3 minute
Question 6: The nurse is caring for a 63kg client with a diagnosis of pneumonia. Vital
signs are B.P. 80/50, HR 110 sinus tachycardia, RR 26; Temperature 102.2 F/39 C. Initial
pH 7.27
PaCO2 53 mm Hg
PaO2 50 mm Hg
SaO2 79%
HCO3- 20 mEq/L
The patient is now intubated and placed on mechanical ventilation with the following
settings: assist control with a respiratory rate of 16, Tidal volume 650, FIO2 100%, and
PEEP 5. Repeat ABG is obtained. Which of one these ABG values indicate the ventilator
A.
pH 7.38
PaCO2 48 mm Hg
PaO2 88 mm Hg
SaO2 95%
HCO3- 22mEq/L
ASSEMBLING & ADMINISTERING A TEST 17
B.
pH 7.55
PaCO2 30 mmHg
PaO2 75 mmHg
SaO2 84%
HCO3- 28mEq/L
C.
pH 7.20
PaCO2 65mmHg
PaO2 68 mmHg
SaO2 80%
HCO3- 18mEq/L
D.
pH 7.50
PaCO2 40 mmHg
PaO2 80 mmHg
SaO2 94%
HCO3- 31mEq/L
ASSEMBLING & ADMINISTERING A TEST 18
Psychomotor Instructional Objective: Associates abnormal ABG lab values with the
need for change in treatment for patients and the ability to evaluate improvement on
Test Answer and Rationale: Answer is A. The client’s initial ABG evaluation shows a
respiratory acidosis. Choice A’s ABG value shows improvement from an acidotic state
with a normal pH of 7.38, an improving PaCO2, a PaO2, SaO2, and HCO3- all now
within normal limits. Choice B shows a respiratory alkalosis with a high pH of 7.55, a
low PaCO2 of 30, a low PaO2, and a borderline HCO3-. Choice C demonstrates a
worsening acidosis, and Choice D represents a metabolic alkalosis with an elevated pH, a
normal PaCO2, and an elevated HCO3- (Hinkle & Cheever, 2014, p. 271-272).
ASSEMBLING & ADMINISTERING A TEST 19
References
Hinkle, J.L., Cheever, K.H. (2014). Brunner & Suddarth’s textbook of medical-surgical
McDonald, M.E. (2018). The nurse educator’s guide to assessing learning outcomes (4th
http://www.pdr.net/drug-summary/Narcan-naloxone-hydrochloride-3837