ATI MED SURG PROCTORED EXAM – STUDY GUIDE 2022/2023
MULTIPLE CHOICE
1. To evaluate the effectiveness of ordered interventions for a patient with ventilatory
failure, which diagnostic test will be most useful to the nurse?
a Chest x-ray
b Oxygen saturation
c Arterial blood gas analysis
d Central venous pressure monitoring
ANS: C
Arterial blood gas (ABG) analysis is most useful in this setting because ventilatory failure causes
problems with CO2 retention, and ABGs provide information about the PaCO2 and pH. The
other tests may also be done to help in assessing oxygenation or determining the cause of the
patient’s ventilatory failure.
DIF: Cognitive Level: Apply (application) REF: 1661
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. While caring for a patient who has been admitted with a pulmonary embolism, the nurse
notes a change in the patient’s oxygen saturation (SpO2) from 94% to 88%. Which action
should the nurse take next?
a Increase the oxygen flow rate.
b Suction the patient’s oropharynx.
c Instruct the patient to cough and deep breath
d Help the patient to sit in a more upright position.
ANS: A
Increasing oxygen flow rate will usually improve oxygen saturation in patients with ventilation-
perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with
perfusion, actions that improve ventilation, such as deep breathing and coughing, sitting upright,
and suctioning, are not likely to improve oxygenation.
DIF: Cognitive Level: Apply (application) REF: 1656
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen
saturation (SpO2) of 88%. The patient is increasingly lethargic. Which intervention will the
nurse anticipate?
a Administration of 100% oxygen by non-rebreather mask
b Endotracheal intubation and positive pressure ventilation
c Insertion of a mini-tracheostomy with frequent suctioning
d Initiation of continuous positive pressure ventilation (CPAP)
, ANS: B
The patient’s lethargy, low respiratory rate, and SpO2 indicate the need for mechanical
ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will
not be helpful because the patient’s respiratory rate is so low. Insertion of a mini-tracheostomy
will facilitate removal of secretions, but it will not improve the patient’s respiratory rate or
oxygenation. CPAP requires that the patient initiate an adequate respiratory rate to allow
adequate gas exchange.
DIF: Cognitive Level: Apply (application) REF: 1658 | 1662
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. The oxygen saturation (SpO2) for a patient with left lower lobe pneumonia is 90%. The
patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is a priority
for the nurse to take?
a Position the patient on the left side.
b Assist the patient with staged coughing.
c Place a humidifier in the patient’s room.
d Schedule a 2-hour rest period for the patient.
ANS: B
The patient’s assessment indicates that assisted coughing is needed to help remove secretions,
which will improve oxygenation. A 2-hour rest period at this time may allow the oxygen
saturation to drop further. Humidification will not be helpful unless the secretions can be
mobilized. Positioning on the left side may cause a further decrease in oxygen saturation because
perfusion will be directed more toward the more poorly ventilated lung.
DIF: Cognitive Level: Apply (application) REF: 1661-1662
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. A nurse is caring for an obese patient with right lower lobe pneumonia. Which position will be
best to improve gas exchange?
a On the left side
b On the right side
c In the tripod position
d In the high-Fowler’s position
ANS: A
The patient should be positioned with the “good” lung in the dependent position to improve the
match between ventilation and perfusion. The obese patient’s abdomen will limit respiratory
excursion when sitting in the high-Fowler’s or tripod positions.
DIF: Cognitive Level: Apply (application) REF: 1662
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, 6. When admitting a patient with possible respiratory failure with a high PaCO2,
which assessment information should be immediately reported to the health care
provider?
a The patient is somnolent.
b The patient complains of weakness.
c The patient’s blood pressure is 164/98.
d The patient’s oxygen saturation is 90%.
ANS: A
Increasing somnolence will decrease the patient’s respiratory rate and further increase the PaCO2
and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%,
weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of
possible impending respiratory arrest.
DIF: Cognitive Level: Apply (application) REF: 1660
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
7. A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the
following medications ordered. Which medication should the nurse discuss with the health
care provider before giving?
a Pantoprazole (Protonix) 40 mg IV
b Gentamicin (Garamycin) 60 mg IV
c Sucralfate (Carafate) 1 g per nasogastric tube
d Methylprednisolone (Solu-Medrol) 60 mg IV
ANS: B
Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the
nurse should clarify the drug and dosage with the health care provider before administration. The
other medications are appropriate for the patient with ARDS.
DIF: Cognitive Level: Apply (application) REF: 1669
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. To determine
whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused
by heart failure, the nurse will plan to assist with
a obtaining a ventilation-perfusion scan.
b drawing blood for arterial blood gases.
c insertion of a pulmonary artery catheter.
d positioning the patient for a chest x-ray.
ANS: C
Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the
, alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the
backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will
not help in differentiating cardiogenic from noncardiogenic pulmonary edema.
DIF: Cognitive Level: Apply (application) REF: 1667
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. A nurse is caring for a patient with ARDS who is being treated with mechanical ventilation
and high levels of positive end-expiratory pressure (PEEP). Which assessment finding by the
nurse indicates that the PEEP may need to be reduced?
a The patient’s PaO2 is 50 mm Hg and the SaO2 is 88%.
b The patient has subcutaneous emphysema on the upper thorax.
c The patient has bronchial breath sounds in both the lung fields.
d The patient has a first-degree atrioventricular heart block with a rate of 58.
ANS: B
The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and
PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be
addressed, but they are not specific indications that PEEP should be reduced.
DIF: Cognitive Level: Apply (application) REF: 1668-1669
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
10. Which statement by the nurse when explaining the purpose of positive end-expiratory
pressure (PEEP) to the family members of a patient with ARDS is accurate?
a “PEEP will push more air into the lungs during inhalation.”
b “PEEP prevents the lung air sacs from collapsing during exhalation.”
c “PEEP will prevent lung damage while the patient is on the ventilator.”
d “PEEP allows the breathing machine to deliver 100% oxygen to the lungs.”
ANS: B
By preventing alveolar collapse during expiration, PEEP improves gas exchange and
oxygenation. PEEP will not prevent lung damage (e.g., fibrotic changes that occur with ARDS),
push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the
patient.
DIF: Cognitive Level: Understand (comprehension) REF: 1669
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
11. A patient with acute respiratory distress syndrome (ARDS) is placed in the prone position.
When prone positioning is used, which information obtained by the nurse indicates that the
positioning is effective?
a The patient’s PaO2 is 89 mm Hg, and the SaO2 is 91%.
b Endotracheal suctioning results in clear mucous return.
MULTIPLE CHOICE
1. To evaluate the effectiveness of ordered interventions for a patient with ventilatory
failure, which diagnostic test will be most useful to the nurse?
a Chest x-ray
b Oxygen saturation
c Arterial blood gas analysis
d Central venous pressure monitoring
ANS: C
Arterial blood gas (ABG) analysis is most useful in this setting because ventilatory failure causes
problems with CO2 retention, and ABGs provide information about the PaCO2 and pH. The
other tests may also be done to help in assessing oxygenation or determining the cause of the
patient’s ventilatory failure.
DIF: Cognitive Level: Apply (application) REF: 1661
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. While caring for a patient who has been admitted with a pulmonary embolism, the nurse
notes a change in the patient’s oxygen saturation (SpO2) from 94% to 88%. Which action
should the nurse take next?
a Increase the oxygen flow rate.
b Suction the patient’s oropharynx.
c Instruct the patient to cough and deep breath
d Help the patient to sit in a more upright position.
ANS: A
Increasing oxygen flow rate will usually improve oxygen saturation in patients with ventilation-
perfusion mismatch, as occurs with pulmonary embolism. Because the problem is with
perfusion, actions that improve ventilation, such as deep breathing and coughing, sitting upright,
and suctioning, are not likely to improve oxygenation.
DIF: Cognitive Level: Apply (application) REF: 1656
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. A patient with respiratory failure has a respiratory rate of 6 breaths/minute and an oxygen
saturation (SpO2) of 88%. The patient is increasingly lethargic. Which intervention will the
nurse anticipate?
a Administration of 100% oxygen by non-rebreather mask
b Endotracheal intubation and positive pressure ventilation
c Insertion of a mini-tracheostomy with frequent suctioning
d Initiation of continuous positive pressure ventilation (CPAP)
, ANS: B
The patient’s lethargy, low respiratory rate, and SpO2 indicate the need for mechanical
ventilation with ventilator-controlled respiratory rate. Administration of high flow oxygen will
not be helpful because the patient’s respiratory rate is so low. Insertion of a mini-tracheostomy
will facilitate removal of secretions, but it will not improve the patient’s respiratory rate or
oxygenation. CPAP requires that the patient initiate an adequate respiratory rate to allow
adequate gas exchange.
DIF: Cognitive Level: Apply (application) REF: 1658 | 1662
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. The oxygen saturation (SpO2) for a patient with left lower lobe pneumonia is 90%. The
patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is a priority
for the nurse to take?
a Position the patient on the left side.
b Assist the patient with staged coughing.
c Place a humidifier in the patient’s room.
d Schedule a 2-hour rest period for the patient.
ANS: B
The patient’s assessment indicates that assisted coughing is needed to help remove secretions,
which will improve oxygenation. A 2-hour rest period at this time may allow the oxygen
saturation to drop further. Humidification will not be helpful unless the secretions can be
mobilized. Positioning on the left side may cause a further decrease in oxygen saturation because
perfusion will be directed more toward the more poorly ventilated lung.
DIF: Cognitive Level: Apply (application) REF: 1661-1662
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. A nurse is caring for an obese patient with right lower lobe pneumonia. Which position will be
best to improve gas exchange?
a On the left side
b On the right side
c In the tripod position
d In the high-Fowler’s position
ANS: A
The patient should be positioned with the “good” lung in the dependent position to improve the
match between ventilation and perfusion. The obese patient’s abdomen will limit respiratory
excursion when sitting in the high-Fowler’s or tripod positions.
DIF: Cognitive Level: Apply (application) REF: 1662
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
, 6. When admitting a patient with possible respiratory failure with a high PaCO2,
which assessment information should be immediately reported to the health care
provider?
a The patient is somnolent.
b The patient complains of weakness.
c The patient’s blood pressure is 164/98.
d The patient’s oxygen saturation is 90%.
ANS: A
Increasing somnolence will decrease the patient’s respiratory rate and further increase the PaCO2
and respiratory failure. Rapid action is needed to prevent respiratory arrest. An SpO2 of 90%,
weakness, and elevated blood pressure all require ongoing monitoring but are not indicators of
possible impending respiratory arrest.
DIF: Cognitive Level: Apply (application) REF: 1660
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
7. A patient with acute respiratory distress syndrome (ARDS) and acute kidney injury has the
following medications ordered. Which medication should the nurse discuss with the health
care provider before giving?
a Pantoprazole (Protonix) 40 mg IV
b Gentamicin (Garamycin) 60 mg IV
c Sucralfate (Carafate) 1 g per nasogastric tube
d Methylprednisolone (Solu-Medrol) 60 mg IV
ANS: B
Gentamicin, which is one of the aminoglycoside antibiotics, is potentially nephrotoxic, and the
nurse should clarify the drug and dosage with the health care provider before administration. The
other medications are appropriate for the patient with ARDS.
DIF: Cognitive Level: Apply (application) REF: 1669
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. To determine
whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused
by heart failure, the nurse will plan to assist with
a obtaining a ventilation-perfusion scan.
b drawing blood for arterial blood gases.
c insertion of a pulmonary artery catheter.
d positioning the patient for a chest x-ray.
ANS: C
Pulmonary artery wedge pressures are normal in the patient with ARDS because the fluid in the
, alveoli is caused by increased permeability of the alveolar-capillary membrane rather than by the
backup of fluid from the lungs (as occurs in cardiogenic pulmonary edema). The other tests will
not help in differentiating cardiogenic from noncardiogenic pulmonary edema.
DIF: Cognitive Level: Apply (application) REF: 1667
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
9. A nurse is caring for a patient with ARDS who is being treated with mechanical ventilation
and high levels of positive end-expiratory pressure (PEEP). Which assessment finding by the
nurse indicates that the PEEP may need to be reduced?
a The patient’s PaO2 is 50 mm Hg and the SaO2 is 88%.
b The patient has subcutaneous emphysema on the upper thorax.
c The patient has bronchial breath sounds in both the lung fields.
d The patient has a first-degree atrioventricular heart block with a rate of 58.
ANS: B
The subcutaneous emphysema indicates barotrauma caused by positive pressure ventilation and
PEEP. Bradycardia, hypoxemia, and bronchial breath sounds are all concerns and will need to be
addressed, but they are not specific indications that PEEP should be reduced.
DIF: Cognitive Level: Apply (application) REF: 1668-1669
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
10. Which statement by the nurse when explaining the purpose of positive end-expiratory
pressure (PEEP) to the family members of a patient with ARDS is accurate?
a “PEEP will push more air into the lungs during inhalation.”
b “PEEP prevents the lung air sacs from collapsing during exhalation.”
c “PEEP will prevent lung damage while the patient is on the ventilator.”
d “PEEP allows the breathing machine to deliver 100% oxygen to the lungs.”
ANS: B
By preventing alveolar collapse during expiration, PEEP improves gas exchange and
oxygenation. PEEP will not prevent lung damage (e.g., fibrotic changes that occur with ARDS),
push more air into the lungs, or change the fraction of inspired oxygen (FIO2) delivered to the
patient.
DIF: Cognitive Level: Understand (comprehension) REF: 1669
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
11. A patient with acute respiratory distress syndrome (ARDS) is placed in the prone position.
When prone positioning is used, which information obtained by the nurse indicates that the
positioning is effective?
a The patient’s PaO2 is 89 mm Hg, and the SaO2 is 91%.
b Endotracheal suctioning results in clear mucous return.
